Timeliness of postnatal surgery in newborns with open neural tube defects: a single center experience.

BACKGROUND: This study aims to evaluate the experience of a tertiary health center on the timeliness of postnatal management in newborns with open neural tube defects (NTDs). METHODS: This is a retrospective review of 38 neonates with NTDs who were treated surgically at a tertiary health care center between January 2009 and January 2019. Five neonates with genetic syndromes were excluded. RESULTS: Twenty-six neonates with NTD underwent surgery on the first postnatal day while 12 neonates with NTD had surgery after the first postnatal day. The reasons for the latency in operative treatment were the delay in the referral of the affected newborn from other health care centers (n=8) and the transient abnormalities in coagulation tests (n=4). Rural residence was significantly more frequent, gestational age at delivery was significantly lower, preterm delivery was significantly more frequent and prenatal diagnosis was significantly less frequent in neonates that underwent surgery for NTD repair after the first postnatal day (p=0.001, p=0.048, p=0.024 and p=0.003 respectively). Postoperative motor dysfunction was significantly more severe (p=0.002), postoperative complications were significantly more frequent (p=0.008), the reoperation and postoperative mortality rates were significantly higher (p=0.009 and p=0.048 respectively) and the duration of hospital stay was significantly longer (p=0.033) for the neonates who underwent surgery after the first postnatal day. CONCLUSIONS: Our study appears to favor the early repair of NTD`s within the first 24 hours of life. Such an approach may reduce the risk of infectious and neurological complications significantly.

An Autopsy Case Report: Prune Belly Syndrome with Overlapping Presentation of Partial Urorectal Septum Malformation Sequence.

Prune belly syndrome (PBS) is characterized by a classical triad of congenitally absent abdominal muscles, bilateral cryptorchidism, and a malformed urinary tract. Urorectal septum malformation sequence (URSM) is identified with the absence of urogenital and anal openings. This case report describes a 15-week-old female fetus with megacystis, ascites and oligohydramnios in a 19-year-old nulliparous woman. The patient underwent preterm labor at the 33rd gestational week and delivered a female newborn weighing 2250 grams who died three days later due to progressive respiratory insufficiency. To the best of our knowledge, this is the third case of an overlap between PBS and URSM in literature. Such an overlap refers to the existence of left renal agenesis, right renal cystic dysplasia, bilateral club foot and lumbar scoliosis as well as the absence of abdominal wall muscles, internal genital organs, urethral, vaginal and anal openings. This case report aims to remind the obstetricians about the concurrent occurrence of PBS with URSM and its poor prognosis.

Two-Year Follow-Up Results of Transobturator Tape Procedure with and without Concomitant Vaginal Surgery.

OBJECTIVE: This study aims to evaluate the subjective and objective outcomes of the transobturator tape (TOT) procedure performed to treat stress urinary incontinence and to determine the efficacy and safety of the TOT procedure when used along with vaginal surgery. METHODS: This is a prospective review of 24 women who had the TOT procedure done only due to stress incontinence; 22 women who underwent concomitant TOT and pelvic floor repair; and 20 women who received concurrent TOT, transvaginal hysterectomy, and sacrospinous ligament fixation. RESULTS: When compared to the patients who had TOT with pelvic floor repair, the patients who underwent TOT with hysterectomy declared to have more dyspareunia (p = 0.008) and they were found to have significantly higher post-void residual volume (p = 0.014). When compared to the patients who had only TOT, the patients who underwent TOT with hysterectomy claimed to have more pelvic pain (p = 0.012) and significantly higher post-void residual volume (p = 0.020). CONCLUSION: The TOT procedure results in moderately high objective cure rates, and concurrent application of pelvic floor repair or transvaginal hysterectomy does not affect these rates. The relatively higher incidences for voiding problems and pelvic pain in women who underwent TOT, hysterectomy, and sacropinous fixation simultaneously suggest that the extent of surgery directly correlates with the severity of postoperative complications.

The Protective Effects of Alpha-Lipoic Acid and Coenzyme Q10 Combination on Ovarian Ischemia-Reperfusion Injury: An Experimental Study.

