Laparoscopic uterine ventrosuspension procedure by using anterior mesh incorporated with bilateral round ligamentopexy: Kahyaoglu technique

A number of vaginal and abdominal surgical techniques have been described for the treatment of apical uterine prolapse. A 38-year-old parous woman has been operated laparoscopically due to grade 3 apical uterine prolapse. A new surgical technique for the treatment of apical uterine prolapse performed by incorporation of the lateral arms of anteriorly anchored uterine polypropylene mesh to bilateral round ligaments has been developed. Due to the young age of the patient and lack of any other uterine pathology, a laparoscopic uterine ventrosuspension procedure combined with bilateral round ligamentopexy has been performed as a low risk uterine prolapse surgery.

Percentage change in body mass index or gestational weight gain: Which is a better predictor of foetal macrosomia?

The aim of the study was to evaluate gestational weight gain (GWG) and percentage change in body mass index (BMI) for prediction of foetal macrosomia. A total of 409 term pregnant women, of whom 86 delivered macrosomic infants (> 4000 g) and 323 delivered non-macrosomic infants were recruited for the study. GWG and body mass index at delivery were significantly higher in the macrosomic than non-macrosomic group (15.8 ± 5.6 vs 13.9 ± 5.6, and 31.4 ± 4.3 vs 29.5 ± 4.3, respectively) (p < 0.05). The receiver operating characteristic curve analysis for testing the significance of weight gain in prediction of macrosomia showed an area under curve of 0.58 (p = 0.012, 95% confidence interval [CI] = 0.52-0.65), and significance of percentage change in BMI in prediction of macrosomia revealed an area under curve of 0.52 (p = 0.51, 95% CI = 0.46-0.59). BMI percentage changes both in obese (BMI ≥ 25) and non-obese (BMI < 25) groups were not statistically significant (p > 0.05). BMI percentage change does not seem to be a strong predictor of foetal macrosomia, and GWG was not found to be an independent risk factor after multivariate regression analysis was performed.

The comparison of microdose flare-up and multiple dose antagonist protocols based on hCG day estradiol (E2), progesterone (P) and P/E2 ratio among poor responder patients in ICSI-ET cycles

OBJECTIVE

Elevated progesterone levels surpassing exact treshold values impede endometrial receptivity and decrease clinical pregnancy rates in different responder patients during assisted reproductive techniques. A progesterone (P): estradiol (E2) ratio of > 1 on the day of hCG administration has also been suggested to be a manifestation of low ovarian reserve. The clinical significance of P/E2 ratio on the day of hCG administration was investigated among poor responder patients.

PATIENTS AND METHODS

Based on the ESHRE Bologna consensus criteria related to poor ovarian response diagnosis, 48 poor responder patients were treated with the microdose flare-up regimen and 34 patients were treated with the multiple-dose GnRH antagonist protocol. All patients were destined to perform a ICSI-ET procedure at the end of the stimulation protocols. Progesterone levels and P/E2 ratios have been detected during controlled ovarian hyperstimulation.

RESULTS

In the microdose flare-up group; the duration of stimulation, total gonadotropin dose used and hCG day E2 levels were significantly higher than the multiple dose antagonist group. However, the mean hCG day P/E2 rate in the microdose flare-up group was less than that in the multiple-dose antagonist group. The clinical pregnancy rates were non significantly higher in the multiple dose antagonist protocol group than in microdose flare-up group.

CONCLUSIONS

Impaired endometrial receptivity caused by elevated P levels results with lower pregnancy rates. Regardless of the selected stimulation protocol, poor responder patients are not prone to exhibit high P and E2 secretion. Increased P/E2 ratio of > 1 on hCG day has limited value to predict cycle outcomes in poor responder patients because of ovarian follicle depletion.

Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study

OBJECTIVE

The underlying inflammation of endometrium may impede normal implantation of placenta during pregnancy. Our objective is to show cervical colonization of ureaplasma and/or mycoplasma as a marker of endometritis in pregnancies complicated with placenta previa that can be a risk factor for placenta accreta and peripartum hemorrhage.

PATIENTS AND METHODS

Cervical cultures for ureaplasma urealyticum and mycoplasma genitalium have been taken from the endocervical region of the cervix of the patients. Subsequent uterine lower segment bleeding suggesting placenta implantation defects have been evaluated during cesarean section.

RESULTS

Of 25 patients: ten (40%) had negative cervical cultures for cervical mycoplasma and/or ureaplasma, 9 (36%) were found to be culture positive for cervical ureaplasma, 1 (4%) was found to be culture positive for cervical mycoplasma. Half of the 10 patients with positive cervical cultures for ureaplasma or mycoplasma and 6 of (40%) 15 patients with negative results had experienced lower uterine segment bleeding during cesarean section.

CONCLUSIONS

Bacterial colonization of cervix in particular with ureaplasma and/or mycoplasma is found to be strongly associated with placenta previa. Before a planned pregnancy, treatment of this infection with appropriate antibiotics is necessary to prevent underlying uterine endometritis that increases the risk for abnormal implantation of placenta.

The outcomes of surgical treatment modalities to decrease "near miss" maternal morbidity caused by peripartum hemorrhage

BACKGROUND

The treatment of patients with peripartum hemorrhage is unfortunately characterized by inadequate treatment that does not adhere to standard therapeutic measures.

AIM

Assessment of different management strategies among patients with severe hemorrhage, particularly the ones with "near-miss" maternal morbidity and mortality to establish clinically useful guidelines for the prevention and management of peripartum hemorrhage.

PATIENTS AND METHODS

In this study, the medical records of 458 patients who have experienced peripartum hemorrhage between March 2009 and March 2012 in a tertiary perinatal center were retrospectively reviewed. Specific surgical treatment modalities utilized to 61 patients with severe peripartum hemorrhage with respect to the procedure timing and effectivity were compared according to the outcomes and efficiency.

RESULTS

Sixty-one patients who have been diagnosed as severe peripartum hemorrhage have been included to the study. Six (75%) of the 8 patients who were treated with B-Lynch brace suture for uterine atony and 9 (60%) of the 15 patients who were treated with the Bakri balloon tamponade system for uterine atony or placenta accreta required hysterectomy following the initial therapeutic measures. The patients who have been treated with bilateral hypogastric artery ligation and B-Lynch brace suture or Bakri balloon uterine tamponade system were less likely to need a complementary hysterectomy for definitive treatment of peripartum hemorrhage when compared with patients treated with either B-Lynch brace suture or Bakri uterine tamponade balloon system alone.

CONCLUSIONS

The efficiency of B-Lynch compression brace sutures and the Bakri balloon uterine tamponade system is unpredictable in terms of the need for hysterectomy for peripartum hemorrhage patients diagnosed as either uterine atony or placenta previa. Regardless of the initial diagnosis, these modalities seem to be more effective in alleviating peripartum hemorrhage when accompanied by hypogastric artery ligation.