Comparison of life quality between geriatric patients who underwent reconstructive surgery and obliterative surgery for pelvic organ prolapse

Objectives: Pelvic organ prolapse (POP) adversely affects women's quality of life. The aim of this study is to compare the life quality after obliterative surgery and reconstructive surgery for  geriatric patients with advanced pelvic organ prolapse. Material and methods: This matched case control study included sexually inactive women aged 65 years or older who had vaginal surgery for pelvic organ prolapse in Tepecik Education and Research Hospiltal between August 2012 and June 2019. Life quality of women who had undergone obliterative or reconstructive vaginal surgery were evaluated and then compared by Turkish validated prolapse quality of life questionnaire (P-QOL). Patients in obliterative and recontructive surgical procedures were matched according to age, body mass index and POP stage and each group included 49 women. Results: P-QOL scale domains, including prolapse impact (26.6 ± 12.1 vs 34.1 ± 16.2; p = 0.01), physical/social limitations (28.3 ± 12.8 vs 34.8 ± 14.4; p = 0.02) and severity measures (24.9 ± 12.6 vs 30.5 ± 13,4; p = 0.035) revealed significantly lower postoperative deterioration in the obliterative group. No significant difference was found in other P-QOL domains. The mean operation time in the obliterative group was shorter than the reconstructive group (respectively; 69.2 ± 21.5 min, 79.7 ± 29.4, p = 0.04). There were no significant differences in estimated blood loss, length of hospital stay and intraoperative complications.  Conclusions: Obliterative surgery is a suitable option in the treatment of advanced pelvic organ prolapse in elderly patients

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions

Objectives: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions. Material and methods: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk. Results: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3. Conclusions: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections

Anterior Segment Findings in Women with Polycystic Ovary Syndrome

Objectives: This study aimed to investigate the anterior segment in women with polycystic ovary syndrome (PCOS) and to compare them with those of healthy reproductive-age female volunteers. Materials and Methods: The study included 50 right eyes of 50 women with PCOS (group 1) and 50 right eyes of 50 healthy women (group 2). Intraocular pressure, Schirmer’s test, tear film break-up time and central corneal thickness were evaluated in all subjects. Correlations between serum hormone (estradiol and testosterone) levels and observed findings were also investigated. Results: Mean central corneal thickness values were significantly higher in the PCOS group (p=0.001). The mean intraocular pressures values were similar between the two groups (p=0.560). Schirmer’s test results and tear film break-up time values were significantly lower in the PCOS group (p=0.001 and p=0.001 respectively). Serum estradiol levels were moderately positively correlated with mean central corneal thickness (r=0.552), weakly positively correlated with intraocular pressure (r=0.351) and weakly negatively correlated with tear film break-up time (r=-0.393). Serum free testosterone levels were weakly correlated with intraocular pressure (r=0.342) and central corneal thickness (r=0.303), and showed weak negative correlations with Schirmer’s test results (r=-0.562) and tear film break-up time (r=-0.502). Conclusion: PCOS leads to physiological and structural changes in the eye. Dry eye symptoms were more severe and central corneal thickness measurements were greater in patients with PCOS. Those are correlated serum testosterone and estradiol levels

Perinatal trends and birth outcomes of Syrian refugee and turkish women

Aim: The impact of migration on health is far-reaching, making migrant populations particularly vulnerable, fueling health inequalities and resulting in serious implications for global health. The aim of our study to assess antenatal care, pregnancy and neonatal outcomes of Syrian refugee women in Turkiye. Material and Methods: Syrian and Turkish pregnants who delivered between 2013-2019 were recruited and categorized into groups according to maternal age at delivery. First trimester combined test, second trimester triple test, preterm delivery, maternal anemia; neonatal stillbirth, APGAR scores, birth weight and breastfeeding status were assessed. Results: 4992 Syrian and 6846 Turkish pregnants were included. Maternal anemia was higher in Turkish patients in 20-34 and ?35 groups. First trimester combined test, APGAR scores and birth weights were lower in Syrian women. Preterm rates higher in Turkish patients in only 20-34 age group. Second-trimester triplet tests were only higher in Turkish women in ?35 age group. Low birth weight was higher in younger Syrian patients. Satisfying breastfeeding results were found in Syrian women. Conclusion: Our study stated that Syrian women are at risk of low birth weight in adolescent and 20-34 age groups and low rates in first trimester combined test in all age groups. However decreased risk of pregnancy complications such as maternal anemia, preterm delivery, cesarean delivery and satisfying breastfeeding results were found in Syrian patients

Can platelet indices be of value in pregnant women with malaria?

