Clinical course and complications of HELLP syndrome according to time of onset.

OBJECTIVE: To evaluate the impact of gestational age on clinical laboratory findings and maternal-perinatal outcomes in patients with HELLP syndrome. METHOD: A retrospective review of 74 patients with HELLP syndrome between January 2007 and October 2010 was performed. Data were stratified into two groups by gestational age at the onset of disease: group 1 (< 34 weeks) and group 2 (> or = 34 weeks). Clinical signs and symptoms, laboratory findings, and maternal and perinatal outcomes were evaluated. RESULTS: No differences were observed between the two groups in the clinical and laboratory characteristics according to onset of HELLP syndrome except for gravidity, parity, and delivery interval. Maternal complications did not differ between the groups. The perinatal mortality rate was 22.9% in total and it was 43.2% in group 1. CONCLUSIONS: The time of onset of the HELLP syndrome mainly affects neonatal outcomes. To assess the effect on maternal morbidity more studies are needed.

Removal of intra-abdominal intrauterine device by laparoscopy.

OBJECTIVE: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. METHODS: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. RESULTS: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. DISCUSSION: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.

Gestational trophoblastic disease: the significance of vaginal metastases.

PURPOSE: To evaluate patients with vaginal lesions in gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management. METHODS: Twelve patients among 75 cases of gestational trophoblastic neoplasia were analyzed retrospectively between 1990 and 1997. Vaginal metastases were documented by physical examination and biopsy. Two patients received MAC III regimen (5 and 7 courses), 4 patients received EMA-CO regimen for 2 to 11 courses, while 6 were administered methotrexate alone. Remission was defined as 3 weekly beta hCG levels below assay sensitivity (<5 mIU/ml). RESULTS: The mean age of the patients was 25.4 years. While 10 of the patients presented initially with hemorrhage and bloody leukorrhea, the remaining 2 were diagnosed during a routine study of hydatidiform mole. The sites of involvement were almost always the anterior distal vaginal wall. Five cases had additional lung and 1 case had lung, liver, spleen and brain metastases. Three of the patients who received methotrexate as monotherapy did not respond to therapy and were switched to EMA-CO. Overall survival was 91.6%. One patient died in the first month of the initial therapy. CONCLUSION: The presence of large vaginal metastases should be classified as a high-risk factor and these patients must be treated by multiple agent chemotherapy.

Dysfunctional uterine bleeding and other menstrual problems of secondary school students in Adana, Turkey.

STUDY OBJECTIVE: We documented such menstrual disorders as dysfunctional uterine bleeding (DUB): dangerous health problem during adolescence. DESIGN, SETTING, PARTICIPANTS: We gave a questionnaire containing 29 questions about menstruation to 3000 secondary school students in Adana, Turkey. RESULTS: The mean age of the students was 15.8 years; their menarche age was 12.9 years. Irregular periods were observed in 26.7% of the cases, 62.2% had at least one irregular bleeding in their lives, 11.3% visited a gynecologist for irregular bleeding, and 4.5% were treated for it. Dysmenorrhea occurred in 38.7% of the students. Forty-one percent used pain killers during their menstruation; half of them received the drugs from their family, and the other half received them over-the-counter without a prescription. Almost half (46.6%) of the girls experienced premenstrual problems. Most of the students (71.4%) discussed their menstrual problems with their mothers. Among the school girls, 15.8% claimed that there was a correlation between school examinations and irregular menses. CONCLUSION: The questionnaire's results show that such menstrual disorders during adolescence as DUB are common but neglected. Medical staff who specialize in adolescent gynecology must address the problem.

Pregnancy outcomes in young Turkish women.

STUDY OBJECTIVE: We documented adolescent pregnancies that were thought to be at high risk for increased obstetric complications. DESIGN, SETTING, PARTICIPANTS: This study covered 442 pregnant women who were under 19 years of age and who delivered in Cukurova University, School of Medicine, Department of Obstetrics and Gynecology between January 1, 1993 and December 31, 1997, retrospectively. RESULTS: The patients' mean age was 18.24 years and their mean gestational age was 38.2 weeks. The newborns' mean birthweight was 3093.05 g and their mean birth height was 45.75 cm. Apgar score in the 1st minute was 6.79 and at the 5th minute 8.37. Cesarean section rate was 28.5%. The most common causes were pregnancy-induced hypertension (PIH) and breech delivery. There were 32 stillborns and 5 early neonatal deaths. The most frequent obstetric complications were PIH (14.5%), preterm delivery (7.0%), and low birthweight (< 2000 g) (10.2%). The pregnant adolescents with obstetric problems (44.4%) had poor obstetric results. CONCLUSIONS: Adolescent pregnancies are considered high risk with many obstetric complications and poor obstetric results. To decrease the complications adolescent pregnancies must be followed-up as high risk pregnancies, especially in developing countries where socioeconomic factors are more pronounced.