Altay Gezer

Perinatal and maternal outcomes of fetal macrosomia

OBJECTIVE To determine the perinatal and maternal outcome of the macrosomic infants. STUDY DESIGN A case-control, retrospective study is performed in the Department of Gynecology and Obstetrics, Istanbul University Cerrahpasa Medical Faculty, between 1988-1992. The maternal and neonatal records of infants with birthweight of at least 4000g (n=1000) were reviewed. Another 1000 cases amongst the newborns delivered in the same period between 2500 and 3999g formed the control group. The obstetrical outcome variables of the groups including mode of delivery and the incidence of maternal and perinatal complications were compared. RESULTS A total of 16,112 deliveries occurred during the study period. The rate of macrosomic deliveries was 6.21% and the rate of the deliveries (4500g or heavier) was 1.04%. The mean birthweight of the study group was 4272+/-239 and 3277+/-316g of the control group (P<0.001). While the cesarean section rate was 28.8% for the study group and it was 16.6% for the control group (P<0.001). In the study group, 17 cases of brachial plexus palsy (2.4%), 16 cases of clavicular fracture (2.3%) and one case of humeral fracture were observed (P<0.001). The rate of perinatal mortality was 0.8% in the study group. No perinatal mortality was recorded in the control group. There were 14 cases (1.4%)of asphyxia related to delivery in the study group (P<0.01). The rate of maternal complications, were significantly higher in the study group (P<0.01). CONCLUSION The macrosomic infants are in increased risk for birth trauma and asphyxia. The risk of birth trauma for the infants weighing 4500g or more is even greater.

Hematological abnormalities in adolescent menorrhagia.

Background: The purpose of this study is to determine the frequency of underlying hematological disorders as the cause of acute adolescent menorrhagia. Methods: The records of 25 patients that were hospitalized with acute adolescent menorrhagia in the Obstetrics and Gynecology Department of Cerrahpa¸sa Medical School of ˙Istanbul University between 1988 and 1995 were analyzed. Results: The mean age of the patients was 13.9±1.6 (SD) years. A hematological abnormality that caused bleeding diathesis and acute menorrhagia was diagnosed in 7 of the 25 patients (28%). There were four cases of immune thrombocytopenic purpura, two cases of Van Willebrand disease and one case of acute promyelocytic leukemia. All seven patients with a coagulation disorder required blood transfusions and the mean hemoglobin level at presentation was 6.2 g/dl.

Oxytocin infusion in labor: the effect different indications and the use of different diluents on neonatal bilirubin levels.

Abstract Objective: To investigate the relationship of neonatal bilirubin levels to oxytocin infusion and the diluent used for oxytocin infusion. Materials and methods: The study was carried out as a prospective, randomized study in Istanbul University Cerrahpasa School of Medicine,Department of Obstetrics and Gynecology between January to December in 1995 . A total of 80 patients managed with oxytocin during labor, enrolled to the study. These patients randomly divided into isotonic % 0.9 saline (Group 1) and 5% glucose solutions (Group 2) by a consecutive order using a balanced block randomization scheme. Forty multiparous patients delivering without oxytocin infusion formed the control group (Group 3). The details of maternal age, gestational age, labor duration, mode of delivery, birth weight of the babies, total volume of fluid administered until delivery and total oxytocin dose were noted in each case. Sodium and initial bilirubin levels were measured in the cord blood. Later on, capillary blood bilirubin and hematocrit concentrations were measured on day 1 and 2 in the newborn nursery. The groups were compared according to these parameters. Results: The data of 29 patients in Group 1, 36 patients in Group 2 and 40 patients in Group 3 were suitable for analysis. The difference between study and control groups regarding the rate of hyponatremia, neonatal hyperbilirubinemia and neonatal jaundice was not statistically significant. Cord plasma sodium levels, cord plasma bilirubin levels and day 1 and 2 hematocrit and plasma bilirubin levels were not statistically different between the groups. Unrespectable of the diluent used, the cord plasma bilirubin levels and day 2 plasma bilirubin levels were significantly higher in the accelerated group. Conclusion: No significant effect of oxytocin infusion was revealed on neonatal hyperbilirubinemia unless oxytocin was for the augmentation of labor.

Appendectomy in the surgical staging of ovarian carcinoma

Objectives: Extensive debulking is accepted as the primary method of operative management for carcinoma of the ovary. However, there is no consensus regarding the role of appendectomy in primary surgical treatment. The aim of this study was to assess the role of appendectomy in the surgical staging and cytoreduction of ovarian carcinoma. Methods: The study was a retrospective review of 90 primary malignant ovarian carcinoma patients who had an appendectomy in addition to primary cytoreductive surgery. Results: Out of 90 patients, 10 (11.1%) had metastasis to the appendix. The rate of metastasis to the appendix was 11.5% (9/78) in malignant epithelial ovarian carcinomas and 8.3% (1/12) in non‐epithelial ovarian tumors. Of the patients with metastasis in the appendix, malignant epithelial ovarian tumors were identified in 90% (serous: 70%; clear cell: 20%), and non‐epithelial malignant ovarian tumor were disclosed in 10% (granulosa cell carcinoma). There were no metastases to the appendix in the other histological types. Although metastasis to the appendix was not observed in early stage ovarian carcinomas, it was detected in 21.4% (9/42) of stage III and 50% (1/2) of stage IV. Macroscopic tumor metastasis in the abdomen was noted in all patients with metastasis to the appendix. Conclusion: Appendectomy for stage I and II patients was not beneficial and did not affect final staging. As a result, for the proper staging of ovarian carcinoma there is no advantage to the addition of routine appendectomy to primary cytoreductive surgery in early stage (stage I and II) malignant epithelial ovarian tumors. Appendectomy would contribute to the cytoreduction of advanced stage disease if it is macroscopically involved.

