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Approximately, one fourth of women have leiomyomas. Leiomyomas are benign tumors that originated from smooth muscle cells. Estrogen is claimed to relate as a cause but exact mechanism has not fully understood. In this study, 95 leiomyoma cases that have been diagnosed by our department in years between 2010 and 2012 were examined. Age ranges of patients, sizes, locations, and numbers of leiomyomas were identified. Immunohistochemically ER (estrogen), PR (progesterone), and Gross cystic disease fluid protein-15 stains were performed to the paraffin blocks and their percentages of staining were noted. Statistically, submucosal and intramural locations were significantly related to ER and PR (p < 0,001). There were significant relationship between ER and PR in 30-50 years age group (p < 0,001). There were significant relationship between ER, PR and locations (p < 0,001), numbers (p < 0,001), sizes of leiomyomas (below 5 cm; p < 0,001), (between 5 and 10 cm; p = 0,037), larger than 10 cm; p = 0,002). Consequently, relationship between leiomyoma and ER, PR were revealed in this study. Also, relationship between leiomyoma locations and patient ages were identified statistically. There was no immunoreactivity with GCDFP-15 in leiomyomas.

This was a cross-sectional study to analyse the relationship between menopausal symptoms and sexual dysfunction among 229 married Turkish women in the 40-65 age group. The study was carried out at a menopause clinic of a state hospital between 1 October and 31 December 2010. Data were collected with Personal Characteristics Form, Menopause Rating Scale (MRS) and the Arizona Sexual Experience Scale (ASEX). The average age of the women was 52.33 (SD = 4.80) years. The average MRS total score was 20.13(SD = 9.20). The ASEX mean score was 19.97 (SD = 5.44). It was determined that there is a positive meaningful relationship between ASEX mean score, MRS total mean score and the sub-score of women. From the results obtained from this study, it can be said that women have differing levels of menopausal symptoms, and as the severity of menopausal symptoms increases, there is an increase in sexual dysfunction., (© 2014 Wiley Publishing Asia Pty Ltd.)

In medicine, estimating the chance of success for treatment is important in deciding whether to begin the treatment or not. This paper focuses on the domain of in vitro fertilization (IVF), where estimating the outcome of a treatment is very crucial in the decision to proceed with treatment for both the clinicians and the infertile couples. IVF treatment is a stressful and costly process. It is very stressful for couples who want to have a baby. If an initial evaluation indicates a low pregnancy rate, decision of the couple may change not to start the IVF treatment. The aim of this study is twofold, firstly, to develop a technique that can be used to estimate the chance of success for a couple who wants to have a baby and secondly, to determine the attributes and their particular values affecting the outcome in IVF treatment. We propose a new technique, called success estimation using a ranking algorithm (SERA), for estimating the success of a treatment using a ranking-based algorithm. The particular ranking algorithm used here is RIMARC. The performance of the new algorithm is compared with two well-known algorithms that assign class probabilities to query instances. The algorithms used in the comparison are Naïve Bayes Classifier and Random Forest. The comparison is done in terms of area under the ROC curve, accuracy and execution time, using tenfold stratified cross-validation. The results indicate that the proposed SERA algorithm has a potential to be used successfully to estimate the probability of success in medical treatment.

Objective: The aim of our study was to evaluate the individual contribution of parity when incorporated as another parameter into the four risk of malignancy indices (RMI 1-4) to differentiate noninvasive benign lesions from invasive malignant ovarian lesions., Materials and Methods: After calculating RMI 1-4 for each patient included in this study, the resulting RMI scores were further multiplied by the parity score (P) of each patient to calculate the RMI parity (RMIP) score., Results: A cutoff value of 300 for RMIP 1 yielded 95.0% specificity, 97.4% negative predictive value (NPV), 88.5% sensitivity, and 79.3% positive predictive value (PPV) and performed better than RMI 1 in the preoperative diagnosis of invasive malignant lesions. RMIP 2 with a cutoff value of 400 yielded 95.0% specificity, 97.4% NPV, 88.5% sensitivity, and 79.3% PPV, and it also performed better than RMI 2. A cutoff value of 400 for RMIP 3 provided 97.5% specificity, 97.5% NPV, 88.5% sensitivity, and 88.5% PPV and performed better than RMI 3. However, a cutoff value of 400 for RMIP 4 provided 90.0% specificity, 97.3% NPV, 88.5% sensitivity, and 65.7% PPV but did not perform better than RMI 4 in the preoperative diagnosis of invasive malignant lesions., Conclusion: RMIP 1-3 scales were more reliable tools for the preoperative diagnosis of invasive adnexal masses compared with the traditional RMI 1-3 scales., (Copyright © 2014. Published by Elsevier B.V.)

