Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial.

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero ("0") was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENTWhat is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery.What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries.What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.

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.

Assessment of oxidative stress markers in cord blood of newborns to patients with oxytocin-induced labor.

AIM: We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetal well-being. METHODS: Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonates were carried out. After the fetal cord was clamped, 5 cm3 blood was drawn into a plain tube without anticoagulant. The samples were centrifuged at 5000 r.p.m. for 5 min. Separated sera were transferred to Eppendorf tubes and were stored at -80 C° until the analysis time. RESULTS: The complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007). CONCLUSION: We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.

Amniotic fluid paraoxonase-1 activity, thyroid hormone concentration and oxidant status in neural tube defects.

AIM: The aim of this study was to investigate the potential association between neural tube defects and paraoxonase-1 activity in amniotic fluid. We studied total oxidant status, total antioxidant capacity, paraoxonase-1 activity and thyroid hormone amniotic fluid concentration in fetuses with neural tube defects. METHODS: The present study was performed at the Department of Obstetrics and Gynaecology and the Department of Clinical Biochemistry of Dicle University between September 2011 and June 2013. The study group included 37 amniotic fluid samples from pregnant women (16-20 weeks of gestation) with fetuses affected by neural tube defects. The control group consisted of 36 pregnant women who were diagnosed with a high-risk pregnancy according to first or second trimester aneuploidy screening and were later confirmed on amniocentesis to have genetically normal fetuses. RESULTS: Amniotic fluid paraoxonase-1 activity and total oxidant status were significantly higher (P = 0.023, P = 0.029, respectively) whereas free T4 was significantly lower (P = 0.022) in fetuses with neural tube defects compared with control subjects. In fetuses with neural tube defects, amniotic fluid paraoxonase-1 activity correlated positively with total oxidant status (r = 0.424**, P = 0.010), and amniotic fluid total antioxidant capacity correlated positively with free t4 (r = 0.381*, P = 0.022). CONCLUSION: This is the first study in the literature to show an association between paraoxonase-1 activity and thyroid hormone concentration and neural tube defects.

CD147 expression in uterine smooth muscle tumors, and its potential role as a diagnostic and prognostic marker in patients with leiomyosarcoma.

OBJECTIVE: To investigate the role of CD147 expression in uterine smooth muscle neoplasms, as a potential diagnostic and prognostic marker in patients with leiomyosarcoma (LMS). STUDY DESIGN: We investigated CD147 protein expression in uterine smooth muscle tumor samples from patients diagnosed with leiomyoma (n = 22), atypical leiomyoma (BLM) (n = 5), smooth muscle tumor of uncertain malignant potential (STUMP) (n = 14), and LMS (n = 22). The intensity and extensity of immunohistochemical staining were compared to determine its potential role in differential diagnosis. Spearman's rank correlation tests were performed to determine the relationship between CD147 expression and prognostic clinical and pathological criteria in the patients with LMS. RESULTS: CD147 was strongly expressed in 81.8% (n = 18) of the LMS tissue samples. In fact expression of CD147 in LMS tissues was significantly higher than that of the three other uterine smooth muscle tumor types (p = 0.000). However, high CD147 expression was found in only one BLM sample and one STUMP sample. Furthermore, CD147 percent expression positively correlated with Ki67 percent expression (r = 0.466, p<0.05) and mitotic index (r = 0.554, p<0.05), respectively. CONCLUSION: Our results suggest that immunohistochemistry may be a helpful tool in determining whether CD147 is a useful marker in the differential diagnosis of certain uterine smooth muscle tumors. CD147 may also have prognostic value for patients with LMS. Yet, in order to determine the extent of this potential marker's utility as a diagnostic and prognostic indicator, a larger randomized multicenter study must be performed.

Prolidase, matrix metalloproteinases 1 and 13 activity, oxidative-antioxidative status as a marker of preterm premature rupture of membranes and chorioamnionitis in maternal vaginal washing fluids.

OBJECTIVE: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM. STUDY DESIGN: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed. RESULTS: VWF levels of prolidase, matrix metalloproteinases 1-13 (p< 0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p<0.05), and oxidative-antioxidative status parameters (p<0.05) were significantly different in women with versus women without chorioamnionitis in the PPROM group. Prolidase, MMP-13, TOS, TAC, and PON-1 were found as important predictors for chorioamnionitis in the PPROM group by the multivariate logistic regression analysis. When the ROC curve analysis for prolidase, MMP-13, TOS, TAC, and PON-1 were performed, all of them were statistically significant for area under the curve (areas under the curve were 0.94, 0.90, 0.80, 0.25, and 0.19, respectively). CONCLUSIONS: This study showed that collagen turnover mediators, especially prolidase, and increased oxidative stress are significantly associated with PPROM. Also, chorioamnionitis can be predicted with prolidase, MMP-13, TOS, TAC, and PON-1 in PPROM patients.

Circadian variation of blood pressure is impaired in normotensive pregnant women with gestational diabetes mellitus.

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP - sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m(2) vs. 90.67 ± 15 g/m(2), P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Effect of caffeic acid phenethyl ester on intra-abdominal adhesion in rats.

BACKGROUND: To determine the impact of caffeic acid phenethyl ester (CAPE) on abdominal adhesion formation after laparotomy. METHODS: Forty female rats were allocated into four distinct groups on which laparotomy alone; laparotomy with traumatization of the uterine horns; laparotomy, traumatization of the uterine horns and intraperitoneal irrigation with saline, and laparotomy, traumatization of the uterine horns and intraperitoneal irrigation with CAPE were performed. After sacrifying the animals on the 14th postoperative day, histopathological examination and biochemical analysis were conducted to evaluate the formation of abdominal adhesions and antioxidant status. RESULTS: In the CAPE group, total adhesion scores were significantly lower than in the control and saline groups. The CAPE group displayed less inflammation, giant cell formation, fibrosis and fibroblastic activity than the control group. On the other hand, the control group displayed higher total adhesion scores. CONCLUSION: The results of this study indicate that the administration of CAPE may have beneficial effects for the prevention of abdominal adhesion formation after laparotomy. Further clinical studies are mandatory to explore the actual therapeutic potential of CAPE.

Imperforate hymen with elevated serum CA 125 and CA 19-9 levels.

OBJECTIVE: To report the clinical characteristics of 14 patients with imperforate hymen and their levels of tumor markers (CA 19-9 and CA 125). STUDY DESIGN: Fourteen patients with imperforate hymen who followed-up between September 2006 and September 2010 in the Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey, were evaluated retrospectively. The clinical features and the management of the patients are discussed. RESULTS: The mean age of the patients was 13.8 years. All patients had primary amenorrhea and pelvic pain. The most common clinical symptoms were cryptomenorrhea in 14 patients, pelvic pain in 11, palpable abdominal mass in 6, voiding difficulties in 7, and defecation problems in 2. In 6 patients with palpable pelvic mass, the mean + standard deviation values of tumor markers were as follows: CA 125, 84.0 +/- 23.7 and CA 19-9, 162 +/- 189. One week after surgery we measured CA 125 and CA 19-9 levels once again. The postoperative mean CA 125 level was 13.8 +/- 3.6, and the mean postoperative CA 19-9 level was 17.5 +/- 3.5. Preoperative levels of CA 125 and CA 19-9 were significantly higher than those of the postoperative period (p < 0.001 for both comparisons). Six patients were treated by T-shaped incision and 8 patients by a central surgical incision through the hymenal membrane. CONCLUSION: Diagnosis of imperforate hymen is very important before undergoing surgery in a different clinic. Many patients have seen several doctors before receiving a clear diagnosis and have had tumor markers evaluated because the presence of pelvic mass in patients suggests the possibility of a gynecologic malignancy. Imperforate hymen is one of the benign conditions that increase serum CA 125 and CA 19-9 levels and which is not listed in the classical medical textbooks. These markers are not needed for the diagnosis.

Translocated intrauterine contraceptive device: experiences of two medical centers with risk factors and the need for surgical treatment.

OBJECTIVE: To present experiences of 21 patients with a translocated intrauterine contraceptive device (IUD) who required surgical treatment and to discuss the diagnosis, surgical management, and complications of such cases. STUDY DESIGN: The cases of 21 patients who were hospitalized with the diagnosis of translocated IUD and had surgical treatment were analyzed retrospectively. RESULTS: The mean age of the patients was 25.7 (range, 20-35). Of the 21 patients, 17 (81%) were in puerperium. IUDs were inserted by trained midwife nurses in 17 cases (81%). Severe lower abdominal pain was reported by 16 patients (76%) during the insertion procedure. At the time of diagnosis, 13 patients (62%) presented with lower abdominal pain. Surgical treatments included laparoscopic surgery (67%), laparotomy, colpotomy, and hysteroscopy. All of the removed IUDs were TCu-380A models. The most frequent complication due to translocation of the IUD was pelvic abscess (38%). CONCLUSION: The incidence of IUD translocations was significantly high in the puerperal period and for insertions performed by educated midwife nurses. Uterine perforation must be taken into consideration when there are complaints of unusually severe abdominal pain during the insertion procedure. Surgical treatment is necessary because of the potential complications of extracavitary IUDs.

Alteration of peripheral blood cells in tubal ectopic pregnancy.

OBJECTIVES: To investigate whether mean platelet volumes and leukocyte counts are altered significantly in patients with tubal ectopic pregnancy (TEP). MATERIALS AND METHODS: Retrospective analysis of mean platelet volumes and leukocyte counts of 138 TEP patients, diagnosed between 2005 and 2012, and the control group consisting of 72 pregnants was performed. Patients with TEP were further subdivided into 2 subgroups composed of 72 ruptured and 66 non-ruptured cases. Statistical analysis was performed using the Kruskal-Wallis and the Mann-Whitney U tests. RESULTS: Mean platelet volume was found to be larger in patients with TEP (whether ruptured or non-ruptured) when compared to controls (p = 0.007). However no significant difference could be observed between the ruptured or non-ruptured cases (p = 0.89). With respect to leukocytosis, the TEP group with tubal rupture had significantly higher white blood cell numbers when compared to the non-ruptured TEP and the control groups (p = 0.022 and p < 0.007, respectively). CONCLUSIONS: Mean platelet volume seems to be higher in ectopic pregnancy and this finding evokes a possible role of increased platelet activity in the pathophysiology Leukocytosis may occur more apparently in EP cases with tubal rupture. However, further prospective, controlled and with a larger sample size studies must be conducted to find clues on the correlation between the clinical entities and laboratory findings.

The efficacy and safety of ureteroscopy for ureteral calculi in pregnancy: our experience in 32 patients.

The aim of this study was to investigate the efficacy and safety of ureteroscopy (URS) in pregnant women. A retrospective analysis was performed on 32 pregnant patients referred to our center between April 2005 and November 2010 with hydronephrosis requiring surgical intervention. A semirigid URS of 9.5 F was used in all patients. The mean age of patients was 27.8 years (range 20-39), and the mean gestation duration was 24 weeks (15-34). The ultrasound findings were diagnostic of obstructive ureteral calculi in 16 (50%) patients and the mean stone diameter was 8 mm. Spinal anaesthesia was performed in 22 (68.8%) patients, while general anaesthesia was performed in 7 (21.8%) patients. Ureteric stones were found in 27 (84.3%) patients during endoscopy, 10 being distal, 9 middle and 8 proximal. There were no stones in five patients. The stones were fragmented with pneumatic lithotripsy in 8 patients and with holmium laser in 17 patients and the fragments were retracted with forceps. Of the 32 patients, 19 (59.4%) required JJ stent insertion peroperatively. There was no serious complication intraoperatively, while urinary tract infection developed in four and renal colic in two patients postoperatively. In one patient, sepsis developed postoperatively, and improved with appropriate treatment. All babies were born normally. Semirigid ureteroscopy for diagnosing and treating ureteral calculi by intracorporeal pneumatic or holmium laser lithotripsy is a safe and reasonable treatment option for pregnant patients.

Diploid karyotype partial mole coexisting with live term fetus--case report and review of the world literature.

A partial molar pregnancy of diploid karyotype coexisting with live term fetus is a rare entity Most instances of partial mole are triploid and only a few eases of diploid partial moles with term delivery have been reported. Here, we report a case of partial mole concomitant with a 37-week live fetus. Postpartum karyotype of the placenta and the fetus revealed both as 46XX. Histological examination of the placenta showed a partial hydatidiform mole. We discuss the diagnosis based on presenting clinical picture and proper management of signs and symptoms of partial molar pregnancy coexisting with live term fetus and diploid karyotype, coupled with a review of the literature.

Retrospective analysis of placenta accreta: management strategies--evaluation of 41 cases.

OBJECTIVE: The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. METHODS: We retrospectively reviewed the medical records of placenta accreta patients who were diagnosed and hospitalized between 2006 and 2010 at the Obstetrics and Gynecology Clinics of the Dicle University Hospital (Center A) and Maternity Hospital (Center B) in Diyarbakir Turkey The data were retrieved from medical charts of both hospitals. Maternal demographic features, clinical outcomes, type of surgical intervention, and complications were evaluated. RESULTS: The incidence of placenta accreta was 1/426 deliveries in Center A and 1/7573 deliveries in Center B over a 5-year period. Thirty-nine (95.1%) patients had placenta previa, and 32 (78.0%) patients had at least one previous cesarean delivery Hysterectomy was performed in 28 (68.3%) of 41 women with placenta accreta and uterine preservation was achieved in 13 (31.7%) of them. One (2.4%) maternal death occurred. Estimated blood loss was >2 liters and all patients required blood products transfusion. CONCLUSION: Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy internal iliac artery ligation, and uterine devascularization procedures.

Internal iliac artery ligation for severe postpartum hemorrhage.

OBJECTIVE: To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH). DESIGN: Multi-center retrospective study. METHODS: The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey. Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated. RESULTS: Totally 53 patients who underwent IIAL procedures were included in the study. All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17 +/- 0.46, 5.49 +/- 3.04, respectively. Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage. CONCLUSION: Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome.

Long-term outcomes of radical and conservative surgery for late diagnosed tubal pregnancies.

OBJECTIVE: To investigate long-term postoperative outcomes of conservative and radical surgery in ectopic tubal pregnancies, and evaluate the results of these techniques. METHODS: A total of 145 patients that operated for tubal pregnancy between January 2006 and January 2009 were reviewed. Data on patient age, reproductive and surgical history history of ectopic pregnancies, serum hCG levels at the time of diagnosis and intraoperative observation were retrospectively obtained from hospital records. Telephone interviews were used to obtain information about exact postoperative time interval in which the patients were trying to get pregnant, and the time when they spontaneously became pregnant. RESULTS: There was no significant difference in cumulative spontaneous intrauterine pregnancy rate for a 2-year of conception period subsequent to conservative (64.3%) and radical (58.3%) surgery (p = 0.636). During the same time interval, the rates of development of ectopic pregnancy for the conservative and radical surgery groups were 17.9% and 4.2%, respectively (p = 0.093). The patients who developed ectopic pregnancy after conservative surgery had significantly higher levels of serum hCG levels (7413 +/- 3155 IU/L) compared with those of patients who not-developed ectopic pregnancy (3436 +/- 2668 IU/L) (p = 0.007). CONCLUSION: In late-diagnosed cases with higher serum hCG levels, conservative treatment should not be the first choice. Indeed, our results suggested that the cumulative pregnancy rates are not significantly higher and the risk of ectopic pregnancy recurrence may be increased with conservative surgery in late tubal pregnancies.

Relaparotomy after initial surgery in obstetric and gynecologic operations: analysis of 113 cases.

CONDENSATION: Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology OBJECTIVE: To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations. STUDY DESIGN: A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery RESULTS: The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n = 42, 37.1%), hypogastric artery ligation (n = 32, 28.3%), hysterectomy (n = 31, 27.5%), and drainage of abscess (n = 7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality CONCLUSION: Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.

Cesarean scar pregnancy mimicking malignant tumor: a case report.

BACKGROUND: Ectopic pregnancy in cesarean scar is rare, however it is occurring with increasing frequency. These ectopic pregnancies can cause serious complications such as severe bleeding, uterine rupture, disseminated intravascular coagulation and maternal death. We present a case of cesarean scar pregnancy diagnosed during laparotomy with frozen section. CASE: A 26-year-old woman, gravida 3, para 3, was admitted to our gynecology clinic because of a 6-week history of irregular vaginal bleeding and anemia. A solid mass originating from the cervix was detected on ultrasound examination. Doppler ultrasound revealed an increase in blood supply. The case was managed by laparotomy. The solid mass was removed and the uterus preserved. CONCLUSION: Although ultrasound is useful in the detection of a typical scar pregnancy, ultrasound images can lead to a misdiagnosis, such as sarcoma or myoma, in some cases. Cesarean scar pregnancy should be considered in the differential diagnosis when an extremely vascularized and exophytic mass located in the isthmic region is detected.

A case of bifocal endometriosis involving a pfannenstiel incision.

A 25-year-old woman was referred to our clinic for atypical cyclic pain and masses at both ends of a Pfannenstiel incision scar. Ultrasound of the anterior abdominal wall showed two masses. Both masses were hypoechoic, heterogeneous lesions located at opposite ends of the scar. The lesions were surgically excised with. Microscopic examination revealed endometrial gland structures with endometrial stroma in fibroadipose tissue in sections of both specimens indicative of endometriosis. Incisional endometriosis (IE) is a form of extrapelvic endometriosis especially in scars of obstetric or gynecologic surgery IE may be multifocal at surgical scars. We report the a case of bifocal incisional endometriosis in Pfannesteil scar. Whole scar evaluation should be done for incisional endometriosis and surgical excision should be performed for treatment.

Evaluation of the relationship between insulin resistance and recurrent pregnancy loss.

OBJECTIVE: To investigate insulin resistance in patients with recurrent pregnancy loss (RPL). DESIGN: Single center, case-control, prospective study. METHODS: The study was performed at the Obstetrics and Gynecology Clinic at the Dicle University Medical Faculty from May to October 2009. 64 study subjects who had RPL were compared to 64 controls. Both groups were compared with fasting glucose, fasting insulin, fasting glucose/fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index values to assess insulin resistance. RESULTS: No significant differences in age and BMI index were found between the study and control subjects (p > 0.005). The mean number of abortions was 3.04 in the study and 0.2 in the control group (p < 0.001). The mean fasting glucose value was 100.84 in the study group, and 89.67 in the control group (p < 0.001). Also, the mean fasting insulin value was 15.51 in the study group and 7.17 in the control group (p = 0.001). The mean glucose/ insulin ratio was 12.24 in the study group and 28.27 in the control group (p = 0.017), and the mean HOMA-IR value was 4.16 in the study group and 1.62 in the control group (p = 0.002). CONCLUSION: Compared with the control group, patients with RPL were more likely to have insulin resistance.