Melahat Emine Dönmez

Use of progestogens in pregnant and infertile patients

Progesterone is an essential hormone in the occurence and maintenance of pregnancy. Natural or synthetic progestogens are commonly used in pregnant patients or patients undergoing infertility treatments for various indications. Most frequently put indications for the use of progestogens in these patient populations are the prevention of spontaneous preterm birth, the prevention of pregnancy loss in pregnancies with an unexplained recurrent pregnancy loss and in patients with threatened abortion. It is also used in pregnant women undergoing nonobstetric surgery, for infertility or recurrent pregnancy loss that is thought to be due to luteal phase defect or as a luteal support in stimulated IVF cycles. We aimed to review the current evidence for the use of progestogens in each of these settings.

Intraperitoneal administration of single dose type I collagen or low dose melatonin to prevent intraperitoneal adhesion formation: A comparative study

OBJECTIVE To compare the prevention of adhesion formation by type I collagen or melatonin solutions in the rat model. STUDY DESIGN A total of 40 female Wistar albino rats were randomly assigned to four groups-type I collagen, melatonin, vehicle control and sham groups. Following midline laparotomy, a standard injury was made on the right uterine horn using bipolar cautery. The animals in the sham group underwent midline laparatomy only. One milliliter of type I collagen, melatonin or vehicle control was instilled onto the injured area immediately before abdominal closure. Fourteen days after the surgery, the type and extent of adhesion formation as well as the uterine horn tissue superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels were measured. RESULTS Both the type and extent of adhesion formation were significantly lower in the type I collagen and melatonin groups compared to the control group. The tissue SOD and CAT activity was significantly higher, and MDA levels were significantly lower in the type I collagen and melatonin groups compared to the control group. CONCLUSION Intraperitoneal administration of type I collagen or low dose melatonin solution onto the injured areas may be an attractive adjuvant to reduce postoperative adhesion formation.

Alterations in placental pendrin expression in pre-eclampsia.

Abstract Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p < 0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r = 0.533, p = 0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia.

Üçüncü basamak bir hastanedeki gebe ve/veya jinekolojik hastalıklı kadınlarda HBsAg, anti-HCV ve anti-HIV sıklığı

Objective: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are viruses that can be transmitted to the health care workers by infected body fluids and from mother to the baby before, during or after delivery. In the present study, we aimed to investigate the frequency of hepatitis B surface antigens (HBsAg), hepatitis C antibodies (anti-HCV), and HIV antibodies (anti-HIV) in pregnant women and/or patients with gynecologic diseases that admit to a university hospital in Bolu. Methods: HBsAg, anti-HCV, and anti-HIV results of the pregnant women and/or patients with gynecologic diseases that admitted to the obstetrics and gynecology clinics between January 2006 and June 2012 were retrospectively investigated. All markers were tested in the microbiology laboratory of our hospital by using macro ELISA method (Axsyme and Architect i2000SR systems, Abbott Diagnostics, Chicago, IL, USA). Results: The frequency of HBsAg, anti-HCV, and antiHIV positivity were 1.8%, 0.5%, and 0% in pregnant women and 1.9%, 1.1%, and 0% in patients with gynecologic diseases, respectively. Conclusion: The frequencies detected in our hospital are at low levels as seen in developed countries. Since there is no effective method of prevention especially from HCV, awareness of this serologic result before high risk procedures will enable the doctors and the health care workers to take extensive measures to prevent the transmission of the disease. J Clin Exp Invest 2013; 4 (2): 166-170

Labial fusion causing acute urinary retention in a young adult: a case report.

Labial fusion is defined as a partial or complete adherence of the labia minora. The labia minora adhesion is a common paediatric gynaecological problem, and occurs more frequently between three months and three years. Adhesions of the labia are rare in adult population. There are a few cases in the literature. The aetiology of labial adhesion probably relates to vaginal inflammation or irritation, and is associated with low oestrogen status. Labial fusions may be caused by infections, inflammatory conditions, dermatological conditions, lack of sexual activity, local trauma, genital circumcision and recurrent urinary tract infections. If the labial adhesions are severe or related to urinary problems, surgical treatment should be considered.

Intraperitoneal Nigella sativa for Prevention of Postoperative Intra-Abdominal Adhesions in Rats

ABSTRACT Objective: To evaluate intraperitoneal administration of Nigella sativa (NS) to prevent postoperative intraperitoneal adhesion (PPA) after surgical manipulation of rat uterine horn. Materials and Methods: Two forms of NS were used in the study (Volatile oil (NSVO) and the ethanolic extract (NSEE)). A total of 50 rats were randomly assigned to the sham group (n = 10), control group (n = 10), NSVO group (n = 10), NSEE group (n = 10), and the Seprafilm group(n = 10). After 14 days, rats were sacrificed. Adhesions were examined macroscopically, and degree of adhesions was scored. A part of horn was excised, and superoxide dismutase (SOD) and glutathione peroxidase activities as well as malondialdehyde levels were evaluated, and histological score was calculated. Results: Total microscopic score of the NSEE group was significantly lower than the control group (p = .001) and was marginally significantly lower than the seprafilm group (p = .005). Collagen formation score was higher in the seprafilm group compared to the sham and NSEE groups (p < 0.001, p = .003, respectively). Apoptotic cells were lower in the NSEE group compared to the control group (p = .003) and also lower in the NSEE and NSVO groups compared to the seprafilm group (p = .001, p < .001, respectively). Only SOD activity was higher in the NSVO and seprafilm groups compared to the control group (p < .001). Conclusion: NSEE form seems to have a possible effect in the prevention of PPAs. This may occur by its effect in decreasing collagen formation and by decreasing apoptosis in the injured tissues. NSVO form seems to induce SOD. Therefore, combined use of NSVO with seprafilm may increase the adhesion preventive effect of seprafilm.

Enterobius vermicularis: Can it be a possible pathogen in Bartholin gland abscess formation?

The most frequent disorders of the Bartholin glands are cysts or abscesses. Bartholin gland abscesses occur generally as a result of polymicrobial infections or agents that cause sexually transmitted diseases. But as far as we know, no parasite has been previously reported among the infectious agents that are detected from the abscesses of the Bartholin gland. Here, we report a 45‐year‐old woman, in the Bartholin abscess aspirate of whom Enterobius vermicularis eggs were detected in between the inflammatory infiltrate by cytological examination.

Fetal supraventricular tachycardia

Objective: The diagnosis of fetal supraventricular tachycardia (SVT) which can be intermittent or continuous is established by 1:1 atrioventricular conduction in echocardiography, and heart rate between 220 and 240 bpm. We aimed to present a fetal SVT case characterized by the loss of variability and intermittent tachycardia attacks in non-stress test (NST). Case: The fetus at 32 weeks of gestation was diagnosed with SVT due to the loss of variability at NST, intermittent tachycardia attacks, 230 bpm at echocardiography and regular 1:1 AV conduction. Oral sotalol therapy was initiated to the mother. At the follow-up, spontaneous vaginal delivery was carried out at week 342/7. Upon observing SVT attack for five minutes at eight hour of the birth, oral digoxin therapy was initiated. No additional SVT attack was observed during 3 months of follow-up. Conclusion: Intermittent fetal SVTs may progress only by the loss of variability at NST during non-attack periods. We believe that it would be useful to follow-up cases closely who have normal biophysical profile except the loss of variability at NST in terms of fetal tachyarrhythmia.

Safe vaginal delivery in a renal transplant recipient: A case report

Here, we aimed to present a case of safe vaginal delivery in a renal transplant recipient and to mention the possible additional risks of caesarean section in such cases. A 40 year-old patient (G4P3), who had undergone renal transplantation 5 years ago, was admitted to our clinic at 39(2/7) weeks of pregnancy. The transplanted kidney at right iliac fossa was sonographically normal except for grade 1 hydronephrosis; the proximity of vascular anastomoses between the transplanted kidney and iliac vessels to the lower segment of the uterus was remarkable. There was no contraindication for vaginal delivery and it was believed that there would be a possible risk of injury to the transplanted kidney with caesarean delivery. The patient delivered a healthy baby weighing 3540 grams. There is a risk of injury to the renovascular and ureter anastomoses in renal transplant recipients during caesarean delivery. Normal vaginal delivery without abdominal compression is the safest method of delivery in these patients. If a situation that can necessitate internal iliac artery ligation or caesarean hysterectomy such as placenta accreata is expected, surgery should be performed in a centre where the renal transplant surgeon can oversee the surgery.