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Öğe Acil Peripartum Histerektomi Olgularının Değerlendirilmesi: Altı Yıllık Deneyim(2010) Özdemir, Suna; Balcı, Osman; Görkemli, Hüseyin; Gezginç, Kazım; Tazegül, Aybike; Yazıcı, FatmaAmaç: Bu çalışmada amacımız hastanemizde gerçekleştirilen acil peripartum histerektomilerin (APH) insidansını, endikasyonlarını, risk faktörlerini, maternal morbidite ve mortalite üzerine etkilerini araştırmak. Planlama: Retrospektif bir çalışma Ortam: Selçuk Üniversitesi, Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD, Konya Hastalar: Çalışmaya Ocak 2003 ile Nisan 2009 tarihleri arasında çeşitli obstetrik nedenlerle yapılan 37 acil peripartum histerektomi vakası dahil edildi. Girişim: Hasta bilgileri, hastane kayıtları ve diğer hastayla ilişkili bilgiler hasta dosyalarından elde edildi. Hastaların demografik özellikleri olarak yaş, parite, gravida, gebelik haftası, ve doğum şekilleri belirlendi. Operasyonla ilişkili bilgiler kaydedildi. Değerlendirme parametreleri: Peripartum histerektominin insidansı, endikasyonları ve risk faktörleri Bulgular: Bu sürede toplam 37 vaka kaydedildi ve APH insidansı % 0,223 olarak belirlendi. Olguların 22 (%59,5)‘sine total, 15 (% 40,5)‘ine subtotal histerektomi uygulandı. Histerektomi endikasyonları %43,2 atoni, %37,8 plasenta previa, acreata ve increata, %13,5 uterin rüptür olarak kaydedildi. Histerektomilerin 20 (%54) ‘si sezaryenlerde, 17 (%46) ‘si vajinal doğum sonrası uygulandı. 3 (%8,1) hastaya ooferektomi, 19 (% 51,3) hastaya bilateral hipogastrik arter ligasyonu yapıldı. DIC ve multi-organ yetmezliği nedeniyle 1 olmak üzere 3 (%8,1) hastada exitus gerçekleşti. Yorum: Uterin atoni postpartum hemoraji ve acil peripartum histerektomi için halen en sık endikasyonu oluşturmaktadır. APH, yüksek maternal morbidite ve mortalite ile seyreden, ancak zamanlaması doğru yapıldığında hayat kurtarıcı bir prosedürdür.Öğe Breus’ mole associated with hereditary thrombophilia in a teenage girl(2011) Özdemir, Suna; Balcı, Osman; Kantarcı, Ali Haydar; Koyuncu, Tuba; Sönmez, CavideBreus mole çoğunlukla ölü doğumların plasentasında rastlanan oldukça nadir bir durumdur. Genellikle dolaşım bozukluğu, kardiyak hastalığı, hipertansiyonu, diyabeti olan ve antikoagulan tedavi alan hastalarda gözlenir. Onyedi yaşında daha önce gebeliği olmayan hasta 2 aylık amenore sonrası oluşan intermittan vajinal kanama ve alt abdomen ağrısı şikayetiyle kliniğe başvurdu. Başvuru esnasında, genel durumu normal ve biyokimyasal bulguları normal sınırlar içindeydi. Yapılan ultrasonografide içerisinde hiper/hipoekojenik alanlar içeren oldukça büyük bir uterus saptandı. Serum ?-HCG 33096 U/ml olarak tespit edildi ve hastaya molar gebelik ön tanısıyla suction küretaj yapıldı. Bununla birlikte histoloji Breus’ mole olarak rapor edildi. Komplet veya parsiyel hidatiform mol bulgularına rastlanmadı. Materyalin genetik incelemesinde herhangi bir kromozomal bozukluk saptanmadı. Hastanın trombofili incelemesinde homozigot factor V leiden mutasyonu tespit edildi. Breus’ mole erken gebelik patolojilerinde göz önünde bulundurulmalı ve bu bozukluğun saptandığı hastalar herediter trombofili açısından taranmalıdır.Öğe The Clinical Value of Preoperative and Intraoperative Assessments in the Management of Endometrial Cancer(LIPPINCOTT WILLIAMS & WILKINS, 2010) Çelik, Çetin; Özdemir, Suna; Esen, Hasan; Balcı, Osman; Yılmaz, OsmanObjective: In this study, we aimed to investigate the diagnostic accuracy of preoperative assessment and frozen-section analysis (FSA) in endometrial cancer by comparing postoperative histopathology. Methods: A total of 72 consecutive patients with endometrial cancer were included in this study. Comprehensive surgical staging was performed in all patients. After abdominal hysterectomy, the uterus was investigated for FSA. For preoperative analysis, histological grade and histological subtypes were investigated. In FSA, all the specimens were reviewed for histological subtype, histological grade, depth of myometrial invasion, lymphovascular space invasion (LVI), and cervical involvement. These results were compared with final histopathology. Data were statistically analyzed. Results: The accuracy of preoperative examination was 95.8% (69/72) for histological type and 90% (65/72) for histological grade. In the frozen section, the accuracies of histological grade and subtype were found to be 92% and 98%, respectively. However, histological grade had 43% sensitivity in preoperative and intraoperative assessments. Myometrial invasion and LVI were correctly diagnosed in 93% and 94% of the cases, respectively. The risk assessment was correctly determined in 63 (87%) of 72 patients. Five patients were underclassified, and there was no lymph node invasion in these patients after final histopathology. Lymph node invasion was higher in patients with grade 3 classification, deep myometrial invasion, positive cervical involvement, and LVI. Conclusions: Frozen-section analysis is a feasible method for the management of the patients with endometrial cancer. However, preoperative and intraoperative assessment of histological grade has lower sensitivity in endometrial cancer.Öğe Çoğul gebeliğin eşlik ettiği ciddi bir ovaryan hiperstimülasyon sendromu olgusu(2009) Özdemir, Suna; Cihangir, Nalan; Çplakoğlu, Mehmet CengizAmaç: Kontrollü ovulasyon induksiyonu sonrasında çoğul gebeliği olan bir olguda gelişen ciddi ovaryan hiperstimülasyon sendromu (OHSS) ve sonuçlarını literatür bilgileriyle birlikte tartışmak. Olgu sunumu: Kontrollü ovulasyon induksiyonu sonrası oosit aspirasyonu ve embryo transferi gerçekleştirilen olguda yaklaşık 15 gün sonra, karında şişlik, nefes almada zorluk ve idrar çıkışında azalma şikayetleri başladı. Pelvik ultrasonografisinde her iki overin hiperstimule görünümde olması, batında yaygın serbest sıvı saptanması üzerine ciddi OHSS tanısıyla kliniğimize yatırıldı. Hastanın hemogram bulgusu, Hb: 14.9 gr/dl, Htc: % 44.2, WBC: 13,100 idi. Diğer biyokimyasal değerleri normal sınırlarda kaydedildi. ?-HCG titresinin yüksekliğine bağlı olarak gebelik pozitif olarak değerlendirildi. Olgumuz intravenöz kolloid replasman tedavisine yanıt vermedi. Toplam 10,000 cc parasentez ve 5000 cc torasentez yapıldı. Sıvı destek tedavisine rağmen genel durumunda bozulma devam etti. Bunun üzerine 8 hafta 1 gün ile uyumlu olan üçüz gebeliği sonlandırıldı. Gebeliğin sonlandırılmasını takiben genel durumu hızla düzelen ve bulguları normale dönen olgu sağlıklı olarak taburcu edildi. Sonuç: Rutin tedavilere yanıt vermeyen ve genel durum bozukluğu artarak devam eden OHSS olgularında gebeliğin sonlandırılması öncelikli olarak düşünülmelidir.Öğe A comparison of maternal and fetal outcomes of pregnancies complicated by moderate to severe thrombocytopenia caused by gestational thrombocytopenia preeclampsia / hellp syndrome and immune thrombocytopenic purpura(2008) Özdemir, Suna; Görkemli, Hüseyin; Acar, Ali; Çelik, Çetin; Kayıkçıoğlu, ErkanBu çalışmada gestasyonel trombositopeni (GT), preeklamp-si/HELLP sendromu ve immün trombositopenik purpuranm neden olduğu orta ve şiddetli trombositopenilerde obstetrik risk faktörlerini, komplikasyonlarını ve gebelik sonuçlarının karşılaştırılması amaçlandı. Çalışmaya trombosit sayısı 100.000/mm3'den düşük olan 135 kadın alındı. Tanılar Hematoloji laboratuvarı tarafından konuldu. Olguların ve yeni doğanların hastane seyirlerindeki klinik özellikleri kaydedildi. Şiddetli trombositopeni GT grubunda diğer iki gruba göre daha düşük gözlendi. Preeklampsi/HELLP sendromlularda oligo-hidramnios, intrauterin gelişme geriliği ve ablatio plasenta yüksek oranlarda saptandı. Bir ve 5. dakikada Apgar skor oranları (7), pH değerleri (7,2) ve mekonyumlu amniyotik sıvı oranları preeklampsi/HELLP sendromlularda daha yüksekti. Neonatal trombositopeni 5 yeni doğanda tespit edildi. Sonuç olarak preeklampsi/HELLP sendromunun eşlik ettiği trombositopenili olgular, obstetrik ve fetal sonuçlar açısından en olumsuz grup olarak saptandı.Öğe Comparison of multiple dose GnRH antagonist and minidose long agonist protocols in poor responders undergoing in vitro fertilization: a randomized controlled trial(SPRINGER HEIDELBERG, 2008) Tazegül, Aybike; Görkemli, Hüseyin; Özdemir, Suna; Aktan, Tahsin MuradObjective To investigate the efficacy of gonadotropin releasing hormone antagonist (GnRH) in poor responders undergoing in vitro fertilization. Study design Ninety-six patients with poor ovarian response in previous treatment cycles were prospectively randomized into two groups. Forty-four patients were stimulated with GnRH antagonist multidose protocol and 45 patients received a standard long agonist protocol. Ovarian response was evaluated by transvaginal ultrasound and hormonal parameters. Cycle characteristics and treatment outcomes were statistically compared between groups. Results There was significantly reduced duration of stimulation and consumption of gonadotrophins in the antagonist group when compared to the agonist group. The estradiol concentrations on the day of human chorionic gonadotropin (hCG) injection, the number of oocytes retrieved, and the number of embryos transferred were similar for both groups. In the antagonist group, eight (18.1%) ongoing pregnancies were achieved and in the agonist group, ten (22.2%) clinical pregnancies were achieved but the difference was not statistically significant. Conclusions The present study was not powered to detect clinically relevant differences between two protocols in outcomes such as pregnancy rate, with confidence.Öğe The Effect of Antenatal Steroids on Fetal Lung Maturation between the 34th and 36th Week of Pregnancy(KARGER, 2010) Balcı, Osman; Özdemir, Suna; Mahmoud, Alaa S.; Acar, Ali; Çolakoğlu, Mehmet C.Aim: To evaluate the effect of antenatal treatment with a single dose of betamethasone between the 34th and the 36th week of pregnancy on the maturation of fetal lung. Methods: To study 100 pregnant women in their 34th-36th week of pregnancy who were diagnosed as susceptible to have preterm delivery. Fifty patients did not receive betamethasone (group 1). The other 50 patients were administered 12 mg betamethasone in a single dose (group 2). Patients who delivered at least 24 h after the administration of betamethasone were included in this study. After delivery, the Apgar score and the development of respiratory distress syndrome (RDS) in the neonates were compared. Results: Group 2 babies had better Apgar scores when compared to group 1, and the difference was statistically significant. Sixteen (32%) neonates of group 1 and 7 (14%) neonates of group 2 required resuscitation, and the difference was statistically significant (p = 0.032; OR = 0.34, 95% CI 0.12-0.93). RDS was detected in 8 newborns of group 1 and 2 of group 2. The difference was statistically significant (p = 0.046; OR = 0.21, 95% CI 0.04-1.08). Conclusion: The administration of a single dose of betamethasone to pregnant women in their 34th-36th week of pregnancy who are likely to have preterm delivery reduces RDS development. There is a need for larger studies to confirm these results.Öğe Evaluation of Endometrial Thickness with Transvaginal Ultrasonography and Histopathology in Premenopausal Women with Abnormal Vaginal Bleeding(Springer Heidelberg, 2010) Özdemir, Suna; Çelik, Çetin; Gezginç, Kazım; Kıreşi, Demet; Esen, HasanObjective This study was undertaken to investigate cut-off value of the endometrial thickness by transvaginal ultrasonography (TvUSG), and to detect the accuracy of preoperative Pipelle biopsy in premenopausal women with abnormal vaginal bleeding. Study design This study was included 144 premenopausal women with abnormal bleeding. Their endometrial thickness was measured by TvUSG and then Pipelle endometrial biopsy was performed. Preoperative histopathologic findings of 57 women who were operated were compared with final histolopathologic examination. Results Of the 144 women, 113 (78.4%) had normal and 31 (21.6%) had an abnormal endometrium. The abnormal endometrium was composed of 11.8% hyperplasia (simple + atypical complex), 4.2% endometrial polyp, and 5.5% adenocarcinoma. An optimal sensitivity and specificity (83.6 and 56.4%, respectively) and negative predictive value with 95.6% for detection of abnormal endometrium were obtained with an endometrial thickness of 8 mm. The accuracy rate of preoperative Pipelle biopsy was 94.7% in a total of 57 women. Conclusion An endometrial thickness >8 mm is more likely than that of 8 mm or less to be indicated with endometrial biopsy in premenopausal uterine bleeding. Pipelle endometrial biopsy is an accurate diagnostic procedure for the detection of high-grade endometrial lesions in premenopausal women.Öğe Factor 5 Leiden Gene Mutation in Endometrium Cancer(2010) Karataylı, Rengin; Özdemir, Suna; Çelik, Çetin; Balcı, Osman; Nergis, Süleyman; Acar, HasanOBJECTIVE: In this study, our aim was to investigate the frequency of mutations on factor 5 Leiden gene (G1691A, A4070G, A5279G loci) in endometrial cancer patients. STUDY DESING: 216 patients who admitted to Selcuk University Meram Faculty of Medicine Obstetrics and Gynecology Department with similar complaints (such as postmenopausal bleeding and dysfunctional uterine bleeding) were included in the study. Patients were divided into 2 groups. In the 1st group, there were 105 endometrioid type endometrial adenocarcinoma patients and in the second group, there were 111 patients whose endometrial pathology reported as benign. Two groups are compared according to frequency of mutations on factor 5 Leiden gene (especially G1691A, A4070G, A5279G loci). RESULTS: There were not any statistically significant differences between groups according to frequency of mutations on factor 5 Leiden gene (p0.743). CONCLUSION: There is no correlation between mutations of factor 5 Leiden gene with endometrial cancerÖğe Induction of Labor with Vaginal Misoprostol Plus Oxytocin Versus Oxytocin Alone(Wiley, 2010) Balcı, Osman; Mahmoud, Alaa S.; Özdemir, Suna; Acar, AliObjective: To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score. Methods: This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-mu g dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed. Results: The mean time from induction to delivery was 9.36 +/- 1.97 hours in the misoprostol plus oxytocin group and 11.08 +/- 3.23 in the oxytocin alone group (P=0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia. Conclusion: A 50-mu g intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.Öğe Induction of Labor With Vaginal Misoprostol Plus Oxytocin Versus Oxytocin Alone(2010) Balcı, Osman; Özdemir, Suna; Mahmoud, Alaa S.; Acar, AliObjective: To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score. Methods: This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed. Results: The mean time from induction to delivery was 9.36± 1.97 hours in the misoprostol plus oxytocin group and 11.08± 3.23 in the oxytocin alone group (P= 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia. Conclusion: A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.Öğe Influence of cumulus cell coculture and cumulus-aided embryo transfer on embryonic development and pregnancy rates(AVES, 2010) Cihangir, Nalan; Görkemli, Hüseyin; Özdemir, Suna; Aktan, Murad; Duman, SelçukObjective: In this study, we aimed to evaluate the influence of autologous cumulus oocyte complex (COC) coculture on embryonic development and quality, and investigate the implantation and pregnancy rates after cumulus-aided embryo transfer in the ICSI-ET cycles. Material and Methods: Ninety five consecutive infertile women undergoing their first cycle of IVF teratment were included in the study. The cases were divided into two groups. Group 1 consisted of 48 women undergoing ICSI, along with autologous cumulus embryo coculture and cumulus-aided emryo transfer. Group 2 comprised 47 consecutive patients who consented to undergo ICSI and in whom autologous cumulus embryo coculture and cumulus-aided embryo transfer were not performed. Implantation and pregnancy rates were compared between the two groups. Results: The demographic data and controlled ovarian hyperstimulation parameters were similar in the two groups. The fertilization and cleavage rates were found to be higher in group 1 when compared with group 2 (p=0.03 and 0.001, respectively). There were no statistical significant differences for the implantation and clinical pregnancy rates between the two groups. Conclusion: Usage of autologous COCs as coculture may improve fertilization and cleavage rates. However, cumulus-aided embryo transfer does not produce an increase in implantation and pregnancy rates.Öğe Recurrent Periclitoreal Abscess Due To Birth Injury: A Case Report(2009) Gezginç, Kazım; Mahmoud, Alaa; Özdemir, SunaPeriklitoral abse vulvar ağrının oldukça az rastlanan bir sebebidir ve vajinal doğuma bağlı oluşan perineal yaralanmalar sonucu oluşması sık karşılaşılan bir durum değildir. Bizim olgumuzda 39 yaşında bayan hasta klitoral bölgede olan şiddetli ağrı ve hassasiyet şikayetleriyle başvurdu. Hasta 2 yıl önce periklitoral bölgeye travmanın olduğu son vajinal doğum sonrası benzer şikayetlerin oluştuğunu ve bunun için çok defa antibiyotik tedavileri aldığını ifade etti. Tedavide abse bölgesi geniş bir şekilde drene edildi ve alan cerrahi olarak onarıldı. Tam iyileşme zamanında ve komplikasyonsuz olarak gerçekleşti. Klitoryus korunarak yapılan cerrahi tedavi tekrarlayan klitoral abselerde küratif bir tedavi olarak görünmektedir.Öğe Specific Dermatologic Features of the Polycystic Ovary Syndrome and Its Association with Biochemical Markers of the Metabolic Syndrome and Hyperandrogenism(WILEY-BLACKWELL, 2010) Özdemir, Suna; Özdemir, Mustafa; Görkemli, Hüseyin; Kıyıcı, Aysel; Bodur, SaitObjective. To investigate biochemical and metabolic abnormalities in relation with cutaneous features of polycystic ovary syndrome (PCOS). Design. Prospective descriptive analysis. Setting. University-based tertiary care. Sample. One-hundred and fifteen untreated consecutive women diagnosed as having PCOS. Methods. Each woman underwent an evaluation of body habitus, acne, hirsutism, seborrhea, androgenic alopecia and acanthosis nigricans. Associations between cutaneous features and hormonal and metabolic parameters were analyzed by means of multivariate logistic regression models. Main outcome measures. Prevalence of cutaneous features in PCOS and associations among the features and biochemical and metabolic parameters. Results. The prevalence of acne, hirsutism, seborrhea, androgenetic alopecia and acanthosis nigricans was 53%, 73.9%, 34.8%, 34.8% and 5.2%, respectively. Acne was not associated with the hormonal, metabolic and anthropometric variables. Hirsutism had positive associations with total testosterone, fasting glucose and total cholesterol, and a negative association with age. Seborrhea was found to be related with free testosterone, fasting glucose and insulin. A negative association was determined among androgenic alopecia and free testosterone, low-density lipoprotein and insulin. Conclusions. Acne and androgenic alopecia are not good markers for the hyperandrogenism in PCOS. Hirsutism appears to be strongly related with hyperandrogenism and metabolic abnormalities in PCOS women.Öğe Tekrarlayan Gebelik Kaybı Olan Hastalarda Trombofili Mutasyon Sıklığının Değerlendirilmesi(2010) Özdemir, Suna; Balcı, Osman; Göktepe, Halime; Görkemli, Hüseyin; Taşçı, Elmas; Acar, HasanAmaç: Çalışmada daha önce en az üç tane gebelik kaybı olan hastalarda bazı trombofilik faktörlerin sıklığının sağlıklı kontrol grubu ile karşılaştırılarak değerlendirilmesi amaçlandı. Yöntem: Çalışmaya 2005-2009 yılları arasında kliniğimize başvuran toplam 301 hasta alındı. Bu hastalar iki gruba ayrıldı. Grup 1 daha önce üç veya daha fazla 20 haftanın altında gebelik kaybı olan 251 hastadan oluştu. Grup 2 aha önce en az 1 tane sorunsuz gebeliği olan ve hiç düşük yapmamış 50 kadın hastayı kapsadı. Tüm kadınlar Faktör V Leiden (FVL), protrombin (G20210A) ve metilentetrahidrofolat redüktaz (MTHFR) C677T varlığı açısından PCR-RFLP yöntemi ile test edildi. Veriler istatiksel açıdan ki-kare testi, student-t ve Mann-Whitney testleri kullanılarak analiz edildi. Bulgular: Her iki grubun yaş ortalaması benzer olarak saptandı. Her üç trombofilik faktör heterozigot ve homozigot olarak incelendi. Değerlendirme sonucunda her üç mutasyon FVL, protrombin, MTHFR bölgesi için de çalışma ve kontrol arasında anlamlı olarak fark tespit edilemedi (p0.05). Çalışma grubunda 134 (% 53.3) hastada, kontrol grubunda ise 23 (% 46) hastada en az bir trombofilik faktör saptandı. Protrombin homozigot mutasyon her iki grubta da bulunamadı. FVL homozigot mutasyon kontrol grubundaki hiçbir hastada tespit edilmedi. Sonuç: Çalışmadan elde edilen veriler FVL, protrombin ve MTHFR mutasyonları ile tekrarlayan gebelik kayıpları arasında anlamlı bir ilişki olmadığını desteklemektedir.
