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    Determining emergency caesarean risk factors in placenta previa cases: a prospective cohort study
    (EDRA S.p.A, 2023) Arı, S.A.; Okmen, F.; Akdemir, A.; Yeniel, A.O.; Ergenoğlu, A.M.; Sagol, S.
    Objective. The aim of the current study was to determine the emergency caesarean section risk factors for patient with placenta previa. Materials and Methods. A total of 98 placenta previa cases were enrolled the current prospective cohort study between November 2018-June 2019. The time, number and frequency of vaginal bleeding episodes, emergency caesarean section requirement, presence of adhesive pathologies was recorded. Results. The mean cervical length was 35.7 (± 8.3) mm. Patients with presence of vaginal bleeding before the 28th week (OR 11 (95%CI 1.85-65.07); p < 0.001); participants who had two or more bleeding occurrences (OR 7.39 (95%CI 1.83-29.80); p = 0.001); patients with cervical length measurements < 30 mm (OR 2.91 (95% CI 0.64-13.14); p = 0.039) had higher risk of emergency caesarean section. Emergency caesarean section rate was 12%. No relation was shown between the emergency caesarean section and invasion pathologies in cases with placenta previa (p = 0.241). Conclusions. The risk of emergency caesarean section is high in patients who had a vaginal bleeding before the 28th gestational week, had two or more bleeding episodes throughout their pregnancy and patients with cervical length was less than 30 mm. © The Authors.
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    Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Tubal Stump Pregnancy
    (Elsevier B.V., 2020) Ozceltik, G.; Yeniel, A.O.; Atay, A.O.; Itil, I.M.
    Objective: To demonstrate a case of left tubal stump pregnancy successfully treated using our 2-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Design: Demonstration of the technique using surgical video footage. Setting: Tertiary university hospital. Interventions: A 27-year-old gravida 3 para 0 patient with a history of laparotomy, left salpingectomy owing to a ruptured tubal pregnancy, was referred to our hospital because of a pregnancy of unknown location. Her serum ? human chorionic gonadotropin level was 8400 U/L, and a transvaginal ultrasound revealed an ectopic pregnancy in the left tubal stump. After discussing medical and surgical treatment options, the patient underwent a 2-step vNOTES approach. First, a diagnostic vNOTES was performed using a 5-mm trocar with autoretracting blade. After confirmation of the diagnosis, the trocar was removed, and the incision was enlarged with blunt dissection. A self-constructed pessary port was then placed through the enlarged colpotomy, and the ectopic pregnancy in the left tubal stump was excised using an advanced bipolar device. The colpotomy was closed with running resorbable sutures. The duration of the surgery was 36 minutes, and the patient was discharged on postoperative day 1 without any complications. Conclusion: Tubal stump pregnancy is a rare form of ectopic pregnancy with an incidence of approximately 0.4% of all ectopic pregnancies [1]. Treatment options include conservative medical management using methotrexate and surgery. Successful surgical treatment using laparoscopy has been previously reported [1,2]. This case demonstrates that vNOTES may be a minimally invasive option for the surgical treatment of tubal stump pregnancy in selected cases. © 2020 AAGL