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.

EFFECT OF INSULIN RESISTANCE ON THE OCCURRENCE OF PREGNANCY IN WOMEN TREATED EMPIRICALLY FOR UNEXPLAINED INFERTILITY.

CONTEXT: The detrimental effects of hyperinsulinemia on human ovaries during follicular development process have been shown in various studies, particularly in women with polycystic ovary syndrome. To our knowledge there is no study regarding the effect of insulin resistance (IR) on the intrauterine insemination (IUI) success in women with unexplained infertility (UEI). OBJECTIVE: To evaluate the effects of IR on the occurrence of pregnancy among infertile women undergoing ovulation induction (OI) with IUI for UEI. DESIGN: Prospective cohort study. SUBJECTS AND METHODS: 173 patients who met the criteria for UEI and under the age of 35 were included in this study. All women underwent OI with IUI and, subsequently, they were divided into two groups based on the presence of pregnancy. Data reviewed for analysis were demographic, clinical, and laboratory features. RESULTS: There were 37 (21.4%) cycles with pregnancy and 136 (78.6%) cycles without pregnancy. Median infertility duration was significantly lower in the pregnant group when compared with non-pregnants (p=0.018). The mean number of previous cycles per patient was also lower in this group (p=0.028). No significant differences were found between the groups in terms of other variables. Levels of insulin, fasting glucose and HOMA-IR were also similar between the two groups. CONCLUSIONS: IR calculated by using HOMA-IR index has no positive or negative effect on the occurrence of pregnancy in women undergoing OI therapy with IUI for UEI.

Effect of intrahepatic cholestasis of pregnancy on maternal serum screening tests.

OBJECTIVE: In this study, we aimed to evaluate whether the changes in the first and second trimester maternal serum biochemical markers used for prenatal screening are associated with euploid pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP). METHODS: A total of 94 pregnant women were included in this retrospective comparative study. Thirty-seven women whose pregnancy was complicated with ICP constituted the study group whereas 57 of them constituted the control group. All hospital records were examined in terms of combined first trimester screening test and second trimester triple test parameters. Perinatal outcomes were also recorded. RESULTS: No significant difference was observed between the two groups in term of age, BMI, and obstetric history (all p > 0.05). Mean serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and serum bile acid concentrations in the study group were significantly higher than in the controls (p < 0.001). There were no significant differences between the two groups in terms of first and second trimester serum biochemical markers. Newborn gender, route of birth, and NICU admission rates were also similar in the two groups. Mean birth weight of the control group was statistically significantly higher than the ICP group (p = 0.012). CONCLUSION: We report no significant differences between pregnancies complicated by ICP and healthy pregnancies in terms of first and second trimester maternal serum screening test results.

Anterior placenta previa is associated with increased umbilical cord blood hematocrit concenrations.

OBJECTIVE: We aimed to evaluate the umbilical cord blood (CB) hematocrit (Hct) levels in women with anterior located placenta previa (PP). METHODS: This is a prospective case-control study performed in a tertiary level maternity hospital. Thirty seven pregnant women diagnosed with anterior PP (study group) and 37 women without PP (control group) included into the study. Groups were matched with regard to age, gestational age, and fetal gender. All women underwent Cesarean section. Umbilical CB Hct levels of the newborns were measured. Demographics, operative features, and neonatal outcomes were recorded. RESULTS: Umbilical CB Hct levels were statistically significantly higher in the PP patients compared with controls (p: 52.6±5.0 vs. 47.5±5.0, p < 0.001). Preoperative maternal hemoglobin (Hgb) and Hct levels were similar in the two groups. However, postoperative Hb and Hct levels were significantly lower in the study group (p: 0.003, p < 0.001, respectively). Intraoperative complication rates were higher in this group. Neonatal Apgar scores were lower and neonatal intensive care unit admission was more common in the PP group when compared with controls. CONCLUSION: We think that anterior PP is associated with increased umbilical CB Hct levels. Neonatologists should consider this condition in the infants born to mothers with anterior PP.

Is there an association between serum vitamin D levels and endometrial polyps?

BACKGROUND/AIM: Anti-proliferative effects of vitamin D (VD) had been proposed previously. Herein, the authors aimed to evaluate serum 25(OH)VitD3 levels in women with endometrial polyps (EPs) and to determine whether VD deficiency is a risk factor for EP formation. MATERIALS AND METHODS: This study was designed as a controlled cross-sectional study. Forty three women with polyps constituted the study group whereas 47 of them constituted the control group. The selection criteria for the study group were hysteroscopic detection and histological confirmation of EPs. The main parameters recorded for each woman were; age, body mass index (BMI), par- ity, smoking status, co-morbidities, dressing style, dairy intake of VD-rich foods, duration of sunlight exposure, skin photo-type, serum levels of 25(OH)VitD3, calcium, phosphor, and albumin. RESULTS: The mean serum 25(OH)VitD3 level was 8.3±7.7 ng/ml in the study group and 9.3 ± 10.2 ng/ml in the control group (p = 0.583). Mean BMI was statistically significantly higher in the study group (p = 0.003). Logistic regression model showed that only significant risk factor for EPs was increased BMI (OR=1.241; 95% CI = 1.070-2.440; p = 0.004). CONCLUSION: VD deficiency is common among the reproductive age women and obesity is the most important risk factor for polyp formation. The authors believe that there is no relation between VD and EPs.

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.

Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age.

OBJECTIVE: To study whether there is any relationship between a serum tumor markers panel (CA19-9, CA 125, CEA, CA15-3 and AFP) and the tumor size in patients with ovarian dermoid cyst in reproductive age. BACKGROUND: Between January 2006-2007, 160 patients were operated in the Department of Infertility, Zekai Tahir Burak Women Health Hospital due to ovarian dermoid cyst. METHODS: The clinical data and serum tumor markers levels of operated patients were retrieved from the records of the department. This was a retrospective study. RESULTS: Forty-four patients (37.6 %) had high levels of CA 19-9 , twenty-seven patients (19.3 %) had high CA 125 levels, eleven patients (9.4 %) had high levels of CEA, five patients (4 %) had high levels of CA 15-3 and one patient (0.9 %) had high AFP levels at the time of initial surgery. The bilaterality rate was 8.1 %. When grouping the tumor size as 10 cm, the mean serum levels of tumor markers had significantly increased by increasing the tumor size (p<0.05) for CA 19-9, CA 125, CEA. CONCLUSIONS: Our study suggests that serum CA 19-9 is probably more accurate marker than other tumor markers in the ovarian dermoid cysts. Also, the most important parameter that affects CA 19-9 elevation in the dermoid cysts, is the tumor size. As the tumor becomes bigger, this relationship becomes more distinct (Tab. 2, Ref. 15).