Objectives: To uncover the predictive value of systemic immune-inflammatory index (SII) and systemic inflammatory response index (SIRI) on early pregnancy loss. Methods: A total of 535 individuals were enrolled in this retrospective analysis. The early pregnancy losses (EPL) group included patients between 18-35 years old who experienced EPL. The control group comprised healthy pregnant women who gave birth at ≥37 weeks. Results: The EPL group had significantly lower plateletcrit (p=0.04), platelet distribution width (PDW, p<0.0001), and RDW (p<0.0001) and higher monocyte (p<0.0001) and SIRI (p0.05). The cut-off value for the SIRI that offers the best sensitivity/specificity balance was 1.48 (sensitivity of 63%; specificity of 63%) in the receiver operating characteristics curve. Among the inflammatory parameters for predicting EPL, PDW had highest specificity (84%), and RDW had the highest sensitivity (80%). Conclusion: This study provides compelling evidence that various inflammatory pathways may significantly contribute to EPL pathogenesis. Moreover, our findings suggest that SIRI could be a more effective marker than NLR, PLR, MLR, and SII in predicting EPL in an ongoing pregnancy, thereby potentially revolutionizing early pregnancy loss diagnostics.
Objectives: To investigate the role of systemic immune-inflammation index (SII) in the diagnosis and severity of intrahepatic cholestasis of pregnancy (ICP). Methods: This case-control research involved 173 pregnant women with ICP and 266 gestational age-related healthy pregnant women as the control group. Criteria for diagnosing ICP were acceptance of increased serum total bile acid (TBA) levels (≥10 μmol/L). The mild ICP group (n=109) had TBA levels ranging between 10-39 µmol/l, while the severe ICP group (n=64) had a minimum TBA level above 40 µmol/l. Sociodemographic data, laboratory results, and SII values were compared between groups. Cut-off values were calculated to predict ICP. The SII was calculated as the platelet count × neutrophil count/lymphocyte count. Results: The leukocyte and neutrophil counts were lower (p<0.01), and the monocyte count was higher (p=0.026) in the severe ICP group compared to the controls. The platelet-to-lymphocyte ratio (PLR) was higher in mild ICP groups than in controls (p<0.01). The optimum PRL cut-off value was 126.2238, with a sensitivity of 57.2% and specificity of 57.1%. Conclusion: Elevated SII values support the evidence for the inflammatory properties of ICP but do not aid in diagnosing and determining its severity. Platelet-to-lymphocyte ratio may be a useful marker in determining ICP.
1 January 2024 in Revista da Associação Médica Brasileira
Background/Objectives: Cesarean delivery often leads to delayed breastfeeding initiation, potentially affecting infant health compared with vaginal delivery. This prospective observational study (conducted between August 2022 and January 2024) comparatively evaluates the impact of delivery method—vaginal, planned cesarean, and emergency cesarean—on breastfeeding initiation and continuation and examines the maternal factors influencing these outcomes. Materials and Methods: We enrolled 338 mother–infant pairs at a tertiary university hospital. Breastfeeding effectiveness was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at birth and at one, three, and six months postpartum. Rates of breastfeeding continuation and formula supplementation were documented through structured interviews. Results: The mothers who delivered vaginally had a significantly higher rate of breastfeeding within one hour after birth (85.5%) compared with planned (57.9%) and emergency cesarean sections (64.9%) (p < 0.001). Baseline BBAT scores were higher for vaginal births but converged across the groups by one month postpartum (p > 0.05). At six months, breastfeeding continuation rates remained high (94.4–95.2%) irrespective of delivery method. Conclusions: Delivery method exerts a transient effect on breastfeeding initiation. With lactation support, the mothers delivering by cesarean section achieved comparable breastfeeding outcomes within the first month postpartum. These findings reinforce the importance of Baby-Friendly Hospital Initiative (BFHI) practices, including immediate skin-to-skin contact, effective pain management, and lactation counseling, in ensuring equitable breastfeeding outcomes.
18 July 2023 in Journal of Obstetrics and Gynaecology Research
Objective: In the recent decades, transperineal ultrasonography has been used to examine patients in urogynaecology practice. In this study, we aimed to evaluate the function of transperineal ultrasonography in women with urinary incontinence.Methods: Forty-five patients who were admitted to our institution between December 2012 and May 2013 and clinically and urodynamically diagnosed as having urinary incontinence (SUI n=20, DI+UUI n=13, MUI n=12) were included in the study. Additionally, 25 clinically and urodynamically continent women were included as the control group. The patients were evaluated using transperineal ultrasonography (USG) in the supine position during rest and straining. An abdominal probe was placed in the perineum vertically and sagittally; when the symphysis pubis, urethra, bladder, vagina, and rectum could be seen clearly on the monitor, the image was frozen. Posterior urethrovesical angle (PUVA), urethral length, bladder wall thickness, and residual urine volume were measured on the image. All measurements were compared statistically between the SUI, UUI, MUI groups, and control group. The post-void residual volume measured using transperineal ultrasonography was compared with the post-void residual volume measured using a catheter during urodynamics.Results: PUVA was significantly different in the SUI and MUI groups at rest than in the control group (p<0.05). During Valsalva maneuvers, PUVA was statistically significantly different in the SUI and MUI groups than in the UUI and control groups (p<0.01). Conclusion: The measurement of PUVA and bladder wall thickness by transperineal ultrasonography is shown to be useful in diagnosis of patients with suspected detrusor instability and structural defects in pelvic floor. Therefore, transperineal USG may be an easy and reliable method which could be an alternative to urodynamic studies in patients who cannot undergo urethral catheterization.