Ultrasonographic features of prenatal testicular torsion: Case report

Although prenatal testicular torsion (PNTT) is rarely observed,it is an important condition that can cause bilateralvanishing testis. Generally, PNTT cases observed asextravaginal torsion and treatment is emergency surgicalop-eration. In this article, 39 week presented a case diagnosedin the prenatal testicular torsion. PNTT diagnosiswas confirmed by Doppler ultrasonography and emergencysurgery was performed. Extravaginal left testiculartorsion gangrene and necrosis of the testis was observedin the operation. Left orchiectomy was performed andintrauter-ine ultrasonographic diagnosis was found to becorrect.Key words: Testicular torsion, prenatal diagnosis, features,ultrasonograph

The effect of vaginal bleeding and non-spesific pelvic pain on pregnancy outcomes in subchorionic hematomas cases

Objectives: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early second trimester subchorionic hematoma cases.  Material and methods: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed with subchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission, ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups were compared according to the clinical features and pregnancy outcomes.  Results: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher (p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70% sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in the other group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancy outcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effect of on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sac was above 35% (p = 0.027).  Conclusions: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma to the gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of the patients increased and the ratio of pregnancy loss was higher

Rudimentary horn pregnancy — ten years of experience

Objectives: This study aimed to evaluate data on early diagnosis and therapeutic management of rudimentary hornpregnancy (RHP).Material and methods: Patients diagnosed with RHP at a tertiary center between for two periods of 2008–2012 and2013–2018 were analysed retrospectively. We obtained information of patients from hospital electronic archive registrationsystem. Data on demographic characteristics, clinical presentation, gestational age at presentation, presenting symptoms,diagnostic methods, and therapeutic management were noted and analysed by descriptive statistical method. Demographicdatas, the complaint of patient’s admission to hospital, history of cesarean section, preliminary diagnosis and intraoperativediagnosis were compared between periods of 2008–2012 and 2013–2018.Results: A total of 14 RHP patients were included. Eight (57.1%) of these patients were diagnosed between 2008–2012 (Group1), whereas six patients (42.9%) were diagnosed between 2013–2018 (Group 2). Rudimentary horn was non-communicatingin 13 patients (92.8%). Communicated form was observed in 1 patient in group 1. RHP was diagnosed on the left side in ninepatients (64.2%). Six of these patients were observed in group 1 and 3 were in group 2. The pre-rupture diagnosis was madein 10 (71.4%) patients. Six (100%) of 10 patients were in group 2. In addition, in group 1, four patients (50%) experiencedintraoperative RHP rupture. RHP was diagnosed before rupture in 2 (33.3%) patients in group 2.Conclusions: It is an indication of advanced ultrasonographic technology as well as increased carefulness on the physicianside and raised alertness on the patient side that today both RHP and preoperative rupture of RHP are less frequent.Still, further awareness is required among physicians of the necessity of excision of a rudimentary horn that is detectedat the time of C-section

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience

Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1–1.4)], low preoperative haemoglobin [OR: 0.96 (0.94–0.98)], uterine weight [OR: 2.69 (2.62–2.76)], and long operation time [OR: 1.04 (1.02–1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96–1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse

A new technique in laparoscopic abdominal access (Evsen Method, Modified Veress Technique)

Objectives: The most important step in laparoscopic surgery is to safely establish the pneumoperitoneum, especially since approximately half of the complications occur during the initial entry into the abdomen. There is a distinct need to modify the available methods to reduce therate of adverse events in laparoscopic entry. In this study, a modified Veress technique (MVT) or Evsen method is introduced.The aim of this article was to present a modified Veress technique for establishing the pneumoperitoneum. Material and methods: The study was conducted at the Dicle University, Faculty of Medicine, Department of Obstetrics and Gynecology, from September 2016 to May 2017. A new laparoscopic entry technique was introduced and compared with the classical Veress technique. A total of 40 cases were included in the study. MVT and the classical Veress method were applied to 26 and 14 patients, respectively. Results: The pneumoperitoneum was established at the first attempt in 23 (88.5%) MVT patients and in 7 (50%) patients from the classical Veress method group. The number of insufflation attempts to establish a successful pneumoperitoneum was lower using MVT and the difference was statistically significant (p: 0.022). As far as time is concerned, a comparison between the groups revealed that the pneumoperitoneum was established in a statistically significantly shorter time using MVT (p < 0.00). Conclusions: The modified Veress technique proved to be superior to the classical Veress method for establishing the pneumoperitoneum. Using the new method, the pneumoperitoneum was established after fewer attempts and in a shorter time

