Does feticide shorten termination duration in second trimester pregnancy terminations?

Backround: A retrospective (case-controlled) study was conducted with the aim of identifying the effect of the use of misoprostol on termination time in patients who did and did not undergo feticide procedures in second trimester pregnancy terminations. Methods: The sampling of the study consisted of 144 pregnant women who were diagnosed as having major fetal anomalies incompatible with life, and were recommended for termination of pregnancy. The investigation showed that feticide procedures were performed for 99 women, and feticide procedures were not performed for 45 women. Misoprostol protocol was administered for 48 hours in the termination period; whether the feticide procedure directly affected the termination duration in patients who did and did not undergo feticide was evaluated. Results: Abortion/birth was achieved in 103 (71.5%) women during the first 48 hours. There was no significant difference between the termination duration of the misoprostol protocol among the women who did and did not undergo feticide. There was no significant difference between the termination durations and fetal biometric measurements (BPD, HC) except head diameters (p=0.020 and p=0.015). Conclusions: The misoprostol protocol is shown to be effective and safe for the termination of pregnancies during the second trimester. Feticide has no affect on the duration of termination. DOI: https://dx.doi.org/10.4314/ahs.v19i1.28 Cite as: \u15e\u131k A, Bilecan S, Kumbasar S, Akpak YK, YA A. Does feticide shorten termination duration in second trimester pregnancy terminations? Afri Health Sci. 2019;19(1). 1544-1553. https://dx.doi.org/10.4314/ahs.v19i1.2

Intrauterine interventions with the aid of ultrasonography

Aim: The aim of this study was to research the applicability of the surgical treatment of intrauterine pathologies with the aid of ultrasonography by passing a laparoscopic grasper or scissor through a metal sheath placed in the cervical canal, and compare this method with hysteroscopy, which is considered the gold standard in diagnosis and treatment.Methods: Our study was conducted with 39 cases where intrauterine pathologies were found with transvaginal ultrasonography (TVUSG). The patients were evaluated for endometrial polyp, submucosal leiomyoma/fibroid and uterine malformations using a transvaginal probe in the 6th to 12th days of the menstrual cycle. Patients with endometrial polyps and submucosal leiomyomas/fibroids were excised with a laparoscopic 5 mm grasper. A laparoscopic plain dissection scissor (5 mm) was used instead of a grasper for the uterine septum. In patients undergoing polypectomy and myomectomy, the uterine cavity was reevaluated by TVUSG about one month later (in the follicular phase after the first menstruation). Patients who underwent resection of the septum after the second menstrual bleeding, intrauterine cavity and tubal were evaluated by hysterosalpingography.Results: Considering the presence of intrauterine pathologies, TUSVG has sensitivity of 1 (0.87- 1.0), specificity of 0.56 (0.21-0.86), positive predictive value of 0.87 (0.71-0.96), negative predictive value of 1 (0.48-1.0), accuracy of 0.89 and positive likelihood ratio of 2.25 (1.03-4.5) for the detection endometrial polyps. When endometrial polyps were found as the intrauterine pathology during TUSVG, the chance of having endometrial polyps in hysteroscopic diagnosis was found to be 2.25 times more compared to those with no pathology. According to hysteroscopic diagnosis, TUSVG has sensitivity of 0.90 (0.74-0.98), specificity of 0.56 (0.21-0.86), positive predictive value of 0.87 (0.71-0.96), negative predictive value of 0.63 (0.25-0.92), accuracy of 0.82 and positive likelihood ratio of 2.03 (0.95-4.2) for intrauterine pathology. When the intrauterine pathology was found during TVUSG, the chance of having these pathologies in hysteroscopic diagnosis was found to be 2.03 times more compared to those with no pathology.Conclusion: We think that the surgical treatment of intrauterine pathologies with the aid of ultrasonography can be an alternative for hysteroscopy

THE RELATIONSHIP BETWEEN BAD OBSTETRIC HISTORY AND THROMBOPHILI

The aim was to evaluate the relationship of recurring miscarriages and in utero mort fetus cases over 20 weeks of pregnancy (except for those caused by a systemic disease or a known pathology) with thrombophilic conditions. Our study was conducted on the patients who were admitted to our clinic with for follow ups or investigation of recurring pregnancy losses. The included patients had had at least 2 fetal losses over 8 weeks into their pregnancy or at least one loss over the 20th gestational week and gave histories of hypertensive pathologies of pregnancy such as preeclampsia or eclampsia. The control group comprised 81 patients who had at least one pregnancy without any complication or fetal loss histories. In our study, the ratios of Factor V Leiden mutation in the study group (106 cases) and the control group (81 cases) were %12 and %1.3 (p=0.01) respectively. In the patient group, the MTHFR homozygous mutation was seen 3.3 times as much and Factor V Leiden heterozygous gene mutation was determined to be seen 8.3 as much as the control group. There was a significant difference between the study and control groups in terms of Protein C and S activity (p<0.0001 ve p<0.001). In the study group, the detection rate of Protein C levels <%65 was 5.2 times more(OR 5.2 2.7-12.49), and the Protein S activity was 12.17 times higher than the control group. Thrombophilic cases may play many roles in the pathologies which arise during pregnancies