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Background We aimed to investigate the impact of adopting an uterine manipulator (UM) on the postoperative (VL) and female sexual function index (FSFI) in patients undergoing abdominal hysterectomy (AH) for benign gynecological disease. Materials and Methods Hysterectomies were performed with the Richardson technique; two variations, a UM or digital guidance, in this technique were used during the colpotomy step. Subjects were randomized and allocated to either hysterectomy with UM guidance (study group) or conventional hysterectomy (control group). Pre- and postoperative VL and FSFI were recorded for each patient. Additionally, surgeons’ and residents’ satisfaction in locating the colpotomy site was also scored by the surgical team postoperatively. Results There was a significant reduction in the VL (10.2 ± 1.2 cm vs. 8.3 ± 0.7 cm, p

Objectives: The extraperitoneal uterosacral ligament suspension (ULS) can be performed during the removal of the uterus in vaginal hysterectomy to prevent cuff prolapse. In this study, we evaluated the modified extraperitoneal ULS technique in terms of preventing cuff prolapse. Methods/Technique: Forty patients with second and third-stage uterine prolapse who were operated were included in the study. During routine vaginal hysterectomy procedure performed on patients, after sacrouterine ligaments which are the first-bites and uteroovarian and round ligaments which are the last-bites have been sutured and knotted, these ligaments were marked with 4-distinct clamps to make the right and left, upper and lower separation. After vaginal cuff was closed the sutures hanged by the clamps were ligated together, and the cuff tissue was stretched to the apical line. Results: According to the POP-Q classification, 22 patients with stage-2 and 18 patients with stage-3 prolapse were operated. During the 2-year follow-up; 4 patients could not be reached and were excluded from follow-up. Five of the remaining 36 patients (13.8%) found to have stage-1 cuff prolapse and 31 (86.1%) of patients had no prolapse. There was no significant decrease in postoperative vaginal length (p 0.05). The PISQ-12 sexual function scores was found similar before and after surgery (p 0.05). Conclusions: The extraperitoneal ULS is a successful method to prevent cuff prolapse after hysterectomy. Although there are various modified forms of this method, the modified ULS, which we have described as the 4-clamp method, seems to be successful in terms of initial results.

Objective: We aimed to investigate the effect of acupuncture performed as an adjuvant therapy to in vitro fertilization, on pregnancy rates by performing acupuncture on the day of embryo transfer, one hour before the procedure and one hour after the procedure. Study Design: In this open-label randomized prospective controlled study, 60 unexplained infertility patients enrolled for in vitro fertilization treatment were randomized by a computer-based number generator for acupuncture performance and no-treatment. All patients received rFSH (Gonal-F®) for ovulation induction and the antagonist Cetrorelix (Cetrotide®) to prevent premature ovulation. Ovulation was triggered by using hCG (Ovitrelle®) and egg collection was done after 36-48 hours. In the study group, acupuncture was performed by intradermal needling, bilaterally with a sterile needle, both one hour before and one hour after the embryo transfer. Acupuncture was not performed on the control group. The results of the treatment were evaluated 12 days after embryo transfer. Results: Thirty patients were randomized into the study group and 30 patients were randomly placed in the control group. Although there was no statistically significant difference between groups in terms of β-hCG positivity, it was 43.3% in the study group and 36.7% in the control group (p>0.05). Conclusion: The success rate of in vitro fertilization was higher in terms of pregnancy rate in the patient group who received acupuncture procedure as well, but the difference was not statistically significant. This may be due to the type of acupuncture procedure selected or insufficient sample size. As a result, further studies involving larger numbers of participants and using different acupuncture techniques are needed.

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.

Objective: We aimed to compare the levels of plasma zonulin, a non-invasive biomarker of increased intestinal permeability, between pregnant subjects, with and without gestational diabetes mellitus (GDM), at 24–28 gestational weeks. The eighty-five consecutive pregnant subjects that presented to our hospital’s obstetrics outpatient clinic and were diagnosed with GDM, for the first time by an oral glucose tolerance test (OGTT), formed the GDM group; 90 consecutive subjects that were not diagnosed with GDM by OGTT, formed the control group. The diagnosis of GDM was made by an OGTT performed between the 24th and 28th weeks of gestation, and in compliance with the American Diabetes Association (ADA) criteria. Plasma zonulin levels were measured by the enzyme-linked immunosorbent assay (ELISA) methods. The Plasma zonulin level was significantly higher in the GDM group than the control group (p < 0.001). A correlation analysis showed that plasma zonulin level was positively correlated to body mass index (BMI), creatinine, fasting plasma glucose, baseline, first hour, and two hours glucose levels and the OGTT, hemoglobin A1C (HbA1C), homeostatic model assessment for insulin resistance (HOMA-IR), and alanine aminotransferase (ALT) levels. Our findings suggest that zonulin may be a non-invasive biomarker involved in the pathogenesis of GDM. Further large-scale studies are needed on this subject.

Objective: We aimed to compare the maternal and neonatal complications in women who had undergone fourth or more cesarean section with to women who had undergone second or third cesarean section. Study Design: 162 women who had four or more cesarean section (study group) and 228 women who had undergone second or third cesarean section (control group) were reviewed retrospectively. Demographic features, obstetric, intraoperative, postpartum and neonatal complications were determined in both groups. Results: The preoperative hematocrit values were lower in study group (35.63.6) than the control group (36.64.3), (p

OBJECTIVE: In this study, our objective was to assess the pain scores using the Visual Analogue Scale (VAS) in patients who were given tramadol prior to office hysteroscopy in order to demonstrate its analgesic activity when given before this procedure. STUDY DESIGN: This prospective study conducted in year 2015 included two group of patients undergoing office hysteroscopy that were defined on the basis of the type of analgesia. Patients in the first group (Group 1, n=44) received oral tramadol prior to the procedure, while patients in the other group (Group 2, n=44) received placebo. VAS scores were determined during (0 minutes) and after (15 minutes) the procedure. RESULTS: There were no significant differences between groups in terms of age, parity and body mass index (p>0.05). Comparison of VAS scores at 0 and 15 minutes, lower values were observed in tramadol patients at 0 minutes (p0.05). CONCLUSION: Although oral tramadol given prior to office hysteroscopy was effective and safe in reducing pain during the procedure, it is not useful for the pain that occurs after processing.

OBJECTIVE: The aim of the study was to determine whether it is possible to differentiate submucosal fibroids before interventional procedures based on mean platelet volume (MPV), in reproductive-age patients presenting with endometrial thickening and abnormal uterine bleeding. STUDY DESIGN: This study included 581 reproductive-age women who underwent diagnostic procedures (curettage or operative hysteroscopy) and were subsequently divided into two groups based on clinico-pathological findings. The first group included those with benign endometrial pathology (control group, n=438), and the second group consisted of those with submucosal leiomyomas (n=143). The demographic characteristics and complete blood count (CBC) data of these patients were collected retrospectively, and comparisons were made between groups. RESULTS: No statistically significant difference was found between the groups according to demographic features and CBC parameters such as hemoglobin levels and white blood count (p>0,05). Platelet counts were significantly higher and MPV values were significantly lower in submucosal leiomyoma patients compared with the control subjects (p

OBJECTIVE: In the present study, we aimed to assess and compare the utility of complete blood count (CBC) parameters and C-reactive protein (CRP) in the diagnosis of pelvic inflammatory disease (PID). STUDY DESIGN: Sixty-six patients diagnosed with PID, and 200 healthy control subjects were included in this case-control study. The groups were compared in terms of demographic properties such as age, parity, body mass index (BMI), hemoglobin value, neutrophil count, platelet count, neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) and CRP. RESULTS: The groups were similar in terms of age, parity, BMI, hemoglobin and platelet count values (p>0.05). Neutrophil counts, CRP values, NLR and PLR were significantly higher and the MPV values were significantly lower in the study group (p

OBJECTIVE: In this study, we tried to compare the efficacies of laparoscopic salpingostomy and medication with a single dose of Methotrexate (50mg/m2) in ectopic pregnancy to determine the differences between the two methods in terms of treatment outcomes. STUDY DESIGN: In this study, 64 patients with ectopic pregnancy who had been administered an MTX therapy between August 2007 and July 2010 (Group A) were compared with another 64 patients with matching ages who had undergone a laparoscopic salpingostomy (Group B). The two groups were compared in terms of age, gravida, parity, initial hCG value, hCG measured at the time of being discharged from the hospital, hCG values checked a week later and the number of hospitalization days. The number of repeating doses and the rate of undergoing a laparoscopy salpingostomy were calculated in patients receiving MTX. RESULTS: The hCG values of the patients in the MTX and laparoscopy groups respectively were as follows: Initial hCG measurement; 670.5±1027.5 vs. 5511.3± 7293.0 (p=0.0001), hCG measured at the time of discharge; 352.3±627.0 vs. 869.7±599.1 (p=0.016), and hCG value after a week; 292.5±617.4 vs 864.1±1531.8 (p=0.023). The difference in the number of hospitalization days between the two groups came out to be significant; 2.4±4.2 for the MTX group and 1.3±1.6 for the laparoscopy group with p=0.01. Repetition of the dose became necessary in 14.1% (9/64) of the patients receiving medical treatment (MTX) as their hCG values did not decrease. Success was achieved in treating 4.7% (6/64) of these patients after the second dose and the rate of undergoing a laparoscopic salpingostomy due to MTX failure was calculated to be 4.6%. CONCLUSION: We found in this study that MTX used as a medical treatment in ectopic pregnancy was as successful as a laparoscopic salpingostomy. MTX failure can be minimized by firmly determining the criteria for the patients who will be given a medical treatment.