BackgroundCesarean section (CS) is one of the most common obstetric procedures worldwide and an increased rate of cesarean section has been observed in recent studies. Maternal and fetal mortality and morbidity associated with cesarean section is an important health problem worldwide. This requires the evaluation of the effect of repeated cesarean delivery on maternal morbidity.Material/MethodsA total of 2460 patients who underwent delivery by CS at a center in southeast Turkey between January 2012 and January 2014 (24 months) were included in the study. The patients were divided into 5 groups according to the number of CSs, and the maternal and neonatal outcomes of the groups were retrospectively evaluated.ResultsA statistically significant difference was found between the groups in terms of maternal age, education level, time of hospitalization, operating time, the presence of dense adhesions, bowel and bladder injury, the presence of placenta previa, hysterectomy, blood transfusion requirements, and need for intensive care (p<0.05). Placenta previa (OR, 11.7; 95% CI, 2.6–53.2) and placenta accreta (OR, 12.2; 95% CI, 3.9–37.8) were found to be important risk factors in terms of the need for hysterectomy. No statistically significant difference was found between the groups for gestational age at birth, birth weight, fifth-minute APGAR score, preoperative and postoperative hemoglobin levels, uterine rupture, wound infection, wound dehiscence, placenta accreta, maternal death, and endometritis (p>0.05). A total of 4 or more CSs was identified as the critical level for most of the major complications.ConclusionsAn increasing number of CSs is accompanied by serious maternal complications. Four or more CSs are of especially critical importance. Decreasing the number of cesarean sections is required to decrease relevant complications. Vaginal birth after CS is an option that should be recommended to the patient.
TWIST gene activity is significantly increased in leiomyoma tissue when compared to normal myometrium. In spite of the fact that the development of uterine leiomyomas is estrogen- and progesterone-dependent, myometrial cells could be triggered by the TWIST gene for uterine leiomyoma development.
ÖzetAmaç: Kliniğimizde son 5 yılda amniosentez yapılan hastalarda işleme bağ-lı fetal kayıp riskinin ve kötü gebelik sonuçlarının artıp artmadığını değer-lendirmek. Gereç ve Yöntem: Bu retrospektif çalışma Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde 2011 Ocak ile 2015 Temmuz tarihleri arasında amniosentez yapılan 387 hastanın dosyalarından ve genetik merkezin kayıtlarından incelenerek yapıldı. Ayrıca kliniğimize kontrole gelen ve amniosentez yapılmayan düşük riskli 250 hasta kontrol grubu olarak belirlendi. Bulgular: Çalışma süresince amniosentez endikasyonu olan 688 hasta mevcuttu. Bunlardan 387 hastaya amniosentez yapıldı. %43.8 amniosentez reddetme oranı mevcuttu. En sık amniosentez endikasyonu anormal Down sendromu tarama testi iken (%57.6), 2. sık-lıkla ileri maternal yaş (%22.5) görülmektedir. Amniosentez yapılan hastaların 24'ünde (%6.2) kromozomal anormallik mevcut olup bunlar içerisinde en sık Down sendromu izlendi (%54). Amniosentez sonrası fetal kayıp 2 hastada (%0.5) görülmüştür. Toplamda kötü gebelik sonuçlarına bakıldığında amniosentez yapılanlarda 8, kontrol grubunda 5 hastada kötü gebelik sonuçları izlenmiş olup gruplar arasında istatisitksel anlamlı fark yoktu (p=0.263). Tartışma: Amniosentez günümüzde sıklıkla kullanılan invaziv prenatal tanı testidir. İşleme bağlı olarak gebelik komplikasyonlarında bir artış görülmemekte-dir. Amniosentez öncesinde hastalara mutlaka yapılacak işlem ve sonuçları hakkında detaylı danışmanlık verilmelidir.
Anahtar KelimelerAmniosentez; İleri Maternal Yaş; Down Sendromu Riski Abstract Aim: To evaluate the risk of fetal loss and poor pregnancy outcomes associated with amniocentesis procedures on patients in our clinic in the last 5 years. Material and Method: This retrospective study was conducted by examining the hospital records and genetic centre records of 387 patients who underwent amniocentesis at the Gynaecology and Obstetrics
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