Cüneyt Evrüke

Prenatal Determination of the Upper Lesion Level of Spina Bifida with Three-Dimensional Ultrasound

Introduction: To evaluate the role of three-dimensional (3D) sonography in the prenatal detection of the upper pole in fetuses with spina bifida. Material and Methods: Women admitted to a tertiary center with pregnancies with isolated open spina bifida were enrolled in the study. All fetuses had 3D sonography to predict the lesion level. The exact lesion level was ascertained using radiography and/or autopsy following the delivery at term or abortion. Results: Forty-eight cases were eligible for this study. Twenty-eight fetuses were diagnosed in the second trimester and the lesion level was precisely predicted in 24 (86%) of them. In 14 (70%) of the 20 fetuses diagnosed in the last trimester, the level was accurately determined. The remaining 10 fetuses, from both the second and third trimesters, were found to have a lesion level that was within one segment of the predicted lesion level. The correct matching rate was 38/48 (79%), and agreement within one segment was achieved in all cases. Discussion: According to our data, 3D ultrasound is useful for the prenatal determination of lesion level in spina bifida, which is an important prognostic factor.

Prevalence and distribution of structural heart diseases in high and low risk pregnancies

OBJECTIVE To establish and compare the frequency of intrauterine congenital heart defects in high-risk and low-risk pregnancies for congenital heart diseases. METHODS Records of 3782 patients who underwent fetal echocardiography at the Pediatric Cardiology Unit were reviewed for reasons of referral and results of echocardiography retrospectively. The categorical variables between the groups were analyzed using a Chi-square test. RESULTS Structural heart defects were found in 213 (5.6%) fetuses in both high and low risk groups. Most common defects were ventricular septal defect (36.2%) and atrioventricular septal defect (14.1%). Frequency of congenital heart diseases was 7.8% (169 fetuses) in high-risk group: 4.1% were complex, 2.3% significant and 1.4% were minor. In low-risk group, the frequency was 2.7% (44 fetuses): 0.6% were complex, 0.8% significant and 1.3% were minor. In this group, rates of congenital defects were high regarding particular reasons: intrauterine fetal death in previous pregnancy (6.3%), abnormal first or second trimester screening tests (4.3%), and multiple gestations (3.4%). The sensitivity and specificity of fetal echocardiography according to transthoracic echocardiography were found to be 86% and 99%, respectively. CONCLUSION Congenital heart diseases rate, as expected, was found to be higher in high-risk group. However, regarding intrauterine fetal death in previous pregnancy, abnormal first or second trimester screening tests and multiple gestation, no statistically significant difference was observed between low-risk and high-risk groups. Therefore, we suggest the routine use of fetal echocardiography in cases we have mentioned above if the staff and equipment of the pediatric cardiology clinic are eligible.

Labial Fusion in a Pubertal Girl: A Case Report

An 18-year-old virgin, pubertal girl was treated for abnormal menses and dysmenorrhea. She had no history of trauma, sexual infection, or abuse. Occlusion of the introitus of the vagina had been first diagnosed 10 years earlier. The patient presented with fusion of the labia minora in the midline, posteriorly. Her physical examination, ultrasonographic laboratory examination, and intravenous pyelogram were all normal. Following surgical treatment, she had no problems at the time of postoperative follow-up.

A new device to facilitate the chorion villus sampling

Abstract No abstract available

Histopathological changes of cervical tissue in women with systemic sclerosis

Systemic sclerosis is a connective tissue disease that can affect almost any organ of the body. The clinical aspects of systemic sclerosis on the reproductive system have been studied in large series, and an increased rate of cesarean section has been reported. For this reason, in the present study the histopathological features of cervical specimens of hysterectomyzed women with systemic sclerosis were evaluated. An increased frequency of vascular and stromal abnormalities in cervical specimens of women with systemic sclerosis were observed. Vascular medial hypertrophy, intimal thickening, and fibrosis were more often encountered in the cervical specimens of the patients with systemic sclerosis. Some of the histopathological features also showed correlation with the clinical profile of the disease. The patients with vascular medial hypertrophy in their cervical specimens were older, had a higher Rodnan score, and had longer duration of the disease. In contrast to vascular medial hypertrophy, periadventitial edema was found in the cervical specimens of the patients who were younger, had a lower Rodnan score, and had shorter duration of the disease. It was concluded that the problems that are seen in common obstetric and gynecological practices in patients with systemic sclerosis may be explained by these tissue abnormalities.

The Reliability of Maternal Serum Triple Test in Prenatal Diagnosis of Fetal Chromosomal Abnormalities of Pregnant Turkish Women

AIM The purpose of this article was to evaluate the reliability of maternal serum triple marker screening of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol for the prenatal diagnosis of fetal chromosomal abnormalities in Turkish pregnant women. METHOD Medical records were used to analyze indications of amniocentesis and quantitative fluorescent-polymerase chain reaction. Anomaly screening was performed for all patients between 13 and 22 weeks of pregnancy. A total of 1725 pregnancies with chromosomal abnormality risk according to triple test screening were accepted for fetal chromosome analysis and quantitative fluorescent-polymerase chain reaction. RESULTS Chromosomal aberrations were observed in 56 (3.2%) cases. About 44.6% of the abnormalities detected were numerical aberrations; however, 55.3% of the abnormalities were structural aberrations. Abnormalities detected were inversion of chromosome 9 in 20 cases, trisomy 21 in 14 cases, 46,XX/47,XX, +21 in 1 case, trisomy 18 in 2 cases, trisomy 13 in 1 case, 47,XXY, in 1 case, 45,X, in 1 case, structural abnormalities in 12 cases, and mosaic or tetraploidy in 6 cases. CONCLUSION Second trimester triple test is an effective screening tool for detecting fetal Down syndrome in Turkish women.

Gebelik ve Toksoplazma Enfeksiyonu

Toksoplazma gondii isimli bir protozoanin sebep oldugu toksoplazmozis enfeksiyonu gebelikte fetal anomalilere ve dusuk-olu dogum gibi olumsuz perinatal sonuclara yol acabildigi icin oldukca onemlidir. Ozellikle cig et, kontamine yiyeceklerle bulasan bu enfeksiyonun prenatal donemde uygun zamanda, dogru tani ve yonetimi ile ciddi norolojik sekel riski azaltilabilmektedir. Dolayisiyla gebe takibi yapan klinisyenlerin bu enfeksiyonu derinlemesine bilmesi onem arz etmektedir. Bu amacla makalemizde, toksoplazma enfeksiyonun prenatal donemde tanisi, komplikasyonlari ve tedavisini ozetlemeyi amacladik.

Renal angiomyolipoma during pregnancy: Case report and literature review

Renal angiomyolipoma is a rare tumor that can be either sporadic or found together with tuberous sclerosis or pulmonary lymphangioleiomyomatosis. These tumors are hormone sensitive and therefore tend to grow during pregnancy and their main complication is the risk of rupture. Optimal management is still controversial because there are very few cases reported in the literature. We expect that the case of our patient, who delivered her baby vaginally at 36 weeks of gestation and underwent definitive treatment (nephrectomy) thereafter, to further enhance the knowledge about the management of these rare tumors during pregnancy.

P17.07: What is marker that will be used for first trimester screening of open spina bifida?

corpus callosum hypoplasia and cortical malformation with inferiory olive complexes heterotopia reminiscent of classical lissencephaly (type I) linked to LIS1 gene deficit. The Miller-Dieker lissencephaly was confirmed by FISH that showed a 17p13.3 deletion at LIS locus. Karyotype and 17p13.3 FISH analysis of both parents were normal, allowing reassuring genetic counseling. To our knowledge, this is the first report of Miller-Dieker syndrome revealed as early as 20.4 weeks gestation by corpus callosum hypoplasia with a diagnosis based on fetal and neuropathological screenings. This report highlights the good impact of neuropathological examination on cause identification after pregnancy terminations for brain malformations.

O124 INTRA UTERINE HEMOSTATIC SUTURE MAY PREVENT FROM HYSTERECTOMY IN PLACENTA ACCRETA AFTER THE PLACENTA REMOVAL

introduction of a new device. We designed the study to provide regular supervision, support and financial incentives to clinical staff. Nonetheless, we found it difficult to consistently collect high quality data and discovered many protocol violations. We addressed these challenges using continuous retraining on standard of care and study protocols, repetitive supportive supervision, strengthened monitoring and reporting systems, conducted realistic training drills, and gave continual feedback and supervisory support. While challenges remain, due to enhanced supportive supervision and monitoring we have collected reliable data on over 4100 women, with only 9% missed cases and 6 % dropped cases in the CRT. Conclusions: Rigorous conduct of CRTs in low resource settings is possible, but researchers/implementers need to be aware of and plan for multiple challenges and implement rigorous, creative supervisory and management interventions.