Evaluation of the Impact of Childbirth Education Classes in Turkey on Adaptation to Pregnancy Process, Concerns About Birth, Rate of Vaginal Birth, and Adaptation to Maternity: A Case-Control Study.

This study aims to examine the impact of childbirth education in Turkey on the adaptation to pregnancy process, concerns about birth, rate of vaginal birth, and adaptation to maternity. This quasi-experimental study with control group was conducted from December 2013 to December 2014. The sample size was 132 primiparous pregnant women ( nexperimental = 66, ncontrol = 66). The average age of the pregnant women in the experimental and control groups was 24.41 ± 3.92 and 23.68 ± 4.19, respectively. The study showed that experimental group participants had lower concerns about birth, higher levels of knowledge, and faster adaptation to pregnancy and postpartum process; they could also give positive feedback about labor pain and action and could start breastfeeding at an earlier stage when compared with those in the control group ( p < .05). Childbirth education classes increase the knowledge of pregnant women and positively contribute in pregnancy, labor, and the postpartum process.

The Frequency of Unplanned Rehospitalization and Associated Factors in Gyneoncology Patients: A Retrospective Study.

OBJECTIVE: In this study, we aim to analyze rate and associated factors with unplanned rehospitalization in gynecological cancer patients. MATERIALS AND METHODS: The electronic database query (2007 to 2014) was used to evaluate rehospitalization rates within 90 days of index admission in patients with gynecological cancer. Multivariable logistic regression was used to identify factors associated with rehospitalization. RESULTS: Mean patient age was 59.05 ± 11.96 years (minimum, 32 years; maximum, 85 years). A total of 152 patients' data were evaluated. Seventy-three patients (48.0%) were rehospitalized within 90 days of discharge. The median length of index hospital stay (from 3 to 34 days) was 8.90 ± 6.03 days. The most common rehospitalization causes includes pain (24.6%), recurrence (21.9%), ascites (13.7%), surgical site infection (12.3%), acute reoperation (9.6%), thromboembolism (8.2%), renal failure (5.5%), ileus/obstruction (2.7%), and lymphedema (1.4%). In multivariable logistic regression model, difference was found between history of operation, receive chemotherapy, development of the complication during hospitalization comorbidities as well as multiparity variables, and rehospitalization (P < 0.05). CONCLUSIONS: Unplanned rehospitalization after discharge for gynecological cancer is common with significant associated risk factors and patient outcomes. Integrated multidisciplinary health care strategies, such as safe transition, communication, patient and family education, accurate medication reconciliation, and short-interval outpatient follow-up may help to prevent rehospitalization after discharge and improve patient outcomes.

HPV types in Turkey: multicenter hospital based evaluation of 6388 patients in Turkish gynecologic oncology group centers.

OBJECTIVE: To evaluate the prevalence of HPV DNA and cervical cytological abnormalities, to compare cervical cytology results and HPV DNA and to define HPV types distribution in a large series of Turkish women who have undergone HPV analysis in hospitals that are members of the Turkish Gynecological Oncology Group. MATERIAL AND METHOD: Between 2006 and 2010, a total of 6388 patients' data was retrospectively evaluated at 12 healthcare centers in Turkey. Demographic characteristics, cervical cytology results, HPV status and types were compared. RESULTS: The mean age of the patients was 38.9±10.2. Overall, 25% of the women were found to be HPV positive. Presence of HPV-DNA among patients with abnormal and normal cytology was 52% and 27%, respectively. There was significant difference with respect to decades of life and HPV positivity (p < 0.05). HPV was positive in (within the HPV (+) patients) 37%, 9%, 27%, 20%, 22%, and 41% of the ASCUS, ASC-H, LSIL HSIL, glandular cell abnormalities, and SCC cases respectively The most common HPV types in our study were as follows; HPV 16 (32%), HPV 6 (17%), HPV 11 (9%), HPV 18 (8%), HPV 31 (6%), HPV 51 (5%), HPV 33 (3%). CONCLUSION: In this hospital based retrospective analysis, HPV genotypes in Turkish women with normal and abnormal cytology are similar to those reported from western countries. Further population based prospective multicenter studies are necessary to determine non-hospital based HPV prevalence in Turkish women.

Postmenopausal complete hydatidiform mole: a case report.

BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a disease with a course of trophoblastic proliferation, and histologically classified as partial hydatidiform mole, complete mole, invasive and metastatic mole, choriocarcinoma and placental site trophoblastic tumor. Occurrence of GTN in postmenopausal women is rare. CASE: We report the case of a 56-year-old postmenopausal woman with a complete mole. The patient was admitted to gynecology outpatient clinic with abdominal pain, nausea and vomiting for about 1 month. Ultrasound examination revealed enlargement of the uterus with endometrial thickness containing hypo/hyper echogeneous and cystic areas. Serum beta-HCG was tested against the possibility of GTN because of the appearance in sonography and was found >5000. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. The serum level of beta-HCG has decreased from initially observed 188,000-0 U/ml in 4th week. The resected uterus contained an endometrial, cystic, grapelike tumor. Microscopic examination demonstrated hydropic degeneration of all the chorionic villi with trophoblastic cell proliferation consistent with a complete hydatidiform mole. CONCLUSION: To our knowledge, our case is the fourth description in the world literature of a benign complete hydatidiform mole in a postmenopausal woman. Although benign gestational trophoblastic disease generally occurs in women of reproductive age and is extremely rare in postmenopausal women, when evaluating patients who are in postmenopausal period the diagnosis of hydatidiform mole must always be considered.

Unusual mechanism of isolated torsion of fallopian tube following minor trauma. Herniation through a broad ligament tear.

Isolated torsion of the fallopian tube without ovarian involvement and associated pathology is a rare event. We report an 18-year-old single female who presented with acute lower abdominal pain during menstruation after a minor trauma of the pelvis. It was diagnosed as isolated torsion of normal right tube during laparatomy due to herniation of the tube through a tear in the broad ligament.

Risk factors for ectopic pregnancy: a case-control study.

AIM: To identify the risk factors for ectopic pregnancy. METHODS: We conducted a prospective case-control study for the role of several risk factors in the occurrence of ectopic pregnancy in Turkey. A total of 225 cases and 375 controls were compared for sociodemographic characteristics, cigarette smoking, obstetric, gynaecological, surgical histories, the presence or absence of assisted conception and contraceptive usage. RESULTS: The main risk factors for ectopic pregnancy were prior ectopic pregnancy (adjusted odds ratio (AOR): 13.1) and a history of infectious reproductive system (AOR for pelvic inflammatory disease: 6.8). Other risk factors found to be associated with an increased risk for ectopic pregnancy were multisexual partner (AOR: 3.5), history of infertility (AOR: 2.5), induced conception cycle (AOR: 3.4), current intrauterine device usage (AOR: 3.2), prior Caesarean section (AOR: 2.1) and cigarette smoking at the time of conception (AOR=1.7). On the contrary, barrier methods were protective from ectopic pregnancy (AOR: 0.4). CONCLUSIONS: The increased awareness and knowledge of risk factors have enabled an early and accurate diagnosis of ectopic pregnancy. This study has found prior pelvic infection to be a major aetiological factor for ectopic pregnancy. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy, infertility history and induced conception cycle, may be the result of a previous pelvic infection that may cause tubal sequelae. These factors are potential targets for intervention and modification.

Dietary intake and nutritional status of Turkish pregnant women during Ramadan.

OBJECTIVE: To determine the effects of Ramadan fasting on dietary intakes, nutritional status and biochemical parameters of Turkish pregnant women. METHODS: We carried out this study at Dr. Zekai Tahir Burak Women's Health Care and Research Hospital, Ankara, Turkey from October 15th to November 13th 2004. Forty-nine fasting group and 49 non-fasting group (control group) voluntarily enrolled for the study. We analyzed the blood biochemical parameters of pregnant women and obtained the dietary intakes from the groups. RESULTS: Compared to the control group, weight gain and energy intake (p<0.05 for second and third trimesters) was less in the fasting group. The percentage of protein (p<0.05 for first and second trimesters) and carbohydrates (p<0.05 for all trimesters) from total energy was higher in the fasting group than in the control group. We noticed a slight increase in the fasting blood glucose, serum total cholesterol high-density lipoprotein-cholesterol and triglycerides (p<0.05 for first trimester) concentrations in the fasting group during Ramadan. However, we found decreased levels in the plasma urea, total cholesterol, triglycerides, low-density lipoprotein-cholesterol and total protein and albumin levels of the fasting group in comparison with the control group. Dietary mineral and vitamin intakes were lower than the recommended daily allowance, except vitamin A and vitamin C in both groups. CONCLUSION: Based on the results of the present study, Ramadan fasting had no significant adverse effect on the health of pregnant women.

Severe perineal lacerations in nulliparous women and episiotomy type.

OBJECTIVE: To determine the patient-related factors associated with severe perineal lacerations in nulliparous women and to evaluate the effect of episiotomy type on the risk of severe perineal tears. STUDY DESIGN: In all, 400 nulliparous women admitted in labor between June and December 2001 were prospectively enrolled. Maternal height, perineal length, fetal birth weight, fetal head circumference, and severe perineal lacerations (third and fourth degrees) were recorded. RESULTS: The rate of severe perineal lacerations was 2% (8/400); 3% with midline, 1% with mediolateral groups. In patients with severe lacerations, perineal length was significantly (p < 0.001) shorter and the head circumference of their babies in the midline significantly (p < 0.05) greater than normal, and birth weights were also significantly (p < 0.05) greater in the mediolateral group. A cut-off value for perineal length of 3.05 cm was found for severe lacerations in the midline group. CONCLUSION: If episiotomy is to be performed, it must be borne in mind that patients with a perineal length of < or = 3 cm have an elevated risk of severe perineal lacerations, and if clinical or ultrasound examination suggests that the fetal head is large, mediolateral episiotomy may be preferred. Otherwise, midline episiotomy must be considered.