İsmet Alkış

The fertility sparing management of postpartum hemorrhage: A series of 47 cases of Bakri balloon tamponade

OBJECTIVE To evaluate the success rate of Bakri balloon tamponade (BBT) for managing postpartum hemorrhage (PPH), intractable to conservative medical treatment, as a fertility sparing intervention. MATERIALS AND METHODS We evaluated 47 women treated with BBT who had severe postpartum hemorrhage and uncontrollable bleeding due to failed treatment with uterotonic agents. The main outcome measure was successful management and preservation of the uterus. RESULTS Forty-seven women were identified for BBT treatment due to severe PPH. BBT was used to successfully manage hemorrhage in 43 patients, and there was no need for hysterectomy. Four patients required an additional surgical procedure. Of the four failures, a subtotal hysterectomy was performed in two patients, and the other two patients underwent a total hysterectomy. The overall success rate was 91.4%, which was comparable to rates reported earlier. The main cause of PPH was uterine atony (43%). CONCLUSION Uterine preservation is an important issue when managing PPH. BBT is an effective, easy to use, and safe procedure for massive PPH that can minimize recourse to hysterectomy after failed medical treatment.

Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital

Abstract Objective: To evaluate and describe a surgical approach for uterine preservation and management of postpartum hemorrhage in placenta percreta. Methods: We analyzed the data of patients who were diagnosed with placenta percreta prenatally and subsequently underwent cesarean section in which local resection technique was used to manage postpartum hemorrhage and uterine preservation at our tertiary care center between 2013 and 2016. The technique includes local resection of placental invasion site and suturing the new uterine edges. Results: The technique of local resection described above was successful in preserving the uterus and stopping the bleeding in 8 of 12 cases. The diagnosis of placenta percreta in all cases was confirmed intraoperatively and postoperatively by histological examinations. Four cases were resorted to hysterectomy. The mean number of transfused erythrocyte suspension was 4.8 ± 2.6. One complication of bladder injury was encountered in which treated conservatively. Conclusion: Local resection of percreta site is an effective, safe and fertility preserving approach that can be applied to manage the postpartum hemorrhage and preservation of uterus in patients with placenta percreta.

Maternal serum CA-125 level is elevated in severe preeclampsia

AIM The aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity. METHODS We evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n=34) and those with mild pre-eclampsia (n=24). Females with healthy pregnancies (n=31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index. RESULTS The CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p<0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r=0.489, p=0.000), systolic blood pressure (r=0.503, p=0.018), and diastolic blood pressure (r=0.532, p=0.000). In contrast, CA-125 was negatively correlated with birth weight (r=0.266, p=0.012) and gestational age at birth (r=0.250, p=0.018). CONCLUSIONS CA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.

Rectal indomethacin use in pain relief during hysterosalpingography: A randomized placebo controlled trial

To evaluate the effectiveness of a rectal nonsteroidal anti‐inflammatory drug (indomethacin) for pain relief during a hysterosalpingography (HSG).

Relationship between maternal blood ceruloplasmin level, catalase and myeloperoxidase activity and neural tube defects

OBJECTIVES The exact pathogenesis of neural tube defects (NTDs) is poorly understood. We aimed at evaluating maternal anti-oxidant capacity (ceruloplasmin level, myeloperoxidase and catalase activity) in pregnancies complicated by NTDs. MATERIAL AND METHODS Fifty-four mothers with NTD-affected pregnancies and 61 healthy mothers, matched for gestational age, were recruited. Maternal venous blood samples were obtained after detailed fetal ultrasound examination to measure myeloperoxidase, catalase activity and ceruloplasmin levels. The clinical characteristics of all participants were collected. RESULTS Maternal blood catalase activity was significantly lower in the study group (117.1 ± 64.8 kU/L) as compared to controls (152.2 ± 110.6 kU/L) (p = 0.044). Maternal blood ceruloplasmin levels were also significantly lower in the study group (180.5 ± 37.7 U/L) as compared to controls (197.9 ± 35.9 U/L) (p = 0.012). Myeloperoxidase activity was similar in both groups (112.6 ± 22.2 U/L vs. 113.6 ± 38.1 U/L) (p = 0.869). CONCLUSIONS In the present study, maternal blood ceruloplasmin level and catalase activity were found to be lower in NTD-affected pregnancies as compared to healthy controls. Thus, it seems safe to conclude that impaired antioxidant capacity may play a role in the development of NTDs during pregnancy, in addition to the genetic, environmental and metabolic factors.

