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OBJECTIVE: To investigate the role of fetal pulse oximetry on cesarean section rates and neonatal outcomes in pregnant women with an indication of induction of labour due to intrauterine growth restriction. MATERIAL-METHOD: Pregnant women who have been planned induction of labour with 50 mcg sublingually misoprostol due to intrauterine growth restriction were assigned into two groups. 46 women in the first group were assessed with fetal heart rate monitoring alone during labour and a cesarean section due to fetal distress was performed according to fetal heart rate monitoring (group 1). 45 women in the second group were assessed with fetal pulse oximetry plus fetal heart rate monitoring and a cesarean section due to fetal distress was performed according to fetal oxygen saturations recorded by fetal pulse oximetry (group 2). Induction to delivery interval, intrapartum variables, Apgar scores, cord blood gas analysis and early neonatal outcomes were compared in between the groups. RESULTS: While oxytocin augmentation (86 % vs 60 %, p: 0.006) and vaginal birth rates (86 % vs 43 %, p

To integrate intermittent fetal pulse oximetry (FPO) to intrapartum fetal assessment and reduce the rate of caesarean sections.A randomised controlled trial using 37 weeks as a restriction point was conducted in 230 women induced with misoprostol. One hundred-fourteen were assessed with intermittent FPO plus fetal heart rate (FHR) monitoring (study group) and 116 were assessed with FHR monitoring alone (control group). The primary outcome measure was caesarean delivery rates. Secondary outcome measures included induction to delivery interval, number of emergency caesarean deliveries performed for fetal non-reassuring FHR patterns and neonatal outcomes.There was a reduction both in the overall caesarean deliveries (study n = 18, (15.7%); vs. control n = 31 (26.7%); p = 0.04), and the rate of caesarean deliveries performed for non-reassuring fetal status in the study group (study n = 11, (9.6%); vs. control n = 23 (19.8%); p = 0.03). Induction to delivery interval was similar in between the groups (759 +/- 481 min in group 1; vs. 735 +/- 453 min in group 2 respectively; p = 0.69).Intermittent FPO in misoprostol induced deliveries decreases both total caesarean rate and the caesarean rate due to non-reassuring FHR patterns.

Purpose. To determine whether spectral Doppler measurements obtained from bilateral uterine, arcuate, radial, and spiral arteries in early gestation correlate with adverse pregnancy outcome. Methods. One hundred five pregnant women underwent transvaginal Doppler sonographic examination of uteroplacental circulation at 6–12 weeks' gestation. Resistance index (RI) and pulsatility index (PI) of bilateral uterine, arcuate, radial, and spiral arteries were measured. Diameters of gestational sac (GS) and yolk sac, crown–rump length (CRL), GS–CRL difference, and GS/CRL ratio were also recorded. Correlation was made with pregnancy outcome. Results. Sixteen women developed adverse pregnancy outcome. In these women, right uterine artery PI and RI were significantly higher than in women with normal obstetrical outcome. Spiral artery PI and RI values were also higher, but the difference was not statistically significant. GS–CRL difference, GS/CRL ratio, and yolk sac diameters were significantly lower in this group. Conclusion. Transvaginal Doppler examination can detect hemodynamic changes in uteroplacental circulation associated with subsequent adverse pregnancy outcome. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

For the prevention of postoperative adhesion formation, one of the most common causes of infertility, none of the adjuvants had been proven uniformly effective. In this study we evaluated the effectiveness of sodium carboxymethylcellulose (SCMC) and disodium cromoglycate (DSCG) in postoperative adhesion prevention in a rat uterine horn model. Thirty female Sprague-Dawley rats were used. After uterine horn abrasion, in 10 rats 10 ml 0.9% saline, in 10 rats 10 ml of 2% SCMC, and in 10 rats 10 ml DSCG were administered intraperitoneally. Two weeks later, all animals were sacrificed and adhesion formation was assessed. All the pieces of the peritoneum biopsies were stained with Luna’s mast cell stain to assess the mast cell degranulation. The mean adhesion scores were 2.1, 2.0 and 1.5 for saline, SCMC and DSCG groups respectively. There were no significant differences among all groups. In the pathologic examination, mast cell degranulation was less in the DSCG group than the other groups.

