Publications by authors named "Reyhan Ayaz"

18 Publications

  • Page 1 of 1

PRENATAL IDENTIFICATION OF ABERRANT RIGHT SUBCLAVIAN ARTERY IN ISOLATION: THE NEED FOR FURTHER GENETIC WORK-UP?

Acta Clin Croat 2020 Dec;59(4):582-589

1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey.

The objective of this study was to evaluate the association between aberrant right subclavian artery (ARSA) and chromosomal abnormalities. The study included 5211 women having attended our unit for fetal anatomic screening and fetal echocardiography from August 2016 until February 2019. After diagnosing ARSA, prenatal invasive testing was discussed with the patients. ARSA affected fetus was determined in 57 cases; of these, there were 38 cases of isolated ARSA and 19 cases of non-isolated ARSA but associated with soft markers and fetal anomalies. Nineteen patients underwent amniocentesis; Down syndrome was determined in two women, both of them from the non-isolated ARSA group, with fetal hydrops, atrioventricular septal defect and esophageal atresia. Fifteen of 38 patients who declined prenatal diagnostic testing, accepted karyotype analysis after delivery and none of these 15 cases had chromosomal abnormalities. Identification of ARSA should be followed by detailed ultrasound examination to ensure that there are no accompanying soft markers and/or structural defects. Isolated ARSA may not be an indication for karyotype analysis or 22q11.2 microdeletions. Non-ARSA implies a strong predictor of aneuploidy, and when additional findings are detected, invasive testing should be offered to the parents. The association between isolated ARSA and genetic disease should be evaluated in large powered prospective studies.
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http://dx.doi.org/10.20471/acc.2020.59.04.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253070PMC
December 2020

Prenatal diagnosis and postnatal course in four fetuses with very rare pulmonary artery anomalies.

Turk J Obstet Gynecol 2021 Mar;18(1):68-75

İstanbul Medeniyet University Faculty of Medicine, Department of Pediatric Cardiology, İstanbul, Turkey.

Pulmonary artery (PA) anomalies are very rare congenital cardiac malformations, a significant number of which remain unrecognized or misdiagnosed during the prenatal period. We report the prenatal diagnosis and outcome of pregnancy with fetal PA anomalies and discuss the related management issues. We identified four cases of prenatally diagnosed rare PA anomalies that were seen and confirmed in the newborn period by echocardiography and computed tomographic angiography at our center from 2018 to 2020. The course of the pregnancy, perinatal outcome, and the postnatal course in each case were analyzed. Three fetuses were born by repeat cesarean section approximately at 39 weeks of gestation and the other woman delivered vaginally. Of the abnormal origin of the left PA (LPA) in two patients, the first had right PA abnormalities derivating from the ascending aorta, and in the second, the LPA originated from the right PA. Two patients had agenesis of ductus arteriosus (DA), the first was accompanied with tetralogy of Fallot (TOF) and right aortic arch with a normal pulmonary valve, the second patient presented with an Absent Pulmonary Valve syndrome with TOF. Prenatal ultrasonography can be used to correctly diagnose the abnormal origin of the PA branches. Branching of the PA, presence of DA, location of the aortic, and ductal arch by the trachea should be routinely screened in the prenatal anatomic examination and the three-vessel and trachea view can determine the primary clues of PA malformations.
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http://dx.doi.org/10.4274/tjod.galenos.2021.40035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962158PMC
March 2021

The effect of 75-g oral glucose tolerance test on maternal and foetal Doppler parameters in healthy pregnancies: a cross-sectional observational study.

J Obstet Gynaecol 2021 Jan 15;41(1):83-88. Epub 2021 Feb 15.

Faculty of Medicine, Department of Biostatistics, Istanbul Medeniyet University, Istanbul, Turkey.

Hyperglycaemia can alter placental resistance to blood flow and hyperglycaemia has adverse perinatal outcomes. Oral glucose tolerance testing (OGTT) increases the maternal plasma glucose levels temporarily and mimics metabolic hyperglycaemia. The blood flow of the uterine artery (UtA), umbilical artery (UA), middle cerebral artery (MCA) were assessed before, 1 and 2 h following the OGTT by using Doppler ultrasonography. Z-score of cerebroplacental ratio (CPR), pulsatility index (PI) for three vessels were evaluated separately. All measurements of the MCA, UA, UtA Doppler parameters were not statistically different for fasting, and 1 and 2 h following the 75 g OGTT in the 53 pregnant women with a singleton gestation in the low-risk group. This study results show that acute hyperglycaemia induced by OGTT has no effect on maternal and foetal Doppler parameters in healthy pregnancies.IMPACT STATEMENT Foetal glucose is affected by maternal blood glucose concentrations and placental blood flow. Acute hyperglycaemia may have an effect on maternal, and foetal Doppler parameters among healthy pregnancies Our findings indicate that blood flow velocity metric measurements in the UA, MCA and UtA were not affected by the OGTT in healthy pregnant women. Acute hyperglycaemia induced by OGTT does not have any effect on fetomaternal circulation, especially foetal brain blood flow. Other foetal vessels including ductus venosus, renal artery, etc. may be affected by maternal blood glucose levels during the OGTT or in diabetic patients. Future prospective studies consisting of diabetic patients are warranted to verify the exact effect of glucose levels on foetal and maternal circulation.
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http://dx.doi.org/10.1080/01443615.2020.1849072DOI Listing
January 2021

Anxiety and Post-Traumatic Stress Disorder Symptoms in Pregnant Women during the COVID-19 Pandemic's Delay Phase.

Psychiatr Danub 2020 Autumn - Winter;32(3-4):521-526

Department of Obstetrics and Gynecology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Kadıkoy, Istanbul, Turkey,

Background: The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has spread all over the world and affected global mental health. Pregnant women may be particularly vulnerable and experience high levels of distress during an infectious disease outbreak. The aim of this study was to determine anxiety and post-traumatic stress disorder (PTSD) symptoms in pregnant women during the COVID-19 pandemic.

Subjects And Methods: This cross-sectional study surveyed a total of 283 pregnant women within the period of May 11 to May 28,2020. During their regular antenatal visit, pregnant women were invited to participate in the study. The self-created personal information form was used to assess the main characteristics of the participants. Anxiety and PTSD symptoms of the pregnant women were measured by the Spielberger State-Trait Anxiety Inventory (STAI) and Impact of Events Scale-Revised (IES-R), respectively.

Results: The mean age of the pregnant women was 29.20±5.55 years. Regarding gestational age, 72 (25.4%), 86 (30.4) and 125 (44.2) were in the first, second and third trimesters, respectively. The mean gestational age was 23.82±11.05 weeks. The mean STAI-S and STAI-T scores were 39.52±10.56 within the cut-off value (39-40) of the instrument and 42.74±8.33, respectively. Furthermore, the mean total IES-R score was 36.60±15.65 within the cut-off value (24) of the instrument. Multiple regression analysis revealed that pregnancy complication (p=0.01) and employment status of husband (p=0.04) were the best predictors of state anxiety. Additionally, the presence of COVID-19-related symptoms (p=0.01) and educational level (p=0.01) were found to predict PTSD symptoms.

Conclusions: Pregnant women would be likely to experience high levels of anxiety and PTSD symptoms during the COVID-19 pandemic's delay phase. The results should sensitize the medical team to increased anxiety and PTDS symptoms of the pregnant women in order to prevent negative outcomes for women and their fetuses.
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http://dx.doi.org/10.24869/psyd.2020.521DOI Listing
January 2021

Anxiety and depression symptoms in the same pregnant women before and during the COVID-19 pandemic.

J Perinat Med 2020 Nov;48(9):965-970

Department of Obstetrics and Gynecology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey.

Objectives With clinical experience from previous coronavirus infections, public health measures and fear of infection may have negative psychological effects on pregnant women. This study aimed to compare the level of anxiety and depression in the same pregnant women before and during the COVID-19 pandemic. Methods The pregnant women continuing pregnancy who participated in the first study which was undertaken to clarify the factors associated with mental health of pregnant women before the COVID-19 pandemic, were included for the current study during the outbreak. Anxiety and depression symptoms of the same pregnant women were evaluated by using the Inventory of Depression and Anxiety Symptoms II and Beck Anxiety Inventory twice before and during the pandemic. Results A total of 63 pregnant women completed questionnaires. The mean age of the women and the mean gestational age was 30.35±5.27 years and 32.5±7 weeks, respectively. The mean total IDAS II score was found to increase from 184.78±49.67 (min: 109, max: 308) to 202.57±52.90 (min: 104, max: 329) before and during the SARS-CoV-2 pandemic. According to the BAI scores the number of patients without anxiety (from 10 to 6) and with mild anxiety (from 31 to 24) decreased and patients with moderate (from 20 to 25) and severe anxiety (from 2 to 8) increased after SARS-CoV-2 infection. Multivariate linear regression analysis revealed that obesity and relationship with her husband are the best predictors of IDAS II scores. Conclusions This study indicated that COVID-19 outbreak affects the mental health of pregnant women negatively which leads to adverse birth outcomes. The level of anxiety and depression symptoms of pregnant women during the COVID-19 infection significantly increased. Healthcare professionals should establish comprehensive treatment plans for pregnant women who are highly vulnerable population to prevent mental trauma during the infectious disease outbreaks.
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http://dx.doi.org/10.1515/jpm-2020-0380DOI Listing
November 2020

Neural tube defects in eastern Turkey; Is low folate status or vitamin B12 deficiency or both associated with a high rate of NTDs?

J Matern Fetal Neonatal Med 2020 Nov 5;33(22):3835-3840. Epub 2019 Jun 5.

Bahceci Fulya Assisted Reproduction Center, Istanbul, Turkey.

The aim of this study was to compare the rates of low folate status and vitB12 deficiency between pregnancies with a NTD-affected fetus and those with a structurally normal fetus in a low-income population residing in eastern Turkey. It was a retrospective cohort study conducted in our perinatology unit in eastern Turkey between 2016 and 2018. The inclusion criterion for the study group was pregnancies with an NTD-affected fetus. The control group was pregnancies who met the following criteria; no prior history of pregnancy with a NTD-affected fetus, spontaneous abortion or stillbirth, no fetal growth problems or structural abnormality in the present pregnancy, and matching by gestational age. Venous blood samples of these women were obtained at the time of ultrasound examination and serum folate and vitB12 levels were measured by chemiluminescence method using ECLIA immunologic test (Roche, cobas e601/602 analyzers) at our laboratory. The rate of NTDs was 130 per 10 000 (151/11 552). VitB12 deficiency was found in 62.9% of the study group and 36.4% of the control group ( <  .001). The rate of low folate status was also different between the groups, with 42.3 and 15.2%, respectively ( <  .001). Of the NTDs cases, 12.5% had only low folate status, 33.7% had only vitB12 deficiency, and 29.8% had both together. The rate of low folate status together with vitB12 deficiency was significantly different between the groups ( <  .001). Low folate status coupled with B12 deficiency seems to be strongly associated with NTDs. Thus, simultaneous correction of their levels may be the best reasonable approach for the prevention of NTDs in low-income regions. This strategy can reduce the rate of NTDs in low-income regions, improve overall population health and mitigate the economic burden of NTDs on health care system.
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http://dx.doi.org/10.1080/14767058.2019.1623778DOI Listing
November 2020

Use of clomiphene citrate alone, urinary follicle-stimulating hormone alone, or both combined sequentially in patients with unexplained subfertility undergoing intrauterine insemination: A randomized trial.

Turk J Obstet Gynecol 2018 Dec 9;15(4):243-248. Epub 2019 Jan 9.

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

Objective: To compare the successes of clomiphene citrate (CC) alone, pure human urinary follicle-stimulating hormone (uFSH) alone, and both combined sequentially in patients with unexplained subfertility couples undergoing intrauterine insemination (IUI).

Materials And Methods: Patients aged 18-38 years who had a normal uterine cavity, at least one normal fallopian tube, and regular menses and were unable to conceive despite unprotected intercourse for at least 12 months were randomized to receive CC alone, uFSH alone, or sequential CC and uFSH before a single IUI. The primary outcomes were clinical pregnancy and live birth rates. The study was approved by the ethics committee of our institution.

Results: A total of 135 patients were randomized, and 121 of these were able to complete the study. Of these, 30% (n=36) had CC alone, 34% (n=41) had uFSH alone, and 36% (n=44) had sequential CC and uFSH. The three groups did not significantly differ in terms of age, duration of infertility, hormone levels, and semen parameters. For CC alone, uFSH alone, and sequential CC plus uFSH groups, pregnancy rates were 8.3%, 17.1%, and 18.2%, respectively (p>0.05), and live birth rates were 8.3%, 12.1%, and 13.6%, respectively (p>0.05).

