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INTRODUCTION[|]To investigate placental immunohistochemical findings and Doppler parameters in normal pregnancies and women with preeclampsia (PE).[¤]METHODS[|]Doppler measurements of umbilical, uterine, and spiral arteries of 23 PE and 12 normal pregnancies followed and delivered between 2008 and 2010 were performed and recorded. Placental specimens were obtained at birth and the microvessel density of spiral arteries was measured immunohistochemically using placental tissue CD 34 antibody expression. Three vessels with the most intense CD34 density were evaluated.[¤]RESULTS[|]There were no significant differences in the umbilical artery pulsatility index (PI), resistance index (RI), or systolic/diastolic ratio (S/D) between the PE and normal pregnancies. The spiral and uterine artery RI, PI, and SD ratios, however, were significantly higher in the PE group. There was no statistically significant difference in the mean microvessel density between the 2 groups.[¤]DISCUSSION AND CONCLUSION[|]The role of the placenta in the development of PE is unquestionable. Vascular pathologies and blood flow characteristics demonstrate significant differences and deteriorations compared with normal pregnancies. Further research is needed to further define the precise pathology.[¤]

WOS: 000504688900004 In the study; SiC reinforced (1-12 wt. %) aluminum matrix composites from waste beverage cans were fabricated by stir casting method. The effect of reinforcement ratio on the experimental density, hardness, the compressive and tensile strength of the composites was investigated. The crystal structures and microstructure of the composite materials were analyzed by X-ray diffraction (XRD) method and scanning electron microscopy (SEM). From the results, the hardness of composites increased from 70,81 HV (pure Al alloy) to 89,80 HV (for 9 wt. % SiC). The compressive and tensile strengths were performed as 763,69 MPa (for 5 wt. % SiC) and 201,79 MPa (for 1 wt. % SiC) compared with pure aluminum alloy ( 620,35 MPa and 154,71 MPa). Ondokuz Mayis University, Scientific Research Project DepartmentOndokuz Mayis University [PYO. MUH.1902-A. 15.001, PYO.MUH.1901.18.007] The authors are pleased with the partial support for this study from Ondokuz Mayis University, Scientific Research Project Department under the grants (PYO. MUH.1902-A. 15.001 and PYO.MUH.1901.18.007). The authors of this study thank the Black Sea Advanced Technology Research and Application Center (KITAM) in Ondokuz Mayis University (OMU) for SEM and XRD analysis.

Aim To compare the classical double-layer uterine closure to a double-layer purse-string uterine closure (Turan technique) in cesarean section regarding short- and long-term results. Methods Patients were randomized into either the double-layer purse-string uterine closure arm (study group, 84 patients) or the classical double-layer uterine closure arm (control group, 84 patients). For short-term comparison, a detailed transvaginal ultrasound examination was planned in all patients 6 weeks after the operation and a wedge-shaped defect in the uterine incision scar was accepted as uterine scar defect and recorded. For the long-term comparison, subsequent pregnancies of these patients were followed up for any complication. Results The number of patients with ultrasonographically visible uterine scar defect was 12 (23.5% of all scar defects) in the study group whereas it was 39 (76.5% of all scar defects) in the control group (P

Effects of tibolone on depressive and anxiety symptoms in symptomatic postmenopausal women Aims: We investigated the effect of tibolone therapy on menopausal symptoms, depression and anxiety scores in women with symptomatic natural menopause compared to control group using Kupperman’s Index, Hamilton Depression Rating Scale and Beck Anxiety Inventory. Methods: One hundred thirty patients with menopausal symptoms enrolled into the study, and 121 patients completed. Group I patients were treated with tibolone 2.5 mg/day. Group II patients received placebo (calcium forte tablet 1000 mg/day). The menopausal, depressive and anxiety symptoms were assessed using Kupperman’s Index, Hamilton Depression Rating Scale and Beck Anxiety Inventory before and at the end of the treatment. For statistical analysis, paired t, multivariate analyses tests were used. Results: At the end of 3 months of therapy, we observed significant improvement in menopausal symptoms, depression and anxiety scores in both groups. When we compared two groups’ Kupperman and Beck Anxiety Inventory (BDI) scores according to time before and after the treatment, Group I scored better than Group II. The superiority of tibolone comparing placebo on depressive symptoms could not be shown in this study. Conclusion: Tibolone’s effects in calming vasomotor symptoms and improving anxiety symptoms suggest it as an alternative when the possible side effects of estrogen and progesterone combination or estrogen

Aim: To investigate the value of tetracycline sclerotherapy for management of recurrent or persisting nonneoplastic ovarian cysts in comparison to the aspiration without sclerotherapy. Material and Methods: Ninety-six patients with proven non-neoplastic ovarian cysts were randomized into two groups. Group 1 patients underwent cyst aspiration together with tetracycline sclerotherapy (n = 48). Group 2 patients underwent only cyst aspiration without tetracycline sclerotherapy (n = 48). Then, all patients were followed up monthly with ultrasonography for 12 months. The procedure was considered to have failed if the recurring cyst, detected by ultrasound, was 4 cm in size or greater. Results: There were no differences between the two groups regarding demographic data, initial cyst volume and tumor markers. Recurrence rates within 12 months were 14.6% in group 1 and 50% in group 2 (P < 0.001). Conclusion: Based on the recurrence rates, we suggest transvaginal aspiration together with tetracycline sclerotherapy rather than only simple transvaginal aspiration in the management of non-neoplastic ovarian cysts.

Amaç: Akciğer olgunluğunu tespit etmek amacıyla özel teknoloji gerektirmeyen basit bazı testleri karşılaştırmak ve rutinde kullanılabilirliğini değerlendirmek. Materyal ve metod: Obstetrik nedenler ile doğumu başlayan, 30-41 hafta arası gebelerden normal doğum travayı veya sezeryan sırasında amnion sıvısı örneği alınan 56 hasta çalışmaya dahil edildi. Örneğin alınmasını takiben hasta başında aynı kişi tarafından Tap test ve Turbidite(bulanıklık) testi yapıldı. Bulgular: Yenidoğanların 12’sinde ( % 21,4 ) Respiratuar Distres sendromu ( RDS ) gelişirken, diğerlerinde RDS gelişmedi. Tap testi ile akciğer matürite tespiti için sensitivite % 91,spesifite % 88; Bulanıklık testi ile akciğer matürite tespiti için sensitivite % 83, spesifisite % 65 olarak tespit edildi. Sonuç: Tap testi öncelikli olmak üzere, bulanıklık testi ise ikinci seçenek olarak teknolojik imkânlar sınırlı ise hasta başında hızlı karar vermede yardımcı olabilir.

SUMMARY Objective: To compare the effects of norethisterone acetate (NETA) and drospirenone on thyroid hormones, glisemic control, serum lipid profile and androgen levels. Material and methods: 50 postmenopausal women with intact ovaries & uterus who have vasomotor complaints but otherwise healthy were prospectively enrolled into the study and 41 of them completed the study. Patients were randomly divided into two groups and prescribed 1mg E2 / 0.5 mg NETA (n=21) or 1mg 17 s E2 / 2 mg drospirenon (n=20) for 3 months. After the treatment thyroid hormones, glisemic control, lipid profile and androgen levels were compared both within the groups and between the groups. For the statistical analysis besides descriptive statistical methods paired and unpaired t test, Mann-Whitney U test and chi square test were used. Statistical significance level was accepted as p≤ 0.05. Results: There was no difference regarding body mass index (BMI), endometrial thickness and thyroid hormones both within the groups and between the groups after the treatment. Total cholesterol (p=0.03), insulin (p=0.009), Homeostasis model assessment (HOMA) (p= 0.01) and fibrinogen (p=0.01) levels were decreased in NETA group after three months. In drospirenon group there was decrease in LDL cholesterol level (p= 0.02), increase in trigliseride level (p=0.04). There was decrement in total testosterone level in both NETA (p=0.0001) and drospirenon (0.001) groups. Conclusion: NETA have beneficial effects on both lipid and carbohydrate metabolism in postmenopausal women. Drospirenon decreases LDL cholesterol while increasing trigliseride level and has no effect on carbohydrate metabolism. Under the light of these data it is wise to suggest NETA containing low dose hormone therapy preparations in postmenopausal women with diabetes risk for controlling vasomotor complaints.

Objective. To investigate the effect of raloxifene therapy on menopausal symptoms, depression and anxiety scores using Kupperman’s Scale, Hamilton Depression Rating Scale (HDRS) and Beck Anxiety Rating Scale (BARS) in osteopenic postmenopausal women. Methods. This was a prospective, randomised, parallel and open labeled clinical study. One-hundred thirty-two postmenopausal osteopenic women with natural menopause enrolled into the study. One-hundred twenty-four of them completed the study. Group I patients were treated with oral raloxifene (60 mg/day), Group II patients were treated with oral calcium supplementation (1000 mg/day) for 3 months. The patient’s menopausal, depressive and anxiety symptoms were assessed by using Kupperman’s Scale, HDRS and BARS, before and at the end of treatment. For statistical analysis unpaired t, ANOVA, RM-ANOVA, MANCOVA, Pearson correlation tests were used. Statistical significance level was established at p5 0.05. Results. Baseline Kupperman’s Scale, HDRS and BARS scores were not different among two groups. At the end of 3 months of therapy, there was improvement in menopausal symptoms, depression and anxiety scores within both groups. When we compared change of scores before and after the treatment; group I scores were better than group II scores. Conclusion. Our results suggest that raloxifene may have a positive effect on mood in osteopenic postmenopausal women.

Objective: To present the management of a case with fetal hepatic calcification diagnosed at 22. weeks of gestation with the review of the literature. Case: The patient was first seen at antenatal clinic at 16th week of gestation with the triple test in normal range. The ultrasonography performed at 22 weeks of gestation revealed hepatic paranchymal calcification in the fetus. Toxoplasma, rubella, cytomegalovirus (CMV), herpes simplex virus, parvovirus IgM, IgG and VDRL tests were ordered. Rubella and CMV IgG tests were positive and the others were negative. There was no additional abnormality in the detailed sonography so the genetic analysis was not suggested. The routine antenatal follow-up was uneventful and the patient was delivered a healthy 3900 g female baby via caserean route due to cephalopelvic discrepancy. After birth physical examination and laboratory tests of neonate were normal. There was hepatic calcification but no other pathology in ultrasonographic examination. Six months after birth, the baby’s physical examination was normal and hepatic calcification was seen to persist in abdominal ultrasonography. Hepatic calcification in this patient was decided to be a benign finding. Conclusion: When a fetal hepatic calcification is diagnosed, detailed ultrasonography should be performed to investigate other organ pathologies. Intrauterine infections should be investigated. If there is an associated ultrasonographic finding, genetic karyotyping should be offered. The prognosis is generally good but dependent to the underlying cause. In most of the cases with isolated liver calcification normal prenatal follow-up is sufficient.

Isolated torsion of tuba (ITT) is a rare cause of acute lower abdominal pain. It is an emergency event and a difficult condition to evaluate clinically. Prompt recognition is desirable in order to avoid irreversible infarction, however pain as the only constant sign, diagnosis is often delayed and rare pre-operatively. It is often a clinical entity of reproductive age women with the incidence of 1/1.5 million. Laparoscopic intervention can be of great value not only by aiding accurate diagnosis but also by providing immediate successful management. We present 20 years old women with left lower abdominal pain diagnosed as isolated torsion of fallopian tube per-operatively. We also discuss diagnostic contradictions of this clinicall entity with current literature.

This study aimed to determine the effectiveness of short-term maintenance treatment with cabergoline and to find out minimum effective dosage of cabergoline during maintenance treatment for patients with microadenoma-related and idiopathic hyperprolactinemia. Cabergoline was administered orally at a dose of 0.5 mg twice per week to 164 de novo hyperprolactinemic patients until serum prolactin level normalized. After this initial treatment phase, patients started on maintenance phase for which they were previously randomized. No maintenance treatment (Group I, n = 36) or cabergoline 0.5 mg (Group II, n = 46), 0.25 mg (Group III, n = 39), 0.125 mg (Group IV, n = 43) was administered twice per week for 8 weeks as maintenance treatment. Then, maintenance phase was finalized and patients were followed up for 6 months. Mean serum prolactin levels through maintenance treatment phase and follow-up period were assessed between groups and within groups. Except for group I, all the groups showed a similar pattern with fast decrease of serum prolactine level during maintenance phase and slower increase during the follow-up period. Notably, the average prolactin level was significantly lower at the last follow-up visit than at the diagnosis time in all of the groups. Stable normoprolactinemia of the groups at the end of follow-up period were 47.2, 37, 48.7, and 34.9%, respectively. The results indicate that short maintanence treatment in idiopathic and microadenoma-related hyperprolactinemia seems as effective as long maintenance treatment in the present study. But, further studies with larger study population and longer follow-up period are needed to make a decision about early treatment withdrawal. Also, during the maintenance treatment adminisitration of medicine to patients should be tapered down to the lowest dose that will maintain prolactin levels normal.

The aim of this study was to assess the preference of pregnant women for mode of delivery in an uncomplicated pregnancy and reasons of their choice, also to determine if maternal characteristics were predictors of maternal preference. Pregnant women applying to the antenatal clinic for a routine control visit were recruited. After verbal consents, a questionnaire was administered to 1,588 pregnant women. Of the women questioned, 84.1% opted for vaginal delivery whereas only 15.9% opted for an elective caesarean delivery. The main reasons for vaginal delivery preference were; earlier healing and earlier hospital discharge, being a more physiological way of delivery and previous vaginal delivery history. The most common reasons for choosing caesarean delivery were; fear of vaginal delivery, tubal ligation demand and to avoid labour pain. Educational status, occupation and gestational age were not found to be influencing factors but age, parity and monthly income were found to be influencing factors for maternal preference.

article i nfo Objective: To compare the efficacy of vaginal versus sublingual misoprostol for second-trimester pregnancy termination, and to evaluate the effect on the blood flow of the uterine and umbilical arteries. Methods: Forty-nine patients were randomized to receive either 200 μg of vaginal misoprostol every 6 hours or 200 μg of misoprostol sublingually every 6 hours. Doppler velocimetry studies were assessed immediately before and 60 minutes after the administration of the first dose. Standard descriptive calculations, Mann-Whitney U, Wilcoxon, and χ 2 tests were performed. Results: The mean interval between induction and onset of active labor, induction and delivery, and the duration of oxytocin administration were significantly shorter in the sublingual misoprostol group. Both routes of administration increased the Doppler indices for the uterine arteries; however, misoprostol via the sublingual route did not affect the umbilical arteries. Conclusion: Sublingual administration of misoprostol for second-trimester medical abortion results in a higher success rate and does not affect umbilical blood flow.

Endometrial stromal sarcoma (ESS) is an uncommon malign neoplasm, and its occurrence outside the uterus is extremely rare in the absence of metastasis or extension of a primary uterine neoplasm. When arising in the pelvis or abdominal cavity, ESS is associated with uterine adnexa or serosal surface of various organs.We present the case of a 46-year-old woman with lower abdominal pain and regular menstruation who underwent laparotomy after a diagnosis of pelvic mass mimicking a right adnexial tumor. Exploration of the pelvis revealed a retroperitoneal mass of 15 cm in diameter in the right illiac fossa without accompanying pelvic or paraaortic lymphadenopathy. Uterus and ovaries were bilaterally normal in size. The pathology showed low-grade ESS of the uterus with direct spread to retroperitoneum without serosal metastases.This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.

