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PURPOSE: To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27 weeks of gestation. METHODS: This was a retrospective cross-sectional study of patients from 14 and 27 weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. RESULTS: A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. CONCLUSION: There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1 mm = 1 week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period.

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BACKGROUND This study aimed to determine the effects of use of a local hemostatic gelatin sponge (GS) on postoperative morbidity in patients undergoing cesarean section (CS). MATERIAL AND METHODS The records of 318 patients who underwent CS surgery were retrospectively evaluated. Group 1 consisted of 59 patients with gelatin sponge (GS) applied, and Group 2 consisted of 259 patients with no GS applied. The groups were compared for time to the first flatus, nausea and vomiting, requirement for anti-emetic drugs, development of postoperative ileus, and the length of hospitalization. RESULTS The patients in Group 1 and Group 2 were statistically similar in mean age, gravida, parity, and body mass index (BMI) (p=0.352, p=0.275, p=0.458, and p=0.814, respectively). No significant difference was determined in the number of patients with nausea, vomiting, anti-emetic drug use, febrile morbidity, and postoperative ileus (p=0.063, p=0.436, p=328, p=0.632, and p=0.179, respectively). Time to the first flatus and length of hospitalization were significantly longer in Group 2 (p<0.001 and p<0.001, respectively). CONCLUSIONS Delay in recovery of bowel motility may be due to the local hypersensitivity reaction caused by GS and/or dislocation of this local hemostat. Women who receive gelatin sponge treatment during CS should be monitored closely for the recovery of postoperative intestinal motility.

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OBJECTIVES: The present study aims to investigate the role of oxidant-antioxidant status in young women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Seventy-one women with PCOS and 53 healthy controls are compared in aspect of demographic characteristics, biochemical data, hormones, and oxidant-antioxidant status. RESULTS: The PCOS group had significantly lower zinc, higher malondialdehyde and gluthathione peroxidase and lower serum catalase levels than the control group (p = 0.016, p < 0.001, p = 0.043 and p = 0.025 respectively). The PCOS patients with IR had significantly higher malondialdehyde, lower catalase and serum zinc levels than the PCOS patients without IR (p = 0.015, p = 0.010, p = 0.001 respectively). The infertile PCOS patients had significantly higher malondialdehyde, lower catalase and serum zinc levels than the fertile PCOS patients (p = 0.022, p = 0.045,p = 0.001 respectively). There was a statistically significant and positive correlation between HOMA-IR and malondialdehyde values (r = 0.523, p = 0.001), between HOMA-IR and glutathione peroxidase values (r = 0.468, p = 0.001) and between HOMA-IR and zinc values (r = 0.601, p = 0.001). There was a statistically significant and negative correlation between HOMA-IR and catalase values (r = -0.493, p = 0.001). CONCLUSIONS: The patients with PCOS are under oxidative stress and this oxidative stress seems to be the highest in patients with IR and with infertility. Despite the prominent increase in the oxidative stress, there was a variation in the antioxidant response.

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OBJECTIVE: To evaluate the relationship of neutrophil/lymphocyte ratio (NLR) with proteinuria and blood pressure level in patients with pre-eclampsia and to investigate whether or not NLR has a role in predicting the severity of pre-eclampsia. STUDY DESIGN: The study comprised 30 healthy pregnant females (Group 1), 37 females with mild pre-eclampsia (Group 2) and 40 with severe pre-eclampsia (Group 3). All the study participants were statistically compared in respect of demographic data, proteinuria levels, and blood pressure levels. RESULT: Age, body mass index, and gestational weeks were similar in all the groups. Maternal NLR was determined to be significantly high in the pre-eclamptic patients (Groups 2 and 3) compared to the healthy pregnant patients (Group 1) (p=0.017). NLR was significantly higher in the severe pre-eclampsia group than in the mild pre-eclampsia group (p=0.032). A significant positive correlation was determined in correlation analysis between NLR and proteinuria (p=0.013, r=0.319). There was also a significant and positive correlation between NLR and systolic/diastolic arterial pressure (p=0.007, r=0.285; p=0.044, r=0.213, respectively). CONCLUSION: In conclusion, while NLR was determined as significantly high in patients with pre-eclampsia, to be able to use this in the classification of the severity of pre-eclampsia, there is a need for further studies on a more extensive population.

