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Biomedical subjects

I M Usta

Publications and source records attributed to I M Usta.

At least 19 recordsLinked to original sources
PubMed2005

Mode of delivery for vertex-nonvertex twin gestations.

OBJECTIVE: To compare the neonatal outcome of vaginally delivered (VD) to that of abdominally delivered (CS) vertex-nonvertex (Vx/NVx) twins. METHODS: Vx/NVx live nonanomalous twin gestations >or=25 weeks delivered from 1984 to 2000 were divided into two groups: VD (N=138), and CS (N=79). The outcome of the second twin was compared. RESULTS: The vaginal delivery rate for the Vx/NVx twins was 63.6%. The median Apgar scores at 1 and 5 min, respectively, were significantly lower in VD [7 (0-9) and 9 (1-10)] compared to CS [8 (2-10) and 9 (2-10)]. The neonatal mortality was also higher in VD (109/1000 vs. 38/1000, p=0.040). Differences in the 1-min Apgar scores persisted when infants <1500 g were excluded. All other neonatal outcome variables studied including respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, trauma, seizures, and length of nursery stay were similar. On logistic regression analysis, vaginal delivery of Vx/NVx twins marginally increased low 5-min Apgar scores and neonatal deaths. CONCLUSION: Vaginal delivery in vertex-nonvertex twins was achieved in 63.6% of cases at the expense of a higher incidence of low 1- and 5-min Apgar scores and neonatal death.

Adult↗
PubMed2001

Rupture of an unscarred uterus with misoprostol induction: case report and review of the literature.

Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an unexpected and devastating complication of pregnancy. With the increased use of misoprostol as a labor-inducing agent, cases of rupture of an unscarred uterus following its use have been published in the literature. We report a case of uterine rupture in a multigravid woman with an intrauterine fetal death at 29 weeks' gestation whose labor was induced with misoprostol. A review of all cases of uterine rupture with misoprostol induction is also included. Excessive doses of misoprostol should be used with extreme caution in multiparous women and in patients with a previously scarred uterus even in the context of intrauterine fetal death or termination of pregnancy.

Adult↗
PubMed2001

The conventional doses of human chorionic gonadotropins may not always be sufficient to induce ovulation in all women: a reappraisal.

BACKGROUND: Failure of ovulation has occasionally been reported following the administration of conventionally recommended doses of exogenous human chorionic gonadotropins. CASE: A 25-year-old nulliparous woman with polycystic ovary syndrome underwent ovulation induction for primary infertility. Following successful ovarian stimulation, she failed to ovulate during two consecutive cycles in response to human chorionic gonadotropin doses of 5,000 and 10,000 IU. When challenged with a higher than conventional dose (15,000 IU) on the third cycle, she ovulated and conceived. CONCLUSION: Conventional doses of exogenous human chorionic gonadotropins occasionally fail to complete the ovulatory process in some women. Women with polycystic ovary syndrome appear to be particularly susceptible. Routine documentation of ovulation and individualization of the dose of exogenous human chorionic gonadotropins could therefore prove to be useful in some of these women in order to achieve the best treatment outcome.

Adult↗
PubMed1999

Current obstetrical practice and umbilical cord prolapse.

The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

Cesarean Section↗
PubMed1995

The impact of a policy of amnioinfusion for meconium-stained amniotic fluid.

OBJECTIVE: To evaluate the impact of an amnioinfusion (AI) policy for thick or moderate meconium-stained amniotic fluid (AF) on neonatal outcome, specifically meconium-aspiration syndrome and its complications. METHODS: We reviewed maternal and neonatal charts of 937 vertex, singleton pregnancies complicated by moderate or thick meconium-stained AF during a 3-year period. The patients were divided into groups according to whether AI was performed. Demographic characteristics, risk factors, mode of delivery, pregnancy outcome, and neonatal complications, including meconium-aspiration syndrome, were analyzed. RESULTS: Four hundred forty patients (47%) received AI (AI group); 497 (53%) did not, for the following reasons: imminent delivery (310 patients), occult meconium (141), or emergency cesarean delivery (46) (no-AI group). Our study did not show any reduction in the incidence of 5-minute Apgar scores of 7 or less (8 versus 7%), meconium below the vocal cords (28 versus 29%), meconium aspiration syndrome (4.5 versus 3.8%), ventilation requirement (4.3 versus 2.4%), or neonatal death (0.7 versus 0.2%) in the AI and no-AI groups, respectively. The AI group had a higher incidence of fetal heart rate abnormalities in labor (48 versus 31%, P < .05), instrumental delivery (15 versus 8%, P < .05), cesarean delivery (28 versus 17%, P < .001), and endometritis (21 versus 13%, P = .004). CONCLUSIONS: With the policy of routine AI for moderate or thick meconium-stained AF, AI was not clinically feasible in 53% of the cases. We were unable to demonstrate any improvement in neonatal outcome in those who received AI for moderate or thick meconium.

Adult↗
PubMed1995

Risk factors for meconium aspiration syndrome.

