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Canan S, İnan MA, Erdem A, Demirdağ E, Gündüz Mİ, Erdem Ö, Erdem M. Evaluation of endometrial receptivity in recurrent pregnancy loss and recurrent implantation failure. Turk J Obstet Gynecol 2024; 21:22-27. [PMID: 38440964 PMCID: PMC10920968 DOI: 10.4274/tjod.galenos.2024.42959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Objective The cause of implantation defects in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) has not been clearly established. We aimed to evaluate the immunohistochemical changes in HOXA-11, β1 integrin, focal adhesion kinase (FAK), cluster of differentiation 44 (CD44), and extracellular matrix protein 1 (ECM1) molecules during the receptive endometrial period in patients with RIF and RPL. Materials and Methods This study was retrospectively conducted at a university hospital. After the exclusion of cases with pathology that may cause a change in the level of receptors in the endometrium, biopsies performed during the receptive period were selected, and the patients were categorized into RPL (n=15), RIF (n=16), control (n=16) groups. All preparations were immunohistochemically stained for HOXA-11, β1 integrin, FAK, CD44, and ECM1. Results HOXA-11 and β1 Integrin expression changes were similar between the RIF and control groups. However, FAK expression was significantly increased in the RIF group (p<0.01). Additionally, ECM1 and CD44 expressions were significantly decreased in the RIF group compared with the control group (p<0.01). There was no significant difference in the endometrial staining of HOXA-11, FAK, and ECM1 in patients with a history of RPL. However, β1 Integrin and CD44 levels were significantly decreased in the RPL group compared with the control group (p<0.05). Conclusion Implantation is a complex process, and altered adhesion mechanisms involved in endometrial receptivity may be related to defective implantation in patients with RIF and RPL. Among the adhesion molecules, the expression of CD44, β1 integrin, FAK, and ECM1 molecules varies in inappropriate implantation compared with the normal population.
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Affiliation(s)
- Sultan Canan
- Sakarya Training and Research Hospital, Clinic of Obstetrics and Gynecology, Sakarya, Turkey
| | - Mehmet Arda İnan
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Ahmet Erdem
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erhan Demirdağ
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Özlem Erdem
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Mehmet Erdem
- Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey
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Cevher Akdulum MF, Arık Sİ, Demirdağ E, Erdem M, Erdem A. In Vitro Fertilization Outcomes With a Dual Trigger in Normoresponders in Antagonist Cycles. Cureus 2023; 15:e45623. [PMID: 37868584 PMCID: PMC10588958 DOI: 10.7759/cureus.45623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To evaluate whether the dual trigger of ovulation with a gonadotropin-releasing hormone (GnRH) agonist and the standard dose of recombinant human chorionic gonadotropin (hCG) (dual trigger) is better than hCG alone in in vitro fertilization (IVF) cycles of patients who responded well to ovarian stimulation. Methods Between January 2013 and December 2021, 5593 antagonist cycles of patients were reviewed. This study included women who had an antral follicle count of 5 or more and exhibited a normoresponse to ovarian stimulation using the GnRH antagonist protocol, as determined by the follicular output rate (FORT). The primary outcome indicators consisted of the quantities of retrieved oocytes and mature oocytes. The secondary outcome markers included live birth rates, clinical pregnancy rates, and continued pregnancy rates. Results A total of 1244 normoresponder women who met the inclusion criteria were identified from the scanned files and subsequently enrolled in the GnRH antagonist protocol. A total of 383 cycles were observed in the group that was given the standard hCG trigger while 861 cycles were observed in the group that was given the dual trigger. The number of mature oocytes and top-quality embryos was significantly higher in the dual trigger group. The maturation rate in the hCG group was 74.8% while it was 76.9% in the dual trigger group (p=0.018). The dual trigger group exhibited an ongoing pregnancy rate of 37.6%, whereas the hCG group had a rate of 30.1% (p = 0.02). The dual trigger group exhibited a slightly higher live birth rate (34.3% vs 29.2%, p = 0.11), although this difference did not reach statistical significance. Conclusion Dual trigger of ovulation was superior to hCG alone in terms of the number of mature oocytes yielded, top quality of embryos, maturation rates, and ongoing pregnancy in IVF cycles of normoresponders having ovarian stimulation on the GnRH antagonist protocol.
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Affiliation(s)
| | | | - Erhan Demirdağ
- Obstetrics and Gynecology, Gazi University, School of Medicine, Ankara, TUR
| | - Mehmet Erdem
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
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Cevher Akdulum MF, Demirdağ E, Arık Sİ, Safarova S, Erdem M, Bozkurt N, Erdem A. Is the First-Trimester Systemic Immune-Inflammation Index Associated With Preeclampsia? Cureus 2023; 15:e44063. [PMID: 37746374 PMCID: PMC10517744 DOI: 10.7759/cureus.44063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVE Preeclampsia (PE) is a serious and common pregnancy issue. There is a systemic inflammation in PE and it is accompanied by increased oxidative stress, but the clear etiology has not been revealed. We aimed to predict PE with the systemic immune-inflammation index (SII) value calculated in the first trimester. MATERIAL AND METHODS This is a retrospective study. One hundred fifty-seven pregnant women were included in the study. Twenty-seven pregnant women were excluded from the study. Age, gravida, parity, and hemogram values were recorded in the patients' first visit file records. The time and mode of delivery, birth weight, and APGAR scores were obtained from the file records of the patients. SII was created using the formula (neutrophil x platelet/lymphocyte). Result: The study group included 30 pregnant women who had been diagnosed with PE. The control group consisted of the remaining 100 pregnant women. There was a statistically significant difference between PE and control groups in terms of SII (p=0.03). The SII level cut-off value for predicting PE was determined to be 836.83. This value's area was found to be 0.635 (0.519-0.752). Furthermore, the selectivity is 0.60 and the sensitivity is 0.40 for these values. Conclusion: SII was found to be significantly higher in people with PE in the study. We showed that the SII value measured in the first trimester can be used to predict PE. It might make sense to combine this marker with the patient's history and other risk factors due to its low selectivity and sensitivity.
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Affiliation(s)
| | | | | | | | - Mehmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
| | - Nuray Bozkurt
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynecology, Gazi University, Ankara, TUR
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Kutlucan H, Işık G, Cevher Akdulum MF, Demirdağ E, Erdem Ö, Bozkurt N. Comparison of Two-Dimensional Transvaginal Ultrasound, Three-Dimensional Transvaginal Ultrasound and Hysteroscopy to Diagnose in Patients With Abnormal Uterine Bleeding: A Retrospective Observational Study. Journal of Diagnostic Medical Sonography 2022. [DOI: 10.1177/87564793221140832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: The principal objective was to compare the diagnostic accuracy of two-dimensional transvaginal ultrasonography (2D TVUS), three-dimensional transvaginal ultrasonography (3D TVUS), and hysteroscopy with histopathology in patients with abnormal uterine bleeding. Materials and Methods: Fifty patients were included and underwent the three imaging methods. The negative predictive value, positive predictive value, sensitivity, and specificity of the methods were calculated. Determination of endometrial pathology and endometrial polyps by measuring the endometrial thickness, volume, and uterine area was examined. Results: The complaint of menorrhagia was reported by 72.0% of participants. Histopathologically, 70.0% of the patients had endometrial polyps and leiomyoma being monitored. An endometrial polyp was detected in 58.0% of the patients by 2D TVUS, 80.0% by 3D TVUS, and 68.0% by hysteroscopy. While 2D TVUS demonstrated 65.71% accuracy in the detection of an endometrial polyp, 3D TVUS had an 80.0% accuracy, and hysteroscopy had a 77.77% accuracy. An endometrial polyp was detected when the uterine area was ≥237 mm2. If the endometrial thickness was over 10.5 mm, it was found to be related to an endometrial polyp. According to the volume measurements by 3D TVUS, the detection of an endometrial polyp was made with 96.4% sensitivity, provided that the pathology volume was ≥0.082 cm3. Conclusion: In this cohort of patients, 3D TVUS achieved a high sensitivity to detect abnormalities and could be considered as an initial diagnostic modality, prior to the surgery, and may rival invasive procedures, such as hysteroscopy.
