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    Adenomyomatous polyp causing acute urinary retention in a postmenopausal woman
    (Modestum Publishing Ltd., 2011) Evsen, Mehmet Sıddık; Sak, Muhammet Erdal; Soydinç, Hatice Ender; Gümüş, Hatice; Özekinci, Selver; Gül, Talip
    A case of adenomyomatous polyp (AP) causig acute urinary retention in postmenopausal period is presented. A 65-year-old, G8P8 women admitted to our clinic with the complaint of vaginal bleeding and vaginal mass was identified. During preoperative hospitalization she complained about not able to urinate. Serum urea and creatinine levels increased [66 mg/dL (range= 10-45) and 2,49 mg/dL (range= 0. 6-1.3) respectively]. Emergent abdominopelvic tomography showed vaginal mass and overdistended bladder. Mass was removed by vaginal route and abdominal hysterectomy was also performed. Pathologic examination revealed non-malignant AP with massive necrosis. A variety of female reproductive tract diseases can cause urinary obstruction. Treatment choice depends on reproductive expectance of the patient. J Clin Exp Invest 2011; 2 (3): 312-314.
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    Analysis of sensitivity, specificity, and positive and negative predictive values of smear and colposcopy in diagnosis of premalignant and malignant cervical lesions
    (Int Scientific Literature, Inc, 2015) Barut, Mert Ulaş; Kale, Ahmet; Kuyumcuoğlu, Umur; Bozkurt, Murat; Ağaçayak, Elif; Özekinci, Server; Gül, Talip
    Background: This study aimed to examine the positive and negative predictive value in the diagnosis of premalignant and malignant lesions of cervical colposcopy, the sensitivity and specificity of smear, and to evaluate the correlation with histopathology of abnormal cytology and colposcopy. Material/Methods: The criteria for inclusion of patients with unhealthy cervix in the study were: Erosion, Chronic cervicitis, and Healed lacerations, Hypertrophied cervix, bleeding on touch, suspicious growth/ulcer/polyp on the cervix, and abnormal discharges from the cervix. Women with frank carcinoma cervix, pregnant females, patients with bleeding per vaginum at the time of examination, and those who had used vaginal medications, vaginal contraceptives or douches in the last 48 h of examination were excluded from the study. Demographic analysis was performed for 450 patients who were admitted to the clinic. Sensitivity, specificity, positive predictive value and negative predictive values of patients to identify cervical pathologies of smear and colposcopy were histopathologically calculated. The statistical software package SPSS 15.0 (SPSS Inc., Chicago, IL, USA) and Spearman's and Chi-Square tests were used for statistical analysis. Results: Sensitivity, specificity, PPD and NDP of smear were 0.57%, 0.76%, 0.26%, 0.92% respectively. Sensitivity, specificity, PPD and NDP of colposcopy were 0.92%, 0.67%, 0.52%, 0.96% respectively. A statistically significant correlation was found between abnormal cytology and histopathology, and abnormal colposcopy finding and histopathology. Conclusions: Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. It was concluded that Pap smear, colposcopy and histopathology should be collectively evaluated to evaluate cervical findings in low socio-economic regions.
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    Are serum Netrin-4 levels predictive of preeclampsia?
    (Via Medica, 2020) İçen, Mehmet Sait; Agaçayak, Elif; Fındık, Fatih Mehmet; Tunç, Senem Yaman; Kaplan, İbrahim; Tan, İlhan; Evsen, Mehmet Sıddık; Gül, Talip
    Objective: To investigate the levels of anti-angiogenic factors, namely sFlt-1 and Netrin-4, in patients with preeclampsia (PE). Material and methods: Cord-blood (UC) sFlt-1 and Netrin-4 concentrations were measured in 30 patients with severe PE, 30 patients with PE and 30 control infants and their mothers (MS). Results: Maternal sFlt-1 levels were significantly higher in the severe PE and PE groups than in the control group. There were no statistical differences among the three groups in maternal and fetal Netrin-4 levels. But Netrin-4 levels were found to be the lowest in the control group and higher in the PE and severe PE groups. The correlation analysis revealed a positive correlation between maternal sFlt-1 levels and maternal Netrin-4 levels (p = 0.012, and r = 0.263), maternal sFlt-1 levels and fetal sFlt-1 levels (p = 0.012, and r = 0.263). Conclusions: There was a positive correlation found between maternal sFlt-1 levels and maternal Netrin-4 levels. We are of the opinion that elevation in levels of Netrin-4 might be secondary to placental hypoxia occurring in PE. The present study led to the consideration of anti-angiogenic biomarkers (sFlt-1 and Netrin-4) on automated platforms for clinical use as an aid in establishing the diagnosis and prognosis of PE.
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    Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery
    (2010) Sak, Sibel; Gül, Talip; Sak, M. Erdal
    Amaç: Preterm doğum erken belirteci olarak serviko-vajinal sekresyonlardaki koriyonik gonadotropin’in rolünü araştırmak.Yöntemler: Bir önceki doğumu erken doğum veya ikinci trimester düşük öyküsü risk faktörü olan, 25-36 gebelik haftasına sahip 55 gebe çalışmaya alındı. Hastaların tümünde servikovajinal sekresyonlardaki beta-insan koriyonik gonadotropin (?-hCG) düzeyleri radioimmunassay yöntemiyle ticari bir kit kullanılarak ölçüldü.Bulgular: Gebelerden 25’i preterm, 30’u term doğum yaptı. Term ve preterm doğum yapana gebe grupları arasında yaş, gebelik sayısı ve parite açısından farklılık saptanmadı (P>0.05). Preterm doğum grubunda yenidoğan APGAR skorları ve bebeklerin antropometrik ölçümleri term doğum grubundan anlamlı düşük bulundu (P<0.05). Serviko-vaginal ?-hCG düzeyleri; preterm grubunda, term doğum grubuna göre anlamlı yüksek bulundu (sırasıyla 94.7±37.7 mIU/ml ve 35.5±14.8 mIU/ml, P<0.001). Beta-hCG için, 75 mIU/ml cut-off değeri olarak alındığında; duyarlılığı %76, özgüllüğü %91.6, pozitif prediktif değeri %95 ve negatif prediktif değeri %79.9 olarak bulundu.Sonuç: Preterm doğum açısından yüksek riskli hastalarda servikovajinal sekresyonlardaki ?-hCG konsantrasyonu iyi bir biyokimyasal belirteç olabilir. Servikovajinal sıvılardaki ?-hCG düzeyine dayanarak preterm doğum geliştireceği öngörülen hastalarda daha yakın takip ile komplikasyonlar azaltılabilir.
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    Bilateral hypogastric artery ligation: A tertiary center experience
    (Harran Üniversitesi Tıp Fakültesi, 2019) Peker, Nurullah; Yavuz, Mustafa; Aydın, Edip; Ege, Serhat; Bademkıran, Muhammet Hanifi; Turan, Gökçe; Karaçor, Talip; Gül, Talip
    Background: The aim of this study was to evaluate the obstetric characteristics and maternal outcomes of patients undergoing bilateral hypogastric artery ligation (BHGAL) for primary postpartum hemorrhage (PPH). Materials and Methods: Digital records and hospital archives of patients who underwent BHGAL in the postpartum period after vaginal delivery (VD) or during or after cesarean section (C/S) in a tertiary center between May 2005 and May 2018 were reviewed retrospectively. Demographic characteristics, parity, gestational week, duration of operation, hospitalisation time, estimated blood loss, laboratory values, transfused blood volume, previous C/S history, and intensive care requirement of the patients were evaluated. The efficacy of BHGAL in controlling bleeding, indications, concomitant surgeries, and intraoperative and postoperative complications were evaluated. Results: There were 276.008 deliveries in our hospital in the specified period. Of the patients with PPH, 41 patients underwent BHGAL after VD and 19 patients underwent BHGAL during or after C/S. In 25 of 28 patients with PPH due to atony, bleeding was controlled by BHGAL, while 3 patients underwent hysterectomy together with BHGAL. While the effectiveness of BHGAL in uterine atony was 89.2%, the success rate was 33.3% when all cases were considered. The most common cause of indication for BHGAL was atony and disseminated intravascular coagulation (DIC) was the most common complication in patients undergoing BHGAL. Iliac vein injury was detected in one patient due to the procedure itself. Conclusions: BHGAL is more effective on controlling PPH due to atony compared to the control of other PPH causes. Most of the complications in these patients are not related to the procedure but are due to the complications of PPH. Therefore, BHGAL continues to be a life-saving method when applied by centers with adequate surgical knowledge and equipment.
