Objective: Partial hydatidiform mole is the type of mole in which a foetus and/or cardiac activity is seen. Clinical diagnosis of missed abortion and anembryonic gestation may cause the partial mole to be missed or misdiagnosed if a histopathologic examination is not carried out. Our objective in this study was to clarify whether it is really necessary to send all abortion materials for histopathological examination considering the rate of mole (complete/partial) among all abortion materials in a university hospital. Material and Methods: In this retrospective cohort study, we evaluated the clinical and histopathological results of 1,004 women with a clinical diagnosis of abortion that were diagnosed at the University of Kütahya Health Sciences Evliya Çelebi Hospital between January 2015 and December 2020. Results: Missed abortion was the most common diagnosis with 638 women (63.5%) among the abortion materials that were sent for histopathology. Complete mole was diagnosed in only one (1/1,004) woman, which was sent to pathology with a diagnosis of anembryonic gestation. The partial mole rate was 9/1,004 and most were diagnosed after a clinical diagnosis of anembryonic gestation (n=5, 55%). Placental villi were seen in 93% (934/1,004) but not in 6% (60/1,004) of the subjects (Arias-Stella reaction) on histopathology, which was possibly an ectopic pregnancy or a very early aborted early gestation in which placenta villi could not be identified. Partial and complete mole hydatidiform constituted 1% (9/1,004) and 0.1% (1,004) of the total cohort respectively. Conclusion: When taking into account the rate of mole hydatidiform (10/1,004) in a clinic where all abortion materials are being sent for histopathological examination routinely, we think that routine histopathological examination of abortion material seems reasonable and safe.
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Objective: This study aimed to define the frequency and type of additional accompanying anomalies in cases with various anomalies of the corpus callosum (ACCs) in our tertiary center in the last 8 years. Material and Methods: This retrospective cross-sectional study included the data of 152 cases of prenatally diagnosed ACCs in a tertiary referral center between October 2012 and November 2020. We evaluated central nervous system and other organ system structural abnormalities, chromosomal abnormalities, and syndromes accompanying in non-isolated forms. Results: During the study period, a total of 152 cases with callosal anomaly were diagnosed throughout the study course in a population of 117,450 live births, resulting in an overall prevalence of 12.9 per 10,000 live births. Of the 152 cases ascertained, 105 (69%) were total agenesis, 38 (25%) were partial agenesis, and 9 (6%) were hypoplasia of the corpus callosum. Of these 152 cases, 80 (52.6%) had isolated ACC and the remaining 72 (47.4%) cases had at least one associated anomaly, including chromosomal anomalies, recognized syndromes, and multiple congenital abnormalities. Conclusion: ACCs are clinically and etiologically heterogeneous, and prenatal diagnosis is possible. Even in isolated cases, the neurodevelopmental prognosis is uncertain and mostly associated with other structural abnormalities, chromosomal and genetic diseases. Due to the underlying etiological cause, accompanying additional anomalies and uncertainty regarding developmental outcomes, chromosomal, syndromic, and additional structural disorders may be clues in antenatal ultrasonographic observation in ACC cases should be investigated with the more detailed sonographic examination and genetic tests.
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Objective: Single umbilical artery (SUA) in fetus have shown to be associated with structural anomalies, chromosomal disordersand growth restiction. In this study, we aimed to present the obstetric outcomes in fetuses with SUA. Material and Methods: In this retrospective study, obstetric results of 30 patients diagnosed with SUA over a 2-year period were analyzed. Results: There were 30 cases of prenatallydiagnosed SUA. Twenty eight patients had singleton pregnancies and 2 had dichorionic diamniotic twin pregnancies. The gestational week at thetime of diagnosis varied between 15 and 24 weeks, with the mean week of diagnosis at 21 weeks. Additional ultrasonographic findings accompanying the SUA were detected in 13 patients (43%). Minor abnormalities (renal pelviectasia, choroid plexus cyst, persistant right umbilicalvein) were detected in 4 patients in this group. More than one abnormality was detected in 7 fetuses. Structural abnormalities were distributed asfollows: cardiovascular system abnormalities in 9 fetuses, musculoskeletal abnormalities in 3 fetuses, urogenital system abnormalities in 3 fetuses,central nervous system abnormalities in 4 fetuses and gastrointestinal system abnormalities in 2 fetuses. Chromosomal abnormalities were detected in 3 fetuses. Intrauterin growth restiriction was not detected in isolated SUA patients and also no chromosomal abnormality was detectedin this group. Conclusion: Umbilical arteries of fetus should be checked during detailed ultrasound examination. Detailed fetal anatomic examination should include fetal echocardiography. During fetal echocardiography, fetal venous system must also carefully be examined.
