Nese Yucel

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.

Vascular risk in women with a history of severe preeclampsia

To assess markers of vascular dysfunction and risk in postpartum women with a history of severe preeclampsia.

Rupture of the pregnant uterus: a 9-year review

Objective: To investigate the frequency of ruptured uterus, possible etiologic factors and fetomaternal outcomes. Study design: A retrospective chart view of all patients with ruptured uterus over a 9-year period from 1995 to 2003 was carried out. Relevant data relating to the clinical features, characteristics of labour, operative procedures, and fetomaternal outcomes were assessed. Results: During the study period there were 17 cases of ruptured uterus among a total of 117,095 deliveries, giving an incidence of 1 in 6,888 deliveries. Thirteen patients (76.5%) were multiparous and mean parity was 1.9. Uterine rupture occurred following vaginal delivery in ten patients. Caesarean delivery was performed in seven (41.2%) patients, of which five (29.4%) patients had a history of previous caesarean section. Abdominal hysterectomy was performed in 12 patients (70.6%), of which 9 (75.0%) were total and 3 (25.0%) were subtotal. The other five patients (29.4%) had suture repairs. In seven patients (41.2%), uterine rupture was associated with oxytocin use. There were one maternal and three perinatal (17.6%) deaths. Conclusion: Sudden fetal heart abnormalities in labouring patients should be taken as a potential sign of danger. Early diagnosis and immediate preoperative resuscitation are of great importance in cases of ruptured uterus. The fetomaternal outcomes can be improved with the experience and skill of the surgical team.

A Retrospective Review of Perioperative Complications in 360 Patients who had Burch Colposuspension

EDITORIAL COMMENT: We accepted this paper for publication because it reports a large experience with the Burch colposuspension operation and presents the complications encountered. It also provides a detailed review of the complications reported by others. In this series of 360 patients, 75.8% had an abdominal hysterectomy performed at the time of the Burch colposuspension. Our urogynaecologist reviewer tells us that this is a very high proportion of hysterectomies although there is a body of opinion that believes that a hysterectomy improves the results when the Burch operation is done in the treatment of women with genuine stress incontinence of urine. The incidence of hysterectomy has to be factored in to the data presented in this paper with regard to the complications that followed the operation. N.B.

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.

The levonorgestrel‐releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis

The aim of this study was to investigate the effectiveness of a levonorgestrel‐releasing intrauterine device (LNG‐IUS) in the symptomatic relief of pain in women with endometriosis and additionally, to assess the changes in womens life quality and serum cancer antigen (CA) 125 levels.

Adnexal torsion in a first-trimester pregnant patient without any predisposing factor: A case report

SummArY Adnexal torsion is an uncommon case during pregnancy. Torsion usually occurs in ovaries with previously diagnosed cysts or tumors. It is rare for a previously normal ovary to undergo torsion in advanced gestation. Here, we report a case of adnexal torsion during the 9th week of pregnancy without any predisposing factors. The patient was admitted to emergency department with mild lower abdominal pain and nausea. With the worsening of clinical and ultrasonographic signs, a right salpingo-ovariectomy was performed. After surgery, the pregnant patient was treated with fluid and appropriate drug supplementations and continuation of the pregnancy was achieved. Adnexal torsion, though rare, should be kept in mind in the differential diagnosis of lower abdominal pain in advanced gestation.

Unclassified tumor of the gonadal stroma in a pregnant woman

Gonadal sex cord stromal tumors contain some of the most morphologically interesting neoplasms of the gonads, and these lead to many important issues in differential diagnosis. Granulosa cell tumors are much more common in females. Unclassified sex cord stromal tumor is rare. We report a case of a 22-year-old woman with acute ruptured unclassified sex cord stromal tumor of the right ovary during pregnancy. The biological behavior of unclassified sex cord stromal tumors resembles that of Sertoli-Leydig cell tumors of intermediate differentiation rather than poorly differentiated tumors, which may have been expected in view of the lack of specific differentiation. This finding is important with regard to postoperative management.