Infertility due to intrauterine residual fetal bone fragments.

A case of intrauterine retention of fetal bone diagnosed 8 years after termination of a pregnancy is presented. The patient had a history of hypermenorrhea infertility, and persistent vaginal discharge beginning after the abortion. Transvaginal sonography demonstrated an intrauterine foreign body. Curettage was performed, and fetal bone fragments were found within the removed materials.

Seventeen-year review of hysterectomy procedures in a university clinic in Istanbul (1985-2001).

OBJECTIVE: Our objective was to review the hysterectomies performed in our clinic for the last 17 years to reveal the facts in relation to the operation. MATERIALS AND METHODS: The records of the patients who had undergone hysterectomy in Istanbul University Cerrahpasa School of Medicine Department of Obstetrics and Gynecology between January 1985 and August 2001 were reviewed retrospectively. Students' t-test and one-way ANOVA test were utilized to compare the data of different hysterectomy groups. RESULTS: Between 1985 and 2001, there were 3,956 women who had undergone hysterectomy operation in the Department of Obstetrics and Gynecology of Cerrahpasa School of Medicine, Istanbul University. There were 3,274 (82.7%) total abdominal hysterectomies (TAH), 424 (10.7%) total vaginal hysterectomies (TVH), 28 (0.7%) subtotal hysterectomies and 230 (5.8%) radical hysterectomies. There were no significant differences in the distribution of hysterectomy type with respect to interval of years. The common indications for hysterectomy were myoma uteri (38.49%), followed by gynecological cancers (21.6%) and uterine prolapse (11.9%). The rate of concurrent procedures were 87.3% for TAH (2,856/3,274) and 95.8% for TVH (406/424). The rate of 'unjustified' hysterectomies (pathological diagnosis that is inappropriate to the indication of the operation) determined as 8.9% in all of the cases. The pathological examination of the specimen was normal in 170 cases (5.1%) of TAH. This rate was 42.1% (183/435) in TVH group. In the TAH group there was no complication in 86.5% of the cases while it was 89.3% in the TVH group. The most common complication was febrile morbidity in the whole group. During the study period, 5 deaths that can be attributed to the hysterectomy operation were observed. The mortality rate was calculated as 0.1% for hysterectomy operation in the study period. CONCLUSION: Although it is widely performed, hysterectomy is a relatively safe surgical procedure. The morbidity and mortality of the operation may be further decreased by the efforts to minimize the rate of the unnecessary hysterectomies and selecting the most appropriate mode for the surgery.

Mid-trimester amniotic fluid angiogenin, lactate dehydrogenase and fibronectin in the prediction of preterm delivery.

OBJECTIVE: Our purpose was to compare angiogenin, lactate dehydrogenase (LDH) and fibronectin levels in mid-trimester amniotic fluid of patients with preterm and term deliveries and to find out their predictive values for preterm birth. STUDY DESIGN: A prospective cohort study was conducted in 55 pregnancies with singleton gestations that underwent amniocentesis at 15-20 weeks for standard genetic indications. Amniotic fluid angiogenin, lactate dehydrogenase and fibronectin levels were measured by enzyme-linked immunosorbent assay (ELISA), radial immundiffusion technic and automated analyzer, respectively. RESULTS: Five patients delivered preterm, five developed signs or symptoms of threatened preterm labor and 45 had term delivery after an uneventful pregnancy. Demographic data were not significantly different. Amniotic fluid angiogenin and lactate dehydrogenase levels were significantly higher in patients with preterm than term deliveries (P<0.001 and 0.02, respectively). Receiver-operator characteristic curve analysis showed that the amniotic fluid angiogenin had the best screening efficiency in predicting preterm delivery. An angiogenin level of 35ng/ml was the optimal cut-off value for the prediction of preterm delivery, with a sensitivity of 100% and specificity of 91%. CONCLUSION: Second-trimester angiogenin is found to be quite effective in the prediction of preterm delivery. Preexisting intrauterine ischemia may be an important risk factor for preterm delivery and already be present in the early mid-trimester.

Plasma and placental levels of interleukin-10, transforming growth factor-beta1, and epithelial-cadherin in preeclampsia.

OBJECTIVE: To investigate the plasma and placental levels of interleukin-10 (IL-10), transforming growth factor-beta1 (TGF-beta1), and epithelial-cadherin (E-cadherin) in normotensive and preeclamptic pregnancies. METHODS: The study population consisted of 33 women with normotensive pregnancy and 35 women with preeclampsia. Peripheral venous blood samples were collected before labor (35.3 +/- 1.1 and 34.2 +/- 3.4 weeks' gestation for normotensive and preeclamptic pregnancies, respectively), and placental tissues were obtained after delivery. Maternal plasma and placental homogenate IL-10, TGF-beta1, and E-cadherin levels were determined by enzyme-linked immunosorbent assay. RESULTS: The mean plasma and placental levels of IL-10, TGF-beta1, and E-cadherin were significantly higher in preeclamptic than normotensive patients (P <.001). The plasma and placental levels of IL-10, TGF-beta1, and E-cadherin significantly increased with the increments in diastolic blood pressure (P <.001). CONCLUSION: IL-10, TGF-beta1, and E-cadherin may be involved in the pathologic process of preeclampsia. The pathophysiologic changes associated with preeclampsia may stem in part from the overproduction of these placental mediators.