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WHAT IS POLYHYDRAMNIOS (INCREASED AMNIOTIC FLUID)?

WHAT IS POLYHYDRAMNIOS (INCREASED AMNIOTIC FLUID)?

Polyhydramnios or hydramnios means an increase in the amount of amniotic fluid. This condition leads to pregnancy complications in 1-2% of cases. Amniotic fluid is one of the most important components of the gestational sac in which the baby is located. This fluid plays a big role in ultrasound assessment of the normal physiology of pregnancy, especially in the second and third trimesters. The main contributors of amniotic fluid are renal urine production, swallowing, inspiration, and diffusion of the fluids via amniotic membranes. Polyhydramnios can cause suspicion at first, especially in normal pregnancies, when the uterus increases in size thus giving a larger-than-usual look to the womb. The uterus may feel more tense, and checking the baby's heartbeat may become difficult due to the fact that the voice is less audible.

WHAT ARE THE CAUSES OF POLYHYDRAMNIOS AND HOW TO EXAMINE IT?

Polyhydramnios is classified according to the excess of the amount of water to determine the risk group. The amount of AFI (Amniotic Fluid Index), measured on 4 quadrants by ultrasound, of 25-29.9 cm is considered mild polyhydramnios, of 30-34.9 cm is moderate polyhydramnios, and of 35 cm and above is classified as severe polyhydramnios. Mild polyhydramnios occurs in 2/3 of all cases and is the most common group. Moderate polyhydramnios accounts for 20% of all cases, and the severe group for 15%. When assessing polyhydramnios, the measurement of total amniotic fluid gives a safer result. In single pocket measurements, the deepest single pocket measurement of 8-9.9 cm is considered mild polyhydramnios; of 10-11.9 cm is moderate polyhydramnios, and 12cm and above is classified as severe polyhydramnios. According to the studies conducted when all these groups were compared, it was shown that severe cases of polyhydramnios were due to an underlying cause, while mild cases of polyhydramnios may not have any underlying cause.

NORMAL CHILDBIRTH

When all risk groups were examined, 15% of the cases were due to fetal congenital anomalies, and 15-20% were related to diabetes mellitus. Among the rarer causes, fetal infections are also indicated. Among these infections, the most common ones are parvovirus, cytomegalovirus, toxoplasma, and syphilis infections. Polyhydramnios can also occur as a result of hydrops (water collection in the baby's body cavities). To mention congenital anomalies, central nervous system diseases such as anencephaly result in polyhydramnios due to obstruction of swallowing. Again, cases such as esophageal obstructions or duodenal (a part of the intestine) atresia, that is, insufficient development of the intestine, result in polyhydramnios. According to studies, as the degree of hydramnios increases, the risk of anomaly increases and reaches up to 30%. Baby's growth alongside polyhydramnios increases the risk of diabetes and growth retardation. The diagnosis of hydramnios in multiple pregnancies is made when the amount of amniotic fluid in the deepest single pocket is 8 cm or more.

Especially in monochorionic pregnancies, twin-to-twin transfusion syndrome should be kept in mind, if one baby has hydramniosis and the other has oligohydramnios (reduced water in infants), the necessary examinations should be performed. If no underlying cause for polyhydramnios is found after all these examinations have been performed, it is called idiopathic polyhydramnios and accounts for up to 70% of all cases. This condition can also be explained by the fact that the increased amount of amniotic fluid, which is mostly baby's urine, can be observed because older babies urinate more.

WHAT DO MANAGEMENT OF PREGNANCY AND DELIVERY WITH POLYHYDRAMNIOS LOOK LIKE?

First of all, polyhydramnios can occur early, that is earlier than the 28th week, or in the late period. The risk of miscarriage and preterm delivery in polyhydramnios cases that started in the early period was found to be increased compared to those that started in the late period. Although polyhydramnios does not change the mode of delivery, especially when accompanied by diabetes, large babies, that is, babies weighing >4000gr, result in cesarean delivery. It has been found that polyhydramnios increases the likelihood of cesarean delivery by about 3 times. Polyhydramnios, which develops in the early stages, stresses other organs in the abdomen due to the size of the growing uterus, the mother feels more tense, and this condition can cause urinary symptoms, for example, by pressing on the bladder.

