MYOMECTOMY DURING CESAREAN SECTION AND ADHESION FORMATION AS A LONG-TERM POSTOPERATIVE COMPLICATION

Objectives: We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S). Methods: This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n: 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV; control group (n: 19) who did not go through myomectomy. Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions. Results: The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p= 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV). Conclusion: Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.Cel pracy: Celem naszego badania była ocena częstości występowania i charakter zrostów pooperacyjnych po zabiegu miolizy lub miomektomii w trakcie cięcia cesarskiego. Metoda: Do badania włączono cztery grupy pacjentek, które miały wykonane cięcie cesarskie (C/S) oraz miolizę powierzchniowego, mniejszego niż 2cm mięśniaka metodą elektrokauteryzacji – grupa I (n:21), usunięcie mięśniaka uszypułowanego – grupa II (n:18), miomektomię mięśniaka wewnątrzściennego/podsurowicówkowego, mniejszego niż 5 cm – grupa III (n:23), nie miały wykonanej miomektomii – grupa IV kontrolna (n:19). Ponowne cięcie cesarskie wykonano u badanych pacjentek w ciągu 1-5 lat. Wszystkie pacjentki oceniono pod kątem małych do średnich zrostów pomiędzy siecią większą i macicą, małych do średnich zrostów w okolicy przydatków, małych do średnich zrostów w okolicy nacięcia powłok i trudności operowania z powodu ciężkich zrostów. Wyniki: Częstość występowania zrostów pomiędzy otrzewną i macicą (p=0,278), małych do średnich zrostów w okolicy przydatków (p=0,831), małych do średnich zrostów w okolicy nacięcia powłok (p=0,804) była podobna pomiędzy badanymi grupami (I,II i III) a grupą kontrolną (IV). Wnioski: Miomektomia podczas cięcia cesarskiego jest bezpieczną procedurą i może być przeprowadzana bez istotnych, pooperacyjnych zrostów

Low-Dose Misoprostol For Second Trimester Pregnancy Termination In Women With A Prior Caesarean Delivery

Introduction: Termination of Pregnancy (ToP) is an obstetric procedure that can be performed by surgical or medical techniques during the first or second trimester of pregnancy. Medical ToP is recommended in the second trimester owing to its low rate of maternal morbidity. Low-dose misoprostol is an effective option in such cases. Aim: To compare the safety and efficacy of two different vaginal misoprostol regimens for ToP in the second trimester in women with previous Caesarean Deliveries (CDs), against controls. Materials and Methods: This retrospective study was conducted at a university hospital, between January 2005 to December 2014. The study cohort was divided into two groups: history of CD (Group I, n=85) and control (Group II, n=434). The method used for ToP was chosen with respect to history of CD. Four doses of 50 mu g misoprostol and 4 doses of 200 mu g misoprostol were applied vaginally each day, until regular uterine contractions were observed, to Groups I and II, respectively. Indication of ToP, gestational the ToP (weeks), duration from induction to abortion (hours), total misoprostol dose (pg), foetal weight (gram), post-abortion hospitalisation time (day), and any complications were recorded. The Chi-square or Fisher's-Exact test was used for qualitative data, and the Student's t-test or Mann-Whitney U-test was used for quantitative data. The p<0.05 was considered significant. Tests were performed using the SPSS statistical package for Windows, version 17 (SPSS, Chicago, Illinois, USA). Results: The success rate of termination was 91.8% (78/85) in Group I and 99.1% (430/434) in Group II (p<0.001). The median induction to abortion interval was 54.08 +/- 42.85 hours for Group I and 47.19 +/- 31.39 hours in Group II (p=0.371). One case of uterine rupture was recorded in Group I (p=0.164). The incidence of requiring transfusion for haemorrhages was higher in Group I than in Group II (5.9% vs. 1.6%, respectively, p=0.032). Conclusion: Low-dose vaginal misoprostol appears to be a safe and effective procedure for second trimester ToP in women with a history of CD.Wo

