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Objective: To present the outcomes of patients treated at a tertiary center for a diagnosis of genitourinary fistula secondary to gynecological and obstetric etiologies.Study Design: In this retrospective study, analysis was made of 18 patients with a diagnosis of genitourinary fistula in a tertiary center between January 2006 and June 2016. Patient data were taken from the archives and patient histories. A record was made of examinations, diagnostic methods such as cystoscopy and fistulography and appropriate medical treatments, demographic data, intraoperative and post-operative complications, duration of hospital stay, surgical operations and types, diameter and location of fistulas.Results: Of the 18 cases, 14 were secondary to obstetric trauma. In 10 of these 14 cases, fistula had developed after difficult vaginal delivery and in four cases, after caesarean section. Four of the 18 cases were secondary to gynecological surgeries, namely hysterectomy and cystocele repairs. Vesicovaginal fistulas were repaired transvaginally while vesicouterine fistulas and bilateral ureterovaginal fistulas were repaired transabdominally. The mean hospital stay was 3.8±1.5 days (2-7 days). Patients were followed up closely in the first 3 months and recurrence developed in only one case.Conclusion: Fistulas secondary to gynecological procedures are uncommon while fistulas secondary to inadequate perineal care, insufficient labor monitoring and difficulties in vaginal delivery techniques are more prevalent in Turkey. Thorough evaluation, using all diagnostic tools for complete diagnosis, understanding the pathophysiology and choosing the best surgical procedure are mandatory to obtain good outcomes after the surgical

Objectives: We aimed to present urinary tract injuries occurring during obstetric and gynecological operations and their clinical consequences. Methods: Twenty-three patients had urological organ injury during obstetric and gynecological operations in a tertiary care center between January 2010 and June 2016, were analyzed retrospectively. Etiologies, type of injury, diagnostic process, treatment methods and complications of urologic injuries and success rate have been investigated. Injuries were categorized into two groups as intra-operative early injuries and post-op late injuries. Early injuries were laceration, rupture, ligation and late injuries were hydronephrosis, contrast material leakage or fistula. Results: Eight patients were diagnosed during operation period or post-op early period and 15 patients who were referred from other hospitals. Thirteen of the injuries were gynecologic and 10 of them were obstetric. Mean age of operated patients was 34.2±9.4 (23-65) years. Ureteral injury and bladder injury was detected respectively in six and two patients getting early diagnosis. Fistula (5/15), hydronephrosis secondary to urethral stricture (3/15) and vaginal erosion (3/15) were detected as late diagnosed injuries. In a patient whom ureter was ligated non-functioning kidney has developed. Conclusions: To reduce rate of urinary system injuries a sound knowledge of anatomy is required and corrected surgical techniques should be used. Early diagnosis and therapy may prevent complications and loss of organs that may lead to morbidity.

Clomiphene citrate (CC) has some negative effects on the endometrium. We aimed to determine the effect of vaginally administered local estrogen (LE) on endometrial thickness (ET) and pregnancy rates in CC stimulated cycles.This was a prospective randomized crossover study that took place in a university hospital. The patients had received CC due to unexplained infertility (UI). Two different treatment protocols were given sequentially as, either CC+LE or CC alone. Each protocol was planned for two cycles and there was a one-month wash-out period between protocols. The effects of LE on the 3(rd) and 9(th) day, the ovulation day (OD) and 7(th) postovulation day (POD7) were investigated.A total of 6 pregnancies were achieved with 3 patients from each protocol. The ET was 7.6±1.4 mm and 8.3±2.1 mm respectively and significantly different in the CC group and the CC+E2 groups on the OD (p=.039), while these values were 9.7±2.3 mm and 10.9±3.0 mm respectively and significantly different on the POD7 (p=.007). There was no significant difference between the groups for arterial PI values on the OD and POD7. The frequency of thin endometrium (6 mm) was 15.2% and 12.2% respectively in the CC group and the CC+E2 group on the OD (p=.628) and 5.1% and 1.2% respectively on the POD7 (p=.182).Adding vaginal LE to CC stimulated cycles led to a significant increase in ET on the OD and POD7. However, this difference in thickness was not reflected in the pregnancy rates in this study.Klomifen sitrat (CC)’ın endometrium üzerinde bazı olumsuz etkileri vardır. CC ile uyarılmış sikluslara vajinal yoldan uygulanan lokal östrojen (LE)’nin endometrial kalınlık (ET) ve gebelik oranları üzerine etkisini belirlemeyi amaçladık.Üniversite hastanesinde gerçekleştirilen prospektif randomize çapraz karşılaştırmalı bir çalışmadır. Hastalar açıklanamayan infertilite (UI) nedeniyle CC aldılar. İki farklı tedavi protokolü ardışık olarak ya CC+LE ya da tek başına CC verildi. Her protokol iki siklus olarak planlandı ve protokoller arasında bir ay kadar yıkama için bekleme süresi bırakıldı. LE’nin etkileri 3. gün, 9. gün, yumurtlama günü (OD) ve yumurtlama sonrası 7. gün (POD7) incelendi.Her protokolde 3’er olmak üzere toplam 6 gebelik elde edildi. CC grubu ve CC+E2 grubunda ET sırasıyla 7.6±1.4 mm ve 8.3±2.1 mm OD anlamlı farklı (p=.039) iken, bu değerler POD7 sırasıyla 9.7±2.3 mm ve 10.9±3.0 mm yine anlamlı farklı idi (p=.007). OD ve POD7 arteriyel PI değerleri için gruplar arasında anlamlı fark yoktu. İnce endometrium (6 mm) sıklığı CC grubu ve CC+E2 gruplarında sırasıyla OD %15.2 ve %12.2 (p=.628) ve POD7 %5.1 ve %1.2 (p=.182) idi.CC ile uyarılan sikluslara vajinal yolla LE eklenmesi OD ve POD7’de ET için anlamlı artış sağlamıştır. Ancak ET artışı bu çalışmada gebelik oranlarına yansımamıştır.

Aim: The aim of our study, to evaluate the patients with complete or incomplete uterine rupture which occurred during pregnancy retrospectively and to analyze and present of the risk factors, maternal and perinatal outcomes, and complications. Method: Sixty one patients diagnosed as uterine rupture were investigated retrospectively in our clinic between 1999 and 2009. Result: The incidence of uterine rupture for our department in a ten year period was calculated as 0.12 %. Fifty four patients (88.5%) were in low socioeconomic status. Fifty one (83.6%) patients did not receive any antenatal care. Forty eight (78.6%) of the cases had previous ute rine surgery due to cesarean, myomectomy or metroplasty. Twenty six cases (42.6%) were grand multiparous. Primer repair of uterus was performed in 58 (95.1%) of the patients. Subtotal abdominal hyste rectomy was performed in three patients (4.9%). There were 15 fetal deaths while no maternal death was occurred. Conclusion: Rupture of the pregnant uterus is a major obstetric comp lication that occurs often with no warning signs. Uterine rupture is a potential complication for patients with non-scarred uterus as well as scarred uterus. Grand multiparty is a very important risk factor, especially in patients without uterine scar. Despite to its low rate, uterine rupture is a very important complication for mother and fetus. Early diagnosis, immediate preoperative resuscitation, rapid replacement of blood loss, and urge surgical therapy are very important in treatment of uterine rupture. Hysterectomy is not the first choice in case of uterine rupture management.

Objectives: The aim of this study was to evaluate the results of the patients who underwent cervical cerclage placement and the contribution of this intervention to the maintenance of pregnancy. Methods: Data of 29 patients who underwent cervical cerclage placement due to cervical insufficiency in Ataturk University Medical Faculty Obstetrics and Gynecology Department Between January 2002 and April 2007 were retrospectively analyzed. The patient\'s age, gestational week, history of abortion, history of previous cervical cerclage, preoperative measurement of cervical length, types of cerclage and delivery weeks were recorded and analysed. Results: The patient\'s ages were between 24 and 43 years. Weeks of gestation were between 12 weeks 2 days and 26 weeks and 1 day. Nineteen patient\'s cervical lengths were less than 20 mm by transvaginal ultrasonography. Eight of patients had funneling sign by transvaginal ultrasonography. Sixteen patients treated with prophylactic cervical cerclage, thirteen women treated with therapeutical cerclage. The cervical lengths of twenty one patients were over 20 mm after the procedure. Five patients reached term. Conclusion: The patient who has risk for cervical insufficiency should be followed with serial ultrasound examination and cervical cerclage should be performed when needed. The prophylactic cerclaje process is still best choice for patients with the history of two or more painless 2nd trimester or early 3rd trimester abortion that typical for cervical incompetence., Amaç: Bu çalışmanın amacı servikal serklaj uygulanan hastaları sonuçlarını ve bu işlemin gebeliğin devamına olan katkısını değerlendirmektir. Yöntemler: Atatürk Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalına Ocak 2002 ile 2007 Nisan tarihleri arasında başvuran ve servikal yetmezlik tanısı ile servikal serklaj uygulanan 29 olgunun verileri geriye dönüşlü olarak incelendi ve sonuçları değerlendirildi. Hastaların yaş, gebelik haftası, abortus veya preterm doğum hikâyesi, servikal serklaj hikâyesi, preoperatif serviksin transvajinal yolla uzunluğunun ölçülmesi, serklaj tipleri ve doğum haftaları kaydedildi ve değerlendirildi. Bulgular: Hastaların yaşları 24-43 arasında değişmekteydi. Gebelik haftaları ise 12 hafta 2 gün ile 26 hafta 1 gün arasında idi. Hastaların 19 (%65.5)\'unda transvajinal ultrasonografik ölçümle serviks uzunluğu 20 mm\'nin altında bulundu. 8 (%27.5) hastada funnelling bulgusu vardı. Toplam 16 hastaya profilaktik serklaj ve diğer 13 (%55.1) hastaya terapotik serklaj uygulandı. Serklaj sonrası 21 (%72.4) hastanın serviks uzunlukları 20 mm\'nin üzerinde ölçüldü. Hastaların beşi terme ulaştı. Sonuç: Servikal yetmezlik için risk faktörü taşıyan hastalara rutin aralıklarla transvajinal ultrasonografi yapılması fetüs için hayat kurtarıcı olabilir. Yine servikal yetmezlik için tipik olan iki veya daha fazla ağrısız olarak 2.trimester düşüğü veya 3.trimester erken doğumu anamnezi veren hastalara profilaktik serklaj uygulamasının iyi bir seçenek olduğunu düşünmekteyiz.

A patient with acute abdomen at 16th week of gestation underwent an emergency laparotomy. At laparotomy two litres of fibrinated and free blood and a dead fetus with placenta was detected intraabdominally. The right ovary and tube was normal and the uterus was normal in size. There was a ruptured and actively bleeding uterine horn on the left side of the uterus. The ruptured uterine horn was excised with the left tube by preserving the left ovary. The patient recovered without any complications, Onaltıncı gebelik haftasında akut batın tablosu ile gelen hasta acil laparotomiye alındı. Laparotomide intraabdominal iki litre fibrine ve defibrine kan ve ölü bir fetus ile birlikte plasentası tesbit edildi. Sağ over ve tüp normal görünümde ve uterus normal boyutlardaydı. Uterusun solunda rupture ve aktif kanamalı uterin horn gözlendi. Rupture uterin horn sol over korunarak sol tüp ile birlikte eksize edildi. Hasta herhangi bir komplikasyon gelişmeden taburcu edildi.

Our object is to determine the prevalence of group B streptococcus (GBS) carriage among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility to formulate a policy for treatment and prevention regarding perinatal GBS diseases in eastern Turkey. A total of 150 pregnant women were screened for GBS colonisation. Samples were collected from the vagina and the rectum of pregnant women, and the ear canal, throat and umbilicus of the neonates of colonised mothers. Antimicrobial susceptibility of the isolates was also investigated. GBS was isolated in at least one specimen from the 150 women in 48 cases; it was estimated that, overall, about 32% of the pregnant women and 17.3% of overall newborns were colonised with GBS. The overall rate of GBS vertical transmission was 54.2% in this study. Maternal colonisation rate was significantly higher in younger ages (p < 0.01) when maternal age of 20 years was taken as a cut-off point. All isolates were found to be sensitive to penicillin, ampicillin, cefazolin and vancomycin. Resistance to erythromycin and clindamycin were found to be 13.5 and 2.7%, respectively.

Homocysteine is an essential amino acid required for the growth of cells and tissues in the human body. Maternal hyperhomocysteinemia is associated with a number of placenta-mediated diseases such as preeclampsia. The aim of this study was to evaluate the plasma level of homocysteine and its association with severity of preeclampsia. A case-control study was performed with 32 mild preeclamptic patients, 25 severe preeclamptic patients, 16 eclamptic patients and 34 controls. Maternal plasma homocysteine concentration was measured prospectively at antenatal period by high-performance liquid chromatography. There were no significant differences in demographic characteristics between the study and control groups. Mean plasma levels of homocysteine in women with severe preeclampsia (16.7 +/- 10.1 micromol/l, mean +/- S.D., n = 25) and eclampsia (16.5 +/- 9.6 micromol/l, mean +/- S.D., n = 16) were significantly higher than those in mild preeclampsia (7.7 +/- 2.4 micromol/l, mean +/- S.D., n = 32) and controls (6.7 +/- 1.6 micromol/l, mean +/- S.D., n = 34) (p0.0001). It should be noted that plasma levels of homocysteine are not significantly different between mild preeclampsia and controls. In conclusion, plasma homocysteine concentrations are increased in severe preeclampsia and eclampsia, but not in mild preeclampsia.

We review, in detail, 2 cases of anthrax during pregnancy, its maternal and perinatal complications, and its management. Patient 1 was a 33-year-old woman at 32 weeks of gestation. She had a submandibular eschar; extensive edema on her face, neck, and upper thorax that inhibited respiratory function; and fever. The patient was treated with penicillin G and prednisolone after the diagnosis of anthrax. She recovered within 10 days but delivered a preterm baby. Patient 2 was a 29-year-old woman at 33 weeks of gestation. Her anthrax lesion was on her right elbow, and therapy consisted of procaine penicillin. She also delivered a preterm baby. These 2 cases show that anthrax during pregnancy can be successfully managed, but preterm delivery could be a complication.