Prenatal multivitamin supplementation increases birth weight

Background: The aim of this study is to examine whether there is any positive impact of prenatal iron and vitamin supplementation on birth weight, and if this practice could be a cause of macrosomia.Methods: A total of 1,838 term pregnant women were included in this study and were divided into four groups: iron group (women having only iron supplementation), vitamin (women using only multivitamins), vitamin+iron (women using both iron and multivitamin preparations), and control group (women having neither iron nor vitamin supplements). Statistical analysis was performed to compare age, gravida, parity, hemoglobin, BMI and birth weight. Groups were compared in terms of macrosomia and correlation analysis carried out between demographics and birth weight.Results: The birth weight was significantly higher in the vitamin group and the vitamin+iron group than in the iron group and the control group. Vitamin supplementation increased the risk of macrosomia 3.9 times, while vitamin+iron usage increased the risk 4.8 times.Conclusions: Uncontrolled use of multivitamins and/or iron supplements may increase tendency for fetal macrosomia. The use of multivitamins and/or iron supplements by pregnant women must take into account maternal age, maternal diet and maternal BMI. Our findings support a reduction in the unnecessary use of vitamin and iron supplements in pregnancy, and a reversal of the trend to start vitamin and iron supplementation without any control. The increasing prevalence of obesity and excessive weight in pregnant women should be a warning against the uncontrolled usage of vitamins and iron during pregnancy

C-reactive protein level and obesity as cardiovascular risk factors in polycystic ovary syndrome

Objective: To investigate the role of C-reactive protein(CRP) level elevation and obesity for the increased cardiovasculardisease risk in polycystic ovary syndrome(PCOS).Methods: A hundred and nine patients with PCOS and 30age matched healthy volunteers with regular menstrualcycle are involved in the study. PCOS group is furthersubdivided into three subgroups according to the bodymass index (BMI). Subgroups included 54 with BMI<25,22 with BMI 25-30, and 33 with BMI>30. Blood samplesfor glucose, insulin, uric acid, and CRP were collected inthe morning after overnight fasting (12 hours). Homeostasismodel assessment-insulin resistance (HOMA-IR)was calculated. Results: Fasting blood glucose, insulin,and HOMA-IR was significantly higher in PCOS group(p=0.02, p=0.01 and p=0.02). CRP level was higher insubgroup with BMI>30. High CRP level in PCOS wasfound to be independent from BMI (p<0.001). HOMA-IRand insulin level was higher in the subgroup with BMI>30.When compared with the control group high insulin levelwas the only to be statistically significant in obese PCOSpatients (p=0.005). HOMA-IR was higher in PCOS subgroupwith BMI>30 when compared with controls and thePCOS subgroup with BMI<25 (p<0.001, p= 0.003).Conclusion: Obesity, hyperinsulinemia, and high CRPlevels are seemed to be related and potentiating eachother in PCOS. Struggling with obesity is one of the mostimportant issues for preventive medicine.Key words: PCOS, CRP, obesity, cardiovascular ris

German strategic culture from the pre-weimar period (II. Wilhelm 1888-1918) to the post-unification period (Merkel 2005-2021)

Stratejik kültür çalışmaları çok da eski bir tarihe dayanmamaktadır. Keza, literatürde stratejik kültür ile ilgili yapılan çalışmalar henüz doyuma ulaşmış değildir. Çünkü stratejik kültür, üzerine düşünülmesi ve araştırma yapılması gereken geniş ve kapsamlı bir konudur. Bu çalışma, Weimar öncesi dönem olan son imparatorluk çağından yani II. Wilhelm'den birleşme sonrası Merkel dönemi sonuna dek olan süreci kapsamıştır. Çalışma, lider söylemleri üzerinden Almanya'nın stratejik kültürünü değerlendirme amacı taşımıştır. Bu kapsamda dönemler ve her dönemin öne çıkan kritik liderleri belirlenmiştir. Ardından ilgili dokümanlara ve arşiv belgelerine ulaşmak için, Alman Başkonsolosluğuna ve Büyükelçiliklere başvurulmuştur. Gerekli belge ve metinler toplandıktan sonra, Maxqda programı ile her bir liderin 7'şer konuşması Analiz edilmiştir. Ardından analiz veri sonuçları ile uzman görüşüne başvurulmuştur. Bunun için, Johnston'ın stratejik kültür ortam düzeni baz alınmıştır. Johnston'ın temel varsayımları dâhilinde, uzmanlara puanlama yaptırıldıktan sonra, istatistiksel işlemler yapılmıştır. Ulaşılan sonuç ile her bir liderin stratejik kültür tutumu grafiklerle detaylı bir şekilde aktarılmıştır. Ardından, her bir dönemin stratejik kültür skalasında puan ortalaması saptanmıştır. Tüm bunlardan sonra Almanya'nın incelenen dönemler kapsamında genel Stratejik kültür puanına ve tutumuna ulaşılmıştır. Bu çalışmada hem nitel hem nicel yöntemler kullanılmıştır. Literatürde daha önce yapılmış olan böyle bir çalışma bulunmamaktadır. Bu çalışmanın literatüre katkı sağlayacağı ve daha sonra bu konuda çalışmak isteyenlere örnek olacağı düşünülmüştür. Anahtar Kelimeler: Stratejik Kültür, Almanya, Alman Şansölyeler, Maxqda Analizi, Lider SöylemleriStrategic cultural studies do not date back to ancient times. Likewise, studies on strategic culture in the literature have not yet reached saturation. Because strategic culture is a broad and comprehensive subject that needs to be thought about and researched. This study covered the process from the last imperial age, which is the pre-Weimar period, from II. Wilhelm to the end of the German post-unification Merkel era. The study aimed to evaluate the strategic culture of Germany through leader discourses. In this context, periods and prominent critical leaders of each period were determined. Then, the German Consulate General and Embassies were contacted in order to reach the relevant documents and archive documents. After collecting the necessary documents and texts, 7 speeches of each leader were analyzed with the Maxqda program. Then, expert opinion was sought with the results of the analysis data. For this, Johnston's strategic culture environment is based on. Within Johnston's basic assumptions, statistical operations were performed after scoring the experts. With the result reached, the strategic culture attitude of each leader is conveyed in detail with graphics. Then, the average score in the strategic culture scale of each period was determined. After all, Germany's general strategic culture score and attitude were reached within the scope of the examined periods. Both qualitative and quantitative methods were used in this study. There is no previous study like this in the literature. It is thought that the study will contribute to the literature and will set an example for those who want to work on this subject later on. Key Words: Strategic Culture, Germany, German Chancellors, Maxqda Analysis, Leader Discourse

Weımar öncesi (II. Wılhelm 1888-1918) dönemden birleşme sonrası (Merkel 2005-2021) döneme Alman stratejik kültürü

Stratejik kültür çalışmaları çok da eski bir tarihe dayanmamaktadır. Keza, literatürde stratejik kültür ile ilgili yapılan çalışmalar henüz doyuma ulaşmış değildir. Çünkü stratejik kültür, üzerine düşünülmesi ve araştırma yapılması gereken geniş ve kapsamlı bir konudur. Bu çalışma, Weimar öncesi dönem olan son imparatorluk çağından yani II. Wilhelm'den birleşme sonrası Merkel dönemi sonuna dek olan süreci kapsamıştır. Çalışma, lider söylemleri üzerinden Almanya'nın stratejik kültürünü değerlendirme amacı taşımıştır. Bu kapsamda dönemler ve her dönemin öne çıkan kritik liderleri belirlenmiştir. Ardından ilgili dokümanlara ve arşiv belgelerine ulaşmak için, Alman Başkonsolosluğuna ve Büyükelçiliklere başvurulmuştur. Gerekli belge ve metinler toplandıktan sonra, Maxqda programı ile her bir liderin 7'şer konuşması Analiz edilmiştir. Ardından analiz veri sonuçları ile uzman görüşüne başvurulmuştur. Bunun için, Johnston'ın stratejik kültür ortam düzeni baz alınmıştır. Johnston'ın temel varsayımları dâhilinde, uzmanlara puanlama yaptırıldıktan sonra, istatistiksel işlemler yapılmıştır. Ulaşılan sonuç ile her bir liderin stratejik kültür tutumu grafiklerle detaylı bir şekilde aktarılmıştır. Ardından, her bir dönemin stratejik kültür skalasında puan ortalaması saptanmıştır. Tüm bunlardan sonra Almanya'nın incelenen dönemler kapsamında genel Stratejik kültür puanına ve tutumuna ulaşılmıştır. Bu çalışmada hem nitel hem nicel yöntemler kullanılmıştır. Literatürde daha önce yapılmış olan böyle bir çalışma bulunmamaktadır. Bu çalışmanın literatüre katkı sağlayacağı ve daha sonra bu konuda çalışmak isteyenlere örnek olacağı düşünülmüştür.Strategic cultural studies do not date back to ancient times. Likewise, studies on strategic culture in the literature have not yet reached saturation. Because strategic culture is a broad and comprehensive subject that needs to be thought about and researched. This study covered the process from the last imperial age, which is the pre-Weimar period, from II. Wilhelm to the end of the German post-unification Merkel era. The study aimed to evaluate the strategic culture of Germany through leader discourses. In this context, periods and prominent critical leaders of each period were determined. Then, the German Consulate General and Embassies were contacted in order to reach the relevant documents and archive documents. After collecting the necessary documents and texts, 7 speeches of each leader were analyzed with the Maxqda program. Then, expert opinion was sought with the results of the analysis data. For this, Johnston's strategic culture environment is based on. Within Johnston's basic assumptions, statistical operations were performed after scoring the experts. With the result reached, the strategic culture attitude of each leader is conveyed in detail with graphics. Then, the average score in the strategic culture scale of each period was determined. After all, Germany's general strategic culture score and attitude were reached within the scope of the examined periods. Both qualitative and quantitative methods were used in this study. There is no previous study like this in the literature. It is thought that the study will contribute to the literature and will set an example for those who want to work on this subject later on

Should warm fresh whole blood be the first choice in acute massive hemorrhage in emergency conditions?

Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section. The patient had massive bleeding from the uterus due to atony. Her hemoglobin (Hb) dropped to 3.5 g/dL. Six units of WFWB were transfused during surgery. Hemodynamic parameters and complete blood count (CBC) stabilized. She was transferred from the intensive care unit (ICU) to obstetrics on day 2 and was discharged on day 7. Described second is the case of a 35-year-old female patient who also underwent emergency cesarean section, and for whom massive bleeding was due to uterine atony. Hb dropped to 2 g/dL and hematocrit (HCT) to 5.4%. Nine units of WFWB were transfused, after which hemodynamic and laboratory parameters stabilized. The patient was extubated the following day, transferred from the ICU to obstetrics on day 3, and was discharged on day 8. Described third is the case of a 36-year-old male patient with stab injuries and hemorrhagic shock who underwent emergency surgery. The patient had injuries to the right renal artery and kidney. Nine units of WFWB were transfused due to continued hemorrhage during surgery. Following surgical control of bleeding and transfusion, hemodynamic parameters improved. The patient was transferred from the ICU on day 5 and discharged on day 10. WFWB transfusion nearly disappeared from civilian medicine after blood was separated into components, and whole blood is not usually available at blood banks. In massive transfusions, WFWB effectively replaces red blood cells (RBCs), platelets, plasma volume, and coagulation factors, while preventing hypothermia and dilutional coagulopathy. Blood components go through biochemical, biomechanical, and immunological changes during long storage, the duration of which affects both transfusion efficacy and associated risks. In the future, with the use of fast donor tests, fast ABO compatibility tests, platelet-sparing leukocyte filters, and developments in pathogen-decreasing technology, fresh whole blood (FWB) may be the first choice for massive transfusion. Future studies will reveal new procedures

The Relation of Regional and General Anesthesia Applied in Cesarean Patients with Postpartum Depression

Abstract Aim: The purpose of the study is to investigate the relationship between the frequency of depression and the type of anesthesia given to the women that deliver by cesarean section. Methods: The study was carried out prospectively on cesarean patients. The study included 58 patients with general anesthesia (GA) and 61 patients with spinal anesthesia (SA). Right before the surgery the patients filled State Trait Anxiety Inventory-1(STAI-1), a form surveying the anesthesia concerns. Edinburg Postpartum Depression Scale was filled six weeks after the delivery.The data were analyzed by IBM SPSS 20 statistical analysis program. Results: The difference between the GA and SA groups were insignificant in terms of age, education, socio-economic level and number of pregnancy (p&lt;0.05). Both groups had high STAI-1 mean values but the difference between them were insignificant (p&gt;0.05). Edinburg Postpartum Depression Scale indicated that depression points were high in 15.5% of the GA group and 8.1% of the SA group. This was statistically significant (p&lt; 0.01). Conclusion: This study showed that postpartum depression rate was higher in patients that had GA compared to the patients with SA. Thus, it is crucial to select the type of anesthesia after careful examination of the patient

Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term

The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM.Impact statement The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups. Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term

Maternal-Fetal Risk Increase From 41 Weeks of Gestation

OBJECTIVES: We aimed to determine the maternal-fetal outcomes in pregnancies who delivered from 41 weeks of gestation. STUDY DESIGN: Obstetrics records of 619 singleton pregnants delivered at our institution were reviewed. 275 of patients who were at ≥ 41 weeks consisted of the study group. The control group was consisted of 344 of patients deliveried between 38 and 41 gestational weeks. The groups were compared on maternal datas, mode of delivery and perinatal outcomes. RESULTS: There were 135/275 (49 %) nulliparous in the study group and 114/344 (33,13 %) nulliparous in the control group ( p < 0,001). Oxytocin was given to 82,18 % and 43,89 % of the study and the control group respectively (p<0.001). Cesarean section for cephalopelvic disproportion was indicated in 48,11% of study group and 12,38 % of control group (p<0.001). Macrosomia (>4000 g) was 19,27% and 13,37% in the study and control group respectively (p=0.048). CONCLUSIONS: Closer monitoring should commence and induction of labor should be considered in gestational week 41

Impact of Advanced Maternal Age on Perinatal Outcomes

OBJECTIVES: To investigate the impact of advanced maternal age on perinatal outcomes. STUDY DESIGN: In this retrospective study, pregnancy records of 616 singletons were reviewed. Subjects were divided into 3 age groups: Group 1; 20-29 years (n=386), Group 2; 30-39 years (n=171) and Group 3; 40 years and older (n=59). The groups were compared for maternal datas such as parity, pre and post-pregnancy body mass index and for obstetrics complications. RESULTS: Pre and post-pregnancy body mass index, gestational diabetes mellitus, delivery <37 weeks, prevalance of cesarean section and proportion of babies admitted to neonatal intensive care unite were significantly higher in women above 40 years (p<0.05). Pregnants aged 40 and older had low birth weight babies than others (3270.8±612.06 gr, p=0.037). CONCLUSIONS: Increasing maternal age showed a significant increase in gestational diabetes melllitus and excess rate of cesarean section. Despite the increased risk of complications in women above 40 years they should have healthy babies by counselling for care in a specialised centre

A Fetus with Iniencephaly Delivered at the Third Trimester

Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination