Ilker Arikan

Endometrioma ^ 3 cm in Diameter per se Does Not Affect Ovarian Reserve in Intracytoplasmic Sperm Injection Cycles

Background: Our aim was to determine the effect of single endometriomas ≤3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles. Methods: We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas ≤3 cm in diameter and who underwent ICSI. Results: The mean age of the patients was 33.3 ± 4.9 years. The mean diameter of endometriomas was 21.8 ± 4.9 mm. Left- and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 ± 4.3 vs. 5.4 ± 3.8). Conclusion: Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles.

Effect of Progesterone as a Tocolytic and in Maintenance Therapy during Preterm Labor

Aims: To assess the efficacy of vaginal micronized natural progesterone as a tocolytic and in maintenance therapy during threatened preterm birth. Methods: Eighty-three women with symptoms of threatened preterm birth were either randomized to study groups receiving tocolytic treatment combined with intravaginal micronized natural progesterone (200 mg daily) or to a control group receiving only tocolysis. Results: Micronized natural progesterone treatment resulted in a prolonged latency period of 32.1 ± 17.8 versus 21.2 ± 16.3 days in the control group and heavier birth weights of 2,982.8 ± 697.8 g versus 2,585.3 ± 746.6 g. No significant differences were found between the groups in admission to the neonatal intensive care unit, stay at the neonatal intensive care unit, need for a mechanical ventilator, respiratory distress syndrome or neonatal sepsis. Conclusion: The treatment of threatened preterm birth with tocolytics combined with intravaginal micronized natural progesterone significantly prolonged pregnancy and increased birth weight. However, an improvement in adverse perinatal outcomes was not observed.

Turkish obstetricians’ personal preference for mode of delivery and attitude toward cesarean delivery on maternal request

Objective(s)(1) To investigate the cesarean rate among actively practicing obstetricians in Turkey and reasons why they choose this mode of delivery for themselves/partners. (2) To investigate the attitudes, practices, and beliefs with respect to cesarean delivery on maternal request (CDMR) among actively practicing obstetricians in Turkey.Study designThis is a descriptive study performed at 7th Congress Of Turkish Society Of Gynecology and Obstetrics. A self-administered questionnaire was used for data collection. During the congress, from the obstetricians attending the congress, 500 were randomly selected; due to the room numbers, the questionnaires (total, 500) and the consent forms were distributed every fourth room. The sampled obstetricians were instructed to return the completed questionnaires and signed consent forms to the congress information desk located throughout the congress. In total, 387 (77.4%) obstetricians responded.ResultsOf the respondents (if female) or their partners (if male), 239 (61.8%) respondents had undergone at least one previous cesarean section (CS), and, of these, 212 (88.7%) were primary elective cesarean deliveries. The most common reason influencing the decision of obstetricians in choosing CS for themselves/partners was reduced anorectal trauma (63.6%). In addition, 158 (40.8%) of the respondents believe that every woman has the right to request a cesarean as a mode of delivery. About half of the respondents (53.2%) said that they would perform a patient-requested CS. The most common reason why obstetricians perform CS due to maternal request was ‘anxiety of patient and her partner and due to their insistence’.ConclusionsTwo-thirds of Turkish obstetricians prefer CS as mode of delivery for themselves/partners. Also half of the obstetricians in our study believe that a woman has the right to request and obtain CDMR, and half of them would agree to perform one.

Oxidative stress and apoptosis in preeclampsia

We aimed to determine the oxidative stress and antioxidant status in preeclamptic placenta. Also, we investigated the apoptotic index of villous trophoblast and proliferation index of cytotrophoblasts. The study included 32 pregnant with preeclampsia and 31 normotensive healthy pregnant women. Malondialdehyde (MDA) and total antioxidant status (TAS) levels were measured in the placenta. For detection of apoptosis and proliferation in trophoblast, apoptosis protease activating factor 1 (APAF-1) and Ki-67 were used. Placental MDA levels in preeclamptic women were significantly higher than normal pregnancies (p=0.002). There was no significant difference between the groups in the TAS levels of placenta (p=0.773). Also, the apoptotic index in villous trophoblasts increased (p<0.001), but proliferation index did not change in preeclampsia (p=0.850). Increased oxidative stress and apoptosis in pathological placenta are not balanced by antioxidant systems and proliferation mechanisms.

Comparison of the histopathological diagnoses of preoperative dilatation and curettage and hysterectomy specimens

Aim:  A biopsy is often taken as part of the preoperative workup, regardless of the indication for hysterectomy. Some authors believe that dilatation and curettage is a poor diagnostic procedure for intrauterine pathologies, but dilatation and curettage has been the method of choice for obtaining an endometrial sample. The aim of this study was to investigate the concordance between endometrial histopathological diagnoses from preoperative dilatation and curettage and hysterectomy specimens. The differences between premenopausal and postmenopausal women were also investigated.

Placental Chorangiosis: The Association with Oxidative Stress and Angiogenesis

Background/Aims: Chorangiosis is considered to be strongly associated with fetal, maternal, and placental disorders, and has been found to be correlated with increased fetal morbidity and mortality. In this study, it is aimed to investigate the association of angiogenesis and oxidative stress with the pathogenesis of chorangiosis. Methods: Expressions of heat shock protein 70 (HSP70), vascular endothelial growth factor-A (VEGF-A) and basic fibroblast growth factor (b-FGF), which are investigated with avidin-biotin-peroxidase method in formalin-fixed, paraffin-embedded sections from placental tissues diagnosed as no chorangiosis (n = 18) and chorangiosis (n = 18), have been evaluated in a semiquantitative manner. Results: There were significant differences between chorangiosis and no chorangiosis cases with respect to birth weight, birth length, and Apgar scores (p < 0.001). Statistically significant (p < 0.001), diffuse and strong expressions with HSP70, VEGF-A and b-FGF were observed in the villous tissue of placental chorangiosis cases when compared with no chorangiosis cases. Conclusion: The majority of the chorangiosis cases had an accompanying poor perinatal outcome, and also those with accompanying angiogenesis and increased oxidative stress demonstrated diffuse and strong expressions of HSP70, VEGF-A and b-FGF. The interaction of maternal, placental, and fetal factors with increased oxidative stress and angiogenesis may possibly contribute to this arising pathologic change.

Herlyn-Werner-Wunderlich syndrome (uterus didelphys, blind hemivagina and ipsilateral renal agenesis) - a case report.

Uterovaginal duplication with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn-Werner-Wunderlich (HWW) syndrome. A 17 year old woman presented with right pelvic pain and dysmenorrhea, present since menarche at 13 and worsening over the past year. Ultrasound examination revealed a right pelvic mass (5×5 cm), double endometrial echoes, and hematocolpos. A right pelvic mass, agenesis of the right kidney, double uterus, and blind hemivagina with hematocolpos were detected by magnetic resonance imaging and intravenous pyelography. A right tubo-ovarian abscess with dense adhesions and a double uterus were observed on diagnostic laparoscopy. Adhesiolysis was carried out and purulent material irrigated. After a course of antibiotics, a vaginal septum resection was performed and the pyocolpos drained. She remained symptom free after four months of follow-up. Prompt and accurate diagnosis and treatment of this syndrome can significantly improve the lives of sufferers and prevent future complications.

Endothelial nitric oxide synthase expression in gestational trophoblastic diseases.

Objective: Nitric oxide is thought to play a role in the regulation of trophoblast activity. The aim of this study was to compare endothelial nitric oxide synthase expression in tissue samples taken from gestational trophoblastic diseases and placentas of normal pregnancies. Methods: The expression of endothelial nitric oxide synthase was tested in formalin-fixed, paraffin-embedded tissues from specimens including 8 first trimester placentas, 3 partial hydatidiform moles, 20 complete hydatidiform moles, 2 invasive moles, and 5 choriocarcinomas. The expression of antibody was scored by a semiquantitative scale to define staining intensity. Results: The first trimester placentas showed moderate expression in the villous. Gestational trophoblastic diseases displayed strong to very strong endothelial nitric oxide synthase expression in the syncytiotrophoblast, villous, and proliferating mononuclear trophoblasts. Conclusions: Endothelial nitric oxide synthase expression seems to have a strong correlation with proliferation of trophoblastic cells, in gestational trophoblastic diseases and in normal pregnancy.

Prenatally diagnosed partial trisomy 3q case with an omphalocele and less severe phenotype.

Trisomy 3q is a very rarely reported chromosomal disorder. Duplication of part of the long arm of human chromosome 3 causes a distinct and severe syndrome that leads to multiple congenital abnormalities. A 27 year-old pregnant woman was admitted to our clinic at 17 weeks of gestation. Prenatal sonography identified a fetus with an omphalocele that contained the liver and bowel, mild ventriculomegaly and polyhydramnios. Amniocentesis revealed the karyotype of 46, XY, der (3) (3qter→3q21: : 3pter→3qter). The pregnancy was subsequently terminated. Postnatally, the proband showed midfacial hypoplasia, micrognathia, hypoplastic 12th ribs, omphalocele and prominent heels. We reported this partial trisomy 3q case because he had less marked malformations compared to other reported cases and also different features such as an omphalocele and hypoplastic 12th rib which have not been described previously in an isolated Trisomy 3q case with this karyotype.

Idiopathic ileoileal invagination two days after cesarean section

Postoperative enteroenteric invagination is rare. The only previously reported case post‐cesarean was secondary to colonic adenocarcinoma. A 27‐year‐old woman with preeclampsia delivered a baby by cesarean section. On the second postoperative day, she had abdominal pain, nausea, vomiting, constipation, and distention. An abdominal x‐ray showed air‐fluid levels, while free fluid (ascites) was detected by ultrasonography. A computed tomography scan did not show the typical invagination picture. Her condition did not improve after 72 h of conservative treatment, and diagnostic laparotomy was performed. A 10 × 3‐cm ileoileal invagination 80 cm proximal to the ileocecal valve was found and manually reduced. The patient was discharged on the fifth postoperative day, and her six‐month follow‐up was normal.