Search

Labial adhesions are generally observed in the premenarchal and postmenopausal period. They are rarely seen in adulthood. Here, two labial fusion cases in the reproductive period are discussed. In the first case, 38-year-old virgin woman presented with anuria to the emergency unit. On her physical examination, labia were fused totally including periurethral area. His history revealed that she was mentally retarded and had primary a menorrhea. She had poor selfcare. On her genital examination, she had secondary sexual characteristics, including axiallypubic hair and breast development at Tanner stage-5. In her surgical treatment, the labia were overturned and a well-defined introitus was constituted. After the operation, topical estrogen prescribed. In second case, a forty-two year old woman with Beiges disease presented with dysuria and difficulty in voiding for about one month. Her obstetric examination revealed that she had two vaginal births. On pelvic examination, genital ulcer was determined on the labium. Besides, adhesion almost completely fused into the bilateral labia minora. For surgical treatment, manual separation technique was used under general anesthesia. After the operation, topical steroid was prescribed. Labial adhesions are observed, especially in the premenarchal period. However, they may be very rarely seen in the reproductive period due to local inflammation and circulating low estrogen levels. Topical estrogens, topical steroids, oral estrogen treatment, manual separation under anesthesia or without anesthesia, sharp or blunt dissection under anesthesia are alternative treatment methods. The success rates of these treatment methods exceed 90%. Besides, the recurrence rate varies between 4% and 20% with manual and sharp dissection methods. Erişkinlerde nadir görülen ve değişik sebeplere bağlı olabilen labial adezyonlarla özellikle premenarş ve postmenapozal dönemde karşılaşılmaktadır. Burada, farklı nedenle oluşan iki erişkin labial füzyon olgusu takdim edilmiştir. Olgu- 1: İdrar yapamama şikayetiyle acil servise başvuran 38 yaşındaki virgo kadının muayenesinde labiumların periüretral alanı da içerecek şekilde tamamen kapattığı görüldü. Anamnezinde, hastanın mental retarde olduğu ve primer amenoresi olduğu öğrenildi. Genel vücut bakımı vasat olan hastanın yapılan muayenesinde meme gelişimi ve pubik kıllanma gibi sekonder seks karakter gelişiminin Tanner Evre- 5 olduğu gözlendi. Olgu 1’in tedavisinde, cerrahi olarak labiumlar dışa devrilerek introital açıklığın devamlılığı sağlandı. İşlem sonrasında östrojenli krem verildi. Olgu-2: Daha önce Behçet hastalığı tanısı alan, yaklaşık bir aydır idrar yaparken zorlanma, yanma yakınmasıyla konsülte edilen 42 yaşındaki hastanın anamnezinde iki normal doğum yaptığı öğrenildi. Hastanın yapılan pelvik muayenesinde labiumlarda Behçet hastalığı ile ilgili olabilecek genital ülser saptandı. Ayrıca bilateral labia minoralarda totale yakın adezyon saptandı. Olgu 2’nin tedavisinde genel anestezi altında manuel ayırma tekniği uygulandı. İşlem sonrasında topikal steroidli krem verildi. Labial adezyonlar özellikle premenarş döneminde, çok seyrek olarak da reprodüktif dönemde lokal enflamasyon ve düşük östrojen düzeyine bağlı olarak görülebilir. Anestezi altında keskin veya künt diseksiyon, anestezi altında veya anestezisiz manuel ayırma, topikal östrojen, oral östrojen, topikal steroid alternatif tedavi yöntemleridir. Tedavi yöntemlerinin başarı oranı %90’a kadar çıkmaktadır. Rekürrens oranı ise manuel veya keskin diseksiyon yöntemleri ile %4-20 arasında değişmektedir.

The aim of this study was to compare maternal concentrations of soluble Endodlin (s-Endoglin) in women with gestational diabetes (GDM) and women with normal glucose tolerance (NGT) in pregnancy. Also, the association of insulin resistance markers and s-Endoglin was investigated. Forty patients complicated by GDM and forty gestational age-matched healthy pregnant women with NGT were included in the present study. s-Endoglin level was higher in patients with GDM compared with the control group (

Amaç: Vajinal duş, vajinal floraya ve ekosisteme zarar verir. Vajinal flora dengesinin bozulması, kadın ve yenidoğan sağlığı üzerinde olumsuz etki yapan birçok nedene yol açmaktadır.Materyal ve metod: Çalışmaya vajinal duş uygulayan 105 hasta dahil edildi. Tüm kadınlardan Pap smear testi alındı. Hastalara neden vajinal duş alışkanlıklarını bırakmaları gerektiğine dair yazılı bilgi verildi. 30 günden önce olmamak üzere ikinci bir Pap smear testi için randevu günü verildi. Hastaların ilk Pap smearleri alındıktan sonra hiçbirine enfeksiyon tedavisi verilmedi. Vajinal duştan önce ve sonra alınan pap smear sonuçları karşılaştırıldı.Bulgular: Pap smear sonuçlarının detaylı karşılaştırmasında şiddetli inflamasyonu olan hasta oranının %11,4'ten %1,9'a düştüğü görüldü. Şiddetli inflamasyondaki azalma istatistiksel olarak anlamlı bulundu (p=0,006). Hafif veya şiddetli ayrımına bakılmaksızın enfeksiyonlu hastalar karşılaştırıldığında; tipik enfeksiyon bulgusu olan olguların oranının %48,5'ten %31,4'e düştüğü görüldü ve istatistiksel olarak anlamlı bulundu (p=0,01).Sonuçlar: Vajinal flora; bir çok faktörün etkisi altında olan, çok karmaşık ve dinamik bir bileşendir. Vajinal duş, vajinal flora yapısına ve dengesine zarar verir. Basit bir vajinal enfeksiyondan servikal neoplaziye kadar geniş bir yelpazede kadın sağlığını olumsuz etkiler., Objective: Vaginal douching damages vaginal flora and ecosystem. The disruption of the equilibrium of vaginal flora composition leads to many outcomes having a negative effect on women and newborn health.Materials and methods: 105 patients who applied vaginal douche were included in this study. All women taken of Pap smear test and the patients were informed in writing about the reasons why they must leave their vaginal douching habits, and a second Pap smear appointment day not earlier than 30 days were given. After taken of patients first Pap smears, none of them took an infection treatment. Pap smear results taken before and after vaginal douche have been compared.Results: It was seen in the detailed comparison of Pap smear outcomes that the rate of patients with violent inflammation decreased from 11.4% to 1.9%. The decrease in violent inflammation was found statistically significant (p=0.006). When the patients with infection were compared regardless of any discrimination of slightly or violent; the rate of the cases with typical infection findings was seen to decrease from 48.5% to 31.4% and found statistically significant (p=0.01).Conclusions: Vaginal flora is a very complex and dynamic component and is under the influence of many factors. Vaginal douching damages vaginal flora structure and balance, and adversely affects women’s health in a wide range from a simple vaginal infection to cervical neoplasia.

Aim The aim of the present study was to investigate the familial and somatic mutations as well as polymorphisms of TP53 gene in patients with uterine leiomyoma. Methods The study included 35 women with histologically diagnosed as uterine leiomyomas at the Gynecology Department of Adnan Menderes University Faculty of Medicine. Tissue and blood samples were analyzed for mutations and polymorphisms of TP53 gene by next generation sequencing (Miseq-Illumina). Acquired data was compared with the normal data in Ensembl database. Data from 1000 genome project and data from exome sequencing analyses in Intergen Genetic Diagnosis Center (Ankara) were used as controls for polymorphism analyses. Results There were no mutations in tissue and blood samples. However, when the polymorphisms were evaluated, a significant difference was found in NM_000546.5(TP53):c.215C > G (p.Pro72Arg) polymorphism between the study and control groups. The results indicated that P72R/P72R genotype increased the risk of leiomyoma development by 6.3 fold (95% confidence interval [CI]: 2.880-13.793). There was a negative correlation between P72R/WT genotype and leiomyoma development (OR = 0.261, 95% CI: 0.114-0.596). P72R/P72R genotype was statistically higher in the patients with leiomyoma compared with the controls and 1000 genomes from Asian, European and World populations. Conclusion The results of the present study suggested that P72R/P72R genotype may be associated with development of uterine leiomyoma in the Turkish population in the Western part of the country.

Poland syndrome is a rare congenital disorder presenting with absence of unilateral thoracic muscles. Upper extremity, rib and connective tissue deformities usually accompany muscle agenesis or hypoplasia on the same side. Although its etiology remains unknown, inadequate perfusion is suspected for related regional tissue hypoplasia/aplasia. There is scarce information about possible cardiopulmonary function involvement due to abnormal thoracic muscle and tissues. A slight change in this function may be worsened in pregnancy affecting maternal and fetal health. Here we present a 30 weeks pregnant patient with Poland syndrome who developed severe shortness of breath and eventually had to have iatrogenic preterm delivery. Rare syndromes compatible with life and reproduction can be a challenge for clinicians especially during pregnancy due to unpredictable effects on gestational physiologic adaptation processes. Therefore, case reports or series regarding pregnancy complications of these rare syndromes provide valuable information for possible complications and their management options.

Amaç: Maternal parametrelerin Prematüre Retinopatisi (ROP)gelişimindeki olası etkilerini araştırmak.Gereç-Yöntem: Merkezimizde doğmuş prematürelerin anneleriningebelik yaşları, beden kitle indeksleri (BKİ), gebelik sayısı, kaçıncı gebelikolduğu, erken membran rüptürü (EMR) ve preterm eylem gelişimi, gestasyoneldiabet tanısı, sigara ve ilaç kullanımı, doğumdan hemen önceki sistolik vediastolik kan basınçları, kan şekeri, kan sayımı, karaciğer ve böbrek fonksiyonparametreleri ve obstetrik ultrason bulguları, ROP gelişen ve gelişmeyenlerarasında bağımsız gruplarda t-testi, Pearson ki-kare ve Mann-Whitney U testlerikullanılarak karşılaştırıldı.Sonuçlar: ROP gelişen 98 bebeğin ortalama doğum haftası29.61±3.45 iken, ROP gelişmeyen 41 bebeğin ise 32.14±2.15 haftaydı. Annegebelik yaşı, BKİ, gebelik sayısı, gebelik sıralaması, gestasyonel diabettanısı, preterm eylem, sigara kullanımı, doğumdan hemen önceki sistolik vediastolik kan basınçları, hemoglobin, hematokrit, üre, kreatinin, ALT, ASTdeğerleri arasında gruplar arası anlamlı fark yokken (p>0.05); Evre 1 ve Evre 3’deki ROP grupları arasında kan şekeriaçısından istatistiksel fark saptandı (p=0.016).Oligohidroamnios, anhidroamnios, fetal distres, intrauterin gelişme geriliği,plasenta dekolmanı, plasenta previa, umbilikal arterde end diastolik akımkaybı, umbilikal ve uterin arter direnç artışı gibi patolojik US bulgusuvarlığında %75.8 oranında ROP görüldüğü, EMR gelişenlerin %83.3’ünde de ROPgeliştiği saptandı (p=0.033).Tartışma: Çalışmamızdaki ROP-kan şekeri ilişkisine ait verilerliteratürle uyumlu olup; tip 1 ROP’a ilerleyen prematürelerin annelerinin kanşekerlerinin Evre 1’dekilerden yüksek olması, maternal kan şekeri yüksekliğinintedavi gerektiren ROP için bir risk faktörü olabileceğini düşündürmüştür. Erkenmembran rüptürü ile obstetrik ultrasonda patolojik bulguların tespitedilmesinin de ROP açısından risk faktörü olduğunun ortaya konmasıyla birlikte,bu ön çalışmanın ışığında yapılacak prospektif çalışmalara ihtiyaç vardır.

Despite the absence of a complete physiologic-pathologic understanding, common accepted theory for development of preeclampsia is incomplete trophoblastic invasion leading to failed uterine and spiral arteriolar remodeling, causing maternal vascular endothelial dysfunction by secreted molecules in response to decreased placental perfusion, placental hypoxia, and ischemia. Placental angiogenesis is especially ineffective in early onset preeclampsia and fetal morbidity/mortality rates are higher because of further decreased blood flow. In this study, we aim to compare the maternal and umbilical cord blood levels of hypoxia-inducible transcription factor-1α (HIF-1α), which is believed to regulate hypoxia-related transcriptional responses, to play role in activating genes for initial phases of placental development and angiogenesis and a physiologic vasodilator molecule nitric oxide (NO) in normal, early and late onset preeclamptic pregnant women.Pregnant women who were diagnosed with preeclampsia (early onset ≤34 weeks; late onset34 weeks) and delivered in our clinic were enrolled for this prospective case-controlled study. Pregnant women without preeclampsia were recruited as control group. HIF-1α and NO levels in maternal and umbilical cord blood measured and compared among groups.A total of 46 cases were enrolled for this study, including 25 preeclamptic (13 in the early onset group and 12 in the late onset group) and 21 normal pregnant women in the control group. Comparison of preeclampsia group to controls revealed higher maternal blood HIF-1α levels in the control group, however higher umbilical cord NO levels in the preeclampsia group (p 0.05 and p 0.001, respectively). In a second analysis, when compared to control group, both early and late onset preeclampsia subgroups were found to have higher umbilical cord blood NO levels (p 0.001).In this study, we observed lower maternal blood HIF-1α levels and higher umbilical cord NO levels in preeclampsia group than controls. These findings suggest that umbilical cord blood NO levels in pregnant women with preeclampsia increase in response to hypoxia. However, lower HIF-1α levels in preeclampsia group can be due to our limited number of cases and we think that there is a need for further studies with larger sample size.

Wilson hastalığı (WH) otozomal resesif bir hastalıktır. Bakır metalinin safra atılım sisteminin bozukluğundan dolayı, özellikle karaciğer, böbrek, kornea ve beyin dokusunda, toksik dozda birikimi ile karakterizedir. Hepatik bulgular oldukça değişkendir; aminotransferazların asemptomatik yükselmesinden, kronik hepatit, siroz, akut veya fulminant karaciğer yetmezliğine kadar değişim gösteren bir klinik tablo izlenebilir. WH’de akut karaciğer yetmezliği, akut intravasküler hemolitik anemi ile karakterizedir. WH olduğu bilinen bir gebede, görülen hemoliz ve trombositopeni bulgusu karaciğer yetmezliğinin yanısıra Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) sendromuna bağlı olarak geliştiği yorumlanabilir. Ancak tanı koymak oldukça güçtür. Burada HELLP sendromu ile prezente olan, postpartum dönemde akut karaciğer yetmezliği bulguları da gelişen WH olgusu literatür eşliğinde tartışılmıştır. Wilson’s disease (WD) is an autosomal recessive disorder. It is characterized by toxic accumulation of copper mainly in the liver and brain but also in cornea and kidney due to a defect in biliary excretion of copper. The hepatic manifestation of WD is diverse and may include asymptomatic elevation of aminotransferase, chronic hepatitis, cirrhosis, or acute/fulminant hepatic failure. Characteristic of acute hepatic failure in WD is concomitance of acute intravascular hemolytic anemia. Acute intravascular hemolytic anemia and thrombocytopenia in WD may be interpreted as a feature of Hemolysis, Elevated Liver Enzymes, Low Platelet Count (HELLP) syndrome besides acute liver failure. The differential diagnosis may be very difficult. Here, WD in pregnancy presenting with clinical symptoms of HELLP syndrome and developing acute liver failure in postpartum period is discussed.

Cornual (interstitial) pregnancy is one of most hazardaous type of ectopic pregnancy. It constitutes 2-4 % of all ectopic gestations and may represent clinically stable until late gestational periods. In this case report, a ruptured 17 week right cornual gestation after failed termination of pregnancy was presented. A 29-year-old woman, G2P1, presented to the emergency department with acute abdominal pain lasting for 12 hours. Her blood pressure was 50/20mmhG, heart rate was 110 bpm. Emergent laparatomy was performed. In laparatomy, hemoperitoneum was observed. Intraoperatively, we encountered a right lateral wall ruptured uterus with a 17 week old fetus in the peritoneal cavity, which suggested a right cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully. Kornual (interstisyel) gebelik oldukça hayati riski olan ektopik gebelik çeşitlerinden biridir. Tüm ektopik gebeliklerin %2-4’ünü oluşturmaktadır. İleri gebelik haftalarına kadar klinik olarak sessiz seyredebilir. Burada, başarısız bir gebelik terminasyonundan sonra, 17.gestasyonel haftada rüptüre olan bir sağ kornual gebelik olgusu sunulmuştur. Yirmi dokuz yaşında gravida 2, para 1, abortus 0 olan hasta, on iki saattir devam eden şiddetli karın ağrısı şikayetiyle acil servise başvurmuştur. Hastanın kan basıncı 50/20 mmhG, nabız 110/dak. idi. Acil koşullarda laparatomy uygulandı. Batın içerisinde yoğun hemorajik vasıfta mai izlendi. Lapratomi esnasında, abdominal kavitede, uterus sağ üst yan duvardan rüptüre olmuş 17 hafta gebelik haftasıyla uyumlu fetus gözlendi. Katastrofik şekilde sonuçlanan bu klinik tablo rüptüre sağ kornual gebelik ile uyumlu idi. Sağ kornual rezeksiyon ve onarım başarılı şekilde uygulandı.

In present case report, diffuse abdominal cellulitis is discussed under light of data in literature. Thirty-nine years old patients refered to our clinic, with the cesarean wound dehiscence and diffuse abdominal erythema, pain, increased temperature at 6th day of cesarean section. Initial diagnosis was diffuse abdominal cellulitis after cesarean section. In spite of antibiotic treatment and drainage, clinic of patient did not regress. So, a transverse insicision at left lumbar area near to midline and below umblicus was performed and phannenstiel insicion was extended upwards to right side under general anestesia. Drainage and debridement was performed. Between two insicions, skin and subcutaneous tissues were left as a bridge and tissue above the fascia was under arch of bridge. Necrotic tissues was excised. The insicions at abdominal area, were expected to heal secondarily. When the clinic and symptoms of patient was improved, at postoperative 36th day, she was discharged with daily wound dressing and control. In conclusion, serious superficial and subcutaneus tissue infections developed after cesarean section should be taken into intensive care and treatment protocols. Besides, these cases should be under observation due to increased risk of sepsis.

The aim of this study was to evaluate serum concentrations of interleukin-6 (IL-6) in relation with hormonal and metabolic profile in patients with and without polycystic ovary syndrome (PCOS).A total of 40 women with PCOS and 40 age-matched controls were eligible for the study. Hirsutism scores, hormonal and metabolic profile as well as IL-6 levels were evaluated in each subject.Women with PCOS exhibited higher body mass index (BMI) and serum concentrations of IL-6 levels than controls (p 0.05); however, levels of IL-6 were not significantly increased when compared with BMI-matched controls (p 0.05). IL-6 levels were significantly correlated positively with BMI and triglyceride levels; however, negatively correlated with high-density lipoprotein levels.The data of this study suggested that serum IL-6 levels were found to be higher in women with PCOS as compared to controls; however, IL-6 levels might be dependent on nutritional status but not on PCOS per se. Raised serum IL-6 levels may be related to BMI and serum lipid levels and may be a predictor for cardiometabolic risks.

Elevated sFlt-1 and sEng is usually a clue for impending preeclampsia and intrauterine growth restriction. Likewise, uterine artery Doppler ultrasound is being investigated for prediction of similar conditions. In this study, we aimed to explore the possible relations of these two proteins in different body compartments with uterine artery Doppler indices (UtAD) in a healthy second trimester obstetric population.Levels of sFlt-1 and sEng were measured in serum and amniotic fluid samples of 43 patients. UtAD were measured on the days of sample collections. Findings were then analyzed for possible correlation.There was a positive correlation between the levels of maternal serum sFlt-1 (MSsFlt-1) and sEng levels (MSsEng) (r= 0.516, p 0.001). The negative correlation between MSsFlt-1 and UtAD was disappeared after elimination of poor obstetric outcome pregnancies (r= -0.371, p= 0.016). No correlation was found between UtAD and studied protein levels in amniotic fluid. Mean MSsFlt-1 level was 305.2 ± 220.1 pg/ml and mean AFsFlt-1 was 48.9 ± 11.8 ng/ml. Mean MSsEng level was 4.5 ± 1.3 ng/ml, mean AFsEng level was found 0.7 ± 0.3 ng/ml. Mean values for UtAD were 1.3 ± 0.4, 0.6 ± 0.1 and 3.5 ± 1.3 for PI, RI, and S/D, respectively.In normal second trimester pregnancies, there is a positive correlation between serum levels of sFlt-1 and sEng levels. Amniotic fluid levels of sEng and sFlt-1 are not correlated with UtAD in uncomplicated pregnancies.

The aim of this study was to compare maternal and umbilical cord serum levels of the angiogenic and anti-angiogenic factors in early- and late-onset pre-eclamptic pregnancies as well as in normal pregnancies, which might have significant importance in the etiology of pre-eclampsia.This prospective case-control study was carried out with pre-eclamptic (early-onset, ≤ 34 weeks and late-onset,34 weeks) and normal pregnant women. VEGF, PIGF, sFlt-1 and sEng levels in maternal and umbilical cord serum were measured before delivery and the findings were compared.The study was conducted with 15 early- and 15 late-onset pre-eclampsia patients, and 17 patients with normal pregnancies. It was found that sEng levels were higher in the umbilical cord serum in the early-onset and in the maternal serum in the late-onset pre-eclampsia group than the control group (p0.05). No significant difference in any factor was observed between the early- and late-onset pre-eclampsia groups.In this study, the results showed that angiogenic and anti-angiogenic factor levels in maternal serum and umbilical cord serum may not be related to the time of onset of pre-eclampsia.

Increased inflammatory response and cytokines are claimed to play a significant role in the etiology of preeclampsia. Interleukin-6 (IL-6) is a proinflammatory cytokine. Limited number of studies evaluating IL-6 levels in preeclamptic patients have produced conflicting results. Therefore, the present study sought to compare maternal and umbilical cord serum levels of IL-6 in early- and late-onset preeclamptic pregnancies as well as in normal pregnancies.A total of 69 participants were enrolled in the study. The control group consisted of 24 participants with normal pregnancies. Preeclampsia group consisted of 45 participants. The preeclampsia group was further classified into the subgroups of early- and late-onset preeclampsia. Late-onset preeclampsia group consisted of 24 women whereas early-onset preeclampsia group consisted of 21 women. Serum and umbilical cord samples of IL-6 were compared.There was no significant difference between maternal and umbilical cord serum IL-6 concentrations between the preeclampsia and control group. No significant difference was observed in maternal and umbilical cord serum IL-6 levels between early- and late-onset preeclampsia groups.Our results do not support an increase in IL-6 levels in patients with early- and late-onset preeclampsia. The clinical relevance of our findings needs to be further investigated.

