Rasit Ilhan

Endouterine hemostatic square suture vs. Bakri balloon tamponade for intractable hemorrhage due to complete placenta previa.

Abstract Aim: To compare the efficiency of endouterine hemostatic square suture and the Bakri balloon tamponade in the treatment of bleeding due to complete placenta previa (CPP). Methods: Thirteen patients with the diagnosis of CPP and intractable bleeding were randomly divided into two groups in a single blind study. Group 1 (n=6) included patients in whom endouterine hemostatic square suture was applied, while group 2 (n=7) included patients in whom Bakri balloon tamponade was applied. The two groups were compared according to the maternal outcomes, the duration of caesarean section, the preoperative and the postoperative hemoglobin and hematocrit (Htc) values, the intraoperative and postoperative blood loss, as well as the newborn characteristics. Results: The duration of operation and the amount of intraoperative bleeding were significantly higher in group 1 (time: 78.3±8.1 vs. 62.8±3.9 min; P<0.05; intraoperative bleeding: 1946±242 vs. 1520±92 mL; P<0.05). The postoperative 24th h Htc values were found to be significantly lower in group 1 than in group 2 (25.6±3.7 vs. 29.5±1.3 g/dL; P<0.05). The postoperative blood loss was higher in group 1 than in group 2. (351±70 vs. 120±56 mL; P<0.05). Conclusion: There are two methods that are effective in preventing bleeding in CPP. However, the Bakri balloon tamponade may be a better alternative due to a shorter operation time and less blood loss.

The efficacy of ampicillin and Lactobacillus casei rhamnosus in the active management of preterm premature rupture of membranes remote from term.

Background We aimed to investigate the treatment efficacy of ampicillin prophylaxis accompanied by Lactobacillus casei rhamnosus over the latency period following preterm premature rupture of membranes (PPROM). Methods Records of 40 patients who presented with PPROM between 230/7–316/7 weeks were analyzed retrospectively. Patients were divided into two groups: group 1 (n=20), treated with ampicillin; and group 2 (n=20), treated with ampicillin plus L. casei rhamnosus. Clinical and laboratory parameters were compared. Delta (Δ) values of each laboratory parameter were calculated by subtracting the value at delivery from the values at admission to the clinic. Results Gestational weeks at delivery (28.1±0.3 weeks versus 31.5±0.4 weeks), latency periods (12.3±1.5 days versus 41.4±4.4 days), 5-minute APGAR scores (6.8±0.1 versus 7.8±0.1), and birth weights (1,320±98 g versus 1,947±128 g) were significantly higher in group 2. White blood cell (WBC) (12,820±353/mm3 versus 11,107±298/mm3), and neutrophil counts (10.7±0.5×103/L versus 8.2±0.5×103/L) were significantly lower in group 2 at delivery. The ΔWBC (2,295±74/mm3 versus −798±−406/mm3), ΔC-reactive protein (5±0.04 mg/L versus 1.6±0.2 mg/L), and Δneutrophil (3±0.2×103/L versus 0.2±−0.1×103/L) were significantly lower in group 2. Conclusion It seems that addition of L. casei rhamnosus to ampicillin prolongs the latency period in patients with PPROM remote from term.

Evaluation of maternal mortality cases in the province of Elazig, Turkey, 2007-2013: a retrospective study.

The aim of this study was to determine the causes and factors influencing maternal mortality. All maternal deaths occurring between January 2007 and November 2013 in the Elazıg Province of Turkey were retrospectively investigated. The maternal age, obstetric history, cause of death, encountered delay model of each case, as well as the overall number of annual live births in the Province were determined. The information of cases was obtained from Directorate of Public Health and hospital records. Families or family doctors were also interviewed to obtain details about the circumstances surrounding each death. There were a total of 64,423 live births in the Province of Elazıg between 2007–2013. The number and ratio of maternal deaths due to direct and indirect causes were 12 and 18.6, respectively. The direct causes of maternal death were hypertensive diseases of pregnancy (n=5, 41.7%), obstetric hemorrhages (n=3, 25%) and pulmonary embolism (n=1, 8.3%). The indirect causes of death were cardiac diseases (n=2, 16.7%) and malignancy (n=1, 8.3%). When classified according to the “Three Delays Model”, 2 cases were in the first delay model and 3 cases in the third delay model; the second delay model led to no maternal deaths. Hypertensive diseases of pregnancy are the leading cause of maternal mortality in our province. The preventable causes of maternal mortality and factors contributing to death must be identified to reduce the incidence.

Fetuin A Concentration in the Amniotic Fluid of Fetuses with Down Syndrome

Fetuin A Concentration in the Amniotic Fluid of Fetuses with Down Syndrome Background: Fetuin-A is a plasma protein called Alfa 2- Heremans Schmid glycoprotein. During the fetal life, it is the major component of non-collagenous bone matrix. The aim of this study was to examine the probable variation of Fetuin A which is produced by the fetal liver and trophoblastic tissue and found in abundance in the amniotic fluid Methods: Twenty cases in which amniocentesis were performed were included in the study between December 2012 and December 2013. Amniotic fluid samples were collected from women who underwent amniocentesis in the second trimester of pregnancy. Conventional cytogenetic culture was performed and ten fetuses with Down Syndrome (DS) were identified. They were classified as Group 1 and ten fetuses with normal karyotype were classified as Group 2. Levels of FetuinA in the amniotic fluid were measured in each group. Results: Age, gender, gestational age, obstetrics history and body mass index of the cases in Group 1 and Group 2 were similar. Mean amnion fluid Fetuin-A levels in Group 1 was 3.5 ± 0.4 ng/mL and these values were detected to be 4.7 ± 0.7 ng/mL in Group 2. There was statistically significant difference between the mean amniotic fluid Fetuin-A levels of two groups. (P=0.001 from the Mann-Whitney U test). Conclusion: In the present study, amnion fluid Fetuin-A levels were found to be significantly lower in the presence of DS. Decreased Fetuin-A levels may be effective on antenatal and postnatal developments of fetuses with DS. By the clarification of its importance treatment modalities may be developed.

