Search

Introduction: The aim of this study was, first, to investigate the difference in fetal atrioventricular conduction in patients with and without intrahepatic cholestasis of pregnancy (ICP) by measuring the fetal PR interval; second, to evaluate the altering effect of ursodeoxycholic acid (UDCA) treatment on the fetal PR interval in ICP patients. Methods: The study consisted of 42 ICP patients and 48 healthy pregnant women. Fetal echocardiography was performed to measure the mechanical PR interval. The fetal PR interval and the clinical characteristics were compared between the two groups. The effect of UDCA treatment on the fetal PR interval in ICP patients was evaluated. Results: In ICP patients, significantly longer fetal PR intervals were observed than in the control group (123.21 ± 8.54 vs. 115.13 ± 5.95 ms, p < 0.001). In the ICP group, there was a positive correlation between the fetal PR interval and maternal fasting total bile acid (TBA) levels (r = 0.514, p = 0.001). After 1 week of treatment with UDCA in patients with ICP, the PR interval was shorter than before, although the reduction was not statistically significant (120.98 ± 6.70 vs. 123.21 ± 8.54 ms, p = 0.095). In patients with severe ICP (TBA >40 mmol/L, n = 10), a significant reduction in the fetal PR interval was observed after treatment with UDCA (127.5 ms [IQR, 118.0–134.75] before vs. 122 ms [IQR, 109.5–126.5] after, p = 0.037). Conclusion: Fetal PR interval increased in ICP patients in correlation with maternal serum TBA concentration. Treatment with UDCA may have limited positive effects on the fetal AV conduction system. The beneficial effects of UDCA on the fetal PR interval may be more pronounced in patients with higher bile acid levels. [ABSTRACT FROM AUTHOR]

We report the case of a fetus with a sonographic diagnosis of hyperechogenic cerebellum at 28 weeks' gestation, which was suspected to be of hemorrhagic origin on fetal ultrasound. As an adjunct to ultrasound, fetal MRI can confirm the hemorrhagic origin of hyperechogenic cerebellar lesions, particularly by showing a high signal on T1‐weighted images. No etiological factors for fetal hemorrhage were found other than maternal hypertension and aspirin use. Postnatal MRI confirmed the prenatal diagnosis of cerebellar hemorrhage without underlying vascular anomaly. [ABSTRACT FROM AUTHOR]

In our perinatology service, we observed two cases of cardiac papillary fibroelastoma in fetuses. This case‐report focused on assessing the prenatal diagnosis and outcome of these two fetal cases in which cardiac fibroelastoma was initially identified via fetal echocardiography and subsequently confirmed by histopathological analysis. [ABSTRACT FROM AUTHOR]

Introduction: To assess changes in blood flow in the uterine, fetal cerebral, and umbilical arteries (UA) by Doppler ultrasound and alterations in the variability of fetal heart rate (FHR) as well as fetal cardiac performance by fetal echocardiography between the 7.00 a.m. and 7.00 p.m. periods in pregnancies ranging from 24 to 39 weeks. Methods: Fifty pregnant participants underwent a customized fetal examination on the same day during both study periods, including Doppler measurements of the umbilical artery pulsatility index (UA-PI), fetal middle cerebral artery-pulsatility index (MCAPI), middle cerebral artery-peak systolic velocity (MCA-PSV), cerebroplacental ratio, uterine artery-pulsatility index (UtA-PI), FHR, and fetal movements as well as various Doppler parameters of the fetal heart such as left isovolumetric contraction and relaxation times, mitral E- and A-wave velocities, the E/A ratio, K-index, filling time, and the myocardial performance index. Results: During the PM period, there was a meaningful increase in the MCA-PSV compared with the AM period. Conversely, the resistance in the MCA, particularly the PI, was found to be lower than that in the AM period. In addition, the FHR measured in the PM period increased compared with that in the AM period. The maternal UtA-PI and fetal UA-PI examined in the AM and PM periods were comparable. In addition, when all cardiac parameters examined in the study periods were compared, no significant difference was observed. Conclusion: The findings reveal that Doppler parameters observed during the study periods may change during the day and that the fetal cardiac function parameters, previously not assessed together, may not change during the day. Subsequent investigations can validate these observations using serial measurements of Doppler parameters in healthy and complicated gravidas. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Istanbul Faculty of Medicine / İstanbul Tıp Fakültesi Dergisi is the property of Istanbul Tip Fakultesi Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by analyzing the outcomes based on the subtype. Methods: This study is a retrospective chart review. Cases diagnosed with fetal DORV by prenatal ultrasound in the maternal–fetal medicine department of our hospital between 2014 and 2022 were included. Data on maternal characteristics, fetal echocardiographic features (type of DORV), pregnancy and neonatal outcomes (termination of pregnancy [TOP], intrauterine fetal death [IUD], neonatal death [NND], death in infancy (IND), survival) were collected and analyzed. Results: Ninety‐nine cases of prenatally diagnosed cases of DORV were included. The prenatal diagnosis was right in 97% of the liveborn fetuses. The cases were classified into subtypes, including transposition of great arteries (TGA), Fallot, ventricular septal defect (VSD), remote, and heterotaxy types. The cohort consisted of 32.3% TGA type, 19.1% fallot type, 11.1% VSD type, 2% remote type, and 35.3% heterotaxy type of DORV. An additional cardiac anomaly was observed in 87% and an extra‐cardiac anomaly was observed in 54% of the cases. When we excluded the cases with heterotaxy type but without any chromosomal abnormality, additional genetic abnormalities were detected in 42% of the remaining cases. Outcome of pregnancy was livebirth in 68/99 (68.7%), IUFD in 5/99 (5.1%), and TOP in 26/99 (26.3%). Postnatal cardiac surgical repair was performed in 48 cases. Survival among livebirths was 39/68 (57.3%). Twenty‐nine neonates or infants who had additional cardiac anomalies and/or genetic abnormalities died before any surgical intervention. The postoperative survival rate was 39/48 (81.2%). Conclusion: The prognosis in DORV depends on the anatomical subtype, the presence, and severity of associated anomalies. Survival increases in isolated cases without any additional structural or genetic anomalies. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Placenta previa is a pregnancy condition associated with the development of complications related to placental insufficiency, including hypertension, preeclampsia and perinatal mortality. Dysfunction in uteroplacental arteries causes the release of cytokines, leukotrienes and immunomodulatory hormones, which leads to an inflammatory reaction. Objectives. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway and vascular endothelial growth factor (VEGF) are known to play crucial roles in inflammation and angiogenetic regulation. This study aimed to demonstrate the morphometric and immunohistochemical effects on inflammation and angiogenesis underlying placenta previa. Materials and methods. Twenty pregnant patients with placenta previa and 20 healthy pregnant patients, all between 30 and 38 weeks gestational age, were included in the study. The gestational age of the pregnancies was determined according to the last date of menstruation and/or ultrasonographic measurements. Blood samples and clinical data were obtained from the prenatal patient groups. Samples were taken from the connecting stem region from both groups. Results. The mean difference between the control and placenta previa patients was statistically signifi- cant for the parameters of blood vessels in villi, diameter of floating small villus, decidual cells, syncytial knots, congestion in blood vessels, fibrinoid accumulation, and inflammation. Significant degeneration and apoptotic changes in the syncytial cells of the root villi and an increase in syncytial nodes and bridges were observed in the placenta previa specimens. In the connecting stem region of the placenta previa samples, blood vessel dilatation, endothelial cell hyperplasia and a higher number of syncytial nodes were observed. In the immuno histochemical examination of the placenta previa samples, an increase in NF-κB and VEGF expression was observed in the endothelial cells, syncytial cells and Hofbauer cells. Conclusions. Vascular endothelial growth factor was found to stimulate endothelial cell proliferation and migration, and to significantly affect angiogenesis during the developmental process of the placenta and remodeling of the uterine vessels, inducing NF-κB signaling and apoptotic development during cytotrophoblastic invasion in the vascularization of the placenta. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate fetal ultrasonographic findings and perinatal outcomes in pregnancies with fetal trisomy 18, trisomy 13, and triploidy. Material and Methods: Pregnancies diagnosed as fetal trisomy 18, trisomy 13, and triploidy at a tertiary center between January 2013 and January 2020 were included in the study. Maternal ages, gestational ages at the time of diagnosis, antenatal follow-ups, prenatal fetal ultrasonography reports, perinatal outcomes, whether the pregnancies resulted in live births, and the outcomes of the newborns were obtained. Results: A total of 104 cases (trisomy 18 [n=74, 71.2%], trisomy 13 [n=21, 20.2%], and triploidy [n=9, 8.6%]) were included in the study, and pregnancy was terminated in 79 (76.0%) of the cases. The most common anomaly was cardiac malformations in fetuses with trisomy 18 and triploidy, and central nervous system anomalies in fetuses with trisomy 13. Of 25 patients who preferred to continue the pregnancy, nine (36.0%) resulted in miscarriage and 13 (52.0%) resulted in fetal death. In all three pregnancies that resulted in live births, newborns died in the early neonatal period. Conclusion: Most fetuses with trisomy 18, trisomy 13, and triploidy have severe fetal malformations. In cases where the pregnancy is not terminated, the risk of fetal loss is high. Patients with the expectation of self-termination should be informed that this loss may not occur until the third trimester and that pregnancy may result in a live birth. [ABSTRACT FROM AUTHOR]

Objective: To investigate the importance of prenatal ultrasound in the detection of Down syndrome by evaluating ultrasonographic and minor ultrasonographic findings in fetuses with this aneuploidy. Methods: Patients who were reported to have trisomy 21 as a result of karyotype analysis performed by cordocentesis, amniocentesis, or chorionic villus biopsy materials and who underwent ultrasound scan before diagnosis between 18 and 26 weeks of gestation by the Maternal Fetal Medicine Department between 2013 and 2020 were included in the study group. Results: The results of 132 of 4525 (2.9%) invasive procedures were reported to have trisomy 21 and ultrasound scans of each fetus were performed in our department. The mean gestational age at the ultrasound scans was 19.2±3.8 (SD) weeks. At least one major structural anomaly or minor ultrasonographic finding was detected in 99.2% of all fetuses. Major structural anomalies were present in 80 (60.6%) fetuses. In fetuses with major structural anomalies, cardiac defects (53.7%) were the most detected anomalies. No ultrasound findings could be detected in one (0.8%) of the remaining 52 patients, and only isolated minor findings were detected in 51 (38.6%) fetuses. More than half (60.7%) of these fetuses had a single minor finding. The most common isolated single minor finding was nuchal fold thickness in 13 (41.9%) fetuses followed by aberrant right subclavian artery in six (19.3%) fetuses. Conclusion: Down syndrome displays a large variety of different sonographic findings on fetal ultrasound. Although major structural anomalies and multiple minor findings are generally considered more important, the presence of any isolated minor marker may be the only detectable finding of Down syndrome. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to investigate the relationship between body mass index (BMI) and gestational age at delivery in patients who underwent cervical cerclage. Material and Methods: The population of this retrospective study comprised the patients aged 18-45 who underwent cervical cerclage procedure in Zeynep Kamil Hospital between 2014 and 2021. Maternal demographic data and clinical characteristics, including BMI at the time of the cervical cerclage, were recorded. Patients were categorized into three groups according to their BMI values: normal (BMI: <25 kg/m²), overweight (BMI: 25-29.9 kg/m²), and obese (BMI: =30 kg/m²) groups. The primary and secondary outcomes of this study were gestational age at delivery and the percentage of deliveries that occurred <37 weeks, respectively. Results: The study sample consisted of 151 patients with a mean age of 30.4±5.6 years. The mean gestational age at cervical cerclage was 18.0±4.0 weeks, and the median gestational age at delivery was 37.0 weeks. Gestational week at delivery was significantly lower, and significantly fewer deliveries at =37 weeks occurred in the obese group compared with the other two groups (p<0.001). There was a significant inverse correlation between maternal BMI and gestational age at delivery (r=-0.516, p<0.001). Conclusion: Gestational age at delivery is inversely correlated with BMI in the pregnancies which have undergone cerclage operation. Accordingly, the risk of preterm delivery is significantly associated with BMI values of =30 kg/m2 in patients with cervical cerclage. Maternal obesity is shown to decrease the success of cerclage. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to describe and compare the cranial and extracranial abnormalities of Pfeiffer syndrome on prenatal imaging with postmortem findings. Case: A healty 23-year-old expectant mother, nulliparous referred to our perinatology clinic for sonographic abnormalities in 19-week gestation. The cranial examination on fetal ultrasonography; The fetal sagittal suture was narrow. Its coronal and lambdoid sutures were nearly closed (Figure 1). We recorded severe ocular proptosis and hypertelorism. The lids were everted everted which is often seen in the more severe forms of Pfeiffer syndrome. We observed pes equinovarus on feet and the broad great toe. The patient was offered the option of termination but the patient and her husband refused. The patient was admitted in 27 weeks old to the emergency department. On ultrasound examination, the fetus was mort in the uterus and taken to delivery. Postnatal fetal examination revealed cloverleaf skull, ocular proptosis, flat midface and nose, clubfeet, broad great toe (Figure 2). FGFR2 gene sequence analysis, c.1019A>G (p.Tyr340Cys) missense variant (rs1554928884 ClinVar: 449398) was detected in heterozygous form. The genetic result supports our clinical findings of Pfeiffer syndrome. Conclusion: Pfeiffer syndrome is a rare genetic disorder with a very poor prognosis because of the many complications. Prenatal diagnosis of this syndrome remains difficult and is based on fetal ultrasonography exploring the head, face and extremities, with a molecular biology analysis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the role of hypoxia-inducible transcription factor-1 alpha (HIF-1α) and angiogenetic factor endothelin-1 (ET-1) expression in regulating hypoxia and placental development by routine histopathological methods., Methods: Twenty preeclamptic and normal placentas were used. Placenta tissue pieces were examined histopathologically after routine paraffin follow-ups. HIF-1α and ET-1 proteins were examined immunohistochemically, and placental tissues were examined ultrastructurally., Results: Increase in syncytial proliferation, endothelial damage in vessels, and increase in collagen were observed in preeclamptic placentas. As a result of preeclampsia, an increase was observed in HIF-1α and ET-1 protein levels in the placenta. Dilatation of endoplasmic reticulum and loss of cristae in mitochondria were observed in trophoblast cells in preeclamptic placental sections., Conclusions: High regulation of oxygen resulting from preeclampsia has been shown to be a critical determinant of placentagenesis and plays an important role in placental differentiation, changes in maternal and fetal blood circulation, trophoblastic invasion, and syncytial node increase. It has been thought that preeclampsia affects secretion by disrupting the endoplasmic reticulum structure and induces mitochondrial damage, and that ET-1 may potentially help in the induction of stress pathways as a result of hypoxia in preeclampsia.