Murat Bozkurt

Surgery for Benign Gynecological Disorders Improve Endometrium Receptivity: A Systematic Review of the Literature

Regardless of the anatomical locations, some benign gynecological disorders (BGDs) such as peritoneal endometriosis, ovarian endometrioma, adenomyosis, uterine leiomyomas, endometrial polyps, uterine septum, and hydrosalpinges may lead to implantation failure. Despite progress in medical therapies, surgery remains a mainstay of BGDs treatment. Although our knowledge of endometrial receptivity after BGDs surgery is limited, it has allowed for significant improvement in the treatment of female subfertility. Many researchers studied on pregnancy outcome following BGDs surgery, but they did not investigate the possible impact of surgery on endometrial receptivity. They, therefore, concluded that pregnancy rates improved after BGDs surgery based on clinical observations. Many of these clinicians believe that surgical resection of BGDs leads to removal of local mechanical effect over the endometrium. Moreover, they accept that BGDs surgery may inhibit the detrimental signaling and secretion of some molecules from the BGDSs into the endometrium that may lead to favorable effect on the endometrium. However, so far, data from randomized controlled trials or systematic review or meta-analyses to answer the question whether surgical treatment of BGDs can improve endometrial receptivity are lacking. The purpose of this systematic review was to evaluate the results of available publications dealing with the impact of reproductive surgery for BGDs on endometrial receptivity.Regardless of the anatomical locations, some benign gynecological disorders (BGDs) such as peritoneal endometriosis, ovarian endometrioma, adenomyosis, uterine leiomyomas, endometrial polyps, uterine septum, and hydrosalpinges may lead to implantation failure. Despite progress in medical therapies, surgery remains a mainstay of BGDs treatment. Although our knowledge of endometrial receptivity after BGDs surgery is limited, it has allowed for significant improvement in the treatment of female subfertility. Many researchers studied on pregnancy outcome following BGDs surgery, but they did not investigate the possible impact of surgery on endometrial receptivity. They, therefore, concluded that pregnancy rates improved after BGDs surgery based on clinical observations. Many of these clinicians believe that surgical resection of BGDs leads to removal of local mechanical effect over the endometrium. Moreover, they accept that BGDs surgery may inhibit the detrimental signaling and secretion of some molecules from the BGDSs into the endometrium that may lead to favorable effect on the endometrium. However, so far, data from randomized controlled trials or systematic review or meta-analyses to answer the question whether surgical treatment of BGDs can improve endometrial receptivity are lacking. The purpose of this systematic review was to evaluate the results of available publications dealing with the impact of reproductive surgery for BGDs on endometrial receptivity.

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.

Application of Bakri balloon in a patient who developed massive postpartum hemorrhage after caesarean section

Postpartum hemorrhage is an important emergency in obstetrics. In this study, we present the application of intrauterine balloon tamponade and its outcomes in a patient who developed massive postpartum hemorrhage after caesarean section. A 39year-old, G5 P3 and 38 weeks pregnant (based on last menstrual period) patient was subjected to emergency caesarean section due to diagnosis of uteroplacental insufficiency and recurrent caesarean section. Four hours after the operation, atony occurred and despite medical treatment the hemorrhage persisted. We inserted a SOS Bakri balloon through the vaginal route and inflated it with 500cc intracavitary saline for achievement of intrauterine tamponade. Vaginal bleeding ended immediately after the procedure. Use of an intrauterine balloon is an easy-to-apply alternative to surgery that provides rapid hemostasis in serious postpartum hemorrhages. Taksim Education and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Universal Hospitals Group, Department of Obstetrics and Gynecology, Malatya, Turkey Taksim Education and Research Hospital, Department of Anesthesiology and Critical Care, Istanbul, Turkey

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.

Can evaluation of the cervix with histogram and Bishop scoring prior to birth induction forecast the birth type for superannuated primigravidas

Purpose: We conducted this study to research both the forecasting efficiency of the cervical histogram and Bishop scoring for birth type (vaginal birth/cesarean) for the superannuated primigravida prior to birth induction. Methods: Ninety primigravidas in week 41 and beyond were included in the present study. Exclusions for the study included prior labor, ruptured membranes, any major uterine operations, cephalopelvic discord, fetal malpresentations, fetal anomalies, multiple pregnancy, placenta previa, vaginal bleeding, a high sensitivity for oxytocin usage, and an estimated fetal weight greater than 4000 g. Histogram hyperechogenic focus and hypoechogenic focus measurements are conducted in normal spontaneous birth (NSD) and cesarean (SECTIO) groups. Findings: Thirty-six patients had a cesarean birth, while 54 of the patients had vaginal births. On logarithmical regression analysis, the Bishop score and the parameters were found statistically significant in terms of proving the cesarean indication (p=0.001). In our cervical histogram, the forecasting efficiency of the hyperechogenic focus and hypoechogenic focus measurements for determining the birth type were not been able to shown (p=0.089 ; p=0.555). Bishop scoring parameters showed statistically significant deviances between the NSD group compared to the cesarean group in terms of a 1-2 cm increase in cervical opening and for being 3-4 cm(p=0.0001), the cervical extinguishment as 40%-50% (p=0.0001), the occurrence of cervical softening (p=0.0001), and the head level at -1 and -2 (p=0.0001). When declaring the cesarean indication, the Bishop score’s AUC value was found as 0.932 and the LR(+) value as 9; while the estimation value for the Bishop score occurring below <5 increased the cesarean birth risk ninefold. Conclusion: During a superannuated nulliparous pregnancy, the Bishop score and the Bishop score’s individual parameters are meaningful for vaginal birth, while a cervical histogram is not significant for forecasting the

To compare aneuploidy rates between ICSI and IVF cases

Introduction: Intracytoplasmic sperm injection (ICSI) currently helps many couples with male infertility. However, ICSI procedure may cause asynchronous sperm decondensation. This could introduce a risk for aneuploidy. The ICSI technique also could cause damage to the second meiotic spindle during injection and cause significantly abnormal pairing of chromosomes when compared with In vitro fertilization (IVF). In this study, we have examined whether ICSI has a higher incidence of aneuploidy when compared with IVF. Material and Methods: A retrospective study was conducted on 36 individuals. Common numbers of chromosome abnormalities were detected using fluorescent in-situ hybridization (FISH). Seven probes were used to detect chromosome X, Y, 13, 16, 18, 21, and 22. Chi-square test was used for statistical analysis and presented as odd ratios with confidence intervals. Results: The age range was 26 through 44 (mean age 35.5) for IVF and 25 through 46 (mean age 35.8) for ICSI. From the 36 egg retrievals, 57 embryos were obtained from nine individuals using IVF and 183 embryos were obtained from 27 individuals using ICSI. For the IVF group, 37 of the 57 examined embryos were abnormal (65%), whereas 128 of 183 examined embryos were abnormal for the ICSI group (69.9%). Among the 57 embryos from the IVF cases, the number of absolute abnormal chromosomes were as follows: X&Y chromosomes: 4 (12.9%), chromosome 13: 9 (29%), chromosome 16: 7 (22.5%), chromosome 18: 6 (19.3%), chromosome 21: 8 (25.8%), chromosome 22: 10 (32.2%). For the ICSI embryos: X and Y chromosomes: 18 (14%), chromosome 13: 34 (26.5%), chromosome 16: 23 (18%), chromosome 18: 23 (18%), chromosome 21: 26 (20.3%), chromosome 22: 31 (24.2%). The odds ratios for the difference between IVF and ICSI for each chromosome were as follows: X&Y chromosomes: 1.53 (0.598-3.916), chromosome 13: 0.969 (0.443-2.122), chromosome 16: 0.709 (0.307-1.639), chromosome 18: 1.650 (0.650-4.188), chromosome 21: 0.777 (0.350-1.724), chromosome 22: 0.647 (0.311-1.348). Overall no significant difference between two insemination procedures was seen 0.948 (0.678-1.324). Conclusions: As a result; ICSI does not create a significantly higher aneuploidy number when compared with IVF as examined by FISH analysis of seven chromosome pairs.

Does preparation for childbirth training reduce the cesarean rate

Purpose: This study was conducted as experimental and prospective to determine the effect of birth preparation training on the birth route preparations of pregnant individuals. Methods: The study was conducted in three state hospitals which operate under Kocaeli State Hospitals Community. The study group included 110 pregnant individuals who attended the hospitals’ birth preparation training classes between 1 January – 30 June 2015 and the control group included 90 pregnant individuals from Kocaeli Maternity Hospital. The chisquared test was used to measure the differences between groups in classified variables, and the t-test was used for parametric variables. P <0.05 was considered to be

Evaluation of the efficiency of antibiotic prophylaxis in cesarean cases

Background: In recent years the rate of cesarean section has significantly increased.To determine the efficacy of prophylactic antibiotics in reducing infectious morbidity after cesarean section. Objectives: In our study, we aimed to evaluate the efficiency of prophylactic antibiotic administration by comparing three groups using single, multiple and no prophylactic antibiotic therapy. Materials and Methods: Our study is a prospective, randomized controlled study including emergent cases, that developed cesarean indication while in active labor, and elective cesarean cases. A total of 90 patients were included in the study, including 30 patients who underwent cesarean delivery and did not undergo an antibiotic prophylaxis (Group 1), 30 patients who underwent a single dose antibiotic prophylaxis (Group II) and 30 patients who underwent multiple dose antibiotic prophylaxis (Group III). Results: The incidence of wound infection was significantly higher in cases that were not using antibiotics at postoperative days 3, 5 and 7 compared to the cases using single and multiple antibiotics. There was not a significant difference between groups in terms of endometritis. Conclusion: Administration of prophylactic antibiotics prevent wound infection but does not prevent development of endometritis.

Adnexal torsion in the first trimester of a spontaneous pregnancy: detorsion and oophoropexy

Introduction: Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. In this case report, we present a case of adnexal torsion during the first trimester of pregnancy and its treatment. Case Presentation: A 28-year old, gravida 1, para 0 patient at 9 weeks gestational age presented to the antenatal clinic with acute abdominal pain in the right lower-abdominal quadrant. The patient was diagnosed with torsion of the right adnexa during pregnancy, and detorsion was performed. The patient was followed throughout the course of pregnancy. She delivered a healthy baby at term by caesarian section. During the caesarian section, both of the adnexa were observed to be normal. Conclusions: With acute abdominal pain, especially in the lower-abdominal quadrant during pregnancy, adnexal pathologies should be considered. Diagnosis of adnexal torsion during the first trimester of pregnancy is often missed due to the nonspecific clinical features and uncommon objective findings. Although surgical intervention should be considered to treat pregnant women suffering from adnexal torsion regardless of the gestational week, abdominal surgery carries some risks to the pregnant woman and unborn fetus.

HORMON REPLASMAN TEDAVİSİNİN MAMOGRAFİK PARANKİM DANSİTESİ ÜZERİNE ETKİSİ

Amac: Yapilan calismada Hormon Replasman Tedavisi (HRT) alan hastalarda parankimal dansite degisikliklerinin, HRT ile olan iliskisi, bu tedavi rejimleri ile artan dansite miktarinin tayinini ve farkli hormon preparatlari kullanan postmenopozal hasta gruplarinin mamografik parankimal dansite degisikliklerinin karsilastirilmasi amaclandi. Materyal ve Metod: Calismaya 05.01.1999- 1.3.2003 tarihleri arasinda Taksim Egitim ve Arastirma Hastanesi menopoz poliklinigine basvuran ve menopoz tanisi konulan 82 hasta dahil edildi. 32 hastaya TAH+BSO operasyonu uygulanmisti. Bu grup kontinu estrojen tedavisi almaktaydi. Gruplardan digerleri degisik hormon replasman tedavi rejimleri almaktaydilar. 10 gruba ayrilan hastalarin her yil cekilen mamografi kontrolleriyle parankimal dansite degisimleri incelendi. Bulgular : HRT alan hastalarin mamografik parankim dansite sonuclari Wolfe klasifikasyonuna gore degerlendirildi. • Mamogfafik dansite artisi %24.3 (n:20). • Mamografik dansite azalisi %7.3 (n:6). • Mamografiik dansitesi sabit olanlar %68.2 (n:56) olarak bulundu. (not: n hasta sayisini gosterir.) Kontinu estrojen tedavisi alan (Climara tts, premarin ve estrofem oral tab) grupta dansite artisi %25 (n:8), azalma %3.1 (n:1), sabit kalma %71.8 (n:23) olarak bulundu. Estrojen ve progesteron kombine kontinu HRT alan grupta dansite artisi %41.6 (n:10), azalma %0 (n:0), sabit kalma %58.3 (n:14) olarak bulundu. Tibolon (Livial oral tablet) kullanan grupta dansite artisi %7.6 (n:2), dansitede azalma %19.2 (n:5), sabit kalma %73 (n:19) olarak bulundu. Sonuc: Calismamizda mamografik parankimal dansitenin en fazla arttigi grup kontinu estrojen+progesteron kullanan hastalardi. Bu grupta dansite artisi %41.6 oraninda idi. Tibolon kullanan grupta bu oran %7.6 ile en dusuk bulunmustur.