Review of a Challenging Clinical Issue: Acute Biliary Pancreatitis During Pregnancy

Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstone. Approximately 70% cases of acute pancreatitis during pregnancy are secondary to gallstones or sludge. Acute pancreatitis is a rare complication with a reported incidence of one per 1.500-4.500 pregnancies. Gallstones cause bile duct obstruction and pancreatic hyperstimulation. These processes lead to increased hydrostatic pressure, trypsin reflux and activation of digestive enzymes within the pancreas and cause autodigestion of pancreas, followed by local inflammation. During pregnancy, the steroid hormones of pregnancy affect the gallbladder motility and bile content. Progesterone induces gallbladder smooth muscle relaxation and estrogens increase bile cholesterol level, enhancing bile stasis. The clinical symptoms include pain in the right upper abdominal area and/or epigastric area, which can radiate to the right flank, scapula and shoulder, anorexia, nausea, vomiting, dyspepsia, low-grade fever and sinus tachycardia, hyperventilation and smell of acetone in the breath. The diagnosis of acute pancreatitis in pregnancy is confirmed by laboratory investigations and imaging methods. The management of acute biliary pancreatitis during pregnancy is similar on a large scale

Prenatal Diagnosis of a Rare Type of Conjoined Twin, Cephalothoracoomphalopagus: A Case Report

Conjoined twins are a rare outcome of a monoamniotic and monochorionic gestation. We present a case of cephalothoracoomphalopagus conjoined twin diagnosed by prenatal ultrasonographic examination. A 26-year-old gravida 2, para 1 woman was referred to our perinatology unit for evaluation because of suspected conjoined twins at 24 weeks of gestation. Her medical history was unremarkable. There was no family history of genetic abnormalities. The diagnosis of conjoined twins was confirmed by prenatal ultrasonographic examination. Conjoined twins occur when two identical individuals are joined by part of their anatomy and share their vital one or more organs. The incidence of conjoined twins ranges from 1:50,000 to 1:250,000 live births. We present a case of male cephalothoracoomphalopagus conjoined twin, which is extremely rare type of conjoined twins. A prenatal diagnosis of shared organs dictates pregnacy termination or possible surgical separation strategies

Prenatal Diagnosis of Twin Reversed Arterial Perfusion (Trap) Sequence: A Case Report

Twin reversed arterial perfusion (TRAP) sequence is a rare condition of monochorionic twin pregnancy. It has an incidence of 1:35.000 pregnancies and constitutes 1% all monochorionic pregnancies. The etiopathogenetic mechanisms are not well defined. There is co-existence of a normal pump twin and an acardiac recipient twin. A 22-year-old nulliparous woman was referred with TRAP sequence. The prognosis in TRAP sequence is lethal for acardiac twin and the fetal mortality of the pump twin is very high due to the cardiac failure. The obstetrician should be aware of TRAP-sequence in twin/multiple pregnancies

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

The Effect of Hands-On Cadaver and Live Surgery Practice on Surgeons' Performance in Urogynecologic Operations: One-Year Follow-Up

WOS: 000504068000001Objective: Surgical procedures need a combination of theoretical knowledge and practical experience to be performed properly. Postresidency education programs provide opportunities to practice new surgical techniques. This article evaluates 2 different educational strategies for learning new techniques in the field of urogynecology. One of the strategies is commonly practiced theoretical education plus observation of live surgeries, and the other strategy is a threefold approach of theoretical education, as well as cadaver training and performing live surgery. Materials and Methods: The study was designed as a prospective cohort study. The occupational experiences of 58 obstetricians and gynecologists were documented prior to the educational interventions. Two groups were created, based on the participants' preferences. Group 1 had theoretical education followed by observation of live surgery through broadcasting. Group 2 had theoretical education, plus a 1-day cadaver-based surgery course, as well as assisting tutors in hands-on operations. At a 1-year follow up, different types of surgeries performed throughout the year by each surgeon were recorded and analyzed using SPSS. Results: Prior to the course, both groups had similar experiences in urogynecologic operations (p > 0.05). In Group 2, significantly more surgeons began to perform tension-free vaginal tape (TVT) interventions regularly after the course (p < 0.001), a procedure considered more technically demanding. Surgeons utilizing any of the midurethral slings including TVT, transobturator tape, or mini-slings increased by 20% in Group 2, a statistically significant increase (p = 0.03). Conclusion: A threefold approach of theoretical education, cadaver practice, and live surgery significantly increases surgeon adaptation to utilization of midurethral slings, compared to exclusively theoretical education with observation of live surgery. (J GYNECOL SURG 20XX:000

