Amaç: Gebeliğin sürdürülmesi için gerekli olan progesteron, gebeliğin 10. haftasına kadar korpus luteum ve sonras›nda plasenta tarafından üretilir. Bu çalışmanın amacı, gebeliğin 6–8 ile 12. haftasındaölçülen serum progesteron konsantrasyonları ile üçüncü trimesterdeplasental disfonksiyonu ortaya koyabilecek parametreler arasındakiilişkiyi araştırmaktır.Yöntem: Gebeliğin 6–8. haftaları ve 12. haftasında ölçülen progesteron değerleri ile gebelikte hipertansif bozukluklar, intrauterin gelişme geriliği, preterm doğum ve düşük doğum ağırlığı gibi plasentaldisfonksiyon belirtileri arasındaki ilişki değerlendirildi. Ayrıca, dahaönceki bir çalışmaya dayanarak, erken gebelik döneminde 11ng/mL’nin üzerindeki ve altındaki progesteron seviyelerine göre ikigrup oluşturuldu ve gestasyonel sonuçlar yönünden bu gruplar arasındaki farklılık incelendi.Bulgular: Gebeliğin 6–8. haftaları ve 12. haftasındaki progesteronkonsantrasyonları, plasental disfonksiyona işaret eden gebelik komplikasyonlarına sahip olan ve olmayan alt gruplar arasında anlamlı şekilde farklı değildi (tüm parametreler için p>0.05). Gebeliğin 6–8. haftalarındaki 11 ng/mL’lik progesteron eşik değeri nedeniyle üçüncütrimester komplikasyonları yönünden iki grup arasında anlaml farklılık bulunmadı.Sonuç: Bu çalışmada, birinci trimesterin erken ve geç dönemlerinde ölçülen progesteron değerlerinin üçüncü trimesterdeki plasental disfonksiyon ile ilişkili olmadığı sonucuna ulaştık. Ayrıca, gestasyonel sonucu öngörmek için daha önce önerilen eşik değeri valide etmedik. Bu nedenle, rutin birinci trimester progesteron taraması gebelik takibini yönlendirmede uygun olmayabilir.
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OBJECTIVE: Placenta previa may cause massive hemorrhage at antenatal, intrapartum or postpartumperiods and is one of the leading causes of maternal morbidity and mortality. Anterior or posterior location of placenta previa can change cesarean technique and management of the operation. Aim of thisstudy is to assess factors increasing intraoperative complications in patients with placenta previa and investigate the significance of anterior placenta location apart from other factors.STUDY DESIGN: This is a retrospective cohort study which was conducted in one center including 83patients followed with placenta previa in three years’ duration. Placental location, presence, and depthof myometrial invasion, previous uterine surgery and the type of uterine incision were evaluated.Intraoperative hemorrhage, need for blood transfusion and hysterectomy, complete blood count parameters of mother and newborn were compared between the anterior and posterior placenta previa.RESULTS: Previous uterine surgery, abnormally invasive placenta and need for blood transfusion weresignificantly higher in patients with anterior placenta previa. The increasing number of previous cesareanoperations enhanced placental invasion to cesarean scar area in anterior placentation, leading to higherrates of blood transfusion, classical incision, and hysterectomy. Also, when the patients with previouscesarean or classical incision were excluded, anterior placentation differed significantly when comparedwith posterior placentation with respect to hemoglobin differences between preoperative and postoperative values.CONCLUSION: Anterior location of placenta previa increases hemorrhagic complications. Placental location, presence, and depth of invasion should be assessed and timing of delivery should be plannedwith appropriate preparation of blood products before delivery.
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Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures. (J Turk Ger Gynecol Assoc 2021; 22: 22-8)
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Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which isan autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodiescan cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy,and to investigate neonatal outcomes.Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed betweenOctober 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITPdiagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route ofdelivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed.Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperativeand postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenitalanomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancywere mostly treated for preparation of delivery. Treatment modalities were similar.Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy whencompared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients shouldbe followed closely in cooperation with the hematology department. (J Turk Ger Gynecol Assoc 2020; 21: 97-101)
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