Preterm delivery (PTD) occurs between 20(0/7)-36(6/7) weeks of pregnancy and is a major cause of perinatal mortality and morbidity. The prevalence is around 12% in Turkey, ranging between 10 to 15% in different centers. Indicated preterm deliveries due to maternal or fetal reasons constitute approximately 20-30% of the total. The rest occur as a result of spontaneous preterm labor (PTL) or preterm prelabor rupture of the membranes (PPROM), about half and half. Although etiology of spontaneous preterm birth has not been fully elucidated, several risk factors are defined. History of PTD and short cervix are two most important risk factors, particularly in singleton pregnancies. If the cervical length is measured to be <25 mm via transvaginal ultrasonography before the 32nd gestational week, it is defined as short cervix. In women with prior PTD, progesterone preparations are recommended between 16th-36th gestational weeks and cervical length is monitorized; additional preventive measures may be required if short cervix is diagnosed. In women without prior PTD, we universally offer transvaginal ultrasonographic cervical length measurement at the time of midtrimester fetal anomaly scan. When short cervix is determined in such cases, cervical cerclage, vaginal progesterone, cervical pessary, alone or in combination, may be recommended depending on the measurement and the gestational age. Asymptomatically dilated cervix, PTL, and PPROM are generally managed according to the gestational age on a case-by-case basis. Data are limited in twin and higher order multiple pregnancies to recommend standart prevention and management protocols.

OBJECTIVE: The present study aims to evaluate the importance of USG findings, in estimating cytogenetic abnormality risks in pregnancies otherwise carrying low risk for aneuploidy. STUDY DESIGN: We reviewed a number of most commonly observed soft markers and structural abnormalities in pregnant women with low risk who underwent invasive prenatal diagnostic tests for USG abnormality in the period from January 2002 to December 2008, retrospectively. In 179 of all cases (9.95%), cytogenetic analysis was recommended because of USG abnormality. RESULTS: 76 patients had structural abnormalities, 95 had soft markers and 8 had intra-uterine growth restriction. We detected 12 aneuploidies in fetuses with structural abnormalities and 1 aneuploidy in fetuses with soft markers. CONCLUSION: We concluded that, although the presence or absence of soft markers can substantially modify the risk of fetal aneuploidy, one or more structural abnormalities inevitably have high risk for aneuplodies as independent factor for low-risk pregnancies.

Failure to observe fetal nasal bone or presence of a short nasal bone at ultrasonography has appeared as a marker of Down syndrome today. The aim of this study was to obtain the nomogram of fetal nasal bone length at 16th–23rd gestational weeks in an unselected Turkish population. Reports of detailed fetal ultrasonographic examination performed in years 2008, 2009 and 2010 at Obstetrics and Gynecology Department of Baskent University Faculty of Medicine were evaluated retrospectively. A total of 1706 cases at the 16th–23rd gestational weeks were included in the study, excluding the ones with chromosomal or structural anomalies. The cases were excluded as well if one or more of the fetal biometric measurements were absent or if the biometric measurements were not compatible with the gestational week calculated according to the last menstrual period. The cases with unknown pregnancy outcomes were not included in the study either. Among the cases included in the study, mean fetal nasal bone (NB) length was determined according to the gestational age of the pregnancy. The correlation of fetal NB length with the gestational age, biparietal diameter (BPD), femur length (FL) and humerus length (HL) measurements was investigated. Mean length of the fetal NB was calculated as 3.7 ± 0.3, 4.0 ± 0.3, 4.3 ± 0.4, 4.8 ± 0.4, 5.1 ± 0.4, 5.5 ± 0.5, 5.9 ± 0.4 mm 6.2 ± 0.4 at the 16th, 17th, 18th, 19th, 20th, 21st, 22nd and 23rd gestational weeks respectively. 10th percentile values were 3.2 mm for 16th, 3.6 mm for 17th, 3.9 mm for 18th, 4.3 mm for 19th, 4.7 mm for 20th, 5.0 mm for 21st, 5.5 mm for 22nd and 5.54 mm for 23rd gestational weeks. Fetal NB length correlated significantly with gestational age, BPD, FL and HL measurements (P < 0.05). In this study we evaluated the normal measurements of the fetal NB length at the 16th–23rd gestational weeks. Of course, studies performed in larger study groups will give more accurate results about fetal NB length in Turkish population.

Objective To define normal values of second trimester fetal nasal bone length (NBL) in a low-risk Turkish population.Method Prenatal records of singleton fetuses who underwent second trimester ultrasonographic examination in the 16 to 23 weeks of pregnancy were retrospectively analyzed for NBL and biometric measurements (BPD, FL and HL). The relationship among NBL and gestational age (GA), biparietal diameter (BPD), femur length (FL) and humerus length (HL) was determined. Additionally, percentile values of NBL for each gestational week were provided.Results A total of 1467 fetuses were included in this study. There was a significant linear association among NBL and GA (R(2) = 0.709), BPD (R(2) = 0.752), FL (R(2) = 0.742) and HL (R(2) = 0.747). Fifth percentile values of fetal NBL were 3.11 mm for 16th, 3.50 mm for 17th, 3.70 mm for 18th, 4.10 mm for 19th, 4.50 mm for 20th, 4.62 mm for 21st, 5.24 mm for 22nd and 5.37 mm for 23rd gestational weeks.Conclusion The study provides normal ranges of NBL between 16 and 23 weeks of pregnancy in a low-risk Turkish population. Future studies with larger sample sizes including pregnancies carrying high risk for aneuploidy are needed to define cut-off values for NBL. Copyright (C) 2011 John Wiley & Sons, Ltd.

Duplication of the renal collecting system is a common abnormality that affects females much more often than males. In 83 to 90%, the duplication anomaly is unilateral. When there is complete duplication of the ureter as well, the upper pole ureter typically implants ectopically, in a site caudal and medial to normal, and this ureter is often obstructed, and the lower pole ureter inserts orthotopically and may reflux. The dilated upper pole collecting system may mimic a cyst or hydronephrosis of the entire kidney. This report describes a case of prenatally diagnosed unilateral complete duplication of the renal collecting system in a female fetus. At 24 weeks' of gestation a ‘cyst-like’ structure in the upper pole of the duplex kidney was seen. Coronal and transvers views revealed a kidney with a duplicated collecting system demonstrating disproportionate hydronephrosis of the upper pole calyces as compared with the lower pole calyces associated with dilated ureter. The delivery occured vaginally at term. The diagnosis of duplication of the renal collecting system was confirmed after birth.

Objective. To determine menopause-related symptoms and quality of life in women aged 40–80 years living in a rural area of Turkey. Methods. A total of 338 women were evaluated in this cross-sectional study. As data sources we used a questionnaire that elicited information on the descriptive, fertility and menopausal characteristics of the women, the Menopause Rating Scale (MRS) and the Short Form-36 (SF-36). Results. The mean age at menopause was 46.5 ± 0.4 years. The complaint stated most often as ‘severe or very severe’ was ‘hot flushes and sweating’ (50.7%). The physical functioning, physical role, bodily pain, general health, social functioning, emotional role and mental health scores of postmenopausal women were statistically higher (p < 0.05) than those of premenopausal women. Scores on physical function, physical role, general health and social function decreased significantly with age in postmenopausal women (p < 0.05), while none of the quality-of-life domain scores differed significantly with age in premenopausal women. Conclusions. Quality of life is worse in postmenopausal women than premenopausal women, and in older than younger women in the postmenopausal period. Thus rural populations are primarily in need of public health care in the postmenopausal period.

