Cornual Ectopic Pregnancy or Angular Pregnancy, Delayed Diagnosis and Treatment of a Pregnancy Complication: A Case Report

Cornual pregnancy is a rare type of ectopic pregnancy and defines an implantation in the upper and lateral uterine cavity. Two to four percent of ectopic pregnancies occur in the interstitial portion of the fallopian tube. An angular pregnancy term is a pregnancy that is located in the lateral angle of the uterine cavity. In the literature there is some confusion about the terms cornual, interstitial and angular pregnancies.We reported a female patient presented to our hospital with an eleven-week history of amenorrhea with two ineffective D and Cs. We were unable to determine whether it was a cornual or angular pregnancy using sonographic examination. A definitive diagnosis of cornual pregnancy was made by laparoscopy and a cornual resection and repair was performed by laparotomy. Understanding the difference between cornual and angular pregnancy is clinically important due to their different management and outcome. Cornual pregnancy, which still remains the most significant cause of maternal mortality, should be considered, particularly in in cases of missed abortions in the first trimester, which are eccentrically located in the uterus

A case of prolonged hyperemesis resulting in hepatorenal failure, foetal distress and neonatal mortality

WOS: 000435694700025PubMed: 29385934Hyperemesis gravidarum is defined as a condition emerging during pregnancy, is prominent with severe nausea and vomiting, a water-electrolyte imbalance and liver-kidney function disorder and causes more than 5% loss of body weight. In cases of severe hyperemesis gravidarum, maternal morbidities such as water-electrolyte imbalance, hepatorenal failure, Wernicke's encephalopathy, splenic avulsion, oesophageal rupture, pneumothorax have been reported. We present a case of hyperemesis gravidarum, which continued until the third trimester and developed secondary hepatorenal failure, a water-electrolyte imbalance, intrauterine growth restriction, anhydramnios, foetal distress and neonatal mortality

Ectopic Pregnancy Management Statistics in Zekai Tahir Burak Education and Research Hospital in One Year

Amaç: Dr. Zekai Tahir Burak Kadın Hastalıkları ve Doğum Eğitim ve Araştırma Hastanesinde 1 yıllık süre içerisinde tedavi edilen ektopik gebelik vakalarının yönetim ve istatistiklerini belirleyerek yeni ektopik gebeliklerin tanı ve tedavisine yaklaşımlarda fayda sağlamak amaçlandı. Yöntem ve Gereçler: Dış gebelik tanısı ile yatırılan 220 hasta çalışma kapsamına alındı. Hasta dosyalarından anamnez, fizik muayene, gebelik testi, USG ve D&C kayıtları toplandı. Hastaların yaşı, polikliniğe başvuru şikayeti, paritesi (nullipar, primipar, multipar) ektopik gebeliğin hangi haftalar arasında teşhis edildiği, başvuru anındaki ßhCG değerleri, USG bulguları, tedavi şekilleri ve cerrahi tedavi yapılanlarda salpenjektomi ve salpingostomi şekilleri kayıtlardan tespit edildi. Bulgular: Yaş ortalaması 29,045,5 olup, hastaların %21,4’ü nullipardı. Hastalar en çok vajinal kanama(% 69,7) ve pelvik ağrı(% 66,4) şikayetleri ile başvurmuşlardı. Vakaların %26,2’si laparotomi, %73,8’i laparoskopi ve %14,5’i metotreksat ile tedavi edilmişti. Operasyona alınan hastaların %59,1’ine salpenjektomi ve %19,5’ine salpingostomi yapılmıştı. Maternal mortalite izlenmedi. Tek doz metotreksat tedavisinin başarı oranı %77,8, cerrahi tedavinin başarı oranı %100 olarak tespit edildi. Tartışma: Jinekolojik acil patolojiler arasında hala sık rastlanan dış gebelik kliniğinin iyi değerlendirilmesi, gelişen teknolojiye paralel olarak tanısının erken dönemde konması konservatif tedavi olanaklarını ön plana çıkarmıştır. Konservatif tedaviler hastalarda başarı ile uygulanabilmekte ve doğru hasta seçimiyle hasta uyumu artmakta, tedavi maliyeti düşmekte, maternal mortalite ve morbidite önemli ölçüde azalabilmektedir.Objective:The aim of this study was to review the management strategies of our clinic for ectopic pregnancies. Material and Methods:The patient files of 220 patients diagnosed with ectopic pregnancy in one year were reviewed retrospectively. The distribution of the patients in the year and the months, the age of the patients, the complaints and the gestational age at admission, the ratio of multiparity, the treatment modalities, and the salpengectomy vs. salpingostomy were recorded. Results:The mean age of the patients was 29,04±5,4 and the rate of nulliparity was %21,4. The most common complaints at the admission were vaginal hemorrahaage(%69,7) and pelvic pain (%66,4). The %26,2 of patients were treated with laparotomy, %73,8 were laparoscopically, and%14,5 were treated with meotrexate. The %59,1 were treated by salpengectomy, %19,5 by salpingostomy. No maternal death was detected in the study. Single dose metotrexate treatment had a success rate of %77,8 and surgical treatment had a success rate of %100. Discussion: In parallel with developing technologies, early diagnosis of emergency gynecological pathologies like ectopic pregnancy has highlighted the possibilities of conservative treatment can be applied with success in patients; patient compliance increased with proper patient selection, treatment costs are decreased and maternal mortality and morbidity can be reduced significantly

Is body mass index a risk factor for low cerebral oxygenation during spinal anesthesia in women undergoing cesarean section? A preliminary study

WOS: 000471902200023PubMed: 31190520Background/aim: In this study, it was aimed to investigate the relationship between body mass index (BMI) and cerebral oxygenation during spinal anesthesia in women undergoing cesarean section. This study also aimed to demonstrate whether fetal cord blood oxygenation was affected by maternal BMI and/or delivery time. Materials and methods: The study included parturients with ASA I score undergoing cesarean section under spinal anesthesia in 2015 and 2016. They were divided into two groups according to BMI: Group 1 comprised parturients with BMI of 2 min (n = 18), and fetal cord blood oxygenation was measured using a blood gas analyzer. Results: Evaluation was made of a total of 25 patients. The RSO2 values were measured at the 20th, 30th, and 35th minutes of the cesarean section procedure and the median values of all the time intervals in Group 1 were significantly lower than those of Group 2 (P < 0.05). The LSO2 value was significantly lower in Group 1 at the 35th minute compared to Group 2 (P < 0.05). The PO2 values of fetal cord blood were significantly lower in Group B (P < 0.05). Conclusion: The results of this study showed that parturients with BMI of < 30 who are undergoing cesarean section under spinal anesthesia might have an increased risk of complications due to decreased cerebral oxygenation related with hypotension. Therefore, it can be suggested that before and during cesarean section these patients should be closely monitored for cerebral oxygenation using NIRS.Kirikkale University Scientific Research Projects Coordination UnitKirikkale University [2015-057]The preliminary results of this study were presented at the 12th Congress of the Turkish-German Gynecological Society, Kyrenia, Turkish Republic of Northern Cyprus, in 2018. The study was financially supported by the Kirikkale University Scientific Research Projects Coordination Unit (Project Number: 2015-057)

Investigating the effects of progesteronederived medication during first and second trimesters on the gestational diabetes development and gestational outcomes

