Long-term postpartum health problems in Turkish women: prevalence and associations with self-rated health

Objective: To examine the frequency of physical and emotional health problems associated with labor and their relationship with self-rated health measures. Methods: Four hundred women were enrolled. Data collection was accomplished through the completion of a form on sociodemographic and obstetric characteristics, a questionnaire that measured the self-rated health level as well as physical health problems, and Edinburgh Postpartum Depression Scale. Results: Most commonly reported health problems in the initial six-week period were fatigue (77.5%), sleep disturbance (76.0%), and dysuria (61.3%). At one-year postpartum, fatigue (33.9%), sleep disturbance (32.8%) and constipation (15.5%) were the most commonly reported complaints. Those who self-reported a poor health at six weeks and one year comprised of 40.0% and 19.8% of the participants, respectively. Conclusion: Further studies in other populations are warranted to better delineate the prevalence rates, which will provide useful data for developing policies aimed at improving postpartum care

A Local Study on Antenatal Features of Preterm Births at 26-32 Versus 33-36 Weeks of Pregnancy

Objective: The antenatal features of pregnancies affect the incidence of preterm births. This retrospective study from Trakya University of Northwestern Turkey, describes antenatal factors involved in preterm births at 26-32 weeks of pregnancy and compares with those involved in preterm births at 33-36 weeks. Study Design: The records of preterm births at 26-32 weeks (earlier preterm births, n=419) and at 33-36 weeks (later preterm births, n=158) during the years 2002-2010 were reviewed and the demographic, obstetric and medical features were evaluated retrospectively. The data was expressed as numbers and percentages and analyzed by SPSS 20.0. Results: Iron supplementation [OR 0.27 (0.16-0.45), p=<0.001], short cervix [OR 9.12 (2.09-39.73) p=0.003] and infection [OR 2.6 (1.2-5.6) p=0.014] were important factors in the emergence of earlier preterm births which occurred at the rate of 1.4%. Conclusions: Earlier preterm births at 26-32 weeks of pregnancy, which compose an obstetric issue, are associated with several antenatal risk factors such as nutrition, cervical problems and infections in Northwestern Turkey

Complex Nature of Neural Tube Defects: A Regional Experience

Objective: The underlying gene-environment interaction of fetal neural tube defects is affected by several factors including geography, ethnicity and time. Local features of fetal neural tube defects were described. Study Design: A prospective cohort study of 48 fetal neural tube defects in a single tertiary medical center at the northwestern region of Turkey (2013-2015) was done via ultrasound, magnetic resonance imaging (MRI), conventional karyotyping, maternal methylenetetrahydrofolate reductase c.677C>T (rs1801133) single-nucleotide polymorphism and maternal serum levels of folic acid, vitamin B12 and zinc. For comparison of means, a Student’s T-Test was used. Results: The prevalence of neural tube defects was 11.4 per 10000 births (48/42000) in northwestern Turkey. The defects on the cranium (n=23; 47.9%) and spine (n=25; 52.1%) were ultrasonographically detected. MRI did not give additional benefit over the ultrasonography. The ratio of associated anomalies in neural tube defect group was 25%. Two fetal neural tube defects with Down syndrome were remarkable. The rate of homozygous methylenetetrahydrofolate reductase c.677C > T SNPs among the mothers of neural tube defect fetuses (n=20) was 15%. Comparing with gestationally matched healthy pregnancies, although maternal BMIs and periconceptional folate intake of neural tube defect group were significantly different, maternal serum folic acid, vitamin B12 and zinc levels were similar. Conclusion: The northwestern region appeared to be a relatively low prevalence area of Turkey for fetal neural tube defects. Any association with maternal serum folic acid, vitamin B12 and zinc levels could not be shown in this region

Emergency cerclage in twins during mid gestation may have favorable outcomes: Results of a retrospective cohort

Purpose. - Cervical cerclage treatment for cervical changes at mid trimester is a very controversial topic in twins. The aim of the study was to present our maternal and fetal outcomes of mid-trimester cervical cerclage in twin pregnancies. Basic procedures. - This study was performed using data extracted from the medical files of the twin pregnancies whom performed emergency cervical cerclage between January 2012 and March 2018 at Trakya University, Facuty of Medicine, Department of Perinatology. Main findings. - Mean (min.-max.) gestational age at delivery was [27.3 (21-34) weeks]. The median time between cervical cerclage and delivery was 6.4 weeks, while the maximum prolongation of the pregnancy was 11 weeks. The median prolongation period of pregnancy was 4.1 weeks in patients with bulging membranes, but 10 weeks in patients with cervical effacement and cervical shortening. Eight infants died at the neonatal period. Two patients (20%) developed late abortions at 21 and 22 weeks of gestation, and 2 women (20%) delivered extremely premature neonates at the 24th weeks. Overall neonatal mortality rate was 40% (8/20 neonates). Twelve out of twenty were born alive (60%). Principal conclusions. - Despite the lack of randomized controlled trials, it seems reasonable to offer emergency cervical cerclage to twin pregnancies with cervical shortening (<15 mm). For the twin pregnancies with advanced cervical dilatation and protruding membranes, emergency cervical cerclage should be an option only for carefully selected patients after informing about the complications and low success rate. (C) 2018 Elsevier Masson SAS. All rights reserved

Comparison of postpartum sonographic findings after uneventful vaginal and cesarean section deliveries

Objective: To prospectively determine the sonographic findings of the postpartum uterus 24 hours after vaginal delivery and cesarean section. Methods: Women who had uneventful vaginal delivery or cesarean section from July 2015 to May 2018 in a tertiary care hospital were prospectively included. Uterine lengths, endometrium, amout of free fluid, the distance between the uterine fundus-promontorium and uterine fundus-L5 were evaluated 24 hours after delivery. Results: The mean (min–max) endometrial thickness in the vaginal delivery and cesarean section groups were 13.3 (4–25) and 12.4 (4–29) mm, respectively. Fundus-cervix length was significantly higher in the vaginal delivery group compared to the cesarean section group (184.05 ± 16.8 vs 163.6 ± 6.7 mm, p <0.001). The measurements of anterior and anterior-posterior walls of the uterus, anteroposterior uterine length and uterine width were similar in both groups. Promontorium-fundus length was significantly higher in patients who delivered vaginally than those by cesarean section (123.3 ± 13.6 vs 108.7 ± 23.3 mm, p = 0.005). Conclusion: The measurement of L5-fundus distance is a simple and effective technique to evaluate the size of the uterus. Homogenous endometrium up to 30 mm in asymptomatic patients may be a normal finding 24 hours after delivery. The results of this study may be helpful in the decision-making process in cases of early postpartum hemorrhage or hemodynamic instability

The relation of fetal colon and rectum diameters with labor in healthy late-third trimester pregnancies

Inan, Cihan (Trakya Author) Sayin, N. Cenk (Trakya Author) Dolgun, Z. Nihal (Trakya Author) Erzincan, Selen Gursoy (Trakya Author) Uzun, Isil (Trakya Author) Sutcu, Havva (Trakya Author) Varol, Fusun (Trakya Author)Objective: To investigate the associations of fetal colon-rectum diameters with labor and fetal distress or meconium passage in healthy pregnancies in the late 3rd trimester. Study design: A total of 162 healthy, singleton pregnant women at >= 36(0/7) weeks who were in the latent phase of labor (n = 69) or those not in labor (n = 93, controls) at the time of ultrasound examination were enrolled. Fetal colon (ascending, transverse, descending, sigmoid) and rectum diameters, Doppler indices of materno-fetal vessels were measured. Data were analyzed according to the mode of delivery. Results: Fetal colon-rectum diameters were smaller in women in labor compared to controls (p = 0.001). Positive correlations were observed between fetal colon-rectum diameters and interval between ultrasound and labor onset in the control group except for those who had scheduled cesarean sections (C/S) (p = 0.001). Similar colon-rectum measurements were obtained in fetuses delivered via cesarean section due to fetal distress or to other indications (p>0.05). In women who had uterine contractions during ultrasound examination; later delivered by vaginal route, no association was observed between Apgar scores and colon-rectum diameters during latent-phase (p > 0.05), and also there were significant positive correlations between different segments of colon-rectum diameters and duration of neonatal meconium passage (p < 0.05). Conclusion: Fetal colon and rectum diameters are smaller during labor and the measurements tend to diminish as the labor approaches, but do not indicate fetal distress. (C) 2018 Elsevier By. All rights reserved

A large posterior encephalocele associated with severe ventriculomegaly, cerebellar atrophy and transposition of the great arteries

Posterior encephalocele is a neural tube defect, which is a sac-like protrusion of the neural tissue and cerebrospinal fluid through a defect in the occipital bone. This embryonic anomaly may coexist with cortical dysplasia, agenesis of the corpus callosum, hydrocephalus, microcephaly, craniofacial abnormalities, ventricular and atrial septal defect. We report a case of a large posterior encephalocele in a fetus accompanied by unexpected major abnormalities including transposition of the great arteries, severe ventriculomegaly and cerebellar atrophy. Postnatal surgical corrections of the posterior encephalocele and then of the transposition of the great arteries were performed but the neonate died 2 months after delivery

Deletion of macro domain containing 2(MACRO D2) associated with transient hydrops fetalis

Cilingir, I. Uzun (Trakya Author) Sayin, Niyazi Cenk (Trakya Author) Gurkan, H.(Trakya Author) Ciftdemir, N. A. (Trakya Author) Atli, E. (Trakya Author) Inan, C. (Trakya Author) Erzincan, S. (Trakya Author) Sutcu, H. (Trakya Author) Vatansever, U. (Trakya Author) Varol, Fusun (Trakya Author)Macro Domain Containing 2 (MACRO D2) gene is a gene from macro family which is highly expressed in the ventriculer zone of the brain during embryonic development. Association between Autism spectrum disorders and MACRO D2 gene polymorphisms has been reported before [1] . Deletion in MACRO D2 gene has also been associated with Kabuki Syndrome which is a well described congential anomaly syndrome [2]