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Mikro Besin Takviyesinin Maternal ve Fetal Sonuçlara Etkisi: D vitamini, Kalsiyum ve Magnezyum

Giris Fetal ve maternal sagliga olumlu etkileri olmasi nedeniyle gebelik doneminde artan ihtiyacla orantili olarak vitamin ve mineral destegine ihtiyac vardir. Bu calismada mikro besin takviyesi olarak D vitamini, Kalsiyum (Ca) ve Magnezyum (Mg) destegi alan gebelerin postnatal sonuclarini ve gebelik komplikasyonlarini arastirmak amaclandi. Materyal ve Metod Yapilan bu prospektif, longitudinal ve kalitatif calismaya Ocak 2016 ve Ocak 2018 tarihleri arasinda 18-40 yas arasi toplam 2114 hasta dahil edilmistir Bulgular Maternal yas araligi tum hasta gruplari icin 28.11 ± 6.12‘ dir. Multivitamin kullanan grubun yas ortalamasi D vitamini grubuna gore daha dusuk saptandi(p= 0.001). Yalnizca Mg ve D vitamini kullanan grupta yuksek lisans seviyesinde egitim gorenler daha fazlaydi( p =0.001). Mg, Ca, D vitamini ve multivitamin kullananimi ile gebelik komplikasyonlari arasinda anlamli iliski bulunamadi. Multivitamin kullanan gebelerde LGA daha fazla goruldu (p=0.038). Ilk gebelik yasi Ca ve mulivitamin kullanan grupta Mg ve D vitamini kullanan gruba gore daha dusuk bulunmustur ( p =0.001). Sonuc Annenin saglikli bir gebelik gecirmesi, maternal komplikasyonlardan korunmasi, fetusun buyume ve gelismesi icin annenin duzenli beslenmesinin yani sira vitamin ve mineral takviyesi onemlidir. Bu takviyelerin literaturde gosterilmis olan yararlarini desteklemek ve rutin kullanimda yer vermek icin daha cok prospektif calismaya ihtiyac vardir.

Relationship between adnexal mass and endometrial thickness in postmenopausal period

Endometrial cancer is the most common gynecological cancer. Increased postmenopausal endometrial thickness may be an indicator of endometrial cancer. Transvaginal ultrasound (TV-USG) is the primary imaging method for evaluating endometrial thickness in the postmenopausal period. The aim was to employ transvaginal ultrasonography in the evaluation of adnexal masses synchronously seen in postmenopausal women with increased endometrial thickness. The work was designed as a retrospective study. The medical records of 155 patients evaluated for increased postmenopausal endometrial thickness were examined. Ultrasonography had been performed on the women in the study for routine follow-up, postmenopausal hemorrhage, pelvic pain, pelvic mass on examination and family history of gynecological cancer. All patients had undergone endometrial evaluation with fractional dilatation and curettage (D & C) or pipelle endometrial sampling. Histopathological diagnosis was based on endometrial sampling results. Adnexal mass was present simultaneously in 17.4% (n = 27) of the women included in the study, while 82.6% (n = 128) had no gynecological pathology other than increased endometrial thickness. The endometrial thickness in the women with postmenopausal adnexal masses was greater than in those without adnexal mass (11.7 mm vs. 7.8 mm, p = 0.009). Non-atypical and atypical endometrial hyperplasia was more frequent in the group with postmenopausal adnexal mass (11.1% vs. 2.8%, 11.1% vs. 3.79, p = 0.03, p = 0.04, respectively). Final histopathological evaluation of patients operated on for adnexal masses revealed tubo-ovarian abscess in 1.9% (n = 1), benign ovarian tumor in 25.9% (n = 7) and malignant ovarian tumor in 11.1% (n = 3) of the patients. In postmenopausal women, adnexal masses can be seen simultaneously with increased endometrial thickness. In this regard, transvaginal ultrasound offers important opportunities for evaluation of both the endometrium and adnexa. Pre-surgery transvaginal ultrasound as well as multivariate serum markers may be used in evaluation models.

Comparing the long-term outcomes of uterosacral and sacrospinous ligament suspension surgeries in apical pelvic organ prolapse

Amac: Bu calismada, apikal pelvik organ prolapsusu (POP) tedavisinde kullanilan sakrospinoz ligaman fiksasyonu (SSLS) ve uterosakral ligaman fiksasyonu (ULS) ameliyatlarinin uzun donem sonuclarini karsilastirmayi amacladik. Gerec ve Yontem: Retrospektif calismamiza apikal POP tanisi almis 52 hasta dahil edildi. Bu hastalarin yirmisi ULS (Grup 1) ile, otuzikisi bilateral SSLS (Grup 2) ameliyati ile tedavi edildi. Hastane bilgi sisteminden operasyon verilerine, 12. ve 36. aydaki muayene bilgilerine, hasta memnuniyet oranlari, objektif ve subjektif kur oranlari ve komplikasyonlara ulasildi. Bulgular: Objektif kur oranlari, 12. ayda grup 1’in %80, Grup 2’nin %78.1 iken; 36. ayda Grup 1’in %70, Grup 2’nin %71.8 bulundu (p>0.05). Subjektif kur oranlari, 12. ayda grup 1’in %100, grup 2’nin %87.4 iken; 36. ayda grup 1’in %100, grup 2’nin %84.1 olarak saptandi (p>0.05). Memnuniyeti cok olan hastalar ULS grubunda SSLS grubuna kiyasla anlamli oranda fazla bulundu ancak memnun olan tum hastalar (cok memnun ve buyuk oranda memnun) ile memnun olmayanlar kiyaslandiginda, gruplar arasi istatistiksel olarak anlamli bir fark bulunmadi (p>0.05). Sonuc: Apikal pelvik organ prolapsusu hastalarinda vaginal olarak sik uygulanan iki yontem olan ULS ve SSLS’nin, basari oranlari ve hasta memnuniyetleri kiyaslandiginda birbirine ustun olmadigi sonucuna varildi.

Women self-reported G-spot existence and relation with sexual function and genital perception

Objective: Aim of study to determine the existence of the G-spot from the healthy women’s point of view and to assess the relationship with sexual function and genital perception. Materials and Methods: Sexually-active healthy polyclinic patients aged between 18 and 54 years (n=309) were classified into three groups as group 1 (do not agree, n=90, 29.1%), group 2 (neutral/do not know, n=61, 19.7%) and group 3 (agree, n=158, 51.1%) with regard to participants’ responses to a question of “does the G-spot exist.” The Female Sexual Function index (FSFI) and Female Genital Self-Image scale (FGSIS) were administered to the participants. Results: Half of the patients (51.1%, n=151) indicated that the G-spot exists. The groups were statistically homogeneous in terms of body mass index, parity, marital status, number of partners, and sexual orientation (p=0.41, p=0.06, p=0.12, p=0.19, p=0.25; respectively). Women with an education level of “less than high school” reported the absence of the G-spot significantly more often than others, whereas women with an education level of “university and higher” reported the presence of the G-spot more often (p≤0.001). Sexual dysfunction was found to be more frequent in group 1 when compared with group 3 (p=0.002, 67.8%, 45.6%). The orgasm subdomain scores of the FSFI and FGSIS total scores were significantly higher in group 3 than in group 1 (p<0.001, p=0.041). Conclusion: Half of healthy women in the Turkish population believe that the G-spot exists. Those women showed better scores in sexual functioning and genital perception.

Early versus delayed removal of indwelling catheters in patients after elective cesarean section: A prospective randomized trial

Abstract Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time. Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time. Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time. Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.

McDonald versus modified Shirodkar rescue cerclage in women with prolapsed fetal membranes

Abstract Purpose: We compared the efficacy of modified Shirodkar and McDonald rescue cerclage techniques in women with singleton pregnancies. Methods: The study sample included 47 women who presented at two tertiary hospitals in Turkey from 2008 to 2017 and underwent rescue cerclage due to cervical incompetence and cervical dilatation with fetal membranes prolapsed into the vagina. The outcomes were compared by cerclage technique used, Shirodkar or McDonald. Results: The McDonald cerclage was applied in 27 cases, and modified Shirodkar cerclage in 20 cases. A longer cerclage-to-birth interval (83.8 ± 37.6 vs. 63.7 ± 38.9 days) and later gestational age at delivery (33 vs. 31 weeks) were observed with the Shirodkar cerclage, although these differences were not statistically significant (p = .08 and .63, respectively). Both groups had similar delivery rates after 28, 32, and 37 weeks (p = .20, .15, and .25, respectively), whereas the modified Shirodkar technique resulted in a higher rate of live births although these differences were not statistically significant (85% vs. 63%, p = .09). Conclusion: The effects of the McDonald and modified Shirodkar cerclage procedures on prolonging pregnancy and improving the live birth rate were similar. Therefore, either technique can be applied to prevent neonatal loss due to advanced prematurity.

Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes

Abstract Background: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue. Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes. Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations. Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p = .03). Pregnancy interval after LSG did not impact maternal–fetal complications or mode of delivery. After a 75 g oral glucose tolerance test (OGTT) for GDM, 75% (n = 6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n = 2) of the late pregnancy after LSG group (p = .009). Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.