The Perspective Of Pregnant Women On Pandemic Influenza Vaccine Before Pandemics

Objective: After pregnant women were detected to have serious complications when infected with pandemic A (H1N1) virus in 2009, priority of their vaccination was accepted. Our study was planned to estimate the perspective of pregnant women on pandemic influenza vaccine in Hacettepe University Medical Faculty, Obstetrics and Gynecology Department, Obstetrics Unit in October 2009, just before pandemic influenza vaccine is implemented, to evaluate the perception of the vaccine. Material and Methods: Our study was conducted by applying questionnaire to 86 pregnant women admitting to Hacettepe University Medical Faculty Obstetrics and Gynecology Department, Obstetrics Unit. Age, trimester of pregnancy, gravida of pregnancy, seasonal influenza vaccine application status and whether the patient found pandemic influenza vaccine necessary were noted after the questionnaire was completed. Results: Pregnant women who filled our questionnaire were between 18 and 39 years of age, 13 of them were in the first trimester, 31 were in the second trimester and 42 were in the third trimester. Out of 86 pregnant women, 66 expressed that they did not find it necessary to have pandemic influenza vaccine. In our study it was found that 23.3% of pregnant women found pandemic influenza vaccine necessary, and although the study population was small, finding the vaccine necessary was not affected from mother's age, trimester of pregnancy or gravida of pregnancy. The only factor demonstrated to affect the acceptance of pandemic influenza vaccine was having been shot for seasonal influenza vaccine. Conclusion: It is very important to inform this group that they have a major risk if they have the disease and to remind and advise them to be vaccinated in routine controls.WoSScopu

Outpatient Versus Inpatient Follow-Up For Intrahepatic Cholestasis Of Pregnancy

Aim of the study The optimum management method and the best time of delivery still remain unclear for intrahepatic cholestasis of pregnancy (ICP). We aimed to ascertain whether there is a benefit of close monitoring at hospital. Material and methods We evaluated the maternal and neonatal records of ICPs over a recent five-year period. A total of 35 women and their 38 newborns were analyzed. The impact of hospitalization was evaluated in terms of delivery type, labor induction, preterm delivery, Apgar scores, and neonatal intensive care unit admission. Results The median maternal age was 30.7 years, and median gestation at diagnosis was 34 weeks. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal in three patients; 32 (91.4%) women had at least one increased hepatic enzyme level. The median AST level was elevated to 66 U/l (almost two-fold), and the median ALT level was 91 U/l (about three-fold). The median gestation time at delivery was 37 weeks. The preterm delivery rate was 45.7%. The median birth weight was 3020 g, and median Apgar scores were 9 and 10 at the 1st and 5th minutes, respectively. Neonatal intensive care unit admission occurred in 21 neonates (55.3%). During pregnancy follow-up, 22 women (62.8%) were hospitalized during their pregnancies. There was no statistically significant difference between groups in terms of obstetric and perinatal outcomes (p > 0.05). However, the hospitalized pregnant women were found to have higher levels of serum transaminases (p = 0.15 and p = 0.01 for ALT and AST, respectively). Conclusions Hospitalization may be helpful in some ICP cases, especially when enzyme levels are elevated.PubMedWoSScopu

Maternal Adipose Tissue, Antenatal Steroids, And Respiratory Distress Syndrome: Complex Relations

The incidences of maternal obesity and obesity-related maternal, fetal and neonatal complications have increased considerably. Obese people may have lower, normal or increased fat mass independent from their body mass index. We aimed to investigate the relationships between antenatal steroid therapy and maternal body fat ratio for the risk of Respiratory distress syndrome (RDS) in preterm infants. Pregnant women and their newborn infants between 24-34 weeks of gestation, who received a full course of antenatal steroid therapy were included in the study. Mother's body weight, body mass index (BMI), and body compositions (muscle, fat, water) were calculated using the bioelectrical impedance method 5 days after giving birth. Neonatal characteristics and respiratory outcomes were noted. A total of 42 mothers and their single premature infants were included in the study. Nineteen (45.2%) infants developed RDS (Group 1) while 23 (54.8%) infants did not develop RDS (Group 2). The mean body fat mass (kg), fat ratio (%), truncal fat mass (kg), and truncal fat ratio (%) were statistically significantly higher in Group 1 than in Group 2. The incidence of RDS was significantly higher in the group of mothers with a body fat ratio >30.0% (n=15/24, 62.5%) when compared with the group of mothers with a body fat ratio <= 30% (n=4/18, 22.2%) (p=0.013). Maternal adipose tissue plays an important role and should be taken into consideration especially in obese women, before giving antenatal steroids to achieve positive effects of the therapy in preterm infants.WoSScopu

Pregnancy Outcome in Women with Familial Mediterranean Fever: A Retrospective Analysis of 50 Cases with A 10-Year Experience

Objectives: Since little is known about perinatal outcome of patients with familial Mediterranean fever (FMF), we report our clinical experience about pregnant women with FMF in this study. Patients and methods: Fifty pregnant women (mean age 29.5 years; range 19 to 39 years) with FMF were enrolled between January 2002 and December 2012. Patient data were collected from computerized database. Clinical characteristics including demographics, pregnancy outcome, maternal and fetal complications during pregnancy or delivery, hypercoagulation disorders and colchicine use were recorded. Labor patterns and perinatal outcomes were assessed. Results: The mean gestational week at delivery was 36.3. Maternal complications were encountered in two patients including hemodialysis associated sepsis and cerebrovascular accident. We did not encounter FMF attacks in the course of pregnancies. A total of 42 patients (84%) were on drug therapy of colchicine. Two congenital anomalies were encountered, one was tanatrophic dysplasia (on colchicine therapy) and the other was an open type neural tube defect (not on colchicine therapy). Patients were also searched for thrombophilias and 15 (30%) had positive test result. The course of the pregnancy was free of venous complications with low molecular weight heparin prophylaxis. Preterm delivery, low birth weight and congenital anomalies were not significantly associated with colchicine therapy. Conclusion: A favorable pregnancy and perinatal outcome may be expected in patients with FMF treated with colchicine. However, close follow-up with prenatal test and laboratory investigations for maternal and fetal well-being including hypercoagulation disorders are thought to be essential.Wo

Etiology And Outcome Of Hydrops Fetalis: Report Of 62 Cases

Aim: We aimed to define the etiologic and prognostic factors in live-born infants with hydrops fetalis (HF) in our tertiary neonatal intensive care unit over a 10-year period. Methods: Medical records of newborn infants with HF during 2002-2011 were reviewed retrospectively. Demographic data, prenatal interventions, clinical and laboratory findings, outcomes, and the results of postmortem examinations were analyzed. Results: During the study period, 62 newborn infants with HF were identified from 16,200 live-born deliveries and the incidence of HF was 3.8/1000 live births in our hospital. Twenty-eight infants (45.2%) had immune HF, whereas 34 (54.8%) had nonimmune HF. An etiologic factor could be identified in 24 (70.5%) infants with nonimmune HF. Lymphatic dysplasias comprised the majority (23.5%) of the infants with nonimmune HF. Mortality rate was 50%. The presence of two or more serous cavity effusions and gestational age were independently associated with the risk of mortality. Conclusion: Despite the improvements in neonatal care, mortality rate in infants with HF is still high. Gestational age and the extent of serous cavity determine the risk of mortality. Timely and advanced prenatal or postnatal new therapeutic strategies may alter this fatal outcome in appropriate patients. Copyright (C) 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.WoSScopu

Pregnancy-Associated Breast Cancer: Clinicopathological Characteristics of 20 Cases with A Focus On Identifiable Causes of Diagnostic Delay

Background: The primary objective of this study was to evaluate the clinicopathological characteristics of patients with pregnancy-associated breast cancer (PABC), with a special focus on diagnostic delays and the identifiable causes of diagnostic delays. Patients and methods: Clinicopathological data of patients treated for PABC between 2003 and 2012 at Hacettepe University Hospital was retrospectively reviewed. Results: 20 patients with PABC were included. The pathological examination revealed predominance of invasive ductal carcinoma (80%), grade III tumors (65%) and advanced-stage (III-IV) disease (75%). In 8 patients (40%), there was a diagnostic delay between occurrence of the presenting symptoms and the initiation of breast mass workup. For these 8 patients, the main identifiable causes of diagnostic delay were the attribution of disease-related symptoms to pregnancy or lactation in 5 (63%) and negligence of symptoms in 2 (25%). Conclusions: PABC mostly presents with advanced-stage disease, and there can be a substantial diagnostic delay before these patients receive treatment. Preconceptional, gestational and postpartum examination of women of reproductive age should include a thorough breast examination and should provide adequate information regarding the physiological changes in breast tissue and the possible pathological symptoms.WoSScopu

Myomectomy During Cesarean Section And Adhesion Formation As A Long-Term Postoperative Complication

Objectives: We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S). Methods: This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n; 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV; control group (n; 19) who did not go through myomectomy. Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions. Results: The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p= 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV). Conclusion: Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.WoSScopu