Placenta accreta spectrum surgery with the Joel Cohen incision for abdominal access: a single-center experience

Objectives: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety. Material and methods: The data on women having a hysterectomy due to PAS between 2013–2021 was collected retrospectively. Operation length, baby’s pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013–2016) or late (2017–2021) years. Results: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27–39). The mean operation length was 150 minutes (75–420), and the anesthesia–to–delivery interval was 32 minutes (5–95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups. Conclusions: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery

Perinatal outcomes of the antenatally diagnosed omphalocele cases: a single tertiary center experience

Objectives: To evaluate the perinatal outcomes of antenatally diagnosed omphalocele cases. Material and methods: This was a retrospective study conducted between July 2014 and February 2020 at the prenatal diagnosis center of a university clinic. Gestational week of diagnosis, associated anomalies, karyotype analysis results, complications during pregnancy, termination/delivery characteristics, and postnatal results were evaluated. Results: The analysis was performed on 58 patients. The median diagnosis time was 14.5 weeks of gestation. Thirty-three cases (57%) were defined in the first trimester. 33 (57%) of 58 patients had one or more concomitant anomalies, while 25 patients (43%) had isolated omphalocele. The most common associated anomaly was a cardiac anomaly which was observed in 17 fetuses (30% of all omphalocele cases). Karyotype analysis was performed in forty-five patients (41 in the prenatal period, 4 in the postnatal period). A normal karyotype was detected in 27 cases (60%). Trisomy 18 was the most common chromosomal anomaly (n = 15, 33.3%). Thirty of 58 patients (52%) requested termination of pregnancy (TOP) in the early pregnancy period. Thirteen of the cases died in-utero (22%). Fifteen pregnancies resulted in live births (26%), of those eight were lost in the first year of life (six of them had additional anomalies, while two of them had isolated omphalocele but the omphalocele pouch was containing the liver in those two babies). Conclusions: Most of the cases with an omphalocele can be diagnosed in the first trimester. Cardiac anomalies were the most common associated anomalies, while trisomy 18 is the most common chromosomal anomaly. Thus, earlier and effective counseling can be made about the prognosis of pregnancy

Noninvasive prenatal diagnosis experience in the Cukurova Region of Southern Turkey: detecting paternal mutations of sickle cell anemia and beta-thalassemia in cell-free fetal DNA using high-resolution melting analysis

WOS: 000326106700008PubMed ID: 23836351ObjectiveThis study used a high-resolution melting (HRM) technique to detect paternal mutations for the noninvasive prenatal diagnosis (NIPD) of -thalassemia and sickle cell anemia (HbS). We also determined the levels of cell-free fetal DNA and total cell-free DNA. MethodsWe used the HRM technique for fetal genotyping of paternal mutations in maternal plasma from 32 pregnancies at risk of -thalassemia and 57 pregnancies at risk of HbS. The DNA levels in maternal plasma were measured using real-time quantitative PCR. Multiples of the median (MoM) values were calculated in women at risk for -thalassemia or HbS. ResultsTwenty-two paternal mutations were detected in 89 pregnant women. Although we were successfully able to detect the paternal -thalassemia mutations, the mutant HbS fetuses could not be distinguished from maternal background in the early weeks of pregnancy. The detection of DYS14 in male fetuses was 100%. The MoM values of women at high risk of having HbS-affected fetuses were higher than those for the other groups. ConclusionHigh-resolution melting is a useful method for NIPD of -thalassemias by detecting paternal mutations in the maternal plasma. Cell-free fetal DNA quantification and MoM values were not informative for HbS or -thalassemias in early pregnancy. (c) 2013 John Wiley & Sons, Ltd.Cukurova University Academic Research Projects UnitCukurova UniversityThis study was supported by the Cukurova University Academic Research Projects Unit

Pregnancy and Toxoplasma Infection

Toxoplasmosis is an infectious disease caused by a protozoa named Toxoplasma gondii. It is a very important disease because it is related to fetal anomalies and poor perinatal outcomes like abortus and stillbirth. It spreads via uncooked meat and contaminated food. Timely and appropriate treatment and management of this infection prenatally reduces the risk of serious neurological sequelae. Therefore it is crucial that clinician who takes care of pregnant women know this infection deeply. In this review we aimed to summarize the prenatal diagnosis, complications and treatment of toxoplasma infection. [Archives Medical Review Journal 2016; 25(4.000): 457-466

A comparative study with conventional smears and liquid-based cytology for diagnostic performance

