Uterine rupture revisited: predisposing factors, clinical features, management and outcomes from a tertiary care center in Turkey

To determine the predisposing factors, modes of clinical presentation, management modalities and fetomaternal outcomes of uterine rupture cases at a tertiary care center in Turkey. A 14-year retrospective analysis of 61 gravid [> 20 weeks of gestation] uterine rupture cases between January 1998 to March 2012 was carried out. The incidence of ruptured uteri was calculated to be 0.116%. Persistence for vaginal delivery after cesarean was the most common cause of uterine rupture [31.1%]. Ablatio placenta was the most common co-existent obstetric pathology [4.9%]. Bleeding was the main symptom at presentation [44.3%] and complete type of uterine rupture [93.4%] was more likely to occur. Isthmus was the most vulnerable part of uterus [39.3%] for rupture. The longer the interval between rupture and surgical intervention, the longer the duration of hospitalization was. Older patients with increased number of previous pregnancies were likely to have longer hospitalization periods. Rupture of gravid uterus brings about potentially hazardous risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center may reduce the incidence of this condition

Pregnancy associated with brucellosis and acute viral hepatitis: course and outcome [co-infections in pregnancy]

To assess the outcome and course of pregnancies complicated by Brucellosis [BCS] and acute viral hepatitis [AVH] infections. Prospective study. Diyarbakir State Hospital, Turkey. Eighty-eight pregnant women admitted to Diyarbakir State Hospital, Turkey. Serum agglutination test [SAT], Coombs anti-Brucella test and / or blood culture system were used in the diagnosis of BCS. Enzyme-linked immunosorbent assays [ELISA] and polymerase chain reaction [PCR] was used in the diagnosis of viral hepatitis. The clinical course and delivery pattern of 32 healthy pregnant women was compared with that of 32 pregnant women who had BCS and 24 pregnant women who were concurrently infected with BCS and AVH. There was no maternal mortality. Preterm delivery occurred in 18.75% of the 32 pregnant women with BCS and 37.5% of 24 pregnant women with BCS and AVH [P = 0.004]. The incidence of low birth weight was also significant between the two groups [p < 0.0001]. Antepartum hemorrhage might be warning sign of the occurrence of complications in pregnant women with BCS and AVH [p < 0.001]. An important observation from the present study is that maternal BCS and AVH [even concurrent] had no effect on the incidence of congenital malformations or stillbirths; it did increase the incidence of prematurity and low birth weight over that seen in the general delivery population. In spite of the high complication rates, BCS and AVH in pregnancy are well-tolerated diseases even when they occur together

Comparison of hysterosalpingography and laparoscopy in the evaluation of infertile women

To compare tuboperitoneal factors of infertile women by hysterosalpingography [HSG] and laparoscopy. In this cohort study, 82 infertile cases were evaluated retrospectively by laparoscopy, 3 months subsequent to HSG in the Department of Gynecology and Obstetrics, Medical School of Dicle University, Diyarbakir, Turkey, between March 2004 and April 2006. The findings of HSG and laparoscopy were compared. Out of the 82 infertile women, pathological findings were observed in 45.1% by HSG, and 54.9% had no pathological finding. On laparoscopic evaluation, however, pathological findings were observed in 65.85%, and 34.15% had no pathological findings. The pathological findings were detected by laparoscopy in 20 of the 45[44.4%] patients who had no pathological findings by HSG, and no pathological findings were detected by laparoscopy in 3 of the 37 [8.1%] patients who had pathological findings by HSG. Laparoscopy revealed no pathological findings in 6 of the 35 patients who had tubal pathology by HSG. The sensitivity of HSG was 63%, specificity was 89.3%, and the positive predictive value was 92%, with a 55% predictive value, and the accuracy ratio was 72%. Laparoscopy is a superior method for the research of tubal and pelvic pathologies in the evaluation of infertility. However, HSG is a more economical and elementary method suitable for evaluation of endometrial and tubal pathologies, and laparoscopy is an appropriate method for examining the external part of tubae, fimbriae, the relation of tuba and ovary, endometriosis, adhesions, tuberculosis, and other pathologies. Therefore, these 2 methods are not alternative, but complementary