Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

AIM: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. MATERIAL AND METHODS: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. RESULTS: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic inflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). CONCLUSION: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Postoperative care in the caesarean intensive care unit: experience from a tertiary maternity hospital

Objective: The aim was to determine whether follow-up in the intensive care unit (ICU) for the postoperative first eight hours was beneficial for early intervention in postpartum hemorrhage. Material and Methods: In our hospital, all patients are admitted to the ICU for the first eight hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively. Results: All cases (n=36,396) who underwent cesarean delivery were reviewed. Three hundred and fifty-nine patients with postpartum hemorrhage were identified and included. In the study group the time between cesarean section and diagnosis of postpartum hemorrhage was 10.1±19.1 hours, and the time between cesarean section and re-laparotomy was 9.26±23.1 hours. A total of three maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivering by cesarean section was 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births. Conclusion: Follow-up of patients in the ICU in the first eight postoperative hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.

Mixed type total abnormal pulmonary venous connection: Prenatal diagnosis features in a case.

The diagnosis of TAPVC in the prenatal period, especially if it is in the obstructive form, is very important in terms of both delivery planning and postnatal management. Here we show how a rare obstructive mixed type abnormal pulmonary venous connection is diagnosed prenatally.

A prospective study of myeloperoxidase levels in water immersion.

INTRODUCTION: We aimed to compare myeloperoxidase levels in cord blood samples of mothers undergoing water immersion or conventional labor. METHOD: We enrolled 52 pregnant women to this case control study meeting the following criteria: uneventful gestational follow-ups, no history of known chronic or pregnancy-associated diseases, cesarean section or uterine operation, BMI <29.9 kg/m2, single vertex presentation, normal fetal heart rate pattern, 37-41 weeks of gestation, estimated fetal weight of 2500-4000 g. The subjects were either undergoing immersion in water (n = 26) or conventional labor (n = 26) and their myeloperoxidase levels were measured from cord blood samples. RESULTS: The mean age of the study population was 24.55 ± 4.9 years. The mean BMI and weight gain during pregnancy were 26.8 ± 2.7 kg/m2 and 11.6 ± 5.3 kg, respectively. The mean age of gestation at birth was 39.6 ± 1.1 weeks, with a mean birth weight of 3205.5 ± 433.2 g. The subjects in water immersion and conventional labor groups showed no difference in terms of age, gestational age, BMI, and birth weight. The mean myeloperoxidase level was significantly lower in the water immersion group (759.8 ± 391.5 U/L) compared to that in the conventional labor group (1832.2 ± 1011.9 U/L, p = 0.004). DISCUSSION: Immersion in water during the first stage of labor seems to be associated with low myeloperoxidase levels, suggesting reduced oxidative stress in this delivery method.

High Rate of Obstetric Complications in Patients With Essential Thrombocythemia.

Background Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm characterized by persistently elevated platelet count without a clear secondary cause. Although most patients with ET are between 55 and 60 years of age, it has been estimated that 20% of women with ET are diagnosed during reproductive ages. Miscarriage is the most frequent complication of ET that has been hypothesized to be caused by microcirculatory disturbances and placental microinfarction. Furthermore, pregnant patients with ET are at increased risk of other pregnancy complications such as preterm delivery and intrauterine growth restriction. Methods This study was planned to evaluate pregnancy outcomes and predictors of obstetric complications in pregnant women with essential thrombocythemia (ET). The data of 21 patients with ET were analyzed retrospectively between 2016 and 2020. Age, parity, history of miscarriage, presence of Janus kinase 2 (JAK2) mutation, history of thrombotic events, treatment of thrombocytosis during pregnancy, and obstetrical outcomes including miscarriage were compared. Results Patients with ET had a significantly higher rate of history of two or more previous miscarriages. Miscarriage and obstetric complications in pregnant women with ET were found to be significantly higher than in the control group. Patients with ET with obstetric complications or miscarriage more frequently had a platelet count of >1000 × 103/µL. Acetylsalicylic acid (ASA) prevented miscarriages, but not obstetric complications, in patients with ET. Conclusion ET increases miscarriage and obstetric complications in pregnancy. Treatment with ASA may reduce pregnancy losses, but not obstetric complications.

Independent predictors of survival in endometrium cancer: platelet-to-lymphocyte ratio and platelet/neutrophil/monocyte-to-lymphocyte ratio

Objective: To evaluate the association between ratios of inflammatory markers and survival in endometrium cancer (EC). Material and Methods: Four hundred ninety-seven patients with epithelial EC were included. The evaluated ratios were neutrophil (N)/lymphocyte (L), neutrophil count divided by the lymphocyte count; platelet (P)/lymphocyte, platelets divided by the lymphocyte count; lymphocyte/monocyte (M), lymphocytes divided by the monocyte count; NM/L, neutrophil plus monocyte divided by the lymphocyte count; PNM/L, the sum total counts of platelets, neutrophils and monocytes divided by the lymphocyte count. Results: The median follow-up time was 24 months (1-129). Recurrence and exitus occurred in 34 (7%) and 18 (3.7%) patients, respectively. Metastasis in pelvic or para-aortic lymph nodes were significantly related only with low L/M. None of the inflammatory ratios were associated with disease-free survival. In multi-variant analysis, only high P/L (>168) and high PNM/L (>171) were related with a statistically significant hazard ratio for death of 2.91 (p=0.024) and 2.93 (p=0.023), respectively. Conclusion: The P/L and PNM/L were in relation with worse overall survival and also independent prognostic factors for OS.