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    Internal Iliac Artery Ligation for Severe Postpartum Hemorrhage
    (Via Medica, 2012) Siddik, Evsen Mehmet; Erdal, Sak Muhammet; Ender, Soydinc Hatice; Serdar, Basaranoglu; Cetin, Bakir; Sibel, Sak; Talip, Gul
    Objective: To evaluate the outcomes of bilateral internal iliac artery ligation (IIAL) in severe postpartum hemorrhage (PPH). Design: Multi-center, retrospective study Methods: The study was performed from January 2005 to December 2010, at the Obstetrics and Gynecology Clinic, Dicle University Medical Faculty and Maternity Hospital, Diyarbakir, Turkey Life-threatening cases of severe postpartum hemorrhage, which could not be controlled with conservative medical and surgical treatments and finally managed with IIAL, were retrospectively evaluated. Results: Totally 53 patients who underwent IIAL procedures were included in the study All patients were hemodynamically unstable. The mean shock index and transfused units of blood were 1.17+/-0.46, 5.49+/-3.04, respectively Uterine atony was the leading cause of severe postpartum hemorrhage and the need for IIAL. Coagulopathy developed in 26 (49.1%) patients during the postoperative follow-up period. Uterus was preserved in 17 (32.0%) cases. Three patients died of complications and/or morbidity associated with hemorrhage. Conclusion: Serious PPH is most frequently associated with uterine atony and IIAL should be considered in cases with severe PPH unresponsive to other treatment modalities. If, in the antenatal period, patients have risk factors of postpartum hemorrhage, they must be transferred to appropriate centers to prevent a possibly fatal outcome.
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    INTRAOPERATIVE FINDINGS OF ADNEXAL TORSION
    (Carbone Editore, 2014) Siddik, Evsen Mehmet; Abdulkadir, Turgut; Serdar, Basaranoglu; Elif, Agacayak; Yaman, Tunc Senem; Sait, Icen Mehmet; Ali, Ozler
    Objective: Adnexal torsion (AT) is a gynecologic emergency. Early intervention is important because it may give opportunity for preserving adnexa for future fertility and the function of the ovary. The aim of the study is to present intraoperative findings of the adnexal torsion. Methods: Demographic data, clinical characteristics and presence of pregnancy were noted. In patients with an intraoperatively detected AT, side (right or left adnexa), direction (clockwise or counterclockwise), number of torsions and the size of torsioned adnexa were evaluated. Results: Seventy two patients in the reproductive age with an intraoperatively detected AT were evaluated in the study. In 64 (89%) patients, the adnexa were preserved. In 50 (69.4%) patients, an AT was detected at the right adnexa but there was no statistically significant difference between two sides (p=0.543). Directions of the torsion were found to be higher in both adnexa as clockwise but the difference was not found to be statistically significant. The number of torsions were found to be higher (especially more than >= 5 times) in patients who had undergone unilateral salphingoophorectomy when compared with detorsioned cases. A linear correlation was observed between increases in the number of adnexal torsions and dimensions of the adnexal mass (r:0.454). Conclusion: Increased size of an adnexal torsion enhances the probability of adnexal necrosis and indication of salpingoophorectomy. With the priority of intraoperative exploration and inspection, the fact that clockwise rotation is a more often seen abnormality in AT, can be an important consideration in the prevention of further adnexal damage during detorsioning maneuvers.