Meryem Kurek Eken

Sirenomelia: a review of embryogenic theories and discussion of the differences from caudal regression syndrome

Abstract Objective: To discuss the pathological features of sirenomelia in the light of our 10 cases and review the current theories. Methods: We identified 10 patients with sirenomelia from our hospital database. All clinical details and the autopsy features of 10 cases were noted. Results: Of the 10 children with sirenomelia seven had bilateral renal agenesis, three had bladder agenesis and one had a renal hypoplasia. Single umbilical artery was found in 60% of children with sirenomelia. External genitalia was ambiguous in seven of 10 patients. Conclusions: Even though the etiology of caudal regression syndrome (CRS) and sirenomelia remains unknown we tend to believe that sirenomelia and CRS might be different entities.

Major determinants of survival and length of stay in the neonatal intensive care unit of newborns from women with premature preterm rupture of membranes

Abstract Objective: To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM). Methods: A population-based retrospective study including 331 singleton pregnant women with PPROM at 24–34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age, oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival. Results: In linear regression analyses, birth weight, ROP, CCD, BPD, PDA, NEC and preeclampsia were significant confounders for length of stay in the NICU. Among them, birth weight was the most powerful confounder for prolongation of the NICU stay (t: −6.43; p < 0.001). In multivariate logistic regression analyses, birth weight, PDA, ROP and PPH were significantly correlated with neonatal survival. PPH was the most powerful confounder in neonatal survival (β: 7.22; p = 0.005). Conclusion: Prematurity-related complications are the most important problems for which precautions should be taken. Therefore, premature deliveries should be avoided to prevent infection and to prolong the latent period in cases of PPROM in order to decrease prematurity-related outcomes.

The impact of abdominal and laparoscopic hysterectomies on women’s sexuality and psychological condition

Objective: To investigate whether there were any differences in the quality of life, sexual function, and self-esteem of patients who underwent total laparoscopic hysterectomy (TLH) (n=42) and total abdominal hysterectomy (TAH) (n=42). Materials and Methods: All premenopausal patients who underwent TLH or TAH because of benign uterine disorders were enrolled. The sexual function and quality of life status were assessed preoperatively and 6 months postoperatively using three standardized validated questionnaires: the Arizona Sexual Experiences Scale (ASEX), the Symptom Checklist-90-Revised (SCL-90-R), and the Rosenberg Self-Esteem Scale (RSES). Results: Preoperative ASEX, SCL-90-R and RSES scores were not different among the hysterectomy subgroups. The postoperative SCL-90-R scores were also not different among the hysterectomy subgroups. The postoperative RSES scores were significantly lower (p<0.05) than the preoperative scores for all procedures (indicating improved self-esteem) but did not differ among the groups. The postoperative ASEX scores were significantly decreased (p<0.01) as compared with the preoperative scores (indicating improved sexual function). When the average score of each item of the ASEX score was compared in both groups, significant differences were observed in sexual drive and arousal in the laparoscopy group (p<0.01). Conclusion: Women undergoing TLH for benign uterine disease may have better outcomes related to certain sexual function parameters than women undergoing TAH.

The Timing of Embryo Transfer Catheter Removal: Should It be Delayed or Done Immediately A Prospective Randomized Trial

Background/Aims: Data on the timing of catheter removal technique following embryo transfer (ET) are quite limited. We aimed to compare the reproductive outcomes of intracytoplasmic sperm injection (ICSI)/ET cycles in which the transfer catheter was removed immediately with those in which the catheter was removed after a delay period and hereby to evaluate the impact that the time interval before removal of the catheter following embryo deposit may have on the fertility outcomes. Methods: A prospective randomized study was designed. ICSI/ET patients <40 years were randomly assigned to either of the group from which catheter was withdrawn immediately within the first 5 s (Group A) or after a 30 s delay (Group B) following ET. Results: Groups A and B consisted of 147 and 148 patients, respectively. Patient demographics and stimulation characteristics were comparable between the groups. Pregnancy rate was 32.2% (95 of 295) and clinical pregnancy rate was 28.8% (85 of 295), whereas ongoing pregnancy was 24.4% (72 of 295) and implantation rate was 29.6% (100 of 338). The comparison of reproductive outcomes revealed no significant differences in pregnancy (p = 0.933), clinical pregnancy (p = 0.673), ongoing pregnancy (p = 0.590), multiple pregnancy (p = 0.801), and implantation rates (p = 0.979) between the groups. Conclusion: No significant difference was observed in the reproductive outcomes between the groups; thus, there appears no requirement to delay the withdrawal of the catheter to improve the outcomes in ICSI cycles.

N-acetylcysteine leads to greater ovarian protection than enoxaparin sodium in a rat ovarian torsion model

This study evaluated the effects of N-acetylcysteine (NAC) and enoxaparin on ovarian tissue preservation, ovarian reserve and oxidative damage following ovarian torsion/detorsion injury. Rats were divided into four groups (n = 6/group): control; ischaemia/reperfusion (I/R); I/R + NAC; I/R + enoxaparin. Twenty-four hours after detorsion, ovarian tissues were collected for histopathological analysis and measurement of tissue 8-OHdG, GSH, MDA, MPO and SOD concentrations, as well as pre- and post-operative circulating AMH concentrations. Administration of NAC resulted in more pre-antral follicles compared with enoxaparin treatment and haemorrhage and follicle cell degeneration were more pronounced in I/R + enoxaparin group than I/R + NAC group. Both NAC and enoxaparin led to a significant reduction in ovarian tissue 8-OHdG (P = 0.004 and P = 0.01, respectively) and MPO (P = 0.013 and P = 0.023, respectively) concentrations compared with I/R group, indicating a protective effect against I/R oxidative damage. Only NAC-treated animals showed a significant increase in GSH and SOD concentrations and decrease in MDA concentrations compared with I/R group (P = 0.007, P = 0.024 and P = 0.026, respectively). These results indicate that NAC is more effective than enoxaparin in minimizing ovarian damage and preserving ovarian reserve following ovarian torsion.

The effect of labour pain in caesarean delivery on neonatal and maternal outcomes in a term low-risk obstetric population

Abstract Planned caesarean delivery (CD) frequency is increasing in many countries, and elective CD accounts for 50% of preventable causes of neonatal respiratory morbidity. The clearing of fluid in the lungs is important for the establishment of normal gas exchange with inspired air. A defect in this clearance can result in respiratory problems in neonate, but on the other hand patients waiting for the onset of spontaneous labour pain, the increase in emergency CD, together with severe mortality and morbidity are causes of concern and cause anxiety and distrust of obstetricians. In the current study, it was observed that foetal respiratory morbidity was reduced in the group with labour pain. The caesarean applied after the onset of labour pain could be a reason for the significant increase in foetal cord cortisol values in term low-risk neonates. A major advantage of this study was the inclusion of a low-risk patient group, and the increase in foetal cortisol secondary to pain in term neonates was shown objectively. Impact statement What is already known on this subject: The timing of CD is reported to be critical for neonatal morbidity, and elective CD accounts for 50% of preventable causes of neonatal respiratory morbidity. The clearing of fluid in the lungs is important for the establishment of normal gas exchange with inspired air. Cortisol secretion from the foetal adrenal gland is stimulated by stress. What do the results of this study add: Labour pain-related stress in the foetus might be a cause for elevated physiological cortisol, and secondary to that, lower respiratory morbidity. Caesarean delivery commenced after the onset of labour pain could be a reason for the significant increase in foetal cord cortisol values in term neonates. A major advantage of this study was the inclusion of a low-risk patient group, and the increase in foetal cortisol secondary to pain in term neonates was shown objectively. What are the implications of these findings for clinical practice and/or further research: Although it would seem to be rational to perform a caesarean section after the onset of labour pain in cases with a planned caesarean and a history of C-section delivery, with respect to maternal complications, especially in those with a history of more than one caesarean or those who have started active labour; there is a need for further prospective studies.

Do younger women with elevated basal follicular stimulating hormone levels undergoing gonadotropin-stimulated intrauterine insemination cycles represent compromised reproductive outcomes?

