Hüseyin Cengiz

Comparison of serum anti-Müllerian hormone levels in normal weight and overweight-obese adolescent patients with polycystic ovary syndrome.

OBJECTIVE To evaluate serum concentration of anti-Müllerian hormone (AMH) in adolescent patients with polycystic ovary syndrome (PCOS) with respect to body mass index (BMI), and to investigate the relationship with clinical, metabolic and hormonal parameters. STUDY DESIGN Fifty-eight adolescent girls (29 normal weight and 29 overweight-obese) diagnosed with PCOS and 28 apparently healthy girls (controls) were enrolled in the study. BMI was calculated in all cases. Serum AMH, hormonal and metabolic parameters were compared between patients with PCOS (normal weight and overweight-obese) and controls. RESULTS Serum AMH did not differ between patients with PCOS and controls (p=0.283), and no correlation was found between BMI and AMH. A significant positive correlation was found between 2-h plasma glucose on 75-g oral glucose tolerance test and AMH (R=0.364, p=0.005). HOMA-IR index and insulin were significantly higher in overweight-obese patients with PCOS than in controls, but no significant difference was found between controls and normal-weight patients with PCOS. CONCLUSIONS AMH was not found to be a reliable predictor for the presence of PCOS, and serum AMH did not differ between obese and non-obese adolescent patients with PCOS.

Genitourinary symptoms in patients with adenomyosis

Introduction and hypothesisAdenomyosis causes problems in women, including dysmenorrhea and abnormally heavy and prolonged menstrual bleeding; however, its etiology is unknown. We hypothesized that urinary symptoms are frequent in patients with adenomyosis and that they affect the patients’ quality of life.MethodsWe conducted a pilot study from September 2011 to December 2011. Ninety-one patients with an ultrasound diagnosis of uterine adenomyosis comprised the study group (adenomyosis group). Ninety-four women with a normal-appearing uterine myometrium on ultrasound comprised the control group. Patients filled out two validated questionnaires, the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Patients also underwent a pelvic examination and urinary symptoms were recorded. Groups were compared using the nonparametric Mann–Whitney U test, chi-square test, and Fisher’s exact test.ResultsThe frequency of urinary symptoms was significantly higher in the adenomyosis group than in the control group (P = 0.0001), including stress urinary incontinence, urgency, daytime frequency, urge urinary incontinence, and dyspareunia. Total UDI scores were significantly higher in the adenomyosis group than those in the control group (P < 0.0001), as were IIQ scores of questions regarding social relations (P < 0.05).ConclusionsOur results suggest that urinary tract dysfunction is associated with adenomyosis and that urinary symptoms may affect patients’ quality of life.

Domestic violence against pregnant women: a prospective study in a metropolitan city, İstanbul

OBJECTIVE Violence against women, particularly against pregnant women, is increasingly being recognized as a significant problem around the world. Limited studies were found about domestic violence among pregnant women. The aim of this study was to determine the prevalence of domestic violence during pregnancy and the factors affecting it. MATERIAL AND METHODS This prospective study was conducted at the Department of Obstetrics and Gynecology, between January 2012 and April 2013. A total of 1349 pregnant women, irrespective of age and socioeconomic status, were interviewed using a questionnaire in the local language. RESULTS The incidence of domestic violence in this study was 2.37%. The mean age of women who reported violence was 29.06±5.53 years. Age, marriage duration, gravidity, parity, educational level, partners educational level, and monthly income exerted no significant influences on women who experienced domestic violence during their pregnancies (p>0.05). Women who resided in the same houses with large extended families were at significantly higher risk of domestic violence during pregnancy in comparison with the pregnant women who lived within a core family (p=0.018). CONCLUSION Domestic violence during pregnancy is a potential public health problem. Education, improvements in economic autonomy, and societys attitudes may reduce domestic violence. Health-care providers should increase their awareness of risk factors to protect women from domestic violence.

A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model.

