Vitamin D levels and C-reactive protein/albumin ratio in pregnant women with cerebral venous sinus thrombosis.

Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.

May human epididymis 4 protein play a role in the etiopathogenesis of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome?

AIM: Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is an extremely advanced form of preeclampsia. Currently, there is no parameter or marker to predict this syndrome; however, it is emphasized that vascular endothelial damage and abnormal immune responses can be the possible etiologies of HELLP syndrome. It is known that human epididymis protein 4 (HE4) is a protease inhibitor and previous studies have shown that HE4 protein levels are increased in many malignancies and inflammatory conditions. Considering that metalloproteinases may also play a role in endothelial damage, which is thought to be involved in the etiopathogenesis of HELLP syndrome, we thought that HE4 protein, which is a protease inhibitor, may be associated with vascular damage. We aimed to investigate the relationship between HELLP syndrome and HE4 protein and to identify a biomarker that can be utilized in the diagnosis of HELLP syndrome. STUDY DESIGN: In this study, 40 patients with HELLP syndrome and 40 healthy pregnant women with similar characteristics without HELLP syndrome were compared. RESULTS: When the results were evaluated, no statistically significant difference was found between serum HE4 protein levels in patients with HELLP syndrome and patients without HELLP syndrome in this study (p: 0.29). CONCLUSION: HE4 protein has no field of use in obstetrics yet. In our study, we aimed to find a new biomarker to identify patients with HELLP syndrome. However, we could not find any statistically significant difference in terms of HE4 protein levels between patients with and without HELLP syndrome. Our study is an important study as it is the first study aiming to use HE4 protein in obstetrics.

Incidence of occult malignancies identified during hysterectomies performed for benign indications.

OBJECTIVE: Hysterectomy is a commonly performed gynaecological procedure worldwide. Although most hysterectomies are performed for benign indications, the possibility of an unexpected malignancy in the final pathology results should be considered. The aim of our study was to investigate the evaluation and management of patients who underwent hysterectomy for benign reasons but were diagnosed with a malignancy in the final pathology results. METHODS: We retrospectively examined the medical records of patients who underwent hysterectomy for benign indications between 2011 and 2017, and recorded the information obtained from these patient files. RESULTS: In total, 1050 patients who underwent hysterectomy for benign indications were included in the study. Among these patients, 127 underwent hysterectomy for uterine prolapse, 230 for uterine myoma, 223 for treatment-resistant menometrorrhagia, 150 for treatment-resistant menometrorrhagia and uterine myoma, 61 for endometriosis, 108 for ovarian cysts, 45 for endometrial polyps, and 106 for treatment-resistant menometrorrhagia and ovarian cysts. In 13 of these patients, malignancy was unexpectedly identified via the final pathology results. Seven of these patients had sarcoma, three had cervical cancer, two had ovarian cancer, and one had metastasis of a haematological malignancy. CONCLUSION: Malignancy was identified in 13 of the 1050 patients included in our study. The incidence of unexpected malignancy in these patients who underwent hysterectomies performed for benign indications was determined to be 1.23%. Seven of these 13 patients had sarcoma. Our results demonstrate the absence of reliable data for preoperative detection of sarcoma.

Use of vacuum-assisted closure in massive puerperal genital hematoma.

Puerperal genital hematomas are rare but life-threatening complications of obstetric emergencies. A pregnant patient (39 weeks) underwent a mediolateral episiotomy during a vaginal delivery. An afterbirth hematoma (approximately 20 cm in diameter) was evacuated, but the use of a vacuum-assisted wound closure system was applied after the sutures opened on the 7th postoperative day. On the 10th day of the vacuum-assisted closure (VAC) application, the wound was completely closed. VAC is an alternative treatment modality that can drain an infection and increase the proportion of granulation tissue in humid and irregular surfaces such as the perineum.