OBJECTIVE: We aimed to compare the efficacy and tolerability of once-weekly alendronate 70 mg/weekly, risedronate 35 mg/weekly and raloxifene 60 mg/daily in the treatment of postmenopausal osteoporosis. STUDY DESIGN: Retrospective case-control study. 216 aged matched postmenopausal women with osteoporosis who received alendronate (n=70), risedronate (n=74), or raloxifene (n=72) for 24 months were retrospectively evaluated. Additionally, all patients received 600 mg Calcium+ 400 IU Vit D daily. Bone mineral density (BMD) was measured by dual X-ray absorptiometry. T scores at baseline and 24 months were evaluated in the lumbar spine, total hip, femur neck, and trochanter. RESULTS: Baseline T scores of each region were not significantly different among three groups. T scores increased in the lumbar spine (p<0.01), femur neck (p<0.05), trochanter (p<0.01) and total hip (p<0.05) following 24 months of alendronate treatment. In the risedronate group, there was a significant increase in the lumbar spine only (p<0.01). Raloxifene treatment did not change T scores of any regions. There was only one case (1.4%) with fracture of forearm in the alendronate group. However, in the risedronate group, 5 cases (6.7%) with fracture (one case of elbow, two cases of finger, one case of hip and one cases of vertebral fractures) were seen during the treatment period. In the raloxifene group, 5 cases (6.9%) of bone fracture (including, three cases of fracture of forearm and one case of hip and one case of vertebral fracture) were seen. The rates of fracture and adverse effects in three groups were comparable. CONCLUSİONS: Alendronate 70 mg/weekly was well tolerated and produced significantly greater increases in BMD than other drugs with low fracture incidence.

OBJECTIVE: To evaluate the value of uterine artery Doppler at 22-24 weeks gestation in the prediction of complications resulting from uteroplacental insufficiency in an unselected population. STUDY DESIGN: A total of 383 women underwent color flow imaging combined with pulsed wave Doppler of both uterine arteries at 22-24 weeks gestation. The mean resistance index of both uterine arteries greater than 0.58, unilateral or bilateral early diastolic notches was considered abnormal. RESULTS: The mean resistance index was greater than 0.58 in 17.5% of cases; the prevalence of unilateral and bilateral early diastolic notches was 11.5% and 3.7%, respectively. The prevalence of gestational hypertension, preeclampsia, and small for gestational age were 2.3%, 0.3%, and 10.2% respectively. The negative predictive values of abnormal resistance index, unilateral and bilateral notches for gestational hypertension were 99.1%, 98.2%, and 97.8% respectively. The negative predictive values of each parameter for babies small for gestational age were 91.8%, 92%, and 90.2% respectively. The positive predictive values of each parameter for gestational hypertension and for babies small for gestational age were less powerful. The combination of these Doppler parameters caused a slight increase in the positive predictive values compared to a single parameter. CONCLUSIONS: The screening efficacy of uterine artery Doppler at 22-24 weeks gestation for adverse perinatal outcome seems poor in population at low risk; however, normal uterine artery Doppler studies in this population could be used to estimate an uncomplicated pregnancy.

The objective of this study was to evaluate the efficacy of fluoxetine and black cohosh in the treatment of women with postmenopausal symptoms. A total of 120 healthy women with menopausal symptoms were recruited to this prospective study with a follow-up period of 6 mo. They were randomly assigned to 1 of 2 groups and were treated with fluoxetine or black cohosh. After entry into the study, patients were examined at the first, second, third, and sixth months of the treatment period. The women kept diaries in which they reported the daily number and intensity of hot flushes and night sweats. In addition, at the beginning and end of the third month, they completed questionnaires consisting of a modified Kupperman Index, Beck’s Depression Scale, and a RAND-36 Quality-of-Life Questionnaire. Statistically significant differences were noted in the Kupperman Index and Beck’s Depression Scale at the end of the third month in both groups compared with baseline values. In the black cohosh group, the Kupperman Index decreased significantly compared with that in the fluoxetine group by the end of the third month. On the other hand, in the fluoxetine group, Beck’s Depression Scale decreased significantly compared with that in the black cohosh group. Monthly scores for hot flushes and night sweats decreased significantly in both groups; however, black cohosh reduced monthly scores for hot flushes and night sweats to a greater extent than did fluoxetine. At the end of the sixth month of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine. By the sixth month of the study, 40 women had discontinued the study—20 (33%) in the fluoxetine group and 20 (33%) in the black cohosh group. Compared with fluoxetine, black cohosh is more effective for treating hot flushes and night sweats. On the other hand, fluoxetine is more effective in improvements shown on Beck’s Depression Scale.

