The Relationship Between Perineal Body Size, Total Vaginal Length, Apical Prolapse, and Prolapse Symptoms.

IMPORTANCE: Currently, apical prolapse is diagnosed via assessing the levels of C and D points in the pelvic organ prolapse quantification (POP-Q) system. However, it is not yet known whether the other components of this system are useful for diagnosing apical prolapse and its symptoms. OBJECTIVE: The aim of the study was to evaluate the association between the perineal body size (PB), total vaginal length (TVL), and apical prolapse and its symptoms. STUDY DESIGN: Two hundred women, 100 women with apical prolapse and 100 women without, were included in this cross-sectional study. The association between the PB, TVL, and apical prolapse and its symptoms were evaluated. The relationship between the other POP-Q measurements and apical prolapse/prolapse symptoms were also evaluated as the secondary outcome of the study. RESULTS: The TVL (cutoff value, ≤8 cm; sensitivity, 80%; specificity, 60%) and the genital hiatus size (GH; cutoff value of >4.5 cm; sensitivity, 90%; specificity, 91%) were significantly associated with apical prolapse. The PB cutoff value of 3.4 cm or less had lower sensitivity (49%) and specificity (70%) for the diagnosis of apical prolapse. The GH (cutoff value, >4.8 cm; area under curve [AUC], 0.927), C (cutoff value, >-5.8 cm; AUC, 0.955), and Ba (cutoff value, >-1.1 cm; AUC, 0.891) were significantly associated with apical prolapse symptoms. However, there was no association between the PB or TVL with symptoms. CONCLUSIONS: The study results showed that the TVL and GH were more strongly associated with apical prolapse than PB. The GH, C, and Ba were also associated with prolapse symptoms, but PB and TVL were not.

Maternal obesity and intra-abdominal adhesion formation at cesarean delivery.

OBJECTIVE: The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery. METHODS: Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m2 and ≥30 kg/m2). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared. RESULTS: Intra-abdominal adhesions were more common in women ≥30 kg/m2 than in those <30 kg/m2 (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m2 vs. 30.5 ± 4.8 kg/m2, p = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m2 vs. 25.7 ± 5.2 kg/m2, p = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m2 than in those <30 kg/m2 (39.6% vs. 23.7%, p = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p = .001) in women ≥30 kg/m2 with intra-abdominal adhesions (16.7% vs. 35.4%, p = .005). CONCLUSION: Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.

The Manchester procedure combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling

This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time, and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix.

Feasibility and Safety of Laparoscopic Surgery in Large Ovarian Masses.

Objectives: To evaluate the feasibility and safety of laparoscopic surgery for large ovarian masses with benign features. Materials and Methods: Women who underwent laparoscopic surgery for an ovarian mass with benign features between 2017 and 2019 at a tertiary referral center were included in the retrospective study. Based on the size of the ovarian mass, the women were divided into the case and control groups of ≥10 cm and <10 cm, respectively. Clinical characteristics, operative findings, histopathological results, and complication rates of the groups were compared. Results: A total of 260 women, 64 women with large masses and 196 with small masses were included in the study. The operation time, intraoperative cyst rupture rate, complication rate, and hospital stay were similar in the case and control groups (P > 0.05). The cyst aspiration rate (29.7% vs. 5.1%, P < 0.001) and the unexpected malignancy rate (7.8% vs. 0.0% P = 0.001) were significantly higher in the case group than in the control group. Conclusion: Laparoscopic surgery was found feasible for the treatment of women with large ovarian masses. However, a higher unexpected malignancy rate requires the careful patient selection and appropriate counseling preoperatively in these cases.

Effect of Nonionizing Radiation on Progesterone Treatment in Endometrial Hyperplasia: An Experimental Rat Study.

