Is temporary clamping of the bilateral common iliac artery beneficial in reducing intraoperative blood loss in patients with segmental resected anterior placenta percreta?: A prospective observational study.

OBJECTIVE: The aim of our study was to investigate whether temporary clamping of the bilateral common iliac artery (BCIA) has a role in reducing intraoperative blood loss in patients with segmentally resected anterior placenta percreta or not. METHODS: This prospective observational study included patients with anterior placenta percreta who underwent cesarean segmental resection either with BCIA temporary clamping or without clamping between October 2022 and September 2023. RESULTS: A comparison of demographic, obstetric, and surgical parameters and the need for transfusion (except for postoperative erythrocyte suspension transfusion) between the two groups revealed no significant difference (P > 0.05). In contrast, the amount of intraoperative blood loss (P = 0.001) (1974 ± 749 mL vs 2702 ± 615 mL) and postoperative erythrocyte suspension transfusion (P = 0.046) in patients who underwent BCIA temporary clamping were significantly lower than in those who did not undergo BCIA temporary clamping. CONCLUSION: Temporary clamping of BCIA plays a significant favorable role both in reducing blood loss and the need for postoperative transfusion in patients with placenta percreta who underwent segmental uterine resection.

The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum.

OBJECTIVES: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. MATERIAL AND METHODS: This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. RESULTS: The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7-49.8)], 26-fold [OR = 26.1 (95% CI, 8.17-83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94-27.1)] increase in the likelihood of placenta percreta, respectively. CONCLUSIONS: Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

THE ROLE OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH PREECLAMPSIA.

PURPOSE: To investigate the changes in the microvascular structure of the retina and optic disk by comparing the optical coherence tomography angiography findings in preeclamptic patients with those in healthy pregnant women and healthy nonpregnant women and also to evaluate the preeclamptic patients after delivery by showing whether the changes are permanent or not. METHODS: Fifty preeclamptic, 50 healthy pregnant, and 50 healthy nonpregnant women enrolled in three groups (preeclamptic pregnant women group, healthy pregnant women group, and nonpregnant women group; respectively). Patients in the preeclamptic pregnant women group were evaluated at three different time points including up to 3 hours before delivery (Group 1), 2, or 3 days after delivery (Group 2), and 6 weeks after delivery (Group 3), and compared with each other. All patients underwent a comprehensive ophthalmologic examination including optical coherence tomography angiography. RESULTS: Choriocapillaris blood flow area, deep foveal density, deep temporal density, deep nasal density, and radial peripapillary capillary inside disk density values were significantly lower in the preeclamptic pregnant women group than in the healthy pregnant women group. Deep foveal density and deep nasal density values were significantly higher in Group 3 than in Group 1 and 2, and deep temporal density was significantly higher in Group 3 than in Group 1. CONCLUSION: Optical coherence tomography angiography diagnosed decreased deep retinal capillary density values in the macula of patients with preeclampsia, but these results improved after delivery.

Identification of autophagy-associated miRNA signature for the cervical squamous cell cancer and high-grade cervical intraepithelial lesions.

Cervical cancer markedly threatens women's health worldwide and currently ranks fourth leading cause of cancer mortality in women according to recent global cancer statistics. Recent advances have proven that not only tumor suppressor and oncogenes but also non-coding RNAs including micro RNAs (miRNAs) have significant impact in the development and progression of cervical cancers. Previous studies have identified many cancer-specific miRNAs for the early detection of cervical cancers. However, the diagnostic and prognostic use of autophagy-associated miRNAs for the cervical squamous cell cancer (SCC) cases and high-grade squamous intraepithelial lesion (HSIL) have not been uncovered. In the present study, we revealed that miRNAs are differentially expressed in both cervical SCC and HSIL. A total of 35 HSIL, 35 cervical SCC and 30 healthy controls were enrolled for the present study. Total RNA including miRNAs were isolated from the FFPE tissue samples and miRNA expression levels were quantified by quantitative PCR. Predicted miRNA targets of autophagy related genes were determined using miRNA-target prediction algorithms. MiR-143, miR-372, miR-375 and miR-30c were markedly downregulated in HSIL and cervical SCC. MiR-130a was significantly upregulated in the cervical SCC group compared to HSIL and control groups. MiR-30a, miR-520e, miR-548c and miR-372 were significantly associated with the overall survival of cervical SCC patients and these miRNAs were determined to be significant diagnostic markers as revealed by ROC analysis. Together, these results indicate that autophagy-associated miRNAs are potentially valuable for the differential diagnosis and targeted therapy to cervical cancer.

Is there a role of prophylactic bilateral internal iliac artery ligation on reducing the bleeding during cesarean hysterectomy in patients with placenta percreta? A retrospective cohort study.

OBJECTIVES: Our study aims to evaluate the effect of bilateral prophylactic internal iliac artery ligation (IIAL) on bleeding in patients with placenta percreta who undergo cesarean hysterectomy (CH) with the use of blunt dissection technique. MATERIAL AND METHODS: This retrospective cohort study included 96 patients with placenta percreta who underwent planned CH with using the blunt dissection technique to allow better vesico-uterine dissection at the gynecology and obstetrics unit of a university hospital between the years 2017-2019. We carried out bilateral IIAL before CH in the study group (group 1) while we performed only CH in the control group (group 2). RESULTS: Group 1 and Group 2 consisted of 50 and 46 patients; respectively. There was no statistical difference between the two groups as regards to the mean estimated blood loss, the mean transfused blood products, the mean operation time, and the number of complications. In total, 24 patients (25%) had complications with the finding that the most common one was bladder injury (16/96, 16,66%). CONCLUSIONS: Routine bilateral prophylactic IIAL before CH in placenta percreta cases does not have a beneficial effect on decreasing the amount of bleeding and the amount blood transfusion.

Temporary Clamping of Bilateral Common Iliac Artery During Cesarean Hysterectomy for the Management of Placenta Percreta.

OBJECTIVE: To evaluate whether bilateral common iliac artery (CIA) temporary clamping reduces blood loss during cesarean-hysterectomy of placenta percreta cases. STUDY DESIGN: A total of 32 women, who underwent cesarean-hysterectomy under bilateral CIA temporary clamping (n = 12) and without any arterial clamping or ligation (control group, n = 20) due to placenta percreta in Gaziantep University Hospital were retrospectively evaluated. The intra- and postoperative outcomes such as blood loss, blood transfusion and complications were compared between the two groups. RESULTS: Age, parity, body-mass-index and gestational-age were similar in the two groups. The estimated blood loss was lower in the temporary clamping of CIA group than the control group (595 ± 172 mL vs 1450 ± 662 mL, P < 0.001). The number of intraoperative packed-red-blood-cells (0.17 ± 0.58 units vs 1.85 ± 1.46 units, P = 0.002) and fresh-frozen-plasma (0.17 ± 0.58 units vs 1.7 ± 1.49 units, P = 0.005) transfusions were lower in the CIA temporary clamping group than the control group. The rate of women, who received blood/blood products were significantly lower in the CIA temporary clamping group compared to the control group (75 % vs 16 %, P = 0.001). Duration of operation was longer in the CIA temporary clamping group (140 ± 38 min vs 90 ± 25 min, p = 0.001). No complication or maternal death was encountered during this study. CONCLUSION: Bilateral CIA temporary clamping method reduces the intraoperative blood loss and the amount of intraoperative blood/blood product transfusions during cesarean-hysterectomy due to placenta percreta.

Topical Rifampicin versus Povidone-Iodine for the Prevention of Incisional Surgical Site Infections Following Benign Gynecologic Surgery: A Prospective, Randomized, Controlled Trial.

In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine irrigation on incisional surgical site infection. Superficial incisional surgical site infection (SSI) following gynecologic surgery is a serious problem for both patient and surgeon in terms of increased morbidity, length of hospital stay, anxiety, and costs. Three hundred patients scheduled for abdominal surgery due to various benign gynecological pathologies were randomly assigned to one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1; saline + rifampicin in group 2; saline +10% povidone iodine in group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. The superficial incisional SSI rate increased significantly with the use of saline alone (p = 0.006). There was no significant difference between saline +10% povidone iodine and saline + rifampicin (p=0.055). The results suggest that the incidence of superficial incisional SSI is significantly reduced when irrigation is performed using rifampicin and povidone-iodine compared with using saline alone.

Analysis of cystic hygroma diagnosed in the prenatal period: 5-years' experience at a tertiary hospital in Southeastern Turkey.

PURPOSE: Our aim was to evaluate the association of cystic hygroma (CH) with fetal malformations and also to investigate the outcome of fetuses with CH diagnosed in the prenatal period. METHODS: We divided the CH patients into two main groups as isolated CH or CH associated with the congenital structural abnormality (CSA) by measuring the thickness of CH and showing other fetal abnormalities. Pregnancy outcomes were recorded as spontaneous abortion, elective termination, intrauterine death, live birth, postnatal death, and lost to follow-up. RESULTS: There were 74 cases of fetal CH including 19 in CSA-CH group and 55 in isolated-CH group diagnosed between 11 and 21 weeks' gestation. Karyotype analysis of these 28 patients revealed 18 (64.2%) normal karyotypes. Pregnancy outcomes included 54 elective terminations, five postnatal deaths, one spontaneous abortion, six live births, four intrauterine deaths, and four patients were lost to follow-up. CONCLUSION: In the presence of any CSA concurrent with CH, prognosis may be considered as poor and any additional help of fetal karyotyping is questionable. But fetal karyotyping may be advocated in counseling patients with isolated CH, in which a better prognosis and resolvement of CH may be expected in case of a normal karyotype.

The potential of serum fetal DNA for early diagnosis of gestational trophoblastic disease.

OBJECTIVE: To study cell-free DNA (cfDNA) levels in patients with gestational trophoblastic disease (GTD) in order to test the hypothesis that cfDNA circulating in maternal plasma could provide early detection of GTD. MATERIALS AND METHODS: This study included 32 patients with GTD (complete mole and partial mole) and 30 non-GTD patients in the first trimester of pregnancy with no other medical problems. cfDNA levels in maternal serum were measured using polymerase chain reaction analysis on Y-chromosome-specific sequences. RESULTS: cfDNA was found as 327±367 pg on average in the control group and 600±535 pg in the GTD group. Within the GTD group, the partial mole group had an cfDNA average of 636±549 pg, and the complete mole group had an cfDNA average of 563±536 pg. Although there was a statistically significant difference between the GTD group and the control group in terms of cfDNA (p=0.02), there was no statistically significant difference between the complete mole group and the partial mole group (p=0.76). CONCLUSION: Non-parametric analysis of covariance in terms of cfDNA in GTD was performed, thereby increasing its power and revealing a significant difference compared with the control group. This indicates that maternal peripheral bloodstream cfDNA monitoring might be significant in the early diagnosis of GTD.

DNA Repair Gene (XPD, XRCC4, and XRCC1) Polymorphisms in Patients with Endometrial Hyperplasia: A Pilot Study.

BACKGROUND In this study, we aimed to evaluate the association between endometrial hyperplasia and DNA repair gene (XPD, XRCC4, and XRCC1) polymorphisms. MATERIAL AND METHODS There were 114 cases enrolled in the study in 4 groups: simple endometrial hyperplasia (SH) (Group 1), complex endometrial hyperplasia without atypia (CH) (Group 2), complex atypical endometrial hyperplasia (CAH) (Group 3), and normal endometrium (NE) (Group 4). Of these cases, 37 cases had SH, 36 cases had CH, 16 cases had CAH, and 25 cases had NE. To evaluate an association between atypia and DNA repair genes, we consider a group that included both SH and CH, the endometrial hyperplasia without atypia cases (Group 5). Genomic DNA was isolated from paraffin-embedded endometrial tissue collected from the Pathology Department of Gaziantep University Medical School. Polymerase chain reaction (PCR) and/or restriction fragment length polymorphism (RFLP) method was used for evaluating of XPD (-751), XRCC4 (-1394 and a variable number of tandem repeats in intron 3), and XRCC1 (-399) genes. RESULTS We observed a notable distinction in patients having endometrial hyperplasia without atypia (the SH+CH group) and the CAH group in terms of XPD (-751) gene polymorphisms. A notable contrast was observed in patients with endometrial hyperplasia without atypia (the SH+CH group) and the NE group in terms of XRCC4 (VNTR intron 3) polymorphisms (P=0.026, P=0.018, respectively). CONCLUSIONS It was evident the DNA repair gene XPD and XRCC4 polymorphisms had a role in the pathophysiology of endometrial hyperplasia.

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Comparison of the Kelly's plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions.

PURPOSE: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). MATERIALS AND METHODS: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence,and the daily pad use were recorded. Patients were filled "rinary Distress Inventory-6(UDI-6)", "Incontinence Impact Questionnaire 7(IIQ-7)" and "Index of Female Sexual Function(IFSI)" questionnaire forms at preoperatively,and postoperative 6th month. No usage of pads was accepted as subjective cure rate.Intraoperative,and postoperative complications were noted. RESULTS: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. CONCLUSIONS: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study.

INTRODUCTION: The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. MATERIAL AND METHODS: Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. RESULTS: A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). CONCLUSIONS: Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

Assessment of total sialic acid levels in patients with hyperemesis gravidarum: a preliminary study.

To determine the levels of serum total sialic acid (TSA) in patients with hyperemesis gravidarum (HG) and their gestational age-matched controls. Thirty pregnant women with HG, and 30 healthy pregnant women at up to 14 weeks of gestation were enrolled in this preliminary study. Total sialic acid levels in maternal serum were measured using the quantitative sandwich ELISA method. We observed statistically significant difference in TSA levels between HG and the control groups (p = .003). The identification of the role of SA in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future. Impact Statement What is already known on this subject? The derivatives of neuraminic acid are collectively referred to as sialic acid (SA). Changes in SA levels are known to trigger various conditions and disorders, including inflammatory, cardiovascular, neurological and endocrine diseases. Although a sensitive test capable of identifying hyperemesis gravidarum (HG) would be useful for diagnosis purposes, such a test is currently not available. Studies focussing on identifying new potential indicators and biomarkers for HG - as well as identifying their relevance in establishing diagnosis and assessing disease severity - would not only assist in elucidating the underlying causes of this condition but would also contribute to the development of new diagnostic tests for HG. What the results of this study add? Total sialic acid levels are significantly higher in sera of the patients with HG. The present study is the first in the literature to assess total sialic acid levels in patients with HG and healthy pregnant women before 14 weeks of gestation. What the implications are of these findings for clinical practice and/or further research? Total sialic acid levels could give an idea to clinicians in the etiopathogenesis of HG. The identification of the role of sialic acid in the prediction, diagnosis and follow-up of HG warrants more comprehensive studies in the future.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study.

