The combined use of the sonographic TOA diameter and laboratory parameters (ESR and CRP level) can aid clinical treatment decisions and improve the prediction of the outcome of medical TOA treatment.

Scar endometriosis is an infrequent type of extrapelvic endometriosis that is rather close together with obstetrical and gynecological surgeries. It is mostly confused with other dermatological or surgical conditions and delays the diagnosis. We report a case of a 50-year-old woman presenting with scar endometriosis 23 years after her last lower segment caesarean section. The epidemiology, diagnosis, pathogenesis, and treatment of the situation are discussed.

Objective: To estimate the accuracy of frozen pathological analysis in patients preoperatively diagnosed with endometrial atypical complex hyperplasia (ACH) and to develop a model predicting the probability of the presence of endometrial carcinoma in ACH. Methods: Patients (n = 128) who underwent total hysterectomies because of diagnoses of ACH were evaluated at four tertiary centers. Results: Diagnoses made using frozen sections and permanent sections were in good agreement (ĸ = 0.61, p < 0.0001). A useful scoring system combining weighted risk factors derived from a regression model is as follows: (2 × age ≥50 years) + (3 × BMI ≥30) + (2 × menopausal status) + (2 × diabetes comorbidity) + (3 × endometrial thickness >12 mm). The AUC of this score was 0.793, and the score afforded 80.9% sensitivity, 70.3% specificity, a 75.3% positive predictive value, and a 76.4% negative predictive value, when a score of 5 was used as a cutoff. Conclusions: Patients with ACH should be evaluated by gynecological oncologists and intraoperative frozen section analysis should be performed by pathologists specializing in the evaluation of gynecological malignancies, because ACH is closely associated with endometrial cancer (EC). Our novel preoperative scoring system may aid in the detection of patients at increased risk of EC and thus guide general gynecologists.

No abstract

The decline in menstrual blood loss among LNG-IUS users was associated with local progestogenic effects and aggravation of intrinsic and extrinsic coagulation pathways. Although the LNG-IUS is a highly effective method for treating heavy menstrual bleeding, care must be taken when a patient has thromboembolic risk factors.

BackgroundTo investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013.MethodsData were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002–2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul.ResultsThe major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013.ConclusionsThis study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey.

Amaç: Çalışmamızda 2005-2012 yılları arasındaki sezaryenlerin yıllara göre dağılımını, sezaryen endikasyonlarını ve epidemiyolojik değişimleri karşı-laştırarak, geleceğe yönelik yapılması gerekenleri tartışmak amaçlanmıştır.Yöntemler: İstanbul Eğitim Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği'nde 2005-2012 yılları arasındaki 10499 doğum içinden sezaryen uygulanan 4137 hastanın dosyaları retrospektif olarak incelendi. Yılla-ra göre sezaryenle doğum yapmış hastalar sezaryen endikasyonlarına, yaş gruplarına, gebelik haftalarına, doğum ağırlıklarına, bebek cinsiyetlerine, sezaryende tercih edilen anestezi türüne ve sezaryenin normal doğuma oranlarına göre yıllık bazda değerlendirildi ve karşılaştırıldı. Results: Cesarean section was performed for 32.5% and 40.1% patients in 2005 and 2012, respectively. The main indications were previous uterine surgery (44.5%), fetal distress (18.3%) and cephalopelvic disproportion (33.7%). There was no statistical difference in terms of gravida, parity, anesthesia, and birth weight in either year. However, cesarean rates were significantly increased in the last four years of the study period in comparison with the first four years. Conclusion:Rates of caesarean section are increasing. To counteract this trend, patients should be informed about the benefits of vaginal delivery and be encouraged to attempt vaginal delivery after cesarean section now that the skills of staff in delivery clinics are improving. Clinicians and patients must be aware of side effects of elective cesarean sections. Pain management during delivery may be considered as a means of reversing the increasing cesarean rates.

Objective: In this study, we investigate the effects of maternal body mass index (BMI), weight gain during pregnancy, delivery stage, amount of amniotic fluid, and amniotic membrane status on the calculation of estimated fetal weight. pregnant women who gave birth in our hospital were reviewed. From records, demographic data of patients, maternal BMI (kg/m 2 ), weight gain during pregnancy, delivery stage, amniotic fluid volume and amniotic membrane status, mode of delivery, ultrasound-estimated fetal weight, and the actual birth weight of the newborn have been reviewed.Results: Birth weight of fetuses estimated by sonography was in the range of 2680-4345 g with an average of 3467.33±417.30 g. The actual birth weight of the newborns was 3468±383.99 g with an average of 2600-4550 g. With ultrasound-estimated fetal weight and the actual birth weight with error range of ±10%, 76% correct prediction rate (n=76) found. When considering maternal parity, stage of labor (latent phase-active phase), sex of the fetus, preconceptional BMI, and maternal weight gain during pregnancy, there is no statistically significant effect (p<0.05) of these factors on the accuracy of the estimated fetal weight. Decreased amniotic fluid and/or rupture of amniotic membranes in pregnant women ultrasound-estimated fetal weight was closer correlation to the actual birth. Conclusion:The correct prediction of fetal weight is of great importance because of the potential risk estimation for the mother and newborn and in deciding the mode of delivery. Therefore, variables that affect the probability of errors in ultrasonographic measurements should be considered in advance, and if necessary, measures should be planned again MethodsThe files of pregnant women applying to our clinic and giving birth between January 2012 and January 2013 were screened. One hundred pregnant women for whom estimated fetal weight measurement was performed using obstetric ultrasonography (USG) and who were 37-42 weeks according to the last menstrual period, singular, alive, and at head presentation were included in the study. Cases with fetal anomalies, multiple pregnancies, dead fetuses, and cases in which detailed fetal biometric measurements cannot be performed because of obstetric emergencies