Journal of the Turkish German Gynecological Association最新文献

Objective: The aim was to find a cost-effective, more practical method to be used in the early gestational weeks as an alternative to the oral glucose tolerance test (OGTT) for predicting gestational diabetes mellitus (GDM). The method selected was adipose tissue measurements made in the first trimester.

Material and methods: The study was designed as a prospective, cohort study. Ultrasound images were used to calculate abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) thicknesses of the first trimester pregnant women. Two groups were formed: those who were diagnosed with GDM and those who were not, based on the results of the OGTT performed in the same patients at 24^th-28^th weeks of gestation. Ultrasonographic records were examined and compared between these two groups using received operator characteristic curves and logistic regression analyses.

Results: A total of 292 pregnant women were included, of whom 21.2% were diagnosed with GDM. In the group diagnosed with GDM, SAT, VAT and total adipose tissue (TAT) values were significantly higher than the women who did not have GDM. Threshold values for SAT, VAT and TAT were 18 mm, 55 mm and 55 mm.

Conclusion: First trimester SAT, VAT and TAT measurements of pregnant women with GDM were significantly higher than those without GDM diagnosis. Although our results showed that adipose measurements cannot be an alternative to OGTT; they may be a powerful aid in identify at-risk pregnant women, suggesting to perform an early OGTT in the first trimester.

Objective: To assess the influence of basal serum levels of luteinizing hormone (LH), total testosterone (TT), and free testosterone (FT) on in vitro fertilization (IVF) success rates in patients with polycystic ovary syndrome (PCOS).

Material and methods: A retrospective cohort analysis of PCOS patients who underwent freeze-all, gonadotropin releasing hormone (GnRH) antagonist IVF protocols from January 2013 to December 2019. Patients were grouped based on median basal serum levels of LH, TT, and FT to compare their IVF outcomes.

Results: A total of 76 women with PCOS diagnosed as per the 2003 Rotterdam criteria were included. When analyzed by LH levels, groups had similar baseline characteristics except for higher mean ± standard deviation TT (1.4±0.9 vs. 1.9±0.9 nmol/L, p=0.02) and FT (0.6±0.5 vs. 0.9±0.5 nmol/L, p=0.03) in the elevated LH group. However, clinical pregnancy rates (CPR) (34.2% vs. 44.7%, p=0.35) and live birth rates (LBR) (21.0% vs. 31.6%, p=0.29) were not different. The group with lower TT had more previous pregnancies (0.9±1.2 vs. 0.3±0.7, p=0.02) and shorter infertility duration (2.3±2.0 vs. 3.7±2.7 years, p=0.04), but again CPR (46.8% vs. 42.8%, p=0.90) and LBR (37.5% vs. 25.7%, p=0.33) were similar. FT analysis revealed no significant differences in CPR (48.2% vs. 36.7%, p=0.36) and LBR (23.2% vs. 37.9%, p=0.22) despite higher TT (1.1±0.4 vs. 2.2±1.1 nmol/L, p<0.001) and LH (6.1±3.8 vs. 11.2±7.2 IU/L, p<0.001) in the high FT group.

Conclusion: Basal serum levels of LH, TT, and FT did not significantly affect IVF outcomes in patients with PCOS using GnRH antagonist, freeze-all protocols.

Stress urinary incontinence (SUI) is a fairly common disease among women. Synthetic meshes are frequently used in midurethral sling procedures due to the high long-term success rates. Because of the publications about vaginal mesh complications in recent years, urogynecologists are turning to techniques without mesh. The purpose of this video is to show that SUI can be treated without mesh complications by utilizing the meshless urethropexy technique. A 50-year-old woman applied to our urogynecology department with complaints of incontinence. Physical examination, stress test, Q-tip test, urine test and transperineal ultrasound performed. Post-void residual urine measured. The patient completed incontinence questionnaires: urogenital distress inventory-6, incontinence impact questionnaire-7. After discussing results SUI was diagnosed. Treatment options were offered to the patient. Due to mesh complications concern the patient preferred this approach and underwent urethropexy. The steps of meshless urethropexy technique was demonstrated in this video. SUI can be treated with this approach without worrying about mesh complications, but long-term results are needed.

The Coronavirus disease-19 (COVID-19) pandemic was declared in March 2020 by the World Health Organization. The severe acute respiratory syndrome-coronavirus-2 virus enters host cells through angiotensin-converting enzyme 2 receptors and transmembrane serine protease type II that are expressed in pulmonary alveoli, as well as in hepatocytes, endothelium, ovaries, uterus, vagina, thyroid, and other tissues. In addition to viral injury, the COVID-19 pandemic, through protective measures such as social isolation and lockdown, has promoted a scenario of psychosocial stress, especially in women. In this context of isolation, anxiety, fear, and mental distress, there is dysregulation of the hypothalamic-pituitary-adrenal axis and subsequent gonadal side effects. Furthermore, studies report an association between COVID-19 and temporary menstrual cycle alterations such, as increased cycle duration, decreased cycle duration, increased menstrual flow, dysmenorrhea, and amenorrhea. Regarding COVID-19 vaccination, menstrual irregularities have been observed in about half of the women, predominantly with a decrease in cycle duration and increased menstrual flow, but without fertility sequelae. The aim of this study was to review the most up-to-date information on the relationship between the COVID-19 pandemic and menstrual irregularities.

Objective: To determine factors affecting obstetric outcomes in pregnancies after conization by loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC) due to cervical intraepithelial neoplasia.

Material and methods: The maternal and clinical characteristics and obstetric outcomes of CKC, LEEP and control groups were evaluated and compared. Risk factors for adverse pregnancy outcomes were evaluated using multiple logistic regression analyses.

Results: The incidence of preterm delivery, preterm premature rupture of membranes (PPROM), low APGAR scores, fetal mortality, and late-period spontaneous abortus was highest in patients who underwent CKC (p<0.05). Cone depth of CKC was greater than LEEP (p=0.025). Cervical length (CL) at pregnancy was CKC < LEEP < controls (p=0.003). Shorter CL at pregnancy and time from conization to pregnancy (t-CP) was correlated with a high incidence of preterm delivery and PPROM (p<0.05). To predict preterm delivery, t-CP <14 months had 63.16% sensitivity and 77.42% specificity [area under the curve (AUC): 0.714, 95% confidence interval (CI): (0.603-0.809); p=0.005], and CL at pregnancy <31 mm had 65% sensitivity and 71.78% specificity [AUC: 0.731, 95% CI: (0.675-0.782); p<0.001]. To predict PPROM, t-CP <15 months had 85.71% sensitivity and 65.22% specificity [AUC: 0.730, 95% CI: (0.603-0.809); p=0.024], and CL <32 mm had 72.73% sensitivity and 61.89% spcificity [AUC: 0.685, 95% CI: (0.675-0.782); p=0.007].

Conclusion: Compared with CKC, LEEP has shorter cone depth and fewer adverse pregnancy outcomes. The t-CP <14 months was a risk for preterm delivery and <15 months was a risk for PPROM. CL at pregnancy <31 mm was a risk for preterm delivery and <32 mm was a risk for PPROM.

Objective: The question of whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection influences ovarian function and oocyte quality has arisen as angiotensin converting enzyme-2 receptors, which facilitates viral infection, are found on reproductive system tissues, including the vagina, placenta, uterus, and ovaries. The primary objective of this prospective study was to evaluate the impact of SARS-CoV-2, on ovarian function, with a focus on anti-Mullerian hormone (AMH) and acute phase reactant levels in patients well after recovery from coronavirus disease-2019 (COVID-19).

Material and methods: This prospective cohort study was conducted in the department of obstetrics and gynecology at a single center between October 2020 and June 2021. In order to investigate the impact of COVID-19 on ovarian reserve, 34 non-pregnant women of reproductive age (24-38 years) with COVID-19 polymerase chain reaction positivity were included.

Results: The difference between AMH levels measured 6 months after COVID-19 infection and baseline AMH levels was -0.31±0.80 ng/dL on average and -0.25 (-2.1-1.3) ng/dL on median. Significant correlations were observed between the change in AMH levels and white blood cell levels (r=-0.434, p=0.010), lymphocyte levels (r=-0.361, p=0.036), C-reactive protein levels (r=0.542, p=0.001), ferritin levels (r=0.570, p=0.001) and procalcitonin levels (r=0.598, p=0.001).

Conclusion: We believe this is the first study to examine whether there is a correlation between the late results of COVID-19 and ovarian function. In this cohort, AMH values decreased 6-months after recovery from COVID-19 and a correlation was found between measures of disease severity and the magnitude of decrease in AMH. However, the study was underpowered and future larger studies are required to validate these findings.

Objective: Contraception use and follow-up visit data from before and in two periods during the coronavirus disease-2019 (COVID-19) pandemic were compared to investigate change in behavior.

Material and methods: A retrospective study of women aged 18-49 years from New York City during three one-year time periods: pre-COVID-19 pandemic [(COV-PRE); n=4,261], early COVID-19 pandemic when the COVID-19 vaccine was not available [(COV-VACNO); n=3,365], and later COVID-19 pandemic when the COVID-19 vaccine was available [(COV-VACAV); n=4,170].

Results: There were higher odds of implant use [odds ratio (OR): 1.42, 95% confidence interval (CI): 1.05, 1.93, p=0.02] during COV-VACNO. There were lower odds for any contraception (OR: 0.88, 95% CI: 0.79, 0.98, p<0.001) or intrauterine device (IUD) (OR: 0.73, 95% CI: 0.61, 0.86, p<0.001) use during COV-VACAV. No differences occurred for bilateral tubal ligation, pill, patch, injection, medical elective abortion, or surgical elective abortion. There was a greater percentage of follow-up visits for any contraception (p=0.02) and IUD (p=0.02) use during COV-VACNO and COV-VACAV than COV-PRE.

Conclusion: When COVID-19 vaccines were unavailable, there were higher odds for use of implants. Once COVID-19 vaccines were available, there were lower odds for any contraception and IUD use. These findings highlight changes in behavior in terms of contraceptive concerns and preferences during a public health crisis that should be planned for by healthcare providers.