Gebelikte Beslenme ve Destek Tedavileri Yağmur SOYKAN İsmail GÜLER Gebelik Öncesi Danışmanlık Eren AKBABA İntrauterin Enfeksiyonlar Ayşe Semra GÜRESER Djursun KARASARTOVA Ayşegül TAYLAN ÖZKAN Gestasyonel Diabetes Mellitus Serdar GÜLER Tedavi Gebeliklerinin Perinatal Sonuçları Pınar Gülşen ÇOBAN Nafiye YILMAZ Preterm Doğum ve Öngörülmesi Engin YURTÇU Betül KEYİF Amniyonik Sıvı Bozuklukları Ümit GÖRKEM Fetal Anöploidi Taraması Bulut VARLI Pınar ÖZCAN Abortus ve Ölü Doğumlar Ali Emre TAHAOĞLU İhsan BAĞLI Fetal Kalbin Değerlendirilmesi Yavuz ŞİMŞEK Gestasyonel Hipertansif Bozukluklar Hasan Ali İNAL Antenatal Fetal İyilik Testleri Hasan Ali İNAL Plasental Yetmezlik ve Fetal Gelişim Kısıtlılıkları Pınar KADİROĞULLARI Kerem Doğa SEÇKİN Omuz Distosisi Zeynep Öztürk İNAL Gebelikte Akut Abdominal Ağrı İbrahim Tayfun ŞAHİNER Murat KENDİRCİ Plasenta Anomalileri Cansu Kübra NERGİSLİ Cihan TOĞRUL Gebelikte Aşılar Başak ERGİN Cihan TOĞRUL Yardımcı Üreme Teknolojisinde Kullanılan İlaçlar ve Gebelik Üzerine Etkisi Deniz TAŞKIRAN Cihan TOĞRUL Çoğul Gebelikler Burak ELMAS Burçin SALMAN ÖZGÜ Obstetrik Ultrasonografi Zeynep ÖZTÜRK İNAL Prenatal Tanısal Genetik Testler Taha TAKMAZ Servikal Yetmezlik Ümit GÖRKEM Perinatal Depresyon Ahmet Alp KARAKAŞLI Sertaç AK

OBJECTIVES:This study aimed to estimate the incidence of maternal near-miss (MNM) morbidity in a tertiary hospital setting in Turkey.MATERIAL AND METHODS:In this retrospective study, we concluded 125 MNM patients who delivered between January 2017 and December 2017 and fulfilled the WHO management-based criteria and severe pre-eclamptic and HELLP patients which is the top three highest mortality rates due to pregnancy. Two maternal death cases were also included. The indicators to monitor the quality of obstetric care using MNM patients and maternal deaths were calculated. Demographic characteristics of the patients, the primary diagnoses causing MNM and maternal deaths, clinical and surgical interventions in MNM patients, shock index (SI) value of the patients with obstetric hemorrhage and maternal death cases were evaluated.RESULTS:The MNM ratio was 5.06 patients per 1000 live births. Maternal mortality (MM) ratio was 8.1 maternal deaths per 100 000 live births. SMOR was 5.14 per 1000 live births. The MI was 1.57%, and the MNM/maternal death ratio was 62.4:1. The SI of MNM patients with obstetric hemorrhage was 1.36 ± 0.43, and the SI of the patient who died due to PPH was 1.74.CONCLUSION:The MNM rates and MM rates in our hospital were higher than high-income countries but were lower than in low- and middle-income countries. Hypertensive disorders and obstetric hemorrhage were the leading conditions related to MNM and MM. However, the MIs for these causes were low, reflecting the good quality of maternal care and well-resourced units. Adopting the MNM concept into the health system and use as an indicator for evaluating maternal health facilities is crucial to prevent MM.

OBJECTIVE:This study was aimed to compare the shock index (SI) values between patients who required blood transfusion due to postpartum hemorrhage (PPH) and patients who received no blood transfusion.METHODS:We conducted this cross-sectional study at a tertiary center between January 2019 and June 2019. A total of 2534 patients who underwent vaginal delivery were included in this study. We measured SI values upon admission, 30 minutes, 1-hour, and 2-hours after delivery. We identified women who required blood transfusion as the study group. Control patients who delivered in the same period and received no blood transfusion were identified in the medical record system and randomly selected. Age, parity, BMI, and SI values at each one prepartum and three postpartum periods of the groups were analyzed.RESULTS:A total of 2534 patients were included in the study. A varying amount of blood transfusion was performed in 54 patients (2.13%). When we compared with patients who did not receive blood transfusion after delivery, patients who received any amount of blood transfusion after vaginal delivery had significantly higher SI values 30 minutes after delivery (0.99±0.20, and 085±0.11, p=0.0001), at 1-hour (1.00±0.18, and 0.85±0.11, p=0.0001), and 2-hours (1.09±0.16, and 0.87±0.11, p=0.0001).CONCLUSION:SI value could be a reliable and consistent marker to predict the requirement for any amount of blood transfusion due to PPH.

