Can striae be used as a marker for the prediction of pelvic organ prolapse?

OBJECTIVE: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). STUDY DESIGN: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n=244) consisted of symptomatic patients with POP, and the control group (n=244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. RESULTS: The presence of striae (p=0.001), number of striae (p=0.001) and Davey score (p=0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p=0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p=0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p=0.04, 95% CI 1.14-1.25) and 2.51 fold (p=0.01, 95% CI 1.66-3.78), respectively. CONCLUSION: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP.

Treatment of uterine prolapse with bilateral hydronephrosis in a young nulliparous woman; a new minimally invasive extraperitoneal technique.

A 37-year-old nulligravid woman presented with a 2-year history of uterine prolapse along with mixed incontinence. Gynecological examination confirmed third degree cystocele and uterine prolapse. Renal ultrasonography showed enlarged kidneys and marked dilation of the bilateral pelvicalyceal system. She was hospitalized and a ring pessary was inserted after bladder catheterization. Her preoperative evaluation was performed and the patient was operated one month after her first admission. Anterior colporrhaphy along with Kurt Extraperitoneal Ligamentopexy was performed without any complication. A control visit on second postoperative month revealed recovery of incontinence symptoms and no prolapse was observed. To our knowledge this is the first reported treatment of a case with bilateral hydronephrosis due to uterine prolapse that were corrected and overcame with a novel minimally invasive extraperitoneal approach by fixation of bilateral round ligaments to the rectus fascia sheet.

Impact of Factor V Leiden, prothrombin and methylenetetrahydrofolate reductase gene mutations on infant birth weight in women with recurrent fetal loss and women with successful pregnancies.

PURPOSE: The aim of this study was to verify whether FV Leiden, PT G20210A, MTHFR C667T or MTHFR A1298C mutations influence the risk of recurrent fetal loss in a sample of Turkish women who had experienced recurrent fetal loss and to evaluate whether the aforementioned thrombophilias and recurrent fetal loss may affect the birth weight of subsequent pregnancies. METHODS: Fifty-eight women with recurrent pregnancy loss and 30 women with successful pregnancies were evaluated. RESULTS: The average birth weights for infants of all women in the study group and for infants of thrombophilia-positive women in the study group were markedly lower than the birth weight of infants in the control group (p<0.001 and p<0.001, respectively). CONCLUSION: Successful pregnancies in women with a history of recurrent fetal losses may be associated with lower birth weights compared to controls, irrespective of thrombophilia status. This conclusion warrants further research.

Expectant management of preterm premature rupture of membranes remote from term with exiguous amniotic fluid and a prolonged latency period: report of two cases.

Management of preterm premature rupture of membranes (PPROM) is a very challenging issue for the obstetricians. We report two cases of PPROM occurring in early gestation remote from term (both < 26 weeks) with exiguous amniotic fluid (amniotic fluid index of < or =2 cm) that were managed successfully by conservative treatment and resulted in a latency period of almost two months. This treatment option might be feasible in carefully selected patients following meticulous evaluation and warrants further research.

Emergent intrauterine resuscitation in a fetus with transient congenital anemia--case report.

A 24-week gestation complicated by fetal hydrops was prepared for intrauterine transfusion to treat possible fetal anemia. During the therapeutic transfusion procedure, blood samples could be not taken from the umbilical vein, and severe fetal bradycardia developed. Given the severity of the condition and the fetal position, transfusion was performed through the most accessible part of the fetal heart, which was the right atrium. Just after the transfusion procedure, fetal cardiac tamponade developed, and the fetal heart collapsed. Subsequently, urgent fetal pericardiac tamponade decompression was performed.

Successful treatment of advanced endometriosis with extremely high CA 125 and moderately elevated CA 15-3 levels.

We present the case of a patient with advanced endometriosis who presented with chronic pelvic pain, bilateral unruptured ovarian endometrioma, massive peritoneal implants and extremely elevated CA 125, and also elevated CA 15-3 levels. Laparoscopy revealed bilateral unruptured ovarian endometrioma and diffuse peritoneal endometriotic implants. Increased association of elevated levels of CA 125 and CA 15-3 is not so common in advanced endometriosis. The case was successfully treated with laparoscopy and combined low-dose oral contraceptive with one year of follow-up. To the best of our knowledge among the reported cases this is the highest CA 15-3 level ever reported with an extremely elevated CA 125 level.