Inanc Mendilcioglu

Clinical pregnancy after uterus transplantation

OBJECTIVE To present the first clinical pregnancy after uterus transplantation. DESIGN Case study. SETTING Tertiary center. PATIENT(S) A 23-year-old Mayer-Rokitansky-Kuster-Hauser syndrome patient with previous vaginal reconstruction and uterus transplantation. INTERVENTION(S) Eighteen months after the transplant, the endometrium was prepared for transfer of the thawed embryos. MAIN OUTCOME MEASURE(S) Implantation of embryo in an allografted human uterus. RESULT(S) The first ET cycle with one day 3 thawed embryo resulted in a biochemical pregnancy. The second ET cycle resulted in a clinical pregnancy confirmed with transvaginal ultrasound visualization of an intrauterine gestational sac with decidualization. CONCLUSION(S) We have presented the first clinical pregnancy in a patient with absolute uterine infertility after uterus allotransplantation. Although the real success is the delivery of a healthy near-term baby, this clinical pregnancy is a great step forward and a proof of concept that the implantation phase works.

Early second-trimester individualized estimation of trisomy 18 risk by ultrasound.

OBJECTIVE To report two second-trimester ultrasound algorithms for trisomy 18 prediction. METHODS Femur length, gross anomaly, choroid plexus cysts, two-vessel cord, and maternal age were documented in pregnancies undergoing genetic amniocentesis. Stepwise logistic regression was used to identify 1) the significant markers for predicting trisomy 18 when gross anomaly was not considered (algorithm 1) and 2) when gross anomaly was also considered (algorithm 2). Patient-specific risk was calculated based on the significant ultrasound markers plus maternal age. The diagnostic accuracy of each algorithm was determined. RESULTS There were 1167 normal and 47 trisomy 18 cases. The mean gestational ages were 16.5 weeks (standard deviation [SD] 1.5) and 17.9 weeks (SD 1.6), respectively. Algorithm 1 consisted of maternal age, choroid plexus cyst, femur length, and two-vessel cord. The sensitivity and false positive rates were 61.7% and 1.5%, respectively, with an area under the receiver operating characteristics curve of 0.880 (P < .001). Algorithm 2 (age, femur length, gross anomaly, and choroid plexus cyst) had a sensitivity of 72.3% and false positive rate of 0.9% with an area under the curve of 0.956 (P < .001). Comparable detection rates were achieved in early gestation at up to and including 17.5 weeks (72.4% and 82.8%, algorithms 1 and 2, respectively, at a 4.0% false positive rate). CONCLUSION The ultrasound markers were sensitive for trisomy 18 detection in the early second trimester.

Recurrent preeclampsia and perinatal outcome: a study of women with recurrent preeclampsia compared with women with preeclampsia who remained normotensive during their prior pregnancies

Objective.  To evaluate the impact of preeclampsia recurrence on perinatal outcome.

Immunohistochemical distribution of cell cycle proteins p27, p57, cyclin D3, PCNA and Ki67 in normal and diabetic human placentas

The placenta is a regulator organ for many metabolic activities between mother and fetus. Therefore, fetal growth is directly related to the placental development. Placental development is a series of events that depend on the coordinated action of trophoblasts’ proliferation, differentiation and invasion. Studies on cell cycle related proteins which control these events are fairly limited. How placental tissue proliferation is affected by diabetes is not exactly known yet. Therefore in this study, the immunohistochemical localizations of cell cycle related proteins like PCNA, Ki67, cyclin D3, p27 and p57 in the differentiation, proliferation and apoptosis mechanisms of normal and diabetic placentas were investigated. Information on cell cycle related proteins that control these events is limited and how they are affected in diabetes mellitus is not fully understood yet. Therefore, in this study, to understand the role of cell cycle regulators in diabetic placentas we aimed to determine the spatio-temporal immunolocalizations of cell cycle regulators in diabetic and normal human term placentas. Term placentas were obtained from diabetic women and from normal pregnancies with informed consent following caesarean deliveries. Placental samples were stained via immunohistochemistry with PCNA, Ki67, cyclin D3, p27 and p57 antibodies and were examined by light microscopy. When compared to control placentas, PCNA, Ki67 and cyclin D3 staining intensities significantly increased in villous parts of diabetes group. Moreover, Ki67 and cyclin D3 stainings also significantly increased in basal plates and chorionic plate respectively. In chorionic plates, p27 and p57 staining intensities significantly decreased in diabetic group. p57 staining also significantly decreased in villous parts of diabetic placentas. Placental abnormalities seen in diabetic placentas could be associated with proliferation and cell cycle arrest mechanisms’ alterations occurred in diabetes mellitus.

Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies

Objectives: To assess the effectiveness of a prostaglandin E1 analog, misoprostol, using different regimens compared with dinoprostone in termination of pregnancies in second and early third trimester complicated by either congenital fetal anomalies or intrauterine fetal demise. Methods: A retrospective review of 59 pregnancies between 15 and 30 weeks was performed which were terminated due to congenital fetal anomalies or intrauterine fetal demise. In group 1 (n=29) 400 μg oral and 600 μg vaginal misoprostol, in group 2 (n=12) 600 μg vaginal misoprostol and in group 3 (n=18) 0.5 mg dinoprostone gel were given for the termination of the pregnancies. All these groups were evaluated for demographic characteristics and delivery findings. Statistical analysis were performed by one‐way ANOVA, Kruskal–Wallis and χ2‐test. Results: No significant statistical difference was observed in terms of age, gravidity, parity, previous abortion, gestational week, frequency of prostaglandin usage, and birth weights among the three groups. The time intervals between the first administration and delivery were 20.3 h for oral vaginal misoprostol, 17.3 h for vaginal misoprostol and 22.5 h for the dinoprostone group (P=0.594). Evacuation rates after single doses were similar in all groups (83%, 73% and 72%, respectively). Uterine tachysystole was the only major side effect encountered in the oral‐vaginal misoprostol group. Conclusions: All three regimens yielded similar results for termination of pregnancies in second and third trimester. The major advantage of misoprostol was the cost.

Prenatal diagnosis of β-thalassemia and other hemoglobinopathies in southwestern Turkey.

Our aim was to evaluate the prenatal diagnosis of β-thalassemia (β-thal) and other hemoglobinopathies in a region with high frequency. After detection by premarital or antenatal screening, 312 patients underwent 420 prenatal diagnostic procedures for 407 fetuses in a 10-year period. Fetal samples were collected by chorionic villi sampling (CVS) in the first trimester and amniocentesis and cordocentesis in the second trimester. Mutation analyses of β-globin and cytogenetic analyses were performed and the most common mutations detected were: IVS-I-110 (G>A), IVS-II-1 (G>A), IVS-I-6 (T>C) and IVS-II-745 (C>G). Hb S [β6(A3)Glu→Val, GAG>GTG)] was the most common hemoglobin (Hb) variant with a frequency of 6.3%. Among 407 fetuses, 105 (25.8%) were diagnosed as affected, while 201 (49.4%) were carriers and 101 (24.8%) were normal. Cytogenetic analyses revealed nine fetuses (2.3%) with numerical chromosomal abnormalities as regular or mosaicism. Prenatal diagnosis of common hemoglobinopathies is safe and effective. Performing cytogenetic analysis in excess fetal material is an acceptable option.

The Effects of Glucocorticoids on Fetal and Placental Development

Glucocorticoids (GCs), steroid hormones produced predominantly by the adrenal gland, are key mediators of stress responses. Whilst the acute and chronic effects of pharmacological glucocorticoid excess are well-recognized (including induction of hyperglycemia, insulin resistance, hyperlipidemia, hypertension and dysphoria, with suppression of immune, inflammatory and cognitive processes), their role in the biology of the response to stress is more nuanced, with balanced homeostatic effects to facilitate short-term survival and recovery from challenge [1, 2]. In addition, glucocorticoids play an essential role in normal fetal development and are important for the development and maturation of various fetal tissues including the liver, lungs, gut, skeletal muscle and adipose tissue in preparation for extrauterine life. Glucocorticoids most notably act during late gestation to stimulate surfactant production by the lung. This action is critical to prepare the fetus for extrauterine life, and it is for this reason that synthetic glucocorticoid treatment is so widely used in preterm pregnancies where lung immaturity threatens neonatal viability. Although these treatments greatly improve survival [3], they are not without adverse effects.

Evaluation of a Fetus with Neu-Laxova Syndrome through Prenatal, Clinical, and Pathological Findings

We report a case of Neu-Laxova syndrome in a fetus at 22 weeks with the ultrasonographic findings of characteristic facial findings, limb contractures, kyphosis and polyhydramnios. Pathological and ultrasonographic studies are discussed.

Placental biopsy by frozen section: Does it have a role in evaluation of fetal well‐being?

Aim:  To assess the effectiveness of post‐partum placental biopsy and frozen section evaluation in diagnosing pregnancy disorders.

Urinary Tract Injuries During Advanced Gynecologic Laparoscopy

Urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.