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To compare the effectiveness of combined treatment of depot medroxyprogesterone acetate (MPA) with gonadotropin-releasing hormone (GnRH) analog and depot MPA alone in the management of simple endometrial hyperplasia without atypia among heavy bleeders.Thirty- four patients with endo- metrial hyperplasia with- out atypia were selected in this prospective randomized study. Group I consisted of 15 patients who were treated with depot MPA combined with GnRH analog. Group 2 consisted of 19 patients who were treated with depot MPA alone. Injections were applied at the beginning of the study and at the end of the 3rd month. Endometrial biopsies were performed at the end of the 6th month. Main outcome measures were endometrial response and reduction of duration and amount of menstrual bleeding.Total and mean duration of menstruation and total number of standardized pads used were signifi- cantly decreased in both groups. These parameters were also significantly lower in group 1 than in group 2 at the end of both the 3rd and 6th months of the study (p0.01). Endometrial response rates were significant- ly higher in group I than in group 2 (100% vs. 44.4%, respectively, p0.05).Management of endometrial hyper- plasia with GnRH analog in addition to depot MPA provides prompt endometrial response and rapid menstru- al cycle control.

The aim of this prospective study is to define markers that can be used in the diagnosis and follow-up of patients with endometriosis by determining serum CA 125, transforming growth factor beta 1 (TGF-beta 1), interleukin 6 (IL-6), and IL-12 levels. The study group consisted of 14 patients diagnosed to have mild to moderate peritoneal endometriosis, 47 patients with ovarian endometrioma during laparoscopy and 12 healthy patients as a control group. Serum CA 125, TGF-beta 1, IL-6, and IL-12 levels were evaluated using ELISA kits. Serum CA 125 levels were significantly higher in the endometrioma group when compared to the control group (p < 0.001) and mild to moderate peritoneal endometriosis group (p

This retrospective study aimed to shed light on the management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. The study included all fresh ICSI cycles performed in the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared with 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared with 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to clinical pregnancy (29.8% versus 38.3%) and live-birth (25.5% versus 31.9%) rates per transfer, as were patients diagnosed with an endometrial polyp during ovarian stimulation (clinical pregnancy rates 45.3% versus 46.9%; live-birth rates 40.6% versus 39.8%). In conclusion, further studies are required to identify the most appropriate management of endometrial polyps. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Lower urinary tract obstruction (LUTO) which is most commonly caused by posterior urethral valves or urethral atresia, is often associated with high perinatal mortality and morbidity and long-term childhood renal dysfunction or even renal failure. LUTO is an uncommon clinical entity that can be diagnosed by ultrasonographic examination and is particularly presented by enlarged bladder, hydronephrosis, hydroureter and oligohydramnios. Despite being a rare pathology of the genitourinary tract, detection rates of it is higher than other congenital abnormalities with ultrasonography. Moreover, ultrasonography has become the most widely used diagnostic tool in the diagnosis of LUTO. Pulmonary hypoplasia resulting from severe oligohydramnios is the most common cause of death. Bladder drainage has a critical role on perinatal survival in fetuses with LUTO especially in those predicted to have a poor prognosis. Further interventions and observations of renal therapies may be required in childhood.

Objective To investigate the impact of embryo replacement depth on IVF and embryo transfer outcomes. Design Retrospective analysis (May 2005 to November 2008) of 5,055 ultrasound-guided embryo transfers belonging to 3,930 infertile couples. The distance between the fundal endometrial surface and the catheter tip was measured and accordingly, patients were divided into five groups. Setting Anatolia IVF Center, Ankara, Turkey. Patient(s) All patients enrolled in the IVF program undergoing embryo transfer. Intervention(s) No patient received any additional procedure or intervention. Main Outcome Measure(s) Clinical pregnancy rate (PR) and ongoing PR. Result(s) Mean total number of embryos transferred in groups 4 and 5 were significantly higher than in groups 2 and 3. Analysis of PRs and outcome of gestations in the five groups studied yielded similar PRs in all groups except for group 1. Conclusion(s) Pregnancy rates and ongoing PRs are higher if the embryos are replaced at a distance >10 mm from the fundal endometrial surface. In addition because significantly more embryos were replaced in cycles where the transfers occurred at a distance of >20 mm, a distance >10 mm to

Summary Purpose: We aimed to define the morphologic effects of valproate (VPA) and oxcarbazepine (OXC) on ovarian folliculogenesis in rats. Methods: Forty female wistar rats (21–24 days old and weighted between 46.4 and 55.3 g) were divided equally into 4 experimental groups, which were applied tap water (control group), 300 mg/kg/day VPA, 100 mg/kg/day OXC, and both VPA and OXC via gavage for 90 days. Ovaries of the rats on proestrous and diesterous phase of estrous cycle according to daily vaginal smear were taken out and placed in a fixation solution. Immunohistochemical and apoptosis (TUNEL) staining protocols were applied. Results: The number of follicles decreased and that of corpora lutea increased significantly in OXC, VPA, and OXC+VPA treated groups compared with control group (p < 0.05). The number of TUNEL positive ovarian follicles was 1.40 ± 0.52 in control group, but it significantly increased to 3.50 ± 0.53, 3.50 ± 0.53, and 4.90 ± 0.88 in VPA, OXC, and VPA+OXC groups (p < 0.0001). The increase in the number of TUNEL positive granulosa cells was also significant for OXC and VPA+OXC groups (p < 0.0001). Immunohistochemical HSCORE decreased for TGFβ1 and IGF1 staining and increased for P53 staining in all drug groups compared with control group (p < 0.001). Intensity of P53 labeling increased, while intensity of TGFβ1, IGF-1, and GDF-9 immunoreactivity decreased significantly in all drug groups compared with control group (p < 0.001). Conclusion: Long-term treatment with VPA or OXC from prepuberty to adulthood causes apoptosis and deterioration of folliculogenesis in rat ovarian follicles.

The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonaclotrophins in couples with unexplained and mild trialefactor subfertility. A total of 838 cycles in 456 women wi th unexplained and inild male-factor subfertility attencling a University-based infertility clinic was evaluated. Of these cycles, 139 resulted in pregnancy (16.6% per cycle) and 96 out of 98 ongoing pregnancies resulted in live term birth. Live birth rate per patient and per cycle was 21.1% and 11.4%. respective ly. Multivariate logistic regression analysis demonstrated that duration of infertility (P = 0.034), type of infertility (P = 0.003), aetiology of infertility (P = 0.004), number of treatment cycles (P = 0.000 1) and number of dominant follicles before human chorionic gonaclotrophin (HCG; P = 0.024) were significant independent factors to predict clinical pregnancy. The duration of infertility (P = 0.043), number of treatment cycles (P = 0.0001) and]lumber of dominant follicles before HCG (P = 0.024) were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration Of Albfertility, inultifollicular response to gonadotrophins and in their first treatment cycle are more likely to Succeed a live birth with IU1 treatment using recombinant gonadotrophins.

The occurrence of double aneuploidy is a relatively rare phenomenon. The clinical presentations are variable depending on the predominating aneuploidy or a combination effect of both. We report the cytogenetic data on products of conception from miscarriages over a period of 5 years. A total of 403 miscarriages were karyotyped and the tissues were villi in all cases. Of 403 cases, 54 cases with single aneuploidy and 2 cases of first-trimester miscarriages with double trisomies were found. These 2 cases with the karyotypes of 48, XXY,+15 and 48, XX,+ 5,+ 7 were cited for the first time in this study. Copyright (C) 2008 S. Karger AG, Basel.

As raloxifene is a mixed estrogen receptor agonist and antagonist, it exerts different effects on apoptosis in different tissues. In this study, we aimed to evaluate apoptosis in the peripheral lymphocytes of postmenopausal women treated with raloxifene and compare it with untreated control subjects. In this way, we expected to deduce some results about the effect of raloxifene on the immune system and to serve as a guide for future studies on this newly proposed effect of a well-known agent. Twenty osteoporotic postmenopausal women treated with raloxifene for 12 months were included in this study. Another 20 osteoporotic postmenopausal women matched for age and postmenopausal years, but without any medication, were chosen as the control group. Apoptosis was evaluated using a morphological and DNA fragmentation assay, in the peripheral lymphocytes of these women. Our results revealed a decrease in the apoptosis percentages of the patients treated with raloxifene (14.6%) with respect to the control subjects (15.8%), but the difference was not statistically significant (p = 0.467). This study indicated that raloxifene treatment had no apoptotic effect on peripheral human lymphocytes compared to controls. (c) 2006 International Federation for Cell Biology. Published by Elsevier Ltd. All rights reserved.

Objective The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey. Design The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice. Results The mean age of participants was 58.64 +/- 8.14 years. The mean age of menopause was 47.21 +/- 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency. Conclusions Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.

To assess the oxidative effects of raloxifene use in postmenopausal women by investigating protein carbonyl levels in the plasma.Nineteen osteoporotic postmenopausal women treated with raloxifene for 12 months were included in the study. Another seventeen postmenopausal women matched for age and postmenopausal years, without any medication were chosen as a control group. Protein carbonyl levels were determined as oxidative stress markers by the use of Levine's method in the plasma of these women.Serum protein carbonyl levels of postmenopausal women treated with raloxifene (1.27 +/- 0.32 nmol/mg protein) were significantly lower than the control group (2.18 +/- 0.27 nmol/mg protein) (p0.05).Oxidative stress has been found responsible for several diseases including cancer. Protein carbonyl levels, which are the products of protein oxidation, are one of the indicators of oxidative stress. Therefore, the decline in protein carbonyl levels in this study revealed the decreasing oxidative stress. According to our results, it might be interpreted that raloxifene does not cause oxidative stress, and it may even have protective effects in long-term use.

The aim of this study was to determine the incidence of stress urinary incontinence among women at the age of 15 and above who applied to the primary health care centers in Ankara, Turkey. We applied the urinary stress incontinence questionnaire to 2,601 women at the age of 15 or above who consulted to the "mother-child health care and family planning centers" in January 2002. To evaluate the urinary incontinence status with respect to age groups and other risk factors, chi-square test was used. Stress incontinence prevalence was 16.1% in our population. Age was a statistically significant risk factor affecting the incidence of stress incontinence. As the number of gravida increases, the frequency of stress incontinence increases (p < 0.05). Presence of a systemic disease was also an important risk factor (p < 0.05). Alcohol use and smoking were not found to affect the incidence of urinary stress incontinence (p > 0.05). As urinary incontinence greatly influences life quality and social and psychological status of the person, and also creates economic burden, predisposing factors of stress incontinence should be well defined and measures should be taken to encourage women experiencing this problem to visit a doctor and to get an efficient treatment.

Objectives Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes. Study design Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal. Results The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups. Conclusions An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer.

AMAC: Bu calismanin amaci Turk kadinlari arasindaki menstruel periyot farkliliklarini ortaya koymak ve bu amacla piktorial kartin kullanilip kullanilamayacaginin ortaya konmasidir. MATERYAL-METOD: Bu calismaya 600 kadin dahil edilmistir. Kadinlarin adet donemlerindeki kanama paternlerini ortaya koymak icin bir anketle birlikte piktorial kart uygulanmistir. Piktorial kart lekelenmis pedlerin, tamponlarin ve pihtilarin gorulmesiyle degerlendirilir. BULGULAR: Katilimcilarin piktorial skorlari degerlendirildiginde 218 hastanin (%36.3) 50’den dusuk, 100 hastanin (%16.7) 50 ile 70 arasi, 129 hastanin (%21.5) 70 ile 100 arasi ve 153 hastanin (%25.5) 100’den yuksek puan aldiklari tespit edilmistir. Gunde 5 veya daha fazla ped kullananlarin %79’unun, ic camasirinda lekelenme olan hastalarin %67’sinin ve hasta bezi kullananlarin %76’sinin piktorial skorlarinin 50’den yuksek oldugu bulunmustur. SONUC: Menoraji tanisini koymada ve tedavi seceneklerini degerlendirmede piktorial kartin kullanilmasini onermekteyiz.OBJECTIVE: The aim of this study was to detect the personal changes during menstrual periods among Turkish women, and to search whether a pictorial blood assessment chart could be used for such a purpose. METHOD: 600 women were included in this study. Along with a questionnaire, pictorial blood assessment chart (PBAC) was applied to investigate the women’s bleeding pattern during the menstrual period. The PBAC is based on the visual appearance of stained towels, tampons and the presence of clots. RESULTS: When the pictorial scores of the participants were evaluated, 218 patients (36.3%) had a score lower than 50, 100 patients (16.7%) had between 50-70, 129 patients (21.5%) had between 70-100 and 153 (25.5%) patients had a pictorial score greater than 100. 79% of women using 5 or more pads during menstruation had a pictorial score greater than 50, 67% of women having blood on their underwear had a pictorial score greater than 50 and 76% of women using big sized pads had a pictorial score greater than 50. CONCLUSION: We recommend the use of pictorial blood assessment chart for the diagnosis of menorrhagia and evaluation of the treatment outcomes.

To determine the prevalence and factors associated with diastasis recti abdominis (DRA) MATERIAL AND METHODS: Between January 2011 and May 2011, we examined 95 patients, aged between 19-24, for the presence of DRA during an ultrasonographic exploration in Mus Obstetrics and Gynecology Hospital, Mus, Turkey DRA was graded by the number of fingerbreadths between the medial edges of the bellies of the rectus abdominis muscle, 3-4 cm above the umbilicus. The exclusion criteria included urogynecologic problems since childhood, excessive protrusion of the vagina due to loss of support, pregnancy obesity less than 6 months postpartum. The relationship between DRA and parity previous abdominal surgery pelvic relaxation as well as type of parity was assessed.Positive correlation was found between parity and DRA (r = 0.77; p0.001). Although there was no significant difference between DRA and the type of delivery among primiparous patients (p = 0.556), DRA increased significantly in the second cesarean section patients (p = 0.004). In this trial, cystocele and rectocele were established in 57% and 43% of patients with DRA, while descensus uteri was present in 10 (52%) patients.Increased parity and recurrent abdominal surgery seem to increase the risk of DRA. However; the importance of DRA in the young women remains unknown.

Objectives To provide information about the effects of blood and mucus on the embryo transfer (ET) catheters after transfer on embryo transfer outcomes. Study design Retrospective analysis of 8311 ultrasound-guided embryo transfers performed in a single center. In 6897 cases (82.9%), there were no blood on the catheter after ET, 1168 transfers were associated with mild blood (14.1%), 33 transfers with moderate blood (0.4%) and 213 transfers with severe blood (2.6%). A total of 6162 transfer catheters were free of mucus (74.8%), whereas mucus was detected on 2081 catheters (25.2%). Results The implantation rate (IR) was highest in the group with no blood on the transfer catheter, and lowest in the group with severe blood on the catheter. The clinical pregnancy rate (CPR) was lowest in the group with severe blood on the catheter. The presence of mucus on the catheter was found to have no effect on IR, CPR, biochemical pregnancy rates, miscarriage rates and live birth rates. Conclusions This study showed decreased IR, CPR and live birth rates in ETs associated with blood on the catheter. Mucus on the catheter appeared to be a simple contamination in this study and pregnancy rates remained unaffected.

