Does detection of a large for gestational age (LGA) fetus in fetal anomaly scan (FAS) require an early oral glucose screening test (OGTT) and can LGA fetus be detected at birth?

OBJECTIVE

Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth.

PATIENTS AND METHODS

Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks.

RESULTS

This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001).

CONCLUSIONS

The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.

Ischemia modified albumin levels in intrauterine growth restriction: levels are increased in fetal cord blood but not in maternal blood

OBJECTIVES

In this study, our aim was to determine the differences between intrauterine growth restriction (IUGR) and normal birth weight fetuses in terms of ischemia modified albumin (IMA) levels. For this purpose, we measured ischemia modified albumin levels in the cord blood of fetuses and venous blood of mothers.

MATERIAL AND METHODS

This study is a prospective study conducted at University of Health Sciences Tepecik Training and Research Hospital between January 2018 and December 2019. According to the inclusion/exclusion criteria, 227 patients were included in the study. Participants were divided into two groups according to the presence (patient group) or absence (control group) of intrauterine growth restriction (IUGR). In addition to routine parameters recorded during pregnancy, the IMA levels and Doppler USG findings of all participants were recorded.

RESULTS

The mean cord blood serum IMA levels of the patient group were significantly elevated compared to controls (p = 0.038). Whereas mean maternal blood serum IMA levels were similar among groups (p = 0.453). The cord blood and mother blood serum IMA levels were not significantly different with regard to the presence or absence of perinatal asphyxia.

CONCLUSIONS

In the literature, studies evaluating IMA levels in the cord and maternal blood of IUGR fetuses are limited. In IUGR patients, IMA level is expected to increase and in our study, IMA levels were significantly increased but the presence of oxidative stress has not been found to affect IMA levels.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.

Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

OBJECTIVE

The aim of this study was to identify the prevalence of anemia and predisposing factors contributing to anemia in pregnant women prior to delivery.

MATERIAL AND METHODS

A retrospective case-control study was conducted on 1221 women who delivered between 37 and 42 weeks of gestation between July 2014 and January 2015. Data on the subjects' socioeconomic and demographic characteristics, pregnancy outcomes, and hemoglobin levels within 24 h prior to delivery were collected. The study population was divided into two groups on the basis of the presence of anemia within 24 h prior to delivery. Anemia was defined as a hemoglobin level of <11 g/dL. The prevalence of pre-delivery anemia was estimated, and antenatal predictors of anemia were determined using multivariate logistic regression analysis.

RESULTS

The prevalence of anemia in women attending our center for delivery was 41.6% [95% confidence interval (CI) =38.84-44.37]. After multivariate logistic regression analysis, parity >3 [odds ratio (OR) =1.82, 95% CI=1.24-2.96, p=0.002], illiterate (OR=2.23, 95% CI=1.35-3.45, p=0.001) and primary educational level (OR=2.01, 95% CI=1.28-3.39, p=0.008), household monthly income per person <250 Turkish liras (OR=2.34, 95% CI=1.49-3.89, p<0.001), first admission at second (OR=1.63, 95% CI=1.24-2.81, p=0.006) and third trimester (OR=2.45, 95% CI=1.41-4.06, p<0.001), number of antenatal visits <5 (OR=1.45, 95% CI=10.5-2.11) and 5-10 (OR=1.3, 95% CI=1.03-2.09), duration of iron supplementation <3 months (OR=2.62, 95% CI=1.51-4.17) and 3-6 months (OR=1.68, 95% CI=1.13-2.91), and occurrence of preeclampsia (OR=1.55, 95% CI=1.03-2.1, p=0.041) were independently associated with anemia.

CONCLUSION

Socioeconomic determinants constitute most of the anemia cases and, hence, should be considered as major risk factors of anemia in women attending for delivery at term.

Prenatal karyotype results of fetuses with nuchal edema, cystic hygroma, and non-immune hydrops

PURPOSE

Subcutaneous edema detected sonographically in the forms of nuchal edema, cystic hygroma (CH), or non-immune hydrops (NIH) may be a sign of chromosomal abnormalities. The aim of this study was to investigate the chromosome abnormality incidence in fetuses with nuchal edema, CH, or NIH.