Does Suture Material Affect Uterine Scar Healing After Cesarean Section? Results from a Randomized Controlled Trial

ABSTRACT Background: Impaired healing of the uterine scar after cesarean has been associated with adverse gynecological and obstetric outcomes. Although a large number of studies have been conducted on the events leading to this, information obtained from prospective randomized studies examining the role of suture material in the formation of cesarean scar defect (CSD) is lacking. Objective: To evaluate the effects of synthetic suture materials on CSD formation. Study design: We performed a two-arm 1:1 randomized study in women with singleton pregnancies undergoing elective primary cesarean delivery after the 38th week of gestation. Uterine scar closure was performed using synthetic absorbable monofilament and multifilament sutures. The primary outcome was residual myometrial thickness (RMT) in the area of the scar, measured by transvaginal ultrasound 6–9 months after birth. Secondary outcomes included differences in mean operative time, mean estimated blood loss at the time of surgery, and the rates of postoperative gynecological sequelae. Results: Complete follow-up was obtained from 94 (88%) of 107 participants. RMT was thicker in the monofilament compared to the multifilament suture group (5.5 ± 2.24 vs. 4.18 ± 1.76, p = 0.01). Hemoglobin delta was higher in the monofilament suture group (1.59 ± 0.96 vs. 1.25 ± 0.60, p = 0.04). There was no statistically significant difference between the monofilament suture and multifilament suture groups in terms of gynecological sequelae. Conclusion: Closure of the uterine scar with monofilament suture has a positive effect on scar healing and increases RMT thickness.

The Female Genital Self-Image Scale (FGSIS): cross-cultural adaptation and validation of psychometric properties within a Turkish population

Introduction and hypothesisWomen’s perceived satisfaction from their own genital appearance is linked to genital image and sexual esteem. A comprehensive and easy to use scale to measure self-image was scarce in the literature. It was aimed in the present study to complement cross-culturally adapted and validated into Turkish version of the Female Genital Self-Image Scale (FGSIS) and to assess its psychometric properties.MethodsAfter cross-cultural adaptation, the Turkish version of the FGSI, Female Sexual Distress Scale-Revised (FSDS-R), and Female Sexual Function Index (FSFI) were administered to 461 female participants. Content/face validity, exploratory, and confirmatory factor analysis, internal consistency, and reliability were appropriately assessed. Predefined and specific hypotheses were formulated for construct validity.ResultsOur findings indicated excellent content/face validity, sufficient internal consistency (Cronbach’s alpha 0.818), and test–retest reliability [intraclass correlation coefficient (ICC) 0.951]. Construct validity was demonstrated by proving the hypothesis that participants who have performed at least one vaginal/clitoral masturbation for the last month reported significantly higher FGSIS scores compared with those who abstained (Z −6.37, p < 0.001). Factor analyses formed one factor structure. In the proposed two-factor construct, all seven items demonstrated good to high correlations with their subdomains and lower correlations with the other domain, indicating sufficient convergent validity.ConclusionsThe FGSIS was successfully validated for use in the Turkish population. The scale exhibited strong psychometric properties to assess perceived female genital image. It might be reliably used in genital cosmetic surgeries and in a variety of gynecologic conditions.

A Novel Technique for Mapping the Vascularity of Labia Minora Prior to Labiaplasty: Cold Light Illumination

Objective Aim of the study was to assess the feasibility of a novel technique to determine the vascularity of labia minora prior to labiaplasty. Methods A cold light source employed in laparoscopic procedures was used to illuminate the outer surface of the labia minora as described in this prospective descriptive study. Results Of the patients, 46.1% (n = 41) had upper third prominence, 36% (n = 32) had middle third prominence, and 18% (n = 16) had lower third prominence according to the Banwell classification of morphologies. Right labia minora width was 0 – 2 cm in 51.7% (n = 46), 2 – 4 cm in 47.2% (n = 42) and > 4 cm in 1.1% (n = 1) of cases. Left labia minora width was 0 – 2 cm in 52.8% (n = 47), 2 – 4 cm in 41.6% (n = 37) and > 4 cm in 5.6% (n = 5) of cases. The incidence of Anterior 2 and Posterior 1 vessels in the different morphologies were statistically significantly different (p = 0.007, p = 0.018). The Anterior 2 vessel was higher in the lower morphology group whereas the Posterior 1 vessel was higher in the upper morphology group. A central vessel was observed in 93.3% (n = 83) of patients in the left labium minus and the right labium minus. The incidence of the Posterior 1 vessel was significantly higher in the left labium minus than in the right labium minus (p = 0.021). Discussion This novel technique to assess labial vascularity using a cold light source could be very useful to reduce dehiscence by avoiding excessive resection of highly vascularized tissue. Most units can easily access a cold light source, which can be used to assess labial vascularity prior to labiaplasty.