The objective of this study was to investigate the determining effects of diagnosis time on pregnancy outcomes in a population of pregnant women with idiopathic thrombocytopenic purpura (ITP). Records of all the pregnant women with thrombocytopenia were evaluated. Those with a confirmed diagnosis of ITP were included in the study. Main outcome measures were antenatal thrombocyte count, postpartum haemorrhage rate, and route of delivery. Foetal outcomes such as foetal thrombocyte count, haemorrhage, and birth weight were also reported as secondary outcome measures. Time of diagnosis either antenatal or preconception did not significantly alter the investigated parameters. Delivery route had no impact on complication rates. Time of diagnosis also did not affect treatment modality. ITP is rare disorder accounting for less than 5 % of all pregnant thrombocytopenias. Time of diagnosis does not affect maternal-foetal outcomes or treatment modality unless diagnosis is made during labour. Compared to gestational thrombocytopenia, treatment rates may differ but treatment modalities remain the same and the effort put into making the differential should be weighed against maternal stress factors for lengthy laboratory evaluation as long as the thrombocytopenia is of pure nature without any systemic involvement.

Background: Consecutive measurements of β-hCG levels and sonographic evaluation of adnexae are critical for choosing the optimal management in ampullar tubal ectopic pregnancies (EP). To select suitable patients for conservative approach, there is a need for an affordable and reliable marker for determining rupture risk. Evaluation of systemic inflammatory markers in combination with serum β-hCG levels and ultrasound might help to decide the appropriate treatment option. Objective: The purpose of the present study was to evaluate the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the rupture risk in ampullar tubal EPs and to compare with intraoperative findings. Methods: A total of 142 patients who underwent surgery for tubal EP were included. Seventy-two patients were in the intraoperatively diagnosed tubal rupture group and 70 patients without rupture findings were included in the control group. Both groups were compared for inflammation markers, β-hCG levels, and sonographic findings. Results: Both NLR and PLR levels were found to be significantly higher in the tubal rupture group (4.62 ± 3.13 vs. 2.67 ± 1.43, 162.94 ± 63.61 vs. 115.84 ± 41.15, p < 0.01, respectively). According to the receiver operating characteristic analysis performed for the diagnostic performance of tubal diameter measurement, β-hCG, NLR, and PLR levels were significantly associated with histopathologically confirmed tubal rupture (p < 0.01). Conclusion: Systemic inflammatory markers are feasible and affordable tools for predicting tubal rupture risk in ampullar EPs and might be useful for determining surgery decision especially in low resource settings.

Objective:The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma.Material and Methods:Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results.Results:Eighty eligible patients were evaluated. Seventy-two (90%) patients had complex hyperplasia with atypia, and 8 (10%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patients; 37 also underwent lymph node dissection. Lymph node dissection was extended to the paraaortic region in 9 of 37 patients. The concomitant endometrial carcinoma rate was 50%. Two patients had lymph node metastasis. Among 40 cases of carcinoma, 17 had deep myometrial invasion and/or cervical or ovarian involvement or grade 2 tumors with superficial myometrial invasion on hysterectomy specimens; 27.5% of all carcinomas were stage Ib or higher.Conclusion:The concomitant endometrial carcinoma rate was high in patients with atypical endometrial hyperplasia. Nearly half of these patients had risk factors for extrauterine spread. Lymph node dissection might be helpful to decide adjuvant treatment.

Aim: To evaluate the diagnostic value of striae gravidarum (SG) presence and localization in predicting the intraperitoneal adhesion (IPA) risk in pregnant women with a history of at least one previous cesarean delivery (CD). Methods: A total of 100 pregnant women with repeated CD were included in this prospective observational study. Patients were divided into three groups according to severity of SG with Davey scoring system. Intraoperative adhesion severity and extension were evaluated by using Nair classification system. Moreover, operation duration and neonatal outcomes were analyzed. Results: Demographic features were comparable between the groups. Adhesion scores were significantly higher in mild and severe SG groups (for mild SG: 1.93 AE 0.99, for severe SG: 2.81 AE 0.88 and for no SG: 1.4 AE 0.57; P < 0.001). Analysis revealed a positive correlation between IPA and severity of SG (P < 0.001). There was a correlation between increased striae density and adhesion severity especially in the right and left upper quadrants of the abdomen (for right quadrant: r = 0.515, P < 0.001; for left quadrant: r = 0.359, P = 0.005). Conclusion: Our results suggest that preoperative evaluation of SG severity and extend particularly in upper quadrants is a feasible option to predict IPA risk in patients with repeated CD.

ÖZETİnfertilite, reprodüktif çağda olan bir çiftin herhangi bir doğum kontrol yöntemi kullanmaksızın, en az bir yıl düzenli cinsel ilişkiye rağmen gebelik elde edilememesi olarak tanımlanır. Yaklaşık olarak çiftlerin %13-15' ini etkilemektedir. Açıklanamayan infertilite ise sperm analizi, ovulasyon testleri, tubal patolojileri değerlendiren tetkiklerinde herhangi bir anormallik saptanamayan olgularda tanımlanan durumdur. Açıklanamayan infertilite prevalansı %22-28 arasında değişmektedir. Açıklanamayan infertilite etiyolojisi; immünolojik, endokrinolojik ve genetik faktörleri de içeren geniş bir heterojeniteye sahiptir. Tedavi planlamasında, daha az kaynak gerektiren ve yan etki profili daha dar olan opsiyonlar ile başlanmalı, cevap alınamaması durumunda daha agresif ve kapsamlı tedavilere geçilmesi akılcı yaklaşım olacaktır. Tedavi yönetiminde ilk aşamada ekspektan yaklaşım ve yaşam tarzı değişiklikleri denenmelidir. Yanlızca klomifen sitrat ya da yanlızca intrauterin inseminasyon kullanımının etkili olmadığı gösterilmiştir. Bu nedenle hastanın yaşı ve over rezervi de göz önüne alınarak, ekspektan tedaviyi takiben, kullanılması gereken ilk basamak tedavi klomifen sitrat ile intrauterine inseminasyon kombinasyonudur. Bu yaklaşım ile siklus başına gebelik oranı yaklaşık %10'lara çıkmaktadır. Yönetimde temel yaklaşım; nedenin izahından çok, fertilite ihtimalini arttıran tedavi modaliteleri arasından, daha basit ve maliyeti düşük olandan, daha kapsamlı ve agresif olan seçeneklere basamak basamak geçilmesi ve tedavilerin çiftler bazında bireyselleştirilmesidir. Anahtar kelimeler: Açıklanamayan infertilite, intrauterin inseminasyon, invitro fertilizasyon ABSTRACT Infertility is defined by the failure to achieve a successful pregnancy after 12 months, timed unprotected intercourse. Almost 13-15 percent of the couples suffer from infertility. Unexplained infertility is the term of determining no abnormalities in sperm analysis, ovulatory and tubal function examinations. The prevalence of unexplained infertility varies between 22 and 28 percent.