WOS: 000249454600517

Anemia in Pregnancy

Iron deficiency anemia (IDA) is the most frequent form of anemia in pregnant women. Folic acid, vitamin B12 deficiency, and hemoglobinopathies are other causes of anemia in pregnancy. Finding the underlying cause are crucial to the management of the anemia. Anemia is defined as hemoglobin of <11 g/dl in the first and third trimester and <10.5 g/dl in second trimester. According to the literature, anemia, particularly severe anemia (Hb<7g/dl) is associated with increased risk of maternal and perinatal mortality and morbidity, and long term adverse effects in the newborn. The association of hemoglobin levels to perinatal outcome has been shown to be U shaped with both high and low hemoglobin levels being associated adverse perinatal outcome such as low birth weight, increased stillbirths. Anemia in pregnancy is a major public health problem. Ideally a woman should have adequate iron stores when she conceives, in order meet to additional requirements of pregnancy. This review focuses on the occurrence, types, maternal and perinatal outcomes, prevention and treatment of anemia during pregnancy. [Archives Medical Review Journal 2013; 22(3.000): 300-316

SUCCESSFUL PREGNANCY AND DELIVERY IN AFIBRINOGENEMIA PATIENT: CASE REPORT

8th International Eurasian Hematology Oncology Congress (EHOC) -- OCT 18-21, 2017 -- Istanbul, TURKEYWOS: 000416742600078

An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients

PubMedID: 22783989Problem: The aim of this study was to evaluate serum procalcitonin (PCT), C-reactive protein (CRP), and plasma D-Dimer levels in mild and severe pre-eclampsia. Method of study: Serum PCT, CRP, and D-Dimer levels were analyzed in 64 cases with pre-eclampsia as the study group and 33 healthy pregnant women in the third trimester as the control group. Pre-eclamptic group consisted of mild (n = 31) and severe pre-eclamptic subgroup (n = 33). Laboratory results were compared between the groups and diagnostic usefulness of these parameters were evaluated. Results: PCT, CRP, and D-Dimer levels were significantly higher in study group than the control group (P = 0.001). PCT, CRP, and D-Dimer were significantly higher in the patients with severe pre-eclampsia than mild pre-eclampsia. There were significant positive correlations between these markers and mean arterial pressure (MAP). Logistic regression analysis using the control and pre-eclampsia group showed that higher PCT (OR, 15.68; 95%-CI, 3.15-78.10), CRP (OR, 14.29; 95%-CI, 3.08-66.34), and D-Dimer levels (OR, 4.97; 95%-CI, 1.22-20.29) were found to be risk factors significantly associated with pre-eclampsia. Conclusions: This study results confirm that evidence of a possible exaggerated systemic inflammatory response in pre-eclampsia especially in severe pre-eclampsia. © 2012 John Wiley & Sons A/S

Evaluation of the cytogenetical results of 4707 cases diagnosed with amniocentesis.

PURPOSE: Amniocentesis is a very crucial diagnostic procedure for preventing the birth of genetically defective fetuses in order to decrease the prevalence of genetic diseases in populations. METHODS: The karyotyping of 4707 fetuses was carried out in our department during the years of 2000-2009 from the samples of amniotic fluids, CVS, fetal tissues and urines which were sent from departments of Gynecology and Obstetrics of Balcali Hospital and other regional hospitals. RESULTS: The mean maternel and gestational age of pregnant women evaluated for prenatal diagnosis were 29.1 years of age and 18.8 months respectively. Among 4707 fetuses that were karyotyped; 2284 fetuses were males and 2205 fetuses were females and 218 (4.63%) fetuses had various chromosomal abnormalities. Consequently, male to female ratio of fetuses that were examined was 1.03. The advanced maternal age pregnancies followed by positive triplescreening were related to the highest rate of chromosomal abnormalities. The mean age of pregnant women having fetuses with chromosomal abnormalities was found to be 33 years of age which suggest that fetal chromosomal abnormalities were associated with maternal age. Numerical chromosomal abnormalities predominated the structural chromosomal abnormalities (55.5% vs to 44.5%). The numerical chromosomal abnormalities with an incidence of 47.9% trisomy 21, 14.1% trisomy 18, 8.7% Klinefelter Syndrome, 7% monosomy X, 6.6% trisomy 13, 1.7% trisomy X, 1.7% XYY Syndrom, 10% mosaics and the others represented the remaining. Of the structural abnormalities 35% were balanced while the 4% were unbalanced. The frequent structural abnormalities were 25.3% 46,XX/XY, inv(9)(p11;q12) and 19.5% 46,XX/XY, inv(9)(p11;q13). Balanced and unbalanced translocations, deletions and duplications were alsocontributed to chromosomal abnormalities in lesser extent. CONCLUSIONS: Corollary to literature and our findings revealed that the advanced maternal age and certain environmental factors can increase the risk of fetal chromosomal abnormalities. Fetal chromosomal abnormalities representing 4.63% in our study group is crucial and underlines the importance of prenatal diagnosis for healthier pregnancies. [Cukurova Med J 2011; 36(1): 8-14