Conservative treatment of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic sutures to the lower segment of the uterus is associated with lower hysterectomy rate compared with the other conservative methods reported in the literature.
Objective: To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies.
Material and Methods:Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m 2 ) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case.
Results:The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11).
Conclusion:A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with singledose methotrexate administration will be treated successfully. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Key words: Ectopic pregnancy, human chorionic gonadotrophin, methotrexate.Received: 8 April, 2013 Accepted: 26 May, 2013 Amaç: Ektopik gebeliklerin tedavisinde methotraksat tedavisinin başarısını belirlemede beta-human koryonik gonadotropin (β-hCG) değerlerinin 0-1, 0-4 ve 0-7 günleri arasında yüzde değişimlerini değerlendirmek.
Gereç ve Yöntemler:Ocak 2011 ile Agustos 2012 tarihleri arasında ektopik gebelik nedeniyle tanı alan ve tek doz metotreksat tedavisi alan 93 olgu çalışmaya dahil edildi. Elektronik ortamda kaydelilen hastaların dosyalarında bulunan tüm bilgiler incelendi. 0-1, 0-4 ve 0-7 günler arasındaki serum β-hCG seviyelerindeki değişim yüzdeleri her olgu için hesaplandı.
Bulgular:Metotreksat tedavisinin başarılı olan olguların %55.8 ve %89.6'da ortanca β-hCG değerleri 0 ve 4. günler arasında azalmış olarak bulundu. Tedavi öncesindeki ortanca β-hCG seviyesi tedavinin başarılı olduğu olgularda daha düşük saptanmasına rağmen iki grup arasında istatistiksel olarak bir fark saptanmadı (p=0.11).Sonuç: Serum β-hCG değerlerindeki 0 ile 4. günler arasındaki düşme olması metoteksat tedavisinin başarısını tahmininde en iyi gösterge olarak ortaya çıkmaktadır, ve tek doz metotreksat ile tedavi edilen ektopik gebeliklerin nihai tedavinin başarısını belirlemek yararlı olacaktır. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Abstract Özet tion of MTX treatment success. The serum β-hCG level before MTX administration has been reported as a particular factor contributing significantly to treatment failure (8). Previously, it has been found that at least a 15% reduction in the β-hCG concentration on the seventh day compared to the fourth day after MTX administration is the best predictor of treatment success, with a positive predictive value of approximately 93.0% (9). A rise in the β-hCG titer on t...
Aim: The aim of this study was to determine the effects of obesity on amniotic fluid (AF) inflammatory markers in second-trimester AF, testing the hypothesis that there is a relationship between maternal body mass index (BMI) and fetal inflammatory exposure. Methods: AF was obtained from 84 singleton pregnant women undergoing elective amniocentesis for karyotype analysis at 16-24 weeks of gestation between April 2014 and May 2016. The cell-free AF was used to analyze interleukin (IL)-1β and IL-6, and matrix metalloproteinase (MMP)-1, MMP-6, and MMP-13. Results: IL-1β levels were significantly higher in class II-III obese patients than in class I obese, overweight, and normal weight patients (14.68 ± 1.37 vs. 13.34 ± 1.86 vs. 13.00 ± 2.22 vs. 10.78 ± 1.92, respectively; p < 0.05). IL-6 levels were lowest in the normal weight group and highest in class II-III obese patients. MMP-1, MMP-6, and MMP-13 levels were also significantly higher in class II-III obese patients than in the other groups. Conclusion: This study demonstrated that the fetuses of class II-III obese women are exposed in utero to higher cytokine and MMP levels than fetuses of lean women. Modification of current cutoff levels of intra-amniotic cytokines and MMPs according to the BMI could improve the accuracy of the prenatal diagnosis of intra-amniotic infection and inflammation.
Achondroplasia is the most prevalent form of dwarfism, and there is little evidence about the optimal management of pregnant women with achondroplasia. We presented a 25-year-old primigravid woman with achondroplasia who was followed up during the pregnancy period and performed elective caesarean section with combined spinal-epidural anaesthesia at the 38th week of gestation. Frequent obstetric follow-up visits and invasive prenatal diagnostic tests should be offered during the antenatal period due to the increased risk for obstetric complications, such as premature delivery and fetal anomalies. Prenatal detailed counselling, comprehensive evaluation of the potential risks, obstetric and perioperative management should be performed by a multidisciplinary care team, including an obstetrician, anaesthesiologist, pulmonologist, cardiologist and neonatologist.
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