OBJECTIVE: To determine the effect of lemon-flavored lollipop on nausea and vomiting of pregnancy.
STUDY DESIGN: This prospective case-control study included 67 first trimester pregnant women. The
12-hour Pregnancy-Unique Quantification of Emesis and Nausea score was calculated at the time of
presentation to the hospital. The study group (32 cases) was given lemon-flavored lollipops while the
control group (35 cases) did not receive lollipops. The Pregnancy-Unique Quantification of Emesis and
Nausea scores of the patients were recalculated on the morning of the post-treatment day.
RESULTS: The Pregnancy-Unique Quantification of Emesis and Nausea scores of the study group were
higher (p=0.013) than in the control group on the day of admission. Pregnancy-Unique Quantification of
Emesis and Nausea scores were similar between the groups on the day after hospital admission
(p > 0.005). The Pregnancy-Unique Quantification of Emesis and Nausea difference values obtained by
extracting the Pregnancy-Unique Quantification of Emesis and Nausea score on the day after hospital
admission from the presentation Pregnancy-Unique Quantification of Emesis and Nausea score were
higher in the study group (p=0.0046). Lemon-flavored lollipops were found to decrease nausea and
vomiting of pregnancy.
CONCLUSION: Lemon-flavored lollipops can be given especially to pregnant women who are concerned
about the possible teratogenic effects of drug use in pregnancy. Lemon-flavored lollipops are
cheap and easily accessible and therefore promising as a non-pharmacological complementary treatment
for nausea and vomiting of pregnancy.
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OBJECTIVE: Primary end-point of this study was to detect if there is an association between walking
speed and urinary incontinence in older women and secondarily to detect an association between urinary
incontinence with other geriatric syndromes.
STUDY DESIGN: This is a prospective and cross-sectional study. Three hundred and eighty-nine old
aged women admitted to the Geriatrics Department of Ankara University were enrolled and urinary incontinence
and type of urinary incontinence, Handgrip strength test, Timed up and Go test, Katz Index
of Independence in Activities of Daily Living, Lawton Index of Instrumental Activities of Daily Living, Mini
Nutritional Assessment, Mini-Mental State Evaluation, Geriatric Depression Scale, Body Mass Index
(BMI) of these participants were recorded. Association of urinary incontinence and these parameters
were analyzed.
RESULTS: The median age of the study population was 68 (58-86 years of age). Two hundred and fiftyeight
(66.32%) had hypertension, 122 (31.36%) had diabetes mellitus, 51 (13.11%) had asthma/Chronic
obstructive lung disease, 49 (12.59%) had coronary artery disease and 9 (2.31%) had cerebrovascular
disease. One hundred and seventy-eight (45.7%) patients had urinary incontinence (88 urge, 55 stress,
35 mixed). One hundred and eight (27.76%) of patients had Mini-Mental State Evaluation score ≤23.
Patients with urinary incontinence detected to have a longer duration of Timed Up and Go test, higher
Geriatric Depression Scale score and BMI with p-values 0.005, 0.004, and <0.01 respectively; and lower
Activities of Daily Living (Katz-Activities of Daily Living) score with a p-value of <0.01 results. Mini-Mental
State Evaluation and Mini Nutritional Assessment scores were not statistically different between the continent
and incontinent group.
CONCLUSION: Whenever urinary incontinence is detected in an older woman, geriatrician referral
should be considered since urinary incontinence is associated with decreased walking speed, Handgrip
strength test, Activities of Daily Living, Instrumental Activities of Daily Living or increased Geriatric
Depression Scale; any of which is a symptom or result of at least one geriatric syndrome.
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OBJECTIVE: The aim of this study is to compare the perinatal outcomes of double cerclage via laparoscopic plus transvaginal technique in women with a history of transvaginal cerclage failure, between women with single transvaginal cerclage. STUDY DESIGN: Five women who were diagnosed with cervical insufficiency with a history of at least one vaginal cerclage failure and 10 women who were diagnosed with cervical insufficiency were included in this study. Laparoscopic cerclage was performed to all women who have a medical history of vaginal cerclage failure, before pregnancy and additional transvaginal cervical cerclage was performed during their pregnancy (Group 1). Single transvaginal cervical cerclage was performed to the 10 women who had a short cervix and/or cervical insufficiency during their pregnancy (Group 2). The number of cerclage failure, perinatal outcomes, gestational week at the time of delivery, birth weight and Apgar scores were evaluated. RESULTS: All five women in group 1 underwent a cesarean section. None of them had chorioamnionitis or poor obstetric outcomes and all gave birth after the 34th week of pregnancy. All ten women in group 2 were evaluated. Two women gave birth vaginally at the 33rd week of pregnancy. Remaining eight cases gave birth above 34th week of pregnancy. Six of the eight cases underwent cesarean section and two of the remaining were delivered vaginally. Mean birth weight of the fetuses were 2490±265 g and 2.710 ±361 g in group1 and group 2, respectively. Mean gestational age at the time of birth in group 1 and group 2 were found 36±1.83 weeks and 35.6±1.14 weeks, respectively. CONCLUSION: Laparoscopic cervical cerclage during pregnancy could be a safe and effective treatment. However, sometimes it might not be enough and transvaginal cervical cerclage may be needed to strengthen cervical tension.
