N terminal-pro brain natriuretic peptide in fetal umbilical cord meconium-stained amniotic fluid: a prospective case control study.

PURPOSE OF INVESTIGATION: To evaluate the value of N terminal-pro brain natriuretic peptide (NTpBNP) levels in fetuses with meconiumtained amniotic fluid (MSAF). MATERIALS AND METHODS: In this case control study, of 36 fetuses, 19 had MSAF and 17 had normal, as controls. The blood samples were taken from the fetal umbilical cord just after birth to measure NTpBNP levels. RESULTS: Mean NTpBNP values were 1.01 ± 0.49 ng/ml in the patient group and 1.70 ± 0.93 ng/ml in the control group. The difference between the groups was statistically significant (p = 0.01) and power was 78% at 95% confidence interval. CONCLUSION: Serum NTpBNP levels were decreased in the study group. The result suggests that NTpBNP may be a valuable marker for fetuses with MSAF.

Percentage change in body mass index or gestational weight gain: Which is a better predictor of foetal macrosomia?

The aim of the study was to evaluate gestational weight gain (GWG) and percentage change in body mass index (BMI) for prediction of foetal macrosomia. A total of 409 term pregnant women, of whom 86 delivered macrosomic infants (> 4000 g) and 323 delivered non-macrosomic infants were recruited for the study. GWG and body mass index at delivery were significantly higher in the macrosomic than non-macrosomic group (15.8 ± 5.6 vs 13.9 ± 5.6, and 31.4 ± 4.3 vs 29.5 ± 4.3, respectively) (p < 0.05). The receiver operating characteristic curve analysis for testing the significance of weight gain in prediction of macrosomia showed an area under curve of 0.58 (p = 0.012, 95% confidence interval [CI] = 0.52-0.65), and significance of percentage change in BMI in prediction of macrosomia revealed an area under curve of 0.52 (p = 0.51, 95% CI = 0.46-0.59). BMI percentage changes both in obese (BMI ≥ 25) and non-obese (BMI < 25) groups were not statistically significant (p > 0.05). BMI percentage change does not seem to be a strong predictor of foetal macrosomia, and GWG was not found to be an independent risk factor after multivariate regression analysis was performed.

Relationship between meconium staining and thymic stromal lymphopoietin.

OBJECTIVE: Epithelium-derived thymic stromal lymphopoietin (TSLP), is a key pro-allergic cytokine that has recently been linked to chronic airway diseases. Our aim is to determine cord blood TSLP levels in pregnancies with meconium stained amniotic fluid. PATIENTS AND METHODS: A total of 44 pregnant women with meconium stained amniotic fluid and a total of 44 healthy pregnant women were enrolled in the study. Cord blood TSLP was measured with TSLP ELISA Kit. RESULTS: We found no statistically significant differences between 2 groups in terms of age and parity. TSLP levels were found to be significantly higher in the cord blood of pregnant women with meconium stained amniotic fluid (104.3 ± 96.9 ng/ml) compared with the control group (63.2 ± 65.3 ng/ml) (p = 0.022). CONCLUSIONS: It seems that TSLP is produced and released in response to meconium.

Does cervical ureaplasma/mycoplasma colonization increase the lower uterine segment bleeding risk during cesarean section among patients with placenta previa? A cross-sectional study.

OBJECTIVE: The underlying inflammation of endometrium may impede normal implantation of placenta during pregnancy. Our objective is to show cervical colonization of ureaplasma and/or mycoplasma as a marker of endometritis in pregnancies complicated with placenta previa that can be a risk factor for placenta accreta and peripartum hemorrhage. PATIENTS AND METHODS: Cervical cultures for ureaplasma urealyticum and mycoplasma genitalium have been taken from the endocervical region of the cervix of the patients. Subsequent uterine lower segment bleeding suggesting placenta implantation defects have been evaluated during cesarean section. RESULTS: Of 25 patients: ten (40%) had negative cervical cultures for cervical mycoplasma and/or ureaplasma, 9 (36%) were found to be culture positive for cervical ureaplasma, 1 (4%) was found to be culture positive for cervical mycoplasma. Half of the 10 patients with positive cervical cultures for ureaplasma or mycoplasma and 6 of (40%) 15 patients with negative results had experienced lower uterine segment bleeding during cesarean section. CONCLUSIONS: Bacterial colonization of cervix in particular with ureaplasma and/or mycoplasma is found to be strongly associated with placenta previa. Before a planned pregnancy, treatment of this infection with appropriate antibiotics is necessary to prevent underlying uterine endometritis that increases the risk for abnormal implantation of placenta.

