Altan Cebeci

Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome.

Objective: Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome. Methods: Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student’s t test, χ2 analysis and Fisher’s exact test as appropriate. Results: Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 ± 6.1 vs. 33.0 ± 5.8 weeks (p = 0.119) and 1,886 ± 764 vs. 1,724 ± 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statistically significant differences. But when analyses were performed according to gestational age before and after 32nd gestational week, the difference of perinatal mortality between the two groups was non-significant (p = 0.644 and p = 0.250), suggesting borderline difference. The most common contributing factor for fetal death after 32nd week was due to abruptio placenta without prenatal follow-up. Neonatal morbidity and neonatal mortality (4.8 vs. 6.3%, p = 0.905) in severe preeclampsia-eclampsia and HELLP syndrome respectively were similar and the difference was statistically nonsignificant. Conclusions: Perinatal mortality and neonatal morbidity-mortality according to gestational age before and after the 32nd week were similar in HELLP syndrome compared with severe preeclampsia-eclampsia without HELLP but overall fetal mortality was higher in HELLP syndrome with no regular prenatal care.

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.

Maternal and Fetal Outcomes in HELLP Syndrome Complicated with Acute Renal Failure

Objective. This study reviews maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure (ARF), and compares clinical and laboratory findings of the cases of HELLP syndrome that did not develop ARF. Materials and Methods. All pregnant women with hypertensive disorders admitted or referred to the maternal and fetal unit were recorded into a perinatal database between January 15, 2002 and September 15, 2003. During the study period, out of 615 cases of hypertensive pregnancy, we followed and delivered 347 cases of severe preeclampsia, of them 132 cases were diagnosed as HELLP syndrome. ARF was defined as creatinine level ≥ 1.2 mg/dL and/or oliguria < 400 mL/24 hr. The cases were divided into three groups on the basis of the highest creatinine level recorded during hospitalization: creatinine < 1.2 mg/dL, creatinine ≥ 1.2 to 2.0 mg/dL, and creatinine ≥ 2.0 mg/dL. Statistical comparisons were performed by Student t test, X2 analysis, and Fishers Exact test as appropriate. The value of P < 0.05 was considered significant. Results. ARF developed in 8.9% (n:31) of severe preeclampsia (n:347); of them, 15 (4.3%) cases were nonoliguric, and all had mildly elevated creatinine levels between 1.2 and 1.9 mg/dL. Moderately elevated creatinine levels were 2 to 3.9 mg/dL in 10 cases, and severely elevated creatinine levels were 4 to 8.4 mg/dL in 6 cases, for a total of 16 (4.6%) cases; creatinine levels were ≥ 2.0 mg/dL (range: 2.0–8.4 mg/dL). HELLP syndrome was the most frequent cause of ARF, 64.5% (n:20/31), and was observed in 15% (n:20) of 132 cases of HELLP syndrome. Fourteen (88%) of 16 cases that had oliguria and creatinine levels ≥ 2 mg/dL were detected in HELLP syndrome (n:14/132; 10.6%). Major maternal complications in HELLP syndrome with ARF and creatinine level ≥ 2 mg/dL in the study group were abruptio placentae (42.8%; n:6/14), incisional hematoma (21%; n:3/14), pulmonary edema (14%; n:2/14), cesarean hysterectomy (7%; n:1/14), and dialysis (50%; n:7/14). There was no maternal mortality. All patients complicated with ARF were discharged without renal impairment. Perinatal mortality was 26.1% in the cases of HELLP syndrome with ARF‐creatinine ≥ 1.2 mg/dL and further increased to 37.5% when creatinine levels were above 2.0 mg/dL, compared with 11.8% in the cases having creatinine < 2.0 mg/dL, and the difference was statistically significant (p:.007). Conclusions. The most contributing factors leading to ARF in HELLP syndrome were abruptio placentae and HELLP syndrome complicated with ARF, particularly, oliguric ARF has relatively higher maternal complications and perinatal mortality.

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 diagnosis of 13q-syndrome in a fetus with dandy-walker malformation

BACKGROUND: Partial deletion of the long arm of the chromosome 13 is a rare chromosomal aberration and may present with microcephaly, colobomata, microphthalmia, distal limb and digital anomalies, cardiac defects, brain and urogenital malformations, anal atresia and growth restriction. CASE: We report such a case in 25th week of gestation referred for sonographic examination which revealed growth restriction, microcephaly, Dandy-Walker malformation, right microphthalmia, micrognathia, marked nuchal edema, four fingers–oligodactyly in feet and in hands with thumb aplasia and ambiguous genitalia. Chromosome analysis identified chromosome 13q deletion [46 XY del (13) (13q31.2/q32.1 → qter)]. Postmortem examination confirmed prenatal findings and showed aniridia, low-set ears, cryptorchidism, and anal atresia. CONCLUSION: Detection of Dandy-Walker malformation, microphthalmia, oligodactyly with thumb aplasia and growth restriction during prenatal ultrasonography should be a reminder of deletion of chromosome 13q and warrant cytogenetic analysis.

Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for congenital cystic adenomatoid malformation of the lung

BackgroundSpontaneous monochorionic triamniotic pregnancy is rare and is at increased risk for pregnancy complications. The presence of an anomalous fetus further complicates the management.Case presentationWe present a case of monochorionic triamniotic triplet pregnancy diagnosed at 15 weeks of gestation with one fetus having developed a multicystic lung lesion, suggestive of congenital cystic adenomatoid malformation (CCAM). At 24 weeks, the largest cyst measured 10 mm in diameter. We managed the pregnancy conservatively and delivered three live male fetuses with birth weights 1560 g, 1580 g and 1590 g at 35 weeks of gestation. Two newborns were admitted to the neonatal intensive care unit with respiratory distress, the third one died due to sepsis 7 days postpartum. One of the newborns was discharged healthy at 24 days postpartum. The newborn with CCAM developed a pneumothorax on the right side, recovered after treatment, and was discharged after one month. Computerized tomography (CT) of the infant at 3 months demonstrated two cystic lesions in the middle lobe of the right lung measuring 25 mm and 15 mm. A repeat CT of the infant at 6 months showed a 30 mm solitary cystic mass.ConclusionMonochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for CCAM, present rarely and can be managed conservatively. These findings may help in decision making and counselling of parents.

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.