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Objective: The cervical tissue consists mainly of an extracellular matrix rich in collagen; important fort the biomechanical properties. During normal gestation, the biomechanical strength of the cervix is determined by the collagen concentration. This study demonstrates the differences and changes of cervical collagen in first trimester abortions and its relation with age and parity. Methods: Cervical punch biopsies were obtained from 59 patients divided into two groups: first trimester abortion group (study group; n=45), and patients with cervical biopsy due to gynecologic reasons (control group; n=14). According to their gestational weeks, 45 first trimester pregnant women (median age=28.2) were divided into 3 groups (<7 weeks, 7-9 weeks, >9 weeks). Biochemical testing was performed and collagen quantity (as μg OH-prolin/mg dry weight) was determined. Hydroxyproline was measured in cervix tissue by the method of Switzer. Finally, the results of collagen and its relation with age and parity were investigated. Results: Collagen quantity was lower in the first trimester pregnant women group (13.06±4.17 μg OH-prolin/mg tissue) (p=0.0001) compared with the control group (24.48±12.87). Moreover, when data were adjusted for gestational weeks, no difference in collagen quantity was found between <7 weeks and control groups (17.01 ± 1.11 μg OH-prolin/mg tissue) (p= 0.047). However the collagen quantities of 7-9 weeks (12.07±3.85 μg OH-prolin/mg tissue) and >9 weeks (11.16± 4.39 μg OH-prolin/mg tissue) groups were statistically lower compared with the control group (p=0.0001). Furthermore, the results of first trimester pregnancy group were evaluated for age and parity. Lineer regression analyses shows that collagen increases with age and decreases with parity. Conclusions: Our study shows that, the collagen content of cervix started to decrease as early as first trimester of gestation. We observed that, from the beginning of 7th gestational week, cervical collagen starts to decrease. In accordance with the literature knowledge, collagen quantity increases with age and with regard to parity. [ABSTRACT FROM AUTHOR]

Objective: Ectopic pregnancy is defined as the implantation of a fertilized egg anywhere outside the uterine cavity. The incidence of ectopic pregnancy is estimated to be between 1% to 2% of all pregnancies. We report a big tubal ectopic pregnancy case with tubal torsion. Case: A 36-year-old woman, gravida 4, parity 2, curettage 1 admitted to Kanuni Sultan Suleyman Training and Research Hospital emergency room with severe abdominal pain. She had mild vaginal bleeding and nausea. Physical examination revealed tenderness of abdomen. The patient' s blood pressure was 90/60 mmHg, pulse rate was 120 beat/min, respiratory rate and body temperature was 16/Min, 37.60C respectively. Generalized abdominal tenderness was noted during palpation and speculum examination revealed slight bleeding through cervical os. Trans abdominal sonography revealed a gestational sac with a live fetus measured at 12th gestational week, located at the superior surface of the uterine fundus. Ectopic pregnancy mass was measured 8x5 cm on widest diameter. After the first emergent investigation, decision for an operation had been given with the pre-diagnosis of an abdominal pregnancy or ruptured ampullary pregnancy. Due to hemodynamic instability and gross abdominal bleeding, laparotomy was decided. Intraoperatively 1 liter of hemoperitoneum was seen. In the right fallopian tube, an ectopic pregnancy which is 75x45 mm in size and with the fallopian tube torsed one complete round. When salpingectomy material was examined, the fetus' crownrump length was measured 59 mm's, which is competible to 12 weeks and 3 days of gestational age. Conclusion: It is possible for ampullary ectopic pregnancies to progress until 13th week of gestation. Torsional involvement caused by the excessive growing of the mass can contribute to worsening of the pain in the groin. The differential diagnosis with abdominal pregnancies can be supported by MRI but operational diagnosis may be considered as urgent laparotomy is crucial in some cases. [ABSTRACT FROM AUTHOR]

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 pre-eclampsia patients between 24 and 34 weeks gestation, 166 were diagnosed with mild pre-eclampsia and 324 were diagnosed with severe pre-eclampsia. Patients with complete data were divided into four groups as patients with no notch (n:58), a unilateral notch (n:93), bilateral notches (n:252) and double notches (n:39). Results: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes (mean 24 h proteinuria, AST, LDH levels) and HELLP syndrome, need for magnesium sulphate treatment, higher systolic and diastolic blood pressure. Conclusion: Bilateral notches and especially double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous rupture of an unscarred uterus is an obstetrical emergency. Its diagnosis is often concealed, leading to maternal and fetal mortality. Many risk factors and clinical presentations been identified. Case: In this case report, we describe 34 years old pregnant woman with postpartum diagnosed uterine rupture with a very rare presentation of omental expression and discuss appropriate management of this presentation. Conclusion: Delay in the diagnosis of uterine rupture will lead in maternal and fetal mortality. [ABSTRACT FROM AUTHOR]

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 pre-eclampsia patients between 24 and 34 weeks gestation, 166 were diagnosed with mild pre-eclampsia and 324 were diagnosed with severe pre-eclampsia. Patients with complete fetal data were divided into four groups as patients with no notch (n:53), a unilateral notch (n:78), bilateral notches (n:219) and double notches (n:39). Results: Bilateral and double notches were predictive for prematurity, lower 1st minute Apgar scores, higher need for neonatal intensive care unit admission, and perinatal mortality. Conclusion: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse fetal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Broad ligament pregnancy also termed as intraligamentous pregnancy is a rare form of ectopic pregnancy. Incidence is reported as 1 in 300 ectopic pregnancies. Case: A 34-year-old, multigravida with 3 previous cesarean section before presented at 8 weeks gestation with intermittent suprapubic pain and vaginal bleeding. She had undergone three cesarean sections before. An abdominal ultrasound e×amination showed free fluid and 3×4 cm left adne×al mass in her abdomen. She was hospitalized for follow-up e×amination and,-hcg level was: 10290, the ne×t day she had the symptoms of acute abdomen and a fall in hematocrit level so she was taken for laparotomy with the diagnosis of ectopic pregnancy under general anestesia. Perop she was found to have a ruptured 3×4cm bleeding site from left mesoovarium. It was found to be an intraligamenter pregnancy, primary abdominal pragnancy. After removal of the lesion, β-hcg levels decreased. Hystopathological confirmation was done. Conclusion: A broad ligament pregnancy is an e×tremely rare condition; a rare form of ectopic pregnancy, and one type of abdominal pregnancy. The diagnosis is seldom established before surgery. We suggest the use of clinical and ultrasonographic findings for the suspicion of pregnancy in the broad ligament because of high incidence of mortality in case of delay in diagnosis. [ABSTRACT FROM AUTHOR]