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    Antenatal Magnesium Sulfate Use for Fetal Neuroprotection: Experience from a Tertiary Care Hospital in Turkey
    (Allied Acad, 2017) Rauf, Melekoglu; Sevil, Eraslan; Ebru, Celik; Yavuz, Simsek; Cemil, Colak
    Aims: We aimed to demonstrate the effect of magnesium sulfate for fetal neuroprotection on maternal and neonatal outcomes of pregnants delivered before 32 weeks. Materials and methods: The records of 107 patients who were delivered before 32 weeks of pregnancy were reviewed retrospectively during the period between January 2011-February 2016. Patients who were treated with MgSO4 for fetal neuroprotective effect constituted the study group, and patients who were not received MgSO4 for the fetal neuroprotection represented the control group. Results: One hundred seven women delivered before 32nd weeks of pregnancy met study criteria and of these patients, 46 were formed the magnesium sulfate group, and the remaining 61 were constituted the control group. The age (28.37 +/- 4.97 versus 29.90 +/- 5.23 respectively; p= 0.129), body mass index (BMI) (26.25 +/- 4.12 versus 26.90 +/- 5.68 respectively; p= 0.342) and gestational age at delivery (28.08 +/- 2.66 versus 28.78 +/- 2.15 respectively; p= 0.136) were similar between the groups. Intraventricular hemorrhage was more common in control group compared with the MgSO4 group [7/61 (11.4%) versus 3/46 (6.5%); p= 0.049]. For the periventricular leukomalacia [1 (2.2%) versus 0 (0%) respectively; p= 0.430], neonatal convulsion [1 (2.2%) versus 3 (4.9%) respectively; P= 0.630] and neonatal encephalopathy [0 (0%) versus 1 (1.6%) respectively; p= 0.570], no substantial differences were seen between the groups. Conclusions: The results of this study suggest that MgSO4 treatment for fetal neuroprotection has a beneficial effect on intraventricular hemorrhage rate. The widespread use of prenatal MgSO4 for the purpose of fetal neuroprotection before 32 weeks of pregnancy at a standard dose protocol could improve the neonatal neurological outcomes.
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    Antenatal magnesium sulfate use for fetal neuroprotection: experience from a tertiary care hospitalin turkey
    (Allıed acad, 40 bloomsbury way, lower ground flr, london, wc1a 2se, england, 2017) Rauf, Melekoglu; Sevil, Eraslan; Ebru, Celik; Yavuz, Simsek; Cemil, Colak
    Aims: We aimed to demonstrate the effect of magnesium sulfate for fetal neuroprotection on maternal and neonatal outcomes of pregnants delivered before 32 weeks. Materials and methods: The records of 107 patients who were delivered before 32 weeks of pregnancy were reviewed retrospectively during the period between January 2011-February 2016. Patients who were treated with MgSO4 for fetal neuroprotective effect constituted the study group, and patients who were not received MgSO4 for the fetal neuroprotection represented the control group. Results: One hundred seven women delivered before 32nd weeks of pregnancy met study criteria and of these patients, 46 were formed the magnesium sulfate group, and the remaining 61 were constituted the control group. The age (28.37 +/- 4.97 versus 29.90 +/- 5.23 respectively; p= 0.129), body mass index (BMI) (26.25 +/- 4.12 versus 26.90 +/- 5.68 respectively; p= 0.342) and gestational age at delivery (28.08 +/- 2.66 versus 28.78 +/- 2.15 respectively; p= 0.136) were similar between the groups. Intraventricular hemorrhage was more common in control group compared with the MgSO4 group [7/61 (11.4%) versus 3/46 (6.5%); p= 0.049]. For the periventricular leukomalacia [1 (2.2%) versus 0 (0%) respectively; p= 0.430], neonatal convulsion [1 (2.2%) versus 3 (4.9%) respectively; P= 0.630] and neonatal encephalopathy [0 (0%) versus 1 (1.6%) respectively; p= 0.570], no substantial differences were seen between the groups. Conclusions: The results of this study suggest that MgSO4 treatment for fetal neuroprotection has a beneficial effect on intraventricular hemorrhage rate. The widespread use of prenatal MgSO4 for the purpose of fetal neuroprotection before 32 weeks of pregnancy at a standard dose protocol could improve the neonatal neurological outcomes.
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    A case of fetal atrial flutter treated successfully by cardioversion in the postnatal period.
