M. Mutlu Meydanli

Effect of postpartum counseling on postpartum contraceptive use

ObjectiveThe aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use.MethodsOne hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked.ResultsJust after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods.ConclusionIn spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.

Labor induction post-term with 25 micrograms vs. 50 micrograms of intravaginal misoprostol.

Objectives: To compare the effectiveness of 25 μg vs. 50 μg of intravaginal misoprostol for cervical ripening and labor induction beyond 41 weeks’ gestation. Methods: The study population consisted of 120 women not in active labor with a gestational age >41 weeks, singleton pregnancy with vertex presentation, reactive fetal heart rate tracing, amniotic fluid index ≥5, and Bishop score <5. Women were randomized to receive either 25 μg (n=60) or 50 μg (n=60) of intravaginal misoprostol. The dose was repeated every 4 h (maximum number of doses limited to six) until the patient exhibited three contractions in 10 min. The main outcome measure was the induction–vaginal delivery interval. Results: There was no significant difference between the two groups with regard to the induction–vaginal delivery interval (685±201 min in the 25 μg group vs. 627±177 min in the 50 μg group, P=0.09). The proportion of women delivering vaginally with one dose of vaginal misoprostol was significantly greater in the 50 μg group (0/49 vs. 41/47, P<0.001). There were no differences in the rates of cesarean and operative vaginal delivery rates, or in the incidences of tachysystole and hyperstimulation syndrome in the two treatment groups. Neonatal outcomes were also similar. Conclusions: Intravaginal administration of 25 μg of misoprostol appears to be as effective as 50 μg for cervical ripening and labor induction beyond 41 weeks’ gestation.

Pelvic Organ Prolapse Complicating Third Trimester Pregnancy

The concomitant phenomenon of a third trimester pregnancy with a significant degree of pelvic organ prolapse is extremely rare. We report on a patient with pelvic organ prolapse complicating third trimester pregnancy treated by concomitant cesarean hysterectomy and abdominal sacrocolpopexy. A 30-year-old woman, gravida 6, parity 5, was admitted to the hospital with uterine contractions in week 35 of gestation. Pelvic examination in the dorsal lithotomy position revealed a stage 3 pelvic organ prolapse. A cesarean hysterectomy was performed. After hysterectomy, the vaginal cuff was suspended to the periosteum overlying the sacral promontory. Cesarean hysterectomy might be a therapeutic option for women who have completed their families and are suffering from severe pelvic organ prolapse complicating third trimester pregnancy, particularly in developing countries where access to health care is limited.

Metabolic Changes in Pelvic Lesions: Findings at Proton MR Spectroscopic Imaging

Objective: The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. Materials and Methods: 17patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. Results: Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. Conclusion: MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.

Is frozen-section diagnosis a reliable guide in surgical treatment of stage I endometrial carcinoma?

Frozen-section diagnoses and paraffin-section diagnoses were compared in 154 patients in stage I endometrial adenocarcinoma. In 134 (87%) of the 154 patients (p < 0.001), a corresponding depth of myometrial invasion was found, and in 132 (85.7%) patients the same tumor grade was established (p < 0.001). Frozen-section diagnosis of stage I endometrial adenocarcinoma is reliable for estimation of the extent of disease and accurately identifies patients who require surgical staging.

Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis.

Small cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.

Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses.

Summary The aim of this study was to evaluate the pathological features and pregnancy outcomes of pregnancy-associated adnexal masses, between 2001 and 2007. During this period, 0.3% of deliveries (35) were associated with adnexal masses. Torsion or rupture of the adnexal mass complicated pregnancy in 17.1% (6/35) of the cases. The most common histopathological diagnosis was dermoid cyst in 40% of cases (14/35), and 8.5% of cases (3/35) were malignant, including borderline ovarian lesion. None of the patients had an adverse pregnancy outcome due to emergency laparotomy. Pregnancy-associated persistent adnexal masses with large size, complex or solid appearance and bilateral location can be managed surgically, which can decrease the risk of complications, such as torsion or rupture and which can diagnose malignancies early.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome

Aim. Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). Methods. The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver–operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk. Results. There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%. Conclusion. As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.

Risk factors for meconium aspiration syndrome in infants born through thick meconium

Objective: To determine risk factors for meconium aspiration syndrome (MAS). Method: A cohort study was conducted of 70 consecutive singleton pregnancies complicated with thick meconium‐stained amniotic fluid delivered at ≥37 weeks’ gestation. Cases were randomized either for elective abdominal delivery or spontaneous vaginal delivery after 20 min of external fetal heart rate (FHR) monitoring. Risk estimation analysis for MAS was performed calculating relative risks (RR) and odds ratios (OR). Results: The presence of meconium below the vocal cords (RR=7.3, 95% CI=2.6–20.3), non‐reassuring FHR tracings (RR=3.0, 95% CI=1.2–7.5), Apgar score ≤6 at 5 min (RR=3.8, 95% CI=1.7–8.4) and an umbilical cord plasma erythropoietin (UCPer) level >50 mlU/ml (RR=5.0, 95% CI=2.1–12.0) were found to be significant risk factors for MAS. The presence of meconium below the vocal cords (OR=33.4, 95% CI=3.6–303.7) and non‐reassuring FHR tracings (OR=12.2, 95% CI=1.3–111.7) remained as significant risk factors at the end of the multivariate analysis. Conclusion: Non‐reassuring FHR tracings and the presence of meconium below vocal cords are associated with an increased risk for MAS in infants born through thick meconium.

Serum Amyloid A Levels Are Increased in Pre-Eclampsia

Aim: The purpose of this study was to examine serum amyloid A (SAA) levels in normal pregnant and pre-eclamptic women. Methods: SAA levels were measured in 25 normotensive and 25 pre-eclamptic pregnant women by enzyme linked immuno-sorbent assay. Results: In pre-eclampsia, SAA level and C-reactive protein (CRP) averaged 28.2 (7.2–135) ng/l and 21 (6.13–91) mg/l, respectively, which were significantly higher than those of normal pregnancy (7.8 [4.65–24.6] ng/l and 6.05 [0.3–19] mg/l, respectively) (p < 0.05). In addition, SAA level was positively correlated to CRP (r = 0.468, p < 0.05). Conclusion: Marked increases of both SAA level and CRP in pre-eclampsia, and their inter-relation, may at least in part contribute to the pathogenesis of pre-eclampsia.