Prenatal diagnosis and postnatal outcomes of right aortic arch anomalies.

PURPOSE: To give a report on the experience of our tertiary perinatology clinic on the pre- and postnatal management of the right aortic arch (RAA) by evaluating the patients as isolated and non-isolated RAA. MATERIALS AND METHODS: Patients referred to our perinatology clinic for fetal echocardiography were evaluated retrospectively. They were assessed in two groups: isolated RAA and non-isolated RAA. The isolated RAA group consisted of patients without any additional cardiac or extracardiac anomalies. According to our routine practice, all patients received detailed prenatal ultrasonography following fetal echocardiography and genetic counseling. RESULTS: A total of 60 patients were evaluated. 38 patients (63.3%) presented with additional cardiac anomalies. 21.7% had extracardiac anomalies, including 16.7% who also had cardiac anomalies. In 2 patients (3.7%) 22q11.2 microdeletion, in 2 patients (3.7%) trisomy 21, in 1 patient (1.9%) trisomy 13 and in 1 patient (1.9%) 20p12.1p11.23 (a deletion of 2880 kbp) were reported. The most common cardiac anomaly associated with RAA was Tetralogy of Fallot (25%). Fetal growth restriction was reported in 8.3% of the cases. 18 patients had isolated RAA. 16 out of the 18 patients had normal genetic analysis. 2 of them (11.11%) presented with a 22q11.2 microdeletion. CONCLUSION: A single-center experience on the diagnosis and management of RAA has been reported in this study. The results indicate that a prenatal cardiac evaluation in 3VV is of utmost importance in all pregnancies to detect RAA and refer these patients to the appropriate perinatology clinics for further evaluation and care.

What is the main factor in predicting the morbidity and mortality in patients with gastroschisis: delivery time, delivery mode, closure method, or the type of gastroschisis (simple or complex)?

Background/aim: There are numerous debates in the management of gastroschisis (GS). The current study aimed to evaluate perinatal outcomes and surgical and clinical characteristics among GS patients based on their type of GS, abdominal wall closure method, and delivery timing. Materials and methods: This study was a retrospective analysis of prospectively collected data of 29 fetuses with GS that were prenatally diagnosed, delivered, and managed between June 2015 and December 2019 at the Obstetrics and Pediatric Surgery Clinics of Kanuni Sultan Süleyman Training and Research Hospital. Results: Twenty-three of the patients had simple GS, and six of them had complex GS. The reoperation requirement, number of operations, duration of mechanical ventilation, time to initiate feeding, time to full enteral feeding, total parenteral nutrition (TPN) duration, TPN-associated cholestasis, wound infection, sepsis, and necrotizing enterocolitis were significantly lower in the simple GS group than in the complex GS group. The mean hospital length of stay was 3.5 times longer in the complex GS group (121.50 ± 24.42 days) than in the simple GS group (33.91 ± 4.13 days, p = 0.009). There were no cases of death in the simple GS group. However, two deaths occurred in the complex GS group. Conclusion: This study indicated that simple GS, compared with complex GS, was associated with improved neonatal outcomes. We suggest that the main factor affecting the patients' outcomes is whether the patient is a simple or complex GS rather than the abdominal wall closure method.

MATERNAL GUT MICROBIOTA IN PREGNANCIES RESULTING IN DOWN SYNDROME NEWBORNS - A PILOT STUDY.

Down syndrome (DS) is one of the main genetic abnormalities of newborns. Therefore, prenatal diagnosis of this syndrome is of paramount importance to the family and the community. The microbiota system is important in early brain development. We tried to study and compare gut microbiota (GM) composition in pregnancies that resulted in DS neonates with pregnancies that resulted in healthy children. The study population consisted of 21 pregnant women having delivered DS newborns (group 1) and 22 pregnant women who had given birth to healthy newborns (group 2). The GM composition was determined and compared between the two groups. There were no significant age and gestational age differences between the two groups (p>0.005 both). Regarding GM analysis, microorganisms of the families Clostridiaceae and Pasteurellaceae were more abundant in the group of women having delivered DS neonates than the group of women having delivered healthy newborns (p<0.05). The results of our pilot study showed that the GM system might have a role in the pathophysiology of DS. The GM changes may be used in the prenatal diagnosis and prevention of this syndrome. Further studies are needed in this field.

Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation.

The aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent intrauterine transfusion (IUT) for foetal anaemia due to red blood cell alloimmunisation and to determine the factors that affected the outcomes. All pregnancies that were treated with IUT due to Rh immunisation between January 2015 and June 2018 in the Kanuni Sultan Süleyman Training and Research Hospital, Department of Obstetrics and Gynaecology, were evaluated retrospectively. IUT due to non-Rh alloimmunisation, parvovirus B19 infection, chronic fetomaternal haemorrhage and foetal anaemia due to homozygous alpha-thalassemia were not included in the study. The perinatal and neonatal outcomes of the patients were retrospectively analysed. The gestational age, ultrasonography findings before and after IUT, laboratory results, complications related to IUT, and data on the newborns were recorded. The cases were divided into two groups, those with complication and those without complications, and their perinatal outcomes were compared. A total of 110 IUTs were performed in 42 foetuses. The survival rate after transfusion was 80.95%. Procedure-related complications were found in 12.7% of cases. There were no significant differences between the demographic and clinical characteristics of the patients with and without complications. The survival rate was lower and perinatal mortality was higher in foetuses with hydrops fetalis. IUT is a safe and effective procedure that can be used in the treatment of foetal anaemia in experienced centres. Survival rates can be increased by referring patients to experienced perinatology centres, by improving the IUT technique, and by reducing technique-related complications.Impact statementWhat is already known on this subject? The predominant use of IUT is to treat foetal anaemia due to red blood cell alloimmunisation. Despite the decrease after anti-D immune globulin prophylaxis, Rh immunisation is still a major cause of foetal anaemia. However, foetal survival rates have increased with the use of IUT.What do the results of this study add? The survival rates were increased after the development of a high-resolution ultrasound. Because foetal monitoring can be performed by ultrasonography, cord accidents and overload findings can be detected during transfusion, which allows for early interventions and increases survival rates.What are the implications of these findings for clinical practice and/or further research? The IUT procedure can be used in the treatment of foetal anaemia in experienced centres. After the technique was improved, the complication rates related to the procedure were decreased and foetal survival rates were increased. Further studies on the use of different IUT techniques will extend our findings.

Comparative cosmetic outcome of surgical incisions created by the PEAK Plasma Blade and a scalpel after cesarean section by Patient and Observer Assessment Scale (POSAS): A randomized double blind study.

OBJECTIVE: To compare the cosmetic result of the PEAK Plasma Blade with traditional scalpel in patients who had primary cesarean delivery by using POSAS (Patient and Observer Assessment Scale). MATERIAL AND METHODS: Fourty women between 20 and 40 years, who were planning to have primary cesarean delivery, were randomized for skin incision with PEAK Plasma Blade (n:20) and with scalpel (n:20) were blinded to their group allocation. At six months, the cosmetic outcome of the cesarean scar was assessed using the POSAS. Subjective scar rating was performed using the patient component of the POSAS. Objective scar assessment was performed by an observer dermatologist blinded to the patient's group allocation. RESULTS: The observer scores (p = 0,003), patient scores (p = 0,001) and the total scores (p = 0,001) of the POSAS scale were significantly lower in favor of the Peak Plasma Blade group with respect to the scalpel group. CONCLUSION: The PEAK Plasma Blade has superior cosmetic outcome compared to traditional scalpel skin incision at cesarean section.

Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study.

