Isolated unilateral severe fetal hydrothorax: spontaneous resolution after birth

Hydrothorax is the accumulation of fluid in the pleural space. A large fetal pleural effusion (hydrothorax) was identified within the right hemithorax in a 22-year-old woman at 39 weeks of gestation. Because the fetal hydrothorax was detected at 39 weeks of gestation, we did not perform any intervention antenatally. A male fetus was delivered by an elective cesarean section at 39 weeks of gestation. He did not require intubation, ventilation or resuscitation in the operating room, and had a good health status. The baby was followed-up in the neonatal intensive care unit. Six days after the birth, the pleural effusion (hydrothorax) was completely resolved spontaneously. Conservative management may be regarded as an option for isolated fetal hydrothorax in uncomplicated, stable cases without hydrops.

The role of oxidative stress in premalignant lesions

PURPOSE OF INVESTIGATION

The authors aimed to evaluate serum total oxidant status (TOS), total antioxidant status (TAS), and oxida- tive stress index (OSI) in women with abnormal cervical cytology, to determine the association between serum oxidant and antioxidant status of these women, and the progression of abnormal cervical cytology.

MATERIALS AND METHODS

A total of 75 women enrolled in the study: 20 women with a determination of atypical squamous cells of undetermined significance (ASCUS), 20 women with low squamous intraepithelial lesions (LSIL), 15 women with high squamous intraepithelial lesions (HSIL) and 20 healthy controls. Serum TOS and TAS were determined and OSI was calculated as the indicator of degree of oxidative stress.

RESULTS

Serum TOS levels and OSI were highest in the HSIL group and there was a trend toward increasing serum TOS levels and OSI from ASCUS to HSIL group.

CONCLUSION

The authors demonstrated that increased oxidative stress with altered antioxidant level is associated with abnormal cervical cytology. Serum oxidant and antioxidant status may provide guidance as a simple and cost-effective method for follow-up, treatment, and recommendation in all stages of lesions.

Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes

OBJECTIVE

To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes.

METHODS

Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry.

RESULTS

The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01).

CONCLUSION

A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

The early pregnancy volume measurements in predicting pregnancy outcome

OBJECTIVE

The authors' aim was to develop a logistic regression model based on the ultrasonographic parameters on maternities which are showing a healthy improvement process during the first trimester of pregnancy.

MATERIAL AND METHODS

Using 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS), and gestational sac (GS) diameters were recorded in 225 women with gestational age < 11 weeks. Simplified V = 0.523 x length x height x width formula was used for the volume calculations. The results which ended in abortion were not included in the study.

RESULTS

Linear regression analyses between yolk sac volume (YSV), YSV = 0.026 + 0.0018 x CRL (r²: 0.15; p < 0.001), gestational sac volume (GSV), GSV= -9.6 + 1.7 x CRL (r²: 0.52; p < 0.001), and embryo volume (EV), EV = -1.64 + 0.18 x CRL (r²: 0.4; p < 0.001), and CRL was made and a linear relationship was detected. The volume measurements showed a meaningful correlation with the week of pregnancy. The space in the GS (GS volume-embryo volume) increased as the age of pregnancy became older (r² = 0.46; p < 0.001).

DISCUSSION

The first volume value was made in the first trimester by transvaginal ultrasonography, which showed a correlation with the age of pregnancy.

Iodine status of pregnant women in a metropolitan city which proved to be an iodine-sufficient area. Is mandatory salt iodisation enough for pregnant women?

The objective of this study was to assess the iodine status of pregnant women in a metropolitan city which was stated as iodine sufficient area after salt iodination program. This multicenter, cross-sectional study was carried out on 3543 pregnant women. Age, gestational weeks, smoking, consumption of iodized salt, dietary salt restriction, history of stillbirth, abortus and congenital malformations were questioned. Spot urine samples were analyzed for urine iodine concentration (UIC). The outcomes were: (a) median UIC in three trimesters of pregnancy and (b) frequency of ID among pregnant women. The median UIC was 73 µg/L. The median UIC was 77 µg/L (1-324), 73 µg/L (1-600) and 70 µg/L (1-1650) in three trimesters of pregnancy, respectively (p: 0.14). UIC <50 µg/L was observed in 36.6% (n: 1295) and UIC<150 µg/L was observed in 90.7% (n: 3214) of pregnant women. Only 1% (n: 34) of the pregnant women had UIC levels higher than 500 µg/L. This study showed that more than 90% of the pregnant women in this iodine-sufficient city are facing some degree of iodine deficiency during their pregnancy. A salt iodization program might be satisfactory for the non-pregnant population, but it seems to be insufficient for the pregnant population.

Effects of altitude changes on Doppler flow parameters for uterine, umbilical, and mid-cerebral arteries in term pregnancy: A pilot study

OBJECTIVE

We hypothesized that maternal and fetal circulations may be affected by moderately high altitudes. Therefore, we compared the differences in maternal and fetal Doppler flow parameters in women with term pregnancy living at a moderately high altitude (1890 m in Erzurum) with those of women living at the sea level (31 m in İstanbul).

MATERIAL AND METHODS

Eighty women (n=40, for each group) with full-term and singleton pregnancies underwent Doppler waveform analysis, and the pulsatility and resistance index values for the uterine, umbilical, and mid-cerebral arteries were recorded. Also, sex, birth, and placental weights during delivery were obtained from the medical records.

RESULTS

Similar mean placental weight values were found at the sea level compared with the moderately high altitude (p>0.05). The mean birth weight values were found to be lower at the moderately high altitude than those at the sea level (p<0.05). The pulsatility and resistance index values for the umbilical and mid-cerebral arteries were found to be similar between the groups (p>0.05). However, the pulsatility and resistance index values for both the right and left uterine arteries were higher at the sea level than those at moderately high altitude (p<0.05, for all).

CONCLUSION

Moderately high altitude does not affect fetal vascular Doppler parameters. However, it appears to increase the uterine artery blood flow bilaterally, and these alterations in the bilateral uterine artery blood flow may be associated with a physiological adaptation to high altitude.

Geophagic behavior in the mountain goat (Oreamnos americanus): support for meeting metabolic demands

Geophagy, the intentional consumption of earth or earth matter, occurs across taxa. Nutrient and mineral supplementation is most commonly cited to explain its adaptive benefits; yet many specific hypotheses exist. Previous research on mountain goats (Oreamnos americanus (Blainville, 1816)) broadly supports nutrient supplementation as the adaptive benefit of geophagy. Here, we use data from an undisturbed population of mountain goats inhabiting a geologically distinct coastal mountain range in southwestern British Columbia to test the hypothesis that geophagic behavior is a proximate mechanism for nutrient supplementation to meet metabolic demands. Our population, observed for over 30 consecutive years, returned each year with high fidelity to the same geophagic lick sites. Logistic regression demonstrated an overall effect of sodium and phosphorus, but not magnesium and calcium, on lick preferences. These data, in conjunction with field observations, provide support for the hypothesis that geophagy provides nutrient supplementation and that geophagy may be an obligate behavior to meet necessary metabolic demands within this population. The implications of our results suggest the necessity to preserve historically important habitats that may be necessary for population health.

Can we predict postpartum depression in pregnant women?

OBJECTIVE

The authors aimed to determine risk factors for postpartum depression (PPD) in this prospective study.

MATERIALS AND METHODS

The study included 285 pregnant women. The first assessment was conducted during pregnancy and a second time at 24 weeks after delivery. The participants were asked to fill out a series of questionnaires, which included psychosocial variables and socio- demographic characteristics, the Beck Depression Inventory (BDI), and Edinburgh Postnatal Depression Scale (EPDS). After delivery, 276 mothers participated again in the study and filled out a similar series of questionnaires.

RESULTS

A significant difference was not found between the socio-demographic and obstetric factors of mothers. A significant relation was found between the BDI score, which is used in antepartum depression evaluation, and EPDS score, which is used on postpartum depression evaluation (rho: 0.433 to 0.645, p < 0.0001). In cases in which BDI score was more than 6 were selected, phenomena in which could develop PPD had 90.3% sensitivity and 45.3% specificity.

CONCLUSIONS

The authors found that there was a correlation between EPDS score and BDI. The rate of PPD was found to be significantly higher in women, who had a depression history. Patients who have a potential risk of PPD should be evaluated during the postpartum period in terms of depression.

The value of transvaginal sonography in detecting endometrial pathologies in postmenopausal women with or without bleeding

AIM

The aim of this study was to estimate the incidence of endometrial pathologies and compare the findings in postmenopausal women with or without bleeding who had endometrial thickness ≥5 mm.

METHODS

Between January 2010 and December 2012 medical records of postmenopausal patients who underwent endometrial biopsy were reviewed retrospectively. 91 patients who presented with postmenopausal bleeding (Group A) with an endometrial thickness equal to or greater than 5 mm and 44 patients with an incidental finding of increased endometrial thickness (≥5 mm) on ultrasound without bleeding (Group B) were included in the study.

RESULTS

The mean endometrial thickness of patients in group A (9.3±4.6) was significantly lower than women in group B (11±4.6). Seven (7.7%) cases of endometrial hyperplasia and 6 (6.6%) cases of endometrial carcinoma were detected in women with bleeding, 2 (4.5%) cases of endometrial hyperplasia and no cases of endometrial carcinoma were diagnosed in group B women. The prevalence of endometrial carcinoma associated with endometrial thickness in group A women whereas we cannot see this relation in group B women. The mean endometrial thickness was highest in women with the histopathologic diagnosis of polyps in this group.

CONCLUSION

In postmenopausal women with bleeding, the risk of endometrial carcinoma increases with increasing endometrial thickness; however, the use of endometrial thickness as a screening test for endometrial carcinoma may not be effective in women without bleeding. 6.5 mm cut-off seems to be acceptable thickness for polyp detection in postmenopausal women with bleeding.

Different phenotypes of polycystic ovary syndrome in Turkish women: clinical and endocrine characteristics

This study presents the differences in clinical, endocrine and metabolic parameters among different polycystic ovary syndrome (PCOS) phenotypes in Turkish women. Four hundred and ten women with PCOS were evaluated, while 97 healthy women served as controls. PCOS were defined by oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovaries on ultrasound (PCO). Patients were subdivided into four phenotypes: OA + HA + PCO (phenotype 1), OA + HA (phenotype 2), HA + PCO (phenotype 3), OA + PCO (phenotype 4). Phenotypes 1-4 were present in 47.1%, 13.2%, 21.2% and 18.5% of patients, respectively. They were also divided into three groups according to the BMI (<25 kg/m(2); 25≤ and ≤30 kg/m(2); and >30 kg/m(2)). ANOVA and Tukey post-hoc HSD tests were used. The LH levels and LH/FSH ratio were higher in phenotype 1 and 2 than phenotype 3. The LDL-C levels were higher in women with phenotype 1 and 4 than in women with phenotype 2. Women with BMI <25 kg/m(2) had higher levels of LH, LH/FSH ratio, and the HDL-C than other two groups. The levels of TG, LDL, fasting insulin and HOMA-IR increased with increasing BMI in four phenotypes. Results suggest that obesity seems to be the primary cause of metabolic disturbances in PCOS women.