Conclusion: In women with unexplained infertility, use of uFSH seemed to increase the success rate compared with CC alone. The sequential regime can significantly reduce the treatment cost if gonadotropin/IUI cycles are planned.
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http://dx.doi.org/10.4274/tjod.99835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334243PMC
December 2018

Characteristics of prenatally detected right aortic arch cases in a single institution.

J Obstet Gynaecol 2018 Oct 19;38(7):895-898. Epub 2018 Mar 19.

a Department of Obstetrics and Gynaecology , School of Medicine, Eskisehir Osmangazi University , Eskisehir , Turkey.

This study aimed to elucidate the diagnostic process, the associated anomalies and the perinatal outcomes of right aortic arch (RAA) in a group of low-risk patients. The obstetric imaging database and digital patient files were reviewed between January 2015 and June 2016. There were 12 RAA cases detected prenatally. Seven foetuses had an aberrant left subclavian artery and one foetus had mirror image branching. The prevalence of RAA was 1.8 in 1000. Invasive prenatal diagnosis was offered to patients and seven tests were performed. There was one associated cardiac anomaly (8.3%) and one extra-cardiac anomaly (8.3%) in the same foetus which cordocentesis revealed trisomy 21. There were also two 22q11.2 microdeletion cases with isolated RAA with aberrant left subclavian arteries. All patients have given live births except one patient has chosen a termination of pregnancy for 22q11.2 microdeletion. The median follow-up time of the newborns was 21 months. None of the babies required surgery for RAA during follow-up. All the babies are alive, except for the one with trisomy 21, who dead at 5 months due to the surgical complications of an oesophageal atresia operation. Patients with an RAA foetus should be offered for foetal karyotyping and analysis for 22q11.2 microdeletion. When isolated, RAA has usually a good prognosis and rarely requires cardiac surgery. Impact Statement What is already known on this subject? Prenatal diagnosis of RAA should prompt a detailed cardiac and extra-cardiac ultrasound examination. When isolated, RAA is associated with 22q11 deletion and aneuploidies in 4.6% and 5.1%, of cases respectively. What the results of this study add? Our study showed that 28.5% of isolated RAA cases are associated with 22q11.2 microdeletion. Cardiac surgery is rarely required when RAA is an isolated anomaly. What the implications are of these findings for clinical practice and/or further research? Invasive prenatal testing for karyotypes and 22q11.2 microdeletion should be offered to patients with RAA, even in the case of an isolated one. Further larger studies are needed to confirm this finding.
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http://dx.doi.org/10.1080/01443615.2018.1430126DOI Listing
October 2018

Sequential use of Foley catheter with misoprostol for second trimester pregnancy termination in women with and without caesarean scars: a prospective cohort study.

J Matern Fetal Neonatal Med 2018 Mar 28;31(5):677-681. Epub 2017 Feb 28.

a Department of Obstetrics and Gynaecology , School of Medicine, Eskisehir Osmangazi University , Eskisehir , Turkey.

Purpose: The aim of this study is to evaluate the effectiveness and safety of misoprostol and Foley catheter in second trimester termination in women with and without caesarean section (CS) scars.

Materials And Methods: Women with an indication for pregnancy termination between 14 and 22 completed weeks of gestation were included to the study. Enrolled women were allocated into three groups: (1) women with no history of CS, (2) women with one CS and (3) women with ≥2 CS. Study consisted 337 patients (233 group 1, 88 group 2 and 16 group 3). Misoprostol and Foley catheter were used sequentially. The primary outcome was the induction to abortion interval. Secondary outcomes were the successful vaginal abortion rate, the percentage of abortions in 24 h and the rates of surgical removal of the placenta, Foley catheter use and major maternal complications (transfusions, thromboembolic events, uterine rupture and death).

Results: Demographic characteristics were comparable. All study outcomes were statistically similar among groups. There was no major maternal complication among all patients.

Conclusions: Sequential use of misoprostol and Foley catheter is safe and effective in second trimester pregnancy termination for patients with and without CS scars.
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http://dx.doi.org/10.1080/14767058.2017.1293037DOI Listing
March 2018

Evaluation of interventricular septum movements in structurally normal foetuses during second and third trimester of pregnancy: A prospective observational study.

J Obstet Gynaecol 2017 Apr 12;37(3):320-326. Epub 2016 Nov 12.

a Department of Obstetrics and Gynaecology, Faculty of Medicine , Eskişehir Osmangazi University , Eskişehir , Turkey.

