Prenatal Diagnosis of Iniencephaly: Clues and Pitfalls

Iniencephaly is a congenital malformation consisting of occipital bone defect with enlargement of the foramen magnum, cervical dysraphism and fixed retroflection of the head due to spinal deformities. A 38-years-old woman presented to Etlik Zubeyde Hanim Maternity Hospital perinatology clinic at 18 week of gestation. Ultrasonography revealed a large occipital encephalocele and short cervicothoracic spine. Termination of pregnancy was recommended with the diagnosis of iniencephaly but the family refused it because of religious concerns. She was lost in follow-up but at 38 weeks she presented to our department with regular uterine contractions. Ultrasonography revealed extreme retroflexion of the head, a very short cervicothoracic spine, an encephalocele and marked polyhydramnios. Due to severe retroflexion of the head, a caudal sweep motion of the ultrasound probe gave an impression of a posteriorly placed bladder. Normal chin and neck relation was lacking. A cesarean section was decided due to marked flexion of the spine. A female fetus was delivered weighing 2790 g, with Apgar scores of 1 at 1 min and 1 at 5 min. Iniencephaly is a lethal abnormality which may be diagnosed prenatally with striking ultrasonographic features

Parenteral Iron Sucrose Therapy for Moderate and Severe Iron-Deficiency Anemia in Pregnancy

Objective: Parenteral iron therapy for iron deficiency anemia is gaining popularity due to its fast and impressing action. However, effectiveness and safety of iron sucrose in pregnant patient population is less clear. In this study, we aimed to review our intravenous iron sucrose use in pregnant patients. Study Design: The medical records of all anemic pregnant patients hospitalized for parenteral iron sucrose therapy were reviewed retrospectively. Results: The results of 117 pregnant women were available. Thirty-one (26.5%) and 86 (73.5%) of the patients were in the 2nd and 3rd trimester of the pregnancy, respectively. Four (%3.4) of the patients had severe and 113 (%96.6) of the patients had moderate anemia. The median gestational age for iron sucrose administration was 31.1 weeks (26.8-34.3). The mean hemoglobin, hematocrit and ferritin levels before and after delivery were 10.8±1.3 gr/l; 9.9±1.3 gr/l, 33.5±4.0; 30.8±4.0 and 89.6±0.7 μg/L; 98.1±0.9 μg/L, respectively. All but 2 (1.8%) patients had elevated hemoglobin levels after iron sucrose therapy. When hemoglobin and hematocrit levels were compared between before iron sucrose therapy and before delivery, there was a 2.8 g/l and 7.8 % increase in the mean hemoglobin and hematocrit levels, respectively and the difference was statistically significant (p= 0.001 and p=0.001, respectively). Five patients (4.3%) reported mild hypersensitivity reaction to intravenous iron in the form of mild itching at the infusion site. No severe or life-threatening hypersensitivity reaction was reported. Conclusion: In this study, we found out that intravenous iron sucrose therapy for iron deficiency anemia is feasible, effective and has a good safety profile

Fetal Ovarian Cyst Rupture Resulting in Transient Fetal Ascites

A 21-year-old gravida 1 para 0 woman was referred to our maternal-fetal medicine center due to a fetal intraabdominal cyst at 32 weeks of pregnancy. On the ultrasonography, lateral and superior to the bladder, there was a sharply circumscribed, thin walled anechoic cystic structure measuring 56x58 millimeter. Our presumed diagnosis was fetal ovarian cyst and we decided to aspirate the fluid and scheduled it on Monday. The family was informed about the situation and the procedure was postponed on Monday for family decision. However, on Monday, there was no cystic structure but surprisingly, severe spontaneous fetal ascites developed. On the follow-up, one week later, there was no intraabdominal fluid or cyst. At 38 weeks 2 days of pregnancy, the patient vaginally delivered a 3460 grams healthy female baby. Although it is rare, ovarian cyst should be in the differential diagnosis of fetal ascites especially when it is recent and transient

A Case of Complete Chorioamniotic Membrane Separation after Amniocentesis Resulted with a Healthy Term Delivery

Separation between amniotic and chorionic membranes is a normal sonographic finding before 14th weeks of gestation. As pregnancy progresses, these membranes fuse and chorionic cavity becomes obliterated. Chorioamniotic membrane separation may occur spontaneously or as a complication of invasive intrauterine procedures. Following invasive fetal intervention, resulting in a condition referred to as chorioamniotic membrane separation (CMS) and it is reported to be associated with adverse perinatal fetal outcomes. Here we present a case of CMS that had occurred after a second trimester amniocentesis and resulted with the delivery of a term healthy baby. Complete post-interventional CMS may complicate pregnancy progression. Although there are no established guidelines to follow, close follow-up may CMS can be managed to be a morbid, rather than mortal condition

Comparison of the Histologic Results of Atypical Glandular Cells-Favor Neoplasia and Atypical Glandular Cells-Not Otherwise Specified

Objective: Cervical cancer screening programs are widely performed in all around the world. The interpretation of the Pap smear test is a big challenge in gynecology practice particularly when associated with atypical glandular cells. In this study, we performed a retrospective analysis of cytologic results associated with atypical glandular cells in our institution. Material and Method: We retrospectively reviewed Pap smear tests resulted as “atypical glandular cells”. A total of 122 women had screening tests reported as “atypical glandular cells” between 2003 and 2013 at the Ministry of Health, Etlik Maternity and Women’s Health Teaching Research. The cytology reported as “atypical glandular cells” were evaluated in two main groups: Atypical glandular cells-favor neoplasia (AGC-FN) and atypical glandular cells-not otherwise specified (AGC-NOS) compared by means of histologic results. Results: Thirty-two women have been reported as AGC-NOS on cytologic examination and 90 women were defined as AGC-FN. There was no significant difference between AGC-FN and AGC NOS groups in terms of age. In AGC-FN group, a total of 13 women (13/90) (14.4%) had malignant histological diagnosis. In AGC-NOS group only one woman (1/32) (3.1%) was diagnosed as malignant. All the malignant cases in this study are older than 35 years. Conclusion: The incidence of AGC is less than 1% in all Pap smear examinations. Two main factors were important in the outcome of the AGC. The first one is the subgroup. AGC-FN group has a higher risk of malignancy. The second important factor is the age of the patient. To be older than 35 years old seems to increase the risk of malignancy

Meigs’ Syndromes with Extremelly High CA125 Level Mimicking Advanced Ovarian Cancer

Meigs' syndrome is defined as pelvic mass with ascites and pleural effusion which can mimic ovarian malignancy. Additionally, elevated serum CA125 level can be seen in Meigs' syndrome. We present 2 cases with solid adnexal mass, ascites and bilateral pleural effusion with high serum CA125 level (2824 IU/mL and 1400 IU/mL) which were diagnosed as ovarian malignancy preoperatively. In both cases level of CA125 were extremely high for Meigs’ syndrome and high level of CA125 in Meigs’ Syndrome is unusual. Solid adnexal mass and serous ascites was detected in explorative laparotomy in 2 cases also. Other genital and abdominal structures were normal. In both cases the right salpingo oophorectomy was performed. In addition, the ovarian fibroma was reported in one case and nonspecific for other case during frozen/section examination. Contralateral salpingo-oophorectomy and total hysterectomy was performed because of the age of patients in one case and non- diagnostic frozen section examination in the other case. Final pathology confirmed the diagnosis of ovarian fibroma in first case and thecoma in the second one. Despite the suggestion of ovarian malignancy in preoperative period, the frozen/section examination is the mainstay in the management of adnexal masses