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Gynecology Obstetrics & Reproductive Medicine
Number of Followers: 1  Open Access journalISSN (Print) 1300-4751 Published by Medical Network  [1 journal]
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- Maternal Serum Fractalkine Concentrations in Pregnancies Complicated by
Fetal Growth Restriction
Authors: Ecem Berfun Toprak Sager , Ibrahim Kale, Hakan Sager, Aysegul Ozel, Murat Muhcu
Pages: 79 - 85
Abstract: OBJECTIVE: Fractalkine is a newly discovered chemokine that is expressed in placental tissue during pregnancy and is subsequently shed into the maternal serum. Although there are a few studies examining the relationship between fractalkine and preeclampsia, its role in isolated fetal growth restriction has not been investigated yet. In this study, we aimed to investigate the relationship between isolated fetal growth restriction and maternal serum fractalkine concentrations. STUDY DESIGN: This cross-sectional study was conducted on 86 pregnant women, 25 of whom were diagnosed with fetal growth restriction in the third trimester, 23 were small for gestational age, and 38 were healthy controls. These three groups were compared in terms of maternal serum fractalkine concentrations. RESULTS: While the highest mean maternal serum fractalkine concentration was found in the small for gestational age group at 23.31 ng/mL, it was determined as 18.06 ng/mL in the fetal growth restriction group and 16.03 ng/mL in the control group. We did not find a statistical difference between the groups in terms of fractalkine concentrations (p=0.258). When the patients with fetal growth restriction and small for gestational age were evaluated as a single group and compared with the control group, the mean fractalkine concentration in the fetal growth restriction+small for gestational age group was higher than the control group, but this difference was not statistically significant (p=0.214). CONCLUSION: Maternal serum fractalkine concentration was higher in both fetal growth restriction and small for gestational age groups compared to healthy controls, but this difference was not statistically significant. The role of the fractalkine molecule in the development of fetal growth restriction remains to be clarified in future studies with larger series.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1342
Issue No: Vol. 29, No. 2 (2023)
- COVID-19 Vaccination Status and Pregnancy Outcome during Third Wave
Authors: Madhusudan Dey, Shyamji Tiwari, Sunil Chawla, Pranjali Dhume, Abhijit Kumar, Priyanshi Chowdhary, Reshu Rawal
Pages: 86 - 92
Abstract: OBJECTIVES: Omicron was declared as a variant of concern by WHO on 26 Nov 2021. Omicron is highly transmissible, but the disease severity and morbidity were lesser compared to the Delta variant. However, COVID-19 Vaccine efficacy was reduced for the Omicron variant whereas it was highly efficacious for the Delta variant. Hence, for evidence-based counseling in pregnant patients about expected outcomes depending on their vaccination status, this prospective cohort study was conducted. STUDY DESIGN: This study was conducted in Base Hospital Delhi Cantt, New Delhi, India during the third wave of SARS-CoV-2 i.e. from Jan 2022 to Mar 2022. All COVID-19-positive patients who were admitted for delivery were followed up till discharge from the hospital. The outcomes in terms of severity of COVID-19 infection, period of gestation at the time of delivery, intrapartum/postpartum complications, fetal distress, meconium staining of liquor, the requirement of neonatal intensive care unit admission were documented and data was analyzed to assess clinical severity of the disease in fully/partially vaccinated+unvaccinated women. RESULTS: During the specified period, 22.32% was the positivity rate among the delivered patients. Of 61.78% were fully vaccinated and 24.39% were either not vaccinated or partially vaccinated. The risk of symptomatic COVID-19 illness, the requirement of supportive management, and maternal and neonatal outcomes in both groups were comparable. CONCLUSION: Unvaccinated or partially vaccinated parturient had no increased risk of symptomatic COVID-19 illness or requirement of supportive management in terms of oxygen inhalation or ventilation as compared with fully vaccinated pregnant women. The study also reported comparable maternal and fetal outcomes in vaccinated and unvaccinated/ partially vaccinated pregnant women. Further studies are required to ascertain whether the comparable outcomes were due to the decreased severity of the disease caused by the omicron variant.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1355
