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    Factors Affecting Successful Vaginal Birth Following Dinoprostone Administration in Post-term Pregnancies
    (Turkiye Klinikleri, 2020) Bademkiran, Muhammed Hanifi; Bademkiran, Cihan; Ege, Serhat; Peker, Nurullah; Oglak, Suleyman Cemil
    Objective: This study will determine the success rates of the predictive factors of vaginal birth in the post-term labor induction of the cervical ripening slow-release insert dinoprostone. Material and Methods: All patients who underwent labor induction were post-term pregnant patients. Post-term pregnancy was defined as lasting >= 42+0 weeks of gestation. Dinoprostone insertion into the posterior fornix was performed according to the Bishop score (<= 6) and maintained for a maximum of 24 hours. Parity, Bishop score, maternal age, fetal gender, and induction time were identified as candidate predictors. The traditional logistic regression method was used to examine the relationship between the outcome and candidate predictors. Discrimination in the model was evaluated by calculating the c-index. Results: Of the 25,678 deliveries that occurred during the study period, 361 (1.4%) women underwent post-term delivery; of these, 293 (81%) succeeded, and 68 (19%) failed to achieve cervical ripening using the dinoprostone slow-release vaginal insert. Three predictors were strongly associated with dinoprostone vaginal delivery success: multiparity (2.88[1.38-6.01]), fetal gender (1.69[0.9-3.0]), and Bishop score (OR: 1.59 [1.45-1.70]). Conclusion: The success of vaginal delivery can be predicted by evaluating factors, including fetal gender, parity, and the Bishop score in post-term pregnancies. Including these factors in the management protocol for labor induction with cervical ripening could improve care quality.
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    Risk factors for relaparotomy after cesarean section due to hemorrhage: a tertiary center experience
    (Taylor & Francis Ltd, 2020) Peker, Nurullah; Yavuz, Mustafa; Aydin, Edip; Ege, Serhat; Bademkiran, Muhammed Hanifi; Karacor, Talip
    Aim: This study aimed to examine the risk factors for relaparotomy after cesarean section (RLACS) due to bleeding. Material and methods: In this retrospective descriptive case-control study, women who underwent RLACS only for bleeding between 2008 and 2019 at a single tertiary center were examined (the center oversees approximately 25,000 deliveries per year). Maternal characteristics, postoperative findings, and surgical features were compared with a control group that included non-complicated cesarean sections (CS). Multivariable logistic regression analysis was used to identify the risk factors for relaparotomy. Results: Relaparotomy complicated 0.07% (n?=?40) of CS during the study period (n?=?58,095). When compared with the control group, age, parity, estimated blood loss (EBL), postoperative pulse, blood replacement, and length of hospital stay were statistically higher in patients undergoing relaparotomy, whereas their postoperative systolic and diastolic blood pressure were found to be low. A history of pelvic surgery, the need for intensive care, and complications were more frequent in patients undergoing relaparotomy. When CSs were grouped according to 8-h periods of the day, it emerged that relaparotomies were mostly performed on the patients who underwent CS after working hours. Time interval during the day of the CS [OR: 2.59 (1.10?6.12)] and high postoperative pulse rate [OR: 1.58 (1.28?1.96)] were found to be independent risk indicators for RLACS (AUC: 0.97). Conclusions: Monitoring vital signs in the postoperative period and increasing the number of physicians and nurses during off-hours in hospitals working with on-call duty procedures as determined by the Ministry of Health will reduce the incidence rate of relaparotomy, maternal morbidity, and mortality due to hemorrhage.