Hastanın 1. gün değerleri 3 gün bıyunca stabil kalmış ancak CRP son değeri 139
olmuştur.
[PS-011]
Peripartum Kardiyomiyopati Tanılı Olguların Değerlendirilmesi
Hidayet Şal, Erhan Hüseyin Cömert, Yasin Semih Ekici, Turhan Aran, Mehmet Armağan Osmanağaoğlu Karadeniz Teknik Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Perinatoloji Bilim Dalı, Trabzon
Amaç: Peripartum kardiyomiyopati (PPKM) kardiyovasküler hastalık öyküsü olmayan kadınlarda hamileliğin son aşamasında veya doğumdan sonraki ilk aylarda kendini gösteren nispeten nadir bir kalp hastalığıdır. PPKM hala kısmen tanımlanmamış çok faktörlü bir etyolojiyi içerir. Otoimmünite, miyokardit, antianjiojenik, tokolitik ilaçlara uzun süreli maruz kalma, malnütrisyon ve genetik yatkınlık gibi çeşitli patojenik hipotezler önerilmiştir. PPKM'nin teşhisi hala diğer sebeplerin dışlanması ile yapılmaktadır. Tam fonksiyonel iyileşme olan olgularda bile, vakaların % 20'sinde yeni bir gebeliğin olması durumunda rekürrens ortaya çıkabilir. Bu çalışmada PPKM tanısı konulan olgularımızın literatür bilgisi eşliğinde değerlendirmeyi amaçladık.
Yöntem: 2016-2018 yılları arasında PPKM tanısı ile yatırılan dört hastanın medikal kayıtları retrospektif olarak taranarak, demografik, ekokardiyografik ve klinik verileri kaydedildi. Önceden bilinen kalp hastalığı olanlar, gebelik takibini kliniğimizde yaptırmayanlar çalışma kapsamı dışına çıkarıldı. Bulgular: Toplam 4 hasta çalışmaya alındı. Ortalama anne yaşı 23, gravida 2, parite 1, gebelik haftası 33 olarak saptandı. Olguların hepsinde tanı anında ortopne saptandı. Hastaların % 25 inde aile öyküsü, % 25’inde bir önceki gebelikte kardiyomyopati öyküsü mevcuttu. Ortalama ejeksiyon fraksiyonu % 41.2 olarak bulundu. Hastanede yatış dönemi ve taburculuk sonrası takipte hiç hasta ölmedi. Bir (% 25) hasta kalp yetmezliği nedeni ile transplantasyon sırasına alındı. PPKM nedeniyle ortalama hospitalizasyon süresi 4 gün olarak saptandı. Taburculuk sonrası ortalama takip süresi 34.8 ± 23 ay idi.
Sonuç: Miyokardiyal hasarın derecesi prognozu belirlerken tam bir iyileşmeden kronik kalp yetmezliğine kadar değişkenlik gösterir. Rekürrens riski taşıdığı için gebelikten kaçınılmalıdır.
[PS-012]
Diabetic ketoacidosis in pregnancy: A case report
Beril Gürlek1, Ramazan Adan1, Mustafa Taşcı2, Sabri Çolak1, Yeliz Malay1, Yaser Işık1, Asiye Semra Kadıoğlu3
1Department of Obstetrics and Gynecology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
2Department of Internal Medicine, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
3Department of Obstetrics and Gynecology, Şar Hospital, Rize, Turkey
Objective: Diabetic ketoacidosis (DKA) is a potentially life-threatening condition in pregnancy, affecting 0.5-3% of diabetic pregnancies. We describe a woman who developed DKA due to use of insulin treatment irregularly.
Case presentation: A 24-year-old nulliparous with type 1 diabetes of two years’ duration, usually poorly managed with insulin, presented at 30 weeks of gestation with malaise, vomiting, and uterine contractions. Random plasma glucose level was 344 mg/dl with urinary ketones. Importantly, arterial blood pH 7.25 and anion gap showed 24 were suggesting the presence of metabolic acidosis. Non-reassuring fetal status was recognized because of the fetal heart trace showed poor variability, with late decelerations. Based on these findings, she was diagnosed as having DKA. Consultations were requested from endocrinologists, anesthesiologists, and neonatologists. She was resuscitated with supplemental oxygen, intravenous fluids, and insulin infusion as per the protocol for DKA. After maternal stabilization, emergency cesarean section planned because of late decelerations continued. A 1850 g female infant with 1st/5th minute APGAR scores of 6/7 was delivered. She had an uneventful postoperative follow-up and she was discharged on day seven after surgery with diet therapy and intensive insulin therapy. Discussion: The fetal effects's causes in DKP involve a combination of severe maternal dehydration with acidosis and maternal electrolyte disturbances, could result reduced uteroplacental perfusion and fetal cardiac arrhyhmias, which may lead to fetal death. All maternal factors should be considered together with a multidisciplinary approach while making a decision regarding delivery. In our case despite intensive treatment of DKA, the fetal heart ritm did not recover, which led to the emergency delivery. Conclusion: Even though the outcomes of DKA during pregnancy have improved over the years, maternal and fetal mortality still remains poor. Prevention, early diagnosis, and aggressive management are the keystones to minimise the consequences of complication.
[PS-013]
Anophthalmia: A rare case report
Beril Gürlek1, Sabri Çolak1, İlknur Merve Kazaz1, Yeliz Malay1, Neslihan Sözen1, Asiye Semra Kadıoğlu2 1Department of Obstetrics and Gynecology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
2Department of Obstetrics and Gynecology, Şar Hospital, Rize, Turkey
Objective: Congenital anophthalmia and microphthalmia are two rare defects of the globe resulting from abnormalities in the development of the primary optic vesicle. Anophthalmia has an incidence of 0.18 to 0.4 in 10000 births and microphthalmia around 1.5 to 19 in 10000 births. Here, we present an anophthalmia case, a rare fetal malformation.
Case presentation: A 31-year-old G3P2 lady at her 22nd gestational week was admitted to our clinic with high alpha fetoprotein test result. In family history, both of her brothers had bilateral anophthalmia and mental retardation but no information about specific syndromes. Ultrasonographic evaluation showed bilateral defects of the globe (Figure 1a, b). MRI revealed the right ocular globe imaging was 6.9 mm (microphthalmia). Left ocular globe could not be distinguished (anophthalmia) (Figure 2a, b). Karyotype analysis was suggested, but patient did not accept amniosynthesis. The patient's pregnancy is now ongoing.
Discussion: Anophthalmia is the congenital absence of the eye that results from interruptions in the normal sequence of embryologic events that occurs between 4th and the 8th week of intrauterine life resulting in maldevelopment of the ocular primordium. Many cases of anophthalmia are associated with specific syndromes. The most common syndromes that are associated with anophthalmia are duplication 3q syndrome, Wolf-Hirschhorn syndrome, duplication 4p syndrome, trisomy 9 mosaic syndrome, duplication 10q syndrome, Patau and Edwards syndrome. Drugs, maternal infections and pesticides have been found as potential agents. In this case, anophthalmia can be syndromic and hereditary because of family history. After birth, we are planning to perform genetic analysis of all three cases in same family and share results.
Conclusion: Diagnosis of anophthalmia involves the investigation of both related etiologies and malformations. Prenatal diagnosis, early management and qualification training for an adequate technical platform are the tools to reduce social harm.