Nebahat Uzunay

Aim: To evaluate the management process and short-term maternal outcomes of pregnant women treated for intrauterine fetal demise (IUFD) at our institution, and to compare maternal outcomes according to the mode of delivery.Methods: In this single-center, retrospective, observational study, 115 cases at ≥20 weeks of gestation with absent fetal cardiac activity on ultrasonography (US) whose management was completed at the same center were analyzed. Demographic/obstetric characteristics and maternal morbidity outcomes (postpartum curettage, blood transfusion, additional interventions due to postpartum hemorrhage, intensive care unit [ICU] admission) were assessed, and surgical procedures performed for various indications were described. Multivariable logistic regression models were constructed to identify factors associated with cesarean delivery and severe maternal morbidity.Results: The mean maternal age was 31.0±6.9 years, and the median gestational age was 32.5 (27.1–35.5) weeks. Induction of labor was performed in 55.7% of cases (most commonly misoprostol, 37.4%). Deliveries occurred vaginally in 74.8%. The median time from admission to delivery was 4.5 (1.4–15.3) hours, and the median length of hospital stay was 2.0 (2.0–3.5) days. Placental pathology examination was performed in 67.0% of cases, with abnormal findings identified in 60.9%. Postpartum curettage was required in 37.4%, blood transfusion in 18.3%, ICU admission in 8.7%, and severe maternal morbidity occurred in 20.0%. Compared with the vaginal delivery group, the cesarean group had a greater hemoglobin decrease, higher transfusion requirement, and more frequent ICU admission (p

OBJECTIVES: Fumarate hydratase (FH)-deficient uterine leiomyomas are a rare variant of smooth muscle tumors that may signal underlying hereditary syndromes like HLRCC, making their recognition crucial for gynecologists and pathologists. STUDY DESIGN: This retrospective case series included ten patients who underwent surgery for uterine fibroids (benign smooth muscle tumors) between November 2015 and October 2023. Immunohistochemistry (IHC)-a lab technique using antibodies to detect specific proteins in tissue-was performed to confirm fumarate hydratase (FH) deficiency. After confirmation, patients underwent renal ultrasonography (kidney ultrasound) and had available imaging reviewed (CT and MRI, both advanced modalities). Each patient also underwent skin assessment for cutaneous leiomyomas (skin tumors) and received counseling for FH deficiency. Demographic, clinical, surgical, and familial data were collected and analyzed descriptively. RESULTS: The mean age of patients was 40.2 years (range: 27-52), and the mean BMI was 26.9 ± 3.8 kg/m². Five patients underwent myomectomy, including one laparoscopically. The remaining five had a hysterectomy via Pfannenstiel incision. All diagnoses of FH-deficient leiomyomas were confirmed by immunohistochemistry. Two patients exhibited notable co-pathologies: one with adenomyosis and the other with a low-grade appendiceal mucinous neoplasm (LAMN). Family history findings included one patient with a sibling diagnosed with renal cell carcinoma, one patient with a sibling diagnosed with endometrial cancer, and another patient with first-degree relatives affected by uterine leiomyoma and endometrial intraepithelial neoplasia. Germline FH mutation analysis was not performed for any patient. Fertility-preserving procedures were offered to women of reproductive age, but no pregnancies were recorded during follow-up. CONCLUSION: FH-deficient leiomyomas (fibroids lacking fumarate hydratase activity) should be considered in patients with large, multiple, or early-onset fibroids. Histopathology (examination of tissue under a microscope) and IHC (immunohistochemistry, a specialized lab technique for identifying proteins in tissue) are essential for diagnosis. Germline FH testing (testing for inherited mutations in the FH gene) was not systematically performed in our cohort. However, genetic referral (to a genetics specialist) was offered to 5 patients in the most recent year. This reflects a shift toward integrating molecular assessment into clinical practice. Our experience highlights the need to incorporate genetic counseling, routine renal imaging (regular kidney scans), and dermatologic evaluation (skin checks) into follow-up, especially for patients with features suggestive of a syndromic condition (that is, symptoms that could indicate a genetic syndrome).

Objective: This study aimed to investigate the relationship between vaginal symptoms, sexual function, and vaginal lubrication levels, measured objectively with the Vaginal Lubrication Kit (VLK), in pregnant women. Material and Methods: This observational, cross-sectional study included 105 pregnant women (age: 30.2 ± 5.8 years, height: 161.4 ± 5.6 centimeter (cm), weight: 68.1 ± 10.3 kg, Body Mass Index (BMI): 26.2 ± 4.4 kg/m2) admitted to the Obstetrics and Gynecology Clinic of Istanbul Training and Research Hospital between January and August 2024. Sociodemographic and obstetric characteristics were recorded, and participants were assessed using the Female Sexual Function Index (FSFI) and Visual Analog Scale (VAS) for vaginal dryness, burning, and dyspareunia. The VLK scores were obtained using a modified Schirmer test strip adapted for vaginal application. Correlation analyses were performed using Spearman’s rank test. Results: The mean number of pregnancy weeks of participants was 20.5±11.4 weeks, and the mean parity was 2.0±1.4. The mean VLK score was 24.6±11.0 mm. The mean FSFI score was 16.6±11.2, whereas the mean VAS scores were 1.9±2.6 cm for vaginal dryness, 2.1±2.7cm for burning, and 1.9±2.7cm for dyspareunia. VLK scores were significantly positively correlated with FSFI scores (r=0.230, p=0.018) and moderate-to-strong negative correlations with VAS dryness (r=–0.680), burning (r= –0.530), and dyspareunia (r=–0.530), (p<0.001). Conclusion: VLK is a safe and non-invasive method to evaluate vaginal lubrication in pregnant women, lower scores being associated with more symptoms and reduced sexual function.

Background: Actinomyces colonization is a known complication associated with long-term intrauterine device (IUD) use. Understanding the clinical and demographic characteristics of affected patients may help clarify the relationship between extended IUD use and the risk of colonization. Methods: Between 2014 and 2024, 259 patients who used copper IUDs and were diagnosed with Actinomyces were retrospectively reviewed from the electronic hospital database of Istanbul Training and Research Hospital, Health Sciences University. Patient demographics, including age, parity, history of abortion, duration of IUD use, clinical symptoms, and diagnostic methods were recorded. Actinomyces diagnosis was made via cytological smears and histopathological confirmation was obtained in a limited number of cases that underwent surgery. Descriptive statistics and correlation tests were used in statistical analyses; significance level was set at p < 0.05. Results: The majority of the 259 patients included in the study had been using IUDs for longer than average duration. The most common complaints were vaginal discharge and pelvic pain, while a significant number of cases were asymptomatic. The diagnosis was mostly made by cytological smear test. Statistical analyses revealed a significant positive correlation between IUD use duration and age ( p < 0.05). No significant association was found between gravidity, parity, abortion history, and Actinomyces diagnosis. These findings suggest that prolonged IUD use is the most significant risk factor for Actinomyces colonization. Conclusion: Long-term use of copper IUDs is a significant risk factor for Actinomyces colonization. These findings emphasize the importance of regular follow-ups and timely IUD replacement to reduce infection-related complications.

Amaç: Çalışmamızın amacı, pelvik organ prolapsusu (POP) olan kadınlarda temporomandibular ekleme (TME) ait parametrelerin semptomatik rahatsızlık düzeyi üzerindeki etkisinin incelenmesidir. Yöntemler: Tanımlayıcı epidemiyolojik araştırma olarak planlanan çalışmamıza, uzman bir hekim tarafından POP tanısı alan 50 kadın dâhil edildi. Katılımcıların POP’a ilişkin semptomatik rahatsızlık düzeyi “Pelvik Organ Prolapsusu Distres Envanteri-6 (POPDE-6)” ile değerlendirildi. TME’ye ait parametreler kapsamında masseter kası üzerindeki tetik nokta varlığı palpasyon yöntemi ile, TME’ye ait hareketlerin değerlendirilmesi cetvel ile, TME’nin fonksiyon kısıtlılığı ise “Çenenin Fonksiyon Kısıtlanma Skalası-20 (ÇFKS-20)” ile bir kereye mahsus olmak üzere değerlendirildi. İstatistiksel analiz, POPDE-6 bağımlı değişken, TME’ye ait parametreler ise bağımsız değişkenler olarak ele alınarak çoklu regresyon analizi ile gerçekleştirildi. Bulgular: ÇFKS-20’nin POPDE-6 üzerinde istatistiksel olarak pozitif yönde anlamlı bir etkisi (p=0,008, B=0,386); sol lateral hareketin ise POPDE-6 üzerinde negatif yönde anlamlı bir etkisi (p=0,012, B=-0,472) bulunurken, TME ait diğer parametrelerin POPDE-6 üzerinde istatistiksel olarak anlamlı bir etkisi bulunmadı (p>0,05). Sonuç: Çalışmamızın sonuçları, TME’ye ait parametrelerin POP’a ait semptomatik rahatsızlık düzeyi üzerinde farklı etkiler göstermesi nedeniyle, klinikte POP tanısı alan bireylerde TME’ye ait parametrelerin de değerlendirilmesinin gerekliliğini vurgulamaktadır.

Aims: Despite symptom inquiry and preoperative sampling are performed for endometrial, cervix and ovarian pathologies in the preoperative evaluation, it is not clear whether cancer will be detected in the surgical specimen of an asymptomatic patient for pelvic organ prolapse surgery. In our study, we aimed to investigate the incidental cancer rates in patients who underwent vaginal or abdominal surgery due to pelvic organ prolapse. Methods: In this retrospective study, all patients who underwent surgery for pelvic organ prolapse at Istanbul Training and Research Hospital between 2019 and 2023 were included in the study. Patients who had diagnosis of cancer were preoperatively excluded from the study. Preoperative transvaginal ultrasound were made for all patients using sonography by 5 MHz probe, (Voluson E8, GE Healthcare, Milwaukee, WI) or MRI. Accompanying endometrial, myometrial and adnexial pathologies were recorded. Routine endometrial thickness at preoperative evaluation was saved. Type of the surgery for pelvic organ prolapse, complications and final pathology reports were recorded. Approval for this study was obtained from İstanbul Training and Resarch Hospital Education Planning and Coordination Department (Date 13.10.2023, Decision No. 277). This study had been performed in accordance with the ethical standards described in Declaration of Helsinki. Results: 107 patients had surgery due to pelvic organ prolapse between between 2019 and 2023. Mean endometrial thickness before surgery was 4.72+-4.27 mm. After surgery, all of the hysterectomy +- salpingooferectomy specimen sent to pathology. In our study there was a statistical difference between preoperative and postoperative diagnosis of endometrial polyps as p:0.0001. Due to the fact that Pipel is more effective in postmenopausal patients, the false-negative rate of office endometrial sampling, and that the main evaluation should be endometrial sampling accompanied by hysteroscopy. We did not evaluate endometrium by hysteroscopy preoperatively, so endometrial polyps can be found incidentally. In our study there was no incidental diagnosis of cancer. Conclusion: Despite the risk of incidental cancer detection is different and controversial in the literature, it was ultimately decided to send the hysterectomy material for routine pathological examination.

Purpose: Threatened preterm labor (TPL) resulting in preterm delivery is known to be one of the leading causes of adverse pregnancy outcomes and neonatal morbidity. In the current study, we evaluated patients with TPL to understand the probable association between positive urogenital culture and preterm labor. Materials and Methods: Medical records of patients who were admitted for TPL between 2018 and 2022 were reviewed. Demographics, gestational history and culture results of both vaginal swabs and urine samples were recorded. Transvaginal ultrasonographic (TVUS) measurement of cervical lengths were performed during preterm or term delivery, and graded as