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

Laparoscopic pectopexy has been described recently for pelvic organ prolapse (POP) and it could be an alternative surgery to sacrohysteropexy. A 36-year-old parity 3 women was operated cause of POP, and on her history, she had performed one sacrospinous ligament fixation with colporrhaphy anterior and one abdominal sacrohysteropexy because of POP. After 6-month follow-up, anatomic and functional cures were provided. Laparoscopic pectopexy could be an alternative procedure for recurrent POP surgery with promising results.

OBJECTIVE: There are cases where ultrasonographic evaluation is inadequate in determining first-trimester healthy pregnancy. In these cases, both the patient and the clinician are involved in a worrying expectation. The single serum progesterone measurement was tried to predict pregnancy prognosis in short time period. This study evaluated the predictive value of a single serum progesterone measurement in first-trimester pregnancy loss. STUDY DESIGN: A prospective case-control study was conducted between July 2013 and July 2014 in Tertiary Hospital. The study compared 106 patients with threatened abortion (vaginal bleeding or spotting) before 13 weeks of gestation with 110 healthy control pregnancies. Samples of serum progesterone were obtained on the day each patient was admitted to the hospital. A Beckman-Coulter macro-Enzyme-linked immunoassay (ELISA) system was used to measure serum levels of progesterone (Beckman-Coulter, Ireland). RESULTS: Progesterone levels were measured when the patients first visited the hospital and they were followed until the end of the first trimester. Progesterone levels differed significantly (p=0.013) between the two groups. The spontaneous abortion rate was significantly (p=0.044) higher in the case group. Progesterone levels differed significantly (p=0.001) between ongoing pregnancy and spontaneous abortion groups. Using a cut-off level of 10.7 ng/mL, the sensitivity, specificity, and positive and negative predictive values were 92.1%, 44%, 92.6%, and 42.3%, respectively, for viable pregnancies. CONCLUSION: A single measurement of progesterone levels in serum can predict the prognosis of a viable first-trimester pregnancy, while it is less effective for identifying non-viable pregnancies.

Aim We aimed to present the outcomes of five pregnant women who had laparoscopic pectopexy in their past. Methods In this retrospective cohort study, we reviewed all female patients who underwent modified laparoscopic pectopexy between 2016 and 2018 at our hospital. Polypropylene monofilament mesh was used for the pectopexy procedure in 36 cases of women suffering from apical pelvic organ prolapse (POP). Five women were pregnant at different dates after the surgery; we included them in the study (n = 5). We collected data including age, gravidity, parity, magnetic resonance image, sonographic image, POP - Quantification scores, neonatal results from the hospital database. Results After uneventful examinations during pregnancy, four women delivered via caesarean section; one of them got pregnant again and delivered successfully. We did not see relapse in apical prolapse or other compartments 3, 6 and 12 months after delivery. All women gave high satisfaction scores regarding POP at 12 months after delivery. Conclusion Laparoscopic pectopexy is an effective and alternative procedure for women with POP and a good option for preserving fertility. We found that pregnancy did not adversely affect the short-term success of laparoscopic pectopexy, and vice versa.

To report a case who experienced uterine rupture at 38th week of gestation and had a history of manipulator associated uterine rupture. A 25 years old primigravid woman at 38 weeks of gestation was referred to our hospital with the signs of active labor. Heavy lower abdominal cramps and signs of acute abdomen suggested uterine rupture and emergent cesarean section was performed. A 3 cm in size and circular in shape uterin rupture at the fundus that was imitative of enlarged previous manipulator associated rupture was observed. A manipulator associated uterine rupture should be repaired when encountered in reproductive ages in order to prevent a possible uterine perforation during subsequent pregnancy.

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient. IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP.

When an embryo implants at the site of a previous cesarean section (CS) defect, it is called cesarean scar pregnancy (CSP). The rate of CS ectopic pregnancy has increased with the rate of CS,[1] which may lead to massive vaginal bleeding, abnormal placentation, and uterine rupture.[2] Two types of CSP have been described; type I (endogenic type) expands through to the uterine cavity and type 2 (exogenic type) shows a progression toward the bladder and abdominal cavity.[3] CSP is a rare type of ectopic pregnancy, and the most effective treatment option still remains unclear.[4]

This study examined the early outcomes of laparoscopic (LS) pectopexy and evaluated its effects on female sexual function and quality of life (QoL).