OBJECTIVE To investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. STUDY DESIGN A double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier(®) groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5-2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier(®) group received 1cm(3) ready-for-use Hyalobarrier(®) gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. RESULTS The extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier(®) groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier(®) groups (p<0.001). CONCLUSION In this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores.

Ischemia-modified albumin as an oxidative stress biomarker in early pregnancy loss

Abstract Background/aims: This study aimed to determine the association between early pregnancy loss and serum ischemia-modified albumin (IMA) concentrations. Methods: Serum samples of 180 women that included healthy pregnant women, women admitted for termination of pregnancy due to the absence of fetal cardiac activity or absence of fetal pole on ultrasonographic examination, and healthy non-pregnant women attending for gynecological examination. Each group included 60 patients. Serum concentrations of IMA were compared among the groups, and the correlations with patients’ age, gravidity, BMI, gestational age and total serum albumin concentrations were calculated. Results: When the groups were compared with respect to IMA concentrations, the group with early pregnancy loss was found to have significantly higher IMA concentrations (p < 0.001). An IMA threshold of >163 ng/mL had a sensitivity of 75%, specificity of 55% to discriminate between healthy pregnant patients and patients with early pregnancy loss in first trimester. Conclusion: Our findings support the theory that possible oxidative stress, a more hypoxic environment and defective placentation lead to increased serum IMA concentrations. These findings may help to shed light on the complicated pathogenesis of early pregnancy loss.

Management of intractable postpartum haemorrhage in a tertiary center: A 5-year experience

Background: The purpose of this study is to describe treatment alternatives to prevent postpartum hysterectomy after failure of conventional therapies. Prevention of hysterectomy was the main outcome studied. Materials and Methods: This is a retrospective study of 19 patients diagnosed to have intractable postpartum hemorrhage and not managed with medical treatment who were subsequently treated with operative interventions in our unit between January 2004 and January 2009. The cases were identified by review of medical records. Results: In the period under review, a total of 17,341 deliveries were conducted, out of which 19 women were managed for intractable PPH. The incidence of severe PPH unresponsive to standard medical treatment was 0.1%. The mean maternal age was 33.5±3.4 years (range 27–39 years). The mean gestational age was 38.3±1.3 weeks (range 37–41 weeks). Organ preserving surgery methods were utilized in all the patients with a success rate 78.9%. The mean duration of surgery was 95 minutes (range 50–130 minutes) and the mean hospital stay was for 5 days. The mean transfused blood volume was 2.4 units as packed red cells. Among these 19 cases, 4 cases were resorted to hysterectomy. Conclusions: In the presence of uncontrolled hemorrhage, this simple procedure should be tried before other complex treatment alternatives are undertaken. Our case series suggests that the combination of uterine artery ligation with B-Lynch sutures might be the best surgical approach because it preserves future fertility better than other methods and avoids high operative risks and morbidity.

The relationship between epicardial adipose tissue thickness and oxidative stress parameters in patients with isolated polycystic ovary syndrome

Abstract Purpose: The aim of this study is to evaluate the correlation between epicardial adipose tissue thickness and oxidative stress parameters in patients with polycystic ovarian syndrome. Methods: The study included 35 patients with PCOS and 35 healthy women. Transthoracic echocardiography was used to measure the epicardial adipose tissue thickness (EATT) of all patients. For all patients, serum TOS, TAS, hs-CRP, and insulin levels were measured according to the literature, and the HOMA-IR values were calculated. Independent samples t-test, Pearson’s correlation analysis, multivariate logistic regression analysis, and receiver operator characteristic curve (ROC) analysis were used in the statistical analysis. Results: Between the patient group and the control group, EATT was significantly higher in the PCOS group compared to the control group (5.4 ± 1.4 mm and 3.9 ± 1.6 mm, respectively; p < 0.001). Similarly, TOS, TAS, and hs-CRP levels were significantly higher in the PCOS group compared to the control group (p < 0.01 for all). The correlation analysis showed a significant positive correlation between EATT and TAS and hs-CRP (r = 0.349, p < 0.01 and r = 0.352, p < 0.01, respectively). Multivariate regression analysis showed a significant correlation between PCOS and EATT, TAS, and diastolic blood pressure (p < 0.05 for all). Conclusions: Epicardial adipose tissue may play a major role in PCOS pathogenesis by leading to an increase in oxidative stress.

Identification of patients at risk for preeclampsia with the use of uterine artery Doppler velocimetry and copeptin.

Abstract Purpose: To investigate the relationship between maternal copeptin levels and uterine artery Doppler examination and progress of preeclampsia. Materials and methods: A cross-sectional study was designed with women those were screened at 20 + 0 – 24+  6 weeks’ gestation between May 2014 and August 2014. The obstetric records of all normotensive women were examined. Uterine artery Doppler velocimetry results and serum copeptin levels were measured. The patients were divided into two groups according to normal (n = 67) and abnormal uterine artery Doppler (n = 21) findings. Results: Maternal age was significantly lower in group 1 (n = 21, 23.9%) than in group 2 (n= 67, 76.1%) (p < 0.05). We found no differences in maternal characteristics, birth weight, gestational age at delivery and copeptin levels between the two groups. Maternal serum copeptin levels were higher in women who subsequently developed preeclampsia. There was also a significant correlation between copeptin levels and the presence of preeclampsia. (p = 0.002). Conclusions: Copeptin levels are significantly higher in patients who develop preeclampsia.

The effect of tubal sterilization with the Pomeroy technique and bipolar electrocauterization on the ovarian reserve and serum anti-Müllerian hormone levels in a rat model

OBJECTIVE To investigate the effects of tubal sterilization techniques on the ovarian reserve and serum anti-Müllerian hormone (AMH) levels in rats. STUDY DESIGN Wistar Hannover rats (n=21) were assigned to the following 3 groups (7 rats/group): Pomeroy technique, bipolar electrocauterization, and control. Pre- and postoperative serum AMH levels, ovarian damage and ovarian follicle counts were assessed. RESULTS Total ovarian damage was higher in the electrocauterization group than in the Pomeroy (p=0.008) and control (p<0.0001) groups. The large antral follicle count was higher in the Pomeroy group than in the electrocauterization (p=0.023) and control (p=0.003) groups. The electrocauterization group had a greater decrease in postoperative serum AMH levels than the Pomeroy and control groups (p=0.031). CONCLUSION Bipolar electrocauterization may have a negative effect on the ovarian structure and ovarian reserve compared to the Pomeroy technique.

Episiotomy and the development of postpartum dyspareunia and anal incontinence in nulliparous females.

OBJECTIVE The impacts of an episiotomy on a womans sex life and ability to relax the pelvic musculature remain largely unknown. The aim of the present study was to assess the impact of an episiotomy on the development of postpartum dyspareunia and anal incontinence. MATERIALS AND METHODS A total of 200 patients participated in the present study. The patients were grouped as follows: vaginal delivery with episiotomy (Group 1, N=100) and Caesarian section (Group 2, N=100). An interview, which asked about the presence of dyspareunia or anal incontinence, was conducted with the participants at 12 weeks postpartum. RESULTS The mean age (years) of Group 1 was 22.6±4.4, and the mean age of Group 2 was 24.1±4.6. Anal incontinence was detected in 4 patients (4%) in Group 1 and 2 patients (2%) in Group 2. Dyspareunia was present in 21 patients (21%) in Group 1 and 8 patients (8%) in Group 2. No significant differences were detected in the severity of anal incontinence between the two groups. The amount of time to the first coitus following delivery and the total amount of intercourse was compared between the two groups. CONCLUSION It appears that episiotomies do not lead to anal incontinence. However, episiotomies may cause dyspareunia, a condition that may negatively affect a womens sex life. Therefore, routine episiotomies are not suggested.