    (Scientific Publishers India, 2017) Rauf, Melekoglu; Sevil, Eraslan; Ayse, Bastemur; Ebru, Celik; Cemsid, Karakurt
    Fetal atrial flutter (AF) is the second common fetal tachyarrhythmias that exist in less than 1% of all pregnancies. It may be related to congestive heart failure, hydrops, neurologic morbidity, or intrauterine death. Early detection and treatment are crucial for getting better neonatal outcomes. We presented a case of fetal atrial flutter diagnosed in the 36th week of gestation and managed successfully by cardioversion in the postpartum period. Cardioversion could be carried out successfully for the treatment of atrial flutter especially in arrhythmias resistant to antiarrhythmic medication during the immediate postpartum period. The recurrence rate of AF after this procedure is very low.
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    A case of fetal atrial flutter treated successfully by cardioversion in the postnatal period.
    (Scıentıfıc publıshers ındıa, 87-greater azad enclave, p o quarsı, alıgarh, 00000, ındıa, 2007) Rauf, Melekoglu; Sevil, Eraslan; Ayse, Bastemur; Ebru, Celik; Cemsid, Karakurt
    Fetal atrial flutter (AF) is the second common fetal tachyarrhythmias that exist in less than 1% of all pregnancies. It may be related to congestive heart failure, hydrops, neurologic morbidity, or intrauterine death. Early detection and treatment are crucial for getting better neonatal outcomes. We presented a case of fetal atrial flutter diagnosed in the 36th week of gestation and managed successfully by cardioversion in the postpartum period. Cardioversion could be carried out successfully for the treatment of atrial flutter especially in arrhythmias resistant to antiarrhythmic medication during the immediate postpartum period. The recurrence rate of AF after this procedure is very low.
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    Conservative management of post-partum hemorrhage secondary to placenta previa-accreta with hypogastric artery ligation and endo-uterine hemostatic suture
    (Wiley, 2017) Rauf, Melekoglu; Ebru, Celik; Sevil, Eraslan; Selim, Buyukkurt
    AimThe aim of this study was to investigate maternal and neonatal outcomes of conservative management of post-partum hemorrhage due to placenta previa-accreta using hypogastric artery ligation and endo-uterine hemostatic suture to lower uterine segment. MethodsThe records of 38 patients who were managed conservatively with hypogastric artery ligation and endo-uterine hemostatic suture to control post-partum hemorrhage secondary to placenta previa-accreta between April 2014 and January 2016, were reviewed retrospectively. Placenta previa-accreta was diagnosed according to gray-scale, color and 3-D power Doppler ultrasonography in addition to the intraoperative findings based on fragmentary or difficult separation of the placenta. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed. ResultsOf these patients, 55.2% were between 25 and 35 years old; 97.5% were multiparous; 71.2% had two or more previous cesarean section and 68.5% had preterm delivery. Women with placenta accreta had a median estimated blood loss of 450 mL; 57.8% of patients had blood transfusion (mean intraoperative transfusion, 2 units packed red blood cells; range, 0-9 units). Median duration of operation was 112.5 min (range, 45-305 min) and 32 patients (84.3%) with placenta accreta did not undergo cesarean hysterectomy. ConclusionConservative 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.
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    Early diagnosis of gestational diabetes mellitus during the first trimester of pregnancy based on the one-step approach of the International Association of Diabetes and Pregnancy Study Groups
    (Springer India, 2018) Rauf, Melekoglu; Sevil, Eraslan; Ebru, Celik; Cemil, Colak
    To examine the utility of the 75 g oral glucose tolerance test (OGTT), conducted according to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG), for the early diagnosis of gestational diabetes mellitus (GDM) and to propose new cut-off values. A total of 350 prospectively enrolled patients were admitted to Inonu University School of Medicine Obstetrics and Gynecology Outpatient Clinic between April 2012 and January 2015 for first-trimester screening. Gestational diabetes mellitus (GDM) during the first trimester of pregnancy (11-13 weeks) was diagnosed using the 75-g OGTT. In patients who tested negative, the OGTT was repeated at 24-28 weeks. GDM was diagnosed in 14.6% of the patients, of whom 80.3% were diagnosed during the first trimester. In these patients, there were no remarkable changes in fasting plasma glucose level when a fasting glucose cutoff of 92 mg/dl was used for the diagnosis of GDM. The sensitivity and specificity of the OGTT were 66.6% and 99.3%, respectively (area under the receiver operating characteristic curve [AUROC] 0.892, 95% CI 0.855-0.923, p < 0.001). The cutoff value for a positive 75-g OGTT result was reduced from 180 to 173 mg/dl for the 1-h post-glucose load (AUROC 0.908, 95% CI 0.873-0.936, p < 0.001) and from 153 to 129 mg/dl for the 2-h post-glucose load (AUROC 0.861, 95% CI 0.515-0.775, p < 0.001). The 75-g OGTT based on IADPSG criteria can be used to detect 80% of GDM cases as early as the first trimester. A modification of current cutoff values would improve the sensitivity of the test but lower its specificity.