Evaluation of Maternal and Fetal Outcomes in the Adolescents Pregnancy

Objective: In this study, our aim is to compare discussing maternal and fetal problems non-adolescent pregnancy with maternal and fetal problems in adolescent pregnancy that seen in hospital. Methods: 15-19 years of age (50 patients) and 20-23 years (96 patients) who gave birth at the Gynaecologi­cal and Obstetric Clinic under the Faculty of Medicine of Dicle University between January 2015-October 2015 were retrospectively evaluated. Age at birth, parity, blood pressure, pulse, gestational age, complications at birth, cesarean section indications, maternal biochemical pa­rameters, patients with preeclampsia and preterm birth, maternal and fetal complications were recorded. Results: Total number of births between January 2015- October 2015 were 1715 patients in our clinic. 62 of them (3.6%) were observed in the adolescent group. Maternal blood transfusion needs were found to be significantly higher in the adolescent group (p=0.004). Fetal abnor­malities and fetal intensive care needs were found to be significantly higher in the adolescent group (p=0.014, p=0.018). Conclusion: Adolescent pregnancies were high-risk pregnancies in terms of maternal anemia and blood transfusion requirements and because of adverse perina­tal outcomes. Therefore, to reduce the adolescent preg­nancy and to minimize perinatal complications should be done more extensive studies

Are serum Netrin-4 levels predictive of preeclampsia?

Objective: To investigate the levels of anti-angiogenic factors, namely sFlt-1 and Netrin-4, in patients with preeclampsia (PE). Material and methods: Cord-blood (UC) sFlt-1 and Netrin-4 concentrations were measured in 30 patients with severe PE, 30 patients with PE and 30 control infants and their mothers (MS). Results: Maternal sFlt-1 levels were significantly higher in the severe PE and PE groups than in the control group. There were no statistical differences among the three groups in maternal and fetal Netrin-4 levels. But Netrin-4 levels were found to be the lowest in the control group and higher in the PE and severe PE groups. The correlation analysis revealed a positive correlation between maternal sFlt-1 levels and maternal Netrin-4 levels (p = 0.012, and r = 0.263), maternal sFlt-1 levels and fetal sFlt-1 levels (p = 0.012, and r = 0.263). Conclusions: There was a positive correlation found between maternal sFlt-1 levels and maternal Netrin-4 levels. We are of the opinion that elevation in levels of Netrin-4 might be secondary to placental hypoxia occurring in PE. The present study led to the consideration of anti-angiogenic biomarkers (sFlt-1 and Netrin-4) on automated platforms for clinical use as an aid in establishing the diagnosis and prognosis of PE

Preeklamptik ve normotansif plasentalarda VEGF ve Vimentin ekspresyon düzeylerinin immunohistokimya ve Western Blot yöntemleri ile incelenmesi

Objective: In this study, we aimed to investigate the expression levels of vascular endothelial growth factor (VEGF) which stimulates angiogenesis and vimentin, an intermediate cytoskeleton filaments, in both preeclamptic and normotensive placentas. Methods: In this study, placentas after birth in 35-38 weeks were included. Ten preeclamptic placentas and ten normal placentas were used. Tissue pieces which had been soaked in 10% formaldehyde solution were examined histologically after routine paraffin follow. The expression levels of VEGF and vimentin were measured by Western Blot. Results: It was found that syncytial proliferation was in­creased in preeclamptic placentas. Intervillous syncytial knots, syncytial edema, collagen increase and vascular endothelial damage were observed. It was observed that VEGF and vimentin expression levels were increased as a result of preeclampsia. Conclusion: Nonfunctional VEGF which could not bind to its receptor leading to increased VEGF level may lead to inadequate angiogenesis in preeclamptic placenta. In addition, it is thought that an increase in vimentin level in preeclamptic placenta may cause reduced vascular per­meability

Is caesarean myomectomy a safe procedure? A comparative study

OBJECTIVE: Uterine myomas are the most common benign pelvic tumours observed during the reproductive period.Increased risks of haemorrhage and postoperative morbidity lead professionals to avoidmyomectomy at the time of Cesarean (C-section). The present study retrospectively analysed the dataof patients who had undergone C-section only and those that had undergone C-section and simultaneous myomectomy. STUDY DESIGN: The data of 42 patients (Group 1) who had underwent caesarean myomectomy andof 50 patients underwent C-section only (Group 2) out of 92 patients that had been taken into C-sectionon the basis of obstetric indications were retrospectively analysed in this study. The relevant patient datawere recorded with the inclusion of demographic data, gestational week, and preoperative and postoperative laboratory findings. Types, locations and sizes (the largest diameter) of individual myomas wereidentified and noted.RESULTS: The mean diameter of myomas was 66.3±30.2 mm. Ten patients that had underwent caesarean myomectomy (23.8%) developed a need for intensive care. No statistically significant differencewas found in laboratory parameters between Group 1 and Group 2.CONCLUSION: Caesarean myomectomy, when performed by experienced obstetricians, does not leadto a significant increase in maternal morbidity and mortality. Although the short-term effects of this procedure are known, there is a need for the conduct of more comprehensive studies to establish its longterm effects on fertility or how it will affect the next pregnancy processe