Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance

AIM

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound-guided vacuum aspiration method as an effective treatment option for CSP.

METHODS

We undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018. All of the operations were carried out under general anesthesia, with patients in the lithotomy position, using suprapubic ultrasonography guidance. A vacuum aspirator was used to aspirate the whole pregnancy material without perforating the previous cesarean section scar.

RESULTS

Ten women with CSP were managed successfully by ultrasound-guided vacuum extraction without complications or further interventions, such as reoperation or methotrexate administration. Three of the 10 patients needed uterine Foley catheter tampon (50 cc) for 4 h after vacuum extraction alone was applied. During the study period, two additional patients who did not meet the criteria for the vacuum extraction method alone were managed with methotrexate plus vacuum application. Because of the rarity of the condition, the majority of CSPs are case reports or small case series reported in published works, with no consensus on the preferred course of treatment.

CONCLUSION

The vacuum extraction method seems to be a good and practical way of treating CSP. Comparisons of efficacy should be undertaken but large sample sizes are required. We hope this study brings a new perspective for larger sample-sized studies, considering the technique is feasible and applicable.

Successful obturator nerve repairing: Intraoperative sural nerve graft harvesting in endometrium cancer patient

INTRODUCTION

Intraoperative injury of obturator nerve is a rare complication of gynecologic surgeries, it has been reported especially in patients with endometriosis and genitourinary malignancies. Gynecologic patients undergoing open lymphadenectomy are at increased risk of obturator nerve injury.

PRESENTATION OF CASE

A 60-year-old woman with FIGO stage II Grade II endometrial adenocarcinoma underwent bilateral pelvic paraaortic lymphadenectomy. During right obturator lymph node dissection, the right obturator nerve was inadvertently transected with Harmonic scalpel sealing system. The graft was used to anastomose epyneurium of distal segment of obturator nerve to its counterpart in the proximal segment with 10–0 prolen suture.

DISCUSSION

In case of iatrogenic nerve transection, microsurgical end to end tension-free coaptation is advocated. In case of the obturator nerve is fixed and because of the thermal injury end to end alignment can not be achieved, nerve grafting is necessary.

CONCLUSION

According to our knowledge, successful immediate grafting of iatrogenically damaged obturator nerve during pelvic lymphadenectomy in our patient is the third report of such a case, but also it has a unique feature of being the first obturator nerve repairing case after dissected with tissue sealing system which causes large sealed area that does not make it possible to make end-to-end anastomosis without nerve harvesting.

Level of depression and hopelessness among women with infertility during the outbreak of COVID-19: a cross-sectional investigation

Background: Novel coronavirus disease 2019 (COVID-19) outbreak negatively impacted on the mental wellbeing of infertile couples, because of the World Health Organization’s recommendation to stop all fertility treatments. This study aims to investigate the level of depression and hopelessness during the COVID-19 outbreak, in women with primary and secondary infertility. Methods: A 16-item online questionnaire was applied to a total of 220 women with primary and secondary infertility in June 2020. Participants’ knowledge and concerns about COVID-19 pandemic stop of treatments and follow-up preferences were evaluated. In addition, the Beck Depression Inventory (BDI) and the Beck Hopelessness Scale (BHS) were adapted to Turkish and applied to each participant. Total scores of inventories between women were calculated. The correlation between depression and hopelessness levels of the groups was evaluated. Results: The BDI and BHS mean scores of 220 infertile women who completed our questionnaire were 14.63 ± 9.123 and 5.43 ± 5.026 and Cronbach’s α-values were 0.853 and 0.904, respectively. It was found that 142 women with secondary infertility had higher mean depression and hopelessness scores (15.92 ± 9.758, 11.81 ± 6.501; P = 0.001) VS 78 women with primary infertility (6.51 ± 5.262, 3.78 ± 3.670; P = 0.000). A strong positive correlation was detected between depression and hopelessness levels for each group (r = 0.625, P = 0.000 and r = 0.740, P = 0.000). Conclusions: Total depression and hopelessness scores of both groups were in a strong positive correlation with primary and secondary infertility during the COVID-19 outbreak. Particularly, women with secondary infertility had mild depression and low levels of hopelessness.

