Gynecology Obstetrics and Reproductive Medicine

Published by Mebas Medikal Basin Yayin
Print ISSN: 1300-4751
p>OBJECTIVE: We aimed to determine the diagnostic values of some clinical and ultrasonographic features for predicting ovarian malignancies in patients with normal serum CA-125 levels. STUDY DESIGN: All of the 84 patients who were diagnosed with ovarian malignancy and 168 patients with benign adnexal mass had normal CA-125 levels, and recruited as study and control groups, respectively. Individual characteristics, ultrasonographic features, and risk of malignancy index (RMI) values of the groups were compared retrospectively. RESULTS: The ages, mean postmenopausal period of the postmenopausal women in the malignant group were significantly higher than the benign group. Nulliparity rates were similar between the two groups. The number of postmenopausal patients was significantly higher in the malignant group. Median cyst diameter and RMI values were significantly higher, and bilaterality and presence of solid area were more frequent in this group. Logistic regression model showed that ovarian cysts larger than 8 cm [Odds ratio (OR): 7.012; p<0.001; 95% Confidence interval (CI): 3.463-14.198], presence of solid area within the cyst [OR: 7.43; p<0.001; 95% CI: 3.799-14.532], and postmenopausal state [OR: 2.893; p=0.027; 95% CI: 1.129-7.412] were found to be significant factors to predict malignancy. CONCLUSION: Ovarian cysts larger than 8 cm, presence of solid area within the cyst, and postmenopausal status are the most important risk factors for ovarian malignancies in these patients with normal CA-125 levels.</p
OBJECTIVE: Mature cystic teratoma, also known as a dermoid cyst, is the most common germ cell tumor of the ovary. In this retrospective study, it is aimed to evaluate clinicopathological findings of the patients who were operated on due to the preliminary diagnosis of dermoid cyst. STUDY DESIGN: Between May 2013 and May 2018, the findings of a total of 143 patients who were operated on with a preliminary diagnosis of dermoid cyst in our institution were analyzed retrospectively. In addition to demographic characteristics such as age, parity number and tumor size, lateralization, preoperative tumor markers, surgical procedure, presence of other pathological findings, and the rate of malignant transformation were analyzed. RESULTS: The median age of patients was 35.4 years and the ratio of nulliparous, primiparous, and multiparous patients was 46.9%, 25.2%, and 28%, respectively. The median tumor diameter was 6.7 cm, 50.3% of which were right-sided, 46.9% were left-sided and the remaining 2.8% were bilateral. Intraoperative torsion was found in 15 (10.5%) cases. The treatment consisted of 60.1% cystectomy by laparoscopy, 3.5% unilateral salpingo-oophorectomy by laparoscopy, 9.8% unilateral salpingo-oophorectomy by laparotomy, while the rate of 16.1% cases underwent hysterectomy with bilateral salpingo-oophorectomy by laparotomy, 10.5% of the cases, cysts were excised during cesarean section. As the final pathology report revealed, of 143 patients, immature teratoma was observed in five cases (3.5%), in one of them (0.7%) mixed germ cell tumor and in three of them (2.1%) borderline mucinous cancer, squamous cell carcinoma, and carcinoid tumor on mature cystic teratoma base were observed. CONCLUSION: Torsion is the most common complication with mature cystic teratoma. The size of the tumor is an important prognostic factor in terms of the malignant transformation of teratoma. Fertility sparing surgery with a minimally invasive surgical approach is available for fertility patients diagnosed with Mature cystic teratoma.
Morcellation of the myoma  
Myomas are the most common benign tumors of the uterus; however, only 1% to 4% of women were diagnosed with myoma during pregnancy. Although a majority of myomas do not cause any problems during pregnancy and rarely present with torsion or necrosis, myomas might lead to an acute abdomen, which then indicate need for an urgent myomectomy. There are various causes for an acute abdomen during pregnancy, and it is not always easy to make the definitive diagnosis with non-invasive diagnostic tools such as ultrasonography. Because the uterus displaces the intra-abdominal organs during pregnancy, diagnosis of a surgical emergency may be delayed and, consequently, increase maternal morbidity and mortality. If a surgical emergency is indicated, laparoscopy is a safe alternative to laparotomy during pregnancy, requiring a shorter hospital stay and less analgesic; therefore, all surgeons and gynecologists should be able to perform a laparoscopy when needed in each trimester of pregnancy. Herein, we report a 31-year-old primigravid woman presented with an acute abdomen at 16 weeks gestation. Ultrasound examination revealed a nearly 10 cm myoma at the right side of the uterine fundus. Suspecting a torsed myoma, an urgent diagnostic laparoscopy, which revealed a large, torsed, subserous myoma with a 2cm base, was performed. Laparoscopic resection and morcellation was done successfully. No intra-operative or post-operative complications were encountered, and the woman gave birth to a healthy infant at term. By presenting this case, we suggest the safe use of laparoscopic myomectomy of a relatively big myoma even in the second trimester of pregnancy.
OBJECTIVE: Primary carcinoma of the fallopian tubes is one of the less common gynecological cancers. It constitutes (0.14-0.18%) of gynecological malignancies. Our study aimed to review the managing process of primary carcinoma of the fallopian tubes in the mono-center institute and to identify prognostic factors impacting survival. STUDY DESIGN: A retrospective cohort study regarding patients with fallopian tube carcinoma treated between July 1991 and December 2005 was identified at the Tunisian anticancer institute “Salah Azaiez”. During this period, we have identified 17 patients. Data such as age, gravidity and parity, menopausal condition, symptoms reported by the patient on presentation, adjuvant therapy, stage of illness, surgical intervention, pathological findings, tumor recurrence, and previous surgical procedures were obtained from the patients’ reports. RESULTS: The average age at the time of diagnosis was 58 years. Fourteen of the included patients were postmenopausal. Surgery was the initial therapy for 15 patients. Optimal cytoreductive surgery was achievable in seven patients with no residual tumors. Histologic examination revealed that serous adenocarcinoma type was the predominant type. Two were in stage I and, four were in stage II; seven were in stage III and four in stage IV. The median follow-up time was 24 months. At the time of the final analysis, 11 patients died of disease. 5-year OS, DFS was 21% and 37% respectively. In our study, only the residual tumor was a significant prognostic factor predicting survival. CONCLUSION: Complete optimal surgery with no residual tumor was the main goal of the surgeon to improved survival in primary fallopian tube carcinoma.
p> Objective: To analyze whether the time the patients entering into prenatal care affects the route of delivery, maternal, and fetal outcomes. Study Design: The electronic medical files of 17,035 women who delivered at the same hospital between January 2008 and December 2014, were retrospectively reviewed. Pregnant women were distributed into one of 5 groups (No-prenatal-visit group, Only-pregestational-visit group, First-visit-prior-to-24-weeks-follow-up group, Early-third-trimester-follow-up group, Late-third-trimester-follow-up group) according to the time of their first pregnancy follow-up visit. The route of delivery, maternal anemia, and fetal outcomes were compared among the groups. Results: Pregnant women in the no-prenatal-visit group were younger and showed higher rates of vaginal delivery (56%), term deliveries (90.7%), and postpartum anemia. Those in the first-visit-prior-to-24-weeks group were older and showed higher rates of both primary and secondary cesarean (58%), and higher rates of term deliveries (93.6%) and lower postpartum anemia. Both the primary and secondary cesarean rates were higher in groups with frequent and early follow-up visits than in a no-prenatal-visit group and late-third-trimester-follow-up group (p<0.001). Conclusion: The rates of cesarean deliveries were found to be increased prominently in pregnant women who began antenatal care early in pregnancy with frequent follow-ups.</p
OBJECTIVE: The ongoing COVID-19 pandemic is causing widespread concern, fear, stress, anxiety, and depression throughout the population worldwide. Pregnant women, being a vulnerable group, are grossly affected by these changing environmental scenarios. The spread of Corona Virus infection itself and the subsequent nation-wide lockdown in India, just like many other countries, has caused a serious impact on antenatal patients. The objective of this study was to bring out the specific concerns of pregnant women during the ongoing COVID-19 pandemic and also to assess the prevalence of Depression and Anxiety Disorder owing to the pandemic. STUDY DESIGN: This cross-sectional survey among antenatal patients was conducted in the outpatient department of a tertiary care obstetric center which is also a designated COVID hospital. Prevalidated questionnaires, Personal Health Questionnaire-9 & Generalized Anxiety Disorder questionnaire-7 were used for data collection. A semi-structured questionnaire was used to evaluate pregnancy-specific concerns of the patients with respect to the COVID-19 pandemic. RESULTS: The overall prevalence of moderate to severe depression in the survey was found to be 13.2% (n=66). The prevalence of moderate to severe anxiety disorder was found to be 9.8% (n=49). CONCLUSION: This study has brought out the need for urgent attention to the psychological impact of COVID-19 on pregnant women. Pregnant women being a vulnerable group, especially during this pandemic, need special attention to their psychological wellbeing as well.
The novel coronavirus disease-19 (COVID-19) considered a global health problem. Pregnant women are considered a COVID-19 high-risk group. A 26-years old woman, G2 P1+0, previous cesarean section, 31 weeks`+4 days, admitted with preterm labor, without fever, cough, and/or respiratory symptoms on admission. She presented to the emergency department with fever, and cough, 27 days before the current admission, she was referred to the Ministry of Health, and her COVID-19 PCR swab at Ministry of Health was positive. She delivered by cesarean section, and the PCR swab of the studied woman taken on admission came positive for COVID-19. The delivered girl was admitted to the neonatal intensive care unit for 16 days. The PCR swab of the delivered girl came negative for COVID-19. This report highlights that the COVID-19 infection during pregnancy may increase the rates of preterm labor and cesarean section. There is no strong evidence of vertical COVID-19 transmission when the infection manifests during the 3rd trimester of pregnancy.
OBJECTIVE: This study aimed to investigate the effect of the COVID-19 outbreak on infertile couples dealing with stress and anxiety during in vitro fertilization treatment. STUDY DESIGN: 252 infertile patients who applied for in vitro fertilization treatment were included in this cross-sectional study. Data were collected via four data collection tools including socio-demographic form, COVID-19 Inventory (COVID-I), COMPI fertility problem stress scale (COMPI-FPSS), and state-trait anxiety scale. Data analysis was conducted by SPSS statistical software included statistical analysis such as averages, standard deviations, correlation, regression, and t-test. RESULTS: Both negative and weak correlations were found between COMPI fertility problem stress scale and subscales of state-trait anxiety scale as well as the total score of state-trait anxiety scale. In terms of socio-demographic characteristics of the participants and their responses in state-trait anxiety scale and ISS forms, the correlation coefficients were also so low. The results also showed that public officials, health professionals, and educators showed lower state-trait anxiety scale (stress-related anxiety) scores. CONCLUSION: During the COVID-19 pandemic, there was an increase in spontaneous pregnancy expectations. Although participants were mostly stressed because of the COVID-19 outbreak, they didn’t change their in vitro fertilization treatment plans during the outbreak.
OBJECTIVE: To investigate the impact of Corona Virus Disease 19 (COVID-19) infection on pregnancy outcomes. STUDY DESIGN: This retrospective study was conducted at a tertiary university hospital between the years of October 2020-October 2021. All the pregnant women with COVID-19 diagnoses were enrolled in the study during this period. Demographic parameters, a history of Favipiravir use, COVID-19 symptoms, treatment approaches, hospitalization, intensive care unit admission, and obstetric and neonatal outcomes were recorded. RESULTS: A total of 92 patients were enrolled in the study. The mean age was 30+5 years. Forty-seven of the patients were asymptomatic (51%). The most common symptoms were respectively; fatigue (37.8%), fever (27.6%), dyspnea (22%), cough (17.8%), headache (11%), anosmia (4.4%), hyperemesis (4.4%), diarrhea (2.2%). There were 20 patients (21.7%) who were hospitalized. Eight of these women (8.6%) required intensive care unit admission due to COVID pneumonia-related acute respiratory distress syndrome. Five of the patients treated in the intensive care unit died due to respiratory failure. Two patients had a miscarriage before the 20th week. There were four stillbirths. The gestational weeks at which fetal death occurred were 24, 26, 28, and 38 weeks of gestation. There were 19 patients with a history of favipiravir use. There was not any other congenital abnormality due to Favipiravir usage.CONCLUSION: Our study showed that COVID-19 disease has similar symptoms in pregnant women to non-pregnant women, according to the literature data. However, COVID-19 infection increases the rates of pregnancy complications and maternal mortality
OBJECTIVE: We aimed to determine the frequency of psychological distress and related factors in infertile women who underwent assisted reproductive technologies during the COVID-19 pandemic and to develop health policies accordingly. STUDY DESIGN: This cross-sectional study was carried out with 352 infertile women who applied to the in vitro fertilization clinic between December 2020-February 2021. In the face-to-face survey study, five questionnaires were given to all participants: (1) a Questionnaire regarding the socio-demographic/general health characteristics of the patient, (2) Impact of Event Scale-Revised, (3) Beck's Depression Inventory, (4) State-Trait Anxiety Inventory -1, (5) State-Trait Anxiety Inventory-2. RESULTS: Post-traumatic stress disorder was detected in 129 (36.6%) infertile women. In cases of diminished ovarian reserve and oocyte freezing; a significantly higher incidence of post-traumatic stress disorder was found compared to patients with unexplained infertility, polycystic ovary syndrome, and male factor infertility (p=0.004). Minimal-mild depression level was detected in 295 (83.8%) participants, and moderate-severe depression level was found in 57 (16.2%) participants. The mean State-Trait Anxiety Inventory-1 and State-Trait Anxiety Inventory-2 scores of infertile women were 43.5±6.7 and 46.6±6.3, respectively. A statistically significant relationship was found between the duration of infertility and moderate-severe anxiety according to State-Trait Anxiety Inventory-1 (p=0.046). CONCLUSION: Our findings show that women with long-term infertility and undergoing oocyte freezing are the most affected patients by the pandemic. It would be appropriate for in vitro fertilization centers to provide psychological support to patients that have a mentally high risk of distress.
OBJECTIVE: With the nationwide lockdown in India, and with a near-exclusive focus on the novel coronavirus disease (COVID-19) there has been a great deal of neglect in the management of other illnesses leading to significant mortality and morbidity. We aimed to assess the feasibility of keeping obstetrics & gynecology services in a secondary care hospital functioning (in terms of regional experiences and comprehensive patient care measures) in the COVID-19 pandemic situation using a clinical approach. STUDY DESIGN: All policies of the World Health Organization and other international obstetrics- gynecological recommendations or guidelines were followed in keeping the services functional. Hospital data of obstetrics and gynecology services were maintained and compared with the previous year’s data of the corresponding period (January to December) through a retrospective observational study. RESULTS: Compared to figures for 2019, in-patient admissions, surgeries, and daycare procedures performed, and deliveries conducted were reduced in total but almost approached previous levels. The number of out-patient attendance and gynecologic laparoscopic surgeries were significantly reduced mostly in the initial month of lockdown (April 2020) and thereafter. Only limited COVID-19 testing was done and there was no mortality in patients or health care workers (HCW) in the obstetrics and gynecological department. CONCLUSION: COVID-19 pandemic had caused an unprecedented global healthcare crisis. The experience and data collected from our hospital in the study period validate the ‘clinical’ working protocol that enables comprehensive maternity and gynecology care at secondary level care centers even in a pandemic situation without adverse outcomes on patients or the hospital staff.
