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To present coronavirus disease-2019 (COVID-19) related maternal mortality in relation to Delta and Omicron waves and to investigate the role of lung ultrasound (LUS) in estimating mortality.This retrospective cohort study was conducted in the obstetrics and gynecology clinic of a tertiary pandemic hospital between March 2020 and January 2022. The hospitalized pregnant women with COVID-19 diagnosis and maternal deaths were studied in relation with Delta and Omicron waves. The relationship between LUS scores of hospitalized patients and maternal mortality was explored.Thousand and sixty-five pregnant women were hospitalized because of COVID-19 infection. Fifty-one (4.79%) of these patients had critical sickness, 96 (9.01%) of them had severe illness, 62 (5.82%) of them were admitted to the intensive care unit and 28 (2.63%) of all hospitalized pregnant women had died. Of the 1.065 patients, 783 (73.5%) were hospitalized before the Delta wave and the maternal mortality rate was 1.28% (10/783), 243 (22.8%) were hospitalized during the Delta wave and the maternal mortality rate was 7% (17/243) [relative risk (RR)=5.478, 95% confidence interval (CI) (2.54-11.8), z=4.342, p0.001]. During the Omicron wave 39 (3.66%) patients were hospitalized and the maternal mortality rate was 2.56% (1/39). Maternal mortality rates, according to LUS scores, were 0.37% (1/273) for LUS 0, 0.72% (2/277) for LUS 1, 2.58% (10/387) for LUS 2 and 11.72% (15/128) for LUS 3 respectively (LUS 3 vs. others; maternal mortality: RR=8.447, 95% CI (4.11-17.34), z=5.814, p0.0001). There were no vaccinated patients in the study cohort.The maternal mortality rate was relatively high, particularly during the Delta wave at our referral center. The Delta wave, delayed vaccination and vaccine hesitancy of pregnant women might have important roles in maternal mortality. Higher LUS scores should warn clinicians of an increased risk of maternal death.

Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.

Implementation of lung ultrasound in the triage of pregnant women during the SARS-CoV-2 pandemics

The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases.All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively.A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases.Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

Introduction and hypothesis: Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. Methods: Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case–control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. Results: The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). Conclusion: The vaginal axis was found to be near-normal in patients who underwent LLMS. WOS:000588608400008 Q2

Objective: To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.Materials and Methods: This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured.Results: The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores.Conclusion: The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes. Amaç: Kadın genital organının anatomisine dair temel veri edinmek ve bu ölçümler ile cinsel işlev ve genital algı arasındaki korelasyonu araştırmak.Gereç ve Yöntemler: Bu prospektif kohort çalışma, 208 sağlıklı premenopozal kadın ile yapıldı. Kadın Cinsel İşlev indeksi (FSFI) ve Kadın Genital Benlik İmajı ölçeği (FGSIS) anketleri uygulandı. Katılımcılar kadın cinsel işlev bozukluğu (FSD) durumuna göre iki gruba ayrıldı. Dış genital ölçümler ile ön ve arka vajinal uzunluk ölçüldü.Bulgular: Dış kadın genital ölçümleri (cm, ortalama ± standart sapma): klitoral prepus uzunluğu 2,05±0,48; glans klitoris uzunluğu 0,87±0,21; glans klitoris genişliği 0,60±0,15; üretra-klitoris mesafesi 2,24±0,55; ön forniks derinliği 7,75±0,92; arka forniks derinliği 9,25±0,75; labia minora genişliği, sağ 2,12±0,86, sol 2,20±0,96. Toplam FGSIS skorları ile klitoral prepus uzunluğu arasında zayıf negatif korelasyon bulundu (p=0,01, r=-0,17), toplam FGSIS skorları ile anterior-posterior vajinal uzunluklar arasında zayıf pozitif korelasyon saptandı (p=0,04, r=0,13; p=0,02, r=0,15). FSD’li katılımcıların (n=82, %39,4) ve FSD’si olmayanların (n=126, %60,6) genital ölçümleri ile toplam FSFI skorları ve orgazm skorları arasında istatistiksel olarak anlamlı bir fark bulunmadı.Sonuç: Kadın genital ölçümlerini geniş bir aralıkta bulundu. Genital ölçümler ile genital algı arasındaki ilişki değişkenlik gösterse de, genital ölçümler ile cinsel işlevler veya orgazm arasında anlamlı bir ilişki bulunmamıştır. Bu bulgular, kozmetik amaçlı genital cerrahilere daha temkinli bir yaklaşım gerektiğini göstermektedir. WOS:000577569000006 2-s2.0-85104747758

