Characteristics and outcome of 102 fetuses with fetal cerebral ventriculomegaly: experience of a university hospital in Turkey.

The aim of this study was to evaluate the incidence of associated structural anomalies and the outcome of fetuses with ventriculomegaly. We retrospectively collected 102 cases of antenatally diagnosed ventriculomegaly examined between 2000 and 2008. Ventricular width measurements were 10-12 mm, 12.1-14.9 mm and ≥ 15 mm in 24.5%, 20.6% and 54.9% of the cases, respectively. Associated structural malformations were detected in 77.4% of the fetuses. Mortality rate of fetuses with associated malformations and isolated ventriculomegaly was 86.1% and 55.7%, respectively (p < 0.001). The mortality rate was significantly lower in mild (10-12 mm) than in moderate (12.1-14.9 mm) and severe (≥ 15 mm) cases (p < 0.05). All of the fetuses with mild isolated ventriculomegaly were alive at >12 months of age, without morbidity. Our results suggest that the prognosis of fetuses with ventriculomegaly mainly depends on the aetiology and on the presence of associated abnormalities. Fetuses with mild isolated ventriculomegaly have a favourable outcome.

Prediction of preeclampsia with maternal mid-trimester placental growth factor, activin A, fibronectin and uterine artery Doppler velocimetry.

OBJECTIVE: To assess whether alterations in the serum levels of placental growth factor, activin A and fibronectin could be detected in patients before they become preeclamptic. And to evaluate and compare the clinical utility of these markers and uterine artery Doppler velocimetry in predicting preeclampsia. METHODS: One hundred and twenty-two normotensive women were prospectively included in the study. Peripheral venous blood samples were obtained and Doppler examination of the uterine arteries was performed between 21 and 26 weeks' gestation. Serum levels of placental growth factor, activin A and fibronectin were measured by enzyme-linked immunoassay and radial immundiffusion technic. RESULTS: Mid-trimester maternal serum activin A and fibronectin levels and average S/D ratios were significantly higher whereas placental growth factor levels were significantly lower in women who subsequently developed preeclampsia than remained normotensive (p<0.001). The best cut-off values for predicting preeclampsia of placental growth factor, activin A and fibronectin based on ROC curve analysis were 90 pg/ml, 14 ng/ml and 370 mg/l respectively. The areas under the curve equal to 0.993, 0.972, 0.872 and 0.813 for placental growth factor, activin A, fibronectin and uterine artery Doppler respectively were determined for the prediction of preeclampsia. CONCLUSION: Placental growth factor, activin A, fibronectin and uterine artery Doppler are all potentially useful as predictors of preeclampsia. Maternal serum midtrimester PGF has the highest predictive value and activin A with a compatible accuracy for early identification of preeclampsia.

Early first trimester ultrasound examination. Is it really efficient in the clinical management of the pregnancy?

OBJECTIVE: This is a retrospective study accomplished to determine the efficiency of the first trimester ultrasound examination especially when performed on elective conditions. MATERIALS AND METHOD: The records of patients who had undergone early first trimester transvaginal ultrasound in Obstetrics and Gynecology Department of Cerrahpasa School of Medicine, Istanbul University between from January 1999 to December 2000 were reviewed. The records of 426 patients were eligible for the analysis. The age, parity, gestational week that the ultrasound performed, the complaint on appliance, the features visible on the ultrasound were noted. The patients were divided into two groups: patients without any complaint (Group 1) and patients applied with any complaint (Group 2). The prognosis of the pregnancy was determined through the follow-up. On the statistical analysis, chi-square test, student-t test, Pearson correlation analysis and multiple linear regression analysis were utilized. RESULTS: In group 1, 79% of examinations were normal whereas the rate of normal ultrasound was 50% in group 2. The difference between the groups was statistically significant (p=0.000). On group 1, 7 subsequent abortions, 7 missed abortions and one case of mole hydatiform were identified (7.6%). When the patient applied with a complaint, ultrasound examination revealed abnormal findings that enabled to reach an accurate diagnosis in 29.9% of these patients. 50 abortions (inevitable or incomplete), 13 missed abortions, 3 ectopic pregnancies and 2 mole hydatiform were diagnosed. The difference between the two groups according to ability to reach a diagnosis on the initial ultrasound was statistically significant (p=0.000). CONCLUSION: The value of ultrasound examination before the 10th weeks of pregnancy is not validated when the patient has no complaint even if it appears as the most powerful mean to assess the accurate gestational age and observing fetal cardiac activity is the best prognostic variable for the outcome of the fetus.

Prognosis of patients with positive screening but negative diagnostic test for gestational diabetes.

OBJECTIVE: This is a retrospective study that is designed to investigate the prognosis of the patients with abnormal diabetes screening test and a negative 100 g oral glucose tolerance test that is accepted as the diagnostic test for gestational diabetes mellitus (GDM). MATERIALS AND METHOD: The records of 281 pregnant patients were reviewed. The data of the patients divided into groups with normal diabetes screening (1 h/50 g oral glucose tolerance test) and abnormal diabetes screening. The patients with abnormal diabetes screening were further divided into all values normal in 100 g Oral glucose tolerance test (OGTT), one value abnormal in 100 g OGTT and GDM subgroups. The prognosis of these patients was reanalyzed concerning the complications that may be attributed to glucose intolerance. RESULTS: Abnormal diabetes screening test was detected in 89 patients (31.6%) and 14 cases were diagnosed as GDM (4.9%). The data of 9 patients were not suitable to analyze. In 31 cases out of 80 (38.75%), an obstetric complication was detected. The rate of similar complications was 27.0% (52/192) in the control group. The difference in the rate of complications was not statistically significant (p>0.05). When the patients with one value abnormal in 100 g OGTT, were further evaluated, the complication rates were 3/9 (33.3%) for the 1st hour abnormal patients, 1/1 for the 2nd hour abnormal patients and 1/1 for the 3rd hour abnormal patients. When the values of 100 g OGTT were compared in complicated and uncomplicated cases, the difference between the groups was not statistically significant (p>0.05). CONCLUSION: 100 g OGTT is the universal diagnostic test for GDM. There is a major subgroup of patients whose screening positive but diagnostic test (100 g OGTT) negative. These patients seem to be prone to develop obstetric complications related to glucose intolerance but there is not a proper means to detect these patients in clinical practice.

Doppler assessment of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction.

BACKGROUND: The aim of the study was to determine the best use of information obtained from Doppler studies of umbilical artery, thoracic aorta and middle cerebral artery in the management of pregnancies with growth restriction. METHODS: The study group consisted of 100 pregnant women with intrauterine growth restricted fetuses. Doppler flow velocity waveforms were obtained from the umbilical artery, middle cerebral artery and thoracic aorta. The pregnancies were grouped according to the umbilical artery Doppler results. There were 29, 30 and 41 fetuses with normal and high PI (pulsatility index), and absent end-diastolic velocity (AEDV) in the umbilical artery, respectively. RESULTS: Birth weight and umbilical vein pH at birth significantly decreased and perinatal mortality rates significantly increased with the worsening of the diastolic flow in the umbilical artery (p<0.01). Increased umbilical artery PI was significantly associated with increased thoracic aorta PI and decreased middle cerebral artery PI (r=0.75 and -0.55, p<0.01 respectively). Perinatal mortality due to fetal asphyxia in fetuses with AEDV in the umbilical artery and in both the umbilical artery and thoracic aorta was 39.5% and 50%, respectively. Detection of AEDV in the thoracic aorta was found to be the most significant predictive factor of perinatal deaths. CONCLUSIONS: The degree of abnormality of the Doppler findings parallels the severity of fetal compromise. Growth restricted fetuses with AEDV detected both in the umbilical artery and thoracic aorta are severely compromised and time gained in utero has no benefit for these fetuses.

A case of prenatally diagnosed fetal neurenteric cyst.

The combination of a thoracic cystic mass with vertebral anomalies on prenatal ultrasound suggests a neurenteric cyst. The outcome of such cysts mostly depends on the extent of the displacement and functional impairment of the adjacent organs and of the associated central nervous system defects. We present a case of a neurenteric cyst diagnosed on prenatal ultrasound at 34 weeks of gestation which was treated successfully in the early neonatal period.

Detailed ultrasonographic findings in Greenberg dysplasia.

A case of Greenberg dysplasia [hydrops fetalis, ectopic calcifications, "moth-eaten" skeletal dysplasia (HEM)] is presented. Fetal ultrasonography at 20 weeks' gestation showed hydrops fetalis, severe micromelia, irregular hyperechogenic foci in the ribs and vertebral bodies, irregular hypo- and hyperechogenic areas and abnormal contour within the long bones, and flattened and "T"-shaped appearance of the vertebrae. Findings on postmortem histological and radiographic examination were consistent with Greenberg dysplasia.

Doppler dynamics: their clinical significance and relationship with fetal blood gases and pH measurements.

The aim of the study is to demonstrate the ability of abnormal Doppler indices to predict the acid-base status of the fetus. A pulsed Doppler study of umbilical artery, middle cerebral artery and thoracic aorta were assessed on 30 intrauterine growth restricted and 27 appropriate-for-gestational-age fetuses immediately before cordocentesis. All the fetuses with absent end diastolic velocity in the umbilical artery were found to be acidemic by cordocentesis. Thoracic aorta pulsatility index (PI) increased and middle cerebral artery PI decreased significantly with increased umbilical impedance (r = 0.702, r = -0.340, respectively). Umbilical artery and thoracic aorta PI significantly increased, whereas middle cerebral artery PI decreased with a decrease in umbilical blood pH (r = -0.760, r = -0.642, r = 0.292, respectively). Doppler findings have a very strong correlation with the acid-base status of the fetuses. Increased umbilical impedance is associated with progressive impairment of placental gas exchange and that by the time diastolic flow is lost hypoxaemia or acidaemia is usually present.

Lipid peroxidation and antioxidants in preeclampsia.

OBJECTIVE: To determine the changes in plasma levels of lipid peroxide, vitamin E and vitamin C in women with preeclampsia and to investigate their relationship with diastolic blood pressure. STUDY DESIGN: Cross sectional study consisting of 22 preeclamptic and 21 healthy pregnant women. Fasting venous blood samples were collected during the antepartum period and plasma levels of malondialdehyde, alpha-tocopherol and ascorbic acid were measured. RESULTS: In the preeclamptic group malondialdehyde, a lipid peroxidation product, was significantly increased, while vitamins E and C were significantly decreased compared to healthy pregnant women. A strong correlation was detected between malondialdehyde and antioxidant factors (vitamins E and C) with blood pressure. CONCLUSION: Our findings are consistent with previous studies suggesting that lipid peroxidation is an important factor in the pathogenesis of preeclampsia. In preeclampsia, antioxidant nutrients are excessively utilised to counteract the cellular changes mediated by free radicals.

Antenatal diagnosis of lethal osteopetrosis.

We describe a case of the lethal form of osteopetrosis diagnosed prenatally by ultrasonography. Anomalies detected on ultrasound examination at 18 weeks' gestation included skeletal hyperdensity, communicating hydrocephalus and short long bones. At 21 weeks' gestation, cordocentesis was performed to measure the levels of calcium, phosphorus and alkaline phosphatase. The fetus was aborted at 22 weeks' gestation. The diagnosis of osteopetrosis was confirmed by postmortem radiological and histopathological analysis.

The value of antithrombin-III and fibronectin in hypertensive disorders of pregnancy.

In this study we evaluated fibronectin as a marker of endothelial cell injury and antithrombin III as a marker of chronic activation of intravascular coagulation. The aim of the study was to establish to normal trends of plasma antithrombin III and fibronectin in general obstetric population and to determine the value of both in predicting, distinguishing and understanding the pathophysiology of pregnancy induced hypertension. The all cases consisted of 173 pregnant, 19 of them were chronic hypertensive, 45 were pregnancy induced hypertensive and 119 were normotensive at blood sampling. Out of 119 normotensive cases, 109 cases had no adverse outcome during their pregnancy. These cases were used as a control group and for the normal trends of antithrombin III and fibronectin in general obstetric population. Ten out of 119 cases who developed preeclampsia during follow up, 19 cases with chronic hypertension and 45 cases with pregnancy induced hypertension consisted of the study group. In the cases who developed preeclampsia during follow up, the value of plasma fibronectin level (above 95% confidence limit for that gestational week) to predict preeclampsia had 90% sensitivity and 94.4% specificity. In distinguishing hypertensive disorders of pregnancy (chronic hypertension or pregnancy induced hypertension) fibronectin had 71.1% sensitivity and 100% specificity. Plasma antithrombin III level (of antigenicity) measured by immunodiffusion method had no value in predicting and distinguishing pregnancy induced hypertension.

The predictive value of fetal heart rate monitoring: a retrospective analysis of 2165 high-risk pregnancies.

The predictive value of fetal heart-rate monitoring on fetal well-being was studied in 2165 high-risk pregnancies. 1883 reactive nonstress test (NST) patterns and 278 nonreactive NST patterns and 4 cases of sinusoidal pattern were obtained. Oxytocin challenge test (OCT) was applied to 263 nonreactive cases. OCT was not applied to 15 cases out of 278 nonreactive NST cases, because of placenta previa, abruptio placenta and previous cesarean section. There were 155 cases with negative OCT, 84 cases with positive OCT and 24 cases with equivocal, prolonged or severe variable decelerations. Sensitivity and specificity were for NST 50 and 88% and for OCT 60 and 67%. The positive and negative predictive values were 11 and 98% for NST and 18 and 93% for OCT. It is concluded that the reactive nonstress test is a reliable test for good outcome but a positive oxytocin challenge test is not a reliable test for poor outcome. Additional procedures are necessary such as assessment of fetal growth, doppler velocity waveforms and fetal biophysical profile to avoid unnecessary obstetric interventions and to reach good fetal outcome.

FHR monitoring and perinatal mortality in high-risk pregnancies.

The aim of the study was to evaluate the effect of the introduction of fetal heart rate monitoring on perinatal mortality rates in high-risk pregnancies. Results were compared with the perinatal mortality rates published previously from our clinics. The study group consisted of 2165 high-risk pregnant patients. The perinatal mortality rate in the study group was 28.6%, and the corrected rate 15.9%. The rates were significantly lower in comparison with the total perinatal mortality rates in former years. We are convinced that fetal heart-rate monitoring resulted in a significant decrease in the perinatal mortality rate. Although the increased use of fetal monitoring cannot reduce perinatal mortality resulting from problems such as genetic disorders, this study shows improved outcomes for many high-risk conditions, in particular postmature pregnancies.