Ziya Gunenc

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy

We aimed to compare the accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) for uterine pathologies among infertile women. A total of 346 patients were selected for operative hysteroscopy, following SIS after TVS. SİS was performed with a Cook Soft 500 IVF catheter. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated to compare the accuracy of TVS, SIS and hysteroscopy for uterine abnormalities. SIS showed a sensitivity of 87%, specificity of 100% and PPV of 100% for endometrial hyperplasia, and a sensitivity and NPV of 100% for polypoid lesions. For submucosal myoma SIS showed a sensitivity of 99% with PPV of 96%. Hysteroscopy had a sensitivity, specificity, PPV and NPV of 98%, 83%, 96% and 91%, respectively for overall uterine pathologies. Finally, SIS seems to be superior to TVS, for uterine pathologies, with respect to hysteroscopy as the gold standard.

Preeclampsia Due to Fetal Non-immune Hydrops: Mirror Syndrome and Review of Literature

Objective. Mirror syndrome (Ballantynes syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic. Methods. A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. Seventy-five cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia. Results. Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and prognosis is mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion. Hydrops fetalis must be considered as a potential risk factor for preeclampsia. It is important that this clinical condition has a potential of about 5% for proceeding preeclampsia.

Prenatal diagnosis of Comel-Netherton syndrome with PGD, case report and review article

Comel-Netherton syndrome (C-NS) is an autosomal recessive disorder of the skin, hair and immune system first reported by Comel in 1949 and Netherton in 1958 (1, 2). This syndrome presents at or soon after birth with generalized erythroderma, scaling, and/or continuous peeling of the skin resembling nonbulloous congenital ichthyosiform erythroderma or peeling skin syndrome. In the neonatal period, 20% of the babies suffer from hypernatremic dehydration, electrolyte imbalances, perturbed thermoregulation, failure to thrive and recurrent infections which may result in neonatal demise [3–5]. The skin lesions are often pruritic, resemble atopic eczema, and show an unstable, undulating course. They are usually accompanied by hair shaft abnormalities that develop during early childhood and may result in diffuse alopecia. The hallmark of C-NS is trichorrhexis invaginata (bamboo hair), but other abnormalities, including pili torti (twisted hair) and trichorrhexis nodosa (hair of varying diameter) have been observed. Markedly elevated IgE levels, allergic reactions to food and common antigens, malnutrition, and increased susceptibility to skin, respiratory tract or systemic infections are also characteristic [6, 7]. There are nearly 150–160 cases of C-NS reported in the literature, its incidence might be 1/200.000 [6] due to challenging diagnostic problems during infancy and early childhood. This syndrome has overlapping features with atopic dermatitis and other recessive ichthyosis. Most patients with C-NS are sporadic cases however, there are reports of affected siblings and of consanguinity in about 10% of the families with C-NS which is common in autosomal recessive inheritance [8–10]. In this study, we present two consanguineous Turkish families (two sisters married with two brothers) of prenatal diagnosis of Netherton syndrome and successful intracytoplasmic sperm injection (ICSI) pregnancies using PGD and a review of literature. To our knowledge, this is the first report of PGD and ICSI in Comel-Netherton syndrome.

Laparoscopic surgery of interstitial (cornual) pregnancy, a case report

We report a successful laparoscopic management of an interstitial pregnancy of a 24- year-old single woman, treated by cornuostomy. The patient was first managed with methotrexate treatment. After the 2. methotrexate administration, the patient suffered from low abdominal pain, and intraabdominal bleeding signs were reported by transvaginal ultrasonograpy. The hemoglobin level was decreased from 12.8 gr/dl to 11.8 gr/dl and the beta hCG level was increased from 8,314 mIU/l to 11,541 mIU/l. The laparoscopic approach to interstitial pregnancy was presented and other management strategies such as medical treatment and laparotomy have been reviewed.

Enterobius vermicularis infection in uterine cavity mimicking endometrial cancer: a case report

Enterobius vermicularis (pinworm) is an intestinal nematode of humans and causes helminthic infection with a worldwide distribution and high prevalence especially in countries with temperate climates. The adult pinworms usually inhabit the cecum and adjacent gut. Gravid females migrate to the rectum and emerge on the perineum at night depositing eggs [1]; they can also migrate into the vagina and invade reproductive systems of women [2, 3]. The ova and larvae of the pinworm can be observed in cervicovaginal smears and there are several reports in literature describing associated salpingitis, pelvic inflammatory disease, infections of the ovary, endometrium, pelvic abscess, and generalised peritonitis [4–11]. While there have been limited case reports of enterobiasis of the female reproductive system, we describe a case of postmenopausal woman with enterobiasis in the uterine cavity mimicking endometrial cancer.

Laparoscopic management of a cornual ectopic pregnancy associated with persistant gestational throphoblastic disease: a case report

A 30-year-old woman underwent laparoscopy for diagnosis and treatment of ectopic pregnancy. A dark-red bulging mass was observed in the right uterine horn. Laparoscopic hysterotomy was performed. The histological examination revealed a hydatidiform mole, which was confirmed by DNA ploidy analysis showing triploidy (69 XXY) as apartial hydatidiform mole after the cytogenetic examination. On the third postoperative day, the thoracic computed tomography scan revealed punctuate lesions. These lesions disappeared after single-agent chemotherapy with methothrexate. To the best of our knowledge, this is the first case of cornual persistent gestational trophoblastic neoplasia managed by laparoscopic surgery.

OP34.09: Vaginal progesterone after multifetal pregnancy reductions

The prevalence of subsequent acute histologic chorioamnionitis was in 8% (11/145) and that of spontaneous preterm delivery was 5% (7/138). Women who were initially diagnosed a short cervix at 28–30 weeks were significantly more likely to have subsequent histologic chorioamnionitis and spontaneous preterm delivery than those who were not. The mean cervical lengths at 20–25 weeks and 28–30 weeks were significantly shorter in women who delivered preterm than in those who delivered at term. Conclusions: In twin gestations, a short cervix initially detected by transvaginal ultrasound at 28–30 weeks is associated with an increased risk of the subsequent histologic chorioamnionitis and the occurrence of spontaneous preterm delivery. Our findings support the hypothesis that a short cervix in asymptomatic pregnant women predisposes to ascending intrauterine infection.