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    Comparison of Bishop's score and cervical length in determining the need for cervical maturation before labor induction
    (Via Medica, 2024) Demir, Hakan; Kole, Emre; Kole, Merve Cakir; Gulluoglu, Ahmet; Danisman, Ahmet Nuri
    Objectives: The aim of this study is to compare the evaluation of cervical length measured by the Bishop score and transvaginal ultrasonography in determining the need for prostaglandin application for cervical ripening in term nulliparous pregnancies. Material and methods: In our study, a total of 120 patients who were admitted to our hospital between February 2015 and August 2015 were divided into two groups as cervical length group and Bishop score group according to hospitalization order by applying the Permuted Block Randomization method, which is one of the Restricted Randomization methods. Each patient included in the study was evaluated with both the Bishop score and transvaginal ultrasonography. Groups were compared according to the APGAR scores in the 1st and 5th minutes, transition within 12 hours, birthing within 24 hours, birthing with only dinoprostone, birthing with only oxytocin, duration of administration of dinoprostone, duration of oxytocin administration, type of birth, rate of cesarean section, and need for neonatal intensive care. Results: While cervical ripening with dinoprostone was applied to 28 (46.7%) of 60 pregnant women in the Bishop group, labor induction with oxytocin was applied to the remaining 32 (53.3%) pregnant women. In the cervical length group, these values were 33 (55.0%) and 27 (45.0%), respectively. There was no statistically significant difference between study groups in terms of the need for dinoprostone for cervical ripening (p = 0.361). Of those with a Bishop score of 4 or below, 78.6% (n = 22) had a cervical length of over 28 mm, and 71.4% (n = 20) needed oxytocin. Of those with a Bishop score above 4, none of them had a cervical length greater than 28 mm. A statistically significant difference was found between those with a Bishop score of 4 or below and those above 4 in terms of cervical length (p < 0.05). Among those with a Bishop score of 4 or below, the percentage of those with a cervical length above 28 mm was significantly higher than that of those with Conclusions: In our study, the delivery time of those with a cervical length of 28 mm and above was significantly higher than those with a cervical length of less than 28 mm, while the bishop score was significantly lower. In order to develop a more objective method that can replace the Bishop scoring system in determining the need for cervical ripening before labor induction, prospective randomized studies that screen larger numbers of patients are needed.
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    Examination of pelvic structures of women with polycystic ovary syndrome using magnetic resonance imaging pelvimetry
    (2024) Köle, Emre; Özen, Selda; Deniz, Merve Erol; Kole, Merve Cakir; Deniz, Alparslan; Aksoy, Lale; Aslan, Erdoğan
    Objective: Our study aimed to evaluate patients with Polycystic Ovary Syndrome (PCOS) using Magnetic Resonance (MR) pelvimetry to determine if there is a specific pelvic type associated with hyperandrogenemia. Method: This study retrospectively analyzed data collected from pelvic MR imaging performed on 36 patients diagnosed with PCOS who attended the outpatient clinic of Alanya Education and Research Hospital between 2021 and 2022. All cases were of reproductive age, between 18 and 49 years, and were initially diagnosed with PCOS via ultrasound, had a history of hirsutism or amenorrhea, followed by subsequent MR imaging. A control group of 35 patients, matched for reproductive age without PCOS diagnosis, hirsutism, amenorrhea, or menstrual irregularities, who underwent MR imaging for any other reason were recruited Results: No significant differences were observed between the groups in terms of age, gravidity, parity, abortions, except for weight and Body Mass Index (BMI). Comparison of MR pelvimetry results between the groups, including pelvic inlet transverse diameter (cm), interspinous diameter (cm), midsagittal pelvic inlet anteroposterior diameter (cm), and midsagittal pelvic outlet anteroposterior diameter (cm), revealed no significant differences. Conclusion: Unfortunatelly, the results did not provide convincing evidence to prove our hypothesis. If it were, we believe, it would provide a bridge between the animal expriments and clinical studies regarding the ethiplogy of PCOS.
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    Female Sexual Function Index Outcome After Posterior Vaginal Tightening Approach and Anterior Cervical Ring Repair when Indicated
    (Springer, 2025) Kole, Emre; Akar, Bertan; Deniz, Alparslan; Kole, Merve Cakir; Aslan, Erdogan; Caliskan, Eray
    BackgroundFemale sexual dysfunction is believed to be associated with pelvic floor dysfunction in most cases. However, correcting prolapse does not always necessarily correct sexual function. The reason for this might be secondary to disregarding anatomically relevant structures during surgical interventions. We aimed to demonstrate that posterior vaginal tightening approach avoiding anteriorly located structures, such as clitoral complex, would yield better results in terms of sexual function.MethodsFifty-seven postmenopausal women with primary complaints of vaginal laxity and Grade I and II prolapse were operated. All patients received posterior vaginal tightening operation, and a cervical ring repair was utilized when indicated (n:25). Perineal repair was done if there was any defect (n:13). Levator plication is not done in any patients. FSFI (Turkish Version) was applied to each patient prior to surgery and at 6th month postoperatively. A Likert-type scale is also utilized to assess the patient satisfaction from the procedures.ResultsAll the domains and the total score of FSFI were observed to be improved. Only the improvement in the pain domain scores was not statistically significant. Satisfaction of the patients from the surgery on a Likert scale was so as to: very satisfied 27 (47.4%), satisfied 12 (21.1%), neither satisfied nor dissatisfied 8 (14%), dissatisfied 5 (8.8%), very dissatisfied 1(1.7%).ConclusionSexual function of women with vaginal laxity can be improved when vulvovaginal erotogenic complex is not disrupted. This can be achieved via a posterior approach while maintaining successful anatomic correction of both posterior and anterior compartments.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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    Is it possible to predict severe postpartum hemorrhage and the need for massive transfusion in placenta previa cases?
    (Via Medica, 2025) Kole, Emre; Akar, Bertan; Doger, Emek; Kole, Merve Cakir; Anik, Yonca; Caliskan, Eray
    Objectives: The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI). Material and methods: Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The placenta accreata index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage (> 2000 mL) and massive transfusion [> 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically. Results: In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy. Conclusions: Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.
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    The Effect of Prognostic Factors on Survival in Endometrioid Type Adenocancer
    (2023) Baştan, Merve; Kole, Merve Cakir; Aksoy, Lale; Köle, Emre; Çorakçı, Aydın
    Objective: The study aims to investigate the prognostic factors in uterine endometrioid adenocarcinoma that affect survival outcomes. Materials and Methods: This retrospective study includes 144 cases which underwent surgical treatment for uterine endometrioid adenocarcinoma. Demographic data and tumour characteristics were evaluated for lymph node metastasis. Stage I and grade 1-2 tumours were divided into lymphadenectomy and non-lymphadenectomy groups, and 5-year survival was assessed. Results: The presence of myometrial invasion of more than 1/2, adnexal metastasis and lymphovascular space invasion were found to be associated with lymph node metastasis (p=0.010 ve 0.019 ve 0.015). In our study, the 5-year survival rate was 87.4%. Survival rate was correlated with age, myometrial invasion, and tumour grade. The 5-year survival rates were 89.8% in lymphadenectomy group and 85.2% in non-lymphadenectomy group, and no statistically significant difference was observed (p=0.575). Conclusion: Myometrial invasion, grade and the age of diagnosis were detected as important prognostic factors of uterine endometrioid adenocarcinomas. We concluded that lymphadenectomy did not increase the survival rate of stage I grade 1-2 endometrioid tumours. Lymphadenectomy may not be performed in stage I grade 1-2 tumours; thus, the morbidities of lymphadenectomy can be avoided.