Yusuf Çakmak

Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia.

Successful vaginal birth after cesarean section is more comfortable than repeat emergency or elective cesarean section. Antenatal examinations are important in selection for trial of labor, while birth management can be difficult when the patients present at emergency condition. But there is an increased chance of vaginal birth with advanced cervical dilation. This study attempts to evaluate factors associated with success of vaginal birth after cesarean section and to compare the maternal and perinatal outcomes between vaginal birth after cesarean section and intrapartum cesarean section in patients who were admitted to hospital during the active or second stage of labor. A retrospective evaluation was made from the results of 127 patients. Cesarean section was performed in 57 patients; 70 attempted trial of labor. The factors associated with success of vaginal birth after cesarean section were investigated. Maternal and neonatal outcomes were compared between the groups. Vaginal birth after cesarean section was successful in 55% of cases. Advanced cervical opening, effacement, gravidity, parity, and prior vaginal delivery were factors associated with successful vaginal birth. The vaginal birth group had more complications (P<0.01), but these were minor. The rate of blood transfusion and prevalence of changes in hemoglobin level were similar in both groups (P>0.05). In this study, cervical opening, effacement, gravidity, parity, and prior vaginal delivery were important factors for successful vaginal birth after cesarean section. The patients’ requests influenced outcome. Trial of labor should take into consideration the patient’s preference, together with the proper setting.

The relationship between hyperemesis gravidarum and maternal psychiatric well-being during and after pregnancy: controlled study

Abstract Objective: Psychiatric symptoms of varying degrees that accompany hyperemesis gravidarum (HG) may continue throughout the pregnancy or after, and these psychological problems may cause morbidity. In this study, we aimed to evaluate the relationship between the HG and psychiatric symptoms in the first trimester and postpartum depression. Methods: Two hundred and seven pregnant who were diagnosed as HG and 177 healthy pregnant women included in this prospective study. All cases were assessed with SCL-90-R in first trimester and with ED in postpartum period. Factors related to postpartum psychiatric symptoms were investigated with bivariate logistic regression analysis. Results: SCL-90-R and ED scores were statistically significant at HG group (p < 0.05). In cases who diagnosed as postpartum depression, the rates of HG and SCL-90-R results were higher (p< 0.05). In the bivariate analysis, the high rates of HG and high SCL-90-R scores were determined to be related to postpartum depression (p < 0.05). Conclusions: The results show that mental health is negatively affected by HG at pregnancy, and in this case, psychiatric symptoms may continue even after discontinuation HG.

Serum serotonin, leptin, and adiponectin changes in women with postpartum depression: controlled study

PurposePostpartum depression (PPD) affects nearly 10% of mothers after delivery and has many serious results. Although many factors associated with PPD, the etiology, and pathophysiology of PPD are not known completely. The relationship between serum serotonin concentration and depression is well known, but there are no enough data regarding the serum change of leptin and adiponectin. The aims of this study are to research the level of serum serotonin, leptin,s and adiponectin concentrations in women with PPD.Materials and methodsA controlled trial has been conducted in three centers. Two hundred and forty four women were evaluated at postpartum day 10 with the Edinburgh Postnatal Depression Scale (EPDD). Venous blood samples were collected and serotonin, and leptin and adiponectin levels were studied using human enzyme-linked immunosorbent assay. Mann–Whitney U test was used for comparison of serum levels of serotonin, leptin, and adiponectin between women with PPD and without. A p value of <0.05 was considered significant.ResultsPPD was detected in 70 postpartum women. The mean serum serotonin level was significantly lower in the group with PPD (p = 0.001), while mean serum adiponectin level was higher (p = 0.001). The mean serum leptin level was not different (p = 0.133).ConclusionsThe serum adiponectin and leptin levels were high in women with PPD. This could play important role in the pathophysiology of PPD. Elevation of serum levels also may play antidepressant role against PPD, especially the early postpartum period.

