Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
The Relationship Between Postpartum Poor Sleep Quality, Fatigue and Postpartum Depression: A Descriptive Research Study of the North West of Türkiye
Kadınlarda Doğum Sonrası Kötü Uyku Kalitesi, Yorgunluk ve Postpartum Depresyon Arasındaki İlişki: Türkiye'nin Kuzey Batısında Tanımlayıcı Bir Çalışma
Sevde ÇUBUKÇU AKSUa , Pelin PALAS KARACAb
aDepartment of Nursing, Balıkesir University Faculty of Health Sciences, Balıkesir, Türkiye
bDepartment of Public Health Nursing, Balıkesir University Faculty of Health Sciences, Balıkesir, Türkiye
Turkiye Klinikleri J Nurs Sci. 2023;15(4):971-80
doi: 10.5336/nurses.2023-96174
Article Language: EN
Full Text
ABSTRACT
 Objective: The study was conducted to examine the relationship between poor sleep quality, fatigue and depression prevalence in women in the 2nd and 6th weeks postpartum in Türkiye. Material and Methods: The research was planned as descriptive-correlational study. The study was conducted with 379 women. The study was conducted in three phases in a city hospital located in the Marmara Region of Türkiye. The data was collected using a form including the demographic/obstetric characteristics of the women, Visual Similarity Scale for Fatigue (VAS-F), Edinburgh Postpartum Depression Scale (EPDS) and Pittsburg Sleep Quality Index. Results: Of the women, 58.2% were multiparous and 50.2% gave birth with cesarean section. Midwives and nurses were involved in 4.3% of the prenatal care and 53.9% of postpartum care. The rate of poor sleep quality was 90.6% in the 2nd week of postpartum and 87.6% in the 6th week of postpartum. The rate of postpartum depression was 29.6%. The mean scores of the primiparous and multiparous women on ''VAS-F'' in the 6th week were higher compared to the mean scores in the 2nd week. The risk of postpartum depression increased with ''VAS-F'' in the 2nd week of postpartum and the ''EPDS'' scores were found to be high in all patients with poor sleep quality. Conclusion: It is recommended that each woman be evaluated individually regarding fatigue, depression and sleep quality in the postpartum period and an intervention plan should be developed for the identified causes.

Keywords: Postpartum; sleep quality; fatigue; postpartum depression
ÖZET
 Amaç: Araştırma, Türkiye'de kadınların postpartum 2 ve 6. haftalardaki kötü uyku kalitesi, yorgunluk ve depresyon prevalansı ile aralarındaki ilişkinin incelenmesi amacıyla yapılmıştır. Gereç ve Yöntemler: Tanımlayıcı tipte yapılan çalışmaya postpartum dönemdeki 379 kadın katılmıştır. Batı Marmara bölgesindeki bir şehir hastanesinde üç aşamalı yürütülen çalışmada veriler; kadınların demografik ve obtetrik özelliklerini içeren form, Yorgunluk Görsel Benzerlik Skalası [Visual Similarity Scale for Fatigue (VAS-F)], Edinburg Postpartum Depresyon Ölçeği [Edinburgh Postpartum Depression Scale (EPDS)] ve Pittsburg Uyku Kalitesi Ölçeği [Pittsburg Sleep Quality Index (PSQI)] ile toplanmıştır. Bulgular: Kadınların %58,2''si multipar olup, %50,2'si sezaryen ile doğum yapmıştır. Ebe ve hemşireler prenatal bakımın %4,3''ünde postpartum bakımın ise %53,9'unda yer almıştır. Kadınların doğum sonrası 2. hafta kötü uyku kalitesi %90,6 ve 6. hafta %87,6 iken, postpartum depresyon oranı %29,6 bulunmuştur. Primipar ve multipar kadınların 6. haftadaki ''VASF'' puan ortalamaları, 2. haftadaki puan ortalamalarına göre daha yüksek bulunmuştur. Doğum sonrası 2. haftada postpartum depresyon riski yorgunlukla artmış olup, kötü uyku kalitesi olanların tamamında EPDS puanları yüksek bulunmuştur. Sonuç: Postpartum dönemde yorgunluk, depresyon ve uyku kalitesi ile ilgili her kadının ayrı ayrı değerlendirilmesi ve belirlenen nedenlere yönelik bir müdahale planı geliştirilmesi önerilmektedir.

Anahtar Kelimeler: Postpartum; uyku kalitesi; yorgunluk; postpartum depresyon
REFERENCES:
  1. Aksu S, Varol FG, Hotun Sahin N. Long-term postpartum health problems in Turkish women: prevalence and associations with self-rated health. Contemp Nurse. 2017;53(2):167-81. [Crossref]  [PubMed] 
  2. Yucel C, Taskin L, Low LK. Validity and reliability of the Turkish version of the Optimality Index-US (OI-US) to assess maternity care outcomes. Midwifery. 2015;31(12):1135-42. [Crossref]  [PubMed] 
  3. World Health Organization. WHO Technical Consultation on Postpartum and Postnatal Care. Geneva: World Health Organization; 2010. Cited: December, 2017. Available from: [Link] 
  4. Hacettepe University Institute of Population Studies [Internet]. [Cited: December, 2017]. Available from: [Link] 
  5. Thomas KA, Spieker S. Sleep, depression, and fatigue in late postpartum. MCN Am J Matern Child Nurs. 2016;41(2):104-9. [Crossref]  [PubMed]  [PMC] 
  6. Dennis CL, Brown HK, Brennenstuhl S, Haddad S, Marini FC, Stremler R. Trajectory and predictors of fatigue among chinese immigrant and chinese canadian-born women in the postpartum period. J Obstet Gynecol Neonatal Nurs. 2020;49(2):167-80. [Crossref]  [PubMed] 
  7. Nurbaeti I, Deoisres W, Hengudomsub P. Association between psychosocial factors and postpartum depression in South Jakarta, Indonesia. Sex Reprod Healthc. 2019;20:72-6. [Crossref]  [PubMed] 
  8. Wen SY, Ko YL, Jou HJ, Chien LY. Sleep quality at 3 months postpartum considering maternal age: A comparative study. Women Birth. 2018;31(6):e367-e73. [Crossref]  [PubMed] 
  9. Okun ML. Disturbed Sleep and Postpartum Depression. Curr Psychiatry Rep. 2016;18(7):66. [Crossref]  [PubMed] 
  10. Lai YL, Hung CH, Stocker J, Chan TF, Liu Y. Postpartum fatigue, baby-care activities, and maternal-infant attachment of vaginal and cesarean births following rooming-in. Appl Nurs Res. 2015;28(2):116-20. [Crossref]  [PubMed] 
  11. Aksu S, Çatalgöl Ş. Kadınların doğum sonrası uzun dönem fiziksel sağlık problemleri ve algıladıkları sağlık düzeyi ile ilişkisi [Long term physical health problems of women after childbirth and their relationship with perceived health level]. Journal of Women's Health Nursing. 2017;3(2):22-42. [Link] 
  12. Doering JJ, Sims DA, Miller DD. How postpartum women with depressive symptoms manage sleep disruption and fatigue. Res Nurs Health. 2017;40(2):132-42. [Crossref]  [PubMed] 
  13. Tobback E, Behaeghel K, Hanoulle I, Delesie L, Loccufier A, Van Holsbeeck A, et al. Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers. Midwifery. 2017;47:22-7. [Crossref]  [PubMed] 
  14. Doering JJ, Dogan S. A postpartum sleep and fatigue intervention feasibility pilot study. Behav Sleep Med. 2018;16(2):185-201. [Crossref]  [PubMed]  [PMC] 
  15. Coo S, Milgrom J, Kuppens P, Cox P, Trinder J. Exploring the association between maternal mood and self-reports of sleep during the perinatal period. J Obstet Gynecol Neonatal Nurs. 2014;43(4):465-77. [Crossref]  [PubMed] 
  16. Giallo R, Gartland D, Woolhouse H, Brown S. Differentiating maternal fatigue and depressive symptoms at six months and four years post partum: Considerations for assessment, diagnosis and intervention. Midwifery. 2015;31(2):316-22. [Crossref]  [PubMed] 
  17. Giallo R, Gartland D, Woolhouse H, Brown S. "I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study. Arch Womens Ment Health. 2016;19(1):25-34. [Crossref]  [PubMed] 
  18. Tham EK, Tan J, Chong YS, Kwek K, Saw SM, Teoh OH, et al. Associations between poor subjective prenatal sleep quality and postnatal depression and anxiety symptoms. J Affect Disord. 2016;202:91-4. [Crossref]  [PubMed] 
  19. Lee KA, Zaffke ME. Longitudinal changes in fatigue and energy during pregnancy and the postpartum period. J Obstet Gynecol Neonatal Nurs. 1999;28(2):183-91. [Crossref]  [PubMed] 
  20. Yurtsever S. Hemodiyaliz hastalarında yorgunluğun değerlendirilmesi [Evaluation of fatigue in individuals undergoing hemodialysis due to chronic renal failure]. Hemşirelikte Araştırma Geliştirme Dergisi. 2003;5(2):3-12. [Link] 
  21. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6. [Crossref]  [PubMed] 
  22. Engindeniz AN, Küey L, Kültür S. Edinburgh Doğum Sonrası Depresyon Ölçeği Türkçe formu geçerlilik ve güvenilirlik çalışması. Bahar Sempozyumları. Ankara: Psikiyatri Derneği Yayınları; 1997. p.51-2.
  23. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. [Crossref]  [PubMed] 
  24. Ağargün YM, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi'nin Geçerliği ve Güvenirliği [Validity and reliability of the Pittsburg Sleep Quality Index]. Turkish Journal of Psychiatry. 1996;7(2):107-11. [Link] 
  25. Scott RH, Wellings K, Lindberg L. Adolescent Sexual Activity, Contraceptive Use, and Pregnancy in Britain and the U.S.: A Multidecade Comparison. J Adolesc Health. 2020;66(5):582-8. [Crossref]  [PubMed]  [PMC] 
  26. Martin A, Horowitz C, Balbierz A, Howell EA. Views of women and clinicians on postpartum preparation and recovery. Matern Child Health J. 2014;18(3):707-13 [Crossref]  [PubMed]  [PMC] 
  27. Healthy People [Internet]. [Cited: December, 2017]. Maternal, infant, and child health. Available from: [Link] 
  28. Christian LM, Kowalsky JM, Mitchell AM, Porter K. Associations of postpartum sleep, stress, and depressive symptoms with LPS-stimulated cytokine production among African American and White women. J Neuroimmunol. 2018;316:98-106. [Crossref]  [PubMed]  [PMC] 
  29. Christian LM, Carroll JE, Porter K, Hall MH. Sleep quality across pregnancy and postpartum: effects of parity and race. Sleep Health. 2019;5(4):327-34. [Crossref]  [PubMed]  [PMC] 
  30. Goldstein AN, Walker MP. The role of sleep in emotional brain function. Annu Rev Clin Psychol. 2014;10:679-708. [Crossref]  [PubMed]  [PMC] 
  31. World Health Organization [Internet]. ©2017 WHO [Cited: December, 2017]. Mental health action plan 2013-2020. Available from: [Link] 
  32. Arifin SRM, Cheyne H, Maxwell M. Review of the prevalence of postnatal depression across cultures. AIMS Public Health. 2018;5(3):260-95. [Crossref]  [PubMed]  [PMC] 
  33. Bolak Boratav H, Toker Ö, Küey L. Postpartum depression and its psychosocial correlates: A longitudinal study among a group of women in Türkiye. Women Health. 2016;56(5):502-21. Erratum in: Women Health. 2017;57(3):402-3. [Crossref]  [PubMed] 
  34. Cankorur VS, Abas M, Berksun O, Stewart R. Social support and the incidence and persistence of depression between antenatal and postnatal examinations in Türkiye: a cohort study. BMJ Open. 2015;5(4):e006456. [Crossref]  [PubMed]  [PMC] 
  35. Turkcapar AF, Kadıoğlu N, Aslan E, Tunc S, Zayıfoğlu M, Mollamahmutoğlu L. Sociodemographic and clinical features of postpartum depression among Turkish women: a prospective study. BMC Pregnancy Childbirth. 2015;15:108. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com