Publications by authors named "Oguz Yucel"

32 Publications

Folic acid-modified methotrexate-conjugated gold nanoparticles as nano-sized trojans for drug delivery to folate receptor-positive cancer cells.

Nanotechnology 2020 Aug 15;31(35):355101. Epub 2020 May 15.

Department of Chemical Engineering, Faculty of Engineering, Istanbul University-Cerrahpaşa, Avcılar 34320, Istanbul, Turkey.

Methotrexate (MTX), an analog of folic acid (FA), is a drug widely used in cancer treatment. To prevent its potential toxicity and enhance therapeutic efficacy, targeted drug delivery systems, especially nanotechnology-folate platforms, are a central strategy. Gold nanoparticles (AuNPs) are promising candidates to be used as drug delivery systems because of their small particle sizes and their inertness for the body. In this study, glutathione (GSH)-coated FA-modified spherical AuNPs (5.6 nm) were successfully synthesized, and the anticancer activity of novel MTX-loaded (MTX/Au-GSH-FA) NPs (11 nm) was examined. Dynamic light scattering (DLS) and transmission electron microscopy (TEM) results showed that MTX/AuNPs possess spherical morphology, nanoscaled particle size, narrow size distribution, and good stability. In vitro studies showed that cytotoxicity of MTX/Au-GSH-FA to folate receptor-positive (FR+) human brain (U-87 MG) and cervical (HeLa) cancer cells enhanced significantly (∼3 and ∼10 fold, respectively) compared to free MTX while there was no significant effect in FR-negative human cell lines A549 (lung carcinoma), PC3 (prostate carcinoma), HEK-293 (healthy embryonic kidney). Moreover, the receptor specificity of the conjugate was shown by fluorescent microscopic imaging. In conclusion, these results indicate that the synthesized novel MTX/Au-GSH-FA NP complex seems to be a good candidate for effective and targeted delivery in FR+ cancer therapy.
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http://dx.doi.org/10.1088/1361-6528/ab9395DOI Listing
August 2020

The importance of uterosacral ligament anatomy in overactive bladder: A preliminary study.

Turk J Obstet Gynecol 2018 Mar 29;15(1):65-69. Epub 2018 Mar 29.

Muğla Sıtkı Koçman University Faculty of Medicine, Department of Obstetrics and Gynecology, Muğla, Turkey.

Objective: To evaluate whether uterosacral ligament (USL) thickness measured using magnetic resonance imaging (MRI) was associated with overactive bladder (OAB) in otherwise healthy women.

Materials And Methods: The study comprised 27 women with OAB and 27 healthy women (control group) who were followed up at the Obstetrics and Gynecology Department of a tertiary referral center. All subjects were evaluated using pelvic MRI to determine the transverse USL thickness. These measurements were compared between the two groups. p values less than 0.05 were considered statistically significant.

Results: The mean age of women in the OAB and control groups were 43.88±9.36 years and 39.92±5.36 years, respectively. The mean body mass index in the OAB group was 29.77±4.82 kg/m and 27.49±3.44 kg/m in the control group. In the comparison of Pelvic Organ Prolapse Quantification system stages between the groups, no statistically significant relationship was determined. In the OAB group, the mean right USL thickness was 2.04±0.34 mm, and the mean left USL was 2.04±0.52 mm. In the control group, the mean right USL thickness was 2.17±0.47 mm, and the mean left USL was 2.09±0.51 mm. There were no statistically significant differences in terms of USL thickness between the OAB and control groups (p>0.05).

Conclusion: No previous studies have been identified in the literature that have investigated the relationship between USL thicknesses and urinary incontinence. In the present study, no significant relationship could be demonstrated between right and left USL thicknesses of the OAB and control groups. This was a preliminary study, and further research with larger sample sizes is required to reach a final conclusion.
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http://dx.doi.org/10.4274/tjod.73669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894539PMC
March 2018

What influences women's contraceptive choice? A cross-sectional study from Turkey.

Ginekol Pol 2017 ;88(12):639-646

Objectives: In our study, we tried to investigate the determinants of women's choices about contraception with the aim of discovering whether or not there is a difference in their preferences before and after consultation with a gynaecologist.

Material And Methods: A total of 1058 women were enrolled. They were given detailed information regarding contraception and contraceptive methods. Subsequently, a survey which was made of 21 questions was administered.

Results: Contraceptive counselling significantly changed the contraceptive choice of women. However, influences from social media and friends, their partners and religious belief affected their contraceptive choices. Significant differences in contraceptive choice were observed when women were categorized according to their marital status, education level, household income, age, and number of children.

Conclusions: Although contraceptive counselling influenced Turkish women's choices, there were still other determinants like social media and input from outside sources such as clerics and husbands, which should be overcome.
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http://dx.doi.org/10.5603/GP.a2017.0115DOI Listing
July 2018

The impact of mode of delivery on the sexual function of primiparous women: a prospective study.

Arch Gynecol Obstet 2017 Apr 6;295(4):907-916. Epub 2017 Feb 6.

Department of Obstetrics and Gynecology, Suleymaniye Women's Health Training and Research Hospital, Istanbul, Turkey.

Aim: The purpose of this study was to evaluate the impact of mode of delivery on the sexual function of women using the Female Sexual Function Index (FSFI).

Methods: This was a prospective study of 452 nulliparous women, comparing their sexual function before and after birth. A Turkish version of the FSFI questionnaire was administered within the first 8 weeks of pregnancy, at 3 and 6 months postpartum in a face-to-face manner and subsequently at the 12th month and 24th month over the telephone.

Results: Age, BMI, education level, house income, duration of marriage, birthweight, and feeding at each time point were similar between group 1 [vaginal birth and mediolateral episiotomy (MLE)] and group 2 [caesarean section (CS)]. In the postpartum period, there were 265 and 138 participants at 3rd month, 216 and 121 participants at 6th month, 189 and 111 participants at 12th month, and 133 and 85 participants at 24th month in group 1 and 2, respectively. The FSFI total scores decreased at 3 and 6 months postpartum in both groups (27.3 to 23.1 in group 1 and 27.5 to 25 in group 2; p < 0.05 for both). Desire, arousal, lubrication, satisfaction and pain scores were significantly decreased at 3 months postpartum in group (1) In group 1, desire, arousal and pain scores remained decreased at the 6th month compared to initial scores. Group 2 had significantly lower desire, lubrication, satisfaction and pain scores at 3 months postpartum compared to their initial scores. Decline in desire and lubrication domains persisted at the 6th month for group (2) None of the FSFI domain scores differed after 6th months when compared to pre-delivery scores in both groups. Compared with the caesarean group, the vaginal birth with MLE group had lower satisfaction and higher pain levels at 3 months postpartum (p < 0.0001, for both). None of the FSFI domains differed at the 6th, 12th or the 24th month between the groups.

Conclusion: Our study revealed that caesarean section is not superior to vaginal birth in terms of preservation of normal sexual function, regardless of short-term postpartum effects. Women should be informed that, irrespective of their type of delivery, sexual function 6 months after childbirth is similar to that in pre-pregnancy.
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http://dx.doi.org/10.1007/s00404-017-4299-7DOI Listing
April 2017

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

Ginekol Pol 2016 ;87(10):701-705

Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University.

Objectives: The aim of the study was to assess the effect of 1 g ampicillin prophylactic dosage whether it is as effective as the dosage of 2 g to prevent maternal and neonatal morbidity in a randomized manner.

Materials And Methods: One hundred and fourty eight singleton pregnant women with preterm premature rupture of membranes between 21 and 33 weeks of gestation were followed-up during the study period in our institution. We com-pared the efficacy of two different different dosages of ampicillin. The study population was randomized into 2 groups. In the group 1, 1 g of intravenous ampicillin was given every 6 hours. In the group 2, 2 g of intravenous ampicillin was given every 6 hours.

Results: There was no significant difference between groups interms of fetal complications (RDS, icterus, mortality, sepsis, transient tachypnea of newborn and the pneumonia), rate of intensive care unit admission, fetal gender, fever, rate of clinical chorioamnionitis, high white blood cell count and the CRP, rate of cases < 30 weeks (p > 0.05). There was a significant differ-ence between the groups for the rate of previous preterm premature rupture of membranes history, steroid administration and the need for tocolysis (p < 0.05).

Conclusions: Although antibiotics seems to be innocent, several side effects have been introduced. It is reasonable to use the lowest dosages in shortest period in order to minimize these unwanted effects.
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http://dx.doi.org/10.5603/GP.2016.0071DOI Listing
July 2018

Incidence of adhesions and maternal and neonatal morbidity after repeat cesarean section.

Arch Gynecol Obstet 2017 Feb 21;295(2):303-311. Epub 2016 Oct 21.

Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey.

Purpose Of Investigation: We investigated the effect of repeat cesarean sections (CSs) and intra-abdominal adhesions on neonatal and maternal morbidity.

Materials And Methods: We analyzed intra-abdominal adhesions of 672 patients.

Results: Among the patients, 173, 206, 151, and 142 underwent CS for the first, second, third, and fourth time or more, respectively. There were adhesions in 393 (58.5 %) patients. Among first CSs, there were no adhesions, the rate of maternal morbidity [Morales et al. (Am J Obstet Gynecol 196(5):461, 2007)] was 26 %, and the rate of neonatal morbidity (NM) was 35 %. Among women who have history of two CSs, the adhesion rate was 66.3 %, the adhesion score was 2.05, MM was 14 %, and NM was 21 %. Among third CSs, these values were 82.1, 2.82, 23, and 14 %, respectively. Among women who have history of four or more CSs, these values were 92.2, 4.72, 31.7, and 18 %, respectively. Adhesion sites and dense fibrous adhesions increased parallel to the number of subsequent CSs. Increased adhesion score was associated with 1.175-fold higher odds of NM and 1.29-fold higher odds of MM. The rate of NM was eightfold higher in emergency-delivered newborns (emergency: 39.4, 40 %; elective: 4.9 %). MM was 20 and 26 % for elective and emergency CSs, respectively.

Conclusions: Emergency operations and adhesions increased complications.
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http://dx.doi.org/10.1007/s00404-016-4221-8DOI Listing
February 2017

Is Maternal Blood Procalcitonin Level a Reliable Predictor for Early Onset Neonatal Sepsis in Preterm Premature Rupture of Membranes?

Gynecol Obstet Invest 2017 15;82(2):163-169. Epub 2016 Jun 15.

Department of Obstetrics and Gynecology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey.

Background: This study is aimed at comparing the early diagnostic accuracy of maternal blood white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin in predicting early onset neonatal sepsis (EONS) among early preterm premature rupture of membrane (PPROM) pregnancies.

Methods: A total of 57 consecutive pregnancies, complicated with PPROM, between 24 and 34 gestational weeks were recruited to the study at Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey between January 2012 and January 2013. All patients were hospitalized and followed up with expectant management. Maternal blood WBC count, CRP and procalcitonin levels were measured in the first 12 h of membrane rupture. EONS was diagnosed using clinical and laboratory findings, and obstetric and neonatal outcomes were noted.

Results: The cutoff value for maternal blood CRP was ≥9.49 mg/dl. This value predicted EONS with 77.8% sensitivity, 80.0% specificity, 77.8% positive predictive value (PPV) and 80.0% negative predictive value (NPV). The cutoff value for maternal blood procalcitonin was 0.071 ng/ml. This value predicted EONS with 85.2% sensitivity, 86.7% specificity, 85.2% PPV and 86.7% NPV.

Conclusion: Maternal blood procalcitonin levels were superior to maternal blood CRP and WBC count in predicting EONS. Consequently, the maternal blood procalcitonin level is a clinically useful, non-invasive and reliable biomarker in antenatal prediction of EONS.
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http://dx.doi.org/10.1159/000446949DOI Listing
July 2017

The role of mean platelet volume and platelet distribution width in the prediction of placental abruption.

J Obstet Gynaecol 2016 Oct 16;36(7):950-953. Epub 2016 May 16.

a Department of Obstetrics and Gynaecology , Adana Numune Training and Research Hospital , Adana , Turkey.

We determined the role of mean platelet volume (MPV) and platelet distribution width (PDW) in the prediction of placental abruption (PA) prior to caesarean section. Data obtained between January 2011 and July 2014 from patients (n = 33) with PA and healthy control subjects (n = 67) matched for age- and gestation-stage were analysed. Pre-operative and post-operative MPV and PDW were significantly different between the PA and control groups when cut-off values for MPV were set at 9.23; sensitivity at 87.8% and specificity at 46.2%; positive predictive value (PPV) at 48.3%; and negative predictive value (NPV) at 90.0%. When the cut-off value for PDW was set at 18.5, the sensitivity was 100% and specificity 71.6%, PPV 40.7% and NPV 59.3% for the prediction of PA. MPV and PDW levels were significantly higher in cases of PA. These results suggest that clinical evaluation of MPV and PDW displays reasonable sensitivity and specificity as a marker of PA, prompting the need for more research in this area of clinical study.
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http://dx.doi.org/10.1080/01443615.2016.1174834DOI Listing
October 2016

Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles: A randomized controlled study.

Avicenna J Med 2015 Oct-Dec;5(4):123-7

Department of Obstetrics and Gynecology, Suleymaniye Maternity and Children's Teaching and Research Hospital, Istanbul, Turkey.

Background: Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during assisted reproductive technology protocols. The aim of this study was to evaluate the role of dopamine agonist as a preventive strategy of OHSS in women at high risk in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles.

Methods: Seventy women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included. The study group received 0.5 mg of cabergoline for 8 days from the day of human chorionic gonadotropin administration in comparison to those who undergo no treatment for the prevention of OHSS. The reduction of the incidence of OHSS was the primary outcome.

Results: The actual incidence of OHSS was 8.33% in the cabergoline group and 20.58% in the control group. Thus, the incidence of OHSS was significantly reduced, by almost 60%, in the cabergoline group in comparison with the control group (relative ratios: 0.4, 95% confidence interval: 0.18-0.79).

Conclusion: Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment. However, the effects of cabergoline on important outcomes, namely, live birth, miscarriage, and congenital abnormalities are still uncertain.
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http://dx.doi.org/10.4103/2231-0770.165121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637949PMC
December 2015

Neither early nor late for becoming pregnant: Comparison of the perinatal outcomes of adolescent, reproductive age, and advanced maternal age pregnancies.

Turk J Obstet Gynecol 2015 Sep 15;12(3):151-157. Epub 2015 Sep 15.

Adana Numune Education and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey.

Objective: To compare perinatal and short-term neonatal outcomes of adolescent, reproductive age, and advanced maternal age (AMA) pregnancies in a low-income region of İstanbul.

Materials And Methods: Three hundred six adolescents, 301 reproductive age, and 303 AMA pregnant women who delivered in Süleymaniye Education and Research Hospital between January 1 2007, and January 31 2015, were recruited to the study population. The clinical, obstetric and short-term neonatal outcomes of the women were analyzed retrospectively.

Results: Adolescent and AMA pregnancies were associated with severe adverse perinatal and short-term neonatal outcomes compared with reproductive-age women. Adolescent and AMA pregnancies had quite similar risks in obstetric outcomes. Adolescent pregnancies were related with severe adverse short-term neonatal outcomes when compared with advanced maternal age pregnancies.

Conclusion: Adolescent and AMA pregnancies should be defined as high-risk pregnancies. Our research indicated that healthcare providers such as obstetricians, midwives, and family physicians should be alert in these populations.
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http://dx.doi.org/10.4274/tjod.94758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558389PMC
September 2015

Knowledge levels of adolescent girls about human papilloma virus and its vaccine.

Turk Pediatri Ars 2014 Jun 1;49(2):142-7. Epub 2014 Jun 1.

Department of Gynecology and Obstetrics, Süleymaniye Maternity Training and Research Hospital, İstanbul, Turkey.

Aim: The aim of our study was to evaluate the level of knowledge of the adolescent girls who presented to our clinic about human papilloma virus (HPV) infection and HPV vaccine.

Material And Methods: Five hundred and one adolescent girls aged between 13 and 18 years who presented to the gynecology outpatient clinic between March 2012 and March 2013 were asked to answer the questions of the questionnaire about HPV and HPV vaccine. The "Participant Information Form" and "HPV Information Assessment Form" were used by examination of the related literature by the investigators. The data obtained were entered into the computer using the SPSS 16.5 program and evaluated. Descriptive statistics were shown with mean, standard deviation, number and percentage values.

Results: The mean age of 501 subjects who were included into the study was 15.92 years. 390 subjects (77.8%) who were included in the study had no information about HPV. 111 subjects (22.2%) stated that they heard of HPV before or had information about HPV. The mean age of the subjects who had information about human papilloma virus was found to be 16.52 years. The mean age of 390 subjects (77.8%) who had no information about human papilloma virus was 15.75 years. It was found that only one of the subjects (0.9%) was vaccinated with HPV vaccine. When the subjects who did not wish to be vaccinated were asked for the reason, 40.9% stated that the reason was inadequate information, 26.4% stated that the reason was high cost, 16.4% stated that the reason was the fact that they did not consider themselves at risk and 16.4% stated that the reason was the fact that they were afraid of side effects.

Conclusions: In our study, it was found that the adolescent girls who constituted our study group had insufficient information about HPV and HPV vaccine. Verbal, written and visual communication tools and internet should be used intensively and efficiently for the objective of introducing HPV vaccine and teaching the precautions related with prevention of cervix cancer in terms of public health. Primarily pediatrician and gynecologists and family physicians who give service for the adolescence age group should be supported to develop appropriate attitudes and behaviors related with HPV vaccine and infection.
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http://dx.doi.org/10.5152/tpa.2014.1545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462274PMC
June 2014

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination.

Singapore Med J 2015 Jun;56(6):353-6

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

Introduction: Intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) was applied to selected infertile patients to determine the effect of gonadotropin-releasing hormone (GnRH) antagonists in IUI cycles, in which recombinant follicle-stimulating hormone (rFSH) had been used for COH.

Methods: This study was conducted between April 1, 2009 and June 10, 2009, and involved a total of 108 patients. These patients had primary or secondary infertility, which resulted in an indication for IUI, and they each received two cycles of ovarian stimulation treatment with clomiphene citrate. The patients were randomised into two groups--patients in group A received rFSH + GnRH antagonist (n = 45), while those in group B received only rFSH (n = 63).

Results: The mean age of the patients was 31.84 ± 3.73 years and the mean body mass index (BMI) was 24.40 ± 1.88 kg/m(2). The mean age and BMI of the patients in groups A and B were not significantly different. There was no significant difference in the mean total rFSH dose administered (988.33 IU in group A and 871.83 IU in group B). When compared to group B, the mean number of follicles that were > 16 mm on the human chorionic gonadotropin (HCG) trigger day was significantly higher in group A (1.58 and 1.86, respectively; p < 0.05). When the two groups were compared, there were no statistically significant differences in the number of cancelled cycles due to premature luteinisation (none in group A vs. two in group B) and the rate of clinical pregnancy (8.9% in group A vs. 7.9% in group B).

Conclusion: No significant improvement in the clinical pregnancy rates was observed when GnRH antagonists were used in COH + IUI cycles, despite the significant increase in the number of follicles that were > 16 mm on HCG trigger day.
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http://dx.doi.org/10.11622/smedj.2014192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469855PMC
June 2015

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection.

Gynecol Endocrinol 2014 Sep 22;30(9):653-6. Epub 2014 May 22.

Department of Obstetrics and Gynecology, Suleymaniye Maternity and Children's Teaching and Research Hospital , Istanbul , Turkey .

Background: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection.

Materials And Methods: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients.

Results: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p > 0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7 ± 0.7 versus 2.6 ± 0.6).

Conclusion: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients.
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http://dx.doi.org/10.3109/09513590.2014.920002DOI Listing
September 2014

Ramadan fasting and pregnancy: implications for fetal development in summer season.

J Perinat Med 2015 May;43(3):319-23

Aims: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women.

Methods: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July-7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan.

Results: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05).

Conclusion: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.
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http://dx.doi.org/10.1515/jpm-2013-0289DOI Listing
May 2015

Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage?

Eur J Contracept Reprod Health Care 2014 Apr 27;19(2):128-33. Epub 2014 Jan 27.

* Department of Obstetrics and Gynaecology, Suleymaniye Maternity Hospital for Research and Training.

Objective: This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage.

Methods: Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted.

Results: Clinical outcomes in the two groups - including mean estimated blood loss, major complication rate, and hospital length of stay - were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group B's mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001).

Conclusion: Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.
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http://dx.doi.org/10.3109/13625187.2013.873400DOI Listing
April 2014

Endometriosis, leiomyoma and adenomyosis: the risk of gynecologic malignancy.

