Intraoperative superior hypogastric plexus block for pain relief after a cesarean section: a case-control study

Aim To investigate the efficacy of intraoperative superior hypogastric plexus (SHP) block for postoperative pain relief in patients undergoing a cesarean section. Methods One hundred and fifteen pregnant women scheduled for an elective cesarean under general anesthesia were randomly divided into an SHP block (n=65) and a control group (n=50). SHP block was administered with bupivacaine injection. The controls received saline injection in the SHP area. Postoperative pain was assessed by the 10-cm visual analog scale (VAS). The presence of side effects and complications, including opioid or non-steroidal anti-inflammatory drugs (NSAID) requirement, gastrointestinal function, nausea, and vomiting were evaluated. Results The SHP block group had significantly lower VAS scores 2, 6, 24, and 48 hours postoperatively (P<0.001) and required a significantly lower rescue dose of NSAID or opioids (P=0.003, P<0.05, respectively). Conclusions SHP block may be an effective and safe pain relief treatment after a cesarean section

Maternal-fetal outcome associated with adolescent pregnancy in a tertiary referral center: a cross-sectional study

Objectives: This study was conducted to compare pregnancy outcomes of early-middle adolescent, late adolescent and adult women. Material and methods: The study focused on early-middle adolescent (n = 145), late adolescent (n = 1655) and adult (n = 1585) women who gave birth during 2014 through 2017, utilizing data obtained from the Zeynep Kamil Women and Children’s Health Training and Research Hospital. Pregnancy outcomes were determined according to the rates of preg¬nancy complications, including method of delivery, birth weight, as well as the rate of newborn intensive care admissions. Results: Comparisons between the studied groups for various pregnancy complications showed highest rates of pre¬term deliveries (PD), preterm premature rupture of membranes (PPROM) and neonatal intensive care unit admission in early-middle adolescent group, whereas the highest cesarean section rates were observed in the adult group (p < 0.001). Conclusions: Analysis of the data revealed that adolescent pregnancy, especially the early-middle adolescent pregnancies, is associated with increased risks of adverse pregnancy outcomes

Vaginal axis on MRI after unilateral and bilateral sacral hysteropexy: a controlled study

The objective of this study was to evaluate the vaginal position on magnetic resonance imaging (MRI) after bilateral abdominal sacral hysteropexy (BASH) and classical abdominal sacral hysteropexy (ASH) and to investigate which method keeps the vagina the most proximate to its original anatomical position. Ten patients, with 10 having BASH, 10 ASH and 10 being nulliparous, were compared. The angle between the vagina and the pubococcygeal plate, the angle between the upper and lower vaginal segments, the distance between the posterior fornix and the 2nd vertebra and the distances between the lateral fornices and spina ischiadica were measured on MRI. A p value less than .05 was considered statistically significant. The distance between the vaginal axis and the left spina ischiadica was greater in the ASH group compared to the control and the BASH group (p = .011, .047), while it was similar between the BASH group and the control individuals (p = .473). The angle between the upper and lower vaginal segments was greater in the ASH group compared to the control group (p = .004), while no significant difference was found between the BASH and control groups (p = .112). BASH keeps the vaginal axis at a more proximate location to its original anatomical position.IMPACT STATEMENT What is already known on this subject: In pelvic reconstructive surgery; the anatomic correction serves the functional results. What the results of this study add: On MRI examination bilateral abdominal sacral hysteropexy (mimicking uterosacral ligament), keeps the vagina closer to the original anatomic position than classical abdominal sacral hysteropexy. Hence functional outcomes could be better, especially in the long term. What the implications are of these findings for clinical practice and/or further research: This study may be of interest for clinicians in terms of different methods for pelvic floor surgery and may be of interest for researchers to investigate the relationship between anatomic position and functional outcomes especially in younger patients

Managemet of puerperal vulvovaginal hematoma with different suture technique; case report

Puerperal hematomas occur in 12 per 1000 deliveries and rarely cause maternal mortality. A 21-year-old female patient, gravida 2 parity 2, was admitted to our clinic with bilateral vulvar hematoma after a spontaneous vaginal delivery. Extensive hematomas are primarily treated with surgical debridement. Due to the consistency of hematoma after debridement, primary retention sutures were placed at the vulva and a silicon catheter was placed between the vulva and retention sutures. The patient was hospitalized for five days. The early diagnosis of puerperal hematomas is very important because many complications can be prevented with early diagnosis and treatment. [Med-Science 2017; 6(3.000): 579-81

Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

Objective: The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. Study Design: Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission. Results: Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission. Conclusion: Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia