Neslihan Carda Seçkin

The effects of hormone replacement therapy on uterine fibroids in postmenopausal women

OBJECTIVE To evaluate and compare the effects of two different modalities of hormone replacement therapy (HRT) on the size of uterine fibroids. DESIGN Randomized clinical study. SETTING The Menopause Center of a public hospital. PATIENTS Postmenopausal women with small asymptomatic uterine fibroids were selected. INTERVENTIONS One group was treated with 50 micrograms transdermal E2 plus 5 mg medroxyprogesterone acetate (MPA) continuously, whereas the second group was given 0.625 mg conjugated equine estrogen plus 2.5 mg MPA continuously. MAIN OUTCOME MEASURE The size of the uterine fibroids was measured before and after the first year of HRT. RESULTS At the end of the first year on HRT, the size of the uterine fibroids was re-evaluated sonographically and no significant difference was found with the oral group, whereas there was a significant increase in the transdermal group. CONCLUSION Hormone replacement therapy with 50 micrograms transdermal E2 plus 5 mg MPA increases the size of the uterine fibroids.

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients

Objectives: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. Methods: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non‐PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3‐h, 100‐g oral glucose tolerance test (OGTT). Results: A family history of diabetes mellitus, pre‐pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre‐pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. Conclusions: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.

Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report

A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult.

The predictive power of endocrine tests for the diagnosis of polycystic ovaries in women with oligoamenorrhea.

Various hormonal parameters and the best logistic regression model to predict disease probability were evaluated in women with polycystic ovary syndrome (PCOS). Concentrations of LH, FSH, LH/FSH ratio, testosterone, free testosterone, SHBG and insulin in serum were recorded in 32 women with PCOS and in 25 controls. A model including LH/FSH ratio, insulin and testosterone measurements yielded the best goodness of fit for classification of women with and without PCOS in the logistic regression analysis. Only LH/FSH ratio and insulin were retained as significant variables. The diagnostic characteristics of LH/FSH ratio and insulin for PCOS when compared by receiver-operator characteristic analysis were found to be equally effective. By combining these two variables a higher area under curve was obtained. LH/FSH ratio, insulin or the combination of these two can predict the disease probability in women with PCOS.

Scapula length measurement for assessment of fetal growth and development

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapula length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R2 = 0.94, p < 0.0001), the biparietal diameter (R2 = 0.94, p < 0.0001), abdominal circumference (R2 = 0.94, p < 0.0001), and the femur length (R2 = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear

Objective: To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti‐inflammatory therapy. Method: A prospective randomized study. Result: 2798 premenopausal non‐pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as ‘inflammatory cellular changes’. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti‐inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 ± 6.3 (18–46) and 1.7 ± 2.3 (0–6), respectively. When these patients underwent colposcopically‐directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences. Conclusion: Colposcopically‐directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

Acardiac twin: a misdiagnosed, mismanaged case

Acardiac twins are usually diagnosed during the antenatal period and almost invariably cause complications to the other fetus. In this case, an acardiac twin pregnancy was misdiagnosed antenatally as a degenerated myoma but ended with delivery of a healthy baby.

A life-threatening second trimester disseminated intravascular coagulopathy with protein s deficiency.

Disseminated intravascular coagulopathy (DIC) is an uncommon but serious complication of pregnancy. Placental abruption is the most common associated condition among the causes of acute obstetrical DIC. We present a case of life-threatening DIC complicating placental abruption in the second trimester of pregnancy with protein S deficiency as a triggering factor, which necessitated urgent termination of pregnancy.

OVULATION INDUCTION AND BREAST CANCER

The use of ovulation-inducing agents in the treatment of infertility is increasing [1, 2], and there has been considerable concern that follicular stimulation may potentially increase the risk of epithelial ovarian cancer [1, 3]. Also, it is suggested that hormonal alterations associated with the use of ovulation-inducing agents may influence breast cancer risk [2]. Nevertheless, it is surprising that until now there has never been any controlled study.

Diagnosis of Antiphospholipid Syndrome During the Diagnostic Workup of Second-Trimester Fetal Bradycardia

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with either arterial and/or venous thrombosis (1). Two cases of APS, which were diagnosed in the second trimester during the diagnostic workup of fetal bradycardia, are presented.