Melatonin levels and microRNA (miRNA) relative expression profile in the follicular ambient microenvironment in patients undergoing in vitro fertilization process.

PURPOSE: Intrafollicular fluid (IFF) melatonin plays a decisive role in maintaining granulosa cells' DNA integrity and protects them against apoptosis. It reduces oxidative stress and improves the oocyte quality with a higher fertilization rate. METHOD: This prospective study investigated the antioxidant property of IFF melatonin and its impact on IVF outcome parameters. We also explored the relative expression of five microRNAs (miR-663b, miR-320a, miR-766-3p, miR-132-3p, miR-16-5p) and levels of cell-free DNA (cfDNA) by real-time PCR in unexplained infertile patients. We collected 425 follicular fluid (FF) samples containing mature oocytes from 295 patients undergoing IVF. RESULTS: Patients were subgrouped based on IFF melatonin concentration (group A ≤ 30 pg/mL, group B > 70 to ≤ 110 pg/mL, group C > 111 to ≤ 385 pg/mL). Our results showed that patients with ≤ 30 pg/mL IFF melatonin levels have significantly higher oxidative stress markers, cfDNA levels, and lower relative expression of miR-663b, miR-320a, miR-766-3p, miR-132-3p, and miR-16-5p compared to other subgroups (p < 0.001). Similarly, they have a low fertilization rate and a reduced number of high-quality day 3 embryos. CONCLUSION: Findings suggest that the therapeutic use of melatonin produces a considerable rise in the number of mature oocytes retrieved, fertilization rate, and good-quality embryo selection. Furthermore, miRNA signature enhances the quality of embryo selection, thus, may allow us to classify them as non-invasive biomarkers to identify good-quality embryos.

The predictive role of sTWEAK levels in pregnant women with first-trimester vaginal bleeding.

PURPOSE: To investigate the relationships of TNF-related weak inducer of apoptosis (sTWEAK), a cytokine related to the TNF superfamily, its newly described soluble receptor sCD163, and the sTWEAK/sCD163 ratio with perinatal outcomes in women with first-trimester vaginal bleeding. MATERIALS AND METHODS: Seventy (41 threatened abortion and 29 control) gestational-age-matched (6-14 weeks) pregnant women were included in the study. Antenatal complications (gestational diabetes, preeclampsia, intrauterine growth restriction, oligohydramniosis, polyhydramniosis), and perinatal outcomes (delivery mode, birth weight, delivery week) were recorded. Women with vaginal bleeding were divided into subgroups by pregnancy outcome (miscarriage or live birth) and subchorionic hematoma incidence. Statistical analyses were performed using the Student's t test, Mann-Whitney U test, chi-square test, and Pearson's correlation coefficient. p Values <.05 were considered as statistically significant. RESULTS: There were no statistically significant differences in sTWEAK or sCD163 levels, in sTWEAK/sCD163 ratios, or antenatal complications between threatened abortion and control patients. Higher sTWEAK levels were significantly correlated with higher rates of miscarriage in the threatened abortion group (p = .014). sCD163 levels were significantly lower in the subchorionic hematoma subgroup of the threatened abortion group (p = .043). CONCLUSIONS: sTWEAK levels may predict the risk of miscarriage in pregnant women with first-trimester vaginal bleeding.

Is the level of maternal serum prohepcidin associated with preeclampsia?

OBJECTIVE: The objective of the study was to compare pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), C-reactive protein (CRP), IL-6 and iron status parameters in preeclamptic (PE) and healthy pregnant women, and to examine the relationship between serum pro-hepcidin levels and iron parameters of preeclampsia (PE). METHODS: In a prospective controlled study, we collected serum from women with normal pregnancy (n = 37) and from women with PE (n = 30) at the Department of Obstetrics and Gynecology at Turgut Ozal University between February 2010 and January 2013. Pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), CRP, IL-6 and iron status parameters were measured in all patients and compared between groups. RESULTS: Levels of serum prohepcidin in PE and control groups were similar and amount 69.4 ± 19.7 and 71.9 ± 22.1 ng/ml, respectively. The difference was not statistically significant (p: 0.694). On the other hand, the study group had a statistically lower iron binding capacity (IBC), total iron binding capacity, transferin, total protein, albumin levels (p < 0.05). No significant differences were found among prohepcidin, Hb concentration, Hct, iron, ferritin, IL-6, urea and creatine in both the groups. CONCLUSION: In pregnancies complicated by PE with normal values of hemoglobin and hematocrit, serum prohepcidin concentrations are similar to those observed in healthy pregnant women. The analysis revealed no significant correlations between prohepcidin level and serum iron, serum ferritin or transferrin in the PE.

