Flecainide as first-line treatment for fetal supraventricular tachycardia.

OBJECTIVE: The aim of this study was to evaluate utilization, efficacy, and side effects of flecainide treatment as first-line agent in patients with fetal supraventricular tachycardia (SVT). METHOD: This retrospective review was conducted on 23 consecutive fetal tachyarrhythmia cases that met inclusion criteria. If the treatment was necessary, then flecainide was used as first-line treatment in all cases. RESULT: Among the study group, there were 21 (91.3%) cases of SVT and 2 (8.6%) cases of Atrial Flutter (AF). Sixteen fetuses had persistent SVT and five fetuses had intermittent SVT. We treated 17 fetuses with flecainide monotherapy and 15 of them converted to sinus rhythm and remaining two fetuses were refractory to monotherapy. The median time to conversion to sinus rhythm was 3.8 ± 1.6 days. Only one fetus (20%) among the intermittent SVT cases required anti-arrhythmic treatment. CONCLUSION: Our study has demonstrated that flecainide is an effective first-line treatment for fetal SVT with high success rate (88.2%), low side effect profile and relatively easy utilization. Based on the current study and recently published article results, flecainide can be recommended as the drug of first choice for treatment of fetal SVT cases.

Contraceptive failure with Copper T380A intrauterine device (IUD): A single tertiary center experience.

OBJECTIVE: The objective of this study was to assess the risk factors of pregnancy with Copper (Cu)T380A IUD and pregnancy outcomes. METHODS: A retrospective study evaluating the risk factors and pregnancy outcomes of 81 patients who conceived with CuT380A IUD in situ. RESULTS: Four ectopic pregnancies and 77 intrauterine pregnancies were detected. Twenty-six pregnancies (33.76%, 26/77) were terminated according to maternal desire. Twenty-five patients (32.46%, 25/77) whose IUDs were removed constituted the Removed IUD Group, and the remaining 26 patients constituted IUD Left in situ Group. Term pregnancy rates (76% vs. 20.8%, p=0.002) were significantly higher in the Removed IUD Group compared with the IUD Left in situ Group. Abortion rates (16% vs. 53.84%, p=0.008) were detected significantly higher in the IUD Left in situ Group. CONCLUSION: The main result of our study was that pregnancy with CuT380A in situ is a significant risk factor for adverse perinatal outcome. Adjusting the scheduled follow-ups for checking the IUD seems to be important in order to prevent accidental pregnancy.

Alanine aminotransferase as a predictor of adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy.

OBJECTIVE: To evaluate the associations between adverse perinatal outcomes and serum transaminase levels at the time of diagnosis in patients with intrahepatic cholestasis of pregnancy. METHODS: We performed a retrospective analysis of patients hospitalized for evaluation of intrahepatic cholestasis of pregnancy from January 2013 to June 2014 in a tertiary center. Seventy-one patients were divided into two groups according to the presence (Group I) or absence of adverse perinatal outcomes (Group II). RESULTS: The mean aminotransferase levels and conjugated bilirubin levels at the time of diagnosis were significantly higher in Group I than in Group II. Receiver operating characteristic curve analysis revealed that the alanine aminotransferase level could predict adverse perinatal outcomes with 76.47% sensitivity and 78.38% specificity, and the cut-off value was 95 IU/L. Among patients with intrahepatic cholestasis of pregnancy, those with adverse perinatal outcomes were significantly older, had an earlier diagnosis, and had higher alanine aminotransferase levels. Using the 95-IU/L cut-off value, patients with intrahepatic cholestasis of pregnancy had a 3.54-fold increased risk for adverse perinatal outcomes. CONCLUSIONS: Patients with intrahepatic cholestasis of pregnancy and high alanineaminotransferase levels should be followed up for possible adverse perinatal outcomes.

Utility of ductus venosus blood flow in the study of cardiac function in fetuses with intracardiac echogenic focus.

PURPOSE: The purpose of this study was to investigate fetal ductus venosus (DV) wave velocities, DV velocity ratios, and DV diastolic time intervals to derive additional information on fetal cardiac function in the presence of an intracardiac echogenic focus (IEF). METHODS: Seventy fetuses at 19-28 weeks of gestation with an IEF and 63 control fetuses were screened using two-dimensional and power Doppler echocardiography. DV wave velocities, DV velocity ratios, and diastolic time intervals were measured. The aortic peak velocity, pulmonary artery peak velocity, left ventricular shortening fraction, and right ventricular shortening fraction, atrioventricular early-diastolic filling velocity (E), atrial contraction velocity (A), and E/A ratio were also measured. RESULTS: The study and control groups were similar in terms of maternal age, body mass index, and gestational age in weeks at the time of examination (p > 0.05). Significant between-group differences were found in DV v-descent (p = 0.03) and a-wave velocities (p = 0.04). CONCLUSIONS: Although the presence of an IEF in the fetal heart does not influence conventional measurements (DV velocity ratios and DV diastolic time intervals), it is associated with changes in DV v-descent and a-wave velocities. These changes may be indirectly related to reduced end-systolic relaxation and augmented atrial contraction in the fetal heart. We therefore suggest examination of DV flow velocities in fetuses with IEF.