OBJECTIVE: To identify potential predictors of meconium aspiration syndrome (MAS) in pregnancies complicated by moderate or thick meconium-stained amniotic fluid (AF). METHODS: In the period 1990-1993, 937 vertex singleton pregnancies with moderate or thick meconium-stained AF were delivered; of these, 39 neonates developed MAS and 898 did not. The two groups were compared retrospectively according to maternal findings, pregnancy outcome, and neonatal complications, using univariate analysis (P < .05 considered significant) and stepwise multiple logistic regression analysis to identify independent significant factors for prediction of MAS and to calculate odds ratios (OR) and 95% confidence intervals. RESULTS: The two groups had a similar mean gestational age at delivery and birth weight. They also had similar incidences of post-dates pregnancies, small and large for gestational age infants, and amnioinfusion use. Univariate analysis identified significant differences between the two groups in 13 variables, two of which were excluded from logistic analysis because of inadequate data. Logistic regression analysis identified only six variables with independent, statistically significant effects on MAS: admission for induction with nonreassuring fetal heart tracing (OR 6.9), need for endotracheal intubation and suctioning below the vocal cords (OR 4.9), 1-minute Apgar score of 4 or less (OR 3.1), present cesarean delivery (OR 3.0), and previous cesarean delivery (OR 2.5). Cigarette smoking was associated with a lower risk for MAS (OR 0.07). The presence of at least one of the five risk factors had a sensitivity of 92%, a specificity of 56%, a positive predictive value of 8%, and a negative predictive value of 99% for MAS. CONCLUSION: Considering the high negative predictive value of the test, infants without any risk factors will not develop MAS and thus can be safely allowed to room with their mothers. Furthermore, this model helps to identify infants who may benefit from 24-hour observation and in counseling women about the neonatal risk for developing MAS.

Adult↗
PubMed1995

Emergent management of puerperal eclampsia.

Eclampsia is a life-threatening emergency that continues to be a major cause of serious maternal morbidity and is still the leading cause of maternal mortality worldwide. Complicated and mismanaged cases are responsible for many maternal deaths. Perinatal morbidity and mortality is also high if eclampsia occurs in the antepartum period. This article reviews eclampsia management with special emphasis on puerperal eclampsia. The complications associated with eclampsia are also discussed.

Acute Kidney Injury↗
PubMed1994

Vulvar fibroepithelial polyp with myxoid stroma: an unusual presentation.

A case of fibroepithelial polyp arising from the labium majus is described. The tumor measured 12 cm in its largest diameter and was connected to the left labium majus by a 12-cm pedicle. The microscopic examination showed hypocellular connective tissue and focal myxoid areas. One year following surgical excision, the patient did not manifest any signs of recurrence. This case is very unusual in that almost all reported vulvar fibroepithelial polyps are small and sessile.

Adult↗
PubMed1994

Acute fatty liver of pregnancy: an experience in the diagnosis and management of fourteen cases.

OBJECTIVE: Our purpose was to investigate the diagnostic problems and maternal-perinatal outcome in cases of acute fatty liver of pregnancy. STUDY DESIGN: Fourteen cases with acute fatty liver of pregnancy managed during the past 8-years were studied with emphasis on presenting symptoms, admitting diagnosis, laboratory findings, clinical course, maternal complications, and neonatal outcome. RESULTS: The mean gestational age at onset was 34.5 weeks (range 28 to 39). Only seven patients had acute fatty liver of pregnancy as a definite or suspected diagnosis on admission. Computed tomography of the liver was performed on 10 patients, with only two positive results. There were no maternal deaths; however, maternal morbidity was frequent: four patients had hepatic encephalopathy, three pulmonary edema, three ascites, four respiratory arrest, two diabetes insipidus, and 10 had transfusion of blood or blood products to correct either disseminated intravascular coagulation or excessive bleeding. Coagulation abnormalities were common: hypofibrinogenemia (< 300 mg/dl) in 13 patients (93%), prolonged prothrombin time in 12 (86%), and prolonged partial thromboplastin time in 11 (79%). The corrected perinatal mortality was 6.6%. CONCLUSION: Acute fatty liver of pregnancy should be suspected in all patients with symptoms of preeclampsia in the presence of hypoglycemia, low fibrinogen, and prolonged prothrombin time, particularly in the absence of severe abruptio placentae. Computed tomography of the liver has a high false-negative rate in patients with acute fatty liver of pregnancy. In spite of the literature's dismal prognosis, our findings indicate that maternal and perinatal outcomes appear favorable in well-managed patients.

Acute Disease↗
PubMed1994

Spontaneous closure of enterovaginal fistula caused by a neglected foreign body.

The problem of a foreign body left in the operative field is rarely discussed in the medical literature despite the multiple complications it might cause. The purpose of this article is to report on a patient who developed an enterovaginal fistula secondary to a pack left in the pelvis to temponade post-hysterectomy bleeding. The fistula closed spontaneously after three months of expectant management. Expectant management of enterovaginal fistulae is feasible. Adequate reporting of the operative procedures performed and the use of tagged sponges is a must.

Adult↗
PubMed1993

Imperforate hymen: report of an unusual familial occurrence.

BACKGROUND: Although imperforate hymen occurs in approximately 0.1% of female newborns, familial occurrence of imperforate hymen has been reported only once. CASES: We report two families in which imperforate hymen was diagnosed in three siblings of each family. One family is described in detail; the patients were two postmenarchal young women and one premenarchal girl. CONCLUSION: Imperforate hymen usually occurs sporadically but can be familial. We advise screening all female newborns and children for vaginal patency, especially family members of an affected child. Identification of other families with a similar problem might point to a specific mode of inheritance.

Adolescent↗
PubMedDate not supplied

Familial pyloric atresia: report of a family and review of the literature.

Pyloric atresia occurs in one in a million births and usually occurs sporadically. We report a family with nine affected members and review the literature for all reported familial cases. The article stresses the possibility of recurrence of pyloric atresia in the progeny of consanguinous parents, with an emphasis on prenatal diagnosis and counseling, diagnosis of the entity in neonates, associated conditions, and prognosis in sporadic and familial cases. A high index of suspicion in affected families contributes to the early diagnosis and treatment with a great impact on outcome.

Adult↗