Changes of sFas and sFasL, oxidative stress markers in serum and follicular fluid of patients undergoing IVF.

PURPOSE: The Fas-Fas Ligand interaction is one of the essential events for the induction of apoptosis whereas the exact role of their soluble forms in the reproductive system is still not fully understood. Also oxidative stress in the pathogenesis of infertility causing diseases in women and has been suggested as one of the important factors that negatively affect IVF outcome. In this study, our aim was to evaluate serum and follicular fluid levels of soluble Fas soluble Fas Ligand, malondialdehyde, superoxide dismutase and total antioxidant capacity in patients undergoing IVF and compared with controls. METHODS: This study included 109 patients. Patients were classified as unexplained infertility (N = 31), PCOS (N = 19), tubal factor (N = 9) and endometriosis (N = 10) and compared with male factor infertility (N = 40) that was the control group. sFas and sFasL levels were measured by immunoassay method. MDA, SOD and TAC levels were measured by colorimetric method. RESULTS: Patients with unexplained infertility, PCOS and tubal factor had significantly lower sFas levels compared with their controls (respectively, p < 0.01, p < 0.05, p < 0.05). However, SOD activity in unexplained infertility, PCOS and endometriosisgroupswere significantly higher than control group (p < 0.01).Decreased follicular fluid TAC levels were found in all patient groups compared with controls (respectively, p < 0.01, p < 0.05, p < 0.01, p < 0.01).Patients with tubal factor had significantly higher serum sFasL (p < 0.05), but lower follicular fluid sFasL levels (p < 0.05) compared with unexplained infertility. Tubal factor and endometriosis groups had lowerfollicular fluid TAC levels compared to unexplained infertility and PCOSgroups (p < 0.01). CONCLUSION(S): In this study, serum and follicular fluid sFas levels were decreased and antioxidant activity was impaired in infertility, possibly implying increased apoptosis. Especially in unexplained infertility group changes in this parametres more remarkable.

Hepcidin, iron status, and inflammation variables among healthy pregnant women in the Turkish population.

PURPOSE: To investigate hepcidin levels in each trimester and their association with other haematological variables and inflammation markers during normal pregnancy among low-risk pregnant women in rural Turkey. METHOD: The series comprised 103 healthy Turkish primigravida women with a normal pregnancy. Blood samples were obtained at 11-14, 24-28 and 30-34 weeks of gestation. Haemoglobin, hematocrit, red cell indices, white blood cell count, platelet count, iron status indicators (plasma iron, transferrin, ferritin levels and iron binding capacity), serum hepcidin, interleukin-6 and C-reactive protein levels were analysed. The proportions were compared using Pearson's χ2 test or Friedman's test. RESULTS: The mean serum hepcidin concentrations at 11-14, 24-28 and 30-34 weeks of gestation were as follows: 7.8 ± 3.4 ng/mL, 8.6 ± 3.1 ng/mL and 7.3 ± 3.0 ng/mL, respectively. The mean serum ferritin concentrations with median values at each trimester were 14.2 (11.5), 9.5 (8.8) and 11.2 (9.3), respectively. The mean serum CRP values at each trimester were 5.1 (4.0), 5.5 (4.6) and 6.0 (5.5), respectively. The serum hepcidin levels were not related to iron status or the haemoglobin, IL-6 or C-reactive protein levels. CONCLUSIONS: There was no association between serum hepcidin and serum ferritin, IL-6 or CRP concentrations in each trimester among low-risk pregnant women.

Impact of inherited thrombophilias on first and second trimester maternal serum markers for aneuploidy.

OBJECTIVE: To evaluate first and second-trimester maternal serum markers in pregnancies complicated with inherited thrombophilias. METHODS: A case-control study was conducted in 50 pregnancies complicated with hereditary thrombophilia and 100 control pregnancies. RESULTS: Each woman with inherited thrombophilia received low molecular weight heparin (LMWH) throughout her pregnancy. Gravidity, parity, number of first-trimester and second-trimester abortions, and rate of adverse pregnancy outcomes (APO) were significantly higher in the thrombophilia group compared to the control group (P < 0.001 for all). Among the thrombophilia group median values of pregnancy associated placental protein-A (PAPP-A) (0.6 vs. 0.9; P < 0.001) and free ß-human chorionic gonadotropin (ß-hCG) (0.9 vs. 1.1; P = 0.001) in the first trimester; median values of α-fetoprotein (AFP) (0.7 vs. 1.1; P = 0.027), unconjugated estriol 3 (uE3) (0.9 vs. 1.1; P < 0.001), and hCG (0.7 vs. 1.2; P < 0.001) in the second trimester were significantly lower with respect to control pregnancies. Multivariate analysis revealed that low uE3 and hCG levels were independently associated with APO. CONCLUSION: Pregnant women with hereditary thrombophilias, all of whom were treated with LMWH, had decreased levels of all first and second trimester serum markers. In addition, levels of hCG and uE3 in the second trimester could independently predict placenta-related disorders and adverse outcomes in these patients.