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OBJECTIVE: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, alternative approaches such as transperineal ultrasound, fetal fibronectin test in cervicovaginal secretions have been investigating for the prediction of the delivery route. We aimed to study whether the usefulness of qualitative fetal fibronectin test in cervicovaginal secretions for the prediction of vaginal delivery in pregnant women at postterm induced with dinoprostone. STUDY DESIGN: A total of 32 nulliparous pregnant women at postterm were enrolled in this prospective observational study. Fetal fibronectin test was applied to all participated women before the induction with dinoprostone and transvaginal ultrasonography was performed to measure cervical length. RESULTS: The women having positive fetal fibronectin test result gave birth through vaginal route, except one case. Although there is no statistically significant difference, the shorter cervical length was associated with vaginal delivery in our population. CONCLUSION: Fetal fibronectin test has a predictive value for delivery route in nulliparous women at postterm. Fetal fibronectin test may be used as a “rule out” test because the rate of fetal fibronectin positivity was found to be higher in patients who gave birth via vaginal route. As also shown in our study, although there is no statistically significant difference, the pregnant women with shorter cervical length might have a high possibility to achieve vaginal delivery.
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OBJECTIVE: Polycystic ovary syndrome, myoma uteri and endometrioma are frequently seen gynecologic problems and all three diseases may cause infertility. Aim of this cross-sectional study was to compare total antioxidant status, ceruloplasmin, total sulfhydryl , total oxidant status, lipid hydroperoxide and oxidative stress index levels in endometrial flushing fluid of patients with Polycystic ovary syndrome (n=20), uterine leiomyoma (n=20), endometrioma (n=19), and healthy women (n=20). STUDY DESIGN: We compare endometrial flushing fluid of patients with polycystic ovary syndrome (n=20), uterine leiomyoma (n=20), endometrioma (n=19) and healthy women (n=20). Endometrial flushing fluid samples were collected during the implantation window of all women. RESULTS: Mean age of groups was 28.90±5.45, 37.25±2.73, 32.84±6.62 and 32.15±5.18 in Polycystic ovary syndrome, myoma uteri, endometrioma and control groups, respectively (p<0.05). Mean total antioxidant status, ceruloplasmin and total sulfhydryl levels indicating antioxidant state were comparable between Polycystic ovary syndrome, myoma uteri, endometrioma and control groups (p=0.806, p=0.156, p=0.328 respectively for markers). Similarly, oxidant state-related markers didn’t differ significantly between 4 groups (p=0.090 for total oxidant status, p=0.087 for lipid hydroperoxide, p=0.312 for oxidative stress index). CONCLUSION: Endometrial flushing fluid total antioxidant status, total oxidant status, lipid hydroperoxide, ceruloplasmin, and total sulfhydryl levels during implantation window didn’t differ between women with Polycystic ovary syndrome, uterine leiomyoma, endometrioma, and healthy controls.
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OBJECTIVES: Online education and certification programs which help most gynecologic surgeons to advance, improve and prove their skills. However, the benefits of such distant programs in terms of complication rate and operation time has not been evaluated so far. The aim of this study was to report the improvement of a single surgeon’s learning curve in total laparoscopic hysterectomy who had no previous mentorship/fellowship education, working in a rural district hospital before and after the completion of a distant on-line education and certification program - Gynaecological Endoscopic Surgical Education and Assessment. STUDY DESIGN: Medical records of patients who underwent total laparoscopic hysterectomy between May 2015 and December 2018 were retrospectively reviewed and grouped based on the certification date of the surgeon, Group 1 before and Group 2 after certification. Groups were compared for variables that impact the learning curve (operation time, complications and conversion to laparotomy) RESULTS: Of the 57 women eligible for evaluation 30 had total laparoscopic hysterectomy in Group 1 and 27 had total laparoscopic hysterectomy in Group 2. BMI, number of vaginal/cesarean births, previous abdominal/pelvic surgeries, operation indications, uterine weight, adnexectomy, and adhesiolysis rates, transfusion requirements, and the decrease in hemoglobin before and after operation were similar between the groups (p>0.05). Operation time was significantly shorter in Group 2 (83 min vs.116 min, p<0.0001). CONCLUSION: Thirty total laparoscopic hysterectomy operations seem enough to reach a plateau in the learning curve for gynecologists working in rural areas with limited facilities who cannot afford lengthily and expensive fellowship/mentorship programs, after completing distant online certification programs.
