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Papers by engin Çelik

Journal of the Turkish-German Gynecological Association

Objective: The umbilicus is traditionally circumvented while performing a vertical midline abdomi... more Objective: The umbilicus is traditionally circumvented while performing a vertical midline abdominal incision. There is a gap in knowledge pertaining to avoiding the umbilicus. Our aim was to determine whether transumbilical or periumbilical midline incision conferred any advantage to the patient. Material and Methods: This is a retrospective cohort study of patients who underwent ovarian cancer surgery with a midline incision, from the pubic tubercle to the xiphoid. All of the surgeries were performed by the same group of gyneacological oncologists. Patients were classified into two groups according to the type of midline incision, transumbilical or periumbilical. The primary endpoint was the wound complication rate of the incisions. Results: Transumbilical and periumbilical midline incisions were performed on 54 and 68 patients, respectively. There were no differences between the two groups in terms of patient characteristics and operative details. The two groups had comparable rates of complications including wound infection (7.4% vs 10.3%, p= 0.75), deep surgical site infection (11.1% vs 4.4%, p= 0.18), evisceration (3.7% vs 4.4%, p= 0.99) and incisional hernia (33.3% vs 33.8%, p= 0.99). Conclusion: According to our findings, circumventing the umbilicus during laparotomy did not have any advantage. Future prospective randomized trials are warranted to confirm it.

Journal of Obstetrics and Gynaecology, 2021

Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can ... more Endometrial cancer (EC) can coexist with gynaecological diseases including adenomyosis which can be defined as the location of endometrial cells within the myometrium. Our aim was to clarify the impact of adenomyosis on the clinical and survival outcomes of EC. We included the patients who underwent an operation for EC and had concurrent adenomyosis in this retrospective cohort study. All clinicodemographical and tumour characteristics with survival outcomes of the patients were analysed comparatively. A total of 763 patients who met the eligibility criteria were included. Of those, 591 patients in the non-adenomyosis group and 172 patients in the adenomyosis group were examined. Disease-specific survival (DSS) was significantly prolonged while progression-free survival (PFS) was not affected by the presence of adenomyosis (p = .004 vs. p = .161). However, adenomyosis did not remain as an independent prognostic factor for EC in multivariate analysis (p = .341). These patients with coexistent adenomyosis and EC have better clinicopathological characteristics and less advanced tumour. Although adenomyosis is associated with prolonged DSS, it has no prognostic importance for survival outcomes of the patients with EC.IMPACT STATEMENTWhat is already known on this subject? Endometrial cancer (EC) can coexist with other gynaecological diseases including uterine adenomyosis. Adenomyosis is typically diagnosed by the pathological evaluation of the uterus following hysterectomy, although diagnosis is possible with imaging methods However, the coexistence of adenomyosis and EC is controversial in the literature.What do the results of this study add? To the best of our knowledge, our study is the largest study performed at a single university hospital. All potential confounding factors including clinicodemographical characteristics of the patients, examination of histopathology slides by the experienced gynaecological pathologists, evaluation of all included factors that may affect the survival outcomes of EC by multivariate analysis were examined. Although adenomyosis is associated with prolonged disease-specific survival (DSS), it has no prognostic importance for survival outcomes of the patients with EC.What are the implications of these findings for clinical practice and/or further research? Women having coexistent adenomyosis and EC should be informed about the impact of adenomyosis on the survival outcomes of EC.

Gynecology Obstetrics & Reproductive Medicine, 2021

OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries. Our... more OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries. Our study aims to determine the effect of the time between diagnosis and surgery of endometrial cancer on the prognosis of the disease. STUDY DESIGN: Patients who were diagnosed with epithelial type endometrial cancer and did not receive preoperative chemotherapy, radiotherapy, or hormonal therapy were included in the study. RESULTS: Two hundred eighty-five patients were included in the study. We divided the patients into two groups regarding before and after 8 weeks from diagnosis to surgery. Clinical characteristics of the patients were comparable between the groups, except for comorbid conditions and body mass index. Using cox-regression analysis, time to operation did not have a significant effect on both recurrence and cancer-associated death risk. The log-rank test analysis also showed that there was no significant difference in progression-free survival and disease-specific survival ...