In this study, the usability of magnesium oxide with titanium dioxide used in the manufacture of polyvinyl chloride door and window profiles is investigated in terms of discoloration or fading and some mechanical properties. By each compound associated with the different amount of MgO and TiO2, five different compounds are used to produce PVC profiles of doors and windows. The most suitable profile in terms of discoloration is obtained from the compound containing MgO and TiO2 with the ratio of MgO to TiO2 of 1/3. It is observed that the addition of MgO into a compound dramatically decreases the elongation of material and thus, it improves the hardness of PVC-based material. It is concluded that the profiles fabricated from the compounds with the ratios of MgO to TiO2 of 1/2 and 1/1 do not meet the standard in terms of brittleness obtained from the impact strength testing in low temperature (−10 °C). It is also concluded that although the brittleness of some profile associated with the ratios of MgO to TiO2 of 1/2 and 1/1 is not in standard values, the addition of the certain amount of MgO into the compound provides some improvements on the discoloration of PVC-based door and window profiles. The obtained results are evaluated by considering the previous studies and thus, they qualitatively agree with the previous studies.

Several studies have verified that hormone replacement therapy (HRT) has protective effects on postmenopausal women's cardiovascular condition. However, highly significant recent studies have reported that women treated with HRT have more cardiovascular events than untreated women. An elevated homocysteine level is one important risk factor for cardiovascular disease (CVD). As a good indicator of CVD risk, we examined the changes in plasma homocysteine levels of postmenopausal women treated with HRT. In our study, we administered estradiol valerate (2 mg) and dionegest (2 mg) to 34 postmenopausal women recruited randomly from our menopause clinic, and measured plasma homocysteine levels of patients at baseline and after 3 and 6 months of therapy. The changes in plasma homocysteine levels of treated patients were not statistically significant (p = 0.241). Our results indicate that 6 months of estradiol valerate and dionegest therapy does not change homocysteine levels in postmenopausal women.

The purpose of this study was to determine the reliability of the vaginal washing-fluid prolactin assay for the diagnosis of premature rupture of membranes (PROM) and to determine a diagnostic cut-off value.Seventy pregnant women between 11 and 40 weeks of gestation who were admitted with vaginal fluid leakage were included in the study group, and were then further subdivided into two subgroups according to amniotic fluid pooling and nitrazine paper test results. Group 1 was the 'confirmed PROM group', positive for both pooling and nitrazine (38 patients). Group 2 was the 'suspected but unconfirmed PROM group' which had possible pooling and/or nitrazine (32 patients). Seventy pregnant women between 11 and 40 weeks of gestation without any complaint and complication were included in the control group (group 3). All patients underwent vaginal washing-fluid sampling and prolactin level determination. For the statistical analysis one-way analysis of variance, Tukey multiple comparison test, chi2 test and receiver operating characteristic (ROC) curve analysis were used.Geometric mean values of vaginal washing-fluid prolactin levels were 616.59 microIU/ml for group 1, 23.98 microIU/ml for group 2 and 10 microIU/ml for group 3 (p0.0001). The optimal diagnostic cut-off value was found to be 30 microIU/ml with 95% sensitivity, 78% specificity, 84% positive predictive value, 93% negative predictive value, 87% accuracy and 11.30 relative risk.We recommend vaginal washing-fluid prolactin level determination as an alternative diagnostic method for PROM.

Using an ultrasensitive assay, prostate-specific antigen (PSA) has been detected in female serum and has been proposed as a potential marker of androgen excess in hirsute women. Measurement of PSA levels in serum may play a role in monitoring hirsutism during antiandrogen therapy. We investigated the role of PSA as a marker of androgen activity in hirsute patients taking spironolactone together with oral contraceptive pills containing ethinyl estradiol and gestodene. Twenty-eight hirsute patients were included in the study. Clinical and biochemical variables including serum levels of PSA (using an ultrasensitive chemiluminscent immunoassay), dehydroepiandrosterone sulfate, total testosterone, free testosterone and 17-hydroxyprogesterone concentrations were recorded at baseline and after six cycles of treatment. Fifteen healthy women were included in the study as controls. Serum PSA levels in hirsute women were clearly higher than in the control group (0.023 +/- 0.004 vs. 0.006 +/- 0.003 ng/ml, p < 0.001) and correlated with baseline serum free testosterone concentrations (r = 0.518, p = 0.005). After 6 months, serum PSA concentrations as compared with baseline values did not change significantly in patients who were given spironolactone plus contraceptive pills (p = 0.4) despite a marked decrease in total testosterone, free testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate and hirsutism score (p < 0.05). Thus, serum PSA levels in hirsute women were higher than in non-hirsute healthy controls. A 6-month course of treatment with spironolactone combined with contraceptive pills containing ethinylestradiol and gestodene did not reduce high serum PSA levels in these subjects. In conclusion, the serum PSA level is not a convenient biochemical marker with the available assays for the management of hirsute women treated with the combination of spironolactone and oral contraceptives.

To evaluate the reliability of vaginal washing fluid beta-HCG for the diagnosis of premature rupture of membranes (PROMs) and to determine a cut-off value.A total of 141 pregnant women were recruited. The first group consisted of 73 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. These were further subdivided into two subgroups. Group 1-confirmed PROM group (amniotic fluid pooling (+) and nitrazine paper test (+); 34 patients). Group 2-suspected but unconfirmed PROM group (amniotic fluid pooling (+/-) and/or nitrazine paper test (+/-); 39 patients). The control group (Group 3) consisted of 68 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. All patients underwent speculum examination for amniotic fluid pooling, nitrazine paper test, vaginal washing fluid beta-HCG sampling and ultrasonographic examination for gestational age determination, amniotic fluid index calculation. One-way ANOVA test, Scheffe multiple comparison test and receiver operating characteristic (ROC) curve analysis were used.Geometric mean values of beta-HCG was found to be 95 for Group 1, 14 for Group 2, 10 for Group 3 (P0.0001). The optimal cut-off was a beta-HCG value of 65 mIU/ml (sensitivity 68%, specificity 95%, positive predictive value 82%, negative predictive value 90%, accuracy 87%).Vaginal washing fluid beta-HCG determination for the diagnosis of PROM is reliable, simple and rapid test.

A prospective randomized placebo controlled clinical trial was carried out on 250 patients (cycles) considered at risk of developing OHSS in an IVF programme. Criteria for inclusion were: estradiol value of more than 3000 pg/ml or the presence of more than 20 follicles on the day of hCG administration. Patients were randomized by using a random table to receive either 20% human albumin 50 ml (n: 82); 6% hydroxyethyl starch (200/0.5) 500 ml (n: 85) or a placebo of 500 ml 0.9% NaCl solution (n: 83) over 30 min during oocyte collection. Groups were similar with respect to patients' age, estradiol levels on hCG day, body mass index, number of oocytes retrieved, number of embryos transferred and pregnancies (P0.05). There was no severe OHSS in patients who received albumin and HES while four patients who received placebo developed severe OHSS. On the other hand moderate OHSS was encountered in four patients in the albumin group; five patients receiving HES; and 12 patients receiving placebo. There was a statistically significant difference in the incidence of moderate, severe and overall OHSS among groups (P values of0.05,0.05, and0.01, respectively). Both HES and albumin significantly reduced the incidence of moderate, severe and overall incidence of OHSS. It is concluded that hydroxyethyl starch is a cheaper and safer alternative to Human Albumin in OHSS prevention.

A 42year-old woman came to the hospital with severe abdominal pain and involuntary guarding. Ultrasonography revealed a 5 cm fundal sub serous leiomyoma and intra abdominal fluid. At surgery, a bleeding vessel on leiomyoma's surface was seen. There was no pathological finding additionally. This was the first case reported that a 5 cm sub serous leiomyoma causes bleeding intra abdominally in a non pregnant woman in the literature.

Essential thrombocythaemia (ET) is a disease characterized by an increased platelet count, megakaryocytic hyperplasia and a hemorrhagic or thrombotic tendency. Pregnancy in patients with ET can have a favorable outcome. However, ET has also been reported to complicate pregnancy by recurrent abortions, intrauterine death, and fetal growth retardation due to placental infarctions. ET has an unusual prevalence of intraabdominal (hepatic, portal and mesenteric) vein thrombosis, especially in young patients, which can lead to portal hypertension. There are ample cases in the literature of both essential thrombocytosis complicating pregnancy and portal hypertension complicating pregnancy, but the coincidence of both conditions appears to be unique. In this case report, we report a successful pregnancy in a patient with a prior diagnosis of essential thrombocytosis with remote secondary portal vein thrombosis and portal hypertension (PH).

Pregnancy and cancer is a complex situation. The coincidence of chronic myelogeneous leukemia (CML) and pregnancy is an uncommon event, in part because CML occurs mostly in older age groups. The management of CML during pregnancy is a difficult problem because of the potential effects of the therapy on the mother and fetus. Imatinib is a relatively new drug in this era and it induces dramatic hematologic and cytogenetic responses in CML but it is not recommended for use during pregnancy or if the patient plans to conceive. In the literature there are very few reports of outcome of pregnancy conceived while on imatinib. In this report, we describe a successful pregnancy and labor under treatment of imatinib in a patient who was diagnosed with CML at the beginning of her pregnancy.

Objective Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage. A retrospective review based on hospital data of 67 patients undergoing emergency peripartum hysterectomy over 10 years was undertaken. Methods Comparison of two different time periods regarding the incidence and the indications of obstetric hysterectomies was made. Results The number of patients with hysterectomy in the first 5 years of the study period (1985-1989) was 43 and during the last 5 years (1990-1994) it was 24. The incidence of hysterectomy during 1985-1989 was 1 in 2495 deliveries and the most common indication for hysterectomy was uterine atony (42%) followed by placenta accreta (25.5%) and uterine rupture (21%). On the other hand, the incidence of hysterectomy during 1990-1994 was 1 in 4228 deliveries and the ranking of indications of hysterectomy was slightly different from group 1 as mostly placenta accreta (41.7%) followed by uterine atony (29.2%). The maternal mortality rate was 4.5% in this series. Conclusion This study showed that over the last decade the incidence of emergency hysterectomy in obstetric practice has declined in our clinic due to availability of high standard obstetric care and more liberal use of cesarean section at risk deliveries, better controlled use of oxytocin and internal iliac artery ligation.

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

To investigate the value of tetracycline sclerotherapy for management of recurrent or persisting non-neoplastic ovarian cysts in comparison to the aspiration without sclerotherapy.Ninety-six patients with proven non-neoplastic ovarian cysts were randomized into two groups. Group 1 patients underwent cyst aspiration together with tetracycline sclerotherapy (n=48). Group 2 patients underwent only cyst aspiration without tetracycline sclerotherapy (n=48). Then, all patients were followed up monthly with ultrasonography for 12months. The procedure was considered to have failed if the recurring cyst, detected by ultrasound, was 4cm in size or greater.There were no differences between the two groups regarding demographic data, initial cyst volume and tumor markers. Recurrence rates within 12months were 14.6% in group 1 and 50% in group 2 (P0.001).Based on the recurrence rates, we suggest transvaginal aspiration together with tetracycline sclerotherapy rather than only simple transvaginal aspiration in the management of non-neoplastic ovarian cysts.

