IntroductionBladder flap hematoma is an unusual complication of cesarean delivery. The exact incidence is unknown (1). A few paper has been written on this surgical complication (2-5). Bladder flap formation has been an important step in standard cesarean delivery. A cesarean delivery can be performed either by suturing or not suturing the visceral peritoneum. When visceral peritoneum is reapproximated, bleeding at the incision site may result in bladder flap hematoma. The traditional method closes visceral and parietal peritoneum, and therefore may lead to this complication (6). Patients with bladder flap hematoma usually present with a mass lesion, signs of hypovolemia (tachycardia, drop in hemoglobin level, decreased urinary output) and/or infection (fever, leukocytosis) (2-5). In the present case, we introduce a patient who presented with an extraordinary sign of bladder flap hematoma. Case PresentationA 25-year-old nulliparous, 40 weeks and 5 days pregnant woman presented to Suleymaniye Maternity, Research and Education Hospital in labor. Transabdominal ultrasonography showed 3490 g fetus in cephalic presentation. She had regular contractions on non-stress test. Her cervical examination revealed a dilatation of 4 cm and an effacement of 80%. She was hospitalized in order to perform vaginal delivery. The woman had neither obstetric risk factors nor systemic diseases. Prenatal screening of the fetus was unremarkable. The patient underwent cesarean delivery due to persistent late decelerations during active labor. Cesarean delivery was performed with the technique of traditional method. The visceral peritoneum was sutured as in the traditional technique. The newborn's weight was 3220 g with an Apgar score of 7 at 1 minute and 9 at 5 minutes. On the first postoperative hour, the patient developed postpartum hemorrhage due to uterine atony. She had severe anemia and tachycardia. Transvaginal ultrasonography revealed the presence of 86×77 mm solid mass interposed between lower uterine segment and bladder (Figure 1). Preoperative hemoglobin level was 11 mg/dL and postoperative drop in hemoglobin was 5 mg/dL. Although bleeding time (2 minutes), platelet count (165.000/mcL), and fibrinogen level (310 mg/dL) were normal, slow-onset hematuria was noticed in the previously clear urinary discharge. She was transfused with 4 units of erythrocyte suspension and 4 units of fresh frozen plasma. The follow ups of the patient were performed using serial transabdominal ultrasounds. The bladder flap hematoma was stable in dimension and the patient was clinically asymptomatic. Intravenous antibiotic therapy with ampicillin/sulbactam (4 g/day) was ordered. Urinary catheter was not removed until gross hematuria was resolved. She had no fever or leukocytosis during the follow-up period. Transvaginal ultrasonography on seventh post-operative day showed an obvious reduction in hematoma size (32×33 mm) (Figure 2). The patient was discharged with oral ampicillin/ sulbactam (1.5 g/day) on the seventh post-operative day AbstractObjective...

The purpose of this study was to evaluate the effects of vitamin D supplementation on ovarian reserve markers, including serum anti-Mullerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and antral follicle count (AFC), in infertile women with diminished ovarian reserve and vitamin D deficiency.A prospective, nonrandomized, cross-sectional study was conducted. Women aged 18 to 41 years who were unable to become pregnant after 12 months of sexual intercourse and had normal tubal patency, partners with normal semen analysis, diminished ovarian reserve, and 25-hydroxyvitamin D [25(OH)D] deficiency were included. Eligible patients' AFC and serum levels of AMH, FSH, 25(OH)D, 1,25-dihydroxyvitamin D [1,25(OH)D], calcium, phosphate, alkaline phosphatase, and parathormone were assessed before and after administration of 300,000 IU of vitamin D ampules. Changes in the parameter values after vitamin D supplementation were compared with the initial levels.The study was conducted in 62 of the 142 participants. The AFC and AMH, 25(OH)D, 1,25(OH)D, phosphate (P < .01), and calcium levels (P < .05) were statistically significantly increased after vitamin D supplementation. Statistically significant decreases in FSH (P < .01) and alkaline phosphatase levels (P < .05) were observed after vitamin D supplementation. No statistically significant correlations were found between 25(OH)D level and AFC, 1,25(OH)D level, AMH level, and FSH level before and after supplementation (P > .05).As improvements in the ovarian reserve markers were obtained with vitamin D supplementation, vitamin D might be considered as a fertility treatment for patients with diminished ovarian reserve and vitamin D deficiency. Abbreviations: [1,25(OH)D] = 1,25-dihydroxyvitamin D, [25(OH)D] = 25-hydroxyvitamin D, AFC = antral follicle count, ALP = alkaline phosphatase, AMH = anti-Mullerian hormone, BMI = body mass index, COS = controlled ovarian stimulation, DOR = diminished ovarian reserve, FSH = follicle-stimulating hormone, IVF = in vitro fertilization, PCOS = polycystic ovary syndrome.

Amaç: Povidone-iodine (Betadine®), ameliyat sonrası dönemde cerrahi alan enfeksiyonunu önlemek için yaygın olarak kullanılan bir solüsyondur. Bu çalışmada cerrahi sonrası ilk pansuman zamanı araştırıldı. Erken (ikinci gün) povidion iyot pansumanı, yara iyileşmesi veya enflamasyonu açısından geç (beşinci gün) pansumanla karşılaştırıldı. Yöntemler: Çalışma Haziran 2017-Haziran 2018 tarihleri arasında bir kadın hastalıkları ve doğum kliniğinde yapıldı. Cerrahi uygulanan hastalar erken ve geç pansuman olarak iki gruba ayrıldı. İki grup, yara iyileşmesi veya enflamasyonu açısından karşılaştırıldı. Enflamasyon, yara bölgesinde kızarıklık, şişme ve seröz akıntı (pürülan olmayan) varlığı olarak tanımlandı. Bulgular: Çalışmaya medyan batın insizyonu olan 49 kadın alındı. Enflamasyon 11 hastada gözlendi (%22,4). Ortalama yaş (45,7±11,3 ve 49,3±9,5), vücut kitle indeksi (29,02±5,6 ve 30,89±4,0), diyabetik hasta oranı (%21 ve %36), hipertansif hasta oranı (%34 ve %36), sigara içme oranı (%13 ve %34), uzun ameliyat süresi (>4 saat) (%32 ve %63) ve ameliyat kategorisi (malign veya bening) enflamatuvar grupta istatistiksel olarak anlamlı değildi. Yirmi iki hastaya ameliyat sonrası ikinci günde (erken grup) povidon-iyot ile pansuman yapılmış, 27 hastaya beşinci günde (geç grup) yapılmıştı. Yara enflamasyonu insidansı erken grupta anlamlı olarak yüksekti (%11'e karşılık %36, p=0,035). Sonuç: Bu çalışmada, erken pansumanın geç pansumanla karşılaştırıldığında avantajı gözlenmedi. Erken pansuman yapılan grupta, insizyon hattındaki enflamasyon oranı daha yüksek gözlendi. Cerrahi yaranın epitelizasyonu tamamlanmadan önce, povidon iyodinin cerrahi yara ile teması ve povidon iyodinin subkütan penetrasyonu yara iyileşmesi sürecini olumsuz etkileyebilir. Anahtar Kelimeler: Povidon iyot, enflamasyon, epitelizasyon, cerrahi alan enfeksiyonu Introduction: Povidone-iodine (Betadine®) is a commonly used solution to prevent surgical site infection in the postoperative period. In this study, time of first dressing after surgery was investigated. Early (second day) povidone-iodine dressing was compared with late (fifth day) dressing in terms of wound healing or inflammation. Methods: The study was conducted in a gynecology clinic between June 2017 and June 2018. The patients who underwent surgery were divided into two groups as early and late dressing. The two groups were compared in terms of wound healing or inflammation. Inflammation was defined as the presence of redness, swelling and serous discharge (non-purulent) at the wound site. Results: The study included 49 women with median incision. Inflammation was observed in 11 patients (22.4%). Mean age (45.7±11.3 vs 49.3±9.5), Body mass index (29.02±5.6 vs 30.89±4.0), rate of diabetic patients (21% vs 36%), rate of hypertensive patients (34% vs 36%), rate of smoking (13% vs 34%), operative time >4 hours (32% vs 63%), and operation category (malign or benign) were not statistically different between patients with normal wound healing and patients with inflammation. Twenty-two patients were dresse...