Skin disorders in women with poor obstetric history: MTHFR polymorphisms and importance of preconceptional counseling

OBJECTIVES

This study focused on the link between skin disorders and Methylenetetrahydrofolate reductase (MTHFR) polymorphisms.

METHODS

Study cases were taken from a pre-conceptional care program where patients with poor obstetric history were evaluated in terms of systemic disorders including skin diseases. This retrospective cohort (n = 472) consisted of 110 (23.3%) and 362 (76.7%) women with or without skin disorders, respectively. For ease of analysis, the history of skin diseases was classified into seven categories: (1) acne/rosacea/other acneiform disorders; (2) fungal disease; (3) pruritis/xerosis; (4) psoriasis vulgaris; (5) acrochordons and other benign skin growths; (6) urticaria/dermatitis; and (7) viral diseases.

RESULTS

In this retrospective cohort of 472 women, we explored the impact of MTHFR A1298C and C677T polymorphisms on skin disorders. Despite similar allelic frequencies, our findings revealed a statistically significant association between the presence of MTHFR polymorphisms and skin disorders (p = .027). Subgroup analysis indicated significantly higher rates of MTHFR polymorphisms in patients with psoriasis vulgaris (p = .033) and acrochordons (p = .030), highlighting their potential relevance in specific skin disorder subtypes.

CONCLUSIONS

The increased prevalence of psoriasis and acrochordons among women with MTHFR deficiency underscores the complex relationship between genetic factors and dermatological health. Our findings emphasized the critical role of MTHFR polymorphisms not only in poor obstetric history but also as significant contributors to skin disorders. This dual association highlights the importance of comprehensive preconception counseling, especially customized for women affected by skin disorders.

Pancake kidney and jejunal atresia: An uncommon dual anomaly detected prenatally-A case report

Pancake kidney is a renal fusion anomaly with only a few reported prenatal diagnoses. Other structural anomalies beyond the urogenital system may also be associated. This study describes a dual anomaly case detected prenatally, comprising of pancake kidney and jejunal atresia. A postnatal abdominal ultrasound confirmed both kidneys were fused in the midline at the aortic bifurcation level, along with a type 3b jejunal atresia. Based on the available limited evidence about pancake kidney, renal functions appear to remain largely preserved and unaffected as in our case according to 6 months of follow-up. However, further investigation is needed to explore any potential association with chromosomal and structural abnormalities in selected cases.

Impact of Increased Activated Protein-C Resistance, Decreased Antithrombin III Activity and Hypocomplementemia on the Gestational Outcomes of Pregnancies with MTHFR Polymorphisms

OBJECTIVE

To evaluate the impact of increased Activated Protein C (APC) resistance, decreased antithrombin III activity and hypocomplementemia on the pregnancy outcomes of the patients with methylentetrahydrofolate reductase (MTHFR) polymorphisms.

METHODS

This study was composed of 83 pregnancies with MTHFR polymorphisms. Increased APC resistance, decreased antithrombin III activity and hypocomplementemia were accepted as risk factors for poor gestational outcome.

RESULTS

Having at least one risk factor resulted in significantly higher rates of "APGAR score of<7" at the first ten minutes (p=0.009). Composite adverse outcome rate was also higher in patients with at least one of the defined risk factors despite lack of statistical significance (p=0.241). Rate of newborn with an "APGAR score of<7" at first ten minutes was significantly higher at patients with hypocomplementemia (p=0.03).

CONCLUSION

Hypocomplementemia is a risk factor for poor gestational outcome in pregnancies with MTHFR polymorphisms.

Refusal of the hospitalization: a distressed dilemma in obstetric practice

Background

Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns.

Objectives

We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians' recommendations.

Design

We have retrospectively evaluated the patients admitted to the 'Obstetric Emergency Outpatient Clinic' and refused hospitalization between 1 January 2019 and 31 December 2019.

Methods

Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients.

Results

A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters.

Conclusion

Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.

