Murat Yayla

Ultrasound screening for fetal major abnormalities at 11-14 weeks.

Background. This study was planned to evaluate the efficiency of the 11–14 week scan in detecting fetuses with major fetal structural abnormalities. Methods. Some 1,290 pregnant women were submitted to a routine ultrasound scan between the 11th and 14th week after the detection of the fetal viability. The fetal anatomy was examined transabdominally, and in suspected cases transvaginally. Following the scans, the patients were examined in the second or third trimester of pregnancy. Fetal structural abnormalities classified as major and early onset were noted. Isolated choroid plexus cysts, cardiac defects not requiring treatment, mild ventriculomegaly, and mild renal pelviectasis in second trimester were not included. Results. Twenty‐four (1.86%) fetuses with various defects were identified, and 17 of these were diagnosed at the 11–14 week scan. The antenatal ultrasound detection rate of the fetuses with major anomalies was 95%, and 70% were detected in the first‐trimester assessment. Four cardiac defects associated with genetic syndromes or requiring operation were included (0.31%) in this series. Two of the fetuses with cardiac defects (50%) had an increased nuchal translucency thickness. In this group, none of the fetuses with karyotype anomalies was born alive. Conclusions. The first‐trimester scan is important in routine antenatal care for early detection of fetal defects, and determination of the fetuses at risk of cardiac anomalies and genetic syndromes.

The use of recombinant factor VIIa in a primigravida with Glanzmann’s thrombasthenia during delivery

Abstract Glanzmann’s thrombasthenia is an inherited hemorrhagic disorder characterized by a severe reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists due to qualitative or quantitative abnormalities of platelet glycoprotein IIb-IIIa. Glanzmann’s thrombasthenia is characterized by potentially major mucocutaneous bleeding and prolonged bleeding time. Platelet counts, platelet morphology, prothrombin, and activated thromboplastin times are all within normal ranges in patients with Glanzmann’s thrombasthenia. Pregnancy and delivery are rare in Glanzmann thrombasthenia patients and have been associated with immediate postpartum hemorrhage. We describe the peripartum management of a 31-year-old primipara with Glanzmann’s thrombasthenia who underwent spontaneous vaginal delivery. Four units of single-donor platelets, two units of packed red blood cells, 36 µg/kg recombinant human coagulation Factor VIIa (rFVIIa) were given during peripartum management.

DO CELLULAR PHONES ALTER BLOOD PARAMETERS AND BIRTH WEIGHT OF RATS

The present study aimed to investigate the effects of microwaves (MW) emitted by cellular phones (CPs) on peripheral blood parameters and birth weights of rats. Thirty-six albino rats were divided into four groups, male (n = 6) and female sham-exposed groups (n = 12) and male (n = 6) and female experimental groups (n = 12). No blood parameters differed following exposure (p > 0.05). The birth weight of offspring in the experimental group was significantly lower than in the sham-exposed group (p < 0.001). No significant differences were observed between rectal temperatures of rats in the sham and experimental groups (p > 0.05). The specific absorption rate (SAR) was found to be 0.155 W/kg for the experimental groups. All parameters investigated were normal in the next generation of rats (p > 0.05).

Maternal Plasma Fibronectin and Advanced Oxidative Protein Products for the Prediction of Preeclampsia in High Risk Pregnancies: A Prospective Cohort Study

Objective: To determine whether maternal plasma fibronectin and advanced oxidative protein products (AOPP) can be used for the prediction of preeclampsia in high-risk women. Study Design: One hundred pregnant women at high risk of preeclampsia were enrolled in this prospective cohort study. Maternal plasma total fibronectin and AOPP levels were measured at 19–25 weeks of gestation. AOPP levels were also measured in 23 normal non-pregnant women. After delivery, the pregnant cohort was assigned to either the normotensive or preeclamptic group depending on their clinical course. Results: Among the 78 pregnant women who completed the study, 19 (24.3%) developed preeclampsia between 36 and 39 (36.8 ± 1.0) weeks of gestation. AOPP levels, which are significantly higher in normotensive pregnant women compared to nonpregnant controls (42.55 ± 15.94 vs. 27.95 ± 10.5; p = 0.0001) were not significantly different between normotensive and preeclamptic women (42.55 ± 15.94 vs. 47.45 ± 14.19 μM; p = 0.23). Plasma fibronectin levels were significantly higher in women who continued to develop preeclampsia rather than remain normotensive (383.68 ± 19.07 vs. 227.65 ± 97.39; p < 0.0001). ROC curve analysis shows that total fibronectin ≥360 mg/l is predictive for the development of preeclampsia. The sensitivity, specificity, positive and negative predictive values are 57, 92, 73 and 85%, respectively, with a likelihood ratio of 7.38. Conclusion: Second trimester plasma concentrations of AOPP are not altered in women that develop pre-eclampsia later in pregnancy. However, total fibronectin levels are significantly increased and may be used to predict the onset of clinical symptoms of preeclampsia.

Prenatal Diagnosis of Bartter Syndrome with Biochemical Examination of Amniotic Fluid: Case Report

Antenatal Bartter syndrome typically presents with marked fetal polyuria that leads to polyhydramnios and premature delivery. In our case, polyhydramnios was detected at 26 weeks of gestation and amniotic fluid chloride level was high. Serial amnion-drains were performed. During indomethacine treatment, fetal bradycardia developed. The mother was given daily oral potassium to maintain normal serum level and prevent fetal arrhythmias. After birth, hypokalaemic alkalosis, low chloride, hyper-reninemia and hyperaldosteronemia were detected.

Transvaginal Sonographic Evaluation of the Cervix in Asymptomatic Singleton Pregnancy and Management Options in Short Cervix

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at <37 weeks. Available evidence supports the use of progesterone to women with cervical length ≤25 mm, irrespective of other risk factors. In women with prior spontaneous PTD with asymptomatic cervical shortening (CL ≤ 25 mm), prophylactic cerclage procedure must be performed and weekly to every two weeks follow-up is essential. This article reviews the evidence in support of the clinical introduction of transvaginal sonography for both the prediction and management of spontaneous preterm labour.

Antenatal Bartter syndrome: analysis of two cases with placental findings.

The prenatal diagnosis of Bartter syndrome can be based on the high chloride level in the amniotic fluid. Microscopic examination of the placenta in untreated cases showed extensive mineralization in the chorionic villi in previous studies. Two cases were presented at 26–29 weeks of gestation with severe polyhydramnios. The mothers were treated with Indomethacin, KCl, and serial amniocentesis in order to reduce the amniotic fluid volume and prevent fetal hypokalemia. The microscopic examination of the placenta revealed focal calcification and acute atherosis in placental vessels. The treatment with Indomethacin in the antenatal period can prevent severe nephrocalcinosis.

Jarcho-Levin Syndrome Presenting as Neural Tube Defect: Report of Four Cases and Pitfalls of Diagnosis

Jarcho-Levin syndrome (JLS) causes severe vertebral and thoracic deformity and has an autosomal-recessive mode of inheritance. Prenatal diagnosis may be difficult in some cases without the history of an affected baby. We present 4 cases of JLS with neural tube defects as the prominent finding. In 2 of them the deformity of the thorax was minimal and was not detected by ultrasonography. Rib anomalies were revealed with radiological and pathological examinations after the termination. The location of the vertebral defect may be the determinant factor for the severity of the thoracic deformity. The real recurrence risk could only be found out after postnatal examinations in cases with neural tube defects.

Sonographically Diagnosed Vault Hematomas Following Vaginal Hysterectomy and Its Correlation with Postoperative Morbidity

Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. Results. The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. Conclusion. Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.

A foreign body (gossypiboma) in pregnancy: first report of a case

The technical name for a surgical sponge left in the body of a patient is inadvertent “gossypiboma.” The word is derived from the Latin word Gossypium for cotton and from the Kiswahili word boma for “place of concealment.” These retained sponges were first seen as “textilomas,” but were renamed “gossypiboma” in 1978. The first case was reported by Wilson in 1884. These are rarely are retrieved in the literature, because of legal complications. A higher incidence of retained laparotomy sponges has been reported in association with gynecological procedures. We report a case of gossypiboma in the 38th week of pregnancy that imitated an ovary neoplasm.