Meryem Eken

OHVIRA syndrome presenting with acute abdomen: a case report and review of the literature☆

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) or Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital anomaly. A 13-year-old female presented with acute abdominal pain and dysmenorrhea. Ultrasonography and magnetic resonance imaging showed uterus didelphys, hematometrocolpos, obstructed hemivagina, and right renal agenesis. Hemivaginal septal resection and anastomosis between the obstructed hemivagina and the normal vagina was tried, but it was not possible. Unilateral hysterectomy was performed. HWW syndrome may present with acute abdomen and is usually treated with vaginal septum resection and drainage of the hematometrocolpos.

Association between maternal circulating 25 hydroxyvitamin D concentration and placental volume in the first trimester

Abstract Objectives: We aimed to assess placental volume and placental mean gray value in vitamin D deficiency and healthy placentas in the first trimester of pregnancy using three-dimensional (3D) ultrasonography (USG) and Virtual Organ Computer-aided Analysis (VOCAL). Methods: This prospective cross sectional study comprised 274 patients, divided into two groups according to the presence or absence of vitamin D deficiency (<20 ng/ml deficient, n = 153, >20 ng/ml not deficient, n= 121) in the first trimester of pregnancy. Placental volume and placental volumetric mean gray values were evaluated. Placental volume (cm3) was analyzed using the VOCAL imaging program and a 3D histogram was used to calculate the volumetric mean gray value (%). Results: Placental volume was significantly less in the vitamin D deficiency group (p = 0.017) Volumetric mean gray value of the placenta was significantly higher in the vitamin D deficiency group (p= 0.003). Maternal serum PAPP-A (MoM) and f-β Hcg (MoM) were significantly lower in the vitamin D deficiency group (p= 0.008, p = 0.003, respectively). In linear regression analyses, serum vitamin D concentration was significantly associated with the plasental volume (β = 0.16; p = 0.01). Conclusion: Placental configuration and development were associated with vitamin D even in the first trimester of pregnancy. To ensure healthy pregnancy outcomes, vitamin D screening applied in the early stages of pregnancy or even before pregnancy.

Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles

PurposeTo demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker.MethodsDV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used.ResultsDV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values.ConclusionsDV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal

Objective: To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). Methods: Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. Results: Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1–3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). Conclusion: Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.

Antral Follicle Diameter Variance Within Each Ovary May Be A Predictor For Poor Response In Cases With Normal Ovarian Reserve

OBJECTIVES To determine the predictive value of antral follicle diameter variance within each ovary for ovarian response in cases with normal ovarian reserve tests. METHODS This is a prospective observational study. One hundred and thirty nine infertile women who underwent ART in IVF-ICSI unit of Zeynep Kamil women and childrens Health Training and research hospital between January 2017 to June 2017 were recruited. Blood samples were collected on day 2/day 3 for assessment of serum FSH and estradiol. Trans-vaginal sonography was done for antral follicle count. During antral follicle count, in order to determine antral follicle diameter variance, diameters of the largest and smallest follicles were recorded. Variance was calculated by subtracting the smallest diameter from the largest one. Following ovarian stimulation with antagonist protocol, poor response was determined in cases with total oocyte number≤3. Ovarian reserve tests and antral follicle diameter variance were utilized to predict cases with poor response in women with normal ovarian reserve. RESULTS Antral follicle diameter variance both in right (AUC=0.737, P<0.001) and left (AUC=0.651, P<0.05) ovaries significantly predicted poor ovarian response. Variance>3.5 mm was found to have 75% sensitivity to predict poor response. Basal serum FSH with estradiol levels and AFC failed to predict poor response (P>0.05). Other significant predictors for poor response were day 5 estradiol level and estradiol level at trigger day (P<0.05). In multivariate regression analysis, both AFC and antral follicle diameter variance in the right ovary were found to be significantly associated with clinical pregnancy, on the other hand peak estradiol concentration and antral follicle diameter variance in the right ovary were significantly associated with poor response. CONCLUSION Antral follicle diameter variance may be utilized to predict poor ovarian response in cases with normal ovarian reserve.

NADİR BİR HETEROTOPİK GEBELİK VAKASI: SPONTAN SİKLUSTA UNİLATERAL KORNUAL VE TUBAL GEBELİK

Amac: Nadiren dogal gebeliklerde olusan heterotopik gebelikte siklikla ruptur sonrasi cerrahi tedavi gerekli oldugunda tani konur. Bu sebeple erken tani hasta icin hayati onem tasimaktadir. Burada rupture tubal gebelik ve gec taninabilen kornual gebelik ile prezente olan heterotopik gebelik vakasi sunmayi amacladik. Olgu: 24 yasinda, nullipar, son adet tarihine gore 7 haftalik spontan gebeligi olan hasta, karin agrisi ve vaginal kanama ile klinigimize basvurdu. Yapilan fizik muayenesinde akut batin bulgulari mevcuttu. Transvaginal ultrasonografisinde endometrial kavitede gestasyonel kese izlenmedi. Endometrium 15 mm ve hiperekojen izlendi. Sag adneksial alanda ektopik odak ve douglasta serbest sivi izlendi. Yapilan tetkiklerinde Hemoglobin: 9.2 gr/dl, β-hcg: 3028.3 m IU / ml olarak gelen hastaya laparoskopi planlandi. Laparoskopik eksplorasyonda sag tuba rupture izlendi. Batinda ortalama 400cc kan ve koagulum izlendi. Uterus ve her iki over normal gorunum ve cesamette izlendi. Sag salpenjektomi yapildi, batin yikanmasinin ardindan laparoskopiye son verildi. Takiben DC kornual gebelik; tubalektopik gebelik.

