Evaluation of subfoveal choroidal thickness in pregnant women using enhanced depth imaging optical coherence tomography.

PURPOSE: To evaluate the subfoveal choroidal thickness (SFCT) measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in pregnant women. METHODS: In this prospective and cross-sectional study, 100 pregnant women and 100 age-matched nonpregnant women were enrolled. The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Pregnancy-related factors including gestational age, maternal weight gain, and fetal weight were noted. RESULTS: Mean SFCT was 371.1 ± 61.8 µm in the study group and 337.2 ± 62.4 µm in the control group (p < 0.001). No significant correlation was found between SFCT and spherical refraction, IOP, AL, CCT, OPP, gestational age, maternal weight gain, or fetal weight. CONCLUSION: Our results suggest that subfoveal choroidal thickness increases in pregnant women compared with age-matched nonpregnant women.

Subfoveal choroidal thickness in preeclampsia: comparison with normal pregnant and nonpregnant women.

PURPOSE: To compare the subfoveal choroidal thickness (SFCT) in preeclampsia, normal pregnancy, and non-pregnant women using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: One hundred nineteen volunteers were enrolled in this prospective and comparative study. The participants were divided into three groups: group 1 (33 preeclamptic women), group 2 (46 normal pregnant), and group 3 (40 non-pregnant healthy women). The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Medical records of pregnant women, including gestational age, maternal weight gain, weight, and proteinuria, were noted. RESULTS: Mean SFCT of groups 1, 2, and 3 were 333.8 ± 55.3 µm (range 235-440 µm), 368.6 ± 67.6 µm (range 223-517 µm), and 334.8 ± 59.9 µm (range 197-432 µm), respectively. The mean SFCT was thicker in group 2 than that in groups 1 and 3 (p = 0.045 and p = 0.038, respectively), whereas no significant difference was seen between groups 1 and 3 (p = 1.0). In group 1, SFCT showed a negative correlation with the CCT (p = 0.009, r = -0.493). In group 2, SFCT showed a positive correlation with OPP (p = 0.030, r = 0.321) and a negative correlation with gestational age and fetal weight (p = 0.008, r = -0.387 and p = 0.011, r = -0.373, respectively). CONCLUSION: Our results suggested that SFCT was significantly thicker in normal pregnant women than non-pregnant women. However, SFCT values of preeclamptic women were similar to those of non-pregnant women.

Relation of Preoperative Thrombocytosis between Tumor Stage and Grade in Patients with Endometrial Cancer.

OBJECTIVE: We aimed to evaluate the predictive value of preoperative thrombocytosis for postoperative tumor stage and tumor grade in patients with endometrial cancer. MATERIALS AND METHODS: This was a retrospective study carried out in our gynecologic oncology department between January 2000 and December 2011. We reviewed the medical charts of 190 patients diagnosed with endometrial carcinoma and underwent complete staging procedure. The clinicopathologic characteristics of the patients such as; age, gravidity, parity, menopausal status, body mass index, co-morbidities (diabetes, hypertension etc.), stage, grade, histological subtype, depth of myometrial invasion, peritoneal washing cytology and preoperative platelet count were recorded. Endometrioid adenocarcinomas were graded according to the FIGO classification. Blood samples for the measurement of platelet count were obtained 3 days prior to the surgery. Thrombocytosis was defined as a platelet count of 300×10(9)/L. P values less than 0.05 derived from two-tailed tests were considered statistically significant. RESULTS: The mean age of the study population was 55.4 (range 33-80) years. The mean gravidity was 3.8 (range 0-12) and the mean parity was 3.32 (range 0-11). 108 (56,8%) patients were with body mass index of >30 kg/m(2). The mean platelet count among women was 288, 6±90.7×10(9)/L (range 105-772×10(9)/L). The majority of the patients were with early stage diseases during the surgeries. 170 (89.5%) of the patients had stage I to II disease, and 20 (10.5%) of them had stage III to IV disease. There were no statistical significance between thrombocytosis and age, gravidity, parity, BMI, cancer grade and stage, histological subtype of the tumor, depth of invasion, cervical involvement, intrauterine tumor volume and peritoneal washing cytology. CONCLUSION: We found that preoperative platelet count was not correlated with the stage or grade of endometrial cancer.

Effect of body posture on intraocular pressure and ocular perfusion pressure in nonglaucomatous pregnant women.

PURPOSE: To investigate the effect of different positions on the intraocular pressure (IOP) and ocular perfusion pressure (OPP) in nonglaucomatous pregnant. MATERIAL AND METHODS: Thirty-one women in their third trimester of pregnancy were enrolled in this prospective and observational study. IOP in both eyes was measured with a Tono-pen® in the sitting position (Si-P), in the supine position (Su-P), in the right lateral decubitus position (R-LDP), and left lateral decubitus position (L-LDP). Systolic and diastolic blood pressure (sBP and dBP) were measured with a digital automatic blood pressure monitor at after 10 min in each position. Mean blood pressure ([mBP] = dBP + 1/3 [sBP-dBP]) and mean OPP (OPP = 2/3 mBP-IOP) were also calculated. Three IOP measurements were performed by the same clinician at the 15th min in each position. RESULTS: The mean IOP was 13.6 ± 3.4 mmHg in Si-P; 16.7 ± 3.5 mmHg in Su-P; 16.4 ± 3.5 mmHg in the R-LDP, and 16.6 ± 3.7 mmHg in the L-LDP. IOP was significantly lower in Si-P compared to Su-P, R-LDP, or L-LDP. The mean OPP was 46.41 ± 5.54 in Si-P; 39.71 ± 6.96 in Su-P; 36.81 ± 6.57 in the R-LDP; and 33.53 ± 7.63 in the L-LDP. OPP values were significantly different between each body position when multiple comparisons were performed. CONCLUSION: According to our data we conclude that Si-P yields the lowest IOP and the highest OPP compared with Su-P, R-LDP, and L-LDP in healthy pregnant women.

Can intravenous injection of tranexamic acid be used in routine practice with active management of the third stage of labor in vaginal delivery? A randomized controlled study.

OBJECTIVE: To estimate the effects of adding intravenous tranexamic acid (TA) to the standard active management of third-stage labor to reduce vaginal blood loss during the third and fourth stages of labor. STUDY DESIGN: A prospective, double-blind, equivalence randomized, controlled study was performed. Women were randomly allocated to receive an intravenous infusion of TA (experimental group, n = 228) or 5% glucose (placebo group, n = 226) at delivery of the anterior shoulder. Active management of the third stage of labor, which includes prophylactic injection of 10 IU of oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction following delivery, was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor. RESULTS: Mean estimated blood loss at the third and fourth stages of labor was significantly lower in the experimental group than that in the placebo group (261.5 ± 146.8 mL versus 349.98 ± 188.85 mL, respectively; p < 0.001). The frequency of postpartum hemorrhage > 500 mL was also lower in the experimental group (4, 1.8%) compared with that in the placebo controls (15, [6.8%]; relative risk, 3.76; 95% confidence interval, 1.27 to 11.15; p = 0.01). No episode of thrombosis occurred in the women who received TA. CONCLUSIONS: The use of TA with standard active management of the third stage of labor reduced postpartum blood loss, and no increase in the incidence of thromboembolic events was observed.

Osseous metaplasia of the cervix and endometrium: a case of secondary infertility.

