İbrahim Ferhat Ürünsak

Comparison of clinical and laboratory findings in early- and late-onset preeclampsia

Abstract Objective: To compare clinical and laboratory findings between the early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: This prospective longitudinal study was performed at a tertiary referral university clinic. All patients meeting the inclusion criteria were divided into two groups, the EOP group and the LOP group, according to gestational age at the onset of disease. The distinction criterion for early versus late onset was set as week 34 of gestation. Clinical and laboratory findings, and maternal–perinatal outcomes were compared between the groups. Results: A total of 157 patients with preeclampsia were included. A significant difference was observed between the groups in terms of diagnosis and severity of the disease (p = 0.007 and <0.001, respectively). The history of previous preeclampsia, diastolic blood pressure and hourly urine output on admission to the hospital were significantly different between the groups (p = 0.016, 0.018 and 0.024, respectively). Latent period for delivery and postpartum hospitalization time were longer in the EOP group than in the LOP group (p = 0.024 and 0.002, respectively). The patients with EOP received betamethazone (p < 0.001) and MgSO4 (p = 0.029) more frequently. Neonatal characteristics such as birth weight, low APGAR score and admission to neonatal intensive care unit were significantly different between the groups (p < 0.001, for all variables). Total proteinuria at 24 h was found significantly higher in the EOP group than in the LOP group (p = 0.012). Conclusion: The results confirmed the opinion that EOP is a distinct and more severe clinical entity than LOP. In particular, higher proteinuria is associated with EOP.

An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients

The aim of this study was to evaluate serum procalcitonin (PCT), C‐reactive protein (CRP), and plasma D‐Dimer levels in mild and severe pre‐eclampsia.

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries.

To evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs).

Clinical and mycological efficacy of single‐day oral treatment with itraconazole (400 mg) in acute vulvovaginal candidosis

This study aimed to investigate the effectiveness of single‐day oral treatment with itraconazole in acute vulvovaginal candidosis (VVC). Vaginitis was demonstrated by both detection of yeast cells and pseudohyphae formation on microscopic examination of vaginal discharge and mycological culture as well as by the clinical signs and symptoms. Clinical and mycological examinations of the 52 patients were performed before, 1 week (short‐term) and 4 weeks (long‐term) after single‐day oral treatment with itraconazole 200 mg b.i.d. The causative yeast fungi were: Candida albicans (76.9%), C. glabrata (9.6%), C. kefyr (9.6%) and C. krusei (3.9%), respectively. In short‐ and long‐term examinations, clinical cure rates were found to be 61.5% and 90.4%, and mycological cure rates were 63.5% and 90.4%, respectively. Itraconazole was found to be 95.0% effective with C. albicans and 75.0% with other Candida species. It is concluded that treatment of acute VVC with itraconazole is safe and effective in the long‐term.

Unilateral Laparoscopic Tubal Reversal Versus IVF

BACKGROUND Tubal sterilization is one of the most important surgical techniques for sterilization. There is a dilemma for women who wish to undo this procedure in the choice between tubal reversal or in vitro fertilization (IVF). PATIENTS AND METHODS In this retrospective cohort study, 134 patients who had had tubal sterilization previously and wished to have another child were enrolled in this study. Primary outcome was clinical pregnancy. The outcomes of 58 women who had had laparoscopic unilateral tubal reversal (Group 1) were compared with those of 76 women who had had IVF (Group 2). RESULTS Clinical pregnancy rates were higher in the tubal reversal group (55.2% in Group 1 and 15.8% in Group 2). Ectopic pregnancy rates were similar (1.7% in Group 1 and 1.3% in Group 2) between the two groups. Clinical pregnancy rates were higher in all age, body mass index, and interval from ligation categories. CONCLUSIONS Laparoscopic unilateral tubal reversal is an important alternative to IVF. However, this is an advanced laparoscopic operation, and more surgeons skilled in this microsurgical operation are still needed.