Objective: To find a boundary value for the number of fetal movements in pregnant women gestation week ≥ 32 and to reduce unnecessary Nonstress test (NST) applications. Patients: 171 pregnant women gestation week ≥ 32 Material and Methods: NST was performed to the pregnant women after their fetal movements were counted within an hour while at rest. NST results (NST category 1-normal, NST category 2-suspicious and NST category 3-abnormal) above and below the boundary value were compared. Findings: When ≤ 5 was chosen as the boundary value for number of fetal movements, NST category 1 was observed in 22 cases (16%) whereas NST category 2 was observed in 7 cases (23%). When ≥ 35 was used as the boundary value, NST category 1 was detected in 20 cases (13%) and NST category 2 was detected in 6 cases (20%). When the boundary value for the number of fetal movements was taken as 16 fetal movements/hour (median value), in group 1 (fetal movement count Result: No significant differences in NST results were observed between group 1 and group 2. Therefore it is difficult to make a prediction about the reactivity of the NST by considering the number of fetal movements. Fetal movement counts can be misleading. Although not statistically significant, the quantitative tendency makes us think that it is more important to take care of the pregnant women with decreased fetal movement count rather than trusting the excess amount of the fetal movements.

Although combined oral contraceptive pills (COCPs) are one of the most commonly used methods of contraception in western countries, they are taken by only a minority of sexually active women in Turkey. The purpose of this research has been to define women's specific misconceptions with regard to the side effects of COCPs.This descriptive and cross-sectional research was conducted on 418 reproductive aged women who agreed to participate. Data were collected through face-to-face interviews with a questionnaire which assessed socio-demographic characteristics and women's beliefs about the side effects of COCPs.It is observed that 45.2% believed that the pills cause weight gain. Another 7.9% of the cases held the belief that COCPs cause cancer. A group of 13.4% of the subjects thought that COCPs lead to infertility, 28.7% believed that they cause headache, 41.1% believed that they cause acne and/or an increase in body hair, and 11.7% were afraid that they cause a decrease in libido.The present study has shown that misconceptions about the side effects of COCPs were considerably prevalent among this cohort group of Turkish women. Healthcare professionals have the potential of playing an important role in dispersing these misconceptions.

The aim of this study was to investigate the effects of two currently used low-dose combined oral contraceptives (COCs) (20 μg ethinyl estradiol [EE]/150 μg desogestrel [DSG] vs. 20 μg EE/100 μg levonorgestrel [LNG]) on plasma homocysteine levels.A total of 90 participants were enrolled in the study; 30 of them had not been using COC for at least 12 months prior to their enrollment, while 60 were on regular treatment within 12-18 months. Therefore, the control group consisted of 30 participants. Group DSG/EE consisted of 30 women and group LNG/EE consisted of 30 women. Serum samples of homocysteine profile were obtained during the early follicular phase.Significantly lower serum homocysteine concentrations (Group DSG/EE: 7.2 +/- 1.3; Group LNG/EE: 9.1 +/- 3.2;8.2 +/- 2.2; p0.05) were observed in DSG/EE group compared to LNG/EE and control groups.Although the decrease in homocysteine levels with 20 μg EE/150 μg DSG containing COC was statistically significant, the clinical relevance of our findings needs to be further investigated.

OBJECTIVE: To determine clinical outcomes of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) at patients who had previous abdominopelvic surgery. Design: A clinical observational, prospective, non randomised trial comparing outcomes of 13 patients who had previous abdominopelvic surgery with outcomes of 19 patients who had not surgery. Setting: Adnan Menderes University Faculty of Medicine, Department of Obstetrics and Gynecology. Patients: Thirty-two subjects [average age 51,1±6,9 (37-66)] who had indication of total abdominal hysterectomy and bilateral salpingooferectomy due to benign pathologies. Interventions: According to ACOG, LAVH was performed by using the Garry technique at the trocar insertions, the Reich technique at the laparoscopic phase and the Heaney technique at the vaginal phase by the same operator. After adhesiolysis and diagnostic procedures, ureters were dissected medially. By coagulating, bilateral round and infundibulopelvic ligaments were cut after the mobilisation of bladder. The operation was completed by the same operation team by vaginal approach consequently. At all operations, 80 W unipolar or 150 W bipolar diathermic dissection and 25-35 W unipolar diathermic cutting were performed. Main outcome measures: Age, parity, menopausal status, preoperative indications, type of previous abdominopelvic surgey and incision, intraoperative indications, adhesion scores, rate of unintended laparotomy, operative time, uterus weight, loss of blood, complications, postoperative pain scores and analgesic requirements, time necessary for returning to normal intestinal function, length of hospitalisation and rate of readmission to hospital. RESULTS: When compared with the patients who had not previous abdominopelvic surgery, all adhesion scores, uterus weight, operative time and the number of total postoperative complications were found significantly high at patients who had previous surgery. Loss of blood, the rate of unintended laparotomy, the number of total intraoperative complications, the length of hospitalisation, postoperative pain scores and analgesic requirements, and the time necessary for returning to normal intestinal functions were not found significantly difference between the two groups. CONCLUSIONS: LAVH is an operation adding the superiority of vaginal hysterectomy to the advantages of abdominal hysterectomy. By carrying the superiority of laparoscopy over laparotomy, it could be performed by an acceptable complication rate depending of increasing experience and technical opportunities.