Asian Pac J Cancer Prev 2013 ;14(10):5589-97

Department of Obstetrics and Gynecology, Research and Training Hospital, Infertility Research and Treatment Center, Suleymaniye Maternity, Istanbul, Turkey E-mail :

The aim of this review article was to evaluate the relationship and the possible etiological mechanisms between endometriosis, leiomyoma (LM) and adenomyosis and gynecological cancers, such as ovarian and endometrial cancer and leiomyosarcoma (LMS). MEDLINE was searched for all articles written in the English literature from July 1966 to May 2013. Reports were collected systematically and all the references were also reviewed. Malignant transformation of gynecologic benign diseases such as endometriosis, adenomyosis and LM to ovarian and endometrial cancer remains unclear. Hormonal factors, inflammation, familial predisposition, genetic alterations, growth factors, diet, altered immune system, environmental factors and oxidative stress may be causative factors in carcinogenesis. Early menarche, low parity, late menopause and infertility have also been implicated in the pathogenesis of these cancers. Ovarian cancers and endometriosis have been shown to have common genetic alterations such as loss of heterozygosity (LOH), PTEN, p53, ARID1A mutations. MicroRNAs have also been implicated in malignant transformation. Inflammation releases proinflammatory cytokines, and activates tumor associated macrophages (TAMS) and nuclear factor kappa b (NF-KB) signaling pathways that promote genetic mutations and carcinogenesis. MED12 mutations in LM and smooth muscle tumors of undetermined malignant potential (STUMP) may contribute to malignant transformation to LMS. A hyperestrogenic state may be shared in common with pathogenesis of adenomyosis, LM and endometrial cancer. However, the effect of these benign gynecologic diseases on endometrial cancer should be studied in detail. This review study indicates that endometriosis, LM, adenomyosis may be associated with increased risk of gynecological cancers such as endometrial and ovarian cancers. The patients who have these gynecological benign diseases should be counseled about the future risks of developing cancer. Further studies are needed to investigate the relationship between STUMPs, LMS and LM and characteristics and outcome endometrial carcinoma in adenomyotic patients.
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http://dx.doi.org/10.7314/apjcp.2013.14.10.5589DOI Listing
January 2015

The effect of different preparations of hormone therapy on tumor necrosis factor-alpha levels in women with surgical menopause.

Gynecol Endocrinol 2008 Feb;24(2):79-83

Department of Obstetrics and Gynecology, School of Medicine, Duzce University, Konuralp, Turkey.

The aim of the present prospective controlled study was to examine the influence of 17beta-estradiol and tibolone on tumor necrosis factor-alpha (TNF-alpha) levels in healthy women with surgical menopause. Forty-five surgically menopausal women were included in the study. Thirty women were randomized to receive tibolone 2.5 mg or 17beta-estradiol 2 mg daily for 16 weeks. Fifteen surgically menopausal women who refused hormone therapy served as controls. Serum was collected from the subjects at baseline and at the end of the study for TNF-alpha assay. Neither tibolone nor 17beta-estradiol showed a significant influence on TNF-alpha level at the end of 16 weeks in comparison with baseline. Although tibolone induced a trend toward decreased level of TNF-alpha (3.30 +/- 0.42 vs. 2.56 +/- 1.94 microg/dl), this was non-significant. The slight increase observed in TNF-alpha level in the control group was also insignificant (3.60 +/- 1.20 vs. 4.10 +/- 0.70 microg/dl). Overall, these results demonstrate no significant effects of either tibolone or 17beta-estradiol on circulating TNF-alpha level in surgically menopausal women. However, the significant difference achieved between the tibolone and control group after treatment is promising and needs to be investigated in trials with longer treatment periods.
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http://dx.doi.org/10.1080/09513590701718307DOI Listing
February 2008

B-Lynch suture after the failure of hypogastric artery ligation to control post-partum hemorrhage due to placenta increta in a patient with the factor V Leiden mutation.

J Obstet Gynaecol Res 2007 Aug;33(4):557-60

Department of Obstetrics and Gynecology, Duzce University, School of Medicine, Ducze, Turkey.

Post-partum hemorrhage may be a life-threatening condition. A case of a patient receiving antithrombotic therapy for the factor V Leiden mutation, in whom post-partum hemorrhage had occurred due to placenta increta, is described. In this case, the post-partum hemorrhage did not respond to bilateral hypogastric artery ligation, while the B-Lynch surgical technique was successful in obtaining hemostasis.
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http://dx.doi.org/10.1111/j.1447-0756.2007.00567.xDOI Listing
August 2007

The effect of ethinyl estradiol-cyproterone acetate treatment on homocysteine levels in women with polycystic ovary syndrome.

Arch Gynecol Obstet 2008 Jan 6;277(1):25-30. Epub 2007 Jul 6.

School of Medicine, Department of Obstetrics and Gynecology, Duzce University, Konuralp, Duzce, Turkey.

Objective: Women with polycystic ovary syndrome (PCOS) have multiple risk factors for cardiovascular disease. The cardiovascular risk marker homocysteine (Hcy) is elevated in women with PCOS. This prospective study investigated the effect of oral contraceptives containing ethinyl estradiol-cyproterone acetate (EE-CA) on serum Hcy levels in women with PCOS.