A transversal section of the fetal thorax in the threevessel view. Thymus diameter (anteroposterior thymus diameter): from the posterior edge of the fetal sternum through the aorta. Thorax diameter (intrathoracic mediastinal diameter): from the posterior edge of the fetal sternum through the anterior edge of the fetal vertebra
OBJECTIVE: To determine the effect of SARS-CoV-2 infection on fetal thymus size by ultrasound. STUDY DESIGN: In this prospective study sonographic fetal thymus size was measured in pregnant women attending our hospital with confirmed SARS-CoV-2 infection by RT-PCR test and age-matched control group. The anteroposterior thymic and the intrathoracic mediastinal diameter was determined in the three-vessel view and their quotient, the thymic-thoracic ratio, was calculated. Results were compared between these two groups. RESULTS: Thirty-six SARS-CoV-2-infected and 47 control group pregnant women were included in this study. Two groups were similar in terms of demographic features and no difference was found for fetal thymus size. CONCLUSION: COVID-19 seems to have no adverse effect on fetal thymus size in mild and moderate patients during the acute phase of the infection.
p> Objective: To introduce an intelligent prenatal screening system, using triple test variables. Study Design: In this study, we have used a backpropagation learning algorithm (a supervised artificial neural network) to develop an intelligent antenatal screening system (heretofore referred as Hacettepe System). Triple test variables were used as input variables, while “Down syndrome” and “non-Down syndrome” fetuses were the output of the algorithm. Unconjugated estriol (E3), beta-human chorionic gonadotropin, and α-feto protein with gestational week and maternal age (triple test) were used as input variables in the training and testing. Multiples of median values of the E3, α-feto protein, and beta-human chorionic gonadotropin were used in this study. The testing group of Hacettepe system consisted of 97 patients who were found to be high-risk (>1/250) during the routine antenatal screening (triple test) and underwent amniocentesis for fetal karyotyping. Results: Amniocentesis was performed in 97 pregnancies with “high-risk” triple test results (>1/250). Fetal karyotyping revealed trisomy 21 in about 9.3% (9/97) of the pregnancies. Our algorithm (Hacettepe System) detected 77.8% (7/9) of Down syndrome cases. Moreover, all of the normal fetal karyotypes were assigned as normal in the Hacettepe System. Conclusion: We have developed an intelligent system using the backpropagation learning algorithm (using triple test variables) to predict trisomy 21.</p
As observed, among the 
p> Objective: The antenatal features of pregnancies affect the incidence of preterm births. This retrospective study from Trakya University of Northwestern Turkey, describes antenatal factors involved in preterm births at 26-32 weeks of pregnancy and compares with those involved in preterm births at 33-36 weeks. Study Design: The records of preterm births at 26-32 weeks (earlier preterm births, n=419) and at 33-36 weeks (later preterm births, n=158) during the years 2002-2010 were reviewed and the demographic, obstetric and medical features were evaluated retrospectively. The data was expressed as numbers and percentages and analyzed by SPSS 20.0. Results: Iron supplementation [OR 0.27 (0.16-0.45), p=<0.001], short cervix [OR 9.12 (2.09-39.73) p=0.003] and infection [OR 2.6 (1.2-5.6) p=0.014] were important factors in the emergence of earlier preterm births which occurred at the rate of 1.4%. Conclusions: Earlier preterm births at 26-32 weeks of pregnancy, which compose an obstetric issue, are associated with several antenatal risk factors such as nutrition, cervical problems and infections in Northwestern Turkey. </p
p>Botryoid rhabdomyosarcoma originating from the cervix is rare among fertile women and constitutes 0.2% of all uterine cancers. A 26-year-old female patient with a cervical polyp presented with a case of sarcoma botryoides. The biopsy specimen confirmed the botryoid sarcoma of the uterine cervix and the patient underwent definitive surgery with lymphadenectomy. Pathology showed negative margins and total extraction of tumor. The tumor was confined to the cervix. The patient is considered group 1A in Intergroup RMS Working Group V (IRSG) criteria and the treatment plan continued with adjuvant vincristine, actinomycin D, cyclophosphamide chemotherapy. In the case of cervical polyps in the fertile age, the specimen must be carefully and histologically examined to rule out genital rabdomyosarcoma. Since the stage is a very important prognostic factor, an early diagnosis is crucial.</p
Pelvic x-ray shows IUD outside the uterus
p>Intrauterine device is one of the most preferred contraceptive methods. Rare complications such as uterine perforation were getting more common due to increased use of intrauterine device and could be seen either with mild manifestations or serious cases like bladder or intestinal damage. A 48-year-old patient who is consulted to our clinic because of a missed copper intrauterine device was presented. The intrauterine device was inserted 28 years ago, detected in pelvis incidentally by x-ray and extracted via laparotomy. Although device has been in abdomen for nearly three decades, we did not see any serious reaction or adhesion during surgery. Management of a patient with intrauterine device should be done carefully and following the instructions before insertion, regular examination at every visit are important.</p
Spontaneous uterine rupture during pregnancy can cause severe complications, even maternal and fetal demise. We report successful management of a spontaneous fundal uterine rupture in a 32 week pregnant who had undergone two previous cesarean sections due to preterm delivery. We explain causes of spontaneous uterine rupture and the management of this rare event in the presented case report.
p> OBJECTIVES: All this study is aimed to evaluate obstetrical and neonatal outcomes among women age 40 years and older. STUDY DESIGN: Among 9962 women who delivered in Mahdia’s hospital between January 2015 and December 2016, 421 women (4.22%) were 40 years old or older at the time of delivery. Our retrospective study included 421 pregnant women aged more than 40 years and 421 controls aged 18-39, stratified to parity. Data were analyzed using Pearson’s χ22 test. RESULTS: The mean age of the case group was 41.32 years and that for the control group was 31.25 years. Preeclampsia and diabetes were the most common pathologies (p=0.01), the mode of delivery was marked by a high rate of cesarean section. The rate of instrumental extractions was not influenced by age. The rate of neonatal admission and 10-minute Apgar Scores<7 were significantly higher in the older group (p<0.05). The rate of abruption placenta, placenta previa, postpartum hemorrhage, and stillbirth were increased in mothers over 40 years but there was no difference statically. CONCLUSION: Based on findings, maternal age over 40 years is associated with a high rate of obstetrical, medical complications and cesarean section deliveries. Better pregnancy monitoring helps to improve this risky situation.</p
p> Objective: To evaluate the impact of psoriasis on pregnancy outcomes. Study Design: Data of pregnant women with chronic plaque psoriasis who were followed up at Hacettepe University Hospital between January 1, 2010 and December 31, 2017 were evaluated. Pregnant women with singleton pregnancies who had chronic plaque psoriasis were included in the study. Patients were divided into two groups based on the clinical course of psoriasis: group 1 (improvement/disease-stable), and group 2 (deterioration). Median maternal age, gravida, parity, gestational week at birth, birthweight, 5th minute APGAR score together with the rates of CS, neonatal intensive care unit (NICU) admission and pregnancy complications (spontaneous abortion, preterm delivery, FGR and preeclampsia) were compared between the groups. Results: There were 29 (61.7%) patients in group 1 and 18 (38.3%) patients in group 2. Mean values for maternal age, gravida and parity were comparable between the groups (p values were 0.32, 0.09 and 0.17, respectively). Median values for gestational week at birth (39.2 vs 36.1, p=0.002), birthweight (3200 vs 2310, p=0.002) and 5th minute APGAR score (9 vs 7, p<0.001) were statistically significantly lower in group 2. Cesarean section (33.3% vs 71.4%, p=0.02), NICU admission (11.1% vs 64.3%, p<0.001) and pregnancy complication rates (p=0.003) were statistically significantly higher in group 2. Frequencies of spontaneous abortion, preterm delivery, FGR and preeclampsia were 6.9%, 10.3%, 3.4% and 3.4% in group 1, and 22.2%, 27.8%, 16.7% and 16.7% in group 2, respectively. Conclusion: Deterioration of psoriasis in pregnancy was associated with adverse obstetric outcome.</p
Design of patients included in the study GW: Gestational weeks, EEG: Early ECHO group, PDA: Patent ductus arteriosus, ECHO:Echocardiography. hsPDA: Hemodynamically significant patent ductus arteriosus.
Objective: Hemodynamically significant patent ductus arteriosus(hsPDA) is resulting in severe mortality and morbidity in infants with extremely low birth weight(ELBW). In our study, we aimed to evaluate the necessity of performing routine echocardiography(ECHO) in the first 72hours in ELBW infants.Study Design:This study was planned retrospectively and observationally.Between June2016 and December2018,36 patients diagnosed with hemodynamically significant PDA(hsPDA) who were hospitalized in the neonatal intensive care unit(NICU),with ≤28Gw or ≤1000g were included in this study.These babies were routinely performed ECHO for PDA between 24-72hours,although they were asymptomatic in the period from June2016 to December2017(n:23).Between January2018 and December2018, patients without PDA symptoms were expected to complete 72hours for routine PDA screening (n:13).The patients were divided into 2 groups as early ECHO group(EEG)(n=23) and late ECHO group (LEG)(n=13).In the presence of at least one of the clinical signs of systemic hypoperfusion and/or pulmonary hyperperfusion, symptomatic PDA was accepted and closure treatment was applied with ibuprofen(n: 23) or paracetamol(n: 5).While the two groups were compared in terms of demographic features,ECHO findings,and the state of taking closure therapy,patients receiving closure therapy were compared in terms of mortality and premature morbidity.Results:The average birth weight of 36 patients was 855.9(± 241.5)g, and the average week of birth was 26.4(± 2.1)Gw.It was observed that the two groups were similar in terms of demographic characteristics.Although the findings of ECHO and treatment rates were similar between the two groups,it was observed that the EEG had earlier closure treatment(p = 0.03). In patients receiving closure treatment, performing early(n:17)and late(n:11) echocardiography showed no statistical difference in the long-term results.Conclusion:Performing early ECHO without symptoms in infants with ELBW may provoke the clinician to give PDA closure treatment earlier. In infants with ELBW,unnecessary closure treatment can be prevented by closely monitoring the symptoms of PDA and performing ECHO when necessary.
p> Objective: The aim of this study was to evaluate the risk factors and outcomes of umbilical cord prolapse Study Design: In this descriptive retrospective study, 94 cases of umbilical cord prolapse between January 2013 and December 2014 in our department were analyzed. Results: 45.166 births occurred in our hospital during the study period, and the prevalence of umbilical cord prolapse was 2.08 (n=94) per 1000 live births, and the perinatal mortality rate was 1.1%. In all pregnant women, the delivery had been performed by emergent caesarean section. The average age, gravida, parity and gestational week of pregnant women were 29.11±6.17, 3.69±2.48, 2.69±2.48 and 37.61±3.17, respectively. Singleton pregnancies were 95.7% (n=90) of all pregnancies and twin pregnancies were 4.3% (n=4). Presentation of the cases were vertex, breech or transverse at 75.5% (n=71), 16% (n=15) and 8.5% (n=8) of all cases respectively. Polyhydramnios complicated 13.8% (n=13) of all cases and average birth weight was 3138.62±759.89 grams. 16% (n=15) of the cases had a birthweight lesser than 2500 gr. 1st and 5th minute APGAR scores were 6.89±2.05 and 8.69±1.39, respectively. The time period between the diagnosis and delivery was demonstrated as 8.24±1.22 minutes. Conclusion: Breech presentation, polyhydramnios, multiple pregnancies and low birth weight are risk factors for umbilical cord prolapse. Shortening the time interval between diagnosis and delivery significantly reduces perinatal mortality. It can be provided at clinics that presenting the appropriate infrastructures for rapid intervention.</p
p> Objective: Obesity is a very common and important health problem and it has become widespread all over the world. Fat tissue is one of the major endocrine organs. Subcutaneous adipose tissue is associated with many diseases such as coronary artery disease, metabolic syndrome, diabetes, impaired lipid profile. Pregnancy is a special condition with metabolic changes involving all systems. We aimed to investigate the relationship and correlation between abdominal fat and HbA1c because of the specific metabolic conditions in pregnancy. Study Design: This is a retrospective study. Ninety-nine (n=99) pregnant women between the ages of 20 and 40 were included in the present study. They have not any other chronic diseases. Ultrasonography was performed between 16.-28. weeks. Abdominal subcutaneous fat tissue was measured during 16-28 weeks of pregnancy. Routine biochemical parameters and HbA1c were evaluated. Results: Subcutaneous fat tissue had a positive correlation with metabolic parameters such as weight and BMI, and a negative correlation with vitamin D level. There is a positive strong correlation with HbA1c level. There was not any correlation between HbA1c and metabolic parameters like triglyceride, LDL, HDL, and cholesterol. Conclusion: There was a strong positive correlation between abdominal subcutaneous fat tissue thickness and HbA1c. However, we didn’t find any correlation between infant weight and metabolic parameters.</p
Marking of the lesion and proposed incision through previous Caesarean section scar. Note the bulging of left lower quadrant of the abdomen
The tumor appearance after the elevation of skin flap&dissection of the external oblique muscle and its aponeurosis
p>Extra-peritoneal leiomyoma is a rare condition with the recognised etiologic factor being direct seeding of the site by a prior uterine surgery with a right metabolic environment. We report a rare case of abdominal wall leiomyoma developing in a fertile woman with no known predisposing factor and highlight the common approach to establish the diagnosis so as to deliver appropriate treatment to the patient.</p
p>This paper describes the perinatal and postnatal outcome of a case considered to have a fetal intra-abdominal extralobar pulmonary sequestration (ELS). Routine midtrimester fetal ultrasonographic scan detected an abdominal echogenic mass between aorta and stomach. It was considered primarily as an intra-abdominal ELS. At postnatal 2 months, computed tomography (CT) scan with intravenous contrast described it as an ELS at the level of diaphragmatic hiatus by showing the aberrant blood supply to the sequestration with venous drainage into the portal confluence. The patient is now 4 years old and asymptomatic; she is being followed-up by a pediatric surgeon. Intra-abdominal ELSs usually remain asymptomatic throughout life; they may be safely observed without surgery unless they become symptomatic or show any change in the characteristics of the radiologic appearance. </p
OBJECTIVE: Aberrant right subclavian artery, which is detected in 1-1.5% of the population, is considered an anatomical variant. Aberrant right subclavian artery is usually not symptomatic, but can sometimes lead to dysphagia due to esophageal compression. On the other hand, it has been found that it has accompanied some fetal anomalies in the last two decades. Although aberrant right subclavian artery is seen at a rate of 1-1.5% in normal chromosomal fetuses, it is seen at a rate of 19-36%, especially in fetuses with Down syndrome. STUDY DESIGN: Our study was carried out in the Department of Obstetrics and Gynaecology at Ankara University Faculty of Medicine between the dates of January 2017-January 2020. Pregnant women have had their detailed ultrasonography at our clinic and who were between 18th-24th gestational weeks were included. Amniocentesis was performed on the patients who have accepted, and genetic results were followed up. The patients who did not accept were followed up until after birth, and genetic testing was requested for babies suggestive of anomaly. RESULTS: Our study included 6205 patients who underwent detailed ultrasonography in our clinic between January 2017 and June 2020. Our detailed ultrasonography application week was between 16-24 weeks. During this period, aberrant right subclavian artery was detected in 47 of our patients. The detection rate of ARSA in the normal population in our study was 0.7% (46/6205). While aberrant right subclavian artery was the only ultrasonographic finding in 28 patients, extra anomalies were observed in 18 patients. Down syndrome was detected in four fetuses, CONCLUSION: We did not find any chromosomal anomalies in any of the patients with isolated aberrant right subclavian artery. Therefore, we do not recommend invasive intervention in patients with isolated aberrant right subclavian artery. On the other hand, our study confirmed that aberrant right subclavian artery screening should be a part of a detailed fetal ultrasonographic examination. Further studies with larger patient groups are needed.
p> Objective: To evaluate the association between abnormal vaginal flora and cytological evidence of HPV with prematurity in high-risk pregnant women. Study design: A prospective cohort study was designed with high-risk pregnant women who delivered singletons between 20-42 gestational weeks between January to November 2018. Vaginal specimens were collected to obtain material from the upper lateral vaginal vault and cervix for direct microscopic examination of vaginal contents and preparation of Gram-stained and pap smear slides. Potential determinants of infection were assessed using the chi-square test. Poisson regression was used to determine the prevalence ratio and 95% confidence interval of the association between the vaginal flora and cytology with prematurity and a p <0.05 was considered as statistical significance. Results: A total of 68 pap smear and high vaginal swab samples were collected from high-risk pregnant women with a mean age of 30.3 years. There were 26 (38.2%) cases of abnormal vaginal flora and 6 (8.8%) of HPV-induced cytological abnormalities. The preterm delivery rate was comparable between women with normal and abnormal vaginal flora (11.9% vs. 11.5%, prevalence ratio 1.0 [95% confidence interval: 0.8-1.2], aPR 1.0 [95% confidence interval: 0.8-1.2]) and between women with and without abnormal cytology (16.7% vs. 11.3%, prevalence ratio 0.9 [95% confidence interval: 0.6-1.4], aPR 0.9 [95% confidence interval: 0.6-1.4]). Conclusions: We determined no association between abnormal cytology or altered vaginal flora in high-risk pregnancy in terms of overall preterm birth rate.</p
p>OBJECTIVE: To investigate the peripheral blood components, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratios (PLR) in cervical cytological abnormalities. STUDY DESIGN: We retrospectively analyzed 185 cases with abnormal and 303 cases with normal cervicovaginal smears (CVS) with blood count profile, from a total number of 9286 patients. RESULTS: Abnormal CVS results consisted of 137 (72%) ASC-US, 16 (8%) ASC-H, 19 (10%) L-SIL, 4 (2%) H-SIL and 9 (4%) AGUS. NLR and PLR of abnormal CVS group were higher than control group (p<0.001). The lymphocyte count was significantly lower in abnormal CVS cases (p<0.001). The number of patients with neutrophilia (neutrophils ≥70% of the total leukocytes) was similar among two groups (p>0.05). CONCLUSION: Neutrophilia is not observed in cervical preinvasive lesions whereas it is common in cervical cancer. In this study, absence of increased neutrophil counts and presence of lymphopenia in patients with abnormal cervical cytology, may indicate an early measure in cervical pathologies.</p
OBJECTIVE: Fetal cerebral ventriculomegaly is defined as enlarged cerebral lateral ventricles. The etiology of fetal cerebral ventriculomegaly is multifactorial. Aneuploidy in ventriculomegaly is detected especially in moderate and severe ventriculomegaly accompanied by structural anomalies. This study aims to evaluate patients with fetal cerebral ventriculomegaly for associated structural and genetic abnormalities and their obstetric and neonatal outcomes. STUDY DESIGN: This retrospective cohort study was conducted at Dokuz Eylul University Faculty of Medicine, Obstetrics and Gynecology Department between January 2009 and December 2019. Eighty-seven cases were included in the study and were evaluated for associated structural abnormalities. The results of genetic diagnostic tests were evaluated retrospectively. Postpartum information of the cases was obtained from the hospital records and neurodevelopmental development of the newborns was recorded. RESULTS: Patients were classified as mild, moderate, and severe ventriculomegaly. Concomitant structural abnormalities were observed in 64% of the patients. Corpus callosum agenesis was the most common abnormality. The incidence of accompanying anomalies in severe ventriculomegaly was found to be significantly higher. Invasive prenatal tests were performed on 27 patients and one of them had a chromosomal abnormality. No significant correlation was observed between the incidence of postpartum neurodevelopmental disorders and the degrees of ventriculomegaly. CONCLUSIONS: Fetal cerebral ventriculomegaly is a dynamic process. The etiology is multifactorial and abnormalities can be detected during follow-up. All patients should be evaluated carefully for associated abnormalities. The cases should also be evaluated for neurodevelopmental outcomes after birth. All diagnosis, follow-up, and treatment options should be handled with a multidisciplinary approach.
Prenatal invasive testing
p>Prenatal screening for chromosomal abnormalities has two components i.e. prenatal screening (maternal serum screening and cell-free fetal DNA screening) and prenatal diagnosis (chorionic villus sampling, amniocentesis, and cordocentesis). Prenatal testing in the past decade is evolving towards non-invasive methods to determine the chromosome abnormality disorders in the fetus without incurring the risk of miscarriage. Conventional tools for prenatal screening included maternal age, maternal serum markers, ultrasound marker (nuchal thickness), and their combinations. With the increased risk of screening test patients were offered diagnostic tests (chorionic villus sampling, amniocentesis, and cordocentesis). After the availability of noninvasive prenatal tests for commercial use in 2011, a great marketing drive is there to establish it as a master tool for prenatal testing. However various society guidelines i.e. ACOG, RCOG, and ISUOG have clearly stated that cell-free fetal DNA based noninvasive prenatal tests is a screening test, not a diagnostic test. In the succeeding paragraph, we will review current trends in the field of cell-free fetal DNA noninvasive prenatal tests and the relevance of invasive testing in the context of noninvasive prenatal tests. Noninvasive prenatal tests does not entirely replace invasive prenatal testing procedures. Positive noninvasive prenatal tests findings must be confirmed by diagnostic tests based on an invasive sample source, mainly chorionic villus sampling or amniocentesis due to false positive and false negative reports of cell-free fetal DNA based tests. Continuing research and development efforts are focused on overriding noninvasive prenatal tests limitations. Recent studies show that procedure-associated risks in the case of prenatal invasive testing are very low as compared to previous studies. Prenatal invasive testing will remain as the backbone of prenatal diagnostic testing until the limitation of noninvasive prenatal tests is overcome.</p
p> OBJECTIVE: The aim of this study was to assess the impact of some oocyte morphological abnormality rates on embryo development and implantation. STUDY DESIGN: Oocyte morphological abnormalities including oocyte size, elliptical shape, vacuole, plain polar body, fragmented polar body, large perivitellin space, perivitellin debris, central granulation, dense central granulation, inclusion body, thick zona pellucida, clusters of smooth endoplasmic reticulum, easy needle insertion and dark cytoplasm were determined for each oocyte. Rates of these oocyte morphological anomalies were determined for each case and the impact of rates on the cycle outcome was analyzed. RESULTS: Similar oocyte morphology abnormality rates were observed between cycles with and without successful embryo implantation. On the other hand, both fragmented polar body and vacuole rates were found to be significantly higher in cycles with Grade 2 embryo transfer. These rate differences were remained significant after adjustment for the age and basal FSH level. CONCLUSION: None of the oocyte morphological features was found to have significant impact on ART outcome. </p
OBJECTIVES: Spontaneous abortion (miscarriage) is a common adverse pregnancy outcome earth-wide, and has remained a challenge in Nigeria. This study aimed at comparing the vaginal microbiome of women who have had episodes of spontaneous abortion with those who have not experienced any incident - in order to find out any possible role of vaginal microbiota in spontaneous abortion. STUDY DESIGN: High vaginal swab samples were collected from the vagina fornix of 6 women of reproductive age, with a history of recurrent spontaneous abortion, as well as those without such history (non-spontaneous abortion). The samples were analyzed and interpreted by standard metagenomic and bioinformatic techniques. RESULTS: The following phyla were encountered in spontaneous abortion and non-spontaneous abortion, respectively: Firmicutes (69.4%, 94.9%), Actinobacteria (12.7%, 1.1%), Bacteroidetes (9.5%, 2.8%), Proteobacteria (7.9%, 0.3%), Chloroflexi (0.2%, 0.0%), Fusobacteria (0.2%, 0.0%), Tenericutes (0.02%, 1.0%). There was more bacterial diversity in spontaneous abortion (H=2.34856) than in Non-spontaneous abortion (H=0.61384), with evenness (EH) of 0.60668 and 0.24703, respectively. On the contrary, Lactobacillus had more relative abundance in non-spontaneous abortion (83%) than spontaneous abortion (23.5%). The following genera (among others) occurred exclusively in spontaneous abortion: Enterococcus (relative abundance=26%), Peptostreptococcus (5.1%), Anaerococcus (2.4%), Dialister (2.1%), Streptococcus (1.9%), Megasphaera (1.3%), Mobiluncus (1.0%), Peptinophilus (0.9%), and Veillonella (0.7%). The efficiency of taxonomic identification, using the operational taxonomic unit clustering method, declined, downstream, from family to species levels. CONCLUSION: Recurrent spontaneous abortion appears to be associated with low vaginal Lactobacillus abundance and high bacterial diversity. We recommend that the current operational taxonomic unit -based sequence taxonomic analysis technique be reviewed.
