An examination by year of cases applied with caesarean hysterectomy because of placenta percreta in a tertiary centre: a retrospective cohort study.

OBJECTIVES: To examine cases applied with caesarean hysterectomy because of placenta percreta by comparing changes in treatment strategies and complications according to year. MATERIAL AND METHODS: A retrospective examination was made of 93 patients applied with caesarean hysterectomy with a diagnosis of placenta percreta in 5-year periods of 2005-2009, 2010-2014, and 2015-2019. Demographic characteristics were recorded, and previous caesareans, history of myomectomy and curettage, gestational weeks, and infant birthweight. Intraoperative and postoperative findings were recorded as operating time, length of stay in hospital and Intensive Care Unit (ICU), transfusion requirement, the amount of erythrocyte suspension (ES) and fresh frozen plasma (FFP) transfused, and requirement for massive transfusion. Anaesthesia type, complications, and the preferred skin-uterus incision were also recorded. RESULTS: The 93 patients comprised 8 cases in the period 2005-2009, 23 in 2010-2014, and 62 in 2015-2019. The number of previous caesarean procedures was observed to increase in parallel with these case numbers. A significant increase was observed in the gestational week of birth, and infant birthweight, and a decrease in operating times. In later years there was seen to be a lower amount of ES and FFP transfused and fewer patients with massive transfusion. Preoperative diagnosis of placenta percreta, the highest preference for general anaesthesia, selection of midline vertical skin incision and uterine fundal incision were greatest in the period 2015-2019. CONCLUSIONS: In cases with placenta percreta, of which there is an increasing incidence, maternal and infant outcomes can be optimised with prenatal diagnosis and planned caesarean hysterectomy by a multidisciplinary team with optimal prenatal preparation.

The efficacy of LigaSure™ open instruments in cases of cesarean hysterectomy due to placenta percreta: a retrospective, record-based, comparative study.

OBJECTIVE: The standard treatment for patients with placenta percreta is cesarean hysterectomy that can cause severe bleeding. New-generation vessel sealing systems like LigaSure can cut and seal vascular structures and tissues. The aim of this study was to retrospectively compare hysterectomies performed with traditional instruments and those performed with LigaSure instruments to determine the possible advantages with the latter. MATERIALS AND METHODS: Patients with placenta percreta who underwent elective cesarean hysterectomy by the same surgeon were divided into two groups based on the type of instruments used. Group 1, the standard conventional hysterectomy group, operated with conventional instruments for cutting and tying; and Group 2, the LigaSure hysterectomy group, operated with the new-generation bipolar sealing and cutting instruments. The groups were retrospectively compared for bleeding, operating time, and complications. RESULTS: In Group 2, the operating time, intraoperative and total transfused erythrocyte suspension units, total fluid in the drain, and total hospital stay were lower than in Group 1 (p < .05), as was the need for internal iliac artery ligation (p = .013). The complication rates were similar between the two groups (p > .05). CONCLUSION: The use of LigaSure open instruments in cesarean hysterectomies in patients with placenta percreta may reduce operating times and the amount of bleeding.

Vaginal epithelioid malignant peripheral nerve sheath tumor nearly misdiagnosed as advanced cervical cancer: A case report.

A 56-year-old woman was referred to our hospital with a pathological diagnosis of squamous cell carcinoma of the cervix. We performed a re-biopsy of the vaginal mass and cervical conization. The mass was originally reported as an epithelioid MPNST after re-biopsy. Strong diffuse S-100 positivity, epithelioid morphology of the lesion, and negativity to all other immune histochemical markers confirmed the diagnosis of epithelioid MPNST. Cervical conization specimen was negative for any neoplasms.

Why some pregnant women refuse glucose challenge test? Turkish pregnant women's perspectives for gestational diabetes mellitus screening.

OBJECTIVE: Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women's opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test. METHODS: This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT. RESULTS: Among women who were ≤28 weeks of gestation, 42.5% (n=82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n=79/193) pointed out their reluctance, and 16.6% (n=32/193) indicated that they had no opinion about the subject. Women who were ≤28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n=62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n=45/119) had GCT in the ongoing pregnancy, while 62.2% (n=74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n=37/74, 50%). CONCLUSION: This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.

Uterine Cervix Metastasis of Myxopapillary Ependymoma Originated from the Spinal Cord.

BACKGROUND: Myxopapillary ependymomas are well differentiated low-grade tumors which have been documented to local or distant metastasis. In the literature, this is a unique case of myxopapillary ependymoma with metastasis to the uterine cervix. Here, we present a rare case of extra neural metastasis of spinal ependymoma that developed over a long period. CASE REPORT: A 34-year-old woman was referred to our hospital for pelvic mass. A mass (110×100 mm) localized between the sacrococcygeal region and the uterus was detected by magnetic resonance imaging. In 2004, she had been operated upon for myxopapillary ependymoma seated in the sacrococcygeal region for the first time. She underwent tumor resection eight times due to the recurrence of spinal tumor in the same region in nine years. Under the diagnosis of uterine neoplasm, we carried out radical hysterectomy, omentectomy and pelvic lymphadenectomy as the surgical procedure. The pathological findings were reported as myxopapillary ependymoma. Immunohistochemically, the myxopapillary ependymal cells showed strong positivity for glial fibrillary acidic protein, whereas they were negative for low molecular weight cytokeratin. The Ki-67 labeling index was about 2-3%. The patient had an uneventful postoperative period. She has remained free of symptoms in the year since surgery. CONCLUSION: Extra-spinal myxopapillary ependymoma is very rare, but it must be considered in the differential diagnosis of pelvic mass lesions.

The diagnostic value of frozen section for borderline ovarian tumours.

Borderline ovarian tumours (BOTs) are characterised histologically by a low degree of cellular proliferation and nuclear atypia in the absence of infiltrative growth or stromal invasion. Surgical treatment has been a crucial component of BOT therapy. Surgical decisions are established intraoperatively via the frozen section. We evaluated the accuracy of frozen section diagnosis. The rate of correct diagnosis, underdiagnosis and overdiagnosis of BOTs with frozen sections was 78%, 17% and 5%, respectively. The sensitivity and positive predictive values for the diagnosis of BOTs with frozen sections were 82.3% and 93.3%, respectively. The positive likelihood ratio was 0.82 (95% CI: 0.85-0.96). The histological classification of BOTs had a significant effect on the accuracy of diagnosis (p = 0.001). Frozen section diagnosis is not suitable to be considered as the gold standard for a definitive diagnosis. Clinicians should be aware that using frozen sections is insufficient for the accurate staging of BOTs.

A rare coexistence of villoglandular papillary adenocarcinoma of the uterine cervix and brenner tumor of the ovary.

Synchronous primary gynecological cancers have been reported to be seen rarely in the literature. In this report, we aimed to describe a 51-year-old patient with the coexistence of villoglandular papillary adenocarcinoma of the cervix uteri and Brenner tumor in the right ovary. She successfully underwent radical hysterectomy, bilateral salphing-oopherectomy and pelvic and para-aortic lymphadenectomy.

Expression of matrix metalloproteinase-1 in round ligament and uterosacral ligament tissue from women with pelvic organ prolapse.

To evaluate the matrix metalloproteinase-1 (MMP-1) expression in different parts of pelvic connective tissue in postmenopausal women with and without pelvic organ prolapse (POP). Ninety-one samples were obtained from only postmenopausal women (42 with POP and 49 non-POP subjects). All women were evaluated by pelvic organ prolapse quantitation. The POP group had stage 2 or more, and the controls had stage 1 or less. Round ligament (RL) and uterosacral ligament (USL) biopsies were obtained from women with POP and controls. Immunohistochemistry for MMP-1 was performed on formalin-fixed and paraffin-embedded sections. The two groups were matched for age, body mass index, parity and postmenopausal status. MedCalc Statistical Software Programme Version 12.0.5 was used for statistical analysis. Expression of MMP-1 were significantly higher in both RL and USL tissue from postmenopausal women with POP, compared with controls. MMP-1 immunoreactivities were identified in both RL and USL biopsies from all women with and without POP. The expression pattern of MMP-1 were similar in these ligaments and were significantly higher in POP group compared with control subjects. These changes indicate a possible relation between MMP-1 expression of RL and USL in women with and without POP.

Emergency peripartum hysterectomy: our 12-year experience.

OBJECTIVE: The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). METHODS: We analyzed retrospectively 44 cases of EPH performed at tertiary obstetric center between January 2001 and April 2013. Data related to demographics, reproductive histories, indications for EPH, and postoperative follow-up were obtained by analyses of hospital records. RESULTS: The overall incidence of EPH was 0.48 per 1,000 deliveries during the study period. The most common indications of EPH were abnormal placentation (50 %), uterine atony (36 %) and uterine rupture (9 %). All patients who underwent EPH with abnormal placentation had one or more previous cesarean sections (CS) except one. In our series, 24 cases (54 %) underwent total hysterectomy, most of which had the diagnosis of abnormal placentation (75 %), whereas subtotal hysterectomy was the choice of management of bleeding in cases with uterine atony (60 %). Maternal mortality was seen in 2 patients (4.5 %). The causes were disseminated intravascular coagulation in one and adult respiratory distress syndrome in the other patient. Perinatal mortality was observed in 7 patients (16 %). The causes for perinatal mortality were placental abruption in 4 and prematurity in 3 patients. CONCLUSIONS: In our series, abnormal placentation was the most common indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.

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.

Surgical Staging of Early Stage Endometrial Cancer: Comparison Between Laparotomy and Laparoscopy.

BACKGROUND: The aim of the present study was to compare the laparotomy (LT) and laparoscopy (LS) in patients who undergone surgical staging for early stage endometrium cancer. METHODS: Retrospective data were collected and analyzed for amount of intraoperative bleeding, complication rates, total resected and laterality specific number of lymph nodes and duration of operation in patients operated with either LT or LS. RESULTS: Seventy-nine stage I endometrium cancer patients were found to be eligible for the trial purposes: 58 (73.4%) treated by LT and 21 (26.6%) treated by LS. The number of lymph nodes was similar in LT (8.9 ± 5.3) and LS (9.2 ± 4.8) (P = 0.8). In LT group, there was no difference in the number of lymph nodes between the right and left sides (10 ± 5.8 and 8.7 ± 4.8 respectively, P = 0.19); in LS group, the number of lymph nodes resected from the right side was higher than the left side (9.8 ± 5 and 7 ± 3.5 respectively, P = 0.039). The amount of intraoperative bleeding and hospitalization period were significantly higher in LT group. Seventy-nine patients had a median follow-up of 30 months. The two groups were similar for disease-free survival (P = 0.46, log rank test). CONCLUSIONS: There was no significant difference between the two methods in terms of number of total resected lymph nodes. In early stage endometrial carcinoma, LS has provided adequate staging and similar survival rates with LT.

Immunohistochemical analysis of connective tissue in patients with pelvic organ prolapse.

The uterosacral ligaments are an important part of the pelvic support system. The objective of this study was to compare the expression of collagen type I and collagen type III in the uterosacral ligament biopsies from women with and without pelvic organ prolapse (POP). The uterosacral ligament biopsies were obtained from women with POP (n = 29) and non-POP subjects (n = 35). Immunohistochemistry for collagen type I and collagen type III was performed on formalin-fixed and paraffin-embedded sections. The two groups were matched for age, body mass index, parity and postmenopausal status. The expression of collagen type I (p < 0.001) and collagen type III (p < 0.0001) differed between women with POP and non-POP subjects. There was decreased expression of collagen type I and increased expression of collagen type III in uterosacral ligaments of women with POP compared with non-POP subjects. This difference indicates a possible relationship between POP and the immunohistochemical expression of collagen type I and collagen type III in uterosacral ligaments.

Acute abdomen due to rupture of Sertoli cell tumor.

PURPOSE: To present a rare case of Sertoli cell tumor that presents with acute abdomen. CASE: A 28-year-old patient with symptoms of acute abdomen has presented to our emergency department. Her examinations revealed a 12 x 10 cm heterogeneous mass in the right ovarian fossa. Laparotomy was carried out immediately. Frozen pathological study revealed a low-grade sex-cord stromal cell tumor. Right salpingo-oopherectomy was performed. During 2 years of follow-up, there was no evidence of disease. CONCLUSION: Although rupture of a malignant ovarian tumor is an infrequent cause of acute abdomen, it should be considered in the differential diagnosis of acute abdomen.

Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication.

Acute pancreatitis is rare cause in pregnancy and gallstones are clearly the most common cause of pancreatitis during pregnancy. Only a small percentage of women with acute pancreatitis are associated with hypertriglyceridemia and it is most often noted during the last two trimesters of pregnancy. Hypertriglyceridemia is a rare cause of pancreatitis in pregnant women and complication such as pancreatitis carries a higher risk of mortality for both the mother and the fetus. Our purpose was to report our experience with acute pancreatitis as a lethal complication of hypertriglyceridemia during the third trimester of pregnancy.

The effect of magnesium sulfate treatment on blood biochemistry and bleeding time in patients with severe preeclampsia.

OBJECTIVE: The objective of this study was to observe the effects of magnesium sulfate on various blood biochemical parameters and coagulation status of patients with preeclampsia. METHODS: During a period of 4 years, 50 patients with severe or mild preeclampsia progressing to severe preeclampsia were included in the cross-sectional study. Prothrombine (PT), activated limited thromboplastin time (aPTT), magnesium level, biochemistry parameters, systolic, and diastolic blood pressure (BP) were measured. These parameters were remeasured in the second hour of magnesium sulfate treatment. RESULTS: After magnesium sulfate therapy; creatinine levels are decreased (p < 0.05), bleeding time is increased and serum magnesium levels are increased (p < 0.01), systolic and diastolic BP values decreased significantly (p < 0.01). PT, aPTT, platelet levels, and coagulation time did not change after treatment. CONCLUSION: Magnesium sulfate infusion prolonged bleeding time in patients with severe preeclampsia. This is clinically important because it worsens the present condition and causes possible complications.

Emergency peripartum hysterectomy in a tertiary Istanbul hospital.

OBJECTIVE: To evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries. METHOD(S): We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA). RESULT(S): The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum histerectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7. CONCLUSION(S): Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures.

Heterotopic pregnancy following ovulation induction by clomiphene citrate and timed intercourse: a case report.

We report a combined intra-uterine and unruptured tubal pregnancy following ovulation induction by clomiphene citrate (CC) and timed intercourse. The diagnosis of heterotopic pregnancy (HP) is the major problem until occurrence of tubal rupture. Because HP is a life-threatening condition, the diagnosis should be made as soon as possible. In a spontaneous conception, HP is a rare event. The risk of HP significantly increases after ovulation induction. Clomiphene itself could be associated with a high HP rate. We present a case with normally developing intra-uterine singleton pregnancy successfully managed by salpingectomy of synchronous tubal pregnancy following ovulation induction by CC and a review of the literature.

The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies.

OBJECTIVE: To assess the association between histopathologically confirmed vascular abnormalities developed during pre-eclampsia and abnormal arterial blood flows recorded during Doppler sonographies. MATERIALS AND METHODS: From pregnant women who attended our clinic between 01/03/2002 and 01/07/2002, a detailed medical history was obtained and routine biochemical blood tests, fetal ultrasonography and UA Doppler scans were performed. In addition, from pre-eclamptic and normal pregnant women who underwent cesarean sections, placental bed biopsies were taken. Thirty two pre-eclamptic [12 mild, 20 severe cases according to American College of Obstetricians and Gynecologists (ACOG) criteria] cases and as a control group 20 normal pregnancies were included in the study. In our study trophoblast invasion into decidual spiral arteries was observed in 75% of mild (9/12), and 55% of severe (11/20) pre-eclampsias. In the control group all the cases demonstrated trophoblast invasion in decidual spiral arteries. Trophoblast invasion in myometrial spiral arteries was noted in 50% (6/12) of mild and 25% (5/20) of severe pre-eclamptic pregnancies. It was seen in 16 cases out of 20 (80%) pregnancies. In the control group, decidual spiral artery invasion manifests significant differences (P<0.01) among groups studied. Invasion in decidual spiral arteries was seen in all normal pregnancies of the control group. There is not any significant difference between mild and severely pre-eclamptic groups (P>0.05). CONCLUSION: Doppler ultrasonography is not only a non-invasive method for evaluating fetal status in pre-eclamptic pregnancies, but it also correlates with partial trophoblastic invasion in spiral arteries, which contributes to the pathophysiologic mechanisms involved in pre-eclampsia.