Orofacial Clefts: Prenatal Diagnosis and Postnatal Management

Orofacial clefts are among the most common congenital malformations which have significant consequences in terms of long term morbidity and health care costs. The overall prevalence of orofacial clefts is estimated to be 9.92 per 10000 births. This review outlines some aspects of etiopathogenesis, prenatal diagnosis and management of the condition

Periviable Preterm Premature Rupture of Membranes: A Retrospective Study on Determinants of Neonatal Mortality

Purpose: The present study aimed to determine the risk factors for fetal and neonatal mortality in the context of Periviable Preterm Premature Rupture of Membranes (PPROM). Patients and Methods: This was a retrospective cohort study conducted at perinatology department of Zekai Tahir Burak Research and Training Hospital. The study population consisted of patients with PPROM before completing the 23rd gestational week were opted for expectant management. Maternal and Neonatal characteristics were recorded. Multivariate Logistic Regression with backward elimination is performed to investigate the effect of certain parameters on neonatal mortality. Results: In multivariate logistic regression model, gestational age <21 weeks at onset of PPROM (Odds Ratio (95% confidence interval): 8.58 (2.41–30.5), p<0.01) and nulliparity (Odds Ratio (95% confidence interval): 4.47 (1.25–15.9), p: 0.02) were independently associated with stillbirth or delivery before 23rd weeks. According to Cox regression model, the significant determinants of survival were: completed gestational weeks at delivery, sepsis in the first neonatal week and presence of pulmonary hypoplasia. Conclusion: The present data suggest that favorable outcomes can be anticipated in periviable PPROM that has occurred after 22th gestational weeks. Completed gestational weeks at delivery and nulliparity are other important determinants of mortality

Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p

Risk factors for CF and BPI.

<p>CF: Clavicular fracture, BPI: Brachial plexus injury, CI: confidence interval, GDM: Gestational diabetes mellitus, * p<0.05.</p

Comparison of maternal, perinatal and neonatal characteristics.

<p>Data expressed as number (%), mean ± SD, CF: Clavicular fracture, BPI: Brachial plexus injury, NS: non significant, min: minutes.</p

Comparison of features of BPI cases with or without associated shoulder dystocia.

<p>Data expressed as number (%), BPI: Brachial plexus injury.</p

The incidence rates of Clavicular fracture, brachial plexus injury and shoulder dystocia.

<p>The incidence rates of Clavicular fracture, brachial plexus injury and shoulder dystocia.</p

One-hour versus two-hour postprandial blood glucose measurement in women with gestational diabetes mellitus: which is more predictive?

The purpose of this study is to investigate postprandial 1-h (PP1) and 2-h (PP2) blood glucose measurements' correlation with adverse perinatal outcomes. This prospective cohort study consisted of 259 women with gestational diabetes mellitus. During each antenatal visit, HbA1c and fasting plasma glucose (FPG) as well as plasma glucose at PP1 and PP2 were analyzed. There were 144 patients on insulin therapy and 115 patients on diet therapy. A total of 531 blood glucose measurements were obtained at different gestational ages between 24 and 41 gestational weeks. PP2 plasma glucose measurements (but not PP1) were positively correlated with fetal macrosomia. But on adjusted analysis, neither PP1 nor PP2 measurements predicted perinatal complications. In addition to PP1 and PP2, neither FPG nor HbA1c were able to predict perinatal complications or fetal macrosomia when controlled for confounding factors except for a positive correlation between fetal macrosomia and HbA1c in patients on diet therapy. Postprandial 1-h and postprandial 2-h plasma glucose measurements were not superior to each other in predicting fetal macrosomia or perinatal complications. Based on our findings, it can be concluded that both methods may be suitable for follow-up as there are no clear advantages of one measurement over the other