Effects of Micronutrient Supplement on Maternal and Fetal Outcomes: Vitamin D, Calcium and Magnesium

Amaç: Fetal ve maternal sağlığa olumlu etkileri olması nedeniyle gebelik döneminde artan ihtiyaçla orantılı olarak vitamin ve mineral desteğine ihtiyaç vardır. Bu çalışmada mikro besin takviyesi olarak D vitamini, Kalsiyum (Ca) ve Magnezyum (Mg) desteği alan gebelerin postnatal sonuçlarını ve gebelik komplikasyonlarını araştırmak amaçlandı.Gereçler ve Yöntem: Yapılan bu prospektif, longitudinal ve kalitatif çalışmaya Ocak 2016 ve Ocak 2018 tarihleri arasında 18-40 yaş arası toplam 2114 hasta dahil edilmiştir.Bulgular: Maternal yaş aralığı tüm hasta grupları için 28.11 6.12‘ dir. Multivitamin kullanan grubun yaş ortalaması D vitamini grubuna göre daha düşük saptandı(p 0.001). Yalnızca Mg ve D vitamini kullanan grupta yüksek lisans seviyesinde eğitim görenler daha fazlaydı(p0.001). Mg, Ca, D vitamini ve multivitamin kullananımı ile gebelik komplikasyonları arasında anlamlı ilişki bulunamadı. Multivitamin kullanan gebelerde LGA daha fazla görüldü(p0.038). İlk gebelik yaşı Ca ve mulivitamin kullanan grupta Mg ve D vitamini kullanan gruba göre daha düşük bulunmuştur(p0.001).Sonuç: Annenin sağlıklı bir gebelik geçirmesi, maternal komplikasyonlardan korunması, fetusun büyüme ve gelişmesi için annenin düzenli beslenmesinin yanı sıra vitamin ve mineral takviyesi önemlidir. Bu takviyelerin literatürde gösterilmiş olan yararlarını desteklemek ve rutin kullanımda yer vermek için daha çok prospektif çalışmaya ihtiyaç vardır.Objective: Due to the positive effects on fetal and maternal health, there is an increased need for vitamin and mineral supplements during pregnancy. In this study, it was aimed to investigate the postnatal outcomes and pregnancy complications of pregnant women who received vitamin D supplementation, calcium (Ca) and magnesium (Mg) as micronutrient supplement.Material and Methods: A total of 2114 patients aged between 18 and 40 years were included in this prospective, longitudinal and qualitative study between January 2016 and January 2018.Results: The mean maternal age was 28.11 6.12 for all patient groups. The mean age of the group received multivitamins was lower than the vitamin D group (p 0.001).In the group receiving only Mg and vitamin D supplements, the number of postgraduate educated patients were more (p 0.001). There was no significant relationship between Mg, Ca, vitamin D and multivitamin use and pregnancy complications. LGA was more frequent in multivitamin-using group (p 0.038). The first gestational age was found to be lower in Ca and multivamine group compared to the group receiving Mg and vitamin D supplement (p 0.001).Conclusion: Vitamin and mineral supplementation as well as the regular daily nutrition is important not only for women to have a healthy pregnancy period without any maternal complications but also for growth and development of the fetus. More prospective studies with larger population are needed for supporting the benefits of these supplements and suggest their routine usage

Uterine rupture in pregnancy subsequent to hysteroscopic surgery: A case series

Uterine rupture during pregnancy is associated with high mortality and morbidity rates in both the fetus and the mother. Hysteroscopic surgeries such as myomectomy and septum resection are known risk factors for uterine rupture in pregnancy following the operation. We present four infertile patients who were admitted to Kocaeli Medical Park Hospital between February 2014 and November 2016. Three of the patients underwent hysteroscopic septum resection without complication and one had hysteroscopic myomectomy and a 7-8 mm sized rupture was detected. All of the patients became pregnant in less than a year after the operations. The first three patients had uterine rupture at 22nd, 38th, and 10th week, which is the earliest rupture in the literature. The last patient had an uneventful pregnancy and the rupture was observed during cesarean section. A short interval between hysteroscopy and pregnancy may increase the risk of rupture. It may be possible to become pregnant despite rupture and not have any problems during the entire pregnancy

Labial Cutaneous Flap Interposition in the Treatment of Recurrent Vesicovaginal Fistula

dogan, ozan/0000-0002-0016-8749WOS: 000447003700001Background: Recurrent vesicovaginal fistula (VVF) repair can be very difficult. Most gynecologists prefer the vaginal route because of the complexity of the abdominal approach. This article presents a simple procedure-a minimally invasive approach-labial cutaneous flap intertposition, that was used to treat an elderly patient with VVF. A cutaneous flap has good vascularity, allows augmentation of the bladder, and permits a vaginal approach. Case: A 72-year-old woman had VVF due to prolonged obstructed labor 30 years prior and had undergone transvaginal primary layered repair for this reason. Later on, she underwent total abdominal hysterectomy (TAH) and sacrocolpopexy to address uterine prolapse and cystocele. VVF developed after the TAH and sacrocolpopexy procedures. After the first postoperative month, she had recurrent urinary incontinence. A fistula between the bladder neck and vagina was noted when she had a vaginal examination and cystoscopy. A cutaneous labial flap was used to repair this recurrent VVF. Results: The labial cutaneous flap for repair of this patient's VVF was used successfully. The patient had no more evidence of recurrent VVF or voiding abnormalities after this procedure. Conclusions: Labial cutaneous tissue can be used to create a successful interposition flap during repair of recurrent VVF, particularly in elderly patients

Nuchal Fold Nomogram and Relationship With He- art and Central Nervous System Anomalies

Amaç: Nukhal fold kalınlığı birinci trimesterda ölçülen ense saydamlığının ikinci trimesterda devamı niteliğindedir. Özellikle anormal karyotip olan vakalar dâhil edilirse bazı sistemik hastalıklarla ilişkisi ve detaylı ultrasound için bir uyarı niteliği taşıması açısından önemlidir. Yöntem: Çalışmamız 2011-2017 yılları arasında Kocaeli Medikal Park hastanesinde takipleri yapılmış 16-24 haftalar arasındaki 1625 tekil normal karyotipli gebelerden oluşmaktadır. Gebelerin detaylı ultrasonografileri yapıldı. Her hafta için %5, %50, %95 percentil nukhal fold kalınlıkları hesaplanarak nukhal fold nomogramı oluşturuldu. Bulgular: Gebelik yaşı ile nukhal fold kalınlığı arasında pozitif korelasyon tespit edildi (p: 0,001, r:0,18). Tüm hastalar içinde 50 fetusta kardiak hastalık, 32 fetusta santral sinir sistemi patolojisi saptandı. Nukhal fold kalınlığı ile kardiovasküler hastalık arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p 0.98 and p0.05). Nukhal fold kalınlığı ile santral sinir sistemi hastalıkları arasında da istatistiksel olarak anlamlı bir ilişki saptanmadı (p0.55 and p0.05).Sonuç: Normal karyotipli fetuslarda nukhal fold kalınlığındaki artış, fetal kalp ve santral sinir sistemi hastalıkları ile artış göstermemektedirIntroduction: Nuchal fold thickness is the first trimester continuation of nuchal translucency in the second trimester. Thick nuchal fold is important in relation to some systemic diseases, including abnormal karyotype fetus.Material-Method: This is a cross-sectional retrospective study that has been performed among 1625 singleton pregnant women with gestational ages between 16-24 weeks that has taken place in Kocaeli Medical Park Hospital from years 2011-2017. We calculated nuchal fold lenght %5, %50, %95 percentile per week and draw nuchal fold nomogram. Results: It has been shown that there is a weak positive correlation between nuchal fold thickness and the gestational week (p: 0,001, r:0,18). In 1625 analysed patients, 50 patients had cardiovascular system (CVS) diseases and 32 patients had central nervous system (CNS) diseases. There was not a statistically significant relationship between nuchal fold thickness and CVS diseases (p 0.98 and p0.05). No statistically significant relationship was found between nuchal fold thickness and CNS diseases (p0.55 and p0.05).Conclusion: The increased nuchal fold thickness in fetuses with normal karyotype does not increase with fetal heart and central nervous system disease

Spontaneous Rupture of Uterine Vein in Twin Pregnancy

Objective. Aim of our study is to present a case of a twin pregnancy following invitro fertilization cycle complicated with hemoperitoneum at third trimester. Case. A 26-year-old nulliparous pregnant woman at 32 weeks of gestation with twin pregnancy following invitro fertilization cycle complained of abdominal pain. After 48 hours of admission, laparotomy was performed with indications of aggravated abdominal pain and decreased hemoglobin levels. Utero-ovarian vein branch rupture was detected on the right posterior side of uterus and bleeding was stopped by suturing the vein. Etiopathogenesis of the present case still remains unclear. Conclusion. Spontaneous rupture of the uterine vessels during pregnancy is a rare complication and may lead to maternal and fetal morbidity and mortality. Diagnosis and treatment are based on the clinical symptoms of acute abdominal pain and laboratory tests of hypovolemic shock signs