RESUMEN
BACKGROUND: Contrary to overt hypothyroidism, the true impact of subclinical hypothyroidism on fertility has not been well established. This study aimed to investigate whether serum thyroid stimulating hormone (TSH) values between 2.5 and 4.5 mIU/L are associated with lower pregnancy rates compared to TSH levels between 0.3 and 2.5 mIU/L in women undergoing ovulation induction with gonadotropins and intrauterine insemination (IUI) for unexplained infertility. METHODS: Medical records of couples with unexplained infertility who underwent IUI treatment between January 2013 and December 2018 were reviewed retrospectively. Cycle characteristics and pregnancy outcomes of patients with serum TSH levels between 0.3-2.5 mIU/L and 2.5-4.5 mIU/L were compared. Primary outcome measures were clinical pregnancy and live birth rate. Secondary outcome measures were total dose of gonadotropin administration, duration of ovulation induction and miscarriage rate. RESULTS: A total of 726 euthyroid women who underwent 1465 cycles of ovulation induction with gonadotropins and IUI were included in the analyses. Patient and cycle characteristics of the two study groups were similar. No statistically significant differences could be detected in the clinical pregnancy (p = 0.74) and live birth rates (p = 0.38) between the two groups. Duration of ovulation induction, total gonadotropin dosage, number of follicles > 17 mm on the trigger day and the miscarriage rates were similar in the two groups. CONCLUSION: In euthyroid women undergoing ovulation induction with gonadotropins and IUI for unexplained infertility, the range of preconceptional serum TSH values between 2.5 and 4.5 mIU/L is not associated with lower pregnancy rates when compared to TSH levels between 0.3 and 2.5 mIU/L.
Asunto(s)
Infertilidad Femenina , Infertilidad , Tasa de Natalidad , Femenino , Humanos , Infertilidad Femenina/terapia , Inseminación Artificial , Nacimiento Vivo , Inducción de la Ovulación , Embarazo , Índice de Embarazo , Estudios Retrospectivos , TirotropinaRESUMEN
Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis. Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA). Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively. Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.
Asunto(s)
Lipocalina 2/orina , Preeclampsia/diagnóstico , Adulto , Biomarcadores/orina , Estudios de Casos y Controles , Femenino , Humanos , Preeclampsia/orina , Embarazo , TurquíaRESUMEN
OBJECTIVE: A cesarean scar pregnancy (CSP) is an extremely rare form of an ectopic pregnancy, which is defined as the localization of a fertilized ovum surrounded by uterine muscular fiber and scar tissue. The objective of this study was to discuss the management options for CSPs in a singleton center. In the current study, we discussed the current management options for CSPs based on our 6 years of experience. MATERIAL AND METHODS: A retrospective evaluation of diagnosed and treated 26 patients with CSPs in Istanbul Kanuni Sultan Suleyman Training and Research Hospital during a 6-year period was discussed. Suction curettage was performed as first-line treatment in patients with a gestation <8 weeks and myometrial thickness >2 mm. RESULTS: Twenty-two (84.6%) patients with CSPs were initially treated surgically (curettage and hysterotomy) and four (15.4%) patients were treated medically with methotrexate injections. Vacuum aspiration was performed in 19 patients as a first-line treatment, six of them needed an additional Foley balloon catheter to be inserted for tamponade because of persistent vaginal bleeding. Suction curettage was successful in 12 patients. The treatment rate for suction curettage with or without Foley balloon catheter tamponade was 16 of 19 (84.2%). CONCLUSION: The early diagnosis of a CSP (7-8 weeks gestation) with a ß-hCG level <17.000 mIU/ml and a myometrial thickness >2 mm can be treated with suction curettage with or without placement of a uterine Foley balloon as curative treatment.
Asunto(s)
Cesárea , Cicatriz/cirugía , Embarazo Ectópico/cirugía , Legrado por Aspiración , Aborto Eugénico/efectos adversos , Aborto Eugénico/métodos , Adulto , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Cicatriz/complicaciones , Cicatriz/epidemiología , Estudios de Factibilidad , Femenino , Edad Gestacional , Humanos , Histerectomía/estadística & datos numéricos , Metotrexato/administración & dosificación , Paridad , Embarazo , Embarazo Ectópico/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Legrado por Aspiración/efectos adversos , Adulto JovenRESUMEN
In recent years with the increase in cesarean section rates, the frequency of placenta accreta cases rises. It causes 33-50% of all emergency peripartum hysterectomies. We present a 42-year-old case who was caught with early postpartum hemorrhage due to retained placental products. The ultrasonography showed a 65 × 84 mm mass in the uterine cavity after the delivery. Due to presence of early postpartum hemorrhage which needs transfusion, an intervention decision was made. The patient underwent curettage but the mass could not be removed so that placental retention was ruled out. Submucous leiomyoma was made as first-prediagnosis. Hysterectomy operation was performed as a curative treatment. Placenta increta diagnosis was made as a final diagnosis with pathological examination. As a result, placental attachment disorders may be overlooked if it is not a placenta previa case.