Local metothrexate treatment of cesarean scar ectopic pregnancy

Myometrial pregnancy developing in a previous caesarean section scar is the rarest of all ectopic pregnancies (EP) and probably one of the most dangerous of all because of the risk of rupture and hemorrhage. The recent recognition of this problem means that diagnosis and management are still in their infancy, and there is no consensus regarding the best management of CSP. Methotrexate (MTX) can be administered systemically or locally, or in both ways, with the aid of ultrasound. Patients diagnosed with caesarean scar pregnancies (CSP) in our clinic underwent transvaginal treatment of ectopic pregnancy. Safe and short treatment under transvaginal ultrasonographic (USG) guidance was performed uneventfully in all cases. The operating time ranged from 5 to 10 minutes with no blood loss. Serum β-hCG (β-subunit of human chorionic gonadotrophin) levels declined to normal levels within a month, and patients were discharged without further complications in two or three hours after the procedure. Our cases show that this treatment is effective, safe, and minimally invasive for patients diagnosed with CSP.

Hysteroscopic septum resection in patients with recurrent abortions and infertility

Objective: The aim of this study was to assess the achievement of pregnancy as well as the reproductive outcome after hysteroscopic septum resection in women with recurrent abortions or infertility. Design: retrospective, clinical trial. Setting: University hospitals. Patient(s): Fourty women with a diagnosis of uterine septum who had a history of pregnancy loss or infertility. They were randomized into two groups. Group I includes 18 infertile women and group II includes 22 recurrent miscarriage women. Intervention(s): Hysteroscopic metroplasty was performed on all patients in both groups. Result(s): 40 patients who were diagnosed with a partial septate uteri had hysteroscopic septum resection and were divided into two groups: Group I (18 patients) presented with infertility and Group II (22 patients) with recurrent abortions. The mean post-operative follow up period was 24 months. Group I, 12 patients (66.6%) and Group II, 17 patients (77.2%) achieved pregnancy, with respective abortion rates of 2 (11.1%) and 4 (18.1%). Conclusion(s): Using hysteroscopy to perform metroplasty on septate uteri makes the procedure safer, easier, and less complicated. This procedure is recommended for all cases diagnosed with an uterine septum.

Microperforate (Pinhole) hymen and infertility;a rare case report

Inroduction Female genital tract anomalies may have a devastating impact on the potential for sexual activity and fertility. Microperforate (pinhole) hymen is one of them. Microperforate hymen can lead to infertility, primary amenorrhea, acute or chronic pelvic pain, abnormal vaginal bleeding, dysuria, pollakiuria or a foul-smelling vaginal discharge. Aim We aim to report a patient who had intercourse problems and infertility complaints later found to have a microper-forate hymen. Discussion Pinhole opening of hymen may permit passage of fluids. Consequently spontaneous pregnancy can occur rarely. A few reports showed pregnancies with intact hymen without penetration of penis. But in general patients have fertility problems. Conclusion The results of the surgery are similar in all techniques and the particular surgical centre will have its own preference of which technique it prefers since after diagnosis definitive treatment is surgical and effective. Failure to manage these patients correctly may have long-term sequelae for their psychological, sexual and reproductive health.

A review of HELLP syndrome, in 17 patients

Introduction Preeclampsia is a well known obstetric complication characterized with hypertension and proteinuria whereas HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) which was first stated by Prichard in 1954 and described by Weinstein in 1982, is a multisystemic disease usually seen in the third trimester and in the postpartum period, usually in 48 - 72 hours following delivery [1]. Aim In this study we aim to share our experience in 17 patients with HELLP syndrome treated in our clinic between January 2005 and March 2008 in regard of the current literature. Material and Methods 17 patients diagnosed with HELLP syndrome between January 2005 and March 2008 were retro-spectively re-evaluated in regard of symptoms, treatment options and prognosis. As such this is a retro-spective study focusing on case reports. Conclusion As noted before main focus of treatment should be on patient stability, in other words, palliative care under intensive care conditions.