Background: Premenstrual syndrome (PMS) is defined as the disabling and cyclic occurrence of emotional and behavioral symptom complex during the latter half of the menstrual cycle. Although its etiology is unknown, it has been speculated that premenstrual syndrome is linked to a deficiency of central serotoninergic activity. Method: The study consisted of a double-blind, placebo controlled trial of fluoxetine at a dose of 20 mg/day or placebo for three menstrual cycles. The 440 women who appeared to meet the eligibility criteria were instructed to record the ‘Calendar of Premenstrual Experiences’ (CPE) scale for two complete menstrual cycles. Of 410 women who successfully completed two cycles of recording their symptoms daily only 35 met the criteria for PMS. These criteria included psychiatric interviews which were made before treatment. Thirty-five PMS patients were randomized into placebo or fluoxetine treatment groups. Results: Our study suggests that fluoxetine at a dose of 20 mg per day was significantly superior to placebo in alleviating the symptoms of PMS. The most common side effects were gastrointestinal irritability (15%), insomnia (11%) and sexual dysfunction (8.5%). Conclusion: Fluoxetine is an effective and well-tolerated drug and appears to have considerable promise in treating a range of symptoms in women with PMS.

Summary Acute fatty liver of pregnancy (AFLP) is a rare disorder of unknown aetiology that is diagnosed typically in the third trimester or early postpartum period. The incidence is estimated to be 1/6692–1/13,328. The obstetric team must have a high index of suspicion of this pathology, particularly in the presence of clinical and laboratory findings, such as nausea, vomiting, jaundice, increased serum transaminase levels, increased prothrombin time and hypoglycaemia. Early diagnosis followed by prompt delivery and supportive care provides significantly improved maternal and perinatal outcome. Delay in diagnosis of this obstetric emergency may lead to rapid progression to hepatic failure, disseminated intravascular coagulation (DIC), haemorrhage, encephalopathy, multiple organ failure and finally death. The case of a 34-year-old woman, gravida 3, para 2, with AFLP complicated with DIC is presented herein with a review of literature and discussion of its origin.

Purpose. To compare the diagnostic accuracy of 2-dimensional sonography (2DUS) and real-time 3-dimensional sonography (3DUS) in the diagnosis of congenital mullerian defects (CMD) with respect to the phase of the menstrual endometrium. Method. The accuracy of sonography was examined on 108 women by 2 gynecologists during the 1st 5 days after cessation of menstrual flow and then re-examined at the cycle days 20–24. Entrance criteria for the patients enrolled in the study were as follows: women who were referred to our center with a suspected Mullerian anomaly at hysterosalpingography, and women who were suspected to have a uterine anomaly at our hospital during infertility, dysmenorrhea, and recurrent abortion workup. First, 1 of the gynecologists performed the 2DUS, and afterwards the 2nd gynecologist performed the real-time 3DUS. Results from both examiners were compared and correlated with the definitive diagnosis obtained by MRI, laparoscopy, or hysteroscopy. The sensitivity and specificity values of 2DUS and real-time 3DUS for the diagnosis of CMD were calculated at follicular and luteal phases. Result. Among the 108 cases suspected to have CMD, the sensitivity and specificity values of real-time 3DUS were significantly higher in the follicular sensitivity, 94.7%, specificity, 75.0%, and luteal phases (sensitivity, 100%, specificity, 93.7%) when compared with 2DUS values (sensitivity of 30.2% and specificity of 78.1% in the follicular phase and sensitivity of 42.1% and specificity of 81.2% in the luteal phase). Conclusion. Real-time 3DUS is an accurate method that can be used for the diagnosis of congenital mullerian defects. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 2010