Background/Aims: To determine predictive values of fetal fibronectin and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in cervicovaginal secretions and ultrasonographic measurement of cervical length for delivery <35 weeks in patients with uterine contractions. Methods: Our study included 51 women between 24 and 35 weeks’ gestation with uterine contractions and 90 controls. Cervicovaginal samples were analyzed for presence of fetal fibronectin and phIGFBP-1. Cervical length was measured by transvaginal sonography. Results: Preterm birth rate was 19.6% (10/51) in the study group. Negative predictive values of fetal fibronectin, phIGFBP-1 and ultrasonographic cervical length <20 mm, and <25 mm for delivery <35 weeks were 91.9, 92.3, 91.1, and 90.5%, respectively. Positive predictive values were 50, 58.3, 100 and 66.7%, respectively. When results of fetal fibronectin/phIGFBP-1 test and ultrasonographic cervical length <25 mm were combined, specificity and positive predictive values of each test for delivery within 7 days increased. Conclusion: Fetal fibronectin and phIGFBP-1 tests have approximately equivalent ability to predict delivery <35 weeks’ gestation. An ultrasonographic cervical length measurement >20 mm or a negative fetal fibronectin/phIGFBP-1 test obtained from patients with uterine contractions at 24–35 weeks’ gestation may avoid overdiagnosis.

Objective: To evaluate the outcome of pregnancies in cases with uterine anomalies.Design: Retrospective evaluation of the outcomes of pregnancies in cases with uterine anomalies at the Department of Obstetrics and Gynecology, Baskent University, Ankara, between January 2002 and January 2006.Setting: Department of Obstetrics and Gynecology, Baskent University School of Medicine, AnkaraPatients: The outcomes of pregnancies in 8 cases with uterine anomalies were evaluated.Main outcome measures: Perinatal outcomeResults: Uterine anomaly was detected in 8 (8/1250, 0.6%) of the cases delivered during this 4-year period. Two cases with uterus didelphys had uneventful antenatal period, and gave birth to healthy newborns by cesarean section with the indications of breech presentation at term. In two of three patients with unicornuate uterus, symmetrical early intrauterine growth restriction developed at the beginning of the third trimester. One of them delivered a viable newborn weighing 2510 g by cesarean section with the indication of breech presentation at 37 weeks of gestation. In the second patient with unicornuate uterus and early intrauterine growth restriction, preterm premature rupture of membranes developed at 31+6 weeks of gestation and premature contractions started at 32+2 weeks. She was delivered by cesarean section due to failure to progress, and gave birth to a viable female weighing 920 g. The third case who had unicornuate uterus had primer infertility, and conceived spontaneously after an diagnostic hysteroscopy. McDonald cervical cerclage was put at 19 weeks of gestation due to incompetent cervix. She gave birth to a viable female weighing 3550 g by cesarean section with the indication of breech presentation at 38+3 weeks of gestation. In one of two cases who had bicornuate uterus, preterm premature rupture of membranes occured at 28+5 weeks of gestation and she gave birth to a viable newborn weighing 1300 g via cesaren section due to fetal distress at 29+5 weeks of gestation. The second patient with bicornuate uterus had uneventful antenatal period, and a healthy baby was delivered by cesarean section at term. One patient with septate uteri had undergone hysteroscopic resection of the uterine septum; antenatal period passed uneventfully and she gave birth to a viable female by vaginal delivery at 38+4 weeks of gestation.Conclusions: Pregnancies in women with uterine anomalies are associated with recurrent miscarriages, preterm labors and deliveries, intrauterine growth restriction, abnormal fetal presentations, and other complications; however, pregnancy in an abnormal uterus may progress without incident and result in normal labor.

Ovarian thecoma, which belongs to the group of sex-cord stromal tumors, is a relatively rare neoplasm. In this report we present a pregnant woman with a solid ovarian mass diagnosed during pregnancy and operated on at the 19(th) gestational week. At surgical exploration, torsion of the ovarian tumor was observed together with ascites and unilateral salpingo-oophorectomy was performed. Pathological examination revealed a luteinized thecoma. After the surgery, the pregnancy continued uneventfully until term.

