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Amaç: Kliniğimizde doğum yapan hastaların prepartum, peripartum ve postpartum dönemdeki kan ve kan ürünleri transfüzyon endikasyonlarını literatür eşliğinde tartışmak.Materyal- Metod: Sancaktepe Şehit Prof.Dr.İlhan Varank Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, 01 Şubat 2018-31 Ekim 2018 tarihleri arasında doğum yapan ve kan transfüzyonu yapılan hastaların demografik özellikleri, doğum kayıtları, kan transfüzyonu zamanı, endikasyonları ve sonuçlarının incelendiği retrospektif gözlemsel bir çalışma yapılmıştır.Bulgular: Çalışma süresince kliniğimizde doğum yapan 3575 hastanın kayıtları incelenmiştir. Hastaların %2,65’ine (n­:95) kan transfüzyonu yapılmıştır. Sezaryen ile doğumların %5,41’ inde, vajinal doğumların ise %1,56’sında kan transfüzyonu uygulanmıştır. Transfüzyon yapılan hastaların %26,3‘inde (n:25) herhangi bir spesifik neden belirtilmez iken %30,5 (n:29) hastada ek risk faktörü olmayıp transfüzyon endikasyonu kronik anemi bulunmuştur. Obstetrik endikasyonlardan en sık uterin atoni %18,9 (n:18) saptanmıştır. Transfüzyon yapılan hastalarda kullanılanan kan ürünleriden eritrosit süspansiyonu ortalama 2,09 ± 1,186 (0-7) ünite, TDP 1,49 ± 1,05 (0-4) ünite uygulanmıştır. Sonuç: Kan ve kan ürünleri transfüzyonları hayat kurtarıcı tedaviler olmakla beraber istenmeyen komplikasyonlara da neden olabilirler. Gebe hastaların izlem ve takiplerinin düzenli yapılması sağlanarak uygun demir ve multivitamin takviyeleri ile gebelikte anemiyi önleyerek transfüzyon oranlarının düşürülebileceğini düşünüyoruz.

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

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

To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a diabetic population in Turkey using a non-mydriatic fundus camera. Patients presenting to our diabetes screening center were evaluated by fundus photography using a non-mydriatic fundus camera. Patients’ age at presentation, diabetes duration, hemoglobin A1c (HbA1c) levels, and treatments used for diabetes were recorded. The data of 1797 female (55%) and 1470 male (45%) diabetes patients (total 3267) were analyzed. The prevalence of DR was 28.6%. DR stage was mild non-proliferative DR (NPDR) in 345 patients (12.9%), moderate NPDR in 300 (11.2%), severe NPDR in 108 (4%), and proliferative DR (PDR) in 12 patients (0.4%). Diabetic macular edema (DME) was detected 98 patients (3.7%). Fundus pictures were inadequate for assessment in 18% of cases (588 patient). Advanced age, longer diabetes duration, higher HbA1c level, and being treated for diabetes were found as risk factors for DR. In this study, we used a non-mydriatic fundus camera to determine the prevalence and risk factors of diabetic retinopathy in a Turkish population. In developing countries, the non-mydriatic fundus camera may be an appropriate way to detect DR in the early stages before it progresses to the proliferative stage.

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

To compare the status of female sexual dysfunction (FSD) between women with a history of previous gestational diabetes mellitus (GDM) and those with follow-up of a healthy pregnancy, using the female sexual function index (FSFI) questionnaire.Cross-sectional study.Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, from September to December 2015.Healthy sexually active adult parous females were included. Participants were asked to complete the validated Turkish versions of the FSFI and Hospital Anxiety and Depression Scale (HADS) questionnaires. Student's t-test was used for two-group comparisons of normally distributed variables and quantitative data. Mann-Whitney U-test was used for two-group comparisons of non-normally distributed variables. Pearson's chi-squared test, the Fisher-FreemanHalton test, Fisher's exact test, and Yates' continuity correction test were used for comparison of qualitative data.The mean FSFI scores of the 179 participants was 23.50 ±3.94. FSFI scores and scores of desire, arousal, lubrication, orgasm, satisfaction, and pain were not statistically significantly different (p0.05), according to a history of GDM and types of FSD (none, mild, severe). HADS scores and anxiety and depression types did not statistically significantly differ according to the history of GDM (p0.05).An association could not be found in FSFI scores between participants with both the history of previous GDM and with healthy pregnancy; subclinical sexual dysfunction may be observed in the late postpartum period among women with a history of previous GDM. This may adversely affect their sexual health.

Introduction: Adnexal torsion can be often seen in reproductive age, butcan occur at any age up to postmenopausal period. Adnexal torsion accounts forabout %3 of gynecologic emergencies. Case Presentation: A 19-year-old female presented with abdominal pain,nausea and vomiting. Diagnostic procedures with abdominal computed-tomographyand pelvic ultrasonography suggested 110x58mm and 74x64x38 mm left-adnexialcysts, respectively. Due to inconclusive radiologic diagnosis and suspiciousphysical abdominal examination, an emergency diagnostic laparotomy wasperformed. Exploratory surgery revealed a necrosed and torsioned left paratubalcyst and torsioned but intact fallopian tube were found. Early surgical intervention with paratubal cyst excision anddetorsion of fallopian tube ensured the preservation of fallopian tubes.Result: Gynecologists’attention and suspicion of rare adnexal torsions are the key factors in makingearly decision and treatment success., Giriş: Adneksiyal torsiyonlar en sık üreme çağındakikadınlarda görülmekle beraber postmenapozal döneme kadar her yaşta görülebilir.Kadınlardaki cerrahi acillerin yaklaşık %3'ünü oluşturur.Olgu: Karın ağrısı ve bulantı kusma şikayetleriyle başvuran19 yaşındaki hastanın yapılan Tüm batın Tomografisinde ve pelvik USG sinde sırasıyla110x58 mm ve 74x64x38 mm sol adneksiyel kist izlendi. Radyolojik olarak over torsiyonutanısı net olarak konulamayan ve fizik muayenesi şüpheli olan hastaya acil tanısallaparotomi uygulandı. Nekroze torsiyone sol paratubal kist ve torsiyone intaktfallop tüpü izlendi. Hastaya yapılan erken cerrahi müdahalede paratubal kisteksizyonu ve fallop tüpünün detorsiyonu yapılarak fallop tüpünün korunmasısağlandı.Sonuç: Nadir görülen adneksiyel torsiyonların erken tanı vetedavi başarısında en önemli faktör jinekologun azami dikkat ve klinikşüphesidir

Pregnancy in patients with Wegener's granulamotosis (WG) is rare, and differential diagnosis of WG flare and preeclampsia is difficult.A pregnant 35 year old with WG was referred with diagnosis of severe preeclampsia; caesarean section was performed. Intubation of the patient was difficult due to subglottic stenosis. Because of the clinical symptom, the case was considered preeclampsia, but p-ANCA of the patient was positive. In pregnancies with WG, differential diagnosis of WG flare-ups from preeclampsia should be made from clinical symptoms and laboratory findings. Serum ANCA titers are not useful in the differential diagnosis of WG flare-ups and preeclampsia because it may be positive in preeclampsia.Differential diagnosis of WG flare-up and preeclampsia should be made by clinical features. In the patients with subglottic stenosis, general anesthesia should not be preferred due to the probability of difficult intubation.

To evaluate the reproductive outcome after hysteroscopic metroplasty in women with a septate uterus, with particular focus on patients suffering from unexplained infertility. Materials and methods: Hysteroscopic septum resection was performed on 181 patients with uterine septa, including 98 patients with infertility and 83 patients with secondary infertility. Patients were placed into 1 of 3 groups: those with unexplained infertility, those who had experienced 1 miscarriage, and those who had experienced 2 or more miscarriages. All were analyzed retrospectively in terms of their reproductive outcome. Results: After undergoing the hysteroscopic septum resection, 43 out of 98 primary infertility patients became pregnant (43.8%). This figure was lower than the pregnancy rates for patients who had experienced 1 miscarriage or 2 or more miscarriages, 70.2% and 82.6%, respectively (P < 0.05). In spontaneous pregnancies, the miscarriage rate for those who had experienced 1 previous miscarriage decreased from 88.1% (37/42) to 13.6% (3/22, P < 0.001); for those who had experienced 2 or more previous miscarriages, it decreased from 96.5% (168/174) to 17.1% (7/41, P < 0.001). The term delivery rate and live birth rate also rose significantly in all of the groups (P < 0.05). The rate of cesarean sections was 28 out of 107 births, or 26.1%. Conclusion: The reproductive prognosis for patients with unexplained infertility can be improved significantly by performing hysteroscopic metroplasty. Vaginal delivery is a safe way of giving birth for these patients.

