Search

Objective: To retrospectively analyze the data of patients who underwent relaparotomy in our clinic, to indicate the incidence, indications and mortality rate of relaparotomy. Methods: Our study included 47 patients who underwent relaparotomy in our clinic between the study dates. Demographic characteristics of the patients, indications for the first operation and the surgical procedure performed during the first operation, the center where the first operation was performed, the indications for relaparotomy and the surgical procedure performed during relaparotomy, the time between two operations, the number of blood transfusion products given, and the mortality after relaparotomy were noted. In our clinic, the incidence of obstetric and gynecological relaparotomy and the mortality rate after relaparotomy were calculated. Results: Of the patients included in our study, 89.4% consisted of patients who underwent obstetric relaparotomy, and 10.6% underwent gynecological relaparotomy. In our clinic, the incidence of obstetric relaparotomy was 0.1%, and the incidence of gynecological relaparotomy was 0.06%. We found the mortality rate of our clinic after relaparotomy to be 2.1% (1/47). We found that the first operations of patients who underwent obstetric relapatomy were cesarean section most frequently with a rate of 81% (34) and a previous cesarean section was the most common indication in 23.8% (10). It was determined that total abdominal hysterectomy was performed most frequently in 80% (4) of the first operations of patients who underwent gynecological relaparotomy, and abnormal uterine bleeding was the most common indication in 60% (3). We determined that the most common indication for both obstetric and gynecological relaparotomy in patients who underwent relaparotomy was hematoma-hemorrhage (64.3% and 40%, respectively). We found that hematoma evacuation-bleeding control was the most common procedure performed in relaparotomy in both obstetric and gynecological relaparotomy (52.4% and 40%, respectively). Conclusion: After the necessary preparations are made, the decision to relaparotomy should be made without delay. Patients with risk factors should be informed in advance and we should recommend that their first surgery be performed in tertiary hospitals as much as possible. We think that we can reduce the need for relaparotomy by controlling the bleeding during the first operation.

COVID-19, 2019’un sonlarında Çin’de ortaya çıkarak tüm dünyaya yayılmıştır. Etken olan virüs "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)"olarak tanımlanmıştır. Hastalık esas olarak damlacık yoluyla bulaşmaktadır. Genel olarak inkubasyon süresi 2-14 gün arasında değişmektedir. Gebeliğin SARS-CoV-2 enfeksiyonuna duyarlılığı artırmadığı, ancak aynı yaştaki gebe olmayan kadınlara kıyasla COVID-19'un klinik seyrini kötüleştirdiği bildirilmiştir. Gebelikte ciddi hastalık ve ölüm için risk faktörleri arasında ileri yaş (özellikle ≥35 yaş), obezite ve diğer komorbiditeler ( hipertansiyon, diyabet vb.) yer alır. Vertikal geçişin sıklığı henüz tam olarak bilinmemektedir. Gebelikte geçirilen COVID-19'un düşük, ölü doğum, neonatal ölüm ve konjenital anomali riskini arttırmadığı düşünülmektedir. Erken doğum ve sezaryen doğum oranlarının COVID-19'lu gebelerde arttığı bildirilmiştir. Gebelik sırasında COVID-19 aşılarının güvenliği ve etkinliği ile ilgili giderek daha fazla veriye ulaşılmaktadır. Bu verilere dayanarak gebelerin COVID-19 aşısı olmaları önerilmektedir. Gebelerde komplike olmayan COVID-19 enfeksiyonu için tedavisiz izlem seçeneği öncelikle düşünülmelidir. Olası tanı almış olan gebelerde risk faktörü varsa veya ağır seyir söz konusu ise tedavi verilmesi düşünülmelidir. COVID-19 pozitifliği doğum için bir endikasyon değildir. Doğum şekline rutin endikasyonlara göre karar verilmelidir. Doğumda multidisipliner bir bakım ekibi mevcut olmalıdır. COVID-19 enfeksiyonu olan anneler doğum odasında cerrahi maske takarak ve uygun el hijyeni ile cilt cilde temasta bulunabilir ve emzirme yapabilirler. Tüm yetişkinlerde olduğu gibi doğum sonrası kadınlara da COVID-19 aşısı önerilmektedir.

Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy. Keywords: Infertility; hysterosalpingography; laparoscopy; tubal factor.

OBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p

Objective: The aim of this study was to investigate the underlying causes of obstetrical disseminated intravascular coagulation (DIC) and to evaluate the laboratory and clinical signs affecting DIC-related morbidity and mortality in women diagnosed with obstetrical DIC in a tertiary referral hospital. Method: The retrospective study included women with DIC who either had a delivery at Dicle University Medical School Gynecology and Obstetrics Department or were referred to this department prior to delivery between May 2006 and May 2016. DIC scoring was performed using the DIC scoring system developed by the International Society of Thrombosis and Hemostasis (ISTH) in 2001. Results: A total of 82 women with obstetrical DIC were included in the study. The incidence of obstetrical DIC in our department was 0.41%. Overall mortality rate was 24% and mortality occurred in 8% of the patients with a DIC score of ≤5 and in 12% of the patients with a score of >5 (p=0.043). Multiple logistic regression analysis indicated that increased INR (International Normalized Ratio) and ALT (Alanin Aminotransferaz) levels led to a significant increase in DIC-related mortality [OR: 1.803 (CI: 1.027-3.167), OR: 1.003 (CI: 1.001-1.005), respectively]. Conclusions: Obstetrical DIC may result in high mortality and morbidity. DIC scoring can be useful for predicting the prognosis and DIC-related mortality. INR and ALT is the most important laboratory parameter in DIC and also can affect mortality.

Objective: The aim of this study is to evaluate the obstetric and neonatal outcomes of pregnant women delivering large for gestational age (LGA) infants. Material and Methods: A total of 399 pregnant women giving birth to LGA infants in the Gynecology and Obstetrics Department of Dicle University Medical Faculty Hospital between January 2014 and December 2018 were included in this retrospective study. Demographic features, pregnancy and infant data, delivery type (vaginal delivery/cesarean delivery), and patients’ indications for cesarean section were assessed. Results: The mean age of the patients was 32.34±6.63, their gravida was 5.16±2.65 and parity was 3.55±2.36. The mean gestational week was 37.12±2.840 weeks and the mean birth weight was 3922.46±643.546 g. Of all patients, diabetes was detected in 28.5%, polyhydramnios in 11.3%, placental invasion anomaly in 4%, and preeclampsia in 9%. While 83.7% (334) of the patients underwent cesarean section, the remaining 16.3% (65) underwent normal delivery. 3.25% (13) of the patients developed complications during delivery. The rate of fetal anomaly was 11.7% (47) in existing pregnancies while the rate of fetal death was 5.01% (20). Conclusion: A cesarean delivery was performed in the majority of pregnant women with a suspected LGA infant. This group of patients exhibited a very high rate of gestational diabetes mellitus and diabetes mellitus. Existing pregnancies constitute a specifical pregnancy population that should be taken into consideration regarding probable complications and problems with the infant.

Objective: This study aimed to determine intrapartum cesarean section rates of our clinic as well as risk factors for intrapartum cesarean section. We also aimed to identify patients with risk factors beforehand and to reduce the intrapartum cesarean section rates and the complications that might occur due to intrapartum cesarean sections. Material and Methods: A total of 150 patients admitted to our clinic for vaginal delivery that ended up having intrapartum cesarean sections (case group) and 200 patients who had a vaginal delivery (control group) were included in our study retrospectively. Demographic, clinical, and neonatal results of the patients were compared. Results: Intrapartum cesarean section rate was determined to be 23% (150/654). The most common indication for intrapartum cesarean section was fetal distress (48%). We found that low gestational week at delivery, nulliparity, and polyhydramnios were independent risk factors for intrapartum cesarean section. We determined that gravidity and parity were not risk factors for intrapartum cesarean section. It was found that 1st minute APGAR scores of babies of patients with intrapartum cesarean section were significantly lower and that intrapartum cesarean section was an independent risk factor for this particular finding. Conclusion: The possibility of the intrapartum cesarean section should be considered in the labor follow-ups of patients with risk factors. We recommend hospital deliveries where the necessary conditions for the mother and fetus are met.

Objectives: To compare preoperatively, intraoperatively and postoperatively the maternal and ne-onatal outcomes of normal-weight, obese and morbid obese pregnant women who delivered by cesarean section in our clinic. Methods: This study retrospectively included 151 singleton pregnancies delivered at ≥37 weeks of gestation by cesarean section. Demographic, clinical and neonatal results of the patients were not-ed and compared between the groups. Results: Among the pregnant women included in this study, length of postoperative hospital stay and presence of chronic diseases were determined to be significantly higher in the morbid obese group compared with other groups (p

Introduction: This study aims to evaluate the pre- and postoperative outcomes of myomas operated in a tertiary clinic. Method: We retrospectively evaluated data from a total of 378 cases operated for myomas between January 2014 and December 2018 in the Dicle University Medical Faculty Obstetrics and Gynecology Clinic. Results: There were 169 cases of abdominal myomectomy (44.7%), 156 cases of total abdominal hysterectomy (41.3%), 15 cases of laparoscopic myomectomy (4%), 13 cases of total laparoscopic hysterectomy (3.4%), 12 cases of myomectomy during cesarean delivery (3.2%), 9 cases of hysteroscopic myomectomy (2.4%), and 4 cases of vaginal myomectomy (1.1%). Pathology results revealed 341 cases of leiomyoma (88.2%), 32 cases of concomitant leiomyoma and adenomyosis (8.4%), and 13 cases of STUMP (3.3%). There were 5 cases of intraoperative bowel injury, 1 case of bladder injury, and 1 case of postoperative wound infection. Conclusion: Myomas can be surgically treated with satisfactory outcomes and low complication rates. The preferred surgical treatment will majorly depend on the patient's fertility expectations.

Amaç: Bu çalışmada; gebelerde, Toxoplasma gondii, Rubella virüs ve Cytomegalovirus infeksiyonlarının bölgemizdeki seroprevalanslarının belirlemesi amaçlanmıştır. Yöntemler: Bu çalışmada hastanemize Eylül 2016 ile Haziran 2018 tarihleri arasında kadın hastalıkları ve doğum polikliniklerine ilk prenatal vizite gelen 18-45 yaş arası gebeler dahil edildi. Bu hastalardan Toxoplasma gondii, Rubella ve Cytomegalovirus virüs serolojisi çalışılanların test sonuçları retrospektif olarak incelendi. Bulgular: Toxoplasma gondii antikorları açısından 8175 hastanın 2853’ inde (%34,9) anti toksoplazma gondii IgG antikorları, 91’ inde (%1,1) anti Toxoplasma gondii IgM antikorları pozitif olarak saptandı. Cytomegalovirus antikorları açısından 2797 hastanın 2775’ inde (%99,2) anti Cytomegalovirus IgG, 20’ sinde (%0,7) anti Cytomegalovirus IgM pozitif olarak saptandı.Rubella virüs antikorları açısından 8158 hastanın 7677’ sinde (%94,1) anti Rubellavirus IgG, 5’ inde (%0,1) anti Rubellavirus IgM pozitif olarak saptandı. Sonuç: Bu çalışmada hastanemize başvuran gebelerin çoğunun toksoplazma seronegatif (%65,1) olduğu tespit edildi.Rubella seroprevalansı (%94,1) Türkiye verileri ile uyumludur. Gebelerin Cytomegalovirus seroprevalansı için seropozitiflik oranı (%99,2) dünya verileri ile uyumludur.

Objectives:The main purpose of our study is to examine cases of pregnant patients with heart diseases in our tertiary referral hospital and to evaluate fetal and maternal outcomes.Materials and Methods:Pregnants with gestational age of 20 weeks or more and with any previous cardiac diseases were examined between 2013 and 2015 retrospectively. Fetal and maternal clinical data were collected accordingly.Results:In total, 6599 live births were carried out in our hospital. Of them, there were 120 pregnants with cardiac disease. Rheumatic valvular heart disease was the most common (n=66, 55%) disorder among the pregnants, followed by the heart rhythm disorders respectively (n=15; 12.5%). Twelve patients had congestive heart failure; twelve patients with congenital heart disease, eight patients with aort valve or aorta pathology; four with pulmonary hypertension, two with coronary artery disease and one with pericardial effusion. Three pregnants had left ventricular ejection fraction (LVEF) of less than 35%, six pregnants had LVEF between 35 to 50% and the rest of the pregnants had LVEF of >50%. Maternal death was not encountered, 22 patients (18.3%) were followed in cardiology intensive care unit postoperatively. Neonatal mortality was developed in 2 cases (1.66%) and the neonatal morbidity was developed in 6 cases (5%). The most common form of delivery was caesarean section (n=97, 81%). Premature birth ratio was 37.5% (n=45).Conclusion:Pregnants with heart disease have chance to give healthy births with low risk for maternal or neonatal complications provided close follow-up by a team of cardiologist, anesthetist, and obstetrician experienced in this field.

Objectives: The most important step in laparoscopic surgery is to safely establish the pneumoperitoneum, especially since approximately half of the complications occur during the initial entry into the abdomen. There is a distinct need to modify the available methods to reduce therate of adverse events in laparoscopic entry. In this study, a modified Veress technique (MVT) or Evsen method is introduced.The aim of this article was to present a modified Veress technique for establishing the pneumoperitoneum. Material and methods: The study was conducted at the Dicle University, Faculty of Medicine, Department of Obstetrics and Gynecology, from September 2016 to May 2017. A new laparoscopic entry technique was introduced and compared with the classical Veress technique. A total of 40 cases were included in the study. MVT and the classical Veress method were applied to 26 and 14 patients, respectively. Results: The pneumoperitoneum was established at the first attempt in 23 (88.5%) MVT patients and in 7 (50%) patients from the classical Veress method group. The number of insufflation attempts to establish a successful pneumoperitoneum was lower using MVT and the difference was statistically significant (p: 0.022). As far as time is concerned, a comparison between the groups revealed that the pneumoperitoneum was established in a statistically significantly shorter time using MVT (p < 0.00). Conclusions: The modified Veress technique proved to be superior to the classical Veress method for establishing the pneumoperitoneum. Using the new method, the pneumoperitoneum was established after fewer attempts and in a shorter time.

Objective: The present study aimed at the retrospective evaluation of the medicalrecords of patients treated for tubo-ovarian abscess (TOA) at our clinic and investigation of the efficacyof USG-guided drainage compared with that of other available treatment modalities. Materialand Methods: Medical records of 100 patients with TOA, who were treated and followed up atthe Department of Gynecology and Obstetrics, School of Medicine, Dicle University between January2009 and April 2015, were reviewed retrospectively. Details such as demographic data, risk factors,clinical and laboratory findings, treatment modalities used, and complications observed wererecorded for each patient. Results: The mean age of the patients was 36.46±11.6 years. Of the 100patients, 10 were menopausal women. Pelvic pain was the most common complaint in all patients(100%). The history of intrauterine or intra-abdominal intervention within six months was themost common risk factor (60.5% patients) for the development of TOA. Of the patients, 25% reportedfever (≥38 °C), 55% had leukocytosis, 85% had high sedimentation rate, and 92% had highCRP levels. The development of leukocytosis was not observed to be associated with the treatmentmodality used (p > 0.05). Of the patients, 38% underwent only medical treatment, 47% underwentmedical treatment followed by surgery, and 15% underwent medical treatment followed by USGguideddrainage. All 34 (72.3%) patients who had undergone surgical treatment required fertilitypreservingsurgery. Intraoperative bowel injury (6.3% patients) and wound site infection (8.5%patients) were among the common complications reported in patients undergoing surgical treatment.The mean duration of hospital stay was 7.9±6 days. The longest mean duration of hospital stay(10.5±3.9 days) was observed in the patients who had undergone USG-guided drainage. Conclusion:Broad-spectrum antibiotic therapy, the first step of treatment in patients with TOA, increasesthe size of abscess. In addition, a significant number of patients with bilateral abscesses require additionalintervention (surgery). Our findings suggest that USG-guided drainage should be consideredonly in patients not responding to medical treatment and not consenting to undergo surgicaltreatment.

Aim We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetal well-being. Methods Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonates were carried out. After the fetal cord was clamped, 5 cm3 blood was drawn into a plain tube without anticoagulant. The samples were centrifuged at 5000 r.p.m. for 5 min. Separated sera were transferred to Eppendorf tubes and were stored at −80 C° until the analysis time. Results The complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007). Conclusion We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.

Objective: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections).Study Design: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. Results: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results.Conclusion: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.

Objectives: This study aimed to evaluate data on early diagnosis and therapeutic management of rudimentary horn pregnancy (RHP). Material and methods: Patients diagnosed with RHP at a tertiary center between for two periods of 2008–2012 and 2013–2018 were analysed retrospectively. We obtained information of patients from hospital electronic archive registration system. Data on demographic characteristics, clinical presentation, gestational age at presentation, presenting symptoms, diagnostic methods, and therapeutic management were noted and analysed by descriptive statistical method. Demographic datas, the complaint of patient’s admission to hospital, history of cesarean section, preliminary diagnosis and intraoperative diagnosis were compared between periods of 2008–2012 and 2013–2018. Results: A total of 14 RHP patients were included. Eight (57.1%) of these patients were diagnosed between 2008–2012 (Group 1), whereas six patients (42.9%) were diagnosed between 2013–2018 (Group 2). Rudimentary horn was non-communicating in 13 patients (92.8%). Communicated form was observed in 1 patient in group 1. RHP was diagnosed on the left side in nine patients (64.2%). Six of these patients were observed in group 1 and 3 were in group 2. The pre-rupture diagnosis was made in 10 (71.4%) patients. Six (100%) of 10 patients were in group 2. In addition, in group 1, four patients (50%) experienced intraoperative RHP rupture. RHP was diagnosed before rupture in 2 (33.3%) patients in group 2. Conclusions: It is an indication of advanced ultrasonographic technology as well as increased carefulness on the physician side and raised alertness on the patient side that today both RHP and preoperative rupture of RHP are less frequent. Still, further awareness is required among physicians of the necessity of excision of a rudimentary horn that is detected at the time of C-section.

WOS:000599171400013 In February 2020, the World Health Organization identified the coronavirus disease 2019 (COVID-19). The virus that causes COVID-19 is known as severe acute respiratory syndrome coronavirus 2. Nations worldwide have reported high death tolls and are adopting measures, particularly in Turkey wherein efforts are made to ensure that pregnant women are minimally affected by this epidemic that has such terrible effects. To date, a total of 206,844 cases have been confirmed in Turkey in approximately 115 days. However, the exact number of pregnant COVID-19 patients in Turkey or worldwide is not yet known. There are no conclusive data that confirm whether pregnant women are at a higher risk of acquiring this infection compared to the rest of the population. It is also not yet known if or how fetuses will be affected by this infection. However, the body of research evidence concerning COVID-19 is rapidly growing, and multiple organizations are constantly updating and expanding resources for interim guidance. In this review, we aimed to summarize the latest available research on COVID-19 virology and epidemiology as well as the status of pregnant healthcare workers together with the reported data on pregnant women and other recent findings and to discuss COVID-19 during pregnancy based on the available data.

WOS:000610981400003 PMID: 33447992 Objective: To investigate the levels of anti-angiogenic factors, namely sFlt-1 and Netrin-4, in patients with preeclampsia (PE). Material and methods: Cord-blood (UC) sFlt-1 and Netrin-4 concentrations were measured in 30 patients with severe PE, 30 patients with PE and 30 control infants and their mothers (MS). Results: Maternal sFlt-1 levels were significantly higher in the severe PE and PE groups than in the control group. There were no statistical differences among the three groups in maternal and fetal Netrin-4 levels. But Netrin-4 levels were found to be the lowest in the control group and higher in the PE and severe PE groups. The correlation analysis revealed a positive correlation between maternal sFlt-1 levels and maternal Netrin-4 levels (p = 0.012, and r = 0.263), maternal sFlt-1 levels and fetal sFlt-1 levels (p = 0.012, and r = 0.263). Conclusions: There was a positive correlation found between maternal sFlt-1 levels and maternal Netrin-4 levels. We are of the opinion that elevation in levels of Netrin-4 might be secondary to placental hypoxia occurring in PE. The present study led to the consideration of anti-angiogenic biomarkers (sFlt-1 and Netrin-4) on automated platforms for clinical use as an aid in establishing the diagnosis and prognosis of PE.

To identify whether red blood cell distribution width coefficient of variation (RDW-CV) and mean platelet volume (MPV) levels can predict clomiphene citrate resistance (CC-R) in infertile, anovulatory females with polycystic ovarian syndrome (PCOS).A total of 89 infertile patients who were admitted to a tertiary center diagnosed with non-obese PCOS were included in this study. The patients were divided into two groups: the first group comprised 53 non-obese patients with PCOS and CC-R, and the second group included 36 non-obese patients with PCOS and CC-S. RDW-CV, RDW-SD, and MPV values, along with routine whole blood count parameters were compared between the groups.RDW-CV values were found to be significantly higher in the patients with CC-R compared to those with CC-S (P0.05). The sensitivity, specificity, positive, and negative predictive values were found to be 69%, 58.1%, 34.5%, and 12.5%, respectively, at an RDW-CV level of 12.85. The odds ratio was calculated as 3.077 (95% CI 1.245-7.603) in terms of the cut-off point.We think that RDW-CV which is a marker of inflammation is a simple, cheap, and accessible marker for the prediction of CC resistance.

Amaç: Bu çalışmada amacımız normal doğum hastalarını kontrol grubu olarak alarak anestezinin fetüs üzerine kısa dönem etkilerini araştırmak, spinal ve genel anestezinin karşılaştırılmasını yapmaktır. Yöntemler: Bu çalışmaya …… Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğine doğum yapmak için başvurmuş, herhangi bir risk faktörü olmayan 50 normal doğum ve 50 spinal, 50 genel anestezi olmak üzere elektif olarak yapılan sezeryanlar dahil edildi. Hastaların yaşları, gravide, pariteleri, gebelik haftaları, doğum kilosu, 1.dakika ve 5.dakika apgarları kaydedildi. Doğum sonrası balon-valv-maske ihtiyacı olan ve yenidoğanın geçici taşipnesi olan bebekler kaydedildi. Bulgular: Çalışmamızda, her iki anestezi tipi ve normal doğum hastaları karşılaştırıldığında 1. dk apgar skorları arasında istatistiksel olarak anlamlı bir farklılık yoktu (p>0.05). 5.dk apgar skorları genel anestezi grubunda spinal anestezi grubuna göre anlamlı olarak daha düşük bulundu (p=0.018). Spinal anestezi grubundaki hastaların 50 (%100)’si, genel anestezi yapılan hastaların 45 (%90)’i, normal doğum yapılan hastaların 48 (%96)’sının 5 dakika apgar skorları>7 üzerinde olup spinal ve genel anestezi grupları arasında anlamlı bir farklılık izlendi (p:0.022). Gruplar arasında balon-valv-maske uygulanması ve yenidoğanın geçici taşipnesi açısından anlamlı bir farklılık izlenmedi (p>0.05). Sonuç: Sonuç olarak spinal anestezi erken dönem neonatal sonuçlar açısından daha iyi olup hangi anestezi yönteminin uygulanacağına her iki yöntemin avantaj ve dezavantajları, hastada mevcut olan patolojiler, operasyonun aciliyeti gibi faktörler, anestezistin deneyimi ve hastanın tercihi göz önünde bulundurularak karar verilmelidir. Genel anestezi yapılma zorunluluğu varsa tercih edilecek ilaçlar açısından fetüse depresan etkisi en az olanlar tercih edilmelidir. Objective: We aimed to investigate the short term effects of anesthesia on the fetus as a control group of patients who have a normal birth and to make a comparison of spinal and general anesthesia. Methods: Normal birth 50 patients without any risk factors and 50 spinal anesthesia and 50 general anesthesia patients with elective caesarean section, applied to giving birth to …..University Department of Obstetrics and Gynecology, were included in this study . The age of the patient, gravida, parity, gestational age, birth weight, 1th and 5th minute apgar score were recorded. It was saved infants needed balloon-valve-mask and infants with transient tachypnea of the newborn in the postpartum period. Results: In our study, 1 min Apgar scores was not significant difference patients who have a normal birth compared to patients who have both type of anesthesia (p> 0.05). 5.dk Apgar scores were significantly lower in genel anesthesia compared to spinal anesthesia group (p: 0.018). Patients who underwent spinal anesthesia 50 (100%), patients who underwent general anesthesia 45 (90%), patients who have normal birth 48 (96%) have 5-minute Apgar scores> 7. 5- minute Apgar scores> 7 was observed significant higher in spinal anesthesia group compared to general anesthesia group (p = 0.022). Requirement of balloon-valve-mask and transient tachypnea of the newborn was not significant difference between groups (p> 0.05). Conclusion: Spinal anesthesia are better in terms of early neonatal outcome, choice of anesthetic technique which will be used should be made on the basis of advantages and disadvantages of both techniques, comorbidities present in the patient, urgency of the operation, experience of the anesthesiologist and patient's choice. If general anesthesia will be required, the drugs with least depressor effect on the fetus should be preferred.

Objective The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. Materials and methods Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. Results A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. Conclusions In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.

We present a very rare case of malignant transformation of a benign mature cystic teratoma. The pathology report revealed malignant transformation of both the epithelial and sarcomatous elements of a benign dermoid cyst. To the best of our knowledge, this appears to be the third case of a malignant fibrous histiocytoma and a squamous cell carcinoma developing from a mature cystic teratoma. Malignant transformation of a dermoid cyst is usually diagnosed postmenopausally, but our patient was premenopausal. The etiology and prognosis of malignant transformation of this benign condition remain unknown.

Objective: The aim of this study was to elucidate the etiology and treatment of primary ovarian insufficiency, which is of unknown cause in 95% of the cases. Materials and Methods: Thirty patients aged 18-40 years who presented to Dicle University Faculty of Medicine Clinic of Obstetrics and Gynecology between June 2012 and January 2014 and were diagnosed as having primary ovarian insufficiency based on their clinical and endocrinologic data, and 30 healthy controls were included in this study. Results: No significant differences were found between patients with primary ovarian insufficiency and control subjects in demographic data and lipid profile levels, thyroid- stimulating hormone, prolactin, and glucose. However, the neutrophil to lymphocyte ratio and levels of follicle-stimulating hormone, luteinizing hormone, total antioxidant status, total oxidant status, and oxidative stress index were significantly higher in patients with primary ovarian insufficiency than in control subjects. In the correlation analysis, follicle-stimulating hormone exhibited a positive correlation with total oxidant status, oxidative stress index, and the neutrophil to lymphocyte ratio (r=0.573** p

Aim The aim of this study was to investigate the potential association between neural tube defects and paraoxonase-1 activity in amniotic fluid. We studied total oxidant status, total antioxidant capacity, paraoxonase-1 activity and thyroid hormone amniotic fluid concentration in fetuses with neural tube defects. Methods The present study was performed at the Department of Obstetrics and Gynaecology and the Department of Clinical Biochemistry of Dicle University between September 2011 and June 2013. The study group included 37 amniotic fluid samples from pregnant women (16–20 weeks of gestation) with fetuses affected by neural tube defects. The control group consisted of 36 pregnant women who were diagnosed with a high-risk pregnancy according to first or second trimester aneuploidy screening and were later confirmed on amniocentesis to have genetically normal fetuses. Results Amniotic fluid paraoxonase-1 activity and total oxidant status were significantly higher (P = 0.023, P = 0.029, respectively) whereas free T4 was significantly lower (P = 0.022) in fetuses with neural tube defects compared with control subjects. In fetuses with neural tube defects, amniotic fluid paraoxonase-1 activity correlated positively with total oxidant status (r = 0.424**, P = 0.010), and amniotic fluid total antioxidant capacity correlated positively with free t4 (r = 0.381*, P = 0.022). Conclusion This is the first study in the literature to show an association between paraoxonase-1 activity and thyroid hormone concentration and neural tube defects.

Objective: The aim of the present study is to provide a retrospective evaluation of placenta accreta cases to identify the factors affecting the blood transfusion requirement, which stands as one of the most important causes of maternal mortality and morbidity.study desıgn: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included in this study. The patients’ data were collected from the hospital’s records.Results: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The group of patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and the blood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007).Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates.

Background: The aim of this study was to evaluate the obstetric characteristics and maternal outcomes of patients undergoing bilateral hypogastric artery ligation (BHGAL) for primary postpartum hemorrhage (PPH). Materials and Methods: Digital records and hospital archives of patients who underwent BHGAL in the postpartum period after vaginal delivery (VD) or during or after cesarean section (C/S) in a tertiary center between May 2005 and May 2018 were reviewed retrospectively. Demographic characteristics, parity, gestational week, duration of operation, hospitalisation time, estimated blood loss, laboratory values, transfused blood volume, previous C/S history, and intensive care requirement of the patients were evaluated. The efficacy of BHGAL in controlling bleeding, indications, concomitant surgeries, and intraoperative and postoperative complications were evaluated. Results: There were 276.008 deliveries in our hospital in the specified period. Of the patients with PPH, 41 patients underwent BHGAL after VD and 19 patients underwent BHGAL during or after C/S. In 25 of 28 patients with PPH due to atony, bleeding was controlled by BHGAL, while 3 patients underwent hysterectomy together with BHGAL. While the effectiveness of BHGAL in uterine atony was 89.2%, the success rate was 33.3% when all cases were considered. The most common cause of indication for BHGAL was atony and disseminated intravascular coagulation (DIC) was the most common complication in patients undergoing BHGAL. Iliac vein injury was detected in one patient due to the procedure itself. Conclusions: BHGAL is more effective on controlling PPH due to atony compared to the control of other PPH causes. Most of the complications in these patients are not related to the procedure but are due to the complications of PPH. Therefore, BHGAL continues to be a life-saving method when applied by centers with adequate surgical knowledge and equipment. Amaç: Bu çalışmanın amacı, primer postpartum kanama (PPK) nedeniyle bilateral hipogastrik arter ligasyonu (BHGAL) uygulanan hastaların obstetrik özelliklerini ve maternal sonuçlarını değerlendirmektir. Materyal ve Metod: Mayıs 2005 ile Mayıs 2018 tarihleri arasında tersiyer bir merkezde postpartum dönemde vajinal doğum (VD) sonrası, sezaryan (C/S) esnasında ya da sonrasında PPK nedeniyle BHGAL uygulanan hastaların dijital kayıtları ve hastane arşiv dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, parite, gestasyonel hafta, operasyon süresi, yatış süresi, tahmini kan kaybı, laboratuvar değerleri, transfüzyon yapılan kan miktarları, önceki C/S öyküsü, yoğun bakım gereksinimi gibi parametrelere bakıldı. BHGAL’nun, kanama kontrolünü sağlamadaki etkinliği, endikasyonları, beraberinde uygulanan ek cerrahileri, intraoperatif ve postoperatif komplikasyonları değerlendirildi. Bulgular: Belirtilen sürede hastanemizde 276008 doğum olmuştur. PPK olan hastaların 41’ine VD sonrasında, 19’una ise C/S esnasında ya da C/S sonrasında BHGAL uygulandı. Atoni nedeniyle PPK olan 28 hastanın 25’ inde kanama BHGAL ile kontrol altına alınırken, 3 hastaya BHGAL ile birlikte histerektomi yapıldı. BHGAL’nun uterin atonide etkinliği %89,2 iken, tüm vakalar değerlendirildiğinde ise başarısı %33,3 olarak bulundu. BHGAL en sık atoni nedeniyle uygulandığı ve BHGAL uygulanan hastalarda en sık komplikasyonun dissemine intravasküler koagülasyon (DİK) olduğu görüldü. İşlemin kendisine bağlı ise bir hastada iliak ven yaralanması tespit edildi. Sonuç: BHGAL’in atoni nedenli PPK’daki kontrolü, diğer PPK nedenlerinin kontrolünden daha etkindir. Bu hastalarda komplikasyonların çoğu işleme bağlı olmayıp PPK’nın komplikasyonlarından kaynaklanmaktadır. Bu yüzden BHGAL, yeterli cerrahi bilgi ve donanıma sahip ellerde uygulandığında hayat kurtarıcı bir yöntem olmaya devam etmektedir.

Aim To investigate whether serum levels of neopterin and inflammatory markers including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and oxidative status indicators were altered in patients with hyperemesis gravidarum (HG) compared to asymptomatic pregnant women. Methods This cross-sectional study was performed including 30 pregnant women with HG (mean age: 30.67 ± 6.68) and 30 asymptomatic pregnant women (mean age: 28.00 ± 5.30). Demographic features, obstetric history, and the Pregnancy Unique Quantification of Emesis/Nausea (PUQE) index were noted. Complete blood count, serum biochemical assay and measurement of CRP, TNF-α, IL-6, total antioxidant status and total oxidative status (TOS) levels were taken and compared between groups. Results White blood cell count (P = 0.013), platelet count (P = 0.015), TOS (P < 0.001), and PUQE score (P < 0.001) were remarkably higher in HG pregnancies. On the other hand, serum levels of lactate dehydrogenase, (P < 0.001), sodium (P < 0.001), potassium (P < 0.001), chloride (P < 0.001) and TAS (P < 0.001) were higher in the control group. There was no difference in the levels of neopterin, CRP, TNF-α and IL-6. In patients with HG, a positive correlation was detected between TOS and serum levels of lactate dehydrogenase, while TNF-α, IL-6 and neopterin were positively correlated with hemoglobin levels. Conclusion Our results demonstrated no association between inflammation and HG. Elucidation of the pathophysiology and complex interaction between various inflammatory processes in HG necessitates further trials on larger series.

INTRODUCTION: Assessment of tubal patency plays an important role in the diagnosis of female infertility. Hysterosalpingography (HSG) and conventional laparoscopy with chromopertubation is traditionally used in the assessment of tubal patency. We aimed to determine the necessity of HSG in evaluation of infertile women according to risk factors for tubal pathology METHODS: This prospective case-control study include 174 infertile patients who were admitted infertility clinic. Age, duration of marriage, sexual relationship status, reproductive history were recorded. Patients were evaluated in terms of risk factors of tubal factors related infertility and existing risk factors were recorded. The patients were divided into 2 groups; Group 1 composed of patients with risk factors and Group 2 composed of patients without risk factors. RESULTS: History of abdominal surgery was the most common risk factors (82.97%) in patients. Thirty five of 47 (74.46%) patients in Group 1 had patency in any tuba and while 118 of 127 (92.91%) patients in Group 2 had patency in any tuba (p=0.001). Bilateral tubal occlusion were identified in 12 of 47 (25.53%) patients in Group 1, and in 9 of 127 (7.08%) patients in Group 2. The difference between two groups was statistically significant (p=0.001). DISCUSSION AND CONCLUSION: Hysterosalpingography may be neglected in case of the evaluation of infertile women without risk factors for tubal pathology. Thus, the patients without risk of tubal factor will be protected from hysterosalpingography procedure which do not provide meaningful contribution has a radiation hazard and is painful prosedure. Larger scaled studies on this subject are warranted to reach more precise conclusion. GİRİŞ ve AMAÇ: Kadın infertilite tanısında tubal açıklığın değerlendirilmesi önemli rol oynar. Histerosalpingografi ve kromopertubasyonlu laparoskopi, tubal açıklığın değerlendirilmesinde geleneksel olarak kullanılmaktadır. Risk faktörü değerlendirilmesine göre tubal faktör olabileceğini düşündüğümüz infertil kadınlarda doğrulama açısından histerosalpingografinin gerekli olup olmadığını belirlemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu prospektif vaka-kontrol çalışmasına infertilite polikliniğine çocuk sahibi olamama şikayetiyle başvuran 174 infertil olgu dahil edildi. Hastaların yaşı, evlilik süresi, cinsel ilişki durumu, reprodüktif öyküsü kaydedildi. Hastalar tubal faktör infertilitesine neden olabilecek risk faktörleri açısından sorgulandı ve mevcut risk faktörleri kaydedildi. Tubal risk faktörü taşıyıp taşımamalarına göre hastalar 2 gruba ayrıldı. Grup 1 risk faktörü taşıyanlar, Grup 2 ise risk faktörü taşımayanlardı. BULGULAR: Olgularda abdominal cerrahi öyküsü en sık (%82.97) bulunan risk faktörüydü. Grup1’de 47 olgunun 35 (%74.46)’inde herhangi bir tubada geçiş varken, Grup 2’de 127 olgunun 118 (%92.91)’inde herhangi bir tubada geçiş vardır. Grup 1’de 47 olgunun 12 (%25.53)’sinde, Grup 2’de ise 127 olgunun 9 (%7.08)’unda bilateral tubal tıkanıklık tespit edildi. Her iki grup arasında bulunan fark anlamlıydı (p=0.001). TARTIŞMA ve SONUÇ: Histerosalpingografi, tubal patoloji için risk faktörü taşımayan infertil kadın değerlendirmesinde yapılmayabilir. Böylece herhangi bir tubal risk faktörü taşımayan olgular, anlamlı katkıyı sağlamayan, ağrılı ve radyasyon tehlikesi göz ardı edilemeyen histerosalpingografi işleminden korunmuş olacaktır. Bu veriyi doğrulayacak daha geniş ölçekli çalışmalara ihtiyaç vardır.

BACKGROUND This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. MATERIAL AND METHODS The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman's and Chi-Square tests were used for statistical analysis. RESULTS Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. CONCLUSIONS Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.

Objective To evaluate the maternal and fetal demographic features and clinical aspects of twin pregnancies with single intrauterine demise. Materials and methods This retrospective study was conducted in Dicle University Faculty of Medicine, Department of Gynecology and Obstetrics between January 2008 and December 2013. There were a total of 594 twin deliveries in our hospital between the given dates. Twenty-nine of these cases were referred to our hospital by another health center because of a preliminary diagnosis of single intrauterine demise. Maternal age, parity, chorionicity, week of fetal death, gestational week at delivery, mode of delivery, birth weight, Activity, pulse, grimace, appearance, respiration scores, maternal fibrinogen levels at delivery and during pregnancy, stay in the neonatal intensive care unit, and obstetric complications were explored in these 29 cases of single intrauterine demise. Results The mean age of the 29 patients who were provided antenatal follow-up and delivery services in our hospital was 29.9±6.5 years. Thirteen (44.8%) of the patients were monochorionic, whereas 16 (55.2%) were dichorionic. Intrauterine fetal death occurred in the first trimester in 6 pateints and in the second or third trimester in 23. In addition, 20 (69%) patients underwent cesarean section, whereas 9 (31%) had spontaneous vaginal delivery. Lastly, none of the patients had a maternal coagulation disorder. Conclusion Twin pregnancies with single intrauterine death can lead to various complications for both the surviving fetus and the mother. Close maternal and fetal monitoring, and proper care and management can minimize complications.

The purpose of the present study is twofold: (a) to investigate the etiology of disseminated intravascular coagulopathy (DIC) caused by obstetrical conditions and (b) to present parameters that can be used in predicting DIC-related mortality in obstetrical patients.Obstetrical patients who had a delivery at or were referred (after delivery) to Obstetrics and Gynecology Clinic of Dicle University between July 2006 and December 2013 were retrospectively analyzed in this study. Those patients diagnosed with DIC were included in the study.Fifty-six obstetrical patients carrying the diagnosis of DIC were included in this study. The overall mortality rate was 25% among these patients. More specifically, the mortality rate was 10.7% among patients with a DIC score ≤5 and 40.7% among those with a DIC score 5. Multiple logistic regression analysis resulted in the finding that international normalized ratio (INR) and urea were among those factors affecting mortality in obstetrical DIC [OR: 8.44 (CI: 1.9-36.8), OR: 1.05 (CI: 1.0-1.1), respectively].DIC is a syndrome that might be caused by obstetrical conditions. It is associated with high mortality and morbidity rates. In obstetrical DIC, urea is the most important factor affecting mortality. In addition, we are of the opinion that DIC score might guide mortality predictions as a determinant of prognosis.

PMID: 28913059 Objective: To compare ‘‘vaginal hysterectomy alone’’ with ‘‘vaginal hysterectomy with prophylactic unilateral sacrospinous ligament fixation’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse (POP). Materials and Methods: Thirty-five patients underwent vaginal hysterectomy alone and 32 patients underwent vaginal hysterectomy with unilateral sacrospinous ligament fixation because of benign pathology between January 2012, and June 2014, were retrospectively analyzed in this study. The patients’ demographic data and preoperative and intraoperative findings were obtained from the hospital records and noted. The patients were invited by phone to a follow-up visit to assess their 1-year anatomic outcomes and symptoms. Results: There was no significant demographic difference between the patients who underwent vaginal hysterectomy alone and those who had a vaginal hysterectomy with sacrospinous ligament fixation. Both length of operation and hospital stay were significantly longer in the patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (p

Elif Agacayak,1 Serdar Basaranoglu,2 Senem Yaman Tunc,1 Mehmet Sait Icen,1 Fatih Mehmet Findik,1 Ibrahim Kaplan,3 Osman Evliyaoglu,3 Talip Gul1 1Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey; 2Department of Obstetrics and Gynecology, Idil State Hospital, Sirnak, Turkey; 3Department of Biochemistry, Dicle University School of Medicine, Diyarbakir, Turkey Introduction: The aim of this study was to investigate whether estradiol (E2), E2 combined with progesterone (Prog) (E2/Prog), and genistein (Gen) treatment had antioxidative and antihyperlipidemic effects in the plasma of ovariectomized (OVX) rats.Materials and methods: Adult female Sprague–Dawley rats were divided into five groups. Rats in all groups, except for those in a sham group, underwent bilateral ovariectomy under general anesthesia. The groups were as follows: sham group; control OVX group; group treated with estrogen (0.014 mg/kg 17-β E2); group treated with a combination of E2 and Prog (0.014mg/kg 17-β E2 plus 0.028 mg/kg drospirenone), and group treated with Gen (10 mg/kg/day). Plasma of rats of each treatment group was analyzed to determine the total antioxidant status, total oxidant status, paraoxonase activity, lipid profile, high-density lipoprotein (HDL-chol), low-density lipoprotein (LDL-chol), total cholesterol (Total-C), triacylglycerols, lipoprotein (a), and oxidative stress index.Results: Plasma Total-C levels and body weight increased in all the OVX groups compared with the sham group (P

Objective: To investigate the troponin I (cTnI) levels in preeclamptic women, compare with the values of healthy pregnant women and also to evaluate whether the association between troponin I levels with severity of preeclampsia. Methods: This study was performed with 83 preeclamptic pregnant women and 40 pregnant women control group having no medical problems who has admitted to the Obstetrics and Gynecology Clinics of Dicle University Medical Faculty between February 2009 and July 2009. Serum troponin I levels were measured and compared between two groups. Results: There was no correlation between serum cTnI levels with hemoglobin, hematocrit age, BMI, platelet count, systolic blood pressure, diastolic blood pressure, ALT, AST, LDH, urea and creatinine. There was no significant differences between the groups in preeclampsia and healthy pregnant women when compared in terms of Troponin I levels (p = 0.501) Conclusion: Preeclampsia was not associated with troponin I levels in our study. So patients with preeclampsia and elevated troponin levels should have further cardiac investigations and close cardiovascular follow-up.

