Misoprostol-induced termination of secondtrimester pregnancy in women with a history of cesarean section: A retrospective analysis of 56 cases

Objective: To assess the effectivity and safety of misoprostol induced termination of pregnancy in the second trimester in women with a history of previous caesarean section. Materials and Methods: Retrospective analysis of case records from the obstetrics and gynecology department of a tertiary care center between January 2009 and February 2012 was performed. Data derived from 219 women, who underwent a second trimester termination of pregnancy, was analyzed in terms of demographics, clinical findings, laboratory and procedural data. The study group consisted of 56 women with a previous caesarean section and the control group was composed of 163 women without such a history. Termination of pregnancies was conducted by administration of misoprostol at doses of 50-600 mcg intravaginally or by surgical evacuation in cases of failure of medical measures. Results: There was no statistically significant difference between two groups in terms of demographics such as age, menarche, number of pregnancies or live births, smoking habit and co-morbidities. Necessity for blood transfusion (p=0.05) and additional procedure for abortion (p=0.056) were found to be similar in both groups. However, laparotomy (p=0.004), uterine rupture (p=0.016), hysterotomy (

Cesarean scar pregnancy: A case report

Pregnancy implantation to the cesarean scar could be the life threatening, although it is a rare event, its ratio increased along with the increasing rate of cesarean delivery. Early diagnosis and treatment may be lifesaving with preserving fertility in these patients. In transvaginal ultrasonography; presence of an empty uterine and cervical cavity, lack of continuity of myometrial setting at the anterior isthmic region and pregnancy implantation to this region should suggest the diagnosis. In this article, we aimed to present a patient with scar ectopic pregnancy with the review of the literature

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

Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience

Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarreduterine rupture and in those with a history of uterine ruptureMaterial and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiarycenter were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergonefertility-preserving surgery were evaluated.Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotalhysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these,eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36–37 wk. of gestation,and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundalrupture, and their inter-pregnancy interval was 9 and 11 mo., respectively.Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to thehigh morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudentin induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancyintervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should bevalidated in another studies

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1–1.4)], low preoperative haemoglobin [OR: 0.96 (0.94–0.98)], uterine weight [OR: 2.69 (2.62–2.76)], and long operation time [OR: 1.04 (1.02–1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96–1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse

Predisposing Factors in The Occurrence Of Complications After Vaginal Hysterectomy

Objective: To investigate the predisposing risk factors in the occurrence of complications after vaginal hysterectomy. Material and methods: The data obtained from 223 patients, admitted to tertiary care center that underwent vaginal hysterectomy due to benign pathology between January 2006 and March 2012 were retrospectively analyzed.Chisquare test was used to evaluate variables in categorized groups. Results: Group variables occurred age, number of pregnancies and abortion, parity, stage according to pelvic organ prolapse classification (POP-Q), periods of hospitalization and urinary catheterization. The main complications were hemorrhage, febrile morbidity and vaginal vault prolapse. Advanced age (> 60), pelvic prolapse, long-term hospitalization and urinary catheterization, were predisposing factors for the presence of complications. Conclusion: Vaginal hysterectomy is a safe and effective method, although not completely devoid of intraoperative or postoperative complications. Advanced age (> 60), POP-Q stage 3-4 pelvic prolapse, prolonged hospitalization and urinary catheterization were seem to be predisposing conditions for the existence of complications. Appropriate preoperative planning and meticulous postoperative care may be helpful to reduce the rate of complications

The effect of clomiphene citrate on oxidative stress parameters in polycystic ovarian syndrome

This study aimed to examine the possible association between the oxidative stress parameters and clomiphene citrate resistance in polycystic ovary syndrome. The demographic data, hormone profiles and oxidant and antioxidant values of 50 clomiphene citrate-resistant polycystic ovary syndrome patients (Group 1), 32 clomiphene citrate-sensitive polycystic ovary syndrome patients (Group 2) and 87 non-polycystic ovary syndrome patients (Group 3) were compared. The average age, follicle-stimulating hormone, oestradiol, thyroid-stimulating hormone and prolactin values of the three groups were found to be homogeneous. Ferroxidase, catalase and myeloperoxidase levels were determined to be lower in the clomiphene citrate-resistant group compared to clomiphene citrate-sensitive and non-polycystic ovary syndrome groups (p < .001). As a result, Polycystic ovary syndrome patients with clomiphene resistance had lower antioxidant (catalase and ferroxidase) levels compared to those who were sensitive to clomiphene and who did not have polycystic ovary syndrome. The myeloperoxidase levels also demonstrated the same trend, which might be due to a compensation mechanism.Impact Statement What is already known on this subject? In the literature, there are many studies evaluating the association between PCOS and oxidative stress. No research related to antioxidants in clomiphene citrate-sensitive and clomiphene citrate-resistant PCOS patients was found in the relevant literature. What do the results of this study add? In this study, the antioxidants catalase and ferroxidase were found to be lower in PCOS women compared to non-PCOS; however, they were the lowest in clomiphene citrate-resistant PCOS women. Interestingly, myeloperoxidase, which is a part of oxidative stress, was also found to be higher in the non-PCOS group. What are the implications of these findings for clinical practice and/or further research? This study contributes to the literature because it is the first to compare the relation between CC and oxidant and antioxidant markers. These markers will be a guide for PCOS management in patients with CC-R

The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia

Objective: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). Study Design: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. Results: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. Conclusion: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options