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Objective Morbidly adherent placenta (MAP) is a clinical condition the prevalance of which is steadily increasing. It is described as the invasion of the placenta into the uterine wall through the myometrium and beyond. Several studies have shown that intercellular adhesion molecule-1 (ICAM-1) increases the invasion capability of tumor cells and placental cells. In our study, we investigated the expression of ICAM-1 in MAP cases. Methods This is a prospective case-control study. Eighty-nine patients who were diagnosed with MAP and 96 patients, without adherent placenta, as a control group were included in the study. ICAM-1 staining was examined by immuno-histochemical staining in placental samples. Results Of the 89 patients in the MAP group, 72 (80.8%) showed positive staining, while 26 (27%) did so in the control group. ICAM-1 positive staining in the MAP group was statistically significantly higher (P=0.03). Conclusion This is the first study investigating the relationship between MAP and ICAM-1 in the literature. In our study, we showed that ICAM-1 expression increased in the MAP group.

The Seckel syndrome is an autosomal recessive inherited disorder that characterized severe pre- and post-natal growth restriction, microcephaly and a bird-like fetal head appearance. A few clinical reports revealed prenatal sonographic findings in the literature.A 29-year-old, Turkish, gravid 3, para 2, woman was referred to our center for further evaluation of a suspicion of microcephaly at 21 weeks' gestation. The couple was third degree consanguineous. Detailed 2- and 3-dimensional sonography scan revealed a bird-headed appearance, prominent eyes with hypotelorism, a severe microcephaly (bi-parietal diameter and head circumference were both 1. Percentile for 21 weeks' gestation), a beaked nose, and increased nuchal fold thickness measurement ( 95th percentile), low-set and prominent ears. All sonographic findings suggested Seckel syndrome and the couple elected termination of pregnancy in the present case.Seckel syndrome should be kept in mind in the differential diagnosis of severe microcephaly, accompanied by fetal growth restriction. 3D ultrasound is a useful adjuvant to routine 2D sonography for prenatal diagnosis of the syndrome and can delineate abnormal fetal head appearance (a bird-headed profile).

Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding.Methods: In this retrospective descriptive case-control study, ...

Objective: As a possible sign of endometrial cancer postmenopausal bleeding should be evaluated carefully. Dilatation and curettage (D&C) is still gold standard for assessment of postmenopausal bleeding. The development of hysteroscopy has provided a minimally invasive approach for endometrial assessment. We aimed to correlate hysteroscopic impressions and pathological findings in postmenopausal bleeding in this study. Material and Methods: This is a retrospective cross-sectional study. This study involves case records of one hundred thirteen women with postmenopausal bleeding. One hundred thirteen women with postmenopausal bleeding who underwent hysteroscopy with diagnostic D&C between January 2012 and January 2013 at Bursa Zübeyde Hanim Maternity Hospital, Department of Obstetrics and Gynecology. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of hysteroscopy were calculated. D&C was set as the 'gold standard'. Results: For the assessment of postmenopausal bleeding hysteroscopy has high sensitivity and specificity for endometrial space occupying lesions (polyp 100%, 93%; fibroid 100%, 91.8%). However for endometrial hyperplasia, hysteroscopy has low sensitivity (75%). Conclusion: Hysteroscopy is a good diagnostic method especially for detecting intrauterine spaceoccupying (polyp, fibroid) lesions, but moderate for endometrial hyperplasia. Hysteroscopic view combined with hysteroscopy guided endometrial biopsy could be a gold standard for endometrial assessment in postmenopausal bleeding. Copyright © 2015 by Türkiye Klinikleri.

Objectives: In this study we aim to evaluate antenatal, perinatal and postnatal outcomes and complications of adolescent pregnancies, as well as to discuss the social and psychological consequences of these pregnancies. Material and methods: We compare a total of 243 pregnant women at age 14–18 years to a vast control group at age 19–36 who all delivered at Bursa Yuksek Ihtisas Training and Research Hospital between years 2005–2014. Results: Antenatal care (folic acid supplementation, pre-conception counseling) was significantly higher in adolescent pregnancy group. Unplanned pregnancy rate was significantly higher in in study group (p < 0.001). Preterm delivery (before 37th week) ratio was statistically higher in pregnancy complications. Conclusions: Adolescent pregnancy is a social entity which should be regulated and prevented by legal measures. Planned pregnancies should be promoted and the public should be educated and informed about the Hazards of adolescent pregnancies. Press institutions, public broadcasting services support the efforts to decrease adolescent pregnancies.

Aim: The aim of this study is to compare the diagnostic accuracy of transvaginal sonography and saline infusion sonography in the detection of intracavitary space-occupying lesions (endometrial polyp and submucous fibroid) in infertile women.Material and Methods: Three hundred and twenty-three women with infertility were involved in this retrospective study. The diagnostic accuracy of transvaginal sonography and saline infusion sonography were compared with respect to evaluation by diagnostic hysteroscopy results. The sensitivity, specificity, predictive values and ROC curves were used to determine the efficacy of methods for detecting the intracavitary space-occupying lesions in infertile patients.Results: The incidence of intracavitary space-occupying lesions was 82.1% infertile women. The endometrial polyp and submucous fibroid were established in 56 (17.3%) and 5(1.5%) patients, respectively. The sensitivity and specificity of transvaginal sonography were 50.8% and 98.1%, respectively. These values were 80.3% and 98.5% for saline infusion sonography, respectively. Saline infusion sonography was found superior to transvaginal sonography for evaluating the intracavitary space-occupying lesions.Conclusion: Saline infusion sonography was more accurate diagnostic modality than transvaginal sonography to assess the intracavitary space-occupying lesions in the infertility population. Therefore the addition of saline infusion sonography to the infertility workup may prevent unnecessary invasive procedures to evaluate the uterine cavity.

Amaç: Tamoxifen kullanımına bağlı kalınlaşmış endometriumun değerlendirilmesinde histeroskopinin yerini belirlemek. Gereç ve Yöntemler: Tamoxifen kullanımı olan hastalar ilk basamakta trans-vajinal ultrason (TVUS) ile değerlendirildi. Endometrial kalınlaşma (5 mm) saptanan hastalar histeroskopi ve dilatasyon-küretaja (D&C) yönlendirildi. Çalışmaya östrojen reseptör pozitif meme kanseri olup en az 1 yıldır 20 mg/gün Tanoxifen kullanan 103 hasta üzerinde yapıldı. TVUSda endometrial kalınlaşma (5 mm) saptanan hastalar histeroskopik biyopsi ve dilatasyon-küretaja yönlendirildi. Endometrial kalınlık saptanan hastaların D&C ve histeroskopik biyopsi sonuçları değerlendirildi. Bulgular: Tamoxifen kullanan 103 hastanın 59 tanesinde endometrial kalınlaşma saptandı. Bu hastaların 35 tanesinde D&Cde materyal elde edilerek patolojik tanı kondu. Materyal elde edilemeyen 24 hasta histeroskopik biyopsiye yönlendirildi. Bu hastaların 11 (%45,8) tanesinde endometrial polip saptandı. Sonuç: Tamoxifen kullanımında endometrial kalınlık saptanan hastalarda D&C tek başına yeterli görünmemektedir. Histeroskopik biyopsi bu hastaların değerlendirilmesinde ilk sırada düşünülmelidir. J Turk Soc Obstet Gynecol 2014;4:215-8 Objective: Aim of this study was to evaluate role of hysteroscopy in thickened endometrium (>5 mm) associated with tamoxifen therapy. Materials and Methods: We performed dilatation and curettage (D&C) and hysteroscopic biopsy to patients for evaluation of thickened endometrium in tamoxifen therapy. One hundred and nine asymptomatic patients with estrogen receptor positive breast cancer treated with tamoxifen 20 mg daily. We performed hysteroscopic biopsy or D&C to patients who have thickened endometrium at transvaginal sonography. We correlate pathology report results of D&C and hysteroscopic biopsy. Results: Fifty-nine of 103 patients have thickened endometrium.Thirty-five of 59 patients diagnosed with D&C (19 inactive endometrium, 15 endometrial polyp, 1 endometrial hyperplasia). D&C couldnt get material 24 of these patients. Hysteroscopic biopsy diagnosed endometrial polyp 11 (45.8%) of these patients. Conclusion: We can state that D&C does not seem accurate enough for detection of intrauterin pathologies in thickened endometrium associated with tamoxifen therapy. We therefore believe it is reasonable to perform hysteroscopic biopsy in asymptomatic tamoxifen treated patients who have thickened endometrium. J Turk Soc Obstet Gynecol 2014;4:215-8

To evaluate a relationship between preeclampsia and prolidase enzyme activity.A prospective cohort study of 41 pregnant women diagnosed with preeclampsia and 31 healthy pregnant women as control group was selected at Harran University Hospital Department of Obstetrics and Gynecology. The prolidase enzyme activity was analyzed in maternal and umbilical cord plasma, amniotic fluid and placental and umbilical cord tissues by Chinard method in addition to maternal serum levels of lactate dehydrogenase (LDH), serum glutamate pyruvate transaminase (SGPT) and serum glutamate oxaloacetate transaminase (SGOT).A significant relationship was found between plasma prolidase activity (635 ± 83 U/L) (p = 0.007), umbilical cord plasma prolidase activity (610 ± 90 U/L) (p = 0.013), amniotic fluid prolidase activity (558 ± 100 U/L) (p = 0.001), umbilical cord tissue prolidase activity (4248 ± 1675 U/gr protein) (p = 0.013) and placental tissue prolidase activity (2116 ± 601 U/gr protein) (p = 0.001) in preeclamptic group when compared to healthy pregnant women.There is a strong correlation between prolidase enzyme activity and preeclampsia. Prolidase enzyme activity may play a role in preeclampsia.

Korkmazer, Engin/0000-0001-8318-2329 WOS: 000382752700007 Objective: Gestational diabetes mellitus (GDM) is associated with increased risk of postpartum type 2 diabetes mellitus and cardiovascular risk factors such as obesity, hypertension, dyslipidemia, and systemic inflammation. We aimed to evaluate the lipid profile and inflammatory status assessed by high sensitive C-reactive protein (hsCRP) and TNF-alpha levels. We also evaluated insulin resistance for all participants. Methods: This study was performed including the pregnant with normal glucose challenge test (GCT) and normal glucose tolerance (NGT) (n: 20), abnormal GCT and NGT (n: 27), and GDM (n: 29) defined by Carpenter and Coustan criteria. Results: In our study, we could not find significantly differences by means of hsCRP levels and lipid profile parameters between groups. But, TNF-alpha levels increased significantly in the GDM or abnormal GCT NGT groups as compared to the normal GCT NGT group. hsCRP was correlated independently with LDL-cholesterol and parity in the abnormal GCT NGT group and atherogenic index of the plasma (AIP) in GDM group. In addition, there was not an independent relationship between AIP and hsCRP in the GDM group when multiple linear regression analysis was performed after adjustment for maternal age was evaluated at 29.49 years. Conclusion: In conclusion, gestational insulin resistance was apparently associated with TNF-alpha, whereas dyslipidemia was slightly associated with hsCRP because of the possible effects of maternal age on lipid markers.

The role of apolipoprotein E (Apo E) gene polymorphisms in the etiology of recurrent pregnancy loss (RPL) is not clearly understood. We evaluated this polymorphism in unexplained pregnancy losses in a group of Turkish women. In our prospective case-control study, 45 well-characterized RPL cases were examined for their Apo E genotypes, based on restriction fragment length polymorphism analysis of polymerase chain reaction (PCR)-amplified fragments. The observed genotypes were compared with those obtained from equal number matched controls. We observed similar Apo E genotypes and E2, E3 and E4 allele frequency distribution among RPL patients and controls. The allele frequencies obtained in patients and controls, respectively, were as follows: E2=8 (9%) and 12 (13.4%) (P=0.342), E3=66 (73.3%) and 60 (66.6%) (P=0.328) and E4=16 (17.7%) and 18 (20%) (P=0.703). Our data did not support the association of Apo E gene polymorphisms with RPL as reported by previous studies. We endorse adequate characterization of RPL cases and adequate sample size prior to addressing such studies.

Objective To study the role of diabetes, hypertension and obesity in etiology of endometrial polyps.

Gaucher disease (GD) is a lysosomal storage disorder characterized with beta-glucocerebrosidase enzime deficiency. The disease is progressive with several manifestations including hematologic abnormalities, organomegaly and bony abnormalities. Pregnancy may excerbate this manifestations. Enzyme replacement therapy (ERT) has been used to improve clinical signs and reverse organomegaly and disease progress. Studies showed that ERT with imiglucerase reduce the risk of abortion and GD related complications. However, there have been only a few published data regarding the effects of imiglucerase on fetus, on newborn and on infant. In this case we report a succesfull pregnancy, delivery and healthy 2-year follow-up of GD under ERT with imiglucerase. Copyright © 2015 by Türkiye Klinikleri.

Korkmazer, Engin/0000-0001-8318-2329 WOS: 000347797000008 PubMed: 25111421 Gestational diabetes mellitus (GDM) is associated with an increased risk of postpartum type 2 diabetes mellitus and cardiovascular risk factors, such as obesity, hypertension, dys-lipidaemia and systemic inflammation. We aimed to evaluate further lipid profile and inflammatory status assessed by high sensitive C-reactive protein (hsCRP) and TNF-alpha in GDM. Based on oral glucose tolerance testing, participants were stratified into three groups: normal 50 g glucose challenge test (GCT), normal 100 g glucose tolerance test (NOGTT) (control group) (n = 40); abnormal GCT NOGTT (glucose intolerance) (n = 37); and GDM (n = 39), defined by Carpenter and Coustan. The three groups did not demonstrate significantly different hsCRP levels (p = 0.4180) and lipid profile parameters, such as total cholesterol (p = 0.4210) and LDL-cholesterol (p = 0.4440) levels. Triglycerides (p = 0.0150) and atherogenic index of the plasma levels (p = 0.0280) were slightly higher in the GDM group. But, TNF-alpha levels increased significantly in the GDM (p < 0.0001) and in glucose intolerance (p = 0.0062) groups as compared with the control group. Among the metabolic syndrome components, insulin resistance was apparently associated with TNF-alpha, whereas dyslipidaemia was slightly associated with hsCRP because of the effects of maternal age on lipid markers. These findings suggest that TNF-alpha has a stronger correlation with pregnancy-associated insulin resistance than hsCRP at 24 to 28 weeks' gestation.

Introduction: Endometrial thickness is measured by transvaginal sonography and thickening indicates an increased risk of malignancy or other pathology (hyperplasia or polyp) in the postmenopausal period. The main screening methods for the uterine cavity are dilatation and curettage, and hysteroscopy. We sought to correlate hysteroscopic and pathological findings in asymptomatic postmenopausal women with sonographically thickened endometrium (> 5 mm) in this study. Material and methods : This retrospective cross-sectional study involved case records of 197 women who have thickened (> 5 mm) endometrium in the postmenopausal period. All these women underwent hysteroscopy with diagnostic dilatation and curettage between January 2012 and January 2013 at the Bursa Zübeyde Hanım Maternity Hospital. Sensitivity, specificity, positive, negative predictive values and p value of hysteroscopy were calculated. Dilatation and curettage was set as the gold standard. Results : For the evaluation of postmenopausal thickened endometrium, hysteroscopy revealed sensitivity, specificity, positive predictive value and negative predictive value as 76.4%, 76.9%, 73.1%, 79.8%, respectively. Conclusions : Hysteroscopy is a fast and accurate technique in evaluation of the intrauterine space occupying lesions (polyp, fibroid) but only moderate for endometrial hyperplasia. Hysteroscopic view combined with direct biopsy could be a gold standard for endometrial assessment.

Sengul, Ilker/0000-0001-5217-0755; Korkmazer, Engin/0000-0001-8318-2329 WOS: 000335651200030 PubMed: 24716936 Purpose: To appraise the frequency of cervical cytological abnormalities in a population at normal risk via analysing the archive records of cytology for the period of approximately 9,5 years, comparing them with patient demographic charecteristics, and discuss the results for women under age of 35. Materials and Methods: A total of 32,578 cases of Pap smears were retrieved and analysed from our archive included the Pap tests performed between January 2001 and April 2010 at the Early Cancer Screening, Diagnosing and Education Center by the consent of three pathologists via utilizing the Bethesda System Criteria 2001 and the results were compared with some demographical characteristics. Results: Our rate of the cervical cytological abnormality was 1.83%, with ASCUS in 1.18%, LSIL in 0.39, HSIL in 0.16%, AGUS in 0.07%, squamous cell carcinoma in 0.02%, and adenoarcinoma in 0.006%. Cytological abnormalities were detected mostly in those with higher age, lower parity, and premenopausal period whereas the smoking status was without influence. Bacterial vaginosis (5.6%) was the most frequent infectious finding (Candida albicans 2.7%; Actinomyces sp. 1.3%; and Trichomonas vaginalis 0.2%) detected on the smears. The rate of abnormal cervical cytology was 9.5% among the women aged between 30-34. Conclusions: Early detection of the cervical abnormalities by means of the regular cervical cancer screening programmes is useful to attenuate the incidence, mortality, and morbidity of cervical cancer. Our prevalence of the cytological abnormalities was much lower than the one in Western populations in general but very similar to those reported from other Islamic countries that may be explained by the conservative lifestyle and the lower prevalence of HPV in Turkey. A remarkable rate of abnormal cervical cytology of women aged 30-34 was pointed out in the present study.