Perinatal outcomes in pregnant women with ITP: a single tertiary center experience.

OBJECTIVES: In this study, we aimed to compare the maternal and neonatal outcomes in pregnant women diagnosed with idiopathic thrombocytopenic purpura (ITP) in our clinic between different platelet groups. METHODS: This study was designed retrospectively. A total of 62 pregnant women with ITP were included in the study. Demographic and clinical data for all cases were evaluated. Perinatal outcomes were evaluated according to platelet counts. RESULTS: The median age of the patients participating in the study was 27, and their ages ranged from 21 to 44. ITP was diagnosed before pregnancy in 32.3 % (n=20) of the patients and during pregnancy in 67.7 % (n=42). The average platelet counts of the patients during the first trimester and birth were 104.8/µL (15-168) and 84/µL (16-235), respectively. The average platelet count of newborns is 242/µL. The most common (74.2 %) ITP treatment method is the combination of steroids and IVIG. The platelet count of 80.6 % of newborns is above 151/µL. There was no statistical difference between the results of both mothers and fetuses when the groups were categorized according to maternal platelet levels. CONCLUSIONS: In this study, no difference was observed in maternal and neonatal morbidity and mortality rates, despite the different platelet counts of patients with ITP. The cooperation of the hematology, gynecology, obstetrics, and neonatology departments is responsible for this.

Platelet indices as potential biomarkers of perinatal outcomes in women with SLE during pregnancy.

AIM: This study aimed to assess the platelet parameters and their prognostic value for perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). METHODS: This retrospective study involved 180 participants, 90 pregnant women with SLE and 90 healthy pregnant women. Clinical and demographic variables including routine first-trimester neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet parameters such as platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT) were compared between the groups. The perinatal outcomes of the whole study group were also compared. RESULTS: SLE patients had lower leukocyte (p = 0.001), lymphocyte (p = 0.001) and platelet counts (p = 0.018), higher PDW (p = 0.002), MPV (p = 0.001), NLR (p = 0.008) and PLR (p = 0.015) and lower PCT (p = 0.015) than the control group. The groups had no significant difference in hemoglobin levels (p = 0.936). SLE patients had higher rates of cesarean section (p = 0.002), small for gestational age (SGA) (p = 0.019) and stillbirth (p = 0.017) and lower birth weight (p = 0.001) than the control group. PCT was a significant predictor of stillbirth with a cut-off value of 0.21, sensitivity of 64.3% and specificity of 83.3% (AUC: 0.843, p < 0.001). CONCLUSION: Pregnant women with SLE have altered platelet parameters and increased inflammatory markers compared to healthy pregnant women. PCT is a simple and useful marker for predicting stillbirth risk in SLE pregnancies.

Fragmented QRS in patients with preeclampsia.

PURPOSE: This study aims to investigate the prevalence, clinical correlates, and prognostic implications of fragmented QRS complexes (fQRS) in pregnant women with preeclampsia (PE), shedding light on the potential role of electrocardiographic markers in identifying cardiac involvement in hypertensive disorders of pregnancy. METHODS: Patients with PE and age-matched low-risk control patients were recruited at a tertiary hospital between January 2015 and January 2023. A comprehensive assessment, including heart rate, PR duration, QRS duration, corrected QT duration, and fragmented QRS, was conducted by 12-lead electrocardiography. Baseline clinical characteristics, laboratory parameters, and electrocardiographic findings were compared between the study groups. RESULT: 128 preeclampsia patients and 122 age- and comorbidity-matched controls were included in the study. The prevalence of fQRS was significantly higher in preeclamptic women compared to normotensive controls (14.1% vs. 3.3%, p = 0.04). ALT levels of pregnant women with preeclampsia and without preeclampsia groups were 43,77 (35.25-48.22) and 23,18 (13.75-33.00) (p: 0.038), respectively. In univariate regression analyses, Na and fragmented QRS were found to be associated with preeclampsia. (p: 0.016 and 0.009, respectively). After multivariable adjustment for variables, Na and fragmented QRS remained strongly associated with preeclampsia (OR: 4.787 (1.556-14.720), p: 0.06; 0.941 (0.893-0.992), p: 0.023, respectively). CONCLUSION: This study provides compelling evidence of an association between preeclampsia and fragmented QRS complexes, implicating electrolyte imbalances and hemodynamic stress as potential contributors to myocardial electrical instability in hypertensive disorders of pregnancy. Further research is warranted to validate these findings and improve risk stratification and clinical outcomes in affected women. Number: 2023/4705 Retrospectively Registered.

Effect of abnormal placentation on fetal heart function and neonatal outcomes.

OBJECTIVE: This study aimed to investigate the fetal modified (mod)-myocardial performance index (MPI) for fetal cardiac function in placenta percreta (PPC) pregnancies with placenta previa (PP) and assess neonatal outcomes. MATERIALS AND METHODS: This study included 104 pregnant women: 52 with PPC and 52 as the control group. Mod-MPI measurements and neonatal outcomes were evaluated in all cases. RESULTS: The PPC group had a significantly lower left ejection time (p = 0.044) and significantly higher mod-MPI (p = 0.001) than the control group. The optimal mod-MPI predictive cut-off value at the neonatal intensive care unit (NICU) admission in the PPC group was 0.53 with 53.8% specificity and 88.5% sensitivity (p = 0.019). The optimal mod-MPI predictive cut-off value at the 5th APGAR score below 7 in the PPC group was 0.55 with a specificity of 67.7% and a sensitivity of 76.2% (p = 0.016). CONCLUSION: Fetal MPI was higher in pregnant women with PPC compared to the control group. Among the PPC cases, those with MPI above a certain predictive level showed more frequent NICU admissions and lower APGAR scores.

Fetal Epicardial Fat Thickness in Obese Pregnant Women: Its Effect on Fetal Cardiac Function and Neonatal Outcomes.

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) together with fetal myocardial performance index (MPI) and its effects on neonatal outcomes in obese pregnant women. MATERIALS AND METHODS: A total of 102 pregnant women, 51 obese and 51 of normal weight, were included in this prospective study. Fetal EFT, and MPI measurements were performed for all patients. RESULTS: Fetal EFT and Mod-MPI showed a statistically significant difference between obese pregnant women and the control group (p=0.0001, p=0.001). The optimal fetal EFT predictive cut-off value for the 5th-minute APGAR score below 7 was 1.22 mm, with a sensitivity of 86.96% and a specificity of 54.43% (p=0.001). CONCLUSION: Fetal EFT and mod-MPI were higher in obese pregnant women. It is encouraging that fetal EFT predicts low APGAR, but more important information can be obtained if postnatal follow-up of these cardiac changes caused by obesity can be performed.

Maternal Cardiac Disease and Perinatal Outcomes in a Single Tertiary Care Center.

OBJECTIVE: This study aims to compare the perinatal outcomes of pregnant women with heart disease and a healthy pregnant control group, as well as the maternal and newborn outcomes of pregnant women with congenital heart disease and acquired heart disease. MATERIAL METHOD: Pregnant women with heart disease and healthy control pregnant women were included in this retrospective study. Sociodemographic data of all patients included in the study were obtained from electronic records. Perinatal outcomes of all patients were compared. RESULTS: A total of 258 pregnant women were included in the study. While 129 pregnant women were diagnosed with heart disease, 129 patients were low-risk pregnant women. Preeclampsia (p=0.004) and cesarean section (p=0.01) rates were higher in pregnant women with heart disease compared to healthy pregnant women. Compared with healthy pregnant women, pregnant women with heart disease had a lower birth weight (p=0.003), a higher fetal growth restriction (FGR) rate (p=0.036), lower birth percentiles (p=0.002), a lower 5-minute APGAR (p=0.0001), a higher neonatal intensive care unit (NICU) admission rate (p=0.001), and a longer NICU stay rate (p=0.001). The mean gestational age at birth of pregnant women with congenital heart disease was higher than that of those with acquired heart disease (p=0.017). CONCLUSION: It was observed that all maternal heart diseases were associated with adverse perinatal outcomes compared to healthy pregnant women. In this series, perinatal adverse outcomes of pregnant women with congenital and acquired heart disease did not differ.

The initial number of fetuses in multiple pregnancy before reduction affects perinatal outcomes.

OBJECTIVE: In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with continuing DCDA twin pregnancies without FR. MATERIALS AND METHODS: FR performed in a university hospital in the last 10 years was evaluated. Pregnancies reduced to DCDA twin pregnancies by reduction from three or more pregnancies and pregnancies that started with DCDA twins and continued with DCDA twins were compared in terms of perinatal outcomes. In the subgroup analysis, those who were reduced from three-chorionic three-amniotic (TCTA) triplets to DCDA twins and those who were reduced to DCDA twin pregnancies from four or more were compared in terms of perinatal outcomes. RESULTS: A total of 119 pregnant women were included in the study, 36 patients underwent FR, while 83 patients were DCDA twins who did not undergo FR. The groups were similar in terms of preterm delivery (p = 0.370). There was a higher rate of miscarriage (21.4% vs. 0.0%, p = 0.019) in the group that was reduced to DCDA twins from quadruplet and above pregnancies compared to the group that was reduced from TCTA triplets to DCDA twins. The gestational week at birth was lower in the group reduced to DCDA twins from quadruplets and above pregnancies (31.00 ± 4.31 vs. 34.64 ± 2.88, p = 0.019). CONCLUSION: The study's results show that the perinatal outcomes of multiple pregnancies with and without FR are the same As the number of reduced fetuses increases, the rates of preterm birth and miscarriage also increase.

Superior mesenteric artery Doppler parameters in the evaluation of fetal hyperechogenic bowel.

OBJECTIVE: The aim of this study was to evaluate the efficacy and clinical effects of superior mesenteric artery (SMA) Doppler indices such as the systole diastole ratio (S/D), Pulsatility (PI), and resistance index (RI) in the diagnosis of hyperechogenic bowel. METHODS: A total of 133 pregnant women, including 66 with hyperechogenic bowel and 67 controls, were enrolled in the study. All participants were evaluated in the second trimester by an experienced obstetrician. Doppler measurements were performed, including superior mesenteric artery peak systolic velocity, S/D ratio, PI, and RI. Statistical analysis was conducted to compare the Doppler parameters between the hyperechogenic bowel and control groups. RESULTS: No significant differences were found between the hyperechogenic bowel and control groups in terms of age, body mass index, gestational week, and fetal measurements. While SMA peak systolic velocity (PSV) showed no significant difference between the groups (p = 0.074), the S/D ratio (4.01 ± 0.59 vs. 3.27 ± 0.57, p = 0.0001), PI (1.51 ± 0.15 vs. 1.29 ± 0.06, p = 0.0001), RI (0.76 ± 0.05 vs. 0.67 ± 0.04, p = 0.0001) were significantly higher in the hyperechogenic bowel group compared to the control group. Screening tests based on Doppler parameters also demonstrated significant differences. The S/D ratio, PI, and RI exhibited good to excellent diagnostic accuracy, as indicated by the area under the curve values. Pregnant women with a high RI value of 0.72 were 101 times more likely to be diagnosed with HB. The odds ratio (OR) for diagnosing HB is 101.66 (CI 95%, 31.04-332.97). CONCLUSION: Doppler indices, specifically the S/D ratio, PI, and RI, showed strong predictive ability and diagnostic accuracy in identifying cases of hyperechogenic bowel. These findings suggest that Doppler ultrasound can serve as a valuable tool for evaluating hyperechogenic bowel and may provide important clinical implications. Further diagnostic tests are warranted to determine the underlying cause of hyperechogenic bowel in individual cases.

Fetal epicardial fat thickness in non-severe idiopathic polyhydramnios: Its impact on fetal cardiac function and perinatal outcomes.

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) along with fetal myocardial performance index (MPI) and its effects on perinatal outcomes in non-severe idiopathic polyhydramnios (IP). MATERIALS AND METHODS: This prospective study included 92 participants, 32 diagnosed with non-severe IP, and 60 healthy pregnant women. Amniotic fluid indices (AFI), umbilical and middle cerebral artery Doppler, EFT, and MPI measurements were performed for all patients. RESULTS: The fetal EFT and MPI values were statistically higher in the non-severe IP group than in the control group (p = 0.0001, p = 0.014, respectively). The optimal fetal EFT cutoff value for predicting non-severe IP disease was found as 1.3 mm with a specificity of 81.7% and sensitivity of 59.4%. The EFT cutoff for predicting cesarean section in non-severe IP cases was 1.25 mm (p = 0.038). Apgar scores, neonatal intensive care unit, respiratory distress syndrome, and stillbirth rates were not different between groups. CONCLUSION: In this study, EFT and MPI were found to be higher in non-severe IP cases compared to controls. It was observed that the increase in MPI and EFT was associated with the increase in cesarean rates, but not with adverse fetal outcomes.

The role of the systemic inflammatory index in determining the length of hospital stay in patients with hyperemesis gravidarum.

OBJECTIVE: In this study, we aimed to investigate the role of peripheral blood parameters and the systemic inflammatory index (SII) in the diagnosis of hyperemesis gravidarum (HG) and whether they have a predictive value in determining the length of hospital stay and the risk of rehospitalization in HG cases. MATERIALS AND METHODS: In the retrospective study, pregnant women who were hospitalized due to HG (n = 112) and pregnant women who were completely healthy (n = 112) were matched for gestational age. Peripheral blood inflammation parameters of the entire study group were evaluated. The length of hospital stay and rehospitalization rate for HG cases were recorded. A total of 224 patients, 112 (50%) in the control group and 112 (50%) in the HG group were included in the study. There was a positive correlation between increased ketonuria and length of hospitalization, peripheric blood parameters, and SII. The degree of ketonuria was found to be statistically insignificant in determining the risk of rehospitalization (p = 0.927). About 28.57% (n = 32) of all HG cases were readmitted to the hospital. When the length of hospital stay was considered, SII was found to be statistically significant in hospitalizations lasting more than 2 days (p = 0.001), but not in rehospitalizations (p = 0.3). CONCLUSION: SII is significant in diagnosing and determining hospitalization of HG. It is sufficient to determine the length of hospital stay but not rehospitalization risk, which is an indicator of disease severity.

Pregnancy termination indications and outcomes before 24 weeks of gestation - a case series.

OBJECTIVE: This study aimed to assess termination of pregnancy (TOP) indications and obstetric outcomes before the 24th gestational week. MATERIALS AND METHODS: This is a retrospective study that includes terminations performed in singleton pregnancies between December 2021 and December 2022 in the Perinatology Clinic of Necmettin Erbakan University Meram Medical Faculty. According to the reasons for TOP, all patients were divided into three groups: maternal, fetal, and obstetric reasons. The termination approach and outcomes were evaluated in all cases. RESULTS: A total of 210 patients were included in the study. Considering termination indications, 18 (8.5%) patients had maternal causes, 127 (60.5%) had fetal causes, and 65 (31%) had obstetric causes. Maternal causes were significantly higher in the 1st trimester and fetal causes in the 2nd trimester (P = 0.001). In the maternal group, 77.8% dilatation and curettage were used, 70.1% misoprostol and 29.9% misoprostol + Foley catheter in the fetal group, and 66.2% misoprostol in the obstetric group (P = 0.0001). The length of hospital stay and recurrent revision curettage were not statistically different between the fetal, maternal, and obstetric groups (P = 0.099, P = 0.8, respectively). CONCLUSION: Termination options should be offered for complicated pregnancies due to fetal, maternal, or obstetric reasons. Pregnancy termination week and indication affect morbidity.

Cerebroplacental ratio and perinatal outcomes in mild-to-moderate idiopathic polyhydramnios cases.

OBJECTIVE: This study will evaluate whether fetal cerebroplacental ratio (CPR) can predict perinatal adverse outcomes in singleton pregnancies with mild and moderate idiopathic polyhydramnios (IP). METHOD: This study was designed as a prospective case-control study between January 2023 and November 2023. Pregnant women diagnosed with mild-to-moderate IP and low-risk singleton pregnancies were included in the study. In all cases, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured at 36-40 weeks of gestation, and CPR was calculated. The group with polyhydramnios was divided into two parts according to whether the CPR value was below 1.08 or 1.08 and above. Perinatal outcomes of all groups were compared. RESULTS: A total of 140 patients were included in the study. Seventy of these were IP cases, and 70 were low-risk pregnant women. UA PI in the IP group was not statistically different from that in the low-risk group, but MCA PI and CPR were significantly lower in the IP group (P = 0.07, P = 0.001, and P = 0.004, respectively). IP cases were divided into a low group (<1.08, n = 18) and a normal group (≥1.08, n = 52) according to the CPR value. Cesarean section rates due to fetal distress were significantly higher in the low-CPR group (n = 8 [44.4%] vs 5 [9.6%], P = 0.001). In the low-CPR group, 5-min Apgar <7, and neonatal intensive care unit (NICU) admission rates were significantly higher (P = 0.045 and P = 0.001, respectively). CONCLUSION: It is encouraging that in cases with mild-to-moderate IP, low CPR predicts emergency delivery due to fetal distress, a low Apgar score at 5 min, and NICU admission.

Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries.

OBJECTIVE: This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP). METHODS: Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared. RESULTS: A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037). CONCLUSION: Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.

Predictability of the Delta Neutrophil Index and Other Blood Parameters on Perinatal Outcomes in Pregnant Women With Systemic Lupus Erythematosus.