The aim of this study was to compare the effects of intrauterine-system-releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta-estradiol daily, orally with combined oral pill containing 1 mg 17 beta-estradiol/2 mg drospirenone daily as hormone replacement therapy, on health-related quality of life (HRQoL) and climacteric symptoms in postmenopausal women.A 6-month prospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. Ninety postmenopausal women were accepted to be part of the study. The Euro Quality of Life-5 Dimensions (EQ-5D) and Euro Quality of Life Visual Analogue Scale (EQ VAS) indexes for HRQoL and Kupperman indexes were compared between two groups of patients.Kupperman indexes of both treatment groups decreased gradually over 6 months, but indexes decreased significantly more in the group with intrauterine-system-releasing 20 µg daily of levonorgestrel. Elevations were observed in EQ-5D indexes and VAS values of both groups. EQ VAS values significantly increased in the group on intrauterine progestogen system. Similar changes were observed in the EQ-5D indexes of both groups.A hormone replacement therapy regimen that includes an intrauterine progestin system decreased climacteric symptoms and increased HRQoL in postmenopausal women during a follow-up period of 6 months. The extent of the relief of symptoms was greater in this group than in women receiving oral combined hormone replacement therapy. It seems therefore that the intrauterine progestin system could represent a method of choice for endometrial suppression in women using estrogen replacement therapy with distinct advantages over systemically administered progestogens, which have been the subject of considerable debate as reported in the recent literature.

Objective. To evaluate the effectiveness of bilateral hypogastric artery ligation (BHAL) according to the underlying cause and future fertility in these women. Method. Fifty-eight women who underwent BHAL operation in our department between 1997 and 2008 were further divided into three subgroups in accordance with the underlying disease. Group 1: Severe preeclampsia with coagulapathy (n:24). Group 2: Postpartum hemorrhage (PPH) due to uterine atony (n:24). Group 3: Massive hemorrhage due to inadequate surgical control of bleeding and/ or uterine rupture (n:10). Effectiveness of BHAL according to the underlying cause and future fertility after BHAL were evaluated. Results. Success rate of BHAL was found to be 87.9% (51 out of 58 patients). Complication rates of the groups were 25%, 12.5%, and 10%, respectively. There was one maternal death in each group. Mean hospital stay, blood and blood products transfusion need were similar for all groups. Thirty women out of 58 had desired future fertility, and 17/30 (56.7%) of them became pregnant within less than 1 year. Conclusion. BHAL is a safe, effective, life-saving procedure in controlling massive PPH. It preserves future fertility and must be the first choice operation for PPH in young women whichever the underlying condition is.

The objective of this study was to determine the incidence, perinatal complications and the outcome of macrosomic infants. A retrospective analysis was made of macrosomic deliveries and of those admitted into the Neonatology Unit. A control group of 854 deliveries weighing between 2500-4000 g was randomly composed. The incidence of macrosomic deliveries, stillbirth rates, sex, parity, maternal age, mode of delivery, perinatal complications like birth traumas, hypoglycemia, polycythemia, asphyxia, admission rate into the neonatal intensive care unit (NICU), and outcome were analyzed. Among a total of 11,827 deliveries, 829 (7%) were macrosomic neonates. Statistical analysis showed male predominance (p = 0.0001), a significant increase in cesarean section (p = 0.0001), and higher parity for the macrosomic group (p = 0.0001). The mothers of macrosomic newborns were older (p = 0.0001). The admission frequency of macrosomic deliveries into the NICU was almost two-fold. Birth injuries were found in 53 (6.4%) macrosomic infants, and macrosomic deliveries had a two-fold risk for birth injuries. Statistical analysis showed a significant difference between macrosomics and the control group for the frequency of birth traumas (p = 0.0007), hypoglycemia (p = 0.0001) and polycythemia (p = 0.0006). There were two deaths in macrosomic group versus one among control cases. Regarding the high birth trauma and NICU admission rates of macrosomic infants, it is important to emphasize the significance of prenatal diagnosis of fetal macrosomia and of management of these high-risk pregnancies in tertiary level hospitals.

Recent data has shown that the use of neoadjuvant chemotherapy (NAC) significantly reduces tumor burden before optimal cytoreductive surgery (CS) and is associated with an improved overall survival (OS). The aim of our study was to evaluate response to treatment and survival of patients with advanced epithelial ovarian cancer (EOC) who received NAC followed by interval cytoreductive surgery (ICS).Fifty-two patients with advanced EOC treated with NAC followed by ICS were retrospectively analyzed. Response to NAC, progression-free survival (PFS), and OS were evaluated. By using univariate and multivariate analyses, the predicted survival rates by the factors were analyzed.Median age of patients at diagnosis were 62 years (range 33-77). The serous cell type was the most common histology (98%). The majority of patients (94%) received a combination therapy of paclitaxel and carboplatin. A median of four cycles of NAC was administered. At the end of NAC, the clinical complete response (CR) with normal clinical examination and normal serum CA 125 level was achieved in 40 patients (77%). Moreover, a radiological CR and a radiological partial response were obtained in 35 patients (67%) and in 16 patients (31%), respectively. ICS was considered standard in 45 (86%) patients. Optimal cytoreduction could be achieved in 43 of 52 patients (83%). After ICS, pathological CR was established in 15 of 52 patients (29%). At the median follow-up of 25 months (range 9-102), 2-year PFS and OS were 31 and 90%, respectively. The median PFS time was 13.3 months (SE 1.1, 95% CI 11-15) and the median OS time was 47.5 months (SE 5.8, 95% CI 36.1-59). The univariate analysis showed that optimal or suboptimal cytoreduction and perioperative blood transfusion were important prognostic factors on OS for patients who received NAC. Patients treated with optimal cytoreduction had significantly better median OS (52.5 months, 95% CI 45-60) than patients who underwent suboptimal cytoreduction (24.2 months, 95% CI 11.3-37) (P = 0.001). Furthermore, the cytoreduction type (optimal vs. suboptimal), surgical procedure (standard vs. non-standard), and perioperative blood transfusion were independent prognostic factors of OS by multivariate analysis (chi (2) = 9.28, P = 0.002, HR 0.28, 95% CI 0.003-0.37; chi (2) = 4.44, P = 0.035, HR 0.15, 95% CI 0.026-0.87; chi (2) = 9.24, P = 0.002, HR 0.75, 95% CI 0.014-0.79, respectively).This study demonstrates that NAC is associated with improved OS for patients with advanced EOC who received NAC followed by ICS. Additionally, our results showed that cytoreduction type, surgical procedure, and perioperative blood transfusion were independent prognostic indicators of OS for patients with advanced EOC who received NAC. Thereafter, NAC may be an alternative treatment to primary cytoreduction.

We present a case of uterine prolapse complicating a second trimester pregnancy which was managed successfully with a vaginal pessary.A 19 year-old primigravid woman referred to the obstetric emergency unit at the 16th week of gestation complaining of uterine prolapse. A silicone ring-shaped middle-size vaginal pessary was placed into the vagina. On each control visit, when the vaginal pessary was removed, the uterine prolapse still persisted until birth. The patient gave birth at 38(th) week by spontaneous vaginal delivery to a healthy baby. After birth, with uterine contractions, uterine prolapse regressed progressively.The management and treatment of uterine prolapse in pregnancy should be individualized depending on the patient's preference. A vaginal pessary may be helpful to avoid complications of this condition and should be considered during patient counseling.Gebeliğin ikinci trimesterinde izlenen uterin prolapsus durumunun vajinal pesser ile başarıyla yönetildiği bir olgu sunulmuştur.19 yaşında, 16 haftalık gebeliği bulunan primigavid hasta kliniğimiz obstetrik polikliniğine rahim sarkması şikâyetiyle başvurmuştur. Orta boy, yuvarlak, silikon pesser vajene yerleştirilerek prolapsus redükte edilmiştir. Her kontrolde vajinal pesser çıkarıldığında prolapsus halinin doğuma kadar sebat ettiği izlenmiştir. 38’inci gebelik haftasında spontan vajinal doğum ile sağlıklı bir bebek doğurtulmuştur. Doğum sonrasında uterin kontraksiyonlarla prolapsus hali progresif olarak gerilemiştir.Gebelikte gelişen uterin prolapsusun yönetiminde ve komplikasyonlarından korunmada vajinal pesser uygulaması faydalıdır ve hasta değerlendirilirken göz önünde tutulmalıdır.

To investigate the relationship between adverse pregnancy outcomes and unexplained elevations of second trimester maternal serum human chorionic gonadotropin (hCG), alpha fetoprotein (AFP) levels and uterine artery Doppler measurements.A total of 144 women between 16-20 weeks of gestation that applied to our clinic for triple test were enrolled into the study. Study group consisted of 84 pregnant women with hCG and/or AFP levelsor =2 MoM. Control group comprised of 60 pregnant women with hCG and AFP levels2 MoM. Study group was further subdivided into 3 subgroups: Subgroup I; only AFPor =2 MoM (n=30), subgroup II; only hCGor =2 MoM (n=64) and subgroup III; both AFP and hCGor =2 MoM (n=10).Operative delivery rate (p = 0.0017), overall complication rate (p=0.0002), bilateral early diastolic notch presence rate (p = 0.015) were high and mean birth weight was low (p=0.045) in the study group. In subgroup I patients, low birth weight [LBW] (p = 0.0008), preterm delivery (p = 0.0001), preeclampsia (p = 0.003) and preterm premature rupture of membranes [PPROM] (p = 0.012) rates were high. In subgroup II patients, only small for gestational age baby [SGA] (p = 0.016) rate was high. In subgroup III patients LBW (p = 0.009), preterm delivery (p = 0.0001) and PPROM (p = 0.01) rates were high. According to Doppler velocimetry studies, bilateral early diastolic notch presence rate was high (p = 0.015) in the study group.Patients with high AFP levels and bilateral uterine artery diastolic notch presence, are candidates for pregnancy complications and these groups of patients should be followed up more intensively.

To estimate prevalence of malignancy and dysplasia in cervical polyps and to judge whether cervical polyps need to be removed routinely. Also to investigate if a cervical polyp is an indicator of endometrial pathology and to assess the necessity of performing dilatation and curettage (D&C). We retrospectively reviewed hospital records of 4,063 cervical polyp cases. Patients’ age, menopausal status and pathological findings were recorded. Descriptive statistics, Pearson’s χ2, Fisher’s exact test were used for statistical analysis. P value of ≤0.05 was accepted significant. Among 4,063 cervical polyps, only 3 (0.1%) cases of malignancy were encountered which were metastasis from endometrium. There were also dysplastic (0.4%), metaplastic (2.1%), inflamatory (1%) changes. Accompanying endometrial pathologies were: endometrial cancer (0.3%), hyperplasia without atypia (1.3%), endometrial polyp (6.6%). There was statistically significant relation between menopausal status and malignancy of cervical polyps (P = 0.055) malignancy of endometrial cavity (P = 0.0001). Routine removal of cervical polyps, although not mandatory, seems clinically prudent because pathological evaluation is needed to confirm the diagnosis and to rule out other possibilities. 10.9% of postmenopausal patients and 7.8% of premenopausal patients were diagnosed with any endometrial pathology accompanying cervical polyp. Therefore, cervical polyps can be a sign of endometrial disease, especially in postmenopausal women with cervical polyp endometrium should be evaluated more carefully.

Objective Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study. Methods Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined. Findings Among 19,533 total births, there were 450 (23.04 per 1000) stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed (P

To determine the diagnostic accuracy of different diagnostic methods (blind dilatationcurettage (DC), transvaginal ultrasonography (TVS), sonohysterography (SH), and hysteroscopy) compared with gold standard (hysteroscopic biopsy's histopathologic result) in diagnosis of focal intrauterine lesions of recurrent postmenopausal bleeding.36 postmenopausal women with recurrent vaginal bleeding after a normal DC results were enrolled into the study. TVS, SH, hysteroscopy were performed on all patients. Outcomes of blind DC, TVS, SH, and hysteroscopy were compared with results of gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated.Blind DC sensitivity, specificity, PPV, and NPV were 47, 68, 57, 59%, respectively in comparison with gold standard. Blind DC fails to diagnose 70% of all focal intracavitary lesions. TVS sensitivity, specificity, PPV, NPV were 63, 78, 89, 41%, respectively. SH yielded better results; with 93% sensitivity, 56% specificity, 86% PPV, and 71% NPV. Hysteroscopy sensitivity, specificity, PPV, and NPV were 100, 44, 84, 100%, respectively.In experienced hands, SH can be an initial evaluation method of uterine cavity for detecting focal lesions in women with recurrent postmenopausal bleeding.

To determine the effect of uterine fundal pressure on shortening the second stage of labor and on the fetal outcome.Randomized controlled trial.Teaching and research hospital.One hundred ninety-seven women between 37 and 42 gestational weeks with singleton cephalic presentation admitted to the delivery unit.Random allocation into groups with or without manual fundal pressure during the second stage of labor.The primary outcome measure was the duration of the second stage of labor. Secondary outcome measures were umbilical artery pH, HCO3-, base excess, pO2, pCO2 values and the rate of instrumental delivery, severe maternal morbidity/mortality, neonatal trauma, admission to neonatal intensive care unit, and neonatal death.There were no significant differences in the mean duration of the second stage of labor and secondary outcome measures except for mean pO2 which was lower and mean pCO2 which was higher in the fundal pressure group. Nevertheless, the values still remained within normal ranges and there were no neonates with an Apgar score7 in either of the groups.Application of fundal pressure on a delivering woman was ineffective in shortening the second stage of labor.

An adenomyoma presenting outside the uterus is an extremely rare entity and only three cases of primary ovarian adenomyoma have been reported up to date. We report the fourth case of ovarian adenomyoma in a 45-year-old woman with an endometrial polyp. Transvaginal ultrasonography revealed a solitary endometrial polyp with an enlarged left ovary which appeared heterogenous with isoechoic and mildly hyperechoic pattern. Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed and histologic examination revealed an adenomyoma arising primarily in the ovary.

Women with polycystic ovary syndrome (PCOS) are insulin-resistant and have increased risk for type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). But it is controversial whether the increased risk of CHD and T2DM is associated with endocrine abnormalities occurring as a consequence of PCOS or whether it is related to obesity or metabolic changes frequently seen in women with PCOS.Since both homocysteine (Hcy) and C-reactive protein (CRP) are supposed to predict T2DM and CHD, we investigated their possible relationship with insulin resistance, obesity, hyperandrogenemia and metabolic alterations in 44 PCOS women and 26 healthy controls matched by age and body mass index (BMI).Hcy and CRP levels were significantly elevated in PCOS women compared with controls (13.30 +/- 4.81 vs. 9.02 +/- 3.36 micromol/l, p0.05 and 4.22 +/- 2.95 vs. 2.66 +/- 2.49 mg/l, p0.05). There was no correlation between Hcy and CRP (r = 0.171, p = 0.05) as two risk markers. While plasma Hcy levels were correlated with BMI, ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), total testosterone, free testosterone, triglyceride and insulin levels and homeostatic model assessment-insulin resistance index (HOMA-IR) (p0.05), CRP was correlated with BMI, total cholesterol, triglyceride, low-density lipoprotein cholesterol and insulin levels and HOMA-IR (p0.05). There was no correlation of CRP with parameters of PCOS such as testosterone and LH/FSH ratio (p0.05). Multiple regression analysis revealed BMI as the major factor examined that influenced both Hcy and CRP levels.In PCOS women, plasma levels of Hcy and CRP were significantly elevated compared with age- and BMI-matched controls. Although most of the PCOS-related endocrine and metabolic changes are related to elevated plasma Hcy and CRP levels in PCOS women, BMI seems to be the major factor determining CHD and T2DM in women with PCOS.