We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.

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...

There were no significant differences in PA Doppler indices for fetuses with or without RDS after steroid administration.

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Background Adrenalectomy require the anatomic preparation of the adrenal gland in the fat-rich retroperitoneal space. In the literature, it was shown that the retroperitoneal fat area affects surgical outcomes in laparoscopic adrenalectomy (LA). Besides the quantity of retroperitoneal fat, its qualitative properties play hypothetically a significant role in the safety profile and perioperative parameters of LA. In this study, we aimed to evaluate the factors associated with adherent periadrenal fat.Methods The prospectively obtained demographic, preoperative, intraoperative and postoperative data of 44 patients who underwent laparoscopic adrenalectomy in our clinic were analyzed retrospectively. The patients was divided into two groups as adherent periadrenal fat (APAF) and non-APAF group. Periadrenal fat tissue was defined as adherent or non-adherent by the attending surgeon according to the difficulty in dissection of adrenal gland from the surrounding fat tissue during the operation.Results The rate of female gender and presence of diabetes mellitus (DM) was higher in the APAF group (respectively, p = 0.038 and p = 0.001). A ROC curve analysis showed that the cut-off point was − 97 HU for APAF. On multivariable analysis using stepwise regression model, we identified presence of DM (OR = 5.073; 95% Cl = 2.192–12.387; p = 0.006) and ARFD > -97 HU (OR = 3.727; 95% Cl = 1.898–11.454; p = 0.008) as independent predictor of APAF.Conclusion APAF seems to affect the perioperative outcomes of LA in terms of operation duration but not perioperative complications.

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