Effect of Nifedipine Used in the Treatment of the Threat of Preterm Labor on Total Uterine Artery Blood Volume Flow Rate

PURPOSE

Evaluation of the effect of maternal nifedipine treatment on total uterine artery blood volume flow rate (TVFR).

METHODS

In this prospective study, 43 women who were admitted to the Perinatology Department of the University of Health Sciences Etlik Zübeyde Hanım Gynecology Training and Research Hospital, with the diagnosis of the threat of preterm labor, and 40 healthy pregnant women, who were randomly selected as the control group, were evaluated between July 1, 2018, and September 1, 2018. A transabdominal ultrasound examination of uterine arteries was performed both before and 48 hours after administration of oral nifedipine for TVFR measurement. For the final analysis, the TVFR levels of the group diagnosed with the threat of preterm labor and the control group were compared.

RESULTS

There was no significant difference in either uterine artery pulsatility index or resistance index values as well as the diameters of the uterine arteries after nifedipine treatment (p>0.05 for all). Total uterine artery blood volume flow rate (TVFR) was 424.66±236.74 mL/min before and 543.39±309.68 mL/min after treatment with nifedipine and was statistically significantly higher (p < 0.05).

CONCLUSIONS

Our study showed a statistically significant increase in total uterine artery blood volume flow rate 48 hours after oral nifedipine treatment.

Fetal pulmonary artery doppler parameters in pregnancies complicated with intrahepatic cholestasis of pregnancy: a prospective case-control study

Objective

The primary aim of this study was to determine whether PATET was altered in the fetuses whose mothers were complicated by intrahepatic cholestasis of pregnancy (IHCP). The secondary aim was to investigate the association between fetal pulmonary artery Doppler parameters with neonatal outcomes in pregnancies complicated by IHCP.

Material and Methods

This prospective case control study was conducted in a tertiary perinatal- neonatal center. A total of 18 fetuses whose mothers were complicated by IHCP were set as the study group and a total of 37 fetuses whose mothers were healthy were selected as the control group. Fetal pulmonary artery Doppler parameters (acceleration time -AT; ejection time -ET; AT/ET ratio) were assessed and neonatal outcomes were evaluated.

Results

Mean pulmonary artery AT, ET, PATET were statistically significant different between the groups (p=0,001; p=0,024 and p=0,003, respectively). The mean PATET value in the IHCP group was 0,217 ± 0,029 while in the control group it was 0,180 ± 0,020 (p=0,003). While PATET values were correlated with gestational age at birth, respiratory distress and NICU admission were not correlated with PATET.

Conclusion

Higher values of PATET may be helpful to understand fetal lung damage secondary to IHCP. of PATET may be helpful to understand fetal lung damage secondary to IHCP.

Skin Color May Predict Intra-Abdominal Adhesions During Repeated Caesarean Section Deliveries

OBJECTIVE

Caesarean rates have increased rapidly for various reasons recently. One of the important reasons among these is medicolegal problems. Our aim with this study was to preoperatively predict abdominal adhesion density by combining the scar tissue morphology formed in the post-caesarean Pfannenstiel incision line and the skin color scoring of the patients.

MATERIAL AND METHODS

Patients who had undergone one caesarean section previously, completed their terms (37-39 weeks) and were under 35 years old were included in the study. Skin color scoring of the patients was performed using the Fitzpatrick skin color scale. Intra-abdominal adhesion scoring of the participant patients was performed using Nair's adhesion scoring system.

RESULTS

The change in abdominal adhesion scores was evaluated based on the Fitzpatrick color scale. Adhesion scores per the Nair intra-abdominal adhesion scoring system were found to be 0.04±0.209 in the FP1 group, 0.35±0.662 in the FP2 group, 1.58±0.923 in the FP3 group, and 2.33±0.577 in the FP4 group (p<0.05). These results showed a significant increase in adhesion density with increasing skin color darkness. Based on these results, it was observed that the abdominal adhesion scores and the frequency of depressed skin scar were significantly increased with increasing Fitzpatrick scores (p<0.05).

