The utility of transrectal ultrasound in adolescents when transabdominal or transvaginal ultrasound is not feasible.

STUDY OBJECTIVE: To present the indications and diagnosis in adolescents undergoing transrectal ultrasound (RU). DESIGN: Retrospective chart review. PARTICIPANTS: Adolescents presenting to gynecology clinic between January 1, 2005 and December 31, 2012. MAIN OUTCOME MEASURES: Detection of RU, transvaginal, and transabdominal (AU) ultrasound indications, and final diagnosis. RESULTS: The main indications for RU were menstrual abnormalities, pelvic pain-dysmenorrhea, and vulvovaginitis. When compared according to final diagnosis adolescents with vulvovaginitis (13.9%) and amenorrhea (8.3%) were evaluated more with RU. CONCLUSION: RU is highly acceptable and it provides images superior to AU. It can be used in adolescents to visualize the pelvic organs and to exclude genital abnormalities and mass lesions.

Herlyn-Werner-Wunderlich syndrome--timely diagnosis is important to preserve fertility.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is an urogenital malformation with uterus didelphys and obstructed hemivagina with ipsilateral renal agenesis. Most of these patients present after the onset of menstruation. We describe two cases diagnosed too late to prevent the complications. CASE: The first patient presented with acute abdomen one year after the onset of menstruation and had salpingectomy due to pyosalpinx. The blind hemivagina was not recognized and she had severe endometriosis. She underwent hysterectomy 8 years later. The second patient presented with foul smelling vaginal discharge when she was 21 years old. She had a simple vaginal septum resection. SUMMARY AND CONCLUSION: In the presence of uterine cavities in a regularly menstruating girl with dysmenorrhea, the presence of both kidneys should be checked. When unilateral renal agenesis and uterus didelphys coexist the first thing that we should remember is to confirm or refute the presence of a blind vagina.

Serum visfatin levels in women with polycystic ovary syndrome.

The aim of this study is to determine the serum levels of visfatin in patients with polycystic ovary syndrome (PCOS) and to understand its correlations with other metabolic and hormonal parameters. Thirty-seven patients with PCOS and 30 women without concomitant disease were included in this study. Serum visfatin levels were similar in patients with PCOS and control group. Visfatin levels were higher in normal weight PCOS when compared with obese PCOS, but it did not reach statistical significance. Visfatin levels correlated negatively with fasting blood glucose, total cholesterol (TC), low-density lipoprotein (LDL) and lipoprotein-a levels in PCOS patients. CRP levels increased both in obese PCOS and in obese controls. Plasma visfatin levels had no correlation with homeostasis model assessment-insulin resistance and fasting insulin levels, but the negative correlation between plasma visfatin levels and lipoprotein-a, fasting plasma glucose, TC and LDL levels may indicate a role for visfatin in cardiovascular disease independent of insulin resistance.

C-reactive protein and lipoprotein-a as markers of coronary heart disease in polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to investigate the risk factors of coronary heart disease, CRP and Lipoprotein-a in polycystic ovary syndrome patients. MATERIAL AND METHODS: Prospectively collected data of polycystic ovary syndrome patients (n=62) and control group (n=40) were compared. RESULTS: PCOS patients had higher HOMA-IR, CRP, DHEAS, free testosterone, FAI, LH and prolactin levels when compared to the control group. Lipoprotein-a levels did not differ between the groups. The obese PCOS group had statistically significantly higher fasting blood glucose, total cholesterol, triglyceride, free testosterone, insulin, CRP and HOMA-IR and statistically significantly lower HDL and SHBG when compared to normal weight PCOS persons. Fasting blood glucose, total cholesterol, LDL, SHBG, CRP, Lipoprotein-a, FSH, LH, TSH, DHEAS and prolactin levels did not differ between the normal weight and obese control groups. CONCLUSION: CRP levels increase in polycystic ovary syndrome patients and can be used as a marker of coronary heart disease. Future studies can be directed at treatments to decrease CRP levels, including antiinflammatory treatments.

Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report.

INTRODUCTION: Arrhythmogenic right ventricular dysplasia is a heritable disease of the heart muscle characterized by fibrofatty degeneration of cardiomyocytes. Patients present with ventricular arrhythmias or congestive heart failure, and sometimes sudden cardiac death occurs. Prenatal diagnosis has become possible with the detection of mutations, but, to the best of our knowledge, no case of prenatal diagnosis has been reported previously. There is little information about the management of arrhythmogenic right ventricular dysplasia in pregnancy, and the preferred mode of delivery is not certain; therefore, we present the case of a patient with arrhythmogenic right ventricular dysplasia and discuss the prenatal diagnosis, patient management and prognosis in pregnancy. CASE PRESENTATION: A 26-year-old Caucasian woman who presented to our hospital with heart palpitations was diagnosed with arrhythmogenic right ventricular dysplasia, and, after three years of follow up with anti-arrhythmic drugs, she wanted to conceive. During pregnancy, she ceased taking her medication. She tolerated pregnancy very well but her cardiac symptoms recurred after her 30th week of pregnancy. She delivered a baby via cesarean section under general anesthesia in her 38th week of pregnancy. She was discharged without any medications and continued lactation for six months. CONCLUSION: Patients with mild to moderate arrhythmogenic right ventricular dysplasia tolerate pregnancy and breastfeeding very well, but patients with end-stage arrhythmogenic right ventricular dysplasia should be discouraged from conception.

Placental volume and vascularization flow indices by 3D power Doppler US using VOCAL technique and correlation with IGF-1, free beta-hCG, PAPP-A, and uterine artery Doppler at 11-14 weeks of pregnancy.

AIMS: The purpose of this study was to investigate correlations between first trimester placental volume (PV) and blood flow indexes (FIs), bilateral uterine artery pulsatility indexes, notching, and biochemical parameters: pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (f-ß-hCG), and insulin-like growth factor-1 (IGF-1) to predict the high-risk pregnancies in the first trimester. METHODS: We prospectively examined 310 patients at 11-14 weeks of pregnancy using transabdominal 3D gray scale and power Doppler ultrasound for assessing PV, vascularization index, FI, and vascularization FI (VFI). The acquired volumes were analyzed using VOCAL™ imaging software. The results were correlated with biochemical parameters. RESULTS: We found significant correlations between PV and biochemical parameters, and between placental blood flow studies and other parameters. Finally, PV/crown-rump length so called the placental quotient is also related to both PAPP-A and VFI. CONCLUSIONS: Placental volumetry, uterine artery Doppler studies, blood flow calculations and biochemical parameters, such as f-ß-hCG, PAPP-A, and IGF-1 could be important in the early and rapid diagnosis of high-risk pregnancies. Thus, they may be useful in first trimester prediction of fetal growth restriction presenting with alterations in PV and vascularity.

Longitudinal examination of cervical volume and vascularization changes during the antepartum and postpartum period using three-dimensional and power Doppler ultrasound.

OBJECTIVE: To assess longitudinally the changes in cervical volume and vascularization during the peripartum period using three-dimensional ultrasound (3D US) and power Doppler and to determine whether these measures change with gestational complications. METHODS: Longitudinal measurements of cervical dimensions by transvaginal 3D US and power Doppler using the virtual organ computer-aided analysis program were performed at 11-14, 22-24, 32-34 weeks' gestation, and at 6 weeks' postpartum in 111 pregnant women. Comparisons were made between women who delivered at term (vs. preterm), nulliparous (vs. parous), with (vs. without) pre-eclampsia and those with (vs. without) gestational diabetes. RESULTS: After establishing reference values for each peripartum period for cervical volume, vascularization index (VI) and flow index (FI), we found that the 2(nd) and 3(rd) trimester volume, 2(nd) trimester FI and postpartum VI were different in nulli- vs. multiparous women. Volume and vascularization parameters were unaffected by preterm labor. Second trimester VI and vascularization flow index values were lower in pre-eclamptic vs. non-pre-eclamptic women (P<0.05), but unaffected by gestational diabetes. CONCLUSION: Cervical volume and vascularization parameters are not helpful in predicting preterm labor and gestational diabetes, but might be associated with pre-eclampsia.