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    Comparison of ultrasound-guided drainage with other available treatment modalities for, treatment of tubo-ovarian abscess
    (Türkiye Klinikleri Yayınevi, 2018) Aydın, Edip; Peker, Nurullah; Bademkıran, M. Hanifi; İçen, Mehmet Sait; Gül, Talip
    Objective: The present study aimed at the retrospective evaluation of the medicalrecords of patients treated for tubo-ovarian abscess (TOA) at our clinic and investigation of the efficacyof USG-guided drainage compared with that of other available treatment modalities. Materialand Methods: Medical records of 100 patients with TOA, who were treated and followed up atthe Department of Gynecology and Obstetrics, School of Medicine, Dicle University between January2009 and April 2015, were reviewed retrospectively. Details such as demographic data, risk factors,clinical and laboratory findings, treatment modalities used, and complications observed wererecorded for each patient. Results: The mean age of the patients was 36.46±11.6 years. Of the 100patients, 10 were menopausal women. Pelvic pain was the most common complaint in all patients(100%). The history of intrauterine or intra-abdominal intervention within six months was themost common risk factor (60.5% patients) for the development of TOA. Of the patients, 25% reportedfever (≥38 °C), 55% had leukocytosis, 85% had high sedimentation rate, and 92% had highCRP levels. The development of leukocytosis was not observed to be associated with the treatmentmodality used (p > 0.05). Of the patients, 38% underwent only medical treatment, 47% underwentmedical treatment followed by surgery, and 15% underwent medical treatment followed by USGguideddrainage. All 34 (72.3%) patients who had undergone surgical treatment required fertilitypreservingsurgery. Intraoperative bowel injury (6.3% patients) and wound site infection (8.5%patients) were among the common complications reported in patients undergoing surgical treatment.The mean duration of hospital stay was 7.9±6 days. The longest mean duration of hospital stay(10.5±3.9 days) was observed in the patients who had undergone USG-guided drainage. Conclusion:Broad-spectrum antibiotic therapy, the first step of treatment in patients with TOA, increasesthe size of abscess. In addition, a significant number of patients with bilateral abscesses require additionalintervention (surgery). Our findings suggest that USG-guided drainage should be consideredonly in patients not responding to medical treatment and not consenting to undergo surgicaltreatment.
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    COVID-19: Gebelik, prenatal bakım ve doğum yönetimi
    (Dicle Üniversitesi Tıp Fakültesi, 2021) Tunç, Senem Yaman; Fındık, Fatih Mehmet; Gül, Talip
    COVID-19, 2019’un sonlarında Çin’de ortaya çıkarak tüm dünyaya yayılmıştır. Etken olan virüs "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)"olarak tanımlanmıştır. Hastalık esas olarak damlacık yoluyla bulaşmaktadır. Genel olarak inkubasyon süresi 2-14 gün arasında değişmektedir. Gebeliğin SARS-CoV-2 enfeksiyonuna duyarlılığı artırmadığı, ancak aynı yaştaki gebe olmayan kadınlara kıyasla COVID-19'un klinik seyrini kötüleştirdiği bildirilmiştir. Gebelikte ciddi hastalık ve ölüm için risk faktörleri arasında ileri yaş (özellikle ≥35 yaş), obezite ve diğer komorbiditeler ( hipertansiyon, diyabet vb.) yer alır. Vertikal geçişin sıklığı henüz tam olarak bilinmemektedir. Gebelikte geçirilen COVID-19'un düşük, ölü doğum, neonatal ölüm ve konjenital anomali riskini arttırmadığı düşünülmektedir. Erken doğum ve sezaryen doğum oranlarının COVID-19'lu gebelerde arttığı bildirilmiştir. Gebelik sırasında COVID-19 aşılarının güvenliği ve etkinliği ile ilgili giderek daha fazla veriye ulaşılmaktadır. Bu verilere dayanarak gebelerin COVID-19 aşısı olmaları önerilmektedir. Gebelerde komplike olmayan COVID-19 enfeksiyonu için tedavisiz izlem seçeneği öncelikle düşünülmelidir. Olası tanı almış olan gebelerde risk faktörü varsa veya ağır seyir söz konusu ise tedavi verilmesi düşünülmelidir. COVID-19 pozitifliği doğum için bir endikasyon değildir. Doğum şekline rutin endikasyonlara göre karar verilmelidir. Doğumda multidisipliner bir bakım ekibi mevcut olmalıdır. COVID-19 enfeksiyonu olan anneler doğum odasında cerrahi maske takarak ve uygun el hijyeni ile cilt cilde temasta bulunabilir ve emzirme yapabilirler. Tüm yetişkinlerde olduğu gibi doğum sonrası kadınlara da COVID-19 aşısı önerilmektedir.
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    The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia
    (2017) Deregözü, Ayşegül; Karaçor, Talip; Acet, Mustafa; Gül, Talip; Evsen, Mehmet Sıddık; Ağaçayak, Elif; Hatirnaz, Safak
    OBJECTIVE: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). STUDY DESIGN: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. RESULTS: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50- 79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. CONCLUSION: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.
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    Diyarbakır ilindeki gebe kadınlarda Toksoplazma, Rubella ve Sitomegalovirus seroprevalansı
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Obut, Mehmet; Doğan, Yasemin; Bademkıran, Muhammed Hanifi; Akgöl, Sedat; Kahveci, Bekir; Peker, Nurullah; Uzundere, Osman; Kaçar, Cem Kıvılcım; Özbek, Erdal; Gül, Talip
    Amaç: Bu çalışmada; gebelerde, Toxoplasma gondii, Rubella virüs ve Cytomegalovirus infeksiyonlarının bölgemizdeki seroprevalanslarının belirlemesi amaçlanmıştır. Yöntemler: Bu çalışmada hastanemize Eylül 2016 ile Haziran 2018 tarihleri arasında kadın hastalıkları ve doğum polikliniklerine ilk prenatal vizite gelen 18-45 yaş arası gebeler dahil edildi. Bu hastalardan Toxoplasma gondii, Rubella ve Cytomegalovirus virüs serolojisi çalışılanların test sonuçları retrospektif olarak incelendi. Bulgular: Toxoplasma gondii antikorları açısından 8175 hastanın 2853’ inde (%34,9) anti toksoplazma gondii IgG antikorları, 91’ inde (%1,1) anti Toxoplasma gondii IgM antikorları pozitif olarak saptandı. Cytomegalovirus antikorları açısından 2797 hastanın 2775’ inde (%99,2) anti Cytomegalovirus IgG, 20’ sinde (%0,7) anti Cytomegalovirus IgM pozitif olarak saptandı. Rubella virüs antikorları açısından 8158 hastanın 7677’ sinde (%94,1) anti Rubellavirus IgG, 5’ inde (%0,1) anti Rubellavirus IgM pozitif olarak saptandı. Sonuç: Bu çalışmada hastanemize başvuran gebelerin çoğunun toksoplazma seronegatif (%65,1) olduğu tespit edildi. Rubella seroprevalansı (%94,1) Türkiye verileri ile uyumludur. Gebelerin Cytomegalovirus seroprevalansı için seropozitiflik oranı (%99,2) dünya verileri ile uyumludur.
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    Dış gebelikte tedavi yaklaşımlarımız
    (2001) Tarlan, Nurten; Gül, Talip; Demirkol, Talat; Demir, Bülent; Soysal, Hamit
    Amaç: Kliniğimizde dış gebelik tanısıyla tedavi ettiğimiz olgularda tedavi yaklaşımlarımızın değerlendirilmesidir. Materyal ve Metod: 01.01.1997-30.06.2000 tarihleri arasında dış gebelik tanısı konularak tedavi edilen 65 olgu tedavi yaklaşımlarımız açısından retrospektif olarak değerlendrildi. Bulgular: 65 olgudan 32'ine (% 49) laparotomi, 25'ine (% 38) laparaskopi, 7'sine (% 11) laparoskopi + laparotomi uygulandı. 36 olguda rüpttir olmuş dış gebelik mevcuttu. 26 (% 41) olguya lineer salpingostomi, 20 (% 31) salpenjektomi, 11 (% 17) segmental rezeksiyon, bir tanesine kornual wedge rezeksiyon, 2 tanesine milking yöntemi, 4 tanesine yalnızca aspirasyon + hemostaz yapıldı. İki olguya 50 mgr/m İ.M tek doz metotrakset uygulandı. Olguların birinde tedavi başarılı olmadı ve laparotomi ile segmental rezeksiyon yapıldı. Beş olguya salpenjectomi ile beraber karşı tarafta tüp lagasyonu yapıldı. Sonuç: Dış gebeliklerin tedavisinde, fertiliteyi korumak amacıyla konservatif tedavi yaklaşımları tercih edilmelidir.
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    Ektopik Gebelik Olgularinda Gebelik Haftasina Göre Tedavi Yaklaşimlarinin Retrospektif Değerlendirilmesi
    (2017) Tunç, Senem Yaman; Sak, Sibel; Peker, Nurullah; Gül, Talip; Başaranoğlu, Serdar; Karaçor, Talip
    Çalışmamızda tersiyer bir merkezde ektopik gebelik (EG) tanılı hastalarda tanıya giden adımlar ve tedavi yöntemleri irdelendi. Son adet tarihine (SAT) göre gebelik haftasının tedavi yöntemleriyle ilişkisi değerlendirildi.Gereç ve Yöntem: Çalışmamızda 2011-2014 tarihleri arasında, üçüncü basamak olan kliniğimizde EG tanısı ile tedavi edilen 192 olgu tanısal yöntemlerine ve tedavi seçeneklerine göre değerlendirildi.Bulgular: EG insidansı 30.8/1000 olarak bulundu. Tek doz metotreksat (MTX) tedavisinin başarı oranı % 69.8, iki doz MTX ile birlikte medikal tedavinin başarı oranı ise % 87.5 olarak bulundu. Cerrahi uygulanan hastalarda en sık cerrahi prosedürün (% 54) salpenjektomi olduğu tespit edildi. 37 hastada (% 19.2) ise izlem tedavisi yeterli oldu. Tedavi şekilleri ile belirli parametreler karşılaştırıldığında; geliş ?-hCG seviyesinin yüksek olması, fetal kardiyak atımın (FKA) pozitif olması, batında serbest mayi olması, kitle boyutunun büyük olması ve SAT' a göre gebelik haftasının büyük olması ile cerrahi tedaviye gidiş arasında istatistiksel olarak anlamlı fark olduğu saptandı (p<0,05).Sonuç: Erken dönemde tanı alan EG' de, SAT' a göre gebelik haftası küçük olan hastaların daha çok izlem ve medikal tedavi ile, daha geç dönemde tespit edilen hastalarda ise cerrahi tedaviye gidişin yüksek olduğu izlendi.
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    The evaluation of diagnostic and clinical findings in grand multiparous patients with endometrial cancer
    (Dicle Üniversitesi Tıp Fakültesi, 2013) Özler, Ali; Turgut, Abdulkadir; Ağaçayak, Elif; İçen, Mehmet Sait; Alabalık, Ulaş; Başaranoğlu, Serdar; Peker, Nurullah; Gül, Talip
    Amaç: Bu çalışmanın amacı grand multipar, endometrium kanserli hastaların tanısal ve klinik özelliklerini diğer endometrial kanserli hastalar ile karşılaştırarak değerlendirmektir. Yöntemler: Kliniğimizde Ocak 2006-Ağustos 2012 tarihleri arasında endometrium kanseri nedeniyle opere edilen 34 hasta dahil edildi. Hastalar doğum sayısına göre üç gruba ayrıldı; Grup 1 (doğum yapmamış hastalar, n=8), Grup 2 (doğum sayıları 1’den 4’e kadar olan hastalar, n=14), Grup 3 (grand multipar hastalar, n=12). Grand multipar hastaların tanısal, klinik ve histopatolojik verileri diğer gruplardaki hastalar ile karşılaştırıldı. Bulgular: Grup 3 (grand multipar) hastaların yaş ortalaması diğer gruplara göre anlamlı yüksek bulundu. (p<0,05). Tüm gruplar tümörün myometrial invazyon derinliği açısından karşılaştırıldığında ise anlamlı bir farklılık tespit edilmedi (p>0,05). Grup 1, 2 ve 3’ deki Evre 1A tümörlü hastaların oranlarının sırasıyla %75, %64,2 ve %83,3 olduğu bulundu. Ayrıca, bütün grand multipar hastaların evre 1 tümöre sahip oldukları bulunmuştur. Sonuç: Sonuç olarak, grand multipar hastaların tanıları daha geç yaşlarda konmakta, fakat erken evrede ve endometrioid tip endometrial kanser tanılarını almışlardır. Son doğumdan itibaren geçen süre endometrial kanser riski üzerine etkili bir faktör olabilir.
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    Evaluation of factors affecting intrapartum cesarean section rates by comparing the data of patients with vaginal delivery: A retrospective case-control study
    (Ortadoğu Reklam Tanıtım Yayıncılık, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Sengi, Abdurrahman; Çalışır, Uğur; Gül, Talip
    Objective: This study aimed to determine intrapartum cesarean section rates of our clinic as well as risk factors for intrapartum cesarean section. We also aimed to identify patients with risk factors beforehand and to reduce the intrapartum cesarean section rates and the complications that might occur due to intrapartum cesarean sections. Material and Methods: A total of 150 patients admitted to our clinic for vaginal delivery that ended up having intrapartum cesarean sections (case group) and 200 patients who had a vaginal delivery (control group) were included in our study retrospectively. Demographic, clinical, and neonatal results of the patients were compared. Results: Intrapartum cesarean section rate was determined to be 23% (150/654). The most common indication for intrapartum cesarean section was fetal distress (48%). We found that low gestational week at delivery, nulliparity, and polyhydramnios were independent risk factors for intrapartum cesarean section. We determined that gravidity and parity were not risk factors for intrapartum cesarean section. It was found that 1st minute APGAR scores of babies of patients with intrapartum cesarean section were significantly lower and that intrapartum cesarean section was an independent risk factor for this particular finding. Conclusion: The possibility of the intrapartum cesarean section should be considered in the labor follow-ups of patients with risk factors. We recommend hospital deliveries where the necessary conditions for the mother and fetus are met.
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    Evaluation of factors affecting perinatal mortality in patients with HELLP syndrome
    (Mebas Medikal Basın Yayın, 2021) Gündüz, Reyhan; Tunç, Senem Yaman; İçen, Mehmet Sait; Gül, Talip; Ertuğrul, Sabahattin
    OBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p<0.05). With respect to methods of delivery, we determined that vaginal delivery was linked to a significantly higher rate of perinatal mortality (p<0.001). Gestational age at delivery, birth weight, 1- and 5-minute APGAR scores were negatively correlated with perinatal mortality. Logistic regression revealed the APGAR score at 5 minutes as the most reliable independent predictive finding for perinatal mortality. CONCLUSION: We think that to decrease perinatal mortality rates, maternal and fetal well-being in patients with HELLP syndrome should be closely monitored and delivery and follow-up should take place at tertiary health institutions after maternal and neonatal intensive care arrangements are made. Particularly, neonates with low 5-minute APGAR scores in the postpartum evaluation of neonatal condition are recommended to be followed-up at the neonatal intensive care unit.
