Efficacy of the lactate dehydrogenase (LDH)/lymphocyte ratio (LLR) to reduce the need for X-ray in pregnant patients with COVID-19.

OBJECTIVES: Pregnancy carries a significant risk for coronavirus disease-2019 (COVID-19) due to natural immunosuppression. A previous study from our center has shown that the lactate dehydrogenase (LDH)/lymphocyte ratio (LLR) can be used in the early diagnosis of COVID-19 and predicting mortality. Based on this, we aimed to determine the effect of LLR on early detection of critical pregnant women and mortality in COVID-19. METHODS: The data of 145 patients who were admitted to our hospital between March and December 2020; diagnosed with COVID-19 and hospitalized, were retrospectively analyzed. RESULTS: The median gestation period was 31 weeks (range: 5-41), 30.3% (n: 44) gave birth and 68.3% (n: 99) were pregnant. Median LLR was 0.13 (range: 0.04-0.70). The rate of cough (47% vs. 22.8%; p=0.003) was found to be high in patients with LLR>0.13. The patients were divided into subgroups. The proportion of patients without active complaints was higher in the Q1, followed by the Q4. The proportion of patients with an initial complaint of cough increased as LLR from Q1 to Q4, the distribution of other complaints did not differ between the quartiles. CONCLUSIONS: The higher rate of cough in the group with high LLR indicates that it may be an important indicator of lung involvement during pregnancy. The highest rate of non-treatment follow-up in the lowest LLR group proved that the LLR value at the time of diagnosis can be used as an important clinical marker in pregnant women.

The effect of myometrial invasion on prognostic factors and survival analysis in endometrial carcinoma.

BACKGROUND: We investigated the relationship between myometrial invasion and the prognostic factors on overall and progression free survival in endometrial carcinoma. METHODS: 122 cases operated with endometrial cancer were included into the study. Progression-free survival and overall survival were evaluated according to degree of myometrial invasion. We also investigated the relationship between myometrial invasion and prognostic factors. RESULTS: The 5- year progression-free survival rate was 90 % in stage I, 66 % in stage II, 32 % in stage III and 60 % in stage IV. The 5- year overall survival rate was 95 % in stage I, 89 % in stage II, 49 % in stage III and 30 % in stage IV. The progression free survival and overall survival for patients with more than 50 % myometrial invasion were detected 67 % at 58 months and 66 % at 60 months, respectively. The clinicopathological variables that significantly correlated with myometrial invasion of more than 50 % were as follows: pelvic lymph node metastasis (p: 0,00029-OR: 11.2), cervical stromal invasion (p: 0008-OR:7.9), LVSI (p< 0.0001-OR: 16.5). CONCLUSION: The depth of myometrial invasion is one of the most important prognostic indicators and determinants of therapy in endometrial cancer.

Cervical Conization and the Risk of Preterm Birth: A Population-Based Multicentric Trial of Turkish Cohort.

INTRODUCTION: Cold Knife Conization (CKC) is one of the most effective methods for the treatment of Cervical Intraepithelial Neoplasia (CIN). Some studies showed a relation between preterm birth and the treatment of CIN; on the other hand, other studies do not show such a relationship. AIM: The present study was conducted with the aim to investigate the pregnancy outcomes of Turkish women regarding demographic characteristics, obstetric history, removed tissue, and residual cervical length after CKC and to determine the effect of removed cervical tissue volume and height on preterm birth. MATERIALS AND METHODS: This study was a population-based, multicenter trial that was conducted on singleton pregnancies between January 2007 and December 2013. The control group comprised of 38,892 patients who gave birth during this period. On the other hand, patients who conceived after CKC during this period were invited to the hospital and included in the case group (n=20). The course of pregnancy following CKC was studied. Preterm birth rates, risk factors for preterm birth, conisation age, cervical smear and colposcopic biopsy results and the volume and height of the removed cervical tissue of those patients were evaluated. RESULTS: There was no statistically significant difference in preterm birth rates between the case and the control groups. None of our cases had any identified preterm birth risk factor except for one case. The average height of removed cervical tissue was 12.6±5.4 mm and the average length of the residual cervix after birth was 28.7±4.3 mm. CONCLUSION: Removal of cervical tissue of 12.6±5.4 mm in height and 2.35±2.27 cm3 in volume will not increase the risk of preterm birth of women who do not have any other preterm birth risk factors. If there is no other preterm birth risk factors, term birth is most probably possible after conisation.

Effect of parity on first-trimester uterine artery Doppler indices and their predictive value for pregnancy complications.

