Nedim Cicek

Can Myomectomy be performed during pregnancy

Objective: To evaluate the effectiveness, safety, complications and outcome of pregnancy after myomectomy performed during pregnancy. Material and Methods: Five pregnant women with myomas requiring operation because of severe abdominal pain were included in the series at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine between October 1, 1996 and February 24, 2001. The patients were controlled with ultrasonography and cardiotocography every month up to 32 gestational weeks and then every 2 weeks. Cesarean section was performed on all patients at 37–40 weeks. Complications and fetoneonatal outcome were recorded. Results: The mean age of the patients was 31.4 ± 3.5 years. The mean parity was 1.4 ± 1.6. The median gestational age at the time of myomectomy was 17.8 ± 3.4 weeks. The mean size of the myomas was 14.0 ± 3.8 cm. The main symptom of all patients was severe abdominal pain in spite of analgesic medication. The mean duration of the operation was 40.0 ± 7.9 min. The mean blood loss was 280.0 ± 83.6 ml. The mean number of myomas removed was 2.8 ± 1.3. Conclusion: Myomectomy during pregnancy can be performed if necessary.

The effect of methyldopa treatment on uterine, umblical and fetal middle cerebral artery blood flows in preeclamptic patients

Abstract The purpose of this study was to evaluate the efficacy of methyldopa in the treatment of preeclamptic patients. This study was performed on 24 preeclamptic women who were in between 25–36 weeks of gestational age. 24 healthy pregnant women were taken as control group. Before starting treatment, 24 preeclamptic patients were examined with Doppler ultrasound. Pulsatility index, resistance index, systolic/diastolic ratio of uterine, umblical and fetal middle cerebral arteries were measured. Preeclamptic patients were treated with totally 1 g methyldopa per day. After 7 d, patients were reexamined with Doppler ultrasound. The effect of methyldopa on uterine, umblical and fetal middle cerebral artery blood flows were detected. Only one control with Doppler ultrasound was done to the healthy pregnant women. Before methyldopa treatment to the preeclamptic women, pulsatility index (PI), resistance index (RI) and systolic/diastolic ratio (S/D) on uterine and umblical arteries were significantly higher than the control group. However, fetal middle cerebral artery (MCA) values were significantly lower than the control group. When Doppler results of preeclamptic patients before and after the methyldopa treatment were compared, no significant differences in terms of Pulsatility Index, Resistance IndexI and S/D ratio of umblical and fetal middle cerebral arteries were found. However, the results of uterine artery were significantly lower after the treatment in preeclamptic patients. Treatment with methyldopa lowered the uterine artery resistance in preeclamptic patients but did not effect the resistance of umblical and fetal middle cerebral artery.

Corticosteroid treatment for prevention of prematurity complications

Abstract Objective: To investigate of efficiency to corticosteroid treatment for prevention of respiratory distress syndrome and other prematurity complications. Materials and Methods: One thousand and six babies born at 26–36th gestational age were investigated for following parameters; the development of respiratory distress syndrome, necessity of surfactant therapy, mean duration of daily ventillatory support, rates of Grade III or IV intraventricular hemorrhage, and periventricular leukomalacia, necrotizing enterocolitis, proven neonatal sepsis and neonatal death. Antenatal steroids were administered in the form of two 12-mg intramuscular doses of betamethasone 12 h apart as a total 24 mg in the 24 h and repeat courses of two 12 mg of betamethasone every 7 days after the first dose of the last course if undelivered. Babies were divided into 4 groups based on betamethasone treatment: The first group or control group didn’t received treatment; the second group received treatment and delivered within 12 h after first injection; the third group delivered 12–24 h after first injection; and fourth group delivered at least 24 h after first injection. The patients ongoing pregnancy at least 1 week were divided into two groups as a single dose and multiple courses in once a week. Results: Significant difference for development of respiratory distress syndrome between fourth group and others was found (p=0.029). There were significant difference for respiratory distress syndrome rate in hypertansive and premature rupture of membranes groups between fourth group and control group (p=0.002, p=0.041). There weren’t significant difference for RDS between repeat doses and single dose groups (p>0.05). Conclusion: Single dose corticosteroid is an effective treatment for the development of RDS and the prevention of other prematurity complications.

Unattended Home Labor until Complete Cervical Dilatation Ending with Hospital Delivery: Analysis of 238 Pregnancies

Objectives. Hospital fear and avoidance of the routine hospital obstetrical interventions cause some women with low-risk pregnancies to spend most of the active labor period at home, and subsequently they present to the hospital for delivery. Our aim was to analyze the maternal and neonatal outcomes of pregnancies with a planned hospital birth, yet spending the first stage of labor at home without a health provider and completing the delivery in the hospital setting. Methods. We retrospectively compared 238 pregnancies having home labor plus hospital delivery (study group) with 476 pregnancies that had spent the whole labor in the hospital setting, considering various maternal and neonatal outcomes. Results. Cesarean and episiotomy rates were lower (P < 0.0001 and P < 0.001, resp.), but neonatal intensive care unit admissions of the infants were more prevalent (P < 0.01) in the study group. Other maternal and neonatal outcomes including neonatal mortality were comparable. Conclusion. Although our preliminary data generally do support the safety of home active labor plus hospital delivery for low-risk pregnancies, the clinical implications of current data warrant further prospective trials.