Selma Oransay, MD

Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.

Complex Relation Between Body mass index and endometriosis

This research aimed to find the relationship between BMI and endometriosis especially related to surgical phenotype and lesion location. An observational cohort study was led by  Holdsworth-Carson et al, from Australia. The article was recently published in "RBMO" . Many earlier studies report that higher BMI is often protective, while lower body mass index (BMI) is associated with endometriosis.  Four hundred and seventy-one laparoscopically operated and histologically confirmed endometriosis patients from Endometriosis and Pelvic Pain Clinic of the Royal Women's Hospital listed their demographic, symptomatic, and relevant medical…

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Urinary Function Alterations after Surgery for Deep Endometriosis.

Laparoscopic surgery is a mainstay therapy for symptomatic patients with DE. Although our findings of improvement in many domains of urinary function are encouraging, postoperative deterioration in urinary function was found for patients with initial normal function. More research is needed to better identify the subpopulations in which surgical intervention provides symptomatic benefit or deterioration. Urinary incontinence significantly affects women's quality of life, and the data on urinary incontinence in patients with deep endometriosis is limited in the literature. Dior…

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Assisted Reproductive Technology Outcomes in Women with and without Endometriosis

Endometriosis causes infertility in one-third of patients, while in approximately 25-35% of infertile women, the cause is endometriosis.  The primary interest and the question of Moss et al. from the University of Queensland, Brisbane, Australia was "the differences in the use and the success rate of assisted reproductive technology(ART) in women with or without endometriosis" while planning this interesting retrospective cohort study. The authors used the data of the Australian Longitudinal Study on Women's Health (ALSWH). The linked data on endometriosis, Assisted…

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Does Delivery Mode Affect the Ovarian Reserve?

Mohr-Sasson et al. from Sheba Medical Center, Israel,  performed a prospective case-control study to assess whether ovarian reserve decreases after cesarian delivery. The study included only women with singleton pregnancies and the change in ovarian reserve after vaginal or cesarian deliveries was estimated by anti-mullerian hormone plasma levels, before one week and after 3 months from the delivery. The ovarian reserve is the reproductive potential of ovaries and the number and quality of eggs. When diminishes, it means a lower count…

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Uterine cancer risk in "endometriosis" and "adenomyosis"

Adenomyosis and endometriosis share similar characteristics, and endometriosis is reported to have an increased risk of ovarian cancer. However, the risk of uterine cancer is not clear yet. Hermens and colleagues from Catharina Hospital, from the Netherlands, designed a population-based retrospective cohort study from the Dutch pathology registry. The patients with the histological diagnosis of adenomyosis, endometriosis, and dermal nevus from this large patient pool between the years 1990-2015 were selected, and adenomyosis/endometriosis, solely endometriosis or adenomyosis; and dermal nevus they…

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Dienogest treatment increases the risk of Endometriosis reoperation rate

The common and accepted therapy of endometriosis is surgery, however medical treatment such as nonsteroidal anti-inflammatory drugs, gonadotropin-releasing hormone agonists, oral contraceptives and oral progestins are used for either relieving pain or to prevent recurrences and reoperation. Due to bone loss and menopausal symptoms, the use of GnRH agonists is not recommended for more than six months.  Dienogest (DNG), which is a progestin with or without the combination of estrogens, has recently been used for endometriosis mainly for preventing reoperation. Several reports are present…

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Best practice: How to reduce intraoperative bleeding?

Although laparoscopic hysterectomy is a popular and common approach for removing benign uterine lesions, some technical steps especially concerning uterine artery closure depend on the surgeon's preference. Uterine artery ligation may be performed either at the uterus level, which is common and easy, but, sometimes closure at the origin of the internal iliac arteries may be necessary. The superiority of one method to the other is still unclear. To clarify the question about "from which level of the uterine artery closure…

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A rare complication of  endometriosis

Morales et al. from the Monterrey School of Medicine, Mexico, reported a case of bowel intussusception in a woman with severe endometriosis to draw attention to this very rare endometriosis complication. The case is a 27 years old young female who was followed up by a gynecologist for mild abdominal pain and endometriosis and using oral contraceptives as a first-line treatment. She was brought to the emergency room with severe right lower abdominal pain, nausea, and vomiting, and after clinical…

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The added value of transvaginal hydro-laparoscopy for infertile women

The added value of invasive diagnostic laparoscopy has been questioned, postponed by the increased usage of ultrasonography for the evaluation of infertile patients. Gordts et al. from Life Expert Center, Leuven, Belgium have been working on an alternative way called "transvaginal hydro-laparoscopy" to evaluate the pelvic organs and adhesions of infertile women since the late '90s. The procedure should be performed by expert gynecologists in an outpatient clinic while the patient is in lithotomy position under conscious sedation. Access is gained by a reusable,…

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The incidence and prevalence of endometriosis in a United States population-based study .

To define the accurate incidence and prevalence estimates of endometriosis among nonselected cohorts in the USA, Christ et al. from the Departments of Obstetrics and Gynecology of the University of Washington, Seattle, planned a retrospective cohort study using the electronic KPWA database between 2006-2015. All enrollees who were 16 to 60 years of age women comprised the study population, who were continuously enrolled at least 2 years before cohort entry, and had at least 1 encounter with the health utilization.  During the…

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Transvaginal Ultrasound Accuracy for Uterosacral Ligament, Torus Uterinus and Posterior Fornix Endometriosis

The accuracy of transvaginal ultrasonography for the diagnosis of deep endometriosis depends on the location. The sensitivity is up to 80% when the lesion is in the rectosigmoid, but it decreases up to 66% for the detection of posterior vaginal fornix endometriosi. The difference becomes more relevant for uterosacral ligament, which is the most common site of deep endometriosis. Ros et al. from University of Barcelona, Spain, aimed to evaluate the diagnostic accuracy of transvaginal ultrasonography in predicting the presence…

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Non-pharmacological self-care: dietary modifications in women with endometriosis.

The academic interest on the role of diet in endometriosis has grown due to its possible relation with inflammation, estrogenic activity, and menstrual cycles. Multiple dietary strategies and prescriptions are being used to deal with the pelvic pain and gastrointestinal symptoms of patients with endometriosis. Current evidence suggests the regular intake of fish oils, green vegetables, and fruits reduces the risk of endometriosis. On the other hand, women who consumed regularly red meat have a higher risk of endometriosis. The…

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Preoperative endometrioma diagnosis

The current clinical experience of gynecologists and radiologists indicates that distinguishing a hemorrhagic cyst from endometriomas or ruptured corpus luteal cysts is compelling. For this reason, chosen criteria that can lead to decisive distinctions are valuable for preoperative identification of endometriomas. Classical magnetic resonance imaging characteristics of the high signal intensity for endometriomas on both TW1 and TW2 imaging are changeable and unreliable. The novel technique named "susceptibility-weighted imaging" is sensitive to blood breakdown compounds that appear with small signal voids.…

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Impact of adenomyosis on sexual life

Considering the similar etiopathogenesis and pain symptoms between adenomyosis and deep infiltrating endometriosis, Alcalde et al. from the Department of Gynecology, University of Barcelona, Spain, aimed to call attention to the presence of potential sexual dysfunction not only in patients with deep infiltrating endometriosis but also in patients with adenomyosis. To raise their concerns about this matter, the authors investigated and compared the charactheristics of women who were diagnosed with "adenomyosis only", with "deep infiltrating endometriosis", and the control group. This prospective,…

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Analyses of the main classification systems of endometriosis in terms of utrasound, MRI and surgery

Several classifications made by gynecologists, image readers, and radiologists lead to confusion while describing the situation and estimating the progress of endometriosis. Daniela Fischerova team from the Charles University of Prague, Czech Republic, analyzed the main classifications of endometriosis in three areas, namely ultrasound imaging, MRI, and surgery. While the papers in the current literature compare the classifications only in surgical aspect, the authors intend to call attention to all image readers and gynecologists to come together for a standardized universal…

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Outcomes of chronic pelvic pain of endometriosis after laparoscopic surgery

The prevalence of endometriosis is up to 35-50% among patients with pelvic pain. Among several medical and surgical options to relieve chronic pelvic pain, surgical options are the preferred method but this depends on patients' age, fertility desire, and disease severity as well. In the current literature, the management of pelvic pain focuses on comparing the surgical and medical therapies of pain relief, whereas the reoccurrence rate and reoperation after operative laparoscopy remain unclear. Laguerre et al from the University…

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Managing Persistent Pelvic Pain in a distinct "pain" clinic

Persistent pelvic pain is an important problem producing physiological stress and productivity loss during the reproductive period of women. A specific pelvic pain clinic named "Mater Health Persistent Pelvic Pain Clinic" was established in 2017 in a part of the emergency department in Mater Hospital, Queensland, Australia. The clinic aimed to reduce the burden of a busy emergency department and to eliminate the need to submit to an emergency department by a multidisciplinary follow-up of patients with persistent pelvic pain. Wilkinson et al.…

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Factors affecting complications and the recurrence of operated deep infiltrating endometriosis

Deep infiltrating endometriosis is classified as penetrating the endometrial tissues more than 5 mm deep on the peritoneal surface, mainly uterosacral ligament, rectovaginal septum, ovarian fossa, pelvic peritoneum, bowels, ureters, and bladder. Treatment of the disease depends on the need for pain relief, fertility, and to prevent the spread of endometrial foci. The surgical approach is the removal of endometriosis foci, and operation of the advanced stages requires highly skilled surgeons to prevent complications and lower the recurrence rate of…

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Endometriosis scar disruption may lead to "spontaneous hemorrhage in pregnancy" and can be life-threatening.

Kollikonda et al from Cleveland Clinic Women's Health Institute, Cleveland, Ohio, US penned a case report about their hemoperitoneum experience during labor, which was recently published in the "Journal of Obstetrics and Gyneaecology Canada". The aim is to warn obstetricians about the occurrence of spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis. Apart from the vascular nature of endometriotic adhesions and their low elasticity, repeated surgical resections may also be the predisposing factors of adhesions to become…

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Evaluation of preoperative risk factors of ureteral endometriosis

Endometriosis affects the urinary tract in 1% to 5.5% of the patients, and among them, bladder involvement is 70-85%, while ureteral involvement alone is 9% to 23%.  Ureteral endometriosis is most commonly unilateral, especially on the left side, usually affecting the distal part. Some patients with ureteral endometriosis don't complain of any related symptoms even though it can cause dysuria, dyspareunia, and chronic pelvic pain. Moreover, there are no standard imaging methods for preoperatively evaluating the presence of ureteral endometriosis.…

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