M. Ozekinci

Immunolocalization of cell cycle proteins (p57, p27, cyclin D3, PCNA and Ki67) in intrauterine growth retardation (IUGR) and normal human term placentas

Placental development involves a series of events that depend on the coordinated action of proliferation, differentiation and invasion of trophoblasts. Studies on cell cycle related proteins controlling these events are fairly limited. It is still not fully determined how placental tissue proliferation is affected by intrauterine growth retardation (IUGR). Information on cell cycle related proteins that control these events is limited and how they are affected in IUGR is not fully understood. The aim of this study was to understand the role of cell cycle regulators in IUGR placentas and to determine the spatio-temporal immunolocalization of these cell cycle regulators in human IUGR and normal term placentas. Placental samples were stained immunohistochemically with PCNA, Ki67, cyclin D3, p27 and p57 antibodies and were examined by light microscopy. In all regions of IUGR placentas, PCNA, Ki67 and cyclin D3 staining intensities were statistically significantly decreased compared to normal controls. p27 staining intensity of the IUGR group was statistically significantly increased in villous parts and chorionic plates in comparison with the normal term placentas. Moreover, p57 staining intensity was statistically significantly increased in all parts of the IUGR group compared to controls. The observed placental abnormalities in IUGR placentas may be associated with arrest mechanisms affecting cell proliferation and cell cycle alterations in IUGR.

Assessment of women who applied for the uterine transplant project as potential candidates for uterus transplantation.

To review the medical charts of women who applied for the uterine transplant project from June 2008 to June 2011 in our hospital retrospectively (18–40 years).

Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma

It has been reported that, compared with simple increased nuchal translucency, fetal cases with septated cystic hygroma (CH) are more likely to face perinatal handicaps. However, pediatric outcomes and proper prenatal counseling for this anomaly have not yet been truly defined. We performed this study to determine pregnancy and pediatric outcomes of fetuses with septated CH. We searched records for cases with septated CH and collected data for structural abnormalities, karyotype analysis, and pregnancy outcomes. Fetuses born with septated CH were also evaluated for their pediatric outcomes. Sixty-nine fetuses with septated CH were enrolled in the study. Results showed that chromosomal abnormalities were present in 28 fetuses (40.6%), and the most common aneuploidy was Turner syndrome (n=14, 20.3%); 16 (23.2%) of the remaining cases, in which aneuploidy was not found, had coexistent structural malformations; 25 (36.2%) cases had normal karyotype and morphology. The total number of live births and infants with unfavorable neurologic follow-up were 13 (18.8%) and 2 (2.9%), respectively. Septated CH is associated with poor perinatal outcomes; therefore, karyotype analysis and ultrasonographic anomaly screening should be performed as initial steps, and expectant management should be offered to couples with euploid fetuses that have normal morphology.

A retrospective analysis of pregnancy outcomes after kidney transplantation in a single center.

Background: We reported pregnancy outcomes after kidney transplantation in a single transplant center. Methods: We reviewed the perinatal outcomes of female kidney transplant patients of reproductive age (18-40 years) from 1987 to 2011. Results: A total of 246 patients were reviewed. Of these, 43 women registered a pregnancy following kidney transplantation. The mean patient age was 31.3 ± 4.2 years (range 24-40). The mean transplant-conception interval was 35.9 ± 12.6 months (range 24-120); 9 patients had a cadaveric allograft. The human leukocyte antigen match was ≥3/6 for 34 patients. The rate of live births was 29/43 (67.4%), miscarriage 10/43 (23.2%), preterm delivery 7/29 (24.1%), preeclampsia 5/29 (17.2%), and intrauterine growth retardation 2/29 (6.9%). Overall, 3/29 patients (10.3%) received a blood transfusion during pregnancy due to persistent symptomatic anemia, despite iron replacement and erythropoietin therapy; 24 patients (82%) had a cesarean section delivery; 3 patients had kidney rejection during pregnancy, with 2 occurring during the 6th postpartum month. Conclusion: Pregnancy should be considered a high risk in renal transplant recipients, necessitating close follow-up.

Effect of injectable medroxyprogesterone acetate and etonogestrel implants on GABA-A and serotonin receptors in white and gray matter of the brain: experimental study in rats.

Abstract The aim of this study was to evaluate the time-dependent effect of progesterone-only contraceptives on the brain and to obtain an improved understanding of mood disorders experienced under this medication. A total of 66 Wistar albino rats were divided into three groups: etonogestrel (ENG) implant (group 1, n = 30); depot medroxyprogesterone acetate (MPA)-injectable (group 2, n = 30); and control (group 3, n = 6) groups. Groups 1 and 2 were each divided into five subgroups, which were examined every 10 d for up to 50 d after medication administration, to evaluate its time-dependent effect. There was no difference in terms of gamma-aminobutyric acid (GABA) and serotonin immunohistochemical staining in white and gray matter among the subgroups of group 1. In group 2, there was a significant decrease in serotonin receptor staining intensity in white and gray matter on day 50, when compared to the control group (p = 0.041). When the subgroups of group 2 were compared, there was a significant decrease in serotonin receptor staining intensity in white and gray matter on days 40 and 50 when compared to day 10. In conclusion, we showed that ENG and MPA have no effect on apoptosis and GABA-A receptors in the brain. We also showed that MPA has time-dependent effects on serotonin receptors, which may be a possible mechanism involved in mood disorders during long-term usage of injectable progesterone-only contraceptives.