Role of spiramycin in prevention of fetal toxoplasmosis.

OBJECTIVE: The aim of this study is to evaluate the efficacy of spiramycin in prevention of mother-to-child transmission of Toxoplasma gondii infection. METHODS: Patients within first trimester of their pregnancy with Toxoplasma IgM positivity (>0.65 index, ELISA, VIDAS) and IgG positivity (>8 IU/ml), who had low IgG avidity (<0.50 index, ELISA, Architet) were considered as having acute toxoplasmosis. These patients who had amniocentesis at the 19th-21st week of pregnancy were examined for the detection of Toxoplasma DNA. Detailed ultrasonographic examinations performed between the 20th and 24th gestational weeks and the mothers and babies were followed for at least one year. RESULTS: Out of 61 patients, 55 (90.2%) had received Spy prophylaxis while 6 (9.8%) cases refused Spy prophylaxis. Toxoplasma PCR test was found to be positive in amniotic fluid of 4 (6.6%) patients obtained by amniocentesis at the 19th-21st week of pregnancy. All four of these patients had refused Spy prophylaxis had positive Toxoplasma PCR in amniotic fluid (p < 0.01). CONCLUSION: Our results seem to encourage the use of spiramycin in women with toxoplasmosis during pregnancy.

The outcome of pregnancy with new onset proteinuria without hypertension: retrospective observational study.

OBJECTIVE: The aim of this study was to evaluate preeclampsia progression of isolated proteinuria and associations with pregnancy outcome. METHOD: We performed a retrospective analysis in patients who were hospitalized for evaluation of new onset proteinuria without hypertension after 20 weeks of gestation between January 2012 and January 2014. One hundred fifty-seven patients who met the inclusion criteria were enrolled the study. RESULTS: After detection of new onset proteinuria, 53 of 157 (33.7%) patients developed preeclampsia and the incidence of gestational proteinuria was found to be 0.33%. Twenty-four hours urine proteinuria testing results were significantly higher in preeclampsia (PE) group compared with the gestational proteinuria (GP) group (p < 0.01). Patients who developed preeclampsia delivered significantly earlier than the GP group (p < 0.01). The weights of the infants born to mothers in the PE group were significantly lower than the other group (p < 0.01). CONCLUSION: The incidence of gestational proteinuria was lower than the previous studies. Preeclampsia developed in 33% of patients with new onset proteinuria in pregnancy. In patients who developed PE had significantly higher proteinuria, lower delivery time and birth weight in their infants. Therefore, patients with new onset proteinuria should be followed-up for preeclampsia development and associated morbidities.

Can abnormal ductus venosus peak velocity index for veins in normal fetuses predict failure of functional closure of the foramen ovale in the postnatal period?

AIM: To investigate whether ductus venosus (DV) wave velocities and/or DV peak velocity index for veins (DV-PVIV) can predict failure of functional closure of the foramen ovale in the postnatal period. MATERIAL AND METHODS: Fetal echocardiography was performed in 455 healthy women with uneventful pregnancies between the 20-24th gestational weeks. DV blood flow and DV-PVIV data were collected prospectively. Echocardiography was repeated in healthy subjects on the 30th postnatal day. Four hundred patients met the study criteria. Newborns with clearly visible foraminal flaps, interatrial septal defects smaller than 5 mm and right-to-left shunting through the defect were accepted as patent foramen ovale (PFO) (n=91). Newborns without PFO (n=309) comprised the control group. RESULTS: A statistically significant difference was detected between the groups with and without PFO in terms of mean DV-PVIV values, DV-D and DV-a wave velocities (p<0.05 for all). ROC analysis showed that increased DV-PVIV values were related to and predictive of PFO (AUC=0.75; p<0.001) and that a threshold value of 0.62, had a sensitivity of 86.8% (95% CI 78.1-93.0%) and a specificity of 51.7% (95% CI 46.1-57.5%). CONCLUSION: DV-PVIV values above 0.62 at the time of fetal echocardiographic examination can predict failure of functional closure of the foramen ovale in the postnatal period.

Laparoscopic removal of an intrauterine device from the sigmoid colon.

Uterine wall perforation which is commonly seen through the posterior wall of the uterus is the most serious complication of an intrauterine device (IUD). We present a case of laparoscopic removal of an IUD from the sigmoid colon in a 31-years-old female who was admitted to hospital with a history of pelvic pain and abnormal vaginal bleeding for one month. The dislocated IUD was removed from the sigmoid colon of laparoscopic intervention without any complications. In conclusion, the treatment modality for the removal of a dislocated IUD is possible by laparoscopic surgery in selected patients where the dislocated IUD is accessible.

Can platelet count and mean platelet volume during the first trimester of pregnancy predict preterm premature rupture of membranes?

AIM: The aim of our study was to evaluate the values of platelet count and mean platelet volume (MPV) obtained from maternal serum during the first trimester to predict subsequent preterm premature rupture of membranes (PPROM). MATERIAL AND METHODS: The records of 318 women with PPROM and 384 healthy controls in a single center between 2009 and 2013 were retrospectively evaluated. Platelet count and MPV values between 7 and 14 weeks of gestation were compared. Receiver-operator curve analysis was performed to identify the optimal platelet count and MPV cut-off levels predicting PPROM. RESULTS: Compared with controls, women with PPROM had significantly increased levels of platelet count and significantly decreased levels of MPV in the first trimester (P < 0.001). The area under the receiver-operator curve was 0.642 for MPV and 0.579 for platelet count. The cut-off values of MPV ≤ 8.6 fL and platelet count ≥216 × 10(3) /µL predicted PPROM with a sensitivity of 58% and 65% and specificity of 62% and 44%, respectively. CONCLUSION: MPV can be used as a more efficient predictor for an early diagnosis of PPROM than platelet count. However, further research combining other markers is needed to increase the efficiency of prediction.

Effects of maternal obesity on antenatal, perinatal and neonatal outcomes.

OBJECTIVE: Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy. METHODS: A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m(2) was underweight, 18.5-24.9 kg/m(2) was normal weight, 25-29.9 kg/m(2) was overweight and ≥30 kg/m(2) was obese. The effects of obesity on fetal and maternal outcomes were investigated. RESULTS: Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01). CONCLUSION: We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.

Robotic-assisted dissection of bulky lymph nodes in cervical cancer.

The resection of bulky lymph node metastases, which may provide a therapeutic benefit, has been proposed in several studies based on laparotomy and laparoscopy. There is no published study in the literature examining the resection of bulky lymph node metastases using a robotic technique. In this report, we presented a patient with cervical cancer who underwent robotic-assisted dissection of bulky lymph nodes. The robotic-assisted operation time was 255 minutes, and the mean console time was 215 minutes. The estimated blood loss was 70 mL. The number of lymph nodes retrieved was 28, and the number of the dissected paraaortic lymph nodes was 13. The number of the lymph node metastases was eight. The bulky lymph nodes which are difficult to be eradicated with standard radiation therapy can be resected with robotic-assisted surgery and successful resection of the lymph nodes can improve the treatment strategy. This minimal invasive technique is safe and feasible for bulky lymph node dissection.

Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery.

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.

A prospective study of rollerball endometrial ablation in the management of refractory recurrent symptomatic endometrial hyperplasia without atypia.

BACKGROUNDS: Menorrhagia - heavy, extended or irregular menstruations - may be associated with endometrial hyperplasia. The aim of this study was to evaluate the clinical efficacy and safety of transcervical rollerball endometrial ablation (EA-R) and to discuss surgical outcomes in patients with simple endometrial hyperplasia without atypia who have had a history of medical treatment failure or recurrence. METHODS: A prospective study was designed. Thirty women underwent EA-R. Preoperative and postoperative menstrual status, sexual activity, and satisfaction with the procedure were assessed. Complications, clinical outcomes, and need for re-intervention were evaluated. RESULTS: No major complications occurred. All patients were discharged from hospital within 24 h. A reduction of menorrhagia was observed in patients as follows: 17 patients (56.67%) had amenorrhea, 10 (33.33%) hypomenorrhea, and 2 (6.67%) eumenorrhea. Hysterectomy was performed only in 1 patient who was unresponsive to ablation treatment. CONCLUSIONS: In selected patients who have persistent uterine bleeding not responsive to conservative therapy, low risk for future endometrial cancer, and wish to retain their uterus, EA-R treatment is safe, effective, and might be an alternative to hysterectomy with good toleration and high rate of patient satisfaction. The advantages of EA-R include low incidence of complications, lower morbidity, shorter hospitalization, and faster recovery.