A broader range of more effective compression techniques are needed in the patients who have an intractable postpartum haemorrhage due to uterine atony despite medical treatment and B-Lynch sutures. The aim of this study was to report the outcome of a series of patients with haemorrhage who were managed by double B-Lynch suture. Fourteen patients who were treated in a tertiary hospital between July 2010 and February 2015 were included in the study. The intractable haemorrhage rate was 0.35% over 5 years (14/4000 births). Bleeding was controlled in all the patients with a double B-Lynch suture. The mean age of the patients was 24 +/- 3.4years. The mean estimated blood loss was 1696 +/- 272.075mL, and the mean transfusion rate was 4.2 +/- 2.5 units. Pregnancy was observed in five patients at follow up. The double B-Lynch suture seems to be an effective and reliable solution to an intractable postpartum haemorrhage resulting from uterine atony and has no unfavourable impacts on fertility. It should be considered before the use of any aggressive surgical techniques such as a hypogastric artery ligation or a hysterectomy. This the first study to investigate the effectiveness of the double B-Lynch suture, and we showed that the hysterectomy and/or hypogastric artery ligation rate can be decreased by adding a second B-Lynch suture in cases where the medical treatment or a single B-Lynch has failed. IMPACT STATEMENT What is already known on the subject? Uterine atony is the most common cause of a primary postpartum haemorrhage. When a simple massage of the uterus and medication failed to manage this condition, various surgical solutions have been sought, including uterine compression sutures, uterine artery ligation, devascularisation of the uterus, internal iliac artery ligation and, ultimately, a hysterectomy. The B-Lynch suturing technique is particularly useful because of its simplicity of application, life-saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. To-date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. However in the cases of when it falls, usually a hysterectomy or a hipogastric artery ligation is preferred. What does this study add? A "double B-Lynch suture seems to be an effective and reliable method in an intractable postpartum haemorrhage due to a uterine atony and has no unfavourable impact on fertility'. What are the implications of these findings for clinical practice? The double B-Lynch suture seems to be an effective, reliable and technically easy method. With this aspect, it might be considered before any aggressive surgical techniques, such as a hypogastric artery ligation and hysterectomy in selected cases.

Alarin is a newly identified peptide hormone. It is implicated that alarinplays roles in regulation of energy metabolism and hypothalamo-pituitary-gonadal axis. Polycystic Ovary Syndrome (PCOS) is a common reproductive and metabolic disease in women during reproductive ages. Over-secretion of Luteinizing Hormone (LH) causes hyperandrogenism in women with PCOS. The purpose of the study was to determine the comparison of alarin levels in women with or without PCOS as well as to investigate the relationship between alarin and LH. Eighty-four women with PCOS and 84 age- and BMI- matched controls were recruited in this cross-sectional study. Circulating alarin levels were assessed via ELISA method. The hormonal and metabolic parameters of the recruited subjects were also determined. The circulating levels of alarin in PCOS subjects were higher than controls (6.11 ± 1.91 vs. 3.93 ± 1.60 ng/ml, P <0.001). Alarin showed a positive correlation with insulin resistance marker, BMI, LH and androgens. Moreover, alarin levels were elevated in women with PCOS having insulin resistance compared to those PCOS women without insulin resistance. In both control and PCOS groups, overweight subjects showed an elevation in circulating levels of alarin with respect to normal weight subjects. In the present study, Alarin level with the highest tertile dosage comparing to alarin level with the lowest tertile dosage could highly increase the probability of PCOS risk prevalence in women. Elevated alarin levels in women with PCOS were associated with not only LH and metabolic parameters but also high probability of having PCOS risk independently.

Purpose: Endocan is a proteoglycan secreted mainly from endothelial cells. It has been implicated that there is a link between endocan and endothelial dysfunction. Polycystic ovary syndrome (PCOS) is a reproductive and metabolic disease associated with increased risk of cardiovascular events. The aims of this study were to ascertain whether circulating endocan levels are altered in women with PCOS, and whether there is an association between endocan and carotid intima media thickness (cIMT). Materials and methods: This cross-sectional study included 80 women with PCOS and 80 age- and BMI-matched controls without PCOS. Circulating endocan levels were measured using ELISA. Metabolic, hormonal parameters and cIMT were determined. 2-h oral glucose tolerance test (2-h OGTT) was performed on all women. Results: Circulating endocan levels were significantly elevated in women with PCOS compared with controls (5.99 +/- 2.37 vs. 3.66 +/- 1.79 ng/ml, P < 0.001). Endocan levels positively correlated with BMI, homeostasis model assessment of insulin resistance (HOMA-IR), free androgen index (FAI), high-sensitivity C-reactive protein (hs-CRP), and cIMT in both PCOS and control groups. Endocan levels did not correlate with fasting blood glucose, 2-h OGTT, A1(C) and lipid parameters. Multiple linear regression analysis revealed that endocan is an independent predictor for cIMT ( = 0.128, 95% CI = 0.118-0.138, P = 0.011). Conclusions: Circulating endocan levels are significantly higher in women with PCOS and endocan is independently associated with cIMT. Elevated endocan levels can be a predictor of increased cardiovascular risk in PCOS subjects.