MATERIALS AND METHODS

The authors performed cytogenetic analysis of 218 singleton fetuses with ultrasound diagnosis of subcutaneous edema in the forms of nuchal edema in the first and second trimesters.

RESULTS

Chromosomal abnormality rates were 30.4, 10.4, 36.8, 34.1, and 60% in the nuchal translucency (NT), nuchal fold thickness (NF), CH, NIH, and CH with NIH groups, respectively. In 71 cases with detected chromosomal abnormalities, 37%, 44%, 15%, and 4% of the pathologic karyotypes were identified as monosomy X, trisomy 21, trisomy 18, and trisomy 13, respectively.

CONCLUSIONS

This study confirms that subcutaneous edema detected sonographically, in the forms of nuchal edema, CH, or NIH, is a significant indicator of abnormal karyotype and deserves further investigation.

Fetal abdominal wall defects: six years experience at a tertiary center

The authors' aim was to detect the associated anomalies and their effect on the management of the fetuses with omphalocele and gastroschisis. Between the period of 2007-2013, the data of fetuses with abdominal wall defects were analyzed. Chromosomal abnormalities and associated morphologic anomalies diagnosed by ultrasonography and autopsy were evaluated. Of the. 61 fetuses, ten (20.4%) omphalocele cases and nine (75%) gastroschisis cases were isolated. Chromosomal abnormalities were found in seven fetuses with omphalocele cases. All fetuses with abnormal karyotypes had multiple additional anomalies. Termination rate was 65.3% for omphalocele group versus none in the gastroschisis group. To give better counseling about the prognosis and outcome of the fetuses with abdominal wall defects, detection of additional anomalies as well as type of the defect are essential tools even if the karyotype is normal.

Use of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated heavy menstrual bleeding

OBJECTIVE

To evaluate the effects of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated with heavy menstrual bleeding.

METHODS

The retrospective study was conducted at a tertiary referral hospital in Izmir, Turkey, and comprised data on adenomyosis patients who were implanted with a levonorgestrel-releasing intrauterine device for heavy menstrual bleeding between December 2004 and January 2008. After the insertion of the device, all patients were followed up by transvaginal ultrasonography and serum haemoglobin levels and menstrual patterns were determined at the 6th and 12th month. Data was analysed using SPSS 10.

RESULTS

The mean age of the 42 women in the study was 43.2 +/- 0.8 years. At the sixth month, amenorrhoea, oligomenorrhoea, spotting and regular menstrual flow were 9.5% (n = 4), 7% (n = 3), 19% (n = 8), and 64% (n = 27), respectively. At the 12th month, the same parametres were 9.5% (n = 4), 7% (n = 3), 12% (n = 5), and 71% (n = 30), respectively. Haemoglobin levels had increased and endometrial thickness had decreased, and these differences were statistically significant (p < 0.001).

CONCLUSION

The easy-to-use levonorgestrel-releasing intrauterine device can be added to the treatment options as a well-tolerated alternative in cases where a woman who has completed her fertility and does not request a hysterectomy has anaemia associated with adenomyosis.

The impact of thrombocytosis on clinicopathological prognostic factors and survival in patients with vulvar cancer

PURPOSE

Reactive thrombocytosis in many solid tumors has widely been studied. In the present study we aimed to investigate whether thrombocytosis is a common and prognostic factor in women with vulvar cancer

MATERIAL & METHODS

The preoperative platelet counts of 41 women, treated for vulvar cancer in our onco-gynecology center between March 1994 and January 2007, were retrospectively reviewed and correlated to clinical and pathological prognostic factors and 5-year survival. The chi-square or Fisher exact tests were used to compare categorical variables. P value < 0.05 was accepted for statistical significance.

RESULTS

The mean age was 65.4 +/- 11.3 years (range 39-83y). All patients had squamous histology The mean platelet count was 335.42 x 109/L +/- 82.03 (range 142-1155x109/L). Thrombocytosis was detected in 8 (19.5%) patients. No correlation was found between thrombocytosis and grade (p = 0.65), LVSI (p = 0.82), tumor size (p = 0.73), depth of invasion (p = 0.18), lymph node metastasis (0.93), and FIGO stage (p = 0.78). The mean follow up time was 118.0 +/-43.1 months (range 60-213 months). At the end of the study period 14 patients (34.2%) had died, 8 (19.5%) had recurrence, 19 (46.3%) were disease-free. General 5-year survival was 68.3% (28/41). The 5-year survival rate for patients with thrombocytosis was 75.0% (6/8), which was not significantly different from the 5-year survival of patients with normal platelet counts (22/33; 66.7%) (p = 0.75).

CONCLUSION

Our study showed that, overall, thrombocytosis was found in about 20% of patients with vulvar cancer and proved to be not linked to the best known prognostic factors and survival. Thus, disease stage and inguinofemoral lymph node status continue to be the best prognostic factors for this disease.

Evaluation of tissue Doppler-derived myocardial performance index in fetuses with intracardiac echogenic focus

OBJECTIVE

To compare cardiac function between fetuses with and without intracardiac echogenic foci (IEFs) by conventional echocardiography and tissue Doppler (TD) imaging.

METHODS

Fetuses having IEF and no additional cardiac or extracardiac anomaly between 20 and 28 weeks (median 22 weeks) of gestation (n = 61) were compared with healthy fetuses between 18 and 29 weeks (median 23 weeks) of gestation (n = 55). Pulmonary artery and aortic peak velocities, atrioventricular (AV) early diastole (E) and atrial contraction (A) velocities and E/A ratios were measured. TD-derived myocardial performance index (MPI) was also measured.

RESULTS

Tricuspid valve E/A ratios, which were 0.634 ± 0.07 versus 0.639 ± 0.06 (p = 0.697), mitral valve E/A ratios, which were 0.604 ± 0.08 versus 0.612 ± 0.07 (p = 0.600), aorta peak velocities, which were 0.709 ± 0.11 versus 0.697 ± 0.11 (p = 0.592) and pulmonary artery peak velocities, which were 0.699 ± 0.12 versus 0.694 ± 0.11 (p = 0.800) in the study and the control groups, respectively. TD-derived measurements in the study and control groups included tricuspid valve MPI, which were 0.452 ± 0.08 versus 0.473 ± 0.09 (p = 0.221) and mitral valve MPI values, which were 0.444 ± 0.1 versus 0.445 ± 0.09 (p = 0.965), respectively, and this difference was not statistically significant.

CONCLUSION

An isolated IEF is not associated with abnormal cardiac function. We suggest that the presence of an isolated IEF should not be an indication for fetal cardiac function examination either with conventional Doppler or TD imaging techniques, unless there is a coexisting cardiac or extracardiac anomaly.

Relationship between mean platelet volume and low-grade systemic coagulation with vitamin D deficiency in primary ovarian insufficiency

OBJECTIVE

Premature menopause in young women is associated with an increased incidence of cardiovascular disease. The present study was designed to determine vitamin D (vit D) and the coagulation parameters such as activated partial thromboplastin time (APTT), PT, D-dimer, white blood cell (WBC), and mean platelet volume (MPV) levels, in primary ovarian insufficiency (POI) patients and control women with a normal menstrual cycle.

MATERIALS AND METHODS

A total of 43 patients with non-diabetic POI were studied in order to evaluate and compare with the control group comprising 33 women with a normal menstrual cycle.

RESULTS

There was no significant difference between the groups for age and body mass index (BMI). D-dimer, WBC, MPV, PT, total cholesterol, and LDL cholesterol were higher in women with POI. APTT levels were also increased but missed the significance in POI group. Women with POI had significantly lower serum vit D levels compared with healthy control group. FSH level was positively correlated with D-dimer, WBC, MPV, and negatively correlated to vit D and serum D vit level was inversely correlated with MPV, APTT, D-dimer, FSH levels in individual women.

CONCLUSIONS

The obtained results seem to indicate that POI patients had low-grade systemic coagulation and fibrinolytic activation as evidenced by elevated D-dimer, WBC, MPV, PT values potentially be used as indicators of risk factor for thrombosis and atherosclerosis in POI women. All of our patients with POI were deficient in vit D. These results also suggest that vit D deficiency plays important roles of POI women and associated with coagulation, independently from age and BMI.