Gestational Outcomes of Pregnant Women with Unilateral Congenital Renal Agenesis

ObjectiveWe evaluated if there were more adverse gestational outcomes of pregnant women with unilateral congenital renal agenesis (UCRA). Study design: This single center retrospective case-control study compared maternal complications and neonatal outcomes from 25 women with UCRA to the outcomes of 125 women with two kidneys. Results: UCRA women had lower gestational weeks at birth and higher rates of preterm delivery (p = 0.004 and <0.001; respectively). Mothers had higher rates of preeclampsia and newborns with congenital anomalies and neonatal intensive care unit (NICU) admission (p = 0.009, 0.042, and 0.039; respectively). Unadjusted odds ratios were significantly higher for preterm delivery and for any APGAR score of <7 at the first 10 min and preeclampsia [OR (95% CI):13.5 (4.66-39.05), 31 (3.44-279.32) and 5.76 (1.33-24.84), respectively]. Conclusion: Maternal UCRA is a risk factor for less optimal obstetric and neonatal outcomes.

Effect of Nonionizing Radiation on Progesterone Treatment in Endometrial Hyperplasia: An Experimental Rat Study

OBJECTIVES

The aim of the study was to evaluate the negative effect of nonionizing radiation on the treatment of endometrial hyperplasia (EH) with oral progesterone.

DESIGN

Forty oophorectomized Wistar Albino female rats were included in this experimental rat study.

MATERIALS AND METHODS

The 4 groups were planned as follows: Group A; sham group; Group B; group receiving oral estradiol hemihydrate 4 mg/kg/day; Group C; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day medroxy progesterone acetate (MPA) and Group D; 4 mg/kg/day oral estradiol hemihydrate followed with 1 mg/day MPA with exposure to nonionizing radiation at 1800 mHz/3 h/day. After the experimental model, uterine horns were sampled and the preparations were evaluated for pathological parameters (glandular density, epithelial cell length, and luminal epithelial cell length) via light microscopy. Nonionizing radiation was created by a signal generator and a compatible mobile phone.

RESULTS

Estrogen was found to increase all parameters related to EH (p < 0.05). Progesterone treatment was found to decrease parameters related to EH (Group B vs. C; luminal epithelial cell length, glandular density, and epithelial length; 11.2 vs. 13.2 μm p = 0.007; 32.5 vs. 35.5, p = 0.068; and 219.9 μm vs. 285 µm, p < 0.001, respectively). Final analyses revealed reduced effectiveness of progesterone treatment in the rats exposed to nonionizing radiation (Group C vs. D); luminal epithelial cell length, glandular density, and epithelial length (11.2 μm vs. 13.5 μm, p = 0.179; 32.5 vs. 52, p < 0.001; and 219.9 μm vs. 374.1 μm, p = 0.001, respectively).

LIMITATIONS

The limitations of our study are that the results of animal experiments may not be appropriate for direct adaptation to humans and the relatively low number of rats included in the study.

CONCLUSION

Nonionizing radiation reduces the effect of progesterone in patients receiving treatment for EH.

Impact of Increased Nuchal Translucency Values on Pregnancy Outcomes: A Tertiary Center Experience

We evaluated the association of nuchal translucency (NT) values above 99th percentile with perinatal outcomes. Materials and methods: Singleton pregnancies with NT values above 99th percentile were investigated. Pregnancies were divided into 3 groups: group 1, NT = 2.6-<3.5 mm; group 2, NT = 3.5-4.5 mm; and group 3, NT > 4.5 mm. Demographic features, clinical characteristics, structural/chromosomal anomaly rates and perinatal outcomes were compared. Results: Normal ultrasonographic anatomy was found in 47.5%, 7.7%, and 14.3% of groups 1, 2, and 3, respectively (p = 0.006). Group 3 had the lowest normal karyotype rate (44.6%) (p = 0.005). Higher frequencies for both miscarriage and pregnancy termination were observed in group 3 compared to group 1 (8.9% vs. 4.9% and 66.1% vs. 32.7%, respectively) (p = 0.02). The lowest rate of normal postnatal anatomic findings was found in group 3 (10.7%) (p = 0.01). Conclusion: NT values above 99th percentile for gestational age seem to be associated with increased rates of chromosomal/structural abnormalities and adverse perinatal outcomes.

Obstetrical history of a family with combined oxidative phosphorylation deficiency 3 and methylenetetrahydrofolate reductase polymorphisms

Objectives

Recurrent pregnancy loss (RPL) is a devastating complication of pregnancy with various etiologic backgrounds.

Case presentation

We present a case of combined oxidative phosphorylation deficiency 3 (COXPD3) carrier pregnant woman with Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. She had five pregnancy losses and a postpartum death due to COXPD3. The patient was admitted to our clinic for the first time at her seventh pregnancy with oocyte donation. The patient was registered in a special antenatal care program and delivered a healthy baby at term. Her eighth pregnancy was terminated due to COXPD3 which was prenatally diagnosed.

Conclusions

Comprehensive and individualized approaches are necessary in RPL cases to obtain optimal outcomes.

Use of the 50-g glucose challenge test to predict small-for-gestational-age neonates

BACKGROUND

To determine a cutoff value for the 50-g glucose challenge test (50-g GCT) for the prediction of small-for-gestational-age (SGA) neonates.

METHODS

This retrospective cohort study was conducted among pregnant women who were screened with the 50-g GCT at Hacettepe University Hospital between 1 January 2016 and 31 March 2019. Patients with 50-g GCT values <74 mg/dL (<10th percentile) served as the study group (n = 244), while patients with 50-g GCT values between 74 to 139 mg/dL served as the control group (n = 3104). Groups were compared in terms of demographic features, clinical characteristics, and obstetric outcomes. Logistic regression analysis was used to determine independent predictors of SGA. Receiver operating characteristic curves were used to assess the performance of 50-g GCT values in predicting SGA.

RESULTS

Lower birthweight, birthweight percentile, and 5th-minute Apgar values, together with higher rates of SGA, were observed in the study group (P < .001 for all). A 50-g GCT value below the 10th percentile (odds ratio: 3.29, 95% CI: 2.31-4.69, P < .001) was a significant independent factor for SGA. A cutoff value of 89.5 mg/dL (84.9% sensitivity, 85.6% specificity) was determined for SGA.

CONCLUSIONS

Low 50-g GCT values (<89.5 mg/dL) may be an early indicator for SGA.

The Effect of Asthma Severity on Perinatal Outcomes: A Tertiary Hospital Experience

OBJECTIVE

To evaluate the effect of asthma severity and disease exacerbation on pregnancy outcomes.

MATERIALS AND METHODS

Pregnancies were classified into 3 groups as mild (n=195), moderate (n=63), and severe (n=26) according to preconceptional asthma severity. Demographic features, clinical characteristics, and perinatal outcomes were compared between the groups. Delivery characteristics and pregnancy outcomes were also compared between the pregnancies with or without asthma exacerbation (43 and 241 pregnancies, respectively).

RESULTS

Worsening of symptoms during pregnancy was higher in moderate and severe asthma groups (p<0.001). Rates of spontaneous abortion, fetal structural anomaly, preterm delivery, preeclampsia, fetal growth restriction (FGR), oligohydramnios, gestational diabetes, and intrauterine fetal demise were higher in moderate and severe asthma groups (p-values were < 0.001, 0.01, 0.008, 0.02, 0.01, < 0.001, < 0.001, and 0.007, respectively). Admissions to neonatal intensive care units and neonatal complication rates were higher among moderate and severe asthma groups (p=0.035 and < 0.001). Spontaneous abortion, preterm delivery, preeclampsia, FGR, oligohydramnios, and neonatal complication rates were higher (p<0.001) in the group with exacerbated symptoms.

CONCLUSION

Moderate to severe asthma before pregnancy and the exacerbation of asthma symptoms during pregnancy may lead to increased rates of perinatal complications.

Assessment of Factors Affecting Breastfeeding Performance and Latch Score: A Prospective Cohort Study

OBJECTIVE

To determine the risk factors that may affect LATCH scores.

MATERIALS AND METHODS

We prospectively evaluated the LATCH scores and any relevant risk factors of patients who delivered at our institution during April and May 2020. All examinations were performed by the same physicians during the study period. LATCH scores were determined at initial breastfeeding session, and postnatal days 1 and 2.

