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 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.

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.