Purpose: To study parameters that could predict in-vitro fertilization (IVF) success in patients who experienced total fertilization failure (TFF) with intracytoplasmic sperm injection (ICSI) in their previous cycles., Methods: Cycle characteristics of patients with TFF (Group I, n = 136 cycles), cycles resulting in embryo transfer (ET) following TFF (Group II, n = 36 cycles) and recurrent TFF (Group III, n = 25 cycles) and were studied retrospectively. Demographic features, cycle characteristics of three groups were compared., Results: Follicle count measuring 15-17 mm was significantly higher in group II when compared to group I (p = 0.02). Total number of retrieved oocytes and mature oocytes were significantly higher in group II when compared to groups I and III (p = 0.001). Estradiol level at oocyte pick up (OPU) day was significantly higher in group II when compared to group I (p = 0.02). When the characteristics of ET cycles and preceding TFF cycles of the same patient were compared, total number of retrieved oocytes (5.11 ± 0.72 (95% CI 3.69-6.52) vs. 11.44 ± 1.60 (95% CI 5.29-17.59)) and mature oocytes (3.26 ± 3.66 (95% CI 2.04-4.47) vs. 6.92 ± 5.61 (95% CI 5.09-8.75)) were found to be significantly lower in TFF cycles (p = 0.001). Five biochemical and 5 clinical pregnancies occurred while only 2 healthy babies were born, corresponding to a live birth rate 5.5%., Conclusions: Increasing the number of retrieved and mature oocytes may increase the success of fertilization in patients with a history of previous failed fertilization. However, live birth rate is still low in embryo transfer cycles.

Introduction: Tubo-ovarian abscess (TOA) is a conglomerated mass of pelvic organs including the tube, the ovary, and the bowel. The most commonly isolated organisms from TOAs are Escherichia coli (E. coli) and Bacteroides species., Case Report: We reported a case of Clostridium septicum (C. septicum) infection from a ruptured TOA with atypical clinical features. Culture of intra-abdominal free fluid obtained during surgery yielded C. septicum. VITEK II (bioMérieux, France) automated system was used for advanced identification of the bacteria. Parenteral clindamycin in combination with an aminoglycoside was used. The patient was discharged 19 days after the surgery and was clinically asymptomatic 6 months after the surgery., Conclusion: The differential diagnosis of TOA caused by C. septicum can be difficult, due to the lack of the symptoms. Tissues infected with C. septicum can become necrotic. A combination of early, adequate antibiotic therapy and surgery is the key point of the treatment.

Purpose: To evaluate the effects of gelatin matrix and thrombin-based hemostatic sealant agents (gelatin-thrombin matrix) on postoperative adhesion formation in the rat uterine horn model., Methods: A total of fourteen female Wistar-Albino rats were used in our postoperative adhesion formation model. Both uterine horns were exposed by midline incision with sterile technique and each uterine horn was traumatized by bipolar electrocautery. Before closure of the abdomen, 0.9 % NaCl solution was administered intraperitoneally in the control group and the gelatin-thrombin matrix was applied on the traumatized areas on the uterine horns of the rats in the study group. At day 21 after the first surgery, the intraperitoneal macroscopic adhesion scores and the extent of fibrosis, inflammation scores, inflammatory cell activities, inflammation types of adhesion tissues, and the level of free oxygen radicals [malondialdehyde (MDA)] and antioxidant enzyme activity [superoxide dismutase (SOD) and glutathione S-transferase (GST)] in the uterine horn tissue were measured., Results: There was no statistically significant difference between the two groups in terms of macroscopic adhesion scores (p = 0.064), MDA levels (p = 0.121), and GST activity (p = 0.360). However, there was statistically significant difference between the two groups in terms of the extent of fibrosis (p < 0.001), inflammation score (p = 0.001), inflammatory cell activity (p = 0.002), and SOD activity (p < 0.001)., Conclusions: Gelatin-thrombin matrix was found to have increased the extent of fibrosis, inflammatory cell activity, and inflammation score, and reduced the activity of SOD, which acts to prevent cell damage.

Objective: To determine if body mass index has an effect on the outcome of in vitro fertilization in patients with polycystic ovary syndrome undergoing controlled ovarian hyperstimulation., Material and Methods: The study included 337 cycles. Patients were stratified into the following 3 groups: normal weight, overweight, and obese. The primary outcome measures were response to ovarian hyperstimulation, the fertilization rate, the implantation rate, and the clinical and ongoing pregnancy rates., Results: Total gonadotropin consumption increased, and the number of retrieved oocytes decreased as the body mass index increased. The implantation rate and clinical pregnancy rate were similar in all 3 groups. In response to the mid-luteal long protocol, the cycle cancellation rate was lower and the number of retrieved oocytes was higher in the overweight and obese groups, as compared to the antagonist protocol., Conclusion: The body mass index did not affect the outcome of in vitro fertilization in women with polycystic ovary syndrome. Additional research is required to better understand the role of stimulation protocols on the cycle outcome.

Purpose: The aim of this study was to evaluate intraoperative and postoperative outcomes of laparoscopic hysterectomy (LH) with routine intraoperative cystoscopy (CYS) for enlarged uterus (>280 g)., Methods: The patients, who underwent LH procedure in the Department of Obstetrics and Gynecology in Düzce University Faculty of Medicine between July 2012 and July 2013, were included in this study. Perioperative outcomes were compared between patients with and without enlarged uterus., Results: Uterus weight of the operated patients ranges between 38 and 700 g. Mean uterus weight was 196.40 ± 142.32 g. Although we found longer operation time (148.75 ± 32.37 vs. 128.28 ± 27.58) and higher delta hemoglobin (2.98 ± 3.09 vs. 1.61 ± 1.29) in patients with enlarged uterus undergoing LH, these findings were not statistically significant (p = 0.077 and 0.058). No significant difference was found between the two groups in terms of need for insertion of pelvic drainage (p = 0.664), duration of bladder catheterization (p = 0.673), time of first postoperative flatus (p = 0.509) and the duration of hospitalization (p = 0.844). None of the patients had postoperative fever. The two groups were not significantly different in terms of postoperative body temperature (p = 0.736). In normal uterus group, 1 patient developed ureterovaginal fistula and 1 patient required re-operation. No major complication was observed in large uterus group., Conclusions: In our study, we compared the outcomes of LH in patients with large uterus measuring up to 700 g. and patients with normal uterus, and we achieved successful results by making minor changes in the operation technique and performing diagnostic CYS at the end of the operation.

Objectives: The aim of the study was to compare the changes in the values of leukocytes, neutrophils, lymphocytes, mean platelet volume (MPV), and systemic inflammatory response (SIR) markers (neutrophil-lymphocyte ratio/ platelet-lymphocyte ratio) in patients with severe preeclampsia (PE) of healthy pregnant and non-pregnant women., Material and Methods: Hematological parameters including MPV and SIR markers [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)] were compered between the between three groups comprising of women with severe PE, healthy pregnant women and healthy non-pregnant women., Results: MPV and PLR did not show statistically significant differences between the three groups (p=0.081, p=0.098). NLR showed a statistically significant difference between the three groups (p=0.000). NLR values of patients with severe PE were statistically significantly higher than healthy non-pregnant women (p=0.000). No statistically significant difference was found between patients with severe PE and healthy pregnant women (p=0.721). The cut-off value of the leukocyte number for severe PE was 7.6 x 10(3)/ml, with 76.7% sensitivity and 60.6% specificity. The cut-off value of neutrophil number was 6.4 x 10(3)/ml for the group with severe PE, with 76.7% sensitivity and 69% specificity., Conclusions: Our results showed that MPV level did not differ among patients with severe PE, healthy pregnant women and non-pregnant women. NLR cannot be used to identify patients with severe PE. PLR measured before termination of pregnancy is not an effective marker for severe PE, either.

