Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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In recent years, there has been a remarkable increase in medical malpractice litigations against OB/GYNs in Turkey and globally. This high litigation atmosphere may have changed attitudes, behaviour and practice of OB/GYNs. In the current study, opinions and attitudes of OB/GYNs regarding defensive medicine and to what extent they practice it were investigated. ⋯ What the implications are of these findings for clinical practice and/or further research: Regulations demanded by OB/GYNs, which were probed in the current study, such as enacting a specific medical malpractice law and establishment of a medically specialised court, should be taken into account by health authorities in Turkey. The findings of the current study is believed to produce important results for the success of Health transformation programme put into practice in Turkey, which was not able to stop increasing C-section rates. Studies evaluating the direct or indirect costs related to defensive medicine practices of OB/GYNs in Turkey should be performed in subsequent research.
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The aim of this study was to investigate the efficacy of the Bakri balloon in the management of PPH. This was a retrospective review of 49 patients, who had Bakri balloon inserted for PPH in KK Hospital between April 2013 and December 2015. The main outcome measure was achievement of haemostasis by Bakri balloon tamponade (BBT). ⋯ Our study adds to the growing body of evidence that BBT is not only effective for management of PPH in haemodynamically stable patients and in cases secondary to uterine atony and placenta praevia, but also in a small number of undiagnosed focal placenta accreta. Impact statement There is limited evidence regarding efficacy of BBT for PPH. Our study supports the use of BBT for PPH due to uterine atony and placenta praevia and in a small number of undiagnosed placenta accreta.
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Observational Study
Gestational weight gain in obese pregnancy: impact on maternal and foetal metabolic parameters and birthweight.
The aim of this prospective, observational study was to investigate the impact of gestational weight gain (GWG) among euglycaemic obese pregnant women on maternal and foetal metabolic parameters and neonatal outcome. Total GWG was recorded for 101 obese, non-diabetic women with a singleton pregnancy. At 28 weeks of gestation, fasting maternal blood samples were analysed for glucose, insulin, c-peptide and lipids. ⋯ Greater understanding of the biological mechanisms involved may help guide future studies to develop targeted interventions for more effective clinical outcomes. This study identified that higher GWG among obese pregnant women resulted in foetal hyperinsulinaemia even in the absence of maternal hyperglycaemia, potentially representing a biological pathway for larger birthweight babies. These results may highlight the need for more intensive dietary and lifestyle interventions among obese women who would not normally receive additional counselling beyond standard antenatal care if not diagnosed with glucose intolerance in pregnancy.
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Loss of oestrogen receptor (ER) and progesterone receptor (PR) expression in endometrial cancer cells indicates poor prognosis. The aim of this study was to determine the correlation of ER and PR expression in cancer cells and the surrounding myometrium with the disease progression. Immunohistochemical expression of ER and PR was detected in cancer and myometrial cells of patients with EC. ⋯ Results of our research support the theory that stromal and myometrial cells may contribute to tumorigenesis in endometrial cancer. Better understanding of ER/PR expression in myometrial cells is needed, and our research opens new possibilities for identification of key pathways and new potential target molecules in EC prognosis and treatment. It is probable that future classification of endometrial cancer will rely on molecular sub-typing, where the status of hormone receptors in the myometrium might play an important role.
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Multicenter Study
Should ovaries be removed or not in early-stage cervical adenocarcinoma: a multicenter retrospective study of 105 patients.
The study population consisted of 105 patients with stage IA to IIB cervical adenocarcinoma (AC) who underwent radical hysterectomy and pelvic lymphadenectomy from three institutions between 1994 and 2015, including 86 patients with bilateral salpingo-oophorectomy (BSO) and 19 patients with ovarian preservation operation. Ovarian metastasis were diagnosed in 3 of 86 patients in BSO group with an incidence rate of 3.5% (3/86). Among the 19 patients with ovarian preservation, none developed an ovarian recurrence in the follow-up (2-71 months). ⋯ Our univariate analysis with clinicopathologic variables revealed that only FIGO stage was the risk factor associated with ovarian metastasis of cervical AC. Our data implied that ovarian preservation in young women with early-stage cervical AC might be safe and not associated with an increased risk of overall mortality. Considering the deleterious effects of surgical castration on the long-term quality and quantity of life, we hold that ovarian preservation should be seriously considered in the surgical management of premenopausal women with early-stage cervical AC.