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    Evaluation of Maternal Hemorrhage in Placenta Accreta
    (2016) Tunç, Senem Yaman; Gül, Talip; Alan, Bircan; Başaranoğlu, Serdar; Yalınkaya, Ahmet; Evsen, Mehmet Sıddık; Ağaçayak, Elif
    OBJECTIVE: The aim of the present study is to provide a retrospective evaluation of placenta accretacases to identify the factors affecting the blood transfusion requirement, which stands as one of the mostimportant causes of maternal mortality and morbidity.STUDY DESIGN: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included inthis study. The patients' data were collected from the hospital's records.RESULTS: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The groupof patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and theblood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007).CONCLUSION: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. Thesepatients should be referred to hospitals that provide multidisciplinary care and management before thedelivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates..
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    Evaluation of patients with uterine perforation after intrauterine device placement and determination of risk factors: A retrospective case-control study
    (Yuzuncu Yil University Faculty of Medicine, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Dönmez, Dicle Akkılıç; Fındık, Fatih Mehmet; Evsen, Mehmet Sıddık; Gül, Talip
    To determine the risk factors by evaluating patients with uterine perforation after intrauterine devices (IUD) placement. Also, it was to make suggestions and contribute to the literature in order to prevent uterine perforation after the IUDs placement and how we should behave when we encounter these patients.Twenty-two patients with uterine perforation after IUDs placement (patient group) diagnosed and treated at our clinic and 30 patients with IUDs in place in the uterine cavity (control group) were retrospectively ev aluated and compared. IUDs insertion by a midwife and during the breastfeeding and puerperal period significantly increased the frequency of uterine perforation after IUDs placement, while insertion during the menstrual period significantly reduced risk. Uterine perforation after IUDs placement were most frequently localized in the myometrium (54.5%) and the douglas (13.6%). Uterine perforation-related complications were absent in 59.1% of patients. Of patients, 40.9% underwent hysteroscopy, 18.2% laparoscopy. The diagnostic method was ultrasonography alone at a rate of 68.2%. IUDs could be inserted during menstruation where possible, and patients could be informed about the high risk of uterine perforation after IUDs placement associated with the breastfeeding and puerperal periods. We recommend that IUDs be inserted with ultrasonography in this period. Midwives should receive regular training in order to increase their knowledge and experience on this subject. We recommend ultrasonography as the primary d iagnostic method. Those with IUDs embedded in the myometrium can primarily undergo hysteroscopy, and those with IUDs in the abdomen can undergo laparoscopy or laparotomy.
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    Öğe
    Gebelikte asitin nadir sebebi: Spontan ovaryan hiperstimülasyon sendromu
    (2012) Gül, Talip; Sak, Muhammet Erdal; Soydinç, Hatice Ender; Evsen, Mehmet Sıdık
    Ovaryan hiperstimülasyon sendromu (OHSS), ovulasyon indüksiyonu yapılan hastalarda sık rastlanan bir komplikasyondur. Spontan gebeliklerde oldukça nadir olmakla birlikte ortaya çıkabilir. Makalemizde 13 haftalık gebe olan ve spontan OHSS tespit edilen olgunun yönetimini sunmayı amaçladık. 35 yaşında hasta karın şişliği, nefes darlığı, bulantı, kusma ve el-ayakta şişme şikayetleriyle polikliniğimize başvurdu. Daha önce invitro fertilizasyonla (İVF) gebe kaldığı ve o gebelikte OHSS geliştiği öğrenildi. Muayene, laboratuar ve ultrasonografik incelemeler sonrası spontan OHSS tanısı konuldu. Konservatif tedavi yapıldı. 38 haftanın bitiminde sağlıklı kız bebek doğurtuldu. Daha önce İVF ile oluşan gebeliğinde OHSS geçiren hastaların, daha sonraki gebelikleri spontan olsa dahi OHSS gelişme riski akılda tutulmalıdır.
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    Öğe
    Geç postpartum eklampsi: İki olgu sunumu
    (2006) Gül, Talip; Demir, Bülent
    AMAÇ: Postpartum geç eklampsi tanısı konulan iki olgunun sunumu. OLGU: Preeklampsinin tüm klinik ve laboratuvar özelliklerini taşıyan, iki kadında, postpartum dördüncü ve yedinci günde konvülziyonlar görüldü ve bu vakalar gözden geçirildi. SONUÇ: Geç Postpartum eklampsinin, pospartum 48. saatten sonrada nadir olmayarak görülebileceğini ve labaratuar degerlerinde düzelme olsada, eklampsi krizinin ortaya çıkabileceğini vurgulamak.
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    Öğe
    Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?
    (Makerere University, 2021) Gündüz, Reyhan; Ağaçayak, Elif; Okutucu, Gülcan; Karuserci, Özge Kömürcü; Peker, Nurullah; Çetinçakmak, Mehmet Güli; Gül, Talip
    Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014-January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.
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    Öğe
    İnfertilite tedavisi gören kadınlarda cinsel mitlere inanma düzeyi
    (ANP Yayıncılık, 2017) Ekmen, Betül Uyar; Özkan, Mustafa; Gül, Talip
    Amaç: İnfertilite, reproduktif ça?da olan bir çiftte herhangi bir do?um kontrol yöntemi kullanmaks?z?n, en azbir y?l düzenli cinsel ili?kiye ra?men gebeli?in olu?mamas?d?r. Cinsel mitler, ki?ilerin cinsel konularda do?ruoldu?unu dü?ündükleri abart?l?, yanl?? ve bilimsel de?eribulunmayan inan??lard?r. Cinsel bilgi ve e?itim eksikli?i;toplumun cinselli?e yakla??m?nda kat? tutum, tabular veyasaklarla birle?ti?inde birçok cinsel soruna ve cinsel i?levbozukluklar?na yol açabilmektedir. Çal??mam?z?n amac?infertilite tedavisi gören kad?nlarda cinsel mitlere inanmadüzeyini belirlemektir. Yöntem: Çal??mam?za 100 primerinfertil kad?n hasta ve 78 sa?l?kl? kad?n al?nm??t?r.Kat?l?mc?lara sosyodemografik veri formu, Arizona CinselYa?ant?lar Ölçe?i-Kad?n Formu ve Cinsel MitleriDe?erlendirme Formu uyguland?. Bulgular: Otuz cinselmitin 9'unda inanma düzeyi infertil kad?nlarda sa?l?kl?kontrollere k?yasla istatistiksel olarak anlaml? düzeydeyüksek bulundu. ?nfertil grupta cinsel mitlere inanmadüzeyini; k?rsal kesimde ya?ama, e?itim süresinin 10 y?ldan az olmas?, geni? aile yap?s?, görücü usulüyle evlenme, infertilite ve tedavi süresinin 6 y?ldan daha uzunolmas?n?n art?rd??? bulundu. Sonuç: ?nfertil kad?nlardacinsel mitlere inanma düzeyi kontrol grubundan yüksekti. Infertil kad?nlar içerisinde inanma düzeyini en çok etkileyen faktör e?itim düzeyiydi. Toplumumuzda ve infertilbireylerde yayg?n olan mitlerin sönmesi ve daha sa?l?kl?bir cinsel ya?am için, cinsel e?itimin bireylere uygunya?ta, do?ru kaynaklardan verilmesi gerekti?ini dü?ünmekteyiz