Early prenatal diagnosis of thoraco-omphalopagus twins at ten weeks of gestation by ultrasound.

Early prenatal diagnosis of conjoined twins, an extreme form of monozygotic twinning, is very important for the further management and counselling of parents because they are associated with high perinatal mortality. We present a case of thoraco-omphalopagus twins diagnosed at ten weeks and four days of gestation by two-dimensional Doppler ultrasound, which was then terminated.

Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000-2006.

AIM: The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates. METHODS: The computed delivery room data of 11.741 liveborn singleton term neonates was used to compare malnourished and nourished newborns. RESULTS: Of the total subjects, 577 (4.9%) were malnourished. There were no differences between the groups with regard to gender distribution, Apgar scores, maternal parity, smoking during pregnancy and type of delivery. Maternal age and neonatal gestational age (GA) were significantly lower in malnourished newborns (P < 0.001). Birthweight (BW), birth length (BL) and head circumference (HC) were significantly lower in the malnourished group compared with well-nourished group (P < 0.001). Mean BW (g) was 2724.7 ± 17.0 in the malnourished group versus 3234.3 ± 3.8 in the well-nourished group; BL (cm) was 47.8 ± 0.1 in malnourished versus 49.5 ± 0.0 in well-nourished neonates; HC (cm) was 33.25 ± 0.1 in the malnourished versus 34.3 ± 0.0 in the well-nourished group. Between the groups, there were significant differences in the ratio of small, appropriate and large for GA (P < 0.001). Of the malnourished newborns, 35.5% were small for GA, 63.3% were appropriate for GA and 1.2% were large for GA. CONCLUSION: Fetal malnutrition (FM) still exists despite the advances in current obstetric care. Neonates of adolescent mothers and of low GA are particularly at risk for FM. The BW, BL and HC of fetally malnourished neonates are lower than that of well-nourished neonates. Like term singleton appropriate and small for GA neonates, term singleton large for GA neonates could also have been fetally malnourished.

New intrauterine growth percentiles: a hospital-based study in Istanbul, Turkey.

OBJECTIVE: To develop gender and gestation-specific growth percentiles for singleton live-born neonates and to compare new weight for age unisex percentiles with Lubchenco unisex percentiles. METHODS: Cross-sectional birth data were collected from the neonatal registry from January 2000 to April 2006 (n = 15.509). After exclusion, the sample included 15.112 neonates. RESULTS: Newly developed weight for age, charts were compared with Lubchenco unisex percentiles, 91.8% of the subjects were classified in the same way (Kappa = 0.74, P < 0.001). Small for gestational age (SGA) and large for gestational age (LGA) according to the Lubchenco percentiles differed from the new percentiles (Mc Nemar test, P < 0.001). The percentage of SGA neonates was underestimated by Lubcheno percentile (5.8% vs. 10.6%, respectively), whereas the percentage of LGA neonates was overestimated by Lubcheno percentile (10.3% vs. 9.3%, respectively). CONCLUSION: New growth chart for newborn delivered at different gestational ages have been established, which can be used to define SGA and LGA in Turkish neonates. Studies comparing the Lubchenco percentiles with new percentiles are needed.

Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial.

OBJECTIVE: To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women. STUDY DESIGN: Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625mg/day (n=35), intranasal 300microg/day estradiol hemihidrate (n=33), percutaneous gel 1.5mg/day estradiol hemihidrate (n=32) or no treatment (control group, n=32). Serum E(2) and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy. RESULTS: After 1 year, the greatest increase in E(2) was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs transdermal gel: p=0.022: oral vs intranasal: p=0.0001; transdermal gel vs intranasal: p=0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p<0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p<0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs transdermal gel: p=0.015; oral vs intranasal: p=0.001; transdermal gel vs intranasal: p=0.735). Control group scored worse in all tests after study (p<0.05). All scores correlated significantly with post-treatment serum E(2) and FSH levels (p<0.001). CONCLUSION: Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.

Effect of timing of episiotomy repair on peripartum blood loss.

BACKGROUND: To evaluate the effect of timing of episiotomy repair on peripartum blood loss. METHOD: In this case-controlled study, nulliparous women were grouped as: group 1: no episiotomy (control; n = 82); group 2: midline episiotomy repair after placental removal (n = 76); group 3: midline episiotomy repair before placental removal (n = 78); group 4: mediolateral episiotomy repair after placental removal (n = 84), and group 5: mediolateral episiotomy repair before placental removal (n = 80). Hemoglobin and hematocrit values were evaluated at admission and 24 h postpartum. RESULTS: The reductions in hemoglobin and hematocrit in all episiotomy groups (groups 2-5) were significantly more than that of control (group 1) (p < 0.05). There was no difference among midline episiotomy groups (groups 2 and 3) whereas a significant difference existed among mediolateral groups (groups 4 and 5) (p < 0.05). When episiotomy repair was done after placental removal, there was a significant difference between midline and mediolateral techniques (groups 2 and 4) (p < 0.05). When repair was done before placental removal, there was no difference in the amount of blood loss regardless of technique (between groups 3 and 5). CONCLUSION: Episiotomy should be avoided to decrease the amount of peripartum blood loss. However, if mediolateral episiotomy is to be performed, it should be repaired before placental removal to decrease the amount of peripartum blood loss.

