The effect of vaginal bleeding and non-spesific pelvic pain on pregnancy outcomes in subchorionic hematomas cases

Objectives: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early second trimester subchorionic hematoma cases.  Material and methods: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed with subchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission, ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups were compared according to the clinical features and pregnancy outcomes.  Results: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher (p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70% sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in the other group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancy outcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effect of on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sac was above 35% (p = 0.027).  Conclusions: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma to the gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of the patients increased and the ratio of pregnancy loss was higher

Cornual molar ectopic pregnancy

The aim of this study is to present a rarely seen cornual molar ectopic pregnancy case regarding with literature. 36 years old patient with the third pregnancy was referred to our clinic with the prediagnosis of viable ectopic pregnancy. The patient had two vaginal delivery history and she had vaginal bleeding as spotting onwards fifteen days. Ultrasonographicassessment demonstrated ectopic pregnancy with positive fetal cardiac activity and 8mm crown-rump length (6W5D) at right cornual region. The patient was performed cornotomy with laparotomy. Postoperative pathological evaluation was reported as a partial molar pregnancy. β-human chorionic gonadotropin (β-hCG) values declined dramatically and so additional treatment was not applied. Molar ectopic pregnancy findings are usually seen as conventional pregnancies and β-hCG values and histopathological evaluation is important for correct diagnosis and follow up

Can complete blood count parameters that change according to trimester in pregnancy be used to predict severe preeclampsia?

We aimed to evaluate the effectiveness of changes over time in complete blood count (CBC) parameters to estimate the diagnosis of preeclampsia. Data on 161 severe preeclampsia patients and 161 healthy pregnant patients who met the study criteria of pregnant women whose CBC had been measured at 10–12, 22–24 and 28–30 weeks of pregnancy were compared. In the preeclampsia group, an increase in the mean platelet volume (MPV) value and a decrease in the number of platelets were statistically significant in the transition from the second to the third trimester. MPV and lymphocyte counts were more significant in the third trimester and neutrophil lymphocyte ratio (NLR) were more significant in the second trimester. We found that evaluation of the changes in lymphocyte, MPV and NLR values in three different trimesters of pregnancy rather than a single trimester was more meaningful to predict severe preeclampsia.Impact Statement What is already known on this subject? Studies have shown that MPV and NLR can predict preeclampsia. However, a clear cut off value could not be determined. The reasons for this may be that the gestational week during which the measurement is made is not standard and the patient groups are not homogeneous. What the results of this study add? In this study, CBC parameters at different stages of the preeclampsia process were compared in the severe preeclampsia group. According to our results, lymphocytes, NLR and MPV can be used to predict severe preeclampsia. In addition, NLR measurements in the second trimester and MPV and lymphocyte measurements in the third trimester were found to be more significant in predicting severe preeclampsia. What the implications are of these findings for clinical practice and/or further research? In order to predict severe preeclampsia, instead of a single measurement of CBC parameters, new calculations should be made that add change over time

Regression of experimental endometriotic implants in a rat model with the angiotensin II receptor blocker losartan

WOS: 000352786800016PubMed ID: 25302540AimEndometriosis is a common disease in women of reproductive age, and many different treatments have been developed, although none has provided a cure. In this study, the efficacy of losartan, an angiotensin II type 1 receptor blocker and an antiangiogenic and anti-inflammatory agent, on regression of experimental endometriotic implants in a rat model was investigated. MethodsPeritoneal endometriosis was surgically induced in 16 mature female Sprague-Dawley rats. The peritoneal endometriotic implant was confirmed after 28 days, and the animals were divided randomly into two groups. The control group (n=8) was given 4mL/day tap water by oral gavage, and the losartan group (n=8) was given 20mg/kg per day losartan p.o. We compared endometriotic implant size, extent and severity of adhesion, as well as plasma and peritoneal lavage fluid cytokine levels including vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-, plasma inflammatory factor pentraxin-3 (PTX-3) and C-reactive protein (CRP) between the treatment groups. ResultsMean surface endometriotic area, histological score of implants, adhesion formation, plasma VEGF, TNF, PTX-3 and CRP levels were significantly lower in the losartan group compared with control (P0.05). ConclusionLosartan suppressed the implant surface area of experimental endometriosis in rats and reduced the levels of plasma VEGF, TNF-, PTX-3 and CRP

The effect of carbamazepine, which increases oestrogen destruction, on the endometriotic implants; an experimental rat model

We planned this experimental study to investigate the effect of carbamazepine (CMZ) on the endometriotic implants. Rats were randomised into four groups after endometriosis surgery. Drinking water was given to the sham group, 0.2 mg/kg oestradiol valerate (EV) to the EV group, 100 mg/kg/day CMZ to the CMZ group, and 0.2 mg/kg EV and 100 mg/kg/day CMZ to the EV-CMZ group. The endometrium of the rats using CMZ stained more intensely with cytochrome P450-3A4 (CYP3A4) enzyme. No endometrial hyperplasia was found in these rats. Endometriotic implants weight was found to be higher in these rats. There was no difference between the groups in terms of staining of the endometriotic implants with CYP3A4 enzyme. Endometriotic implants were less stained with the CYP3A4 enzyme than the endometrium. According to our results, CMZ does not increase the destruction of oestrogen in the endometriotic implants, unlike the endometrium. It may even cause the lesion to enlarge.Impact statement What is already known on this subject? Endometriosis is an oestrogen-dependent, progressive disease. Carbamazepine (CMZ) is known to increase oestrogen degradation by activating the cytochrome P450-3A4 (CYP3A4) enzyme. CMZ can be used in the treatment of endometriosis because it increases oestrogen breakdown in tissues. What do the results of this study add? CMZ can protect the endometrium against hyperplasia by increasing the amount of CYP3A4 enzyme in the endometrium. This effect could not be demonstrated in the endometriotic implants. The presence of CYP3A4 enzyme less in the endometriotic implants than in the endometrium may explain this situation. In addition, the fact that CMZ does not increase the enzyme in the endometriotic implants may contribute to this situation. What are the implications of these findings for clinical practice and/or further research? CMZ may not be a suitable alternative in the treatment of endometriosis. However, it may protect against endometrial hyperplasia. Clinical studies are needed for this effect