Evaluation of Nrg4 and thiol/disulfide homeostasis in patients with GDM.

BACKGROUND: In this study, we aimed to evaluate the role of neuregulin4 (Nrg4) in the etiopathogenesis of gestational diabetes mellitus (GDM) and thiol/disulfide homeostasis as an indicator of oxidative stress. METHODS: This prospective, case-control study included 34 women with diabetes and 34 healthy pregnant women who applied between January 2017 and January 2020. Levels of native and total thiol, disulfide and Nrg4 were measured in both diabetes mellitus and healthy pregnant groups. RESULTS: When compared to the control group, the serum neuregulin4 levels in the diabetes group were considerably lower (3.22 ± 2.16 vs. 4.55 ± 0.96, p < 0.001). Native thiol (292.67 ± 43.65 vs. 366.40 ± 51.28; p < 0.001), total thiol (388.60 ± 46.60 vs. 414.52 ± 54.19; p < 0.001) levels and native thiol/total thiol ratio (75.51 ± 8.95 vs. 88.35 ± 3.54; p < 0.001) were lower in diabetes group compared to control group. Disulfide level (47.96 ± 19.52 vs. 24.06 ± 7.69) and disulfide/native thiol (17.13 ± 8.03, vs. 6.67 ± 2.30) and disulfide/total thiol (12.24 ± 4.47 vs. 5.82 ± 1.77) ratios were higher in diabetes group (all p < 0.001). CONCLUSIONS: We suggested that decreased Nrg4 level and impaired oxidative stress parameters may be related with the increased risk of diabetes. However, we did not found a correlation between the Nrg4 and oxidative stress parameters.

Shear-wave elastography for detection of placenta percreta: a case-controlled study.

BACKGROUND: Prenatal diagnosis of placenta percreta (PP) is important to be able to provide effective management and a multidisciplinary approach to minimize the complications. PURPOSE: To evaluate the role of shear-wave elastography (SWE) in the prenatal diagnosis of PP. MATERIAL AND METHODS: A total of 18 women with PP and 20 pregnant women with normal placenta in the second or third trimesters were included in this prospective study. SWE was used to determine the elasticities of the placenta (in the maternal edge of the placenta) and myometrium. The obstetric data regarding grayscale and Doppler ultrasonography, and perinatal outcomes were reviewed. A mean placental SW velocity (SWV) cut-off value was determined to predict the presence of placental adherence. RESULTS: The SWV values of the PP group in the maternal edge of the placenta were significantly higher than those of the control group (1.95 ± 0.19 m/s and 1.69 ± 0.23 m/s; P = 0.001). Myometrial SWV was also higher in the PP group compared to the control group (2.25 ± 0.39 m/s and 1.90 ± 0.71 m/s; P = 0.002). A receiver operating characteristic (ROC) curve analysis was performed and the best cut-off value of placental SWV was determined as 1.92 m/s with sensitivity of 58% and specificity of 80%, to predict the placental adherence in patients with PP. CONCLUSION: Placental stiffness was significantly higher in patients with PP than in pregnant women with normally localized placenta. Thus, we thought that SWE of the placenta might be used as an alternative method in the diagnosis of PP.

A comparison of crystal phenol treatment, midline primary closure and Limberg flap reconstruction methods in female patients with primary pilonidal sinus disease.

Pilonidal sinus disease (PSD) is a chronic problem often occurs in healthy hirsute men, however, women may also be affected. A range of conservative techniques to surgical flaps have been used to treat this condition. Currently, midline primary closure (MPC) is considered the standard of therapy; however, no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure. Recently, flap reconstruction methods have been applied and superiority of these methods have been shown. Treatment methods should be employed to the individual, taking into account recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill. KEY WORDS: Crystal Phenol Treatment, Female Patient, Pilonidal Sinus, Limberg Flap Reconstruction, Primary Midline Closure.

The relationship between gestational week and QT dispersion in cesarean section patients undergoing spinal anaesthesia: A prospective study.

BACKGROUND: Pregnancy affects the cardiovascular system, particularly the cardiac conduction system, thereby increasing the susceptibility of patients towards arrhythmia. QT interval results in ventricular arrhythmias, predominantly polymorphic ventricular tachycardia. The present study was planned to investigate the relationship between a gestational week and QT dispersion in cesarean section patients undergoing spinal anaesthesia. METHODS: The study included 40 patients between the ages of 18 and 45 who had no symptoms of anaemia and undergoing elective cesarean section. The patients were separated into two groups based on the gestational week as Group I <39 weeks and Group II ≥39 weeks. The patient was given a sitting position and the puncture site was cleansed with 10% povidone-iodine antiseptic solution. After placing a sterile drape on the patient, the subarachnoid space was punctured through an appropriate vertebral space (L3-L4 or L4-L5) using a pencil-point 25G spinal needle, followed by intrathecal injection of 12.5 mg (2.5 mL) 5% hyperbaric bupivacaine hydrochloride. Electrocardiographic (ECG) records were obtained both preoperatively and at 1, 5, and 10 minutes after spinal block, and the QT, QTc, QTd, and corrected QTd (QTcd) intervals were estimated using Bazett's formula. RESULTS: There was no significant difference between the two groups within the QT and QTc intervals. QTcd measured after post-operative was significantly higher in Group II (P = .007). CONCLUSION: The results indicated that spinal anaesthesia may prolong the QTdc interval in patients with a gestational week of ≥39 weeks undergoing cesarean section.

Evaluation of Plasma Free Amino Acid and Carnitine Levels in Patients with Cesarean Scar Pregnancy.

AIM AND OBJECTIVE: This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. MATERIALS AND METHODS: This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: the CSP group (n = 30) and the healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twenty-seven carnitines and their esters and 14 FAAs were analysed by liquid chromatography - mass spectrometry (LC-MS/MS). RESULTS: The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14-1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in the CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5- 1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2, were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values, were significantly higher in the CSP group than in the control group. However, there was no statistical significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson's correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. CONCLUSION: Since several plasma carnitines and FAA levels were higher in the CSP group than in the control group, we think that scar pregnancy increases the metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.

A spontaneous pregnancy and live birth in a woman with primary infertility following the excision of an ovarian adrenal rest tumor: A rare case.

Adrenal rest tumors are a rare extra-adrenal complication of congenital adrenal hyperplasia (CAH) in women although they are more commonly found in the testes of male patients with CAH. An ovarian adrenal rest tumor (OART) may coexist with CAH or imitate its symptoms without CAH. In this case report, we present the case of a woman with OART without CAH, whose main complaint was infertility and who had a baby after successful surgical treatment.

Recurrent pregnancy loss and metabolic syndrome.

OBJECTIVES: The aim of this study was to evaluate the frequency of metabolic syndrome (MetS) and its components in patients with unexplained recurrent pregnancy loss (RPL). MATERIAL AND METHODS: A cross-sectional study was held including 115 patients with unexplained RPL who were referred to a tertiary center between December 2018 and December 2019. In the study, MetS was classified according to The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria on the basis of metabolic risk factors. Frequency of MetS in the patients with unexplained RPL was investigated. The relationship between miscarriage rate and metabolic risk factors was also evaluated. RESULTS: According to our study the percentage of MetS in patients with unexplained RPL was 24.4%. When evaluated according to different age groups, it was 18.4% in patients aged 20-29 years, and it was 27.8% in patients aged 30-39 years. At least having one of its components were high (82.6%) in all patients with unexplained RPL. CONCLUSIONS: The percentage of MetS or of at least having one of its components were high in patients with unexplained RPL. Increased number of having MetS components were associated with increased miscarriage rate.

Copper and ceruloplasmin levels are closely related to the severity of preeclampsia.

Objective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease.Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists' 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman's rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity.Results: The mean ± SD of the Cu was 81.2 ± 11.84 µg/dl in the mild preeclampsia cases and 160.2 ± 20.89 µg/dl in the severe preeclampsia cases (p < .001). The mean ± SD of the CP was 33.0 ± 4.81 mg/dl in the mild preeclampsia cases and 65.3 ± 9.17 mg/dl in the severe preeclampsia cases (p < .001). The Cu and CP levels were significantly higher in the patients with HELLP syndrome, which is an advanced and more severe form of severe preeclampsia, than in the mild and severe preeclampsia patients (p < .001 and p < .001, respectively). Therefore, the serum Cu and CP levels were correlated with the severity of preeclampsia (r = 859, p < .001 and r = 786, p < .001, respectively). In addition, there was a positive correlation between the serum Cu and CP levels and the systolic and diastolic blood pressure values and aspartate amino transferase levels (AST), and a negative correlation between the serum Cu and CP levels and the platelet count.Conclusion: This was the first study in which the ceruloplasmin and Cu levels were investigated in HELLP syndrome patients. When considering the results obtained in the present study, there were significant relationships between the Cu, CP levels which are the markers of oxidative stress and the preeclampsia severity.

