Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

AIM: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. MATERIAL AND METHODS: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. RESULTS: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic inflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). CONCLUSION: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Risk factors for antibiotic therapy failure in women with tubo-ovarian abscess: A systematic review and meta-analysis.

AIM: Medical therapy with antibiotics only and surgical drainage are the treatment options of tubo-ovarian abscess (TOA). It is not yet known exactly which cases need surgical treatment. The aim of this systematic review and meta-analysis was to evaluate the risk factors leading antibiotic therapy failure in women with TOA. METHODS: We searched the following databases from inception to June 1, 2022: PubMed, Ovid MEDLINE, The Cochrane Library, and Scopus. We also searched reference lists of eligible articles and related review articles. The observational cohort, cross-sectional, and case-control studies were included in the meta-analysis. At least four review authors independently selected eligible articles, assessed risk of bias, and extracted data. The random effect model was used in the meta-analysis. RESULTS: A total of 29 studies, including 2890 women, were included in the study. The age, abscess size, history of intrauterine device use, postmenopausal status, history of diabetes mellitus, fever, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, and history of pelvic inflammatory disease were found as significant risk factors for antibiotic therapy failure in women with TOA. CONCLUSIONS: The findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.

Evaluation of the Success of Hysteroscopic Uterine Septum Resection.

Objectives: The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Materials and Methods: Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Results: Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Conclusion: Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.

Do the change in ß-hCG values between the 0th and 4th days in tubal ectopic pregnancy treatment with a single-dose methotrexate (MTX) protocol predict the need for a second dose of MTX?

AIM: The single-dose methotrexate (MTX) regimen is effective and minimizes side effects but an additional second dose is needed in case of failure in an ectopic pregnancy (EP). We aimed to predict the additional MTX dose by evaluating the change in ß-hCG values between day 0 and day 4 in EPs with administered single-dose MTX regimen. METHOD: A total of 454 tubal EPs between 2013 and 2019 were evaluated retrospectively. Cases cured with a single dose of MTX without an additional dose were accepted as the control group, and cases under a single-dose regimen were cured by applying a second dose of MTX on the 7th day were accepted as the study group. Obstetric and demographic characteristics and the change in ß-hCG values compared in both groups. RESULTS: Age, body mass index (BMI), gravida, smoking, abdominal surgery, presence of IUDs, initial ß-hCG levels (0th day), and EP size were similar in both groups, but the presence of previous EP history was significantly higher in the study group. The change of ß-hCG from days 0 and 4 determined that a 20% increase predicts the need for a second dose of MTX with 72.4% sensitivity, and 87.8% negative predictive value (NPV). CONCLUSION: The single-dose MTX protocol is successful in 83.3% of convenient cases (as the control group), but an increase of 20% in ß-hCG between days 0 and 4 predicts the patients who need to be administered second-dose MTX, and thus, a double-dose MTX protocol will be achieved early.

Postoperative care in the caesarean intensive care unit: experience from a tertiary maternity hospital

Objective: The aim was to determine whether follow-up in the intensive care unit (ICU) for the postoperative first eight hours was beneficial for early intervention in postpartum hemorrhage. Material and Methods: In our hospital, all patients are admitted to the ICU for the first eight hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively. Results: All cases (n=36,396) who underwent cesarean delivery were reviewed. Three hundred and fifty-nine patients with postpartum hemorrhage were identified and included. In the study group the time between cesarean section and diagnosis of postpartum hemorrhage was 10.1±19.1 hours, and the time between cesarean section and re-laparotomy was 9.26±23.1 hours. A total of three maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivering by cesarean section was 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births. Conclusion: Follow-up of patients in the ICU in the first eight postoperative hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.

Histological results of HPV genotyping from a colposcopy center.

