Clinical characteristics, maternal and neonatal outcomes of pregnant women with SARS-CoV-2 infection in Turkey.

OBJECTIVES: To evaluate clinical features, laboratory test results, maternal and neonatal outcomes of pregnant patients with the Coronavirus disease (COVID-19). BACKGROUND: COVID-19 is a highly contagious disease caused by a severe acute respiratory coronavirus 2 (SARS-CoV-2). Healthy pregnant women are more susceptible to developing COVID-19. METHODS: We reviewed clinical data from pregnant patients with a laboratory-confirmed SARS-CoV-2, who were admitted to two tertiary care hospitals in Turkey. Demographic, clinical characteristics, laboratory test results, imaging findings, treatment received, maternal and neonatal outcomes were collected. RESULTS: A total of 24 pregnant women were enrolled in this study. The mean maternal and gestational age was 26.9±5.37 years and 24.15±10.61 weeks, respectively. Cough was observed as the most common symptom (n=15; 62.5 %). The lowest lymphocyte percentage was 20.83±13.05 (%). Nine women have delivered by Caesarean section, while one had a vaginal birth. One woman with critical COVID-19 died 2 days later postpartum. The neonate had been transferred to neonatal intensive care unit and died within 24 hours of birth. CONCLUSION: Our findings showed that except for one patient, the clinical course of COVID-19 during pregnancy was mild. Early hospitalization of pregnant women with confirmed and suspected COVID-19, liberal testing for SARS-CoV-2, active management with a multidisciplinary team seemed to be critical to recovery (Tab. 3, Ref. 31).

Neutrophil to lymphocyte and platelet to lymphocyte ratios increase in ovarian tumors in the presence of frank stromal invasion

Objective: The aim of this study was to assess the predictive value of neutrophil/lymphocyte and platelet/lymphocyte ratios for borderline, malignant ovarian tumors, and borderline cases with microinvasion. Methods: Totally 275 women with sonographically detected ovarian tumor were enrolled for this study. All subjects underwent gynecological surgery via endoscopic or conventional approach and ovarian masses were all evaluated histopathologically by the same pathologist. All study population was divided into three groups as group with borderline tumors, benign tumors, or malignant tumors according to the histopathological diagnosis. Just before surgical intervention, a blood sample was obtained from each participant to analyze CA125 level, neutrophil, platelet, and lymphocyte count. Results: Neutrophil/lymphocyte ratio (AUC = 0.604, P = 0.02) was a significant predictor for malignant cases. Optimal cutoff value for the neutrophil/lymphocyte ratio was found to be 2.47 with 63.4 % sensitivity and 63.5 % specificity for malignancy prediction. Odds ratio of high neutrophil/lymphocyte ratio for malignancy risk was 2.5 (95 % CI 1.3-4.8, P = 0.004). Platelet/lymphocyte ratio (AUC = 0.621, P = 0.007) was a significant predictor for malignant cases. Platelet/lymphocyte ratio (AUC = 0.568, P = 0.05) was also predictive for cases without a benign mass. Optimal cutoff value for the platelet/lymphocyte ratio was found to be 144.3 with 54 % sensitivity and 59 % specificity for malignancy prediction. Odds ratio of high platelet/lymphocyte ratio for malignancy risk was 2.1 (95 % CI 1.1-3.8, P = 0.02). Conclusion: Neutrophil/lymphocyte and platelet/lymphocyte ratios are predictors for malignant ovarian tumors but not borderline tumors even in case of microinvasion (AU)

No disponible

Neutrophil to lymphocyte and platelet to lymphocyte ratios increase in ovarian tumors in the presence of frank stromal invasion.

