Elective cervical cerclage versus no treatment in women with the history of cervical insufficiency: retrospective analysis of pregnancy outcomes.

PURPOSE OF INVESTIGATION: To evaluate the effectiveness of elective cervical cerclage (CC) on the pregnancy outcome of patients with cervical insufficiency. MATERIAL AND METHODS: A retrospective cohort study was conducted on women with an obstetric history of cervical insufficiency on whom CC was applied or not. The two groups were compared for the main measure outcomes of mean gestational age at delivery, birth weight, Apgar scores at five minutes, number of premature and preterm deliveries, rate of preterm premature rupture of membranes, incidence of neonatal death, and admission to the neonatal intensive care unit (NICU). RESULTS: A total of 183 women were eligible for the final analysis in the CC group and 183 were taken as the control group. There were significant differences in terms of the mean gestational age at delivery (37 ± 4.0 vs. 34±5 weeks, p = 0.001), the mean birth weight (3,000 ± 870 vs. 2,200 ± 860 grams, p = 0.001), the number of preterm deliveries (< 37 weeks) (40% vs. 63%, p = 0.001, OR: 0.4, 95% CI: 0.26-0.61) between CC and control groups, respectively. Median Apgar scores at five minutes were 9 in CC group and 8 in the control group (p = 0.001) and the percentages of admission to NICU were 14% in CC group and 34% in the control group (p = 0.001, OR: 0.30, 95% CI: 0.17-0.52). CONCLUSION: The placement of elective CC seemed to be effective in patients with a history of mid-trimester abortion or preterm delivery due to cervical insufficiency.

Is thrombin-activatable fibrinolysis inhibitor antigen (TAFIag) level significant in recurrent miscarriage?

OBJECTIVE: The aim of this study was to evaluate the plasma thrombin-tat fibrinolysis inhibitor antigen (TAFIag) levels in women with recurrent miscarriage (RM) and age-matched healthy parous women as controls. MATERIALS AND METHODS: A total of 80 patients were enrolled in this study. As a study group (group 1), the authors evaluated 49 RM patients who had two or more consecutive abortions with unknown etiology before 12 weeks of gestation. The remaining 31 patients (group 2) were age-matched healthy parous women with no history of miscarriage and experienced at least one live baby. RESULTS: Comparisons of blood TAFIag levels revealed no statistically significant difference between women with recurrent miscarriages and control group. CONCLUSIONS: The findings of the present study indicated that TAFIag level was not associated with recurrent miscarriages.

Experience of hysteroscopy indications and complications in 5,474 cases.

OBJECTIVE: To evaluate the indications, intraoperative diagnoses, and complication rates of both diagnostic and operative hysteroscopic procedures. MATERIALS AND METHODS: Five thousand four hundred seventy-four (5474) hysteroscopic procedures performed in the department of gynecologic endoscopy unit between May 2005 and December 2012 were retrospectively analyzed from the archives. Indications, intraoperative diagnosis, and complications of all gynecological endoscopic procedures are recorded. RESULTS: Abnormal uterine bleeding in premenopausal and postmenopausal women was the most frequent indication for diagnostic hysteroscopies in 1,887 (40%) cases. The most common preoperative indication for operative hysteroscopy was endometrial polyps in 469 (55.7%) cases and submucous leiomyomas in 151 (17.9%) cases. In this series, the most common complication was uterine perforation which occured in 15 (0.27%) out of 5,474 cases and the rate for diagnostic hysteroscopy and operative hysteroscopy was 0.06% and 1%, respectively. CONCLUSION: Hysteroscopy is a safe and effective minimally invasive procedure with very low complication rate.

Does Kruger's strict criteria have prognostic value in predicting ICSI clinical results?

OBJECTIVE: The purpose of this study was to compare clinical results of ICSI for different sperm morphology subgroups divided according to Kruger's classification system. MATERIALS AND METHODS: This retrospectively study was conducted at Zeynep Kamil Training and Researching Hospital in Istanbul (Turkey). The study included 332 intracytoplasmic sperm injection (ICSI) cycles. The patients were under 37 years of age with primary infertility who were admitted to the Department of Reproductive Endocrinology and Infertility, from January 2005 to June 2009. The patients were divided in three groups based on Kruger's strict criteria. Normal sperm morphology was less than 4% in group 1, between 4-14% in group 2, and greater than 14% in group 3. All patients underwent ICSI and embryo transfer (ET) following controlled ovarian hyperstimulation (COH). The groups were compared to the rates of fertilization, implantation, clinical pregnancy, abortion, and live birth. RESULTS: Pregnancy occurred in 132 (39.7%) of all ICSI cycles. There was no statistically significant difference between regarding groups regarding the rates of fertilization, implantation, clinical pregnancy, biochemical pregnancy, abortion, and live birth. CONCLUSION: The authors concluded that the normal sperm morphology defined by Kruger's strict criteria and sperm motility will not be able to predict prognosis of ICSI cycles.

Synchronous primary cancers of the endometrium and ovary: a case report.

Synchronous primary cancers of the endometrium and ovary are found in 5% of women with endometrial cancer and 10% of women with ovarian cancer. In the present case, a multigravid 46-year-old woman complained of lower abdominal pain and abdominal distension. She did not define abnormal uterine bleeding. Screening ultrasound revealed a papillary containing structure, irregular, cystic 16 x 15 x 10 cm right ovarian mass. Preoperative endometrial biopsy revealed endometrioid adenocarcinoma. Ascites sampling, radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, omentectomy, appendectomy and cytologic sampling of the undersurface of the diaphragm were carried out. Intraoperative and histological examinations showed Stage IIIC papillary serous carcinoma and stage IC endometrioid adenocarcinoma. Synchronous genital tract neoplasms constitute a more common clinical problem than would generally be expected.