Umbilical CORD S100B levels in active and passive smoker women.

OBJECTIVES: In utero fetal exposure to tobacco smoke has been found to be associated with adverse pregnancy outcome and increased maternal and fetal risks. The aim of this study was to compare umbilical cord blood S100B levels of infants of active smoker, passive smoker and non-smoker mothers. SUBJECTS AND METHODS: A total of 82 women, 26 habitual smokers, 27 passive smokers and 29 controls, who were admitted for repeat elective cesarean delivery with uncomplicated term gestations were included in the study. The age, gravidity, parity and gestational week at delivery were recorded on admission for the delivery. Ultrasonographic evaluation was routinely done on admission and birth weights of the newborns were measured immediately upon delivery. Umbilical cord blood was collected following delivery of the infants and serum S100B levels were analyzed at the end of the study period. The groups were compared according to S100B levels. RESULTS: No significant difference was found between the three groups regarding age, gravidity, gestational week at delivery or birth weight of the infants (p > 0.05). Biparietal diameter of the fetuses of active smoker mothers were significantly smaller than passive smokers and controls (90.3 ± 1.8 vs 94.2 ± 2.8 and 93.8 ± 2.5, respectively). Mean S100B level in the umbilical cord blood of active smokers was lower than passive smokers and controls (768.9 ± 446.9 vs 1050.1 ± 383.2 and 1035.3 ± 405.2) (p = 0.024). CONCLUSIONS: Fetuses of active smoker mothers had lower cord blood S100B levels, suggesting a possible injury of glial cells.

Predictive value of umbilical artery Doppler for adverse perinatal outcome in patients with HELLP syndrome.

OBJECTIVE: In this study, we aimed to evaluate in a prospective design the importance of pathologic umbilical artery (UA) Doppler findings as a predictive marker for neonatal outcome in patients with HELLP syndrome. PATIENTS AND METHODS: A total of 45 pregnant women at 24-42 weeks of gestation with a diagnosis of HELLP syndrome were included. The study group consisted of 20 patients with abnormal UA Doppler results, and the remaining 25 HELLP syndrome patients with normal UA Doppler results were assigned to the control group. All patients were followed up until delivery, and the neonatal characteristics were compared. RESULTS: Baseline characteristics of the groups were similar. In the study group, gestational week at delivery and infant birth weight were significantly lower (p < 0.05). The rates of significant neonatal morbidity, neonatal mortality, and neonatal intensive care unit (NICU) admission were significantly higher in study group patients (p < 0.05). CONCLUSIONS: UA Doppler abnormalities can be considered predictive of poor neonatal prognosis in patients with HELLP syndrome, as they were significantly related with higher rates of neonatal mortality and significant morbidity.

First and second trimester biochemical markers in familial mediterranean fever.

OBJECTIVES: Our aim was to investigate whether the maternal serum concentrations of first and second trimester serum analytes are altered in familial Mediterranean fever (FMF) pregnancies. MATERIALS AND METHODS: The screening tests were compared in a series of 16 serum samples from FMF pregnancies and in a cohort of 48 pregnant women with normal pregnancy. Serum samples were obtained between 11 and 13 weeks; 16 and 18 weeks gestation. RESULTS: Serum pregnancy-associated plasma protein-A (PAPP-A) levels, expressed as multiples of the median (0.9 ± 0.45 MoM) in the control group, were significantly higher than FMF patients (0.6 ± 0.3 MoM) (p = 0.027). Analyses of alpha-fetoprotein, human chorionic gonadotropin and oestriol levels showed no significant differences between FMF and normal pregnancies. CONCLUSIONS: Our study revealed that low levels of PAPP-A are associated with FMF.

The effects of water birth on neonatal outcomes: a five-year result of a referral tertiary centre.

OBJECTIVE: As scant information is present about the effect of water birth on newborns, we aimed to detect the fetal outcomes of water birth. MATERIALS AND METHODS: A hundred and ninety one among totally 220 newborns who were born by water birth were enrolled. The demographic and clinical features of the patients, birth complications, infection rates and rates of neonatal intensive care unit attendance were evaluated. RESULTS: The mean gestational week and birth weight were 39.2±1.3 weeks and 3326±409 g. 26% of the mothers was primiparous. Birth trauma was observed in three patients (1.6%) as one brachial nerve paralysis, one cord rupture and one cephal hematoma. Six of the patients (3.1%) were admitted to neonatal intensive care unit (NICU); four of whom had respiratory tract problems. CONCLUSIONS: Water birth is a safe method of delivery for the neonates when certain criteria are met.  

Ankaferd blood stopper in episiotomy repair.

BACKGROUND AND OBJECTIVE: Ankaferd blood stopper (ABS) is a new hemostatic agent that is licensed for external hemorrhages. ABS comprises of a standard mixture of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica which has also been approved in Turkey for the management of bleeding. The authors, aim was to evaluate the efficacy of ABS spray in terms of blood loss during episiotomy repair. MATERIALS AND METHODS: The authors included pregnant women with a term singleton fetus (37-40 wks) in a vertex position, who were at least 18-years-old, had delivered vaginally, and required a mediolateral episiotomy. The patients were randomly assigned to one of the two approaches: 20 (Group 1) to ABS and 20 (Group 2) to isotonic saline solution (0.9% NaCl). The authors applied 4 ml ABS spray solution (1 ml/puff X 4) or isotonic saline solution (0.9% NaCl) (4 ml) topically on a sponge applied on the episiotomy. The sponge was weighed before and after the episiotomy repair to determine the amount of bleeding. Hemoglobin values were also recorded on admission and 12 hours after delivery. RESULTS: Both groups were similar in terms of maternal age, parity, body mass index and gestational age. The sponges weighed heavier in Group 2. Baseline hemoglobin values measured on admission showed no significant differences between the groups. Hemoglobin on the first postpartum day was significantly higher in the ABS group (p < 0.05). The operative time for episiotomy repair for the two groups was also statistically insignificant. No major immediate or delayed complications were observed in either group. CONCLUSION: In this study group, the application of 4 ml of ABS instead of isotonic saline solution lessened bleeding.

Dehydroepiandrosterone supplementation improves predictive markers for diminished ovarian reserve: serum AMH, inhibin B and antral follicle count.

OBJECTIVE: To evaluate the effect of dehydroepiandrosterone (DHEA) supplementation on ovarian reserve by measuring markers such as antral follicle count, serum anti-Müllerian hormone (AMH) and inhibin B in patients with diminished ovarian reserve. STUDY DESIGN: This prospective study was undertaken at Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. Forty-one patients with diminished ovarian reserve were included in the study and received supplementation with DHEA 25mg, t.i.d., for at least 6 weeks. Serum AMH, inhibin B, follicle-stimulating hormone (FSH) and oestradiol, and antral follicle count were determined before and after DHEA supplementation. Baseline ovarian reserve parameters such as antral follicle count, FSH, oestradiol, AMH, inhibin B, clinical and laboratory IVF outcomes, and pregnancy rates were studied. RESULTS: There were significant differences in day 3 FSH, oestradiol, antral follicle count, AMH and inhibin B levels before and after DHEA supplementation in all patients (p=0.001, 0.001, 0.002, 0.001 and 0.001, respectively). The study population was divided into two age groups (<35 and ≥35 years) to determine whether there was a difference in the effect of DHEA supplementation between younger and older patients with diminished ovarian reserve. Significant differences were found in all of the parameters in both study groups (p<0.05). CONCLUSIONS: DHEA supplementation is an effective option for patients with diminished ovarian reserve. Prior to assisted reproductive technology, patients with diminished ovarian reserve should be offered DHEA supplementation as an alternative to oocyte donation.

The effect of diet on pregnancy outcomes among pregnant with abnormal glucose challenge test.

OBJECTIVES: Gestational diabetes mellitus (GDM) is defined as glucose intolerance, first time detected in pregnancy. Diagnostic criteria for GDM have changed over the decades. The aim of the study was to examine the effect of diet on birth weight, number of large for gestational age (LGA) (birth weight > 90th percentile) babies, total maternal weight gain, gestational age and route of delivery among patients with positive 50 g glucose challenge test (GCT) and negative 100 g oral glucose tolerance test (OGTT). PATIENTS AND METHODS: A prospective randomized controlled study was conducted among patients with positive 50 g GCT and negative 100 g OGTT. A plasma glucose value of 140 mg/dL was used as the threshold to define an abnormal GCT result. In group 1 50 patients were given a caloric diet and compared with group 2 with 50 patients without a given diet. Patients were followed up until delivery and evaluated for birth weight, number of LGA babies, total maternal weight gain, gestational age and route of delivery. RESULTS: There were no significant differences between the groups in maternal age, parity, body mass index and gestational age at delivery. There were significant differences in birth weight, number of LGA babies, total maternal weight gain during pregnancy. The mean gestational age at delivery was 38.7±1.2 weeks in group 1 and 38.9±1.1 weeks in group 2 (p = 0.615). The mean birth weight in group 1 was 3328±399 g and 3623±485 g in group 2 (p = 0.007), cesarean rate was 32% in group 1 and 40% in group 2 (p = 0.405). CONCLUSIONS: In the management of patients with positive 50 g GCT and negative 100 g OGTT, patients who were prescribed medical nutrition therapy by a dietitian experienced in GDM management had better perinatal outcomes.

Clavicular fracture: its incidence and predisposing factors in term uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate fetal and maternal predisposing factors associated with clavicular fracture. PATIENTS AND METHODS: In this study we reviewed all term uncomplicated deliveries in our Hospital between January 2009 and April 2010. The diagnosis of clavicular fracture was established by physical examination and in clinically diagnosed patients confirmed by radiology. We compared deliveries with clavicular fracture (study group) with a sample of 150 patients (control group) matched for time at active phase of labor from all vaginal deliveries. The data included maternal age, gestational age, fetal weight, and infant sex, presence of gestational diabetes, labor duration and induction and shoulder dystocia. RESULTS: In the Unit 16819 deliveries occurred during the period. The study included 9700 uncomplicated pregnancies at > or = 37 weeks of gestation delivered vaginally. We identified 73 cases of clavicular fracture with an prevalence of (73/9700) 0.75%. The study group had a significantly higher prevalence of shoulder dystocia (6.8% vs. 0.6%). Logistic regression analysis revealed maternal age and fetal weight as significant risk factors influencing clavicular fractures. CONCLUSIONS: Main risk factors for clavicular fracture identified from our study seem as maternal age and birth weight.  

Vaspin and C-reactive protein levels in hyperemesis gravidarum.

OBJECTIVES: To determine vaspin and C-reactive protein (CRP) concentrations in hyperemesis gravidarum (HEG). MATERIALS AND METHODS: Twenty-six women with HEG and 26 control subjects matched for gestational age and body mass index were examined. The levels of vaspin, CRP and lipid profile in all subjects were measured. RESULTS: The vaspin levels were significantly higher in hyperemetic patients than in the healthy pregnant women (1308.3 ± 116.5 vs. 1145.9 ± 335.1 ng/ml, respectively) (p < 0.05). Women with HEG had significantly higher levels of CRP than the control group. Serum vaspin concentrations inversely correlated with total cholesterol, triglyceride, very low-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol levels. CONCLUSIONS: We found evidence of inflammation in HEG.

Alarming rise of cesarean births: a single center experience.

BACKGROUND AND OBJECTIVES: The increase in cesarean section rates requires detailed investigation worldwide. The goal of this study was to analyze the distribution of indications and rates of cesarean sections in a developing country and to introduce the measures for controlling increased cesarean deliveries. MATERIAL AND METHODS: Electronic medical records of the patients who underwent cesarean section were retrospectively evaluated between the years of 2006 and 2008. RESULTS: Total of 42,547 vaginal delivery, 104 instrumental vaginal delivery and 28357 cesarean section were performed. The instrumental delivery and cesarean section rates were 0.14 and 39.9%, respectively. The most common indication was repeat cesarean that was present in 9224 patients (32.5%) followed by fetal distress in 6427 patients (22.6%). CONCLUSIONS: Encouraging vaginal delivery for patients with previous cesarean by community based national approaches seems the leading measure to control the increased rates of cesarean section in developing countries.

Removal of uterine fibroids during cesarean section: a difficult therapeutic decision.

PURPOSE OF INVESTIGATION: Myoma excision during cesarean delivery has traditionally been discouraged, however controversy persists among studies of myomectomy being performed during cesarean section. In this study, medical records of patients who underwent cesarean section our institution were evaluated retrospectively. METHODS: A total of 70 cases of cesarean myomectomy done during this period were included (group 1) and compared with the patients who underwent cesarean section alone (group 2). RESULTS: Mean surgical time of the myomectomy group was 58.1 +/- 23 minutes which was significantly increased (p < 0.01). Mean postoperative hemoglobin value was 9.6 +/- 1.5 in the myomectomy group and 10.8 +/- 1.01 in controls (p = 0.01). Length of hospital stay was significantly longer in the myomectomy group (p < 0.05). CONCLUSION: This study shows that myomectomy during cesarean section is a feasible procedure without any serious complications. The procedure is related with increased blood loss that does not require blood transfusion.