Ethical and legal aspects of abortion

The Angels asked God: Is there a solution for the abortion debate? God: Yes, of course my Angels. It will be resolved. The Angels: When? God: Not in my lifetime. (Oktay Kadayifci) The abortion debate is an emotional, sensitive and complicated issue that interests society and religion. Our intention is not to convince you to accept either side of the debate, but to help with an understanding of both sides. As a health care provider, our mission is to reduce unwanted pregnancies and provide a loving home for all children. Whatever our efforts as a medical health care provider, they have not been successful in meeting the needs. One of the available methods is pregnancy termination, but the main issue is whether pregnancy termination is a method or not. Pro-life and pro-choice proponents have their strong and reasonable views. In this paper, we try to clarify the claims of both sides without any intervention.

A unilateral tubal twin pregnancy.

Ann Saudi Med 2006;26(4):333 A 20-year-old woman, primigravida, with a last menstrual period 8 weeks ago, presented with lower abdominal pain for two days and vaginal bleeding for one day. The gynecological examination found vaginal bleeding, no enlargement in uterine size, and a painful mass 4 centimeters in diameter in the right adnexal region. The serum β-HCG level was 8200 mIU/mL. Transvaginal ultrasonography revealed no gestational sac in the uterine cavity, but there were two gestational sacs in the right fallopian tube (Figures). A unilateral tubal twin pregnancy

Annular hymenotomy for imperforate hymen

Imperforate hymen is the most common obstructive anomaly of the female genital tract. Conventional surgical treatment for this condition is the cruciate incision made on the hymen. The aim of this study was to evaluate a novel technique that preserves virginity after hymenotomy using electrocautery.

Unusual complication of 1st-trimester surgical abortion in patient with a septate uterus: intrauterine fallopian tube herniation.

Introduction We report an unusual complication of 1st-trimester surgical abortion in a patient with a partial septate uterus, presenting as secondary infertility. During hysteroscopy and laparoscopy, herniation of the right tube into the uterine cavity was observed. Th e herniation was repaired at a second laparoscopy. Th is case supports the use of ultrasound guidance during surgical abortion in selected cases, to decrease procedure-related morbidity.

P27.01: The evaluation of seven fetal cases with head‐neck tumor and thus need for the EXIT procedure

Objectives: Oropharyngeal and neck masses are extremely rarely seen tumors of the fetal life. These tumors have the potential to obstruct the airway which needs emergency neonatal interventions. This study aimed to report prenatal findings of these fetuses and determine the factors influencing on the postnatal outcome and need for the ex utero intrapartum terapy (EXIT). Methods: We present a retrospective review of prenatal presentation, size and location of the mass, diagnostic accuracy of imaging studies, presence of fetal hidrops, associated anomalies such as polyhydramnios, intraoperative management, complications, maternal and neonatal outcomes. Results: Fetal tumors had occured which three of them at oropharynx and four of them at neck. The mean gestational age at diagnosis was 34.2 (min 26 – max 38) weeks. Sonographic features of masses were found to be appopriate in all cases. The mean gestational age at delivery was 36 weeks (min 30 – max 39). It was found polyhydramnios in three cases and all of them delived prematurely and required an intervention for the patency of airway, such as endotracheal entubation or tracheostomy by EXIT procedure. Prenatal sonography was the main diagnostic tool for all patients; however we had the possibility to confirm the diagnosis with magnetic resonance imaging (MRI) in three of them. The pathological examination revealed a pair of hemangioma, teratoma and lymphangioma and one hamartoma. One of the neonatal cases was lost due to bleeding but the others were lost due to prematurity and respiratory problems. One of the cases with diagnosed lymphangioma was treated by surgical method, but the other one was treated by medical treatment. Conclusions: The improved visualization of the relationship of the mass to the entire airway and existence of polyhydramnios may help predict which patients are at the highest risk for airway obstruction, and thus the need for the EXIT strategy.