Selim Büyükkurt

Comparison of clinical and laboratory findings in early- and late-onset preeclampsia

Abstract Objective: To compare clinical and laboratory findings between the early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: This prospective longitudinal study was performed at a tertiary referral university clinic. All patients meeting the inclusion criteria were divided into two groups, the EOP group and the LOP group, according to gestational age at the onset of disease. The distinction criterion for early versus late onset was set as week 34 of gestation. Clinical and laboratory findings, and maternal–perinatal outcomes were compared between the groups. Results: A total of 157 patients with preeclampsia were included. A significant difference was observed between the groups in terms of diagnosis and severity of the disease (p = 0.007 and <0.001, respectively). The history of previous preeclampsia, diastolic blood pressure and hourly urine output on admission to the hospital were significantly different between the groups (p = 0.016, 0.018 and 0.024, respectively). Latent period for delivery and postpartum hospitalization time were longer in the EOP group than in the LOP group (p = 0.024 and 0.002, respectively). The patients with EOP received betamethazone (p < 0.001) and MgSO4 (p = 0.029) more frequently. Neonatal characteristics such as birth weight, low APGAR score and admission to neonatal intensive care unit were significantly different between the groups (p < 0.001, for all variables). Total proteinuria at 24 h was found significantly higher in the EOP group than in the LOP group (p = 0.012). Conclusion: The results confirmed the opinion that EOP is a distinct and more severe clinical entity than LOP. In particular, higher proteinuria is associated with EOP.

An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients

The aim of this study was to evaluate serum procalcitonin (PCT), C‐reactive protein (CRP), and plasma D‐Dimer levels in mild and severe pre‐eclampsia.

Non‐puerperal inversion of the uterus caused by leiomyosarcoma: A case report and clinical management

Uterine inversion is a rare complication of the postpartum period, but it is an even rarer complication of the non‐puerperal period. A 49‐year‐old nulliparous woman was admitted to the hospital with the following complaints: abnormal vaginal bleeding, pain, anuria and a mass protruding from the vulva. The mass was removed by twisting and a laparotomy was required for massive bleeding due to the inversion. The diagnosis of complete inversion was made during the laparotomy. Total abdominal hysterectomy and bilateral salpingo‐oophorectomy was performed and the pathological examination revealed a leiomyosarcoma. Uterine inversion in the non‐puerperal period is an extremely rare event and it should be kept in mind that the cause of the inversion may be a malignant disease, like leiomyosarcoma.

Misoprostol for midtrimester termination of pregnancy in women with 1 or more prior cesarean deliveries.

To evaluate the safety and efficacy of vaginal misoprostol for midtrimester termination of pregnancy (TOP) in women with 1 or more prior cesarean deliveries (CDs).

Prenatal Determination of the Upper Lesion Level of Spina Bifida with Three-Dimensional Ultrasound

Introduction: To evaluate the role of three-dimensional (3D) sonography in the prenatal detection of the upper pole in fetuses with spina bifida. Material and Methods: Women admitted to a tertiary center with pregnancies with isolated open spina bifida were enrolled in the study. All fetuses had 3D sonography to predict the lesion level. The exact lesion level was ascertained using radiography and/or autopsy following the delivery at term or abortion. Results: Forty-eight cases were eligible for this study. Twenty-eight fetuses were diagnosed in the second trimester and the lesion level was precisely predicted in 24 (86%) of them. In 14 (70%) of the 20 fetuses diagnosed in the last trimester, the level was accurately determined. The remaining 10 fetuses, from both the second and third trimesters, were found to have a lesion level that was within one segment of the predicted lesion level. The correct matching rate was 38/48 (79%), and agreement within one segment was achieved in all cases. Discussion: According to our data, 3D ultrasound is useful for the prenatal determination of lesion level in spina bifida, which is an important prognostic factor.

Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure.

BACKGROUND The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. CASE REPORT Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. CONCLUSION The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.

Perinatal autopsy evaluation of 2150 autopsies in the Çukurova region of Turkey.

Abstract Objective: We aimed to document the reasons of perinatal deaths in a large autopsy series performed in our institute, which is a reference center in the Çukurova region of Turkey. Material and Method: The study included 2150 autopsies performed between January 2000 and December 2012at our institute. Diagnoses were categorized according to the detected pathologies; congenital malformations were detailed based on systems. Results: A pathology was detected in 1619 of 2150 (73.3%) autopsies. Congenital malformations were the most common diagnosis with 68.2%. Neural tube defects and central nervous system malformations were the most frequent system malformation in 28.8% of cases, followed by the urogenital system (11.4%) and musculoskeletal system (8.3%), respectively. Malformation syndromes including multisystem anomalies were defined in 109 cases (9.3%). Conclusion: Congenital malformations are the most common reason for perinatal deaths, with autopsy having an additive role to prenatal and genetic evaluations and providing foresight for planning a subsequent pregnancy. Öz Amaç: Türkiye’nin Çukurova bölgesi için referans merkez konumunda olan ve oldukça geniş otopsi serisi içeren kurumumuzda yapılan fetal otopsi olgularını, değerlendirerek perinal ölüm nedenlerini tespit etmeyi amaçladık. Gereç ve Yöntem: Ocak 2000 ve Aralık 2012 yılları arasında kurumumuza gelen 2150 adet otopsi raporu yeniden değerlendirildi. Olgular tanılarına göre gruplandırıldı. Ayrıca konjenital malformasyonlar yer aldıkları sistemlere göre alt gruplara ayrıldı. Bulgular: Toplam 2150 olgunun 1619’unda (%73,3) patolojik bulgu saptandı. En sık patoloji %68,2 oranında konjenital malformasyonlar idi. Nöral tüp defektleri ve santral sinir sistemi anomalileri en sık malformasyon idi (%28,8). Bunu sırasıyla ürogenital sistem (%11,4) ve kas-iskelet sistemi (%8,3) takip etmekteydi. Bunun yanısıra, 109 olguda (%9,3) çoklu sistem tutulumu gösteren malformasyon sendromları tanımlandı. Sonuç: Fetal otopsi prosedürü, son yıllarda sayısal düşüş göstermekle birlikte, özellikle gebelik beklentisi olan kişiler için, prenatal tarama yöntemlerine tanısal katkısı olmakta ve malformasyonun yineleme olasılığı hakkında öngörü sağlamaktadır.

Do all deliveries with elective caesarean section need paediatrician attendance

Aim: To determine whether paediatrician attendance to deliveries with elective caesarean section (CS) is really needed for term and also for preterm babies with 35–37 weeks gestational age. Methods: Singleton newborns ≥35 gestational weeks without any identified risk factor were evaluated for resuscitation steps prospectively after CS under regional and general anaesthesia. Results: 545 infants were included in the study. 150 (27.5%) of infants needed only supplemental oxygen and 23 (4.2%) neonates needed bag and mask ventilation. None of the babies needed cardiopulmonary resuscitation (CPR) (chest compression) or endotracheal tube insertion/epinephrine administration. More infants required supplemental oxygen and bag-mask ventilation in general anaesthesia delivery group compared to spinal/epidural anaesthesia group (35.5% vs. 24.4%, p = 0.29 for oxygen and 9.2 % vs. 2.3%, p < 0.0001 for bag-mask) The need for resuscitation steps was not statistically significantly different between neonates who were born in 35–37 gestational week and neonates who were born ≥38 week (p = 0.170 for supplementary oxygen, p = 0.442 for bag-mask ventilation). Conclusion: There is not increased risk for chest compression and entubation for infants ≥ 35 gestation weeks without antenatally identified risk factors born with elective CS either under regional or general anesthesia and only 4.2% of the babies needed bag-mask ventilation, so a health care personel who knows basic NRP may be sufficient in the clinics where it is easy to achieve an advanced skilled health care personel when needed.

Mucoepidermoid carcinoma of the parotid gland with ovarian and peritoneal metastasis

Metastatic ovarian carcinoma generally arises from the gastrointestinal tract. Mucoepidermoid carcinoma is the most common malignant tumor of the salivary gland. It typically disseminates to the regional lymph nodes and surrounding soft tissues. Distant metastasis of the parotid mucoepidermoid carcinoma is very rare, and it usually occurs to the lungs, bones and liver. A 28‐year‐old woman with a history of high grade mucoepidermoid carcinoma of the parotid gland was admitted with ascites and bilateral ovarian masses. Breast examination, endoscopic evaluation of the gastrointestinal tract, total bone scintigraphy, abdominopelvic and chest tomography and cytological analysis of the ascites did not detect a primary malignancy. Nevertheless, pathological examination of the ovaries revealed a metastasis from the mucoepidermoid carcinoma. Metastatic ovarian tumors usually originate from the gastrointestinal tract. Other sources of tumor metastasis should also be considered.

Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012.

Abstract Objective: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. Methods: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics’s (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. Results: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. Conclusions: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.