Objective. This study aims to evaluate whether alpha-lipoic acid and/or coenzyme Q10 can protect the prepubertal ovarian tissue from ischemia-reperfusion injury in an experimental rat model of ovarian torsion. Materials and Methods. Forty-two female preadolescent Wistar-Albino rats were divided into 6 equal groups randomly. The sham group had laparotomy without torsion; the other groups had torsion/detorsion procedure. After undergoing torsion, group 2 received saline, group 3 received olive oil, group 4 received alpha-lipoic acid, group 5 received coenzyme Q10, and group 6 received both alpha-lipoic acid and coenzyme Q10 orally. The oxidant-antioxidant statuses of these groups were compared using biochemical measurement of oxidized/reduced glutathione, glutathione peroxidase and malondialdehyde, pathological evaluation of damage and apoptosis within the ovarian tissue, and immunohistochemical assessment of nitric oxide synthase. Results. The left ovaries of the alpha-lipoic acid + coenzyme Q10 group had significantly lower apoptosis scores and significantly higher nitric oxide synthase content than the left ovaries of the control groups. The alpha-lipoic acid + coenzyme Q10 group had significantly higher glutathione peroxidase levels and serum malondialdehyde concentrations than the sham group. Conclusions. The combination of alpha-lipoic acid and coenzyme Q10 has beneficial effects on oxidative stress induced by ischemia-reperfusion injury related to ovarian torsion.

The clinical significance of classical and new emerging determinants of adenomyosis.

OBJECTIVE: The present study aims to analyze the diagnostic accuracy of clinical characteristics together with new emerging laboratory markers of adenomyosis. METHODS: This study was a retrospective analysis of clinical and laboratory characteristics of 99 women who underwent hysterectomies with (study group) or without (control group) a diagnosis of adenomyosis, 56 and 43 patients in each group, respectively. RESULTS: The women with adenomyosis were more likely to have younger age (OR = 1.14, 0.789-0.971 95% CI, P = 0.010), higher parity (OR = 1.81, 0.308-0.988 95% CI, P = 0.046), higher number of curettage (OR = 1.90, 1.189-3.041 95% CI, P = 0.007), dysmenorrhea (OR = 117.49, 2.715-5084.883 95% CI, P = 0.013) and elevated mean platelet volume (OR = 5.17, 2.054-13.028 95% CI, P = 0.000). After receiver-operating-characteristics curve analysis, using a cut-point of 8.5 fL, the preoperative mean platelet volume predicted adenomyosis with a sensitivity of 56.6% and specificity of 82.6%. CONCLUSIONS: Those findings suggest gynecologists to give priority on adenomyosis when premenopausal paraous patient with a history of curettages admitted with a complaint of dysmenorrhea and elevated levels of MPV.

Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width.

AIM: The present study aims to evaluate how components of complete blood count are altered in women with a history of recurrent pregnancy loss. MATERIAL AND METHODS: This was a retrospective evaluation of 60 women who had a history of recurrent pregnancy loss, 60 healthy women who had a first trimester pregnancy and 60 healthy parous women. RESULTS: When compared with pregnant women and healthy controls, the women with a history of recurrent pregnancy loss had significantly higher red cell distribution width (RDW) and platelet distribution width (PDW) (P = 0.001 for both). Thrombophilia was detected in 31.7% of the women who had a history of recurrent pregnancy loss (19 out of 60). When compared to the women without thrombophilia, the women with thrombophilia had significantly lower body mass index (P = 0.034) but significantly higher RDW, PDW and plateletcrit (respectively, P = 0.043, P = 0.001 and P = 0.002). There were significant and positive correlations between RDW and PDW (r = 0.615, P = 0.001), RDW and plateletcrit (r = 0.343, P = 0.007) and PDW and plateletcrit (r = 0.340, P = 0.008) in women with a history of recurrent pregnancy loss. CONCLUSION: An elevation in PDW and RDW values was found to be associated with recurrent pregnancy loss.

Frequency of a persistent yolk sac and its relationship with the gestational outcome.

