Baris Mulayim

Helicobacter pylori infection detected by 14C-urea breath test is associated with iron deficiency anemia in pregnant women.

Aims:  To determine whether there is a relationship between Helicobacter pylori (H. pylori) infection, iron deficiency anemia and thrombocytopenia in pregnant women.

A lost intrauterine device. Guess where we found it and how it happened

Perforation of the uterus by an intrauterine device (IUD) is a serious complication occurring at or following 1/350 to 1/2500 insertions. It is more common among women with ‘lost’ IUDs. If a woman presents with pelvic pain and a history of a ‘lost’ IUD, X-rays of the abdomen and of the pelvis should be ordered. We report on a ‘lost’ IUD that had been inserted 12 years previously. It was found in the lower anterior abdominal wall. Most probably uterine perforation had happened during a dilatation and curettage (D & C) attempted for removal of the device. Thereafter the IUD must have migrated to the abdominal wall. This case illustrates that unless it can be recovered by simple traction on the threads, a trained medical professional should be called upon for removal of the IUD.

Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: a randomized, double blind, placebo-controlled trial.

OBJECTIVE To evaluate the effectiveness of sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women. DESIGN Placebo-controlled, double-blind, randomized trial. SETTING University hospital. PATIENT(S) Fifty-two women with an indication for diagnostic hysteroscopy. INTERVENTION(S) Randomized women who had received either 200 mug of misoprostol (n = 25) or placebo (n = 27) sublingually 2 hours before hysteroscopy. Two subgroups (women with or without previous vaginal delivery) were formed. MAIN OUTCOME MEASURE(S) Number of women requiring cervical dilatation, duration of dilatation, ease of dilatation, and complications during procedure. RESULT(S) In the misoprostol group, 14 patients needed cervical dilatation, versus 21 in the placebo group. Duration of dilatation was longer in the placebo group than in the misoprostol group. In subgroup 1, seven patients in the misoprostol group (n = 13) and nine patients in the placebo group (n = 12) needed cervical dilatation. The duration of the dilatation was similar between the groups. In subgroup 2, both the need for cervical dilatation (58.3% vs. 80.0%) and the duration of dilatation (31.0 +/- 18.8 vs. 73.0 +/- 82.0 seconds) were found to be lower in the misoprostol (n = 15) than in the placebo (n = 12) group, respectively. Those differences were all not significant. CONCLUSION(S) Sublingual misoprostol before diagnostic hysteroscopy did not seem to facilitate cervical ripening statistically; however, the results are remarkable and are promising clinically. Further studies are required to reassess the use of sublingual misoprostol in patients before hysteroscopy.

Early oral hydration after cesarean delivery performed under regional anesthesia.

To establish an early, safe, and well‐tolerated time to start oral hydration after cesarean delivery.

Doxycycline causes regression of endometriotic implants: a rat model.

BACKGROUND Doxycycline (Dox) has a number of non-antibiotic properties. One of them is the inhibition of matrix metalloproteinase (MMP) activity. The aim of this study was to assess the effects of Dox in a rat endometriosis model. METHODS Endometriosis was surgically induced in 40 rats by transplanting of endometrial tissue. After 3 weeks, repeat laparotomies were performed to check the implants and the animals were randomized into four groups: Group I, low-dose Dox (5 mg/kg/day); Group II, high-dose Dox (40 mg/kg/day); Group III, leuprolide acetate 1 mg/kg single dose, s.c.; and Group VI (controls), no medication. The treatment, initiated on the day of surgery and continuing for 3 weeks, was administered to the study groups. Three weeks later, the rats were euthanized and the implants were evaluated morphologically and histologically for immunoreactivity of MMP-2 and -9, and interleukin-6 (IL-6) concentration in the peritoneal fluid was assayed. RESULTS Treatment with leuprolide acetate, or high-dose or low-dose Dox caused significant decreases in the implant areas compared with the controls (P = 0.03, P = 0.006, and P = 0.001, respectively). IL-6 levels in peritoneal fluid decreased in Group I (P = 0.02) and Group III (P < 0.05). MMP H scores were significantly lower in the group that received low-dose Dox in both epithelial and stromal MMP-2 and -9 immunostaining when compared with the control group [P = 0.048, P = 0.002, P = 0.007 and P = 0.002, respectively, MMP-2 (epithelia), MMP-2 (stroma), MMP-9 (epithelia) and MMP-9 (stroma)]. CONCLUSIONS Low-dose Dox caused regression of endometriosis in this experimental rat model.

Sublingual misoprostol after surgical management of early termination of pregnancy

OBJECTIVE To assess the efficacy of sublingual misoprostol after surgical management of early termination of pregnancy (ETP) regarding duration and amount of bleeding, presence of retained products of conception (RPOC), and endometrial thickness. DESIGN Prospective, randomized clinical trial. SETTING University hospital. PATIENT(S) One hundred five patients admitted for possible management of early pregnancy failure and unwanted pregnancy. INTERVENTION(S) Manual vacuum aspiration (control and study groups) plus 400 microg sublingual misoprostol (study group) at pregnancy termination, and transvaginal ultrasonography (both groups) 10 days after the procedure. MAIN OUTCOME MEASURE(S) Duration and amount of bleeding and presence of RPOC and endometrial thickness 10 days after the procedure. RESULT(S) Bleeding lasted 3.2 and 5.1 days in the study and control groups. Severe vaginal bleeding occurred in two patients in the study group and in six patients in the control group. Mean endometrial thickness was 5.5 mm in the study group and 6.9 mm in the control group. These differences were statistically significant. No cases of RPOC occurred in the study group; two cases occurred in the control group. CONCLUSION(S) In countries in which surgical management of ETP is still done, using sublingual misoprostol postoperatively may reduce the duration and amount of bleeding.

A mullerian anomaly ‘‘without classification’’: Septate uterus with double cervix and longitudinal vaginal septum

The incidence of congenital uterine anomalies in the general population is estimated to be 0.001e10% [1]. The most commonly seen anomalies are septate and arcuate uteri, which represent 75% of all mullerian anomalies. The majority of mullerian duct anomalies are considered to be sporadic or multifactorial in nature; however, polygenic and genetic patterns of inheritance have been described [2,3]. There are two theories to explain the development of mullerian duct anomalies, the classical unidirectional regression theory, and an alternative bidirectional theory in which it is hypothesized that the process proceeds simultaneously in both the cranial and the caudal directions. Anomalies such as a complete septum with a duplicated cervix or an isolated vertical upper vaginal septum could only be explained by the second theory [4,5]. We report the case of a woman with a complete uterine septum, and a double cervix with a longitudinal vaginal septum, and search the available literature for similar cases. A 28-year-old nulligravida woman was admitted to our hospital due to being unable to conceive. She had been married for 2 years and had never used any contraceptive methods. She had regular menses but had dysmenorrhea and sometimes also dyspareunia. A longitudinal vaginal septum from the midportion of the vagina to the cervix, and the presence of two separate cervixes were identified following a speculum examination. Transvaginal ultrasound showed a normal uterine contour, then hysterosalpingography was performed. When a contrast media was injected into the right cervix, the uterine cavity was filled, however, the fallopian tubes were not. When the contrast media was then injected into the left cervix and uterine cavity, the left fallopian tube and pelvic cavity filled with contrast media, but the right fallopian tube was not filled with contrast media. Following

Extrauterine Displaced Intrauterine Devices: When Should They Be Surgically Removed?

Use of the intrauterine device (IUD) is widely accepted as a contraceptive method throughout the world because of its safety, economy, efficiency, and reversibility. However, IUD use is associated with rare side effects and complications, such as irregular menstrual bleeding, dysmenorrhea, pelvic infections, expulsion of the device, and uterine perforation. Uterine perforation is a rare but serious complication that generally occurs during insertion of the device, but may also occur as a result of migration of the IUD through the uterine wall. Expulsion and dislocation of the IUD may lead to pregnancy; however, pregnancy can still occur even when the IUD remains in utero, and its efficacy has been demonstrated to be about 97% [1]. Displaced IUDs are associated with potential risks to the adjacent organs, such as the bowel or bladder, and might also lead to pelvic infections and abscesses. The management of extrauterine displaced IUDs still remains controversial, and no consensus opinion exists. In this case report, a patient presented with an undesired pregnancy and a displaced IUD, which was located within a pelvic abscess in the Douglas pouch. The management of extrauterine displaced IUDs is also discussed. A 28-year-old woman had an undesired pregnancy with a displaced IUD, which was found within a pelvic abscess in the Douglas pouch. She was referred to our clinic, complaining of pelvic pain, fever, fatigue, nausea, vomiting and missed menstrual period. She had a history of IUD insertion 4 years ago and no history of previous pelvic inflammatory disease or sexually transmitted disease. Her menstrual periods were regular. Her inflammation markers were as follows: C-reactive protein was 50 mg/L, and leukocyte count was 15,000/μL.

Pubertal Failure and Primary Amenorrhea with Uterine Hypotrophy Due to Hypogonadotropic Hypogonadism

BACKGROUND Primary amenorrhea can be a sign of either delayed puberty or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. CASE A virgin 27-year-old woman with pubertal failure, primary amenorrhea, and uterine hypotrophy due to hypogonadotropic hypogonadism sought treatment at our institution. She was diagnosed as having MRKH syndrome 10 years ago at another institution after pelvic ultrasonography revealed no uterus or ovaries. Unfortunately, no further investigations had been made or treatments implemented during the ensuing decade. SUMMARY AND CONCLUSION In female patients in whom the uterus cannot be visualized with ultrasonography, magnetic resonance imaging and/or laparoscopy should be considered to ensure that the diagnosis is correct. Besides further imaging, hormonal assessment and breast development should always be initially considered for the diagnosis of delayed puberty and MRKH syndrome.