p> Objective: Threatened abortion is a stressful condition for a pregnant woman which may influence mental health. This study aims to investigate the relationship between threatened abortion, anxiety, and depression during pregnancy. Study Design: Study group consisted of 121 pregnant women <20 weeks of gestation having vaginal bleeding; control group consisted of 129 pregnant women <20 weeks of gestation not having vaginal bleeding in their pregnancy until that time. Hospital anxiety and depression scale was used to assess potential anxiety and depression. Results: Statistical analyses indicated that (i) vaginal bleeding group had significantly higher rates of moderate/ severe anxiety (28.1% vs. 14.7% p=0.010); (ii) there was no statistically significant difference between depression rates of the women according to the presence of vaginal bleeding (38.8% vs. 34.9% p=0.517); (iii) low education (OR=2.233; 95% CI: 1.177-4.236; p=0.014) was possible predictors of antenatal depression. Although in the univariate analyses age, gravidity, and parity were associated with anxiety, only nulliparity was found as possible predictors of anxiety (OR=2.589; 95% CI: 1.362-4.922, p=0.004). Conclusion: Pregnant women without obstetric complications had similar rates of depression and anxiety as in women with threatened abortion, although anxiety levels were higher in women with threatened abortion. </p
OBJECTIVE: Knowing about complications, care sought by women is essential for understanding the risks, services, programs, and policies for abortion care. This study aimed to know the magnitude of abortion complications and to define the care sought by rural tribal women. STUDY DESIGN: Rural community-based cross-sectional study was carried out in villages near Sewagram Wardha and Melghat, Amravati, Maharashtra, India. RESULTS: Spontaneous abortions rate was 3.30% in villages around Sewagram and 0.32% in villages of Melghat. The reported complications rate for induced abortions was 1% in Sewagram villages and 0.1%in Melghat villages. In Sewagram villages, among 24 (4.3%) women who had complications with spontaneous abortions, the reported complications were: vaginal bleeding in 33.3% (1.4% of all spontaneous abortions), abdominal pain in 33.3%, weakness in 29.16% (1.2% all spontaneous abortions), backache in16.6% (0.7%of spontaneous abortions), fever in 12.5%(0.5% of spontaneous abortions), excessive vaginal discharge in 8.33% (0.3% of spontaneous abortions), and other complications in 8.33% (0.36% of spontaneous abortions) women. Among 7 women (3.9% of all 177), who reported complications after induced abortions, 57.1% (2.2% of all induced abortions) reported, vaginal bleeding and 28.5% (1.1% of induced abortions) reported abdominal pain. In Melghat villages only 4 women reported complications with spontaneous abortions (0.32% spontaneous abortions): two (0.16% spontaneous abortions) reported abdominal pain, one (0.08% spontaneous abortions) reported vaginal bleeding, and one (0.08% of spontaneous abortions) reported backache. In villages of Melghat 2 women (3.7%) out of 27 induced abortions cases had complications: one had vaginal bleeding, discharge, pain, weakness, another only vaginal bleeding. In villages of Melghat 2 of the total 6 sought health facility care, however, no one reported to specialists despite complications. Nevertheless, there was neither abortion-related mortality nor near-miss morbidity or severe morbidity during the same duration. CONCLUSION: Research is needed about traditional therapies, reverse pharmacology, socio-behavioral issues in addition to creating awareness in women about abortion complications, long-term squeal, and the necessity of care-seeking.
OBJECTIVES: The World Health Organization recommends feticide for termination of pregnancy after 20 weeks of gestation, and the Royal College of Obstetricians & Gynecologists after 21 weeks and 6 days. Digoxin is a commonly used feticidal agent. This retrospective study aimed to show the effect of different doses of digoxin on the timing of fetal demise when used for feticide. STUDY DESIGN: Our retrospective cohort study included 57 patients who underwent feticide by routine intra-amniotic digoxin 0.75 mg or 1 mg between 2016 and 2018 at the Ataturk University Medical Faculty Research Hospital. The patients were administered undiluted digoxin 0.75 mg (3 ccs) or 1 mg (4 ccs) with a 20-gauge spinal needle inserted through the amniotic membrane. After digoxin administration, the fetal heartbeat was monitored every hour by ultrasound, and recorded. RESULTS: In this retrospective study, we reviewed the data of 61 patients who underwent feticide by intra-amniotic digoxin 0.75 mg and 1 mg. Digoxin 3 ccs (n=23) and digoxin 4 ccs (n=34). The two groups were not significantly different in terms of age, gestational week, and termination indications. We reviewed the medical records of all subjects and noted any side effects. CONCLUSIONS: In our study, we investigated the effect of different doses of intra-amniotic digoxin on the fetal demise in accordance with the literature. Despite our small sample size, we conclude that a higher dose of digoxin will reduce the time to asystole and minimize the mental burden of the procedure on the patient.
p> Objectıve: Tubo-ovarian abscess is mostly a consequence of pelvic inflammatory disease. We aimed to compare success of the different surgical methods in tubo-ovarian abscess treatment. Study Design: 53 patients with Tubo-ovarian abscess that were hospitalized and operated in the Department of Obstetrics and Gynecology at Kanuni Sultan Suleyman Training and Research Hospital during one year were included. Patients who had underwent salpingectomy/salpingo-oophorectomy and only abscess drainage were compared. Results: Salpingectomy/salpingo-oophorectomy had been done in 74.5% of cases and only drainage had been applied in 25.5% of cases. Difference in mean values between 2 groups were not observed except white blood cell count. Conclusıon: Treatment of Tubo-ovarian abscess must be a combination of parenteral antibiotics and early surgical procedure to prevent poor outcomes. There is not any difference between different surgical techniques. But additionally more studies are needed to better understand which operation technique is more effective and less complicated.</p
p> OBJECTIVE : To evaluate results of patients with conservative management of tuboovarian abscess (TOA). STUDY DESIGN: A retrospective cohort study of women with TOA. Between January 2012 and February 2015, all women that hospitalized with diagnosis of TOA enrolled in this study. Cases were analyzed with respect to age, parity, medical conditions, history of intra-uterine device use, size of TOA, C-reactive protein (CRP) levels, white blood cell (WBC) count, CA-125 levels, antibiotic usage, hospitalization period. RESULTS: Thirty-nine patients with TOA included in to this study. Mean age was 38.2 ± 11.5 years. Mean size of TOA was 5. 7 ± 2.1 cm. In comparison between patients with abscesses ≤ 6cm or >6cm, TOA size is not associated with important outcomes including duration of antibiotherapy and duration of hospitalization. CONCLUSION: Women with TOAs should be admitted to the hospital and immediately started in parenteral antibiotics. Due to high levels of success with antibiotherapy, immediate surgical management should always be performed in cases of rupture.</p
Laparoscopic view of the uterus and bilateral adnexal masses with obliterative cul-de-sac from extensive adhesions at the rectum
The gross specimen showed a right tubo-ovarian abscess, a left mature teratoma, and normal uterine cervix
The case is a 44-year-old-female who presented with right lower abdominal pain without fever or leukocytosis. She had previous mechanical valve replacement with taking warfarin for last ten months from the diagnoses of infective endocarditis. The ultrasonography showed bilateral complex ovarian mass. At laparoscopy, the patient had a right tubo-ovarian abscess and a left mature teratoma with extensive adhesions to the rectum. A case illustrates an uncommon premenopausal age with right tuboovarian abscess and left mature teratoma. The laparoscopic surgery is an excellent benefit for quicker recovery time, smaller incisions, less post-operative pain, and especially of a few infections that will affect to underlying disease of the patient.
  • Tayfun VuralTayfun Vural
  • Burak BayraktarBurak Bayraktar
  • Suna Yildirim KaracaSuna Yildirim Karaca
  • [...]
  • Cuneyt Eftal TanerCuneyt Eftal Taner
OBJECTIVES: In this study, we aimed to determine the risk factors in predicting the need for surgical treatment due to medical treatment failure in patients with tubo-ovarian abscess. STUDY DESIGN: This is a retrospective cohort study performed in a university hospital between 2015 and 2020. Sixty-nine patients with tubo-ovarian abscess were treated with parenteral antibiotics. Some of them required surgery because antibiotic treatment was not successful. We compared the group in which parenteral antibiotic treatment was successful with the group that required surgical treatment. The conservative treatment group consisted of 43 (62.3%) patients who responded to antibiotic therapy alone (gentamicin-clindamycin), and the operation group consisted of 26 women (37.7%) who did not reply to antibiotic therapy and required operation. Demographic, clinical, sonographic, and laboratory results were compared between the two groups using univariate and logistic regression analyses. RESULTS: Overall, up to 37.7% (26/69) of the patients underwent surgery after failure of antibiotic therapy. Patients who failed antibiotic therapy had higher infection parameters such as C-reactive protein (205±109 mg/dL vs. 115 ± 90 mg/dL, p=0.002), platelet count (349 ± 108 x 103/mm3 vs. 298 ± 95 x 103/mm3, p=0.042), and neutrophil-to-lymphocyte ratio (18.8 ± 35.7 vs. 8.2 ± 6.9, p=0.022). Also in the same group, larger tubo-ovarian abscess size (61.6±16.6 mm vs 45.8 ± 10.3 mm, p<0.001) and more frequent intrauterine device use (46.2% vs 16.3%, p=0.007) were observed. But none of them (C-reactive protein, neutrophil-to-lymphocyte ratio, tubo-ovarian abscess size, presence of an intrauterine device) was found to be a significant independent factor in anticipating conservative treatment failure of tubo-ovarian abscess in logistic regression analysis. CONCLUSION: Although helpful in diagnosis, none of the demographic, sonographic, or laboratory parameters can predict surgical treatment in women with tubo-ovarian abscess.
p>Opioid abuse during pregnancy is increasing in women of childbearing age in Turkey. The frequency of clinical signs of withdrawal in infants who exposed to heroin in utero are varying between 16-90%. Here, we present five newborn infants presenting with neonatal abstinence syndrome who were hospitalized in Neonatal Intensive Care Unit of Mersin Maternity and Children’s Hospital. All of the five infants were symptomatic including irritability, tremors, high-pitched cry, excessive sucking and seizure. Hyperirritability was the predominant sign. Seizure was observed two of the five infants which clinically presented between 1st-5th day of life and was controlled with phenobarbital. We have experienced seizure due to withdrawal of opioid more than the past reports and we thought that interrupting breastfeeding may facilitate seizure. Breastfeeding may slow down the decrease of opioid level in blood and may reduce the symptoms. In conclusion, opioid abuse in pregnancy is a growing sociological problem in Turkey and a protocol for management is required for neonatologists.</p
p>Objective: The aim of the present study is to provide a retrospective evaluation of placenta accreta cases to identify the factors affecting the blood transfusion requirement, which stands as one of the most important causes of maternal mortality and morbidity. study desıgn: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included in this study. The patients’ data were collected from the hospital’s records. Results: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The group of patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and the blood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007). Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates. </p
Hysteroscopic chromotubation, the observation of the flow of the highly concentrated methylene blue via tubal ostium (test positive) with an interval of one second (a), (b), (c). View of negative test (Where there was no passage of the highly concentrated methylene blue) 
p> Objective The aim of this study was to evaluate the diagnostic accuracy of hysteroscopic chromopertubation (HCT) in the assessment of tubal patency by comparing its results with laparoscopic chromopertubation (LCT). Study Design The population of this prospective cohort study consisted of both fertile and infertile women. Sixty-four women were included to the study. HCT was assessed by the observation of the transport of highly concentrated methylene blue from uterine cavity to tubal ostia. The results of HCT were compared with the results of LCT as a gold standard. The accuracy of HCT, sensitivity, specificity, positive and negative predictive values in diagnosing tubal patency were calculated. Results The results of HCT and LCT were evaluated for right and left tubes, separately. One hundred and twenty-eight tubes were determined. Sensitivity, specificity, positive and negative predictive values for HCT were; 85.85%, 59.09%, 91% and 46.43%, respectively. Conclusion This study’s result showed that HCT had high sensitivity and moderate specificity values in the assessment of tubal patency. HCT during office hysteroscopy could give the chance to practitioners to assess tubal patency without subjecting the patient to multiple procedures. </p
Objective: To investigate the accuracy of fetal weight estimation made by the last prenatal ultrasound measurement in low birth weight newborns (<2500 g). Study Design: A total of 1082 women were evaluated in this retrospective cohort study. Demographic and clinical information of the mother and newborn and obstetric ultrasonography measurements and findings performed in the last week before birth were recorded. Accuracy of fetal weight estimation and parameters affecting it was investigated. Results: Accurate estimation rates were lower in the term compared to the preterm delivery group; and in the SGA group compared to the AGA group (respectively, p=0.016, p=0.032). Accurate estimation rates (p=0.182) were comparable between the 500-1500 g and 1501-2500 g subgroups. The multiple linear regression analysis showed that gestational age at birth, birth weight, examination during labor, and duration between examination to delivery were statistically significant for the accurate estimation(p=0.001) Conclusions: Accurate estimation rates were lower in the term compared to the preterm delivery group, and in the SGA group compared to the AGA group. The factors affecting accurate estimation were found to be gestational age at birth, birth weight, examination during labor, and duration between examination to delivery.Keywords: Accurate estimation rate, Duration between examination to delivery, Examination during
p> Objective: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). Study Design: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. Results: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. Conclusion: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.</p
p> OBJECTIVE : Abnormal uterine bleeding which is the most frequent complaint among pre- and postmenopausal women should be investigated to rule out endometrial cancer. An intra-operative frozen section can be taken to examine the suspicious of the malignancy. The study aims to investigate the accuracy of frozen section in suspicious of endometrial malignancy. STUDY DESIGN: Fifty patients with pre-malign endometrial pathology and malignant ultrasound characteristics were included in this study and their preoperative biopsy, frozen and postoperative pathological results were examined. RESULTS: The kappa coefficient between postoperative pathology and frozen section was 0.88 (p<0.05) and 95% confidence interval was (0.63-1.12). This indicates that the amount of agreement between the two tests was strong, thus the frozen section would be considered as a valid indicator of postoperative pathology results. CONCLUSIONS: Frozen section is a valuable method to investigate the suspicious of malignancy in endometrial pre-malign lesions.</p
OBJECTIVE: To determine the factors indicating the accuracy of fetal weight estimation in the last prenatal ultrasonography before delivery in preterm newborns with normal amniotic fluid volume.STUDY DESIGN: Three hundred and seventy-one singleton pregnancies with normal amniotic fluid volume and delivered at between 24+0 and 37+0 gestational weeks were evaluated in a retrospective study. Any possible associations between the absolute percentage error of fetal weight estimations and the maternal and fetal data were examined.RESULTS: In 135 of the 371 women (36%), the absolute percentage error was greater than 10%. The mean absolute percentage error was 8.7±7.5%. The mean absolute percentage errors were 4.1±2.7% and 16.8±6.4% in the accurate and inaccurate estimation groups, respectively.The rate of women examined during labor was significantly higher in the inaccurate estimation group compared to the accurate estimation group. There were no significant differences in age, body-mass-index, gestational age at delivery, estimated-fetal-weight, actual birth weight, days from the last ultrasound examination to delivery, small for gestational age rate, placenta localization or fetal presentation between the two groups. Examination during labor (β=0.224) was the most important factor for the prediction of the absolute percentage error, followed by gestational age at delivery (β=–0.198), presence of (β=–0.158), and body-mass-index (β=0.142).CONCLUSION: In 36% of our study population, the absolute percentage error was >10%. Examination during labor was the most important factor for the prediction of the absolute percentage error, followed by gestational age at delivery, presence of small for gestational age, and body-mass-index.
