Overactive Bladder
  • Women who complain about frequent urination, involuntary leakage of urine due to sudden need for urination…
  • The women who complain about not being able to get to the restroom in time when they need to urinate can get rid of their problems easily with various medicines, special exercises, or surgery.

  • Laparoscopic Hysterectomy was done in Düzce for the first time
  • Laparoscopic Hysterectomy was done in Düzce Atatürk State Hospital for the first time
  • Laparoscopic Hysterectomy was done in Atatürk State Hospital by Obstetrician and Gynecologist Surgeon Ozan Doğan for the first time.
  • Surgeon Doğan gave information on the operation and said, “In the laparoscopic hysterectomy operation, the intra-abdominal organs are viewed by using an optical device called ‘laparoscope’ inserted through a small incision made in the navel, and the ovaries and the uterus are removed with the help of thin surgical instruments. As is known, in contrast to the operation area pain, large scar, and long recuperation periods observed in the open hysterectomy operations, the laparoscopic hysterectomy operations eliminate such disadvantages and also shorten the operation period and hospitalization duration. The patient can be discharged the next day. After the operations performed by using this method, the patients can go back to work within 2 weeks. For many patients, the operation does not take longer than 1 hour, and the blood loss is very little. Since the postoperative pain is very little, there is no need for the painkillers used in the conventional surgery.”
What is ectopic (extrauterine) pregnancy?

 

The ectopic pregnancy is the condition in which the fertilized ovum has become embedded outside the uterine cavity.

What is ectopic pregnancy?

The ectopic pregnancy is the condition in which the fertilized ovum has become embedded outside the uterine cavity. Over 90% of the ectopic pregnancies take place in the fallopian tubes (the tubular organs that connect the ovaries to the uterus). As the pregnancy grows, life-threatening intraabdominal bleedings may occur due to rupture of the fallopian tube. This condition may require urgent surgical intervention.

What are the risk factors for ectopic pregnancy?

Ectopic pregnancy history in previous pregnancies

Previous fallopian tube surgery

Pelvic or abdominal surgery history

Sexually transmitted infections 

Pelvic Inflammatory Disease (PID)

Endometriosis (Chocolate Cyst)

Smoking

Getting pregnant while being protected with intrauterine device (IUD)

Being over 35 years old

The use of the assisted reproductive technology like in-vitro fertilization treatment increases the ectopic pregnancy risk. 

However, nearly half of the women who have experienced ectopic pregnancy do not have known risk factors. 

 

What are the symptoms of ectopic pregnancy?

Initially, the ectopic pregnancy has the similar symptoms with normal pregnancy such as late menstruation, tenderness in breasts, nausea, and positive pregnancy test. When you have complaints such as abnormal vaginal bleeding, lumbar pain, dull ache in abdomen or pelvis, light cramping in some part of your pelvis, it may be difficult to understand whether you have an ectopic pregnancy or a healthy pregnancy. In cases of abnormal bleeding, pelvic pain, and positive pregnancy test, you must make sure to consult with your Gynecologist and Obstetrician against the probability of ectopic pregnancy.

As the ectopic pregnancy grows, if a fallopian tube is ruptured especially, more serious symptoms like a sudden and severe pain in the abdomen or pelvis, dizziness, and fainting may emerge. This condition may indicate a life-threatening internal bleeding. You must apply to the emergency service as soon as possible.

How is ectopic pregnancy diagnosed?

In case of ectopic pregnancy suspicion, the pregnancy hormone (beta-hcg) levels in blood are checked in addition to abdominal examination. Additionally, ultrasonography is used to see if the gestational sac is in or out of the uterus. Sometimes the results of the examinations and tests conducted allow diagnosing the ectopic pregnancy immediately, but most of the times, it may be necessary to repeat these tests every few days.

How is ectopic pregnancy treated?

The ectopic pregnancy can be treated in 2 ways: medication and surgery.

  • Medication

Surgery

Which medicines are used to treat ectopic pregnancy?

Methotrexate is the most common medicine used to treat ectopic pregnancy. This medicine terminates the pregnancy by stopping the growth of cells and embryo. In this treatment, there is no need to remove the fallopian tube (the tubular organ that connects the ovary to the uterus).

When the medicines are used to treat ectopic pregnancy?

Your doctor will decide on using methotrexate by considering various factors such as the pregnancy hormone levels, the size of the gestational sac, existence of heartbeats of the embryo in the gestational sac, and whether the fallopian tube that contains the gestational sac has been ruptured. One of the most important factors is that you can have your blood analyzed regularly after the medication. You cannot use methotrexate while breastfeeding or if you have a serious problem like liver diseases.

How is the methotrexate administered?

The methotrexate is usually injected through the hip in a single dose. Before taking methotrexate, blood tests are conducted to measure the hCG level and the functions of certain organs. If the hCG levels do not drop sufficiently after the first dose, an additional methotrexate dose can be administered.

When is surgery done to treat ectopic pregnancy?

If the ectopic pregnancy has been diagnosed late, and if termination of the pregnancy has been delayed, the tubes may be stretched, ruptured, or burst. Such cases require urgent surgical intervention. Sometimes, even if the fallopian tube is not ruptured, the patients who will not get benefit from the methotrexate treatment may also be taken under operation. In that case, the ectopic pregnancy may be removed from the tube, or the whole tube may be removed together with the pregnancy.

How is the operation performed?

This operation is typically performed through laparoscopy. This procedure uses a thin, lighted camera inserted through small incisions in the abdomen.

Can the ectopic pregnancy be prevented?

Mostly, the ectopic pregnancy cannot be prevented. 

Can the ectopic pregnancy affect the future pregnancies?

When you have experienced an ectopic pregnancy, the risk of ectopic pregnancy in your future pregnancies increases. During your future pregnancies, you must watch out for symptoms of ectopic pregnancy until your doctor verifies that your gestational sac is growing in the right place. You must have yourself checked out regularly before and during your pregnancy.

Sexual Desire and Pleasure Enhancement Procedures

When there is extreme skin-folding around the clitoris, the clitoris appears large and irregular and is hardly stimulated during sexual intercourse, making it difficult for women to have orgasm.

Clitoral Hoodoplasty

When there is extreme skin-folding around the clitoris, the clitoris appears large and irregular and is hardly stimulated during sexual intercourse, making it difficult for women to have orgasm. The clitoral hoodoplasty is a procedure carried out for easier stimulation during sexual intercourse and having a more aesthetic appearance by removing the excess skin folds around the clitoris. This operation can be done together with the labia majora and minora cosmetic surgeries. After the operation, more sexual pleasure is obtained as a result of more frequent and intense clitoral stimulation. 

G-SHOT

G-shot is a procedure applied to improve sexual pleasure. The G point that is a region in the front part of the vagina is enlarged through injection. As the injection material, the platelet-rich plasma (PRP) acquired from the patient’s own blood or a filler like hyaluronic acid can be used.

It has been shown that the women who had this procedure have enhanced vaginal orgasm and libido.

O-SHOT

O-shot is a procedure applied to increase the clitoral orgasms. The platelet-rich plasma (PRP) acquired from the patient’s own blood or collagen is injected around the clitoris. It has been shown that this procedure has increased the frequency and intensity of clitoral orgasms.

Labiaplasty

It can be preferred for the reasons such as large, prolapsing, wrinkled, dark, or asymmetrical vaginal labia.

Although there is no clear description for a “normal” labium, the labia minora that do not exceed the labia majora can be regarded as normal. Labia minora enlargement may cause both aesthetic and functional problems. Large labia minora may increase the vaginal infection frequency. Likewise, some women need labia aesthetic operation for reasons such as their labia minora being noticeable under underwear or bikinis, feeling pain and irritation as they rub against their garments, difficulty in playing sports, and feeling pain during sexual intercourse as their labia minora enter the vagina. 

Labiaplasty is a surgical procedure that includes redimensioning or reshaping of the labia minora. 

It can be performed under local or general anesthesia. It is an operation that takes 30 minutes on average. The patient can be discharged the same day or the next day. The patient can take a shower 1 day after the operation. Since self-melting sutures are used in the operation, there is no need to remove the sutures. The operation leaves no scar, and its results are permanent. After the labiaplasty operation, it is necessary to avoid the sea and pools and take a break from sex for minimum 2-3 weeks against the risk of infection. This operation is special and obligatory to be performed by experienced specialists, because there is no turning back from cutting of the labia minora. It is very important to select a technique special to the person. Let’s make a preliminary interview for labiaplasty, talk about the choices of technique special to you.

Genital Region Labia Minora Aesthetics & Labia Minora Prolapse Operation Treatment Summary

 

Operation Name

Labiaplasty

Hospitalization Duration

0-1 night

Operation Duration

1-2 hours

Duration for Returning to Work – Social Life

10-14 days

Anesthesia Type

General- Spinal

Full Recuperation Period

6-8 weeks

Convalescence Period

7 days

Permanence of Results

Permanent

Genital Region Labia Majora Aesthetics & Labia Majora Reduction Operation Treatment Summary

 

Operation Name

Labia Majora Reduction & Labia Majoraplasty

Hospitalization Duration

0-1 night

Operation Duration

1-2 hours

Duration for Returning to Work – Social Life

10-14 days

Anesthesia Type

General- Spinal

Full Recuperation Period

6-8 weeks

Convalescence Period

7 days

Permanence of Results 

Permanent



Vaginal Tightening - Vaginal Firming - Vaginoplasty

The interiors and opening of the vagina may loosen due to aging, vaginal delivery, or bad recovery of delivery incision.

This loosening may cause complaints such as loss of sexual appetite, loss of sensation, vaginal noises, and vaginal flatulence. Such complaints may cause the woman to lose her self-confidence, and the couples to take no pleasure in sexual intercourse.

Luckily there are ways to fix this.

Surgical or non-surgical treatments can be applied depending on the patient’s preference and the degree of vaginal looseness. 

Thanks to revolutionary technological advancements, safe, simple, painless, quick vaginal tightening and firming with instant results can be achieved by using Laser or Radio Frequencies. It is also possible to tighten muscles and tissues, remove excess vaginal tissue, and downsize the vaginal opening and canal by surgical operations. After the procedure carried out by talented and experienced hands, more pleasure is taken during sexual intercourse. 

In terms of price and need, this procedure is no more monopolized to the rich and the celebrities. 

Do not underestimate your vaginal problems; let’s talk about the advantages and disadvantages of vaginoplasty.

Vaginal Tightening & Firming Operation Treatment Summary

 

Operation Name

Vaginoplasty

Hospitalization Duration

0-1 night

Operation Duration

1 hour

Duration for Returning to Work – Social Life

1-2 days

Anesthesia Type

General-Spinal

When can I have sex after the operation?

4 weeks later

Convalescence Period

1-2 days

Permanence of Results

Permanent

 

 



Episiotomy - Perineoplasty

The birth incisions made to facilitate exit of the baby or the fissures occurring spontaneously during a normal delivery may heal badly and disturb the individual in terms of appearance…

The birth incisions made to facilitate exit of the baby or the fissures occurring spontaneously during a normal delivery may heal badly and disturb the individual in terms of appearance and they may also cause complaints such as pain, vaginal noises during sexual intercourse. The badly healed scar tissue can be repaired aesthetically with an easy operation under local or general anesthesia. The vaginal tightening procedure can also be carried out during the same operation if necessary.

What is Episiotomy?

Episiotomy is a controlled incision made at the entrance of the vagina so that the baby’s head can come out more easily during normal delivery. The episiotomy incision made to reduce the tension in the vaginal and anal regions protects the vagina against uncontrolled tears and the neighboring tissues, anus, urethra (urinary tract after the urine bag and providing discharge of urine) against uncontrolled injuries. Obviously, such uncontrolled injuries can be prevented not only with the measures we take but also with the observance of our instructions by the mother. Otherwise, the mothers who are acting in a nonconforming manner, tired of laboring may have tears (dechirure) when they push in an uncontrolled manner, despite the episiotomy.

Is episiotomy applied in every normal delivery?

Episiotomy is generally applied in the first delivery and when the vagina is not flexible enough to let the baby’s head out. However, there is no rule such as always making episiotomy in the first delivery nor a rule such as never making episiotomy in the second or third delivery. Therefore, episiotomy is decided during the delivery, on the basis of the condition of the vaginal tissues.

How is episiotomy performed?

After the vulva has opened fully to let the baby pass through the birth canal, i.e. the baby has proceeded in the birth canal as much that the baby’s hair can be seen, during the normal delivery, an incision is made at the entrance of the vagina with scissor upon the first labor pain. This procedure is applied under local anesthesia. Episiotomy can be made in various directions, but mostly the 6, 7 and 8 o’clock positions are applied.

After the delivery, episiotomy is repaired with melting stitches. In this process, pain can be felt on the suture line. It may take a few weeks that these stitches are absorbed by the body and the scar heals. In this process, the suture line can be cleaned with Batticon, and the patient can take a shower.

Caution !!!

·         If you notice that the stitches are open

·         If you notice bad odor and discharge from the scar

·         If you cannot sit on it or feel extreme pain when you sit, you must consult your doctor immediately.

Due to recent popularization of the genital aesthetic operations, numerous patients do not like their episiotomy sutures and apply to learn if they can be done over. Of course, they are the operations we have a chance to do the necessary repair over. It is possible to make the region appear as if it had not been cut at all by removing the damaged tissues, bringing the edges of the wound together properly, and using aesthetic stitches. At this stage, it is necessary to have a good wound site care and nutrition.

What is Perineoplasty?

Perineum is the skin, subcutaneous connective tissue, and the muscle tissue between vagina and anus. As the number of normal deliveries rises and the person gets older, the vaginal tissues become less tight, less elastic, and wider than before. This causes the couples to have more difficulty in feeling each other during sexual intercourse, which in turn causes to have less pleasure in sexual intercourse. This results in sexually unsatisfying and unhappy relationships.

The perineal aesthetic operations called perineoplasty are done mostly to repair episiotomy scars. The episiotomy stitches not healed properly after delivery, open or inflamed stitches, or improper healing of the perineal tears left to heal without stitching may cause visible aesthetic problems in the perineum. Such aesthetic problems are caused not only by delivery. Structural anatomical disorders, and improper healing of the wound site after the bartholin’s cyst surgery also causes aesthetic problems. Together with this operation, the other genital aesthetic operations like vaginoplasty (vaginal tightening) and labiaplasty (labia minor aesthetic) can also be done as per the patient’s request.

HOW IS THE PERINEOPLASTY OPERATION DONE?

Under sedation or under general anesthesia or spinal, or colloquially waist-down, anesthesia in the operating room, depending on the duration of the operations to be done simultaneously, some diamond-shaped tissue is removed from the perineum, and the region is restored aesthetically.

It is ensured that persons have more pleasure in sexual intercourse by tightening the vaginal entrance thanks to this operation. Clitoris can become more easily stimulated. An aesthetically more beautiful appearance is obtained.

Episiotomy - Perineoplasty

PRE-PREGNANCY EXAMINATION

The first few weeks of the pregnancy are the most important period for development of the baby. However, numerous women are even unaware of their pregnancy during this period. Therefore, every woman who contemplates pregnancy must absolutely have herself checked by a gynecologist and obstetrician before quitting protection. The purpose of this check is to detect any potential abnormalities and risk factors to arise during the pregnancy, delivery, or after the delivery. 

The chronic diseases (such as hypertension, anemia, diabetes, epilepsy, thyroid), gynecologic diseases (such as myoma, ovarian cyst, infections), and the conditions related to previous pregnancies (miscarriage, birth with anomaly, ectopic pregnancy, stillbirth-premature birth), which may change the pregnancy follow-up and affect the pregnancy negatively are queried in this examination. The dose adjustment of the regularly taken medicines as per the pregnancy is also handled in this check. Information is given on the changes required to be made in the dietary habits, smoking and drinking alcohol, work life, sleep and rest habits, and exercising habits. If not conducted within the last one year, the cervical cancer screening (smear) test is conducted. The blood tests deemed appropriate by your doctor are done. 

HOW IS THE OVULATION PERIOD CALCULATED?

Although the menstrual period is between 28 and 32 days for most of the women, some women have shorter and still some other have longer menstrual periods. A menstrual period between 21 and 35 days is deemed normal.

For the women whose menstrual cycles are regular, the ovulation time is calculated by going 14 days back from the first day of the next menstrual cycle.

For most of the women, the ovulation day is between the days 11 and 21 starting from the first day of the menstrual cycle, and having sexual intercourse within this period increases the chance of pregnancy.

If the menstrual cycles are not regular, we can find the ovulation time by monitoring the follicle with ultrasonography.

WHAT ARE SYMPTOMS OF PREGNANCY?

·         Delayed Menstruation

·         Implantation Bleeding: While the emerging embryo settles in the uterus, you may have some stain-like or a bit more bleeding 6-12 days after the intercourse. In some women, cramps may accompany the bleeding.

·         Fullness and tenderness of the breasts

·         Weakness, fatigue

·         Nausea, vomiting

·         Frequent urinating

·         Cracks and stains on the skin

WHAT ARE THE TESTS REQUIRED TO BE CONDUCTED IN PREGNANCY?

The pregnancy period is composed of 3 trimesters each of which lasts about 3 months. The 1st trimester includes the first 13 weeks (months 1, 2, and 3); the 2nd trimester includes the period from the end of the first one to week 26 (months 4, 5, and 6); and the 3rd trimester includes the rest of pregnancy until delivery (months 7, 8, and 9). 

·         Complete blood count

·         Full urine test

·         Infection screening tests (the Ig M and Ig G antibodies for toxoplasma, rubella, and CMV, VDRL for syphilis, hepatitis, and HIV tests are conducted) 

·         Kidney and Liver function tests (urea, creatinine, AST, ALT)

·         Fasting blood glucose

·         Thyroid function tests (TSH, T4)

·         Blood type

·         DOUBLE SCREENING TEST: It is the test conducted between the weeks 11 and 14 to search for Down Syndrome (trisomy 21) and trisomy 18. The baby’s neck thickness and nasal bone are checked in the ultrasonographic evaluation. The maternal age, the values of beta hCG and PAPP-A in blood are determined and combined with the ultrasonography findings. In consequence of the test, the private risk rate is determined. 

