Evaluation of vaginal birth safety in twin pregnancies with the first twin in cephalic presentation

Objective: To evaluate vaginal birth safety by comparing the results of cesarean birth in twin pregnancies with the first twin in vertex presentation. Material and methods: A retrospective cohort study of vertex-presenting twin pregnancies between 32 weeks 0 days and 38 weeks 6 days of gestation was conducted at our hospital from January 2013 to December 2014. The study population was divided according to the mode of birth. The primary outcome was early neonatal mortality, and secondary outcomes related to maternal and perinatal clinical characteristics were analysed between the groups. Results: Of 45,166 births, 1.92% (n = 869) were twin pregnancies. Of the 295 pregnancies meeting the study criteria, 30.16% (n = 89) were in the vaginal birth group, while the remaining 69.84% (n = 206) were in the cesarean birth group. In the vaginal birth group, all the first twins were delivered via vaginal birth, while among the second twins, 82.03% (n = 73) were delivered via vaginal birth, and the remaining 17.97% (n = 16) were delivered via cesarean birth. In the vaginal birth group, the early neonatal mortality rate was 22.4‰ (n = 2), and it was 9.7‰ (n = 2) in the cesarean birth group. All of the deaths occurred in pregnancies under 37 weeks of gestation. Conclusion: The neonatal outcomes between the vaginal birth and cesarean birth groups were similar in term pregnancies with the first in twin vertex presentation, whereas adverse neonatal outcomes were increased in the vaginal birth group in preterm second twin pregnancies.

Immunolocalization of FOXP3, JAK1 and STAT5 in Preeclamptic, Intrauterine Growth Restricted and Gestational Diabetic Human Placentas

Objective: The aim of the study to show the relation of T cells in placental villous fragments with FOXP3,JAK1 and STAT5 receptors in different conditions such as GDM, PE and IUGR placental tissues. Methods: Specimens of ten(10) diabetic placentas, ten(10) preeclamptic, ten(10) intrauterine growth restricted placentas and ten(10) control placentas were collected by systematic uniform random sampling. Immunohistochemical detections of FOXP3, JAK1 and STAT5 were performed in histological sections for each group’s placental tissue. The H-score value was derived for each specimen by calculating the sum of the percentage of syncytiotrophoblast and syncytial nodes in placenta and intervillus area. They were categorized by intensity of staining, multiplied by its respective score. Results: FOXP3, JAK1 and STAT5 immunoreactivity comparisons are shown in four groups of placentas. FOXP3 immunoreactions significantly increase in GDM group. JAK1 and STAT5 immunoreactions significantly decrease in PE group. STAT5 immunoreactivity was detected crucially increase in GDM group. Discussion: The results showed that in different conditions such as PE,GDM and IUGR, T cells in placental villous fragments have relation with FOXP3,JAK1 and STAT5 receptors and that FOXP3 can inactivate the PE and IUGR in the placental tissue. We have also confirmed as other studies that JAK-STAT pathway plays important role in PE,IUGR and GDM placental tissue.

Ovarian Hilus Cell Hyperplasia and Sertoli-Leydig Cell Tumor in a Patient with Postmenopausal Virilization: a Rare Case Report

Objective; We present a case report regarding a 71-year-old woman with postmenopausal virilization caused by ovarian hilus cell hyperplasia and Sertoli-Leydig cell tumor who was suffered from hair loss, clitoromegaly and hirsutism. Case Report; The patient’s plasma testosterone levels were high. In the MRI examination, a nodular formation of 20x26mm in size was observed in the right ovary. At the transvaginal ultrasound, a cystic mass of 28x28mm was seen in the right ovary. Then we performed a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The final pathology showed a poorly differentiated Sertoli Leydig cell tumor at the right ovary and hilus cell hyperplasia at the left ovary. Sertoli-Leydig cell tumors, which are relatively less common, are extremely rare to be seen in the postmenopausal period. Conclusion; What distinguishes this case from others is that Sertoli-Leydig cell tumor and hilus cell hyperplasia may cause virilization symptoms together, in addition to its prevalence in advanced age.

importance of maternal ischemia modified albumin, non stress test and doppler ultrasonography in foreseeing perinatal asphyxia

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: Women with preeclampsia had higher IMA compared to controls. The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p<0.001, control; 10.28±1.57 vs 18.09±2.13 p<0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p<0.001, control; 16.37±1.97 vs 6.72± 1.53 p<0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p<0.001, control; 7,42±1,94 vs 9,72±2,19 p<0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing.

Tubal reanastomosis results of our clinic: A tertiary center experience

Objective: In our study, it was aimed to determine the clinical results of 42 patients who underwent tubal reanastomosis for various reasons. Materials and Methods: Our study included 42 patients at fertile age who presented to our clinic for tubal reanastomosis between 2017 and 2019. Demographic information and surgery notes of the patients were accessed through the hospital files and hospital archive system. For retrospective screening, patients were contacted by phone and their pregnancy status was learned. Results: Of the patients, 47.6% (n=20) were operated on due to a wish for fertility, 53.4% (n=22) because of other reasons. The mean age of the patients was 36.2 and the mean number of children of the patients was 4.85. Laparotomy was performed in 23.8% (n=10) of the patients, and laparoscopic surgery in 76.2% (n=32). Our intrauterine pregnancy rate after tubal reanastomosis was calculated as 9.5%. Conclusion: Tubal reanastomosis can be performed by both laparoscopic and mini-laparotomy methods. We recommend performing bilateral reanastomosis if possible. We think that it would be appropriate to prioritize laparoscopic surgery because it is minimally invasive and provides high pregnancy success.

Cerclage outcomes in singleton pregnancies at risk for preterm birth following assisted reproductive treatments

Objective: We aimed to evaluate the obstetric and neonatal outcomes of singleton pregnancies at risk for preterm birth (PTB) following assisted reproductive treatments and underwent cervical cerclage placement. Material and methods: A total of 42 women with singleton pregnancies following ART who underwent cerclage between 2009-2021 were included in this retrospective study. Indications of the cerclage procedure, gestational age at cerclage placement and delivery, neonatal birthweight, and requirement for admission to the neonatal unit of newborns were evaluated. Results: Of those cerclage placement performed in women with a history of second-trimester loss (19%), women with suspected cervical insufficiency according to pre-pregnancy evaluation (52.4%), women with the unicornuate uterus (4.8%), women with cervical shortening/or suspicious changes on ultrasonography (11.9%), and women with detection of cervical dilatation/shortening beyond 20 weeks of gestation (11.9%). Of the total group, 7.1% resulted in late miscarriages, while the remaining 92.9% ended with a live birth with mean gestational age at delivery of 37.0±2.5 weeks. Of those live births, 92.3% (36/39) delivered at >34 weeks and %74.4 (29/39) delivered at term. Except one neonatal death due to extremely PTB at 26th weeks, all infants were discharged from the hospital with well condition. Conclusion: ART pregnancies are evaluated as a special group as having a higher PTB risk at baseline. Cerclage may be considered in broader indications for suspected cervical insufficiency in these pregnancies. There is need for further studies on the effectiveness of cerclage in these ART pregnancies with suspected cervical insufficiency based on different criterions used.

Sonoelastographic assessment of the normal uterus and ovaries using the Shear Wave Elastography according to different menstrual phases

Objective: In most of the gynecological studies conducted using the Shear Wave Elastography (SWE) method in the literature, the menstrual cycle period was not taken into account. Current study, we aimed to describe the sonoelastographic features of normal myometrium and ovaries in healthy women and to define their variability during the different phases of the menstrual cycle using the SWE method. Material and methods: All cases were selected from individuals between the ages of 24-31, with regular menstrual cycles and no systemic disease. Each case was called in, 1-5th, 12-16th, 21-24th day of their menstrual cycles and was evaluated by B-mode imaging and SWE in pelvic ultrasonography. The relationship of menstrual phases with uterine and ovarian elasticity was investigated by comparing all measurements made in different menstrual phases. Results: No statistically significant difference was observed between the volume of right and left ovaries in terms (p> 0.05). There was no statistically significant difference in terms of elastography measurements obtained from the uterus, right and left ovaries for each menstrual phase according to Bonferroni Correction (p> 0.0163). Conclusion: Although there was a slight decrease in myometrial SWE measurements in the follicular phase, there was no significant difference regarding the SWE measurements of uterus and ovaries in early follicular, peri-ovulatory, and luteal menstrual stages. Further studies with a large number of participants are needed to suggest whether gynecological studies planned to be carried out with the shear wave elastography method should be planned in a specific menstrual phase.

False Endometrial Thickening in Postmenopausal Patients Using Anticoagulants or Antiplatelets Agents

Objective There is no report that anticoagulant or antiplatelet use may lead to abnormal endometrial sonographic findings. This retrospective study reports our first results associated with endometrial sampling in asymptomatic postmenopausal women using anticoagulants or antiplatelet. Materials methods A total of 268 postmenopausal patients who applied to our gynecology outpatient clinic for any reasons except postmenopausal bleeding were included in the study. Patients were divided into three groups according to using drug status: first healty control group [HCG], second anticoagulants agents group [ACG], and third antiplatelet agents group [APG]. The effects of anticoagulant and antiplatelet agents on endometrial thickness were compared with histopathological findings. Results The mean endometrial thickness was significantly greater in group ACG [5.2 mm] and APG [4.1 m] than in group HCG [3.3 mm]. No significant differences were found in the mean endometrial thickness between groups HCG and APG. However, it is noteworthy that the average endomeric thickness in the ACG group is more than the other two groups and this is statistically significant [p < 0.05]. Conclusion If the thickness of the endometrium was > 4 mm. endometrial sampling may be recommended in in asymptomatic postmenopausal women using anticoagulants or antiplatelet agents.

Cervical Insufficiency and Cerclage Treatment of Pregnant Syrian Refugees

Objective: We aimed to evaluate the cervical cerclage treatment among the Syrian refugees with cervical insufficiency. Material and Methods: Retrospective data of 42 Syrian pregnant women who had cervical cerclage suture due to cervical insufficiency between 2015 and 2017 scanned and analyzed with SPSS 22. Results: The mean age of the cases included in the study was 27.4±6.8. 12 cases (28.6%) had spontaneous pregnancy losses twice in the 2nd trimester. 24 cases (57.1%) gave birth via spontaneous vaginal delivery, whereas 18 cases (42.9%) gave birth via cesarean section. A statistically significant difference was determined between pre-cerclage and post-cerclage cervical length. Whilst no difference was detected in pre-cerclage cervical length for deliveries at week 37, a significant difference was detected in post-cerclage length. Conclusıon: Increased miscarriages and second-trimester pregnancy losses seen in the first years of the war especially due to the use of chemical weapons and the stress suffered thereafter as well as the increased reproductive interest after the war bring together a greater desire for a healthy pregnancy and delivery. We believe that cervical-length measurement using transvaginal sonography during post-cerclage checks is important and that measurement of a cervical length equal to or above 30 mm may increase the probability of term delivery and decrease maternal, and most importantly, neonatal complications associated with preterm labor.