Retrospective Analysis of Morbidly Adherent Placenta in a Tertiary Care Referral Centre - A Decade of Experience

We have read the article by Ozturk et al. entitled “Epab and Pabpc1 are differentially expressed in the postnatal mouse ovaries”

This is a case of a housewife from Erbil city in northern Iraq. It highlights one of the rare complication of inserting a coil for contraception. Coil perforation and migration is a recognized complication. The overall incidence of perforation is 0.4/1000 solid devices. The presenting symptoms are very variable and can be very minimal indeed. Radiological methods can help to confirm the diagnosis and also to plan treatment. While few advocate laparoscopic surgery to retrieve the lost coil, most think that laparotomy is the best approach to achieve effective removal of the migrated coil.

T he pregnancy outcome in women with Systemic Lupus Erythematosus (SLE) has unquestionably improved with a significant decrease in pregnancy morbidity over the last five decades from 40% in the early 1960’s to less than 15% in recent years

Introduction:
A great proportion of women are gaining weight excessively during pregnancy. This has been shown to have deleterious effects on the mother and the fetus. The aim of this study was to determine the prevalence of excessive gestational weight gain, its risk factors, socio-obstetrical profile of women with excessive gestational weight gain and its pregnancy outcomes.

Methodology:
This was a descriptive, cross-sectional study. Data was collected using an interviewer administered questionnaire. Pre-pregnancy body mass index and gestational weight gain were calculated. Based on the gestational weight gain, participants were classified according to the IOM 2009 guidelines into three groups: less than recommended, recommended, and more than recommended gestational weight gain. Maternal and fetal outcomes were recorded. The data was analyzed with Epi InfoTM 7.1.4.0. Proportions were compared using Chi-Squared or Fisher’s test. P-values were considered statistically significant if less than 0.05.

Results:
The prevalence of excessive gestational weight was 30.6%. It was associated with maternal obesity without an increase rate of Caesarean births (p=0.98). Excessive gestational weight gain increased the rates of hypertensive disorders in pregnancy (p=0.001) and macrosomia (p=0.04).

Conclusion:
Maternal obesity and excessive gestational weight gain are associated with adverse pregnancy outcome

Placenta Accreta (PA) is a term used to describe various types of abnormal placentation, when chorionic villi attach directly to or invade the myometrium [1]. This is a significant cause of maternal morbidity and mortality being the most common reason for emergent postpartum hysterectomy. Major risk factors for PA are placenta previa and previous caesarean section.

The number of patients with PA is increasing; therefore accurate early prenatal identification of abnormal placentation is of paramount importance for optimal obstetric management.

Although Ultrasound (US) remains the primary diagnostic tool for the diagnosis of abnormal placentation, the role of MRI has been increasing.

The aim of our paper is to present MRI appearance of abnormal placentation based on two cases.

Gynecological malignancies have always been my key point of interest. Gynecological cancers are one of the leading cause of cancer related mortality and morbidity. After working many years in the field of gynecological Oncology and related research work I am keen to share my experience and knowledge with all of you.

MicroRNA (miRNA) dysregulation has been found to influence carcinogenesis, metastasis, and the proliferation of human cancers, including cervical cancer. Multiple miRNAs have been shown to impact gene expression, suggesting they have oncogenic or tumor suppressing properties in cervical cancer. This review provides an overview of current knowledge of miRNAs in cervical cancer, and discusses their potential as biomarkers for diagnosis, prognosis and prediction of therapeutic outcomes. miRNAs are very stable and easily collectable from body fluids, and have received attention for use as a candidate specific and sensitive diagnostic/ prognostic tool. Research performed over the last decade has shown a substantial number of miRNAs to be dysregulated in cervical cancer. Studies have even identified the target genes and proteins of those miRNAs, furthering our understanding of the impact of miRNA on cellular activity. It is now well known that miRNAs play critical roles in the control of hallmark functions, such as invasion, metastasis, proliferation, and apoptosis, in cervical cancer. Combined with information on dysregulation, this information may help diagnosis at a precancerous state, the prediction of whether cervical cancer cells will go through malignant transformations or migrations, or prognostication. Despite a lack of incorporation in the clinic, miRNAs are gaining interest as biomarkers for cervical cancer.

Pathological conditions such as cysts, neoplasm, long mesovarium and adnexal venous congestion may lead to the ovarian torsion. Early diagnosis and treatment of ovarian torsion is important to preserve ovarian functions and to prevent future infertility. This ovarian torsion-detorsion process is named as ischemia-reperfusion injury. Reperfusion leads to more severe injury in tissue than ischemia. Studies demonstrated that the agents with antioxidant or anti-inflammatory activities may be beneficial in reducing ovarian ischemia reperfusion injury. Also, studies revealed the beneficial effect of controlled reperfusion in the prevention of ovarian tissue damage. However; ischemia/reperfusion damage continues to be a serious problem clinically.

Introduction:
Transvaginal ultrasound is the main reference technique in the evaluation of adnexal masses. Based on the Breast Imaging Reporting and Data System (BIRADS) classification Amor et al. suggested adapting this system to gynecologic ultrasound for the evaluation of adnexal masses: Gynecologic Imaging Reporting and Data System (GI-RADS) and based on recognition patterns and criteria recommended by the IOTA group.

Materials and methods:
A retrospective observational study was performed on women with adnexal masses who were diagnosed and operated consecutively at the Virgen de la Arrixaca Clinical University Hospital in Murcia between January 2013 and December 2014. All patients underwent transvaginal or transrectal ultrasound. GI-RADS1 was not included (no mass). GI-RADS2 and 3 lesions were classified as benign and GI-RADS4 and 5 as probably malignant.

Results:
387 patients, mean age 43 (13- 88), 246 premenopausal (63.5%) and 142 postmenopausal (36.5%).387 masses were classified: 3 GI-RADS2 (0.7%), 316 GI-RADS3 (811.7%), 20 GI-RADS4 (5.1%) and 48 GI-RADS5 (12.4%). GI-RADS2, none was malignant. GI-RADS3, 3.1% were malignant. GI-RADS4, 60% were malignant and GI-RADS5, 91.7% were positive for malignancy. Sensitivity 84.9% (95%CI 74.3–91.6%), Specificity 96.3% (95%CI 93.6-97.9%); LR+ 22.7 (CI95% 12.9–39.9), LR- 0.2 (95%CI 0.1-0.3); Odds Ratio 144.2 (95%CI 59.4 – 349.8). Area under the ROC curve 0.90.

Conclusion:
The GI-RADS reporting system has proved to perform well as a diagnostic system and it seems to be useful in everyday clinical practice. However, it would be advisable to check the classification criteria for GI-RADS 3 and 4 in order to achieve greater diagnostic reliability.

In recent years, the “choosing wisely” campaign has been started to avoid unnecessary examinations, treatments and procedures on the patients.