Evaluation of Inferior and Superior Vena Cava and the Vena Cava Ratio in Growth Restricted Fetuses.

OBJECTIVE: To evaluate the changes in the diameters of superior vena cava (SVC) and inferior vena cava (IVC) and to measure the ratio between SVC and IVC in growth-restricted fetuses and compare these results with normally grown fetuses. METHODS: Twenty-three consecutive patients with fetal growth restriction (FGR) (Group I) and 23 pregnant gestational age-matched controls (Group II) between 24 and 37 weeks of gestation were enrolled in the study between January 2018 and October 2018. The diameter of the SVC and IVC from inner wall to inner wall was measured in all patients by sonographic examination. The ratio between the diameter of the SVC and IVC was also measured in each patient to eliminate the gestational age factor. We have named this ratio the "vena cava ratio" (VCR). All parameters were compared between the two groups. RESULTS: The diameter of the SVC was significantly greater in the fetuses with FGR (2.6-7.7 [5.4]) than in controls (3.2-5.6 [4.1]; P = .002; P < .01). The diameter of the IVC was significantly less in the fetuses with FGR (1.6-4.5 [3.2]) than in controls (2.7-5 [3.7]; P = .035; P < .05). The VCR was between 1.1 and 2.3 and the median value was 1.8 in Group I. The VCR was between 0.8 and 1.7 and the median value was 1.2. VCR was significantly higher in fetuses with FGR (P = .001 P < .01). CONCLUSION: This study shows that VCR is higher in fetuses with growth restriction. Further studies are needed to clarify the association between VCR and antenatal prognosis and postnatal results.

Placental and serum levels of human Klotho in severe preeclampsia: A potential sensitive biomarker.

INTRODUCTION: The Klotho (KL) gene, initially defined as an anti-aging gene in mice, shares 86% of the amino acid sequence withthe human KL protein. The KL gene plays roles in endothelial nitric oxide production, angiogenesis, antioxidant enzyme production and protecting against endothelial dysfunction, all of which may be associated with preeclampsia (PE). Human KL is the precursor of the gene products: α-KL and ß-KL. In this study, we evaluated the gene expression, serum and placental levels of human KL in women with severe PE, pregnant women with chronic hypertension and healthy pregnant controls. Also, the gene expression, serum and placental levels of human decorin (DCN) were evaluated. METHODS: A total of 36 patients with severe PE, 10 with chronic hypertension, and 28 with healthy controls were enrolled. Placental and serum levels together with of KL and DCN were measured by ELISA and alsogene expression of these were evaluated. RESULTS: Placental and serum KL levels were significantly higher in the PE than in the controls and in women with chronic hypertension. Serum DCN levels were significantly higher in the PE women compared to controls and pregnant women with chronic hypertension. Placental DCN was similar in PE and healthy controls. There was no significant difference in the gene expression of KL and DCN in the groups. The best cut-off level for human KL to identify the presence of PE was calculated as 12.48 pg/ml with a sensitivity of 100% and and specificity of 96%, whereas for DCN 62.33 ng/ml to assess the presence of PE with a sensitivity of 86.1% and a specificity of 88%. CONCLUSION: Human KL may be a valuable marker for PE, with high sensitivity and specificity. It also appears to be more sensitive and specific than human DCN.

Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study.

OBJECTIVE: To investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL). METHODS: After 48 h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37 weeks of gestation. RESULTS: The patients were divided into two groups as women delivered ≥ 37 weeks (38.68 ± 1.01 weeks) (n = 25) and those delivered < 37 weeks (34.28 ± 2.53 weeks) (n = 21). The mean ± SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 ± 9.23 vs 29.91 ± 7.03 mm, p < 0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p = 0.026) and mid-anterior MT-to-CL (p = 0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1 mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%. CONCLUSION: Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.

Does emergency cerclage really works in patients with advanced cervical dilatation?

OBJECTIVE: To asses the efectivity of emergency cerclage in the patients with advance cervical dilatation and prolapsed membranes. MATERIAL METHODS: The patients who have ≥4 cm cervical dilatation with protruding membranes were included in the study. The patients were divided into two groups. Group I was consisted of the patients who had emergency cerclage procedure and group II was consisted of the patients who denied the operation and expectantly managed. The physical examination, pregnancy outcomes and the complications were compared between the groups. The results of the patients with emergency cerclage were analysed. RESULTS: 21 patients were referred with a ≥4 cm cervical dilatation with protruding membranes 33.3% of women with emergency cerclage were delivered within one week from the admission. One patient, who was a grand multiparous (G6P4A1), was delivered a healthy infant at 40 weeks of gestation. The remaining five patients were delivered between 21 and 24 weeks, but all the infants were died due to extreme prematurity.Two patients (22.2%) developed chorioamnionitis that necessitated long hospitalization (14-21 days). In group II (expectant management) 83,3% of the patients were delivered within the 48 h from the admission. There were no case of chorioamnionitis in group II. CONCLUSION: Emergency cervical cerclage is not a rationale option for the patients with an advanced cervical dilation (>4 cm) together with protruding membranes in early second trimester because of the short prolongation time and high complication rate.

Pregnancy Outcomes in Women with Strictly Controlled Type 1 Diabetes Mellitus.

OBJECTIVE: To evaluate the pregnancy outcomes in mothers with controlled Type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS: Thirty seven pregnant patients with controlled T1DM were included in the study. RESULTS: Twenty (54%) out of 37 patients had preterm delivery (<37 weeks of gestation). The type of delivery was induced vaginal delivery in 9 (24.3%) patients and cesarean section in 27 (72.9%) patients. Preeclampsia developed in 6 (16.2%) patients. Macrosomia was found in 9 (24%) patients. Two antenatal death occured. CONCLUSION: Even in the most favorable conditions, the pregnant patients with T1DM would have a great risk for preterm delivery and cesarean section, moderate risk for macrosomia, preeclampsia, and an undefined risk for antenatal death.