Journal of the Turkish German Gynecological Association最新文献

Objective: Surgical site infection (SSI) is a common complication, especially following emergency caesarean section (CS) leading to maternal morbidity and prolonged hospital stay. Results are conflicting regarding the ideal method of skin closure after abdominal surgery in clean contaminated and contaminated wound. To compare the outcome of wound health between primary and delayed primary closure (DPC) of skin incision in emergency CS.

Material and methods: A total of 70 pregnant women undergoing emergency caesarean deliveries with a history of membrane rupture were randomized into group A (n=40) and group B (n=30). In group A monofilament sutures were placed in skin incision but the wound was left open for daily dressing with normal saline. It was closed by tying the monofilament sutures on fifth day and stitches were removed on seventh day. In group B skin was apposed by a routine primary closure procedure.

Results: No patient in group A required secondary wound closure following SSI (p<0.001) and duration of hospital stay was also significantly reduced (p<0.05).

Conclusion: This trial demonstrated that DPC is effective in reduction of requirement of secondary stitches due to SSI in emergency CS.

Objective: Recurrent cesarean deliveries are associated with intra-abdominal adhesions, and these adhesions affect maternal and neonatal morbidity. The aim of this study was to evaluate the relationship between the severity of striae gravidarum (SG) and intra-abdominal adhesions detected during cesarean section (CS).

Material and methods: In this prospective, case-control study, women undergoing a second CS were divided into three groups according to the severity of SG (group 1 - no SG; group 2 - mild SG; group 3 - moderate to severe SG). Demographic and clinical characteristics, grade of intra-abdominal adhesions, Fitzpatrick skin type (FST), and serum 25-hydroxy vitamin D [25(OH)D] levels were assessed in all groups.

Results: A total of 150 cases were divided into three equal groups. There was no significant difference in body mass index among the groups (p=0.155). Although lower vitamin D levels were observed in group 3 compared to the other groups (p=0.034), the grade of adhesions was not associated with vitamin D level (p=0.281). All of the grade 2-4 adhesions occurred in mild to moderate cases of SG. Intra-abdominal adhesion was absent in 92% of CS (p<0.001) in pregnancies where SG was not detected. No intra-abdominal adhesions were observed in women with FST type 1 and in 80% of cases with type 6 skin, grade 2-4 adhesions were found (p<0.001).

Conclusion: Pregnant women with moderate SG and dark skin are at high-risk of increased incidence of intra-abdominal adhesions in subsequent CS.

Objective: The aim of this study was to evaluate the effectiveness of emergency cervical cerclage (EmC) in twin pregnancies with a fully dilated cervix and amniotic membrane prolapse.

Material and methods: This retrospective study examined records from December 2015 to December 2022 and included 20 twin pregnancies. The patients were divided into two groups, the EmC group (EmC group) and the no EmC (control) group, and pregnancy outcomes were compared.

Results: EmC was performed after amnioreduction in 11 twin pregnancies. Nine patients who refused EmC were followed up with expectant management. The mean gestational age at first examination was similar between the EmC (21.36±1.62 weeks) and control group (21.00±3.16 weeks, p=0.372). The median (range) volume of removed amniotic fluid was 151.82 (120-420) mL. Cases in the EmC group gained a significantly longer delay until delivery (47.72±28.14 days) compared to controls (2.33±0.5 days, p<0.001). All of the women in the control group gave birth within three days following admission to hospital. The mean gestational age at birth was significantly higher in the EmC group (28.18±4.53 weeks) than in the control group (21.57±3.53 weeks, p<0.001). Thirteen (59.09%) infants survived in the EmC group while only two infants (22.22%) of one patient survived in the control group (p<0.001).

Conclusion: EmC increases the survival rate of infants by prolonging the gestational age at delivery in twin pregnancies. Clinicians and patients should be encouraged regarding the use of EmC in twin pregnancies with a fully dilated cervix and prolapsed amniotic membranes.

Currently, there is limited information available on the best course of action for advanced epithelial ovarian cancer (OC) with isolated extra-peritoneal disease in the cardiophrenic lymph nodes. Recently, there have been numerous reports of successful surgical removal of metastatic cardiophrenic lymph nodes in patients with OC, mostly during primary or interval cytoreduction procedures. However, the optimal management of isolated, extra-peritoneal cardiophrenic lymph node metastasis (ICLNM) remains unclear, since this clinical scenario is rather uncommon in OC and chemotherapy is so far the indicated treatment for patients with from advanced stage disease. We searched the English-language literature for cases of OC with ICLNM or recurrence, evaluating the feasibility and safety of surgical excision. From 2009 to 2022 only 11 cases were reported. In seven the tumor was of serous histology. ICLN was detected in five cases with primary disease and in the remaining six it was recurrence of OC. The primary disease was treated in 10/11 patients with primary cytoreduction while the other received systemic chemotherapy. The ICLNM was removed in all the patients, in 10 via video-assisted thoracic surgery and in one via transdiaphragmatic incision. Median follow-up was 10 months.

Objective: The aim of this study was to investigate the efficacy of injectable, platelet-rich fibrin (PRF) for the treatment of vaginal atrophy, also known as genitourinary syndrome of menopause (GSM), which may affect a third of a woman's lifespan.

Material and methods: This study included postmenopausal patients who had symptoms of genitourinary syndrome, such as vaginal burning, dryness, itching, and sexual dysfunction. Injectable platelet-rich fibrin (i-PRF) was applied to three areas on the posterior vaginal wall twice, one month apart. The genitourinary symptoms of the patients were evaluated using the female sexual function index (FSFI) and sexual life quality questionnaire before and one and six months after the procedure.

Results: Thirty-five patients were recruited with a mean age of 54.1±5.5 years. The analysis of the desire, arousal, lubrication, orgasm, satisfaction, pain, and total scores of the pre-procedural and post-procedural FSFI and sexual life quality questionnaire scores revealed significant improvements (p<0.001).

Conclusion: i-PRF treatment provided advantages such as safe and easy application, autologous material nature, absence of procedure-related complications or side effects, short procedure time, absence of the need for hospitalization, low cost, and a non-hormonal nature. These results suggest that injectable, PRF may be a promising treatment option in patients with symptoms of GSM. However, larger randomized controlled studies are needed to confirm and validate our findings.

There is a growing need for dental treatments in women during the puerperal period as a consequence of hormonal and physiological changes that occur. There are effective methods that dentists can apply while treating patients in the puerperal period and while ensuring the maintenance of treatment. The framework of these methods covers a wide range of subjects, from the examination and diagnosis process of the dentist to the treatment protocols and the oral hygiene motivation of the patient. This review focuses on restorative treatment protocols that dentists would apply to patients in the puerperal period and the maintenance of these treatments.