Semih Uludag

The influence of obesity on ICSI outcomes in women with polycystic ovary syndrome

The objective of the study was to compare intracytoplasmic sperm injection (ICSI) outcome and gonadotropin doses between obese women with PCOS and non-obese patients with PCOS. This follow-up study represents ICSI outcomes in obese women with PCOS (BMI ≥ 30 kg/m2) compared with non-obese women with PCOS (BMI < 30 kg/m2). Obese (n = 18) and non-obese (n = 26) women with PCOS underwent long protocol pituitary suppression, ovarian stimulation and ICSI with fresh embryo transfer. Obese patients with PCOS required higher doses of gonadotropin (2994 IU vs 1719 IU; p < 0.001). Miscarriage rate was significantly higher in obese women compared with the non-obese women with PCOS (60% vs 6.7%, p = 0.002). Our results are valuable for counselling couples before initiation of assisted reproduction techniques (ART).

Removal of ascites up to 7.5 liters on one occasion and 45 liters in total may be safe in patients with severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially lethal complication of ovulation induction. We report herein a case with OHSS treated by serial vaginal paracentesis. A 31-year-old patient was hospitalized due to severe OHSS after in vitro fertilization (IVF)–embryo transfer. Transvaginal drainage was performed with a standard 17-gauge IVF needle connected to a vacuum pump through a drainage set in nine courses. We removed 45 liters of ascitic fluid in total and 7.5 liters of ascitic fluid in one course, leading to improvement of the patients condition and laboratory parameters. In conclusion, removal of ascites up to 7.5 liters on one occasion and 45 liters in total by serial vaginal paracentesis may be performed in patients with severe OHSS.

Sonographic findings and perinatal outcome of multiple pregnancies associating a complete hydatiform mole and a live fetus: a case series.

The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF).

Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols

OBJECTIVE The aim of this study was to compare the use of systemic and local methotrexate in the treatment of cesarean scar pregnancy. STUDY DESIGN In this retrospective cohort study, we collected the data of 44 patients with cesarean scar pregnancy. The patients were grouped according to treatment modality: Group 1, local methotrexate injection (n=17) and Group 2, systemic methotrexate (n=27). The groups were compared with respect to side effects, recovery time, reproductive outcome, and treatment cost. RESULTS The mean gestational age at diagnosis (6.4±0.93 vs. 5.4±0.80 weeks, p=0.001), pretreatment serum β-human chorionic gonadotrophin level [27,970 (11,010-39,421) vs. 7606 (4725-16,996) mIU/mL, p=0.001], and lesion size (2.74±1.36 and 1.28±0.55cm, p=0.001) were higher in Group 1. All patients were cured by primary therapy without additional surgery. The mean times for β-human chorionic gonadotrophin normalization, the uterine-mass disappearance, were significantly shorter in Group 1 than in Group 2 (6.17±1.55 vs. 8.11±2.0 weeks, p=0.001 and 10.47±4.14 vs. 13.40±4.44 weeks, p=0.002, respectively). The cost of treatment was similar between groups (281.133±112.123

Acute pulmonary failure due to pulmonary edema during tocolytic therapy with nifedipine

vs. 551.134±131.792

Spontaneous uterine perforation due to pyometra

, p=0.76). The total pregnancy rates were not different between groups (5/16, 31.4% vs. 6/11, 54.6%, p=0.301). One recurrent cesarean scar pregnancy occurred after systemic methotrexate. Oral ulcers, the most common side effect, were seen in seven patients in Group 2. CONCLUSION Even though treatment success and reproductive outcomes are similar, local methotrexate is superior to systemic methotrexate with regard to recovery time, side effects, and treatment costs, even in patients with unfavorable pretreatment prognostic predictors.

A case of renal cell carcinoma with solitary metastasis to the ovary.

