Prenatal and Postnatal Management of Intrauterine Pleural Effusions Associated with Nonimmune Hydrops Fetalis.

OBJECTIVE: Nonimmune hydrops fetalis (NIHF) is defined as the accumulation of excess fluid in two or more body cavities in the fetus without blood incompatibility between mother and baby. We aimed to present our prenatal and postnatal management of intrauterine pleural effusions associated with NIHF. STUDY DESIGN: A total of 60 patients diagnosed with NIHF with intrauterine pleural effusion were analyzed retrospectively. Gestational age of delivery or fetal demise, the intrauterine treatment procedure including extrauterine intrapartum treatment (EXIT), chest tube, and medical treatment methods in fetuses with chylothorax analyzed. RESULTS: Thirty-nine patients (65%) were born alive between 26 and 38 weeks. A thoracoamniotic shunt was placed in one patient during the intrauterine period. Seven patients were placed bilaterally during the postnatal period, all without the umbilical cord being clamped during delivery. But 25 patients died within the first few days following birth. A total of four patients had chylothorax. Two patients who did not respond to medical treatment (somatostatin) were injected with thoracic local batticon and cured. A total of 14 patients were discharged with healing. CONCLUSION: Cases of progressive prenatal pleural effusions associated with NIHF have a high risk for fetal and neonatal death. We think that extreme prematurity increases postnatal mortality because it negatively affects the development of the lung and heart. A close obstetric follow-up and a multidisciplinary approach are required for the management to be selected.

Cord blood gas results of pregnancies complicated by preeclampsia and the relationship of these results with the amount of proteinuria.

AIM: To evaluate whether there is a statistically significant difference between the cord blood gas parameters of pregnancies complicated with preeclampsia and uncomplicated pregnancies and to show whether the amount of proteinuria affects fetal cord blood gas parameters in pregnancies complicated with preeclampsia. METHODS: The study was designed retrospectively. Between 2016 and 2019, the neonatal results and cord blood gas results of 109 pregnant women who were diagnosed with preeclampsia and 75 nonpreeclamptic randomly selected pregnant women were compared. The preeclampsia group was divided into groups according to amount of proteinuria. SPSS 21.0 statistics program was used, and comparative analysis was carried out. RESULTS: The data of the 109 preeclampsia cases and 75 control groups included in the study were compared, and there was no statistical difference between the fetal cord blood gas parameters between the groups (p > 0.05). The median first and fifth minute Apgar scores were found significantly lower in the preeclampsia group compared to the control group (6, 8 and 8, 9, respectively; p < 0.001). Also, the amount of proteinuria does not alter cord blood gas parameters (p > 0.05). CONCLUSION: Preeclampsia poses a risk for the neonatal period as it reduces the neonatal Apgar scores due to the chronic hypoxic process it creates. However, it was observed that the amount of proteinuria, which is one of the diagnostic criteria, did not affect neonatal results on Apgar scores or fetal cord blood gas parameters.

The relationship of menopausal symptoms with the type of menopause and lipid levels.

INTRODUCTION: Many postmenopausal women experience hot flashes, night sweats, decreased sexual desire and vaginal dryness. In this study, we aimed to compare the menopause symptom levels of surgical menopause patients and natural menopause patients by using a Menopause Rating Scale (MRS) and investigate whether there is a relationship between lipid levels and menopausal symptoms in surgical menopause patients. MATERIAL AND METHODS: This cross-sectional study was conducted on postmenopausal women who applied to the gynecology outpatient clinic. A total of 187 patients were analyzed. Of these,112 were the surgical menopause group and the remaining 75 were the natural menopause group. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were measured by using an enzymatic color test. In order to evaluate the postmenopausal symptoms of postmenopausal women included in the study, the MRS questionnaire adapted to the Turkish population was used. RESULTS: Considering the results of the MRS of the two groups, the results of surgical menopause patients were found to be statistically significantly higher. The results were statistically significantly higher in both the total score and in the two subgroups(somatic and psychological subgroups)in the surgical menopause group. When the MRS results(subgroups and total score)of women in the surgical menopause group were classified as mild and severe, no statistically significant relationship was found between symptom severity and blood lipid levels. CONCLUSIONS: In the surgically induced menopause group, it was shown by this study that menopausal symptoms were more severe than the natural menopause group. Unlike natural menopausal patients, no relationship was found between lipid levels and severity of menopausal symptoms in surgical menopausal patients.

