Relation between mothers' types of labor, birth interventions, birth experiences and postpartum depression: A multicentre follow-up study.

AIM: This definitive and cross-sectional study was conducted to determine the relation between mothers' types of labor, birth interventions, birth experiences and postpartum depression. METHODS: A total of 1010 mothers who gave birth in four different provinces of Turkey were chosen to participate in the study via purposive sampling method Results: The Edinburgh Postpartum Depression Scale score was determined to be 13 and over in 36.4% of the women. In this study, it was determined that the Edinburgh Postpartum Depression Scale scores for women in the 18-24 age group who had a vaginal birth, did not have health insurance, experienced health problems during pregnancy and were not trained about type of labor during pregnancy were statistically higher. There was no significant correlation between the birth experiences and postpartum depression. The linear regression model showed that there was a statistically significant correlation between enema and amniotomy interventions practised during the birth and the Edinburgh Postpartum Depression Scale scores. CONCLUSION: In conclusion, it is thought that preparing the mothers for birth with birth preparation training in the antenatal period and imposing the necessary regulations in the delivery room for the mothers to have a positive birth experience are important in reducing postpartum depression risk.

Effects of tamoxifen on tissue nitrite/nitrate levels and plasma lipid peroxidation in female rats.

PURPOSE OF INVESTIGATION: The effects of tamoxifen on lipid peroxidation and oxidant-antioxidant balance in an animal model were studied. METHODS: Twelve female adult rats were divided into two groups and DMSO and tamoxifen dissolved in DMSO were administered. Tissues taken from the brain, liver and ovary of rats were dissected. MDA, nitrite, nitrate levels and plasma LDL oxidation in brain, ovary and liver tissues were measured and compared. RESULTS: Induced LDL MDA levels were significantly lower in the tamoxifen group (p = 0.009). MDA levels in the liver were significantly lower in the tamoxifen group whereas nitrite levels were found significantly higher (p < 0.05). Brain and ovarian tissues demonstrated no significant difference with respect to MDA, nitrite and nitrate levels. CONCLUSION: Tamoxifen has no negative effects on lipid peroxidation in an animal model.

Vaginal fluid pH, cervicovaginitis and cervical length in pregnancy.

AIM: The purpose of this prospective study was to determine the possible association among vaginal fluid pH, cervicovaginitis and cervical length in singleton pregnancies at 16-22 weeks of gestation. METHODS: A total of 240 asymptomatic singleton pregnancies at 16-22 weeks of gestation were included to the study. Vaginal fluid pH was determined using pH paper in a sterile speculum examination, and cervical length was examined by transvaginal ultrasonographic measurement. Vaginitis was diagnosed by pH determination and wet mount smear; cervicitis was diagnosed by cervical examination. Patients were followed to delivery and hospital records were reviewed to extract obstetric information. Preterm delivery was defined as delivery at or prior to 36 weeks of gestation. Abnormal pH was defined as a pH of > 5.0. Patients with cervicovaginitis (n = 72) were compared with those without any trace of infection (n = 60). RESULTS: The mean gestational age was 20.3 +/- 1.4. We found an significant association among cervicovaginitis, cervical length and vaginal pH. There was a significant correlation between an elevated vaginal pH (> 5.0) and a shortened cervical length (r = -0.59, p < 0.001). Vaginal fluid pH > 5.0 was associated with increased risk of preterm delivery (OR 4.3, 95% CI 2.0, 9.3; p = 0.001) as well as delivering an infant of less than 2,500 g (OR 4.0, 95% CI 1.4, 11.0; p = 0.009). CONCLUSIONS: Elevated vaginal fluid pH in women at 16-22 weeks of gestation seems to be associated with a decreased cervical length and increased risk of preterm delivery.

Relation between Doppler findings and perinatal outcomes in fetuses with intrauterine growth restriction.

PURPOSE OF INVESTIGATION: To find the relationship between fetal Doppler findings and perinatal outcomes in intrauterine growth restriction. METHODS: Eighty-two cases with a prenatal diagnosis of intrauterine growth restriction between November 2008 and July 2009 were included in this prospective study at Ege University School of Medicine. Fetuses were grouped according to Doppler parameters: those with normal Doppler findings (n = 43), and those with impaired arterial (n = 27) and venous systems (n = 12). RESULTS: Out of 82 growth restricted cases, 43 (52.4%) had normal Doppler findings, while 27 (32.9%) displayed impaired arterial parameters and 12 (14.6%) had impaired venous parameters. The mean first minute Apgar scores were 7.57 +/- 1.53 for the group with normal Doppler flows, 6.8 +/- 2 for the group with an impaired arterial system, and 4 +/- 1.94 for the group with an impaired venous system. Two cases from the normal Doppler flow group (n = 42), four cases from the impaired arterial flow group (n = 27), and 11 cases from the impaired venous flow group (n = 11) had fifth minute Apgar scores under 6. Evaluation of the umbilical artery blood gas revealed acidosis in two cases from the normal Doppler flow group (n = 42), three cases from the impaired arterial system group (n = 27), and five cases from the impaired venous system group (n = 11). CONCLUSION: A Doppler spectrum from normal to venous system impairment correlated with poor fetal outcomes including fetal acidosis, fetal mortality and morbidity, decreased Apgar scores at 1 and 5 min, and neonatal morbidity.

Laparoscopic resection or sonography-guided vaginal aspiration of endometriomas prior to ICSI-ET does not worsen treatment outcomes.

OBJECTIVE: To evaluate the effect of the management modality of ovarian endometriomas on ovarian response to COH (controlled ovarian hyperstimulation) and ART (assisted reproductive technology) treatment outcome. DESIGN: Retrospective case control study. SETTING: Ege University Infertility-Family Planning Research and Treatment Center. PATIENTS: 115 cycles of 84 patients who underwent ICSI-ET (intracytoplasmic sperm injection-embryo transfer) with ejaculated sperm were enrolled in the study. The endometrioma resection group (Group I) was comprised of 36 cycles in 29 patients who were treated with laparoscopic endometrioma cyst resection prior to treatment; endometrioma aspiration (Group II) was comprised of 26 cycles in 15 patients whose endometriomas were aspirated prior to treatment; and the control group (Group III) was comprised of 53 cycles in 40 patients for whom the only infertility cause was the tubal factor. INTERVENTIONS: ICSI-ET treatment, laparascopic ovarian endometrioma cyst resection, transvaginal ultrasonography-guided endometrioma cyst aspiration. MAIN OUTCOMES MEASURES: COH results and ICSI-ET treatment outcomes. RESULTS: The groups were similar in all characteristics except for the mean age of the patients in group II being older than those in group I. Gonadotropin consumption was higher, peak estradiol level lower, and the number of oocytes less in the laparascopic resection group (Group I) with respect to the control group. The number of follicles was lower in the cyst aspiration group (Group II) with respect to the control group. The number of follicles larger than 15 mm, number of metaphase II oocytes, the fertilization, pregnancy and implantation rates were similar in all three groups. CONCLUSION: Interventions (laparascopic endometrioma resection, transvaginal ultrasound-guided endometrioma cyst aspiration) performed on endometriomas prior to ART treatment do not worsen the treatment outcome.

Evaluation of VEGF in placental bed biopsies from preeclamptic women by immunohistochemistry.

OBJECTIVE: The aim of the study was to determine VEGF protein with immunohistochemical staining in placental bed biopsies of preeclamptic pregnancies in comparison to normal controls. DESIGN: Prospective cohort study. METHODS: The placental bed biopsies were obtained from 12 patients with preeclapmsia and ten patients for a control group at the time of cesarean delivery. Tissue samples of the placental bed were examined for VEGF protein distribution with avidin-biotin-peroxidase immunohistochemistry. Two blinded histopathologists were asked to score each sample for the intensity of staining and the number of cells stained in a randomly selected HPF of each sample. The resulting "H-score" was computed as a product of intensity and percent of cells stained. RESULTS: VEGF expression was significantly lower in both the myometrium and stroma of the preeclamptic group compared to the control group (77.2 +/- 25.4 vs 134 +/- 44.3, p = 0.007; 194.1 +/- 20.7 vs 170.2 +/- 17, p = 0.017, respectively). CONCLUSION: VEGF expression is significantly lower in placental bed biopsies of preeclamptic pregnancies.

The maternal and neonatal effects of the volatile anaesthetic agents desflurane and sevoflurane in caesarean section: a prospective, randomized clinical study.

This study compared maternal and neonatal outcomes in women undergoing elective caesarean section under general anaesthesia with desflurane or sevoflurane; the neonatal effects were also compared with those in women undergoing epidural anaesthesia. Fifty women requesting general anaesthesia were randomly assigned to receive either 3% desflurane or 1% sevoflurane. Twenty-five women requesting regional anaesthesia received epidural anaesthesia with ropivacaine. Comparing desflurane sevoflurane with respect to their maternal haemodynamic effects, maternal blood pressure levels were higher and tachycardia was more frequent in the desflurane group. Comparing general and epidural anaesthesia, no significant differences were detected in terms of neonatal Apgar scores or neurological adaptive capacity scores. In conclusion, 3% desflurane or 1% sevoflurane for general anaesthesia and ropivacaine for epidural anaesthesia for elective caesarean section had similar effects on neonatal outcomes. In women who received desflurane, blood pressure and heart rate elevation were significantly higher than in the sevoflurane group, though this difference did not have any clinical importance.