Amaç: Gestasyonel diabetes mellitus tanısı almış olup 1. ve 2. Trimesterde progesteron kullanmamış gebeler ile en az 4 hafta progesteron kullanmış gebelerin 75 g oral glukoz tolerans testi (OGTT) kan şekeri değerleri ile yenidoğan sonuçlarının karşılaştı rılması amaçlanmıştır. Yöntem: Bu tek merkezli, retrospektif, kesitsel, olgu çalışması Ocak 2014 – Haziran 2016 tarihleri arasında gebe polikliniğimize başvuran gebeler üzerinden yürütüldü. Takip edilen gebeliğinde gestasyonel diabetes mellitus tanısı konan ve doğumu kliniğimizde gerçekleşen 337 gebe çalışmaya dahil edildi. Hastalar gebeliğinin 1. veya 2. trimesterinde progesteron kullananlar (n59) ve kullanmayanlar (n278) olarak iki gruba ayrıldı. Veriler SPSS programı ile analiz edildi. Bulgular: Progesteron türevi ilaç kullanmayan grup ile kullanan grup arasında 75 g OGTT 0. ve 2. saat ortalama kan şekeri değerleri açısından istatistiksel olarak anlamlı bir fark gözlenmezken; 1. saat kan şekeri değerleri progesteron kullanan grupta anlamlı yüksek bulundu (p0.05). Bu yükseklik progesteron türevlerinden haftalık enjeksiyon formu olan 17-OH progesteron kaproat kullanan gebelerde gözlendi. Gruplar arasında doğum ağırlığı, 1. Dakika APGAR skoru ve 5. dakika APGAR skoru açısından da istatistiksel anlamlı bir fark gözlenmedi. Sonuç: Gebeliğin birinci ve ikinci trimesterinde en az dört hafta, intramüsküler 17- OH progesteron kaproat kullanan gebelerde 75 g OGTT 1. saat değerlerinde anlamlı yükselme tespit ettik. Popülasyonumuzun küçük olması sebebiyle sonuçlarımızın karşılaştırılabileceği yeni çalışmalara ihtiyaç duyulmaktadır.Objective: We aimed to compare newborn outcomes and blood glucose values of 75-g oral glucose tolerance test (OGTT) in pregnant women who were diagnosed gestational diabetes mellitus and did not receive progesterone in 1st and 2nd trimesters and the pregnant women who received progesterone for at least 4 weeks. Methods: This single-center, retrospective, cross-sectional case study was conducted on pregnant women who were admitted to our obstetrics polyclinic between January 2014 and June 2016. A total of 337 pregnant women who were established with the diagnosis of gestational diabetes mellitus during their pregnancies followed up and delivered at our clinic were included in the study. The patients were separated into two groups as those received progesterone during 1st or 2nd trimester of their pregnancies (n59) and those did not receive progesterone (n278). The data were analyzed by SPSS software. Results: While there was no statistically significant difference between the group not receiving progesterone-derived medication and the group receiving progesterone-derived medication in terms of mean 0-hour and 2-hour blood glucose values of 75-g OGTT, 1- hour blood glucose values were significantly higher in the group receiving progesterone (p0.05). This high value was observed in pregnant women who received 17-OH progesterone caproate,which is a weekly injection form of progesterone derivatives. There was no statistically significant difference between the groups in terms of birth weight, and 1-minute and 5-minute APGAR scores. Conclusion: We found significant increase in 1-hour values of 75-g OGTT in pregnant women who received 17-OH progesterone caproate for at least four weeks during first and second trimesters of their pregnancies. Further studies are required to compare our results since our population is small

The Evaluation of Attachment Style and Temperament in Patients With Hyperemesis Gravidarum: Does the Idea That Hyperemesis Gravidarum Has a Psychological Origin Persist?

WOS: 000436153100014Background: Hypremesis Gravidarum (HG) is a common disease in pregnancy during the first trimester. Patients suffering from HG commonly present with dehydration, nutritional depletion, electrolyte imbalance, and the loss of at least 5% of body weight. Although the psychological etiology of HG is not clear, it has been shown that psychiatric symptoms are extensively present in patients with HG. Objectives: The aim of this study was to investigate the relationship between temperament, attachment style and hyperemesis gravidarum. Materials and Methods: This case-control study was conducted at Kirikkale University Hospital in Kirikkale, Turkey, between May 2015 and May 2017. A total of 98 pregnant women suffering from HG in their first trimester of pregnancy (HG group) and 95 healthy pregnant women in their first trimester of pregnancy (control group) were included in the study. Adult attachment styles were determined as secure, fearful, preoccupied, and dismissing. The evaluation of temperament was done using the TEMPS-A scale. Results: The mean secure attachment style score in the HG group was 3.9 +/- 0.9 and significantly lower than the mean attachment style score (4.6 +/- 1.1) in the control group (P = 0.001). In the TEMPS-A scale, patients with HG showed significantly higher mean depressive (9.7 +/- 3.8) and mean anxious scores (13 +/- 2.3) than those of the control group (6.6 +/- 2.9 and 8 +/- 0.9, respectively) (P = 0.001 and P = 0.040, respectively). Conclusions: This study revealed that HG patients had more common depressive and anxious temperament characteristics and lower secure attachment style than non-HG patients. Due to the fact that attachment and temperament styles are relatively stable throughout life, we thought that psychiatric problems may play a role on development of HG

Retrospective analysis of endemic melasma patients

Gunduz, Ozgur/0000-0003-1021-5219WOS: 000404407400006PubMed: 28652905Melasma is an acquired diffuse hypermelanosis characterized by localized, symmetrical, irregular, light-to-dark brown maculae occurring in sun-exposed areas of skin. The aim of this retrospective study was to determine demographics of patients, analysis of etiologic factors, clinical features, efficacy and side effects of available topical treatments due to high incidence of melasma patients. In this study melasma patients in Birecik State Hospital were investigated retrospectively. Between January 2014 and October 2015, 1008 patients had diagnosis of melasma in 49,809 applications of 24,603 different patients who admitted to Dermatology Outpatient Clinics. Of the 1008 patients, 263 had completed 3-month treatment period. These patients did not receive treatment in June, July, August and September. All melasma patients were rural and dealing with agriculture. There was no significant difference between female and male patients in terms of age. Of the 253 female melasma patients, only 2 of them had not child and none of them were using hormone drug. Of the 263 patients with melasma, Fitzpatrick skin type was 3 in 79 (30%) patients, 4 in 184 (70%) patients. Sanliurfa city showed higher fertility rate, sun exposure, and skin type than Turkey as a whole. These predisposing factors may explain higher melasma occurrence in Sanliurfa. Patient information about preventive measures and treatment play important role in treatment of cosmetic condition. The most important measure seems to advise patients about sun-protection especially during pregnancy

Magnesium Sulfate Has Potential Scavenging Effects on Cyclophosphamide-Induced Ovarian Damage in A Rat Model

Objective: This study proposed to investigate whether magnesium sulfate (MgSO4)could reduce the ovarian damage induced by cyclophosphamide (Cyc). Material and Methods:Thirty female rats were used for this study: Control group (n10)- Only laparotomy; Cyc groupn10)-75 mg/kg Cyc intraperitoneally; and CycMgSO4 group (n10)-75 mg/kg Cyc on day 0 and200 mg/kg MgSO4 on days 1-7 (both intraperitoneally). The extent of histopathological damage andthe number of ovarian follicles were determined. The levels of anti-Mullerian hormone (AMH)were measured in blood samples. Results: Statistically significant differences in the AMH valueswere observed in the control group versus Cyc group and Cyc group versus CycMgSO4 group(p0.05). The levels of AMH were the least in the Cyc group. The total tissue damage in the Cycgroup was significantly higher than that in the control, as well as in the CycMgSO4 group(p0.05). The follicle counts were the least in the Cyc group. Conclusion: Cyc caused ovarian damage and reduced the ovarian reserves. The ovarian reserves in the MgSO4-treated group were better than those in the other groups, and there was least ovarian damage in the MgSO4-treated group