Pregnancy Follow-up
These are a set of regular check-ups to evaluate the health condition of mother and baby in the period from detection of the pregnancy to the delivery, to create a pregnancy care plan, predict the problems that may arise and treat these problems. During pregnancy follow-up, the patient should be informed about the conditions that may pose a danger and require referral to health institutions. The expectant mother should be informed about conditions such as abdominal pain, headache, increased blood pressure, vaginal bleeding, water leakage, decreased baby movements, and high fever.
In the first examination of the pregnancy, it should be ascertained that the fetus is developed in the uterus in a healthy way. With the vaginal ultrasound examination, it is checked whether the gestational sac is positioned in the uterus where it should be. In this way, ectopic pregnancy is ruled out. In addition, in the ultrasound evaluation, it is observed whether there is deformity in the uterus, whether there are diseases that may adversely affect the pregnancy, such as uterine fibroids or ovarian cysts. In addition, the presence of abnormal pregnancy conditions such as molar pregnancy (hydatidiform mole) in the uterus should also be examined.
If ultrasound evaluation in the first examination of pregnancy shows that it is in the normal range, some tests will be requested from the expectant mother. These tests are as follows:
** Blood count and blood group
(Do you have anemia or coagulation disorder? Is there blood incompatibility?)
** Fasting blood sugar, HbA1c, liver and kidney tests
(Do you have latent diabetes? Is there liver and kidney dysfunction?)
** Thyroid hormone tests
(Is there any thyroid disease that may cause miscarriage or adversely affect the intelligence of the baby?)
** Infectious disease tests
(Is there any disease such as hepatitis, AIDS, rubella, toxoplasma, syphilis that will adversely affect the baby during pregnancy and delivery?)
** Pap-smear test
(Is there a precursor to cervical cancer?)
Pregnancy screenings
In the follow-up of a healthy pregnancy, all screenings are completed in four main steps. In the case of different clinical situations, additions to or eliminations from screenings can be made. After 24-28 weeks of pregnancy when all these scans are completed, the pregnancy follow-up is completed by checking the baby's weight, growth, water and well-being in the remaining weeks.
** Week 11 to 14 : Dual Screening Test
(It is the chromosomal disease screening test with the highest diagnostic power for Down (trisomy-21) and Edward's syndrome (trisomy-18) by measuring the baby's height and nuchal translucency on ultrasound and detecting the level of two hormones in the mother's blood.)
** Week 16 to 18 : MS-AFP Test
(It is a very sensitive blood test in detecting spinal cord developmental defects such as spina bifida. Your physician will recommend this screening if deemed necessary.)
** Week 20 to 22 : Second Level (detailed) Ultrasound Examination
(It is an imaging in which all organs and systems of the baby are examined and reported by ultrasound during this period when the baby's bone structures are not yet developed.)
** Week 24 to 28 : Sugar Loading Test
(It is a challenge test to screen for gestational diabetes. Diabetes is most likely to be detected when it is performed during this week.)
** Fetal DNA in Maternal Blood
(Blood of the expectant mother also contains fetal DNA of 10%, in addition to her own DNA. It is possible to detect some chromosomal disorders (such as Down syndrome) with an accuracy rate of up to 99% via the genetic analysis performed by separating these DNA fragments. This test is not a routine screening test.)
High-Risk Pregnancy Follow-Up
The existing chronic diseases that an expectant mother has before pregnancy and the problems that emerge after pregnancy can lead to the different risks. Pregnant women with this condition are called high-risk or high-risk pregnancies.
Causes leading to risky pregnancy,
Chronic diseases, Diabetes, heart, goiter, rheumatic diseases, kidney diseases.
If the expectant mother is under 18 years old or over 35 years old.
Smoking, alcohol and drug use by the expectant mother.
Women who are very overweight (BMI above 30) and very thin (BMI: less than 20)
Pregnancy-related hypertension, high blood pressure
Multiple pregnancies
Having a pregnancy history such as preterm birth, stillbirth, early separation of the baby's spouse, pregnancy poisoning in previous pregnancies
Problems: The placenta is critical for the baby's health, placental location abnormalities
Polycystic Ovary Syndrome
POLYCYSTIC OVARY SYNDROME IS SEEN IN ONE OF EVERY 20 WOMEN
Polycystic ovary syndrome is a disorder that manifests itself with menstrual irregularity, hair growth and weight problems in women of reproductive age. This disease should be kept under regular control in terms of serious conditions that may lead to infertility and health problems that may occur in the coming years.
Polycystic ovary syndrome (PCOS) is a disorder characterized by chronic non-ovulation, in which many genetic and environmental factors are effective. Chronic ovulation problem manifests itself clinically with menstrual irregularities, dysfunctional bleeding and infertility. It is associated with ovulation disorders, hair growth and hormonal disorders that begin in the first years of the patient's menstruation. 1 out of every 20 women suffer from this syndrome. Genetic factors play an important role in its formation. It is seen in 24% of mothers and 32% of sisters of women with polycystic ovary syndrome. Clinical findings of hyperandrogenism (high male hormone) are hair growth, acne and male pattern baldness. Approximately 70% of women with high male hormones have hair growth.
According to the ultrasonographic findings of the patients, if there are 12 or more peripherally arranged follicles with a diameter of 2-9 mm in an ovary and/or the ovarian volume is large (>10 ml), it is defined as polycystic ovary. The presence of a single polycystic ovary is sufficient for the diagnosis of polycystic ovary.
Polycystic ovary syndrome symptoms appear during the age of first menstruation. Patients with polycystic ovary syndrome usually have less than 9 or no periods in a year. A significant portion of the patients have abdominal obesity, that is, an apple-shaped body.
It is seen in both thin and obese PCOS patients. However, when compared to non-obese patients, the rate of hidden sugar is higher in obese patients.
HOW PATIENTS WITH POLYCYSTIC OVARY SYNDROME SHOULD EAT
- The first goal should be to achieve and maintain the ideal body mass index.
- Overweight or obese patients should limit their daily calorie intake and avoid artificial and natural sugary foods. In particular, Eating plenty of fruits as a healthy food option enables high calorie intake and increases blood sugar level rapidly.
- Plenty of protein foods, fresh vegetable dishes and salads should be consumed. Foods such as pastries, rice, pasta, ice cream, fruit juices are calorie bombs that can be taken quickly and easily, making it difficult or even impossible to lose weight.
- Correcting the diet and adding sports helps some of the patients with menstrual irregularity to regulate their menstruation.
USING BIRTH CONTROL PILLS IS NOT HARMFUL IN TREATMENT OF PCOS.
Birth control pills: It is the first treatment option for patients with menstrual disorders. Pills containing 30-35 μg ethinyl estradiol and antiandrogenic progestin (drosperinone and cyproterone acetate) are preferred. They reduce the level of male hormone by suppressing ovarian functions. They bring the male hormone levels back to normal in the first month of treatment. They suppress ovarian-derived male hormone production at the end of the 3rd week. The acne effects is seen in 1-2 months. Due to the hair growth cycle, 6-12 months are required for it to be effective on hair growth. Terminal hair growth cannot be completely stopped with birth control pills, it only slows down, so mechanical methods are also necessary. However, the use of birth control pills has various disadvantages such as causing venous thrombosis and migraine headaches. After three months of treatment, the patient should be reassessed for the efficacy of the treatment and for androgen levels. As a general rule, it is recommended to use birth control pills until the patient reaches gynecological maturity or until there is a significant decrease in body mass index. At this point, the treatment should be interrupted for a few months and the normal pattern should be evaluated. One of the issues that women worry about is whether birth control pills are the cause of infertility later on. Birth control pills do not have such a negative effect.
Unfortunately, even if the frequency of polycystic ovary syndrome does not change due to the increase in malnutrition, inactivity and obesity in the last two decades, the number of patients who need treatment and are highly resistant to treatment is increasing.
Early Down Syndrome Risk Monitoring
In order to detect Down Syndrome before birth, some tests are applied to expectant mothers in the prenatal period to screen for the disease even if there is no risk factor. Among these tests, the most commonly used double test is done at 11-14 weeks of pregnancy. As the name suggests, it is based on the application of two separate tests together. It has a blood and an ultrasonography part. Ultrasonographically, it includes the measurement of the nuchal translucency of the baby, and it is observed whether the nasal bone is formed. Down Syndrome risk is determined by adding the mother's age and weight, the baby's head-butt distance along with these values.
The reliability of the double screen test, namely, the detection rate of Down Syndrome, is around 90% with a false positive rate of 5%. Therefore, it is the test that should be preferred first in screening. In these tests, the probability or risk of Down Syndrome is tried to be determined. Our aim is to group pregnant women as those with high risk and those with low risk.
A definitive diagnosis can be made by recommending amniocentesis (based on culture and karyotype analysis of cells shed from the fetal skin, digestive and respiratory systems in the amniotic fluid) or CVS (applied by taking a sample from the baby's placenta with the help of a needle and catheter between 11 and 14 weeks) to the high-risk group. Amniocentesis and CVS results are conclusive. They provide a definite conclusion if baby has Down Syndrome or not.
Menopause Follow-up and Analysis (Mammography-Hormone-Bone Densitometry)
Mostly, menopause period starts at the age of 40 and continues until the age of 55, on average. During this period, menstrual bleeding begins to become irregular. Then menstrual bleeding is completely stopped. Menopause is a natural process. The menopause that starts before the age of 40 is called "premature menopause".
MAMOGRAPHY
Breast cancer is the most common cancer in women. The cancerous mass in the breast can be detected much earlier thanks to mammography, before it reaches a palpable size. In breast cancers that are detected before they reach a palpable size, the chance of treatment and survival rate is high without removing the breast. Especially after the age of 40, women should have regular mammograms and breast cancer screenings, even if they have no complaints.
In our hospital's Radiology Service, digital mammograms are taken with the world's most advanced and least irradiated 3D Tomosynthesis Digital Mammography System and evaluated by experts in breast radiology.
Do not neglect your annual regular check-ups. Early diagnosis is very important for a healthy future…
BONE DENSITOMETRY
Bone densitometry is often used in the diagnosis of osteoporosis, which affects postmenopausal women but can also be seen in men.
Osteoporosis is a gradual loss of calcium that causes bones to become thinner and more fragile.
You should immediately have bone densitometry, if you
Do not take enough calcium foods (milk and dairy products) in your daily diets,
Have an irregular diet,
Are Diabetics
Passed kidney stones and have other kidney diseases
Use cortisone drugs, some anti-acid stomach drugs and sedative drugs for a long time,
Consume tea, coffee, cigarette and alcohol excessively
Have a genetic predisposition.
Have given birth more than two
Are a women in menopause period
Are a woman or man over 50 years old.
Diagnosis and Treatment of Infertility
METHODS OF DIAGNOSIS OF INFERTILITY
By definition, infertility is the inability to achieve pregnancy despite having sexual intercourse 2-3 times a week without using any contraception method for at least one year.
Tests to be Done in the Diagnosis of Infertility:
1. Sperm Count: In the spermiogram test performed after 3 days of sexual abstinence, sperm count, motility and structure are evaluated.
2. Hormone tests performed on the 3rd day of menstruation
3. HSG (hysterosalpinography): It is possible to detect whether the fallopian tubes are open and a disorder in the uterine tissue that prevents pregnancy from settling.
4. USG: Vaginal ultrasonography is performed to evaluate the condition of the uterus and ovaries, and whether there are pathologies such as uterine fibroids, polyps, and whether there is a cystic structure in the ovaries.
5. Laparoscopy
Hysteroscopy
Device used for hysteroscopy is a few millimeters thick camera device equipped with a light. By expanding the cervix with special instruments, the device is gently passed through the cervix and inserted into the uterus. Thus, the inside of the uterus is visualized
Colposcopy
Colposcopy provides a close examination of the cervix, vagina or vulva. The illuminated instrument called colposcope enlarges the view of the cervix, thus enabling it to be examined and seen better.
Vaginal Smear + HPV (Wart) Tests
The smear test is a special cervical screening test for women to evaluate the cervix (cervix) and to check for infections and cancer-precursor conditions. In case of suspicious findings or abnormal cells in the Pap smear, your doctor may request HPV research. There are many types of HPV. While some of them only cause genital warts, some are closely related to cervical cancer.
Gynecological Oncology Diagnosis and Surgery
Myoma Surgery
Myomas are formed by the abnormal growth of smooth muscle cells in the muscle layer called myometrium in the uterus. Often more than one fibroid develops.
Uterine Cancer
Uterine Cancer most commonly develops from the inner layer of the uterus, called endometrium. Uterine cancer occurs as a result of uncontrolled proliferation of cells in the endometrium layer. The resulting cancer cells can reach the lymph nodes, surrounding organs or organs in the distant region with blood flow. Less common uterine tumors are sarcomas. These tumors form in the muscle layer of the uterus.
Ovarian Cancer
The main structure of the ovaries, which contain many different cells in its tissue, is epithelial cells. Ovarian cancer may occur as a result of uncontrolled division and proliferation in epithelial cells or cells of the embryonic period. 80 percent of ovarian cancers, which are mostly seen after menopause, occur in the epithelial tissue. Embryonic tumors are detected in 60 percent of ovarian cancers that are seen under the age of 20.
Cervical Cancer
Cervical cancer is the most common gynecological cancer in developing and underdeveloped countries. Every year, 500,000 new cases of cervical cancer are diagnosed worldwide. Cervical cancer, which usually occurs around the age of 50, has also started to be seen in young women in recent years. Although breast cancer ranks first among the most common cancers in women, cervical cancer is more important than breast cancer due to its life-threatening character.
Incontinence (Incontinence) Diagnosis and Treatment
What is incontinence? What are the symptoms?
Incontinence, namely involuntary incontinence, is a very common health problem in society.
It is more common in women. Causes of incontinence include Pregnancy, childbirth, cystocele, rectocele, uterine prolapse, menopause, obesity, operations such as hysterectomy, urinary tract infections. Although its severity varies, it can occur as a drop of urine when coughing, laughing or increased intra-abdominal pressure (stress incontinence), as well as in the form of inability to reach the toilet with a sudden urination sensation and incontinence (urge incontinence). Sometimes both types of incontinence can be combined (mixed type incontinence).
If the degree of incontinence affects daily life and quality of life, a doctor must be consulted. In most patients, serious outcomes and incontinence can be treated with simple lifestyle changes and simple medical treatments.
What are the types of incontinence?
Stress incontinence: This type of incontinence is defined as incontinence when there is a sudden increase in intra-abdominal pressure such as coughing, sneezing, laughing, etc. Stress incontinence occurs as a result of insufficiency or weakness of the valves in the bladder and urethra (the channel that opens out of the bladder). The most important risk factors are pregnancy, childbirth and menopause. It occurs due to weakening of the support tissue of the pelvic floor and urinary bladder. Its treatment is surgical. Patients benefit greatly from the surgery called TOT.
Urge incontinence: It is defined as the incontinence of urine with a sudden urge to urinate. It occurs as a result of involuntary contractions that occur suddenly in the bladder and incontinence occurs before the person can reach the toilet. Urge incontinence causes include urinary tract infections, bladder irritating substances (stones in the urinary tract, sand…), bowel problems, Parkinson's disease, Alzheimer's disease, stroke and diseases such as Multiple sclerosis. Urge incontinence is also called hyperactive bladder syndrome if there is no causative disease.
Overflow incontinence: It is inability to sense the bladder movements, although the bladder is full, there is no sense of urination due to loss of sensation, and when urine is stored in volumes exceeding the bladder capacity, incontinence in the form of overflow occurs. This type of incontinence is seen with bladder injuries, urethral obstruction or diseases that cause damage to the nerves, such as diabetes, spinal cord injuries, or multiple sclerosis.
Mixed incontinence: Sometimes incontinence can be in the form of both stress and urge incontinence. In this case, it is classified as mixed incontinence.
Ovarian Cysts and Its Treatment
Ovarian cysts are very common in women. Although most cysts are harmless and go away on their own, it is necessary to monitor each ovarian cyst to make sure it does not cause problems. Most ovarian cysts do not cause symptoms. Some go away on their own. Some ovarian cysts can cause severe pain due to twisting (torsion), bleeding and bursting (rupture). They can cause a dull ache in the abdomen or pain during intercourse. Apart from that, the most common symptoms of ovarian cysts can be listed as follows:
Menstrual irregularity
Abdominal bloating and pain
Digestive system disorders
Urinary tract complaints
In some cases, even emergency surgery may be required. Most functional cysts resolve spontaneously in one or two cycles without the need for treatment. If the cyst is large and causing symptoms, hormone (birth control pill) therapy or surgery may be recommended.
Diagnosis and Treatment of HPV and Condylomas (Genital Warts)
Condylomas (Genital Warts)
Genital warts are lesions that usually occur in the genital area, caused by the HPV virus.
The HPV virus enters the body through damaged skin during sexual intercourse. Although the condom reduces the transmission, it does not decisively prevent the entry of the virus into the body and the transmission of the wart. The virus is most commonly transmitted by sexual contact, but it can also be transmitted without contact. Although rare, warts can also be seen in virgin women. It is possible to burn the warts with cautery and freeze them with cryotherapy, but it can recur in people with a weak immune system.
There are more than 200 types of HPV virus. Some types (6,11) can cause genital warts and others (16,18) can cause cervical cancer in women. Therefore, HPV type determination should be made from genital warts. Not every case of genital warts will be cervical cancer, but the risk of cancer is increased. Therefore, regular smear follow-up should be done.
Cause and Treatment of Recurrent Miscarriages
Recurrent Miscarriages (Habitual Abortus)
Two or more miscarriages that occur before the 20th week of pregnancy and before the baby reaches 500 grams are called recurrent miscarriages. The first sign of miscarriage is vaginal bleeding. This may be a light-colored bleeding or a dark brown bleeding mixed with vaginal secretions. Vaginal bleeding is often accompanied by abdominal pain and cramps. Recurrent miscarriages are usually caused by genetic disorders and problems in embryo formation.
Uterine anatomical disorders and cervical insufficiency
Coagulation disorders
Hormonal disorders (diabetes, thyroid gland diseases, progesterone hormone deficiency)
Infections
Parental chromosomal disorders
Antiphospholipid antibodies
There is no cause in 50% of recurrent miscarriages. Treatment should be planned according to the cause. Aspirin and/or anticoagulant needles are used in patients with coagulation disorders. In the case of unexplained recurrent miscarriage without any cause, low-dose aspirin is used empirically.
Intrauterine Polyps
Diagnosis and Treatment
Uterine polyps (Endometrial Polyp)
Endometrial polyps are benign formations that originate from the innermost layer of the uterus in the uterus. Polyps are usually detected by ultrasonography and water-ultrasound, but the definitive diagnosis is made by pathological examination after removal of the polyp by curettage or hysteroscopy.
Polyps usually cause complaints such as excessive or prolonged menstrual bleeding, intermittent bleeding, bleeding during intercourse, bleeding during menopause, and discharge. Polyps can rarely cause inability to conceive or miscarriage. The factors that cause polyps are not fully known, and it is estimated that excess estrogen activity may cause this condition. Endometrial polyps are common in people treated with tamoxifen for breast cancer. Most of the polyps do not cause any complaints, but they should be removed when the polyp is noticed. Polypectomy can be performed by curettage or hysteroscopically.
Female Genital Aesthetics (Labiaplasty-Vaginoplasty)
In women, genital aesthetics can be expressed as all of the operations applied to the genital region (inner and outer lip, vagina, around the clitoris and perineum). These operations may have aesthetic purposes or they may be performed with the expectation of functional benefit.
The enlargement of the vaginal opening, which is a frequently observed discomfort in the field of gynecology, can also be eliminated by genital aesthetics. Genital aesthetics is also recommended for the elimination of sexual problems that are caused by the loss of elasticity of the vagina. Other appearance disorders in the genital area can occur after events such as excessive weight gain or birth, and genital aesthetic surgeries are applied as a solution to such conditions.
Cystocele (Bladder Prolapse) and Uterine Prolapse
Diagnosis and Treatment
“Uterine prolapse” is caused by excessive stretching of the muscles and connective tissues in the abdomen and pelvis area due to multiple pregnancies, normal births, giving birth to an overweight baby, lifting something heavy, low estrogen, coughing frequently, obesity, straining too often and some lung disorders. This problem occurs when the ligaments and muscles of the pelvis weaken and do not provide adequate support to the uterus. Therefore, the uterus protrudes out of the vagina. Although this condition can often be seen in advanced age, it can be seen in women of all ages. However, it affects women who have had more than one normal birth and is more common. While mild sagging problems do not require treatment, if this problem bothers the person and affects his normal life, treatment can be applied.
Laparoscopic Myoma, Cyst Tube Surgery
Benign tumors of varying sizes, located in the female uterus and connected to the uterine cavity within the muscle tissue of the uterus and to the outside of the uterus, sometimes with a stem, are called myoma. Physicians perform surgery with two techniques for the treatment of myoma. One of them is performed with open abdominal incision and the other with closed laparoscopic method. While determining the technique, the physician may request additional imaging, i.e. lower abdominal MRI, if necessary, and then choose the technique to be performed according to his/her experience. Whether the operation will be open or closed is decided according to the size and number of myoma and the experience of the physician. Submucous myoma, which cause severe pain and bleeding in the uterine cavity, can be easily removed with a closed daily procedure called hysteroscopy.
In Gynecology, Laparoscopic surgery (operation with closed method), myoma removal, uterus-tube-ovary removal, ovarian cysts, tube ligation, chocolate cyst, incontinence treatment and gynecological cancer surgeries can be performed in our hospital.
Laparoscopic myoma surgery provides faster recovery, less risk of infection and rapid return to life with appropriate patient selection.
Laparoscopic Uterine Removal Surgery
Uterine removal surgery, which is performed by opening small diameter holes in the abdomen or around the navel and sending optical instruments and auxiliary tools, is called Closed Uterine Surgery (Hysterectomy).
Main reasons why laparoscopy method is preferred in uterine surgeries are as follows:
Low risk of adhesions and infection in the abdomen as abdomen is not opened during the operation,
Low postoperative pain,
Ability to return patient to his/her routine life quickly after operation,
Ability to look closer to the uterus and intra-abdominal organs, therefore good surgical control,
No post-operative scarring and abdominal hernias after operation as no incision opened on the abdomen and around umbilicus during operation.
Common causes of laparoscopic womb removal are uterine myoma, non-medicated bleeding, and uterine lining cancer.
Diagnosis and Treatment of Bartholin's Cyst and Abscess
Bartholin's glands are located on both sides of the vaginal opening and their main function is to produce secretions and provide lubrication during sexual intercourse. The secretion (slippery and transparent) produced with the help of glands is transmitted to the vaginal opening through the canal, triggered by sexual stimulation.
Bartholin's cyst and abscess are encountered as a result of obstruction of the gland duct for different reasons. This type of cyst and abscess is common in women. Since the obstruction in the canal will prevent the secretion from being pushed out, it causes secretion to accumulate inside. The accumulated secretion enlarges the duct, causing the formation of a fluid-filled mass. The situation where the mass is filled with only secretion is called a cyst, while if the mass contains pus, it is called an abscess.
Although temporary relief (drainage) is provided in Bartholin gland cyst and abscess, the definitive solution is surgery. There are two techniques in surgery, cystectomy or marsupialization by an expert doctor.
Diagnosis and Treatment of Chronic Vaginal Infections
Physiological discharge in women is odorless, itchy, transparent in color and in small amounts. Apart from this, all kinds of smelly, itchy, yellow-green foamy milk cut style, white intense discharge is pathological. If not treated properly, it may require vaginal and cervical cultures and long-term treatment when necessary.