First trimester maternal serum pregnancy-associated plasma protein-A is a predictive factor for early preterm delivery in normotensive pregnancies

In this study, we investigated whether the concentrations of pregnancy-associated plasma protein-A (PAPP-A) or free β-hCG (fβhCG) in the first trimester can identify women at increased risk of subsequent preterm delivery in the absence of hypertensive disorders. Preterm and early preterm deliveries are defined as those deliveries before completing 37 and 34 weeks, respectively. A total of 868 women were enrolled into this study. According to the level of the markers, the patients were evaluated in three groups: 1 - maternal serum level ≤ 5 th percentile, 2 - between 5th and 95th percentiles, 3 - ≥ 95 th percentile. In the group of patients with a PAPP-A level ≤ 5 th percentile [≤ 0.35 multiples of the median (MoM)], mean gestational age (GA) at delivery, mean birth weight and the number of the cases with early preterm delivery were significantly lower than the others. Mean level of PAPP-A was significantly lower in cases with early preterm than term deliveries (0.58 ± 0.32 versus 1.09 ± 0.69; p = 0.01). Maternal serum level of fβhCG did not show significant difference between these groups (0.84 ± 0.45 versus 1.17 ± 0.77; p = 0.15). Low levels of maternal serum PAPP-A (≤ 0.35 MoM) (Odds ratio = 7; 95% confidence interval 1.8-27.7; p = 0.0048) significantly predicted early preterm delivery in normotensive pregnancies. Women with low levels of PAPP-A at first trimester have a higher risk of early preterm delivery even in the absence of hypertensive disorders.

A complete gonadal dysgenesis case with mental retardation, congenital hip dislocation, severe vertebra rotoscoliosis, pectus excavatus, and spina bifida occulta

BACKGROUND

46,XY, or Swyer syndrome, is a complete gonadal dysgenesis. Patients usually presents with primary amenorrhea with underdeveloped secondary sex characteristics. Phenotypes of these patients are female. In this report, a Swyer syndrome case is reported with novel clinical features that are classified as connective tissue disorders. This case and the 2 other previously reported Swyer syndrome cases with ascendant aortic aneurysm and diaphragmatic hernia are suggest that the Y chromosome has an important role in the structure of connective tissue.

CASE

Here we report a case of a 17-year-old with clinical features of 46,XY complete gonadal dysgenesis including external female genitalia, hypoplastic uterus, hypergonadotrophic hypogonadism, incomplete secondary sex characterics, primary amenorrhea, and normal male karyotype. In addition, she had mild mental retardation, severe rotoscoliosis, pectus excavatus, spina bifida occulta, hip dislocation, and long, slender extremities. She had a rudimentary uterus and streak gonads; after giving her cyclic estrogen and progesterone pills, she was able to menstruate.

SUMMARY AND CONCLUSION

In this report, a Swyer syndrome case was discussed regarding clinical features, especially those are not characteristic for Swyer syndrome after a review of the literature.

Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass

Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.

Somatostatin analogs regress endometriotic implants in rats by decreasing implant levels of vascular endothelial growth factor and matrix metaloproteinase 9

OBJECTIVE

To examine the effect of somatostatin analogs on surgically induced endometriosis in rat models.

STUDY DESIGN

Endometrial tissue was implanted onto the abdominal peritoneum of 26 rats that were randomized into 3 groups. The rats in group 1(n = 9) were subcutaneously administered with 0.02 mg/kg/d of octreotide (a short-acting analog)for 28 days . The rats in group 2 (n = 8) were subcutaneously injected with 20 mg/kg of a single dose of a long-acting analogue lanreotide The rats in group 3 were given no medication and served as controls (n = 9).

RESULTS

Mean volume and histologic score of implants in groups 1 (P < .01 and P < .05, respectively) and 2 (P < .01and P < .05, respectively) were significantly lower than that in group 3. There were significant reductions in vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) immunoreactivities in group 1 (0.67 ± 0.50 and 1.22 ± 0.44, respectively; both P < .01) and group 2 (0.71 ± 0.48 and 0.86 ± 0.69, respectively; both P < .01) when compared with the control group (1.78 ± 0.83 and 2.11 ± 0.78, respectively).

CONCLUSION

Somatostatin analogs has regressed significantly the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF and MMP-9.

