Fetal pancreatic hyperechogenicity may be an early ultrasonographic sign of gestational diabetes mellitus

Aim: To determine whether fetal pancreatic echogenicity assessment is associated with gestational diabetes mellitus (GDM).Methods: A prospective cross-sectional study was conducted in a cohort of 160 pregnant women with uncomplicated singleton pregnancies. Fetal ultrasonography was performed between 24 and 28 weeks of gestation for conventional fetal biometry. Based on their pancreatic sonogram results, subjects were divided into two groups, that is, hyperechogenic pancreas group and iso-moderate echogenic pancreas group. Birth characteristics (mode of delivery) and fetal outcomes (gestational age at birth, fetal gender, birth length and weight, Apgar for 1. Versus 5. Minutes) were recorded and the relationship between pancreatic hyperechogenicity and the presence of GDM was assessed.Results: Sixty-six cases with hyperechogenic pancreas (group 1) and 70 cases with iso-moderate echogenic pancreas (group 2) were included to the study. There were no significant differences in maternal demographic and obstetric features between the groups. Fetal birth weight and length were significantly higher in the hyperechogenic pancreas group (p < .0001, p = .013; respectively). Hyperechogenic pancreas was significantly and positively associated with GDM risk. Hyperechogenic pancreas was significantly and positively associated with an increased GDM risk by 29.8 times compared to grade 1 isoechogenic group (p < .0001).Conclusion: An accurate prediction model for GDM among pregnant women via hyperechogenic pancreas may be created. Fetal hyperechogenic pancreas may be used as a complementary biomarker for the detection of pregnant women suspected of GDM.

The effect of increased amnion volume severity on fetal Doppler indices and perinatal outcomes in idiopathic polyhydramnios

Aim: To evaluate the relationship between polyhydramnios severity and alterations in Doppler indices and perinatal outcomes in idiopathic polyhydramnios.Methods: This prospective case control study was conducted in a tertiary hospital with 173 singleton pregnancies between 29 and 41 weeks gestational age between May 2015 and December 2016. Polyhydroamnios is classified as mild (amniotic fluid index 25-30 cm), moderate (30.1-35 cm), and severe (>35 cm) and the number of the patients in mild, moderate, and severe groups were 55, 39, and 26, respectively. The results were compared with 53 healthy controls. Fetal echocardiography and Doppler measurements of the groups were made and the perinatal outcomes from each group were noted. The relationship between the results and the severity of polyhydramnios was analyzed statistically.Results: The myocardial performance index was significantly higher in the fetuses of women with severe polyhydramnios compared to the other groups (p = .006). There were statistically significant differences among the groups in terms of first and fifth minutes according to the Apgar scores (p = .011, p = .016 respectively). In the severe polyhydramnios group compared with other groups, the middle cerebral artery pulstatility index was significantly lower (p = .002), while middle cerebral artery peak systolic velocity and umbilical artery pulstatility index values were significantly higher (p = .0001, p = .045).Conclusions: Our study showed an increase in myocardial performance index and middle cerebral artery peak systolic velocity values and a decrease in middle cerebral artery pulstatility index values, especially in the severe idiopathic polyhydramnios group. Idiopathic polyhydramnios were associated with low first and fifth minute Apgar score. Additionally, the increase in umbilical artery pulstatility index value and the decrease in middle cerebral artery pulstatility index value became more apparent with the increase in amniotic fluid volume. It should be taken into consideration that brain sparing effect may develop especially in cases with severe polyhydramnios.

A frequently asked question: Is it normal not to feel my baby's movements yet?

BACKGROUND

This study aims to investigate average gestational week in which mothers feel their baby's movements for the first time, and the maternal-fetal factors affecting this time.

METHODS

A total of 423 pregnant women between 11 and 25 weeks of gestation were included in this prospective study. The patient cohort was divided into three subgroups according to the gestational week in which fetal movements were felt for the first time by the pregnant women. The women who felt the first movement before 25th percentile value constituted Group 1; between 25th and 75th percentile value constituted Group 2; and beyond 75th percentile value constituted Group 3. These three groups were then compared in terms of maternal age, parity, body mass index (BMI), tea and coffee consumption during pregnancy, smoking, educational status, accordance of mother to regular pregnancy follow-ups, placental site, and gender of the baby.

RESULTS

These three groups were statistically and significantly different regarding the above mentioned determinants except for mothers' tea and coffee consumption, smoking, and gender of the baby (p < 0.05).

CONCLUSION

This study revealed factors that affect maternal perception of first fetal movements in both a positive and negative manner. Although it is hard to define an exact time for each individual, an approximate time according to our data can be given to a mother, which considers an affecting factor on the basis of average gestational week.

A non-invasive method to rule out transient tachypnea of the newborn (TTN): fetal pulmonary artery acceleration to ejection time ratio

OBJECTIVE

To investigate whether fetal pulmonary artery acceleration to ejection time (PATET) ratio can predict or rule out subsequent diagnosis of transient tachypnea of the newborn (TTN).

METHODS

This prospective cohort study included 105 pregnant women in labor, who met the inclusion criteria. Eighteen of these women were removed from the study cohort, because of an inability to acquire sufficient Doppler waveforms and a longer duration of deliveries. According to subsequent diagnosis of TTN in the neonate, the two groups were constituted, TTN+ and TTN-.

RESULTS

There were no statistically significant differences between the groups regarding maternal obstetric and demographic features. The neonatal intensive care unit (NICU) submission rate was significantly higher in the TTN+ group (100%, 17%, P<0.0001, respectively). Regarding the fetal pulmonary artery Doppler findings, PATET ratio in the TTN+ group was significantly lower than the TTN- group (0.307 vs. 0.389, P<0.0001, respectively). The PATET ratio and diagnosis of TTN were inversely correlated (r=-0.41, P<0.001), even if adjusted for birth weight, gestational age and fetal gender (r=0.42, P=0.0021). The cut-off value of 0.319 provided 82.7% specificity, 83.3% sensitivity, 96% negative predictive value and 41.6% positive predictive value. Additionally intraobserver ICC for PATET was found to be 0.86.

CONCLUSION

The fetal PATET ratio seems to serve as a promising tool to rule out subsequent diagnosis of TTN.

MicroRNA Expression Profile in the Prenatal Amniotic Fluid Samples of Pregnant Women with Down Syndrome

Background:

Down syndrome, which is the most common human chromosomal anomaly that can affect people of any race and age, can be diagnosed prenatally in most cases. Prenatal diagnosis via culture method is time-consuming; thus, genetic analysis has thus been introduced and is continually being developed for rapid prenatal diagnosis. For this reason, the effective use of microRNA profiling for the rapid analysis of prenatal amniotic fluid samples for the diagnosis of Down syndrome was investigated.

Aims:

To evaluate the expression levels of 14 microRNAs encoded by chromosome 21 in amniotic fluid samples and their utility for prenatal diagnosis of Down syndrome.

Study Design:

Case-control study.

Methods:

We performed invasive prenatal testing for 56 pregnant women; 23 carried fetuses with Down syndrome, and 33 carried fetuses with a normal karyotype. Advanced maternal age and increased risk for Down syndrome in the screening tests were indications for invasive prenatal testing. The age of gestation in the study and control groups ranged between 17 and 18 weeks. The expression levels of microRNA were measured by real-time polymerase chain reaction.

Results:

The expression levels of microRNA-125b-2, microRNA-155, and microRNA-3156 were significantly higher in the study group than in the control group.

Conclusion:

The presence of significantly dysregulated microRNAs may be associated with either the phenotype or the result of abnormal development. Further large-scale comparative studies conducted in a variety of conditions may bring novel insights in the field of abnormal prenatal conditions.

Relationship between first trimester aneuploidy screening test serum analytes and placenta accreta

OBJECTIVE

The aim of this study is to determine whether there is a relationship between first trimester serum pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fβhCG) MoM values and placenta accreta in women who had placenta previa.

STUDY DESIGN

A total of 88 patients with placenta previa who had first trimester aneuploidy screening test results were enrolled in the study. Nineteen of these patients were also diagnosed with placenta accreta. As probable markers of excessive placental invasion, serum PAPP-A and fβhCG MoM values were compared in two groups with and without placenta accreta.

RESULTS

Patients with placenta accreta had higher statistically significant serum PAPP-A (1.20 versus 0.865, respectively, p = 0.045) and fβhCG MoM (1.42 versus 0.93, respectively, p = 0.042) values than patients without accreta.

CONCLUSIONS

Higher first trimester serum PAPP-A and fβhCG MoM values seem to be associated with placenta accreta in women with placenta previa. Further studies are needed to use these promising additional tools for early detection of placenta accreta.

Nuchal cord: is it really the silent risk of pregnancy?

OBJECTIVE

To evaluate the relationship between entanglement of umbilical cord around the fetal neck and adverse perinatal outcomes.

METHODS

In this prospective cohort study, perinatal outcomes of 218 pregnancies complicated with nuchal cord (NC) (study group) were compared with 190 uncomplicated pregnancies (control group). Main outcome measures were umbilical cord pH values, APGAR scores and cesarean section (C/S) rates. Fetal distress was stated as an abnormal heart rate pattern on electronic fetal heart monitorization.

RESULTS

There were no statistically significant differences in maternal demographic and obstetric features, between groups. There were no statistically significant differences regarding C/S rates between groups, even though fetal distress was significantly the leading indication for cesarean delivery, in the study group (p = 0.021). The number of entanglement was significantly related with fetal distress (p < 0.001). There were no statistically significant differences in umbilical cord gas values, one-minute and five-minute APGAR scores between the groups. Furthermore, there was a significant male dominance in the study group (p = 0.014) and also, amniotic fluid indexes (AFI) were significantly higher in this group (p = 0.002).

CONCLUSION

This study demonstrated that, entanglement of umbilical cord around the fetal neck or NC is not related with adverse perinatal outcomes such as acidosis and low APGAR scores. So that, a targeted care on NC via ultrasound during labor, is not an essential part of the examination.

Complete hydatidiform mole presenting as placenta previa in a twin pregnancy with a coexisting normal foetus: Case report

We present a case of a patient with a complete hydatidiform mole co-existing with a normal foetus (CMCF) who had a caesarean section in week 32 of gestation, resulting in a live female infant weighing 1590 grams. The mother, with a normal bleeding pattern, did not require any surgical intervention. She was discharged from hospital on the third post-operative day. Premature termination is recommended in this type of pregnancy because of the risks associated with molar pregnancies. However, with the close follow-up of these pregnancies, good maternal and perinatal results may be obtained.

Comparison of serum maternal adiponectin concentrations in women with isolated intrauterine growth retardation and intrauterine growth retardation concomitant with pre-eclampsia

OBJECTIVE

The aim of this study was to compare serum maternal adiponectin concentrations in pregnant women with isolated intrauterine growth retardation (IUGR) and in pregnant women with IUGR concomitant with pre-eclampsia (IUGRcwPE).

MATERIAL AND METHODS

Thirty patients with isolated IUGR (group 1), 20 patients with IUGRcwPE (group 2), and 30 healthy controls (group 3) between age 18-40 were included into the study. Venous blood samples of those patients were obtained in the starving state. Adiponectin concentrations were measured by enzyme-linked immunosorbent assay in serum obtained after centrifugation. To find the differences between the groups, student t-test and one-way ANOVA statistical methods were used.

RESULTS

There were no differences between the groups in terms of age, body mass index, gestational age, and parity (p>0.05). The values of amniotic fluid index (p<0.001) and weight gained during pregnancy (p=0.017) were significantly different when compared among the three groups. The mean concentrations of adiponectin were 94.041 pg/mL in the IUGR group, 55.717 pg/mL in the IUGRcwPE group, and 51.831 pg/mL in the control group. Both of the differences between the IUGR and IUGRcwPE groups (p value; <0.05) and IUGR and control groups were statistically significant (p value; <0.001). However, there were no significant differences between the IUGRcwPE group and control group (p>0.05).

CONCLUSION

We found that IUGR increased maternal serum adiponectin concentrations; however, this rise does not occur in pregnant women with IUGRcwPE.