Ahmet Yalinkaya

The comparison of amino-terminal probrain natriuretic peptide levels in preeclampsia and normotensive pregnancy.

Abstract Objective: The purpose of this study was to evaluate the levels of amino-terminal probrain natriuretic peptide (Nt pro-BNP) in preeclampsia in comparison with normotensive pregnancy. Materials and methods: Women with preeclampsia (proteinuria ≥300 mg/24 h and at least two readings of systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg) (n=32 mild preeclampsia and n=8 severe preeclampsia) were compared with normotensive women (n=40). Serum Nt pro-BNP was measured using an electrochemiluminescence immunoassay (ECLIA) method (Nt pro-BNP, Roche) with a Roche modular analytics E170 immunoassay analyzer. Statistical analysis was carried out by the Student t-test, and a P value of <0.05 was accepted as statistically significant. Results: The median serum Nt pro-BNP was 430±28.91 pg/mL in preeclampsia. The levels of serum Nt pro-BNP were 74±16.82 pg/mL in normotensive pregnant women (P<0.001) and significantly higher in women with preeclampsia (P<0.001). Conclusion: The higher levels of serum Nt pro-BNP in preeclamptic women may be an indicator of high left-ventricular filling pressure, and indicate left-ventricular diastolic dysfunction.

The use of recombinant factor VIIa in a primigravida with Glanzmann’s thrombasthenia during delivery

Abstract Glanzmann’s thrombasthenia is an inherited hemorrhagic disorder characterized by a severe reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists due to qualitative or quantitative abnormalities of platelet glycoprotein IIb-IIIa. Glanzmann’s thrombasthenia is characterized by potentially major mucocutaneous bleeding and prolonged bleeding time. Platelet counts, platelet morphology, prothrombin, and activated thromboplastin times are all within normal ranges in patients with Glanzmann’s thrombasthenia. Pregnancy and delivery are rare in Glanzmann thrombasthenia patients and have been associated with immediate postpartum hemorrhage. We describe the peripartum management of a 31-year-old primipara with Glanzmann’s thrombasthenia who underwent spontaneous vaginal delivery. Four units of single-donor platelets, two units of packed red blood cells, 36 µg/kg recombinant human coagulation Factor VIIa (rFVIIa) were given during peripartum management.

The relationship between thrombophilic mutations and preeclampsia: a prospective case-control study

BACKGROUND Preeclampsia and its association with thrombophilia remain controversial, due to inconsistent results in different studies, which include different ethnic groups, selection criteria, and patient numbers. The aim of this study was to determine the relationship between thrombophilia and preeclamptic patients in our region. METHODS In a prospective case-control study, we compared 100 consecutive women with preeclampsia and eclampsia (group 1) with 100 normal pregnant women (group 2). All women were tested two months after delivery for mutations of factor V Leiden, methylenetetrahydrofolate reductase (MTHFR), and prothrombin gene mutation as well as for deficiencies of protein C, protein S, and antithrombin III. RESULTS A thrombophilic mutation was found in 42 (42%) and 28 (28%) women in group 1 and group 2, respectively (P=0.27, OR 1.5, 95%CI 1.0–2.2). The incidence of Factor V Leiden mutation (heterozygous), prothrombin mutation (heterozygous), prothrombin mutation (homozygous), MTHFR mutation (homozygous) was not statistically significant in group 1 compared with group 2 (P>0.05). Also, deficiencies of protein S, protein C, and antithrombin III were not statistically significant in group 1 compared with group 2 (P >0.05). CONCLUSION There was no difference in thrombophilic mutations between preeclamptic patients and normal pregnant women in our region. Therefore, we suggest that preeclamptic patients should not be tested for thrombophilia.

Laparoscopy-assisted transinguinal extracorporeal gonadectomy in six patients with androgen insensitivity syndrome

OBJECTIVE To describe a new surgical technique to treat prophylactic gonadectomy in patients with androgen insensitivity syndrome. DESIGN Prospective study. University hospital. PATIENT(S) Six patients with androgen insensitivity syndrome.Laparoscopy-assisted transinguinal or suprapubic extracorporeal gonadectomy. MAIN OUTCOME MEASURE(S) Accessibility, operation time, and cost-effectiveness. INTERVENTION(S) Laparoscopy-assisted transinguinal extracorporeal gonadectomy under general anesthesia was performed successfully, with no complications, in all patients as a one-day procedure. The operation times were 12 to 22 minutes (average, 16 minutes). Histopathologic examination revealed testicles in all cases. The cost of each operation was approximately dollar 500 to dollar 1000. CONCLUSION(S) Laparoscopy-assisted transinguinal or suprapubic and extracorporeal gonadectomy has several advantages over laparotomy and operative laparoscopy, including short operating time, safety, simplicity, and cost-effectiveness.

Aggressive angiomyxoma of the female pelvis and the labium

Aggressive angiomyxoma is an extremely uncommon neoplasm of the female pelvis and perineum. In 1883, Virchow first introduced the entity of soft tissue myxomata (1). A century later in 1983, Steeper and Rosai presented nine cases of a distinctive soft tissue tumor in the female genitalia and pelvic soft tissues, and termed it ‘aggressive angiomyxoma’ (AAM) (2). Approximately 94 cases had been described until 1996, and Fetsch et al. reported the largest series of AAM (3). Despite its benign histological appearance, although it does not metastasize, AAM demonstrates a pronounced tendency for aggressive local, often multiple recurrences (4). It is histologically characterized by a predominantly myxoid stroma and an abundance of thinand thick-walled vascular channels (5). In our first case, isolated labial AAM including pedicle was 45 15 7 cm, which was the largest in the labial area, whereas, in literature, the largest size was reported to be 60 20 cm in the pelvic gluteal region (6). In literature, there is no evidence that AAM originating from Douglas’ pouch extended into the abdomen. We herein report two cases of this rare condition. The first one was the largest labial AAM, and the second orginated from Douglas’ pouch and extended into the abdomen.

Full-Term Pregnancy in a Non-communicating Rudimentary Horn: A CaseReport

Unicornuate uterus with a rudimentary horn is a rare anomaly of the female genital system resulting from inco mplete development of one of the mullerian ducts. It might end in grave obstetrical and gynecological complications in the absence of early diagnosis and proper management. A rare case of a full-term pregnancy in a non-communicating rudimentary horn is presented in this paper. A 24-year-old pregnant woman carrying the preliminary diagnosis of placenta percreta was referred to our clinic by reason of vaginal bleeding at a gestational age of 38 weeks. She underwent emergency cesarean section in our clinic, which led to the finding that her condition was not placenta percreta, but a full-term pregnancy in a non-communicating rudimentary horn. The need for a high index of suspicion as well as the use of ultrasonography plays a key role in the early diagnosis of this rare condition. Rudimentary horn pregnancy must be suspected in patients referred with the preliminary diagnosis of placenta percreta.

The comparison of endogenous angiogenesis inhibitors in normotensive and preeclamptic placentas: an immunohistochemical study

Objective: Recently, it has been reported that endogenous angiogenesis inhibitors play a key role in the pathophysiology of preeclampsia. Thrombospondin-1, angiostatin and vasostatin are endogenous angiogenesis inhibitors and so far have not been shown in placenta at the immunohistochemical level. The aim of this study was to compare staining patterns of these endogenous angiogenesis inhibitors immunohistochemically in placentas of preeclamptic and normotensive pregnant women. Methods: Into the study, placentas from 20 preeclamptic and 20 normotensive pregnant women were included. Central and peripheral tissues were taken from both sides of placentas. Paraffin tissue blocks were prepared and stained for immunohistochemical analysis. Slides were evaluated for syncytiotrophoblasts, cytotrophoblasts, extra-villous throphoblasts and decidual cells. The degree of staining of slides were classified as negative, weak, moderate and strong. Results: Samples from preeclamptic patients were compared with those of normotensive. Staining of thrombospondin-1 was observed to increase in decidual cells, syncytiotrophoblasts in chorionic and stem villi and stroma of stem villi. Increased staining of thrombospondin-1 was only significant in the amniotic epithelium of the central sections. In addition, increased staining intensity of angiostatin was detected in the amniotic epithelium and chorionic plate of central sections of placenta. In peripheral sections, staining of angiostatin also increased in decidual cells but decreased in chorionic plate. Vasostatin staining in decidual cells, decidual stroma and chorionic villous stroma from peripheral sections decreased, but any difference was not observed in the central sections. Conclusion: Our results suggest that thrombospondin-1, angiostatin and vasostatin may play a role in the pathophysiology of preeclampsia. Further molecular studies are required to understand this role.

Continuous amnioinfusion via an epidural catheter following spontaneous membrane rupture: A case report

Preterm premature rupture of membranes (PPROM) is seen in 3% of all pregnancies, and is a frequent cause of preterm birth, neonatal mortality and morbidity. The most important complications are maternal and foetal infection, prematurity, umbilical cord compression, hypoxia or asphyxia due to cord prolapse, pulmonary hypoplasia and extremity deformities. The basic approach to PPROM therapy aims to prevent premature birth and the development of foetal distress, and decrease the risk of maternal and foetal infection, and amniotic fluid loss. In compliance with these objectives, alternatives of PPROM therapy demonstrate a wide spectrum, including watchful waiting, amniopatch application, recurrent amnioinfusions and emergency birth. However, repeated amnioinfusions in cases of fluid loss, especially within 6 hours of therapy, provides only minimal benefit. In this case presentation, we attempted to describe a different and cost-effective continuous amnioinfusion technique performed to confer survival benefit for an immature anhydramniotic foetus affected by PPROM at the border of viability.

Bakri balloon placement effectively treats uterine atony and placenta previa

ABSTRACT The aim of this study was to explore the success rates of Bakri balloon placement in patients with placenta previa and uterine atony. In addition, we compared bilateral internal iliac artery ligation (B-IIAL) and Bakri balloon placement in terms of their ability to inhibit haemorrhage in postpartum placenta previa patients. The hospital reports filed annually from 2010 to 2015 were reviewed. In total, 54 patients were evaluated: 42 patients with placenta previa and uterine atony were treated with Bakri balloons, and 12 placenta previa patients with postpartum haemorrhage underwent B-IIAL when medical treatment failed. The results showed that the success rates of Bakri balloon placement rate in placenta previa and uterine atony patients were 71.4% and 89.2%, respectively. The comparative analysis of placenta previa patients treated via Bakri balloon placement and B-IIAL showed that the requirements for packed red blood cell and fresh frozen plasma, pre- and post-partum haemoglobin levels, pre- and post-partum platelet counts, and hospitalization times differed significantly between the two groups (all p < 0.05). Bakri balloon tamponade could be considered an effective treatment for placenta previa and uterine atony. The technique is minimally invasive and can serve as a second-line treatment for patients with postpartum haemorrhage when medical procedures fail.

Evaluation of Maternal Hemorrhage in Placenta Accreta

Objective: The aim of the present study is to provide a retrospective evaluation of placenta accreta cases to identify the factors affecting the blood transfusion requirement, which stands as one of the most important causes of maternal mortality and morbidity. study design: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included in this study. The patients’ data were collected from the hospital’s records. Results: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The group of patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and the blood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007). Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates.