Does Home Birth Reduce the Risk of Pelvic Organ Prolapse?

Objectives: To determine the relationship between vaginal birth and the development of POP among women who deliv­ered in non-hospital settings (home birth). Material and methods: Data were collected retrospectively from the files of patients who presented to a hospital outpatient clinic between April 1, 2011 and April 1, 2012 with complaints of urinary incontinence, uterine sagging, vaginal mass, or vaginal pain. The patients’ age, height, weight, body mass index, menopause age, number of deliveries, and presence of hypertension and diabetes mellitus were noted. Patients whose urogynecologic evaluation included POP Quantification (POP-Q) scoring were included in the study. The patients were separated into a group of women who had never given birth and another group of women with one or more deliveries. Results: Of the 179 patients in the study, 28 had never given birth and 151 had given birth at least once. The nulliparous patients had no cystocele, rectocele, or uterine prolapse. The prevalence rates of cystocele, rectocele, and uterine prolapse were significantly higher in the multiparous group. Cystocele, rectocele, and uterine prolapse development were significantly correlated with number of deliveries, but there was no statistical association with age, body mass index, menopausal age, diabetes mellitus, or hypertension. univariate analysis reveals that the only factor effective in the development of cytocele, rectocele and prolapse is the number of births. Conclusions: Our study suggests that only number of deliveries is associated with development of cystocele, rectocele, and uterine prolapse in women who gave birth by vaginal route in residential settings

Ocena łożyska całkowicie przodującego przy pomocy rezonansu magnetycznego i ultrasonografii w celu wykrycia łożyska wrośniętego i jego wariantów

Objective: To evaluate the importance of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting placental adherence defects. Material and methods: Patients diagnozed with total placenta previa (n=40) in whom hysterectomy was performed due to placental adherence defects (n=20) or in whom the placenta detached spontaneously after a Cesarean delivery (n=20) were included into the study between June 2008 and January 2011, at the Department of Obstetrics and Gynecology, Ege University (Izmir, Turkey). Gray-scale US was used to check for any placental lacunae, sub-placental sonolucent spaces or a placental mass invading the vesicouterine plane and bladder. Intra-placental lacunar turbulent blood flow and an increase in vascularization in the vesicouterine plane were evaluated with color Doppler mode. Subsequently, all patients had MRI and the results were compared with the histopathologic examinations. Results: The sensitivity of MRI for diagnosis of placental adherence defects before the operation was 95%, with a specificity of 95%. In the presence of at least one diagnostic criterion, the sensitivity and specificity of US were 87.5% and 100% respectively, while the sensitivity of color Doppler US was 62.5% with a specificity of 100%. Conclusions: Currently, MRI appears to be the gold standard for the diagnosis of placenta accreta. None of the ultrasonographic criteria is solely sufficient to diagnose placental adherence defects, however, they assist in the diagnostic process.Cel pracy: Celem pracy była ocena przydatności ultrasonografii (US) i rezonansu magnetycznego (MRI) w wykrywaniu nieprawidłowości implantacji łożyska. Materiał i metoda: Do badania włączono pacjentki, które leczone były w Klinice Położnictwa i Ginekologii na Uniwersytecie Ege w Izmirze (Turcja), w okresie od czerwca 2008 do stycznia 2011, z powodu łożyska całkowicie przodującego (n=40). U 20 pacjentek wykonano histerektomię z powodu trudności w oddzieleniu łożyska a u 20 łożysko oddzieliło się samoistnie w trakcie cięcia cesarskiego. Zastosowano skalę Graya do oceny lakun w łożysku, wolnych przestrzeni pod płytą łożyska oraz masy łożyskowej naciekającej płaszczyznę pęcherzowo-maciczną oraz pęcherz moczowy. W badaniu USG z kolorowym Dopplerem oceniano turbulentny przepływ krwi w lakunach wewnątrzłożyskowych oraz wzrost unaczynienia w płaszczyźnie pęcherzowo-macicznej. Następnie wszystkie pacjentki miały wykonane badanie MRI a wyniki porównano z oceną histopatologiczną. Wyniki: Czułość badania MRI dla rozpoznania nieprawidłowości implantacji łożyska przed operacją wyniosła 95% a specyficzność również 95%. Przy obecnym przynajmniej jednym kryterium diagnostycznym, czułość i specyficzność badania USG wyniosły odpowiednio 87,5% i 100%, podczas gdy czułość kolorowego Dopplera wyniosła 62,5% a specyficzność 100%. Wnioski: Obecnie badanie MRI jest złotym standardem wykrywania łożyska wrośniętego. Żadne z ultrasonograficznych kryteriów nie jest wystarczające do rozpoznania nieprawidłowości implantacji łożyska, aczkolwiek pełnią funkcję pomocniczą w procesie diagnostycznym

Chronic Tubal Torsion Mimicking a Tubo-Ovarian Abscess; Case Report

Isolated tubal torsion is an uncommon cause of acute abdominal pain with the incidence of about 1/1,500,000 women. Here, we present a 36-year-old patient who was referred to us with the diagnosis of tuboovarian abscess resistant to medical treatment. Although she was hospitalized and was medicated, her complaints did not reduce. Diagnostic laparoscopy was performed, and salpingectomy was performed on account of tubal torsion