Objective: Cigarette smoke contains many toxic chemicals associated with poor reproductive outcome and reduced fertility. It also has a negative effect on sperm motility and morphology. The aim of this study was to analyze the effects of male and female cigarette smoking on the outcomes of in vitro fertilization (IVF)., Study Design: In this comparative prospective analysis, the effects of smoking on outcomes of IVF including semen parameters, oocyte quality, fertilization rate, transfer day embryo scores and pregnancy rates were analyzed. For this purpose, patients were grouped based on their follicular or seminal fluid cotinine (a nicotine metabolite) levels as smokers and non-smokers (non-smokers: female (n=171), male (n=118), smokers: female (n=43), male (n=96))., Results: The mean age and baseline hormonal levels of all groups were found to be comparable. While the numbers of total and mature oocytes collected were higher in the smoker group (p=0.005 and p=0.006, respectively), oocyte quality index, fertilization rate, embryo development rate and pregnancy rate were not significantly different between the groups (p>0.05). Analysis based on the type of ovarian hyperstimulation protocol (GnRH agonist, antagonist and others) showed that within the antagonist group the mean age of smokers was significantly lower and the total number of collected oocytes was significantly higher compared with non-smokers. Cigarette smoking among men did not have a significant negative effect on outcomes of IVF whether their partners were smokers or nonsmokers. Regression analysis did not give any significant difference when male and/or female smoking status was analyzed for fertilization rates, transferred embryo qualities and clinical pregnancy rates., Conclusion: Cigarette smoking does not have detrimental effects on outcomes of IVF., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Introduction: It still remains an unanswered question whether, in the absence of gynecological malignancy and under elective conditions, to perform abdominal hysterectomy (AH), offering a safer approach, or to perform a laparoscopic hysterectomy (LH) procedure., Aim: We aimed to compare LH operations performed with a tissue fusion device accompanied by intraoperative diagnostic cystoscopy with traditional AH operations involving bilateral ureteral dissection., Material and Methods: The integrity of the ureters, ureteral peristalsis and the diameter of the ureters were examined during AH by inspection. At the end of LH, the bladder wall was systematically evaluated by cystoscopy and a jet of urine spurting was noted from both ureteral orifices., Results: The operation time was longer in patients who underwent LH + CYS (p = 0.0001). The decline in hematocrit and hemoglobin levels in the postoperative period was significantly higher in patients who underwent AH + UD (p = 0.0001 and p = 0.002, respectively). No significant difference was found between the two groups in terms of ureteral injury, bowel injury or bladder injury (p = 0.378, p = 1.000 and p = 1.000, respectively). There was no statistically significant difference between the two groups in terms of mean body temperature and postoperative blood transfusion requirements (p = 0.051 and p = 0.210, respectively). Mean parenteral analgesic requirement and length of hospital stay were significantly different between the groups (p = 0.005 and p = 0.0001). No statistically significant difference was found between the two groups in terms of postoperative cardiopulmonary complications, re-operation rate or occurrence of genitourinary fistula (p = 1.000, p = 1.000 and p = 1.000, respectively)., Conclusions: We concluded that LH performed with a tissue fusion device involving diagnostic cystoscopy yields major and minor complication rates similar to safely performed AH operations preserving ureters.

Objectives: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment., Materials and Methods: The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass., Results: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0.203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx., Conclusions: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility.

The aim of this article was to evaluate the clinical, endocrine, and cardiovascular disease risk profile differences among main polycystic ovary syndrome (PCOS) phenotypes. One hundred and thirty-nine consecutive women were included in the study. Body mass index (BMI), serum follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone, estradiol, testosterone, dehydroepiandrosterone sulfate, fasting glucose, low density lipoprotein (LDL-C), total cholesterol, high density lipoprotein (HDL-C) high sensitive CRP, c-peptide, insulin, insulin sensitivity and carotid intima thickness were compared among different phenotype groups of PCOS: Group 1-PCO (polycystic ovaries)-anovulation (n = 34), Group 2-Hyperandrogenemia (HA)-anovulation (n = 30), Group 3-HA-PCO (n = 32), and Group 4-HA-PCO-anovulation (n = 43). Statistically significant differences among the different phenotype groups in terms of waist hip ratio, total cholesterol, LH, estradiol, fasting glucose, progesterone, free testosterone, and carotid intima media thickness were observed. The lowest mean CIMT was observed in Group 3, and the highest fasting glucose levels were in Group 4, while the lowest mean free testesterone was measured in Group 1. BMI, LDL-C, and total cholesterol showed significant positive correlations with CIMT (r = 0.411, P = 0.001; r = 0.258, P = 0.006; r = 0.199, P = 0.033). The lowest LDL-C, total cholesterol, and BMI were found in Group 3, but differences were not statistically significant. High-sensitive CRP levels were similar among the groups (P = 0.103). Group 3 PCOS with PCO and hyperandrogenemia phenotype has lower cardiovascular disease risk compared to other phenotypes.

Objective: To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy., Design: Prospective randomized controlled trial., Setting: Maternity and teaching hospital in Turkey., Population: One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy., Methods: Sixty-two women received a single dose and 58 received a multiple dose methotrexate regimen., Main Outcome Measures: Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses)., Results: In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77-1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 +/- 7.6) compared with the multiple dose group (18.3 +/- 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side-effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35-0.92)., Conclusion: A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side-effects, but the time for hCG levels to fall below 5 mU/mL is shorter.

Objective: To evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital., Methods: The data of 461 patients who underwent interval tubal ligation (ITL) at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique, and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or who had a complication and/or an unplanned laparotomy were analyzed., Results: The mean age of patients was 35.1 (range: 21-51), gravidity was 4.6 (range: 2-9), parity was 3.2 (range: 2-7), and number of living children was 3.1 (range: 2-6). Out of 461 patients, only 2 (0.4%) had complications related with general anesthesia. Two cases (0.4%) had bleeding from the port-site, 3 cases (0.6%) had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding (0.2%) and one case had bleeding (0.2%) from the vaginal wall. There was only one (0.2%) intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1%, and all the complications were encountered in patients who had laparoscopic surgery., Conclusion: Outpatient tubal ligation is a convenient and safe procedure, and implementing endoscopic surgical techniques is necessary for correction of the complications.

Objective: To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) regimen., Design: A case series with a retrospective statistical analysis., Setting: Maternity and teaching hospital in Turkey., Patient(s): Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy., Intervention(s): Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency., Main Outcome Measure(s): Ipsilateral and contralateral tubal obstruction rates., Result(s): Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction., Conclusion(s): In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy.

Objectives: To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy., Method: A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords 'partial hydratidiform mole', 'hydatidiform mole' and 'coexisting fetus'., Results: At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented., Conclusion: Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.

Objective: To utilize infant outcomes and to identify risk factors associated with umbilical cord prolapse., Materials and Methods: Birth records of 80 cases with umbilical cord prolapse and 800 randomly selected controls were reviewed retrospectively. Statistical analysis was performed using logistic regression models., Results: Prolapse of the umbilical cord complicated 0.47% (n=80) of all deliveries included in the study (n=16,874). Multiparity was more common in patients with umbilical cord prolapse (63.8-49.4%, P=0.014). Umbilical cord prolapse occurred in breech presentation in six cases (7.5%) and in transverse presentation in three of the cases (3.8%). The occurrence of breech presentation among the control cases was 1.0% and of the transverse lie was 0.1% (P<0.001). Fetuses with umbilical cord prolapse had lower fetal weight; particularly, fetal weight less than 2,500 g was a significant risk factor (3-2.4%, P<0.001). We also found that spontaneous rupture of membranes (OR=8.93; 95%, CI=4.16-19.14), Bishop score greater than 8 (OR=5.48; 95%, CI=3.21-9.34), and polyhydramnios (OR=21.0; 95%, CI=11.4-38.7) were risk factors for umbilical cord prolapse. The newborns that were delivered after umbilical cord prolapse graded lower Apgar scores less than 7 at 5 min (6.3-1.4%, P=0.002)., Conclusion: Abnormal fetal presentation, multiparity, low birth weight, prematurity, polyhydramnios, and spontaneous rupture of membranes, in particular with high Bishop scores, are risk factors for umbilical cord prolapse. Early amniotomy increases the variable decelerations and hence increases the rate of cesarean section because of fetal distress, but it may prevent pregnant women from umbilical cord prolapse, which has a high mortality rate. However, large randomized trials are needed to prove that early amniotomy decreases the incidences of umbilical cord prolapse.

The authors report a case of intravesical migration of an intrauterine contraceptive device (IUD) with secondary stone formation in a 28-year-old woman who presented with recurrent urinary tract infections. After incomplete removal of the migrated copper-T 380-A from the pelvic cavity by laparoscopy, cystoscopy was performed and the arms of the IUD with the calculus formed around them were removed via the cystoscope. Intravesical migration of an IUD should be suspected in any woman with an unretrieved device and with recurrent urinary symptoms.

Objective: To determine the possible predictors of methotrexate treatment failure in ectopic pregnancy., Study Design: Fifty-eight patients diagnosed with ectopic pregnancy were treated with methotrexate (50 mg/m2). Selected variables in the history of the patients, the signs and symptoms at the time of admission, transvaginal ultrasound findings and serum beta-human chorionic gonadotropin (beta-hCG) levels on day 1 and 3 were evaluated in a logistic regression model to predict treatmentfailure, defined as tubal rupture., Results: Methotrexate treatment failed in 9 cases (15.5 %). Another 9 cases (15.5%) required a second dose of methotrexate, and no treatment failures were observed in these cases. The presence of subchorionic tubal hematoma in the ectopic gestation (OR = 22.9, CI = 2.7-194.7, p = 0.004), the presence of an embryo (OR = 24, CI = 2.1-269, p = 0.01) and day 1 serum beta-hCG level > or = 3,000 mIU/mL (OR = 27.1, CI = 2.1-342.5, p = 0.01) were the main predictors of treatment failure. Follow-up serum beta-hCG levels > or =3,500 mIU/mL (OR = 42.9, CI = 4.3-421) on day 3 were significant predictors of treatment failure. Follow-up risk score was calculated as > 4 on day 3 by adding day 3 serum beta-hCG level to the admission score. Only 1 treatment failure (2.4%) occurred in 42 patients with an admission score of nil. No treatment failure occurred in 39 patients whose follow-up score was nil. The increase in admission risk (OR = 32.1, CI = 3.8-270, p = 0.001) and follow-up risk (OR = 9.2, CI = 2.4-35.2) were significant predictors of treatment failure., Conclusion: Transvaginal ultrasound findings are as important as serum beta-hCG level on the first day of methotrexate treatment. In unruptured cases, day 3 serum beta-hCG level is important to reevaluate the decision to continuefollow-up or perform early surgery for increased risk of treatment failure.

Aim: To evaluate the histopathologic findings relating to tissue samples collected at surgical uterine evacuation in first-trimester spontaneous miscarriages., Methods: In this retrospective study, histopathologic diagnosis of the tissue samples obtained via surgical uterine evacuation in patients who were admitted to the Early Pregnancy Clinic in a 12-month period with the diagnosis of incomplete miscarriage (n = 970), missed miscarriage (n = 406) and anembryonic miscarriage (n = 230) in the first trimester was recorded and compared with the presurgery diagnosis., Results: Uterine evacuation was performed in cases of incomplete miscarriage (n = 970, 60.4%), missed miscarriage (n = 406, 25.2%) and anembryonic miscarriage (n = 230, 14.3%). Histopathologic examination revealed the product of conception in 1119 patients (69.7%), while partial hydatidiform mole was diagnosed in 33 patients (2.1%). Complete hydatidiform mole was detected in only seven cases (0.43%). Exaggerated placental site and placental site trophoblastic nodule was detected in two cases (0.12%). Decidual tissue without chorionic villi was reported in 272 patients (16.9%), raising the suspicion of presence of other pathology., Conclusions: By routine histopathologic assessment of products of first-trimester spontaneous miscarriages, important pathologies such as molar pregnancy and placental trophoblastic disease can be diagnosed. Histopathological assessment has great value in the identification of an ectopic pregnancy or infection when compared with clinical and laboratory findings.

Objective: To evaluate the induction-to-abortion time of 3 pharmacokinetic-based protocols at 13-20 weeks of gestation., Study Design: A randomized trial was conducted on 153 patients. The oral group (n = 51) received 100 microg misoprostol orally every 2 hours, the vaginal group (n = 51) received 200 microg misoprostol vaginally every 4 hours, and the sublingual group (n = 51) received 100 microg misoprostol sublingually every 2 hours., Results: The mean induction-to-delivery time was shorter in the sublingual group (mean, 651 +/- 507) as compared to the vaginal group (mean, 1,056 +/- 634, p = 0.01). The number of patients who delivered within 12 hours was significantly higher in the sublingual group (n = 39, 78%) as compared to the oral (n = 26, 52%) and vaginal (n = 20, 40%) groups (p < 0.001). The numbers of patients who delivered within 24 hours were comparable in the sublingual (n = 47, 94%) and oral (n = 46, 92%) groups but higher than in the vaginal group (n = 39, 78%; p = 0.02). The total misoprostol dose was 543 +/- 422 microg in the sublingual group, 878 +/- 533 microg in the vaginal group and 741 +/- 413 microg in the oral group (p < 0.001)., Conclusion: A pharmacokinetic-based application of 100 microg of sublingual misoprostol every 4 hours is more effective for induction of second-trimester abortion as compared to 100 microg oral misoprostol every 2 hours and 200 microg vaginal misoprostol every 4 hours.

Background: Cornual pregnancy is a rare type of ectopic pregnancy. Methotrexate (MTX) has been used successfully for the treatment of tubal pregnancies; however, its use for interstitial pregnancies is less common., Cases: Three cases of cornual pregnancy were successfully treated with a single MTX injection (50 mg/m2), without complications., Conclusion: A single MTX injection as medical treatment is an alternative to surgical treatment of cornual pregnancies.

Background: Misoprostol fails to induce labour in 5-20% of women at term., Aim: To analyse possible predictors of unsuccessful induction with 50 microg vaginal misoprostol and effectiveness and the safety of intracervical Foley catheter application in induction failures., Methods: An observational study was conducted on 1030 women with singleton, live fetuses, vertex presentation, > 34 weeks of gestation and Bishop score < 5. Induction of labour with 50 microg vaginal misoprostol repeated every 6 h was attempted. Women without regular uterine contractions and cervical changes at the end of 24 h were considered to be unsuccessful, and a transcervical Foley balloon catheter was placed and inflated with 50 mL saline. Possible predictors of induction failures were analysed via logistic regression analysis. Neonatal outcomes and vaginal delivery achieved after Foley catheter were also determined., Results: Induction was successful in 918 cases (89.1%) and Foley catheter was placed in 112 (10.8%) women. Increasing gestational age in weeks (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.68-0.88) and increasing Bishop score (OR 0.73, 95% CI 0.60-0.90) decreased the risk of failed induction. Failure rates were 16% (27/169) in post-term nulliparous women with Bishop score