CONCLUSION

The aim of this study was to increase the prediction rates by adding the skin color scoring to the scar tissue characteristics, which have been used in previous studies. The results of this study indicate that the combination of these two parameters may be more effective in predicting intra-abdominal adhesions. Nevertheless, there is a need for studies with a much higher number of patients and multiple parameters to be able to predict intra-abdominal adhesion density preoperatively with greater accuracy.

Can Derived Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Delta Neutrophil Index Predict Spontaneous Abortion?

OBJECTIVE

To evaluate the efficacy of complete blood count indices for the prediction of miscarriage.

MATERIALS AND METHODS

A retrospective case-control study was conducted in a tertiary hospital. This study consisted of 389 cases (32 elective and 193 spontaneous abortions, 164 healthy pregnancies). Maternal demographic characteristics, complete blood cell (CBC) parameters, neutrophil-lymphocyte ratio (NLR), derived NLR, systemic inflammatory immune index (SII), platelet-to-lymphocyte ratio (PLR), and delta neutrophil index (DNI) that were in the routine first trimester CBC were compared between groups.

RESULTS

There were no significant differences among groups in terms of demographic and obstetric characteristics. Statistically significant differences were observed for Hb, white blood cell (WBC), lymphocyte (L), NLR, SII, and PLR between the subgroups (p=0.003, p=0.045, p=0.000, p=0.002, p=0.043, p=0.010, respectively). There were no significant differences among groups in terms of the remaining parameters. When healthy pregnancies and spontaneous abortions were compared, statistically significant differences were detected for NLR, SII, PLR (p=0.001, p=0.039, and p=0.000, respectively). Moreover, when healthy pregnancies and elective abortions were compared, only NLR was found as statistically different (p=0.050). Area under curve (AUC) was calculated for PLR as 0.659 (%95 CI: 0.582-0.735) and a cut-off value of 158.1 was found with highest sensitivity and specificity (60.6 % and 61.6%, respectively) according to the results obtained from Youden's index. AUC was calculated for NLR as 0.591 (%95 CI: 0.507-0.675) and a cut-off value of 3.135 was found with highest sensitivity and specificity (56% and 54.5%) according to the results obtained from Youden's index.

CONCLUSION

In conclusion, decreased PLR and NLR levels may be used as practical and cost-effective markers for the prediction of miscarriages.

The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience

BACKGROUND

Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results.

METHODS

This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0-40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1^st-5^th minute APGAR scores, and OAE results were compared between the groups.

RESULTS

1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001).

CONCLUSIONS

Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.

Fetal fibular hemimelia with focal femoral deficiency: A case report

Fibular hemimelia (FH) is a congenital deficiency in which a part or all of the fibular bone is hypoplastic or aplastic and associated with hypoplastic tibia and foot anomalies. The main differential diagnoses include proximal focal femoral dysplasia, Femur-Fibula-Ulna syndrome, and Femoral Hypoplasia-Unusual Facies syndrome. Proximal focal femoral dysplasia, which has a short, angulated femur with normal mineralization may be associated with FH. We report a case of unilateral FH with focal femoral deficiency detected at 18 weeks of gestation during a routine ultrasonographic anatomic screening. Sonographic findings were a unilateral short femur (1.8 cm, 3 weeks shorter than expected for gestational weeks), agenesis of ipsilateral fibula and angulation of ipsilateral tibial shaft. During a routine ultrasonographic anatomic scan, all the long bones are carefully measured and evaluated. Long bone shortness can be a part of syndrome or an isolated finding.

Utility of the modified myocardial performance index in growth-restricted fetuses

OBJECTIVES

The modified myocardial performance index (Mod-MPI) can be used to assess myocardial function. Fetal growth restriction can affect fetal myocardial function, thereby altering the Mod-MPI. The results of previous studies on the utility of the Mod-MPI in growth-restricted fetuses are conflicting. The aim of this study was to calculate the left modified-MPI in growth-restricted fetuses and to compare the results with those of healthy fetuses.

METHODS

This was a prospective cross-sectional case-control study. In total, 40 women with growth-restricted fetuses and 40 women with fetuses of normal weight (controls) at 29-39 gestational weeks were enrolled in the study. An experienced obstetrician calculated the Mod-MPI for each fetus. Women with systemic diseases or fetuses with chromosomal/structural abnormalities were excluded from the study. The results of Mod-MPI measurements of the two groups were compared.

RESULTS

The mean single deepest vertical pocket (SDVP) of amniotic fluid, estimated fetal weight (EFW), and isovolumetric relaxation time (IRT) was significantly lower in the fetal growth restriction (FGR) group as compared with these parameters in the control group (P < .05). The uterine artery (UtA) pulsatility index (PI) was significantly higher in the FGR group as compared with that in the control group (P < .05). There were six cases of absent end-diastolic flow (AED) in the FGR group. There were no statistically significant between-group differences in the Mod-MPI, isovolumetric contraction time (ICT), and ejection time (ET) (P > .05). There was also no statistically significant correlation between the Mod-MPI in the fetuses with AED and the control group for Mod-MPI (P > .05).

CONCLUSION

The utility of the Mod-MPI in FGR remains unclear. Future studies with larger populations are needed to determine the utility of the Mod-MPI as a predictor of cardiac compromise in FGR.

Analysis of cystic hygroma diagnosed in the first trimester: Single-center experience

Objective:

To evaluate the obstetric outcomes of fetuses with cystic hygroma other than karyotype abnormalities and structural malformations.

Material and Methods:

We conducted a retrospective study based on the review of medical records of pregnant women in whom ultrasonographic diagnosis of fetal cystic hygroma was established in the first trimester from January 2014 to October 2018. All patients were offered genetic counselling and prenatal invasive diagnostic procedures to obtain fetal karyotype. For ongoing pregnancies fetal echocardiography and detailed second trimester sonographic anomaly screening was performed by a perinatologist/pediatric cardiologist. The demographic characteristics of the women and the results of the karyotype analysis were obtained from the database of our hospital and correlated with the obstetric outcomes.

Results:

Within a five-year period, there were 106 cases of fetal cystic hygroma. Of those, fetal cardiac malformations were detected in four and micrognathia in one fetus. Eighty-five women underwent fetal invasive procedures and karyotype abnormalities were detected in 52 of the cases. Fetal outcomes of 33 cases with normal karyotype and 21 cases in whom karyotyping analysis were not performed due to patient refusal were enrolled into the study. Obstetric outcomes of 21 women who refused karyotyping consisted of 13 livebirths, seven missed abortions, and one fetal death, whereas those of 33 women with normal karyotype were; 12 livebirths, 12 missed abortions, two hydrops fetalis, and five fetal deaths. Nineteen of 33 fetuses with a normal karyotype and eight of 21 fetuses in whom karyotyping was not performed were terminated.

Conclusion:

The presence of cystic hygroma carries a high risk for fetal karyotype abnormalities and cardiac malformations. The postnatal outcomes of the fetuses with cystic hygroma appeared to be correlated with the absence of structural malformations and karyotype abnormalities.

Surgical reconstruction in female genital mutilation

Female genital mutilation (FGM) is an unusual condition for our country. However, an increase in FGM in future days can be predicted with the increasing numbers of exchange students coming from African countries, migration of refugees and socioeconomic relations with the African countries. We want to share our experience of two FGM victims admitted to our clinic with the request of reconstructive vulvar surgery before their marriage. Both women had WHO Type III FGM. Physical examination findings and surgical reconstruction techniques were presented.