Issue No: Vol. 29, No. 2 (2023)
- Perinatal Outcomes among Cases of Predicted and Unpredicted Macrosomia
Authors: Merita Isaku, Enxhi Vrapi, Tedi Bimbashi , Ina Cala, Kizjona Perdja, Redi Hoxhallari, Astrit Bimbashi
Pages: 93 - 98
Abstract: OBJECTIVE: Macrosomia is strongly associated with a range of adverse maternal and neonatal outcomes. The effectiveness of screening remains controversial because expecting a macrosomic fetus affects intrapartum management, promoting elective cesarean sections. This study aims to identify differences in outcomes and management among cases with predicted and unpredicted macrosomia. STUDY DESIGN: This is a retrospective study of 779 live-born, cephalic, singleton macrosomic babies delivered at our institution from January 2017 to December 2019. Cases of macrosomia were categorized as unpredicted and predicted. Ultrasonographic weight predictions are made using the Hadlock formula. Data regarding mode of delivery, shoulder dystocia, perineal trauma, episiotomy use, and postpartum hemorrhage were retrieved. Data were stored in a secure database. The review board of the institution approved the study. Statistical analysis is performed utilizing the Mann-Whitney U test for continuous data, the chi-square test for cardinal variables, and logistic regression analysis. Significance was set as p<0.05. RESULTS: Macrosomia is successfully predicted in 268 (34.4%) women. The rate of cesarean sections was significantly higher in the predicted group (46.4% vs. 35.4%, p=0.002). The higher rate of elective cesarean sections among women with predicted macrosomia (26.1% vs. 15.1%, p=0.02) contributed to this difference. Women with predicted macrosomic fetuses were more prone to perineal traumas, such as episiotomy (48.9% vs. 31.3%) or third/4th -degree lacerations (4.8% vs. 1.95%). Shoulder dystocia and other neonatal complications did not differ significantly among the groups. CONCLUSION: Acknowledging macrosomia before delivery increases elective cesarean sections and it decreases the rate of adverse neonatal outcomes such as birth asphyxia.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1379
Issue No: Vol. 29, No. 2 (2023)
- Maternal and Perinatal Outcomes of Pregnancies with Uterine Leiomyomas
Authors: Caner Kose, Busra Korpe, Tugba Kinay, Seval Yilmaz Ergani, Rahmi Sinan Karadeniz, Ali Turhan Caglar, Yaprak Engin Ustun
Pages: 99 - 106
Abstract: OBJECTIVE: We aimed to determine the effect of uterine leiomyoma characteristics and cesarean myomectomy on maternal and perinatal outcomes. STUDY DESIGN: The study included patients with singleton pregnancies and uterine leiomyomas who had delivered at or beyond 24 weeks' gestation; without comorbidities, uterine anomalies, or fetal malformations. Data from 240 patients were studied between 2012 and 2022 in the perinatology clinic of a tertiary care center. Maternal and perinatal outcomes were obtained from medical records. RESULTS: Among the women with uterine leiomyomas, 21.7% were delivered vaginally and 78.3% via cesarean section. Myomectomy was performed in 150 out of 188 (79.8%) patients undergoing cesarean section. It was found that cases with leiomyomas ≥7 cm, compared to those with <4cm, had deliveries at earlier gestational weeks (36w6/7±2d vs. 37w+6/7±2d, p=0.018) and had lower newborn birthweight (2849.44±516.74 g vs. 3237.5±350.6 g, p<0.001), longer operation time (105.92±34.78 min vs. 68.21± 22.31 min, p<0.001) and a higher rate of neonatal intensive care unit requirement (48.1% vs. 13.7%, p<0.001). In cases with ≥2 leiomyomas compared to those with single leiomyomas, gestational age at birth was smaller and birthweight was lower (p<0.05). The amount of blood loss (969.66±427.21 mL vs. 738.15±337.2 mL and 553.84±366.46 mL), duration of surgery (83.23±29.56 min vs. 64.47±17.96 min) and transfusion requirements (36% vs. 5.3% and 28.8%) were higher in women who underwent myomectomy during cesarean section than in the other women undergoing only cesarean section or delivering vaginally (p<0.05). CONCLUSION: It was found that a leiomyoma size of ≥7 cm and number of ≥2 were both associated with earlier gestational age at birth and lower birth weight. Myomectomy performed during cesarean section increased the blood loss, duration of surgery, and the need for transfusion.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1333
Issue No: Vol. 29, No. 2 (2023)
- A New Awareness: Probiotic, Prebiotic and Microbiota Knowledge and
Attitude of Obstetricians
Authors: Duygu Tugrul Ersak, Ozgur Kara, Atakan Tanacan, Burak Ersak, Dilek Menekse Beser, Dilek Sahin
Pages: 107 - 113
Abstract: OBJECTIVE: In this study, we aimed to investigate the knowledge and attitudes of obstetricians about probiotics, prebiotics, and microbiota and evaluate the differences by years in the profession. STUDY DESIGN: This cross-sectional study was conducted on obstetricians working in a tertiary center. A non-validated questionnaire consisting of 18 questions was collected face-to-face. The first part of the questionnaire evaluated the sociodemographic data and the duration of the profession, the other parts assessed the knowledge of prebiotic, probiotic, and microbiota of obstetricians and their attitudes toward prescribing or suggesting these supplements. Furthermore, the obstetricians were divided into two groups: those with a profession less than <12 years and ≥12 years according to the median value of the whole study group to assess the impact of the experience. RESULTS: There was a statistically significant difference between obstetricians with a profession of < 12 years and ≥12 years in their self-knowledge assessment of probiotics, prebiotics, and microbiota. However, the correct definitions were chosen at similar rates. Only 40% of obstetricians with a <12 years of profession thought the use of probiotics during pregnancy to be safe, while more than two-thirds of the obstetricians with a profession of ≥12 years found it safe. Additionally, significant differences were found between the groups’ sources of information, and the purpose of recommendation. CONCLUSIONS: The knowledge and attitude of obstetricians towards probiotics, prebiotics, and microbiota may be affected by the duration of the profession.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1395
Issue No: Vol. 29, No. 2 (2023)
- The Implications of Multiple Repeat Cesarean Deliveries on Maternal
Morbidity
Authors: Esra Can, Süleyman Cemil Oğlak
Pages: 114 - 121
Abstract: OBJECTIVE: This study aimed to assess the obstetric outcomes of cesarean delivery (CD) in a cohort of pregnant women who had a history of four or more previous CDs and compared them with those who had a history of three or fewer previous CDs. STUDY DESIGN: The cohort of this retrospective study consisted of all pregnant women who gave birth in our hospital via elective or emergency CD and who had previously undergone one or more other cesarean sections. Pregnant women who had a history of four or more CDs were included in the multiple repeat CD group, and cases who had a history of fewer than 4 CDs were enrolled in the lower-order repeat CD (comparison) group. Demographic data, medical history, clinical features, intraoperative events, and postoperative complications were recorded. RESULTS: The multiple repeat CD group comprised 63 women, and the lower-order repeat CD group (comparison group) included 1097 cases. Intraabdominal dense adhesions (28.6% versus 14.1%, p=0.002), placenta previa (11.1% versus 4.1%, p=0.009), placenta accreta spectrum (PAS) (7.9% versus 2.4%, p=0.008), bladder injury (6.3% versus 1.7%, p=0.011), intraoperative massive hemorrhage (7.9% versus 2.2%, p=0.004), uterine artery ligation (4.8% versus 1.1%, p=0.012), internal iliac artery ligation (4.8% versus 1.2%, p=0.008), cesarean hysterectomy (4.8% versus 1.5%, p=0.045), blood transfusion (12.7% versus 4.1%, p=0.001), and maternal intensive care unit (ICU) admission (14.3% versus 2.0%, p<0.001) were significantly more common among women in the multiple-repeat CD group compared with the lower-order repeat CD group. CONCLUSIONS: Pregnant women having multiple repeat CDs have a significantly increased risk of dense adhesions, placenta previa, PAS, intraoperative massive hemorrhage, blood transfusion, bladder injury, additional surgical interventions, including uterine artery ligation, internal iliac artery ligation, cesarean hysterectomy, and maternal ICU admission.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1401
Issue No: Vol. 29, No. 2 (2023)
- Does Baseline Serum Androgen Levels Have an Impact on Ovulation Induction
Cycle Outcomes by Using Clomifene Citrate among Infertile Women with
Polycystic Ovary Syndrome' A Retrospective Cohort Study
Authors: Serkan Kahyaoglu, Muzeyyen Gulnur Ozaksit, Gozde Karacan Duman, Deniz Ozturk Atan, Inci Kahyaoğlu, Meryem Kuru Pekcan, Ozlem Moraloglu Tekin
Pages: 122 - 127
Abstract: OBJECTIVE: Hyperandrogenism is one of the diagnostic criteria for polycystic ovary syndrome. Women with polycystic ovary syndrome suffer from infertility due to anovulation. Hyperandrogenism results in follicular arrest at the antral stage during folliculogenesis. baseline intrinsic hyperandrogenism affects the success of ovulation induction or not. The relationship between baseline serum androgen levels and ovulation induction cycle outcomes by using clomifene citrate among infertile women with polycystic ovary syndrome has not been investigated thoroughly. STUDY DESIGN: Ovulation induction cycle outcomes of 35 infertile women diagnosed with polycystic ovary syndrome according to Rotterdam criteria who have received 50-100 mg/day clomifene citrate have been evaluated retrospectively. Menstrual cycle day 2-5 serum levels for gonadotropins, androgens, metabolic parameters, and ovulation induction cycle outcomes have been compared between women who have and have not achieved clinical pregnancy following treatment. RESULTS: Serum basal follicular stimulating hormone, LH, E2, fasting cholesterol, glucose, and HOMA-IR levels were comparable between these two groups of patients. Unlike other serum androgens, baseline serum-free testosterone level is significantly lower for patients who have achieved clinical pregnancy following ovulation induction with clomifene citrate. The baseline serum cut-off level for free testosterone to predict clinical pregnancy was 1.94 pg/ml with 75% sensitivity and 67% specificity rates. CONCLUSION: Lower or higher levels of androgenic milieu within the ovaries result in defective folliculogenesis and ovulation failure. Increased serum levels of free testosterone which is a proxy for ovarian androgen production might be a detrimental factor for clinical pregnancy rates of women with polycystic ovary syndrome by impairing proper folliculogenesis.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1371
Issue No: Vol. 29, No. 2 (2023)
- An Important Tool in Lymphedema Management: Validation of the Turkish
Version of the Gynecologic Cancer Lymphedema Questionnaire
Authors: Hanife Abakay , Ummuhan Abdulrezzak, Turkan Akbayrak
Pages: 128 - 137
Abstract: OBJECTIVE: This study aimed to research the reliability and validity of the Turkish version of the gynecologic cancer lymphedema questionnaire for individuals with gynecologic cancer. STUDY DESIGN: The study included 60 patients who underwent gynecologic cancer surgery with lower limb lymphedema in the lymphedema group and 30 who underwent gynecologic cancer surgery without lower limb lymphedema in the non-lymphedema group. The Turkish adaptation of the gynecologic cancer lymphedema questionnaire was completed by considering the cultural adaptation process. For the evaluation of lymphedema, circumference measurement, skin layer thickness, and lymphoscintigraphy assessments were performed. The intraclass correlation coefficient was calculated for gynecologic cancer lymphedema questionnaire test-retest reliability, the Cronbach alpha was calculated for internal consistency reliability and the criteria validity method was used for survey validity. RESULTS: The symptom subsections and total score of the gynecologic cancer lymphedema questionnaire, the intraclass correlation values for test-retest points were 0.780, 0.968, 0.695, 0.945, 0.896, 0.945, and 0.947. The Cronbach a values for internal consistency were 0.928, 0.824, 0.656, 0.429, 0.923 and 0.948 for the subsections. Criteria validity was used for the validity analysis and statistically significant (p<0.05) positive correlations were determined between skin fold thickness measurements and total points on the scale in the lymphedema group for values at the midpoint of the right and left tibial shaft (r=0.336, r=0.284). CONCLUSION: The gynecologic cancer lymphedema questionnaire was determined to be a reliable and valid scale to differentiate patients with lower limb lymphedema from those without lower limb lymphedema in a Turkish female population.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1348
Issue No: Vol. 29, No. 2 (2023)
- Neonatal Surgery Intensive Care Unit: Hacettepe University Experience
Authors: Umit Ayse Tandircioglu, Hasan Tolga Celik, Sule Yigit, Murat Yurdakok
Pages: 138 - 142
Abstract: OBJECTIVES: Surgical treatment in the neonatal period is very significant. The neonatal surgery intensive care model has been applied in our hospital for about six years. This study aims to examine the data gathered from the neonatal intensive care unit of our hospital and to understand how this model contributed to the health improvement of newborns with surgical problems. STUDY DESIGN: The file records of newborns admitted to the neonatal intensive care unit were retrospectively analyzed from January 2014 to December 2019. The protocol was registered with Clinical Trials.gov identifier NCT04734002. RESULTS: The total number of newborns admitted to the neonatal intensive care unit was 5442. Surgery was performed on 546 of these patients. Two hundred and four patients were hospitalized due to congenital heart disease. Two hundred patients were operated on by pediatric surgeons whereas 142 were operated on by other surgery specialists. In the last six years, the mortality rate was 5.25% in babies without surgical diseases and 18.3% in those with surgical diseases (p<0.05). The hospitalization periods of the babies followed up in our neonatal intensive care unit in the last two years were evaluated. Thereupon, premature babies with other diseases were hospitalized for an average of 9.6 days; however, those patients who require surgery were hospitalized for 33.0 days (p<0.05). The term babies, who did not have any surgical diseases were hospitalized for an average of 4.8 days and those with surgical indications for 16.5 days (p<0.05). CONCLUSION: We believe that the neonatal surgery intensive care unit model should become widespread in Türkiye. We intend to draw attention to this matter through our study, sharing our own experience.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1315
Issue No: Vol. 29, No. 2 (2023)
- Spontaneous Rupture of Renal Cell Carcinoma in Pregnancy: A Case Report
Authors: Mohamed Zakieldahshoury, Hassaan A. Gad, Salah Ahmed
Pages: 143 - 145
Abstract: Renal cell carcinoma is the most common type of malignancy in pregnancy. Rupture of renal cell carcinoma is not uncommon. The diagnosis of renal cell carcinoma is often delayed as the clinical presentation might resemble other pregnancy-related disorders or asymptomatic in most cases and a complete ultrasonographic examination of the abdomen is not a part of the routine obstetric evaluation. We report a rare case with spontaneous rupture of renal cell carcinoma in 20 years old in full-term pregnancy primigravida presented by hypertensive disorder and severe abdominal pain with massive retro peritoneum collection, radical nephrectomy was done and the patient life was saved.
PubDate: 2023-08-15
DOI: 10.21613/GORM.2022.1266
Issue No: Vol. 29, No. 2 (2023)
