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OBJECTIVES The study aimed to determine the awareness of emergency contraception (EC) and knowledge of its use as well as the unplanned pregnancy rate among women in the immediate postpartum period in Ankara, Turkey's second largest city. METHODS Interviews were carried out among 1955 women on their first or second day postpartum. The interview was based on a questionnaire containing 19 questions covering participants' awareness and experience of using EC as well as their future approach to its use. RESULTS The rate of unplanned pregnancy was 18.2% and the rate of EC awareness was 26.0%; 89.4% of those who were aware of EC knew how to use it correctly. In the multivariate regression analysis, employment, household income and level of education were independently associated with EC awareness; gravidity, household income, level of education and number of abortions were independently associated with unplanned pregnancy. Awareness of EC increased significantly (p

Postoperative adhesions can cause serious complications, including intestinal obstruction, chronic abdominopelvic pain, and infertility in women. Here we investigate the effects of disulfiram on the postoperative adhesion model. Female Wistar rats were used (n = 72). The animals were separated into six groups (12 rats per group): group 1 (control), group 2 (300 mg/kg disulfiram administered for 3 days preoperatively), group 3 (50 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 4 (300 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 5 (50 mg/kg disulfiram administered 14 days postoperatively only), and group 6 (300 mg/kg disulfiram administered 14 days postoperatively only). A histopathologic examination was performed. Immunohistochemical stainings for matrix metalloproteinase-2 and 9 (MMP-2, and MMP-9) and vascular endothelial growth factor (VEGF) were evaluated. The macroscopic adhesion scores were significantly lower in the disulfiram groups (groups 3, 4, and 6) compared to the control group (p < 0.05). Inflammation scores were lower in all groups receiving disulfiram, but only reached statistical significance in group 4 (p < 0.05). In the immunohistochemical evaluation of the groups, MMP-9 was significantly lower in group 5 than group 4 (p < 0.05). There was no significant difference between the groups for MMP-2 and VEGF. We found that disulfiram reduced postoperative adhesion formation. Disulfiram becomes more effective (by directly reducing inflammation) when initiated during the preoperative period at high doses.

AIM To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p

Currently, apical prolapse is diagnosed via assessing the levels of C and D points in the pelvic organ prolapse quantification (POP-Q) system. However, it is not yet known whether the other components of this system are useful for diagnosing apical prolapse and its symptoms.The aim of the study was to evaluate the association between the perineal body size (PB), total vaginal length (TVL), and apical prolapse and its symptoms.Two hundred women, 100 women with apical prolapse and 100 women without, were included in this cross-sectional study. The association between the PB, TVL, and apical prolapse and its symptoms were evaluated. The relationship between the other POP-Q measurements and apical prolapse/prolapse symptoms were also evaluated as the secondary outcome of the study.The TVL (cutoff value, ≤8 cm; sensitivity, 80%; specificity, 60%) and the genital hiatus size (GH; cutoff value of4.5 cm; sensitivity, 90%; specificity, 91%) were significantly associated with apical prolapse. The PB cutoff value of 3.4 cm or less had lower sensitivity (49%) and specificity (70%) for the diagnosis of apical prolapse. The GH (cutoff value,4.8 cm; area under curve [AUC], 0.927), C (cutoff value,-5.8 cm; AUC, 0.955), and Ba (cutoff value,-1.1 cm; AUC, 0.891) were significantly associated with apical prolapse symptoms. However, there was no association between the PB or TVL with symptoms.The study results showed that the TVL and GH were more strongly associated with apical prolapse than PB. The GH, C, and Ba were also associated with prolapse symptoms, but PB and TVL were not.

Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) t...

The aim of this retrospective study was to demonstrate the effectiveness of APRI, DNI, NLR, PLR, and PDW in predicting the severity of gestational hypertension (GHT) and PE and to determine whether these factors can be used as screening tools. Normotensive pregnant women (n = 792) served as the control group. 1,213 single pregnant women who met the following criteria for a GHT diagnosis were included in the study group. We found a significantly higher mean PLR and NLR value. The mean PDW value was significantly lower in the control group than in the other groups. The SPE group had a significantly higher mean APRI score. The groups did not differ by their DNI. We determined PDW and APRI as independent parameters that predicted SPE by multiple logistic regression analysis. In retrospective analysis of blood samples taken from these participants below week 20, we found that the APRI value differed significantly between the control and SPE groups. NLR, PLR, DNI, and PDW had no clinical significance. We further suggested that APRI may provide a clinical indication of progression from hypertensive pregnancy disorders to SPE, which seems to be a promising implication that should be verified by further studies.IMPACT STATEMENTWhat is already known on this subject? Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality. Screening pregnant women for risk factors for developing hypertensive disorders and identifying women at high risk in early pregnancy and initiating prophylactic treatment are important for pregnancy monitoring and planning in experienced centres. Because only 30% of women who will develop preeclampsia can be predicted by risk factors, the combined use of laboratory tests and imaging with risk factors to calculate a woman’s risk of developing preeclampsia is currently being investigated. However, no proven marker has yet been found.What do the results of this study add? In our study, we found that NLR, PLR, DNI, and PDW have no clinical significance in assessing the risk of developing gestational hypertension and preeclampsia and in predicting the severity of preeclampsia. However, in our study, we found that APRI can provide a clinical indication of the progression of hypertensive pregnancy to SPE.What are the implications of these findings for clinical practice and/or further research? This study represents an important contribution to the literature because it is the first study to examine the association between APRI and HT in pregnancy. What is already known on this subject? Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality. Screening pregnant women for risk factors for developing hypertensive disorders and identifying women at high risk in early pregnancy and initiating prophylactic treatment are important for pregnancy monitoring and planning in experienced centres. Because only 30% of women who will develop preeclampsia can be predicted by risk factors, the combined use of laboratory tests and imaging with risk factors to calculate a woman’s risk of developing preeclampsia is currently being investigated. However, no proven marker has yet been found. What do the results of this study add? In our study, we found that NLR, PLR, DNI, and PDW have no clinical significance in assessing the risk of developing gestational hypertension and preeclampsia and in predicting the severity of preeclampsia. However, in our study, we found that APRI can provide a clinical indication of the progression of hypertensive pregnancy to SPE. What are the implications of these findings for clinical practice and/or further research? This study represents an important contribution to the literature because it is the first study to examine the association between APRI and HT in pregnancy.

İlk olarak Çin'in Wuhan kentinde tanımlanan yeni tip koronavirüs hastalığı (COVID-19), küresel bir halk sağlığı sorunu olan, bir çeşit solunum yolu enfeksiyonudur. Vaka raporları ve küçük kohort çalışmalarından oluşan, gebelikte COVID-19 ile ilgili veriler sınırlıdır. Doğum sonrası ürosepsis de küresel olarak yaygın bir hastalıktır ve pekçok yayın bulunmaktadır. Sepsis bulguları olan postpartum hastalar, salgın sırasında; halk sağlığı ve hastanın kendi iyiliği açısından COVID-19 için test edilmelidir. Ürosepsisin klinik özellikleri, doğum sonrası hastalarda COVID-19 hastalığına benzer olabilir. Bu olgu sunumu ile; postpartum dönemde ani akut solunum bozukluğu ve septik şok bulguları geliştiren bir vakada COVID-19 enfeksiyonu ve ürosepsis ayırıcı tanısının ve tedavisinin nasıl yönetildiğini anlatmak amaçlanmıştır.

Various congenital anomalies of the female tract such as agenesis, vertical or lateral fusion failure, and canalization failure occur when the normal development of the Müllerian duct disrupts in any stage of developmental milestones. A cavitated non-communicating rudimentary horn is reported in about 20%-25% of women with unicornuate uterus. A 36-year-old patient, gravida 2 para 2, was admitted to the hospital with a complaint of worsening lower abdominal pain occurring on each menses for 8 months. A 6-cm accessory cavitated left uterine mass suggestive of hematometra was shown on ultrasound examination. It was decided to perform hemi-hysterectomy to remove the left uterine horn by the laparoscopic route. Here we aimed to demonstrate the laparoscopic management of a rudimentary horn case and emphasize the crucial steps that surgeons should safely perform during the operation.

Background/aim Turkey accepts refugees from many countries, principally Syria. More than 2.7 million refugees live in Turkey.We evaluated the neonatal outcomes of refugees. Materials and methods We retrospectively reviewed the clinical and demographic characteristics of refugee infants born in our hospital between August 2013 and September 2016. Results Refugees (718 Syrian, 136 Iraqi, 32 Afghani, and 21 of other nationalities) accounted for 907 of 49,413 births. The mean refugee maternal age was lower than that of Turkish women, whereas the gestational age (GA) and birthweight were similar. Refugees required fewer cesarean sections but exhibited greater small- and large-for-GA rates (P < 0.05). Refugee and Turkish infant mortality rates did not differ significantly (0.8 vs. 0.4%). Eighty-nine (12.3%) refugee neonates and 6682 (13.5%) Turkish neonates were admitted to our neonatal intensive care unit (NICU). Jaundice and perinatal asphyxia were significantly more common in refugees, whereas respiratory distress syndrome, GA ≤32 weeks, and infant birthweight

This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time, and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix. (J Turk Ger Gynecol Assoc 2022

Objectives: The aim of the study was to evaluate the negative effect of nonionizing radiation on the treatment of endometrial hyperplasia (EH) with oral progesterone. Design: Forty oophorectomized Wistar Albino female rats were included in this experimental rat study. Materials and Methods: The 4 groups were planned as follows: Group A; sham group; Group B; group receiving oral estradiol hemihydrate 4 mg/kg/day; Group C; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day medroxy progesterone acetate (MPA) and Group D; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day MPA with exposure to nonionizing radiation at 1800 mHz/3 h/day. After the experimental model, uterine horns were sampled and the preparations were evaluated for pathological parameters (glandular density, epithelial cell length, and luminal epithelial cell length) via light microscopy. Nonionizing radiation was created by a signal generator and a compatible mobile phone. Results: Estrogen was found to increase all parameters related to EH (p < 0.05). Progesterone treatment was found to decrease parameters related to EH (Group B vs. C; luminal epithelial cell length, glandular density, and epithelial length; 11.2 vs. 13.2 μm p = 0.007; 32.5 vs. 35.5, p = 0.068; and 219.9 μm vs. 285 µm, p < 0.001, respectively). Final analyses revealed reduced effectiveness of progesterone treatment in the rats exposed to nonionizing radiation (Group C vs. D); luminal epithelial cell length, glandular density, and epithelial length (11.2 μm vs. 13.5 μm, p = 0.179; 32.5 vs. 52, p < 0.001; and 219.9 μm vs. 374.1 μm, p = 0.001, respectively). Limitations: The limitations of our study are that the results of animal experiments may not be appropriate for direct adaptation to humans and the relatively low number of rats included in the study. Conclusion: Nonionizing radiation reduces the effect of progesterone in patients receiving treatment for EH.

Aim: The aim of this study was to evaluate the prognostic value of the preoperative systemic inflammatory markers in patients with serous-type ovarian cancer and to reveal their relationship with survival.Materials and Methods: Data from 86 serous type ovarian cancer patients were evaluated retrospectively. Neutrophil-lymphocyte (NLR), lymphocyte-monocyte (LMR) and platelet-lymphocyte (PLR) ratios were used as preoperative inflammatory markers. The patients were grouped as high or low risk according to NLR, LMR and PLR values. Median values were used as cut-off values for categorizing groups. The effects of NLR, LMR and PLR values on disease-free survival (DFS) and overall survival (OS) with clinical, surgical and pathological variables were investigated.Results: The median age of the patients was 58.03 years (range; 25-80). The stage of the disease was found as 12 patients stage I-II and 74 patients stage III-IV. The median follow-up was 29.45 months (range; 1-63), during this period 21 (24.4%) patients developed recurrence and 15 (17.4%) patients died due to the disease. The mean DFS time was 46.32 ± 3.00 months and OS time was 51.30 ± 2.43 months in the whole study group. For DFS; omentum metastasis, splenic metastasis, diaphragmatic metastasis, colon metastasis, surgical outcome and adjuvant treatment success and for OS; omentum metastasis, whether the patient received adjuvant therapy and adjuvant treatment success were found to be significant (p0.05).Conclusion: It was found that preoperative inflammatory markers could not predict disease-free survival and overall survival in serous type ovarian cancer., Amaç: Seröz tip over kanserinde preoperatif sistemik inflamatuar belirteçlerin prognozu predikte etmedeki etkinliğini değerlendirmek ve sağ kalım ile ilişkilerini tanımlamak amaçlandı.Gereç ve Yöntemler: Çalışma grubu seröz tip over kanseri nedeniyle tedavisi yapılan 86 hastadan oluşturuldu. Hastalara ait veriler retrospektif olarak tarandı. Preoperatif inflamatuar belirteçler olarak nötrofil/lenfosit oranı (NLO), lenfosit/monosit oranı (LMO) ve trombosit/lenfosit oranları (TLO) kullanıldı. Hastalar NLO, LMO ve TLO değerlerine göre yüksek veya düşük riskli olarak gruplandırıldı. Grupları kategorize etmede sınır değer olarak ortanca değerler kullanıldı. Klinik, cerrahi ve patolojik değişkenlerle birlikte NLO, LMO, TLO değerlerinin hastalıksız sağ kalım (HSK) ve genel sağ kalım (GSK) üzerindeki etkisi incelendi.Bulgular: Hastaların ortanca yaşları 58.03 (aralık; 25-80) yıldı. Evre 12 hastada evre I-II ve 74 hastada evre III-IV’tü. Ortanca takip süresi 29.45 aydı (aralık; 1-63) ve bu süre içerisinde 21 (%24,4) hastada rekürrens geliştiği ve 15 (%17,4) hastanın hastalıktan dolayı öldüğü tespit edildi. Tüm çalışma grubunda ortalama HSK süresi 46.32±3,00 ay ve GSK süresi 51.30±2.43 aydı. HSK için; omentum metastazı, dalak metastazı, diyafragma metastazı, kolon metastazı, cerrahi sonuç ve adjuvant tedavi başarısı, GSK için; omentum metastazı, hastanın adjuvant tedavi alıp almaması ve adjuvan tedavi başarısı anlamlıydı (p0.05).Sonuç: Seröz tip over kanserinde, preoperatif inflamatuar belirteçlerin hastalıksız sağ kalımı ve genel sağ kalımı öngörmede yönlendirici olmadığı tespit edilmiştir.

The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery.Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (30 kg/mIntra-abdominal adhesions were more common in women ≥30 kg/mIntra-abdominal adhesion formation following cesarean delivery is more common in obese women.

A global public health problem with a high rate spread and transmission, Coronavirus outbreak has become the most talkedabout matter throughout the world. We are severely affected by the nations with vast numbers of deaths; it was hard to predict such a colossal pandemic with terrifying consequences. Elective surgeries are limited, but situations requiring an urgent gynaecological or obstetric surgical approach must still be performed during the COVID-19 pandemic. Concerns regarding surgical safety and the risk of viral transmission during surgery are of great importance. In this review, we aimed to summarize the concepts related to laparoscopic gynecological surgery during COVID-19 pandemic in the light of current literature.

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero ("0") was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENT What is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery. What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries. What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.

Background/aim To evaluate the effects of hysterectomy on rat ovaries and the possible protective role of peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist-rosiglitazone against ovarian reserve decrement. Materials and methods Forty-five adult Wistar albino rats were randomly divided into three groups. Hysterectomy was performed (n = 15) in group 1 [H]; 1 mg/kg/day PPAR-γ agonist/rosiglitazone was used for 50 days after hysterectomy (n = 15) in group 2 [H + R]; a sham operation was performed (n = 15) in group 3 [control, C]. Blood samples were collected for anti-Müllerian hormone (AMH) evaluation in all groups and simultaneous ovarian Doppler examination was performed in [H] and [H + R] groups before and after (50 days) hysterectomy. All animals were sacrificed to obtain ovaries for histological examination. Results AMH levels were found to be significantly decreased at postoperative day 50 in all groups (P < 0.05). Histopathologic analysis showed that primary, preantral, and antral follicle counts were significantly higher in the [H] group as compared to the [C] and [H + R] groups (P < 0.05). There was no significant difference between the [C] and [H + R] groups in terms of follicle numbers (P > 0.05). In the ovarian Doppler blood flow analysis, all parameters were significantly decreased in group [H] (P < 0.05), but not in the [H + R] group (P > 0.05) on postoperative day 50. Conclusion Hysterectomy affects the histopathological structure of rat ovaries and PPAR-γ agonist-rosiglitazone improves the ovarian Doppler blood flow parameters.

Objective: To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients. Material and Methods: Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients’ characteristics, operative data, and post-operative outcomes were collected and statistically analyzed. Results: A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p

Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.

Introduction/Background The objective of this retrospective, multi-centred study was to determine the incidence of occult uterine sarcoma in women operated for presumed uterine leiomyoma. Methodology We reviewed all myomectomy and hysterectomy operations performed with a pre-operative diagnosis of uterine leiomyoma at four tertiary centres, from January 2013 until December 2017, in Ankara, Turkey. The medical records of occult uterine sarcoma patients were analyzed to determine prognostic factors for disease-free survival (DFS) and overall survival (OS). Results A total 18604 women underwent hysterectomy or myomectomy during the study period. There were 56 cases of occult uterine sarcomas (51 uterine leiomyosarcomas, and five endometrial stromal sarcomas). The incidence of occult uterine sarcoma was 0.30% (56/18604) or approximately 1/332. The median DFS was 31.0 months (95% confidence interval [CI] 9.6–52.3 months). The 3-year and 5-year DFS rates were 44.1% and 34.0%, respectively. The 3-year and 5-year OS rates were 68.8% and 50.0%, respectively. For 5-year DFS, stage of the disease (stage IA vs. more advanced stages; p=0.007), rapidly growing myoma (p=0.01) and complete surgical staging at initial operation (p=0.02) were found to be statistically significant in univariate analysis. However, only stage of the disease (Hazard Ratio: 3.45, 95% Confidence Interval 1.13–10.49; p=0.02) remained as an independent prognostic factor for decreased DFS in multivariate analysis. Conclusion Our results indicated that the incidence of occult uterine sarcoma was 0.3% (1/332) in women operated for presumed uterine leiomyoma. Early and complete surgical resection might offer better DFS for these patients. Disclosure Nothing to disclose.

Non-ionizing radiation is related with many pathologies.Determine association between non-ionizing radiation and endometrial hyperplasia.Fifty oopherectomized Wistar albino rats were administered Estradiol hemihydrate (4 mg/kg) to induce hyperplasia, and were exposed to 1800 MHz radiation created by a mobile phone and a signal generator working as base station. This study was carried out with 5 groups in two phases. The study groups were. Control group without any exposure; group receiving estrogen in first phase of the study; group receiving estrogen in both phases; group receiving estrogen in the first phase and exposed to non-ionizing radiation during second phase and group taking estrogen in both phases and exposed to non-ionizing radiation during the second phase. Following both phases, uterine horns were excised and evaluated based on glandular density (GD), epithelial cell height (ECH), and luminal epithelial cell height (LECH).Estrogen increased all parameters during both phases (LECH, GD, and ECH values were 12,2 vs. 16,5 (p = 0.001), 34 vs. 47 (p0.001), and 201 vs. 376.6 (p = 0.001), respectively during the first phase; LECH, GD and ECH values were 13,2 vs. 20,3 (p0.001), 35.5 vs. 65,5 (p0.001), 219.9 vs. 419.6 (p0.001), respectively, during the second phase).Non-ionizing radiation increased all values without estrogen exposure (LECH, GD and ECH values were 13,2 vs. 17,2 (p = 0,074), 35,5 vs. 59 (p = 0.074), and 219 vs. 318.3 (p0.001), respectively) or with estrogen exposure (LECH, GD, and ECH, values were 20,3 vs. 22,8 (p = 0,168), 65,5 vs. 77 (p = 0,058), and 419,6 vs. 541,6 (p = 0.004), respectively).Non-ionizing radiation progressed endometrial hyperplasia in an experimental rat model with/without estrogen exposure.

To evaluate the predictive and clinical utilization of the mean platelet volume (MPV) in severe preeclamptic women. MPV is known as platelet size and associated with platelet activation or new platelet synthesis. Platelet count is decreased by vascular endothelial damage in cases of severe preeclampsia. It leads to increased turnover of platelets.The severe preeclamptic women with and without preeclampsia during pregnancy were divided into subgroups depending on the gestational birth week early, (34), late (34-37) preterm birth and term (≥37) gestational weeks. Their MPV was measured 24 hours prior to birth and compared with all subgroups according to the gestational week.The study subgroups were performed from early (n = 87), late (n = 48) preterm and term (n = 76) birth with severe preeclampsia, whereas early (n = 69), late (n = 63) and term (n = 228) without gestational hypertensive disorders were recruited in the control subgroups. The MPV of the early, late preterm and term preeclamptic subgroups was statistically higher than that of the control subgroups (9.4 ± 1.3fL vs 8.6 ± 1.2 fL, p0.001; 9.5 ± 1.0 fL vs 8.5 ± 0.9 fL, p0.001 and 10.2 ± 1.1 fL vs 8.9 ± 1.2 fL, p0.001), whereas the mean platelet count of all the study subgroups was significantly lower (237.3 ± 81.3 × 10The MPV may be a predictive marker of severe preeclampsia.

Amaç: Bu çalışmada,4000 gr ve üzerinde bebek doğuran 643 gebenin doğum şeklinin ve doğumağırlıklarının maternal ve neonatal komplikasyonlar üzerine olan etkisinin değerlendirilmesi amaçlanmıştır.Materyalmetod: 643 hasta doğumşekline (vajinal veya sezaryen) ve doğum ağırlıklarına (4000-4500 ve ≥4500gram) göre gruplara ayrıldı. 4000 gramın üzerinde doğum yapan hastalar doğumşekline göre komplikasyon oranları açısından karşılaştırıldı. Daha sonrahastalar 4000-4499 gr ve ≥4500 gr doğum yapanlar olarak ayrıldı. Bu ikigrubun kendi içinde komplikasyonaçısından fark olup olmadığı araştırıldı.Bulgular: Makrozomik infant öyküsü, neonatal ağırlık veeşlik eden DM, sezaryen ile doğum yapan grupta yüksek saptandı. Neonatal komplikasyonlar açısından herhangi birfark saptanmadı. maternal postpartum Hb değeri sezaryen olan grupta anlamlı düşük bulundu. 4500 gramın üzerindedoğan bebeklerin doğum şekli ile komplikasyon oranları değişmezken, 4000-4499gram arasında postpartum Hb değeri sezaryen olan grupta anlamlı düşük saptandı.Sonuç: Rutin sezaryen ile doğumun makrozomik infantlardakomplikasyonları azaltma açısından belirgin bir üstünlük sağlamadığıgörülmektedir. Makrozomik infant doğurma riski olan hastalarkişiselleştirilmeli ve doğum komplikasyonu açısından risk taşıyan hastalarsezaryene yönlendirilmelidir., Objective: This study aims toanalyze the effect of delivery method and birth weight over maternal andneonatal complications in 643 women who gave birth to babies weighing 4000 g orabove. Material method: 643 patients weredivided into groups according to their delivery method (vaginal or caesarean)and birth weight (4000-4500 g or ≥4500 g). Patients who delivered babies weighing over 4000 g were comparedin terms of complication rates according to their delivery method. Subsequently,groups of patients were compared according to delivery weighing 4000 – 4499 gand ≥4500 g, and were analyzed to find out whether there are differencesbetween in terms of complications.Results: Macrosomic infanthistory, neonatal weight and concomitant DM were observed higher in the groupof caesarean delivery patients. No difference was found in neonatal complications.Maternal postpartum hemoglobin levels were significantly lower in caesariandelivery group. No difference was found in terms of complication rates betweenboth delivery method groups in babies born over 4500 g, whereas postpartumhemoglobin level was significantly lower in the group of caesarian delivery ofbabies weighing 4000 – 4499 g.Conclusion: Itis observed that routine caesarian delivery does not provide a significantadvantage in reducing complications in macrosomic infants. Women with suspected fetal macrosomia should be individualized and prophylactic cesarean delivery may be consideredfor patients who has the risk of delivery complications.

letter to the editor

The aim of this study was to investigate the possible therapeutic effects of Doxycycline (Dox) on endometriotic lesions in an experimental rat model. Thirty-seven female Wistar albino rats with surgically induced endometriosis were randomized and divided into four groups. The rats were administered 5 mg/kg/day oral Dox in Group 1 (low-dose Dox group, n=9), 20 mg/kg/day oral Dox in Group 2 (high-dose Dox group, n=10) and 1 mg/kg single dose, subcutaneous leuprolide acetate in Group 3 (leuprolide acetate group, n=9). The rats in Group 4 (control group, n=9) were given no medication. The rats received medication for three weeks and were then sacrificed to evaluate the morphological and histological features of the implants. Matrix metalloproteinase (MMP)-9 immunoreactivity of the implants was also evaluated. The size of the endometriotic implants decreased in Groups 1-3 but statistically significant differences were not observed among the groups. The mean surface area of the endometriotic implants decreased from 69.3 +/- 30.8 to 52.1 +/- 27.0 mm(2) in Group 1 (P>0.05), from 60.2 +/- 18.9 to 38.6 +/- 28.7 mm(2) in Group 2 (P>0.05) and from 58.1 +/- 33.1 to 26 +/- 9.0 mm(2) in Group 3 (P=0.03). The epithelial MMP-9 immunohistochemical score was significantly higher in Group 1 and lower in Group 3 when compared with the control group (Group 4) (P=0.042 and P=0.014, respectively). When the stromal MMP-9 immunohistochemical and histopathological scores of the endometriotic implants were compared, no statistically significant differences were found among the groups. Although there was no statistically significant difference, Dox reduced the endometriotic implant area in the rat endometriosis model. Further studies are required to investigate the potential efficacy of Dox in endometriosis due to its widespread use and tolerability.

Tapisiz, Omer/0000-0002-7128-8086 WOS: 000348826200002 PubMed: 25462212 Objective: Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT(1)Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT(1)Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model. Study design: Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF. Results: The mean area of implants decreased from 48.2 +/- 24.7 to 293 +/- 15.8 mm(2) in Group I (M) (P = 0.008) and from 62 +/- 32.1 to 39.9 +/- 18.1 mm(2) in Group II(L) (P = 0.003). In Group III (C), the mean area increased from 41.1 +/- 31.1 to 60.4 +/- 37.1 mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group I (M) in epithelial VEGF immunostaining when compared to Group II(L) and Group III (C) (P = 0.006). Conclusion(s): Montelukast may effectively cause a significant decrease in the area of endometriotic implants. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Aim To determine factors associated with face presentation of term fetuses delivered. Methods Of 34 480 consecutive, term deliveries of uncomplicated pregnancies within a 3-year period, all live, singleton term fetuses with cephalic presentation in which no lethal anomalies occurred that were diagnosed with a face presentation were studied. Factors that may have contributed to the etiology of the presentation including age, parity and fetal size were evaluated. Ultrasonographic evaluation was recorded. Results Fifty cases were diagnosed with an incidence of 0.14%. Parity was not associated with face presentation. Birthweight of 4000 g or more indicated an increased risk of approximately 2.9-fold, whereas fetuses weighing 3000–3499 g were found to have a relatively decreased risk of face presentation when compared with the general obstetrics group (P = 0.015 and 0.001, risk ratio = 2.948 and 0.450, respectively). With physical examination, only 70% were diagnosed correctly. Conclusion Face presentation is a rare event and birthweight more than 4000 g was found to be associated with face presentation. Parity is not an associated factor.

Objective: Knowledge of baseline laparoscopic and robotic surgical skills of future learners is essential to develop teaching strategies that best fit them. The objectives of this study are to determine baseline laparoscopic and robotic skills of high school and college students and compare them to those of current obstetrics and gynecology residents.Material and Methods: A cross-sectional (Class II-2) pilot study. Laparoscopic and robotic surgical skills of college and high (secondary) school students were evaluated using simulators and compared to those of obstetrics and gynecology residents. In addition, questionnaire data were collected regarding video game playing and computer use.Results: A total of 17 students, both high school (n=9) and college (n=8), in addition to 11 residents, completed the study. Overall, students performed comparably to the residents in simple exercises (p>.05). However, students took significantly longer time to complete complex exercises (p=.001). Finally, students played video games significantly more than residents (p

Despite the fact that spontaneous (non-traumatic) bilateral humeral fractures without trauma are seen as a rare entity, especially grand mal epileptic convulsions may result in these types of fracture in the adult. A 32-year-old early postpartum patient without osteoporosis and with a history of epilepsy is presented here. She had not used anticonvulsant drugs for nearly ten years. After a convulsive epileptic attack on the day of a cesarean section, bilateral humeral shaft fractures were diagnosed on the 5th postpartum day causing bilateral shoulder pain. An earlier chest anteroposterior X-ray including the humerus would be a help in order to perform earlier diagnosis. It should be taken into consideration that humeral bone fractures may happen without any trauma especially in early postpartum patients. A high degree of suspicion should be kept in mind while treating a patient in the post-ictal phase; as, if treated promptly, treatment leads to complete functional recovery.

Results: Considering all the cases, 94,4 % (n=2040) had normal cytology, 3,8 % (n=82) had LSIL and 1,8 % (n=39) had HSIL. In the cytological evaluation, 8,75% (n=189; n=115 HPV(+), n=74 HPV(-)) of the patients were diagnosed as ASCUS. The incidence of HPV positivity was 12,6% (n=272). The most common subtype was HPV type 6 (n=109, 5%) while the incidences of the other subtypes from second most common to least common were as follows; type 18 (n=63, 2,9%), type 16 (n=53, 2,4%), type 11 (n=20, 0,9%), type 45 (n=10, 0,4%), type 52 (n=10, 0,4%), type 59 (n=4, 0,18%) and type 51 (n=3, 0,14%). Among the HPV positive patients, the most common HPV subtype was type 6 (n=109, 40%), and the other subtypes were type 18 (n=63, 23,2%), type 16 (n=53, 19,5%), type 11 (n=20, 7,3%), type 45, 51, 52 and 59. Conclusions: Eighty-nine percent of the HSIL smears were positive for HPV subtype 16 and/or 18. This suggests that by the use of vaccination programs, a significant amount of precancerous cervical lesions and cancer might be prevented.

Trombositopeni, gebelikte cogunlukla masum olup tedavi gerektirmemesine ragmen agir trombositopenisi olan hastalarda postpartum kanamaya bagli maternal morbidite ve mortalite riski artmaktadir. Olgumuzda; 26 yasinda, 3.trimester basinda platelet sayisi normal sinirlarda olan fakat dogumdan bir gun once ciddi trombositopenisi tespit edilen gebenin periferik yaymasinda trombosit kumeleri gorulup fonksiyonlari normal olarak tespit edildi. Vajinal dogum sonrasi siddetli kanama gelismesiyle birlikte medikal tedavi ve kan/kan urunleri replasmani yapildi. Immunolojik neden goz onunde bulundurularak iv metilprednizolon uygulandi. Uygulanan tedavilere ragmen kanamanin devam etmesi uzerine kompresyon amaci ile uterin kaviteye Bakri balon, vajene adrenalinli tampon yerlestirildi ve kanamanin kontrol altina alinmasi ile birlikte 24. saatte cekildi. Hasta postpartum 6. gununde trombosit sayisi normal sinirlarda iken taburcu edildi. 6. haftadaki kontrolunde tekrar trombositopeni tespit edilen hastada lekelenme tarzinda kanama sikayeti mevcuttu. Immunolojik neden dusunulerek oral metilprednizolon baslandi ve 7 gun sonra trombosit sayisi yukselerek sikayetleri geriledi.

Objectives Chylous ascites is the pathologic accumulation of lymphatic fluid in the peritoneal cavity. Patients who underwent surgery for gynecologic malignancy and had postoperative chylous ascites were evaluated retrospectively. Methods We reviewed 1514 patients who had staging surgery for gynecologic malignancy at our institution from January 2003 to February 2012. We analyze the patients who develop chylous ascites and who didn't. Results Twenty-four (2%) patients had postoperative chylous ascites. In the patients with chylous ascites, the median number of removed para-aortic lymph nodes was 26 (range 8–54), while this number was 17 (range 1–76) for the patients who didn't develop chylous ascites (p=0.001). Among the patients with chylous ascites, nine patients took chylous diet and 15 patients took TPN as the initial treatment. Totally seven (29%) patients required surgical correction, since 17 (71%) responded to conservative treatment . In the TPN group, the time from staging surgery to the diagnosis of chylous ascites was significantly longer in the group who required surgery compared with the group who did not (20days vs 8days, p:0.037). In addition this time wasn't statistically different from the patients' time in the diet group who didn't require surgery. Conclusion The aggressiveness of para-aortic lymphadenectomy should be individualized and the lymphatics should be controlled with suture ligation or hemoclips, since the extent and method of para-aortic lymphadenectomy has a determinative role in the development of chylous ascites. It may be logical to treat chylous ascites with diet rather than TPN initially in case the symptoms occur later.

To determine the incidence, indications and the risk factors of emergency peripartum hysterectomy (EPH). We analyzed retrospectively 30 cases of emergency peripartum hysterectomy performed at the Obstetrics Department of a tertiary, research and education hospital between the years of 2006 and 2010. Demographic, medical and clinical data of the patients were recorded. Data stored were expressed as mean ± standard deviation. There were 30 cases of EPH among 82,363 deliveries. The overall incidence of EPH was 0.364 per 1,000 deliveries from 2006 to 2010. Nine hysterectomies were performed after vaginal delivery (0.16/1,000 vaginal deliveries) and the remaining 21 hysterectomies were performed after cesarean section (0.78/1,000 cesarean sections). Two cases (6.7 %) were performed as subtotal and remaining 28 cases (93.3 %) were performed as total hysterectomy. Indications of EPH were uterine atony (43.3 %, 13/30), placenta accreta (40.0 %, 12/30) and uterine rupture (16.7 %, 5/30). All patients [7/7 (100 %)] with placenta previa and 11 of 12 patients (91.7 %) with placenta accreta had previously cesarean sections. There were two maternal deaths due to coagulopathy and pulmonary embolism. Two stillbirths (6.6 %) and 2 early neonatal deaths (6.6 %) were recorded. It should be kept in mind that cases of placenta previa and/or placenta accreta with previous cesarean sections have a very high probability of EPH. The delivery should be performed in suitable clinical settings with experienced surgeons when the risk factors like placenta previa and/or placenta accreta are determined so as to achieve optimal outcome.

SUMMARY Infertility is defined as the time of one year of unprotected intercourse without conception and affects approximately 15% of the couples. Data available over the years reveal that pathology is found among 55% of cases in women, 35% of cases in men and the remaining 10% of cases are defined as unexplained infertility. Male infertility is commonly due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It should be the first laboratory investigation for men while evaluating a couple's infertility. Here, we tried to review the semen analysis as a very important laboratory investigation in evaluating the infertile couples with all points in the light of last published World Health Organization (WHO) criteria.

Pelvic organ prolapse is a highly prevalent condition, and the lifetime risk of requiring surgical treatment could be as high as 11% [1, 2]. Among patients who wish to retain their reproductive capacity or retain their uterus, uterine conservation can be offered. A variety of surgical techniques including vaginal, abdominal, and laparoscopic (conventional or robotic) approaches can be used. Minimally invasive approaches have been associated with reductions in morbidity associated with open techniques, but also with longer operative times [3]. This article is protected by copyright. All rights reserved.

To compare cytogenetic data of first-trimester missed abortions in intracytoplasmic sperm injection (ICSI) for non-male factor-mediated and spontaneous pregnancies.Using karyotype analysis, we conducted a retrospective cohort trial of missed abortions following ICSI for non-male factor and spontaneous pregnancies. Patients experienced missed abortions during the first 12 weeks of pregnancy. Dilation and curettage procedure was performed followed by cytogenetic evaluations. Two patient groups were created: ICSI (n = 71) and spontaneous pregnancies (n = 81). At least 20 GTG-banded metaphases were analyzed in each case for cytogenetic analyses. Statistical analyses were performed using NCSS 2007 Statistical Program software. The significance level and confidence interval for all analyses were set to p 0.05 and a 95% confidence interval, respectively.A total of 49.3% (75/152) of the miscarriages were cytogenetically abnormal among the patients. We detected cytogenetically abnormalities in 47.9% (34/71) of the ICSI group and 50.6% (41/81) of the control group, which were not statistically significant differences (p=NS). The sex chromosome abnormalities were similar between the ICSI and control groups (p=NS). The most prevalent abnormalities that were observed in the ICSI and control groups with first-trimester pregnancy loss were trisomy (n = 42; 27.6%), Turner syndrome (45, X0, n = 13; 8.6%), triploidy (n = 13; 8.6%), 48 chromosomes (n = 5; 3.3%), and mixed chromosomal abnormalities (n = 3; 1.2%). In addition, the karyotypes were similar between the ICSI and control groups (p=NS). We observed increases in fetal aneuploidy rates with increased maternal age (30 years = 23.9% vs. 31-34 years = 37.0% vs. 35-39 years = 82.9% vs.39 years = 90.9%). However, the observed increases in fetal aneuploidy rates were not statistically significant (p=NS).The aneuploidy rates and sex chromosome anomalies following ICSI for non-male factor were similar to those following natural conception.

The increasing use of laparoscopy has resulted in added complications specific to the laparoscopic approach, such as trocar site hernia (TSH), which is an uncommon but well-recognized problem for both regular laparoscopic and robotic-assisted laparoscopic procedures. We describe an extremely rare case of TSH at an 8-mm port site occurring a relatively short time after surgery in a 53-year-old patient undergoing roboticassisted laparoscopic hysterectomy for benign reasons. Additionally, this report attempts to explain the possible etiological factors relating to TSH following robotic-assisted surgery. According to our case report, a defect in the 8-mm port that may lead to hernia is one possible explanation, and closure of the 8-mm trocar sites' fascia may be a safer approach during robotic-assisted surgery. Additional reports are needed to accurately determine the frequency of occurrence and importance of this complication. Copyright (C) 2013 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.

In our study, we aimed to determine the prevalence of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections among infertile couples and effects of these infections on infertility.Prevalence of Chlamydia, Mycoplasma, Ureaplasma antibodies and Chlamydia IgM antibodies and its effect on these agents' sperm parameters, namely, morphology, density, and motility were investigated among a total of 212 patients including fertile and infertile couples. Chlamydia, Mycoplasma, Ureaplasma antigens were evaluated using ELISA in the cervical and urethral samples. Chlamydia IgM antibody was measured using micro-ELISA in blood samples.No difference was detected among the fertile and infertile groups in the serological investigation of urethral and cervical samples with respect to the prevalence of Chlamydia, Mycoplasma, Ureaplasma antigens and Chlamydia IgM antibody and sperm parameters (p0.05).There is no significant difference between fertile and infertile couples in terms of the prevalence of the above mentioned infections. Accordingly, during the infertility assessment, infertile couples should not be routinely screened for these infective agents without any clinically sound evidence.

Histomorphologic and morphometric effects of peripubertal superior ovarian nerve (SON) transection were evaluated during adult life in rats. Twenty Sprague-Dawley rats were randomly divided into two groups: the SON-transected (SON-t) group (n = 10) and the sham-operated control group (n = 10). Total follicle development was not influenced; however, follicular maturation was seriously stunted by the procedure, as evidenced by significantly thinner theca interna and follicular wall.