Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

A case report of twin reversed arterial perfusion sequence with expectant management

Acardiac twin or TRAP (twin reversed arterial perfusion) sequence is a rare complication of monochorionic pregnancies. In these cases, the heart is either absent or non-functional. It’s controversial whether conservative management or therapeutic treatment is better in TRAP-sequence. In this case, we present a 19-years old, primigravida diagnosed with spontaneous monochorionic monoamniotic twin pregnancy at 7th week of gestation. One of the fetuses had a crown-rump length of 8 mm and fetal heart rate 122/minute while the other one had a crown-rump of 7 mm with no detected fetal heartbeat. At the 11th week of gestation, the acardiac twin continued growing despite the absence of the fetal heart beat and fetal extremities. The cranium could not be evaluated clearly. The diagnosis of TRAP sequence was confirmed by the reversed direction of flow observed in the umbilical artery. Since the patient and her husband did not want any intervention, no interventional diagnostic and treatment modalities were applied. Preterm labor started at the 32th week. Because the presentations were transverse and breech, pump and acardiac fetus, respectively, a cesarean delivery was performed. A healthy female baby, weighing 1650 gr with APGAR scores of 9-10, first and fifth minutes, respectively, was delivered along with the acardiac fetus which was 1550 gram in weight, fetal heart beat negative, with upper and lower extremity deformities. The uniqueness of the present case is that there was no significant difference in the weight of both twins. The acardiac twin was as large as the pump twin. Except for twenty days hospitalization because of neonatal respiratory distress syndrome, which was a consequence of preterm labor, there were no problems with the pump twin even though managed conservatively. In monochorionic twin pregnancies, when one of the twins is found to be fetal heartbeat negative and it continues to grow with concomitant structural abnormalities, the TRAP sequence should come to mind. If the acardiac fetus is small and the pump fetus has no complications, the conservative approach can be considered. Our goal should be to deliver the pump twin with minimal complications. To achieve this, follow-ups and treatment should be individualized for each patient, the pump fetus should be monitored closely

Maternal and Neonatal Outcomes Related to Iron Deficiency Anemia and Serum Ferritin Status: A Multicenter Prospective Study From Eastern Marmara, Turkey

Aim:The aim was to evaluate the incidence of iron deficiency anemia in pregnancy in the East Marmara region of Turkey in order to determine its prevalence along with the effects and associations of iron supplementation on maternal and neonatal outcomes.Materials and Methods:This study was conducted in six centers and included a total of 1102 pregnant women. Blood samples were collected for hematological status and serum ferritin levels during pregnancy, and the adverse maternal and perinatal outcomes were determined. Iron deficiency anemia was diagnosed according to the World Health Organization criteria as hemoglobin level of < 11 g/dl and ferritin level of <15 μg/dL.Results:The rate of anemia was 19.8%, with 44% of them receiving iron supplementation. The maternal age was lower in the anemic group (26.5 vs. 27.7, p = 0.01). Selective iron use was more frequent in the anemic group, while routine iron use was more frequent in the non-anemic group (47.1% vs. 29.3%; p = 0.01).Conclusion:Iron deficiency anemia is a frequent problem in pregnancy. However, many anemic pregnant women do not receive iron therapy. Iron supplementation may have positive effects on maternal and perinatal outcomes. In order to combat iron deficiency anemia in pregnancy, wide spread use of iron supplements should be established

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

WOS: 000405108100009PubMed: 28727133Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

İlk Trimesterdeki Uterin Prolapsusun Vajinal Pesser ile Tedavisi

Uterine prolapse during pregnancy is a rare condition with an estimated incidence of1:10,000–15,000 pregnancies. Premature labor and delivery are the most prevalent complicationsin pregnancies with pelvic organ prolapse. Various treatment methods from conservativeapproaches to surgery are possible. In this paper we report a 27 year-old patientwho was treated with Arabin pessary due to uterine prolapse in the first trimester.Gebelikte uterin prolapsus nadir görülen bir durumdur, tahminen 10–15 bin gebelikte 1 görülür.Pelvik organ prolapsusu gelişen gebeliklerde en yaygın komplikasyon erken doğumdur.Konservatif yaklaşımdan cerrahiye kadar, çeşitli tedaviler mümkündür. Bu çalışmada,ilk trimesterde uterin prolapsus nedeniyle Arabin pesser ile tedavi edilen 27 yaşındaki birhasta sunulmuştur

Coexistence of uterine smooth muscle tumors of uncertain malignant potential (Stump) and subserosal leiomyoma: A rare cause of postmenopausal bleeding [Malign potansiyeli belirsiz uterus düz kas tümörü (Stump) ve subserozal leiomyoma birlikteliği: postmenopozal kanamanin nadir bir nedeni]

