Zeitschrift fur Geburtshilfe und Neonatologie最新文献

Purpose: Ductus venosus (DV) Doppler velocimetry reflects fetal cardiac function. Gestational diabetes mellitus (GDM) is assumed to impair cardiac function due to fetal hyperglycemia. The purpose of this study was to assess the ability of DV Doppler to predict an adverse perinatal outcome (APO) in term pregnancies with GDM.

Methods: This is a retrospective cohort study including GDM pregnancies of singleton, non-anomalous fetuses without any signs of placental dysfunction. All GDM women who primarily had a vaginal delivery attempt and in which DV Doppler was examined from 37+0 weeks on were included. Receiver operating characteristic curve (ROC) analyses were performed to assess the predictive value of DV pulsatility index (DV-PI) regarding a composite APO (CAPO). Furthermore, a subgroup analysis was performed regarding the presence of a large-for-gestational-age (LGA) newborn.

Results: A total of n=89 cases were included. Overall, CAPO occurred in 26 out of 89 cases (29.2%). All DV Doppler examinations showed a positive A wave. DV-PI was>95th percentile in 8 out of 89 cases (9%). Overall, ROC analysis showed no significant association of DV-PI with CAPO (AUC=0.523, p=0.735). However, regarding individual APO parameters, ROC analysis showed a significant association of DV-PI with 5th-min AGPAR (AUC=0.960, p=0.027), which was not confirmed after exclusion of LGA cases.

Conclusion: In GDM pregnancies at term, DV Doppler sonography seems to have no benefit for APO prediction.

The placenta is a temporary organ that provides communication between the mother and fetus. Maternal diabetes and abnormal placental angiogenesis may be linked. We investigated the angiogenesis mechanism resulting from VEGF and glucose stimulation in PECs obtained from human term placenta. Immunohistochemistry was performed to characterize PECs obtained from human term placenta. D-glucose was added to the medium containing PECs to establish normoglycemic and hyperglycemic conditions. The expression levels of VEGF, VEGFR-1 and VEGFR-2 genes and proteins in PECs from the control and experimental groups were analyzed by RT-PCR and Western blotting, respectively. With 48-hours incubation, gene expressions increased due to hyperglycemia, while protein levels increased due to the combined effect of VEGF and hyperglycemia. While VEGFR-2 gene expression and protein amounts increased in 24-hours due to the combined effect of VEGF and hyperglycemia, the effect of VEGF stimulation and glucose level on VEGFR-2 decreased in 48-hour incubation with time. VEGF, VEGFR-1 and VEGFR-2 genes and proteins were affected by hyperglycemic conditions in PECs. Hyperglycemia occurring in various conditions such as gestational diabetes mellitus and diabetes mellitus may affect VEGF, VEGFR-1 and VEGFR-2 genes and proteins of PECs derived from human term placenta.

Objectives: We present the original technique of compression hemostatic sutures on the lower uterine segment due to early postpartum hemorrhage during cesarean section, with a literature review.

Methods: A retrospective clinical case study was conducted at the tertiary perinatal center. Twelve patients had nine planned and three urgent cesarean sections due to antenatally verified placenta previa and/or placenta accreta spectrum and defined early postpartum hemorrhage > 1000 mL during cesarean section. As the use of uterotonics failed to produce any effect and hemorrhage persisted, compression sutures of the lower uterine segment were made by our own technique, as follows: below the hysterotomy, a horizontal corrugated suture is placed from the right to the left corner and after 2-3 cm vertically and backwards at several sites from the left to the right corner, where it is tightened.

Results: Seven patients had one cesarean section, three patients had two cesarean sections, and seven patients had pregnancy from the in vitro fertilization procedure in their history. There were six patients with placenta previa and six patients with anterior invasive placenta accreta or increta. Original hemostatic procedure was applied successfully in ten cases, and after placement of O'Leary suture and persistent bleeding in two cases. In this group, no hysterectomy was performed, and patients received blood transfusion of 440-880 mL. Three patients later had spontaneous pregnancies.

