Double notches: association of uterine artery notch forms with pregnancy outcome and severity of preeclampsia.

OBJECTIVE: To assess uterine artery Doppler waveforms and notches performed in the third trimester as a predictor of adverse outcomes. METHODS: Of 490 preeclampsia (PE) patients between 24 and 34 weeks gestation, 166 were diagnosed with mild PE and 324 were diagnosed with severe PE. Patients were divided into four groups (no notch, a unilateral notch, bilateral notches and double notches). RESULTS: Bilateral and double notches were predictive of shorter follow-up times, adverse laboratory outcomes, HELLP syndrome, prematurity, neonatal intensive care unit admission and perinatal mortality. CONCLUSION: Double notches represent progressive deterioration in the uterine artery and are predictive of adverse maternal outcomes.

The outcome of Manchester-Fotergill operation for uterine decensus repair: a single center experience.

PURPOSE: The aim of this study was to evaluate the clinical characteristics, peri- and post-operative outcomes, and clinical effectiveness of the Manchester-Fothergill (MF) procedure for uterine descensus as a uterine-sparing surgery. METHODS: In this study, 49 patients underwent the MF procedure as a uterine-sparing surgery for uterine descensus during 2008-2012 in the Department of Urogynecology at Kanuni Sultan Süleyman Research and Teaching Hospital, Istanbul, Turkey. RESULTS: Medical records and follow-up data were collected from 24 of the 49 patients (48.9 %). The mean age was 49.3 ± 9.1 years, and parity 3.6 ± 1.5; 41.6 % were post-menopausal; 6 patients (25 %) had grade II, and 18 (75 %) had grade III uterine prolapse; 95.8 % had associated cystoceles, and 79.1 % had associated rectoceles; 66.6 % complained of urinary incontinence. On follow-up examination, the cervical stumps were satisfactorily situated in 23 of 24 patients, and recurrent prolapse was seen in 1 patient (4.1 %). Bladder perforation was repaired at the time of the operation in 1 patient, and one complained of post-operative urinary retention. CONCLUSION: The MF procedure is a viable option to surgically correct uterine descent while preserving the uterus to treat recurrent prolapse with a low complication rate and low morbidity.

Subfoveal choroidal thickness in preeclampsia: comparison with normal pregnant and nonpregnant women.

PURPOSE: To compare the subfoveal choroidal thickness (SFCT) in preeclampsia, normal pregnancy, and non-pregnant women using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: One hundred nineteen volunteers were enrolled in this prospective and comparative study. The participants were divided into three groups: group 1 (33 preeclamptic women), group 2 (46 normal pregnant), and group 3 (40 non-pregnant healthy women). The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Medical records of pregnant women, including gestational age, maternal weight gain, weight, and proteinuria, were noted. RESULTS: Mean SFCT of groups 1, 2, and 3 were 333.8 ± 55.3 µm (range 235-440 µm), 368.6 ± 67.6 µm (range 223-517 µm), and 334.8 ± 59.9 µm (range 197-432 µm), respectively. The mean SFCT was thicker in group 2 than that in groups 1 and 3 (p = 0.045 and p = 0.038, respectively), whereas no significant difference was seen between groups 1 and 3 (p = 1.0). In group 1, SFCT showed a negative correlation with the CCT (p = 0.009, r = -0.493). In group 2, SFCT showed a positive correlation with OPP (p = 0.030, r = 0.321) and a negative correlation with gestational age and fetal weight (p = 0.008, r = -0.387 and p = 0.011, r = -0.373, respectively). CONCLUSION: Our results suggested that SFCT was significantly thicker in normal pregnant women than non-pregnant women. However, SFCT values of preeclamptic women were similar to those of non-pregnant women.

Evaluation of subfoveal choroidal thickness in pregnant women using enhanced depth imaging optical coherence tomography.

PURPOSE: To evaluate the subfoveal choroidal thickness (SFCT) measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in pregnant women. METHODS: In this prospective and cross-sectional study, 100 pregnant women and 100 age-matched nonpregnant women were enrolled. The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Pregnancy-related factors including gestational age, maternal weight gain, and fetal weight were noted. RESULTS: Mean SFCT was 371.1 ± 61.8 µm in the study group and 337.2 ± 62.4 µm in the control group (p < 0.001). No significant correlation was found between SFCT and spherical refraction, IOP, AL, CCT, OPP, gestational age, maternal weight gain, or fetal weight. CONCLUSION: Our results suggest that subfoveal choroidal thickness increases in pregnant women compared with age-matched nonpregnant women.

Prenatal ultrasound findings and a new ultrasonographic sign of epidermolysis bullosa with congenital pyloric atresia: a report of three cases.

Epidermolysis bullosa with pyloric atresia (EB-PA) is a rare autosomal recessive disease that is characterized by fragility of the skin and mucous membranes. The course of EB-PA is usually severe and often lethal in the neonatal period. In most cases, prenatal diagnosis of this syndrome is considered in pregnancies at risk for recurrence. EB-PA can be described during pregnancy with sonographic signs such as polyhydramnios with a dilated stomach, the "snowflake sign", which are echogenic particles in the amniotic fluid, and several other anomalies. In this report, we present three cases of EB-PA suggested by the results of prenatal sonography, and describe a new ultrasonographic sign, i.e., complete chorioamniotic membrane separation, which can be helpful for the diagnosis. The prenatal diagnoses were confirmed postnatally. Two of the three cases had no family history, and one of these two cases was the product of a non-consanguineous couple.

Effect of body posture on intraocular pressure and ocular perfusion pressure in nonglaucomatous pregnant women.

PURPOSE: To investigate the effect of different positions on the intraocular pressure (IOP) and ocular perfusion pressure (OPP) in nonglaucomatous pregnant. MATERIAL AND METHODS: Thirty-one women in their third trimester of pregnancy were enrolled in this prospective and observational study. IOP in both eyes was measured with a Tono-pen® in the sitting position (Si-P), in the supine position (Su-P), in the right lateral decubitus position (R-LDP), and left lateral decubitus position (L-LDP). Systolic and diastolic blood pressure (sBP and dBP) were measured with a digital automatic blood pressure monitor at after 10 min in each position. Mean blood pressure ([mBP] = dBP + 1/3 [sBP-dBP]) and mean OPP (OPP = 2/3 mBP-IOP) were also calculated. Three IOP measurements were performed by the same clinician at the 15th min in each position. RESULTS: The mean IOP was 13.6 ± 3.4 mmHg in Si-P; 16.7 ± 3.5 mmHg in Su-P; 16.4 ± 3.5 mmHg in the R-LDP, and 16.6 ± 3.7 mmHg in the L-LDP. IOP was significantly lower in Si-P compared to Su-P, R-LDP, or L-LDP. The mean OPP was 46.41 ± 5.54 in Si-P; 39.71 ± 6.96 in Su-P; 36.81 ± 6.57 in the R-LDP; and 33.53 ± 7.63 in the L-LDP. OPP values were significantly different between each body position when multiple comparisons were performed. CONCLUSION: According to our data we conclude that Si-P yields the lowest IOP and the highest OPP compared with Su-P, R-LDP, and L-LDP in healthy pregnant women.