Antenatal corticosteroids for women at risk of preterm delivery: the "Emperor's New Clothes" tale in medical practice.

OBJECTIVE: To introduce the effect of a single course of betamethasone for pregnant women at risk of preterm delivery (PTD). MATERIALS AND METHODS: In this study, a single course of 12 mg Bethamethasone was administered twice in 24 h (between 24-34 gestational weeks) for antenatal corticosteroid prophylaxis. Four hundred ninety-three neonates fulfilled the inclusion criteria and they were categorized (259 singletons, 192 twins and 42 triplets who met the inclusion criteria) into two groups according to the utilization of antenatal corticosteroid as control (n = 202) and study (n = 291) groups. We used respiratory distress syndrome (RDS), congenital pneumonia, intraventricular hemorrhage (IVH), neonatal sepsis, and bronchopulmonary dysplasia (BPD) as primary outcomes for the evaluation of neonatal morbidity. RESULTS: Study and control groups were similar in terms of clinical characteristics. RDS, congenital pneumonia, neonatal sepsis, and BPD rates were significantly higher in the study group (betamethasone) (p = .05, p = .007, 0.003, and 0.004, respectively) between 24-34 gestational weeks (when the neonates of multiple pregnancies were excluded from the analysis, we have demonstrated that congenital pneumonia (p = .033) and neonatal sepsis (p = .030) were still significantly higher in the betamethasone group). The neonates of 24-28 gestational weeks were compared separately and we demonstrated that RDS (p = .012), congenital pneumonia (p = .022), IVH (p = .044), neonatal sepsis (p = .023), and BPD (0.001) were also more frequent in the study group. When the 28-32 gestational week data were compared, IVH (p = .020) and neonatal sepsis (p = .017) were more frequent in the single course betamethasone users. However, we could not demonstrate a significant difference between the control and study groups between 32-34 gestational weeks in terms of the primary neonatal outcomes used in this study. CONCLUSION: Single course antenatal betamethasone administration may be ineffective on the respiratory complications of preterm and very preterm infants while it may be unfavorable for extremely preterm infants. WHAT IS NEW ABOUT THE PAPER, WHAT COULD ADD TO THE CURRENT KNOWLEDGE: Pregnant women at risk for preterm labor must be under intensive antenatal care programs, and if possible, necessary precautions must be undertaken to prevent fetal hypoxia together with etiology specific treatments. This approach might contribute to better perinatal outcomes than just administering antenatal corticosteroid therapy.

Unplanned pregnancy and awareness of emergency contraception: a postpartum period survey.

OBJECTIVES: The study aimed to determine the awareness of emergency contraception (EC) and knowledge of its use as well as the unplanned pregnancy rate among women in the immediate postpartum period in Ankara, Turkey's second largest city. METHODS: Interviews were carried out among 1955 women on their first or second day postpartum. The interview was based on a questionnaire containing 19 questions covering participants' awareness and experience of using EC as well as their future approach to its use. RESULTS: The rate of unplanned pregnancy was 18.2% and the rate of EC awareness was 26.0%; 89.4% of those who were aware of EC knew how to use it correctly. In the multivariate regression analysis, employment, household income and level of education were independently associated with EC awareness; gravidity, household income, level of education and number of abortions were independently associated with unplanned pregnancy. Awareness of EC increased significantly (p < .05) with age, household income and educational level; knowledge about the correct use of EC increased with age and educational level (p < .05). CONCLUSION: EC awareness among the study population was low and was related to household income and educational level. Household income, educational level and gravidity were the most important factors associated with unplanned pregnancy. Governments must therefore establish appropriate health policies and provide contraceptive education to women from adolescence onwards.

Abnormal Umblical Artery Doppler is Utilized for Fetuses with Intrauterine Growth Restriction Birth at 280/7-336/7 Gestational Weeks.

Purpose: To compare short-term perinatal outcomes in preterm infants with intrauterine growth restriction (IUGR) in those with absent or reversed end-diastolic umbilical artery blood flow (AREDF) to those with normal end-diastolic umbilical artery blood flow (NEDF). Methods: This study included preterm births (280/7-336/7 gestational weeks) with IUGR with AREDF (n = 86) or NEDF (n = 27). Results: There were lower mean gestational weeks, birth weights, and a higher ratio of corticosteroid application in the AREDF group (p < 0.05). The mean length of neonatal intensive care unit stay of the AREDF group was significantly longer (p < 0.001). Sepsis and feeding intolerance ratios in the AREDF group were also significantly higher (p = 0.041 and p < 0.001 respectively). Conclusions: Patients with IUGR and umbilical Doppler abnormalities have longer neonatal intensive care unit stays.

Initial Experience of Superb Microvascular Imaging for Key Cardiac Views in Foetal Assessment before 15 Weeks Gestation.

BACKGROUND: In the first trimester, ultrasound confirmation of normal or abnormal cardiac anatomy is difficult. B-mode and colour flow Doppler (CFD) are used to assess the foetal heart. Superb microvascular imaging (SMI) can visualise blood flow within the heart and vessels in early gestation. OBJECTIVE: We report an initial experience of SMI for visualisation of normal and abnormal cardiac anatomy in the first trimester. METHODS: Transabdominal foetal echocardiography was performed between 11 + 6 and 14 + 3 weeks (Aplio 500 US system, Toshiba Medical Systems, Tokyo, Japan) from January 2017 to December 2017. All scans were performed at a tertiary foetal cardiology unit. To assess the potential utility of the technique for early gestation screening, normal scans were reviewed by foetal medicine trainees with respect to the B-mode, CFD and SMI. Three key views were selected to compare modalities: the 4-chamber view, outflow tracts and the 3-vessel and trachea view (VTV). Visualisation rates of key echocardiographic features of significant cardiac abnormalities by SMI were reviewed. RESULTS: Fifty-five normal echocardiograms and 34 cardiac abnormalities were included. In the normal heart, when B-mode, CFD and SMI were assessed separately, SMI had the highest rate of visualisation of 4-chamber, outflow tracts and 3-VTV (93, 85 and 83%, respectively). Intra-observer reliability was moderate for SMI of the 3 standard views (kappa 1, 0.64 and 0.64); inter-observer for 4-chamber and outflow tract views was moderate (kappa 0.64 and 0.77). In 29/34 abnormal cases, SMI showed key features, enhancing greyscale visualisation. CONCLUSION: SMI has potential to become a useful, complementary modality for early foetal echocardiography. Further prospective studies are warranted to establish the place of the technique in assessment of the first trimester foetal heart.

Predictivity of mean platelet volume in severe preeclamptic women.

INTRODUCTION: To evaluate the predictive and clinical utilization of the mean platelet volume (MPV) in severe preeclamptic women. MPV is known as platelet size and associated with platelet activation or new platelet synthesis. Platelet count is decreased by vascular endothelial damage in cases of severe preeclampsia. It leads to increased turnover of platelets. METHODS: The severe preeclamptic women with and without preeclampsia during pregnancy were divided into subgroups depending on the gestational birth week early, (<34), late (34-37) preterm birth and term (≥37) gestational weeks. Their MPV was measured 24 hours prior to birth and compared with all subgroups according to the gestational week. RESULT: The study subgroups were performed from early (n = 87), late (n = 48) preterm and term (n = 76) birth with severe preeclampsia, whereas early (n = 69), late (n = 63) and term (n = 228) without gestational hypertensive disorders were recruited in the control subgroups. The MPV of the early, late preterm and term preeclamptic subgroups was statistically higher than that of the control subgroups (9.4 ± 1.3fL vs 8.6 ± 1.2 fL, p < 0.001; 9.5 ± 1.0 fL vs 8.5 ± 0.9 fL, p < 0.001 and 10.2 ± 1.1 fL vs 8.9 ± 1.2 fL, p < 0.001), whereas the mean platelet count of all the study subgroups was significantly lower (237.3 ± 81.3 × 109 /L, 270.0 ± 83.9 × 109/L, p = 0.015; 232.3 ± 80.1 × 109/L vs 268.8 ± 92.7 × 109/L, p < 0.001 and 221.8 ± 70.3.9 × 109/L vs 232.9 ± 82.3 × 109/L, p = 0.03). The sensitivity and specificity of the cut-off MPV for all the subgroups were each less than 80%. CONCLUSION: The MPV may be a predictive marker of severe preeclampsia.

Intrapartum, postpartum characteristics and early neonatal outcomes of idiopathic polyhydramnios.

This paper investigates the effect of idiopathic polyhydramnios on the intrapartum and postpartum characteristics of labour and early neonatal outcomes. In this study, intrapartum and early neonatal outcomes of 207 women with idiopathic polyhydramnios and 336 matched healthy pregnant patients were evaluated. In the case of idiopathic polyhydramnios, the active phase of labour became longer when compared to the control group (5.76 ± 3.56 h vs. 4.38 ± 2.8 h, p: 001). The risk of preterm birth (OR 5.23; 95% CI: 2.04-13.42) and caesarean section (OR 2.26; 95% CI: 1.56-3.28) was higher in women with IP. Patients with IP had a higher rate of transcient tachypnoea of the newborn (TTN), newborn resuscitation, admission to neonatal intensive care unit (NICU), ventilator requirement, newborn jaundice, newborn hypoglycaemia and structural anomalies. IP did not cause any appreciable maternal risk during the intrapartum or postpartum periods. However, neonatal morbidity and post-natal anomaly rates were higher in the case of IP.

Is late adolescence a real risk factor for an adverse outcome of pregnancy?

