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Objectives: Cesarean section is one of the most common operations worldwide since decades. However, the optimum surgical cesarean section technique is still being discussed. Closure or non-closure of the rectus muscles is also unclear among obstetricians. We aimed to evaluate the effect of rectus muscle re-approximation (RMR) in cesarean section on postoperative pain among singleton primi gravida elective cesarean sections at term. Material and methods: The current study was planned as a prospective, blinded, randomized controlled trial. A total of 279 elective primi gravida singleton cesarean sections; 142 undergoing RMR and 137 not-undergoing RMR were included in the study. All participants were managed with our clinic's postoperative protocol and obstetric outcomes were also recorded. The patients' pain was assessed face to face 24 hours and 48 hours after operation by using visual analog scale (VAS) score. Results: The elective singleton primi gravida cesarean sections with and without RMR exhibited no significant difference with respect to maternal age, Body Mass Index, delivery week and other obstetric outcomes. The VAS scores at 24th and 48th hours (67 ± 24 versus 69 ± 25, p: 0.635; 47 ± 25 versus 52 ± 26, p: 0,126, respectively) were similar between the RMR and non-RMR group. Conclusions: RMR has not any negative effect on postoperative pain, operation time, analgesic use and hospital stay in singleton primi gravida elective CS at term. Additionally, RMR did not lead to any adverse postoperative risks such as increased blood loss and sub-rectus hematoma. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the maternal serum ischemia-modified albumin (IMA) concentration as an oxidative stress biomarker in pregnancies complicated by preterm pre-labor rupture of membranes (PPROM) without maternal clinical infection and compare these results with healthy pregnancies. Material and methods: The present cohort study included 40 pregnancies complicated by PPROM and 49 similar gestational age healthy pregnancies in the third trimester of gestation. Maternal venous blood specimens were obtained at the day of first diagnosis. Maternal serum IMA level was assayed with an Albumin Cobalt Binding test. The subjects were followed up until delivery and perinatal outcomes were recorded. Results: The maternal serum IMA concentrations were significantly higher in the study group (0.56 ± 0.05 absorbance units) as compared to controls (0.54 ± 0.03 absorbance units) (p = 0.020). The maternal serum IMA concentrations were not significantly correlated with the initial maternal white blood cell count (r: 0.118, p = 0.269) and C-reactive protein levels (r: 0.066, p = 0.541). The maternal serum IMA concentrations were negatively correlated with gestational age at delivery (r: --0.248, p = 0.019), birthweight (r: --0.247, p = 0.020) and Apgar scores (r: --0.200, p = 0.049; r: --0.245, p = 0.020). The threshold value of maternal serum IMA concentration above 0.55 absorbance units indicated the pregnancy complicated by PPROM by 57.5% sensitivity and 57.1% specificity (Area under curve 0.613, confidence interval 0.50--0.73). Conclusions: The current study supported for the first time that there is an association between increased maternal serum IMA levels and the development of PPROM in the third trimester of gestation without maternal clinical infection. Elevated maternal serum IMA levels may alert the obstetrician about poor ongoing perinatal outcomes in the early phase of PPROM before increased maternal C-reactive protein and white blood cell count. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) in the long-term treatment of heavy menstrual blood loss in women unrelated to intrauterine pathology.Methods: One hundred and six parous women aged 33-48 years with recurrent heavy menstrual bleeding (HMB) participated in this study. The women were followed up for 24 months and were assessed for intensity of bleeding both for pre- and post-insertion periods. An LNG-IUS was inserted in each patient within 7 days of the start of menstrual flow. The women were followed up at 1, 3, 6, 12, 18, and 24 months following the insertion of the intrauterine device.Results: One hundred and two women completed the follow-up period and had a significant reduction in the amount of menstrual blood loss. The LNG-IUS was well tolerated by all women. Pre-treatment of the use of the LNG-IUS, endometrial biopsy patterns for irregular proliferative endometrium and for atypical simple hyperplasia were 34/106 (32.08%) and 61/106 (57.55%) respectively and after treatment no abnormal pathologic findings were determined (p < 0.001).Conclusion: Our findings indicate that the LNG-IUS is effective for significantly reducing the amount of menstrual blood loss in women with HMB. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the maternal thiol/disulfide homeostasis in pregnant women complicated by preterm prelabor rupture of membranes (PPROM) and to compare the results with healthy pregnancies.Materials and Methods: This cohort study consisted of thirty-nine pregnancies complicated by PPROM and 44 gestational age-matched healthy pregnancies in the third trimester of gestation. Maternal serum samples were obtained at the day of diagnosis, and thiol/disulfide profiles were measured by using an automated assay method. The patients were followed till delivery, and perinatal outcomes were noted.Results: The maternal native thiol (319.9 ± 30.5 μmol/L versus 305.1 ± 49.2 μmol/L, p: .100), total thiol (379.2 ± 38.8 μmol/L versus 363.6 ± 56.4 μmol/L, p: .142) and disulfide (29.7 ± 11.7 μmol/L versus 29.3 ± 10.1 μmol/L, p: .864) levels were similar between the groups. Maternal disulfide/native thiol, disulfide/total thiol and native thiol/total thiol ratios were similar between the groups (p: .610, p: .565 and .562, respectively). The maternal serum thiol/disulfide profiles were not significantly correlated with maternal serum C-reactive protein, white blood cell count values and ongoing pregnancy outcomes (p > .05).Conclusions: The current study demonstrated that there was not any disturbance in maternal thiol/disulfide homeostasis in pregnancies complicated by PPROM at the time of initial diagnosis. Follow-up studies with larger sample size are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the maternal serum thiol/disulfide homeostasis in pregnancies complicated by idiopathic intrauterine growth restriction (IUGR) and to compare the results with healthy pregnancies.Materials and Methods: This descriptive cohort study included 55 pregnant women complicated by idiopathic IUGR and 57 similar gestational aged healthy pregnant women in the third trimester of gestation. Maternal serum samples were collected at the day of diagnosis and the thiol/disulfide homeostasis was measured by using an automated assay method. The patients were followed up until delivery and perinatal outcomes were recorded.Results: Maternal serum native thiol (308.1 ± 40.7 μmol/L vs. 282.4 ± 60.6 μmol/L) and total thiol (346.8 ± 48.1 μmol/L vs. 324.0 ± 62.2 μmol/L) concentrations were significantly lower in IUGR group compared with healthy controls (p: .010 and p: .032, respectively), whereas disulfide (19.3 ± 8.7 μmol/L vs. 20.8 ± 7.8 μmol/L) concentrations were similar between the groups (p: .350). Maternal serum disulfide/native thiol and disulfide/total thiol ratios were higher in IUGR group compared with healthy controls (p: .014 and p: .017, respectively), whereas native thiol/total thiol ratio was significantly lower in IUGR group compared with healthy controls (p: .016).Conclusions: This study suggests that there is an impaired maternal thiol/disulfide homeostasis in pregnancies complicated by idiopathic IUGR during the third trimester of gestation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the utility of maternal serum calponin 1 level in the prediction of delivery within 7 days among pregnancies complicated with threatened preterm labor.Materials and Methods: Eligible women who presented at 24-34 weeks of gestation with threatened preterm labor underwent sampling for serum calponin 1 level and cervical length measurement. They were followed up until delivery prospectively and the perinatal outcomes of the patients were recorded.Results: Of 73 women included in the study, 36 women delivered within 7 days and 37 women delivered beyond 7 days after admission. The maternal serum calponin 1 level was significantly high in women who delivered within 7 days (p: 0.031). The threshold value of 2 ng/mL for maternal serum calponin 1 predicted delivery within 7 days with 61.1% sensitivity and 62.2 specificity (area under curve, 0.658, confidence interval 0.53-0.79). The general accuracy values for maternal cervical length measurement (≤25 mm), serum calponin 1 level (>2 ng/mL) and the combination of two tests to predict delivery within 7 days was found to be 64.4%, 61.6% and 72.1%, respectively.Conclusions: The maternal serum calponin 1 level may be a useful biomarker in short-term prediction of preterm birth among pregnancies complicated with threatened preterm labor, in addition to cervical length measurement. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the current study was to investigate the psychopathological symptoms, psycho-emotional state, dream anxiety, and insomnia in healthy, mild and severe preeclamptic postpartum women and their relation to the severity of preeclampsia (PE).Materials and Methods: This observational study included 45 healthy, 41 mild preeclamptic and 44 severe preeclamptic postpartum women. The 90-item Symptom Checklist Revised, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Van Dream Anxiety Scale (VDAS) were used to evaluate the psychopathological symptoms, psycho-emotional state, insomnia, and dream anxiety of the participants after delivery.Results: Severe preeclamptic women had higher VDAS scores than mild preeclamptic and healthy postpartum women (p: 0.001). The psychopathological symptoms were more frequent in preeclamptic women than in healthy controls (p: 0.001). Severe preeclamptic women had the highest scores in Hospital Anxiety-Depression Scale and Insomnia Severity Index (p: 0.001, p: 0.001, respectively).Conclusion: Preeclampsia negatively affects the psycho-emotional state, psychopathological symptoms and sleep patterns. Further, disturbed dreaming was more frequent in PE and also, all of these conditions became worse with the severity of PE. We speculated that the obstetricians should offer their preeclamptic patients an appropriate mental health care at bedside and postpartum period as needed. [ABSTRACT FROM AUTHOR]

Purpose: To compare maternal liver elasticity scores by Acoustic Radiation Force Impulse (ARFI) elastosonography in healthy and preeclamptic pregnancies and its association with the severity of the disease.Materials and Methods: Forty-two healthy, 33 mild, 33 severe preeclamptic and 28 pregnant women with Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome were included into the study. Maternal liver elasticity was measured by ARFI elastosonography at the first day of puerperium. The maternal and neonatal outcomes of the patients were retrieved from the medical records.Results: The ARFI-Mean liver elastosonography scores of controls and mild preeclamptic women were lower than severe preeclamptic and HELLP syndrome women (p: 0.001). The mean ARFI elastosonography score >1.22 m/s indicated the effect of severe preeclampsia on maternal liver elasticity with 72.7% sensitivity and 74.7% specificity (Area under curve [AUC], 0.835, 95% confidence interval [CI], 0.757-0.913). The mean ARFI elastosonography score >1.31 m/s indicated the effect of HELLP syndrome on maternal liver elasticity with 78.6% sensitivity and 75.9% specificity (AUC, 0.794, 95% CI, 0.695-0.892).Conclusions: The maternal liver becomes stiffer in severe preeclampsia and HELLP syndrome measured by ARFI elastosonography. The increased maternal liver ARFI scores may alert the obstetrician about the possible maternal puerperal morbidity. [ABSTRACT FROM AUTHOR]

Background: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies.Methods: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted.Results: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV.Conclusion: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS. [ABSTRACT FROM AUTHOR]

The aims of this prospective study were to detect maternal serum chemerin level in patients with preeclampsia and investigate its association with disease severity and neonatal outcomes. Maternal serum chemerin levels were significantly elevated in severe preeclamptic women (394.72 ± 100.01 ng/ml) compared to mild preeclamptic women (322.11 ± 37.60 ng/ml) and healthy pregnant women (199.96 ± 28.05 ng/ml) (p = .001). Maternal serum chemerin levels were positively correlated with systolic and diastolic blood pressure, C-reactive protein levels, homeostasis model assessment of insulin resistance, proteinuria, AST, ALT, and duration of hospitalisation. Gestational week at delivery, birthweight, and APGAR scores at 1 and 5 min were negatively correlated with maternal serum chemerin level. A maternal serum chemerin level of >252.0 ng/ml indicated preeclampsia with 95.5% sensitivity and 95.7% specificity. There was a positive correlation between maternal serum chemerin level and severity of preeclampsia. Additionally, adverse neonatal outcomes were significantly associated with high maternal serum chemerin levels. [ABSTRACT FROM PUBLISHER]