Turkish obstetricians' self-birth preferences, attitudes and practices towards caesarean section on maternal request and vaginal birth after caesarean section: a national online survey.

The aim of the study was to investigate the reasons for Turkish obstetricians having self-caesarean section on maternal request (CSMR) and their attitudes and practices related to CSMR and vaginal birth after caesarean section (VBAC). The questionnaire form constructed by the authors was sent online to obstetricians working in different cities of Turkey. A total of 206 obstetricians participated and answered a self-administered questionnaire. The self-birth preferences were as follows: 17% had a vaginal delivery (VD), 61.2% had a caesarean section (CS), 4.9% had both VD and CS. Of the participants with CS, 56.3% had CSMR. The most common reason for their having self-CSMR was that it was 'safe for the baby'. The most common reason for performing CSMR with their patients was 'due to birth anxiety and phobia'. Fifty-five percent of the participants said that they first recommended VD. The most common concern related to VBAC was 'I'm afraid of legal sanctions about complications'. Although many Turkish obstetricians recommend VD to their patients, they are afraid of the complaints/trials related to unforeseen complications during VD. IMPACT STATEMENTWhat is already known on this subject? Caesarean section (CS) rates all over the world and in Turkey are rising. The exact frequency of CS on maternal request (CSMR) is not known, but it is estimated to be between 4% and 18%.What do the results of this study add? Although Turkish obstetricians had high self-CSMR rates, they thought that it was more correct to direct patients to vaginal delivery (VD). Obstetricians are afraid of unforeseen complications during VD and related complaints and legal trials.What are the implications of these findings for clinical practice and/or further research? Physicians expect improvements in the judgement and punishment issues related to unforeseen complications in the birth process. Besides the actual rates of CSMR need to be reported in the literature and why obstetricians perform CSMR needs to be investigated globally.

RETROSPECTIVE ANALYSIS OF BORDERLINE OVARIAN TUMORS: OUTCOMES AT A SINGLE CENTER.

We wanted to discuss our experiences in the approach to borderline ovarian tumors, which constitute a group different from epithelial ovarian tumors with respect to their biological structure in line with retrospective information gathered from our cases. A total of 25 patients operated on for the indication of adnexal masses diagnosed as borderline ovarian tumors based on frozen section results were included in our study. Patient age, tumor diameter, tumor markers and surgeries performed were discussed in the light of the literature. Statistical analyses were performed using the SPSS software. The patient mean age was 43.84±11.34 years. The mass was localized in the right (n=13), left (n=11) or both (n=1) adnexal regions. The mean tumor diameter was 12.9±5.84 cm. Histopathologic examination established the diagnosis of serous borderline (n=14 patients) and mucinous borderline (n=11) ovarian tumors. Although the results of our study are consistent with current literature data, a greater number of current studies should be performed on borderline ovarian tumors, which are defined as a class of tumors different from epithelial ovarian tumors.

Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fi xation: a comparative study.

OBJECTIVE: To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fi xation procedures. MATERIALS AND METHODS: Forty-three women who had vaginal sacrospinous fixations (SSF) using Dr. Aksakal's Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. RESULTS: The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not signifi cantly different between the surgery groups. CONCLUSION: The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

Validation of the Turkish version of the International Consultation on Incontinence Questionnaire-vaginal symptoms (ICIQ-VS).

INTRODUCTION AND HYPOTHESIS: The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) was developed and validated in 2006 to evaluate vaginal symptoms, sexual matters, and quality of life of patients. This study aimed to validate the Turkish version of ICIQ-VS. METHODS: The English version of the questionnaire was translated into Turkish. On the basis of the pelvic organ prolapse quantification (POP-Q) system, symptomatic women with ≥ 2 grade pelvic organ prolapse (POP) were included in the symptomatic (patient) group and asymptomatic women with ≤ 1 grade POP in the asymptomatic (control) group. The questionnaire was administered three times: after the first examination of the women (T1), 3 weeks after T1 (T2), and 3 months after the POP surgery (T3). RESULTS: A total of 111 women were included in the study (symptomatic group, n = 53; asymptomatic group, n = 58). The missing data were ˂ 2%; the test-retest reliability was between 0.807 and 0.963, and the differences between the symptomatic and asymptomatic women were significant (p ˂ 0.001). A significant positive correlation existed between POP-Q and the vaginal symptom score, sexual matter score, and quality-of-life score (rs = 0.844, 0.393, and 0.698, respectively; p < 0.001). The Cronbach's alpha was 0.72 for the vaginal symptom score and 0.73 for the sexual matter score. The sensitivity to change was significant (p ˂ 0.05). The effect size values of the vaginal symptom score, sexual matter score, and quality-of-life score were 2.55, 2.33, and 1.56, respectively. CONCLUSION: The Turkish version of ICIQ-VS was successfully validated in this study, and a newer version of the questionnaire was made available for assessing vaginal symptoms, sexual matters, and quality of life of patients with POP.

The Effect of Prognostic Factors and Adjuvant Radiotherapy on Survival in Patients with High-Grade Early-Stage Endometrial Cancer: A Retrospective Clinical Study.

BACKGROUND This retrospective clinical study aimed to investigate the effect of prognostic factors and adjuvant radiotherapy in patients with high-grade early-stage endometrial cancer on overall survival (OS) and disease-free survival (DFS). MATERIAL AND METHODS The medical records of patients diagnosed with high-grade, early stage (I or II) endometrial adenocarcinoma who had received adjuvant radiotherapy after surgery were reviewed. RESULTS Seventy-nine patients included 39 patients (49.4%) with stage II endometrial cancer, 25 patients (31.6%) with histologic grade 3 tumors, and 47 patients (59.5%) with endometrial cancer showing lymphovascular space invasion (LVSI). There were 45 patients (57.0%) who received external pelvic radiotherapy with an average dose of 46.0 Gy (range, 11.2-50.4 Gy), and 34 patients (43.0%) received vaginal brachytherapy (VBT) with an average dose of 21.5 Gy (range, 10-36 Gy). Multivariate analysis showed that tumor stage (HR, 4.066; 95% CI, 1.227-13.467; p=0.022) and histologic grade (HR, 16.652; 95% CI, 4.430-62.589; p<0.001) were independent predictors for OS. Increased serum CA-125 levels (HR, 1.136; 95% CI, 0.995-1.653; p=0.047) and histologic grade (HR, 3.236; 95% CI, 1.107-15.156; p=0.015) were independent predictors for DFS. Adjuvant radiotherapy was not found to be significantly associated with improved OS (HR, 1.259; 95% CI, 0.518-3.058; p=0.612) or DFS (HR, 1.056; 95% CI, 0.994-1.123; p=0.078). CONCLUSIONS This retrospective study showed that in high-grade early-stage endometrial cancer treated with postoperative adjuvant radiotherapy, independent predictors for OS were tumor stage and grade. Adjuvant radiotherapy was not associated with improved OS or DFS.

Translation, cultural adaptation, and validation of Australian pelvic floor questionnaire in a Turkish population.

OBJECTIVES: The aims of the study were the translation, cultural adaptation, and validation of self-administered Australian Pelvic Floor Questionnaire (APFQ) in a Turkish population. STUDY DESIGN: The APFQ was translated into Turkish with forward and back translation by native speakers, and the Turkish version was tested on 15 volunteer patients. 53 patients who had at least one symptom related to pelvic floor dysfunction were included as the patient group, and 51 women who had no symptoms related to pelvic floor dysfunction were included as the control group. All of the women in the patient group were examined gynecologically in the lithotomy position, the cough stress test was performed. and prolapses was evaluated with the POP-Q (Pelvic organ Prolapse Quantification System). The Urinary Distress Inventory was answered by all symptomatic women. All women answered the questionnaire again after a three-week interval. The content/face validity, reliability, stability, and construct validity were studied. RESULTS: The Cronbach's alpha results were above 0.7 for all subscales of the questionnaire (bladder:0.842, bowel:0.733, prolapse:0.858, sexual function:0.750) showing adequate internal consistency (reliability). The test/retest analysis (stability) showed high reproducibility with an intraclass coefficient above 0.85 in the patient group and above 0.75 in the control group. Except for the sexual function subscale, discriminant validity showed a significant difference between the patient and control groups. A significant correlation was found between the total bladder subscale score and the UDI-6 scores (rho:0.828, p:0.000,) and a significant correlation was found between the total prolapse score and the POP-Q scores (rho:0.574, p:0.000). CONCLUSION: The Turkish version of the self-administered APFQ is a reliable and valid instrument for evaluating symptom severity and impact of pelvic floor disorders on the quality of life of Turkish-speaking women.

Immunhistochemical analysis of Nuclear Factor Kappa Beta expression in etiopathogenesis of ovarian tumors1.

PURPOSE: To investigate the place of the transcription factor nuclear kappa B (NF-kB), which is a marker of chronic inflammation, in the etiology of the ovarian carcinoma. METHODS: NFkB analysis with the immunohistochemical method has been performed. To evaluate immunohistochemical NF-kB expression in the ovarian tissue, the H-score method. H-score = ∑ Pi (i+1), where ''Pi'' is the percentage of stained cells in each intensity category (0-100%) and ''i'' is the intensity indicating weak (i=1), moderate (i=2) or strong staining (i=3). RESULTS: It has been seen that, the mean H score is statistically significantly higher in the patient group with serous and musinous adenocarcinoma diagnosis than the two other patient groups (p<0.005). CONCLUSIONS: Factor nuclear kappa B is an important mediator that acts in the chronic inflammation. The highest expression rates are determined by the immunohistochemical method in the ovarian cancer group.

Immunhistochemical analysis of Nuclear Factor Kappa Beta expression in etiopathogenesis of ovarian tumors

Abstract Purpose: To investigate the place of the transcription factor nuclear kappa B (NF-kB), which is a marker of chronic inflammation, in the etiology of the ovarian carcinoma. Methods: NFkB analysis with the immunohistochemical method has been performed. To evaluate immunohistochemical NF-kB expression in the ovarian tissue, the H-score method. H-score = ∑ Pi (i+1), where ''Pi'' is the percentage of stained cells in each intensity category (0-100%) and ''i'' is the intensity indicating weak (i=1), moderate (i=2) or strong staining (i=3). Results: It has been seen that, the mean H score is statistically significantly higher in the patient group with serous and musinous adenocarcinoma diagnosis than the two other patient groups (p<0.005). Conclusions: Factor nuclear kappa B is an important mediator that acts in the chronic inflammation. The highest expression rates are determined by the immunohistochemical method in the ovarian cancer group.

The evaluation of the effect of vaginal delivery and aging on anal sphincter anatomy and function.

OBJECTIVE: This study was conducted to evaluate the effect of vaginal delivery and aging on anal sphincter anatomy and function. METHOD: Asymptomatic thirty women were included in this prospective study. Group 1 included 10 women (age range: 18-50) who had never been pregnant. Group 2 included 10 women (age range: 18-50) who had vaginal delivery. Group 3 included 10 women over 50 who had vaginal delivery. RESULTS: There was no statistically significant difference between the three groups in terms of resting and squeeze pressures. It was found that sphincter thickness showed statistically significant difference between the group 1 and group 3, and also group 2 and group 3. There was not statistically significant difference between the group 1 and group 2 in terms of sphincter thickness. There was a positive correlation between the age and sphincter thickness in all groups. In terms of sphincter thickness and pressure findings there was a positive correlation between the squeeze pressure and external anal sphincter thickness only in group 3. CONCLUSION: The vaginal delivery did not have a negative influence on the structure and function of the anal sphincter in asymptomatic women. However, it was found that anal sphincter thickness changed strongly in a positive manner with aging.

Mean Platelet Volume in Early Diagnosis of Adnexal Torsion.

BACKGROUND: Adnexal torsion (AT) is among the gynecological emergencies; more common in reproductive age, if diagnosed late, this can cause ovarian failure and infertility, but rarely thrombophlebitis and peritonitis. Despite these severe complications, preoperative diagnostic tests are not enough for early diagnosis. There are certain pieces of literature on the subject that reveal changes in mean platelet volume (MPV) values occur in inflammatory and ischemic diseases and that these changes have diagnostic and prognostic significance. However, there are no studies investigating this relationship with adnexal torsion. AIMS: The aim of the study is to investigate the diagnostic and prognostic significance of the mean platelet volume value in the early diagnosis of patients with adnexal torsion. STUDY DESIGN: Case-control study. METHODS: Pre-operative demographic data, MPV, leukocyte count and neutrophils to lymphocytes (N/L) ratio in the blood samples of 51 patients, who were operated on preliminary adnexal torsion and diagnosed as adnexal torsion with a benign ovarian cyst (AT group) were retrospectively compared with those of 50 patients who were operated upon because of benign ovarian cysts and without torsion (control group) at this hospital between 2006 and 2014. RESULTS: The mean MPV level was found to be 8.1 (7.1-10.7) fL in the AT group and 7.9 (6.6-10.2) fL in the control group; no statistically significant difference was found between the groups (p>0.05). Leukocyte count and N/L ratio in the AT group were, on average, 12×10(3)/mm(3) and 82% respectively and in control group; they were, on average, 7.2×10(3)/mm(3) and 59%, respectively. A statistically significant increase was found in the leukocyte count and N/L ratio of the AT group compared to the control group (p<0.001). The platelet count in the AT group was, on average, 253×10(3)/mm(3) and in the control group it was, on average, 280×10(3)/mm(3); no statistically significant difference was detected between these two groups (p>0.05). No correlation was detected between the MPV, platelet and leukocyte counts. The sensitivity of the leukocytosis to the AT cases was found to be 66.7%, and selectivity was 94%. CONCLUSION: The AT diagnostic and prognostic importance of MPV value has not been determined in this study.

Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia?

OBJECTIVE: This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+). MATERIALS AND METHODS: Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study. RESULTS: The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, κ = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%. CONCLUSIONS: Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.