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The study aims to evaluate the effects of multi-dose methotrexate (MTX) or subsequent salpingectomy on ovarian reserve and explain the conditions that cause the change in serum anti-Müllerian hormone (AMH) levels.Our department had 58 tubal EP patients treated with a multiple-dose MTX protocol or subsequent salpingectomy between 2017-2020. Serum AMH level was measured in each patient before the medication and 3-6 months after therapy. Patients' details were recorded and analyzed later.The mean AMH value decreased in 32 patients (-17.8%), increased in 26 patients (+31.5%) (p0.0001). In the group with an increase, there was a rather high number of patients with a polycystic ovary (PCO) condition compared to the other group (p = 0.0001). AMH values increased in patients with PCO and decreased in patients having no PCO (p0.001).Multiple-dose MTX or subsequent salpingectomy treatment in tubal ectopic pregnancy (EP) patients might not refer to significant differences in patients' AMH levels. Remarkably, post-treatment AMH levels were significantly increased in EP patients with PCO and decreased in those without this condition. PCO may be a protective condition for ovarian reserve.

Objectives: Our study aims to evaluate the effect of bilateral prophylactic internal iliac artery ligation (IIAL) on bleeding in patients with placenta percreta who undergo cesarean hysterectomy (CH) with the use of blunt dissection technique. Material and methods: This retrospective cohort study included 96 patients with placenta percreta who underwent planned CH with using the blunt dissection technique to allow better vesico-uterine dissection at the gynecology and obstetrics unit of a university hospital between the years 2017–2019. We carried out bilateral IIAL before CH in the study group (group 1) while we performed only CH in the control group (group 2). Results: Group 1 and Group 2 consisted of 50 and 46 patients; respectively. There was no statistical difference between the two groups as regards to the mean estimated blood loss, the mean transfused blood products, the mean operation time, and the number of complications. In total, 24 patients (25%) had complications with the finding that the most common one was bladder injury (16/96, 16,66%). Conclusions: Routine bilateral prophylactic IIAL before CH in placenta percreta cases does not have a beneficial effect on decreasing the amount of bleeding and the amount blood transfusion

Objective: To determine the indications for termination of pregnancy, and their consistency with autopsy data to offer an insight into termination of pregnancy having regard to conditions in Turkey.Study Design: Three hundred and ninety-one pregnancies terminated before the 24th gestational week were enrolled in this study. Maternal age, gravidity, parity, abortion, the status of folic acid usage, consanguineous marital status, gestational week, anomalies that led to termination and pathological diagnoses were recorded. Anomalies that led to termination were grouped as central nervous system , cardiovascular system, gastrointestinal system, genitourinary system, pulmonary, musculoskeletal, head-neck, chromosomal, genetic, multiple anomalies and others. Four groups were formed based on the consistency of prenatal ultrasound diagnosis with pathological diagnosis.Results: Mean age, gravidity, parity, abortion, and gestational week were 28 years, 3, 1, 1, and 15.7 weeks, respectively. One hundred and thirty-eight (35.2%) patients had consanguineous marriage. Three major causes of termination were central nervous system (45.78%), head-neck (17.4%) and multiple anomalies (14%). One hundred and twenty-eight (71.5%) patients with central nervous system anomalies were not using folic acid. Comparison of prenatal ultrasound findings with pathology results, 275 (70.3%) patients had full consistency, 46 (11.8%) had other findings at autopsy besides the confirmed sonographic findings, 34 (8.7%) had some sonographic findings not confirmed at autopsy, and 4 (1%) had no consistency between the findings.Conclusion: Central nervous system anomalies constitute the most common indication for termination of pregnancy in this retrospective study. Low rate of periconceptional folic acid among those cases is remarkable. First-trimester screening for earlier detection of fetal anomalies may be important in high-risk groups such as those with consanguineous marriages.

Aim To investigate the level of knowledge among high school and university students about the human papillomavirus (HPV) and its vaccine. Methods Our study included 3039 Grade 9-12 students from 12 high schools and university students enrolled in medical and non-medical departments. The students completed a 30-item questionnaire, which included three demographic items (sex, age and grade) and measured knowledge regarding HPV, HPV vaccine, smear test and cervical cancer. Students responded by selecting one of the choices "true/false/I don't know." Results One thousand seven hundred and forty eight high school students (57.5%) and 1291 university students (42.5%) completed the questionnaire. One thousand three hundred and fourty one students were male (44.1%) and 1698 were female (55.9%). Mean age was 18.8 (min: 14 max: 33). The university group had significantly more correct responses (P = 0.001). The high school group had significantly more unknown responses (P = 0.001). In both groups, female and male students had comparable correct responses (High school; female: 25.28%, male: 24.45%, P = 0.42; University; female: 62.46%, male: 63.09%, P = 0.35). While medical students had more correct responses than both nursing students and students from non-medical university departments, nursing students had more correct responses than students from the non-medical university departments (P = 0.001). Conclusion Knowledge about HPV is limited in adolescence, which marks the beginning of sexual activity. Educational programs targeted at adolescents are needed to negate the increasing rate of HPV-related gynecological cancers in our population. The HPV vaccine should urgently be introduced to the routine immunization schedule.

