Pregnancy and Crimean-Congo haemorrhagic fever.

Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5-30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.

Dysmenorrhea treatment with a single daily dose of rofecoxib.

OBJECTIVES: To investigate the efficacy of single daily doses of rofecoxib, a selective inhibitor of cyclooxygenase-2, in dysmenorrhea. METHODS: Fifty-five patients were included in this randomized, placebo-controlled, cross-over study. Patients were randomized to use placebo, naproxen sodium (550 mg), 25 and 50 mg doses of rofecoxib in various orders. Pain intensity, analgesic efficacy of drugs, total number of pills used and side effects were evaluated. RESULTS: Rofecoxib with daily single doses of 25 and 50 mg decreased the pain intensity in a manner similar to naproxen sodium. Most of the patients (85.45% and 96.46%) evaluated the analgesic efficacy of rofecoxib as 'perfectly effective'. Rofecoxib was found to be effective for pain relief both in primary and secondary dysmenorrhea. Gastrointestinal adverse effects were less than those with naproxen sodium. CONCLUSIONS: A 'one a day' dose of 25 mg rofecoxib is an effective choice with lower gastrointestinal adverse effects than naproxen sodium.

Endometrial patterns and endocrinologic characteristics of asymptomatic menopausal women.

The endometrial histology and endocrinologic and demographic characteristics of 556 asymptomatic postmenopausal women, who attended the menopause outpatient clinic at Ankara Numune Education and Research Hospital were studied before initiating estrogen replacement therapy. Of these women, 486 (87.4%) had atrophic endometrium, 37 (6.65%) had proliferative endometrium, 27 (4.86%) had endometrial hyperplasia without atypia, three (0.54%) had endometrial hyperplasia with atypia and three (0.54%) had endometrial adenocarcinoma on their biopsy specimens. When demographic characteristics of the patients were considered, we found that the patients with endometrial adenocarcinoma and endometrial hyperplasia with atypia had potential risk factors for endometrial pathology such as chronic anovulation, diabetes or hypertension. This study confirms that routine endometrial sampling in asymptomatic postmenopausal women is not warranted, but patients with associated risk factors should be screened for endometrial pathology before starting estrogen replacement therapy.

Nucleated red blood cells as a marker in acute and chronic fetal asphyxia.

OBJECTIVE: To investigate the variations of nucleated red blood cell (NRBC) counts in acute and chronic fetal hypoxia and to examine if it could be possible to establish a cutoff value for the number of NRBCs for prediction of fetal acidosis. METHOD: We prospectively studied 77 pregnant women. Patients were grouped as acute (n=11) and chronic fetal distress (n=21) and controls (n=45). At delivery the umbilical cord was double clamped and blood samples were collected. RESULTS: The mean NRBC counts in chronic fetal distress group was higher than acute fetal distress. NRBC counts were found to be correlated with umbilical cord pH (r=-0.57; P<0.001). The cutoff value predicting fetal acidosis was determined as 14/100 leukocytes (sensitivity 87%, specificity 81%) by using ROC analysis. CONCLUSION: The duration and the severity of fetal asphyxia may be predicted by the number of NRBCs per leukocyte.

The predictive value of fetal acoustic stimulation.

OBJECTIVE: To compare the predictive abilities, test duration times, and incidence of nonreactive results in the acoustic stimulation test (AST) and the nonstress test (NST). METHOD: Four-hundred randomly selected patients, delivering within 7 days of a preceding test, were divided into two groups (group I: NST; group II: AST). In the AST group, fetal heart rate tracing were recorded for the first 5 minutes as a baseline recording. If the reactivity criterion was not met, transabdominal acoustic stimulation to the fetal head was performed. In the NST group, nonreactive tests were followed by a repeat NST. In both groups, nonreactive tests were followed by oxytocin challenge test (OCT) on the same day. Depressed 5-minute Apgar scores (< 7) and an umbilical arterial blood pH of < 7.2 were taken as indicators of fetal distress. Sensitivity, specificity, and predictive values of NST and AST were calculated and compared. RESULTS: The incidence of nonreactive tests was lower in the AST group. AST decreased the test duration time by 10.1 minutes. The sensitivity values were 87.5% in the NST group and 85.7 in the AST group; specificities of were found to be 94% for AST and 88% for NST. The negative predictive value was found to be 98% in each group, but the positive predictive value was 54.5% in the AST group and 38.8% in the NST group. CONCLUSION: AST offers benefits, by decreasing the incidence of nonreactive tests and reducing the test time. AST lowers the rate of false positives without changing the negative reliability of NST. It is a safe test and allows more efficient use of perinatal services.

Treatment of bacterial vaginosis with oral or vaginal ornidazole, secnidazole and metronidazole.

OBJECTIVE: To evaluate the clinical efficacy and tolerance of oral or vaginal ornidazole, secnidazole and metronidazole or their combinations for treatment of bacterial vaginosis. METHOD: In an open, randomized, prospective study, 152 patients with bacterial vaginosis according to Amsel's criteria were included into the study. The patients were divided into eight groups: (1) oral ornidazole 2 x 500 mg/day for 5 days; (2) vaginal ornidazole 500 mg/day for 5 days; (3) oral and vaginal ornidazole for 5 days; (4) oral secnidazole 2 g in a single dose; (5) oral secnidazole 2 g in a single dose and vaginal ornidazole 500 mg/day for 5 days; (6) oral secnidazole 2 g in a single dose and vaginal metronidazole 2 x 500 mg/day for 7 days; (7) oral ornidazole 2 x 500 mg/day for 5 days and vaginal metronidazole 2 x 500 mg/day for 7 days; and (8) vaginal metronidazole 2 x 500 mg/day for 7 days. None of the partners received any treatment. RESULT: We found a 100% cure rate in both oral and vaginal ornidazole and oral secnidazole-vaginal metronidazole groups. CONCLUSION: Vaginal treatments including ornidazole and metronidazole are not as effective as both oral and vaginal drug combinations.

Urinary incontinence in women of reproductive age.

We investigated the prevalence and the consequence of urinary incontinence in the Turkish population, representing a composition of European and Asian populations. During a 12-month period, the standard urinary incontinence questionnaire was answered by 1,250 women of reproductive age who were admitted to the outpatient clinic with various gynecologic complaints, except for women whose main complaints were urinary incontinence. These patients were randomly selected by stratification according to the following five age-groups: 18-24, 25-29, 30-34, 35-39, and 40-44. The prevalence of incontinence was measured for each group. Urinary incontinence prevalence was 24.5%; in 6.6% the incontinence occurred at least once daily. The lowest prevalence was found in the younger age-groups (18-29 years) and the highest in 40-44 years of age. Two hundred and sixty-one incontinent women (85%) had never sought medical help. The results indicated that urinary incontinence was common among women of reproductive age and only few sought medical help. We suggest that more public education about women's urinary problems and more attention to this problem by physicians are the mainstays of management.

Nitric oxide production by human umbilical vessels in severe pre-eclampsia.

OBJECTIVE: Pre-eclampsia is characterized by an increased vascular tone which might be related to an abnormal endothelial cell function. As representatives of the fetal circulation, we compared the nitric oxide (NO)-releasing capacity of human umbilical vessels from normal and pre-eclamptic pregnancies. METHODS: Normal and pre-eclamptic umbilical vessels were mounted in parallel in an organ chamber with three perfusion lines superfusing the same detector tissue (rubbed rat aortic ring). In this cascade system the capacity of the umbilical vessels to release NO was measured under basal conditions and after stimulation with histamine, bradykinin or calcium ionophore A23187. RESULTS: Relaxations dependent on basal NO release were found to be significantly higher in pre-eclamptic vessels (especially in veins) than in normal vessels. Conversely, stimulated NO release in response to histamine or bradykinin was significantly decreased in pre-eclamptic umbilical arteries, but not in veins, compared with normal vessels. However, there was no significant difference in the release of NO in response to A23187 between normal and pre-eclamptic vessels. CONCLUSIONS: The NO-releasing and NO-producing capacity in the vessels from fetal circulation is not diminished in pre-eclampsia. However, in pre-eclamptic umbilical arteries the NO release in response to certain stimuli (histamine or bradykinin) is diminished, probably as a result of alterations in the receptor function.

Salpingitis isthmica nodosa in infertility and ectopic pregnancy.

Excised tubal segments from 94 infertile women with tubal obstruction, with a mean infertility duration of 5.3 years, and 40 women with ectopic tubal pregnancy were studied histopathologically to evaluate the association with salpingitis isthmica nodosa (SIN). The mean age of the 94 infertile women with tubal obstruction was 24.5 years. Hysterosalpingographies and laparoscopy were performed on all of them. Only the women with ectopic pregnancies we performed salpingectomy on were included in the present study. The incidence of SIN in women with tubal obstruction was 7.4%, in women with ectopic tubal pregnancy 10%, and in the control group the incidence was 0.2%. In 60% of the cases, SIN was present in both of the tubes. Based on this study, we conclude that SIN is significantly associated with infertility and ectopic tubal pregnancy.

Abdominal pregnancy following gonadotropin treatment.

An abdominal pregnancy after treatment with human menopausal and chorionic gonadotropins is reported. The role of induction of ovulation with human menopausal and chorionic gonadotropins as a cause of ectopic pregnancy has not been delineated. However, it appears that ultrasonography has become one of the most important aids in the diagnosis of abdominal pregnancy.