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    A comparison of the clinical features of molar pregnancy in adolescents and adults
    (Professional Medical Publications, 2024) Ozer, Mehmet; Ozer, Pinar Tugce; Karaca, Ibrahim; Karaca, Suna; Ileri, Alper; Budak, Adnan
    Objective: To compare the age -specific clinical features of molar pregnancy and to describe the risk factors associated with this situation. Method : This retrospective case -control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (<= 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents. Results : This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 +/- 2.73 days versus 3.59 +/- 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%). Conclusions: A dolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.
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    Association of polycystic ovary syndrome with mammographic density in Turkish women: a population-based case-control study
    (Assoc Medica Brasileira, 2023) Senkaya, Ayse Rabia; Ari, Sabahattin Anil; Karaca, Ibrahim; Kebapci, Eyup; Ismailoglu, Eren; Oztekin, Deniz Can
    OBJECTIVE: The objective of this study was to investigate the breast densities and Breast Imaging-Reporting and Data System scores of patients with polycystic ovary syndrome and normoovulatory women and to determine whether these patients constitute a high-risk population for breast cancer.METHODS: This retrospective case-control study was conducted at our institution between January 2022 and December 2022, involving patients diagnosed with polycystic ovary syndrome. Menstrual periods, hyperandrogenemic findings, and ultrasound reports of the patients were retrieved from our hospital's database. Patients who met at least two of the Rotterdam criteria were included in the polycystic ovary syndrome group. A total of 70 premenopausal patients over the age of 40 years, diagnosed with polycystic ovary syndrome, and 70 normoovulatory women, matched for age and body mass index, were included in the study. The two groups were compared regarding age at menarche, menstrual pattern, gravida, parity, levels of follicle-stimulating hormone, luteinizing hormone, and estradiol, endometrial thickness, breast density category, and Breast Imaging-Reporting and Data System classifications.RESULTS: Patients in the polycystic ovary syndrome group had a higher age at menarche (12.7 vs. 12.3, p=0.006). There was no difference between the gonadotropin levels in both groups. However, the estradiol level was higher in the polycystic ovary syndrome group (p<0.001). There was no statistically significant difference between the two groups in terms of breast density and Breast Imaging-Reporting and Data System scores (p=0.319 and p=0.650, respectively).CONCLUSION: Although we can conclude that the risk of breast malignancy is not increased in patients with polycystic ovary syndrome, the impact of the complex hormonal status of polycystic ovary syndrome on breast cancer remains unclear in the literature.
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    The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study
    (Elsevier Masson, Corp Off, 2023) Ileri, Alper; Karaca, Suna Yildirim; Ileri, Hande; Karaca, Ibrahim; Golbasi, Hakan; Ozer, Mehmet; Budak, Adnan
    Aim: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage.Methods: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) >= 25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records.Results: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351).Conclusions: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.
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    Facilitating method for removal of the large uterus after laparoscopic hysterectomy: Vaginal vault vertical incision
    (Elsevier Masson, Corp Off, 2023) Karaca, Ibrahim; Demirayak, Gokhan; Ozturk, Emine; Adiyeke, Mehmet; Inan, A. Hamdi; Karaca, Suna Yildirim
    Background: In patients with a large uterus, an important part of the laparoscopic hysterectomy operation time is the phase of removing the uterus from the abdomen.The development of techniques that will shorten the morcellation time is the key to reducing the total operation time. Aim: To evaluate the effect of vaginal cuff vertical incision in accelerating removal of the large uterus in lapa-roscopic hysterectomy. Methods: This study was performed with patients who underwent total laparoscopic hysterectomy. In the study group, a vertical incision was performed in the middle of the posterior vaginal stump before the vaginal removal of the larger uterus (weighing more than 500 g). The control group consisted of patients who under-went vaginal morcellation after conventional colpotomy. Patients in both groups were matched in terms of uterine weights +/-50 g and the same vaginal morcellation technique was applied to all patients. Results: In patients who underwent a vertical incision procedure, the time to remove the uterus from the abdomen (17.55 +/- 2.53 min vs 26.62 +/- 4.72 min, p<0.001) and the total operation time (130.81 +/- 12.83 min vs.143.29 +/- 13, 15 min, p = 0.001) was statistically significantly less than the patients without vertical incision. There was no difference between the groups in terms of intraoperative complications, drop in hemoglobin levels, time to flatus, postoperative 6th,24th hour visual analog score and length of hospital stay. Conclusions: The vertical incision procedure reduces the time to remove the large uterus from the abdomen after laparoscopic hysterectomy and, accordingly, the total operation time. This procedure may be the pre-ferred method before vaginal morcellation, especially in large uterus.(c) 2022 Elsevier Masson SAS. All rights reserved.
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    Is frozen embryo transfer truly a risk factor for postpartum hemorrhage?
    (Wiley, 2024) Yavuz, Onur; Karaca, Ibrahim
    [No abstract available]
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    Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study
    (Royal College Surgeons Edinburgh, 2024) Kebapci, Eyuep; Karaca, Ibrahim; Senkaya, Ays Rabia; Hacioglu, Ali Doruk
    Objective: To compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methods: Pelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. Results: Puborectal hiatus distance was higher in the HD group (59.2 +/- 8.7 mm vs. 55.5 +/- 7.1 mm, p = 0.03). Similarly, the distance to the M line was greater in the HD group (18.3 +/- 4.8 mm vs. 16 +/- 4.6 mm, p = 0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 +/- 291.4 mm(2) vs. 1897.5 +/- 352.5 mm(2), p = 0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p = 0.03). There was a negative correlation between birthweight and obturator internus muscle area (r = -0.388, p = 0.02), and a positive correlation with M line distance (r = 0.344, p = 0.04). Conclusion: Levator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.
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    Uterine isthmus contractions during pregnancy
    (Mosby-Elsevier, 2024) Yavuz, Onur; Karaca, Ibrahim
    [No abstract available]