Unique Liver Disease of Pregnancy Requiring Anaesthesia Support: A Case with Severe Hyperemesis Gravidarum.

Hyperemesis gravidarum (HG) is one of the common unique liver diseases that occurs during pregnancy. Mild cases can be spontaneously resolved in time but severe cases usually require supportive medical treatment to relieve symptoms. Moreover, differential diagnosis may be required in severe cases that manifest with persistent nausea-vomiting, dehydration and weight loss refractory to treatment. Thus, to rule out any gastrointestinal pathology, this case was referred to the outpatient anaesthesia clinic after the first unsuccessful awake endoscopy attempt without sedation. Therefore, anaesthetic support for endoscopy of a pregnant woman with severe HG was presented in this case report.

Prevalence of gestational diabetes mellitus evaluated by universal screening with a 75-g, 2-hour oral glucose tolerance test and IADPSG criteria.

OBJECTIVE: To determine the prevalence of gestational diabetes mellitus (GDM) and its association with maternal age among Turkish women diagnosed by International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. METHODS: A cross-sectional study was conducted in 2013-2015 among non-diabetic pregnant women aged 18-49 years who were universally screened for GDM by IADPSG criteria. The percentage of women meeting each diagnostic threshold and the prevalence of GDM by age group were calculated. Linear trends were evaluated by logistic regression. RESULTS: Among 1434 women screened, 159 (11.1%, 95% confidence interval 9.5%-12.7%) were diagnosed with GDM; eleven of these women had been diagnosed according to a fasting glucose level in the first trimester. The prevalence of GDM was 6.6% (10/151), 7.3% (37/507), 8.8% (42/479), 16.7% (45/270), and 35.2% (25/71) among women aged younger than 25, 25-29, 30-34, 35-39, and 40 years or older, respectively. GDM prevalence increased with age (P<0.001). The numbers of women diagnosed with GDM in the second trimester who exceeded one, two, and three thresholds of the 2-hour oral glucose tolerance test were 66 (44.6%), 52 (35.1%), and 30 (20.3%), respectively. CONCLUSION: Prevalence of GDM was correlated with maternal age. Most women diagnosed in the second trimester exceeded the threshold at only one of the three timepoints.

Confirmation of the prenatal mosaic trisomy 2 via fetal USG and cytogenetic analyses.

Mosaic trisomy 2 in second-trimester amniocentesis is a very rare aneuploidy. The outcome of the pregnancies is quite variable, spontaneous abortions are frequent. A 37-year old woman underwent amniocentesis at 18 weeks of gestation because of abnormal serum screening with single umbilical artery (SUA) and cardiac dextroposition in fetal ultrasound (USG), and the cytogenetic result was 47,XX,+2[12]/46,XX[73]. Repeated amniocentesis and simultaneously cordocentesis at 21 weeks of gestation were ended with the analyses of the same mosaic aneuploidy. In addition to SUA and cardiac dextroposition, diaphragmatic hernia was detected in USG examination that was confirmed by fetal magnetic resonance imaging. The pregnancy was terminated at 22 weeks of gestation. Prenatal diagnosis of two or more cells with trisomy 2 at amniocentesis with USG findings should alert the physician for clinically significant aneuploidy and the presence of low-level trisomy 2 mosaicism at amniocentesis should be confirmed.

Comparison of pharmacokinetic profiles of moxifloxacin in Caesarean versus non-pregnant sectioned women by fully validated HPLC with fluorescence detection.

In this study, a simple, rapid, cost-effective, and sensitive reversed-phase high-performance liquid chromatographic method has been developed and validated for the analysis of moxifloxacin in plasma. The chromatographic separation was achieved on a Zorbax Eclipse XDB-C18 column (150 mm x 4.6 mm i.d.) connected to a Phenomenex C(18) column (4 mm x 3.0 mm i.d.) using a mixture of acetonitrile: 15 mM citrate buffer (pH 3) (23:77, v/v) as the mobile phase with isocratic system at a flow rate of 1 mL/min. Fluorescence detection was employed with excitation at 290 nm and emission at 500 nm. Lomefloxacin was used as internal standard. Plasma samples were prepared with addition of acetonitrile only. The method was fully validated according to the International Conference on Harmonization (ICH) guidelines. The results of the validation parameters were: linearity range, 3-6000 ng/mL (R(2) = 0.9994); mean recovery, 100.48 %; limit of quantification, 5 ng/mL; limit of detection, 1 ng/mL; and intra- and inter-day precision less than 3.2% and 5.1%, respectively. The robustness of the method was evaluated and confirmed with fractional factorial design. After validation studies, the method was applied in order to conclude the effects of pregnancy on postoperative pharmacokinetic profiles of moxifloxacin. For this aim, moxifloxacin was given to non-pregnant women (n=9) and caesarean-sectioned women (n=6) as a single intravenous dose (400 mg Avelox(R) infusion). Plasma samples were analyzed in order to compare pharmacokinetic profiles of pregnants and non-pregnants. Peak serum concentrations of non-pregnant and caesarean-sectioned women at the arterial port after the infusion were 4.95 +/- 1.50 and 1.56 +/- 0.16 microg/mL, respectively. The mean elimination half-life, volume of distribution and calculated area under the concentration-time curve (AUC)(0-infinity) were 5.54 +/- 0.73 h, 65.58 +/- 6.30 L and 49.95 +/- 6.30 microg.h/mL for non-pregnant women and 3.50 +/- 0.37 h, 215.85 +/- 24.87 L and 10.53 +/- 0.66 microg.h/mL for caesarean-sectioned women, respectively. These results indicated that pregnancy has a significant effect on the pharmacokinetics of moxifloxacin.