Mehmet Bulbul

Gynecologic age is an important risk factor for obstetric and perinatal outcomes in adolescent pregnancies.

BACKGROUND Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity. AIM To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA. METHODS In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA≤3 years (101 women) and GA>3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period. FINDINGS Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA>3 years, adolescent pregnancies with GA≤3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU. CONCLUSION Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

Effect of multiple repeat cesarean sections on maternal morbidity: data from southeast Turkey.

Background Cesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity. Material/Methods A total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated. Results A statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6–53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9–37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications. Conclusions An increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient.

Mislocated extrauterine intrauterine devices: Diagnosis and surgical management

OBJECTIVE Presentation of the diagnostic and surgical treatment methods of our extrauterine intrauterine device (IUD) cases. MATERIAL AND METHODS We retrospectively evaluated the data of 21 extrauterine IUD cases at our clinic between 2008 and 2010. The symptoms, diagnostic methods, and surgical treatments were evaluated. RESULTS A total of 14 copper and seven levonorgestrel (LNG) IUDs were used. IUD had been inserted during lactation in 71.4% of the patients. The reasons for presentation of patients were unintended pregnancy in 19.05%, pelvic pain in 19.05%, and pelvic pain with vaginal bleeding in 23.8%. IUD in two patients were located the retroperitoneal area. IUD string had not been visible during routine follow-up in 38.1% of the patients. Laparoscopy was performed in 14 patients and laparotomy was performed for dense adhesions in seven patients. CONCLUSION Extrauterine IUDs can present with various clinical symptoms. Ultrasonography and X-Ray are sufficient for the diagnosis. Surgical removal is needed to prevent possible complications, and the preferred surgical technique in appropriate patients is laparoscopy.

Is there a relationship between low vitamin D and rotaviral diarrhea

For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection.

Association between serum 25-hydroxyvitamin D levels and TTN.

Aim: To investigate the association between serum 25-hydroxyvitamin D (25(OH)D3) levels and transient tachypnea of the newborn (TTN). Methods: Calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH) and serum 25(OH)D3 levels were measured in 51 infants diagnosed with TTN and 59 healthy control infants for comparison. Demographic factors including gestational age, birth weight, gender, delivery mode, parity, vitamin D supplementation during pregnancy and severity of TTN were recorded. Results: The serum levels of 25(OH)D3 were significantly lower in infants with TTN compared to infants with no respiratory distress (p < 0.01). There was no statistically significant difference in serum Ca, P and ALP levels between the groups while the serum levels of PTH were significantly higher in the study group (p < 0.01). No correlation was found between the serum 25(OH)D3 levels and severity of TTN. Vitamin D supplementation (400 IU/day) during pregnancy did not affect the serum levels of newborns. Conclusion: Our data suggests that lower 25(OH)D3 serum levels are associated with an increased risk of TTN and vitamin D may have a role in the pathogenesis of TTN.

Comparação de traqueotomia percutânea precoce e tardia em unidade de terapia intensiva para adultos

BACKGROUND AND OBJECTIVES Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. METHODS Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0-7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10cmH2O and those with bleeding diathesis or platelet count under 50,000dL(-1) were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. RESULTS There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p<0.05). CONCLUSION Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation.

Inner myometrial laceration – an unusual presentation of antepartum and postpartum hemorrhage: case reports and review of the literature

Abstract Objective: The aim of this study is to evaluate the diagnostic criteria, treatment options and progression of cases who have antenatal or postpartum hemorrhage due to internal myometrial laceration (IML) and to review the literature. Study design: The files of eight patients who were diagnosed to have IML between August 2012 and July 2015 were evaluated retrospectively. Results: The patient group consisted of four patients who had an emergency c-section due to massive bleeding during labor and four patients who had an emergency laparotomy due to uncontrolled bleeding after vaginal delivery after evaluation of the patient for signs of 4Ts (trauma, tissue retention, uterine tonus, and trombin). Primary suturation was the first-line treatment in all patients. In two of the patients, hysterectomy was performed after the defined surgical procedures were not successful in controling the bleeding. Conclusion: The presented case series is a pioneering study that describes IM which is a poorly defined reason of postpartum hemorrhage, as the cause of bleeding during labor. Primary suturation is the first-step, further surgery might be required in order to treat this life-threathening condition and the decision should be based on the age and the fertility status of the patient.

Contents Vol. 81, 2014

I.J.P. Arnhold, São Paulo A. Bereket, Istanbul J.-P. Bourguignon, Liège J.-C. Carel, Paris F. Cassorla, Santiago J.-P. Chanoine, Vancouver, B.C. F. Chiarelli, Chieti P.E. Clayton, Manchester W. Cutfi eld, Auckland M. Donaldson, Glasgow D.B. Dunger, Cambridge L. Dunkel, London U. Feldt-Rasmussen, Copenhagen J.J. Heinrich, Buenos Aires A.C. Hokken-Koelega, Rotterdam A. Hübner, Dresden K.Y. Loke, Singapore C. Maff eis, Verona C.J. Migeon, Baltimore, Md. M.B. Ranke, Tübingen M.A. Rivarola, Buenos Aires R.G. Rosenfeld, Los Altos, Calif. D.E. Sandberg, Ann Arbor, Mich. M.O. Savage, London T. Tanaka, Tokyo G. Van Vliet, Montreal, Que. R. Verkauskiene, Kaunas