The significance of fetal maxillary length in the first trimester screening for trisomy 21.

OBJECTIVE: The present study aims to specify the significance of fetal maxillary length by establishing a nomogram for a Turkish population and by investigating its relationship with the ultrasonographic and biochemical parameters which are commonly used to screen trisomy 21 in the first trimester of pregnancy. METHODS: The present observational study investigates 1,308 Turkish women who had 11- to 14-week-old singleton healthy pregnancies. Fetal crown-rump length (CRL), nuchal translucency (NT), nasal bone length (NBL) and maxillary length are measured by ultrasonography and maternal serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (HCG) are determined. RESULTS: A positive and significant correlation was detected between the fetal maxillary length and gestational age (r = 0.309, P < 0.001) as was the case with fetal CRL (r = 0.357, P < 0.001) and NBL (r = 0.487, P < 0.001). Although there was a significant and positive correlation between fetal maxillary length and maternal serum PAPP-A levels (r = 0.201, P < 0.001), a significant and negative correlation was found between fetal maxillary length and the maternal serum concentrations of free beta-HCG (r = -0.238, P < 0.001). Fetal maxillary length increased in accordance with the advancing gestational age and increasing CRL. Maternal serum PAPP-A concentrations and fetal CRL and NBL were addressed as independent predictors of fetal maxillary length. CONCLUSIONS: The length of fetal maxillary bone is a promising biometrical parameter which can be reliably and efficiently used to screen trisomy 21 in first trimester. Fetal maxillary length is also found to correlate with gestational age, CRL, NBL and PAPP-A significantly. It would be rational to use a combination of nasal and maxillary bone length measurements in case serum concentrations of PAPP-A or beta-HCG cannot be assessed.

Plasma homocysteine, vitamin B12 and folate levels in hydatidiform moles and histopathological subtypes.

OBJECTIVE: To investigate the association of mole hydatidiform with plasma homocysteine, vitamin B(12), and folate levels. METHODS: Sixty-eight patients diagnosed with mole hydatidiform at our clinic between February and October 2007 were assessed in a case-control study. Plasma homocysteine, vitamin B12, and folate levels, taken before evacuation of patients with hydatidiform mole, were compared with the results of 100 healthy normal pregnants of first trimester; and also plasma homocysteine, vitamin B12, and folate levels were compared according to histopathological types of mole hydatidiforms. SPSS 14.0 package program was used to analyze the data. Logarithmic transformation was applied for variables. Parameters were expressed as mean+/-standard deviation. RESULTS: The mean of plasma homocysteine levels was higher in molar group (0.8+/-0.13) than in normal pregnant group (0.7+/-0.13) and the difference was statistically significant (P<0.001). The mean of plasma vitamin B12 levels was found to be similar both in normal pregnant women (2.4+/-0.17) and in the molars (2.4+/-0.15) (P=0.272). The mean of plasma folate levels was lower in molar group (1.0+/-0.15) than in normal pregnant women (1.2+/-0.17) and the difference was statistically significant (P<0.001). The hydatidiform moles of 68 patients were divided into two groups according to histopathological examination: 36 patients were partial moles and the others were complete. The difference of plasma mean homocysteine, vitamin B12, and folate levels in these two groups was not statistically significant. There were statistically significant differences of plasma mean homocysteine and folate levels one by one in complete and in partial moles when compared with the normal pregnants. The mean of plasma folate levels were lower (1.0+/-0.17 for partials, 1.0+/-0.13 for completes) and the homocysteine levels were higher (0.9+/-0.14 for partials, 0.8+/-0.12 for completes) than the levels of normal group. CONCLUSION: This study suggests that there may be an association between plasma folate and homocysteine levels with hydatidiform moles. Folate may play a protective role in preventing molar pregnancy. Further controlled prospective studies are needed to investigate the possible effect of homocysteine, vitamin B12, and folate in molar pregnancies.