The impact of cervical dilatation on pregnancy outcomes after cerclage placement in women with a short cervical length.

OBJECTIVE: The aim of the study was to compare the outcome of pregnancies with cerclage placement in which cervical length was <15 mm and 15-25 mm. We further investigated the impact of cervical dilatation on delivery at <34 weeks. MATERIAL AND METHODS: Women with singleton gestations with cerclage placement due to cervical insufficiency were enrolled into the study. The data were collected prospectively between September 2004 and February 2009. We divided patients into two categories: (group I) cervical length below 15 mm, (group II) cervical length between 15-25 mm. We compared the pregnancy outcomes of the two groups and also analyzed the independent impact of cervical dilatation on delivery <34 weeks. RESULTS: The cervical cerclage group <15 mm had a similar incidence of preterm delivery <34 weeks gestation to the cerclage group 15-25 mm (p=0.4). No significant difference in rate of neonatal survival (p=0.6) was found between the two groups. Increased cervical dilatation in centimeters was found to be a significant predictor of delivery before 34 weeks gestation (OR: 3.4, 95% CI: 1.3-8.5, p=0.009). CONCLUSIONS: The extent of cervical shortening did not have a significant independent effect on the perinatal outcome of patients with cerclage placement. However, the presence of cervical dilatation prior to cerclage placement in cases of cervical insufficiency may worsen perinatal outcomes by increasing the rate of delivery before 34 weeks.

Effect of GnRH analogues and octreotide treatment on apoptosis and the cell proliferation of endometrium adenocarcinoma cell lines.

OBJECTIVE: The aim of this study was to compare apoptotic and antiproliferative effects of gonadotropin-releasing hormone analogues and their combination with octeotide on endometrioid endometrial cancer cell lines. MATERIAL AND METHOD: Women diagnosed with endometrioid adenocarcinoma at the department of Gynecology and Obstetric of Kocaeli University Medical School were included in this research. Endometrium cancer cell lines obtained from three patients were used for this study. After trypsinization in 0.5% in calcium magnesium, free phosphate buffer solution (CMFPBS) cells were seeded on glass slides in 24-well plates containing DMEM-F12 medium and 10% fetal calf serum as culture medium. Cells were incubated for 24 hours at 37ºC in 5% CO2. GnRH agonist leuprolide (Lucrin 1 µmol/L), GnRH antagonist ganirelix (Orgalutran 1 µmol/L), leuprolide with octreotide (Sandostatin 10-6 mol/L), ganirelix with octreotide and no drug were added to the wells. Apoptosis and cells proliferations were evaluated after 12, 24, 48 and 72(th) hours of incubation. The percentage of apoptotic cells was evaluated by TdT mediated biotin-dUTP nick-end labeling (TUNEL) method; cell proliferation was assessed by bromodeoxyuridine (BrdU) incorporation. RESULTS: Apoptotic index in grade I EEC cell line among ganirelixoctreotide treated cells and leuprolide-octreotide combination therapy were respectively higher than the untreated control (p<0.001, p=0.001). The number of apoptotic cells in grade II EEC cell line among leuprolide-octreotide and leuprolide were significantly (p<0.001, p<0.001) higher than in controls. In grade III EEC cell line, the number of TUNEL positive cells among leuprolide, ganirelix and ganirelixoctreotide therapiy groups were significantly higher than in untreated control. Time dependent antiproliferative effect was obtained with leuprolide and leuprolide-octreotide in grade I EEC (p<0.001, p<0.001). Grade II EEC cell line is not influenced by hormonotherapies. However, the antiproliferative effect was obtained with ganirelix, leuprolide and leuprolide-octreotide in grade III cell line. CONCLUSION: GnRH analogues appears to have a direct effect, enhancing the apoptotic index and decreasing the cell proliferation in endometrial adenocancer cell lines.

Transient osteoporosis of pregnancy: case report.

Transient osteoporosis of pregnancy is a rarely observed skeletal pathology developing in the last months of pregnancy. Meticulous evaluation is important for the differential diagnosis of severe and progressive hip and/or groin pain in pregnant patients. MRI is a valuable and safe technique for demonstrating bone marrow edema and skeletal abnormalities during pregnancy. Avoidance of vaginal delivery and non-weight bearing measures are essential in order to prevent complications such as hip fractures related to transient osteoporosis of pregnancy. We present the diagnostic evaluation and treatment of an uncommon case of transient osteoporosis of pregnancy with resolution of symptoms and postpartum.