Geçmişten bugüne Koço:Geçmiş İstanbul'dan bize yadigar Koço ve Tanaş

Taha Toros Arşivi, Dosya No: 112-Lokantalarİstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033

Care during the third stage of labour: obstetricians views and practice in an Albanian maternity hospital

<p>Abstract</p> <p>Background</p> <p>Relatively little is known about current practice during the third stage of labour in low and middle income countries. We conducted a survey of attitudes and an audit of practice in a large maternity hospital in Albania.</p> <p>Methods</p> <p>Survey of 35 obstetricians and audit of practice during the third stage was conducted in July 2008 at a tertiary referral hospital in Tirana. The survey questionnaire was self completed. Responses were anonymous. For the audit, information collected included time of administration of the uterotonic drug, gestation at birth, position of the baby before cord clamping, cord traction, and need for resuscitation.</p> <p>Results</p> <p>77% (27/35) of obstetricians completed the questionnaire, of whom 78% (21/27) reported always or usually using active management, and 22% (6/27) always or usually using physiological care. When using active management: 56% (15/27) gave the uterotonic after cord clamping; intravenous oxytocin was almost always the drug used; and 71% (19/27) clamped the cord within one minute. For physiological care: 42% (8/19) clamped the cord within 20 seconds, and 96% (18/19) within one minute. 93% would randomise women to a trial of early versus late cord clamping.</p> <p>Practice was observed for 156 consecutive births, of which 26% (42/156) were by caesarean section. A prophylactic uterotonic was used for 87% (137/156): this was given after cord clamping for 55% (75/137), although timing of administration was not recorded for 21% (29/137). For 85% of births (132/156) cord clamping was within 20 seconds, and for all babies it was within 50 seconds. Controlled cord traction was used for 49% (76/156) of births.</p> <p>Conclusions</p> <p>Most obstetricians reported always or usually using active management for the third stage of labour. For timing and choice of the uterotonic drug, reported practice was similar to actual practice. Although some obstetricians reported they waited longer than one minute before clamping the cord, this was not observed in practice. Controlled cord traction was used for half the births.</p

Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction

AIM: This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA). METHODS: The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital “Koço Gliozheni†in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated. RESULTS: Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups. CONCLUSION: Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies

Bulgaristan'ın Vidin Şehrinde Halil ve İbrahim İkiz Kardeşlerin Kurdukları Kültür Vakfı ve Onun "Şefkat" Kıraathanesi

[No Abstract Available

Esansiyel trombositemide koroner baypas cerrahisi

[No Abstract Available

Current Point of View in Preterm Labor Management in Albania

The purpose of this study was to prevent preterm labor that uses maintenance with tocolysis therapy. This paper emphasizes the fact that there are very few hospital protocols of preterm labor that use maintenance tocolysis therapy. Our goal is to identify the possible benefits of such therapy based on individual selection of pregnant women and their gestational age. We bring our university hospital experience study of three years with a long term use of tocolysis at risk pregnancy unit at the “Koço Gliozheni” University Hospital of Obstetrics and Gynecology, Tirana, Albania. Qualitative method is used in this study and the prospective controlled population based study during March 2011 to March 2013 included pregnant women hospitalized for preterm labor with the criteria of: singleton pregnancy, 28-32 weeks of gestation, with no PPROM; maintenance with tocolysis therapy over one month period. Women were divided in two groups: 28-30 weeks gestation age and 30-32 weeks gestation age; tocolytics used: indomethacine, ritrodine, nifedipine, magnesium sulfate. Data collected showed that 325 pregnant women with admission diagnosis of preterm labor which met the study criteria went under the maintenance with tocolysis therapy, 200 patients or 61.5 % with gestation age 20-30 weeks, and 125 patients or 38.5 % were 30-32 weeks of gestations. There was a significant difference in patient group of 28-30 weeks gestation age by prolonging their pregnancy more than the group of 30-32 weeks gestation age. The prolongation of pregnancy was 45 days with the use of tocolysis therapy and these patients had a major benefit compared to those that used just emergency tocolysis therapy. The study draws to the conclusion that the use of maintenance with tocolysis therapy where there is no urgency indication for any intervention to interrupt the stay of the baby in uterus, gives considerable benefits to preterm labor diagnosed women of their singleton pregnancies and prolongs pregnancy substantially. However, use of larger population study and more studies need to be done in order to offer suitable guidelines to prevent preterm labor. Keywords: gestation, preterm labor, prevent, tocolysis therap

Statistical Data About Risk Factors and Pregnancy Outcome of Placenta Previa

Placenta previa is a placental location close to or over the internal cervical os. The aim of this study was to evaluate: risk factors, maternal and neonatal outcomes in patients with placenta previa. Material and methods: We conducted a retrospective cohort study of 38 women who have had a caesarean section for placenta previa at a tertiary referral University Hospital of Obstetrics and Gynecology “Koço Gliozheni” in Tirana, Albania. The period of this study was from January 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. All cases of placenta previa were managed by medical team, obstetric consultants and all data were calculated with SPSS.20 program. Results: In total, 38 women with placenta previa were classified in three different types of placenta previa: Marginal placenta previa occurred in 16 women(42.1%), Complete placenta previa occurred in 19 women(50%) and with accreta placenta previa in 3 women(7.9%). The mean age of mothers was 30,61 years old, mode = 35, median = 30 and Std. deviation = 4.641 years. Conclusions: The prevalence rate of section caesarean and placenta previa is increased during the years. Several obstetrical factors have been found to be risk for placenta previa including: advancing maternal age, previous caesarean delivery, previous abortions, previous uterine surgery, multiparity, previous placenta previa, low socio-economic status, mother’s cigarette smoking /alcohol use. Placenta previa is associated with an increase in preterm birth and neonatal and maternal outcome. Other complications of pregnancy can be associated with placenta previa, but the majority of women deliver healthy babies

Therapeutic Effect and Safety of Early Treatment of Patent Ductus Arteriosus with Oral Ibuprofen in Preterm Infants

Background: Patent ductus arteriosus (PDA) is a common problem encountered in premature infants, especially those with respiratory distress syndrome. PDA can lead to life-threatening complications. Intravenous ibuprofen was shown to be as effective and to cause fewer side effects. If ibuprofen is effective intravenously, it will probably be effective orally too. Aim: This study was designed to determine the effectiveness and safety of oral ibuprofen compared to IV ibuprofen or no intervention for closing a PDA in preterm infants with RDS. Material and methods: A prospective study, randomized, a blindfold was conducted in NICU, at UOGH "Koço Gliozheni", Tirana, from February 2010-August 2013. The study included a total of 128 preterm infants, 28-35 weeks, ≤2500gr birth weight, in the first 48-96 hours of life, with SDR and confirm the presence of DBA's (Ǿ≥1.5mm) by echocardiographic examination. Infants were treated with Ibuprofen oral, intravenous Ibuprofen, no medical interventions, in randomized order. The cycle of treatment: 10 + 5 + 5/mg/kg, every 24 hours. Were highlighted the basic characteristics of infants included in the study, the effectiveness of treatment (closure of DBA's), side effects, complications, and the effectiveness of treatment. For continuous variables were calculated the average and standard deviation. The p≤0.05 value was accepted as statistically significant. All tests are two-sided. RR and OR were presented with 95% CI. Results: 38 infants were treated with Ibuprofen oral, 35 infants with intravenous Ibuprofen and 37 infants underwent no medical intervention. The effectiveness of early treatment: DBA remained open, after early treatment, in 7foshnja (18.4%) in group oral Ibuprofen vs 20 infants (54%) in the group that did not undergo any medical intervention [RR = 0.34; 95% CI = 0.16-0.7; p = 0.04], vs 6 infants (17.1%) in the group of intravenous Ibuprofen [RR = 1.07; 95% CI = 0.4-2.8; p≥0.05]. There was observed no statistically significant change of direction of side effects and complications, p≥0.05. Conclusions: Oral Ibuprofen is an effective and safe alternative when used for the treatment of DBAs to babies born prematurely and with low birth weight.Keywords: DBA, preterm births, Ibuprofen, treatment of early/late, side effects, complication

Les fortifications d'Apollonia d'Illyrie : nouvelles méthodes et nouveaux outils pour l'étude architecturale et historique

International audienc

Safety and Concerns of Diagnostic Imaging Utilisation during Pregnancy

Pregnancy is special situation where human body of pregnant woman undergoes various physiological changes. These changes are complex and involve in a way all anatomical systems. Medical care during pregnancy is interesting and often challenging as it often engages medical management and diagnostic procedures that can place at risk the fetus and the mother as well. Diagnostic imaging modalities are available for diagnostic use during pregnancy. These include X-ray, ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT), and other modalities as well. Ultrasonography so far is the most common diagnostic imaging modality used during pregnancy; however, other modalities may be required to be employed. Diagnostic X-ray is the most frequent cause of anxiety for obstetricians and patients as well. To a great extent of this concern is secondary to a general belief that any radiation exposure is harmful and will result in an anomalous fetus. This anxiety could lead to inappropriate therapeutic abortion and lawsuit. Actually, most diagnostic radiologic procedures are associated with little, if any, known significant fetal risks. The concern and anxiety among obstetricians, physicians in general and patients as well is present in almost all of them in Albania, though, concerns of this kind exist even in well organised medical systems in developed countries. Having mentioned that, however, in latter one they are isolated cases as physicians are well informed as medical specialists work in close collaboration with interdisciplinary approach of health care delivery as a team. On the other hand, patient education is a great tool in transmitting proper professional information to interested population in regards of this matter. Conclusions: Since according to the American College of Radiology and American College of Obstetricians and Gynecologists, no single diagnostic X-ray procedure results in radiation exposure to a degree that would threaten the well-being of the developing preembryo, embryo, or fetus, Albanian physician must counsel patients appropriately about the potential risks and measures that can reduce diagnostic X-ray exposure.Keywords: Diagnostic imaging modalities, pregnancy, exposure, risk, utilisation, appropriate