Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas.

OBJECTIVE: To determine whether myomectomy during cesarean delivery is safe and feasible among pregnant women with leiomyomas. METHODS: In a retrospective study, data were reviewed from pregnant women with uterine leiomyomas who delivered by cesarean at a center in Turkey between May 1, 2007, and April 30, 2014. Women were divided into two groups: cesarean myomectomy (CM) or cesarean only (CO). Data were analyzed for characteristics of the uterine leiomyomas, hematologic changes occurring between the preoperative and postoperative periods, duration of the operation, and length of hospital stay. RESULTS: Overall, 76 women formed the CM group and 60 formed the CO group. The mean diameter of the leiomyomas did not differ between CM and CO groups (4.6±2.5cm vs 5.2±2.2cm; P=0.175). More patients in the CM group than in the CO group had subserous (24 [31.6%] vs 7 [11.7%]; P=0.006) and uterine corpus (57 [75.0%] vs 30 [50.0%]; P=0.003) leiomyomas. Fewer patients in the CM group had intramural (44 [57.9%] vs 49 [81.7%]; P=0.003) and fundal (15 [19.7%] vs 25 [41.7%]; P=0.005) leiomyomas. CONCLUSION: Surgeons were more likely to remove corporal and subserous leiomyomas than other types; size did not seem to affect decision making. CM can be a safe operation for some patients.

Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion.

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

Awareness of Turkish female adolescents and young women about HPV and their attitudes towards HPV vaccination.

BACKGROUND: The aim of the study was to assess the knowledge about HPV and HPV vaccines and attitudes towards vaccination among the females aged 9-24 years in Turkey. MATERIALS AND METHODS: Self-administered questionnaires were filled out individually by the participants covering demographic information, knowledge about HPV infection and HPV vaccines, attitudes towards vaccination, and the perceptions of them about their parental attitudes about vaccination. RESULTS: Of the 408 subjects participating in the study, 41.6% (n=170) had heard of HPV. Thirty-three percent (n=136) knew the causal relationship between HPV and cervical cancer. Only 27.9% (n=114) of them knew that HPV vaccines can prevent cervical cancer. Eleven percent (n=46) of the females participating in the study were willing to be vaccinated, and only 1.4% (n=6) were already vaccinated at the current time. The main reason listed among the participants who were not willing to be vaccinated was lack of information. CONCLUSIONS: Awareness and knowledge of Turkish female adolescents and young women about HPV, relation with cervical cancer and prevention of cervical cancer by Pap smear and vaccine are still limited. If the most important barrier to vaccination, which is reported as lack of information, were to be addressed, it would greatly impact the decision-making and vaccine acceptance.

Role of transvaginal sonography in the diagnosis of retained products of conception.

INTRODUCTION: The aim of this study was to evaluate the criteria of endometrial thickness to detect retained products of conception following first trimester spontaneous abortion or elective pregnancy termination. METHODS: This was a retrospective study on 116 patients who underwent uterine re-evacuation with a diagnosis of retained products of conception based on clinical and sonographic findings. Pathologic reports of samples obtained during re-evacuation were reviewed for the presence of gestational tissue. Endometrial thickness determined by transvaginal sonography and certain clinical features (gestational age and interval between initial curettage and re-evacuation, which may affect presence or absence of gestational tissue, parity, indication for initial curettage) were noted. The sensitivity and specificity of sonographic measurement of endometrial thickness for detecting retained products of conception were assessed. RESULTS: Histopathologic reports confirmed the diagnosis of retained products of conception in 66 of 116 patients (56.9%). Percentage of nulliparity and the time elapsed between initial curettage and re-evacuation were significantly high in patients with retained products of conception. The sensitivity and specificity of endometrial thickness greater than 13 mm for detecting retained products of conception were 85 and 64%, respectively. CONCLUSION: An endometrial thickness of 13 mm or more, detected by transvaginal sonography, has the best diagnostic efficiency for detection of retained products of conception following first trimester spontaneous abortion or elective pregnancy termination.

Does hysteroscopic polypectomy without cycle cancellation affect IVF?

Endometrial polyp (measuring <2 cm) was diagnosed by transvaginal ultrasonography performed on days 7 and 9 of the cycle in six patients who underwent IVF. These six patients were treated by hysteroscopic polypectomy preceding oocyte retrieval under general anaesthesia after informed consent was obtained. The cause of infertility was male factor in three patients, tubal factor in one, and two cases were unexplained. All patients had undergone ovulation induction and luteal support according to the long luteal protocol. As a result, in three cases pregnancy was achieved (one multiple and two singleton) and three cases were unsuccessful. One of the pregnant women gave birth at term, while the other two pregnancies are still ongoing. There is still no consensus regarding the management of patients diagnosed with endometrial polyp in IVF cycles. Cryopreservation, cycle cancellation and embryo transfer preceding polypectomy is the current management choice. The treatment modalities will be clarified only if embryo transfer preceding polypectomy in the same cycle is proven to be safe. This approach has been used in only six patients so far, and further studies with more patients are needed to confirm these findings.