Maternal near-miss patients and maternal mortality cases in a Turkish tertiary referral hospital

Objectives: This study aimed to estimate the incidence of maternal near-miss (MNM) morbidity in a tertiary hospital setting in Turkey. Material and methods: In this retrospective study, we concluded 125 MNM patients who delivered between January 2017 and December 2017 and fulfilled the WHO management-based criteria and severe pre-eclamptic and HELLP patients which is the top three highest mortality rates due to pregnancy. Two maternal death cases were also included. The indicators to monitor the quality of obstetric care using MNM patients and maternal deaths were calculated. Demographic characteristics of the patients, the primary diagnoses causing MNM and maternal deaths, clinical and surgical interventions in MNM patients, shock index (SI) value of the patients with obstetric hemorrhage and maternal death cases were evaluated. Results: The MNM ratio was 5.06 patients per 1000 live births. Maternal mortality (MM) ratio was 8.1 maternal deaths per 100 000 live births. SMOR was 5.14 per 1000 live births. The MI was 1.57%, and the MNM/maternal death ratio was 62.4:1. The SI of MNM patients with obstetric hemorrhage was 1.36 ± 0.43, and the SI of the patient who died due to PPH was 1.74. Conclusion: The MNM rates and MM rates in our hospital were higher than high-income countries but were lower than in low- and middle-income countries. Hypertensive disorders and obstetric hemorrhage were the leading conditions related to MNM and MM. However, the MIs for these causes were low, reflecting the good quality of maternal care and well-resourced units. Adopting the MNM concept into the health system and use as an indicator for evaluating maternal health facilities is crucial to prevent MM

Investigation of the Distribution of Fetal Nasal Bone Percentile Values in First-Trimester Fetal Anomaly Screening

INTRODUCTION: We aim to determine the fetal nasal bone length (NBL) percentile values that can be used in the prediction of the fetal anomaly at 11-14 weeks of gestation in a low-risk population. METHODS: Our prospective and cross-sectional study included four hundred and eighty-six singleton pregnancies who applied for the first-trimester aneuploidy screening test at 11-14 weeks of gestation. We excluded pregnant women with fetal structural or chromosomal anomaly, nuchal translucency >3mm, an absent nasal bone, and in utero fetal death. Reference and percentile values of the NBL were calculated separately for 11,12,13,and 14. gestational weeks. RESULTS: Standard NBL measurements were performed in 486 pregnancies according to inclusion and exclusion criteria. Median NBL values were computed for each gestational age (GA), for 11,12,13 and 14. weeks of gestation was found 1.6mm (range=1.1-2.5), 1.8mm (range=1.1-3.0), 2.0mm (range=1.4-3.1), and 2.2mm (range=1.7-2.8), respectively. A positive significant correlation was found between NBL and the crown-rump length (CRL) (NBL (mm) = [0.02xCRL(mm)] + 0.73, r=.483; p<.001). The 5th percentile of NBL for GA was calculated, for 11,12, 13, and 14. weeks of gestation was found 1.2mm,1.4mm,1.5mm, and 1.7mm respectively. DISCUSSION AND CONCLUSION: We revealed the reference value of NBL for each gestational week in the first trimester of the low-risk population. The data obtained in our study can be used in the screening of genetic syndromes, especially Down syndrome, associated with nasal bone hypoplasia. Our reference value of NBL for the first trimester in singleton pregnancy varies from both previous racial and ethnic groups studies, and other Turkish studies

Serebral palsili çocuklarda kalça subluksasyonu ve dislokasyonunun cerrahi rekonstrüksiyonu

WOS: 000427282300003PubMed ID: 29526153Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1 +/- 10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre-and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2 degrees preoperatively and 20.4 degrees postoperatively. In preoperative period, MP and NSA were 72.7% and 160 degrees, respectively, which improved to 24.3% and 130 degrees, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. Conclusion: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery.Amaç: Bu çalışmada serebral palsi (SP) hastalarındakalça subluksasyonu ve dislokasyonunun tedavisinde femurvarus derotasyon osteotomisi (VDRO) ve Dega transiliyakosteotomisinin etkinliği incelendi.Hastalar ve yöntemler: Geriye dönük bu çalışmaya Temmuz2010 - Aralık 2015 tarihleri arasında kalça subluksasyonu vedislokasyonu nedeniyle ameliyat edilen 22 SP hastasının (9 erkek,13 kadın; ort. yaş 8.7 yıl; dağılım 4-18 yıl) 25 kalçası dahiledildi. Ortalama takip süresi 36.1±10.4 ay (dağılım 20-65.6 ay)idi. Tüm olgularda femur VDRO ve Dega transiliyak osteotomisiuygulandı. Ameliyat sonrasında hastaların hiçbirine alçı ileimmobilizasyon uygulanmadı. Hastalar ameliyat öncesinde vetakip süresinde kaba motor fonksiyon sınıflandırma sistemi ileklinik olarak değerlendirildi. Asetabular indeks (Aİ), migrasyonyüzdesi (MY) ve boyun-cisim açısı (BCA) ameliyat öncesinde,sonrasında ve takip süresinde çekilen pelvis grafileri ileölçülüp belgelendi. Ameliyat sırası ve sonrası komplikasyonlarkaydedildi.Bulgular: Kaba motor fonksiyon sınıflandırma sistemi skorları16 hastada iyileşti. Ameliyat öncesi ortalama AI 33.2°, ameliyatsonrası 20.4° idi. Ameliyat öncesi sırasıyla %72.7 ve 160° olanMY ve BCA, ameliyat sonrası sırasıyla %24.3 ve 130°’ye iyileşti.Aİ, BCA ve MY’deki ameliyat sonrası iyileşme istatistiksel olarakanlamlı idi (p<0.001). İki hastada implant yetmezliği nedeniylerevizyon cerrahisi uygulandı ve torakolomber skolyozu olanbir hastada artmış pelvik oblisiteye bağlı kalça subluksasyonusaptandı.Sonuç: Serebral palsi hastalarında kalça subluksasyonu vedislokasyonunun femur VDRO ve Dega transiliyak osteotomisiile rekonstrüksiyonu femoroasetabular uyum sağlar. Hızlı düzelmeiçin alçı ile immobilizasyon olmaksızın erken fizyoterapi teşvikedilir

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

WOS: 000452634300005PubMed ID: 29759883Objective: Tibial derotation osteotomy can be used in the treatment of rotational deformities in case of ineffective conservative management. Our aim was to evaluate the results of the patients who underwent minimal invasive plate osteosynthesis for tibial derotation osteotomies. Methods: Total of 16 patients (17 procedures) were included in this study. Mean age was 11.5 (3-25) years. We clinically assessed the tibial torsion by measuring the thigh-foot angle (TFA). No immobilization was used postoperatively and range of motion exercises were begun immediately. The patient was allowed weight-bearing activity, as tolerated, when callus formation was seen on the radiographs, at approximately three to four weeks after surgery. Results: The mean follow-up time was 27.5 months. Mean preoperative and follow up TFA were 27 degrees of internal rotation and 3.74 degrees of external rotation, respectively. A mean of 22.3 degrees improvement was achieved postoperatively. There was only one wound detachment, which was accepted as a complication and healed with local wound care. Conclusions: The recurrence risk and correction loss can be decreased with plate-screw fixation. Minimal invasive surgery would also decrease the risk of wound complications

Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy.

OBJECTIVES: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. PATIENTS AND METHODS: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. RESULTS: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. CONCLUSION: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery

Treatment of iatrogenic pes calcaneus deformity in patients with cerebral palsy, short term results

Amaç: Serebral palside ekin kontraktürü çoğunlukla aşil tendonu uzatma prosedürleri ile tedavi edilmektedir. Bu işlemlerin en önemli komplikasyonu ise tendonun aşırı uzatılmasına bağlı gelişen ve yürümeyi olumsuz etkileyen pes kalkaneus deformitesidir. Bu çalışma ile serebral palsi tanılı hastalarda gelişen iyatrojenik pes kalkaneus deformitesinin tibialis anterior ve peroneus brevis tendon transferleri ile tedavisinin etkinliğini belirlemek amaçlanmıştır. Gereç ve yöntem: Çalışmaya ortalama yaşları 11.5 olan 8 çocuk (14 ayak) dahil edilmiştir. Ameliyat öncesi ve sonrası kaba motor fonksiyon sınıflama sistemi (GMFCS) seviyeleri, ayak bileği eklem hareketleri ve kas gücü değerlendirmeleri yapılmıştır. Ameliyat sonrası ayrıca plantar fleksiyon tork gücü de bakılmıştır. Bulgular: Ortalama 43 aylık (25-90 ay) takip sonunda ameliyat öncesinde plantar fleksiyonu olmayan hastalarda ortalama 10.1 derece aktif plantar fleksiyon elde edilmiştir. Tork değerleri ise 90°/sn ve 120°/sn açısal hızlarda 14.6 ve 8.7 N/m olarak ölçülmüştür. Sonuç: Serebral palsi hastası çocuklarda gastroknemius-soleus kompleksinin aşırı uzatılmasına bağlı gelişen pes kalkaneus deformitesinin yeni bir teknik olarak tibialis anterior ve peroneus brevis tendonlarının aşil tendonuna transferleri ile plantar fleksiyon gücünde ve GMFCS seviyelerinde anlamlı iyileşme elde edilmiştir.Purpose:Heel cord/calcaneal tendon lengthening procedures are commonly performed to treat the equinus deformity in cerebral palsy. Although it is mostly successful, pes/talipes calcaneus deformity secondary to over lengthening can be considered to be the most significant complication. The purpose was to determine the effectiveness of tibialis anterior and peroneus brevis tendon transfers in the surgical reconstruction of iatrogenic pes calcaneus deformity in cerebral palsy patients. Materials and methods: Fourteen feet of eight patients were included. The average age was 11.5 years. Gross functional capacity, range of motion and muscle strength evaluations were compared pre- and postoperatively. Besides, power of plantar-flexion torque was checked. Results: The mean follow up was 43 (range: 25–90) months. None of the patients could perform measurable plantar flexion, preoperatively. The mean values for postoperative plantar flexion and dorsiflexion were 10.1° and 17.1°, respectively. Postoperatively, mean peak torques at 90°/sec and 120°/sec for plantar flexion were 14.6 and 8.7 N/m, respectively. Conclusion: Significant improvement was observed in the plantar flexion power and GMFCS levels after using this technique to treat pes calcaneus foot deformity due to over-lengthening of the gastro-soleus muscle complex in CP patients

Femoral derotation osteotomy in children with cerebral palsy using the pediatric proximal femoral nail

We designed a pediatric proximal femoral nail (PPFN) to overcome fixation method-related complications when performing femoral derotation osteotomy in cerebral palsy patients. Preliminary results of cerebral palsy patients who underwent femoral derotation osteotomy fixed using PPFN to treat in-toeing were evaluated. Sixteen patients with a mean age of 10 years were included. Mean follow-up duration was 36 months. There was no significant difference in the follow-up neck-shaft angle and articulotrochanteric distance values (P = 0.2 and 0.3). PPFN provides stable fixation, early weight-bearing, reduces soft-tissue disruption while limiting the complications due to fixation technique

Surgical correction of hallux valgus deformity in children with cerebral palsy

Objective: This study aimed to present a treatment algorithm for the correction of the hallux valgus defor-mity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results. Methods: 29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6e22) years. The mean follow-up was 33 (range 22e59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the bunion in six patients (11 feet); and MTP joint arthrodesis in four patients (7 feet). The hallux valgus angle (HVA) and the anteroposterior intermetatarsal angle (IMA) were used for radiologic evaluation and the DuPont Bunion Rating Score was used for clinical evaluation. Results: The follow-up period was 36 (range 22e59) months in reconstructive group, 27 (range 24e29) months in soft tissue group, and 29 (range 23e41) months in MTP arthrodesis group. Significant im-provements were detected in hallux valgus angle in three groups postoperatively but in soft tissue group correction loss was observed during follow up. Best results were achieved in arthrodesis group and worse in soft tissue group in terms of clinical evaluation. Conclusion: According to our results isolated soft tissue procedures are ineffective in CP patients. Soft tissue procedure combined with metatarsal osteotomy has satisfactory results. Level of evidence: Level IV, therapeutic study

Results of supracondylar femoral extension osteotomy and patellar tendon advancement in patients with cerebral palsy

Amaç:Diz fleksiyon kontraktürü ve patella alta serebral palsi (SP) hastalarında yaygın görülen ve yürüme fonksiyonunu önemli ölçüde bozan patolojilerdir. Suprakondiler femur ekstansiyon osteotomisi (SFEO) ve patellar tendon ilerletme (PTİ) ameliyatları SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan yöntemler arasındadır. Bu çalışmanın amacı SP kaynaklı diz fleksiyon kontraktürünün ve patella altanın tedavisinde uygulanan SFEO ve PTİ ameliyatlarının etkinliğinin incelenmesidir. Gereç ve yöntem: Bu retrospektif çalışmaya 2013 ve 2015 yılları arasında SP tanısı olan ve diz fleksiyon kontraktürü için SFEO ve patella alta için PTİ ameliyatı yapılan on bir hasta (22 diz) dâhil edildi. Ameliyat edildiklerinde hastaların ortalama yaşı 13; ortalama takip süresi 31 aydı. Hastalar klinik olarak kaba motor fonksiyon sınıflama sistemi (KMFSS) ve diz fleksiyon kontraktürünün nüksü ile radyografik olarak ameliyat öncesi, ameliyat sonrası, takip anterior-posterior ve lateral diz grafileri ile değerlendirildi. Koshino-Sugimoto indeksi (KS), komplikasyonlar kaydedildi. Bulgular: KMFSS değerleri yedi hastada yükselmiştir. Takipler sırasında bir olguda diz fleksiyon deformitesinin nüksü saptandı ve SFEO ile tedavi edildi. Ameliyat öncesi KS indeksi ortalaması 1.37 iken ameliyat sonrasında 1.07 ve son takipte 1.24 ölçüldü (p=0.004). İki olguda takiplerde serklaj teli iritasyonu saptandı ve ilave cerrahi ile teller çıkarıldı. Sonuç:SP’ye bağlı diz fleksiyon kontraktürünün ve patella altanın SFEO ve PTİ ile başarılı radyolojik ve klinik sonuçlara ulaşılarak tedavi edildiği görülmüştür.Purpose: Knee flexion contracture and patella alta are common problems in cerebral palsy (CP) patients and disrupts gait function significantly. Supracondylar femur extension osteotomy (SFEO) and patellar tendon advancement (PTA) are among the leading treatment methods. We reviewed the efficacy of SFEO and PTA in the treatment of knee flexion contracture and patella alta of CP patients. Materials and methods: In this retrospective study 22 hips of 11 CP patients who were operated between 2013 and 2015 were reviewed. The mean age was 13 years when the patients were operated and the mean follow-up period was 31 months. SFEO and PTA were peroformed in all cases. Patients were evaluated clinically with gross motor function classification system (GMFCS) and recurrence of knee flexion contracture and radiologically with knee radiograph. The Koshino-Sugimoto index (KS) was recorded. Results: GMFCS scores were improved in seven patients. Recurrence of knee flexion contracture was detected in one case who was treated with revision SFEO. The mean preoperatively KS was 1.37; postoperatively KS was 1.07 and follow-up 1.24 (p=0.004). Cerclage wire irritation was detected in two cases and extracted with additionally surgical procedures