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Öğe Evaluation of Myomectomy During Cesarean Section: A Tertiary Center Experience(2024) Bozbay, Özlem Polat; Arslan, Dorşin Sancar; Gündüz, Reyhan; Bozbay, NizamettinAim: The study aims to investigate the outcomes of patients who underwent myomectomy during cesarean section in our tertiary center. Material and method: This study was conducted between January 1, 2015 and May 31, 2022. The patients included in the study were divided into three groups: patients with myoma uteri and pregnancy who underwent cesarean section and simultaneous myomectomy (Group 1), patients with myoma uteri and pregnancy who underwent cesarean section only (Group 2), and pregnant patients without myoma who underwent cesarean section only (Group 3). The groups were compared in terms of preoperative and postoperative results. Results: A total of 138 patients, 56 40.6% (Group 1), 31 22.5% (Group 2), 51 37% (Group 3) were included in the study. When compared according to demographic characteristics, Group 1 and Group 2 had significantly higher age and significantly lower gravida and parity (p: <0.001, p: 0.048, p: 0.005, respectively). There was no significant difference between Group 1 and Group 2 in terms of myoma size and number (p: 0.162, p: 0.228, respectively). Operative time, laboratory results, and blood transfusion requirements were similar between the groups. Conclusion: Performing a myomectomy during a cesarean section, considering the potential risks based on our data, is a feasible procedure when carried out by experienced surgeons at tertiary hospitals. Precautions should also be taken regarding complications. We believe that the decision to include or exclude a myomectomy during a cesarean section should be discussed with the patient, considering the risk-benefit ratio and the factors mentioned above, and should be made on a case-by-case basis.Öğe Evaluation of Myomectomy During Cesarean Section: A Tertiary Center Experience(Selçuk Üniversitesi, 2024) Bozbay, Özlem Polat; Arslan, Dorşin Sancar; Gündüz, Reyhan; Bozbay, NizamettinAim: The study aims to investigate the outcomes of patients who underwent myomectomy during cesarean section in our tertiary center. Material and method: This study was conducted between January 1, 2015 and May 31, 2022. The patients included in the study were divided into three groups: patients with myoma uteri and pregnancy who underwent cesarean section and simultaneous myomectomy (Group 1), patients with myoma uteri and pregnancy who underwent cesarean section only (Group 2), and pregnant patients without myoma who underwent cesarean section only (Group 3). The groups were compared in terms of preoperative and postoperative results. Results: A total of 138 patients, 56 40.6% (Group 1), 31 22.5% (Group 2), 51 37% (Group 3) were included in the study. When compared according to demographic characteristics, Group 1 and Group 2 had significantly higher age and significantly lower gravida and parity (p: <0.001, p: 0.048, p: 0.005, respectively). There was no significant difference between Group 1 and Group 2 in terms of myoma size and number (p: 0.162, p: 0.228, respectively). Operative time, laboratory results, and blood transfusion requirements were similar between the groups. Conclusion: Although myomectomy can be performed during a cesarean section by an experienced surgeon in a tertiary center, it should be noted that complications may arise and that precautions must, therefore, be taken.Öğe Obstetrik nedenlere bağlı gelişen posterior reversible ensefalopati sendromu olgularının erken saptanması, tedavi yaklaşımı, yönetimi ve sonuçlarının değerlendirilmesi(Dicle Üniversitesi, Tıp Fakültesi, 2019) Bozbay, Nizamettin; Ağaçayak, ElifAmaç: Amacımız obstetrik nedenlere bağlı gelişen posterior reversible ensefalopati sendromunun (PRES) görüntüleme yöntemleri kullanılarak kranial değişikliklerin erken saptanması ve yönetimini ele almaktır. Materyal ve Metod: Çalışma kapsamında Dicle Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde, Ocak 2010-Aralık 2017 tarihleri arasında 48 posterior reversible ensefalopati sendromu tanısı alan ve 37 normal kranial görüntüleme saptanan hastaların bilgileri değerlendirildi. Hastalar Grup-1 (Posterior reversible ensefalopati sendromu), Grup-2 (normal kranial görüntüleme) olarak sınıflandırıldı. Hastalara ait demografik veriler, fizik muayene bulguları, laboratuar parametreleri, hastalara hastanemizde ve/veya öncesinde yapılan cerrahi müdahaleler, hastaneye yatış süresi, hastaların yoğun bakımda kalış süreleri, hastaların başka kliniğe transferi sağlanıp sağlanmadığı gibi bilgiler hastane arşiv dosyalarından ve elektronik arşiv veri tabanından temin edildi. Bulgular: Kliniğimize 7 yıllık dönemde toplamda 274 şiddetli preeklampsi ve eklampsi tanısı alan gebe başvurmuştur. Bu hastalardan nörolojik semptom tarifleyen 94 hastaya ek görüntüleme yöntemleri istenmiştir. İntrakranial kanama+DIC olan 2 hastanın maternal ölümle sonuçlandığı görüldü. Bu çalışmaya ek görüntüleme yöntemlerine başvurulan hastalardan 48 (% 56,47) hasta grup 1 olarak, 37 (%43,53) hasta grup 2 olarak adlandırıldı. Toplamda 85 hasta çalışmaya dahil edildi. Grup 1 hastalarda ALT, PT, INR değerinin Grup 2 hastalara göre anlamlı olarak yüksek bulundu (p<0,05). PLT ve albumin değerinin Grup 1 hastalarda anlamlı olarak daha düşük olduğu izlendi (p<0,05). Grup 1 hastaların hastanede kalma süreleri 8.44 gün, grup 2 hastaların 6.54 gün olduğu görülmektedir. Grup 1 hastalarda 32'sinin (%66,67) grup 2 hastalarda 20'sinin (%54,05) yoğun bakım ihtiyacı olduğu saptandı. Hastaların 56'sına (%65,88) kliniğimizde, 29'una (%34,22) dış merkezde ilk müdahalesinin yapıldığı tespit edildi. Sonuç: Yaptığımız çalışmada Grup 1 ve Grup 2 hastaları karşılaştırıldığında laboratuar parametreleri bakımından anlamlı bulunan değerlerdeki değişikliklerin erken tespit edilip, erken müdahale edildiğinde prognoz üzerine olumlu etkili olacağı ve posterior reversible ensefalopati sendromunu öngörmede hekime yol gösterici olacağını öngörmekteyiz ve maternal morbidite ve mortalitenin azaltılabileceğine katkıda bulunduğunu düşünmekteyiz.Öğe Prediction of posterior reversible encephalopathy syndrome (PRES) due to obstetric causes(Perinatal Medicine Foundation, 2023) Bozbay, Nizamettin; Bozbay, Özlem Polat; Ağaçayak, Elif; Oğlak, Süleyman Cemil; Avcı, Fazıl; Acar, AbdullahObjective: This study aimed to identify the demographic, laboratory, and clinical parameters that would help us identify patients at risk of posterior reversible encephalopathy syndrome (PRES) due to obstetric causes. Also, we analyzed the variables that might predict the development of obstetric-related PRES. Methods: This retrospective study examined a total of 274 hypertensive pregnant women diagnosed with preeclampsia (PE) and eclampsia from January 2010 to December 2017 at Dicle University Faculty of Medicine. Of these, 85 cases who underwent cranial imaging by mag-netic resonance imaging (MRI) or computed tomography (CT) were included in the study. Results: According to the cranial imaging results, 48 patients (56.47%) were reported as PRES (Group 1) and 37 patients (43.53%) were normal (Group 2). The incidence of patients diagnosed with PRES was found to be 17.51% when all PE and eclampsia patients were included. International Normalized Ratio (INR), and prothrombin time (PTT) values were significantly higher, and maternal age, gravida, parity, platelet (PLT), and albumin values were significantly lower in the PRES group compared to the cases in group 2 (p<0.05). As a predictor of PRES, INR values higher than 0.94 (sensitivity=75.0%, specificity=67.6%) and PTT values higher than 11.7 (sensitivity=75.0%, specificity=54.1%) were found to be significant factors. Conclusion: We consider that high INR, PTT, low PLT, low albumin, young age, early gestational week, low gravida, and parity parameters can help clinicians to predict and diagnose earlier PRES cases due to obstetric causes.Öğe PROSPECTIVE EVALUATION OF MEDIUM-TERM OUTCOMES OF PATIENTS UNDERGOING HYSTEROSCOPIC UTERINE SEPTUM RESECTION(Rojan GÜMÜŞ, 2021) Tekeş, Gülten Çirkin; Gündüz, Reyhan; Bozbay, Nizamettin; Buğday, Rezan; Ağaçayak, ElifObjectives: To retrospectively and prospectively investigate the pregnancy outcomes after hysteroscopy (H/S) for septum resection in patients detected to have a uterine septum after presenting with a history of recurrent pregnancy loss (RPL), diagnosis of secondary infertility or primary infertility. Methods: This study included 62 patients with infertility or a history of RPL who underwent hysteroscopic uterine septum resection. Patients who had uterine anomalies other than a uterine septum, such as submucous myoma, endometrial polyp were excluded. Those discharged home with a live infant after a uterine septum operation were compared based on certain variables, those who succeeded and those who failed were categorized into group 1 and group 2, respectively. The two groups were compared with regard to the total number of deliveries before and after the operation, total number of abortions, preterm and term deliveries, delivery methods, control hysterosalpingographies (HSG) and whether they were reoperated. Results: In our study, 25 (40%) patients were primary infertile, 37 (60%) had secondary infertility or a history of RPL. Hysteroscopic septum resection was performed under general anesthesia in 61 and spinal anesthesia in 1 of these patients. Of the patients who were postoperatively discharged home with a live infant, 8 (26.7%) were determined to be primary infertile and 22 (73.3%) to have secondary infertility or a history of RPL. The rate of discharge with a live infant was determined as 76.9% among patients who conceived. The success rate of Group 1 patients, who were secondary infertile or had history of RPL, was significantly higher compared to patients who were primary infertile. Conclusions: Hysteroscopic uterine septum resection is a method with an easy application and high effectiveness. The success of the operation is particularly higher in patients who have a history of RPL or are secondary infertile compared with patients who are primary infertile.
