Is there a relationship between age and side dominance of tubal ectopic pregnancies? – A preliminary report

Objectives: To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies. Material and Methods: One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and ≥40 years. Results: Of the patients who were ≥ 30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p=0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p=0.037). In the ≥ 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p=0.48). Conclusions: Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy, however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age

Ocena łożyska całkowicie przodującego przy pomocy rezonansu magnetycznego i ultrasonografii w celu wykrycia łożyska wrośniętego i jego wariantów

Objective: To evaluate the importance of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting placental adherence defects. Material and methods: Patients diagnozed with total placenta previa (n=40) in whom hysterectomy was performed due to placental adherence defects (n=20) or in whom the placenta detached spontaneously after a Cesarean delivery (n=20) were included into the study between June 2008 and January 2011, at the Department of Obstetrics and Gynecology, Ege University (Izmir, Turkey). Gray-scale US was used to check for any placental lacunae, sub-placental sonolucent spaces or a placental mass invading the vesicouterine plane and bladder. Intra-placental lacunar turbulent blood flow and an increase in vascularization in the vesicouterine plane were evaluated with color Doppler mode. Subsequently, all patients had MRI and the results were compared with the histopathologic examinations. Results: The sensitivity of MRI for diagnosis of placental adherence defects before the operation was 95%, with a specificity of 95%. In the presence of at least one diagnostic criterion, the sensitivity and specificity of US were 87.5% and 100% respectively, while the sensitivity of color Doppler US was 62.5% with a specificity of 100%. Conclusions: Currently, MRI appears to be the gold standard for the diagnosis of placenta accreta. None of the ultrasonographic criteria is solely sufficient to diagnose placental adherence defects, however, they assist in the diagnostic process.Cel pracy: Celem pracy była ocena przydatności ultrasonografii (US) i rezonansu magnetycznego (MRI) w wykrywaniu nieprawidłowości implantacji łożyska. Materiał i metoda: Do badania włączono pacjentki, które leczone były w Klinice Położnictwa i Ginekologii na Uniwersytecie Ege w Izmirze (Turcja), w okresie od czerwca 2008 do stycznia 2011, z powodu łożyska całkowicie przodującego (n=40). U 20 pacjentek wykonano histerektomię z powodu trudności w oddzieleniu łożyska a u 20 łożysko oddzieliło się samoistnie w trakcie cięcia cesarskiego. Zastosowano skalę Graya do oceny lakun w łożysku, wolnych przestrzeni pod płytą łożyska oraz masy łożyskowej naciekającej płaszczyznę pęcherzowo-maciczną oraz pęcherz moczowy. W badaniu USG z kolorowym Dopplerem oceniano turbulentny przepływ krwi w lakunach wewnątrzłożyskowych oraz wzrost unaczynienia w płaszczyźnie pęcherzowo-macicznej. Następnie wszystkie pacjentki miały wykonane badanie MRI a wyniki porównano z oceną histopatologiczną. Wyniki: Czułość badania MRI dla rozpoznania nieprawidłowości implantacji łożyska przed operacją wyniosła 95% a specyficzność również 95%. Przy obecnym przynajmniej jednym kryterium diagnostycznym, czułość i specyficzność badania USG wyniosły odpowiednio 87,5% i 100%, podczas gdy czułość kolorowego Dopplera wyniosła 62,5% a specyficzność 100%. Wnioski: Obecnie badanie MRI jest złotym standardem wykrywania łożyska wrośniętego. Żadne z ultrasonograficznych kryteriów nie jest wystarczające do rozpoznania nieprawidłowości implantacji łożyska, aczkolwiek pełnią funkcję pomocniczą w procesie diagnostycznym

Kombinacja wewnątrzczaszkowej przezierności i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymestrze ciąży: opis przypadku i przegląd literatury

Neural tube defects are congenital defects of the central nervous system caused by lack of neural tube closure. First trimester screening for aneuploidy has become widespread in the recent years. Fetal intracranial translucency (IT) can be easily observed in normal fetuses in the mid-sagittal plane. The absence of IT should be an important factor taken into consideration in the early diagnosis of open spinal defects. 3D ultrasonography is especially useful in cases of spinal anomalies where the visualization of the fetal structure is insufficient due to fetal position. We present a combination of intracranial translucency and 3D sonography used in the first trimester diagnosis of a neural tube defect case.Wady cewy nerwowej są wrodzonymi defektami centralnego układu nerwowego spowodowanymi brakiem zamknięcia cewy nerwowej. Badania skriningowe w pierwszym trymestrze w kierunku aneuploidii stały się w ostatnich latach bardzo rozpowszechnione. Płodowa przezierność wewnątrzczaszkowa może być oceniona w prawidłowych płodach w płaszczyźnie pośrodkowej. Brak przezierności wewnątrzczaszkowej (IT) powinien być istotnym czynnikiem ryzyka branym pod uwagę we wczesnej diagnostyce otwartych wad cewy nerwowej. Ultrasonografia 3D jest szczególnie przydatna w przypadkach gdy uwidocznienie struktur płodu jest niewystarczające z uwagi na pozycję płodu. Przedstawiamy kombinację przezierności wewnątrzczaszkowej i ultrasonografii 3D w diagnostyce wad cewy nerwowej w pierwszym trymetrze ciąży

Perfore apandisit sonrası gelişen peritonit, peritonial abse ve erken doğum: 2 olgu sunumu

Although appendicitis is the most common non-obstetric surgical problem in pregnancy, it is difficult to diagnose. Because, clinic examinations, laboratory findings are different and all of the radiologic imaging techniques can not be used in pregnancy. In order to this, complications of appendicitis may occur. One of the most important complications of the appendicitis is perforated appendicitis. We reported two pregnant women who operated in the third trimester for perforated appendicitis and had diffuse peritonitis and peritoneal abscess after surgery. In pregnancy, preterm birth rate is higher after perforated appendicitis. Difficulties in diagnosis make appendicitis more complicated with pregnancy and fetal outcome become worse.Apandisit, gebelikte en sık rastlanılan obstetrik dışı cerrahi problem olmasına rağmen gebelikte tanı koymak zorlaşır. Gebelikte gerek klinik bulguların, gerekse laboratuar bulgularının farklı olması ve radyolojik görüntüleme yöntemlerinin daha kısıtlı kullanılması tanı koymayı zorlaştırır ve geciktirir. Bu nedenle apandisitin komplikasyonları ortaya çıkabilir. Apandisitin en önemli komplikasyonlarından biri perfore apandisittir. Makalemizde,3. trimesterde perfore apandisit nedeniyle opere olan ve ameliyat sonrası dönemde kliniğimizde erken doğum tehtidi tanıları ile takip edilirken peritonit ve yaygın peritonial abse saptanan ve erken doğum yapan 2 olgu sunulacaktır. Gebelikte perfore apandisit sonrası erken doğum riski yüksektir. Tanı koymadaki zorluklar, apandisitle birlikte gebeliği de komplike hale getirmekte, hem anne hem de fetus açısından olumsuz sonuçlar doğurmaktadır

Prenatal diagnosis of caudal regression syndrome without maternal diabetes mellitus

Caudal regression syndrome is a rare congenital malformation with varying degrees of early gestational developmental failure. It is also known as sacral agenesis or caudal dysplasia. The cause of this malformation is thought to be defects in neuralization around the 28th day of the gestational period. Although maternal uncontrolled diabetes, genetic predisposition and vascular hypoperfusion are the possible risk factors, actual pathogenesis is unclear. CRS is generally diagnosed at prenatal assessment, but also a varying number of newborns with some degree of anomaly may be presented. In our case, we diagnosed a caudal regression syndrome fetus early in the second trimester. Determination of the pathology early in the gestational age gives parents a chance for termination of pregnancy. Although diabetes mellitus is the major risk factor for CRS, as in our case, sporadic presentations may occur. So clinicians should consider CRS when CRL is shorter than expected and incomplete vertebral ossification is observed both in gray scala and 3D imaging ultrasonography. (J Turkish-German Gynecol Assoc 2011; 12: 186-8)Kaudal regresyon sendromu (KRS) çeşitli derecelerde erken gestasyonel gelişim bozukluğunun gözlendiği nadir bir konjenital anomalidir. Bu durum sakral agensesis ya da kaudal displazi olarak da bilinmektedir. Gebeliğin 28. günü civarında oluşabilecek nöralizasyon defekti bu malformasyonun nedeni olarak düşünülmektedir. Maternal kontrolsüz diabet, genetik yatkınlık ve vasküler hipoperfüzyon olası risk faktörleri olmasına rağmen, gerçek patogenezis belirsizdir. KRS tanısı genellikle prenatal olarak koyulur, ancak yine de değişen sayıda yeni doğan çeşitli derecelerde anomalilerle tanı alabilirler. Sunulan kaudal regresyon sendromlu fetüs olgusuna erken ikinci trimesterde tanı koyduk. Patolojinin erken gebelik haftalarında belirlenmesi ile aile gebelik terminasyonu şansına sahip olabilir. Diabetes mellitus, KRS için majör faktörü olmasına karşın, bizim olgumuzda olduğu gibi spoaradik durumlar da sözkonusu olabilir. Böylece, klinisyenler beklenenden kısa CRL ile karşılaştıklarında ve hem gri skala hem de 3D ultrasonografide tamamlanmamış vertebral ossifikasyon görünümü saptadıklarında kaudal regresyon sendromunu düşünmelidir. (J Turkish-German Gynecol Assoc 2011; 12: 186-8