The aim of this study is to compare the diagnostic efficacy, treatment effectiveness and cost of office hysteroscopy procedure with classic hysteroscopy in women suspected of having an intrauterine space occupying lesion, after being examined for abnormal uterine bleeding.Among 544 cases admitted to our outpatient clinic due to abnormal uterine bleeding, 123 cases suspected of having an intrauterine space occupying lesion on 3D transvaginal ultrasound were included in the study. Patients were informed about classic and office hysteroscopy and asked to choose one of them. Fifty-seven cases preferred classic hysteroscopy and 66 cases preferred office hysteroscopy. The Visual analog scale was used to measure pain in office hysteroscopy cases while the Likert scale was used for patient satisfaction and cost was calculated in Turkish Lira.According to the histopathological examination, 65.9% of the cases (n=81) were diagnosed as polyp and 7.3% of the cases (n=9) were diagnosed as submucous leiomyoma. Mean operation time was 11±5.6 min. for office hysteroscopy and 42.6±18.4 min. for classic hysteroscopy (p0.001). The level of pain before the operation was 0.3±0.1 (0-1), during the operation 2.8±2.5 (0-10) and after the operation 1.5±1.6 (0-8) in Office hysteroscopy cases. Among the Office hysteroscopy cases, 89.3% were very satisfied and 86.3% will advise other patients to have the procedure. Patients were evaluated at sixth month after the procedures and 92.4% of office hysteroscopy group and 96.4% of classic hysteroscopy group were symptom free. At sixth month of the office hysteroscopy procedure 83.3% of the cases were satisfied with the procedure and 81.8% would advice other patients to have the procedure. The mean cost of classic hysteroscopy was 3.6 times higher than the office procedure.Office hysteroscopy is a safe and satisfactory procedure for the patient and provides a fast "see and treat" option at a low cost as an out patient procedure without need for general anesthesia. It should be utilized as a first line diagnosis and treatment option.Anormal uterin kanama yakınması ile başvuran, muayenesi sonrasında rutin yapılan transvaginal ultrasonografide endometriyal kavite içinde lezyon düşünülen hastaların, ofis histeroskopi ile ulaşılan tanı, tedavi sonuçlarını ve maliyeti klasik histeroskopik yaklaşımdan elde edilen sonuçlar ile karşılaştırmayı amaçladık.Çalışmaya anormal uterin kanama ile polikliniğe başvuran 544 olgu arasından 3D transvajinal ultrasonografide uterus içinde yer kaplayıcı lezyonu olan toplam 123 olgu alındı. Hastalara klasik ve ofis histeroskopi yöntemleri anlatılarak bir işlemi tercih etmesi istendi. Bu olguların 57 tanesi klasik histeroskopi ve 66 tanesi ofis histeroskopi ile tedaviyi tercih etti. Ofis histeroskopi olgularında görsel analog skala kullanılarak, tüm olgularda Likert skalası kullanılarak memnuniyet ve Türk Lirası olarak işlemin maliyeti hesaplandı.Nihai patoloji sonuçlarına göre endometrial polip görülme sıklığı %65.9 (n=81), submuköz myom görülme sıklığı %7.3 (n=9) olarak bulundu. Ortalama işlem süresi ofis histeroskopi için 11.0±5.67, klasik histeroskopi için 42.6±18.4 dakika olarak bulundu (p0.001). Ofis histeroskopisi yapılan hastalarda işlem öncesi ağrı ortalaması 0.3±0.1 (0–1), işlem sırasındaki ağrı ortalaması 2.8±2.5 (0–10), işlem sonrası ağrı ortalaması 1.5±1.6 (0–8) olarak bulundu. Ofis histeroskopi sonrası hastaların işlemden çok memnun kalma ve tavsiye edilir bulma oranları sırasıyla %89.3 ve %86.3 olarak tespit edildi. Ofis histeroskopi grubundaki 66 hastanın tedavi sonrası 6. ayda semptomsuz fayda görme oranı %92.4 ve klasik histeroskopi grubunda ise %96.4 olarak hesaplandı (p=0.3). Ofis histeroskopi sonrası 6 ayda ise hastaların işlemden memnun kalma ve tavsiye edilir bulma oranları sırasıyla %83.3 ve %81.8 olarak tespit edildi. Maliyet analizinde ofis histeroskopinin klasik yaklaşımdan 3.6 kat ucuz olduğu tespit edildi.Ofis histeroskopisi, hızlı sonuç veren, genel anestezi gerektirmeyen, doğrudan görüntülemeyi ve tedaviyi sağlayan, ayaktan hastada yapılabilen, düşük maliyetli, hasta açısından güvenilir ve tatminkar bir yöntemdir. Anormal uterin kanamalı hastalarda intrakaviter lezyondan şüpheleniliyor ise ilk basamak tanı ve tedavi aracı olarak düşünülmelidir.

Aim: To determine how fetal pulse oximetry behaves in various cardiotocographic (CTG) tracings and correlates with neonatal outcome. Patients and Methods: Pregnant women undergoing active labor with singleton pregnancies of 32–42 weeks were enrolled. CTG recordings were reassuring or nonreassuring (namely variable or persisting late decelerations). Pulse oximetry values during labor and changing throughout deceleration and recovery phases, duration and frequency of pulse oximetry recordings

To compare efficacy and safety of vaginal misoprostol (PGE(1) analog) with dinoprostone (PGE(2) analog) vaginal insert for labor induction in term pregnancies.A total of 112 women with singleton pregnancies ofor =37 weeks of gestation, and low Bishop scores underwent labor induction. The subjects were randomized to receive either 50 mug misoprostol intravaginally every 4 h to a maximum of five doses or a 10 mg dinoprostone vaginal insert for a maximum of 12 h. Time interval from induction to vaginal delivery, vaginal delivery rates within 12 and 24 h, requirement of oxytocin augmentation, incidence of tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean section due to fetal distress and neonatal outcome were outcome measures. Student's t test, Chi square test, Fischer's exact test were used for statistical analysis.Time interval from induction to vaginal delivery was found to be significantly shorter in misoprostol group when compared to dinoprostone subjects (680 +/- 329 min vs. 1070 +/- 435 min, P0.001). Vaginal delivery rates within 12 h were found to be significantly higher with misoprostol induction [n = 37 (66%) vs. n = 25 (44.6%); P = 0.02], whereas vaginal delivery rates in 24 h did not differ significantly between groups [n = 41 (73.2%) vs. n = 36 (64.2%); P = 0.3]. More subjects required oxytocin augmentation in dinoprostone group [n = 35 (62.5%) vs. n = 20 (35.7%), P = 0.005] and cardiotocography tracings revealed early decelerations occurring more frequently with misoprostol induction (10.7 vs. 0%, P = 0.03). Tachysystole and uterine hyperstimulation, mode of delivery, rate of cesarean sections due to fetal distress and adverse neonatal outcome were not demonstrated to be significantly different between groups (P = 1, P = 0.5, P = 0.4, P = 0.22, P = 0.5).Using vaginal misoprostol is an effective way of labor induction in term pregnant women with unfavorable cervices, since it is associated with a shorter duration of labor induction and higher rates of vaginal delivery within 12 h. Misoprostol and dinoprostone are equally safe, since misoprostol did not result in a rise in maternal and neonatal morbidity, namely, tachysystole, uterine hyperstimulation, cesarean section rates and admission to neonatal intensive care units as reported previously in literature.

Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum beta-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility. (authors)

We aimed to evaluate the effects of ovulation induction on Ki67 expression and dysplasia scores of female rat ovaries. Twenty female Wistar rats were randomized either to receive 150 IU/kg human menopausal gonadotropin on estrous day 2 and 75 IU/kg human chorionic gonadotropin on the day of preestrous (induction group, n= 10) or saline as placebo on the corresponding days (control group, n= 10). After five estrous cycles bilateral oophorectomy was performed to compare the Ki67 expression and dysplasia score of the ovarian epithelium. The mean number of the cells that stained positive for Ki67 was 159.6 +/- 101.92 in the follicles, 283.4 +/- 42 in the corpus luteum, and 151 +/- 75.1 in the stroma of the study group compared to 41.8 +/- 35.6 (P= 0.03), 43.2 +/- 28.3 (P= 0.007), and 55.6 +/- 18.6 (P= 0.01), respectively, in the control group. The mean number and rate of cells that stained positive for Ki67 in the epithelium was significantly higher in the ovulation induction group (758 +/- 71 and 63 +/- 1.6%, respectively) compared to the control group (386 +/- 23, P < 0.001; and 60 +/- 1.1%, P < 0.001; respectively). The mean dysplasia score was significantly higher (9.6 +/- 1.3) in the study group compared to the control group (5.08 +/- 0.9, P < 0.001). Ovulation induction in rats resulted in increased Ki67 expression and dysplastic features in the ovarian epithelial cells.

Magnetic resonance (MR) imaging and MR angiography were used for the differential diagnosis and preoperative planning of a 17 weeks of age rudimentary horn pregnancy. A 26-year-old primigravida was referred to our hospital with a preliminary diagnosis of abdominal pregnancy. After an inconclusive ultrasound evaluation we were able to identify a rudimentary horn pregnancy, extent of the placental invasion, and the vascular supply via MR imaging and time of flight sequence MR angiography. The obtained data were also used for preoperative planning, which resulted in an uncomplicated, prerupture laparotomy for pregnancy termination and a healthy female.

Objective: To compare the efficacy of misoprostol 50 µg vaginally and 50 µg sublingually for labor induction at term. Materials and Methods: One hundred and sixty women were randomized to receive misoprostol 50 µg vaginally (n = 80) or 50 µg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures. Results: The mean induction to delivery time was 748 ± 379 min in the vaginal group and 711 ± 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 ± 1.2) compared with the vaginal group (1.1 ± 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 µg sublingually, but neonatal outcomes are similar.

Summary: The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4–5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1–0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p

Medical termination of pregnancy (medical abortion) as an alternative to surgical abortion has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, we evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion.The study population consisted of 32 women seeking abortion of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/m2 intramuscularly and the dose of misoprostol was 800 micrograms intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure.Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +/- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment.The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this medical abortion, a comparison with RU 486 in prospective controlled randomized trials is necessary.Medical termination of pregnancy (medical abortion), as an alternative to surgical abortion, has many advantages since it does not require anesthetics and there is no risk of cervical laceration or uterine perforation. In the present study, the authors evaluated the efficacy of methotrexate and intravaginally administered misoprostol for early abortion. The study population consisted of 32 women seeking termination of a normal intrauterine pregnancy of 8 weeks or less documented by ultrasound. The dose of methotrexate was 50 mg/sq. m intramuscularly and the dose of misoprostol was 800 mcg intravaginally. The final outcome of treatment was evaluated on day 14 or 16, and an abortion was considered successful if pregnancy was terminated without a surgical procedure. Abortion occurred in only 23 (71.8%) of 32 women. There were 9 failures (28.1%); 3 were ongoing pregnancies (9.3%) and 6 were incomplete abortions (18.7%) requiring suction curettage. After the exclusion of treatment failures, the mean duration of vaginal bleeding was 16.3 +or- 2 days. No serious side effects occurred as a result of methotrexate and misoprostol treatment. The use of methotrexate and intravaginal misoprostol for the termination of pregnancy requires larger studies to determine the safety and efficacy of this type of medical abortion; a comparison with RU 486 in prospective controlled randomized trials is necessary.

Primary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma.We present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin.