The outcome of the vein of Galen aneurysmal malformation cases diagnosed prenatally.

Vein of Galen aneurysmal malformation (VGAM) is a rare foetal anomaly associated with neurodevelopment delay, cardiac failure, and even perinatal death. We aimed to assess prenatal features of VGAM and describe postnatal outcomes. This was a retrospective study involving six foetuses diagnosed with VGAM prenatally in two centres. All of the cases underwent foetal neurosonography and echocardiography. The presence of ventriculomegaly, intracranial haemorrhage and cardiac failure was recorded. Pregnancy and neonatal outcome information were obtained from medical records. The mean gestational age at diagnosis was 31.1 ± 5.1 weeks, and the mean size of VGAM was 29.2 ± 5.2 × 26.4 ± 3.3 mm. Ventriculomegaly was detected in five of six (83.3%) cases. Intracranial haemorrhage was present in five (83.3%) cases. Cardiac failure was shown in four (66.6%) foetuses. Three foetuses underwent termination of pregnancy (TOP); in two cases, neonatal death occurred. One patient was treated with endovascular embolisation, and there was no cardiac problem or neurodevelopment delay. Prenatally diagnosed VGAM have a poor prognosis, mainly if a cardiac failure or neurological consequences (intracranial haemorrhage, hydrocephaly) are present in utero.Impact StatementWhat is already known on this subject? VGAM is the most common cerebral arteriovenous malformation detected prenatally, and it can lead to severe consequences in the perinatal period.What do the results of this study add? The accuracy of foetal neurosonography is excellent for detecting VGAM and associated brain abnormalities. Foetal echocardiography is mandatory for the prediction of prognosisWhat are the implications of these findings for clinical practice and/or further research? VGAM is associated with severe brain injury, cardiac failure, and the prognosis is generally poor. We need predictors to identify those expected to benefit from postnatal therapy.

Rare case of human tail with tethered cord.

Dorsal cutaneous appendage or human tail is a rare lesion with a variable prognosis depending on the presence of associated anomalies. In the absence of structural, chromosomal abnormalities and genetic syndromes, this cutaneous lesion may be a marker for underlying occult spinal dysraphism. The evaluation of the conus medullaris can help to detect of small a skin lesions related with low-lying spinal cord conus. We report a case of the tail with tethered cord diagnosed with ultrasound at 21 weeks of gestation.

Labial fusion: A rare cause of urinary retention in reproductive age woman and review of literature.

Labial fusion usually affects prepubertal girls and postmenopausal women, it may rarely occurs in reproductive years in the absence of predisposing factors such as vulvar infections, dermatitis, trauma, female circumcision and lichen sclerosis. Should be considered in differential diagnosis in the differential diagnosis of urinary retention even if the patient doesn't have history of sexual intercourse.

Evaluation of maternal serum folate, vitamin B12, and homocysteine levels andfactor V Leiden, factor II g.20210G>A, and MTHFR variations in prenatallydiagnosed neural tube defects.

BACKGROUND/AIM: Neural tube defects (NTDs) are common congenital malformations that develop as a result of interactions between several genes and environmental factors. Many factors have been investigated in order to understand the etiology of NTDs, and many studies have identified folate intake as a common contributing factor. The exact etiology of the disease is still unknown. MATERIALS AND METHODS: In this study, we compared serum folate, vitamin B12, and homocysteine levels, along with common thrombophilia-related genetic variations, including factor V Leiden, factor II g.20210G>A, MTHFR c.677C>T, and MTHFR c.1298A>C, in 35 pregnant women with fetal NTDs and 38 pregnant women with healthy fetuses. RESULTS: A significant difference in serum vitamin B12 level and factor V Leiden frequency was detected between the two groups. On the other hand, serum folate, homocysteine levels, and factor II g.20210G>A, MTHFR c.677C>T, and MTHFR c.1298A>C were not significantly different in the NTD group compared to the controls. CONCLUSION: These results indicate that vitamin B12 supplementation along with folate may help in lowering NTD frequency. In addition, this is the first study that provides evidence for a possible relationship between increased NTD risk and factor V Leiden.

Effect of Young Maternal Age on Obstetric and Perinatal Outcomes: Results from the Tertiary Center in Turkey.

BACKGROUND: Young maternal age is variously defined in studies of its effect on obstetrics and perinatal outcomes. Also, pregnancy has been reported as the leading cause of death in adolescent girls in low- and middle-income countries. AIMS: The aim of the study was to evaluate whether young maternal age was associated with an increased risk of obstetrics and perinatal adverse outcomes. STUDY DESIGN: Case-control study. METHODS: This case-control study was derived from a database of the medical records between January 2008 and December 2012. In the present study, 1374 teenage pregnancy and 1294 adult pregnancy cases were included. After restriction of analyses to singleton primiparous women, 1282 teenage pregnancy and 735 adult pregnancy cases were analyzed. Maternal age was separated into three groups: 15 and less, 16-19, and 20-34 years. Adjusted odds ratios (ORs) were derived through logistic regression models for the potential confounding factors. RESULTS: Adolescents aged 15 years and younger had higher risks of preterm delivery, early preterm delivery, intrauterine fetal death and neonatal death compared with women aged 20 to 34 years after adjustment for confounding factors. In addition, both groups of adolescents had higher risks for anemia and episiotomy and lower risk of cesarean delivery. The rates of preeclampsia, gestational diabetes, chronic diseases, intrauterine growth restriction (IUGR) were higher in the adult group. CONCLUSION: Younger maternal age was correlated with increased risks of preterm delivery, fetal and neonatal death and anemia.

Prediction of gestational diabetes mellitus at first trimester in low-risk pregnancies.

OBJECTIVE: We aimed to assess the relationship among the sex hormone-binding globulin (SHBG), homeostasis model assessment (HOMA), glycosylated hemoglobin (HbA1c), and cholesterol panel values to predict subsequent gestational diabetes mellitus (GDM) in low-risk pregnancies. MATERIALS AND METHODS: Thirty-eight pregnant women with GDM and 295 low-risk pregnant women without GDM were included in this study. Maternal blood samples were obtained during the first trimester examination to determine the SHBG, HbA1c, fasting blood glucose, insulin, thyroid stimulating hormone (TSH), free thyroxine, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) levels. The variables that exhibited statistically significant differences between the groups and independent predictors for GDM were examined using logistic regression analysis. The risk of developing GDM, according to cutoff values, was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: The SHBG, HOMA, LDL, and TG levels were found to be the significant independent markers for GDM [adjusted odds ratio (OR) = 0.991; 95% confidence interval (CI), 0.986-995; OR = 1.56; 95% CI, 1.24-1.98; OR = 1.02; 95% CI, 1.01-1.04; and OR = 1.01; 95% CI, 1.00-1.02, respectively]. The HbA1c, body mass index, and mean arterial pressure values were nonindependent predictors of GDM. The areas under the ROC curve used to determine the predictive accuracy of SHBG, HOMA, TG, and LDL-C for development of GDM were 0.73, 0.75, 0.70, and 0.72, respectively. For a false positive rate of 5% for the prediction of GDM, the values of the sensitivities were 21.1, 26.3, 21.1, and 18.4%, respectively. CONCLUSION: The HOMA, SHBG, TG, and LDL-C levels are independent predictors for subsequent development of GDM in low-risk pregnancies, but they exhibit low sensitivity.

Association between maternal serum 25-hydroxyvitamin D level and pre-eclampsia.

OBJECTIVES: The objective of the study was to evaluate the association of maternal plasma levels of 25-hydroxyvitamin D (25(OH)D) at late second and third trimester and the risk of pre-eclampsia. METHODS: In this prospective cohort study, maternal plasma 25(OH)D levels were measured at late second and third trimester in 77 women who later developed pre-eclampsia (31 non-severe and 46 severe cases) and 180 women without pre-eclampsia. RESULTS: The mean gestational age of the timing of the blood sampling was 31.1 ± 4.4 at control group, 32.6 ± 5.7 at non-severe pre-eclamptic group and 32.3 ± 5.4 at severe pre-eclamptic group. The mean 25(OH)D concentration was significantly low in severe pre-eclampsia group (5.8 ± 4.5 ng/ml) than non-severe pre-eclampsia (11.8 ± 7.3 ng/ml, p = 0.039) and control groups (14.9 ± 12.0 ng/ml, p < 0.0001). There was no statistically significant difference in 25(OH)D concentration between non-severe pre-eclamptic and control groups (p = 0.404). In women with 25(OH)D concentration <20 ng/ml, a 12.45-fold increase in the odds of severe pre-eclampsia were detected. CONCLUSION: Women with severe pre-eclampsia had low serum 25(OH)D levels. The correlation between maternal 25(OH)D levels and aspartate aminotransferase, alanine transaminase, serum creatinine levels, platelet count were not determined. 25(OH)D levels may be used as an independent predictive marker of severe pre-eclampsia.

Prenatal diagnosis and outcomes of fetal teratomas.

PURPOSE: Our aim was to evaluate the diagnostic performance of ultrasonography (US) in the prenatal identification of teratomas and the perinatal outcome of the fetuses with those teratomas. METHODS: In this retrospective case series study, we searched the archives using the keywords "fetal mass" or "fetal tumor" or "fetal teratoma" and "sacrococcygeal teratoma," diagnosed between 2009 and 2014, within the US database of our center. RESULTS: One hundred seven fetuses were prenatally diagnosed as having a cystic or solid mass, tumor, or teratoma. Nineteen of those cases were diagnosed prenatally as having fetal teratoma, but that diagnosis could not be verified in three cases. In one fetus, the prenatal diagnosis could not be confirmed. The sensitivity of US in identifying fetal teratoma was 100% and the false-positive rate, 3.3%. Six pregnancies complicated by a fetal teratoma were terminated. A normal karyotype was identified in all fetuses that underwent karyotyping. Among the nine women who continued their pregnancy, polyhydramnios was identified in four fetuses; although high-output heart failure was also identified in two of those fetuses during prenatal follow-up, none developed hydrops. On delivery, nine infants were born alive, but three (33.3%) of them died within the early neonatal period. CONCLUSIONS: US has very high sensitivity and low false-positive rates in identifying fetal teratoma prenatally. The risk of chromosomal abnormalities is very low in fetuses with teratoma, and their prognosis depends on the location and size of the tumor and any associated perinatal complications.

Prenatal diagnosis and outcome of lymphangiomas and its relationship with fetal chromosomal abnormalities.

OBJECTIVES: Our aim was to evaluate ultrasound findings and perinatal outcome after prenatal diagnosis of lymphangioma. METHODS: This was a retrospective case series study. We searched the archives of our ultrasound database at our center for cases with the prenatal diagnosis of the lymphangioma in the period between January 2008 and November 2014. We described maternal, fetal and perinatal variables for all cases. RESULTS: Nine fetuses with lymphangioma were identified. All cases were diagnosed during the second and third trimesters with the average gestational age of 22.6 ± 3.9 weeks. The average diameter of lymphangioma was 55.4 ± 20.1 mm at the time of diagnosis. Five fetuses (55.6%) had lymphangioma on the neck, and four fetuses (44.4%) had lymphangioma on other localizations. Normal fetal karyotype was detected in all cases. There were a total of six live births, one intrauterine death and two medical terminations of pregnancy following the diagnosis of lymphangioma. No abnormal Doppler finding or hydrops were detected in the antenatal follow-up of remaining six cases. CONCLUSION: The risk of chromosomal abnormalities is very low in pregnancies with isolated lymphangioma. The outcome of pregnancies with lymphangioma is generally favorable and prognosis depends on their locations and size.

Relationship between first trimester visualization of the intracranial translucency and spina bifida.

PURPOSE: To establish a reference range for the intracranial translucency (IT). METHODS: In this prospective study, we examined 596 singleton fetuses at 11-14 weeks of gestation using transabdominal ultrasonography. The distribution curves of the anterior-posterior diameter of the IT were established according to the gestational weeks, and the percentiles for 11-14 weeks of gestation were calculated. Regression analysis was performed to estimate the relationship between the anterior-posterior diameter of the IT and other fetal biometric parameters. RESULTS: The mean anterior-posterior diameter of the IT was 1.8 ± 0.4 mm. From 11 to 14 weeks of gestation, the IT diameter increased linearly with advancing gestation. The linear regression equation for the IT × crown-rump length (CRL) was IT = CRL × 0.0184 + 0.575 (R = 0.385, p < 0.001). The linear regression equation for the IT × biparietal diameter (BPD) was IT = BPD × 0.0532 + 0.632 (R = 0.346, p < 0.001). The linear regression equation for IT × gestational age (days) (GA) was ICT = GA × 0.024 - 0.339 (R = 0.25, p < 0.001). The linear regression analysis revealed significant correlations of the IT with CRL, BPD, and GA. CONCLUSION: The IT increases linearly with increasing CRL, BPD, gestational age in weeks, and gestational age in days.

Effect of thyroid dysfunction and autoimmunity on pregnancy outcomes in low risk population.

PURPOSE: The objective of this study was to assess the effect of thyroid dysfunction and autoimmunity in early pregnancy on adverse pregnancy and neonatal outcome. METHODS: 497 pregnant women between 10 and 12 gestational age were invited who were attending for their first antenatal visit and asked to perform blood tests for thyroid function and antithyroid peroxidase antibodies. A total of 395 women were recruited in the present study. Cases were classified into four groups according to thyroid function and anti-TPO results. The pregnancy outcomes included gestational diabetes mellitus, preeclampsia, preterm delivery, cesarean rate, small for gestational age, low birth weight. RESULTS: 2.5-(OR 2.5, 95% CI 1.06-5.89) and 4.8-(OR 4.85, 95% CI 1.89-12.42) fold increase in preterm delivery was detected in groups with isolated anti-TPO positivity and subclinic hypothyroidism with anti-TPO positivity compared to reference group, respectively. No association was found between thyroid dysfunction and anti-TPO positivity with gestational diabetes, preeclampsia, cesarean rates, low birth weight and small for gestational age neonates. CONCLUSION: Pregnant women with anti-TPO antibody positivity alone or with subclinic hypothyroidism were more likely to experience a spontaneous preterm delivery.

The utility of cervical elastosonography in prediction of cervical insufficiency: cervical elastosonography and cervical insufficiency.

OBJECTIVE: To evaluate the utility of cervical elastosonography (ES) in prediction of cervical insufficiency (CI). METHODS: A total of 40 women, of which 20 who had previously received the diagnosis of CI and 20 healty women were included in the study. None of the women were pregnant. All subjects underwent sonographic evaluation including cervical length measurement and ES of uterine cervix. Adjacent muscular tissue was the reference point for elastosonography evaluation. Tissue strain ratio values were obtained from all the patients. RESULTS: The area around the internal cervical os of the group with CI was found to be significantly softer as compared to the control group (higher SR rate, p < 0.05). Furthermore, the outer parts of the cervix (sites A and D) were also found harder in the group that had CI (lower SR rate, p < 0.05). CONCLUSIONS: According to our knowledge, this is preliminary study to evaluate the predictive value of cervical ES in CI and we concluded that ES can be used as reliable method to determine CI but it is necessary to be studied in different cohort groups.

Comparison of 24-hour urinary protein and protein-to-creatinine ratio in women with preeclampsia.

OBJECTIVE: To compare the spot urine protein-to-creatinine (P/C) ratio and 24-hour urine protein excretion in pregnant women with preeclampsia and also to determine the best discriminator values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. STUDY DESIGN: Prospective study of 200 pregnant women with new onset hypertension at or greater than 140/90 mmHg after 20 weeks of gestation. Women were instructed to collect urine during a 24-hour period, and after the 24-hour urine sample collection was completed a mid-stream urine specimen was obtained for P/C ratio determination. The correlation between 24-hour urine protein excretion and spot urine P/C ratio was calculated. The receiver operating characteristic (ROC) curve was used to identify the cut-off values of the spot P/C ratios for 300 mg and 2000 mg protein per 24h. Areas under ROC curves were calculated. RESULTS: There was a significant correlation between 24-hour protein excretion and the urine P/C ratio (r=0.828, p<0.0001). The cut-off P/C ratio for 300 mg per 24h was 0.28: sensitivity and specificity were 60.4% and 77.9%, respectively. The positive predictive value (PPV) was 77.5% and negative predictive value (NPV) was 60.9%. The cut-off P/C ratio for 2000 mg per 24h was 0.77: sensitivity and specificity were 96.8% and 98.6%, respectively. The PPV was 96.8% and NPV was 98.6%. Area under ROC curves for 24-hour urine total protein of 300-2000 mg/day and >2000 mg/day were 0.74 (95% CI 0.66-0.80) and 0.99 (95% CI 0.95-0.99), respectively. CONCLUSIONS: Spot P/C ratio is a poor predictor of 24-hour proteinuria but can predict proteinuria >2000 mg better than 300-2000 mg.

The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa.

OBJECTIVE: To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. STUDY DESIGN: We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents. RESULTS: The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. CONCLUSIONS: The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications.