Alin Başgül

Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section: A prospective randomized study

OBJECTIVE To compare general and spinal anesthesia with respect to the short-term outcome of newborns born by elective cesarean deliveries. METHODS Pregnant women admitted to our hospital from January 1999 to July 2000, for whom elective repeat cesareans were planned after 37 weeks gestation, were allocated randomly after their informed consent to spinal anesthesia or general anesthesia. Maternal age, gestational age, birth weight, Apgars score, hospital stay duration, and duration of cesarean section time were all noted. The rate of the neonatal respiratory depression, perinatal asphyxia, and admittance to the neonatal intensive care unit of the infants were documented. We also studied arterial samples withdrawn from the cord for the pH, bicarbonate, PaO(2) (oxygen pressure, arterial), and PaCO(2) (carbon dioxide pressure, arterial). The serum levels of creatine kinase with myocardial-specific isoform, aspartate aminotransferase, alanine aminotransferase, and total cortisol levels of the newborns were measured and served in ruling out perinatal stress and in confirming the diagnosis of perinatal asphyxia (and of myocardial damage). Statistical analyses was performed with the use of an unpaired Students t-test, Chi-square test, and a power calculation was done. RESULTS From the randomly selected patients, we had 38 (45.2%) infants for general anesthesia and 46 (54.8%) for spinal anesthesia. None of our primary endpoints favored any of the study groups, and the clinical short-term outcome of the infants was similar in the neonates born both by spinal and general anesthesia (P>0.05). The biochemical assays did not rule out or confirm any differences in the occurrence of perinatal stress (P>0.05). CONCLUSION Anesthesia type does not seem to influence the short-term outcome of the newborn infants for the elective cesarean deliveries. We believe that both spinal and general anesthesia could be performed in elective term cesarean deliveries without any risk to the newborn infants.

The influence of prenatal counselling on postpartum contraceptive choice.

This study tested the hypothesis that individual counselling in the third trimester would increase postpartum contraceptive use to a greater extent than only providing an educational leaflet. A total of 180 third trimester pregnant women of mean age 28.3 years who were attending Marmara University Hospital for prenatal care were enrolled. One-third were randomly allocated to receive prenatal contraceptive counselling and the remaining two-thirds (control group) received an educational leaflet. Participants were followed-up at 6–9 months postpartum. The majority of subjects (91.5%) wanted to use contraception after delivery but 26.7% did not know which method to use. At follow-up, 79.6% of all women had begun a postpartum contraceptive regime and 68.7% were using a modern contraceptive method. Overall, there was no statistically significant difference in postpartum contraception use between the control and intervention groups in this study population. It is, therefore, concluded that prenatal counselling was not superior to educational leaflets for increasing the use of effective and modern postpartum contraception.

The efficacy of first-trimester PAPP-A and free βhCG levels for predicting adverse pregnancy outcome

Abstract Objective: To determine whether first-trimester measurements of maternal serum PAPP-A and free βhCG levels were associated with adverse pregnancy outcomes. Study Design: First trimester maternal serum free βhCG and PAPP-A were measured in 490 singleton pregnancies. Pregnancies were followed by the fetal-maternal unit, and predictive efficacy of these markers for small for gestational age (SGA) babies, gestational diabetes mellitus and hypertensive disorders were analyzed by cut-off values determined by using a ROC analysis, and also, by using the fifth percentile as the cut-off value. Results: The sensitivities for PAPP-A in predicting pregnancies with a SGA baby and those complicated by a hypertensive disorder were 49% and 73%, respectively, when optimal cut-off values were used. Specificities were 76% and 65%, respectively. Serum free βhCG had no predictive value for individual pregnancy outcomes. Conclusion: Efficacy of first trimester maternal serum markers in predicting adverse pregnancy outcome is low. Even after optimization of cut-off values, these markers do not appear to be clinically acceptable as an effective tool for screening for adverse pregnancy outcomes.

Hydatid Cyst of the Uterus

BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of Echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.

Thoraco-Omphalopagus Conjoined Twins Detected at as Early as 9 Weeks of Gestation: Transvaginal Two-Dimensional Ultrasound, Color Doppler and Fetoplacental Doppler Velocity Waveform Findings

Here we report a case of conjoined twins that were diagnosed antenatally by routine two-dimensional transvaginal ultrasound examination at as early as the 9th week of gestational age. The fetuses were of the thoraco-omphalopagus type and were sharing the liver, as confirmed by color Doppler. There was a reversed flow in the single ductus venosus of the twins. Umbilical arterial and venous blood flow waveform did not show any abnormality for this gestational age. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins in the first trimester by transvaginal two-dimensional ultrasound and color Doppler examination. Although conjoined twins were described at first trimester before, fetoplacental Doppler waveform findings at this gestational age have been described very rarely. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins and delineating the extent of organ sharing in the first trimester, and early diagnosis can help the parents with the option for pregnancy termination. The importance of expert early vaginal sonography and color Doppler findings is emphasized.

Three-dimensional ultrasound power Doppler assessment of the cervix: comparison between nulliparas and multiparas.