AIM: To investigate the relationship between parity and first-trimester uterine artery Doppler indices and determine their predictive value for pregnancy complications. METHODS: In 679 singleton pregnancies (388 parous and 291 nulliparous) attending for routine care at 11-14 weeks of gestation, we recorded maternal characteristics, medical and obstetric history, the presence of protodiastolic notching and measured uterine artery resistance index (RI). RESULTS: Parous women had a lower prevalence of bilateral notches (64 vs. 77.6%; p = 0.0002), median level of RI did not show any significant difference. In parous cases complicated with pregnancy-induced hypertension (PIH) (0.78 vs. 0.70; p = 0.0003) or miscarriage (0.86 vs. 0.71; p = 0.0003) mean levels of RI were significantly higher than in the nulliparous cases. By using mean RI we could predict the cases with PIH (area under curve (AUC) 0.63; p = 0.012), early PIH (AUC 0.84; p < 0.0001) and miscarriage (AUC 0.87; p < 0.0001) in the group of parous women. CONCLUSION: Parity has a significant effect on uterine artery Doppler findings in the first trimester of pregnancy. In the group of parous women the mean level of RI had a higher predictive value for miscarriage, early PIH and PIH.

First trimester maternal serum pregnancy-associated plasma protein-A is a predictive factor for early preterm delivery in normotensive pregnancies.

In this study, we investigated whether the concentrations of pregnancy-associated plasma protein-A (PAPP-A) or free ß-hCG (fßhCG) in the first trimester can identify women at increased risk of subsequent preterm delivery in the absence of hypertensive disorders. Preterm and early preterm deliveries are defined as those deliveries before completing 37 and 34 weeks, respectively. A total of 868 women were enrolled into this study. According to the level of the markers, the patients were evaluated in three groups: 1 - maternal serum level ≤ 5 th percentile, 2 - between 5th and 95th percentiles, 3 - ≥ 95 th percentile. In the group of patients with a PAPP-A level ≤ 5 th percentile [≤ 0.35 multiples of the median (MoM)], mean gestational age (GA) at delivery, mean birth weight and the number of the cases with early preterm delivery were significantly lower than the others. Mean level of PAPP-A was significantly lower in cases with early preterm than term deliveries (0.58 ± 0.32 versus 1.09 ± 0.69; p = 0.01). Maternal serum level of fßhCG did not show significant difference between these groups (0.84 ± 0.45 versus 1.17 ± 0.77; p = 0.15). Low levels of maternal serum PAPP-A (≤ 0.35 MoM) (Odds ratio = 7; 95% confidence interval 1.8-27.7; p = 0.0048) significantly predicted early preterm delivery in normotensive pregnancies. Women with low levels of PAPP-A at first trimester have a higher risk of early preterm delivery even in the absence of hypertensive disorders.

A complete gonadal dysgenesis case with mental retardation, congenital hip dislocation, severe vertebra rotoscoliosis, pectus excavatus, and spina bifida occulta.

BACKGROUND: 46,XY, or Swyer syndrome, is a complete gonadal dysgenesis. Patients usually presents with primary amenorrhea with underdeveloped secondary sex characteristics. Phenotypes of these patients are female. In this report, a Swyer syndrome case is reported with novel clinical features that are classified as connective tissue disorders. This case and the 2 other previously reported Swyer syndrome cases with ascendant aortic aneurysm and diaphragmatic hernia are suggest that the Y chromosome has an important role in the structure of connective tissue. CASE: Here we report a case of a 17-year-old with clinical features of 46,XY complete gonadal dysgenesis including external female genitalia, hypoplastic uterus, hypergonadotrophic hypogonadism, incomplete secondary sex characterics, primary amenorrhea, and normal male karyotype. In addition, she had mild mental retardation, severe rotoscoliosis, pectus excavatus, spina bifida occulta, hip dislocation, and long, slender extremities. She had a rudimentary uterus and streak gonads; after giving her cyclic estrogen and progesterone pills, she was able to menstruate. SUMMARY AND CONCLUSION: In this report, a Swyer syndrome case was discussed regarding clinical features, especially those are not characteristic for Swyer syndrome after a review of the literature.

Pregnancy Outcome of Multiparous Women Aged over 40 Years.

Objective. The aim of this study was to evaluate the effect of maternal age on prenatal and obstetric outcome in multiparaous women. Materials and Methods. A retrospective case control study was conducted, including women aged 40 years and over (study group, n = 97) who delivered at 20 week's gestation or beyond and women aged 20-29 years (control group, n = 97). Results. The mean age of women in the study group was 41.2 ± 1.7 years versus 25.4 ± 2.3 years in the control group. Advanced maternal age was associated with a significantly higher rate of hypertension, diabetes mellitus, fetal complication, and 5-minute Apgar scores <7 (P < 0.05). Caeserean section rate, incidence of placental abruption, preterm delivery, and neonatal intensive care unit admission were more common in the older group, but the differences were not statistically significant. Conclusions. Advanced maternal age is related to maternal and neonatal complications.

Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass.

Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.

Follicular variant of papillary thyroid carcinoma arising from a dermoid cyst: a rare malignancy in young women and review of the literature.

OBJECTIVE: Benign or mature cystic teratomas, also known as dermoid cysts, are composed of mature tissues, which can contain elements of all three germ cell layers. Malignant transformation of a mature cystic teratoma is more common in postmenopausal women, however, it can also, rarely, be identified in younger women. We present a case of a 19-year-old woman with malignant transformation of an ovarian mature cystic teratoma. CASE REPORT: Our case was a 19-year-old woman, who was diagnosed postoperatively with follicular variant of papillary thyroid carcinoma in a mature cystic teratoma. She underwent right cystectomy for adnexal mass. Postoperative metastatic workup revealed a non-metastatic disease and the patient did not undergo any further treatment. After 2 months, a near-total thyroidectomy was performed. Serum thyroglobulin levels were monitored on follow-up and the patient is asymptomatic. CONCLUSION: Malignant transformation of a dermoid cyst is a rare ovarian neoplasm. We believe that unilateral oophorectomy or cystectomy is a reasonable treatment option for cases in which there is no evidence of capsular invasion, vascular invasion or gross metastasis, and preservation of fertility is desired. Total thyroidectomy was diagnosed in selected cases. Serial serum thyroglobulin should be used as a tumor marker for follow-up.

VACTERL-H syndrome: first trimester diagnosis.

We present two consecutive female fetuses with identical upper limb anomalies. The first of the cases was found to have ventriculomegaly, atrial septal defect, anal atresia, narrowing of the duodenal lumen and unilateral renal agenesis at the end of the second trimester. These abnormalities were characteristic of autosomal recessive VACTERL-H syndrome. The second case was diagnosed to have absent radii and thumbs at 11 weeks. Detailed examination of fetal limbs in the first trimester screening in cases with high risk is useful for early detection of this malformation.

Antenatal Bartter syndrome: analysis of two cases with placental findings.

The prenatal diagnosis of Bartter syndrome can be based on the high chloride level in the amniotic fluid. Microscopic examination of the placenta in untreated cases showed extensive mineralization in the chorionic villi in previous studies. Two cases were presented at 26-29 weeks of gestation with severe polyhydramnios. The mothers were treated with Indomethacin, KCl, and serial amniocentesis in order to reduce the amniotic fluid volume and prevent fetal hypokalemia. The microscopic examination of the placenta revealed focal calcification and acute atherosis in placental vessels. The treatment with Indomethacin in the antenatal period can prevent severe nephrocalcinosis.

Correlation between first-trimester maternal serum markers, second-trimester uterine artery doppler indices and pregnancy outcome.

AIMS: The aim of this study was to assess the correlation between first trimester maternal serum free beta-human chorionic gonadotropin (fBHCG), pregnancy-associated plasma protein A (PAPPA), second-trimester uterine artery (UA) Doppler measurements and adverse pregnancy outcomes. METHODS: Serum levels of PAPPA and fBHCG were determined at the first trimester, and patients underwent bilateral UA Doppler assessments at 20-25 weeks of gestation. A serum PAPPA level <0.4 MoM was termed as low and the abnormal Doppler findings were the presence of bilateral notches and RI >0.52 (mean) or unilateral notch and RI >0.66 (90th percentile). RESULTS: Mean PAPPA level was significantly lower in cases with unilateral or bilateral notches (1.09; 0.79 and 0.80 MoM for 0, 1 and 2 notches, p < 0.001). Fifty-two cases (12.8%) had a low PAPPA level; in this group the incidence of abnormal Doppler was significantly higher (34.6 vs. 18.4%, p = 0.011). In the presence of abnormal Doppler in a case with a low serum PAPPA the risk of pregnancy-induced hypertension (OR = 4.56, p = 0.0067), low birth weight (OR = 6.8, p = 0.0002) and the risk of at least one complication (OR = 7.6, p = 0.00001) were significantly high. CONCLUSION: Combination of first- and second-trimester findings might improve the efficiency of screening for pregnancy complications.