Does raloxifene therapy affect mammographic breast cancer screening in postmenopausal patients?

OBJECTIVE: The aim of the study was to determine mammographic breast density changes during raloxifene therapy in postmenopausal patients MATERIALS AND METHODS: Fifty-five cases who were using raloxifen therapy were included in this retrospective analysis. Raloxifene was given for osteopenia and osteoporosis according to low bone mineral density measured by dual-energy X-ray absorptiometry (DEXA). None of the patients were using hormone replacement therapy 12 months before the initiation of raloxifene treatment or during the study. Mammographic breast density was determined by mammography before the initiation of raloxifene treatment (baseline) and after 12 to 16 months of therapy. The Breast Imaging Reporting and Data System (BI-RADS) breast density score was used for the evaluation of mammographic density. RESULTS: There was no change in mammographic breast density when the baseline and the first mammography taken after the initiation of therapy were compared (p = 0.32). There was no significant correlation between the duration of raloxifene treatment and mammographic density measured after raloxifene treatment (r = -0.158, p = 0.25). Only in one patient did the BI-RADS classification of 2 change to 3 after 12 months of therapy. CONCLUSIONS: In conclusion, raloxifene therapy for 12 to 16 months does not increase mammographic breast density in postmenopausal women with low bone mass.

Preemptive meloxicam for postoperative pain relief after abdominal hysterectomy.

OBJECTIVE: This study was conducted to evaluate the analgesic efficacy of meloxicam in abdominal hysterectomy. METHODS: The study population consisted of 52 patients scheduled for total abdominal hysterectomy who were ASA 1 or 2 physical status female. Patients were allocated randomly to receive orally either 15 mg of meloxicam (Group M, n = 27) or placebo (Group P, n = 25) before anesthesia induction. After intravenous administration of 1.5 mg kg(-1) of tramadol, anesthesia was induced with an intravenous loading dose of 1-2 mg kg(-1) propofol. Anesthesia was maintained on intravenous infusion of propofol at 6-12 mg kg(-1) h plus tramadol at 1 mg kg(-1) h(-1), vecuronium, and a 2:1 nitrous oxide-oxygen mixture. RESULTS: The relative propofol consumption was lower in Group M than in Group P, (p < 0.05). The time for analgesic rescue decreased in the order Group M > Group P (p < 0.01). The degree of sedation was similar between the groups (p > 0.05) and the visual analog scores (10-cm scale) and verbal rating scale data differences were present in the first 2 h only (p < 0.05). When side-effects were evaluated nausea and vomiting were found to be lower in group M than in group P (p < 0.05). CONCLUSION: Preemptive meloxicam provided better postoperative analgesia than placebo.

Retrospective analysis of endometrial polyps carried out at Ege University Hospital.

OBJECTIVE: The aim of the present study was to assess the incidence of endometrial polyps in women presenting with different symptoms to Ege University Hospital. MATERIAL AND METHODS: Patient records were retrospectively scanned and patients with a histopathological diagnosis of endometrial polyps were included in the analysis. RESULTS: 53 patients had been diagnosed with endometrial polyps. Sixty-four percent of the patients were postmenopausal and the most common presenting symptom was postmenopausal vaginal bleeding (26.4%). Forty-nine percent of the diagnoses were made by endometrial sampling. CONCLUSION: In a university hospital setting the majority of the endometrial polyp cases diagnosed were in postmenopausal women. Standard endometrial sampling failed to detect almost half of the cases.

Pelvic actinomycosis in a postmenopausal patient with systemic lupus erythematosus mimicking ovarian malignancy: case report and review of the literature.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram-positive organism Actinomyces israelii usually associated with intrauterine devices. Systemic lupus erythematosus is an autoimmune disorder associated with multiple primary and drug-related immunological defects that predispose patients to infections. The combination of both diseases in a postmenopausal patient is a rare occurrence. A case of a pelvic mass in a 49-year-old postmenopausal patient with systemic lupus erythematosus treated with immunosuppressive therapy for two years is presented. The patient presented with lower abdominal pain to the gynecology clinic and was found to have a pelvic tumor. She had no history of intrauterine device use. Histopathologic examination of the laparotomy specimen revealed pelvic actinomycosis.

Acute myeloblastic leukemia in pregnancy: a case report and review of the literature.

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.

Subcutaneous metastasis of endometrial adenocarcinoma: case report of an incidental diagnosis during abdominal sonography.

A rare case of subcutaneous metastasis from endometrial adenocarcinoma detected incidentally on the anterior abdominal wall during routine abdominal sonography is reported. A 62-year-old woman with clinical FIGO Stage IA, grade 2 endometrial mixed type (endometrioid and mucinous) adenocarcinoma was found with a subcutaneous mass located in the abdomen 18 months after initial surgery.

Comparison of hydrosonography and diagnostic hysteroscopy in the evaluation of infertile patients.

OBJECTIVE: In the present study we evaluated the value of hydrosonography in the screening for intracavitary structural pathologies in patients with a history of infertility before the implementation of assisted-reproductive technology. Hysterescopy was regarded as the gold standard procedure. STUDY DESIGN: A retrospective study. MATERIAL AND METHODS: A total number of 115 infertile women aged between 19 and 47 (33.4 +/- 5.3), who were candidates for assisted reproductive techniques, were enrolled in this retrospective analysis. The study comprised data obtained from patients undergoing infertility investigation between 2001 and 2003 at Ozel Ege IVF Center and the Department of Obstetrics and Gynecology of Ege University Faculty of Medicine. The results obtained by hydrosonography were later compared with those of hysteroscopy. Sensitivity, specificity, positive predictive value and negative predictive value for hydrosonography were calculated. RESULTS: In a total of 115 women, 53 (46%), 24 (20%), 30 (26%) and 8 (7%) were found to have normal endometrial cavities, submucous myoma, endometrial polyps and uterine septum, respectively, on hydrosonography. Forty-five (85%) of 53 women, who were supposed to have normal findings on hydrosonography, were confirmed by hysteroscopy. In the remaining eight women (15%), two had endometrial polyps, three had uterine septum, one had submucous myoma and two had intrauterine synechia on hysteroscopic examinations. The sensitivity, specificity, positive and negative predictive values of hydrosonography in the detection of structural endometrial cavity lesions were 85%, 75%, 75% and 84%, respectively. Two intrauterine adhesions were not recognized by hydrosonography. CONCLUSION: Hydrosonography may be a useful tool in the evaluation of intrauterine cavity structural pathologies in infertile patients with the exception of intrauterine adhesions. In addition, hydrosonography was found to be sensitive in the detection of intrauterine septum.

Pulmonary edema after ritodrine therapy during pregnancy and subsequent cesarean section with epidural anesthesia.

Ritodrine, a beta-sympathicomimetic drug that is frequently used for the prevention of preterm birth. Preterm delivery is an important cause of low birth weight. One of the most important side-effects of ritodrine is pulmonary edema. In patients developing pulmonary edema after ritodrine therapy, aggressive fluid resuscitation during the operation period should be avoided. Successful epidural anesthesia can be achieved with a slow-onset epidural block after moderate fluid infusion. We report the management of a pregnant patient developing pulmonary edema after ritodrine therapy and undergoing cesarean section with epidural anesthesia.

The triage of squamous cell abnormalities of cervical cytology by human papilloma virus screening.

OBJECTIVE: The aim of the study was to determine the presence of human papilloma virus (HPV) infection in cervical swabs by the use of the Digene Hybrid Capture assay in a cohort of patients with squamous cell abnormalities found in cervical cytologic screening. MATERIALS AND METHODS: Thirty-four (0.3%) of 1,100 patients who came for their routine cervical cytologic screening and diagnosed as having squamous cell abnormalities were enrolled in the study. Colposcopy-directed biopsy was obtained from all study patients. HPV DNA was sought in cervical swab specimens placed in Digene transport medium by the use of the Digene Hybrid Capture assay. The findings of cervical cytology, colposcopy-directed biopsy and HPV screening were compared. RESULTS: In a total of 34 women who were diagnosed as having squamous cell abnormalities in their routine cervical cytologic screening, 15 women had atypical squamous cell lesions of undetermined significancy (ASCUS), 16 women had low-grade cervical intraepithelial lesions (LGSIL), and three women had high-grade cervical intraepithelial lesions (HGSIL). Five (15%) of these women tested positive for HPV screening in cervical swabs where four women had infection with high-risk and one woman had infection with low-risk subtypes. None of the patients with koilocytotic changes of the squamous cells in the class of LGSIL histopathologically tested positive for HPV screening. In addition, one patient diagnosed as having invasive cervical carcinoma histopathologically tested negative for HPV screening. Atypical vascularization was seen colposcopically in this 37-year-old woman who had ASCUS cytologically. CONCLUSION: HPV screening seems to have value in the triage of patients with ASCUS with no clear advantage to colposcopy-directed biopsy. The routine performance of HPV screening for the triage of patients with squamous cell abnormalities has no advantage over colposcopy-directed biopsy.

MDR1 gene expression in endometrial carcinoma.

The objective of the present study was to determine the MDR1 gene expression in endometrial cancer. Twenty-six newly diagnosed patients with endometrial carcinoma were included in this study. Patients were treated with surgery followed by adjuvant radiotherapy. Four- to six-micrometer sections of the archival paraffin-embedded blocks were cut, deparaffinized, and stained by immunohistochemical technique using P-glycoprotein dye. Endothelial cell staining was used as the positive control of the dye. Immunostaining was categorized from 0% to 100% based on the percentage of cells stained by examining 3-4 high-power fields. The mean P-glycoprotein immunoreactivity for the whole study group was 17 +/- 25% (0-90). Tauhe mean P-glycoprotein immunoreactivity was 21 +/- 26% (0-90) for the endometrioid histology and 6 +/- 13% (0-30) for the clear cell histology. P-glycoprotein immunoreactivity was not detected in a case of mucinous histologic subtype. There was a significant negative correlation between age and P-glycoprotein immunoreactivity (r = -0.530, P = 0.005). The P-glycoprotein immunoreactivity was found to be 30% positive in only one case of clear cell histologic type out of five. However, P-glycoprotein immunoreactivity was not significantly lower in clear cell histologic subtype compared with endometrioid subtype of endometrial cancer (P = 0.116). P-glycoprotein immunoreactivity was found to be 0% in grade 1 (n = 2), 22 +/- 28% in grade 2 (n = 17), and 8 +/- 14% in grade 3 (n = 7) patients (P = 0.273). Premenopausal patients were found to have a significantly higher P-glycoprotein expression (40 +/- 33)% vs. 11 +/- 20%, P = 0.04). P-glycoprotein immunoreactivity was found to be less with advanced age in endometrial carcinoma. However, premenopausal patients were found to have a significantly higher P-glycoprotein expression.

Preoperative and postoperative correlation of histopathological findings in cases of endometrial hyperplasia.

OBJECTIVES: To determine the preoperative and postoperative correlation of histopathological findings in cases of endometrial hyperplasia. MATERIAL AND METHODS: One hundred and three patients with endometrial hyperplasia detected by surgical curettage performed due to various gynecologic pathologies were treated by hysterectomy. We compared retrospectively the histopathological diagnoses found on curettage with those found on hysterectomy specimens. The classification scheme endorsed by the International Society of Gynecological Pathologists was used to classify the endometrial hyperplasia. The histologic findings found on the endometrial tissue of curettage specimens were correlated with those from hysterectomy specimens. Histopathologic evaluation was performed by a single skilled gynecologic pathologist. RESULTS: A total number of 103 women--76 (73.8%) premenopausal and 27 (26.2%) postmenopausal--were determined to have endometrial hyperplasia on histopathological evaluation of endometrial tissues obtained by endometrial curettage performed for evaluation of various bleeding abnormalities. These included 94 patients with simple hyperplasia without atypia (91.3%), two patients with simple hyperplasia with atypia (1.9%), five patients with complex hyperplasia without atypia (4.9%), and two patients with complex hyperplasia with atypia (1.9%). Histopathological evaluation of endometrial tissue obtained from hysterectomy specimens (of patients diagnosed with hyperplasia on curettage) revealed a total number of 65 cases (63.1%) with endometrial hyperplasia, and 38 cases (36.9%) with various histopathological findings. The correlation between preoperative and postoperative endometrial histologic findings was found to be statistically insignificant (r = 0.105, p = 0.29). Among 94 patients who were found to have simple hyperplasia without atypia on curettage specimens, 55.3%, were found to have simple hyperplasia without atypia, 1.1% simple hyperplasia with atypia, 5.3% complex hyperplasia without atypia, 9.6% secretory endometrium, 4.3% proliferative endometrium, 21.3% disorganized proliferative endometrium, 1.1% corpus luteum persistency, 1.1% basal endometrium, and 1.1% endometrium cancer on final hysterectomy specimens. CONCLUSION: Postoperative diagnosis of endometrial pathology might be different from that of preoperative especially in cases with simple endometrial hyperplasia without atypia.