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    Emergency cervical cerclage: effect on pregnancy outcome and mode of delivery
    (Taylor & Francis Ltd, 2014) Cavus, Yunus; Uysal, Ahmet; Balsak, Deniz; Acar, Zuat; Ince, Zehra; Uysal, Fatma
    Aim: To evaluate the effectiveness of emergency cervical cerclage (ECC) and its effect on the mode of delivery. Patients and methods: Between April 2007 and July 2011 patients attending MH Diyarbakir Obstetrics and Gynecology Hospital and MH Seferihisar State Necat Hepkon Hospital who underwent ECC were included in this retrospective analysis. Results: At the time of ECC, the mean gestational age, cervical length and cervical dilatation were 21.4 +/- 2.2 weeks, 4.3 +/- 0.8 cm and 11 +/- 2.4 mm, respectively. The average time between the procedure and birth was 13.8 +/- 4.9 weeks and this period was sufficient to maintain a viable pregnancy (p < 0.05). In this study, 12 patients (60%) were delivered vaginally and eight (40%) patients delivered with CS (40%). the difference was statistically insignificant (p = 0.371). Regarding the gestational age at time of delivery, 55% of patients delivered at 36 weeks, 70% at 32 weeks, and 80% of them delivered at 28 weeks. The total live birth rate was 90%. Conclusion: ECC provides satisfactory time for the fetus to gain sufficient viability. Pregnancies with emergency cerclage show no difference in terms of birth method, whether cesarean or vaginal birth, and delivery type does not appears to be linked to ECC.
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    Treatment of Vaginal Cuff Prolapses with Posterior Intravaginal Sling and Evaluation of Efficiency with International Consultation on Incontinence QuestionnaireVaginal Symptoms Method in the Long Term: Preliminary Results
    (Wiley, 2013) Balsak, Deniz; Uysal, Ahmet; Cavus, Yunus; Ince, Zehra; Acar, Zuat; Gungor, Aysenur; Hacivelioglu, Servet
    Objectives: The aim of this study was to research the efficiency of posterior intravaginal sling (PIVS) procedure in vaginal cuff prolapse, together with possible complications, long-term effects and effects of the method on vaginal and sexual function and quality of life of patients. This retrospective study comprised 21 patients with vaginal cuff prolapse. Methods: PIVS procedure was performed in 21 patients with vaginal cuff prolapse with quantification stages 2, 3, or 4 of pelvic organ prolapse. Patients were assessed according to the International Consultation on Incontinence QuestionnaireVaginal Symptoms before and after operation. Results: The average follow-up period was 24.6 months. The rate of surgical success was 100%, the rate of mesh erosion was 14.2% and the rate of dyspareunia was 33.3%. Vaginal symptom, sexual matter and quality of life scores were statistically significant in the postoperative period compared to the preoperative period (P = 0.001, P = 0.001, P = 0.001, respectively). Conclusion: PIVS is an effective and reliable method of treating vaginal cuff prolapse. However, its complication profile is not yet at an acceptable level. We believe that the rate of mesh erosion will regress to a more acceptable level with the improvement of mesh technology and postoperative method. The necessary incontinence surgery is easily performed together with PIVS procedure. PIVS restores the vaginal and sexual functions of patients and increases their quality of life significantly.