Association between preterm labour and pelvic floor muscle function.

We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour. Impact statement What is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor's function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial. What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour. What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce the risk of a spontaneous preterm birth.

The Diagnostic Value of ß-Human Chorionic Gonadotropin, Progesterone, and Ischemia-Modified Albumin and Their Combined Use in the Prediction of First Trimester Abortions.

Objective. To investigate serum levels of free ß-HCG, progesterone, and ischemia-modified albumin (IMA) and their combined use in the prediction of first trimester abortions. Methods. A total of 156 pregnant women between 5 and 13 weeks of gestational age were included in this study. At admission, serum levels of free ß-HCG, progesterone, and IMA were noted and all cases were divided into two groups; Group I (n = 77) resulted in abortion including missed abortion, incomplete/complete abortion, and inevitable abortion whereas Group II (n = 79) included normal pregnancies. Results. Compared to Group II, the significantly decreased value of free ß-HCG progesterone and significantly increased value of IMA were found in Group I (P < 0.01, P < 0.01, P < 0.01, resp.). When combining all three parameters, sensitivity 75%, specificity 99%, PPV 98%, and NPV 76% were obtained. The multivariate logistic regression analysis revealed the free ß-HCG, progesterone, and IMA independent factors in the prediction of abortions. Conclusions. The combined use of free ß-HCG, progesterone, and IMA levels can be useful in the prediction of first trimester spontaneous abortions.

Ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury in a rat ovarian-torsion model.

BACKGROUND/AIMS: To evaluate the ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury in a rat ovarian-torsion model. METHODS: 32 Sprague-Dawley rats were randomly divided into four groups: (1) ischemia group (n = 8) in which only left adnexal torsion was performed for 2 h, but no treatment was given; (2) vehicle group (n = 8) in which left adnexal torsion was performed for 2 h and at the end of 2 h ischemia polyethylene glycol (3% PEG, 1 ml, i.p.) was administered and a 24-hour reperfusion was continued; (3) clotrimazole group (n = 8) in which left adnexal torsion was performed for 2 h and at the end of 2 h ischemia clotrimazole (30 mg/kg, i.p.) was administered and a 24-hour reperfusion was continued, and (4) control group (sham-operated, n = 6) in which no adnexal torsion and no treatment were given. The criteria for ovarian ischemia were follicular cell degeneration, vascular congestion, hemorrhage and infiltration by inflammatory cells. Each specimen was scored for each criterion (0, none; 1, mild; 2, moderate; 3, severe). RESULTS: Clotrimazole significantly decreased plasma levels of serum malondialdehyde, ischemia-modified albumin, and total oxidant status. CONCLUSION: This study showed the ovarian-protective effects of clotrimazole on ovarian ischemia/reperfusion injury.

Failed labor induction in nulliparous women at term: the role of pelvic floor muscle strength.

INTRODUCTION AND HYPOTHESIS: The prolongation, protraction or complete cessation of labor is called failed labor. It is one of the leading indications for cesarean delivery. The goal of this study was to measure pelvic floor muscle strength and investigate its effect on labor in nulliparous pregnant women. METHODS: A total of 88 patients were included in the study. The study was conducted in nulliparous pregnant women with a low Bishop score (≤ 7). A low-dose intravenous oxytocin protocol was used for labor induction in all patients. Evaluation of pelvic floor muscle (PFM) strength was performed using a vaginal pressure measurement device just before labor induction. The duration of labor stages and the rate of failed labor were considered the main outcomes. The study group consisted of patients whose labor failed and who subsequently underwent cesarean delivery. The control group consisted of patients who delivered vaginally. The pelvic floor muscle strength and main outcome measures of the two groups were compared. RESULTS: No differences were found in age, weight, height, body mass index (BMI), and neonatal birth weight between the study and control groups. The mean resting and maximum squeeze pressures in the study group were 29.6 ± 9.8 and 56.4 ± 12.1 cm H(2)O respectively, significantly higher than in the control group. The best predictor of failed labor was a maximum squeeze pressure value of 59 cm H(2)0 (51.6% sensitivity and 87.7% specificity). CONCLUSIONS: Pelvic floor muscle strength appears to play a role in predicting failed labor.

Thoracopagus conjoined twins: a case report.

