A New Technique for Surgical Treatment of Vaginal Agenesis Using Combined Abdominal-Perineal Approach

Optimum therapeutic approach in vaginal agenesis has always been an area of extensive controversies. Although surgical management gained priority due to the evolution of techniques, there is currently no consensus in the literature regarding the best type of surgical approach. The most commonly preferred surgical procedure among gynecologists is McIndoe operation which involves the creation of a space between bladder and rectum, insertion of a mold covered with split-thickness skin graft into that neovaginal space, and use of postoperative vaginal dilation to avoid stenosis. However, many modifications have been introduced in time in an attempt to increase the success rates. In this paper, we describe two cases with vaginal agenesis with functioning uterus who were subjected to surgery by combined abdominal-perineal approach. The surgical technique also included the use of a specially designed vaginal mold made up of polymethyl methacrylate and use of Hyalobarrier gel which is an adhesion-preventing agent

Retrospective Evaluation Of Changing Rates For Operative Vaginal Delivery Over The Decades In A Single Tertiary Health Care Center

Objective: To evaluate the changing rates for operative vaginal delivery (OVD) over the decades in our institution. Material and Methods: This is a retrospective and descriptive study. A total of 10458 births in 1976, 1986, 1996, 2006 and 2016 were included in the study. Cases were divided into five groups according to years of delivery: group 1 (1976, n= 2668), group 2 (1986, n= 2393), group 3 (1996, n= 1751), group 4 (2006, n= 1751), and group 5 (2016, n= 1895). The percentage of total operative deliveries, the percentage of births with forceps, the percentage of vacuum extractions and the percentage of births by cesarean were compared between the study years. Results: The frequency of OVD was 16.4%, 17.1%, 5.1%, 1.9% and 0% in 1976, 1986, 1996, 2006 and 2016, respectively. The frequency of forceps applications in OVDs was 99.3%, 99.58%, 99.83%, 99.94% and 0%, respectively. The caesarean rates in the study years were 11.4%, 19.2%, 44.7%, 69.3% and 77.9%, respectively. There was a statistically significant difference in the percentage of total operative deliveries, percentage of births with forceps, percentage of vacuum extractions, and percentage of cesarean delivery (p< 0.001). Conclusion: As in the rest of the world, OVD applications within the decades have decreased dramatically, and cesarean delivery has increased significantly. Supporting OVD practices and increasing the number of physicians with sufficient experience in this area may contribute to reducing the increased cesarean section frequency.Wo

Spontaneous Pregnancies In Patients With At Least One Failed Ivf Cycle After The Management Of Autoimmune Disorders, Hereditary Thrombophilia, And Methylation Disorders

Objective: This study aimed to describe the impact on achieving spontaneous pregnancy of treating patients with at least one failed in-vitro fertilization (IVF) cycle for autoimmune disorders, hereditary thrombophilia, and methylation disorders. Methods: Fifty-three patients who met the enrollment criteria seen between January 2007 and October 2017 were included in this retrospective cohort study. The patients were retrospectively assessed for the presence of hereditary thrombophilia, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, serum vitamin B12/folate/homocysteine levels, and autoimmune antibody positivity. The required data were extracted from the institutional patient database. Statistical analyses were performed on Statistical Package for the Social Sciences (SPSS.22®). The Kolmogorov-Smirnov test was used to evaluate the distribution of the data, and since the data did not following a normal distribution, proportions and median (minimum-maximum) values were used. Results: The 53 patients included in the study had singleton pregnancies. The distribution of autoantibodies was as follows: thyroid peroxidase (n=17); antithyroglobulin (n=11); double-stranded DNA (n=4); antinuclear (n=8); anti-smooth muscle (n=1); and anticardiolipin IgG and IgM (n=1). Autoimmune diseases included Hashimoto's thyroiditis (n=23); SLE (n=7); Behcet's disease (n=1); Sjogren's syndrome (n=1); ulcerative colitis (n=1); and anti-phospholipid antibody syndrome (n=1). Ten patients had heterozygous Factor V Leiden thrombophilia; two had homozygous Factor 5 Leiden thrombophilia; and three had the prothrombin 20210A heterozygous mutation. Twenty-eight patients were positive for autoantibodies and hereditary thrombophilia and/or MTHFR polymorphisms. Conclusions: Evaluation and management of hereditary thrombophilia, MTHFR gene polymorphisms, and/or autoimmune conditions may be beneficial for patients with unexplained infertility.PubMedWo

