A life-threatening second trimester disseminated intravascular coagulopathy with protein s deficiency.

Disseminated intravascular coagulopathy (DIC) is an uncommon but serious complication of pregnancy. Placental abruption is the most common associated condition among the causes of acute obstetrical DIC. We present a case of life-threatening DIC complicating placental abruption in the second trimester of pregnancy with protein S deficiency as a triggering factor, which necessitated urgent termination of pregnancy.

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients.

OBJECTIVES: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. METHODS: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). RESULTS: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. CONCLUSIONS: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.

Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report.

A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult.

The predictive power of endocrine tests for the diagnosis of polycystic ovaries in women with oligoamenorrhea.

Various hormonal parameters and the best logistic regression model to predict disease probability were evaluated in women with polycystic ovary syndrome (PCOS). Concentrations of LH, FSH, LH/FSH ratio, testosterone, free testosterone, SHBG and insulin in serum were recorded in 32 women with PCOS and in 25 controls. A model including LH/FSH ratio, insulin and testosterone measurements yielded the best goodness of fit for classification of women with and without PCOS in the logistic regression analysis. Only LH/FSH ratio and insulin were retained as significant variables. The diagnostic characteristics of LH/FSH ratio and insulin for PCOS when compared by receiver-operator characteristic analysis were found to be equally effective. By combining these two variables a higher area under curve was obtained. LH/FSH ratio, insulin or the combination of these two can predict the disease probability in women with PCOS.

Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear.

OBJECTIVE: To assess the rate of undetected dysplasia in patients with two consecutive reports of inflammatory cellular changes without atypia on Pap smears despite anti-inflammatory therapy. METHOD: A prospective randomized study. RESULT: 2798 premenopausal non-pregnant patients were evaluated by Pap smears of the cervix. Of these, 397 (14.2%) were reported as 'inflammatory cellular changes'. A total of 238 (8.5%) had persistent inflammatory changes without atypia despite the anti-inflammatory therapy. Fourteen patients refused colposcope. The mean age and parity of the remaining 224 patients were 30.2 +/- 6.3 (18-46) and 1.7 +/- 2.3 (0-6), respectively. When these patients underwent colposcopically-directed biopsies of the cervix, in 51 (22.7%) patients human papillomavirus lesions, dysplasia and in situ cancer were noted. Mean age, parity, age of marriage, prevalence of smoking and contraceptive methods of the two groups of patients (173 vs. 51) did not show statistically significant differences. CONCLUSION: Colposcopically-directed biopsies of the cervix are indicated even when inflammatory cellular changes without atypia persist despite therapy.

The effects of hormone replacement therapy on uterine fibroids in postmenopausal women.

OBJECTIVE: To evaluate and compare the effects of two different modalities of hormone replacement therapy (HRT) on the size of uterine fibroids. DESIGN: Randomized clinical study. SETTING: The Menopause Center of a public hospital. PATIENTS: Postmenopausal women with small asymptomatic uterine fibroids were selected. INTERVENTIONS: One group was treated with 50 micrograms transdermal E2 plus 5 mg medroxyprogesterone acetate (MPA) continuously, whereas the second group was given 0.625 mg conjugated equine estrogen plus 2.5 mg MPA continuously. MAIN OUTCOME MEASURE: The size of the uterine fibroids was measured before and after the first year of HRT. RESULTS: At the end of the first year on HRT, the size of the uterine fibroids was re-evaluated sonographically and no significant difference was found with the oral group, whereas there was a significant increase in the transdermal group. CONCLUSION: Hormone replacement therapy with 50 micrograms transdermal E2 plus 5 mg MPA increases the size of the uterine fibroids.

The importance of endometrial fluid collection in postmenopause.

OBJECTIVE: We sought to determine the importance of postmenopausal endometrial fluid collection, which has almost invariably been accepted as a finding of a malignant process. METHODS: Out of 1,500 postmenopausal patients admitted to our center mainly for their postmenopausal symptoms, endometrial fluid collection was detected in 15 cases during transvaginal pelvic ultrasonographic evaluations. These patients were evaluated with cervical smears as well as endocervical and endometrial curretages. The fluid collections were aspirated and measured. RESULTS: The mean age and mean menopausal age were 51.7 +/- 1.3 and 5.7 +/- 9.8 years, respectively. Six of the patients were already on hormone replacement therapy. Nine were asymptomatic and the others had vaginal discharge and pelvic pain. Ten patients had normal findings on pelvic examination, and in the others benign cervical polyps, previous cervical amputation, cervical erosion, and nabothian cysts were detected. The volume of the directly measured fluid was 7.9 +/- 4.0 cm3. The cervical smears, the cytological examinations of the fluids, the colposcopic examinations and the endocervical curretages were negative, and the histopathological evaluation of the endometrial curretage specimens revealed no premalignant or malignant disease, but blood and fibrin in 1 patient, inactive endometria in 9 patients, proliferative endometria in 4 patients and senile cystic atrophy in 1 patient. CONCLUSION: Although there was no malignancy in our series, the conflicting results of the limited number of studies made us cautious and we still consider that postmenopausal patients with endometrial fluid collection may be at risk for gynecologic cancers and that every effort should be made in order to rule out such a condition.

A study of premature ovarian failure in Turkish women.

The parameters that could be responsible for or could be the end results of the premature ovarian failure were evaluated in 100 patients and compared with the same parameters of a control group consisting of 30 ovulatory healthy women with regular menstrual cycles. The incidence of premature ovarian failure was 6.6%. The mean age of the premature ovarian failure group was 39.2 +/- 4.1 years (range 30-58) whereas this was 45.6 +/- 3.1 years (range 39-52) for the control group. The mean menopausal age was 4.0 +/- 4.3 years (range 1-30). The prevalence of being a widow, divorcee or single was high in the premature ovarian failure group (p < 0.01). Of the hormonal and metabolic parameters, thyroid-stimulating hormone (TSH) and high-density lipoprotein (HDL) levels showed significant differences between the two groups (p < 0.01 and p < 0.05, respectively) and of the parameters reflecting bone metabolism, alkaline phosphatase levels showed a significant difference (p < 0.05). The bone mineral densitometric measurement values were lower in the premature ovarian failure group (p < 0.05). Because premature ovarian failure is not a rare disorder and because the patients have an early estrogen deficiency we concluded that, whatever the etiologic factor, hormone replacement therapy needs to be given as early as possible.

Postmenopausal vulvar pruritus--colposcopic diagnosis and treatment.

Vulvar pruritus is a common symptom in post-menopausal women and treatment is easy if the diagnosis is duly recognized. The purpose of this study is to show the importance of colposcopic examination and directed biopsies in 27 post-menopausal women with pruritus. Biopsy sites were selected by colposcopy. The prevalence of vulvar pruritus, vulvar pathologies, vulvar dystrophies and vulvar intraepithelial lesions (VIN) were 2.18%, 1.49%, 0.94% and 0.07% respectively. Vulvar dystrophies were treated by topical steroids and success rate was 100%. All patients with vulvar pruritus need examination under colposcopy to define optimal therapy and to exclude atypia or malignancy.