Prenatal Sonographic Three-dimensional Virtual Organ Computer-assisted Analysis Thymic Volume Calculation May Predict Intrauterine Growth Restriction.

Background: Intrauterine growth restriction (IUGR) refers to fetuses that are small for their gestational age. There is no effective test to predict this disease. The aim of our study is whether fetal three-dimensional (3D) ultrasonography (USG)-assisted thymus volume (TV) measurement predicts IUGR cases. Methods: Fetal 3D USG thymus measurement between 15 and 24 weeks of gestation was performed in a total of 100 women of reproductive age. Fetal TV was measured using the virtual organ computer-assisted analysis system program. All cases were followed up in terms of pregnancy complications until delivery. Results: IUGR was developed in six cases in total. In cases with IUGR, mean fetal TV was found to be statistically significantly lower than in healthy cases without it. When the fetal TV was taken as 0.1645, the sensitivity was calculated as 89.5% and the specificity as 50% for predicting IUGR. The use of low fetal volume parameters is a significant and good indicator for predicting IUGR according to the binary logistic regression analysis result. Conclusion: According to the results of this study, 3D fetal TV measurement may be used in routine second-trimester sonographic anomaly screening to predict the development of fetal IUGR. In this way, fetal mortality and morbidity caused by IUGR may be reduced.

Evaluation of the height of the corpus callosum body region in fetal meningomyelocele malformation.

PURPOSE: To investigate height of the corpus callosum (CC) in order to describe the corpus callosum anomalies in fetuses with meningomyelocele (MMC) and compare these findings with the corpus callosum of healthy fetuses. METHODS: In this study, fetal MRI examinations were performed on 44 fetal MMC malformation cases. As the control group, 34 fetal MRI examinations, which were anatomically normal, were evaluated retrospectively. In the study group, lateral ventricle diameter, the level and diameter of the MMC defect, and CC height were measured. In the control group, CC height and lateral ventricular diameter were measured. RESULTS: The mean CC body height was 1.36 mm in the study group, and 2.48 mm in the control group. The height of the CC body region of the study population was inclined to be thinner compared with the control population (p<0.001). CONCLUSIONS: The fact that the height of the CC body region was found to be thinner in fetal MRI in cases of MMC compared with normal fetuses suggests that various callosal anomalies are uncertain, investigation of additional callosal anomalies may be beneficial in the decision for the continuation of pregnancy, and termination or intrauterine surgery in cases with MMC. Further large case group studies are needed.

Carbon Dioxide Pneumoperitoneum May Alter Ovarian Apoptosis: An Experimental Study.

OBJECTIVES: The aim of this study was to evaluate ovarian immunohistochemical CD95 expression in a rabbit carbon dioxide pneumoperitoneum model. MATERIALS AND METHODS: The study group including seven rabbits was subjected to intra-abdominal pressure (IAP) (12 mmHg); the control group was not subjected to IAP (the sham group, n = 7). At the end of the experiment, ovariectomy was performed. Immunohistochemical stained histologic specimen of the ovary with CD95 was evaluated. Based on the degree of cytoplasmic or membranous staining for CD95 from 0 (none) to 3 (severe), a microscopic apoptosis scoring system was used. RESULTS: Statistically significantly higher apoptosis scores in ovarian surface epithelial cells (2.57 ± 0.53, vs. 1.14 ± 0.38, P = 0.002, Mann-Whitney U-test, respectively), follicular epithelial cells (2.85 ± 0.38, vs. 1.85 ± 0.38, P = 0.002, Mann-Whitney U-test, respectively), and stromal cells (2.71 ± 0.49, vs. 1.29 ± 0.49, P = 0.002, Mann-Whitney U-test, respectively) were observed in pneumoperitoneum group, compared with no-pneumoperitoneum group. CONCLUSION: Even at safe IAP (12 mmHg) for an acceptable operation time period, there was a significant increase in apoptosis of ovarian cells.

The effect of low-dose combined hormone therapy (oestradiol and norethindrone acetate) on serum C-reactive protein levels and life quality in natural menopause women.

INTRODUCTION: To assess the effect of low-dose combined oestradiol and norethindrone acetate hormone therapy (HT) on serum C-reactive protein (CRP) levels and life quality in natural menopause women. MATERIAL AND METHODS: Forty-five natural menopause women admitted to the clinic during a 1-year period and diagnosed as menopause, who planned to have HT for menopausal symptoms, were enrolled in this prospective study. The serum CRP levels were measured, and vasomotor symptoms scores were graded according to the Blatt-Kupperman menopause index, and life quality scores according to the Menopause-Specific Quality of Life Questionnaire (MENQOL) were recorded before and after (3 months later) hormone therapy. RESULTS: The Blatt-Kupperman menopause index and MENQOL scores were significantly decreased after 3 months of low-dose treatment. No significant difference was found between white blood cell counts and serum CRP levels before and after 3 months of hormone therapy. CONCLUSIONS: Considering all HT types and biochemical effects, low-dose HT, which had positive results in terms of quality of life, was a safe treatment and could be preferred to conventional-dose preparations in cases without contraindications. Low-dose combined HT containing oestradiol and norethindrone acetate did not alter the serum CRP level in postmenopausal cases.

Pemphigoid gestationis in a third trimester pregnancy.

Pemphigoid gestationis (PG) is a rare vesiculobullous dermatosis of pregnancy. It is commonly seen in second or third trimester. The diagnosis is frequently made with direct immunofluorescence studies of perilesional skin. Prompt recognition and appropriate management may reduce morbidity of this disease. Herein we present a case of pemphigoid gestationis occurring in a 33-year-old primigravida woman with symptoms of generalized pruritus.

Hand and wrist complaints in pregnancy.

PURPOSE: Hand and wrist complaints can decrease the quality of life of pregnant women, which can occur or aggravate during pregnancy and advance to chronic state if left untreated. The purpose of this study was to describe hand and wrist complaints in relation to pregnancy and assess their significance in pregnancy. METHODS: In a prospective cross-sectional study, 383 participants were randomly selected from among pregnant women on or over 28 weeks of gestation, attending the primary care maternal health clinic in a university hospital. The prevalence and severity of hand and wrist complaints were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The symptomatic pregnant women were consulted by an orthopedist. The specific diagnoses of the patients were made based on patient history and physical examination. RESULTS: According to BCTQ scoring 258 (67.4 %) pregnant women were symptomatic. The diagnoses were as follows: asymptomatic 125 (32.6 %), nonspecific symptoms 138 (36 %), tendinitis 80 (20.9 %), carpal tunnel syndrome (CTS) 39 (10.2 %) and cubital syndrome 1 (0.3 %). There was no association noted between the diagnoses and numbers of pregnancies, occupational status, age, gestational weeks, weight gain or body mass index (BMI) (p > 0.05). CONCLUSION: The prevalence of hand and wrist complaints is high in pregnant women. All pregnant women should be investigated for hand and wrist complaints in routine antenatal checks to ensure good life quality during pregnancy and for avoiding these complaints advancing to chronic state. Further studies are needed to evaluate the effect of musculoskeletal systems disorders in pregnancy.

Disability and psychiatric symptoms in hyperemesis gravidarum patients.

PURPOSE: Nausea and vomiting is an important health problem which adversely affects the daily routine and quality of life in pregnant women. The purpose of this study was to measure the level of change in the quality of life, depression and anxiety in hyperemesis gravidarum (HG) patients in relation to social-demographic data and disease variables. METHODS: One hundred pregnant women hospitalized with the diagnosis of HG were included in the study. A total of 100 healthy pregnant women were also evaluated as the control group. All the patients in the study completed the socio-demographic data form, the Hospital Anxiety and Depression Scale (HADS-A and D) and Brief Disability Questionnaire (BDQ). RESULTS: The mean HADS-D subscale score was 7.09 ±3.91 in HG patients and 5.73 ± 3.32 in controls. The depression score in the HG patients were significantly higher than that of the control group (p = 0.009). The mean HADS-A subscale score was 7.73 ± 3.86, which was significantly higher in HG patients compared to 6.70 ± 3.31 in controls (p = 0.045). The mean BDQ score was 11.2 ± 4.40 in HG patients and 8.5 ± 3.31 in the control group of pregnant women, thus, significantly higher in the HG group as compared to controls (p < 0.0001). In the HADS-D, 52 patients in the HG group and 40 patients in the control group scored above the threshold value (p = 0.089). In the HADS-A, 28 patients in the HG group and 20 in the control group scored above the threshold value (p = 0.185). CONCLUSIONS: In patients with HG, a significant deterioration of physical and social health was encountered. HG disease is independent of any underlying psychiatric condition and adversely affects the quality of life of the sufferer.

Alterations of natriuretic peptides amino-terminal pro B-type natriuretic peptide and amino-terminal pro C-type natriuretic peptide during the pregnancy.

OBJECTIVE: The aim of this study was to determine the plasma levels of natriuretic peptides amino-terminal pro B-type natriuretic peptide (NT proBNP) and amino-terminal pro C-type natriuretic peptide (NT proCNP) during pregnancy and any possible changes occurring in each trimester. METHODS: This was a prospective longitudinal case-control study conducted in a University Hospital antenatal outpatient clinic. Subjects were all healthy pregnant women without a history of previous cardiac disease, hypertension or preeclampsia, and each patient was assessed during every trimester, and blood samples were collected for the measurement of NT proBNP and NT proCNP levels. RESULTS: Twenty pregnant women were followed-up during pregnancy without any complications. We obtained longitudinal levels of natriuretic peptides in each trimester. The mean NT proBNP levels were 14.95 ± 16.8, 9.37 ± 10.76, 52.48 ± 126.65 pmol/ml and the mean NT proCNP levels were 44.64 ± 41.64, 45.70 ± 47.03, 47.22 ± 55.09 pmol/l, respectively. No statistically significant alteration of plasma levels of natriuretic peptides was detected between trimesters. CONCLUSION: This is the first study evaluating the longitudinal levels of NT proCNP during the pregnancy, and demonstrates that NT proCNP remained constant, but NT proBNP levels do not significantly alter during pregnancy.

Appendix and uterus metastasis of squamous cell carcinoma arising from mature cystic teratoma of the ovary.

Mature cystic teratoma of the ovary rarely undergoes malignant transformation. There is no consensus for a treatment modality because of the rarity of the disease. Herein we present a case of squamous cell carcinoma (SCC) arising in a mature cystic teratoma (MCT) in a 66-year-old patient. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, appendectomy, and bilateral pelvic + paraaortic lymph node dissection. The histopathological examination revealed malignant invasion of the appendix and uterus. The patient, who refused the continuation of treatment initiated with the administration of a single dose of cisplatin, died 5 months later because of the disease. It is imperative that gynecologists consider appendectomy in SCC arising from MCT cases.

Pregnancy in the setting of asymptomatic non-cirrhotic chronic portal vein thrombosis complicated by pre-eclampsia.

Portal vein thrombosis (PVT) can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.

Spontaneous intraamniotic hemorrhage in the second trimester mimicking an abdominal wall defect.

We report here a case of spontaneous intraamniotic haemorrhage in the second trimester which mimicked an abdominal wall defect. The ultrasound and magnetic resonance imaging findings are discussed and a review of the literature regarding differential diagnosis of bleeding and abdominal wall defects is made.

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p <0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.

Serum IL-6 level may have role in the pathophysiology of unexplained infertility.

PROBLEM: The aim of this study was to compare the serum levels of interleukin (IL)-6 of women with unexplained infertility with fertile subjects. METHOD OF STUDY: Serum IL-6, and tumor necrosis factor-alpha (TNF-alpha) levels of 45 infertile and 44 fertile women on day 3 of menstrual cycle were assessed and compared for this prospective controlled study. RESULTS: The mean serum IL-6 level was significantly higher in women with unexplained infertility, compared with fertile women (5.71 +/- 1.81 and 4.31 +/- 1.79, P < 0.001, Student's t-test). There was no significant difference in TNF-alpha level among the groups. CONCLUSION: Significant difference in serum IL-6 levels between unexplained infertile and fertile women suggests that this cytokine may be involved in pathophysiology of unexplained infertility.

Is there any relation between development of persistent non-reassuring fetal heart rate pattern and acutely increased uterine artery vascular flow resistance during dinoprostone use in prolonged pregnancies?

OBJECTIVE: To investigate the relation between changes in Doppler parameters of fetal and uterine arteries and development of persistent non-reassuring fetal heart rate (FHR) pattern during induction of labor with dinoprostone (Propess) in pregnancies at >or=41 weeks gestation. DESIGN: Prospective cohort study. SETTING: Etlik Zubeyde Hanim Women's Hospital, Turkey. SAMPLE: One hundred forty-one prolonged pregnancies. METHODS: Doppler parameters of umbilical, middle cerebral, and uterine arteries were measured before and 4-6 hours after dinoprostone application between uterine contractions. Non-reassuring FHR pattern and persistent non-reassuring FHR pattern criteria were defined based on NICE 2007 guidelines. Women with successful spontaneous vaginal delivery were recruited as a control group (n=108), while women who underwent cesarean delivery due to persistent non-reassuring FHR pattern were recruited as a study group (n=15). MAIN OUTCOME MEASURES: Prediction of non-reassuring FHR pattern with Doppler analysis of uterine and fetal arteries. RESULTS: After dinoprostone application there was significant enhancement in uterine artery resistance index (RI) in the study group compared to the control group (p=0.002). Receiver operating characteristics curve analysis identified a uterine artery RI increase value of 0.11 as the optimal threshold for prediction of persistent non-reassuring FHR pattern with 73.3% sensitivity and 69.4% specificity. Logistic regression analysis demonstrated that an increase in the uterine artery RI was predictive for persistent non-reassuring FHR pattern (odds ratio (OR) 4.97; 95% CI 1.5-16.8). CONCLUSION: Acute increase in uterine artery RI due to dinoprostone use may end with persistent non-reassuring FHR pattern in prolonged pregnancies. This may allow earlier prediction of persistent non-reassuring FHR pattern development and risk assessment.

Testosterone versus clobetasol for maintenance of vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia.

OBJECTIVE: To evaluate the therapeutic regimens and symptomatic response rates in patients with vulvar lichen sclerosus associated with variable degrees of squamous cell hyperplasia (mixed disease). MATERIAL AND METHODS: Eighty-three women with biopsy-proven vulvar mixed disease were evaluated for this retrospective study. All patients were initially treated with topical fluorinated corticosteroids, and then 2% testosterone propionate in petrolatum or 0.05% clobetasol 17-propionate (44 (53%) versus 39 (47%)). RESULTS: The remission rates were 82 and 93% in the testosterone and clobetasol subgroups at the end of 6 months (p=0.112), respectively. The disease recurred in 8% of the patients. The recurrence rates in the testosterone and clobetasol arms were 13 and 5%, respectively (p=0.163). The histopathological review of the repeat vulvar biopsies of the patients without symptomatic relief revealed 6 (60%) patients with persistent disease, 2 (20%) with lichen sclerosus, 1 (10%) with atypical squamous hyperplasia, and 1 (10%) with VIN1. Two patients with recurrent disease and 2 patients with vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia were treated with skinning vulvectomy. CONCLUSIONS: Clobetasol resulted in higher remission and lower recurrence rates than those in testosterone therapy, although statistically significant differences were not obtained. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.

Is there a correlation between tumor marker panel and tumor size and histopathology in well staged patients with borderline ovarian tumors?

AIMS: To investigate whether there is a correlation between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well staged patients with borderline ovarian tumors (BOTs). METHODS: Four tumor markers (CA 125, CA 19-9, CA 15-3, and CEA) were analysed clinically in 60 well staged patients with borderline ovarian tumor, for this retrospective observational study. RESULTS: Most patients had serous histology and early stage disease, and the mean age at the time of diagnosis was 40.70 years (range: 19-73). Twenty-nine patients (48.3%) had high CA 125 levels (>35 U/l), 15 patients (25%) had high levels of CEA (>4 ng/ml), 12 patients (20%) had high levels of CA 19-9 (>37 U/ml), and 9 patients (15%) had high levels of CA 15-3 (>30 ng/ml) at the time of initial surgery. The positive rate of CA 125, CA 19-9, CA 15-3, and CEA in serous tumor were 57.9, 7.9, 7.9 and 15.8%, respectively. These figures were 31.8, 40.9, 27.3 and 40.9% in mucinous tumor. The positive rate of CA 125 in the serous group was statistically significantly higher than that in the mucinous group, while the positive rates for CA 19-9 and CEA in mucinous histology was significantly higher than those in serous tumors. In case of grouping the tumor size as <4, 4.1-10 and >10 cm, the mean serum levels of tumor markers had significantly increased by increasing tumor size (p<0.05 for CA 125, and CA 19-9, p>0.05 for CA 15-3, and CEA). CONCLUSION: The high levels of tumor markers, especially for CA 125 and CA 19-9, may indicate the larger tumor size. The elevation of serum CA 125 may suggest serous tumors, while the high level of serum CA 19-9 and CEA may indicate mucinous BOTs.

Comparison of the effect of single-dose and multiple-dose methotrexate therapy on tubal patency.

OBJECTIVE: To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) regimen. DESIGN: A case series with a retrospective statistical analysis. SETTING: Maternity and teaching hospital in Turkey. PATIENT(S): Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy. INTERVENTION(S): Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency. MAIN OUTCOME MEASURE(S): Ipsilateral and contralateral tubal obstruction rates. RESULT(S): Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction. CONCLUSION(S): In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy.

Partial molar pregnancy and coexisting fetus with diploid karyotype.

OBJECTIVES: To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy. METHOD: A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords 'partial hydratidiform mole', 'hydatidiform mole' and 'coexisting fetus'. RESULTS: At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented. CONCLUSION: Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.

Vulvar edema as a rare complication of laparoscopy.

Vulvar edema as a complication of laparoscopy is a rare condition. A 23-year-old woman was admitted with progressive dysmenorrhea and underwent laparoscopic bilateral endometrioma cystectomy. Twenty-seven hours after surgery, unilateral vulvar edema was observed. It resolved with the application of ice packs and insertion of a Foley catheter. We conclude that this is a rare, normally benign condition that is easy to manage.