Placental site trophoblastic tumor (PSTT) is a highly rare form of gestational trophoblastic diseases that arise from intermediate trophoblastic cells. By presenting this case, we aimed to review the treatment and diagnosis, approach to PSTT.A 31-year-old (G2P1A1L1) patient had abnormal vaginal bleeding. Serum ß-HCG was 5.82 mIU/ml and the transvaginal USG detected a polypoid mass in uterine cavity. Probe curettage was performed. Histopathologic specimens were confirmed as PSTT. No metastasis was detected. A total abdominal hysterectomy was performed.PSTT is a rare tumor. In contrast to other trophoblastic tumors, PSTT produces a small amount of ß-HCG and it is relatively insensitive to chemotherapy. Adjuvant chemotherapy is suggested to follow surgical treatment in the cases with metastasis.

Heterotopic pregnancy refers to simultaneous presence of intrauterine and ectopic gestational sacs. Its incidence ex­hibits a rising trend due to the increased use of assisted reproductive technology (ART). This paper aims to present a rare case of tubal and cesarean scar heterotopic pregnancy that occurred following a spontaneous pregnancy. The pa­tient presenting with delayed menstruation and abdominal-inguinal pain was evaluated. Transvaginal ultrasonography revealed a gestational sac located in the scar of a previous cesarean section and in the left tubal region corresponding to a gestational age of 4 weeks and 5 days. The patient was hospitalized and informed about conservative and surgi­cal methods. Then, she was administered a single dose of methotrexate 75 mg intramuscularly. Post-operative period included ultrasonographic and laboratory follow-up. In conclusion, it should be remembered that single-dose systemic methotrexate therapy might constitute an alternative to surgery in unruptured hemodynamically stable cases. J Clin Exp Invest 2016; 7 (2): 200-202

The aim of this study was to evaluate the morphometric and immunohistochemistry in umbilical cords from patients with severe pre-eclampsia with and without haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. The patient and control groups were similar according to baseline obstetric characteristics. White blood cell count in patients with HELLP syndrome and the control group was significantly increased among patients with HELLP syndrome (p < 0.001). Morphometric examination and endothelial core length were significantly different between the groups. In the umbilical cord cross-section of the HELLP group, endothelial cell degeneration in the vessel wall and basement membrane thickening were observed. In the muscle layer of blood vessels, the following disorders were found: increased collagen fibres in the muscle cell, hyperplasia and separation of muscle fibres as well as edema in the intermediate connective tissue. Immunohistochemical analysis showed that endothelial cells, basal membrane and fibroblast cells in the HELLP group expressed high levels of CD44. Vessel wall and amniotic epithelial basement membrane thickening were observed in the HELLP group. Matrix metalloproteinase 9 (MMP9) was expressed. Fibroblast and smooth muscle cells were fusiform and showed a positive reaction to immunohistochemical staining of α-actin smooth muscle.

BACKGROUND We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). MATERIAL AND METHODS A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. RESULTS No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). CONCLUSIONS It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area.

AMAC: Calismamizda tersiyer bir merkezde ektopik gebelik (EG) tanili hastalarda taniya giden adimlar ve tedavi yontemleri irdelendi. Son adet tarihine (SAT) gore gebelik haftasinin tedavi yontemleriyle iliskisi degerlendirildi. GEREC ve YONTEM: Calismamizda 2011-2014 tarihleri arasinda, ucuncu basamak olan klinigimizde EG tanisi ile tedavi edilen 192 olgu tanisal yontemlerine ve tedavi seceneklerine gore degerlendirildi. BULGULAR: EG insidansi 30.8/1000 olarak bulundu. Tek doz metotreksat (MTX) tedavisinin basari orani % 69.8, iki doz MTX ile birlikte medikal tedavinin basari orani ise % 87.5 olarak bulundu. Cerrahi uygulanan hastalarda en sik cerrahi prosedurun ( % 54) salpenjektomi oldugu tespit edildi. 37 hastada (% 19.2) ise izlem tedavisi yeterli oldu. Tedavi sekilleri ile belirli parametreler karsilastirildiginda; gelis β-hCG seviyesinin yuksek olmasi, fetal kardiyak atimin (FKA) pozitif olmasi, batinda serbest mayi olmasi, kitle boyutunun buyuk olmasi ve SAT’ a gore gebelik haftasinin buyuk olmasi ile cerrahi tedaviye gidis arasinda istatistiksel olarak anlamli fark oldugu saptandi (p

PMID:32083306 Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture Material and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Objective: To investigate the predisposing risk factors in the occurrence of complications after vaginal hysterectomy. Material and methods: The data obtained from 223 patients, admitted to tertiary care center that underwent vaginal hysterectomy due to benign pathology between January 2006 and March 2012 were retrospectively analyzed.Chisquare test was used to evaluate variables in categorized groups. Results: Group variables occurred age, number of pregnancies and abortion, parity, stage according to pelvic organ prolapse classification (POP-Q), periods of hospitalization and urinary catheterization. The main complications were hemorrhage, febrile morbidity and vaginal vault prolapse. Advanced age (> 60), pelvic prolapse, long-term hospitalization and urinary catheterization, were predisposing factors for the presence of complications. Conclusion: Vaginal hysterectomy is a safe and effective method, although not completely devoid of intraoperative or postoperative complications. Advanced age (> 60), POP-Q stage 3-4 pelvic prolapse, prolonged hospitalization and urinary catheterization were seem to be predisposing conditions for the existence of complications. Appropriate preoperative planning and meticulous postoperative care may be helpful to reduce the rate of complications.

BackgroundTo evaluate the protective effects of curcumin in experimental ischemia and ischemia/reperfusion (I/R) injury of rat ovaries.MethodsForty-eight female adult Wistar Albino rats were used. Rats divided into six groups and designed: Sham, Torsion, Detorsion, Sham + Curcumin, Torsion + Curcumin, and Detorsion + Curcumin. Except for the Sham and Sham + Curcumin group, all groups were performed to bilateral adnexal torsion for 3 h. Bilateral adnexal detorsion was implemented in the Detorsion and Detorsion + Curcumin groups. The injection of curcumin was intraperitoneally achieved 30 min before the sham, torsion and detorsion.ResultsTotal oxidant status levels (TOS), oxidative stress index (OSI) and histologic scores values of ovarian tissue were higher in the torsion and detorsion groups than the sham group (p

