Ahmet Uysal

Cesarean Scar Pregnancy Diagnosis, Management, and Follow-up

Cesarean scar pregnancy is a very rare form of pregnancy and a life‐threatening situation. It has become an important and serious problem over the last 10 years, as a result of the worldwide increase in cesarean births. In this retrospective series, the diagnosis of cesarean scar pregnancy, management, treatment methods, risk factors, and possibility of subsequent normal pregnancy are discussed, and case descriptions are presented.

Emergency cervical cerclage: effect on pregnancy outcome and mode of delivery

Abstract Aim: To evaluate the effectiveness of emergency cervical cerclage (ECC) and its effect on the mode of delivery. Patients and methods: Between April 2007 and July 2011 patients attending MH Diyarbakir Obstetrics and Gynecology Hospital and MH Seferihisar State Necat Hepkon Hospital who underwent ECC were included in this retrospective analysis. Results: At the time of ECC, the mean gestational age, cervical length and cervical dilatation were 21.4 ± 2.2 weeks, 4.3 ± 0.8 cm and 11 ± 2.4 mm, respectively. The average time between the procedure and birth was 13.8 ± 4.9 weeks and this period was sufficient to maintain a viable pregnancy (p < 0.05). In this study, 12 patients (60%) were delivered vaginally and eight (40%) patients delivered with CS (40%). the difference was statistically insignificant (p = 0.371). Regarding the gestational age at time of delivery, 55% of patients delivered at 36 weeks, 70% at 32 weeks, and 80% of them delivered at 28 weeks. The total live birth rate was 90%. Conclusion: ECC provides satisfactory time for the fetus to gain sufficient viability. Pregnancies with emergency cerclage show no difference in terms of birth method, whether cesarean or vaginal birth, and delivery type does not appears to be linked to ECC.

The protective effect of quercetin on IMA levels and apoptosis in experimental ovarian ischemia-reperfusion injury.

OBJECTIVE To investigate the protective effect of quercetin (QE), an anti-inflammatory and anti-oxidant agent, on torsion-detorsion induced histopathological changes and blood IMA levels in experimental ovarian ischemia-reperfusion (IR) injury. STUDY DESIGN Twenty-four female Wistar rats were randomly divided into four groups in this study (n=6). Group I, (sham operation); Group II, torsion-detorsion plus saline (IR); Group III, torsion-detorsion plus solvent (dimethylsulfoxide: DMSO, IR+DMSO); Group IV, torsion-detorsion plus 15 mg/kg/bw quercetin (IR+QE) injected intraperitoneally 30 min prior to detorsion. After 3h of reperfusion, the right ovaries were removed surgically. The ovary tissue samples were fixed in 10% formalin solution for histopathological and immunohistochemical examination. Blood samples were obtained at the end of the procedures for each group of animals. RESULTS Ovarian sections in Groups II and III showed higher follicular cell degeneration, hemorrhage, vascular congestion and edema when compared with Group I. Administration of quercetin in rats significantly prevented degenerative changes in the ovary. Significantly less histopathological changes were found in Group IV compared with Groups II and III. Caspase-3 and TUNEL positive cells were detected in the ovarian surface, follicle epithelium, and stromal cells in all experimental groups, and there was a significant increase in Groups II and III compared with Group I (P<0.05). Treatment with quercetin decreased the number of caspase-3 and TUNEL positive cells. IR increased the ischemia modified albumin (IMA) levels in comparison to the sham group (1.06 ± 0.10 ABSU and 0.92 ± 0.08 ABSU, P<0.05). Quercetin administration before IR reduced the levels of IMA (0.93 ± 0.08 ABSU, P<0.05). CONCLUSION Administration of quercetin is effective in preventing tissue damage induced by IR injury in ovaries.

Acne severity and the Global Acne Grading System in polycystic ovary syndrome

To evaluate the association between acne, quantified by the Global Acne Grading System (GAGS), and abnormal clinical and laboratory markers of androgen excess in patients with polycystic ovary syndrome (PCOS).

Prevalence of congenital toxoplasmosis among a series of Turkish women

BACKGROUND Toxoplasma gondii infection during pregnancy causes congenital malformations. Pregnant women should be screened for this infection since it is preventable and treatable. AIM To study the sero prevalence of Toxoplasma gondii infection among pregnant women living in lzmir, Turkey. MATERIAL AND METHODS A blood sample was obtained from 4651 women aged between 15 and 45 years, during their first trimester of pregnancy. IgM and IgG antibodies against Toxoplasma gondii were measured using an ELISA assay. Among women with both IgG and IgM antibodies positive, an IgG avidity test was performed, using a VIDAS kit. RESULTS IgG antibodies were positive in 1871 (39.9%) participants. Of these, 48 (2.5%) also had positive IgM antibodies. In 41 of these 48 women, the IgG avidity test was performed and only one woman had a low avidity. This woman was treated with Spiramycin. Her offspring had an intrauterine growth retardation and oligohydramnios. A chorioretinitis was diagnosed in the offspring of other woman with both antibodies positive. CONCLUSIONS In this series, the prevalence of congenital toxoplasmosis was low. However, women with positive antibodies against Toxoplasma Gondii should be further studied and followed during their pregnancy.

The Usage of 2 and 3-Dimensionel Ultrasound in Prenatal Diagnosis of Sacrococcygeal Teratoma: Report of a Case

DOI: 10.4328/JCAM.2055 Received: 17.09.2013 Accepted: 01.10.2013 Printed: 01.10.2013 J Clin Anal Med 2013;4(suppl 2): 123-5 Corresponding Author: Ahmet Uysal, Çanakkale Onsekiz Mart Üniversitesi, Kadın Hastalıkları ve Doğum ABD, Çanakkale, Türkiye. T.: +905332635540 E-Mail: drahmetuysal@hotmail.com Özet Sakrokoksigeal teratom 1:40.000 canlı doğum prevalansı ile tüm fetal tümörlerin yarısını oluşturmaktadır. Sıklıkla benign davranışlı olmasına rağmen, kalp yetmezliği ve hidropsa neden olması mortalite ve morbidite oranını yükseltmektedir. Kötü prognoza neden olan faktörler kitlenin solid komponentinin fazla olması ve 30 haftadan önce hidrops gelişmesidir. Prenatal dönemde B mod, renkli Doppler ultrasonografi ve üç boyutlu ultrasonografi (3B US) ile lezyonun karakterizasyonu yapılabilmektedir. 27 yaşında G2P1 gebeye yapılan obstetrik ultrasonografik değerlendirmede, biometrik ölçümlere göre 18. haftalık kız fetusta, sakrokoksigeal bölgede, 22x23 mm boyutlarında, düzgün sınırlı, heterojen ekojen içyapıda kitlesel lezyon saptandı. Ailenin gebeliğin devamını istemi ile gebelik terme kadar yakın takip edildi. Tümörün ani hızlı büyümesi nedeniyle, fetal hidrops veya plasentomegali gibi komplikasyonlar gelişmemişken gebeliğin 36. haftasında sezaryen ile komplikasyonsuz olarak doğum gerçekleştirildi. Operasyon sonucu histopatolojik değerlendirmede sakrokoksigeal bölgedeki kitlesel lezyon immatür teratom olarak raporlandı.

Sleep disturbance among women with chronic pelvic pain

To investigate the effect of chronic pelvic pain (CPP), a debilitating condition, on sleep quality.

Predictive value of striae gravidarum severity for intraperitoneal adhesions or uterine scar healing in patients with previous caesarean delivery

Abstract Objective: Previous abdominal operations might cause severe intraperitoneal adhesions (IPA), which can complicate caesarean section (CS) procedures. When selecting the mode and timing of delivery, obstetricians are also curious about uterine scar healing if the previous operation was a CS. Uterine scar thickness is an indicator of uterine scar healing. We aimed to evaluate the possible predictive value of striae gravidarum (SG) on IPA formation and uterine scar thickness (UST). Methods: Fifty-five women with a previous CS history were evaluated for SG Davey Score. They were investigated for IPAs and lower segment uterine scar thickness during the current CS operation. Results: Out of the patients with no SG (n = 11), mild SG (n = 10) and severe SG (n = 34), 1 (9.1%), 3 (30%) and 17 (50%) had IPA, respectively (p = 0.044). The mean uterine scar thicknesses in the no SG, mild SG and severe SG groups were 3.82 ± 4.04, 5.20 ± 4.13 and 5.18 ± 3.52, respectively (p = 0.561). Conclusions: To the best of our knowledge, this was the first study to investigate the relationship between SG and IPA and uterine scar thickness. The SG status of a patient with a previous delivery and abdominal operation history might help predict IPA status before planning a new operation.