PURPOSE: Prevention of postpartum haemorrhage (PPH) is essential in the pursuit of improved health care for women. Oxytocin, the most commonly used uterotonic agent to prevent PPH, has no established the route of administration. In this study we aimed to compare whether the mode of oxytocin administration, i.e., intravenous and intramuscular administration, has an effect on the potential benefits and side effects. MATERIALS AND METHODS: A total of 256 women were randomised into two groups: intramuscular group (128) or intravenous group (128). RESULTS: Estimated blood loss during the third stage of labour was similar between the two groups (p = 0.572). Further there were no statistically significant difference was noted between the two groups in terms of the mean duration of labor, duration of the third stage of labor, manual removal of the placenta, need for instrumental delivery, need for blood transfusion, PPH ≥500 mL, PPH ≥1000 mL, or length of hospital stay. CONCLUSION: Using oxytocin by intravenous and intramuscular route has a similar efficacy and adverse effects.

Differentiated therapy in pre- and postmenopausal adnexal torsion based on malignancy rates: A retrospective multicentre study over five years.

INTRODUCTION: The purpose of this study was to investigate the clinical presentation, intra and postoperative outcomes in pre and postmenopausal women who underwent operations for adnexal torsion, and to define our experience diagnosing and managing postmenopausal women with adnexal torsion. METHODS: One hundred and fifty-seven patients who underwent operation with a diagnosis of adnexal torsion were analyzed according to demographic characteristics, menopausal status, preoperative signs and symptoms, surgical findings and applied surgical procedures, and pathological results in four tertiary centers. RESULTS: The main indication for surgery for the postmenopausal women was pelvic mass (58% vs. 40%), while for premenopausal women the main indication was suspicion of torsion (55% vs. 24%), (each p < 0.001). The duration of time between being admitted to the hospital and entering operating room as well as the duration of surgery and postoperative hospitalization were statistically longer in the postmenopausal group (each p < 0.001). While extensive surgeries were performed for 68% of the postmenopausal group, this was required for only 3% of the premenopausal group. Functional cysts were the most common pathologic finding in premenopausal women, and only 2 cases of malignancy (1.6%) were seen as opposed to the postmenopausal group, where malignancy was diagnosed in 16% of cases (p < 0.001). DISCUSSION: Adnexal torsion in postmenopausal women is an uncommon event. Malignancy risk should be considered before operation. CONCLUSION: The malignancy rate was 16% in postmenopausal women with adnexal torsion. Thus, extensive surgeries are more common in postmenopausal women with adnexal torsion.

Plasma serotonin levels are elevated in pregnant women with hyperemesis gravidarum.

PURPOSE: This study aimed to determine the association between serotonin and hyperemesis gravidarum. MATERIALS AND METHODS: Plasma samples of 87 women in their first trimester pregnancies with HG (n = 28), morning sickness of pregnancy (n = 30) and control (n = 29) groups were obtained. Plasma levels of serotonin were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. RESULTS: When the groups were compared with respect to serotonin levels, the group with hyperemesis gravidarum was found to have significantly higher serotonin levels (p = 0.001). A significant positive correlation was found between the serotonin level and the PUQE score in all study subjects (r = 0.578, p = 0.0001). A serotonin threshold of >277.58 ng/mL had a sensitivity of 75%, specificity of 86.4%, positive predictive value of 72.4%, negative predictive value of 87.9%, and a likelihood ratio of 5.53 (p = 0.0001). CONCLUSIONS: Our findings support the possible role of serotonin in the pathogenesis of hyperemesis gravidarum.

Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial.

PURPOSE: Almost 50% of the patients experience moderate-to-severe pain during endometrial biopsy. The study aimed to examine the effectiveness of intrauterine lidocaine for relieving pain during endometrial biopsy. METHODS: A randomised trial was conducted in 120 patients undergoing endometrial biopsy. Sixty-seven women were assigned to the paracervical block group and 53 were assigned to the intrauterine lidocaine group. The main outcome measure was pain intensity, measured using the visual analogue scale, during and after the procedure. RESULTS: The groups were similar with regard to age, body mass index, gravidity, total number of previous vaginal deliveries, menopausal status, and uterine depth. The pain scores immediately after the procedure were similar in the groups (p = 0.079). However, the pain scores 30 min after the procedure were significantly lower in the intrauterine group than in the paracervical group (p = 0.0001). CONCLUSIONS: Compared to paracervical block, intrauterine lidocaine may be the preferred anaesthesia for endometrial biopsy, and it does not cause any serious complications.