Aydın Çorakçi

Diagnostic accuracy of real‐time 3D sonography in the diagnosis of congenital Mullerian anomalies in high‐risk patients with respect to the phase of the menstrual cycle

To compare the diagnostic accuracy of 2‐dimensional sonography (2DUS) and real‐time 3‐dimensional sonography (3DUS) in the diagnosis of congenital mullerian defects (CMD) with respect to the phase of the menstrual endometrium.

Misoprostol 50 μg Sublingually versus Vaginally for Labor Induction at Term: A Randomized Study

Objective: To compare the efficacy of misoprostol 50 µg vaginally and 50 µg sublingually for labor induction at term. Materials and Methods: One hundred and sixty women were randomized to receive misoprostol 50 µg vaginally (n = 80) or 50 µg sublingually misoprostol (n = 80). The doses were given every 4 h (maximum 6 doses). Primary outcome measure was number of cesarean deliveries. Induction to delivery time, delivery within 24 h, the number of misoprostol doses given; the need for oxytocin augmentation, tachysystole and uterine hyperstimulation rates and neonatal outcomes were secondary outcome measures. Results: The mean induction to delivery time was 748 ± 379 min in the vaginal group and 711 ± 425 in the sublingual group (p = 0.56). The number of women delivering within 24 h was 73 (91.3%) in the vaginal group and 74 (92.5%) in the sublingual group (p = 0.78). The mean number of misoprostol doses required was significantly higher in the sublingual group (1.9 ± 1.2) compared with the vaginal group (1.1 ± 0.4; p < 0.001). More women in the sublingual group experienced tachysystole (n = 14, 17.5%) compared with the vaginal group (n = 3, 3.8%; p = 0.005). Seven cases (8.8%) in the vaginal group and 12 cases in the sublingual group (15%) required emergent cesarean delivery for fetal heart rate abnormalities (p = 0.22). Other neonatal outcomes including umbilical artery pH, Apgar scores and intensive care unit admission were similar in the two groups. Conclusion: Sublingual misoprostol is as efficacious as vaginal misoprostol for induction of labor. More frequent tachysystole is observed with misoprostol 50 µg sublingually, but neonatal outcomes are similar.

Maternal colonisation with group B streptococcus and effectiveness of a culture-based protocol to prevent early- onset neonatal sepsis

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high‐risk‐based antibiotic prophylaxis was compared with high‐risk‐based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early‐onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor‐based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early‐onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high‐risk‐based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early‐onset neonatal sepsis with GBS when compared with high‐risk‐based approach alone.

Pure nongestational choriocarcinoma of ovary

IntroductionPrimary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma.Case report and discussionWe present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin.

SIGNIFICANTLY DECREASED P27 EXPRESSION IN ENDOMETRIAL CARCINOMA COMPARED TO COMPLEX HYPERPLASIA WITH ATYPIA (CORRELATION WITH P53 EXPRESSION)

P27 expression was examined on paraffin-embedded specimens in proliferative, secretory, hyperplastic and neoplastic human endometrium by immunohistochemistry. The results of p27 immunoreactivity in endometrial carcinomas were compared with clinicopathological indicators as well as with p53 expression. Thirty-eight cases of endometrial carcinoma, 30 normal functional (15 proliferative, 15 secretory), 24 hyperplastic endometrium (12 without atypia, 12 with atypia) specimens were studied by using monoclonal p27 and p53 antibodies. The streptavidin-biotin-peroxidase detection system was used and the intensity and the distribution of immunoreactivity was evaluated semiquantitatively. p27 expression was present both in the proliferative and secretory phases; the expression being stronger in the secretory period. In complex hyperplasia with atypia, p27 expression was even higher and it was significantly reduced in the endometrial carcinoma group (p<0.05). No significant correlation was found between p27 expression and any of the clinicopathologic prognostic parameters (p>0.05). Nuclear p53 expression was detected in 13 (34.2%) patients with endometrial carcinoma and was higher in non-endometrioid carcinomas and in tumors with increasing FIGO grade (p<0.05). High expression of p53 was not found to be a significant prognostic indicator of survival (p> 0.05). No p53 expression was detected in the endometria with proliferation, secretion or hyperplasia either simple without atypia or complex with atypia. Surprisingly, tumors with absent/low p27 expression showed absent/low p53 expression. Our data suggest that p27 is necessary to control the proliferation of endometrium and its loss of expression seems to play a role in some aspects of endometrial carcinogenesis.

