Fetal pulmonary artery Doppler parameters in pregnancies complicated with intrahepatic cholestasis of pregnancy: a prospective case-control study

Objective: The primary aim of this study was to determine whether pulmonary artery acceleration time (AT) to ejection time (ET) ratio (PATET) was altered in fetuses of mothers with intrahepatic cholestasis of pregnancy (IHCP). The secondary aim was to investigate the association between fetal pulmonary artery Doppler parameters with neonatal outcomes in pregnancies complicated by IHCP. Material and Methods: This prospective case control study was conducted in a tertiary perinatal-neonatal center. A total of 18 fetuses whose mothers' pregnancies were complicated by IHCP were included as the study group and a total of 37 fetuses of mothers with healthy pregnancies were selected as controls. Fetal pulmonary artery Doppler parameters (AT; ET; AT/ET ratio) were assessed and neonatal outcomes were evaluated. Results: Mean pulmonary artery AT, ET and PATET were significantly different between the groups (p=0.001, p=0.024 and p=0.003, respectively). The mean PATET value in the IHCP group was 0.217±0.029 while in the control group it was 0.180±0.020. While PATET values were correlated with gestational age at birth, respiratory distress and need for neonatal intensive care admission were not correlated with PATET. Conclusion: Higher values of PATET may be a useful biomarker of fetal lung damage, secondary to IHCP.

Role of derived neutrophil-to-lymphocyte ratio, uric acid-to-creatinine ratio and Delta neutrophil index for predicting neonatal outcomes in pregnancies with preeclampsia.

We aimed to compare the maternal and neonatal systemic inflammatory markers, platelet indices and new indices in biochemical parameters in women with preeclampsia and healthy controls. The secondary aim was to investigate whether there was a relationship between maternal hematological markers and neonatal outcomes. A retrospective case control study was conducted in a tertiary hospital. Maternal demographic and birth characteristics, complete blood count indices, derived neutrophil to lymphocyte ratio (dNLR), Delta neutrophil index (DNI), uric acid-to-creatinine (Cre) ratio and uric acid-to-alanine transaminase ratio, neonatal hematological parameters were compared between the preeclamptic group and control group. The study consisted of 170 cases (84 preeclampsia and 86 control). Neutrophil-to-lymphocyte ratio (NLR), dNLR, blood urea nitrogen (BUN), creatinine (Cre), uric acid, LDH, aspartate transaminase (AST) and alanine aminotransferase (ALT), uric acid-to-Cre ratio and uric acid-to-ALT ratio were higher and statistically significant in the preeclamptic group than in control ones (p: 0.000 - BUN, Cre, uric acid, LDH, p: 0.001 - AST, p: 0.004 - ALT, p: 0.000 - uric acid-to-Cre ratio, p: 0.009 - uric acid-to-ALT ratio, respectively). NLR and platelet-to-lymphocyte (PLR) ratio were significantly higher in newborns of preeclamptic mothers (p: 0.039; p: 0.004, respectively). A low-moderate correlation between maternal uric acid-to-Cre ratio and neonatal PLR was detected (r: 0.193; p: 0.013). Moreover, moderate negative correlations between maternal PLR (r:-0.231, p: 0.002), uric acid (r: 0.332, p:0.000) and adverse neonatal outcomes were found. Uric acid and PLR, which can be easily calculated clinically may predict adverse neonatal outcomes.IMPACT STATEMENTWhat is already known about this topic? Preeclampsia is known as a significant cause of maternal morbidity and mortality. Haematological indices have been evaluated for the prognosis of many kinds of disease.What do the results of this study add? This study has focussed on new combined haematological-biochemical indices and its relationship with neonatal outcomes. Both higher NLR, derived NLR, DNI and lower PLR were recorded as useful markers for preeclampsia.What are the implications of these findings for clinical practice and/or further research? Some indices that were calculated by assessing basic and simple blood parameters may help clinicians to predict clinical outcomes of preeclampsia.

Comparison of maternal serum NRG-4 levels in healthy and preeclamptic pregnancies

Objective: The new adipokine, neuregulin-4 (NRG-4), acts as a signaling protein and plays a role in lipogenesis, inflammatory events and atherosclerosis. The aim was to investigate maternal levels of NRG-4 in preeclampsia (PE) disease. Material and Methods: Pregnant women with PE, divided into severe and mild PE, and gestational age-matched healthy pregnant women, as a control group, were recruited. NRG-4 levels were measured using an ELISA. NRG-4 levels in the groups and the relation between NRG-4 and clinical and laboratory parameters were analyzed. Results: There were 41 women in the PE group, 11 (26.8%) in the severe and 30 (73.2%) in the mild subgroups and 41 controls. There were no significant differences between the groups in terms of maternal age, gravidity, parity, abortion, gestational week at the time of blood sampling, levels of hemoglobin, platelet count, alanine and aspartate transaminases (p=0.067, p=0.819, p=0.957, p=0.503, p=0.054, p=0.217, p=0.306, and p=0.270 respectively). The PE group had higher body mass index, nitrogen urea and creatinine values, and diastolic and systolic blood pressure (p=0.005, p<0.001, p<0.001, p<0.001, and p<0.001 respectively). In addition, earlier gestational week at delivery, lower birth weight and Apgar scores at 1 and 5 minutes and the occurrence of non-reassuring fetal heart rate tracing were found in the PE group (p=0.010, p=0.004, p=0.005, p=0.005, and p=0.026 respectively). There were no significant differences between the groups in terms of NRG-4 (p=0.611). No correlation was identified between clinical parameters examined and NRG-4 levels (p=0.722). Conclusion: No association was found between NRG-4 concentrations and PE patients, regardless of severity of PE, compared to healthy pregnancies. Future longitudinal studies are needed to confirm this lack of association in PE.

Neurosonographic assessments of corpus callosum related structures in growth-restricted fetuses.

PURPOSE: The aim of this study was to evaluate whether corpus callosum length (CCL), corpus callosum-fastigium length (CCFL) and the angle between CCL-CCFL (CCFA) were altered in growth-restricted fetuses. METHODS: This prospective case-control study was conducted in a tertiary center. A total of 80 singleton fetuses were included in the study, classified as 36 late-onset growth-restricted fetuses and 44 adequate-for-gestational-age fetuses. All biometric measurements and Doppler assessments of umbilical artery, middle cerebral artery, and ductus venosus were performed via the trans-abdominal route. CCL, CCLF, and CCFA were assessed via the trans-vaginal route. RESULTS: Late-onset growth-restricted fetuses showed significantly reduced CCL and CCFL. There was no statistically significant differences in terms of CCFA. Moderate-high correlations between CCL and biparietal diameter, head circumference, abdominal circumference, FL and gestational age were detected (r: 0.482 p: 0.000; r: 0.537 p: 0.000; r: 0.488 p: 0.000; r: 0.519 p: 0.000; and r: 0.472 p: 0.000, respectively). CONCLUSION: This study adds to the literature that CCFA has not changed despite the decrease in CCL and CCFL in late-onset fetal growth restriction that might be a result of the redistribution of cerebral blood flow. To clarify the prognostic implications of these results in terms of neural and cognitive functions in postnatal life, there is a need for larger prospective studies.

Perinatology clinic in the coronavirus disease-2019 pandemic: what harms, often teaches.

BACKGROUND: Compartmental models simplify the mathematical modeling of infectious diseases based on reported cases. In the absence of precautions, personal protective equipment, quarantine and social distancing, a Susceptible-Exposed-Infectious-Recovered (SuEIR) model with Unscented Kalman Filter for coronavirus disease-19 (COVID-19) Forecasts in Turkey has revealed 174 641 infected people on August 15, 2020, whilst the reported case was 12 216. Through numerical experiments, the effects of quarantine, social distancing, and COVID-19 testing on the dynamics of the outbreak varies. We herein present the documentation of the work in a perinatology clinic during COVID-19 pandemic to find the reflection in a pandemic hospital as even in the pandemic, pregnancy complications and fetal diagnosis/therapy are time-sensitive and cannot be delayed. During the prevention of the horizontal transmission to the health-care workers (HCWs), testing all pregnant women with nasopharyngeal/oropharyngeal swabs for severe acute respiratory syndrome coronavirus (SARS-COV-2) undergoing birth, ultrasound examinations, invasive procedures appear to be the gold standard so that appropriate precautions can be taken if the screen is positive. Though it is logical, it may be incompatible with a busy obstetric practise as a pending polymerase chain reaction (PCR) result should never delay any emergent procedure. OBJECTIVE: We aim to describe the development of COVID-19 disease of 408 HCW out of 1462 by the exposure to pregnant women while providing obstetric care in a single tertiary perinatology unit under strict clinical triage, recommended precautions and wearing personal protective equipment and compare the maternal and perinatal outcome with those of the preceding three months. STUDY DESIGN: A prospective cohort study involving the pregnant women and the HCW with positive PCR for SARS-COV-2 were carried out to correlate with the horizontal transmission while documenting the perinatal work. RESULTS: 25 HCW, including nurses/midwives: 11, doctors: 7 and health technicians: 3 and support staff: 4 developed positive PCR for SARS-COV-2 while providing healthcare to 162 cases: mild-moderate (n = 146), severe (n = 12) and critical (n = 1) and asymptomatic (n = 3) in obstetric population. 22 out of 25 HCW were working in the perinatology unit. COVID-19 clinic was asymptomatic (n = 8), mild-moderate (13) or severe (n = 2) in HCW. However, "Exposed" group in the SuEIR model, both the pregnant women and the HCW that have already been infected and have not been tested, which have been also capable of infecting the "Susceptible" group could not be determined. Some of the HCW and the pregnant women in the "Exposed" group were tested and transferred to the "Infectious" group (which were reported to be PCR positive), while the rest of them who recovered, transitted to the so-called "Unreported Recovered" group. The ratio of the women with severe pre-eclampsia admitted to intensive care unit increased significantly during the lockdown (p = .01). CONCLUSIONS: In a nonstop pandemic perinatology clinic, exposure to 162 PCR positive pregnant women may be correlated with a 5.4% (22/408) documented horizontal transmission in the frontline HCW despite clinical triage and personal protective equipment.

The effect of real-time polymerase chain reaction cycle threshold values on perinatal outcomes of pregnant women with COVID-19.

OBJECTIVE: To evaluate the effect of cycle threshold (Ct) values on the pregnancy outcomes of women with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This prospective cohort study was conducted on pregnant women with COVID-19. A real-time polymerase chain reaction (RT-PCR) assay of a nasopharyngeal and oropharyngeal specimen was used for the diagnosis. Initial Ct values for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests were recorded. 22.9 was the 50th percentile Ct value of the study population. The study population was divided into two groups based on their Ct values: (1) Cases with Higher Ct values (Ct > 22.9)(n = 50) and (2) Cases with lower Ct values (Ct ≤ 22.9)(n = 55). Demographic features, clinical characteristics, disease progression, laboratory test results and pregnancy outcomes were compared between the groups. A receiver operating characteristic (ROC) curve was used to assess the performance of Ct values in predicting obstetric complications. RESULTS: Obstetric complication rate was significantly higher in cases with lower Ct values (p < .001). A significantly lower lymphocyte count together with higher ESR, procalcitonin and IL-6 values were observed in the cases with lower Ct values (p > .05). Additionally, a significantly higher NICU admission rate and longer hospital stays were present in the cases with lower Ct values (p > .05). The value in ROC curves with the best balance of sensitivity/specificity was 22.5 (85.7% sensitivity, 63.6% specificity). CONCLUSION: Lower Ct values may be associated with an increased rate of obstetric complications in pregnant women with COVID-19. Physicians should be cautious in the management of cases with Ct levels below 22.5.

Can Derived Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Delta Neutrophil Index Predict Spontaneous Abortion?

OBJECTIVE: To evaluate the efficacy of complete blood count indices for the prediction of miscarriage. MATERIALS AND METHODS: A retrospective case-control study was conducted in a tertiary hospital. This study consisted of 389 cases (32 elective and 193 spontaneous abortions, 164 healthy pregnancies). Maternal demographic characteristics, complete blood cell (CBC) parameters, neutrophil-lymphocyte ratio (NLR), derived NLR, systemic inflammatory immune index (SII), platelet-to-lymphocyte ratio (PLR), and delta neutrophil index (DNI) that were in the routine first trimester CBC were compared between groups. RESULTS: There were no significant differences among groups in terms of demographic and obstetric characteristics. Statistically significant differences were observed for Hb, white blood cell (WBC), lymphocyte (L), NLR, SII, and PLR between the subgroups (p=0.003, p=0.045, p=0.000, p=0.002, p=0.043, p=0.010, respectively). There were no significant differences among groups in terms of the remaining parameters. When healthy pregnancies and spontaneous abortions were compared, statistically significant differences were detected for NLR, SII, PLR (p=0.001, p=0.039, and p=0.000, respectively). Moreover, when healthy pregnancies and elective abortions were compared, only NLR was found as statistically different (p=0.050). Area under curve (AUC) was calculated for PLR as 0.659 (%95 CI: 0.582-0.735) and a cut-off value of 158.1 was found with highest sensitivity and specificity (60.6 % and 61.6%, respectively) according to the results obtained from Youden's index. AUC was calculated for NLR as 0.591 (%95 CI: 0.507-0.675) and a cut-off value of 3.135 was found with highest sensitivity and specificity (56% and 54.5%) according to the results obtained from Youden's index. CONCLUSION: In conclusion, decreased PLR and NLR levels may be used as practical and cost-effective markers for the prediction of miscarriages.

Skin Color May Predict Intra-Abdominal Adhesions During Repeated Caesarean Section Deliveries.

OBJECTIVE: Caesarean rates have increased rapidly for various reasons recently. One of the important reasons among these is medicolegal problems. Our aim with this study was to preoperatively predict abdominal adhesion density by combining the scar tissue morphology formed in the post-caesarean Pfannenstiel incision line and the skin color scoring of the patients. MATERIAL AND METHODS: Patients who had undergone one caesarean section previously, completed their terms (37-39 weeks) and were under 35 years old were included in the study. Skin color scoring of the patients was performed using the Fitzpatrick skin color scale. Intra-abdominal adhesion scoring of the participant patients was performed using Nair's adhesion scoring system. RESULTS: The change in abdominal adhesion scores was evaluated based on the Fitzpatrick color scale. Adhesion scores per the Nair intra-abdominal adhesion scoring system were found to be 0.04±0.209 in the FP1 group, 0.35±0.662 in the FP2 group, 1.58±0.923 in the FP3 group, and 2.33±0.577 in the FP4 group (p<0.05). These results showed a significant increase in adhesion density with increasing skin color darkness. Based on these results, it was observed that the abdominal adhesion scores and the frequency of depressed skin scar were significantly increased with increasing Fitzpatrick scores (p<0.05). CONCLUSION: The aim of this study was to increase the prediction rates by adding the skin color scoring to the scar tissue characteristics, which have been used in previous studies. The results of this study indicate that the combination of these two parameters may be more effective in predicting intra-abdominal adhesions. Nevertheless, there is a need for studies with a much higher number of patients and multiple parameters to be able to predict intra-abdominal adhesion density preoperatively with greater accuracy.

The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience.

BACKGROUND: Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results. METHODS: This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0-40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1st-5th minute APGAR scores, and OAE results were compared between the groups. RESULTS: 1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001). CONCLUSIONS: Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.

Endometrioma surgery is associated with increased risk of subsequent assisted reproductive technology cycle cancellation; a retrospective cohort study.

The aim of this study was to assess the effect of laparoscopic removal of endometrioma on assisted reproductive technology (ART) outcome. A retrospective cohort study was conducted at a university hospital between January 2014 and December 2017. The ART group consisted of 26 women who underwent 44 ART cycles in the presence of ovarian endometrioma and the surgery group consisted of 53 women who underwent 58 ART cycles after laparoscopic removal of ovarian endometrioma/s. There were no statistically significant differences between the groups regarding demographic parameters and background features including cycle parameters. The live birth rates in the ART and Surgery groups per embryo transfer were 23.7 and 26.1%, respectively (p = .800). The rate of cycle cancellation due to poor response and/or failed oocyte retrieval was significantly higher in the Surgery group than ART group (13.7 vs. 0%, respectively; p = .018). In conclusion, cystectomy significantly increases the risk of cycle cancellation due to poor ovarian response, which might be catastrophic individually. However, it does not seem to affect the live birth rates.IMPACT STATEMENTWhat is already known on this subject? Both the presence of an endometrioma or surgical removal may have deleterious effects on fertility potential.What do the results of this study add? Our results confirm that although cystectomy has no benefit on the number of oocytes collected and live birth rate, it increases the risk of cycle cancellation significantly in assisted reproductive technology cycles following endometrioma surgery.What are the implications of these findings for clinical practice and/or further research? Postponing cystectomy until a freeze-all cycle may be the best option to maximise the number of oocytes retrieved and to maximise the ovarian response.

Severe thrombocytopenia in pregnancy: a retrospective study.

: Thrombocytopenia is defined as a platelet count less than 150 000/µl and it is the most common hematologic disease after anemia in pregnancy. This study aims to investigate pregnant women with severe thrombocytopenia (platelet count <50 000/µl). In the relevant literature, few studies have addressed severe thrombocytopenia in pregnancy. This is a retrospective study based on the data from a reference center in Ankara, Turkey between January 2016 and December 2017. The study group consisted of 51 pregnant women who had two platelet counts lower than 50 000/µl. Descriptive statistical methods were utilized to analyze the results. The study analyzed the causes of severe thrombocytopenia, maternal and fetal-neonatal outcomes, and the management of the patients. The common causes of severe thrombocytopenia were hypertensive disorders (66.7%), immune thrombocytopenia (13.7%), massive obstetric hemorrhage (7.8%), and disseminated intravascular coagulation (5.9%). The preterm delivery occurred in 58.8% of the patients, and 46 live-births (two twins), six stillbirths, and one pregnancy termination emerged. Postpartum hemorrhage occurred in four (0.08%) patients, and blood transfusion was performed in 15 (29.4%) patients. The platelet transfusion was required to increase the platelet count of 30 (58.8%) patients. The study showed that the incidence of causes in severe thrombocytopenia in pregnancy varied considerably from mild and moderate thrombocytopenia. Despite severe thrombocytopenia, maternal and neonatal bleeding complications were infrequent in the study group.

Selection of a correct treatment protocol in caesarean scar pregnancies.

OBJECTIVE: This study aims at assessing the effectiveness of various treatment protocols with the help of some parameters in caesarean scar pregnancies. METHODS: A total of 26 patients were assessed in the study. The patients were divided into 4 groups. Group 1 consisted of those who had a wedge resection (n = 7), group 2 those who had a suction curettage (n = 10), group 3 those who had a systemic methotrexate (MTX) (n = 5) and group 4 those who had a systemic + local MTX (n = 4). The ßHcg half-lives, haemoglobin levels at the time of admittance and discharge, and hospital stays of the groups were compared. RESULTS: The difference between group 1 and group 4 was found significant (p = 0.002) with respect to days of hospital stay. There was no statistically significant difference between the groups with respect to ßHcg half-lives and haemoglobin values. CONCLUSION: The results of our study showed that there were no significant differences between treatment outcomes when appropriate protocols were employed. Therefore, the important point in CSPs is to assess correctly the type of CSP, the myometrial thickness and the patient's hemodynamic condition and select the most appropriate protocol accordingly rather than trying to establish a single standard treatment protocol.

Analysis of cystic hygroma diagnosed in the first trimester: Single-center experience

Objective: To evaluate the obstetric outcomes of fetuses with cystic hygroma other than karyotype abnormalities and structural malformations. Material and Methods: We conducted a retrospective study based on the review of medical records of pregnant women in whom ultrasonographic diagnosis of fetal cystic hygroma was established in the first trimester from January 2014 to October 2018. All patients were offered genetic counselling and prenatal invasive diagnostic procedures to obtain fetal karyotype. For ongoing pregnancies fetal echocardiography and detailed second trimester sonographic anomaly screening was performed by a perinatologist/pediatric cardiologist. The demographic characteristics of the women and the results of the karyotype analysis were obtained from the database of our hospital and correlated with the obstetric outcomes. Results: Within a five-year period, there were 106 cases of fetal cystic hygroma. Of those, fetal cardiac malformations were detected in four and micrognathia in one fetus. Eighty-five women underwent fetal invasive procedures and karyotype abnormalities were detected in 52 of the cases. Fetal outcomes of 33 cases with normal karyotype and 21 cases in whom karyotyping analysis were not performed due to patient refusal were enrolled into the study. Obstetric outcomes of 21 women who refused karyotyping consisted of 13 livebirths, seven missed abortions, and one fetal death, whereas those of 33 women with normal karyotype were; 12 livebirths, 12 missed abortions, two hydrops fetalis, and five fetal deaths. Nineteen of 33 fetuses with a normal karyotype and eight of 21 fetuses in whom karyotyping was not performed were terminated. Conclusion: The presence of cystic hygroma carries a high risk for fetal karyotype abnormalities and cardiac malformations. The postnatal outcomes of the fetuses with cystic hygroma appeared to be correlated with the absence of structural malformations and karyotype abnormalities.

Fetal fibular hemimelia with focal femoral deficiency: A case report.

Fibular hemimelia (FH) is a congenital deficiency in which a part or all of the fibular bone is hypoplastic or aplastic and associated with hypoplastic tibia and foot anomalies. The main differential diagnoses include proximal focal femoral dysplasia, Femur-Fibula-Ulna syndrome, and Femoral Hypoplasia-Unusual Facies syndrome. Proximal focal femoral dysplasia, which has a short, angulated femur with normal mineralization may be associated with FH. We report a case of unilateral FH with focal femoral deficiency detected at 18 weeks of gestation during a routine ultrasonographic anatomic screening. Sonographic findings were a unilateral short femur (1.8 cm, 3 weeks shorter than expected for gestational weeks), agenesis of ipsilateral fibula and angulation of ipsilateral tibial shaft. During a routine ultrasonographic anatomic scan, all the long bones are carefully measured and evaluated. Long bone shortness can be a part of syndrome or an isolated finding.

Neural and cardiac injury markers in fetal growth restriction and their relation to perinatal outcomes.

OBJECTIVE: To compare the levels of umbilical cord blood Neuron-Specific Enolase (NSE) and troponin T and venous blood gas samples between healthy newborns and growth-retarded fetuses with impaired Doppler velocity or low APGAR scores. MATERIALS AND METHODS: This study was a prospective cohort study. The study group comprised 26 patients with intrauterine growth restriction and pathologic Doppler symptoms, and the control group included 24 healthy fetuses. Umbilical cord blood and blood gas samples were taken from all patients. The blood samples were centrifuged and sent to a laboratory to study NSE and troponin T Perinatal outcomes were evaluated from the medical records of the newborns. RESULTS: Both groups were similar in terms of demographic characteristics. Fetuses with fetal growth restriction (FGR) were born earlier and had lower APGAR scores than the study group. Chronic hypoxemic fetuses in the study group had lower cord pH and HCO3 levels. Further, troponin T levels were higher in the study group than in the control group. There were no major differences in Doppler velocity measurements. CONCLUSION: It has been understood that cardiac and neuronal injury detection on fetuses with FGR, troponin T, and NSE are indicators that can be used. In the literature there are studies with heterogeneous paradigms using different indicators to find neuronal injury. As a result of this study, it is clear that to assess neonatal prognosis, wider-scoped and comparative studies will provide more information about the subject.

Primitive neuroectodermal tumor of genital tract in hysterectomized patient: A case report.

Primitive neuroectodermal tumors are high-grade malignant neoplasms. These are uncommon entities for the female genital tract. The treatment, management and follow-up period of Ewing's tumors are not well-defined because of their rarity in the genital tract. Surgical debulking is the mainstay treatment in all cases. After debulking surgery, patients receive chemotherapy and/or radiotherapy and there is a relation between disease stage and survival. Herein, we present a case of ovarian primitive neuroectodermal tumor with a review of previously reported cases.

Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome.

AIM: To compare the surgical results and reproductive performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction. METHODS: A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate uterus) and 78 patients with class U1a (T-shaped uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited. RESULTS: The operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [CI]: 3.6 ± 0.9 [1.8-5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71% ( P < .001) in class U2b and from 4% to 62.1% ( P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% CI, 29.1-387.1; P < .001) and class U1a (OR 35.7; 95% CI, 11.6-109.9; P < .001). The postoperative reproductive performances of both anomalies were similar. CONCLUSION: Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.

Effects of obstetric gel on the process and duration of labour in pregnant women: Randomised controlled trial.

The present study investigated maternal and neonatal outcomes in pregnant women who used obstetric lubricant gels during active labour. This prospective randomised controlled study included 180 pregnant women. Women were randomly assigned to two groups during the first-stage of labour. Pregnant women in the obstetric gel group received standard antepartum care plus vaginal application of obstetric gel. Women in the control group received standard antepartum care without obstetric gel. Mean duration of the second stage of labour was significantly shorter in the obstetric gel group than control group (45 ± 34 min vs. 58 ± 31 min, respectively; p = .005). Mean APGAR values at 5 min were significantly higher in the obstetric gel group (9.5 ± 0.6 vs. 9.2 ± 0.7; p = .0014). Among nulliparous women, mean duration of the second stage of labour was significantly shorter in the gel group than control group (53 ± 52 min vs. 83 ± 45 min, respectively; p = .003). Using obstetric gel at the beginning of the first stage decreases the length of the second stage of labour, particularly in nulliparous women, and may be associated with an improved APGAR score at 5 min. Impact statement A limited number of studies in the literature have demonstrated that obstetric gels shorten the second stage of labour and are protective for the pelvic floor. The results of this study show that using obstetric gel shortens the second stage of labour in only nulliparous, but not multiparous women. In addition, a significant improvement in the 5 min APGAR score was seen in the neonates of women who used obstetric gel. The application of obstetric gels during the labour of nulliparous women may be a useful clinical practice and may have a widespread use in the future.

True management of Obstructed Hemi-vagina and Ipsilateral Renal Anomaly syndrome.

Herlyn-Werner-Wunderlich syndrome is an unusual congenital anomaly of the female genitourinary system, which is described as uterine didelphys with Obstructed Hemi-vagina and Ipsilateral Renal Anomaly (OHIRA), also known as OHVIRA syndrome. Typical symptoms are pelvic pain, tenderness, pelvic mass due to blood collection in the obstructed hemi-vagina and uterus, and dysmenorrhea that usually begins shortly after menarche. Clinical suspicion is very important for diagnosis and correct management avoids both short- and long-term complications. Surgical removal of the vaginal septum is the main treatment method. Herein, we describe the evaluation and surgical management of a patient with OHVIRA syndrome who was diagnosed using magnetic resonance imaging and pelvic ultrasound.