Objective. Conjoined twin is a rarely seen congenital anomaly together with severe mortality and morbidity. The more common types of conjoined twins include the thoracopagus type, where the fusion is anterior, at the chest, and involves the heart. We are reporting one case of conjoined thoracopagus twins diagnosed by ultrasonography at 11 weeks. Case Report. In a multigravid pregnant woman who has been admitted to our clinic with a diagnosis of conjoined twins, thoracopagus, by ultrasonography at an 11-week gestation, termination of the pregnancy was performed. Conclusion. Making an early diagnosis with ultrasonographic examination gives the parents a chance to elect pregnancy termination.

Skin venous thromboembolism by combined oral contraceptive in a woman with acquired angioedema and Factor V Leiden mutation.

OBJECTIVE: The purpose of this study is to report a case of acquired angioedema and Factor V Leiden mutation in a woman who had started taking an oral contraceptive (OC), and to review the literature. RESULTS: A 44-year-old nonobese and nonsmoking woman was admitted to our hospital because of pain and progressive erythematous lesion on her left groin. The patient had had a 6-week history of combined OC use. There was no family history of angioedema. With a diagnosis of necrotizing fasciitis, surgical debridement of all necrotic tissue was considered with fasciocutaneous flap. Histopathological analysis showed diffusely fresh bleeding areas with diffused subcutaneous necrosis. The culture of the necrotic tissue was negative. Postoperatively, she restarted combined OC, and then the painful petechial and rapidly disseminated ecchymotic lesions were seen. Oral contraceptive was stopped immediately. A venous Doppler ultrasonography of the lower extremities showed subacute thrombosis in the left popliteal vein. Complement C3 level was normal, but amounts of C4, C1 esterase inhibitor level and activity were low. Factor V Leiden was positive for the heterozygous presence of Factor V gene. CONCLUSIONS: Women with angioedema and Factor V Leiden should be counseled against using hormonal contraceptives containing estrogen, and because they may interact in a synergistic manner in the pathogenesis of cutaneous lesions and/or venous thrombosis, appropriate individualized therapy should be defined. Further studies are needed.

Comparison of cerebral magnetic resonance and electroencephalogram findings in pre-eclamptic and eclamptic women.

OBJECTIVE: To compare the cerebral magnetic resonance (MR) and electroencephalogram (EEG) findings in pre-eclamptic and eclamptic pregnant women. METHODS: A total of 38 pregnant women with mild pre-eclampsia (n = 15), severe pre-eclampsia (n = 11) and eclampsia (n = 12) were included in this study. Cranial MR without contrast and EEG were performed in these women on admission or within 3 days of onset. Follow-up control MR or EEG evaluations were performed 4-6 weeks postpartum in women with MR or EEG abnormalities in the initial examination. To compare differences, X(2) test, Fisher exact or Mann-Whitney U-tests were used. RESULTS: Abnormal cranial MR findings were found in one (6%) pre-eclamptic woman, in four (36%) severe pre-eclamptic women, and in 11 (92%) eclamptic women. Cranial MR findings were consistent with ischaemia in 15 (39%) patients and haemorrhage in one (3%) case. Two (5%) severe pre-eclamptic women showed cerebral infarction during the follow-up period. MR and EEG abnormalities were totally resolved in 88% of cases. The MR findings of 12 (71%) patients were located in the occipital lobes followed by the parietal lobes in six (40%) cases. Three (20%) mild pre-eclamptic women, four (36%) severe pre-eclamptic women and 10 (83%) eclamptic women had abnormal EEGs. The EEG changes were totally resolved in 13 of 14 (93%) patients after the first month. In one patient with cerebral haemorrhage, the EEG changes lasted for a duration of 6 months. CONCLUSIONS: A correlation between EEG abnormalities and MR findings was found in this study. The combined use of MR and EEG may help to determine the prognosis for these patients, but the interictal EEG findings recorded in eclampsia were non-specific.

Effect of different preparations of hormone therapy on lipid and glucose metabolism, coagulation factors, and bone mineral density in overweight and obese postmenopausal women.