OBJECTIVE: The aim of this study was to assess the predictive value of neutrophil/lymphocyte and platelet/lymphocyte ratios for borderline, malignant ovarian tumors, and borderline cases with microinvasion. METHODS: Totally 275 women with sonographically detected ovarian tumor were enrolled for this study. All subjects underwent gynecological surgery via endoscopic or conventional approach and ovarian masses were all evaluated histopathologically by the same pathologist. All study population was divided into three groups as group with borderline tumors, benign tumors, or malignant tumors according to the histopathological diagnosis. Just before surgical intervention, a blood sample was obtained from each participant to analyze CA125 level, neutrophil, platelet, and lymphocyte count. RESULTS: Neutrophil/lymphocyte ratio (AUC = 0.604, P = 0.02) was a significant predictor for malignant cases. Optimal cutoff value for the neutrophil/lymphocyte ratio was found to be 2.47 with 63.4% sensitivity and 63.5% specificity for malignancy prediction. Odds ratio of high neutrophil/lymphocyte ratio for malignancy risk was 2.5 (95% CI 1.3-4.8, P = 0.004). Platelet/lymphocyte ratio (AUC = 0.621, P = 0.007) was a significant predictor for malignant cases. Platelet/lymphocyte ratio (AUC = 0.568, P = 0.05) was also predictive for cases without a benign mass. Optimal cutoff value for the platelet/lymphocyte ratio was found to be 144.3 with 54% sensitivity and 59% specificity for malignancy prediction. Odds ratio of high platelet/lymphocyte ratio for malignancy risk was 2.1 (95% CI 1.1-3.8, P = 0.02). CONCLUSION: Neutrophil/lymphocyte and platelet/lymphocyte ratios are predictors for malignant ovarian tumors but not borderline tumors even in case of microinvasion.

Endometrial malignancies arising on endometrial polyps and precursor lesions.

INTRODUCTION: Polyps are covered with endometrial epithelium and composed of varying proportions of gland, stroma, and blood vessels. Traditionally, endometrial polyps are accepted as a precursor of cancer. The aim of this study was to evaluate the relationship between malignancies arising on endometrial polyps and precursor lesions of these malignancies. MATERIALS AND METHODS: Data of patients who underwent total abdominal hysterectomy because of a malignancy diagnosed on endometrial polyps were obtained retrospectively from pathology archives. RESULTS: When all malignancies on endometrial polyp were considered, 37% of cases were Type I, 55% were Type II, and 7% were carcinosarcoma. Endometrial intraepithelial carcinoma (EIC) was detected as tumor-adjacent areas on the polyp in eight of the patients who were diagnosed with serous carcinoma. CONCLUSION: The authors found a precursor lesion in 20 (74%) of their patients who showed endometrial malignancy developing on endometrial polyps. Even when an overt malignancy is not detected on polyps in the curettage material, precursor lesions should be carefully searched.

Levonorgestrel-releasing intrauterine device use as an alternative to surgical therapy for uterine leiomyoma.

OBJECTIVE: To evaluate the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of leiomyoma related menorrhagia and to assess the effect of LNG-IUS on uterine, leiomyoma, and ovarian volume. MATERIALS AND METHODS: In this prospective before and after study, LNG-IUS was inserted in 38 women with myoma-related menorrhagia. The patients were evaluated for serum levels of hemoglobin, hematocrit and uterine, leiomyoma, and ovarian volume at the time of insertion and at six months. RESULTS: Significant reduction in the Pictorial Blood Loss Assessment Chart (PBAC) score and increases in serum hemoglobin levels and in amenorrhea was observed within three months. However, there was no statistically significant reduction in the myoma and uterine volume. Ovarian volume, also, did not changed significantly. CONCLUSION: The use of LNG-IUS is effective in reducing menorrhagia associated with leiomyomas with improvement in hemoglobin levels and may be a simple and effective alternative to surgical treatment of leiomyoma-related abnormal uterine bleeding (AUB-L) without significant influence on the volume of leiomyoma and ovarian and uterine volume.

Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis.

BACKGROUND: In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES: To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY: We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA: Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS: Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS: Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS: In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.

Antioxidant effect of erdosteine and lipoic acid in ovarian ischemia-reperfusion injury.