Vaginal Schwannoma in a case with uterine myoma.

Only 1% of gynecological neoplasms are vaginal, and mesenchymal tumors constitute only 2% of vaginal neoplasms. The most common form is leiomyomas. Schwannomas arise from the peripheral nerve sheath. We report a case of vaginal schwannoma associated with uterine myoma. A 52-year-old woman presented with lower abdominal pain and menorrhagia for a duration of 6 months. At sonographic examination, the patient was found to have uterine myomas and a solid mass measuring 5x4.5 cm beneath the vaginal wall. At laparotomy, the uterus with myoma was removed using our standard operation procedures. Surgical excision of the mass from vaginal aspect was also undertaken, and the histology demonstrated schwannoma. The tumor cells were vimentin (+), desmin (-), smooth muscle alpha-actin (-), HMB-45 (-), MART-1 (-) and S-100 (+). There is no evidence of recurrence during 6 months follow-up. The differential diagnosis of a mass in the vagina includes also schwannomas. Immunocytochemical labeling of the tumor cells is essential. Simple resection of the mass is the preferred method of treatment.

Maternal plasma fibronectin and advanced oxidative protein products for the prediction of preeclampsia in high risk pregnancies: a prospective cohort study.

OBJECTIVE: To determine whether maternal plasma fibronectin and advanced oxidative protein products (AOPP) can be used for the prediction of preeclampsia in high-risk women. STUDY DESIGN: One hundred pregnant women at high risk of preeclampsia were enrolled in this prospective cohort study. Maternal plasma total fibronectin and AOPP levels were measured at 19-25 weeks of gestation. AOPP levels were also measured in 23 normal non-pregnant women. After delivery, the pregnant cohort was assigned to either the normotensive or preeclamptic group depending on their clinical course. RESULTS: Among the 78 pregnant women who completed the study, 19 (24.3%) developed preeclampsia between 36 and 39 (36.8 +/- 1.0) weeks of gestation. AOPP levels, which are significantly higher in normotensive pregnant women compared to nonpregnant controls (42.55 +/- 15.94 vs. 27.95 +/- 10.5; p = 0.0001) were not significantly different between normotensive and preeclamptic women (42.55 +/- 15.94 vs. 47.45 +/- 14.19 microM; p = 0.23). Plasma fibronectin levels were significantly higher in women who continued to develop preeclampsia rather than remain normotensive (383.68 +/- 19.07 vs. 227.65 +/- 97.39; p < 0.0001). ROC curve analysis shows that total fibronectin >or=360 mg/l is predictive for the development of preeclampsia. The sensitivity, specificity, positive and negative predictive values are 57, 92, 73 and 85%, respectively, with a likelihood ratio of 7.38. CONCLUSION: Second trimester plasma concentrations of AOPP are not altered in women that develop pre-eclampsia later in pregnancy. However, total fibronectin levels are significantly increased and may be used to predict the onset of clinical symptoms of preeclampsia.

A single horn endometrial carcinoma of a uterus bicornis unicollis.

In this report, we describe a case of endometrial carcinoma arising in one horn of a bicornuate uterus. The diagnosis of this rare combination can be missed unless an unrecognized postmenopausal bleeding alerts the gynecologist to make a careful search for both endometrial cavities that may be curetted. Physicians should remember the possible existence of a separate uterine cavity when endometrial cancer is clinically suspected but histology fails to confirm the diagnosis.

Verrucous carcinoma of the cervix in a case with uterine prolapse.

Verrucous carcinoma of the female tract is rare. We present a case involving association of verrucous carcinoma of the cervix with uterine prolapse. A 86-year-old woman was admitted with postmenopausal vaginal bleeding. The gynecologic examination revealed the uterine prolapse with a exophytic tumorous mass (3 x 6 x 8 cm) on the cervix. A punch biopsy was taken from the tumor, which revealed coilocytotic and mild dysplastic changes in the squamous epithelium; invasion of the underlying stroma could not be evaluated. A cervical swab was tested for human papillomavirus (HPV) DNA using the polymerase chain reaction, and HPV type 31 was detected. The tumorous mass was totally excised. The histopathologic diagnosis was consistent with verrucous carcinoma of the cervix: exophytic lesion was composed of thickened, acanthotic papillary squamous epithelium with mild dysplasia and diffuse parakeratosis, and no obvious invasion was observed. The patient was periodically controlled by pelvic examination and was free of progressive disease at 6 months. The diagnosis and treatment of verrucous carcinoma of the cervix may be difficult in some cases. The presence of HPV type 31 in our case might indicate the possibility that HPV is the etiology of this neoplasm.

Comparison of the effects of the levonorgestrel-releasing intrauterine system (Mirena) and depot-medroxyprogesterone acetate (Depo-Provera) on subendometrial microvascularisation and uterine artery blood flow.

OBJECTIVE: To compare the effects of the levonorgestrel-intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA) on subendometrial vascularisation and uterine artery blood flow. STUDY DESIGN: The trial compared 25 patients wearing a LNG-IUS and 25 patients receiving DMPA. The subendometrial blood flow was evaluated using power Doppler analysis; the pulsatility index (PI) and resistance index (RI) in the uterine artery and spiral arteries were evaluated with spectral Doppler. RESULTS: The PI and RI of the uterine artery and endometrial thickness did not differ significantly between the two groups. The subendometrial vascularisation was lower and the PI in the spiral arteries was higher in DMPA-users. CONCLUSION: In spite of a similar prevalence of bleeding disturbances, the effects of DMPA and the LNG-IUS on the subendometrial microvascularisation differ.

Screening properties of human papillomavirus testing for predicting cervical intraepithelial neoplasia in atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion smears: a prospective study.

The aim of the present study was to determine the usefulness of human papillomavirus (HPV) testing for predicting cervical intraepithelial neoplasia (CIN) 1 and 2 to 3 on cervical biopsies in women who had atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) on Papanicolaou tests. In this prospective cohort, 167 women with abnormal cytologic examination (ASCUS and LSIL) were evaluated by colposcopy-directed biopsy and endocervical curettage. Colposcopy was performed on all study participants to obtain cervical tissue for histologic examination for detection of underlying CIN in patients with an initial cytologic test result of ASCUS and LSIL. A sample for HPV DNA detection by polymerase chain reaction was obtained. The HPV type 16 was positive in 35.4% of the 167 women with abnormal cytologic examination result in our gynecologic outpatient's clinic. Histologic diagnosis of CIN 1 was found in 45 of 135 women with ASCUS and in 17 of 32 women with LSIL. According to the cytologic findings, the frequency of CIN grade 2 or 3 in patients classified as ASCUS and LSIL was 12.5% (17/135) and 18.7% (6/32), respectively. Of the ASCUS smears, 9.6% were positive for HPV type 16. The sensitivity of the HPV type 16 using polymerase chain reaction technique threshold in detecting CIN 1 and CIN 2 to 3 was 57% and 46% in ASCUS-LSIL cytologic examination, respectively. The positive predictive value of HPV type 16 ranged from 60% in patients with CIN 1 and 42% in CIN 2 to 3 in ASCUS-LSIL. By contrast, negative predictive value was 58% in patients with CIN 1 and 80% in CIN 2 to 3. The low positive predictive value of HPV testing with ASCUS smears suggests that HPV positivity could be not used for predicting the presence of CIN 2 to 3.

A new metabolic scoring system for analyzing the risk of hypertensive disorders of pregnancy.

OBJECTIVE: The aim of this study was to investigate the relationship between some components of metabolic syndrome (MS) and pregnancy induced hypertension (PIH). STUDY DESIGN: Forty-one patients with PIH (gestational hypertension or preeclampsia) after 32 weeks of gestation were compared with 97 normotensive pregnant women. Metabolic scores (0-4) were created using standard deviations in normotensive cases: mean level + 1SD for BMI (>31 kg/m(2)), mean level + 1SD for triglyceride (>287 mg/dl), mean level + 1SD for fasting serum glucose (>90 mg/dl)) and mean level - 1SD for HDL (<48 mg/dl). RESULTS: The mean values for BMI (31.6 +/- 5.7 vs. 27.7 +/- 3.6; P < 0.0001), fasting triglyceride (341 +/- 129 vs. 220.7 +/- 67; P < 0.0001) and glucose (87.5 +/- 17.1 vs. 79.6 +/- 10.4; P = 0.0009) were higher in hypertensive group. The proportions of the women with a positive result for each of the components were significantly higher in the group of PIH. The percentage of the cases having 2 (35.2 vs. 8.2%; P = 0.0002) and 3 or more (27 vs. 4.1%; P = 0.0003) components of MS was higher in the hypertensive group and the percentage of the cases with none of these factors was high in the normotensive group (10.8 vs. 56.7%; P < 0.0001). CONCLUSION: The presence of multiple components of MS may be a risk factor in the development of PIH. New scoring systems according to the gestational age might be useful in analyzing the risk of PIH.