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Establishing a prognostic model for endometrial cancer (EC), that individualizes risk and management plan per patient and disease characteristics.this is multicentre retrospective study conducted in 9 European gynaecologic cancer centres. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pre-treatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III).Out of 1,150 women, 1,144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88% and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracy of model I, II and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively.Endometrial Cancer Individualised Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy.

Aim: Childbirth education classes support women to achieve a pleasing pregnancy and delivery. We aimed to determine the effects of CEC on obstetric outcomes in women who underwent labor induction with dinoprostone in an underdeveloped region of our country in this study. Material-methods: Prospective study was conducted in Tunceli State Hospital, Department of Obstetrics and Gynecology, between August 2019 and March 2020. Age between 18-40, singleton pregnancy, no presence of chronic disease, and no history of cesarean section was included. CEC was provided by midwives who had certified. It started in the first trimester of pregnancy and continued until the last weeks of pregnancy. All participants received a total of 12 lessons. Results: 171 patients recruited, including 82 (48%) of cases continued CEC, and 89 (52%) patients had no admission to CEC. 69.5% of patients delivered vaginally, and we performed a cesarean section in 30.5% of cases in control groups. 83.1% of cases achieved vaginal delivery, and 16.9% underwent cesarean section in the CEC group. The vaginal birth rate was significantly higher in the CEC group than controls (p: 0.03). Neonatal outcomes were similar between the two groups. Conclusion: CEC is an inexpensive option to promote maternal and neonatal health. It can be a useful tool to reduce cesarean birth rates and should be used widely all over the country.

Aim: Oral glucose challenge test (OGTT) is widely used around the world screening for gestational diabetes mellitus (GDM). In our study, we aimed to evaluate the effect of 75 g OGTT on maternal and fetal Doppler parameters. Material and Methods: Measurements of umbilical artery PI, RI, S/D, middle cerebral artery (MCA) PSV, PI, RI and mean PI, RI S/D of uterine arteries assessed 1 hour before OGTT and 1 hour following the test in 46 pregnancies between 24-28 weeks of gestation. Mann Whitney-U test was employed to compare variables. Statistical significance was established at p

Bulut, Berk (isu author) Removal of uterus during laparoscopic hysterectomy (LH) is occasionally challenging and therefore sometimes requires morcellation. Morcellation techniques for hysterectomy can spread the cancer cells which were presumed benign preoperatively in to the abdomen or pelvis. Probability of an undetected malignity should not be disregarded and accordingly must be shared with the patient prior to LH. The present study aimed to identify the demographic and the clinical factors associated with the need for morcellation in patients undergoing LH. A total of 153 patients who underwent LH for presumed benign causes were enrolled in this retrospective study. Subjects were divided into two groups according to the need for the morcellation during the LH: Morcellation group and intact vaginal removal (IVR) group (it was possible to deliver the uterine specimen vaginally). The two groups were compared with respect to demographic and clinical characteristics, indications for LH, preoperative ultrasonographic findings and postoperative complications. The frequency of the postmenopausal women was significantly higher in the morcellation group than the IVR group (p = 0.005). Preoperative uterus width (p < 0.001) and postoperative Uterus weight (p < 0.001) were significantly higher in the morcellation group compared to that of the IVR group. There were no significant differences between the groups regarding the complication rate. Uterine weight (OR: 1.020, 95% CI: 1.008-1.031, p = 0.001) and menopause (OR: 2.571, 95% CI: 1.328-4.980, p < 0.001) were predictive for the need of morcellation. A cut-off value of 287.5 gram was able to predict the need for morcellation with 87% sensitivity and 71% specificity. The present study demonstrates that uterine weight and presence of the menopause are predictive for the need of morcellation at the time of the total LH. These factors should be considered in preoperative planning and used to further guide surgeons in providing LH. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Introduction: To avoid mesh-related complications, autologous transobturator-tape (a-TOT) technique is a viable option in stress urinary incontinence (SUI) surgery. The method differs from TOT and retropubic tape (RT) in the usage of autologous tissue. We hypothesized that a-TOT improves female sexual dysfunction (FSD) more than TOT and RT. Methods: This is a retrospective cohort study. Patients who underwent a-TOT, TOT, and RT surgeries were surveyed regarding the cure of SUI, complications, and FSD parameters. The groups were compared according to baseline and postoperative data. Results: A-TOT, TOT, and RT groups included 37, 69, and 36 patients, respectively. The median follow-up time was 19 months. The groups were similar in terms of preoperative characteristics. The objective cure, subjective cure, and overall complication rates were comparable among the groups (p > 0.05). A-TOT group had significant improvements in mean female sexual function index (FSFI) scores, TOT group deteriorated, and RT group remained stable (p = 0.001, p = 0.001, and p = 0.226, respectively). The postoperative mean total FSFI scores were 25.73 ± 2.46, 23.17 ± 3.35, and 21.53 ± 2.47 for the a-TOT, TOT, and RT groups, respectively. The a-TOT group had better results than the TOT and RT groups (p < 0.05 and p < 0.05), and besides, the difference between the TOT and RT groups was statistically significant (p < 0.05). According to percentage changes in domain scores following the operations, the a-TOT group had significantly better results in desire, arousal, lubrication, satisfaction, and pain domains than the TOT group (p < 0.05) as well as better desire, arousal, and pain domains (p < 0.05) than the RT group. Discussion/Conclusions: Besides comparable outcomes in SUI treatment, the a-TOT technique provides improvements in female sexual functions while TOT worsens and RT does not change. Favorable outcomes in sexual functions caused by improvements in desire, arousal, satisfaction, and pain domains are observed following the a-TOT technique.

To evaluate the efficacy of carbetocin for the prevention of postpartum hemorrhage (PPH) and related events after vaginal or cesarean delivery.Medline, Scopus, Embase, and the Cochrane Library were searched in February 2018 using combinations of the relevant MeSH terms, keywords. Randomized studies, comparing carbetocin to any other uterotonic agent, in the management of cesarean and vaginal deliveries, were conducted. Two reviewers independently extracted the data. A random-effects meta-analysis was used for quantitative synthesis. Also, Bayesian random-effect metaregression was used to estimate the posterior probabilities (PP) for benefits of carbetocin use.After the full-text review, 30 trials were included in the meta-analysis. Compared to oxytocin, carbetocin was associated with a reduced need for additional uterotonic use in women undergoing cesarean delivery (RR 0.43, 95% CI 0.30-0.59,Carbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in women at increased risk of PPH undergoing cesarean delivery. There is still a need for high-quality trials on its effectiveness in preventing PPH in high-risk women.PrecisCarbetocin is effective in reducing the need for additional uterotonic use and postpartum blood transfusion in high-risk women undergoing Cesarean delivery.

Aim: We aimed to compare postoperative vaginal lengths and risk of occurrence of cuff hematoma after laparoscopic and laparotomic hysterectomy operations performed with benign indications according to the operation technique. Material and Methods: Between January 2017 and January 2018, 267 patients who underwent total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) with benign indications were evaluated. Before the operation demographic characteristics of the patients, the results of probe curettage, smear results, previous operations and chronic diseases were recorded. After hysterectomy the patients were discharged following 1st and 2nd day controls. The presence of cuff hematoma was evaluated by transvaginal ultrasound on the 7th postoperative day and vaginal lengths were measured after hysterectomy by aid of hegar bougie. Results: There was no significant difference between the two groups of 200 patients, including age, gravida, parity, history of operation, history of chronic disease, and demographic characteristics. Treatment-resistant menometrorrhagia was the most common indication in 44 patients (44%), whereas myoma uteri 96 (96%) were the most common indication in patients with TAH. After hysterectomy, vaginal length was calculated as 6.35 ± 0.81 cm in TLH group and 6.73 ± 0.92 cm in TAH group. The difference between the two groups was statistically significant (p = 0.002). When the presence of cuff hematoma was evaluated, 14 patients in the TLH group and 18 patients in the TAH group were found to have no significant difference between the groups. Conclusion: It has been observed that the development of hematoma on the vaginal cuff in the postoperative period is not affected by the operation type of the patients performed hysterectomy. In addition, it is observed that the demographic characteristics of the patients in the preoperative period do not have a great effect on the type of operation. In patients performed TLH, the postoperative vaginal length is shorter than in patients with TAH. However, postoperative vaginal length measurement is a criterion that can be evaluated in the second plan. Primarly, surgical option should be determined by considering preoperative indications and its suitability for minimally invasive surgery.