Evaluation of HPV, smear and colposcopy results in patients with diabetes

BACKGROUND AND AIMS

This study aimed to evaluate whether there is a difference in human papillomavirus (HPV), smear, and cervical biopsy results between patients with and without diabetes mellitus (DM).

METHODS

Retrospectively, 136 patients with positive high risk (HR) HPV screening results with and without DM who underwent colposcopy between 2015 and 2019 were identified. The clinicopathological characteristics and HR HPV screening results were reported and analyzed. The results of the patients with and without DM were compared.

RESULTS

HPV 16 positivity, Atypical Squamous Cells of Undetermined Significance (ASCUS), and Cervical Intraepithelial Neoplasia 1 (CIN 1) in smear and biopsy results were higher in patients with DM than patients without DM.

CONCLUSIONS

The higher HPV positivity in patients with diabetes may require reforming the frequency and method of cervical cancer screening to be applied to this patient group.

The comparison of pegylated liposomal doxorubicin and beta-carotene effects on JAR and JEG-3 choriocarcinoma human cell culture models

Objective:

The aim was to investigate the effectiveness of pegylated liposomal doxorubicin (PLD), beta-carotene, and a combination of PLD and beta-carotene on JAR and JEG-3 human choriocarcinoma (CC) cell lines for the treatment of CC.

Material and Methods:

JAR and JEG-3 cells were cultured. PLD and beta-carotene trial groups were determined with different doses (for single drug trial; PLD 1, 2, 5 μg/mL and beta-carotene 1, 5, 10 μg/mL, and for combined drug trial; all PLD doses combined with beta-carotene 5 μg/mL). Drugs were administered to cultures simultaneously, and 72 hours later the cells were detached using trypsin-ethylenediamine tetraacetic acid solution. The percentage of apoptotic cells was determined by flow cytometry after annexin V staining. One set of the supernatant was collected before trypsin application to investigate beta-human chorionic gonadotropin (β-hCG) and hyperglycosylated hCG (H-hCG) levels. Statistical analyses of the apoptotic ratios were performed using Shapiro-Wilk, Kruskal-Wallis and Mann-Whitney U tests.

Results:

Apoptosis increased in JAR and JEG-3 cultures after treatment with all doses of PLD (p<0.05). A single application of each beta-carotene dose increased apoptosis in JAR cells (p<0.05) but had no apoptotic effects on JEG-3 cells. In the PLD and beta-carotene combination group, apoptosis increased in both JAR and JEG-3 cells (p<0.05).

Conclusion:

To our knowledge, this is the first investigation of the effectiveness of PLD, beta-carotene, and PLD + beta-carotene combination therapy in two different CC cell lines. PLD is a promising chemotherapeutic drug, and beta-carotene can be used as a novel non-chemotherapeutic agent for treatment of CC. Based on the results of this study, vitamin A supplementation may have promise as a preventive measure. However, these data need support from animal experiments and clinical trials.

A new and feasible uterine compression suture technique in uterine atony to save mothers from postpartum hemorrhage

BACKGROUND

Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus.

AIMS

The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us.

SUBJECTS AND METHODS

In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure.

RESULTS

All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis.

CONCLUSIONS

We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.

