Uterine Arcuate Artery Calcification on Transvaginal Sonography May Correlate With Known Risk Factors for Atherosclerosis.

OBJECTIVES: Uterine arcuate artery calcification is an incidental finding on transvaginal sonography. We conducted this study to evaluate the clinical importance of arcuate artery calcification and its association with the serum lipid profile and carotid artery atherosclerosis. METHODS: Serum lipid profiles, carotid artery intima thicknesses, and Doppler parameters of uterine arteries were examined in 25 patients with uterine arcuate artery calcification and 25 control participants. The parameters were compared between the groups. RESULTS: The mean pulsatility indices, mean resistive indices, and systolic-to-diastolic ratios of the right and the left uterine arteries were significantly higher in the calcification group (P< .01). Serum total cholesterol and low-density lipoprotein cholesterol levels were significantly higher, whereas the serum high-density lipoprotein cholesterol level was significantly lower in patients with uterine arcuate artery calcification than controls (P < .01). Right and left common carotid artery intima thicknesses were also significantly higher in the calcification group (P < .01). CONCLUSIONS: Uterine arcuate artery calcification is an incidental finding on transvaginal and transabdominal pelvic sonography, and it is correlated with an abnormal lipid profile and increased thicknesses of the intimal layers of the carotid arteries. We suggest that an incidental finding of arcuate artery calcification during vaginal sonography is a reason to screen for generalized atherosclerosis and related disorders.

Manual strangulation of the uterine isthmus after placental removal to reduce blood loss during cesarean section.

INTRODUCTION: This study aimed to evaluate the effect of manual strangulation of the uterine isthmus on the amount of blood loss during cesarean section. MATERIAL AND METHODS: This is a prospective randomized controlled trial. A total of 118 participants were enrolled in the study. Manual strangulation of the uterine isthmus just after placental removal was performed during cesarean section in group I (n = 57; the strangulation group). Strangulation was not performed in group II (n = 61; the control group). Preoperative and postoperative venous blood hemoglobin, capillary hemoglobin, and absorbed blood levels during the operation were compared between the two groups. RESULTS: The median age of the patients was 28.5 (19-41). The median body mass index of the patients in the study was 27 (21-42). There were no significant differences in the demographic characteristics of the patients between the groups. The median difference between the preoperative and postoperative 4-6 h capillary hemoglobin values was significantly lower in the strangulation group (2.0 (0-9)) than in the control group (3.0 (0-8)). The amount of absorbed blood during the operation was also significantly lower in the strangulation group (164.5 ml (69-1310)) than in the control group (230 ml (35-3223)). CONCLUSIONS: Manual uterine strangulation of the uterine isthmus immediately after the removal of the placenta may induce a 30% decrease in blood loss during cesarean section.

Effect of misoprostol on bone mineral density in women with postmenopausal osteoporosis.

OBJECTIVE: To evaluate the effect of misoprostol on bone mineral density in postmenopausal women. MATERIALS AND METHODS: The study was performed in a randomized controlled prospective manner in 90 women with menopause at Süleymaniye Maternity and Women's Diseases Teaching and Research Hospital between January and December 2003. Cases were divided into three groups each consisting of 30 women who were in menopause for at least 1 year and had t-scores less than -1 by dual energy X-ray densitometry (DEXA). Group I was treated with misoprostol and calcium, Group II received tibolone and calcium and Group III was given calcium only and considered as control group. In all patients, bone mineral density in L1-L4 vertebrae, femur neck and Ward triangle were measured by DEXA and t and z scores were calculated. RESULTS: All groups were similar demographically. Bone mineral density in L1-L4 vertebrae, femur neck and Ward triangle in the group treated with misoprostol, increased by 5, 8.1 and 3.6%, respectively. In the tibolone group, bone mineral density in L1-L4 vertebrae, femur neck and Ward triangle increased by 8.3, 5.3 and 7.8%, respectively. There was not a significant difference in t and z-scores and bone mineral density measurements between misoprostol and tibolon groups. CONCLUSION: Misoprostol may be an alternative treatment for patients with osteopenia and osteoporosis who are not suitable for hormone replacement therapy.

Incomplete healing of the uterine incision after caesarean section: Is it preventable?

OBJECTIVE: To find out whether a change in suturing technique might affect the healing of the uterine scar after caesarean section (CS). STUDY DESIGN: In this randomised prospective study, 78 term pregnant patients delivered by CS were allocated to two different suturing techniques either including or excluding the endometrial layer. The integrity of the uterine incision was checked by ultrasound 40-42 days after the operation. Any deviation from the full thickness apposition of the anterior uterine wall (with the ratio: [anterior wall thickness/(anterior wall thickness+height of the wedge shaped defect)]<1) was considered to represent incomplete healing. Both groups were then compared in terms of the frequency of incomplete healing. Chi square and Student's t-test were used where appropriate. A logistic regression model was used to adjust for confounding factors. RESULTS: The frequency of incomplete healing was significantly lower in the group treated by full thickness suturing (44.7% versus 68.8%); (OR: 2.718; CI: 1.016-7.268). Similarly the mean values for the incomplete healing ratio were 0.77+/-0.17 and 0.86+/-0.17 (p = 0.03) in split and full thickness groups, respectively. After adjusting for other confounding factors the suture technique still remained as a significant determinant of the incisional healing (p = 0.04). CONCLUSION: By selecting full thickness suturing technique one may significantly lower the incidence of incomplete healing of the uterine incision after CS.