Malaria infection in pregnancy is a serious disease with feto-maternal adverse outcomes. In this study we evaluated and compared the haematologic parameters of pregnant women with and without malarial infection. This case-control study included a total of 145 participants (59 pregnant women with malaria and 86 aparasitemic pregnant women). Haematological parameters were evaluated using an automated hemo-analyser. Haemoglobin, platelet, white blood cell and platelet distribution width (PDW) of pregnant women with malaria were found to be significantly lower than pregnant without malaria. However, the mean platelet volume (MPV) of pregnant women with malaria was significantly higher than those without infection.Impact Statement What is already known on this subject? Malaria infection in pregnancy is a serious disease and may affect haematological parameters. What do the results of this study add? Platelet indices were significantly changed in malaria. Especially mean platelet volume (MPV) with malaria was significantly higher than those without infection. What are the implications of these findings for clinical practice and/or further research? Among the expected differences in haematologic parameters of pregnant women with malaria, the increase in MPV has been a novel finding. The increase in MPV level of pregnant with malaria should be investigated further to address the value of MPV as a prognostic factor

Gebelikte İlaç Maruziyetinin Prenatal ve Postnatal Sonuçları

Amaç: Hastanemize başvuran ve perinatoloji konseyimizde değerlendirdiğimiz gebelerden ilaç kullanım öyküsü olanların demografik özelliklerini ve maruz kalınan ilaçların Yapısal Tedavi Edici Kimyasallar Sınıflaması (ATC) sistemine göre dağılımlarını belirlemektir. Yöntem: Bu araştırma retrospektif kohort bir çalışma olarak tasarlanmıştır. Hastane veri tabanından elde edilen veriler, literatür ışığında değerlendirilmiştir. Gebeliğinde ilaç kullanımı tespit edilen gebelerin sıklıkla hangi ilaçları kullandıkları ATC sistemine göre kategorize edildi. Aynı zamanda gebelerin demografik verileri, eğitim durumları, gelir seviyeleri, alkol sigara kullanımları, obstetrik sonuçları incelendi. Bulgular: Çalışmamıza İzmir Tepecik Eğitim ve Araştırma Hastanesi, Perinatoloji Bölümü Konseyi’nde değerlendirilen 99 gebe dahil edildi. Gebelerde ortalama yaş 31,70 [18-47, standart sapma (SS)=5,880], ortalama gravida 2,81 (1-8, SS=1,452), ortalama parite 1,4 (0-5, SS=0,988) ve başvuru sırasındaki ortalama gebelik haftası 11,27 (5-30, SS=4,692) olarak hesaplandı. Ortalama ilaç kullanım süresinin ortalama 66,56 gün olduğu tespit edildi. Çalışmamızda %29,33 oranıyla en sık sinir sistemini ilgilendirilen ilaçların kullanıldığı bunu %15,03 oranıyla sindirim sistemini ilgilendiren ilaçların takip ettiği gözlendi. İlaca maruz kalan 100 gebenin sadece 5’inde doğumsal anomali gözlemlenmiştir. Sonuç: Gebelerin demografik verileri, maruz kaldıkları ilaçların dağılımları literatür ile benzer şekildedir. Ancak daha önceki çalışmalardan farklı olarak isteğe bağlı küretaj tercihi daha düşük orandadır. Bununla birlikte doğumsal anomali görülme durumu da beklenenden yüksek değildir

The effect of maternal anxiety during delivery on birth outcomes

Birth anxiety can be defined as the fear of direct pain, the fear of the birth process. The aim of this study is to investigate the effect of anxiety level at the time of birth on the birth process and maternal and neonatal outcomes. Materials and Methods: Anxiety scores of the patients were recorded. Demographic data of the patients, cervical examination findings, place of residence, education level, type of delivery, APGAR score, presence of episiotomy or dehiscence in normal deliveries, 1st, 2nd and 3rd stages of labor, analgesia needs, prenatal and postnatal hemoglobin variability were recorded. The patients were divided into two groups as those with low (n=76) and moderate/high (n=24) anxiety levels, and the effect of anxiety level on birth outcomes was compared. Results: 53.9% (n=41) of pregnant women with low level of anxiety were nulliparous, and 91.7% (n=22) of patients with moderate/high level of anxiety were nulliparous (p=0.001). Postpartum hemoglobin change in pregnants with low level of anxiety, was higher than the pregnant women with moderate/high level of anxiety (p=0.00). A statistically significant relationship was found between age and anxiety level, the anxiety score of younger pregnant women was significantly higher (p=0.001). Conclusion: Although we did not find a statistically significant relationship between prepartum anxiety level and fetal and neonatal outcomes in our study, the amount of bleeding was less in pregnant women with low anxiety. We also concluded that previous birth experience and maternal age affect the anxiety score

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone

Purpose: The study’s aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. Methods: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. Results: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540–2150) for VD and 1359.4 ± 318.4 (780–2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Conclusion: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery