Comparison of hysterosalpingography and transvaginal hydrolaparoscopy in patients with tubal factor infertility: a prospective cohort study.

AIM: To evaluate the usefulness, diagnostic accuracy, and cost-effectiveness of transvaginal hydrolaparoscopy (THL) in infertile women with abnormal hysterosalpingogram (HSG) results without obvious pelvic pathology. MATERIAL AND METHODS: THIRTY INFERTILE WOMEN (AGE: 20-40 years) who had tubal pathology in HSG were enrolled in the study. All patients underwent THL instead of standard laparoscopy. A cost analysis was performed comparing HSG and THL methods. RESULTS: In comparison of the HSG of cases by considering the chromopertubation results by THL, the sensitivity and specificity of HSG were 85.1% and 56%, respectively. The reasons for preferring standard laparoscopy rather than THL were: failure in accessing of Douglas (n = 3), insufficient monitoring of pelvis (n = 1), hydrosalpinx (n = 1), and intense peritubal adhesion (n = 1), which were 10%, 3%, 3%, and 3%, respectively. The complication rate was 3.8%. Cost analysis of the procedures showed that the total cost of the THL group was 34.8% lower than the HSG group. CONCLUSIONS: In the elective patients group, THL is more feasible than HSG. Transvaginal hydrolaparoscopy is effective, simple and safe, avoiding the cost, possible complications, time and postoperative patient discomfort compared to conventional laparoscopy.

The use of ultrasound during intrauterine insemination in unexplained infertility may improve pregnancy outcomes.

OBJECTIVE: To investigate the role of ultrasound guidance in intrauterine insemination (IUI). MATERIALS AND METHODS: A retrospective study was conducted. The data was collected from the records of 197 couples with unexplained infertility who underwent IUI with a total of 267 IUI cycles in the in vitro fertilization center of our hospital between January 2009 and December 2010. RESULTS: Of the 267 IUI cycles, 145 were carried out as US-guided, while 122 cycles IUI were performed with a blind procedure. In the US-guided IUI and blinded IUI groups, the pregnancy rates were 23.4 and 13.9%, respectively. The difference between the groups was statistically significant (p = 0.049), thereby indicating that US guidance improves pregnancy rates. In the US-guided IUI group, 9.7% of the cases were difficult, while in the blinded IUI group, 26.2% were difficult and the difference between the groups was also statistically significant (p < 0.001). CONCLUSION: US guidance in IUI improves pregnancy rates and reduces the frequency of difficult IUI.

A case with vesicouterine fistula: mini review.

AIM: The objective is to present a case with vesicouterine fistula after cesarean section. CASE: A 27-year-old female patient, G2P2, was admitted to hospital with the complaint of severe crampy pelvic pain and dysuria during micturition without any incontinence. She had two cesarean sections, last was 14 months before admission. Her urinalysis revealed microscopic hematuria. Diagnosis of uterovesical fistula suspected by transvaginal ultrasonography and diagnosed by hysterography. Vesicouterine fistula operated by transperitoneal approach without any complication. CONCLUSION: Increasing cesarean section rates concomitantly carries increasing maternal and neonatal adverse outcomes including operative complications as genitourinary fistulae.

Ultrasonographic diagnosis of fetal structural abnormalities in prenatal screening at 11-14 weeks.

PURPOSE: The aim of the study was to determine the detection rate of structural abnormalities at the 11-14 week ultrasound examination as a part of two-stage screening process in low-risk pregnancies. MATERIALS AND METHODS: A total of 1085 consecutive low-risk pregnant women participated in screening by two-stage ultrasonography for the estimation of the sensitivity of the first and second trimester ultrasound scans in the detection of major anomalies as a part of routine screening. RESULTS: Of 1085 pregnancies, 21 (1.93%) fetuses had at least one major structural defect considered detectable by routine ultrasound screening; 14 (1.29%) were identified at early screening and an additional 5 (0.47%) at late screening. Two abnormalities were not detected prenatally, and data were obtained from the patients after delivery. CONCLUSION: The majority of fetal structural abnormalities can be detected by sonographic screening at 11-14 weeks, but detailed fetal anatomic survey performed at 18-22 weeks should not be abandoned.

