A retrospective analysis of patients treated for gestational trophoblastic diseases: a 4-year experience of a tertiary hospital.

AIM: To study incidence, clinical outcome, and follow-up data of the gestational trophoblastic disease (GTD) in patients diagnosed in the present Department. MATERIALS AND METHODS: This study included the authors' retrospective clinical records regarding the cases of GTD which were diagnosed and followed up between January 2011 and January 2015. Patients' age, gravidity and parity, obstetric history, subgroup of GTD, gestational weeks, management results, and pre-post treatment ß-hCG levels was investigated and an incidence study was constituted. RESULTS: Total of 56 GTD cases were hospitalized and clinical records of 16,840 normal spontaneous deliveries were evaluated during the study period. The incidence of GTD was 3.3/1,000 cases. After histopathological examination, nine of 47 cases were partial molar pregnancy, whereas 38 cases were complete moles. There were no choriocarcinoma and invasive moles. All cases were treated with vacuum curettage without complication. CONCLUSION: The GTD incidence in this clinic is high with a rate of 3.3/1,000 per pregnancy compared to Turkish literature. High birth rates of our population may play a role in high incidence results. Further investigation in this field is essential.

Role of mean platelet volume and neutrophil/lymphocyte ratio to predict single-dose methotrexate treatment success in tubal ectopic pregnancy.

OBJECTIVE: The aim of the study was to evaluate the value of mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) to predict single-dose methotrexate (MTX) treatment success in ectopic pregnancy (EP). MATERIALS AND METHODS: A total of 115 EP diagnosed and hemodynamically stable women were enrolled in the study and divided into two groups as group 1, the treatment success group (n= 78) and group 2, the treatment failure group (n = 37). The authors compared the groups in terms of MPV and NLR. RESULTS: MPV and NLR levels were higher in MTX treatment successful group than in failure group.The cut-off values of MPV and NLR were determined as 10.1 fL and 1.82, respectively. These cut off values showed similar sensitivity and specificity in prediction of MTX treat- ment success. CONCLUSION: MPV and NLR can be used as reliable markers to predict single-dose MTX treatment success however further studies are needed.

A predictor of small-for-gestational-age infant: oral glucose challenge test.

OBJECTIVE: This study was performed to investigate the role of first-hour 50-g oral glucose challenge test (GCT) parameters in predicting the risk of delivering a small-for-gestational-age infant and to determine the accuracy of estimated fetal weight. METHODS: We screened 2,643 pregnant women >20 years of age and excluded 552 patients according to exclusion criteria. Newborns were assigned to three groups as SGA(n:100), AGA(n:100), and LGA(n:100) according to birth weight. All mothers received 50-g GCT in their 24-28th weeks of gestation. We examined the relationship between birthweight and test results. RESULTS: First-hour serum glucose level after the test significantly predicted babies with small for gestational age. Optimal cutoff value was obtained at a level of 74.5 mg/dl with 67% sensitivity and 55% specificity. The estimated fetal weight of Hadlock 5 formula was strongly correlated with the birth weight (Pearson r = 0.89). CONCLUSION: Our study revealed that 50-g oral glucose challenge test may predict small-for-gestational-age cases with 67% sensitivity, and our data revealed that there is a significant correlation between estimated fetal weight of Hadlock 5 formula and the birth weight.

The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is the most important infectious cause of central nervous system disease and hearing loss in children. AIMS: In this study, we aimed to investigate the role of maternal screening in early diagnosis of congenital infection in highly immune populations. METHODS: A total of 163 women were included in the study; 103 of the subjects were pregnant and were at full term. The other 60 women were not pregnant, and all were healthy. RESULTS: CMV IgG seropositivity among the pregnant and control groups was found to be 98.1% (101/103) and 98.3% (59/60), respectively, and high IgG avidity was found in all women who had IgG positivity. We did not find any primary CMV infection in the two groups. The recurrent infection rate was found to be 5.82% in the pregnant group and 3.33% in the control group. There were no significant differences between the pregnant and control women in terms of CMV excretion in urine samples (4.85 vs. 3.33%, respectively; P = 1.000) or CMV-DNA presence in serum samples (1.94 vs. 0.0%, respectively; P = 0.532). The presence of symptomatic infection was not observed in any of the 104 babies born from the 103 pregnancies. CONCLUSIONS: According to our results, a maternal screening-based approach would be useful for only a very small group that is at risk of primary infection. Considering the cost of the scan, a routine maternal-based screening program is unadvisable in developing societies, but it is necessary for studies of different cohort groups and infectious diseases.

Experience with different techniques for the management of postpartum hemorrhage due to uterine atony: compression sutures, artery ligation and Bakri balloon.

OBJECTIVES: To report our experience with different management approaches to treat postpartum hemorrhage (PPH) due to uterine atony with reference to need for hysterectomy. METHODS: A retrospective study of data of all women who delivered in Dr. Sami Ulus Medical and Research Hospital between April 2010 and April 2013 was collected from the department's medical records, to identify patients who had undergone the compressive suture techniques, artery ligation, Bakri balloon application and hysterectomy operation because of PPH due to uterine atony. RESULTS: A total of 32 cases who had PPH due to uterine atony were identified. Bleeding was successfully treated without the need for hysterectomy in 25 patients. Compressive suture technique and artery ligation without Bakri balloon application were used in 22 patients with the success rate of 72.7%. Bakri balloon was applied to ten patients, and there were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. The overall success rate of intrauterine balloon tamponade alone was 70%. The success of Bakri balloons in combination with artery ligation and B-Lynch suture was promising. CONCLUSION: Our case series suggest that in the condition of PPH due to atony, both compression sutures and Bakri balloon tamponade are effective methods. In combination of uterine artery ligation and B-Lynch suture with Bakri balloon tamponade might be the best surgical approach due to its higher success according to our results. To obtain more information further studies with large case series are important.