Objective To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API). Materials and methods This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology. Results Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively. Conclusion ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.

Cervical cancer markedly threatens women's health worldwide and currently ranks fourth leading cause of cancer mortality in women according to recent global cancer statistics. Recent advances have proven that not only tumor suppressor and oncogenes but also non-coding RNAs including micro RNAs (miRNAs) have significant impact in the development and progression of cervical cancers. Previous studies have identified many cancer-specific miRNAs for the early detection of cervical cancers. However, the diagnostic and prognostic use of autophagy-associated miRNAs for the cervical squamous cell cancer (SCC) cases and high-grade squamous intraepithelial lesion (HSIL) have not been uncovered. In the present study, we revealed that miRNAs are differentially expressed in both cervical SCC and HSIL. A total of 35 HSIL, 35 cervical SCC and 30 healthy controls were enrolled for the present study. Total RNA including miRNAs were isolated from the FFPE tissue samples and miRNA expression levels were quantified by quantitative PCR. Predicted miRNA targets of autophagy related genes were determined using miRNA-target prediction algorithms. MiR-143, miR-372, miR-375 and miR-30c were markedly downregulated in HSIL and cervical SCC. MiR-130a was significantly upregulated in the cervical SCC group compared to HSIL and control groups. MiR-30a, miR-520e, miR-548c and miR-372 were significantly associated with the overall survival of cervical SCC patients and these miRNAs were determined to be significant diagnostic markers as revealed by ROC analysis. Together, these results indicate that autophagy-associated miRNAs are potentially valuable for the differential diagnosis and targeted therapy to cervical cancer.

Objectives: To compare immunohistochemical detection of Human chorionic gonadotropin (hCG) expression in paraffin embedded tissue of squamous cell carcinomas (SCC) and high grade squamous intraepithelial lesions (HSIL). Methods: The samples in this retrospective study were obtained from the archives of the Pathology Department at Gaziantep University, Gaziantep, Turkey, over the period from January 2012 to September 2016. The study group consisted of 55 cases of SCC and 45 cases of HSIL. Tissue expression of hCG was detected by specific binding of anti-hCG antibody using an automated immunohistochemistry staining device. The categorical variables of intensity and coverage were analyzed statistically using Pearson Chi-Square test. Results: High grade squamous cell lesions cases showed weak (84.4%, n=38/45) to no (15.6%, n=7/45) staining for hCG. None of the HSIL cases showed strong positivity. Strong positivity for hCG was detected in 90.9% (n=50/55) of SCC cases. Conclusion: Our study supports the association of ectopic hCG expression in cancer pathogenesis by demonstrating strong hCG immunoreactivity only in SCC cases. This finding can be helpful in supporting the diagnosis of invasive carcinoma in small or fragmented biopsies, which can on their own be confusing for the pathologists.

Our aim was to evaluate the association of cystic hygroma (CH) with fetal malformations and also to investigate the outcome of fetuses with CH diagnosed in the prenatal period.We divided the CH patients into two main groups as isolated CH or CH associated with the congenital structural abnormality (CSA) by measuring the thickness of CH and showing other fetal abnormalities. Pregnancy outcomes were recorded as spontaneous abortion, elective termination, intrauterine death, live birth, postnatal death, and lost to follow-up.There were 74 cases of fetal CH including 19 in CSA-CH group and 55 in isolated-CH group diagnosed between 11 and 21 weeks' gestation. Karyotype analysis of these 28 patients revealed 18 (64.2%) normal karyotypes. Pregnancy outcomes included 54 elective terminations, five postnatal deaths, one spontaneous abortion, six live births, four intrauterine deaths, and four patients were lost to follow-up.In the presence of any CSA concurrent with CH, prognosis may be considered as poor and any additional help of fetal karyotyping is questionable. But fetal karyotyping may be advocated in counseling patients with isolated CH, in which a better prognosis and resolvement of CH may be expected in case of a normal karyotype.

Objective To evaluate the outcomes of cases of prenatally-diagnosed congenital pulmonary airway malformation (CPAM). Methods We retrospectively evaluated cases of prenatally-diagnosed CPAM between 2004 and 2018. Ultrasonographic features such as visualization of a fetal lung mass and heterogeneous pulmonary parenchyma were used for CPAM diagnosis. Prenatal and postnatal findings were compared in terms of accuracy regarding the CPAM diagnosis. Results The sample consisted of 27 cases. There were four cases in which the patients opted for the termination of pregnancy due to the severity of the lesion. A total of 23 neonates were delivered, and CPAM was confirmed in 15 cases. The median gestational age at delivery was 37 weeks (28–40 weeks) and the mean birth weight was 2,776 g. There were two neonatal deaths, one due to pneumothorax, and the other due to hypoplastic left heart syndrome (HLHS). A total of five patients with respiratory problems were operated in the postpartum period. There were eight misdiagnosis: bronchopulmonary sequestration (five cases), congenital lobar emphysema (two cases), and congenital diaphragm hernia (one case). Conclusion A precise postnatal diagnosis is very important to organize the proper management of the pregnancies with fetuses with CPAM. The positive predictive value of the prenatal diagnosis of CPAM via ultrasonography is of 70.3%. The differential diagnosis of CPAM may be prolonged to the postpartum period in some cases.

Objective: This study was aimed to evaluate 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels in patients with first trimester miscarriage. Methods: This prospective cohort study included 35 women, who were diagnosed with miscarriage (patient group) and 35 healthy pregnant women below 14 weeks of gestation (control group), who did not report any complaints. 8-OHdG levels were measured with a competitive ELISA (Enzyme-Linked ImmunoSorbent Assay) high sensitivity kit and MDA levels were also measured in both groups. Results: There wasn’t difference in terms of complete blood count, thyroid-stimulating hormone (TSH), homocysteine values, parity, age, body mass index (BMI) and gestational age between the groups. Serum 8-OHdG and MDA levels were significantly higher in the patient group (p=0.001). A moderate positive significant correlation between the gestational week and MDA values and a weak but significant positive correlation between 8-OHdG values and gestational week were detected in the patient group. Conclusion: 8-OHdG and MDA could play a role in the etiopathogenesis of first-trimester miscarriage. However, this role must be further delineated in large-scaled studies for early diagnosis and management of this condition.

Objective To compare the efficiency of the partial mesh removal (PMR) versus subtotal mesh removal (SMR) on urogenital distress and sexual functions in patients who experienced vaginal mesh extrusion. Material and methods Between June 2014 and January 2018, 45 patients who experienced vaginal mesh extrusion following midurethral sling surgeries and therefore underwent mesh excision were evaluated retrospectively. The effectiveness of PMR and SMR was compared using the "Urinary Distress Inventory-6 (UDI-6)" and "Female Sexual Function Index (FSFI)" forms, at the 6th month postoperatively. Results Fourteen PMR-patients and 21 SMR-patients who met the study criteria were evaluated for the study. There was a significant improvement in UDI-6 scores and FSFI scores in both PMR and SMR groups at the 6th month postoperatively (p=0.001, p=0.001, p=0.001, and p=0.001, respectively). When the two groups were compared in terms of improvement rates, there was no significant difference in UDI-6 scores [(-)30.21±6.56% vs. (-)26.33±9.01%, p=0.222]. However, there was a statistically significant improvement in the FSFI scores in the SMR group [(+)83.71±14.81% vs. (+)124.42±36.82%, p=0.001]. There was no significant difference in overactive bladder symptoms between the two groups, with a decrease of 75% in the PMR group and 71.42% in the SMR group (p=0.721). Recurrent stress urinary incontinence was observed in two (14.2%) patients in the PMR group and four (19.1%) patients in the SMR group at the 6th month postoperatively (p=0.544). Conclusion In cases where extrusion is developed, subtotal/total mesh removal provides a significant improvement in patients' complaints of sexual dysfunction related to extrusion.

Cervical cancer is the fourth leading cause of cancer death among women globally. The prognosis of cervical cancer patients differs considerably, and clinical outcomes are difficult to predict. Given the significant roles of miRNAs in human cancers, identification of novel and reliable miRNA biomarkers is important for targeted cervical cancer therapy. In the present study, we aimed to reveal biological significance of miR-200a, miR-423, miR-34a, miR-193a, and miR-455 for the prognosis and diagnosis of cervical cancer and their association with the clinical outcomes of patients. Distinct expression profiles of miRNAs in formalin-fixed paraffin-embedded tissue samples of patients and healthy controls were evaluated using qRT-PCR. We identified miR-200a, miR-455, and miR-34a were significantly downregulated in cervical squamous cell carcinoma tissues compared to normal cervix tissue from healthy controls. Both miR-455 and miR-34a confer a promising diagnostic factor for the cervical cancer while miR-200a showed no significance in ROC analysis. Notably, low expression of miR-34a was markedly associated with the poor overall survival of cervical cancer patients as revealed by Kaplan-Meier survival analysis. Also, univariate and multivariate analysis indicated miR-34a expression as an independent prognostic factor. Consequently, our results underline the importance of distinct expression miRNAs in cervical squamous cell carcinoma.

Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly's plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence, and the daily pad use were recorded. Patients were filled “rinary Distress Inventory-6(UDI-6)”, “Incontinence Impact Questionnaire 7(IIQ-7)” and “Index of Female Sexual Function(IFSI)” questionnaire forms at preoperatively, and postoperative 6th month. No usage of pads was accepted as subjective cure rate. Intraoperative, and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.

Introduction The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. Material and Methods Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. Results A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). Conclusions Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy.We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was3 mm and/or vascular invasion was present, then hysterotomy was preferred.Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age.TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

Objectives: To determine the validity of fetal kidney length and amniotic fluid index (AFI) in labor dating. Methods: This prospective study included 180 pregnant women followed up in the outpatient clinic at the Department of Obstetrics and Gynecology, Gaziantep University, Turkey, between January 2014 and January 2015. The gestational age (GA) was estimated by early fetal ultrasound measures and last menstrual period. Routine fetal biometric parameters, fetal kidney length, and amniotic fluid index were measured. We studied the correlation between fetal kidney length, amniotic fluid index, and gestational age. Result: The mean gestational age depending on last menstrual period and early ultrasound was 31.98±4.29 (24-39 weeks). The mean kidney length was 35.66±6.61 (19-49 mm). There was a significant correlation between gestational age and fetal kidney length (r=0.947, p =0.001). However, there was a moderate negative correlation between GA and AFI. Adding fetal kidney length to the routine biometrics improved the effectiveness of the model used to estimate GA (R 2 =0.965 to R 2 =0.987). Conclusion: Gestational age can be better predicted by adding fetal kidney length to other routine parameters. Saudi Med J 2016; Vol. 37 (5): 533-537 doi:10.15537/smj.2016.5.14225 How to cite this article: Ugur MG, Mustafa A, Ozcan HC, Tepe NB, Kurt H, Akcil E, Gunduz R. Fetal kidney length as a useful adjunct parameter for better determination of gestational age. Saudi Med J 2016; Vol. 37 (5): 533-537.

Aim: To perform a retrospective review of gynecologic malignancies originating from gastrointestinal system. Material and Methods: The study included 35 patients who underwent surgery at Gaziantep University, Faculty of Medicine, Department of Gynecology and Obstetrics from January 2007 to December 2017 and they were diagnosed with secondary gynecological malignancies originating from the gastrointestinal system (GIS) in their pathological examination. The patientsÂ’ age, primary tumor, and metastatic tumor localization and size were recorded. The malignancies were classified based on origin, as those arising from the colon, appendix, pancreas, stomach, peritoneum, and those of an unknown origin. Results: The mean age of the patients was 50.8 years (min: 24, max: 98) and the mean tumor diameter was 9.8 cm (min: 2 cm, max: 23 cm). Malignancies originating from the colon were most common secondary gynecologic malignancies. The primary tumor was localized at the colon in 21 patients (60%), stomach in eight (22.8%), and in the pancreas in one patient, appendix in one patient and peritoneum in one patient (2.8%). The origin of the primary tumor could not be determined in three patients (8.5%) as follow-up was not performed in our hospital for these patients. Of the malignancies originating from the colon (n=21), 16 (76.1%) metastasized to the ovaries, four (19%) to the vagina, and one (4.7%) to the cervix, while all tumors originating from the stomach, peritoneum, pancreas, appendix and those derived from the GIS without specific origin metastasized to the ovaries. Of the ovarian metastases, 26 (86.6%) were bilateral while four (13.3%) were unilateral. In metastatic tumors, pathological diagnoses included adenocarcinoma, signet ring cell carcinoma and mucinous carcinoma. Conclusion: Female genital system is among the substantial targets of metastasis of GIS-derived tumors. Metastatic tumors have a more aggressive behavior. Metastatic tumors must be distinguished from primary tumors as treatment modalities differ in these tumors. For these reasons, a multidisciplinary approach should be employed in the diagnosis, management and follow-up of cases, and the genital system should be screened carefully during both preoperative assessment and postoperative follow-up in patients with primary GIS malignancies.