Publications by authors named "Emine Seda Guvendag Guven"

46 Publications

Carbon Dioxide Pneumoperitoneum May Alter Ovarian Apoptosis: An Experimental Study.

Gynecol Minim Invasive Ther 2021 Apr-Jun;10(2):91-95. Epub 2021 Apr 14.

Department of Obstetrics and Gynecology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.

Objectives: The aim of this study was to evaluate ovarian immunohistochemical CD95 expression in a rabbit carbon dioxide pneumoperitoneum model.

Materials And Methods: The study group including seven rabbits was subjected to intra-abdominal pressure (IAP) (12 mmHg); the control group was not subjected to IAP (the sham group, = 7). At the end of the experiment, ovariectomy was performed. Immunohistochemical stained histologic specimen of the ovary with CD95 was evaluated. Based on the degree of cytoplasmic or membranous staining for CD95 from 0 (none) to 3 (severe), a microscopic apoptosis scoring system was used.

Results: Statistically significantly higher apoptosis scores in ovarian surface epithelial cells (2.57 ± 0.53, vs. 1.14 ± 0.38, = 0.002, Mann-Whitney -test, respectively), follicular epithelial cells (2.85 ± 0.38, vs. 1.85 ± 0.38, = 0.002, Mann-Whitney -test, respectively), and stromal cells (2.71 ± 0.49, vs. 1.29 ± 0.49, = 0.002, Mann-Whitney -test, respectively) were observed in pneumoperitoneum group, compared with no-pneumoperitoneum group.

Conclusion: Even at safe IAP (12 mmHg) for an acceptable operation time period, there was a significant increase in apoptosis of ovarian cells.
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http://dx.doi.org/10.4103/GMIT.GMIT_96_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140544PMC
April 2021

Biotin deficiency in hyperemesis gravidarum.

J Obstet Gynaecol 2019 Nov 23;39(8):1160-1163. Epub 2019 Jul 23.

Departments of Obstetric and Gynecology, Faculty of Medicine , Trabzon , Turkey.

The aim of this study was to determine the serum biotin levels in patients with hyperemesis gravidarum (HG). Ninety pregnant women with HG (mild ( = 30), moderate ( = 30) and severe ( = 30)), and 80 pregnant women without HG were included for this study. In both groups, serum biotin levels were measured. There were no statistically significant differences in demographic and clinical characteristics between the HG groups and the control group except for PUQE scores. Serum biotin levels in all hyperemesis gravidarum groups were statistically significantly lower than control group. Negative statistically significant correlation between hyperemesis gravidarum severity and serum biotin levels was noted. This is the first study that shows low serum biotin levels in women with hyperemesis gravidarum. Impact statement Almost 80% of pregnant women have nausea and vomiting. If nausea and vomiting became severe and the symptoms combined with weight loss and ketonuria; the diagnosis should be hyperemesis gravidarum (HG). The etiopathogenetic factors of this unwanted condition have not been exactly known. Biotin is an essential water-soluble vitamin. Biotin catabolism increases in pregnancy. Marginal biotin deficiency occurs in approximately 50% of the gestations despite the "normal" biotin intake on the diet. Current study results elucidated that serum biotin levels were lower in HG cases compared to non HG cases. This study is the first study that reports the association between low serum level of biotin and HG. Further research is needed to show the importance of biotin supplementation in women with hyperemesis gravidarum.
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http://dx.doi.org/10.1080/01443615.2019.1604640DOI Listing
November 2019

Disability, psychiatric symptoms, and quality of life in infertile women: a cross-sectional study in Turkey.

Shanghai Arch Psychiatry 2016 Apr;28(2):86-94

Department of Obstetrics and Gynecology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.

Background: Infertility is a major life crisis which can lead to the development of psychiatric symptoms and negative effects on the quality of life of affected couples, but the magnitude of the effects may vary depending on cultural expectations.

Aim: We compare the level of psychiatric symptoms, disability, and quality of life in fertile and infertile women in urban Turkey.

Methods: This cross-sectional study enrolled 100 married women being treated for infertility at the outpatient department of the Obstetrics and Gynecology Department of the Rize Education and Research Hospital and a control group of 100 fertile married women. All study participants were evaluated with a socio-demographic data screening form, the Hospital Anxiety and Depression Scale (HADS), the Brief Disability Questionnaire (BDQ), and the Short Form Health Survey (SF-36).

Results: The mean anxiety subscale score and depression subscale score of HADS were slightly higher in the infertile group than in controls, but the differences were not statistically significant. The proportion of subjects with clinically significant anxiety (i.e., anxiety subscale score of HADS ≥11) was significantly higher in infertile women than in fertile women (31% v. 17%, χ (2)=5.37, p=0.020), but the proportion with clinically significant depressive symptoms (i.e., depression subscale score of HADS >8) was not significantly different (43% v. 33%, χ (2)=2.12, p=0.145). Self-reported disability over the prior month was significantly worse in the infertile group than in the controls, and 4 of the 8 subscales of the SF-36 - general health, vitality, social functioning, and mental health - were significantly worse in the infertile group. Compared to infertile women who were currently working, infertile women who were not currently working reported less severe depression and anxiety and better general health, vitality, and mental health.

