Evaluation of perinatal outcomes of pregnancies having increased nuchal translucency in first trimester screening test and normal karyotype

WOS: 000408441500004Amaç: Çalışmamızda ilk trimester Down sendromu tarama testinde Nukal Translusensi (NT) ölçümü ≥ 95. persantil bulunan ancak genetik inceleme sonucunda normal karyotip saptanan gebeliklerin perinatal sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: İlk trimester tarama testinde NT ≥ 95. persantil saptanan ve karyotipleme yapılan hastaların sonuçları retrospektif olarak tarandı. Sayısal ya da yapısal kromozomal anomali saptanmamış olguların dosyalarından anne yaşı, obstetrik ve aile öyküsü bilgilerine ulaşıldı. Hastalarla telefon ile mülakat yapılarak gebeliğin nasıl sonuçlandığı, gebelik süresince ve yenidoğan/infant/çocukluk dönemi takiplerinde herhangi bir anormallik saptanıp saptanmadığı öğrenildi. Bulgular: NT 7.2 mm bulunan bir olgunun detaylı fetal USG incelemesinde majör kardiyovasküler anomaliler saptanması nedeni ile termine edilmiş olduğu, NT 2.8 mm bulunan bir ikiz gebelikte fetuslardan birinde 13. haftada kalp atımının negatifleştiği, öploid olduğu saptanan diğer fetusta IUGR geliştiği ve 23. haftada in utero kayıp olduğu, NT 2.8 mm bulunan iki olgudan birinde 16. haftada, diğerinde 30. haftada in utero fetal kayıp yaşandığı, NT 3.9 mm bulunan ve hafif pyelektazi kaydedilmiş fetusun yenidoğan takiplerinde renal pelvis çaplarının normal sınırlara gerilediği görülmüştür. NT 2.9 mm bulunan başka bir fetusta ise doğum sonrası hipospadias saptanmış olduğu bilgisi edinilmiştir. Sonuç: Genetik incelemede normal karyotipleme elde edilse bile NT 95. persantil ve üzerinde olan fetuslar in utero fetal kayıp, majör yapısal anomaliler, genetik sendromlar ve nörolojik gelişimsel sorunlar açısından yüksek risk taşıyabilirler. Aile bu konuda bilgilendirilmeli ve izlem süreci yenidoğan, infant, çocukluk dönemi boyunca devam etmelidir.Objective: To assess the perinatal outcomes of fetuses having nuchal translucency (NT) greater than 2.5 mm and with normal karyotype. Materials and Methods: Results of pregnancies with an increased nuchal translucency (95. percentile and above) in the first trimester screening test and those with karyotyping were examined retrospectively. Cases without chromosomal abnormalities were evaluated for the maternal age, obstetric and family history. Information about the outcomes of pregnancies and any abnormalities detected during pregnancy/ neonatal /infancy / childhood follow- ups were obtained by telephone interviews. Results: A case that had 7.2 mm NT had been terminated due to major cardiovascular abnormalities. One fetus in twin pregnancy that had 2.8 mm NT resulted in missed abortion in 13 weeks of gestation and intrauterine growth restriction developed in the other euploid fetus and resulted in utero exitus at 23 weeks of gestation. Other two cases having 2.8 mm NT resulted in utero fetal demise at 16 weeks and 30 weeks. Another case having 3.9 mm NT who had mild pyelectasis had normal renal pelvic diameter in the neonatal period. Hypospadias was diagnosed postpartum in another fetus with 2.9 mm NT. Conclusion: Even among fetuses with normal karyotype, NT > 95th percentiles may present an increased risk for in utero fetal death, major structural abnormalities, genetic syndromes and neurological developmental problems. Families should be informed about it and follow-up processes should be continued throughout the newborn, infancy and childhood period

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

Background: Presacral teratomas are usually observed in the first two decades of life and have a 50-67% incidence of malignant transformation. Surgery is the treatment of choice

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

Background: Presacral teratomas are usually observed in the first two decades of life and have a 50-67% incidence of malignant transformation. Surgery is the treatment of choice. Case Report: Here, we report the case of 24-year-old female with chronic urinary retention after surgery for a presacral teratoma. Conclusion: Retroperitoneal pelvic surgery may cause pelvic plexus and nerve injury, leading to permanent bladder dysfunction and urinary retention

Effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: Does it have any effect on postoperative vital signs? A prospective randomized study

WOS: 000399742600008PubMed ID: 27187047Objective: To investigate the effect of peritonization at cesarean section on postoperative vital signs which was thought to be an indirect finding secondary to increased sympathetic activity originated from pain caused by stretched peritoneum. Methods: One hundred and thirty-three pregnant women were randomized to four groups; Closure of parietal peritoneum only (group 1; n=32), closure of visceral and parietal peritoneums (group 2; n=32), no closure of peritoneums (group 3; n=32) and closure of the visceral peritoneum only (group 4; n=32). All participants were monitored for blood pressure, pulse activity and hourly urinary output during the first postoperative 24h. Postoperative pain was measured using a Visual Analogue Scale 6th and 24th hours after surgery. Return of bowel function was measured from the end of the operation to the first passage of flatus. Operating time, pre- and postoperative hemoglobin, postoperative complications, length of hospital stay and postoperative urine osmolarity were noted. Results: The mean surgery duration was significantly longer in group 2. Diuresis was found significantly decreased in group 2. Pulse rate and systolic and diastolic blood pressure were significantly higher in group 2. Closure of both peritoneums was associated with higher post-operative pain as assessed using Visual analogue scale score analyses in group 2. Conclusion: Both visceral and parietal membrane closure in cesarean section should be avoided in women with hypertensive disorders, renal function abnormalities and autonomic dysfunction because of increased postoperative pain and associated sympathetic overactivity

