Spontaneous twin pregnancy in uterus bicornis unicollis.

Abnormal fusion of the Müllerian ducts or failure of resorption of the septum causes varying degrees of congenital uterine malformation. They are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Twin gestation in a case of bicornuate uterus is extremely rare. A 37-year-old multiparous woman conceived a twin dichorionic diamniotic pregnancy spontaneously. Three-dimensional ultrasound revealed bicornuate uterus with one embryo in each cavity. Perinatal course was uneventful. At 35 weeks of pregnancy, spontaneous labour started and twin babies were delivered by bilateral low transvers caesarean section. Because of the rare occurrence of twin gestation in bicornuate uterus, there is no uniform guideline to manage these cases appropriately. Delivery by planned caesarean section could avoid the possible obstetric complications by dystocia.

Effect of surgical staging on 539 patients with borderline ovarian tumors: a Turkish Gynecologic Oncology Group study.

OBJECTIVE: The objectives of this study were to examine demographic and clinicopathologic characteristics and to determine the effects of primary surgery, surgical staging and the extensiveness of staging. METHODS: In a retrospective Turkish multicenter study, 539 patients, from 14 institutions, with borderline ovarian tumors were investigated. Some of the demographic, clinical and surgical characteristics of the cases were evaluated. The effects of type of surgery, surgical staging; complete or incomplete staging on survival rates were calculated by using Kaplan-Meier method. RESULTS: The median age at diagnosis was 40 years (range 15-84) and 71.1% of patients were premenopausal. The most common histologic types were serous and mucinous. Majority of the staged cases were in Stage IA (73.5%). 242 patients underwent conservative surgery. Recurrence rates were significantly higher in conservative surgery group (8.3% vs. 3%). Of all patients in this study, 294 (54.5%) have undergone surgical staging procedures. Of the patients who underwent surgical staging, 228 (77.6%) had comprehensive staging including lymphadenectomy. Appendectomy was performed on 204 (37.8%) of the patients. The median follow-up time was 36 months (range 1-120 months). Five-year survival rate was 100% and median survival time was 120 months. Surgical staging, lymph node sampling or dissection and appendectomy didn't cause any difference on survival. CONCLUSION: Comprehensive surgical staging, lymph node sampling or dissection and appendectomy are not beneficial in borderline ovarian tumors surgical management.

Effect of cervical length on second trimester pregnancy termination.

AIM: To evaluate the value of sonographic measurement of cervical length as a predictor of abortion or delivery within 24 h by misoprostol in second trimester termination of pregnancy (TOP). MATERIAL AND METHODS: One hundred and sixty-three women underwent TOP between 14 and 26 weeks of pregnancy due to various indications. The primary outcome was abortion within 24 h. Cervical length was measured before transvaginal administration of misoprostol. The effects of cervical length, total misoprostol dose, parity, and gestational age at diagnosis on successful TOP were evaluated. RESULTS: One hundred and sixty-three women were eligible who met the inclusion criteria. TOP occurred in 80.5% of patients within 24 h. Parous women had shorter prolonged induction to expulsion period over 24 h (14.1% vs 28.6%, P = 0.061). Total misoprostol dose and history of abortion were parameters that affected induction to delivery period (P = 0.002 and P = 0.041). Using an optimum cutoff of 36 mm, 58.2% sensitivity and 68.2% specificity were obtained. In addition, positive and negative predictive values were 85.36% and 33.3%, respectively. Pregnant women whose preinduction cervical length was shorter than 36 mm had a shorter induction time and needed a lower total misoprostol dose to achieve TOP than women with a cervical length longer than 36 mm (P = 0.027 and P = 0.011, respectively). CONCLUSION: Transvaginal measurement of cervical length before administration of prostaglandin analogue was not correlated with successful TOP within 24 h. It cannot be used as a predictor in light of our findings.

The effect of myomectomy on health-related quality of life of women with myoma uteri.

AIM: An equal consideration should be paid to improving health-related quality of life (HRQoL) in addition to successful medical outcome. Many studies have evaluated the effect of other methods rather than myomectomy on HRQoL, and have focused solely on the presence of myoma without regarding any concurrent pelvic pathology. METHODS: This study involved 80 patients with myomas and 75 controls. Domains of the Short Form - 36 (SF-36) questionnaire were evaluated pre- and postoperatively in 72 women with myomas. Furthermore, any correlations between myoma characteristics and SF-36 physical components (PC) and mental components (MC) were investigated. RESULTS: All SF-36 domains were lower in women with myoma uteri than in the control group, except for physical and social function. There was no correlation between PC and MC scores and the number, location and total volume of the myomas. However, fundal and posteriorly positioned myomas were related with the PC score, and posterior myomas with the MC score. Women with uteri over 200 cm(3) had significantly lower mean PC and MC scores. After myomectomy, all SF-36 domains were improved except for physical function and mental health. CONCLUSION: The findings from this study suggest that myomectomy improves HRQoL, and that myoma characteristics may modulate quality of life domains.

The effect of myoma uteri and myomectomy on sexual function.

INTRODUCTION: This is a report about the effects of myoma uteri and myomectomy on sexual function in women. AIM: The aim of this article was to determine the effects of myoma uteri and myomectomy on sexual function in women. METHOD: The study was designed as a controlled clinical study in an academic clinical research center. The study patients consisted of 80 women with myoma uteri and 75 control women. Baseline characteristics and properties of the myomas were recorded. A validated questionnaire was used to determine pre- and postoperative sexual function in the patients. MAIN OUTCOME MEASURE: Female sexual function index (FSFI) scores of the women were recorded before and after surgery. RESULTS: Women with myoma uteri had lower FSFI pain and satisfaction scores than women without it, even after correction for possible confounders. Fundal and posterior myomas were associated with pain, whereas only posterior myomas were related to the overall FSFI scores. However, although there was no relation between the volume of the myomas and the FSFI scores, women with a uterine volume over 200 cm(3) had significantly lower mean FSFI satisfaction, pain, and total scores. The mean FSFI pain and total scores of the patients improved significantly after undergoing a myomectomy. CONCLUSIONS: The findings of this study suggest that a potential impairment of sexual function exists in women with myomas. This is mainly because of pain during sexual intercourse, although it does not seem to have an effect on either the arousal or orgasmic phases. Furthermore, the performance of a myomectomy may alleviate pain during intercourse, and thereby improve sexual function in the patients.