Conclusions: Married women from urban Turkey seeking treatment for infertility do not have significantly more severe depressive symptoms than fertile married controls, but they do report greater physical and psychological disability and a poorer quality of life. The negative effects of infertility were more severe in infertile women who were employed than in those who were not employed. Larger follow-up studies are needed to assess the reasons for the differences between these results and those reported in western countries which usually report a higher prevalence of depression and anxiety in infertile patients.
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http://dx.doi.org/10.11919/j.issn.1002-0829.216014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5004092PMC
April 2016

Contribution of neutrophil activation in the differentiation of urine infection and contamination in pregnant women.

Gynecol Obstet Invest 2015 13;80(2):124-7. Epub 2015 May 13.

Department of Microbiology, Recep Tayyip Erdoğan University, Medical Faculty Hospital, Rize, Turkey.

Background: Urinary tract infections are among the most common bacterial infections of humans. Urine culture is the gold standard for asymptomatic bacteriuria and pyuria is not always present in bacteriuria, nor is it specific for bacteriuria.

Objective: The aim of the present study was to determine neutrophil activation and the contributions of this activation in the differentiation of infection and contamination.

Methods: The serum and urine myeloperoxidase (MPO) levels of 50 pregnant females with symptoms suggesting UTI and 25 healthy non-pregnant control subjects were measured using the enzyme-linked immunosorbent assay (ELISA) method and the obtained values were compared with the results of urine microscopy and urine culture.

Results: The leukocyte count in urine was significantly higher in group 1 (infection) and group 2 (contamination) when compared with the control group (group 1 mean: 18.2; group 2 mean: 14.2; control mean: 4.8; ANOVA test, p ≤ 0.00). According to the obtained ELISA values, a statistical difference in the levels of urine MPO between the patient and control groups was seen (p ≤ 0.00). There was no statistical difference among the groups for serum MPO levels (p ≥ 0.451).

Conclusion: The study findings suggest that standardized measurement techniques such as dipstick screening assay for urine MPO level may be useful in differentiating infection and contamination, especially in pregnant patients.
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http://dx.doi.org/10.1159/000381898DOI Listing
June 2016

Evaluation of the effects of fasting associated dehydration on maternal NGAL levels and fetal renal artery Doppler parameters.

J Matern Fetal Neonatal Med 2016 24;29(4):629-32. Epub 2015 Feb 24.

a Department of Obstetrics and Gynecology .

Objective: The aim of this study was to evaluate maternal neutrophil gelatinase-asssociated lipocalin (NGAL) levels and fetal renal artery (fRA) Doppler flow indices in pregnant women fasting in Ramadan in respect of dehydration in long hot summer days as a marker of hypoperfusion and early renal injury.

Methods: A cross-sectional observational study was carried out at a University Hospital. Fasting pregnant women and non-fasting age, gravidity and gestational age-matched women were evaluated for hematologic, blood biochemistry and urine parameters in the first and fourth weeks of the Ramadan. Umbilical artery and fRA Doppler flows were studied in each evaluation.

Results: Blood urea nitrogen, potassium and hematocrit levels, blood and urine NGAL levels were significantly higher, and fRA Doppler indices increased in fasting women (p < 0.05) during the second visit in the last week of the Ramadan, while non-fasting women had no significant alterations in each evaluation (p > 0.05).

Conclusions: Adequate maternal vascular volume is essential for the maintenance of healthy pregnancy. Fasting during the long and hot summer days leads to fluid deprivation and dehydration which was found to be related to subclinical maternal renal dysfunction and increased fRA Doppler indices.
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http://dx.doi.org/10.3109/14767058.2015.1014789DOI Listing
September 2016

Tubal pregnancy associated with endometrial carcinoma after in vitro fertilization attempts.

Case Rep Obstet Gynecol 2014 28;2014:481380. Epub 2014 Dec 28.

Department of Gynecology and Obstetrics, School of Medicine, Black Sea Technical University, 61200 Trabzon, Turkey.

Endometrial carcinoma is rarely seen during reproductive ages and commonly related to infertility, polycystic ovarian syndrome (PCOS), and obesity. Pregnancy associated endometrial carcinoma is even rarer and this is the second case reported in the literature concerning tubal pregnancy associated endometrial carcinoma. We present a case of a 36-year-old woman with a history of PCOS, infertility, and several attempts of ovulation induction and in vitro fertilization, who was diagnosed with tubal pregnancy and a well differentiated endometrial carcinoma. We also review the literature about pregnancy associated endometrial carcinoma in the first trimester.
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http://dx.doi.org/10.1155/2014/481380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295414PMC
January 2015

Is the measurement of serum ischemia-modified albumin the best test to diagnose ovarian torsion?

Gynecol Obstet Invest 2015 9;79(4):269-75. Epub 2015 Jan 9.

Department of Obstetrics and Gynecology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.

Aim: The aim of this study is to evaluate the diagnostic value of serum oxidative stress marker levels (ischemia-modified albumin, IMA; malondialdehyde, MDA) and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) levels that occur in ovarian torsion and to determine the threshold value of these markers in the diagnosis of ovarian torsion.

Methods: In this prospective case-control study, 34 women (the study group) with acute pelvic pain (20 with and 14 without ovarian torsion) and 40 control subjects were included. The diagnosis of ovarian torsion was confirmed with laparoscopy in all cases. Preoperative serum samples were collected in the study group. Serum oxidative stress marker levels (IMA and MDA) and TOS, TAS and OSI levels were measured.

Results: Serum MDA, TOS and IMA concentrations were significantly higher in women with ovarian torsion than in the healthy control group. However, serum TAS, TOS and OSI concentrations were significantly higher in women without ovarian torsion than within the healthy control group. Only IMA significantly distinguished patients with or without ovarian torsion. The best IMA value, according to the receiver operating characteristic curve, was 0.7045 absorbance units, with 90.00% sensitivity and 92.31% specificity. The patients in the ovarian torsion group had significantly lower serum TAS and OSI levels compared with patients without ovarian torsion.

Conclusion: The elevated serum IMA levels with high sensitivity-specificity values observed in women with ovarian torsion seem to have a potential role as a serum marker in the preoperative diagnosis of ovarian torsion in emergency settings.
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http://dx.doi.org/10.1159/000367787DOI Listing
February 2016

The role of hypoxia at primary dysmenorrhea, utilizing a novel hypoxia marker--SCUBE1.

J Pediatr Adolesc Gynecol 2015 Feb 20;28(1):63-65. Epub 2014 May 20.

Department of Gynecology and Obstetrics, Recep Tayyip Erdoğan University, Faculty of Medicine, Rize, Turkey.

Study Objective: To determine the SCUBE1 levels in adolescents with primary dysmenorrhea.

Design: A prospective cross-sectional study.

Setting: A university hospital outpatient clinic, Rize, Turkey.

Participants: A total of 40 adolescent girls, 15 on menses and 25 not on menses.

Interventions And Main Outcome Measures: Demographic features and menstrual history of the participants were assessed and blood samples were obtained for detecting the platelet volume, platelet counts, and SCUBE1 levels of the participants.

Results: No difference was detected between the 2 groups in mean platelet volume, platelet count, and SCUBE1 levels.

Conclusion: Future trials are required to investigate the relation between SCUBE1 levels and primary dysmenorrhea.
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http://dx.doi.org/10.1016/j.jpag.2014.05.001DOI Listing
February 2015

Is resveratrol a potential substitute for leuprolide acetate in experimental endometriosis?

Eur J Obstet Gynecol Reprod Biol 2015 Jan 11;184:1-6. Epub 2014 Nov 11.

Departments of Gynecology and Obstetrics, Recep Tayyip Erdogan University, School of Medicine, 53020 Rize, Turkey.

Objective: Resveratrol, a phytoalexin polyphenol, has anti-angiogenic, antioxidant, anti-inflammatory properties. We aimed to compare the anti-inflammatory and anti-angiogenic effects of resveratrol and leuprolide acetate (LA) in an experimental endometriosis model.

Study Design: A prospective experimental study was conducted in a University Surgical Research Center. Thirty-three non-pregnant female Sprague-Dawley rats, in which experimental model of endometriosis were surgically induced were randomly divided into four groups. Group 1 was administered 30 mg/kg resveratrol i.m. for 14 days, group 2 was given 1mg/kg s.c. single dose LA, group 3 was administered both resveratrol and LA, and group 4 had no medication. After two weeks medication rats were sacrificed and size, histopathology and immunreactivity to matrix metalloproteinase (mmp)2, mmp9, vascular endothelial growth factor (VEGF) of the endometriotic implants were evaluated. Plasma and peritoneal fluid levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) were analyzed.

Results: The endometriotic implant volumes, histopathological grade and immunreactivity to mmp2, mmp9 and VEGF were significantly reduced (p<0.001), and plasma and peritoneal fluid levels of IL-6, IL-8 and TNF-α were significantly decreased in group 1 and group 2 in comparison to group 3 and group 4 (p < 0.001).

Conclusion: Resveratrol alone is a potential agent for the treatment of endometriosis and may be an alternative to LA. In contrast, the combination of LA and resveratrol decreased the anti-inflammatory and anti-angiogenic effects of each agent. Since resveratrol is widely used as an alternative therapy for a variety of conditions, it can undermine the effectiveness of LA. Therefore, caution should be exercised when used in combination with other agents.
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http://dx.doi.org/10.1016/j.ejogrb.2014.10.041DOI Listing
January 2015

Pemphigoid gestationis in a third trimester pregnancy.

Case Rep Obstet Gynecol 2014 9;2014:127628. Epub 2014 Nov 9.

Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdoğan University, Merkez, Islampasa Mahallesi, Sehitler Caddesi, No. 74, 53100 Rize, Turkey.

Pemphigoid gestationis (PG) is a rare vesiculobullous dermatosis of pregnancy. It is commonly seen in second or third trimester. The diagnosis is frequently made with direct immunofluorescence studies of perilesional skin. Prompt recognition and appropriate management may reduce morbidity of this disease. Herein we present a case of pemphigoid gestationis occurring in a 33-year-old primigravida woman with symptoms of generalized pruritus.
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http://dx.doi.org/10.1155/2014/127628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241730PMC
November 2014

Evaluation of female sexual function index and associated factors among married women in North Eastern Black Sea region of Turkey.

Turk J Obstet Gynecol 2014 Sep 15;11(3):153-158. Epub 2014 Sep 15.

Recep Tayyip Erdoğan University Faculty of Medicine, Department of Gynecology and Obstetrics, Rize, Turkey.

Objective: The aim of this study was detection of Female Sexual Function Index (FSFI) scores of married women living in North Eastern Black Sea region of Turkey and comparison with demographic data.

Materials And Methods: A cross-sectional, descriptive study conducted at a University Hospital, gynecology and obstetrics outpatient clinic. Married women between 18-50 years of age, without any complaint enrolled in the study and participants were asked to fill out the form of FSFI. Age, gravidity and number of living children, duration of marriage, education and income levels, employment status, and contraceptive methods has been questioned. Sexual desire, arousal, lubrication, orgasm, satisfaction, pain subscales, and total score of FSFI were determined and compared with demographic data.

Results: Lower FSFI levels were detected from 70.9% of the respondents. Age, duration of marriage and number of children were adversely affected the FSFI scores. Intermediate education level and usage of a contraceptive method were related with higher FSFI scores. Pain scores were high in all participants independently from other parameters.

Conclusions: For identification of women's sexual dysfunction, increasing the knowledge level and awareness about sexuality are required.
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http://dx.doi.org/10.4274/tjod.43815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558326PMC
September 2014

Hand and wrist complaints in pregnancy.

Arch Gynecol Obstet 2014 Sep 20;290(3):479-83. Epub 2014 Apr 20.

Department of Obstetrics and Gynaecology, Recep Tayyip Erdoğan University School of Medicine, İslampaşa Mah. Şehitler Caddesi No: 74, 53100, Rize, Turkey,

Purpose: Hand and wrist complaints can decrease the quality of life of pregnant women, which can occur or aggravate during pregnancy and advance to chronic state if left untreated. The purpose of this study was to describe hand and wrist complaints in relation to pregnancy and assess their significance in pregnancy.

Methods: In a prospective cross-sectional study, 383 participants were randomly selected from among pregnant women on or over 28 weeks of gestation, attending the primary care maternal health clinic in a university hospital. The prevalence and severity of hand and wrist complaints were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). The symptomatic pregnant women were consulted by an orthopedist. The specific diagnoses of the patients were made based on patient history and physical examination.

Results: According to BCTQ scoring 258 (67.4 %) pregnant women were symptomatic. The diagnoses were as follows: asymptomatic 125 (32.6 %), nonspecific symptoms 138 (36 %), tendinitis 80 (20.9 %), carpal tunnel syndrome (CTS) 39 (10.2 %) and cubital syndrome 1 (0.3 %). There was no association noted between the diagnoses and numbers of pregnancies, occupational status, age, gestational weeks, weight gain or body mass index (BMI) (p > 0.05).

Conclusion: The prevalence of hand and wrist complaints is high in pregnant women. All pregnant women should be investigated for hand and wrist complaints in routine antenatal checks to ensure good life quality during pregnancy and for avoiding these complaints advancing to chronic state. Further studies are needed to evaluate the effect of musculoskeletal systems disorders in pregnancy.
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http://dx.doi.org/10.1007/s00404-014-3244-2DOI Listing
September 2014

Management of cesarean scar pregnancy with suction curettage: a report of four cases and review of the literature.

Arch Gynecol Obstet 2014 Jun 25;289(6):1171-5. Epub 2014 Jan 25.

Department of Obstetrics and Gynecology, School of Medicine, Recep Tayyip Erdoğan University, İslampaşa Mah, 53200, Rize, Turkey,

Purpose: To present the outcomes of four cases of cesarean scar pregnancy treated with suction curettage.

Methods: Four patients were ultrasonographically diagnosed with cesarean scar pregnancies treated with suction curettage in a tertiary care center.

Results: Serum β-human chorionic gonadotropin levels ranged between 1,681 and 15,573 mU/mL, gestational sac diameter measured from 10 to 24 mm and scar thickness was between 4.7 and 6.8 mm. All patients underwent suction curettage under general anesthesia with transabdominal ultrasonography guidance. No complications were observed during or after operation.

Conclusion: Suction curettage is a viable alternative for conservative treatment in selected cases of patients who are diagnosed with CSP early in gestation and who have a myometrial thickness of more than 4.5 mm.
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http://dx.doi.org/10.1007/s00404-014-3143-6DOI Listing
June 2014

Thyroid diseases in pregnancy: The importance of anamnesis.

Pak J Med Sci 2013 Sep;29(5):1187-92

Serap Baydur Sahin, Departments of Endocrinology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey.

Objective: Primary objective of our study was to evaluate the efficiency of detailed medical history and thyroid examination of the pregnant women presenting to our clinic from Rize province and nearby which was an endemic goiter region. It was aimed to investigate the frequency of thyroid diseases, pregnancy outcomes and the efficiency of screening with thyroid function tests during the first trimester of pregnancy as secondary endpoint. Methodology : A prospective clinical study was conducted with 998 pregnant women between the ages of 17-48 years. In the first step of our study, a detailed medical history was obtained and a detailed thyroid gland examination was performed in all the patients (n=998). In the patients diagnosed with thyroid disease or considered to have thyroid disease with these results (n=107), thyroid diseases were evaluated with thyroid function tests and imagining methods. Analyses of socio-demographic data and nutrition were also made. In the second step, thyroid stimulating hormone (TSH), free T3 and free T4 tests were performed in the first antenatal examination of the pregnant cases considered not to have thyroid disease after medical history and examination (n=891). Parameters of thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and TSH receptor auto antibodies (TRAb) were investigated in the cases whose TSH, sT3 and sT4 levels were different than the reference values after examination of the endocrinologist. Thyroid ultrasonography was performed. Urinary iodine levels in 24 hour urine were investigated.

Results: During pregnancy, the incidence of hyperthyroidism and hypothyroidism in the whole study group were 2.8% (28/998) and 4.3% (43/998), respectively, 6.7% of the patients (67/998) had a diagnosis of thyroid disease before pregnancy. Hyperthyroidism and hypothyroidism depending on the TSH screening results were 1.9% (17/891) and 1.1% (10/891) respectively and the incidence of overt hyperthyroidism and overt hypothyroidism were 0.2% (2/891) and 0.2% (2/891) in the pregnant cases considered not to have thyroid disease with medical history and examination.

Conclusion: Detailed medical history and family history obtained during the first trimester of pregnancy helped us to identify 6.7% of thyroid diseases among the pregnant women. This result effectively emphasizes the importance of detailed first prenatal examination regarding the thyroid.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858910PMC
September 2013

Which endometrial pathologies need intraoperative frozen sections?

Asian Pac J Cancer Prev 2013 ;14(10):6121-5

Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan Univercity , Rize, Turkey E-mail :

Background: Endometrial cancers are the most common gynecologic cancers. Endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology. It is performed routinely in many clinics prior to surgery in order to exclude an endometrial malignancy. We aimed to investigate the accuracy of endometrial sampling in the diagnosis of endometrial pathologies and which findings need intra-operative frozen sections.

Materials And Methods: Three hundred nine women applying to a university hospital and undergoing endometrial sampling and hysterectomy between 2010 and 2012 were included to this retrospective study. Data were retrieved from patient files and pathology archives.

Results: There was 17 patients with malignancy but endometrial sampling could detect this in only 10 of them. The endometrial sampling sensitivity and specificity of detecting cancer were 58.8% and 100%, with negative and positive predictive values of 97.6%, and 100%, respectively. In 7 patients, the endometrial sampling failed to detect malignancy; 4 of these patients had a preoperative diagnosis of complex atypical endometrial hyperplasia and 2 patients had a post-menopausal endometrial polyps and 1 with simple endometrial hyperplasia.

Conclusions: There is an increased risk of malignancy in post-menopausal women especially with endometrial polyps and complex atypia hyperplasia. Endometrial sampling is a good choice for the diagnosis of endometrial pathologies. However, the diagnosis should be confirmed by frozen section in patients with post-menopausal endometrial polyps and complex atypia hyperplasia.
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http://dx.doi.org/10.7314/apjcp.2013.14.10.6121DOI Listing
August 2014

Alterations of natriuretic peptides amino-terminal pro B-type natriuretic peptide and amino-terminal pro C-type natriuretic peptide during the pregnancy.

J Matern Fetal Neonatal Med 2014 Jul 5;27(11):1103-7. Epub 2013 Nov 5.

Department of Obstetrics and Gynecology and.

Objective: The aim of this study was to determine the plasma levels of natriuretic peptides amino-terminal pro B-type natriuretic peptide (NT proBNP) and amino-terminal pro C-type natriuretic peptide (NT proCNP) during pregnancy and any possible changes occurring in each trimester.

Methods: This was a prospective longitudinal case-control study conducted in a University Hospital antenatal outpatient clinic. Subjects were all healthy pregnant women without a history of previous cardiac disease, hypertension or preeclampsia, and each patient was assessed during every trimester, and blood samples were collected for the measurement of NT proBNP and NT proCNP levels.

Results: Twenty pregnant women were followed-up during pregnancy without any complications. We obtained longitudinal levels of natriuretic peptides in each trimester. The mean NT proBNP levels were 14.95 ± 16.8, 9.37 ± 10.76, 52.48 ± 126.65 pmol/ml and the mean NT proCNP levels were 44.64 ± 41.64, 45.70 ± 47.03, 47.22 ± 55.09 pmol/l, respectively. No statistically significant alteration of plasma levels of natriuretic peptides was detected between trimesters.

Conclusion: This is the first study evaluating the longitudinal levels of NT proCNP during the pregnancy, and demonstrates that NT proCNP remained constant, but NT proBNP levels do not significantly alter during pregnancy.
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http://dx.doi.org/10.3109/14767058.2013.850488DOI Listing
July 2014

Appendix and uterus metastasis of squamous cell carcinoma arising from mature cystic teratoma of the ovary.

Case Rep Obstet Gynecol 2013 13;2013:474891. Epub 2013 Jun 13.

Department of Obstetrics and Gynecology, Recep Tayyip Erdoğan University School of Medicine, İslampaşa Mah. Tıp Fakültesi Dekanlığı, Merkez, 53100 Rize, Turkey.

Mature cystic teratoma of the ovary rarely undergoes malignant transformation. There is no consensus for a treatment modality because of the rarity of the disease. Herein we present a case of squamous cell carcinoma (SCC) arising in a mature cystic teratoma (MCT) in a 66-year-old patient. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, appendectomy, and bilateral pelvic + paraaortic lymph node dissection. The histopathological examination revealed malignant invasion of the appendix and uterus. The patient, who refused the continuation of treatment initiated with the administration of a single dose of cisplatin, died 5 months later because of the disease. It is imperative that gynecologists consider appendectomy in SCC arising from MCT cases.
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http://dx.doi.org/10.1155/2013/474891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697224PMC
July 2013

Disability and psychiatric symptoms in hyperemesis gravidarum patients.

Arch Gynecol Obstet 2014 Jan 27;289(1):55-60. Epub 2013 Jun 27.

Department of Family Medicine, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey.

Purpose: Nausea and vomiting is an important health problem which adversely affects the daily routine and quality of life in pregnant women. The purpose of this study was to measure the level of change in the quality of life, depression and anxiety in hyperemesis gravidarum (HG) patients in relation to social-demographic data and disease variables.

Methods: One hundred pregnant women hospitalized with the diagnosis of HG were included in the study. A total of 100 healthy pregnant women were also evaluated as the control group. All the patients in the study completed the socio-demographic data form, the Hospital Anxiety and Depression Scale (HADS-A and D) and Brief Disability Questionnaire (BDQ).

Results: The mean HADS-D subscale score was 7.09 ±3.91 in HG patients and 5.73 ± 3.32 in controls. The depression score in the HG patients were significantly higher than that of the control group (p = 0.009). The mean HADS-A subscale score was 7.73 ± 3.86, which was significantly higher in HG patients compared to 6.70 ± 3.31 in controls (p = 0.045). The mean BDQ score was 11.2 ± 4.40 in HG patients and 8.5 ± 3.31 in the control group of pregnant women, thus, significantly higher in the HG group as compared to controls (p < 0.0001). In the HADS-D, 52 patients in the HG group and 40 patients in the control group scored above the threshold value (p = 0.089). In the HADS-A, 28 patients in the HG group and 20 in the control group scored above the threshold value (p = 0.185).

Conclusions: In patients with HG, a significant deterioration of physical and social health was encountered. HG disease is independent of any underlying psychiatric condition and adversely affects the quality of life of the sufferer.
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http://dx.doi.org/10.1007/s00404-013-2934-5DOI Listing
January 2014

Pregnancy in the setting of asymptomatic non-cirrhotic chronic portal vein thrombosis complicated by pre-eclampsia.

Case Rep Obstet Gynecol 2013 28;2013:984271. Epub 2013 May 28.

Department of Obstetrics and Gynecology, Faculty of Medicine, Recep Tayyip Erdoğan University, Merkez, 53100 Rize, Turkey.

Portal vein thrombosis (PVT) can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.
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http://dx.doi.org/10.1155/2013/984271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679696PMC
June 2013

The effect of cabergoline on folicular microenviroment profile in patients with high risk of OHSS.

Gynecol Endocrinol 2013 Aug 6;29(8):749-53. Epub 2013 Jun 6.

Department of Obstetrics and Gynecology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey.

The aim of this study to evaluate the effect of cabergoline on follicular microenvironment by measuring follicular fluid (FF) insulin like growth hormone -I (IGF-I), antimullerian hormone (AMH), inhibin B and hepatocyte growth factor (HGF) levels in women with PCOS and high risk of ovarian hyperstimulation syndrome (OHSS). In this prospective cohort study, 41 women with PCOS undergoing controlled ovarian hyperstimulation for assisted reproduction and having the high risk factors for OHSS are included. The women in the study group (n = 15) received cabergoline for OHSS prevention while the women in the control did not received any medications for OHSS prevention. FF samples were collected during oocyte pick-up procedure for all women were determined using commercially available ELISA kits. Concentrations of FF IGF-I, AMH, inhibin B and HGF were assessed. In the study group FF AMH (2.96 ± 1.27 versus 1.91 ± 0.64 ng/mL), Inhibin B (1339.47 ± 198.56 versus 1200.09 ± 133.64 pg/mL), HGF (5623.21 ± 2411.09 versus 3787.42 ± 2269.89 pg/mL) and IGF-I (298.60 ± 37.80 versus 219.90 ± 71.40 pg/mL) concentrations were significantly decreased compared with control group. Cabergolin prevents OHSS in high risk patients by disrupting FF hormone microenvironment.
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http://dx.doi.org/10.3109/09513590.2013.801440DOI Listing
August 2013

Spontaneous intraamniotic hemorrhage in the second trimester mimicking an abdominal wall defect.

J Turk Ger Gynecol Assoc 2013 1;14(2):109-12. Epub 2013 Jun 1.

Department of Obstetrics and Gynecology, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey.

We report here a case of spontaneous intraamniotic haemorrhage in the second trimester which mimicked an abdominal wall defect. The ultrasound and magnetic resonance imaging findings are discussed and a review of the literature regarding differential diagnosis of bleeding and abdominal wall defects is made.
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http://dx.doi.org/10.5152/jtgga.2013.13471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881743PMC
March 2014

Cord blood oxidative stress markers correlate with umbilical artery pulsatility in fetal growth restriction.

J Matern Fetal Neonatal Med 2013 Apr 29;26(6):576-80. Epub 2012 Nov 29.

Recep Tayyip Erdogan University, School of Medicine, Department of Obstetrics and Gynecology, Rize, Turkey.

Objective: To compare cord blood oxidative stress markers (OSM) between intrauterine small fetuses with high umbilical artery (UA) Doppler indices and normal indices.

Methods: Forty women who had oligohydramnios and intrauterine growth-restricted fetuses with abnormal (n = 20, group I) or normal Doppler indices (n = 20, group II) were included. All patients underwent fetal Doppler ultrasound studies. Cord blood was collected at birth and six OSMs (ischemia-modified albumin (IMA), hepatocyte growth factor (HGF), malondialdehyde (MDA)) levels, total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were studied.

Results: The mean cord blood IMA, MDA, TOS, and OSI values for group I were significantly increased when compared to the group II (p < 0.001 for IMA, MDA, TOS, and OSI). However the mean cord blood HGF and TAS values were statistically significantly decreased in group I, compared with group II (p < 0.001 for HGF, and TAS). A significant positive (for IMA, MDA,TOS levels, and OSI ratio) and negative (for HGF and TAS levels) correlations between UA pulsatility index (PI) and cord blood OSM were found.

Conclusion: The correlation between cord blood OSM and Doppler blood flow changes shown in this study may contribute to understanding the underlying oxidative stress-related mechanisms.
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http://dx.doi.org/10.3109/14767058.2012.745497DOI Listing
April 2013

An uncommon complementary isochromosome of 46,XY, i(9)(p10),i(9)(q10) in an infertile oligoasthenoteratozoospermic man.

Fertil Steril 2011 Jan 20;95(1):290.e5-8. Epub 2010 Jun 20.

Department of Obstetrics and Gynecology, School of Medicine, Rize University, Rize, Turkey.

Objective: To report a rare case of male infertility associated with oligoasthenoteratozoospermia and complementary isochromosome 46 XY, i(9)(p10),i(9)(q10).

Design: Case report.

Setting: Reference hospital.

Patient(s): Infertile oligoastenozoospermic man with complementary isochromosome 46,XY, i(9)(p10),i(9)(q10).

Intervention(s): Peripheral blood lymphocytes obtained for karyotyping, and florescence in situ hybridization (FISH) analysis for gonadal mosaicism in ejaculated spermatozoa.

Main Outcome Measure(s): Physical examination, semen analysis, GBG banding, and FISH procedure.

Result(s): The semen analysis revealed oligoasthenoteratozoospermia. The lymphocytic karyotype detected a complementary isochromosome 46,XY, i(9)(p10),i(9)(q10), and the FISH procedure showed abnormal sperm.

Conclusion(s): This the first report of oligoasthenoteratozoospermia associated with complementary isochromosome 46,XY, i(9)(p10),i(9)(q10).
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http://dx.doi.org/10.1016/j.fertnstert.2010.05.028DOI Listing
January 2011

Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study.

Acta Obstet Gynecol Scand 2010 Jul;89(7):889-95

Department of Obstetrics and Gynecology, Rize University, School of Medicine, Rize, Turkey.

Objective: To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy.

Design: Prospective randomized controlled trial.

Setting: Maternity and teaching hospital in Turkey.

Population: One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy.

Methods: Sixty-two women received a single dose and 58 received a multiple dose methotrexate regimen.

Main Outcome Measures: Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses).

Results: In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77-1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 +/- 7.6) compared with the multiple dose group (18.3 +/- 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side-effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35-0.92).

Conclusion: A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side-effects, but the time for hCG levels to fall below 5 mU/mL is shorter.
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http://dx.doi.org/10.3109/00016349.2010.486825DOI Listing
July 2010

Can serum oestradiol be a predictor of quality of oocytes and embryos, maturation of oocytes and pregnancy rate in ICSI cycles?

Gynecol Endocrinol 2011 Apr 14;27(4):279-85. Epub 2010 Jun 14.

In Vitro Fertilization Clinic, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.

Our aim was to assess the influence of ratios of oestradiol (E2) to either number of follicles ≥ 14 mm on the day of human chorionic gonadotropin administration (E2/fol) or the number of oocytes retrieved (E2/o) during oocyte pick up and total serum E2 levels on the day of embryo transfer (ETE2) on the outcome of ICSI cycles. The assessed outcomes were number of oocytes retrieved (NRO), number of mature oocytes (NMO), number of fertilised oocytes (NFO), number of transferred embryos (NTE), qualities of oocytes (OQS), qualities of embryos (EQS) and pregnancy rates (PR). Two hundred and twenty-seven ICSI-ET cycles admitted to our IVF clinic during a 2-year period with normal ovarian reserve receiving long luteal GnRH agonist protocol were included. The E2/fol levels correlated positively with NRO (r = 0.202, p = 0.002), NMO (r = 0.199, p = 0.003) and NFO (r = 0.159, p = 0.018). However, we observed negative correlations between E2/o and NMO (r = -0.329, p <0.001), NFO (r = -0.219, p = 0.001), EQ5 (r = -0.203, p = 0.040). Oocyte quality scores were not affected from either E2/fol or E2/o levels. Implantation, clinical and ongoing PRs were comparable between groups categorised due to E2/fol, E2/o and ETE2. It seems that high E2/fol ratio may have beneficial effects on NRO, NMO and NFO while E2/o may adversely affect these parameters. Neither of the E2 levels is associated with pregnancy rates in women with normal ovarian reserve.
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http://dx.doi.org/10.3109/09513590.2010.491168DOI Listing
April 2011

Does brucellosis in human pregnancy increase abortion risk? Presentation of two cases and review of literature.

J Obstet Gynaecol Res 2010 Apr;36(2):418-23

Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Hospital, Turkey.

Brucellosis is one of the most common zoonotic diseases that can be encountered during pregnancy. We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim-sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications.
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http://dx.doi.org/10.1111/j.1447-0756.2009.01156.xDOI Listing
April 2010

Serum IL-6 level may have role in the pathophysiology of unexplained infertility.

Am J Reprod Immunol 2009 Oct 24;62(4):261-7. Epub 2009 Aug 24.

Obstetrics and Gynecology Clinic, Health Ministry Ergani Goverment Hospital, Diyarbakir, Turkey.

Problem: The aim of this study was to compare the serum levels of interleukin (IL)-6 of women with unexplained infertility with fertile subjects.

Method Of Study: Serum IL-6, and tumor necrosis factor-alpha (TNF-alpha) levels of 45 infertile and 44 fertile women on day 3 of menstrual cycle were assessed and compared for this prospective controlled study.

Results: The mean serum IL-6 level was significantly higher in women with unexplained infertility, compared with fertile women (5.71 +/- 1.81 and 4.31 +/- 1.79, P < 0.001, Student's t-test). There was no significant difference in TNF-alpha level among the groups.

Conclusion: Significant difference in serum IL-6 levels between unexplained infertile and fertile women suggests that this cytokine may be involved in pathophysiology of unexplained infertility.
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http://dx.doi.org/10.1111/j.1600-0897.2009.00734.xDOI Listing
October 2009

Is there any relation between development of persistent non-reassuring fetal heart rate pattern and acutely increased uterine artery vascular flow resistance during dinoprostone use in prolonged pregnancies?

Acta Obstet Gynecol Scand 2009 ;88(8):894-900

Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Hospital, Ankara, Turkey.

Objective: To investigate the relation between changes in Doppler parameters of fetal and uterine arteries and development of persistent non-reassuring fetal heart rate (FHR) pattern during induction of labor with dinoprostone (Propess) in pregnancies at >or=41 weeks gestation.

Design: Prospective cohort study.

Setting: Etlik Zubeyde Hanim Women's Hospital, Turkey.

Sample: One hundred forty-one prolonged pregnancies.

Methods: Doppler parameters of umbilical, middle cerebral, and uterine arteries were measured before and 4-6 hours after dinoprostone application between uterine contractions. Non-reassuring FHR pattern and persistent non-reassuring FHR pattern criteria were defined based on NICE 2007 guidelines. Women with successful spontaneous vaginal delivery were recruited as a control group (n=108), while women who underwent cesarean delivery due to persistent non-reassuring FHR pattern were recruited as a study group (n=15).

Main Outcome Measures: Prediction of non-reassuring FHR pattern with Doppler analysis of uterine and fetal arteries.

Results: After dinoprostone application there was significant enhancement in uterine artery resistance index (RI) in the study group compared to the control group (p=0.002). Receiver operating characteristics curve analysis identified a uterine artery RI increase value of 0.11 as the optimal threshold for prediction of persistent non-reassuring FHR pattern with 73.3% sensitivity and 69.4% specificity. Logistic regression analysis demonstrated that an increase in the uterine artery RI was predictive for persistent non-reassuring FHR pattern (odds ratio (OR) 4.97; 95% CI 1.5-16.8).

Conclusion: Acute increase in uterine artery RI due to dinoprostone use may end with persistent non-reassuring FHR pattern in prolonged pregnancies. This may allow earlier prediction of persistent non-reassuring FHR pattern development and risk assessment.
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http://dx.doi.org/10.1080/00016340903100347DOI Listing
August 2009

Placental fas/fas ligand expression in early pregnancy losses.

Am J Reprod Immunol 2008 Jul 1;60(1):1-7. Epub 2008 Apr 1.

Department of Obstetrics and Gynecology, Health Ministry Etlik Women's Health and Maternity Hospital, Ankara, Turkey.

Problem: The aim of this study was to compare the expression levels of Fas and Fas ligand (FasL) in first-trimester placentas obtained from spontaneous abortions in patients with antiphospholipid antibody syndrome (APS) or factor V (FV) Leiden mutation, compared with values in placentas from induced abortions in patients negative for these conditions.

Method Of Study: We studied explants from 6- to 10-week-old placentas that had been prepared by collagenase digestion from 10 spontaneous abortions from APS-positive patients, nine spontaneous abortions in patients positive for FV Leiden mutation, and 10 induced abortions. All tissues were analyzed by flow cytometry for expression of Fas and FasL.

Results: Flow cytometric analysis showed that placental FasL expression was significantly lower in abnormal pregnancies than in normal ones. However, no such difference was observed for Fas expression.

Conclusion: FasL on placental cells may be involved in the maintenance of immune privilege, thereby ensuring the safety and growth of placental tissues. Dysregulation of apoptotic mechanisms may play a critical role in spontaneous abortions.
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http://dx.doi.org/10.1111/j.1600-0897.2008.00583.xDOI Listing
July 2008

Prenatal diagnosis of isolated laryngeal atresia: case report and literature review.

J Ultrasound Med 2007 Sep;26(9):1243-9

Department of Obstetrics and Gynecology, Ministry of Health, Etlik Women's Health and Maternity Teaching and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.7863/jum.2007.26.9.1243DOI Listing
September 2007