First trimester volumetric measurements: relation with hormone levels and fetal heart rate.

PURPOSE: This study aimed to examine two-dimensional ultrasound (2D US) volumetric measurements of 1st trimester structures and their relationship with ß-hCG, progesterone, and fetal heart rate (FHR) in 6-10 weeks healthy pregnant women. METHODS: Using conventional 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS) and gestational sac (GS) were measured in 80 women. Volumetric measurements were done in 32 cases that were selected among 80 women, using a simplified formula for the volume of a prolate ellipsoid: V = 0.523 × length × height × width. The ß-hCG and progesterone levels were recorded. The heart rate was determined from M-mode tracings using electronic calipers. RESULTS: Moderately positive correlation was found between FHR versus CRL, embryo volume and GS volume. FHR increased linearly with CRL value, till CRL became 15 mm, after which it formed a plateau. ß-hCG increased linearly till CRL was 15 mm, and then it formed a plateau. Progesterone level was stable till CRL became 20 mm, embryo volume 2 cm(3), after which it increased linearly. CONCLUSION: Various ranges of relations are observed between FHR, obstetric, and hormonal measurements. The relationship between these parameters might be used for determination of abnormal growth and adverse outcomes in early pregnancy.

Evaluation of risk factors and effect of physical activity in caesarean section in nulliparous women.

OBJECTIVE: The aim of this study was to evaluate risk factors for caesarean section (CS) in nulliparous women and to determine the effect of physical activity on ease of labour. METHODS: A prospective observational study, including 282 nulliparous women at 37-41 gestational weeks was conducted. Maternal demographic characteristics, obstetric history and Modified Grimby scale for evaluation of physical activity were noted. Patients were classified into spontaneous labour and induction group. Multiple logistic regression model was used to assess independent risk factors for type of delivery. RESULTS: Caesarean rate was increasing with higher educational status (p < 0.001). Maternal height, maternal and paternal age were higher, whereas dilatation on admission was lower in CS group (p < 0.05). Maternal age, weight gain and CS rate were higher in induction group (p < 0.05). Fetal distress as a cause of CS was detected higher in induction group (p < 0.05). Physical activity has no significant effect on mode of delivery (p > 0.05). Maternal height (p = 0.011), and cervical dilatation on admission (p = 0.004) were identified as predictor factors for CS. CONCLUSION: Cervical dilatation is the most important negative predictive factor for CS, whereas, moderate physical activity has no effect on mode of delivery. Fetal distress was the most frequent cause of CS in induction group.

Evaluation of risk factors in cesarean delivery among multiparous women with a history of vaginal delivery.

OBJECTIVE: To predict the risk of cesarean delivery (CS) for multiparous women who have undergone previous vaginal delivery. MATERIAL AND METHODS: A prospective observational study was performed, among multiparous pregnancies that were between 38 and 41 gestational weeks and had a singleton, vertex presentation fetus. Women's physical activity score, obstetric history, intrapartum and postpartum events were assessed. Multivariable logistic regression was used to explore risk factors associated with CS. RESULTS: Of the 245 total 83.7% had spontaneous labor and 16.3% were induced. Seventy-five percent of the induced women required CS, whereas only 19.5% of those with spontaneous labor required CS (p<0.001). The logistic regression analysis model included maternal weight gain, physical activity score, cervical dilatation, and fetal weight as the predictors of CS. We detected 7 (10%) maternal complications in women who underwent intrapartum CS. CONCLUSION: Labor induction is significantly associated with increased risk of cesarean delivery among previously vaginally delivered women and maternal weight gain, physical activity score, cervical dilatation, and fetal weight are most accurate parameters in the prediction of the risk of CS delivery. Intrapartum CS has an increased risk of maternal morbidity.

First trimester maternal serum PAPP-A and free ß-HCG levels in hyperemesis gravidarum.

OBJECTIVE: To evaluate whether hyperemesis gravidarum (HG) affects first-trimester maternal serum PAPP-A and free ß-hCG levels. METHOD: An observational study was conducted in 115 cases of HG and 110 control pregnancies who attended the first-trimester prenatal screening program between January 2006 and July 2010. RESULTS: Maternal serum TSH levels were lower and free T4, and transaminases (ALT, AST) levels were higher in pregnancies complicated with HG compared with controls (p < 0.05 for all). In HG cases, median values of maternal serum PAPP-A were significantly higher with respect to normal pregnancies (1.2 vs 1.0 MoM; p = 0.009). Similarly, median values of free ß-hCG were 1.3 MoM in HG pregnancies and 1.0 MoM in controls (p = 0.006). Multivariate analysis revealed that PAPP-A and hCG were independently associated with HG after controlling for TSH, free T4, AST, and ALT. CONCLUSION: HG is associated with elevated levels of PAPP-A and free ß-hCG, and such changes are independent of serum indicators of thyroid and liver function.

Oxidant/antioxidant status in premenstrual syndrome.

PURPOSE: To investigate oxidant/antioxidant status in premenstrual syndrome (PMS). METHODS: Study group (n = 20) consisted of PMS and control group (n = 21) consisted of normal menstruating women. The serum oxidant status was assessed by the lipid hydroperoxide (LHP), malondialdehyde (MDA) and protein carbonyl (PC); the antioxidant status was assessed by the total thiol (T-SH) and total antioxidant capacity (TAC). RESULTS: The study and control groups revealed no statistical difference, in terms of day 3 LHP, MDA, PC, T-SH and TAC levels. There were no significant differences between groups in terms of day 21 MDA, PC and T-SH levels. However, day 21 LHP levels were increased and TAC levels were decreased in the study group compared with the control group. CONCLUSION: Increased oxidative stress and reduced antioxidant capacity may occur in PMS. It can be speculated that the imbalance of oxidant/antioxidant systems may be a cause or the consequence of the various stress symptoms in PMS.

Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies.

PURPOSE: To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. METHODS: The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. RESULTS: Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. CONCLUSIONS: Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

Serum platelet-activating factor acetylhydrolase activity: relationship with metabolic syndrome in women with history of gestational diabetes mellitus.

OBJECTIVE: The aim of this study was to evaluate plasma platelet-activating factor acetylhydrolase (PAF-AH) activity in euglycaemic women with history of gestational diabetes (GDM), and to explore whether this activity is associated with metabolic syndrome (MS) in this group of women. METHODS: The cross-sectional study included 36 women with history of GDM and 40 women with history of normal glucose tolerance in pregnancy (control group). RESULTS: Compared to the controls, the GDM group had significantly higher mean values for serum glucose, insulin, HOMA-IR, triglyceride, GGT and plasma PAF-AH activity, and a statistically higher prevalence of MS. Within the GDM group, women diagnosed with MS had significantly higher PAF-AH activity than those without MS (p=0.002). CONCLUSION: This is the first study to have shown that plasma PAF-AH activity and GGT levels may be significant for evaluating atherosclerosis risk and metabolic hepatic damage in women with history of GDM.

Nifedipine for the treatment of preterm labor in twin and singleton pregnancies.

PURPOSE: To investigate the outcomes of singleton and twin pregnancies that were complicated by spontaneous preterm labor and received nifedipine tocolysis. METHODS: We identified the following subjects from a computerized, hospital database: 58 singleton and 32 twin pregnancies that were between 24 and 34 weeks of gestation, admitted for spontaneous preterm labor without rupture of the membranes, and receiving tocolysis with nifedipine. Data were analyzed using the Chi-square test, the Mann-Whitney test, and the Kaplan-Meier survival analysis. RESULTS: Spontaneous, preterm delivery occurred in 31.1% cases of singleton and 81.3% of twin pregnancies. Although the 22% of the mothers of twins did not have cervical changes upon admission, 37% of twins were delivered within 48 h. Mean for delivery weeks from admission to 36 weeks was significantly less for twin than it was for singleton gestations (32.3 ± 1.0 vs. 35.0 ± 0.5 weeks, respectively; Mantel-Cox X (2) = 41.118; p < 0.001). The maternal side effects were not significantly different between the groups. No serious cardiovascular complication had been found in either group. CONCLUSIONS: Tocolysis with nifedipine is effective and safe for use in both singleton and twin gestations.

Fetal magnetic resonance imaging in obstetric practice.

Ultrasonography (USG) is the primary imaging method for prenatal diagnosis of fetal abnormalities since its discovery. Although it is the primary method of fetal imaging, it cannot provide sufficient information about the fetus in some conditions such as maternal obesity, oligohydramnios and engagement of the fetal head. At this stage, magnetic resonance imaging (MRI) facilitates examination by providing more specific information. The need and importance of fetal MRI applications further increased by the intrauterine surgery which is currently gaining popularity. Some advantages of fetal MRI over USG are the good texture of contrast, a greater study area and visualization of the lesion and neighbourhood relations, independence of the operators. Also it is not affected by maternal obesity and severe oligohydramnios. However, MRI is inadequate in detecting fetal limb and cardiac abnormalities when compared to USG. MRI is not used routinely in pregnancy. It is used in situations where nonionizing imaging methods are inadequate or ionizing radiation is required in pregnant women. It is not recommended during the first trimester. Contrast agent (Godalinium) is not used during pregnancy. It is believed that MRI is not harmful to the fetus, although the biological risk of MRI application is not known. MRI technique is superior to USG in the detection of corpus callosum dysgenesis, third-trimester evaluation of posterior fossa malformations, bilateral renal agenesis, diaphragmatic hernia and assessment of lung maturation. Especially, it is the method of choice for evaluation of central nervous system (CNS) abnormalities. Fetal MRI has a complementary role with USG. It provides important information for prenatal diagnosis, increases diagnostic accuracy, and in turn affects the prenatal treatment, prenatal interventions and birth plan.

First-trimester ultrasonography revealed a gestational sac featuring cystic spaces and no visible embryo: a case of trisomy 7.

Ultrasound examination in early pregnancy has steadily gained importance and is now routine for most women in the first trimester. The sonographic features of early trisomy 7 pregnancies are not well characterized. We present a case of trisomy 7 in which early pregnancy ultrasound revealed a gestational sac featuring cystic spaces and no visible embryo. Based on comparison with a previously reported case of trisomy 7 featuring a multicystic anembryonic gestational sac we suggest that this ultrasonographic finding may be a sign of trisomy 7.

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period.

OBJECTIVE: To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS: Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS: Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION: If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.

Effect of genistein therapy on plasma levels of asymmetric dimethylarginine in healthy postmenopausal women: a randomized, placebo-controlled study.

The aim of this study was to investigate the effects of pure genistein therapy on asymmetric dimethylarginine in healthy postmenopausal women. Healthy postmenopausal women received pure genistein (n=21) or placebo (n=17) for 6 months, and no statistically significant effects on plasma asymmetric dimethylarginine levels were found with pure genistein treatment.

Does glomerular hyperfiltration in pregnancy damage the kidney in women with more parities?

OBJECTIVES: We aimed to investigate the glomerular hyperfiltration due to pregnancy in women with more parities. METHODS: Five hundred women aged 52.57 +/- 8.08 years, without a history of hypertension, diabetes mellitus or complicated pregnancy were involved in the study. They were divided into three groups. Group 1: women with no or one parity (n = 76); group 2: women with two or three parities (n = 333); group 3: women with four or more parities (n = 91). Laboratory parameters and demographical data were compared between the three groups. RESULTS: Mean age, serum urea and serum creatinine were similar between three groups. Patients in group 3 had significantly higher GFR values compared to groups 1 and 2 (109.44 +/- 30.99, 110.76 +/- 30.22 and 121.92 +/- 34.73 mL/min/1.73 m(2) for groups 1, 2 and 3, respectively; P = 0.008 for group 1 vs group 3; P = 0.002 for group 2 vs group 3). CONCLUSIONS: In our study, we suggest that glomerular hyperfiltration due to pregnancy does not have adverse effects on kidney in women with more parities. Pregnancy may have possible protective mechanisms for kidney against adverse effects of glomerular hyperfiltration.

Acute urinary retention caused by a large impacted leiomyoma.

OBJECTIVE: Both acute urinary retention (UR) and impacted pelvic mass are rare events in women. We report a case of complete UR caused by impaction of a large myomatous uterus. CASE: A 36-year-old virgin woman presented to the outpatient clinic of our department for further investigation of her pelvic mass. Abdominal sonography showed a solid, hypoechoic, 11 x 9 cm mass filling the pelvic cavity. After sonography, the patient was unable to void second time in that week and a Foley catheter had to be re-inserted. Laparotomy revealed a large myoma filling the entire pelvic cavity. The uterus-mass complex was impacted in the pelvis, leiomyoma had been compressing the uterus into the base of the pelvis. Myomectomy was performed. CONCLUSION: It seems that complete UR associated with pelvic mass is usually a sign of pelvic impaction of the mass.