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Amaç: Kliniğimizde relaparotomi yapılan hastaların verilerini retrospektif olarak incelemek, relaparotomi insidansını, endikasyonlarını ve mortalite oranını belirtmektir. Yöntemler: Çalışmamıza çalışma tarihleri arasında kliniğimizde relaparotomi yapılan 47 hasta dahil edildi. Hastaların demografik özellikleri, ilk operasyon endikasyonları ve ilk operasyon sırasında yapılan cerrahi işlem, ilk operasyonun hangi merkezde yapıldığı, relaparotomi endikasyonları ve relaparotomi sırasında yapılan cerrahi işlem, iki operasyon arasındaki süre, verilen kan transfüzyon ürünlerinin sayısı ve relaparotomi sonrası mortalite olup olmadığı not edildi. Kliniğimizin obstetrik ve jinekolojik relaparotomi insidansı ve relaparotomi sonrası mortalite oranı hesaplandı. Bulgular: Çalışmamıza dahil edilen hastaların %89,4’ü obstetrik relaparotomi, %10,6’sı jinekolojik relaparotomi yapılan hastalardan oluşmaktadır. Kliniğimizin obstetrik relaparotomi insidansı %0,1, jinekolojik relaparotomi insidansı %0,06 olarak tespit edildi. Kliniğimizin relaparotomi sonrası mortalite oranını %2,1 (1/47) olarak tespit ettik. Obstetrik relapatomi yapılan hastaların ilk operasyonlarının en sık %81 (34) oranında sezaryen olduğu, endikasyon olarak en sık %23,8 (10) geçirilmiş sezaryen olduğunu tespit ettik. Jinekolojik relaparotomi yapılan hastaların ilk operasyonlarının en sık %80 (4) oranında total abdominal histerektomi olduğu, endikasyon olarak en sık %60 (3) anormal uterin kanama olduğu tespit edildi. Relaparotomi yapılan hastaların hem obstetrik hem de jinekolojik relaparotomilerde en sık endikasyonunun hematom-hemoraji olduğunu belirledik (sırasıyla %64,3 ve %40 oranında). Relaparotomi operasyonunda yapılan işlem olarak hem obstetrik hem de jinekolojik relaparotomilerde en sık olarak hematom boşaltımı- kanama kontrolü yapıldığını tespit ettik (sırasıyla %52.4 ve %40 oranında). Sonuç: Relaparotomi kararı gerekli hazırlıklar yapıldıktan sonra gecikmeden verilmelidir. Risk faktörü olan hastalar önceden bilgilendirilip ilk operasyonlarının mümkün olduğunca üçüncü basamak hastanelerde olmasını önermeliyiz. İlk operasyon sırasında gerekli kanama kontrolünü yaparak relaparotomi ihtiyacını azaltabileceğimizi düşünmekteyiz. 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.

Objectives: The aim of this study is to discuss whether performing the human papillomavirus test on women aged 25-30 in Turkey has any effect on preventing cervical cancer. It is aimed to reevaluate the screening program. Methods: A total of 400 patients between the ages of 25-30 who had the Papanicolaou smear and the human papillomavirus test were included in our study. Pap smear and the human papillomavirus test were performed again on the patients with a positive human papillomavirus test for high-risk types in accordance with the screening program. Demographical and clinical characteristics of the patients were recorded. The incidence of human papillomavirus test positivity with a high risk among patients aged 25-30, regression, and persistence ratios were calculated. Results: The incidence of human papillomavirus test positivity with a high risk among patients aged 25 to 30 was found to be 7%. Human papillomavirus persistence ratio was 17.6% and the regression ratio was 82.4%. Among patients with a positive high-risk human papillomavirus test between the ages of 25 and 30, human papillomavirus 16 was found in 47.1% of the patients. For one of our patients with a persistent human papillomavirus 16 positivity, conization was performed after the cervical biopsy. Conclusion: We believe that human papillomavirus, which plays an important role in the etiology of cervical cancer, should be screened from the age of 25. This way, we can catch and treat precursor lesions of cervical cancer at earlier ages and lower the incidence and mortality of cervical cancer.

