Thyroid papillary cancer-related pregnancy: a case report

Differentiated thyroid cancer is the second-most frequent tumor among those tumors diagnosed during pregnancy after breast cancer; it also is the most common endocrine malignancy. Pregnancy-associated cancer was defined as a malignancy detected during pregnancy or within 2 years of delivery, but most of the patients with pregnancy-associated cancer were recognized in the postpartum period. The best time for surgery is unclear. Its management is a challenge for both doctors and patients. Enlargement of the thyroid gland in pregnancy is usually a physiological change related to pregnancy, but even if it is rare, it can be due to thyroid malignancy. We report a case of 31-year-old female diagnosed with thyroid papillary cancer during pregnancy with no symptoms except for a lump on her neck. For this reason, the examination of the thyroid gland and the examination of neck lymph nodes should be routinely performed on all pregnant women

Physiological changes in pregnancy and covid-19

Gebelik, gelişmekte olan fetüsün gereksinimlerini karşılamak için tüm sistemlerde birçok fizyolojik ve anatomik değişimin olduğu bir dönemdir. Genel olarak, gebelikteki fizyolojik ve anatomik değişiklikler enfeksiyonlara duyarlılığı arttırır, enfeksiyon tanısını ve/veya klinik seyrini zorlaştırabilir veya geciktirebilir. Gebelikte COVID-19 ile ilişkili olan başlıca sistemler; solunum sistemi, bağışıklık sistemi ve renin-anjiotensin -aldosteron sistemidir (RAAS). Bu makalede, bu sistemlerdeki fizyolojik değişiklikler ve muhtemel COVID-19 ilişkisi anlatılacaktır.Pregnancy is a period in which there are many physiological and anatomical changes in all systems to meet the needs of the developing fetus. In general, physiological and anatomical changes in pregnancy increase susceptibility to infections, making the diagnosis and/or clinical course of infection difficult or delayed. The main systems associated with COVID-19 in pregnancy are; respiratory system, immune system and renin-angiotensin-aldosteron system (RAAS). In this article, the physiological changes in these systems and possible COVID-19 relationship will be explained

Do first trimester maternal serum follistatin like 3 levels predict preeclampsia and/or related adverse pregnancy outcomes?

Purpose of Investigation: The aim of this study is to evaluate whether first trimester maternal serum follistatin like 3 (FSTL3) levels can be used to predict preeclampsia and related obstetric complications. Materials and Methods: The serum levels of FSTL3, pregnancy associated plasma protein A (PAPP-A), and free beta-hCG were determined in the first trimester from a sample of 180 pregnant women. All patients had first- and second-trimester ultrasound evaluations. The pregnancy outcome was defined as 'adverse' if one of the following outcomes were observed: fetal death, preeclampsia, pregnancy-induced hypertension (PIH), delivery of a small infant for gestational age (SGA) or preterm delivery. Results: FSTL3 levels were not significantly different for preeclampsia and related adverse obstetric outcomes compared to the control group (p < 0.05). Only PAPP-A MoM values were lower in the adverse obstetric outcome group than in the control (p = 0.040). There was no significant association among FSTL3 levels and the presence of any complications, according to our ROC curve analyses (p = 0.846). Conclusions: First trimester FSTL3 levels are not predictive for preeclampsia or adverse pregnancy outcomes

Guideline on pregnancy and diabetes by the society of specialists in perinatology (PUDER), Turkey

Diabetes mellitus (DM) is the most common endocrinologic problem in pregnancy. In Turkey, the reported prevalance is between 1.9-27.9%, with an average of 7.7%. While some of these cases are pregestational diabetes (PGDM), about 90% are detected during the pregnancy for the first time and diagnosed as gestational diabetes (GDM). Diabetes in pregnancy confers serious risks regarding the fetus, newborn and the mother. Therefore, we offer GDM screening for all pregnant women preferantially between 24-28 weeks of gestation. Either one-step 75-g oral glucose tolerance test (OGTT) or two-step 50-g glucose challenge test and 100-g OGTT may be used for the screening and diagnosis. In pregnancies with high-risk for DM, screening should be performed earlier, if possible, in the first antenatal visit. When GDM is diagnosed, maternal glycemic control is tried to be achieved by diet and exercise program, and if necessary, by using insulin. The use of metformin or glyburide in pregnancy is also possible. In women with the diagnosis of DM before pregnancy, preconceptional control of plasma glucose levels is of utmost importance in order to prevent adverse pregnancy outcomes. In pregnancies with GDM regulated by diet and exercise, pregnancy follow-up may be performed as in the low risk group without any pregnancy complications. If maternal or fetal distress is not observed, delivery is planned between 39+0 -40+6 weeks. Although caesarean section is recommended when estimated fetal weight is 4500 g or more, the mode of delivery may be decided more appropriately on a case-by-case basis. Copyright © 2020 by Türkiye Klinikleri

VV-ECMO for COVİD-19 related ARDS during pregnancy

Objectives: Right ventricular (RV) failure following heart transplant (HTx) carries significant morbidity and mortality. When medical therapy becomes ineffective, mechanical circulatory support (MCS) could be lifesaving. Protek Duo (LivaNova) is a recent temporary right ventricular assist device (RVAD). The dual-lumen cannula is inserted percutaneously via right internal jugular vein (IJV) under fluoroscopy and transesophageal echocardiography guidance. The inflow portion is positioned in the right atrium and the outflow tip in the pulmonary trunk, the cannula is then connected to an extracorporeal centrifugal pump (CentriMagTMAbbott) and provides up to 4 L/min in order to unload the RV. Aim of the study was to verify the feasibility and safety of this novel approach in the setting of RV failure after HTx. Methods: Single-center observational retrospective study investigating the use of Protek Duo percutaneous RVAD for RV failure after HTx was conducted from May 2019 to November 2021. Results: Main characteristics are shown in the table. Six patients were included in the study, 66 % had a MCS prior HTx. RVAD was successfully implanted in all patients on a median time of 34[4–53] hours after HTx. All patients were successfully weaned off RVAD after a median of 17[9–26] days. There were no major devicerelated adverse events. None of the patients required conversion to surgical RVAD. 66% developed IJV thrombosis despite adequate anticoagulation therapy. Survival at ICU discharge was 83%, only one patient died due to fungal endocarditis. In-hospital mortality was 17%

What do expectant parents know about antenatal ultrasound screening?

Objective: We aimed to investigate and compare the background knowledge and attitudes of pregnant women and their partners about antenatal ultrasound scans. Materials and methods: A cross-sectional survey was conducted in a university perinatology clinic. Pregnant women and their partners who underwent the first trimester ultrasound scan or the second trimester anomaly scan were invited to complete a questionnaire which contained items on their sociodemographic characteristics, knowledge, and attitude. Results: In total, 500 eligible expectant mothers and their partners (220 in the first trimester and 280 in the second trimester) were recruited. The knowledge and attitude of expectant mothers and fathers were statistically similar. Working status, education level, and presence of chronic disease were the factors affecting the number of correct answers in both expectant mothers and fathers. The knowledge levels of both the expectant mothers and fathers were similar in the first and second trimesters. Conclusions: Pregnant women's and their partners' attitudes and knowledge on antenatal ultrasound scans were similar and generally satisfactory

Monitoring and Prognosis of Pregnant Women Diagnosed with Placenta Previa

Amaç Plasenta previa tanısı alan gebelerin takipleri ve prognozlarını değerlendirmek. Gereç ve Yöntem Ocak 2013 - ocak 2016 tarihleri arasında plasenta previa tanısı almış ve takiplere gelmiş 36 gebenin demografik verileri, ultrasonografi bulguları, gebelikte tanı haftası ve gebelik sonuçları retrospektif olarak değerlendirildi.Bulgular Plasenta previa olgularında ortalama yaş 33,41±3,89 olarak bulundu. Tanı sırasındaki ortalama gebelik haftası 29,25±4,46 , ortalama doğum haftası 35,32±3,57 , ortalama doğum kilosu 2740,15±842,2 gr idi. Plasenta previa için risk faktörü (yüksek gravida, ileri maternal yaş, geçirilmiş uterin cerrahi vb.) varlığı %88,8 olarak saptandı. Maternal kanama nedeniyle %27,7 (n=10) hastaya değişik miktarlarda kan transfüzyonu yapıldı. Sonuç Antenatal komplikasyonlar, maternal kanama, erken doğum ve erken doğuma bağlı sorunlar plasenta previa olan hastalarda morbidite ve mortalitenin en önemli sebebidir. Tanının önceden bilinmesi operasyonun doğum eylemi başlamadan elektif şartlarda ve tecrübeli bir ekip tarafından donanımlı merkezlerde yapılmasını sağlar; bu durum da komplikasyon gelişme olasılığını azaltır. ( Sakarya Tıp Dergisi 2016, 6(4):196-201 )Aim Evaluation of monitoring and prognosis of pregnant women diagnosed with placenta previa. Material and Method The results of 36 pregnant women diagnosed with placenta previa during pregnancy were evaluated retrospectively in between January 2013 – January 2016.. Results The mean age of the patients with placenta previa was found as 33.41±3.89 . Mean gestational age at the time of the diagnosis was 29.25±4.46 , mean gestational age at delivery was 35.32±3.57 , mean birth weight was 2740.15±842.2 gr . The risk factors for placenta previa (multiparity, advanced age, previous uterine surgery etc.) was found in 88.8% of the patients. 27.7% of the patients recieved variable amount of blood transfusion due to maternal bleeding. Conclusion Antenatal complications, maternal bleeding, premature birth and problems related to prematüre birth are the main causes of morbidity and mortality in cases of plecenta previa. Being aware of plecenta previa results in elective surgery before the onset of delivery with an experienced team at tertiary hospitals. Thus; the incidence of complications decreases. ( Sakarya Med J 2016, 6(4):196-201