Evaluation of prenatally diagnosed fetal sacrococcygeal teratomas: A case series of seventeen pregnancies from South-central Turkey.

OBJECTIVE: To evaluate sacrococcygeal teratoma (SCT) cases according to associated cardiac, extracardiac, and chromosomal anomalies in the prenatal period, and to review their outcomes. MATERIALS AND METHODS: Data of pregnancies with a prenatal diagnosis of SCT between 2009 and 2019 were retrospectively reviewed. RESULTS: One ongoing pregnancy was excluded. There were five medically terminated cases, three due to severe heart failure and the remaining two due to additional congenital defects. Two infants who had heart failure due to hyperdynamic flow died in the neonatal period. Nine infants are well and alive at the time of writing. CONCLUSION: When a lesion is detected in the sacrococcygeal region during fetal sonography, the differential diagnosis should be made with an appropriate evaluation with emphasis on a possible diagnosis of fetal SCT. Tumor growth and heart failure should be monitored with serial scans when SCT has been diagnosed prenatally.

The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies.

BACKGROUND: Pregnancy at advanced maternal age has become more common in both developed and developing countries over the last decades. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. The objective of this study is to investigate the impact of advanced maternal age on perinatal and neonatal outcomes of nulliparous singleton pregnancies. METHODS: Records of patients admitted to the Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, between January 2011 and July 2015 for routine mid-trimester fetal ultrasonography were retrospectively reviewed. The control (age: 18-34 years), advanced maternal age (35-39 years), and very advanced maternal age (> 40 years) groups included 471, 399, and 87 women, respectively. RESULTS: Gestational diabetes, gestational hypertension, and cesarean delivery rates were more common in the very advanced maternal age group, with compared with the advanced maternal age and the younger age group. There were no significant differences in regarding rates of spontaneous preterm delivery before 34 weeks of gestation, prolonged rupture of membranes, large for gestational age infants, and operative vaginal delivery rates between the groups. Also, there were no significant differences regarding in APGAR scores, the rate of low birth weight infants, and neonatal morbidity rates between the groups. However, admission to the neonatal intensive care unit requirement was more common in the two advanced maternal age groups compared with the control group. CONCLUSION: Advanced maternal age is a risk factor for gestational diabetes mellitus, gestational hypertension, preeclampsia, small for gestational age infants, spontaneous late preterm delivery, and cesarean section, with significant potential clinical implications.

Fetal Oropharyngeal and Neck Tumors: Determination of the Need for Ex-Utero Intrapartum Treatment Procedure.

BACKGROUND: The aim of this study was to assess the ex-utero intrapartum therapy (EXIT) applied to 3 of the 7 cases with oropharyngeal or neck masses and review the indicators of the need for an EXIT procedure. CASE REPORT: Prenatal presentation, size and localization of the masses, existence of fetal hydrops and associated findings such as polyhydramnios, intraoperative managements, complications, and maternal and neonatal outcomes were evaluated through a retrospective analysis. Four cases had neck masses and three cases had oropharyngeal masses. Prenatal sonography was used as the main diagnostic tool for all patients. The median gestational age was 34.5 weeks at the time of diagnosis and 36 weeks at delivery. Polyhydramnios was observed in three of the seven cases and they were delivered prematurely. Interventions such as endotracheal intubation or tracheostomy were performed to provide patency of the airway during delivery by the EXIT procedure in three cases. Hemangioma was found in two cases, teratoma in two cases, lymphangioma in two cases and hamartoma in one case following pathological examination of the masses. CONCLUSION: The localization of mass, its characteristics, invasion (if it exists), and relation to the airway are the main factors used to determine the need for EXIT. The presence of polyhydramnios may be an important indicator to predict both the need for EXIT and fetal outcomes.

RAPID FLUID ADMINISTRATION AND THE INCIDENCE OF HYPOTENSION INDUCED BY SPINAL ANESTHESIA AND EPHEDRINE REQUIREMENT: THE EFFECT OF CRYSTALLOID VERSUS COLLOID COLOADING.

PURPOSE: Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was conducted to evaluate the effects of rapid crystalloid (Lactated Ringer's solution; LRS) or colloid (hydroxyethyl starch; HES) cohydration with a second intravenous access line on the incidence of hypotension and ephedrine requirement during spinal anesthesia for cesarean section. METHODS: We studied 90 women with uncomplicated pregnancies undergoing elective cesarean section under spinal anesthesia. Intravenous access was established in all patients with two peripheral intravenous lines, the first being used for the baseline volume infusion. Immediately after induction of spinal anesthesia, LRS (Group L) or HES (Group C) infusions were started at the maximal possible rate via the second line in groups L and C respectively. In the third group (Group E), patients received lactated Ringer's solution at a 'keep vein open' rate to maintain the double-blind nature. The incidence of hypotension, ephedrine requirements, total amount of volume and side effects were recorded. RESULTS: The incidence of hypotension was significantly greater in group E than in groups L and C, and greater in group L than in group C (p < 0.03 and p < 0.01 respectively ). The total dose of ephedrine used to treat hypotension was significantly less in groups L and C than in group E (p < 0.001 and p < 0.001 respectively). Groups L and C received similar infusion volumes and doses of ephedrine. CONCLUSIONS: Giving either LR or HES coloading via a second IV line caused less hypotension and required less use of ephedrine compared to no coloading. There were no maternal or neonatal side effects.

Comparison of clinical and laboratory findings in early- and late-onset preeclampsia.

OBJECTIVE: To compare clinical and laboratory findings between the early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). METHODS: This prospective longitudinal study was performed at a tertiary referral university clinic. All patients meeting the inclusion criteria were divided into two groups, the EOP group and the LOP group, according to gestational age at the onset of disease. The distinction criterion for early versus late onset was set as week 34 of gestation. Clinical and laboratory findings, and maternal-perinatal outcomes were compared between the groups. RESULTS: A total of 157 patients with preeclampsia were included. A significant difference was observed between the groups in terms of diagnosis and severity of the disease (p = 0.007 and <0.001, respectively). The history of previous preeclampsia, diastolic blood pressure and hourly urine output on admission to the hospital were significantly different between the groups (p = 0.016, 0.018 and 0.024, respectively). Latent period for delivery and postpartum hospitalization time were longer in the EOP group than in the LOP group (p = 0.024 and 0.002, respectively). The patients with EOP received betamethazone (p < 0.001) and MgSO4 (p = 0.029) more frequently. Neonatal characteristics such as birth weight, low APGAR score and admission to neonatal intensive care unit were significantly different between the groups (p < 0.001, for all variables). Total proteinuria at 24 h was found significantly higher in the EOP group than in the LOP group (p = 0.012). CONCLUSION: The results confirmed the opinion that EOP is a distinct and more severe clinical entity than LOP. In particular, higher proteinuria is associated with EOP.

Differential effect of neocuproine, a copper(I) chelator, on contractile activity in isolated ovariectomized non-pregnant rat, pregnant rat and pregnant human uterus.

The study was conducted to examine effects of a selective copper(I) chelator, neocuproine on the spontaneous or oxytocin-induced contractions in isolated ovariectomized non-pregnant rat, pregnant rat and pregnant human uterus. Uterus activity was evaluated in tissues obtained from bilaterally ovariectomized non-pregnant rats on the 21st day of the operation (n = 24), pregnant rats on the 19-21st day of gestation (n = 24) and women undergoing caesarean section at 38-42 weeks of pregnancy (n = 15). Neocuproine (100 microM) significantly suppressed the amplitude and frequency of the spontaneous contractions in the ovariectomized non-pregnant rat uterus while this agent facilitated the frequency of the spontaneous or oxytocin-induced contractions in the pregnant rat and human uterus without altering the amplitude of these contractions. At high concentration of 200 microM, neocuproine could enhance the amplitude of the contractions in the pregnant uterus. These effects were blocked by a purinergic receptor antagonist, suramin (100 microM) and did not occur following the administration of neocuproine-copper(I) complex or copper(II) chelator cuprizone. alpha, beta-methylene ATP increased the amplitude and frequency of contractions in the pregnant uterus, but not affected the contractions in the ovariectomized non-pregnant rat uterus, and neocuproine potentiated this facilitation effect. However, the suppressive effect of neocuproine on the ovariectomized non-pregnant rat uterus increased in the presence of alpha,beta-methylene ATP. Beta-adrenoceptor blocker, propranolol or nitric oxide synthase inhibitor, L-nitroarginine did not affect the responses to neocuproine. These findings suggest that neocuproine can affect the uterus contractile activity by modulation purinergic excitatory responses and that copper(I)-sensitive mechanisms may play a role in this effect.