It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations.This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P.001) were independently associated with adverse maternal outcomes.High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

Amaç : Bu çalışmada amacımız sigara içen ve içmeyen preeklamptik gebelerin plasentasında Ezrin-Radixin-Moesin (ERM) protein expresyonlarının immunohistokimyasal ve Western Blot yöntemiyle değerlendirmektir. Gereç ve Yöntem: Çalışmaya Dicle Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğine yatan 30 normotensif (15 adet sigara içmeyen ve 15 adet sigara içen) ve 30 preeklampsi tanısı almış hastanın (15 adet sigara içmeyen ve 15 adet sigara içen) histolojik takip için plasenta örnekleri alındı. Histokimyasal olarak Hematoksilen-eozin boyası kullanıldı, immunohistokimyasal olarak ERM immun boyamaları yapıldı. Dokular analiz için mikrografları çekildi. Görüntüleme yapılan bantların resimleri çekildi. Bulgular: Sigara içmeyen preeklampsi plasenta kesitlerinde villusların yapılarının bütünlüğünü kaybettiği gözlendi. Stromal alanlarda dejenerasyon, sinsityal düğüm ve köprülerde artış izlendi. Trofoblastik hücrelerde yer yer kopuntular , villuslarda hiyalinizasyon ve fibrinoid alanlar izlendi. Sigara içen preeklampsi plasenta kesitlerinde villuslarda dejenerasyon gözlendi. Sonuç: Sigara kullanımı mikrovillus ve hücre-hücre bağlantısını önemli ölçüde etkileyip, ERM protein seviyesinin azalmasına neden olduğu, plasental gelişimi olumsuz yönde etkileyebileceğini tesbit ettik. ERM proteinlerinin aktivasyonu uyaracak ve kontrol altına alabilecek bir tedavinin preeklempsi etiyolojisine katkı sağlayabileceği kanaatindeyiz. Aim: In this study, our aim is to evaluate the protein expressions of Ezrin-Radixin-Moesin (ERM) by immunohistochemical and Western blot in the placenta of preeclamptic pregnant women who smoke and do not smoke. Material and methods: Placental samples were taken for the histological follow-up of 30 normotensive patients (15 non-smokers and 15 smokers) and 30 preeclampsia patients (15 non-smokers and 15 smokers) hospitalized in the Dicle University Faculty of Medicine Obstetrics and Gynecology clinic. Histochemically, Hematoxylin-eosin dye was used, and immunohistochemically, ERM immune staining were performed. Micrographs were taken for analysis of tissues. Results: It was observed that non-smoking preeclampsia lost the integrity of the structures of the villi in the placenta sections. Degeneration in the stromal areas, increase in syncytial nodes and bridges were observed. In the trophoblastic cells, ruptures were observed, hyalinization and fibrinoid areas were observed in the villi. Degeneration of villi was observed in the smoker preeclampsia placenta sections. Conclusion: We have found that smoking significantly affects microvilli and cell-cell linkage, resulting in decreased ERM protein level and may negatively affect placental development. We believe that a treatment that can stimulate activation and control of ERM proteins can contribute to the etiology of preeclampsia. Dicle Üniversitesi Bilimsel Araştırma Projeleri Koordinatörlüğü (DÜBAP) tarafından TIP.18.031 numaralı proje ile desteklenmiştir.

Objective: In this study, our aim is to compare discussing maternal and fetal problems non-adolescent pregnancy with maternal and fetal problems in adolescent pregnancy that seen in hospital. Methods: 15-19 years of age (50 patients) and 20-23 years (96 patients) who gave birth at the Gynaecologi­cal and Obstetric Clinic under the Faculty of Medicine of Dicle University between January 2015-October 2015 were retrospectively evaluated. Age at birth, parity, blood pressure, pulse, gestational age, complications at birth, cesarean section indications, maternal biochemical pa­rameters, patients with preeclampsia and preterm birth, maternal and fetal complications were recorded. Results: Total number of births between January 2015- October 2015 were 1715 patients in our clinic. 62 of them (3.6%) were observed in the adolescent group. Maternal blood transfusion needs were found to be significantly higher in the adolescent group (p=0.004). Fetal abnor­malities and fetal intensive care needs were found to be significantly higher in the adolescent group (p=0.014, p=0.018). Conclusion: Adolescent pregnancies were high-risk pregnancies in terms of maternal anemia and blood transfusion requirements and because of adverse perina­tal outcomes. Therefore, to reduce the adolescent preg­nancy and to minimize perinatal complications should be done more extensive studies. Bu çalışmada amacımız hastanede karşılaştığı­mız adölesan gebeliklerdeki maternal ve fetal sorunlar ile adölesan olmayan gebeliklerde görülen maternal ve fetal sorunları karşılaştırılarak tartışmaktır. Yöntemler: Dicle Tıp Fakültesi Kadın Hastalıkları ve Do­ğum kliniğinde Ocak 2015-Ekim 2015 tarihleri arasında doğum yapmış 15-19 yaş (50 hasta) ve 20-23 yaş (96 hasta) gebeler retrospektif olarak değerlendirildi. Yaş, pa­rite, tansiyon, nabız, vücut kitle indeksi, sigara, gebelik haftası, doğum şekli, doğumda gelişen komplikasyonlar, sezaryen endikasyonları, annenin biyokimyasal paramet­releri, preeklampsi ve preterm eylem gelişen hastalar, kan transfüzyonu ve yoğun bakım ihtiyacı, bebeğin 1. ve 5 da­kika APGAR skoru, kilosu, amnion mayisi, fetal anomali varlığı, yoğun bakım ihtiyacı kaydedildi. Bulgular: Ocak 2015- Ekim 2015 tarihleri arasında top­lam doğum sayımız 1715 idi. Bunların 62 (%3,6) ’sinin adölesan yaş grubunda olduğu izlendi. Maternal kan transfüzyonu ihtiyacı adölesan grupta anlamlı olarak yük­sek tespit edildi (p: 0.004). Fetal anomali ve fetal yoğun bakım ihtiyacı adölesan grupta anlamlı olarak yüksek tes­pit edildi (p değerleri sırasıyla p:0.014 p:0.018). Sonuç: Adölesan gebelikler, özellikle maternal anemi ve kan transfüzyonu ihtiyacı açısından artmış risk ve kötü perinatal sonuçlara neden olduğundan yüksek riskli ge­beliklerdir. Bu nedenle bu gebelikleri azaltmak ve peri­natal komplikasyonları en aza indirmek için daha geniş kapsamlı çalışmalar yapılmalıdır.

ÖZETAmaç: Bupilot çalışmada, çoklu foliküler gelişimi olan kontrollü ovarianhiperstimülasyon (KOH) sikluslarında çift intrauterin inseminasyon (IUI)'ninetkinliğini göstermeyi amaçladık. Yöntemler:Tersiyerbir merkezde Kadın Hastalıkları ve Doğum Kliniğinde Mart 2017ile Mart 2018 tarihleri arasında yardımcı üreme teknikleri (YÜT) merkezinde IUIprogramına alınan 20 ile 35 yaş aralığında 38 hastaya hCGyapılmasından sonra 18. ve 36. saatte 2 kez IUI yapılmış ve kontrol grubu olarak 22 ile 35 yaş aralığında 32 hastaya human chorionic gonadotropin (hCG) yapıldıktan sonra 36. saatte 1kez IUI yapılmıştır. Toplam 70 hastanın mevcut kayıtlardan hasta ile ilgilidemografik özellikler; Yaş, kilo, boy, daha önceki gebelik öyküsü (gravide, parite), öyküsündesigara alışkanlığı, hastaların adetin üçüncü gün hormon düzeyleri [ follicle stimulatinghormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], Prolaktin,Anti-Müllerianhormone (AMH), antral folikül sayısı(AFC), infertilite tipi ve süresi kayıt edildi.Bulgular:Çalışmada,nisan 2017-mayıs 2018 tarihleri arasında toplam 70 infertil hasta dahil edildi. Bunların 32 (%45.7)’sinin 1 kezIUI yapılmış grubunda iken, 38’i (%54.2) 2 kez IUI yapılmış grubunda olduğuizlendi.İki gruptaki kadınların HCG günü dominant Follikül sayısı>15mm değerleri bakımından mediandeğerleri incelendiğinde, çalışma grubundaki 2.0(1-3), kontrol grubundakilerinise 2.0(1.0-3.0) olarak bulundu (P=0.139).İkigruptaki kadınların Klinik gebelik oranı(%) değerleri bakımındandeğerleri incelendiğinde, çalışma grubundaki %21.05, kontrol grubundakilerinise %18.75 olarak bulundu (P=0.812). Sonuç:Buçalışmada KOH ile ovülasyonindüksiyonu sonrası intrauterin inseminasyon yapılan olgularda tek ve çift IUI yapılmasının klinik gebelik oranları arasında anlamlı bir fark olmadığı gözlenmiştir. Dolayısıyla intrauterin inseminasyon yapılan olgulardamaliyet göz önünde tutularak sonuçlarıhastayla paylaşmak gerekir., Objective: In this pilot study, itwas aimed to demonstrate the efficacy of double intrauterine insemination (IUI)in the controlled ovarian hyperstimulation (COH) cycles with multiplefollicular development. Methods: Thirty-eight