Seyhun Sucu

Summary of 2185 prenatal invasive procedures in a single center: A retrospective analysis

Objective: To determine the frequency, indications, and outcomes of diagnostic invasive prenatal procedures (DIPP) performed in a university hospital. Materials and Methods: This retrospective, observational study included 2185 cases of DIPP (chorionic villus sampling, amniocentesis, and cordocentesis) performed at the department of obstetrics and gynecology of a university hospital between 2010 and 2016. We included all DIPP cases performed between 11 and 24 weeks of gestation. We compared the different types of DIPP performed in our hospital. Results: Two thousand one hundred eighty-five procedures were performed (1853 amniocenteses, 326 chorionic villus sampling, and 6 cordocenteses). The main indication for performing invasive procedures was abnormal results of aneuploidy screening for trisomy 21, followed by maternal age, and fetal structural abnormality. The fetal karyotype was altered in 154 (26.1%) cases. Trisomy 21 was the most common aneuploidy followed by trisomy 18, monosomy X, and trisomy 13. Fetal karyotype could not be revealed in 42 (2%) cases due to maternal contamination in 18 cases, inadequate sampling in 4 cases, and failure of cell culture in 27 cases. There were 2 pregnancy losses due to the invasive procedure (only in amniocentesis). Conclusion: The ideal approach to pregnancies with a detected chromosomal abnormality should be tailored according to the individual choice of the couples regarding whether they decide for or against a child with a known chromosomal abnormality.

Use of Bladder Filling to Prevent Urinary System Complications in the Management of Placenta Percreta: a Randomized Prospective Study

Introduction The aim of our study was to evaluate the effect of filling the bladder on peripartum genitourinary injuries (especially bladder complications) in women with placenta percreta and to compare patient characteristics. Material and Methods Our prospective cohort study consisted of pregnant women with placenta percreta who underwent planned cesarean hysterectomy at the Department of Obstetrics and Gynecology of Gaziantep University Hospital between January 2015 and July 2016. Bladders were filled with 300 ml saline solution to determine surgical borders better and enable dissection of the lower uterine segment without excessive bleeding or unintended injury. Results A total of 66 women were included in the study: 32 women whose bladders were filled during surgery (filled-bladder group) and 34 women whose bladders were not filled (not filled-bladder group). Comparisons of demographic and obstetrical data, surgical parameters, the need for transfusion, and bladder injury rates revealed no significant differences between the two groups. We did not observe any beneficial effect of filling the bladder on preventing urinary complications compared with the women whose bladders were not filled (p = 0.339). Conclusions Filling the bladder with saline solution and mobilization of the bladder from the lower uterine segment did not have a statistically significant beneficial effect on preventing complications of the genitourinary system. But although the beneficial effects were not significant, shorter operation times, shorter postoperative hospital stays, and fewer bladder injuries were noted in patients whose bladders were filled.

Chondrosarcoma mimicking an adnexal mass: A very rare case report

Chondrosarcoma is considered as a common primary bone sarcoma. These sarcomas can form large masses without any specific symptoms because there are no barriers in pelvic anatomy to prevent the enlargement of tumors, and can mimic ovarian masses. We present a pelvic chondrosarcoma in a woman aged 37 years who was misdiagnosed as having an ovarian mass due to the limited information obtained from imaging studies. Pelvic chondrosarcoma should be considered in patients who have pelvic masses with solid components. It should be kept in mind that interventions should be performed at centers where there are orthopedic surgeons with experience of this subject.

Is ultrasound-guided suction curettage a reliable option for treatment of cesarean scar pregnancy? A cross-sectional retrospective study

Abstract Purpose: The purpose of our study is to present clinical courses and outcomes of 50 first-trimester cesarean scar pregnancy (CSP) cases, which are managed either with transabdominal ultrasound (TAUS)-guided suction curettage alone or abdominal hysterotomy. Methods: We retrospectively analyzed our records from 2011 to 2016 at a single-center. TAUS-guided suction curettage alone was preferred in hemodynamically stable patients when the myometrial thickness was ≥3 mm and there was no vascular invasion. If the myometrial thickness was <3 mm and/or vascular invasion was present, then hysterotomy was preferred. Results: Statistical analysis of age, gravidity, parity, history of previous CS (≥3 or <3), presence of embryonic cardiac activity, complaints (vaginal bleeding, pelvic pain, or both), preoperative and postoperative hemoglobin levels (g/dl), blood transfusion, initial serum β-hCG levels, and duration to resolution of β-hCG demonstrated no significant difference between TAUS-guided suction curettage and abdominal hysterotomy groups. There was a significant difference between two groups in terms of postoperative length of stay in the hospital and gestational age. Conclusion: TAUS-guided suction curettage in selected cases may be considered as a reliable first-line treatment option due to its low cost, ease of application, lower side-effect profile, and potentially minimal influence on future fertility in CSP patients that are hemodynamically stable.

Oxidative Stress Markers in Tubal Ectopic Pregnancy

uterine cavity is known as ectopic pregnancy. It is a complication observed in 1%-2% of all pregnancies.1 Despite the progress in diagnostic techniques, ectopic pregnancy remains a crucial cause of maternal morbidity and mortality throughout the world, especially in the countries where prenatal care is poor.2 More than 95% of the ectopic pregnancies are located in the tuba.3 The etiopathogenesis of tubal ectopic pregnancy has not been clarified yet, though this condition is usually associated with tubal abnormalities and dysfunction, such as abnormal tubal-cilia activity or contractility.4 Reactive oxygen species produced during metabolic and physiological processes occurring in the body are known as oxidants. Antioxidants play a role in reducing the harmful effects that the oxidants cause in the body. There is a delicate balance between oxidants and antioxidants inside the cells, and if this balance tips in favor of oxidants, a condition of oxidative stress occurs, which may cause cellular damage.5 Any damage that occurs in the tubas at a cellular level may predispose women to a defective tubal transport of the embryo, which is a central process in ectopic pregJCOG 2018;28(1):9-13

No increase in free fetal DNA level in ectopic pregnancy: A preliminary study

Objective: The aim of this study was to diagnose ectopic pregnancy in the early period by measuring cell-free fetal DNA (cffDNA) levels in maternal blood using spectrophotometry. Materials and Methods: Thirty patients with ectopic pregnancy and 30 patients with first trimester intrauterine pregnancy were enrolled in this prospective controlled study. cffDNA levels in maternal serum were measured using spectrophotometry. Results: There were no differences between the two groups in terms of cffDNA absorbance levels. Conclusion: Spectrophotometry is not suitable for measuring cffDNA levels to diagnose ectopic pregnancies in the early period. Practical and cost-effective methods should be found or larger patient series should be investigated.

Early vulvar and umbilical incisional scar recurrence of cervical squamous cell carcinoma: Earlier than usually expected

Cutaneous metastasis is considered as a hazardous condition depending on the mean survival around 9 months, which usually originates from cancers of the breast, lung, ovary, colon, and rarely from the cervix. The crucial prognostic factor of cutaneous metastasis depends on the period between the primary malignancy and cutaneous metastasis. We report two cases of the unusual presentation of squamous cell cancer of the cervix that developed vulvar and umbilical metastasis in the 5th month of primary treatment. Both of our patients survived for 11 months following the primary treatment. In addition, our first case is the earliest vulvar recurrence of cervical carcinoma in the English literature following appropriate medical and surgical management.

Emergency peripartum hysterectomy: single center ten-year experience

Abstract Purpose: The purpose of our study is to determine the incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a university hospital. Methods: This retrospective study includes 54 cases of EPH performed at the department of obstetrics and gynecology of Gaziantep University Hospital between the years 2005–2015. We included all hysterectomy cases during the first 24 h after delivery beyond 20 weeks of gestation. We compared the most common indications of EPH between each other. Results: There were 54 EPH out of 8922 deliveries with an incidence of 6.1 per 1000 deliveries during the study period. The most common indication was abnormal placentation (74.0%). Urinary tract injury (33.4%) was the most common intraoperative complication. Bilateral hypogastric artery ligation, urinary tract injury, type of hysterectomy, post-op stay in the hospital, delivery in another hospital and other complications were significantly related to the type of EPH indication (p < 0.05). Conclusion: Abnormal placentation was the most common indication for EPH. Previous CS can be suggested as a high-risk factor for abnormal placentation. The delivery should be performed in appropriate clinical settings with experienced surgeons when high-risk factors like abnormal placentations are determined preoperatively.

Analysis of cystic hygroma diagnosed in the prenatal period: 5-years’ experience at a tertiary hospital in Southeastern Turkey

Abstract Purpose: Our aim was to evaluate the association of cystic hygroma (CH) with fetal malformations and also to investigate the outcome of fetuses with CH diagnosed in the prenatal period. Methods: We divided the CH patients into two main groups as isolated CH or CH associated with the congenital structural abnormality (CSA) by measuring the thickness of CH and showing other fetal abnormalities. Pregnancy outcomes were recorded as spontaneous abortion, elective termination, intrauterine death, live birth, postnatal death, and lost to follow-up. Results: There were 74 cases of fetal CH including 19 in CSA-CH group and 55 in isolated-CH group diagnosed between 11 and 21 weeks’ gestation. Karyotype analysis of these 28 patients revealed 18 (64.2%) normal karyotypes. Pregnancy outcomes included 54 elective terminations, five postnatal deaths, one spontaneous abortion, six live births, four intrauterine deaths, and four patients were lost to follow-up. Conclusion: In the presence of any CSA concurrent with CH, prognosis may be considered as poor and any additional help of fetal karyotyping is questionable. But fetal karyotyping may be advocated in counseling patients with isolated CH, in which a better prognosis and resolvement of CH may be expected in case of a normal karyotype.