The Effects of Rocuronium-sugammadex on Fetomaternal Outcomes in Pregnancy Undergoing Electroconvulsive Therapy: A Retrospective Case Series and Literature Review.

Introduction The aim of this study was to evaluate the anesthesia management of pregnant patients who received electroconvulsive therapy (ECT) at our hospital and to examine the effects of this procedure on mothers and fetuses. Methods This study was conducted with 15 pregnant patients who underwent the ECT procedure who did not benefit from medical treatment or who did not want medical treatment. We evaluated the psychiatric, obstetric, and especially anesthesiology records of these patients. All of the patients received 1 mg/kg propofol with 0.6 mg/kg rocuronium. Eight mg/kg sugammadex was used to terminate the effects of the non-depolarizing neuromuscular blocking agents. Their demographic characteristics, history of diagnosis, total ECT sessions, duration of hospitalization, discharge status, neonatal outcomes, short- and long-term maternal or fetal complications, anesthetic management, and recovery parameters were retrospectively reviewed. Results Fifteen pregnant patients received a total of 95 ECT treatments. No anesthesia-related maternal complications developed. In terms of the recovery parameters of the patients, the mean duration of the motor seizure was 28.7 ± 6.3 seconds, the mean time to spontaneous respiration was 224 ± 21.8 secs, the mean time to opening the eyes was 403.6 ± 21.1 secs, and the mean time to command compliance was 415.24 ± 81.15 secs. The mean gestational week was 14.06 ± 6.65, and the mean number of pregnancies was 2.87 ± 2.29. Seven (46,7%) patients were in the first trimester of pregnancy, six (40%) were in the second trimester, and two (13.3%) were in the third trimester. Spontaneous abortion occurred in four patients, six patients gave birth by spontaneous vaginal delivery, and five patients delivered by cesarean section. Neonatal respiratory distress developed in only one fetus. Conclusion Anesthesia management during ECT can be provided safely by using propofol and rocuronium-sugammadex in pregnancy in the postoperative period. However, there is a risk of abortion and neonatal respiratory distress in the use of ECT, especially in the first trimester period. It is advisable to inform the patient's family in detail before this procedure outcome.

Cytogenetic screening in couples with Habitual Abortions.

OBJECTIVE: Habitual abortion (HA) is defined at least three consecutive pregnancy losses. One of the etiologic causes is parental chromosomal anomalies. In this study, we aimed to that investigate the effect of parental chromosomal abnormalities on HA. METHODS: The cytogenetic results of patients with at least three abortions referred to our university hospital between January 2010 - March 2017 were evaluated. A total of 1154 couples with HA were analysed. Peripheral lymphocyte cultures incubated for 72 h were used for karyotype analysis via the Giemsa banding technique. RESULTS: Of a total 1154 couples (2308 patients) 37 female (3.2%) and 17 male (1.47%) had abnormal karyotypes. Reciprocal translocation carriage (n = 26; 1.12%) was the most commonly detected structural anomaly, followed by X chromosome mosaicism (n = 16; 0.69%),Robertsoniantranslocation (n = 9; 0.38%), Chromosomal inversion (n = 6; 0.26%). Chromosomal polymorphisms, which are considered minor chromosomal changes, were detected in 221 (9.57%) individuals. CONCLUSION: Our study exhibits that chromosomal analysis in patient with HA is an appropriate approach to elucidate the aetiology of HA. Data from cytogenetic screening can be used in guiding couples planning future pregnancies and in prenatal diagnosis of chromosomal anomalies in the foetus.

Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital.

OBJECTIVE: The main objective of this study is to analyse the circumstances and management of peripartum hysterectomies performed on patients with placenta percreta. METHODS: This study included 37 patients who were diagnosed with placenta percreta, a condition in which the placenta invades the uterine wall, and who therefore underwent a peripartum hysterectomy. Their demographic characteristics, history of past caesareans, uterine surgery and curettage, duration of hospitalization, admission to an intensive care unit, neonatal outcomes, skin and uterus incision type, hypogastric artery ligation (HAL), complications, quantities of transfused ES (erythrocyte suspensions), and FFP (fresh frozen plasma), maternal morbidity and mortality and postoperative pathology results were retrospectively reviewed. RESULTS: All pregnant patients who underwent a caesarean hysterectomy due to placenta percreta had a history of caesarean section and also of placenta praevia totalis. Bilateral HAL was performed in two patients (5.4%), owing to uncontrollable bleeding during the bladder dissection. The complications most frequently observed were bladder injury (13.5%), followed by infection (8.1%) and relaparotomy (5.4%). There was no mortality. Twenty-three (62.2%) of the patients had ES and 11 patients (29.7%) had FFP transfusions. According to the histopathology findings, 33 of the 37 patients (89.1%) reportedly had placenta percreta, three patients had placenta increta, and one patient had placenta accreta. Analysis of the neonatal status at birth showed that the gestational age was, on average, the 35th week. The birth weight was normal in relation to the gestational week, but the first and fifth minute Apgar score, which measures the physical condition of an infant, was found to be lower than the normal range. CONCLUSIONS: If a pregnant patient undergoes uterine surgery or has a history of a caesarean with placenta praevia, she is likely to have placenta percreta. In placenta percreta cases with bladder invasion; careful suturing of the high-volume vessels on the posterior wall of the bladder, through the bladder serosa is important in reducing the amount of bleeding and preventing future fistula formation.

Associations of serum fetuin-A and oxidative stress parameters with polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to compare serum fetuin-A levels and oxidative stress markers, as indicators of insulin resistance, in women with polycystic ovary syndrome (PCOS) and in healthy controls. METHODS: This prospective case-control study included 46 patients with PCOS and 48 age- and body mass index-matched control women. Levels of serum hormones, fetuin-A, and oxidative stress markers were measured in blood samples taken during the early follicular period from each participant. RESULTS: Follicle-stimulating hormone (FSH), luteinising hormone (LH), total testosterone levels, and the LH/FSH ratio were found to be significantly higher in women with PCOS than in controls. Serum total antioxidant status, total oxidant status, and oxidative stress index parameters all indicated significantly higher levels of oxidative stress in PCOS patients than in controls. Serum fetuin-A levels, which were analyzed as an indicator of insulin resistance, were higher in the PCOS group than in the control group (210.26±65.06 µg/mL and 182.68±51.20 µg/mL, respectively; p=0.024). CONCLUSION: The data obtained from the present study suggest that higher levels of both serum fetuin-A and oxidative stress markers might be related with PCOS.

A new biomarker for the early diagnosis of ovarian torsion: SCUBE-1.

OBJECTIVE: Prompt diagnosis and management are essential for saving the adnexal organs from infarction in cases of ovarian torsion (OT). This study aimed to determine the diagnostic significance of signal peptide, complement C1r/C1s, Uegf, and Bmp1 (CUB), and epidermal growth factor-like domain-containing protein-1 (SCUBE-1) levels in cases of OT, an emergent ischemic condition, and the relationship of SCUBE-1 with oxidative stress parameters. METHODS: This prospective study was conducted among 15 OT patients and 20 age- and gravidity-matched healthy women. SCUBE-1 serum concentrations were determined by using enzyme-linked immunosorbent assays. In addition, oxidative stress was evaluated by measuring the serum levels of advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), and glutathione (GSH). RESULTS: The SCUBE-1 titers were significantly higher in the patients with OT than in the controls (p=0.008). In addition, serum FRAP and GSH levels were significantly lower in the OT patients than in the controls (p<0.001 for both). Serum AOPP levels were higher in the OT patients, but this trend was not statistically significant (p>0.05). Furthermore, there were no correlations between SCUBE-1 levels and age, gravidity, parity, cyst size, and AOPP, FRAP, or GSH levels (p>0.05). CONCLUSION: We believe that SCUBE-1 may be a promising biomarker for the early diagnosis of OT.

Serum ischemia modified albumin level and its relationship with the thiol/disulfide balance in placenta percreta patients.

The pathogenesis of placenta percreta (PP) is not very well known. This study was designed to analyse the oxidative stress (OS), the thiol/disulphide balance, and ischaemia-modified albumin (IMA) the women with PP. The study included 38 pregnant women with PP and 40 similarly aged healthy pregnant women in their third trimester of gestation. We measured the IMA, native and total thiols, and disulphide concentrations in the maternal sera of all of the participating women. The IMA levels were higher and the native and total thiols were lower in the PP group than in the control group. However, there was no statistical significance with respect to the thiol/disulphide balance between the two groups. The results of this study suggest that an increase in the ischaemia and OS and a decrease in the antioxidant status may contribute to the pathogenesis of PP. Impact statement What is already known on this subject? Placenta percreta (PP) is a serious complication of pregnancy. Although there are several studies investigating the pathophysiological mechanism of PP, whether the pathology results from a lack of decidua or from the over-invasiveness of trophoblasts remains controversial. The pathology of PP is poorly understood. What do the results of this study add? This prospective study has shown an increased ischaemia modified albumin (IMA) and a decreased antioxidant capacity in the patients with placenta percreta. The results from 38 women with PP suggest that the serum concentrations of IMA and the oxidative stress parameters may be able to predict PP in cases of uncertainty. What are the implications of these findings for clinical practice and/or further research? The implication of these findings shed light on understanding the pathogenesis of PP for further research.