BACKGROUND:Platelets are blood elements thought to play a role in the immune system and therefore tumor development and metastasis. Platelet activation parameters such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) can be easily evaluated with the whole blood count and have been studied as markers of systemic inflammatory responses in various cancer types. Our aim in this study was to evaluate the correlation between endometrial pathologies and MPV, PDW and PCT.MATERIALS AND METHODS:A total of 194 patients who presented to our clinic with abnormal vaginal bleeding were included in our study. The patients were divided into 3 groups (endometrial hyperplasia, endometrial cancer, control) according to their pathology results. The groups were compared for MPV, PDW, and PCT values obtained from the blood samples taken on endometrial biopsy day.RESULTS:The endometrial cancer patients were the oldest group (p=0.04). There was no significant difference between the three groups in terms of white blood cell count (WBC), platelet count (PC), and hemoglobin (Hb) level. The highest MPV (p<0.001), PDW (p=0.002), and PCT (p<0.001) levels were in the endometrial cancer group, and the lowest levels were in the control group.CONCLUSIONS:The easy evaluation of platelet parameters in patients who are suspected of having endometrial pathology is a significant advantage. We found MPV, PDW, and PCT to be correlated with the severity of endometrial pathology with the highest values in endometrial cancer. Studies to be conducted together with different laboratory parameters will further help evaluate the diagnosis and severity of endometrial cancer and precursor lesions.

Objective: To evaluate the effects of Ramadan fasting on fetal development and outcomes of pregnancy. Methods: We performed this study in Antakya State Hospital of Obstetrics and Child Care, between 28 June 2014 and 27 July 2014 (during the month of Ramadan). A total of two hundred forty healthy pregnant women who were fasting during Ramadan, were included in the groups. The three groups were divided according to the trimesters. The each group was consisted of 40 healthy pregnant women with fasting and 40 healthy pregnant women without fasting. For evaluating the effects of Ramadan on fetus, ultrasonography was performed on all pregnant women in the beginning and the end of Ramadan. We used the essential parameters for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. Results: No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. On the other hand, a statistically significant increase was observed in maternal weight in the second and third trimesters and a significant increase was observed in the amniotic fluid index in second trimester. Conclusion: In Ramadan there was no bad fetal outcome between pregnant women with fasting and pregnant women without fasting. Pregnant women who want to be with fast, should be examined by doctors, adequately get breakfast before starting to fast and after the fasting take essential calori and hydration. More comprehensive randomized studies are needed to explain the effects of fasting on the pregnancy and fetal outcomes.

OBJECTIVE:While the relationship between platelet crit (PCT), platelet distribution width (PDW) and hypertension has been well-documented, data on the association between PCT, PDW and preeclampsia are scant at best. In our study we aimed to investigate the possible correlation of PCT and PDW with preeclampsia and disease severityMATERIAL AND METHODS:A total of 110 preeclamptic and 100 healthy pregnant women were included in the study Baseline PCT and PDW were measured using an automatic blood counterin the entire study population.RESULTS:While there were no significant differences between the preeclampsia group and the control group in terms of hemoglobin and platelet counts, the PDW, mean platelet volume (MPV), systolic and diastolic blood pressure, proteinuria, WBC and Hs-CRP levels were significantly higher in the preeclampsia group. In addition, PCT level was significantly lower in the preeclampsia group as compared to controls. Moreover subgroup analysis revealed that PDW and MPV levels were significantly increased in severely preeclamptic patients when compared to mildly preeclamptic patients.CONCLUSIONS:Our study results revealed that PCT and PDW levels were associated with both, the presence and severity of preeclampsia.

Uterine prolapse is usually an entity of elderly women and is very rare in pregnancy. Fetal and maternal complications can increase in pregnant women with uterine prolapse. In this article, we presented a woman who admitted to policlinic with complain of travail at the gestation of 33th week and was hospitalized to the hospital with diagnosis of uterine prolapse and preterm labor. A live female infant weighing 1750 gr was delivered via cesarean section because of unresponsive to medical therapy for preterm labor. It was observed that uterine prolapse was regressed spontaneously after a month of postpartum. Uterine prolapse, if seen in pregnancy, is an entity that should be careful in terms of fetal and maternal complications and treatment varies according to the patient.