PROBLEM: This study aimed to evaluate the predictive value of delta neutrophil index (DNI), a peripheral blood parameter, on perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). METHOD OF STUDY: One hundred eighty-one participants, 78 pregnant women with SLE, and 103 healthy pregnant women were included in this retrospective study. Peripheral blood parameters including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and DNI taken in the first trimester were compared between groups. RESULTS: NLR, PLR, and DNI were significantly higher in the SLE group (p = 0.027, p = 0.007, p = 0.0001, respectively). The same parameters were not found to be significant in determining disease activity in pregnant women with SLE (p > 0.05). When the predictive value of DNI for SGA in pregnancies with SLE was evaluated by receiver operating characteristic curve (ROC), the area under the ROC curve (AUC) was 0.666 (95% CI; 0.544-0.788, p = 0.018) with 84.6% sensitivity, 53.8% specificity, 56.0% PPV, and 78.1% NPV at a cut-off value of 0.16. The predictive value of DNI according to ROC for stillbirth in pregnancies with SLE was AUC 0.731 (95% CI: 0.539-0.923, p = 0.019) with a cut-off value of 0.17, sensitivity of 90%, specificity of 51.5%, PPV of 58.5%, and NPV of 87.2%. CONCLUSIONS: Although DNI's prediction of SGA and stillbirth in pregnant women with SLE is encouraging, it needs more evidence from prospective studies with larger series.

Fetoscopic surgery for amniotic band syndrome: Case series.

We aimed to evaluate the fetoscopic procedure indications, procedure-related complications, and neonatal outcomes in cases diagnosed with amniotic band syndrome (ABS). Stage II and III cases according to Hüsler classification were included for fetoscopic surgery. Scissors were used to release the amniotic band in six cases, and a diode laser was used in one case. A single entry was made in all cases. The majority of the children acquired a functional limb (71.4%). Fetal morbidity was mainly linked to the consequences of preterm premature rupture of the membranes (57.1%) and preterm birth (28.5%). Excluding complicated cases, fetoscopic band release is encouraging in cases of ABS in the limbs.

Predictability of Hematological Parameters in the Diagnosis of Cesarean Scar Pregnancy.

Introduction Cesarean scar pregnancy (CSP) is an increasing clinical condition that causes serious maternal morbidity and mortality. This study aimed to evaluate if inflammation markers measured by hemogram can aid in the diagnosis of CSP. Materials and Methods A total of 86 patients were included in the study. The cases were divided as CSP ( n : 42) and normal pregnancy (NP) ( n : 44). At the time of admission, peripheral blood neutrophils, lymphocytes, monocytes, thrombocytes, systemic inflammatory index (SII) (neutrophil × platelet/lymphocyte), neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were all measured. CSP and NP diagnoses were made by transabdominal or vaginal ultrasonography. Results In the CSP group, mean age ( p < 0.001), gravida ( p < 0.001), parity ( p < 0.001), number of surviving children ( p < 0.001), number of abortions ( p < 0.001), cesarean number ( p < .001), dilatation and curettage count ( p = 0.013), monocyte (M) value ( p = 0.039) and monocyte/lymphocyte value (MLR) ( p = 0.035) were significantly higher than the control group. The optimal M value cut-off value was found to be > 0.40, the sensitivity value was 78.57, and the specificity value was 50.00. AUC = 0.632 (SE = 0.061) for the MLR value. The optimal MLR cut-off value was found to be > 0.232, the sensitivity value was 61.90, and the specificity value was 63.64. Conclusion Hemogram parameters, which are simple, inexpensive, and easily accessible, M and MLR are significantly higher in the diagnosis of CSP and can be used as an auxiliary parameter for ultrasonography.

Effect of cervical changes on the cesarean scar area and niche formation after preterm and term cesarean sections.

OBJECTIVE: The purpose of this study is to assess the scar area and niche formation after cesarean section in women who had preterm or term deliveries and underwent cesarean section at various stages of labor. METHOD: This prospective cohort study consists of cases who underwent the first cesarean section for different obstetric reasons. The patients were divided into four groups regarding gestational age and cervical dilatation. After a cesarean section, all patients were called for vaginal ultrasonography control at 12 weeks. The location of the scar and the presence of a niche were evaluated. The residual (RMT), proximal, and distal myometrial thicknesses were evaluated where the scar and niche were located. RESULTS: A total of 87 cases were included in the study. There was no difference in the prevalence of niche between the groups (p > 0.05). RMT and proximal and distal myometrial thickness were not different between the 37 ≥ week and 37 < week groups, while RMT and proximal and distal myometrial thickness were significantly lower in women with active labor (p =0.001, p= 0.006, p =0.016). The location of the scar was the isthmus at 37 weeks and above (p= 0.002), it was in the cervical canal in the group below 37 weeks (p= 0.017). CONCLUSION: The gestational week and cervical changes did not affect the prevalence of the niche. In cases of active labor and preterm deliveries, the CS scar defect was located in the cervical canal; however, in cases of term deliveries, it was located in the isthmic area.