atrial electromechanical coupling intervals in pregnant subjects

Summary Objective The aim of this study was to evaluate atrial conduction abnormalities obtained by tissue Doppler imaging (TDI) and electrocardiogram analysis in pregnant subjects. Methods A total of 30 pregnant subjects (28 ± 4 years) and 30 controls (28 ± 3 years) were included. Systolic and diastolic left ventricular (LV) function was measured using conventional echocardiography and TDI. Inter-atrial, intra-atrial and intra-left atrial electromechanical coupling (PA) intervals were measured with TDI. P-wave dispersion (PD) was calculated from a 12-lead electrocardiogram. Results Atrial electromechanical coupling at the septal and left lateral mitral annulus (PA septal, PA lateral) was significantly prolonged in pregnant subjects (62.1 ± 2.7 vs 55.3 ± 3.2 ms, p < 0.001; 45.7 ± 2.5 vs 43.1 ± 2.7 ms, p < 0.001, respectively). Inter-atrial (PA lateral – PA tricuspid), intra-atrial (PA septum – PA tricuspid) and intra-left atrial (PA lateral – PA septum) electromechanical coupling intervals, maximum P-wave (Pmax) duration and PD were significantly longer in the pregnant subjects (26.4 ± 4.0 vs 20.2 ± 3.6 ms, p < 0.001; 10.0 ± 2.0 vs 8.0 ± 2.6 ms, p = 0.002; 16.4 ± 3.3 vs 12.2 ± 3.0 ms, p < 0.001; 103.1 ± 5.4 vs 96.8 ± 7.4 ms, p < 0.001; 50.7 ± 6.8 vs 41.6 ± 5.5 ms, p < 0.001, respectively). We found a significant positive correlation between inter-atrial and intra-left atrial electromechanical coupling intervals and Pmax (r = 0.282, p = 0.029, r = 0.378, p = 0.003, respectively). Conclusion This study showed that atrial electromechanical coupling intervals and PD, which are predictors of AF, were longer in pregnant subjects and this may cause an increased risk of AF in pregnancy.

Evaluation of tissue Doppler-derived myocardial performance index in fetuses with intracardiac echogenic focus

Abstract Objective: To compare cardiac function between fetuses with and without intracardiac echogenic foci (IEFs) by conventional echocardiography and tissue Doppler (TD) imaging. Methods: Fetuses having IEF and no additional cardiac or extracardiac anomaly between 20 and 28 weeks (median 22 weeks) of gestation (n = 61) were compared with healthy fetuses between 18 and 29 weeks (median 23 weeks) of gestation (n = 55). Pulmonary artery and aortic peak velocities, atrioventricular (AV) early diastole (E) and atrial contraction (A) velocities and E/A ratios were measured. TD-derived myocardial performance index (MPI) was also measured. Results: Tricuspid valve E/A ratios, which were 0.634 ± 0.07 versus 0.639 ± 0.06 (p = 0.697), mitral valve E/A ratios, which were 0.604 ± 0.08 versus 0.612 ± 0.07 (p = 0.600), aorta peak velocities, which were 0.709 ± 0.11 versus 0.697 ± 0.11 (p = 0.592) and pulmonary artery peak velocities, which were 0.699 ± 0.12 versus 0.694 ± 0.11 (p = 0.800) in the study and the control groups, respectively. TD-derived measurements in the study and control groups included tricuspid valve MPI, which were 0.452 ± 0.08 versus 0.473 ± 0.09 (p = 0.221) and mitral valve MPI values, which were 0.444 ± 0.1 versus 0.445 ± 0.09 (p = 0.965), respectively, and this difference was not statistically significant. Conclusion: An isolated IEF is not associated with abnormal cardiac function. We suggest that the presence of an isolated IEF should not be an indication for fetal cardiac function examination either with conventional Doppler or TD imaging techniques, unless there is a coexisting cardiac or extracardiac anomaly.