OBJECTIVE: To investigate the effects of erdosteine and alpha lipoic acid (ALA) in a rat model of ovarian ischaemia-reperfusion injury. STUDY DESIGN: Forty-eight female Wistar albino rats were separated, at random, into six groups of eight rats. The groups were classified as: sham, torsion, detorsion, detorsion+erdosteine 100mg/kg, detorsion+alpha lipoic acid (ALA) 100mg/kg, and detorsion+erdosteine+ALA. The investigators executing the biochemical and histological analyses were blinded to the randomization until the end of the study. RESULTS: The TOS (Total Oxidant Status) and OSI (Oxidative Stress Index) levels are higher in the Torsion and Detorsion groups when compared with the ones in the Sham group (p<0.05). Strong correlation was found between OSI and total histological score in the sham, torsion and detorsion groups (r=0.765, p<0.001). The mean levels of TOS and OSI in the rats that received erdosteine and/or ALA were significantly lower compared with the sham, torsion and detorsion groups (p<0.05). Mean TOS and mean OSI were lower in the detorsion+erdosteine+ALA group compared with the detorsion+erdosteine and detorsion+ALA groups (p<0.05). In comparison with the detorsion group, the numbers of primordial follicles (p=0.006) and primary follicles (p=0.036) were increased in the groups that received erdosteine and/or ALA. CONCLUSIONS: Erdosteine and ALA decreased ischaemia-reperfusion injury in an experimental rat ovarian torsion model; combination treatment had a greater effect than either agent alone. Treatment with erdosteine and/or ALA was found to preserve the loss of reproductive capacity normally observed after ovarian torsion.

Prognostic factors affecting lymph node involvement in cervical cancer.

AIM: Clinical and histopathological factors that affect lymph node involvement in cervical cancer and the prognostic importance of these factors were evaluated in this study. MATERIALS AND METHODS: A total of 179 patients were diagnosed with cervical cancer between January 2001 and June 2010 and were included in this study. The patients' charts were evaluated retrospectively and information was collected by reaching 89 patients and asking questions. RESULTS: When the prognostic factors that affect pelvic lymph node involvement were evaluated, increased tumor size and increased invasion depth, presence of lymphovascular area involvement, and an advanced stage were observed to statistically significantly increase pelvic lymph node involvement. No relationship was found between tumor histology and grade; parametrial, endometrial, vaginal involvement, and pelvic lymph node involvement. CONCLUSION: Knowledge of prognostic factors in cervical cancer plays an important role in determining the morbidity and mortality and the treatment strategies.

Relation of red cell distribution width to the presence and severity of endometriosis.

AIM: Although the exact pathogenesis of endometriosis is not known, it is proposed to be a chronic inflammatory disease. The asso- ciation between red cell distribution width (RDW) and inflammation is well established. Therefore, in the present study, the authors aimed to investigate the association between presence and severity of endometriosis and RDW. MATERIALS AND METHODS: Fifty endometriosis patients and 48 controls were included in the study. The endometriosis group was categorized in two subgroups as mild-to-moderate (n = 35) and moderate-to-severe disease (n = 15). CA-125 and RDW values of all participants were measured. RESULTS: Both RDW (17.7 ± 2.2 vs 14.9 ± 1.5, p < 0.001) and CA-125 (50.6 ± 35.1 vs 27.9 ± 4.8) levels were significantly higher in the endometriosis patients when compared to the control group. Moreover the authors found a significant positive correlation between RDW and CA-125 levels (r: 0.495, p < 0.001). CONCLUSION: The present study results demonstrated that RDW levels were significantly increased in endometrio- sis patients and associated with the severity of endometriosis.

The importance of immediate verification of a cervical cytological abnormality with histology.

BACKGROUND: A serious proportion of the patients with invasive cervical cancer can be women who have had abnormal smear findings known for at least 6 months. AIMS: The aims of the study were to evaluate the cervical cytohistopathologic correlation in the population studied, and to discuss the acceptability of immediate histological verification for minor Papanicolaou smear abnormalities. MATERIALS AND METHODS: A total of 443 patients who were admitted with abnormal smear results and had undergone immediate colposcopy, cervical biopsy and endocervical curretage in the gynecologic oncology clinic between the years of 2003-2009 were enrolled into the present retrospective study. One-way analysis of variance and independent t-tests were used to study the results. RESULTS: The distribution of abnormal smear results were documented as 46.27%, 29.57%, 13.76%, 7.67%, 1.58%, 0.67%, and 0.45% for atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), squamous cell carcinoma (SCC), atypical glandular cell (AGC), and adenocarcinoma, respectively. The percentages of cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) and greater lesions were 70.49%, 35.29%, 15.26%, and 9.75% for HSIL, ASC-H, LSIL, and ASC-US, respectively. Moreover, 38.36% of all the CIN 2-3 or cancer (n = 104) cases originated from those with low grade referral diagnosis (ASC-US and LSIL). CONCLUSIONS: The majority of cases in the study were predominantly ASC-US and LSIL and approximately 40% of all the high grade lesions came from those with low grade referral diagnosis. This shows poor cytohistopathological correlation and calls the triage of minor cytological abnormalities into question.

