Fırat Tülek

Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population

OBJECTIVE To address the possible risk factors, eventual pregnancy outcomes, and probable troubles in follow-ups of pregnancies complicated by an isolated single umbilical artery and to provide data on Turkish cases in such an aspect that ethnic divergences may have influence. MATERIAL AND METHODS A total of 16568 singleton pregnancies that were delivered between May 2006 and May 2013 were retrospectively screened. Ninety-three fetuses were found to have an isolated single umbilical artery. One-hundred pregnancies that did not show any structural or chromosomal abnormalities were randomly selected from the rest of the cases to establish the control group. IBM SPSS Statistics 20.0 software was utilized for statistical analysis. Non-parametric data were analyzed with Mann-Whitney U test and were presented as means±standard deviations. P values less than 0.05 were statistically significant. For the adjustment of confounding factors, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. RESULTS The incidence of small for gestational age (SGA) fetuses and hypertensive disorders in pregnancy was found to be significantly higher in cases with an isolated single umbilical artery (p<0.001 and p=0.022, respectively). Maternal smoking was found to be independently associated with the occurrence of an isolated single umbilical artery (OR: 3.556; 95% CI: 1.104-11.45). The risk of preterm birth was not higher in the study group (OR: 0.538; 95% CI: 0.576-2.873). The incidence of cases who underwent cesarean delivery because of non-reassuring fetal heart trace was similar in the study and control groups (p=0.499). CONCLUSION Attention should be paid to the development of hypertensive disorders in cases with a diagnosis of an isolated single umbilical artery, and parents should be counseled properly, including the information on increased risk of SGA. Strict follow-up of pregnancies complicated with an isolated single umbilical artery in terms of preterm birth seems unfeasible except in cases with accompanying risk factors for preterm labor.

The effects of isolated single umbilical artery on first and second trimester aneuploidy screening test parameters

Abstract Objective: Reliability of first and second trimester screening tests largely depends on accurate estimation of maternal serum marker values. Reduced reliability could lead redundant invasive tests or misdiagnosis. Adjustments of serum marker values for confounding factors like insulin-dependent diabetes, maternal weight or maternal rhesus status are essential. We aimed to investigate whether isolated single umbilical artery alters first and second trimester test parameters or not. Methods: Routine detailed obstetric ultrasonographies performed were retrospectively screened for this study. Among spontaneously conceived singleton pregnancies, women who were found to have single umbilical artery without any additional structural anomalies or aneuploidies were selected. First and second trimester screening test results were accessible for 98 and 102 of the cases with isolated single umbilical artery, respectively. Results: Among first trimester screening test parameters, PAPP-A (pregnancy-associated plasma protein A) MoMs were found significantly higher in isolated single umbilical artery group. AFP MoMs were found significantly elevated in isolated single umbilical artery group in second trimester quadruple tests. Conclusion: Existence of single umbilical artery could alter the estimation of MoM values of maternal serum markers. Reliability of prenatal screening tests could be improved by adjusting these parameters in accordance with isolated single umbilical artery.

Pregnancy complicated by a Krukenberg tumor with an undetermined origin and its management

Krukenberg tumor in pregnancy is very rare and management of this condition is a dilemma for physicians. Moreover, the existence of a primary Krukenberg tumor is still in debate. Herein, we present a 29‐year‐old woman at 29 weeks of pregnancy, admitted with premature labor and revealed to have a signet ring cell ovarian tumor with an undetermined primary origin. A primary Krukenberg tumor or a Krukenberg tumor with an undetermined origin has not been previously reported in a pregnant patient. By virtue of the controversy, we are not eager to use the term ‘primary Krukenberg tumor’ for this case, although the possibility of the existence of this kind of tumor cannot be totally ignored.

Post-partum tubal ligation at time of cesarean delivery or via laparoscopy as an interval sterilization has similar effects on ovarian reserve

Objective To observe and compare the effect of postpartum tubal ligation procedures on ovarian reserve at women desiring tubal ligation as a contraceptive method at the end of pregnancy. Material and Methods Eighty-one women were included in the prospective study. Tubal ligation (TL) was performed at time of cesarean delivery (CD) (n:49) and as an interval procedure by laparoscopy (LS) at postpartum period (n:32). Anti-mullerian hormone (AMH) was used to determine ovarian reserve. Blood samples were taken twice from each subject; first sample was taken before delivery from all subjects and second sample was taken 4 months after sterilization. AMH level differences were compared in each group and between groups. Results The preoperative AMH values of CD and LS groups were similar 2.30 ng/ml (max 5.20, min0.42 ng/ml), 1.80 ng/ml (max3.50, min0.40 ng/ml ), respectively (P=0.262). The postoperative AMH values of CD and LS groups were 1.30 ng/ml (max 2.60, min 0.30 ng/ml), 0.90 ng/ml (max 2.50,min 0.20 ng/ml), respectively (P=0.284). When comparison is done for the preoperative and postoperative values of each group the change was statistically significant for both groups p<0.001. The decrease in mean AMH values in CD and LS groups were 37,83% and 44,15%, respectively. The percentage changes of AMH values were not statistically significant (p=0,286). Conclusion Tubal ligation at time of CD and interval sterilization with LS have similar effects on ovarian reserve.

Double balloon catheters: a promising tool for induction of labor in multiparous women with unfavourable cervices

OBJECTIVE The aim of the present study is to compare the effectiveness and safety of oxytocin and cervical ripening balloon in women with unfavorable cervices for inducing labor. MATERIAL AND METHODS Total of eighty pregnant women between 37-41 gestational weeks having singleton pregnancies and intact membranes with unfavorable cervix were randomized in two groups, cervical ripening balloon (n=40) and oxytocin infusion (n=40). The primary outcomes were the labor time and the route of delivery. Secondary outcomes were the effect of parity on time of labor, obstetric and perinatal outcomes. RESULTS The median time to delivery was 9,45 hours in cervical ripening balloon and 13,2 hours in oxytocin group in multiparous women. The differences were statistically significant (p<0.001). Median time until delivery was 11.48 hours at cervical ripening balloon group and 13,46 hours at oxytocin group; the differences were statistically significant (p<0.001). Cesarean delivery ratios were similar in both groups (p=0.431). CONCLUSION The results of the present study were promising for balloon usage especially in multiparous women. It is beneficial to support these data with wide ranged population based studies.

Isolated Megacisterna Magna in a Fetus with Trisomy 21: Case Report

Megacisterna magna is classicaly defined as a cisterna magna measured above 10 milimeter. There is limited data in literature about outcomes of isolated cisterna magna enlargement. These limited amount of data indicates normal neonatal and developmental outcomes however shortness of the available evidences about the outcomes of isolated cisterna magna enlargement render this issue confounding. Here we present a case with an isolated enlarged cisterna magna that was shown to have trisomy 21 afterwards. This is the second case with isolated cisterna magna enlargement reported to have trisomy 21 in the literature. A mild association between cisterna magna enlargement and chromosomal anomalies could be existing particularly with trisomy 21. Risk of chromosomal anomalies should be kept in mind when counselling the patients with isolated cisterna magna enlargement.

Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum

OBJECTIVE To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. MATERIAL AND METHODS A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. RESULTS Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. CONCLUSION The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered.