The Role of Granulocyte-macrophage Colony Stimulating Factor in Recurrent Pregnancy Losses

Objective:A specific factor cannot be detected in approximately half of recurrent pregnancy losses (RPL). The aim of the present study was to investigate the role of a cytokine, granulocyte-macrophage colony stimulating factor (GM-CSF), in the etiology of recurrent pregnancy losses.Method:A total of 50 patients who had been admitted to the gynecology and obstetrics clinics of İstanbul University Medical School between January 1995 and September 2001 were included into the study and allocated to five groups including control and study groups. The study groups included 30 patients and the control groups included 20 patients. There were 3 study groups including non-pregnant women who had abortion (2 groups) and a spontaneous abortion group, which were selected among the recurrent pregnancy loss (RPL) subjects with unknown etiology. The spontaneous abortion, non-pregnant RPL group and pregnant RPL group were accepted as study group). These groups were compared with the control groups, which included pregnant and non-pregnant healthy women.Results:Moderate and severe GM-CSF activity was detected in the decidua of all cases in fertile and elective termination groups. However no significant difference was detected in the surface epithelium, gland epithelium and stromal GCSF activities. Endometrial GM-CSF activity was determined to decrease in spontaneous abortion and RPL cases.Conclusion:Reduced GM-CSF activity in the decidua may have a role in the etiology of RPL. Besides, the level and distribution of GM-CSF in different compartments of the decidua may be a determinant factor in the prognosis of pregnancy

Laparoscopic Management of a Torsioned Round Ligament Fibroid

Round ligament fibroids are rare tumors and can present as inguinal, adnexal, or vulvar masses. Preoperative diagnosis can be made by ultrasonography or magnetic resonance imaging (MRI). A 28-year-old virgin female presented with pelvic pain that persisted for a few days. Her sonographic evaluation detected a well-defined hyperechoic 45 × 40 mm right adnexal mass interfering endometrioma. A contrast-enhanced pelvic MRI showed a 43 × 39 × 32 mm solid mass located in the right adnexa. Laparoscopic exploration revealed a well-defined double torsion around the peduncle pinky solid mass arising from the right round ligament. The mass was resected with the final histopathological diagnosis being leiomyoma. The diagnosis of round ligament fibroids can be challenging, and laparoscopy is one of the first options where surgical facilities are available

The Impact of COVID-19 Pandemic on Female Sexual Behavior

Objective:The Coronavirus disease-2019 (COVID-19) related isolation has resulted in economic damage, loneliness, fear of death, and depression all around the world. Self-isolation and social distance lead to unintended psychological effects and negatively affect sexual life. This study aimed to investigate women’s sexual behavior during the COVID-19 pandemic in our country.Method:This prospective, observational study was conducted in a tertiary referral hospital between June 27 and July 27, 2020. A questionnaire consisting of 13 questions regarding the sexual life during the COVID-19 pandemic was applied to 169 women aged 18-45 years. Demographic characteristics were recorded. The questions evaluating sexual behavior about the relationship with partner, sexual desire, frequency of intercourse, sexual satisfaction, and fertility desire were asked.Results:The mean age of the participants was 32.9±7.74 years (18-45). Regarding the per capita monthly income, 84 (60%) patients had a decrease, 53 (37.9%) of them remained stable, and only 3 (2.1%) of them had an increase during the pandemic. Sexual desire was decreased by 32.9% of the participants and remained the same in 58.6% of the participants. A higher rate of 40.5% was observed in the decreased group than in the stable income group with 22.7% (p=0.03). A statistically significant difference was found between the decrease in sexual desire rates. However, when the change in income level of the groups and their sexual satisfaction rates were compared, it was found that sexual satisfaction increased in those with a lower income level, and the difference was statistically significant (p=0.04).Conclusion:Acute stress caused by the COVID-19 pandemic negatively affected sexuality. The decreased income level reduces sexual desire, but we observed an increase in sexual satisfaction rates in this group

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). Birthweight, duration of labour, maternal age, weight, gravida and use of oxytocin were similar between the groups (p>0.05). Conclusion: Urinary catheterization before birth reduces the rate of PUR

Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri

Aim This study aimed to compare the surgical outcomes of laparoscopic hysterectomy (LH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in women with undescended-enlarged uteri. Materials and methods This cross-sectional study was conducted with 78 women who underwent LH (48 patients) or vNOTES hysterectomy (30 patients) for benign gynecological pathologies. The dimension of the uterus, operation time, intraoperative blood loss, the presence of peri-, postoperative complications, conversion to laparotomy, pre-, postoperative hemoglobin (Hb), and hematocrit (Hct) levels, postoperative hospital stay, total dose of postoperative analgesics, VAS scores at the postoperative 6th and 24th hours, and the final pathology reports were recorded. Results There was no significant difference between LH and vNOTES hysterectomy groups regarding age (47 vs. 47.5 years, p = 0.92), parity (2 vs. 2, p = 0.74), and BMI (30.8 vs. 28.2 kg/m2, p = 0.31). The patients in the vNOTES hysterectomy group had significantly shorter durations of surgery (45 vs. 160 min) and hospitalization (48 vs. 72 h) than the LH group (p < 0.001, p < 0.001, respectively). The 24th hour VAS score was lower (VAS score 2 vs. 3, p = 0.003) in favor of the vNOTES hysterectomy group. In matched group analysis, the 24th hour VAS score (2 vs. 3, p = 0.008), operation time (45 vs. 157, p < 0.001), and hospitalization (48 vs. 72, p < 0.001) were lower in the vNOTES hysterectomy group than the LH group. Conclusion vNOTES hysterectomy provides favorable outcomes compared to conventional LH considering the shorter operation time, hospitalization, and lower 24th h VAS score

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope?

Aim To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. Methods A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS = 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. Results Moderate pain (4 = 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. Conclusion In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy