Emre Erdogdu

The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa.

OBJECTIVE To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. STUDY DESIGN We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents. RESULTS The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. CONCLUSIONS The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications.

Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia

OBJECTIVE To compare the spot urine protein-to-creatinine (P/C) ratio and 24-hour urine protein excretion in pregnant women with preeclampsia and also to determine the best discriminator values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. STUDY DESIGN Prospective study of 200 pregnant women with new onset hypertension at or greater than 140/90 mmHg after 20 weeks of gestation. Women were instructed to collect urine during a 24-hour period, and after the 24-hour urine sample collection was completed a mid-stream urine specimen was obtained for P/C ratio determination. The correlation between 24-hour urine protein excretion and spot urine P/C ratio was calculated. The receiver operating characteristic (ROC) curve was used to identify the cut-off values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. Areas under ROC curves were calculated. RESULTS There was a significant correlation between 24-hour protein excretion and the urine P/C ratio (r=0.828, p<0.0001). The cut-off P/C ratio for 300 mg per 24h was 0.28: sensitivity and specificity were 60.4% and 77.9%, respectively. The positive predictive value (PPV) was 77.5% and negative predictive value (NPV) was 60.9%. The cut-off P/C ratio for 2000 mg per 24h was 0.77: sensitivity and specificity were 96.8% and 98.6%, respectively. The PPV was 96.8% and NPV was 98.6%. Area under ROC curves for 24-hour urine total protein of 300-2000 mg/day and >2000 mg/day were 0.74 (95% CI 0.66-0.80) and 0.99 (95% CI 0.95-0.99), respectively. CONCLUSIONS Spot P/C ratio is a poor predictor of 24-hour proteinuria but can predict proteinuria >2000 mg better than 300-2000 mg.

Prenatal diagnosis and outcomes of fetal teratomas.

Our aim was to evaluate the diagnostic performance of ultrasonography (US) in the prenatal identification of teratomas and the perinatal outcome of the fetuses with those teratomas.

Third trimester uterine torsion

Uterine torsion is a rare event in the third trimester pregnancy. We report a case with uterine torsion diagnosed during cesarean section (CS). The patient was a 29-year-old primigravid at 39 weeks gestation with a singleton pregnancy. The patient arrived on the hospital with membrane rupture. Vaginal examination demonstrated a nulliparous cervix with no significant effacement or dilatation. Cephalopelvic disproportion was determined on the pelvic examination. The fetus was found to be in a head presentation. NST was reactive. Estimated fetal weight was 4,200 g. CS was recommended with the indication of cephalopelvic disproportion. Under general anesthesia, a Pfannenstiel incision was made and the lower uterine segment was exposed. There was no unusual finding at this point in the surgery. A transverse lower segment incision was made, a 4,100 g male baby was delivered. Then the uterus was examined again. There were two 8 and 6 cm subserous myomas on the fundus of the uterus. But the left ovary was on the right side of the patient and there was prominently engorged vessels on the lower surface of the uterus (Fig. 1). At this point, uterine torsion was suspected. After 180 derotation of the uterus, there was no uterine incision in the anterior lower uterine segment. The bladder was in normal anatomical position and the hysterotomy incision was in the posterior uterine segment. Because the myomas were thought to be the possible cause of the uterine torsion, myomectomy was performed. The patient recovered well from her surgery and discharged on the fourth postoperative day. Torsion of the pregnant uterus which does not exceed 45 is considered to be a physiological. Extreme torsion of 180 at term is a rare [1]. Because of the nonspecific presentation and generally successful outcome, it is possible that this condition is underreported. Jensen reported 212 and Wilson reported 38 cases from a variety of countries. Wilson and Jensen reported 18 and 12 % fetal mortality rate. Leimyomas, uterine malformations, ovarian cycts and adhesion are the known factors associated with uterine torsion [2, 3]. The diagnosis of uterine torsion was confounded by other diagnoses, failure to progress in labor or suspected abruption [4, 5]. Uterine torsion is usually established only after opening the abdomen or sometimes after the closure of the uterine incision as in case [6]. Rarely, in suspected cases, MR is useful for diagnosis. ‘X shaped upper vagina’ appearance is typical [7]. If the pregnancy is term, CS should be performed and the etiological factor should be treated. When derotation of the uterus is not possible, a transverse incision in the lower uterine segment is a safe choice [8]. Finally, uterine torsion should always be considered as part of a differential diagnosis of complications in the third trimester of pregnancy. Patients with sudden onset of abdominal pain and shock in late pregnancy may be due to torsion of uterus with or without concealed placental abruption. 11 % of the cases with uterine torsion is asymptomatic, anatomical landmarks; position of the adnexal structures and bladder should be examined carefully during CS [9, 10].

A rare case of rhombencephalosynapsis and prenatal diagnosis

Rhombencephalosynapsis (RES) is an extremely rare cerebellar malformation that is characterised by vermian agenesis associated with fusion of the cerebellar hemispheres and peduncles. RES is often ...

Prenatal diagnosis and outcome of lymphangiomas and its relationship with fetal chromosomal abnormalities

Abstract Objectives: Our aim was to evaluate ultrasound findings and perinatal outcome after prenatal diagnosis of lymphangioma. Methods: This was a retrospective case series study. We searched the archives of our ultrasound database at our center for cases with the prenatal diagnosis of the lymphangioma in the period between January 2008 and November 2014. We described maternal, fetal and perinatal variables for all cases. Results: Nine fetuses with lymphangioma were identified. All cases were diagnosed during the second and third trimesters with the average gestational age of 22.6 ± 3.9 weeks. The average diameter of lymphangioma was 55.4 ± 20.1 mm at the time of diagnosis. Five fetuses (55.6%) had lymphangioma on the neck, and four fetuses (44.4%) had lymphangioma on other localizations. Normal fetal karyotype was detected in all cases. There were a total of six live births, one intrauterine death and two medical terminations of pregnancy following the diagnosis of lymphangioma. No abnormal Doppler finding or hydrops were detected in the antenatal follow-up of remaining six cases. Conclusion: The risk of chromosomal abnormalities is very low in pregnancies with isolated lymphangioma. The outcome of pregnancies with lymphangioma is generally favorable and prognosis depends on their locations and size.

