The effects of estrogen therapy and estrogen combined with different androgenic progestins on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women.

OBJECTIVE: The aim of the present study was to compare the effect of three different progestins with differing androgenicity on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women. Additionally, the relationship between testosterone and insulin resistance was assessed. METHODS: The study included 125 postmenopausal women. Estradiol (E(2)) 2 mg/day was given to 20 hysterectomized women and the remaining 105 women were randomized into three treatment groups: E(2) 2 mg/day plus dienogest 2 mg/day (n=35); E(2) 2 mg/day plus norethisterone acetate (NETA) 1 mg/day (n=35); E(2) 2 mg/day plus medroxyprogesterone acetate (MPA) 2.5 mg/day (n=35). A 75-g oral glucose tolerance test was performed at the initial and 3-month visit. Serum glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were measured before and after treatment. RESULTS: A significant treatment-related increase was observed only in the E(2)/MPA group for insulin resistance (p=0.031). When the change in the insulin/glucose ratio was compared, the E(2) group was significantly different from the E(2)/MPA and E(2)/NETA groups (p=0.008 and 0.02, respectively). Only the E(2)/dienogest group showed a treatment-related increase in fasting glucose level (p=0.037). A decrease in total cholesterol and LDL-C levels was observed in all groups (p=0.004 and 0.012, respectively). The only significant decrease in HDL-C level was observed in the E(2)/NETA group (p=0.005). CONCLUSION: Estrogen therapy had a positive effect on carbohydrate and lipid metabolism in overweight-obese postmenopausal women. The addition of progestin to estrogen therapy attenuated estrogen's positive effects slightly; however, the biological actions of the three different androgenic progestins used did not result in any variation.

Risk factors and perinatal outcomes associated with umbilical cord prolapse.

OBJECTIVE: To utilize infant outcomes and to identify risk factors associated with umbilical cord prolapse. MATERIALS AND METHODS: Birth records of 80 cases with umbilical cord prolapse and 800 randomly selected controls were reviewed retrospectively. Statistical analysis was performed using logistic regression models. RESULTS: Prolapse of the umbilical cord complicated 0.47% (n=80) of all deliveries included in the study (n=16,874). Multiparity was more common in patients with umbilical cord prolapse (63.8-49.4%, P=0.014). Umbilical cord prolapse occurred in breech presentation in six cases (7.5%) and in transverse presentation in three of the cases (3.8%). The occurrence of breech presentation among the control cases was 1.0% and of the transverse lie was 0.1% (P<0.001). Fetuses with umbilical cord prolapse had lower fetal weight; particularly, fetal weight less than 2,500 g was a significant risk factor (3-2.4%, P<0.001). We also found that spontaneous rupture of membranes (OR=8.93; 95%, CI=4.16-19.14), Bishop score greater than 8 (OR=5.48; 95%, CI=3.21-9.34), and polyhydramnios (OR=21.0; 95%, CI=11.4-38.7) were risk factors for umbilical cord prolapse. The newborns that were delivered after umbilical cord prolapse graded lower Apgar scores less than 7 at 5 min (6.3-1.4%, P=0.002). CONCLUSION: Abnormal fetal presentation, multiparity, low birth weight, prematurity, polyhydramnios, and spontaneous rupture of membranes, in particular with high Bishop scores, are risk factors for umbilical cord prolapse. Early amniotomy increases the variable decelerations and hence increases the rate of cesarean section because of fetal distress, but it may prevent pregnant women from umbilical cord prolapse, which has a high mortality rate. However, large randomized trials are needed to prove that early amniotomy decreases the incidences of umbilical cord prolapse.

Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures.

AIM: To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. METHODS: Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. RESULTS: All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomen without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. CONCLUSION: Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.

Fertility and recurrence results of conservative surgery for borderline ovarian tumors.

OBJECTIVES: To evaluate the fertility and recurrence outcomes in women treated with fertility-sparing surgery for borderline ovarian tumors. METHODS: A total of 142 patients with borderline ovarian tumors managed surgically from 1993 to 2004 were identified from gynecologic oncology and pathology files of SSK Ankara Maternity and Women's Health Teaching Hospital. Sixty-two of those patients who had conservative surgery were eligible for the study. Information was acquired by retrospective medical record review and patient interview. RESULTS: The observed recurrence rates after radical and fertility-sparing surgery were 0.0% and 6.5%, respectively. Four patients from the conservative surgery group developed recurrence, in contrast to none of the patients from the non-conservative surgery group. No disease-related deaths occurred in any group. In the conservatively managed group, ten women had successful pregnancies, with a total of 10 live births and 3 abortions. The mean duration of follow-up for the conservative surgery group was 44.3 months (range, 3-128). CONCLUSION: Fertility-sparing surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility. Recurrence is noted significantly more often after this type of treatment and close follow-up is needed to detect recurrent disease.