Maternal and fetal outcomes in pregnancies with pulmonary hypertension: Experience of a tertiary center

Objective: Pregnancies complicated with PHT are serious debates for obstetricians due to high maternal and fetal complication potentials. The aim of the study was to present our maternofetal outcomes in pregnant women with pulmonary hypertension. Materials and methods: This study was performed using data extracted from the medical files of 23 pregnancies of 18 patients with PHT who were followed-up in the obstetrics and gynecology department. Results: The average age was 27.09 ± 6.97 (range: 14–38) years. The most frequent maternal cardiac pathologies were cardiac valvular disease (mitral or aortic insufficiency) (n = 4), atrial septal defect (n = 3), mitral stenosis (n = 3), ventricular septal defect (n = 2) and arrhythmia (n = 2). Caesarean section and normal vaginal delivery were performed in 13 and 7 deliveries, respectively. Therapeutic dilatation and curettage was performed in 3 patients. Preterm delivery occurred in 4 pregnancies and there were 2 intrauterine growth retardations, 1 preeclampsia and 2 maternal pulmonary edemas. One patient underwent re-laparotomy 5 days after delivery due to uterine hematoma. Totally, 20 newborns (14 female, 6 male) were delivered. Most of the complications were seen in advanced PHT classes. Conclusion: The care of the pregnant women with PHT necessitates a well-planned, multidisciplinary approach focusing on close monitoring before, during and after delivery. This approach may contribute to reduction of poor maternal and fetal outcomes

A Local Study on Antenatal Features of Preterm Births at 26-32 Versus 33-36 Weeks of Pregnancy

Objective: The antenatal features of pregnancies affect the incidence of preterm births. This retrospective study from Trakya University of Northwestern Turkey, describes antenatal factors involved in preterm births at 26-32 weeks of pregnancy and compares with those involved in preterm births at 33-36 weeks. Study Design: The records of preterm births at 26-32 weeks (earlier preterm births, n=419) and at 33-36 weeks (later preterm births, n=158) during the years 2002-2010 were reviewed and the demographic, obstetric and medical features were evaluated retrospectively. The data was expressed as numbers and percentages and analyzed by SPSS 20.0. Results: Iron supplementation [OR 0.27 (0.16-0.45), p=<0.001], short cervix [OR 9.12 (2.09-39.73) p=0.003] and infection [OR 2.6 (1.2-5.6) p=0.014] were important factors in the emergence of earlier preterm births which occurred at the rate of 1.4%. Conclusions: Earlier preterm births at 26-32 weeks of pregnancy, which compose an obstetric issue, are associated with several antenatal risk factors such as nutrition, cervical problems and infections in Northwestern Turkey

Complex Nature of Neural Tube Defects: A Regional Experience

Objective: The underlying gene-environment interaction of fetal neural tube defects is affected by several factors including geography, ethnicity and time. Local features of fetal neural tube defects were described. Study Design: A prospective cohort study of 48 fetal neural tube defects in a single tertiary medical center at the northwestern region of Turkey (2013-2015) was done via ultrasound, magnetic resonance imaging (MRI), conventional karyotyping, maternal methylenetetrahydrofolate reductase c.677C>T (rs1801133) single-nucleotide polymorphism and maternal serum levels of folic acid, vitamin B12 and zinc. For comparison of means, a Student’s T-Test was used. Results: The prevalence of neural tube defects was 11.4 per 10000 births (48/42000) in northwestern Turkey. The defects on the cranium (n=23; 47.9%) and spine (n=25; 52.1%) were ultrasonographically detected. MRI did not give additional benefit over the ultrasonography. The ratio of associated anomalies in neural tube defect group was 25%. Two fetal neural tube defects with Down syndrome were remarkable. The rate of homozygous methylenetetrahydrofolate reductase c.677C > T SNPs among the mothers of neural tube defect fetuses (n=20) was 15%. Comparing with gestationally matched healthy pregnancies, although maternal BMIs and periconceptional folate intake of neural tube defect group were significantly different, maternal serum folic acid, vitamin B12 and zinc levels were similar. Conclusion: The northwestern region appeared to be a relatively low prevalence area of Turkey for fetal neural tube defects. Any association with maternal serum folic acid, vitamin B12 and zinc levels could not be shown in this region

The relation of fetal colon and rectum diameters with labor in healthy late-third trimester pregnancies

Inan, Cihan (Trakya Author) Sayin, N. Cenk (Trakya Author) Dolgun, Z. Nihal (Trakya Author) Erzincan, Selen Gursoy (Trakya Author) Uzun, Isil (Trakya Author) Sutcu, Havva (Trakya Author) Varol, Fusun (Trakya Author)Objective: To investigate the associations of fetal colon-rectum diameters with labor and fetal distress or meconium passage in healthy pregnancies in the late 3rd trimester. Study design: A total of 162 healthy, singleton pregnant women at >= 36(0/7) weeks who were in the latent phase of labor (n = 69) or those not in labor (n = 93, controls) at the time of ultrasound examination were enrolled. Fetal colon (ascending, transverse, descending, sigmoid) and rectum diameters, Doppler indices of materno-fetal vessels were measured. Data were analyzed according to the mode of delivery. Results: Fetal colon-rectum diameters were smaller in women in labor compared to controls (p = 0.001). Positive correlations were observed between fetal colon-rectum diameters and interval between ultrasound and labor onset in the control group except for those who had scheduled cesarean sections (C/S) (p = 0.001). Similar colon-rectum measurements were obtained in fetuses delivered via cesarean section due to fetal distress or to other indications (p>0.05). In women who had uterine contractions during ultrasound examination; later delivered by vaginal route, no association was observed between Apgar scores and colon-rectum diameters during latent-phase (p > 0.05), and also there were significant positive correlations between different segments of colon-rectum diameters and duration of neonatal meconium passage (p < 0.05). Conclusion: Fetal colon and rectum diameters are smaller during labor and the measurements tend to diminish as the labor approaches, but do not indicate fetal distress. (C) 2018 Elsevier By. All rights reserved

Deletion of macro domain containing 2(MACRO D2) associated with transient hydrops fetalis

Cilingir, I. Uzun (Trakya Author) Sayin, Niyazi Cenk (Trakya Author) Gurkan, H.(Trakya Author) Ciftdemir, N. A. (Trakya Author) Atli, E. (Trakya Author) Inan, C. (Trakya Author) Erzincan, S. (Trakya Author) Sutcu, H. (Trakya Author) Vatansever, U. (Trakya Author) Varol, Fusun (Trakya Author)Macro Domain Containing 2 (MACRO D2) gene is a gene from macro family which is highly expressed in the ventriculer zone of the brain during embryonic development. Association between Autism spectrum disorders and MACRO D2 gene polymorphisms has been reported before [1] . Deletion in MACRO D2 gene has also been associated with Kabuki Syndrome which is a well described congential anomaly syndrome [2]