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The aim of this study was to define the actual rate of the traction needed and the balloon catheter or tenaculum requirement for hysterosalpingography (HSG) examinations, and to investigate the correlation between pain scores with the type of traction, operator, parity or the type of infertility. 788 patients undergoing HSG participated in the trial. The HSG examinations were completed in 58% of the patients (458) without any traction. Traction was needed in 42% of patients, those with the balloon catheter in 26.9%, and those with the tenaculum only at 15%. Patients with balloon catheter traction had similar pain scores to those using tenaculum traction. The pain scores changed according to the operator. HSG examinations should be performed step-by-step and the need for traction evaluated during the procedure.IMPACT STATEMENT What is already known on this subject? HSG is a technique to evaluate fallopian tube patency and other potential intrauterine pathology in infertile women. What do the results of this study add? Traction was not needed in more than half of the HSG examinations. The pain due to the balloon catheter and tenaculum is similar. What the implications are of these findings for clinical practice and/or further research? HSG examinations should be performed step-by-step by checking the need for traction. Traction with the balloon catheter prevents the uterine spasm, infection and bleeding complications during or after the HSG.

Background: The objective of this study was to conduct a randomized controlled trial in order to examine the hemodynamic impacts of two different doses of intrathecal isobaric bupivacaine (5 mg and 7 mg) when combined with 15 µg fentanyl in the context of patients undergoing caesarean section under combined spinal epidural anesthesia. Methods: Eighty patients with American Society of Anesthesiologists physical status I and II, aged between 16–50 years, who would undergo elective caesarean section under combined spinal epidural anaesthesia were randomly allocated to Group A and Group B (n = 40, for each group). Group A patients received a solution containing 5 mg isobaric bupivacaine + 15 µg fentanyl (1.3 mL), while Group B patients received a solution containing 7 mg isobaric bupivacaine + 15 µg fentanyl (1.7 mL) intrathecally. Incidences of hypotension, intraoperative systolic blood pressure, diastolic blood pressure, heart rate, motor block resolving time, and analgesia duration were recorded. Results: Group A had a substantially lower incidence of hypotension than Group B (p = 0.022). Patients in Group B had significantly lower systolic blood pressure values at the 6th, 8th, 10th, 12th, 14th, 15th, and 30th minutes of the surgery compared to Group A (p = 0.012, p = 0.014, p = 0.005, p = 0.016, p < 0,001, p = 0.002, and p = 0.011; respectively). Both groups had similar diastolic blood pressure and heart rate values during surgery (p > 0.05). The motor block resolving time and analgesia duration were longer in Group B compared to Group A (p < 0.001 for both). Two (5%) patients in Group A and ten (25%) patients in Group B experienced postoperative itching (p = 0.012). Conclusions: We concluded that combining 5 mg isobaric bupivacaine with 15 mcg of fentanyl administered intrathecally provides adequate anaesthesia while maintaining better hemodynamic stability in patients undergoing caesarean section. Clinical Trial Registration: The study has been registered with registration number NCT05136040 on https://classic.clinicaltrials.gov/ct2/results?cond=&term=+NCT05136040&cntry=&state=&city=&dist=.

Objective: This aim of this study is to assess the ovulation induction cycles based on clomiphene citrate and gonadotropin administration and specify the factors associated with successful outcomes. Study Design: This is a prospective study of 631 patients who underwent 917 ovulation induction cycles. While clomiphene citrate was used in 680 cycles (74.2%) and recombinant follicle-stimulating hormone was administered in 237 cycles (25.8%). Results: A total of 153 pregnancies were achieved in 917 ovulation induction cycles, indicating a clinical pregnancy rate of 16.7%. The ovulation induction cycles which ended up with clinical pregnancy had a significantly lower frequency of smoking (p=0.005), shorter infertility duration (p=0.001), higher basal luteinizing hormone (p=0.021) and lower basal progesterone (p=0.008) than unsuccessful cycles. The clomiphene citrate cycles which ended up with clinical pregnancy had a significantly lower frequency of smoking (p=0.011), shorter infertility duration (p=0.001) and lower basal progesterone (p=0.013) than the unsuccessful cycles. The recombinant follicle-stimulating hormone cycles which ended up with clinical pregnancy had a significantly higher basal luteinizing hormone (p=0.008) than the unsuccessful cycles. Basal luteinizing hormone and progesterone concentrations could significantly distinguish the patients who were able to conceive in ovulation induction cycles (p=0.021 and p=0.008, respectively). Conclusions: Smoking, longer duration of infertility, and elevated basal progesterone are poor prognostic factors for clinical pregnancy in clomiphene citrate and recombinant follicle-stimulating hormone cycles.

