Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography / Avaliação dos parâmetros lacrimais de pacientes submetidas à indução de ovulação por curto período pela tomografia de coerência óptica do segmento anterior

ABSTRACT Purpose: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time. Methods: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra­diol; eye examinations were also repeated. Result: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively). Conclusion: We observed impro­vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.

RESUMO Objetivo: Os efeitos dos hormônios esteróides se­xuais nos parâmetros lacrimais são conhecidos. O objetivo deste estudo foi examinar como os efeitos nos parâmetros lacrimais durante a exposição a altas doses de esteróides sexuais em um curto período de tempo. Métodos: Quarenta pacientes que foram admitidas na clínica de infertilidade do nosso hospital e planejavam a indução de ovulação por gonadotropinas exógenas. Antes do início da indução da ovulação, os níveis basais de estradiol foram medidos no terceiro dia do ciclo menstrual e os exames oftalmológicos foram efetuados pelo Departamento de Oftalmologia do nosso hospital. Os níveis de estradiol foram medidos no dia da indução da ovulação usando gonadotrofina coriónica humana e comparados aos estradiol basal; exames oftalmológicos também foram repetidos. Resultado: Quarenta mulheres com período reprodutivo e idade média de 33,3 ± 4,2 anos foram incluídas neste estudo. Os níveis basais de estradiol foram significativamente maiores (p<0,001) após a indução da ovulação do que antes desta. Os resultados dos testes de ruptura do filme lacrimal e após a indução foi de 6,2 ± 2,8 s e 8,4 ± 1,4 s respectivamente. Os valores do teste de Schirmer foram 14,3 ± 7,1 mm e 20,6 ± 6,2 mm, respectivamente antes e depois da indução. Ambos os valores foram significativamente maiores após a indução da ovulação (p<0,001; p=0,001 respectivamente). Conclusão: Observamos uma melhora nos testes de função lacrimal após o uso de estradiol, mesmo por tempo limitado. O uso de estradiol durante a menopausa poderá melhorar os sintomas do olho seco em pacientes.

May myo-inositol and d-chiro-inositol (40:1) treatment be a good option on normal-weighted polycystic ovary syndrome patients without insulin resistance?

AIM: To investigate the effectiveness of myo-inositol and d-chiro-inositol (MI:DCI) (40:1) treatment in normal-weight polycystic ovary syndrome (PCOS) patients without insulin resistance. METHODS: This retrospective case-control study included PCOS patients without insulin resistance who were diagnosed in the gynecology and obstetrics clinic of Baskent University Konya Practice and Research Hospital between January 2016 and October 2019 and received at least 6 months of MI:DCI (40:1) treatment. The patients were divided into two groups according to body mass index (BMI). Twenty-nine anovulatory patients without insulin resistance with a BMI of 18-25 were included in group 1 (normal-weight group), whereas 17 patients without insulin resistance with BMI > 25 were included in group 2 (obese/overweight group). Ovulation status of both groups was compared after MI:DCI treatment. RESULTS: Ovulation was detected in 23 of 29 patients in the normal-weight group, whereas it was detected only in 5 of 17 patients in the obese/overweight group; this difference was statistically significant (P < 0.001) (Table 2, Figure 1). Post-treatment progesterone levels of both groups were compared and in the normal-weight PCOS group was significantly higher than the obese/overweight group (P < 0.001) (Table 2, Figure 2). In addition, spontaneous pregnancy following treatment was observed in six of the seven (85.7%) patients in the normal-weight group who wanted to conceive, whereas it was observed in only two of the six (33.3%) patients in the obese/overweight group who wanted to conceive. CONCLUSION: Our results showed that MI:DCI (40:1) treatment may be a first-line treatment in normal-weight PCOS patients without insulin resistance.

Is placental KISS-1 expression associated with first trimester abortion spontaneous?

OBJECTIVE: Several studies have examined biological markers during the first trimester to predict the maintenance of a healthy pregnancy. One such marker is kisspeptin, which is encoded by the KISS-1 gene. We aimed to determine whether firsttrimester pregnancy losses were associated with levels of placental KISS-1 expression. METHODS: This prospective case control study was conducted at a tertiary center. The study group included 27 and 24 patients who underwent dilation and curettage at <10 weeks of gestation, due to first trimester spontaneous pregnancy loss and for elective termination (control), respectively. Placental and decidual tissues from all patients were sectioned and immunohistochemically analyzed for kisspeptin. RESULTS: Age, gravida status, parity number, gestational week, and number of previous abortions did not significantly differ between the groups. KISS-1 expression levels were significantly lower in the group with spontaneous abortion compared with the group with elective termination. The median staining intensity of KISS-1 expression in the elective and spontaneous termination groups were 3 (strong) and 2 (moderate), respectively (P=0.004). KISS-1 expression levels were significantly lower among patients with previous abortions in the elective termination group (P=0.002). CONCLUSION: KISS-1 expression levels were found to be significantly reduced in patients with spontaneous pregnancy loss; KISS-1 plays an important role in the implantation and continuation of pregnancy.

Serum and placental periostin levels in women with early pregnancy loss.

OBJECTIVES: Periostin is secreted from the placenta in the embryonic period and it is emphasized that it may be involved in endometrial implantation. In this study, we aimed to investigate periostin serum levels and placental tissue expression in first trimester pregnancy losses. STUDY DESIGN: In this prospective case-control study, 30 patients who underwent dilatation and curettage with first trimester spontaneous abortion (<10 weeks of gestation) were included in the study group and 30 patients who had voluntary pregnancy termination (<10 gestational weeks) were included in the control group. Serum samples collected from the study and control groups were analyzed usingenzyme-linkedimmunosorbent assay (ELISA), and trophoblastic and decidual tissues were examined using immunohistochemical staining with streptavidin-biotin-peroxidase techniques. RESULTS: There were no significant differences between the groups in terms of age, gravida status, parity number, gestational week, and number of previous abortions. In the spontaneous abortion group, the serum level of periostin was significantly lower than in the voluntary termination group (6.56 ± 4.16 pg/mLvs. 9.51 ± 4.52 pg/mL, p = 0.03). There was no significant difference between the two groups in terms of periostin expression in decidual and trophoblastic tissue (p = 0.617, p = 0.274, p = 0.497). CONCLUSION: Periostin serum levels were significantly reduced in patients with spontaneous pregnancy loss. Periostin can be used as a predictive marker for the success of endometrial implantation.

Evaluation of the tear parameters of ovulation induction patients in a short time period with anterior segment optical coherence tomography.

PURPOSE: The effects of sex steroid hormones on tearparameters are known. Theaim of this studywas to examine the effects on tear parameters during exposure to high-dose sex steroids in a short period of time. METHODS: Forty patients who were admitted to the infertility clinic of our hospital and planned to undergo ovulation induction with exogenous gonadotropins were included in our study. Prior tothe initiation of ovulation induction, the basal levels of estradiol were measured on day 3 of the menstrual cycle and ophthalmologic examinations were performed by the ophthalmology department of our hospital. The estradiol levels were-measured on the day ofovulation induction usinghuman chorionic gonadotropin and compared with basal estra-diol; eye examinations were also repeated. RESULT: Forty women with reproductive period and average age of 33.3 ± 4.2 years were included in this study. Basal levels of estradiol were significantly (p<0.001) higher after ovulation induction than before induction. The scores in the break-up timeand after induction were 6.2 ± 2.8 sn and 8.4 ± 1.4 sn, respectively. The values of Schirmer's test were 14.3 ± 7.1 mm and 20.6 ± 6.2 mm before and after induction, respectively. Both values were significantly higher after ovulation induction (p<0.001; p=0.001, respectively). CONCLUSION: We observed impro-vemet in tear function tests following the use of estradiol even for a limited time.The use of estradiol during menopause may improve dry eye symptoms in patients.

Role of mean platelet volume in pregnancy to predict gestational diabetes mellitus in the first trimester.

