Laparoscopic Evacuation of an Early Pregnancy.

STUDY OBJECTIVE: Minimally invasive surgical procedures have shown significant improvement over the last 20 years. Today, nearly half of the surgeries, including oncology, are performed with minimally invasive methods. In obstetrics and gynecology surgery practice, laparoscopy can now be used in almost all operations. In this video, we performed a laparoscopic evacuation of a 12-week missed abortion case like a cesarean section at the time of bilateral salpingectomy. DESIGN: A case report (Canadian Task Force classification III). SETTING: A tertiary referral center in Bursa, Turkey. PATIENT: A 38-year-old patient. INTERVENTION: Laparoscopic evacuation of the pregnancy product (like a cesarean section) and bilateral salpingectomy. The local institutional review board approved the video. MEASUREMENTS AND MAIN RESULTS: Gravida: 4, parity: 3. The patient was in the 12th week of her gestation when we diagnosed a missed abortion. In situs of the operation, there was a 12-week pregnancy filling the pouch of Douglas. We clipped the uterine arteries bilaterally and retracted the bladder flap to create a safe surgical incision in the low anterior segment of the uterus. We used the monopolar cautery to incise the uterus from superior to inferior similar to the low vertical classic uterine incision in the cesarean section. The abortus material was removed with the laparoscopic endobag, and bilateral salpingectomy was performed. CONCLUSION: Developments in minimally invasive surgery are progressing day by day. As advances in laparoscopic and robotic surgery progress, complicated surgical procedures would be done efficiently.

Serum decorin measurement in prediction of the risk for preterm birth.

OBJECTIVE: To define serum decorin (sDEC) levels in healthy pregnants and in patients with preterm labor (PTL), and to introduce possible role of sDEC in predicting the risk for preterm birth (PTB). MATERIALS AND METHODS: Thirty-one women with diagnosis of PTL between 24th to 32nd weeks of pregnancy were compared with 44 healthy pregnants in this prospective case-control study. Maternal blood sDEC and uterine cervical length (CL) measurements were conducted at referral. RESULTS: Median sDEC level was significantly decreased in PTL group (p = 0.013). Median CL was significantly shorter in PTL group (p < 0.001). There was not any correlation between sDEC level and maternal age, BMI, and gestational age at blood sampling time within PTL (p = 0.955, p = 0.609, p = 0.079, respectively) and control groups (p = 0.652, p = 0.131, and p = 0.921, respectively). There was not any association between sDEC level and PTB within 7 days, before 34th weeks, but before 37th weeks there was (p = 0.206, 0.091, and p = 0.026, respectively). There was not any correlation between sDEC level and the CL in PTL group (p = 0.056). CONCLUSIONS: sDEC has a limited effect in prediction of PTB within a week or before 34th weeks. Combination of sDEC with CL measurements predicted PTB before 37th weeks.

The effects of pregnancy on nasal physiology.

BACKGROUND: Nasal congestion that is not present before pregnancy represents a distinct clinical entity called pregnancy rhinitis. The aim of this study is to evaluate the clinical characteristics of nasal physiology over the course of pregnancy. METHODS: The study was conducted with 85 pregnant women and 26 nonpregnant controls. We measured nasal airway patency objectively via acoustic rhinometry (ARM) and anterior rhinomanometry (RMM) and subjectively via the Nasal Obstruction Symptom Evaluation (NOSE) scale in each trimester and compared the results to those of the controls. RESULTS: The NOSE scores of control and pregnant women showed no difference (p = 0.866). Minimal cross-sectional area (MCA1; minimal cross sectional area at nasal valve and MCA2; minimal cross sectional area at the level where the head of inferior turbinate is placed) decreased significantly between the first and third trimesters: first trimester 0.37 cm(2), third trimester 0.31 cm(2). There was no difference between each trimester with regard to total nasal resistance. The correlation analysis between the NOSE score and both total volume and MCA1 in all patients showed no significance (r = -0.10, p = 0.318; r = -0.04, p = 0.654, respectively). CONCLUSION: Pregnancy affects nasal physiology adversely and impairs nasal breathing in some women. However, based on the findings of this study, we concluded that this clinical entity may not be considered as a disease without complementary symptoms despite the presence of objective changes in nasal parameters.

An unusual presentation of a submucous leiomyoma accounting to a non-puerperal uterine inversion: A case report.

Non-puerperal uterine inversion is an extremely rare gynaecological event that is usually associated with uterine tumours such as submucous or cervical leiomyomas. In this report, we describe a case of uterine inversion due to a large submucous leiomyoma in a 42-year-old multiparous and obese Caucasian woman.

Comparison of magnesium sulfate and mannitol in treatment of eclamptic women with posterior reversible encephalopathy syndrome.

OBJECTIVE: To evaluate and compare the effectiveness of magnesium sulfate (MgSO(4)) and mannitol in the treatment of posterior reversible encephalopathy syndrome (PRES) in eclamptic women. STUDY DESIGN: This retrospective analysis includes 62 eclamptic women between 22 and 40 weeks of gestation who were diagnosed with PRES in a tertiary care center. To treat neurological symptoms, 34 women received magnesium sulfate (Group 1) and the remaining 28 received 20% mannitol (Group 2) at the discretion of treating physician. RESULTS: Ten patients from both Group 1 (29%) and Group 2 (35.7%) were normotensive at admission. 59 of 62 patients presented with seizure. All patients underwent fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). Parietooccipital region and cerebellum were the most commonly affected areas. The duration of treatment was significantly shorter in Group 1 than Group 2 (p < 0.001). Neurological examinations and the recovery after treatment were significantly better in favor of MgSO(4) group (p = 0.039). CONCLUSION: Mannitol is not superior to magnesium sulfate in achieving neurological recovery. Magnesium sulfate seems to be the agent of choice for treatment of PRES.

Comparative effects of risedronate, atorvastatin, estrogen and SERMs on bone mass and strength in ovariectomized rats.

OBJECTIVE: The aim of this study was to investigate bone protective effects of risedronate, atorvastatin, raloxifene and clomiphene citrate in ovariectomized rats. METHODS: Our study was conducted on 63 rats at Experimental Research Center of Celal Bayar University. Six-month-old rats were divided into seven groups. There were five drug administered ovariectomized groups, one ovariectomized control group without drug administration and one non-ovariectomized control group without drug administration. Eight weeks postovariectomy, rats were treated with the bisphosphonate risedronate sodium, the statin atorvastatin, the estrogen 17beta-estradiol and the selective estrogen receptor modulators (SERMs) raloxifene hydrochloride and clomiphene citrate by gavage daily for 8 weeks. At the end of the study, rats were killed under anesthesia. For densitometric evaluation, left femurs and tibiae were removed. Left femurs were also used to measure bone volume. Right femurs were used for three-point bending test. RESULTS: Compared to ovariectomized group, femur cortex volume increased significantly in non-ovariectomized group (p=0.016). Compared to non-ovariectomized group, distal femoral metaphyseal and femur midshaft bone mineral density values were significantly lower in ovariectomized group (p=0.047). In ovariectomy+atorvastatin group, whole femur and femur midshaft bone mineral density and three-point bending test maximal load values were significantly higher than ovariectomized group (p=0.049, 0.05, and 0.018). When compared to the ovariectomized group, no significant difference was found with respect to femoral maximum load values in groups treated with risedronate, estrogen, raloxifene and clomiphene (p=0.602, 0.602, 0.75, and 0.927). In ovariectomy+risedronate group, femur midshaft bone mineral density values were significantly higher than the values in ovariectomized group (p=0.023). When compared to ovariectomized group, no significant difference was found with respect to femur midshaft bone mineral density values in groups treated with estrogen, raloxifene and clomiphene (p=0.306, 0.808, and 0.095). CONCLUSIONS: While risedronate sodium prevented the decrease in bone mineral density in ovariectomized rats, atorvastatin maintained mechanical characteristics of bone and also prevented the decrease in bone mineral density as risedronate sodium.

Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction.

PURPOSE: To evaluate the role of ultrasonographic and various maternal and fetal parameters in predicting successful labor induction. METHODS: Body mass index, cervical length, dilatation, effacement, Bishop score, parity, maternal age and birth weight were evaluated in 189 singleton pregnant women at 37-42 weeks of gestation and having induction of labor. All underwent induction of labor with oxytocin. Body mass index was calculated using the formula weight (kg)/height(2) (m), cervical measurement was performed by transvaginal ultrasonography and Bishop score was determined by digital examination of cervix. RESULTS: Logistic regression analysis indicated that the cervical length and body mass index were independent variables in determining the risk of cesarean section (OR = 1.206, P = 0.000, CI 95% = 1.117-1.303; OR = 1.223, P = 0.007, CI 95% = 1.058-1.414 respectively). In multiple linear regression analysis, the effect of cervical length and body mass index on induction delivery interval was found to be statistically significant (t = 5.738, P = 0.000; t = 2.680, P = 0.009, respectively). ROC curve showed that the best parameter in predicting the risk of cesarean section was cervical length and that cervical length and body mass index were better parameters compared to the Bishop score (the areas under the curve are 0.819, 0.701 and 0.416, respectively). CONCLUSIONS: Body mass index and transvaginal cervical length were better predictors compared to the Bishop score in determining the success of labor induction.