Bulgular: Adölesan grubun yaş ortalaması 16,72±1,21, kontrol grubundaki hastaların yaş ortalaması... more Bulgular: Adölesan grubun yaş ortalaması 16,72±1,21, kontrol grubundaki hastaların yaş ortalaması 28,68±4,14 idi. Eğitimsiz ve düşük eğitim düzeyi oranı adölesan grubunda daha fazla idi. Adölesan gebelik grubunda epizyotomi ile normal doğum oranı yüksek, sezaryen oranları ise düşük saptandı. Preeklampsinin adölesan gebelik grubunda daha sık görüldüğü saptandı. Fetal anomali sıklığı kontrol grubunda daha yüksek idi. Birinci dakika Apgar skorları adölesan gebelik grubunda daha düşük saptandı.

Journal of the Turkish-German Gynecological Association, 2021

The effect of diagnostic hysteroscopy performed before fresh and frozen-thawed embryo transfer in... more The effect of diagnostic hysteroscopy performed before fresh and frozen-thawed embryo transfer in IVF cycles on the reproductive outcomes Eserol et al. The diagnostic hysteroscopy before embryo transfer

Journal of Obstetrics and Gynaecology Research, 2020

Urologia Internationalis, 2020

Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of s... more Midurethral slings (MUSs) have been used successfully for the last 20 years in the treatment of stress urinary incontinence and accepted as the gold standard surgical procedure. High success rates and minimal invasiveness of surgery are among the most important advantages, but sometimes serious complications can occur during or after surgery. Although serious complications are rare after widely performed transobturator tape (TOT) operation, awareness, early diagnosis, and aggressive management are essential as they can progress with serious morbidity and mortality. In order to reduce the infectious complications after MUS procedures, in addition to sterility of the operating theater and the operating equipment, the type of mesh used and the preparation of the surgical site are crucial. We aimed to present the successful management of a case of necrotizing fasciitis in a TOT patient.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018

Background: Digital cervical evaluation has been used to determine the likelihood of vaginal deli... more Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was g...

ePoster, 2019

Introduction/Background The purpose of this study was to investigate prognostic factors associate... more Introduction/Background The purpose of this study was to investigate prognostic factors associated with overall survival (OS) in endometrioid endometrial cancer (EC). Methodology A multicenter, retrospective department database review was performed to identify patients with endometrioid EC at seven high-volume gynecologic oncology centers in Turkey. A total of 4993 women who had undergone primary surgery between 1999 and 2018 were included. Women were staged according to the 2009 FIGO staging system. Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results Three thousand two hundred and nineteen women (64.5%) were classified as stage IA, 1034 (20.7%) as IB, 286 (5.7%) as II, 72 (1.4%) as IIIA, 15 (0.3%) as IIIB, 173 (3.55) as IIIC1, 128 (2.6%) as IIIC2, and 66 (1.3%) as stage IV. The median age at surgery was 58 years (range, 21–94 years), and the median duration of follow-up was 47 months (range, 3–227 months). For the entire cohort, the 5-year disease-free survival was 75.1% whereas the 5-year OS was 82.2%. Age ≥60 years (Hazard ratio [HR]: 1.21, 95% confidence interval [CI]:1.06–1.40; p=0.005), myometrial invasion (MMI) ≥1/2 (HR: 1.19, 95% CI:1.02–1.41; p=0.02), lymphovascular space invasion (LVSI) (HR: 1.29, 95% CI:1.05–1.58; p=0.01), and baseline serum CA 125 ≥35 U/ml (HR: 1.29, 95% CI:1.08-1.55; p=0.005) were identified as independent prognostic factors for decreased OS. Conclusion Age ≥60 years, MMI ≥1/2, LVSI, and baseline serum CA 125≥35 U/ml seem to be independent prognostic factors for decreased OS in Turkish endometrioid EC population. Disclosure Nothing to disclose. Abstract EP487 Table 1 Clinicopathological characteristics of 4993 endometrioid endometrial cancer patients undergoing surgery Abstract EP487 Table 2 Univariate and multivariate analyses of 4993 women with endometrioid endometrial cancer undergoing surgery with regard to disease-free survival Multivariate Analyses Events (5-year DFS) Univariate Analyses p HR 95% CI p Age, y <60, ≥60 402/2822 (81.0%), 399/2171 (74.1%) <0.001 1.24 1.09–1.42 0.001 Myometrial invasion <1/2, ≥1/2 461/3493 (81.3%), 340/1500 (70.8%) <0.001 1.21 1.04–1.41 0.012 FIGO grade 1 or 2, 3 687/4487 (79.1%), 112/497 (69.1%) <0.001 Primary tumor diameter <3 cm, ≥3 cm 261/2071 (81.9%) 524/2787(74.9%) <0.001 LVSI Absent, Present 541/3857 (80.5%), 257/1128 (70.1%) <0.001 1.24 1.03–1.51 0.021 Baseline serum CA 125 <35, ≥35 553/3357 (77.7%), 143/602 (68.1%) <0.001 1.25 1.06–1.49 0.009 Stage I, II, III, IV 590/4253 (80.6%), 60/286 (74.0%), 120/388 (59.8%), 31/66 (40.0%) 0.003 <0.001 0.006 1.0, 1.30, 2.21, 4.64 1.01–1.68, 1.76–2.78, 3.01–6.97 0.038, <0.001, <0.001 Abbreviations: DFS: disease-free survival, HR: hazard ratio, CI: confidence interval, LVSI: Lymphovascular space invasion Abstract EP487 Table 3 Univariate and multivariate analyses of 4993 women with endometrioid endometrial cancer undergoing surgery with regard to overall survival Multivariate Analyses Events (5-year OS) Univariate Analyses p HR 95% CI p Age, y <60, ≥60 326/2822 (84.2%), 303/2171 (79.4%) <0.001 1.21 1.06–1.40 0.005 Myometrial invasion <1/2, ≥1/2 375/3493 (84.5%), 254/1500 (77.1%) <0.001 1.19 1.02–1.41 0.028 FIGO grade 1 or 2, 3 539/4487 (83.1%), 90/497 (73.6%) <0.001 Primary tumor diameter <3 cm, ≥3 cm 218/2071 (84.5%), 401/2787 (80.1%) <0.001 LVSI Absent, Present 444/3857 (83.6%), 185/1128 (77.4%) 0.001 1.29 1.05–1.58 0.012 Baseline serum CA 125 <35, ≥35 55/3357 (81.2%), 117/602 (73.0%) <0.001 1.29 1.08–1.55 Stage I, II, III, IV 476/4253 (84.0%), 48/286 (78.1%), 81/388 (70.9%), 24/66 (44.6%) 0.027, 0.009, 0.002 1.0, 1.27, 1.88, 3.91 0.97–1.67, 1.46–2.41, 2.46–6.22 0.073, <0.001, <0.001 Abbreviations: OS: overall survival, HR: hazard ratio, CI: confidence interval, LVSI: Lymphovascular space invasion

Journal of Endometriosis and Pelvic Pain Disorders, 2019

Purpose: Synchronous endometrial and ovarian cancer is defined as the concurrent presence of ovar... more Purpose: Synchronous endometrial and ovarian cancer is defined as the concurrent presence of ovarian cancer with endometrial cancer. We aimed to evaluate whether there is an effect of endometriosis on progression-free survival and overall survival of women with synchronous endometrial and ovarian cancer. We also compared these findings with the patients having endometrial-only tumors and ovarian-only tumors. Methods: The patients who underwent surgery for endometrioid or clear-cell endometrial-only tumors and/or ovarian-only tumors and synchronous endometrial and ovarian cancer between 2005 and 2016 were included in this cohort study. The effect of the presence of endometriosis on progression-free survival and overall survival in these women who met the criteria was determined using statistical methods. Women were also compared regarding their demographic, clinical, and pathological characteristics. Results: A total of 176 patients were included in this study. All histology types of...

Gynecology Obstetrics & Reproductive Medicine, 2019

OBJECTIVE: Digital cervical evaluation has been used to determine the likelihood of vaginal deliv... more OBJECTIVE: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, alternative approaches such as transperineal ultrasound, fetal fibronectin test in cervicovaginal secretions have been investigating for the prediction of the delivery route. We aimed to study whether the usefulness of qualitative fetal fibronectin test in cervicovaginal secretions for the prediction of vaginal delivery in pregnant women at postterm induced with dinoprostone. STUDY DESIGN: A total of 32 nulliparous pregnant women at postterm were enrolled in this prospective observational study. Fetal fibronectin test was applied to all participated women before the induction with dinoprostone and transvaginal ultrasonography was performed to measure cervical length. RESULTS: The women having positive fetal fibronectin test result gave birth through vaginal route, except one case. Although there is no statistically significant difference, the shorter cervical length was associated with vaginal delivery in our population. CONCLUSION: Fetal fibronectin test has a predictive value for delivery route in nulliparous women at postterm. Fetal fibronectin test may be used as a "rule out" test because the rate of fetal fibronectin positivity was found to be higher in patients who gave birth via vaginal route. As also shown in our study, although there is no statistically significant difference, the pregnant women with shorter cervical length might have a high possibility to achieve vaginal delivery.

Istanbul Medical Journal, 2018

Psoriasis (Ps) (MIM 177900) is a chronic inflammatory skin disease that manifests as red, scaly s... more Psoriasis (Ps) (MIM 177900) is a chronic inflammatory skin disease that manifests as red, scaly skin plaques with various degrees of severity and affects almost 2% of the population (1). Psoriasis vulgaris is the most common type of the disease. Several factors associated with the skin, immune system,and human genome have been implicated in the pathogenesis of Ps. Histologically, Ps is characterized by the hyperproliferation and impaired differentiation of keratinocytes, dilated hyperplastic blood vessels, and inflammatory infiltration of leucocytes mainly into the dermis (2). It is suggested that the infiltration of activated T-cells induces keratinocyte proliferation in Ps (3). Nitric oxide (NO), a multifunctional secondary messenger,which acts as a vasodilator, immunomodulator, antioxidant, and bactericide, contributes to the modulation of gene expression, and alters their functions thorough the nitrosylation of involved proteins. NO plays a role in the maintenance of skin homeostasis,and it is a strong regulator of keratinocyte growth and differentiation (4). NO is produced in and released from keratinocytes in high amounts and is the key inhibitor of cellular proliferation and inducer of differentiation in vitro. NO is synthesized from L-arginine by three NO synthases (NOS), namely NOS1 or neuronal, NOS2 or inducible, and NOS3 or endothelial NO synthase (5). These NOS are expressed by skin cell types, and NOS2 is expressed by keratinocytes in Ps and other inflammatory skin disorders (6). The NOS3 gene is found on chromosome 7q35-36, within a length of 4.4 kb (7). The NOS3 gene has several allelic variants, and some of them are functional. The exon 7 Glu298Asp missense variant (rs1799983) and the intron-4 27-bp variable number tandem repeat (VNTR) variant of NOS3 are proposed to be related with NOS3 dysfunction, resulting in impairment of NO production (8). Therefore, in present study, we aimed to investigate the relationship of Ps with the NOS3 gene functional variants in a Turkish cohort. The results obtained from the study were compared both between each other and with the clinical parameters. Is There any Association Between the Functional Variants of the NOS3 Gene and Psoriasis? Introduction: Psoriasis (Ps) is a chronic, immune-mediated inflammatory skin disorder with an incompletely understood etiology. The aim of this study was to investigate the relationship between the suspectibility to Ps and G894T (rs1799983) and variable number tandem repeat (VNTR) variants of the endothelial nitric oxide synthase (NOS3) gene. Methods: This is a case-controlled study that included 74 Ps patients in addition to 74 matched healthy unrelated controls from the same locality. The NOS3 gene variants were analyzed by polymerase chain reaction (PCR) and/or PCR-restriction fragment lenght polymorphism (PCR-RFLP). Results: The NOS3 G894T TT genotype and T allele were more common in the Ps group compared to the healthy controls (p=0.000, p=0.001, respectively). The NOS3 VNTR variant BB genotype and B allele were higher in the patient group than in the control group (p=0.005, p=0.000 respectively). The NOS3 VNTR AA genotype was lower in the patient group (p=0.027). However, a stratified analysis including arthritis, the Ps area and severity index (PASI), the age of onset, and family history revealed no significant correlation between the NOS3 G894T and NOS3 VNTR genotypes (p>0.05). Conclusion: These results suggest that the NOS3 G894T and VNTR variants are associated with Ps in a Turkish cohort. However, future studies are needed to understand the genetic role of the NOS3 variants in the development of Ps.

Istanbul Medical Journal, 2017

Zeynep Kamil Tıp Bülteni, 2018

Giriş:Pelvik egzenterasyon rekürren jinekolojik kanserlerde kür veya daha uzun sağkalım amacıyla ... more Giriş:Pelvik egzenterasyon rekürren jinekolojik kanserlerde kür veya daha uzun sağkalım amacıyla uygulanan ultraradikal bir cerrahidir. Bu çalışmanın birincil amacı kliniğimizce pelvik egzenterasyon operasyonu uygulanan hastaların klinik özelliklerini, operatif ve postoperatif komplikasyon türlerini ve sıklığını tanımlamaktır. Kısa dönem ortalama sağkalım ve hastalıksız sağkalım rakamlarını belirlemek çalışmanın ikincil amacıdır.Materyal Metod:Kliniğimizde 2013-2017 yılları arasında Pelvik egzenterasyon yöntemi ile opere edilen 14 nüks serviks, endometriyum, vagina kanserli hasta retrospektif olarak incelenmiştir.Sonuçlar:Hastaların 11 tanesi rekürren serviks kanseri 2 tanesi rekürren endometriyum kanseri 1 tanesi de rekürren vagina kanseri idi. Opere edilen hastaların ortanca yaş 52.5 olarak hesaplanmıştır. Hastaların çoğunluğu (%57) daha önce opere edilmeyen kemoradyoterapi ile tedavi edilen hastalardan oluşmakta idi. En sık uygulanan pelvik egzenterasyon tipi total pelvik egzent...

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 7, 2017

The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics is complicated owing ... more The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics is complicated owing to physiological changes, particularly during late pregnancy and the postpartum period. Therefore, a pregnancy-modified DIC score that includes only three components of the International Society on Thrombosis and Hemostasis (ISTH) DIC score has been constructed. Our aim was to determine how many blood-transfused postpartum women actually had the diagnosis of overt DIC according to the modified ISTH score and had the correct indications for blood transfusion. We retrospectively analyzed 279 women who had received transfusion of at least two units of blood for postpartum hemorrhage. We used the modified ISTH score for DIC, which is based on platelet count, fibrinogen concentration, and prothrombin time (PT) differences. A total score of 26 points or higher indicated overt DIC, whereas a score lower than 26 points represented nonovert DIC. According to the modified ISTH score, 100 of the 27...

Pakistan Journal of Medical Sciences, 2017

Objective: Neonatal jaundice is the most common condition that requires hospital admission and ou... more Objective: Neonatal jaundice is the most common condition that requires hospital admission and outpatient follow-up after discharge in neonates. The values of more than 17 mg/dL in term infants are accepted as neonatal significant hyperbilirubinemia. We aimed to define if there is any relationship between second trimester serum markers and neonatal severe hyperbilirubinemia to protect the neonates from its neurological damage. Methods: Total 1372 pregnant women were enrolled who had done triple test between April 2014 and 2015 and then given birth at our hospital. Our primary outcome was neonatal significant hyperbilirubinemia. Results: The mean age of our study population was 27.9±5.6. A total of 59 patients had babies with neonatal hyperbilirubinemia after exclusion of Rh incompatibility. We detected that the presence of in vitro pregnancy, maternal health problems or poor obstetric history had no effect on the risk for neonatal hyperbilirubinemia. Neonatal hyperbilirubinemia was related with low E 3 levels. The ratios of AFP/E 3 and hCG/E 3 were the most helpful to predict the neonatal hyperbilirubinemia. Conclusions: According to our results, low E 3 levels in the triple test result can be helpful to predict the development of the neonatal hyperbilirubinemia. However, this is a bit expensive and many developing countries may not afford it.

Gynecology Obstetrics & Reproductive Medicine, 2017

OBJECTIVE: The present study aimed to define characteristics of the patients who were readmitted ... more OBJECTIVE: The present study aimed to define characteristics of the patients who were readmitted with the diagnosis of surgical site infections after gynecologic or obstetric procedures and management of these patients. We also reviewed the literature in this context. STUDY DESIGN: We examined 120 patients with surgical site infections that had been hospitalized and managed medically and/or surgically between April 2014 and April 2015. Characteristics of the patients were recorded and analyzed. RESULTS: The mean age of the patients was 33.4±11.8 years. The patients were readmitted for surgical site infections on the mean of 9.6±5.4 days after the first operation. The most frequent procedures resulted with SSI were cesarean delivery, abdominal hysterectomy and vaginal birth. When patients were compared according to these procedures, there were statistically significant differences regarding age, gravida, parity, preoperative white blood cell count, postoperative white blood cell count and antibiotics usage. CONCLUSION: Combining evidence-based surgical site infections prevention practices and clinician and patient cooperation will result in reduction in surgical site infections incidence following obstetric and gynecologic procedures. Because of economic burden and threat to the physical and psychological health of the patients, these modifiable risks should be recognized and surgical site infections should be minimized. After surgical site infections occurred, diagnosis and proper management with antibiotics and wound care with debridement and secondary suturing is important.

The Medical Journal of Okmeydani Training and Research Hospital, 2017

Objective: Tubo-ovarian abscess (TOA) is mostly a consequence of pelvic inflammatory disease (PID... more Objective: Tubo-ovarian abscess (TOA) is mostly a consequence of pelvic inflammatory disease (PID). TOA is characterized by an inflammatory mass involving the fallopian tube, ovary and occasionally other adjacent pelvic organs. TOA is a serious life-threatening condition that must be diagnosed and managed immediately. Complete history and pelvic examination includes the most important part of the diagnosis. Surgery is necessary for both definitive diagnosis and treatment of TOA especially for suspicious abscess rupture or finding of a TOA in a postmenopausal woman. Our objective was to compare characteristics of patients who undergo surgical treatment and medical treatment. Material and Method: We examined 92 patients with TOA that had been hospitalized and treated medically or surgically. 53 patients had undergone operation and 39 patients had taken only antibiotherapy. Patients who underwent surgical treatment were called as Group 1 and took only medical treatment are called as Group 2. Results: When patients treated surgically are divided into 2 groups which were operated as salpengectomy/salpingooopherectomy and drainage, difference in mean values between these two groups were not observed except WBC count. When we compared mean values of patients between Group 1 and 2, parity, antibiotherapy duration and hospitalization period were found different. Conclusion: It's very important to decide that which patient should be hospitalized and treated with combination of surgical methods and antibiotherapy or which patient should take with only antibiotherapy. Correct decision will be helpful for patient reducing morbidity, adhesions, need for radical surgery and harmful to ovaries.

Journal of the Turkish German Gynecological Association, 2016

Material and Methods: 238 multiparous women with a history of vaginal birth at 37-42 gestational ... more Material and Methods: 238 multiparous women with a history of vaginal birth at 37-42 gestational weeks were enrolled in our study. 110 women had underwent C-section. Control group was chosen randomly from women giving birth by vaginal route. Results: Overall, 238 multiparous women with a history of vaginal delivery at 37-42 gestational weeks were enrolled in our study. The history of operative delivery, that of labor induction and presence of meconium and the indication of admission to the delivery room were different between groups. A lower Bishop score and biophysical profile, smaller gestational period, and lower birth weight were associated with the group requiring a C-section, whereas older age and a long time interval from the previous birth were associated with the group not requiring a C-section. Conclusion: A strategy involving either labor induction or not could be individualized for each patient to eliminate the risk factors for adverse outcomes. To identify criteria for the standardization of labor management, further studies are needed.

Journal of Medical Biochemistry, 2017

SummaryThe aim of this study was to evaluate fertility hormone levels in adolescent girls and ten... more SummaryThe aim of this study was to evaluate fertility hormone levels in adolescent girls and ten years older women with menstrual irregularities and with or without polycystic ovaries on ultrasound examination.The study population consisted of 276 patients aged 12–18 years and 469 patients aged 22–28 years who had menstrual irregularities with or without polycystic ovaries on ultrasound examination. All subjects underwent a comprehensive medical assessment including documentation of the detailed history, physical and gynecological examination, measurement of the essential laboratory variables, and measurement of the fertility hormone levels.Within 745 patients (mean age: 21.4±4.8), 276 patients were aged 12–18 years (group 1) and 469 patients were aged 22–28 years (group 2). Dehydroepiandrosterone sulfate (DHEA-S) (237.7 (22.6–721.5) vs. 162.5 (2.4–660.7) respectively; p<0.001) was significantly higher in group 1 than group 2. There were 74 subjects (26.8%) with LH/FSH ratio &gt...