Objectives: Gestational diabetes mellitus (GDM) is defined as glucose intolerance detected for the first time in pregnancy or identified during pregnancy. Mean platelet volume (MPV) is a marker of activation and function of platelet. Several studies investigated the relation between MPV and GDM. The purpose of the present study is to predict GDM in the first trimester by using MPV value.Materials and methods: Two hundred pregnant women with GDM and 200 normal pregnant women were enrolled in the study. The first trimester MPV values of GDM and control groups were compared to predict GDM in the first trimester.Results: Women with GDM had higher MPV value compared with the control group (p < .001). The area under the receiver-operator curve was 0.70 for MPV. The cutoff value of MPV was 7.38 fl with 70% sensitivity and 60% specificity. According to the ages, MPV value was higher in GDM group in the individuals who were above 28-year-old (p < .001).Conclusion: MPV can be used to predict GDM in the first trimester.

Phosphodiesterase 4 inhibitor plus metformin is superior to metformin alone for the treatment of polycystic ovary syndrome: A rat model study.

The role of metformin in the management of polycystic ovary syndrome (PCOS) and PCOS-related obesity remains controversial. Recent research on the treatment of PCOS-related obesity investigated novel therapeutic agents with the potential to work synergistically with metformin. The aim of the present study was to determine the synergistic effect of a phosphodiesterase 4 inhibitor (PDE4i) and metformin on weight and hormonal changes in a rat model of PCOS. A total of 40 female Sprague-Dawley rats were randomly divided into 4 groups (n=10/group): Sham; PCOS control (no medication after PCOS induction with dehydroepiandrosterone); metformin (300 mg/kg/day p.o. after PCOS induction); and metformin + PDE4i (300 mg/kg/day p.o. metformin + 0.5 mg/kg/day p.o. PDE4i after PCOS induction). The body weight was measured every 7 days, from day 1 to day 49. Vaginal smears were performed and examined daily via light microscopy for determination of the stage of each rat's estrous cycle. At the end of 21st day and at the end of the study, blood samples were collected from rats and the testosterone and insulin levels were measured. Immunohistochemical staining was performed to quantify phosphorylated cyclic AMP response element-binding protein expression in all groups. At the end of the study, the median body weight differed significantly among the groups (χ2=30.581, P<0.001), being the highest in the PCOS control group and the lowest in the metformin + PDE4i group. At the end of the study, the median testosterone level differed significantly among the groups (χ2=27.057, P<0.001), being the highest in the PCOS control group and the lowest in the metformin + PDE4i group. The cycle was restored to normal at the end of the study in all the rats in the metformin and metformin + PDE4i groups, whereas an irregular cycle persisted in all the rats in the PCOS control group. In conclusion, PDE4i + metformin was superior to metformin alone in reducing weight gain and decreasing the testosterone levels in a rat model of PCOS.

Vitamin D receptor gene TaqI single nucleotide polymorphism is not associated with lead levels in maternal and umbilical cord blood.

PURPOSE: We aimed to investigate the association of vitamin D receptor (VDR) gene TaqI single nucleotide polymorphism (SNPs) with serum lead (Pb) levels in maternal and umbilical cord blood. MATERIALS AND METHODS: Eighty-one patients who lived in Konya, Turkey for the last 3 years and had delivery at Baskent University Konya Hospital in 2016 were included in this study. Venous blood samples were drawn from each volunteer immediately before giving birth to determine the maternal Pb levels and VDR SNPs. Additionally, umbilical cord blood samples were collected from the umbilical vein into tube with EDTA as an anticoagulant immediately after birth to determine Pb levels of the fetus. RESULTS: The median level of Pb in the maternal blood was 29.00 (Interquartile Range (IQR) = 16.35) µg/L and the median Pb level in the cord blood was 22.50 (IQR = 9.75) µg/L. Blood Pb level of women living in the urban area was significantly higher than in those living in the rural area (Z = 2.118; p = .034). There was a very strong positive correlation between the Pb levels in the maternal blood and in the umbilical cord blood (ρ = 0.825, p < .001, respectively). Regarding VDR SNPs, "TT", "TC", and "CC" VDR TaqI genotypes were observed in 28 (34.6%), 45 (55.5%), and eight samples (9.9%), respectively. Pb levels in maternal and cord blood were higher in women with the "CC" VDR TaqI genotype; however, there was no statistically significant difference (p > .05). CONCLUSIONS: Although women with the "CC" VDR TaqI genotype had higher maternal and cord blood Pb levels, this was statistically insignificant and therefore, VDR TaqI SNPs did not significantly affect maternal and umbilical cord blood Pb levels.

