The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

The contribution of PET/CT to the differentiation of benign and malignant pleural effusion in patients with ovarian carcinoma.

OBJECTIVE: The present study investigates the ability of non-invasive contribution of positron emission tomography (PET)/computed tomography (CT) to distinguish between benign pleural effusions (BPE) and malignant pleural effusions (MPE) in patients diagnosed with ovarian carcinoma (OC). MATERIAL AND METHODS: Included in the study were 32 OC patients with a PE diagnosis. The cases with BPE and MPE were compared in terms of the PE maximum standardized uptake value (SUVmax), PE SUVmax/mean standardized uptake (SUVmean) value of the mediastinal blood pool (TBRp), the presence of pleural thickening, the presence of supradiaphragmatic lymph node, unilateral or bilateral PE, pleural effusion diameter, patient age and CA125 value. RESULTS: The mean age of the 32 patients was 57±2.8 years. TBRp>1.1, pleural thickening and supradiaphragmatic lymph node were observed significantly more frequently in the MPE than the BPE cases. While no pleural nodules were detected in patients with BPE, they were present in 7 of the patients with MPE. The rates of distinction between the MPE and BPE cases were as follows: the sensitivity of the TBRp value was 95.2% and specificity was 72.7%; the sensitivity of pleural thickness was 80.9% and specificity was 81.8%; the sensitivity of supradiaphragmatic lymph node was 38% and specificity was 90.9%; and the sensitivity of the pleural nodule was 33.3% and specificity was 100%. There were no significant differences between two groups in any other factors. CONCLUSIONS: Pleural thickening and TBRp values ascertained through PET/CT may aid the distinction between MPE-BPE, especially in patients with advanced stage OC with a poor general condition, or those who cannot undergo surgery.

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone.

PURPOSE: The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

Volumetric PET parameters are predictive for the prognosis of locally advanced cervical cancer.

BACKGROUND: The present study evaluates the relationship between PET/CT findings and survival in patients with locally advanced cervical cancer (LACC) with a squamous cell histology. METHODS: The study included 70 patients with LACC (FIGO stage IB2-IVA). The relationship between pretreatment PET/CT parameters, age, stage, lymph node metastasis and survival was evaluated using the univariate and multivariate Cox proportional hazards model. RESULTS: The mean age of the 70 patients was 57.4 years and the mean duration of follow-up was 33.6 months. Disease progression occurred in 36 patients and 32 patients died during the follow-up period. In the univariate analysis, MTV-P and TLG-P were found to be related to progression-free survival (PFS), and stage, MTV-P, TLG-P and SUVmax-Ps were found to be related to overall survival (OS). However, only MTV-P and TLG-P were found to be independent prognostic factors for both PFS and OS. CONCLUSIONS: The present findings suggest that volumetric PET parameters (MTV-P, TLG-P) predict the progression and survival of the patients with LACC.

Clinical value of metabolic PET parameters of primary vulvar carcinoma.

PURPOSE: We aim to establish the prognostic value of metabolic parameters of the primary tumor in patients diagnosed with vulvar squamous cell carcinoma (VSCC) who underwent a pretreatment F-18 FDG PET/CT scan. MATERIALS AND METHODS: This retrospective study included 47 patients with a histopathologically confirmed diagnosis of VSCC, and who underwent a F-18 FDG PET/CT scan prior to treatment. The disease stage and age at diagnosis, and the maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor, based on a baseline PET scan, were recorded. The relationship between these factors, and progression-free survival (PFS) and overall survival (OS) was evaluated. RESULTS: The mean age of the 47 study patients was 69.6±1.9 years. Among the patients, 18 were in early stage of the disease and 29 were in the advanced stage. The age, and SUVmax, SUVmean, MTV and TLG values were statistically significantly associated with OS and PFS. Furthermore, it was noted that OS and PFS were significantly longer in the early stage patients than in the advanced stage patients, in patients with a tumor size <4cm than those with a tumor size ≥4cm, and in patients with a negative lymph node metastasis than those with a positive lymph node metastasis. CONCLUSION: Our findings suggest that PET parameters are prognostic factors for VSCC. To the best of our knowledge, this study is the first to investigate the prognostic value of the PET parameters of primary tumors in patients with VSCC, and as such, we believe it contributes to literature.

Why is it important to report early possible COVID-19 PET/CT findings in cancer patients? Explaining with a case series.

BACKGROUND: Coronavirus disease-2019 (COVID-19) causing a pandemic mostly results in mild symptoms; however, it can evolve into serious complications. It is emphasized that if the term from the recent anticancer treatment to the diagnosis of COVID-19 was short, the probability of serious events increased in cancer patients. Therefore, early detection of COVID-19 and prevention of serious events is very important. We aimed to investigate whether it is possible to detect COVID-19 early by positron emission tomography (PET)/computed tomography (CT). METHODS: We retrospectively evaluated the images and clinical findings of patients who underwent PET/CT due to malignancy and whose COVID-19 polymerase chain reaction (PCR) test were detected positive subsequently. RESULTS: Eight cancer patients with positive COVID-19 PCR tests were included in the study. PET/CT revealed subpleural ground-glass opacities (GGOs) showing mild fluorodeoxyglucose (FDG) uptake that could be compatible with COVID-19 in 4 of 8 patients. The number of affected lobes ranged from 1-4. All patients were diagnosed with COVID-19 by PCR test when symptoms and/or lung findings worsened on the days after PET/CT. The time interval between the last anticancer treatment and COVID-19 diagnosis in five patients was ≤7 days. During the follow-up, six of the cases (75%) needed mechanical ventilation and died later. CONCLUSION: COVID-19 may be recognised early by detecting incidental findings in PET/CT, especially in asymptomatic cancer patients. Potential complications may be prevented by early diagnosis and anticancer therapy changes. Therefore, possible COVID-19 findings in PET/CT should be reported and the patient should be referred to relevant clinician.

PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis.

AIM: We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC). METHODS: We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUVmax, SUVmean, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated. RESULTS: The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUVmax (AUC = 0.757), 6 for SUVmean (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUVmax and SUVmean values were not predictive. CONCLUSIONS: The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.

Comparison of the Effects of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy on Sexual Function and Quality of Life.

It is known that benign gynecological diseases negatively affect sexual function. For this reason, hysterectomy provides improvement in sexual function as well as symptoms such as bleeding and pain. The effects of abdominal hysterectomy (TAH) and laparoscopic hysterectomy (TLH), which are the two most common types of hysterectomy today, are not clear. In our study, we investigated the effects of TAH and TLH on sexual function and quality of life as well as intraoperative and postoperative results. In 329 TLH and 126 TAH patients, we compared both and between themselves preoperatively and postoperatively by using the standardized and validated female sexual function index (FSFI) and European quality of life five-dimension scale (EQ-5D). In conclusion, we found that both types of hysterectomy were effective in improving sexual function, and we concluded that improvement in the laparoscopy group was statistically higher. Patients who require hysterectomy for benign gynecological reasons should be informed that TLH has a more positive effect on sexual function as well as other advantages, and if the patients' main complaint is sexual dysfunction, TLH should be preferred compared to TAH.

Transabdominal ultrasonography: A non-invasive method for diagnosing vaginal atrophy.

OBJECTIVE: Genitourinary syndrome of menopause is a definition of all symptoms caused by hypoestrogenemia in menopausal age and one of the most common symptoms is vaginal atrophy. The diagnosis methods which are used for vaginal atrophy may be painful. A novel method total vaginal thickness and total mucosal thickness measuring could be determine vaginal atrophy. MATERIAL AND METHODS: This is a prospective case-control study involving 60 women in each group of 120 patients. One of the groups is comprised postmenopausal, histopathologically diagnosed vaginal atrophic women and the other group comprised 24-35 aged women who were no symptoms of vaginal atrophy and vaginal swab samples are not compatible with vaginal atrophy. All women who participated in the study underwent transabdominal ultrasound and total vaginal thickness and total mucosal thickness were measured. RESULTS: Total vaginal thickness and total mucosal thickness were found lower in the postmenopausal group compared to premenopausal women (p = 0.005 and p = 0.07, respectively). The cutoff value was determined as 8.55 mm for total vaginal thickness and 1.52 mm for total mucosal thickness, and the diagnostic power of these values is a specificity of 88.89% (95% confidence interval: 51.75-99.72%) and a ppv of 92.86% (95% confidence interval: 66.53-98.84%) for total vaginal thickness and a specificity of 80.95% (95% confidence interval: 58.09-94.55%) and a ppv of 89.47% (95% confidence interval: 71.10-96.71%) for total mucosal thickness. CONCLUSION: Vaginal atrophy is a painful symptom for menopausal women and the diagnostic methods may be invasive and painful too. Total vaginal thickness and total mucosal thickness measuring with transabdominal ultrasound could be an alternative method for diagnosis and treat vaginal atrophy easily.

Uterine manipulator requirement in laparoscopic surgery of Ectopic Pregnancy.

OBJECTIVE: The advantages of laparoscopic surgery used in the treatment of ectopic pregnancy is well-known; however, the efficacy of uterine manipulators remains unknown. In this study, we aimed to investigate the efficacy of uterine manipulators in the laparoscopic treatment of ectopic pregnancy. METHODS: Overall, 118 patients who underwent laparoscopy due to ectopic pregnancy in Department of Obstetrics and Gynaecology at Tepecik Education and Research Hospital between January 2010 and January 2018 and who met the inclusion criteria were included in the study. Groups of patients undergoing surgery with or without the use of a uterine manipulator were compared in terms of demographic data, operative and postoperative results. RESULTS: No difference was noted between the groups in terms of age, parity, body mass index, smoking, side of ectopic pregnancy mass, previous operations and pregnancy type. However, the size of ectopic pregnancy mass measured by ultrasonography was significantly larger (p = 0.006) and the operation time was significantly shorter (p<0.001) in the group where uterine manipulators were not used than in the uterine manipulator group. CONCLUSION: We concluded that not using a uterine manipulator in laparoscopic procedures for ectopic pregnancy did not increase operative complications and that operation time was higher in procedures using uterine manipulators.

Obstetric Outcomes of Syrian Refugees and Turkish Citizens.

BACKGROUND: To present the differences in prenatal, labor and neonatal outcomes for Syrian refugees and Turkish citizens. METHODS: Between January 2013 and December 2016, all patients in our hospital were screened retrospectively. Totally, 17000 pregnant women included in the study were divided into three groups: group 1: 4802 pregnant in Syrian refugees group; group 2: 6752 pregnant in the low-income Turkish citizens (LI groups); and group 3: 5446 women in high-income Turkish citizens (HI groups). The groups were compared for demographic parameters, prenatal, labor and postnatal results. RESULTS: Age, gestational week, birth weights, antenatal follow-up, antenatal iron supplementation and prenatal hemoglobin (Hb) values were significantly lower in the Syrian refugee group (P < 0.001). Only moderate preterm delivery and moderate low birth weight were higher in the refugee group (P = 0.023 and P = 0.001). Stillbirth rates were similar in all three groups (P = 0.203), but all other neonatal complications were higher in the Turkish citizens group. CONCLUSION: In comparison to non-refugee control patients, adverse perinatal outcomes were not observed in pregnant refugees. The refugee health policies of the Republic of Turkey seem to be working. However, further larger multicenter studies may provide more convincing data about obstetric outcomes and health results in the Syrian refugee population.

Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital.

The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35-40 years old. (2) 40-45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate.

Various BhCG monitoring protocols for predicting the success of single-dose methotrexate in the treatment of ectopic pregnancy.

We investigated various monitoring protocols on the success of methotrexate therapy in patients with tubal ectopic pregnancy. The data from patients who received single-dose methotrexate therapy as their first-line treatment was reviewed. The Beta-human chorionic gonadotropin (BhCG) days 1-4 and days 1-7 follow-up protocols were compared with the BhCG day 4-7 follow-up protocol, in terms of the treatment. Cut-off values were determined for the reduction of BhCG between the days 1-4 and days 1-7. There were no significant differences between the groups in terms of the demographic data, except for BhCG fourth- and seventh-day values. There was a 21% decrease in BhCG between days 1 and 4 and a 32% decrease for BhCG between days 1 and 7 as good predictors for treatment success. These follow-up protocols allow earlier and more cost-effective methods than the protocol based on a 15% reduction in BhCG levels between days 4 and 7. Impact statement What is already known on this subject? A decrease of 15% BhCG levels between days 4 and 7 is a common protocol for predicting the success of a single-dose methotrexate therapy of an ectopic pregnancy. What do the results of this study add? This clinical study offers the cut-off values for the various BhCG follow-up protocols recently found in the literature for single-dose methotrexate therapy for the treatment of ectopic pregnancy. What are the implications of these findings for clinical practice and/or further research? We identified the importance of fourth-day BhCG for measuring the success of single-dose methotrexate therapy. Therefore, after randomised, multicentre, prospective clinical trials, the most common follow-up protocol can be changed to a single-dose methotrexate therapy for ectopic pregnancy.

Clinicopathologic evaluation of uterine smooth muscle tumors of uncertain malignant potential (STUMP): A single center experience.

OBJECTIVE: To investigate the clinical outcomes and histopathological features of uterine smooth muscle tumors of uncertain malignant potential (STUMP). METHODS: The study analysed cases diagnosed with uterine STUMP in a tertiary center, between January 2003 and September 2018. We investigated the clinical, operative and histopatholologic data of the cases. Follow-up information and clinical outcomes were also examined. RESULTS: 28 cases with uterine STUMP were studied. The mean age of the patients was 44.5 ± 9.0 years and the median parity was 2 (0-6). The mean tumor diameter was 6.3 cm (range 2-27 cm) and most (78.6%) of the tumors were located intramurally. In 25% of the cases diagnosis was after myomectomy, while in the others diagnosis was after hysterectomy. Of the patients who wanted to preserve the uterus and their fertility and who did not therefore undergo a subsequent hysterectomy, one patient became pregnant without any complication. One case with a history of myomectomy, presented as STUMP. The median follow-up time was 45.4 months (range 5-180). Recurrence occured in one case (3.7%) 33 months after diagnosis. Distant metastasis occurred in the lungs and the pathology of the biopsy was liposarcoma, and the patient died of the disease 62 months after diagnosis. CONCLUSION: Uterine STUMP is a rare condition, and diagnosis can be difficult, often with unusual combinations of findings. Prognosis for the patient is unclear and their is a risk of recurrence with the tumors. To reduce mortality, regular follow-up and a centralised approach are recommended.

The effects of threatened abortions on pregnancy outcomes.

OBJECTIVES: The effects of first trimester threatened abortions on prenatal and postnatal pregnancy outcomes. MATERIAL AND METHODS: Data from 24.835 pregnant women were retrospectively analysed. The pregnant women were divided into two groups according to whether they had a first trimester threatened abortion or not. The demographic data and prenatal, postnatal and labour outcomes were compared for the two groups. Those cases with miscarriages during their follow-up, pregnant women with systemic diseases, multiple pregnancies and patients who were diagnosed with cervical erosion and cervical polypoid formation during vaginal bleeding examinations were all excluded. RESULTS: The age (p < 0.001), ART pregnancy rate (p = 0.03) and nulliparity rate (p = 0.013) in those with the risk of miscar- riage were statistically significantly higher than those without the risk. The gestational weeks (p < 0.001) and birth weights (p < 0.001) were significantly lower for the miscarriage group than in the control group. Hyperemesis gravidarum (p < 0.001), gestational diabetes mellitus (GDM) (p < 0.001) and placenta previa (p = 0.018) rates were statistically significantly and more frequent in the pregnancies with the threatened abortion group than in the control group. The rates of caesarean delivery were statistically significantly higher in the threatened abortion group (p < 0.001). CONCLUSIONS: Threatened abortion between 6- and 14-weeks gestational age is a complication that may cause anxiety in the early weeks of pregnancy. But the treatment, follow-up and cause of threatened abortion all remain unclear.

Maternal and neonatal outcomes of adolescent pregnancy.

OBJECTIVE: To examine the maternal and neonatal outcomes of adolescent pregnancies. METHODS: Deliveries that occurred in a high-volume tertiary center between January 2013 and December 2016 were retrospectively analyzed. We studied pregnant women who were under 19 years of age at the time at which they gave birth, and who underwent regular follow-up. Pregnancies associated with chromosomal abnormalities, early pregnancy losses (before 20 weeks), and ectopic pregnancies were excluded. RESULTS: In all, 101 pregnant women aged <15 years and 3611 aged 15-19 years were enrolled. The control group contained 13,501 randomly selected pregnant women aged 25-30 years. The median gestational week at delivery was lower in adolescents. Adolescent pregnancies were associated with higher rates of threatened abortion and pre-eclampsia. Gestational diabetes mellitus was less common, whereas the risk for cesarean section was higher, in adolescents. In addition, women aged <15 years were at higher risk for preterm delivery. The rates of <3rd percentile birth weight percentiles by gestational age were 6.9%, 5.1%, 4.2% and <10th percentile were 16.8%, 14.5%, 11% in the three groups, respectively. The 5 min Apgar scores were lower for the babies of adolescents, and the requirement of newborn intensive care was higher for the infants of mothers aged <15 years. CONCLUSION: Adolescent pregnancy is a significant issue worldwide. Adverse outcomes differ among study populations, but both preterm delivery and low birth weight are of concern, as are a higher cesarean rate.

Effects of fetal gender and low first trimester aneuploidy screening markers on preterm birth.

OBJECTIVE: To show the relation between fetal gender and preterm birth (PTB) in low values of first trimester aneuploidy test markers. MATERIAL AND METHOD: A total of 29,528 patients included the study of them 7382 was PTB and all patients grouped according to fetal gender. Demographic data and perinatal complications were determined. According low PAPP-A MoM (<0.4) and low free BhCG MoM (<0.5) values PTB subgroup relative risks were calculated for each fetal gender. RESULTS: The PTB rate and birth weight was significantly higher in male gender. At low PAPP-A MoM values Late PTB in male infant (aRR 95% CI 2.028) and late miscarriage (LM) category with low free BhCG MoM values in female infant (aRR 95% CI 0.907) was determined statistically significant. CONCLUSIONS: Male gender has an effect on PTB rate. In low values of first trimester aneuploidy test markers late PTB risk is increasing in male gender and also LM risk is decreasing in female gender. Further studies are required in order to determine the relation between PTB and fetal gender and first trimester aneuploidy screening test.

Role of endometrial sampling in cases with asymptomatic cervical polyps.

Cervical polyps are benign neoplasms of the cervix and frequently asymptomatic; however, they may cause intermenstrual, postcoital, and postmenopausal bleeding. The excision of cervical polyps and necessity of endometrial sampling is remain controversial. The objective of our study was to determine the association between cervical polyps and smear and endometrial pathologies. 221 patients were included in the study and all patients data reviewed retrospectively. All patients were divided into two groups; 1. Premenopausal, 2. Postmenopausal. The groups were compared in terms of demographic information, histopathological results and polyp number and size. Also endometrial sampling results were divided; 1. premalignant-malignant group 2. benign group. There was a statistically significant difference between polyp size and premalignant and malignant endometrial pathologies in the postmenopausal patient group (p = 0.048 and p = 0.002). The cut-off value for polyp length was determined to be 19 mm and that for polyp volume was determined to be 2150 mm3. The use of Pap smear screening before polypectomy can give information about malignancy potential of asymptomatic cervical polyps. However, if polyps sizes are length of >19 mm and volume of >2300 mm3, especially in postmenopausal females endometrial sampling should be recommended.

The incidence, causes, and management of lower urinary tract injury during total laparoscopic hysterectomy.

OBJECTIVES: Determining the incidence and causes of lower urinary tract injury in patients undergoing total laparoscopic hysterectomy and examining the procedures applied for management. METHODS: Patients who underwent total laparoscopic hysterectomy in a large referral center between 1 January 2015 and 31 October 2017 for benign gynecological reasons were included in the study. Patients who underwent laparoscopic supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy and robot-assisted laparoscopic hysterectomy were not included in this study. The hospital records of all patients included in the study were examined and the incidence, causes and management of lower urinary tract injuries were reviewed. RESULTS: Total lower urinary tract injury rate was found as 2.01%, and these injuries were evaluated separately as bladder and ureter injuries. All the bladder injuries had occurred on the posterior wall of the bladder during vesicouterine dissection; six cases were intraoperatively detected and one case was detected on the first postoperative day. Most of ureteral injury cases were detected in the early postoperative period (75%). The rates of previous cesarean section and endometriosis were significantly higher in patients with injury to the bladder and ureter than in the control group (p<0,001). There was no significant difference between the patients with lower urinary tract injury and the control group regarding uterine weight, estimated blood loss, bilateral salpingo-oophorectomy, the presence and location of fibroids, and laparoscopic or vaginal closure of the vaginal cuff. CONCLUSION: Laparoscopic hysterectomy may be a good option in appropriate patients, but in case of previous cesarean section and endometriosis cases, patients should be informed about the possible complications in detail before the operation and care should be taken during dissection.

Importance of transvaginal ultrasonography before endometrial sampling in asymptomatic postmenopausal patients.

Endometrial cancer is the most common gynecologic cancer. Transvaginal ultrasonography (TV USG) is considered to be the first-line diagnostic method for the evaluation of endometrial cancer. 213 asymptomatic postmenopausal patients (192 benign, 21 patients malignant endometrial findings after endometrial sampling) who underwent evaluation with gray-scale TV USG at maximum 48h before endometrial sampling were included. Except for hypertension (P=0.004) and endometrial thickness (P=0.003), there was no significant difference in the demographic data, endometrial fluid and endometrial cystic areas detected on TV USG between the groups. A cut-off value of 8.35mm for endometrial thickness yielded 98.05% positive predictive value with 95% CI. If the endometrial thickness is ≥8.35mm at TV USG performing endometrial curettage will be reasonable not to wait until 11mm and endometrial sampling is not required if TV USG shows fluid and cystic areas in the endometrial cavity.