Journal of the Turkish German Gynecological Association最新文献

Objective: To evaluate the knowledge and use of emergency contraception (EC) amongst antenatal care attendees at the Federal Medical Center, Bida (FMCB), Nigeria.

Material and methods: This was a cross-sectional, hospital-based, descriptive study involving women attending routine check-up at antenatal clinic of FMCB. Self-administered questionnaires were completed by the women after having obtained written informed consents. Data was analyzed using the Statistical Package for the Social Sciences (SPSS), version 23.0 (IBM Inc., Armonk, New York, USA). Descriptive statistical analysis was employed. Statistical significance was set at a p value of <0.05.

Results: This research involved 129 women and demonstrated that only 43 (33.3%) had any knowledge of EC. Eighteen of these (41.9%) had their source of information from health workers followed by friends and peers (n=12, 27.9%) and one (2.3%) from public health campaign. Only 17.5% had used EC, with the majority (65.2%) using levonorgestrel pills, 13.1% used an intrauterine contraceptive device and 3.3% used the combined oral contraceptive pills. About two-thirds (67.4%) had no idea when EC would be effective. Age, tertiary level of education, religion, ethnicity, and upper socioeconomic status were all significantly associated with awareness of EC.

Conclusion: The majority of the women in our cohort were not aware of EC and the proportion who had used EC was even lower. Therefore, there is a need to increase the awareness and effective use of EC through health education and advocacy.

Torsion is the most frequent complication of ovarian dermoid cysts. Adnexal torsion typically presents as a severe abdominal pain and is treated as an acute surgical emergency. However, if surgery is delayed or the diagnosis is not made in a timely manner, autoamputation of the ovary is a very rare, but possible, complication. Herein, we report a case of an autoamputated ovary with a dermoid cyst and review the literature. A 33-year-old patient presented with pelvic pain lasting three weeks and was scheduled for a laparoscopy due to the presence of bilateral ovarian cysts, with a dermoid cyst identified on the left ovary. During the procedure, it was discovered that both the left fallopian tube and ovary were absent. The infundibulo-pelvic ligament appeared to terminate abruptly at the pelvic brim. Moreover, an 8 cm pelvic mass was found lodged in the cul-de-sac, which was extensively adherent to the bowel and the uterus, and was covered by vascular omental tissue. Histopathological analysis revealed that this pelvic mass was a dermoid cyst. The cyst contained adipose tissue, hair, and microscopic ovarian stroma, confirming the diagnosis. This case highlights the complexity of diagnosing and managing pelvic masses. Clinicians should maintain a high index of suspicion for ovarian torsion and consider the possibility of autoamputation when an ovary is not found in its anatomical location, especially if imaging suggests the presence of a dermoid cyst. This case also underscores the importance of meticulous surgical dissection for the complete removal of such masses.

Objective: To evaluate the oncological and reproductive outcomes of patients with ovarian sex-cord stromal tumors (SCSTs) treated with fertility sparing surgery (FSS).

Material and methods: This retrospective study included patients diagnosed with malignant ovarian SCSTs between February 2007 and June 2020 at Başkent University Hospital, Ankara. All patients underwent FSS, which preserved at least one ovary and the uterus. Data on demographics, surgical and pathological features, adjuvant treatments, follow-up, recurrence, survival, and obstetric outcomes were collected. Follow-up continued until September 2025, with survival analyses performed using Kaplan-Meier and Cox regression methods.

Results: The median age of the 35 included patients was 29.0 years, with a median follow-up of 141.0 months. Recurrence occurred in 17.1%, and disease-related mortality was 8.6%. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 85.7% and 97.1%, respectively. No significant factors influenced DFS, while adjuvant therapy impacted OS in univariate analysis. All patients maintained regular menstrual cycles post-treatment. Nine patients conceived (36.0%), resulting in 12 pregnancies and 6 live births (50.0%). Chemotherapy did not significantly affect fertility outcomes.

Conclusion: FSS in patients with ovarian SCSTs demonstrated favorable oncologic and reproductive outcomes. Larger, prospective multicenter studies are necessary to optimize management strategies and establish definitive guidelines for fertility preservation in this patient population.

Objective: To assess the diagnostic performance of the ultrasound-based #Enzian classification in comparison with laparoscopic surgical findings in patients with endometriosis.

Material and methods: This retrospective cohort study included patients who underwent laparoscopic excisional surgery for endometriosis between September 2023 and October 2024. Preoperative transvaginal ultrasound assessments were performed using the International Deep Endometriosis Analysis protocol, with findings recorded according to the updated #Enzian classification. Diagnostic performance was evaluated through sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. Statistical analyses were conducted using SPSS version 26.0.0.0, with statistical significance set at p<0.05.

Results: The study included 66 patients. The #Enzian classification demonstrated the highest diagnostic accuracy in compartments FA and FB (98.82% and 98.59%, respectively), both with perfect sensitivity and minimal false positives. The left ovary (O left) also showed strong performance (92.87% accuracy). In contrast, compartment A had low sensitivity (12.12%) despite a low false-positive rate. Compartments B left and C exhibited good accuracy (86.82% and 91.88%), with minimal false positives and moderate sensitivity. Variable results were observed in compartments O right and T. Although sensitivity was incomplete for FU, FI, and FO, specificity remained high across these subgroups.

Conclusion: The #Enzian ultrasound classification provides a reliable diagnostic framework, demonstrating high accuracy across multiple compartments. It is recommended that future studies include larger sample sizes and longitudinal design to further validate these findings.

Our objective is to present the laparoscopic management of a mature cystic teratoma originating from the fallopian tube and to discuss different surgical approaches. A 28-year-old nulliparous woman presented with right groin pain, and after the diagnostic evaluation, laparoscopic exploration was performed for diagnosis and treatment. Intraoperative findings revealed a 4-5 cm cyst protruding from the right tubal fimbrial ostium was identified, originating from the tubal cavity without ovarian connection. The cyst was successfully extracted through milking technique, preserving the fallopian tube. Mature cystic teratomas of the fallopian tube are extremely rare, with approximately 75 cases reported in the literature. When located near the fimbrial end, direct extraction with tubal preservation is feasible, particularly important for patients desiring future fertility. This case demonstrates successful conservative laparoscopic management preserving tubal function.

Objective: To evaluate the feasibility, safety, and surgical outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in patients with enlarged uteri due to benign, premalignant, and malignant conditions.

Material and methods: Patients who underwent vNOTES hysterectomy at a tertiary gynecologic oncology center were included. Patients with large uteri (>280 g or equivalent to >12-week size) were included regardless of prior cesarean delivery, obesity, nulliparity, or the presence of premalignant or malignant pathology. Demographic data, surgical outcomes, and complication details were analyzed. Complications were classified as minor or major.

Results: The cohort consisted of 46 women with a median age of 54 (40-74) years, and median body mass index 31 (21-51) kg/m². A history of previous abdominal surgery was present in 58.7%, and 21.7% (10/46) had previously undergone cesarean section. The median operative time was 56 (35-95) minutes, and the median uterine weight was 410 (280-1036) grams. The overall conversion and complication rates were both 4.3% (n=2). No major complications were observed. Minor complications included intraoperative bleeding controlled without transfusion and postoperative vaginal bleeding managed conservatively. The median hospital stay was 30 (16-72) hours. All patients were discharged without requiring reoperation during the postoperative period.

Conclusion: vNOTES hysterectomy was a feasible and safe, minimally invasive approach for patients with enlarged uteri, including those with obesity, prior abdominal surgery, and premalignant or malignant indications. It provides favorable surgical outcomes with low complication and conversion rates. This study supports the use of the vNOTES technique with a broader adoption in patients with large uteri.

A 51-year-old woman presented with two years of postmenopausal spotting, mainly postcoital. Although vaginal atrophy was considered, prior use of vaginal estrogen at another center had not improved her symptoms. She had a history of persistent human papillomavirus (HPV) 16 infection and abnormal cytology. Initial colposcopy showed CIN 1 but one year later, a biopsy revealed CIN 2, and loop electrosurgical excision procedure (LEEP) was performed with negative margins. At 6-month follow-up, HPV positivity and low-grade squamous intraepithelial lesion persisted, with CIN 2 on colposcopy. Despite being offered repeat LEEP, the patient opted for definitive surgery. Due to a family history of ovarian cancer, she also requested bilateral salpingo-oophorectomy. This case highlights an individualized approach to recurrent cervical dysplasia and postmenopausal bleeding. Despite long-term follow-up, cervical dysplasia persisted, necessitating surgical intervention. The procedure was completed laparoscopically without complications. Cervical stump excision is a rare but important option in patients experiencing persistent symptoms or premalignant lesions after subtotal hysterectomy (SH). This case highlights careful patient selection and thorough counseling regarding potential long-term risks, including bleeding, dysplasia, and cervical malignancy, following SH.

Objective: To investigate the potential influence of serum estradiol (E₂) and progesterone (P₄) levels, measured one day before artificially prepared frozen embryo transfer (FET), on pregnancy rates in women who received combined vaginal and injectable P₄.

Material and methods: This retrospective cohort study analyzed the association between serum E₂ and P₄ levels on the day before FET in 167 cases prepared with hormone replacement therapy between February 2022 and October 2023. The primary outcomes assessed were the pregnancy and live birth rates. We modeled a cut-off serum value based on luteal support for pregnancy. Luteal support was through a combination of vaginal suppositories and subcutaneous injections. Multivariate logistic regression was used to test relationships between pregnancy outcomes and independent variables. Cut-off values were evaluated using receiver operating characteristic (ROC) analysis and percentile analysis.

Results: No significant relationships were found between serum E₂ or P₄ levels on the day before FET and pregnancy rates. The mean E₂ level was 169.0±51.9 pg/mL for individuals who achieved conception and 177.7±56.9 pg/mL for individuals who did not conceive (p=0.45). The corresponding values for P₄ were 28.1±18.4 ng/mL and 31.2±25.4 ng/mL, respectively (p=0.73). No differences were observed in body mass index (BMI) or endometrial thickness between the groups. Cut-off values for predicting pregnancy using E₂ and P₄ could not be determined using ROCs. However, no one in the lowest 10^th percentile of serum P₄ levels conceived (range 10.0-15.6 ng/mL). When multivariate logistic regression was used, this finding lost significance suggesting that low serum levels are related to age, BMI, and/or other factors.

Conclusion: In artificially prepared FET cycles, the serum E₂ and P₄ levels one day before embryo transfer do not significantly affect pregnancy rates in women with serum E₂ levels between 150-300 pg/mL and P₄ between 10-40 ng/mL when ROC was used for evaluation. However, percentile analysis suggests that serum P₄ levels should be more than 15.6 ng/mL when combined injectable and vaginal P₄ is used for programmed FET. Although this finding may be due to the confounding effects of age, BMI, and other factors affecting steroid metabolism, when controlled for in the multivariate logistic regression.