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Volume : 54 Issue : 1 Year : 2024

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 54 (1)
Volume: 54  Issue: 1 - 2023
FRONTMATTERS
1.Cover

Page I

2.Editorial Board

Pages II - IX

ORIGINAL RESEARCH
3.Does detection of follicle rupture affect success in intrauterine insemination cycles? A tertiary center experience
Çiğdem Yayla Abide, Belgin Devranoğlu, Nurullah Peker, Ebru Çöğendez, Pınar Kumru
doi: 10.14744/zkmj.2022.65391  Pages 1 - 6
INTRODUCTION: The aim of this study is to investigate the effect of intrauterine insemination (IUI) performed simultaneously with ultrasound detected follicular rupture during biological reproduction window on pregnancy rates in patients with unexplained infertility undergoing ovulation induction (OI) cycles with gonadotropins.
METHODS: Three-hundred and twenty-five patients with unexplained infertility were included in this prospective cohort study, who received recombinant follicular stimulating hormone (75–150 IU/day) or Human Menopausal Gonadotropin starting from the 2nd to 3rd days of the cycle. IUI was carried out with ultrasonographic monitoring of the follicles. The presence of free fluid within the Douglas pouch, detection of corpus luteum, and/or loss of the dominant follicle was interpreted as follicular rupture. Pregnancy rates with or without follicular rupture were compared after 14 days.
RESULTS: Among those with follicular rupture, the time between administration of recombinant hCG and IUI was significantly longer as compared to those without follicular rupture (p<0.001). β hCG was positive at 14 days after IUI in 19.01% (31/163) and 13.92% (22/158) of the cases with or without follicular rupture, respectively. The difference in pregnancy rates was not significant (p=0.219).
DISCUSSION AND CONCLUSION: IUI simultaneously performed with ultrasound-detected follicular rupture in OI cycles with gonadotropins does not increase pregnancy rate.

4.High dose versus low dose oxytocin for induction of labor of nulliparous Robson group II women at term
Ümit Taşdemir, Elif Gül Yapar Eyi
doi: 10.14744/zkmj.2022.92408  Pages 7 - 11
INTRODUCTION: Induction of labor refers to stimulation of uterine contractions before the beginning of the labor spontaneously. Labor induction procedure using oxytocin is increasing over the years. Herein, we aimed to compare the cesarean section (CS) rates in Robson Group II women by administering either high-dose or low-dose oxytocin induction protocols and to evaluate the duration of labor, fetal and maternal outcomes, and complications.
METHODS: In total of 150 nulliparas between 37and 42 weeks of gestation with singleton, viable, vertex presented and without uterine surgery, uterine anomaly history, and congenital anomalies were included to our study. The participants were divided into two groups regarding initial dose and dosing increments of oxytocin. Sixty-four patients were included in high dose group and 86 patients were included in low-dose group. Oxytocin was started at a dose of 4 miliunit (mU/min) and was increased 4 miliunit (mU/min) per 15 min until effective contractions were obtained in the high dose of oxytocin group. Oxytocin was started at a dose of 2 miliunit (mU/min) and was increased 2 miliunit (mU/min) per 15 min until effective contractions were obtained in the low dose of oxytocin group. Effective contractions are defined as over 200 montevideo unit in 10 min.
RESULTS: High-dose induction protocol did not indicate a difference in the duration of the first stage of active labor but shortened the second stage significantly (p=0.015). There was no significant difference in the CS rates, maternal, and fetal complications of two groups. High-dose induction protocol may have induced an increase in thick meconium-stained births (p=0.044), however did not promote fetal distress rates determined with cord blood gas or reduce Apgar scores.
DISCUSSION AND CONCLUSION: There was no difference between high- and low-dose induction protocols in terms of CS rates, maternal, and fetal complications. Both protocols seem safe to use in nulliparous term pregnant women.

5.Effectiveness of tranexamic acid on bleeding in conization
Ayşe Betül Albayrak Denizli, Evrim Bostancı Ergen, Pelin Özdemir, Özgür Aktaş, Burak Giray, Canan Kabaca Kocakuşak
doi: 10.14744/zkmj.2022.62534  Pages 12 - 16
INTRODUCTION: Bleeding is the most common complication of conization of cervix. Hemostatic sutures, intraoperative ferric subsulfate, or vasopressin can be used when intraoperative bleeding occurred, whereas oral tranexamic acid (TA) may be used for post-operative bleeding. In this study, we aimed to find out whether intraoperative cervical TA administration in patients undergoing conization caused changes in the amount of intraoperative bleeding and post-operative hemogram.
METHODS: Patients who have undergone cervical conization between January 2019 and July 2019 in Zeynep Kamil Health Application and Research Center Gynecological Diseases and Birth Clinic were evaluated. One hundred and five patients were included to our study. One ampoule of 10% TA was applied cervically to 47 of these patients. Both groups were evaluated in terms of measuring the intraoperative amount of blood in the aspirator, changes in post-operative hb/htc/plt values compared to the pre-operative values, and the rate of post-operative bleeding.
RESULTS: In our study, the amount of intraoperative hemorrhage and pre-operative hemoglobin, hematocrit, and platelet values compared to the post-operative values were found to be similar in both groups.
DISCUSSION AND CONCLUSION: Although TA has been shown to be effective on hemorrhage in benign gynecologic operations, menorrhagia, and postpartum hemorrhages, no significant effect on hemorrhage in conization with cervical TA administration has been demonstrated.

6.Single-center and retrospective analysis of growth hormone supplementation in IVF patients of age 40 years and older
Sanai Aksoy, Ebru Alper, Sinem Ertaş
doi: 10.14744/zkmj.2022.93284  Pages 17 - 21
INTRODUCTION: Female age is the most important factor determining success in Assisted reproductive technologies (ART) cycles. The objective in this study was to observe how growth hormone (GH) supplementation affects ART outcome parameters in advanced age women (40 years and above).
METHODS: This retrospective study involved 807 patients of age 40 years and older who applied to the tertiary ART clinic between January 01, 2018, and December 31, 2021. Only the first ın vitro fertilisation cycles of the cases were taken into consideration in the study. The study group involved 56 cases which received GH supplementation and the control group involved 751 cases which received conventional ovarian stimulation. The cycles of 177 patients (seven patients in the study group and 170 patients in the control group) were canceled because of inadequate ovarian response, lack of oocytes or fertilization failure. In the GH group, patients used 4 mg recombinant Somadotropin (Saizen 12 mg/1.5 mL, Merck Germany) for 3 days starting from the 2nd or 3rd day of menstruation.
RESULTS: Although the duration of infertility was longer in the group that received GH (6.07±4.91 vs. 4.43±4.70), the total amount of gonadotropin usage was lower than control group (4734.00±76.76 vs. 5191, International unit [IU]±743.70). The rate of cycles cancelled, total number of oocytes retrieved, total number of Metaphase II oocytes, rate of oocyte maturation, number of 2PN, rate of fertilization, embryo utilization rate, and number of transferable embryos were similar in the two groups. While the pregnancy rates were comparable, the live birth rate was observed to be higher in the GH group (5.8% vs. 18.8% p=0.013).
DISCUSSION AND CONCLUSION: In women aged 40 years and older, GH supplementation is associated with lower amount of gonadotropins usage for ovarian stimulation and higher live birth rates.

7.Ultrasonographic findings and natural history of pregnancies diagnosed as fetal trisomy 18, trisomy 13, and triploidy
Gizem Elif Dizdaroğulları, Oya Demirci, Münip Akalın, Aydın Öcal, Mucize Eriç Özdemir, Özge Kahramanoğlu, Ali Karaman
doi: 10.14744/zkmj.2022.48658  Pages 22 - 27
INTRODUCTION: The aim of this study was to investigate fetal ultrasonographic findings and perinatal outcomes in pregnancies with fetal trisomy 18, trisomy 13, and triploidy.
METHODS: Pregnancies diagnosed as fetal trisomy 18, trisomy 13, and triploidy at a tertiary center between January 2013 and January 2020 were included in the study. Maternal ages, gestational ages at the time of diagnosis, antenatal follow-ups, prenatal fetal ultrasonography reports, perinatal outcomes, whether the pregnancies resulted in live births, and the outcomes of the newborns were obtained.
RESULTS: A total of 104 cases (trisomy 18 [n=74, 71.2%], trisomy 13 [n=21, 20.2%], and triploidy [n=9, 8.6%]) were included in the study, and pregnancy was terminated in 79 (76.0%) of the cases. The most common anomaly was cardiac malformations in fetuses with trisomy 18 and triploidy, and central nervous system anomalies in fetuses with trisomy 13. Of 25 patients who preferred to continue the pregnancy, nine (36.0%) resulted in miscarriage and 13 (52.0%) resulted in fetal death. In all three pregnancies that resulted in live births, newborns died in the early neonatal period.
DISCUSSION AND CONCLUSION: Most fetuses with trisomy 18, trisomy 13, and triploidy have severe fetal malformations. In cases where the pregnancy is not terminated, the risk of fetal loss is high. Patients with the expectation of self-termination should be informed that this loss may not occur until the third trimester and that pregnancy may result in a live birth.

8.The effect of obesity on reproductive outcomes in ICSI/ET cycles
Serap Emre, Meriç Karacan, Tuğba Özcan
doi: 10.14744/zkmj.2022.26937  Pages 28 - 31
INTRODUCTION: Obesity is an important public health problem among women at reproductive age. The relationship between obesity and reproductive functions is well known mainly in the negative way. This study aims to explore the effects of obesity on intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) cycles and pregnancy outcomes.
METHODS: This study was yielded retrospectively at a tertiary Reproductive Medicine and Infertility Center. Patients aged between 25 and 45 years, who underwent ICSI and ET procedure for infertility between 2015 and 2017 were included recruited in this study. Patients were stratified into three groups, as: (i) body mass index (BMI) <25 kg/m2 (normal weight); (ii) BMI between 25 and 30 kg/m2 (overweight), and (iii) BMI >30 kg/m2 (obese). The success was defined as positive serum ß-hCG levels 10–12 days after the ET.
RESULTS: A total of 196 women were included in the study. A negative association was found between conception, live birth rate, and BMI (normal weight versus obese patients) (p=0.036). A mean of 2.25 oocytes more were collected in patients with normal BMI compared with obese women (p=0.014).
DISCUSSION AND CONCLUSION: This study revealed that obesity negatively affects conception and live birth rates in patients undergoing ICSI-ET procedures.

9.Milrinone usage in a neonatal intensive care unit: Indications, side effects, and outcomes
Aslı Okbay Güneş, Güner Karatekin, Sevilay Topçuoğlu, Nilgün Karadağ, Handan Hakyemez Toptan, Elif Özalkaya
doi: 10.14744/zkmj.2022.90958  Pages 32 - 37
INTRODUCTION: We aimed to evaluate the indications, side effects, and outcomes of milrinone infusion in neonates.
METHODS: Twenty-five neonates, who were admitted to the neonatal intensive care unit and received milrinone infusion between January 2015 and June 2019, were retrospectively evaluated.
RESULTS: The mean birth weight and gestational age of the neonates were 2220±1020 g and 35±4 weeks, respectively. The indications for milrinone infusion included pulmonary hypertension (PH) (n=14, 56%), low cardiac output syndrome (LCOS) (n=10, 40%), and post-ligation syndrome (n=1, 4%). Hypotension was the most common clinical side effect (n=9, 36%), thrombocytopenia (n=7, 28%), and azotemia (n=5, 20%) which were the most common laboratory side effects. The mortality rate was higher among the neonates who had PH (n=12, 85.8%) compared to those who had LCOS (n=4, 40%). The mean vasoactive inotropic score was higher (79.5±74.48) in the neonates with LCOS who died compared to the ones who survived (45±29.6).
DISCUSSION AND CONCLUSION: The most common indication for milrinone was PH, the most common clinical side effect was hypotension, and the most common laboratory side effect was thrombocytopenia. Close monitoring of blood pressure, thrombocyte count, and renal function tests should be performed in patients receiving milrinone. Milrinone was found to be more successful in treating LCOS compared to treating PH. The increased need for inotropic support while receiving milrinone was associated with high mortality.

