Perinatal outcomes of renal transplant pregnancies: a 22-year experience at a single tertiary referral center.

Background: Renal transplantation not only prolongs survival but also improves quality of life and fertility, particularly in patients with end-stage renal disease. The aim of this study was to evaluate the renal and perinatal outcomes of pregnancy after renal transplantation at a high volume academic tertiary hospital.Methods: Fifty-one renal transplant patients (RTPs) who experienced pregnancy after transplantation and received care at Ege University Hospital between January 1995 and December 2017 were retrospectively identified. Data on demographics, comorbidities, and clinical perinatal outcomes were analyzed.Results: The median age of expectant mothers with renal transplantation was 30.51 ± 5.28 years (range 23-41). The mean interval between discontinuing birth control methods and the last menstrual period was 22 months. Preeclampsia occurred in six pregnancies (11.5%), and 43 of 52 pregnancies resulted in live births (82.6%). The mean gestational age at birth was 36.35 ± 2.36 weeks (range: 26-38). A total of 15 births were preterm deliveries (28.8%). Intrauterine growth retardation (IUGR) was detected in four cases. The mean birth weight was 2664.58 ± 613.99 g (range: 600-3.800 g). Twelve newborns were hospitalized in the neonatal intensive care unit (23%). A significant inverse correlation between birth weight and preconception serum creatinine level was found (p < .001; r = -0.532). An inverse correlation between the interval between transplantation and pregnancy and low postpartum serum creatinine level was established significantly (p < .05; r = -0.331). In addition, an inverse correlation between preconceptional serum creatinine and postpartum serum creatinine in the first year was found statistically significant (p < .001, r = -0.681).Conclusion: Even though pregnancy does not seem to adversely affect renal graft function, risks of perinatal as well as obstetrical complications should not be ignored. Pregnancies in RTPs should be followed closely by a multidisciplinary team of experts to minimize perinatal complications before and during pregnancy.

Systemic atherosclerosis and voiding symptom.

OBJECTIVE: To evaluate the effect of atherosclerosis on the storage and voiding symptoms of the bladder in women with overactive bladder (OAB). STUDY DESIGN: We retrospectively reviewed the charts of women with OAB who were evaluated between 2013 and 2015 in our urogynecology unit. Charts were assessed for history, examination findings, urinary diary, quality of life (QOL) questionnaires, urodynamic studies (UDSs), and four main risk factors for atherosclerosis: hypertension, diabetes mellitus, smoking, and hyperlipidemia. In a previous study, these were defined as vascular risk factors. Cases were excluded for insufficient data, diabetes mellitus with dysregulated blood glucose, or prolapse greater than 1cm to avoid confusing bladder outlet obstruction. We included 167 eligible cases in this study. We evaluated storage and voiding symptoms such as frequency, nocturia, residual urine volume, and voiding difficulties and UDS findings such as maximum bladder capacity, first desire, strong desire, detrusor overactivity, and bladder contractility index. The vascular risk score was categorized as "no risk" if the woman did not have any of the four risk factors and "at risk" if she had any of the factors. Independent sample t-test and chi-square tests were performed for analyses. RESULTS: Among the participants (n=167), 71.9% had at least one vascular risk factor. Those who were at risk were facing significantly more wet-type OAB (p=0.003) and nocturia (p=0.023). Moreover, mean age (p=0.008) and mean gravidity (p=0.020) were significantly higher in the at-risk group, whereas mean total nocturia QOL questionnaire scores (p=0.029) were significantly lower. CONCLUSION: Our findings suggest that aging and atherosclerosis may be associated with severe OAB and poorer QOL. Nocturia and related parameters of poor quality can be explained by impaired bladder neck perfusion. Future trials need to assess vascular and molecular changes in women with OAB.

The disappearing brain-sparing effect in early-onset fetal growth restriction fetuses revisited.

OBJECTIVE: To evaluate the association between the brain-sparing situation and perinatal outcomes in fetuses with early-onset fetal growth restriction (EO-FGR) with absent or reverse end-diastolic flow in the umbilical artery (UA A/REDF). METHODS: We evaluated fetuses with EO-FGR who had patterns of UA A/REDF without abnormal venous Doppler indices. Participants were divided into two groups according to measurements of mid-cerebral artery pulsatility index (MCA PI) just before delivery. Group 1 (n = 45) included those with a brain-sparing effect (BSE) (a MCA PI <5th percentile for the gestational age) and group 2 (n = 14) included those with a disappearing BSE, defined as an MCA PI increase towards normal values after the BSE detected at the initial evaluation. Short-term perinatal outcomes were analyzed. RESULTS: Compared to group 1, group 2 had a significantly low birth weight (p = 0.018) and high rates of extended neonatal intensive care unit hospitalization (p = 0.049 respectively). CONCLUSION: On the basis of longitudinal measurements of MCA PI, increases after the reduction <5th percentile might be related to poor perinatal outcomes in fetuses with EO-FGR who had UA A/REDF without abnormal venous flow patterns.

The beneficial effects of levetiracetam on polyneuropathy in the early stage of sepsis in rats: electrophysiological and biochemical evidence.

ABSTRACT Critical illness polyneuropathy (CIP) is a common complication in long (≥1 week) critical/intensive care hospitalizations. Rapidly progressing atrophy and weakness of the limb, trunk and, particularly, respiratory muscles may lead to severe morbidity or mortality. The aim of the present study was to investigate the protective effects of levetiracetam (LEV) on CIP in the early stage of sepsis in rats. We simulated CIP by a surgically induced sepsis model and verified it by lower-limb electromyography (EMG) (amplitude and duration of CMAP, and distal latency). We evaluated the effects of various doses of LEV treatment (300, 600, and 1200 mg/kg i.p.) on CIP by performing electrophysiology, and determining plasma tumor necrosis factor (TNF)-α, lipid peroxides (malondialdehyde, MDA) levels, and total antioxidant capacity (TAC). Our data showed: (1) significant suppression of CMAP amplitude and prolongation of distal latency in the saline-treated sepsis group, and distal latency as well as CMAP amplitudes benefiting best from the 600 mg/kg LEV treatment; (2) significant rise in plasma TNF-α and MDA levels in the saline-treated sepsis group, but significant ameliorations by the 600 and 1200 mg/kg LEV treatment; (3) highly significant suppression of TAC in the saline-treated group, but profound reversals in all LEV-treated groups. We conclude that 300, 600, and 1200 mg/kg i.p. doses of post-septic treatment by LEV has possibly acted in a dose-dependent manner to both protect and restore the affected peripheral nerves' axon and myelin following surgical disturbance of the cecum to induce sepsis and consequent polyneuropathy.

How do delivery mode and parity affect pelvic organ prolapse?

OBJECTIVE: To determine the association between mode of delivery, parity, and pelvic organ prolapse, as assessed by the pelvic organ prolapse quantification system. DESIGN: Cross-sectional study. SETTING: Tertiary referral center, Turkey. POPULATION: A total of 1964 women with benign gynecological disorders who presented between October 2009 and July 2011. METHODS: Evaluation using the pelvic organ prolapse quantification system and questionnaire assessing previous obstetrics and medical history. MAIN OUTCOME MEASURES: Difference in pelvic organ prolapse stages between nulliparous and multiparous women, impact of parity and mode of delivery. RESULTS: In the study population, 86.4, 7.2 and 6.4% had pelvic organ prolapse of stages 0-I, II, and III-IV, respectively, and 7.9% had significant prolapse beyond the hymen. The mean age, parity, and number of vaginal deliveries were significantly higher in the prolapse than in the non-prolapse group. Vaginal delivery was associated with an odds ratio of 2.92 (95% confidence interval 1.19-7.17) for prolapse when compared with nulliparity. Each vaginal delivery increased the risk of prolapse (odds ratio 1.23; 95% confidence interval 1.12-1.35) after controlling for all confounding factors. Cesarean delivery had no impact on the odds for prolapse. CONCLUSIONS: Vaginal delivery was an independent risk factor for prolapse, and additional vaginal deliveries significantly increased the risk. However, cesarean delivery had no effect on the development of prolapse in this material.

Quality of life scores improve in women undergoing colpocleisis: a pilot study.

OBJECTIVE: To evaluate the quality of life and surgical outcomes in women who had undergone colpocleisis. STUDY DESIGN: This was a prospective small cohort study conducted between August 2010 and September 2011. Twelve women with pelvic organ prolapse were offered obliterative vaginal surgery and were informed about the surgical procedure. Ten women accepted this operation and were included in the study. Before and after colpocleisis, cases were evaluated by urogynecological examination, and quality of life was assessed by the Turkish language validated prolapse quality of life questionnaire (P-QOL), in which a low total score indicates a good quality of life. RESULTS: The mean age was 74.9±4.5 (range 68-85). The general score of the P-QOL was reduced during the follow-up period, reflecting a significant effect on quality of life and clinical improvement in women with the colpocleisis operation. There was no morbidity due to colpocleisis or recurrent pelvic organ prolapse in follow-up period. CONCLUSION: In our small cohort including elderly women, colpocleisis provided high levels of surgical outcomes as well as a significant improvement in quality of life without significant morbidity.

Effect of placenta previa on fetal growth restriction and stillbirth.

AIM: To examine the association between placenta previa and adverse perinatal outcomes such as low birth weight, preterm delivery, stillbirth and fetal growth restriction (FGR). METHODS: This retrospective cohort study includes 12,034 delivered pregnant women who were recruited for the study between 2004 and 2010 in Ege University Hospital. Data were collected by browsing the clinic's archives. The association between placenta previa and adverse perinatal outcomes was determined via Chi-square tests and Student's t test. Logistic regression analysis was used to adjust for confounding factors in evaluating the association between placenta previa and the adverse perinatal outcomes. RESULTS: There was no significant relationship between placenta previa and FGR or stillbirth. Low birth weight and preterm delivery were significantly higher in the placenta previa group. According to logistic regression analysis, low birth weight was associated with an OR of 3.01 (95 % CI 2.05-4.52) and preterm delivery was associated with an OR of 8.14 (95 % CI 5.60-11.83); while, placenta previa did not affect FGR and stillbirth significantly. CONCLUSION: Although there is no consensus on the association between placenta previa and FGR in previous studies, we suggest that placenta previa is not a reason for placental insufficiency. Management of placenta previa especially depends on maternal hemodynamic parameters such as heavy hemorrhage and hypotensive shock rather than fetal well-being protocols based on serial growth ultrasound and fetal Doppler investigation.

The role of umbilical cord thickness and HbA1c levels for the prediction of fetal macrosomia in patients with gestational diabetes mellitus.

OBJECTIVE: The aim of this study was to investigate the effects of HbA1c levels and umbilical cord thickness upon birth weight, particularly in pregestational and gestational diabetic patients. METHOD: Pregnant women were included in the study and were divided into two groups. The first group consisted of patients who were diagnosed with pregestational or gestational diabetes mellitus. The control group consisted of pregnant women who were not diagnosed with pregestational or gestational diabetes mellitus. Ultrasound examination was performed twice. Examinations were performed at 27-28 weeks and 36-37 weeks of gestation, respectively. During ultrasound examinations, fetal anthropometric parameters, biparietal diameter, abdominal circumference, femur length and estimated fetal weight (which was calculated automatically according to Hadlock's formula) were measured. Additionally, the sonographic cross-sectional areas of the umbilical cord, the umbilical arteries and the umbilical vein were measured in a free loop of the umbilical cord, using the software of the ultrasound machine. The cross-sectional area of Wharton's jelly was computed by subtracting the cross-sectional area of the vessels from that of the umbilical cord. HbA1c levels were measured for diabetic patients. RESULTS: At 27-28 gestational weeks, umbilical cord area and Wharton's jelly values were found to be statistically different in macrosomic fetuses compared with non-macrosomic fetuses for both groups (for cord area, P = 0.012; for Wharton's jelly, P = 0.001). Additionally, umbilical cord diameter vein and artery values were not statistically different between the two groups when macrosomic fetuses were compared with non-macrosomic fetuses. At 36-37 gestational weeks, when the relationship between umbilical cord components and birth weight was examined, there was a statistically significant difference when comparing macrosomic fetuses with non-macrosomic fetuses. There was a statistically significant correlation between umbilical cord area, umbilical cord diameter and fetal weight estimation at 36-37 gestational weeks. HbA1c values and fetal macrosomia did not show a statistically significant relationship (P = 0.701). CONCLUSION: A significant relationship between umbilical cord components and birth weight was not specific for the diabetic group. There was a significant relationship between birth weight and umbilical cord components for the control group as well. If the estimated fetal weight is combined with umbilical cord components, macrosomic fetuses can be predicted with more accuracy.