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    3D high frequency endovaginal ultrasound evaluation of urethral and pelvic morphology in stress urinary incontinence in first pregnancy
    (Elsevier, 2021) Peker, Hakan; Peker, Berna Haliloğlu
    Objective: We aimed to compare the morphological characteristics of pelvis and urethra in nulliparous pregnant women with and without stress urinary incontinence (SUI) by 3D high-frequency endovaginal ultrasound (3D-EVUS). Study design: At 36-38 weeks of gestation, 40 nulliparous pregnant women with and without SUI underwent 3D-EVUS assessment. The anteroposterior and transverse diameters of levator hiatus (LH), pubovisceral muscle thicknesses at 3,9 and 12 o'clock, right and left paravaginal areas, symphysis angle, bladder-symphysis distance (BSD), uretral complex thickness (Ut), urethral complex width (Uw), urethral complex volume (UV), urethral length (UL), intramural urethra, rhabdosphincter thickness (Rt), rhabdosphincter width (Rw), rhabdosphincter length (RL), and rhabdosphincter volume (RV) were measured by 3D-EVUS. Results: Longer LH transverse diameter (34.8 +/- 3.8 mm vs 31.1 +/- 2.1 mm), shorter LH anteroposterior diameter (47.8 +/- 6.2 mm vs 52.4 +/- 2.6 mm), and wider symphysis angle (116.3 +/- 5.6 vs 111.5 +/- 5.3 degrees) were detected in nulliparous pregnant women with SUI compared those without SUI (p = 0.001, p = 0.001 and p = 0.013; respectively). RV of less than 1.26 cm(3) was found to have a sensitivity of 100 % and a specificity of 100 % for the presence of SUI in nulliparous pregnant women. Conclusions: Constitutionally different pelvic shape and decreased urethral rhabdosphincter measurements can be used to predict SUI in nulliparous pregnant women. (C) 2021 Elsevier B.V. All rights reserved.
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    Carbetocin Versus Oxytocin for Prevention of Postpartum Hemorrhage in Cesarean Section
    (Turkiye Klinikleri, 2021) Gürsoy, Ali; Ilter, Erdin; Çelik, Aygen; Peker, Berna Haliloğlu; Serifsoy, Talat Ercan; Atasayan, Kemal; Özekici, Umit
    Objective: We aimed to compare the haemodynamic effects of carbetocin and oxytocin in preventing postpartum hemorrhage during cesarean delivery. Material and Methods: This study was conducted retrospectively in a university hospital. Women in the carbetocin group (n=42) and women in the oxytocin group (n=78) were evaluated in terms of changes in hemoglobin level, hematocrit level, uterotonic need, urine output, blood transfusion requirement, hospital stay, postoperative fever and need for peripartum hysterectomy. Results: There was not statistically significant difference between their additional uterotonic need but preoperative and postoperative 24th hour hemoglobin reduction, calculated estimated blood loss and platelet count diminution percentage were significantly lower in the carbetocin group compared to oxytocin group (p=0.044; p=0.042; p=0.004, respectively). Besides that, the rate of blood loss of >= 500 mL was lower but not significantly different in patients receiving carbetocin compared to those using oxytocin (p=0.059) and the duration to reach 1,500 cc urine output of carbetocin group was significantly lower than the oxytocin group (p=0.001). Conclusion: Carbetocin appears to be more effective in the hemoglobin reduction, platelet reduction and calculated estimated blood loss. In addition, another advantage of carbetocin is that it has lower negative effects on urine output than oxytocin. It is noteworthy that carbetocin administration can prevent postpartum hemorrhage in appropriate cases.
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    Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study
    (Medicinska Naklada, 2021) Peker, Hakan; Atasayan, Kemal; Peker, Berna Haliloğlu; Kilicci, Çetin
    Aim To investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section. Methods One hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n = 65) and a control group (n = 50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non -steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated. Results The SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P < 0.001) and required a significantly lower rescue dose of NSAID or opioids (P = 0.003, P < 0.05, respectively). Conclusions SHP block may be an effective and safe pain relief treatment after a cesarean section.
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    KadÖnlarda ?zlenen Üriner ?nkontinans: UluslararasÖ KÖlavuzlar I?Ö?Önda Güncel Yönetim
    (2017) Dökmeci, Fulya; Peker, Berna Haliloğlu; Yeniel, Ahmet Özgür
    Üriner inkontinans kadÖnlarda sÖk görülen bir problem olup, kiLinin yaLam kalitesini ciddi bir Lekilde bozmakta ve önemli sa?lÖk problemlerine yol açmaktadÖr. Türk Ürojinekoloji ve Rekonstrüktif Cer- rahi Derne?i KÖlavuz ÇalÖLma Grubunun oluLturdu?u bu derlemede kadÖnlarda üriner inkontinans yönetimi için düzenlenmiL kÖlavuzlarÖn irdelenmesi ve elde edilen sonuçlarÖn ortaya konmasÖ hede- flenmiLtir. Bu derleme ile kÖlavuzlarda genel kabul görmüL, ortak klinik yaklaLÖmlarÖn belirlenmesi, üriner inkontinansÖ olan kadÖnlarÖn tanÖ ve tedavisi için tartÖLmasÖz ve net olan adÖmlarÖn ortaya kon- masÖ amaçlanmÖLtÖr. AyrÖca, fikir birli?ine kavuLmamÖL tartÖLmalÖ önerilerin de altÖnÖ çizerek herkes tarafÖndan daha iyi anlaLÖlmasÖnÖ sa?lanmasÖ amaçlanmÖLtÖr