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Objective: To assess the indications and distribution of cases chosen for termination of pregnancy and reasons delaying until third trimester termination. Methods: Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups , as early termination (<23 weeks of gestation) and late termination (≥23 weeks of gestation). All pregnant women who underwent termination were classified according to related systemic pathology and chorionicity. Reasons for delaying until third trimester termination were evaluated in four groups. Results: During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most frequent indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason for delaying termination was failure of screening by ultrasound (65.6%). Conclusion: Systematic screening for fetal anomalies is the main step for prevention of affected pregnancies. Information given to parents for TOP is important, but the decision for TOP is influenced by many factors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the sonographic characteristics of fetuses with trisomy 18 and trisomy 13. Materials and Methods: From March 2002 to December 2006, we reviewed the database and medical records of 25 cases with trisomy 18 and trisomy 13. The subjects were recruited from pregnant women undergoing prenatal sonographic examinations at 13-28 weeks of gestation and subsequently proven trisomy 18 or 13. The results of ultrasound findings were reviewed in these cases with chromosomes confirmed as trisomy 18 and/or 13. Results: All cases had at least one abnormal sonographic finding. The common sonographic findings included choroid plexus cysts, abnormal head shape, cardiac anomalies, holoprosencephaly with associated facial anomalies, abnormal feet and/or hands, especially polydactyly, clenched hand, omphalocele. Non-structural abnormal findings such as polyhydroamnios or fetal growth restriction were seen in less than one third of the fetuses. Discussion: Nearly all fetuses with trisomy 18 or 13 had characteristic sonographic patterns of abnormalities demonstrated at midpregnancy. Detailed ultrasound at midpregnancy could effectively screen fetuses with trisomy 18 or 13 for further genetic testing. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the sonographic characteristics of fetuses with trisomy 18 and trisomy 13. Materials and Methods: From March 2002 to December 2006, we reviewed the database and medical records of 25 cases with trisomy 18 and trisomy 13. The subjects were recruited from pregnant women undergoing prenatal sonographic examinations at 13-28 weeks of gestation and subsequently proven trisomy 18 or 13. The results of ultrasound findings were reviewed in these cases with chromosomes confirmed as trisomy 18 and/or 13. Results: All cases had at least one abnormal sonographic finding. The common sonographic findings included choroid plexus cysts, abnormal head shape, cardiac anomalies, holoprosencephaly with associated facial anomalies, abnormal feet and/or hands, especially polydactyly, clenched hand, omphalocele. Non-structural abnormal findings such as polyhydroamnios or fetal growth restriction were seen in less than one third of the fetuses. Discussion: Nearly all fetuses with trisomy 18 or 13 had characteristic sonographic patterns of abnormalities demonstrated at midpregnancy. Detailed ultrasound at midpregnancy could effectively screen fetuses with trisomy 18 or 13 for further genetic testing. [ABSTRACT FROM AUTHOR]

Objective: We have aimed to evaluate perinatal outcome of selective fetocide in monochorionic diamniotic twins discordant for major fetal anomalies. Materials and Methods: The study group included nine cases of monochorionic diamniotic twin (triplet) pregnancies discordant for major fetal anomalies including anencephaly (n=2), inencephaly (n=1), lumbar meningomyolocele (n=1), hydrops fetalis (n=1), acardiac twin (n=2), twin-to-twin transfusion syndrome (stage III, n=1) and monochorionic triamniotic triplet discordant for anencephaly (n=1). For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forcep. The procedures were performed under the guidance of transabdominal ultrasonography. Results: The mean gestational age of the cases at intervention and at delivery were 20 weeks (R=16-24) and 34 weeks (R=22-38), respectively. The procedure of bipolar coagulation was carried out in mean 20 min (R=15-40 min) without maternal complication. One case was aborted at 20 weeks of gestation because of preterm premature rupture of membrane after the procedure. Another case was delivered before 32 weeks, at 28+4 week of gestation, and died six months postnatally which was unrelated to the intervention. The other seven cases were delivered after 32 gestational weeks. In eight cases, the procedures were performed without fetal complication. Perinatal outcome was as 88.8% (n=8/9) live births. Postnatal ages of surviving seven babies were between 8-40 months, and they have been growing up as healthy. Discussion: Ultrasonographic guided bipolar cord coagulation as a selective fetocide can be succesfully performed to increase the survival rate or prevent morbidity of healthy co-twin in the cases of monochorionic diamniotic (triplets), discordant major fetal anomalies candidate for selective termination, and should be offered as a choice of prenatal therapy after the parents were informed of the intervention or follow up. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prenatal findings, associated anomalies, and prognosis of right aortic arch (RAA) anomalies. Material and Methods: All cases referred for detailed ultrasonography and fetal echocardiography between October 2006 and July 2009 were systematically examined for aortic arch anomalies and associated cardiac and extracardiac anomalies. Prenatal findings of all cases with aortic arch anomalies and intracardiac and extracardiac findings were prospectively registered in an electronic database that included fetal echocardiography. Outcomes of the cases were collected postnatally from the patients' obstetricians, neonatal unit archieves, and pediatric cardiologists. Results: We detected 12 cases of RAA (0.37%; n=12/3200). Mean gestational age at diagnosis was 24 weeks (range, 21-33 weeks). Of the 12 cases of RAA, five (41.7%) had a major cardiac defect, including tetralogy of Fallot (n= 3), atrioventricular septal defect (n=1), and ventricular septal defect (n=1). An extracardiac anomaly was observed in three cases (25%). The fetal karyotype was trisomy 21 in one case with increased nuchal translucency (6.6 mm). Microdeletion 22q11 analyses performed in three cases were normal. The postnatal courses of the cases with isolated RAA were uneventful. Two cases associated with major cardiac and extracardiac anomalies were lost in the early neonatal period. The case of trisomy 21 was terminated. The other four cases of RAA with an associated cardiac anomaly are currently in follow up. Conclusion: Aortic arch anomalies, particularly RAA, can be diagnosed by fetal echocardiography. The prognosis for isolated RAA is relatively good compared with that for RAA with associated anomalies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the natural history of isolated muscular ventricular septal (m-VSD) defects during gestation and up to 1 year postnatally, as well as the association with chromosomal anomalies. Material and Methods: Between August 2007 and July 2012, 76 fetuses with isolated m-VSDs represented the study population. The following variables were evaluated: site and size of the m-VSDs, presence of chromosomal anomalies, pregnancy outcome, and spontaneous closure rate from diagnosis up to 1 year postnatally. Results: Of the 76 cases with m-VSD, 1 fetus died after birth and 31 cases were lost to follow-up after birth. Thus, a total of 44 fetuses reached their first year of postnatal life, and these cases were available for analysis. Three (6.8%) of 44 defects closed spontaneously in utero, 33 (75%) closed within 1 year, and 8 (18.2%) remained patent. Overall, spontaneous closure occurred more frequently in the apical defects, but no significant difference was found for spontaneous closure between the mid-muscular and apical defects (p > 0.05). Also, 83.8% (36 of 44) of defects ≤3 mm closed during gestation or the first year of life. Conclusion: We infer that m-VSDs have a high spontaneous closure rate during the first year of life. Also, small m-VSDs frequently close spontaneously. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal and perinatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzyme levels, and low platelets) syndrome. Materials and Methods: Maternal and neonatal charts of 1,222 consecutive pregnancies complicated by severe preeclampsia, eclampsia, or HELLP syndrome at our maternal-perinatal unit were reviewed. Patients were divided into three groups: 903 (73.9%) with severe preeclampsia, 123 (10.1%) with eclampsia, and 196 (16.0%) with HELLP syndrome. Results: The overall incidence of adverse maternal outcome was 5.9%. The rates of adverse maternal outcomes for women with HELLP syndrome and eclampsia were higher than for severe preeclampsia (13.8% vs. 11.4% vs. 3.4%, respectively) (p=0.000). Birth weight was lower in patients with HELLP syndrome than in patients with eclampsia and severe preeclampsia (p=0.005). No significant difference in neonatal morbidity was found among the three groups. Perinatal mortality tended to be higher in the severe preeclampsia group than in the HELLP syndrome and eclampsia groups (p=0.231). Conclusion: Pregnancies complicated by HELLP syndrome had significantly higher maternal morbidity than those with severe preeclampsia and eclampsia. Perinatal and neonatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP syndrome were dependent on gestational age rather than being disease dependent. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate prognosis of types of ventricular septal defects and coexistence of associated cardiac and extracardiac defects. Methods: 120 prenatal diagnosed pregnancies associated with ventricular septal pathology were retrospectively evaluated and divided into four groups, as atrioventricular septal defects, perimembranous septal defects, muscular septal defects and univentricular formation. Each group was divided further into four groups, as isolated defect, co-existing extracardiac defect, septal defect with extracardiac defect and septal defect with co-existing cardiac and extracardiac defect. Postnatal follow-up was continued at least until 8 months of life. Results: Median gestational age at diagnosis was 26.3 weeks, 47 cases were diagnosed before 24 weeks. After dispersion of septal defects there was a statistical significance of p=0.0089 between groups. Of 31 cases with atrioventricular septal defects, only one case survived (3.2%) and there was a high association with extracardiac defects and abnormal karyotype (p=0.002). 69 cases with perimembranous ventricular septal defects were diagnosed, and 24 cases (34.8%) survived with significance for abnormal karyotype (p=0.039). Of 18 cases born with muscular septal defects 12 cases (66.7%) stay alive. We had two cases with univentricular structure; both cases decided for termination of pregnancy. Conclusion: The more complicated and severe the pathology, the worse the prognosis. Individualized counseling is the most important point in decision making together with families. [ABSTRACT FROM AUTHOR]