Regarding the circulatory system, edema may occur due to pressure on the vessels. In cases of severe respiratory distress of the mother, an appropriate amount of amniotic fluid can be taken in a procedure called amnioreduction. Its purpose is to normalize the level of amniotic fluid. In cases of polydidramniosis, some drugs that reduce the baby's urination can also be given to the mother, and these drugs pass from the mother to the baby through the placenta and have an effect on the baby. Such interventions are rarely applied today and can be called experimental, and are applied in the form of personalized planning.

 

 

normaldoğum

WHAT IS A NORMAL CHILDBIRTH?

A normal birth is defined as the birth of a baby in cephalic position in the period of 37-42 weeks of pregnancy as a result of spontaneous sufficient uterine contraction and opening of the cervix.

HOW DOES A NORMAL CHILDBIRTH BEGIN?

The onset of normal labor is a difficult condition to understand, especially in the first pregnancies. Intermittent uterine contractions, also called false labor, can be felt before the onset of normal labor. The main indicator of the onset of labor are regular and periodic uterine contractions. It can also be felt as a feeling of pressure on the breech and vagina area. Another method of understanding is a vaginal examination performed during admission to the hospital. Usually 3-5cm vaginal opening and sufficient cervical softening are indicators of childbirth. However, bleeding, water breaking, and a decrease in baby movements are issues that must be evaluated in the hospital.

 

HOW DOES THE CHILDBIRTH PROCESS PROGRESS?

At the beginning of labor, first of all, the position of the baby relative to the birth canal, the path that the baby will follow, and the part that will enter the birth canal are determined. With the help of ultrasound and vaginal examination, the part where it will enter the birth canal is defined. According to these conditions, the mode of delivery is determined. For normal delivery, the head arrival is the most optimal situation. In the last months of pregnancy, the baby is positioned relative to the mother's womb. According to this fit, the baby is positioned upside down, the legs are curled up according to the circumference of the abdomen, and the arms are folded in the rib cage. The umbilical cord, on the other hand, is usually located in the dec between the arms and legs. The baby's head usually settles in the bone structures of the mother in the last weeks of pregnancy or in labor, which is called pelvic insertion. After that, the baby's head goes down due to the force of amniotic fluid, regular contractions of the uterus from the top, and the mother's pushing. After the head descends, the chin approaches the sternum, the head makes a rotational movement inside in order to fit the narrowest part of the bone structures to the narrowest diameter of its head. With these movements, the baby reaches out. At this time, the baby's head usually looks at the back of the mother. After the baby's head is born, the baby's head and body turn 90 degrees so that the back shoulders can be born, creating a position for the back body and shoulders to come out of the structures called bone pelvis in the most appropriate way. It is called external rotational motion. The head is turned to the appropriate direction where the head comes out and then the shoulders are delivered. With the birth of the shoulders, the rest of the body part comes out more quickly. Then postpartum hemorrhage follows the removal of placenta.

 

HOW IS A NORMAL CHILDBIRTH MANAGED?

Management of normal delivery is based on evaluating the well-being of the mother and the baby and whether the course of delivery is normal or not. During the first admission of the pregnant woman to the delivery room, the evaluation of the estimated weight of the baby, the way of delivery, the condition of amniotic fluid, and the placement of the placenta is analyzed. According to this evaluation, doctors try to understand whether there is a situation that prevents normal vaginal delivery or not. If there is no obstacle to normal delivery, then the pregnant woman is admitted for delivery. The baby's well-being is usually evaluated by monitoring the baby's heartbeat (cardiotocography). After ultrasonography and the evaluation of the baby's heartbeat, the risk assessment is completed and the decision on how to proceed is made. In particular, the decrease in the number of heartbeats per minute (bradycardia) of the baby during and after uterine contractions is considered as a sign that the baby is in distress. By monitoring the uterine contractions that will bring about the birth of the baby, it can also be understood whether the mother’s pushing force is sufficient/regular. If an abnormality is detected in uterine contractions, this situation is corrected and effective contractions are achieved. Finally, in cases where the baby's heartbeat is good and uterine contractions are effective, it is evaluated whether the labor (uterus opening and the progress of the baby) proceeds normally, and in case of deviations from the normal labor graph, necessary interventions are made.

IS EPISIOTOMY NECESSARY IN NORMAL CHILDBIRTH?