Effect of Young Maternal Age on Obstetric and Perinatal Outcomes: Results from the Tertiary Center in Turkey.

BACKGROUND Young maternal age is variously defined in studies of its effect on obstetrics and perinatal outcomes. Also, pregnancy has been reported as the leading cause of death in adolescent girls in low- and middle-income countries. AIMS The aim of the study was to evaluate whether young maternal age was associated with an increased risk of obstetrics and perinatal adverse outcomes. STUDY DESIGN Case-control study. METHODS This case-control study was derived from a database of the medical records between January 2008 and December 2012. In the present study, 1374 teenage pregnancy and 1294 adult pregnancy cases were included. After restriction of analyses to singleton primiparous women, 1282 teenage pregnancy and 735 adult pregnancy cases were analyzed. Maternal age was separated into three groups: 15 and less, 16-19, and 20-34 years. Adjusted odds ratios (ORs) were derived through logistic regression models for the potential confounding factors. RESULTS Adolescents aged 15 years and younger had higher risks of preterm delivery, early preterm delivery, intrauterine fetal death and neonatal death compared with women aged 20 to 34 years after adjustment for confounding factors. In addition, both groups of adolescents had higher risks for anemia and episiotomy and lower risk of cesarean delivery. The rates of preeclampsia, gestational diabetes, chronic diseases, intrauterine growth restriction (IUGR) were higher in the adult group. CONCLUSION Younger maternal age was correlated with increased risks of preterm delivery, fetal and neonatal death and anemia.

Critical pulmonary stenosis with prenatal diagnosis: a case series and review of literature

Objective: The aim of the study is to investigate the morphology of right ventricular cavity, the tricuspid valve size and the treatments applied at postnatal period in cases with critical pulmonary stenosis (PS) having intact ventricular septum. Methods: Seven cases included in the study who were considered to have critical PS in fetal echocardiography at second and third trimesters. The fetuses found to have antegrade jet stream at pulmonary valve level and reverse flow at ductus arteriosus as well as hyperthrophy and hypoplasia on the right ventricle were determined as critical PS. The cases were categorized as bipartite or tripartite according to the morphology of right ventricular cavity. Z-score of tricuspid valve was calculated according to the week of gestation. Results: Bipartite right ventricle cavity was found in cases diagnosed at second trimester, and tripartite right ventricle cavity in cases diagnosed at third trimester. Tricuspid valve Z-score of the cases with bipartite right ventricle morphology was less than those with tripartite. Two out of seven cases were monochorionic diamniotic twin pregnancies. Balloon valvuloplasty was performed on postnatal second day despite the prostaglandin E1 (PGE1) infusion in 3 cases with bipartite, and 3 cases required Blalock-Taussing shunt. In four tripartite cases, cyanosis control was better by PGE1 infusion, and balloon valvuloplasty was performed on postnatal second day in 3 cases and on postnatal 55th day in 4 cases. No Blalock-Taussing shunt was required. Conclusion: In critical PS cases, the treatment methods to be applied during postnatal period may vary according to the right ventricle being of two or three parts and the stenosis level of tricuspid valve.

Association between maternal serum 25-hydroxyvitamin D level and pre-eclampsia

Abstract Objectives: The objective of the study was to evaluate the association of maternal plasma levels of 25-hydroxyvitamin D (25(OH)D) at late second and third trimester and the risk of pre-eclampsia. Methods: In this prospective cohort study, maternal plasma 25(OH)D levels were measured at late second and third trimester in 77 women who later developed pre-eclampsia (31 non-severe and 46 severe cases) and 180 women without pre-eclampsia. Results: The mean gestational age of the timing of the blood sampling was 31.1 ± 4.4 at control group, 32.6 ± 5.7 at non-severe pre-eclamptic group and 32.3 ± 5.4 at severe pre-eclamptic group. The mean 25(OH)D concentration was significantly low in severe pre-eclampsia group (5.8 ± 4.5 ng/ml) than non-severe pre-eclampsia (11.8 ± 7.3 ng/ml, p = 0.039) and control groups (14.9 ± 12.0 ng/ml, p < 0.0001). There was no statistically significant difference in 25(OH)D concentration between non-severe pre-eclamptic and control groups (p = 0.404). In women with 25(OH)D concentration <20 ng/ml, a 12.45-fold increase in the odds of severe pre-eclampsia were detected. Conclusion: Women with severe pre-eclampsia had low serum 25(OH)D levels. The correlation between maternal 25(OH)D levels and aspartate aminotransferase, alanine transaminase, serum creatinine levels, platelet count were not determined. 25(OH)D levels may be used as an independent predictive marker of severe pre-eclampsia.

Unusual presentation of fetus in fetu in triplet pregnancy mimicking abdominal wall defect

Abstract Fetus in fetu (FIF) is a rare form of twinning in which an immature twin develops parasitically inside the other twin. The most frequent location of a parasitic fetus is the retroperitoneal region. A FIF located on the abdominal wall is an unusual condition, and it should be kept in mind as one of the differential diagnoses of abdominal wall masses.