Cesarean scar pregnancy: A case report

Pregnancy implantation to the cesarean scar could be the life threatening, although it is a rare event, its ratio increased along with the increasing rate of cesarean delivery. Early diagnosis and treatment may be lifesaving with preserving fertility in these patients. In transvaginal ultrasonography; presence of an empty uterine and cervical cavity, lack of continuity of myometrial setting at the anterior isthmic region and pregnancy implantation to this region should suggest the diagnosis. In this article, we aimed to present a patient with scar ectopic pregnancy with the review of the literature

Rudimentary horn pregnancy — ten years of experience

Objectives: This study aimed to evaluate data on early diagnosis and therapeutic management of rudimentary hornpregnancy (RHP).Material and methods: Patients diagnosed with RHP at a tertiary center between for two periods of 2008–2012 and2013–2018 were analysed retrospectively. We obtained information of patients from hospital electronic archive registrationsystem. Data on demographic characteristics, clinical presentation, gestational age at presentation, presenting symptoms,diagnostic methods, and therapeutic management were noted and analysed by descriptive statistical method. Demographicdatas, the complaint of patient’s admission to hospital, history of cesarean section, preliminary diagnosis and intraoperativediagnosis were compared between periods of 2008–2012 and 2013–2018.Results: A total of 14 RHP patients were included. Eight (57.1%) of these patients were diagnosed between 2008–2012 (Group1), whereas six patients (42.9%) were diagnosed between 2013–2018 (Group 2). Rudimentary horn was non-communicatingin 13 patients (92.8%). Communicated form was observed in 1 patient in group 1. RHP was diagnosed on the left side in ninepatients (64.2%). Six of these patients were observed in group 1 and 3 were in group 2. The pre-rupture diagnosis was madein 10 (71.4%) patients. Six (100%) of 10 patients were in group 2. In addition, in group 1, four patients (50%) experiencedintraoperative RHP rupture. RHP was diagnosed before rupture in 2 (33.3%) patients in group 2.Conclusions: It is an indication of advanced ultrasonographic technology as well as increased carefulness on the physicianside and raised alertness on the patient side that today both RHP and preoperative rupture of RHP are less frequent.Still, further awareness is required among physicians of the necessity of excision of a rudimentary horn that is detectedat the time of C-section

A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality

Are serum Netrin-4 levels predictive of preeclampsia?

Objective: To investigate the levels of anti-angiogenic factors, namely sFlt-1 and Netrin-4, in patients with preeclampsia (PE). Material and methods: Cord-blood (UC) sFlt-1 and Netrin-4 concentrations were measured in 30 patients with severe PE, 30 patients with PE and 30 control infants and their mothers (MS). Results: Maternal sFlt-1 levels were significantly higher in the severe PE and PE groups than in the control group. There were no statistical differences among the three groups in maternal and fetal Netrin-4 levels. But Netrin-4 levels were found to be the lowest in the control group and higher in the PE and severe PE groups. The correlation analysis revealed a positive correlation between maternal sFlt-1 levels and maternal Netrin-4 levels (p = 0.012, and r = 0.263), maternal sFlt-1 levels and fetal sFlt-1 levels (p = 0.012, and r = 0.263). Conclusions: There was a positive correlation found between maternal sFlt-1 levels and maternal Netrin-4 levels. We are of the opinion that elevation in levels of Netrin-4 might be secondary to placental hypoxia occurring in PE. The present study led to the consideration of anti-angiogenic biomarkers (sFlt-1 and Netrin-4) on automated platforms for clinical use as an aid in establishing the diagnosis and prognosis of PE

Unscarred uterine rupture and subsequent pregnancy outcome — a tertiary centre experience

Objectives: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarreduterine rupture and in those with a history of uterine ruptureMaterial and methods: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiarycenter were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergonefertility-preserving surgery were evaluated.Results: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotalhysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these,eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36–37 wk. of gestation,and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundalrupture, and their inter-pregnancy interval was 9 and 11 mo., respectively.Conclusions: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to thehigh morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudentin induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancyintervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should bevalidated in another studies

Hypogastric artery ligation in postpartum haemorrhage: a ten-year experience at a tertiary care centre

This study investigated patients who underwent bilateral hypogastric artery ligation (BHAL) due to postpartum haemorrhage (PPH). Patients who underwent BHAL because of PPH following a conservative treatment were included in this study. Placental abnormalities were referred to as placenta accreta. A total of 130 BHAL procedures took place at the study hospital as a result of PPH. Of these, 39 (30%) were referred to the hospital. The rate of BHAL requirement was 62 out of 10,000 births. Among the 130 patients, the most frequent indication for BHAL was placenta accreta (58.5%). Haematological parameters were poorer among the referral patients. Four of the exitus patients (80%) were referral patients. The mortality rate among the referral patients was 10.25%, whereas this rate was only 1.01% among the patients who gave birth at the hospital. PPH is a life-threatening condition that requires immediate medical attention. BHAL, with its fertility-preserving features, is a good option that can be employed in all PPH patients. BHAL not only preserves patients’ fertility, but it also gives them a higher chance of survival.IMPACT STATEMENT What is already known on this subject? PPH is a life-threatening condition. Due to the worldwide increase in caesarean sections, placenta accreta has also increased. BHAL is a vital treatment method for PPH. What do the results of this study add? Placenta accreta is one of the most common causes of PPH. Traditional hysterectomy rates can be reduced by replacing this treatment with BHAL in this group of patients. Without early intervention in PPH, a patient’s mortality risk can increase by up to 10 times. As research and surgeons’ experience grows, PPH can be controlled with treatments with less complex modalities without the need for BHAL. What are the implications of these findings for clinical practice and/or further research? The need for BHAL should be kept in mind when addressing PPH, especially in cases of placenta accreta. The need for hypogastric artery ligation, which is a more aggressive treatment for the surgical correction of the pathology, can be reduced as surgeons’ experience increases. Early intervention and/or referral in cases of PPH is of great importance

