Management of cervical cancer during pregnancy.

Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account.

Can plateletcrit, an underestimated platelet parameter, be related with preterm labour?

OBJECTIVE: Noninvasive and simple markers are needed for the prediction of preterm delivery in women at risk for preterm labour. The aim of this study was to determine the value of platelet indices in the prediction of preterm delivery. DESIGN: A retrospective study. SETTING: Routine antenatal care in Zonguldak Bülent Ecevit University between 2008 and 2011. SAMPLE: Ninety patients who delivered between 28 and 37 weeks of gestational age and 128 patients who delivered at term. METHODS: Plateletcrit and other haematological markers, cervical dilatation and effacement, and the neutrophil-to-lymphocyte ratio as an inflammation marker. MAIN OUTCOME MEASURE: The role of platelet indices in predicting the preterm delivery. RESULTS: The platelet count, plateletcrit, white blood cell count, red cell distribution width, and neutrophil count were significantly higher in the preterm delivery group. Receiver operating characteristic curve analysis showed that the plateletcrit cut-off value for predicting spontaneous preterm labour was 0.201%, with a sensitivity of 95.6% and specificity of 87.5%; the cut-off value for the platelet count was 234 ? 103/mm3 with a sensitivity of 81.0% and specificity of 71.0%. CONCLUSION: Plateletcrit is a low-cost, widely available, and noninvasive marker that might be used for the prediction of preterm delivery in patients with a history of preterm labour.

Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey.

In this retrospective study, we investigated patient characteristics and fetal and maternal outcomes of placenta praevia and accreta at two tertiary hospitals in Istanbul. A total of 364 pregnancies complicated by placenta praevia with (n = 46) and without (n = 318) placenta accreta managed between January 2005 and December 2010 were reviewed. Among 364 women, 46 (12.6%) had placenta accreta and 318 (87.4%) had placenta praevia without accreta. The rates of curettage history and caesarean delivery were significantly higher in the group with placenta accreta. Furthermore, we found that emergency surgery had negative effects on maternal outcomes in the placenta praevia group. In addition, when accreta was suspected at ultrasound examination in women who had placenta praevia, the mean estimated blood loss during surgery was reduced significantly. If placenta praevia is detected, a careful ultrasound examination should be performed and the patient should undergo elective surgery at a tertiary referral hospital.

Diagnosis and management of cesarean scar pregnancy.

OBJECTIVE: To evaluate the diagnosis and management modalities of cesarean scar pregnancy according to our experience. DESIGN AND SETTING: Retrospective study at the Women's Health Research and Education Hospital. PATIENTS: Six patients were diagnosed and treated for cesarean scar pregnancy (CSP) with dilatation and curettage, methotrexate (MTX), or laparatomy. RESULTS: One patient chose the surgical option due to her desire to have a tubal ligation. In the second case methotrexate was applied initially, but two weeks later suction curretage was applied due to abdominal pain and vaginal bleeding. Suction curettage was used as an initial treatment for four patients. There were not any complications in three of four patients. One patient had heavy vaginal bleeding which started after curettage. On ultrasonographic examination, increasing hemorrhage was seen between the uterus and the bladder so subtotal hysterectomy was performed. DISCUSSION: Ultrasound should be used effectivelly in evaluation of pregnant patients with previous cesarean deliveries. There is still no unique treatment modality for CSP, so treatment should be tailored for each patient. Before the 7th week, abortion should be considered. After the 7th week, MTX and/or surgical options should be preferred.

What Are the Risk Factors for Lymphocyst Formation Apart From Lymphnode Dissection and Lymphnode Count in Gynecologic Malignancy?

Aim: Lymphocyst is one of the most common complications of lymphadenectomy and generally encountered during uro-gynecological oncology surgeries. We aimed to define the risk factors for formation of a lymphocyst in patients with various gynecological cancer types in whom a lymphadenectomy was performed. Methods: This retrospective study was performed on 206 patients. Of the 206 patients, 100 were diagnosed with a lymphocyst, and 106 were assigned to a control group. Laboratory findings and surgical characteristics of the patients were compared. Results: No differences were observed in age, pre-operative hemoglobin; platelet, white blood cell, and lymphocyte counts; or pre-operative albumin level (p = 0.315, 0.500, 0.525, 0.683, 0.740, and 0.97, respectively). A significant effect of the heparin dose × heparin days interaction and lymphocyst formation was observed (p = 0.002). Lymphocysts were most frequently detected in the ovarian cancer subgroup (49 %). Significant differences were detected between the groups in the percentages of patients who underwent CT only and RT only treatments (p = 0.001 and 0.002, respectively). The logistic regression analysis revealed a relationship between the LMWH dose × days interaction and formation of a lymphocyst (OR, 1.10; 95 % CI, 1.0-1.13; p = 0.01). Conclusion: The association between total LMWH dose administered and the formation of lymphocysts in patients with gynecological pelvic cancer was investigated for the first time. Significant relationship between heparin dose × days and lymphocyst formation was found. Although anticoagulation with LMWH is essential for preventing thromboembolism, it should be used appropriately to prevent other complications, such as bleeding and lymphocysts.