Do different delivery systems of estrogen therapy influence serum lipids differently in surgically menopausal women?

AIM: To compare the influence of different delivery forms of estrogen therapy (ET) on serum lipid levels. METHODS: For this prospective, randomized, controlled study, 132 surgically menopausal women were assigned to 12 months of therapy with oral conjugated estrogen 0.625 mg/day (n = 35), intranasal 300 microg/day estradiol hemihydrate (n = 33), percutaneous gel 1.5 mg/day estradiol hemihydrate (n = 32) or no treatment (control group, n = 32). Total cholesterol (t-Chol), triglycerides, high-, low-, and very low-density lipoprotein (HDL-Chol, LDL-Chol, and VLDL-Chol, respectively) levels were determined at baseline, and cycles 6 and 12. Data were analyzed using repeated measures ANOVA. RESULTS: All delivery forms significantly decreased t-Chol and LDL-Chol while increasing HDL-Chol after 6 and 12 cycles. The oral route significantly increased whereas other modalities significantly decreased serum triglycerides after cycle 6 and 12. VLDL-Chol levels were significantly increased using the oral route after cycle 12 while intranasal and percutaneous gel forms decreased the level after cycles 6 and 12. CONCLUSION: Oral, intranasal and transdermal gel delivery modes of ET have beneficial effects on serum lipids, as shown by decreased t-Chol and LDL-Chol, and increased HDL-Chol levels in surgically menopausal women. The oral form should be used with care in women with hypertriglyceridemia and with increased VLDL-Chol levels. However, the oral route seems to be more effective in decreasing LDL-Chol levels than the percutaneous gel form.

The effect of mode of delivery on postpartum sexual functioning in primiparous women.

The objective of this paper is to evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. A total of 248 primiparous women were recruited into this study. One hundred fifty-six delivered spontaneously with mediolateral episiotomy and 92 had elective cesarean section. Sexual function was evaluated by the Female Sexual Function Index, a validated questionnaire separately evaluating desire, lubrication, orgasm, satisfaction, and pain. Subjects were questioned relating their pre-pregnancy experiences during the first antenatal visit when the pregnancy was not more than six gestational weeks. The test was repeated 6 months postpartum. Statistical evaluation was carried out by SPSS for Windows v.11. In the vaginal delivery with mediolateral episiotomy group, there were significant decreases in the scores 6 months after delivery when compared to scores before pregnancy (p<0.001). In the cesarean section group, no difference was observed between pre-pregnancy and postpartum scores (p>0.05). When the two groups were compared, there was a significant difference between 6 months postpartum scores (p<0.001). Not only pain, but also other important aspects of sexual function, such as arousal, lubrication, orgasm, and satisfaction are affected by performing mediolateral episiotomy during vaginal delivery, well beyond the puerperal period. Concerning its effects on postpartum sexual functioning, a policy of restricting mediolateral episiotomy use should be adopted.

Recurrent mucinous cystadenoma in a 20-year-old woman: was hysterectomy inevitable?

A recurrence of ovarian mucinous cysts is very rare. Over a period of 21 months, a 20-year-old patient had three laparotomies resulting initially in the removal of one ovary with a mucinous cystadenoma and two cystectomies for the same pathology, but ultimately leading to hysterectomy and salphingo-oopherectomy. Because mucinous tumors are usually benign and most of the time multilocular, management of young patients is challenging, especially in the case of recurrence. Follow-up of these patients is very important and transvaginal ultrasound seems to be currently the most effective diagnostic tool for the follow-up of young patients treated with cystectomy for benign mucinous cystadenomas.

Plasma homocysteine in late pregnancies complicated with preeclampsia and in newborns.

