Pregnancy outcomes with a copper 380 mm2 intrauterine device in place: A retrospective cohort study in Turkey, 2011-2021.

OBJECTIVES: To investigate pregnancy outcomes in patients with pregnancies with a copper 380 mm2 intrauterine device (IUD) in situ at conception. STUDY DESIGN: In this retrospective study, we identified patients with pregnancies with a copper 380 mm2 IUD between 2011 and 2021 from the electronic health record system. According to their initial diagnosis, we classified the patients as having nonviable intrauterine pregnancies (IUPs), viable IUPs, or ectopic pregnancies. Among the viable IUPs, we divided the ongoing pregnancies into two subgroups as IUD-removed and IUD-retained. We compared the pregnancy loss (miscarriage before 22 weeks) rates and adverse pregnancy outcomes (at least one of preterm birth, preterm premature rupture of membranes, chorioamnionitis, placental abruption, or postpartum hemorrhage) of IUD-removed and IUD-retained pregnancies. RESULTS: We identified a total of 246 patients with pregnancies with an IUD. We excluded six (2.4%) patients without follow-up data and seven (2.8%) patients with levonorgestrel-IUD and included the remaining 233 (44 [18.9%] ectopic pregnancy, 31 [13.3%] nonviable IUP, and 158 [67.5%] viable IUP) patients. Among the 158 women with viable IUP, 21 (13.3%) underwent abortion, leaving 137 (86.7%) who elected to continue the pregnancy. A total of 54 (39.4%) patients with ongoing pregnancy had the IUD removed. We found a lower rate of pregnancy loss among those who underwent removal (18/54 [33.3%]) compared to those with a retained IUD (51/83 [61.4%], p < 0.001). After accounting for pregnancy loss, adverse pregnancy outcomes remained increased in the IUD-retained group (17/32 [53.1%]) compared to the IUD-removed group (10/36 [27.8%], p = 0.03). CONCLUSIONS: Pregnancy in the setting of a copper 380 mm2 IUD is high risk. Our results demonstrate that pregnancy outcomes improve by removal of the copper 380 mm2 IUD. IMPLICATIONS: Prior studies have suggested that the removal of the IUD improves outcomes, but all have limitations. Our results from a very large series with care in a single institution provide contemporary evidence to support copper 380 mm2 IUD removal to reduce the risk of both early pregnancy loss and later adverse outcomes.

Correction: Serial measurement of cytokines strongly predict COVID-19 outcome.

[This corrects the article DOI: 10.1371/journal.pone.0260623.].

Evaluation of long-term antibody kinetics in healthcare workers vaccinated with inactivated COVID-19 Vero cell vaccine (CoronaVac), a propensity score-matched observational study.

OBJECTIVES: This study aimed to evaluate the long-term antibody kinetics after vaccinating with an inactivated COVID-19 Vero cell vaccine (CoronaVac) in healthcare workers (HCWs) at a single center in Turkey. METHODS: For this prospective observational study, Chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) were used for the determination of binding antibodies (bAb) and neutralizing antibodies (nAb), respectively. Antibody kinetics were compared for the potential influencing factors, and propensity score analysis was performed to match the subcohort for age. RESULTS: Early bAb and nAb response was achieved in all 343 participants. Titers of bAbs against SARS-CoV-2 on 42 days post-vaccination (dpv) were higher in HCWs who were aged <40 years and who had a history of COVID-19. SARS-CoV-2 bAb levels in HCWs on days 42 (n = 97), 90 (n = 97), and 180 (n = 97) were 175 IU/ml (3.9-250), 107 IU/ml (2.4-250), and 66.1 IU/ml (2.57-250), respectively (p<0.001). SARS-CoV-2 bAb (p<0.001) and nAb (p<0.001) titers decreased significantly over time. There was a high negative correlation between SARS-CoV-2 antibody titers and inverse optic density of nAb responses (Pearson correlation coefficient: -0.738, p<0.001). CONCLUSIONS: When the antibody responses were compared, it was seen that the vaccine immunogenicity was better in those who had prior COVID-19 history and were aged <40 years. In the course of time, it was determined that there was a significant decrease in bAb and nAb responses after the 90th day. These results may guide approval decisions for booster COVID-19 vaccines.

Effects of skin-to-skin contact on afterpain and postpartum hemorrhage: A randomized controlled trial.

This study determined the effects of skin-to-skin contact between the mother and the infant during the third stage of labor on postpartum hemorrhage and pain. This assessor-blinded randomized controlled trial was conducted with primiparous women. Skin-to-skin contact interventions between the infants and their mothers occurred for 30 min after birth (n = 34), whereas the infants in the control group were provided routine care (n = 34). Data were gathered using a Personal Information Form, the Visual Analog Scale-Pain, postpartum bleeding follow-up bags, and records of blood oxytocin and beta endorphin levels. There was no significant difference in beta-endorphin levels in both groups (p = 0.771), whereas it was determined that the 30th min oxytocin level was significantly higher in the intervention group (The Visual Analog Scale-Pain score at the postpartum sixth hour was significantly lower in the intervention group. It was found that skin-to-skin contact made at the third stage of labor reduced the amount of postpartum hemorrhage. The results of this study suggested that skin-to-skin contact intervention may have beneficial effects on postpartum pain and postpartum hemorrhage in the early postpartum period.

A new technique for emergency cerclage: Guard suture method.

Objective The aim of this study was to introduce a novel technique to treat midtrimester cervical insufficiency with prolapsed membranes. Material and methods This retrospective study included patients with singleton pregnancies between 16 and 28 gestational weeks that underwent emergency cervical cerclage in a tertiary center. Patients were divided into two groups as McDonald method and guard suture method group according to the procedure they underwent. The following variables were recorded and evaluated: gestational age at cerclage, cervical length between the suture and external cervical os measured by transvaginal ultrasound on postoperative 1st and 7th day, gestational age at delivery, time between the procedure and delivery, intraoperative complications, newborn intensive care unit (NICU) admission, Apgar scores of neonates, and discharged alive newborns. Results During the study period, 38 patients underwent emergency cerclage procedure. Twenty-three were included in the McDonald group and 15 were in the guard suture group. The mean gestational age at the time of cerclage was 22.1 (17 -27) weeks and the mean gestational age at delivery was 33.9 (26- 38) weeks. Prolongation time between cerclage and delivery was 80.42 (1 - 140) days. Significantly higher 1st and 5th minutes Apgar scores and significantly lower NICU admission was found in the guard suture group (p = 0.04, p = 0.01 and p = 0.02, respectively). Conclusion In cases with cervical insufficiency and prolapsed membranes, emergency cerclage may prevent premature birth by prolonging pregnancy. Guard suture method is safe, effective, and easily applicable and can help obstetricians achieve better fetal and neonatal outcomes.

Serial measurement of cytokines strongly predict COVID-19 outcome.

PURPOSE: Cytokines are major mediators of COVID-19 pathogenesis and several of them are already being regarded as predictive markers for the clinical course and outcome of COVID-19 cases. A major pitfall of many COVID-19 cytokine studies is the lack of a benchmark sampling timing. Since cytokines and their relative change during an infectious disease course is quite dynamic, we evaluated the predictive value of serially measured cytokines for COVID-19 cases. METHODS: In this single-center, prospective study, a broad spectrum of cytokines were determined by multiplex ELISA assay in samples collected at admission and at the third day of hospitalization. Appropriateness of cytokine levels in predicting mortality were assessed by receiver-operating characteristic (ROC) analyses for both sampling times in paralel to conventional biomarkers. RESULTS: At both sampling points, higher levels of IL-6, IL-7, IL-10, IL-15, IL-27 IP-10, MCP-1, and GCSF were found to be more predictive for mortality (p<0.05). Some of these cytokines, such as IL-6, IL-10, IL-7 and GCSF, had higher sensitivity and specificity in predicting mortality. AUC values of IL-6, IL-10, IL-7 and GCSF were 0.85 (0.65 to 0.92), 0.88 (0.73 to 0.96), 0.80 (0.63 to 0.91) and 0.86 (0.70 to 0.95), respectively at hospital admission. Compared to hospital admission, on the 3rd day of hospitalization serum levels of IL-6 and, IL-10 decreased significantly in the survivor group, unlike the non-survivor group (IL-6, p = 0.015, and IL-10, p = 0.016). CONCLUSION: Our study results suggest that single-sample-based cytokine analyzes can be misleading and that cytokine levels measured serially at different sampling times provide a more precise and accurate estimate for the outcome of COVID-19 patients.

Spondylenchondrodysplasia mimicking a systemic lupus erythematosus: A diagnostic challenge in a pediatric patient.

Spondyloenchondrodysplasia (SPENCD) is a rare autosomal recessive skeletal dysplasia caused by biallelic mutations in the ACP5 gene that encodes tartrate-resistant acid phosphatase (TRAP). The extra-osseous phenotype of SPENCD is extremely pleiotropic and is characterized by neurological impairment and immune dysfunction. This phenotype can mimic systemic lupus erythematosus. Herein, we report a child presented with systemic lupus erythematosus-like symptoms, including multisystem inflammation, autoimmunity, and immunodeficiency, but was subsequently diagnosed as SPENCD.

Myometrial thickness overlying cesarean scar pregnancy is significantly associated with isthmocele formation in the third month of the postoperative period.

OBJECTIVE: To determine some associated factors for isthmocele formation 3 months after the treatment of cesarean scar pregnancy (CSP). MATERIALS AND METHODS: This is a prospective consecutive case series of CSP managed by fertility preservation modalities at a single tertiary care center from May 2016 to March 2019 (n=95). Patients with a diagnosis of CSP were identified and followed prospectively to collect data on the patients' demographics; detailed medical, surgical, and social history; symptoms; imaging and laboratory parameters at the time of CSP diagnosis and during treatment; treatment modalities, myometrial thickness; and outcomes in terms of isthmocele formation. RESULTS: Mean myometrial thickness overlying scar pregnancy was significantly lower in the group with isthmocele formation, and the mean gestational age of scar pregnancy was also significantly lower in the group with isthmocele formation following treatment of scar pregnancy (p<0.05). Multivariate regression analysis was conducted to determine associations between certain variables and isthmocele development, which revealed that the gestational age of scar pregnancy and myometrial thickness were significantly associated with isthmocele formation. CONCLUSION: Myometrial thickness and gestational age of scar pregnancy were significantly associated with isthmocele formation 3 months after treatment.

Investigation of the preventive effects of dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) on cisplatin-induced ovarian damage in rats.

To investigate whether Dehydroepiandrosterone (DHEA) and Caffeic acid phenethyl ester (CAPE) had any preventive effect against the ovarian damage caused by cisplatin (CP) (cis-diamminedichloroplatinum) in rats. On the first day ovaries were removed, Anti-Müllerian hormone (AMH) was measured (Group1, n:6), in the other groups 7.5 mg/kg cisplatin was administered intraperitoneally. In Group 2 (n = 6), 0.1 ml saline, in Group 3 (n = 5), 20 umol/kg CAPE, in Group 4 (n = 7), DHEA 6 mg/kg were administered every day. On the 10th day, ovaries were removed, AMH was measured. Ovary reserve (primordial/primary/secondary/tertiary/atretic follicles, AMH), ovarian damage scores (follicular degeneration, congestion, hemorrhage, edema, inflammation) were compared. The number of tertiary follicles were statistically high in the CAPE group (p = .015), the inflammation score in the DHEA group (p = .012), AMH level (p = .009) in the control group. The lowest number of atretic follicles (AF) was in the control group, while the highest number of AF was in the DHEA group (p = .002). Significant decreases in AF were the case in the cisplatin and DHEA groups compared to the control group (p < .008). The AMH values had the highest positive correlation with the number of primordial follicles and the highest negative correlation with the number of AF. The cut off point for AMH was 1.57 ng/ml as an indicator of low ovarian reserve. Cisplatin causes total damage and increased numbers of AF on the ovary. Depending on this, AMH levels fall. These negative effects of cisplatin are not obstructed by CAPE or DHEA, and may even be increased by DHEA.

