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Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo A Blastocyst Transfer in A Fresh-Cycle
(Springer, 2019) Coksuer, Hakan; Barut, Mert Ulas; BozkurT, Murat; Agacayak, Elif; Sak, Sibel; Demir, Mustafa; Caliskan, Eray
ObjectiveTo analyze the effects of acupuncture on in vitro fertilization patients with unexplained infertility.MethodsWe retrospectively analyzed the charts of a total of 302 cycles performed in 273 patients attending Assisted Reproductive Technology (ART) Centre from August 2013 to August 2016. During the study period, embryo transfer with acupuncture (Acupuncture group, 46 cases) and without acupuncture (Control group, 42 cases) were applied. Prior to embryo transfer, the following points were used in the acupuncture group: Neiguan (CX 6), Diji (SP 8), Taichong (Liv 3), Baihui (Gv 20), and Guilai (S 29). These sessions were carried out two times before and after embryo transfer in a single day. In addition, auricular acupuncture was also performed at ear points, including ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi) and ear point 34 (Naodian). The biochemical pregnancy rate and clinical pregnancy rate after transplantation were compared between two groups.ResultsThe clinical pregnancy rate in the acupuncture group was higher than that in the control group [60.9% (28/46) vs. 33.3% (14/42), respectively, P<0.05]. Likewise, the live birth rate in the acupuncture group was also higher than that in the control group [71.7% (33/46) vs. 31.0% (12/42), P<0.01).ConclusionAdministration of acupuncture on the day of embryo transfer dramatically improved fertility results in women who underwent in vitro fertilization/intra-cytoplasm sperm injection for reproduction.
Amniotic fluid paraoxonase-1 activity, thyroid hormone concentration and oxidant status in neural tube defects
(Wiley-Blackwell, 2016) Sak, Sibel; Agacayak, Elif; Tunc, Senem Yaman; Icen, Mehmet Sait; Findik, Fatih Mehmet; Sak, Muhammet Erdal; Yalinkaya, Ahmet
AimThe aim of this study was to investigate the potential association between neural tube defects and paraoxonase-1 activity in amniotic fluid. We studied total oxidant status, total antioxidant capacity, paraoxonase-1 activity and thyroid hormone amniotic fluid concentration in fetuses with neural tube defects. MethodsThe present study was performed at the Department of Obstetrics and Gynaecology and the Department of Clinical Biochemistry of Dicle University between September 2011 and June 2013. The study group included 37 amniotic fluid samples from pregnant women (16-20 weeks of gestation) with fetuses affected by neural tube defects. The control group consisted of 36 pregnant women who were diagnosed with a high-risk pregnancy according to first or second trimester aneuploidy screening and were later confirmed on amniocentesis to have genetically normal fetuses. ResultsAmniotic fluid paraoxonase-1 activity and total oxidant status were significantly higher (P = 0.023, P = 0.029, respectively) whereas free T4 was significantly lower (P = 0.022) in fetuses with neural tube defects compared with control subjects. In fetuses with neural tube defects, amniotic fluid paraoxonase-1 activity correlated positively with total oxidant status (r = 0.424**, P = 0.010), and amniotic fluid total antioxidant capacity correlated positively with free t4 (r = 0.381*, P=0.022). ConclusionThis is the first study in the literature to show an association between paraoxonase-1 activity and thyroid hormone concentration and neural tube defects.
Assessment of oxidative stress markers in cord blood of newborns to patients with oxytocin-induced labor
(Wiley, 2017) Karacor, Talip; Sak, Sibel; Basaranoglu, Serdar; Peker, Nurullah; Agacayak, Elif; Sak, Muhammet Erdal; Turgut, Abdulkadir
Aim: We aimed to measure the extent of oxidative stress experienced during labor by the neonates of pregnant women undergoing induced or spontaneous birth and to compare the effects of induced labor on fetalwell-being. Methods: Sixty-four healthy pregnant women referring to the Department of Gynecology and Obstetrics, Dicle University Medical Faculty between October 2010 and May 2011 were included in this comparative study. Pregnant women undergoing induced labor by oxytocin were group 1 and those without labor induction were group 2. Post-partum Apgar score was calculated at 1 and 5 min and measurements of weight and height of the neonateswere carried out. After the fetal cordwas clamped, 5 cm(3) blood was drawn into a plain tube without anticoagulant. The samples were centrifuged at 5000 r.p.m. for 5 min. Separated sera were transferred to Eppendorf tubes and were stored at -80 C degrees until the analysis time. Results: The complete blood counts and biochemistry results indicated that there were no statistically significant differences in regards to diseases between the two groups. Nitric oxide and asymmetrical dimethylarginine values of the two groups were not significantly different; however, there were statistically significant differences in the malondialdehyde, paraoxonase, total antioxidative status, and total oxidative status values of the two groups (respectively, P = 0.005, P = 0.006, P = 0.008, and P = 0.007). Conclusion: We observed that oxytocin-induced labor increases stress markers but does not affect Apgar scores. Oxidative stress in pregnant women may trigger antioxidative mechanisms. Prospective studies in larger cohorts are needed to better understand the impact of oxytocin-induced labor on pregnant women and neonates.
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.
Comparison of serum and salivary alpha-fetoprotein levels in pregnancies complicated with neural tube defects
(Yerküre Tanıtım & Yayıncılık Hizmetleri A.Ş., 2020) Karaçor, Talip; Bülbül, Mehmet; Nacar, Mehmet Can; Kırıcı, Pınar; Önderci, Muhittin; Peker, Nurullah; Sak, Sibel
Objective: To compare the serum and salivary values of alpha-fetoprotein (AFP) used in screening neural tube defects (NTD) during pregnancy. To investigate whether saliva can be used instead of serum in NTD screening. Method: The study was conducted between May 2018 - November 2019 at Adıyaman University. The study included 41 pregnant women complicated by NTD and 44 healthy pregnant women. Three ml venous blood and 2 ml saliva samples were taken from both groups. Serum and saliva samples were not diluted. AFP concentration was measured at 450 nm by using commercially available enzyme-linked immunoassay. The intra‐ , and inter- test assay coefficients (CVs) of the kit were <8% and <10%, respectively. SPSS 21 program was used for data analysis. Mann-Whitney Test was used for the analysis of continuously changing parameters. The correlation coefficient was calculated by Spearman test. A p value of less than 0.05 was accepted for statistical significance. Results: When serum and salivary AFP values were compared between the two groups, the AFP values were found to be higher in both NTD group samples (p<0.001, p<0.001). In both groups, correlation analysis for serum and salivary AFP values showed a strong positive correlation (r=0.730, p<0.001). When the cut-off value for serum AFP is taken as 0.26, NTD can be determined with 100% sensitivity and 90% specificity (AUC: 0.932, p<0.001). When the cut-off value for salivary AFP is taken as 0.034, it can detect NTD with 95% sensitivity and 92% specificity (AUC: 1.00, p<0.001). Conclusion: Salivary and serum AFP values showed strong positive correlation between themselves. We believe that saliva can be used in NTD screening performed by AFP measurement.
Comparison of sVCAM-1 and sICAM-1 levels in maternal serum and vaginal secretion between pregnant women with preterm prelabour ruptures of membranes and healthy pregnant women
(Taylor & Francis Ltd, 2019) Sak, Sibel; Barut, Mert; Incebiyik, Adnan; Agacayak, Elif; Kirmit, Adnan; Koyuncu, Ismail; Sak, Muhammet
Objective: The study aims to evaluate the maternal serum and the vaginal fluid levels of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecular (sICAM-1) in pregnant women complicated by preterm prelabour ruptures of membranes (PPROM). Materials and methods: The prospective case control study included 34 pregnant women with PPROM and 34 healthy pregnant women. Patients with additional diseases, a smoking habit and vaginal bleeding, as well as those using antibiotics, during the study period were not included in the study. Cervicovaginal fluid and serum samples were taken during the patients' admission. The demographic data, maternal serum and vaginal fluid sVCAM-1 and sICAM-1, C reactive protein (CRP) and leukocyte counts were noted for all pregnant women included in the study. The sVCAM-1 and sICAM-1 levels were measured by enzyme-linked immunosorbent assay kits. Results: In pregnant women with PPROM, the serum leukocyte (mean +/- SD =11.41 +/- 1.067 versus 9.18 +/- 1.56, p < .0001), serum sVCAM-1 (median 771.20 versus 704.60 ng/ml, p < .001), sICAM-1 (mean +/- SD 213.10 +/- 35.59 ng/ml versus 188.11 +/- 37.35 ng/ml, p = .06), vaginal sVCAM-1 (median 208.00 versus 140.20 ng/ml, p = .014) and sICAM-1 (mean +/- SD 32.32 +/- 6.49 ng/ml versus 24.87 +/- 6.79 ng/ml, p < .001) values were found to be significantly higher in pregnant women with PPROM than in healthy pregnant women. A positive and significant correlation was observed between the leukocyte count and the vaginal sVCAM-1 level (r = 0.850; p < .001). Conclusion: To the best of our knowledge, this is the first study evaluating the levels of sICAM-1 in maternal serum in pregnant women with PPROM. The maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels can be used as biochemical markers supporting the PPROM diagnosis because of the increase in both maternal serum and vaginal fluid sVCAM-1 and sICAM-1 levels in pregnant women with PPROM.
Copper and ceruloplasmin levels are closely related to the severity of preeclampsia
(Taylor & Francis Ltd, 2020) Sak, Sibel; Barut, Mert; Celik, Hakim; Incebiyik, Adnan; Agacayak, Elif; Uyanikoglu, Hacer; Kirmit, Adnan
Objective: The aim of this study was to investigate the maternal serum concentrations of copper (Cu) and ceruloplasmin (CP) in patients with mild preeclampsia, severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and to determine their association with the severity of the disease. Methods: This study was carried out at the largest tertiary care health center in the southeast region in Turkey and Department of Obstetrics and Gynecology, Dicle University Hospital. A total of 179 pregnant women, including 58 healthy pregnant women and 71 mild preeclampsia, 26 severe preeclampsia, and 24 HELLP syndrome cases classified according to the American College of Obstetricians and Gynecologists? 2013 guidelines were included in this prospective study. Blood samples were taken from all the pregnant women to evaluate the serum Cu and CP levels. The Cu level was determined via atomic absorption/emission spectroscopy, while the serum CP level was assessed with a nephelometric assay using an automatic image analyzer. Spearman?s rank correlation tests were used to determine the correlations between the serum levels of the antioxidative markers and the preeclampsia severity. Results: The mean???SD of the Cu was 81.2???11.84 ?g/dl in the mild preeclampsia cases and 160.2???20.89 ?g/dl in the severe preeclampsia cases (p?
Cytogenetic screening in couples with Habitual Abortions
(Elsevier Masson, Corporation Office, 2019) Sak, Sibel; Incebiyik, Adnan; Hilali, Nese Gul; Agacayak, Elif; Uyanikoglu, Hacer; Akbas, Halit; Sak, Muhammet Erdal
Objective: Habitual abortion (HA) is defined at least three consecutive pregnancy losses. One of the etiologic causes is parental chromosomal anomalies. In this study, we aimed to that investigate the effect of parental chromosomal abnormalities on HA. Methods: The cytogenetic results of patients with at least three abortions referred to our university hospital between January 2010 - March 2017 were evaluated. A total of 1154 couples with HA were analysed. Peripheral lymphocyte cultures incubated for 72 h were used for karyotype analysis via the Giemsa banding technique. Results: Of a total 1154 couples (2308 patients) 37 female (3.2%) and 17 male (1.47%) had abnormal karyotypes. Reciprocal translocation carriage (n = 26; 1.12%) was the most commonly detected structural anomaly, followed by X chromosome mosaicism (n = 16; 0.69%), Robertsoniantransiocation (n = 9; 0.38%), Chromosomal inversion (n = 6; 0.26%). Chromosomal polymorphisms, which are considered minor chromosomal changes, were detected in 221 (9.57%) individuals. Conclusion: Our study exhibits that chromosomal analysis in patient with HA is an appropriate approach to elucidate the aetiology of HA. Data from cytogenetic screening can be used in guiding couples planning future pregnancies and in prenatal diagnosis of chromosomal anomalies in the foetus. (C) 2018 Published by Elsevier Masson SAS.
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.
Evaluation of postoperative sexual function in patients after trans-obturator-tape operation
(Aves Press Ltd, 2016) Agacayak, Elif; Basaranoglu, Serdar; Yavuz, Mustafa; Tunc, Senem Yaman; Sak, Sibel; Turgut, Abdulkadir; Deregozu, Aysegul
Introduction: In this study, we aimed to evaluate postoperative sexual function of patients, who had undergone colporraphy anterior and transobturator tape operation due to cystocele and stress urinary incontinence. Materials and Methods: In our study, 52 patients with cystocele and stress urinary incontinence that were admitted to Dicle University, School of Medicine, Department of Obstetrics arid Gynecology between January 2009 and January 2014, were included in the study. Patients with previous hysterectomy, patients who had rectocele repair during operation, patients in menopause were excluded from the study. Patients completed the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 before and after under going surgery. Results: Mean age of the patients in our study was 42.04 +/- 7.50, average body mass index of the patients was 30.1 +/- 3.7 kg/m(2). Average follow-up time was 31.5 +/- 11.3 months. 22 (42.3%) patients did not completely recovery the postoperative complaints. 2 (3.8%) patients had increased postoperative complaints. The positive correlation between postoperative complaints with dyspareunia was observed (r= 0.355 **p: 0.010). 5 (9.6%) patients developed postoperative complications. These complications, urinary comfortable inability in 2 (%3.8) patients, mesh erosion in 1(%1.9) patient, developed de novo urinary incontinence in 2 (%1.9) patients. The total result according to Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 was observed significant improvement in sexual function (p= 0.000). Conclusion: Urinary incontinence negatively affects the sexual life of women. We observed improvement in sexual function of women that had went transobturator tape operation for urinary incontinence.
Evaluation of sexual function in women with hypogonadotropic hypogonadism using the female sexual function index (FSFI) and the beck depression inventory (BDI)
(International Scientific Information, Inc., 2018) Barut, Mert Ulaş; Çoksüer, Hakan; Sak, Sibel; Bozkurt, Murat; Ağaçayak, Elif; Hamurcu, Uğur
BACKGROUND: Hypogonadotropic hypogonadism (HH), or secondary hypogonadism, results from reduced secretion of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH), by the pituitary gland, resulting in lack of production of sex steroids. The aim of this study was to evaluate self-reported sexual function in sexually active women with and without HH using two evaluation methods, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory (BDI). MATERIAL AND METHODS: The study recruited 88 women who attended an outpatient in vitro fertilization (IVF) clinic in Turkey for primary infertility, between August 2013 and August 2016. All patients were sexually active with an age that ranged from 20–41 years. Following an initial examination, including measurement of FSH and LH levels, all study participants were asked to complete the FSFI and BDI self-reporting questionnaires. Patients were divided into Group 1 (with HH) (N=42) and Group 2 (the control group) (N=46). RESULTS: Analysis of the patient responses to questions regarding their sexual function in the FSFI and BDI showed that of the 42 patients in Group 1 (the HH group), 27 patients (64.28%) reported sexual dysfunction; of the 46 patients in Group 2 (the control group) 14 patients (30.34%) reported sexual dysfunction. Analysis of the FSFI lubrication scores and orgasm scores showed a statistically significant difference between the two groups (both, p<0.01). CONCLUSIONS: Women with HH require both physical and psychological support to improve their sexual function, self-esteem, mental health, and quality of life.
Gebelik anemisinin perinatal sonuçlara etkisi
(Dicle Üniversitesi Tıp Fakültesi, 2009) Sak, Muhammet Erdal; Özkul, Özgür; Evsen, Mehmet Sıddık; Sak, Sibel; Evliyaoğlu, Osman
Gebelikte tedavi edilmemiş aneminin yenidoğanda komplikasyonlar ile ilişkili olabileceği bildirilmektedir. Çalışmamızın amacı gebelikte maternal anemi tespit edilen hastalardaki perinatal sonuçları değerlendirmektir. Çalışmaya ikinci trimesterde hemoglobin (Hb) düzeyi 8 g/dl’nin altında olan 29 anemik gebe kadın (Grup 1) ile Hb düzeyi 10 g/dl’nin üzerinde olan 30 gebe kadın (Grup 2) dahil edildi. Her iki grup için preterm doğum, intrauterin gelişme geriliği (IUGG) ve yeni doğan ünitesine sevkedilme oranları incelendi. Grup 1 de ortalama Hb konsantrasyonu 7.2±0.4 gr/dl, Grup 2 de 12.1±0.9 olarak saptandı (P<0.001). Preterm doğum oranı Grup 1 de %34.4 iken Grup 2 de %13.3 olarak bulundu (P=0.05). Grup 1 ile grup 2 arasında IUGG açısından anlamlı fark izlenmezken (P>0.05), yeni doğan ünitesine sevk oranı anemik grupta anlamlı yüksek bulundu (sırasıyla %44.8 ve %166, P=0.019). Gebelik anemisinin antenatal takipler sırasında belirlenmesi ve tedavisi perinatal komplikasyonların azaltılması bakımından önemlidir. Maternal aneminin perinatal sonuçlara etkileri açısından daha ileri çalışmalara ihtiyaç vardır.
Gebelikte adneksiyel kitle: Olgu sunumu ve literatür verilerinin değerlendirilmesi
(Dicle Üniversitesi Tıp Fakültesi, 2009) Sak, Muhammet Erdal; Koplay, Mustafa; Özkul, Özgür; Evsen, Mehmet Sıddık; Sak, Sibel
Ultrasonografi nin (USG) yaygın olarak kullanımını takiben, adneksiyel kitleler gebelerde daha sık saptanır hale gelmiştir. Bu çalışmada, antenatal takip sırasında saptanan adneksiyel kitlenin takip ve tedavi protokolü literatür bulgularıyla birlikte değerlendirildi. Gebelikte tespit edilen adneksiyel kitlelerin yönetimi; gebelik haftası, semptomatolojisi, ultrasonografi ve muayene bulguları doğrultusunda düşünülen ön tanıya göre, ailenin de görüşü alınarak şekillendirilir. Gebelik esnasında cerrahi girişimin komplikasyonları da göz önüne alınarak, gebelerde adneksiyel kitleye yaklaşım için uygun tedavi protokoller oluşturulması gerekliliği açıktır. Sonuç olarak, obstetrik USG’de adneksler mutlaka değerlendirilmeli, gebelerde abdominal cerrahi endikasyonu konurken çok dikkatli olunmalıdır
Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial
(Taylor & Francis Inc, 2021) Kilic, Gokhan Sami; Demirdag, Erhan; Findik, Mehmet Fatih; Lutfi Tapisiz, Omer; Sak, Muhammet Erdal; Altinboga, Orhan; Sak, Sibel
We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero (0) was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENT What is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery. What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries. What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.
Imperforate Hymen with Elevated Serum CA 125 and CA 19-9 Levels
(Sci Printers & Publ Inc, 2013) Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Soydinc, Hatice Ender; Sak, Sibel; Yalinkaya, Ahmet
OBJECTIVE: To report the clinical characteristics of 14 patients with imperforate hymen and their levels of tumor markers (CA 19-9 and CA 125). STUDY DESIGN: Fourteen patients with imperforate hymen who followed-up between September 2006 and September 2010 in the Department of Obstetrics and Gynecology, Dicle University School of Medicine, Diyarbakir, Turkey, were evaluated retrospectively. The clinical features and the management of the patients are discussed. RESULTS: The mean age of the patients was 13.8 years. All patients had primary amenorrhea and pelvic pain. The most common clinical symptoms were cryptomenorrhea in 14 patients, pelvic pain in 11, palpable abdominal mass in 6, voiding difficulties in 7, and defecation problems in 2. In 6 patients with palpable pelvic mass, the mean +/- standard deviation values of tumor markers were as follows: CA 125, 84.0 +/- 23.7 and CA 19-9, 162 +/- 189. One week after surgery we measured CA 125 and CA 19-9 levels once again. The postoperative mean CA 125 level was 13.8 +/- 3.6, and the mean postoperative CA 19-9 level was 17.5 +/- 3.5. Preoperative leziels of CA 125 and CA 19-9 were significantly higher than those of the postoperative period (p < 0.001 for both comparisons). Six patients were treated by T-shaped incision and 8 patients by a central surgical incision through the hymenal membrane. CONCLUSION: Diagnosis of imperforate hymen is very important before undergoing surgery in a different clinic. Many patients have seen several doctors before receiving a clear diagnosis and have had tumor markers evaluated because the presence of pelvic mass in patients suggests the possibility of a gynecologic malignancy. Imperforate hymen is one of the benign conditions that increase serum CA 125 and CA 19-9 levels and which is not listed in the classical medical textbooks. These markers are not needed for the diagnosis. (J Reprod Med 2013;58:47-50)
İnfertil Çiftler İçin Tek veya Çift İntrauterin İnseminasyon (IUI): Çift IUI Klinik Gebelik Oranlarını Artırır mı?
(2018) Sak, Muhammet Erdal; Ağaçayak, Elif; Çelik, Hakim; Budak, Özcan; Barut, Mert Ulaş; Sak, Sibel
Amaç: Bu pilot çalışmada, çoklu foliküler gelişimi olan kontrollü ovarian hiperstimülasyon (KOH) sikluslarında çift intrauterin inseminasyon (IUI)'nin etkinliğini göstermeyi amaçladık.Gereçler ve Yöntem: Tersiyer bir merkezde Kadın Hastalıkları ve Doğum Kliniğinde Mart 2017 ile Mart 2018 tarihleri arasında yardımcı üreme teknikleri (YÜT) merkezinde IUI programına alınan 20 ile 35 yaş aralığında 38 hastaya hCG yapılmasından sonra 18. ve 36. saatte 2 kez IUI yapılmış ve kontrol grubu olarak 22 ile 35 yaş aralığında 32 hastaya human chorionic gonadotropin (hCG) yapıldıktan sonra 36. saatte 1 kez IUI yapılmıştır. Toplam 70 hastanın mevcut kayıtlardan hasta ile ilgili demografik özellikler; Yaş, kilo, boy, daha önceki gebelik öyküsü (gravide, parite), öyküsünde sigara alışkanlığı, hastaların adetin üçüncü gün hormon düzeyleri [ follicle stimulating hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], Prolaktin, Anti-Müllerian hormone (AMH), antral folikül sayısı (AFC), infertilite tipi ve süresi kayıt edildi.Bulgular: Çalışmada, nisan 2017-mayıs 2018 tarihleri arasında toplam 70 infertil hasta dahil edildi. Bunların 32 (%45.7)’sinin 1 kez IUI yapılmış grubunda iken, 38’i (%54.2) 2 kez IUI yapılmış grubunda olduğu izlendi.İki gruptaki kadınların HCG günü dominant Follikül sayısı >15mm değerleri bakımından median değerleri incelendiğinde, çalışma grubundaki 2.0(1-3), kontrol grubundakilerin ise 2.0(1.0-3.0) olarak bulundu (P=0.139).İki gruptaki kadınların Klinik gebelik oranı(%) değerleri bakımından değerleri incelendiğinde, çalışma grubundaki %21.05, kontrol grubundakilerin ise %18.75 olarak bulundu (P=0.812).Sonuç: Bu çalışmada KOH ile ovülasyon indüksiyonu sonrası intrauterin inseminasyon yapılan olgularda tek ve çift IUI yapılmasının klinik gebelik oranları arasında anlamlı bir fark olmadığı gözlenmiştir. Dolayısıyla intrauterin inseminasyon yapılan olgularda maliyet göz önünde tutularak sonuçları hastayla paylaşmak gerekir.
İntrauterin fetal guatr
(2009) Çaça, Fatma Nur; Sak, Sibel; Sak, M. Erdal; Koplay, Mustafa; Özkul, Özgür
Üreme çağındaki kadınlarda tiroid bezi hastalıklarısık görülmektedir. Hipertiroidizm, gebeliktesıklıkla rastlanılan maternal endokrinopatilerdenbiridir. Hipertiroidizm gebelik seyrini, fetusu,postpartum dönemde maternal ve neonatalkoşulları olumsuz etkiler. Propilthiouracil (PTU)plasentadan daha az geçtiği için gebe kadınlardatercih edilmektedir. Ancak yüksek dozda fetalhipotiroidiye neden olacağından serum serbesttiroksin düzeyini üst sınırda tutan en düşük dozhedeflenmelidir. Bu yazıda polihidramniyosumevcut olan ve hipertiroidik annesi PTU kullandığıiçin fetal guatr oluşan bir olguyu sunuyoruz.
Kontrasepsiyon yöntemlerinin etkinliği ve kadınların eğitim düzeyi: Güneydoğu Anadolu’da bir ilçe örneği
(Dicle Üniversitesi Tıp Fakültesi, 2008) Sak, M. Erdal; Evsen, Mehmet Sıddık; Sak, Sibel; Çaça, Fatma Nur
Bu çalışmada bölgesel bazda, başvurulan kontraseptif yöntemleri, buna rağmen gelişen istenmeyen gebelikler ve öğrenim düzeyi ilişkisini değerlendirmek amaçlanmıştır. Ocak 2007-Nisan 2008 tarihleri arası Ergani Devlet Hastanesi Kadın Doğum polikliniğine başvuran ve kontraseptif yöntem kullanan 152 multipar kadında; yaş, gebelik ve doğum sayısı, evlilik süresi, istenmeyen gebelik ve buna bağlı küretaj oranları, hastaların öğrenim durumları gibi parametreler değerlendirildi. Çalışma grubunu oluşturan kadınların yas ortalaması 29.7±6.6 yıl, ortalama evlilik süresi 9.5±5.7 yıl, gravida 3.5±1.8 (1-9) ve parite: 2.8±1.3 (1-6) idi. En sık kullanılan yöntem koitus interruptus olup (% 42.1), diğer yöntemler, sıklık sırasına göre; rahim içi araç (RİA) (%19.1), oral kontraseptifler (%15.8), kondom (%13.2), tüp ligasyonu (% 7.2) ve diğerleri (% 2.6) idi. Kadınların eğitim düzeyi yükseldikçe, RİA ve oral kontraseptif kullanımı artmaktaydı (P<0.001). İstenmeyen gebelik ve buna bağlı küretaj oranları en sık koitus interruptus, en seyrek RİA yönteminde idi. Etkili aile planlaması kullanma oranın yükseltilerek, bireylerin istenmeyen gebeliklerden sağlıklı ve güvenli olarak korunmaları için, doğurganlık çağındaki kadınların eğitim düzeyinin yükseltilmesi gerekmektedir.
Levels of neopterin and other inflammatory markers in obese and non-obese patients with polycystic ovary syndrome
(International Scientific Literature Inc., 2015) Ağaçayak, Elif; Tunç, Senem Yaman; Sak, Sibel; Başaranoğlu, Serdar; Yüksel, Hatice; Turgut, Abdulkadir; Gül, Talip
Background: We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). Material/Methods: A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-? (TNF-?), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. Results: No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-?, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-?, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). Conclusions: It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area.
Multiple repeat caesarean deliveries: do they increase maternal and neonatal morbidity?
(Taylor & Francis Ltd, 2017) Tunc, Senem Yaman; Agacayak, Elif; Sak, Sibel; Basaranoglu, Serdar; Goruk, Neval Yaman; Turgut, Abdulkadir; Tay, Hayrettin
Objective: The aim of the present study is to evaluate the effects of the increased number of caesarean deliveries (CDs) in cases of multiple repeat caesarean deliveries (MRCDs) on maternal and neonatal morbidity. Methods: MRCDs admitted to our hospital between January 2013 and September 2014 were analysed retrospectively. A total number of 1133 women were included in the study and were divided into 4 groups. Group 1: second CDs (n=329); Group 2: third CDs (n=225); Group 3: fourth CDs (n=447); Group 4: fifth CDs (n=132). The clinical, demographic, intraoperative and postoperative data of the patients were registered upon the review of patient files. Results: The differences among the groups were found to be statistically significant in terms of mean maternal age, gravida, APGAR (Activity, Pulse, Grimace, Appearance, Respiration) scores, hospital stay and operation time. In addition, the difference was also statistically significant for severe adhesion, bladder injury and premature birth. No statistically significant difference was observed among the groups with respect to placenta previa, placenta accreta, caesarean hysterectomy, uterine scar rupture. Conclusions: According to our findings, MRCDs seem to increasing the maternal and neonatal morbidity even though they are not life-threatening.

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