Reproductive outcome of women with unicornuate uterus.

This study was undertaken to examine the reproductive impact of unicornuate uterine abnormalities cases in a group of 571 women with a uterine anomaly. Hospital records of 1784 patients who presented to the infertility outpatient clinic with infertility, recurrent pregnancy loss, pain or acute abdomen during the study period between January 1991 and January 2001, were reviewed retrospectively. The reproductive performance of women with unicornuate uterus was poor, with a live birth rate of only 29.2%, prematurity rate of 44%, miscarriage rate of 29%, and an ectopic pregnancy rate of 4%.

Septate uterus with a double cervix and longitudinal vaginal septum.

OBJECTIVE: To report the clinical features of 9 cases and review the previously reported 8 cases of an uncommon müllerian anomaly, characterized by the presence of a complete uterine septum with cervical duplication and represent a a longitudinal vaginal septum. STUDY DESIGN: Retrospective clinical study. RESULTS: Nine patients aged 21-32 presented to our clinic with complaints of dyspareunia, dysmenorrhea, and primary or secondary infertility. All 9 patients displayed a single uterus with smooth fundal contour, double cervix and longitudinal vaginal septum. Some additional abnormal findings were associated with these anomalies in some patients: polycystic ovaries in 3 cases and different degrees of endometriosis in 2 cases. Most of the patients had normal tubal patency. CONCLUSION: According to a MEDLINE search, only 8 cases of septate uterus with cervical duplication and a longitudinal vaginal septum have been reported to date. We report 9 more cases, which suggest that this atypical septate uterus type is probably more frequent than reported. These cases support the bidirectional müllerian theory and may imply the presence of another type of mullerian anomaly.

Emergency peripartum hysterectomy.

OBJECTIVE: To review the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy. STUDY DESIGN: We analyzed retrospectively 38 cases of emergency peripartum hysterectomy operations performed between January 1996 and June 2001 at Zekai Tahir Burak Women's Health Research and Education Hospital. The indications, risk factors and the associated complications were noted. Standard tests were used to calculate odds ratios (ORs) and their 95% confidence intervals (CI). RESULTS: Thirty-eight cases of postpartum hysterectomy were performed. All of these cases were referred to our center from rural areas. The rate of peripartum hysterectomy was 1/3736 deliveries. The main indications for hysterectomy were placenta accreata, uterine rupture and uterine atony. There were four maternal deaths. CONCLUSION: Peripartum hysterectomy is a necessary life saving operation. Timely operation minimizes the morbidity and mortality.

Maternal deaths and their causes in Ankara, Turkey, 1982-2001.

This study was carried out to determine the incidence and causes of maternal deaths about a 20-year period at the Zekai Tahir Burak Women's Health Education and Research Hospital (ZTBWHERH), Ankara, Turkey. All maternal deaths from January 1982 to July 2001 were reviewed and classified retrospectively. Using a computer-generated list, 348 patients admitted to the Labour Department of ZTBWHERH during 1982-2001 were selected as controls. Medical records were reviewed for demographic data, history of antenatal care, route of delivery, referral history, and perinatal mortality. Cases and controls were compared, and standard tests were used for calculating odds ratio (OR) and 95% confidence interval (CI) for the association of demographic and delivery characteristics. During this period, there were 174 maternal deaths and 430,559 livebirths, giving a maternal mortality ratio of 40.4/100,000 livebirths. The mortality rate declined from 85.1/100,000 in 1982 to 11.6/100,000 in 2001. One hundred thirty (74.7%) deaths were due to direct obstetric causes and 24 (13.7%) were abortion-related, while 20 (11.4%) were due to indirect obstetric causes. The most common cause of direct obstetric deaths was pre-eclampsia/eclampsia, followed by obstetric haemorrhage and embolism. Abortion-related sepsis and haemorrhage, anesthesia-related deaths, obstetric sepsis, acute fatty liver of pregnancy, and ectopic pregnancy accounted for other causes of deaths. Cardiovascular disease was the leading indirect cause of death. Referral, lack of antenatal care, and foetal death at admittance were associated with 8-, 3-, and 6-fold increased risk of maternal mortality respectively (OR 8.89, 95% CI 5.7-13.8; OR 3.74, 95% CI 2.5-5.5; OR 6.38, 95% CI 3.1-13.1). Although maternal mortality ratios have declined at the hospital, especially in the past five years, the rate is still high, and further improvements are needed. The problem of maternal mortality remains multifactorial. Short-term objectives should be focused on improving both medical and administrative practices. Improving the status of women will necessarily remain a long-term objective.

Reproductive outcome of septate uterus after hysteroscopic metroplasty.

We evaluated the reproductive outcome after hysteroscopic metroplasty in the patients with septate uterus. The reproductive performance of 361 patients with septate uterus during the follow-up period of 18 months after the surgery was analyzed retrospectively for a period of 10 years. A total of 180 (49.8%) pregnancies were achieved after metroplasty during the follow-up period of 18 months. Of the 180 pregnancies 117 (57.2%) reached to term and 34 (18.8%) ended in preterm delivery and the remaining 29 (16%) resulted in abortion. Of the preterm babies 18 (52.9%) were able to live. We obtained 135 (75%) live babies totally. Hysteroscopic metroplasty improves the reproductive performance of septate uterus significantly especially in the cases with recurrent pregnancy loss and should be considered highly as a corrective approach for such patients.