Expectant management vs. cerclage in cases with prolapsed or visible membranes in the second trimester: is 24 weeks gestation threshold critical?

OBJECTIVES: The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes. METHODS: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks. RESULTS: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 ± 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 ± 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 ± 48.6 days [Median=28 (3-138)] vs. 12 ± 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2). CONCLUSIONS: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.

Neutrophil-to-lymphocyte ratio is a predictor of biochemical miscarriage following artificial frozen embryo transfer cycles.

The aim of this study is to examine the relationship between complete blood count (CBC) inflammatory markers and pregnancy outcome following artificial frozen embryo transfer cycles (AC-FET). This was a retrospective cohort study including 183 patients undergoing an AC-FET. The inflammatory markers including white blood cell count (WCC), neutrophil and lymphocyte count, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were compared between cycles with and without clinical pregnancies. Furthermore, these markers were compared between pregnancies with and without biochemical and clinical miscarriages. NLR was significantly higher in cycles with biochemical miscarriages (p = 0.009). Receiver operating curve analysis was performed to assess the role of NLR in predicting biochemical pregnancy. The area under the curve was 0.714 (95% confidence interval; 0.578-0.850, p = 0.009). The optimal cut-off value for NLR that was associated with biochemical miscarriage was 2.48 with 63% sensitivity and 75% specificity. A logistic regression analysis was performed with biochemical miscarriage as the dependent variable. An NLR value below 2.48 was an independent variable to affect biochemical miscarriage (OR: 0.2, 95% CI 0.05-0.92, p = 0.030). NLR emerged as a reliable predictor of biochemical miscarriage in AC-FET.Impact StatementWhat is already known on this subject? NLR and PLR are novel markers of inflammation. They are related to various gynecological and obstetric conditions including spontaneous abortion, preeclampsia. These markers are also associated with assisted reproductive technology success in fresh cycles.What the results of this study add? This is the first study to investigate the association of these markers with FET cycles. Our results have shown that cycles that ended in biochemical miscarriage had a significantly higher NLR compared with cycles continuing as a clinical pregnancy. An NLR value above 2.48 was predictive of biochemical miscarriage following AC-FET.What the implications are of these findings for clinical practice and/or further research? A high NLR level might have a significant value for the identification of patients at risk of biochemical miscarriage. Future research should assess the impact of anti-inflammatory agents on pregnancy outcomes in patient populations where systemic inflammation is documented by CBC inflammatory markers.

The association of seminal oxidation reduction potential with sperm parameters in patients with unexplained and male factor infertility

ABSTRACT Purpose: Understanding the effects of high oxidation reduction potential (ORP) levels on sperm parameters will help to identify patients with unexplained and male factor infertility who may have seminal oxidative stress and determine if ORP testing is needed. This study aimed to evaluate the association between seminal ORP and conventional sperm parameters. Materials and Methods: A total of 58 patients who provided a semen sample for simultaneous evaluation of sperm parameters and ORP between January and September 2019 were enrolled in this retrospective study. To identify normal and high ORP levels, a static ORP (sORP) cut-off value of 1.36mV/106sperm/mL was used. Sperm parameters were compared between infertile men with normal sORP (control group, n=23) and high sORP values (study group, n=35). Results: Men with sORP values >1.36mV/106sperm/mL had significantly lower total sperm count (TSC) (p <0.001), sperm concentration (p <0.001) and total motile sperm count (TMSC) (p <0.001). In addition, progressive motility (p=0.04) and fast forward progressive motility (p <0.001) were significantly lower in the study group. A negative correlation was found between sORP and TSC (r=-0.820, p <0.001), sperm concentration (r=-0.822, p <0.001), TMSC (r=-0.808, p <0.001) and progressive motility (r=-0.378, p=0.004). Non-progressive motility positively correlated with sORP (r=0.344, p=0.010). Conclusions: This study has shown that TSC, sperm concentration, progressive motility and TMSC are associated with seminal oxidative stress, indicated by a sORP cut-off of 1.36mV/106sperm/mL. Presence of oligozoospermia, reduced progressive motilty or low TMSC in sperm analysis should raise the suspicion of oxidative stress and warrants seminal ROS testing.