PURPOSE:To investigate the outcomes of pregnancies with a sonographically detected nuchal cord (NC) from a single center in south-eastern Turkey.MATERIALS AND METHODS:A retrospective study was carried out at Maternity and Child Health Hospital Diyarbakir, Turkey, between 2011 and 2013. A-total of 477 pregnancies with sonographically detected NC during the second and third trimesteri of gestation (20-40 weeks) were included. The control group consisted of 1,043 randomly selected pregnancies without NC matched for gestational age at the time of ultrasound examination. Outcome variables, including maternal age, parity, gestational age at delivery, mnode of delivery, intrapartum fetal heart abnormalities, meconium-stained amniotic fluid, birth weight, and one- and five-minute Apgar scores, were compared between the two groups.RESULTS:There were no statistically significant differences in any of the outcome variables between patients with sonographically detected NC and controls.CONCLUSIONS:The presence of NC indicates a need for increased care but is not associated with adverse perinatal outcomes.

Objective: The aim of this study is to investigate the relationship between deep myometrial invasion and other prognostic factors in endometrial cancer. Recurrence rates, disease free survival and overall survival rates were evaluated in endometrial cancer patients with MI>50%. Sudy Design: A total of 132 patients with endometrial cancer who underwent surgical treatment between 2001 and 2011 were identified. Demographic, clinicopathological, surgical/adjuvant treatment and follow-up data were extracted. Results: Pelvic lymph node invasion ratio was 28,9% and para-aortic lymph node invasion ratio was 15,5% in patients with myometrial invasion is greater than 50%. Other prognostic factors especially lympho-vascular space invasion and pelvic/para-aortic lymph node metastasis were significantly higher when myometrial invasion is above 50% and also there was significant difference in recurrence rates, overall survival and disease free survival rates between patients with superficial and deep myometrial invasion (p<0.05). Conclusion: Myometrial invasion is an important prognostic parameter and can be determined intraoperatively to decide whether to perform pelvic and para-aortic lymph node dissection.

Labial fusion usually affects prepubertal girls and postmenopausal women, it may rarely occurs in reproductive years in the absence of predisposing factors such as vulvar infections, dermatitis, trauma, female circumcision and lichen sclerosis.Should be considered in differential diagnosis in the differential diagnosis of urinary retention even if the patient doesn't have history of sexual intercourse.

The aim of this study was to explore the success rates of Bakri balloon placement in patients with placenta previa and uterine atony. In addition, we compared bilateral internal iliac artery ligation (B-IIAL) and Bakri balloon placement in terms of their ability to inhibit haemorrhage in postpartum placenta previa patients. The hospital reports filed annually from 2010 to 2015 were reviewed. In total, 54 patients were evaluated: 42 patients with placenta previa and uterine atony were treated with Bakri balloons, and 12 placenta previa patients with postpartum haemorrhage underwent B-IIAL when medical treatment failed. The results showed that the success rates of Bakri balloon placement rate in placenta previa and uterine atony patients were 71.4% and 89.2%, respectively. The comparative analysis of placenta previa patients treated via Bakri balloon placement and B-IIAL showed that the requirements for packed red blood cell and fresh frozen plasma, pre- and post-partum haemoglobin levels, pre- and post-partum platelet counts, and hospitalization times differed significantly between the two groups (all p < 0.05). Bakri balloon tamponade could be considered an effective treatment for placenta previa and uterine atony. The technique is minimally invasive and can serve as a second-line treatment for patients with postpartum haemorrhage when medical procedures fail.

Objective:The purpose of this study is to examine the protective effects of maresin 1 on testicular injury induced by ischemia reperfusion.Methods: 24 Sprague-Dawley male rats were divided into 3 groups.The groups are planned as follows; sham, ischemia reperfusion and ischemia reperfusion+maresin 1 groups.The spermatic cord was detected and clamped for 2 hours to establish the prompt.After 2 hours, the clamp was removed and testicular reperfusion was achieved for 2 hours.At the end of the reperfusion phase, testicular tissues were taken and total antioxidant capacity (TAC), total oxidant capacity (TOC), superoxide dismutase (SOD), malondialdehyde (MDA) and myeloperoxidase (MPO) levels were determined by spectrophotometric method.Results: In the ischemia-reperfusion group, TOS and MDA and MPO are increased, the levels of TAS and SOD molecules are decreased.TOS and SOD levels are increased and TAS, MDA and MPO levels are decreased in the Maresin-1 treatment group. Conclusion:These results show us that a single dose of maresin-1 application is effective against oxidative damage caused by ischemia reperfusion.

We present a very rare case of malignant transformation of a benign mature cystic teratoma. The pathology report revealed malignant transformation of both the epithelial and sarcomatous elements of a benign dermoid cyst. To the best of our knowledge, this appears to be the third case of a malignant fibrous histiocytoma and a squamous cell carcinoma developing from a mature cystic teratoma. Malignant transformation of a dermoid cyst is usually diagnosed postmenopausally, but our patient was premenopausal. The etiology and prognosis of malignant transformation of this benign condition remain unknown.

OBJECTIVE: To examine histopathologic changes and correlation between TNF-alpha and pSTAT3 expression levels by western blot and immunohistochemical methods in preeclamptic placentas. STUDY DESIGN: Obstetrical properties and bio-chemical and hematological features of patients with preeclampsia and healthy subjects were compared. Paraffin sections obtained from placenta were stained with hematoxylin-eosin for histopathologic examination. RESULTS: In histopathologic examination of preeclamptic placentas, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and calcified and hyalinized villous spots were observed. CONCLUSION: In preeclamptic placentas, we observed that trophoblastic invasion may downregulate STAT3 phosphorylation and can correlate with TNF-alpha elevation. Even though trophoblast invasion may interfere with both vascular and immune systems, TNF-alpha is not directly involved in the STAT3 signaling pathway in the preeclamptic placenta. (Anal Quant Cytopathol Histpathol 2017; 39: 149-156)

Objectives: The aim of this study was to investigate the benefits of the newly revised "The international federation of gynecology and obstetrics (FIGO), 2009" sytem and whether there was a difference in new system comparison to 1988 FIGO staging sytem for endometrial carcinoma.Methods: A total of 132 patients who underwent complete surgical staging for endometrial cancer were enrolled retrospectively. Those patients' overall survival and disease free survival were compared with 1988 and 2009 staging system.Results: The five year overall survival (OS) rates for patients with 1988 FIGO stage 1 and 2 were 97% and 100%, respectively. In 2009 system, the OS rates for 1 and 2 were 97% and 100%, respectively. There was no statistically significant differences between stage 1 and stage 2 for OS rates in 1988 and 2009 as well.Conclusions: The newly revised system could be less complex for understanding, but it does not discriminate survival rates better, especially in earlier stages. A new staging system and uniform surgical staging could be discussed.

Rhizomelic chondrodysplasia punctata (RCDP) is a rare autosomal recessive disorder characterized by stippled epiphyses and rhizomelic shortening of the long bones within the heterogenous group of chondrodysplasia punctata (1). There are few reports discussing the antenatal diagnosis of RCDP. We report prospective antenatal diagnosis of a case with RCDP in a fetus without family history.A 30 year old multigravid was referred to our clinic at 29 weeks gestation following ultrasound detection of short femur length. The parents had first degree consanguinity and the family had no history of skeletal dysplasia. Ultrasonographic evaluation revealed that the femur and tibias were below the 3rd centile. Multiple punctuations were detected in proximal and distal epiphyses of the humeri and femur (Fig. la-lb). The remaining long bones were appropriate in length for gestational age. Nasal hypoplasia, micrognatia and increased prenasal thickness were detected in the fetal profile. No additional malformation was detected. Diagnosis of RCDP was suspected due to the findings of stippled epiphyses in the context of rhizomelic limb shortening. Fetal blood sampling analysis revealed PEX 7 mutation in consistent with Type 1 RCDP. Follow up ultrasonographic examination at 32 weeks 6 days of gestation demonstrated the previous findings detected earlier. Cesarean section (CS) was performed at 39 weeks gestation with the indication of previous CS. Morphologic features of the newborn were flat face, hypertelorim, broad nose, antevert nares, long and smooth philtrum, down turned comers of the mouth, broad ear nodules and short neck (Fig. lc). Postnatal radiographs revealed shortening of the both humeri and femoras and stippling of long bones (Fig. Id).Since RCDP is inherited in an autosomal recessive manner, there will be a negative family history for most cases. So the diagnosis can be done if a family history exists but cases have been reported even without such a history. Similar to the present case; Gendal et al. reported a case of rhizomelic chondrodysplasia punctata in a dichorionic twin, in which one was noted to have rhizomelic limb shortening at 25 weeks of gestation. The humeri were shaped like dumbbells and multiple hyperechoic foci were noted in the humeral and proximal femoral epiphyses. Diagnosis of rhizomelic chondrodysplasia punctata was confirmed in this twin by demonstration of absent alkyl-dihydroxyacetone phosphate synthase activity in cultured skin fibroblasts after postmortem examination (2). Also Hertzberg et al. described prospective antenatal diagnosis of RCDP in a fetus with no family history. In the light of sonographic findings including rhizomelic shortening in combination with premature ossification and stilliping of multiple epiphyses. Amniosynthesis revealed deficient fibroblast peroxisomal plasmalogen synthesis enzymes, which confirmed the diagnosis (3).Nasal hypoplasia, micrognatia and increased prenasal thickness were the only additional sonographic findings in the present case. Basbug et al. reported sonographic diagnosis of a case with type 1 RCDP at 30 weeks of gestation with bilateral cataracts (4). …