Second trimester abortion as a cause of maternal death: a case report

Each year, an estimated 529 000 maternal deaths occur worldwide. In literature, it is known that  maternal mortality can occur during pregnancy, peripartum and also in postpartum period. Although very rare, maternal deaths may occur after spontaneous abortion. In present case, 37 year old G5P4  (Caesarean Section) women was admitted to Adnan Menderes University, Obstetrics and Gynecology  clinic with diagnosis of missed abortion at 18 weeks' gestation. She had been hospitalized in the public maternity hospital for five days due to abortus incipience and prolapse of amnion membranes but had no  contractions. Fetal heart beats ceased at the second day of hospitalization. Medically induced abortion  was recommended but not accepted by the patient. At the fifth day of hospitalization, she was referred to our clinic due to deterioration of general health condition, low blood pressure and tachycardia. In  emergency department, it was determined that she was not oriented, had confusion, had blood pressure  of 49/25 mmHg and tachycardia. In ultrasonographic examination, 18 week in utero ex fetus was  determined and there was free fluid in abdominopelvic cavity. The free fluid was suspected to be amniotic fluid due to rupture of uterus. Laparotomy was performed, no uterine rupture, hematoma or atony was observed. However during laparotomy, a very bad smelling odor, might be due to septicemia, was felt in the operation room. Cardiac arrest occurred during that operation. In autopsy report, it was concluded that maternal death was because of remaining of inutero ex fetus for a long time. In conclusion, although very rare, maternal deaths after spontaneous abortion may occur. Because spontaneous abortion is a common outcome of pregnancy, continued careful, strict monitoring and immediate treatment of  especially second trimester spontaneous abortion is recommended to prevent related, disappointing, unexpected maternal deaths.Key words: Second trimester, spontaneous abortion, maternal death

Comparison of the effects of intranasal and transdermal estradiol plus dydrogestorone on lipids, lipoprotein(a) and apolipoproteins in postmenopausal women

Amaç: Bu araştırmanın amacı, postmenopozal kadınlarda, intranazal ve transdermal 17 östradiol ile didrogesteronun kombine kesintisiz hormon replasman tedavisinin, serumlipid, lipoprotein(a) ve apolipoprotein düzeyleri üzerindeki etkilerini karşılaştırmaktır. Gereç ve Yöntem: Bu prospektif araştırmaya yaşları 43-54 arasında değişen, sağlıklı 50 postmenopozal kadın dahil edildi. Olgular, 12 hafta süre ile 300 μg/g ün intranazal 17 β- östradiol (n=25) veya 50 μg/gün transdermal östradiol (n=25) almak üzere iki gruba randomize edildi. Bütün olgulara 10 mg/gün oral didrogesteron kesintisiz verildi. Araştırmanın başında ve sonunda, total kolesterol, trigliserid, HDL, LDL, VLDL, lipoprotein(a), Apo A-I ve Apo B düzeyleri, grup içi ve gruplar arasında farkın yüzdeleri karşılaştırıldı. İstatistiksel analiz içinMann-WhitneyUveWilcoxontesti kullanıldı. P<0,05anlamlı kabul edildi. Bulgular: Araştırmayı, intranazal grubunda 16, transdermal gurubunda 18 olmak üzere 34 olgu tamamladı. İntranazal östradiol grubunda, tedavi başlangıcına kıyasla, tedavi sonunda sadece apolipoprotein B düzeyinde anlamlı bir azalma izlenirken (2,0±0,4'den 0,9±0,1'ye, p=0,028), total kolesterol, trigliserid, HDL, LDL,VLDL, lipoprotein(a) ve Apo A-I düzeylerinde anlamlı değişiklik izlenmedi. Transdermal östradiol gurubunda hiçbir değişkende anlamlı değişiklik gözlenmedi. Her iki grup arasında, tüm değişkenler açısından anlamlı farklılık yoktu. Sonuç: İntranazal ve transdermal östradiolün, didrogesteron kombinasyonuyla yapılan kesintisiz hormon replasman tedavisinin, total kolesterol, trigliserid, HDL, LDL, VLDL, lipoprotein(a) ve Apo A-I düzeylerine etkileri benzerdir.Objective: To compare the effects of continuous hormon replacement therapy in the form of intranasal and transdermal 17β-estradiol combined with dydrogesterone on serum lipids, lipoprotein(a) and apolipoproteins among postmenopausal women. Materials and methods: In this prospective study, 50 healthy postmenopausal women aged 43-54 years were randomly assigned to receive either 300 μg/day intranasal 17β- estradiol (n=25) or 50 μg/day transdermal 17β- estradiol (n=25) for 12 weeks. All women also received 10 mg/day oral dydrogesterone continuously. At the end of the study, changes in serum total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a), Apo A-I and Apo B levels within and percent changes between the groups were compared. Mann-Whitney U and Wilcoxon tests were used as indicated. P-values below 0.05 were considered significant. Results: Thirty-four women completed this study (intranasal group, n=16; transdermal group, n=18). In intranasal estradiol group, only apolipoprotein B levels were decreased significantly after 12 weeks of treatment (2.0±0.4 to 0.9±0.1, p=0.028) whereas no changes in the levels of total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a) and Apo A-I were observed. Also, in transdermal estradiol group, no significant changes were seen in all variables. No significant differences with regard to variables were noted between the groups at the end of the study. Conclusions: The effects of intranasal and transdermal estradiol plus dydrogestorone asa continouos hormone replacement therapy on the serum total cholesterol, triglyceride, HDL, LDL, VLDL, lipoprotein(a) and Apo A-I levels are similar in postmenopausal women