Radical abdominal trachelectomy is a safe and fertility preserving option for women with early stage cervical cancer.

PURPOSE OF INVESTIGATION: To present the surgical, oncological and obstetrical outcomes gained from patients who underwent radical abdominal trachelectomy (RAT) in Zeynep Kamil Women and Children Diseases Education and Research Hospital and radical Yeditepe University Hospital. METHODS: A total of eight RATs were performed between 2003-2010. Data were obtained from medical and pathological records of the patients. RESULTS: The mean age of the patients was 27.37 +/- 6.39 years. The mean follow-up time of the patients was 33.62 +/- 27.47 months. Three (37.5%) patients had a tumor size smaller than 2 cm, and five (62.5%) patients had a tumor size larger than 2 cm. Seven (87.5%) patients had stage IB1 and one (12.5%) patient had stage IIA tumor. Three (37.5%) patients had late postoperative complications: uterotubal abscess, severe lymphedema and lymphocyst. There were no recurrences. Three patients became pregnant which resulted in two live births and one abortus. The spontaneous pregnancy rate was 50%. CONCLUSION: We think that RAT is a reliable surgical option for a patient with early stage cervical cancer who wants to preserve fertility.

Discrepancy of pre- and postoperative grades of patients with endometrial carcinoma.

PURPOSE: To investigate the diagnostic accuracy of endometrial curettage in patients with endometrial carcinoma. In this retrospective study, pre- and postoperative histopathologic findings of patients with endometrial cancer were investigated. METHODS: 168 patients with the final diagnosis of endometrial cancer were enrolled in the study. Pre- and postoperative histopathologic diagnoses and grades (according to the 1988 FIGO classification) of the patients were compared retrospectively. RESULTS: 22 patients were diagnosed as having endometrial hyperplasia and the remaining 136 patients had endometrial carcinoma preoperatively. Overall discrepancy rate of grades was 39% (31% upgrade, 8% downgrade; p < 0.05). There was also 9% discrepancy between the pre- and postoperative histopathological types. CONCLUSION: It has been suggested that since endometrial cancer patients with low grades according to the preoperative pathologic diagnosis have a potential to upgrade, the management of these patients if myometrial invasion is less than one-half thickness, simply by hysterectomy plus bilateral salpingo-oophorectomy (without lymph node sampling), might actually miss some patients who actually deserve surgical staging. Further studies are needed to draw a sufficient conclusion.

Successful medical treatment of cesarean scar pregnancy: a case report.

OBJECTIVE: Cesarean scar pregnancy is implantation of the pregnancy within the fibrous tissue of the cesarean scar which is completely surrounded by myometrium. METHOD AND RESULT: A 32-year-old woman, gravida 2, para 1 presented at our emergency department with mild lower abdominal pain and minimal vaginal bleeding. She was diagnosed with cesarean scar pregnancy. Conservative treatment with methotrexate 50 mg/m2 was administered IM on days 0 and 8. Her betaHCG value was zero at the 14th week after beginning of the treatment. CONCLUSION: Repeated methotrexate administration in the management of cesarean scar pregnancy should be attempted in informed patients who especially desire fertility and can be closely followed up.

Difficulties in achieving optimal cytoreduction in primary peritoneal carcinoma management.

Primary peritoneal carcinoma (PPC) occurs mostly in older women and rarely in women under 50 years of age. The mean age of patients with PPC in our study was 65.5 years. We present the clinical and demographic data, management of cases and the results of six women who underwent exploratory laparotomy between January 2003 and August 2006.

Investigation of Keyes skin biopsy instrument for cervical biopsy procedures versus Kevorkian biopsy forceps.

OBJECTIVE: We aimed to investigate the utility and efficacy of the Keyes skin biopsy instrument for cervical biopsy procedures. MATERIAL AND METHODS: A prospective clinical trial was conducted on 50 women with cervical lesions. Colposcopy-guided cervical biopsies were collected using a Keyes biopsy punch and a Kevorkian biopsy forceps and the two methods were compared with definitive histopathological examination of the specimens obtained by the loop electrosurgical excision procedure (LEEP), conization or hysterectomy. RESULTS: There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. The sensitivity, specificity, positive and negative predictivity of specimens were all 100% for both methods. CONCLUSIONS: The Keyes biopsy punch was found to be a safe, rapid and accurate diagnostic tool in cervical biopsy procedures. Based on the results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other cervical biopsy methods.

A case of endodermal sinus tumor associated with the first pregnancy and successful management of the second pregnancy: a case report and review of the literature.

BACKGROUND: Pregnancy complicated by endodermal sinus tumor (EST) of the ovary has rarely been reported. CASE: A huge ovarian EST causing bowel obstruction was found in a 22-year-old patient at 34 weeks of gestation. Abnormally high alpha-fetoprotein (AFP) levels suggested a malignant germ cell tumor of the ovary. The patient was submitted to cesarean section and fertility sparing surgery, and then received four courses of combination chemotherapy. There was no evidence of recurrence 19 months after initial treatment but transvaginal ultrasound (US) evaluation showed an intrauterine pregnancy of six weeks. We delivered a 3,200 g healthy male baby with Apgar scores of 8 and 9 by elective cesarean section at 39 weeks of gestation. CONCLUSIONS: Successful outcome of a second pregnancy is possible after treatment with fertility sparing surgery and combination chemotherapy for an endodermal sinus tumor associated with a first pregnancy. Moreover checking of weekly AFP levels and performing monthly abdominal US could be effective for surveillance of these pregnancies. However management of EST during pregnancy should be based on consideration of the patient's presenting condition, preferences, and gestational age.

Primary serous carcinoma of the fallopian tube with synchronous cervical epidermoid carcinoma in situ: a case report.

Primary carcinoma of the fallopian tube is rare and its preoperative diagnosis difficult due to the lack of specific symptoms. In this report we present a rare case of primary carcinoma of the fallopian tube with synchronous cervical high-grade squamous intraepithelial lesion (HSIL). A 39-year-old women was admitted to our hospital for routine gynecological examination and underwent surgery because of the finding of HSIL on a routine papanicolaou smear. The histological diagnosis on cervical biopsy and conization material were of cervical intraepithelial neoplasia III (CIN III). Serous carcinoma of the fallopian tube was incidentally found during a planned hysterectomy operation. Postoperatively the patient received six cycles of adjuvant chemotherapy (carboplatin and paclitaxel) and is still under routine control. In conclusion, the genital tract should be examined in detail in case of any existence of a primary genital tumor and CA125 should be added to the examination.

Management of a case of primary vaginal cancer with irreducible massive uterine prolapse--a case report.

Primary cancer of the vagina constitutes 1-2% of all malignant genital tract tumors in women. As one of the most complicated therapeutic problems in gynecological oncology, this disease had been deemed to be untreatable until the end of 1930s. Presently, as a result of technological improvements in radiotherapy and radical surgery, more favorable prognoses are known to be achieved even in advanced cases. In the present case, a woman with vaginal cancer and Stage IV massive uterovaginal prolapsus, which could not be repositioned under general anesthesia, was repositioned by surgical intervention prior to radiotherapy to avoid any potential vesicovaginal fistula formation. The cervix was bilaterally suspended to the pectineal ligaments by polypropylene mesh.

Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation.

Letrozole was compared with clomiphene citrate (CC) as a first-line treatment for ovulation induction in women with polycystic ovaries (PCOs). A total of 106 women with primary infertility and a diagnosis of PCOs were randomized to receive either 100 mg CC (n = 55) or 2.5 mg letrozole (n = 51) daily for 5 days. Human chorionic gonadotrophin (hCG) at a dose of 10000 IU was administered when at least one follicle with a mean diameter > or = 18 mm was observed using transvaginal ultrasound. The number of mature follicles was significantly lower, but endometrial thickness and ovulation and pregnancy rates were significantly higher in the letrozole group than in the CC group. In conclusion, letrozole is associated with a higher pregnancy rate than CC in PCO patients and may have a role as a first-line treatment for anovulatory patients with PCOs.