Journal of the Turkish-German Gynecological Association

Journal of the Turkish-German Gynecological Association

Basic info

  • Publisher: Galenos Publishing House
  • Country of publisher: turkey
  • Date added to EuroPub: 2019/Aug/08

Subject and more

  • LCC Subject Category: Medicine, Gynecology
  • Publisher's keywords: Medicine, Gynecology
  • Language of fulltext: english

Publication charges

  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

  • Type of License: CC BY-NC-ND
  • License terms
  • Open Access Statement: Yes
  • Year open access content began: 2000
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

Best practice polices

  • Permanent article identifier: DOI
  • Content digitally archived in: Other
  • Deposit policy registered in: None

This journal has '22' articles

Detrimental effect of Hypericum perforatum on ovarian functions

Detrimental effect of Hypericum perforatum on ovarian functions

Authors: Buket Demirci, Fadime Kahyaoğlu, Tolga Atakul, Mustafa Yılmaz, Yavuz Özoran
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Abstract

Objective: Hypericum perforatum is widely used for depression and distress treatment as an over-the-counter plant at any age. This study investigated the safety of H. perforatum on ovarian function and infertility. Material and Methods: H. perforatum was given to rats in two different dosages (100 and 300 mg/kg/day) with drinking water for four weeks. Half of the treatment groups were sacrificed at the end of the four-week intervention, the remainder was sacrificed after an additional four-week waiting period to see if there was reversibility. At the end of the experiment, blood samples and both ovarian tissues were obtained under anesthesia with ketamine and xylazine (50 mg/kg and 5 mg/kg, respectively). Results: Although primordial follicle numbers were not affected with a dose of 100 mg/kg, they were significantly decreased (28.6%) when the dose was tripled. Primary follicle numbers stayed the same, but secondary and tertiary follicles numbers were significantly dose-dependently decreased, and remained significantly low four weeks after the intervention. Anti-mullerian hormone (AMH) levels were not significantly different between the groups. Conclusion: H. perforatum treatment did not change serum levels of AMH because the primary follicle number did not decrease. However, the other follicle counts decreased in a dose-dependent manner and full recovery was not regained after four weeks. The detrimental effect of H. perforatum on primordial follicles should be taken into consideration because any woman using H. perforatum could also experience ovarian failure.

Keywords: Anti-mullerian hormone, ovarian capacity, rational drug treatment, rat, St. John’s wort
Using an innovative stacked ensemble algorithm for the accurate prediction of preterm birth

Using an innovative stacked ensemble algorithm for the accurate prediction of preterm birth

Authors: Pari Ramalingam, Maheshwari Sandhya, Sharmila Sankar
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Abstract

Objective: A birth before the normal term of 38 weeks of gestation is called a preterm birth (PTB). It is one of the major reasons for neonatal death. The objective of this article was to predict PTB well in advance so that it was converted to a term birth. Material and Methods: This study uses the historical data of expectant mothers and an innovative stacked ensemble (SE) algorithm to predict PTB. The proposed algorithm stacks classifiers in multiple tiers. The accuracy of the classiffication is improved in every tier. Results: The experimental results from this study show that PTB can be predicted with more than 96% accuracy using innovative SE learning. Conclusion: The proposed approach helps physicians in Gynecology and Obstetrics departments to decide whether the expectant mother needs treatment. Treatment can be given to delay the birth only in patients for whom PTB is predicted, or in many cases to convert the PTB to a normal birth. This, in turn, can reduce the mortality of babies due to PTB.

Keywords: Preterm birth, neonatal death, risk factors of preterm birth, stacked ensemble, stacked generalization, meta-learning
Selective fetal reduction in monochorionic twins: Preliminary experience

Selective fetal reduction in monochorionic twins: Preliminary experience

Authors: Vatsla Dadhwal, Aparna K. Sharma, Dipika Deka, Latika Chawla, Nutan Agarwal
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Abstract

Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India. Material and Methods: This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin. Results: Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively. Conclusion: Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.

Keywords: Monochorionic, selective fetal reduction, bipolar cord coagulation, interstitial laser, radiofrequency ablation
Effects of mature cystic teratoma on reproductive health and malignant transformation: A retrospective analysis of 80 cases

Effects of mature cystic teratoma on reproductive health and malignant transformation: A retrospective analysis of 80 cases

Authors: Sefa Kurt, Hüseyin Aytuğ Avşar, Ömer Erbil Doğan, Hasan Bahadır Saatli, Uğur Saygılı
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Abstract

Objective: To examine cases of mature cystic teratoma (MCT) that were diagnosed and treated in our clinic regarding their association with fertility, and to detect the rate of malignant degeneration and the types of malignancies. Material and Methods: Patients who underwent surgery due to adnexal mass between April 2012 and August 2017 and were diagnosed as having MCT were retrospectively examined. The mean age of the 80 patients who met the inclusion criteria was 30.60±10.5 years. Nine had infertility according to hospital records. Sixty-seven percent of these (n=6) had accompanying endometriosis and MCT was bilateral in 55.5% (n=5). Malignant degeneration was present in 6.25% (n=5), all were monodermal tumors. Malignant degeneration was more common among patients with larger diameter adnexal masses (9.1±2.9 cm) and in those of postmenopausal age. Tumor markers were within the normal range for patients who developed malignancy. Malignant degeneration was not present among infertile patients with endometriosis. Results: Although MCTs do not seem to negatively affect the ovarian reserve, infertility is prominent in patients with concurrent endometriosis. During assessment, concurrent endometriosis should be considered. Imaging findings, large adnexal masses, and postmenopausal period are important for the assessment of MCT concerning malignant degeneration. It should not be overlooked because tumor markers may be normal. Conclusion: MCTs can be present concurrent with endometriomas. In such cases, infertility is more distinct. In MCT malignant degeneration, mass diameter, complex mass internal structure, and postmenopausal status are important factors.

Keywords: Mature cystic teratoma, malignant degeneration, infertility treatment
Association of decreased C1q/tumor necrosis factorrelated protein-5 levels with metabolic and hormonal disturbance in polycystic ovary syndrome

Association of decreased C1q/tumor necrosis factorrelated protein-5 levels with metabolic and hormonal disturbance in polycystic ovary syndrome

Authors: Mehmet Çalan, Murat Alan, Pınar Alarslan, Gökçen Ünal Kocabaş, Giray Bozkaya, Ahmet Çağdaş Acara, Behnaz Aslanipour, Özge Fenercioğlu, Ahmet Murat Iş...
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Abstract

Objective: C1q/tumor necrosis factor-related protein-5 (CTRP5) is a novel peptide hormone involved in the metabolism of energy regulation. Polycystic ovary syndrome (PCOS), which is a reproductive and metabolic disorder, is associated with insulin resistance. The aim of the current study was to compare circulating levels of CTRP5 in women with and without PCOS and to investigate possible associations between CTRP5 and metabolic-hormonal parameters. Material and Methods: The present cross-sectional study contained 80 women with PCOS and 80 age and body mass index-matched women without PCOS. Circulating levels of CTRP5 were calculated using an enzyme-linked immunosorbent assay. We also measured hormonal and metabolic parameters. Results: Patients with PCOS had lower levels of circulating CTRP5 compared with women without PCOS (6.90±2.64 vs 11.73±3.66 ng/mL, p<0.001). CTRP5 was negatively correlated with insulin resistance, free-androgen index, and body mass index in both the PCOS and control groups. Moreover, patients with PCOS who had insulin resistance showed lower circulating CTRP5 levels compared with those without insulin resistance. In both the control and PCOS groups, overweight subjects had lower circulating levels of CTRP5 compared with participants of normal weight. Logistic regression analyses indicated that subjects in the lowest tertile for CTRP5 level had higher risk for PCOS compared with those in the highest tertile of CTRP5. Conclusion: Decreased circulating levels of CTRP5 were associated with higher risk of PCOS, as well as having metabolic disturbance among women with PCOS.

Keywords: Polycystic ovary syndrome, C1q/tumor necrosis factor-related protein-5, insulin resistance, body mass index, free-androgen index
Spontaneous and in vitro fertilization pregnancies have comparable first trimester screening profiles for Down syndrome

Spontaneous and in vitro fertilization pregnancies have comparable first trimester screening profiles for Down syndrome

Authors: Yılmaz Güzel, Engin Türkgeldi, Hande Yağmur, Zeki Salar, Başak Balaban, Bülent Urman, Özgür Öktem,
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Abstract

Objective: We aimed to compare the first trimester screening profiles of spontaneous (n=972) and in in vitro fertilization (IVF) pregnancies (n=339) in a population of patients who had uncomplicated singleton pregnancies comparable for maternal age, gestation, body mass index, and ethnicity. Material and Methods: A non-interventional analysis of retrospective cohort data and review of the literature. Results: All IVF pregnancies were achieved via intracytoplasmic sperm injection using the same ovarian stimulation protocol with recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist, cetrorelix acetate. The means of the multiple of median (MoM) of pregnancy-associated plasma protein-A (PAPP-A) were slightly lower in the fresh (1.19±0.6 vs 1.33±0.7, respectively; p=0.056) and frozen embryo transfer (1.03±0.5 vs 1.33±0.7, respectively; p=0.036) IVF pregnancies compared with natural conceptions. However, when the medians of the MoMs of PAPP-A and beta-human chorionic gonadotrophin (β-hCG), and their distributions were compared across the mode of conception, there were no differences between IVF pregnancies spontaneous pregnancies. Furthermore, the scatterplot diagram and curve fitting regression analyses revealed no difference in the temporal relations of β-hCG and PAPP-A with each other and gestational age between spontaneous and IVF pregnancies. Conclusion: These results support the notion that uncomplicated singleton IVF pregnancies have similar first trimester screening profiles to spontaneous conceptions.

Keywords: First trimester screening, pregnancy-associated plasma protein-A, beta-human chorionic gonadotrophin, nuchal translucency, pregnancy, in vitro fertilization, intracytoplasmic sperm injection
Decoding stillbirths using the Relevant Condition at Death classification: Study from the developing worldgerm

Decoding stillbirths using the Relevant Condition at Death classification: Study from the developing worldgerm

Authors: Neeraj Kulkarni, Deepti Pinto Rosario, Liji Sarah David, Reeta Vijayaselvi, Manisha Madhai Beck,
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Abstract

Objective: To determine the stillbirth rate in 2017 at Christian Medical College, a tertiary care perinatal center in South India, and to identify causes for the various stillbirths that occurred using the Relevant Condition at Death (ReCoDe) classification. Material and Methods: Medical records of the women with stillbirths between January 1st, to December 31st, 2017, were retrieved and analyzed using the SPSS software (IBM, version 23). The study was approved by the institutional review board (minute no: 11273, retro dated: 28/3/2018). Results: Of the total 14696 deliveries between January 1st, 2017, to December 31st, 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors: 156 (64.2%) women were booked and the rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5% (n=67). A greater number of un-booked women had gestational hypertension as compared with booked women (41% vs 24%, p=0.005). Fetal characteristics: still births secondary to lethal congenital anomalies were seen in 18.2% (n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones (24.7% vs 2.3%, p=0.001). Obstetric factors: one or two previous miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: we were able to successfully classify 84.2% of the stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies. Conclusion: The ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% of cases. The majority of cases in our set were due to fetal growth restriction, hypertensive disorders of pregnancy, and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive ntenatal care system, early recognition, and close monitoring of high-risk pregnancies.

Keywords: Stillbirth, ReCoDe intrauterine fetal demise, developing world, gestational hypertension, uteroplacental insufficiency
Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome

Cystoscopic evaluation and clinical phenotyping in interstitial cystitis/bladder pain syndrome

Authors: Ömer Acar, Tufan Tarcan,
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Abstract

Herein, we aimed to review, report, and discuss the role of cystoscopy and clinical phenotyping in interstitial cystitis/bladder pain syndrome (IC/BPS). For this purpose; a comprehensive nonsystematic review of the relevant literature was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original manuscripts, review articles, case series, and case reports were taken into consideration. Data regarding the indications for, technique, and possible findings of cystoscopy with hydrodistension (HD) and biopsy, as well as clinical implications of cystoscopic information and the concept and use of clinical phenotyping within the context of IC/ BPS were extracted and discussed. IC/BPS is diagnosed based on symptomatic assessment and exclusion of confusable diseases. There is no universal agreement upon the evaluation and diagnostic algorithm of IC/BPS. The majority of the guidelines recommend cystoscopy with HD and biopsy as a diagnostic prerequisite. Various different techniques have been described for cystoscopy with HD. General or epidural anesthesia is more commonly preferred and advocated while assessing endoscopic alterations in patients suspected of having IC/BPS. Cystoscopy with HD and biopsy enables more objective exclusion of confusable diseases. It also provides the basis of the European Society for the Study of Interstitial Cystitis classification. Patients with IC/BPS who demonstrate positive cystoscopic (glomerulations and/or Hunner lesion) and histologic findings have a more severe symptomatology and may benefit from lesion-targeted endoscopic treatments. Clinical phenotyping has been implemented for IC/BPS and may be used for individualized assessment and treatment.

Keywords: Bladder pain, cystoscopy, hydrodistension, biopsy, phenotyping
Step-by-step ligation of the internal iliac artery

Step-by-step ligation of the internal iliac artery

Authors: İlker Selçuk, Bora Uzuner, Erengül Boduç, Yakup Baykuş, Bertan Akar, Tayfun Güngör
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Abstract

The internal iliac artery is the main vascular supply of pelvic visceral structures. All pelvic surgeons must know the anatomic landmarks and basic steps of internal iliac artery ligation in order to stop massive pelvic hemorrhage. This cadaveric demonstration and clinical review of the internal iliac artery shows the anatomic landmarks and basic steps of internal iliac artery ligation.

Keywords: Gynecologic, hypogastric, bleeding, postpartum, pelvic
Step-by-step colpotomy in total laparoscopic hysterectomy: a technique to avoid apical support damage to the upper vagina

Step-by-step colpotomy in total laparoscopic hysterectomy: a technique to avoid apical support damage to the upper vagina

Authors: Selim Mısırlıoğlu, Tonguç Arslan, Bülent Urman, Çağatay Taşkıran,
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Abstract

The purpose of this video article is to demonstrate our colpotomy technique that enables maximal protection of the cervical ring, helps to prevent the ureteral injury by distancing, and avoids shortening of the vagina at total laparoscopic hysterectomy. Step-by-step explanation of the colpotomy technique is presented using educational video setting in university-affiliated private hospital. After the uterine artery transection, a VECTEC surgical uterine manipulator (VECTEC, Hauterive, France) was inserted into the vagina in place of the sharp curette. The plastic rotating blade of uterine manipulator was strongly pushed forward into the anterior vaginal fornix. Colpotomy incision was started from the uppermost middle point of an anterior vagina, and extended to both sides with a monopolar L-hook electrocautery at 40 watts cutting mode. Then the manipulator’s blade was maneuvered into the right lateral fornix, and THUNDERBEAT platform (Olympus Medical Systems Corp, Tokyo, Japan) was chosen as the modality of energy for the ransection of the rest of the vagina. At the posterior part of colpotomy, the vaginal wall was cut from the uppermost part of uterosacral ligaments, as well. Finally, the left lateral fornix was cut by the same principles, and colpotomy was completed circumferentially. In conclusion, maximal preservation of paracervical ligaments with this technique preserve the apical support of vagina, and avoids shortening of vaginal length. The technique also minimizes the ureteral injury by distancing.

Keywords: Keywords *
The relationship between semen parameters in processed and unprocessed semen with intrauterine insemination success rates

The relationship between semen parameters in processed and unprocessed semen with intrauterine insemination success rates

Authors: Leila Mollaahmadi, Afsaneh Keramat, Ashraf Ghiasi, Mozhgan Hashemzadeh
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Abstract

Objective: To evaluate the relationship between semen parameters and intrauterine insemination (IUI) success rates. Material and Methods: This retrospective study was conducted during a 4-year period (2011-2015) on the medical records of 350 couples admitted to the infertility center of Beast Hospital in Tehran. The participants’ data such as age, duration of infertility, semen parameters [including volume, concentration, motility, normal morphology and total motile sperm count (TMSC)] before and after sperm processing, as well as the IUI results were extracted from the patients’ records. Only the first IUI cycle of the couples was considered. The main outcome criterion for the IUI success was serum positive beta human chorionic gonadtotropin 14 days after IUI. The collected data were analyzed using the Mann-Whitney U test, chi-square, and Fisher’s exact tests. Results: The overall pregnancy rate for each couple was reported as 23.42% (82/350). There was no significant difference in the mean age of the couple and infertility duration between the groups who achieved pregnancy and those who failed. The two groups showed no significant differences in pre and post processing of semen parameters (including volume, concentration and TMSC). Sperm motility and normal sperm morphology before and after sperm processing were significantly different between the two groups, respectively (p=0.023 before sperm processing and p=0.032 after) (p=0.032 before sperm processing and p=0.007 after). Conclusion: Sperm motility and normal sperm morphology have an effect in IUI success.

Keywords: Intrauterine insemination, sperm parameters, pregnancy rate
Overcoming barriers to vaginal hysterectomy: An analysis of perioperative outcomes

Overcoming barriers to vaginal hysterectomy: An analysis of perioperative outcomes

Authors: Ido Sirota, Shannon A. Tomita, Lisa Dabney, Alan Weinberg, Linus Chuang
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Abstract

Objective: To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state. Material and Methods: Retrospective chart review of 452 patients who underwent vaginal hysterectomy performed by a single surgeon. Patients’ age, vaginal delivery, uterine weight, previous pelvic surgery, previous cesarean delivery, removal of ovaries were compared, as well as estimated blood loss (EBL), operating room time (ORT), length of stay, intraoperative complications and postoperative complications. Multivariable logistic regression was used, and all data were analyzed at the level of p<0.05 statistical significance using SAS system software (SAS Institute Inc., Cary, NC), version 9.3. Results: The mean age was 57.13±11.52 years and the median vaginal delivery was 2. The uterine weight range was 16.6-1174.5 g (mean 169.79±183.94 g). The incidences of blood transfusion and bladder injury were 3.03% and 0.66%, respectively. Factors shown to be associated with longer ORT included greater uterine weight, removal of ovaries, posterior repair, tension-free vaginal tape sling, prolapse, and EBL >500 mL (p<0.001). The factors associated with EBL >500 mL were greater uterine weight (p=0.001), uterine myomas (p=0.016) and premenopausal state (p=0.014). The factors associated with conversion to laparotomy were greater uterine weight (p<0.001) and premenopausal state (p<0.001). Conclusion: Vaginal hysterectomy is a safe and feasible approach for patients desiring hysterectomy regardless of uterine weight and vaginal delivery. (J Turk Ger Gynecol Assoc 2019; 20: 8-14)

Keywords: Vaginal hysterectomy, perioperative outcomes, minimally invasive
Results of an internal audit on the survival of patients with uterine sarcoma

Results of an internal audit on the survival of patients with uterine sarcoma

Authors: Florian Ebner, Saskia Wiedenmann, Inga Bekes, Wolfgang Janni, Nikolaus de Gregorio, Amelie de Gregorio,
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Abstract

Objective: In the last 5 years there has been much discussion about the surgical procedure for uterine fibroids, and essentially, also uterine sarcoma. Still there exists no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of this study was to confirm the suspected association between intraoperative spread of tumor by morcellation and impaired outcomes in patients with sarcoma. Material and Methods: After the local ethics commission positively reviewed the study protocol, the oncologic database of our university hospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted from the medical files and survival information was collected by contacting the patient’s general practitioners if last follow-up-status was older than 6 months. For the analysis, patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regarding information provided by the surgical report. Results: Data on 57 patients with uterine sarcoma were available for further analysis. The median age and body mass index of the patients was 63 years and 27 kg/m², respectively. The sarcoma subtypes were 25 leiomyosarcoma, 19 carcinosarcoma, 9 endometrioid stroma sarcoma, 3 adenosarcoma, and one case without further differentiation. In the majority, no morcellation was performed (M- group, n=44) and 51 patients received open surgery (3 laparoscopic, 1 vaginal, and 2 incomplete surgeries). The median time of follow-up was 31 months. The disease-free survival was 50.5 months and the Cox regression analysis showed a hazard ratio of 3.06 [no significant difference between the two subgroups (p=0.079; 95% confidence interval (CI): 0.9-10.6)]. The overall survival was found as 62.2 months and the Cox regression analysis showed a hazard ratio of 3.216 with a statistically significant difference between the two subgroups (p=0.013; 95% CI: 1.3-8.1). Conclusion: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence is low during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 of 57). If sarcoma is suspected or diagnosed then en-bloc resection of the uterus can prolong survival. Thus, morcellation of the uterus and not the surgical technique (en-bloc resection) is the prognostic factor and should be avoided in any suspicious case. (J Turk Ger Gynecol Assoc 2019; 20: 15-22)

Keywords: Sarcoma, uterine, hysterectomy, fibroids, risk factors
Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial

Comparing perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy: A randomized controlled trial

Authors: Muhibat A. Afolabi, Grace G. Ezeoke, Rakiya Saidu, Munirdeen A. Ijaiya, Abiodun S. Adeniran,
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Abstract

Objective: To compare the effectiveness of perioperative vaginal misoprostol with intraoperative pericervical hemostatic tourniquet in reducing blood loss during abdominal myomectomy. Material and Methods: A randomized controlled trial involving women with uterine leiomyoma who underwent abdominal myomectomy was conducted at a tertiary facility in Nigeria. Participants were recruited after they gave informed consent and randomized into group I (single dose 400 μg vaginal misoprostol one-hour before surgery) and group II (intraoperative pericervical hemostatic tourniquet). Eighty participants (40 in each group) were recruited. Uterine size was measured in centimeters above the pubic symphysis, and blood loss estimation involved direct volume measurement and gravimetric methods. The main outcome measures were intraoperative blood loss, blood transfusion, and recourse to hysterectomy. Ethical approval and trial registration were obtained; the data were analyzed using the SPSS software version 21.0; p<0.05 was considered significant. Results: Participants in group I had higher mean intraoperative blood loss (931.89±602.13 vs 848.40±588.85 mL, p=0.532), intra-operative blood transfusion rates (60 vs 55%; p=0.651) and mean units of blood transfused (1.30±1.20 vs 1.20±1.30; p=0.722) compared with group II. The mean uterine size (19.50±6.93 vs 20.05±6.98 cm; p=0.725) and number of fibroid nodules (11.25±7.99 vs 11.45±8.22; p=0.912) were comparable. The change in post-operative hematocrit was 2.66±2.21% vs 3.24±2.85% (p=0.315) and post-operation blood transfusion was 2.5 vs 5% (p=0.556). There was no recourse to hysterectomy in either of the study groups. While adverse effects of misoprostol occurred in 5 (12.5%) participants of group I. Conclusion: The effectiveness of perioperative vaginal misoprostol is comparable to intra-operative hemostatic pericervical tourniquet in reducing blood loss during abdominal myomectomy. (J Turk Ger Gynecol Assoc 2019; 20: 23-30)

Keywords: Uterine leiomyoma, misoprostol, hemostatic tourniquet, abdominal myomectomy, hemostasis

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