The assessment of twin pregnancies delivered in our clinic: three-year experience

Objective: Twin pregnancies constitute 1–2% of all pregnancies. With the recent developments in assisted reproductive technologies, the incidence of multiple pregnancy has increased. Preterm labor is held responsible for the poor neonatal outcomes primarily. In our study, we aimed to assess fetal-maternal outcomes of twin pregnancies seen in our clinic. Methods: One hundred and thirty twin pregnancy cases out of 4241 pregnant women who delivered in our clinic between 01.01.2017 and 01.01.2020 were included in the study. The labor records of the patients were reviewed retrospectively and their data for age, week of gestation, delivery type, birth weight, fetal sex, chorionicity characteristics and laboratory parameters were recorded. Definitive statistics and SPSS 21.0 for statistical analyses were used to evaluate the data obtained from the study. The data were presented as mean ± SD (standard deviation). Results: The incidence of twin pregnancy was found 3%. In the ultrasonographic imaging evaluated during diagnosis, 27.7% of the cases were monochorionic and 72% of them were dichorionic. Of the pregnant women, 12.3% were at term and 87.7% were at preterm period. When the preterm fetuses were evaluated, 37.7% of 114 preterm fetuses were delivered at late preterm period, 29.2% of them at mid-preterm period and 20.8% at premature preterm period. The rates of treatment pregnancy (pregnancy provided by ovulation induction and assisted reproductive technologies) and spontaneous twin pregnancy were 20% and 80%, respectively. Mean maternal age was found 31.3. When evaluated in terms of maternal morbidity, preterm labor and premature rupture of membrane were the most common problems. Mean newborn weight was 1832g and 59.3% of the newborns had low birth weight and 21.8% of them had very low birth weight. While one fetus had transverse presentation in 12.5% of the patients, at least one fetus had breech presentation in 53.1% of the cases and 34.4% of the cases had head-head presentation. Conclusion: Twin pregnancies are characterized by the increased feto-maternal risks. Therefore, both antenatal and intrapartum management should be maintained diligently

The assessment of maternal deaths between 2015 and 2020 in Elazığ, Turkey

Objective: To determine the maternal deaths and the factors affecting them in our city. Methods: The maternal deaths occurred in our city between January 2015 and June 2020 were reviewed retrospectively. The review was conducted by checking “Maternal Death Registry Forms” of the Provincial Directorate of Health. In cases where additional data related with the cause of death were required, the relatives of the cases, associated family practitioner, The Council of Forensic Medicine or local authorities were contacted. The data of the cases including age, gravida, parity, abortion, delivery type, week of gestation during delivery, period of death and maternal deaths due to direct, indirect and incidental causes were recorded. Based on total live births and maternal deaths within 6.5 years, maternal mortality rate was found as the maternal death number per 100,000 live births. Descriptive statistics were used for the statistical analysis of the data. Results: A total of 46.618 live births occurred between 2015 and 2020 in Elazığ. The number of maternal deaths due to direct and indirect causes is 7, and maternal mortality rate was found 15.01/100,000. Hypertensive diseases during pregnancy (n=3, 42.8%), pulmonary embolism (n=1, 14.3%) and cerebral thrombosis (n=1, 14.3%) were among the natural causes of maternal deaths. Indirect cause for maternal death was cardiac diseases (n=2, 28.6%). When they were categorized according to the Three Delays Model, there were 3 death cases in the first delay model and 2 death cases in the third delay model, but there was no maternal death in the second delay model. Conclusion: Maternal death is an significant public health issue which develops due to the generally preventable causes and maintains its importance. The factors contributing to death should be paid attention in order to decrease maternal death rates

Purse-string suture technique using a mini-Pfannenstiel incision to treat large dermoid cysts

This study describes the purse-string suture technique using a mini-Pfannenstiel incision for the surgical treatment of large ovarian dermoid cysts. We investigated intra and postoperative outcomes in 24 patients who underwent removal of large ovarian dermoid cysts through a mini-Pfannenstiel incision using the purse-string suture technique. The surgical procedure was performed by two experienced surgeons. The mean diameter of the cysts was 11.9 cm. The mean operation time was 46 min and the intraoperative rupture rate was 8.3%. No patient developed chemical peritonitis. The length of hospitalisation was 36 h. The recurrence rate was 8.3% in the same ovary at 1-year follow-up. In conclusion, ovarian dermoid cysts measuring >8 cm in diameter can be effectively treated through a mini-Pfannenstiel incision using the purse-string suture technique.Impact Statement What is already known on this subject? Dermoid cysts are the most common ovarian germ cell tumours occurring in the second and third decades of life, and these tumours are usually treated surgically. There is a lack of consensus among gynaecologists regarding the optimal surgical treatment modalities for ovarian dermoid cysts; however, laparoscopic cystectomy is the gold standard for the surgical treatment of dermoid cysts. Notably, aspiration of dense cystic contents may be difficult during laparoscopic cystectomy. What do the results of this study add? Our technique enables easy removal of dense cystic materials including hair and bone fragments. The short operation time, low recurrence rate and the minimal incisional scar serve as advantages of our novel method. What are the implications of these findings for clinical practice and/or further research? This surgical technique can be successfully used in clinical settings with limited facilities for laparoscopic surgery