Abstract Objective Our aim is to demonstrate the importance of methotrexate (MTX) therapy for the treatment of ectopic pregnancy (EP). Methods This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX. Results Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy. Conclusion Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

Cystic hygroma is a congenital malformation of the lymphatic system. They are associated with chromosomal abnormalities and major structural anomalies. We describe a case of cystic hygroma associated with monosomy X and termination of pregnancy at 14 weeks of gestation.

Sirenomelia is a rare and lethal congenital malformation. It is associated with a variety of anomalies and oligo/anhydramniosis. We present a case of sirenomelia detected in early second trimester presenting with anhydramniosis.

OBJECTIVE: Pregnancy in renal transplant recipient was considered unsafe in the past. To date, these patients have successful pregnancy outcome. In this study, we aimed to analyze the outcome of pregnancy in kidney transplant recipients and the consequences on renal function. STUDY DESIGN: Retrospective analysis RESULTS: We found that the mean gestational age at delivery for patients were 35.22 weeks and 55.5% patients had preterm delivery and this result is higher than normal pregnant population. CONCLUSION: Pregnant women who renal transplant recipient have higher risk for preterm labor and hypertension compared normal pregnant women.

OBJECTIVE: Hysterectomy is the most frequently performed major surgery and is the most common major abdominal operation following cesarean section. The most common indication is uterine leiomyoma. The objective of this study is to evaluate the abdominal hysterectomy indications, intraoperative and postoperative complications and surgical morbidity. STUDY DESIGN: Demographic information, surgical indications, intraoperative and postoperative complications, hospitalization periods and clinical follow-up information of the patients who underwent abdominal hysterectomy at Hacettepe University Hospital, Department of Obstetrics and Gynecology between 2000 and 2004 were retrieved from patients’ files and follow-up forms. Statistical evaluations were performed using SPSS 10.0 for Windows program and p

Limb Body Wall Complex (LBWC) is a rare developmental anomaly which is classified together with midline defects. Despite the anomaly arises from an error occuring during the embryonic folding, the exact pathophysiological mechanisms are poorly understood. The clinical picture is characterized by thoracoabdominoschisis, eventration of the internal organs, limb reduction defects and sometimes craniofacial abnormalities. In this report we present (with the informed consent of the patient) the first trimester ultrasonographic diagnosis of a fetus with the classical findings of LBWC accompanied by exencephaly, megacystis and kyphoscoliosis which are rare in the literature. Today, this mortal anomaly can be diagnosed during the early weeks of gestation by ultrasonography. Prenatal detection of the anomaly is critical since offers an option of pregnancy termination.

OBJECTIVE: The objective of our study was to evaluate our experience on pregnancies after cancer treatment and pregnancy-associated cancer. STUDY DESIGN: The clinical records of 96 pregnant women including previously received treatment for cancer and association of cancer with pregnancy who admitted to our department were enrolled between 2002 and 2012. Demographics, pregnancy outcomes, maternal and fetal complications, perinatal outcomes, cancer types and treatments performed were evaluated. RESULTS: The study group was consisting of 96 cases, 59 out of 96 were cancer survivors and 37 were pregnancy-associated cancer patients. Of those thirty seven, 25 were synchronous with the pregnancy and 12 were metachronic. Pregnancies resulted in 77 healthy newborns, 7 abortions and 12 medical terminations. The most common type of cancer was the breast cancer in 25 patients, followed by thyroid, leukemia, osteosarcoma, lymphoma and ovarian cancer. Patients were treated for their cancer with different modalities including surgery, chemotherapy and radiotherapy. We encountered maternal mortality in 8 cases, all occurred after delivery. CONCLUSIONS: Since management of a pregnancy of a cancer survivor and pregnant woman with cancer a hard work, multidisciplinary approach involving gynecologists, pediatricians, oncologists is essential. Interval between cancer and pregnancy and timing of initiation of therapy in cases of pregnancy associated cancer are important issues in the perspective of fetal/neonatal well-being.