Treatment of chronic cervicitis: the loop electrosurgical excision procedure

The effectiveness and morbidity of excisional biopsy of cervical tissue using the electrosurgical excision procedure for the treatment of chronic cervicitis was investigated. In this study, loop diathermy was used in the treatment of one hundred patients with chronic cervicitis. Before the procedure, cervical smear and colposcopic examination were done. Then the loop diathermy was performed under local anesthesia. All the removed specimens were evaluated histopathologically. The mean operation time was 6.34 +/- 1.37 minutes. The complication of bleeding and secondary infection were 5% and 4%, respectively. All the patients had normal cervical smear (Papanicolaou class I or II). In the microscopic evaluation, thermal damage of the removed specimens were negligible. Six cases (6%) with CIN (CIN I = 4, CIN II = 2) were determined and the others (94%) were reported as chronic cervicitis in the histopathologic examinations of the removed specimens. After the operation, these cases with CIN were followed up for one year with cervical smears and colposcopic examinations. One of the six patients with CIN had recurrence and underwent cold-knife conization. This new technique is simple, quick and cheap. It can be used confidently to provide both diagnosis and treatment with minimal thermal tissue injury in cases with chronic cervicitis.

Prevalence, management and outcome in eclampsia

OBJECTIVE

To review the management of eclampsia in our institution.

METHOD

The prevalence, management and outcome of women with eclampsia over a period of 8 years were reviewed at our referral medical center. There were 444 patients with eclampsia among 5757 deliveries (1 in 12.96 deliveries or 7.71% of deliveries). Most of the cases were uneducated and had received no antenatal care. One hundred eighty-one cases were nulliparous (40.77%). High parities of more than five were observed in 27.93% of cases. A standard magnesium sulfate regimen, similar to Prichard's intramuscular regimen, was used.

RESULTS

Magnesium sulfate effectively controlled the convulsions. The incidence of abdominal delivery among 397 cases with ante- and intrapartum eclampsia was 50.12%. Perinatal mortality was very high (591.47% 0) for all cases. Maternal complications were serious and led to maternal death in 42 women (9.46%).

CONCLUSION

Eclampsia is still a serious obstetric complication particularly in uneducated women who do not receive antenatal care.

Menstrual disorders and pelvic pain after sterilization

Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p > 0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p < 0.001) and laparoscopy (p < 0.01) groups but non-significantly in the colpotomy group (p > 0.05). Comparison of these parameters between the groups did not show any significant differences (p > 0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p > 0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.

Pomeroy tubal ligation by laparoscopy and minilaparotomy

Pomeroy tubal ligation is a widely-used method for surgical female sterilization. A laparoscopic technique of Pomeroy tubal ligation using endoloop sutures is compared with the conventional technique of Pomeroy tubal ligation by minilaparotomy. Forty-four women requiring sterilization were randomly selected for either laparoscopy (n = 24) or minilaparotomy (n = 20). Mean operative time in the laparoscopy group (18.90 +/- 5.56 with a range of 12-35 minutes) was not significantly different from that in the minilaparotomy (23.12 +/- 8.24 with a range of 15-45 minutes) group. In all women, tubal specimens confirmed tubal histology. Both laparoscopy and minilaparotomy procedures may be performed for Pomeroy tubal ligation with minor morbidity. In clinics with appropriate conditions, Pomeroy tubal ligation by laparoscopy may be preferable to minilaparotomy.

Changes in ovarian function after tubal sterilization

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E2 levels (p < 0.001). Progesterone levels significantly decreased (p < 0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.

Ruptured uterus

Uterine rupture, an important cause of maternal and fetal mortality, is still occasionally seen in our region. In this study we reviewed 41 cases of uterine rupture encountered between the years 1983 and 1988, in a total of 3962 hospital deliveries with a frequency of 1 in 96.6 deliveries. Sixteen cases (39.0%) were over 35 years old. Twenty-five patients (60.9%) were grand multiparous (more than five pregnancies). There were no uterine ruptures in primigravid women. Ruptures were mostly (75.6%) due to cephalopelvic disproportion. Subtotal hysterectomy was the first choice of management for 35 cases. The maternal mortality rate was 7.3% while fetal mortality was 82.9%. Midwife education, regular antenatal care and hospital deliveries are important factors in prevention of this obstetric hazard.