S. Gunalp

Women’s perceptions of caesarean section: reflections from a Turkish teaching hospital

Caesarean section as a contentious topic has attracted attention world-wide and different dimensions of the issue has been investigated. The primary reason behind these initiatives have been the upsurge of caesarean sections both in the developed and developing world and the realisation that the operation may not always contribute positively to the mothers and babys health. By contrast, several studies have demonstrated both the short and long term negative effects. Research has also revealed that factors other than medical necessity play an important role in the decision to perform a caesarean section. Turkey, although reliable data does not exist, can be classified among the countries experiencing the caesarean epidemic, at least among highly educated and wealthy mothers. This research, exploring the perceptions of mothers in a teaching hospital with a high caesarean rate, is a rare example of its kind in Turkey. The main finding is the dissatisfaction of the mothers undergoing caesareans during their stay in the hospital.

Single intramural leiomyoma with normal hysteroscopic findings does not affect ICSI–embryo transfer outcome

Where there is no distortion of the endo-myometrial junction, the effect of an intramural leiomyoma on reproductive performance is controversial. The current study compared the performance of patients having a single leiomyoma and intact endometrium confirmed by hysteroscopy (study group) with that of controls having intact endometrium alone in intracytoplasmic sperm injection (ICSI) cycles. A total of 61 consecutive infertile patients were retrospectively enrolled into the study group from a computerized IVF database. The control group consisted of 444 age-matched patients undergoing ICSI-embryo transfer without any endocervical or intrauterine pathology confirmed by both transvaginal ultrasonography and office hysteroscopy. The baseline characteristics, performance of ovarian stimulation and embryological data were similar between the two groups. The clinical pregnancy per embryo transfer (36 versus 38%) and implantation rate (20 versus 19%) were also comparable. Although the miscarriage rate tended to be higher in the leiomyoma group (27 versus 19%), the difference did not reach statistical significance. In conclusion, in the presence of intact endometrium, a single intramural leiomyoma does not seem to have a deleterious effect on ICSI cycles. Before ICSI is attempted, hysteroscopy may be useful for ruling out distortion of the endometrium due to leiomyoma in selected cases.

DISSEMINATED PERITONEAL LEIOMYOMATOSIS

Abstract Disseminated peritoneal leiomyomatosis (DPL) is a rare entity, occuring primarily in premenopausal women. The lesion is characterized by numerous subperitoneal nodules of benign smooth muscle proliferations which usually mimics the macroscopic appearance of the peritoneal carcinomatosis. We report a case of DPL and multiple uterine leiomyomas, occuring in a 50 year old premenopausal woman who was on oral contraceptives for the last three years. In order to diagnose this entity clinicians and pathologists have to be alert and collaborative during the intraoperative frozen section consultation.

The effect of vaginal pH on the efficacy of vaginal misoprostol for induction of labor

Background. Misoprostol was reported to be an effective agent for cervical ripening and induction of labor. Our purpose was to evaluate whether vaginal pH affected the efficacy of misoprostol for induction of labor.

Steroid Cell Tumor of the Ovary in an Adolescent: A Rare Case Report

Steroid cell tumors (SCTs) of the ovary are a rare subgroup of sex cord tumors, account for less than 0.1% of all ovarian tumors, and also will present at any age. These tumors can produce steroids, especially testosterone, and may give symptoms like hirsutism, hair loss, amenorrhea, or oligomenorrhea. For the evaluation of androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S) are the first laboratory tests to be measured. A pelvic ultrasound and a magnetic resonance imaging are useful radiologic imaging techniques. Although steroid cell tumors are generally benign, there is a risk of malignant transformation and clinical malignant formation. Surgery is the most important and hallmark treatment.

Autoimmune estrogen dermatitis in an infertile female

Abstract Autoimmune estrogen dermatitis is a cyclical cutaneous eruption that occurs premenstrually and goes to the rapid resolution within a few days of menstrual cycles. The disorder has variable clinical manifestations consisting of macules, papules, vesicles, urticarial lesions, bullae, eczematous plaques, and erythema multiforme-like lesions. Herein, we present a case of a 30-year-old woman with attacks of edema and erosions involving the oral and genital mucosal sites on every first day of her menstruation period. She had also multiple endocrinological problems such as hypotroidism and infertility. To determine the sex hormon sensitivity, intradermal skin tests were performed. Based on her personal history and skin test findings, a diagnosis of autoimmune estrogen dermatitis was made. After the oophorectomy, she was free from the skin and mucosal symptoms. We propose that it is important to suspect the diagnosis of autoimmune estrogen dermatitis in patients who present with recurrent cylic eruptions and it must be kept in mind that these patients might have a concomitant infertility.

Evaluation of the relation between preapoptotic sperm rate in ejaculate and intrauterine insemination success rate in patients with unexplained infertility.

abstract The parameters measured in the standard semen analysis may be insufficient for exact differentiation between fertile and infertile men. Therefore, we assume that the high rate of apoptotic sperm in ejaculate may play a role on the aetiology of unexplained infertility. Couples with unexplained infertility treated by ovulation induction and intrauterine insemination were consecutively enrolled (n = 94). To determine the proapoptotic sperm rate, the ejaculate from patients was stained with annexin V. Thirteen of the 94 couples (13.8%) conceived after intrauterine insemination. The annexin V-positive sperm rate was found to be 20.0% in the whole group. In women failing to conceive, the annexin V-positive sperm rate was 20.8% compared to 15.7% in patients who achieved pregnancy. Although there is a trend towards higher preapoptotic sperm rate in couples failing to get pregnant with insemination, the difference did not reach statistical significance.