Calcium-channel blockers (CCB) are the new members of the tocolytic drugs [1]. We report a case of pulmonary edema (PE) associated with tocolytic use of oral nifedipine. According to the available literature, this is the first case of pulmonary edema associated with the use of nifedipine at conventional dose. A 39-year-old, previously healthy, G4P3 was admitted with rupture of membranes. On admission, blood pressure was 120/70 mm Hg, pulse rate was 84 beats/min. Transabdominal ultrasonography showed 33-week-old singleton fetus. Blood tests revealed that white blood cell was 9.7 9 10/mL and C-reactive protein was 12.8 mg/dL. She was started on amoxicillin 1 g intravenously every 6 h, and nifedipine 20 mg orally every 4 h and betamethasone 12 mg intramuscular daily for 2 days. For the first day of her admission, 2,000 cc parenteral fluid was given to the patient and was reduced to 1,000 cc daily. At fourth day of her admission, she complained of dyspnea with sudden onset and a vague chest, and back pain. Her condition rapidly deteriorated and cardiac and respiratory arrest ensued. After the first resuscitation she was intubated. Arterial blood gases at room air showed severe hypoxemia (PaO2: 53, CO2: 26). She was immediately transported to the operating room due to persisted fetal bradycardia, and 1,850 g/28 cm infant, with APGAR scores of 5 at 1 min and 7 at 5 min was delivered via cesarean section. She was admitted to the intensive care unit postoperatively. Chest X-ray showed bilateral haziness with mild pleural effusion and chest computed tomography revealed thickening of interlobular septums, pleural effusion, basal atelectasis, and ground glass pattern suggestive of pulmonary edema (Fig. 1). Left ventricular-ejection fraction was 60 %, and creatine kinase and creatine kinase MB were within normal limits. Intravenous furosemide was started 30 mg every 8 h for the first day and furosemide doses were adjusted thereafter based on the patient’s condition and urine output. After 4 days of the operation, she was discharged with good condition. First reported cases of CCB related pulmonary edema was associated with parenteral tocolytic use of nicardipine [2]. Later, Abbas et al. [3] reported the first case of PE associated with tocolysis with oral nifedipine at a dose of 40 mg for every 6 h in patients with preterm premature rupture of membranes. CCB has negative inotropic effect causing reflex tachycardia that impairs diastolic filling. Moreover, vasodilatation caused by CCBs predominantly affect precapillary rather than post capillary vessels and thus, leading to interstitial fluid accumulation. It seems possible that even at conventional doses, when combined with betamethasone and parenteral fluid infusion, CCB predisposes pregnant patients to the PE as in the present case. In accordance with aforementioned theory and case series, in their comprehensive analysis, Ogunyemi [4] showed that preterm delivery, antenatal steroids, magnesium sulfate, tocolysis and nifedipine use as a tocolytic were independent risk factors for the development of PE. In conclusion, CCB may cause life-threatening complications in pregnant patients taking antenatal steroids and M. S. Kutuk (&) M. T. Ozgun S. Uludag M. Dolanbay Department of Obstetrics and Gynecology, Faculty of Medicine, Gevher Nesibe Hospital, Erciyes University, 38039 Kayseri, Turkey e-mail: mskutuk@erciyes.edu.tr

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre

Possible presentations include menstrual irregularities, pelvic pain, chronic cervicitis, spontaneous miscarriage and infertility. Th e cervical fi ndings on colposcopy vary from normal, to caulifl ower-like growths, ulcerations and pathognomonic sandy patches. Th ese grainy sandy patches may be deeply or superfi cially situated in the epithelium. Th e epithelial surface over the deeply grained patches is smooth and grains are not moveable. Th ere may be contact bleeding. Direct examination of cervical tissue (quantitative compressed biopsy technique) is the diagnostic test of choice (Poggensee et al. 2001). Granulomatous infl ammatory reaction to the ova is a common histological fi nding, and dense fi brosis is usually found at later stages of the disease. Praziquantel has been used for the treatment of schistosomiasis since the 1970s. Praziquantel is administered as a single oral dose 40 mg/kg of body weight. Th is single treatment has a cure rate of 88.6% and egg reduction rate of over 98% (Tchuent é et al. 2004). It is still the drug of choice today due to high effi cacy, excellent tolerability, few and transient side eff ects, simple administration and competitive cost (Wu et al. 2011). Th e risk of reinfection of a person living in the UK is negligible unless that person travels back to an endemic area. In endemic areas, location of residence, age 12 years, and incomplete treatment are the signifi cant independent predictors of reinfection (Satayathum et al. 2006). Th e association between schistosomiasis and bladder cancer is well documented but there is no consensus on the relationship between cervical schistosomiasis and cervical carcinoma. Schistosomiasis alters the cervical epithelial barrier and increases the risk of human papilloma virus (HPV) and human immunodefi ciency virus (HIV) infection (Petry et al. 2003). Co-infection with schistosomiasis, HPV and HIV may accelerate progression to cervical carcinoma. Women found to have cervical schistosomiasis should have prompt treatment and be off ered screening for HPV and HIV.

A Case of Dichorionic Twin Pregnancy Concordant for Bilateral Cleft Lip and Palate and Discordant for Spina Bifida; Schisis Association

Majmudar B , Henderson PH 3rd , Semple E . 1983 . Salpingitis isthmica nodosa: a high-risk factor for tubal pregnancy . Obstetrics and Gynecology 62 : 73 – 78 . Saracoglu FO , Mungan T , Tanzer F . 1992 . Salpingitis isthmica nodosa in infertility and ectopic pregnancy . Gynecologic and Obstetric Investigation 34 : 202 – 205 . Seeber BE , Barnhart KT . 2008 . Ectopic pregnancy . In: Gibbs RS , Karlan BY , Haney AF et al., editors . Danforth ’ s obstetrics and gynecology . Philadelphia: Lippincott, Williams and Wilkins . p 69 – 87 . Skibsted L , Sperling L , Hansen U et al . 1991 . Salpingitis isthmica nodosa in female infertility and tubal diseases . Human Reproduction 6 : 828 – 831 . Stock RJ . 1990 . Histopathology of fallopian tubes with recurrent tubal pregnancy . Obstetrics and Gynecology 75 : 9 – 14 . Stovall TG . 2007 . Early pregnancy loss and ectopic pregnancy . In: Berek JS , editor . Berek and Novak ’ s gynecology . Philadelphia: Lippincott, Williams and Wilkins . p 601 – 637 .

Laparoscopically-assisted vaginal hysterectomy for enlarged uterus: operative outcomes and the learning curve

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers’ education to change this attitude should be implemented.