Prenatal radiation exposure

Pregnant women may be exposed to nonionizing, ionizing radiation and contrast media via diagnostic or therapeutic procedures and workplace exposure. When computed tomography or magnetic resonance imaging is performed on a pregnant woman, the effects of exposure to radiation, high magnetic fields and contrast media, which can be risky for a fetus, should be considered. Nonionizing radiation that is not significantly risky for a fetus includes microwave, ultrasound, radio frequency and electromagnetic waves, while ionizing radiation that can be teratogenic, carcinogenic or mutagenic includes particles and electromagnetic radiation. The effects of radiation are associated with the level of exposure and stage of fetal development. Organogenesis (two to seven weeks after conception) and the early fetal period (eight to fifteen weeks after conception) are the most sensitive stages for a fetus. Noncancerous health effects have not been determined at any stage of gestation with less than 50 mGy (5 rad) exposure dose of ionizing radiation. Higher exposure levels may lead to spontaneous abortion, growth restriction, and mental retardation. The risk of cancer is increased regardless of the dose. Although the use of iodinated contrast media is generally thought to be safe during pregnancy, the risk of fetal hypothyroidism should be considered and it should be used only when necessary. The use of gadolinium-based contrast media during pregnancy is controversial because of the lack of clinical data. The purpose of this article is to review the existing literature regarding the prenatal radiation exposure and to discuss fetal risk of radiation

Characterization of greater middle eastern genetic variation for enhanced disease gene discovery

The Greater Middle East (GME) has been a central hub of human migration and population admixture. The tradition of consanguinity, variably practiced in the Persian Gulf region, North Africa, and Central Asia1-3, has resulted in an elevated burden of recessive disease4. Here we generated a whole-exome GME variome from 1,111 unrelated subjects. We detected substantial diversity and admixture in continental and subregional populations, corresponding to several ancient founder populations with little evidence of bottlenecks. Measured consanguinity rates were an order of magnitude above those in other sampled populations, and the GME population exhibited an increased burden of runs of homozygosity (ROHs) but showed no evidence for reduced burden of deleterious variation due to classically theorized ‘genetic purging’. Applying this database to unsolved recessive conditions in the GME population reduced the number of potential disease-causing variants by four- to sevenfold. These results show variegated genetic architecture in GME populations and support future human genetic discoveries in Mendelian and population genetics

Plasenta yapışma anomalisi tanısında magnetik rezonans görüntüleme ve ultrasonografinin yeri

Gebelik patolojilerinin etiyoloji, tanı ve tedavisindeki bilgi birikimi günden güne artmaktadır. Çağımızda yeni teknoloji kullanımının artmasına rağmen peripartum kanamalara bağlı anne ölümleri önemli bir halk sağlığı sorunudur. Peripartum kanamalar maternal morbidite ve mortalitenin önemli nedenleri arasında ilk sıralarda yer almaktadır. Bu kanamaların önemli nedenleri arasında plasenta previa totalis yer almaktadır(1). Plasenta yapışma anomalileri desidua bazalisteki defekte bağlı plasental trofoblastların desidual tabakayı aşıp derinlere invazyon göstermesi sonucu ortaya çıkar. Bunlar plasenta akreta, inkreta ve perkreta olmak üzere üç alt başlıkta incelenir. En önemli risk faktörü gebelikte plasenta previa totalis halinin bulunmasıdır. Geçirilmiş uterin cerrahi, özelliklede sezaryen ile doğum öyküsü ve anne yaşı en başta gelen risk faktörleridir(1). Plasenta yapışma anomalisi ile ilgili semptom bulunmamaktadır. Tanı hekimin şüphe duyması ile konulur. Özellikle gebelikte var olan plasenta previa totalis hali ve geçirilmiş sezaryen öyküsü plasental yapışma anomalisi açısından uyarıcı olmalıdır. Plasenta yapışma anomalisinin prenatal dönemde tanısının konulmuş olması, gerekli tedbirlerin alınması açısından son derece önemlidir. Özellikle anne açısından hayat kurtarıcıdır. Erken tanı ile preoperatif kan hazırlığı yapılabilir, preoperatif gerekli konsültasyonlar istenir ve hastanın elektif koşullarda, uygun zaman ve mekanda doğum yapması sağlanır(1). Tanı magnetik razonans görüntüleme(MRI) ve ultrasonografi ile konulur. Son yıllarda yapılan çalışmalar MRI'ın tanı koymada spesifitesi ve sensitivitesinin oldukça yüksek olduğunu ortaya koymuştur(2). Son zamanlarda yapılan çalışmalarda üç boyutlu power doppler ultrasonografinin spesifitesi ve sensitivitesi de oldukça yüksek bulunmuştur. Ancak hiçbir ultrasonografik yöntem tek başına %100 tanı koyucu Idir(1). Plasenta akreta kesin tedavisi histerektomidir(1). Ama bu karar alınırken anın fertilite isteği ön planda tutulmalıdır. Fertilite isteği devam eden hastalarda uterus koruyucu cerrahi her zaman ön planda tutulmalıdır. Plasenta akreta ve varyantlarının prenatal dönemdeki tanısında MRI ve ultrasonografi yöntemleri kullanılarak tanıda en etkin yöntemi, tanı kriterlerinin spesifite ve sensitivitesini saptayabilmek amacı ile bu çalışmayı planladık

Ultrasound homojenizasyonun karaciğer homojenatlarında süperoksit dismutaz, glutasyon peroksidaz, katalaz aktiviteleri ve lipid peroksit düzeylerine etkileri

Amaç: Çalışmada mekanik ve ultrasound (sonikasyon) homojenizasyon tekniklerinin karaciğer süperoksit dismutaz, glutasyon peroksidaz, katalaz aktiviteleri ile lipid peroksitleri ve total protein düzeylerine etkileri araştırılmıştır. Gereç ve Yöntem: Bu amaçla taze dana karaciğeri küçük parçalara ayrılarak mekanik homojenizasyon (2 dk) ve sonikasyon (2, 4, 6, 8 ve 10 sn) grupları oluşturuldu. Süperoksit dismutaz, glutasyon peroksidaz, katalaz enzim aktiviteleri ile lipid peroksitleri ve total protein düzeyleri homojenatların süpernatantında spektrofotometrik yöntemlerle belirlendi. Bulgular: Süperoksit dismutaz, glutasyon peroksidaz, katalaz aktiviteleri ile total protein düzeylerinin, mekanik homojenizasyon gruplarında, sonikasyon grubuna göre önemli düzeyde farklı (P<0.05) olduğu tespit edildi. Sonikasyon grubu süperoksit dismutaz ve glutasyon peroksidaz aktiviteleri, mekanik homojenizasyon grubuna göre yüksek, katalaz aktiviteleri ise düşük bulundu (P<0.05). Glutasyon peroksidaz aktivitesi, 8 sn sonikasyon grubunda, 2, 4, 6 ve 10 sn'lik gruplara göre düşük (P<0.05) belirlenirken, katalaz 8 sn sonikasyon grubu diğer sonikasyon gruplarına göre en yüksek (P<0.05) aktivite düzeylerini gösterdi. Total protein düzeyleri 8 sn sonikasyon grubunda diğer gruplara göre düşük olarak gözlemlendi, istatistiksel fark ise 2, 6 ve 10 sn (P<0.05) gruplar arasında belirlendi. Lipid peroksidasyonu 8 sn grupta diğer gruplara göre yüksek seyrettiği, ancak istatistiksel farkın 2 sn (P<0.05) grup ile oluştuğu belirlendi. Öneriler: Karaciğer homojenatlarında, antioksidan enzim aktiviteleri ile lipid peroksidasyon ve total protein düzeyleri üzerine mekanik homojenizasyon ve sonikasyon tekniklerinin etkilerinin farklı olduğu, ayrıca, 8 sn sonikasyon uygulamasının, tüm parametreler için kritik bir nokta olabileceği düşünülmüştür.Aim: In this study, effects of ultrasound homogenisation (Sonication) technique on the activities of superoxide dismutase, glutathione peroxidase, catalase, levels of lipid peroxidation and total protein in liver homogenates were investigated. Materials and Methods: Postmortem healthy fresh calf liver was used as the material. Liver was sliced and grouped as mechanical homogenisation (2 min) and sonication group (2, 4, 6, 8 and 10 second sonication). Activities of superoxide dismutase, glutathione peroxidase, catalase, levels of lipid peroxidation and total protein were measured in supernatant of homogenisated samples by spectrophotometric methods. Results: Superoxide dismutase, glutathione peroxidase, catalase activities and total protein levels in mechanical group were significantly different from sonication groups (P&lt;0.05). In sonication groups, superoxide dismutase and glutathione peroxidase activities were higher and catalase activity was lower from mechanical group (P&lt;0.05). As regards glutathione peroxidase activity, 8 sec sonication group was the lowest compared to 2, 4, 6 (P&gt;0.05) and 10 sec (P&lt;0.05) groups whereas 8 sec catalase activity was the highest compared to other sonication groups (P&lt;0.05). Total protein level was the lowest in 8 sec group compared to the other sonication groups which significant difference was determined in 2, 6 and 10 sec (P&lt;0.05) groups. Lipid peroxidation level was the highest in 8 sec sonication group compared to other sonication groups with a significance in 2 sec group (P&lt;0.05). Conclusions: In liver homogenates, antioxidant enzyme activities, lipid peroxidation and total protein levels were significantly different between mechanical and ultrasound homogenisation groups. Sonication for 8 seconds suggested to be critical point

Is grand multiparity a risk factor for the development of postmenopausal osteoporosis?

Objective: In this study, we investigated the relationship between the development of postmenopausal osteoporosis and parity