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    Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational and Gestational Diabetic Mothers: A Prospective Case-Control Study
    (OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2023) Sezer, Salim; Oğlak, Süleyman Cemil; Atiş Aydin, Alev; Süzen Çaypinar, Sema; Kaya, Başak; Bestel, Melih
    Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses. Copyright © 2023 by Türkiye Klinikleri.
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    Comparison of Robson Classification in adolescent pregnant with adult pregnant
    (Yuzuncu Yil Universitesi Tip Fakultesi, 2024) Gunkaya, Samet Osman; Bestel, Melih; Koyuncu Aydın, Seher; Ayanoglu, Esra; Bağlar, Ismail; Tug, Niyazi
    The number of cesarean sections performed worldwide is increasing day by day. Establishing a common classification system for cesarean births is important in understanding what factors lead to the increase in these procedures. The aim of our study is to identify trends in adolescent cesarean births by applying the Robson classification, compare them with the adult group, and examine the groups that make the most significant contribution to the increasing rates. This retrospective cohort study documented information on birth weight, mode of delivery, gestational age at birth, parity, maternal gestational age, cesarean indications, and ten-group Robson Classification in pregnant adults and adolescents. The cesarean section rate in adult pregnant women was 39.4%, and the cesarean section rate in adolescents was 14.8%. Group 5 made the biggest contribution to cesarean section rates in both the adult group and the adolescent group. Group 5 was statistically significantly higher in adult cesarean deliveries (p=.001). Other groups where adult cesarean section was significantly more common were group 3 and group 8 (8%; p=0.009, 4.4% p=0.001, respectively). In adolescent cesarean delivery, significant cesarean contributions in group 1, group 2 and group 6 were higher in the adolescent group (23.5%; p=.001, 16.3%; p=.001, 16.3%; p=.001). The contribution of adult pregnant women and adolescent pregnant women to cesarean section rates varies. This study reveals the need for trained health personnel who are prepared and scheduled to attend teenage births. © 2024, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
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    Diagnostic Role of Hysteroscopy In Women With Abnormal Uterine Bleeding: A Single-Center Retrospective Study
    (Yuzuncu Yil Universitesi Tip Fakultesi, 2025) Gunkaya, Samet Osman; Tekelioğlu, Meltem; Karataş, Suat; Sahin, Fatih; Keskin, İlkhan; Bestel, Melih; Tug, Niyazi
    Hysteroscopy is a minimally invasive technique that has advantages over blind curettage, such as direct visualization of the intrauterine cavity, biopsy of the suspicious area, and simultaneous treatment of benign intracavitary lesions. The stud y aims to evaluate the diagnostic role of hysteroscopy in endometrial and focal intracavitary lesions. This retrospective study was conducted in the department of obstetrics and gynecology of a tertiary center between January 2018 and July 2022. Diagnostic hysteroscopy was performed on women with abnormal uterine bleeding, and lesions seen during hysteroscopy were noted and excised using a resectoscope. Uterine sampling with blind curettage was applied to all patients. The resected lesions and uterus samples were evaluated histopathologically. Diagnostic accuracy of hysteroscopy was higher than 90% in each group classified according to morphology of endometrium as normal, atrophic and hyperplastic. Sensitivity, specificity and diagnostic accuracy were higher than 90% for focal intracavitary pathologies. Sensitivity for endometrial hyperplasia and cancer were 80% and 50%, respectively. Hysteroscopy is exceedingly viable for distinguishing intracavitary pathologies such as polyps, myomas and foreign bodies in ladies with abnormal uterine bleeding. However, for the diagnosis of endometrial hyperplasia and cancer, a hysteroscopy-guided biopsy with uterine curettage is needed to be combined with hysteroscopy. © 2025, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
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    Partner Satisfaction in Labiaplasty Patients
    (Oxford Univ Press Inc, 2024) Bestel, Melih; Uçar, Elif; Dogan, Ozan
    Background Labiaplasty, which has become increasingly popular in recent years, is chosen by women for both cosmetic and functional reasons. It creates significant changes in female sexuality, resulting in high satisfaction rates, but there are limited data on its effects on male sexual response.Objectives The aim of this study was to investigate the effects of labiaplasty on partners.Methods The partners of 49 patients who underwent labiaplasty between January 2020 and May 2023 were included in the study. Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok-Rust Sexual Satisfaction Scale, and New Sexual Satisfaction Scale questionnaires were administered to the partners preoperatively and 6 months postoperatively.Results There was no significant difference between preoperative and postoperative responses to the MSHQ-EjD questionnaire. The postoperative increase in the New Sexual Satisfaction Scale compared with the preoperative score was statistically significant. Statistically significant positive changes were observed postoperatively in the Golombok-Rust Sexual Satisfaction Scale categories of intercourse frequency, communication, satisfaction, and nature of sexual intercourse.Conclusions Labiaplasty operation had positive effects on male sexual response but had no effect on ejaculation function and difficulty.