Introduction Endometrial cancer (EC) is the most frequent gynecological cancer. Transvaginal ultrasound (TVU) plays a leading role in the pre-operative workup and often is the first diagnostic instrumental examination. Despite expert hands' ultrasound is recommended to assess myometrial invasion in early stage EC, this method is a strictly operator-dependent examination, and varying degrees of sensitivity and specificity have been reported. The present review aims to provide an update of ultrasound imaging in the preoperative work-up for EC patients. Evidence acquisition A double-blind search was performed from May to September 2020. The following keywords: 'ultrasound', 'transvaginal ultrasound', and 'endometrial cancer' were searched in Pubmed search engines, Scopus, and Web of Science. The Prisma statement was followed for the selection of the articles included. Evidence synthesis The initial search provided 958 studies, of which 11 were included in the analysis. Non-English articles, not relevant to the purposes of this study, case reports, and articles with fewer than 40 cases were excluded. Conclusions TVU sensitivity and specificity in myometrial infiltration and cervical invasion is comparable to MRI but has lower costs, greater patient tolerability, and does not require contrast agents. An expert operator should perform the ultrasound examination in patients with suspected EC The presence of myometrial lesions, such as leiomyomas, could lower the diagnostic accuracy of ultrasound, so special attention should be paid to patients with concomitant uterine lesions.

The evaluation of uterine anatomy at term is challenging. The grown fetus usually obstructs the view of the posterior elements of the uterus. The evaluation of adnexa and ovaries is also often not possible as the structures are high up in the abdominal cavity and out of the scanning depth. Luckily, pathologies requiring the assessment of adnexa are relatively rare at term pregnancies. The focus of anatomic ultrasound at term is the evaluation of the lower uterine segment, the placenta, the cervix, and the bladder. These structures have clinical relevance due to conditions such as placenta previa, placenta accrete spectrum (PAS), and risk assessment for a trial of labor after cesarean. The uterus undergoes significant changes throughout pregnancy and at term; the fully developed lower uterine segment (LUS) is present by 37 weeks’ gestation. We will discuss the formation of LUS and its surgical relevance later on in this chapter.

Placenta percreta (PP) is a life-threatening condition and its surgery poses a very high potential for bleeding. The recommended treatment is a cesarean hysterectomy. There are several techniques reported in the literature to reduce the bleeding during percreta operations.To show and describe a practical and novel intraoperative maneuver to minimize the hemorrhage during cesarean hysterectomy for PP.The patients who were diagnosed with PP and underwent cesarean hysterectomy (CH) in our unit between 2016 and 2020 were retrospectively evaluated. These patients were divided into two groups. Group A included patients who underwent hysterectomy with intraoperative FIST maneuver. Group B included patients with ordinary cesarean hysterectomy. The groups were compared with regards to the intraoperative bleeding, surgical complications, and perioperative outcomes.Seventy-two patients who had a cesarean hysterectomy and diagnosed with PP during the study period were included in this retrospective cohort. 22 patients underwent intraoperative FIST maneuver with CH as Group A and 50 patients underwent ordinary CH as Group B. The demographic variables including maternal age, gravida, number of previous cesarean sections, and body-mass index were not statistically different between the two groups. Intraoperative FIST maneuver was significantly associated with reduced operative hemorrhage, the need for transfusion of erythrocyte suspension, admission to intensive care unit, and hospitalization days (FIST maneuver is a very practical, easy to apply, and effective method that reduces the obstetrical bleeding during cesarean hysterectomy in placenta percreta cases.

We hypothesized that spinal anesthesia could lead to impairment in bladder function and consequently, to postoperative urinary retention (POUR), particularly in patients undergoing urogynecologic surgery. This study was aimed to compare the rate of the POUR between the subjects receiving spinal and general anesthesia who underwent urogynecologic surgery. One hundred and eighty subjects who underwent urogynecologic surgery between June 2016 and May 2019 were retrospectively analyzed to evaluate the risk of POUR after general versus spinal anesthesia. All subjects underwent a standardized voiding trial subsequent to surgery, which was performed by backfilling the bladder with 300 ml of saline. The presence of > 100 ml volume in the post-void bladder scan was defined as POUR. The primary outcome was to compare rates of POUR between spinal and general anesthesia. Identifying the risk factors for POUR was the secondary outcome of this study. Spinal anesthesia group included 80, and the general anesthesia group consisted of 100 patients. The overall rate of the POUR was %22.8. The proportion of the patients with POUR was significantly higher in the spinal anesthesia group compared to that of the subjects in the general anesthesia group (%33.8vs%14, P=0.002). Multivariate logistic regression analysis revealed that the adoption of spinal anesthesia (Odds ratio: 3.172, 95%CI: 1.383-7.275, P=0.006) and presence of diabetes (Odds ratio: 5.840, 95% CI:2.325-14.666, P< 0.001) were independent predictors for the development of POUR. The rate of the POUR is significantly higher in patients receiving spinal anesthesia than those receiving general anesthesia among women undergoing urogynecologic surgery. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Objective: To evaluate folate and B12 levels in fetuses who had been diagnosed with neural tube defects (NTDs) and healthy fetuses in Van Yüzüncü Yıl University and Van State Education and Research hospitals between March-August 2019. Material and Method: 38 pregnant women who had been diagnosed with fetuses with NTDs prenatally, and 40 healthy controls were recruited. The chi-square test and Mann-Whitney U test were employed to compare variables. Results: None of the women had taken folic acid preconceptionally in the NTD group. However, 4 (10%) women had taken folic acid supplementation in the preconception period in the control group, and this was significantly different among the groups (p=0.04). The women who had taken folic acid in the first trimester of pregnancy were 9 (23.6%) and 32 (80%) in cases and controls, respectively, and it was significantly different (p=0.01). The mean B12 level was 248.7±65.4ng/ml in cases and 239.3±27.5 ng/ml in controls, and there was no significance between the groups (p=0.78). The mean folate level was 9.6±4.8 ng/ml in cases and 9.8±3.9 ng/ ml in controls, and it was similar between the groups (p=0.62). Conclusion: We did not show difference in folate and B12 levels. However, folic acid intake in preconception or in the first trimester of pregnancy was significantly higher in women who have healthy babies compared to the NTD group., Amaç: Van Yüzüncü Yıl Üniversitesi ve Van Eğitim ve Araştırma Hastanesi’nde NTD tanısı koyulan ve sağlıklı fetüsü olan gebelerin B12 ve folat düzeyini karşılaştırdık. Gereç ve Yöntem: NTD tanısı koyulan 38 hasta ve 40 kontrol grubu çalışmaya dahil edildi. İstatistiksel analizde ki-kare testi ve Mann-Whitney U testi kullanıldı. Bulgular: NTD grubunda hiçbir hastada prekonsepsiyonel dönemde folik asit kullanımı yoktu ancak kontrol grubunda 4 (%10) hastada prekonsepsiyonel folik asit kullanımı mevcuttu ve bu fark istatistiksel olarak anlamlıydı (p=0,04). NTD grubunda 9 (%23.6), kontrol grubunda 32 (%80) hastada ilk trimesterde folik asit desteği alınmıştı ve bu istatistiksel olarak anlamlıydı (p=0,01). Ortalama B12 seviyesi NTD grubunda 248.7±65.4ng/ml, kontrol grubunda 239.3±27.5 saptandı ve bu fark anlamlı değildi (p=0,78). Ortalama folat seviyesi NTD grubunda 9.6±4.8 ng/ml, kontrol grubunda 9.8±3.9 ng/ml saptandı ve bu fark anlamlı değildi (p=0,62). Sonuç: Her iki grup arasında B12 ve folat seviyeleri farklı değildi ancak, sağlıklı bebeği olan grupta prekonsepsiyonel dönemde ve ilk trimesterde folik asit kullanımı NTD grubuna göre anlamlı olarak daha fazlaydı.

To assess whether assessment with ultrasound could improve the detection of emergency cesarean section (ECS) in laboring women.Women who presented with symptoms of active labor or women in need of labor induction were invited to participate in the study. Women included in the study were evaluated with ultrasonography for fetal biometry and vaginal examinations for Bishop score assessment. The main aim in this study was determining factors associated with ECS due to fetal distress and obstructed labor.No fetal biometry variable was associated with ECS due to any indication (fetal distress and obstructed labor combined) in the univariate analysis. In multivariate analyses, biometry variables were adjusted for Bishop score at admission and only abdominal circumference percentile showed a significant association with the odds of ECS due to any indication (OR:1.02, 95% CI: 1.01-1.03). Biparietal diameter and abdominal circumference variables were associated with the odds of ECS due to obstructed labor in both univariate and multivariate analyses (Ultrasound assessment at admission, in addition to Bishop score assessment, did not significantly improve the prediction of ECS. Also, the fetal biometry alone had poor predictive capability for ECS. Routine ultrasound assessment at labor admission appears to be ineffective for predicting ECS.PrecisFetal biparietal diameter and abdominal circumference showed an association with emergency cesarean due to obstructed labor but the predictive accuracy of fetal biometry was low. Routine ultrasound examination at admission, in addition to Bishop score assessment, may not useful for assessing the risk of emergency section in unselected populations.

Introduction/Background Choriocarcinoma is the most aggressive, malignant form of gestational trophoblastic disease. The most common localization is uterus. However, in some cases, it can be found in cervix, tuba uterina or ovaries. Here, we present two different clinical cases of which were misdiagnosed as ectopic pregnancy. Methodology A 36 year-old patient admitted to our department for investigation of irregular vaginal bleeding. On ultrasound examination, the endometrial line was thin and bilateral adnexial structures were normal. B-hcg level was 2815 mIU/L, progesteron was 0.2. On B-hcg follow-up, the levels were 2764 and 2877 at two days intervals. The patient was given methotrexate for the diagnosis of ectopic pregnancy. One week later, B-hcg level increased to the 5373 mIU/lt. The MRI showed a 25 × 22 mm cervical mass with parametrial invasion with rectal serosal involvement (figure 1). Biopsy confirmed the cervical choriocarcinoma. The patient underwent chemotherapy (EMA-CO). Results The second case was a 31 year-old woman (gravida 2 para 2) was operated due to the ruptured ectopic with B-hcg of 29.251. On exploration, a ruptured and actively bleeding ectopic mass with size of 4 × 3 cm was noted on the ampulla of left fallopian tube as well as abundant haemoperitoneum with 600 cc of blood. A complete left salpingectomy was performed (fig-2,3). The final diagnosis was primary tubal choriocarcinoma of 2 cm in size which involved the whole layer of tubal wall and ruptured into pelvic cavity at the ampulla region. Computed tomography scans were negative for metastasis. Patient underwent monochemotherapy. Conclusion Knowledge of the characteristics of the choriocarcinoma is very important for accurate diagnosis and treatment, especially when the tumor is localized on the rare locations and where a high level of serum B-hcg is absent. We aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the gestational choriocarcinoma should be kept in mind. Disclosure Nothing to disclose

This study aimed to investigate if the pregnancy associated plasma Protein-A (PAPP-A) multiples of median (MoM) levels could be used as a marker for the early prediction of RDS. The present study was designed with data gathered from 1773 patients who were referred to our institution for first trimester fetal chromosomal anomaly screening. First trimester PAPP-A MoM values and postnatal RDS occurrences in these pregnancies were retrospectively analysed. Of the 1773 neonates that were included in the study, 28 were delivered at or beyond 37 weeks, and 42 were delivered less than 37 weeks of gestation. In the group of neonates at or beyond 37 weeks, the cut-off value for RDS prediction was determined as 1.02. For this cut-off value, sensitivity was 72.41% and specificity was 91.84%. The area under curve (AUC) was determined to be statistically significant (

Uterine fibroids (UFs) are the most common benign solid tumors of the female genital tract manageable by surgical of pharmacological approach. When the medical management is ineffective or surgery is primarily requested, several surgical approaches can be used. Among these, minimally invasive surgery might be preferred. Myomectomy is the standard surgical treatment when fertility sparing is claimed. It can be performed via laparoscopy, robotic surgery and hysteroscopy and the choice depend on UFs features and surgeon's skill. Alongside these minimally invasive options, mini-laparotomy has been proposed as a less invasive surgical approach comparable to the well-established minimally invasive options. The aim of this review is to describe the most recent advances in minimally invasive techniques to perform myomectomy, comparing them with mini-laparotomy approach.