PURPOSE: To investigate the role of partial human papillomavirus (HPV) genotyping tests in predicting the diagnosis of high-grade cervical intraepithelial lesion and cancer (HSIL +) as a result of colposcopic histopathology. MATERIALS AND METHODS: The study included 2872 patients who presented at our colposcopy unit between January 1, 2015 and December 31, 2019 and underwent colposcopy for the first time. The patients were compared in terms of HSIL + results as HPV 16/18 and HPV other type positive groups. RESULTS: HSIL + was determined at the rate of 22.3% in the HPV 16/18 group and at 7.0% in the HPV Other group, and the difference was statistically significant (p = 0.000). HPV 16/18 types were found to be responsible for 84.8% of cervical cancers and 83.5% of HSIL and worse cases. CONCLUSION: Partial HPV 16/18 genotyping is an effective strategy in the triage of HPV-positive women. HPV type identification consistent with the epidemiology of HPV types in HSIL + cases in the screened population, and the age-appropriate use of primary HPV tests will determine the sensitivity and cost effectiveness of screening.

The Relationship Between Perineal Body Size, Total Vaginal Length, Apical Prolapse, and Prolapse Symptoms.

IMPORTANCE: Currently, apical prolapse is diagnosed via assessing the levels of C and D points in the pelvic organ prolapse quantification (POP-Q) system. However, it is not yet known whether the other components of this system are useful for diagnosing apical prolapse and its symptoms. OBJECTIVE: The aim of the study was to evaluate the association between the perineal body size (PB), total vaginal length (TVL), and apical prolapse and its symptoms. STUDY DESIGN: Two hundred women, 100 women with apical prolapse and 100 women without, were included in this cross-sectional study. The association between the PB, TVL, and apical prolapse and its symptoms were evaluated. The relationship between the other POP-Q measurements and apical prolapse/prolapse symptoms were also evaluated as the secondary outcome of the study. RESULTS: The TVL (cutoff value, ≤8 cm; sensitivity, 80%; specificity, 60%) and the genital hiatus size (GH; cutoff value of >4.5 cm; sensitivity, 90%; specificity, 91%) were significantly associated with apical prolapse. The PB cutoff value of 3.4 cm or less had lower sensitivity (49%) and specificity (70%) for the diagnosis of apical prolapse. The GH (cutoff value, >4.8 cm; area under curve [AUC], 0.927), C (cutoff value, >-5.8 cm; AUC, 0.955), and Ba (cutoff value, >-1.1 cm; AUC, 0.891) were significantly associated with apical prolapse symptoms. However, there was no association between the PB or TVL with symptoms. CONCLUSIONS: The study results showed that the TVL and GH were more strongly associated with apical prolapse than PB. The GH, C, and Ba were also associated with prolapse symptoms, but PB and TVL were not.

Maternal obesity and intra-abdominal adhesion formation at cesarean delivery.

OBJECTIVE: The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery. METHODS: Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m2 and ≥30 kg/m2). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared. RESULTS: Intra-abdominal adhesions were more common in women ≥30 kg/m2 than in those <30 kg/m2 (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m2 vs. 30.5 ± 4.8 kg/m2, p = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m2 vs. 25.7 ± 5.2 kg/m2, p = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m2 than in those <30 kg/m2 (39.6% vs. 23.7%, p = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p = .001) in women ≥30 kg/m2 with intra-abdominal adhesions (16.7% vs. 35.4%, p = .005). CONCLUSION: Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.

Feasibility and Safety of Laparoscopic Surgery in Large Ovarian Masses.

Objectives: To evaluate the feasibility and safety of laparoscopic surgery for large ovarian masses with benign features. Materials and Methods: Women who underwent laparoscopic surgery for an ovarian mass with benign features between 2017 and 2019 at a tertiary referral center were included in the retrospective study. Based on the size of the ovarian mass, the women were divided into the case and control groups of ≥10 cm and <10 cm, respectively. Clinical characteristics, operative findings, histopathological results, and complication rates of the groups were compared. Results: A total of 260 women, 64 women with large masses and 196 with small masses were included in the study. The operation time, intraoperative cyst rupture rate, complication rate, and hospital stay were similar in the case and control groups (P > 0.05). The cyst aspiration rate (29.7% vs. 5.1%, P < 0.001) and the unexpected malignancy rate (7.8% vs. 0.0% P = 0.001) were significantly higher in the case group than in the control group. Conclusion: Laparoscopic surgery was found feasible for the treatment of women with large ovarian masses. However, a higher unexpected malignancy rate requires the careful patient selection and appropriate counseling preoperatively in these cases.

Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases.

AIM: To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS: A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS: A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p < 0.001). According to the ROC curve analyses, the optimal cut-off value for NLR and PLR were 2.51 (sensitivity, 72%; specificity, 78%) and 154.4 (sensitivity, 61%; specificity, 64%) in the diagnosis of adnexal torsion, respectively. CONCLUSION: NLR and PLR have been found useful hematological markers for the diagnosis of adnexal torsion. NLR and PLR could be helpful in cases, which is difficult to make a definitive diagnosis with patients' symptom and the ultrasonographic examination.

The significance of sonographically thickened endometrium in asymptomatic postmenopausal women.

OBJECTIVE: To investigate the correlation between sonographic, hysteroscopic, and pathological findings in postmenopausal asymptomatic patients with sonographically thickened endometrium. METHODS: The records of postmenopausal patients who attended the Menopause Outpatient Clinic of a tertiary women's hospital in Ankara, Turkey between January 1, 2012 and December 15, 2013 were retrieved. A total of 266 postmenopausal women without vaginal bleeding underwent hysteroscopic evaluation and endometrial sampling. Patients whose pathological records indicated an endometrial thickness equal to or greater than 6 mm (double layer) on transvaginal ultrasonography without any symptoms were included in the study. RESULTS: The most frequently detected focal intrauterine lesions in asymptomatic women were endometrial polyps, which were diagnosed in 168 (63.1%) cases. Twenty-four (9%) patients were diagnosed as having simple hyperplasia, 4 (1%) atypical hyperplasia, and 8 (3%) endometrial adenocarcinoma. Two of the patients with adenocarcinoma were diagnosed based on endometrial polyps, and 6 cases showed endometrial hyperplasia on hysteroscopy, while histological examination showed endometrial carcinoma. CONCLUSION: We suggest 10.5 mm as the cutoff value for endometrial thickness and recommend hysteroscopy following dilatation and curettage to increase diagnostic efficacy and provide definitive treatment in asymptomatic postmenopausal women with thickened endometrium.

Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma?

OBJECTIVES: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. METHODS: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. RESULTS: In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. CONCLUSION: A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.

The value of ultrasonographic tubo-ovarian abscess morphology in predicting whether patients will require surgical treatment.

OBJECTIVE: To determine if the ultrasonographic morphology of a tubo-ovarian abscess (TOA) could be used to predict if a patient will require surgical treatment. METHOD: A retrospective cohort study reviewed medical records from patients diagnosed with TOA via ultrasonography between January 2009 and January 2014 at a tertiary referral center in Turkey. Patients with pelvic inflammatory disease and an inflammatory adnexal mass, identified during sonographic examination, were included in the study. Ultrasonographic morphology, demographic characteristics, and clinical and laboratory findings were compared between patients who required surgical treatment and those who did not. RESULTS: Records were included from 164 patients; medical therapy was successful in 121 (73.8%) patients and 43 (26.2%) required surgical treatment. TOA morphology was identified, using ultrasonography, as unilocular cystic, complex multicystic mass, or pyosalpinx in 56 (34.1%), 73 (44.5%), and 35 (21.3%) patients, respectively. No correlation was present between ultrasonographic TOA morphology and patients requiring surgical treatment (all P>0.05). Multivariate analyses demonstrated that an abscess larger than 6.5 cm in size (P=0.027), fever at admission (P<0.001), and parity greater than two (P=0.026) were independent predictors of patients requiring surgical treatment for TOA. CONCLUSION: Although increased TOA size, fever at admission, and parity were associated with increased odds of patients with TOA requiring surgical treatment, ultrasonographic TOA morphology was not.

Success rates of single-dose methotrexate and additional dose requirements among women with first and previous ectopic pregnancies.