Objective: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse.Design: Retrospective evaluation of the outcomes of patients with uterovaginal prolapsus who were underwent sacrospinous ligament fixation between 2005 and 2006.Setting: Department of Obstetrics and Gynecology, Baskent University School of Medicine, AnkaraPatients: The outcomes of 15 patients with uterovaginal prolapsus who underwent sacrospinous ligament fixation evaluated. Main outcome measures: Early and late operative complications and patients' subjective and objective symptoms.Results: Intraoperative transfusion was needed for one patient. Mean operation time was 152,6 +/- 27,7 minutes. Mean hospitalization day was 2,3 +/- 0,9. No complications were occurred during hospitalization. Cuff prolapsus was occurred in one patient at 3 months after the operation and a small cysto-rectocele was occurred at 12 months after the procedure. No patient was complained of dysparonea at 12 months.Conclusions: It seems that sacrospinous ligament fixation technique is an effective and safe procedure for preventing cuff prolopsus in patients marked uterovaginal prolapsus.

PURPOSE OF INVESTIGATION To compare the effects of 50 microg of vaginal misoprostol with 25 microg for labor induction at term. METHODS One hundred and forty-seven pregnant women with indications for labor induction and cervical Bishop's score of < or = 6 were randomly assigned to receive either 50 microg (n = 74) or 25 microg (n = 73) of vaginal misoprostol every four hours until either a Bishop's score of > or = 8 or adequate uterine contraction frequency had been achieved. Induction-to-vaginal-delivery time was considered the primary outcome measure. RESULTS Mean induction-to-vaginal-delivery time was significantly shorter in the 50-microg group than in the 25-microg group (526 +/- 141 min vs 745 +/- 218 min, respectively); oxytocin was administered to 65.8% of the patients in the 25-microg group and to 35.1% in the 50-microg group (p < .05). The incidence of tachysystole was significantly higher in the 50-microg group than in the 25-microg group (12% vs 2.7%, p < .05). We found no statistically significant difference between the two groups with respect to the rate of primary cesarean section, incidence of hyperstimulation syndrome, or neonatal outcome (p > .05). CONCLUSION Fifty micrograms of vaginally administered misoprostol is an effective and inexpensive means of inducing labor at term. Uterine tachysystole may be associated more frequently with a 50-microg dose of vaginal misoprostol than with a 25-microg dose. Clinicians must accurately document the frequency and intensity of uterine contractions before every 50-microg dose of misoprostol is administered.

BACKGROUND This prospective randomized-controlled animal study was designed to determine the effects of atorvastatin on experimentally induced endometriosis in a rat model. METHODS Thirty-seven Wistar-Albino rats in which endometriotic implants were induced were randomly divided into four groups. Group I (Low-dose atorvastatin group, eight rats) were given 0.5 mg kg(-1) day(-1) oral atorvastatin. Group II (High-dose atorvastatin group, 10 rats) were given 2.5 mg kg(-1) day(-1) oral atorvastatin. Group III were given a single dose of 1 mg kg(-1) s.c. leuprolide acetate (GnRH agonist group, nine rats). Group IV were given no medication and served as controls (10 rats). All rats received the treatment for 21 days and were then euthanized to assess the implants' size, vascular endothelial growth factor (VEGF) level in peritoneal fluid and histological score. RESULTS At the end of the treatment, the mean areas of implants were smaller and VEGF levels in peritoneal fluid were lower in Groups II and III than those in Group I and the control group (all P < 0.05). The mean areas of implants decreased from 41.2 +/- 13.9 to 22.7 +/- 13.9 mm(2) after medication in Group II and decreased from 41.2 +/- 18.1 to 13.1 +/- 13.8 mm(2) in Group III (both P < 0.05), whereas in Group I, the mean area increased from 43.0 +/- 12.7 to 50.5 +/- 13.9 mm(2) (P < 0.05). CONCLUSIONS High-dose atorvastatin caused a significant regression of endometriotic implants.