Uterine arteriovenous malformation (AVM) is defined as abnormal and nonfunctional connections between the uterine arteries and veins. Although the patients typically present with vaginal bleeding, some patients may experience life-threatening massive bleeding in some circumstances. The treatment of choice depends on the symptoms, age, desire for future fertility, and localization and size of the lesion; however, embolization of the uterine artery is the first choice in symptomatic AVM in patients at reproductive age with expectations of future fertility. We report a case of acquired AVM (after D/C) with an extensive lesion, which was successfully treated with bilateral uterine artery embolization (UAE).

Objectives: Diagnosis and management of non-obstetric acute abdomen during pregnancy is a cause of concern both for the obstetricians and the general surgeons. A resistance against operation during pregnancy leads to unnecessary delay which may increase both maternal and fetal morbidity, even mortality. In this study we present our experience in surgical management of pregnant patients with non-obstetric acute abdomen. Study Design: Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2004 to 2012. Women were excluded from the analysis if the surgical procedure was obstetric in nature. Demographics, gestational age, symptoms, operative results, postoperative complications, pregnancy outcome and imaging studies were assessed. Results: There were 24 patients with a mean age of 28,25±3.51 years. Operations are often performed in the second trimester. Most common symptoms were abdominal pain (100%) and nausea (83%). Ovarian torsion and appendicitis were the most common etiologies causing non-obstetrical acute abdomen (33% and 25%, respectively). All patients tolerated surgery well, 11 of them had no postoperative complications, however 3 fetal losses, 4 preterm deliveries, 3 PPROM, 1 re-operation and 1 vaginal bleeding were observed. One patient died from acute respiratory distress syndrome in the 24th day of the surgery. Ultrasonography was performed in 22 patients, MR imaging was used in 11 patients. Sonographic findings were diagnostic in 59%, while MR was successful in assigning the correct diagnosis in 100%. Conclusions: The issue of surgical management of non-obstetric acute abdomen during pregnancy is an important concern for clinicians who care women. Prompt diagnosis and appropriate surgical approach are the cornerstones of the management. Due to the diagnostic limitations of ultrasonography, MR imaging has become increasingly popular and gave direction to management strategy.

Goldenhar Syndrome also known as oculoauriculovertebral spectrum (OAVS) is a rare syndrome characterized by hemifacial microsomi, microtia, epibulbar dermoids, ear malformations and hemivertebrae. The mode of inheritance is clearly unknown and mostly polygenic etiology. The aim of this presentation is to present this young mother with oculoauriculovertebral spectrum and related problems. Most of the individuals with this syndrome do not notice themselves before the time of diagnosis. For that reason, we followed this patient’s pregnancy and performed cesarian section due to cephalopelvic disproportion. The enlighting of these patients with this syndrome is very important for the evaluation of this family and for the future pregnancies.

The cystic formation of the rete ovarii has been described rarely in the medical literature. Before performing pathologic examination they are mostly confused with other ovarian cystic structures. Currently, with the help of the certain distinguishing features of the rete ovarii tumors, diagnosing a primary tumor of the rete ovarii is much easier. Herein we describe a case of a postmenopausal patient presenting with a right sided adnexal mass, a rare tumor of t he rete ovarii, the cystadenoma.

Marfan syndrome is an autosomal dominant disorder characterized by abnormalities of skeletal, cardiovascular and ocular systems. Pregnant women may suffer from hemodynamic stress resulting from increased cardiac output and structural changes in the aortic wall leading dilatation and dissection of the aorta. It is usually advised to avoid pregnancy to women with Marfan Syndrome however with advances in medicine, successful pregnancies with Marfan Syndrome are reported. Therefore, the aim of this study is to review the literature over a case with a successful management during pregnancy.