Platelet-to-lymphocyte ratio: A new inflammatory marker for the diagnosis of preterm premature rupture of membranes.

OBJECTIVE: Preterm premature rupture of membranes (PPROM) is closely related with maternal and fetal complications. Therefore, early diagnosis is extremely important to provide maternal and fetal well-being. Many inflammatory markers have been evaluated for their ability to diagnose membrane rupture at early stages. We aimed to investigate the relationship between the platelet-to-lymphocyte ratio (PLR) and preterm premature membrane rupture. MATERIAL AND METHODS: In this study, 121 pregnant women with PPROM and 96 age-matched pregnant women with spontaneous preterm labor who were admitted to our hospital between January 2014 and December 2015 were enrolled. Demographic data, complete blood cell count results, and neonatal outcomes were recorded. RESULTS: The neutrophil and platelet counts were higher in the PPROM group (9948.4±3393.2 vs. 7466.1±1698.5/mm3 and 244.5±60 vs. 210.6±64.8/mm3, respectively, p<0.001). The PLR and neutrophil-to-lymphocyte ratios (NLR) were both significantly higher in the PPROM group (p<0.001). Correlation analysis revealed that the PLR was positively correlated with the NLR (r=0.10, p=0.031). The ability of the PLR to diagnose preterm premature rupture of membranes was evaluated using an ROC curve. The sensitivity and specificity of the PLR was 57.8% and 73.7%, respectively, at a threshold >117.14 (p<0.001). CONCLUSION: The PLR might be a cost effective, easy to use, and practical marker for the early diagnosis of PPROM, which can help to determine the appropriate waiting time for delivery and provide maternal and fetal well-being.

GnRH agonist triggering affects the kinetics of embryo development: a comparative study.

BACKGROUND: To evaluate the effects of an ovulation triggering agent, human chorionic gonadotropin (hCG), versus a gonadotropin-releasing hormone agonist (GnRHa) on early embryo development in vitro using a time-lapse system. METHODS: Retrospective analysis of a prospectively collected database. A total of 739 embryos from 152 infertile couples undergoing intracytoplasmic sperm injection cycles. INTERVENTIONS: Embryo culture in a time-lapse incubator (EmbryoScope, Vitrolife, Göteborg, Sweden). MAIN OUTCOME MEASURES: Embryo morphokinetic parameters. RESULTS: In the 152 women, 252 embryos were derived from GnRHa-triggered cycles compared with 487 embryos derived from hCG-triggered cycles. Time-lapse analysis revealed that embryos from cycles triggered by a GnRHa cleaved faster than embryos derived from hCG-triggered cycles. CONCLUSION: Triggering with a GnRHa in in vitro fertilization cycles affects embryo kinetics.

Absence of luteal phase defect and spontaneous pregnancy in IVF patients despite GnRH-agonist trigger and "freeze all policy" without luteal phase support: a report of four cases.

Human chorionic gonadotropin (hCG) is commonly used for final oocyte maturation in "in vitro fertilization" (IVF)-treatment cycles, however, the main important risk is development of severe ovarian hyperstimulation syndrome (OHSS). OHSS can almost be avoided by using gonadotrophin-releasing-hormone agonist for final oocyte maturation in an antagonist protocol. However, primarily this approach lead to a very poor reproductive outcome, despite the use of a standard luteal phase support. The reason seems to be severe luteolysis. Obviously, luteolysis post-gonadotropin-releasing-hormone-agonist (post-GnRH-a) trigger is individual specific, and not all patients will develop a complete luteolysis, as expected previously. Luteolysis can been reverted by the administration of hCG. Unprotected intercourse around the time of ovulation induction and oocyte retrieval can lead to a spontaneous conception in IVF treatment and, endogenous hCG, produced by the trophoblast, will rescue the corpora lutea. Therefore, one should not rely on complete luteolysis after GnRH-a triggering and, especially patients for egg donation and pre-implantation-genetic diagnosis for single gene disorder, have to be counselled to avoid unprotected intercourse.

The role of gynecological, urological, and psychiatric factors in chronic pelvic pain.

AIM: In this study, the effectiveness of diagnostic laparoscopy, one of the methods used in the diagnosis and treatment of chronic pelvic pain, was investigated by the etiological examination of patients with chronic pelvic pain, who were treated and followed up on our clinic, allowing for gynecological, urological, and psychological factors. MATERIALS AND METHODS: In this study, the importance of diagnostic laparoscopy in chronic pelvic pain was assessed in 44 patients diagnosed with chronic pelvic pain between September 2005 and May 2006. Additionally, the records of 31 patients who did not have pelvic pain and on whom laparoscopy was performed due to tubal ligation at the same time were assessed. FINDINGS: The study group and the control group were compared in terms of laparoscopic findings. There were laparoscopic findings in 38 (86 %) of the 44 patients in the study group and pathological findings in 13 (41 %) of the 31 patients in the control group. Differences between the groups were statistically significant (p < 0.05). RESULT: Chronic pelvic pain is a syndrome in which biological and psychosocial factors play a role. Laparoscopy for chronic pelvic pain is an operation based on the "see and fight" principle.

Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonates.

AIM: To investigate the effects of delayed cord clamping (DCC) on peripheral hematopoietic progenitor cells (HPCs) and hematological parameters in premature infants (<32 weeks) during the neonatal period. METHODS: This was a prospective, randomized, and controlled, single-center study. Prior to delivery, 21 infants were randomly assigned to immediate cord clamping (ICC) at 5-10 s and 21 infants to DCC at 30-45 s. One milliliter blood sample was taken in the first 30 min of life. HPCs were measured by three-color flow cytometry using monoclonal antibodies. RESULTS: There were no significant differences between groups in either maternal or neonatal demographics. All HPC counts were higher in the ICC group, but the difference was not significant. CD34+ cell counts were 45.3 ± 36.6/µL in the ICC and 33.2 ± 26.6/µL in the DCC group (P=0.33); multi-potent progenitor cell counts were 43.2 ± 35/µL in the ICC and 31.1 ± 26.6/µL in the DCC group (P=0.28); and hematopoietic stem cell counts were 2.1 ± 2.1/µL in the ICC and 2.1 ± 3.1/µL in the DCC group (P=0.66). CONCLUSION: Contrary to our expectation, all HPC counts were lower in the DCC group.

The effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome.

OBJECTIVE: To evaluate the effects of metformin on the ovarian stromal blood perfusion in the patients with polycystic ovary syndrome (PCOS). METHODS: Twenty-five women with PCOS who underwent a Doppler examination of the ovarian stroma was evaluated; hormonal, anthropometric, and biochemical parameters of patients were determined. After the patients were treated with 850 mg metformin twice a day for 6 months, the same parameters were evaluated in the same patients. RESULTS: After metformin treatment, although pulsatility index (PI) was increased from 1.80 +/- 1.23, 1.84 +/- 1.28 to 2.20 +/- 1.10, 2.19 +/- 0.83 in the right and left ovary, respectively, and resistance index was increased from 0.84 +/- 0.25, 0.83 +/- 0.23 to 1.16 +/- 0.37, 1.10 +/- 0.26 in the right and left ovary respectively (P < 0.05), peak systolic velocity (PSV) was decreased from 12.30 +/- 1.72, 12.34 +/- 1.55 to 10.25 +/- 0.97, 10.53 +/- 1.33 in the right and left ovary respectively (P < 0.05). PI and RI did not show any difference between the homeostatic model assessment insulin resistance index (HOMA-IR) >or= 2.38 and HOMA-IR < 2.38 groups before and after metformin treatment (P > 0.05). However, PSV was decreased significantly from 13.05 +/- 1.35, 12.82 +/- 2.02 to 11.03 +/- 0.71, 10.25 +/- 0.42 in HOMA-IR >or= 2.38 group in the right and left ovary, respectively, and PSV was decreased from 11.50 +/- 2.67, 11.28 +/- 0.26 to 9.10 +/- 0.58, 9.28 +/- 0.25 in HOMA-IR < 2.38 group in the right and left ovary, respectively, before and after metformin treatment (P < 0.05). PSV for both ovaries were positively correlated with HOMA scores before and after metformin treatment [(r = 0.713, P = 0.000; r = 0.617, P = 0.04 and r = 0.635, P= 0.03; r = 0.483, P = 0.031 respectively]. CONCLUSION: Metformin treatment affected ovarian stromal blood flow in PCOS patients.