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OBJECTIVE: We aimed to investigate the utility of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte count as biomarkers to distinguish malignant from benign ovarian masses. MATERIAL AND METHODS: We retrospectively reviewed the histopathological results of 185 benign and 33 malignant cases following surgery for an initial diagnosis of adnexal mass and confirmed ovarian masses. Age, cancer antigen 125 (CA-125), white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), mean platelet volume (MPV), platelet distribution width (PDW), NLR, PLR, and lymphocyte counts were compared between groups. RESULTS: The significant diagnostic factors to distinguish malignant from benign disease were age (35.5±22 vs. 62±13 years; p<0.001) and CA-125 levels (16.6±21 vs. 98±366 U/mL; p<0.001). No significant difference was observed in WBC count, Hct, Hb, platelet count, PDW, and MPV between groups. To distinguish malignant from benign masses, lymphocyte count (1.29±0.91 vs. 1.80±0.67×10(3) cells/µL, p<0.001), NLR (4.95±5.36 vs. 3.32±2.72, p=0.024), and PLR (203.41±107.84 vs. 160.75±70.84, p<0.001) were identified as markers. The cutoff values were lymphocyte count of >1500 cells/µL (p<0.001), NLR of 3.4732 (p=0.033), PLR of 161.13 (p<0.001), CA-125 of >40 U/mL (p<0.001), and age of >53 years (p<0.001); their respective sensitivity and specificity were 66.7% and 77.8% [area under the curve (AUC), 0.723±0.055], 68.8% and 54.1% (AUC, 0.624±0.058), 81.8% and 50.8% (AUC, 0.683±0.052), 78.8% and 77.8% (AUC, 0.797±0.057), and 81.8% and 82.2% (AUC, 0.888±0.025). Multiple logistic regression analysis revealed cutoff explanatory and accuracy values of 68.2% and 94.9%, respectively, for lymphocyte count, NLR, PLR, CA-125, and age as independent parameters to distinguish malignant from benign ovarian masses. CONCLUSION: In combination with age and CA-125 levels, NLR, PLR, and lymphocyte count may be helpful to preoperatively distinguish malignant from benign ovarian masses.

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OBJECTIVE: To compare the results of two different techniques of uterine closure in caesarean section operations in which assistant surgeons participated. METHODS: A total of 765 patients were separated into two groups.In Group1(n = 380), the assistant surgeon, while pulling the suture in a caudal direction with the left hand, held the uterine wall from the joined site with the right hand to prevent upward tension of tissue. In Group 2 (n = 385), the suture was placed by the assistant surgeon by pulling it in the cephalic direction with the right hand. These two techniques were evaluated in respect of the postoperative decrease in haemoglobin level ,the need for additional sutures and operative outcomes. RESULTS: The need for additional sutures was determined as statistically high in Group 2 at mean 0.5 ± 0.6 compared to mean 0.2 ± 0.5 in Group1 (p < 0.001). The mean operating time was determined as statistically significantly longer in Group 2 (Group1, 38.0 ± 5.6 mins and Group2, 41.3 ± 4.3 mins) (p < 0.001). The postoperative decrease in hb was statistically significantly greater in Group 2 (Group1, 1.1 ± 0.4, Group2, 1.2 ± 0.4) (p = 0.002). CONCLUSION: The cephalic direction placement of the suture with the right hand of the assistant surgeon in uterine closure leads to bleeding due to tissue cuts in the lower wound lip and thereby creating a need for additional sutures. Therefore, the suture should be placed in a caudal direction with the left hand.

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OBJECTIVE: To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH). METHODS: The present cross-sectional study at a single center in Turkey compared vaginal length and sexual function among women who received TLH, TAH, VH, or no surgery (groups 1, 2, 3, and 0, respectively) between January 2011 and April 2014. All women underwent hysterectomy for benign reasons at least 3months before the study and were sexually active. Vaginal length was measured between the hymenal ring and vaginal apex. Sexual function was assessed via the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, short form (PISQ-12). RESULTS: Vaginal length in groups 0, 1, 2, and 3 was 10.9±1.5, 8.9±1.4, 8.5±1.2, and 8.1±0.7cm, respectively; it was significantly longer in the control group (P<0.001), and significantly shorter in group 3 than in group 1 (P=0.03). The mean PISQ-12 score in groups 0, 1, 2, and 3 was 18.6±5.2, 12.9±3.0, 13.8±4.4, and 11.5±4.4, respectively, and was significantly higher in group 0 (P<0.001). CONCLUSION: Total hysterectomy shortened vaginal length and compromised sexual function regardless of the technique used.

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OBJECTIVE: The efficacy and safety were assessed of a misoprostol regimen used alone or in combination with foley catheter for second trimester pregnancy termination. METHODS: A retrospective examination was made of the records of patients who underwent pregnancy termination at 14-24 weeks of gestation in our university hospital between January 2011 and June 2014. Records were available for patients 378 who underwent terminations. Group 1 comprised patients with no history of cesarean section. An initial dose of 200 µg misoprostol was administered intravaginally and then until the termination was completed an additional 200 µgr dose was administered sublingually every 4 hours (Group 1: 234 patients). Group 2 comprised patients with a history of cesarean section. An initial dose of 200 µg misoprostol was administered intravaginally and 2 hours later an intracervical foley catheter was inserted (Group 2: 144 patients). RESULTS: The total misoprostol dosage used was 1160 µg and 560 µg (p< 0.001), intervals from the administration of the first misoprostol tablet until termination were 854.8 and 704.2 minutes (p= 0.03) in Groups 1 and 2, respectively. CONCLUSIONS: The misoprostol + foley catheter combination reduces the total dosage of misoprostol required for termination and shortens the termination interval, thereby increasing patient's comfort. Based on these results, the usage of the misoprostol + foley catheter combination can be recommended especially for patients with a history of caesarian section.

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OBJECTIVE: To evaluate Nesfatin-1 levels in patients with and without intrauterine growth restriction and to analyze the correlation between Nesfatin-1 levels and fetal birth weights. METHODS: This study comprised a total of 81 cases; 41 patients with IUGR and 40 healthy cases. Demographic data, pregnancy weeks, fetal birth weights and Nesfatin-1 levels were all recorded. The Nesfatin-1 levels were compared between the groups and the correlation between fetal birth weights and Nesfatin-1 levels was analyzed. RESULTS: No statistical significant difference was determined between the groups in terms of demographic data (p > 0.05). Average birth weights were determined as 3420 ± 259 g in the control group and 2041 ± 350 g in the IUGR group, which was found to be statistically unequal (p = 0.001). The average Nesfatin levels in the control group were 0.069 ± 0.011 and 0.094 ± 0.042 in the IUGR group. This difference was statistically unequal (p = 0.001). While no correlation was determined between Nesfatin levels and fetal birthweights in the control group (r = -0.034 versus p = 0.836), in the IUGR group and when all the cases were evaluated together, a statistically moderately significant negative correlation was determined (r = -0.469, p = 0.002 and r = -0.251, p = 0.024, respectively). CONCLUSIONS: Although intrauterine growth is a multifactorial process, the effect mechanism has not yet been established. The results of this study offer some indications about the possible effect of Nesfatin 1 on fetal growth.

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OBJECTIVE: To investigate whether serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels could be used as a marker to determine the severity of preeclampsia. METHODS: This prospective cohort study included pregnant women with preeclampsia and severe preeclampsia and normotensive pregnant controls admitted between January 2013 and July 2014. Preeclampsia was graded according to the recently revised criteria of the American College of Obstetricians and Gynecologists (ACOG). Serum NT-proBNP levels were compared among the groups. RESULTS: Of the 49 women with preeclampsia, 25 had severe preeclampsia. The controls were 27 normotensive pregnant women admitted during the same period. Serum NT-proBNP levels were significantly higher in the preeclampsia groups than in the control group (p < 0.001). In addition, NT-proBNP levels were significantly higher in the severe preeclampsia group compared with both the preeclampsia group (p < 0.001) and the control group (p < 0.001). CONCLUSION: The ACOG has recently revised the grading of hypertensive diseases of pregnancy and the criteria for severe preeclampsia. In line with these revised guidelines, serum NT-proBNP levels appear to be a useful marker to evaluate the severity of preeclampsia.