Abstract Aim: To assess the sonographic cervical characteristics between nulliparous and multiparous women. Subject and methods: Transvaginal three-dimensional ultrasound and power Doppler using the virtual organ computer-aided analysis (VOCAL) program were performed on 71 nulliparas and 59 multiparas at a mean gestational age of 25.3±7.9 weeks. We compared the cervical volume and power Doppler vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) between nulliparas and multiparas. Results: The mean cervical volume and mean VI, VFI, FI measurements were not significantly different between multiparas and nulliparas. Conclusion: Our observations suggest that the morphological changes in the cervix of parous women are merely configurational without a change in cervical mass and vascularization. These configurational changes might result from the inevitable cervical streching during labor and represent a healing process that does not involve a subsequent change in mass or vascularity.

Drug utilization and teratogenicity risk categories during pregnancy

A limited number of studies have investigated in detail the use of drugs during pregnancy. Researchers in the present study investigated the details of drug utilization in pregnant women during the month before pregnancy, at the time that they became aware of the pregnancy, and during the first trimester. Face-to-face interviews were conducted with 359 pregnant women who were admitted to the fetal medicine unit at a university hospital for diagnosis and follow-up. A questionnaire was used to document sociodemographic characteristics and details of drug use. Drugs were categorized according to the US Food and Drug Administration fetal risk classification. Mean maternal age was 29.9±5.1 y, and mean gestational age was 19.6±9.5 wk. Many of the pregnant women studied (46.6%) were university graduates, and most (61.9%) had a relatively high annual income. Mean gestational age when participants first learned of their pregnancy was 39.8±16.4 d. One hundred seventeen participants (32.6%) used drugs during the month before conception, 54 (15%) at the time when they learned of their pregnancy, 180 (50.1 %) at the time of the interview, and 289 (80.5%) during the first trimester. The percentages of drugs in categories D and X used by these subjects were 14%, 13.5%, 2.9%, and 5.9%, respectively. Most of the drugs were hormones. The total rate of drug utilization was not high before and during the first trimester of pregnancy. A considerable number of women were using drugs from the D and X categories; however, these numbers decreased significantly when women learned of their pregnancies. Intake of folic acid, vitamins, and iron was very low during the preconception period and was not high enough during the first trimester; this suggests that particular attention should be paid to the use of beneficial “safe” drugs during the preconception and early pregnancy periods.

The Istanbul international consensus statement on the perinatal care of multiple pregnancy

Abstract The purpose of this document is to expand the 1995 ISTS/COMBO Declaration of Rights which was initially produced to promote awareness of the special needs of multiple birth infants, children, and adults. It addresses the clinical and ethical dimensions of perinatal care of multiple pregnancy. The ad hoc committee was chaired by Isaac Blickstein. The following individuals were present (in alphabetical order): Birgit Arabin (Zwolle, Netherlands/Berlin, Germany), Isaac Blickstein (Rehovot, Israel), Frank A. Chervenak (NY, USA), Zehra Nese Kavak (Istanbul, Turkey), Louis G. Keith (Chicago, USA), Eric S. Shinwell (Rehovot, Israel) and Yves Ville (Paris, France). Secretary of the meeting was Alin Basgul (Istanbul, Turkey). This statement was endorsed by the International Society of Twin Studies (Ghent, Belgium, June, 2007) and by the World Association of Perinatal Medicine (Florence, Italy, September, 2007).

Antenatal diagnosis of velocardiofacial syndrome by 3D ultrasonography

1 Fetal Maternal Unit, Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey 2 Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey 3 Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey 4 Department of Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Turkey 5 Department of Pediatric Genetics, Marmara University School of Medicine, Istanbul, Turkey

P024: Comparing the first trimester and second trimester screening programmes for the screening of Down's Syndrome

Methods: This is a retrospective study of 83 fetuses referred to our center for nuchal abnormalities with a normal karyotype. The study included 58 cases with increased nuchal translucency ≥ 3.5 mm (71%), 15 cases with cystic hygroma (18%) and 10 cases with generalized hydrops (12%). All fetuses were followed up by serial detailed ultrasound examination. Post-natal follow-up was obtained from the paediatricians or general practitioners. Results: The median gestational age at the time of screening was 13 [11 to 14] weeks with a median maternal age of 31 [19–49] years. 40 of the 58 cases with increased NT (77%) delivered at a median gestational age of 38 weeks with a median birthweight of 3299 g. There were 3 spontaneous miscarriages and 2 cases of unexplained intrauterine death. 5 terminations of pregnancy were performed for fetal abnormalities. Outcome of pregnancy is unknown for 8 cases. 32 infants were follow-up to 14 [3–24] months and 66% of them are thought to be healthy. However various anomalies were found in 11 cases (34%): 2 cases with cardiacdefects and one with cleft palate were detected on antenatal US, a case of Noonan syndrome was diagnosed during the neonatal period, one child developed convulsions related to epidural hemorrhage and 3 children showed transient developmental delay but are developing normally at 12 to 14 months. Of the 10 cases with generalized hydrops and normal karyotype, 9 miscarried or underwent termination of pregnancy and of the 15 cases with cystic hygroma, 11 delivered of liveborn babies which follow-up led to the diagnosis of developmental delay in one and cardiac defect in another. Conclusion: Around 70% of pregnancies with increased nuchal translucency and normal karyotype have a good prognosis. Although most structural abnormalities are most commonly associated with hydrops or cystic hygroma, about 30% of them will show other anomalies including cardiac defects, intrauterine growth retardation, cleft palate and cerebral ventriculomegaly. Cystic hygroma without hydrops diagnosed in the first trimester carries a better prognosis as any few of them will evolve into a hydropic form in the second trimester.