·         TRIPLE SCREENING TEST: It is the test conducted between the weeks 16 and 18 to search for Down Syndrome (trisomy 21), trisomy 18, and neural tube defect (the gap in the baby’s spinal cord region). The evaluation is made against the maternal age, the baby’s head diameter (BPD measurement) in ultrasonography, and the beta hCG, estriol (E3), and AFP values in the blood analysis. 

·         DETAILED (2nd LEVEL COLORED) ULTRASONOGRAPHY: This is the ultrasonography carried out in the weeks 20-22 by the perinatology (risky pregnancy) department to have a detailed organ screening of the baby. 

·         ORAL GLUCOSE TOLERANCE TEST (OGTT): The test conducted between the weeks 24 and 28 by giving blood after drinking glucose on empty stomach. It detects the gestational diabetes in the expectant mother.      

·         INDIRECT COOMBS: If the mother is Rh(-) and father is Rh(+), their bloods are incompatible, and the Anti-D immunoglobulin injection can be applied on the basis of the result of the indirect coombs test conducted in the week 28. The Anti-D immunoglobulin injection must definitely be repeated after the birth.

NAUSEA-VOMITING IN PREGNANCY

It is seen in 70-85% of the pregnant women. It starts usually around the week 6 and ends around the week 12. Although it is seen mostly in the mornings, it can happen any time of the day.        

The pregnant women who complain about nausea must eat less but frequently, avoid the fluid intake between half an hour before and half an hour after the meal, sip instead of drinking at once, and avoid fatty and spicy foods that increase nausea and vomiting. Salty crackers, lemon and ginger may do good. In case of nausea that does not clear up with these measures and causes vomiting, your doctor may start medication.

If vomiting is severe and oral feeding is not possible, if the pregnant woman vomits more than 3-4 times a day and has lost more than 5% weight during pregnancy, and if her blood table shows deterioration, it may be necessary to hospitalize her. 

URINARY TRACT INFECTION IN PREGNANCY

It is the most frequently observed infection in pregnancy. Since the uterus will prevent complete emptying of the urinary bladder because of the pressure it applies on the bladder as it expands during the pregnancy, the infection risk increases. It may have symptoms such as frequent urinating, urinary burning, malodorous urine, nausea, inguinal pain, back pain, and flank pain, or it may have no symptoms at all and be detected during the urine analysis. The antiseptic medicines that clean the urine and antibiotics can be used in its treatment. If the pregnant patients with this complaint are not treated, the infection may progress and affect the kidneys. Besides, it may affect the pregnancy process and cause premature delivery or that the babies have low birth weights.

CERVICAL INSUFFICIENCY

The cervix is the exit from the uterus and remains rigid and closed until the birth begins. In the pregnant women whose cervices are weak, the cervix begins to shrink and open early, and then, there is the premature birth risk. The cervical insufficiency is monitored by checking the cervical length on the ultrasound. 

In order to prevent premature delivery, it is aimed to postpone the delivery beyond the week 37 by stitching the cervix with a method called cerclage in the suitable pregnant women. The 3rd month of the pregnancy, i.e. the weeks 12-14, is the optimum time for cervical stitch. However, if the cervical shrinkage is detected in an earlier or later period, emergency cervical cerclage may be applied. Before applying the cerclage, its benefits and complications must be evaluated rather well. In case of spasms and cramps like labor pain, vaginal bleeding, breaking of water, high fever or shivering, vomiting, malodorous vaginal discharge after cervical cerclage, it is necessary to consult a doctor. The cervical stitch is left there until the week 37. However, if the labor pains are regular in the previous period and delivery action begins, it is removed. Its removal is not difficult.

PLACENTA PREVIA (CLOSURE OF THE CERVIX BY THE PLACENTA)

Placenta previa is the condition when the placenta settles near or in such a manner as to cover the cervix completely. When the cervix begins to expand before delivery or the placenta detaches from the uterus during delivery, hemorrhage occurs. It is observed more frequently among those who have undergone uterine surgery and those who have had cesarean section delivery previously. Its most frequent symptom is painless bleeding. These patients must avoid sexual intercourse and manual vaginal examination. The pregnant women who have been diagnosed to have placenta previa cannot have normal vaginal delivery; they are made to have cesarean section delivery before beginning of the labor pains if possible.

PLACENTAL DETACHMENT (EARLY DETACHMENT OF THE PLACENTA)

It is detachment of the placenta from the uterine wall. It is observed more frequently among smokers, pregnant women older than 35 years of age, pregnant women diagnosed to have hypertension and preeclampsia (toxemia of pregnancy), and those who were hit in the abdominal region. Its symptoms are vaginal bleeding, tender uterus, and frequent uterine spasm that does not go away. If the placenta detaches from the uterine wall, the blood flow to the baby stops, and thus the food and oxygen transfer to the baby also stops. In that case, emergency cesarean section delivery is necessary.

GESTATIONAL DIABETES

 

It is the diabetes diagnosed during pregnancy. Although insulin secretion increases in pregnancy, the hormones secreted by the placenta starting from the 6th month resist the insulin. This resistance causes the blood glucose in the women who are under diabetes risk to rise. The blood glucose that rises without control causes that the glucose in the baby also rises, and the problems that can even cause the death of the fetus. Therefore, the gestational diabetes is a disease that must be diagnosed absolutely and monitored correctly. 

The risk is particularly higher for the pregnant women who are older than 35 years of age, are overweight, have delivered baby heavier than 4,000 grams previously, put on excessive weight during pregnancy, have diabetes history in the family, have excessive water, and whose babies are big according to their current weeks according to the ultrasound image. 

The oral glucose tolerance test is suggested for all pregnant women to detect gestational diabetes. The OGTT (Oral Glucose Tolerance Test) is conducted between the weeks 24 and 28. If the pregnant woman is in the high risk group, the test can be conducted in the earlier weeks as well. Generally, 75 g challenge test is applied at a single stage. The fasting blood glucose is checked in the morning hours after fasting for 8-12 hours. Then, the person is made drink a solution that includes 75 g of sugar. The fasting blood glucose ≥92 mg/dl, 1st hour postprandial blood glucose ≥180 mg/dl, 2nd hour postprandial blood glucose ≥153 mg/dl; if one of the values is high, the gestational diabetes diagnosis is established.

For the women diagnosed to have gestational diabetes, their diets must be adjusted, and insulin therapy must be commenced if necessary. The diet varies by the patient’s weight, height, additional diseases, and physical activities. The dietary list prepared for every pregnant woman is different, and the diet is special to person. The weight gain must be followed at each check.

PREECLAMPSIA (TOXEMIA OF PREGNANCY)

It is a condition that starts generally after the week 20 of pregnancy and in which the tension exceeds 140/90 mm/hg. If it is ignored, it may cause serious problems that go up to growth retardation in the baby, premature birth, stillbirth, or even maternal death. The protein leakage and edema may accompany urine. 

The blood pressure (tension) of every pregnant woman diagnosed to have preeclampsia must be monitored regularly. The urine test, full blood analysis, bleeding profile tests must be made, and the baby’s umbilical cord blood flow must be measured with Doppler ultrasonography.

The treatment varies by the week of pregnancy. Salt consumption must be limited; fluid intake must be increased; and excessive physical activity and stress must be avoided. In order to keep the tension under control, the antihypertensive drugs that can be used in pregnancy can be preferred. If the pregnancy is in its final phases, the pregnant woman is made deliver the baby as early as possible, because delivery is the definite treatment of preeclampsia. 

REASONS FOR CESAREAN SECTION BIRTH

·         Previous uterine surgery (c-section, myoma removal)

·         Baby in a position inconvenient for delivery (breech, transverse arrest)

·         Baby with an estimated birth weight over 4000 g and head circumference over 100 mm

·         No increase in opening of the cervix despite sufficient labor pains (non-progressive delivery)

·         Sagging of the baby’s cord into the vagina

·         Placental detachment (detachment of the placenta)

·         Fetal Distress (irregularity in the baby’s heartbeats)

·         Placenta previa (closure of the cervix by the placenta)

·         Multiple pregnancies

·         Unsuitability of the pregnant woman’s pelvic structure for vaginal delivery

·         The conditions that make vaginal delivery risky for the pregnant woman (heart disease, herniated disc, congenital hip dislocation, respiratory tract diseases, etc.)

·         Delivery fear

·         Mother’s request



Diet to Boost Immune System during Pregnancy

Under normal conditions, the immune system functions perfectly and protects the body against millions of bacteria, viruses, germs, and parasites. It is necessary to pay more attention to diet to keep the immune system strong during the pregnancy period.

In order to have a strong immune system:

  1. Iron supplements

Iron is the key mineral in pregnancy. It boosts the energy level and resistance to infection and diseases. The daily amount of iron suggested for pregnant women is 27 mg.

The diet must include red meat, green leafy vegetables like spinach and chard, and whole grains. In order to increase iron absorption, it is necessary to consume vitamin C sources together with these foods.

  1. Zinc supplements

Zinc supports the body at the cellular level. In addition to cell generation, division, and protection, it also has a role in strengthening of the immune system.

For sufficient zinc absorption, the diet must include veal, lamb meat, turkey, dairy products, dried nuts, and whole grains.