Objective: To compare and evaluate the influences of expectant and aggressive management of severe preeclampsia on the first year neurologic development of the infants in pregnancies between 27 and 34 weeks of pregnancy. Methods: Seventy women with severe preeclampsia between 27 and 34 weeks of gestation were included in the study. 37 patients were managed aggressively (Group 1) and 33 patients were managed expectantly (Group 2). Glucocorticoids, magnesium sulfate infusion and antihypertensive drugs were administered to each group. After glucocorticoid administration was completed Group 1 was delivered either by cesarean section or vaginal delivery. In Group 2 magnesium sulfate infusion was stopped after glucocorticoid administration was completed. Antihypertensive drugs were given, bed rest and intensive fetal monitorization were continued in this group. Results: The average weeks of gestation, one minute and five minute apgar scores and hospitalization time in intensive care unit were similar in both groups (P > 0.05). Three neonatal complications in Group 2 and five in Group 1 were detected according to the Denver Developmental Screening Test-II and one pathologic case was detected in both groups following neurologic examination. Neonatal mortality was seen in seven patients in Group 1 and one in Group 2. There were no significant differences between groups in terms of neonatal mortality and morbidity and maternal morbidity (P > 0.05). The average latency period was 3.45 ± 5.48 days in Group 2 and none in Group 1. Conclusion: There was no significant difference in the first year neurological development of infants whose mothers underwent either expectant and aggressive management for severe preeclampsia.

Urinary tract injuries are one of the most serious complications of pelvic surgery and its incidence is about 0.1-1.5%. A 28 year-old woman who had delivered by emergency cesarean section in the second stage of labour presented at the emergency department with pain commencing on the fifth day of the birth. The diagnosis was left ureteral angulation due to deep myometrial suturing during surgery. The patient was regularly followed-up by ultrasonography once a week until the left pelvic ectasia disappeared. Medical therapy is given when necessery. The aim of this report is to evaluate expectant management for the treatment of ureteral angulation that is diagnosed in the early period after ceasarean section.Uriner sistem komplikasyonları pelvik cerrahi girişimlerin en ciddi komplikasyonlarıdır ve yaklaşık olarak %0.1–1.5 sıklıkta görülür. Sezaryen ile 5 gün önce doğum yapmış ve acile karın ağrısı ile gelen 28 yaşındaki bir vaka sunuldu. Tanı derin myometriyal sütüre bağlı oluşan sol üreteral açılanma olarak değerlendirildi. Hasta pelvik konjesyonu gerileyene kadar haftalık ultrasonlarla takip edildi. Bu vaka, erken dönemde tanı konulan vakalarda bekle gör tedavisinin yeri olduğunu göstermek için sunuldu.

To assess the indications and distribution of cases chosen for termination of pregnancy and reasons delaying until third trimester termination.Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups, as early termination (23 weeks of gestation) and late termination (≥23 weeks of gestation). All pregnant women who underwent termination were classified according to related systemic pathology and chorionicity. Reasons for delaying until third trimester termination were evaluated in four groups.During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most frequent indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason for delaying termination was failure of screening by ultrasound (65.6%).Systematic screening for fetal anomalies is the main step for prevention of affected pregnancies. Information given to parents for TOP is important, but the decision for TOP is influenced by many factors.Gebelik sonlandırması kararı alınan olguların endikasyonu ve dağılımı ile bu işlemin üçüncü trimestere kadar gecikme nedenleri.2002–2006 yılları arasında hastane konseyinde görüşülen olguların retrospektif çalışması. Olgular, (erken sonlandırma (23.gebelik haftası) ve geç sonlandırma (≥23.gebelik haftası) olmak üzere iki grupta değerlendirildi. Gebelik sonlandırması uygulanan gebelerin tümü, etkilenmiş sistemin patolojisi ve koryonisiteye göre sınıflandırılmıştır. Üçüncü trimesterde sonlandırmaya neden olan gecikmeler dört grupta incelenmiştir.Bu beş yıllık dönemde 1.449 komplike gebelik değerlendirildi ve 713 olguya sonlandırma seçeneği sunuldu. 677 olgunun (%94.95) 412′ sine (%60.09) ve 265′ ine (%39.91) sırasıyla, erken ve geç sonlandırma uygulanmıştır. En sık görülen endikasyonlar santral sinir sistemi anomalileri (%57.7), kromozom anomalileri (%11.7) ve ürogenital anomalilerdi (%8.4). Gebelik sonlandırmasında gecikmelere yol açan en sık neden, ultrasonografi taramasındaki yetersizlik (%65.6) olarak değerlendirilmiştir.Etkilenmiş gebeliklerden korunmanın en önemli adımı, fetal anomaliler açısından sistematik taramadır. Gebelik sonlandırması açısından ailelere verilen bilgi önemli olup, sonlandırma kararında pek çok etken rol almaktadır.