Expectant management of triplets or multifetal reduction to twins; comparison of preterm delivery and live birth rates

Objective: The management of multiple pregnancies is still a challenge. The aim of this study was to compare the outcome of triplet pregnancies managed expectantly or by multifetal pregnancy reduction to twins. Study design: For this retrospective, comparative and monocentric study, the medical files of all women with triplets who admitted to our institution over a 13-year period were examined. Women requesting multifetal pregnancy reduction to have twins formed the study group, and women with triplets who wished to continue their pregnancies formed the control group. Main outcome measures were durations of pregnancies presented as number of weeks gestation, abortion rates, term and preterm birth rates, fetal loss and live birth rates. Results: During the study period, 171 women with triplets admitted to our institution. One hundred fifty one patients are included in this study. Forty-five women carrying triplets wished to continue their pregnancies and 106 women requested multifetal pregnancy reduction to have twins. Fetal reduction of triplets to twins was associated with a significantly lower incidence of birth before 34th gestational week and higher incidence of late preterm and term birth rates without changing live birth rates. Conclusion: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in a later gestational age at birth compared with the triplet gestations managed expectantly. © 20212-s2.0-8511927565

Surgical treatment of uterine atony: an assessment of final year obstetrics and gynecology residents in Turkey with a questionnaire

Purpose of nvestigation: The objective of this study is to assess the approaches of last-year obstetrics and gynecology (Ob&Gyn) residents towards surgical treatment of uterine atony. Materials and Methods: A self-administered questionnaire was used for the data collection. The questionnaire was sent to final year residents in the period from September 2013 to December 2014 through electronic mail or face-to-face conversation. Results: Last-year residents of Ob&Gyn preferred balloon tamponade as a first choice in nulliparous, but uterine compression suture for multiparous women in the management of uterine atony refractory to medical treatment during cesarean section. Uterine artery and internal iliac artery ligation came to forefront in the management of multiparous women. One fifth of residents did not watch any surgical intervention for uterine atony and most of them did not perform it before. Conclusion: The present results suggest that if residents do not perform or at least watch uterus-sparing procedures during their residency training, then a significant percentage of the residents could not perform these procedures by themselves except balloon tamponade

Myomectomy over the age of forty

Purpose of Investigation: The aim of this study is to evaluate the fertility results of women who had myomectomy surgery in their forties for fertility preservation. Materials and Methods: All women who had myomectomy surgery in her forties were included in the study. Phone interviews were conducted and the patients were asked whether they had any pregnancy after myomectomy. Results: During the study period, 82 women had myomectomy surgery in this hospital. Sixty-nine patients had abdominal surgery for myomectomy and they were considered as women wishing to preserve childbearing capacity. Three of them achieved three pregnancies which all ended in miscarriage. Conclusion: The treatment of fibroids in women who desire future fertility is myomectomy, but once a woman reaches the age of 35. her fertility begins to decline and the success rates of IVF treatment for women over 40 using their own oocytes are low. All the data should be discussed with the patient who will have an abdominal surgery for uterine myoma

cell lung cancer in Turkey

Aim: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays.Materials and methods: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5 +/- 10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces.Results: The patient delay was found to be 49.9 +/- 96.9 days, doctor delay was found to be 87.7 +/- 99.6 days, and total delay was found to be 131.3 +/- 135.2 days. The referral delay was found to be 61.6 +/- 127.2 days, diagnostic delay was found to be 20.4 +/- 44.5 days, and treatment delay was found to be 24.4 +/- 54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p < 0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p < 0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p < 0.05).Discussion: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly. (C) 2015 Elsevier Ltd. All rights reserved