Surgical management of postpartum haemorrhage: Analysis of 14 cases

OBJECTIVE: The aim of this study was to present our experience with surgical management of postpartum haemorrhage (PPH). STUDY DESIGN: Data of 14 cases with surgically managed PPH were retrospectively analyzed. Maternal characteristics, the indication for surgery, estimated blood loss, postoperative complications were recorded. RESULTS: During the study period there were six postpartum hysterectomies, three hysterectomies together with internal iliac artery ligation (IIAL) and five women had IIAL in our unit. The incidence of peripartum hysterectomy due to PPH was 0.40/1000 deliveries and the incidence of IIAL due to PPH was 0.53/1000 deliveries. Three out of eight women where IIAL was performed also required hysterectomy to arrest bleeding, giving an overall uterine preservation rate of 62.5%. The main indications for postpartum hysterectomy and/or IIAL were uterine atony in 12 cases (85 %) and uterine rupture in two cases (15 %). Mean estimated blood loss was 2732.1±1080.5 mL (range 1200-4500). There was one maternal death (%7) due to hypovolemic shock during postpartum hysterectomy for uterine atony. CONCLUSION: Uterine atony is the main indication for postpartum hysterectomy and/or IIAL. IIAL is an effective procedure to control PPH. In failed cases, emergency obstetric hysterectomy remains an essential life-saving procedure

Prenatal Diagnosis of Neural Tube Defects: Evaluation of 112 Cases

OBJECTIVE: The aim of this study was to represent our experience of the prenatal sonographic diagnosis of NTDs at our institution during a five year period. STUDY DESIGN: All fetuses with a prenatally detected neural tube defect were included in this retrospective analysis. Demographic characteristics and prenatal ultrasound findings were presented. RESULTS: NTD was diagnosed in 112 fetuses, which represents 1.99% of 5605 fetuses scanned between 2004 and 2009. Mean maternal age and gestational week at the time of diagnosis were 25.5 ± 5.6 (17-40) years and 20.6 ± 6.3 (12-38) weeks, respectively. A total 78 pregnancies were terminated due to presence of anencephaly (n=21), encephalocele (n=14), open spina bifida (n=35) and iniencephaly (n=8). Selective fetocide was performed in a dichorionic twin pregnancy discordant for anencephaly. Five fetuses died in-utero. Twenty-one viable fetuses were delivered by cesarean section and 7 fetuses were delivered vaginally. Fifteen fetuses were operated during the neonatal period and of these, 4 (26.7%) died postoperatively. Of the operated fetuses, only two (13.3%) survived (both of which showing normal cranial findings during antenatal follow-up) without neurological or orthopedic sequels. CONCLUSION: NTDs carry mostly a dismal prognosis. Prenatal diagnosis of NTDs before viability is important for management

Surgical Management of Postpartum Haemorrhage: Analysis of 14 Cases

OBJECTIVE: The aim of this study was to present our experience with surgical management of postpartum haemorrhage (PPH). STUDY DESIGN: Data of 14 cases with surgically managed PPH were retrospectively analyzed. Maternal characteristics, the indication for surgery, estimated blood loss, postoperative complications were recorded. RESULTS: During the study period there were six postpartum hysterectomies, three hysterectomies together with internal iliac artery ligation (IIAL) and five women had IIAL in our unit. The incidence of peripartum hysterectomy due to PPH was 0.40/1000 deliveries and the incidence of IIAL due to PPH was 0.53/1000 deliveries. Three out of eight women where IIAL was performed also required hysterectomy to arrest bleeding, giving an overall uterine preservation rate of 62.5%. The main indications for postpartum hysterectomy and/or IIAL were uterine atony in 12 cases (85 %) and uterine rupture in two cases (15 %). Mean estimated blood loss was 2732.1±1080.5 mL (range 1200-4500). There was one maternal death (%7) due to hypovolemic shock during postpartum hysterectomy for uterine atony. CONCLUSION: Uterine atony is the main indication for postpartum hysterectomy and/or IIAL. IIAL is an effective procedure to control PPH. In failed cases, emergency obstetric hysterectomy remains an essential life-saving procedure

The Value of Cervical Smears Collected with The ThinPrep Technique in The Detection of Endometrial Cancer

OBJECTIVE: As liquid-based cervical cytology show promise for detecting endometrial adenocarcinoma, the aim of this study was to evaluate the cytological findings in liquid-based cytology of women in with endometrial cancer. Pap smear findings were correlated with histological grade and stage of the tumor to determine whether the presence of atypical cells have any prognostic value. STUDY DESIGN: This prospective study comprises 51 women with endometrial cancer from which a pre-operative cervical Thinprep Pap smear was available. In all cases endometrial thickness was measured transvaginally. The Bethesda nomenclature system for cervico-vaginal cytology was used to define atypical glandular cells (AGCs), atypical squamous cells (ASCs) and endometrial adenocarcinoma cells (EACs). Statistical analysis was done with the independent T test and χ2 test. RESULTS: Cytological atypia was present in a total 26 (51%) cases. AGCs or EACs were present in Pap smears of 19 (37%) women. The rate of FIGO grade 2-3 tumor in patients with and without AGCs/EACs was 36.8% (7/19) and 12.5% (4/32), respectively (p=0.09). Figures for endometrial thickness were 14.8 ± 5.6mm and 16.8 ± 6.6mm, respectively (p=0.3). Thirty-two percent (6/19) of patients with AGCs/EACs were FIGO stage 1C or more, whereas the rate for patients with normal cytology was 20% (5/25) (p=0.59). CONCLUSION: The sensitivity of the ThinPrep Pap smear in detecting endometrial cancer is low. AGCs/EACs on Pap smear do not correlate with tumor grade or stage and there is no association between endometrial thickness and incidence of AGCs/EACs on Pap smear