Vedat Atay

Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility

OBJECTIVE To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. DESIGN Retrospective case report series. SETTING The obstetrics and gynecology clinic of a medical school. PATIENT(S) Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. INTERVENTION(S) Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. MAIN OUTCOME MEASURE(S) Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. RESULT(S) Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. CONCLUSION(S) Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.

Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia

The aim of this cohort is to investigate whether any haematologic changes detectable by simple complete blood count (CBC) precede pre‐eclampsia development and the diagnostic value of these markers in clinical practice for prediction of pre‐eclampsia.

Evaluation of neonatal outcomes in elective repeat cesarean delivery at term according to weeks of gestation

Aim:  Our aim is to evaluate the association between gestational age at delivery and neonatal outcomes in elective cesarean delivery.

Aromatase inhibitors for infertility in polycystic ovary syndrome : the beginning or the end of a new era?

A meta-analysis of four trials showed significant advantage in pregnancy and delivery rates with aromatase inhibitors compared with CC in women with PCOS. A recent randomized trial demonstrated no clear benefit.

Serum vitamin B12 and homocysteine levels in pregnant women with neural tube defect

Objective. The aim of the study is to investigate the importance of serum vitamin B12 levels in pregnant women with foetal neural tube defect (NTD). Study design. This study consists of 31 pregnant women having fetuses with NTD. The pregnant women in the study group were selected among cases with normal folate levels. Serum vitamin B12 levels were investigated. Additionally, complete blood count, serum iron level, iron binding capacity, ferritin, folate, free T3, free T4, thyroid stimulating hormone and plasma homocysteine levels were measured. Control group consisted of 32 pregnant women who did not have a history of NTD in previous pregnancies and did not have fetuses with NTD in present pregnancy. NTD was diagnosed between14th and 20th gestational age. The mean gestational age of members of control group was the same as those of NTD group. Results. There was no statistically significant difference between pregnants with NTD and control group according to number of cases with vitamin B12 deficiency. Conclusion. It seems that vitamin B12 deficiency does not play a causative role in the development of foetal NTD. Monitoring maternal homocystein levels might be important in understanding the aetiologies of foetal NTD.

Prenatal diagnosis of vertebral deformities associated with pentalogy of Cantrell: The role of three-dimensional sonography?

Pentalogy of Cantrell was diagnosed in a fetus at 14 weeks of gestation, on routine two‐dimensional sonographic examination with Doppler imaging, which revealed a midline supraumbilical abdominal wall defect including herniated liver, an ectopia cordis without intracardiac anomalies, and a large omphalocele containing intestines. Although left unilateral club foot deformity was also detected as an associated anomaly in the same examination, severe lumbar lordoscoliosis was only detected by using three‐dimensional sonography because of the spatial configuration of the deformity. After termination of the pregnancy, postnatal inspection of the fetus confirmed the diagnosis of pentalogy of Cantrell associated with skeletal deformities and revealed low implant ears as an additional finding. Although two‐dimensional sonography with Doppler imaging is sufficient to diagnose pentalogy of Cantrell, it may fail to show the complex vertebral deformities and three‐dimensional sonography may assist in visualizing the defect accurately.

The outcome of adding peripheral neuromodulation (stoller afferent neuro-stimulation) to anti-muscarinic therapy in women with severe overactive bladder

Objective. Anti-muscarinic treatment alone and peripheral neuromodulation with concomitant anti-muscarinic treatment were compared in patients with severe overactive bladder. Methods. In this prospective study, 40 women with severe overactive bladder according to the 7-day voiding diary without any prior treatment completed the Incontinence Impact Questionnaire (IIQ-7) and were randomised into anti-muscarinic-alone and combination treatment groups. Twenty women received daily 4 mgs of tolterodine orally and in 20 women Stoller afferent neuro-stimulation (SANS) therapy was performed concomitantly for 12 weeks to the same anti-muscarinic regimen. After 12 weeks of therapy, two of the patients drop out of the study and remaining patients filled out the IIQ-7 questionnaire and the 7-day voiding diary again. Pretreatment and post-treatment QoL scores and the 7-day voiding diaries were compared. Mann–Whitney U, Wilcoxon and two sided significance tests were used. Results. Thirty-eight women fulfilling the criteria were included in the study. Severity of overactive bladder symptoms decreased significantly in both treatment groups. However, the decrease in combination treatment group was more significant than the anti-muscarinic-alone group. Adverse events were similar between the two groups. Conclusion. Combining SANS and anti-muscarinic therapy resulted in significantly better clinical outcomes and IIQ-7 scores as compared with anti-muscarinic treatment alone in patients with severe overactive bladder.

Tension-Free Vaginal Tape for Surgical Relief of Intrinsic Sphincter Deficiency: Results of 5-year Follow-up

STUDY OBJECTIVE We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. DESIGN A prospective study (Canadian Task Force classification II-3). SETTING Tertiary center of medical faculty. PATIENTS We studied 47 patients. INTERVENTIONS Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. MEASUREMENTS AND MAIN RESULTS Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth years follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. CONCLUSION Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.

First trimester screening for Down syndrome in rhesus negative women.

To explore the effect of maternal rhesus status on first‐trimester screening markers for Down syndrome.

Predictive value of amniotic fluid volume measurements on perinatal outcome

Amniotic fluid volumes were measured in 1,659 pregnant women to determine the predictive value of these measurements on perinatal outcome. All cases were evaluated by other tests of fetal well-being. 128 cases were oligohydramniotic, and 1,531 cases were normal. In all cases, several parameters were assayed, e.g. fetal distress, way of delivery, meconium in amniotic fluid, Apgar score, transfer to pediatric clinics and early-late neonatal complications. The results of the perinatal evaluation of oligohydramnios were as follows: assessing fetal distress: specificity 94.2%, sensitivity 18.4%, positive predictive value 35.9%, negative predictive value 86.7% and accuracy 82.8%, and assessing low Apgar score the values were 93.0, 21.3, 95.9 and 89.5%, respectively. As a result, measurement of the amniotic fluid volume is an important parameter predicting perinatal outcome, and its predictive value increases if it is combined with other fetal well-being tests with different end points.