  1. Vitamin D supplements

Vitamin D, also known as the sun vitamin, helps the immune system by fighting the infection.

In order to meet the need for vitamin D, it is necessary to take sunbath, eat oily fish like salmon twice a week, and eat eggs every day.

  1. Probiotic supplements

A diet that supports the intestinal health has direct positive effects on the immune system as well. The probiotics are friendly bacteria needed for a healthy microflora.

For natural intake of probiotics, it is necessary to consume homemade yogurt, kephir, and pickles. The probiotic supplements suggested by your doctor can also be taken in the pregnancy period.

  1. Ample antioxidant, vitamin, and mineral supplements

During pregnancy, it is essential to eat at least 5 portions of various fresh season vegetables and fruits a day to support the immune system. The diet must include especially the green leafy vegetables like spinach, chard, parsley; sulphurous foods like broccoli, cauliflower, onion, garlic; antioxidant-rich foods like beet, red cabbage; and orange, kiwi, pomegranate, and mandarin that are high in vitamin C.

  1. Raw dried nuts

The unroasted dried nuts are necessary for strong immunity thanks to their rich manganese, copper, and riboflavin contents.

The pregnant women must eat a handful of raw almonds, hazelnuts, and walnuts a day.

Vitamin and Mineral Supplementation in Pregnancy

Due to needs of the baby, the amounts of vitamins and minerals the mother needs to take increase in pregnancy.

 

What are the benefits of vitamins and minerals?

The vitamins and minerals play a significant role in body functions, growth, and development. Due to needs of the baby, the amounts of vitamins and minerals the mother needs to take increase in pregnancy. If such needs are not met sufficiently, the health of both the mother and the baby is affected negatively.

Should I take vitamin and mineral supplements in pregnancy?

When you are on a healthy diet that includes vegetables, fruits, lean red meat, white meat (poultry and fish), fermented dairy products, legumes, and grains, you can take the vitamins and minerals you need naturally through nutrition. However, the lack of folic acid, vitamin D, and iodine is frequent issue in our country. In that case, the use of vitamin and mineral supplements becomes vitally important.

When should I begin to take vitamin and mineral supplements?

Ideally, each woman planning pregnancy should begin to change her diet and take vitamin and mineral supplements before becoming pregnant to optimize mother and child health. The nutritional evaluation and consultancy must be continued during pregnancy and breastfeeding.

Folic Acid

Folic acid is one of the B vitamins and prevents the spina bifida (gap in the spine occurring when the baby’s spine and spinal cord do not form fully in the uterus) risk for the fetus. Taking folic acid supplement also reduces the risk of potential postnatal heart diseases and brain tumor development for the baby.

The suggested daily dose is 400 microgram (mcg). Ideally, it is necessary to start taking folic acid in the period when pregnancy is planned and continue to take it until the 13th week of pregnancy. 

In the following cases, your doctor may advise you to take a higher dose (5 mg daily) folic acid: 

·         Previous pregnancy that included spina bifida,

·         If you or your husband has spina bifida,

·         If you take certain medicines for epilepsy,

·         If you have celiac disease (lifelong chronic intestinal allergy to gluten) or diabetes,

·         If your body mass index is 30 or above (obesity),

·         If you have sickle cell anemia (the blood disease in which the red blood cells are shaped like sickle as a result of hemoglobin abnormality) or thalassemia disease (a genetic blood disease)…

Vitamin D

Vitamin D is an indispensable vitamin for everybody. Many people may have vitamin D deficiency for reasons such as failure to take sufficient sunlight or structurally low vitamin D reserves. Taking vitamin D supplement in the pregnancy period is essential for the mother’s holistic health and baby’s healthy development as well as healthy birth and growth of the baby. With the sufficient vitamin D supplementation, the potential risk of rickets in the babyhood and childhood periods can be decreased. Since vitamin D deficiency is widespread in our country, the Ministry of Health suggests each pregnant woman 1200 IU vitamin D after the week 12 and also in the breastfeeding period.

Iodine

The iodine deficiency constitutes a potential risk of hypothyroidism in the mother and the baby. The World Health Organization (WHO) suggests both pregnant women and breastfeeding women take iodized salt and take 250 mcg iodine. The iodized salt must be stored in a glass jar away from direct sunlight.

Choline

Choline is a type of vitamin B that is transferred in high amounts from the mother to the fetus. The adequate intake of choline is very important for the development of central nervous system. It has positive impact on the babies’ cognitive function (intelligence and management functions such as consciousness, memory, perception, abstract thought, judgment) development. Egg, meat, fish, dairy products, kidney bean, Brussels sprout, broccoli, and spinach are good sources of choline. 

