Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

A late-onset hematoma developed after sexual intercourse following sacrospinous hysteropexy and mid-urethral sling surgery: case report

Introduction: Sacrospinous hysteropexy is a minimally invasive surgical procedure option for apical prolapse repair. Despite a significant number of postoperative hemorrhage and hematoma cases reported in the literature, life-threatening hemorrhage as a complication after sacrospinous hysteropexy is rare. In this case, in addition to sacrospinous hysteropexy, midurethral sling surgery was performed via the needleless technique for stress urinary incontinence. The case presented here is of a hematoma that developed following sexual intercourse on the 10th postoperative day after sacrospinous hysteropexy and its successful management and treatment without re-operation. A review of the literature did not reveal any cases similar to the present one. Method: Both sacrospinous hysteropexy using the Surelift® Contasure Prolapse System and midurethral sling surgeries were performed without any intraoperative complications. Case: A 40-year-old, female patient who had undergone both sacrospinous hysteropexy and midurethral sling surgery presented with pain following sexual intercourse on the 10th postoperative day. A hematoma of 4 cm was palpated at vaginal examination on the right posterolateral site and confirmed with computed tomography (CT) and magnetic resonance imaging (MRI). A vaginal tamponade was put in place and removed after 2 days follow-up in the hospital. After two weeks, contrast MRI revealed a hematoma smaller in size and after one month the hematoma was not observed. Discussion: Vascularity of the sacrospinous ligament (SSL) space includes an abundance of collateral blood vessels and significant anatomical variations can result from anastomosis. Finding and repairing injured vessels during SSL and pararectal area surgeries transvaginally or via laparotomy is difficult even for the experienced surgeon. Although sacrospinous hysteropexy is a minimally invasive transvaginal procedure, adverse effects may result due to the physical trauma of sexual intercourse so the patient should be warned to avoid sexual intercourse during the postoperative recovery period. If concurrent procedures have been performed along with sacrospinous hysteropexy, finding the source of the complication is essential for management and treatment. Conclusion: Knowledge of treatment options and pelvic vascular anatomy is fundamental for the diagnosis and management of complications. Although the literature is lacking in relevant data and case studies, the example of this case indicates that having sexual intercourse can result in postoperative development of hematoma in the SSL area, and that the patient should be warned to avoid sexual intercourse during the 6-week postoperative period. Vaginal packing should be the first treatment approach for management of intraoperative and postoperative hematoma and hemorrhage

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

Objectives: Our objective was to evaluate in our clinic the perinatal outcomes of patients diagnosed with ICP based on pre-treatment maternal serum bile acid levels, attempt to identify the risk group and review the literature in light of this information.  Material and methods: In total, 370 patients diagnosed with ICP were included in the study, divided into two groups based on the fasting total serum bile acid level before UDCA (Group 1: 10 ≥ 40 μmol/L, and Group 2: ≥ 40 μmol/L). The groups were examined for clinical characteristics and pregnancy outcomes.  Results: It was found that preterm delivery and neonatal intensive care need increased at a serum bile acid cut-off value of 34 μmol/L. Regardless of serum bile acid, significantly higher rates of meconium-stained amniotic fluid and foetal distress were observed in patients whose diagnoses were made before 34 weeks of gestation.  Conclusions: Foetal complications over 40 μmol/L of serum bile acid were significantly increased. However, slightly lower levels cut-off values (34 μmol/L) were obtained in terms of preterm birth and neonatal intensive care need. The incidence of meconium-stained amniotic fluid and foetal distress was higher in patients whose diagnosis were made before 34 weeks of gestation.

A case report of twin reversed arterial perfusion sequence with expectant management

Acardiac twin or TRAP (twin reversed arterial perfusion) sequence is a rare complication of monochorionic pregnancies. In these cases, the heart is either absent or non-functional. It’s controversial whether conservative management or therapeutic treatment is better in TRAP-sequence. In this case, we present a 19-years old, primigravida diagnosed with spontaneous monochorionic monoamniotic twin pregnancy at 7th week of gestation. One of the fetuses had a crown-rump length of 8 mm and fetal heart rate 122/minute while the other one had a crown-rump of 7 mm with no detected fetal heartbeat. At the 11th week of gestation, the acardiac twin continued growing despite the absence of the fetal heart beat and fetal extremities. The cranium could not be evaluated clearly. The diagnosis of TRAP sequence was confirmed by the reversed direction of flow observed in the umbilical artery. Since the patient and her husband did not want any intervention, no interventional diagnostic and treatment modalities were applied. Preterm labor started at the 32th week. Because the presentations were transverse and breech, pump and acardiac fetus, respectively, a cesarean delivery was performed. A healthy female baby, weighing 1650 gr with APGAR scores of 9-10, first and fifth minutes, respectively, was delivered along with the acardiac fetus which was 1550 gram in weight, fetal heart beat negative, with upper and lower extremity deformities. The uniqueness of the present case is that there was no significant difference in the weight of both twins. The acardiac twin was as large as the pump twin. Except for twenty days hospitalization because of neonatal respiratory distress syndrome, which was a consequence of preterm labor, there were no problems with the pump twin even though managed conservatively. In monochorionic twin pregnancies, when one of the twins is found to be fetal heartbeat negative and it continues to grow with concomitant structural abnormalities, the TRAP sequence should come to mind. If the acardiac fetus is small and the pump fetus has no complications, the conservative approach can be considered. Our goal should be to deliver the pump twin with minimal complications. To achieve this, follow-ups and treatment should be individualized for each patient, the pump fetus should be monitored closely

Maternal and Neonatal Outcomes Related to Iron Deficiency Anemia and Serum Ferritin Status: A Multicenter Prospective Study From Eastern Marmara, Turkey

Aim:The aim was to evaluate the incidence of iron deficiency anemia in pregnancy in the East Marmara region of Turkey in order to determine its prevalence along with the effects and associations of iron supplementation on maternal and neonatal outcomes.Materials and Methods:This study was conducted in six centers and included a total of 1102 pregnant women. Blood samples were collected for hematological status and serum ferritin levels during pregnancy, and the adverse maternal and perinatal outcomes were determined. Iron deficiency anemia was diagnosed according to the World Health Organization criteria as hemoglobin level of < 11 g/dl and ferritin level of <15 μg/dL.Results:The rate of anemia was 19.8%, with 44% of them receiving iron supplementation. The maternal age was lower in the anemic group (26.5 vs. 27.7, p = 0.01). Selective iron use was more frequent in the anemic group, while routine iron use was more frequent in the non-anemic group (47.1% vs. 29.3%; p = 0.01).Conclusion:Iron deficiency anemia is a frequent problem in pregnancy. However, many anemic pregnant women do not receive iron therapy. Iron supplementation may have positive effects on maternal and perinatal outcomes. In order to combat iron deficiency anemia in pregnancy, wide spread use of iron supplements should be established

Association of serum and follicular fluid leptin and ghrelin levels with in vitro fertilization success

 Objectives: The aim of this study was to evaluate the relationship between in vitro fertilization (IVF) cycle outcomes, serum and follicular fluid (FF) levels of leptin and ghrelin. Material and methods: Forty-four women who underwent intracytoplasmic sperm injection cycles (ICSI) were enrolled in the study. On the third day (D3) of the menstrual cycle, venous blood samples were drawn for serum measurements of leptin and ghrelin. The follicular fluid (FF) and the corresponding oocyte were obtained from a single dominant preovulatory follicle at the time of oocyte pick-up. The FF and D3 serum leptin and ghrelin concentrations were measured by enzyme-linked immunosorbent assay. The relationship between pregnancy rate and serum, follicular fluid levels of leptin and ghrelin were analyzed. Results: Of the 44 cases included, nineteen achieved clinical pregnancy (43.18%). Follicular fluid ghrelin levels were significantly lower in the pregnant group than non-pregnant group (p &lt; 0.05) With respect to FF leptin, there was no statistically significant differences between the pregnant and non-pregnant women (p &gt; 0.05). There was no statistically significant difference in D3 serum ghrelin between pregnant and non-pregnant groups (p &gt; 0.05). However, D3 serum leptin levels were significantly lower in pregnant women than non-pregnant women (p &lt; 0.05). Conclusions: Lower ghrelin levels in the follicular fluid were associated with higher pregnancy rates. Also, D3 serum leptin levels were inversely correlated with clinical pregnancy rates. These findings support the potential role of these molecules on IVF outcomes

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

WOS: 000405108100009PubMed: 28727133Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

A comparison of emergency and therapeutic modified Shirodkar cerclage: an analysis of 38 consecutive cases

Objective:To compare the maternal and neonatal outcomes of patients with emergency versus therapeutic cerclage.Materials and Methods:The study included 38 female patients who underwent cervical cerclage using the modified Shirodkar method in the Obstetrics and Gynecology Clinics of Düzce University Medical Faculty Hospital and Düzce Atatürk State Hospital.Results:The operating time for the emergency cerclage group was significantly longer than that of the therapeutic group (30.40 minutes vs 19.85 minutes, p=0.001). Following the cerclage procedure, the cervical length was longer in the therapeutic cerclage group [29.90 millimeters (mm) vs. 22.45 mm, p=0.001]. The cerclage to birth interval was also longer in the therapeutic group (91 vs. 138 days).Conclusion:In comparison with therapeutic cerclage, the total duration of pregnancy after emergency cerclage is shorter, and newborns have a greater need for intensive care. Both methods, however, protect against advanced prematurity, which causes neonatal loss

İlk Trimesterdeki Uterin Prolapsusun Vajinal Pesser ile Tedavisi

Uterine prolapse during pregnancy is a rare condition with an estimated incidence of1:10,000–15,000 pregnancies. Premature labor and delivery are the most prevalent complicationsin pregnancies with pelvic organ prolapse. Various treatment methods from conservativeapproaches to surgery are possible. In this paper we report a 27 year-old patientwho was treated with Arabin pessary due to uterine prolapse in the first trimester.Gebelikte uterin prolapsus nadir görülen bir durumdur, tahminen 10–15 bin gebelikte 1 görülür.Pelvik organ prolapsusu gelişen gebeliklerde en yaygın komplikasyon erken doğumdur.Konservatif yaklaşımdan cerrahiye kadar, çeşitli tedaviler mümkündür. Bu çalışmada,ilk trimesterde uterin prolapsus nedeniyle Arabin pesser ile tedavi edilen 27 yaşındaki birhasta sunulmuştur

Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial

ELLIBES KAYA, ASKI/0000-0002-1323-7416WOS: 000494047100010PubMed: 29886771Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12?h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time. Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2?h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12?h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time. Results: Urinary frequency (p?=?.04), microscopic hematuria incidence (p?=?.04), postoperative mobilization time (p?=?.01), and length of hospital stay (p?=?.009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time. Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay