İntrautelerin inseminasyon uygulama zamanı ve sayısının gebeliğin oluşumuna etkisi

Son yıllarda infertilite kliniklerinin kullanımında artışa rağmen, infertilite prevalansında bir değişiklik gözlenmemiştir. Yaş ve sosyoekonomik düzey gibi demografik özellikler infertilite oranını etkilemektedir. Genel olarak popülasyorda çocuk doğurma yaşının ertelenmesi, ileri yaşta gebe kalmaya çalışan kadınların oranında artışa yol açmıştır. İnfertilite prevalansı ırk ve etnik kökene göre değişiklik göstermemektedir. Düşük sosyoekonomik düzeydeki gruplarda infertilite oranı daha yüksektir. İnfertilite tedavisinde önemli bir yere sahip olan intrauterin inseminasyon; uygun infertil hastalarda uygulandığında hem sonuçlan açısından hem de maaliyeti açısından oldukça yüz güldürücü bir tedavi yöntemidir. Bizim bu çalışmada amacımız; ovülasyon indüksiyonu uygulanan hastalarda hCG uygulanımı sonrasında intrauterin inseminasyon uygulanma zamanı ve sayısının gebeliğin oluşumu üzerine etkinliğinin araştırılması oldu. Bu çalışma Selçuk Üniversitesi Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda polikliniğimize başvuran 50 infertil hasta üzerinde prospektif ve randomize olarak yapıldı. Çalışmaya dahil edilen hastalar iki gruba ayrıldı. 1. gruptaki 25 hastaya ovülasyon indüksiyonu sonrası 10.000Ü hCG uygulanımından 36 saat sonra bir kez intrauterin inseminasyon uygulandı. 2. gruptaki 25 hastaya ise ovülasyon indüksiyonu sonrası 10.000Ü hCG uygulanımından 24 ve 48 saat sonra iki kez olmak üzere intrauterin inseminasyon uygulandı. Her iki grupta aynı oranda olmak suretiyle her iki gruptaki hastaların bir kısmına gonadotropinlerle diğer kısmına ise klomifen sitratla ovülasyon indüksiyonu uygulandı. Her iki grup yaş ortalaması, infertilite süresi, vücut kitle indeksi, ortalama FSH, LH, E2 değerleri ve ovülasyon indüksiyonu ajanları açısından birbirleriyle karşılaştırıldı ve her iki grup arasında anlamlı istatiksel bir farklılık saptanmadı. Çalışmamızda ovülasyon indüksiyonu sonrası uygulanan intrauterin inseminasyon sonuçlarına bakıldığında; 1. gruptaki hastaların 5 'inde gebelik saptanırken ( gebelik oranı hasta başına (%20), siklus başına %10 ), 4620'sinde (%80) hastada gebelik oluşmadı. 2. gruptaki hastaların l'inde gebelik saptanırken ( gebelik oranı hasta başına (%4), siklus başına %1.9 ), 24 'ünde (%96) hastada gebelik oluşmadı. Çalışmaya alınan her iki gruptaki hastalara uygulanan intrauterin inseminasyon sonuçlan birbirleriyle karşılaştırıldığında aralarında istatiksel olarak anlamlı bir farklılık saptanmadı (P>0.05 ). Sonuç olarak çift IUI uygulamasının aileye getireceği ekonomik yük ve psikolojik travmadan dolayı tek IUI uygulamasının daha doğru olacağı kanaatindeyiz.Although admission to infertility clinics is increased in recent years there is no change infertility prevalance. Demographic properties such as age and socioeconomical level effect infertility ratio. In general since pregnancy age is delayed in the population, there is an increase in the ratio of women who want to be pregnant in older ages. The prevalance of infertility show no difference according to the race and the ethnics. The infertility ratio is higher in the group with low socioeconomical level, intrauterine insemination that has an important role in infertility treatment when used in appropriate infertile patient is a very predictive modality by the aspects of outcomes and costs. Our aim in this study is to investigate the efficiency of intrauterine insemination application time and number after P-hCG application to patients under ovulation induction. The study is carried out in Obstetrics and Gynecology Clinic of Selçuk University Faculty of Meram Medicine outpatient clinics and over 50 infertile patients in a prospective and randomized way. Patient included in the study are divided in to two groups. To 25 patients included in the first group only one intrauterine insemination is applied after giving 10.000 IU hCG following ovulation induction. To 25 patients in the second group after 10.000 IU hCG application following ovulation induction two intrauterine insemination is done after 24 hours and 48 hours of the procedure. With similar ratios in both groups some of the patients had ovulation induction with clomiphene citrate, some with gonadotrophins. Boths group are compared with each other according to the avarage age, the duration of infertility, body mass index and avarage FSH, LH and E2 value and the agents used in ovulation induction. In our study when the resultsof intrauterine insemination applied after ovulation induction are evaluated. In the first group the pregnancy is detected by 5 patients (pregnancy rate per patient is 20%, pregnancy rate per cycle is 10%). In the 20 of the patients (80%) no pregnancy is 48detected. In the second group while pregnancy is detected in 1 patient (pregnancy rate per patient is 4%, pregnancy rate per cycle is 1.9%). In 24 patients (90%) no pregnancy is detected. When the results of intrauterine insemination applied to both group of patients are compared no statistical difference is detected (P>0.05) As a result we concluded that single intrauterine insemination treatment is more reasonable than double intrauterine insemination treatment when the economical cost and the psychological trauma of the patient is considered