10.Pre-operative and post-operative changes in values of CRP and hemogram in children with perforated appendicitis
Ali Enez, Ayşenur Celayir
doi: 10.14744/zkmj.2022.04809  Pages 38 - 42
INTRODUCTION: Since acute appendicitis is a clinical condition that develops after inflammation of the appendix, changes in the markers related to infection are expected in the laboratory tests of these cases. In this study, it was aimed to determine the changes in C-reactive protein (CRP) and hemogram examinations taken before and after surgery in children with perforated appendicitis and even to determine the markers that could indicate appendix perforation.
METHODS: This study was conducted in children with perforated appendicitis who were operated on in our pediatric surgery department in 2019. Only patients whose pre-operative and post-operative laboratory tests were performed in our hospital were included in the study. The demographic characteristics, pre-operative and post-operative (CRP, White blood cell [WBC], neutrophil, lymphocyte, mean platelet volume [MPV], and platelets [PLT]) values were analyzed retrospectively.
RESULTS: Only 69 of 141 children with perforated appendicitis who were operated on in 2019 had pre- and post-operative tests performed in our hospital. Of the 69 cases included in our study, 29 were female (40.1%) and 40 were male (59.9%). The median pre-operative values of CRP, WBC, neutrophil, lymphocyte, MPV, and PLT were 4.4 (0.2–21.66) mg/dL, 14.46 (5.27–32.6) 103/mm3, 10.03 (2.6–20.25) 103/mm3, 1.76 (0.17–8.69) 103/mm3, 8.7 (6.99–134) fL, and 280 (134–497) 103/mm3, respectively. The median values of CRP, WBC, Nötrofil, Lenfosit, MPV, and PLT on the 5th post-operative day were 3.8 (0.2–17.7) mg/dL, 11.39 (4.4–36.8) 103/mm3, 8.63 (2.12–22.02) 103/mm3, 1.75 (0.41–6.17) 103/mm3, 8.7(6.5–146) fL, and 286 (146–721) 103/mm3, respectively. The difference of CRP and WBC between pre- and post-operative values was found to be significant based on Wilcoxon Signed Rank Test (Non-parametric) (<0.05).
DISCUSSION AND CONCLUSION: Moderately high CRP and WBC values are important as an infection marker in the diagnosis of acute appendicitis. Similar to the literature, it has been shown that the CRP level, which was high before the operation, gradually decreased after the operation, but still did not return to normal at discharge. The decrease in CRP and WBC values after surgery is an indication that inflammation has regressed after appendectomy, but it takes time to completely return to normal.

CASE REPORT
11.Nipple reconstruction with skate flap technique after central lumpectomy in Paget’s disease located on the nipple
Sami Acar, Sezer Çetin
doi: 10.14744/zkmj.2022.92499  Pages 43 - 46
Paget’s disease of the breast is a pathological condition that causes long-term com-plaints in the nipple-areola complex (NAC). It is characterized by eczematous changes in the nipple. The underlying breast lesion is usually ductal carcinoma in situ, but invasive cancer can also be found. Since the clinical manifestations are very similar to many common skin rashes that a woman has experienced in her life, the diagnosis can easily be overlooked or misdiagnosed. While the traditional treatment for Paget’s disease is mastectomy; in appropriate cases, the use of radiotherapy in combination with breast-conserving surgery comes to the fore. It is aimed to present the treatment process of our patient who was admitted with a complaint of a non-healing nipple wound for a long time and was diagnosed with Paget’s disease of the breast as a result of breast-preserving surgery. Skate flap technique was preferred for nipple re-construction after central lumpectomy, and there was no loss of projection after radiotherapy. NAC is an important anatomical part of the breast and its cosmetic appearance is significantly affected in the case of surgical excision. For this reason, in cases requiring central lumpectomy, efforts should be made for nipple reconstruction.

12.Acute obstructive jaundice and hematochezia in a 3-year-old child: Attention for massive hemobilia
Ayşenur Celayir, Naime İpek Öztürk, Serdar Moralıoğlu, Feyza Yıldız, Hatice Akay, Hülya Yavuz
doi: 10.14744/zkmj.2022.05902  Pages 47 - 52
Massive hemobilia, an acute life-threatening condition, remains a diagnostic challenge in pediatric patients due to its rarity. In this study, the difficulties encountered in the diagnosis and treatment of acute massive hemobilia and acute obstructive jaundice in a 3-year-old boy are discussed in the light of the literature.

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