Human Chorionic Gonadotropine in Cul-de-sac Fluid in Tubal Ectopic Pregnacy; A New Diagnostic Approach.

INTRODUCTION: Although new diagnostic abilities are being utilised increasingly yet early detection of tubal pregnancy remains a challenge. The use of highly sensitive hCG kits has facilitated the early diagnosis of a pregnancy. But it takes time to determine the localisation of the pregnancy. Early diagnosis of ectopic pregnancy may reduce the morbidity of ectopic pregnancy. AIM: This study was conducted to analyse the cul-de-sac and serum ßhCG ratio in tubal ectopic pregnancy cases which may be a new diagnostic approach for ectopic pregnancy. MATERIALS AND METHODS: Between January 2004 and July 2011, 263 patients with ectopic pregnancy were included in the study. Risk factors of patients and treatment modalities were evaluated. hCG was measured in peripheral serum and peritoneal fluid, obtained by puncture of Douglas pouch in 52 patients with tubal ectopic pregnancy. hCG level was determined in the cul-de-sac fluid and in the maternal serum for comparison. RESULTS: Tubectomy (5.3%), history of abortion (9.5%), history of previous surgery (14.8%), previous cesarean section (8%) and pelvic infamatorry disease (15.9 %) were the important risk factors for ectopic pregnancy in our cases. In 51 of 52 patients with tubal pregnancy, the cul-de-sac hCG vaule and the serum hCG value ratio was >1. CONCLUSION: It is concluded that the ratio of hCG in cul-de -sac and serum can be used for the verification of tubal ectopic pregnancy in addition to other diagnostic methods. This may help rapid confirmation of the diagnosis of ectopic pregnancy.

Sonographic measurement of fetal ear length in Turkish women with a normal pregnancy.

BACKGROUND: Abnormal fetal ear length is a feature of chromosomal disorders. Fetal ear length measurement is a simple measurement that can be obtained during ultrasonographic examinations. AIMS: To develop a nomogram for fetal ear length measurements in our population and investigate the correlation between fetal ear length, gestational age, and other standard fetal biometric measurements. STUDY DESIGN: Cohort study. METHODS: Ear lengths of the fetuses were measured in normal singleton pregnancies. The relationship between gestational age and fetal ear length in millimetres was analysed by simple linear regression. In addition, the correlation of fetal ear length measurements with biparietal diameter, head circumference, abdominal circumference, and femur length were evaluated.Ear length measurements were obtained from fetuses in 389 normal singleton pregnancies ranging between 16 and 28 weeks of gestation. RESULTS: A nomogram was developed by linear regression analysis of the parameters ear length and gestational age. Fetal ear length (mm) = y = (1.348 X gestational age)-12.265), where gestational ages is in weeks. A high correlation was found between fetal ear length and gestational age, and a significant correlation was also found between fetal ear length and the biparietal diameter (r=0.962; p<0.001). Similar correlations were found between fetal ear length and head circumference, and fetal ear length and femur length. CONCLUSION: The results of this study provide a nomogram for fetal ear length. The study also demonstrates the relationship between ear length and other biometric measurements.

Prenatal diagnosis of complete atrioventricular septal defect: perinatal and neonatal outcomes.

Objective. The purpose of this study was to establish the outlook for fetuses diagnosed with complete atrioventricular septal defect (cAVSD) prenatally and its relation to additional cardiac, extracardiac, and chromosomal abnormalities. Methods. We retrospectively reviewed fetal echocardiograms diagnosed with cAVSD from January 2002 to December 2007, comparing fetuses with and without aneuploidy. Results. Complete antrioventricular septal defect was confirmed in 62 fetuses. Mean maternal age was 28.79 +/- 4.78 years (range 20-38). Mean gestational age was 23.69 +/- 5.48 weeks (range 12-38). Fetal karyotype was known in all fetuses. An abnormal karyotype was found in 21 fetuses. Complete AVSD occurred without any other intracardiac abnormality in 28 fetuses. Extracardiac anomalies were present in 38 fetuses. As for pregnancy outcomes, there were 36 (58%) terminations of pregnancy and 4 (6.4%) intrauterine fetal deaths. In these four fetuses, complex cAVSD was associated with atrioventricular block (one case), heterotaxy (one case), and fetal hydrops (two cases). Of the 22 live births, 5 were neonatal deaths without surgery while 17 babies underwent surgery and 13 have survived to date. The mean survival age was 53 +/- 4 months (range 22-64 m). Conclusion. AVSD is associated with chromosomal, other cardiac, and extracardiac abnormalities. The detection of these abnormalities is important in order to give the best indication of the likely outcome when counselling parents.

Cardiac and other malformations in parapagus twins.

INTRODUCTION: Conjoined twins occur in one 50-200,000 live births and approximately 75% of all cases are thoracopagus twins. Parapagus conjoined twins are rare and are not included in many review articles. CASE REPORT: The cardiovascular system of a male parapagus (dicephalus, tetrabrachius, dipus) conjoined twins was studied. Twin B had bilateral bilobed lungs and a normal heart, while bilateral trilobed lungs and right isomerism was found in twin A. They shared a diaphragm and an abdominal cavity. There were two complete heads on two necks, two thoraxes, one abdomen, four arms, two legs, two complete vertebral columns, a single pelvis, and severe cardiac abnormalities.