Amaç: Bu çalışmanın amacı grand multipar, endometrium kanserli hastaların tanısal ve klinik özelliklerini diğer endometrial kanserli hastalar ile karşılaştırarak değerlendirmektir. Yöntemler: Kliniğimizde Ocak 2006-Ağustos 2012 tarihleri arasında endometrium kanseri nedeniyle opere edilen 34 hasta dahil edildi. Hastalar doğum sayısına göre üç gruba ayrıldı; Grup 1 (doğum yapmamış hastalar, n=8), Grup 2 (doğum sayıları 1’den 4’e kadar olan hastalar, n=14), Grup 3 (grand multipar hastalar, n=12). Grand multipar hastaların tanısal, klinik ve histopatolojik verileri diğer gruplardaki hastalar ile karşılaştırıldı. Bulgular: Grup 3 (grand multipar) hastaların yaş ortalaması diğer gruplara göre anlamlı yüksek bulundu. (p0,05). Grup 1, 2 ve 3’ deki Evre 1A tümörlü hastaların oranlarının sırasıyla %75, %64,2 ve %83,3 olduğu bulundu. Ayrıca, bütün grand multipar hastaların evre 1 tümöre sahip oldukları bulunmuştur. Sonuç: Sonuç olarak, grand multipar hastaların tanıları daha geç yaşlarda konmakta, fakat erken evrede ve endometrioid tip endometrial kanser tanılarını almışlardır. Son doğumdan itibaren geçen süre endometrial kanser riski üzerine etkili bir faktör olabilir. Objective: The aim of the present study is to evaluate differences in diagnostic and clinical characteristics of the grand multiparous patients with endometrial cancer comparing with the other patients with endometrial cancer. Methods: A total of 34 patients that operated for endometrial cancer between January 2006 and August 2012 in our clinic were included. The patients were divided into three groups according to the number of births; group 1 (nulliparous patients, n=8), group 2 (the number of delivery from one to four, n=12), group 3 (grand multiparous patients, n=12). The diagnostic, clinical and histopathological data of the patients in the group 3 (grand multiparous patients) were compared with those of the other groups. Results: The mean age of the patients in group 3 (grand multipara) was found to be significantly higher than those of the other groups (p0.05). The percentages of patients with the tumor stage 1A in the groups 1, 2 and 3 were found to be 75%, 64.2% and 83.3%, respectively. All of the grand multiparous patients (group 3) were found to have stage 1 tumor. Conclusion: In conclusion, grand multiparous patients were diagnosed at advanced age but their diseases were endometrioid type endometrial cancer at an early stage. The protective effect of pregnancies against endometrial cancer decreases at advanced age. The period of time after last birth may be a factor on the risk of endometrial cancer.

SUMMARY Objective: The aim of the present study is to evaluate etiologic factors in patients with recurrent pregnancy loss (RPL). Material and methods: The records of patients admitted to Obstetrics& Gynecology Clinic of Dicle University Medical Faculty Hospital, from 2008 to 2011 were evaluated. Of the 114 patients who all tests were applied for diagnosis in our hospital were enrolled to study. For etiologic evaluation; Parental chromosome analysis, maternal antiphospholipid antibodies, hysterosalpingography for mullerian anomalies, thrombophilic disorders (factor V leiden mutation, prothrombin gene mutation) and endocrine (diabetes mellitus, thyroid hormone disorder) tests applied to patients. Results: The mean age and mean number of abortus were 29.7±6.6, 3.2±1.3 respectively. Fifty (43.9%) patients had at least one etiologic factor where as 64 (56.1%) were idiopathic. Major chromosomal aberrations were detected in four (%3.5) couples as inversion of the ninth chromosome. The frequency for other pathologies; mullerian anomaly:14 (%12.3), factor V leiden mutation:7 (%6.1), prothrombin gene mutation:6 (%5.3) and antiphospholipid antibodies in 10 (%8.8) patients. Conclusion: The prevalance for major chromosomal aberrations, mullerian anomalies, thrombopylic disorders and other pathologic conditions which evaluated in the study were found similar to reported previously. Polymorphism of 9qh+ (heterochromatic centromeric regions) was seen in 39 (%34.2) parents. Further studies are needed to understand that, if this result related to the genetic polymorpisym of the study population? or the pathology associated with RPL?.

Objective: Etiology of premature preterm rupture of membranes (PPROM) is not yet completely known and chorioamnionitis is one of the most important complications of its. We aimed to evaluate whether prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in vaginal washing fluid (VWF) were associated with etiology of PPROM and whether these markers could be used to predict chorioamnionitis in PPROM. Study Design: This prospective case control study enrolled fifty pregnant women with PPROM and 50 healthy pregnant women. The VWF samples were taken at the time of admission in the PPROM group and patients were followed for chorioamnionitis. Prolidase, matrix metalloproteinases, oxidative-antioxidative status, and inflammation markers in VWF were assayed. Results: VWF levels of prolidase, matrix metalloproteinases 1-13 (p< 0.001), oxidative stress parameters, total oxidative stress (TOS) (p < 0.001) and oxidative stress index (OSI) (p = 0.002), and hs-CRP (p = 0.045) were significantly higher in the PPROM group than in the controls. Antioxidative status parameters, levels of paroxanase (PON-1) (p < 0.001) and total antioxidant capacity (TAC) (p < 0.001), were significantly lower in the PPROM group than in the controls. Mean VWF levels of prolidase (p < 0.001), metalloproteinases (p

Objective: To determine the predisposing factors, modes of clinical presentation, management modalities and fetomaternal outcomes of uterine rupture cases at a tertiary care center in Turkey. Methodology: A 14-year retrospective analysis of 61 gravid ( >20 weeks of gestation) uterine rupture cases between January 1998 to March 2012 was carried out. Results: The incidence of ruptured uteri was calculated to be 0.116%. Persistence for vaginal delivery after cesarean was the most common cause of uterine rupture (31.1%). Ablatio placenta was the most common co-existent obstetric pathology (4.9%). Bleeding was the main symptom at presentation (44.3%) and complete type of uterine rupture (93.4%) was more likely to occur. Isthmus was the most vulnerable part of uterus (39.3%) for rupture. The longer the interval between rupture and surgical intervention, the longer the duration of hospitalization was. Older patients with increased number of previous pregnancies were likely to have longer hospitalization periods. Conclusion: Rupture of gravid uterus brings about potentially hazardous risks. Regular antenatal care, hospital deliveries and vigilance during labor with quick referral to a well-equipped center may reduce the incidence of this condition.

We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetal well-being.Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonates were carried out. After the fetal cord was clamped, 5 cmThe complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007).We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.

The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity.MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n = 329); Group 2: third CDs (n = 225); Group 3: fourth CDs (n = 447); Group 4: fifth CDs (n = 132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files.The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture.According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

Senem Yaman Tunc,1 Elif Agacayak,1 Neval Yaman Goruk,2 Mehmet Sait Icen,1 Abdulkadir Turgut,1 Ulas Alabalik,3 Cihan Togrul,4 Cenap Ekinci,5 Aysun Ekinci,6 Talip Gul1 1Department of Obstetrics and Gynecology, School of Medicine, Dicle University, 2Department of Obstetrics and Gynecology, Diyarbakir Memorial Hospital, 3Department of Pathology, School of Medicine, Dicle University, Diyarbakir, 4Department of Obstetrics and Gynecology, School of Medicine, Hitit University, Corum, 5Department of Histology and Embryology, 6Department of Medical Biochemistry, School of Medicine, Dicle University, Diyarbakir, Turkey Aim: The purpose of this study was to investigate the protective effect of honokiol on experimental ischemia/reperfusion injury of rat ovary.Materials and methods: A total of 40 female Wistar albino rats were used in this study. The rats were divided into five groups as follows: sham (Group I), torsion (Group II), torsion + detorsion (Group III), torsion + detorsion + saline (Group IV), and torsion + detorsion + honokiol (Group V). Bilateral adnexa in all the rats except for those in the sham group were exposed to torsion for 3hours. The rats in Group IV were administered saline, whereas the rats in Group V were administered honokiol by intraperitoneal route 30minutes before detorsion. Tissue and plasma concentrations of malondialdehyde and nitric oxide were determined. Ovarian tissue was histologically evaluated. Data analyses were performed by means of Kruskal–Wallis test and Mann–Whitney U-test (Bonferroni correction) in SPSS 15.0 (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL, USA).Results: The torsion and detorsion groups had higher scores in vascular congestion, hemorrhage, and inflammatory cell infiltration compared with the sham group (P