Study Design: A total of 30 women with PCOS were enrolled in this prospective study. The diagnosis of PCOS was made according to the criteria of the Rotterdam PCOS consensus workshop group. All women took oral contraceptives containing EE/CA (35 microg/2 mg) for 3 months. Serum samples for Hcy, lipid profile and hormones were obtained during the early follicular phase (days 3-5) of the spontaneous or progestin-induced bleeding at baseline, and after the third treatment cycle.

Results: Three months of EE-CA therapy significantly decreased the Hcy levels from 55.97 +/- 16.04 to 54.03 +/- 16.15 (P = 0.01). A significant correlation was observed between the Hcy and total and free testosterone levels (r = 0.44, P = 0.015 and r = 0.46, P = 0.001 respectively).

Conclusions: Although the decrease in Hcy levels with EE-CA therapy was statistically significant, further studies are necessary to determine the clinical benefit of this treatment.
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http://dx.doi.org/10.1007/s00404-007-0401-xDOI Listing
January 2008

Anti-Müllerian hormone levels during hormonal contraception in women with polycystic ovary syndrome.

Eur J Obstet Gynecol Reprod Biol 2007 Oct 1;134(2):196-201. Epub 2007 Mar 1.

Department of Obstetrics and Gynecology, Duzce University, School of Medicine, 81620 Konuralp, Duzce, Turkey.

Objective: The use of oral contraceptive (OC) pills alters the characteristic features of polycystic ovary syndrome (PCOS) complicating the diagnosis of this disease. Anti-Müllerian hormone (AMH) levels are high in PCOS patients and are stable throughout the menstrual cycle in healthy subjects. This study examined the influence of hormonal suppression with OC therapy on the serum AMH levels in women with PCOS and with normal menstrual cycles.

Study Design: Thirty women with PCOS and 15 women with normal menstrual cycles were enrolled in this prospective study. Serum was collected from the subjects during the early follicular phase of the menstrual cycle and after the sixth cycle of oral contraceptive therapy, and stored frozen until assayed. The effect of OC therapy on the serum AMH, estradiol (E(2)), luteinizing hormone (LH), follicle-stimulating hormone (FSH), free testosterone, total testosterone, and dehydroepiandrosterone sulfate (DHEA-S) levels was studied. In addition, ovarian volume and follicle count were assessed.

Results: The serum AMH levels in PCOS patients were significantly higher than in healthy women at baseline (+/-S.D.; 5.49+/-2.26 and 1.93+/-0.51 ng/ml, respectively; p=0.001). After six cycles of OC therapy, no significant changes in the AMH levels were observed in either the PCOS patients or normally cycling women. Ultrasound showed significant reductions in ovarian volume and follicle number and size at 6 months in both groups.

Conclusion: Although significant reductions were observed in ovarian volume and follicle number, 6 months of contraceptive therapy did not change the serum AMH concentration in either group. AMH may be considered a new marker in PCOS patients who are already on contraceptive treatment.
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http://dx.doi.org/10.1016/j.ejogrb.2007.01.012DOI Listing
October 2007

Intrathecal sufentanil (1.5 microg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy.

J Anesth 2006 ;20(4):274-8

Department of Anaesthesia, Abant Izzet Baysal University, Duzce School of Medicine, Duzce, Turkey.

Purpose: We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section.

Methods: This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0 microg sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0.

Results: No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-microg sufentanil groups than in the 1.5-microg sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores.

Conclusion: The addition of sufentanil 1.5 and 2.5 microg to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-microg sufentanil group when compared with that in the 2.5- and 5-microg groups.
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http://dx.doi.org/10.1007/s00540-006-0437-2DOI Listing
January 2007

Ultrasonographic cervical length measurement at 10-14 and 20-24 weeks gestation and the risk of preterm delivery.

Eur J Obstet Gynecol Reprod Biol 2007 Feb 8;130(2):176-9. Epub 2006 May 8.

Department of Obstetrics and Gynecology, Abant Izzet Baysal University, Duzce Medical School, 81620 Konuralp, Duzce, Turkey.

Objective: To compare cervical length measurements at 10-14 and 20-24 weeks gestation in asymptomatic women with singleton pregnancies and to assess the measurements as a predictor of preterm delivery.

Study Design: In this prospective study, cervical length was measured in 152 asymptomatic women with singleton pregnancies using transvaginal ultrasonography at 10-14 and 20-24 weeks gestation. The primary outcome measure was spontaneous preterm delivery before 35 weeks of gestation. The mean cervical length was calculated at both stages, and lengths were compared between the term and preterm groups.

Results: The rate of spontaneous preterm deliveries was 10.5%. The mean cervical length at 10-14 and 20-24 weeks was 40.5 and 37.1mm, respectively. The cervical length at 10-14 weeks was not significantly different between those who delivered at term (40.9 mm) and those who delivered preterm (38.6 mm). By contrast, the cervical length at 20-24 weeks was significantly shorter in the group that had preterm deliveries (28.4 mm) than in those who had term deliveries (37.8 mm) (P < 0.001). The cervical shortening was more apparent in the group that delivered prematurely (from 38.6 to 28.4 mm) than in that which delivered at term (from 40.9 to 37.8 mm).

Conclusion: Cervical length measurement used to predict preterm delivery was found to be more predictive at 20-24 weeks. Cervical length measurement at 10-14 weeks was not reliable for predicting preterm delivery. The mean cervical length tapered gradually from the first to the second scan, and the more rapid cervical shortening was found to be associated with increased risk for preterm delivery.
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http://dx.doi.org/10.1016/j.ejogrb.2006.03.021DOI Listing
February 2007

Emergency peripartum hysterectomy: a 9-year review.

Arch Gynecol Obstet 2006 May 7;274(2):84-7. Epub 2006 Feb 7.

Department of Obstetrics and Gynecology, Duzce School of Medicine, Abant Izzet Baysal University, 81620, Konuralp, Duzce, Turkey.

Objective: To determine the incidence, indications, risk factors, and complications of emergency peripartum hysterectomy.

Study Design: A retrospective study of the patients requiring an emergency peripartum hysterectomy of a 9-year period was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 h after delivery. Demographic and clinical variables were obtained from the maternal records.

Results: There were 34 emergency peripartum hysterectomies out of 117,095 deliveries for a rate of 0.29 per 1,000. Of the 16 cases that were delivered by cesarean section, seven had a previous cesarean section and 18 cases were delivered vaginally, including two using vacuum extraction. Total hysterectomy was performed in 24 patients, and subtotal hysterectomy in ten patients. The indications for hysterectomy were uterine rupture (n=12), placenta accreta (n=10), uterine atony (n=7), and hemorrhage (n=5). There were two maternal deaths, six stillbirths, and two early neonatal deaths.

Conclusion: This study identified surgical deliveries, uterine rupture, placenta accreta, and uterine atony as risk factors for emergency peripartum hysterectomy. The most common reason for abnormal placental adherence was a previous cesarean section. Multiparity and oxytocin use for uterine stimulation were among the risk factors for uterine atony that necessitated emergency peripartum hysterectomy.
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http://dx.doi.org/10.1007/s00404-006-0124-4DOI Listing
May 2006

Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation.

Knee Surg Sports Traumatol Arthrosc 2006 Jul 13;14(7):646-53. Epub 2006 Jan 13.

Department of Orthopedics and Traumatology, GATA Haydarpasa Training Hospital, Uskudar, 34668, Istanbul, Turkey

The purpose of this study was to evaluate the early clinical outcomes of the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction using biodegradable cross pin fixation. The nature of this study is a prospective nonrandomized clinical outcome study. Thirty-five patients who underwent BPTB ACL reconstruction with a minimum of 2 years follow-up evaluation were included in the study. Thirty BPTB autografts and five BPTB allografts were fixed with two biodegradable 2.7 mm cross pins (Rigid Fix) on the femoral side. Clinical evaluation included International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and Telos stress device measurements. The average Lysholm knee score was 94.7 (of 100). Twenty-four patients reported an excellent result. The other eight patients were in a good group. According to the IKDC scores, 23 (66%) patients reported normal function, 12 (34%) patients reported nearly normal function, and no (0%) patient reported abnormal or severely abnormal function. Telos stress device values were less than 3 mm of sagittal displacement in 28 patients and 5 mm in 7 patients. No patients complained that their knees gave way fully, even with moderate or strenuous activities. All of the patients have returned to their preinjury level of activity and athletic participation. Clinical results support this technique as a reliable alternative for patellar tendon fixation in ACL reconstruction.
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http://dx.doi.org/10.1007/s00167-005-0019-0DOI Listing
July 2006

Transperineal versus transvaginal ultrasonographic evaluation of the cervix at each trimester in normal pregnant women.

Aust N Z J Obstet Gynaecol 2005 Jun;45(3):191-4

Department of Obstetrics and Gynaecology, Abant Izzet Baysal University, Duzce Medical School, Duzce, Turkey.

Aims: To compare transvaginal and transperineal ultrasonography in the assessment of cervical length and cervical changes in normal gravid patients at each trimester.

Methods: Transperineal and transvaginal ultrasonographic cervical length was measured on 104 asymptomatic pregnant women between 10 and 14, 20-24, and 30-34 weeks' gestation and the presence of a funnel was also noted. The study used the McNemar chi2 test to assess the difference between two methods in their ability to obtain a measurement, and the Pearson correlation coefficient to determine the relationship between the paired transperineal and transvaginal cervical lengths.

Results: Cervical length measurements were obtained by transvaginal ultrasonography in all 104 patients and by transperineal ultrasonography in 101 patients (97.1%) (P = 0.1). By gestational age, the greatest length discrepancy (2.8 mm) between the two ultrasonographic methods was found at 10-14 weeks (P < 0.001). At 20-24 and 30-34 weeks' gestation, the mean length differences were less than 1 mm (P < 0.01 and P = 0.337, respectively). Cervical funnelling was observed in 16 patients by both methods, whereas in two patients from the 20-24 week gestational age group, funelling was observed by transvaginal ultrasonography and not by transperineal ultrasonography.

Conclusions: Cervical length measurements by transperineal ultrasonography show good correlation with transvaginal ultrasonographic measurements and it is a satisfactory alternative to a transvaginal evaluation of the cervix throughout pregnancy.
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http://dx.doi.org/10.1111/j.1479-828X.2005.00378.xDOI Listing
June 2005

Rupture of the pregnant uterus: a 9-year review.

Arch Gynecol Obstet 2005 Sep 21;272(3):229-31. Epub 2005 Apr 21.

Department of Obstetrics and Gynecology, Duzce School of Medicine, Abant Izzet Baysal University, 81620 Konuralp/Duzce, Turkey.

Objective: To investigate the frequency of ruptured uterus, possible etiologic factors and fetomaternal outcomes.

Study Design: A retrospective chart view of all patients with ruptured uterus over a 9-year period from 1995 to 2003 was carried out. Relevant data relating to the clinical features, characteristics of labour, operative procedures, and fetomaternal outcomes were assessed.

Results: During the study period there were 17 cases of ruptured uterus among a total of 117,095 deliveries, giving an incidence of 1 in 6,888 deliveries. Thirteen patients (76.5%) were multiparous and mean parity was 1.9. Uterine rupture occurred following vaginal delivery in ten patients. Caesarean delivery was performed in seven (41.2%) patients, of which five (29.4%) patients had a history of previous caesarean section. Abdominal hysterectomy was performed in 12 patients (70.6%), of which 9 (75.0%) were total and 3 (25.0%) were subtotal. The other five patients (29.4%) had suture repairs. In seven patients (41.2%), uterine rupture was associated with oxytocin use. There were one maternal and three perinatal (17.6%) deaths.

Conclusion: Sudden fetal heart abnormalities in labouring patients should be taken as a potential sign of danger. Early diagnosis and immediate preoperative resuscitation are of great importance in cases of ruptured uterus. The fetomaternal outcomes can be improved with the experience and skill of the surgical team.
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http://dx.doi.org/10.1007/s00404-005-0733-3DOI Listing
September 2005

Two successive pregnancies after ursodeoxycholic acid therapy in a previously infertile woman with antimitochondrial antibody-negative primary biliary cirrhosis.

Fertil Steril 2005 Mar;83(3):761-3

Department of Internal Medicine, Aibü Duzce Medical School, Duzce, Turkey.

Objective: To describe the benefit of ursodeoxycholic acid (UDCA) for the initiation and completion of a successful pregnancy in a previously infertile woman with primary biliary cirrhosis.

Design: Case report.

Setting: A university hospital with relevant departments.

Patient(s): A 29-year-old woman with primary biliary cirrhosis and failure to conceive for 6 years.

Intervention(s): Establishment of diagnosis with a liver biopsy, pretreatment of patient with UDCA before conception, and continuation of UDCA after first trimester until term. UDCA was used in the second pregnancy again after the first trimester.

Main Outcome Measure(s): Achievement of a safe conception and full-term pregnancy.

Result(s): Two consecutive successful pregnancies, a healthy 3,250-g male infant and a healthy 3,000-g female infant. The second conception occurred in a period without the use of UDCA, implicating a latent beneficial effect of either UDCA or the previous pregnancy via some possible immune mechanism.

Conclusion(s): Ursodeoxycholic acid could help achieve conception in infertile women with primary biliary cirrhosis. The use of UDCA after the first trimester is shown to be safe in two consecutive pregnancies. Although it cannot be conclusive, the unintentional use of UDCA in the first 20 days after conception did not result in any teratogenicity in the first child.
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http://dx.doi.org/10.1016/j.fertnstert.2004.11.010DOI Listing
March 2005

Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl.

Acta Obstet Gynecol Scand 2004 May;83(5):504-5

Department of Obstetrics and Gynecology, Abant Izzet Baysal University, Duzce Medical School, 14400 Konuralp/Duzce, Turkey.

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http://dx.doi.org/10.1111/j.0001-6349.2004.00092a.xDOI Listing
May 2004

A case of primary Addison's disease with hyperemesis gravidarum and successful pregnancy.

Eur J Obstet Gynecol Reprod Biol 2004 Mar;113(1):100-2

Department of Obstetrics and Gynecology, Abant Izzet Batsal University, Duzce Medical School, Duzce Tip Fakultesi, Kadin Hastaliklari ve Dogum A.D, Konuralp/Duzce 14400, Turkey.

We followed up a pregnant woman with Addison's disease diagnosed before conception. She presented with hyperemesis gravidarum. Throughout pregnancy, she received prednisone and the basic disease did not deteriorate during pregnancy. She was delivered by caesarean section due to breech presentation. The fetal prognosis was good.
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http://dx.doi.org/10.1016/j.ejogrb.2003.01.001DOI Listing
March 2004

Primary omental pregnancy presenting with hemorrhagic shock. A case report.

Gynecol Obstet Invest 2003 ;55(2):116-8

Department of Obstetrics and Gynecology, Abant Izzet Baysal University, Duzce Medical School, Duzce, Turkey.

Abdominal pregnancy is a very rare and serious type of extrauterine gestation that accounts for approximately 0.003% of all ectopic pregnancies. Omental pregnancy, an extremely rare form of abdominal pregnancy, can be primary or secondary to a tubal pregnancy that aborts out of the fimbria and reimplants in the peritoneal cavity. We present an additional case of primary omental pregnancy at 12 gestational weeks presenting with symptoms of hemoperitoneum and acute abdomen.
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http://dx.doi.org/10.1159/000070188DOI Listing
October 2003
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