Conservative management of postpartum hemorrhage

We appreciate Dr Wangs advice on our previous study [1] and his valuable review on this important topic. Dr Wang has pointed out several important issues, and we would like to respond and further discuss here. First of all, our study included 47 cases of pregnant womenwho had postpartum hemorrhage (PPH), intractable to conservative medical management. The majority of our patients underwent cesarean section (CS), and some of them had high risk for PPH. As per our hospitals policy, the preoperative strategy for high-risk patients includes the preparation of adequate blood-transfusion products and the availability of at least one senior consultant obstetrician who is able to manage PPH. Two recent articles have shown the effectiveness of uterine-vessel embolization; however, we think that predelivery embolization is not a good alternative to CS in the case of a pregnant woman with a healthy thirdtrimester pregnancywith placenta previa [2,3]. Similarly, the article by Huang et al [2] showed its effectiveness in the termination of pregnancy with placenta previa due to fetal death and serious fetal malformations at 22e29 weeks, or persistent vaginal bleeding at 21e22 weeks of pregnancy before viability. Therefore, it is obvious that predelivery embolization cannot be accepted for the pregnant woman who has a healthy third-trimester pregnancy. Also, our institution has no resources for embolization, and so we have no strategy for that kind of treatment. Nonetheless, we think that it can be a good alternative to CS in the case of pregnancy termination before viability, as stated by Huang et al [2]. In addition, iliac or uterine-artery ligation might also be considered in patients with PPH. However, these techniques need some surgical skills, especially for internal iliac-artery ligation, and also cause concern for some complications. In our study, the intraoperative strategy when dealingwith PPH, either due to the uterine atony or abnormal placentation, included firstly the medical conservative treatment (uterine massage, uterotonics, and bimanual compression), and then applying the Bakri balloon tamponade (BBT). If the bleeding did not stop, the invasive procedure, including vessel ligation or uterine compression sutures, was performed, and if this failed finally, hysterectomy was performed. We agree with the report by Liu et al [4], and it seems rational to ligate the uterine artery in pregnant women with uterine leiomyomas, who are undergoing CS. Importantly, it should be suggested to perform ligation to the uterine artery (right or left) that provides the blood supply to the leiomyoma. Secondly, BBT should be appliedwhenmedical treatment fails to stop bleeding during delivery, either vaginal or CS, after exclusion

Factors Associated with Mammographic Density in Postmenopausal Women.

Objectives Breast density increases the risk of breast cancer, but also in the interpretation of mammography is also important. This study examine the risk factors affecting breast density in postmenopausal women. Methods Between January 2013 and January 2014, 215 patients admitted to The Clinics of Gynecology and Obstetrics with complaints of menopause were taken. According to the results of mammography, Group I (non-dense, n = 175) and Group II (dense, n = 40) were created. The informations of the caseswere analyzed retrospectively. Results In Group I, body mass index (BMI), number of pregnancies, parity were significantly higher than group II (P < 0.05). In group II, the withdrawal period of menstruation and progesterone levels were significantly higher (P < 0.05). In logistic regression analysis, BMI for dense breasts and number of pregnancies were found to be an independent risk factor (P < 0.05). Conclusion Increased BMI, pregnancy and parity, result of reduction in density , but longer duration of menopause and increased progesterone cause an increase in density. BMI and the number of pregnancy was found to be independent risk factors for reducing breast density.

Evaluation of thyroid functions in molar pregnancies

Bulgular: Komplet mol tanısı konulan hastaların yaş ortalaması 33.87±12.14 iken, parsiyel mol tanısı konulan hastaların yaş ortalaması 31.73±10.12 idi. İki grup arasında yaş açısından istatiksel anlamlı fark bulunmadı (p: 0.139). Komplet mol tanısı konulan hastaların TSH değeri ortalamaları 0.5±0.9 mIU/ml iken, parsiyel mol olgularının TSH değeri ortalamaları 1.0±1.2 mIU/ml olarak bulundu. Parsiyel mol olgularının TSH değerleri, komplet mol olgularına göre daha yüksek bulundu (p: 0.001).

The effect of cerclage on pregnancy outcomes in cervical changes

1Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Van, Türkiye 2TC Sağlık Bakanlığı Sağlık Bilimleri Üniversitesi Van Bölge Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği, Van, Türkiye 3TC Sağlık Bakanlığı Sağlık Bilimleri Üniversitesi Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği, Diyarbakır, Türkiye

What should the optimal intrauterine pressure be during outpatient diagnostic hysteroscopy? A randomized comparative study

The aim of this study was to evaluate and compare lower and higher uterine filling pressures during outpatient diagnostic hysteroscopy.