The association between ischaemia-modified albumin levels in umbilical vein and intrauterine growth restriction.

Abstract Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Ischaemia-modified albumin (IMA), a product deriving from albumin as a result of the modification by oxidative free radicals in response to hypoxia, was previously used as a marker of ischaemia in acute coronary syndrome. We performed this study to determine whether umbilical venous IMA levels are associated with IUGR. A total of 40 pregnancies with IUGR were compared with 40 of normal fetal development. Blood samples were obtained from the umbilical vein after delivery. IMA levels in the IUGR group were higher than in the control group (78.74 ± 6.87 vs 74.43 ± 7.84 U/ml, respectively, p = 0.011). An elevated IMA level was associated with IUGR (OR: 1.079, 95% CI: 1.000–1.163, p = 0.049). We suggest that IMA, which was formerly proved to arise in ischaemic conditions, may also be a valuable marker in perinatal hypoxia and IUGR detection.

Fetal Circulatory Variation in an Acute Incident Causing Bradycardia

Umbilical artery\vein, middle cerebral artery, and ductus venosus Doppler velocimetry were performed at 33 weeks of gestation in the settings of an intrauterine growth restricted fetus during a heart rate deceleration. Interestingly, we recorded a sudden onset redistribution of fetal blood flow with fetal bradycardia. Spontaneous normalization of waveforms was observed once fetal heart rate returned to normal. Our case provides evidence to circulatory variation of a human fetus resulting from an acute incident causing bradycardia.

P11.07: Transabdominal oocyte pick up in a patient with mullerian agenesis and solitary pelvic kidney

A 24 year old patient presenting with primary amenorrhea and primary infertility of 6 years was diagnosed as MayerRokitansky-Küster-Hauser (MRKH) syndrome. She was confirmed to have a normal karyotype (46, XX) and normal sexual development. Serial hormonal determinations indicated normal ovarian function and appropriate early follicular FSH; LH levels(4.58IU/L;5.2IU/L). On evaluation of pelvis a solitary kidney was visualised with ultrasonography and MRI. Bilateral ovaries were located close to abdominal wall laterally. Her ovaries could not be adequately imaged transvaginally with a 5-MHz to 9-MHz transvaginal ultrasound probe. The ovaries located entirely lateral to bilateral pelvic brims were better visualized using a 2-MHz to 7-MHz transabdominal probe. Following controlled ovarian hyperstimulation and 36 hours after hCG trigger, eight M2 oocytes were retrieved transabdominal-transperitoneally with transvaginal ultrasound probe guidance (Figure 1). Four grade 1 embryos were vitrified. Transabdominal-transperitoneal ultrasound guided oocyte retrieval might be more adequate in selected cases.

Congenital high airway obstruction syndrome and abnormal pulmonary situs: An extremely rare prenatal association

A 27-year-old gravida 2 para 1 woman, at 23 weeks of gestation, was referred to Akdeniz University Perinatology Department for evaluation of fetal ascites. Grayscale ultrasonography revealed enlarged and hyperechoic lungs, and dilated and prominent trachea that extended to the subglottic level, compressed heart and low cardiothoracic circumference ratio, inverted diaphragmatic convexity, ascites, and skin edema with polyhydramnios (Figures 1 and 2). According to these findings, congenital high airway obstruction syndrome (CHAOS) due to laryngeal atresiawas considered as the diagnosis. The couple was informed about ex utero intrapartum treatment (EXIT) and the relatively poor prognosis of the syndrome. Finally, pregnancy termination was chosen. Fetal autopsy revealed laryngeal atresia, intact esophagus without fistula, ventricular septal defect and hypoplastic right kidney. The lungs were bilaterally enlarged. The right and left lungs were bilobulated and trilobulated, respectively (Figures 3 and 4). The length of the right bronchus from the carina to its first branch was longer than the left side. The situs of other organs was normal. Finally, amniocentesis revealed a normal male karyotype (46,XY). With today’s high resolution ultrasound probes, it is straightforward to detect the major features of CHAOS. However, the potential higher failure rate in EXIT procedure of a fetus with a lower level obstruction ascribes further importance to recognizing CHAOS

Abnormal patterns of blood flow through the uterine arteries: Is it a clue for placental abruption in clinically suspected cases?

Placental abruption is defi ned as ‘ premature separation of normally implanted placenta from uterus, generally characterised by abdominal/pelvic pain, vaginal bleeding and uterine tenderness ’ . It complicates approximately 1% of births and is one of the most important causes of maternal morbidity and perinatal mortality (Tikkanen 2011). Th erefore, accurate diagnosis of abruption and, possibly, prediction of its worsening are extremely important when considering a conservative treatment. However, as is oft en the case, the classic triad is present only in minority of cases. Moreover, ultrasonography, despite recent technical advances, is not sensitive in detection of abruption (Glantz and Purnell 2002). Unfortunately, the most sensitive indicator of abruption still seems to be the presence of foetal compromise.