Information about the clinical behaviour and risk factors of Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMPs) is extremely limited. Most of the patients with STUMP are at reproductive age. Postmenopausal bleeding (PMB) can occur about 10% of patients after menopause. An uterine leiomyosarcoma may be the cause of PMB in some cases but STUMPs are not a common cause of PMB. We reported here a 51-year-old woman presenting with PMB having STUMP and multiple bening subserosal leiomyomas. © 2017 Gunes Kitap Kirtasiye. All rights reserved

MATERNAL AND NEONATAL OUTCOMES RELATED TO IRON DEFICIENCY ANEMIA AND SERUM FERRITIN STATUS: A MULTICENTER PROSPECTIVE STUDY FROM EASTERN MARMARA, TURKEY

Aim: The aim was to evaluate the incidence of iron deficiencyanemia in pregnancy in the East Marmara region of Turkey in orderto determine its prevalence along with the effects and associationsof iron supplementation on maternal and neonatal outcomes.Materials and Methods: This study was conducted in sixcenters and included a total of 1102 pregnant women.Blood samples were collected for hematological status andserum ferritin levels during pregnancy, and the adversematernal and perinatal outcomes were determined. Irondeficiency anemia was diagnosed according to the WorldHealth Organization criteria as hemoglobin level of < 11g/dl and ferritin level of <15 ?g/dL.Results: The rate of anemia was 19.8%, with 44% of themreceiving iron supplementation. The maternal age was lower in theanemic group (26.5 vs. 27.7, p = 0.01). Selective iron use wasmore frequent in the anemic group, while routine iron use wasmore frequent in the non-anemic group (47.1% vs. 29.3%; p =0.01).Conclusion: Iron deficiency anemia is a frequent problem inpregnancy. However, many anemic pregnant women do notreceive iron therapy. Iron supplementation may have positiveeffects on maternal and perinatal outcomes. In order to combat irondeficiency anemia in pregnancy, wide spread use of ironsupplements should be established.Amaç: Bu çalışmanın amacı, demir takviyesi ve demir durumunun maternal ve neonatal etkileri ile birlikte Türkiye'nin Doğu Marmara bölgesinde gebelikte görülen demir eksikliği anemisi insidansını değerlendirmektir. Materyal ve Metot: Bu çalışma Doğu Marmara Bölgesi'nin (Türkiye) üç ilinde altı merkezde gerçekleştirilmiş ve toplam 1102 gebeyi kapsamıştır. Gebelik sırasında hematolojik durum ve serum ferritin düzeyleri için kan örnekleri toplandı ve olumsuz maternal ve perinatal sonuçlar belirlendi. Demir eksikliği anemisi, Dünya Sağlık Örgütü kriterlerine göre hemoglobin<11g/dl ve ferritin< 15 ?g/dL olarak tanımlandı. Bulgular: Çalışmaya dahil edilen kadınlarda anemi oranı % 19.8 idi ve bunların % 44'ü demir desteği alıyordu. Maternal yaş anemik grupta daha düşüktü (26.5'e karşı 27.7, p = 0.01). Anemik grupta selektif demir kullanımı daha sık görülürken, anemik olmayan grupta rutin demir kullanımı daha sık görüldü (% 47.1'e karşılık% 29.3; p = 0.01). Sonuç: Demir eksikliği anemisi gebelikte sık görülen bir problemdir. Bununla birlikte, birçok anemik gebeye demir tedavisi verilmez. Demir takviyesi, bazı maternal ve perinatal sonuçlar üzerinde olumlu etkileri olabilir. Gebelikte demir eksikliği anemisiyle mücadele etmek için demir takviyelerinin yaygın kullanımı sağlanmalıdır

Uterusun atipik immunuhistokimyasal özellikleri olan perivasküler epiteloid hücreli tümörü

Perivascular epithelioid cell tumors (PEComa) are a rare type of mesenchymal tumor arising from perivascular epithelial cells. The prognostic classification of PEComas, the nature of their biological behaviour and the criteria determining their malignancy potential remain uncertain. PEComas usually show immunoreactivity for melanocytic (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) markers. Surgery is the most recommended primary treatment. We reported an uterin PEComa with atypical immunohistochemical features. © 2016, Gunes Kitap Kirtasiye. All rights reserved

Scar Endometriosis Following Cesarean Section

OBJECTIVE: The purpose of our study was to evaluate clinical features of abdominal wall endometriosis following cesarean section. STUDY DESIGN: Our institution's database over a 5-year period was performed, yielding 9 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography. The clinical data were analyzed. RESULTS: All patients had a history of at least one prior cesarean section. None of them had endometriosis history. All presented with focal pain near the surgical scar, which was cyclic in seven patients. Three patients presented with a palpable mass near the scar. Sonography detected all lesions within the abdominal wall, with a mean diameter of 30 mm. All lesions were vascular, and solid, with some cystic changes. CONCLUSION: Abdominal wall endometriosis frequently presents with cyclical pain during menstruation which is localised to a palpable mass in the abdominal wall especially in those who have had previous cesarean section. Complete surgical excision is curative