Talat Umut Kutlu Dilek

Treatment of viable cesarean scar ectopic pregnancy with suction curettage

Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy.

Progressive Cervical Length Changes versus Single Cervical Length Measurement by Transvaginal Ultrasound for Prediction of Preterm Delivery

Background: To evaluate cervical length changes as predictors of preterm delivery. Methods: Two hundred and fifty-seven pregnant women underwent transvaginal ultrasound examination at 16 and 24 weeks of gestation. Cervical length was measured and the difference between the 2 measurements was calculated. The sensitivity, specificity, positive predictive value and negative predictive value of cervical length and cervical length changes were calculated and these methods were compared by receiver-operating characteristic (ROC) curve analysis. Results: Preterm delivery (before 37 weeks of gestation) occurred in 19 patients (7.4%). The mean cervical length was shorter in the preterm group, the area under the ROC curve for prediction of preterm delivery was 0.914, ultrasound had a sensitivity of 84.2% to predict preterm delivery with a false-positive rate of 18.5%, and the relative risk was 4.56 at the 34.3-mm cutoff value at 24 weeks of gestation. In contrast, a cervical length change on transvaginal ultrasound had a sensitivity of 73.3% to predict preterm delivery with a false-positive rate of 18.1%, and the relative risk was 4.08 at the 6.6-mm cutoff value. Conclusion: A single cervical length measurement obtained at 24 weeks of gestation can predict preterm delivery as accurately as cervical length change.

Spontaneous Twin Pregnancy in Uterus Bicornis Unicollis

Abnormal fusion of the Müllerian ducts or failure of resorption of the septum causes varying degrees of congenital uterine malformation. They are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Twin gestation in a case of bicornuate uterus is extremely rare. A 37-year-old multiparous woman conceived a twin dichorionic diamniotic pregnancy spontaneously. Three-dimensional ultrasound revealed bicornuate uterus with one embryo in each cavity. Perinatal course was uneventful. At 35 weeks of pregnancy, spontaneous labour started and twin babies were delivered by bilateral low transvers caesarean section. Because of the rare occurrence of twin gestation in bicornuate uterus, there is no uniform guideline to manage these cases appropriately. Delivery by planned caesarean section could avoid the possible obstetric complications by dystocia.

Effect of cervical length on second trimester pregnancy termination.

Aim:  To evaluate the value of sonographic measurement of cervical length as a predictor of abortion or delivery within 24 h by misoprostol in second trimester termination of pregnancy (TOP).

A case series on fetal ovarian cysts

Objective: We aimed to discuss the ultrasonographic characteristics and follow-ups of 7 fetuses which were established with the diagnosis of prenatal fetal ovarian cyst and followed up between 2012 and 2017. Cases: Sonographic findings and prenatal and postnatal progress of a total of 7 cases with fetal ovarian cyst which were detected by chance during the routine gestational follow-ups performed in the third trimester of pregnancy were presented. While four of the seven cases were lost during prenatal and postnatal periods, it was observed that 3 cases persisted in their follow-ups. Conclusion: Fetal ovarian cysts are the abdominal cystic masses which are diagnosed with a gradually increasing frequency. The majority of them are functional cysts. Regular follow-up of the cyst size and ultrasonographic characteristics is the most frequently used method in the approach. Waiting for follow-up and spontaneous regression in fetal ovarian cysts which do not exhibit septation and increase in the size, and have thin walls and no heterogeneous cystic content seems to be an appropriate approach.

Isolated fetal lymphatic malformation of the thigh: prenatal diagnosis and follow-up

Fetal lymphatic malformation can be found in different parts of the fetal body. It occurs most frequently in the nuchal and axillary region and less frequently in the abdomen or inguinal areas. Lymphatic malformation has been associated with fetal aneuploidy, hydrops fetalis, structural malformations, and intrauterine fetal death. A 31-year-old gravida 3, para 2 woman was admitted to our hospital at 22 weeks of gestation (confirmed by ultrasonographic examination). The fetus was alive, and had a mass derived from the left inguinal region extending to the anterior left leg with fluid-filled cavities about 3–5 cm in size. There was no evidence of intra-abdominal extension of the mass. Amniocentesis was performed. Fetal magnetic resonance imaging revealed a left inguinal cystic mass, which extended to the left thigh. Antenatal follow-up was uneventful. The mother gave birth at term with a cesarean section. Postnatal clinical examination and imaging examination confirmed the diagnosis of lymphatic malformation. Fetal lymphatic malformation carries a high risk of aneuploidy and fetal malformations. Patients diagnosed with lymphatic malformation in antenatal follow-up should be assessed in terms of coexistent anomalies. Fetal karyotyping should be done and the fetus should be monitored for fetal hydrops.

Central nervous system findings associated with co-twin death in twin pregnancy: Correlation between ultrasonography and magnetic resonance findings

Objective: In this article, we aimed to discuss central nervous system findings appearing in living fetus after co-twin death in a twin pregnancy and therefore the correlation and its supplementary characteristics between magnetic resonance imaging (MRI) and ultrasonography. Case: Of the thirty-tree-year-old patient who was pregnant for the second time, 24x25 mm hyperechogenic view compatible with hemorrhage in frontal horn of the left lateral ventricle was observed in the surviving fetus after in utero loss of monochorionic co-twin at 27 weeks of gestation. It was also found that the adjacent cerebral parenchyma was also in heterogeneous view. In the MRI carried out, hemorrhage indicators reaching to parenchyma and opening to ventricle were observed on bilateral basal ganglions, being more distinct on the left. With these findings, the lesion was evaluated as grade IV germinal matrix hemorrhage. While the woman was pregnant for 29 weeks and 6 days, one male baby which was 1153 g was delivered by cesarean section after the rupture of membrane. Conclusion: Ultrasonography and magnetic resonance imaging complete each other in the diagnosis of the complications of central nervous system appearing in the surviving co-twin after the death of other co-twin. MRI provides better anatomical details for revealing ischemia-associated late sequels.