OBJECTIVE: To determine the effects of different preparations of hormone therapy (HT) on lipid and glucose metabolism, coagulation factors, and bone mineral density (BMD) in overweight and obese postmenopausal women. DESIGN: A randomized, nonblinded, controlled study. SETTING: Karadeniz Technical University, Department of Obstetrics and Gynecology. PATIENT(S): A total of 352 overweight and obese (body mass index >25 kg/m2) postmenopausal women. INTERVENTION(S): Ninety women received 2.5 mg of tibolone; 84 received 2 mg of E2 plus 1 mg of norethisterone acetate (E2/NETA); 90 received 0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate (CEE/MPA); and 88 did not receive any menopausal therapy (control). MAIN OUTCOME MEASURE(S): At baseline and after 6 months of treatment, we measured total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), insulin, glucose, factor VII, factor VIII, von Willebrand factor, antithrombin III, protein S, protein C, fibrinogen, and BMD at the lumbar spine L1-L4. RESULT(S): There were no statistically significant differences among the groups for any variables at baseline. After 6 months of treatment, the three regimens decreased total cholesterol, triglyceride, LDL, and fibrinogen; E2/NETA and CEE/MPA increased HDL, and tibolone decreased HDL; higher insulin concentrations were found in the control and tibolone groups. Body mass index, HDL, fibrinogen levels, and L1-L4 BMD were independent factors in the prediction of HT use. CONCLUSION(S): Body mass index, HDL, fibrinogen levels and L1-L4 BMD were independent factors in the prediction of HT use. Treatment with tibolone, E2/NETA, and CEE/MPA resulted in minimal improvement in lumbar spine BMD but had a beneficial effect on the procoagulation system, with minimal changes in glucose metabolism after 6 months of therapy.

The association of birthweight with maternal and cord serum and amniotic fluid growth hormone and insulin levels, and with neonatal and maternal factors in pregnant women who delivered at term.

AIM: To investigate the influence of maternal and cord serum and amniotic fluid growth hormone (GH) and insulin and other neonatal and maternal factors on birthweight. METHODS: A total of 160 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 50), large for gestational age (LGA) (n = 50) or average for gestational age (AGA) (n = 60). GH and insulin levels were measured in maternal and cord serum and amniotic fluid at birth. RESULTS: GH levels in maternal and cord serum and amniotic fluid showed no differences among the three weight groups (P > 0.05). The cord insulin level was significantly lower in SGA (P < 0.01). The insulin level in venous cord blood correlated with birth and placental weights and neonatal height, whereas maternal serum and amniotic fluid insulin levels, and maternal and cord serum and amniotic fluid GH levels did not show any correlation with birthweight. The cord GH level at birth was correlated with GH levels after 4 postnatal weeks in the SGA group (P < 0.01). In addition, birthweight showed a correlation with prepartum maternal weight, maternal weight gain, maternal height, neonatal length and placental weight in all three weight groups. CONCLUSIONS: Cord GH, maternal serum and amniotic fluid GH and insulin levels did not correlate with birthweight in all three weight groups. The lack of correlation for GH levels in maternal and cord serum and amniotic fluid suggests that these compartments may be non-communicating separate units.

Chorioamnionitis risk and neonatal outcome in preterm premature rupture of membranes.

OBJECTIVE: The objective of this study was to compare the neonatal outcome in patients with preterm premature rupture of membranes with and without clinical chorioamnionitis. STUDY DESIGN: This is a retrospective study that included 254 pregnant women with preterm rupture of membranes. The study group was divided according to the presence or absence of clinical chorioamnionitis defined as the presence of two or more of the following criteria: maternal temperature >38 degrees C on two or more occasions > or =1 h apart, maternal tachycardia (> or =120 beats/min), uterine tenderness, foul smelling amniotic fluid, maternal leukocytosis > or =20,000 mm(-3) with bands and positive C reactive protein. Also the study population was divided according to the use of tocolysis. Exclusion criteria included multiple pregnancy, fetal congenital anomalies, diabetes mellitus and severe preeclampsia. Amniotic fluid was collected from the cervix or from the transabdominal amniocentesis. Antibiotics and tocolysis were used according to the hospital protocols. Parametric and nonparametric statistics were used for comparisons. RESULTS: There were no significant differences in birth weight, Apgar scores at 1 and 5 min, rates of respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis between patients with and without clinical chorioamnionitis or between women who received tocolysis and the ones that did not receive tocolysis. In cases of clinical chorioamnionitis and when tocolysis was used the neonates stayed longer in the neonatal intensive care unit (NICU). CONCLUSION: Patients with preterm premature rupture of membranes and clinical chorioamnionitis have similar neonatal outcomes than the ones without clinical chorioamnionitis.

Coagulation inhibitors in preeclamptic pregnant women.

OBJECTIVE: Our objective was to detect clinical evaluation of coagulation inhibitors in preeclamptic and normotensive pregnant women and to determine their important role in pathogenesis of preeclampsia. METHODS: A total of 20 mild, 20 severe preeclamptic and 45 normotensive pregnant women were included in this study. The plasma value of antithrombin III (AT-III) activity, proteins C and S activity, PT, PTT, fibrinogen and platelet counts were determined. RESULTS: The values AT-III were lower in women with severe preeclampsia than in controls (p<0.05). In all groups, there was no significantly difference in the concentration of protein C activity, protein S and fibrinogen (p>0.05). The plasma thrombocyte counts were significantly lower in severe preeclamptic women than in normotensive women (p<0.05). There was no significant difference in the prothrombin time value in all groups, but a significantly difference with regard to partial thromboplastin time between severe preeclamptic and the control group (p<0.0001). It was longer than the control. CONCLUSION: The markers of hemostasis activation such as protein S, protein C activity together with fibrinogen levels are not useful tools but the reduction of AT-III and platelet counts would seem useful in different pathological situations in pregnancy to predict and monitor the severity of the condition.

Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome.

AIM: To compare perinatal outcome of patients with HELLP syndrome to that of patients with chronic hypertension and superimposed preeclampsia on chronic hypertension without HELLP syndrome. METHODS: We retrospectively evaluated the perinatal outcome of 147 pregnancies complicated by the HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome. RESULTS: Gestational age at delivery and birthweights were lower among women with HELLP syndrome than among women with superimposed preeclampsia and chronic hypertension (P < 0.05). There were no statistically significant differences among the three groups with respect to intrauterine growth retardation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, Apgar score, admission to neonatal intensive care unit, overall rate of cesarean delivery and cesarean delivery rate for fetal distress. The total perinatal mortality rate was 17% (28/147) and was more frequent in the HELLP group (27%). Multivariate logistic regression analysis showed that gestational age at delivery (RR 0.45) and birthweight (RR 0.99) were risk factors for adverse outcome. CONCLUSIONS: Perinatal outcome is primarily influenced by gestational age at delivery and birthweight independent of the severity of the hypertensive status of pregnant women.

The relationship between serum dehydroepiandrosterone sulfate concentration and bone mineral density, lipids, and hormone replacement therapy in premenopausal and postmenopausal women.

OBJECTIVE: To investigate the relationship between serum dehydroepiandrosterone sulfate (DHEAS) concentration and bone mineral density (BMD), lipids, and hormone replacement therapy (HRT) in postmenopausal women. METHODS: Two hundred twenty-seven women aged >40 years were admitted to the study and divided into three groups: 61 premenopausal normally menstruating women, 108 postmenopausal women who were not receiving HRT, and 58 postmenopausal women receiving HRT. DHEAS levels and lipid patterns were measured. BMD measurements of the lumbar spine (L1-L4) were performed by dual-energy x-ray absorptiometry (DXA). RESULTS: A positive correlation between DHEAS levels and BMD was found in all three groups. A linear regression model was used to assess the effect of age, body mass index (BMI), parity, and BMD of lumbar vertebrae (L1-L4) on changes in the serum level of DHEAS and found that aging and BMD at the spine had a significant association with serum level of DHEAS and only aging after adjustment for age, BMI, parity, and lipid patterns among the three groups. Age (RR 0.80), DHEAS (RR 0.98), and osteoporosis/osteopenia rate (RR 24.94) were also found to be independent influencing factors for HRT use. CONCLUSIONS: A positive correlation between DHEAS levels and BMD was found in all three groups. Our study confirms earlier reports that DHEAS levels decrease with age in premenopausal and, especially, postmenopausal women regardless of estrogen treatment. DHEAS levels in postmenopausal women were not associated with atherogenic lipid patterns in the present study.

Primary retroperitoneal liposarcoma.

A retroperitoneal liposarcoma that marginally involved the right kidney and ovary was presented clinically as an adnexial mass in a 61-year-old woman. At laparatomy a large retroperitoneal mass in addition to the right kidney and ovary was removed totally. A well-differentiated retroperitoneal liposarcoma was detected in histological speciment. Adjuvant irradiation was given. The 5-year survival rate of retroperitoneal liposarcoma is low. Curative resection remains the main treatment for primary and recurrent liposarcomas.