Serum endothelin-1 and placental alkaline phosphatase levels in placenta percreta and normal pregnancies.

PURPOSE: To evaluate the circulatory levels of endothelin 1 (ET-1) and the placental alkaline phosphatase (ALP) in pregnant women with placenta percreta (PP) and a control group. METHODS: This study was carried out in the Obstetrics and Gynecology and in the Biochemistry Departments of Harran University Medical School. Forty-four women who underwent cesarean section (CS) due to PP and 44 women who underwent CS for other obstetric reasons were included in this study. The PP diagnosis was made by a pathologic examination that showed an extreme trophoblastic invasion involving the uterine serosa.The levels of circulating ET-1 and placental ALP were measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Women with PP more frequently received antenatal steroids and blood transfusions and they delivered at an earlier gestational age compared to controls. In women with PP, preoperative circulating ET-1 and placental ALP levels were lower than in the controls (p < .05 for both). CONCLUSIONS: The findings suggest that a decrease in ET-1 and placental ALP levels might play a role in the pathogenesis of PP.

The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women.

Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.

Serum Angiogenic and Anti-angiogenic Markers in Pregnant Women with Placenta Percreta.

BACKGROUND: Placenta percreta is the morbidly adherent form of all the placental invasion abnormalities. The pathology that underlies placenta percreta is poorly understood. AIMS: To compare the levels of circulating vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 in pregnant women with placenta percreta to a control group. STUDY DESIGN: Case-control study. METHODS: Twenty-two women who underwent caesarean section due to placenta percreta and 22 women who underwent caesarean section for other obstetric reasons were included in this study. The diagnosis of placenta percreta was defined as extreme trophoblastic invasion involving serosa of the uterus. Venous blood samples were collected for biochemical comparison of circulating vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 from all pregnant women. RESULTS: Women with placenta percreta were significantly older, had higher gravidity, received more frequent antenatal steroids and blood transfusions and delivered at an earlier gestational age when compared to the control group. In women with placenta percreta, preoperative circulating levels of vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 were lower than the controls (p<0.001, p<0.001 and p<0.05, respectively). While the postoperative levels of vascular endothelial growth factorand soluble fms-like tyrosine kinase 1 levels were higher in placenta percreta (p=0.001 and p<0.001, respectively), placental growth factor levels were similar in both groups. CONCLUSION: The findings of this study suggest that a decrease in vascular endothelial growth factor, placental growth factor and soluble fms-like tyrosine kinase 1 levels may be related to placenta percreta etiopathogenesis.

A Huge Ovarian Dermoid Cyst: Successful Laparoscopic Total Excision.

Giant ovarian cysts, ≥15 cm in diameter, are quite rare in women of reproductive age. Here, we present a case of ovarian cyst with unusual presentation treated by laparoscopic surgery. On histology, mass was found to be mature cystic teratoma. The diagnostic and management challenges posed by this huge ovarian cyst were discussed in the light of the literature.

Are multiple repeated cesarean sections really as safe?

AIM: Surgical complications were compared between patients with three or less prior cesarean deliveries and four or more prior cesarean deliveries. MATERIALS AND METHODS: Records of 120 patients who had undergone cesarean sections (CSs) in our Department of Obstetrics and Gynecology, between August and November 2015, were retrospectively studied. Cases were reviewed on the basis of age, type of operation, type of anesthesia, number of CSs, time of hospitalization, and intra-operative and post-operative complications. RESULTS: Cesarean sections had been performed on 62 (51.7%) patients whose cesarean number was three or less, while 58 (48.3%) patients had multiple CSs four or more. Patients with four or more prior cesareans had an increased rate of intra-abdominal adhesions, compared with the other group. There was no significant difference in the gestational weeks, neonatal admission rate, incidence of cesarean hysterectomy, uterine scar rupture, placenta previa with placental invasion anomalies, bladder and bowel injuries, incidence of peripartum hemorrhage and blood transfusion rate between the two groups. CONCLUSION: There is no greater risk of maternal complications in patients with four or more prior cesareans, excepting intra-abdominal adhesions.