Obstetric outcomes of intramural leiomyomas in pregnancy.

AIM: The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group. MATERIALS AND METHODS: The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group. RESULTS: The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5-63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8-66.5), premature rupture of mem- branes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4-20.0), preterm birth (OR: 4.7, 95% CI 1.9-11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8-34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found. CONCLUSIONS: Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

Comparison of second trimester uterine artery pulsatility index between IVF and spontaneous twin pregnancies.

PURPOSE OF INVESTIGATION: The authors aimed to determine and compare the uterine artery pulsatility index (PI) between spontaneous and IVF twins in the second trimester. MATERIALS AND METHODS: All medical records of twin pregnancies, whose fetal screening was done between May 1999 and December 2013, were evaluated retrospectively. All twin pregnancies without detected/suspicious anatomical or genetic fetal anomalies, systemic diseases, biochemical abnormalities, and familial genetic diseases were included in the data analyses. Fetuses with no information on spontaneous or IVF conception and fetuses with undetermined uterine artery impedance of second trimester were excluded from the data analyses. RESULTS: A total of 151 twin pregnancies were evaluated in the analyses. The percentages of spontaneous and IVF twins were 24.5% and 75.5%, respectively. Mean gestational age was 19.95 ± 2.25 weeks in IVF twin group and 20.10 ± 2.19 weeks in spontaneous twin group. The difference of the gestational age between groups was not statistically significant. Mean uterine artery impedance was found as 0.78 ± 0.22 in IVF twins and 0.96 ± 0.31 in spontaneous twins respectively). Mean values were significantly lower in the IVF twins (p = 0.09). CONCLUSION: The uterine artery PI in the second trimester is significantly lower in IVF twins compared to the spontaneous twins.

Uterine artery pulsatility index and diastolic notch laterality according to the placental location.

PURPOSE OF INVESTIGATION: The authors aimed to determine the effect of placental site on uterine artery pulsatility index (PI) values and tendency for laterality of uterine artery diastolic notch in singleton pregnancies. MATERIALS AND METHODS: All medical records of singleton pregnancies whose first trimester screening was done between years of 2004-2014, were evaluated retrospectively. Singleton pregnancies with detected/suspicious anatomical or genetic fetal anomalies, any systemic disease, familial genetic diseases, artificial reproduction techniques or missing data were excluded. Mean left and right uterine artery PI values and diastolic notch laterality ratios according to placental sites were determined and compared. RESULTS: A total of 2,067 singleton pregnancies were included in data analyses. Mean gestational age was 12.57 ± 0.61 weeks. Left and right uterine artery PI was 1.42 ± 0.47 and 1.48 ± 0.56, respectively. Uterine artery notch was present in 18.86%. PI measurements did not show any statistical difference according to placental locations. Uterine artery notch laterality ratios according to common placental sites are as following; in anterior location (n = 190) 67% bilateral, 21% left sided, 12% right sided; in posterior (n = 136) 66% bilateral, 18% left sided, 16% right sided. CONCLUSION: The placental site has no effect on uterine artery PI values and the laterality of uterine artery notch in singletons.

A VARIANT CASE OF 6p24 DELETION SYNDROME (OMIM #612582).

The 6p24 deletion syndrome, a contiguous gene deletion syndrome is characterized by a wide spectrum of clinical presentations. In this case report we present an antenatal case of 6p 24 deletion syndrome variant involving FOXC1 gene. First trimester fetal screening of a 34 year old pregnant female revealed ultrasonographic anomalies and chorionic villus sampling was performed to rule out any chromosomal anomaly. Cytogenetic examination resulted in normal 46,XY karyotype. In the following weeks further anomalies like cleft palate/lip, thick nuchal fold, ventral septal defect and low set ear were detected with ultrasonography. At 20 weeks of gestation, amniocentesis and whole genome array-CGH analysis revealed a 9.6 Mb interstitial deletion in the 6p25.2p24.1 region which has many genes including an important gene, FOXC1 and 119 Kb interstitial deletion at 9q22.31. The pregnancy was terminated. Postmortem morphological examination revealed turricephaly, hypertelorism, depressed nasal bridge, broad nasal tip, left sided cleft lip, low-set small ears, micrognathia, short neck, increased nuchal fold, short broad distal phalanges, broad thumbs, broad halluces and broad toes.

Practical biometric ratios of first-trimester screening.

PURPOSE: The authors aimed to determine some practical contributive biometry ratios of the first trimester screening in order to note more accurate measurements and recognize abnormal/mistaken measurements. MATERIALS AND METHODS: All medical records of singleton pregnancies whose first-trimester screening that was performed between the years of 2004-2010, were evaluated retrospectively. Singleton pregnancies with detected/suspicious anatomical or genetic fetal anomalies, any systemic disease, and familial genetic diseases were excluded. The following ratios were calculated and compared: measurements of biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], femur length [FL], and crown rump length [CRL] of included fetuses, to each other were calculated. Mean and standard deviations of the ratios were determined for each gestational weeks of 11(0-6), 12(0-6), and 13(0-6). RESULTS: A total of 1,615 singleton pregnancies were included in the data analyses according to exclusion and inclusion criteria. Mean maternal age was 29.5 +/- 4.6 years. Mean gestational age of the fetuses was 12.6 +/- 0.6 weeks. Mean and standard deviation of the ratios were as follows; CRL/BPD: 3.0 +/- 0.2; AC/BPD: 3.0 +/- 0.2; CRL/AC: 1.0 +/- 0.1; CRL/HC: 0.8 +/- 0.1; CRL/FL: 8.8 +/- 1.6; BPD/FL: 2.9 +/- 0.6; AC/FL: 8.9 +/- 1.6; HC/FL: 11.1 +/- 2.2, and HC/AC: 1.3 +/- 0.1. Among these ratios the standard deviation was small in the ratios of CRL/BPD, AC/BPD, CRL/AC, CRL/HC, and HC/AC. The equations of these ratios were derived from linear regression analyses. The AC/BPD, and CRL/AC ratios had lower R2 values than others, indicating a rather constant ratio. CONCLUSIONS: The ratios of CRL/BPD, AC/BPD, and CRL/AC seem more practical to be used in the first-trimester fetal ultrasonography practice.

Lithiazis in the periurethral gland of a woman.

We present a very rare case of stone formation in the periurethral gland of a 49-year-old woman who was referred to our hospital with suspicion of a malignant or granulomatous soft-tissue lesion in the paraurethral area. The lesion was excised and the histopathological examination revealed cystic dilatation and squamous metaplasia in the lining of the glandular structure and surrounding lymphocyte infiltration. The scanning electron microscope examination of the stone revealed egg shell-like stratified concentric calcifications. The chemical composition revealed by the X-ray diffraction technique was a mixture of calcium oxalate and phosphate similar both at the outer and inner layers.