OBJECTIVES: This study aimed to determine the frequency of a persistent yolk sac in pregnancies at 12 to 13 weeks and to investigate whether a persistent yolk sac is associated with an adverse gestational outcome. METHODS: This study reviewed a total of 282 women who had normal singleton pregnancies with a gestational age of 12 weeks to 13 weeks 6 days and who were consecutively admitted to the study center for first-trimester screening (for chromosomal abnormalities) between April 2010 and February 2011. A persistent yolk sac has been defined as a yolk sac that has achieved a diameter of 5.6 mm or greater without losing its internal pressure at the 12th week of pregnancy or later. RESULTS: A persistent yolk sac was detected by sonography in 25 pregnancies. The average diameter of the persistent yolk sacs ± SD was 6.3 ± 0.2 mm (range, 5.6-8.0 mm). The frequency of a persistent yolk sac in pregnancies at 12 weeks was significantly higher than that at 13 weeks (P = .017). A persistent yolk sac was not associated with adverse perinatal outcomes, including abnormal sonographic findings, isolated structural defects, poor obstetric outcomes, and perinatal mortality. CONCLUSIONS: Although yolk sacs mostly disappear toward the end of the first gestational trimester, they may sometimes persist even to the 13th week of gestation. The persistence of the yolk sac seems to be unrelated to an adverse perinatal outcome.

Sonographic evaluation of the yolk sac.

This pictorial essay aims to inform related clinicians by summarizing the normal and abnormal sonographic findings of the yolk sac in the first trimester of pregnancy. An abnormality in the sonographic appearance of a yolk sac can predict subsequent embryonic death or abnormalities. Therefore, the accurate recognition of normal and abnormal sonographic findings concerning the yolk sac can be used to anticipate the course of pregnancy.

Irregular yolk sac shape: is it really associated with an increased risk of spontaneous abortion?

OBJECTIVES: The yolk sac is the first conceptional structure that becomes sonographically visible within the gestational sac. Because the yolk sac is the primary route of exchange between the embryo and the mother, it is essential in early embryonic life. This study aimed to determine whether an irregular yolk sac shape is associated with an increased risk of spontaneous abortion. METHODS: The shape and size of the yolk sac were assessed by transvaginal sonography in 183 women who had normal and healthy pregnancies with gestational ages of 6 to 8 weeks. RESULTS: Most of the embryos had a yolk sac with a regular shape (152 of 183 [83%]), whereas the remaining embryos had a yolk sac with an irregular shape (31 of 183 [17%]). Although there was a trend toward a lower rate of irregular yolk sacs with advancing gestational age, the difference was not statistically significant (P = .13). Spontaneous abortion occurred in 6 of 183 pregnancies (3.3%): 1 of the 31 (3.2%) with an irregular yolk sac shape and 5 of the 152 (3.3%) with a regular yolk sac shape. The rates of spontaneous abortion were statistically similar for pregnancies with a regular yolk sac shape and those with an irregular shape (P > .99). CONCLUSIONS: This study suggests that an irregular yolk sac shape is unrelated to an increased risk of spontaneous abortion.

Simultaneous bilateral tubal pregnancy after in vitro fertilization and embryo transfer.

OBJECTIVE: Ectopic pregnancies are known to occur with increased frequency after in vitro fertilization (IVF) and related techniques. We present a case of bilateral tubal pregnancy following IVF and embryo transfer (ET). CASE REPORT: A 27-year-old woman was referred to our IVF clinic because of primary infertility, and underwent three cycles of IVF-intracytoplasmic sperm injection treatment. In her third cycle, 32 days after ET, she suffered from pelvic pain and vaginal bleeding. Transvaginal ultrasonography revealed bilateral tubal ectopic pregnancy with fluid in the pouch of Douglas but no intrauterine gestational sac. One of the embryos had fetal heart motion. Laparoscopic bilateral salpingostomy was performed immediately. The postoperative course was uneventful. Pathologic examination also identified chorionic villi and placental tissue in both tubes, and an Arias-Stella reaction without villi in the endometrium. CONCLUSION: The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.