Uterine rupture in pregnancy subsequent to hysteroscopic surgery: A case series.

Uterine rupture during pregnancy is associated with high mortality and morbidity rates in both the fetus and the mother. Hysteroscopic surgeries such as myomectomy and septum resection are known risk factors for uterine rupture in pregnancy following the operation. We present four infertile patients who were admitted to Kocaeli Medical Park Hospital between February 2014 and November 2016. Three of the patients underwent hysteroscopic septum resection without complication and one had hysteroscopic myomectomy and a 7-8 mm sized rupture was detected. All of the patients became pregnant in less than a year after the operations. The first three patients had uterine rupture at 22nd, 38th, and 10th week, which is the earliest rupture in the literature. The last patient had an uneventful pregnancy and the rupture was observed during cesarean section. A short interval between hysteroscopy and pregnancy may increase the risk of rupture. It may be possible to become pregnant despite rupture and not have any problems during the entire pregnancy.

Side effects and acceptability of Implanon: a pilot study conducted in eastern Turkey.

OBJECTIVE: To assess side effects during the first 6 months of use of Implanon. DESIGN AND METHODS: The study was conducted in eastern Turkey between June 2004 and May 2005. Forty-one healthy women, aged 18-40 years who chose to use Implanon participated in the study. The implant was inserted between days 1 and 5 of the menstrual cycle. Findings were recorded before and during 6 months following insertion. Statistical analyses were performed using SPSS package programme including paired samples t-test. RESULTS: No pregnancy occurred during the study. Ninety days after initiation of therapy, three of the 41 patients (7.3%) had regular periods, 14 (34.1%) were amenorrhoeic and the remaining 24 (58.5%) had some type of abnormal bleeding. Dysmenorrhoea affected significantly less women (1/41, i.e. 2.4%) than before treatment (17/41, i.e. 41.5%), but mastalgia increased significantly as it was reported by five previously unaffected participants (12.2%). Mood changes appeared in seven patients (17.1%) and acne in 11 of them (26.8%). The circulating levels of protein C, total cholesterol and oestradiol dropped significantly. Endometrial thickness decreased significantly. At completion of the study period, removal of the implant was requested by eight of the 41 patients (19.5%) because of irregular bleeding (six women), depressive symptoms requiring treatment (one woman) or weight gain (one woman). CONCLUSIONS: Mainly because of irregular bleeding, the discontinuation rate of Implanon at 6 months among the women in this region is high (19.5%).

Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in southern Turkey.

Primary infections caused by Toxoplasma gondii, rubella and cytomegalovirus (CMV) can lead to serious complications in pregnant women. The aim of this study was to determine the seroprevalence of Toxoplasma, rubella and CMV infections through antenatal screening. In this study, the consecutive records of 1652 pregnant women examined between the period March 2004 to January 2006 were included. The results of the antenatal screening for Toxoplasma, rubella and CMV during the first trimester of pregnancy were evaluated. Anti-Toxoplasma, anti-rubella and anti-CMV IgG and IgM antibodies were assayed using an enzyme linked immunosorbent assay method. Of the 1652 pregnant women tested, anti-Toxoplasma IgG antibody was found in 860 (52.1%) of the cases, while 9 (0.54%) of the subjects tested positive for anti-Toxoplasma IgM. Anti-rubella IgG and IgM antibodies were reactive in 1570 (95.0%), and in 9 (0.54%) of the tested women, respectively. Moreover, 1568 (94.9%) of them were found to be positive for anti-CMV IgG, while 7 (0.4%) tested positive for anti-CMV IgM. Consequently, because of the high seropositivity of T. gondii, rubella and CMV in the pregnant women, the country's health authorities should be alerted, and preventive measures should be taken.

[Investigation of the prevalence of Trichomonas vaginalis in women with complaints of vaginal discharge and itching]. / Vaginal akinti ve kasinti sikayeti olan kadinlarda Trichomonas vaginalis yayginliginin arastirilmasi.

Trichomonas vaginalis (T. vaginalis) is the most common pathogen that is sexually spread in women. In this study, the presence of Trichomonas vaginalis was investigated in patients with vaginal discharge and itching who presented at the polyclinic of the Mustafa Kemal University Medical Faculty Department of Gynecology. These women were between 20-40 years of age. During gynecologic examination of patients, vaginal fluid samples were collected with swaps from the speculum and fornics to two tubes that contained sterile saline. One of the vaginal discharges collected with swaps was used for direct microscopic examination and Giemsa staining. The other one was used for culturing for T. vaginalis in Trichomonas medium that contained horse serum and antibiotics. While the fre-quency of T. vaginalis was found to be 1.81% (5 of the 275 samples) by the direct microscopic examination and Giemsa stain, this ratio was 2.18% (6 of the 275 samples) by the culture method. In conclusion, it was decided to use the culture method in diagnosis of T. vaginalis in addition to direct microscopic examination. This was the first study of T. vaginalis infection in our region and it was compared with other studies carried out in other regions of Turkey. Our results were somewhat lower than those in other regions.

A prospective randomized study comparing misoprostol and oxytocin for premature rupture of membranes at term.

OBJECTIVE: The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term. METHODS: Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction-delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome. RESULTS: Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 +/- 2.45 hours in the misoprostol group and 11.57 +/- 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities. CONCLUSION: Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin.

Induction of labor with misoprostol in pregnancies with advanced maternal age.

OBJECTIVE: The objective was to compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in advanced aged pregnancies with a Bishop score of < 6. STUDY DESIGN: A hundred advanced aged (> or = 35 years) pregnant patients with a Bishop score of < 6 were randomized into two groups. The first group (50 patients) received 50 microg intravaginal misoprostol four times with 4 h intervals and the second group received oxytocin infusion for induction of labor starting from 2 mIU/min and was increased every 30 min with 2 mIU/min increments up to a maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome, and maternal complications were recorded. Statistical analyses were performed using the Mann-Whitney U, Chi-squared and t tests to determine differences between the two groups. A p value < or = 0.05 was considered significant. RESULTS: Misoprostol was superior for induction of labor in advanced aged pregnancies with Bishop score of < 6, as the mean time from induction to delivery was 9.61 +/- 4.12 h and 11.46 +/- 4.86 h in the misoprostol and oxytocin groups respectively, with a significant difference between the groups (p = 0.04). The rate of vaginal delivery was higher in the misoprostol group (84.0%) than in the oxytocin group (80.0%), but the difference did not reach significance (p = 0.60). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no cases of uterine rupture occurred. The 1- and 5-min mean Apgar scores were 6.98 +/- 1.17 to 9.08 +/- 0.99 and 6.88 +/- 1.81 to 9.00 +/- 1.35 in the misoprostol and oxytocin groups respectively, with no significant differences between the groups (p = 0.74, p = 0.83). No cases of asphyxia were present. The rate of admission to the neonatal intensive care unit was similar in both groups. CONCLUSION: Intravaginal misoprostol seems to be an alternative method to oxytocin in the induction of labor in advanced aged pregnant women with low Bishop scores, as it is efficacious, cheap, and easy to use. But large studies are necessary to clarify safety with regard to the rare complications such as uterine rupture.

Induction of labor in great grandmultipara with misoprostol.

OBJECTIVE: To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in great grandmultiparous pregnancies with a Bishop score of <6. STUDY DESIGN: Sixty-four great grandmultiparous (delivering the tenth, or greater, infant) pregnant patients with a Bishop score of <6 were randomized in two groups with 32 patients receiving 50 microg intravaginal misoprostol four times with 4h intervals, and 32 patients receiving oxytocin infusion for induction of labor starting from 2 mIU/min, increasing it every 30 min with 2 mIU/min increments up to maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann-Whitney U-test, Chi-Square test and hypothesis test about differences for two proportions (t-test) to determine differences between the two groups. P < or = 0.05 was considered significant. RESULT: The mean time from induction to delivery was 9.91+/-4.30 and 10.88+/-4.72 h in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups. The rate of vaginal delivery was 84.4 and 87.5% in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups (P = 0.72). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no case of uterine rupture occurred. The 1 and 5 min mean Apgar scores were 6.91+/-1.57-8.88+/-1.39 and 7.22+/-1.24-9.06+/-0.84 in the misoprostol and oxytocin administered group with no significant differences between the groups (P = 0.38 and 0.51). No case of asphyxia was present. The rate of admission to neonatal intensive care unit was higher in the misoprostol administered group, but the difference was not significant. CONCLUSION: Intravaginal misoprostol is an alternative method to oxytocin in induction of labor in great grandmultiparous pregnant women with low Bishop scores, as it is effective, cheap and easy to use. Safety about rare complications and neonatal morbidity needs clarifications with further studies.

Peripartum hysterectomy in a teaching hospital in the eastern region of Turkey.

OBJECTIVES: The aim of this study was to find the incidence and clinical implications of peripartum hysterectomy in our hospital at the Eastern region of Anatolia. STUDY DESIGN: We analyzed retrospectively all cases of peripartum hysterectomy performed at YYU Medical Faculty Hospital between January 1995 and April 2003. Emergency peripartum hysterectomy was performed for hemorrhage which cannot be controlled with other conventional treatments within 24h of a delivery. There were 24 cases of emergency peripartum hysterectomy performed. RESULTS: The incidence of emergency peripartum hysterectomy was 5.09 per 1000 deliveries. Half of the hysterectomies followed cesarean section. Eleven patients were referred to our clinics from other hospitals. Uterine atony (45.8%) was the most common indication and placenta accreta (25.0%) was the second most common. Eighteen patients (75%) had subtotal hysterectomy. Bladder injury was seen in three cases. Re-exploration was performed in three cases (12.5%). Seventeen patients stayed in hospital over 7 days. There were four (16.7%) maternal deaths all of whom were referred from other hospitals. CONCLUSION: The mortality and morbidity of performing a peripartum hysterectomy is elevated, especially if performed in critical patients referred from other hospitals.

Combined bladder, urethral and uterine rupture after a normal, spontaneous vaginal delivery at home: a case report.

BACKGROUND: Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home. CASE: A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen. CONCLUSION: To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.

[Case report: Treatment with arterial embolization in a destroyed cervical pregnancy]. / Bozulmus servikal gebelikte arteryel embolizasyon ile tedavi.

Cervical pregnancy is a rare form of ectopic pregnancy. It is frequently associated with extensive hemorrhage, which, in severe cases, may be stopped only by hysterectomy. We report a case of a destroyed cervical pregnancy simulating cervical cancer. The patient was conservatively managed with simple selective uterine artery embolization without methotrexate administration. Her vaginal bleeding ceased after embolization. No additional treatment was given. The patient resumed normal menstruation two months after embolization.

[Uterine leiomyoma embolization: Role of power Doppler ultrasonography]. / Uterin leyomyom embolizasyonu: power Doppler US'nin rolü.

PURPOSE: The vascularity of uterine leiomyoma was evaluated by power Doppler ultrasonography (PDUS) before and after bilateral uterine artery embolization (UAE) in order to establish the efficacy of the procedure and contribution to the treatment. MATERIALS AND METHODS: UAE was performed in 20 symptomatic patients with uterine leiomyoma. In addition to MRI and gray scale US, patients were evaluated by PDUS to assess the vascularity of the uterus and leiomyomas before and 6 months after the embolization and the findings were compared with angiography. Vascularity was categorized into 3 groups as mild (5 cases), moderate (7 cases) and marked (8 cases). Relationship between the findings of PDUS and treatment results were analyzed statistically by one-way ANOVA and post-hoc Tukey tests. RESULTS: In PDUS except their calcified and degenerated regions leiomyomas displayed more vascularity peripherally than centrally, before the embolization. Six months after the embolization, a decrease of 37%, 44% and 59% was observed in the mass of the leiomyomas that had revealed mild, moderate and marked vascularity before the embolization. Greater mass reduction occurred in leiomyomas with high pre-embolization vascularity (p < 0.05). CONCLUSION: PDUS gives important information about the vascularity of uterine leiomyomas before and after uterine artery embolization, which became a widespread treatment option in recent years. It can be helpful in the selection of patients for uterine artery embolization by revealing the vascularity of the leiomyomas. Also it is a non-invasive and cheap method in the determination of the efficacy of the procedure in the early and late periods after embolization.

Mucinous appendicular cystadenocarcinoma during pregnancy. A case report.

BACKGROUND: Primary appendicular adenocarcinoma is a rare type of appendicular carcinoma. We report mucinous appendicular adenocarcinoma during pregnancy. To our knowledge, this is the third reported case. CASE: A 35-year-old woman at 21 weeks of gestation presented with acute abdominal symptoms for the previous 10 days and underwent appendectomy. Histopathologically, examination of the appendectomy material was reported as "mucinous appendicular cystadenocarcinoma." The pregnancy was terminated by misoprostol induction. A right hemicolectomy and staging procedure were performed on the third postpartum day with relaparotomy. CONCLUSION: Although it rarely coexists with pregnancy, primary appendicular adenocarcinoma should be considered in pregnant women with atypical acute abdominal symptoms of long duration. Primary adenocarcinoma of the appendix should be treated with right hemicolectomy even if it is a secondary procedure. Termination of pregnancy is not essential to the surgical procedure, and the decision on the outcome of the pregnancy should be made with the patient.

Recurrent impetigo herpetiformis in a pregnant adolescent: case report.

Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology. A 17 year old patient who developed Impetigo Herpetiformis for the second time in the 27th week of her 2nd pregnancy is presented. The patient improved with corticosteroids treatment but the lesions did not clear completely and had flare ups during stressful periods which brings us to conclusion that Impetigo Herpetiformis at least has a common pathway with Generalized Pustular Psoriasis in the pathogenesis as stress provoked exacerbations.