Aim: The evaluation of the uterine artery recanalization rate and color Doppler parameters during follow-up after bilateral uterine artery ligation (BUAL) for postpartum hemorrhage (PPH) related to uterine atony. Material and method: A total of 40 female patients who underwent BUAL for PPH related to uterine atony and 96 females who gave birth without complication at Hatay Obstetrics and Gynecology Hospital between January 2009 and December 2012 (48 months) were included in the study. The patients' uterine artery recanalization rate and all subjects' color Doppler ultrasonographic parameters (PI, RI, PSV and EDV) were evaluated at the 6th and 12th months. Result: No statistically significant difference was found between the age, obstetric history (gravida and parity), BMI, type of delivery, birth weight and gestational age when the demographic data of the groups were evaluated. The patient group UtA recanalization rate was 32.5% and 37.5% for the left and right UtA respectively at the 12-month follow-up. No statistically significant difference was found in the comparison of 6- and 12-month right and left uterine artery diameters and color doppler parameters of the patient group (UtA diameters P=0.322 and P=0.787, RI index P=0.390 and P=0.094, PI index P=0.949 and P=0.374, PSV P=0.335 and P=0.085, EDV P=0.173 and P=0.418, respectively). However, right and left ovarian volume was found to significantly increase during follow-up in patient group (P < 0.001 for both right and left ovary). On the other hand, a statistically significant difference was found between the patient group and the control group in the comparison of the 6- and 12-month right and left uterine artery values (6th month; P < 0.001 for both UtA diameters, RI, PI, PSV, EDV; 12th month; P < 0.001 for right UtA diameter, RI, PI, PSV, EDV and P=0.002 for left UtA diameter). A statistically significant difference was found only in right ovary volume in the 6th month evaluation of the patient and control group ovary volumes (P=0.011). Discussion: The recanalization rate and isolated uterine blood supply during low-term follow-up are low following the BUAL technique. The evaluation of future fertility results will be helpful in determining the reliability of this procedure in a definite manner.

Iletisim: Dr. Dilek Benk Silfeler. Alaaddin Koyu Gungor Uydukent 30 Parsel, D11/3 Antakya, Hatay Tel: 0326 221 33 17 Basvuru tarihi: 29.10.2011 Kabul tarihi: 26.06.2012 Online baski: 17.04.2014 e-posta: drsilfeler@yahoo.com Giris Hipergonadotropik hipogonadizm, hipotalamohipofizer aks dogal olmasina ragmen primer gonadal yetmezlik sonucu ortaya cikar. Parsiyel veya inkomplet olgularda puberte baslasada devami saglanamaz. Primer gonadal yetmezliklerde ozellikle FSH cok yuksektir. Bu yukseklik sekiz-dokuz yasindan itibaren belirginlesir. Bu hastalarda supheli genitalya olmazsa bile karyotip analizi yapilmasi onerilmektedir.[1] Tedavide ostrojen ve testesteron verilmesi onerilmektedir. Her ne kadar tam bir fikir birligi olmasa da 13-14 yaslarinda tedaviye baslanmasi onerilmektedir.[1]

Aim: The evaluation of the effect of repeat cesarean sections in adolescent pregnancies on the morbidity, obstetric and perinatal results. Materials and methods: We reviewed the patient file and hospital records of patients who underwent at least one cesarean section among adolescent age group pregnant women who gave birth at our clinic between January 2010 and May 2013. The patients were divided into two groups as the patients who underwent the second cesarean section (116 patients) and those who underwent the third cesarean section (36 patients). The demographic data, maternal data and obstetric and perinatal results of the patients were evaluated. Results: A significant difference was present between the patients in the evaluation of the total number of examinations during pregnancy (P = 0.001), total maternal weight gain during pregnancy (P = 0.006), and the first examination gestational age (P = 0.006) and all values were less favorable in the third cesarean group. The gestational week at birth (P < 0.001), birth weight (P < 0.001), and APGAR score (P < 0.001) in the group with the third cesarean section were statistically significantly lower than the second cesarean section. The third cesarean cesarean was found to cause a significant risk increase for placenta accreta risk in adolescent pregnancies (P = 0.042). Conclusion: The increasing number of cesarean sections in the adolescent group is seen to be a significant risk factor for low gestational week of birth, low birth weight and related morbidities. The most important reason for the increased morbidity with increasing cesarean sections in the adolescent age has been defined as placenta accreta.

Objective: Mean Platelet Volume (MPV) is an important indicator of platelet activation. It is known that MPV increases in patients with coronory artery disease, diabetes mellitus, atherosclerosis and Polycystic ovary syndrome (PCOS). Our aim was to measure the MPV in lean patients with polycystic ovary syndrome.Methods: The present study was designed to examine the platelet function by measuring MPV in non-obese women with PCOS. A total of 50 outpatients with PCOS were included. The control group consisted of 50 healthy subjects. Serum platelet, MPV, and white blood cell (WBC) levels were compared and evaluated retrospectively in all participants. These values were compared by statistical analysis.Results: There were no statistically significant difference in between groups regarding MPV (p=0.357), WBC (p=0.414) and platelet (p=0.666).Conclusion: There are studies implying MPV increase in PCOS patients, in our patients MPV levels did not correlate with PCOS except for patients with obesity. We think that PCOS itself has no effect on MPV levels and obesity changes MPV levels.

Objective: To assess the working conditions and current challenges of the gynecology assistants in Turkey and to propose solutions within this context.Materials and methods: A survey on the problems of assistant doctors and the solution proposals they offered was executed with gynecology assistants who serve at the teaching, research and university hospitals in different regions of Turkey.Results: 60 gynecology assistants from 7 training institutions (university and teaching research hospitals) were included in the study. 75% of the participants (n:45) prefered gynecology as their first choice in the medical specialty exam. 51% of the survey participants(n:31) were satisfied with their existing conditions. The main problem was determined as severe working conditions by 43% of the participants. (n:26) Based on the answers of 42% of the participants(n:25), malpractice was observed as the leading concern following the specialty. Furthermore, setting rules on duty hours and daily leave after duty as well as arranging working hours were the common opinion of assistant doctors with regard to the solution proposals to the working conditions. Additionally, issuing assistant report cards and boosting participation in conferences and scientific research activities were other prevailing opinions of the assistant doctors when it comes to reducing training problems.Discussion: It is striking that under the current circumstances, assistant gynecologists are discontent with strenuous working environment and inadequate training. The common proposed solution is to initiate standardization in all training agencies across Turkey.

SUMMARY Objective: To assess the working conditions and current challenges of the gynecology assistants in Turkey and to propose solutions within this context. Materials and methods: A survey on the problems of assistant doctors and the solution proposals they offered was executed with gynecology assistants who serve at the teaching, research and university hospitals in different regions of Turkey. Results: 60 gynecology assistants from 7 training institutions (university and teaching research hospitals) were included in the study. 75% of the participants (n:45) prefered gynecology as their first choice in the medical specialty exam. 51% of the survey participants(n:31)were satisfied with their existing conditions. The main problem was determined as severe working conditions by 43% of the participants. (n:26) Based on the answers of 42% of the participants(n:25), malpractice was observed as the leading concern following the specialty. Furthermore, setting rules on duty hours and daily leave after duty as well as arranging working hours were the common opinion of assistant doctors with regard to the solution proposals to the working conditions. Additionally, issuing assistant report cards and boosting participation in conferences and scientific research activities were other prevailing opinions of the assistant doctors when it comes to reducing training problems. Discussion: It is striking that under the current circumstances, assistant gynecologists are discontent with strenuous working environment and inadequate training. The common proposed solution is to initiate standardization in all training agencies across Turkey.

This report describes the case with a very early onset of cellulitis due to hematoma after the transobturator tape placement for stress urinary incontinence. A 35-year-old woman underwent a transobturator tape operation for stress urinary incontinence. Twelve hours after the operation, she complained of high fever and an erythematous and painful area in the medial region of her right thigh. White blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were elevated. Infection did not resolve despite piperacillin/tazobactam administration. Magnetic resonance imaging demonstrated an abscess formation in the adductor region of the thigh. The drainage of the abscess was performed. The symptoms of the patient resolved after the drainage. She was discharged 20 days after the operation. Although the transobturator midurethral sling operation is a minimally invasive surgical procedure, clinicians must be very careful about the rare but serious complications of the procedure. We recommend a very close follow-up of these patients in terms of bleeding from the obturator vasculature during the early postoperative period.