Serum adenosine deaminase and its isoenzyme activities in pregnancy

OBJECTIVE

ADA is widely distributed in human tissues, which may contribute to the maturation of the immunological system, especially the proliferation and differentiation of lymphoid cells, and seems to be critical at different stages of the maturation process. The activity of ADA changes in diseases characterized by the alteration of cell-mediated immunity. In this study we examined changes in serum total ADA activity and the patterns of two ADA isoenzymes, ADA-1 and ADA-2, in healthy pregnant women, and evaluated the possible role of the alteration of cell-mediated immunity during pregnancy as causes of changes in ADA activity.

MATERIALS AND METHODS

We measured serum activities of total ADA, ADA-1 and ADA-2 in healthy pregnant women (n=129) and age-matched healthy nonpregnant women (n=42). We divided the study group into three different subgroups: first trimester, second trimester and third trimester.

RESULTS

Serum ADA, ADA-1 and ADA-2 activities in healthy pregnant women were significantly lower than in nonpregnant women (p<0.001, p<0.001 and p<0.01 respectively). ADA (p<0.001) and ADA-2 (p<0.001) activities in the first trimester were significantly lower than in the control group. However, there were no significant differences between the first trimester and control group according to their ADA-1 activities (p=0.016). ADA (p<0.001), ADA-1 (p<0.001) and ADA-2 (p<0.008) activities in the second trimester were significantly lower than in the control group. Combined trisomy 21 risk, biochemical trisomy 21 risk, age risk and trisomy 18 + Nuchal translucency (NT) risk were calculated using a first trimester screening test in 63 pregnant women. Furthermore, trisomy 21 risk, age risk and trisomy 18 risk were calculated by triple test in 52 pregnant women. ADA, ADA-1 and ADA-2 activities were not significantly correlated with risks in the first trimester screening test. ADA-1 activity was slightly significantly negative correlated with age risk (r= -0.314, p<0.05) and trisomy 18 risk (p<0.05) in the triple test. ADA (p<0.05) and ADA-2 (p<0.05) activities were slightly significantly correlated with gestational age, while there was no significant correlation between ADA-1 activity and gestational age.

CONCLUSION

Serum ADA activity may be useful for clinical diagnosis and observation of high-risk pregnancies in which cell-mediated immunity has been altered.

VACTERL-H syndrome: first trimester diagnosis

We present two consecutive female fetuses with identical upper limb anomalies. The first of the cases was found to have ventriculomegaly, atrial septal defect, anal atresia, narrowing of the duodenal lumen and unilateral renal agenesis at the end of the second trimester. These abnormalities were characteristic of autosomal recessive VACTERL-H syndrome. The second case was diagnosed to have absent radii and thumbs at 11 weeks. Detailed examination of fetal limbs in the first trimester screening in cases with high risk is useful for early detection of this malformation.

Correlation between first-trimester maternal serum markers, second-trimester uterine artery doppler indices and pregnancy outcome

AIMS

The aim of this study was to assess the correlation between first trimester maternal serum free beta-human chorionic gonadotropin (fBHCG), pregnancy-associated plasma protein A (PAPPA), second-trimester uterine artery (UA) Doppler measurements and adverse pregnancy outcomes.

METHODS

Serum levels of PAPPA and fBHCG were determined at the first trimester, and patients underwent bilateral UA Doppler assessments at 20-25 weeks of gestation. A serum PAPPA level <0.4 MoM was termed as low and the abnormal Doppler findings were the presence of bilateral notches and RI >0.52 (mean) or unilateral notch and RI >0.66 (90th percentile).

RESULTS

Mean PAPPA level was significantly lower in cases with unilateral or bilateral notches (1.09; 0.79 and 0.80 MoM for 0, 1 and 2 notches, p < 0.001). Fifty-two cases (12.8%) had a low PAPPA level; in this group the incidence of abnormal Doppler was significantly higher (34.6 vs. 18.4%, p = 0.011). In the presence of abnormal Doppler in a case with a low serum PAPPA the risk of pregnancy-induced hypertension (OR = 4.56, p = 0.0067), low birth weight (OR = 6.8, p = 0.0002) and the risk of at least one complication (OR = 7.6, p = 0.00001) were significantly high.

