Mert Ulaş Barut

Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions.

Background This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. Material/Methods The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman‘s and Chi-Square tests were used for statistical analysis. Results Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. Conclusions Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.

Human Papilloma Viruses and Their Genotype Distribution in Women with High Socioeconomic Status in Central Anatolia, Turkey: A Pilot Study

Background In the present study we retrospectively evaluated the results of outpatients who had an HPV analysis, and present objective evidence for the administration of preventive inoculation in our area. Material/Methods We retrospectively reviewed 532 outpatients who visited a single center between 2012 and 2016 and had an HPV infection analysis. The criteria for inclusion of patients with unhealthy cervix in the study were: erosion, chronic cervicitis, healed lacerations, hypertrophied cervix, and abnormal discharges from the cervix. Results We found that 122 out of 532 patients were infected with HPV, and the rate of multiple infections was 59.0% (72/122). HR-HPV (group 1 carcinogens HPV-16 (18.9%, 23/122), HPV-18 (13.1%, 16/122), HPV- 31 (4.9%, 6/122), HPV-33 (3.3%, 4/122), HPV-35 (7.4.9%/122), HPV-39 (5.7%, 7/122), HPV-45 (5.7%, 7/122), HPV-51 (11.5%, 15/122); Group 3 LR-HPV; HPV-6 (31.1%, 38/122), HPV-11 (26.2%, 32/122), HPV-42 (9.0%, 11/122) and HPV-43 (4.9%, 6/122). In terms of linear-by-linear association test, no significant statistical difference was identified between years. The P value for HPV infection rate on year basis was P>0.05. Conclusions In this hospital-based retrospective analysis, HPV types were found to be similar to HPV types reported in developed countries. We firmly suggest that patients should be informed about the risk of HPV infection at early ages.

There is a Positive Correlation Between Socioeconomic Status and Ovarian Reserve in Women of Reproductive Age

Background The purpose of this study was to investigate the potential association between socioeconomic status and ovarian reserve, anti-Mullerian hormone level, antral follicle count, and follicle stimulating hormone level in women of reproductive age. Material/Methods A total of 101 married women between 20–35 years of age who presented to the Department of Obstetrics and Gynecology, Health Research System In Vitro Fertilization (HRS IVF) Center between October 2014 and November 2015 and met the inclusion criteria were included in this study. The participants were divided into three socioeconomic groups using Kuppuswamy’s socioeconomic status scale. Thirty-one participants were assigned to the low socioeconomic status group, 37 to the middle socioeconomic status group, and 33 to the high socioeconomic status group. On days 3–6 of the menstrual cycle, 10 mL of blood was collected from the participants for follicle stimulating hormone and anti-Mullerian hormone measurements. Transvaginal ultrasonography was performed for both ovaries for the purpose of counting antral follicles measuring 2–10 mm in diameter. Results Both ovarian reserve parameters, namely anti-Mullerian hormone level and antral follicle count, exhibited a significant association with socioeconomic status (p=0.000 and p=0.000, respectively). The association between follicle stimulating hormone level and socioeconomic status was also significant (p=0.000). Conclusions A low socioeconomic status aggravated by sources of stress such as undernutrition and financial hardships affects ovarian reserve, which should be remembered in approaching infertile patients.

Serum ischemia modified albumin level and its relationship with the thiol/disulfide balance in placenta percreta patients

Abstract The pathogenesis of placenta percreta (PP) is not very well known. This study was designed to analyse the oxidative stress (OS), the thiol/disulphide balance, and ischaemia-modified albumin (IMA) the women with PP. The study included 38 pregnant women with PP and 40 similarly aged healthy pregnant women in their third trimester of gestation. We measured the IMA, native and total thiols, and disulphide concentrations in the maternal sera of all of the participating women. The IMA levels were higher and the native and total thiols were lower in the PP group than in the control group. However, there was no statistical significance with respect to the thiol/disulphide balance between the two groups. The results of this study suggest that an increase in the ischaemia and OS and a decrease in the antioxidant status may contribute to the pathogenesis of PP. Impact statement What is already known on this subject? Placenta percreta (PP) is a serious complication of pregnancy. Although there are several studies investigating the pathophysiological mechanism of PP, whether the pathology results from a lack of decidua or from the over-invasiveness of trophoblasts remains controversial. The pathology of PP is poorly understood. What do the results of this study add? This prospective study has shown an increased ischaemia modified albumin (IMA) and a decreased antioxidant capacity in the patients with placenta percreta. The results from 38 women with PP suggest that the serum concentrations of IMA and the oxidative stress parameters may be able to predict PP in cases of uncertainty. What are the implications of these findings for clinical practice and/or further research? The implication of these findings shed light on understanding the pathogenesis of PP for further research.

Copper and ceruloplasmin levels are closely related to the severity of preeclampsia

Abstract Objective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease. Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists’ 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman’s rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity. Results: The mean ± SD of the Cu was 81.2 ± 11.84 µg/dl in the mild preeclampsia cases and 160.2 ± 20.89 µg/dl in the severe preeclampsia cases (p < .001). The mean ± SD of the CP was 33.0 ± 4.81 mg/dl in the mild preeclampsia cases and 65.3 ± 9.17 mg/dl in the severe preeclampsia cases (p < .001). The Cu and CP levels were significantly higher in the patients with HELLP syndrome, which is an advanced and more severe form of severe preeclampsia, than in the mild and severe preeclampsia patients (p < .001 and p < .001, respectively). Therefore, the serum Cu and CP levels were correlated with the severity of preeclampsia (r = 859, p < .001 and r = 786, p < .001, respectively). In addition, there was a positive correlation between the serum Cu and CP levels and the systolic and diastolic blood pressure values and aspartate amino transferase levels (AST), and a negative correlation between the serum Cu and CP levels and the platelet count. Conclusion: This was the first study in which the ceruloplasmin and Cu levels were investigated in HELLP syndrome patients. When considering the results obtained in the present study, there were significant relationships between the Cu, CP levels which are the markers of oxidative stress and the preeclampsia severity.

Kliniğimize Başvuran Mol Gebelik Olgularının Retrospektif İncelenmesi

Amac: Calismamizda klinigimizde parsiyel ve komplet mol hidatiform tanisi alan olgularin retrospektif olarak analizini amacladik. Yontemler: Bu calismada, Ocak 2015 - Ocak 2018 tarihleri arasinda gestasyonel trofoblastik hastalik tanisi alan 89 hastanin dosya bilgisine ulasildi ve retrospektif olarak degerlendirildi. Toplam 89 hastanin kayitlari incelendi. Hastalardan 76 komplet molar ve 13 parsiyel molar gebelik olmak uzere iki gruba ayrildi. Mevcut kayitlardan hastalarin yas, gravida, parite, abortus, kan gruplari, β HCG, vakum kuretaj oncesi s-HCG degerleri, serum tiroid uyarici hormon (TSH), serbest tiroksin (T4) ve serbest tri-iyodotironin (T3) ve histopatoloji ile ilgili sonuclari kayit edildi. Bulgular: Ocak 2015 - Ocak 2018 tarihleri arasinda toplam dogum sayisi 3927 olarak tespit edildi. Gestasyonel trofoblastik hastalik insidansi 22.6/1000 dogum olarak tespit edildi. Calismaya dahil edilen kadinlarin yas dagilimi incelendiginde; yas ortalamasi 29.55±9.79 olarak bulundu. Calismada parsiyel mol tanisi alan olgularin beta HCG ortalama degeri 229082±354929.69 mIU/ml, komplet mol tanisi alan olgularin ise 258017.47±379942 mIU/ml olarak bulundu. Beta HCG degerleri acisindan iki grup arasinda istatistiksel olarak anlamli fark bulunmadi (P=0.784). Olgularin tiroid fonksiyon testleri incelendiginde, %13,4 (12)’unun hipertiroidi oldugu bulundu. Hastalarin vakum-kuretaj materyallerinin histopatoloji sonuclari incelendiginde, olgularin %85,4 (76)’ unun komplet mol iken %14,6 (13)’sinin parsiyel mol oldugu izlendi. Sonuc: Calismamizda sonuc olarak, molar gebelik vakalarinda tetkik ve tedavileri goz onune alindiginda tiroid fonksiyon testi etkilendigi gozlenmektedir. Bu olgularda anestezi oncesi mutlaka tiroid fonksiyon testleri degerlendirmek gerekir. Bu olgulara kuretaj sonrasinda β- hCG takiplerinin yapilmasi hususunda hastalar bilgilendirilmeli ve herhangi bir takip yapilmamasi halinde hayati tehlike olusturabilecegi aciklanmalidir.

True knot of the umbilical cord in advanced weeks of pregnancy: a case report

True knot of the umbilical cord is a very rare condition. Usually a true knot is noticed after delivery and does not lead to problems. It is relatively less common than the other umbilical cord anomalies. Most authors agree that there is little that can be done to prevent fetal death in undiagnosed true knot. In our case, the patient gave birth to a healthy male baby weighing 2700 grams by normal vaginal delivery after an ultrasound was suggestive of intrauterine growth restriction (IUGR). The baby’s Apgar scores were 8 at one minute and 9 at five minutes. The umbilical cord measured 125 cm and contained two loose true knots. It was surprising that the baby could survive until term with these two knots and we hypothesize that this was the cause of the IUGR. Our case was interesting as neither neurologic sequela nor intrauterine death developed, despite two true umbilical cord knots. Harran University Faculty of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey Sakarya University Faculty of Medicine, Department of Obstetrics and Gynecology, Sakarya, Turkey Introduction True umbilical cord knots may occur in approximately 0.3-2% of all births. The placenta is a discoid reddish-brown structure attached to the uterine wall that binds the fetus to the mother via the umbilical cord. A normal umbilical cord contains two arteries and one vein. Wharton’s jelly is a special substance contained within the umbilical cord which serves to protect the vessels from trauma by acting as a cushion. A true umbilical knot develops when a fetus slips through a loop in the umbilical cord. The most common symptom of a true knot is reduced fetal activity after 37 weeks. Complications may develop during delivery, although they do not increase the risk of fetal death. Prognosis may be very good with proper delivery, care and management. Risk factors for a true umbilical knot include: Proceedings in Obstetrics and Gynecology, 2017;7(3):8 True knot of the umbilical cord 2 multiple pregnancy including twins, a long umbilical cord, fetuses that are small for their gestational age, polyhydramnios, and monozygotic twins. Diagnosis of a true umbilical cord knot includes routine ultrasound examination during pregnancy, color Doppler ultrasound, examination of the placenta and umbilical cord during delivery. The best method for antenatal diagnosis of a true umbilical cord is three-dimensional Doppler ultrasound.

Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis

Abstract This study was planned to investigate whether measuring of Doppler indices with TV-DUS improved the diagnosis of adenomyosis. Preoperative Doppler indices of subjects with a preliminary diagnosis of adenomyosis were compared with the histopathological results of excised specimens. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of the measured indices were also calculated. Sensitivity, specificity, PPV and NPV and positive and negative likelihood ratios (LR+) and (LR−) of TV-US in the diagnosis of adenomyosis were found to be 70.8%, 62.1%, 40.4%, 85.4%, 1.96 and 0.47, respectively. Sensitivity, specificity, PPV, NPV, LR + and LR − in the diagnosis of adenomyosis following the addition of TV-DUS were found to be 90%, 94.2%, 81.8%, 97%, 15.5 and 0.10, respectively. Concomitant use of TV-US and TV-DUS improved correct diagnosis of adenomyosis with high sensitivity.

Comparison of sVCAM-1 and sICAM-1 levels in maternal serum and vaginal secretion between pregnant women with preterm prelabour ruptures of membranes and healthy pregnant women

Abstract Objective: The study aims to evaluate the maternal serum and the vaginal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecular (sICAM-1) in pregnant women complicated by preterm prelabour ruptures of membranes (PPROM). Materials and methods: The prospective case control study included 34 pregnant women with PPROM and 34 healthy pregnant women. Patients with additional diseases, a smoking habit and vaginal bleeding, as well as those using antibiotics, during the study period were not included in the study. Cervicovaginal fluid and serum samples were taken during the patients’ admission. The demographic data, maternal serum and vaginal fluid sVCAM-1 and sICAM-1, C reactive protein (CRP) and leukocyte counts were noted for all pregnant women included in the study. The sVCAM-1 and sICAM-1 levels were measured by enzyme-linked immunosorbent assay kits. Results: In pregnant women with PPROM, the serum leukocyte (mean ± SD =11.41 ± 1.067 versus 9.18 ± 1.56, p < .0001), serum sVCAM-1 (median 771.20 versus 704.60 ng/ml, p < .001), sICAM-1 (mean ± SD 213.10 ± 35.59 ng/ml versus 188.11 ± 37.35 ng/ml, p = .06), vaginal sVCAM-1 (median 208.00 versus 140.20 ng/ml, p = .014) and sICAM-1 (mean ± SD 32.32 ± 6.49 ng/ml versus 24.87 ± 6.79 ng/ml, p < .001) values were found to be significantly higher in pregnant women with PPROM than in healthy pregnant women. A positive and significant correlation was observed between the leukocyte count and the vaginal sVCAM-1 level (r = 0.850; p < .001). Conclusion: To the best of our knowledge, this is the first study evaluating the levels of sICAM-1 in maternal serum in pregnant women with PPROM. The maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels can be used as biochemical markers supporting the PPROM diagnosis because of the increase in both maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels in pregnant women with PPROM.

Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital

Abstract Objective: The main objective of this study is to analyse the circumstances and management of peripartum hysterectomies performed on patients with placenta percreta. Methods: This study included 37 patients who were diagnosed with placenta percreta, a condition in which the placenta invades the uterine wall, and who therefore underwent a peripartum hysterectomy. Their demographic characteristics, history of past caesareans, uterine surgery and curettage, duration of hospitalization, admission to an intensive care unit, neonatal outcomes, skin and uterus incision type, hypogastric artery ligation (HAL), complications, quantities of transfused ES (erythrocyte suspensions), and FFP (fresh frozen plasma), maternal morbidity and mortality and postoperative pathology results were retrospectively reviewed. Results: All pregnant patients who underwent a caesarean hysterectomy due to placenta percreta had a history of caesarean section and also of placenta praevia totalis. Bilateral HAL was performed in two patients (5.4%), owing to uncontrollable bleeding during the bladder dissection. The complications most frequently observed were bladder injury (13.5%), followed by infection (8.1%) and relaparotomy (5.4%). There was no mortality. Twenty-three (62.2%) of the patients had ES and 11 patients (29.7%) had FFP transfusions. According to the histopathology findings, 33 of the 37 patients (89.1%) reportedly had placenta percreta, three patients had placenta increta, and one patient had placenta accreta. Analysis of the neonatal status at birth showed that the gestational age was, on average, the 35th week. The birth weight was normal in relation to the gestational week, but the first and fifth minute Apgar score, which measures the physical condition of an infant, was found to be lower than the normal range. Conclusions: If a pregnant patient undergoes uterine surgery or has a history of a caesarean with placenta praevia, she is likely to have placenta percreta. In placenta percreta cases with bladder invasion; careful suturing of the high-volume vessels on the posterior wall of the bladder, through the bladder serosa is important in reducing the amount of bleeding and preventing future fistula formation.