Sertac Esin

A comparison of short-term outcomes between laparoscopic supracervical and total hysterectomy

OBJECTIVE The purpose of this study was to compare perioperative outcome measures of laparoscopic supracervical (LSH) and total hysterectomies (TLH). STUDY DESIGN This is a retrospective analysis of 1016 LSHs and TLHs at a tertiary medical center between November 1999 and August 2008 in a multivariate logistic regression model. RESULTS Overall, the groups were similar. Most of the perioperative outcome measures did not differ statistically between the groups. However, the risk of serious complications was higher for TLH (5.8% vs 2.5%; odds ratio [OR], 2.72; 95% confidence interval [CI], 1.35-5.49). Specifically, urinary tract injury occurred more frequently in TLH (2.2% vs 0.5%; OR, 4.75; 95% CI, 1.21-18.56). Conversion to laparotomy was significantly more common in TLH (5.8% vs 4.1%; OR, 2.25; 95% CI, 1.20-4.22). CONCLUSION In this largest comparison, short-term morbidity of TLH and LSH is overall similar. TLH presents a clinically small, but statistically significant, increased risk of urinary tract injury and conversion to laparotomy.

The Manchester operation for uterine prolapse

To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation.

Comparison of Sublingual Misoprostol With Lidocaine Spray for Pain Relief in Office Hysteroscopy: A Randomized, Double-Blind, Placebo-Controlled Trial

STUDY OBJECTIVE To compare the effectiveness of sublingual misoprostol with lidocaine pump spray for office hysteroscopy. DESIGN Premenopausal women who had an indication for office hysteroscopy were included in this randomized, double-blind, placebo-controlled study. Eighty-two patients were evaluable for the final analysis. SETTING A tertiary referral center. PATIENTS Premenopausal women who had an indication for office hysteroscopy were included. Eighty-two patients were evaluable for the final analysis. INTERVENTIONS Patients were randomized to receive either sublingual misoprostol and placebo of lidocaine or lidocaine pump spray applied to the cervix and placebo of misoprostol. MEASUREMENTS AND MAIN RESULTS When compared with the lidocaine group, patients in the misoprostol group reported less pain by the immediate visual analog scale scores (2.2 ± 0.98 vs. 2.6 ± 0.99, p = .030), whereas visual analog scale scores at 10 minutes were similar between groups (2.1 ± 0.98 vs. 2.36 ± 1.06, p = .156). CONCLUSION Sublingual misoprostol is more effective than lidocaine spray in pain reduction during office hysteroscopy. Misoprostol may cause vaginal spotting, which may impair the vision during hysteroscopy especially just after the menstrual period. Preventive measures should be taken to make the procedure pain free because the physician may underestimate pain perception during the procedure.

Fetal tyhmus size as a predictor of histological chorioamnionitis in preterm premature rupture of membranes

Abstract Objective: To predict histological chorioamnionitis (CA) in the cases of preterm premature rupture of membranes by using fetal thymus transverse and anteroposterior diameters and areal measurements. Methods: Fifty healthy and 50 patients diagnosed with preterm premature rupture of membranes (PPROM) between 24 and 37 weeks of gestation were included in the study. Fetal thymus measurements were done and repeated on a weekly basis until delivery, Furthermore white blood cell, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured every other day until delivery, too. Following delivery, all patients’ placentas were sent to pathology. Results: Histological CA was detected in 48% of the PPROM patients. There were no patients in either group with clinical CA. Thymus transverse diameter had 91% sensitivity, 81% specificity, 82% PPV, and 91% NPV in predicting histological CA in PPROM patients. No linear relationship was found between thymus anteroposterior diameter measurements and gestational age. Thymus area measurements have sensitivity of 75%, specificity of 81%, PPV of 78%, NPV of78% in determining CA in patients with PPROM. Conclusion: Both thymus transverse diameter and area measurement are more significant than sedimentation and CRP values in predicting histological CA. Fetal thymus measurements can be used in early diagnosis of infections among high risk patients.

Chocolate or orange juice for non-reactive non-stress test (NST) patterns: a randomized prospective controlled study

Abstract Objective: The objective of the study was to compare bitter chocolate and orange juice with the control group for non-reactive non-stress test (NST) patterns and for maternal perception of fetal movements. Study design: Pregnant women who were followed-up on an outpatient basis and admitted for a NST and had a non-reactive result were randomized prospectively into bitter chocolate, orange juice and control groups. 180 patients were evaluable for the final analysis. Results: Although there was a trend for orange juice group for having higher percentages of reactive NST patterns on control, there was no statistically significant difference between three groups (p = 0.159). Besides this, maternal perception of increased fetal movements was similar between groups (p = 0.755). The control group had lower post-test capillary blood glucose concentrations when compared with chocolate and orange juice groups (p = 0.01) and after post-hoc tests, this difference was found to be between orange juice and control groups. Conclusions: Although orange juice resulted in higher blood glucose levels, this was not synonymous with better NST results on control; in such a way that bitter chocolate, orange juice and no intervention had similar effects on non-reactive NST patterns and also on maternal perception of fetal movements.

Finding the Best Formula to Predict the Fetal Weight: Comparison of 18 Formulas

Background: To compare the accuracy of 18 formulas in predicting fetal weight and also to make a comparison of these formulas in low-birth-weight fetuses (<2,500 g) and in fetuses weighing >4,000 g. Methods: Four-hundred-and-ninety-five pregnant patients were enrolled. The estimated fetal weight was calculated using 18 different formulas. The mean percentage error, the mean absolute percentage error and reliability analysis were used to compare the performance of the formulas. Results: The Cronbachs alpha was the highest in the formulas Hadlock I (0.977 (95% CI = 0.972-0.980)), Hadlock III (0.977 (95% CI = 0.972-0.980)) and Ott (0.975 (95% CI = 0.970-0.979)) in all fetuses. It was the highest in formulas Ott (0.383 (95% CI = 0.091-0.581)), Hadlock IV (0.371 (95% CI = 0.074-0.572)) and Combs (0.369 (95% CI = 0.071-0.571)) in fetuses >4,000 g. It was the highest in formulas Coombs (0.957 (95% CI = 0.940-0.569)), Ott (0.956 (95% CI = 0.939-0.968)) and Hadlock IV (95% CI = 0.956 (0.938-0.968)) in fetuses <2,500 g. Conclusion: We noted that formulas Hadlock I, Hadlock III and Ott may be used to predict the estimated fetal weight accurately in all fetuses in our study. Formulas Ott, Hadlock IV and Coombs may be preferred to predict EFW in fetuses <2,500 g and >4,000 g. Better formulas should be developed to predict the fetal weight in fetuses >4,000 g.

Adnexal masses encountered during cesarean delivery

To outline and discuss the clinical features and outcomes of adnexal masses that were treated during cesarean delivery at a tertiary referral hospital located in Ankara, Turkey.

The Effect of Parity on Labor Induction with Prostaglandin E2 Analogue (Dinoprostone): An Evaluation of 2090 Cases

Objective: The aim of this study was to investigate the effect of parity on cervical ripening and labor induction with intra-vaginal slow-release dinoprostone and to determine the safety and efficacy of this medication in a tertiary referral center. Methods: The medical records of 2090 pregnant women who underwent cervical ripening and induction of labor with Dinoprostone between January 2007 and December 2010 were retrospectively reviewed. All women included in the study had singleton pregnancies greater than 37 gestational weeks and the Bishop score was less than 4. Our induction of labor policy was to use dinoprostone for patients <35 years old and low parity (≤ 2). Ten milligram of intravaginal slow-release dinoprostone was applied vaginally for 24 hours. Nulliparousand multiparous patient results were compared. Results: One thousand one hundred seventy two nulliparous and 918 multiparous patients were included in the study. Indications for induction of labor were; post-term pregnancy in 67.2%, oligohydramniosis in 11.8 %, severe intrauterine fetal growth restriction in 9.7%, severe gestational hypertension or chronic hypertension or preeclampsia necessitating delivery in 6.8 %, and premature rupture of membranes in 4.4 %. The mean patient age, gestational age, parity and Bishop Score before induction were 25.22 ± 4.9, 40.21 ± 1.2, 1.6 ± 0.4 and 2.47 ± 0.2, respectively. The induction to active phase, active phase to vaginal delivery and induction to vaginal delivery durations for nulliparous and multiparous groups were (7.5 ± 6.3 vs. 6.8 ± 6.0, p=0.012) and (7.7 ± 5.6 vs. 5.8 ± 5.0, p=0.001) and (15.6 ± 7.7 vs. 13.5 ± 5.4, p=0.023), respectively. The delivery rates during the first 24 hours after application of dinoprostone were 65.7 % and 71.5 % for nulliparous and multiparous patients, respectively (p=0,001). In the nulliparous group, the change in Bishop Score was significantly higher than the multiparous patient group (p=0.034). During labor, 31.1% of the patients needed oxytocin augmentation and this was 34.9% in the nulliparous and 26.4% in the multiparous groups (p=0.001). The cesarean delivery rate was higher in the nulliparous group (34.3% vs. 24.9%, p=0.002). The percentage of newborns with 5-minute Apgar scores less than 7 and the percentage of newborns requiring neonatal intensive care unit (NICU) were similar between nulliparous and multiparous groups. Conclusion: Dinoprostone seems to be an effective agent for induction of labor in patients with an unfavorable cervix for patients <35 years old and with low parity (≤ 2). The induction to vaginal delivery duration is shorter and delivery rate in the first 24 hours is higher in multiparous group. The perinatal outcomes are comparable between groups.

Fetal echogenic bowel in association with Zellweger syndrome

Increased echogenicity of fetal bowel in the second trimester obstetrical ultrasound has been described in association with several pathologic conditions, such as growth restriction, aneuploidy, cystic fibrosis, congenital infections, and gastrointestinal malformations. Zellweger syndrome (ZS) is the prototype of peroxisomal disorders characterized by craniofacial dysmorphism and severe neurologic abnormalities. We report two cases with fetal echogenic bowel (FEB) but no associated anomalies and normal fetal growth. After birth, clinical and laboratory findings led to diagnosis of ZS. Association of FEB with neurometabolic disorders is limited to a few case reports in the medical literature. To the best of our knowledge, this is the first report of ZS associated with FEB.

Pfannenstiel vs. midline incision for early stage endometrial carcinoma

Surgical staging is the cornerstone of the management of endometrial carcinoma and it is generally performed through a midline incision (MI). However complication rates are higher and more serious following MIs than Pfannenstiel incisions (PIs). Moreover these complications may be more frequent in patients with endometrial carcinoma since most have comorbidities such as diabetes or obesity. This prospective study compares the 2 incisions with respect to early postoperative morbidity and adequacy for systematic lymph node dissection. Between 2000 and 2005 168 consecutive patients with endometrial carcinoma underwent surgery at the Department of Obstetrics and Gynecology of Hacettepe University Faculty of Medicine Ankara Tqrkiye. Exclusion criteria were as follows: (1) Advanced stage disease or extra uterine metastasis; (2) unfavorable histologic study results (clear-cell carcinoma or serous papillary carcinoma); (3) high-grade disease (grade 3); (4) previous hysterectomy without lymph node dissection; (5) cancer antigen 125 level greater than 35 U/mL; (6) severe cardiopulmonary disease precluding steep Trandelenburg position; (7) preoperative chemotherapy or radiotherapy. (excerpt)