The potential of 4D sonography in the assessment of fetal neurobehavior--multicentric study in high-risk pregnancies.

OBJECTIVE: An evolving challenge for obstetrician is to better define normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. PATIENTS AND METHODS: Prenatal neurological assessment in high-risk fetuses using four-dimensional ultrasound applying the recently developed Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel Tison's neurological assessment at term (ATNAT) for all live-borns and general movement (GM) assessment for those with borderline and abnormal ATNAT. RESULTS: Inclusion criteria were met by 288 pregnant women in four centers of whom 266 gave birth to a live-born baby. It was revealed that 234 fetuses were neurologically normal, 7 abnormal and 25 borderline. Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2. Out of 25 KANET borderline fetuses, ATNAT was normal in 7, borderline in 17 and abnormal in 1, whereas the GM assessment was as follows: normal optimal in 4, normal suboptimal in 20, and abnormal in 1. In summary, out of 32 borderline and abnormal fetuses ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2. CONCLUSION: The sonographic test requires further studies before being recommended for wider clinical practice.

Normal standards of fetal behavior assessed by four-dimensional sonography.

OBJECTIVE: In this prospective randomized study, fetal behavior was investigated in order to determine the standard parameters of fetal movements and facial expressions in all three trimesters of normal pregnancy. METHODS: Sixty-three pregnant women with singleton pregnancies in all trimesters were included in the investigation. Four-dimensional (4D) ultrasound was performed for each patient over a 30-minute period. Variables of maternal and fetal characteristics including gestational age, eight fetal movement patterns in the first trimester, and sixteen parameters of fetal movement and fetal facial expression patterns in the second and third trimesters were recorded for the construction of fetal neurological charts. RESULTS: In the first trimester, a tendency towards an increased frequency of fetal movement patterns with increasing gestational age was noticed. Only the startle movement pattern seemed to occur stagnantly during the first trimester (p > 0.05). At the beginning of the second trimester, the frequency of fetal movement patterns tended to increase. During the second and third trimester, multiple regression and polynomial regression revealed statistically significant changes in tongue expulsion (p < 0.05), smiling (p < 0.05), grimacing (p < 0.05), swallowing (p < 0.05), eye blinking (p < 0.01), head movements, and all hand to body contact movements (p < 0.01), except for head anteflexion (p > 0.05). There were no statistically significant changes during the second and third trimesters in mouthing, yawning, and sucking (p > 0.05). At the middle of the third trimester, the fetuses displayed decreasing or stagnant incidence of fetal facial expressions except for eye blinking, which showed increased frequency with increasing gestational age. A statistically significant correlation was found between all head movements and hand to body contact patterns during the second and third trimesters except for head anteflexion (r = -0.231; p > 0.05). CONCLUSIONS: The full range of quantitative fetal facial expressions and fetal movement patterns can be assessed successfully by 4D sonography. It is important to be able to assess normal fetal behavior throughout gestation to identify abnormal behavior before birth.

Effect of smoking on pregnancy-associated plasma protein A, free beta-human chorionic gonadotropin, and nuchal translucency in the first trimester of pregnancy.

Data were collected from 1275 pregnant Turkish women screened prospectively for chromosomal anomalies to determine whether first-trimester levels of maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) and the thickness of nuchal translucency are affected by smoking and other covariables. Only normal singleton pregnancies were included. After weight correction, comparisons were made between smokers and nonsmokers. Mean values of PAPP-A and beta-hCG were reduced in women who smoked 5 or more cigarettes a day compared with nonsmokers. The median beta-hCG level decreased significantly as gravidity and parity increased; no effect was noted on PAPP-A. Median PAPP-A and beta-hCG levels tended to increase, but not significantly in women who had had 2 or more miscarriages. Smoking alters maternal levels of serum analytes, with the magnitude of the impact related to the number of cigarettes smoked per day. This effect can be detected in the first trimester of pregnancy.