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A 50-year-old woman presented with symptoms of abnormal uterine bleeding. Ultrasonography showed an intrauterine cavity nodule sized approximately 2 cm. A hysteroscopic resection was diagnosed. The histopathology revealed high-grade endometrial stromal sarcoma. The surgery was laparoscopic surgical staging with indocyanine green sentinel lymph node mapping. Two positive indocyanine green sentinel lymph node of the right and left pelvic nodes showed no nodal metastasis. Also, the five positive indocyanine green sentinel lymph node showed no nodal metastasis. The occult lymph nodes were dissected at the right and left pelvic nodes for nodes 4 and 9, respectively. Conclusively, hysteroscopic resection is beneficial for the diagnosis of uterine sarcoma. Notwithstanding, laparoscopy can be used for uterine cancer and the indocyanine green sentinel lymph node showed no false negative. The patient was stage IA.
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OBJECTIVE: We aimed to investigate the effect of acupuncture performed as an adjuvant therapy to in
vitro fertilization, on pregnancy rates by performing acupuncture on the day of embryo transfer, one hour
before the procedure and one hour after the procedure.
STUDY DESIGN: In this open-label randomized prospective controlled study, 60 unexplained infertility
patients enrolled for in vitro fertilization treatment were randomized by a computer-based number generator
for acupuncture performance and no-treatment. All patients received rFSH (Gonal-F®) for ovulation
induction and the antagonist Cetrorelix (Cetrotide®) to prevent premature ovulation. Ovulation was
triggered by using hCG (Ovitrelle®) and egg collection was done after 36-48 hours. In the study group,
acupuncture was performed by intradermal needling, bilaterally with a sterile needle, both one hour before
and one hour after the embryo transfer. Acupuncture was not performed on the control group. The
results of the treatment were evaluated 12 days after embryo transfer.
RESULTS: Thirty patients were randomized into the study group and 30 patients were randomly placed
in the control group. Although there was no statistically significant difference between groups in terms of
β-hCG positivity, it was 43.3% in the study group and 36.7% in the control group (p>0.05).
CONCLUSION: The success rate of in vitro fertilization was higher in terms of pregnancy rate in the patient
group who received acupuncture procedure as well, but the difference was not statistically significant.
This may be due to the type of acupuncture procedure selected or insufficient sample size. As a
result, further studies involving larger numbers of participants and using different acupuncture techniques
are needed.
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OBJECTIVE: We aimed to investigate the role of incomplete of antenatal steroid therapy by comparing
with no and complete steroid exposure on mortality and morbidity in preterm infants.
STUDY DESIGN: This is a prospective, an observational study which includes preterm infants of 32
weeks of gestation and/or ≤1500 grams who were referred to Izmir Dr. Behcet Uz Children’s Hospital
NICU during the one year period. Infants were divided into three groups according to the administration
of antenatal steroid as those who received incomplete-dose antenatal steroid, complete dose steroid
therapy and those with no steroid exposure. Intubation at the delivery room, surfactant requirement, the
inotropic requirement in the first 72 hours and morbidities associated with prematurity were determined
as the primary results. Mortality and bronchopulmonary dysplasia at discharge and stage ≥2 retinopathy
were analyzed as secondary outcomes.
RESULTS: We found that 54 infants were born with an incomplete dose, 55 infants with complete dose
and 38 infants with no steroid therapy. Surfactant requirement, inotropic requirement, and hemodynamically
significant patent ductus arteriosus were lower in the steroid exposure group leading to a statistical
difference (p <0.05). Also, it was found that mortality and Bronchopulmonary dysplasia was lower in
the incomplete and complete dose steroid groups, leading to a statistical difference (p <0.05).
CONCLUSION: We speculate that even incomplete dose steroid may reduce mortality by reducing respiratory
distress syndrome.
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OBJECTIVE: This study was aimed to investigate the effect of perineal massage in the second stage of labor in prevention perineal traumas during childbirth. STUDY DESIGN: This observational study was conducted with 171 nulliparous women delivered by vaginally between January 2017 and May 2019. All the patients managed by the selective episiotomy principle. All the patients were divided into two groups: the perineal massage group and the control group. The perineal massage was performed during the second stage of labor until the baby's head was birth. The control group received routine labor care. In the case of threatening tears in any patient and at the preference of the midwife, mediolateral episiotomy was performed. Following childbirth, the perineum and vagina were examined for perineal tears and episiotomy by the midwives. RESULTS: The length of the second stage of labor was significantly lower in the massage group (36±19 minute) compared with the control group (46±25 minute, p=0.024). Twenty-five women (28.8%) in the massage group had intact perineum after vaginal birth, compared with five (6.0%) in the control group (p=0.003). The rate of first- and second-degree perineal tears are higher in the massage group [28 patients (32.2%) and 9 patients (10.3%), respectively] than in the control group [10 patients (11.9%) and 5 patients (6.0%), respectively, p<0.001]. The incidence of episiotomy was significantly lower in the massage group (25 patients, 28.7%) than in the control group (64 patients, 76.1%, p<0.001). CONCLUSION: Perineal massage should be considered a routine intervention to reduce the incidence of perineal trauma.
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