Ali Irfan Guzel

Emergency Peripartum Hysterectomy: 16-year Experience of a Medical Hospital

Background: We conducted this retrospective study to evaluate the outcomes and indications of emergency peripartum hysterectomy (EPH) as a life‐saving procedure. Methods: We analyzed a series of 140 cases of EPH, between January 1993 and December 2008 in our clinic, retrospectively. The data were collected from the patients files. The incidence, demographic characteristics, risk factors, indications and outcomes of hysterectomy, peripartum complications, the operation types, maternal morbidity and mortality and fetal mortality were evaluated. Results: A total of 26,015 of women were delivered. The incidence of EPH was 5.38 per 1,000 deliveries. The mean age was 34.19 ± 6.04 years (range, 21‐49 years), gravidity was 6.84 ± 3.38 (1‐17) and parity was 5.58 ± 3.04 (0‐15). Of the 140 cases, 90 were delivered by cesarean section [29 (20.71%) of these had had a previous cesarean section] and 50 were vaginally delivered. One hundred and five cases had subtotal hysterectomy and 35 had total abdominal hysterectomy. The most common indications for EPH were uterine atony followed by uterine rupture and abnormal placentation. Mean operation time was 142.23 ± 43.70 minutes. The average blood transfusion was 4.79 ± 3.36 (1‐14) units. Relaparotomy was performed in 23 cases. Maternal mortality was seen in 13 cases. Seventy‐nine of the cases delivered at an outside center and were referred to our clinic for the intensive care unit. Sixty‐one of the cases delivered at our clinic and 31 had stillbirths. Conclusion: This study suggests that the most common indications for EPH are uterine atony, uterine rupture and abnormal placentation. This is probably due to the advanced age of pregnancies and multiparity in our region. Therefore, we believe that the risk of EPH may be decreased with appropriate and closer prenatal care as well as education of the pregnant women.

Vaginal douching practice and related symptoms in a rural area of Turkey

PurposeTo investigate vaginal douching habits and associated factors among women living in rural Turkey.MethodsThis study was performed in the gynecology department of a government hospital in a rural area of Turkey, from February to March 2010. The study included 393 women admitted to the gynecology clinic. The age, marital status, education, socioeconomic status, reason for vaginal douching, douching frequency, symptoms, and previous treatments were investigated. All of the subjects were asked about the use of, frequency, and reason for vaginal douching. Significant risk factors in the vaginal douching group and odds coefficients were found using binary logistic regression.ResultsThe major symptoms of the subjects were itching and vaginal discharge. Of the 393 women, 317 (80.66%) performed vaginal douching and all of them had recurrent or treatment-resistant mixed agent vulvovaginitis. The majority of the women douched for ritual cleansing or washing before prayer (nxa0=xa0278; 91.6%). The majority of the cases (nxa0=xa0354; 90.1%) were of lower socioeconomic and educational status. The odds ratios and 95% confidence interval (CI) of the risk variables vaginal douching frequency, cervical motion tenderness, dyspareunia, and vaginal itching were 9.39 (2.07–42.48), 7.31 (2.08–25.64), 6.52 (2.26–18.78), and 1.46 (1.22–1.74), respectively.ConclusionsIn our region, vaginal douching is a common practice among women, especially those of lower socioeconomic and educational status. Clinicians should inform patients about the risks of vaginal douching to minimize the risks associated with this behavior.

Factors affecting the degree of hirsutism in patients with polycystic ovary syndrome.

PurposeTo investigate the clinical features of patients with polycystic ovary syndrome (PCOS) and compare the patients with hirsutism to those without.MethodsIn total, 304 consecutive females with PCOS were evaluated. The cases were divided into two groups of hirsute or non-hirsute. The risk factors recorded were age, age at menarche, body mass index (BMI), luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, and total testosterone (tT) levels and hirsutism scores. Statistical analyses were performed using the Student’s t test and logistic regression.ResultsOf all the cases, 224 were hirsute (hirsutism score ≥8). No significant difference was observed between the groups for age or age at menarche. BMI and hormone levels, including LH, FSH, estradiol and tT, were higher in hirsute patients than those in non-hirsute patients (pxa0<xa00.05). The logistic regression model showed that BMI, tT, LH, and estradiol were significant risk factors with odds ratios and 95% confidence intervals of 5.81 (2.22–15.18), 4.57 (2.34–8.90), 2.61 (1.73–3.94), and 2.29 (1.30–4.05), respectively.ConclusionsHirsute patients with PCOS have different clinical characteristics from those that are non-hirsute in terms of BMI, LH, FSH, estradiol, and tT levels. We also determined the odds ratios of these different parameters. BMI was the most important risk factor for the degree of hirsutism.