Effects of anxiety and depression levels on low birth weight and prematurity in pregnant women

Düşük doğum ağırlığı olan bebek dünyaya getirmede ya da prematüre doğum yapmada gebenin depresyon ya da anksiyete düzeyinin etkisinin olup olmadığını araştırmayı amaçladık. Gereç ve yöntem: Buçalışma Meram Tıp Fakültesi gebe polikliniğine Nisan 2016 ile Haziran 2016 tarihleri arasında başvuran, herhangi bir fiziksel engeli olmayan, psikiyatrik bir tanı ve tedavi almamış, 3. trimester gebeliği olan gebelik takiplerinde ve doğum sürecinde herhangi bir problem olmayan, normal gebelik takibindeki 233 gebe ile yürütülmüştür. Katılımcılara kendilerini tanımaya yönelik 16 maddelik kişisel bilgi formu, Hastane Anksiyete Depresyon Ölçeği (HAD) ve Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire (TEMPS-A) ölçeği uygulanmıştır. İstatistiksel analizler için SPSS 15 Statistical Software (USA) programı kullanıldı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların (ortalama, standart sapma, frekans) yanı sıra niceliksel verileri için Mann Whitney-U testi kullanıldı. Anlamlılık p<0.05 düzeyinde değerlendirildi. İki örneklem grubu arasında korelasyon olup olmadığını anlamak için ise Spearman'ın korelasyon testi (non-parametrik korelasyon) kullanılmıştır. Bulgular: Doğum haftası ile doğum ağırlığı arasında anlamlı pozitif iyi derecede korelasyon mevcut (korelasyon katsayısı 0,649) iken, anksiyöz mizaç ile doğum haftası ve doğum ağırlığı arasında anlamlı pozitif düşük derecede korelasyon saptanmıştır (korelasyon katsayları 0,217 ve 0,189).Düşük doğum ağırlığı ile anksiyöz mizaç skoru arasında istatistiksel olarak anlamlı ilişki saptanmıştır(p=0,021). Erken doğum ile anksiyöz mizaç arasında istatistiksel olarak anlamlı ilişki bulunmuştur(p< 0,001). Sonuç: Erken doğum yapan ve düşük doğum ağırlıklı bebeği olan annelerin anksiyete düzeylerinin yüksek olduğu tespit edilmiştir.We aimed to investigate whether maternal depression or anxiety levels has an effect on premature birth or low birth weight. Material and Method:This study was carried out at Meram Faculty of Medicine pregnancy outpatient clinic between April and June 2016.The study was conducted with 233 pregnant women having a normal pregnancy in the third trimester,who did not have any physical disabilities, no psychiatric diagnosis and treatment, and no problems during the pregnancy and birth process.A 16-item personal information form, Hospital Anxiety Depression Scale (HAD) and a Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire (TEMPS-A) scale were used to identify participants. SPSS 15 Statistical Software (USA) program was used for statistical analysis.Descriptive statistical methods (mean, standard deviation, frequency), as well as Mann Whitney-U test for quantitative data were used to evaluate the data.A p value of <0.05 considered as significant.Spearman's correlation test (non-parametric correlation) was used to determine if there was a correlation between the two sample groups. Results:There wasa significant positive correlation between the gestational week at birth and birth weight (Correlation coefficient0.649).Significant positive low-order correlations were found between anxious temperament and birth week and birth weight (Correlation coefficient0,217 and 0,189).Statistically significant correlation was found between low birth weight and anxious temperament score (p=0.021).Also, there was a statistically significant correlation between preterm delivery and anxious temperament (p <0.001). Conclusion: Anxiety levels of mothers who had premature birth and low birth weight were high

A New Technique For Treatment of Imperforate Hymen By Aortic Punch

To present a case of imperforate hymen treated by aortic punch without damaging the structure of the hymen. A 15-year-old girl was admitted to our clinic with history of pelvic pain for 3 months. On inspection of external genitalia, a bulging bluish membrane was seen on retracting the labia without a patent hymenal orifice. Suprapubic ultrasonographic examination demonstrated a large hematocolpos measuring 17x10 cm and hematometra measuring 3x4 cm. The hymen was perforated to 0.5 cm in diameter by an aortic punch from the middle of the distended and imperforate hymenal membrane. Blood in the vagina was drained using irrigation with a saline solution. Postoperative period was uneventful. The patient was followed up for 6-months; the patient was asymptomatic and had regular normal menstrual cycles and normal pelvic ultrasonography. Hymen protection is important in different ethnic groups and countries as it is in our country, when treatment is planned, the sociocultural values of the society should be considered

The Outcome Analysis of Cesarean Section Cases in One-Year Period

OBJECTIVE: The purpose of the study is to evaluate the rates, indications and complications of patients who had undergone cesarean section in one year, in the department of obstetrics and gynecology Selçuk Univercity, Meram Medical Faculty. STUDY DESIGN: Patients who gave birth between january 2005 and january 2006 in our hospital were enrolled in this study and retrospectively analized. The cesarean section rates, its complications, indications, the patients mortality and morbidity were studied. RESULTS: The total number of births in one year was 2148. Of these 2148 births, 1055 (49.11%) were vaginal births and the remaining 1093 (50.88%) were cesarean deliveries. Although prior cesarean deliveries were the major indication with 402 (36.77%) cases, fetal distress with 144 (13.17%) cases, elective cesarean with 124 (11.34%), abnormal pelvis (CPD) with 108 (9.88%) cases were also found to be high. Two cases of maternal mortality were detected in our study. (18.29/10000). Of these two mortalities, one was HELLP Syndrome and the other one was preeclampsia patients. The morbidity rate was found to be 14%. 11% febrile morbidity, 1.28% postoperative endometritis, 1.09% urinary tract infection, 0.73% wound infection were detected. One patient had urinary bladder injury during surgery. CONCLUSIONS: The rates of cesarean deliveries are increasing day by day. The increased rates of prior cesarean deliveries is a critical factor for the risks of recurrent surgeries and cost-effectiveness. We concluded that to determine the real indications for primary cesarean deliveries and to be more selective and careful are assumed to decrease the cesarean delivery rates

Recurrent Periclitoreal Abscess Due To Birth Injury: A Case Report

Periclitoral abscess is a rare cause of severe vulvar pain and exceedingly infrequent occurance after perineal injury of vaginal birth. Case: A 39-year-old woman was presented with severe tenderness and swelling of her clitoris. She had been similar complaints for approximately 2 years with multiple rounds of antibiotics after her last vaginal birth including injury of periclitoral region. Treatment consisted of a wide local drainage of the abscess, and restoration of the periclitoral area. Healing was not delayed and no discomfort has been reported postoperatively. Curative theraphy of a recurrent clitoral abscess can be accomplished by surgical treatment with preservation of the clitoris

The Applicability and Use of Doppler Ultrasonography in The First Trimester

In contemporary obstetrics, the idea of “the pathological processes which are apt to cause complications or diseases at the later stages of pregnancy or even at the postnatal period could be revealed in early pregnancy weeks is spreading. Most researchers are readily willing to use all available means of technology to detect the pathologies which could develop in the early weeks of pregnancy. Along with the first trimester screening tests, the importance and application fields of the first trimester doppler ultrasonography is frequently discussed. This review will discuss shortly the first trimester screening tests and then will focus on the advantages and applicability of the first trimester doppler ultrasound as mentioned in the current literature

Termination of Pregnancy in a Patient with Advanced Ovarian Cancer

Ovarian cancer during pregnancy is a rare entity and the management of the disease can be challenging for the patient and the clinician. In this case, we report a case of advanced ovarian carcinoma diagnosed during pregnancy, which was managed with termination of pregnancy and chemotheraphy. The patient was underwent exploratory laparatomy including the right ovarian cystectomy, omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy after frozen section of borderline serous cystadenocarcinoma at the 14 week of gestation. After final histopathology, the patient was staged as having FIGO stage IIIC disease. The pregnancy was termineted with the decision of patient and her family. The patient was treated with chemotheraphy

Recurrent Hydatiform Mole: Report of A Case with Fourth Recurrence

In this report, it is objected to demonstrate 4th recurrence of molar pregnancy in a patient with a past history of 3 suction curettages for 2 complete and 1 partial moles. A 31-year-old woman was referred to our hospital with diagnosis of mole. There was no history of consanguinity. The mother of the patient had history of molar pregnancy and both sisters had primary infertility and IVF failures. Karyotype analysis of the patient and her husband was normal. The calculated serum β-hCG level was 188000IU/ml and she had an endometrial thickness of 40mm with a crumb like image. Thyroid function tests were normal. Suction curettage was performed and histopathological examination revealed complete HM. The patient is still being followed up with serial serum β-hCG levels. Families who have recurrent molar pregnancies should be informed about that subsequent pregnancies are at increased risk of having molar conception

Pregnancy-onset obsessive-compulsive disorder: clinical features, comorbidity, and associated factors

WOS:000362920300006Objective: The prevalence rate of obsessive-compulsive disorder (OCD) was found to be higher in women during pregnancy and puerperium than that estimated in the general population. Additionally, the symptomatology of OCD shows several variations during the lifetime of women. Objective of the current study was to examine the clinical characteristics and comorbidity with other anxiety and mood disorders of pregnancy-onset obsessive-compulsive disorder (POCD) and to investigate factors related to POCD. Method: The study sample was composed of three groups. The first group (POCD group) included 20 consecutive pregnant women meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for OCD, showing an onset of OCD during their current pregnancy. The second group (non-OCD group) consisted of 207 consecutive pregnant women without any mood or anxiety disorders to assess factors associated with POCD. In addition, the study included a control group to compare the symptoms of POCD and non-pregnancy-onset OCD. The control group was composed of 40 nonpregnant female outpatients with OCD. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). OCD and other anxiety or mood disorders were determined by means of the Structured Clinical Interview for DSM-IV (SCID-I). Comorbid axis II disorders were diagnosed with the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Results: The mean onset time of OCD in the POCD group was 13.3±6.35 (week5-28) gestational weeks. OCD occurred during the first trimester of pregnancy in 9 women (45%), during the second trimester in 10 (50%) women, and during the third trimester in 1 (5%) woman. The most common obsessions were contamination (n16, 80%) and symmetry/exactness (n6, 30%), and the most common compulsions were cleaning/ washing (n16, 80%) and checking (n12, 60%) in POCD. Thirteen (65%) of the pregnant OCD patients met the criteria for a mood or anxiety disorder. Generalized anxiety disorder was the most frequently diagnosed axis I disorder (40%, n8). The independent factors associated with POCD were cigarette smoking (p0.002), the existence of an anxiety disorder at onset of pregnancy (p0.000), and obsessive-compulsive personality disorder (p0.003). Conclusion: The present study suggests that POCD presents similar clinical characteristics with nonpregnancy-onset OCD. Mood or anxiety disorder comorbidity is observed in more than half of the women with POCD. Additionally, pregnant women who have at least one of 3 factors (cigarette smoking, the existence of an anxiety disorder at onset of pregnancy, and obsessive-compulsive personality disorder) seem to be at risk for POCD

Management of a Viable Ectopic Pregnancy on Caesarean Scar After IVF-ET Procedure: A Case Presentation

To present the management of a viable ectopic pregnancy on caesarean scar following IVF-ET procedure. A 33-year old woman with gravida 2, parity 1 admitted to our outpatient clinic in her 8th weeks of gestation. She had a previous caesarean section 4 years ago. Transabdominal ultrasound examination revealed empty uterine cavity and cervical canal, but an intramural viable gestation near the cesarean scar. Laparotomy was performed. The gestational sac was bulging and thinning out the uterine wall anteriorly at the scar site. We evacuated the products of conception and repaired scar. After 2 hours from the operation an abundant vaginal bleeding occurred and an emergent relaparatomy performed. No active bleeding focus could be detected but bilateral uterine arteries were ligated. As a result, caesarean scar pregnancy is a highly complicated type of ectopic pregnancy and should be kept in mind during routine obstetric practice