Aim was to detect the seroprevalences of Herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis in a subpopulation of Turkey. The study was performed in the “Golbasi” rural area of Ankara, the capital city of Turkey. Ten milliliter of peripheral blood was drawn from 1,115 women over 15 years old. Once the sera were separated, ELISA was used to detect seropositivity. Data were transferred to Epi Info Version 6.0 statistical program and the analysis was performed. Among all participants, 53.5% were found to be seropositive for HSV-2 and 52.2% were found to be seropositive for C. trachomatis. This study detected a much higher HSV-2 and C. trachomatis seroprevalence for the Turkish population than expected and previously reported. A percentage around 50% for both agents creates an important conflict with the common misbelief of the Turkish population that sexually transmitted diseases are not common in this population. This study points out the importance of preventive measures and the need for greater surveillance for sexually transmitted infections among the Turkish population.

The aim of this study was to analyse whether some cases of unexplained infertility and implantation failure after IVF could be explained by different expression levels of the matrix metalloproteinases (MMP-2, 9), their tissue inhibitors (TIMP-2, 3) and intercellular (ICAM-1) and vascular (VCAM-1) adhesion molecules in endothelial cells. Total RNA was extracted from the endometrial tissues of 41 women (unexplained infertile, group 1, n = 15; fertile volunteers, group 2, n = 15 and patients with implantation failure after IVF, group 3, n = 11). MMP-2, MMP-9, TIMP-2, TIMP-3, ICAM-1 and VCAM-1 mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. In the endometrium from women with unexplained infertility and implantation failure after IVF, MMP-2 and TIMP-3 expression were significantly decreased when compared with the fertile group (P < 0.05 and P

As genomic imprinting plays a critical role in the development of the placenta, the aim of this study was to detect whether the expression levels of the imprinted genes IGF2 and H19 in the endometrium differ between infertile and fertile women.Total RNA was extracted from 30 (15 unexplained infertile and 15 fertile) women's endometrial tissue. cDNA was synthesized from total RNAs of each sample. IGF2 and H19 mRNA expression levels were measured quantitatively using the Real Time PCR method. In order to determine the allelic expression of IGF2 and H19, genomic DNA was extracted from endometrial tissues.When compared with the control group, increased mRNA expression of IGF2 was detected (1.5-fold change, P=0.015) in the unexplained infertility group. In contrast, H19 expression was lower in the infertility group as compared to the control group (4-fold change, P0.0001). Restriction analysis of cDNA-derived PCR product showed that all patients and controls indicated monoallelic expression of IGF2 and H19.Our results showed that altered expression of these imprinted genes might affect implantation and that their timely and appropriate activation is important for proper functioning. To understand the molecular epigenetic basis of implantation and placental development, genomic imprinted genes should be further investigated.

To evaluate the net effect of raloxifene on overall quality of life and sexual function in postmenopausal women. The study was performed in the Gynecology and Obstetrics outpatient clinic of Gazi University Faculty of Medicine between January 2002 and February 2005. Fifty postmenopausal women, in whom raloxifene was indicated for prevention and treatment of osteoporosis, were considered the study group. Fifty postmenopausal women who were not osteoporotic were enrolled as the control group. Participants completed a questionnaire composed of several parts (GRISS, BDI and ISI), at the beginning and end of the 12-month treatment period. Two groups were similar to each other with respect to total GRISS scores at the beginning and at the end of the study (P = 0.929 and P = 0.508; respectively). Raloxifene was associated with a significant improvement from baseline in the total scores of BDI (P = 0.0001), whereas this improvement was not significantly different from the control group (P = 0.216). With regard to ISI scores, there were no differences between groups in total scores. Raloxifene use did not seem to affect subscores of ISI either. This study failed to prove any deleterious effect of raloxifene on quality of life and sexual functions.

Vaginal evisceration is described as extrusion of intraperitoneal contents secondary to the disruption of the vagina. It is an extremely rare emergency condition.To describe a very rare case of vaginal evisceration that occurred after blunt trauma in a patient with no prior pelvic surgery.This report describes vaginal evisceration in a 73-year-old female with no prior pelvic surgery, after blunt trauma. The patient was handled by the cooperation of gynecology and general surgery departments. An immediate surgery was performed after stabilization of the patient and no postoperative complications occurred.Whatever be the treatment approach, emergency management of vaginal evisceration is critical to the preservation of a viable bowel. Repositioning of viable bowels into the abdominal cavity and appropriate surgical repair are cornerstones of the treatment.

Objective: To compare the effects of low-dose oral contraceptives used alone and in combination with a gonadotropin-releasing hormone (GnRH) analog to treat heavy menstrual bleeding. Methods: Fifty-eight patients with heavy menstrual bleeding were prospectively randomized into two treatment groups to receive either a low-dose oral contraceptive alone (group 1), or combined with a GnRH analog (group 2) for 6 months. The patients' hormonal profiles, and hemoglobin and hematocrit levels were measured at the beginning and at the end of the treatment period. Results: Hemoglobin and hematocrit levels significantly improved in both groups after 6 months of treatment (P

To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (or=200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes.Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a valueor=200 mg/dL after 50-g test and were diagnosed to have GDM.Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT200 mg/dL.Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.

Objective: To compare anal sphincter function following spontaneous vaginal delivery and cesarean delivery, and assess the association of perineal length and sphincter injury with each delivery mode. Method: Perineal length was measured and anal manometric measurements were performed in 120 primigravidas before and after delivery. Results: Mean values for maximum anal resting and squeeze pressures were significantly lower after delivery irrespective of the mode of delivery, but there was a positive correlation between postpartum maximum anal resting pressure and perineal length (r=0.24, P

Objective To evaluate the association between glycemic levels with glucose loading test during pregnancy and maternal and perinatal outcomes. Methods Retrospective analysis of 2059 singleton pregnancies screened for gestational diabetes mellitus at Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2004 and December 2006 was conducted. Sensitivity and specificity of the 50 g glucose loading test was calculated for different cut-off values in our population. Maternal and perinatal outcomes in different groups with different results after screening test were compared. Results An increase in cut-off value from 140 to 145 mg/dl seems to be associated with a significant increase in specificity along with a tolerable decrease in sensitivity. A cut-off value of 147.5 mg/dl is associated with a higher specificity and a slightly lower sensitivity. However, the cut-off value 150 mg/dl seems to be associated with a significant decrease in sensitivity. As for the upper limit, a cut-off value of 180 mg/dl is associated with a 90% specificity and a cut-off value of 200 mg/dl is associated with a 99% specificity. A 100% specificity could be reached only after a cut-off value of 221 mg/dl. A GLT value of 180 mg/dl or higher was found to be associated with poor maternal and fetal outcomes, regardless of the result obtained after the diagnostic test. Conclusion Results obtained after 50 g GLT should be evaluated separately for each patient and the diagnostic test which is time-consuming, uncomfortable and expensive can be omitted up to a cut-off value of 147.5 mg/dl, especially for those patients with no risk factors. Besides, a GLT value of 180 mg/dl or higher proves the diagnostic test unnecessary as these patients are associated with unfavorable perinatal and fetal outcomes.

Septo-optic dysplasia, also known as de Morsier syndrome, is a rare congenital entity almost always characterized by hypoplasia/dysplasia of the optical nerve, chiasma or optic radiations and the complete or partial absence of the septum pellucidum. It may also be accompanied by other malformations, including multiple facial dysmorphism, midline defects, cleft lip and palate, musculoskeletal and other non-neurological eye features. Various cases have been reported which have presented various combinations of symptoms and stigmata of the syndrome. We here present a unique case of septo-optic dysplasia with familial repetition, a considerably early antenatal diagnosis and an accompanying omphalocele, a feature never before connected with the syndrome. Copyright (C) 2009 S. Karger AG, Basel

[1]. The gonads of these patients develop into ovaries in utero, but then degenerate into streaks owing to the lack of a second X chromosome [1]. Cesarean is the usual mode of delivery in these patients [3], but in the present case the patient had a spontaneous vaginal delivery. Gonadal neoplasm can occur in up to 30% of cases and gonadoblastoma accounts for the majority of tumors [2]. Gonadoblastoma may synthesize estrogens or testosterone and is associated with dysgerminoma in 50% of cases [4]. In one case report 5 different histological subtypes of germ cell malignancies were described [4]. Early diagnosis is important and immediate gonadectomy is strongly recommended, as these tumors may even develop in infancy. A multidisciplinary approach with psychological support is important for the management of patients with pure gonadal dysgenesis. Normal uterine function including vaginal delivery is possible in these patients. References

Objective Sexuality is a basic human function that can affect general well-being and overall life quality. The aim of this study was to assess the level of knowledge on and attitude toward sexuality of a subgroup of Turkish women. Methods A cross-sectional survey including 1007 women was carried out concurrently in gynecology and urology outpatient clinics of Gazi University Faculty of Medicine, Turkey, between January 2003 and December 2003. A self-created questionnaire for data collection was administered to the participants, which addressed questions concerning their sexual life, sexual problems and attitudes towards sexuality. Statistical package for the social sciences (SPSS) was used for the data analysis of the study (SPSS ver. 11.0 Inc. Chicago, IL, USA). Results The data included 1007 patients aged 14–77 (mean: 35.6 ± 11.1). Among the women assessed, 90.2% were married, 79.8% were premenopausal and 77.1% were currently sexually active. 68.7% entered sexual intercourse 1–2 times per week, while 28.5% had an average of 3–4. 77.8% were aware of experiencing an orgasm and 74.7% had at least one orgasm. Only 21.4% of all women had an orgasm during each sexual intercourse. 2.2% of those who had never experienced an orgasm concurrently applied to a medical center. The average age of first intercourse was 21.3 ± 4.1 years. Conclusions Because there is no national data on sexual health in Turkey, analysis and evaluation of the severity of the problem, and alternatives for international comparisons are not possible. In our opinion, this study presents a valuable perception into the current sexual behavior of Turkish women.

Objective Adolescents tend to be at risk for unwanted pregnancies, so detecting their level of knowledge on emergency contraception and providing them information is important to prevent such pregnancies. Hence, in two faculties at Gazi University, this study aimed to detect freshman students' level and need of knowledge on emergency contraception and to evaluate their attitude towards emergency contraception. Materials and Methods The study was performed with freshman students of the Occupational Education Faculty and the Technical Education Faculty. A questionnaire including questions about demographic properties, obstetrical history, status of contraceptive use, level of knowledge and opinions on emergency contraception was administered to the students. Data was analyzed statistically with the computer program EPI Info 6.0. Results A total number of 385 adolescents were included in the studys; 157 of whom were males (40.8%) and 228 of whom were females (59.2%). To the question “is there any way to prevent a possible pregnancy after an unprotected sexual intercourse?”, 166 students replied “yes” (50.5%), 39 “no” (11.9%) and 124 “I do not know” (37.7%). Of 166 students replying “yes,” 114 (68.7%) listed a possible contraceptive method. The mostly cited method was “morning after pills” (n = 62; 54.4%), followed by curettage (n = 15; 13.2%). Among all students, 158 (49.8%) informed us that they were aware of the presence of “morning after pills” whereas 159 (50.2%) claimed they were not. Eighty-six male students (70.5%) and 115 female students (72%) emphasized that they would use emergency contraception upon necessity. Conclusion Half of the participants were familiar with various options to prevent pregnancy after an unprotected sexual intercourse episode, but they lacked specific knowledge about possible methods and ways to use them. Thus, it is essential that information about emergency contraception be included in adolescents' educational programs and that adolescents be provided with easily accessible medical services.