Objective: To present coronavirus disease-2019 (COVID-19) related maternal mortality in relation to Delta and Omicron waves and to investigate the role of lung ultrasound (LUS) in estimating mortality. Materials and Methods: This retrospective cohort study was conducted in the obstetrics and gynecology clinic of a tertiary pandemic hospital between March 2020 and January 2022. The hospitalized pregnant women with COVID-19 diagnosis and maternal deaths were studied in relation with Delta and Omicron waves. The relationship between LUS scores of hospitalized patients and maternal mortality was explored. Results: Thousand and sixty-five pregnant women were hospitalized because of COVID-19 infection. Fifty-one (4.79%) of these patients had critical sickness, 96 (9.01%) of them had severe illness, 62 (5.82%) of them were admitted to the intensive care unit and 28 (2.63%) of all hospitalized pregnant women had died. Of the 1.065 patients, 783 (73.5%) were hospitalized before the Delta wave and the maternal mortality rate was 1.28% (10/783), 243 (22.8%) were hospitalized during the Delta wave and the maternal mortality rate was 7% (17/243) [relative risk (RR)=5.478, 95% confidence interval (CI) (2.54-11.8), z=4.342, p<0.001]. During the Omicron wave 39 (3.66%) patients were hospitalized and the maternal mortality rate was 2.56% (1/39). Maternal mortality rates, according to LUS scores, were 0.37% (1/273) for LUS 0, 0.72% (2/277) for LUS 1, 2.58% (10/387) for LUS 2 and 11.72% (15/128) for LUS 3 respectively (LUS 3 vs. others; maternal mortality: RR=8.447, 95% CI (4.11-17.34), z=5.814, p<0.0001). There were no vaccinated patients in the study cohort. Conclusion: The maternal mortality rate was relatively high, particularly during the Delta wave at our referral center. The Delta wave, delayed vaccination and vaccine hesitancy of pregnant women might have important roles in maternal mortality. Higher LUS scores should warn clinicians of an increased risk of maternal death.
This is the first study that reported the value of AF Na and K levels for prediction of respiratory morbidities in term and preterm infants. However, further studies including larger number of infants are required to confirm the role of AF analysis to predict neonatal respiratory morbidities. Randomized controlled trial (RCT) number: NCT02813954.
Özet: ‹lk trimesterde tiroid fonksiyonunun gebelik sonuçlar›Amaç: Bu çal›flma ilk trimesterde tiroid disfonksiyonu olan gebelerde oluflabilecek kötü perinatal sonuçlar›n s›kl›¤›n›n belirlenmesi amac›yla yap›ld›.Yöntem: Çal›flmaya, hastanemiz gebe poliklini¤ine 2012-2015 tarihleri aras›nda baflvuran, gebelik haftas› 4 ile 43 hafta aras›nda de-¤iflen 1000 gebe al›nd›. ‹lk trimesterde tiroid fonksiyonlar›na bak›lan gebeler; abortus, erken preterm, geç preterm, toplam preterm, erken membran rüptürü, intrauterin geliflme gerili¤i, oligohidroamniyoz, preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, geç term gebelik, postterm gebelik, do¤um flekli, 1. dk ve 5. dk Apgar skorlar›, do¤um tart›s›, yenido¤an yo¤un bak›m gereksinimleri aç›s›ndan de¤erlendirilerek ilk trimester tiroid fonksiyon testleri verileri (serum TSH, serbest T4, serbest T3 düzeyleri) ile iliflkilendirildi.Bulgular: Çal›flmam›zda hastalarda hipotiroidi s›kl›¤› %8,7, subklinik hipotiroidi s›kl›¤› %8.6, hipertiroidi s›kl›¤› %3.6 ve subklinik hipertiroidi s›kl›¤› %3.6 olarak saptand›. Tiroid fonksiyon patolojisi tespit edilen ve edilmeyen hastalar abortus, erken preterm, geç preterm, toplam preterm, intrauterin geliflme gerili¤i, oligohidroamniyoz, preeklampsi, gestasyonel hipertansiyon, gestasyonel diyabet, geç term gebelik, postterm gebelik, do¤um flekli, 1. dk ve 5. dk Apgar skorlar›, sezaryen endikasyonlar› ile s›kl›¤›, do¤um tart›s›, yeni-do¤an yo¤un bak›m gereksinimi aç›s›ndan incelendi¤inde, tedavi alan hastalar aç›s›ndan istatistiksel olarak anlaml› bir fark bulunma-d›. Hipotiroidi saptanan gebe grubunda erken membran rüptürü daha s›k olarak gözlendi.Sonuç: Gebelerde ilk trimester tiroid fonksiyonlar›n› irdeleyen endokrin çal›flma gruplar›nda ilk trimesterde rutin tiroid fonksiyon testi yap›lmas› aç›s›ndan kesin bir fikir birli¤i olmamakla birlikte, tiroid fonksiyon patolojisinin fetüse olas› potansiyel zararlar› nedeniyle, Türkiye gibi endemik iyot eksikli¤inin bulundu¤u ülkelerde, baflta riskli gebeler olmak üzere, TSH taramas›n›n önemli oldu¤u düflünülmektedir.Anahtar sözcükler: ‹lk trimester, gebelik, tiroid fonksiyon bozuklu¤u. AbstractObjective: In this study, we aimed to determine the frequency of potential poor perinatal outcomes in pregnant women with thyroid dysfunction in the first trimester. Methods:A total of 1000 pregnant women whose weeks of gestation varied between 4 and 43 and who admitted to the obstetrics clinic of our hospital between 2012 and 2015 were included in our study. The pregnant women whose thyroid functions were checked in the first trimester were evaluated in terms of abortion, early preterm, late preterm, total preterm, premature rupture of membranes, intrauterine growth retardation, oligohydramnios, preeclampsia, gestational hypertension, gestational diabetes, late term pregnancy, postterm pregnancy, delivery type, 1-minute and 5-minute Apgar scores, birth weight, newborn intense care needs, and they were associated with the data of thyroid function tests in the first trimester (serum TSH, free T4, and f...
Objective:To evaluate the open abdomen technique (laparostomy) used in complications of major gynecological oncology surgery. Methods: We analyzed retrospectively the surgical database of all patients who had undergone major open surgery by the same gynecologic oncologist over a 5-year period. All patients who had had open abdomen procedure were identified; demographic data and indications of primary surgery, temporary abdominal closure procedure details, fascia closure and morbidity, mortality rates were evaluated. Intraabdominal infection and intraoperative massive hemorrhage were the major indications for all open abdomen cases. Mannheim Peritonitis Index was used perioperatively to determine open abdomen decision in intraabdominal infections. Vacuum Assisted Abdominal Closure system and Bogota Bag were used for temporary abdominal closure techniques. Results: Out of the total 560 patients who had undergone major oncological surgery, 19 patients (3.3%) had open abdomen procedure due to surgical complications. Eleven patients had intraabdominal infection, six patients had hemodynamic instability due to peri and postoperative hemorrhage, two patients had gross fecal contamination during posterior pelvic exenteration surgery. The fascia was closed totally in 15 (78%), partially in 3 (15%) and could not be closed in 1 patient who had died secondary to multiorgan failure. Total morbidity and mortality rates were 26% (5/19) (two intrabdominal abscess, one pulmonary embolism, one skin necrosis, one enteroatmospheric fistula) and 5.2% (1/19) respectively. Conclusion: Open abdomen is a life-saving procedure when applied with correct indications and timing. Gynecological oncologic surgeries are candidates to serious complications and gynecologic oncologists dealing with such surgery should be as experienced as general surgeons in this regard.
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