Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy

Objectives: Intrahepatic cholestasis of pregnancy is the most common pregnancy specific liver disease and related with adverse maternal and perinatal outcome. Red blood cell distribution width, an anisocytosis marker in a complete blood count, has been used as an inflammation marker in various diseases. However the association of red blood cell distribution width with intrahepatic cholestasis of pregnancy is unknown. We aimed to evaluate the relationship between red blood cell distribution width and intrahepatic cholestasis of pregnancy. Material and methods: Ninety pregnant women with intrahepatic cholestasis of pregnancy and ninety healthy pregnant women were included in the study. Their clinical and laboratory characteristics including red blood cell distribution width, liver function tests, fasting and postprandial bile acid concentrations were analyzed. Results: Serum red blood cell distribution width cell levels were significantly higher in pregnants with intrahepatic cholestasis of pregnancy than healthy pregnants. We also demonstrated that red blood cell distribution Width levels were higher in severe disease than mild disease and was significantly correlated with fasting and postprandial bile acid concentration in intrahepatic cholestasis of pregnancy group. Conclusions: Our study showed that red blood cell distribution width, an easy and inexpensive marker; were associated with intrahepatic cholestasis of pregnancy and can be used as a diagnostic and prognostic marker in intrahepatic cholestasis of pregnancy

Risk factors for hysterectomy among patients with placenta previa totalis

Objective: The aim of the study is to assess risk factors for hysterectomy among patients with placenta previa totalis (PPT). Methods: The medical records of all patients delivered by cesarean section (CS) for PPT were retrospectively reviewed. Eligible cases were divided into those who underwent peripartum hysterectomy (PH) and those who did not. The two groups were compared in terms of demographics, operative features and perinatal outcomes. Logistic regression analysis was used to identify risk factors associated with hysterectomy. Results: PH was performed in 43 (44.7%) patients with PPT. Referral patients were older when compared with those without hysterectomy (p: 0.029). The median values for gravidity, parity, number of live children and previous CS were statistically significantly higher in the hysterectomy group (p<0.05). Perioperative need for blood transfusion, anteriorly placed placenta and abnormal placental invasion were statistically significantly more frequent in the hysterectomy group (p<0.001). Intraoperative complication rate was higher in this group, and bladder injury was the most common complication. No significant differences were observed between the groups in terms of perinatal outcomes. In binomial logistic regression analysis; advanced maternal age (≥ 31 years), number of previous CS (≥2), preoperative need for blood transfusion, and abnormal placental invasion were found to be independent risk factors for PH in patients with PPT. Conclusion: The findings of this study suggest that placenta invasion anomaly, advanced maternal age, increased number of previous CS, and increased need for blood transfusion are important risk factors for PH in patients with PPT

Circulating ADAMTS-12 levels in early- and late-onset severe preeclampsia

Aim of this study is to determine whether maternal serum ADAMTS-12 levels differ among early-onset ( [Med-Science 2016; 5(3.000): 785-9

Drug Resistant Fetal Arrhythmia in Obstetric Cholestasis

Obstetric cholestasis (OC) is a pregnancy specific liver disease characterized by increased levels of bile acid (BA) and pruritus. Raised maternal BA levels could be associated with intrauterine death, fetal distress, and preterm labor and also alter the rate and rhythm of cardiomyocyte contraction and may cause fetal arrhythmic events. We report a case of drug resistant fetal supraventricular tachycardia and concomitant OC. Conclusion. If there are maternal OC and concomitant fetal arrhythmia, possibility of the resistance to antiarrhythmic treatment should be kept in mind

Is there yet a role for internal iliac artery ligation in obstetric hemorrhage with the current gain in popularity of other uterus sparing techniques?

Purpose: To evaluate the success rates and subsequent fertility outcomes of internal iliac artery ligation (IIAL) in uterine atony (primary ligated and secondary added to other uterus sparing techniques), retroperitoneal hematoma, and placenta adherent abnormalities.Material and methods: Fifty two women who underwent IIAL for different causes of postpartum hemorrhage were retrospectively evaluated.Results: Among 26 women with intractable uterine atony, 12 had primary, and 14 secondary IIAL, due to ongoing bleeding following the B-Lynch suture or the Bakri balloon tamponade. The success rates were 91% and 71.4% in the primary and secondary IIAL groups, respectively. The success rates of IIAL in 12 women with placental adhesion abnormalities and another 12 with obstetric retroperitoneal hematoma were 75% (9/12) and 83% (10/12) respectively. Nine (17%) hysterectomies were performed after failure of IIAL. Two maternal deaths occurred in our study. The rate of achieving pregnancy was not significantly different between the groups.Conclusions: Hysterectomy rates might be decreased with the addition of IIAL provided that other uterus sparing techniques; B-Lynch or the Bakri balloon was to fail separately. IIAL can save lives in severe obstetric retroperitoneal hematoma. IIAL does not affect fertility even it is combined with other uterus sparing techniques like the Bakri balloon and B-Lynch suture

Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

Purpose: To evaluate the risk factors of prolonged hospitalization in patients with hyperemesis gravidarum (HEG). Material and Methods: The medical records of 114 patients who were admitted to the Zekai Tahir Burak Womens Health Education and Research Hospital with a diagnosis of HEG in the period January 2013 to June 2014 were analyzed retrospectively. Hospital stay of more than 4 days was considered as prolonged hospitalization. Ninety -three patients with HEG who needed hospitalization less than four days formed the control group and 21 patients with HEG who needed hospitalization equal to or longer than four days formed the study group. The variables regarding age, body mass index, week of pregnancy, number of parity, daily vomiting number, number of days in hospital, need of combined antiemetic use, complete blood count, biochemistry markers, hormone tests, urine analysis were evaluated to assess their relationship with the risk factors for prolonged hospitalization in patients with HEG. Results: Twenty-one of 114 patients diagnosed with HEG had a prolonged hospital stay, with a mean stay of 5.1 days. Age, body mass index, week of pregnancy, need of using combined antiemetics, complete blood count parameters, liver and kidney function tests were not associated with the duration of hospitalization. Daily vomiting, maternal serum TSH levels and blood urea nitrogen levels were 2.4 +/- 1.3 vs 4.2 +/- 1.9; p= 0.01, 1.19 +/- 0.71 vs 0.82 +/- 0.67; p= 0.04, 21.2 +/- 6.4 vs 18.1 +/- 5.3; p= 0.03; respectively, and these differences were found to be statistically significant among groups. The serum maternal TSH < 0.1 and micro;IU/mL and vomiting and #8805; 5 per day were found to be significant indicators for longer hospitalization (OR = 4.05, 95%CI = 1.07-15.3; P <0.05, OR=9.55, 95%CI = 1.81-50.4 P <0.05; respectively). Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000): 113-118

Extra-abdominal removal of placenta during cesarean section: a prospective randomized controlled trial of a novel technique

Aim: To evaluate intraoperative and early postoperative outcomes of a novel placenta delivery technique; extra-abdominal removal vs. intra-abdominal removal of the placenta during cesarean section (CS)

B-Lynch uterine compression sutures in the conservative surgical management of uterine atony

Overall success rate of the B-Lynch sutures and B-Lynch sutures plus BIIAL was 75 and 94.4 %, respectively. The B-Lynch technique does not necessarily require specific suture material. Uterine devascularization or BIIAL did not increase the risk of the possible short-term complications such as uterine necrosis. In case of failure of the B-Lynch uterine compression sutures, BIIAL may be beneficial to save the uterus

First and Second Trimester Biochemical Markers in Familial Mediterranean Fever

Familial Mediterranean Fever (FMF) is the most common hereditary monogenic auto-inflammatory disease. In this study we aimed to document whether FMF affects the biochemical components of first and second trimester combined aneuploidy screening tests including serum free beta human chorionic gonadotropin (&#946;-hCG), placenta associated plasma protein-A (PAPP-A), unconjugated estriol (uE3), total hCG and alfa-fetoprotein (AFP). In this prospective case control study, a total of consecutive 59 singleton pregnancies, 29 of with FMF and other 30 healthy women, were followed from the first trimester to end of the pregnancy. Most of pregnant women with FMF (86.2%) were under treatment with colchicine. The markers PAPP-A, free &#946;-hCG and the nuchal translucency (NT) thickness were examined at 11-13 weeks. Serum samples for AFP, uE3 and total hCG were obtained at 16-19 weeks after detailed examination. There were no cases of fetal chromosomal anomaly in neither of the groups. Both first-and second trimester marker levels were not significantly different in absence of aneuploidy or neural tube defects in FMF and control group. No difference was seen for NT measurements. False-positive rate for Down syndrome was comparable between the groups using a term risk cut-off level of 1/250. Pregnant with FMF should be reassured about the not altered levels of first-and second trimester marker. Therefore readjusting the serum markers used for Down syndrome screening is not advised. Future trials of larger scale are needed to assess any need for readjustment of the risk in the patient population with FMF. [Med-Science 2016; 5(2.000): 448-56