Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus.

OBJECTIVES: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL). METHODS: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%). RESULTS: Placental volume was significantly larger in GDM (411.59 ± 170.82 versus 343.86 ± 128.94 cm(3); p = 0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65 ± 7.02 versus 38.71 ± 7.91, respectively; p = 0.277). Placental volume was significantly correlated with gestational week (r = 0.219, p = 0.035) and parity (r = 0.228, p = 0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r = -0.278, p = 0.007; r = -0.315, p = 0.002; r = -0.322, p = 0.001, respectively). CONCLUSIONS: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.

Normal ranges of biorbital and interorbital distances in healthy Turkish pregnancies at 19-23 weeks of gestation and correlation with craniofacial structures.

OBJECTIVE: We aimed to determine the normal ranges for biorbital (BOD) and interorbital distances (IOD) during the second trimester in Turkish women with normal pregnancies and to assess the correlation between BOD, IOD, and other fetal craniofacial structures and biometric parameters. MATERIAL AND METHODS: Our retrospective study comprised 1328 women with singleton normal pregnancies who had undergone ultrasonography (USG) examinations at 19-23 weeks of gestation in the second trimester screening. The measurements of BOD and IOD were obtained with the coronal section of the fetal face at the plane of orbits. RESULTS: Mean BOD was 3.4±0.33 cm, whereas mean IOD was 1.28±0.24 cm. Correlation analysis revealed that BOD was significantly correlated with IOD, transcerebellar diameter (TCD), cisterna manga (CM), nuchal fold (NF), nasal bone (NB), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and gestational week. There was a significant relation between IOD and the lateral ventricle posterior horn, TCD, CM, NF, NB, BPD, HC, AC, and FL. CONCLUSION: The reference ranges obtained in our study enabled accurate evaluation of BOD and IOD in the second trimester of normal pregnancies. USG detection of fetal orbital biometric anomalies may alert the clinician for different anomalies associated with abnormal development of eye.

De novo reciprocal translocation t(5;11)(q22;p15) associated with hydrops fetalis (reciprocal translocation and hydrops fetalis).

OBJECTIVE: This is a case of a prenatally diagnosed non-immune hydrops fetalis (NIHF) associated with translocation t(5;11)(q22;p15). An association between NIHF and this translocation has not been reported previously. CASE REPORT: The patient was referred to the perinatology clinic with hydrops fetalis diagnosis at 23 weeks' gestation. We noted that the fetus had bilateral pleural effusion, ascites, widespread subcutaneous edema, membranous ventricular septal defect, hypoplastic fifth finger middle phalanx, clinodactyly, single umbilical artery. We performed cordocentesis. Chromosomal analysis on blood showed a balanced translocation between the long arm of chromosome 5 and the short arm of chromosome 11 with karyotype of 46,XX,t(5;11)(q22;p15). CONCLUSION: We present prenatal diagnosis of a de novo translocation (5;11) in a hydropic fetus with ultrason abnormalities. In our case, karyotype analysis of the fetus, mother and father provided evidence of a de novo translocation, that might explain the NIHF.

Foetal axillary lymphangioma with ipsilateral pes equinovarus: pitfalls in sonographic differential diagnosis (axillary lymphangioma & pes equinovarus).

Lymphangiomas are rare congenital malformations of the lymphatic system. Despite the benign histology, they are likely to grow rapidly and invade the surrounding tissues. In contrast to the cystic hygromas, lymphangiomas at the axillary region tend to have normal karyotype. However, associated hydrops makes the prognosis poor. Due to isolated few cases in the literature, the true incidence of foetal axillary lymphangiomas is not known. We present here a pre-natal ultrasonographic diagnosis of a 15-week foetus with rapidly growing axillary lymphangioma with ipsilateral foot abnormality which had normal karyotype.

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography.

OBJECTIVES: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL). METHODS: This case-control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%). RESULTS: Preeclamptic and control group consisted of 27 (mean age: 28.90 ± 5.95 years, mean gestation: 32.0 ± 4.55 weeks) and 54 (mean age: 29.48 ± 5.78 years, mean gestation: 32.61 ± 4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62 ± 91.69 versus 370.98 ± 167.82 cm(3); p = 0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24 ± 8.41 versus 33.50 ± 8.90%; p = 0.043). Placental volume was significantly correlated with the estimated fetal weight (r = 0.319; p = 0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r = -0.244, p = 0.024; r = -0.283, p = 0.005; r = -0.241, p = 0.024, respectively). CONCLUSIONS: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.

Normal range of intracranial translucency in healthy Turkish pregnancies and its association with first trimester maternal serum biochemistry and ductus venosus pulsatility index. .

OBJECTIVE: To measure the intracranial translucency (IT) by establishing reference ranges in uncomplicated singleton Turkish pregnancies and to evaluate the association of IT with maternal serum biochemistry, gestational week, crown-rump length (CRL) measurement, nuchal translucency (NT) and ductus venosus Doppler velocimetry. MATERIALS AND METHODS: 190 uncomplicated singleton pregnancies were included in the study. IT, NT and CRL measurements between 11-14 gestational weeks were obtained with mid-sagittal plane. Two independent measurements were taken and averaged to obtain the final measurement used in the calculations. Statistical analysis was performed with SPSS for Windows 20.0 software package. Correlation analysis was used to determine the association between IT and NT pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (ß-hCG) and CRL length. A p-value of <0.05 was considered statistically significant. RESULTS: The assessment rate of IT was 167/190 (87.89%). The mean CRL length, gestational week, NT and IT measurements were 63.63±10.05 mm, 12.28±0.75 weeks, 1.23±0.43 mm (range: 0.20-2.68) and 2.29±0.49 mm (range: 0.18-3.80), respectively There was no significant correlation between IT and maternal serum PAPP-A MoM (r=-0.34, p=0.698) or maternal serum free ß-hCG MoM (r=-0.79, p=0.363), respectively. There was weak but statistically significant correlation between IT with with maternal weight (r=0.172, p=0.047), CRL length (r =0.301, p<0.001), gestational week (r=0.286, p=0.001) and NT measurement (r=0.224, p=0.007), respectively. There was no significant association between IT with ductus venosus Doppler pulsatility index (r=0.108, p=0.213). CONCLUSION: IT can be easily measured while scanning for NT. This study shows normal range values in healthy Turkish pregnancies. Consistent with recent data, our results show positive correlation with gestational week and CRL length. Maternal serum biochemistry does not have any effect on IT. Besides, our study highlights that IT is correlated with NT and adds newly to the literature that there is no correlation of IT with ductus venosus pulsatility index.

Acute abdomen and massive hemorrhage due to placenta percreta leading to spontaneous uterine rupture in the second trimester.

Placental invasion anomalies are rare obstetrical complications. They cause severe third trimester hemorrhage, severe postpartum bleeding, and maternal morbidity and mortality unless they are diagnosed antenatally. We present a rare case with placenta percreta leading to spontaneous uterine rupture during the second trimester with an acute abdomen and hypovolemia. 

Retrospective analysis of fetal anterior abdominal wall defects.

OBJECTIVE: To analyze fetal abdominal defects diagnosed during the prenatal period in the perinatology department in a tertiary center in Turkey. METHODS: This retrospective study consisted of 27 cases diagnosed with fetal abdominal wall defects between January 2011 and February 2014 in the perinatology outpatient clinic of Celal Bayar University, Manisa, Turkey. RESULTS: Eighteen (66.7%) cases were diagnosed with omphalocele, 6 (22.2%) had gastroschisis, and 3 (11.1%) had limb body wall defects. Twenty-one (77.7%) patients diagnosed either as omphalocele or limb body wall defect were offered karyotype analysis; 11 (52.4%) of them accepted the intervention, and 2 of the 11 patients (18.2%) had abnormal karyotype. Regarding the omphalocele cases; 12 (66.6%) cases had isolated omphalocele, whereas 6 of the 18 cases (33.3%) had associated anomalies. Expectant management was performed in 8 (66.7%) of 12 isolated omphalocele cases. Two of the isolated omphalocele group (16.7%) had missed abortion, the other 2 (16.7%) had termination of the pregnancy because of the associated chromosomal anomaly (47,XXY and 45,X0). Three of the gastroschisis group (50%) had missed abortion, and the other 3 (50%) had expectant management with cesarean delivery between 38-39 gestational weeks. Cases with limb body wall defect were terminated due to the lethal condition. CONCLUSION: The prenatal diagnosis of fetal abdominal wall defects is important, because they differ greatly in terms of perinatal and neonatal morbidity and mortality due to underlying chromosomal abnormalities and associated structural anomalies.

