Acute abdomen in pregnancy requiring surgical management: a 20-case series.

OBJECTIVES: The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. A reluctance to operate during pregnancy adds unnecessary delay, which may increase morbidity for both mother and fetus. In this study, we present our experience in pregnant patients with acute abdomen. STUDY DESIGN: Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2007 to 2010. Demographics, gestational age, symptoms, fetal loss, preterm delivery, imaging studies, operative results, postoperative complications and histopathologic evaluations were recorded. Ultrasound (US) and magnetic resonance (MR) imaging studies were evaluated. Data analyses were performed with Microsoft Excel and statistical evaluations were done by using Student's t-test. RESULTS: There were 20 patients with a mean age of 32 years. The rate of emergency surgery was seen to be significantly higher in the second trimester (p<0.05). Most common symptoms were abdominal pain (100%) and nausea (80%). US was done in all patients while MR imaging was used in 30%. However, US findings were consistent with surgical findings in only 55%, while MR was successful in assigning the correct diagnosis in 83.3%. Appendicitis and adhesive small bowel obstruction were the most common etiologies causing acute abdomen (30% and 15%, respectively). All patients tolerated surgery well, and postoperative complications included wound infection, 10%, preterm labor, 5%, and prolonged paralytic ileus, 5%. One patient died from advanced gastric carcinoma and the only fetal death was seen in this case. CONCLUSIONS: Prompt diagnosis and appropriate therapy are crucial in pregnant with acute abdomen. The use of US may be limited and CT is not desirable due to fetal irradiation. MR has thus become increasingly popular in the evaluation of such patients. Adhesive small bowel obstruction should be kept in mind as an important etiology.

Effects of combined estrogen and progesterone replacement treatment on detrusor contractility and histology in oophorectomized rats.

AIM: The aim of this study was to investigate the effects of estrogen plus progesterone treatment administered after surgical menopause on morphological and muscarinic receptor sensitivity in detrusor muscle bands of rats. MATERIALS AND METHODS: A total of 40 female Albino-Wistar rats were assigned into two groups to undergo surgical menopause with sham operation (n = 10) and bilateral oophorectomy (n = 30). Thirty oophorectomized rats were assigned into three groups for different treatments administered for 8 weeks beginning from the 7th postoperative day. At the end of the 8th postoperative week, laparotomy was performed in all of them and the urinary bladders were excised and investigated with light microscope. All statistical analysis and graphs were performed using GraphPad Prism version 4. P < 0.05 was considered to be statistically significant. RESULTS: It was determined that average bodyweights were increased to some extent in oophorectomized and sham groups after treatment and while it was more marked in the group receiving estrogen therapy, bodyweights were decreased in the group receiving estrogen plus progesterone therapy. However, this was not statistically significant. No statistically significant difference was determined between the sham, placebo and 17-ß estradiol treatment groups regarding contractile response of urinary bladder tapes to carbachol (P > 0.05). Contractile responses of urinary bladder tapes of the estrogen plus progesterone treatment group were found to be statistically lower than the placebo group (P < 0.05). CONCLUSION: Our in vitro findings demonstrate that treatment with estrogen plus progesterone decreases muscarinic activity in oophorectomized rats, whereas estrogen-only treatment does not. Our study establishes the basis for further studies to answer whether combination of estrogen and progesterone treatment can restore detrusor overactivity associated with sex hormone defects seen at menopause.

Leptin and leptin receptor levels in pregnant women with hyperemesis gravidarum.

OBJECTIVE: To investigate the association between the leptin, leptin receptor and hormone levels and hyperemesis gravidarum, and to determine whether these two parameters may be early markers for hyperemesis gravidarum. METHODS: The study group consisted of 18 pregnant women with hyperemesis gravidarum and the control group consisted of 18 healthy pregnant women. Demographic characteristics were recorded and body mass index (BMI) values were calculated for all the pregnant women. Serum leptin, leptin receptor, insulin, cortisol, thyroid hormone and human chorionic gonadotrophin (hCG) levels were measured. RESULTS: When the two groups were compared with respect to leptin levels, the group with hyperemesis gravidarum was found to have significantly higher leptin levels (P = 0.037). No intergroup differences were observed in serum cortisol, insulin, hCG, thyroid hormone levels or BMI values. In the group with hyperemesis gravidarum, an inverse correlation was detected between cortisol and leptin (r = -0.762, P < 0.01), and hCG and thyroid-stimulating hormone (r = -0.503, P < 0.05), whereas a significant correlation was detected between insulin and leptin (r = 0.538, P < 0.05), leptin and BMI (r = 0.711, P < 0.01), and between TT3 and hCG (r = 0.605, P < 0.01). CONCLUSION: It was concluded that leptin could play a role in, and be defined as, a marker of hyperemesis gravidarum.