Objective: Investigation of the thyroid function test (fT3, fT4 and TSH) results and the prevalence of overt/subclinical hypothyroidism according to age groups in patients who had applied to our hospital and diagnosed with pregnancy. Material and Methods: Two thousand nine hundred and thirty-six women diagnosed with pregnancy for the first time upon seeing the fetal heartbeats with ultrasonography between January 2015 and December 2018, were included in our study. Patients were divided into 5 age groups, namely, the age groups of ≤18 years of age, 19-25 years, 26-35 years, 36-45 years and >45 years of age. The fT3, fT4 and TSH levels were statistically compared between all the patients and age groups. Results: Two thousand nine hundred and thirty-six pregnant women were included in the study. The mean fT3 value was found as 3.180±0.519 (pg/mL), fT4 value as 1.051±0.258 (ng/d/L) and TSH value was found as 2.000±1.595 (mIU/mL) in all the population. The mean fT3, fT4 and TSH values were not statically different among the age groups (p=0.06, p=0.08 and p=0.829, respectively). No statistically significant differences were found among all the age groups as regards hyperthyroidism, euthyroidism, subclinical hypothyroidism and overt hypothyroidism (p=0.200). Conclusion: Consistently with the previous studies in our country, the prevalence of subclinical hypothyroidism was found as high as 22.7% in our study. We think that scanning for hypothyroidism must be performed in the pregnancy period without discriminating between risk groups in our country, which is located in the iodine deficiency region. However, considering the different age groups, we believe that TSH levels must be measured with the same apprehensiveness for each age group since no statistically significant differences are found between age groups.
Objective: To evaluate clinical features, laboratory test results, and maternal and neonatal outcomes of pregnant patients with the Coronavirus disease (COVID-19). Methods: We reviewed clinical data from pregnant women with a laboratory-confirmed SARS-CoV-2, who were admitted to our university hospital in Türkiye. Demographic and clinical characteristics, laboratory test results, and maternal and neonatal outcomes were collected. Results: A total of 46 pregnant women were included in this study. The mean maternal age was 28 (min. 21 – max. 39) years and gestational age was 31 (min. 26 – max. 41) weeks. Two (4.37%) pregnant women were vaccinated with 1 dose of BioNTech® vaccine, and all other patients were unvaccinated. Shortness of breath was the most common symptom present in 15 cases (32.6%). Twenty-seven (58.69%) pregnant women gave birth in the preterm period, and 19 (41.30%) in the term period. Six (13.04%) pregnant women were followed up in the Anesthesia Intensive Care Unit. Two women with critical COVID-19 died in the postpartum period. Conclusion: COVID-19 infection has negative consequences in terms of maternal and neonatal outcomes. The most common causes of adverse neonatal outcomes are iatrogenic or spontaneous preterm births, while the most common causes of adverse maternal outcomes are prolonged hospitalization time, increased likelihood of intensive care hospitalization, and maternal deaths. The most effective way to prevent this situation is to get vaccinated regardless of trimester.
Gebeliğin intrahepatik kolestazı (GİK); gebeliğin 2. Trimestr'ından sonra gelişen, karakteristik olarak serum safra asidi yüksekliği ve kaşıntı ile seyreden gebeliğe özgü bir karaciğer hastalığıdır. Prevelansı; etnik köken, genetik ve çevresel faktörlere bağlı değişkenlik göstermekle birlikte ülkemizdeki sıklığı %0.45 olarak bildirilmiştir. Genetik faktörlerden özellikle hepatositlerde fosfolipid transportunda görevli ABCB4 geni üzerinde durulmaktadır. Risk faktörleri arasında geçirilmiş GİK öyküsü, ileri maternal yaş (>35), multiparite, oral kontraseptif kullanımı ile birliktelik gösteren kolestaz öyküsü, yardımcı üreme teknikleri ile gebe kalmak, ovaryan hiperstimulasyon sendromu, çoğul gebelik, kronik Hepatit C hastası olmak yer almaktadır. En sık semptomu kaşıntıdır ve genelikle avuç içi ve ayak tabanında izlenir. Serum safra asidi yüksekliği (>10 µmol/L) etkilenen gebelerin %90'ında görülür. Serum aminotransferazları hastaların %60'ında artış göstermektedir. Bu artış çoğunlukla normalin 2 katını geçmemektedir. GİK olan hastalarda intrauterin fetal kayıp, mekonyumlu amnion mayi, spontan ve iatrojenik preterm doğum, yenidoğan yoğun bakım ihtiyacı artmış olarak izlenmiştir. Bu komplikasyonlardan fetal dolaşımda artan safra asidi sorumlu tutulmaktadır. Tedavinin amacı maternal biyokimyasal değerlerin normal referans aralığı yakın tutulması, maternal kaşıntı başta olmak üzere semptomların azaltılması ve fetal komplikasyonların önlenmesidir. Ursodeoksikolik asit (UDCA) diğer yöntemlerle karşılaştırıldığında serum safra asidi düzeylerinde ve karaciğer enzimlerinde daha belirgin düzelme sağlamaktadır. İntrauterin fetal kayıp GİK'te ani olarak gelişmekte ve bu nedenle NST, USG ve doppler USG değerlendirmelerinin takipteki yeri sınırlıdır. Gebelerin hangi sıklıkta izleneceği konusunda bir fikir birliği yoktur. Preterm doğum beklenen hastalarda akciğer matürasyonu için kortikosteroid önerilmektedir. GİK olan hastalarda fetal mortalitenin 36. haftada doğumu gerçekleştirilenlerde daha düşük olduğu bildirilmiştir.
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