Early low molecular weight heparin for postpartum hemorrhage in women with pre-eclampsia. Is it effective to prevent consumptive coagulopathy?

Background: Postpartum hemorrhage has been one of the most common cause of maternal morbidity and mortality. An association between pre-eclampsia (PE) and postpartum hemorrhage has been shown in previous studies. The aim of this study was to compare some characteristics of postpartum hemorrhage between women with and without PE.Methods: Some characteristics of postpartum hemorrhage were compared between women with (n = 34) and without PE (n = 34). Majority of the cases underwent low molecular heparin administration at postpartum eighth hour, however, in cases who did not give satisfactory responses to blood product transfusions, to block suspected disseminated intravascular coagulation (DIC) secondary to the PE induced vascular injury, low molecular weight heparins were started within 2 h of postpartum hemorrhage. Some characteristics of cases with and without PE and with and without early low molecular weight heparin administration were compared.Results: There were five cases who needed massive transfusions in group with PE, conversely, no case required massive transfusion in group without PE (p < .05), in these five cases prophylactic dose low molecular weight heparin was started within 2 h of postpartum period, these cases determined according to the changes in hematocrit, platelet, and fibrinogen levels with corresponding transfusions. Mean systolic and diastolic blood pressures were significantly higher in PE group. Highest lactate dehydrogenase (LDH) level during follow up was significantly higher in group with PE. Mean numbers of erythrocyte, thrombocyte, and fibrinogen transfusions were significantly higher in PE group. Duration of hospital stay was also significantly higher in group with PE.Conclusions: Postpartum hemorrhage in women with PE may be resistant to blood product transfusions due to DIC and vicious cycle can be blocked by early low molecular weight heparin administration.

Wnt signaling pathway in early- and late-onset preeclampsia: evaluation with Dickkopf-1 and R-Spondin-3 glycoproteins.

OBJECTIVE: Wnt signaling has been identified as an essential pathway that can direct cell proliferation, migration, and tissue homeostasis. This study aimed to evaluate the role of Wnt signaling pathway in early-onset and late-onset preeclampsia (PE) using serum Dickkopf-1 and R-Spondin-3 glycoproteins. STUDY DESIGN: A total of 80 pregnant women were included in this study. The patients were divided into three groups: (1) control (2) early-onset PE, and (3) late-onset PE. The serum levels of Dickkopf-1 and R-Spondin-3 were measured using an enzyme-linked immunosorbent assay. RESULTS: Of the 80 pregnant women enrolled in the study, 27 were control, 27 had early-onset PE, and 26 had late-onset PE. No differences were found in the maternal age, gravida, parity, and body mass index among the groups (P = 0.536, 0.230, 0.202, and 0.642, respectively). The serum level of Dickkopf-1 was significantly higher in the early-onset PE group compared with the control group (P = 0.006). The serum level of Dickkopf-1 was statistically similar in control group compared to late-onset PE group (P = 0.064). However, no significant difference was found in the serum levels of Dickkopf-1 and R-Spondin-3 between the early- and late-onset PE groups (P > 0.05). Additionally, the Spearman's correlation analysis revealed a significant negative correlation between maternal serum level of Dickkopf-1 and maternal age (r = - 0.522, P = 0.005). CONCLUSION: The increased serum level of Dickkopf-1 might be associated with the process of pathogenesis of early-onset PE. Further studies would elucidate their exact roles in the pathogenesis of PE.

Evaluation of FGF-19 and ß-klotho as biomarkers in patients with intrahepatic cholestasis of pregnancy.

INTRODUCTION: Fibroblast growth factor-19 (FGF-19) and its co-receptor, beta-klotho, regulate bile acid synthesis in the liver as an enterohepatic feedback mechanism. In this study, our aim was to investigate the circulating FGF-19 and ß-klotho levels in intrahepatic cholestasis of pregnancy (ICP) cases. MATERIAL AND METHODS: A cross-sectional study including 40 women whose pregnancies were complicated with ICP were recruited for the study group. Forty randomly selected healthy pregnant women comprised the control group. The patient characteristics, including maternal age, gravidity, parity, gestational age at the time of diagnosis, body mass index (BMI), and obstetric history, were recorded. The serum FGF-19 and ß-klotho concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS: Maternal age, gravidity, parity, body mass index at assessment, and gestational age at blood sampling were similar between the two groups (p > 0.05). Moreover, there were no significant differences in the FGF-19 and ß-klotho concentrations between the two groups (p = 0.341 and p = 0.086, respectively). A positive correlation was detected between the ß-klotho and FGF-19 levels, as well as between the FGF-19 level and BMI (r = 0.368, p = 0.020 and r = 0.389, p = 0.013, respectively). CONCLUSIONS: The serum FGF-19 and ß-klotho concentrations did not differ between the pregnancies with ICP and the healthy controls. However, in some cases, abnormalities in the FGF-19, ß-klotho, and FGFR4 signaling system may play roles in the pathogenesis of ICP.

Maternal cytoglobin (CYGB) serum levels in normal and preeclamptic pregnancies.

OBJECTIVE: To investigate cytoglobin levels in women with preeclampsia and women with uncomplicated pregnancies. MATERIALS AND METHODS: A cross-sectional study including 26 pregnant women complicated with early-onset preeclampsia (EO-PE) and 26 pregnant women complicated with late-onset preeclampsia (LO-PE) were recruited for the study group. Twenty-seven healthy pregnant women selected randomly were included in the control group. The serum CYGB concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS: Gestational age at delivery and mean birth weight were significantly lower in the preeclampsia groups than in the control group and were found to be the lowest in the EO-PE group (p < .001). Serum CYGB levels were significantly higher in the EO-PE and LO-PE groups as compared with the control group (9.99 (6.08) ng/ml (EOPE), 10.04 (7.04) ng/ml (LOPE) versus 2.84 (0.82) ng/ml), (p < .001). However, a significant difference was not found between the EO-PE and LO-PE groups regarding CYGB levels (p = 1.000). CONCLUSIONS: Serum CYGB levels were significantly higher in patients with EO-PE and LO-PE as compared to healthy pregnant women.

Role of ischemia-modified albumin in the evaluation of oxidative stress in intrahepatic cholestasis of pregnancy.

Objective: The objective of this study is to investigate the ischemia-modified albumin (IMA) level, and the IMA/albumin ratio (IMAR) in healthy pregnant women, and pregnant women with intrahepatic cholestasis of pregnancy (ICP). Material and method: This cross-sectional study included 53 women with ICP and 52 healthy pregnant women. Their serum IMA and albumin levels were analyzed, and the women were followed up to delivery. Results: No significant intergroup differences were identified in maternal age, body mass index, and gestational age at the time that the blood samples were taken. The gestational age at delivery and the serum albumin level was significantly lower (p = .002 and p < .0001, respectively) in the ICP group than in the healthy pregnant women. Although no differences in IMA levels were shown between the groups, IMA/albumin levels were higher in the ICP group than in the healthy pregnant women (p = .004). Conclusion: Serum IMA levels did not differ between pregnant women with ICP and healthy pregnant women, while the IMAR was significantly higher in the ICP group versus the healthy pregnant women.

Maternal serum sestrin 2 levels in preeclampsia and their relationship with the severity of the disease.

OBJECTIVE: To investigate sestrin 2 (SESN2) levels in preeclampsia (PE) cases and uncomplicated pregnancies. METHODS: Cross-sectional study including 26 pregnant women with PE, 24 with severe-PE, and 30 randomly selected healthy pregnant women. RESULTS: The mean arterial pressure, severe proteinuria, number of HELLP syndrome cases, and serum SESN2 levels in the severe PE group were significantly higher than those in the other groups (p < 0.001, p < 0.001, p = 0.006, and p = 0.004, respectively). Negative correlation was found between the birth interval (r = -.262, p = 0.019) and the SESN2 level. CONCLUSION: SESN2 seems to play a role in the pathophysiology of PE, especially in severe PE cases.

Modified abdominal packing method in "near miss" patients with postpartum hemorrhages.

OBJECTIVE: To describe a more effective abdominal packing method in patients with disseminated intravascular coagulation following peripartum hysterectomy due to postpartum hemorrhage (PPH). MATERIALS AND METHODS: The present retrospective and descriptive study was conducted to document six cases with refractory pelvic bleeding who underwent a second surgery for PPH between January 2016 and December 2017 at Istanbul Zeynep Kamil Woman and Children Diseases Training and Research Hospital. RESULTS: Karateke packing was performed to control intra-abdominal massive hemorrhages of five women who were referred to our clinic due to PPH who had undergone peripartum hysterectomy and hypogastric artery ligation but hemostasis could not be provided. In addition, a case of hypovolemic shock due to placenta percreta rupture in a woman who had also undergone an emergency hysterectomy and hypogastric artery ligation, which had failed. Hemostasis was provided in all patients. No method-related complication developed. CONCLUSION: Karateke packing is a very easy method to perform, it is more effective than the classic abdominal packing technique, with a low complication rate, and most importantly, life-saving in patients undergoing a peripartum hysterectomy due to PPH and thereafter experiencing diffuse hemorrhage.

An effect of maternal nifedipine therapy on fetoplacental blood flow: a prospective study.

PURPOSE: The aim of this study is to assess the effects of maternal nifedipine administration on placental and fetal blood flow. METHODS: A total of 29 patients with preterm labor diagnosis admitted to the tertiary care center, Zeynep Kamil Hospital, were evaluated. Before and 24-48 h after administration of oral nifedipine, Doppler ultrasound scan was carried out to measure fetal middle cerebral artery, ductus venosus, umbilical artery, and maternal uterine artery blood flow. RESULTS: After 24 and 48 h of therapy, there were no changes in mean PI and RI in the umbilical arteries and ductus venosus (p > 0.05). Fetal middle cerebral artery and maternal uterine artery PI and RI values showed a significant reduction 24-48 h after oral nifedipine therapy (p < 0.05). CONCLUSIONS: Our study showed that 24 and 48 h after oral nifedipine therapy, there is a significant increase in fetal MCA and maternal uterine artery blood flow, while fetal umbilical artery and ductus venosus Doppler values do not change.

Could first- and second-trimester biochemical markers for Down syndrome have a role in predicting intrahepatic cholestasis of pregnancy?

INTRODUCTION: The aim of this study is to compare first- and second-trimester Down syndrome biochemical screening markers in intrahepatic cholestasis of pregnancy (ICP) and normal pregnancies. MATERIAL AND METHODS: This observational case-control study was conducted at Health Sciences University Zeynep Kamil Maternity and Children's Health Training and Research Hospital and the Department of Obstetrics and Gynecology at Erciyes University Medical Faculty during 2016-2017. The study included 165 patients, and consisted of 62 women who had been diagnosed with ICP (the ICP-diagnosed group) and 103 healthy pregnant women (the control group). First-trimester free ß-human chorionic gonadotropin (ß-hCG), pregnancy-associated plasma protein-A (PAPP-A) and second-trimester total ß-hCG, estriol (E3), α-fetoprotein (AFP), and inhibin A levels were compared between the two groups. RESULTS: The mean patient age was 28.67 ±5.96 years, with no significant difference between the groups (p > 0.05). Average PAPP-A levels were significantly lower in the ICP-diagnosed group (p < 0.001). When the cut-off value for PAPP-A was taken as ≤ 0.93 multiple of median (MoM), the sensitivity and specificity values for ICP were 73.8% and 56.3%, respectively (95% CI, AUC ± SE: 0.663 ±0.042). CONCLUSIONS: The decrease in PAPP-A MoM value indicates an increase in the risk of developing ICP, while changes in other markers were not sufficient to predict ICP.

Insulin-like growth factor-1 receptor expression in pediatric tumors: a comparative immunohistochemical study

Background/aim: Insulin-like growth factor-1 receptor (IGF-1R) is a pivotal receptor tyrosine kinase involved in the cell cycle and malignant tumor transformation. It is differentially expressed in various types of tumors. We aimed to determine the expression of IGF- 1R in different pediatric tumors and to shed light on possible new indications of anti-IGF-1R treatment approaches. Materials and methods: A total of 147 specimens were analyzed according to their expression of IGF-1R. Specimens included those from rhabdomyosarcomas, Wilms tumors, Ewing sarcoma/primitive neuroectodermal tumors, peripheral neuroblastic tumors, acute lymphoblastic lymphoma, Hodgkin lymphoma, Burkitt lymphoma, retinoblastoma, pleuropulmonary blastoma, Langerhans cell histiocytosis, endodermal sinus tumors (ESTs), and myeloid sarcoma. Analysis was performed on tissue sections by immunohistochemically staining for IGF-1R expression. Results: All six specimens of EST cases showed positivity for IGF-R1. Additionally, about 56% of the Hodgkin lymphoma, 80% of the rhabdomyosarcoma, and 70% of the Wilms tumor specimens showed positivity for IGF-R1 expression. Conclusion: All ESTs examined in our study expressed IGF-1R and to our knowledge this is the first report regarding ESTs and IGF-1R expression. IGF-1R could be included among confirmatory markers for ESTs and, from a therapeutic viewpoint, ESTs should also be examined for IGF-1R expression for beneficial regimens.

Outcome of Cesarean Myomectomy: Is it a Safe Procedure?

OBJECTIVE: Myomectomy performed during cesarean section is still controversial because of the potential for associated complications, especially with large myomas. Many obstetricians avoid performing cesarean myomectomy procedures because of the risk of uncontrollable hemorrhage. However, the prevalence of pregnant women with myomas is increasing, leading to an increase in the likelihood that physicians will encounter this issue. The aim of this study was to compare outcomes and complications of patients who either had or did not have cesarean myomectomy. METHOD: A total of 361 patients were evaluated in this retrospective study. Patients who had cesarean section with myomectomy and patients had cesarean section without myomectomy were compared with regard to demographics, drop in hemoglobin levels, complications, blood transfusion rates and duration of operation. These parameters were also compared when the diameter of the myoma was larger than 5 cm. Values of p < 0.01 and p < 0.05 were considered statistically significant. RESULTS: While maternal age and gravidity were similar in both groups (p > 0.05), the mean myoma diameter was smaller and the duration of operation was longer in the group who underwent cesarean myomectomy (p < 0.05). The reduction in hemoglobin level, rate of complications, and number of transfusions were similar in both groups (p > 0.05). CONCLUSION: This study shows that myomectomy during cesarean section does not increase complications or transfusion rates and appears to be a safe procedure.