OBJECTIVE: To compare the obstetrical and neonatal outcomes of late adolescent (LA) and adult pregnancies. METHODS: Between January 2012 and December 2012, a total of 313 late adolescent pregnant aged between 16 and 19 years and 418 adult pregnant women aged between 20 and 35 years having given birth in our maternity service were enrolled into this case-control study. The demographic and clinical data were reviewed from hospital database and patients' medical records. RESULTS: The incidence of preterm birth (PB) in the LA group was significantly higher than in the adult group (p = 0.001), while the incidence of gestational diabetes mellitus was significantly lower (p = 0.001). The mean birth weight and the rate of delivered macrosomic fetuses in the study group were lower than in the control group (p = 0.03). The LA group had significantly higher rate of vaginal delivery when compared to the adult group (p = 0.001). Both the rate of pregnancy induced hypertensive disorders and postpartum hemorrhage were not statistically different between the two groups (p = 0.31; p = 0.38, respectively). The LA group had lower rate of stillbirth when compared to the adult group; however, the difference was statistically insignificant (0.3% versus 1.2%) (p = 0.24). CONCLUSIONS: The LA pregnancy should be closely followed up during their antenatal care period due to the significantly higher rate of PB.

The effect of serum and follicular fluid anti-Mullerian hormone level on the number of oocytes retrieved and rate of fertilization and clinical pregnancy.

OBJECTIVE: The objective of this study was to evaluate the relationship between oocyte yield, fertilization, and clinical pregnancy (CP), and anti-Mullerian hormone (AMH) level in serum and follicular fluid during in vitro fertilization treatment. METHODS: Forty-four infertile women who underwent IVF treatment using multiagonist protocol were included in this study. Baseline level of AMH in serum and follicular fluid was measured on third day of menstrual cycle. AMH level in serum and follicular fluid was then measured again on day of oocyte pick-up. Pearson correlation and binary regression tests were used for statistical analysis. For Type 1 error, p=5% was selected as cut-off value for statistical significance. RESULTS: Serum AMH level was positively correlated with total number of oocytes retrieved and rate of fertilization and CP (r=0.397, p=0.008; r=0.401, p=0.007; and r=0.382, p=0.011, respectively). There was significantly negative correlation between serum level of follicle-stimulating hormone (FSH) and fertilization rate (r=-0.320; p=0.034), as well as serum FSH level and CP rate (r=-0.308; p=0.042). There were no significant correlations between AMH level in follicular fluid and IVF treatment outcomes. CONCLUSION: Serum AMH levels may be more reliable for prediction of total number of oocytes retrieved and rate of fertilization and CP than AMH levels in follicular fluid.

Risk factors for clavicle fracture concurrent with brachial plexus injury.

PURPOSE: The aim of this study was to evaluate the risk factors for clavicle fracture concurrent with brachial plexus injuries. METHODS: A retrospective study was conducted at a tertiary centre. The hospital records of 62,288 vaginal deliveries were evaluated retrospectively. There were 35 cases of brachial plexus injury. Of these patients, nine had brachial plexus injuries with clavicle fracture and 26 without clavicle fracture. The analysed risk factors for clavicle fracture concurrent with brachial plexus injury were gestational diabetes, labour induction and augmentation, prolonged second stage of labour, estimated foetal weight above 4000 g, birth weight above 4000 g, risky working hours, and the requirement of manoeuvres to free the impacted shoulder from behind the symphysis pubis. RESULTS: Labour augmentation with oxytocin increased the risk of clavicle fracture in cases of brachial plexus injury (OR 6.67; 95% CI 1.26-35.03). A birth weight higher than 4000 g also increased the risk of clavicle fracture. Risky working hours, gestational diabetes, estimated foetal weight higher than 4000 g, and requirement of shoulder dystocia manoeuvres did not increase the risk of clavicle fracture. CONCLUSIONS: Labour augmentation and actual birth weight higher than 4000 g were identified as risk factors for clavicle fracture in cases of brachial plexus injury.

Obstetric outcome of second trimester antenatal bleeding.

OBJECTIVE: To evaluate the clinical significance of vaginal bleeding in pregnant women between 14th and 22th gestational weeks. METHODS: This retrospective case-control study was conducted between September 2010 and December 2013. Two-hundred nineteen pregnant women with vaginal bleeding between 14th and 22th gestational weeks were compared with 325 pregnant women without vaginal bleeding for their maternal and early neonatal outcomes. RESULTS: Mean gestational age and birth weight of study group were significantly different from those of the control group respectively (37.9 ± 2.8 versus 38.9 ± 1.4 and 3071 ± 710 versus 3349 ± 446 for groups p < 0.001). Vaginal bleeding between 14th and 22th gestational weeks had increased risk of having preterm birth (PB) and preterm premature rupture of membranes (PPROM) (OR: 10.8, 95% CI: [4.5-26.1]; OR: 12.0, 95% CI: [3.5-40.6], respectively). Gestational diabetes mellitus (GDM) and polyhydramnios ratio in the study group was significantly higher than the control respectively (4.1% versus 1.2%, p = 0.031; 1.9% versus 0%, p = 0.025). CONCLUSION: Pregnant women with vaginal bleeding was a significantly risk factor for PB, PPROM, GDM, and polyhydramnios. Consequently, these pregnancies should be closely followed up for maternal and fetus complications.