Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section

STUDY DESIGN: Retrospective. PURPOSE: This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia. OVERVIEW OF LITERATURE: Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia. METHODS: We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS). RESULTS: Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months. CONCLUSIONS: Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

Thyroid diseases in pregnancy: the importance of anamnesis

Objective: Primary objective of our study was to evaluate the efficiency of detailed medical history and thyroid examination of the pregnant women presenting to our clinic from Rize province and nearby which was an endemic goiter region. It was aimed to investigate the frequency of thyroid diseases, pregnancy outcomes and the efficiency of screening with thyroid function tests during the first trimester of pregnancy as secondary endpoint

Methods: A prospective clinical study was conducted with 998 pregnant women between the ages of 17-48 years. In the first step of our study, a detailed medical history was obtained and a detailed thyroid gland examination was performed in all the patients [n=998]. In the patients diagnosed with thyroid disease or considered to have thyroid disease with these results [n=107], thyroid diseases were evaluated with thyroid function tests and imagining methods. Analyses of socio-demographic data and nutrition were also made. In the second step, thyroid stimulating hormone [TSH], free T3 and free T4 tests were performed in the first antenatal examination of the pregnant cases considered not to have thyroid disease after medical history and examination [n=891]. Parameters of thyroid peroxidase antibodies [TPOAb], thyroglobulin antibodies [TgAb] and TSH receptor auto antibodies [TRAb] were investigated in the cases whose TSH, sT3 and sT4 levels were different than the reference values after examination of the endocrinologist. Thyroid ultrasonography was performed. Urinary iodine levels in 24 hour urine were investigated

Results: During pregnancy, the incidence of hyperthyroidism and hypothyroidism in the whole study group were 2.8% [28/998] and 4.3% [43/998], respectively, 6.7% of the patients [67/998] had a diagnosis of thyroid disease before pregnancy. Hyperthyroidism and hypothyroidism depending on the TSH screening results were 1.9% [17/891] and 1.1% [10/891] respectively and the incidence of overt hyperthyroidism and overt hypothyroidism were 0.2% [2/891] and 0.2% [2/891] in the pregnant cases considered not to have thyroid disease with medical history and examination

Conclusion: Detailed medical history and family history obtained during the first trimester of pregnancy helped us to identify 6.7% of thyroid diseases among the pregnant women. This result effectively emphasizes the importance of detailed first prenatal examination regarding the thyroid

Primary ovarian ectopic pregnancy

Almost 1-2% of the all pregnancies implants in the ectopic localization. The incidence of primary ovarian pregnancy is reported to be one in 7000 to 40000 pregnancies. We aimed to evaluate the diagnosis and treatment of this rare condition. A 32 years-old Caucasian woman, gravida 2, parity 2, was referred to our clinic with the complaint of pelvic pain started suddenly with vomiting and nausea. There was a painful fullness at the right adnexal region in the gynecologic examination of the patient. A live embryo in size of 4x3 cm was detected in right adnexal region and within a hypoechoic soft tissue field. Embryo was almost 7 weeks. Serum beta hCG [beta -hCG] level was 50885 IU/ml. The patient underwent an urgent laparoscopy. The ruptured right ovarian ectopic pregnancy was detected during laparoscopy. Cystectomy was performed by right ovarian wedge resection. The diagnosis is usually made with the pathologic examination of the specimen. Therefore, Spiegelberg's criteria are very important for diagnosis of ectopic pregnancy. The basic principle in the medical and surgical treatment is to preserve the fertility of the patient