NUKAL TRANSLUSENSİ ARTMIŞ VE KARYOTİPİ NORMAL GEBELİKLERDE PERİNATAL SONUÇLARIN DEĞERLENDİRİLMESİ

Amac: Calismamizda ilk trimester Down sendromu tarama testinde Nukal Translusensi (NT) olcumu ≥ 95. persantil bulunan ancak genetik inceleme sonucunda normal karyotip saptanan gebeliklerin perinatal sonuclarinin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Ilk trimester tarama testinde NT ≥ 95. persantil saptanan ve karyotipleme yapilan hastalarin sonuclari retrospektif olarak tarandi. Sayisal ya da yapisal kromozomal anomali saptanmamis olgularin dosyalarindan anne yasi, obstetrik ve aile oykusu bilgilerine ulasildi. Hastalarla telefon ile mulakat yapilarak gebeligin nasil sonuclandigi, gebelik suresince ve yenidogan/infant/cocukluk donemi takiplerinde herhangi bir anormallik saptanip saptanmadigi ogrenildi. Bulgular: NT 7.2 mm bulunan bir olgunun detayli fetal USG incelemesinde major kardiyovaskuler anomaliler saptanmasi nedeni ile termine edilmis oldugu, NT 2.8 mm bulunan bir ikiz gebelikte fetuslardan birinde 13. haftada kalp atiminin negatiflestigi, oploid oldugu saptanan diger fetusta IUGR gelistigi ve 23. haftada in utero kayip oldugu, NT 2.8 mm bulunan iki olgudan birinde 16. haftada, digerinde 30. haftada in utero fetal kayip yasandigi, NT 3.9 mm bulunan ve hafif pyelektazi kaydedilmis fetusun yenidogan takiplerinde renal pelvis caplarinin normal sinirlara geriledigi gorulmustur. NT 2.9 mm bulunan baska bir fetusta ise dogum sonrasi hipospadias saptanmis oldugu bilgisi edinilmistir. Sonuc: Genetik incelemede normal karyotipleme elde edilse bile NT 95. persantil ve uzerinde olan fetuslar in utero fetal kayip, major yapisal anomaliler, genetik sendromlar ve norolojik gelisimsel sorunlar acisindan yuksek risk tasiyabilirler. Aile bu konuda bilgilendirilmeli ve izlem sureci yenidogan, infant, cocukluk donemi boyunca devam etmelidir. Anahtar Kelimeler : Ikili tarama testi; karyotip; nukal translusensi.

Occult serous carcinoma of fallopian tube presenting as supraclavicular lymphadenopathy.

a Department of Obstetrics and Gynecology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey b Department of Pathology, Zeynep Kamil Education and Research Hospital, Istanbul, Turkey c Department of Obstetrics and Gynecology, Şisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey d Department of Obstetrics and Gynecology, Suleymaniye Education and Research Hospital, Istanbul, Turkey

SERUM BETA CROSSLAPS AS A PREDICTOR FOR OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN

Amac: Postmenopozal kemik yikimini azaltmak amaciyla hormon replasman tedavisi (HRT) veya bifosfonat (BP) tedavisi verilen hastalarda tedavi surecinde kemik yikim hizinin guncel bir marker olan serum crosslaps (β-CTx) ile degerlendirilmesi. Gerec ve yontemler; Zeynep Kamil Egitim Arastirma Hastanesi poliklinigine basvuran en az bir yil suredir menstruasyonu olmayan, Follikul Stimulan Hormon degeri (FSH) > 40 IU/L Ostrojen (E2) 0.05). BP kullanan olgularin baslangictaki β-CTx duzeyleri, HRT kullanan olgulardan anlamli yuksekti (p < 0.01). BP kullananlarin 6. aydaki β-CTx duzeyleri, HRT alanlardan anlamli duzeyde yuksek bulundu (p < 0.05). BP kullanan olgularda; baslangictaki β-CTx duzeyine gore 6. ay β-CTx duzeyinde gorulen dusus istatistiksel olarak anlamli bulunmustur (p < 0.05). Sonuc: Serum β-CTx olcumu erken donemde degisim gostererek ozellikle hizli kemik kaybi olan hastalarda tedavinin etkinligini degerlendirmede kemik mineral yogunluguna gore daha erken yol gosterici olmakla birlikte bu konuda daha uzun sureli calismalara ihtiyac vardir

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

BACKGROUND Presacral teratomas are usually observed in the first two decades of life and have a 50-67% incidence of malignant transformation. Surgery is the treatment of choice. CASE REPORT Here, we report the case of 24-year-old female with chronic urinary retention after surgery for a presacral teratoma. CONCLUSION Retroperitoneal pelvic surgery may cause pelvic plexus and nerve injury, leading to permanent bladder dysfunction and urinary retention.