The role of day 0 and day 4 β-human chorionic gonadotropin values and initial ultrasound findings in predicting the success of methotrexate treatment in ectopic pregnancy

Objectives: To determine the role of baseline ultrasound findings and the changes between β- human chorionic gonadotropin(hCG) values on day 0 to day 4 in patients receiving single-dose methotrexate (MTX) therapy for tubal ectopic pregnancy.Material and methods: One hundred fourteen patients who were hospitalized with a diagnosis of ectopic pregnancy andtreated with single-dose methotrexate were included in this retrospective study. The successful treatment group (n = 88)comprised patients in whom serum β-hCG levels were resolved with single-dose methotrexate treatment, and the failedtreatment group (n = 26) included patients who received second dose methotrexate and/or surgery. Ultrasound findings,laboratory findings, and serum β-hCG values at the time of admission and D4 and D7 β-hCG values were compared.Results: The success rate of single-dose methotrexate treatment was 77.2%. In the successful treatment group, the initialβ-hCG values of the patients were lower than the unsuccessful treatment group (1479.14 ± 1253.49, 4442.88 ± 3392.58,respectively) (p = 0.0001). A decrease of more than 35% between D0-D4 increased the probability of successful treatment(p = 0.017). Although ectopic focus size and abdominal free fluid showed no significant difference between the two groups,endometrial stripe thickness was significantly higher in the unsuccessful treatment group (12.61 ± 5.79, 9.28 ± 3.53) (p = 0.002).Conclusions: In addition to the basal β-hCG value, endometrial stripe thickness of ultrasound findings should also beconsidered in determining patients with a high chance of success in single-dose MTX treatment.β-hCG changes betweenD0-D4 may be advantageous in the clinical management of ectopic pregnancy for earlier evaluation

Anterior uterocervical angle: is it an ultrasonographic screening tool that estimates the latent phase duration in post term pregnancies?

Objectives: In recent years, in addition to cervical length measurement, a new ultrasonographic parameter has been defined  as uterocervical angle (UCA), which can be used in the prediction of preterm labor. In this study,we evaluated the place of uterocervical angle in predicting the latent phase duration in postterm pregnancies. Material and methods: This prospective study consists of 90 pregnant women aged between 18 to 40 years who were hospitalized with a diagnose of late term pregnancy. Pregnant women with a latent phase duration of 1200 minutes or less were defined as Group 1. Patients with latent phase duration over 1200 minutes were defined as Group 2. All patients’ age, BMI, smoke, cervical length measurements, uterocervical angle, latent and active phase of labor durations, length of the third stage and delivery types were compared. Results: The UCA median value of group 1 was 120 (94–147), and group 2 was 99 (94–105) (p < 0.001). CL medians of Groups 1 and 2 were 29 (17–43) and 28 (27–41) respectively (p: 0.871). UCA (AUC: 0.917, p < 0.0001) significantly predicted prolonged latent phase duration. Optimal cut off value was obtained at the value of 105 degree (100% sensitivity, 75% specificity) for UCA. Kaplan-Meier survival analysis showed that duration of labor was significantly higher in a group with low UCA (p: 0.013). Discussion: UCA can be a successful tool that can be used to predict duration of labor in cases of postterm pregnancies with medical induction

Factors Influencing the Postpartum Length of Hospital Stay in Eclamptic Women

SUMMARYObjectiveTo determine which variables are associated with postpartum length of hospital stay in eclamptic patients.Materials and MethodsThe study sample comprised 98 eclamptic patients who were admitted to our perina-tology unit during the period between January 1998 and May 2003. The study sample was divided into two postpartum length-of-stay groups: the short-stay group (1–3 days) consisted of 33 patients and the long-stay group (4 days and longer) consisted of 65 patients. The groups were compared with respect to the demographic characteristics, clinical and laboratory variables, and complications.ResultsThe mean hospitalization periods for the short-stay and long-stay groups were 2.48 ± 0.79 and 5.60 ±2.12 days, respectively (p=0.010). The mean prepartum follow-up period after the onset of eclampsia was longer in the long-stay group than in the short-stay group (12.11 ±27.63 vs. 5.08 ± 6.08 hours). The proportion of patients receiving magnesium sulfate therapy longer than 12 hours was higher in the long-stay group (p = 0.014). The long-stay group had higher diastolic arterial blood pressure than that of the short-stay group (p=0.006). The total cesarean delivery rate for the short-stay group was 48.5%, compared with 67.7% in the long-stay group (p=0.081). Conclusion: The duration of magnesium therapy, the timing, and the mode of delivery should be individualized to reduce the length of hospital stay in eclamptic patients

Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p

Risk factors for CF and BPI.

<p>CF: Clavicular fracture, BPI: Brachial plexus injury, CI: confidence interval, GDM: Gestational diabetes mellitus, * p<0.05.</p

Comparison of features of BPI cases with or without associated shoulder dystocia.

<p>Data expressed as number (%), BPI: Brachial plexus injury.</p