Magnetic resonance imaging and angiography for the prerupture diagnosis of rudimentary uterine horn pregnancy.

Magnetic resonance (MR) imaging and MR angiography were used for the differential diagnosis and preoperative planning of a 17 weeks of age rudimentary horn pregnancy. A 26-year-old primigravida was referred to our hospital with a preliminary diagnosis of abdominal pregnancy. After an inconclusive ultrasound evaluation we were able to identify a rudimentary horn pregnancy, extent of the placental invasion, and the vascular supply via MR imaging and time of flight sequence MR angiography. The obtained data were also used for preoperative planning, which resulted in an uncomplicated, prerupture laparotomy for pregnancy termination and a healthy female.

The effects of human amniotic membrane and fibrin sealant in the prevention of postoperative adhesion formation in the rabbit ovary model.

Summary: The study group consisted of 29 female, white New Zealand rabbits. The rabbits were randomized into 3 groups and a midline laparotomy was performed in order to make a 4–5 mm long lesion using a scalpel in both ovaries. In Group 1, both of the ovaries were left uncovered. In Group 2, the right ovaries were covered by human amniotic membrane graft. In Group 3, 0.1–0.2 mL of Tisseel solution was applied to the lesion in the right ovaries. No medication was applied to the left ovaries in any of the groups and thus this ovary acted as an individual control. After 2 weeks the adhesion scores were graded by relaparotomy in a blind manner. Fibrin sealant showed a significant reduction in postoperative adhesion formation compared with the amniotic membrane graft and control groups (p<0.001). Therefore, it can be concluded that fibrin sealant can be used as an adjuvant during reproductive surgery.

Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy.

Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2‐D and 3‐D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29‐year‐old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum β‐hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility.

Prospective case control comparison of fetal intrapartum oxygen saturations during epidural analgesia.

BACKGROUND The purpose of this study was to compare fetal oxygen saturation by fetal pulse oximetry in parturients with and without epidural labor analgesia in a prospective case control study. METHODS Fetal oxygen saturation values were compared in term pregnant women who received epidural analgesia (epidural group) with those in women who did not (control group). Mode of delivery, Apgar score, fetal oxygen saturation, cord blood gas analysis and fetal outcomes were also compared. RESULTS A total of 150 pregnant women (75 in each group) gave written consent and were enrolled. The average fetal oxygen saturation during the first stage of labor (active phase) was 45.6 +/- 8.1% for the epidural group and 45.9 +/- 7.4% for the control group (NS); saturations for the second stage of labor were 44.9 +/- 8.8% and 45.3 +/- 6.7%, respectively (NS). In the epidural group, the duration of the first stage of labor was significantly longer (565 +/- 217 min) than the control group (434 +/- 222 min; P= 0.001). Cesarean delivery rates, neonatal cord blood gas analysis, Apgar scores, and neonatal outcomes were similar in the two groups. CONCLUSIONS Fetal oxygen saturation values are similar in the first and second stage of labor in the presence or absence of epidural labor analgesia.

Unsuccessful management of acardiac fetus with intrafetal alcohol injection.

Twin reversed arterial perfusion (TRAP) sequence is an extreme form of twin-to-twin transfusion in which the normal ‘pump’ twin perfuses its acardiac cotwin. The pump twin has a 50% mortality rate due to congestive heart failure, and polyhydramnios and preterm delivery are further obstetric complications. The risk of an adverse pregnancy outcome is increased when the ratio of acardiac twin : pump twin weight exceeds 70%. Management of TRAP sequence includes elective termination, observation and follow-up using ultrasound or cardiotocography, digoxin therapy for cardiac failure of the pump twin and interventions that target the blood supply of the acardiac fetus. Coagulation of the vascular anastomosis under sonoendoscopic control and percutaneous umbilical cord ligation are invasive therapeutic options. Percutaneous intrafetal alcohol injection has also been reported as a simple and less invasive procedure1,2. We report here our unsuccessful management using intrafetal alcohol injection of an acardiac acephalic twin pregnancy in a 16-year-old woman, gravida 1 para 0, at 12 weeks of gestation. On admission, ultrasound evaluation demonstrated a monochorionic twin pregnancy in which one of the fetuses had no head and upper extremities but normal mobile lower extremities (Figure 1) and significant edema around the trunk. Despite the absence of the heart, blood flow in the