OBJECTIVE: To emphasize the efficacy and safety of the prenatal invasive procedures for prenatal diagnosis of Tay-Sachs disease. STUDY DESIGN: In this case series, the results of the prenatal invasive procedures that were performed for diagnosing Tay-Sachs disease in 8 patients between 2000 and 2008 are reported. The samples were obtained by chorionic villus sampling or by cordocentesis. Total hexosaminidase level and the percentage of isoenzyme ß-Hexosaminidase A were measured in fetal samples. RESULTS: There were 8 patients in diagnosed prenatatlly between 2000-2008. Sufficient material for enzyme analysis was obtained without any complications. Total hexosaminidase levels and the percentage of hexosaminidase were in normal limits in all fetal samples. All pregnancies ended up with uneventful term births. CONCLUSION: Tay-Sachs disease can be diagnosed prenatally by measuring hexosaminidase enzyme activity in fetal tissue samples with an acceptable complication rate. Prenatal diagnosis should be offered to families who have affected siblings with Tay-Sachs disease.

Breast cancer is the most common cancer among women with a lifetime risk of 11%. Pregnancy-associated breast cancer is defined as cancer diagnosed during pregnancy or up to 1 year post partum. Surgery is the definitive treatment for pregnancy-associated breast cancer. For node-positive patients or node-negative patients with a tumor greater than 1 cm, a 4 to 6 month course of chemotherapy is the standard of care. Provided that chemotherapy is not used in the first trimester, it appears to be relatively safe. A forty-two year old pregnant woman in the third trimester presented with an advanced breast cancer. Since she had an advanced stage cancer and since she was in the third trimester, she was decided to be treated with chemotherapy. After three weeks, an emergent cesarean section was performed because the fetus was in acute distress. On the 20th day, the baby died because of cardiopulmonary arrest. The cause of the death was concluded as perinatal hypoxia secondary to chemotherapy. Even though chemotherapy is shown to be safe during the second and third trimester in many clinical trials, each case should be handled separately since the assumption of safety may differ in each case. These pregnants should be observed closer

Skeletal dysplasias are a group of diseases with a wide spectrum related to bone and cartilage. Some forms are lethal whereas some forms have milder clinical progression. Prenatal diagnosis of skeletal dysplasias may be possible especially when there is an index case in the family. Ultrasonography plays the central role in prenatal diagnosis and most common sonographic features are angulation of long bones, bending of femur or bowing signin the long bones. We present a case whose follow up for fetal short extremities ended with termination of pregnancy. The differential diagnosis is hard and depend especially on the fetal x-ray. Final diagnosis was lethal type osteogenesis imperfecta.

Ectopic pregnancy is still one of the leading causes of maternal mortality. Due to the popularity of elective sterilization procedures, the incidence of ectopic pregnancies following tubal sterilization began to increase in recent years and post-sterilization ectopic pregnancies account more than 10% of all ectopic pregnancies. This case report describes a 41-year-old woman with a diagnosis of an ectopic tubal pregnancy 10 years after laparoscopic tubal sterilization who was successfully managed via laparoscopy. Also, the incidence and risk factors for tubal sterilization failures, mechanisms of failure, and outcomes of failed cases are discussed.

Ureteropelvic junction obstruction is a rare congenital abnormality. The mode of inheritance is thought to be autosomal dominant with variable expressivity. Here, a consanguineous family whose three siblings diagnosed to have various degree of ureteropelvic junction obstruction is presented. Ureteropelvic junction obstruction may have a genetic background and may recur in subsequent pregnancies. Furthermore, genetic thrombophilias may be associated with urinary abnormalities. Further molecular studies are necessary to prove that finding.

