İsmet Gün

Evaluation of neonatal outcomes in elective repeat cesarean delivery at term according to weeks of gestation

Aim:  Our aim is to evaluate the association between gestational age at delivery and neonatal outcomes in elective cesarean delivery.

Prenatal diagnosis of vertebral deformities associated with pentalogy of Cantrell: The role of three-dimensional sonography?

Pentalogy of Cantrell was diagnosed in a fetus at 14 weeks of gestation, on routine two‐dimensional sonographic examination with Doppler imaging, which revealed a midline supraumbilical abdominal wall defect including herniated liver, an ectopia cordis without intracardiac anomalies, and a large omphalocele containing intestines. Although left unilateral club foot deformity was also detected as an associated anomaly in the same examination, severe lumbar lordoscoliosis was only detected by using three‐dimensional sonography because of the spatial configuration of the deformity. After termination of the pregnancy, postnatal inspection of the fetus confirmed the diagnosis of pentalogy of Cantrell associated with skeletal deformities and revealed low implant ears as an additional finding. Although two‐dimensional sonography with Doppler imaging is sufficient to diagnose pentalogy of Cantrell, it may fail to show the complex vertebral deformities and three‐dimensional sonography may assist in visualizing the defect accurately.

The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature

Abstract To determine the efficacy and safety of primary medical treatment with systemic methotrexate (MTX) in caesarean scar ectopic pregnancy, we conducted a Medline/PubMed search on the relevant English literature from January 1978 to January 2012. The search yielded 27 publications of 40 cases of caesarean scar ectopic pregnancy. The literature search showed a very liberal use of systemic MTX treatment with unfavourable outcomes, although the major determinant of the clinical efficacy was found in here to be β-hCG level together with embryonic cardiac activity (ECA) status. A caesarean scar ectopic pregnancy presented with a serum β-hCG concentration of ≤ 12,000 mIU/ml (odds ratio, OR 5.68, 95% confidence interval, CI, 1.37–23.48) and absence of ECA (OR 4.80, 95% CI, 1.14–20.08) was found to be associated with higher efficacy rate of primary systemic MTX treatment. Administration of primary systemic MTX treatment was found to be ideal for a caesarean scar ectopic pregnancy presented before 8 weeks’ gestation, with a β-hCG concentration of ≤ 12,000 mIU/ml together with an absent ECA (OR 14.52, 95% CI, 2.36–89.09).

Primary retroperitoneal mucinous cystadenoma with a sarcoma-like mural nodule: an immunohistochemical study with histogenetic considerations and literature review.

Primary retroperitoneal mucinous cystadenomas (PRMCs) are extremely rare tumors and their association with sarcoma-like mural nodules (SLMNs) has not been described thoroughly. The aim of this study is to characterize the gross and microscopic features and the immunohistochemical profile of the first case of PRMC with SLMN and to discuss the differential diagnosis of SLMNs. The literature related to primary retroperitoneal mucinous tumors is reviewed in an attempt to clarify the histogenesis of the epithelial and sarcomatoid components of the associated mural nodules. A 34-yr-old woman presented with a 14-cm retroperitoneal cystic lesion with a 6-cm mural nodule. An immunohistochemical study with a panel of 19 antibodies and a histochemical study for mucin stains were performed. The epithelial component of the PRMC showed positive staining for cytokeratin (CK) 7, CK AE1/3, epithelial membrane antigen, carcinoembryonic antigen, and calretinin. The neoplasm was not immunoreactive for CK 20, CK 5/6, and the other antibodies used in this study. In addition, it stained positively for mucin by mucicarmine, periodic acid-Schiff, and Alcian blue. The stromal cells of the cyst showed estrogen receptor positivity. SLMN cells were negative for all CKs and other epithelial markers used in the study, but they showed diffuse positive staining for vimentin and CD68, and positive staining for Ki-67 was demonstrated in 25% of these cells. The immunohistochemical and histochemical profiles of PRMC were similar to those of ovarian mucinous neoplasms and the mesothelium. The formation of SLMNs seems to be related to subepithelial hemorrhage and some reactive epithelial changes near the mural nodules. The specific immunohistochemical and morphologic features of SLMNs are helpful in differentiating them from malignant mural nodules, including true sarcomas, osteoclast-rich undifferentiated carcinomas, and carcinosarcomas. Such a differentiation is critical in view of its significant impact on the management of these neoplasms, particularly in young patients who desire to preserve their fertility.

Common sonographic characteristics of trisomy 8 mosaicism

⁎ Corresponding author at: Department of Obstetrics andGynecology, GATAHaydarpasa Training Hospital, Istanbul, 34668, Turkey. Tel.: +90 216 542 2020x4457; fax: +90 216 348 78 80. E-mail addresses: drismetgun@gmail.com, drsmetgun@yahoo.com (I. Gun). Trisomy 8 mosaicism is a rare chromosomal abnormality seen more commonly in the male fetus [1,2]. It has high phenotypic and cytogenetic variability, and the degree of mosaicism does not relate to phenotypic appearance. The prevalence is about 1:25 000–50 000 births [2]. The life expectancy of these infants is generally normal. In contrast, complete trisomy 8 is usually lethal [1]. Trisomy 8mosaicism is characterized by pathologies such as intracranial and genitourinary abnormalities, multiple skeletal abnormalities, some congenital cardiovascular disorders, deep palmar and plantar creases, some solid neoplastic and hematological lesions, and mental retardation. Intracranial abnormalities include agenesis of the corpus callosum (ACC) and ventriculomegaly. Other signs such as corneal abnormalities, cleft palate, and strabismus have been rarely reported [2,4]. The present paper reports a case of trisomy 8mosaicism diagnosed at 23 weeks of gestation in a fetus carried by a 25-year-old patient (G1, P0)whohad a normal second-trimestermaternal serumscreening result. The detailed sonographic examination showed bilateral renal pyelectasis, polyhydramnios, bilateral ventriculomegaly, ACC, ventricular septal defect, dysmorphic face, and a single umbilical artery (Fig. 1). ACC was later confirmed by fetal MRI. Because the diagnosis was made at 23 weeks of gestation, cordocentesis was performed and revealed a fetal karyotype of 47,XY,+8[8]/46,XY[42]. The degree of mosaicism was 16%. Termination of the pregnancy was offered, but was declined by the patient. At term, a male neonate weighing 3780 g was delivered vaginally. The prenatal findings were confirmed post partum. In addition, contractures of fingers and toes were seen and surgical repair for the undescended testis was scheduled.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility.

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of β-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

Expression of P-cadherin (cadherin-3) and E-selectin in the villous trophoblast of first trimester human placenta.

OBJECTIVE Although trophoblastic invasion has a critical role in human placental development, very little is known about them. The aim of the present study was to localise the expression of P-cadherin (cadherin-3) and E-selectin in first trimester placenta. MATERIAL AND METHODS This study was conducted on 140 patients who had applied to Gülhane Military Medical Academy, Haydarpaşa Education Hospital, Department of Obstetrics and Gynaecology between 2005 and 2006. The patients were divided into three groups: ectopic pregnancy group (Group 1), spontaneous abortion group (group 2) and curettage group (group 3 and/or control group). Patients with a history of systemic diseases (such as thrombophilia), a disease or anatomical diagnosis that may cause recurrent abortion or an aetiological factor for ectopic pregnancy were excluded from the study. Paraffin blocks were stained with E-selectin and P-cadherin in accordance with the procedure. Demographic characteristics of patients (patient age, gravida, parity, number of previous abortions, and last menstrual period) and staining intensities were compared using Analysis of Variance (ANOVA) among groups. RESULTS According to the average scale score of P-cadherin staining of cells, the three groups were statistically different from each other (p=0.0001). This difference stems from statistically significantly lower scores in the spontaneous abortion group than in both the ectopic pregnancy group (p<0.001) and the control group (p<0.001). E-selectin immunostaining showed no positive staining in the groups. CONCLUSION In placental trophoblasts, decreased P-cadherin immunoreactivity plays a role in the aetiopathogenesis of spontaneous abortion.

Effect of an Amniotic Sheet on Pregnancy Outcomes

OBJECTIVES Our aim was to evaluate whether the presence of an amniotic sheet affects obstetric and neonatal outcomes. METHODS All singleton pregnant women with and without a sonographic diagnosis of an amniotic sheet between the 16th and 24th weeks of pregnancy were retrospectively identified. Two women without an amniotic sheet were randomly selected from the similar stratified periods as a control group for each case. The demographic characteristics and obstetric and perinatal outcomes were compared between the groups. Multivariable logistic regression was also performed for potential confounding factors. In addition, the subsequent pregnancies of 12 women with an amniotic sheet were followed during the antenatal and postnatal periods. RESULTS The prevalence of an amniotic sheet was 1.13%. The risk factors for an amniotic sheet were primiparity, previous normal vaginal delivery, previous dilation and curettage, and previous abortions. When the groups were compared in terms of maternal and neonatal outcomes, the rates of a nuchal cord at birth, breech birth, birth weight of less than 2500 g, preterm delivery (<37 weeks), and neonatal intensive care unit admission were higher in the amniotic sheet group than the control group. There were 2 intrauterine deaths in the amniotic sheet group. In addition, an amniotic sheet was not observed again in any of the subsequent pregnancies of the 12 cases from the amniotic sheet group, and these pregnancies eventuated uneventfully. CONCLUSIONS An amniotic sheet is associated with an increase in poor obstetric outcomes. Therefore, close monitoring of pregnancies after diagnosis is required.

Is prenatal volumetric evaluation of aneurysm of the vein of Galen important in the prediction of adverse fetal outcome

Aneurysm of the vein of Galen is a rare congenital vascular malformation of the central nervous system. There are controversies in the literature regarding the possible prognostic value of aneurysmal volume estimation with 3‐dimensional US for the prediction of fetal outcome. In this report, we present a case of prenatally diagnosed large aneurysm of the vein of Galen complicated by heart failure in a fetus. The volume of the malformation was calculated as 17.8 cm3 and the fetal outcome was poor.

Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain

Abstract Objective: To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women. Methods: This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3). Controls were matched for age and delivery time. Urinary/fecal incontinence were questioned and Female Sexual Function Index (FSFI) questionnaire was completed. Total FSFI and domain scores were compared. Statistical evaluation was performed using One-way ANOVA test or χ2 test. Statistical significance was defined as p < 0.05. Results: No women had urinary/fecal incontinence nor sexual dysfunction. Mean total FSFI points in Group 1 were significantly lower than in Groups 2 and 3 (p = 0.001). There were significant differences in sexual desire between groups 1 and 3 (p = 0.005), in arousal and in orgasm between both groups 1 and 2 (p = 0.001 and p = 0.038, respectively) and groups 1 and 3 (p = 0.001 and p = 0.001, respectively). There was no significant difference between groups 2 and 3 in any parameters or total points. Conclusions: Vaginal delivery with mediolateral episiotomy is not associated with urinary and/or fecal incontinence and sexual dysfunction but associated with a decreased sexual functioning as well as sexual desire, arousal and orgasm within postpartum five years.