Tekin Durukan

The effect of steroids on the biophysical profile and Doppler indices of umbilical and middle cerebral arteries in healthy preterm fetuses

OBJECTIVE To examine the effect of antenatal steroids on the biophysical profile and the Doppler parameters of umbilical and middle cerebral arteries of healthy fetuses. STUDY DESIGN Thiry-five singleton pregnancies between the gestational ages of 28 and 34 weeks, who received two consecutive doses of betamethasone 24h apart to accelerate pulmonary maturation were prospectively studied. Fetal biophysical profile and Doppler assessment were performed at 0 (pre-steroid), 24, 48, 72, 96 and 120 h after the administration of first dose. We compared the percentage of the fetuses with biophysical parameters present for each of the five components of the biophysical profile and the Doppler indices, using Cochrans Q-test, Friedmans test and one way analysis of variance of repeated measures where appropriate. The statistical significance was defined as P<0.05. RESULTS The mean delivery time was 36.9(+/-1.8) weeks. There was a statistically significant difference in the frequency of the following findings in the pre- compared to post-steroid measurements: absence of body movements (48 h, P<0.05), non-reassuring fetal heart rate tracings (24, 48 and 72 h, P<0.05) and absence of breathing movements (24, 48 and 72 h, p<0.05). Initially none of the biophysical profile score was <or=6, whereas at 24, 48 and 72 h, 13.3, 76.7, 16.7% of them, respectively, were <or=6 (P<0.05). None of the Doppler indices was found to be affected by the steroid administration. CONCLUSION Maternal betamethasone administration can cause a significant but transient, reduction in biophysical profile scores, however the middle cerebral and umbilical artery Doppler indices were found to be unaffected suggesting the reliability of this modality for the evaluation of the fetuses previously exposed to the antenatal steroids.

Surgical outcome of transobturator tape procedure in obese and non-obese women

The objective of this study was to assess the impact of body mass index (BMI) on transobturator tape (TOT) success rates, patient acceptability and complications 1 year following surgery. The medical records of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) patients who underwent the TOT operation were retrospectively reviewed. The patients were divided into non-obese (BMI < 25) and obese (BMI ≥ 30) groups. Baseline and 1 year post-surgical outcomes were assessed by including multichannel urodynamics, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores and cure, failure and success rates. There were no significant differences between groups in terms of urodynamic parameters, objective cure rate and subjective success, quality of life scores, or postoperative complications. Both obese and non-obese patients had cure and/or improvement of their symptoms and had better quality-of-life in the postoperative period. As a conclusion, BMI does not affect the clinical effectiveness of TOT operation in the treatment of female SUI or MUI.

Hyperlipidemic pancreatitis during pregnancy

A case of acute pancreatitis associated with type V hyperlipoproteinemia is reported. A 26-year-old-woman was referred to our department with nausea, vomiting, and severe abdominal pain at 24 weeks gestation. Elevation of pancreatic enzymes with profound hypertriglyceridemia (60 mmol/L) was noticed, and a diagnosis of hyperlipidemic pancreatitis was made on the day of admission. Because she had no history of non-gestational hyperlipidemia, the observed hyperlipidemia was thought to be gestational in origin. The treatment consisted of nasogastric decompression, intravenous hyperalimentation, insulin infusion, and plasma exchanges. Progressive abatement of the symptoms occured, and on the fifth day of admission, complete resolution was observed. On the seventh day of hospitalization, advancing preterm labor and associated fetal distress was diagnosed, which necessitated a cesarean delivery. The infant was lost due to severe immaturity. Pancreatic pseudocyst formation complicated the postpartum period, which was managed by percutaneous drainage. Early diagnosis, close monitoring, consistent supportive treatment and awareness of complications are the key points in the management of gestational pancreatitis.

Alcohol Injection for the Intrauterine Treatment of Chorioangioma in a Pregnancy with Transfusion Resistant Fetal Anemia: A Case Report

Chorioangiomas are usually small, clinically inevident, benign vascular lesions of the placenta, but larger ones may cause serious perinatal and neonatal complications. There is need for in utero intervention in these fetuses. Several interventions are described to relieve pathophysiologic insult on fetus. Alcohol injection is one of the therapeutic interventions. In this case, we present a patient with chorioangioma and early onset of hydrops fetalis and polyhydramnios at 24th week of gestation. Successful intratumoral injection of absolute ethyl alcohol relieved hydrops fetalis and polyhydramnios. Unfortunately, pregnancy ended at 28th week and a 1,330 g fetus was delivered.