Conclusion: Our own hemostatic method with a simple technique, fast learning, and minimal logistics contributes to successful management of this currently global problem of morbidly adherent placenta previa.

Purpose: The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes.

Material and methods: In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI - 2nd- or 6th-hour SI) values were calculated.

Results: A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%).

Conclusion: The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.

Congenital LQTS is an often undetected inherited cardiac channel dysfunction and can be a reason for intrauterine fetal demise. It can present in utero as CTG and ultrasound abnormalities, i. e., bradycardia, ventricular tachycardia, or fetal hydrops. Diagnosis is made by CTG, echocardiography, or fMCG. Intrauterine therapy with a ß blocker and i. v. magnesium should be started. Our objective was to examine the current knowledge about diagnosis and treatment of LQTS and in particular to highlight the opportunity of vaginal birth under continuous intravenous magnesium therapy. Therefore, a thorough MEDLINE and Google Scholar search was conducted. Randomized controlled trials, meta-analyses, prospective and retrospective cohort trials, and case reports were considered. We showed the possibility of vaginal delivery under continuous magnesium therapy in a case of suspected fetal LQTS. A stepwise concept for diagnosis, monitoring, and peripartum management in low, intermediate, and high risk cases of fetal LQTS is presented. If risk is low or intermediate, a vaginal delivery under continuous monitoring is reasonable. Induction of labor at term should be evaluated.

The treatment of newborns with craniofacial abnormalities such as cleft lip and/or palate poses special challenges for healthcare providers. Often, the collaboration of an interdisciplinary team of pediatricians, orthodontists, and oral and maxillofacial surgeons is necessary. Therapy using feeding or stimulation plates can improve feeding and strengthen orofacial muscle tone. The treatment of patients with cleft lip and palate using conventionally manufactured feeding plates as well as the treatment of patients with reduced orofacial muscle tone through stimulation plates therapy are established and widely used methods. The conventional production of these plate appliances can lead to serious complications such as swallowing of impression material and airway obstruction due to aspiration. Through an innovative, entirely digital workflow using computer-assisted design and manufacturing of the appliances in a 3D printer, risks can be minimized and time and costs can be saved. This article aims to explain the digital workflow of treating newborns with 3D CAD/CAM feeding and stimulation plates through two case studies.

Objective: We aimed to investigate cardiotrophin-1 (CT-1) concentrations in the serum of pregnant women with gestational diabetes mellitus (GDM).

Materials and methods: This prospective non-interventional cohort study was conducted with 160 pregnant women who applied to the Umraniye Training and Research Hospital, Department of Obstetrics and Gynecology between October 2022 and May 2023. The GDM group was formed from 80 pregnant women who were diagnosed with GDM according to the 75-g OGTT. The control group consisted of 80 healthy pregnant women who were matched with the GDM group in terms of age and body mass index and had a normal 75-g OGTT result. Two groups were compared in terms of maternal serum CT-1 concentrations.

Results: Both groups were similar in terms of demographic features and the gestational week at blood sampling for CT-1 (p>0.05 for each). The mean maternal serum CT-1 concentration was found to be 1420.9 pg/ml in the GDM group, while it was determined as 1455 pg/ml in the control group (p=0.738). When the GDM and control groups were divided into two subgroups, normal weight and overweight according to the participants' BMI, serum CT-1 concentrations were found to be similar in these four groups (p=0.084). When the GDM group was divided into two groups of diet-only and the insulin-using group for blood glucose regulation and compared with the control group, the three groups were also similar in terms of serum CT-1 concentrations (p=0.189).

Conclusion: CT-1 is an adipokine involved in the regulation of glucose metabolism and has been suggested to be associated with the pathophysiology of diabetes mellitus. In this study, serum CT-1 concentrations were found to be similar in the group with GDM and the group with normal glucose tolerance. Whether CT-1 contributes to the development of GDM is currently unclear and requires further investigation.

Introduction:   The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions.

Methods:   In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm.

Results:   No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04).

Conclusion:   The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.