Treatment Of Rectovaginal Fistula Using Sphincteroplasty And Fistulectomy

Aim To assess the results of the treatment of rectovaginal fistulas with incontinence and impaired anal tonus. Materials and Methods This study comprised three rectovaginal fistula groups that were treated using sphincteroplasty and fistulectomy: group 1: eight women with simple rectovaginal fistula due to birth trauma; group 2: six rectovaginal fistula cases that were associated with chronic inflammatory diseases; and group 3: five cases with at least one failed repair attempt. In the second step, operations that took place before the year 2000 were compared to the operations that took place after the year 2000 in terms of demographic and clinical characteristics. Results All of the simple rectovaginal fistula cases healed after the operation. Five of the group 2 patients healed after the operation. However, 1 patient with Crohn's disease needed to undergo reoperation, but successfully healed after 6 months. On the contrary, 3 patients in group 3 healed (60%) whereas 2 of them failed to heal. Clinical characteristics of the patients were different between the groups (before and after the year 2000). Conclusion The choice of operation must be done according to the patient's underlying pathology. Proper management of associated inflammatory diseases and systemic disorders is recommended for necessary complex cases.PubMedScopu

The importance of proteinuria in preeclampsia and its predictive role in maternal and neonatal outcomes

Objective: To evaluate impact of 24-h proteinuria level in preeclampsia on maternal/perinatal outcomes. Methods: Singleton pregnancies with preeclampsia delivered after 24 weeks of gestation were included. Patients were divided into mild (0.3 to <2 g) (n=72), severe (2 to <5 g) (n=30), and massive (≥5 g) (n=24) proteinuria groups, and cut-off values of 24-h proteinuria for composite adverse maternal and neonatal outcomes were calculated. Results: Twenty-four hour  proteinuria level cut-offs for composite adverse outcomes were 3275 mg (72.2% sensitivity, 85.6% specificity) and 2395 mg (72.7% sensitivity, 78% specificity) respectively. Conclusion: Severe and massive proteinuria were related to poor maternal, perinatal, and neonatal outcomes

Behcet’s disease and pregnancy: what to expect?

The relationship between Behcet’s disease (BD) and pregnancy is only reported in limited number of studies. We retrospectively collected data of 26 women with BD diagnosis and their 66 pregnancies. We analysed patients according to disease activity, age at BD diagnosis, age at first/last pregnancy, obstetric history, obstetric complications, neonatal birthweight, associated foetal abnormalities and pregnancy-related complications. Sixteen miscarriages (24.2%), two intrauterine deaths (3%) and 48 live births (72.8%) were identified. Preterm labour was observed in 12 (24%) of 50 deliveries. Colchicine was used in six pregnancies, however, there was no drug treatment for BD in the remaining 59. There was a higher rate of preterm labour and low birthweight in patients using colchicine. BD was in remission in 60 (90.9%) of 66 pregnancies, and disease flared up only in six cases. In conclusion, BD patients with altered symptoms during pregnancy carry an increased risk of obstetric complications.IMPACT STATEMENT What is already known on this subject: There are limited and conflicting data about the interaction between BD and gestation. What the results of this study add: Our findings indicated that patients who were in an active symptomatic phase of BD and were being treated with colchicine had an increased risk of preterm delivery and low birthweight. What the implications are of these findings for clinical practice and/or further research: Clinicians should consider increased obstetric complication risk among patients with active BD