OBJECTIVE: To report a case of osseous metaplasia of the cervix and endometrium as a cause of secondary infertility. DESIGN: Case report. SETTING: Istanbul Bakirkoy Women and Children Teaching and Research Hospital. PATIENT(S): A 31-year-old patient with secondary infertility owing to osseous metaplasia of the endometrium and cervix in whom uterine perforation occurred during the removal of bone fragments. INTERVENTION(S): Diagnostic and operative hysteroscopy and laparotomy. MAIN OUTCOME MEASURE(S): Visualization of the disappearance of the osseous metaplasia region with transvaginal ultrasound examination after the hysteroscopy intervention. RESULT(S): Osseous metaplasia lesions are removed by operative hysteroscopy. During this operation, laparotomy was done because of perforation of the uterine wall, and the perforated area was repaired. Two weeks after surgery, the patient underwent a transvaginal ultrasound examination, and the abnormal ultrasound appearance had resolved. CONCLUSION(S): As a rare cause of infertility, osseous metaplasia can be seen in the cervix and the endometrium. If osseous metaplasia is deep enough during operative hysteroscopy, uterine perforation may occur. Clinicians must be careful for this reason, especially in cases of deep osseous metaplasia.

Using intraumbilical vein injection of oxytocin in routine practice with active management of the third stage of labor: a randomized controlled trial.

OBJECTIVE: To estimate the efficacy of the routine use of intraumbilical vein injection of oxytocin with active management of the third stage of labor in reducing blood loss and length of the third stage. METHODS: In this prospective, randomized, double-blind trial, 412 women undergoing vaginal delivery who did not have risk factors for postpartum hemorrhage were randomly allocated to receive either 20 international units oxytocin diluted with 26 mL saline (n=207) or 30 mL saline (n=205) by intraumbilical vein injection. Active management of the third stage of labor (prophylactic injection of 10 international units oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction) was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor. RESULTS: The mean estimated blood loss was significantly lower in women treated with oxytocin compared with women in the placebo group (195.3+/-81.0 mL compared with 288.3+/-134.1 mL, respectively; P<.001). The third stage of labor was significantly shorter in the oxytocin group than in the placebo group (4.5+/-1.6 minutes compared with 7.9+/-3.4 minutes, respectively; P<.001). The percentages of placentas remaining undelivered beyond 15 minutes were 0% in the oxytocin group and 4.4% in the placebo group (P=.002). CONCLUSION: The use of intraumbilical injection of oxytocin with the active management of the third stage of labor significantly reduced postpartum blood loss and the duration of the third stage. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094028. LEVEL OF EVIDENCE: I.

Effects of perineal trauma on postpartum sexual function.

AIM: This article is a report of a study of the extent of postpartum sexual dysfunction associated with perineal trauma. BACKGROUND: Sexual health problems are common in the postpartum period but despite this it is a topic that lacks professional recognition. After delivery, many women experience reduced sexual desire and reduced vaginal lubrication, as well as weaker and shorter orgasms. METHODS: Women giving birth in the study hospital between 2005 and 2006 and meeting the inclusion criteria were studied, i.e. women at low-risk who expected vaginal delivery at over 38 weeks' gestation with a single foetus in the vertex position. One hundred and sixty-five women were invited for postpartum check-ups 3 months later and 55 attended. A detailed gynaecologic examination was carried out and the perineum was carefully inspected by the same physician. Questionnaires were administered and 20-minute face-to-face interviews were carried out to compare the women's sexual lives before pregnancy and after giving birth. FINDINGS: Compared to women with intact perineum, those who had both episiotomy and second degree perineal tears, had lower levels of libido, orgasm, and sexual satisfaction and more pain during intercourse. The presence of at least one sexual problem (reduced sexual desire, reduced vaginal arousal, reduced vaginal lubrication, reduced frequency of orgasm, dissatisfaction with sexual life and dyspareunia) was statistically significant more common after birth. CONCLUSION: Limiting perineal trauma during delivery is important for the resumption of sexual intercourse after childbirth. Routine episiotomy and fundal pressure should be avoided to prevent perineal trauma.

Successful treatment of primary vaginal diffuse large B-cell lymphoma using chemotherapy.

