Placenta accreta spectrum surgery with the Joel Cohen incision for abdominal access: a single-center experience

Objectives: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety. Material and methods: The data on women having a hysterectomy due to PAS between 2013–2021 was collected retrospectively. Operation length, baby’s pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013–2016) or late (2017–2021) years. Results: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27–39). The mean operation length was 150 minutes (75–420), and the anesthesia–to–delivery interval was 32 minutes (5–95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups. Conclusions: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery

Postnatal Cardiovascular Adaptation

Fetus depends on placental circulation in utero. A successful transition from intrauterin to extrauterine life depends on succesful physiological changes during labor. During delivery, fetus transfers from a liquid environment where oxygen comes via umbilical vein to air environement where oxygenation is supported via air breathing. Endocrinological changes are important for fetus to adapt to extrauterine life. In addition to these, cord clemping plays a crucial role in postnatal adaptation. Establishment of neonatal postnatal life and succesful overcome, the fetal cardiovascular transition period are important to stay on. [Archives Medical Review Journal 2016; 25(2.000): 181-190

Non Invasive Surfactant Application

Surfactant replacement therapy has been the mainstay of treatment for preterm infants with respiratory distress syndrome for more than twenty years. In recent years, the growing interest in noninvasive ventilation has led to novel approaches of administration. Non-invasive techniques of respiratory support were developed in order to reduce the adverse effects associated with ventilation via an endotracheal tube. Noninvasive surfactant administration technique during spontaneous breathing along with nasal continous positive airway pressure support successfully reduces the need for further respiratory support and bronchopulmonary dysplasia rate in very low birth weight infants. Here we reviewed the new approches ton surfactant administration. [Archives Medical Review Journal 2013; 22(4.000): 634-644

Respiratory Distress Syndrome and its Complications

Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing efforts. Respiratory distress syndrome or complications caused by respiratory distress syndrome are the most important causes of mortality and morbidity in premature infants. This article briefly reviews respiratory distress syndrome and its complications. [Archives Medical Review Journal 2013; 22(4.000): 615-630

Evaluation of Neonates with Ventriculitis

Backgroud: Neonatal meningitis and ventriculitis still remain a problem with high mortality in spite of systemic and intraventricular antibiotics. Ventriculitis due to repeated taps is a serious problem of posthemorragic hydrocephalus in preterm infants. Methods: In this study, we evaluated 16 infants with ventriculitis followed at Cukurova University Faculty of Medicine Neonatal Intensive Care Unit between January 1999-December 2004. Results: Mean gestational week was 33± 5 (25-40) weeks and mean birth weight was 2096 ± 912 (980-3500) grams. Venticulitis was diagnosed at 38 ± 22 days. Eleven of the infants had intraventricular hemorrhage and 15 had hydrocephalus, 5 of whom had congenital hydrocephalus. Drainage of CSF was performed by taps in 13 infants. Gram negative microorganisms (Klebsiella pneumonia, Pseudomonas aeruginosa) were predominating in cultures. Both intravenous and intraventricular antibiotic treatment was performed according to the cerebrospinal fluid cultures. Vancomycine and amicasine as intraventricular therapy were performed for 28 ±17 days. Cerebrospinal fluid protein levels increased significantly at 8 infant during intraventricular therapy. Mean cerebrospinal fluid protein at the begining of intraventricular treatment was 624.1± 429.1 (109-1330) mg/dl while on 14th day of treatment it was 993.7± 582.2 (89-1750) mg/dl. Seven of the infants were ventriculoperitoneal shunted 6 of them were reinfected. Seven of the infants were died during treatment, 1 infant with ventriculoperitoneal shunt was treated and 8 infants were discharged during treatment because of parents’ refusal of therapy. Conclusion: Despite the new treatment regimens, the ventriculitis still remains a problem because of nonstandardized practice in neonatal care. [Cukurova Med J 2013; 38(4.000): 553-558

Changes on preterm morbidities with antenatal magnesium

WOS: 000480626400027Purpose: The effect of magnesium sulphate (MgSO4) to mothers with imminent premature birth at <34 weeks on neonatal morbidities like intraventricular hemorrhage, feeding intolerance, retinopathy or bronchopulmoner dysplasia is not clear. We evaluated the effect of antenatal magnesium sulfate exposure on premature early and late morbidities and mortality retrospectively. Materials and Methods: 108 infants <= 32 gestational age having antenatal magnesium were grouped as Mg (+) and 172 infants <= 32 gestational age not having antenatal magnesium were grouped as Mg (-). Results: Respiratory Distress Syndrome, intraventricular hemorrhage, severe intraventricular hemorrhage (grade 3 and 4), retinopathy of prematurity and bronchopulmonary dysplasia were less in Mg (+) group compared to Mg (-) group but it is not statistically significant, except Respiratory Distress Syndrome. Conclusion: This retrospective study showed that ante natal exposure to MgSO4 did not have statistically significant beneficial effect on either morbidities or mortality in premature infants

Do all deliveries with elective caesarean section need paediatrician attendance?

WOS: 000311678300062PubMed ID: 22708525Aim: To determine whether paediatrician attendance to deliveries with elective caesarean section (CS) is really needed for term and also for preterm babies with 35-37 weeks gestational age. Methods: Singleton newborns >= 35 gestational weeks without any identified risk factor were evaluated for resuscitation steps prospectively after CS under regional and general anaesthesia. Results: 545 infants were included in the study. 150 (27.5%) of infants needed only supplemental oxygen and 23 (4.2%) neonates needed bag and mask ventilation. None of the babies needed cardiopulmonary resuscitation (CPR) (chest compression) or endotracheal tube insertion/epinephrine administration. More infants required supplemental oxygen and bag-mask ventilation in general anaesthesia delivery group compared to spinal/epidural anaesthesia group (35.5% vs. 24.4%, p = 0.29 for oxygen and 9.2 % vs. 2.3%, p = 38 week (p = 0.170 for supplementary oxygen, p = 0.442 for bag-mask ventilation). Conclusion: There is not increased risk for chest compression and entubation for infants >= 35 gestation weeks without antenatally identified risk factors born with elective CS either under regional or general anesthesia and only 4.2% of the babies needed bag-mask ventilation, so a health care personel who knows basic NRP may be sufficient in the clinics where it is easy to achieve an advanced skilled health care personel when needed

Glucose-6-phosphate dehydrogenase activity, structure, molecular characteristics and role in neonatal hyperbilirubinemia in cord blood in Cukurova region

WOS: 000294093600002PubMed ID: 21853648Ozlu F, Satar M, Menziletoglu-Yildiz S, Unlukurt i, Aksoy K. Glucose-6-phosphate dehydrogenase activity, structure, molecular characteristics and role in neonatal hyperbilirubinemia in cord blood in Cukurova region. Turk J Pediatr 2011; 53: 130-136. The most common causes of neonatal indirect hyperbilirubinemia are blood incompatibility and erythrocyte enzyme defects. Glucose-6-phosphate dehydrogenase (G6PD) is a guarantee of erythrocyte stability and capability of existence of red cells. We present here the results of a study on the effect of enzyme kinetics and different mutations on neonatal hyperbilirubinemia in the Cukurova region. Two hundred healthy term male neonates born in Cukurova University Balcali Hospital, Adana Maternity Hospital and Cukurova Maternal and Children's Hospital between 1 November 2004 and 30 November 2007 were consecutively studied. Nanogen (R) DNA microarray was used to determine Gd Union, Gd San, Gd Mediterranean, and Gd San Antonio mutations. Quantitative G6PD enzyme assays were performed. Glucose-6-phosphate dehydrogenase deficiency was detected in six out of 200 male neonates (3%). The other 194 neonates had normal G6PD activity, with a mean of 8.3 +/- 2.1 IU/g hemoglobin (Hb) (5.2-12.7 IU/g Hb). Clinical follow-up, enzyme kinetics and genetic studies were performed in the G6PD-deficient neonates. Differences were observed in clinical outcomes, rates of bilirubin decline and maximum total bilirubin levels in the neonates having the same mutation. These differences might be caused by the effects of kinetic variant on the hyperbilirubinemia without the direct effect of the mutation. In future studies, mutation analyses of further G6PD-deficient cases may address the genotype differences and their clinical effects in G6PD-deficient patients.Cukurova University Scientific Research Project UnitCukurova UniversityThis study was supported by Cukurova University Scientific Research Project Unit

Megacystis microcolon intestinal hypoperistalsis syndrome in a newborn

WOS: 000458742100040

The activity and kinetics of pyruvate kinase in hypoxic newborns (vol 22, pg 567, 2005)

WOS: 000247875700011