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    Placenta Previa and Adverse Neonatal Outcomes in A Tertiary Center
    (2024) Bestel, Melih; Alpay, Verda; Ekiz, Ali; Bestel, Aysegul; Karaaslan, Onur; Yildirim, Dogukan; Polat, İbrahim
    Objective: Abnormal localization of the placenta with complete or partial closure of the cervix is called placenta previa. Placenta previa occurs in approximately 0.3-0.5% of pregnancies. In this study, we aimed to determine the risk factors and adverse fetal outcomes by comparing the neonatal outcomes of patients who underwent cesarean section for placenta previa with those of patients who underwent cesarean section for other indications. Method: Patients with singleton pregnancies diagnosed with placenta previa were retrospectively analyzed. Placenta previa, risk factors, and adverse neonatal outcomes were estimated using multivariate logistic regression models. Results: A total of 61,110 deliveries were analyzed, and 632 deliveries (288 patients, 344 controls) were included in the study. The prevalence of placenta previa was 0.47%. Advanced maternal age [odds ratio (OR)=3.03], multigravida (?5) (OR=2.31), previous abortion (OR=1.58) and curettage (OR=2.32) were significant risk factors for placenta previa. However, these patients had an increased risk of 1st minute Apgar score <7 (OR=1.59) and neonatal intensive care unit (NICU) admission (OR=2.15). At the same time, the risk of Apgar score <7 at 1 min (OR=5.59) and 5 min (OR=3.94) and NICU admission (OR=28.47) increased in infants of patients with placenta previa <34 weeks. Newborns in the >37 weeks gestational age group with placenta previa were more likely to have a lower birth weight (OR=4.21) and an Apgar score <7 at 5 min (OR=1.89). Conclusion: Pregnancies with a diagnosis of placenta previa were associated with an increased risk of serious fetal outcomes compared with cesarean deliveries for all other indications, regardless of delivery timing.
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    The Impact of Different Management Options of Ectopic Pregnancy on Future Fertility
    (2023) Bestel, Aysegul; Gunkaya, Osman Samet; Bestel, Melih; Aldikactioglu Talmac, Merve; Yazkan Erdoğan, Kübra; Göksever Çelik, Hale
    In this study, our aim was to evaluate the subsequent fertility status of women treated with different methods for ectopic pregnancy. Patients diagnosed with ectopic pregnancy between January 2012 and July 2020 were included in the study. Fertility outcomes of the patients treated with medical or surgical options were questioned. In the study, 659 patients who met the eligibility criteria were included . A single dose of MTX was administered in 37 patients (32.2%) and two doses of MTX were applied in 14 patients (12.2%) and surgery was preferred in 64 patients (55.7%) in the infertile group. In 213 patients (39.2%) in the fertile group, MTX was administered as a single dose while two doses of MTX and surgery was preferred in 49 patients (9.0%) and 282 patients (51.8%), respectively. No statistically significant difference was detected between the groups according to treatment approaches. There was no significant difference regarding fertility outcomes following different typ es of treatments for ectopic pregnancy. For this reason, the methods to be chosen for the treatment of ectopic pregnancy should be evaluated according to the individual factors of the patient.
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    The Importance of Screening Tests and Amniocentesis in Approach to Pregnant Women Over the Age of Thirty-Five
    (Galenos Publ House, 2022) Sezer, Salim; Bestel, Melih; Bolluk, Gokhan; Gezdirici, Alper
    Objective: Our goal was to evaluate the approach to the increased risk of fetal chromosomal anomaly in pregnant women over thirty-five years of Methods: We retrospectively examined pregnant women over the age of 35 who underwent interventional procedures for fetal karyotype analysis in the Perinatology Clinic of University of Health Sciences Turkey Kanuni Sultan Suleyman Training and Research Hospital. Regardless of the indication for karyotype analysis, pregnant women over the age of 35 who underwent karyotype analysis were included in the study. Results: Abnormal karyotype was detected in 76 (8.7%) of a total of 867 pregnant women examined in the study. Of 76 abnormal karyotypes, 51 were found as trisomy 21 (67.7%), 15 as trisomy 18 (21%), and 3 as trisomy 13 (4%). Three fetal karyotype analyzes revealed Turner syndrome (4%), 1 Klinefelter syndrome (1.3%), 2 mosaic trisomy 21 (2.6%) and 1 mosaic Turner syndrome (1.3%). In the patients who underwent interventional procedures primarily because of advanced maternal age, abnormal karyotype was detected in 6 (1.9%) of them. The rates of abnormal karyotype results for double, triple and quadruple tests were 6.4%, 1.9% and 5.8%, respectively. Conclusion: The use of a triple test has no definite impact on the results of pregnant women of older age. When there is no fetal abnormality in the ultrasound, double and quadruple tests may be requested or since the fetal death rate is minimal in amniocentesis, it can be recommended directly without performing any screening tests in pregnant women with older age.