Mode of delivery does not have a relationship with high-risk HPV positivity

Objective: This study aims to evaluate the delivery room data for patients who give birth with standard vaginal delivery and caesarean section (C/S), to estimate whether high-risk (HR) HPV status affected the mode of delivery. Methods: Between January 2014 and January 2018, 8,376 pregnant women gave birth in our hospital. Of 8,376 patients, 1,039 pregnant women were aged 30 years and older and had HPV results known. They had a singleton pregnancy and no contraindications for standard delivery. Results: C/S rates for all HR HPV groups were lower than for all HPV-negative groups. However, no statistically significant difference was found between HR HPV-positive and HPV-negative patients for C/S rates got all 987 patients (18.75% vs. 24.39%) (p = 0.463), 245 primiparous patients (50.0% vs. 59.83%) (p = 0.629) and 742 multiparous patients (11.53% vs. 12.56%) (p = 0.876). Conclusion: HR HPV positivity does not affect normal vaginal labour progress and does not statistically increase C/S rates at the labour ward. Therefore, HR HPV positivity should not be regarded as a negative risk factor for normal vaginal labour progress.

Comparison of sexual function scale scores in women according to the contraception method used as part of family planning strategy in Turkey

Background: Continuation of sexuality is essential for a healthy partnership. However, the contraceptive method used by women of reproductive age may affect their sexual function. Aim: This study was aimed to compare sexual function scale scores in women according to the contraception method used as part of family planning strategy in Turkey. Methods: We surveyed sexually active women who used any contraceptive method served as family planning services in Turkey (ethinylestradiol/levonorgestrel pills, copper intrauterine device, condoms) and also tubal sterilisation, or coitus interruptus. Women completed an online questionnaire which asked for information on sociodemographic factors and sexual intercourse characteristics, including items from the Female Sexual Function Index (FSFI). A total FSFI score less than 26.55 was considered to indicate sexual dysfunction. Results: The questionnaire was completed by 242 women between the ages of 18 and 40 years. Condoms (34.7%) were the most frequent and tubal sterilisation (8.3%) was the least frequent contraception method among the women. The lowest total FSFI domain score was observed in the coitus interruptus group (24.31 ± 6.92), and scores for arousal, lubrication, orgasm, and pain subgroups were at the lowest levels in this group. Female sexual dysfunction (FSD) was mostly seen in women whose partner used the coitus interruptus method (P = 0.038). Conclusion: Women who used coitus interruptus had the highest rates of sexual dysfunction compared to all other women. The prevalence of FSD was very high in this traditional contraception method group, which may be attributed to the fear of getting pregnant. We conclude that counselling on modern contraception methods as part of family planning strategy in Turkey is an excellent way to enhance female sexuality.

Investigation of CD56, ADAM17 and FGF21 Expressions in the Placentas of Preeclampsia Cases

Objective: In the present study, we investigated the expression of CD56, ADAM17 and FGF21 antibodies (Ab), which we think have an effect on the pathophysiology of preeclampsia (PE), in pregnant patients with healthy placentas and placentas with PE. The expression of these antibodies has been investigated in a limited amount of former research, but their role in PE has not yet been clarified. With this study, we aimed to contribute to the elucidation of the pathophysiology of PE and the detection of new target molecules for treatment. Materials and Methods: Parturients with singleton pregnancy at 32 weeks or above without any maternal or fetal pathology who were admitted to the Department of Obstetrics and Gynecology, Zonguldak Bülent Ecevit University Practice and Research Hospital between 11 January 2020 and 7 January 2022 were included in the present study. Pregnant women with coexisting disease or a pathology related to the placenta (ablation placenta, vasa previa, hemangioma, etc.) were excluded. CD56, ADAM17 and FGF21 antibodies were histopathologically and immunohistochemically detected in 60 placentas with PE (study group) and 43 healthy placentas (control group). Results: CD56, ADAM17 and FGF21 proteins were all more intensely expressed in preeclamptic placentas and a statistically significant difference was found between the two groups for all three antibodies (p < 0.001). Deciduitis, perivillous fibrin deposition, intervillous fibrin, intervillous hemorrhage, infarct, calcification, laminar necrosis and syncytial node were found to be significantly more common in the study group (p < 0.001). Conclusions: We observed that CD56, ADAM17 and FGF21 expressions increased in preeclamptic placentas. These Ab may be responsible for the pathogenesis of PE, which can be illuminated with further studies.