Maternal-fetal outcome associated with adolescent pregnancy in a tertiary referral center: a cross-sectional study

Objectives: This study was conducted to compare pregnancy outcomes of early-middle adolescent, late adolescent and adult women. Material and methods: The study focused on early-middle adolescent (n = 145), late adolescent (n = 1655) and adult (n = 1585) women who gave birth during 2014 through 2017, utilizing data obtained from the Zeynep Kamil Women and Children’s Health Training and Research Hospital. Pregnancy outcomes were determined according to the rates of preg¬nancy complications, including method of delivery, birth weight, as well as the rate of newborn intensive care admissions. Results: Comparisons between the studied groups for various pregnancy complications showed highest rates of pre¬term deliveries (PD), preterm premature rupture of membranes (PPROM) and neonatal intensive care unit admission in early-middle adolescent group, whereas the highest cesarean section rates were observed in the adult group (p < 0.001). Conclusions: Analysis of the data revealed that adolescent pregnancy, especially the early-middle adolescent pregnancies, is associated with increased risks of adverse pregnancy outcomes

Comparison of two different antibiotic regimens for the prophylaxisis of cases with preterm premature rupture of membranes: a randomized clinical trial

Objectives: The aim of the study was to assess the effect of 1 g ampicillin prophylactic dosage whether it is as effective as the dosage of 2 g to prevent maternal and neonatal morbidity in a randomized manner. Materials and methods: One hundred and fourty eight singleton pregnant women with preterm premature rupture of membranes between 21 and 33 weeks of gestation were followed-up during the study period in our institution. We com­pared the efficacy of two different different dosages of ampicillin. The study population was randomized into 2 groups. In the group 1, 1 g of intravenous ampicillin was given every 6 hours. In the group 2, 2 g of intravenous ampicillin was given every 6 hours. Results: There was no significant difference between groups interms of fetal complications (RDS, icterus, mortality, sepsis, transient tachypnea of newborn and the pneumonia), rate of intensive care unit admission, fetal gender, fever, rate of clinical chorioamnionitis, high white blood cell count and the CRP, rate of cases &lt; 30 weeks (p &gt; 0.05). There was a significant differ­ence between the groups for the rate of previous preterm premature rupture of membranes history, steroid administration and the need for tocolysis (p &lt; 0.05). Conclusions: Although antibiotics seems to be innocent, several side effects have been introduced. It is reasonable to use the lowest dosages in shortest period in order to minimize these unwanted effects

Premature Ovarian Failure in a Patient with Robertsonian Translocation Rob (14;15): Is it only a Coincidence?

Women have fixed ovarian follicles after birth and the number of the follicles declines with age.The decrease can be regulated by genetic,hormonal and/or therapy procedures. Radiation exposure can lead to premature ovarian failure (POF). POF is defined as interruption of the ovarian function in an adolescent woman.Genetic disorders including translocations and damage on the ovarian tissue may result POF.The essential diagnostic criteria is an adolescent woman younger than 40 years of age.The diagnosis depends on at least 4 months of amenorrhea and increased FSH levels (≥40 mIU/ml) in 2 blood samples at an interval of 1 month. </p

Stres Üriner Inkontinansi Olan Kadinlarda Suburetral Doku Elastikiyetinin Değerlendirilmesinde Elastosonografinin Yeri

