Gokhan Yildirim

Efficacy of Intravenous Tranexamic Acid in Reducing Blood Loss after Elective Cesarean Section: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

We sought to determine the efficacy and safety of tranexamic acid (TA) in reducing blood loss during elective cesarean section (CS). We performed a randomized, double-blind, placebo-controlled study of 660 women who underwent elective CS. The patients were randomly selected to receive an intravenous infusion of either TA (1 g/10 mL in 20 mL of 5% glucose; N = 330) or 30 mL 5% glucose prior to surgery. The primary outcome was the estimated blood loss following CS. No demographic difference was observed between groups. The mean estimated blood loss was significantly lower in women treated with TA compared with women in the placebo group (499.9 ± 206.4 mL versus 600.7 ± 215.7 mL, respectively; P < 0.001), and the proportion of women in the TA group who had an estimated blood loss >1000 mL was significantly lower than in the placebo group (7 [2.1%] versus 19 [5.8%], respectively; relative risk [RR] 2.7; 95% confidence interval [CI] 1.1 to 6.3; P < 0.03). Furthermore, more women in the placebo group than in the TA group required additional uterotonic agents (48 [14.5%] versus 28 [8.5%], respectively; RR 1.7; 95% CI 1.1 to 2.6; P = 0.02). Maternal and neonatal outcomes did not differ significantly. TA significantly reduced bleeding during CS, the percentage of patients with blood loss >1000 mL, and the need for additional uterotonic agents. Furthermore, the incidence of thromboembolic events did not increase. Our results suggest that TA can be used safely and effectively to reduce CS bleeding.

Tumor necrosis factor α, interleukin-6 and interleukin-10 polymorphisms in preeclampsia

Aim:  Preeclampsia (PE) is one of the most serious disorders of pregnancy. The imbalance between pro‐ and anti‐inflammatory cytokines may play a role in its etiology. The aim of the present study was to investigate whether cytokine gene polymorphism is associated with PE, and to evaluate the relationship between genotypes and clinical/laboratory manifestation of PE.

Which type of mid-urethral sling procedure should be chosen for treatment of stress urinary incontinance with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape

Objective. To compare tension‐free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency. Design. Retrospective study. Setting. Gynecology department, Bakirkoy Women and Childrens’ Hospital, Istanbul. Sample. Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid‐urethral sling procedures (TVT = 180, TOT = 120). Methods. Before the operation, a complete medical history was taken and a gynecologic examination was performed. Subjects with detrusor overactivity or previous sling surgery were excluded. Clinical checkups were conducted at 3, 6, and 12 months, and then annually. Main outcome measures. Intraoperative complications, postoperative complications, and subjective cure rates. Results. There were no significant differences in demographics between the TVT and TOT groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy. At a mean follow‐up of 31.2±9.1 (range 12–46) months, the overall cure rates were 78.3% for TVT and 52.5% TOT (p<0.0001). The risk of treatment failure in women who received TOT was 4.9 times higher than in women who underwent TVT. There were no significant differences in perioperative and postoperative complication rates between the two groups. Conclusion. TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.

Can Intravenous Injection of Tranexamic Acid Be Used in Routine Practice with Active Management of the Third Stage of Labor in Vaginal Delivery? A Randomized Controlled Study

OBJECTIVE To estimate the effects of adding intravenous tranexamic acid (TA) to the standard active management of third-stage labor to reduce vaginal blood loss during the third and fourth stages of labor. STUDY DESIGN A prospective, double-blind, equivalence randomized, controlled study was performed. Women were randomly allocated to receive an intravenous infusion of TA (experimental group, n = 228) or 5% glucose (placebo group, n = 226) at delivery of the anterior shoulder. Active management of the third stage of labor, which includes prophylactic injection of 10 IU of oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction following delivery, was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor. RESULTS Mean estimated blood loss at the third and fourth stages of labor was significantly lower in the experimental group than that in the placebo group (261.5 ± 146.8 mL versus 349.98 ± 188.85 mL, respectively; p < 0.001). The frequency of postpartum hemorrhage > 500 mL was also lower in the experimental group (4, 1.8%) compared with that in the placebo controls (15, [6.8%]; relative risk, 3.76; 95% confidence interval, 1.27 to 11.15; p = 0.01). No episode of thrombosis occurred in the women who received TA. CONCLUSIONS The use of TA with standard active management of the third stage of labor reduced postpartum blood loss, and no increase in the incidence of thromboembolic events was observed.

Prenatal diagnosis of imperforate hymen with hydrometrocolpos

Imperforate hymen is one of the most simple and most common anomalies in the female genital organs, occurring in 0.1% of girls born at term. Some are recognized because of mucocolpos at birth, but the diagnosis is usually not detected before puberty. Rarely, obstetric sonography may prenatally detect imperforate hymen due to presentation of hydrocolpos or hydrometrocolpos in the fetus if fetal cervical and vaginal secretions accumulate in response to circulating maternal estrogens. Nonetheless, reports of prenatal ultrasound diagnosis of hydrometrocolpos are still very rare. In this article we report a prenatally diagnosed of imperforate hymen with hydrometrocolpos.

Termination of pregnancy for fetal anomaly

To assess the indications of termination of pregnancy (TOP) for fetal anomaly beyond 22 weeks of gestation.

Comparison of single-dose and two-dose methotrexate protocols for the treatment of unruptured ectopic pregnancy

Summary The purpose of this study was to compare the safety and success rates of single- and two-dose methotrexate (MTX) protocols for the treatment of unruptured tubal ectopic pregnancy. This retrospective study included 87 patients with ectopic pregnancy who were treated with MTX therapy (single-dose protocol: 46 patients; two-dose protocol: 41 patients). Both protocol groups were compared with regard to success rates, β-hCG and progesterone levels, the presence of cardiac activity, a history of previous ectopic pregnancy, ectopic mass size, gestational age, adverse events, and number of repeat MTX doses. Success rates between the single-dose and two-dose methotrexate therapy groups were comparable (87% vs 90.2%; OR 0.7, 95% CI 0.18–2.75; p = 0.74). No significant differences were found between the groups in factors influencing MTX treatment success rate, including the mean β-hCG level, mean progesterone level, the presence of a positive cardiac activity, mean ectopic mass size, mean endometrial thickness, and the presence of a yolk sac. There were also no significant between-group difference were found in the percentage of women who needed a repeat dose of MTX (17.3% vs 7.3%; OR 0.3, 95% CI 0.09–1.52; p = 0.20) and in the percentage of adverse events (45.7% vs 58.7%; OR 1.6, 95% CI 0.71–3.93; p = 0.28). In conclusion, medical treatment with single-dose or with two-dose systemic MTX seem to be equal therapeutic options for patients with unruptured ectopic pregnancy.

Preeclampsia Due to Fetal Non-immune Hydrops: Mirror Syndrome and Review of Literature

Objective. Mirror syndrome (Ballantynes syndrome) refers to the association of fetal hydrops and maternal preeclampsia. The aim of this study was to determine the relation and incidence between fetal hydrops and preeclampsia in our clinic. Methods. A retrospective review of patients associated with fetal hydrops and findings with preeclampsia was used. Seventy-five cases with single pregnancy and diagnoses with nonimmune hydrops fetalis were found. According to the data 4 cases were found related with preeclampsia. Results. Mirror syndrome is rarely encountered and underdiagnosed. We found a frequency of 5.3% (4 cases in 75 affected pregnancies) for single non-immune hydrops cases in which maternal hypertension occurred. Fetal outcome is depending on etiology and prognosis is mainly very low. Maternal symptoms and laboratory findings are resolving after intrauterine fetal death or delivery. Conclusion. Hydrops fetalis must be considered as a potential risk factor for preeclampsia. It is important that this clinical condition has a potential of about 5% for proceeding preeclampsia.

Membrane sweeping to induce labor in low-risk patients at term pregnancy: A randomised controlled trial

Objective. To evaluate the efficacy of membrane sweeping at initiation of labor induction in low-risk patients at term pregnancy (38–40 gestational weeks). Methods. This prospective study included 351 antenatal women who were randomly assigned to one of two groups: a sweeping of the membranes group (n = 181) and a no sweeping control group (n = 170). The primary outcome measure was the proportion of women who entered spontaneous labor within 1 week of entry into the study. Secondary outcome measures included mode of delivery and maternal and fetal complications. Results. Five patients (two in the sweeping group and three in the no sweeping group) were excluded from the study because of breech presentation at labor. There were no statistically significant differences between the two groups regarding maternal age, parity or Bishop score. The proportion of subjects who entered spontaneous labor before 41 weeks of gestation was significantly different between the two groups (p < 0.0001). The mode of delivery did not differ significantly between the groups and there was no statistically significant difference in maternal or fetal complications. Conclusions. Sweeping of membranes is a safe method to reduce the length of term in pregnancy and the incidence of prolonged gestation in a low-risk population. There is no evidence that sweeping the membranes increases the risk of maternal or neonatal adverse outcomes.

Is routine cervical dilatation necessary during elective caesarean section? A randomised controlled trial

Objective: The purpose of this prospective randomised study was to determine the effect of routine cervical dilatation during elective caesarean section on maternal morbidity.