Episiotomy means cutting of the pubic region in Greek. Episiotomy used to be the preferred method for avoiding uncontrolled tearing. However, studies have shown that episiotomy leads to increased tearing in the breech region. In another study, when spontaneous tears and episiotomy were compared; It was found that the risk of fecal and gas incontinence increased up to six times in patients who underwent episiotomy. Because of all these, episiotomy is not performed in every patient. Episiotomy is preferred in daily practice in cases where there is a high risk of trauma if the delivery is difficult, shoulder insertion, breech birth, baby's head position, or if the episiotomy is not opened.

WHAT ARE THE BENEFITS AND HARMS OF NORMAL CHILDBIRTH TO THE MOTHER?

Normal birth carries low risks for mother and baby. Compared to cesarean section, bleeding, infection, removal of the uterus after or during delivery (peripartum-postpartum hysterectomy) or anesthesia complications are less common. However, pelvic floor dysfunction is more common in women who have had a normal delivery. In another study, it was also revealed that urinary incontinence while coughing, sneezing, straining, laughing, which is called stress urinary incontinence, is more common in women who gave birth normally than women who gave birth by cesarean section. Breastfeeding and interaction in the early period of the baby after normal delivery are also shown among its benefits.

WHAT ARE THE BENEFITS OF A NORMAL CHILDBIRTH FOR BABY?

During a normal vaginal delivery, the baby's rib cage is compressed while passing between the hip bones, so the likelihood of fluid remaining in the lungs is lower than in cesarean section. This situation gives an advantage over cesarean section because the baby receives oxygen and releases carbon dioxide during breathing immediately after birth. This clearly reduces the likelihood of the newborn going to intensive care. The need for an operating room and anesthesia in case of cesarean section also takes away the chance for close contact between mother and baby (skin contact, emotional intimacy and expression). In this regard, normal childbirth also seems to have more advantages for babies than cesarean section.

 

Our published works on the subject:

Reassessing the length of labour in healthy Turkish women: a retrospective and descriptive study. Boz İ, Kumru S, Buldum A, Firat MZ.

 

Posterior Urethral Valves

How Are Posterior Urethral Valves (PUV) Treated?

The treatment of posterior urethral valves generally requires surgery. In some infants diagnosed with a posterior urethral valve in the womb, as the bladder fills, there is an incomplete but still some outflow of urine. In such cases, if the amount of amniotic fluid is within the normal range, it is permissible to do only observations of fetus's condition without any interventions. It is possible because the main purpose of intrauterine surgeries is to restore the normal level of amniotic fluid in order to ensure the normal course of development of fetus’s lungs, thereby increasing its chances for life. Therefore, in cases where even with the diagnosis of the posterior urethral valve, the level of amniotic fluid is normal, there is no need for operations.

As for surgical interventions, the medical community still does not have long-term data on how intrauterine surgeries affect the preservation of infant kidney function and save them from dialysis or kidney transplantation throughout their later life. Despite the fact that the results of experiments conducted on animals show a positive effect of operations on the functioning of the kidneys, as well as the presence of a similar trend in humans, to obtain an accurate answer, the data on this topic still needs to be significantly expanded.

What methods are used for intrauterine treatment of posterior urethral valves?

Vesicoamniotic shunting

Vesicoamniotic shunting

Vesicoamniotic Shunting

 

The main goal of intrauterine treatment of posterior urethral valve is to ensure the proper outflow of fetal urine in the womb, which prevents the lack of amniotic fluid, promotes the development of the lungs, and thus prevents the death of the fetus immediately after birth due to pulmonary insufficiency. The most common solution for restoring normal urination of the fetus is considered to be vesicoamniotic shunting. This type of surgery is performed by applying local or regional (spinal) anesthesia and then installing a vesicoamniotic shunt - all accompanied by ultrasound. The catheter is placed so that one end remains inside the baby's bladder, and the other remains in the amniotic sac containing the amniotic fluid. This procedure makes it possible for urination to occur through the catheter, not the urethra. Such surgeries are short-term and easy to perform. However, in cases of displacement of the catheter or its blockage, repeated surgeries may be required.

What methods are used for intrauterine treatment of posterior urethral valves?

 

Laser Ablation

Fetal cystoscopy is a visual examination of the fetal bladder using a 3 mm diameter camera accompanied by ultrasound. For this procedure, the mother is given anesthesia, and the fetus, in turn, is also given anesthesia through the umbilical cord and muscle relaxants (drugs that reduce muscle tone and decrease motor activity).

A visual examination helps the doctor to understand whether the cause of abnormalities in urination lies in the valve of the posterior urethra, or the absence of the urethra (urethral atresia), or the pathological narrowing of the internal lumen of the urethra (stenosis). Thus, fetoscopy allows us to find out the exact cause of the obstruction at the exit of the bladder. In cases where the obstruction is caused by posterior urethral valves, the laser fiber is inserted through another channel with a diameter of 1 mm parallel to the camera channel, after which the valve is removed by the laser, ensuring the normal flow of urine. If the problem is urethral atresia or stenosis, then appropriate treatment planning is carried out. In cases where laser cystoscopy is unsuccessful, it can cause damage to neighboring organs, as well as the formation of fistulas. In such situations, repeated surgeries may be required.

What methods are used for intrauterine treatment of posterior urethral valves?

 

Vesicostomy, Vesicocentesis, And Fetal Ureterostomy

Surgical operations to ensure the temporary or permanent excretion of urine by creating an external fistula of the bladder, although not common, still take place. Such urinary excretion can and does affect the reduction of pressure in the bladder, but its effect on the normalization of the level of amniotic fluid (a determining factor in the development of the lungs) is questionable. All other types of surgeries, unlike laser ablation and bypass surgery, are invasive and not so widespread in practice. Some babies may also have enlarged urethra inside the bladder. This condition is called ureterocele, and if it is observed during fetal cystoscopy, a procedure to decompress the ureterocele can be performed with a laser.

 

How successful are intrauterine operations to remove the posterior urethral valve?

 

It is believed that in the absence of surgery, the chances for life of babies with a diagnosis of posterior urethral valves are approximately 25 percent. Due to the fact that babies remain under the pressure of the umbilical cord in the womb, they die in the womb or at an early stage after birth due to severe lung failure. The data proves that intrauterine posterior urethral valve removal surgeries increase the chances of fetal life by two times. This applies to both vesicoamniotic shunting and laser ablation. Although there is strong evidence that this increases the infants' survival rate, there is still no evidence of how these surgeries affect the long-term kidney function in infants’ later life. Current data suggests that vesicoamniotic shunting is not effective when it comes to maintaining infant kidney function. With regard to laser ablation, the available evidence indicates that infants who have undergone this procedure have better kidney function than infants who have not undergone any surgical intervention. It is worth noting that all the data regarding the use of these treatment methods is relatively new, and still needs to be expanded. Due to the relatively recent discovery of these methods, patients who have undergone such surgeries have not yet reached the age of 10, 20 and 30 years.

normal-gebelik-selahattin-kumru

Monitoring of Healthy Pregnancy

Although pregnancy and childbirth are part of our daily life, it takes a lot of effort to make sure that there are no problems, or if they occur, to make the right decision. Therefore, the control of the course of pregnancy should be systematized.

First visit

Those who come with a suspected pregnancy and a delayed menstrual cycle are examined to determine the exact status of pregnancy. During this examination, it is possible to diagnose the pregnancy and determine whether there are any risks. At the first examination, we can detect the incompatibility of blood, the presence of pregnancy, the number of fetuses (single or multiple), additional problems (for example, maternal diseases such as uterine fibroids, ovarian cysts, etc.) and make a treatment plan depending on their presence or absence.

If no abnormalities were detected during the first visit, the next examination is usually scheduled between 11-14 weeks.

If there are no additional problems during the examination between 11-14 weeks, the age of the fetus is usually confirmed, the nuchal translucency (NT) measurement is performed, and additional assessments are made. A double or combined test is also performed, taking a sample of chorionic villi, assessing blood flow in the venous duct, blood flow in the c. All of this can help detect some serious fetal abnormalities and problems. In cases of single pregnancy without additional risk, the next control is usually scheduled for the twentieth week of pregnancy. Cases with additional risk are tracked according to the risk.

At 20-22 weeks, an examination is performed to identify such abnormalities of the mother, like anemia and the risk of premature birth. The fetus is also examined for the presence of developmental abnormalities. A thorough ultrasound examination conducted during this period helps to identify any serious health problems of the mother and child. If there are no additional risks, the next examination is scheduled for 24-28 weeks.

In the period from 24 to 28 weeks, the control is carried out to assess the development of the fetus and to detect diabetes in the mother. In cases of blood incompatibility, at the 28th week, an immunoglobulin Rh (also called RhoGAM or Anti D) procedure is performed, which is aimed at preventing sensitization of the mother during childbirth and has proven to be very successful.

If there are no abnormalities, a follow-up check is carried out in the period from 32 to 34 weeks, when both the development of the fetus and its and the mother's problems are evaluated.

In the absence of additional risks identified during the period of previous visits, the last examination is scheduled for approximately 38 weeks, when the method of future delivery is determined, and a control assessment of the fetus is made. The birth itself is planned for the 40th week. If by that time the birth does not begin, the doctors, in accordance with each case, decide on further actions.

fetal-sistoskopik

Fetal Cystoscopy

Obstruction of the lower parts of the urinary system of the fetus in the womb is observed with a probability approximately equal to one case per 5,000-10,000 infants. This disease, which is more common in male infants, manifests itself as urethral atresia, urethral obstruction, or most often as a posterior urethral valve (PUV).

The inability to properly excrete urine causes a lack of amniotic fluid, which causes abnormalities in the development of the baby's lungs, which causes most babies to die due to lung failure immediately after birth, even if they managed to survive in the womb. A significant number of infants experience distress or death due to compression by the umbilical cord in the womb. The probability of death in the absence of treatment in such cases is approximately 90%.

The accumulation of urine in the upper section of the urinary system due to abnormalities in urination negatively affects the development of the kidneys. Therefore, even infants who survive in the absence of intrauterine treatment will require dialysis or kidney transplantation in later life.

Ensuring the proper flow of fetal urine in the womb (for example, using vesicoamniotic bypass catheters) promotes proper lung development, which prevents a lack of amniotic fluid. This increases the chances of the fetus's life by about 4-5 times (from 10 percent to almost 50).

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Methods of fetal surgery

Fetal surgeries are conducted to solve health problems of the fetus. The reason for this is that in some cases, the absence of any intervention can lead to the deterioration of the fetus health.

Blood transfusion to the fetus in the womb

This procedure is performed in situations of blood incompatibility or fetal anemia and consists of blood transfusion to the fetus accompanied by ultrasound through the umbilical cord. The results of this simple operation are very successful, and the risks are relatively low. It often saves the life of the fetus.

Treatment of myelomeningocele

This is a neural tube defect, colloquially known as a hole in the back, accompanied by a buildup of fluid in the fetal head. Intrauterine surgery, in this case, is proven to be superior to postpartum surgery.

Congenital cystic adenomatoid malformation

This lung lesion, on the one hand, presents a problem for the development of the fetal lungs, on the other hand, it puts pressure on the chest, which makes it difficult for blood to move from the vessels to the heart. As a result of problems with the cardiovascular system of the fetus, it may have problems with the lungs after birth.

Diaphragmatic hernia

The diaphragm is a hard membrane that separates the thoracic and abdominal cavities. Ruptures in this membrane lead to the fact that the intra-abdominal organs (stomach, liver) fall into the chest cavity, and prevent the development of the lungs, exerting pressure on them. Promising studies are showing that by placing a balloon device in the trachea of the fetus, it is possible to reduce lung development problems.

Congenital heart disease

Strictures (aortic or pulmonary stenosis) that occur during the outflow of blood from the heart can harm the cardiovascular system, which leads to the need for postpartum surgery. Recently, studies have been conducted and published showing that balloon dilation of these strictures, accompanied by ultrasound, can be very useful.

Obstruction of the lower urinary tract

Lesions that prevent the exit of fetal urine (most often the posterior urethral valve) first cause stagnation of urine in the fetal bladder, and with progression – in the urethra and kidneys, which leads to kidney failure. Besides, the lack of amniotic fluid negatively affects the development of fetal lungs. Providing full-fledged urination of the fetus in the womb increases the chances of survival of newborns. This happens either by bypass surgery or by laser removal.

 

Professor Dr. Selahattin Kumru, vesicoamniotic catheter insertion surgery.

https://www.youtube.com/watch?v=sV8ZHenVSnU&feature=emb_logo

Professor Dr. Selahattin Kumru, vesicoamniotic catheter insertion control surgery.

Twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome is a serious complication that occurs during the pregnancy of twins with one placenta (monochorionic pregnancy). In cases where connective vessels are formed between the veins coming from one placenta, the blood pumped by the heart of one fetus (donor) can flow in excess to the second fetus (recipient). The continuous flow of blood pumped from one fetus to other causes anemia (anemia), developmental delay, and the amniotic fluid deficiency (oligohydramnios) in the donor fetus, while the fetus receiving the blood (recipient) also has an increase in blood volume (hypervolemia), an excess of amniotic fluid (polyhydramnios), and weight gain. If you do not interfere with this process, the fetus that loses blood will not survive due to anemia, and the fetus that receives blood in excess will also not be able to survive due to heart failure caused by excessive exercise due to a large volume of blood. The death of one of the infants exacerbates the problem and can lead to death or severe disability of the other.

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Coronavirus can be transmitted to the baby in the womb!

The head of the branch of the Turkish Association of Gynecology and Obstetrics in Antalya, as well as a specialist in gynecology and obstetrics and perinatology, Professor Dr. Selahattin Kumru, said that there is very little data on pregnancy problems caused by the coronavirus epidemic. Although some research has been devoted to this topic in the past, new developments that have emerged in 2020 have made their changes. Speaking about the coronavirus, which has already caused more than 50 million people and more than 1 million deaths worldwide, Dr. Kumru added: "It was previously reported that the coronavirus is not transmitted to the unborn. However, with the latest data, it became clear that the coronavirus receptors (the parts of the virus that it uses to attach) were found in the placenta. It was also revealed that the virus itself has also been detected in the placenta of some infants."

The head of the Turkish Association of Gynecology and Obstetrics of Antalya branch, Professor Dr. Selahattin Kumru, said that there is a possibility of transmission of the coronavirus from the mother to the baby. Dr. Kumru reported on the latest research data, and also warned expectant mothers about this.

Cases of transmission of the virus through the mother's blood were detected in Peru and France

Dr. Kumru said that viruses of the same family of SARS and MERS were more often detected in the blood at one time, which suggested that they could be transmitted to the fetus through the mother's blood. Regarding the new coronavirus, he added: "Although the fact that the coronavirus is detected less frequently in the mother's blood makes people think that the risk of blood transmission is low, in fact, this probability still exists. Recently, cases of mother-to-fetus transmission of coronavirus have been reported in Peru and France. That is why the probability of transmission of the virus still has a place to be. Tests of the immune system of babies have already given the first cases of positive results for diseases associated with the coronavirus. Cases of infection are confirmed."

As for what to do in the case of transmission of the coronavirus from the mother to the fetus, we will help to understand a recent study conducted by the International Union of Perinatology, headed by a Turkish surgeon. It states that the coronavirus causes problems such as premature birth and low birth weight. Therefore, in the case of infection with coronavirus, the child should be seriously examined. It was reported that in the case discovered in France, the fetus also had neurological symptoms. Therefore, it is useful to be careful. There are also drugs used to prevent the disease COVID-19. New studies of the drug Chloroquine have been published. Chloroquine has previously been used for rheumatic diseases. Currently, although in small quantities, there is also information that the use of this drug in early pregnancy can also increase the risk of such prenatal fetal abnormalities as kidney problems, cleft palate or cleft lip and heart disease. Of course, even if the positive effects of this drug outweigh the risks, in cases of pregnancy, you should not forget about their existence.

Pregnant women who contracted coronavirus

Compared to the rest of the patients, pregnant women have a higher risk of lung problems, and therefore they may need artificial ventilation more than others. Therefore, Dr. Kumru added, pregnant women who have contracted the coronavirus should be closely monitored by doctors. The spread of coronavirus is not an obstacle to becoming a mother, but to avoid the risk of infection, pregnant women should carefully observe the rules of social distancing, mask mode, and hygiene. (DHA)

ikiz-hamilelik

Multiple Pregnancy

The presence of more than one fetus in the uterus (womb) is called "multiple pregnancy". As a rule, most often it is twins, and less often triplets, fours, or even more. Multiple pregnancies are initially defined as high-risk pregnancies. These risks can have adverse consequences for both the mother and the fetus. For the mother, multiple pregnancies are associated with the risk of diabetes, anemia, premature birth, urinary tract infection, and other minor complaints. For the fetus, this may be accompanied by increased risks such as congenital abnormalities, lower birth weight, prematurity, and a higher likelihood of needing a neonatal intensive care unit. Besides, with multiple pregnancies occurring in a single placenta (monochorionic pregnancy), there may also be some special risks. For example, twin-to-twin transfusion syndrome, anemia-polycythemia sequence, selective restriction of intrauterine development. Some of them require constant monitoring and evaluation, while others require intrauterine surgery. Cases of pregnancy with triplets or a large number of fetuses, although less common, usually have a higher risk than with twins.

cell-free-DNA-Anne-Kanında-Fetal-DNA-selahattin-kumru

Fetal DNA (extracellular DNA) in maternal blood

The method described in the literature as fetal DNA, extracellular DNA, or non-invasive prenatal diagnosis from maternal blood is currently one of the most advanced in medical science. During normal pregnancy, some cells belonging to the fetus (the unborn child in the womb) enter the mother's bloodstream. These cells have also been shown to remain in some maternal tissues (such as the thymus gland) for extended periods. In addition to these fetal cells, there is also DNA called extracellular DNA, which is passed from the fetus to the mother's bloodstream. When these DNA fractions are detected, it is possible to investigate the presence of certain genetic diseases of the fetus, primarily trisomy. As for trisomy (Down syndrome and other trisomy diseases), it should be remembered that the result of a mother's blood test with such a test is not an exact answer about whether trisomy is in the fetus, but a forecast of the likelihood of this ailment. In other words, this test is not a diagnostic test for fetal trisomy. For these reasons, if the test shows a low probability, it does not mean that the fetus does not have trisomy but simply indicates that the risk of its occurrence is very low. In cases where the test shows a high probability, you should resort to more detailed studies of the fetus.

bebege-bobrek-ameliyati-selahattin-kumru

Kidney surgery saved the baby's life in the womb!

In Antalya, Dr. Selahattin Kumru and his team operated on a 16-week-old baby in the womb who had a bloated bladder and dilated kidneys. The baby, who, thanks to this operation, survived and was born at 33 weeks, was named Emirhan. 31-year-old mother Fatma Acar said: "Thanks to the efforts of doctors, I finally took my healthy baby in my arms. I am very happy."

The intrauterine surgery of the baby, who had a bloated bladder, dilated kidneys, and a lack of amniotic fluid that supports life, was performed by the Head of the Department of Obstetrics and Gynecology at the Faculty of Medicine of Akdeniz University, Professor Dr. Selahattin Kumru and his team.

According to the doctor, "the baby, who was born at 33 weeks, had an abnormality in the womb, called "posterior urethral valve," because of which his urine could not normally flow out of his bladder, and began to accumulate there. If in such situations you do not provide timely surgical intervention, these stagnations pass to the kidneys, thereby causing a complete failure of their work. Since the urine cannot flow normally, a lack of amniotic fluid is formed (after all, they almost completely consist of fetal urine). Lack of amniotic fluid negatively affects the development of the lungs, which is the main cause of death in most infants suffering from this disease."

The baby's kidneys are functioning well

Dr. Kumru said that in Emirhan's case, a catheter was installed to restore normal intrauterine urination: "The catheter was placed so that one end remained inside the baby's bladder, and the other end remained in the amniotic sac containing the amniotic fluid. Thus, we eliminated the accumulation of urine, as well as all the negative effects on the kidneys. Having eliminated the lack of amniotic fluid, we also took care of the full development of the baby's lungs. Everything went well for the baby. At 22 weeks, we successfully installed the catheter. At 33 weeks after the catheter moved, after consulting with colleagues from the neonatal department, we decided to perform the delivery. At the moment, the functioning of the baby's kidneys is good."

This diagnosis was made after the third month of pregnancy. As the doctor stated: "In such cases, as soon as we are sure that the kidneys are functioning, we perform bypass surgery."

We were referred to a specialist

Fevzi Acar, the patient's husband, said that when she was in the third month of pregnancy, she was undergoing a routine check-up at another hospital, she was found to have a cyst. After learning that Dr. Kumru is one of the best specialists, they went to Akdeniz University Hospital. "Dr. Kumru showed the necessary attention and care. Thanks to his professionalism, our son was born healthy. At 33 weeks, our baby's shunt moved, and the doctors had to resort to preterm birth. Everything went great." Emirhan was safely discharged from the hospital after 5 days under constant supervision.

Click here to read the article published on the CNN TÜRK website ...

2020, Prof. Dr. Selahattin Kumru. Tüm Hakları Saklıdır. Web Tasarım