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Adnexal torsion (AT) is a condition in which there is sometimes difficulty in making a preoperative diagnosis since there are no routine laboratory markers and this condition is usually intraoperatively diagnosed. Many of the studies have indicated that the neutrophil-to-lymphocyte ratio (NLR) is a significant inflammatory marker in various diseases. In this study, we aimed to investigate the diagnostic efficacy of the NLR on the diagnosis of AT. Patients surgically treated for AT were analysed retrospectively. A total of 27 AT patients were included in the study (Group 1). Another 30 patients who were surgically treated for a unilateral ovarian mass and did not have torsion or malignity on the final histopathological examination were assigned to the control group (Group 2). White blood cells (WBCs), neutrophils, lymphocytes and the NLR were compared between groups. The mean WBC values for Groups 1 and 2 were 9.7 ± 1.8 and 7.6 ± 1.5 K/µL (P < 0.001), respectively. The mean neutrophil values were also significantly higher in Group 1 (P < 0.001). However, the mean lymphocyte values were significantly higher in Group 2 (P < 0.001). Mean NLR was significantly higher in Group 1 (P < 0.001). Sensitivity and specificity of WBC > 8.8 were 83.3% and 74.1%, respectively. Sensitivity and specificity of NLR > 3 were 88.9% and 100%, respectively. Furthermore, the area under the ROC curve (AUC) was 0.933 for the NLR and 0.830 for WBC. With respect to the diagnosis of adnexal torsion, an NLR > 3 was identified as a more sensitive marker than the high WBC count. Therefore, an NLR > 3 seems to be a valuable marker in cases where it is difficult to diagnose AT.

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The aim of this study is to assess vitamin D levels in eclampsia, preeclampsia and healthy pregnant women and the role of vitamin D deficiency in the etiology of preeclampsia (PE). Forty healthy pregnant women, 83 preeclamptic and 32 eclamptic pregnant women were included. Maternal and infant medical records were reviewed. Blood samples were obtained from all groups. Demographics and serum vitamin D levels were compared between the groups. No statistical differences were observed in age, gravidity, parity, weight, height and BMI between the three groups. Week of pregnancy and weight at birth in eclamptic and preeclamptic patients were lower compared to the healthy patients (P<0.001 and P<0.001, respectively). Systolic and diastolic blood pressures were higher in eclamptic (P<0.001) and preeclamptic patients (P<0.001) compared to the healthy pregnant group. The rate of cesarean section was found to be higher in preeclamptic and eclamptic patients (P<0.001). Vitamin D levels were lower in both preeclamptic and eclamptic patients compared to healthy normotensive pregnant women (P<0.001). Preeclamptic and eclamptic women were similar in terms of the data compared. Vitamin D supplementation is considered to decrease the risk of both preeclampsia and eclampsia in the patient population at risk for vitamin D deficiency.

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OBJECTIVE: To compare the use of solifenacin and fesoterodine in treatment of overactive bladder (OAB). METHODS: This prospective study was conducted on patients diagnosed with OAB who presenting to the Department of Obstetrics and Gynecology and Urology, School of Medicine, Kahramanmaras Sütçü Imam University, Kahramanmaras, Turkey between October 2013 and August 2014. Patients were randomized into 2 groups. Group 1 (n=60) received 5 mg solifenacin per day, while Group 2 (n=59) received 4 mg fesoterodine per day. All the patients' OAB symptom scores (OABSS) in weeks 0, 4, and 12 were recorded. In addition, treatment costs and side effects of the drugs were evaluated. RESULTS: Average OABSS (score 1) was determined as: 9.5 ± 2.8 for Group 1 and 10.7 ± 1.8 for Group 2 at week 0; 2.2 ± 1.2 (Group 1) and 2.4 ± 1.3 (Group 2) at week 4 (score 2); and 1.3 ± 0.5 for Group 1 and 1.3 ± 0.6 for Group 2 at week 12 (score 3). In addition, no statistically significant difference was found between the scores (p=0.062 (score 1), p=0.464 (score 2), and p=0.527 (score 3). The discontinuation rate of medication due to its side effects was 0 (0%) for Group 1, and 6 (10.2%) for Group 2. Intragroup changes in the scores 1-2, 1-3, and 2-3 values was statistically significant in both groups (p less than 0.001). CONCLUSION: No significant difference was found between the OABSS of these 2 drugs. However, discontinuation of drugs due to side effects was more frequent in fesoterodine.