Objective: To investigate pregnancy outcomes and compare the clinical characteristics of coronavirus 2019 (COVID-19) disease in pregnant and agematched non-pregnant women. Materials and Methods: Hospital records of four tertiary care centers were reviewed retrospectively. The subjects comprised 188 pregnant patients and 799 non-pregnant women who were admitted to these hospitals. Results: Pregnancy significantly affected the clinical severity of COVID-19 and this effect was more prominent in pregnant women at >20 weeks gestation (p

The emerging evidence for the asymptomatic carriers of SARS-CoV-2 infection emphasized the critical need for universal screening of pregnant women.This study aimed to present the prevalence of overall and asymptomatic SARS-CoV-2 infection rates in pregnant women admitted to the hospital, and assess the diagnostic accuracy of maternal symptoms and lung ultrasound (LUS) findings in detecting the infection.This prospective cohort study was conducted at a single tertiary center in Istanbul, Turkey, for a month period starting from 27 April 2020. Women with a confirmed pregnancy regardless of the gestational week admitted to the obstetric unit with any indication were consecutively underwent LUS and PCR testing for SARS-CoV-2.A total of 296 patients were included for the final analysis. The universal screening strategy diagnosed 23 pregnant women (7.77%) with SARS-CoV-2 infection. The rate of symptomatic and asymptomatic patients diagnosed with SARS-CoV-2 was found as 3.72% (A one-month trial period of universal testing for SARS-CoV-2 infection with RT-PCR in pregnant women who admitted to the hospital showed an overall and asymptomatic infection diagnose rate of 7.77% and 4%, respectively. Using lung ultrasound was found more predictive in detecting the infection than the use of symptomatology solely.

Objective: Enough data can be found in the literature regarding the protective effect of tubal ligation on gynecological cancers. In addition, a large body of evidence revealed that prophylactic bilateral salpingectomy had no significant negative effect on the ovarian function, quality of life, sexuality, surgery duration, and cost-effectivity. This study was aimed at exploring the underlying factors that motivate women for either opportunistic bilateral salpingectomy (OBS) or tubal ligation, particularly focusing on their preferences, knowledge, and beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Materials and Methods: A total of 54 patients who had undergone surgical sterilization with either OBS or tubal ligation were included in this prospective cohort study. The acceptance rate of the OBS at the time of cesarean section among pregnant women seeking surgical sterilization was calculated. The underlying reasons for women's acceptance or refusal for salpingectomy were assessed by a non-validated data collection tool that had 14 open-ended questions focusing on the women's preferences, knowledge, beliefs toward female sterilization, satisfaction from counseling, and body image following the salpingectomy. Results: The acceptance rate of OBS at the time of cesarean section among pregnant women and electively among non-pregnant women were 93.5% (n=43/46) and 75% (6/8), respectively. The main driving factors influencing the decision of preferring OBS over tuba! ligation were the risk-reducing effect for ovarian cancer and superior pregnancy prevention. Conclusion: The acceptance rate of OBS at the time of cesarean section was found to be very high, and it should therefore be offered at the time of cesarean section to women who desire permanent contraception. WOS:000556541500007 32850186

Lung ultrasound (LUS) is an effective tool to detect and monitor patients infected with 2019 coronavirus disease (COVID‐19). The use of LUS on pregnant women is an emerging trend, considering its effectiveness during the outbreak. Eight pregnant women with a diagnosis of COVID‐19 confirmed by nasal/throat real‐time reverse transcription polymerase chain reaction testing who underwent point‐of‐care LUS examinations after routine obstetric ultrasound are described. A routinely performed LUS examination revealed serious lung involvement in 7 cases: 2 were initially asymptomatic; 3 have chest computed tomography; 1 had initial negative real‐time reverse transcription polymerase chain reaction results; and 1 had initial negative computed tomographic findings. Treatment for COVID‐19 was either commenced or changed in 87.5% of the patients (n = 7 of 8) on LUS findings. Among patients with abnormal LUS findings, treatment was commenced in 5 patients (71.5%) and changed in 2 patients (28.5%). One normal and 7 abnormal LUS cases indicate the impact of routine LUS on the clinical outcome and treatment of pregnant women.

Background: COVID-19 is a novel type of the coronavirus family with an incompletely described clinical course. Little is known about the psychological aspects, particularly for vulnerable populatio...

Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in thelateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications.This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament.Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel(corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers.Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligamentwas 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left externaliliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of theright pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to theright obturator canal it was 3.57±0.93 cm.Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac veinwas measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels. Amaç: Pektopeksi cerrahisi sırasında, prolapse olan uterus veya vajinal apeks pektineal ligamana sabitlenir. Obturator fossa üzerinde prevesikal ve paravajinal boşluğun lateral kısmında bulunan anatomik yapılar, komplikasyonları önlemek için yapılacak cerrahi adımların önemini arttırmaktadır. Bu çalışma, vasküler yapıların pektineal ligamana yakınlığını değerlendirmek için yapılmıştır. Gereç ve Yöntemler: Pektopeksi cerrahisi sırasında cerrahi sütür alanı ile eksternal iliak ven, pubik anastomotik damarlar (korona mortis) ve obturator kanal arasındaki mesafeler 7 taze kadın kadavrada iki taraflı olarak ölçülmüştür. Bulgular: Pektineal ligamanın toplam uzunluğu solda 5,9±0,76 cm ve sağ tarafta 6,5±1,14 cm idi. Pektineal ligamanın orta noktası solda 2,8±0,52 cm ve sağ tarafta 3,6±0,47 cm idi. Sol pektineal ligamanın orta noktasından, sol eksternal iliak vene ortalama mesafe 1,04±0,23 cm, sol korona mortise 2,15±0,48 cm ve sol obturator kanala ortalama mesafe 3,12±0,95cm idi. Sağ pektineal ligamanın orta noktasından sağ eksternal iliak vene ortalama mesafe 1,25±0,43 cm, sağ korona mortise 2,37±0,63 cm ve sağ obturator kanala ortalama 3,57±0,93 cm idi. Sonuç: Çalışmanın anatomik bulguları pektineal ligamanın ana damarlarla yakın ilişki içinde olduğunu doğrulamıştır. Eksternal iliak ven, pektineal ligamana en yakın anatomik yapı olarak ölçülmüştür. Cerrahlar, pektineal ligamanın ana damarlara yakınlığı nedeniyle hayatı tehdit eden komplikasyonları en aza indirmeye dikkat etmelidir. WOS:000523674600004 2-s2.0-85084803009

International Urogynecological Association (IUGA) and the International Continence Society (ICS) and the Joint IUGA/ICS Working Group on Complications Terminology formulated a standardized terminology and classification of complications related to the use of prosthesis in female pelvic floor surgeries. It was mainly purposed to globally standardize the complications and related definitions in order to obtain factual rates and to enable comparisons and surgical audits. Although this unique classification has frequently been cited in the literature, some concerns have been raised against its complexity of use and inter- and intraobserver variability. This review aimed to discuss the rationale behind the IUGA/ICS complication classification system, underline the opposing views, and provide the Turkish version of an online calculator facilitating the universal coding to increase the utility.

Tinelli, Andrea/0000-0001-8426-8490; erol, onur/0000-0002-7411-1200; GULER, OGUZ/0000-0001-7756-4267 WOS: 000514513400001 PubMed: 32064967 Objective: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). Methods: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. Results: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). Conclusions: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

This study aims to psychometrically validate the Turkish version of the Vulvovaginal Symptom Questionnaire (VSQ).Postmenopausal women with and without genitourinary syndrome of menopause (GSM) were included as the target population and the control group. Psychometric properties were validated both for sexually active (21 items) and passive women (16 items). Several a priori hypotheses were formulated to assess construct validity. Scores of GSM-Assessment Tool, Female Sexual Function Index, Michigan Incontinence Severity Index, Female Genital Self-Image Scale, and Menopause Rating Scale and their correlation with VSQ scores were compared.A total of 242 postmenopausal women were included. The VSQ showed good internal consistency with a Cronbach alpha coefficient of 0.822 (0.800-0.821) and 0.873 (0.853-0.870) in sexually active and passive women, respectively. Originally proposed model (4-factor model, n = 162) showed adequate fit in women with active sexuality and the 3-factor model (n = 242) showed moderate fit. The test-retest reliability was good for symptoms, emotions, and life impact subscales (intraclass correlation coefficient [ICC]: 0.846, 0.835, and 0.755, respectively) and moderate for sexual impact subscale (ICC: 0.643). More than 75% of hypotheses were confirmed.Our study shows successful cross-cultural adaptation and validation with sufficient psychometric properties for VSQ to be used in Turkish postmenopausal women with GSM.

IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Effects of SARS-CoV-2 on the neurological system have been investigated. Evidence of Guillain-Barre Syndrome (GBS) cases associated with SARS-CoV-2 infection have recently been reported. A 34-year-old multiparous woman with COVID-19 infection at her 37th (4/7) gestational week was presented here. She was diagnosed with Guillain Barre Syndrome at postpartum. As we know recently this was the first case mentioned in the literature. The clinical course of GBS with COVID-19 after childbirth may be similar to GBS patients not infected with COVID-19.

Female hypospadias is a very rare congenital anomaly and its impact on fertility has not yet been clearly defined. A 21-year-old woman with hypospadias was admitted with secondary infertility, dyspareunia, and urge symptoms. She was successfully treated with vaginal flap urethroplasty and broad spectrum antibiotics. Postoperatively, her symptoms resolved and she conceived spontaneously and aborted at her 17th gestational week following premature rupture of membranes suggesting infection. She then conceived spontaneously again and delivered a healthy term baby 30 months after the operation. Female hypospadias may cause chronic pelvic infections, urge symptoms, sexual dysfunction, hence infertility with time. After achieving normal anatomy by vaginal flap urethroplasty, treatment of chronic infections allows restoring normal urologic and sexual functions, and fertility.

WOS: 000489618100008, PubMed: 31673472, Objective: To evaluate the current problems and future career plans of obstetrics and gynecology residents in Turkey. Materials and Methods: In this cross-sectional study, a survey was conducted with 143 trainees from 25 cities in different regions of Turkey. The questionnaire, which was sent via e-mail to all available trainees, consisted of four parts: information on hospitals, number and variety of surgical interventions, scientific activities, and current problems. Descriptive statistics were used to analyze participants' responses. Results: The mean number of trainees in each hospital was 24 in education and research hospitals and 15 in university hospitals (p

Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than − 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

Gunumuzde ortalama yasam suresinin, Orta Cag’da yasayanlarin iki katindan fazla olmasinin ana nedeni bilimsel calismalarin insanliga yaptigi katkidir. Bu calismalar sayesinde bizden once yasayanlardan daha uzun bir hayat surmekteyiz. Bilimin gelisimi ve insan yararina kullanimi, yapilan calismalarin yaziya dokulmesi, baskalari tarafindan okunmasi, anlasilmasi, tartisilmasi ve uygulanmasiyla baslamistir. Gunluk pratigimizde kullandigimiz tani yontemleri, uygulamalar ve ilaclar, yillarca suren calismalarin sonuclarina gore sekillenmistir. Bunun devamliligini saglamak icin, saglik alaninda calisanlar sorgulamaci ve arastirmaci olmalidir.Yillardir kullanilan yontemler de dahil tum uygulamalara sorgulayan gozle bakmak, daha iyisi icin arastirma yapmak mesleki gelisime buyuk katki saglayacaktir. Sasirtici olarak, uzun zamandir klinik pratikte var olan bazi yaklasimlar bile cok az sayida dogru duzenlenmis calismaya dayalidir.

Current gold-standard treatment of recurrent vulvovaginal candidiasis (RVVC) is mainly based on maintenance with fluconazole. Moderate to high recurrence rates at long-term use and secondary fluconazole resistance emerge as reasons to seek for new topical maintenance regimens. In this study, it is aimed to assess the efficacy and safety of boric acid-based treatment approach to treat clinical RVVC. In this retrospective study, patients who were diagnosed with RVVC received a treatment package for six months that consist of induction with boric acid vaginal suppositories 600 mg daily for 14 nights followed by maintenance for five nights starting with every fifth day of the menstrual cycles; a vaginal estriol-lactobacilli combination; and several rigorous life-style changes. The success was defined as the absence of symptomatic recurrence during the follow-up. Success rate at the first year was found to be 94.8% in a total of 173 patients. Mild, reversible side effects were observed in five patients (2.9%). Boric acid, along with a vaginal estriol-lactobacilli combination and lifestyle changes can be a safe and effective alternative in lieu of potent systemic antifungal drugs as a first-line treatment for the patients referred with RVVC., NA

Objective Evidence for the use of lung ultrasound scan (LUS) examinations in coronavirus 2019 pneumonia is rapidly growing. The safe and non-ionizing nature of LUS drew attention, particularly for pregnant women. This study aimed to contribute to the interpretation of LUS findings in pregnant women for the obstetricians. Materials and methods LUS was performed to pregnant women suspected of or diagnosed as having Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) in the first 24 hours of admission. Fourteen areas (3 posterior, 2 lateral, and 2 anterior) were scanned per patient for at least 10 seconds along the indicated anatomical landmarks. The scan was performed in supine, right-sided and left-sided positions, respectively. Each area was given a score between 0 and 3 according to the specific pattern. Results In this study, 21 still images and 21 videoclips that enabled dynamic and real-time evaluation were provided. Pleural line assessment, physiologic A-lines, pathologic B-lines, light beam pattern, white lung pattern, and specific patterns for quick recognition and evaluation are described. Conclusion The potential advantages and limitations of LUS and its areas of use for obstetricians are discussed. LUS is a promising supplementary imaging tool during the SARS-CoV-2 pandemic. It is easy to perform and may be feasible in the hands of obstetricians after a brief didactic course. It may be a firstline imaging modality for pregnant women.

