Background: The aim of this study was to investigate factors affecting the sex lives of middle-aged women, and whether surgical menopause affects sexual function differently from natural menopause, by comparing effects on sexual performance of women with similar demographic features. Material/Methods: The study included 151 women with surgical menopause (SM), 357 women with natural menopause (NM), and 186 perimenopausal women (PM). The women were asked to complete a 6-question survey of sexual performance parameters. The relationship between the demographic and clinical features and hormone levels of the groups and sexual function parameters were evaluated. We also compared these parameters between the 3 study groups, and paired comparisons were made between the SM group and the NM group. Results: Demographic features, serum DHEA-S, total testosterone, and FSH levels were found to have statistically significant effects on sexual performance of women (p<0.05). The sexual function scores for the frequency of sexual desire, coitus, and orgasm were significantly higher in the PM group, whereas vaginal lubrication scores were lower compared to the NM and SM group (p<0.05). In paired comparison of NM and SM, the scores for the frequency of coitus, orgasm, and vaginal lubrication were significantly higher in the SM group, while sexual desire frequency scores were higher in the NM group (p<0.05). Conclusions: Our study approached to this topic in an extended manner and found significant relationships between several demographic-clinical and hormonal factors. SM was found to not affect female sexual performance, except for sexual desire, more than NM.

Aims: Melatonin is the most powerful antioxidant and protects sperm, oocyte and embryo against oxidative stress. The effect of tryptophan, which is the building block of melatonin, on follicular melatonin levels and IVF outcomes is unknown. The objective of this study was to investigate the effect of tryptophan administration, a precursor for melatonin, on the levels of intrafollicular melatonin with the aim to reveal the correlation between tryptophan and the total number and quality of oocytes as well as clinical pregnancy rates. In addition, we aimed to examine the effect of melatonin increased by tryptophan on uterine and ovarian blood flow. Methods: Out of 103 patients who applied to Ondokuzmayis University IVF clinic for IVF treatment, 51 patients were administered a 100 mg dose of tryptophan orally (Group A) and 50 control patients who were randomly selected did not receive tryptophan (Group B). Firstly, follicular melatonin levels were compared between Group A receiving tryptophan and Group B without tryptophan. Both groups were also compared according to the oocyte count, oocyte count, fertilized oocyte count, embryo count and pregnancy rates, ultimately. In addition, all patients were measured for uterine and ovarian artery blood flow by vaginal ultrasound on the day of OPU.. Results: There were no differences in age (32.16 ± 3.82 years vs 33.06 ± 4.44 years) (p = 0.276), BMI (28.45 ± 2.82 kg/m)2 vs 28.15 ± 3.03kg/m2 (p = 0.602) and peak estradiol levels (2451.69 ± 469.75 pg/ml vs 2420.26 ± 443.71 pg / ml) (p = 0.73) between the groups. Group A exhibited high levels of melatonin in the follicular fluid with a mean value of 259.8 pg/ml, whereas Group B had 91.3 pg/ml (p <0.001). There were found significant differences in the oocyte count (9.08 ± 3.22 vs 7.66 ± 1.89) (p = 0,008), mature oocyte count (7.2 ± 2.8 vs 6.1 ± 1.8) (p = 0,021) and fertilized oocyte count (6.35 ± 2.44 vs 5.28 ± 1.69) between group A and group B. Pregnancy rates were higher in group A (35.3%). The pregnancy rate (30%) was lower in Group B, which did not receive tryptophan and had low melatonin levels in follicular fluid. However, there was no statistically significant difference. Uterine, ovarian artery systolic and diastolic blood flows of Group A were significantly lower than Group B (P <0.001). Conclusions: Administration of tryptophan to IVF patients significantly increases the level of melatonin in follicular fluid. The results demonstrate that high levels of melatonin in follicular fluid may increase oocyte count and quality although they do not significantly improve clinical pregnancy rates.

Objective Our objective was to investigate the most common anomalies in our region with a retrospective evaluation of the congenital anomaly cases, who applied to the outpatient department of perinatology Materials and Methods: We was reviewed file of congenital anomaly cases, who applied to the outpatient department of perinatology in the Medical Faculty at Ondokuz Mayıs University between May 2014 and May 2019,and to determine the risk factors related to these anomalies. Seven hundred twenty-five pregnant women, whose infants were diagnosed with congenital anomalies in our center, were included in the present study. Parameters like the mother's age, consanguineous parents, history of previous habitual abortions, history of siblings with anomalies, number of parity and abortus history, gestational week at diagnosis, smoking, alcohol and drug consumption in the first trimester, periconceptional folic acid use, co-morbidities, ultrasonographic findings, presence of the karyotype analysis, double and triple screening tests, termination decisions were compared with the anomaly types. Results: In our study, we determined the incidence of anomalies in our region with some limitations. Except for the central nervous system anomalies (most common anomaly group), the incidence ranking of the anomalies in our region was different from the rankings reported in other national studies The CVS anomalies were the second most common anomaly group. Conclusion: An education program prepared for the pregnant women in our region about the goal of the diagnostic and screening tests and routine pregnancy controls will increase the chance of early diagnosis. We believe that the conduction of region-based prenatal and postnatal studies instead of hospital-based studies will contribute more to a clear understanding of the anomaly incidences in our region.

Objective: In this study, our objective was to evaluate the abnormal collagen destruction and turnover and the prolidase activity in the etiopathogenesis of endometriosis, which may deteriorate the collagenous structure of exracellular matrix (ECM). Materials and Methods: For the assessment of the prolidase activity, venous blood samples were obtained from 37 patients, who had applied to the outpatient department of the Medical Faculty at Ondokuz Mayıs University with complaints of pelvic pain, dysmenorrhea and infertility between October 1st, 2011 and February 15th, 2012, underwent clinical and ultrasonographic examination, prediagnosed with endometriosis, and scheduled for laparoscopy or laparotomy. A total of 22 patients, who were diagnosed with endometriosis via intraoperative exploration and/or pathological examination, constituted the study group and the remaining 15 patients, who did not have any pathological finding or were diagnosed with a benign disease except for endometriosis, constituted the control group. Serum samples obtained from all patients were first centrifuged and then stored in a freezer at -70 C until the time of analysis. During the analysis, the prolidase activity was measured following the necessary biochemical enzymatic processing. Results: We found a statistically significant difference between stage 4 and stage 1,2,3 patients in the study group regarding the CA 125 levels (p=0.018). On the other hand, there was no statistically significant difference between stage 1,2,3 patients in the study group and the control group for serum prolidase levels (p=0.778). There was a statistically significant difference between stage 4 endometriosis patients in the study group and the control group considering the serum prolidase levels (p=0.026). Conclusion: We conclude that serum prolidase activity has a critical function in the development of the endometriotic lesions. In endometriosis patients, the increase in the serum prolidase activity may play an important role in the progress to more advanced stages and in the development of infertility.

Corresponding author / Sorumlu yazar: Pervin Karlı Address / Adres: Amasya Üniversitesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Amasya, Türkiye e-Mail: parpi2300@hotmail.com ⸺ Conflict of Interest: No conflict of interest was declared by the authors. Çıkar Çatışması: Yazarlar çıkar çatışması bildirmemişlerdir. ⸺ Financial Disclosure: The authors declared that this study has received no financial support. Finansal Destek: Yazarlar bu çalışma için finansal destek almadıklarını beyan etmişlerdir. ⸺ Published: 8/29/2019 Yayın Tarihi: 29.08.2019

Aim: Misdiagnosis is frequent in premature rupture of membranes (PROM) patients. The most accurate diagnosis of PROM requires reliable laboratory tests. Due to the lack of a gold-standard diagnostic method, many methods have been proposed in this regard. The aim of this study is to determine an easy diagnostic method in early membrane rupture and to determine the usability, reliability and cut-off values of vaginal creatinine measurements in the detection of PROM compared to vaginal placental alpha microglobulin-1 (PAMG-1) test.Methods: We designed a cross-sectional study. A total of 63 patients admitted to the Obstetrics and Gynecology Clinic of Samsun Ondokuz Mayıs University with suspected PROM between 15 November 2012 and 15 June 2013 were included in this study. Following anamnesis, all patients were vaginally subjected to PAMG-1 (AmniSure® ROM) test with sterile speculum and injected with 5 cc of saline into the vagina, and then, a 3 cc sample was retrieved with the same injector and put into a biochemistry tube. Immediately thereafter, the material was sent to the biochemistry laboratory, centrifuged and stored at -70 0C until all samples were studied. The patients were classified as PROM and non-PROM based on the positive or negative result of PAMG-1 test. Following this classification, the patients were also grouped as PROM and non-PROM according to their vaginal creatinine values.Results: The mean maternal age of our patients was 26.3 years in the PROM group and 28.8 years in the non-PROM group. The mean gestational weeks were 30.8 weeks in the PROM patients and 32.5 weeks in the non-PROM patients. Of 20 patients subjected to PAMG-1 test for PROM diagnosis, 17 were PAMG-1 and creatinine positive while 3 were PAMG-1 negative and creatinine positive. Of 43 patients subjected to PAMG-1 test, 42 were PAMG-1 negative while 1 was PAMG-1 positive and creatinine negative. Accordingly, vaginal creatinine was found to have 94.4% sensitivity, 93.3% specificity, 85% positive predictive value, and 97.7% negative predictive value in PROM diagnosis. The mean creatinine values in the PROM and non-PROM groups were 0.39 (0.31) mg/dl and 0.04 (0.10) mg/dl, respectively (p=0.05).Conclusion: Creatinine assessment in vaginal flushing fluid can be a cheaper, faster, easily accessible and highly accurate test with 94.4% sensitivity and 93.3% specificity in PROM diagnosis.

Pelvic organ prolapse and vaginal cuff prolapse are clinical conditions that affect women’s quality of life and require surgical treatment. In this study, we aimed to present apical vaginal prolapse and uterine descensus treatment with two new techniques. The classical sacrospinous ligament fixation technique fixes only one or two corners of the vaginal apex to the sacrospinous ligament, but it does not support the upper anterior and posterior vaginal fascia. Since it expands the upper part of the vagina with a suture put on the sides of the vaginal apex, it may not only expose the anterior and posterior vaginal walls to greater intraabdominal pressure and cause cystocele and enterocele development, but lead to sexual problems, as well. Apart from this, if sacrospinous colpopexy is performed to one side only, the vaginal apex is deviated towards the fixation, thus spoiling the vaginal anatomy. With our following methods, we imitate the physiological anatomy: Transapical circular Sacrospinous colpopexy (TACSAC) and Transcervical apical circular Sacrospinous uteropexy (TACSU). TACSAC: Bilateral side walls of the vaginal apex are marked with a color pencil 2 cm medially to the right and left ischial spine and 2 cm in length. Vaginal apex walls are bilaterally and vertically incised until the submucosa layer. Two submucosal tunnels are opened by using a right-angle clamp between the tips of two vertical incisions on the vaginal apex. The vaginal apex is fixed with a TOT mesh through these channels. In TACSU, the same procedure is followed for the cervix. These methods are more likely to mimic normal anatomy, easier to perform, and lower risk of complications.

Breast cancer is the most common malignancy of women at reproductive age. Nowadays, with increasing early diagnosis, survival rate is higher, which is why the number of patients wanting to get pregnant are on the rise. Fertility preservation, ovulation induction, the safety of these interventions and pregnancy results are discussed in this review.

Purpose To determine long-term outcome of infants with isolated or multiple soft markers but no structural or chromosomal abnormalities. Methods A retrospective study of 78 pregnant women who were referred for amniocentesis and found to have soft markers including echogenic intracardiac focus/foci (EIF), echogenic bowel (EB), unilateral or bilateral choroid plexus cysts, (UCPCs or BCPCs) mild pyelectasis and single umbilical artery but no structural anomalies and outcomes of the liveborns with a 4- to 9-year follow-up was conducted. Results Among 28 fetuses with EIF, allergic asthma and epilepsy were diagnosed in two liveborns. We followed up nine pregnancies with EB, epilepsy was present in one case. Allergic asthma was detected in both UCPCs and BCPCs, whereas epilepsy and attention-deficit/hyperactivity disorder (ADHD) were diagnosed in two liveborns with BCPCs. Twelve liveborns with multiple soft markers were evaluated; no pathology was detected in most of them except one case of allergic asthma, one case of hearing impairment and one case of ADHD. Conclusions This study shows longer-term favorable outcomes of the liveborns with isolated or multiple soft markers without any aneuploidy and may provide insight into this debated point.

The aim of this study was to evaluate the validity of platelet count (PC) and indices, including mean platelet volume (MPV), platelet distribution width (PDW) and platelet crit (PCT), in identifying the pregnancies at risk for preeclampsia. Demographic data and laboratory tests for PC, MPV, PDW and PCT of 250 pregnant women (100 normotensive pregnants, 121 pregnants with severe preeclampsia and 29 pregnants with mild preeclampsia) were retrospectively analyzed. Platelet counts and indices were compared between the study groups. MPV and PDW were significantly higher in preeclamptic pregnant women when compared to the normal group (p=0.006, p=0.046) and area under ROC curve for MPV was found statistically significant. PC, MPV and PCT were found significantly increased in late-onset preeclampsia (p<0.05) whereas there was no significant difference in these three indices in terms of severity of the disease. ROC analysis for MPV levels to differentiate earlyonset and late-onset preeclamptic cases was also found statistically significant. Measurement of MPV may contribute to identify the pregnants at risk for preeclampsia and assess the onset-time. PDW may be also useful in detection of the pregnant at risk for preeclampsia.

To evaluate the diagnostic value of HE4 for distinguishing malignant pelvic masses from benign ones.

OBJECTIVE: The aim of the study was to evaluate the effect of preventing development of postpartum infections by vaginal preparation with povidone iodine before cesarean delivery, with a retrospective file scanning. STUDY DESIGN: This study included 250 pregnant women undergoing cesarean delivery, who applied our clinic between the dates 2010-2011. All women received the standard antibiotic prophylaxis, 1 gr cefazolin iv before 30 minutes from the operation. Patients were investigated in two groups, vaginal cleansing with povidone iodine before cesarean delivery (126 case) or no cleansing (124 case), the groups compared with presence of postoperative fever endometritis and wound infection. RESULTS: Demographic characteristics of two groups were similar. There were no differences in age, height, weight, BMI, time of pregnancy, number of prior cesarean delivery, preoperative-postoperative time of staying in hospital, preoperative - postoperative hemoglobin values (p>0.05); there was only statistically significant difference in operating time (p 0.05). Comparing the two groups with postoperative wound infection, there is only one case in vaginal cleansing group and three cases in the other group. There is no statistically significant difference between the groups (p>0.05). Because of absence of endometritis in two, groups, we could not assess efficiency of vaginal cleansing in postpartum endometritis. No statistically significant difference was determined between the groups, in postoperative fever and postoperative wound infection (p>0.05). CONCLUSIONS: Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative fever and wound infection morbidities, although this is not statistically significant.

Aim: Our aim was to find out whether placement of the embryo transfer catheter guide through the cervical canal at the time of embryo expulsion influences pregnancy rates. Material and Method: We retrospectively compared in vitro fertilization (IVF) outcomes related to the placement of the embryo transfer catheter guide through the cervix. Subjects were divided into two groups: embryo transfers (ET) performed with the inner catheter alone through the cervical canal (n= 55, Group 1) and transfers performed with the double catheter set through the cervix (n= 58, Group 2). Results: A total of 113 ETs were carried out in women undergoing IVF treatment. Although the pregnancy ratio seemed to be higher among the transfers carried out with the inner catheter alone inserted through the cervix, no statistically significance for this was detected (odds ratio: 1.644, 95% confidence bound, p> 0.05). Discussion: Placement of the catheter guide through the cervical canal at the time of embryo expulsion may not have any effect on the IVF-ET outcome.

OBJECTIVE: The present study was aimed to determine the effects of preeclampsia severity and thrombocytopenia on maternal and fetal prognosis in hypertensive pregnant women, and to discuss the clinical and biochemical findings in light of the literature. STUDY DESIGN: Three hundred and one pregnant patients, who had been admitted to the Department of Obstetrics and Gynecology of our clinic, with the diagnosis of preeclampsia between October 2006 and October 2008, were retrospectively evaluated. The patients were divided into two groups as patients with mild and severe preeclampsia. Additionally, the patients were analyzed in two subgroups according to their platelet counts, as the groups with low and normal platelet counts. RESULTS: When the patients with mild and severe preeclampsia were compared with regard to maternal complications, no significant difference was determined between the two groups (p>0.05). However, a significant difference was noted between the groups with respect to the development of eclampsia and HELLP syndrome (p<0.05). Eclampsia (n=17; 12%) and HELLP syndrome (n=30; 21.1%) were more common in the patients with severe preeclampsia. On the other hand, no significant difference was noted between the two groups in terms of fetal outcomes (p>0.05). When the patients with low and the normal platelet counts were compared with respect to maternal complications, it was noted that HELLP syndrome (n=39; 51%) and eclampsia (n=11; 14.5%) were more common in patients with low platelet counts, when compared to the patients with normal platelet counts,and difference between the two groups was significant (p<0.05). Birth weight was significantly lower in patients with low platelet counts (p<0.05). CONCLUSIONS: There is a significant relationship between the severity of preeclampsia and potential complications. The risk for the development of HELLP syndrome and eclampsia increases in patients with severe preeclampsia. Furthermore, the risk for the development of complications increases with a decreased platelet count.

INTRODUCTION:Hysterectomy is the most common major gynecologic operation, together with bilateral salpingo-oophorectomy in the majority of women over the age of 45. AIM:To investigate whether surgical menopause affects female sexual performance differently from natural menopause. METHODS:The study included 121 women who had undergone surgical menopause and 122 women who had undergone natural menopause. All the women had similar economic, sociocultural, and personal demographic profiles, had been postmenopausal for at least 1 year, and were between the ages of 45 and 65. The women were asked to complete a six-question survey of sexual performance parameters (sexual desire, coital frequency, arousal, orgasm frequency, dyspareunia, and vaginal lubrication). These sexual performance parameters were compared between the surgical and natural menopause groups. RESULTS:With the exception of vaginal lubrication, sexual performance parameters were not statistically different between the two groups (P > 0.05). Vaginal lubrication in the surgically menopausal group was lower than in the naturally menopausal group (P < 0.05). Serum dehydroepiandrosterone sulphate, prolactin, and thyrotropin levels were not statistically different between the groups (P > 0.05), whereas serum estradiol and total testosterone levels in the surgically menopausal group were lower than those of the naturally menopausal group (P < 0.05). CONCLUSION:The results of this study showed that surgical menopause did not affect female sexual performance differently from natural menopause, with the exception of vaginal lubrication.

OBJECTIVE:The aim of this study was to compare perinatal outcomes between adolescent and adult pregnancies.MATERIAL AND METHODS:In 527 adolescent and 1334 adult pregnant women who delivered at Ondokuz Mayis University Obstetrics and Gynecology Department between 2006 and 2013, perinatal outcomes were retrospectively compared in terms of including spontaneous abortion, induced abortion rate, dilatation and curettage (D&C), pregnancy-induced hypertension, premature prelabor and prelabor rupture of membranes, polihydramnios, oligohydramnios, maternal anemia, delivery modes and also neonatal outcomes including 5th minute Apgar score and fetal birth weight.RESULTS:The ratio of pregnancy induced hypertension and postpartum hemorrhage was higher in adults, but, anemia was more common in adolescents. There was statistically significant difference in the mode of delivery; the ratio of cesarean section was higher in adults whereas the rate of induced abortions and D&C significantly increased in adolescents. Low birth weight (LBW) and extremely LBW rates were significantly higher in adolescents, however, 5th minute Apgar scores were found to be higher than adult group.CONCLUSION:These results show that the perinatal care is fairly improved in Turkey.

Aim The aim of this study was to investigate the effect of vitamin C on the growth of experimental endometriotic cysts. Material and Methods The endometrium of the uterine horn wall (diameter, 4mm) was implanted onto the inner surface of the anterior abdominal wall of 40 Wistar albino adult female rats, by laparotomy. The day after the implantation, the rats were randomly assigned into four groups (control group and experimental groups [V1, V2, and V3]) comprising 10 rats each. For 6 weeks, the control group (Group C) received 1mL distilled water, whereas the experimental groups (Groups V1, V2, and V3) received 0.5mg, 1.25mg, and 2.5mg of vitamin C in 1mL of distilled water, respectively. The doses were given via oral gavage once per day. At the end of the administration, a second laparotomy was performed and endometriotic cyst volumes and weights of rats among the groups were compared. In addition, the stromal and glandular tissue and the natural killer cell contents of the cysts were compared among the groups. Results The cyst volume in Group V3 and the cyst weights in Groups V2 and V3 were significantly lower than those in Group C. The natural killer cell content in Groups V1, V2, and V3 was significantly lower than that in Group C. Stromal and glandular tissue contents of the groups were not significantly different. Conclusions The dose-dependent vitamin C supplementation significantly reduced the volumes and weights of the endometriotic cysts.