The association of seminal oxidation reduction potential with sperm parameters in patients with unexplained and male factor infertility.

PURPOSE: Understanding the effects of high oxidation reduction potential (ORP) levels on sperm parameters will help to identify patients with unexplained and male factor infertility who may have seminal oxidative stress and determine if ORP testing is needed. This study aimed to evaluate the association between seminal ORP and conventional sperm parameters. MATERIALS AND METHODS: A total of 58 patients who provided a semen sample for simultaneous evaluation of sperm parameters and ORP between January and September 2019 were enrolled in this retrospective study. To identify normal and high ORP levels, a static ORP (sORP) cut-off value of 1.36mV/106sperm/mL was used. Sperm parameters were compared between infertile men with normal sORP (control group, n=23) and high sORP values (study group, n=35). RESULTS: Men with sORP values >1.36mV/106sperm/mL had significantly lower total sperm count (TSC) (p <0.001), sperm concentration (p <0.001) and total motile sperm count (TMSC) (p <0.001). In addition, progressive motility (p=0.04) and fast forward progressive motility (p <0.001) were significantly lower in the study group. A negative correlation was found between sORP and TSC (r=-0.820, p <0.001), sperm concentration (r=-0.822, p <0.001), TMSC (r=-0.808, p <0.001) and progressive motility (r=-0.378, p=0.004). Non-progressive motility positively correlated with sORP (r=0.344, p=0.010). CONCLUSIONS: This study has shown that TSC, sperm concentration, progressive motility and TMSC are associated with seminal oxidative stress, indicated by a sORP cut-off of 1.36mV/106sperm/mL. Presence of oligozoospermia, reduced progressive motilty or low TMSC in sperm analysis should raise the suspicion of oxidative stress and warrants seminal ROS testing.

An in vitro 3D diabetic human skin model from diabetic primary cells.

Diabetes mellitus, a complex metabolic disorder, leads to many health complications like kidney failure, diabetic heart disease, stroke, and foot ulcers. Treatment approaches of diabetes and identification of the mechanisms underlying diabetic complications of the skin have gained importance due to continued rapid increase in the diabetes incidence. A thick and pre-vascularized in vitro 3D type 2 diabetic human skin model (DHSM) was developed in this study. The methacrylated gelatin (GelMA) hydrogel was produced by photocrosslinking and its pore size (54.85 ± 8.58 µm), compressive modulus (4.53 ± 0.67 kPa) and swelling ratio (17.5 ± 2.2%) were found to be suitable for skin tissue engineering. 8% GelMA hydrogel effectively supported the viability, spreading and proliferation of human dermal fibroblasts. By isolating dermal fibroblasts, human umbilical vein endothelial cells and keratinocytes from type 2 diabetic patients, an in vitro 3D type 2 DHSM, 12 mm in width and 1.86 mm thick, was constructed. The skin model consisted of a continuous basal epidermal layer and a dermal layer with blood capillary-like structures, ideal for evaluating the effects of anti-diabetic drugs and wound healing materials and factors. The functionality of the DHSM was showed by applying a therapeutic hydrogel into its central wound; especially fibroblast migration to the wound site was evident in 9 d. We have demonstrated that DHSM is a biologically relevant model with sensitivity and predictability in evaluating the diabetic wound healing potential of a therapeutic material.

Proteomic analysis in endometrial cancer and endometrial hyperplasia tissues by 2D-DIGE technique.

OBJECTIVE: To compare the protein expression of complex atypical endometrial hyperplasia, endometrial carcinoma and healthy endometrial tissues, and by this way, to identify proteins that can be used for diagnosis, prognosis and therapeutic targets. METHODS: Histopathological examination of the D&C material had reported "benign endometrial changes", "complex atypical endometrial hyperplasia" and "endometrioid adenocarcinoma" and 30 patients ,who underwent surgery with these diagnosis, were studied. Protein profiles of the study groups were detected using 2D-DIGE technique and compared to the control group. Protein spots which showing different expression, were defined by MALDI TOF/TOF-MS method. RESULTS: In the present study, significant elevations were observed in the levels of K2C8, UAP56, ENOA, ACTB, GRP78, GSTP1, PSME1, CALR, PPIA, PDIA3 and IDHc proteins when comparisons were made among the cancer cases and the healthy and complex atypical hyperplasia cases. We determined that the induction of CALR activity may be a factor that progresses apoptosis, thus, may be a hope for postoperative new chemotherapy treatment methods. Moreover, when the expressions of the CAH1 and PPIB proteins are compared to complex atypical hyperplasia and endometrial adenocarcinoma stages, we determined that the CAH1 and PPIB levels increased in more advanced stages. Among these indicators, the proteins that had the closest relation to advanced stage cancer were determined as K2C8, UAP56 and GRP78. CONCLUSION: We think that it would be useful to determine the diagnosis, prediction of prognosis and identifying therapeutic targets of the highlighted proteins of our study that are K2C8, UAP56, GRP78 and CALR in endometrial cancer.

Microfibrous scaffolds from poly(l-lactide-co-ε-caprolactone) blended with xeno-free collagen/hyaluronic acid for improvement of vascularization in tissue engineering applications.

Success of 3D tissue substitutes in clinical applications depends on the presence of vascular networks in their structure. Accordingly, research in tissue engineering is focused on the stimulation of angiogenesis or generation of a vascular network in the scaffolds prior to implantation. A novel, xeno-free, collagen/hyaluronic acid-based poly(l-lactide-co-ε-caprolactone) (PLC/COL/HA) (20/9.5/0.5 w/w/w) microfibrous scaffold was produced by electrospinning. Collagen types I and III, and hyaluronic acid were isolated from human umbilical cords and blended with the GMP grade PLC. When compared with PLC scaffolds the PLC/COL/HA had higher water uptake capacity (103% vs 66%) which may have contributed to the decrease in its Young's Modulus (from 1.31 to 0.89 MPa). The PLC/COL/HA better supported adipose tissue-derived mesenchymal stem cell (AT MSC) adhesion; within 24 h the cell number on the PLC/COL/HA scaffolds was 3 fold higher. Co-culture of human umbilical vein endothelial cells and AT MSCs induced capillary formation on both scaffold types, but the PLC/COL/HA led to formation of interconnected vessels whose total length was 1.6 fold of the total vessel length on PLC. Clinical use of this scaffold would eliminate the immune response triggered by xenogeneic collagen and transmission of animal-borne diseases while promoting a better vascular network formation.

HOXA-10 gene expression in ectopic and eutopic endometrium tissues: Does it differ between fertile and infertile women with endometriosis?

OBJECTIVE: To compare HOXA-10 gene expression in eutopic endometrium samples, between fertile and infertile endometriosis patients and the fertile control cases, and in endometrium and endometrioma specimens, between severe and moderate endometriosis cases. STUDY DESIGN: Prospective clinical study included women without infertility and endometriosis (Group 1); women without infertility but with endometrioma (Group 2); and infertile women with endometrioma (Group 3). In addition, the Group 2 and 3 cohort were assessed based on the findings obtained during laparoscopy, based on the (rAFS) scoring, as women with a rAFS score of 16-40 were evaluated in Group A, whereas those with rAFS score above 40 were considered in Group B. HOXA-10 gene expression was evaluated in both secretory endometrium tissue and endometrioma specimens. RESULTS: Eutopic endometrium samples from group 2 (reference gene = 0,680 vs. target gene = 0,362) and group 3 (reference gene = 0,641 vs. target gene = 0,183) patients revealed a 1,871-fold and 3,509-fold decrease in HOXA-10 gene expression, respectively, as compared to group 1. Endometrial HOXA-10 gene expression was 1,778-fold down-regulated in group 3 women (reference gene = 1,510 vs. target gene = 0,850), when compared to group 2. Both eutopic endometrium and endometrioma tissue samples from severe endometriosis patients revealed 1,259-fold (reference gene = 1,523 vs. target gene = 1,210) and 1,338-fold (reference gene = 1,274 vs. target gene = 0,952), down-regulation in HOXA-10 gene expressions, respectively, as compared to moderate cases. CONCLUSION: Endometrial HOXA-10 gene expression in women with endometriosis is significantly down-regulated than in those without endometriosis. Endometriosis patients with infertility have significantly lower levels of endometrial HOXA-10 gene expression than endometriosis without infertility; thus decreased expression of this gene may, directly or indirectly, be related with the endometriosis-associated infertility. Severe endometriosis cases express, in their both endometrium and endometrioma tissues, significantly lower levels of HOXA-10 gene than moderate endometriosis cases.

The Timing of Embryo Transfer Catheter Removal: Should It be Delayed or Done Immediately? A Prospective Randomized Trial.

BACKGROUND/AIMS: Data on the timing of catheter removal technique following embryo transfer (ET) are quite limited. We aimed to compare the reproductive outcomes of intracytoplasmic sperm injection (ICSI)/ET cycles in which the transfer catheter was removed immediately with those in which the catheter was removed after a delay period and hereby to evaluate the impact that the time interval before removal of the catheter following embryo deposit may have on the fertility outcomes. METHODS: A prospective randomized study was designed. ICSI/ET patients <40 years were randomly assigned to either of the group from which catheter was withdrawn immediately within the first 5 s (Group A) or after a 30 s delay (Group B) following ET. RESULTS: Groups A and B consisted of 147 and 148 patients, respectively. Patient demographics and stimulation characteristics were comparable between the groups. Pregnancy rate was 32.2% (95 of 295) and clinical pregnancy rate was 28.8% (85 of 295), whereas ongoing pregnancy was 24.4% (72 of 295) and implantation rate was 29.6% (100 of 338). The comparison of reproductive outcomes revealed no significant differences in pregnancy (p = 0.933), clinical pregnancy (p = 0.673), ongoing pregnancy (p = 0.590), multiple pregnancy (p = 0.801), and implantation rates (p = 0.979) between the groups. CONCLUSION: No significant difference was observed in the reproductive outcomes between the groups; thus, there appears no requirement to delay the withdrawal of the catheter to improve the outcomes in ICSI cycles.

Impact of insulin resistance and obesity on intracytoplasmic sperm injection outcomes in young women with polycystic ovary syndrome.

OBJECTIVE: To examine effects of body mass index (BMI) and insulin resistance (IR) on the in vitro fertilization (IVF) outcomes in women with polycystic ovary syndrome (PCOS). METHODS: A total of 106 women with PCOS who underwent intracytoplasmic sperm injection were investigated. The patients were stratified into groups according to their BMI [healthy weight: BMI <25 kg/m2 (n=51), overweight: ≤25-29.9 kg/m2 (n=27), and obese: ≥30 kg/m2 (n=28)]. Secondly, the patients were classified based on the presence of IR (IR was considered to be present if homeostatic model assessment-IR was >2.5). The main outcome measures were reproductive and IVF outcomes with respect to BMI and IR. RESULTS: The basal hormonal evaluations, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, estradiol, testosterone, DHEAS, AMH, and antral follicle counts, were similar between the groups of BMI and IR. The number of retrieved oocytes, MII oocytes, embryo counts, and fertilization and pregnancy rates were similar between lean and overweight/obese PCOS with and without IR. Even though pregnancy and delivery rates per started cycle and embryo transfer were higher in healthy-weight women with PCOS than in overweight/obese patients, it did not reach statistical significance. CONCLUSION: Reproductive outcomes in women with PCOS according to BMI and IR were similar. Neither BMI nor IR had an independent effect on ovarian response and IVF success in young women with PCOS.

Perifollicular blood flow and its relationship with endometrial vascularity, follicular fluid EG-VEGF, IGF-1, and inhibin-a levels and IVF outcomes.

PURPOSE: The aim of this study is to investigate the association of perifollicular blood flow (PFBF) with follicular fluid EG-VEGF, inhibin-a, and insulin-like growth factor-1 (IGF-1) concentrations, endometrial vascularity, and IVF outcomes. METHODS: Forty women with tubal factor infertility were included in a prospective cohort study. Each woman underwent IVF/ICSI procedure. Individual follicles of ≥16 mm (n = 156) were evaluated by power Doppler analysis and categorized as well-vascularized follicles (WVFs) or poorly vascularized follicles (PVFs). WVFs referred to those with perifollicular vascularity of 51-100 %. Each follicular fluid (FF) was individually aspirated and FF/serum EG-VEGF, inhibin-a, and FF IGF-1 levels were evaluated. Zones III-IV endometrial vascularity was classified as a well-vascularized endometrium (WVE). The presence of a WVE and mature oocytes, in addition to the embryo quality and clinical pregnancy rate (CPR), were recorded for each follicle. The main outcome measures were FF serum EG-VEGF, inhibin-a, IGF-1 levels, and WVE and IVF outcome per PFBF. RESULTS: For WVFs, the level of FF EG-VEGF (p = 0.008), oocyte quality (p = 0.001), embryo quality (p = 0.002), a WVE (p = 0.001), and CPR (p = 0.04) increased significantly. The pregnant group was characterized by increased numbers of WVFs (p = 0.044), a WVE (p = 0.022), and increased levels of FF IGF-1 (p = 0.001) and serum EG-VEGF (p = 0.03). FF IGF-1 >50 ng/mL (AUC 0.72) had 75 % sensitivity and 64 % specificity for predicting CPR. CONCLUSIONS: WVFs yield high-quality oocytes and embryos, a WVE, increased FF EG-VEGF levels, and increased CPRs.

Chromosome aberrations [dup(1q)] in endometrial cancer: Gene analysis of 54 surgical specimens in Turkey.

OBJECTIVE: We aimed to evaluate the frequency of chromosomal aberrations and mutations in the k-ras or Her-2/neu genes in surgical specimens of endometrial carcinoma and their association with clinicopathological findings. MATERIALS AND METHODS: Fifty-four patients who were treated for endometrial cancer between April 2010 and May 2011 at the Kocaeli University Obstetrics and Gynecology Department, Kocaeli, Turkey were enrolled in a prospective study. Clinical and histopathological findings were recorded. Genetic analysis, which included the detection of chromosomal deletions and duplications, as well as k-ras and Her-2/neu mutations, was performed on endometrial samples from surgical specimens. RESULTS: In 70% of cases, tumor size was >2 cm or covered the entire uterine cavity, affecting mostly corpus (76%) and invading less than half of the myometrium (80%). Forty-six cases (86%) had endometrioid-type carcinoma, and early stage (Stage I, 65%) and higher grade (Grade II-III, 66%) tumors were predominant. Lymph node and lymphovascular involvement was positive in 11% and 28% of the patients, respectively. Chromosomal aberrations (deletion or duplication) and Her-2/neu and k-ras mutations were encountered in 44%, 15%, and 13% of surgical specimens, respectively. The most common chromosomal aberration was dup(1q) (n = 16). Oncogenic mutations in Her-2/neu or k-ras had no association with the severity of endometrial cancer, but the presence of chromosomal aberrations, as a whole or dup(1q) alone, were associated with higher tumor size, deeper myometrial invasion, advanced stage or grade, lymphovascular invasion, and lymph node involvement (p < 0.05 for all). CONCLUSION: Chromosomal aberrations, particularly dup(1q), are related to advanced disease in endometrial cancer. Genetic analysis of cancer tissues may provide important insights in determining disease prognosis.

Exogenous cesarean scar pregnancies managed by suction curettage alone or in combination with other therapeutic procedures: A series of 33 cases and analysis of complication profile.

AIM: The aim of this study was to review our exogenous cesarean scar pregnancy (CSP) cases that were managed through transabdominal ultrasound (TAUS)-guided suction curettage either alone or with a concomitant additional therapeutic modality. The study was carried out over a 6-year period and we compared clinical outcomes, success rates and complication profiles between the two therapeutic approaches. METHODS: A total of 33 exogenous CSP patients who were managed by suction curettage were extracted from the medical records. The patients were analyzed according to the intervention applied in the two groups as: TAUS-guided suction curettage alone (Group 1); and additional therapeutic tools, such as systemic or intracavitary administration of methotrexate and intracavitary ethanol instillation, in combination with suction curettage (Group 2). Basic demographic and clinical characteristics of women experiencing hemorrhagic complications and those who did not after the treatment were also compared. RESULTS: There were no cases of uterine perforation, hysterectomy or unresponsiveness to treatment in our analyzed CSP cases. Four patients, two in each group, required blood transfusion. Our success rate in the overall patient population was 87.8% (29/33). Fourteen out of 16 patients who were treated with TAUS-guided suction curettage alone, and 15 out of 17 patients who received other interventional treatment modalities preceding suction curettage revealed successful resolution of the CSP without any complication (P = 0.948). Clinical and demographic characteristics of women who experienced any hemorrhagic complication did not significantly differ from those who did not. CONCLUSION: In appropriate CSP cases, TAUS-guided suction curettage appears to be a reliable treatment option with acceptable success rates and similar complication profile to other therapeutic options.

Do younger women with elevated basal follicular stimulating hormone levels undergoing gonadotropin-stimulated intrauterine insemination cycles represent compromised reproductive outcomes?

OBJECTIVE: To compare stimulation characteristics and reproductive outcomes in women representing elevated and normal day 3 FSH levels and to evaluate the prognostic significance of day 3 FSH on the reproductive outcomes of gonadotropin-stimulated IUI (GS-IUI) cycles in women <35 years. STUDY DESIGN: A cross-sectional study was designed. Unexplained infertility patients at the age ≤36 years, who underwent IUI, following gonadotropin stimulation (GS), were investigated. From 105 women with a day 3 FSH≥ 10U/L, 170GS/IUI cycles were assigned to Group EF; whereas a control group (Group NF, normal FSH) was constituted of 170 cycles with a day 3 FSH levels <10U/L. Demographic and stimulation characteristics as well as reproductive outcomes were compared. Primary outcome measure of this study was the biochemical, clinical and ongoing pregnancy rates. Secondary outcome measures were total gonadotropin dose, duration of gonadotropin stimulation, multiple pregnancy, miscarriage and cycle cancellation rates. RESULTS: ß-hCG positivity, clinical and ongoing pregnancy rates did not differ between women with normal and elevated FSH levels (p=0.234, 0.282 and 0.388, respectively). Total gonadotropin dose, multiple pregnancy and miscarriage rates were not significantly different between the groups (p=0,181, 0.652 and 0.415, respectively). Duration of stimulation was significantly longer and cycle cancellation rate was significantly higher in Group EF than in Group NF (p=0.005 and 0.021, respectively). CONCLUSION: Younger women with elevated day 3 FSH represent comparable reproductive outcomes in GS-IUI cycles to those with normal FSH levels, although they may require longer periods of stimulation and are at higher risk of cycle cancellation. Thus, GS-IUI could be a possible treatment option in this patient group and should not be neglected.

The predictive value of lactate peak detected by the magnetic resonance spectroscopy in the brain of growth-restricted fetuses for adverse perinatal outcomes.

OBJECTIVE: To compare perinatal outcomes between patients with and without abnormal Doppler findings and lactate peak in the fetal brain detected by magnetic resonance spectroscopy ((1)HMRS) and to assess the feasibility of fetal brain lactate in the prediction of adverse obstetric outcomes in growth-restricted fetuses. METHODS: Pregnancies with FGR fetuses underwent Doppler ultrasonography and 3 Tesla (1)HMRS for the presence of lactate peak prior to the delivery. Patients were assigned into the following groups; normal Doppler, no lactate peak (Group 1), normal Doppler, lactate peak (+) (Group II), abnormal Doppler, no lactate peak (Group III), abnormal Doppler, lactate peak (+) (Group IV). RESULTS: Five perinatal deaths, all in Group IV, were encountered (p < 0.001). Perinatal death rate was higher in patients with Doppler flow abnormality ((5/12 (41.7%)) than in patients without Doppler abnormality (0/23) (p < 0.001) and was significantly higher in the presence (5/18 (27.8%)) than in the absence of lactate peak (0/17) (p = 0.019). CONCLUSIONS: Fetuses with brain lactate peak detected by (1)HMRS in addition to altered Doppler findings are more likely to develop short-term morbidities and perinatal death. Fetal brain lactate detected by (1)HMRS may represent a clinical marker of altered brain metabolism and further perinatal complications.

Reproductive and obstetric outcomes in mosaic Turner's Syndrome: a cross-sectional study and review of the literature.

BACKGROUND: Turner's syndrome (TS) is depicted as a total or partial absence of one X chromosome that results in ovarian dysgenesis. Chances of spontaneous pregnancy in TS are rare and the outcome of the pregnancies is known to be poor with an increased risk of miscarriage and stillbirths. Our aim is to evaluate reproductive and obstetric outcomes of natural conception and in-vitro fertilization (IVF) cycles in mosaic TS patients. METHODS: A total of 22 mosaic TS cases (seventeen 45,X/46,XX and five 45,X/46,XX/47,XXX karyotypes) were evaluated. RESULTS: Live birth and abortion rates were found as 32.7 % and 67.3 %, respectively in 52 pregnancies. Implantation, clinical pregnancy and take home baby rates were detected as 3.7 %, 8.6 % and 5.7 %, respectively per IVF cycle as a result of 35 cycles. Fecundability analysis revealed that 5 % of the cases experienced first pregnancy within 6 months and 8 % within the first 2 years. Mosaicism ratio did not have an effect on the time to the first pregnancy (p = .149). CONCLUSION: Only a small proportion of the mosaic TS patients conceive in the first 2 years of the marriage. Age of menarche and age of marriage appear not to have any impact on the chance of conceiving. Mosaic TS cases should counseled about the low odds of pregnancy and high miscarriage rates.

Prenatal diagnosis and management of a fetal neck mass.

We report the case of a benign mesenchymal spindle-cell tumor located on fetal neck, diagnosed during prenatal ultrasound and magnetic resonance investigation. A 30-year-old woman (gravida 2, para 1) was referred to our perinatology unit for evaluation of a fetal neck mass that had been identified on ultrasonography at 29 weeks gestation. A right lateral neck mass was observed (size: 42×40 mm) that extended from the preauricular region to right clavicula. Fetal MRI revealed a solid heterogeneous mass arising from the right lateral neck and there was no invasion around tissue and no extension of the mass into the chest. At 37 weeks after birth, we observed that the mass was subcutaneous and there was no invasion to the surrounding tissue. The trachea was not compressed and there was no extension of the mass into the chest. Then, the neck mass was completely resected after birth without any complications. Histopathological examination of tumor was consistent with mesenchymal spindle-cell tumor. Immunohistochemical staining with CD34 and actin was positive; however, caldesmone, epithelial membrane antigen (EMA), and S-100 was negative. Fetal MRI performed during the pregnancy for investigation of fetal neck masses detected on ultrasound gives compatible results observed in the neonate after birth and maintains adequate findings for follow-up and planning of treatment.

Do the interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes?

OBJECTIVE: To determine whether interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes. MATERIALS AND METHODS: A total of 268 unselected pregnant women were recruited in the study. The study population consisted of four groups of women: group 1 (n=203) screened negative for bacterial vaginosis (BV) both in the first and second trimesters; group 2 (n=18) screened negative for BV in the first trimester but positive in the second trimester; group 3 (n=33) screened positive for BV in the first trimester but negative in the second trimester; and group 4 (n=14) screened positive for BV both in the first and second trimesters. Urine culture, cervico-vaginal cultures, and bacterial vaginosis were screened between 11-14 weeks and 20-24 weeks. RESULTS: Two hundred fifty women were eligible for analysis in the study after lost-to-follow up patients were excluded. Previous abortion ≥1 and previous preterm delivery at 24-34 weeks ≥1 were statistically significantly higher in group 2. The number of patients who were diagnosed as having preterm premature rupture of membranes (PPROM) was statistically significantly higher in group 4. Sexual intercourse during the first trimester, cervical length during the second trimester, and history of preterm birth (PTB) were statistically significant risk factors for preterm birth <37 weeks (1.27; (1.12-1.44); 5.33; (1.84-15.41); 6.95; (1.58-30.54), respectively). CONCLUSION: Presence or treatment of BV did not influence rates of PTB. The probability of PPROM would be higher in patients who are BV positive both in the first and second trimesters.

Mullerian adenosarcoma of the uterus associated with tamoxifen treatment for breast cancer.

Mullerian adenosarcoma following tamoxifen therapy is a rare condition. Our aim was to report the youngest patient in the literature with uterine mullerian adenosarcoma who was undergoing tamoxifen therapy for breast cancer. A premenopausal woman aged 38 years who was undergoing tamoxifen therapy for breast cancer, was admitted with symptoms of lower abdominal pain and irregular vaginal bleeding and malodorous vaginal discharge that had continued for at least 6 months. A pelvic examination revealed a large and malodorous polypoid mass protruding through the cervix and an enlarged uterus. A biopsy from the protruding polypoid mass was reported as a large area of necrosis with neoplastic mesenchymal cells. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oopherectomy, pelvic-paraaortic lymph node dissection, and omentectomie. The histologic diagnosis was Mullerian adenosarcoma. As a result, she was discharged to the oncology department. The woman is alive and her chemoradiotherapy treatment is ongoing. The role of tamoxifen therapy in the development of endometrial neoplasms remains unclear, but all cases of endometrial thickening and vaginal bleeding must be investigated for Mullerian adenosarcoma in tamoxifen users.

The effect of childhood cancer therapy on ovarian reserve and pubertal development.

The effects of childhood cancer therapy on ovarian reserve tests and on pubertal development within 5 years were compared with a control group. The study group was composed of 41 patients who underwent chemotherapy during pre-menarche (subgroup A; n = 15) and after menarche (subgroup B; n = 26); the control group was composed of 44 patients admitted with non-cancer related diseases (in total n = 85). Mean total ovarian volume and total antral follicle counts on ultrasound examination were significantly lower in the study group compared with the control group (3.5 ± 2.3 versus 5.2 ± 2.4 ml; P = 0.001; and 3.4 ± 3.3 versus 8.6 ± 3.5; P < 0.001, respectively). Mean FSH level was significantly higher in the study group (13.5 ± 16.2 versus 7.3 ± 2.7 mIU/ml; P = 0.017). Anti-Müllerian hormone levels in subgroup A were significantly higher than in subgroup B (1.8 ± 0.1 versus 1.5 ± 0.08 pg/dl; P = 0.034). In conclusion ovarian volume, antral follicle count and FSH can be used for evaluating the harmful effect of cancer chemotherapy on ovarian follicles. Post-menarche, Anti-Müllerian values reveal that ovarian follicles are more sensitive to the devastating effects of cytotoxic treatment.