patients involved in IUI program, aged 20-35 years, underwenthuman chorionic gonadotropin (hCG)procedure in assisted reproductive techniques (ART), between March 2017 andMarch 2018, in the Gynecology and Obstetrics Clinics of a tertiary center.Thereafter, double IUI was performed at 18th and 36thhours; thirty-two patients, aged 22-35 years, received hCG, and a single IUIwas performed at the 36th hour. Demographic characteristics of 70patients were recorded from the hospital records; age, weight, height, previoushistory of pregnancy (gravida, parity), smoking habits, hormonal levels at the3rd day of their menstrual cycle [follicle stimulatinghormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], prolactin,anti-Mullerian hormone (AMH), antral follicle count (AFC), type and duration ofinfertility. Results: A total of 70 infertilepatients were included in the study between April 2017 and May 2018. Of those,32 (45.7%) were in the single IUI group and 38 (54.2%) were in the double IUIgroup. When the median values of the dominant follicle number> 15 mm on theHCG day of the women in the second group were examined, they were found as 2.0(1-3) and 2.0 (1.0-3.0) in the study and control group, respectively (p =0.139).When the clinical pregnancy rates (%) of thewomen in the two groups were examined, they were found as 21.05% and 18.75% inthe study and control group, respectively (p = 0.812).Conclusion: In the present study,it was observed that there was no significant difference between the clinicalpregnancy rates of single and double IUI procedure during intrauterineinsemination after ovulation induction with COH. Therefore, by considering thetreatment costs, it is necessary to share the results with the patient in thecases of intrauterine insemination.

Amaç: Bu çalışmada anjiogenezi stimule eden vasküler endotel büyüme faktörü (VEGF) ve bir mezenşimal markır olan vimentin proteinlerinin preeklamptik ve normotansif plasentalardaki ekspresyon düzeylerini araştırmayı amaçladık. Yöntemler: Çalışmaya 35-38. haftalardaki doğum sonrası plasentalar dahil edildi. 10 adet preeklamptik ve 10 adet normal plasenta kullanıldı. %10’ luk formaldehit solüsyonuna atılan doku parçaları rutin parafin takiplerinden sonra histopatolojik olarak incelendi. VEGF ve vimentin protein düzeyleri Western Blot yöntemiyle ölçüldü. Bulgular: Preeklamptik plasentalarda sinsisyal proliferasyonun artmış olduğu izlendi. İntravillous sinsityal düğümler, sinsityal ödem, kollajen artışı ve damarlarda endotel hasar gözlendi. Preeklampsi (PE) sonucu plasentadaki VEGF ve vimentin protein düzeylerinin artış gösterdiği gözlendi. Sonuç: Preeklamptik plasenta dokusunda fonksiyonel olmayan VEGF ligandının reseptörüne bağlanamadığı için VEGF miktarının arttığı ve bu durumun yetersiz anjiogeneze neden olduğu olasıdır. Ayrıca preeklamptik plasentadaki vimentin artışının vasküler permeabilitenin azalmasına neden olabileceği düşünülmektedir., Objective: In this study, we aimed to investigate the expression levels of vascular endothelial growth factor (VEGF) which stimulates angiogenesis and vimentin, an intermediate cytoskeleton filaments, in both preeclamptic and normotensive placentas. Methods: In this study, placentas after birth in 35-38 weeks were included. Ten preeclamptic placentas and ten normal placentas were used. Tissue pieces which had been soaked in 10% formaldehyde solution were examined histologically after routine paraffin follow. The expression levels of VEGF and vimentin were measured by Western Blot. Results: It was found that syncytial proliferation was in­creased in preeclamptic placentas. Intervillous syncytial knots, syncytial edema, collagen increase and vascular endothelial damage were observed. It was observed that VEGF and vimentin expression levels were increased as a result of preeclampsia. Conclusion: Nonfunctional VEGF which could not bind to its receptor leading to increased VEGF level may lead to inadequate angiogenesis in preeclamptic placenta. In addition, it is thought that an increase in vimentin level in preeclamptic placenta may cause reduced vascular per­meability.