Bilateral sacrospinous fixation without hysterectomy: 18-month follow-up

OBJECTIVE The aim of this study was to evaluate the results of bilateral sacrospinous fixation (SSF), which was performed with surgical mesh interposition and bilateral vaginal repair. MATERIAL AND METHODS Twenty-two patients underwent SSF between 2010 and 2012, and the results were evaluated retrospectively. The results at preoperative and postoperative 6(th), 12(th), and 18(th) months of the pelvic organ prolapse quantification system (POP-Q) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) were compared using Friedman and Wilcoxon Signed Ranks tests. Values of p<0.05 and <0.01 were considered statistically significant. RESULTS According to the POP-Q, significant healing was observed on all vaginal vault points (p=0.001), and no prolapse was observed until the 18-month follow-up stage. There were also prominent patients who felt satisfactory with respect to their sexual life according to PISQ-12 (p=0.001). CONCLUSION This technique appears to provide an adequate clinical resolution, and it may be the primary surgical option for women with pelvic organ prolapse.

Does performing cesarean section after onset of labor has positive effect on neonatal respiratory disorders

Abstract Objective: The aim of this study is to evaluate whether neonatal respiratory disorders relate to the onset of labor or labor pain in patients with history of previous cesarean section. Methods: This prospective controlled study comprised 164 patients, grouped according to the presence of labor and related labor pain. All patients in both groups were applied cesarean section at 38 weeks gestational age or beyond due to previous cesarean section. The cord blood pH, Apgar scores and the need for the neonatal intensive care unit were compared. Results: There was a greater need for the neonatal intensive care unit in the control group and the cord blood pH values were higher in the study group (p < 0.05). No significant difference was determined between the groups in respect of Apgar scores (p > 0.05). Conclusion: The onset of labor and related labor pain provide a positive contribution to a reduction in neonatal respiratory disorders. Therefore, it can be considered reasonable to perform a cesarean section after the onset of labor or related pain.

The Degree of Ultrasonographic Amniotic Fluid Echogenicity for the Prediction Meconium Staining During Labor

ABS TRACT Objective: The aim of this study is to evaluate the relationship between appearance of amniotic fluid on ultrasound and presence of meconium during labor. Material and Methods: This prospective study was conducted on 376 laboring women. The relationship between the degree of amniotic fluid echogenicity (normal, mild, intense) and degree of meconium stained amniotic fluid (clear, mild, thick) during labor was investigated. Positive and negative predictive values for determining meconium-staining amniotic fluid were evaluated using chi-square and Fisher’s-exact tests. A value of p<0.05 was accepted as statistically significant. Results: The rate of echogenic amniotic fluid imaging on ultrasound was 44.4%. The consistency rate between the ultrasonography and amniotic fluid examination during/after labor was 51.1%, which was not statistically significant (p=0.121). However the negative predictive value of non-thick echogenicity was 84.3% in ruling out thick meconiumstained fluid, only when amniotic fluid index was normal (p<0.05). Conclusion: Ultrasonographic echogenity of amniotic fluid is generally not a reliable method for predicting meconium-stained amniotic fluid. However in pregnancies with normal amniotic fluid, absence of thick echogenicity seems reliable for predicting the absence of thick meconium-stained amniotic fluid.

Postpartum Depression and Associated Factors in Patients Who Admitted to Our Clinic to Make Child Birth

Yöntemler: Bu çalışma prospektif kontrollü çalışma olup 482 olgu incelendi. Antenatal dönemde tüm olgular Beck depresyon ölçeği ile değerlendirildi. Beck depresyon ölçeğine göre 17 ve üzerinde puan alan olgular çalışmadan çıkartıldı. Çalışma 431 olgu ile tamamlandı. Olguların yaş, evlilik süreleri ve sayısı, eğitim durumları, ekonomik faktörler, kişisel faktörler yanı sıra doğum ve yenidoğan ile ilgili faktörlerin PPD ile ilişkisi araştırıldı. PPD olan ve olmayan gruplar arasında bu faktörler Pearson ki-kare testi ile karşılaştırıldı. Ayrıca multilojistik regresyon analizi ile PPD ile ilişkili faktörler araştırıldı. İstatistiksel anlamlılık p değerinin 0,05 altında olması şeklinde değerlendirildi.

Can Urinary Catheterization Before Birth Reduce Postpartum Urinary Retention

Objective: Postpartum urinary retention (PUR) is defined as no spontaneous micturition in a period of more than 6 hours postpartum or residual volume of >150cc after urination. If a diagnosis is not made, there may be problems of over-distention of the bladder and consequently, denervation, detrusor atony and long-term micturition problems. This study aimed to examine the effect of urinary catheterization during birth on postpartum urinary retention (PUR). Study Design: A prospective randomized study was conducted with 137 patients. The study and control groups were formed according to a random number table. In the study group, urinary catheterization was applied before birth. In both groups, the time of the first postpartum micturition was recorded and after the first micturition, the residual urine volume was measured with catheterization. Cases with no spontaneous micturition in the first 6 hours postpartum were accepted as PUR. The two groups were compared with respect to time of first micturition and residual urine volume using Mann Whitney U-test and the presence of PUR with Chi-square test. Results: The time to first micturition was determined to be shorter in the group where urinary catheterization was applied before birth, the PUR rate was lower and the amount of residual urine was less (p 0.05). Conclusion: Urinary catheterization before birth reduces the rate of PUR.

Non-sirotik portal hipertansiyonda gebeliğin başarılı yönetimi: olgu sunumu

Giris: Gebelik ve karaciger hastaligi nadir ve karmasik bir durum olarak ele alinir. Saglikli bir karacigerde bile gebelige ozgu komplikasyonlarin yani sira, onceki portal hipertansiyonuna bagli karaciger hasari varligi belirgin hemodinamik sorunlara yol acan ilave riskler gelistirir . Olgu: 22 yasinda non-sirotik portal hipertansiyonlu profilaktik endoskopik varis ligasyonu yapilmis bir hastanin ek komplikasyon olmayan gebeligi sunulmustur. Gebelik terme kadar sorunsuz izlenmis ve basarili bir sezaryen gerceklestirilmistir. Sonuc : Non-sirotik portal hipertansiyonda karaciger fonksiyonlari genellikle korunur ve gebelige bagli ozofagus varis kanamasi riskindeki artis tartismaya aciktir .

Serviks poliplerinin klinikopatolojik değerlendirmesi

Amac: Klinik pratikte servikal poliplerin nasil yonetilecegi yaygin bir tartisma konusudur. Randomize kontrollu prospektif calismalar etik olarak dogru bulunmadigindan bu konudaki calismalar retrospektif olmaktadir. Malin transformasyon potansiyeli pre ve postmenapozal hastalarda endise olusturmaktadir. Bu calismada, servikal polip gorulen hastalarda, semptom ve menopoz durumuna gore polipektomi piyeslerinin patoloji sonuclarinin karsilastirilmasi amaclanmistir. Gerec ve Yontem: Servikal polip tanisi konulan 245 hasta retrospektif olarak incelendi. Total olarak 270 polip incelendi. Patoloji sonuclari menopoz durumu ve semptomlara gore Fisher’s Exact Test ve Fisher-Freeman-Halton Test ile karsilastirildi. Istatistiksel anlamlilik p<0.05 ve p<0.01 olarak kabul edildi. Bulgular: Olgularda invazif hastalik gorulmedi. Sadece postmenapozal bir hastada servikal intraepitelyal neoplazi (CIN 1) goruldu. Poliplerin %39,6’si (n=97) asemptomatik hastalarda, %53,9’u (n=132) anormal uterin kanamasi olan hastalarda ve % 6,5’i (n=16) missed abortus ile basvuran hastalarda goruldu. Anormal uterin kanamasi olan olgularda servikal polip belirgin olarak fazla idi. Sonuc: Rutin servikal polipektomi gereksizdir. Kolposkopi kullanimi ve sitoloji klinik ve menopozal durumun degerlendirilmesiyle beraber polipektomiden once dikkate alinmalidir.