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BACKGROUND: Preeclampsia (PE) is a hypertensive disorder that occurs in 2% to 8% of pregnancies. Although numerous studies have investigated the etiology and pathophysiology of preeclampsia, the precise pathological mechanisms remain poorly understood. Hence, in the present study malondialdehyde (MDA) levels and SOD expression, and Cu and Zn concentrations and ratios were correlated with birth weights in pregnant women with and without PE, and in non-pregnant females of reproductive age. MATERIAL AND METHODS: Malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities were determined spectrophotometrically, and Cu and Zn levels were determined using atomic absorption spectrometry in serum from 42 non-pregnant women (NP), 40 healthy pregnant women (HP), and 38 pre-eclamptic pregnant (PE) women. Subsequently, Cu/Zn ratios were calculated and associations with birth weights were analyzed using Spearman correlations. RESULTS: Cu, Zn, and MDA levels and Cu/Zn ratios were significantly higher in the PE group than in the HP and NP groups, and were significantly higher in the HP than in the NP group (p<0.001 and p<0.001; respectively). In contrast, serum Zn and SOD levels were significantly lower in the PE group than in HP and NP groups, and were significantly lower in the HP group than in the NP group (p<0.001 and p<0.001; respectively). However, only Cu and Zn levels were significantly associated with fetal birth weights (r=-0.433, p<0.001). CONCLUSIONS: Serum Cu/Zn ratios may reflect vascular complications of PE, and the ensuing increases in lipid peroxidation may play important pathogenic roles.

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OBJECTIVE: In this study, we aimed to compare the Syrian refugees and resident Turkish pregnant population in terms of Toxoplasma seroprevalence. METHODS: Data acquired from Kahramanmaras Necip Fazil City Hospital Department of Obstetrics and Gynecology between 2012 and 2013 were analyzed retrospectively. Results of 7201 Toxoplasma IgM tests and 4113 Toxoplasma IgG tests were evaluated. RESULTS: For 2012 and 2013 Toxoplasma IgM seropositivity was found in Syrian refugees 4.76% and 4.84% respectively in our study. In the same population Toxoplasma IgG seropositivity rates were 80% and 62.6%, respectively. Toxoplasma IgM seropositivity rates for the native peoples in Turkey in 2012 and 2013 was 1.96% and 2.34%, while in the same population Toxoplasma IgG seropositivity was detected 49.7% and 45.7% respectively. Toxoplasma IgM seropositivity was statistically higher in Syrian refugees for each year (p <0.001 and 0.019, respectively). Toxoplasma IgG seropositivity of Syrian refugees was statistically higher (p <0.001 and <0.001 respectively). CONCLUSION: Since it was found in our study that toxoplasma seropositivity rates of Syrian refugees living in the region of Kahramanmaras were statistically higher than the rates of local inhabitants, we consider that this condition should be taken into account in the follow-ups of Syrian pregnant refugees outnumbering in Kahramanmaras and its vicinity.

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OBJECTIVE: To investigate the effect of ovarian torsion on plasma high-sensitivity C reactive protein (hs-CRP) levels and to determine whether hs-CRP levels were a useful adjunct that could be used in the diagnosis of ovarian torsion. MATERIALS AND METHODS: Sixteen nulligravid 4-month-old female Wistar albino rats were randomly and equally allocated into two groups. Control group, sham operation (n = 8) group, and study group, ovarian torsion (n = 8) group. Ovarian torsion model was created using titanium vascular clips and vascular clips were kept for a 2-h period. Right ovaries were surgically removed at the end of the procedure in each group. Blood was sampled before and after operation to assess plasma hs-CRP levels. Ovarian histopathologic findings scores and plasma hs-CRP levels were evaluated. RESULTS: In study group, the mean plasma hs-CRP level was significantly higher than that in the control group. (0.91 ± 0.18 vs. 0.39 ± 0.06 mg/l, respectively, p < 0.001), following 2 h of ovarian torsion. Histologic examinations of the right ovary confirmed the torsion model. Histologic score of the specimens had higher scores for follicular cell degeneration (p = 0.002), vascular congestion (p = 0.002), inflammatory cell infiltration (p = 0.003), and hemorrhage (p < 0.001) in the study group. For the change in the plasma hs-CRP value for a cut-off value of >0.275 mg/l, sensitivity and specificity were calculated as 100 %. CONCLUSION: The measurement of hs-CRP in a rat model seems to be a valuable plasma marker in early detection and diagnosis of ovarian torsion. However, further clinical and experimental studies of a larger size are required.

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OBJECTIVE: To investigate the relationship between fetal birth weight and maternal hemoglobin concentrations in different trimesters. METHODS: This prospective cross-sectional study comprised 329 women, monitored and delivered between January 2013 and January 2014 in our clinic. Hemoglobin concentrations in all trimesters and all birth weights of the newborns were recorded. Comparisons and correlations were made of the maternal hemoglobin concentrations and birth weights in each trimester. RESULTS: A positive correlation was determined between fetal weight and increased first trimester maternal hemoglobin concentration (p: 0.025). No correlation was found between fetal weights and second and third trimester hemoglobin concentrations (p = 0.287, p = 0.298, respectively). When the effect of independent factors on fetal weight was investigated, it was determined that birth week and first trimester hemoglobin levels were the factors of most influence. CONCLUSIONS: Low hemoglobin concentrations in the first trimester of gestation seem to be associated with low fetal birth weights. Anemia can directly cause poor in utero fetal growth due to inadequate oxygen flow to the placental tissue or it can be an indirect indicator of maternal nutrition deficiency. In both circumstances, this study reveals that treatment of anemia before and in the early stages of pregnancy is directly correlated with better fetal outcomes.

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OBJECTIVE: The aim of the study was to analyze the anti-angiogenic role of thalidomide and to assess whether thalidomide had any influence on a rat model of surgically-induced endometriosis. MATERIALS AND METHODS: Endometriosis was induced through surgical induction and homologous transplantation in 16 rats. The rats were randomly separated into two groups as thalidomide (n=8) and control (n=8) groups. Using oral gavage, 100 mg/kg thalidomide 0.5 ml was administered to the first group and saline 0.5 ml to the control group. Histopathologic findings and volume analysis of implants were evaluated after 4 weeks. Vascular endothelial growth factor-A (VEGF-A) and oxidative markers were run from the fluid through peritoneal lavage. RESULTS: The average implant volume decreased significantly in the thalidomide administrated group after treatment (53.3 and 22.9 mm3 respectively, p=0.012). Significant differences observed in the histopathologic scores of the thalidomide group (3 and 1 respectively, p=0.012) were not observed in the control group. Significant decreases were observed in the levels of VEGF-A and myeloperoxidase (MPO) from oxidative markers (p=0.004, p=0.037, respectively). CONCLUSION: Thalidomide provides volumetric and histopathologic recovery in implants particularly because the VEGF inhibition and anti-angiogenic effect, which suggests that it could be effective in the treatment of endometriosis.

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Hematometrocolpos is accumulation of blood in the vagina and uterine cavity due to intra-uterine hemorrhage. A 20-year-old female presented to our clinic with massive menorrhagia at menarche after progestin usage. Hematometrocolpos was detected by transabdominal ultrasonography. She was pale because of heavy bleeding for 5 days and hemoglobin level was measured as 5.1 g/dl. Initial treatment was blood transfusion and medical drug therapy. After resolution of the hematometrocolpos was shown by transabdominal ultrasound 2 days later, the patient, who was stable, was discharged without complication. Obstruction of the female genital outflow tract is rarely seen. Hematocolpos has been reported in elderly women following vaginal occlusion due to radiotherapy, vaginal fibroma and labial synechiae causing infection or inflammatory conditions. The case is presented here because of the successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.

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Introduction. Although pyogenic granulomas (PG) are common and benign vascular proliferations of the skin and mucous membranes, they are relatively rare on the vulva. Case Presentation. A 57-year-old G7P7 postmenopausal woman presented with a 3-year history of a foul smell and bleeding lesions in the genital region. A gynecologic examination revealed multiple large papillomatous, pedunculated, and lobulated lesions that were cherry-red and infective in appearance. There was a 2-cm lesion at the upper intersection of the labia majora, a 2-cm lesion on the right labium majus, and a 4-cm lesion on the clitoris. The patient complained of itching, and the lesions were asymptomatic, except for occasional bleeding. All lesions were excised and sent for histopathological examination, which revealed an ulcerated polypoidal structure with extensive proliferation of vascular channels lined by a single layer of endothelium. The histopathological features were consistent with PG. Conclusion. The present case is the first case of multiple pyogenic granulomas on the vulva in a postmenopausal woman.