The Importance of Clinical, Radiologic and Laboratory Parameters in the Diagnosis of Ovarian Torsion: Retrospective Study

Gereç ve Yöntem: Bu çalışma Aralık 2011 ile Aralık 2012 yılları arasında Fırat Üniversitesi Kadın Hastalıkları ve Doğum Kliniğinde over torsiyonu nedeniyle opere edilen hastaların dosyalarının incelenmesiyle gerçekleştirildi. Over torsiyonu nedeniyle cerrahi uygulanan hastaların yaş, gebelik ve doğum sayıları ile over torsiyonunu destekleyen ultrasonografik parametreler (over boyutu, over kisti varlığı, periferik dizilimli foliküller, doppler ultrasonografide vasküler akım varlığı, girdap işareti, pelvik bölgede serbest sıvı varlığı) ve laboratuvar parametreleri (hemoglobin, hematokrit, platelet ve beyaz küre sayıları) incelendi. Preoperatif bulantı, kusma, hassasiyet, defans ve rebound varlığı gibi semptom ve bulgular kayıt altına alındı. Verilerin istatistiksel değerlendirmesinde tanımlayıcı istatistik kullanıldı.

Double-balloon tamponade in the management of postpartum hemorrhage: a case series

To show the efficacy of double-balloon cervical ripening catheter in the management of postpartum hemorrhage originating from the lower segment of the uterus or the upper parts of the vagina. Methods Patients with intractable bleeding from the lower segment of the uterus and the upper parts of the vagina after Cesarean or vaginal deliveries were treated by double-balloon cervical ripening catheter. Results Double-balloon catheter was used in seven patients, and it was properly placed in all of them. No other intervention was needed to control bleeding. Two patients were delivered vaginally, and five patients were delivered by Cesarean section. Length of hospitalization was longer in the vaginal delivery patients (average hospitalization was 12 days in the vaginal delivery patients and 5 days in the Cesarean section patients). The need for blood and blood products transfusion (average of blood and blood products transfusion was 30 U in the vaginal delivery patients and 6 U in the Cesarean patients) was also higher in the vaginal delivery patients. Conclusion Although double-balloon cervical ripening catheter is designed for the induction of labor, it can successfully control intractable bleedings from the lower segment of the uterus and the upper parts of the vagina. This procedure can save patients from undergoing more morbid procedures.

Tessier number 30 cleft: report of an antenatally diagnosed case

Abstract Tessier no. 30 cleft, also known as median mandibular cleft or lower midline facial cleft, is extremely rare. Less than 100 cases are reported in the literature, which show great variation in severity and associated abnormalities. We herein report a median mandibular cleft extending into the neck. Its importance comes from the fact that it is one of the two cases diagnosed antenatally and it is the first one diagnosed as early as 17 weeks of gestation. Early diagnosis allowed the patient to deliver in a more specialized clinic that was able to deal with immediate postnatal complications. The family was psychologically prepared for the delivery of a baby with a major anomaly.

An advanced cervical ectopic pregnancy

Abstract The aim of this paper is sharing our experience in an advanced cervical ectopic pregnancy (CEP), which is managed by conservative surgery. We herein report a case of a 24-week pregnant woman with CEP. She was first referred to a tertiary center due to early starting intrauterine growth retardation and oligohydramniosis. Surgery was planned as soon as the diagnosis of CEP was made. By taking measures to reduce bleeding, conservative surgery was succesfully performed, and a hysterectomy was avoided. The fertility of the patient was preserved. The possibilty of CEP must be always be kept in mind, and the exact localization of the gestational sac must be determined in all patients. In advanced pregnancies, ultrasonographic examination must not only focus on examination of the fetus but also focus on the examination of contours of the uterus. These will give us the chance to diagnose CEP as soon as possible and reduce morbidity and mortality.

Perinatal outcomes of multiple pregnancies after assisted reproductive technology

Bulgular: Ortalama anne yaşı, gravida ve parite sırasıyla 29.5±5.8 yıl, 2.1±1.7 adet ve 1±1.7 adet idi. Gebeliklerin %68.5’i spontan, %25.9’u intrasitoplazmik sperm injeksiyonu-embriyo transferi sonrası ve %5.6’sı intrauterin inseminasyon sonrası idi. Hamile kadınların %35.2’sine tokoliz tedavisi ve olguların %50’sine prepartum betametazon uygulandı. YÜT çoğul gebeliklerinde uygulanan tokoliz oranı, spontan çoğul gebeliklerden yüksek idi (%58.8 ve %24.3, p=0.01). YÜT çoğul gebeliklerinde diyetle regüle gestasyonel diyabet oranı yüksek (%17.6 ve %2.7) iken; tiroit fonksiyon bozukluğu oranı ise daha düşük (%5.9 ve %13.5) idi.