Publications by authors named "Ayse Filiz Gokmen Karasu"

24 Publications

  • Page 1 of 1

Intraoperative Complications and Conversion to Laparatomy in Gynecologic Robotic Surgery.

J Invest Surg 2021 Jul 21:1-4. Epub 2021 Jul 21.

Department of Obstetrics and Gynecology, Umraniye Research and Training Hospital, Memorial Sisli Hospital, Istanbul, Turkey.

Introduction: In this study our objective was to document complications encountered during our initial experience with the robotic system and also state the cases in which conversion to laparotomy was necessary.

Material And Methods: This study is a retrospective analysis of robotically performed gynecological and gynecologic oncology procedures at a single center from July 2016 to July 2018. Patient demographics and preoperative indications were obtained from the electronic medical records.

Results: The patients had a mean age of 53.6 years (range, 25-84 years). The operative time ranged from 1 h and 50 min to 9 h (mean, 5 h and 2 min). Most of the complications were managed within minutes and with robotic assisted suturing when necessary. Five patients out of 83 patients needed a surgical conversion from robotic surgery. Conversion rate was 6.02%.

Conclusion: During the study period we were able to manage complications uneventfully without requiring conversion to laparotomy most of the time. Vascular complications encountered during robotic surgery can be managed without requiring conversion to laparatomy.
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http://dx.doi.org/10.1080/08941939.2021.1949411DOI Listing
July 2021

Intraoperative Complications and Conversion to Laparatomy in Gynecologic Robotic Surgery.

J Invest Surg 2021 Jul 21:1-4. Epub 2021 Jul 21.

Department of Obstetrics and Gynecology, Umraniye Research and Training Hospital, Memorial Sisli Hospital, Istanbul, Turkey.

Introduction: In this study our objective was to document complications encountered during our initial experience with the robotic system and also state the cases in which conversion to laparotomy was necessary.

Material And Methods: This study is a retrospective analysis of robotically performed gynecological and gynecologic oncology procedures at a single center from July 2016 to July 2018. Patient demographics and preoperative indications were obtained from the electronic medical records.

Results: The patients had a mean age of 53.6 years (range, 25-84 years). The operative time ranged from 1 h and 50 min to 9 h (mean, 5 h and 2 min). Most of the complications were managed within minutes and with robotic assisted suturing when necessary. Five patients out of 83 patients needed a surgical conversion from robotic surgery. Conversion rate was 6.02%.

Conclusion: During the study period we were able to manage complications uneventfully without requiring conversion to laparotomy most of the time. Vascular complications encountered during robotic surgery can be managed without requiring conversion to laparatomy.
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http://dx.doi.org/10.1080/08941939.2021.1949411DOI Listing
July 2021

Short and middle-term outcomes of vaginally assisted laparoscopic sacropolpopexy.

Low Urin Tract Symptoms 2021 Apr 7;13(2):291-298. Epub 2020 Dec 7.

Department of Obstetric and Gynecology İstanbul, Medicalpark Hospitals, Istanbul, Turkey.

Objective: Vaginally assisted laparoscopic sacrocolpopexy (VALS), which is a combined surgical approach where a vaginal hysterectomy is initially performed, followed by transvaginal placement of synthetic mesh and laparoscopic suspension, can be an alternative to overcome the dissection, suturing limitations of laparoscopic sacrocolpopexy. The aim of this study was to compare the operative times and middle-term anatomic outcomes of women with uterovaginal prolapse undergoing VALS with those of women undergoing abdominal sacrocolpopexy.

Methods: This is a prospective cohort study that evaluates operation times, anesthesia times, estimated blood loss, middle-term outcomes, perioperative and postoperative complications. We compared the results of 47 women who had the VALS to that of 32 abdominal sacrocolpopexy (AS).

Results: The mean follow up was 22.4 months for AS group and 20.5 months for VALS group. The VALS group (median 1 day) had shorter hospitalization duration than the AS group (median 3 days). The mean operation time was significantly shorter in the VALS group (125.9 minutes) than the AS group (151.9 minutes) (P = .03). There was no significant difference in perioperative and postoperative complication rates. Objective failure rate (8.5% in VALS, 15.6% in AS), subjective failure rates (6.4% in VALS, 9.4% in AS), recurrence (2.1% in VALS, 9.4% in AS) and mesh exposition rates (2.1% in VALS, 9.4% in AS) were similar in both procedures.

Conclusions: VALS with shorter operative time and hospitalization than conventional AS is a promising modification minimally invasive technique for sacrocolpopexy especially for those inexperienced in laparoscopic sacrocolpopexy.
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http://dx.doi.org/10.1111/luts.12369DOI Listing
April 2021

Fundal pressure in the second stage of labor (Kristeller maneuver) and levator aniavulsion.