OBJECTIVE: The aim of this study is to evaluate the outcomes of gonadotropin-releasing hormone agonist treatment for ovarian cysts, which are developed during tamoxifen use due to breast cancer. STUDY DESIGN: This was a retrospective cohort study including the patients who were under tamoxifen treatment due to stage I-III breast cancer and who were administered leuprolide acetate for ovarian cysts with low malignancy risk between 2012-2020. RESULTS: Leuprolide acetate was administered to a total of 16 patients with ovarian cysts. The median age was 39.5 (33-52), the median size of the ovarian cyst was 42.5 (39-79) mm, and the median duration of tamoxifen use was 22 (7-36) months. Leuprolide acetate was administered at doses of 3.75 mg for 1 month at 10 (62.5%) patients, 7.5 mg in two months at 3 (18.75%) patients, and 11.25 mg in three months at 3 (18.75%) patients. Ovarian cysts were regressed after treatment at 13 patients, while 3 patients underwent surgery. CONCLUSION: Leuprolide acetate can be used as an option in the treatment of ovarian cysts that develop in breast cancer patients under tamoxifen therapy. Keywords: Breast neoplasms, Gonadotropin-releasing hormone, Ovary, Ovarian cyst, Tamoxifen
Study protocol
Clinical characteristics of study population and comparison of three groups.
p> Objective: Meconium ileus of preterm infant is a kind of intestinal obstruction. There is no standard medical treatment of meconium ileus of preterm infant. Study Design: During the study period, preterm infants under 1250 g and have clinical signs of meconium obstruction were retrospectively included in the study. In the first two days, rectal saline and metoclopramide started and if not respond these infants assigned to receive oral or rectal n-acetyl cysteine and control group remained to receive a saline enema. Results: One hundred and twenty-one infants were included in the study. Thirty-four of them received oral n-acetyl cysteine (group 1) and fifty-two had treated with rectal n-acetyl cysteine (group 2), thirty-five of them served as a control group (group 3). The mean gestational ages were 28, 28, 27 weeks and birthweights were 942, 1010, 965 grams for group 1 & 2 & 3 respectively. There was a difference between groups for reaching full enteral feedings (13 ±2, 13 ±3, 15±3, group 1 & 2 & 3 respectively, p=0.001). Conclusion: According to this study, it can be stated that orally administered n-acetyl cysteine is tolerable and as effective as rectal n-acetyl cysteine when used for MIPI.</p
PPolycystic ovary syndrome is the most common endocrine abnormality that affects reproductive-aged women. Diagnostic criteria of polycystic ovary syndrome have been established by different societies in recent years, and hyperandrogenism remains as one of the main criteria for diagnosis. Cutaneous manifestations of hyperandrogenism include hirsutism, acne and androgenic alopecia and are commonly observed in women with polycystic ovary syndrome. The major determinants of cutaneous manifestations are increased production of androgen and increased tissue availability. Cutaneous manifestations of hyperandrogenism are cosmetic problems, which produce significant emotional distress and psychological morbidity. Treatment includes a combination of combined oral contraceptives, antiandrogens, insulin sensitizers, gonadotropin releasing hormone agonists, topical medications, and cosmetic procedures. The diagnosis, management, and treatment approaches are described in detail in this review.
A 21-year-old primigravid pregnant woman of 33 gestational weeks applied to our Perinatology Clinic with acute abdominal pain. The pain was spreading from the midline to the right lower quadrant of the abdomen. Guarding and rebound tenderness existed in the right lower quadrant. An ultrasonographic examination revealed a single alive fetus and normal amniotic fluid. A whole blood count revealed leukocytosis and there were no signs of preterm labor or placental abruption. Fetal heart rate decelerations in a non-stress test were observed, and a decision for cesarean section and abdominal exploration were made. A healthy male baby of 2,500 grams was delivered. In the abdominal exploration, all peritoneal surfaces were coated with a dark red- to brown-colored dense material, like mud. There were two endometriotic cysts in the left ovary; one had a 6-cm mean diameter and was ruptured, while the other was intact and had a mean diameter of 2–3 cm. Both cysts were excised and sent for pathologic examination. The patient had no postoperative problems over two days and was discharged. The final pathologic diagnosis was endometriotic cysts.
p>We report a case of 72-year-old woman who was hospitalized with vaginal bleeding and abdominal pain. Magnetic resonance imaging showed tumor both in endometrial cavity and ovaries with multiple distant metastasis. Her serum alpha-fetoprotein level was >54000 ng/mL. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy, appendectomy, bilateral pelvic and paraaortic lymph node dissection, a 20 cm ileal resection with ileal anastomosis, metastasectomy were performed and peritoneal washing was obtained. The pathologic diagnosis was endometrial hepatoid adenocarcinoma. Because of her poor medical condition, she received only palliative chemotherapy. After two days of 5-fluorouracil she died within 2 months. Hepatoid adenocarcinomas are extrahepatic neoplasms that exhibit features of hepatocellular carcinoma. It was first reported as gastric neoplasm but is seen in many different organs and its frequency is increasing. To date only 11 cases of hepatoid adenocarcinoma of the endometrium were reported. It has a poor prognosis and there isn’t an effective treatment yet.</p
Top-cited authors
Mehmet Şükrü Budak
  • Health sciences university
Sedat Akgöl
  • Istanbul Sehir University
Madhusudan Dey
  • Armed Forces Medical College
Devendra Arora
  • Armed Forces Medical College
Sanjay Singh
  • Army College of Medical Sciences