The effectiveness of contraception methods and educational level of women: A sample from Southeast Anatolia

The aim of present study was to evaluate relationships between contraceptive methods, their failures and educational status of women in Southeast Anatolia.152 multiparous women who use a contraceptive method and applied to Obstetrics and Gynecology Clinics of Ergani State Hospital were selected. Patients’ age, gestation and birth numbers, marriage period, the ratios of unwanted gestations and related curettage and educational levels were determined.The mean age of study group was 29.7±6.6 years, mean marriage period 9.5±5.7 years, mean gravida 3.5±1.8 (1-9) and mean parity was 2.8±1.3 (1-6). Applied contraceptive methods were as follows: coitus interruptus (42.1%), intrauterine device (IUD) (19.1%), oral contraceptives (15.8%), condom (13.2%), tubal ligation (7.2%) and others (2.6%). The frequency of IUD and oral contraceptives were increasing, parallel to increased educational levels of women (P<0.001). Unwanted gestation and related curettage ratios were most frequent in coitus interruptus and the least in IUD methods.In conclusion, to increase use of effective and safe family planning methods and protect women from unwanted gestations, the educational levels of women should be increased

Emergency peripartum hysterectomy

The aim of the present study was to determine the incidence, indications and maternal characteristics of emergency peripartum hysterectomy (EPH).Medical records belong to 49 patients, that undergone EPH at Diyarbakır Gynecology and Obstetrics Hospital, between September 2005 and August 2008 were retrospectively reviewed. During three years, from 63463 deliveries, hysterectomy was performed to 49 patients (0.77/1000) due to obstetrical hemorrhage. Indications for EPH were uterine atony (49.6%), uterine rupture (42.9%) and placenta accreata (8.2%). The mean age of patients was 34.6±5.7 years, and mean gravida was 5.5±2.4. Subtotal hysterectomy was performed to 31 (63.3%) patients and total hysterectomy to 18 (36.7%) of them. Bilateral hypogastric artery ligation was performed to 8 (16.3%) and unilateral ooferectomy to 7 (14.3%). Two of our patients died secondary to uncontrolled uterine bleeding.In conclusion, uterine atony and uterine rupture were the most frequent causes of EPH. Emergent and appropriate management of these patients is the most important life saving procedure

Gebe ratlara farklı dozlarda uygulanan malathionun fetüs böbrek dokusu üzerine teratojenik etkileri

Bu çalışmanın amacı gebe ratlara düşük dozlarda subakut uygulanan Malathion (ML)’un fetüs böbrek dokusu üzerine teratojenik etkisini araştırmaktır. Toplam 28 Sprague-Dawley gebe rat randomize olarak her grupta 7 adet gebe rat olacak şekilde 4 gruba ayrıldı. ML’un dozuna bağlı olarak, gruplar; kontrol, ML 2.5 (2.5 mg/kg/gün dozunda oral yoldan (p.o) ML uygulandı), ML 5 (5 mg/kg/gün, p.o) ve ML 10 (10 mg/kg/gün, p.o) olmak üzere 4 gruba ayrıldı. ML uygulamsı erkekler ve dişilerin aynı ortama konulmasından itibaren başladı (çiftleşmeden itibaren). Günlük ML uygulamasına doğuma kadar devam edildi. ML’un, dozuna paralel bir şekilde gebe ratlarda böbrek dokusu ve serum enzimleri (asetilkolinesteraz (AChE), lipaz, amilaz) üzerine toksik etkiler oluşturduğu, ayrıca yavru rat böbreklerinde ise ML’un dozuna bağlı olmayarak, tüm dozlarda teratojenik etkiye neden olduğu belirlendi. Histopatolojik veriler biyokimyasal verileri doğruladı. ML’un düşük dozlarının bile hem anne hem de yavru böbrekleri üzerine toksik ve teratojenik böbrek hasarına neden olduğu sonucuna varıldı.The aim of this study was to investigate the teratogenic effects of Malathion (ML) induced by different doses on fetal kidney tissues in pregnant rats. A total of 28 Sprague-Dawley pregnant rats were randomly divided into 4 groups of 7 rats each. Depending on ML dose, four groups were formed, including (I) control, (II) ML 2.5 (ML 2.5 mg/kg/day, orally), (III) ML 5 (5 mg/kg/day, orally), and (IV) ML 10 (10 mg/kg/day, orally). ML application started when the male and female were put together (when mating started). Daily ML application was continued until birth. It was determined that in parallel with dose of ML, ML resulted in toxic effects on serum enzymes (acetyl-cholinesterase (AChE), amylase and lipase) and kidney tissues of pregnant rats, and also -regardless of ML dose in fetal kidneys- it led to teratogenic effects in all the doses. Biochemical data wasconfirmed by histopathologic data. We concluded that ML leads to kidney damage in both pregnant and fetal rats as a result of its teratogenic and toxic effects