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Affiliation(s)
- Hazal Kutlucan
- Department of Gynecology and Obstetrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gizem Işık
- Department of Gynecology and Obstetrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Erhan Demirdağ
- Department of Gynecology and Obstetrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özlem Erdem
- Department of Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nuray Bozkurt
- Department of Gynecology and Obstetrics, Gazi University Faculty of Medicine, Ankara, Turkey
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Turan G, Aslan Çetin B, Turgut E, Aydın Z, Demirdağ E, Taghiyeva T. Comparison of maternal and neonatal outcomes in twin pregnancies according to delivery types: vaginal delivery or Cesarean delivery? Perinat J 2022. [DOI: 10.2399/prn.22.0302005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Our aim was to compare the maternal and neonatal outcomes of twin pregnancies, which result in vaginal delivery (VD) and Cesarean section (CS), and the factors affecting the decision of CS. Methods: Twin pregnancies between 30 and 39 weeks who gave birth in a tertiary center were included in the present study. The demographic data and maternal and neonatal outcomes of the patient groups who gave birth <32 weeks, 32–37 weeks, and >37 weeks were recorded and compared according to the type of birth. Results: A total of 1209 patients were included in the study. The 1- and 5-minute Apgar scores of the 1st and 2nd fetuses in twin pregnancies <32 weeks of gestation were higher in the CS group at a statistically significant level (p=0.007, p=0.010, p=0.001, and p=0.003, respectively). The 1- and 5-minute Apgar scores of the 2nd fetuses of the pregnant women >37 weeks of age were higher in the VD group at a statistically significant level (p=0.039 and p=0.032, respectively). The newborn intensive care unit (NICU) admission rates of 1st fetus and 2nd fetus in the groups of <32 weeks, 32–37 weeks, and >37 weeks were higher in those born by CS at a statistically significant level when compared to those born by VD (1st fetus p<0.001, p<0.001, p=0.016, respectively; 2nd fetus p<0.001, p<0.001, p=0.012, respectively). Conclusion: It must be kept in mind that twin pregnancies have high risks. However, vaginal delivery can be considered as a safe and reasonable option in appropriately selected cases and in the presence of experienced obstetricians by being careful about maternal and neonatal complications which might occur.
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Demirdağ E, Güler İ, Cevher Akdulum MF, Şahin E, Tufan AD, Erdem A, Erdem M. Comparison of natural and artificial cycles in frozenthawed embryo transfer: A retrospective analysis of 1696 cycles. Turk J Obstet Gynecol 2022; 19:28-34. [PMID: 35343217 PMCID: PMC8966319 DOI: 10.4274/tjod.galenos.2021.17981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kutlucan H, Karabacak RO, De Buyser S, Erdem A, Bozkurt N, Demirdağ E, Wildemeersch D. Assessment of a Novel Fixation Method of a Frameless Intrauterine Contraceptive Device Inserted during Cesarean Delivery as a Means of Preventing Displacements and Expulsions: A Prospective Observational Study. Life (Basel) 2022; 12:life12010083. [PMID: 35054475 PMCID: PMC8779012 DOI: 10.3390/life12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
Abstract
The primary objective of this study was to assess the novel fixation method of a frameless copper-releasing intrauterine device inserted following placental delivery during cesarean section and analyze its impact in reducing device displacement and expulsion during and after uterine involution. We hypothesized that the dual-anchoring technique could reduce the risk of intrauterine device displacement and expulsion during and after the uterine involution. The study was conducted at the Gazi University Medicine Faculty Hospital in Ankara, Turkey. Twenty-one pregnant women were enrolled. Insertion was performed following placental removal. To confirm the proper placement and good retention of the device, the distance between the fundal serosa (S) and device anchor knot (A) was measured (S–A) during follow-ups, by ultrasound. There were significant differences in the S–A, as observed by ultrasound at discharge and at 6 weeks post-delivery, which is consistent with the tissue contractions associated with uterine involution. Notwithstanding the uterine involution, no device displacements or expulsions occurred, which indicated a good retention of the frameless device. This innovative retention method of the frameless intrauterine device ensures a well-tolerated, long-term contraception, allowing for immediate contraception and proper pregnancy spacing for cesarean scar healing, and overcomes the issue of expulsion encountered with conventional intrauterine systems.
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Affiliation(s)
- Hazal Kutlucan
- Department of Gynecology and Obstetrics, School of Medicine, Gazi University, Ankara 06500, Turkey; (R.O.K.); (A.E.); (N.B.); (E.D.)
- Correspondence:
| | - Recep Onur Karabacak
- Department of Gynecology and Obstetrics, School of Medicine, Gazi University, Ankara 06500, Turkey; (R.O.K.); (A.E.); (N.B.); (E.D.)
| | - Stefanie De Buyser
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Ahmet Erdem
- Department of Gynecology and Obstetrics, School of Medicine, Gazi University, Ankara 06500, Turkey; (R.O.K.); (A.E.); (N.B.); (E.D.)
| | - Nuray Bozkurt
- Department of Gynecology and Obstetrics, School of Medicine, Gazi University, Ankara 06500, Turkey; (R.O.K.); (A.E.); (N.B.); (E.D.)
| | - Erhan Demirdağ
- Department of Gynecology and Obstetrics, School of Medicine, Gazi University, Ankara 06500, Turkey; (R.O.K.); (A.E.); (N.B.); (E.D.)
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Selvi İ, Erdem M, Demirdağ E, Cevher F, Karakaya C, Erdem A. Comparison of frozen-thawed embryo transfer protocols in patients with previous cycle cancellation due to uterine peristalsis: a pilot study. Turk J Med Sci 2021; 51:1365-1372. [PMID: 33535734 PMCID: PMC8283447 DOI: 10.3906/sag-2012-149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background/aim To investigate the optimal protocol for frozen-thawed embryo transfer (FET) cycles in patients who previously had a cycle cancellation due to uterine peristalsis (UP). Materials and methods Thirty-four patients with previous embryo transfer (ET) cancellation due to UP during artificial cycle (AC) were included retrospectively. In the proceeding cycle, endometrium was prepared with AC (n: 23) in AC-FET group or with stimulated cycle that contains letrozole (L) (n: 11) in L-FET group. Intravenous bolus dose of 6.75 mg atosiban (Tractocile; Ferring Pharmaceuticals, Switzerland) injection was performed to all patients of AC-FET group due to UP ≥ 4/min on the planned ET day of proceeding cycle. Atosiban was not used in L-FET group. Primary outcome was live birth rate (LBR) per ET. Secondary outcomes were clinical pregnancy rate (CPR) per ET, implantation rate (IR), cycle cancellation rate. Results The baseline characteristics such as age, body mass index, antral follicle count, duration of infertility, and the number of prior in vitro fertilization attempts of each group were similar. The IR, CPR per ET, LBR per ET, CPR per cycle and LBR per cycle were significantly higher; cycle cancellation rates were significantly lower in L-FET group as compared to the AC-FET group. Conclusion Endometrial preparation with letrozole significantly improves CPR and LBR in FET cycles of patients with previous cycle cancellations due to UP.
