The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum.

OBJECTIVES: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. MATERIAL AND METHODS: This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. RESULTS: The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7-49.8)], 26-fold [OR = 26.1 (95% CI, 8.17-83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94-27.1)] increase in the likelihood of placenta percreta, respectively. CONCLUSIONS: Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

Comparison of MED 12 gene mutation and microRNA-124 expression in leiomyoma and myometrium of Turkish patients.

OBJECTIVES: It is believed that there are still unclear areas in the formation mechanism of leiomyomas. In our study, it was aimed to investigate the formation mechanisms of leiomyomas due to local MED 12 gene exon 2 mutation and local microRNA-124 expression in a Turkish population. MATERIAL AND METHODS: Thirty patients who underwent hysterectomy for leiomyoma uteri at Gaziantep University between January 2013 and January 2016 were included in our study. In the pathology specimens of these patients, the patient's myometrium tissue and her own leiomyoma tissue were analysed via quantitative Realtime PCR in association with MED 12 exon 2 mutation and microRNA-124 expression. RESULTS: The average age of the 30 patients included in our study is 46.67 ± 5.42 and 13 patients had single leiomyoma; 17 patients had more than one leiomyoma. There were significantly higher c.130G> T (p.G44C) mutation and c.131G> A (p.G44A) mutation of MED 12 gene exon in leiomyoma tissues than healthy myometrium tissues of same patients. There was a 3.7-fold decrease in the expression of microRNA-124 in leiomyoma tissues compared to intact eutopic myometrium tissues, but this difference was not statistically significant. CONCLUSIONS: In recent studies, it has been suggested that MED 12 gene may play an active role in the formation of fibroids. MED12 and ß-catenin / Wnt pathway were emphasized, and alternative genetic pathways are sought in fibroid formation. Also, tumour suppressor and oncogenesis effects of microRNAs have been demonstrated in many different studies. Since it is involved in the Wnt pathway, microRNA-124 has been blamed by some previous studies for the formation of fibroids. This study demonstrates that MED12 exon 2 mutations and probably microRNA-124 gene expressions might contribute to uterine leiomyoma pathology.

Subcutaneous irrigation with rifampicin vs. povidone-iodine for the prevention of incisional surgical site infections following caesarean section: a prospective, randomised, controlled trial.

The aim is to investigate the effect of irrigation of subcutaneous tissue with saline, rifampicin, or povidone-iodine on incisional surgical site infections following caesarean section. Three hundred patients scheduled for caesarean section were randomly assigned into one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in group 1 (control); saline + rifampicin in group 2; saline + 10% povidone-iodine in group 3. Patients who developed a superficial incisional surgical site infection within 30 days were recorded. The surgical site infection rate did not differ when using rifampicin or povidone-iodine (p = .202). It was observed that there was a statistically significant increase in the rate of incisional surgical site infections as the existence of comorbidities (p = .001), perioperative blood transfusion (p = .020), and midline incision (p = .004). Irrigation of subcutaneous tissue with rifampicin or 10% povidone-iodine is not effective in preventing surgical site infections after caesarean section.IMPACT STATEMENTWhat is already known on this subject? An increase has recently been observed in the incidence of SSI particularly in caesarean sections due to reasons, such as that elderly mothers are more commonly operated on compared to the past and long and complicated operations (Lachiewicz et al. 2015) and there are no clear decisions on measures to be taken. Also, there are not many studies on this subject (De Nardo et al. 2016; Solomkin et al. 2017).What do the results of this study add? In our study, we investigated the effectiveness of subcutaneous agents that have been used by many surgeons for years and we've revealed that it's not effective. There is no study in the literature comparing 3 different irrigation agents as we did in our study. For this reason, we think that we will make an important contribution to the measures to be taken in this important issue.What are the implications of these findings for clinical practice and/or further research? This study may contribute to reaching a sufficient level of evidence on surgical wound infections after caesarean sections, which are still missing in the literature, and that may be guiding for the studies that will be conducted on this subject in the future.

The possible effects of maternal electronic media device usage during pregnancy on children's sleep patterns.

OBJECTIVE: In recent years, there has been increasing scientific evidence about potential health risks caused by electromagnetic fields because of electronic media devices. Therefore, this study aimed to examine the possible association between electronic media device usage during pregnancy and sleep patterns in children and the possible role of electronic media device presence in the sleeping environment on children's sleep disturbances. MATERIAL AND METHODS: The study was carried out with 400 healthy children aged between 1 month and 5 years whose parents agreed to complete the questionnaire form. The questionnaire form consisted of questions about the history of prenatal and postnatal electromagnetic field exposure caused by electronic media devices and the presence of sleep disturbances in children. Data were analyzed with SPSS for Windows program. P-values <0.05 were considered statistically significant. RESULTS: Sleep problems were more prevalent in children whose mothers lived near a base station during pregnancy (p<0.05). Sleep disorders were more frequent and sleep duration was shorter in children whose mothers used electronic devices (television, computer, mobile phone, wi-fi, microwave oven) during pregnancy (p<0.05). Sleep problems were also more common in children with electronic media devices in the sleeping environment during the night (p<0.05). Sleep disturbances were not associated with maternal consumption of tobacco or alcohol or history of disease during pregnancy (p>0.05). CONCLUSION: Our results highlight that exposure to electromagnetic fields caused by electronic media devices during the prenatal or postnatal period could be associated with sleep patterns in childhood. Considering the widespread use of electronic media devices, it may be an important public health problem given the long-term consequences of sleep disorders in childhood.

Retrospective Evaluation of Patients Treated for Ectopic Pregnancy: Experience of a Tertiary Center.

OBJECTIVE: In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. METHODS: In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. RESULTS: Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (ß-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose ß-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose ß-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. CONCLUSION: The fertility status of the patients, the clinical and laboratory findings, and the levels of ß-hCG are the factors that must be considered in planning the appropriate treatment.

Subcutaneous rifampicin versus povidone-iodine for the prevention of incisional surgical site infections following gynecologic oncology surgery - a prospective, randomized, controlled trial.

OBJECTIVES: Surgical site infection (SSI) following gynecologic oncology surgery is a severe problem for both patient and surgeon in terms of increasing morbidity, length of hospital stay, anxiety, and costs. In this prospective, randomized, controlled study we investigated the effect of subcutaneous rifampicin and povidone-iodine on incisional SSI following gynecologic oncology surgery. MATERIAL AND METHODS: Three hundred patients scheduled for abdominal surgery due to any malign gynecological pathology were randomly assigned into one of three groups of 100 members each, as follows: the subcutaneous tissue was irrigated with saline in Group 1; saline + 10% povidone iodine in Group 2; saline + rifampicin in Group 3. Patients were invited to follow-up once every 10 days in a 30-day period for evaluation. Patients who developed a superficial incisional SSI were recorded. RESULTS: No significant relationship was observed between the SSI and the subcutaneous agents used (p = 0.332). It was observed that there was a statistically significant increase in the rate of incisional surgical site infections as the period of hospitalization (p = 0.044), patient's age (p = 0.003), existence of comorbidities (p = 0.001), and perioperative blood transfusion (p = 0.021) increased. CONCLUSIONS: Subcutaneous agents are not effective in preventing surgical site infections after gynecologic oncology surgeries. Further large-scale prospective randomized controlled studies may provide other options to prevent SSIs.

Colostrum immunoglobulins and oxidative capacity may be affected by infant sex and maternal age and parity

Background/aim: The aims of this study were to determine the levels of the total antioxidant status (TAS), the total oxidant status (TOS), the oxidative stress index (OSI), and the concentration of immunoglobulin A (IgA) and M (IgM) in colostrum, and evaluate relationships between these parameters and maternal age, maternal parity, and infant sex. Materials and methods: The analysis was performed in serum samples of colostrum which were collected from 90 mothers on the first day of lactation between 10:00 and 12:00 AM Results: The measurements established that no significant association existed between the TAS level of colostrum and parity, maternal age, or infant sex. However, mothers 18 to 30 years of age had significantly lower colostrum TOS and OSI levels compared with mothers older than 30 years of age. IgA and IgM values of the colostrum of primiparous mothers were significantly higher than those of multiparous mothers, whereas no correlations existed with the age of the mother. Additionally, significantly higher colostrum IgA and IgM values were observed in female infants fed colostrum compared with male infants. Conclusion: In conclusion, sex-based hormonal changes in mothers during pregnancy may be associated with the different colostral immunoglobulin levels for male and female infants.

Analysis of cystic hygroma diagnosed in the prenatal period: 5-years' experience at a tertiary hospital in Southeastern Turkey.

PURPOSE: Our aim was to evaluate the association of cystic hygroma (CH) with fetal malformations and also to investigate the outcome of fetuses with CH diagnosed in the prenatal period. METHODS: We divided the CH patients into two main groups as isolated CH or CH associated with the congenital structural abnormality (CSA) by measuring the thickness of CH and showing other fetal abnormalities. Pregnancy outcomes were recorded as spontaneous abortion, elective termination, intrauterine death, live birth, postnatal death, and lost to follow-up. RESULTS: There were 74 cases of fetal CH including 19 in CSA-CH group and 55 in isolated-CH group diagnosed between 11 and 21 weeks' gestation. Karyotype analysis of these 28 patients revealed 18 (64.2%) normal karyotypes. Pregnancy outcomes included 54 elective terminations, five postnatal deaths, one spontaneous abortion, six live births, four intrauterine deaths, and four patients were lost to follow-up. CONCLUSION: In the presence of any CSA concurrent with CH, prognosis may be considered as poor and any additional help of fetal karyotyping is questionable. But fetal karyotyping may be advocated in counseling patients with isolated CH, in which a better prognosis and resolvement of CH may be expected in case of a normal karyotype.

No increase in free fetal DNA level in ectopic pregnancy: A preliminary study.

OBJECTIVE: The aim of this study was to diagnose ectopic pregnancy in the early period by measuring cell-free fetal DNA (cffDNA) levels in maternal blood using spectrophotometry. MATERIALS AND METHODS: Thirty patients with ectopic pregnancy and 30 patients with first trimester intrauterine pregnancy were enrolled in this prospective controlled study. cffDNA levels in maternal serum were measured using spectrophotometry. RESULTS: There were no differences between the two groups in terms of cffDNA absorbance levels. CONCLUSION: Spectrophotometry is not suitable for measuring cffDNA levels to diagnose ectopic pregnancies in the early period. Practical and cost-effective methods should be found or larger patient series should be investigated.