Int Urogynecol J 2021 01 26;32(1):229-230. Epub 2020 Nov 26.

Department of Obstetric and Gynecology, Bezmialem Vakif University, İstanbul, Turkey.

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http://dx.doi.org/10.1007/s00192-020-04616-7DOI Listing
January 2021

The usual suspect: cross-sectional study of fundal pressure at second stage of delivery and the association with pelvic floor damage.

Int Urogynecol J 2021 07 9;32(7):1917-1924. Epub 2020 Sep 9.

Department of Obstetric and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey.

Introduction And Hypothesis: Uterine fundal pressure is applied to accelerate birth by increasing the expulsive force of the uterus in the second stage of delivery. The aim of the study was to evaluate the effect of using uterine fundal pressure during the second stage of delivery on the rate of pelvic floor damage among primiparous women using three-dimensional transperineal ultrasonography.

Methods: The women were divided into two groups: the fundal pressure group included women where the fundal pressure maneuver was applied (n = 39); the control group included women who delivered spontaneously without fundal pressure (n = 47). 3D-TPU was performed within 48 h of delivery, and LAM biometry, LAM defect and loss of tenting were determined.

Results: Anteroposterior hiatal dimensions on resting, maximal Valsalva and maximal PFMC were found to be higher in the fundal pressure group (p < 0.0001, p = 0.008, p = 0.007, respectively). The mean hiatal area at rest was larger in the fundal pressure group than in the control group (p = 0.04). The rate of LAM defect was significantly higher in the fundal pressure group (p = 0.001). The rate of loss of tenting was significantly higher in the fundal pressure group (p < 0.0001). According to multivariate regression models, the fundal pressure was the only independent factor associated with LAM defect (OR = 5.63; 95% CI = 12.01-15.74) and loss of tenting (OR = 8.74; 95% CI = 2.89-26.43).

Conclusions: Fundal pressure during the second stage of delivery is associated with a higher risk of LAM defect and loss of anterior vaginal wall support.

Clinical Trial Registration: NCT03752879.
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http://dx.doi.org/10.1007/s00192-020-04523-xDOI Listing
July 2021

Association of intrinsic sphincter deficiency with urine flow acceleration measurement.

Low Urin Tract Symptoms 2021 Jan 9;13(1):154-159. Epub 2020 Sep 9.

Department of Urology, Bezmialem Vakif University, İstanbul, Turkey.

Background: Intrinsic sphincter deficiency (ISD) is associated with an inability to maintain mucosal coaptation either at rest or in the presence of stress resulting from damage to muscles or nerves that maintain tonus. The purpose of our trial was to determine the role of urodynamic measurements of flow such as maximum flow rate, flow time, and acceleration speed of flow to assess the urethral resistance on prediction of stress incontinence and ISD.

Materials And Methods: Our study was based on a retrospective analysis of urodynamic records of female patients performed for urinary incontinence. Mean flow rate, maximum flow rate, detrusor pressure at maximum flow, vesical pressure at maximum flow, maximum detrusor pressure, and flow rate at maximum detrusor pressure measurements were extracted from the voiding phase of urodynamic charts. The slope of the maximum flow was used to calculate acceleration of flow (Qacc). The urodynamic records of 142 women were reviewed and Qacc was measured.

Results: The mean age of the ISD group was 53.3 ± 12.5 (24-78) and of the non-ISD group 53.7 ± 12.5 (35-74). The mean Qacc (30.3 ± 16.1° [mL/s ]) in the ISD group was significantly higher than in the non-ISD group (21.6 ±9.6° [mL/s ]). Urodynamic bladder capacity of the non-ISD group (432.3 ± 90.4 mL) was higher than the ISD group (389.2 ± 109) (P = .01).

Conclusion: The Valsalva leak point pressure and maximum urethral closure pressure measurements in assessing urethral function are not useful for predicting incontinence surgery failure. We demonstrated that Qacc is higher in ISD stress incontinent women than stress incontinent women. Qacc may demonstrate urethral resistance and tonus in a more reliable manner.
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http://dx.doi.org/10.1111/luts.12348DOI Listing
January 2021

Association of intrinsic sphincter deficiency with urine flow acceleration measurement.

Low Urin Tract Symptoms 2021 Jan 9;13(1):154-159. Epub 2020 Sep 9.

Department of Urology, Bezmialem Vakif University, İstanbul, Turkey.

