Esra Esim Büyükbayrak

Diagnostic power of the vaginal washing-fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes

Objective: The purpose of this study was to determine the reliability of the vaginal washing-fluid prolactin assay for the diagnosis of premature rupture of membranes (PROM) and to determine a diagnostic cut-off value.Study design: Seventy pregnant women between 11 and 40 weeks of gestation who were admitted with vaginal fluid leakage were included in the study group, and were then further subdivided into two subgroups according to amniotic fluid pooling and nitrazine paper test results. Group 1 was the ‘confirmed PROM group’, positive for both pooling and nitrazine (38 patients). Group 2 was the ‘suspected but unconfirmed PROM group’ which had possible pooling and/or nitrazine (32 patients). Seventy pregnant women between 11 and 40 weeks of gestation without any complaint and complication were included in the control group (group 3). All patients underwent vaginal washing-fluid sampling and prolactin level determination. For the statistical analysis one-way analysis of variance, Tukey multiple comparison test, χ2test and receiver operating characteristic (ROC) curve analysis were used.Results: Geometric mean values of vaginal washing-fluid prolactin levels were 616.59 µIU/ml for group 1, 23.98 µIU/ml for group 2 and 10 µIU/ml for group 3 (p<0.0001). The optimal diagnostic cut-off value was found to be 30 µIU/ml with 95% sensitivity, 78% specificity, 84% positive predictive value, 93% negative predictive value, 87% accuracy and 11.30 relative risk.Conclusions: We recommend vaginal washing-fluid prolactin level determination as an alternative diagnostic method for PROM.

Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis

ObjectiveThe purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present.MethodPremenopausal women applying to our gynecology outpatient clinic with vaginal discharge complaint were enrolled prospectively into the study. Each patient evaluated clinically with direct observation of vaginal secretions, wet mount examination, whiff test, vaginal pH testing and chlamydia rapid antigen test. Each patient also evaluated microbiologically with vaginal discharge culture and gram staining. Clinical diagnosis was compared with the microbiological diagnosis (the gold standard). Diagnostic accuracy was measured with sensitivity, specificity, positive (ppv) and negative predictive values (npv).Results460 patients were included in the study. 89.8% of patients received a clinical diagnosis whereas only 36% of them had microbiological diagnosis. The sensitivity, specificity, ppv, npv of clinical diagnosis over microbiological culture results were 95, 13, 38, 82%, respectively. The most commonly encountered microorganisms by culture were Candida species (17.4%) and Gardnerella vaginalis (10.2%). Clinically, the most commonly made diagnoses were mixed infection (34.1%), bacterial vaginosis (32.4%) and fungal infection (14.1%). Symptoms did not predict laboratory results. Predisposing factors (DM, vaginal douching practice, presence of IUD and usage of oral contraceptive pills) were not found to be statistically important influencing factors for vaginal infections.ConclusionClinical diagnosis based on combining symptoms with office-based testing improves diagnostic accuracy but is insufficient. The most effective approach also incorporates laboratory testing as an adjunct when a diagnosis is in question or treatment is failing.

Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage

PurposeTo determine the diagnostic accuracy of different diagnostic methods (blind dilatation & curettage (D&C), transvaginal ultrasonography (TVS), sonohysterography (SH), and hysteroscopy) compared with gold standard (hysteroscopic biopsy’s histopathologic result) in diagnosis of focal intrauterine lesions of recurrent postmenopausal bleeding.Methods36 postmenopausal women with recurrent vaginal bleeding after a normal D&C results were enrolled into the study. TVS, SH, hysteroscopy were performed on all patients. Outcomes of blind D&C, TVS, SH, and hysteroscopy were compared with results of gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated.ResultsBlind D&C sensitivity, specificity, PPV, and NPV were 47, 68, 57, 59%, respectively in comparison with gold standard. Blind D&C fails to diagnose 70% of all focal intracavitary lesions. TVS sensitivity, specificity, PPV, NPV were 63, 78, 89, 41%, respectively. SH yielded better results; with 93% sensitivity, 56% specificity, 86% PPV, and 71% NPV. Hysteroscopy sensitivity, specificity, PPV, and NPV were 100, 44, 84, 100%, respectively.ConclusionsIn experienced hands, SH can be an initial evaluation method of uterine cavity for detecting focal lesions in women with recurrent postmenopausal bleeding.