OBJECTIVE: Non-Hodgkins lymphomas (NHL) rarely affect the vagina. As a result, a standard treatment has not been defined. CASE REPORT: A 34-year-old female virgin patient with a primary vaginal NHL stage IEA, diffuse large cell B lineage, showed an excellent response to cytotoxic chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) without surgery or radiotherapy. She had experienced no recurrence after 40 months. CONCLUSION: In young patients who wish to preserve their fertility, chemotherapy alone may be the treatment of choice for primary diffuse large B-cell NHL of the lower female genital tract.

Primary primitive neuroectodermal tumor of the uterus: a case report.

Neuroendocrine carcinomas primitive neuroectodermal tumor (PNET) arise from Kulchitsky cells and are frequently seen in gastrointestinal tract and lungs. But they are unusual in gynecology practice. We presented a case of PNET arising in the uterine corpus of a 22-year-old woman. To our knowledge, this is the first description of small-cell carcinoma of the uterine corpus with a pseudocyst formation within the myometrium without endometrial invasion.

Persistent subumbilical discharge associated with actinomycosis caused by intrauterine contraceptive device: a case report.

Intrauterine devices are a very effective form of contraception used worldwide for more than 2 centuries. One of the serious, but rare, complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. In this report we describe, persistent periumbilical discharge associated actinomycosis caused by migration of a copper intrauterine contraceptive device. To our knowledge, this is the first report of persistent periumbilical discharge caused by migration of a copper intrauterine contraceptive device. We recommend consideration of this minor possibility during evaluation of women with chronic abdominal discharge.

Complete surgical resection of retroperitoneal leiomyosarcoma in pregnancy: a case report.

Retroperitoneal soft tissue sarcoma (RPS) is extremely rare in pregnancy, so there has been little experience in dialing with this condition. We report our experience of a pregnant patient with a retroperitoneal soft tissue sarcoma, which was treated by complete surgical resection at 17 weeks gestation. After regular follow-up, the patient admitted to our hospital in labor, in the 38th gestational week and vaginally delivered a male fetus weighing 3,200 g with Apgar score of 8 and 10 at 1 and 5 min respectively. Adjuvant radiotherapy and chemotherapy is controversial in RPS and due to postoperative continuation of pregnancy in our case, the adjuvant therapy was not practiced. The patient had an uneventful recovery, and no recurrence was detected for 20 months in the follow-up period.

Postmenopausal tuberculosis endometritis.

Tuberculosis remains a global health problem, primarily in developing countries with inadequate health services. A significant portion of tuberculosis in these settings is extrapulmonary, including tuberculosis of the genitourinary tract. Patients with genital tuberculosis are usually young women detected during work up for infertility. After menopause, tuberculosis of the endometrium is a rare possibility probably because of the decreased vascularity of the tissues. We present a case of endometrial tuberculosis with postmenopausal vaginal bleeding.

Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for congenital cystic adenomatoid malformation of the lung.

BACKGROUND: Spontaneous monochorionic triamniotic pregnancy is rare and is at increased risk for pregnancy complications. The presence of an anomalous fetus further complicates the management. CASE PRESENTATION: We present a case of monochorionic triamniotic triplet pregnancy diagnosed at 15 weeks of gestation with one fetus having developed a multicystic lung lesion, suggestive of congenital cystic adenomatoid malformation (CCAM). At 24 weeks, the largest cyst measured 10 mm in diameter. We managed the pregnancy conservatively and delivered three live male fetuses with birth weights 1560 g, 1580 g and 1590 g at 35 weeks of gestation. Two newborns were admitted to the neonatal intensive care unit with respiratory distress, the third one died due to sepsis 7 days postpartum. One of the newborns was discharged healthy at 24 days postpartum. The newborn with CCAM developed a pneumothorax on the right side, recovered after treatment, and was discharged after one month. Computerized tomography (CT) of the infant at 3 months demonstrated two cystic lesions in the middle lobe of the right lung measuring 25 mm and 15 mm. A repeat CT of the infant at 6 months showed a 30 mm solitary cystic mass. CONCLUSION: Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for CCAM, present rarely and can be managed conservatively. These findings may help in decision making and counselling of parents.