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

Background: Presacral teratomas are usually observed in the first two decades of life and have a 50-67% incidence of malignant transformation. Surgery is the treatment of choice. Case Report: Here, we report the case of 24-year-old female with chronic urinary retention after surgery for a presacral teratoma. Conclusion: Retroperitoneal pelvic surgery may cause pelvic plexus and nerve injury, leading to permanent bladder dysfunction and urinary retention

Plasenta Akreata Spektrumu Olan ve Olmayan Plasenta Previa Vakalarında Risk Faktörü, İnsidans, Perinatal ve Maternal Sonuçların Değerlendirilmesi

Amaç: Plasenta akreata spektrumu (PAS), özellikle gelişmekte olan ülkelerde fetomaternal morbidite ve mortalitenin ana sebebi olan obstetrik kanama için önemli bir risk faktörüdür. Bu çalışmada; PAS olan ve olmayan plasenta previa olgularının özellikleri, insidansı, maternal ve fetal sonuçlarının araştırılması amaçlanmıştır. Ek olarak, PAS ile başvuran plasenta previa vakalarının klinik özellikleri ve risk faktörlerinin analiz edilmesi amaçlanmıştır.Gereç ve Yöntemler: Plasenta previa ile birlikte PAS olan ve olmayan gebelikleri analiz etmek amacıyla retrospektif kohort bir çalışma planlandı. Ocak 2005 ile Aralık 2014 arasında yazılı ve elektronik olarak tıbbi kayıtlar gözden geçirildi. Plasenta previa tanısı ultrasonografik olarak, PAS ise klinik olarak plasentanın uterustan ayrılma aşamasında zorluk olarak tanımlandı.Bulgular: Ocak 2005 ile Aralık 2014 arasında toplam 11351 doğumun retrospektif analizi yapıldı. 387 plasenta previa tanısı konulmuş olgu izlendi. Bu olguların 11'inde çoğul gebelik saptandı ve bu vakalar çalışma dışı bırakıldı. Kurumumuzda plasenta previa insidansı ‰3.41 idi. PAS riskini ≥4 gebelik sayısı 1,56 kat, ≥2 geçirilmiş sezeryan sayısı 9,74 kat, ≥3 abort sayısı 3,83 kat ve gestasyonel hipertansiyon varlığı 29,72 kat, gestasyonel diabet varlığı 49 kat arttırmıştır. Risk faktörlerinin lojistik regresyon analizinde ≥3 abort sayısı, ≥2 geçirilmiş sezaryen sayısı ve gestasyonel hipertansiyon varlığı anlamlı olarak değerlendirilmiştir.Sonuç: Plasenta previa vakalarında; ≥3 abort sayısı, geçirilmiş sezaryen sayısının ≥2 ve gestasyonel hipertansiyon varlığı PAS gelişimi açısından en önemli risk faktörleridir. Bu risk faktörlerine sahip plasenta previa olgularının gebeliği boyunca PAS gelişimi açısından sıkı takibi maternal-neonatal morbidite ve mortalite üzerine azalan bir etkiye sahip olabileceğini düşünmekteyiz

Predictive value of serum and follicular fluid chemerin concentrations during assisted reproductive cycles in women with polycystic ovary syndrome

Aims To evaluate the effect of serum and follicular fluid (ff) Chemerin levels on Assisted Reproductive Technology (ART) outcomes in lean patients with PCOS. Materials and methods The study included 76 infertile reproductive aged women, between 21-35 years who underwent intracytoplasmic sperm injection (ICSI) procedure. Serum and ff Chemerin levels were evaluated. Fertilization and clinical pregnancy rate were compared between the groups. Results Serum (13.32 ng/ml versus 29.82 ng/ml) and ff chemerin (35.90 ng/ml versus 87.60 ng/ml) levels were significantly higher in lean PCOS patients compared to controls (p < .01). Serum (24.5 ng/ml versus 18.4 ng/ml) and ff chemerin (71.7 ng/ml versus 52.8 ng/ml) levels were higher in subjects without clinical pregnancy compared to the subjects with clinical pregnancy (p < .05). A cutoff value of 36.2 ng/ml in the ff chemerin level was found to estimate clinical pregnancy with 83% sensitivity and 52% specificity (Area under the curve 0.66; 95% confidence interval, 0.53-0.79). A cutoff value of 12.7 ng/ml in the serum chemerin level was found to estimate clinical pregnancy with 91% sensitivity and 49% specificity (Area under the curve 0.65; 95% confidence interval, 0.52-0.78). Clinical pregnancy rates were significantly higher in group with lower serum chemerin levels (80.0% versus 30.4%, p < .001). High serum chemerin levels are associated with failure of assisted reproduction [OR:0.1(95% CI, 0.03-0.4, p < .001)]. Conclusions PCOS is associated with higher serum and ff chemerin levels and high serum chemerin level is a risk factor for failed ART cycle