Each year, an estimated 529 000 maternal deaths occur worldwide. In literature, it is known that maternal mortality can occur during pregnancy, peripartum and also in postpartum period. Although very rare, maternal deaths may occur after spontaneous abortion. In present case, 37 year old G5P4 (Caesarean Section) women was admitted to Adnan Menderes University, Obstetrics and Gynecology clinic with diagnosis of missed abortion at 18 weeks' gestation. She had been hospitalized in the public maternity hospital for five days due to abortus incipience and prolapse of amnion membranes but had no contractions. Fetal heart beats ceased at the second day of hospitalization. Medically induced abortion was recommended but not accepted by the patient. At the fifth day of hospitalization, she was referred to our clinic due to deterioration of general health condition, low blood pressure and tachycardia. In emergency department, it was determined that she was not oriented, had confusion, had blood pressure of 49/25 mmHg and tachycardia. In ultrasonographic examination, 18 week in utero ex fetus was determined and there was free fluid in abdominopelvic cavity. The free fluid was suspected to be amniotic fluid due to rupture of uterus. Laparotomy was performed, no uterine rupture, hematoma or atony was observed. However during laparotomy, a very bad smelling odor, might be due to septicemia, was felt in the operation room. Cardiac arrest occurred during that operation. In autopsy report, it was concluded that maternal death was because of remaining of inutero ex fetus for a long time. In conclusion, although very rare, maternal deaths after spontaneous abortion may occur. Because spontaneous abortion is a common outcome of pregnancy, continued careful, strict monitoring and immediate treatment of especially second trimester spontaneous abortion is recommended to prevent related, disappointing, unexpected maternal deaths.Key words: Second trimester, spontaneous abortion, maternal death

The aim of the present study was to evaluate plasma concentrations of thrombin activatable fibrinolysis inhibitor (TAFI) in relation with hormonal, metabolic, and hemostatic profile in patients with and without polycystic ovary syndrome (PCOS).A total of 38 women with PCOS and 37 age and body mass index (BMI) matched controls were eligible for the study. Hirsutism scores, hormonal, metabolic, and hemostatic profile as well as TAFI levels were evaluated in each subject.Women with PCOS exhibited higher plasma concentrations of TAFI levels than controls (107.42 ± 34.77% versus 91.86 ± 23.88%, p = 0.027). TAFI levels were significantly correlated positively with BMI, fasting insulin levels, modified Ferriman Gallwey scores and Homeostasis Model Assessment (HOMA) index, systolic blood pressure, and waist and hip circumferences, whereas negatively correlated with activated partial thromboplastin time (p 0.05). However, after adjustment for all possible confounding factors, none of the parameters was significantly deterministic on TAFI levels.The data of the present study suggested that plasma TAFI levels were higher in women with PCOS as compared with healthy age and BMI-matched controls, indicating impaired fibrinolysis. This hypofibrinolytic state may be responsible for the increased cardiovascular disease risk in women with PCOS.

This study aimed to investigate maternal serum concentrations of s-Endoglin and compare s-Endoglin with other inflammatory markers in prediction of time to delivery, in pregnancies complicated by preterm premature rupture of membranes (PPROM).Fifty five patients complicated by PPROM whose gestational age were between 2433 weeks and 44 matched healthy pregnant women were included in present study. Maternal concentrations of s-Endoglin concentrations were measured by an enzyme-linked immunosorbent assay (ELISA) and compared with maternal inflammatory markers including interleukin-6 (IL-6), white blood cell (WBC) count and serum C-reactive protein (CRP). The best variable for prediction of preterm birth was computed.Mean s-Endoglin levels in PPROM were lower than control groups (0.24 ± 0.12 pg/ml and 0.69 ± 0.25 pg/ml, respectively, p 0.01). Besides IL-6 (p 0.01), WBC (p = 0.016) and CRP (p = 0.010) levels were higher in PPROM group. In PPROM group, ROC analysis results of s-Endoglin for prediction of preterm delivery48 h,7 days,32 weeks were not different (p 0.05). For predicting preterm birth before 48 h and 7 days, only IL-6 at cut off value0.70 (pg/ml) and0.55 (pg/ml) had area under curve (AUC); 0.871 (0.7750.965), p 0.01, AUC; 0.925 (0.8560.993), p 0.001, respectively.s-Endoglin as an anti-angiogenic marker seemed to have a role in pathogenesis but results of present study showed that, unlike IL-6, it was unsatisfactory for estimating time to delivery in PPROM.

Adropin is a recently identified protein in liver, brain and many peripheral tissues, which is important in energy homeostasis. The purpose of this study is to determine adropin levels in patients with endometrium cancer (EC).A total of 74 patients (47 EC patients and 27 healthy controls) were included in the study. Fasting venous blood samples were collected from all patients. Serum adropin levels were measured by an enzyme-linked immunosorbent assay (ELISA). The correlations between serum adropin levels and clinicopathologic variables were determined.In body mass index and age-matched groups of patients, adropin levels were determined lower in patients with EC than control group (p0.01). Adropin levels were negatively correlated with age (r = -0.265, p = 0.023), homeostasis model-resistance index (HOMA-IR) (r = -0.294, p = 0.005) and fasting insulin levels (r = -0.292, p = 0.001). It was shown that in receiver operator characteristic (ROC) analysis, at cut-off value ≤ 1.055 (ng/ml), adropin had 92.7% sensitivity, 91.5% specificity and had AUC = 0.948, CI; 0.894-1.000 for diagnosis of EC (p0.001).Adropin seems to be an important protein in pathogenesis of EC. Clearly, there are largely unknown aspects of adropin in EC pathophysiology and require further multi-centered, molecular and genetic studies including high number of cases.

OBJECTIVE: To determine the relationships between maternal and fetal cord serum leptin levels, maternal and fetal anthropometric measurements and placental weight. Design: Prospective clinical research Setting: Adnan Menderes University Hospital, Aydin, Turkey Patients: Thirty-three, healhty, first trimester pregnant women without any obstetric high risk. Interventions: Maternal anthropometric measurements and venous blood samples were collected at the first trimester and at term. Fetal anthropometrics and placental weight were recorded. Main outcome measurements: Leptin, body weight, body mass index (BMI), ponderal index (PI) and fetal sex. RESULTS: Serum leptin levels at term were increased when compared with those at the first trimester. The more BMI at the first trimester, the less total weight gain during gestation. Maternal weight at the first trimester was positively correlated with placental weight only, whereas maternal weight at term was positively correlated with both fetal and placental weight. The higher maternal BMI at term and the higher placental weight. Fetal weight, fetal BMI and PI were significantly and positively correlated with fetal cord leptin and placental weight. The same kind of correlation existed with the placental weight and cord leptin level. Fetal cord leptin and fetal sex was not correlated. CONCLUSIONS: One of the determinants of fetal and placental weight is the maternal weight at term, rather than the total weight gain during the pregnancy. Relatively thin women at the beginning of pregnancy gain more weight than the subjects that are relatively obese at the beginning of pregnancy. So maternal weight at term comes into a balance. Consequently, it seems that an optimal birth weight is achieved. Maternal leptin levels at the first trimester could not predict fetal growth. Fetal cord leptin is effective more than maternal leptin on fetal growth.

Bu çalışmanın amacı, terme yakın gebeliklerde, amni- yon sıvı miktarı ile maternal vücut sıvı kompartman hacimleri ve maternal obezite arasındaki ilişkinin araştırılmasıdır. This study aimed to investigate the relationship between amniotic fluid volume and mainlyvolume of maternal body fluid compartments and secondly maternal obesity in near term pregnancies. STUDY DESIGN A case control study was conducted involving 211 women with near term singletonpregnancies who attended Adnan Menderes University Faculty of Medicine between 2007 and 2009.Patients in Group 1(n=119), included near term pregnancies with normal amniotic fluid index (AFI) andGroup 2 included near term pregnancies complicated with idiopathic oligohydramnios (n=92).Oligohydramnios was diagnosed when AFI was measured < 8 cm. For determining maternal body fluidstatus we used valid formulas (defined in methods). Maternal body mass index (BMI), weight gain during pregnancy and volume of maternal body fluid compartments including total body water, intracellularfluid volume, extracellular fluid volume, interstitial fluid volume, plasma volume and plasma osmolalitywere compared between two groups.RESULTS: There was no significant difference between the groups in terms of maternal BMI, weight inpartum, weight gain during pregnancy, volume of maternal body fluid compartments, plasma osmolality(p> 0.05). Besides, there was no significant correlation with these parameters and AFI (p> 0.05). CONCLUSION: Our data favor that maternal BMI, volume of maternal body fluid compartments andplasma osmolality do not have any effect on amniotic fluid volume in near term pregnancies

Aim. The purpose of this study was to investigate factors affecting the success of different treatment modalities for the management of ectopic pregnancy (EP).Methods. One hundred and ninety-seven patients with EP, were included in the study. Patients were treated with either intramuscular methotrexate (Mtx) or surgical treatment.Results. Mtx was applied in 97 (49.2%) patients. In 67 patients (69.1%), a single dose of Mtx and in 30 patients (30.9%) a multiple dose of Mtx was applied. Forty-seven (70.14%) patients were successfully treated with a single-dose Mtx. In the multiple-dose group, the success rate was 70% (21/30 patients). The difference between the success rates was not statistically significant. When the initial serumβhCG value was βhCG value was >3000 mIU/mL. On the other hand, if the EP mass diameter was ≥25 mm.Conclusion. The results of the study showed that single-dose treatment with Mtx could be as successful as multiple doses. Overall success of Mtx treatment depended on initialβhCG value and EP mass diameter.

Objective. The aim of this study was to investigate whether platelet indices-mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) would be useful as noninvasive biomarkers for determining the severity of endometriosis. Methods. A retrospective review of the medical charts of 164 patients diagnosed with endometriosis and who were operated on between 2001 and 2013 was performed. The stage of endometriosis was determined according to revised American Society for Reproductive Medicine criteria. Results. In patients with advanced endometriosis (Stages 3-4), PLT, PCT levels were found to be significantly higher and MPV, PDW values to be significantly lower when compared to initial endometriosis (Stages 1-2). In addition, there was a significant positive correlation between PLT (r: 0.800, P: 0.001) and PCT (r: 0.727, P: 0.002) and the inflammatory marker white blood cell count (WBC). Conclusion. Our finding may not sufficient for employing platelet indices solely in this differential diagnosis, but our finding could provide a suggestion for clinical physicians so that attention is paid to the value of platelet indices and that these may be taken into account when making decisions about the initial or advanced stages of endometriosis.

The aim of this study is to compare galanin and IL-6 levels in pregnant women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT). Also association of insulin resistance markers, galanin and IL-6 was investigated.The study registered 30 pregnant women with GDM and 30 pregnant women with NGT. Fasting venous blood samples were collected from all patients. Galanin and IL-6 levels were measured by an enzyme-linked immunosorbent assay.Galanin and IL-6 levels were found higher in pregnant women with GDM (p 0.001). A significant positive correlation was determined between galanin concentrations and glucose (r = 0.240, p = 0.065), insulin (r = 0.681, p 0.001), HbA1c (r = -0.644, p 0.001), IL-6 (r = 0.783, p 0.05) and oral glucose challenge test results (r = 0.745, p 0.001) in pregnant women included in study, whereas no significant association was determined between galanin and gestational age (r = 0.058, p = 0.662), body mass index (r = -0.019, p = 0.886).Galanin and IL-6 were found to be significantly associated with insulin resistance markers in GDM, thus may play important roles in regulation of glucose hemostasis.

Coxiella burnetii is the causative agent of the common zoonotic disease known as Q fever. Human infection is mostly maintained by inhalation of contaminated aerosols that originate from infected birth products, milk and urine. Sexual transmission has also been reported. In pregnant women the disease causes abortion during the first trimester, while at later stages it tends to become chronic causing low birth weight babies and premature birth. The aim of this study was to investigate the prevalence of C.burnetii in women who had miscarriages, their spouses and in a control group composed of women with normal delivery by using serological and molecular methods. A total of 89 cases (58 female, 31 male; age range: 21-64 years, mean age: 33.1 ± 7.6 years) were included in the study. Women who had abortion (n= 36) were recruited along with their husbands (n= 31), and 22 women who had normal pregnancy were accepted as controls. Blood and placental tissue samples (after abortion or normal delivery) were collected from all of the female subjects, while blood samples were collected from the males. C.burnetii IgG and IgM antibodies in the sera of patients and controls were analysed by ELISA and indirect fluorescein antibody (IFA) methods, and the presence of C.burnetii DNA was searched in whole blood and placenta samples by using polymerase chain reaction (PCR). In our study, C.burnetii Phase II IgG antibody positivity rates in women who had miscarriages, their spouses and in women with normal delivery were found as 27.8% (10/36), 38.7% (12/31) and 4.5% (1/22), respectively by ELISA, while those rates were detected as 27.8% (10/36), 41.9% (13/31) and 9.1% (2/22), respectively by IFA which was accepted as the reference method. However C.burnetii Phase I IgM, Phase I IgG and Phase II IgM antibodies were not detected in none of the subjects by both methods. The relatively high seropositivity rate in our study group (25/89; 28.1%) was thought to be associated with high rates of livestock breeding in our region. Although C.burnetii IgG seropositivity rate in in women who had miscarriages was higher than women with normal delivery, the difference was not found to be statistically significant (x2= 2.906, p= 0.088). When the results of the women with miscarriages and their spouses were evaluated together, it was detected that C.burnetii IgG antibodies were not determined in the spouses of four seropositive women (two positive with 1/64, two with 1/128 titer); titer was 1/64 in four women and their spouses and two women with 1/128 titer had spouses with 1/64 titer. The determination of high titer phase II IgG positivity in 13% (4/31) of the spouses of women who had miscarriages was of notice. All of the blood (n= 89) and placenta samples (n= 51, 29 were from aborted and 22 from normal delivered women) were negative for C.burnetii DNA by PCR. In conclusion, since livestock breeding is common in our region, in cases with recurrent abortion and premature births, women and their husbands should be screened for C.burnetii.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a benign cutaneous hamartoma characterized by intensely erythematous, pruritic, and inflammatory papules that occur as linear bands along the lines of Blaschko. There is a considerable clinical and histological resemblance between ILVEN and linear psoriasis, lichen striatus, linear lichen planus, and invasion of epidermal nevus by psoriasis. The pathogenesis of ILVEN is unknown. It is regarded as a genetic dyskeratotic disease reflecting genetic mosaicism. Here, a case of vulvar and perianal condyloma superimposed ILVEN is presented.

This study was conducted for the purpose of assessing, in the light of results of other research carried out in the present researchers' clinic and in Turkey, the status of twin pregnancies in Turkey, the incidence of twin births, perinatal and mortality rates associated with twin pregnancies, and the problems experienced in Turkey in cases of multiple and twin pregnancies.Materials and Methodology:The outcomes of twin births that occurred at the researchers' clinic during the period 2001–2009 were studied retrospectively. Seventeen studies conducted in Turkey on multiple and twin pregnancies during the years 1991–2010 were included in the study.Findings:It was observed that the mean multiple pregnancy rate in Turkey is 1.9% and the mean twin birth rate is 1.7%. It was also observed that a large majority (80–97.3%) of multiple pregnancies in Turkey are twin pregnancies. It was noted from Turkish literature that the mean gestational age of twins at birth varies between 33–36.2 weeks and that mean birthweights are 2065–2327 grams for the first-born twin and 1887–2262 grams for the second-born. These findings were observed to be lower than what is indicated in the literature. Perinatal and neonatal mortality, at 58–156/1000 and 40–98/1000 respectively, were seen to be higher than in the literature.Conclusion:It can be seen that preterm birth rates for twin pregnancies in Turkey are higher than what is indicated in the literature and that prenatal and neonatal mortality rates are also similarly higher.

The aim of this study was to investigate and to compare the effects on serum homocysteine levels of early initiated oral and transdermal oestrogen replacement therapies (ERTs) given to women without a uterus who had undergone surgically induced menopause. Homocysteine levels are considered one of the predictors of cardiovascular disease risk.This study included 45 women with surgical menopause. Of 45 women, 15 received oral ERT, (oestradiol hemihydrate 2 mg/day, Estrofem®), 15 received transdermal ERT (oestradiol hemihydrate 0.1% gel 1.5 mg/day, Estreva®) and 15 received no hormone therapy. Blood samples were collected from all women to measure homocysteine levels at the mean time of 15 weeks after surgical menopause. Obtained results of the groups were compared.There were no significant differences in age, height, weight, body mass index (BMI), waist circumference and time elapsing since menopause between the three groups. The duration of ERT was not significantly different between the therapy groups. There was no significant difference in homocysteine levels between the groups (p0.05). No significant correlation was found between weight, BMI and homocysteine levels (p0.05).Considering that homocysteine is a predictor of risk for cardiovascular disease, the results of this study showed that early initiation of ERT in healthy surgically induced menopausal women neither protects nor deteriorates cardiovascular disease.

First trimester obstetric ultrasonography of a 32-year old female patient revealed a 13-week-old (according to the length of the femur and abdominal circumference) intrauterine live pregnancy with the absence of the fetal head. Medical abortus was performed with the diagnosis of acephaly and final diagnosis was confirmed by pathological and radiological examinations. We present and discuss the possible etiopathologic mechanisms of an acephaly case, which is described as acardia-acephaly complex in the literature, and usually appears in cases of twin reversed arterial perfusion sequence, but has not been previously reported as an isolated finding.

Vaginal vault dehiscence (VVD) may occur rarely after hysterectomy. Although mostly, a vaginal cuff dehiscence is seen after robotic or laparoscopic hysterectomy, it may also be observed as a complication of abdominal or vaginal hysterectomy. Vaginal repair is one of the techniques used for VVD. Here, we will describe a case of vaginally repaired VVD, associated with intra-abdominal hematoma after postpartum hysterectomy.