Associations between second-trimester amniotic fluid levels of ADAMTS4, ADAMTS5, IL-6, and TNF-? and spontaneous preterm delivery in singleton pregnancies

We investigated the roles of inflammatory cytokines and the A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) family in the etiopathogenesis of spontaneous preterm delivery by comparing the ADAMTS4, ADAMTS5, interleukin (IL)-6, and tumor necrosis factor-? (TNF-?) levels in second-trimester amniotic fluid between pregnant women with preterm birth and term controls. All pregnant women who underwent second-trimester amniocentesis for genetic analysis between January 1, 2016, and January 1, 2018, were enrolled in this study. From this cohort, 22 patients who subsequently experienced spontaneous preterm delivery before 34 weeks of pregnancy formed the study group, and 22 age- and body mass index (BMI)-matched patients without preterm birth constituted the control group. No significant differences were observed between the preterm birth and control groups in terms of age, BMI, obstetric history of preterm delivery, gestational age at amniocentesis, or indication for amniocentesis. The mean amniotic fluid levels of ADAMTS4 and ADAMTS5 were significantly increased in the preterm birth group compared to the control group (248.3±22.6 and 182.4±19.8 pg/mL, P=0.012; and 198.6±21.6 and 159.1±21.7 pg/mL, P=0.035, respectively). Significantly increased IL-6 and TNF-? levels were also detected in the amniotic fluid of women who experienced spontaneous preterm delivery, relative to controls (142.1±16.2 and 95.8±16.4 pg/mL, P0.001; and 139.4±12.5 and 89.6±11.2 pg/mL, P0.001, respectively). The results of this study imply that increased mid-trimester amniotic fluid levels of ADAMTS4, ADAMTS5, IL-6, and TNF-? play an important role in the pathophysiology of spontaneous preterm delivery. © 2019 Walter de Gruyter GmbH, Berlin/Boston

The evaluation of perinatal outcomes in pregnancies complicated with thrombophilias [Trombofili saptanan gebelerde perinatal sonuçlari{dotless}ni{dotless}n degerlendirilmesi]

Objective: In our study we included pregnant patients diagnosed with thrombophilia in whom thromboprophylaxis was initiated and evaluated their perinatal outcomes (pregnancy loss, preeclampsia, low birth weight, preterm labor, and venous thrombosis). We aimed to compare perinatal outcomes of the study group with those of control group with negative thrombophilia screening results. Material and Methods: Pregnant subjects that applied to Obstetrics and Gynecology Department of Çukurova University Faculty of Medicine Hospital between June 2010 and February 2012 were recruited in the study. Patients with a positive thrombophilia screening for primary and secondary recurrent pregnancy loss were initiated a thromboprophylaxia protocol in the first trimester and their demographic backgrounds and past obstetric histories were also recorded. In addition to this, the type of thrombophilia and number of thrombophilia defects were also noted and the route of birth and perinatal outcomes were evaluated prospectively. The control group included patients who had a history of recurrent unexplained miscarriages, with a negative thrombophilia screening. Differences between both groups were statistically significant at a p value <0.05. Results: Sixty patients diagnosed with thrombophilia were included in the study group, while 50 patients with no etiological cause including thrombophilia composed the control group. When the perinatal outcomes were compared; pregnancy loss, development of preeclampsia/eclampsia (p=0.257), rate of low weight baby according to gestational week (p=0.619), preterm birth rate (p=0.232) and the incidence of venous thrombosis (p=0.246) did not differ significantly. The cesarean section rate in the study group was 55% (33-60) and 18% (9/50) in the study group (p=0.000) and the difference was statistically significant between both groups. Conclusion: Our study discovered similar findings and perinatal outcomes in patients with and without thrombophilia. The only significant difference between both groups was the difference in cesarean rates

3D ultrasonographic evaluation of the fetal heart with Ebstein's anomaly: Original image

Ebstein's anomaly is an infrequent form of congenital heart disease. The diagnosis can be made on 2D sonography by detecting the apical displacement of the septal and posterior leaflets of tricuspid. Valvular insufficiency and cardiomegaly are also commonly seen. A 3D examination of fetal Ebstein's anomaly is described at 21st week of gestation, showing the volumetric four chamber view of heart. 3D evaluation of fetal heart permits to better understand the anatomy as well as to store the volume in order to perform offline analysis. Copyright © 2011 by Türkiye Klinikleri