OBJECTIVE To compare stimulation characteristics and reproductive outcomes in women representing elevated and normal day 3 FSH levels and to evaluate the prognostic significance of day 3 FSH on the reproductive outcomes of gonadotropin-stimulated IUI (GS-IUI) cycles in women <35 years. STUDY DESIGN A cross-sectional study was designed. Unexplained infertility patients at the age ≤36 years, who underwent IUI, following gonadotropin stimulation (GS), were investigated. From 105 women with a day 3 FSH≥ 10U/L, 170GS/IUI cycles were assigned to Group EF; whereas a control group (Group NF, normal FSH) was constituted of 170 cycles with a day 3 FSH levels <10U/L. Demographic and stimulation characteristics as well as reproductive outcomes were compared. Primary outcome measure of this study was the biochemical, clinical and ongoing pregnancy rates. Secondary outcome measures were total gonadotropin dose, duration of gonadotropin stimulation, multiple pregnancy, miscarriage and cycle cancellation rates. RESULTS β-hCG positivity, clinical and ongoing pregnancy rates did not differ between women with normal and elevated FSH levels (p=0.234, 0.282 and 0.388, respectively). Total gonadotropin dose, multiple pregnancy and miscarriage rates were not significantly different between the groups (p=0,181, 0.652 and 0.415, respectively). Duration of stimulation was significantly longer and cycle cancellation rate was significantly higher in Group EF than in Group NF (p=0.005 and 0.021, respectively). CONCLUSION Younger women with elevated day 3 FSH represent comparable reproductive outcomes in GS-IUI cycles to those with normal FSH levels, although they may require longer periods of stimulation and are at higher risk of cycle cancellation. Thus, GS-IUI could be a possible treatment option in this patient group and should not be neglected.

What is Turkish women's opinion about vaginal delivery?

Objective: To determine Turkish women’s opinion about vaginal birth. Materials and Methods: This prospective cohort study was conducted in Department of Obstetrics and Gynecology of Süleymaniye Maternity Research and Training Hospital in İstanbul, Turkey, between February 2015 and April 2015. The participants of this study were 100 primiparous pregnant women who had vaginal deliveries. The women were interviewed face-to-face after the birth. Data were collected through a socio-demographic and clinical questionnaire. Results: Ninety percent of the women reported vaginal birth as the ideal mode of delivery route; a minority of the women (10%) had decided on cesarean birth before having a vaginal birth. Anxiety of pain was the major factor that influenced choice of delivery type before giving birth. After vaginal birth, 84% of women were satisfied with vaginal birth and reported that they would prefer vaginal birth for their next pregnancy. However, 16% reported that they would prefer cesarean birth for their next pregnancy due to pain of labor, pain of episiotomy, anxiety, and prolonged duration of labor. Conclusion: The results suggest the majority of women prefer to give birth vaginally and reported vaginal birth as the ideal choice.

Effect of vaginal washing before intravaginal dinoprostone insertion for labor induction: A randomized clinical trial

Prostaglandins have a dual action of cervical ripening and induction of uterine contraction. This study was designed to compare the effectiveness of vaginal washing just before insertion of intravaginal dinoprostone.

Serum procalcitonin levels together with clinical features and inflammatory markers in women with tubo-ovarian abscess for discriminating requirements for surgery for full recovery

Abstract Tubo-ovarian abscess (TOA) coexists in 15% of cases with pelvic inflammatory disease. Medical treatment is the first line of approach in women with TOA, however, 25% of cases fail to respond to antibiotics, therefore, these cases need to undergo surgical intervention. We aimed to determine factors leading to failure of medical treatment in women diagnosed with TOA. According to our results among 144 women, 27 cases required surgical intervention for full recovery. None of the demographic, sonographic or laboratory findings, including procalcitonin level, had significant predictive value for the failure of medical treatment in women with TOA. Impact statement What is already known on this subject? Tubo-ovarian abscess (TOA) coexists in 15% of cases with pelvic inflammatory disease. Medical treatment is the first line approach in women with TOA, however, 25% of cases fail to respond to antibiotics, therefore, these cases need to undergo surgical intervention. Several risk factors have been evaluated in order to predict the failure of medical treatment. What do the results of this study add? None of the variables, including age, parity, mass diameter, serum CRP, procalcitonin levels and sedimentation rate had significant value for predicting TOA cases that required surgical intervention for full recovery. What are the implications of these findings for clinical practice and/or further research? In clinical practice, identification of risk factors leading to the failure of medical treatment helps clinicians to inform patients and help surgeons predict those who need surgical intervention.