Embryonic heart rate as a prognostic factor for chromosomal abnormalities.

OBJECTIVE: The purpose of this study was to evaluate the role of a slow embryonic heart rate in embryos before 7 weeks' gestation as a marker in screening for chromosomal abnormalities. METHODS: Fifty-seven embryos before 7 weeks' gestation with slow heart rates were compared with 1156 embryos of the same gestational period with normal heart rates. Embryos that showed an increased risk of chromosomal abnormalities in the screening blood tests underwent invasive analysis for abnormal karyotype detection. RESULTS: The rates of first-trimester death were 15.8% for pregnancies with slow embryonic heart rates (9 of 57) and 2.5% for those with normal heart rates (29 of 1156). Because of the increased risk of chromosomal abnormalities, amniocentesis was performed on 6 with slow embryonic heart rates and 61 with normal embryonic heart rates. After karyotype analysis, there were 2 fetuses with trisomy 21 in each group, which represented significantly higher percentage of embryos with trisomy 21 in the slow-heart rate group compared with the normal-heart rate group (P < .05). CONCLUSIONS: When a slow embryonic heart rate is detected before 7 weeks' gestation, there is a higher likelihood of chromosomal abnormalities.

Predicting fetal asphyxia in intrahepatic cholestasis of pregnancy.

PURPOSE: Intrahepatic cholestasis of pregnancy (ICP) is a disease associated with high-perinatal morbidity and mortality rates. It is important to have parameters that aid in predicting fetal outcomes. Certain parameters affecting asphyxia in newborns to mothers with ICP are evaluated in this study. METHODS: One hundred eighty-seven cholestatic pregnancies were analyzed, retrospectively. Fetal asphyxia was defined as an APGAR score of less than 7 at 5 min postpartum. Predictors of asphyxia in ICP were analyzed by binary multivariate logistic regression analysis. RESULTS: Thirty-six of the cholestatic pregnancies ended up having an asphyctic newborn at the time of delivery (19.2%). There was a statistically significance difference in the levels of total bile acids (TBA) (42.4 +/- 15.2 vs. 33.8 +/- 12.9 micromol/L, P < 0.01), HDL cholesterol (54.2 +/- 15.9 vs. 61.3 +/- 12.2, P = 0.01), total cholesterol (279.0 +/- 51.4 vs. 257.7 +/- 51.6, P = 0.02), and triacylglycerol (299.4 +/- 94.6 vs. 260.4 +/- 118.7) between the asphytic and nonasphytic group. Binary multivariate logistic regression analysis demonstrated that TBA levels (OR 1.04, 95% CI 1.01-1.08, P = 0.03) and exposure time (OR 1.11, 95% CI 1.05-1.17, P < 0.01) were the most important independent variables predicting fetal asphyxia in ICP. CONCLUSIONS: In this study, it has been demonstrated that for the evaluation of fetal status, increased TBA levels in the mother and increased exposure time for the fetus to these increased values of TBA within the maternal circulation system help to predict increased risk of asphyxia in newborns to ICP mothers.

Effect of the subdermal contraceptive etonogestrel implant (Implanon) on biochemical and hormonal parameters (three years follow-up).

OBJECTIVE: To determine whether the use of the subdermal contraceptive implant releasing etonogestrel (Implanon) affects serum hormonal and biochemical indices. METHODS: Seventy women with a mean age of 28.5+/-3.4 years were enrolled into this prospective observational study. After placement of an Implanon rod, they were followed-up for three years. Baseline and end-of-study values of serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol, triglycerides, fasting glucose, blood urea nitrogen (BUN), creatinine, SGOT, SGPT, follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, free 3,5,3'-tri-iodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and prolactine (PRL) were compared using Student's t-test. RESULTS: There was no failure of contraception during the three year period. No statistically significant differences were observed between the initial and final levels of fasting blood glucose, BUN, SGOT, SGPT, LDL, HDL, E2, FSH, LH, fT3, fT4 and TSH (p>0.05), but the increase in PRL, cholesterol and triglycerides, and the decrease in creatinine levels at the end of three years were statistically significant (p<0.05) although the values were still within normal ranges. CONCLUSION: Our findings confirm data from the literature according to which Implanon does not affect meaningfully reproductive hormonal parameters, thyroid function, hepatic and renal functions, and glucose metabolism. However, further studies are needed to elucidate lipid metabolism changes.

