Reproduction, Fertility and Development, Dec 17, 2021
This study was based on the pathophysiology of the disease and aimed at predicting ovarian hypers... more This study was based on the pathophysiology of the disease and aimed at predicting ovarian hyperstimulation syndrome (OHSS) by determining the importance of ratios obtained from the inflammatory process associated with oestradiol and progesterone in recent years. Out of 242 infertile women who underwent assisted reproductive therapy, 59 patients who developed OHSS were taken as the study group, while the remaining 122 normo-responder (NR) and 61 hyper-responder (HR) patients constituted the control group. The neutrophil to lymphocyte (NLR) and oestradiol/progesterone (EPR) ratios were found to be statistically significantly higher in the OHSS group (P < 0.001). A multivariate logistic regression analysis revealed that the NLR (OR = 2.410, P = 0.001) and EPR (OR = 1.701, P = 0.028) were independent predictors for the development of OHSS. In conclusion, in OHSS inadequate progesterone levels may inhibit suppression of the exaggerated inflammatory process caused by high E2 levels, and NLR and EPR can be used to predict the development of OHSS in patients undergoing controlled ovarian hyperstimulation during in vitro fertilisation cycles.
Jinekoloji - obstetrik ve neonatoloji tıp dergisi, Jun 18, 2017
Aim: In this study, we aimed to investigate contraceptive intentions after voluntary termination ... more Aim: In this study, we aimed to investigate contraceptive intentions after voluntary termination of pregnancy among adolescents. Material And Methods: The medical records of 133 adolescents who applied to Etlik Zubeyde Hanim Women’s Health Teaching and Training Hospital Family Planning Clinics between June 2014 and December 2015 for elective surgical abortion were reviewed. Demographic variables and contraceptive choices after abortion were evaluated. Results: The mean age was 17.6 years (min= 16, max=19). After voluntary termination of pregnancy, the most preferred contraception method was condom % 29.3 and oral contraceptives % 25.6 respectively. The rate of use of intrauterin device and long acting hormonal contraceptive methods were similar and found %12.8. The percentage of women who applied no contraception was %19.5. Conclusion: Adolescents need to effective contraceptive counseling protocols and intensive efforts should be spent for reducing adolescent pregnancies and perinatal complications of this group.
O granulosa cell tumors (GCT) are rare neoplasms that arise from the sex cord stromal cells of th... more O granulosa cell tumors (GCT) are rare neoplasms that arise from the sex cord stromal cells of the ovary and represent 2% to 5% of all ovarian cancers.1 The tumors most commonly affect adults, but 5% present in prepuberty.1 Peak incidence of GCT is in the age group of 50-55 years.1 Granulosa cell tumors are hormonally active tumors and the main symptoms are a result of hyperestrogenism. In the reproductive age group, patients may have menstrual irregularities such as menorrhagia, intermenstrual bleeding, or amenorrhea, and in postmenopausal women, abnormal uterine bleeding may be the presenting symptom.1 However, acute pelvic pain caused by tumor rupture and hemoperitoneum may be rarely the first sign of disease. We present a rare cause of acute abdomen syndrome due to ruptured ovarian GCT in a premenopausal woman. A 45-year-old multiparous premenopausal patient was admitted to our emergency service with acute pelvic pain. Vital signs were stable except for tachycardia. Abdominal tenderness and left adnexal mass was detected by pelvic examination. The patient complained of menometrorrhagia for 3 months and all laboratory tests including complete blood count, s-human chronic gonadotropin, and infection markers were within normal limits. A solid mass (82x67 mm) in the left ovary with 73x22 mm free intra-abdominal liquid was determined during the transvaginal ultrasonographic examination (Figure 1). Doppler measurement of the mass was resistance index (RI): 0.57 and pulsatility index (PI): 0.86 (Figure 2). Hemoglobin level showed a decreasing pattern, and acute abdomen symptoms developed during the follow-up period. Therefore, laparoscopic surgery was performed. At surgery, ruptured left ovarian mass, and intra-abdominal 1000 cc of fresh and old blood clots were detected. Laparoscopic left salpingo-oophorectomy was performed. Frozen section examination was reported as GCT. Therefore, the operation was extended to the right salpingooferectomy, total abdominal hysterectomy, bilateral pelvic, and para-aortic lymphadenectomy. Final pathologic examination was reported as “stage IC granulosa cell tumor.” The patient received platinum-based adjuvant chemotherapy, postoperatively. Granulosa cell tumors are rare and reported incidents of 0.58-1.6/100.000 women a year.2 These tumors secrete estradiol, and this is responsible for the clinical signs like menorrhagia, intermenstrual bleeding or amenorrhea.3 Approximately 25-50% of GTCs are associated with endometrial hyperplasia whereas 5-13% are associated with an endometrial cancer.1 Endometrial cancer related to GTCs is usually well differentiated, at early stage and with good prognosis. Granulosa cell tumors are staged surgically according to the International Federation of Gynecology and Obstetrics ovarian cancer staging system. Assessment of stage is the most important factor in determining prognosis and to guide postoperative treatment recommendations. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy is recommended for women who are done with Clinical Note
ABSTRACT To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up unti... more ABSTRACT To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up until 42 weeks and induction if the patient has still not given birth at 42 weeks. Six hundred women at 287+/-1 days of gestation with definitely unfavorable cervical scores were randomized to labor induction (N=300) or spontaneous follow-up (N=300) with twice-weekly nonstress testing and amniotic fluid measurement and once-weekly biophysical scoring. The treatments used in the induction group were (1) vaginal administration of 50 microg misoprostol (n=100), (2) oxytocin induction (n=100), and (3) transcervical insertion of a Foley balloon (n=100). The primary outcome measures were the cesarean delivery rate, whether or not the normal hospital stay had to be extended, and the neonatal outcomes. Secondary outcome measure included number of emergency cesarean deliveries performed for abnormalities of the fetal heart rate (FHR). The abdominal delivery rate was 19.3% in the induction group and 22% in the follow-up group (p=0.4). The mean length of hospital stay in the two main groups was 1.4+/-0.8 days and 1.3+/-1 days, respectively (p=0.1). Significantly higher rates of macrosomia and shoulder dystocia were seen in the follow-up group (24.6 and 2.3%) than in the induction group (7.6%, p<0.001; 0.3%, p=0.03). Meconium-stained amniotic fluid and meconium aspiration syndrome were observed significantly less frequently in the induction group (9.3 and 1.3%) than in the follow-up group (20.3%, p<0.001; 4%, p=0.03). Rates of emergency abdominal delivery in response to worrying FHR traces, neonatal intensive care unit admission, and low umblical artery pH were similar in the two groups. There was one intrauterine fetal death in the follow-up group. Induction of labor at 41 weeks of gestation does not increase the cesarean delivery rate or cause a longer stay in hospital than follow-up until 42 weeks, and neonatal morbidity is also lower after induction.
Background: Cornual pregnancy is a rare type of ectopic pregnancy. Methotrexate (MTX) has been us... more Background: Cornual pregnancy is a rare type of ectopic pregnancy. Methotrexate (MTX) has been used successfully for the treatment of tubal pregnancies; however, its use for interstitial pregnancies is less common. Cases: Three cases of cornual pregnancy were successfully treated with a single MTX injection (50 mg/m2), without complications. Conclusion: A single MTX injection as medical treatment is an alternative to surgical treatment of cornual pregnancies.
Aim: The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year e... more Aim: The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center. Material & Method: Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited for this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period. Results: Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Tw...
Aim of the study is to evaluate the pregnancy outcome and recurrence of the disease in patients w... more Aim of the study is to evaluate the pregnancy outcome and recurrence of the disease in patients with endometrioma. All patients who underwent laparoscopic surgery for endometrioma between January 2017- 2020 in Etlik Zubeyde Hanim Women Health Training and Research Hospital, had a stage 3-4 disease, and met the inclusion criteria were evaluated. The exclusion criteria were; being menopausal, having laparotomy for endometrioma surgery, or presence of concomitant leiomyoma. The post-operative reproductive outcome and the recurrence rate were evaluated. Out of the 97 patients recruited, 57 (58.8%) were followed up for infertility, while the remaining forty had no desire for future pregnancy. Sixty-seven patients had elective surgery, and 30 (30.9%) underwent emergency surgery. Pregnancy was achieved in 18 (31.5%) within 3-18 months (8.94±4.54) after surgery, of which seven (38.8%) were spontaneous pregnancies while 11 had pregnancy through assisted reproductive techniques. The live birt...
Reproduction, Fertility and Development, Dec 17, 2021
This study was based on the pathophysiology of the disease and aimed at predicting ovarian hypers... more This study was based on the pathophysiology of the disease and aimed at predicting ovarian hyperstimulation syndrome (OHSS) by determining the importance of ratios obtained from the inflammatory process associated with oestradiol and progesterone in recent years. Out of 242 infertile women who underwent assisted reproductive therapy, 59 patients who developed OHSS were taken as the study group, while the remaining 122 normo-responder (NR) and 61 hyper-responder (HR) patients constituted the control group. The neutrophil to lymphocyte (NLR) and oestradiol/progesterone (EPR) ratios were found to be statistically significantly higher in the OHSS group (P < 0.001). A multivariate logistic regression analysis revealed that the NLR (OR = 2.410, P = 0.001) and EPR (OR = 1.701, P = 0.028) were independent predictors for the development of OHSS. In conclusion, in OHSS inadequate progesterone levels may inhibit suppression of the exaggerated inflammatory process caused by high E2 levels, and NLR and EPR can be used to predict the development of OHSS in patients undergoing controlled ovarian hyperstimulation during in vitro fertilisation cycles.
Jinekoloji - obstetrik ve neonatoloji tıp dergisi, Jun 18, 2017
Aim: In this study, we aimed to investigate contraceptive intentions after voluntary termination ... more Aim: In this study, we aimed to investigate contraceptive intentions after voluntary termination of pregnancy among adolescents. Material And Methods: The medical records of 133 adolescents who applied to Etlik Zubeyde Hanim Women’s Health Teaching and Training Hospital Family Planning Clinics between June 2014 and December 2015 for elective surgical abortion were reviewed. Demographic variables and contraceptive choices after abortion were evaluated. Results: The mean age was 17.6 years (min= 16, max=19). After voluntary termination of pregnancy, the most preferred contraception method was condom % 29.3 and oral contraceptives % 25.6 respectively. The rate of use of intrauterin device and long acting hormonal contraceptive methods were similar and found %12.8. The percentage of women who applied no contraception was %19.5. Conclusion: Adolescents need to effective contraceptive counseling protocols and intensive efforts should be spent for reducing adolescent pregnancies and perinatal complications of this group.
O granulosa cell tumors (GCT) are rare neoplasms that arise from the sex cord stromal cells of th... more O granulosa cell tumors (GCT) are rare neoplasms that arise from the sex cord stromal cells of the ovary and represent 2% to 5% of all ovarian cancers.1 The tumors most commonly affect adults, but 5% present in prepuberty.1 Peak incidence of GCT is in the age group of 50-55 years.1 Granulosa cell tumors are hormonally active tumors and the main symptoms are a result of hyperestrogenism. In the reproductive age group, patients may have menstrual irregularities such as menorrhagia, intermenstrual bleeding, or amenorrhea, and in postmenopausal women, abnormal uterine bleeding may be the presenting symptom.1 However, acute pelvic pain caused by tumor rupture and hemoperitoneum may be rarely the first sign of disease. We present a rare cause of acute abdomen syndrome due to ruptured ovarian GCT in a premenopausal woman. A 45-year-old multiparous premenopausal patient was admitted to our emergency service with acute pelvic pain. Vital signs were stable except for tachycardia. Abdominal tenderness and left adnexal mass was detected by pelvic examination. The patient complained of menometrorrhagia for 3 months and all laboratory tests including complete blood count, s-human chronic gonadotropin, and infection markers were within normal limits. A solid mass (82x67 mm) in the left ovary with 73x22 mm free intra-abdominal liquid was determined during the transvaginal ultrasonographic examination (Figure 1). Doppler measurement of the mass was resistance index (RI): 0.57 and pulsatility index (PI): 0.86 (Figure 2). Hemoglobin level showed a decreasing pattern, and acute abdomen symptoms developed during the follow-up period. Therefore, laparoscopic surgery was performed. At surgery, ruptured left ovarian mass, and intra-abdominal 1000 cc of fresh and old blood clots were detected. Laparoscopic left salpingo-oophorectomy was performed. Frozen section examination was reported as GCT. Therefore, the operation was extended to the right salpingooferectomy, total abdominal hysterectomy, bilateral pelvic, and para-aortic lymphadenectomy. Final pathologic examination was reported as “stage IC granulosa cell tumor.” The patient received platinum-based adjuvant chemotherapy, postoperatively. Granulosa cell tumors are rare and reported incidents of 0.58-1.6/100.000 women a year.2 These tumors secrete estradiol, and this is responsible for the clinical signs like menorrhagia, intermenstrual bleeding or amenorrhea.3 Approximately 25-50% of GTCs are associated with endometrial hyperplasia whereas 5-13% are associated with an endometrial cancer.1 Endometrial cancer related to GTCs is usually well differentiated, at early stage and with good prognosis. Granulosa cell tumors are staged surgically according to the International Federation of Gynecology and Obstetrics ovarian cancer staging system. Assessment of stage is the most important factor in determining prognosis and to guide postoperative treatment recommendations. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy is recommended for women who are done with Clinical Note
ABSTRACT To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up unti... more ABSTRACT To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up until 42 weeks and induction if the patient has still not given birth at 42 weeks. Six hundred women at 287+/-1 days of gestation with definitely unfavorable cervical scores were randomized to labor induction (N=300) or spontaneous follow-up (N=300) with twice-weekly nonstress testing and amniotic fluid measurement and once-weekly biophysical scoring. The treatments used in the induction group were (1) vaginal administration of 50 microg misoprostol (n=100), (2) oxytocin induction (n=100), and (3) transcervical insertion of a Foley balloon (n=100). The primary outcome measures were the cesarean delivery rate, whether or not the normal hospital stay had to be extended, and the neonatal outcomes. Secondary outcome measure included number of emergency cesarean deliveries performed for abnormalities of the fetal heart rate (FHR). The abdominal delivery rate was 19.3% in the induction group and 22% in the follow-up group (p=0.4). The mean length of hospital stay in the two main groups was 1.4+/-0.8 days and 1.3+/-1 days, respectively (p=0.1). Significantly higher rates of macrosomia and shoulder dystocia were seen in the follow-up group (24.6 and 2.3%) than in the induction group (7.6%, p<0.001; 0.3%, p=0.03). Meconium-stained amniotic fluid and meconium aspiration syndrome were observed significantly less frequently in the induction group (9.3 and 1.3%) than in the follow-up group (20.3%, p<0.001; 4%, p=0.03). Rates of emergency abdominal delivery in response to worrying FHR traces, neonatal intensive care unit admission, and low umblical artery pH were similar in the two groups. There was one intrauterine fetal death in the follow-up group. Induction of labor at 41 weeks of gestation does not increase the cesarean delivery rate or cause a longer stay in hospital than follow-up until 42 weeks, and neonatal morbidity is also lower after induction.
Background: Cornual pregnancy is a rare type of ectopic pregnancy. Methotrexate (MTX) has been us... more Background: Cornual pregnancy is a rare type of ectopic pregnancy. Methotrexate (MTX) has been used successfully for the treatment of tubal pregnancies; however, its use for interstitial pregnancies is less common. Cases: Three cases of cornual pregnancy were successfully treated with a single MTX injection (50 mg/m2), without complications. Conclusion: A single MTX injection as medical treatment is an alternative to surgical treatment of cornual pregnancies.
Aim: The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year e... more Aim: The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center. Material & Method: Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited for this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period. Results: Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Tw...
Aim of the study is to evaluate the pregnancy outcome and recurrence of the disease in patients w... more Aim of the study is to evaluate the pregnancy outcome and recurrence of the disease in patients with endometrioma. All patients who underwent laparoscopic surgery for endometrioma between January 2017- 2020 in Etlik Zubeyde Hanim Women Health Training and Research Hospital, had a stage 3-4 disease, and met the inclusion criteria were evaluated. The exclusion criteria were; being menopausal, having laparotomy for endometrioma surgery, or presence of concomitant leiomyoma. The post-operative reproductive outcome and the recurrence rate were evaluated. Out of the 97 patients recruited, 57 (58.8%) were followed up for infertility, while the remaining forty had no desire for future pregnancy. Sixty-seven patients had elective surgery, and 30 (30.9%) underwent emergency surgery. Pregnancy was achieved in 18 (31.5%) within 3-18 months (8.94±4.54) after surgery, of which seven (38.8%) were spontaneous pregnancies while 11 had pregnancy through assisted reproductive techniques. The live birt...
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