CONCLUSION

Combination of first- and second-trimester findings might improve the efficiency of screening for pregnancy complications.

Antenatal Bartter syndrome: analysis of two cases with placental findings

The prenatal diagnosis of Bartter syndrome can be based on the high chloride level in the amniotic fluid. Microscopic examination of the placenta in untreated cases showed extensive mineralization in the chorionic villi in previous studies. Two cases were presented at 26-29 weeks of gestation with severe polyhydramnios. The mothers were treated with Indomethacin, KCl, and serial amniocentesis in order to reduce the amniotic fluid volume and prevent fetal hypokalemia. The microscopic examination of the placenta revealed focal calcification and acute atherosis in placental vessels. The treatment with Indomethacin in the antenatal period can prevent severe nephrocalcinosis.

A single horn endometrial carcinoma of a uterus bicornis unicollis

In this report, we describe a case of endometrial carcinoma arising in one horn of a bicornuate uterus. The diagnosis of this rare combination can be missed unless an unrecognized postmenopausal bleeding alerts the gynecologist to make a careful search for both endometrial cavities that may be curetted. Physicians should remember the possible existence of a separate uterine cavity when endometrial cancer is clinically suspected but histology fails to confirm the diagnosis.

A new metabolic scoring system for analyzing the risk of hypertensive disorders of pregnancy

OBJECTIVE

The aim of this study was to investigate the relationship between some components of metabolic syndrome (MS) and pregnancy induced hypertension (PIH).

STUDY DESIGN

Forty-one patients with PIH (gestational hypertension or preeclampsia) after 32 weeks of gestation were compared with 97 normotensive pregnant women. Metabolic scores (0-4) were created using standard deviations in normotensive cases: mean level + 1SD for BMI (>31 kg/m(2)), mean level + 1SD for triglyceride (>287 mg/dl), mean level + 1SD for fasting serum glucose (>90 mg/dl)) and mean level - 1SD for HDL (<48 mg/dl).

RESULTS

The mean values for BMI (31.6 +/- 5.7 vs. 27.7 +/- 3.6; P < 0.0001), fasting triglyceride (341 +/- 129 vs. 220.7 +/- 67; P < 0.0001) and glucose (87.5 +/- 17.1 vs. 79.6 +/- 10.4; P = 0.0009) were higher in hypertensive group. The proportions of the women with a positive result for each of the components were significantly higher in the group of PIH. The percentage of the cases having 2 (35.2 vs. 8.2%; P = 0.0002) and 3 or more (27 vs. 4.1%; P = 0.0003) components of MS was higher in the hypertensive group and the percentage of the cases with none of these factors was high in the normotensive group (10.8 vs. 56.7%; P < 0.0001).

CONCLUSION

The presence of multiple components of MS may be a risk factor in the development of PIH. New scoring systems according to the gestational age might be useful in analyzing the risk of PIH.

Semilobar holoprosencephaly with associated cyclopia and radial aplasia: first trimester diagnosis by means of integrating 2D-3D ultrasound

INTRODUCTION

Holoprosencephaly (HPE) is commonly associated with facial malformations. We present a case of semilobar HPE associated with distal limb defect which was detected at 12 weeks of gestation.

CASE

The fetus had a crown-rump length of 60 mm (12 weeks-4 days), had nuchal translucency thickness of 1.5 mm. Initial two-dimensional (2D) ultrasound revealed the absence of nasal bone, decreased BPD and abnormal profile. Transvaginal 2D ultrasound was effective in the detection of HPE (partially absence of the interhemispheric fissure, fused thalami, the choroid plexuses were not visualized bilateraly: absent 'butterfly' sign), cylopia, absence of the nose and unilateral radial aplasia. Three dimensional (3D) ultrasound provided a better visualization of the associated anomalies. The necropsy result confirmed the sonographic findings: the diagnosis was semilobar HPE, cyclopia, absence of the nose, and the absence of the radius and the thumb in the left arm.