Radical versus conservative surgery for vulvar carcinoma

The comparison of the radical and conservative surgical approaches for vulvar carcinoma in relation to the rate of recurrence and complications.

Neonatal morbidity mortality outcomes in pre-term premature rupture of membranes.

We present a retrospective review of 228 pre-term premature rupture of membranes (PPROM) singleton pregnancies followed-up in our clinic between 1996 and 2005. The most common neonatal morbidities in PPROM cases are respiratory distress syndrome (RDS), sepsis and intraventricular haemorrhage (IVH). The route of delivery does not affect newborn intensive care unit (NICU) requirements, perinatal asphyxia, sepsis and IVH rates in PPROM cases. NICU and PPV requirements, RDS, sepsis and IVH rates increase if the Apgar score is < 5. Neonatal morbidity and mortality rates increase as the latent period lengthens. C reactive protein (CRP) on admission, last CRP, birth weight and the 5 min Apgar score was found to be associated with NICU requirements; only the 5 min Apgar score was found to be associated with RDS; and last leukocyte count and maternal haemotocrit was found to be associated with sepsis and pneumonia, independently. In PPROM cases, CRP on admission, last CRP, birth weight, the 5 min Apgar score, last leukocyte count and maternal haemotocrit, should be considered to predict neonatal outcomes.

Chitotriosidase and YKL‐40 in normal and pre‐eclamptic pregnancies

To compare macrophage activation in normal and pre‐eclamptic pregnancies by determining YKL‐40 concentration and chitotriosidase activity in maternal and cord serum.

Vascular cell adhesion molecule‐1 (VCAM‐1) and leukocyte activation in pre‐eclampsia and eclampsia

Objective: To evaluate the levels of VCAM‐1 in pre‐eclampsia/eclampsia as a possible marker of leukocyte activation and endothelial damage. Methods: We performed a case‐control study on 25 healthy pregnant women and 35 patients diagnosed as pre‐eclampsia or eclampsia which were randomly selected. Peripheral venous blood samples were obtained and serum levels of VCAM‐1 were measured by enzyme‐linked immunoassay (ELISA). Results: In pre‐eclampsia/eclampsia, VCAM‐1 levels were higher than in normal pregnancy. Serum concentrations of VCAM‐1 were significantly higher in severe pre‐eclampsia and eclampsia compared to mild pre‐eclampsia or healthy controls. ROC analysis detected that VCAM‐1 ≥450 ng/ml had a sensitivity of 0.79 and a specificity of 0.90 in detecting severe pre‐eclampsia and eclampsia. Conclusion: This is the first study to correlate VCAM‐1 levels with severity of disease in pre‐eclampsia. Our findings indicate that increasing levels of soluble VCAM‐1 are present in the circulation of patients with severe pre‐eclampsia/eclampsia compared to mild pre‐eclampsia or healthy pregnant women. Elevated VCAM‐1 levels may represent a possible mechanism by which endothelial cells attract leukocytes and cause endothelial cell damage.

Prognosis of patients with positive screening but negative diagnostic test for gestational diabetes

Abstract  Objective: This is a retrospective study that is designed to investigate the prognosis of the patients with abnormal diabetes screening test and a negative 100 g oral glucose tolerance test that is accepted as the diagnostic test for gestational diabetes mellitus (GDM). Materials and Method: The records of 281 pregnant patients were reviewed. The data of the patients divided into groups with normal diabetes screening (1 h/50 g oral glucose tolerance test) and abnormal diabetes screening. The patients with abnormal diabetes screening were further divided into all values normal in 100 g Oral glucose tolerance test (OGTT), one value abnormal in 100 g OGTT and GDM subgroups. The prognosis of these patients was reanalyzed concerning the complications that may be attributed to glucose intolerance. Results: Abnormal diabetes screening test was detected in 89 patients (31.6%) and 14 cases were diagnosed as GDM (4.9%). The data of 9 patients were not suitable to analyze. In 31 cases out of 80 (38.75%), an obstetric complication was detected. The rate of similar complications was 27.0% (52/192) in the control group. The difference in the rate of complications was not statistically significant (p>0.05). When the patients with one value abnormal in 100 g OGTT, were further evaluated, the complication rates were 3/9 (33.3%) for the 1st hour abnormal patients, 1/1 for the 2nd hour abnormal patients and 1/1 for the 3rd hour abnormal patients. When the values of 100 g OGTT were compared in complicated and uncomplicated cases, the difference between the groups was not statistically significant (p>0.05). Conclusion: 100 g OGTT is the universal diagnostic test for GDM. There is a major subgroup of patients whose screening positive but diagnostic test (100 g OGTT) negative. These patients seem to be prone to develop obstetric complications related to glucose intolerance but there is not a proper means to detect these patients in clinical practice.

Systemic lupus erythematosus and pregnancy.

We present a retrospective study of 42 consecutive cases of systemic lupus erythematosus (SLE) and pregnancy followed and delivered during the period 2002–2007 in our department. The mean patient age was 28.6 years and the nulliparity rate was 45.2%. Disease flare up occurred in 9.5% of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 33%, 16.6% and 19% of patients, respectively. Mean gestational age at delivery was 36.9 ± 4.2 and mean birth weight was 2,750 ± 844 g. Stillbirth, fetal growth restriction, pre-eclampsia and pre-term delivery rates were 7.1%, 14.3%, 2.4% and 23.1%, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes. Antiphospholipid antibodies, renal involvement and lupus activation did not have any significant influence on poor obstetric outcome. Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.