Ductus arteriosus diameters in fetuses with early- and late-onset fetal growth restriction.

PURPOSE: Fetal growth restriction (FGR) is a common pregnancy complication that can be associated with several adverse perinatal outcomes. One of these negative outcomes is ductus arteriosus, especially in preterm babies. In this study, intrauterine heart function and ductus diameter were evaluated in babies with FGR. METHODS: Thirty-seven fetuses with FGR were compared with 37 normal-weight fetuses at the same gestational week. In our study, ventricular diameters, aorta, pulmonary artery, ductus arteriosus (DA), aortic arch diameter, and flow traces were examined. In addition, the aorta and aortic isthmus diameters were proportioned to the ductus diameter, and the left ventricular myocardial performance index (MPI) [(ICT + IRT)/ET] was evaluated. RESULTS: There was no difference in DA diameters between the patient and control groups. The intragroup comparison of the cases with early- and late-onset FGR revealed no statistically significant difference between DA diameters. However, the ratios of the aortic annulus diameter/ductus diameter (AOD/DAD) and aortic isthmus diameter/ductus diameter (AID/DAD) were significantly lower in early-onset FGR because the diameter of the DA was greater. In addition, the mod-MPI values were higher in the patient group. CONCLUSIONS: In our study, although the ductal diameters did not change significantly in the patient group, the ductal diameter was greater in the early-onset intrauterine growth restriction (FGR) group compared with other cardiac measurements. The mod-MPI value, a cardiac function indicator, was higher in fetuses with FGR. These findings may be useful for evaluating postnatal cardiac functions in FGR.

Time-Varying GPS Displacement Network Modeling by Sequential Monte Carlo.

Geodetic observations through high-rate GPS time-series data allow the precise modeling of slow ground deformation at the millimeter level. However, significant attention has been devoted to utilizing these data for various earth science applications, including to determine crustal velocity fields and to detect significant displacement from earthquakes. The relationships inherent in these GPS displacement observations have not been fully explored. This study employs the sequential Monte Carlo method, specifically particle filtering (PF), to develop a time-varying analysis of the relationships among GPS displacement time-series within a network, with the aim of uncovering network dynamics. Additionally, we introduce a proposed graph representation to enhance the understanding of these relationships. Using the 1-Hz GEONET GNSS network data of the Tohoku-Oki Mw9.0 2011 as a demonstration, the results demonstrate successful parameter tracking that clarifies the observations' underlying dynamics. These findings have potential applications in detecting anomalous displacements in the future.

Contribution of fetal magnetic resonance imaging in the evaluation of neurosonographically detected cases of isolated mild and moderate cerebral ventriculomegaly.

AIM: This study aimed to present the contribution of prenatal magnetic resonance imaging (MRI) in the diagnosis of fetuses that were previously identified as isolated mild and moderate cerebral ventriculomegaly (VM) by ultrasound (US). METHODS: The data between February 2013 and August 2020 were collected for women who were diagnosed with isolated mild or moderate fetal VM by US and subsequently underwent a fetal MRI. RESULTS: Among 321 women, 21 (6.5%) had a clinically important additional finding after MRI. Twelve of 276 (4.3%) fetuses with mild VM and 9 of 45 (20%) with moderate VM had turned out to have additional central nervous system abnormalities. Additional findings were detected more in fetuses with moderate VM, mothers with an anterior-located placenta, and mothers with higher body mass indexes (BMIs) with statistical significance (p = 0.001, p = 0.013, p = 0.036, respectively). The most common additional MRI finding was grade 3 or 4 germinal matrix hemorrhage, which was detected in 11 of 21 fetuses (52.3%). CONCLUSIONS: Considering the countries' health policies, prenatal MRI would contribute mostly to the diagnosis of fetuses with moderate VM, pregnancies with anterior-located placenta, and mothers with high BMIs. According to our data, we believe that MRI will be valuable, especially in the diagnosis of grade 3 and 4 intracranial hemorrhage group.

Can the Cell-free DNA Test Predict Placenta Accreta Spectrum or Placenta Previa Totalis?

BACKGROUND: Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks. AIM: To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages. MATERIALS AND METHODS: This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test. RESULTS: The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6-10), 6.8 (6.7-10.7), and 7.1 (4.7-9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587). CONCLUSIONS: According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center.

OBJECTIVES: To evaluate the maternal and neonatal outcomes of expected and unexpected pathologically proven placenta accreta spectrum (PAS) cases in a single multidisciplinary center. MATERIAL AND METHODS: This was a retrospective cohort study of 92 PAS cases from January 2011 until September 2021. Only cases with histopathologically invasive placentation were included in the study. The cases diagnosed at the time of delivery were defined as unexpected PAS (uPAS) and those diagnosed antenatally as expected PAS (ePAS). Maternal and neonatal outcomes of both groups were compared. RESULTS: Thirty-five (38%) of 92 cases were in the uPAS group. Placenta previa and high-grade PAS (percreata) were significantly higher in the ePAS group (p=0.028, p<0.001; respectively). The mean packed red blood cell transfusion was significantly higher in the uPAS group (p=0.030) but transfusions of other blood products were similar in the two groups. There was no significant difference in intraoperative complication rates between the two groups. Preterm delivery (<37 weeks) was significantly higher in the ePAS group (p<0.001), but there was no significant difference between the two groups in terms of adverse neonatal outcomes. CONCLUSIONS: Our single center data show that although ePAS cases include more highly invasive PAS cases, maternal hemorrhagic morbidity is lower than uPAS cases. Reducing maternal morbidity in PAS cases can be achieved by increasing antenatal diagnosis.

Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation.

The aim of this study was to assess whether serum markers would be useful as a new predictor of preterm birth in patients with spontaneous, late preterm labour. Patients diagnosed with late preterm labour were divided into preterm delivery (229 patients) and term delivery (178 patients) groups. The two groups were compared in terms of clinical characteristics and levels of serum markers (leukocyte subtypes, platelet, C-reactive protein [CRP], neutrophil to lymphocyte ratio [NLR] and platelet to lymphocyte ratio [PLR]), which were obtained at admission. The levels of leukocyte (p < .001), neutrophil (p < .001), CRP (p = .001), NLR (p < .001) and PLR (p = .003) were significantly higher, whereas lymphocytes (p = .012) were significantly lower in the preterm delivery group, compared to the term delivery group. On multivariate regression analysis, NLR positive was the most powerful predictive variable (OR = 1.41; 95%CI: 1.32-1.51; p = .005). NLR had the highest area under curve (0.711; 95%CI 0.662-0.760) in predicting preterm birth and a NLR >6.2 had the highest sensitivity (65.1%) and specificity (62.5%). High NLR at admission is an independent predictor of preterm birth in patients with spontaneous, late preterm labour. Impact statement What is already known on this subject: Preterm birth accounts for 5-12% of all births, and is a major factor associated with perinatal morbidity and mortality worldwide. However, more than 70% of preterm births occur at late preterm between 340/7 and 366/7 weeks of gestation. The central role of systemic and subclinical infections in preterm labour is well documented. Intrauterine infection leading to delivery can be measured by using a variety of laboratory parameters. What do the results of this study add: Neutrophil to lymphocyte ratio is an inexpensive, easily interpretable and promising haematologic parameter that is widely available. This study explored the association of high neutrophil to lymphocyte ratio with the risk of preterm birth in women with preterm labour between 34 and 37 weeks of gestation. What are the implications of these findings for clinical practice and/or further research: Neutrophil to lymphocyte ratio could be used in combination with existing markers to improve detection rates of preterm birth. Concomitant use of markers could be more powerful than measuring any of the individual markers alone.

Role of lymphadenectomy in disease-free and overall survival on low risk endometrium cancer patients.

OBJECTIVES: Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer. MATERIAL AND METHODS: Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec-tomy was performed in 184 cases, and not performed in 73 cases. RESULTS: There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo-logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer. CONCLUSIONS: Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques.

OBJECTIVE: To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes. METHODS: In this case-control study, 412 women who underwent CVS at 11-14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution. RESULTS: The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4-2.7, P=0.008]. CONCLUSION: The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

Can the Myocardial Performance Index Be Used as a New Predictive Factor for a Poor Prognosis in Fetuses With Idiopathic Polyhydramnios?

OBJECTIVES: The purpose of this study was to determine whether there are any changes in cardiac function in fetuses with idiopathic polyhydramnios and also to evaluate the value of the myocardial performance index for prediction of adverse perinatal outcomes. METHODS: A prospective case-control study was conducted with a total of 134 fetuses between 24 and 40 weeks' gestation. Polyhydramnios was defined as an amniotic fluid index of greater than 24 cm. Seventy-three fetuses of healthy mothers were assigned as the control group whereas 36 fetuses with an amniotic fluid index of 24 to 34 cm constituted the nonsevere polyhydramnios group, and 31 fetuses with an amniotic fluid index of 35 cm or greater constituted the severe polyhydramnios group. Fetal echocardiography was performed to compare cardiac function parameters among groups. To determine which perinatal outcomes were independently associated with an increased myocardial performance index, a multivariate logistic regression analysis was performed. RESULTS: The myocardial performance index was significantly higher in polyhydramnios groups compared with controls (P < .001). Among fetuses with polyhydramnios, the myocardial performance index was significantly higher in severe polyhydramnios compared with nonsevere polyhydramnios (P = .003). An increased myocardial performance index in polyhydramnios was independently associated with nonreassuring fetal status (odds ratio, 2.12; 95% confidence interval, 1.41-4.53; P = .005), emergency cesarean delivery (odds ratio, 1.54; 95% confidence interval, 1.12-2.37; P= .025), and respiratory distress syndrome (odds ratio, 1.79; 95% confidence interval, 1.21-3.87; P = .012). CONCLUSIONS: An increased myocardial performance index is an early indicator of adverse perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.

Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction.

OBJECTIVES: Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes. METHODS: The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed. RESULTS: Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05-1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09-1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11-2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08-1.71; P = .017). CONCLUSIONS: Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.

Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study.

OBJECTIVES: To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation. METHODS: Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately. RESULTS: Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h. CONCLUSIONS: Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.

High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia.

OBJECTIVES: The aim of our study is to determine whether first-trimester neutrophil-to-lymphocyte ratio (NLR) and plate-let-to-lymphocyte ratio (PLR) would be useful as new predictors of subsequent preeclampsia. MATERIAL AND METHODS: Medical records of women with preeclampsia and healthy controls from a tertiary referral center were retrospectively evaluated. The two groups were compared in terms of clinical characteristics and first-trimester levels of hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR. Receiver operating characteristic curve (ROC) analysis was performed to identify the optimal NLR and PLR levels predicting preeclampsia. RESULTS: Neutrophil (p < 0.001), platelet (p < 0.001), NLR (p < 0.001) and PLR (p < 0.001) levels were significantly elevated, whereas hemoglobin concentration (p = 0.003) was significantly lower in the group with preeclampsia as compared to the control group. On multivariate regression analysis, NLR (OR 1.43; 95% CI 1.21-1.76; p = 0.005) and PLR (OR 1.38; 95% CI 1.15-1.63; p = 0.008) were the most powerful predictive variables. The area under the ROC was 0.716 and 0.705 for NLR and PLR, respectively. The cut-off values of NLR ≥ 3.08 and PLR ≥ 126.8 predicted preeclampsia with the sensitivity of 74.6% and 71.8% and specificity of 70.1% and 72.4%, respectively. CONCLUSIONS: High NLR and PLR during the first trimester are independent predictors of subsequent preeclampsia.

Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes.

AIM: The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes. MATERIAL AND METHODS: Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as <6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories. RESULTS: Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of <6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65). CONCLUSION: Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.

Predictors of severity in primary postpartum hemorrhage.

PURPOSE: To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH. METHODS: Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses. RESULTS: PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006). CONCLUSION: Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.

Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation.

PURPOSE: To identify risk factors and perinatal outcomes associated with the duration of latency period in women who experience preterm premature rupture of membranes (PPROM). METHODS: A retrospective study of women who experienced PPROM between 24 and 34 weeks of gestation was performed in a single tertiary center between 2009 and 2013. Patients were divided into two groups based on the duration of the latency period after PPROM: Group 1 ≤72 h and Group 2 >72 h. Risk factors and perinatal outcomes were compared according to latency period. Student's t test and Chi-square test were used to compare continuous and categorical variables, respectively, between the two groups. Multivariate regression analysis was performed to control for potential confounding variables. RESULTS: In total, 3,257 patients presented with PPROM during the study period; of these, 204 (6.3 %) met the inclusion criteria. Higher gestational age upon admission (odds ratio [OR] = 0.83, 95 % confidence interval [CI] = 0.79-0.87; p < 0.001), oligohydramnios (OR = 0.47, 95 % CI = 0.25-0.91; p = 0.018), and twin gestation (OR = 0.67, 95 % CI = 0.45-0.89; p = 0.032) were independently associated with a shortened latency period. In addition, prolonged latency significantly increased the occurrence of chorioamnionitis (OR = 2.23, 95 % CI = 1.48-3.14; p = 0.002), placental abruption (OR = 1.9, 95 % CI = 0.95-3.53; p = 0.033), and decreased the length of stay of neonates in the intensive care unit (OR = 0.85, 95 % CI = 0.39-1.79; p = 0.021). CONCLUSION: Gestational age at PPROM, twin gestation, and oligohydramnios significantly affected the latency period. Although a latency period >72 h was associated with chorioamnionitis and placental abruption, adverse neonatal outcomes were not affected.

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.

The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

Cellular blue nevus of the vulva mimicking Bartholin's gland abscess in a 15-year-old girl: a case report.

INTRODUCTION: Literature review revealed descriptions of three cellular blue nevus (CBN) in the gynecologic tract. Two of them were myometrial CBN and incidental findings in hysterectomies performed in women aged 37 and 48 years. The single ectocervical CBN involving the hymenal ring and vagina was reported in a 19-year-old woman. The other reported cases of cervical blue nevi were common type and have been localized to endocervix. CASE REPORT: Vulvar CBN in left labia majora mimicking Bartholin's gland abscess in a 15-year-old white virgin girl and also the youngest case has not been reported previously. CONCLUSION: CBN should be considered in the differential diagnosis of vulvar masses in adolescent period.

Risk factors for surgery in patients with tuba-ovarian abscess.

OBJECTIVE: To determine the factors that increases the need of surgery in the treatment of tuba-ovarian abscess. MATERIAL AND METHOD: Fifty patients, who were diagnosed with tuba-ovarian abscess between January 2005 and December 2010 at Aegean Obstetrics and Gynecology Education and Research Hospital, were reviewed retrospectively. Patients were divided into two groups as Group A includes 19 patients treated medically and Group B includes 31 patients treated surgically. Patient characteristics of both groups were compared in terms of risk factors, clinical findings, abscess size and length of hospital stay. RESULTS: The mean age of the patients was 41.2 ± 10.4 (range 19-73). A statistically significant difference was found between the mean age of the patients (37.4 ± 8.6) treated medically and the mean age of the patients (43.5 ± 10.8) treated surgically (p 0.042). The patients treated medically were younger than those treated surgically. In addition, there was a statistically significant difference between the groups in terms of abscess sizes (p 0.001, 81.7 ± 38.2 and 43.5 ± 19.0 mm, respectively). Accordingly, the size of abscess was larger in the surgical treatment group. No significant difference was found between the two groups in terms of smoking status and duration of hospital stay (p 0.157, 0.085, respectively). Previous attacks of PID, history of minor uterine operation and use of IUD's were not different between the groups (p 0.166, 0.490, 0.080, respectively). CONCLUSION: Being older in age and having larger abscess size increase proceeding to surgery in patients with tuba-ovarian abscess.