Rapid prenatal diagnosis of common aneuploidies in amniotic fluid using quantitative fluorescent polymerase chain reaction.

BACKGROUND/AIMS: Quantitative fluorescent polymerase chain reaction (QF-PCR) is a successful prenatal diagnostic method which has been regularly used for the diagnosis of common chromosomal abnormalities in recent years. This method provides diagnosis of common aneuploidies in a few hours after sampling with a high throughput, very low error rates and low cost. METHODS: In this study, 576 amniotic fluid samples were analyzed for trisomies 13, 18, and 21 and sex chromosome aneuploidies using different commercial QF-PCR kits (ChromoQuant version 1, Aneufast, ChromoQuant version 2). Test results were compared with those obtained by conventional cytogenetic analyses. RESULTS: Nine cases of trisomy 21 (1.6%), 1 case of trisomy 13 (0.17%), 3 cases of trisomy 18 (0.52%), 1 case of Turner syndrome (0.17%), 2 cases of Klinefelter's syndrome (0.34%), 2 cases of triploidy (0.34%) and 1 case of XXX (0.17%) were detected by QF-PCR. The results obtained by QF-PCR were consistent with the results of cytogenetic studies (except for 2 samples which had structural chromosomal abnormalities which could not be detected by QF-PCR). CONCLUSION: The QF-PCR method is an appropriate choice for rapid aneuploidy testing in our as well as in other populations.

Role of laparoscopic uterine artery coagulation in management of symptomatic myomas: A prospective study using ultrasound and magnetic resonance imaging.

STUDY OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterine artery coagulation (LUC) in symptomatic myomatous patients. DESIGN: Prospective study (Canadian Task Force classification II). SETTING: Tertiary care center PATIENTS: Twenty-one women with myomatous uteri. INTERVENTIONS: Laparoscopic uterine artery coagulation. MEASUREMENTS AND MAIN RESULTS: Laparoscopic uterine artery coagulation for myoma was performed by three-puncture laparoscopy, and the difference in uterine and/or myoma volume was determined every 3 months for 12 months clinically and using ultrasonographic and MRI calculations of uterine volume. In addition, pre and postprocedure uterine Doppler indices were determined. Main outcome measures were symptomatic improvement after LUC and reduction in volume calculated by ultrasonography and magnetic resonance imaging (MRI). All treated women reported less bleeding after treatment. At 12 months, a 57% reduction in bleeding was seen in these patients. The mean postoperative pictorial blood loss assessment was significantly lower at 12 months: 303 +/- 30.4 mL (95% CI 284-328) baseline versus 173.5 +/- 17.8 mL (95% CI 164-184) after treatment, p < .05. Postoperative pain was documented in all the patients with a visual analog scale, with a mean of 1.6 cm recorded. The mean reduction in uterine volume (pre- to post-LUC) was 195 +/- 24.3 cm3 (range 89-438). The mean operating time was 52.1 +/- 7.2 minutes (95% CI 49.8-55.4), and the mean estimated blood loss was 65.2 +/- 11.8 dL (95% CI 59.6-70.8). Mean hospitalization time was 32.3 +/- 6.6 hours (95% CI 29.2-35.4). The complication rates were low with the procedure (fever, infection). No patient required hysterectomy due to complications. Ninety percent of the women were satisfied with the procedure. CONCLUSION: Laparoscopic uterine artery coagulation is effective in the management of symptomatic myomas, reducing bleeding and the volume of both uterus and myomas as documented by ultrasonography and MRI. Laparoscopic uterine artery coagulation is a cost-effective and low-morbidity option compared with conventional approaches such as myomectomy or hysterectomy. If the patient's predominant complaint is the feeling of a mass and/or bleeding, alternative treatment options should be explored. The results of this study are encouraging, but more research is needed to validate the cost-effectiveness and long-term results.

Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy.

AIM: Little data exist on the impact of chronic low dose corticosteroid therapy during pregnancy on gestational diabetes mellitus (GDM). METHOD: We compared 25 pregnant women receiving long-term (>4 weeks) corticosteroid for newly diagnosed idiopathic thrombocytopenic purpura (ITP) (study group) and 108 normal pregnant women (control group) in this case-control study. Main outcome measures were 1-h, 50-g and 3-h, 100-g glucose tolerance tests (GTTs). Women in both groups were also screened with 75-g GTT 6 weeks after delivery. RESULTS: The mean duration of corticosteroid therapy was 9.8+/-4.9 (range 6-25) weeks. Compared with controls, study group patients had a greater prevalence of diagnosed GDM (24.0 vs. 2.8%, P=0.01). Of these patients, 83.3% were diagnosed with GDM at 16 weeks gestation. An impaired 75-g GTT was also more frequent in the study group (P=0.01). CONCLUSION: Our findings suggest that long-term corticosteroid therapy may be associated with the development of diabetes in pregnant women and early GTT should be performed in pregnant women on corticosteroid therapy.

Reproductive and obstetric characteristics of adolescent pregnancies in Turkish women.

OBJECTIVE: To evaluate reproductive and obstetric characteristics of adolescent pregnancies in Turkish population. DESIGN: Retrospective study. SETTING: Social Security Agency (SSK) Aegean Obstetrics and Gynecology Teaching Hospital (tertiary referral center). PATIENTS: One thousand and eight hundred adolescent pregnant women who referred to our center, between January 12, 2002 and March 15, 2003. The adolescent age group was defined as young women between the ages of 13 and 19. INTERVENTIONS: None. OUTCOME MEASURES: Socio-demographic characteristics, contraceptive histories, sexually transmitted infections (STI), and obstetric outcomes of the patients. RESULTS: Mean age was 17.3 (range 13-19) years. Among all adolescent pregnancies 1368 (76%) cases were planned, and 1512 (84%) cases were married. Approximately 70% of the patients with a non-planned pregnancy were not using any contraceptive methods. Although there were no patients with HIV infection, there were a considerable percentage of patients with positive cervical screening tests for Human Papilloma Virus (8.05%). A majority of adolescent mothers (77%) lacked prenatal care; mean gestational week at the first prenatal visit of the patients taking prenatal care was 28.2 (range 6-39) weeks. There were 249 (13.83%) abortions. Mean gestational age at delivery was 36 +/- 2 (range 25-41) weeks. The most common obstetric complication was low birth weight (28.72%). CONCLUSIONS: Adolescent pregnancy rate in Turkey is similar to those in developed countries. However, there are considerable differences which possible reflect ethnic and socio-cultural differences, in between two populations. Our major problems seem to be the low rate of previous effective contraceptive use for unintended adolescent pregnant women and the high rate of inadequate prenatal care for adolescent pregnant women, even if their pregnancies are intended.

Prothrombin G20210A mutation in cases with recurrent miscarriage: a study of the mediterranean population.

BACKGROUND: Thrombophilic predisposition may be one of the underlying causes of recurrent miscariage (RM). The purpose of this study was to evaluate the Prothrombin G20210A mutation in cases with history of RM. MATERIAL AND METHODS: A total of 104 cases, 55 with diagnosis of RM and 49 control cases, were included in this controlled study. In all cases, in addition to full examination tests, Prothrombin 20210A mutation analysis was carried out by means of Polymerase Chain Reaction (PCR). RESULTS: Mean number of the abortion was 3.51 +/- 0.74 in the RM group and 0.08 +/- 0.27 in the control group (p < 0.05). As a consequence of comprehensive examinations, in 24 (43.6%) of 55 RM cases at least one etiologic factor was put forth. Prothrombin G20210A mutation was observed in six (10.9%) cases of the RM group and one (2.04%) in the control group (p < 0.05). Four of the six cases (66.7%) of Prothrombin G20210A mutation had a subsequent pregnancy. Among these four pregnancies, there was one spontaneous loss at 14 weeks of gestation and one severe pre-eclampsia. CONCLUSION: Our data together with literature suggest that Prothrombin G20210A mutation may be associated with RM. We recommend this genetic testing as a screening tool for women with history of RM.

Necrotizing fasciitis after abdominal hysterectomy: a report on five cases.

Necrotizing fasciitis, a severe soft tissue infection, was first described 80 years ago. It occurs rarely in obstetric and gynecology practice. We reviewed medical records of 2,894 women who had underwent an abdominal hysterectomy at the Social Security Agency Aegean Obstetrics and Gynecology Teaching Hospital between 2001 and 2005, and identified 5 (0.17%) cases of necrotizing fasciitis, which are described.

Comparison of pituitary-ovarian function in patients who have undergone successful renal transplantation and healthy women.

Twenty-eight renal transplantation patients, aged 19-35 years, and 30 healthy women of reproductive age were enrolled into the study. Analyses revealed significant differences between study and control groups' midluteal serum P levels and between study and control groups' serum PRL levels. Although most renal transplantation patients have plasma estrogen and gonadotropin levels similar to those in healthy women, several problems, such as luteal phase defect, might affect transplant recipients.

Adenosarcoma of the uterus: a case report.

Adenosarcomas of the uterus are very rarely observed and diagnosed. In this report, we present a case of a uterine adenosarcoma that was diagnosed in February 2002.

Hepatic and splenic hydatid cyst during pregnancy: a case report.

Hydatid disease is primarily a disease of sheep and cattle. Human beings are accidental hosts. We present a 32-year-old multigravida at 25 weeks of pregnancy in whom splenic and liver cysts were diagnosed by ultrasonography and magnetic resonance imaging (MRI). The splenic cyst was removed and a healthy baby was delivered vaginally at term.

Voiding symptoms in pregnancy: an assessment with international prostate symptom score.

OBJECTIVE: The aim of the study was to evaluate the voiding symptoms of pregnant women and to compare the symptoms amongst trimesters and controls by means of the International Prostate Symptom Score (IPSS). MATERIALS AND METHODS: Voiding symptoms of 256 pregnant and 230 non-pregnant healthy women hospitalized for other reasons were evaluated. Subjects who had a history of urological and neurological problems or previous pelvic surgery associated with urinary symptoms and those who had urinary tract infection were excluded from the study. The pregnant group was then subdivided into subgroups as to the trimesters of pregnancy. The IPSS assesses seven symptoms on a scale of 0 (no symptoms) to 5 (symptom always present) and was administered as a self-administered questionnaire with the assistance of a trained nurse. Symptom scores of each group and subgroup and the distribution of scores were assessed. RESULTS: The mean scores for all questions in the pregnant group were significantly higher than controls. The comparison of mean scores according to trimesters showed a significant difference for the questions of frequency, intermittency, urgency, weak stream, nocturia, quality of life and for the total scores. The distribution of the scores for each question showed that frequency and nocturia were the most prominent symptoms in pregnancy. The percentage of the respondents with an IPSS score of >7 was 47.6% and the percentage of a quality of life score of >/=4 (mostly dissatisfied) was 48.4%. CONCLUSIONS: Voiding symptoms during pregnancy are highly prevalent. These symptoms worsen as the pregnancy progresses.

Comparative morphological differences between umbilical cords from chronic hypertensive and preeclamptic pregnancies.

To compare morphological changes in the umbilical cords from chronic hypertensive and preeclamptic patients having normal or pathological umbilical artery Doppler ultrasonographic results. Umbilical cords from 34 normotensive, 31 chronic hypertensive and 70 preeclamptic women with normal and abnormal Doppler flow velocity waveforms (FVW) at 35-40 gestational weeks were studied. Morphological changes in the umbilical cords were examined on formalin-fixed, paraffin-embedded sections. The total umbilical cord area, total vessel area, and wall thickness of umbilical vessels were measured in systematic random samples using unbiased stereology methods. An ANOVA test was used for statistical analysis. In the chronic hypertensive and preeclamptic groups with normal Doppler FVW, the thickness of the umbilical cord vessels remained nearly constant, whereas both the total area and the lumen area were reduced. These changes correlate with the histopathological findings, suggesting a mainly vasoconstrictive effect. By contrast, analysis of the preeclamptic group with pathologic Doppler FVW showed a comparable reduction of all parameters of the umbilical cord. Histopathological findings were related to smaller, contracted smooth muscle cells of the vessel wall, which is suggestive of a predominant hypoplastic mechanism. As a result of reduced uteroplacental perfusion, fetal hypoxia and intrauterine growth retardation become unavoidable in preeclampsia. The histopathological changes in the umbilical cord between the chronic hypertensive and preeclamptic patients depend on the Doppler results. In conclusion, the umbilical artery Doppler FVW indices provide good values for predicting intrauterine growth retardation in preeclamptic patients.