Fetal and placental anthropometry and blood glucose levels inwomen at low risk of gestational diabetes mellitus

Amaç: Gestasyonel diyabetes mellitus (GDM) taraması pozitif ancak tüm oral glukoz tolerans test (OGTT) degerleri normal ve sadece birOGTTdegeri anormal olan gebelerin, fetal ve plasental antropometrik degerlerinin kıyaslanması Gereç ve Yöntem: GDM riski olmayan, 38.-40.gebelik haftaları arasında dogum yapmıs ve 24.-28.gebelik haftaları arasında 50 gram 1 saatlik glukoz tarama testi (GTT) uygulanan 317 olgunun dosyaları, retrospektif olarak incelendi. Tarama sonucu negatif olanlar ve taramasının pozitif olması nedeniyle (GTT-1.saat kan glukoz düzeyi 140 mg/dl) OGTT uygulanan olgular arastırmaya alındı. OGTT sonuçlarına göre, iki çalısma ve iki kontrol grubu olusturuldu: Group 1, tarama pozitif ancak OGTT’de tüm degerleri normal (OGTT - TDN, =24) olguları kapsadı. Grup 2, tarama pozitif ve OGTT'de sadece bir degeri yüksek (OGTT-BDY, =16) olgulardan olusturuldu. Kontrol grupları ise, tarama negatif (GTT-Normal, n=263) ve GDM ( =14) olgularından olusturuldu. Sadece GDM olguları diyet tedavisine alındı. Tüm olguların doguma kadar normoglisemik kalmaları saglandı. Gebelik öncesi agırlık ve vücut kitle indeksi (VKI), gebe son agırlıgı, gebelikte kilo alımı, fetal agırlık, ponderal indeks, plasental agırlık ve fötoplasental oranları kıyaslandı. Fetal ve plasental agırlıgın ve fötoplasental oranın, maternal antropometrik ölçümler ve kan glukoz degerleriyle iliskisi arastırıldı. Bulgular: Tüm degiskenler açısından, gruplar arasında istatistiksel bir fark yoktu. Fetal agırlıkla hiçbir degisken arasında iliski bulunmadı. Plasental agırlıkla, OGTT-2.saat dısında, tüm OGTT degerleriyle pozitif bir korelasyon saptandı. Plasental agırlıkla, gebelik öncesi VKI arasında pozitif, gebelikte kilo alımı arasında zayıf negatif bir iliski görüldü. Fötoplasental oranla, gebelikte kilo alımı arasında zayıf pozitif, GTT-0.saat degeri arasında zayıf negatif bir iliski saptandı. Sonuç: Sadece tarama pozitif oldugu içinGDMriski görece düsük özel bir populasyonda, “tanı testi negatif veya glukoz intoleransı” olan gebelerin fetal ve plasental antropometrik degerleri olumsuz etkilenmemektedir. Aynı sonucun, sadece diyet tedavisi alan GDM olgularında da gözlenmesi, riski görece düsük gebelerde çalısılmıs olmasından ve diyet tedavisinin yeterli olmasından kaynaklandıgını düsündürmektedir.Ancak GDM riski görece yüksek gebelerde dikkatli olunmalıdır.Aim: To compare fetoplacental anthropometric outcomes of gestational diabetes mellitus (GDM) in screening negative and positive women Material and Methods: By retrospective surveillance of 317 women who delivered in their 38th-40thweek ofgestation and who had undergone glucose challenge test (GCT) in their 24th-28th of gestation, the screen negative and positive women (GCT-1st hour ≥140 mg/dl) were assigned into four groups: The screen positive women all of whose OGTT values were normal (n=24), screen positive women who had only one abnormal value (n=16),women negative for GDM (n=263) and women with GDM (n=14). Only GDM group was given a diet therapy. We compared fetal and placental weight (FW, PW), ponderal index and fetoplacental ratio (FPR). We also investigated the correlations between all variables. Results: There was no significant difference in all variables between the groups. There was no correlation between FW and all other variables. There was a positive correlation between PW and BMI and all OGTT values except OGTT 2 hour value. The correlation between PW and weight gain and FPR and GTT-0.hour value was negative, whereas a positive correlation between FPR and weight gain was determined. Conclusion: In a special population with a low risk of GDM, “having a negative diagnostic test or impaired glucose tolerance” do not adversely affect fetoplacental anthropometric outcomes. The same results also exist for the GDM cases. It might be due to the fact that the study was conducted in a low risk group and the diet therapy was appropriate. However, care should be taken in pregnant women at high risk

Preeklamptik hastalarda eritrosit indeksleri

Objective: The purpose of study was to investigate erythrocyte indices in patients with preeclampsia. Materials and Methods: The study population consisted of 102 patients with preeclampsia (49 mild, 53 severe preeclampsia) and 98 control pregnant patients. For the entire study population, red blood cell indices, including baseline mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and red blood cell (RBC) were measured by using an automatic blood counter. Results: In the preeclampsia group, the median RDW was 15% (13.8-16.57), whereas in the control group it was 13.9% (13-15.6) (p<0.01). On the other hand, the mean MCV value was 80.42±7.86 (fL) in preeclampsia group and 83.88±2.31 (fL) in control group (p=0.003). Besides, the mean MCHC value was 33.66±1.71 (g/dL) in preeclampsia group and 33.09±1.48 (g/dL) in control group (p=0.012). However MCH and RBC values were not statistically different between the groups. (p>0.05) Moreover, subgroup analysis revealed that RDW levels were significantly increased in preeclampsia subjects than in mild preeclampsia patients (15.4% (13.9-17.45) vs 14.3% (13.7-15.7), p=0.031), MCV levels were decreased (78.81±7.91 (fL) vs 82.16± 7.43 (fL), p=0.03), RBC values were increased (4.16 (3.79-4.85)x(1012/L) vs 3.82 (3.45- 4.34)x(1012/L), (p=0.006)) in patients with severe preeclampsia when compared to the patients with mild preeclampsia. In the receiver operator characteristic (ROC) analysis of subjects with and without preeclampsia, RDW and MCV showed high predictive values (p<0.01). Besides, in ROC analysis of preeclampsia patients with different severities, RDW and RBC showed the ideal predictive values (p=0.006, p=0.031, respectively). Conclusion: Our study results revealed that among the red blood cell indices, only increased RDW values were associated with both the presence and the severity of preeclampsia.Amaç: Bu çalışmanın amacı preeklampsi tanısı konmuş hastalarda eritrosit indekslerini araştırmaktır. Gereç ve Yöntemler: Bu çalışmaya 102 preeklampsi (49 hafif ve 53 şiddetli preeklampsi olmak üzere) ve 98 kontrol hastası dahil edilmiştir. Tüm çalışma grubunda eritrosit indeksleri olan ortalama korpuskular hacim (MCV), ortalama korpuskular hemoglobin (MCH), ortalama korpuskular hemoglobin konsantrasyonu (MCHC), eritrosit sayımı ve eritrosit dağılım genişliği değerleri otomatik kan sayım cihazı ile ölçüldü.Bulgular: Preeklampsi grubunda, medyan RDW %15 (13,8-16,57), ortalama MCV değeri 80,42±7,86 (fL), ortalama MCHC değeri 33,66±1,71 (g/dL) ve kontrol grubunda medyan RDW %13,9 (13-15,6), ortalama MCV değeri 83,88±2,31 (fL), ortalama MCHC değeri 33,09±1,48 (g/dL) idi (sırasıyla p0,05). Preeklampsi grubunda subgroup analizi yapıldığında, hafif preeklampsi grubuna göre, ciddi preeklampsi grubunda artmış RDW değerleri (% 15,4 (13,9-17,45) vs %14,3 (13,7-15,7), p=0,031), azalmış MCV değerleri (78,81±7,91 (fL) vs 82,16±7,43 (fL), p=0,03), artmış RBC değerleri (4,16 (3,79-4,85)x(1012/L) vs 3,82 (3,45-4,34)x(1012/L), (p=0,006) saptandı. Preeklampsi ve kontrol grubu hastalarının Receiver operatör karakteristik (ROK) analizi sonuçlarına göre eritrosit sayımı ve eritrosit dağılım genişliğinin hastalığı tespit etmede yüksek prediktif değerleri saptandı (p<0,01). Ayrıca ROK analiz sonuçlarına göre, hafif ve ciddi preeklampsili hastalarda RDW ve RBC değerleri hastalığın ciddiyetini belirlemede ideal prediktif değerlere sahip idi (p=0,006, p=0,031). Sonuç: Eritrosit indeksleri arasında artmış RDW değerleri hem preeklampsi tanısı, hem de hastalığın ciddiyeti ile ilişkilidir

Blood transfusion in obstetricks and gynecology

Amaç: Ilimizde bulunan üniversite ve dogum hastanelerinin verilerini kullanarak kadın hastalıkları ve dogum servislerinde yapılan kan transfüzyonları hakkında bilgi saglamak. Gereç ve Yöntem: Ilimiz hastanelerinin Kadın Hastalıkları ve Dogum servislerinde Ocak 2005 ileAgustos 2006 tarihleri arasındaki 20 aylık transfüzyon kayıtları geriye dönük tarandı. Bu sürede dogum servisleri ile erken gebelik ve jinekoloji servisleri degerlendirildi. Bu servislerde kaç hastaya kan ürünü verildigi ve miktarı belirlendi, dogum sayıları dogum sekline bakılmaksızın kaydedildi. Erken gebelik müdahaleleri ve jinekolojik hasta olarak bu servislere yatırılıp ameliyat edilen veya invaziv girisimde bulunulan hasta sayıları da saptandı. Sadece tıbbi tedavi gören hastalar bu çalısmanın dısında tutuldu. Her iki hastanenin transfüzyon hızları, kan ürünü çesidi kullanımı özellikleri, toplam transfüzyon miktarları, yıllık ihtiyaçları, transfüzyon yapılan olgularda hasta basına transfüzyon miktarları belirlendi. Yine her gruptan 100 hasta için ihtiyaç duyulan miktarlar hesaplandı.Bu incelemeler yine tüm olguları kapsayacak sekilde irdelendi. Iki hastane degerlerini karsılastırmak için iki örnek oranının karsılastırılması yapıldı. Bulgular: Bu çalısmada dogum hastaları, erken gebelik veya jinekolojik hastalıklar nedeniyle invaziv girisim yapılmıs 10.149 hasta saptandı. Bunların 954'üne (%9,4) kan ürünü verildi. Hasta basına ortalama 2 ünite transfüzyon yapıldıgı, her 100 hasta için 18,3 ünite kan ürünü gerektigi belirlendi. Hem dogum hastaları hem diger hastalar için üniversite hastanesinde daha az oranda hastaya ancak hasta basına daha çok miktarda kan verilmesi gerektigi saptandı (p<0.05). Sonuç: Kadın hastalıkları ve dogum servislerinde girisim ve müdahale yapılan hastalarda kan ve kan ürünleri transfüzyonu önemli bir oranda gerçeklestirilmektedir. Kan ürünlerinin ayrıstırılması tam kan kullanım oranını azaltacaktır.Purpose: Using data from a university and a maternity hospital in our province, we aimed to report on the practice of blood use. Material and Methods: Data between January 2005 and August 2006 were retrospectively obtained from the archives of the obstetrics and gynecology clinics from two hospitals. The data of obstetrics clinics and early pregnancy and gynecology clinics were evaluated seperately. Patients treated medically were excluded. Transfusion rates, type of blood product rates, total and annual uses, requirements for every 100 patients and amounts of transfusion per patient were calculated. Two-sample ratio-test was used for comparison of the data from two hospitals. Results: There are 10149 patients who had delivered or experienced any invasive procedures, and 954 (9.4%) of them had been transfused. The amount of blood products transfused was at an average of 2 units per patient. The requirement for every 100 patients was 18.3 units of blood products in these two hospitals. More blood was used per patient in the university hospital, although the transfusion rate was lower than the maternity hospital's (p<0.05). Conclusion: Transfusions of blood and use of blood products are quite common in the practice of obstetrics and gynecology clinics. Providing blood products would reduce the use of whole blood

True umbilical cord cyst: a case report

Umbilical cord cysts are important due to their association with fetal chromosomal abnormalities and fetal structural defects and in case of their rapid growth of umbilical cord cysts they are associated with compression of umbilical vessels and fetal distress. In this article we aimed to present a case with two umbilical cord cysts detected by ultrasonography at 31 weeks of gestation and who had delivered a healthy male fetus by cesarean section at 37 weeks of gestation. Histopathological examination of placenta and umbilical cord after birth revealed that cysts were true allantoic cysts. An additional urachal pathology and anomaly was not observed and the newborn was discharged after primary excision. As a result, we think that ultrasound examination of umbilical cord should be an important and routine part of obstetric ultrasonography

