The safety of misoprostol alone use for second-trimester termination of pregnancy in women with previous caesarean deliveries.

PURPOSE: To investigate the safety of misoprostol use in second-trimester pregnancy termination among women with previous caesarean sections. MATERIALS AND METHODS: This is a retrospective cohort study conducted in a tertiary centre, examining 359 patients whose pregnancy was terminated with misoprostol alone between 14 and 24 weeks with the indication of foetal anomalies. Two dose regimens were administered vaginally or sublingually: (1)400 mcg misoprostol every 3-6 h; (2) 200 mcg misoprostol every 3-6 h following a loading dose of 400 mcg. The patients were divided into three groups according to the number of previous caesarean sections (CSs) and compared in terms of demographic and clinical characteristics and complications. Termination-related complications were the primary outcomes considered. RESULTS: Of the 217 patients, 80 (36.8%) had no previous uterine scar, 79 (36.4%) had one previous CS, and 58 (26.7%) had at least two prior CSs. The overall complication rate was 0.9%. There were no differences among groups in terms of complications (p > 0.05). There was no difference in complications in women with prior CS when they were compared according to the misoprostol regimens used (p > 0.05). The total dose of misoprostol used ranged from200 to 3,600 mcg. The treatment success of misoprostol during the second trimester was 92.1%. According to regression analysis, an increase in the week of gestation increased the failure rate of misoprostol for inducing second-trimester abortion by 2.7 times (95%CI (1.38-5.39)). CONCLUSION: Misoprostol alone is a safe and effective option for terminating second-trimester pregnancies with one or more previous CSs in settings where mifepristone is unavailable.

Effects of transobturator tape procedure on female sexual function at 2-year follow-up: A prospective cohort study with matched control group.

OBJECTIVES: We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls. METHODS: Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used. RESULTS: The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, P < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, P = .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, P < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores. CONCLUSIONS: Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.

Circulating level of serum secreted frizzled-related protein 5 decreases in polycystic ovary syndrome.

OBJECTIVES: To analyse the SFRP-5 serum levels in PCOS and to investigate the relationship between SFRP-5 and other metabolic parameters in PCOS. MATERIAL AND METHODS: This is a prospective case-control study carried out in a research hospital. A total of 88 subjects including 43 patients diagnosed PCOS according to Rotterdam criteria and age -BMI matched 45 healthy controls were evaluated. Serum SFRP5, fasting blood glucose, insulin levels and HOMA-IR scores of the groups were determined and compared. The cut-off of SFRP-5 for detecting PCOS was calculated. RESULTS: Serum SFRP-5 levels were lower in PCOS group compared to the controls (290.13 ± 187.66 ng/mL vs 533.03 ± 208.55 ng/mL, p < 0.001). There was no correlation in the PCOS group regarding SFRP-5 and other parameters. The role of SFRP-5 to predict the PCOS risk was assessed with receiver operating curve (ROC). The sensitivity of SFRP-5 was 74.4% and the specificity was 75.6% at a threshold ≤388.38 ng/ml in PCOS. CONCLUSION: SFRP-5 could be a beneficial marker for PCOS diagnosis, follow-up and treatment.

Comparison of endometrial cancer risk in patients with endometrial precancerous lesions: WHO 1994 vs EIN classification.

Our aim was to investigate the frequency of concurrent endometrial cancer in patients with endometrial precancerous lesions (PCLs) using World Health Organization 1994 (WHO94) and endometrial intraepithelial neoplasia (EIN) systems. We retrospectively investigated patients that underwent surgery for endometrial PCLs according to WHO94 or EIN systems at Hacettepe University Gynecology Clinic between January 2002 and June 2014. Of the 267 patients, 189 (70.9%) were in the WHO94 group, 78 (29.2%) were in the EIN group. Mean age of patients was 50.2 years. Sixteen patients (8.5%) in WHO94 group and 15 (%19.2) patients in the EIN group had EC (p = 0.013). In WHO94 group, EC rate in patients with atypical EH (32.6%) was significantly more than patients with non-atypical EH (1.4%) (p < .001). Atypical EH and EIN are actual PCLs which could be accompanied by EC. Therefore, atypical EH and EIN should be treated surgically if there is no desire for fertility. IMPACT STATEMENTWhat is already known on this subject? Endometrial hyperplasias are precursors lesion in the pathogenesis of endometrium adenocarcinomas. There are two classification systems: World Health Organization System and endometrial intraepithelial neoplasia system (WHO and EIN).What do the results of this study add? In this paper, we report on endometrial precancerous lesions. Controversy continues over the endometrial precancerous lesion classification. We also share our experiences in this regard. We concluded that the EIN system was superior in determining concurrent cancer risk.What are the implications of these findings for clinical practice and / or further research? The paper should be of interest to readers in the areas of gynecology.It is important to clarify the classifications of precancerous lesions in order to guide clinicians in the treatment of patients with endometrial precancerous lesions. In this context, it could be suggested to use the EIN system more widely.

Elevated circulating Selenoprotein P levels in patients with polycystic ovary syndrome.

Selenoprotein P (SeP), an hepatokine that is primarily produced by liver, has been reported to affect glucose metabolism. In this study, we aimed to measure and compare serum SeP values in patients with polycystic ovary syndrome (PCOS) and a healthy control group, and to investigate whether there was a relationship between SeP values and insulin resistance in patients with PCOS. This prospective case-control study included 40 patients with PCOS and 39 healthy women (non-PCOS) matched for age and body mass index. SeP levels were significantly higher in the PCOS group compared with the healthy controls (7.48 ± 3.80 vs. 5.17 ± 3.20 mg/ml, p = .005). Serum insulin, hs-CRP, HOMA-IR, FBG, total-testosterone, and free-testosterone levels were higher in women with PCOS than in controls. In an unadjusted model and after adjusting for potential confounders, SeP had increased odds for PCOS (p = .007). ROC curve analysis showed that the area under the ROC curves were 0.691 (95% CI: 0.576-0.806, p < .003) for SeP levels. The optimal cut-off value of SeP for detecting PCOS was ≥5.87 mgl/ml. We showed, for the first time, that serum SeP levels were increased significantly in PCOS, Our results suggest that there is a potential link between PCOS and SeP levelsIMPACT STATEMENTWhat is already known on this subject? Selenoprotein deficiency causes various dysfunctions associated with oxidative stress, but recent studies found that increased SeP levels were associated with insulin resistance. Circulating SeP levels have been found to be increased in patients with type 2 diabetes mellitus (T2DM).What the results of this study add? Our study is the first in the literature to examine the relationship between SeP levels and the presence of PCOS. Serum SeP levels were increased significantly in PCOS.What the implications are of these findings for clinical practice and/or further research? SeP seemed to have a role in PCOS. SeP can be used to predict metabolic disorders associated with PCOS and to determine treatment methods.

The role of transvaginal color doppler indices to predict malignancy in abnormal uterine bleeding according to PALM-COEIN classification.

INTRODUCTION: The objective of this study is to analyze the differences in transvaginal color Doppler parameters in premenopasual women with abnormal uterine bleeding (AUB) among PALM-COEIN groups. MATERIALS AND METHOD: This cross-sectional study was performed in a training and educational hospital, included 147 premenopausal women with AUB. Patients were divided into four groups according to PALM-COEIN. All subjects were evaluated by transvaginal Doppler sonography and uterine artery (UA) pulsatility and resistive indexes (PI, RI) were calculated then compared. RESULTS: Four groups named AUB-P, AUB-E, AUB-M and AUB-O included 39, 30, 32 and 46 patients, respectively. The mean age of patients was 44.82 (35-55 years), EC rate was 3.4 %. UA-PI was lower in the AUB-M group compared with AUB-P and AUB-O (p < 0.001). UA-RI was different among gruops (p < 0.001). UA-RI was lowest in the AUB-M, and highest in the AUB-O (0.60 ± 0.15; 0.85 ± 0.05 respectively). The cut-off values of ET, UA-PI and UA-RI for detecting AUB-M were 13.5, 1.55 and 0.71 respectively. CONCLUSION: Transvaginal color Doppler sonography may be beneficial in detecting the etiology of AUB in premenopausal women.