Effect of pregnancy on recurrence of symptomatic uterine myomas in women who underwent myomectomy.

BACKGROUND: There is no consensus in the literature regarding risk factors associated with recurrence of uterine leiomyomas. In this study, we evaluated the factors that affect the recurrence of uterine leiomyomas in women who underwent laparotomic or endoscopic myomectomy. METHODS: This retrospective study included 378 patients that underwent myomectomy. Patient follow-up ranged from two to eight years, and they were classified according to the recurrence of myoma uteri. Age, gravidity, parity, presenting complaints, prior surgery, comorbidity, smoking status, intraoperative and postoperative features, and Ca 125 levels were obtained from the hospital records and patient files. RESULTS: Recurrence was detected in 67 women (17.72 %). No statistically significant differences were observed in the demographic data and past obstetric history between the recurrent and non-recurrent groups. The number of myomas was higher in the recurrence group as compared to the non-recurrence group [2 (range: 1-41) vs 1 (1-19), respectively, p =0.022]. Pregnancy rates were statistically higher in the recurrence group as compared to the non- recurrence group (17.9 % vs 7.1 %, respectively, p =0.005). Pregnancy after myomectomy increased the risk of recurrence by 2.8-fold (odds ratio: 2.87; 95 % confidence interval: 1.34-6.13). No significant differences were observed between the two groups regarding the surgical route, fibroid size, uterine location, and position of the myomas in the uterus. CONCLUSION: Women who had more than two myomas should be informed of the possibility of recurrent myoma uteri. Additionally, pregnancy in women who previously had a myomectomy was found to be a risk factor for recurrence of the uterine myoma. HIPPOKRATIA 2018, 22(3): 122-126.

Factors affecting recurrence after surgery for ovarian mature cystic teratoma.

We aimed to evaluate the risk factors for recurrence of surgically managed ovarian mature cystic teratoma (MCT). A total of 178 women with MCT managed surgically at our clinic were included in this retrospective study. The cases were followed for a minimum of 34 months. Risk factors recorded were age, gravidity, diameter of MCT, tumour markers, bilaterality, operation time and recurrence time. One hundred forty-one women (79.2%) underwent laparoscopy and the other thirty-seven patients (20.8%) underwent laparotomy. The mean age of patients with cyst recurrence was significantly lower than that of patients without recurrence (p = 0.02). There was a significantly lower median gravidity and parity in this group. The capacity of younger age, lower gravidity and parity in predicting the recurrence of ovarian MCT was analysed using receiver operating characteristic curve analysis. The cut-off value of age, number of gravidity and parity was 26, 1 and 0, respectively. In conclusion, younger age and lower gravidity and parity were predictive of recurrence due to a more conservative approach in young and nulliparous patients. Therefore, we suggest regular follow-up visits during the postoperative period, especially for younger patients and those with lower numbers of gravidity and parity.

Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess.

This study assessed the risk factors for poor clinical outcomes in patients with tubo-ovarian abscess (TOA). Patients managed with medical therapy and discharged within 7 days without complications constituted the favourable prognosis group (n = 22), whereas those who were managed surgically or discharged after 7 days of antibiotic therapy constituted the poor prognosis group (n = 87). Variables including age, gravidity, number of dilation and curettage procedures, caesarean delivery, smoking status, serum C-reactive protein levels, serum white blood count, body temperature, abscess diameter, presence of an intrauterine device (IUD), duration of IUD placement and length of hospitalisation were evaluated to assess their relationship with the clinical prognosis of TOA. Abscess diameter of ≥ 6 cm was a significant parameter that increased the risk eightfold for poor prognosis. No significant differences were observed regarding the other variables.

Recurrence factors in women underwent laparoscopic surgery for endometrioma.

AIM: The aim of this paper was to assess the risk factors for endometrioma recurrence in women underwent laparoscopic surgery for endometrioma. METHODS: This retrospective designed study included 113 cases that underwent laparoscopic surgery for endometrioma; of these women, recurrent endometrioma was detected in 33 (29.20%) subjects and other showed no recurrence (70.80%). Age, gravidity, parity, diameter of the mass, bilaterality, previous pelvic surgery, operation type, presence of adhesions, Ca 125 levels and recurrence time was obtained from hospital records and special gynecology forms. RESULTS: Demographic and obstetric past history of the cases showed no statistically significant difference between the groups (P>0.05). Higher diameter of the mass, previous pelvic surgery, operation type, presence of adhesion and higher Ca 125 levels were risk factors for endometrioma recurrence (P<0.05). Receiver operator curve (ROC) analysis demonstrated that diameter of the mass, previous pelvic surgery and Ca 125 levels may be discriminative risk factors for endometrioma recurrence. CONCLUSION: Endometriomas ≥ 4.5 cm, especially in cases with pelvic adhesions, previous pelvic surgery and higher Ca 125 levels should be excised totally.

A prospective randomized trial of postoperative pain following different insufflation pressures during gynecologic laparoscopy.

OBJECTIVE: To determine the effects of different intra-abdominal pressure values on visceral pain following gynecologic laparoscopic surgery in the Trendelenburg position. STUDY DESIGN: This randomized, controlled prospective trial was conducted at a tertiary education hospital and included 150 patients who underwent gynecologic laparoscopy with different abdominal insufflation pressures. There were 54 patients in the 8 mmHg low pressure group (LPG), 45 in the 12 mmHg standard pressure group (SPG), and 51 in the 15 mmHg high pressure group (HPG). We assessed mean age, body mass index (BMI), duration of surgery, analgesic consumption, length of hospital stay, amount of CO2 expended and volume of hemorrhage. Visceral pain and referred visceral pain were assessed 6, 12, and 24 h postoperatively using a visual analog scale (VAS). RESULTS: There was no significant difference in age, BMI, analgesic consumption or length of hospital stay among groups. The mean operative time and total CO2 expended during surgery were higher in the LPG compared with the SPG and HPG. The mean intensity of postoperative pain assessed by the VAS score at 6 and 12 h was less in the LPG than in the SPG and HPG and was reduced significantly at 12 h. VAS scores at 24 h in the LPG and SPG were lower than in the HPG. CONCLUSION: Pain is reduced by low insufflation pressure compared with standard and high insufflation pressure following gynecologic laparoscopic surgery in the Trendelenburg position. However, low insufflation pressure may result in longer operation times and increased hemorrhage.

Evaluation of uterine perfusion in postmenopausal women receiving hormone replacement therapy.

OBJECTIVES: The authors evaluated uterine perfusion in postmenopausal women receiving hormone replacement therapy (HRT) by using transvaginal Doppler ultrasonography. MATERIALS AND METHODS: A total of 60 postmenopausal women receiving HRT were included in this prospective case control study. The patients were divided into two groups. The study group received HRT for at least one year. Uterine perfusion was evaluated by transvaginal Doppler ultrasonography and pulsatility index (PI) and resistance index (RI) of uterine arteries were also recorded with a 5-7.5 MHz transvaginal probe. All patients gave informed consent to the study. Statistical analyses were carried out by using the statistical packages for SPSS 15.0 for Windows. RESULTS: Demographic characteristics of the cases showed no statistically significant difference between the groups. There was a statistically significant difference between PI and RI of uterine arteries. In the study group PI and RI were lower than in the control group. As the duration of HRT use was prolonged, a decline in PI and RI increased (p < 0.05). CONCLUSION: The current study showed that HRT has positive effects on uterine blood flow in postmenopausal women and may be evaluated by transvaginal Doppler ultrasonography.

Outcomes of pregnancies in women with parity ten or more: a case control study.

PURPOSE: To determine the outcomes of pregnancies in women with parity ten and more. MATERIALS AND METHODS: We designed this study in a government hospital in rural Turkey. Pregnant women with parity of ten or more (n=126) were evaluated and compared with pregnant women with parity lower than ten (n=90). The risk factors recorded were maternal age, parity, gestational age (weeks), delivery mode, fetal birth weight and Apgar scores. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, U.S.A.). RESULTS: During the study period, a total of 12,551 deliveries were delivered at the current clinic. One hundred and twenty-six mothers were delivered with parity ten or more with a ratio of 1.01%. There was a statistically significant difference between the study and control group by means of maternal age, parity, fetal birth weight and 1- and 5-min Apgar scores (p < 0.05). There was no difference in delivery mode between the groups. CONCLUSION: According to this study, pregnant women with parity ten or more showed no adverse clinical characteristics when compared with pregnant women with parity lower than ten.

Abdominal wall endometriosis following cesarean section: report of five cases.

BACKGROUND: Endometriosis is the presence of endometrial tissue outside the uterus. Abdominal wall endometriosis is a very rare location of this pathology. We aimed to report a series of five cases of abdominal wall endometriosis following cesarean section at our clinic. CASE REPORT: All of our cases had had previous cesareans section and complained of pain at the pfannensteil incision scar. The cases presented palpable and tender masses near the scar. After excision of the masses histopathology reported the masses as endometriosis. CONCLUSION: Abdominal wall endometriosis is a rare condition. Clinicians should be aware of this pathology especially in women presenting with a painful mass near the scar of a previous cesarean section.

Association of serum sex steroid levels and bone mineral density with CYP17 and CYP19 gene polymorphisms in postmenopausal women in Turkey.

Many clinical conditions, including osteoporosis, are associated with serum levels of sex steroids. Enzymes that regulate rate-limiting steps of steroidogenic pathways, such as CYP17 and CYP19, are also regarded as significant factors that may cause the development of these conditions. We investigated the association of two common polymorphisms, in the promoter region (T→C substitution) of CYP17 and exon 3 (G→A) of CYP19, with bone mineral density (BMD) in the lumbar spine and femoral neck and serum androgen/estradiol, in a case-control study of 172 postmenopausal women aged 62.3 ± 9.6 years (mean ± SD). The CYP17 TC genotype was significantly overrepresented in patients compared to controls, and TC genotype neck T-score and lumbar T-score values were significantly higher in patients compared to controls. CYP17 TC and TT genotype testosterone and DHEA-SO(4) levels were lower in patients compared to controls. All three genotypes of CYP19 had almost the same distribution among patients. The CYP19 AG genotype, however, was most frequent among controls. CYP19 lumbar BMD levels were close to each other among the different genotypes; however, AA and AG genotypes were significantly lower in patients. Testosterone and DHEA-SO(4) levels in the CYP19 GG genotype were higher compared to those of the other genotypes in patients but not in controls. CYP19 GA individuals had lower E(2) levels and lower BMD in controls and patients. Femoral neck BMD and lumbar T-score were also diminished with GA transition. In conclusion, CYP17 and CYP19 gene polymorphisms were found to be associated with osteoporosis in postmenopausal women in Turkey.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study.

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85%; interassay variation: 3.45-8.22%) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH(4), and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95% confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH(4) were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Amniotic fluid amino acid levels in non-immune hydrops fetalis: a case-control study

In a prospective case-control study, we compared the amniotic fluid amino acid levels in non-immune hydrops fetalis (NIHF) and normal fetuses. Eighty fetuses underwent amniocentesis for different reasons at the prenatal diagnosis unit of the Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University. Forty of these fetuses were diagnosed with NIHF. The study included 40 women each in the NIHF (mean age: 27.69 ± 4.56 years) and control (27.52 ± 5.49 years) groups, who had abnormal double- or triple-screening test values with normal fetuses with gestational ages of 23.26 ± 1.98 and 23.68 ± 1.49 weeks at the time of sample collection, respectively. Amniotic fluid amino acid concentrations (intra-assay variation: 2.26-7.85 percent; interassay variation: 3.45-8.22 percent) were measured using EZ:faast kits (EZ:faast GC/FID free (physiological) amino acid kit; Phenomenex, USA) by gas chromatography. The standard for quantitation was a mixture of free amino acids from Phenomenex. The levels of 21 amino acids were measured. The mean phosphoserine and serine levels were significantly lower in the NIHF group, while the taurine, α-aminoadipic acid (aaa), glycine, cysteine, NH4, and arginine (Arg) levels were significantly higher compared to control. Significant risk variables for the NIHF group and odds coefficients were obtained using a binary logistic regression method. The respective odds ratios and 95 percent confidence intervals for the risk variables phosphoserine, taurine, aaa, Arg, and NH4 were 3.31 (1.84-5.97), 2.45 (1.56-3.86), 1.78 (1.18-2.68), 2.18 (1.56-3.04), and 2.41 (1.66-3.49), respectively. The significant difference between NIHF and control fetuses suggests that the amniotic fluid levels of some amino acids may be useful for the diagnosis of NIHF.

Evaluation of adolescent pregnancies: 10-year experience of a hospital in rural Turkey.

PURPOSE: To evaluate the characteristics of adolescent pregnancies admitted to our clinic. MATERIALS AND METHODS: This retrospective and descriptive study was performed at Ergani State Hospital from January 2000 to December 2010. This is an outpatient gynecology and obstetrics at government hospital in Southern Eastern Region of Turkey. A total of 15,210 pregnancies were delivered during the study period, of whom 711 of them were adolescent pregnancies. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: During the study period, of the total of 15,210 deliveries 711 (4.6%) were adolescent pregnancies (age range 14-19 years). The mean age (95% CI) of the patients was 17.90 +/-1.12 (17.82-17.98) years old. Most of the patients were nulliparous (n = 559, 78.60%). Mean gestational weeks, fetal birth weight and fetal birth length and 95% CI values were as follows: 37.11 +/- 2.53 (36.93-37.30), 3045.73 +/- 51.70 (3007.65-3083.79) and 48.68 +/- 2.31 (48.51-48.85), respectively. Six hundred and twenty (87.20%) of the patients delivered spontaneously by the vaginal route, while 91 (12.80%) were delivered by cesarean section. Although the age range of the patients was not wide, there was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length (p < .01). CONCLUSION: According to this study, the ratio of adolescent pregnancies was found to be 4.6% which was lower than other regions of Turkey. The majority of the patients were nulliparous and most delivered spontaneously by the vaginal route. There was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length.

Umbilical cord prolapse in the southeast region of Turkey: evaluation of 79 cases.

OBJECTIVE: The aim of the study was to determine the risk factors and perinatal outcomes of umbilical cord prolapse (UCP). MATERIAL AND METHODS: This study was performed at Dicle University between January 2000 and December 2008 on 79 cases in which deliveries were complicated by umbilical cord prolapse. RESULTS: 0.36% of all deliveries were complicated by umbilical cord prolapse. The presentation of the fetuses were as follows: vertex, breech and transverse lie and foot presentation. Thirty-four (43%) fetuses with UCP had a fetal weight of < or = 2500 g as compared with nine (9%) for fetuses in the control group (p < 0.05). Mothers in the study group were 1.3 times more likely to be multiparas than the control group (p = 0.16) Cesarean section was performed in 76 cases (96.2%) and there were nine (11.3%) perinatal deaths. CONCLUSION: Umbilical cord prolapse is a risk factor of perinatal morbidity and mortality. Fetal weight < or = 2500 and abnormal fetal presentation are associated with increased risk of umbilical cord prolapse. Cesarean section resulted in a significantly decreased risk of perinatal mortality.

The association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor.

PURPOSE: We assessed the association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor. METHODS: Over a five-year period, cases treated for ovarian cancer were randomly assigned. The data were collected from gynecological oncology, radiation oncology, medical oncology and pathology departments. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (Chicago, IL, USA). Survival was analyzed by the method of Kaplan and Meier, using log-rank (Mantel-Cox) analysis. RESULTS: 51 cases with ovarian cancer were evaluated. Cases with thrombocytosis were found to have greater CA-125 levels, more advanced stage disease, more ascites and shorter periods of survival. CONCLUSION: Thrombocytosis is a poor prognostic factor in ovarian cancer. As reported previously, it is associated with aggressive tumor biology. Thus, preoperative thrombocytosis can be a used as a marker of poor outcomes.

The clinical significance of HPV screening in premalignant cervical lesions.

PURPOSE: We evaluated the clinical significance of human papilloma virus (HPV) screening in premalignant cervical lesions. METHODS: This prospective study was performed at Dicle University, School of Medicine, Department of Obstetrics and Gynecology, from January 2009 to June 2009. A total of 60 cases were evaluated. Thirty cases had premalignant cervical lesions. The prevalence of HPV was analyzed by polymerase chain reaction and types determined by Hybrid Capture II. The cases that had premalignant cervical lesions were evaluated with colposcopy. Statistical analyses were carried out by using the statistical packages for SPSS version 12.0 for Windows (Chicago, IL, USA). RESULTS: Of all the cases, those with premalignant cervical lesions had higher prevalence of HPV DNA. The cases that had high oncogenic HPV type had more abnormal colposcopic findings. CONCLUSION: Premalignant cervical lesions should be evaluated by cervical cytology, colposcopy, HPV DNA screening and cervical tissue sampling. In this way, development of cervical cancer can be prevented.

The effect of flurbiprofen as prophylactic analgesic before hysterosalpingography.

Hysterosalpingography (HSG) is associated with pain during the four-step procedure. This prospective, double-blind, randomized, placebo-controlled study was conducted to investigate the effect of the analgesic flurbiprofen, administered prior to HSG, in 60 women. Thirty women were randomized to receive 100 mg of flurbiprofen, orally, 1 h prior to HSG and a further 30 women were randomized to receive placebo. Injection of contrast medium was more painful than the other steps in the HSG procedure in both groups; however, there was no significant between-group difference in terms of pain experienced in the individual steps of HSG. Pain scores at 5 and 30 min after the procedure were compared between the two groups. There was a significant decrease in the visual analogue scale pain score in the flurbiprofen-treated group compared with the placebo-treated group at both time points. Thus, the authors recommend flurbiprofen as a prophylactic analgesic to be administered before HSG procedures.

Clinical significance of procalcitonin in cervico-vaginal secretions of women with preterm rupture of membranes.

PURPOSE: To compare vaginal fluid procalcitonin (PCT) concentrations in cases of preterm premature rupture of membranes (PPROM) and healthy pregnant women, and to determine whether the PCT concentrations are of value in the diagnosis of PPROM cases and clinical amnionitis. METHODS: 50 cases with PPROM and 50 healthy pregnant women were enrolled in the study. In the PPROM group, analysis was conducted on PCT concentrations with reference to serum leucocytosis, serum C-reactive protein level and urine analysis, as well as to presence/absence of clinical amnionitis. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS: Procalcitonin levels in the PPROM group were significantly higher than in cases of healthy pregnant women (1.17 vs 0.05 ng/ml; p < 0.001). In the PPROM group PCT concentrations between the patients with and without clinical amnionitis were comparable. Also, a significant correlation was observed between PCT and leucocytosis (r = 0.64; p < 0.001) and C-reactive protein (r = 0.90; p < 0.001). CONCLUSION: These findings suggest that the value of vaginal fluid PCT determinations can be useful for diagnostics of PPROM cases suspected of intrauterine infection.