Foetal cardiac assessment is a standard part of antepartum obstetric ultrasound evaluation. Heart examination, including four-chamber view and outflow tract views, should be routinely performed for all women as recommended by The International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). Although the anatomical survey of foetal heart is well-defined, current knowledge on myocardial contractility is scarce. The aim of our study was to investigate the interventricular septum (IVS) shortening in normal foetuses. Interventricular septum length and thickness were assessed by re-evaluation of 3-dimensional spatiotemporal image correlation (STIC) acquisition planes in second and third trimesters of pregnancy in otherwise structurally normal foetuses. Twenty-one foetuses were included to the study. Mean gestational age at second and third trimester investigations were 24.4 (±1.6) and 31.3 (±2), respectively. Systolic and diastolic IVS length and thickness were significantly correlated with the gestational age. Interventricular septum shortening and thickening indexes were not different between second and third trimesters. Foetal cardiac contractility is a subject that recently gained attention. The current study revealed that interventricular septum shortening and thickening was relatively stable during second and third trimesters of pregnancy.
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http://dx.doi.org/10.1080/01443615.2016.1242560DOI Listing
April 2017

Analgesic effects of acetaminophen, diclofenac and hyoscine N-butylbromide in second trimester pregnancy termination: a prospective randomized study.

J Matern Fetal Neonatal Med 2016 Dec 3;29(23):3838-42. Epub 2016 Mar 3.

a Department of Obstetrics and Gynecology , School of Medicine, Eskisehir Osmangazi University , Eskisehir , Turkey.

Objectives: This prospective, randomized study aimed to compare the analgesic effects of acetaminophen, diclofenac and hyoscine-N-butylbromide (HnBB) in cases of second trimester pregnancy termination.

Methods: In 60 women with indications for second trimester pregnancy termination, three analgesic agents were randomized into three groups: group 1, acetaminophen; group 2, diclofenac; and group 3, HnBB. A visual analog scale (VAS) used for the evaluation of pain perception. The primary outcome of the study was mean VAS score during the procedure and last VAS score before the completion of termination. The secondary outcomes were the induction-to-abortion interval, the percentage of aborted cases within the first 24 h and finally the need for parenteral analgesia.

Results: Demographic characteristics were similar among the groups. The mean VAS and last VAS scores before termination did not differ among the groups (p = 0.3 and 0.2, respectively). The need for parenteral analgesia did not differ among the groups (p = 0.3). Although a shorter induction-to-abortion interval and greater number of cases with successful termination before 24 h were found in the HnBB group, the differences were not statistically significant (p = 0.6 and 0.5, respectively).

Conclusions: Our study did not demonstrate a difference in pain perception among second trimester pregnancy termination cases using acetaminophen, diclofenac and HnBB.
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http://dx.doi.org/10.3109/14767058.2016.1148134DOI Listing
December 2016

Effect of obesity on perioperative outcomes of laparoscopic hysterectomy.

J Reprod Med 2013 Nov-Dec;58(11-12):497-503

Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.

Objective: To compare the effect of obesity on perioperative outcomes in women undergoing laparoscopic hysterectomy.

Study Design: In this retrospective cohort study, perioperative outcomes of all women who underwent laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign conditions were compared between obese (body mass index > or = 30 kg/m2) and nonobese women.

Results: Baseline characteristics were similar between 320 (33.0%) obese and 550 (67%) nonobese women except for race and the rates of hypertension and diabetes. The adjusted rates of urinary tract injury, vaginal cuff dehiscence, postoperative fever, and ileus were similar between the groups. For obese women, however, bleeding requiring transfusion was almost 3-fold (3.1 vs. 1.1%, adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.10-7.80) and laparotomy risk was approximately 2-fold (7.5 vs. 3.5%, AOR 2.35, 95% CI 1.30-4.24) increased. The rate of urinary tract injury was 3.2% when obese women had TLH, but it was 0.3% for LSH performed on nonobese women. Of all 7 cuff dehiscences, 5 (71%) occurred in nonobese women undergoing TLH.

Conclusion: Obesity increased the risk of bleeding requiring transfusion and conversion to laparotomy but did not influence the other perioperative complications. On subgroup analysis, LSH in nonobese women seems to result in best outcomes.
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April 2014

Efficacy of passive uterine straightening during intrauterine insemination on pregnancy rates and ease of technique.

J Obstet Gynaecol Res 2012 Jan 9;38(1):291-6. Epub 2011 Nov 9.

Department of Obstetrics and Gynecology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey.

Aim: The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI).

Material And Methods: A randomized controlled trial was conducted at Zeynep Kamil Maternity and Pediatric Research and Training Hospital. Participants were 460 women with unexplained infertility. Interventions were IUI by passive straightening of the uterus by means of bladder filling, or IUI performed with an empty bladder. Main outcome measures included pregnancy rate and difficulty of IUI.

Results: Four hundred and sixty couples were allocated: 230 couples were allocated to the full bladder group, and 230 couples were allocated to the empty bladder group (control). The pregnancy rate was higher in the full bladder group than in the empty bladder (control) group (P=0.03, 13.5% vs 7.4%; relative risk [RR] 1.95 for pregnant patients; 95% confidence intervals [CI] 1.048-3.637). The risk of undergoing difficult IUI was higher in the empty bladder group than the full bladder group (P<0.001; 10.0% vs 37.8%, RR 0.18 for difficulty IUI; 95% CI 0.11-0.30). The clinical pregnancy rate was also higher in the group of patients who had easy IUI than in the group of patients who had difficult IUI (P<0.05, 12.7% [42/331] vs 5.5% [6/110]); RR 2.51 for pregnancy; 95% CI 1.04-6.09).

Conclusion: Passive straightening of the uterus makes the procedure less difficult and improves the clinical pregnancy rate.
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http://dx.doi.org/10.1111/j.1447-0756.2011.01684.xDOI Listing
January 2012

The effect of obesity on total abdominal hysterectomy.

J Womens Health (Larchmt) 2010 Oct;19(10):1915-8

Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.

Objective: To compare perioperative outcomes of total abdominal hysterectomy (TAH) between obese and nonobese women.

Methods: The medical charts of all women who underwent TAH for benign gynecological conditions at Temple University Hospital between 1997 and 2002 were reviewed. We excluded those who had concomitant surgery except for adnexal removal. The rates of perioperative indices were compared between obese (body mass index [BMI] ≥ 30 kg/m²) and nonobese women; p < 0.05 was considered significant.

Results: Of 357 women, 172 (48.2%) were obese, and 185 (51.8%) were not. Among the baseline characteristics, only race was statistically different between the groups. There were more African American women among the obese women (82.5% vs. 70%, p < 0.05). Postoperative complications, including urinary tract injury, were not significantly increased in the obese group. On the contrary, nonobese women had a significantly higher incidence of ileus (13.5% vs. 6.4%, p < 0.05). Although operative time was significantly prolonged for obese women, obesity did not increase the length of hospitalization, transfusion rate, and perioperative hemoglobin change. All these results remained the same even after controlling for race.

Conclusions: Contrary to the general opinion, obesity does not significantly affect the perioperative outcomes for TAH performed for benign gynecological causes.
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http://dx.doi.org/10.1089/jwh.2010.2032DOI Listing
October 2010

Does surgical volume influence short-term outcomes of laparoscopic hysterectomy?

Am J Obstet Gynecol 2010 Jul 28;203(1):24.e1-6. Epub 2010 Apr 28.

Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.

Objective: To evaluate whether surgical volume has an impact on short-term outcomes of laparoscopic hysterectomy.

Study Design: This is a retrospective analysis of 1016 laparoscopic hysterectomies.

Results: The surgeons were divided into 2 groups based on a cutoff of 30 cases. Patient characteristics, the rates of laparotomy (4.5% vs 6.7%), and serious complications (3.6% vs 5.5%) were similar between 9 "high" and the remaining 39 "low volume" gynecologists, respectively (P < .05). Mean operating time was longer in the "low volume" group. Compared with their first 29 hysterectomies, the "high volume" surgeons decreased their operating time significantly in their subsequent cases. The "high volume" surgeons improved their conversion rate (9.2% vs 2.4%; P < .0001) over time but not their serious complications.

Conclusion: In laparoscopic hysterectomy, increasing the surgical volume can reduce the operating time and the risk for conversion to laparotomy but not the rate of serious complications.
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http://dx.doi.org/10.1016/j.ajog.2010.01.070DOI Listing
July 2010

Postpartum sexual function of women and the effects of early pelvic floor muscle exercises.

Acta Obstet Gynecol Scand 2010 Jun;89(6):817-22

Department of Midwifery, Faculty of Health Sciences, University of Marmara, Istanbul, Turkey.

Objective: To evaluate the effects of early pelvic floor muscle training after vaginal delivery on sexual function.

Design: Prospective randomized study.

Settings: Urogynecology clinic of a tertiary medical center in Istanbul, Turkey.

Population: Total of 75 primiparous women.

Methods: Pelvic floor-muscle strength was assessed during rest and straining in primiparous women in their 4th postpartum month, after which the women were randomized into training (n = 37) and control (n = 38) groups. Patients were re-evaluated in the 7th postpartum month.

Main Outcome Measures: Female sexual function and pelvic muscle strength scores.

Results: Desire, pain and total female sexual index scores were significantly higher in the 7th month compared to 4th month in both groups (p < 0.05). However, sexual arousal, lubrication, orgasm, and satisfaction scores were improved in the 7th month in the training group (paired t-test, p < 0.001), but not significantly in the control group (p > 0.05). All domains except satisfaction were significantly higher in the training group compared with the controls. Pelvic floor-muscle strength was found to be increased in the 7th month in the training group (Wilcoxon rank test, Z = 4.123, p < 0.001), whereas there was no significant difference between the 4th and 7th month measurements in the controls (p > 0.05).

Conclusion: Pelvic floor-muscle training improves pelvic floor-muscle function, and starting after the puerperal period, exercise appears to have positive effects on female sexual function.
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http://dx.doi.org/10.3109/00016341003801623DOI Listing
June 2010

Unilateral hydroureteronephrosis after a mesh procedure.

J Minim Invasive Gynecol 2010 Mar-Apr;17(2):232-4

Department of Obstetrics and Gynecology, University of Yeditepe, Bostanci, Istanbul, Turkey.

Synthetic mesh has become a popular treatment of pelvic floor relaxation and pelvic organ prolapse, with low complication rates. We describe the case of a woman with unilateral hydroureteronephrosis after a mesh procedure (Gynecare Prolift; Ethicon Women's Health & Urology, Ethicon, Inc., Somerville, New Jersey) successfully treated by neoureterocystostomy. A 39-year-old woman with pelvic organ prolapse underwent the mesh procedure. Two months later, she had left flank pain, and hydroureteronephrosis was diagnosed on the same side despite cystoscopic confirmation of ureteral passage at the first operation. The arm of the mesh was removed surgically, and neoureterocystostomy was performed successfully. Mesh surgery is not without serious complications, and surgeons should bear in mind the possible complications associated with this surgical procedure.
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http://dx.doi.org/10.1016/j.jmig.2009.11.014DOI Listing
July 2010

Lidocaine jelly and plain aqueous gel for urethral straight catheterization and the Q-tip test: a randomized controlled trial.

Obstet Gynecol 2009 Sep;114(3):547-550

From the Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.

Objective: To compare the pain perception between lidocaine and plain aqueous gel during assessment of postvoid residual volume and the Q-tip test.

Methods: : Patients were randomly assigned to either to 2% lidocaine hydrochloride jelly or plain aqueous gel. The allocated gel was first used to lubricate a catheter that was inserted into the bladder to measure the postvoid residual volume. After removal of the catheter, a cotton swab, coated with the same allocated gel, was advanced to the urethrovesical junction until resistance was felt. The angle of the swab with the horizontal plane was measured at rest and with Valsalva maneuver. Relevant baseline characteristics and the Wong-Baker FACES pain scores (where 0 is for no pain and 5 for worst pain) were compared.

Results: After randomization, lidocaine and the plain aqueous gel arms consisted of 69 and 68 women, respectively. Baseline characteristics of the groups were similar. Significantly fewer women in the lidocaine group (62.3%) reported any pain than those allocated to plain aqueous gel (80.9%) (odds ratio 0.39, 95% confidence interval 0.18-0.85). The median pain score was significantly lower in the lidocaine group (1, range 0-5) compared with 2 (range 0-4), P<.001).

Conclusion: When compared with plain aqueous gel, 2% lidocaine jelly significantly reduces pain perception during evaluation of postvoid residual volume and the Q-tip test.

Level Of Evidence: I.
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http://dx.doi.org/10.1097/AOG.0b013e3181b43808DOI Listing
September 2009
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