Iron

Our body uses iron to produce a substance in the red blood cells, which carries oxygen to organs and tissues. Simultaneously with the blood production increased in the pregnancy period to meet the oxygen need of the fetus, the need for iron doubles. In case of iron deficiency, anemia, and in connection with the anemia, miscarriage, premature birth, postpartum hemorrhage, and fetal underdevelopment can be observed. Severe cases of iron deficiency may also cause maternal deaths. The daily need for iron supplementation is 27 mg. Lean red meat, poultry, fish, dry bean, and green pea are good iron sources. If the iron-rich foods are consumed together with the vitamin C-rich foods like citrus and tomato, the iron is absorbed better. The dairy products like yogurt must not be consumed together with meat products. Milk and dairy products reduce iron absorption.

Calcium

Calcium constitutes the bone and dental structures of the fetus. Including also the pregnant women at the age of 19 and above, all women must take 1,000 mg calcium a day. It is suggested that the mother takes calcium with foods. The dairy products like skimmed milk, kephir, cheese, and yogurt are good calcium sources. If you have difficulty in digesting the dairy products, you can take calcium from broccoli and dark green leafy vegetables. 

Omega-3

The Omega-3 fatty acids constitute a fat type that exists naturally in numerous species of fish. They play a significantly important role in the development of the fetus’ brain. In order to obtain the maximum benefit from the Omega-3 fatty acid, the women must eat at least two portions of fish a week before and during pregnancy, and in the breastfeeding period. If the pregnant women are unable to eat fish, they are recommended taking minimum 200-300 mg Omega-3 fatty acid supplement in triglyceride form at 3/2 EPA/DHA ratio.

Vitamin K

Vitamin K is necessary for normal blood coagulation. Since their vitamin K levels are too low, the newborn babies are at the risk of bleeding. In order to prevent this, your baby will be given vitamin K after the birth. If it is not specifically considered that your baby is at the risk of bleeding, you do not need to take vitamin K supplements during pregnancy.

Vitamin A

Excessive vitamin A might damage the nervous system development of the fetus. Therefore, it is necessary to avoid the supplements that include more than 700 microgram of vitamin A during pregnancy. Besides, it is necessary not to consume liver and the foods that include liver products in which the vitamin A levels are high.

Vitamin E

The vitamin E that has antioxidant features is available in various foods including fats and oils, meat, egg, and leafy vegetables. It is a rare thing to observe vitamin E deficiency due to its abundance in the diet. However, in cases such as cholestatic liver disease, pancreatic insufficiency, fat absorption disorders, and nutrition disorders, vitamin E deficiency can be observed. If there is not any condition that causes vitamin E deficiency, you do not need to take vitamin E supplements during your pregnancy.

Vitamin B Supplements (except folic acid)

There are 8 types of vitamin B: B1, B2, B3, B5, B6, B7, B9, and B12. In case of its deficiency, weakness, fatigue, forgetfulness, and anemia can be observed. Since the need for the vitamin B12 increases more than need for the other group B vitamins during pregnancy, the vitamin B12 deficiency is widespread. The vitamin B12 deficiency is associated with both the premature births and the births with low birth weight. Pyridoxine (vitamin B6) that is an important group B vitamin helps to reduce your nausea-vomiting complaints in the early periods of your pregnancy.

The recommended Dietary Reference Intakes (DRI) and the tolerable Upper Intake Levels (UL) for pregnant women and breastfeeding women

 

 

DRI

UL for pregnant and breastfeeding women

For pregnant women 

For breastfeeding women

Fat-soluble vitamins

Vitamin A

770 mcg

1300 mcg

3000 mcg

Vitamin D

600 IU (15mcg)

600 IU (15 mcg)

4000 IU (100 mcg)

Vitamin E

15 mg

19 mg

1000 mg

Vitamin K

90 mcg

90 mcg

No sufficient data

Water-soluble vitamins

Vitamin C

85 mg

120 mg

2000 mg

Thiamine

1.4 mg

1.4 mg

No sufficient data

Riboflavin

1.4 mg

1.6 mg

No sufficient data

Niacin

18 mg

17 mg

35 mg

Vitamin B6

1.9 mg

2 mg

100 mg

Folic acid

600 mcg

500 mcg

1000 mcg

Vitamin B12

2.6 mcg

2.8 mcg

No sufficient data

Minerals

Calcium

1000 mg

1000 mg

2500 mg

Phosphor

700 mg

700 mg

4000 mg

Iron

27 mg

9 mg

45 mg

Zinc

11 mg

12 mg

40 mg

Iodine

220 mg

290 mcg

1100 mcg

Selenium

60 mg

70 mcg

400 mcg

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