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Objective: The aim of this study is to investigate the effect of intrauterine insemination (IUI) performed simultaneously with ultrasound detected follicular rupture during biological reproduction window on pregnancy rates in patients with unexplained infertility undergoing ovulation induction (OI) cycles with gonadotropins. Material and Methods: Three-hundred and twenty-five patients with unexplained infertility were included in this prospective cohort study, who received recombinant follicular stimulating hormone (75–150 IU/day) or Human Menopausal Gonadotropin starting from the 2nd to 3rd days of the cycle. IUI was carried out with ultrasonographic monitoring of the follicles. The presence of free fluid within the Douglas pouch, detection of corpus luteum, and/or loss of the dominant follicle was interpreted as follicular rupture. Pregnancy rates with or without follicular rupture were compared after 14 days. Results: Among those with follicular rupture, the time between administration of recombinant hCG and IUI was significantly longer as compared to those without follicular rupture (p

The cannabis plant, whose homeland is Central Asia, has two species, indica and sativa. It has been used for pleasure, medicinal treatment and religious purposes since ancient times. The word marijuana is used to refer to the dried leaves, flowers, stems and seeds of both species of this plant. Marijuana is the most used substance for pleasure in the world after alcohol and tobacco. According to the World Health Organization, approximately 2.5% of the world's population uses cannabis plants. This rate is expected to increase as the number of countries allowing legal use of cannabis for medicinal or recreational purposes increases

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.

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.

WOS:000638452800001 PMID: 33820484 One of the least common forms of Mullerian anomalies is Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis (OHVIRA). HWWS is also known as OHVIRA syndrome. Patients with OHVIRA syndrome generally present with increasing pelvic pain, dysmenorrhoea, and pelvic mass during puberty, shortly after menarche. These patients may be treated successfully with a minimally invasive method. Case report We present three previously asymptomatic patients with OHVIRA syndrome who presented with acute abdomen shortly after menarche. These patients were treated with a minimally invasive method. Conclusion Patients with OHVIRA syndrome may be treated with minimally invasive method after definitive diagnosis and, laparoscopy and laparotomy should be avoided as much as possible. Minimally invasive treatment modality is not only cost-effective, but also provides symptomatic relief and preserves fertility.

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

Background: The relationship between placental localization and fetus is unclear. This study was aimed to determine the relationships between placental localization, ultrasound findings and pregnancy outcomes of the third trimester of pregnancies.Materials and Methods: Three-hundred and two women were included in the study. Maternal age, gravidi-ty, parity, abortion and live birth numbers, types of previous births, gestational age, femur length (FL), bipa-rietal diameter (BPD), head circumference (HC), abdominal circumference (AC), placental localization (ante-rior/posterior/lateral/fundus), umbilical artery systolic/diastolic ratio (S/D), fetal presentation, type of deliv-ery, post-partum parameters of infant were obtained from archive records.Results: The placentas were located in the anterior, posterior, fundal and lateral uterine wall in 38.1%, 30.1%, 19.9%, and 11.9% of individuals, respectively. Measurements of the HC in the third trimester were differed according to the localization of the placenta, and the HC measurements were significantly higher if the placental localization was anteriorly (p=0.045). There were no differences in other ultrasonographic measurements (S/D, BPD, AC ve FL), in the height, weight, and gender of the baby, gestational week at delivery, APGAR scores and type of delivery according to the placental localization (p>0.05).Conclusions: In this study, we found that placental localization did not affect pregnancy outcomes, type of delivery and gender of the baby in risk-free, spontaneous and single pregnancies in the third trimester. Also, we stated that the previous birth type did not give an idea about placental localization. We think that placenta implantations, except placental location anomaly and invasion anomaly, do not provide precise information about pregnancy outcomes and type of delivery., Amaç: Plasenta lokalizasyonu ve fetüs arasındaki ilişki belirsizdir. Bu çalışmada, gebeliğin üçüncü trimesterindeki plasenta lokalizasyonu ile ultrasonografi bulguları ve gebelik sonuçları arasındaki ilişkilerin belirlenmesi amaçlanmıştır.Materyal ve metod: Çalışmaya 302 kadın dahil edildi. Anne yaşı, gravidite, parite, düşük ve canlı doğum sayısı, önceki doğum şekilleri, gebelik yaşı, femur uzunluğu (FL), biparietal çap (BPD), baş çevresi (HC), abdominal çevre (AC), plasenta lokalizasyonu (anterior/posterior/lateral/fundus), umblikal arter sistolik/diyastolik oranı (S/D), fetal prezentasyon, doğum şekli, bebeğin doğum sonrası parametreleri arşiv kayıtlarından elde edildi.Bulgular: Plasenta lokalizasyonları sırasıyla bireylerin %38.1, %30.1, %19.9 ve %11.9'unda anterior, posterior, fundal ve lateral uterin duvarda bulunuyordu. Üçüncü trimesterde HC ölçümleri plasenta lokalizasyonuna göre farklılık gösteriyordu ve plasenta lokalizasyonu anteriorda ise HC ölçümleri anlamlı olarak daha yüksekti (p=0.045). Diğer ultrasonografik ölçümlerde (S/D, BPD, AC ve FL), bebeğin boy, kilo ve cinsiyeti, doğum haftası, APGAR skorları ve doğum şeklinde plasenta lokalizasyonuna göre farklılık yoktu (p>0.05).Sonuç: Bu çalışmada üçüncü trimesterdeki risksiz, spontan ve tekil gebeliklerde plasenta lokalizasyonunun fetal sonuçları, doğum şeklini ve fetal cinsiyeti etkilemediğini saptadık. Ayrıca önceki doğum şeklinin plasenta lokalizasyonu hakkında fikir vermediğini tespit ettik. Plasenta lokalizasyon anomalisi ve invazyon anomalisi dışındaki plasenta implantasyonlarının fetal sonuçlar ve doğum şekli hakkında kesin bilgi vermediğini düşünmekteyiz.

Amaç: GnRH antagonist protokollü IVF-ICSI sikluslarında hCG günü çalışılan serum estradiol ve progesteron değerlerinin tedavi sürecini, implantasyon ve klinik gebelik oranlarını nasıl etkilediğini araştırmak amaçlandı. Yöntemler: İkinci basamak bir merkezde, 2019-2020 yılları arasında kontrollü ovaryan stimülasyon (KOS) sonrası ICSI tedavisi uygulanan IVF-embriyo transferi (ET) siklusu yapılan hastalar retrospektif olarak tarandı. Hastalar, hCG uygulandığı güne ait serum östradiol (E2) seviyesine göre üç gruba ayrıldı: Grup A (4000 pg/ml). Ayrıca, hCG uygulanan güne ait serum P4 seviyesine göre de 4000 pg/ml). In addition, they were divided into two groups as

Objective: To evaluate the 8-day methotrexate (MTX)/folinic acid (FA) as a first-line chemotherapy regimen treatment in terms of complete regression of disease in women with low-risk gestational trophoblastic neoplasia (GTN). Material and Methods: All patients with low-risk GTN treated with an 8-day MTX/FA regimen were retrospectively included in the study. International Federation of Obstetrics and Gynecology and the modified World Health Organization Prognostic Scoring System were used to classify the risk of GTN. All women received diagnostic imaging evaluation before starting the treatment. The same MTX/FA regime was used repeating as a two-week cycle until normalization of the beta-human chorionic gonadotropin (ß-HCG), thus monthly ß-HCG follow-up was scheduled for up to 1 year. Results: Successful treatment was achieved in 56/66 (84.8%) patients. Nine (13.6%) women had resistance and 1 (1.6%) toxicity. The resistance patients were successfully treated with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) protocol, whereas the patient who showed toxicity to the MTX/FA regime was successfully treated with actinomycin-D. Conclusion: Eight-day MTX/FA regime could be useful in low-risk GTN patients with good security margins. The toxicity rates in this protocol were determined as quite low. All resistance was treated successfully with the EMA-CO protocol.

