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    A comparison of maternal outcomes in complicated vaginal and cesarean deliveries
    (7847050 Canada Inc, 2017) Agacayak, E.; Basaranoglu, S.; Tune, S. Y.; Icen, M. S.; Findik, F. M.; Sak, S.; Gul, T.
    Objective: The purpose of this study was to compare general characteristics, laboratory data, and maternal outcomes of patients who experienced complications in the first 24 hours after a normal vaginal delivery or cesarean section (C-section). This way, the authors intended to determine the results of complications in these patients. Materials and Methods: Data of patients referred from the peripheral care centers to the present tertiary care center in the first 24 hours after a vaginal delivery or C-section due to the presence of various complications were screened retrospectively from 2009 to 2013. Clinical and demographic characteristics, laboratory parameters, indications for C-section, mortality rates, maternal morbidities, surgical and medical treatments administered in the clinic, as well as operations performed in other care centers were noted. Results: A total of 330 patients were included in this study. Of these patients, 285 constituted the postoperative group (C-sections) whereas 45 constituted the postpartum (vaginal deliveries) group. There was no statistically significant difference between the two groups in demographic characteristics, results of laboratory parameters, maternal morbidity, and mortality rates. Requirement of hysterectomy and relaparotomy was significantly higher in the postoperative group. Conclusions: In the early follow-up, it was found that complicated C-sections and vaginal deliveries had similar results. However, it should also be mentioned that higher requirement of hysterectomy and relaparotomy emerged as an undesirable condition among the postoperative patients in this study. With this in mind, mode of delivery should be selected according to the overall health status of the patient and indications for C-section.
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    Fibroblast growth factor-1 expression in the endometrium of patients with repeated implantation failure after in vitro fertilization
    (Verduci Publisher, 2013) Sak, M. E.; Gul, T.; Evsen, M. S.; Soydinc, H. E.; Sak, S.; Ozler, A.; Alabalik, U.
    BACKGROUND: An examination of the alterations in Fibroblast Growth Factor-1 (FGF-1) expression in a group of repeated implantation failure after in vitro fertilization (IVF) patients, when compared to fertile patients. PATIENTS AND METHODS: Study group consisted of 24 patients with repeated implantation failure and 29 fertile control patients. Endometrial samples received at the luteal phase were exposed to immunohistochemical staining for the fibroblast growth factor-1 (FGF-1) with antibodies. RESULTS: In the study group all patients have primary infertility (n = 24), and the average duration of infertility was 3.9 +/- 1.3 years. The average recurrent IVF failure was 2.6 +/- 0.6 attemps. There were no significant differences in the histological data according to the Noyes classification (p = 0.226) and age (p = 0.231) between the patients in the study and control groups (n=29). The control group was found to have more severe expression of FGF-1 (< 0.001) than the study group when endometrial glandular epithelial cells, stromal cells and vascular endothelial cells were evaluated. CONCLUSIONS: Endometrial glandular epithelial cells, stromal cells and vascular endothelial cells of the control and study group were evaluated and it was found that the control group displayed a stronger expression of the FGF-1 (< 0.001). The expression of FGF-1 in the IVF implantation failure group is less than in the fertile group, which suggests that growth factors such as FGF-1 are important maternal factors effecting implantation.
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    THE IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL EVALUATION OF PERICYTES IN HUMAN FULL TERM PLACENTAS OF GESTASYONAL DIABETES MELLITUS
    (Carbone Editore, 2013) Deveci, E.; Soker, S.; Turgut, A.; Aktas, A.; Ayaz, E.; Sak, S.; Seker, U.
    Pericytes, vessel wall plays a stabilizing role in the regulation of blood flow in the microcirculation. The purpose of this study is based on non-diabetic pregnancies complicated by gestational diabetes pregnancies to investigate the morphological structure of pericyte cells. In this study, as a control group human placental tissues from normotensive pregnancies was collected from diabetic wome at 28-35 weeks of gestation. Pericytes with smooth alpha-actin positive cells, endothelial cells, and painted like a belt was surrounded. Pericytes, capillary plexus and endothelial cells of large vessels in the mesenchyme around the middle shows desmin positive reaction. Placental micro vessels examined by transmission electron microscopy showed many pericytes. Placentas of gestational diabetes group, heterochromatin nucleus hypertrophy, dilatation of endoplasmic reticulum, mitochondria cristae in length, shortening was observed thickening of the filamentary structure. The contractile function of the barrier formed by endothelial cells, pericytes and can increase the contractions were considered
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    Placental expression of vimentin, desmin and ultrastructural changes in the villi in patients with HELLP syndrome
    (Verduci Publisher, 2013) Sak, M. E.; Deveci, E.; Turgut, A.; Sak, S.; Evsen, M. S.; Gul, T.; Kalkanli, S.
    OBJECTIVES: To examine placental expression of vimentin and desmin in relation to ultrastructural changes within the placental villi in cases of HELLP syndrome. STUDY DESIGN: Formaldehyde-fixed and paraffin- embedded specimens of 15 healthy pregnant and 13 Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, placentas were used for Harris hematoxylin staining, vimentin and desmin immunohistochemistry, and transmission electron microscopy (TEM). RESULTS: Increased of fibrinoid necrosis in vascular wall and the periphery of villi were observed in sections of the placentas with HELLP syndrome. Increased expression of vimentin in the intravillous area and increased expression of desmin on blood vessel wall, were seen in placentas of patients with HELLP syndrome when compared to placentas of healthy pregnant. CONCLUSIONS: Augmentation of intermediate filaments, desmin, vimentin may disturb normal movements of endothelial cells, and may display placental dysfunction that is unable to compensate the endothelial instability and the related hypertension in HELLP syndrome. Further studies are needed to get more definit results and also to compare HELLP syndrome with preeclampsia.
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    Risk factors for maternal mortality in eclampsia: analysis of 167 eclamptic cases
    (Verduci Publisher, 2012) Sak, M. E.; Evsen, M. S.; Soydinc, H. E.; Turgut, A.; Ozler, A.; Sak, S.; Celik, Y.
    BACKGROUND: The aim of this study was to evaluate risk factors associated with maternal mortality in patients with eclampsia. METHODS: The probable risk factors of maternal mortality including maternal age, length of hospital stay, gestational age, systolic and diastolic blood pressures; hematocrit, hemoglobin, platelet count, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase were determined from patients' charts and Odds ratios (OR) of these factors were detected using by logistic regression analysis. RESULTS: According to logistic regression model, AST [OR, (95% Confidence Interval, CI): 7.39 (2.71-20.13)]; ALT [6.45 (2.42-17.16)]; postpartum diastolic blood pressure [4.58 (1.80-11.62)]; hematocrit [3.52 (1.86-6.65)]; hemoglobin [2.67 (2.01-3.55)] were found to be significant risk factors for maternal mortality. CONCLUSIONS: In eclamptic patients, close monitoring of particular laboratory values and blood pressure, and early intervention to alterations of certain variables will provide possibility for prevention against potential complications and subsequently decreasing mortality.
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    Which factors may influence the duration of misoprostol-induced abortion in the second trimester?
    (I R O G Canada, Inc, 2013) Sak, M. E.; Soydinc, H. E.; Evsen, M. S.; Sak, S.; Gul, T.
    Background: To investigate the factors that may affect the time interval between induction and fetal expulsion in misoprostol-induced termination of second trimester pregnancy. Materials and Methods: A retrospective analysis of second-trimester pregnancies terminated in the second trimester between October 2008 and 2010 was performed. Induction was done by administration of 400 mcg intravaginal misoprostol. The correlation between the duration of abortion and maternal, fetal, and clinical features were statistically analyzed with multivariate regression analysis. Results: One hundred and seventy-five singleton pregnancies that met the inclusion criteria were evaluated. The average gestational age at the first induction was 18.3 weeks. The mean time interval between the first induction and expulsion was 37.2 +/- 21.3 (range 3 to 160) hours. Fetal expulsion occurred significantly at a later gestational age and those with a higher blood glucose level at admission. However, no correlation could be established between the duration of abortion and the number of pregnancies, deliveries, age, hemoglobin levels or platelet count. Conclusions: Misoprostol is safe and effective in induction of abortion during second-trimester pregnancies. The induction-to-abortion interval is longer in patients with hyperglycemia and advanced gestational age. Prospective, randomized studies are necessary to better understand the factors influencing the duration of abortion.