Polycystic ovary syndrome is associated with elevated plasma soluble CD40 ligand, a marker of coronary artery disease.

OBJECTIVE: To determine the level of plasma soluble CD40 ligand (sCD40L) in patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: Baskent University School of Medicine in Turkey. PATIENT(S): Thirty-one patients with PCOS and 31 non-PCOS (control) patients. INTERVENTION(S): Determination of plasma sCD40L and homocysteine levels. MAIN OUTCOME MEASURE(S): Plasma sCD40L, fasting glucose, fasting insulin, homeostatic model assessment insulin resistance index (HOMA-IR), LH, FSH, E(2), total T, DHEAS, total cholesterol, high- and low-density lipoprotein cholesterol, triglyceride, homocysteine, and high-sensitivity C-reactive protein (hsCRP). RESULT(S): The mean serum fasting insulin and HOMA-IR levels were significantly higher in the PCOS group. The mean serum homocysteine level was significantly higher in the PCOS group. Despite a trend for higher high-sensitivity C-reactive protein levels in the PCOS group, the difference did not reach statistical significance. The mean plasma sCD40L level in the PCOS group was significantly higher than that in the control group (5.14 +/- 3.65 ng/mL vs. 3.45 +/- 2.64 ng/mL, respectively). CONCLUSION(S): Polycystic ovary syndrome is associated with elevated levels of sCD40L and homocysteine.

Are CD57+ natural killer cells really important in early pregnancy failure?

OBJECTIVE: The aim of this study was to compare the CD57+ Natural Killer (NK) cell counts in normal pregnancies and in cases grouped according to different types of early pregnancy failure. MATERIALS AND METHODS: A prospective case control study which was set in Baskent University Faculty of Medicine, Obstetrics and Gynecology Department. A total of 119 women whose pregnancies ended in the first trimester were divided into elective pregnancy termination, incomplete miscarriage, intrauterine demise, ectopic pregnancy and recurrent pregnancy loss groups. CD57+ NK cells were stained and counted in the histologic preparations of the decidua in all of these groups. RESULTS: CD57+ NK cell counts were 2.14+/-1.42 in control, 2.24+/-1.92 in incomplete miscarriage, 1.82+/-1.34 in intrauterine demise, 2.54+/-1.80 in ectopic pregnancy and 3.42+/-2.15 in recurrent pregnancy failure group. There were no statistically significant differences between the control group and the other four groups with respect to the CD57+ NK cell counts. CONCLUSION: This study suggests that CD57+ NK cell count is not associated with early pregnancy failure.

Acute abdomen caused by primary torsion of the omentum in hydatid disease.

Hydatid disease is a considerable social health problem because of its endemic distribution in many countries. Although hydatid disease is usually seen in the liver or lung, it may present anywhere in the body. Here, we present a patient with a primary torsion of a hydatid cyst attached to the greater omentum with a peduncle that caused acute abdomen. This is the first report of a primary torsion of the omentum in hydatid disease. Clinicians are urged to be cognizant of the different and rare locations of hydatid disease, especially in endemic countries.

Efficacy of vaginal misoprostol before hysteroscopy for cervical priming in patients who have undergone cesarean section and no vaginal deliveries.

We wanted to investigate the effect of misoprostol administered vaginally before operative hysteroscopy on cervical dilation, complications, and failure rates in patients who have undergone cesarean section and who have never delivered vaginally. Sixty patients who had undergone cesarean section, who had never delivered vaginally before, and were about to undergo hysteroscopy for various intrauterine lesions were included in this randomized controlled study. Thirty-two patients in the study group were given misoprostol 400 microg, and 28 patients in the control group were given placebo (hexetidine pill) vaginally twice, 6 and 12 hours before the procedure. Primary endpoints were cervical width detected with Hegar dilators and complication and failure rates. Mean cervical width was greater in patients in the study group (6.5 +/- 0.8) than it was in patients in the control group (3.0 +/- 0.6), (p = .0001). Complication and failure rates were lower in patients in the study group (p = .01). Administration of vaginal misoprostol before hysteroscopy proved to be effective in cervical ripening and in reducing complication and failure rates.