Polycystic Ovary Syndrome and Risk of Endometrial Cancer: a Mini-Review

The polycystic ovary syndrome is the most common endocrinological disorder of reproductive age women with a prevalence of 5 to 8 %. The most common diagnostic criteria used for polycystic ovary syndrome are oligo- or an-ovulation, clinical and/ or biochemical signs of hyperandrogenism and polycystic ovaries. Hyperandrogenism results in increased estrogen levels and lack of cyclic progesterone due to anovulation and persistent stimulation of the endometrium may lead to endometrial hyperplasia or adenocarcinoma development. In this mini review, we aimed to evaluate the possible relationship between polycystic ovary syndrome and endometrial cancer.

Maternal serum vitamin D levels in pregnancies complicated by neural tube defects.

Abstract Objective: The association between vitamin D deficiency and abnormal neural development has been proposed previously. We aimed to evaluate maternal serum vitamin D levels in pregnancies complicated by neural tube defects (NTDs) and compared them with healthy pregnant women. Methods: A total of 60 pregnant women were included in this controlled cross-sectional study. Thirty of the patients whose pregnancies were complicated by meningocele, meningomyelocele, encephalocele, anencephaly and fetal acrania constituted the study group, whereas 30 normal pregnant women constituted the control group. The main parameters recorded for each woman were as follows: age, body mass index (BMI), gestational week (GW), gravidity, abortion, co-morbidities, dressing style, consumption of milk and dairy products and serum levels of 25(OH)VitD3, calcium, albumin and total protein. Results: The mean maternal serum 25(OH)VitD3 level was 6.2u2009±u20095.0u2009ng/ml in the study group and 9.1u2009±u20097.3u2009ng/ml in the control group (p: 0.071). The mean maternal serum calcium level was statistically significantly higher in the control group, and calcium-rich dietary intake was also more common in this group (pu2009<u20090.05). There was no statistically significant difference between groups in terms of age, BMI, GW, dressing style and serum levels of albumin and total protein. Conclusions: Vitamin D deficiency is common among pregnant women, and maternal serum calcium levels were lower in pregnancies complicated by NTD than healthy pregnant women. Larger further studies are required to evaluate the effects of calcium-rich dietary sources or vitamin D and calcium in the development of NTDs.

May maternal anti-mullerian hormone levels predict adverse maternal and perinatal outcomes in preeclampsia?

Abstract Background: Prediction of preeclampsia and adverse maternal and perinatal outcomes with biomarkers has been proposed previously. Anti-mullerian hormone (AMH) is a growth factor, which is primarily responsible of the regression of the mullerian duct, but also used to predict ovarian reserve and decreases with age similar to the fertility. Aim: To evaluate the predictive role of maternal anti-mullerian hormone (mAMH) in adverse maternal and perinatal outcomes in preeclampsia. Methods: This prospective case-control study was conducted at current high-risk pregnancy department in a tertiary research hospital and 45 cases with preeclampsia classified as study group and 42 as control group. Data collected and evaluated were; age, body mass index (BMI), marriage duration (MD), gestational weeks (GW), gravidity, parity, mode of delivery, birth weight, newborn Apgar score, newborn gender, maternal complication, perinatal outcome, some laboratory parameters and mAMH. The association between mAMH levels and maternal and fetal outcomes were evaluated. Results: There were no statistically significant differences between groups in terms of age, BMI, MD, gravidity, parity and newborn gender (pu2009>u20090.05). GW, vaginal delivery, birth weight, newborn Apgar score, were statistically significantly lower in preeclamptic patients when compared with non-preeclamptic patients (pu2009<u20090.001). Adverse maternal and perinatal outcomes were statistically significantly higher in the study group (pu2009<u20090.001). The laboratory values [alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen (BUN), creatinine, lactic dehydrogenase (LDH), uric acid and fibrinogen) were statistically significantly lower in the control group (pu2009<u20090.001). The mAMH level was significantly lower in the preeclamptic group (p: 0.035). There was no correlation between mAMH levels and demographic and clinical parameters. The area under the ROC curve (AUC) was 0.590 and the cut-off value was 0.365u2009ng/ml with sensitivity of 67.4% and specificity of 47.1% for mAMH. Logistic regression analysis showed a statistically insignificance between mAMH and maternal complication and perinatal outcome (p: 0.149). Conclusion: According to this study, mAMH level was lower in preeclamptic patients than in normal pregnants, and is found to be a discriminative factor with low sensitivity and specificity. There was no relationship between mAMH and adverse maternal and perinatal outcomes. Further randomized controlled studies with more participants are needed to evaluate the accurate effects of mAMH levels on preeclampsia and should increase the power of mAMH levels in predicting the preeclampsia.

Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome

PurposeWe designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.MethodsIn this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (χ2) test with Yates’ correction, the Student’s t test, logarithmic transformation, and the logistic regression method.ResultsNinety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (Pxa0=xa00.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1xa0≤xa03 and Apgar score 5xa0≤xa05) were found to be at significant risk for perinatal mortality (Pxa0<xa00.001). The odds ratios (95% CI) were 3.0 (2–5), 3.42 (1.82–6.41), 0.62 (0.44–0.86) and 4.66 (2.04–10.63), respectively.ConclusionsMaternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.

Evaluation of maternal and perinatal outcomes among overweight women who experienced stillbirth

Abstract Objective: To investigate associations between overweight and adverse clinical outcomes among women who experienced stillbirth. Methods: 234 pregnant women (stillbirth group, nu2009=u2009115; live birth group, nu2009=u2009119) were included in this retrospective case-control study. Recorded risk factors were age, gravidity, parity, gestational weeks, fetal birth weight, gestational diabetes mellitus (GDM), preeclampsia (PE), intrauterine growth restriction (IUGR), levels of prenatal test markers (alpha-fetoprotein (AFP), pregnancy-associated plasma protein, human chorionic gonadotropin (β-hCG) and E3) and body mass index (BMI). Results: Statistically significant differences were observed between the groups in terms of birth weight, IUGR, GDM, PE, AFP level, β-hCG level, maternal E3 level and BMI (pu2009<u20090.05). Subgroup analyses revealed that 34 and 81 patients in the stillbirth group were of normal weight and overweight, respectively, fetal birth weight, IUGR, GDM, PE, AFP level, β-hCG level and E3 level differed significantly between these subgroups and the live birth group (pu2009<u20090.05). Conclusions: Women who experience stillbirth tend to be more overweight than those who experience live birth. Additionally, IUGR, GDM and PE are more common among overweight women. Therefore, overweight women should be encouraged to lose weight before pregnancy. If they become pregnant without losing weight, they should be followed up closely to avoid adverse perinatal outcomes.

Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy

Background This study aimed to evaluate the association between complications and clinical parameters with obesity in 273 women who have undergone abdominal myomectomy during the study period. Methods The patients were classified into two groups according to body mass index (BMI) (≤30 kg/m2 and >30 kg/m2). Demographic, preoperative and postoperative clinical parameters were evaluated. Results Demographic, preoperative and postoperative clinical parameters were evaluated. The results showed statistically significant differences between the obese and non‐obese groups in terms of age, gravidity, diameter of fibroid (DOF), postoperative hemoglobin, duration of hospital stay, and complications. Patients in the obese group had greater DOF and complications such as hemorrhage, postoperative fever, wound infection and ileus (p < 0.05). Conclusion Based on our results, we conclude that obesity adversely affects the clinical outcomes of patients who undergo abdominal myomectomy.

Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess

This study assessed the risk factors for poor clinical outcomes in patients with tubo-ovarian abscess (TOA). Patients managed with medical therapy and discharged within 7 days without complications constituted the favourable prognosis group (n = 22), whereas those who were managed surgically or discharged after 7 days of antibiotic therapy constituted the poor prognosis group (n = 87). Variables including age, gravidity, number of dilation and curettage procedures, caesarean delivery, smoking status, serum C-reactive protein levels, serum white blood count, body temperature, abscess diameter, presence of an intrauterine device (IUD), duration of IUD placement and length of hospitalisation were evaluated to assess their relationship with the clinical prognosis of TOA. Abscess diameter of ≥ 6 cm was a significant parameter that increased the risk eightfold for poor prognosis. No significant differences were observed regarding the other variables.