Elective cervical cerclage versus no treatment in women with the history of cervical insufficiency: retrospective analysis of pregnancy outcomes.

PURPOSE OF INVESTIGATION: To evaluate the effectiveness of elective cervical cerclage (CC) on the pregnancy outcome of patients with cervical insufficiency. MATERIAL AND METHODS: A retrospective cohort study was conducted on women with an obstetric history of cervical insufficiency on whom CC was applied or not. The two groups were compared for the main measure outcomes of mean gestational age at delivery, birth weight, Apgar scores at five minutes, number of premature and preterm deliveries, rate of preterm premature rupture of membranes, incidence of neonatal death, and admission to the neonatal intensive care unit (NICU). RESULTS: A total of 183 women were eligible for the final analysis in the CC group and 183 were taken as the control group. There were significant differences in terms of the mean gestational age at delivery (37 ± 4.0 vs. 34±5 weeks, p = 0.001), the mean birth weight (3,000 ± 870 vs. 2,200 ± 860 grams, p = 0.001), the number of preterm deliveries (< 37 weeks) (40% vs. 63%, p = 0.001, OR: 0.4, 95% CI: 0.26-0.61) between CC and control groups, respectively. Median Apgar scores at five minutes were 9 in CC group and 8 in the control group (p = 0.001) and the percentages of admission to NICU were 14% in CC group and 34% in the control group (p = 0.001, OR: 0.30, 95% CI: 0.17-0.52). CONCLUSION: The placement of elective CC seemed to be effective in patients with a history of mid-trimester abortion or preterm delivery due to cervical insufficiency.

Experience of hysteroscopy indications and complications in 5,474 cases.

OBJECTIVE: To evaluate the indications, intraoperative diagnoses, and complication rates of both diagnostic and operative hysteroscopic procedures. MATERIALS AND METHODS: Five thousand four hundred seventy-four (5474) hysteroscopic procedures performed in the department of gynecologic endoscopy unit between May 2005 and December 2012 were retrospectively analyzed from the archives. Indications, intraoperative diagnosis, and complications of all gynecological endoscopic procedures are recorded. RESULTS: Abnormal uterine bleeding in premenopausal and postmenopausal women was the most frequent indication for diagnostic hysteroscopies in 1,887 (40%) cases. The most common preoperative indication for operative hysteroscopy was endometrial polyps in 469 (55.7%) cases and submucous leiomyomas in 151 (17.9%) cases. In this series, the most common complication was uterine perforation which occured in 15 (0.27%) out of 5,474 cases and the rate for diagnostic hysteroscopy and operative hysteroscopy was 0.06% and 1%, respectively. CONCLUSION: Hysteroscopy is a safe and effective minimally invasive procedure with very low complication rate.

Effects of natural progesterone on endometriosis in an experimental rat model: is it effective?

UNLABELLED: To assess the effects of the natural progesterone on the endometriosis in a rat model. MATERIALS AND METHODS: Endometriosis was surgically induced in 20 rats by transplanting an autologous fragment of endometrial tissue onto the inner surface of the abdominal wall. Rats in control group had no medication but 2.5 mg/kg/weekly natural progesterone was administered to rats in study group for four weeks. After that, all rats were sacrificed and dimensions of endometriosis were measured and they were evaluated morphologically and histologically. Scoring systems were used to evaluate preservation of epithelia. RESULTS: Two rats in the study group and one rat in the control group died of complications related to surgery. At the end of the treatment, there was a reduction in the size of the endometriotic lesions in the study group (p < 0.01). According to histological evaluation, the study group had lower score than control goup which was statistically significant (p = 0.014). CONCLUSIONS: Natural progesterone is effective against endometriosis in rat model.

Complications of gynecological laparoscopy: experience of a single center.

BACKGROUND: The purpose of this study was to describe the prevalence and type of laparoscopic complications seen in a teaching hospital. MATERIALS AND METHODS: Four hundred and forty-one diagnostic and operative laparoscopic procedures were performed by the same senior resident/resident surgical team. Direct entry technique was used for all procedures. RESULTS: The procedures included 74 (16.8%) diagnostic and 367 (83.2%) operative laparoscopies. The overall complication rate was 7.7% (34 cases). Conversion to laparotomy occurred in 16 cases (3.6%). CONCLUSIONS: The complication rate was found to be slightly higher than the rates quoted in the literature. This rate of 7.7% is still an acceptable one.

Modified myocardial performance index for evaluation of fetal cardiac function in pre-eclampsia.

