Cervical Cancer Screening in Women Aged Older Than 65 Years.

OBJECTIVES: Considerable debate exists among guidelines regarding when cervical cancer screening can be safely stopped. The authors aimed to compare the efficiency of human papillomavirus (HPV) test, cytology, and previous screening history for the diagnosis of cervical intraepithelial neoplasia (CIN) 2+ lesions in women aged older than 65 years. MATERIALS AND METHODS: This is a retrospective cohort study. Multiple logistic regressions were used to compare the efficiency of the HPV test, cytology, and previous screening history for the diagnosis of histologically proven CIN 2+ lesions. RESULTS: A total of 5,427 women were included in the study. A total of 2,143 women were tested with HPV and 52 (2.4%) of them were HPV-positive. Abnormal cytology was detected in 359 (6.6%) women. Most of the women (70.4%) had inadequate screening in the previous 10 years. According to regression analysis, an HPV-positive test increases the risk of probability of CIN 2+ 136.111 times [95% CI for odds ratio (OR) = 41.212-449.538] compared with an HPV-negative test ( p < .001). Abnormal cytology increases the probability of CIN 2+ 13.072 times (95% CI for OR = 3.878-44.062) compared with normal cytology ( p < .001). Inadequate or positive previous screening increases the likelihood of CIN 2+ 9.705 times (95% CI for OR = 1.603-58.756) compared with adequate and negative previous screening ( p = .013). CONCLUSIONS: Adequate previous screening is a valuable strategy, and abnormal cytology is an important screening test in women aged older than 65 years. However, the HPV test is the most determinant parameter for CIN 2+ risk in elderly women.

Solving an incomplete puzzle: risk factors of low back pain during pregnancy.

OBJECTIVES: Low back pain during pregnancy is a common disorder with an obscure etiopathogenesis. This study sought to investigate the association of low back pain by assessing various epidemiologic and clinical risk factors including weight changes, the presence of striae gravidarum, and intraperitoneal adhesions. MATERIAL AND METHODS: A total of 250 pregnant women between 37 and 40 gestational weeks who were scheduled for cesarean section were included in this multicenter prospective trial. Sociodemographic parameters and physical examination findings were noted and assessed as potential risk factors that may play a role in the development of low back pain. RESULTS: The mean age of the study population was 29.98 ± 5.23 years and low back pain was identified in 120 (48%) patients. According to the logistic regression results, an increase in BMI (%) during pregnancy (odds ratio: 1.240; 95% CI: 1.061-1.448; p = 0.007) is correlated with the presence of low back pain. Separately, receiver operating characteristic curve analysis suggested that an increase in BMI (%) during pregnancy has a sensitivity of 77.5% and a specificity of 60% for the prediction of low back pain, and the cutoff point was found to be 15.5%. CONCLUSIONS: Our results imply that an increase in BMI (%) was correlated with low back pain during pregnancy. Weight gain should be personalized for each pregnancy and the increase in BMI (%) during gestation should be reduced. Measures should be taken to assure appropriate weight control to prevent low back pain during pregnancy.

Unplanned pregnancy and awareness of emergency contraception: a postpartum period survey.

OBJECTIVES: The study aimed to determine the awareness of emergency contraception (EC) and knowledge of its use as well as the unplanned pregnancy rate among women in the immediate postpartum period in Ankara, Turkey's second largest city. METHODS: Interviews were carried out among 1955 women on their first or second day postpartum. The interview was based on a questionnaire containing 19 questions covering participants' awareness and experience of using EC as well as their future approach to its use. RESULTS: The rate of unplanned pregnancy was 18.2% and the rate of EC awareness was 26.0%; 89.4% of those who were aware of EC knew how to use it correctly. In the multivariate regression analysis, employment, household income and level of education were independently associated with EC awareness; gravidity, household income, level of education and number of abortions were independently associated with unplanned pregnancy. Awareness of EC increased significantly (p < .05) with age, household income and educational level; knowledge about the correct use of EC increased with age and educational level (p < .05). CONCLUSION: EC awareness among the study population was low and was related to household income and educational level. Household income, educational level and gravidity were the most important factors associated with unplanned pregnancy. Governments must therefore establish appropriate health policies and provide contraceptive education to women from adolescence onwards.

Predictors of adverse maternal and perinatal outcomes in a refugee population from an active conflict country, Syria.

OBJECTIVE: To elucidate predictors of adverse maternal and perinatal outcomes in refugees emigrating from an active conflict region (Syria). MATERIALS AND METHODS: This study included Syrian pregnant women who gave birth in Etlik Zübeyde Hanim Training and Research Hospital between 2013 and 2016. Adverse perinatal outcomes were defined as preterm labor, premature rupture of membranes, early membrane rupture, intrauterine growth retardation, hypertension, perinatal excites, and erythrocyte-transfused cases. Factors associated with those adverse outcomes were assessed using multiple logistic regression analysis. RESULTS: Having an active smoking habit [odds ratio (OR): 2.647, 95% confidence interval (CI): 1.767-3.965; p<0.001], obesity (OR: 2.272, 95% CI: 1.396-3.699; p=0.001), and adolescent age (OR: 1.732, 95% CI: 1.204-2.491; p=0.003) were found to be the most important predictors of adverse maternal and perinatal outcomes. Eighty of 129 (62%) smokers, 45 of 81 (55.65%) obese individuals, and 91 of 169 adolescents (53.8%) had adverse maternal and perinatal outcomes. CONCLUSION: Prevention strategies for obesity, smoking, and adolescent pregnancies should be implemented primarily to reduce maternal and antenatal adverse outcomes. Pregnant women with these risk factors in a refugee community emigrating from a conflict-zone nation should be followed up closely.

Prevalence of endometrial polyps coexisting with uterine fibroids and associated factors.

OBJECTIVE: The aim of the study was to investigate the prevalence of endometrial polyps in patients with uterine fibroids and associated factors of coexistence of these two pathologies. MATERIALS AND METHODS: The medical records of 772 patients who underwent hysterectomy because of uterine fibroids were retrospectively reviewed. Patients were divided into two groups according to the presence of endometrial polyps in the histopathologic examination. Demographic, clinical and histopathologic findings of the patients with and without endometrial polyps were compared. Student's t-test, Mann-Whitney U test, Pearson's Chi-square test, and logistic regression analysis were used for statistical analysis. RESULTS: The prevalence of the endometrial polyps in uterine fibroid cases was found 20.1% (n=155). Age ≥45 years (odds ratio [OR] 1.61; 95% confidence interval [CI]: [1.06-2.44]; p=0.014), presence of hypertension (23.9% vs. 17.5%; p=0.047), endometrial hyperplasia (OR 4.00; 95% CI: [1.92-8.33]; p<0.001) and cervical polyps (OR 3.13; 95% CI: [1.69-5.88]; p<0.001) were significantly associated with the coexistence of endometrial polyps and uterine fibroids. Endometrial polyps were more common in patients with ≥2 fibroids (p=0.023) and largest fibroid <8 cm (p=0.009). A negative correlation was found between condom use and endometrial polyps (8.1% vs. 3.9%; p=0.044). CONCLUSIONS: The prevalence of the endometrial polyps coexisting with uterine fibroids was 20.1%. Age, hypertension, endometrial hyperplasia, cervical polyps, and number of fibroids were positively correlated; condom use and size of largest fibroid were negatively correlated with the coexistence of these two pathologies.