The aim of this study was to determine the relationship between maternal serum homocysteine levels in preeclampsia and the severity of the disease, neonatal serum homocysteine levels, maternal complications, and fetal outcome. Fifty pregnant women were included in this prospective study, of which 25 were severe (group I) and 25 were non-severe preeclamptic (group II). Maternal and neonatal serum homocysteine levels were measured by the fluorescence polarization immunoassay (FPIA) method. Maternal homocysteine levels in both groups were compared. The association of maternal and neonatal serum homocysteine levels with maternal complications and fetal outcome was investigated. When the maternal serum homocysteine cut-off value was accepted as 15 micromol/L, significant differences in relation to maternal (eclampsia; hemolysis, elevated liver enzymes, and low platelet count syndrome) and fetal (in utero mort fetalis, low birthweight) complications were observed between the group with maternal serum homocysteine level > 15 micromol/L and the group with maternal serum homocysteine level < or = 15 micromol/L ( p < 0.05). Hyperhomocysteinemia during pregnancy is a risk factor for both development of preeclampsia and its complications. Given that the diagnosis and treatment of hyperhomocysteinemia is possible, clinical trials to determine whether treatment to reduce homocysteine would be valuable in the prevention of both maternal and fetal complications in preeclampsia should be designed.

Features of patients with vulvar dermatoses in dermatologic and gynecologic practice in Turkey: is there a need for an interdisciplinary approach?

AIM: Vulvar dermatoses are very common problems in women and they are associated with significant morbidity. The aims of the present study were to evaluate the features of patients with vulvar diseases in gynecology and dermatology out-patient clinics in Turkey, and to determine the need for a multidisciplinary vulvar clinic in this country. METHODS: A total of 310 patients with vulvar problems as their primary complaints were included in the study. There were 144 women from a dermatology clinic and 166 women from a gynecology clinic. The following factors were recorded for all patients: physical examination findings, menarche age, age at first intercourse, education level, marital status, clinical diagnoses and associated gynecologic problems. RESULTS: There were no significant differences between the two groups when the mean age, menarche age and age at first intercourse were compared (P > 0.05). The number of unmarried women was statistically significantly higher in the dermatology group than in the gynecology group (P < 0.0001). The number of women who graduated from high school and university was also statistically significantly higher in the dermatology group than in the gynecology group (P < 0.01). The frequency of gynecologic problems was statistically significantly higher in the gynecology group than in the dermatology group (P < 0.001); however, dermatologic conditions were the most frequent diagnosis overall (33.54%). Forty patients in the gynecology group were referred to the dermatology clinic. CONCLUSIONS: The approach to patients with vulvar disorders varies from country to country. However, multidisciplinary clinics seem to improve the understanding of vulvar diseases, to make correct diagnoses and to raise patients' quality of life. The need for a multidisciplinary vulvar clinic should not be ignored by the physicians in Turkey.

Lipoprotein(a) levels in women with pre-eclampsia and in normotensive pregnant women.

AIM: To determine if plasma lipoprotein(a) levels are elevated in pre-eclampsia and if so, their association with the severity of the disease. METHODS: Ninety-one pre-eclamptic (48 mild, 43 severe) and 40 healthy normotensive pregnant women at more than 32 gestational weeks were recruited into study. Plasma levels of lipoprotein(a), lipids, total protein, albumin and fibrinogen were measured in all subjects. RESULTS: All groups were comparable with respect to maternal age, maternal weight, gravidity and parity. Platelet count, total serum protein and albumin levels were significantly decreased, whereas fibrinogen levels significantly increased in the pre-eclamptic group. There was no difference between the groups with respect to total cholesterol and low-density lipoprotein levels. In the pre-eclampsic group, triglyceride and very-low-density lipoprotein concentrations were significantly higher, whereas high-density lipoprotein levels were significantly lower. No difference in serum lipoprotein(a) levels was found between the three groups. CONCLUSIONS: No statistically significant difference existed between normotensive pregnant, and pre-eclamptic women, with regard to plasma lipoprotein(a) levels. It is improbable that high serum lipoprotein(a) levels are risk factors for the development of pre-eclampsia; however, elevated triglyceride-rich lipoproteins might cause endothelial damage leading to pre-eclampsia.

Serum leptin levels in preeclamptic pregnant women: relationship to thyroid-stimulating hormone, body mass index, and proteinuria.

The objective of this study was to evaluate the change in maternal serum leptin levels in preeclampsia and to study the relationship between maternal serum leptin and thyroid-stimulating hormone (TSH), body mass index (BMI), newborn weight, and proteinuria. Eighty-five pregnant women were included in this prospective study, of whom 50 were preeclamptic and 35 were normotensive. Maternal serum leptin levels were measured by the radioimmunoassay technique and TSH levels were measured by the electrochemiluminescence immunoassay method. The maternal serum leptin levels of preeclamptic and normotensive pregnant women were compared. In each group, the relationship between maternal serum leptin levels and TSH levels, BMI, newborn weight, and proteinuria was evaluated. The maternal serum leptin level was significantly higher in the preeclamptics than in the normotensive pregnant women. In the preeclamptic group, there was a strong positive correlation between maternal serum leptin levels and BMI (r =- 0.80; p < 0.001), a very weak positive correlation between maternal serum leptin levels and proteinuria (r = 0.305; p < 0.05), and a very weak inverse correlation between maternal serum leptin levels and birth weight (r = -0.377; p < 0.01). In the same group, there was no correlation between maternal serum leptin and serum TSH levels (r = 0.22; p > 0.05; Pearson correlation test). Leptin may be involved in the pathology of preeclampsia, and elevated maternal serum leptin levels may be a marker for the early stages of preeclampsia in pregnant women.

The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss.

BACKGROUND: Our purpose was to determine whether blood loss during cesarean section and postoperative endometritis rate were associated with the method of placental removal and site of uterine repair. METHODS: This prospective randomized study involved 840 women who underwent cesarean section. The patients were grouped into four: (1) manual placental delivery + exteriorized uterine repair; (2) spontaneous placental delivery + exteriorized uterine repair; (3) manual placental delivery + in situ uterine repair; (4) spontaneous placental delivery + in situ uterine repair. Patients were excluded if they had received intrapartum antibiotics, had chorioamnionitis, required an emergency cesarean hysterectomy, had rupture of membranes for more than 12 hr, had bleeding diathesis, and had abnormal placentation or prior postpartum hemorrhage. The main outcome measures were postoperative hemoglobin and hematocrit values, and postcesarean endometritis. RESULTS: There were no statistically significant differences in mean maternal age, parity, gestational age, presence and duration of membrane rupture and number of vaginal examinations between the four groups. The decrease in postoperative hemoglobin (P < 0.05) and hematocrit (P < 0.001) was significantly greater in the manual removal groups (groups 1 and 3) than in the spontaneous expulsion groups (groups 2 and 4) at 48 hr postoperatively. The incidence of postoperative endometritis was significantly higher in manual removal groups (15.2%) (groups 1 and 3) than in spontaneous groups (5.7%) (groups 2 and 4) (P < 0.05). CONCLUSIONS: Manual removal of the placenta at cesarean delivery results in more operative blood loss and a higher incidence of postcesarean endometritis.

Bilateral sertoli cell adenoma and serous cyst in a patient with androgen insensitivity syndrome.

Thirty-year-old woman with lower abdominal pain was operated due to adnexial mass. Cystectomy on right gonad revealed sertoli cell adenoma and simple serous cyst and left gonadal biopsy showed immature testis tissue. Later, laparoscopic left gonadectomy was made. Histopathology of the left gonad was consistent with sertoli cell adenoma.

Effect of daily hormone therapy and alendronate use on bone mineral density in postmenopausal women.

OBJECTIVE: To evaluate the effect of daily oral and transdermal hormone therapy alone or in combination with alendronate on bone mineral density in postmenopausal women. DESIGN: Comparative prospective clinical study. SETTING: Outpatient clinic of a training and research hospital. PATIENT(S): One hundred seventy-three consecutive postmenopausal women with no previous hormone therapy and a bone mineral density T score <-1 SD were randomly enrolled. INTERVENTION(S): Oral conjugated estrogen, alone or with alendronate, or transdermal estrogen, alone or with alendronate, given for 1 year. All patients also received medroxyprogesterone acetate and calcium. MAIN OUTCOME MEASURE(S): Bone density measurement at L2 to 4 region by dual-energy X-ray absorptiometry. RESULTS: At the end of 1 year, significant increase in bone density measurements were seen in all groups. Oral conjugated estrogen and transdermal estrogen have the same effect on bone mineral density loss. Hormone therapy alone stabilized the bone mineral density loss. Hormone therapy together with alendronate resulted in better values in all groups. CONCLUSION: Hormone therapy is adequate in osteopenic women. However, hormone therapy plus alendronate is advantageous in women with considerable bone mineral density loss.

Gynecological examinations for social and legal reasons in Turkey: hospital data.

AIM: Women in Turkey are subjected to gynecologic examinations not only for legal reasons, such as sexual assault or violence against pregnant women, but also for various social reasons, such as suspicions of premarital intercourse, prostitution, loss of virginity, and pregnancy at the time of entering into a new marriage. The examinations are performed by general practitioners, forensic physicians, and gynecologists. This study presents social reasons for gynecologic examinations of women in Turkey. METHOD: We analyzed the reasons for gynecologic examination of 412 women at the 1st Obstetrics and Gynecology Department, Sisli Etfal Training and Research Hospital, between January 1, 1999 and June 30, 2001. RESULTS: Out of 27,376 women at the Department, 412 (1.5%) underwent gynecologic examination for social or legal reasons: 82 (19.9%) for entering into a new marriage, 41 (10.1%) for violence against pregnant women, 28 (6.7%) for sexual assault, 53 (12.8%) for suspicion of prostitution, and 208 (50.5%) for the determination of virginity. CONCLUSION: Gynecologic examinations for legal or social reasons in Turkey are still rather common. Medicolegal regulation of gynecological examinations should be changed to protect women's human rights.