OBJECTIVE: To assess cardiac function by means of the modified myocardial performance index (Mod-MPI) in fetuses of pre-eclamptic mothers without intrauterine growth restriction and to compare this with values from normal controls. METHODS: A cross-sectional study was conducted including a total of 72 fetuses at between 26 and 40 weeks' gestation. Forty fetuses of healthy mothers were assigned as the control group (Group I) while 15 fetuses of mildly pre-eclamptic mothers constituted Group II and 17 fetuses of severely pre-eclamptic mothers constituted Group III. Two-dimensional gray-scale and Doppler fetal echocardiography was used to exclude cardiac anomalies and calculate the Mod-MPI. RESULTS: The mean+/-SD Mod-MPI values of Groups I, II and III were 0.43+/-0.045, 0.44+/-0.064 and 0.44+/-0.064, respectively (P=0.680). The mean aortic peak systolic velocity (PSV), the mean mitral valve early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities were significantly lower in fetuses of severely pre-eclamptic mothers than in fetuses of mildly pre-eclamptic mothers and control fetuses. CONCLUSION: The fetal global myocardial function assessed by Mod-MPI does not seem to change in mild or severe pre-eclampsia. The lower mitral E-wave and A-wave peak velocities and the lower aortic PSV seem to reflect the increased cardiac afterload against which the fetal heart has to work, rather than systolic or diastolic cardiac dysfunction, in the fetuses of severely pre-eclamptic mothers.

Ultrasonographic appearance of cervical pregnancy following successful treatment with methotrexate.

We report a case of cervical ectopic pregnancy successfully treated with systemic methotrexate. Conservative management with single-dose methotrexate was undertaken, but owing to the failure of human chorionic gonadotropin (hCG) levels to fall by 15% by day 7 and the persistence of fetal cardiac activity, two further doses of methotrexate were required. The patient's hCG levels were monitored, and repeat transvaginal ultrasonography was performed until complete resolution of the pregnancy by spontaneous miscarriage. We describe the ultrasonographic findings, which showed that the sac size increased despite treatment.

Torsades de pointes in 3 patients with leukemia treated with arsenic trioxide.

Arsenic trioxide is used in clinical trials in the treatment of relapsed and resistant cases of acute promyelocytic leukemia. Adverse effects from arsenic in these studies have been multisystemic. Arsenic is known to cause corrected QT-interval prolongation and T-wave changes, but the potential for serious ventricular arrhythmias is less well understood. Torsades de pointes, a form of ventricular tachycardia, has been reported with arsenic poisoning but not at therapeutic doses used in protocols for hematologic malignancies. We describe 3 patients in whom this arrhythmia developed while they were treated with arsenic trioxide. Early recognition of the arrhythmia or correction of contributory factors is important because arsenic induced ventricular arrhythmias are known to be resistant to most chemical methods and electrical cardioversion.

The number of follicles and ovarian volume in the assessment of response to clomiphene citrate treatment in polycystic ovarian syndrome.

OBJECTIVE: To evaluate whether the number of follicles and ovarian volume have any significance in evaluating the response to clomiphene citrate treatment in polycystic ovarian syndrome (PCOS). DESIGN: A prospective study of 70 infertile women, 44 of which were diagnosed with polycystic ovarian syndrome. MAIN OUTCOME MEASURES: Follicle numbers and volumes in both ovaries, hormonal profile, response to Clomiphene Citrate(CC). RESULTS: Ovarian volume was significantly greater in cases with polycystic ovarian syndrome than controls. However, ovarian volume in the Clomiphene Citrate nonresponders was significantly greater than in Clomiphene Citrate responders in the polycystic ovarian syndrome group. The number of small follicles was significantly higher in cases with polycystic ovarian syndrome than controls, and in the Clomiphene Citrate nonresponder group this number was also significantly higher than in Clomiphene Citrate responders. Endocrine features of patients with polycystic ovarian syndrome revealed that Dehydroepiandrostenedione sulfate, Androstenedione, follicle stimulating and luteinizing hormone do not discriminate between patients who respond to Clomiphene Citrate and those who do not respond. However, Testosterone and luteinizing hormone levels differ significantly in responders and nonresponders. CONCLUSIONS: Small multiple follicles (> 9) and enlarged ovarian volume (> 6.8 ml) were the most prominent transvaginal ultrasonographic features of ovaries in Clomiphene Citrate nonresponsive patients with polycystic ovarian syndrome. Higher levels of Testosterone, luteinizing hormone and significantly higher number of small follicles were associated with lack of Clomiphene Citrate response. These ultrasonographic features and laboratory assays could be clinically useful for distinguishing better the Clomiphene Citrate nonresponders from responders.

Longitudinal vaginal septum: an unusual cause of postpartum total uterine prolapse.

Longitudinal vaginal septum, a rare congenital fusion defect of mullarian ducts rarely causes dystosia of labour and total uterine prolapse. Several surgical techniques were developed for repair of prolapse but no consensus has been reached on one type of operation.

