The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (-) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population. Impact statement What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton's jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings. What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (-) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%. What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.
IntroductionBladder flap hematoma is an unusual complication of cesarean delivery. The exact incidence is unknown (1). A few paper has been written on this surgical complication (2-5). Bladder flap formation has been an important step in standard cesarean delivery. A cesarean delivery can be performed either by suturing or not suturing the visceral peritoneum. When visceral peritoneum is reapproximated, bleeding at the incision site may result in bladder flap hematoma. The traditional method closes visceral and parietal peritoneum, and therefore may lead to this complication (6). Patients with bladder flap hematoma usually present with a mass lesion, signs of hypovolemia (tachycardia, drop in hemoglobin level, decreased urinary output) and/or infection (fever, leukocytosis) (2-5). In the present case, we introduce a patient who presented with an extraordinary sign of bladder flap hematoma. Case PresentationA 25-year-old nulliparous, 40 weeks and 5 days pregnant woman presented to Suleymaniye Maternity, Research and Education Hospital in labor. Transabdominal ultrasonography showed 3490 g fetus in cephalic presentation. She had regular contractions on non-stress test. Her cervical examination revealed a dilatation of 4 cm and an effacement of 80%. She was hospitalized in order to perform vaginal delivery. The woman had neither obstetric risk factors nor systemic diseases. Prenatal screening of the fetus was unremarkable. The patient underwent cesarean delivery due to persistent late decelerations during active labor. Cesarean delivery was performed with the technique of traditional method. The visceral peritoneum was sutured as in the traditional technique. The newborn's weight was 3220 g with an Apgar score of 7 at 1 minute and 9 at 5 minutes. On the first postoperative hour, the patient developed postpartum hemorrhage due to uterine atony. She had severe anemia and tachycardia. Transvaginal ultrasonography revealed the presence of 86×77 mm solid mass interposed between lower uterine segment and bladder (Figure 1). Preoperative hemoglobin level was 11 mg/dL and postoperative drop in hemoglobin was 5 mg/dL. Although bleeding time (2 minutes), platelet count (165.000/mcL), and fibrinogen level (310 mg/dL) were normal, slow-onset hematuria was noticed in the previously clear urinary discharge. She was transfused with 4 units of erythrocyte suspension and 4 units of fresh frozen plasma. The follow ups of the patient were performed using serial transabdominal ultrasounds. The bladder flap hematoma was stable in dimension and the patient was clinically asymptomatic. Intravenous antibiotic therapy with ampicillin/sulbactam (4 g/day) was ordered. Urinary catheter was not removed until gross hematuria was resolved. She had no fever or leukocytosis during the follow-up period. Transvaginal ultrasonography on seventh post-operative day showed an obvious reduction in hematoma size (32×33 mm) (Figure 2). The patient was discharged with oral ampicillin/ sulbactam (1.5 g/day) on the seventh post-operative day AbstractObjective...
The widespread use of high-resolution obstetric ultrasound has allowed extensive evaluation not only of the fetus, but also of the placenta and umbilical cord. Most of the available data on complication rates and clinical course of fetuses with umbilical cord cysts are limited and is in the form of case reports and small case series. We aimed to present the outcome of a fetus with an isolated umbilical cord cyst on the third trimester. The fetus was delivered by cesarean section because of fetal distress and died three days later following the operation due to perinatal asphyxia. It should be remembered that large umbilical cysts may cause fetal distress by pressure on the cord vessels in case of rapid growth. It is vital to consider the ultrasonographic examination of the umbilical cord as one of the important parts of the examination. ÖZYüksek çözünürlüklü obstetrik ultrasonun yaygın kullanımı ile sadece fetusun değil, aynı zamanda plasenta ve umbilikal kordun geniş çaplı değerlendirilmesi mümkün olmuştur. Umbilikal kord kistleri olan fetusların klinik seyri hakkındaki mevcut verilerin çoğu sınırlıdır, daha çok komplikasyon oranları ile ilgilidir ve vaka raporları ve küçük vaka serileri biçimindedir. Bu vaka sunumunda; üçüncü trimesterde izole umbilikal kord kisti ile prezente olan bir fetusun sonucunu sunmayı amaçladık. Fetüs, fetal distres nedeniyle sezaryen ile doğurtuldu ve operasyondan üç gün sonra perinatal asfiksi nedeniyle exitus oldu. Büyük umbilikal kistlerin hızlı büyüme durumunda kordon damarları üzerinde baskı ile fetal sıkıntıya neden olabileceği unutulmamalıdır. Umbilikal kordun ultrasonografik incelemesinin, muayenenin önemli kısımlarından biri olarak kabul edilmesi hayati önem taşımaktadır. Anahtar kelimeler: Umbilikal kist; fetal anomali; umbilikal kord.
Objective:To determine Turkish women’s opinion about vaginal birth.Materials and Methods:This prospective cohort study was conducted in Department of Obstetrics and Gynecology of Süleymaniye Maternity Research and Training Hospital in İstanbul, Turkey, between February 2015 and April 2015. The participants of this study were 100 primiparous pregnant women who had vaginal deliveries. The women were interviewed face-to-face after the birth. Data were collected through a socio-demographic and clinical questionnaire.Results:Ninety percent of the women reported vaginal birth as the ideal mode of delivery route; a minority of the women (10%) had decided on cesarean birth before having a vaginal birth. Anxiety of pain was the major factor that influenced choice of delivery type before giving birth. After vaginal birth, 84% of women were satisfied with vaginal birth and reported that they would prefer vaginal birth for their next pregnancy. However, 16% reported that they would prefer cesarean birth for their next pregnancy due to pain of labor, pain of episiotomy, anxiety, and prolonged duration of labor.Conclusion:The results suggest the majority of women prefer to give birth vaginally and reported vaginal birth as the ideal choice.
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