The effectiveness of bilateral hypogastric artery ligation for obstetric hemorrhage in three different underlying conditions and its impact on future fertility

Objective. To evaluate the effectiveness of bilateral hypogastric artery ligation (BHAL) according to the underlying cause and future fertility in these women. Method. Fifty-eight women who underwent BHAL operation in our department between 1997 and 2008 were further divided into three subgroups in accordance with the underlying disease. Group 1: Severe preeclampsia with coagulapathy (n:24). Group 2: Postpartum hemorrhage (PPH) due to uterine atony (n:24). Group 3: Massive hemorrhage due to inadequate surgical control of bleeding and/or uterine rupture (n:10). Effectiveness of BHAL according to the underlying cause and future fertility after BHAL were evaluated. Results. Success rate of BHAL was found to be 87.9% (51 out of 58 patients). Complication rates of the groups were 25%, 12.5%, and 10%, respectively. There was one maternal death in each group. Mean hospital stay, blood and blood products transfusion need were similar for all groups. Thirty women out of 58 had desired future fertility, and 17/30 (56.7%) of them became pregnant within less than 1 year. Conclusion. BHAL is a safe, effective, life-saving procedure in controlling massive PPH. It preserves future fertility and must be the first choice operation for PPH in young women whichever the underlying condition is.

Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case.

Essential thrombocythaemia (ET) is a disease characterized by an increased platelet count, megakaryocytic hyperplasia and a hemorrhagic or thrombotic tendency. Pregnancy in patients with ET can have a favorable outcome. However, ET has also been reported to complicate pregnancy by recurrent abortions, intrauterine death, and fetal growth retardation due to placental infarctions. ET has an unusual prevalence of intraabdominal (hepatic, portal and mesenteric) vein thrombosis, especially in young patients, which can lead to portal hypertension. There are ample cases in the literature of both essential thrombocytosis complicating pregnancy and portal hypertension complicating pregnancy, but the coincidence of both conditions appears to be unique. In this case report, we report a successful pregnancy in a patient with a prior diagnosis of essential thrombocytosis with remote secondary portal vein thrombosis and portal hypertension (PH).

Comparison of success rates of ‘transvaginal aspiration and tetracycline sclerotherapy’ versus ‘only aspiration’ in the management of non-neoplastic ovarian cysts

Aim:  To investigate the value of tetracycline sclerotherapy for management of recurrent or persisting non‐neoplastic ovarian cysts in comparison to the aspiration without sclerotherapy.

Raloxifene: is it really effective on mood changes in postmenopausal osteopenic women?

Objective. To investigate the effect of raloxifene therapy on menopausal symptoms, depression and anxiety scores using Kuppermans Scale, Hamilton Depression Rating Scale (HDRS) and Beck Anxiety Rating Scale (BARS) in osteopenic postmenopausal women. Methods. This was a prospective, randomised, parallel and open labeled clinical study. One-hundred thirty-two postmenopausal osteopenic women with natural menopause enrolled into the study. One-hundred twenty-four of them completed the study. Group I patients were treated with oral raloxifene (60 mg/day), Group II patients were treated with oral calcium supplementation (1000 mg/day) for 3 months. The patients menopausal, depressive and anxiety symptoms were assessed by using Kuppermans Scale, HDRS and BARS, before and at the end of treatment. For statistical analysis unpaired t, ANOVA, RM-ANOVA, MANCOVA, Pearson correlation tests were used. Statistical significance level was established at p < 0.05. Results. Baseline Kuppermans Scale, HDRS and BARS scores were not different among two groups. At the end of 3 months of therapy, there was improvement in menopausal symptoms, depression and anxiety scores within both groups. When we compared change of scores before and after the treatment; group I scores were better than group II scores. Conclusion. Our results suggest that raloxifene may have a positive effect on mood in osteopenic postmenopausal women.

Comparing the effects of intrauterine progestin system and oral progestin on health‐related quality of life and Kupperman index in hormone replacement therapy

Aim:  The aim of this study was to compare the effects of intrauterine‐system‐releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta‐estradiol daily, orally with combined oral pill containing 1 mg 17 beta‐estradiol/2 mg drospirenone daily as hormone replacement therapy, on health‐related quality of life (HRQoL) and climacteric symptoms in postmenopausal women.

Vaginal versus sublingual misoprostol for second-trimester pregnancy termination and effect on Doppler measurements

To compare the efficacy of vaginal versus sublingual misoprostol for second‐trimester pregnancy termination, and to evaluate the effect on the blood flow of the uterine and umbilical arteries.

Successful management of uterine prolapse during pregnancy with vaginal pessary: a case report.

UNLABELLED We present a case of uterine prolapse complicating a second trimester pregnancy which was managed successfully with a vaginal pessary. CASE A 19 year-old primigravid woman referred to the obstetric emergency unit at the 16th week of gestation complaining of uterine prolapse. A silicone ring-shaped middle-size vaginal pessary was placed into the vagina. On each control visit, when the vaginal pessary was removed, the uterine prolapse still persisted until birth. The patient gave birth at 38(th) week by spontaneous vaginal delivery to a healthy baby. After birth, with uterine contractions, uterine prolapse regressed progressively. CONCLUSION The management and treatment of uterine prolapse in pregnancy should be individualized depending on the patients preference. A vaginal pessary may be helpful to avoid complications of this condition and should be considered during patient counseling.