Korhan Kahraman

Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle

OBJECTIVE To compare the efficacy of microdose GnRH agonist (GnRH-a) flare-up and multiple dose GnRH antagonist protocols in patients who have a poor response to a long luteal GnRH-a protocol. DESIGN Prospective, randomized, clinical study. SETTING University hospital. PATIENT(S) Forty-two poor responder patients undergoing intracytoplasmic sperm injection (ICSI)-embryo transfer cycle. INTERVENTION(S) Twenty-one patients received microdose leuprolide acetate (LA) (50 microg twice daily) starting on the second day of withdrawal bleeding. The other 21 patients received 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter. MAIN OUTCOME MEASURE(S) Serum E(2) levels, number of growing follicles and mature oocytes, embryo quality, dose of gonadotropin used, cancellation, fertilization, implantation rate and pregnancy rate (PR). RESULT(S) The mean serum E(2) concentration on the day of hCG administration was significantly higher in the microdose GnRH-a group than in the GnRH antagonist group (1,904 vs. 1,362 pg/mL). The clinical PRs per started cycle of microdose GnRH-a and GnRH antagonist groups were 14.2% and 9.5%, respectively. There were no statistically significant differences in the other ovulation induction characteristics, fertilization and implantation rates. CONCLUSION(S) Microdose GnRH-a flare-up protocol and multiple dose GnRH antagonist protocol seem to have similar efficacy in improving treatment outcomes of poor responder patients.

The role of low-molecular-weight heparin in recurrent implantation failure: a prospective, quasi-randomized, controlled study.

Low-molecular-weight heparin did not provide any beneficial effect on pregnancy outcomes in patients with two or more implantation failures. Further trials are needed to confirm a trend in favor of low-molecular-weight heparin in the subgroup with women with three or more implantation failures.

Hysteroscopic management of vaginal septum in a virginal patient with uterus didelphys and obstructed hemivagina

OBJECTIVE To report the hysteroscopic management, preserving hymen integrity, of a vaginal septum in a virginal patient with uterus didelphys and obstructed hemivagina as a short and safe alternative to the conventional method. DESIGN Case report. SETTING University hospital. PATIENT(S) A 13 year-old girl with uterus didelphys and obstructed hemivagina. INTERVENTION(S) Hysteroscopic septum resection. MAIN OUTCOME MEASURE(S) Hysteroscopic resection, preserving hymen integrity, of a vaginal septum in uterus didelphys and obstructed hemivagina in an adolescent patient. RESULT(S) The vaginal septum was resected safely in the patient, and hymen integrity was preserved. The cyclic dysmenorrhea and hematometra disappeared, and the patient was free of dysmenorrhea after 1 year of follow-up. CONCLUSION(S) Hysteroscopy, preserving hymen integrity, provides excellent visualization in adolescents and is an easy, quick, convenient, and effective tool in the management of obstructed hemivagina.

Uterine rupture at the 29th week of subsequent pregnancy after hysteroscopic resection of uterine septum

OBJECTIVE To describe a patient with uterine rupture in the subsequent pregnancy after hysteroscopic resection of a uterine septum. DESIGN Case report. SETTING University hospital. PATIENT(S) A 30-year-old nulliparous woman, with a history of a first trimester spontaneous abortion, hysteroscopic uterine septum resection by cutting diathermy using the operating hysteroscope, and a second hysteroscopic procedure for a residual septum, was admitted to our clinic with symptoms of hemodynamic shock at the 29th week of gestation. INTERVENTION(S) Immediate laparotomy was performed. MAIN OUTCOME MEASURE(S) Uterine rupture in the second trimester of the subsequent pregnancy with fetal loss. RESULT(S) Midfundal complete uterine rupture was observed at the site of the resected uterine septum, accompanied by an extrauterine exanimate fetus. CONCLUSION(S) Uterine rupture may occur in pregnancies after hysteroscopic resection of the uterine septum. Clinicians who perform this procedure, especially in the cases with repeated procedures using cutting diathermy, must warn and inform their patients about the risks of their later pregnancies.

Perinatal outcomes of idiopathic polyhydramnios

OBJECTIVE To investigate the perinatal outcomes of cases with idiopathic polyhydramnios. STUDY DESIGN Retrospective analysis of 160 singleton pregnancies that were under routine surveillance at the department of obstetrics from 2008 to 2010 was performed to assess perinatal outcomes. Finally, 59 cases were included as idiopathic polyhydramnios, and 101 cases were included as controls. Preterm delivery (<37 weeks), gestational age at birth, low birth weight (<2500 g), very low birth weight (<1500 g), macrosomia (>4000 g), 1- and 5-min APGAR scores <7, small for gestational age (SGA) fetuses, large for gestational age (LGA) fetuses, C-section rates, number of fetal distress, admission to neonatal intensive care unit (NICU) after delivery, neonatal death within the first 7 days, and deaths before the age of 1 year were selected as perinatal outcome variables. RESULT Significantly higher preterm labors and low 1- and 5-min APGAR scores were noted in the idiopathic polyhydramnios group compared with the control group. CONCLUSION Although perinatal outcomes are conflicting in literature, idiopathic polyhydramnios warrants close surveillance especially near term.

Cervical varix complicating marginal placenta previa: A unique coexistence

Uterine cervical varix (CV) is a very rare condition during pregnancy and may cause moderate to severe hemorrhage. We present the third reported case of huge CV coexisting with placenta previa in the English literature. A 40‐year‐old chronic hypertensive patient with marginal placenta previa also had cervical varix causing hemorrhage. At the 38th gestational week emergent cesarean section was performed because of placental abruption. Placenta previa is a risk factor for CV and patients with placenta previa who have moderate bleeding should be examined for this coexistence. The choice of management is close follow‐up and cesarean section close to term.

Follicular fluid concentrations of IGF-I, IGF-II, IGFBP-3, VEGF, AMH, and inhibin-B in women undergoing controlled ovarian hyperstimulation using GnRH agonist or GnRH antagonist

OBJECTIVE To compare follicular fluid concentrations of IGF-I, IGF-II, IGFBP-3, inhibin-B, VEGF, and AMH in women undergoing controlled ovarian hyperstimulation with a long-luteal GnRH agonist protocol or multiple-dose GnRH antagonist protocol. STUDY DESIGN A total of 80 cycles were included; long-luteal GnRH agonist group (n=40) and multiple dose GnRH antagonist group (n=40). All follicular fluid samples were obtained from mature follicles during oocyte retrieval. IGF-I and IGFBP-3 concentrations were measured by immunoradiometric assay. IGF-II, VEGF, AMH, and inhibin-B concentrations were measured by enzyme-linked immunosorbent assay. RESULTS There were no significant differences in the concentrations of the studied follicular fluid markers, cycle parameters, and treatment outcomes between GnRH agonist and GnRH antagonist protocols. CONCLUSIONS The long-luteal GnRH agonist protocol and multiple-dose GnRH antagonist protocol seem to have similar effects on the follicular microenvironment in women undergoing controlled ovarian hyperstimulation.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma

Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1–2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63‐year‐old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.

Acardiac acephalic twin gestation with transposition of great arteries in pump twin.

ABSTRACT  We report here a case of twin reversed arterial perfusion sequence with transposition of great arteries in the pump twin. Color Doppler and fetal echocardiographic examination revealed an acardiac, anencephalic twin without upper limbs and a pump twin with transposition of great arteries. To our knowledge despite multiple anomalies reported in the acardiac twin, major anomalies, especially of a cardiac type are extremely rare and not reported in the pump twin, which maintains circulation. Management is directed at saving the pump fetus; therefore, we believe that during sonographic exam, emphasis should be placed on associated organ anomalies or complications that may hamper viability of the pump.

Hysteroscopic resection of uterine submucous leiomyoma protruding through hymen in a 16-year-old adolescent.

BACKGROUND Uterine leiomyomas are rarely seen in adolescent and to date nine leiomyoma cases have been reported under age 17. Eight of these have been treated surgically via laparotomic myomectomy. CASE A 16-year-old girl presented with a painless, lobulated necrotic mass protruding through the introitus. The mass originated from posterior uterine wall resected using hysteroscopy. Final pathology report revealed a submucous uterine leiomyoma. SUMMARY AND CONCLUSION Submucous uterine leiomyomas may present as a vaginal mass in adolescents and can be safely treated using hysteroscopy.