Elif Agacayak,1 Aysenur Keles,2 Ugur Deger,3 Mehmet Sirin Ozcelik,1 Nurullah Peker,1 Reyhan Gunduz,1 Murat Akkus,4 Huseyin Buyukbayram2 1Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakır, Turkey; 2Department of Pathology, Dicle University School of Medicine, Diyarbakır, Turkey; 3Department of Obstetrics and Gynecology, Memorial Hospital, Diyarbakır, Turkey; 4Department of Histology and Embryology, Dicle University School of Medicine, Diyarbakır, TurkeyCorrespondence: Elif Agacayak, Dicle University School of Medicine, Department of Gynecology and Obstetrics, Diyarbakir, 21280, Turkey, Tel +90 412 2488001/4904, Fax +90412 2488523, Email drelifagacayak@gmail.comAim: This study aims to determine an important parameter in progression from pre-invasive lesions of endometrium to endometrial cancer and also evaluate the effect of this parameter on the progression of endometrial cancer.Material and Method: In our study,30 patients with normal endometrial tissue (group 1), 56 patients who had endometrial hyperplasia without atypia (group 2), 36 patients who had endometrial hyperplasia with atypia (group 3), and 63 patients with endometrial cancer (group 4) were included. Age, parity, body-mass index, systemic diseases, and tumor markers of patients were evaluated. Expression levels of Ezrin, Radixin, and Moesin proteins were immunohistochemically evaluated in terms of frequency, intensity, and score value.Results: When we compared hyperplasia cases with or without atypia; frequency, and score value of ezrin expression and frequency, intensity, and score value of moesin expression was significantly higher in patients who had hyperplasia with atypia (p:0.000 p:0.001 p:0.003, p:0.032 p: 0.035 p:0.015 p:0.005, respectively). It was observed that the frequency and score value of moesin expression were significantly higher in patients with endometrial cancer when compared with patients who had hyperplasia with atypia (p:0.003 p:0.045). The frequency of moesin expression was significantly higher in patients who had postoperative mortality (p:0.030 p:0.039).Conclusion: Increased frequency of moesin expression in the preoperative period in patients with atypical hyperplasia should alert the surgeon in terms of malignancy. If the frequency of moesin expression increases in cases with endometrial cancer, the patient should be followed closely in terms of progression in the postoperative period.Keywords: hyperplasia, endometrial cancer, moesin, progression

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.

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.

PMID:31909461 Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1.1.4)], low preoperative haemoglobin [OR: 0.96 (0.94.0.98)], uterine weight [OR: 2.69 (2.62.2.76)], and long operation time [OR: 1.04 (1.02.1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96.1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.

PMID: 32231852 Objective: To evaluate the prevalence of uterine anomalies in infertile patients with polycystic ovary syndrome (PCOS) admitted to our tertiary hospital inSoutheastern Turkey.Materials and Methods: The files of 3033 patients with infertility who presented to the infertility polyclinics were retrospectively analyzed, and uterine anomalieswere detected in 131 patients. Seven hundred ten of these patients were evaluated as having PCOS, 55 of whom had uterine anomalies. Patients with PCOS werealso divided into two subgroups as those with primary and secondary infertility.Results: Of the 3033 patients with infertility who were evaluated, 57 (8%) of 710 infertile patients with PCOS, and 74 (3%) of 2323 non-PCOS patients withinfertility had uterine anomalies. A statistically significant difference was found between the two groups (p

Tokgoz, Vehbi Yavuz/0000-0002-4113-385X; Demir, Selim/0000-0002-1863-6280; sipahi, mehmet/0000-0001-8344-9863 WOS: 000461905700016 PubMed: 30744441 The aim of this study was to investigate the findings of ultrasound that could predict the metabolic syndrome (MetS) which may develop in polycystic ovary syndrome (PCOS) patients. A total of 96 consecutive PCOS patients, who were scheduled for any gynaecologic examination from January 2015 to January 2016 and who were eligible for the study, were prospectively enrolled in it. About 15.6% of PCOS patients were diagnosed with MetS. The mean age of the MetS patients and the non-MetS patients were 25.8 and 23.3, respectively (p = .056). The mean ovary volume was calculated as being 11.7 mL in the MetS patients and as 9.6 mL in the non-MetS patients (p = .027). The Doppler and the other ultrasound findings were compared between the groups and no significant difference was observed. When a receiver operator characteristic curve analysis was conducted for the ovarian volume to predict MetS, the area under curve was 0.67 (95% CI, 0.52-0.81). The optimum cut-off point for OV was determined at 9.2 mL, with the sensitivity and specificity of 80.0% and 50.6%, respectively. The risk of developing MetS appears to be higher in PCOS patients with higher OV values.Impact statement What is already known on this subject? Metabolic syndrome is not rare in PCOS patients. There are several studies to specify a predictor for MetS development in PCOS. Most are biochemical predictors, such as hyperandrogenemia, a visceral adiposity index, lipid accumulation product, adiponectin index and a leptin-to-adiponectin ratio. What do the results of this study add? The ultrasound markers to predict the insulin resistance at PCOS is already used, but are new for predicting MetS. Giresun UniversityGiresun University [SAG-BAP-A-200515-32] The research was supported by Giresun University [SAG-BAP-A-200515-32]

PMID: 32500679 WOS:000692172500016 To show how interstitial pregnancy can be safely managed with a laparoscopic resection

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8–0.9 per week increase; p Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

BACKGROUND: 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. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: 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. RESULTS: 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

WOS:000623754000001 PMID: 33645414 Objective To investigate the effect of surgical procedure on the operation's results in patients undergoing emergency peripartum hysterectomy (EPH). Methods The records of patients who underwent EPH due to postpartum hemorrhage between 2010 and 2020 in two tertiary centers with a high crude delivery rate were retrospectively analyzed. Surgical data were compared according to the EPH type. Results During the study period, 115,709 births occurred in these two centers. EPH was administered for 181 (1.6%) of these patients. Sixty-seven (37%) of the EPH cases involved subtotal EPH (SEPH), and 114 (63%) were total EPH (TEPH). Surgical time (107.3 +/- 17.6 vs. 134.2 +/- 32.3 min, p < 0.001), erythrocyte transfusion count (2.6 +/- 1.3 vs. 4.3 +/- 6.2, p < 0.001), ureter injury (0.0 vs. 7.9%), bladder injury (1.5 vs. 28.1%), disseminated intravascular coagulation (1.5 vs. 9.6%), need for relaparotomy (4.5 vs. 14%), and intensive care unit admission (19.4 vs. 52.6%) were found to be higher in the TEPH group compared to the SEPH group (p < 0.05). In addition, the total length of hospitalization was longer in the TEPH group (4.5 +/- 2.3 vs. 6.1 +/- 4.6 day, p = 0.011). Conclusion According to the results, if the bleeding in peripartum hemorrhage requiring EPH can be controlled with SEPH, attempting to remove the cervix completely may be associated with increased surgical time, blood transfusion need, and surgical complications.

Amaç: Kliniğimizdeki amniyosentez uygulanan olguların retrospektif analizini yapmak ve bu konudaki deneyimimizi paylaşarak literatüre katkı sunmaktır.Yöntem: Çalışmamıza ikinci trimesterde amniyosentez uygulanan 632 olgu dahil edildi. Olguların demografik özellikleri, gebelik haftaları, amniyosentez endikasyonları, işleme bağlı komplikasyonları, kültür başarısı, sitogenetik sonuçları, kromozom anomalisi saptanan olguların sonuçları ve endikasyonları değerlendirildi. Kromozom anomalisi, komlikasyonları, kültür başarısızlığı oranları ve en sık amniyosentez endikasyonları belirtildi. Kromozom anomalisi olan olguların sonuçları sayısal ve yapısal anomi olarak belirtildi.Bulgular: Çalışmamıza dahil edilen tüm olguların yaş ortalamaları 33.7±6.8 yıl, gebelik haftaları 17.5±1.0 hafta olarak tespit edildi. Amniyosentez sonucu kromozom anomalisi tespit edilen olgu oranı%22.4, kültür başarısızlığı oranı %2.1 ve komplikasyon oranı %0.5bulundu. En sık amniyosentez endikasyonları ve kromozom anomalisi tespit edilen olgularda amniyosentez endikasyonları aynı olupbunlar sırasıyla; kombine testin yüksek riskli olması, üçlü tarama testinin yüksek riskli olması ve ultrasonografide (USG) anomali olmasıdır. Kromozom anomalisi tespit etme oranı birden fazla endikasyonun birlikte görülüp amniyosentez uygulanan olgularda dahayüksek bulundu.Sonuç: Prenatal tanı için USG ve serum tarama testleri yaygınolarak kullanılmakla birlikte yüksek riskli hastalara kesin tanı içinamniyosentez gibi invazif testlere ihtiyaç vardır. Tarama testlerinde birden fazla kromozom anomalisi riski taşıyan olgularda, prenatal tanı için amniyosentezin daha önemli olduğu sonucuna varıldı. Objective: The aim is to contribute to the literature by carrying out retrospective analysis of the cases who underwent amniocentesis in our clinic and sharing our relevant experience. Methods: A total of 632 cases who underwent amniocentesis in the second trimester were included in our study. The cases’ demographic characteristics, weeks of gestation, amniocentesis indications, procedure-related complications, culture success, cytogenetic results, and the results and indications of the cases found to have chromosomal anomalies were evaluated. Chromosomal anomalies, their com plications, culture failure rates and most common amniocentesis indications were reported. The results of the cases with chromosomal anomalies were presented as numerical and structural anomalies. Results: The mean age of all cases included in our study was 33.7±6.8 years, and their mean weeks of gestation were 17.5±1.0 weeks. The rate of the cases found to have chromosomal anomaly by amniocentesis was 22.4%, the culture failure rate was 2.1%, and complication rate was 0.5%. The most common amniocentesis indications and the amniocentesis indications in cases found to have chromosomal anomaly were the same, and they were as following respectively: combined test being high risk, triple screening test being high risk and presence of anomaly in the ultrasonography (USG). The rate of detecting chromosomal anomaly was higher in the cases who had multiple indications and underwent amniocentesis. Conclusion: Although USG and serum screening tests are used commonly for prenatal diagnosis, invasive tests such as amniocentesis are needed for the final diagnosis in patients with high risk. We concluded that amniocentesis is more important for prenatal diagnosis in cases who are under risk of having multiple chromosomal anomalies in the screening tests.

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. COVID-19 originated in China in late 2019 and has spread all over the world. The causative virus has been defined as "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)". The disease is mainly transmitted by droplets. In general, the incubation period varies between 2-14 days. It has been reported that pregnancy does not increase susceptibility to SARS-CoV-2 infection, but worsens the clinical course of COVID-19 compared to non-pregnant women of the same age. Risk factors for serious illness and death in pregnancy include advanced age (especially ≥35 years), obesity, and other comorbidities (hypertension, diabetes, etc.). The frequency of vertical transition is not yet known exactly. It is thought that COVID-19 during pregnancy does not increase the risk of miscarriage, stillbirth, neonatal death and congenital anomalies. It has been reported that the rates of preterm birth and cesarean delivery are increased in pregnant women with COVID-19. More and more data are available regarding the safety and efficacy of COVID-19 vaccines during pregnancy. Based on these data, it is recommended that pregnant women be vaccinated against COVID19. For uncomplicated COVID-19 infection in pregnant women, the option of follow-up without treatment should be considered first. If there are risk factors or severe prognosis in pregnant women with a possible diagnosis, treatment should be considered. COVID-19 positivity is not an indication for delivery. The mode of delivery should be decided according to routine indications. A multidisciplinary care team should be present at birth. Mothers with COVID-19 infection can make skin-to-skin contact and breastfeed in the delivery room by wearing a surgical mask and with proper hand hygiene. As with all adults, postpartum women are also offered the COVID-19 vaccine.

Objectives: The aim of this study is to investigate the effects of a birth preparation program on birth satisfaction. Material and methods: This cross-sectional study was conducted with patients who applied to our hospital between January 2018 and January 2019. A total of 164 pregnant women (Study Group) who applied for the birth preparation program and completed all training in our hospital and 152 pregnant women who did not apply for the birth preparation program and who did not know about such training (Control Group) were included in the study. Demographical data and obstetric parameters of the groups were recorded. All patients were evaluated with the Visual Analog Scale and Salmon’s Item List scale 48 hours after the delivery. The scores of both groups were compared. Results: There were no significant differences between the groups in terms of age, gravida, parity, gestational week of birth, the birth weight of infants, and 5th-minute APGAR scores. It was found that the Visual Analog Scale scores of the Control Group were significantly higher than in the Study Group. The Salmon’s Item List scores of the Study Group were significantly higher than those of the patients in the Control Group (< 0.01). Conclusions: The birth preparation program increases satisfaction during labor and decreases the traumas that may occur in the following births and increase comfort in the postpartum period. For this reason, such programs must be applied commonly to ensure that women can face both the birth and postpartum processes comfortably.

WOS:000649743300001 PMID: 33757147 Objectives: To evaluate the FIGO's novel classification system versus the classic terminology in patients with abnormal uterine bleeding. Material and methods: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yasargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. Results: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis:196 (38.1%), local adenomyosis:32 (6.2%)], leiomyoma in 386 [submucous:161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). Conclusions: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.

Objectives: The aim of this study was to compare a combination treatment with CC plus letrozole versus gonadotropins in CC-resistant polycystic ovary syndrome (PCOS) patients with regard to ovulation and clinical pregnancy rate. Material and methods: One hundred sixteen CC-resistant infertile PCOS patients were evaluated retrospectively. The patients were divided into two groups. Group 1 (n = 73) received CC plus letrozole, and Group 2 (n = 43) received gonadotropins. Results: The ovulation rate in Group 1 was 65/73 (89%), the pregnancy rate was 13/73 (18%), the twin foetuses rate was 1/73 (1.3%) and the miscarriage rate was 2/73 (2.7%). In Group 2, the ovulation rate was 41/43 (95%), and the pregnancy rate was 8/43 (19%) the rate of the twin foetuses was 1/43 (2.3%) and the miscarriage rate was 1/43 (2.3%). There was no statistically significant difference in the ovulation (p = 0.25), pregnancy (p = 0.91), twin foetuses (p = 0.89) and miscarriage p = 0.89) rates between two groups. Conclusions: This new drug combination suggests that it may be a lower cost, lower risk alternative treatment that increases the rate of ovulation. Larger randomized clinical trials are needed to provide information on live birth rates of this combination.

WOS:000619650600004 Abstract OBJECTIVE: Ovarian torsion is a gynecologic problem that presents as acute lower abdominal pain. As a result, blood flow to the ovaries decreases and ischemia develops. Many medications have been used to treat ovarian torsion, including carvacrol. We conducted an experimental ischemia/reperfusion (torsion-detorsion) model using rats to observe the effects of carvacrol on ovarian torsion by immunohistochemical study. STUDY DESIGN: Thirty-two female Wistar rats were randomly categorized into 4 groups (8 rats per group): control group, ischemia group, ischemia/reperfusion group, and ischemia/reperfusion + carvacrol-treated group. Ischemia was created by sealing the left ovaries for 3 hours, followed by 3-hour reperfusion. For the ischemia/reperfusion + carvacrol-treated group, 100 mg/kg carvacrol was administered orally in 2 mL 0.9% NaCl after the reperfusion. All animals were sacrificed, and ovarian tissues were dissected for routine paraffin wax embedding tissue protocol. RESULTS: Control groups showed normal ovarian histological structures. In the ischemia group, hyperplastic granulosa cell vascular dilation, severe hemorrhage, and inflammation were observed. The ischemia/reperfusion group showed edema, inflammation, congestion, degenerated follicles, and cells with pyknotic nuclei. In the ischemia/reperfusion + carvacrol group, degenerative changes and vascular pathologies were decreased in ovarian tissues. Endothelin-1 (ET-1) was expressed in degenerated follicles and vascular endothelial cells in the ischemia and ischemia/reperfusion group. Expression of ET-1 was decreased in follicular cells but negative in stromal and luteal cells in the ischemia/reperfusion + carvacrol group. ADAMTS-5 expression was positive in degenerated follicles, apoptotic cells, and inflammatory cells in the ischemia and ischemia/reperfusion groups. In the ischemia/reperfusion + carvacrol group, corona cells and a few inflammatory cells around vessels showed positive ADAMTS-5 expression. CONCLUSION: ET-1 can induce angiogenic development with the decrease of degenerative development and inflammation in the carvacrol group. ADAMTS-5 molecule may be a marker of cellular structure and extracellular matrix development in different stages of development of ovarian cells and follicles in ischemia and oxygen deficiency caused by ischemia reperfusion.

WOS:000576583500004 Objective: To compare the serum and salivary values of alpha-fetoprotein (AFP) used in screening neural tube defects (NTD) during pregnancy. To investigate whether saliva can be used instead of serum in NTD screening. Method: The study was conducted between May 2018 - November 2019 at Adıyaman University. The study included 41 pregnant women complicated by NTD and 44 healthy pregnant women. Three ml venous blood and 2 ml saliva samples were taken from both groups. Serum and saliva samples were not diluted. AFP concentration was measured at 450 nm by using commercially available enzyme-linked immunoassay. The intra‐ , and inter- test assay coefficients (CVs) of the kit were

Oral kontraseptiflerden (OKS) sonra dünyada ikinci sırada tercih edilen doğum kontrol yöntemi olan rahim içi araç (RİA); etkili, ekonomik ve emniyetli bir yöntem olarak bilinmektedir. Etkinliği yüksek olmasına ve doğal hormonal siklusu bozmamasına rağmen bazı komplikasyonları mevcuttur. RİA kullanımına bağlı olarak gelişebilen komplikasyonlar arasında ektopik gebelik, uterus perforasyonu, spontan veya septik abortus, tubal adezyon, peritonit, pelvik abse, sepsis ve pelvik inflamatuvar hastalık yer almaktadır. Rahim içi araç kullanan kadınlarda pelvik inflamatuvar hastalık insidansının üç ile beş kat artmış olduğu bildirilmektedir.Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde 2018-2019 yılları arasında çeşitli nedenler ile RİA çıkarılma kararı alınmış 233 kadın çalışmaya alınmıştır. Kültür için vajinaya kuru, steril disposable spekulum yerleştirildi. Vajinaya temas etmesinden sakınılarak RİA ipinden klemple tutularak serviksten çıkarıldı. Mikrobiyolojik tetkik için alınan örnekler 10-15 dakika içinde laboratuvara ulaştırıldı. Çalışmamıza alınan RİA tipi bakırlı Copper T 380 A ve Mirena® (Levonergestrelli [LNG] RİA) olup Sağlık Bakanlığı tarafından ücretsiz olarak temin edilebilmektedir. Mikrobiyoloji laboratuvarımızda kültür için sıvı besiyeri olarak buyyon aerob besiyeri olarak kanlı agar kullanıldı. Ekim yapılan aerob besiyerleri 370C de en az 48 saat bekletildikten sonra sonuç değerlendirildi. Çalışmaya aldığımız bireylerin minimum yaşı 20, maksimum 70 olup; yaş değerleri 39,64 ± 8,37 olarak bulunmuştur. Ortanca yaş ise 39'dur. Çıkarılan araçların %83,7'si bakırlı RİA iken %16,3'ü LNG RİA idi. Bireylerin %29,2'sinin 3, %21,2'sinin 2, %17,6'sının 4 gebelik öyküsü mevcuttu. Küretaj öyküsü hastalarımızın %58,2'inde bulunmazken, %30,5'inde 1 adet küretaj öyküsü bulunmaktaydı. Hastaların %41,2'sinde pelvik muayenede akıntı mevcutken, antibiyotik kullanım öyküsü %19,7, vajinal lavaj öyküsü %21,9, disparoni şikayeti olanlar %39,5, pelvik inflamatuvar hastalık öyküsü veya tuba ovaryan abse öyküsü %18,5 olarak bulunmuştur. Tüm RİA'lar içerisinde % 32,6 oranında üreme olmadı, %11,6 E.coli, %7,3 Lactobacillus türleri üredi. Bakırlı RİA'lar ierisinde %30,8 üreme olmazken, Mirenada® bu oran %42,1 idi.Sonuç olarak, bakırlı RİA kullanımı ile Mirena® arasında kolonizasyon açısından anlamlı fark bulunmadığı ayrıca çıkarılan RİA'ların teorik olarak kabul edildiği gibi steril olmadığı gözlenmiştir. Çalışmanın sağladığı katkı, rahim içi araçların güvenle kullanımının sürdürülebileceği ve yeni çalışmalara ışık tutabileceğini düşünmekteyiz.Anahtar Kelimeler: rahim içi araç, levonorgestrelli intrauterin araç, genital kolonizasyon, inflamasyon The intrauterine device (IUD), which is the second contraceptive method preferred in the world after oral contraceptives, is known as an effective, economical and safe method. Although it is high in efficacy and does not disrupt the natural hormonal cycle, it has some complications. Complications that may develop due to intrauterine use include ectopic pregnancy, uterine perforation, spontaneous or septic abortion, tubal adhesion, peritonitis, pelvic abscess, sepsis, and pelvic inflammatory disease. It is reported that the incidence of pelvic inflammatory disease has increased three to five times in women using intrauterine devices.Totally 233 women who were decided to remove the IUD for various reasons in the Gynecology and Obstetrics and Gynecology Clinic of Sivas Cumhuriyet University between 2018-2019 were included in the study. For culture, a dry, sterile disposable speculum was placed in the vagina. Avoiding contact with the vagina, the intrauterine device was removed from the cervix by holding it with a clamp on the device string. Samples taken for microbiological examination were delivered to the laboratory within 10-15 minutes. The IUD type included in our study is Copper T 380 A and Mirena® and is provided free of charge by the Ministry of Health. In our microbiology laboratory, blood agar was used as broth and aerob medium as liquid medium for culture. The results were evaluated after keeping the aerobic media at least 48 hours at 370C.The minimum age of the individuals we participated in the study is 20, maximum 70 years; age values were found to be 39.64 ± 8.37. The median age is 39 years. While 83.7% of IUDs removed were copper IUD, 16.3% were LNG IUD. Of the individuals 29.2% had 3 pregnancies, 21.2% had 2 pregnancies and 17.6% had 4 pregnancies. While pregnancy termination history was not found as 58.2%, 30.5% had a termination history. Of the patients 41.2% had vaginal discharge during pelvic examination and antibiotic use history was 19.7% and vaginal lavage history was 21.9% and those with dyspareunia history were 39.5% and pelvic inflammatory disease history or tuba ovarian abscess history was 18.5%. Among all IUDs, 32.6% did not reproduce, 11.6% E.coli and 7.3% Lactobacillus species reproduced. While 30.8% reproduction did not occur in copper IUDs, this rate was 42.1% for Mirena®.As a result, it was observed that there was no significant difference between the use of copper IUD and Mirena® in terms of colonization, and the extracted IUDs were not sterile as theoretically accepted. We believe that the contribution of the study, the safe use of intrauterine devices can continue and shed light on new studies.KeyWords: intrauterine device, intrauterine with levonorgestrel tool, genital colonization, inflammation 102

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.

Objectives: We aimed to investigate the thiol/disulfide balance in ketone positive (hyperemesis gravidarum) and ketone negative pregnant women with nausea and vomiting. Material and methods: A total of 60 patients under the 14th week of pregnancy were included in this study, and they were divided into two groups. Group 1 included 30 pregnant women with ketone positive, group 2 included 30 ketone negative pregnant women with nausea, and vomiting. Results: The native thiol, disulfide, and total thiol concentrations were measured using an automated method and compared among the two groups. There were also three indexes that are derived from disulfide, native and total thiol (Index 1 = 100 × disulfide/native thiol); (Index 2 = 100 × disulfide/total thiol); (Index 3 = 100 × native thiol/total thiol). When compared with Group 1 and Group 2, total thiol was high, native thiol was low but not statistically significant. Disulphide (p = 0.046), index 1 (p = 0.036) and index 3 (p = 0.034) were statistically significant. Conclusions: Patients with ketone positive are shifting to OS direction due to lack of nutrients and electrolytes. This study emphasizes the therapeutic potential of antioxidant supplementation, which is becoming an increasingly used approach in treating the symptoms of women with ketone positive.

Objects: Benfothiamin is a highly potent form of vitamin B1 protecting endothelial function. On the other hand, vitamin D provides restoration of muscular tissue by inhibition of apoptosis and acceleration of cellular proliferation following muscle injury. We assumed that the administration of these vitamins in ischemia/ reperfusion (I/R) injury, could reduce the damage by alteration of the release of various oxidant and antioxidant mediators leading to cellular damage. Materials and Methods: We assigned 30 Wistar Albino males rats into 5 groups. In the control group (n=6), rats were anaesthetized and total antioxidant capacity (TAS), total oxidant capacity (TOS), malondialdehyde (MDA), superoxide dismutase (SOD) and nitricoxide (NO) level were measured in lower extremity soleus muscle. Benfotiamin and D were given to the groups and the values of these parameters were evaluated in ischemia reperfusion muscle tissue specimens. All tissues were examined histologically. Results: We detected a significant change in groups 3 and 4 for antioxidant NO level after ischemia and reperfusion. Therefore, we observed that the administration of vitamin D and benfothiamin increased NO levels in muscle especially during reperfusion. The level of other oxidants TOS and MDA and antioxidants TAS and SOD were not significant during I/R at given periods. Overall vitamin D and benfothiamin have acute beneficial effects especially in improving I/R injury of lower extremity, even at non-critical periods. Conclusion: Acute term effects of benfothiamin and vitamin D can be useful during where changes due to I/R. The effects can be evaluated during long term I/R.

Tokgoz, Vehbi Yavuz/0000-0002-4113-385X; sipahi, mehmet/0000-0001-8344-9863 WOS: 000461363000014 PubMed: 29298531 Background: Using anogenital distance to determine fetal sex is a new method. There is only one study in the literature. We predict that it will pass through the literature as a new method that can be used in determining fetal sex especially in first trimester. Introduction: Determination of fetal gender before birth has been a matter of curiosity for both the family and the clinician. In the presence of gender-linked genetic disease, it becomes an obligation instead of an interest. The aim of this study was to determine the fetal gender accurately at first trimester with anogenital distance (AGD) and to investigate the correlations of nuchal translucency (NT), fetal heart rate (FHR), and crown-rump length (CRL) with AGD. Materials and methods: In this prospective cross-sectional study, AGD measurement was performed in 111 patients with singleton pregnancy from 11 to 13 weeks and 6 days (CRL 45-84 mm). Measurements of AGD >= 4.8 mm were identified for males, and AGD Results: Genders were demonstrated accurately for males as 76.7% and for females as 97.1%. The mean value of AGD was 3.6 mm for females and 5.1 mm for males. There were no relations between fetal gender and FHR and also NT. Conclusions: Gender can be detected with great accuracy in gestations between 11 to 13 weeks and 6 days by using AGD. CRL and gestational week (GW) were determined as nonsignificant predictors of fetal gender by AGD measurement. In order to obtain more accurate results with AGD, consideration of further studies with larger series in different races is recommended.

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.

PMID:31802467 bjectives: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early second trimester subchorionic hematoma cases. Material and methods: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed with subchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission, ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups were compared according to the clinical features and pregnancy outcomes. Results: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher (p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70% sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in the other group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancy outcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effect of on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sac was above 35% (p = 0.027). Conclusions: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma to the gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of the patients increased and the ratio of pregnancy loss was higher.

PMID:31802466 Objectives: To investigate maternal serum catalase, myeloperoxidase and ferroxidase levels in pregnant women with Hyperemesis Gravidarum and to compare the results with healthy pregnancies. Material and methods: In this study, 60 female patients admitted to the Health Sciences University, Gazi Yasargil Training and Research Hospital, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups: Group 1 included 30 pregnant women with hyperemesis gravidarum; Group 2 included 30 healthy pregnant women. Pregnancies over 14 weeks were excluded from the study. Results: The laboratory and laboratory characteristics of both groups are shown in Table 1. No significant differences were found between the groups in terms of the maternal age, gestational age, gravidity, parity, fasting glucose level, and BMI. The maternal blood CAT levels were significantly higher in the HG group (219.6 ± 111.3 kU/L) when compared to the control group (71.5 ± 52.5 kU/L) (p < 0.001). The maternal blood MPO levels were lower in the control group (121.5 ± 36.3 U/L) than in the study group (90.9 ± 56.4 U/L) (p = 0.016). However, the ferroxidase levels were similar between the two groups. The independent variables BMI, age, parity, gravidity and gestational week effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of CAT (0.001), MPO (0.005) values. Conclusions: This study suggests that antioxidants in response to oxidative stress gave different reactions with different mechanisms; Also, we believe that insufficient food intake suppresses the immune system and this has an important role on antioxidants.

Tokgoz, Vehbi Yavuz/0000-0002-4113-385X; sipahi, mehmet/0000-0001-8344-9863 WOS: 000475253200001 PubMed: 31237153 Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

Objective: To gain insight into the effect of gestational diabetes mellitus (GDM) on cord blood dynamic thiol/disulfide homeostasis. Materials and methods: A prospective case-control study was carried out for 132 pregnant women (62 GDM, 70 controls). The cord blood samples were collected from all the participants, and the native thiol-disulfide exchanges were examined by means of an automated method enabling to measure thiol-disulfide balance. In addition to investigating shifts in thiol disulfide balance between GDM and healthy pregnancies, we sought to correlate the thiol / disulfide homeostasis parameters with other clinical and laboratory characteristics of patients with GDM and using insulin (n = 19) and on a diet only (n = 43). Results: Disulfide amounts, disulfide/native thiol and disulfide/total thiol rates increased (p < 0.001) while native thiol/total thiol decreased in the cord blood of infants born to diabetic mothers (p < 0.001). Furthermore, the patient group administered with insulin and diet only was compared. Disulfide, Disulfide/Native thiol*100, Disulfide/total thiol*100, Native/total thiol*100 differ significantly according to the results (p < 0.05). Disulfide, Disulfide / native thiol * 100, Disulfide/total thiol*100, HbA1c and 75gr are higher than those in patients who do not use insulin. Only Native/total thiol*100 values are higher in patients who use insulin than those who do not. Conclusion: This study suggests that the infants born to diabetic mothers are exposed to increased oxidative stress. In addition, the patients who use insulin better control their blood glucose, thus reducing the need of newborns for intensive care.

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.

Amaç: Biz bu çalışmada amniyon sıvı miktarının tahmini fetal ağırlığın hesaplanmasına etkisini araştırmayı planladık.Materyal - Metod: Ocak 2017 – Haziran 2019 tarihleri arasında Bozok Üniversitesi Araştırma ve Uygulama Hastanesi'ne başvuran 150 gebe incelendi. Bu gebeler 34 - 41 hafta arasındadır ve 48 saat içinde doğumları gerçekleşti. Gebelerin demografik bilgilerine, maternal VKİ (kg/m2), amniyon sıvısı, ultrasonografik tahmini fetal ağırlık, yenidoğanın gerçek doğum ağırlığına ulaşıldı. Çalışmaya tekil, canlı gebelikler dahil edildi. Fetal anomaliler, çoğul gebelikler, ölü fetuslar, membran rüptürü olan olgular çalışma dışında bırakıldı. Tüm gebelerin ultrasonografik değerlendirilmesi aynı asistan hekim tarafından gerçekleştirildi. Tüm hastalardan yatışta yapılacak girişimler için aydınlatılmış onam formu alındı. İstatistiksel analizler Statistical Package for Social Sciences (SPSS Inc; Chicago, IL, USA) versiyon 20.0 yazılımı kullanılarak yapıldı.Sonuçlar: Çalışmamızda ölçülen tahmini fetal ağırlık ile doğum ağırlıkları arasındaki fark normal ASİ grubunda 186.06±121.03, oligohidramniyoz grubunda 235.44±204.77, polihidramniyoz grubunda 277.82±160.88 olarak ölçüldü. Fetüsün cinsiyeti ve plasenta yerleşiminin fetal ağırlığın doğru tahmin edilmesine istatistiksel olarak anlamlı etkisi yoktur. Değerlendirilen parametreler arasında, VKİ < 30 olan gebelerde ultrasonografik tahmini fetal ağırlığın, gerçek doğum ağırlığıyla daha yakın korelasyon gösterdiği sonucuna varılmıştır.Tartışma: : Fetal ağırlığın doğru tahmin edilmesi anne ve yenidoğan açısından olası risklerin öngörülmesi ve doğum şekline karar verilmesinde büyük önem arz etmektedir. Bu sebeple ultrasonografik fetal ağırlık ölçümlerini etkileyen değişkenler önceden bilinmeli ve hata olasılıkları göz önünde bulundurulmalıdır. Çalışmamızda tahmini fetal ağırlık ile doğum ağırlıkları arasındaki farkı oligohidramniyoz ve polihidramniyoz gruplarında daha fazla bulduk. (p= 0.015)Anahtar Kelimeler: Tahmini fetal ağırlık, Gerçek doğum ağırlığı, Oligohidramniyoz, Polihidramniyoz Objective: In this study we investigate the effects of the amount of amniotic fluid on the calculation of estimated fetal weight.Material and Method: Determinations were done in 150 gravid women who admitted to Bozok Univercity Research and Practice Hospital from January 2017 to June 2019. These patients were in their 34 and 41th gestational weeks and all of them delivered in maxium 48 hours following hospitalization. Demographic data of patients, maternal BMI (kg/m2), amniotic fluid volüme, ultrasonographic estimated fetal weight and the actual birth weight of the newborn has been reached. In the study a single, alive pregnancies were included. Fetal anomalies, multiple pregnancies, dead fetuses, rupture of amniotic membrane cases excluded from the study. Ultrasonographic assessment of all pregnant women carried out by the same assistant. From all patients informed consent for initiatives taken at admission are taken form. For statistical analysis, Statistical Package for Social Sciences (SPSS Inc; Chicago, IL, USA) 20.0 program is used. Results: In our study differency between estimated fetal weight and actual birth weight is found 186.06±121.03 in control group, 235.44±204.77 in oligohydramnios group and 277.82±160.88 in polyhydramnios group. When considering maternal sex of the fetus and placental position there is no statistically significant effect to the correct estimation of fetal weight found. Of the parameters measured, in pregnant women with BMI