Amaç: Stres Üriner İnkontinansı (SÜİ) olan kadın hastalarda Elastosonografinin (ES) klinik ve diagnostik deerini saptamak. Gereç ve yöntemler: SÜİ tanısı olan 30 kadın ve şikayeti olmayan 30 kadın hastanın ES tetkikindeki suburetral doku elastikiyetleri karşılaştırıldı. Ped testi, Q-tip ve stres testleriyle SÜİ ve mesane boynunun hipermobilitesi teşhis edildi. ES tetkikinde mesane altı (MA) ve cilt altı (CA) dokular ile üretra (Ü) ölçüm alanları olarak deerlendirildi. MAĞCA,ÜĞCA ve MAĞÜ oranları hesaplandı. ES esnasında elde edilen bu oranların tanısal deeri ROC curve analizi ile incelendi. Bulgular: MAĞCA (AUC0.962, P0.001) ve ÜĞCA (AUC0.953, P0.001) stres test pozitişii için anlamlı prediktördür. MAĞCA (AUC0.883, P0.001) ve ÜĞCA (AUC0.885, P0.001) Ped testi için anlamlı prediktördür. MAĞCA (AUC0.877, P0.001) ve ÜĞCA (AUC0.857, P0.001) Q tip test pozitişii için anlamlı prediktördür. Lineer regresyon analizinde Stres test pozitişii MAĞCA (R20.84, beta0.369, P0.026) ve ÜĞCA (R20.84, beta0.496, P0.003) ile istatistiksel olarak anlamlı birliktelik göstermektedir. Sonuç: ES ile doku elastikiyetinin karakterizasyonu, SÜİ ve mesane boynu hipermobilitesinin teşhisinde umut verici bir teknik olup, SÜİ cerrahisi için hasta seçiminde ek metot olarak kullanılabilir.Objective: To determine clinical and diagnostic value of elastosonography (ES) in women with stress urinary incontinence (SUI). Material and methods: Thirty subjects with SUI and 30 subjects without SUI were compared in terms of elastosonographic suburethral tissue elasticity. SUI and bladder neck hypermobility was determined by pad test, Q-tip and stress tests. Measurements points included under bladder (UB), subcutaneous fatty tissue (SC), and the urethra (U) points. Three indices were calculated using these measurements (UB/SC, U/SC and UB/U). The diagnostic value of ES indices were investigated using receiver operating characteristic (ROC) curve analyses. Results: ES UB/SC (AUC0.962, P0.001) and U/SC (AUC0.953, P0.001) were significant predictors for stress test positivity. ES UB/SC (AUC0.883, P0.001) and U/SC (AUC0.885, P0.001) were significant predictors for pad test positivity. ES UB/SC (AUC0.877, P0.001) and U/SC (AUC0.857, P0.001) were significant predictors for Q tip test positivity. In linear regression analysis, stress test positivity was significantly associated with the ES UB/SC (R20.84, beta0.369, P0.026) and ES U/SC (R20.84, beta0.496, P0.003). Conclusion: Elastosonographic tissue elasticity determination is a promising tool in bladder neck hypermobility and SUI diagnosis, and may be used as an adjunctive method in selecting patients appropriate for stress urinary incontinence surgery

Shorter the cervix, more difficult the placenta percreta operations

Background: To determine the impact of cervical length (CL) on the clinical outcome of patients undergoing peripartum hysterectomy due to placenta previa/percreta

Can FMR1 CGG repeat lengths predict the outcome in ICSI cycles?

Objectives: The aim of this study was to assess relationship between CGG repeat lengths and ovarian reserve and response to controlled ovarian stimulation (COH). Material and methods: This prospective cohort study was carried out on patients (n = 49) who were admitted to the in vitro fertilization (IVF) clinic of the Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, University of Health Sciences. Women under 40 years of age with premature ovarian insufficiency underwent genetic analysis to determine CGG repeat lengths. Ovarian reserve was assessed for each participant and participants underwent ovarian hyperstimulation and intracytoplasmic sperm injection (ICSI) cycle. Relationships between ovarian reserve, cycle outcome and CGG repeat lengths were assessed. Variables including fertility assessment including ovarian reserve tests (Follicle stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol (E2), Prolactin (PRL), Thyroid stimulating hormone (TSH), Antimullerian hormone (AMH), antral follicle count (AFC) tests) and some IVF cycle characteristics were assessed in relation to number of CGG repeat numbers. Results: None of the ovarian reserve tests and cycle characteristics was found to be correlated with CGG repeat lengths. Comparison of ovarian reserve tests and cycle characteristics revealed no difference between groups of women with CGG repeat length &gt; 55 and CGG repeat length ≤ 55. Antimullerian hormone (AMH) was a significant predictor for cycle cancellation (AUC = 0.779, P = 0.008). AMH level &gt; 0.035 was found to be the optimal cut off value to predict cycles reaching to embryo transfer with 71% sensitivity and 85% specificity. The rate of cycle cancellation was 71% in cases with AMH ≤ 0.035 whereas it was 20% in cases with AMH &gt; 0.035 (p = 0.001). No difference was determined between groups with and without cycle cancellation in terms of CGG repeat lengths (55.3 vs. 53.9, p = 0.769). Among cycles reaching to embryo transfer stage, 3 (13.6%) pregnancies were achieved. Conclusions: Our data showed no relationship between CGG repeat lengths and ovarian reserve and response to controlled ovarian stimulation. This data also showed that no clinical difference between FMR gene mutation related POI and other etiologies

Comparison of the Effect of Laparoscopic and Abdominal Hysterectomy on Lower Urinary Tract Function, Vaginal Length, and Dyspareunia: A Randomized Clinical Trial

Objectives: The effect of hysterectomy on vesicourethral and sexual functions remains controversial. The primary objective of this study was to compare the effects of a laparoscopic hysterectomy and a total abdominal hysterectomy on lower urinary tract function. The secondary aims were to compare the two surgeries in terms of postoperative vaginal length and dyspareunia. Materials and Methods: This was a prospective randomized clinical study in which 292 women were assigned to either the laparoscopic hysterectomy (n=146) or total abdominal hysterectomy (n=146) groups. The vaginal length and urodynamic measurements were taken, and the patients were asked to grade the presence and severity of dyspareunia using a visual analog scale 3 weeks before and 12 weeks after the surgery. The relationship between the postoperative vaginal length and the incidence of dyspareunia was evaluated. The urodynamic procedures used included uroflowmetry and voiding cystometry to record the maximum flow rate (Q-max) and to assess the bladder capacity. Results: The preoperative vaginal length was similar between the groups, whereas the postoperative vaginal length was significantly longer in the laparoscopic hysterectomy group. When the 15 patients who developed postoperative dyspareunia were evaluated, no differences in the postoperative vaginal length were seen, but a significant difference in the change in the length of the vagina was found when compared with the other patients. No significant difference was found with regard to pre- and postoperative Q-max, bladder capacity, and change in bladder capacity between the study groups. Conclusions: The change in the length of the vagina was much more remarkable after total abdominal hysterectomy, compared with laparoscopic hysterectomy. It seems that the Q-max and the bladder capacity increase after hysterectomies, regardless of the surgical type. Further prospective randomized comparative studies are warranted to ascertain whether laparoscopic hysterectomies cause less damage to the pelvic floor, compared with abdominal hysterectomies

The utility of detecting ovulation to predict success in ovulation induction and intrauterine insemination cycles — a prospective observational study

Objectives: The success of ovulation induction-intrauterine insemination (OI-IUI) procedures may be limited by the absence of ovulation detection. The aim of this study was to evaluate the empirical use of ultrasonography and luteal phase progesterone (P4) as ovulation indicators and determine its effect on pregnancy outcome in OI-IUI cycles. Material and methods: This prospective observational study, which was performed in a university setting, included 107 women with unexplained infertility. Following OI, IUI was performed 36 hours after human chorionic gonadotropin (hCG). P4 was measured 72–96 hours after hCG. At the same time, the appearance of ovaries and signs indicative of ovulation, which are decreased follicle dimensions, irregularity of follicular walls, and the presence of free fluid in the Douglas pouch, were noted. Results: In 58 patients (54.2%), ovulation was detected at the P4 level of &gt; 10 ng/mL. Eighty-nine patients had ultrasound images suggestive of ovulation. However, only 50 of these were confirmed ovulation as indicated using P4. Implantation was observed in a total of 13 patients (12.1%). All patients were in the ovulation detected group with P4 &gt; 10 ng/mL (AUC: 0.750; p = 0.004). P4 of &gt; 21.5 ng/mL detected successful ovulation and was strongly associated with implantation with 77% sensitivity and 61% specificity (OR: 9.9; 95% CI: 2.4–41.2). Body mass index (BMI) &gt; 23.9 kg/m2 was a reliable anovulation indicator as a secondary outcome (AUC: 0.696; p = 0.02). Conclusions: In 45.8% of the patients, ovulation did not occur even with OI treatment. The association of progesterone measurement and ovarian ultrasound scanning between 72 and 96 hours after hCG treatment can be used to detect ovulation. In doing so, we can find the optimal treatment for patients with infertility in their next cycle