Background: Intrinsic sphincter deficiency (ISD) is associated with an inability to maintain mucosal coaptation either at rest or in the presence of stress resulting from damage to muscles or nerves that maintain tonus. The purpose of our trial was to determine the role of urodynamic measurements of flow such as maximum flow rate, flow time, and acceleration speed of flow to assess the urethral resistance on prediction of stress incontinence and ISD.

Materials And Methods: Our study was based on a retrospective analysis of urodynamic records of female patients performed for urinary incontinence. Mean flow rate, maximum flow rate, detrusor pressure at maximum flow, vesical pressure at maximum flow, maximum detrusor pressure, and flow rate at maximum detrusor pressure measurements were extracted from the voiding phase of urodynamic charts. The slope of the maximum flow was used to calculate acceleration of flow (Qacc). The urodynamic records of 142 women were reviewed and Qacc was measured.

Results: The mean age of the ISD group was 53.3 ± 12.5 (24-78) and of the non-ISD group 53.7 ± 12.5 (35-74). The mean Qacc (30.3 ± 16.1° [mL/s ]) in the ISD group was significantly higher than in the non-ISD group (21.6 ±9.6° [mL/s ]). Urodynamic bladder capacity of the non-ISD group (432.3 ± 90.4 mL) was higher than the ISD group (389.2 ± 109) (P = .01).

Conclusion: The Valsalva leak point pressure and maximum urethral closure pressure measurements in assessing urethral function are not useful for predicting incontinence surgery failure. We demonstrated that Qacc is higher in ISD stress incontinent women than stress incontinent women. Qacc may demonstrate urethral resistance and tonus in a more reliable manner.
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http://dx.doi.org/10.1111/luts.12348DOI Listing
January 2021

Administration of rectal cytotec versus rectal buscopan before hysteroscopy.

Minim Invasive Ther Allied Technol 2020 Jun 3:1-5. Epub 2020 Jun 3.

Department of Gynecologic Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming. This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure. Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively ( = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (=.11). There was no difference with regard to other studied parameters. HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
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http://dx.doi.org/10.1080/13645706.2020.1748059DOI Listing
June 2020

Less Blood Loss by Earlier Oxytocin Infusion in Cesarean Sections? A Randomized Controlled Trial.

Z Geburtshilfe Neonatol 2020 Oct 2;224(5):275-280. Epub 2020 Mar 2.

Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey.

Purpose: The aim of our study was to evaluate the positive effect of starting an IV oxytocin infusion early before uterine incision on intraoperative blood loss.

Methods: A total of 101 women between 18-40 years who underwent a primary elective cesarean section (CS) were included in this randomized controlled trial. The patients were divided into two groups. In Group I (n=51), oxytocin infusion was administered immediately after incision of the visceral peritoneum during CS. In Group II (n=50), infusion was administered immediately after clamping the umbilical cord. The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean reduction in hemoglobin and hematocrit levels, need for additional uterotonics and hemostatic uterine sutures, blood transfusion, post-operative pain score, and additional surgical procedures.

Results: There were statistical significant differences either in the change of the hemoglobin concentration (1.27±0.75 vs.1.74±0.81; p<0.01) or in the change of hematocrit concentration (3.89±2.24 vs. 5.41±2.93; p<0.01). Intraoperative blood loss was significantly lower in Group I when compared to Group II (475.86±150.11 vs. 605.1±203.2; p<0.01).

Conclusions: Our findings suggest that the starting IV oxytocin infusion early before uterine incision reduces intraoperative blood loss. This could be effective to replace starting IV oxytocin infusion late after umbilical cord clamping or delivery of the placenta.

Einleitung: Das Ziel unserer Studie war es. die positive Wirkung der beginnenden IV Oxytocin-Infusion früh vor der Uterusinzision auf den intraoperativen Blutverlust zu bewerten.

Material Und Methodik: In diese randomisierte kontrollierte Studie wurden insgesamt 101 Frauen zwischen 18 und 40 Jahren eingeschlossen, die sich einem primären elektiven Kaiserschnitt unterzogen hatten. Die Patienten wurden in 2 Gruppen eingeteilt. Gruppe I (n=51); Die Oxytocin-Infusion wurde unmittelbar nach der Inzision des viszeralen Peritoneums während der CS verabreicht. Gruppe II (n=50); Die Infusion wurde unmittelbar nach dem Klemmen der Nabelschnur verabreicht. Das primäre Ergebnis war das mittlere Blutverlustvolumen während der CS. Zu den sekundären Ergebnissen gehörte die mittlere Verringerung der Hämoglobin- und Hämatokritwerte, Bedarf an zusätzlichen Uterotonika und hämostatischen Uterusnähten, Bluttransfusion, postoperativer Schmerzscore und zusätzliche chirurgische Eingriffe.

Ergebnisse: Es gab statistisch signifikante Unterschiede zwischen der Änderung der Hämoglobinkonzentration 1,27±0,75 vs.1,74±0,81; p<0,01) oder der Änderung der Hämatokritkonzentration(3,89±2,24 vs. 5,41±2,93; p<0,01). Der intraoperative Blutverlust war in Gruppe I im Vergleich zu Gruppe II signifikant geringer (475,86±150,11 vs. 605,1±203,2; p<0,01).

Diskussion: Unsere Ergebnisse legen nahe, dass die beginnende intravenöse Oxytocin-Infusion früh vor der Uterusinzision den intraoperativen Blutverlust verringert. Dies könnte wirksam sein, um eine beginnende intravenöse Oxytocin-Infusion zu einem späten Zeitpunkt nach dem Klemmen der Nabelschnur oder der Abgabe der Plazenta zu ersetzen.
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http://dx.doi.org/10.1055/a-1108-2017DOI Listing
October 2020

The Effects of Micronized Progesterone and Cabergoline On a Rat Autotransplantation Endometriosis Model: A Placebo Controlled Randomized Trial.

J Invest Surg 2021 Aug 6;34(8):897-901. Epub 2020 Jan 6.

Department of Pathology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey.

Aim: The etiology of endometriosis is complex and various theories have been postulated. Endometriosis pathogenesis involves genetic susceptibility, immunologic alterations and inflammatory prerequisite pathways. In this pilot experimental animal study we wanted to investigate the effects of cabergoline and micronized progesterone on a rat endometriosis model.

Material And Methods: All rats were provided and housed in the animal laboratory of the Experimental Research Center of Bezmialem Vakif University. This was a placebo controlled randomized trial. The endometriosis model consisted of autotransplantation of endometrial tissue on 21 adult Sprague-Dawley rats. Endometriosis formation by second-look laparotomy was confirmed 8 weeks later. After measuring the endometriosis implant area the rats were randomized into three intervention groups: cabergoline treatment group, micronized progesterone treatment group and the control group. Four weeks after treatment, a third laparotomy was performed to remeasure implant volumes. Endometriotic implants were obtained for histopathological and immunohistochemical analysis.

Results: After 4 weeks of treatment endometriosis implant sizes diminished in all groups. There was no statistically significant difference regarding implant size volume before and after treatment among the groups. The peritoneal histopathology and immunohistochemistry showed no difference with regards to IL-6 and TNF-α staining among groups.

Conclusion: We conclude that oral treatment of cabergoline and micronized progesterone for 4 weeks was not statistically effective in endometriotic implant regression. However, we believe further studies are warranted. Treatment for longer durations or via different routes may be investigated in further studies. When ethically applicable other mammals may be considered such as baboons.
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http://dx.doi.org/10.1080/08941939.2019.1705442DOI Listing
August 2021

The predictive value of weight gain and waist circumference for gestational diabetes mellitus.

Turk J Obstet Gynecol 2019 Sep 10;16(3):199-204. Epub 2019 Oct 10.

Universitiy of Health Sciences, Elik Zübeyde Hanım Women's Diseases Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.

Objective: The first objective of this study was to investigate the relationship between gestational diabetes mellitus (GDM) and gestational weight gain (WG), waist circumference (WC), prepregnancy, and gestational body mass index (BMI). The second aim of our study was to assess the ability of WG, WC, prepregnancy, and gestational BMI with special reference to their cut-off points on predicting the risk of GDM in pregnant women in Turkey.

Materials And Methods: A total of 261 women who underwent screening for GDM with the 75-g glucose tolerance test (GTT) between 24 and 28 gestational weeks were included. According to the 75-g oral GTT results, women were classified into two groups: the GDM group and non-GDM group. The data collected included age, parity, plasma glucose level for fasting, 1- and 2-h tests, WC, prepregnancy and gestational BMI, prepregnancy weight, WG during pregnancy, gestational age at birth, and birth weight.

Results: WC at 20-24 weeks of gestation, prepregnancy BMI, and gestational BMI had a predictive capacity for GDM. According to our results, optimal cut-off points for the best predictive value of GDM were WC of 100 cm with a sensitivity of 84% and specificity of 70%, prepregnancy BMI of 25 kg/m with a sensitivity of 81.8% and specificity of 76%, and gestational BMI of 28.3 kg/m with a sensitivity of 75% and specificity of 77.4%.

Conclusion: The measurement of prepregnancy BMI, gestational BMI, and WC may be useful in predicting the risk of GDM. Pregnant women with increased prepregnancy BMI, gestational BMI, and WC measurements may be susceptible to the development of GDM.
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http://dx.doi.org/10.4274/tjod.galenos.2019.03266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792050PMC
September 2019

Incidence and outcomes of eclampsia: a single-center 30-year study.

Hypertens Pregnancy 2019 May 17;38(2):119-123. Epub 2019 Mar 17.

b Department of Obstetrics and Gynecology , Bezmialem Vakif University Medical Faculty , Istanbul , Turkey.

Objective: We aimed to determine the incidence of eclampsia at Erciyes University Hospital which is a tertiary referral center situated at central Anatolia. Additionally, we investigated eclampsia-associated maternal and perinatal outcomes for the 30-year study period.

Methods: A retrospective review was performed for all women who were diagnosed with eclampsia and admitted to the Erciyes University Medical School, Department of Obstetrics and Gynecology from January 1985 to December 2015. Improvement in management gained over time was determined by comparing the results of the years 2005-2015 with data which were already published from years 1985-1999 and 2000-2004.

Results: Eclampsia prevalence was 289/46,928 (% 0.61). Maternal age at the time of diagnosis did not differ statistically; however, gestational age at diagnosis and birth weight decreased significantly throughout the years (p < 0.005). The perinatal mortality rate showed a slight decrease throughout the years (p = 0.238). Maternal mortality rate also decreased throughout the years; it was 1.7% in 2005-2009 and 0 % in 2010-2015 (p = 0.246).

Conclusion: The prevalence of eclampsia cases has decreased over the years. Maternal mortality attributed to eclampsia has also declined. The early diagnosis and treatment of eclampsia have resulted in the increase of premature deliveries. The perinatal mortality rate showed a slight decrease throughout the years (p = 0.238); however, it is not at a desirable rate compared to developed countries.
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http://dx.doi.org/10.1080/10641955.2019.1590719DOI Listing
May 2019

Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus.

J Obstet Gynaecol 2018 Oct 19;38(7):922-926. Epub 2018 Mar 19.

a Department of Obstetrics and Gynecology , Health Sciences University, Süleymaniye Women and Children's Health Training and Research Hospital , İstanbul , Turkey.

The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (-) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population. Impact statement What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton's jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings. What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (-) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%. What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.
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http://dx.doi.org/10.1080/01443615.2018.1434136DOI Listing
October 2018

What is your diagnosis?

J Turk Ger Gynecol Assoc 2017 Dec;18(4):219-220

Department of Obstetrics and Gynecology, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Turkey.

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http://dx.doi.org/10.4274/jtgga.2017.0030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776162PMC
December 2017

Clinical and metabolic characteristics of Turkish adolescents with polycystic ovary syndrome.

J Obstet Gynaecol 2018 Feb 18;38(2):236-240. Epub 2017 Sep 18.

a Faculty of Medicine, Department of Obstetrics and Gynecology , Bezmialem Vakif University , Istanbul , Turkey.

The aim of this study was to investigate the clinical, endocrine, metabolic features and prevalence of metabolic syndrome (MBS) in Turkish adolescents with polycystic ovary syndrome (PCOS) and the differences in metabolic parameters between adolescent PCOS with or without the presence of polycystic ovaries (PCO) on ultrasound. Subjects (n = 77) were classified into two groups: oligomenorrhea (O) and clinical and/or biochemical hyperandrogenism (HA) (n = 38), without PCO and O + HA with PCO (n = 39). The control group consisted of 33 age-matched adolescents. Adolescents with PCOS had a significantly higher body mass index (BMI), waist circumference and levels of LH, LH/FSH ratio, triglyceride, insulin, HOMA-IR, free androgen index and lower levels of SHBG and FSH. After adjustment for BMI, LH, LH: FSH ratio remained significantly higher. Adolescents with PCOS had a higher prevalence of MBS. No significant differences in lipid profiles, insulin levels and insulin sensitivity in both the PCOS groups were seen. HDL-C levels were lower in the O + HA + PCO group compared to the controls. BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS. Impact statement Many studies have investigated the effect of PCOS on metabolic and cardiovascular risks. It is thought that PCOS increases metabolic and cardiovascular risks. Increase in metabolic and cardiovascular risks associated with PCOS may be handled with early diagnosis and early intervention of PCOS in adolescents, although the diagnosis of PCOS in adolescents could be hard because of the features of PCOS overlapping normal pubertal physiological events. However, early identification of adolescent girls with PCOS may provide opportunities for prevention of well-known health risks associated with this syndrome and reduction of long-term health consequences of PCOS by reducing androgen levels and improving metabolic profile. Our results also support that BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS.
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http://dx.doi.org/10.1080/01443615.2017.1345875DOI Listing
February 2018

Nurses' Knowledge and Opinions on HPV Vaccination: a Cross-Sectional Study from Istanbul.

J Cancer Educ 2019 02;34(1):98-104

Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı Vatan Caddesi, Fatih, 34093, İstanbul, Turkey.

Implementing a HPV vaccination program is currently under evaluation by the Turkish health ministry. For screening and vaccination programs to be successful, the cooperation of nurses is essential. We aimed to evaluate (1) basic knowledge of nurses and nursing interns regarding HPV infection and cervical cancer, (2) their attitudes towards smear testing and HPV vaccination, and (3) their viewpoint on vaccination of school age children. This cross-sectional study was undertaken at Bezmialem Vakif University. The survey was designed to assess knowledge about HPV infection, Pap smear testing, cervical cancer, HPV vaccine, attitudes towards HPV vaccination, and school-based vaccination programs. Validity content was determined by expert gynecologists, and a pilot study was performed on 10 nurses. A total of 550 questionnaires were handed out; 499 were completed. Our response rate was 90.7%. Fifty-nine participants answered all the knowledge questions correctly. The calculated knowledge score of the female participants was 6.99 ± 2.22, the male participants was 5.89 ± 2.92. Female participants were more knowledgeable (p < 0.0001). Out of the 353 female participants, 18.6% (n = 66) had undergone smear testing. There were 20 (5.6%) female and 6 (4%) male participants who were vaccinated against HPV. The leading answer for not having a HPV vaccine was "I'm not at risk for a HPV infection" (n = 106, 34.9%). There was a statistical relationship between "HPV knowledge score" and answering "Yes" to "Do you want your children/future children to be vaccinated? (p = 0.001) and "Do you think including the vaccine in the Turkish immunization program is necessary?" (p = 0.001). Nurses in our cohort seem to have satisfactory basic knowledge regarding HPV infection; however, their viewpoints on vaccination were not favorable. Strategies and intervention materials for HPV vaccination will be necessary if a national immunization program will be initiated.
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http://dx.doi.org/10.1007/s13187-017-1272-xDOI Listing
February 2019

Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report.

Rev Bras Ginecol Obstet 2017 Aug 7;39(8):436-440. Epub 2017 Aug 7.

Department of Gynecology and Obstetrics, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

 Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported.  A congested, multinodular myomectomy specimen was resected. Histologically, smooth muscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the K-67 index was of 2-3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence.  Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant.
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http://dx.doi.org/10.1055/s-0037-1604057DOI Listing
August 2017

Dental health dispositions of pregnant women: A survey from a hospital clinic in Istanbul.

J Obstet Gynaecol 2017 Aug 3;37(6):752-756. Epub 2017 May 3.

a Department of Obstetrics and Gynaecology , Bezmialem Vakif University , Istanbul , Turkey.

Dental hygienic habits should be maintained in pregnancy despite challenges. We aimed to study the dental attitudes and habits of pregnant women. The patients attending our hospital clinic were invited to fill out a structured questionnaire categorised into three major domains: (1) general oral hygiene status, (2) dental habits, and (3) dental attandence both during pregnancy and prior to pregnancy. Four hundred and seventy four women agreed to participate. Mean age of participants was 28 (18-43). While 184 (38%) women reported brushing twice a day, only 98 (20%) women claimed using floss and or mouth rinse. Fifty-nine (12.4%) women had a dental visit in their current pregnancy and 24 (5.1%) received professional treatment. Obstetric care givers should convey the importance of dental care to their patients. We suggest that dental health should be improved antenatally, and be assessed in detail by dental health care providers. Impact Statement Poor oral health conditions have shown to be associated with an increased risk of adverse pregnancy outcomes, especially in low-income countries and regions. There is escalating evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene. Our results showed that dental hygienic practices of pregnant women are disconcerting in Turkey. The need for inter-professional collaboration among obstetric healthcare providers and dental specialistis is crucial for conveying to women the importance of dental care in pregnancy and beyond.
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http://dx.doi.org/10.1080/01443615.2017.1306837DOI Listing
August 2017

A rat hysteropexy model for evaluating adhesion formation and comparison of two different structured meshes.

Int Urogynecol J 2017 Nov 24;28(11):1695-1700. Epub 2017 Apr 24.

Department of Obstetrics and Gynecology, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan St.), Fatih, 34093, İstanbul, Turkey.

Introduction And Hypothesis: Peritonization of mesh during sacrohysteropexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking, and peritonization may not be completely possible in a laparoscopic hysteropexy procedure. Our main objective was to describe a basic experimental rat sacrohysteropexy model. We hypothesized that even when peritoneal closure was omitted, using composite mesh would result in less adhesions to the viscera.

Methods: Twenty in-bred female virgin Wistar Hannover rats were used in this study. Standardized hysteropexy procedure and adhesion model is described step by step with two different mesh materials: polypropylene and a composite polyester. Mesh was anchored between the posterior cervix and anterior longitudinal ligament of the lumbar vertebrae. Macroscopic adhesion scores and histopathological tissue reaction was investigated.

Results: Macroscopically, the surface area involved in adhesions was similar between groups. However, adhesions in the polypropylene group were more dense, required sharp dissection for lysis, and yielded higher total macroscopic adhesion scores (p < 0.001). Histologically, a more pronounced host inflammatory response was encountered in the polyester group (p < 0.001).

Conclusions: We describe a rat hysteropexy model and a previously established uterine adhesion model. Adhesion scores in the composite mesh group were lower, and bowel involvement was not seen. Our findings are promising, and further research investigating antiadhesive composite mesh use for hysterosacropexy would be appropriate, especially when peritoneal closure is omitted.
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http://dx.doi.org/10.1007/s00192-017-3328-1DOI Listing
November 2017

Amniotic fluid "sludge"; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery.

J Matern Fetal Neonatal Med 2018 Jan 26;31(2):135-140. Epub 2017 Jan 26.

a Department of Obstetrics and Gynecology , Hacettepe University Faculty of Medicine , Ankara , Turkey.

Introduction: The aim of our study is to determine prevalence and clinical significance of the presence of amniotic fluid "sludge" among asymptomatic patients at high-risk for spontaneous preterm delivery, prospectively.

Material And Methods: In our study, 99 patients at high risk for spontaneous preterm delivery were evaluated for the presence of amniotic fluid sludge with transvaginal ultrasonography at 20-22, 26-28, and 32-34 gestational weeks, prospectively; between August 2009 and October 2010 in Hacettepe University Hospital. And, these patients were followed up for their delivery weeks and pregnancy outcomes. We defined the high-risk group as the patients possessing one or more of the followings; a history of spontaneous preterm delivery, recent urinary tract infections, polyhydramnios, uterine leiomyomas, müllerian duct anomalies, and history of cone biyopsy or LEEP. Patients with multiple gestations, placenta previa, fetal anomalies, or symptoms of preterm labor at first examination were excluded. We have obtained ethical board approval from Hacettepe University (16.07.2009-HEK/No:09-141-59).

Results: The prevalence of amniotic fluid sludge in the study population was 19,6% (18/92). The rates of spontaneous preterm delivery at <37 weeks of gestation were 66,7% (12/18), within the patients with sludge and 27,0% (20/74) within the patients without sludge. Patients with sludge had a higher rate of spontaneous preterm delivery (p = 0.002). A higher proportion of neonates born to patients with amniotic fluid sludge had a neonatal morbidity (50% (9/18) vs. 24,3% (18/74), p = 0.044) and died in the perinatal period, (p = 0,013) than those born to patients without sludge. When we combined sludge and cervical lenght (CL) (<25 mm) and used it as a screening test to identify women at risk for preterm delivery; it catched more women with preterm delivery, (p = 0.000). While sensitivity of sludge was 37,5%, and sensitivity of CL was 34%, sensitivity of "sludge positive or CL ≤25 mm" was 56% for preterm birth (PTB) in high-risk group.

Conclusions: The prevalence of amniotic fluid sludge is 19,6% and "sludge" is an independent risk factor for spontaneous preterm delivery among asymptomatic patients at high-risk for spontaneous preterm delivery. PTB is by far the leading cause of infant mortality, and prevention of PTB has been an elusive goal. When sludge added to screening, we can catch more PTB.
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http://dx.doi.org/10.1080/14767058.2016.1277700DOI Listing
January 2018

Risk factors and microbiology of wound infections following cesarean delivery: Experience of a single institution.

J Infect Chemother 2016 Oct 3;22(10):667-70. Epub 2016 Aug 3.

Suleymaniye Research and Education Hospital, Microbiology, Istanbul, Turkey. Electronic address:

Aims: To determine the prevalence of wound infection following cesarean delivery, risk factors, common bacterial pathogens and their antibiotic sensitivity.

Material-method: The study population consisted of 5787 cesarean deliveries. All of the patients received 2 g doses of cephazolin perioperatively for antibiotic prophylaxis. Patients with wound infection who had two doses of 1 g cephazolin postoperatively and who were continued on oral preparations of 500 mg of cephuroxime twice daily for 5 days after hospital discharge were included in Group A. Patients with wound infection whose postoperative antibiotics and antibiotics after discharge were omitted were included in Group B. Patient related variables, gestational age, co-morbidities, cesarean section indications, neonatal intensive care requirements were assessed. Risk factors were evaluated according to the type of the procedure (elective or emergent) and administered antibiotic protocol.

Results: The incidence of wound infection following cesarean section was 0,37% in elective operations and 5,4% in emergency cases. On the other hand, wound infection rate was found to be 1,35% in antibiotic receiving group (Group A) and 1,12% in the group not receiving antibiotics (Group B).

Conclusion: Increased rate of wound infections were remarkable in emergency cases and postoperative antibiotics did not have a major impact in reducing the rate of wound infection following cesarean section.
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http://dx.doi.org/10.1016/j.jiac.2016.07.001DOI Listing
October 2016

Utilization of Wilms' tumor 1 antigen in a panel for differential diagnosis of ovarian carcinomas.

Turk J Obstet Gynecol 2016 Mar 10;13(1):37-41. Epub 2016 Mar 10.

Lütfi Kırdar Research and Training Hospital, Department of Pathology, İstanbul, Turkey.

Objective: Ovarian metasteses are often mistaken for primary adenocarcinoma. Studies conducted in recent years have focused on a search for an immunohistochemical marker to aid the differential diagnosis primary and metastatic ovarian carcinoma. Our study objective was to study the usefulness of Wilms tumor 1 (WT 1) antigen in this context.

Materials And Methods: The study was conducted at the pathology clinic of Lütfi Kırdar Training and Research Hospital. Deparaffinated blocks of 40 epithelial ovarian tumors, 40 colon adenocarcinomas, and 35 cases of omentum metastases were studied. Cytokeratin 7 (CK 7), cytokeratin 20 (CK 20), and WT 1 were applied to all specimens.

Results: All ovarian adenocarcinomas were stained with CK 7 (100%). Colorectal adenocarcinomas were stained positive with CK 20 in 87.5% of cases. Primary ovarian adenocarcinomas stained positive with WT 1 in 82.5% of the cases and none of the colorectal adenocarcinomas showed staining with WT 1 (0%).

Conclusion: WT 1 can be used in conjuction with CK 7 in the differential diagnosis of ovarian carcinomas.
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http://dx.doi.org/10.4274/tjod.22220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558354PMC
March 2016

Sonographic depiction of fetal ureters.

J Matern Fetal Neonatal Med 2016 28;29(14):2378-81. Epub 2015 Sep 28.

d Department of Obstetrics and Gynecology , Suleymaniye Maternity Training and Research Hospital , Istanbul , Turkey.

Aims: Classic literature states that the fetal ureter should not be visible unless dilated. Our main objective was to produce an effective, reproducible method for fetal ureter depiction during an anatomic survey. Our secondary objectives were to record the frequency of visible ureters among normal fetuses and among fetuses with mild pyelectasis and also to determine the diameter of the sonographically demonstrated ureter.

Subjects And Methods: One hundred twenty consecutive fetuses undergoing a second trimester scan were enrolled in the study. Ninety-nine anatomically normal fetuses and 21 fetuses with isolated mild pyelectasis (antero-posterior renal pelvis diameter of ≥4 mm and <7 mm) were subjected to a detailed anatomical survey. One hundred twenty fetuses were analyzed bilaterally.

Results: A total of 154 (64.2%) ureters were depicted. In the first group 123 (62.1%) ureters, in the second group 31 (73.8%) ureters were depicted (p = 0.06). The diameters of the ureters ranged from 0.4 to 2.7 mm. The majority (n = 80) (52%) were visualized at both proximal and distal segments.

Conclusions: Our study demonstrates that the ureter can be demonstrated in normal fetuses and in fetuses with mild pyelectasis. Ureteral depiction is likely to be composed of normal transient passage of urine associated with peristalsis and is not always a pathological finding.
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http://dx.doi.org/10.3109/14767058.2015.1086330DOI Listing
January 2017

Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles.

Arch Gynecol Obstet 2016 Feb 25;293(2):345-50. Epub 2015 Jun 25.

Balıkesir State Hospital, Balıkesir, Turkey.

Purpose: To demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker.

Methods: DV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used.

Results: DV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values.

Conclusions: DV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.
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http://dx.doi.org/10.1007/s00404-015-3796-9DOI Listing
February 2016
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