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Objective: Umbilical cord is crucial to the development, well-being and survival of the fetus, but also being vulnerable to kinking, compressions, traction, and torsion which may affect the perinatal outcome. Abnormally coiled cords have been reported to be more frequentin cases with adverse perinatal outcome. It was aimed to evaluate the umbilical coiling index (UCI) postnatally and its association with perinatal morbidity and mortality. Material and Methods: We conducted a cross sectional study for over 12 months in ESIC MC & PGIMSR, Bengaluru. A total of 321 term consenting parturient mothers with singleton live pregnancy in cephalic presentation were randomly selected by a singleobserver admitted in labour room irrespective of their parity. After delivery, the UCI was calculated as the number of complete coils divided bythe total length of the cord in centimetres, UCI was grouped as hypocoiled (<10th percentile), normocoiled (10th to 90th percentile) and hypercoiled(>90th percentile). The statistical tests used were chi-square test and Fisher exact test in SPSS v24, p value of less than 0.05 was taken as statistically significant. Results: The mean UCI was 0.18 +/- 0.096. Of the patients, 9.3% (30 out of 321) had hypocoiled (UCI<0.082) and 9.7% (31patients) had hypercoiled (UCI>0.316). Hypercoiled is significantly associated with fetal distress [OR=13.5 (0.003-0.008)] p=0.001, neonatal intensive care unit (NICU) admission [OR=19.14 (0.01 to 0.015)] p<0.001 and meconium staining [OR=5.65 (0.024-0.030)] p=0.017. It was alsofound that presence of nuchal cord in hypercoiled group was significantly associated with fetal distress [OR=4.661 (0.052-0.061)] p=0.031. Conclusion: Abnormal UCI is associated with adverse perinatal outcome. Clinical significance: Antenatal detection of the coiling index can identifythe fetuses at risk and thus help in timely intervention and further management.
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Objective: To evaluate and compare cycle outcomes following triggering final oocyte maturation with dual trigger of concomitant gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) administration versus hCG alone for women with expected normal ovarian response that underwent antagonist cycles with intracytoplasmic sperm injection (ICSI). Material and Methods: Women with expected normal ovarian response that underwent GnRH antagonist cycles with ICSI between January 2010 and April 2020 were evaluated in this retrospective cohort study. A total of 2,443 patients were included. Dual trigger was used for oocyte maturation in 637 cycles whereas hCG alone was used for triggering in 1,806 women. Cycles with dual trigger were assigned to study group and cycles with hCG alone are taken as controls. Results: Number of retrieved oocytes (14.08±3.58 vs. 13.15±3.61), number of metaphase 2 oocytes (9.77±3.08 vs. 8.06±3.14), fertilization rate (0.75±0.19 vs. 0.69±0.19), implantation rate (0.43±0.48 vs. 0.35±0.50) and clinical pregnancy rate (49.9% vs. 40.6%) were significantly higher in dual trigger group in comparison to hCG alone group. Higher number of good quality embryos were obtained in dual trigger group (85.7% vs. 76.3%). Live birth rate was significantly increased in dual trigger group in comparison to hCG only trigger group (45.1% vs. 36.7%). Multivariate logistic regression analysis showed dual trigger is a significant factor in predicting live birth deliveries (odds ratio 1.426, 95% confidence interval 1.185-1.716). Conclusion: Dual-triggering appears to improve embryo quality, increase implantation rates, clinical pregnancy rates and live birth rates in women with expected normal ovarian response that underwent GnRH antagonist cycles.
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The cause of urogenital fistulas can be surgical from either obstetric or gynecological. While its common presentation is continuous drainage of urine from the urinary system through the fistula, rarely it can be presented as an abscess. Our case was the first case of urethrocutaneous fistula after transobturator tape operation presented as an abscess. In this case report, an urethrocutaneous fistula developed in a 49-year-an old woman after a transobturator tape operation was mentioned. The fistula was treated with mesh removal and follow-up. In literature, our case is the first case of urethrocutaneous fistula after transobturator tape operation. In conclusion, urinary tract fistulas, which are rare, sometimes manifest themselves as abscesses. These cases can be solved by a high index of suspicion.
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Objective: Frozen section procedure gives a great advantage of fertility preserving in young women with borderline ovarian tumors (BOTs). However diagnostic accuracy of frozen section in BOTs is not as high as the other ovarian lesions. In the present study, we aimed to evaluate the comparison of frozen section results and final pathology results in patients with BOTs. Material and Methods: A total of 97 patients who had BOTs, either on the frozen section or final paraffin section in our clinic between 2007 and 2017 were included in the study. Frozen section and final pathology were compared with medical records of the patients such as age, menstruation, preoperative serum CA-125 and CA 19-9 values, histological diagnosis, subtype, size, localization, and capsule involvement. Results: In BOTs, the diagnostic accuracy of the frozen section was 67%. Frozen section has 74% sensitivity, 40% specificity, 83% positive predictive value and 29% negative predictive value. In the present study, the only factor that affects the accordance between the frozen section and the final paraffin section was the papillarity of the tumor, and it was observed that when the tumor was more papillary, the results had been more compatible. Conclusion: In BOTs, surgical management should be performed with caution depending on the frozen section to avoid overtreatment, especially in young women.
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Objective: The aim of this study is to compare the maternal and perinatal outcomes of twin adolescent pregnancies and twin adult pregnancies. Material and Methods: A study was conducted on twin pregnancies delivered between 2014 and 2019 in tertiary hospital. Twin pregnancies between 10 and 19 years old were classified as the adolescent group (study group) and 20 and 34 years old were classified as the control group. Results: Our study included 54 adolescent twin pregnancies and 818 control group twin pregnancies. The adolescent group delivering approximately 1 week earlier compared with the control group (p=0.023). The adolescent group had approximately 2.3 times higher risk in terms of moderate preterm (28–34 weeks) [OR, 2.34; 95% [CI], 1.34–4.09; p=0.002]. Anemia was significantly higher in adolescents (p=0.039). When 105 live newborns from the adolescent group were compared with 1601 newborns from the control group, the birth weight of the newborns in the adolescent group was 191 g less on average, their height was 1.3 cm shorter on average, and their head circumference was 1 cm smaller on average (p=0.001, p=0.002, and p=0.002, respectively). The adolescent newborns had an approximately 3.1 times increased prevalence of LBW [OR, 3.13; 95% [CI], 1.73–5.65; p<0.001). The fifth-minute APGAR scores were lower in newborns from the adolescent group (p=0.026). Moreover, the need for neonatal intensive care was higher in the adolescent group (p=0.033). Conclusion: Adolescent twin pregnancies should be considered at high risk because of obstetric complications and poor pregnancy outcomes.
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Objective: The impact of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection on the reproductive system is still not known. We aimed to investigate the menstrual characteristics of healthcare professionals employed in the coronavirus disease2019 (COVID-19) clinics and to investigate whether COVID-19 alters the pattern of the menstrual cycle. Material and Methods: This cross-sectional study was conducted on 275 healthcare professionals. Results: During the pandemic, 12% of the cases experienced irregular cycles, and 33.8% of the cases reported that their amount of bleeding had changed. Also, 23.6% of the cases had an increase in dysmenorrhea. The ratio of dysmenorrhea, irregular cycle, changes in bleeding time, and amount of bleeding were similar in doctors, nurses, and other healthcare professionals (p>0.05). Among all cases, 20.4% (n=56) had SARS-CoV-2 infection. The ratio of increase at dysmenorrhea was found to be significantly higher in women who had SARS-CoV-2 infection (35.7% vs 20.5%) (p=0.022; p<0.05). Besides, the ratio of cases that experienced changes in their amount of bleeding was found to be higher in SARS-CoV-2 group (53.6% vs 28.8%) (p=0.001; p<0.05). There was no statistically significant difference between cases who had infection and those who did not have regarding having an irregular cycle and change in duration of bleeding (p>0.05). Conclusion: The menstrual pattern and cycle length did not change significantly during the pandemic. Also, SARS-CoV-2 infected cases reported a difference in the amount of bleeding and increased dysmenorrhea after infection. This study provides first step to establish whether COVID-19 has an immediate impact on menstrual function.
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Objective: To compare the success, clinical outcomes, maternal and neonatal complication rates following Kiwi Omnicup or the Malmstrom metal cup in vacuum assisted delivery. Material and Methods: One hundred eighty eight vaginal deliveries which were achieved by the use of Kiwi Omnicup or the Malmstrom metal cup in Zeynep Kamil Women’s Health Training and Research Hospital between January 2008 to March 2015 were screened from prospectively collected database. All cases were singleton, viable pregnancies with cephalic presentation. Groups were compared in terms of some maternal and fetal complications and morbidities including cephal hematoma, caput succadanum, hemorrhagic ischemic encephalopathy, molding, acidosis, hypothonia, shoulder distocia, meconium passage, maternal vaginal lacerations, blood hematoma, rib fructure, cervical laceration, 3rd and 4th degree lacerations and the uterine atonia. Results: Fetal complications were significantly different between groups. The rate of cephal hematoma was significantly higher in Malmstrom metal cup whereas the rate of fetal acidosis was significantly higher in group with Kiwi Omnicup (p<0.05). Also the rate of unsuccessful cases was significantly higher in Malmstrom metal cup group. There were 2 cases of fetal death in Kiwi Omnicup group, however no case of fetal death in other group. Conclusion: In our study, we have shown that there are some specific fetal complications for each tool and the rate of unsuccessful cases was significantly higher in Malmstrom metal cup group. We concluded that selection of vacuum extraction tool should be based on the knowledge of maternal fetal conditions, specific complications and the success rates of the tools.
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