Resul Arisoy

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.

Spot Protein/Creatinine Ratio in Preeclampsia as an Alternative for 24-Hour Urine Protein

BACKGROUND Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, random spot sampling for a urine protein to creatinine (P/C) ratio has been investigated. AIMS The aim of the study was to determine the diagnostic accuracy of the protein to creatinine ratio (P/C) compared with 24-hour urine collection for the detection of remarkable proteinuria and to evaluate the P/C ratio for different proteinuria ranges in patients with preeclampsia. STUDY DESIGN Case-control study. METHODS Two hundred and eleven pregnant women who met the criteria of preeclampsia comprised the study group and fifty three pregnant women were taken as the control group. Spot urine specimens for measuring P/C ratio were obtained taken immediately before 24-hour urine collection. The correlation between the P/C ratio in the spot urine samples and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test. RESULTS It was found a good positive correlation between the P/C ratio and 24-hour protein excretion, with a correlation coefficient (r) of 0.758. The best cut-off which gave the maximum area under the curve was 0.45 for 300 mg, 0.9 for 1000 mg, 1.16 for 2000 mg, 1.49 for 3000 mg, 2.28 for 4000 mg and 2.63 for 5000 mg per 24h. A P/C ratio above 0.9 strongly predicts significant proteinuria for more than 1 gram (AUC 0.97, 95% CI: 0.94-0.99 and sensitivity, specificity, positive and negative predictive value of 91%, 95.4%, 95.2%, and 91.2%, respectively). CONCLUSION The P/C ratio can be used as a screening test as a good predictor for remarkable proteinuria. The P/C ratio seems to be highly predictive for diagnosis to detect proteinuria over one gram and it could be used as a rapid alternative test in preeclamptic patients not to delay implementation treatment.

Evaluation of maternal serum folate, vitamin B12, and homocysteine levels andfactor V Leiden, factor II g.20210G>A, and MTHFR variations in prenatallydiagnosed neural tube defects

BACKGROUND/AIM Neural tube defects (NTDs) are common congenital malformations that develop as a result of interactions between several genes and environmental factors. Many factors have been investigated in order to understand the etiology of NTDs, and many studies have identified folate intake as a common contributing factor. The exact etiology of the disease is still unknown. MATERIALS AND METHODS In this study, we compared serum folate, vitamin B12, and homocysteine levels, along with common thrombophilia-related genetic variations, including factor V Leiden, factor II g.20210G>A, MTHFR c.677C>T, and MTHFR c.1298A>C, in 35 pregnant women with fetal NTDs and 38 pregnant women with healthy fetuses. RESULTS A significant difference in serum vitamin B12 level and factor V Leiden frequency was detected between the two groups. On the other hand, serum folate, homocysteine levels, and factor II g.20210G>A, MTHFR c.677C>T, and MTHFR c.1298A>C were not significantly different in the NTD group compared to the controls. CONCLUSION These results indicate that vitamin B12 supplementation along with folate may help in lowering NTD frequency. In addition, this is the first study that provides evidence for a possible relationship between increased NTD risk and factor V Leiden.

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.

Maternal and fetal risk factors affecting perinatal mortality in early and late fetal growth restriction

OBJECTIVE To determine the factors which affect the perinatal deaths in early and late fetal growth restriction (FGR) fetuses using threshold of estimated fetal weight (EFW) < 5(th) percentile. MATERIALS AND METHODS This retrospective study included singleton 271 FGR fetuses, defined as an EFW < 5(th) percentile. All fetuses considered as growth restrictions were confirmed by birth weight. Fetuses with multiple pregnancy, congenital malformation, chromosomal abnormality, and premature rupture of membrane were excluded. Samples were grouped in early and late FGR. Early FGR fetuses was classified as gestational age at birth ≤ 34 weeks and late FGR was classified as gestational age at birth > 34 weeks. Factors which affect the perinatal deaths were analyzed descriptively in early and late FGR. The perinatal mortality was calculated by adding the number of stillbirths and neonatal deaths. RESULTS The study included 86 early and 185 late FGR fetuses, 31 resulted in perinatal deaths, 28 perinatal deaths were in early FGR, and three perinatal deaths were in late FGR. Perinatal deaths occurred more commonly in early FGR fetuses with an EFW < 3(rd) percentile. Prior stillbirth, preeclampsia, the degree of increasing vascular impedance of umbilical artery(UA) and uterine artery (UtA) showed significant correlation with perinatal death in early FGR. All three perinatal deaths in late FGR occurred in fetuses with EFW < 3(rd) percentile and severe oligohydramnios. Also, placental abruption and perinatal death was found significantly higher in increased vascular impedance of UtAs whatever the umbilical artery Doppler. CONCLUSION Only EFW < 3(rd) percentile and severe olgohydramnios seem to be contributing factors affecting perinatal death in late FGR in comparison with early FGR.

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.