OBJECTIVE: Maternal mortality has always been thought as one of the primary indicator of developmental status of a country. There may be some problems in achieving this level. Almost all of the south east European countries are developing countries and share some similarities regarding the social, cultural and economical background. Thus, incidence and etiologies of maternal mortality and therefore precautions are thought to be similar. To determine the current status we decided to make a survey with the related countries within the context of 2nd Congress of SEESPM. This report will summarize the results of the attendant countries. STUDY DESING: A simple questionnaire related to maternal mortality was prepared asked each representative to fill that form. The questionnaire consisted of three parts. Aim of the first part was to get some knowledge about the geographical and economical properties of that country The second part was related directly to maternal mortality. The third part was about the etiology of maternal mortality. RESULTS: Turkey has the largest surface area and the largest population among the countries. But Romania has the largest gross domestic product and the mean gross national income per capita. Most of the countries have national legislations for maternal mortality, presence of skilled attendant in delivery and for abortions. Among the countries Albania has the highest maternal mortality rate. All the attendant countries have national registry for maternal mortality and therefore these data belong to nationwide statistics in all of the countries.

OBJECTIVE: Detection of parvovirus B19 seropositivity in a group of pregnant women. STUDY DESIGN: Parvovirus B19 IgM and IgG seropositivity was investigated in 58 pregnant women. RESULTS: None of the 58 pregnant women had parvovirus B19 IgM seropositivity and 27% (n: 16) of the patients had IgG seropositivity. CONLUSIONS: Parvovirus B19 IgG seropositivity increases in pregnants by aging and it is reported as 60- 70 %. In our study the seropositivity was lower than the rates reported in the literature. Parvovirus B 19 infection is rare during pregnancy. Maternal- to- foetal transmission during acute maternal infection is about 33 %. Most of the foetal infections are asymptomatic. Common clinic presentations are miscarriage or foetal non-immun hydrops. In our opinion, routine screening of parvovirus B 19 infection should not recommended during pregnancy and screening should be limited with the hydropic fetuses because of some reasons including rarity of acute maternal infection during pregnancy, difficulty in predicting of foetal transmission, and irrelevance with fetal anomalies, rarity of miscarriage and hydrops foetalis even if fetal infection is considered.

To discuss an ambiguous genitalia case diagnosed antenatally. A fetus with ambiguous genitalia has been determined during US scan performed during 28th gestational week and confirmed with physical exam postnatally. External genitalia evaluation should be a part of routine anomaly screening as ambiguous genitalia can be life threatening issue especially in enzyme defects according to the deficient enzyme type

To discuss two pregnants with end stage renal failure. Two pregnancies delivered successfully during 37th and 38th weeks of pregnancy. Chronic renal failure patients who required dialysis can rarely become pregnant. Although there are some improvements in recent years, fetal survival is still about 50% in these patients. Most common complications are hypertension, polyhydramnios, and preterm labor. Spontaneous delivery occurs at an average of 32nd gestational week. Prematurity due to preterm labor is still the most common reason for neonatal mortality. Polyhydramnios can be prevented by increasing the dialysis dose and so duration of gestation can be prolonged and fetal survival improves. Because of two dialysis patients managed in our hospital, we aimed to investigate the recent data about chronic renal failure patients that required dialysis during pregnancy.

OBJECTIVE: To evaluate the association between the degree of hyperprolactinemia and the possibility of presenting a pituitary adenoma with magnetic resonance imaging. In addition, a threshold value for prolactin level was studied in order to predict micro/macroadenoma. STUDY DESIGN: A total of 43 patients from a tertiary center, with persistent hyperprolactinemia were retrospectively evaluated. Only patients with a prolactin level more than 20ng/mL with two consecutive analyses were undertaken. Magnetic resonance imaging (MRI) was performed to all cases. RESULTS: Of the 43 cases, microadenoma and macroadenoma was observed in 14 (32.6%) and 1 (%2.3) patient, respectively. The mean levels of PRL among patients with normal pituary imaging and microadenomas were similar. The unique case with macroadenoma had a PRL level of 56.2ng/mL. When the patients (n=39) were enrolled according to PRL levels, such as 0.5). CONCLUSION: There is no consensus for the cut-off PRL level to predict micro/macroadenoma in patients with persistent hyperprolactinemia. According to limited data, micro/macroadenoma may be presented even in PRL levels less than 100ng/ml. Therefore, the possibility of micro/macroadenoma should not be underestimated in patients with mild-moderate hyperprolactinemia according to the available literature.