Ahmet Gul

Perinatal Outcomes of Twin Pregnancies Discordant for Major Fetal Anomalies

Objective: The aim of this study was to determine perinatal outcomes of twin pregnancies discordant for a major fetal anomaly and to compare with twins without anomaly. Methods: All twin pregnancies admitted or referred to the maternal-fetal unit were prospectively entered into a computer database. Chorionicity, fetal anomaly, mean gestational age at delivery, birth weight and perinatal survival rate were reviewed. Main Outcome Measures: Mean gestational age at delivery, birth weight and perinatal survival rate of twins with and without anomaly. Results: There were 48 cases of monochorionic diamniotic (MCDA), 2 cases of monochorionic monoamniotic (MCMA) and 217 twins with dichorionic (DC) placentation. Out of 267 twin pregnancies, there were 17 (6.3%) twins with fetal anomaly. Twins discordant for a major fetal anomaly were diagnosed in 13 cases (4.8%). We observed 3 cases with MCDA and 10 cases with DC placentation and the incidence of discordance for a major fetal anomaly as 4.6% (10/217) in DC and 6.0% (3/50) in MC twin pregnancies. We identified 8 cases (62%) with craniospinal, 2 (15%) with gastrointestinal, 2 (15%) with urinary system, and 1 case (8%) with both craniospinal and gastrointestinal anomalies. There were significant differences between the normal co-twin of the major anomaly group (n = 13) and twins without anomaly group (n = 235) in mean gestational age at delivery (32 vs. 34 weeks; p = 0.029), mean birth weight (1,640 vs. 2,030 g; p = 0.022) and perinatal survival rate (69.2 vs. 91.1%; p = 0.018), respectively. Conclusion: The presence of a fetus with a major anomaly in a twin gestation increases the risk of preterm delivery, low birth weight and perinatal mortality of the normal co-twin.

Neonatal outcome in pregnancies after preterm delivery for HELLP syndrome

Objective: To compare neonatal outcome after preterm delivery of infants where pregnancy had been complicated by the HELLP syndrome. Study Design: The maternal and neonatal charts of 475 consecutive pregnancies complicated by hypertensive disorders at our perinatal unit were reviewed. The HELLP syndrome was defined by previously published laboratory criteria. 93 women fulfilled the criteria and constituted our HELLP syndrome study group. 188 normotensive patients who were delivered because of preterm labor comprised the control group. Results were compared by means of χ2 analysis and Student’s t test where appropriate. Results: There were 518 pregnancies complicated by hypertensive disorders and 93 by HELLP syndrome. The incidence of HELLP syndrome among women with severe preeclampsia was 19.5%. We found a significant difference in the incidence of intrauterine growth restriction (61.2 vs. 5.8%, p < 0.0001), intrauterine fetal death (13.9 vs. 6.9%, p = 0.035), abruptio placenta (13.9 vs. 2.6%, p = 0.001), and fetal distress (35.4 vs. 12.2%, p < 0.0001) between the two groups. There were no significant differences in complications (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis and sepsis) between the HELLP syndrome group and controls. However, the neonatal death rate and the need for mechanical ventilation and neonatal intensive care were greater in the HELLP syndrome group. Conclusions: Our study suggests an increased mortality and morbidity in newborns of mothers complicated with HELLP syndrome that can be partly attributed to increased rates of intrauterine growth restriction and fetal distress, particularly beyond 32 weeks of gestation.

Natural History of 11 Cases of Twin-twin Transfusion Syndrome Without Intervention

The natural history of 11 cases of twin-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin pregnancies has been reviewed. Seven cases before 28 weeks and four pregnancies after 28 weeks had been followed up without intervention. Eight cases had premature uterine contractions. All seven pregnancies before 28 weeks aborted, leading to a 100% mortality rate. After 28 weeks all mothers delivered live births. The diagnosis of TTTS before 28 weeks, and with premature uterine contraction, seems to be a poor prognostic sign.

The outcome of twin pregnancies complicated by single fetal death after 20 weeks of gestation.

A retrospective study involving 972 twin births was conducted to evaluate the maternal and fetal outcomes of twin pregnancies complicated by single fetal death. The incidence of single fetal death in twin pregnancies after 20 weeks was 3.3%. Preterm birth rates for 37 and 32 gestational weeks were 81.3% and 41.6% respectively. The median interval between the diagnosis of fetal death and the delivery was 11 days (range 1-27 days). Eighteen (56%) infants were delivered by cesarean and 14 (43%) vaginally. Twin-twin transfusion syndrome (TTTS) was the cause of single fetal death in 8 of 32 twin pregnancies (25%). Ten of the surviving co-twins were lost in the neonatal period (31.3%) and half of those neonatal deaths were due to TTTS. TTTS is the major contributor for perinatal mortality in same-sex twins complicated by single fetal death. The death of one twin in utero should not be the only indication for preterm delivery, and in case of severe prematurity with a stable intrauterine environment; expectant management may be advisable until fetal lung maturation ensues.

Prenatal sonographic and magnetic resonance imaging diagnosis of cystic neuroblastoma.

resolved spontaneously and did not result in cord prolapse in labor3. These authors also observed that several cases of cord prolapse in labor had not had prenatally detectable cord presentations3. Therefore they concluded that funic presentation at a prenatal sonogram was not synonymous with cord prolapse in labor. While in selected cases conservative management with close monitoring and attempt at vaginal delivery have been advocated4, it is our opinion that in the presently described case funic presentation would not resolve, and cord complications in labor would have been likely due to the anatomical relationship between the internal cervical os and the marginal cord insertion. We recommend that in all cases of funic presentation the cord insertion into the placenta should be identified. This will allow appropriate obstetric management and may help prevent the mortality and morbidity associated with cord prolapse.

Detection Rate of Trisomy 21 in Fetuses with Isolated and Non-Isolated Aberrant Right Subclavian Artery

Objective: The purpose of this study was to determine the frequency of chromosomal anomalies among the fetuses with isolated and non-isolated aberrant right subclavian artery (ARSA), and to evaluate the sonographic findings associated with ARSA. Methods: This is a retrospective study conducted during the period between January 2008 and December 2012 at the maternal fetal medicine units of three different referral centers. Results: Among the 148 cases of ARSA, 98 were isolated and 50 were associated with cardiac anomalies, extracardiac malformations or soft markers. Trisomy 21 was the only chromosomal anomaly with a prevalence of 6.8% (10/148). The corresponding rate was 6.1% (6/98) and 8% (4/50) for isolated and non-isolated ARSA, respectively. Cardiac anomalies, extracardiac findings and soft markers were detected in 5.4% (8), 10.8% (16) and 24.3% (36) of cases, respectively. Among the 10 fetuses with trisomy 21, 6 were isolated, 4 were associated with soft markers, 2 were associated with fetal growth restriction and 1 was associated with hydrops fetalis. Cardiac anomalies were not observed in any of these fetuses. Conclusion: The prenatal diagnosis of ARSA should prompt meticulous anatomic survey, and karyotype analysis might be offered even in the absence of associated findings.

Prenatal diagnosis of pygopagus tetrapus parasitic twin: case report

BackgroundAsymmetric and parasitic conjoined twins are rarer anomalies of monochorionic monoamniotic twins, consisting of an incomplete twin attached to the fully developed body of the co-twin.Case presentationA 30-year-old multigravid woman referred to maternal fetal unit due to polyhydramnios at 28th week of gestation. Sonographic examination revealed a single fetus and polyhydramnios with amniotic fluid index 30 cm. The fetus had normal apparent single head, spine, thorax, abdomen, two upper and two lower limbs, and two relatively well developed rudimentary parasitic lower limbs at sacral region. Lower limbs of the autosite were moving freelly but no movement was detected at the parasite. The parasite contained irregular lower limbs and left foot with three toes. Short and deformed long bones were also present in the parasitic limbs. A Cesarean section was performed at 38th week of gestation and a live female infant weighing 3600 g was delivered. The parasitic lower limbs were totally excised. Post-operative period was uneventful and the newborn was discharged as healthy. Post-natal follow-up was normal at nine-month-old.ConclusionPygopagus tetrapus parasitic twin is a rare form of conjoined twins and in utero diagnosis with ultrasound assists in prenatal management and counselling with parents.

THU0329 Budd-chiari syndrome in behÇet's disease: a retrospective multicenter study

Background The aim of this study was to determine the demographic, clinical, laboratory and management characteristics along with the clinical course of Budd-Chiari syndrome (BCS) associated with Behçets disease (BD). Methods Sixty patients with BD with BCS (40 male, 20 female) were identified in 23 rheumatology centers (Group I). A total of 169 consecutive patients (100 male, 69 female) with BD who did not have clinically apparent BCS during the follow-up were evaluated as the control group (Group II). Results Comparison of the demographic and clinical findings between the Group I and the Group II were as follows: The mean age of disease onset was 23.1 +/- 6.7 years vs. 26.8±0.6 years (p=0.013), mean age at diagnosis was 27.2±0.9 vs. 30.4±0.6 years (p=0.008), arthritis was 10% vs. 28.4% (p=0.002), papulopustular skin lesion was 48.3% vs 69.2% (p=0.003), central nervous system (CNS) involvement 10% vs. 3% (p=0.03), cardiac involvement was 16.7% vs. 2.4% (p<0.001), superficial thrombophlebitis was 23.3% vs. 4.7% (p<0.001), and deep vein thrombosis was 58.3% vs. 15.4% (p<0.01). On diagnosis 50% of BD patients with BCS were classified as Child-Pugh A. Inferior vena cava obstruction was observed in 38.3% and portal vein thrombosis was seen in 3.3% of the patients with BCS. Mortality in BCS patients with BD was 18.3%. BCS related treatment after diagnosis in patients with BD were as follows: 71.7% of patients were treated with monthly cyclophosphamide intravenous pulses, 53.3% received intravenous pulse corticosteroids, 55.9% used azathioprine, 54.2% had warfarine treatment, and 50.8% were treated with low molecular weight heparin. Conclusions This study shows a higher frequency of cardiac and CNS involvement, superficial thrombophlebitis, papulopustular skin lesion, deep vein thrombosis in BD patients with BCS. Arthritis was observed less common in BD patients with BCS. The mean age onset was lower in patients with BCS. Medical treatment with immunosuppressive agents and anticoagulation appears to be the treatment of choice in BD patients with BCS. The majority of the patients with BCS were Child–Pugh class A on diagnosis. The inferior vena cava is frequently involved and, often associated with deep vein thrombosis and cardiac involvement. Disclosure of Interest None declared

Postmenopozal smearlerin servikal intraepiteliyal neoplazi yönünden değerlendirilmesi

Objective: To investigate the prevelance of CIN in postmenopausal women in our region. Material and Methods: Between 1997 and 2000 years, 12783 women who applied Menopause Clinic for taking hormone replacement therapy with or without complaints were retrospectively evaluated. Results: Of the 349 cases with abnormal smear findings, 265 were CIN I (%75.8 ), 40 were CIN II (%11.4 ), 6 were CIN III (%2), 2 were carsinoma insituf %0.6 )and 36 were koilocytosis (%10.2 ). General prevelance of abnormal cervical findings in this age group was determined aproximately % 3. Conclusios: Although in women of postmenopausal age early stage servical intraepithelial lesions is seen not rare, it is clearly that they must be evaluated for transformation zone even if they are asymptomatic.

Fetal situs anomalilerinde prenatal tanı ve perinatal sonuçlar

Objective: The aim of this report was to evaluate fetal situs anomalies and to find out perinatal outcomes. Material and Methods: Patients admitted or referred to Maternal and Fetal Unit were scanned for fetal anomalies with ultrasonography (USG) between 18 and 23 weeks of gestational age or later at first admission. Fetal cardiac and visceral situs were determined, karyotype analysis was performed when indicated. Prenatal diagnosis of cardiac and extra-cardiac fetal anomalies, postnatal course of the cases and findings of pathological examination were noted. Results: Nine (21%) cases of fetal situs anomalies were detected in 43 (0,9%) cases of cardiac anomalies out of 4800 admission. Mean GA at diagnosis and mean GA at deliveiy or termination of pregnancy was 26 weeks of pregnancy (range:14-36) and 32 weeks of pregnancy.{range:18-39), respectively. We diagnosed 6 cases of situs inversus totalis and 3 cases of partial situs inversus. In five cases, major cardiac anomalies were detected in addition to situs anomaly. They were defined as cardiosplenic syndromes. Two of them were terminated, one died at 34 weeks, one case was delivered at 35 weeks due to hydrops fetalis and was lost at neonatal period. Another case has been diagnosed at 33 weeks of gestation and delivered at 36 weeks and died at neonatal period. The most common detected cardiac anomalies were atroventricular septal defect (n:5), hypoplastic right ventricule (n:l), hypoplastic left ventricule (n:l), truncus arteriosis (n:l), transposition of the great arteries (n:l), ventricular septal defect (n:2), systemic and pulmonary^ venous return anomalies (n:2). Extra-cardiac anomalies included pleural effusion, ascite, cutaneous edema, hydrops fetalis, choleduct cyst, situs inversus of the lungs, malrotation of the colon, skelatal dysplasia and bilateral talipes deformity of the feet. Karyotyping was performed in seven cases and all showed normal chromosomal arrangement. Three cases of isolated situs inversus totalis were live bom and showed normal development up to 3, 15 and 24 month-old. Conclusions: The cases with isolated situs inversus have relatively good prognosis but the cases of cardiosplenic syndromes presenting with a major cardiac anomalies have high perinatal mortality.