Methylenetetrahydrofolate Reductase Polymorphisms And Pregnancy Outcome

Introduction Aim of the study was to evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) polymorphisms on pregnancy outcome. , Materials and Methods A total of 617 pregnancies of women who were investigated for MTHFR C677T and A1298C polymorphisms prior to pregnancy were included in the study. Cases were classified into “homozygous polymorphisms” (Group I), “heterozygous polymorphisms” (Group II), and patients without polymorphisms who functioned as controls (Group III). Patients with polymorphisms were assigned to a specific protocol at least 3 months before becoming pregnant. Administration of low molecular weight heparin (LMWH) was started very early during pregnancy. The Beksac Obstetrics Index (BOI) was used to estimate the obstetric risk levels for the different groups. , Results We found that the early pregnancy loss (EPL) rate increased as MTHFR polymorphism complexity increased and that the early EPL rate was significantly higher in patients with MTHFR C677T polymorphism compared to patients with MTHFR A1298C polymorphism (p = 0.039). There were significant differences between the previous pregnancies of the patients in the 3 study groups in terms of perinatal complications and EPLs (p = 0.003 and p = 0.019). The BOI decreased as the severity of polymorphisms increased. An association between MTHFR polymorphisms and congenital malformations and chromosomal abnormalities was observed. We could not demonstrate any statistically significant difference between study groups when the 3 groups were compared with regard to the pregnancy outcomes under specific management protocols. , Conclusion MTHFR polymorphisms are potential risk factors for adverse pregnancy outcomes.PubMedWoSScopu

Uropathogens And Gestational Outcomes Of Urinary Tract Infections In Pregnancies That Necessitate Hospitalization

Background and Objectives Our aim is to identify uropathogens that cause urinary tract infections (UTIs) that necessitate hospitalization, and analyze outcomes of gestational UTIs. Methods This study consisted of 30 pregnant women who necessitate hospitalization because of UTI (7.8% of gestational UTIs during the same period of time). UTI that necessitates hospitalization is defined as clinical complaints, urination problems, urine analysis and culture positivity, fever and uterine discomfort. Patients with at least two positive cultures (≥ 100,000 cfu/ml) were included to this study. Antimicrobial susceptibility tests were obtained in all cases in order to determine antimicrobial resistance and to choose the ideal antibiotics for treatment. Results In our study, we have found that Escherichia coli is the most common microorganism (56.7%). Enterococcus faecalis (13.3%) and Klebsiella pneumonia (10%) were other frequently observed microorganisms. In this series, mean gestational week at birth was 35 weeks 5 days (range 23-40 weeks). Mean birthweight was 2,656 g (range 500-3,700 g). Twenty-three cases (76.7%) were hospitalized before 37th gestational week and preterm delivery rate was 56.3%. Maternal risk factors and coexisting diseases were detected in 11 (36.7%) patients as follows: diabetes mellitus in 4, thrombophilia in 3, thyroid disorders in 3 and hydroureteronephrosis in 1 case. Cesarean section rate was 65.2%. Conclusions Knowing uropathogens of patient population is beneficial in the management of patients and better planning of future medical treatments. Preterm labor seems to be an important complication in pregnancies with UTIs going together with fever and urination problems.PubMedScopu

Outpatient Versus Inpatient Follow-Up For Intrahepatic Cholestasis Of Pregnancy

Aim of the study The optimum management method and the best time of delivery still remain unclear for intrahepatic cholestasis of pregnancy (ICP). We aimed to ascertain whether there is a benefit of close monitoring at hospital. Material and methods We evaluated the maternal and neonatal records of ICPs over a recent five-year period. A total of 35 women and their 38 newborns were analyzed. The impact of hospitalization was evaluated in terms of delivery type, labor induction, preterm delivery, Apgar scores, and neonatal intensive care unit admission. Results The median maternal age was 30.7 years, and median gestation at diagnosis was 34 weeks. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal in three patients; 32 (91.4%) women had at least one increased hepatic enzyme level. The median AST level was elevated to 66 U/l (almost two-fold), and the median ALT level was 91 U/l (about three-fold). The median gestation time at delivery was 37 weeks. The preterm delivery rate was 45.7%. The median birth weight was 3020 g, and median Apgar scores were 9 and 10 at the 1st and 5th minutes, respectively. Neonatal intensive care unit admission occurred in 21 neonates (55.3%). During pregnancy follow-up, 22 women (62.8%) were hospitalized during their pregnancies. There was no statistically significant difference between groups in terms of obstetric and perinatal outcomes (p > 0.05). However, the hospitalized pregnant women were found to have higher levels of serum transaminases (p = 0.15 and p = 0.01 for ALT and AST, respectively). Conclusions Hospitalization may be helpful in some ICP cases, especially when enzyme levels are elevated.PubMedWoSScopu