Meckel-gruber syndrome, a rare fetal anomaly: a case report

Otozomal resesif geçisli bir hastalık olan Meckel-Gruber Sendromu (MGS), multipl konjenital anomali içeren nadir bir hastalıktır ve letal seyreden bir sendromdur. MGS'nin klasik triadı; bilateral kistik renal displazi, oksipital ensefalosel ve postaksiyal polidaktilidir. Bunlardan üçünden en az ikisinin olması tanıyı koydurur. Bu yazıda intrauterinMGSsaptanan bir olgu sunulmasını amaçladık. Son adet tarihine göre 23 hafta 5 günlük gebelik + multipl fetal anomali nedeni ile gebe poliklinigimize refere edilen olgu obstetrik ultrasonografi ile degerlendirildi. Yasayan 2 saglıklı çocugu olan 26 yasındaki olgunun hikayesinden, daha önce 32. gebelik haftasında ölü dogum öyküsü oldugu, nedeninin bilinmedigi ama polidaktilisi bulundugu ögrenildi. Olgunun yapılan ultrasonunda fetal bilateral multikistik displastik böbrek, her iki elde polidaktili, bilateral ventrikülomegali ve anhidroamniyos saptandı. MGS düsünülen ve anhidramniyosu olan gebeye konsey kararı sonucu ve ailenin istegi ile tıbbi tahliye uygulandı. 750 gram agırlıgında bir erkek bebek ölü olarak dogurtuldu. Genetik incelemesi yapılan fetusun kromozom analizi normal (46, XY) olarak geldi. Otopsi sonucunda bilateral polikistik böbrek, her iki el ve ayaklarda polidaktili ve micrognati mevcuttu. Prenatal bilateral genislemis multikistik böbrek tanısı MGS'yi akla getirmelidir ve santral sinir sistemi malformasyonları ve polidaktili arastırması yapılmalıdır. Bununla birlikte fetal otopsinin tanının dogrulanmasında önemlidir.Meckel-Gruber Syndrome (MGS), an autosomal recessive disease, is a rare and lethal syndrome with congenital polymalformations Classical triad of MGS is bilateral cystic renal dysplasia, occipital encephalocele and postaxial polydactyly. For diagnosis, two out of these three findings required to be present. In this article, we aimed to present a case with intrauterineMGS. Patient with 23 weeks and five days pregnancy (according to her last menstrual period) with multiple anomalies was evaluated by obstetric ultrasonography. The obstetric history of the 26-year-old patient revealed that she had 2 healthy living children and one previous intrauterine ex fetus with polydactyly and an unknown cause at 32 weeks of gestation. Ultrasonographic examination of the case showed fetal bilateral multicystic dysplastic kidney, polydactyly in hands, bilateral ventriculomegaly and anhidroamnios. The case was diagnosed as MGS and underwent medical termination of pregnancy with the consent of family and the council of doctors. An ex male infant weighing 750 grams was delivered. Genetic analysis showed normal chromosome analysis (46, XY). Bilateral polycystic kidneys, and polydactyly of both hands and feet, and microgynathy were found in autopsy. Investigation of central nervous system malformations and polydactyly should be conducted in patients with prenatal detection of bilateral enlarged multicystic kidneys, when MGS is considered as a possible diagnosis. Furthermore verification of the diagnosis with fetal autopsy is important

Circulating s-Endoglin concentrations in non-obese patients with gestational diabetes mellitus

The aim of this study was to compare maternal concentrations of soluble Endodlin (s-Endoglin) in women with gestational diabetes (GDM) and women with normal glucose tolerance (NGT) in pregnancy. Also, the association of insulin resistance markers and s-Endoglin was investigated. Forty patients complicated by GDM and forty gestational age-matched healthy pregnant women with NGT were included in the present study. s-Endoglin level was higher in patients with GDM compared with the control group (p .01). Besides a positive correlation was found between s-Endoglin and fasting glucose (r = 0.206, p = .057), insulin (r = 0.302, p = .005), HbA1c (r = 0.376, p < .01), HOMA-IR values (r = 0.283, p = .008) in pregnant women included in the study. s-Endoglin, as an anti-angiogenic marker seemed to have a role in pathogenesis and significantly associated with insulin resistance markers in non-obese GDM, thus may play important roles in the regulation of glucose hemostasis.Impact Statement What is already known on this subject? In women with GDM, hyperglycaemia induced glycosylation products might cause oxidative stress that may be subsequently involved in the release of inflammatory mediators, inducing angiogenesis What the results of this study add? s-Endoglin has an anti-angiogenic effect and is a useful marker of endothelial injury, activation of inflammation, senescence and oxidative stress, we speculate that it may be involved in the pathogenesis of GDM. What the implications are of these findings for clinical practice and/or further research? s-Endoglin seemed to have a role in the regulation of glucose hemostasis. Further exploration of novel factors like s-endoglin in the pathogenesis of GDM, is essential and valuable to develop new therapeutic strategies for this complex disease and its complications