Objective: The aim of this study was to show the effect of erythropoietin on ischemia-reperfusion-induced oxidative damage in fetal rat brain. Methods: Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 20 min, and reperfusion was achieved by removing the clamps for 30 min. The control group was made up of noninjured rats that were 19 days pregnant. In the ischemia-reperfusion group no treatment was given, while 0.4 ml of human serum albumin solution and 5,000 U/kg recombinant human erythropoietin (r-Hu-EPO) were administered in the vehicle and treatment groups 30 min before ischemia-reperfusion injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid-reactive substances (TBARS) for each fetal rat. A one-way analysis of variance and the post-hoc test were used for statistical analysis. Results: TBARS increased to statistically significantly higher levels in fetal rat brain after ischemia-reperfusion injury than were found in the control group. Recombinant human erythropoietin prevented the increase in TBARS after ischemia-reperfusion injury. Conclusion: Recombinant human erythropoietin has been shown to have neuroprotective effect in intrauterine ischemia-reperfusion-induced fetal brain damage in rats.

It should be kept in mind that cases of placenta previa and/or placenta accreta with previous cesarean sections have a very high probability of EPH. The delivery should be performed in suitable clinical settings with experienced surgeons when the risk factors like placenta previa and/or placenta accreta are determined so as to achieve optimal outcome.

Our objective was to compare the collagen and muscle content of the round ligament of uteri in women with pelvic organ prolapse. We evaluated the tissue samples obtained from the round ligaments of 22 patients with uterine prolapse who underwent vaginal hysterectomy (group A, study) and from 26 patients with no pelvic relaxation in whom total abdominal hysterectomy was performed for benign reasons (group B, controls). Morphometric analysis was performed on histologic cross-sections of the round ligament. Sections from each sample were stained with hematoxylin and eosin and Masson's trichrome methods. A computer system was used for morphometric measurements. We used independent samples t-test or Mann-Whitney U test to investigate the difference between the two groups. It was found that the smooth muscle fraction of the round ligament in women with uterine prolapse was significantly decreased compared with that of healthy control subjects and concluded that decreased smooth muscle content may be an important pathogenetic factor in uterine prolapse.

To evaluate the effect of perioperative duloxetine on pain management in patients recovering from laparoscopic hysterectomy. Design: A randomized placebo-controlled trial. Setting: A university hospital. Patients: Of 100 patients enrolled, 80 were randomized 1:1 to receive perioperative duloxetine (n = 40) or placebo (n = 40). Interventions: Patients undergoing laparoscopic hysterectomy for benign conditions from November 2017 through March 2018 received 2 doses of 60 mg duloxetine or placebo 2 hours before and 24 hours after surgery. Measurements and Main Results: The Quality of Recovery (QoR)-40 questionnaire was completed by participants after discharge. Study and control groups were compared in terms of questionnaire scores, opioid analgesic use, and hospital length of stay. The baseline characteristics of the groups were comparable; median total QoR-40 scores were 111 of 200 and 112 of 200 for duloxetine and the placebo group, respectively; the difference did not reach statistical significance (p = .91). Although the physical independence subcomponent of the recovery questionnaire was improved in favor of duloxetine, none of the subcomponents reached statistical difference between groups. The groups did not differ in terms of postoperative narcotic analgesic use and hospital length of stay (p >.05). Conclusion: Perioperative duloxetine did not reduce pain, need for narcotic analgesia, or hospital length of stay following laparoscopic hysterectomy.

BackgroundMature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts.Patients and MethodsThe preoperative findings, operative techniques and post-operative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003.ResultsIn 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35–180 minutes).ConclusionUsing strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.

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Please cite this paper as: Dede F, Celen S, Bilgin S, Ure G, Ozcan A, Buzgan T, Kose R. Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole‐of‐population report. BJOG 2011; DOI: 10.1111/j.1471‐0528.2011.03002.x. Objective  To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey. Design  A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection. Setting  Nationwide in Turkey. Population  Thirty‐six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection. Methods  Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009. Main outcome measure  Maternal mortality as a result of H1N1 virus infection. Results  The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one‐fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause‐specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77–5.43). Conclusions  Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza‐like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause‐specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.

Elevated MDA levels and decreased SOD activity in umbilical cord blood may show the possibility of insufficient protective mechanisms against increased oxidative stress in SGA neonates born by cesarean section.