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ABSTRACT Objective: To evaluate the maternal and fetal outcomes associated with caesarean sections (CS) repeated fourth and fifth times. Methods: We performed a retrospective study of 110 patients undergoing CS repeated fourth and fifth times between May 2014 and May 2015. The patients were divided into two groups: group 1 had CS repeated four times (n = 90) and group 2 had CS repeated five times (n = 20), and the maternal and fetal outcomes of the groups were retrospectively evaluated. Results: There were no statistically significant differences between fourth and fifth CS groups with regard to the maternal age, gravida, body mass index, gestational age at birth, birth-weight, and Apgar scores at 5 minutes (p > 0.05). We found no significant differences between the fourth and fifth CS groups in terms of injury to peripheral organs, intra-abdominal adhesions, caesarean hysterectomy, uterine dehiscence or rupture, time during operation, length of hospital stay, and need for blood transfusions (p > 0.05). Compared with the elective cases, perioperative complications and length of hospital stay were significantly higher in the urgent group (p = 0.034 and p = 0.005). Conclusion: Women with CS repeated four or five times have increased risks for perioperative complications. Placenta previa with or without accreta and intra-abdominal adhesions seem to be the major causes of increased morbidity.
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Aim: Epiphytic lichens are biological indicators, which can give information about the environmental changes of the ecosystem. The differences in richness and community compositions of lichens can indicate the environmental quality of their location. This study was done in order to examine the possible differences in richness and in community composition of lichens that may have occurred in the research area, Kurşunlu Waterfall Nature Park and surroundings.Methodology: Kurşunlu Waterfall Nature Park and surroundings was divided into 4 sections; natural area near brook, natural pine forest area, planted pine forest area and agricultural greenhouses area. The study was planned to focus on epiphytic lichens living on Pinus brutia Ten. trees. European Guideline, which is a standardized method to assess lichen diversity (LDV) on tree bark for monitoring environmental stress, was used for monitoring quality of four different environmental conditions with lichens. In order to determine the differences of lichen community composition of these four conditions, some statistical analyses were performed. Results: Lichen richness of planted pine forest area was found poorer and statistically different than the other areas. In addition, the lichen community composition of natural pine forest area was found significantly different than the agricultural greenhouse area and the natural area near brook, partly different than the planted pine forest area. Statistical evaluations indicate that the natural pine forest area had natural or semi-natural habitat characteristics and there was no or less eutrophication in this region. Also it showed that other areas were affected by the presence of human damage and eutrophic pollution load in the environment. This eutrophic pollution load was related to non-ecological agriculture applications around the park. Interpretation: This study proves that epiphytic lichens change their community composition by adapting to changes in environmental conditions. Also this study showed that lichens are strong indicators of environmental quality.