Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey.

BACKGROUND: Cesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity. MATERIAL/METHODS: A total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated. RESULTS: A statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6-53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9-37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications. CONCLUSIONS: An increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient.

The effect of B-Lynch uterine compression suture performed for uterine atony on future menstrual pattern and reproductive outcome.

OBJECTIVES: The effects of B-Lynch (UCS) compression sutures applied in postpartum hemorrhage cases due to uterine atony on menstrual pattern, fertility, obstetric outcomes, dysmenorrhea and dyspareunia were evaluated. MATERIAL AND METHODS: Between January 2012 and March 2017, 77 patients (study group 37, control group 40) diagnosed postpartum hemorrhage in our clinic were included in the study. The long-term results of the patients were evaluated comparatively. RESULTS: In the B-Lynch UCS group, an increase in the postoperative menstrual cycle length and the intensity of dyspareunia measured by the VAS score, and a statistically significant decrease in the duration of menstrual bleeding were observed. In the control group, a decrease in the self-estimated time of postpartum menstrual bleeding and a statistically significant increase in dyspareunia VAS values ​​were observed. There was a statistically significant difference between the groups in terms of menstrual cycle length only after treatment. CONCLUSION: B-Lynch UCS can be used effectively and safely in PPH due to uterine atony without causing any additional pathology in menstrual pattern, fertility, dysmenorrhea and dyspareunia complaints other than the length of the menstrual cycle.

Can various complete blood count parameters helpful in preoperative diagnosis of adnexal torsion?

OBJECTIVE: Adnexal torsion is an important gynecological emergency due to nonfrequent but possible adverse reproductive outcomes. There is no specific laboratory marker to support the preoperative diagnosis or that can be used clinically. The aim of this study was to investigate the diagnostic values of platelet, neutrophil, lymphocyte, and red cell markers as an early indicator of ovarian torsion. METHODS: This retrospective study included 28 female patients who were treated surgically for adnexal torsion between August 2010 and July 2020, and 29 control group women. The demographic data and routine hematological values of patients were compared for adnexal torsion prediction. RESULTS: There were no differences between the groups in terms of the platelet count, platelet distribution width, red cell distribution width, and mean platelet volume values, and there were no differences in the demographic data. Statistical differences were found among white blood cell, hemoglobin, hematocrit, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio, and 81.5% sensitivity and 82.1% specificity were identified for neutrophil/lymphocyte ratio 2.45 (area under the curve AUC 0.892; 95%CI 0.808-0.975; p<0.001). Odds ratio for neutrophil/lymphocyte ratio was 2.62 (95%CI 0.861-7.940, p=0.029). CONCLUSION: According to the regression analysis, neutrophil/lymphocyte ratio was found to be the most beneficial among all blood count parameters for the pre-diagnosis of AT.

Inner myometrial laceration - an unusual presentation of antepartum and postpartum hemorrhage: case reports and review of the literature.

OBJECTIVE: The aim of this study is to evaluate the diagnostic criteria, treatment options and progression of cases who have antenatal or postpartum hemorrhage due to internal myometrial laceration (IML) and to review the literature. STUDY DESIGN: The files of eight patients who were diagnosed to have IML between August 2012 and July 2015 were evaluated retrospectively. RESULTS: The patient group consisted of four patients who had an emergency c-section due to massive bleeding during labor and four patients who had an emergency laparotomy due to uncontrolled bleeding after vaginal delivery after evaluation of the patient for signs of 4Ts (trauma, tissue retention, uterine tonus, and trombin). Primary suturation was the first-line treatment in all patients. In two of the patients, hysterectomy was performed after the defined surgical procedures were not successful in controling the bleeding. CONCLUSION: The presented case series is a pioneering study that describes IM which is a poorly defined reason of postpartum hemorrhage, as the cause of bleeding during labor. Primary suturation is the first-step, further surgery might be required in order to treat this life-threathening condition and the decision should be based on the age and the fertility status of the patient.

Can various complete blood count parameters helpful in preoperative diagnosis of adnexal torsion?

SUMMARY OBJECTIVE: Adnexal torsion is an important gynecological emergency due to nonfrequent but possible adverse reproductive outcomes. There is no specific laboratory marker to support the preoperative diagnosis or that can be used clinically. The aim of this study was to investigate the diagnostic values of platelet, neutrophil, lymphocyte, and red cell markers as an early indicator of ovarian torsion. METHODS: This retrospective study included 28 female patients who were treated surgically for adnexal torsion between August 2010 and July 2020, and 29 control group women. The demographic data and routine hematological values of patients were compared for adnexal torsion prediction. RESULTS: There were no differences between the groups in terms of the platelet count, platelet distribution width, red cell distribution width, and mean platelet volume values, and there were no differences in the demographic data. Statistical differences were found among white blood cell, hemoglobin, hematocrit, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio, and 81.5% sensitivity and 82.1% specificity were identified for neutrophil/lymphocyte ratio 2.45 (area under the curve AUC 0.892; 95%CI 0.808-0.975; p<0.001). Odds ratio for neutrophil/lymphocyte ratio was 2.62 (95%CI 0.861-7.940, p=0.029). CONCLUSION: According to the regression analysis, neutrophil/lymphocyte ratio was found to be the most beneficial among all blood count parameters for the pre-diagnosis of AT.

Mislocated extrauterine intrauterine devices: Diagnosis and surgical management.

OBJECTIVE: Presentation of the diagnostic and surgical treatment methods of our extrauterine intrauterine device (IUD) cases. MATERIAL AND METHODS: We retrospectively evaluated the data of 21 extrauterine IUD cases at our clinic between 2008 and 2010. The symptoms, diagnostic methods, and surgical treatments were evaluated. RESULTS: A total of 14 copper and seven levonorgestrel (LNG) IUDs were used. IUD had been inserted during lactation in 71.4% of the patients. The reasons for presentation of patients were unintended pregnancy in 19.05%, pelvic pain in 19.05%, and pelvic pain with vaginal bleeding in 23.8%. IUD in two patients were located the retroperitoneal area. IUD string had not been visible during routine follow-up in 38.1% of the patients. Laparoscopy was performed in 14 patients and laparotomy was performed for dense adhesions in seven patients. CONCLUSION: Extrauterine IUDs can present with various clinical symptoms. Ultrasonography and X-Ray are sufficient for the diagnosis. Surgical removal is needed to prevent possible complications, and the preferred surgical technique in appropriate patients is laparoscopy.

Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies.

BACKGROUND: Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity. AIM: To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA. METHODS: In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period. FINDINGS: Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU. CONCLUSION: Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

Postpartum contraception in adolescents: data from a single tertiary clinic in southeast of Turkey.

AIM: We aimed to evaluate the postpartum contraception preferences of adolescent women in this study. MATERIALS & METHOD: This descriptive study was prepared after a retrospective analysis of file records of primigravida women who had given birth at the Adiyaman University School of Medicine Training and Research Hospital Department of Obstetric and Gynecology between January 2010 and June 2012. More than 12 months had passed after birth. The adolescents who were included in the study and the control group women were called by phone and invited to our clinic. A total of 506 adolescents and 1,046 control group women came to the clinic and were evaluated. The control group was formed of women between the age of 20-35 years who gave given birth in our clinic during the same period and were randomly selected. Postpartum obstetric history, contraception methods and data of these patients were recorded. RESULTS: The mean age was 18.3±0.4 years and 28.2±4.9 years in the adolescent group and control group respectively. No contraception other than lactation amenorrhea was used by 256 women of the adolescent group (50.6%) and 345 women of the control group (33%). The most commonly used contraceptive method in both groups other than lactation amenorrhea was condoms (160 women (64%) and 230 women (32.8%) respectively). The annual contraceptive failure rate was 3.95% in the adolescent group and 1.72% in the control group. The highest failure rate was with lactation amenorrhea in both groups. DISCUSSION: Adolescent women mostly use contraceptive methods with low reliability such as lactation amenorrhea and the calendar method in the postpartum period. Providing adequate contraceptive education is therefore important. On the other hand, starting such training starting in the early postnatal period will prevent recurring adolescent pregnancies with a short pregnancy interval.

Obstetric Scar Endometriosis: Retrospective Study on 19 Cases and Review of the Literature.

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. This disease is one of the most common gynecologic disorders in reproductive age women. It generally occurs in pelvic cavity. But extrapelvic location has been defined (such as extremities, central nervous system, lungs, pleurae, liver, umbilicus, pericardium, urinary tract, intestines, and surgical scar tissue). Scar endometriosis is a rare disease and defined as presence of endometriotic lesions on the abdominal (such as cesarean section and hysterectomy) or vaginal (episiotomy) excision line. It is difficult to diagnose due to the extreme variability in presentation. The symptoms are nonspecific, typically involving pain, swelling at the incision site at the time of menstruation. Excision and histopathologic examination are necessary for diagnosis. We present a case series of obstetric scar endometriosis and review of the literature.