Kadir Guzin

The relation of increased uterine artery blood flow resistance and impaired trophoblast invasion in pre-eclamptic pregnancies

Objective: To assess the association between histopathologically confirmed vascular abnormalities developed during pre-eclampsia and abnormal arterial blood flows recorded during Doppler sonographies. Materials and methods: From pregnant women who attended our clinic between 01/03/2002 and 01/07/2002, a detailed medical history was obtained and routine biochemical blood tests, fetal ultrasonography and UA Doppler scans were performed. In addition, from pre-eclamptic and normal pregnant women who underwent cesarean sections, placental bed biopsies were taken. Thirty two pre-eclamptic [12 mild, 20 severe cases according to American College of Obstetricians and Gynecologogists (ACOG) criteria] cases and as a control group 20 normal pregnancies were included in the study. In our study trophoblast invasion into decidual spiral arteries was observed in 75% of mild (9/12), and 55% of severe (11/20) pre-eclampsias. In the control group all the cases demonstrated trophoblast invasion in decidual spiral arteries. Trophoblast invasion in myometrial spiral arteries was noted in 50% (6/12) of mild and 25% (5/20) of severe pre-eclamptic pregnancies. It was seen in 16 cases out of 20 (80%) pregnancies. In the control group, decidual spiral artery invasion manifests significant differences (P<0.01) among groups studied. Invasion in decidual spiral arteries was seen in all normal pregnancies of the control group. There is not any significant difference between mild and severely pre-eclamptic groups (P>0.05). Conclusion: Doppler ultrasonography is not only a non-invasive method for evaluating fetal status in pre-eclamptic pregnancies, but it also correlates with partial trophoblastic invasion in spiral arteries, which contributes to the pathophysiologic mechanisms involved in pre-eclampsia.

Emergency peripartum hysterectomy in a tertiary Istanbul hospital

ObjectiveTo evaluate the incidence, risk factors, indications, outcomes and complications of emergency peripartum hysterectomy performed after cesarean and vaginal deliveries.Method(s)We analyzed retrospectively 28 cases of emergency peripartum hysterectomy operations performed between February 2001 and February 2007 at the Istanbul Goztepe Training and Research Hospital, which is a teaching hospital operating under the Turkish Ministry of Health. The indications, risk factors and the associated complications were compared with control groups. Statistical analysis was performed using the STATA version 7.0 statistical package (Stata Corporation, College Station, TX, USA).Result(s)The overall incidence of emergency peripartum hysterectomy at our hospital is 0,37 in 1,000 deliveries. Abnormal placental adherence and uterine atony comprised 85% of the indications for peripartum hysterectomy. Postoperative maternal morbidity occurred in 15 cases (54%). Most had a febrile morbidity and depression. Seven patients underwent postpartum histerectomy due to consumptive coagulopathy. There was one maternal mortality (4%) and five perinatal mortalities (18%). The maternal death was due to consumptive coagulopathy after placental abruption. All patients had to receive blood transfusions. The median number of postoperative hospitalization days was 7.Conclusion(s)Peripartum hysterectomy is still a dramatic life-saving operation with high risks. The most common reason for abnormal placental adherence is previous uterine procedures.

Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication

Acute pancreatitis is rare cause in pregnancy and gallstones are clearly the most common cause of pancreatitis during pregnancy. Only a small percentage of women with acute pancreatitis are associated with hypertriglyceridemia and it is most often noted during the last two trimesters of pregnancy. Hypertriglyceridemia is a rare cause of pancreatitis in pregnant women and complication such as pancreatitis carries a higher risk of mortality for both the mother and the fetus. Our purpose was to report our experience with acute pancreatitis as a lethal complication of hypertriglyceridemia during the third trimester of pregnancy.

The effect of magnesium sulfate treatment on blood biochemistry and bleeding time in patients with severe preeclampsia

OBJECTIVE The objective of this study was to observe the effects of magnesium sulfate on various blood biochemical parameters and coagulation status of patients with preeclampsia. METHODS During a period of 4 years, 50 patients with severe or mild preeclampsia progressing to severe preeclampsia were included in the cross-sectional study. Prothrombine (PT), activated limited thromboplastin time (aPTT), magnesium level, biochemistry parameters, systolic, and diastolic blood pressure (BP) were measured. These parameters were remeasured in the second hour of magnesium sulfate treatment. RESULTS After magnesium sulfate therapy; creatinine levels are decreased (p < 0.05), bleeding time is increased and serum magnesium levels are increased (p < 0.01), systolic and diastolic BP values decreased significantly (p < 0.01). PT, aPTT, platelet levels, and coagulation time did not change after treatment. CONCLUSION Magnesium sulfate infusion prolonged bleeding time in patients with severe preeclampsia. This is clinically important because it worsens the present condition and causes possible complications.

Heterotopic pregnancy following ovulation induction by clomiphene citrate and timed intercourse: a case report

We report a combined intra-uterine and unruptured tubal pregnancy following ovulation induction by clomiphene citrate (CC) and timed intercourse. The diagnosis of heterotopic pregnancy (HP) is the major problem until occurrence of tubal rupture. Because HP is a life-threatening condition, the diagnosis should be made as soon as possible. In a spontaneous conception, HP is a rare event. The risk of HP significantly increases after ovulation induction. Clomiphene itself could be associated with a high HP rate. We present a case with normally developing intra-uterine singleton pregnancy succesfully managed by salpingectomy of synchronous tubal pregnancy following ovulation induction by CC and a review of the literature.

Expression of matrix metalloproteinase-1 in round ligament and uterosacral ligament tissue from women with pelvic organ prolapse

To evaluate the matrix metalloproteinase-1 (MMP-1) expression in different parts of pelvic connective tissue in postmenopausal women with and without pelvic organ prolapse (POP). Ninety-one samples were obtained from only postmenopausal women (42 with POP and 49 non-POP subjects). All women were evaluated by pelvic organ prolapse quantitation. The POP group had stage 2 or more, and the controls had stage 1 or less. Round ligament (RL) and uterosacral ligament (USL) biopsies were obtained from women with POP and controls. Immunohistochemistry for MMP-1 was performed on formalin-fixed and paraffin-embedded sections. The two groups were matched for age, body mass index, parity and postmenopausal status. MedCalc Statistical Software Programme Version 12.0.5 was used for statistical analysis. Expression of MMP-1 were significantly higher in both RL and USL tissue from postmenopausal women with POP, compared with controls. MMP-1 immunoreactivities were identified in both RL and USL biopsies from all women with and without POP. The expression pattern of MMP-1 were similar in these ligaments and were significantly higher in POP group compared with control subjects. These changes indicate a possible relation between MMP-1 expression of RL and USL in women with and without POP.

Primary clear cell carcinoma of the vagina that is not related to in utero diethylstilbestrol use

Vaginal clear cell adenocarcinoma (VCCA) is most commonly related to in utero diethylstilbestrol (DES) use. Primary VCCA is an extremely rare entity except for this well-known condition. In this paper, a 23-year old, virgin, unmarried woman who was diagnosed with VCCA is presented. The woman had suffered from weakness and fatigue, and there was no history of in utero DES use. Magnetic resonance imaging showed a huge mass (Stage IIA in the FIGO classification) in the vaginal cavity, and a biopsy under general anesthesia revealed that it was a VCCA. Because of the advanced stage, no resection was planned, and the patient was treated with radiation therapy followed by chemotherapy. After a 14-month follow-up, she was doing well.

The management of an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma

We present two case studies: an unusually sited isthmicocervical leiomyoma and a huge prolapsed pedunculated submucous leiomyoma of the uterus. Case 1 was a 25-year-old virginal woman with a diagnosis of cervical leiomyoma with symptoms of anemia and menorrhagia. Magnetic resonance imaging revealed a mass impinging on the bladder and rectum. Myomectomy was the selected operation because of the patient’s age and her desire to preserve fertility, even though the tumor’s size and location increased the risk of operative blood loss and would make the surgical procedure difficult to perform. The pathological specimen was benign. Case 2 was a 43-year-old patient with a chief complaint of difficulty in voiding plus severe vaginal bleeding. The gynecological examination revealed a necrotic mass that filled the vagina completely and stretched its walls. The sonographic findings were consistent with a pedunculated submucous leiomyoma. Total abdominal hysterectomy and bilateral salpingoophorectomy were performed. The histopathological evaluation was benign leiomyoma of the uterus. Cervical and pedunculated submucous leiomyomas are uncommon and represent a technicosurgical difficulty due to location and huge size. However, in order to regress the complications and improve the patient’s quality of life regarding desire to preserve fertility, conservative surgical regimens should be chosen.

Induction of Labor with Dinoprostone Vaginal Insert; Is it Safe and Effective in Term Pregnancy with Premature Rupture of Membranes?

ABS TRACT Objective: Our aim in this study is to compare the efficacy and safety of controlledrelease dinoprostone vaginal insert in patients with intact membranes and premature rupture of membranes (PROM). Material and Methods: Eighty-six term pregnants with singleton pregnancy, with no prior uterine scar, vertex presentation, bishop score ≤ 5, were included in the study. Patients were divided into two groups as PROM patients (n:27) and patients with intact membranes (n:59). Labor induction with controlled-release dinoprostone vaginal insert was performed to all cases. The groups were compared with each other in terms of cervical ripening, success of the induction, adverse neonatal outcomes and presence of maternal side effects. Results: In the PROM group and the intact membrane group, the cervical ripening was completed at 4th hours and at 6 th hours, respectively (p=0.01 and p=0.001). The mean time to onset of active labor was 6,63 hours in the PROM group and 7,81 hours in the intact membranes group (p=0.1). There was no significant difference in low 1. and 5. minute Apgar scores, low umbilical artery pH, administration to neonatal intensive care unit, and operative vaginal delivery between the two groups. Maternal vomiting, diarrhea, uterine tachysystole were not observed and there was no case of maternal or neonatal death. Conclusion: These data overall suggest that controlled-release dinoprostone insert use is effective and safe in patients with PROM just like in patients with intact membranes.

The diagnostic value of frozen section for borderline ovarian tumours

Borderline ovarian tumours (BOTs) are characterised histologically by a low degree of cellular proliferation and nuclear atypia in the absence of infiltrative growth or stromal invasion. Surgical treatment has been a crucial component of BOT therapy. Surgical decisions are established intraoperatively via the frozen section. We evaluated the accuracy of frozen section diagnosis. The rate of correct diagnosis, underdiagnosis and overdiagnosis of BOTs with frozen sections was 78%, 17% and 5%, respectively. The sensitivity and positive predictive values for the diagnosis of BOTs with frozen sections were 82.3% and 93.3%, respectively. The positive likelihood ratio was 0.82 (95% CI: 0.85–0.96). The histological classification of BOTs had a significant effect on the accuracy of diagnosis (p = 0.001). Frozen section diagnosis is not suitable to be considered as the gold standard for a definitive diagnosis. Clinicians should be aware that using frozen sections is insufficient for the accurate staging of BOTs.