PURPOSE: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. METHODS: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. RESULTS: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum ß-hCG levels, and duration to resolution of ß-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. CONCLUSION: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

Chondrosarcoma mimicking an adnexal mass: A very rare case report.

Chondrosarcoma is considered as a common primary bone sarcoma. These sarcomas can form large masses without any specific symptoms because there are no barriers in pelvic anatomy to prevent the enlargement of tumors, and can mimic ovarian masses. We present a pelvic chondrosarcoma in a woman aged 37 years who was misdiagnosed as having an ovarian mass due to the limited information obtained from imaging studies. Pelvic chondrosarcoma should be considered in patients who have pelvic masses with solid components. It should be kept in mind that interventions should be performed at centers where there are orthopedic surgeons with experience of this subject.

Summary of 2185 prenatal invasive procedures in a single center: A retrospective analysis.

OBJECTIVE: To determine the frequency, indications, and outcomes of diagnostic invasive prenatal procedures (DIPP) performed in a university hospital. MATERIALS AND METHODS: This retrospective, observational study included 2185 cases of DIPP (chorionic villus sampling, amniocentesis, and cordocentesis) performed at the department of obstetrics and gynecology of a university hospital between 2010 and 2016. We included all DIPP cases performed between 11 and 24 weeks of gestation. We compared the different types of DIPP performed in our hospital. RESULTS: Two thousand one hundred eighty-five procedures were performed (1853 amniocenteses, 326 chorionic villus sampling, and 6 cordocenteses). The main indication for performing invasive procedures was abnormal results of aneuploidy screening for trisomy 21, followed by maternal age, and fetal structural abnormality. The fetal karyotype was altered in 154 (26.1%) cases. Trisomy 21 was the most common aneuploidy followed by trisomy 18, monosomy X, and trisomy 13. Fetal karyotype could not be revealed in 42 (2%) cases due to maternal contamination in 18 cases, inadequate sampling in 4 cases, and failure of cell culture in 27 cases. There were 2 pregnancy losses due to the invasive procedure (only in amniocentesis). CONCLUSION: The ideal approach to pregnancies with a detected chromosomal abnormality should be tailored according to the individual choice of the couples regarding whether they decide for or against a child with a known chromosomal abnormality.

Early vulvar and umbilical incisional scar recurrence of cervical squamous cell carcinoma: Earlier than usually expected.

Cutaneous metastasis is considered as a hazardous condition depending on the mean survival around 9 months, which usually originates from cancers of the breast, lung, ovary, colon, and rarely from the cervix. The crucial prognostic factor of cutaneous metastasis depends on the period between the primary malignancy and cutaneous metastasis. We report two cases of the unusual presentation of squamous cell cancer of the cervix that developed vulvar and umbilical metastasis in the 5th month of primary treatment. Both of our patients survived for 11 months following the primary treatment. In addition, our first case is the earliest vulvar recurrence of cervical carcinoma in the English literature following appropriate medical and surgical management.

Emergency peripartum hysterectomy: single center ten-year experience.

PURPOSE: The purpose of our study is to determine the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a university hospital. METHODS: This retrospective study includes 54 cases of EPH performed at the department of obstetrics and gynecology of Gaziantep University Hospital between the years 2005-2015. We included all hysterectomy cases during the first 24 h after delivery beyond 20 weeks of gestation. We compared the most common indications of EPH between each other. RESULTS: There were 54 EPH out of 8922 deliveries with an incidence of 6.1 per 1000 deliveries during the study period. The most common indication was abnormal placentation (74.0%). Urinary tract injury (33.4%) was the most common intraoperative complication. Bilateral hypogastric artery ligation, urinary tract injury, type of hysterectomy, post-op stay in the hospital, delivery in another hospital and other complications were significantly related to the type of EPH indication (p < 0.05). CONCLUSION: Abnormal placentation was the most common indication for EPH. Previous CS can be suggested as a high-risk factor for abnormal placentation. The delivery should be performed in appropriate clinical settings with experienced surgeons when high-risk factors like abnormal placentations are determined preoperatively.