OBJECTIVE: To compare the success of the single-dose methotrexate regimen and the requirement for a second or third dose of methotrexate between women with their first ectopic pregnancy (EP) and those with previous EP. METHODS: In a retrospective cohort study, data were analyzed from women treated for EP by single-dose methotrexate at a Turkish tertiary referral center between January 2010 and December 2013. Data were compared between women with at least one previous EP and those with their first EP. RESULTS: The success rate of the protocol in the first and previous EP groups was similar: 93.0% (320/344) and 87.3% (48/55), respectively. History of previous EP was not a predictor of treatment failure. However, the requirement for additional methotrexate doses was significantly higher in the previous EP group (16/48 [33.4%]) than in the first EP group (55/320 [17.2%]; P=0.03). Multivariate analysis showed that history of tubal surgery (P=0.006) and initial levels of the ß-subunit of human chorionic gonadotropin (P=0.001) were significant predictors of treatment failure. CONCLUSION: Although the single-dose regimen had similar success rates in the previous EP and first EP groups, additional doses of methotrexate were more frequently required in the previous EP group.

Prevalence of endometrial polyps coexisting with uterine fibroids and associated factors.

OBJECTIVE: The aim of the study was to investigate the prevalence of endometrial polyps in patients with uterine fibroids and associated factors of coexistence of these two pathologies. MATERIALS AND METHODS: The medical records of 772 patients who underwent hysterectomy because of uterine fibroids were retrospectively reviewed. Patients were divided into two groups according to the presence of endometrial polyps in the histopathologic examination. Demographic, clinical and histopathologic findings of the patients with and without endometrial polyps were compared. Student's t-test, Mann-Whitney U test, Pearson's Chi-square test, and logistic regression analysis were used for statistical analysis. RESULTS: The prevalence of the endometrial polyps in uterine fibroid cases was found 20.1% (n=155). Age ≥45 years (odds ratio [OR] 1.61; 95% confidence interval [CI]: [1.06-2.44]; p=0.014), presence of hypertension (23.9% vs. 17.5%; p=0.047), endometrial hyperplasia (OR 4.00; 95% CI: [1.92-8.33]; p<0.001) and cervical polyps (OR 3.13; 95% CI: [1.69-5.88]; p<0.001) were significantly associated with the coexistence of endometrial polyps and uterine fibroids. Endometrial polyps were more common in patients with ≥2 fibroids (p=0.023) and largest fibroid <8 cm (p=0.009). A negative correlation was found between condom use and endometrial polyps (8.1% vs. 3.9%; p=0.044). CONCLUSIONS: The prevalence of the endometrial polyps coexisting with uterine fibroids was 20.1%. Age, hypertension, endometrial hyperplasia, cervical polyps, and number of fibroids were positively correlated; condom use and size of largest fibroid were negatively correlated with the coexistence of these two pathologies.

Severe Preeclampsia versus HELLP Syndrome: Maternal and Perinatal Outcomes at <34 and ≥34 Weeks' Gestation.

BACKGROUND: Preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome are important disorders affecting the health of both the mother and fetus. Prediction of the maternal and perinatal outcomes at early and late gestational age is important for the management of both disorders. AIMS: The purpose of the study was to investigate adverse maternal and perinatal outcomes in severe preeclampsia and HELLP syndrome cases according to gestational age. STUDY DESIGN: Retrospective cross-sectional study. METHODS: One hundred and ninety-seven pregnancies with severe preeclampsia and 56 pregnancies with HELLP syndrome were included the study. Clinical characteristics and adverse maternal and perinatal outcomes were noted from medical records. Participants were divided into two groups at <34 and ≥34 weeks' gestation: the severe preeclampsia group and the HELLP syndrome group. The differences between the outcomes in the groups were investigated. Statistical analysis was performed using the Student t test, Fisher Exact test and Yates' Chi-square test. RESULTS: Eclampsia was more common in HELLP syndrome cases at <34 weeks' gestation (p 0.028). However, eclampsia rates were statistically similar between groups at ≥34 weeks' gestation. The requirement for blood products transfusion was higher in the HELLP group at all gestational weeks. No statistical difference was found in perinatal outcomes between severe preeclampsia and HELLP groups at less than and more than 34 weeks' gestation. CONCLUSION: Eclampsia risk increases in HELLP syndrome, especially at gestations less than 34 weeks. Perinatal morbidity at less than 34 weeks' gestation and mortality were similar in severe preeclampsia and HELLP syndrome cases at the same gestational age.

Abdominal scar characteristics: do they predict intra-abdominal adhesions with repeat cesarean deliveries?

AIM: The aim of this study was to evaluate the relation between abdominal scar characteristics and the severity of intra-abdominal adhesions with repeat cesarean deliveries. METHODS: A total of 208 women with at least one previous cesarean delivery at or beyond 37 weeks of gestation who were admitted for repeat cesarean delivery were enrolled in this study. Scars were categorized as depressed, flat or elevated according to their appearance, and hyperpigmented or the same color as the surrounding skin according to their pigmentation status. Intraoperative adhesions were graded according to the modified Nair's classification and categorized as no adhesion, filmy or dense adhesions. RESULTS: No significant difference was found between women with or without adhesions regarding age, body mass index, gestational week at delivery, number of previous cesarean deliveries or the duration since the last cesarean delivery. Women with depressed scars had more intra-abdominal adhesions than women with flat or elevated abdominal scars (P = 0.013). There was no significant difference in the incidence of hyperpigmented and non-pigmented scars between women with or without adhesions (39.4% vs 41.3% and 60.6% vs 58.7%, respectively) (P > 0.05). Scar width was significantly larger in patients with intra-abdominal adhesions than in patients without adhesions (3.6 ± 1.1 vs 3.2 ± 0.9) (P = 0.003), whereas scar length did not differ significantly (15.2 ± 1.3 vs 15.1 ± 2.1) (P > 0.005). CONCLUSION: There is a relation between depressed abdominal scars and intra-abdominal adhesions, whereas pigmentation status does not differ between women with or without adhesions.

The role of gel application in decreasing pain during speculum examination and its effects on papanicolaou smear results.

PURPOSE: This study aimed to investigate the effects of water-based gel application in reducing pain or discomfort associated with speculum examination, and compared the presence of unsatisfactory Papanicolaou smear results between gel-applied and control groups. METHODS: In this prospective randomized controlled study, a total of 1,580 patients were analyzed. The subjects were randomized to a gel group and a control group. For the collection of the smear sample, water-based gel was used in the gel group and dry speculum was used in the control group. All patients were asked to score their pain on a numeric pain scale at two time points during the procedure (insertion and opening phase of speculum). Cytopathologists who analyzed the smear cytology were blinded to the study. Pain intensity during speculum examination, as well as unsatisfactory smear results, were analyzed between the groups. RESULTS: The pain scores obtained at two different time points of speculum application were significantly lower in the gel group compared to the control group both in premenopausal and postmenopausal women (p < 0.001). The ratios of unsatisfactory cytopathologic examination results were 1.13 and 1.39% for the gel-applied and control groups, which were not significantly different. CONCLUSION: Lubrication of the outer superior and inferior blade of the plastic vaginal speculum with a small amount of a water-soluble lubricant gel decreases the pain associated with insertion and opening of the vaginal speculum in both premenopausal and postmenopausal women without affecting the quality of the cytology results during the collection of Papanicolaou test specimens.

The relationship between endometrial thickness and pregnancy rates in GnRH antagonist down-regulated ICSI cycles.

OBJECTIVE: To investigate the effects of endometrial thickness measurements and serum hormone levels on the outcomes of GnRH antagonist down-regulated ICSI cycles. STUDY DESIGN: Forty consecutive infertile women undergoing controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonists for ICSI were enrolled in this study. All patient's age, day 3 FSH, antral follicle count (AFC), serum E2 levels on day 3, E2 on stimulation day 5, E2 on day of hCG administration, endometrial thickness on the baseline (ETMBaseline), on day 5 of stimulation (ETMDay 5), on day of hCG administration (ETMhCG) and cycle outcomes were recorded. The outcomes of pregnant and nonpregnant women were compared. RESULTS: Women's age was 33.6 +/- 4.9. Overall pregnancy rate was 45% (n = 18), clinical pregnancy rate was 27.5% (n = 11) and ongoing pregnancy rate was 20% (n = 8). In pregnant women, baseline AFC was significantly higher compared with nonpregnant women (p = 0.01). There was no significant correlation between ETMhCG and E2 level on the day of hCG, number of retrieved oocytes or patients' age. CONCLUSION: For achieving pregnancy, endometrial thickness on the day of hCG is not a determining parameter, and the only significant determinent is AFC in GnRH antagonist down-regulated ICSI cycles.