Evaluation of complications developing during and after transvaginal ultrasound — guided oocyte retrieval

Objectives: To investigate the complications of the oocyte retrieval procedure currently used in in vitro fertilisation. Material and methods: We examined 1.031 patients who underwent oocyte retrieval in the IVF unit of our hospital for complications developed during and after the procedure. Results: No complications developed related to sedation or general anaesthesia. Vaginal bleeding was observed in 3.1% of the patients. There was no intra-abdominal bleeding or pelvic organ injuries requiring surgery. Two patients developed pelvic abscesses. Ovarian hyperstimulation syndrome (OHSS) occurred in 1.45% of the patients. Almost all of the patients tolerated the oocyte retrieval process well. After the procedure, only 2% of the patients described their pain as severe, and 0.4% as the worst pain they had ever experienced. Conclusions: The most common complication during oocyte retrieval is vaginal bleeding, which is largely controlled by buffer application. In conclusion, the oocyte retrieval process can be considered a safe procedure

Can evaluation of the cervix with histogram and Bishop scoring prior to birth induction forecast the birth type for superannuated primigravidas?

Purpose: We conducted this study to research both the forecasting efficiency of the cervical histogram and Bishop scoring for birth type (vaginal birth/cesarean) for the superannuated primigravida prior to birth induction. Methods: Ninety primigravidas in week 41 and beyond were included in the present study. Exclusions for the study included prior labor, ruptured membranes, any major uterine operations, cephalopelvic discord, fetal malpresentations, fetal anomalies, multiple pregnancy, placenta previa, vaginal bleeding, a high sensitivity for oxytocin usage, and an estimated fetal weight greater than 4000 g. Histogram hyperechogenic focus and hypoechogenic focus measurements are conducted in normal spontaneous birth (NSD) and cesarean (SECTIO) groups. Findings: Thirty-six patients had a cesarean birth, while 54 of the patients had vaginal births. On logarithmical regression analysis, the Bishop score and the parameters were found statistically significant in terms of proving the cesarean indication (p=0.001). In our cervical histogram, the forecasting efficiency of the hyperechogenic focus and hypoechogenic focus measurements for determining the birth type were not been able to shown (p=0.089 ; p=0.555). Bishop scoring parameters showed statistically significant deviances between the NSD group compared to the cesarean group in terms of a 1-2 cm increase in cervical opening and for being 3-4 cm(p=0.0001), the cervical extinguishment as 40%-50% (p=0.0001), the occurrence of cervical softening (p=0.0001), and the head level at -1 and -2 (p=0.0001). When declaring the cesarean indication, the Bishop score’s AUC value was found as 0.932 and the LR(+) value as 9; while the estimation value for the Bishop score occurring below \u3c5 increased the cesarean birth risk ninefold. Conclusion: During a superannuated nulliparous pregnancy, the Bishop score and the Bishop score’s individual parameters are meaningful for vaginal birth, while a cervical histogram is not significant for forecasting the birth type

Can evaluation of the cervix with histogram and Bishop scoring prior to birth induction forecast the birth type for superannuated primigravidas?

Purpose: We conducted this study to research both the forecasting efficiency of the cervical histogram and Bishop scoring for birth type (vaginal birth/cesarean) for the superannuated primigravida prior to birth induction. Methods: Ninety primigravidas in week 41 and beyond were included in the present study. Exclusions for the study included prior labor, ruptured membranes, any major uterine operations, cephalopelvic discord, fetal malpresentations, fetal anomalies, multiple pregnancy, placenta previa, vaginal bleeding, a high sensitivity for oxytocin usage, and an estimated fetal weight greater than 4000 g. Histogram hyperechogenic focus and hypoechogenic focus measurements are conducted in normal spontaneous birth (NSD) and cesarean (SECTIO) groups. Findings: Thirty-six patients had a cesarean birth, while 54 of the patients had vaginal births. On logarithmical regression analysis, the Bishop score and the parameters were found statistically significant in terms of proving the cesarean indication (p=0.001). In our cervical histogram, the forecasting efficiency of the hyperechogenic focus and hypoechogenic focus measurements for determining the birth type were not been able to shown (p=0.089 ; p=0.555). Bishop scoring parameters showed statistically significant deviances between the NSD group compared to the cesarean group in terms of a 1-2 cm increase in cervical opening and for being 3-4 cm(p=0.0001), the cervical extinguishment as 40%-50% (p=0.0001), the occurrence of cervical softening (p=0.0001), and the head level at -1 and -2 (p=0.0001). When declaring the cesarean indication, the Bishop score’s AUC value was found as 0.932 and the LR(+) value as 9; while the estimation value for the Bishop score occurring below <5 increased the cesarean birth risk ninefold. Conclusion: During a superannuated nulliparous pregnancy, the Bishop score and the Bishop score’s individual parameters are meaningful for vaginal birth, while a cervical histogram is not significant for forecasting the birth type

The effectiveness of extended fetal heart screening in a Tertiary Center

Our study is to evaluate the effectiveness of extended fetal heart screening in a tertiary center and research the sensitivity, specifity and the positive and negative values of echocardiography.316 patients who were diagnosed with congenital anomalies among those scanned with the extended fetal heart screening protocol in the perinatology department of our hospital were included in our study. Patients who were not diagnosed with congenital anomalies were excluded. Fetal echocardiographies were perfomed on patients who were admitted to our perinatology clinic, in accordance with the ISUOG extended fetal heart screening protocol. In our study, 55.3% of all cases with cardiac anomalies are concomitant with extracardiac anomalies. An interventional procedure was performed on 52.5% of the patients for karyotyping purposes. 19.3% was terminated early in the pregnancy, 5% and 12.5% were lost during the intrauterine and neonatal periods, respectively. In our study, upon comparison of the fetal and neonatal results, we determined that the false positive and negative rates for fetal echocardiography were 3.5% and 9.4% respectively.In our study, the sensitivity, specificity, positive predictive value and accuracy of echocardiography were determined as 91%, 99%, 98% and 99% respectively during the application of ISUOG recommendations in a tertiary center

The Effect of First Trimester Smear Results on Pregnancy and Neonatal Outcomes in a Turkish Population

Objective:We aimed to investigate the relationship between neonatal and pregnancy outcomes and cervicovaginal smear-determined reactive cellular changes and/or inflammation revealing an infectious agent in the first trimester of pregnant patients.Method:A total of 153 pregnant women, who were in their first trimester period, were enrolled to the study. Records related to the pregnancy and neonates were identified and further analyzed.Results:In terms of smear results, of 152 patients, 54 (35.5%) were reported as normal while 96 (63.2%) had reactive cellular changes and/or inflammation and 2 (1.3%) had atypical squamous cells of undetermined significance. In 117 patients (76.4%), no infectious agent was observed while 22 patients (14.5%) had fungus (candida), 8 had protozoon (trichomonas vaginalis), and 5 (3.3%) had bacterial vaginosis. There was no statistically significant difference observed for average pregnancy weeks, baby’s birth weight, preterm birth and neonatal intensive care need between patients with reactive cellular changes and/or inflammation and those with normal smear results (p=0.72, p=26, p=0.44, p=0.52).Conclusion:We found no association between inflammation or reactive cellular changes of smear results in the first trimester of pregnancy and adverse pregnancy or neonatal outcomes as being first research in our country

Effects of secondary trimester maternal serum screening on the results of pregnancy

In our study it was aimed to research the relations between pregnancy complications and frequencies of maternal and fetal complications which can be observed after the further follow-ups with biochemical indicators in gravid individuals whom found to be risky in quad test.120 patients who applied and had their labors conducted in İstanbul Training and Research Hospital and took quad test AFP (alpha fetoprotein), HCG (human chorionic gonadotropin), uE3 (unconjugated estriol), inhibin-A are included in our study. Conclusions planned to be obtained in this study are, IUGR (intrauterine growth deficiency), macrosomia, gestational diabetes, preeclampsia and preterm birth. 64 (% 53, 4) out of 120 patients participated in the study had normal labors while 56 (%46, 6) of the patients had labors with caesarean birth. On 70 (%58.3) patients whom did not develop obstetric complications, AFP value calculated as average as 1.00±0.74 MoM, uE3 value calculated as  0.89±0.4 MoM, hCg value calculated as 0.97±0.5 MoM and inhibin A value calculated as an average of  0.95±0.5 MoM.  On 50 (%41.6) patients whom developed obstetric complications, AFP value found as average of 1,06±0,74, uE3 value found as 0.96±0.39 MoM, hCG value found as 0.99±0.77 MoM and Inhibin A value found as 1.023±0.62 MoM. There were no significant deviation between the cases with obstetric complications and cases without obstetric complications in terms of AFP, uE3, HCG and Inhibin A values. There were no significant relation between threshold values of AFP, HCG, uE3 and inhibin A which are used in quad test as secondary trimester serum indicators in low risk populations and pregnancy complications

Retrospective analysis of cases with Endometrial Cancer

We planned this study with the aim of determining histological types, clinical, surgical stage and grade of endometrial cancer cases which were followed-up and operated on in our clinic and giving an opinion on epidemiological features. Our study was a retrospective study consisted of 298 patients who had medical operations with the diagnosis of endometrial cancer. Endometrial cancer was diagnosed via dilatation and curettage. Routine preoperative examinations were wanted from the cases. Clinical stage was determined. After the diagnosis, total abdominal hysterectomy and bilateral salpingo-ooforectomy (TAH+BSO) were applied; while only pelvic lymph node dissection was applied on the patients who had good prognostic data, total pelvic and paraaortic lymph node dissection were applied to the group with bad prognostic data. All materials were examined in the pathology laboratory of our hospital. In endometrial cancer staging, FIGO surgical staging system -2009 was used. FIGO was used in grade classification and World Health Organization Classification of Tumors system was used for the histological classification. Our study was composed of 298 patients who had endometrial cancer. Of the patients who were included in the study, average age was 56.54±9.69, BMI average was 31.47±6.20, gravida average was 4.16±2.59, and parity average was 3.41±2.15. Distributions of the patients by surgical stages were as follows; there were 32 patients whose tumor stage was in 1A (%10.7), 127 patients in 1B  (42.6%), 47 patients in 1C  (15.8%), 18 patients in 2A  (6.0%), 7 patients in 2B   (2.3%), 30 patients in 3A  (10.1%), 2 patients in 3B  (0.7%), 30 patients in 3C  (10.1%), 2 patients in 4A  (0.7%) and 3 patients in 4B  (1.0%). Of the patients with endometrial cancer in our study, tumors of 102 patients were (34.2%) in grade I, 139 were (46.6%) in grade II and 57 were (19.1%) in grade III. Because endometrial cancer shows earlier symptoms than the other gynecological cancers, it can be diagnosed in early stages. There is a surgical standard treatment, but it changes according to the stages and general state of the patients

Effect of mRNA COVID-19 vaccine on ovarian reserve of women of reproductive age

Objectives: To evaluate the effect of messenger ribonucleic acid (mRNA) vaccines developed for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) on the ovarian reserve of women of reproductive age. Material and methods: This prospective study was conducted between July and December 2022 in a tertiary care hospital affiliated with a university. A total of 117 patients were included in the study. The patients were divided into two groups. The first group (n = 62) consisted of women of reproductive age who received two doses of Pfizer-BioNTech COVID-19 vaccine administered 21 days apart. The control group (n = 55) included women with the same demographic characteristics who did not plan to be vaccinated. Hormonal values and basal antral follicle count were compared between two groups. Results: The mean age of the study group was 26.3 ± 3.6 years, and the mean age of the control group was 25.4 ± 6.2 years (p = 0.332). In the vaccinated group, mean follicular stimulating hormone (FSH) on day 2 was 5.29 ± 2.28; luteinizing hormone (LH): 5.18 ± 1.3; E2: 46.43 ± 24.51; anti-Mullerian hormone (AMH): 4.17 ± 2.1; antral follicle count: 16.23 ± 8.04; right ovarian volume: 6.4 ± 1.7; left ovarian volume: 6.2 ± 2.1. FSH measured at D2 in the control group was 5.68 ± 1.89; LH: 5.22 ± 2.2; E2: 48.41 ± 27.12; AMH: 4.30 ± 1.74; number of antral follicles: 15.64 ± 9.04; right ovarian volume: 6.1 ± 1.8; left ovarian volume: 6.3 ± 1.4. There were no statistically significant differences for FSH, LH, E2, AMH, ovarian volume, and number of antral follicles on the second day of menstruation between the groups. Conclusions: According to the results of the present study, the mRNA SARS-CoV-2 vaccine does not affect the ovarian reserve of patients

Does preparation for childbirth training reduce the cesarean rate?

Purpose: This study was conducted as experimental and prospective to determine the effect of birth preparation training on the birth route preparations of pregnant individuals. Methods: The study was conducted in three state hospitals which operate under Kocaeli State Hospitals Community. The study group included 110 pregnant individuals who attended the hospitals’ birth preparation training classes between 1 January – 30 June 2015 and the control group included 90 pregnant individuals from Kocaeli Maternity Hospital. The chi-squared test was used to measure the differences between groups in classified variables, and the t-test was used for parametric variables. P <0.05 was considered to be significant A survey form was used to identify individual demographic information, obstetric stories, and preferred birth route in order to collect relevant data. Findings: The survey reveals that 67% of the pregnant individuals prefer vaginal birth while 33% prefer cesarean birth. In choosing the birth route, 60% of the pregnant individuals make their own decisions, while 28.2% make the decision together with their partner, and 11.8% report the decision being made by their doctor. It is observed that—after attending the birth training—all of the individuals preferred vaginal birth. For the pregnant individuals, their birth route choices before and after the birth preparation training had been observed as highly statistically significant ( p<0, 005). However, when the choices of the pregnant individuals who participated in birth preparation training is compared to the control group’s choices, no statistical significance was found. Rates of cesarean were alike for both groups. Conclusions and Suggestions: In this study, for the individuals who participate in birth preparation training, the choice of the birth route is found to be affected by age, literacy, and former birth route experienced. However, no significant evidence was found regarding reducing the choice of cesarean. A pregnant individual’s birth route choice will be more healthy as she becomes qualified for, and receives sufficient treatment between the preconception stage to after birth, alternative birth routes, and consultancy for overcoming birth pain and relaxation methods

Adnexal masses: Clinical approach and pathological findings Adneksiyal kitleler: Klinik yaklaşım ve patolojik bulgular

Our study aims to investigate patients with adnexal masses without known pathologies in conjunction with their demographic data, patient history, length of hospitalization, complications, ratio of approaching patients laparoscopically or with laparotomy, and pathological findings. Patient data were collected retrospectively by browsing patient filed. Besides clinical information such as length of hospitalization, used surgical technique, whether there was a transition to laparotomy, whether there was a perioperative complication, and pathological examination results of the sample taken, data like the radiological size of the mass, number of previous operations, circumstances that lead to comorbidity, age, and state of menopause during surgery were collected. Among 110 patients, 48 (43.6%) were applied laparoscopy, while 56 (50.9) were applied laparotomy. The mean length of surgery was 107.4±53.8 minutes (40-181 mins.). Most seen surgery indications were persistent cyst seen in 55 patients (50%) and complex cyst seen in 16 patients (14.5%). In patients diagnosed with adnexal masses, distinguishing benign and malign masses by simultaneous usage of history, physical therapy, laboratory tests, and transvaginal ultrasonography, and deciding for laparoscopy and/or laparotomy based on this for treatment, is a highly reliable method. ÖzetÇalışmamız da patolojisi bilinmeyen adneksiyal kitlesi olan hastaların, sosyodemografik verileri, hasta özellikleri, hastanede yatış süreleri, komplikasyonları, hastalara laparoskopik veya laparotomi ile yaklaşım oranları, patolojik bulguları ile birlikte değerlendirilmesi amaçlanmıştır. Hasta bilgileri retrospektif olarak hasta dosyalarının taranması sonucu elde edilmiştir. Hastanede kalış süresi, perioperatif komplikasyon, kullanılan cerrahi teknik, laparotomiye geçiş olup olmadığı, alınan materyalin patolojik inceleme sonucu gibi klinik bilgilerin yanında radyolojik olarak kitlenin boyutu, daha önce geçirilmiş ameliyat sayısı, komorbidite oluşturan durumlar, cerrahi esnasında menopoz durumu ve yaş gibi bilgiler  değerlendirilmiştir. 110 hastanın 48 (%43,6) ine laparoskopi, 56 (%50,9) sına laparotomi yapılmıştır. Ameliyat süresi ortalaması 107,4±538 dakikadır  (40-181 dk.). En sık ameliyat endikasyonu, 55 hastada  (%50) saptanan persiste kist ve ikinci sıklıkta 16 hastada (%14,5) komplike kisttir. Adneksiyal kitle tanısı alan hastalarda, öykü, fizik muayene, laboratuvar tetkikleri, transvaginal ultrasonografi ile bir arada kullanılarak benign-malign ayırımının yapılması ve buna göre laparoskopi ve/veya laparotomi ile tedavisi oldukça yüksek güvenilirliğe sahiptir