Gestational diabetes mellitus is as innocent as you think?

Background: We aimed to compare fetal outcomes, fetal hypoxia, acidemia and maternal chracteristics including hemoglobin A1c, doppler indices between gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (DM) among pregnant women treated with insulin.Methods: Data of pregnant patients with diagnosis of pregestational diabetes (type 1 and 2) and GDM who were treated with insulin (GDM A2 in White classification) was retrospectively collected and compared. Patients with active chronic systemic disease, multiple pregnancies, lost to follow up and detected fetal malformations were exluded. Maternal characteristics, umbilical doppler indices and amnion fluid index, gestational age at delivery, delivery characteristics (including vaginal delivery, or cesarean section) and newborn characteristics such as birth weight, Apgar score and umblical cord pH were all recorded.Results: A total of 130 patients (67 patients with GDM and 63 pregestational DM) were recruited to the study. There were no significant difference regarding type of delivery, fetal birth weight, umbilical cord Hb and gestational birth age. No other significant difference in frequency of low Apgar scores and fetal acidosis or metabolic acidosis were reported. HbA1c and blood glucose levels and insulin dosage were significantly statistically higher in pregestational group.Conclusions: The frequency of fetal distress parameters and poor fetal outcome were similar between groups although pregestaional diabetic patients had higher HbA1c rates. Therefore, patients with GDM (A2) should be followed up as closely as pregestational (overt) diabetic patients

“Near miss” maternal morbidity following repeat rescue cerclage for twin pregnancy

Objective Repeat cervical cerclage is one of the treatment options described in the literature for when the primary cerclage suture fails. However, infectious complications of cerclage placement may be encountered which are more obvious for the newborn. In our presented case, severe acute maternal morbidity was encountered for the sake of prolonging pregnancy. Case(s) Twenty-seven year old nullipar patient at 23+5 gestational weeks with dichorionic diamniotic pregnancy was admitted to our emergency clinic with complaints of “pain” and “vaginal bleeding”. At 18 weeks of pregnancy she had a Shirodkar cerclage procedure indicated by a short cervical length (14 mm) at our hospital. She presented with “bulging of membranes” to a different institution and underwent a repeat cerclage at 23+3 weeks. Chorioamnionitis was suspected and the patient was counselled for a pregnancy termination. After termination of pregnancy, “cardiac arrest” developed. After 2 minutes of resuscitation sinus rythm was obtained. The patient was admitted to the ICU. Conclusion The role of repeat cerclage is controversial. Efforts should be maximized to rule out underlying intrauterine infection prior to placement of a cerclage suture for there to be a therapeutic benefit of prolonging the pregnancy

Fingolimod Alters Tissue Distribution and Cytokine Production of Human and Murine Innate Lymphoid Cells

Sphingosine-1 phosphate receptor 1 (S1PR1) is expressed by lymphocytes and regulates their egress from secondary lymphoid organs. Innate lymphoid cell (ILC) family has been expanded with the discovery of group 1, 2 and 3 ILCs, namely ILC1, ILC2 and ILC3. ILC3 and ILC1 have remarkable similarity to CD4+ helper T cell lineage members Th17 and Th1, respectively, which are important in the pathology of multiple sclerosis (MS). Whether human ILC subsets express S1PR1 or respond to its ligands have not been studied. In this study, we used peripheral blood/cord blood and tonsil lymphocytes as a source of human ILCs. We show that human ILCs express S1PR1 mRNA and protein and migrate toward S1P receptor ligands. Comparison of peripheral blood ILC numbers between fingolimod-receiving and treatment-free MS patients revealed that, in vivo, ILCs respond to fingolimod, an S1PR1 agonist, resulting in ILC-penia in circulation. Similarly, murine ILCs responded to fingolimod by exiting blood and accumulating in the secondary lymph nodes. Importantly, ex vivo exposure of ILC3 and ILC1 to fingolimod or SEW2871, another S1PR1 antagonist, reduced production of ILC3- and ILC1- associated cytokines GM-CSF, IL-22, IL-17, and IFN-γ, respectively. Surprisingly, despite reduced number of lamina propria-resident ILC3s in the long-term fingolimod-treated mice, ILC3-associated IL-22, IL-17A, GM-CSF and antimicrobial peptides were high in the gut compared to controls, suggesting that its long term use may not compromise mucosal barrier function. To our knowledge, this is the first study to investigate the impact of fingolimod on human ILC subsets in vivo and ex vivo, and provides insight into the impact of long term fingolimod use on ILC populations

Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: Single-center experience

Aim The aim of this study was to investigate the efficacy, and the safety of systemic multidose methotrexate (MTX) for the treatment of cesarean scar pregnancy (CSP). Material and Methods This retrospective cohort study was performed using records from the Department of Obstetrics and Gynecology, Erciyes University, between 2010 and 2012. The data were analyzed with respect to obstetric characteristic, course of treatment, clinical, and reproductive outcomes. Results A total of 13 patients were evaluated. The median gestational age at diagnosis was 5 weeks 5 days (range: 4-9 weeks). The mean beta human chorionic gonadotrophin level was 11240.31 +/- 9812.68IU/L (range: 2565-36111IU/L). All patients were successfully treated with systemic multidose MTX therapy. The average MTX dose was 5.7 (range: 2-9). The interval between the first MTX injection and the normalization of beta human chorionic gonadotrophin was 8 +/- 2.27 weeks (range: 4-12 weeks). One patient showed mild leucopenia that reversed after the treatment. Three patients had successful uncomplicated intrauterine pregnancy after the treatment, which resulted in term infants. Conclusion Systemic multidose MTX therapy is an effective and safe treatment method for CSP. However, further studies are needed to compare the safety, effectiveness and reproductive outcome of different treatment modalities in CSP

F-18 fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in planning of surgery and sentinel lymph node screening in vulvar cancers

To determine the effectiveness of FDG-PET/CT in the assessment of inguinofemoral lymph node (IFLN) in patients with vulvar cancer by comparing FDG-PET/CT results, sentinel lymph node (SLN) screening with gamma probe, and the results of frozen section and definitive pathology in these lymph nodes

A Case of a Placenta Percreta Presenting with Severe Vaginal Bleeding Following Early Second Trimester Pregnancy Termination

A 14-week pregnant woman was admitted to the hospital for pregnancy termination because of early rupture of membranes. Dilatation and curettage were performed because the placenta did not separate spontaneously after fetus evacuation. The placenta could not be extracted and severe vaginal bleeding occurred. The patient's condition deteriorated. Placenta percreta was detected intraoperatively. Emergency hysterectomy was performed. Because of the high risk of maternal morbidity and mortality, it is important to consider placenta percreta in the presence of prolonged first and second trimester pregnancy termination, especially in those patients with a history of uterine surgery