Idiopathic thrombocytopenic purpura in pregnancy: a single institutional experience with maternal and neonatal outcomes

We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation. At the time of delivery six mothers had normal platelet counts and seven had low platelet counts. Nine deliveries were by vaginal route and four were by cesarean section. Eleven infants were born with normal platelet counts and one was thrombocytopenic at the time of delivery. No infant showed any clinical signs of hemorrhage and there were no neonatal complications. Two fetuses died; one of them because of ablatio placentae and the other was intrauterine dead. In conclusion, ITP in pregnancy requires the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, anesthesiologist, and neonatologist is essential.

Misoprostol in labor induction

The efficacy of a new dosing regimen of misoprostol, a recently introduced labor-inducing agent, was studied. Fifty-eight patients received 50 microg of misoprostol intravaginally and the dose was repeated every 3 hours until uterine contractions begin. Those who had an adequate contraction pattern, defined as three contractions in 10 minutes, were not given the repeat dose. Oxytocin augmentation, but not further misoprostol doses, was used in patients with an inadequate contraction pattern. The maximum total daily dose was 200 microg. The patients had the mean age of 28.9 +/- 5.4, the mean gestational age of 211.8 +/- 46.6 days, the mean gravidity of 2.5 +/- 1.2, the mean parity of 0.9 +/- 0.9 and the mean initial Bishop score of 1.6 +/- 1.8. The mean required dose of misoprostol was 120.5 +/- 54.7 microg and 10 of 58 patients required oxytocin augmentation. The mean induction of labor to delivery time was 701.5 +/- 404.0 minutes. When 3 cases who gave birth with caesarean section were excluded, the interval was 708.4 +/- 407.2 minutes. The mean 5th minute Apgar score of the newborns was 8.2 +/- 2.5. Two patients developed tachysystole after the second dose of misoprostol and were managed with vaginal irrigation and O2 supplementation successfully. Slight nausea and vomiting in 2 patients were the other adverse reactions. Our findings revealed that, 50 microg intravaginal misoprostol, combined with oxytocin augmentation when necessary, appears to be an effective and safe method of labor induction.

Determination of relative acidities of some alpha, omega-bis(3-alkyl(aryl)-4,5-dihydro-1H-1,2,4-triazol-5-on-4-yl) alkanes

The solutions of nine alpha, omega-bis(3-alkyl(aryl)-4,5-dihydro-1H-1,2,4-triazol-5-on-4-yl) alkanes were titrated with tetrabutylammoniumhydroxide (TBAH) in methanol, using potentiometric methods. The half neutralization potentials values were found for all cases. Potentiometric titration curves of compounds in methanol with 0.03 M TBAH are similar to those of weak acids obtained in aqueous media with strong bases. Methanol is found to be a suitable medium for the weakly acidic compounds titrated since they are poorly dissolved in other organic solvents. A comparison among the compounds having the same alkyl chains between the two ring systems has shown that basicity increases and acidity decreases as the size of alkyl chains increases. However, the compound with a substituted phenyl group was found to be the most acidic one among the examined compounds indicating that phenyl group donates ring electrons less effectively to the system. This can be attributed to the stability of the benzene ring.

Laparoscopic treatment of benign adnexial cysts

The results of laparoscopic adnexial cyst excision operations performed within the last 2.5 years in our clinic are reported. Thirty-three adnexial masses thought to be benign after gynaecological examination and ultrasonographic findings were treated. Laparoscopy was done in 32 cases but laparotomy had to be performed in one case of stage IV endometriosis. The mean duration of the operations was 72.78 +/- 34.09 minutes and no major complication occurred. Pathologic examinations of the specimens were reported as benign in all cases. According to these results, laparoscopy should be the preferred method in the treatment of benign adnexial cysts.