Gokhan Goynumer

Vascular risk in women with a history of severe preeclampsia

To assess markers of vascular dysfunction and risk in postpartum women with a history of severe preeclampsia.

The effect of tubal sterilization through electrocoagulation on the ovarian reserve

BACKGROUND The study was conducted to compare the effects of tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve. STUDY DESIGN Eighty-eight patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day-3 serum follicle stimulating hormone, luteinizing hormone, estradiol, inhibin-B and antimüllerian hormone and Day-3 total ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups. RESULTS A significant difference between the postoperative 10th-month Day-3 total ovarian volumes and anthral follicle counts was detected between the electrocoagulation and mechanical clips application groups. CONCLUSION Tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.

The effect of magnesium sulfate treatment on blood biochemistry and bleeding time in patients with severe preeclampsia

OBJECTIVE The objective of this study was to observe the effects of magnesium sulfate on various blood biochemical parameters and coagulation status of patients with preeclampsia. METHODS During a period of 4 years, 50 patients with severe or mild preeclampsia progressing to severe preeclampsia were included in the cross-sectional study. Prothrombine (PT), activated limited thromboplastin time (aPTT), magnesium level, biochemistry parameters, systolic, and diastolic blood pressure (BP) were measured. These parameters were remeasured in the second hour of magnesium sulfate treatment. RESULTS After magnesium sulfate therapy; creatinine levels are decreased (p < 0.05), bleeding time is increased and serum magnesium levels are increased (p < 0.01), systolic and diastolic BP values decreased significantly (p < 0.01). PT, aPTT, platelet levels, and coagulation time did not change after treatment. CONCLUSION Magnesium sulfate infusion prolonged bleeding time in patients with severe preeclampsia. This is clinically important because it worsens the present condition and causes possible complications.

Double notches: association of uterine artery notch forms with pregnancy outcome and severity of preeclampsia

Objective: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. Methods: Of 490 preeclampsia (PE) patients between 24 and 34 weeks gestation, 166 were diagnosed with mild PE and 324 were diagnosed with severe PE. Patients were divided into four groups (no notch, a unilateral notch, bilateral notches and double notches). Results: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes, HELLP syndrome, prematurity, neonatal intensive care unit admission and perinatal mortality. Conclusion: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes.

Rescue cerclage when foetal membranes prolapse into the vagina

Abstract A cross-sectional study was conducted to evaluate the efficacy of rescue cerclage in patients with a dilated cervix and prolapsed foetal membranes. Thirty-five patients presenting with cervical dilatation and prolapsed foetal membranes were included in the study. A McDonald cerclage was placed in 27 patients. The duration of pregnancy prolongation and the number of deliveries after 28 weeks were evaluated. The median prolongation of pregnancy after cerclage placement differed significantly between the cerclage and bed-rest groups (64 days versus 13.5 days). Of the 27 patients who had cerclage, 17 (63%) delivered after 28 weeks of gestation, whereas all patients in the bed-rest group delivered before 28 weeks of gestation. The take-home baby rate was 63% in the cerclage group. When pregnancies were complicated by cervical dilatation with membrane prolapse into the vagina, placement of a McDonald cerclage in appropriately selected patients can be a beneficial therapeutic option. Impact statement Although the effectiveness and safety of rescue cerclage is controversial, our study provides strong support for the notion that cervical cerclage accompanied by long-term broad-spectrum antibiotics improves the perinatal outcomes in singleton gestations with membrane prolapsed into the vagina. Further prospective randomised trial is required to prove these findings.

The levonorgestrel‐releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis

The aim of this study was to investigate the effectiveness of a levonorgestrel‐releasing intrauterine device (LNG‐IUS) in the symptomatic relief of pain in women with endometriosis and additionally, to assess the changes in womens life quality and serum cancer antigen (CA) 125 levels.

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.

Fetal Cardiac Anomalies

This review is intended to give a practical guide to ultrasound recognition of the commonly observed fetal cardiac abnormalities and their key features on standard imaging planes during antenatal anomaly screening examinations. All information provided here, on the diagnosis and management of fetal cardiac anomalies, is based on the personal experiences of the authors and their expert reviews of the selected previously published studies.

Levonorgestrel containing intrauterine device (Mirena®) in the treatment of dyfunctional uterine bleeding; patients’ view and our experience

Abnormal uterine bleeding is a common cause for visits to gynecology polyclinics and one of the treatment options is levonorgestrel containing intrauterine device (LNG IUD; Mirena®). The aim of this study is to evaluate patient satisfaction following insertion of Mirena® in women with the indication of abnormal uterine bleeding and to share our data concerning the use of Mirena. The study population of this retrospective study consisted of women with the diagnosis of dysfuntional abnormal uterine bleeding with Mirena® inserted between 1 January 2015-31 December 2015. Information about age, obstetric and gynecologic history of the patients, histologic diagnosis of endometrial sampling, pelvic ultrasound reports were retrieved from medical records of the patients. Afterwards, interviews on phone were conducted. Patient satisfaction, complications, rate of amenorrhea, rate of expulsion or displacement, need for removal and if removed the treatment modality preferred were noted. Patient satisfaction was assessed by a scale of four as not satisfied, satisfied, very satisfied and extremely satisfied. A total of 61 Mirena® were inserted during study period and 50 patients were included in the study. We could interview with 31 patients on phone. No complication occurred related to vaginal insertion of Mirena® Twelve patients were amenorrheic, 4 patients oligomenorrheic, 4 patients were complaining of metrorrhagia (spotting). Displacement of Mirena® did not occur, however in 6.45%. of the patients Mirena® came out accidentally. Four patients wanted their Mirena® to be removed. Eight patients were “not satisfied” at all, the other patients were satisfied from the treatment. As a result, Mirena® was overall a well-tolerated treatment modality and around three-quarter of the patients with Mirena® inserted for the treatment of abnormal uterine bleeding are satisfied from the treatment.