Çağrı Gülümser

Laparoendoscopic single-site surgery for acute adnexal pathology during pregnancy: preliminary experience

Abstract Objective: To report the feasibility of laparoendoscopic single port surgical approach for the management of huge adnexal cysts and adnexal torsion during pregnancy. To discuss the optimal method of entry into the peritoneal cavity for pregnant patients. Design: Two case report. Method and patient(s): Two pregnant patients with adnexal mass. First patient, suffering from persistent and progressive abdominal distention and pain on her 12th week of pregnancy, was diagnosed with an ovarian cyst in 18 cm diameter on left ovary. The other patient had IVF twin pregnancy and presented with left adnexal torsion on the 25th week of pregnancy Intervention(s): Single-port laparoscopic ovarian cystectomy on the 12th week of pregnancy in patient one and single-port left adnexectomy in a twin pregnancy on the 25th week of pregnancy in patient two. Main outcome measure(s): Feasibility of single port laparoscopic intervention during pregnancy for adnexal mass. Result(s): Complete resolution of the symptoms for both pregnant women after the surgeries. No fetal and maternal complication was diagnosed during both pregnancies. Conclusion(s): Single port laparoscopy with open-entry technique is feasible and might be a better surgical option for the pregnant patients with adnexal pathology. However, further studies with larger sample size are needed to reach clear conclusion.

Decrease in middle ear resonance frequency during pregnancy

Many physiological changes occur during pregnancy. The aim of the study was to reveal whether there is a change in middle ear resonance frequency during pregnancy. A prospective case-control study was designed at a tertiary referral center. The study included 46 pregnant women at the third trimester (27-40 weeks) and 43 nonpregnant voluntary women. All the study subjects underwent pure-tone audiometry and multifrequency tympanometry. Pure-tone hearing levels at frequencies of 250 to 8000 Hz and resonance frequency values were compared between pregnant and nonpregnant women. Impact of age, side of the tested ear, and weight gained in pregnancy on resonance frequency were evaluated. Air conduction threshold values at frequencies of 250 Hz and 500 Hz were significantly higher in pregnant women than in the control group (P<0.001). Middle ear resonance frequency values of both ears in pregnant women were found to be significantly lower than those in control group (P<0.001). There was no statistically significant relation of middle ear resonance frequency values to age or side of the tested ear in both groups (P>0.05). A negative correlation between weight gained in pregnancy and middle ear resonance frequency values was determined for the left ear (correlation coefficient for left ears: –0.348, P=0.018). The results of this study suggest that resonance frequency may be decreased during the pregnancy. More comprehensive studies in which many pregnant women followed regularly before and after pregnancy are needed to have more certain links.

Fetal sex discordance in a monochorionic twin pregnancy following intracytoplasmic sperm injection: A case report of chimerism and review of the literature

A 39‐year‐old woman who became pregnant with twins after an intracytoplasmic sperm injection was referred at the ninth gestational week to determine chorionicity. Ultrasonographic examination showed a monochorionic diamniotic twin pregnancy. First trimester nuchal translucency measurements of the fetuses were 1.6 and 2.7 mm. A non‐invasive prenatal test was performed and revealed low risk. One fetus appeared to be female and the other male at the 14th gestational week. Second trimester anatomic scanning results were otherwise normal for both fetuses. The newborns delivered at term appeared to be normal female and male babies phenotypically. At the fourth month, buccal cell analysis showed chimeric karyotypes, 46,XX[98]/46,XY[2] and 46,XY[98]/46,XX[2] in the female and male infant, respectively. The recognition of sex discordance despite monochorionicity may be a clue for the diagnosis of such rare cases of chimerism in dizygotic twins, most of which occur in pregnancies obtained by assisted reproductive technology.

Maternal mortality due to hemorrhage: population-based study in Turkey

Abstract Objective: The aim of this study was to determine the epidemiological characteristics of maternal mortality due to postpartum hemorrhage, and to investigate whether national preventative measures of the Maternal Mortality Program have been successful in Turkey. Design: A population-based cohort study. Setting: Turkish National Maternal Mortality Data collected by the Turkish Ministry of Health. Participants: Women who died due to hemorrhage during pregnancy or after delivery within the initial 42 days, from 2012 to 2015, throughout Turkey (N = 812/146). Main outcome measures: The preventability and problems in each maternal death due to hemorrhage. Results: A total of 779 maternal deaths were identified during the study period. Our estimate of the Maternal Mortality Ratio (MMR) in the 3-year period was 19.7 per 100,000 live births. Of the 779 deaths, the report listed 411 as direct and 285 as indirect deaths. Direct obstetric complications were the leading causes of maternal deaths, the most common of which was maternal cardiovascular diseases (21%) and obstetric hemorrhage (20.6%). Conclusion: Improving data surveillance and implementing national guidelines for the prevention and management of major complications of pregnancy, childbirth, and puerperium is necessary to reduce MMR. The healthcare authorities of Turkey should continue to set a sustainable development goal of ≤70 maternal deaths per 100,000 live births by 2030. We believe our results may provide useful information for other developing countries that are aiming to reduce maternal mortality, as well as mobilize global efforts to improve women’s health.

P01.08: Comparison of preventive measures for preterm deliveries in twin pregnancies between pessary-progesteron and cerclage alone

Objectives: To evaluate effectiveness of combined treatment with cervical pessary (CP) and vaginal Progesterone (VP) for the prevention of preterm birth in singleton pregnancies with cervical consistency index (CCI) ≤ 5th percentile at 11–13 weeks’ gestation. Methods: Prospective study from January 2016 to February 2017 was performed and transvaginal CCI and cervical length (CL) measurement were taken at 11–13.6 weeks’ gestation in 615 singleton pregnancies. Patients with CCI ≤ 5th percentile were offered combined treatment with CP and VG 200 mg/day. VP was given until 34 weeks; CP was removed at 36 weeks or at the onset of labour. Patients with uterine contractions, bleeding or premature rupture of membranes were excluded. Preterm birth defined as born before 37 weeks of gestation, was match (1:3) by gestational age and CCI. Results: 36 pregnant women of study group (who received treatment) had an average CL measurement of 37.4 mm, CCI of 51% and the mean gestational age at enrolment was 12.3 weeks compared to the control group (12 patients who did not receive treatment) 40.4 mm, 53% and 12.1 weeks respectively. Combined treatment compared to no treatment was associated with a statistically significant increase at the gestational age at delivery (33.3 VS 28.4 weeks; p <0.001). Conclusions: Combined treatment with CP and VP in singleton pregnancies with CCI ≤ 5th percentile at 11–13.6 weeks increases the gestational age at delivery.

Maternal and perinatal characteristics of small-for-gestational-age newborns: Ten-year experience of a single center

Objective: To analyze the maternal and perinatal characteristics of small-for-gestational-age (SGA) newborns compared with appropriate-for-gestational-age (AGA) newborns in singleton pregnancies managed at our hospital between January 2006 and December 2015. Material and Methods: The study (n=456) and control (n=4925) groups included pregnancies resulting in SGA and AGA newborns, respectively. Additionally, two SGA subgroups were defined according to abnormal (n=34) and normal (n=57) Doppler findings. Maternal demographic features; intracytoplasmic sperm injection (ICSI) pregnancies; gestational age at delivery; birth weight; major congenital anomalies, karyotype abnormalities, and genetic syndromes; maternal and obstetric problems such as hypertensive disorders, diabetes, oligohydramnios, preterm birth; admission to the neonatal intensive care unit (NICU), and perinatal mortality were recorded, and the two groups were compared with respect to these parameters. Results: Mean maternal age, parity, gestational age at delivery, and birthweight were significantly lower; the frequencies of ICSI pregnancies, hypertensive disorders, oligohydramnios, preterm delivery, major congenital anomalies, karyotype abnormalities and genetic syndromes, admission to the NICU and perinatal mortality were significantly higher in the study group (p<0.05). None of the study parameters were significantly different between the two SGA subgroups (p>0.05). Conclusion: The association of SGA with ICSI pregnancies, hypertensive disorders, oligohydramnios, preterm delivery, congenital/chromosomal anomalies, NICU admission and perinatal mortality may be important in perinatal care. Clinical suspicion of SGA necessitates appropriate monitorization and management. Although obstetric outcomes were not significantly different between the two SGA subgroups with abnormal and normal Doppler findings in this study, this finding must be evaluated with caution due to the small sizes.

Recurrent Cystic Hygroma with Normal Karyotype in Two Consecutive Pregnancies

We herein describe a woman with two consecutive pregnancies affected by fetal nuchal cystic hygroma (CH) with a normal karyotype. A 33-year-old woman (gravidity 2, parity 1) was referred to us because of fetal hydrops. No consanguinity or Rh isoimmunization was involved in her current or previous pregnancy. First-trimester ultrasonography revealed nuchal CH, and chorion villus sampling was performed to exclude aneuploidy. In the first pregnancy, the CH had regressed and aortic coarctation was detected by second-trimester fetal echocardiography. In the current pregnancy, the CH had progressed and was complicated by the development of nonimmune hydrops. Termination of the pregnancy was performed at 21 weeks’ gestation. Recurrence of fetal CH in subsequent pregnancies is extremely rare. CH with a normal karyotype can be inherited as an autosomal recessive trait. This report describes a woman with recurrent CH with normal karyotypes and different prognoses

Is colposcopic evaluation necessary in all women with postcoital bleeding

OBJECTIVE To evaluate what extent postcoital bleeding (PCB) is an indicator of cervical cancer (CIN2 (+)). METHODS This is a retrospective cohort study. Between 2007 and 2013, amongst all referred patients, a total of 1491 consecutive women who had both conventional cytology and cervical biopsy were enrolled in the study. Of those 237 women have PCB, according to biopsy results, subjects were divided into two groups: CIN1 (-) and CIN2 (+). Multiple logistic regressions was used to construct a model to predict the occurrence of CIN 2 (+) based on age, menopause, marriage status, smoking, PCB, HPV and cytology. RESULTS Among the all women with CIN 2 (+) colposcopy guided biopsy result, PCB was 13.1% (53/406). The relationship between biopsy results and age, parity, menopausal status, marital status, smoking, presence of PCB, HPV DNA, and cytology is statistically significant (p=0.012, p=0.001, p=0.023, 0.013, p>0.001, p=0.038, p<0.001, p<0.001, respectively). According to regression analysis only smoking, HPV (+) and abnormal cytology increase the probability of CIN2 (+); 1.687 times (p=0.018), 4.065 times (p<0.001), 5.787 times (p=0.001) respectively. Having PCB only does not indicate an increased risk of CIN2 (+). CONCLUSION Colposcopic examination and biopsy should be performed only in the situation where women have PCB and any of the following: smoking, positive HPV, or abnormal cytology.