Gökhan Karakoç

Reliability of posterior-left atrium space index measurements during 20–24 weeks of gestation in structurally normal fetuses

Abstract Objective: We aimed to evaluate the correlation between clinical parameters and the post-left atrium (LA) space index, which is a candidate screening marker for total anomalous pulmonary venous connection (TAPVC). We also calculated the inter- and intra-observer variabilities of measurements for this parameter. Methods: The LA-descending aorta distance/descending aorta diameter ratios (post-LA space index) were obtained from 165 fetuses between 20 and 24 weeks of gestation. Regression analyses were utilized to evaluate the correlations across clinical parameters and the post-LA space index. Intraclass correlations coefficients were calculated for the intra- and inter-observer agreements of three examiners with different sonographic experience. Results: The mean (±SD) maternal and gestational age (GA) was 28.6±4.9 years and 21.7±0.9 weeks of gestation, respectively. In multivariate analyses, there was no correlation between post-LA space index and maternal age, fetal gender, or GA at cardiac scan. There were moderate to strong correlations across the measurements by different examiners, indicating good inter- and intra-observer agreements. Conclusion: The post-LA space index during 20–24 weeks of gestation is a simple and reliable marker that is not affected by GA. However, its potential as a screening tool for TAPVC warrants further clinical investigation.

Thickness measurement of fetal epicardial adipose tissue in structurally normal fetuses between 24 and 28 weeks of gestation

Objective: Ultrasonographic measurement of epicardial adipose tissue (EAT) is carried out frequently adults as an indirect indicator of lipogenesis and metabolic syndrome. However, the information on the measurement of this tissue in fetus is limited. Our aim is to determine the measurement values of fetal EAT thickness according to the weeks in non-complicated pregnancies. Methods: Thirty-nine pregnant women, who admitted to maternity clinic between 24 and 28 weeks of gestation for routine follow-up and who had no problem in their fetal and maternal follow-ups, were included in our study. Fetal EAT thickness was measured in the Perinatology Clinic. The relationship of fetal EAT measurements with the week of gestation was evaluated statistically. Results: Maternal age (p=0.33) and body mass index (p=0.88) according to the weeks of gestation were similar. Median [interquartile range] fetal EAT thicknesses at 24+, 25+, 26+ and 27+ weeks of gestation were 1.29 mm [1.267–1.320], 1.295 mm [1.275–1.305], 1.325 mm [1.297–1.355] and 1.34 [1.330–1.355], respectively. There was a significant difference only in the measurements between 25 and 26 weeks of gestation (p=0.048). Conclusion: Fetal EAT thickness increases in direct proportion to the week of gestation. Proportionately, the highest increase is between 25 and 26 weeks of gestation.

The significance of reverse flow in ductus venosus between sixteen and twenty weeks’ gestation

Objective: To evaluate the correlation between reversed a-wave in ductus venosus at 16-20 weeks’ gestation and trisomy 21 and adverse perinatal outcomes. Materials and Methods: Our study included 174 pregnant women who were under follow-up at a tertiary center between May and September 2010. Ductus venosus Doppler (DVD) measurements were obtained throughout the 6-month period from women who underwent amniocentesis procedures due to increased risk for trisomy 21 in terms of first or second trimester screening test results. These women were followed up for enrollment of subsequent data about perinatal outcomes. Results: In 13 of 174 cases, Doppler studies indicated a reversed a-wave in the ductus venosus. Of these fetuses, 3 were diagnosed as having trisomy 21 after amniocentesis, which related to 60% (3 of 5 fetuses) of all fetuses with trisomy 21. The pregnant women with reversed a-wave in DVD also had an increased rate of preeclampsia (15%) and gestational diabetes mellitus (GDM) (23%) in late pregnancy. Conclusion: Reversed a-wave in ductus venosus between 16-20 weeks’ gestation is associated with increased risk of trisomy 21, preeclampsia, and GDM. If further prospective studies confirm its utility, DVD interrogation for trisomy 21 may be extended until 20 weeks’ gestation.

Comparison of bupivacaine and ropivacaine in combination with fentanyl used for walking epidural anesthesia in labor

Objective: Effective pain relief during labor is essential to reduce maternal and perinatal morbidity arising due to pain-induced maternal sympathetic activation, and to avoid unnecessary cesarean sections performed due to maternal anxiety. Walking epidural analgesia on labor reveals lower pain scores, leading to higher maternal satisfaction with better cardiovascular and pulmonary physiology. Despite the extensive use and relative safety of bupivacaine, newer drugs such as ropivacaine have been developed as alternative agents to decrease the risk for cardiac and central nervous system toxicity. Materials and Methods: One hundred women who requested epidural analgesia in active labor were randomly allocated into two groups; one group received 20 mL of ropivacaine 0.125% with fentanyl 50 µg and the other received 20 mL of bupivacaine 0.125% with fentanyl 50 µg. The efficacy of analgesia, adverse effects, and obstetric and neonatal outcomes of both groups were compared. Results: There were no differences between the two study groups in the measured obstetric and neonatal outcomes. The onset time, duration of analgesia, and sensory levels were similar between the groups. Visual analog pain scale scores did not differ between the groups before analgesia or at any of the subsequent evaluation periods. Conclusion: Both ropivacaine and bupivacaine provide equivalent labor analgesia with high maternal satisfaction and tolerable adverse effects in the clinically used dose range. No adverse obstetric or neonatal outcomes were observed in either group. Therefore, either drug is a reasonable choice for labor analgesia and can be used without jeopardizing the safety of the mother and fetus.