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Affiliation(s)
- İlknur Selvi
- Department of Obstetrics & Gynecology, Koru Hospital, Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics & Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Erhan Demirdağ
- Department of Obstetrics & Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Funda Cevher
- Department of Obstetrics & Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Cengiz Karakaya
- Department of Medical Biochemistry and IVF Unit, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ahmet Erdem
- Department of Obstetrics & Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Demirdağ E, Akdulum MFC, Guler I, Oguz Y, Erdem A, Erdem M. IVF Outcomes of Microdose Flare-up, GnRH Antagonist, and Long Protocols in Patients having a Poor Ovarian Response in the First Treatment Cycle. J Coll Physicians Surg Pak 2021; 31:523-527. [PMID: 34027862 DOI: 10.29271/jcpsp.2021.05.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the IVF outcome of patients assumed to be poor responders before their first cycle treated by microdose flare-up or GnRH antagonist protocols with patients who had a poor ovarian response after their first cycle stimulated with long GnRH protocol. STUDY DESIGN Observational cohort study. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynecology, IVF Unit of Gazi University Faculty of Medicine, from September 2014 to February 2019. METHODOLOGY Patients treated with the first cycle of IVF and diagnosed as poor responders after ovarian stimulation were evaluated according to the treatment protocol, including microdose flare-up (Group 1: 136 patients), GnRH antagonist (Group 2: 105 patients), and long GnRH agonist (Group 3: 77 patients). RESULTS Basal FSH level was significantly lower in group 3 compared to other groups (p<0.05). The number of oocytes retrieved, the number of metaphase II oocytes were similar between groups, although the mean AFC was significantly higher in group 3 than in group1 and 2 (p<0.05). Clinical pregnancy rates per patient were higher in group 3 (20.8%) than in group 1 (12.5%) and group 2 (13.3%), but the difference was not statistically significant (p=0.230). The live birth rate per patient was statistically higher in group 3 (19.5%) as compared to other groups (8.8%, 9.5%, respectively; p<0.05). CONCLUSION Long protocol may be an option in poor responders undergoing IVF. Ovarian reserve markers are essential factors with stimulation protocol for the success of IVF in poor responder patients. Key Words: Infertility, Ovulation ınduction, Ovarian reserve, Fertilisation in-vitro, Oocyte retrieval, Pregnancy outcome, Reproductive techniques, Assisted.
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Affiliation(s)
- Erhan Demirdağ
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Gazeteci Yazar Muammer Yaşar Bostancı Sokak, 06560 Yenimahalle/Ankara, Turkey
| | - M Funda Cevher Akdulum
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Gazeteci Yazar Muammer Yaşar Bostancı Sokak, 06560 Yenimahalle/Ankara, Turkey
| | - Ismail Guler
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Gazeteci Yazar Muammer Yaşar Bostancı Sokak, 06560 Yenimahalle/Ankara, Turkey
| | - Yuksel Oguz
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Turkey
| | - Ahmet Erdem
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Gazeteci Yazar Muammer Yaşar Bostancı Sokak, 06560 Yenimahalle/Ankara, Turkey
| | - Mehmet Erdem
- Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Gazeteci Yazar Muammer Yaşar Bostancı Sokak, 06560 Yenimahalle/Ankara, Turkey
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Dağdeviren EG, Dur R, Fadıloğlu E, Demirdağ E, Öztürk Ç, Altay M. Molar pregnancy in cesarean section scar: A case report. Turk J Obstet Gynecol 2017; 14:249-251. [PMID: 29379669 PMCID: PMC5780570 DOI: 10.4274/tjod.26878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/05/2017] [Indexed: 12/13/2022] Open
Abstract
Cesarean scar ectopic pregnancies and molar pregnancies are two very rare obstetric pathologies. In both cases, serious morbidities are involved that require careful management. The coexistence of the two clinical conditions is far less common and there are a limited number of cases in the literature. In this case report, a 34-year-old patient with previous cesarean section was diagnosed as having a molar pregnancy in a cesarean scar through ultrasonography. The patient was asymptomatic at that time. Ultrasonography revealed a protruding mass at the cesarean section and her human chorionic gonadotropin level was measured as 59.705 mIU/mL. Due to the risk of severe bleeding, cesarean section scar excision and revision were performed via laparotomy after counselling the patient. Removal of all trophoblastic tissue was observed as a result of the frozen pathology and the operation was terminated. After the definite pathology result came as a complete molar pregnancy, the patient was followed up according to molar pregnancy follow-up protocols and cured completely. Despite the alternative treatment options (methotrexate application, curettage, uterine artery embolization) in such patients, the decision for surgery was made after counselling the patient. In this very rare clinical condition, patients should be closely monitored and the appropriate treatment option should be applied as soon as possible, taking into consideration the bleeding risks of both pathologies.
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Affiliation(s)
- Elif Gülşah Dağdeviren
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Erdem Fadıloğlu
- Kilis State Hospital, Clinic of Women’s Health, Kilis, Turkey
| | - Erhan Demirdağ
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağatayhan Öztürk
- University of Health Sciences, Etlik Zübeyde Hanım Women’s Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Metin Altay
- TOBB University of Economics and Technology Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Women’s Health, Ankara, Turkey
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Fadıloğlu E, Dur R, Demirdağ E, Öztürk Ç, Fadıloğlu Ş, Kaplan M, Tapısız ÖL. Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy. Turk J Obstet Gynecol 2017; 14:187-190. [PMID: 29085710 PMCID: PMC5651895 DOI: 10.4274/tjod.57984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Erdem Fadıloğlu
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Erhan Demirdağ
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağatayhan Öztürk
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Şeyma Fadıloğlu
- Ankara Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Metin Kaplan
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ömer Lütfi Tapısız
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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Mutlu MF, Erdem M, Erdem A, Mutlu I, Guler I, Demirdağ E. The impact of premature progesterone rise on the outcome of intrauterine insemination cycles with controlled ovarian hyperstimulation in unexplained infertility. Eur J Obstet Gynecol Reprod Biol 2016; 203:44-8. [DOI: 10.1016/j.ejogrb.2016.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/23/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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Özdemirci Ş, Demirdağ E, Kasapoğlu T, Karahanoğlu E, Başer E, Yalvaç S, Tapisiz ÖL. Obstetric outcome of second trimester antenatal bleeding. J Matern Fetal Neonatal Med 2015; 29:3395-9. [PMID: 26692339 DOI: 10.3109/14767058.2015.1130815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks. METHODS This retrospective case-control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes. RESULTS Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9 ± 2.8 versus 38.9 ± 1.4 and 3071 ± 710 versus 3349 ± 446 for groups p < 0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5-26.1]; OR: 12.0, 95% CI: [3.5-40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p = 0.031; 1.9% versus 0%, p = 0.025). CONCLUSION Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.
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Affiliation(s)
- Şafak Özdemirci
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
| | - Erhan Demirdağ
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Taner Kasapoğlu
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and.,c Department of Epidemiology , Institute of Health Sciences, Hacettepe University , Ankara , Turkey
| | - Ertuğrul Karahanoğlu
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Emre Başer
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
| | - Serdar Yalvaç
- b Department of Obstetrics and Gynecology , Perinatology & High-Risk Pregnancy Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey , and
| | - Ömer Lütfi Tapisiz
- a Department of Obstetrics and Gynecology , Obstetrics Clinic, Etlik Zubeyde Hanım Women's Health Education and Research Hospital , Ankara , Turkey
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Guler I, Erdem M, Erdem A, Demirdağ E, Tunc L, Bozkurt N, Mutlu MF, Oktem M. Impact of testicular histopathology as a predictor of sperm retrieval and pregnancy outcome in patients with nonobstructive azoospermia: correlation with clinical and hormonal factors. Andrologia 2015; 48:765-73. [DOI: 10.1111/and.12510] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- I. Guler
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - M. Erdem
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - A. Erdem
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - E. Demirdağ
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - L. Tunc
- Department of Urology; Gazi University School of Medicine; Ankara Turkey
| | - N. Bozkurt
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - M. F. Mutlu
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
| | - M. Oktem
- Department of Obstetrics & Gynecology; Gazi University School of Medicine; Ankara Turkey
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