Comparison of the clinical efficacy and safety of flutamide versus flutamide plus an oral contraceptive in the treatment of hirsutism.

OBJECTIVE: To compare the clinical, hormonal, biochemical and hemotological effects of flutamide versus flutamide plus an oral contraceptive (OC) in the treatment of hirsutism. PATIENTS: Eighty-four women with hirsutism were equally randomized to receive either flutamide or flutamide plus OC. DESIGN: Eighty-four women with hirsutism were recruited from patients presenting to our hospital. Each patient underwent a complete medical and gynecological examination as well as blood cell counts, biochemical and endocrine profiles. Hirsutism scores and laboratory tests were done during the 1st, 3rd and 6th months of therapy. Thirty-seven women in the flutamide group (taking 250 mg flutamide per day) and 32 women in the flutamide plus OC group (taking 250 mg flutamide plus 35 microg ethinyl estradiol and 2 mg cyproterone acetate per day) regularly followed the therapy regimens. RESULTS: There were no significant differences in Ferriman-Gallway scores at the beginning and at the end of the therapies between the two groups (p > 0.05). At the 6th month, the decreases in Ferriman-Gallway scores were significant in both flutamide (from 18.95 +/- 4.44 to 14.46 +/- 5.02; p < 0.05) and flutamide plus OC groups (from 19.94 +/- 4.31 to 15.58 +/- 4.28; p < 0.05). In the first group, 2 of 6 oligomenorrheic women had regular cycles at the end of the therapy. Oligomenorrhea in 8 women was all changed to regular cycles in the flutamide plus OC group. Regarding the hormonal profile, only in the second group were prolactin, free testosterone and dehydroepiandrosterone sulfate levels significantly decreased (p < 0.05). Hepatic function tests were significantly increased in both groups, but they were all within normal ranges. CONCLUSION: These data suggest that both therapies were similarly effective and safe in the treatment of hirsutism. In women with oligomenorrhea and/or needing contraception, adding an OC shows better results than flutamide treatment alone in providing regular cycles.

[Polymerase chain reaction for Chlamydia trachomatis in urine specimens from patients with mucopurulent genital discharge]. / Mukopürülan genital akintisi olan hastalarin idrar örneklerinde Chlamydia trachomatis'in polimeraz zincir reaksiyonu ile arastirilmasi.

The aim of this study was to investigate the DNA of Chlamydia trachomatis by polymerase chain reaction (PCR) in the first-void urine samples of patients with mucopurulent genital discharge and to compare the results with the urethral/endocervical swab culture method. First-void urine samples from 56 patients (46 female, 14 male) and urethral swab samples from 14 male patients were tested by PCR. Additionally, shell-vial culture method was performed for the urethral/endocervical swab samples which were collected from 46 female and 14 male patients. Four (2 females, 2 males) of the patients (7.1%) showed positive results by both of the methods. In five (8.9%) of the urine samples, internal control tests were found negative, indicating the presence of amplification inhibitors, and the culture results of these patients were also negative. Since the PCR method (Cobas Amplicor CT, Roche Diagnostic Systems, NJ, USA) which was used in the study included internal control programme to identify inhibitors in urine, the sensitivity was improved. As a result, the perfect (100%) correlation between culture and PCR methods, lead to the conclusion that PCR is a rapid and reliable method for the detection of C. trachomatis in urine samples, however more detailed studies are necessary related to the sensitivity and specificity of PCR method.