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Background: Polycystic ovarian syndrome (PCOS) is a chronic endocrinopathy of unexplained etiology linked to obesity. Neuregulin 4 (NG-4) is an adipokine synthesized primarily by brown adipose tissue; that keeps glucose and lipids in hemostasis. Earlier research tested serum NG-4 correlation with metabolic parameters in PCOS; herein, we aimed to examine serum NG-4 validity as a marker for PCOS with respect to obesity parameters and the influence of obesity on NG-4 concentrations. Methods: A cross-sectional study recruited 120 women into two groups; PCOS cases (60/120) and healthy controls (60/120). For every participant, three sets of data were recorded; anthropometric data (age, height, and weight for calculation of body mass index (BMI), waist/hip ratio, and systolic and diastolic blood pressure) hormonal levels, including serum (luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio, prolactin, anti-Mullerian hormone (AMH), testosterone, and insulin) and biochemical biomarkers (fasting blood sugar, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), high and low-density lipoproteins (HDL and LDL), and NG-). Results: Serum NG-4 levels were significantly higher among PCOS vs. healthy controls. The univariant analysis confirmed a significant correlation of NG-4 to BMI, hormonal, and metabolic parameters. None of the obesity parameters were correlated with serum NG-4; only PCOS had an effect on serum NG-4 with p < 0.001 in multivariate analysis. At a cutoff value of 32 (ng/mL), NG-4 showed the highest sensitivity and specificity in discriminating PCOS cases with an area under the curve (AUC) of 0.97, p < 0.001. Conclusions: Serum NG-4’s strong relation to hormonal and biochemical parameters that define PCOS independent of BMI and waist-to-hip ratio makes it a reliable biomarker in diagnosing and following up PCOS cases.

In this review article we are reflecting on the subject of caesarean hysterectomy. The importance of this operation comes from the fact that postpartum bleeding remains number one killer of pregnant women in large parts of the world. One of the most difficult decisions an obstetrician has to make is when he/she decides to go for caesarean hysterectomy. As we will know from the article below the procedure itself is not free of risk, in fact there is high incidence of different morbidities in addition to the fact that most of these patients are haemodynamic ally unstable and very high anaesthetic risk. We hope that the future can bring about many improvements in the effectiveness of current management techniques which would lead to a much reduced need to the more drastic measures like caesarean hysterectomy.