OBJECTIVES: The aim of the study was to evaluate the negative effect of nonionizing radiation on the treatment of endometrial hyperplasia (EH) with oral progesterone. DESIGN: Forty oophorectomized Wistar Albino female rats were included in this experimental rat study. MATERIALS AND METHODS: The 4 groups were planned as follows: Group A; sham group; Group B; group receiving oral estradiol hemihydrate 4 mg/kg/day; Group C; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day medroxy progesterone acetate (MPA) and Group D; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day MPA with exposure to nonionizing radiation at 1800 mHz/3 h/day. After the experimental model, uterine horns were sampled and the preparations were evaluated for pathological parameters (glandular density, epithelial cell length, and luminal epithelial cell length) via light microscopy. Nonionizing radiation was created by a signal generator and a compatible mobile phone. RESULTS: Estrogen was found to increase all parameters related to EH (p < 0.05). Progesterone treatment was found to decrease parameters related to EH (Group B vs. C; luminal epithelial cell length, glandular density, and epithelial length; 11.2 vs. 13.2 µm p = 0.007; 32.5 vs. 35.5, p = 0.068; and 219.9 µm vs. 285 µm, p < 0.001, respectively). Final analyses revealed reduced effectiveness of progesterone treatment in the rats exposed to nonionizing radiation (Group C vs. D); luminal epithelial cell length, glandular density, and epithelial length (11.2 µm vs. 13.5 µm, p = 0.179; 32.5 vs. 52, p < 0.001; and 219.9 µm vs. 374.1 µm, p = 0.001, respectively). LIMITATIONS: The limitations of our study are that the results of animal experiments may not be appropriate for direct adaptation to humans and the relatively low number of rats included in the study. CONCLUSION: Nonionizing radiation reduces the effect of progesterone in patients receiving treatment for EH.

Unplanned pregnancy and awareness of emergency contraception: a postpartum period survey.

OBJECTIVES: The study aimed to determine the awareness of emergency contraception (EC) and knowledge of its use as well as the unplanned pregnancy rate among women in the immediate postpartum period in Ankara, Turkey's second largest city. METHODS: Interviews were carried out among 1955 women on their first or second day postpartum. The interview was based on a questionnaire containing 19 questions covering participants' awareness and experience of using EC as well as their future approach to its use. RESULTS: The rate of unplanned pregnancy was 18.2% and the rate of EC awareness was 26.0%; 89.4% of those who were aware of EC knew how to use it correctly. In the multivariate regression analysis, employment, household income and level of education were independently associated with EC awareness; gravidity, household income, level of education and number of abortions were independently associated with unplanned pregnancy. Awareness of EC increased significantly (p < .05) with age, household income and educational level; knowledge about the correct use of EC increased with age and educational level (p < .05). CONCLUSION: EC awareness among the study population was low and was related to household income and educational level. Household income, educational level and gravidity were the most important factors associated with unplanned pregnancy. Governments must therefore establish appropriate health policies and provide contraceptive education to women from adolescence onwards.

The Effect of Disulfiram in the Prevention of Postoperative Adhesion Formation in an Experimental Rat Uterine Horn Model.

Postoperative adhesions can cause serious complications, including intestinal obstruction, chronic abdominopelvic pain, and infertility in women. Here we investigate the effects of disulfiram on the postoperative adhesion model. Female Wistar rats were used (n = 72). The animals were separated into six groups (12 rats per group): group 1 (control), group 2 (300 mg/kg disulfiram administered for 3 days preoperatively), group 3 (50 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 4 (300 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 5 (50 mg/kg disulfiram administered 14 days postoperatively only), and group 6 (300 mg/kg disulfiram administered 14 days postoperatively only). A histopathologic examination was performed. Immunohistochemical stainings for matrix metalloproteinase-2 and 9 (MMP-2, and MMP-9) and vascular endothelial growth factor (VEGF) were evaluated. The macroscopic adhesion scores were significantly lower in the disulfiram groups (groups 3, 4, and 6) compared to the control group (p < 0.05). Inflammation scores were lower in all groups receiving disulfiram, but only reached statistical significance in group 4 (p < 0.05). In the immunohistochemical evaluation of the groups, MMP-9 was significantly lower in group 5 than group 4 (p < 0.05). There was no significant difference between the groups for MMP-2 and VEGF. We found that disulfiram reduced postoperative adhesion formation. Disulfiram becomes more effective (by directly reducing inflammation) when initiated during the preoperative period at high doses.

Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial.

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero ("0") was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENTWhat is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery.What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries.What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.

Effects of melatonin on uterine hypertrophy/hyperplasia: A preliminary experimental rat study.

Endometrial hyperplasia is a process of endometrial proliferation that results in a thickening of the endometrial tissue. Melatonin might be able to change the pathophysiological process and prognosis into a positive way that might prevent and heal endometrial hyperplasia, which is the first stage of endometrial cancer. For this perspective, we tried to investigate the effect of melatonin on uterine hypertrophy/hyperplasia in an experimental rat model. Forty Wistar-Albino rats were undergone bilateral oophorectomy and randomized into four groups. To create a model of uterine hypertrophy/hyperplasia in all groups, except the control group [C] (n = 10), 4 mg/kg/day estradiol hemihydrate were given for 14 days. The uterine hypertrophy/hyperplasia was evaluated histopathologically in the left uterine horns, then the groups were treated for 14 days as follows; melatonin (10 mg/kg/day/po) [M] (n = 10), melatonin + estradiol hemihydrate (10 mg/kg/day/po and 4 mg/kg/day/po) [M + E] (n = 10), and dark environment [D] (n = 10). Finally, the effects of the melatonin were examined histopathologically in the right uterine horns. An uterine hypertrophy/hyperplasia model was established in all groups compared to the control group (p < 0.05). In the [M] and [M + E] groups, epithelial cell height and luminal epithelial cell height significantly decreased (41µm vs 12µm, p = 0.005; 14µm vs 10µm, p = 0.005, respectively for [M] group) and (32µm vs 14µm, p = 0.012; 17µm vs 10µm, p = 0.017, respectively for [M + E] group). The [D] group exhibited a significant decrease in epithelial cell height (33µm vs 20µm, p = 0.017). With or without estrogen exposure, melatonin-treated and physiologically melatonin-released rats experienced a significant uterine hypertrophy/hyperplasia recovery. Melatonin may have protective effects on endometrial hyperplasia.

Laparoscopic hemi-hysterectomy in a noncommunicating uterine horn: The critical steps to be considered.

Various congenital anomalies of the female tract such as agenesis, vertical or lateral fusion failure, and canalization failure occur when the normal development of the Müllerian duct disrupts in any stage of developmental milestones. A cavitated non-communicating rudimentary horn is reported in about 20%-25% of women with unicornuate uterus. A 36-year-old patient, gravida 2 para 2, was admitted to the hospital with a complaint of worsening lower abdominal pain occurring on each menses for 8 months. A 6-cm accessory cavitated left uterine mass suggestive of hematometra was shown on ultrasound examination. It was decided to perform hemi-hysterectomy to remove the left uterine horn by the laparoscopic route. Here we aimed to demonstrate the laparoscopic management of a rudimentary horn case and emphasize the crucial steps that surgeons should safely perform during the operation.

What is the impact of PPAR-γ agonist-rosiglitazone on ovarian reserve after hysterectomy? An experimental study

Background/aim: To evaluate the effects of hysterectomy on rat ovaries and the possible protective role of peroxisome proliferator- activated receptor gamma (PPAR-γ) agonist-rosiglitazone against ovarian reserve decrement. Materials and methods: Forty-five adult Wistar albino rats were randomly divided into three groups. Hysterectomy was performed (n = 15) in group 1 [H]; 1 mg/kg/day PPAR-γ agonist/rosiglitazone was used for 50 days after hysterectomy (n = 15) in group 2 [H + R]; a sham operation was performed (n = 15) in group 3 [control, C]. Blood samples were collected for anti-Müllerian hormone (AMH) evaluation in all groups and simultaneous ovarian Doppler examination was performed in [H] and [H + R] groups before and after (50 days) hysterectomy. All animals were sacrificed to obtain ovaries for histological examination. Results: AMH levels were found to be significantly decreased at postoperative day 50 in all groups (P < 0.05). Histopathologic analysis showed that primary, preantral, and antral follicle counts were significantly higher in the [H] group as compared to the [C] and [H + R] groups (P < 0.05). There was no significant difference between the [C] and [H + R] groups in terms of follicle numbers (P > 0.05). In the ovarian Doppler blood flow analysis, all parameters were significantly decreased in group [H] (P < 0.05), but not in the [H + R] group (P > 0.05) on postoperative day 50. Conclusion: Hysterectomy affects the histopathological structure of rat ovaries and PPAR-γ agonist-rosiglitazone improves the ovarian Doppler blood flow parameters.

Gynecological laparoscopic surgery in the shade of COVID-19 pandemic

A global public health problem with a high rate spread and transmission, Coronavirus outbreak has become the most talked-about matter throughout the world. We are severely affected by the nations with vast numbers of deaths; it was hard to predict such a colossal pandemic with terrifying consequences. Elective surgeries are limited, but situations requiring an urgent gynaecological or obstetric surgical approach must still be performed during the COVID-19 pandemic. Concerns regarding surgical safety and the risk of viral transmission during surgery are of great importance. In this review, we aimed to summarize the concepts related to laparoscopic gynecological surgery during COVID-19 pandemic in the light of current literature.

Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7-336/7 Gestational Weeks.

Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (280/7-336/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.

Non-Ionizing Radiation Created by Mobile Phone Progresses Endometrial Hyperplasia: An Experimental Rat Study.

BACKGROUND: Non-ionizing radiation is related with many pathologies. AIM: Determine association between non-ionizing radiation and endometrial hyperplasia. METHODS: Fifty oopherectomized Wistar albino rats were administered Estradiol hemihydrate (4 mg/kg) to induce hyperplasia, and were exposed to 1800 MHz radiation created by a mobile phone and a signal generator working as base station. This study was carried out with 5 groups in two phases. The study groups were. Control group without any exposure; group receiving estrogen in first phase of the study; group receiving estrogen in both phases; group receiving estrogen in the first phase and exposed to non-ionizing radiation during second phase and group taking estrogen in both phases and exposed to non-ionizing radiation during the second phase. Following both phases, uterine horns were excised and evaluated based on glandular density (GD), epithelial cell height (ECH), and luminal epithelial cell height (LECH). RESULTS: Estrogen increased all parameters during both phases (LECH, GD, and ECH values were 12,2 vs. 16,5 (p = 0.001), 34 vs. 47 (p <0.001), and 201 vs. 376.6 (p = 0.001), respectively during the first phase; LECH, GD and ECH values were 13,2 vs. 20,3 (p <0.001), 35.5 vs. 65,5 (p <0.001), 219.9 vs. 419.6 (p <0.001), respectively, during the second phase).Non-ionizing radiation increased all values without estrogen exposure (LECH, GD and ECH values were 13,2 vs. 17,2 (p = 0,074), 35,5 vs. 59 (p = 0.074), and 219 vs. 318.3 (p <0.001), respectively) or with estrogen exposure (LECH, GD, and ECH, values were 20,3 vs. 22,8 (p = 0,168), 65,5 vs. 77 (p = 0,058), and 419,6 vs. 541,6 (p = 0.004), respectively). CONCLUSION: Non-ionizing radiation progressed endometrial hyperplasia in an experimental rat model with/without estrogen exposure.

Neonatal outcomes in Syrian and other refugees treated in a tertiary hospital in Turkey

Background/aim: Turkey accepts refugees from many countries, principally Syria. More than 2.7 million refugees live in Turkey.We evaluated the neonatal outcomes of refugees. Materials and methods: We retrospectively reviewed the clinical and demographic characteristics of refugee infants born in our hospital between August 2013 and September 2016. Results: Refugees (718 Syrian, 136 Iraqi, 32 Afghani, and 21 of other nationalities) accounted for 907 of 49,413 births. The mean refugee maternal age was lower than that of Turkish women, whereas the gestational age (GA) and birthweight were similar. Refugees required fewer cesarean sections but exhibited greater small- and large-for-GA rates (P < 0.05). Refugee and Turkish infant mortality rates did not differ significantly (0.8 vs. 0.4%). Eighty-nine (12.3%) refugee neonates and 6682 (13.5%) Turkish neonates were admitted to our neonatal intensive care unit (NICU). Jaundice and perinatal asphyxia were significantly more common in refugees, whereas respiratory distress syndrome, GA ≤32 weeks, and infant birthweight <2000 g were more common in Turkish infants. The total NICU admission cost of approximately 450,000 USD was paid by the Turkish government. Conclusion: The numbers of refugees and refugee births continue to grow. The Turkish people and government have provided medical, social, and economic support to date; international assistance is needed.

Outcomes of robotic, laparoscopic, and open hysterectomy for benign conditions in obese patients

OBJECTIVE: To compare outcomes of robotic-assisted (RAH), total laparoscopic hysterectomy (LH), and total abdominal hysterectomy (TAH) for benign conditions in obese patients. MATERIAL AND METHODS: Retrospective cohort (Class II-2) analysis. All obese patients who underwent RAH, LH or TAH for benign conditions by a single surgeon at the University of Texas Medical Branch between January 2009 and December 2011 were identified and their charts reviewed. The patients' characteristics, operative data, and post-operative outcomes were collected and statistically analyzed. RESULTS: A total of 208 patients who underwent RAH (n=51), LH (n=24) or TAH (n=133) were analyzed. There were no significant differences among the groups in demographic characteristics, indications for surgery or pathologic findings. RAH and LH were associated with lower estimated blood loss (EBL) (p<0.001) and shorter length of hospital stay (LOS) (p<0.001) compared with TAH. In addition, RAH and LH had lower intraoperative and early postoperative (≤6 weeks) complications compared with TAH (p=0.002). However, the procedure time was longer in RAH and LH (p<0.001). No significant differences were noted among the groups for late post-operative complications (after 6 weeks) or unscheduled post-operative visits. CONCLUSION: Minimally invasive hysterectomy appears to be safe in obese patients with the advantages of less EBL, fewer intraoperative complications, and shorter LOS.

Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy.

Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.