Eralp Baser

Why women request cesarean section without medical indication

Objective. To understand the reasons of the cesarean delivery on maternal request (CDMR) without medical indication would help to reduce the rates of unnecessary cesarean-delivery (CD). The objective of this study is to determine the basal knowledge of women regarding normal delivery (ND) and CD and also to assess their attitudes about CDMR, and to find out the reasons influencing those attitudes. Methods. The study included 400 women who completed a 45-item questionnaire that assessed their basal knowledge of ND, CD, and their attitudes and beliefs about the mode of delivery and CDMR. Results. Mean age of the study population was 32 ± 10.2 years (range 18–66). Majority of the women would choose the ND because of its ‘being completely natural’ (89%) and no anesthesia and operative risk related with ND (76%). Only 33% of the women indicated that ND might cause genital organ prolapse and/or stress urinary incontinence and just 26% and 24% of the women would choose CD to prevent pelvic organ prolapse and stress urinary incontinence, respectively. On the other hand, 50% and 54% of the women would indicate that they could choose CD in order to prevent labor pain and to minimize the risk of fetal distress during the labor. Furthermore, 47% of the women had an opinion that that CD could be performed by maternal request without medical indication. Educational level had no effect of CDMR although more educated women had more accurate knowledge about the some risk and benefits of ND and CD. Binary logistic regression analysis revealed that fear of labor pain (p = 0.02, OR: 15.0, CI: 0.494–0.966), maternal age (p = 0.01, OR: 6.3,CI: 1.00–1.05), and knowledge about the relation between the ND and pelvic organ prolapse/urinary incontinence (p < 0.001, OR: 4.8, CI: 0.549–0.966) were the independent prognostic variables for the CDMR . Conclusion. Although majority of the women had wrong idea or no idea about the risks and benefits of CD, nearly half of them indicated that women can always demand CDMR. This study shows that basal knowledge of the women should be improved by education.

Roles of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios in the Early Diagnosis of Malignant Ovarian Masses

BACKGROUND The present study aimed to investigate the utility and importance of the various parameters of complete blood count panel for benign-malignant differentiation of adnexal masses. MATERIALS AND METHODS This retrospective study involved 316 patients with documented benign and 253 patients with malignant adnexal masses who underwent primary surgical treatment at a tertiary referral center. Prior to the study, all benign and malignant cases were compared within their own groups and then the benign and malignant cases were compared to each other. For all cases, cut-off, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), neutrophil, lymphocyte, platelet and CA-125 parameters, and the results were compared in regards to the groups. RESULTS NLR, PLR, neutrophil, CA-125, and platelet values were higher in the malignant compared to the benign cases (p<0.01). The lymphocyte value was lower in the malignant cases (p<0.01). No significant differences were found for basophils and eosinophils (p > 0.05). For CA-125, the sensitivity, specificity, PPV and NPV for all cases were 78%, 62%, 62% and 78%, respectively. For NLR, they were 65.6%, 72.1%, 65.3%, and 72.3%, and for PLR, 48%, 81%, 67%, and 66%. Additionally, the sensitivity and specificity were 55% and 77% for CA-125, 66% and 58% for NLR, and 61% and 58% for PLR in early malignant cases. CONCLUSIONS NLR and PLR appear to be useful methods that can be applied together with CA-125 due to the relatively high sensitivity values for the malign-benign differentiation of ovarian masses. Although the specificity of these parameters is lower than CA-125, especially in cases with early malignant ovarian pathology, their sensitivity being higher is promising for the early diagnosis of ovarian cancer. It can be used to detect ovarian malignancies in the early stages, and it will increase the treatment options and improve survival rates.

Awareness of Turkish Female Adolescents and Young Women about HPV and their Attitudes Towards HPV Vaccination

BACKGROUND The aim of the study was to assess the knowledge about HPV and HPV vaccines and attitudes towards vaccination among the females aged 9-24 years in Turkey. MATERIALS AND METHODS Self-administered questionnaires were filled out individually by the participants covering demographic information, knowledge about HPV infection and HPV vaccines, attitudes towards vaccination, and the perceptions of them about their parental attitudes about vaccination. RESULTS Of the 408 subjects participating in the study, 41.6% (n=170) had heard of HPV. Thirty-three percent (n=136) knew the causal relationship between HPV and cervical cancer. Only 27.9% (n=114) of them knew that HPV vaccines can prevent cervical cancer. Eleven percent (n=46) of the females participating in the study were willing to be vaccinated, and only 1.4% (n=6) were already vaccinated at the current time. The main reason listed among the participants who were not willing to be vaccinated was lack of information. CONCLUSIONS Awareness and knowledge of Turkish female adolescents and young women about HPV, relation with cervical cancer and prevention of cervical cancer by Pap smear and vaccine are still limited. If the most important barrier to vaccination, which is reported as lack of information, were to be addressed, it would greatly impact the decision-making and vaccine acceptance.

Comparison of Sublingual Misoprostol With Lidocaine Spray for Pain Relief in Office Hysteroscopy: A Randomized, Double-Blind, Placebo-Controlled Trial

STUDY OBJECTIVE To compare the effectiveness of sublingual misoprostol with lidocaine pump spray for office hysteroscopy. DESIGN Premenopausal women who had an indication for office hysteroscopy were included in this randomized, double-blind, placebo-controlled study. Eighty-two patients were evaluable for the final analysis. SETTING A tertiary referral center. PATIENTS Premenopausal women who had an indication for office hysteroscopy were included. Eighty-two patients were evaluable for the final analysis. INTERVENTIONS Patients were randomized to receive either sublingual misoprostol and placebo of lidocaine or lidocaine pump spray applied to the cervix and placebo of misoprostol. MEASUREMENTS AND MAIN RESULTS When compared with the lidocaine group, patients in the misoprostol group reported less pain by the immediate visual analog scale scores (2.2 ± 0.98 vs. 2.6 ± 0.99, p = .030), whereas visual analog scale scores at 10 minutes were similar between groups (2.1 ± 0.98 vs. 2.36 ± 1.06, p = .156). CONCLUSION Sublingual misoprostol is more effective than lidocaine spray in pain reduction during office hysteroscopy. Misoprostol may cause vaginal spotting, which may impair the vision during hysteroscopy especially just after the menstrual period. Preventive measures should be taken to make the procedure pain free because the physician may underestimate pain perception during the procedure.

Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia

To investigate the risk factors potentially associated with high‐risk human papillomavirus (HPV) persistence in women undergoing cold‐knife conization (CKC) for treatment of high‐grade cervical intraepithelial neoplasia (CIN).

Chocolate or orange juice for non-reactive non-stress test (NST) patterns: a randomized prospective controlled study

Abstract Objective: The objective of the study was to compare bitter chocolate and orange juice with the control group for non-reactive non-stress test (NST) patterns and for maternal perception of fetal movements. Study design: Pregnant women who were followed-up on an outpatient basis and admitted for a NST and had a non-reactive result were randomized prospectively into bitter chocolate, orange juice and control groups. 180 patients were evaluable for the final analysis. Results: Although there was a trend for orange juice group for having higher percentages of reactive NST patterns on control, there was no statistically significant difference between three groups (p = 0.159). Besides this, maternal perception of increased fetal movements was similar between groups (p = 0.755). The control group had lower post-test capillary blood glucose concentrations when compared with chocolate and orange juice groups (p = 0.01) and after post-hoc tests, this difference was found to be between orange juice and control groups. Conclusions: Although orange juice resulted in higher blood glucose levels, this was not synonymous with better NST results on control; in such a way that bitter chocolate, orange juice and no intervention had similar effects on non-reactive NST patterns and also on maternal perception of fetal movements.

Effect of pre-procedural state-trait anxiety on pain perception and discomfort in women undergoing colposcopy for cervical cytological abnormalities.

BACKGROUND Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities. Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distress on patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant association with procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervical cytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients. MATERIALS AND METHODS This prospective study was performed at the Gynecologic Oncology Department of Zekai Tahir Burak Womens Health Education and Research Hospital in Ankara, Turkey between January and June 2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnaire were filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervical cytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analog scale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI and VAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety, pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were considered statistically significant. RESULTS A total of 222 women met the inclusion criteria within the study period. Mean patient age was 38.5±9.6. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scores for pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedure related discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxiety level, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scores were significantly affected by state anxiety level, marital status, prior gynecological examination and educational status. CONCLUSIONS Additional measures should be implemented in women that carry higher risk for experiencing pain and discomfort. Social, cultural and lifestyle issues may also affect womens experiences during colposcopy, therefore further studies are needed to define specific determining factors in various populations.

Second trimester fetal nasal bone length in a low‐risk Turkish population

To define normal values of second trimester fetal nasal bone length (NBL) in a low‐risk Turkish population.

Emergency peripartum hysterectomy: experience of a major referral hospital in Ankara, Turkey.

Abstract The objective of this study was to report and discuss the incidence, clinical characteristics and outcomes of emergency peripartum hysterectomies (EPH) performed at a tertiary referral hospital in Ankara, Turkey. The labour and delivery unit database was retrospectively analysed for emergency peripartum hysterectomies (EPH) performed between January 2008 and January 2013, at the Zekai Tahir Burak Womens Health Training and Research Hospital. A total of 92,887 deliveries were accomplished within the study period. EPH was performed in 48 cases, and the incidence was 0.51 in 1,000. Abnormal placentation was the most common indication for EPH. Most common complications were blood product transfusion and postoperative fever. None of the cases resulted in maternal mortality. Serious maternal complication rates were relatively low in our study. In cases that are unresponsive to initial conservative measures, EPH should be performed without delay and a multidisciplinary team approach should be conducted whenever possible.

The impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age.

OBJECTIVE The purpose of this study was to investigate the impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age. MATERIAL AND METHODS A total of 11 587 pregnancies were reviewed retrospectively from patient medical records. Singleton pregnancies greater than 24 weeks of gestation were included. The study group consisted of women ≥40 years old at the time of delivery, and the control group consisted of women aged between 20 and 30 years old. Data regarding age, parity, gestational age, mode of delivery, and obstetric and neonatal complications were collected. Firstly, pregnancies ≥40 years and the younger control group were compared altogether with respect to the obstetric and neonatal complications. Secondly, both groups were divided into subgroups according to parity, and a second comparison was made with controls. RESULTS Mean maternal age in the study and control groups was 43±2.2 and 24±2.8 years, respectively. In women ≥40 years old, all of the investigated obstetric and neonatal complications except postpartum haemorrhage and foetal malformations were higher when compared to younger controls (p<0.05). In the nulliparous ≥40 year old group, the most significant complications were preterm delivery (45.3%), low 5-minute Apgar score (15.2%), and neonatal intensive care unit admission (15.2%). On the other hand, in the multiparous group, preeclampsia (16.6%), abruptio placentae (5.1%), foetal demise (7.2%), and macrosomia (9.6%) were found to be significantly higher when compared to controls. CONCLUSION The study suggests that pregnancies of maternal age ≥40 years carry increased risks for both neonatal and obstetric complications, and these risks seem to be effected by parity.