Objective:Endometriosis is seen in women during their reproductive period, where stromal tissue and functional endometrial glands of the uterus are observed outside the uterine cavity. In this study, we aimed to identify the clinical characteristics of our patients who underwent surgery with scar endometriosis and to discuss the surgical results in light of the literature.Materials and Methods:A total of 24 patients who underwent surgery and diagnosed as having endometriosis as the result of a pathologic examination were retrospectively evaluated.Results:The mean age of the patients was 31 years. Thirteen presented to general surgery and 11 presented to gynecology outpatient clinics. The pain was cyclical in 19 patients. There was history of cesarean section in 9 patients, twice in 12, and 3 times in three patients. The mean diameter was 39.1 mm on ultrasound, and 37.5 mm on magnetic resonance imaging. Endometriosis was on the left side of the incisions in 13, whereas it was on the right in 11. The mean weight of the lesions was 61.6 grams.Conclusion:The occurrence of endometriosis is supported by the iatrogenic implantation theory. In the event of a mass in the abdominal wall, previous obstetric and gynecologic operations and a history of a painful mass during menstruation periods must be questioned. In the treatment of scar endometriosis, excision is required by obtaining secure margins. If diagnosis can be established preoperatively, unnecessary surgeries can prevented.
Objective: During pectopexy surgery, the prolapsed uterus or the vaginal apex is fixed to the pectineal ligament. The anatomic structures found in the lateral part of the prevesical and paravaginal space above the obturator fossa, raise the importance of the surgical steps required to prevent complications. This study was conducted to evaluate the proximity of vascular structures to the pectineal ligament. Materials and Methods: The distances between the surgical suturing area during pectopexy surgery and the external iliac vein, pubic anastomotic vessel (corona mortis) and obturator canal were measured bilaterally in seven fresh female cadavers. Results: The total length of the pectineal ligament was 5.9±0.76 cm on the left and 6.5±1.14 cm on the right side; the midpoint of the pectineal ligament was 2.8±0.52 cm on the left and 3.6±0.47 cm on the right side. From the midpoint of the left pectineal ligament, the mean distance to the left external iliac vein was 1.04±0.23 cm, to the left corona mortis it was 2.15±0.48 cm, and to the left obturator canal it was 3.12±0.95 cm. From the midpoint of the right pectineal ligament, the mean distance to the right external iliac vein was 1.25±0.43 cm, to the right corona mortis it was 2.37±0.63 cm, and to the right obturator canal it was 3.57±0.93 cm. Conclusion: The anatomic findings of the study confirmed that the pectineal ligament was in close association with main vessels. The external iliac vein was measured as the closest anatomic structure to the pectineal ligament. Surgeons must be careful to minimize life-threatening complications because of the proximity of the pectineal ligament to main vessels.
Aim:The aim of this study was to evaluate the risk factors, maternal and perinatal outcome in cases with placental abruption and to determine frequent risk factors in placental abruption cases and decrease the risk of placental abruption with more detailed evaluations in emergency admissions and labor follow up in high risk patients. We intended to reduce maternal and perinatal morbidity and mortality in our clinic by developing a management protocol for placental abruption.Materials and Methods: 142 patients who were admitted to cesarean section after the 20th gestational week and clinically diagnosed with placental abruption between January 2014 and January 2019 from the archives of Umraniye Training and Research Hospital were screened retrospectively. Make a diagnosis of placental abruption was made by considering the retroplacental hematoma of the operation. 7 patients were excluded for various reasons, and 137 patients were included in study. Results:The cause of admission to the hospital was %49.6 (n=68) bleeding, %28.5 (n=39) pain, %10.9 (n=15) water breaks, %0.7 (n=1) fall, %1.5 (n=2) overdue, %3.6 (n=5) nausea, headache was observed while %5.1 (n=7) for control purpose only. It was observed that %65.2 (n=90) of the cases were interned with suspiction of detachment and %34.8 (n=48) developed detachment during follow up. While the rate of in utero ex fetus and percent of placental detachment were significantly higher in the cases with suspected placental abruption than in the cases placental abruption during follow up and prepartum and postpartum hemoglobin levels were significantly lower. In %31.4 (n=43) of the cases, blood and blood products replacement was needed. While %32.8 (n=45) of the babies didn't require neonatal intensive care unit (NICU), %42.3 (n=58) were discharged after NICU hospitalization and %9.5 (n=13) were ex during NICU hospitalization. %15.3 (n=21) were observed as IUEF during the admission. Conclusion:Placental abruption clearly increases maternal and perinatal morbidity and mortality. Determining the risk factors, perinatal and maternal outcomes of placental detachment cases will help to manage these pregnancies and minimize complications. Management protocols should be developed for pregnant women with risk factors for placental detachment in order to minimize maternal and perinatal morbidity and mortality.
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