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Objective: To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti-inflammatory therapy. Method: A prospective randomized study. Result: 2798 premenopausal non-pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as ‘inflammatory cellular changes’. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti-inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 ± 6.3 (18–46) and 1.7 ± 2.3 (0–6), respectively. When these patients underwent colposcopically-directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences. Conclusion: Colposcopically-directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with either arterial and/or venous thrombosis (1). Two cases of APS, which were diagnosed in the second trimester during the diagnostic workup of fetal bradycardia, are presented.

Objective To evaluate and compare the effects of two different modalities of hormone replacement therapy (HRT) on the size of uterine fibroids. Design Randomized clinical study. Setting The Menopause Center of a public hospital. Patients Postmenopausal women with small asymptomatic uterine fibroids were selected. Interventions One group was treated with 50 μ g transdermal E 2 plus 5mg medroxyprogesterone acetate (MPA) continuously, whereas the second group was given 0.625mg conjugated equine estrogen plus 2.5mg MPA continuously. Main Outcome Measure The size of the uterine fibroids was measured before and after the first year of HRT. Results At the end of the first year on HRT, the size of the uterine fibroids was re-evaluated sonographically and no significant difference was found with the oral group, whereas there was a significant increase in the transdermal group. Conclusion Hormone replacement therapy with 50 μ g transdermal E 2 plus 5mg MPA increases the size of the uterine fibroids.

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapul length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R(2) = 0.94, p < 0.0001), the biparietal diameter (R(2) = 0.94, p < 0.0001), abdominal circumference (R(2) = 0.94, P < 0.0001), and the femur length (R(2) = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Objective: We sought to determine the importance of postmenopausal endometrial fluid collection, which has almost invariably been accepted as a finding of a malignant process. Methods: Out of 1,500 postmenopausal patients admitted to our center mainly for their postmenopausal symptoms, endometrial fluid collection was detected in 15 cases during transvaginal pelvic ultrasonographic evaluations. These patients were evaluated with cervical smears as well as endocervical and endometrial curretages. The fluid collections were aspirated and measured. Results: The mean age and mean menopausal age were 51.7 ± 1.3 and 5.7 ± 9.8 years, respectively. Six of the patients were already on hormone replacement therapy. Nine were asymptomatic and the others had vaginal discharge and pelvic pain. Ten patients had normal findings on pelvic examination, and in the others benign cervical polyps, previous cervical amputation, cervical erosion, and nabothian cysts were detected. The volume of the directly measured fluid was 7.9 ± 4.0 cm3. The cervical smears, the cytological examinations of the fluids, the colposcopic examinations and the endocervical curretages were negative, and the histopathological evaluation of the endometrial curretage specimens revealed no premalignant or malignant disease, but blood and fibrin in 1 patient, inactive endometria in 9 patients, proliferative endometria in 4 patients and senile cystic atrophy in 1 patient. Conclusion: Although there was no malignancy in our series, the conflicting results of the limited number of studies made us cautious and we still consider that postmenopausal patients with endometrial fluid collection may be at risk for gynecologic cancers and that every effort should be made in order to rule out such a condition.

Disseminated intravascular coagulopathy (DIC) is an uncommon but serious complication of pregnancy. Placental abruption is the most common associated condition among the causes of acute obstetrical DIC. We present a case of life-threatening DIC complicating placental abruption in the second trimester of pregnancy with protein S deficiency as a triggering factor, which necessitated urgent termination of pregnancy.

Objectives: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. Methods: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). Results: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. Conclusions: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.

Acardiac twins are usually diagnosed during the antenatal period and almost invariably cause complications to the other fetus. In this case, an acardiac twin pregnancy was misdiagnosed antenatally as a degenerated myoma but ended with delivery of a healthy baby.

The purpose of this study is to evaluate the data related to the genetic amniocentesis performed in a single university hospital. Medical records were used to analyze indications of amniocentesis, the results of chromosome analysis, complications and pregnancy outcomes from January 1998 through January 2002. Anomaly screening was performed to all patients attending to our Obstetrics and Gynecology Department between 16 and 20 weeks of pregnancy. The staff obstetricians–gynecologists performed all of the second-trimester genetic amniocentesis. Totally 2,686 patients attended to our department between 16 and 20 weeks of pregnancy during the index period. A total of 131 genetic amniocentesis were performed. The indications were advanced maternal age (cut off age 35) in 24, suspicion of genetic abnormality on ultrasound in 15, history of siblings with Down syndrome in 2 and abnormal triple screen in 90 patients, respectively. There were two pregnancy losses due to the procedure; thus the overall complication rate of second-trimester genetic amniocentesis was 1.5%. Being one of the most performed invasive techniques for prenatal diagnose, second-trimester genetic amniocentesis is a reliable and safe method. Although the size of this study is limited, our complication rates are similar to the related literature.

A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult.

Various hormonal parameters and the best logistic regression model to predict disease probability were evaluated in women with polycystic ovary syndrome (PCOS). Concentrations of LH, FSH, LH/FSH ratio, testosterone, free testosterone, SHBG and insulin in serum were recorded in 32 women with PCOS and in 25 controls. A model including LH/FSH ratio, insulin and testosterone measurements yielded the best goodness of fit for classification of women with and without PCOS in the logistic regression analysis. Only LH/FSH ratio and insulin were retained as significant variables. The diagnostic characteristics of LH/FSH ratio and insulin for PCOS when compared by receiver-operator characteristic analysis were found to be equally effective. By combining these two variables a higher area under curve was obtained. LH/FSH ratio, insulin or the combination of these two can predict the disease probability in women with PCOS.

Periodic fever or familial Mediterranean fever (FMF), a genetically inherited disease recently mapped to chromosome 16 [ 11, is characterized by paroxysmal and self-limiting attacks of fever, peritonitis, synovitis, pericarditis and pleuritis. It is almost exclusively confined to populations originating from the south and east coasts of the Mediterranean Sea, and Turkey is one of the populations most affected. Amyloidosis is the most severe complication of the disease, however effective prophylaxis with colchicine administration is possible. The effect of pregnancy on the natural course of the disease and appropriate management during pregnancy remain controversial. We recently admitted a 30-year-old pregnant woman from the Mediterranean coast of Turkey with a diagnosis of severe maternal ascites and intrauterine growth retardation during week 32 of her pregnancy. A history revealed that she had been experiencing attacks of FMF since she was 10 years of age, yet she was placed on colchicine pro

A case of nonimmune hydrops fetalis resulting from fetal methemoglobinemia is presented. A woman with a pregnancy at 17 weeks' gestation was admitted after combustion gas intoxication. Although the mother totally recovered, the fetus showed signs of nonimmune hydrops fetalis at follow-up. Fetal methemoglobin levels were very high.

The use of ovulation-inducing agents in the treatment of infertility is increasing [1, 2], and there has been considerable concern that follicular stimulation may potentially increase the risk of epithelial ovarian cancer [1, 3]. Also, it is suggested that hormonal alterations associated with the use of ovulation-inducing agents may influence breast cancer risk [2]. Nevertheless, it is surprising that until now there has never been any controlled study.