DISCUSSION

Transvaginal 2D sonographic examination is effective in detection of the cases with HPE at first trimester. Fetal morphological study through 3D ultrasound may facilitate the diagnosis of associated anomalies.

Arthrogryposis multiplex congenita: analysis of twelve cases

OBJECTIVE

The term arthrogryposis multiplex congenita (AMC) refers to multiple joint contractures present at birth. AMC is not a specific disorder but is the consequence of neurological, muscular, connective tissue, and skeletal abnormalities or intrauterine crowding, which may lead to limitation of fetal joint mobility and the development of contractures.

METHODS

Cases referred to our perinatology department for detailed examination were retrospectively analyzed.

RESULTS

Twelve cases with AMC were detected during the antenatal period. The ultrasound features related to the "lack of movement" included limb abnormalities (multiple contractures, clenched hands, and clubbed feet), short umbilical cord, polyhydramnios, pulmonary hypoplasia, camptodactyly, and micrognathia. Five of the early detected cases (71%) were found to have increased nuchal translucency or nuchal fold. All of the cases at the third trimester resulted in neonatal death.

CONCLUSION

First trimester screening may be useful for early diagnosis of AMC. Sonographic findings in late pregnancy might be helpful in predicting the prognosis. Due to the high recurrence risk, a specific screening program should be performed for the following pregnancies by examination of the fetus several times for movement and position of the limbs.

Fetuses with single umbilical artery: analysis of 45 cases

OBJECTIVE

The aim of this study was to analyze cases and determine the clinical significance of a prenatally detected single umbilical artery (SUA) in our population.

MATERIALS AND METHODS

All second and third trimester sonographic examinations carried out between January 2004 and September 2007 in our perinatology unit were reviewed. The postnatal results of the fetuses with SUA were obtained from the medical records and the patients.

RESULTS

From a total of 5,620 pregnant patients who were examined by ultrasound (US) scan between 15-36 weeks, a single umbilical artery was found in 45 cases, representing an incidence of 0.8%. Of these, 20 (45%) also presented with other malformations. There were six neonatal deaths, one fetal demise, and six terminations of pregnancy due to severe malformations in this group. Three cases with associated anomalies underwent surgery and one case required intensive care in the neonatal period. The only cytogenetic abnormality was trisomy 18 in one case. Six of 45 fetuses (13%) with single umbilical arteries had abnormal echocardiographic findings. In two of the fetuses associated anomalies (cleft palate and esophageal atresia) were detected after birth. In pregnancies without associated anomalies no aneuploidy was found and they were completely normal at birth and during the neonatal period.

CONCLUSIONS

Scanning the umbilical cord is one of the essential parts of US examination. As the rate of cardiac malformations seen with single umbilical arteries is high, fetal echocardiography should be performed in suspected cases. The newborn should be reexamined immediately after birth due to the possibility of undetected anomalies.

Clinicopathologic analysis: relationship between endometrial carcinoma and uninvolved endometrium

OBJECTIVE

The aim of this study was to compare the histopathologic features and surgical stage of endometrial carcinoma with tumor-free endometrial tissues.

METHODS

Data from the files of 80 patients with endometrial carcinoma who were managed at Haseki Training & Research Hospital between January 2001 and July 2007 were evaluated. We assessed tumor-free endometrium, stage, histologic type and grade, depth of myometrial invasion, peritoneal cytology, adnexal-cervical involvement, lymphovascular space invasion (LVSI), and lymph node metastases.

RESULTS

Twenty-nine patients (43%) with endometrial carcinoma had concomitant endometrial hyperplasia. Seven patients (10%) had one or more areas of metaplasia in the endometrium adjacent to the carcinoma. Endometrial carcinoma with atrophic background was significantly associated with aggressive histopathologic type (p < 0.04) and LVSI (p < 0.02).

CONCLUSION

The histological characteristics of non-tumoral endometrium were found to be critical in determining the type of aggressive tumor and LVSI in atrophy-associated carcinomas.