Objective: Reliable data regarding maternal mental well-being during the Severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic are scarce. This study aimed to assess the state/trait anxiety and obsessive-compulsive symptoms of pregnant women and compare those with the non-pregnant population using patient-reported validated outcome measures. Materials and Methods: This prospective case-control study was conducted at a tertiary ‘Coronavirus Pandemic Hospital’ in İstanbul, Turkey in April, 2020. Pregnant and non-pregnant women were consecutively allocated to two groups regardless of gestational age. The primary outcome was to identify the anxiety levels and obsessive-compulsive symptoms of pregnant women during the SARS-CoV-2 pandemic using the State-Trait Anxiety inventory (STAI) and Maudsley Obsessive-Compulsive inventory (MOCI), respectively. Results: Two hundred three pregnant women and 101 non-pregnant women were included. The mean STAI-S questionnaire score of pregnant and nonpregnant women was 41.96±9.15 and 46.62±12, respectively (p=0.001). The overall incidence of STAI >40 in pregnant and non-pregnant women was 62.6% and 73.3%, respectively. The mean total score of MOCI was 17.9±6.7 and 15±6.6 in pregnant and non-pregnant women, respectively. The overall incidence of 30-item-MOCI ≥13.1 in pregnant and non-pregnant women was 61.6% (125/203) and 30.7% (31/103), respectively (p

Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association of COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events.The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection.This was a multicenter retrospective cohort study including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, and Turkey). The data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. The secondary outcomes included maternal death, preeclampsia, and stillbirth. The association between the primary outcome and 12 candidate predictors having a known association with severe COVID-19 in pregnancy was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios. All the potential predictors were evaluated in 1 model and only the baseline factors in another. The predictive accuracy was assessed by the area under the receiver operating characteristic curves.Of the 793 pregnant women who were positive for SARS-CoV-2 and were symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The 'mini-COvid Maternal Intensive Therapy' model included the following demographic and clinical variables available at disease onset: maternal age (adjusted risk ratio, 1.45; 95% confidence interval, 1.07-1.95; P=.015); body mass index (adjusted risk ratio, 1.34; 95% confidence interval, 1.06-1.66; P=.010); and diagnosis in the third trimester of pregnancy (adjusted risk ratio, 3.64; 95% confidence interval, 1.78-8.46; P=.001). The optimism-adjusted area under the receiver operating characteristic curve was 0.73. The 'full-COvid Maternal Intensive Therapy' model included body mass index (adjusted risk ratio, 1.39; 95% confidence interval, 1.07-1.95; P=.015), lower respiratory symptoms (adjusted risk ratio, 5.11; 95% confidence interval, 1.81-21.4; P=.007), neutrophil to lymphocyte ratio (adjusted risk ratio, 1.62; 95% confidence interval, 1.36-1.89; P.001); and serum C-reactive protein (adjusted risk ratio, 1.30; 95% confidence interval, 1.15-1.44; P.001), with an optimism-adjusted area under the receiver operating characteristic curve of 0.85. Neither model showed signs of a poor fit. Categorization as high-risk by either model was associated with a shorter diagnosis to intensive care unit admission interval (log-rank test P.001, both), higher maternal death (5.2% vs 0.2%; P.001), and preeclampsia (5.7% vs 1.0%; P.001). A spreadsheet calculator is available for risk estimation.At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high- and low-risk for progression to critical disease, even where resources are limited. This can support the nature and place of care. These models also highlight the independent risk for severe disease associated with obesity and should further emphasize that even in the absence of other comorbidities, vaccination is particularly important for these women. Finally, the model also provides useful information for policy makers when prioritizing national vaccination programs to quickly protect those at the highest risk of critical and fatal COVID-19.

Study Objective To compare the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach with conventional laparoscopy (CL) in opportunistic bilateral salpingectomy (BS) alone for permanent female sterilization as an opportunistic cancer prevention strategy. Design Prospective cohort study. Setting Two-centered tertiary hospitals. Patients Ninety-six women with a nonprolapsed uterus seeking definitive surgical permanent contraception. Interventions Patients were scheduled for BS and assigned to a study arm in a 2:1 fashion (CL:vNOTES allocation ratio) concerning patient's choice. Measurements and Main Results Patients were followed at their postoperative first week and first month. The visual analog score (VAS), Patient Global Impression of Improvement, and Female Sexual Function Index scales were used to assess the pain, patient satisfaction, and discomfort/pain after vaginal penetration, respectively. Patients who underwent to vNOTES had a significantly higher number of previous abdominal surgery (median difference, 1.97; 95% confidence interval [CI], 1.12–3.48; p = .016). Compared with CL, vNOTES was associated with lower 6-hour (rate ratio [RR], 0.63; 95% CI, 0.50–0.77) and 24-hour (RR, 0.33; 95% CI, 0.23–0.46) postoperative VAS scores and less amount of postoperative analgesics (RR, 0.54; 95% CI, 0.36–0.78). The slope of change in postoperative VAS scores was in a shorter time in the vNOTES group (RR, 0.47; 95% CI, 0.36–0.60). The rate of postoperative improvement was higher in the vNOTES group than the CL group at the postoperative first week (87.5% vs 68.2%, χ2 = 4.232, p = .032) and first month (96.9% vs 87.9%, χ2 = 2.091, p = .140). The rate of patients reporting postoperative decline in Female Sexual Function Index /pain scores (RR, 0.97; 95% CI, 0.47–1.96) was found to be similar in both of the study groups, and no postoperative complication was observed in either group. Conclusion Women seeking permanent sterilization and who underwent BS for ovarian cancer risk reduction purposes had higher satisfaction, less postoperative pain, lower analgesic requirement, and similar surgical outcomes in the vNOTES group than the CL group, even in patients with previous surgeries and a nonprolapsed uterus. vNOTES approach could be the preferred method for the opportunistic BS in female sterilization.

Background Influencing factors involved in the decision to undergo labiaplasty are evolving and show diversity among different settings and countries. Updated underlying motivators may assist in clinical decision-making and assessing outcomes from the patients’ perspective. Objectives Herein, the main motivators of women undergoing labiaplasty and sociodemographic features are discussed. Methods Seventy-one patients who were scheduled for labiaplasty were assessed via an open-ended, well-detailed questionnaire to determine the main motivational factors from the patients’ perspective. Validated questionnaires to measure genital self-image, self-esteem, body appreciation, attitude toward having cosmetic surgery, sexual dysfunction, and body-dysmorphic disorder were performed. Results Half of the patients reported that they had an idea about the appearance of other women’s genitalia (50.7%) and were influenced through the media (47.9%). The majority of those (71.8%) stated that they did not have normal genitalia and considered labiaplasty more than 6 months ago (88.7%). The pornography consumption rate in the last month was 19.7% and was significantly related with lower genital self-image and self-esteem. The main motivation was improvement in appearance (43.7%) and a better sexual life (26.8%). Patients reported aesthetic (52.1%), sexual (46.5%), and psychological (39.4%) reasons leading to their decision. Patient-reported 8-items of 11-item motivators for having labiaplasty were statistically consistent with validated questionnaires. The self-esteem and body appreciation of the patients were comparable to the literature. Genital self-image and sexual function were found to be impaired. Conclusions The women’s main motivator for labiaplasty was improvement in genital appearance integrated with their aesthetic and sexual demands. Eleven-item motivators derived from the statements of women seeking labiaplasty were determined in this study. Sociodemographic features and main motivators can conveniently be used as normative data for this population. Level of Evidence: 4

Endometrial cancer is the most common gynecological cancer. Increased postmenopausal endometrial thickness may be an indicator of endometrial cancer. Transvaginal ultrasound (TV-USG) is the primary imaging method for evaluating endometrial thickness in the postmenopausal period. The aim was to employ transvaginal ultrasonography in the evaluation of adnexal masses synchronously seen in postmenopausal women with increased endometrial thickness. The work was designed as a retrospective study. The medical records of 155 patients evaluated for increased postmenopausal endometrial thickness were examined. Ultrasonography had been performed on the women in the study for routine follow-up, postmenopausal hemorrhage, pelvic pain, pelvic mass on examination and family history of gynecological cancer. All patients had undergone endometrial evaluation with fractional dilatation and curettage (D & C) or pipelle endometrial sampling. Histopathological diagnosis was based on endometrial sampling results. Adnexal mass was present simultaneously in 17.4% (n = 27) of the women included in the study, while 82.6% (n = 128) had no gynecological pathology other than increased endometrial thickness. The endometrial thickness in the women with postmenopausal adnexal masses was greater than in those without adnexal mass (11.7 mm vs. 7.8 mm, p = 0.009). Non-atypical and atypical endometrial hyperplasia was more frequent in the group with postmenopausal adnexal mass (11.1% vs. 2.8%, 11.1% vs. 3.79, p = 0.03, p = 0.04, respectively). Final histopathological evaluation of patients operated on for adnexal masses revealed tubo-ovarian abscess in 1.9% (n = 1), benign ovarian tumor in 25.9% (n = 7) and malignant ovarian tumor in 11.1% (n = 3) of the patients. In postmenopausal women, adnexal masses can be seen simultaneously with increased endometrial thickness. In this regard, transvaginal ultrasound offers important opportunities for evaluation of both the endometrium and adnexa. Pre-surgery transvaginal ultrasound as well as multivariate serum markers may be used in evaluation models. [Med-Science 2018; 7(4.000): 848-51]

The abdominal aorta is divided into two parts (right and left) at the level of the fourth-fifth lumbar vertebra and called the common iliac artery. Anterior to the sacroiliac joint, common iliac arteries are divided into external and internal iliac arteries. The external iliac artery supplies the lower limb, and the internal iliac artery is the major vascular supply of the pelvis. Internal iliac artery is divided into anterior and posterior trunk. The anterior trunk supplies the pelvis, visceral organs, and the posterior trunk supplies pelvic parietal structures. The broad ligament envelopes the uterus anteriorly and posteriorly with its sheets and continues as the pelvic peritoneum at the lateral side of the pelvic wall. After cutting the pelvic peritoneum, the retroperitoneal area is visualized and the internal iliac artery with other great vessels of the abdomen can be noted.

ÖZETGiriş ve AmaçRekürren üriner trakt enfeksiyonları (RUTE) yönetilmesi güç önemli bir halk sağlığı sorunudur. En sık etkeni Escherichia coli’dir. RUTE’nin önlenmesinde kontinü ve post-koital profilaksi seçenekleri arasından post-koital profilaksi daha az doz gerektirmesi ve benzer etkinlik ile öne çıkmaktadır. Bu çalışmada post-koital profilaksinin RUTE’nin önlenmesindeki etkinliğinin araştırılması amaçlanmıştır. Materyal ve MetodBu retrospektif çalışmaya RUTE sebebiyle düşük doz nitrofurantoin ile post-koital profilaksi ve yaşam tarzı değişiklikleri uygulanan premenapozal, gebe olmayan, cinsel aktif kadınlar dahil edilmiştir. Profilaksi altı ayda sonlandırılmış ve sonraki altı aylık takipleri değerlendirilmiştir.BulgularÇalışmaya toplam 39 hasta dahil edilmiştir. 1 hasta hafif gastrointestinal yan etki üzerine ilacı bırakmıştır. Tanımlayıcı istatistik analizine 38 hasta dahil edilmiştir. Profilaksi süresince hiçbir hastada rekürrens görülmemiş olup başarı oranı %100’dür. Profilaksi sonrası altı aylık dönemde ise 1 hastada (%2.63) 4.ayda rekürrens görülmüştür. Profilaksi başlangıcından itibaren 12 aylık başarı %97.37 (n=37/38) olarak bulunmuştur.Sonuç Düşük doz (50 mg) nitrofurantoin ile post-koital profilaksisi; premenapoz, gebe olmayan rekürren üriner trakt enfeksiyonlu kadınlarda profilaksi süresince ve profilaksi sonrası ilk altı ayda etkili ve güvenli bulunmuştur. Bu etkinin doğrulanması için longitudinal prospektif çalışmalara ihtiyaç vardır.

Background: to find the effects of mechanical bowel preparation (MBP) on operative field visualization, and to measure pneumoperitoneum pressure (PP) and Trendelenburg inclination angle (TIA) values. Methods: in this two-centred, randomised, single-blind and controlled study, 90 patients who underwent laparoscopic gynaecological surgery for benign conditions were included. After the exclusions, 44 patients received MBP with oral sodium phosphate enema (study group) and 42 did not receive bowel preparation or underwent diet restrictions (control group). An objective visual index, PP and TIA were measured in a stepwise design of assessments. Results: the Visual Index at first inspection right after establishing a 12 mmHg PP and a standard 30° TIA was found to be significantly in favour of the study group (p = 0.015). The lowest reached TIA in standard 12 mmHg PP following stepwise decrease was observed as 15.2° and 25° in the study and control groups, respectively (p < 0.001). The lowest reached PP was 8.9 mmHg and 11.9 mmHg in the study and control groups, respectively (p, NA

ÖZETGiriş ve AmaçAdneksiyal kitlelerin preoperatif olarak malignite riskinin değerlendirilmesi,operasyonun yapılacağı merkeze ve ekibe karar verilmesi açısından önemarzetmektedir. Bu durum hastanın postoperatif prognozu ile doğrudanilişkilidir. Bu çalışmada adneksiyal kitlelerin preoperatif değerlendirmesindemevcut olan malignite riski belirleme modellerinden Risk of Malignancyİndex(RMI) versiyonlarının ve Assessment of DifferentNeoplasias in the Adnexa (ADNEX) modelinin malignite öngörüsündeki başarı oranlarının incelenmesiamaçlanmıştır.Materyal veMetodTersiyer eğitim araştırma hastanesinde Eylül 2014-Haziran2016 tarihleri arasında adneksiyel kitle nedeniyle opere tüm hastalarretrospektif olarak değerlendirildi, ultrasonografi, klinik bilgi ve Ca 125verileri ile RMI I-II-III-IV skorları ve ADNEX model malignite risk yüzdelerihesaplandı, sonuçlar patolojik tanılar ile değerlendirildi. Bulgular191 vakanın verilerideğerlendirildiğinde RMI I (>200) duyarlılık %66 özgüllük %88.4 PPV %68.6,NPV %87.1, RMI II (>200) duyarlılık %75.5, özgüllük %78.3, PPV %57.1,NPV%89.3, RMI III(>200) duyarlılık %66, özgüllük %88.4, PPV %68.6, NPV %87.1, RMI IV(>450)duyarlılık %67.9, özgüllük %90.6, PPV%73.5, NPV %88 olarak izlendi. ADNEXmodel için çalışmada 3 farklı malignite sınır değeri uygulanmıştır. Maligniteriskinde %5’lik sınır değer kullanıldığında duyarlılık %98.1, özgüllük %46.4,PPV %41.3, NPV%98.5, %10’luk sınır değer kullanıldığında duyarlılık %94,3,özgüllük %63, PPV %49,5, NPV%96,7, %15’lik sınır değer kullanıldığındaduyarlılık %94,3, özgüllük %72,5, PPV %56,8 NPV%97,1 olarak saptandı.SonuçADNEX modeli duyarlılık ve özgüllük sonuçları literatür ilebenzer olarak izlenmiştir. RMI versiyonlarının sonuçları literatürlekarşılaştırıldığında duyarlılık açısından literatüre göre daha düşük, özgüllükverileri literatür ile benzer izlenmiştir. Duyarlılık sonuçlarında ADNEXmodeli RMI versiyonlarına göre oldukça yüksek değerlere ulaşmakla birlikteözgüllük açısından daha kısıtlı olduğu izlenmiştir. Sonuçların doğrulanmasıiçin longitudinal çalışmalara ihtiyaç vardır., Aim Preoperativeevaluation of adnexial masses is crucial for decision processes of preoperativepreparation. It is also directly related to prognosis. In this study, weaimed to evaluate the performances of versions of Risk of Malignancy Index(RMI) and Assesment of Different Neoplasias in the Adnexa (ADNEX) model fordiagnosis of malignancy.Matherials and MethodWe retrospectivelyevaluated patients who applied with adnexial mass to our tertiary gynecolocialcenter between 1st of September, 2014 and 30th of July, 2016. Of 206 patients, 15were excluded due to missing CA 125 and ultrasonograpic measurement andrecurrent ovarian cancer diagnoses.191 patients wereincluded into the study. Demographic, ultrasonographic data and CA-125 valueswere all recorded and RMI I to IV scores and malignancy risk percents for ADNEXmodel were calculated. Three cut-off values for malignancy probabilites (5%,10%, and 15%) were applied for ADNEX model. Resultswere compared to postoperative pathological diagnoses. FINDINGS. Sensitivity (SEN), specifity (SPE), positivepredictive value (PPV), and negative predictive value (NPV) were 66%, 88.4%,68.6%, and 87.1% for RMI I, 75.5%, 78.3%, 57.1%, and 89.3% for RMI II, 66%,88.4%, 68.6%, and 87.1% for RMI III, and 67.9%, 90.6%, 73.5 and 88% for RMI IV.For ADNEX model, SEN, SPE, PPV, and NPV values were 98.1%, 46.4%, 41.3%, and98.5% for cut-off value of 5%, 94.3%, 63%, 49,5%, and 96.7% for cut-off valueof 10%, and 94.3%, 72.5%, 56.8%, and 97.1% for cut-off value of 15%.CONCLUSION. Results of versions of RMIwere similar to those in the literature in terms of specifity, but lower interms of sensitivity. Sensitivity and specifity values for ADNEX model weresimilar to those of the literature. Although sensitivity of ADNEX model werehigher than those of versions of RMI, specifity values were lower. Futureprospective studies could be performed to evaluate diagnostic perfomances ofthose indices and to develop newer indices in terms of better SEN and SPE.