Rapidly progressing A/H1N1 (09) pandemic influenza virus infection in pregnancy.

We presented a pandemic H1N1 2009 influenza virus infection in two pregnant women who were referred to the intensive care unit (ICU) with a rapidly progressive disease course. Both women had unremarkable past medical history. The first woman had the symptoms of fever, cough, dyspnea and tachypnea lasting for four days. The second woman refused to take oseltamivir treatment. They were both referred to ICU with the diagnosis of pneumonia and acute respiratory distress syndrome. The second woman was intubated for two days in ICU. Both women showed a gradual improvement in their follow up and were discharged. Early admission, prompt diagnosis and early recourse to antiviral treatment gives better results in H1N1 infected pregnant women (Fig. 2, Ref. 10).

Two-year experience of obstetric cholestasis: outcome and management.

PURPOSE: Our aim was to evaluate the management and outcome of obstetric cholestasis in our perinatology unit. METHODS: We analyzed 44 pregnant women complicated by cholestasis. Data were collected retrospectively. Details of patient demographics and outcomes of pregnancy were recorded. Patients were randomized due to their decision to take ursodeoxycholic acid (UDCA) therapy or not. RESULTS: Forty-four women of age 28.09 +/- 4.6 years delivered 45 newborns. The mean gestational age at diagnosis of obstetric cholestasis was 32.36 +/- 3.75 weeks. The mean delivery time was 38.25 +/- 1.5 weeks. Spontaneous premature delivery occurred in five (11.4%) of the patients. No stillbirths were observed. Serum transaminases decreased significantly in 26 of the patients who were treated with oral UDCA therapy. Twelve (27.2%) babies were admitted to the neonatal intensive care unit (NICU). Out of 12 mothers whose babies were admitted to NICU, nine patients had not received UDCA (p = 0.07). CONCLUSION: UDCA is effective in lowering transaminases.

Successful water birth in a woman with vaginismus.

Vaginismus is a common sexual dysfunction. The case of a successful water birth in a woman with vaginismus is presented. Water birth should be considered as an alternative method of birth in women with vaginismus.

Treatment approaches in tubo-ovarian abscesses according to scoring system.

BACKGROUND: The aim of this study was to define treatment modalities in tubo-ovarian abscesses (TOA) using a scoring system. As there is no scoring system for TAO there is still a controversy on the management. In our opinion, as there is no evidence based TAO management strategy, a scoring system is needed in the management of these patients. For this purpose we prospectively tried to define that may be useful for favoring a treatment modality and the effects of the parameters on the outcome. METHODS: The study group comprised of hundred and eighty-four patients hospitalized between May 2001 and June 2008. Patients were divided in three groups according to the treatment modality--laparotomy (group 1, n: 122), medical treatment, (group 2, n: 34), and laparoscopic surgery (group 3, n: 28). Antibiotic regimens or other means of treatment strategies were directed according to our scoring system. RESULTS: Of the patients, 122 underwent laparatomy, 34 received medical treatment and 28 had operative laparoscopy. Intraoperative complications in the group of 122 patients who underwent laparatomy were bowel injury in 8 patients (6.5%) and ureteral injury in six (4.9 %). Fourteen patients (11.4 %) in the laparatomy group suffered from morbidity related to abdominal incision. In the laparoscopy group two patients (7.1 %) had bowel injury. CONCLUSION: With this study, we propose a scoring system in TOA cases and define treatment strategies accordingly. According to the results of our study, laparoscopy serves the best treatment option. Medical treatment, despite longer follow up, may be suitable in well-selected cases (Tab. 3, Ref. 39). Full Text in free PDF www.bmj.sk.

Vertical rectus abdominis myocutaneous flap for vaginal reconstruction after radical pelvic surgery for Stage II vaginal carcinoma.

Primary carcinomas of the vagina are uncommon, occurring only 2-3% of all gynecological malignancies. In women with early stage of disease, primary surgery, consisting of radical vaginectomy (plus hysterectomy in patients with tumors involving the upper vagina) and systematic dissection of lymphatic drainage of tumor, is a valid option. In these patients, a rectus abdominis myocutaneous (RAM) flap may be favorably used for vaginal reconstruction during radical pelvic surgery. Here we describe a case of Stage II vaginal carcinoma treated with radical pelvic surgery and vertical-RAM (V-RAM) flap reconstruction.