The number of follicles and ovarian volume in the assessment of the response to clomiphene citrate in polycystic ovarian syndrome.

OBJECTIVE: To evaluate whether the number of follicles and ovarian volume have any significance in evaluating the response to clomiphene citrate treatment in Polycystic ovarian syndrome (PCOS). DESIGN: A prospective study of 70 infertile women, 44 of which were diagnosed with PCOS. SETTING: Zeynep Kamil Women and Children's Hospital Infertility Polyclinic. MAIN OUTCOME MEASURES: Follicle numbers and volumes in both ovaries, hormonal profile, response to Clomiphene Citrate (CC). Ovarian volume was significantly greater in PCOS cases than controls. However ovarian volume in the CC nonresponders was significantly greater than in CC responders in the PCOS group. The number of small follicles was significantly higher in PCOS cases than controls, and in the CC nonresponder group this number was also significantly higher than in CC responders. Endocrine features of patients with PCOS revealed that FSH, LH/FSH, DHEAS and Androstenedion do not discriminate between patients who respond to CC and those who do not respond. However, Testosterone (T) and LH levels differ significantly in responders and nonresponders. Small multiple follicles (> 9) and enlarged ovarian volume (> 6.8 ml) were the most prominent transvaginal ultrasonographic features of ovaries in CC nonresponsive patients with PCOS. Higher levels of T, LH, and significantly higher number of small follicles were associated with lack of CC response. These ultrasonographic features and laboratory assays could be clinically useful for distinguishing better the CC nonresponders from responders.

Chlamydial serology and histerosalpingography in predicting tubal disease in infertility patients.

To evaluate the role of Chlamydial serology and hysterosalpingography (HSG) in predicting tubal disease, alone or combined with versus laparoscopy, which is known to be the gold standard but an invasive procedure. In 135 patients who suffered from infertility for at least 2 years admitted to Zeynep Kamil Women and Children's Hospital, Department of Infertility between January 5, 1993 to March 18, 1995. Chlamydial antibody titers were measured, HSG were performed. Tubal disease was identified by laparoscopy. 19 patients with endometriosis and 22 patients who could not be followed were excluded from study group. The final study group comprised 94 patients who had antibody titers, HSG laparoscopy. Sensitivity, specificity, positive and negative predictive values of each diagnostic test were calculated, differences in proportions and means were calculated using chi 2 test and analysis of variance, respectively. For HSG, sensitivity was 88.9%, specificity was 78%, positive predictive value (PPV) was 71% and negative predictive value (NPV) was 92%. For chlamydial antibody titers, sensitivity was 52%, specificity was 68%, PPV was 37% and NPV was 80%. For both HSG and Chlamydial antibody titers, sensitivity was 34%, specificity was 64%, PPV was 36% and NPV was 62%. In our study population 35 (37%) of the infertile women had tubal factor identified by laparoscopy and 37% of these had positive Chlamydial antibody titers. These findings indicate that in our population tubal factor has an important place among causes of infertility but in its etiology Chlamydial infection does not seem to play a major role contrary to previous reports. This can be explained by lower incidence of Chlamydial infections due to infrequency of multipartner sexual relationships and advanced age of first intercourse among women in society. Measurement of antibody titers neither by itself nor in Combination with HSG were not found to be cost-effective and beneficial. We propose conventional HSG as a single, cost-effective procedure since it is also almost as predictive as laparoscopy in detecting tubal disease among our infertile population.

Pentoxifylline in male-factor infertility: its therapeutic efficacy after oral administration.

OBJECTIVE: To determine whether the oral use of pentoxifylline improves the fertilization ability, concentration and motility of spermatozoa of poor fertilizer male subject. DESIGN: Analysis of the spermiogram parameters before and after oral pentoxifylline administration. SETTING: Zeynep Kamil Women and Children's Hospital, Department of Infertility. PATIENTS: Fourteen healthy, untreated male partners of couples who applied to our infertility department and were found to have poor semen parameters. MAIN OUTCOME MEASURES: Data of the semen analyses and fertilization rates are compared before and after treatment. RESULTS: Before the treatment, the average percentage sperm motility and density were 30.1 +/- 8 (%) and 14.8 +/- 3.2 (10(6)/ml), respectively. The same parameters were found to be 37.8 +/- 13 (%) and 19.5 +/- 10 (10(6)/ml), respectively, following the treatment. Not significant, p = 0.08 and p = 0.116, respectively). CONCLUSION: None of the semen parameters evaluated were improved by oral administration of pentoxifylline. Therefore pentoxifylline does not increase percentage motility and density of spermatozoa or the fertilization rates.