Aytul Corbacioglu Esmer

Female sexual function and associated factors during pregnancy

The objective of this study was to assess the changes in female sexual function during pregnancy and to identify associated factors among Turkish population using a validated questionnaire. Furthermore, we aimed to examine Turkish pregnant womens beliefs regarding sexual activity and describe their source of information about sexuality during pregnancy.

Prenatal sonographic diagnosis of fetus in fetu.

Fetus in fetu is a rare form of monozygotic twinning where an immature twin develops parasitically in the other twin. This condition was first described by Johann Friedrich Meckel in 1800.1 It is a rare condition with less than 190 cases reported in the literature, which were mostly diagnosed after birth. Advances in sonography have made the diagnosis of this condition possible in the prenatal period. The prenatal diagnosis was first reported in 1983,2 and only a few cases of antenatal diagnosis of fetus in fetu have been published until now. Here we report a case of fetus in fetu diagnosed by prenatal sonography in the third trimester of pregnancy. A 36-year-old woman, gravida 4, para 3, was referred to our department at 36 weeks’ gestation with a fetal abdominal cystic mass. Amniocentesis had been performed at another center for fetal talipes equinovarus and an abdominal cystic mass at 22 weeks. Chromosome analysis results were normal. Sonography revealed a 36-week fetus with bilateral talipes equinovarus. In the retroperitoneal region of the fetus adjacent to the left kidney and vertebral column, a fluid-filled sac was observed. A solid mass measuring 50 × 35 × 20 mm was “floating” within this cystic structure, which was 50 × 46 × 59 mm in size (Figure 1 and Video 1). Within the mass, a rudimentary spine and extremities representing an anencephalic fetus in fetu were noted (Video 1). Color flow Doppler investigation revealed blood flow through a stalk from the cyst wall to the floating mass (Video 1). Findings were well matched with the diagnosis of fetus in fetu. In the host fetus, there was substantial coiling of the umbilical cord and dilatation of the umbilical vein, suggesting varicosis, at the level of insertion into the fetal abdomen (Figure 2 and Video 2). Three days after our examination, the fetus died in utero at 37 weeks. A dead male fetus weighing 2650 g was delivered vaginally. The postmortem examination findings were consistent with the prenatal sonographic findings. There was substantial thrombosis in the umbilical vein close to the insertion site of the cord to the fetus (Figure 3, A and B). Autopsy findings revealed a solid mass within a fluid-filled sac surrounded by a transparent membrane (Figure 3C). The solid mass was connected to the membrane by a tiny stalk containing vessels. Microscopic examination of the solid mass showed the general characteristics of welldifferentiated tissues of the fetus in fetu, including skin, neuroglial tissue, vertebra, bone, cartilage, and adrenal cortex (Figure 4). Prenatal sonographic findings of fetus in fetu are a fluid-filled sac with a solid portion floating within it. The most common location of a fetus in fetu is retroperitoneal, constituting 80% of cases, but other locations such as scrotal, nuchal, and intracranial have also been described.2–5 Almost all fetus in fetu cases are anencephalic, and most have a vertebral column and limbs. The blood supply is usually a vascular pedicle, which originates from the abdominal aorta or other regional vessels. The use of prenatal magnetic resonance imaging to confirm the prenatal diagnosis of fetus in fetu has also been described.6 Fetus in fetu occurs secondary to unequal division of totipotent cells at the blastocyst stage, causing a small cellular mass to be included in a more mature embryo.4 Molecular analysis using informative genetic markers showed no genetic differences between the host infant and the fetiform mass.7 Although the monozygotic twin theory was generally accepted, it might not be sufficient to explain the occurrence of multiple fetuses in fetu and its association with teratomas.8 Defective implantation of the blastocyst was postulated to be the underlying mechanism.9 A molecular genetic analysis in 2 cases of fetus in fetu showing different methylation patterns between a host infant and fetiform mass has been reported.10 This finding suggested that a blastocyst originating from one zygote may be implanted in the other blastocyst during the process of methylation or after the establishment of methylation.10 The main differential diagnosis of fetus in fetu is teratoma. Fetus in fetu can be distinguished from teratoma by the presence of a vertebra. Teratomas are most commonly seen in the sacrococcygeal or head and neck region, whereas fetus in fetu cases are typically located in the

Intrauterine diagnosis and treatment of fetal goitrous hypothyroidism

We present two cases of fetal hypothyroidism with goiter which were successfully diagnosed and treated in utero. In both cases, ultrasonographic examination demonstrated a bilobed solid anterior neck mass with increased vascularity compatible with enlarged thyroid gland. Fetal blood sampling revealed hypothyroidism. Intra‐amniotic injection of L‐thyroxin caused a reduction in thyroid gland size and enabled vaginal delivery without complication. In the first case, maternal thyroid hormone levels and autoantibodies were normal and the neonate had hypothyroidism suggesting the diagnosis of dyshormonogenesis. In the second case, the fetus had transient hypothyroidism, which resolved spontaneously after delivery. Maternal thyroid function tests and autoantibodies were normal and both the mother and neonate had normal urinary iodine, excluding the diagnosis of iodine deficiency or excess. Thus, we believe that transplacental transfer of undetermined factors might be a cause of transient congenital hypothyroidism. Also, we reviewed the literature and described controversial issues regarding the management of fetal goiter.

Prenatal Diagnosis of Persistent Left Superior Vena Cava and its Clinical Significance

BACKGROUND Persistent left superior vena cava (PLSVC) is a variant of systemic venous return which is observed in 0.3% of autopsies in the general population and in 4-8% of patients with congenital heart disease. AIMS To evaluate associated cardiac, extracardiac and chromosomal anomalies in prenatally diagnosed cases of PLSVC and to review their outcome. STUDY DESIGN Retrospective comparative study. METHODS The data of patients with a prenatal diagnosis of PLSVC between May 2008 and January 2013 were reviewed retrospectively. RESULTS Data of 31 cases were reviewed. Fifteen (48.4%) cases were associated with cardiac defects and 17 (54.8%) cases had associated extracardiac sonographic or postpartum findings. Two fetuses had karyotype anomalies. Outcome was significantly more favorable in cases not associated with cardiac defects in comparison to those associated with cardiac anomalies (84.6% vs. 33.3%, p=0.009). All cases with isolated PLSVC survived, while among the cases associated with extracardiac anomalies, with cardiac anomalies and with both extra-cardiac and cardiac anomalies, the survival rate was 75%, 50% and 22.2%, respectively. The most frequent group of cardiac anomalies associated with PLSVC was septal defects and VSD was the most common heart defect individually, being observed in nine fetuses. CONCLUSION Prenatally diagnosed PLSVC is associated with cardiac and extracardiac anomalies in the majority of cases. Outcome is significantly worse if PLSVC is associated with a cardiac defect, and the prognosis is excellent in isolated cases.

Stage-Related Outcome after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome

Aim: To review the perinatal outcome of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation in a developing country with detailed analysis according to the stage of the syndrome. Methods: This was a retrospective study of 85 TTTS cases treated with fetoscopic laser coagulation at the Fetal Diagnosis and Treatment Unit of Istanbul Faculty of Medicine between January 2006 and March 2013. Results: The surgical failure rate was 5.8% (5/85). Among all the cases of the total cohort, only 1 fetus survived in 27 pregnancies (31.8%), and both fetuses survived in 22 pregnancies (25.9%). In 49 pregnancies (57.6%) at least one fetus survived at the end of the neonatal period. The overall survival and live birth rates were 41.8% (71/170) and 56.4% (96/170), respectively, and they significantly decreased as the stage of disease increased. Delivery occurred before 32 weeks of gestation in 54 (63.5%) pregnancies. Logistic regression analysis showed that gestational age at delivery was the only independent factor, and the risk of nonsurvival significantly decreased with increasing age. Conclusion: Based on our experience, the outcome of fetoscopic laser coagulation of the placental anastomoses for TTTS became worse as the Quintero stage of the disease advanced.

Bipolar Cord Coagulation in the Management of Complicated Monochorionic Twin Pregnancies

Aim: To report our experience in selective termination of monochorionic twin pregnancies with bipolar cord coagulation and to analyze the pregnancy outcomes and complications based on the indication of the procedure. Methods: This is a retrospective study of 71 complicated monochorionic pregnancies treated with bipolar cord coagulation between August 2006 and March 2013. Results: The rates of live birth and survival up to 28 days after birth were 73.2% (52/71) and 63.4% (45/71), respectively. The highest rates of survival up to 28 days after birth were in the procedures with an indication of selective intrauterine growth restriction, while the lowest rates of survival were recorded with the indication of twin reversed arterial perfusion sequence and discordant anomaly. However, there were no statistically significant differences in the live birth and perinatal survival rates among the four different groups of indications. Conclusion: The survival rate of bipolar cord coagulation in complicated monochorionic pregnancies such as twin-to-twin transfusion syndrome, twin reversed arterial perfusion sequence, selective intrauterine growth restriction and discordant anomaly was 63% in our series.

Prenatal Diagnosis of Torcular Herophili Thrombosis Report of 2 Cases and Review of the Literature

Prenatally diagnosed thrombosis of the torcular herophili is very rare, and it is sometimes misdisgnosed due to unfamiliarity. Sonography with color Doppler imaging is the key imaging modality for prenatal diagnosis of torcular herophili thrombosis. Typical prenatal sonographic findings include a well‐defined triangular anechoic collection in the occipital region and an echogenic structure within the collection, which represents the thrombus. Fetal magnetic resonance imaging is usually used as an adjunctive modality for prenatal diagnosis, as it confirms the diagnosis by providing more precise anatomic information and better characterization of the lesion. We present 2 cases of thrombosis of an ectatic torcular herophili with serial sonographic and magnetic resonance imaging examinations, as well as a review of the literature regarding the prenatal diagnosis of torcular herophili thrombosis.

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.

Role of subcutaneous closure in preventing wound complications after cesarean delivery with Pfannenstiel incision: A randomized clinical trial

The aim of this study was to evaluate the role of suture closure of the subcutaneous tissue in preventing wound complications after cesarean section with a Pfannenstiel incision, and to investigate factors associated with wound complications.

Is There an Appropriate Cutoff Age for Sampling the Endometrium in Premenopausal Bleeding

Aim: To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). Methods: Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. Results: Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. Conclusion: There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.