A case of acromegaly in pregnancy: Concomitant transsphenoidal adenomectomy and cesarean section

The case of a 32-year-old woman at 29 weeks gestational age with acromegaly initially diagnosed in pregnancy is presented. During follow-up at 34 weeks of gestation, concomitant emergency cesarean section and transsphenoidal surgery were performed because of advancing vision loss. In tertiary centers, success in pregnancy can be made possible for a patient with acromegaly under the constant supervision of an obstetrician and neurosurgeon.

Acute fatty liver of pregnancy after aspirin intake

Acute fatty liver is a rare but fatal complication of pregnancy. Here we describe a patient presenting with stupor and jaundice after aspirin intake at 35 weeks of gestation. Supportive management and delivery resulted in uneventful discharge of the patient and the newborn. Differential diagnosis and management of this condition are discussed.

Postpartum oral glucose tolerance tests in mothers of macrosomic infants: inadequacy of current antenatal test criteria in detecting prediabetic state

OBJECTIVE To assess the presence of subtle carbohydrate metabolism abnormalities in otherwise healthy mothers who have given macrosomic birth by utilizing postpartum oral glucose tolerance test (PPOGTT). STUDY DESIGN Prospective controlled study enrolled gestational diabetic women (GDM, n=10), mothers with macrosomic infants (MwMIs, n=62) and controls (n=50). RESULTS Receiver operating characteristic (ROC) curve analysis revealed that incremental 1-h+2-h PPOGTT value >111 mg/dl had a sensitivity of 80% and specificity of 78% in predicting antecedent diabetes. PPOGTT results were positive in 53.2% of MwMIs and 28% of controls (P<0.01). Maternal low-density lipoprotein and triglyceride levels, 50 gram glucose challenge test (50 g GCT) values and neonatal weight were the significant predictors of PPOGTT results. ROC analyses suggested that threshold of 50 g GCT should be lowered in order to better predict subjects with both macrosomia and positive PPOGTT. CONCLUSION PPOGTT may identify a subset of women with macrosomic infants who have metabolic alterations of a prediabetic state. The discrepancies between antenatal and postpartum tests may reflect the need for redefinition of currently utilized criteria in screening and diagnosis of GDM.

An abdominal pregnancy 10 years after treatment for pelvic tuberculosis.

An abdominal pregnancy after treatment for female genital tuberculosis is presented. Early treatment after the diagnosis of female genital tuberculosis may restore fertility in the rare patient. Chemotherapy is the cornerstone of therapy. Ectopic pregnancies are common and should be ruled out to avoid catastrophic results.

Massive vulval oedema complicating pregnancy.

Bilateral severe vulval oedema complicating pregnancy is unusual (Morris et al. 1990). To date only a few patients with massive vulval oedema in pregnancy have been reported. Vulval oedema in association with tocolytic therapy, preeclampsia, ovarian hyperstimulation, staphylococcus septicaemia, diabetes mellitus, syphilis, partial hydatidiform mole, and even maternal death have been reported (Morris et al. 1990; Bracero and Didomenico 1991; Brittain et al. 1991; Awwad et al. 1994; Jakobi et al. 1995; Trice et al. 1996; Radomanski et al. 1998; Deren et al. 2000; Tam et al. 2002; Finkler et al. 1987; Ewing et al. 1979; Calleri et al. 1999). The purpose of this study is to describe a 36 week pregnant woman with thrombocytopenia, severe anaemia, and massive vulval oedema and to review the related literature and possible treatment modalities.

Abdominal pregnancy following gonadotropin treatment

An abdominal pregnancy after treatment with human menopausal and chorionic gonadotropins is reported. The role of induction of ovulation with human menopausal and chorionic gonadotropins as a cause of ectopic pregnancy has not been delineated. However, it appears that ultrasonography has become one of the most important aids in the diagnosis of abdominal pregnancy.