OBJECTIVE:The aim of the study was to investigate whether the clinical features and laboratory parameters affect maternal and fetal outcomes in pregnancies complicated with HELLP syndrome.MATERIAL AND METHODS:The medical records of pregnant patients complicated with HELLP syndrome were analyzed retrospectively between June 01, 2003 and June 01, 2010. The demographic data, medical history, admission symptoms, clinical and laboratory findings and recovery time were evaluated. The adverse maternal outcomes including eclampsia, placental abruption, disseminated intravascular coagulation, postpartum hemorrhage, pulmonary complications, cerebral edema and visual loss were recorded. Fetal growth restriction, necessity for neonatal intensive care unit admission and perinatal mortality were recorded as an adverse fetal outcome.RESULTS:The incidence of HELLP syndrome was 0.52%. The mean age of the patients was 28.93±7.90 (range 17-45). HELLP syndrome was diagnosed on average in the 33.68±4.41(th) (ranged 24-40) week of gestation. Eighteen cases (40.9%) were nullipara and twenty-six cases (59.1%) multipara. The most common complications were eclampsia (40.9%) and abruption placenta (15.9%). Pregnancy was terminated within 48 hours in all patients. The rate of cesarean section was 90.9%. Perinatal mortality rate in HELLP syndrome was 31.8%. There was no maternal mortality.CONCLUSION:Neither clinical characteristics nor laboratory parameters was found effective for prediction of adverse maternal and fetal outcomes.

Aim:In this paper we evaluated the relationship between the number of the removed lymph nodes and postoperative morbidity during the lymphadecetomy in the early stage endometrium cancer.Material and Method: Seventy-two patients with the diagnosis of stage I-II endometrium cancer underwent radical hysterectomy + pelvic and paraaortic lymphadenectomy in Izmir Atatürk Training and Research Hospital, Department of Gynecology and Obstetric, between 01.04.2002-31.04.2009.The clinical and the pathologic findings, immediate operative and postoperative records of the patients were reviewed.The mean follow-up time was fifty months. Findings:The analysis mainly focused on the comparison of the patients with 11 or fewer to more than 11 lymph nodes removed.The number of the patients who have had >11 nodes (Dissection group) removed and < 11 nodes (Sampling group) removed were more 37 (51,4%) and 35 (48,6%), respectively.There were no statistically significant differences between the groups in terms of recurrence and mortality.However, concomitant lymphatic dissection has resulted in longer anesthesia time and hospital stay, more blood loss as well as higher blood transfusion rates. Conclusion:Although the therapeutic efficacy of lymphatic dissection in the early stage endometrial cancer was the same with lymphatic sampling ,the incidence of morbidity was much less in the sampling group.

GirişGebelik ürününün, uterin kavitede endometrium dışında herhangi bir yere yerleşmesine dış gebelik veya ekstrauterin gebelik adı verilir.Dış gebeliğin tüm gebeliklerin %1.3 ile %2'sini oluşturduğu tahmin edilmektedir. [1][4] Abdominal gebeliklerde gestasyonel kese genellikle pelvise veya karaciğer ve mezenter gibi yüksek vasküler bölgelere implante olur. [4]Maternal morbidite ve mortalitenin önemli nedenlerindendir.Erken tanı ve tedavi ile potansiyel mortalite ciddi bir şekilde azaltılabilir. [5]Abdo-minal gebelik gelişmekte olan ülkelerde daha sık görülmektedir.Bunun primer nedeni bu ülkelerdeki artmış pelvik enflamatuvar hastalık prevalansıdır

OBJECTIVE We aimed to investigate the possible association between Helicobacter pylori infection and Hyperemesis gravidarum. MATERIAL AND METHODS Thirty-six pregnant women with Hyperemesis gravidarum with severe vomiting (more than 4 times a day), weight loss (≥3 kg), ketonuria and 36 pregnant women gestational age-matched, without nausea and vomiting attending our outpatient clinic for antenatal care were enrolled the study. Demographic data of the patients were registered. Blood samples for hemogram, serum electrolytes (sodium, potassium, chloride, and calcium), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), creatine, thyroid stimulating hormone (TSH), free T3-T4, total T3-T4, and urine samples for ketonuria, stool samples for HpSA were studied. The data of both groups were compared. RESULTS Eight Hyperemesis gravidarum patients (22.2%) and 1 control patient (2.8%) were established HpSA positive and it was statistically significant (p:0.037). There was no significant difference between Hyperemesis gravidarum and control subjects in terms of age, gestational week, parity, educational level, socioeconomic status and smoking. There was anemia in 5 Hyperemesis gravidarum patients, 4 of them were HpSA positive. HpSA positivity was more prevalent in Hyperemesis gravidarum patients with anemia (p=0.003). Severe vomiting (more than 4 times a day), heartburn, epigastric pain, duration of hospitalization (more than 4 days) and weight loss (≥5 kg) were not correlated to HpSA positivity. CONCLUSION The pregnant women with Hyperemesis gravidarum have a significantly higher prevalence of Helicobacter pylori compared with control subjects.