Ductus Venosus Doppler Flow Velocity after Transplacental and Non-transplacental Amniocentesis during Midtrimester.

OBJECTIVE: We aimed to evaluate ductus venosus Doppler waveforms before and after amniocentesis in order to investigate any effect of amniocentesis on fetal myocardial hemodynamics. We also evaluated the umbilical artery, uterine artery and fetal mid-cerebral artery Doppler waveforms in order to investigate any relationship with ductus venosus Doppler changes. METHODS: The study population consisted of 56 singleton pregnancies having genetic amniocentesis. Twenty seven of them had transplacental needle insertion; whereas 29 of them had non-transplacental amniocentesis. Uterine artery, umbilical artery, mid-cerebral artery and ductus venosus pulsatiliy index and resistance index were measured just before and after amniocentesis. RESULTS: Amniocentesis does not cause any significant changes in fetal ductus venosus Doppler waveforms. There is also no significant changes in uterine artery, umbilical artery, mid-cerebral artery pulsatility and resistance index. CONCLUSION: Amniocentesis-whether transplacental or not- does not cause any significant effect on fetal myocardial hemodynamics.

The effect of parity on first trimester uterine artery Doppler waveforms in low-risk singleton pregnancies.

OBJECTIVES: The aim of the study was to evaluate the effeot of parity on uteroplacental blood flow during the first trimester in low-risk singleton pregnancies. MATERIALS AND METHODS: Uterine artery Doppler examinations were performed in 190 singleton pregnancies between 11-14 gestational weeks. Twenty-five pregnancies were excluded from the study due to history ci preeclampsia, diabetes mellitus or inherited thrombophilia. A total of 165 low-risk singleton pregnancies were included in the study Mean uterine artery pulsatility index (P1) was recorded and compared between nulliparous and multiparous women. The relation between maternal age, gestational week, maternal weight, parity biochemica, markers and abnormal uterine artery Doppler flows was evaluated. T-test and logistic regression analyses were used for the statistical analysis. RESULTS: A total of 165 singleton pregnancies without any risk factors for uteroplacental insufficiency were includec in the study Of them, 58 (36.7%) were nulliparous and 107(63.3%) were parous. Correlation analysis revealed that the uterine artery pulsatifity indices during the first trimester were not affected by maternal age and parity: CONCLUSIONS: Mean uterine artery pulsatility indices are not different in nulliparous and multiparous low nisA pregnancies at 11-14 weeks of gestation.

Effect of Anaesthesia Methods for Regaining Daily Life Activities in Cesarean Patients.

OBJECTIVE: Postpartum period is physically, socially and emotionally a difficult time for the parents and the baby to become a family. We tried to investigate how the anaesthesia method affects patients who underwent cesarean delivery, as a factor which also affects this period. METHODS: Two hundred and six parturients, who underwent elective cesarean delivery in Celal Bayar University Hafsa Sultan Hospital were recruited for our study. After demographic data and anaesthesia methods were noted, an EQ-5D health survey and Katz ADL scale were evaluated face to face 24 hours postoperatively, and by telephone on the 5th postoperative day. RESULTS: The percentage of patients who had general anaesthesia was 35.2% (n=71), while 19.8% (n=40) had epidural anaesthesia and 45% (n=91) had spinal anaesthesia. Among -these three methods, the EQ-5D health survey revealed that the outcome at postoperative 24 hours was best in epidural anaesthesia and that general anaesthesia outcome was the worst (p=0.007). The Katz ADL scale at postoperative 24. hours showed that epidural anaesthesia was better than the other methods for regaining daily life activities (p<0.05). CONCLUSION: Our study showed that epidural anaesthesia had the most effective role among the methods in regaining daily life activities after elective cesarean delivery, which was demonstrated using the EQ-5D health survey and Katz ADL scale.

Prenatal diagnosis of congenital high airway obstruction syndrome: report of two cases and brief review of the literature.

Congenital high airway obstruction syndrome (CHAOS) is the obstruction of the fetal upper airways, which may be partial or complete. It is usually incompatible with life. Prenatal recognition of the disease is quite important due to the recently described management options. We report here two cases of CHAOS due to tracheal atresia diagnosed by antenatal ultrasonography and fetal MRI. We also briefly review the relevant literature with the associated management options.

Prenatal diagnosis and fetomaternal outcomes of two cases with placental chorioangioma.

Placental chorioangiomas greater than 4 cm in diameter are rare placental tumors. They have adverse fetomaternal outcomes. We present our experience with two cases having a giant angioma and review the relevant literature.

Comparative effects of risedronate, atorvastatin, estrogen and SERMs on bone mass and strength in ovariectomized rats.

OBJECTIVE: The aim of this study was to investigate bone protective effects of risedronate, atorvastatin, raloxifene and clomiphene citrate in ovariectomized rats. METHODS: Our study was conducted on 63 rats at Experimental Research Center of Celal Bayar University. Six-month-old rats were divided into seven groups. There were five drug administered ovariectomized groups, one ovariectomized control group without drug administration and one non-ovariectomized control group without drug administration. Eight weeks postovariectomy, rats were treated with the bisphosphonate risedronate sodium, the statin atorvastatin, the estrogen 17beta-estradiol and the selective estrogen receptor modulators (SERMs) raloxifene hydrochloride and clomiphene citrate by gavage daily for 8 weeks. At the end of the study, rats were killed under anesthesia. For densitometric evaluation, left femurs and tibiae were removed. Left femurs were also used to measure bone volume. Right femurs were used for three-point bending test. RESULTS: Compared to ovariectomized group, femur cortex volume increased significantly in non-ovariectomized group (p=0.016). Compared to non-ovariectomized group, distal femoral metaphyseal and femur midshaft bone mineral density values were significantly lower in ovariectomized group (p=0.047). In ovariectomy+atorvastatin group, whole femur and femur midshaft bone mineral density and three-point bending test maximal load values were significantly higher than ovariectomized group (p=0.049, 0.05, and 0.018). When compared to the ovariectomized group, no significant difference was found with respect to femoral maximum load values in groups treated with risedronate, estrogen, raloxifene and clomiphene (p=0.602, 0.602, 0.75, and 0.927). In ovariectomy+risedronate group, femur midshaft bone mineral density values were significantly higher than the values in ovariectomized group (p=0.023). When compared to ovariectomized group, no significant difference was found with respect to femur midshaft bone mineral density values in groups treated with estrogen, raloxifene and clomiphene (p=0.306, 0.808, and 0.095). CONCLUSIONS: While risedronate sodium prevented the decrease in bone mineral density in ovariectomized rats, atorvastatin maintained mechanical characteristics of bone and also prevented the decrease in bone mineral density as risedronate sodium.

Comparison of the Bishop score, body mass index and transvaginal cervical length in predicting the success of labor induction.

PURPOSE: To evaluate the role of ultrasonographic and various maternal and fetal parameters in predicting successful labor induction. METHODS: Body mass index, cervical length, dilatation, effacement, Bishop score, parity, maternal age and birth weight were evaluated in 189 singleton pregnant women at 37-42 weeks of gestation and having induction of labor. All underwent induction of labor with oxytocin. Body mass index was calculated using the formula weight (kg)/height(2) (m), cervical measurement was performed by transvaginal ultrasonography and Bishop score was determined by digital examination of cervix. RESULTS: Logistic regression analysis indicated that the cervical length and body mass index were independent variables in determining the risk of cesarean section (OR = 1.206, P = 0.000, CI 95% = 1.117-1.303; OR = 1.223, P = 0.007, CI 95% = 1.058-1.414 respectively). In multiple linear regression analysis, the effect of cervical length and body mass index on induction delivery interval was found to be statistically significant (t = 5.738, P = 0.000; t = 2.680, P = 0.009, respectively). ROC curve showed that the best parameter in predicting the risk of cesarean section was cervical length and that cervical length and body mass index were better parameters compared to the Bishop score (the areas under the curve are 0.819, 0.701 and 0.416, respectively). CONCLUSIONS: Body mass index and transvaginal cervical length were better predictors compared to the Bishop score in determining the success of labor induction.

Prenatal administration of granulocyte-macrophage colony-stimulating factor increases mesenchymal vascular endothelial growth factor expression and maturation in fetal rat lung.

The aim of this study was to determine influence of prenatal granulocyte-macrophage colony-stimulating factor (GM-CSF) administration on lung growth, maturation, and vascular endothelial growth factor (VEGF) expression. Twenty Wistar rats received sterile saline (1 mL) or recombinant human GM-CSF (50 micro g/kg) on day 16 of pregnancy. Rats were sacrificed on days 18 and 20 of gestation. H-score for VEGF was calculated immunohistochemically. Alveolar VEGF expression on days 18 and 20 of gestation was significantly higher in the GM-CSF group (P < .01). Increase in VEGF with prenatal GM-CSF administration indicates that GM-CSF may stimulate lung growth and maturation and may be protective against lung disease due to prematurity.

Antenatal administration of granulocyte-macrophage colony-stimulating factor increases fetal lung maturation and endothelial nitric oxide synthase expression in the fetal rat lung.

OBJECTIVES: We investigated how maternal administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) induced fetal lung maturation compared with dexamethasone and whether maternal administration of GM-CSF and dexamethasone influenced the fetal lung eNOS expression. STUDY DESIGN: Thirty pregnant rats were divided into three groups of 10 rats each to receive GM-CSF, dexamethasone or saline solution at 16 days of gestation. Lung maturation using bronchial area and immunohistochemical lung airway epithelium and the vascular endothelial eNOS expression, using H Scores, were evaluated at 18 and 20 days of gestation. The statistical analysis was done with the Kruskal-Wallis test for comparisons of more than two groups and the Mann-Whitney U-test as a post hoc test using SPSS for windows release 10.0. Values of p>0, 0.05 were considered significant. RESULTS: On the 20th day of gestation both GM-CSF and dexamethasone injections caused a significant increase in fetal lung bronchial area, as compared with the controls (24.9%, 36.8%, 13.4%, respectively, p=0.001). eNOS immunoreactivity was observed in the endothelium of large pulmonary vessels and large and small airway epithelium on the 18th and 20th day of gestation. Maternal GM-CSF and dexamethasone increased lung eNOS expression in the airway epithelium when compared to controls. CONCLUSION: Maternal administration of GM-CSF induced fetal lung maturation and this effect may be mediated, at least partly, by an increase in the eNOS expression.

Pelvic floor function and anatomy after childbirth.

OBJECTIVE: To investigate pelvic floor muscle function and anatomy after childbirth in continent women differing in obstetric history. STUDY DESIGN: Young, continent women, age range 20-40 years, were recruited into 3 groups: 1. elective, prelabor cesarean delivery (n =12); 2. vaginal delivery (n = 15); and 3. age-matched nulliparas as controls (n = 13). Pelvic floor muscle strength was measured by a perineometer and also assessed by vaginal palpation. Magnetic resonance imaging of the pelvic floor at rest and on maximal strain was performed. Statistical analysis was carried out using SPSS 10.0 (Chicago, Illinois) for Windows (Microsoft, Redmond, Washington); p < 0.05 was considered significant. RESULTS: Pelvic floor muscle strength was not different between the vaginal delivery and cesarean groups. The descent of the bladder and cervix on straining was greater in the subjects who delivered vaginally than in the cesarean delivery and nulliparous groups. There was a positive and significant correlation between the duration of labor and the area of the levator sling and also between birth weight and the descent of the cervix on straining. CONCLUSION: The results of this study show that delivery method does not affect pelvic muscle strength.