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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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    Maternal and neonatal outcomes of couvelaire uterus
    (2021) Ileri, Alper; Karaca, Suna Yildirim; Öztekin, Deniz; Umut, Fethiye; Şenkaya, Ayşe Rabia; Aytaç, Hakkı
    Couvelaire uterus is a life-threatening condition in which placental abruption causes bleeding that penetrates the uterine myometrium. The objective of this study was to determine the risk factors of Couvelaire uterus and maternal and neonatal outcomes. Obstetrics emergency clinic data between January 2013 – December 2019 were screened and placental abruption patients confirmed by pathology or surgery note were recruited. Patients were divided into two groups; with or without Couvelaire uterus. Clinical features; such as maternal age, gravida, parity, gestational age at delivery, comorbidities, chief complaint, ultrasonography examination, placental pathology, degree of placental separation, DIC (disseminated intravascular coagulation), required hysterectomy and transfusion, maternal hemoglobin, maternal or fetal ICU (intensive care unit) admission, neonatal birth weight, APGAR 1’ and 5’ scores were compared. Age, gravida, and parity were significantly higher in patients with couvelaire uterus (p<0.001, p=0.017, p=0.034 respectively). The degree of placental separation was significantly larger and APGAR 1’ and 5’ scores significantly lower in the Couvelaire uterus group (p <0.001). Incident of Couvelaire uterus increases with higher age, gravida, and parity. Neonatal APGAR scores were lower and intrauterine fetal death rates were higher in Couvelaire uterus patients.