Relationship between second trimester uterina artery doppler ultrasonography and poor pregnancy prognosis in low risk Turkish population

AMAÇ: Düşük riskli Türk populasyonunda preeklampsi, intrauterin gelisim kısıtlılığı, erken doğum gelişebilecek gebeliklerin önceden saptanmasında uterin arter spektral Doppler ultrasonografisinin etkinliğini araştırmak. GEREÇ ve YÖNTEM: Araştırmaya 2000 - 2003 tarihleri arasında antenatal polikliniğe basvuran,18-22. haftaları arasında rutin fetal biyometri, ayrıntılı organ taraması ve bilateral uterin arter spektral Doppler uygulanan 1029 adet gebe dahil edildi. Çoğul gebelikler ve fetal anomali saptanan hastalar araştırma kapsamına alınmadı. Doğum sonrası hastalar telefon ile aranarak, gebelik seyri ve sonucu ile ilgili veriler standart bir telefon röportaj formu yardımı ile alındı. Bilateral Uterin arterlerin PI değerleri z-skorları, hesaplanarak normal grup ile intrauterin gelişim kısıtlılığı, preeklampsi, erken doğum gruplarındaki ortalama PI-z skor farklılıkları irdelendi. ROC eğrileri yardımı ile her bir kötü prognoz için optimum esik değerler ve bu değerlere göre Doppler uygulamalarının öngörüdeki tanısal belirleyiciliği saptandı. Uterin arterler için çentikleşme sıklıkları da belirlenerek kötü prognoz öngörüsündeki tanısal belirleyicilikleri incelendi. BULGULAR: Kırküç kadında (%4,2) preeklampsi, 62 kadında (%6,1) <5 persantil dogum(IUGG), 214 kadında (%20,8) 37 hafta altı dogum, 6 kadında (%0,6) intrauterin ölüm, 36 kadında (%3,5) neonatal ölüm görüldü. Uterin arter pulsatilite indeksi Z skoru ortalama degerleri preeklampsi, IUGG, erken dogum olgularında sırasıyla: 0.53, 0.55, 0.14 idi. Uterin arter PI degeri z skoru optimum esik degerleri preeklampsi, IUGG, erken dogum için sırasıyla 0.12, 0.59 ve 1.58 olarak bulundu. Bu esik degerlerde uterin arter z skorunun duyarlık, özgüllük, pozitif ve negatif belirleyici değerleri preeklampsi için 0.44, 0.76, 0.07, 0.97; IUGG için 0.22, 0.83, 0.07, 0.95; erken dogum için 0.09, 0.93, 0.24, 0.79. Bilateral uterin arterde prediastolik çentik preeklampsi, intrauterin gelisim geriligi gruplarında yüksek oranda saptandı (p<0,05). Erken doğum grubunda farklılık izlenmedi. Prediastolik çentik için, duyarlık, özgüllük, pozitif ve negatif belirleyici değerleri sırasıyla preeklampsi için 0.25, 0.83, 0.05, 0.87 intrauterin gelişme geriliği için 0.31, 0.86, 0.23, 0.82 idi. SONUÇ: Düşük riskli Türk populasyonda uterin arter Doppler ultrasonografisinin kötü obstetrik prognoz öngörüsünde katkısı vardır.OBJECTIVE: The aim of study is to evaluate the efficacy of uterin arter Doppler ultrasonography to predict preeclampsia, intrauterine growth restriction and premature birth in low riskTurkish population MATERIALS and METHODS: 1029 women who were admitted to antenatal clinic and fetal biometry, second trimester anomaly scanning and bilateral uterine artery spectral Doppler performed were included in this study. Multiple pregnancies and fetal anomalies were excluded. Outcome of pregnancy-related data obtained by the help of a standard telephone interview form. Bilateral uterine artery z-scores of the PI values calculated and differences in the average PI-z scores between control group and separately <5 persantile birth, preeclampsia, premature birth group evaluated. With the help of ROC curves for each poor prognosis, the optimal threshold values were determined and according to these values diagnostic predictions of Doppler application were revealed. The frequencies of uterine artery notch were determined and diagnostic values for prediction of poor prognosis were identified. RESULTS: In women; 43 (4%) preeklampsia, 62 (6.1%) <5 persantile birth (IUGR), 214 (20,8%) <37 weeks birth, 6 (0.6%) intrauterine death, 36 (3.5%) neonatal deaths were seen. Uterine artery pulsatility index (UAPI) Z score mean values of preeclampsia, IUGR, premature birth were 0.53, 0.55, 0.14, respectively.UAPI - z scores of the optimum threshold values for preeclampsia, IUGR, premature birth were 0.12, 0:59 and 1:58, respectively. In these threshold of z scores in the uterine artery, sensitivity, specificity, positive predictive value(PPD) and negative predictive value (NPD) for preeclampsia were 0.44, 0.76, 0.07, 0.97; for IUGR 0.22, 0.83, 0.07, 0.95 and for premature birth 0.09, 0.93, 0.24, 0.79, respectively. Bilateral uterine artery diastolic notches revealed a high percentage in preeclampsia, intrauterine growth retardation group(p<0,05). In the preterm group no difference was seen. For prediastolic notch sensitivity, specificity, PPD and NPD in pre-eclampsia, respectively, 0.25, 0.83, 0.05, 0.87; inIUGR0.31, 0.86, 0.23, 0.82. CONCLUSION: Uterine artery Doppler ultrasound might contribute to the prediction of poor obstetric prognosis in low riskTurkish population

Clinicopathologic characteristics and reproductive outcomes of patients with borderline ovarian tumors (BOTs): A single institute experience and a review of the literature

OBLECTIVES: In borderline ovarian tumor (BOT) cases, evaluating the therapy forms, the percentage of recurrence and survival and the condition of fertility after conservative surgery, for those with a fertil- ity wish. STUDY DESIGN: The files, follow-up forms and pathological reports of 96 cases, diagnosed with BOT, at our clinic, treated between 1994-2009, have been retrospectively evaluated. RESULTS: The mean age of the evaluated cases was 39.54&plusmn;13.4. On the basis of histopathological data, 46 cases (47.9%) had serous and 41 cases (42.7%) had mucinous, and 9 cases (9.4%) had other histological subtypes. 88 cases were in stage I, 2 cases (2.1%) were in stage II and 6 cases (6.2%) were in stage III. 89 (92.7%) cases were operated with laparatomy, 7 (7.3%) cases were operated with laparoscopy. In 52 cases (54.1%), conservative (fertility preserving) surgery was applied (27 cases USO, 8 cases cystectomy, 17 cases USO-staging), in 44 cases (45.8%) radical surgery (in 32 cases, complete staging, TAH-BSO in 11 cases, TAH-USO in 1 case). 26% of the cases (25 cases) underwent postoperative adjuvant chemotherapy. In 39 cases with fertility wish, 8 pregnancy occured after therapy. In the follow-up, 10 cases (10.4%) had recurrence. The rate of recurrence was 4% (2/44) after radical surgery and 15% (8/52) after conservative surgery. The general disease-free survival rate of the cases (DFS) was 89.6%, and there was no significant difference between radical and conservative surgery in view of DFS (95.45% vs 84.62%, p=0.97). CONCLUSION: In cases of borderline ovarian tumor, the best therapy is surgical debulking and the post-operative recurrence rate is generally low. Although the recurrence risk in patients who underwent conservative surgery is relatively higher, disease free survival rates are no different than those who had radical surgeryOBLECTIVES: In borderline ovarian tumor (BOT) cases, evaluating the therapy forms, the percentage of recurrence and survival and the condition of fertility after conservative surgery, for those with a fertil- ity wish. STUDY DESIGN: The files, follow-up forms and pathological reports of 96 cases, diagnosed with BOT, at our clinic, treated between 1994-2009, have been retrospectively evaluated. RESULTS: The mean age of the evaluated cases was 39.54&plusmn;13.4. On the basis of histopathological data, 46 cases (47.9%) had serous and 41 cases (42.7%) had mucinous, and 9 cases (9.4%) had other histological subtypes. 88 cases were in stage I, 2 cases (2.1%) were in stage II and 6 cases (6.2%) were in stage III. 89 (92.7%) cases were operated with laparatomy, 7 (7.3%) cases were operated with laparoscopy. In 52 cases (54.1%), conservative (fertility preserving) surgery was applied (27 cases USO, 8 cases cystectomy, 17 cases USO-staging), in 44 cases (45.8%) radical surgery (in 32 cases, complete staging, TAH-BSO in 11 cases, TAH-USO in 1 case). 26% of the cases (25 cases) underwent postoperative adjuvant chemotherapy. In 39 cases with fertility wish, 8 pregnancy occured after therapy. In the follow-up, 10 cases (10.4%) had recurrence. The rate of recurrence was 4% (2/44) after radical surgery and 15% (8/52) after conservative surgery. The general disease-free survival rate of the cases (DFS) was 89.6%, and there was no significant difference between radical and conservative surgery in view of DFS (95.45% vs 84.62%, p=0.97). CONCLUSION: In cases of borderline ovarian tumor, the best therapy is surgical debulking and the post-operative recurrence rate is generally low. Although the recurrence risk in patients who underwent conservative surgery is relatively higher, disease free survival rates are no different than those who had radical surger

Level of anxiety, depression, self-esteem and quality of life among the women with vaginitis

Background: Present aim is to evaluate anxiety, depression, quality of life and self-esteem in patients with vaginitis (not only specific to candidasis) and also to determine factors affecting vaginitis such as demographic, cultural and psychological causes.Methods: Each patient completed a self-administered questionnaire (Rosenberg’ Self-Esteem Scale, Short-Form 36, Quality of Life Scale, Beck Anxiety Inventory, and Beck Depression Inventory, Body Image Scale) and underwent a careful examination of the vulva and vagina. The cross-sectional study was carried out with two groups. The first group consisted of 107 women between the ages 18 and 45 years and had no physical disease but reccurrent vulvovaginitis (≥4 in a year).  The comparison control group consisted of 94 healthy (no vaginitis symptoms in 12 months) age matched volunteer participants.Results: Women with vaginitis had significantly higher anxiety and depression scores. There was no statistically significant difference in body image scale. Regarding type of marriage, arranged type was statistically significantly higher in vaginitis group while flirting type was statistically higher in control group. University school degree and income was statistically significantly lower in vaginitis group. Living residence as rent and vaginal douch was statistically significantly higher in vaginitis group.Conclusions: A better detailed history should be taken into consideration for personal stress sources and treatment support should be provided for patients with vaginitis. Not only gynecologists but also a multidisciplinary team should take part in the treatment and follow up of the patients to cope with recurrency even in non-specific vaginitis