Gelişmekte olan ülkelerde kadın genital sisteminin en sık görülen malignitesi endometrium kanseri (EK)'dir. Çalışmamızda EK hücreleri olan Ishikawa hücrelerinde, klinikte EK tedavisinde kullanılan ilaçlar olan karboplatin ve progesteronun anti-tümöral etkileri araştırılmış olup, aynı zamanda yine klinikte vitamin D (VD) eksikliğinde kullanılan kalsitriolün anti-neoplastik etkileri incelenmiştir. Bu bağlamda, bu bileşiklerin tümör hücreleri üzerindeki inhibitör etkisi, hücre canlılığı saptanarak belirlenmiş olup, karboplatin, progesteron ve kalsitriolün hücrelerde doza ve zamana bağlı olarak hücre inhibisyonunu arttırdıkları saptanmıştır. Yine, kalsitriolün karboplatin ile birlikte hücrelere uygulandığında hücreler üzerindeki öldürücü etkilerinin arttığı saptanmıştır. Kanser tedavisinde en önemli basamak olan apoptoz sonuçları değerlendirildiğinde, her üç maddenin de hücrelerde apoptozu tetiklediği, karboplatinin hücrelerde doza bağlı olarak apoptozu arttırdığı, progesteron ve kalsitriolün ise, artan dozlar ile birlikte hücrelerde nekrozu da tetiklediği gözlenmiştir. Ayrıca, ilaç kombinasyonları değerlendirildiğinde apoptoz değerleri arasında bir fark saptanmamıştır. Yine, karboplatin, progesteron ve kalsitriolün hücrelerde migrasyonu tetiklemek yerine 12 saat sonunda hücrelerin ölümüne yol açtığı saptanmıştır. Karboplatin + kalsitriolün birlikte kullanımının hücrelerde migrasyon deneyinde hücre ölümünü daha çok tetiklediği saptanmıştır.Anahtar Kelimeler: Endometrium kanseri, karboplatin, progesteron, kalsitriol, anti-tümör. Endometrial cancer (EC) is the most common malignancy of the female genital system in developing countries. In our study, anti-tumoral effects of carboplatin and progesterone that are used in the treatment of EC were investigated on Ishikawa endometrial cancer cell lines. Anti-neoplastic effects of calcitriol, which is used in vitamin D (VD) deficiency were also investigated. In this context, the inhibitory effect of these compounds on tumor cells were determined by detecting cell viability and it was observed that carboplatin, progesterone and calcitriol increased the dose and time dependent cell inhibition. Again, when the calcitriol is applied along with carboplatin anti-tumoral effects were increased. When the results of apoptosis were evaluated, which is the most important step in cancer treatment, it was observed that all three substances triggered apoptosis in cells, carboplatin increased the apoptosis in cells via dose-dependent and progesterone and calcitriol increasing doses triggered necrosis. Besides, there was no difference in apoptosis levels when combinations of these agents were evaluated. In addition, carboplatin, progesterone and calcitriol were found to cause cell death instead of triggering migration at the end of 12 hours. Combined usage of carboplatin and calcitriol was found to trigger cell death more frequently during the migration test.Key Words: Endometrial cancer, carboplatin, progesterone, calcitriol, anti-tumor. 87

sipahi, mehmet/0000-0001-8344-9863 WOS: 000468754900021 PubMed: 30980277 Purpose To evaluate the effect of remote ischemic conditioning (RIC) on ovarian ischemia/reperfusion injury in a rat model. Methods A total of 36 Wistar albino rats with a body weight of 220-250 g were used for this study. Right adnexal torsion was performed for 180 min, and at the end of the period, the adnex was released and the abdomen was reclosed for 180 min for reperfusion. Torsion and detorsion procedures were applied to all rats except group 1 (sham, control). The right lower extremity was tied to perform remote tissue ischemia in groups 3, 4, 5, and 6. The goal of the procedure, which was purplish discoloration and pulselessness of the extremity, was maintained. After 5 min of ischemia, reperfusion was achieved for 5 min. Repeating this procedure 3 times was defined as hypoxia attacks (RIC). Retrieved ovaries were examined for tissue injury with biochemical, histopathologic, and immunohistochemical analysis. Results Unlike the control group, vascular congestion, hemorrhage, edema, and inflammatory cell infiltration were observed in group 2 (only I/R [ischemia/reperfusion]). In groups 3 (I/R + RIC), 4 (I/R + RIC), 5 (I/R + RIC), and 6 (I/R + RIC), edema and inflammatory cell infiltration were not observed. However, vascular congestion and hemorrhage that were detected in these groups were higher than in group 1 (Control) and less than in group 2 (I/R). The Caspase-3 Index was found to be increased in all groups compared to group 1 (P < .001). However, the increase in the RIC-performed groups was significantly less than in group 2. The apoptotic index, which was determined by the TUNEL, was also found to be increased in all groups compared to group 1 (P < .001). When the comparison was made in relation to group 2, the decrease of AI in RIC-performed groups was statistically significant, except the decrease in group 6 (P = .29). Conclusions It is not clinically conceivable to prepare the tissue for pre-ischemia in ovarian torsion. However, the RIC application, which will be initiated if torsion is suspected when arrangements are made for surgery, might be a simple, effective, and inexpensive approach to prevent I/R injury in the clinic. Giresun University BAP Committee [SAG-BAP-A-160317-87] The study was supported by the Giresun University BAP Committee (SAG-BAP-A-160317-87).

75th Scientific Congress of the American-Society-for-Reproductive-Medicine (ASRM) -- OCT 12-16, 2019 -- Philadelphia, PA WOS: 000487821304065 … Amer Soc Reprod Med Giresun University Scientific Research Projects DepartmentGiresun University [SAG-BAP-A-2302] This study was supported by grants from Giresun University Scientific Research Projects Department (SAG-BAP-A-2302)

The aim of this study is to investigate vitamin D deficiency and the associated risk factors in pregnant women and their infants in the Black Sea region of Turkey. One hundred and twenty healthy pregnant women in the last trimester and their healthy newborn pairs were observed between June and August 2017 in Giresun province. The serum 25(OH)D3 and calcium levels were measured through the samples collected from maternal and neonatal cord blood. The effects of maternal lifestyle on the maternal vitamin D levels were assessed by multiple regression analysis. The mean concentrations of 25(OH)D3 were found to be 9.54 ± 6.35 ng/mL and 11.16 ± 6.52 ng/mL in the maternal and neonatal cord blood sera, respectively. Vitamin D deficiency (≤20 ng/mL) and severe vitamin D deficiency (≤5 ng/mL) were observed in between 94.2% and 24.2% of mothers and 90% and 10% of infants, respectively. The clothing style, the consumption of milk/dairy products and antenatal multivitamin supplement usage were found as significant factors on the serum vitamin D levels. Even during the Summer months, the vitamin D deficiency in mothers and infants was observed at high rates in the Eastern Black Sea region of Turkey. As a result, it has been concluded that routine maternal serum 25(OH)D3 measurements for clinical follow-up, vitamin D supplementation and regular consumption of dairy products should be recommended.Impact StatementWhat is already known on this subject? Vitamin D deficiency is a very important risk factor to be considered for maternal and infant health. In a large number of studies, it has been observed that the risk of a vitamin D deficiency in women during their pregnancy was found to be higher, depending on the various strong influences such as the demographic and maternal lifestyles. Whatthe results of this study add? A vitamin D deficiency associated with the demographic and lifestyle factors of pregnant women and their infants was investigated in Giresun province, located in the Eastern Black Sea region of Turkey. The results of this study add that a vitamin D deficiency in the maternal and in the infants may be observed at high rates in regions with mostly rainy weather, even during the Summer months. Whatthe implicationsareof these findings for clinical practice and/or further research? The vitamin D levels in infants can be determined indirectly by looking at the vitamin D levels in third trimester pregnancies. Furthermore, it is suggested as a non-invasive method to determine vitamin D levels by taking advantage of the maternal level, without measuring the vitamin D levels of infants. Thus, this will be effective to reduce health costs and to prevent the possible diseases affecting the future life of infants. Routine maternal serum 25(OH)D3 measurements for clinical follow-up, vitamin D supplementation and the regular consumption of dairy products should be recommended to pregnant women with risk factors, even in the Summer in the Black Sea Region of Turkey. In addition, further studies are needed to investigate the vitamin D deficiency associated with the demographic and lifestyle factors of pregnant women and their infants, especially for the different locations of Turkey. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Amaç: Bu çalışmanın amacı, 2. Trimesterde yapılan ayrıntılı ultrasonografilerdeki plasenta lokalizasyonun maternal faktörlerle ilişkisi olup olmadığını belirlemek ve gebelik sonuçları ile obstetrik komplikasyonları öngörmedeki etkisini incelemektir.Yöntem: Çalışmaya, Ankara Yıldırım Beyazıt Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi'nde 2016-2018 yılları arasında doğum yapmış 18-45 yaş arası 753 hasta dahil edildi. Gebelerin 18-24. gestasyonel haftalarda yapılan obstetrik ultrasonografilerindeki plasenta lokalizasyonları retrospektif olarak incelendi. Plasenta yerleşim yerleri ön üst, ön alt, arka üst ve arka alt olarak gruplandırıldı. Ardından plasenta lokalizasyonlarının, maternal faktörler ve gebelik sonuçlarıyla ilişkisi incelendi.Bulgular: Maternal yaş, gravida ve parite sayısının artmasının, plasentanın arka alt lokalizasyonunu arttırdığı tespit edildi (p

Endometriozis, endometrium dokusunun uterin kavite dışında olduğu ve reprodüktif çağdaki kadınların %10'unda görülen, östrojen bağımlı, genellikle pelvik ağrı, dismenore, disparoni ve infertiliteye neden olabilen patofizyolojisi net olarak bilinmeyen enflamatuvar bir hastalıktır. CX3CL1 (Fraktalkine-FKN), normal ve enflame epitel hücrelerinden eksprese edilen bir kemokin olup, spesifik reseptörü olan CX3CR1 aracılığı ile lökositlerin adezyon ve migrasyonundan sorumlu regülatuvar proteindir.Endometriozisli hastalarda CX3CL1'in bazal serum düzeyi ve bu kemokinin spesifik reseptör polimorfizmlerinin, immün sistem disfonksiyonu ile bağlantılı olabileceği düşünülen endometriozisin patofizyolojisini açıklamaya olası katkısının araştırılması amaçlanmaktadır. Sivas Cumhuriyet Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde çeşitli benign jinekolojik endikasyonlar ile ameliyat kararı alınmış ve ameliyatlar sonucunda elde edilen doku örneklerinin histopatolojik incelenmesi sonucunda endometriozis tanısı almış n=50 olgu hasta grubunu oluştururken, endometriozis tanısı almamış n=35 olgu kontrol grubunu oluşturmuştur. Gruplar benzer yaş aralığında oluşturulmuştur. Her iki gruba da CX3CL1'in bazal serum düzeyini değiştirebileceğinden, kronik hastalığı olanlar, gebeler, kanser hastaları, ameliyat sonrasındaki 3 ay içerisinde OKS veya progestin türevleri kullanmış olanlar ve immün yetmezliği olan bireyler dahil edilmemiştir.Gruplardan ameliyattan 3 ay sonrasındaki poliklinik kontrollerinde venöz tam kan örnekleri alındı. ELİSA yöntemi ile CX3CL1'in bazal serum düzeyleri belirlendi. Kan örneklerinden izole edilen DNA, PolimeraseChainReaction (PCR) ile çoğaltıldı ve RestrictionFragmentLengthPolymorfhism (RFLP) yöntemi ile CX3CR1'in önceden tanımlanmış olan T280M, V249I polimorfizmlerinin allel sıklıkları belirlendi.CX3CL1'in bazal serum düzeyi, endometriozis grubunda 1,4±1,3 ng/ml ve kontrol grubunda 13,9±11 ng/ml olarak fark istatistiksel olarak anlamlı bulunmuştur (p0,05).Sonuç olarak, endometriozis hastalarında, kontrol grubuna göre CX3CL1 bazal serum düzeyi düşüklüğü ve CX3CR1'in T280M polimorfizminde heterozigot ve homozigot allel değişimleri anlamlı olarak bulundu. Bu durumun endometriozis gelişimindeki immun sistem aracılı patofizyolojik süreçlerin açıklanmasına katkı sağlayabileceği ve yeni çalışmalara ışık tutabileceğini düşünmekteyiz. Endometriosis is an inflammatory disease in which endometrial tissue is outside the uterine cavity and is seen in 10% of reproductive age women, whose estrogen-dependent pathophysiology is often unknown, which can cause usually pelvic pain, dysmenorrhea, dyspareunia and infertility. CX3CL1 (Fractalkine-FKN) is a chemokine expressed from normal and inflamed epithelial cells and is the regulatory protein responsible for adhesion and migration of leukocytes through its specific receptor CX3CR1.The aim of this study is to investigate the baseline serum level of CX3CL1 and the possible contribution of this chemokine-specific receptor polymorphisms to explain the pathophysiology of endometriosis, which is thought to be related to immune system dysfunction in patients with endometriosis.In the Department of Obstetrics and Gynecology, Faculty of Medicine, Sivas Cumhuriyet University, surgical decision was taken with various benign gynecological indications and histopathological examination of the tissue samples obtained after the operation revealed n = 50 cases diagnosed as endometriosis while n = 35 cases were defined as control group. The groups were formed in a similar age range. Both groups did not include patients with chronic disease, pregnant women, cancer patients, those who had used OCS or progestin derivatives within 3 months postoperatively and individuals with immunodeficiency, as CX3CL1 could change the basal serum level.Venosus blood samples were obtained from the groups at the outpatient clinic visits at 3 months after the operation. The basal serum levels of CX3CL1 were determined by ELISA method. DNA were isolated from blood samples and amplified by PolymeraseChainReaction (PCR) and Allele frequencies of the predefined T280M, V249I polymorphisms of CX3CR1 were determined by RestrictionFragmentLengthPolymorfhism (RFLP) method.Basal serum levels of CX3CL1 was found 1.4±1.3ng / ml in the endometriosis group and 13.9±11 ng / ml in the control group and the difference was statistically significant (p 0.05).In conclusion; compared with the control group, in patients with endometriosis, low basal serum levels of CX3CL1 and heterozygous and homozygous allele changes in T280M polymorphism in the CX3CR1 were found statistically significant. We think that this situation may contribute to the explanation of immune system mediated pathophysiological processes in the development of endometriosis and may shed light on new studies. 89

WOS:000506310500005 PubMed: 31909462 Objectives: Ghrelin levels can play an important role in maintaining the energy balance of pregnant women. Therefore, we investigated the relationship between HG and Ghrelin. Material and methods: 50 female patients admitted to the VAN Yuzuncu Yil University, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups: Group 1 included 25 pregnant women with HG, Group 2 included 25 healthy pregnant women. Results:The two groups showed similarities in terms of age, gravidity, B-HCG and gestational age.There was no statistically significant difference between the two groups in terms of the Ghrelin levels (p = 0.867). Conclusions: This study shows that there is no difference between Ghrelin levels and HG during pregnancy. Increased Ghrelin in previous studies was attributed to low oral intake. Another study reported lower Ghrelin levels are not the result of, but are rather the cause of, reduced oral intake during. The balancing of these two conditions does not lead to a change in the level of Ghrelin.

Giriş ve Amaç: Diş eti sağlığını birçok faktör etkilemektedir.Oral hijyeninin yetersiz olması periodontal hastalıkların oluşmasınınprimer etkenidir. Periodontal hastalıkların sistemikdurum üzerine etkileri son yıllarda yapılan çalışmalarla ortayakonulmuştur. Preterm ve düşük ağırlıklı doğum ağırlığı, gelişmişve gelişmekte olan ülkeler için önemli bir sorundur. Literatürde,periodontal hastalık ile erken doğum ve düşük doğumağırlığının ilişkili olduğu gösterilmiştir. Bu çalışmanın amacı,Doğu Karadeniz Bölgesindeki gebe kadınlarda periodontalsağlık bilgisi ve farkındalık derecesini değerlendirmektir.Gereç ve Yöntem: Çalışmaya Temmuz 2018 ile Aralık 2018 tarihleriarasında Trabzon ve Giresun illerindeki iki ayrı merkezdekadın doğum polikliniğine başvuran ve araştırmaya katılmayıkabul eden gönüllü gebeler dahil edilmiştir. Veriler, hastalarınbizzat kendilerince doldurdukları, araştırmacılar tarafından yapılandırılmışkesitsel anketler kullanılarak toplanmıştır. Anketmaddelerinde gebelik bilgileri, periodontal sağlık bilinci, kişiselve sosyo-demografik değişkenler ele alınmıştır.Bulgular: Çalışmamızda yaş ortalaması 30,1 5,3 olan 397gebenin % 30,7’ si üniversite, % 35’ nin ise lise mezunu olduğubelirlendi. Gebelerin azınlığının (%16,8) dental plak hakkındabilgi sahibi olduğu, %32,6 ’sının dental plağın zararlı etkilerinibildiği ortaya çıktı. Bununla beraber gebelerin %51,4’ünün dişetindeki kanamanın periodontal hastalığı gösterdiğini ifadeetmiştir. Çalışmamız, gebelerin çoğunluğunun (%80,1) diş etihastalığının ana nedenini bilmemesine ve sadece %15,1’ ininperiodontal hastalığın erken doğuma yol açabileceğini bilmesinerağmen, % 56’ sının gebelikte diş fırçalama sıklığının arttırılmasıgerektiğine inandığını göstermektedir.Sonuç: Çalışmanın sonucunda elde edilen veriler, gebe kadınlardadiş ve diş eti sağlığı konusunda bilgi ve farkındalıkdüzeyinin zayıf olduğunu ortaya koymuştur. Periodontal hastalığıve buna bağlı gelişebilecek erken doğum gibi obstetrikkomplikasyonları önlemek için antenatal dönemde gebelereağız sağlığını iyileştirecek eğitim programları planlanmalı, bilgidüzeyi arttırılmalıdır. Introduction: There are many factors that affect gingivalhealth. The primary factor that leads to the development ofperiodontal disease is poor oral hygiene. The influences ofperiodontal diseases on systemic health have been reportedthrough research conducted in recent years. Preterm and lowbirth weight is a significant problem in developed and developingcountries. In literature, it has been shown that periodontalhealth is associated with preterm birth and low birthweight. The aim of this study is to evaluate the knowledge ofpregnant women from Eastern Black Sea region of Turkey regardingtheir periodontal health and awareness on the issue.Material and Methods: Research includes pregnant womenwho volunteered to take part in the study, after having consultedthe clinic of obstetrics and gynecology of two distinct centers in Trabzon and Giresun between the dates July2018 and December 2018. Data was collected from surveysstructured by researchers, filled in by the patientsthemselves. In the survey data regarding the pregnancyinformation of the volunteers, periodontal health awareness,personal and socio-economic variables were alsoexamined.Results: In the study, of the 397 pregnant women witha mean age of 30.1 5.3; %30.7 were college graduatesand %35 were high school graduates. It was realized thata minority of the pregnant women (%16.8) had knowledgeabout the dental plaque and %32.6 knew the harmfuleffects of the dental plaque. In addition, %51.4 of pregnantwomen have stated that bleeding of the gums representedperiodontal disease. Our study shows that eventhough majority of pregnant women (%80.1) do not knowthe main reason of periodontal disease and only %15.1know periodontal disease may lead to preterm birth; %56believe that tooth brushing frequency should be increasedduring pregnancy.Conclusion: The data obtained through this study revealedthat pregnant women have insufficient knowledgeand low awareness level regarding their dental and periodontalhealth. In order to prevent periodontal disease andobstetric complications, which may result from periodontaldisease such as preterm birth, during antenatal period,pregnant women, should be provided with the neededknowledge on these subjects through educational programs.Such programs should be planned and knowledgeshould be increased.

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.

Cerrahi menopozun hastaların psikolojik durum ve cinsel fonksiyonlara etkisi ve tedavisi halen tartışmalıdır. Bu amaçla transabdominal histerektomi ve bilateral salpingooferektomi (TAH+BSO) geçiren hastalarda oral ve transdermal östrojen tedavilerinin psikolojik durumlar ve cinsel fonksiyonlar üzerine etkilerini karşılaştırdık. Çalışmamızda benign endikasyonlarla TAH+BSO yapılan 52 hasta rastgele randomizasyonla üç gruba ayrıldı. Ameliyattan 12 hafta sonra 17 hastaya kontrol grubu olarak tedavi verilmezken (grup kontrol) 18 hastaya oral östrojen (grup oral), 17 hastaya transdermal östrojen (grup TTS) başlandı. Hastalara ameliyattan önce, 12 ve 28 hafta sonra Beck Depresyon İndeksi (BDI) ve Kadın Cinsel Fonksiyon İndeksi (FSFI) uygulandı. Grup Kontrol’de ameliyat öncesi ve sonrası arasında değişiklik olmadı. Grup Oral’de tedavi sonrası psikolojik durumlar ve cinsel fonksiyonlar üzerine olumlu yanıt gözlenirken grup TTS’de değişiklik gözlenmedi. Çalışmamızın sonucunda cerrahi menopozun hastaların psikolojik durum ve cinsel fonksiyonları üzerine etkisi görülmezken oral östrojen tedavisinin olumlu etkilerinin olabileceği görüldü. The effect and treatment of psychopathological conditions and sexual functions of surgically menopausal patients is still controversial. For this purpose, we compared the effects of oral and transdermal estrogen treatments on psychological status and sexual function in patients who underwent transabdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO). In our study, 52 patients who underwent TAH + BSO with benign indications were randomly assigned to three groups. Twelve weeks after the operation, 17 patients were not treated as a control group (group 1), 18 patients were given oral estrogen (group 2) and 17 patients were transdermal estrogen (group 3). Beck Depression Index (BDI) and Female Sexual Function Index (FSFI) were administered before operation, 12 and 28 weeks after operation. There was no change in preoperative and postoperative results in group 1. In group 2, there was a positive response to psychological conditions and sexual functions after treatment, but no change in group 3 was observed. As a result of our study, it was observed that positive effects of oral estrogen therapy could be seen when there was no effect on the psychological status and sexual functions of surgical menopausal patients.