RESULTS

We analyzed 338 patients in this prospective study. Patients with high-risk pregnancies were found to have lower LATCH scores at each measurement (p: 0.002, 0.001, and 0.09, respectively). Skin-to-skin contact immediately after delivery and breastfeeding longer than 20 min in the first session did not improve LATCH scores (p>0.05). Breastfeeding within 30 min after delivery significantly improved LATCH scores at each session (p<0.01 for all). Odds ratios of having a LATCH score lower than 8 was 10.9 (95% CI: 4.22-28.37) for the patients breastfed after more than 30 min, while this ratio was 2.17 (95% CI: 1.34-3.50) and 6.5 (95% CI: 3.46-12.58) for the patients having a high-risk pregnancy and cesarean section, respectively. Furthermore, we also determined a positive statistically significant association between parity and all LATCH scores according to regression analyses (p: 0.005, 0.028, and 0.035 for LATCH scores at initial breastfeeding, postnatal day 1 and 2, respectively) CONCLUSION: High-risk pregnancies, patients who delivered by cesarean section, and patients not attempting to breastfeed within 30 min tend to have lower LATCH scores.

Maternal Mortality: 10 Year Experience of a Tertiary Center in Turkey

We retrospectively evaluated five maternal mortality cases that occurred in our institution within the last 10 years. Rate of maternal mortality was 24.5 per 100000 live births. Maternal mortality causes were cardiopulmonary failure secondary to veno-occlusive disease, septic shock secondary to osteosarcoma, pulmonary thromboembolism secondary to metastatic breast cancer, septic shock secondary to cholecystitis, and postpartum hemorrhage secondary to Niemann-Pick disease. Four out of five cases were evaluated as indirect maternal mortality cases. Three out of five cases ended up with a healthy newborn, while other cases ended up with abortus and postpartum exitus.

The Effect of Small Size Uterine Fibroids on Pregnancy Outcomes in High-risk Pregnancies

OBJECTIVE

 To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid.

METHODS

 This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes.

RESULTS

 There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy.

CONCLUSION

 Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safely performed in properly selected cases.

Acrochordons and autoimmunity: Significance of preconceptional counseling

BACKGROUND

Acrochordons are benign hypertrophic lesions of the skin of which the pathophysiology is unclear.

OBJECTIVE

This study aimed to examine the association of acrochordons with autoimmune disorders in patients with a poor obstetric history.

METHODS

This retrospective cohort involved 350 female patients with poor obstetric history who were included in a preconceptional care program to investigate risk factors for obstetric complications. These patients were further investigated for the co-existence of autoimmune disorders (defined by either a diagnosis of autoimmune diseases or autoimmune antibody positivity) and acrochordons.

RESULTS

An autoimmune disorder was present in 55.7% (195/350) of the patients. The rate of acrochordons was significantly higher in patients with autoimmune disorders (n= 195) compared to the control group (n= 155) (8.21% versus 2.58%, respectively) (p= 0.043). When the autoimmune disease positive (n= 58) and autoimmune antibody-positive (n= 137) groups were separately analyzed, acrochordons were found more frequently in the autoimmune disease group (p= 0.004). However, there was no statistically significant co-occurrence of autoimmune antibody positivity and the presence of skin tags (p= 0.135).

CONCLUSION

There may be immune system-related biological mechanisms underlying the pathogenesis of acrochordons. Preconceptional counseling is beneficial for women with poor obstetric history and acrochordons.

Importance of shock index in the evaluation of postpartum hemorrhage cases that necessitate blood transfusion

This study aims to determine cutoff values for shock index (SI) to predict the need for transfusion and composite adverse outcomes in postpartum hemorrhage (PPH) cases. One hundred thirty PPH cases (study group) that necessitated blood transfusion were retrospectively compared to a frequency-matched control group (n = 130). Receiver operating characteristic (ROC) curves and decision tree [Classification & Regression Tree (C&RT) and Chi-square Automatic Interaction Detector (CHAID)] were used to identify cutoff values for SI. Cutoff values for postdelivery, peak and delta SI values for the prediction of PPH that required transfusion were 0.9125 (0.815 sensitivity, 0.923 specificity), 0.9145 (0.892 sensitivity, 0.823 specificity) and 0.195 (0.823 sensitivity, 0.885 specificity), while cutoff values for the same SI values in the prediction of composite adverse outcome were 1.315 (0.645 sensitivity, 0.616 specificity), 1.183 (0.613 sensitivity, 0.737 specificity) and 0.487 (0.710 sensitivity, 0.758 specificity). Delta SI was superior to postdelivery and peak SI in the prediction of PPH that required transfusion. Peak SI was superior to postdelivery and delta SI in the prediction of composite adverse outcome. In conclusion, increased postdelivery, peak, and delta SI values were related to adverse outcomes for PPH. SI seems to be a practical and effective method for the objective assessment of postpartum hemorrhage.

Fetal Cell Microchimerism; Normal and Immunocompromised Gestations in Mice

Objective: To compare fetal cell microchimerism in normal and immunocompromised gestations. Materials and methods: The study consists of two groups of mature female mice. In the control group and the immunocompromised study group, 5 mg of saline and cyclosporine were injected intraperitoneally, respectively. In the second step, all female mice were mated with "Actine-Luc (+) green fluorescent protein (GFP)" transgenic male mice. Immunohistochemical studies (ALPL-antiluciferase, cytokeratin-antiluciferase, and CD 105-antiluciferase) were carried out on maternal liver, skin, and lung tissues at 6-7th and 14-15th gestational days, and postpartum 3-4th, 12th, and 18-24 months. Results: GFP (+) cells were detected in maternal liver and skin but not in lung tissue. Liver was the most affected tissue. GFP was found to be more intense in the immunocompromised group. Conclusion: Fetal microchimerism was demonstrated in maternal liver and skin and found to be more intensive in the immunocompromised group.

Granulomatosis with polyangiitis and pregnancy: Anti-neutrophil cytoplasmic antibody, placental inflammation, chorangiosis and pre-eclampsia

Granulomatosis with polyangiitis (GPA) is a rare necrotizing autoimmune disease involving small vessel vasculitis. Pregnancies with GPA have increased rates of obstetric complications including pre-eclampsia. Differential diagnosis of GPA flares up and pre-eclampsia may be difficult and necessitates careful clinical practice. A 26-year-old pregnant woman with GPA was referred for hypertension. The absence of GPA signs and symptoms, negative anti-neutrophil cytoplasmic antibody titer and the presence of clinical and laboratory findings supported the diagnosis of pre-eclampsia rather than a GPA flare-up. The newborn was delivered via cesarean section at the 30th gestational week due to severe superimposed pre-eclampsia. Pathological examination of the placenta demonstrated the presence of chorangiosis and focal placental infarcts. GPA should be considered as a risk factor in pregnancy and requires careful clinical management to have good gestational outcome. Physicians should be vigilant regarding gestational diabetes and pre-eclampsia as well as GPA flare-up.

Is bacterial vaginosis associated with autoimmune antibody positivity?

OBJECTIVE

To evaluate the association between bacterial vaginosis (BV) and autoimmune antibody positivity.

METHOD

We evaluated Papanicolaou-stained cervicovaginal smears of 210 patients with poor obstetric history who were admitted to a special preconception counselling programme. Cytological specimens with various types of microorganisms except for BV, epithelial cell abnormalities and other non-neoplastic findings, including inflammation were excluded from the cohort in addition to patients with autoimmune and chronic inflammatory diseases. The remaining study population (n = 121) was divided into two groups of patients with autoimmune antibody positivity (study group, n = 80) and patients without antibody positivity (control group, n = 41).

RESULTS

The rate of BV was demonstrated to be 13.8% and 2.4% in the study and control groups respectively (P = .042). We also demonstrated that the anti-nuclear antibody was positive in 58.3% of the cases with BV.

CONCLUSION

BV was found more frequently in patients with autoimmune antibody positivity to a statistically significant degree.

Prenatal diagnosis of central nervous system abnormalities: Neurosonography versus fetal magnetic resonance imaging

OBJECTIVE

To share our experience in diagnosis of congenital central nervous system (CNS) abnormalities by fetal magnetic resonance imaging (MRI).

STUDY DESIGN

This study consisted of 110 pregnancies. Neurosonography (NS) findings were compared with MRI results. Anomalies were categorized into 10 groups: 1) Corpus callosum (CC) and cavum septum pellucidum (CSP) anomalies, 2) Neural tube defects (NTD), 3) Posterior fossa anomalies (PFA), 4) Primary ventriculomegaly (PVM), 5) Microcephaly, 6) Macrocephaly, 7) Periventricular leukomalacia (PVL), 8) Craniosynostosis, 9) Intracranial hemorrhage (ICH) and 10) Lumbosacral teratoma. Demographic features, clinical characteristics and perinatal outcomes of the study subjects were evaluated.

RESULTS

Gestational weeks for NS and for MRI were 25.5 and 26.5 weeks, respectively. Fourteen (12.7%) pregnancies were terminated. PVM (n = 36, 32.7%), CC and CSP anomalies (n = 29, 26.3%), PFA (n = 11, 10%) and NTD (n = 11, 10%) were the most common fetal MRI indications. There were no statistically significant differences between the accuracy of fetal NS and fetal MRI for CC and CSP anomalies, NTDs, PFA and PVM (p = 0.09, 0.43, 0.45 and 0.23, respectively). However, fetal MRI was more accurate for the detection of normal anatomic findings in cases with suspected microcephaly, macrocephaly and craniosynostosis in NS when pooled together (p = 0.007). Furthermore, MRI also seemed to be advantageous in CC & CSP anomalies though it was not validated by statistical measures. No statistically significant difference was found for diagnostic performance of NS and MRI according to gestational week (p = 0.27).

CONCLUSION

Fetal MRI in addition to NS may improve diagnostic accuracy in pregnancies with congenital CNS abnormalities.

Relationship of Cholelithiasis and Urolithiasis with Methylenetetrahydrofolate Reductase Polymorphisms

AIM

To investigate the relationship of cholelithiasis and urolithiasis with Methylenetetrehydrofolate Reductase (MTHFR) polymorphism(s) in patients with poor obstetric history to search whether they are risk factors for adverse pregnancy outcome.

MATERIALS AND METHOD

This study is consisted of 94 patients with poor obstetric history. Patients were evaluated in terms of the presence of cholelithiasis and urolithiasis in association with MTHFR polymorphism(s). Additional laboratory tests including homocysteine measurements were also performed. ROC analysis for assessing the performance of blood homocysteine level in predicting the presence of cholelithiasis and urolithiasis were also performed.

RESULTS

Patients were divided into three groups such as cholelithiasis group (n = 9, 9.6%), urolithiasis group (n = 18, 19.1%) and control group (n = 67, 71.3%). Groups did not differ in term of age and Beksac obstetrics index (BOI) which is "[living child+(π/10)]/gravidity." The rate of the presence of MTHFR polymorphisms were 88.9% (8/9), 88.9% (16/18) and 43.3% (29/67) in cholelithiasis, urolithiasis and control groups respectively. Median homocysteine levels were found to be 13.1, 11.6 and 7.2 micromol/lt for the groups respectively. Statistically significant differences were found for MTHFR polymorphism rates and homocysteine levels (<0.001 for both). According to ROC analysis, 10.9 mcmol/L (88.9% sensitivity, 89.6% specificity) and 9.25 mcmol/L (83.3% sensitivity, 73.1% specificity) were determined to be cutoff values of homocysteine for cholelithiasis and urolithiasis respectively.

CONCLUSION

More frequent MTHFR polymorphisms are observed in women with a clinical history of gall or renal stones. Thus, screening of these patients may be benefical for the approprate management of their subsequent pregnancies.

Concerns of Pregnant Women in "Prenatal Screening/Diagnosis" Practice and Termination of Pregnancy

OBJECTIVE

To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP).

STUDY DESIGN

This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP.

RESULTS

Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP.

CONCLUSION

Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

5 Years' Experience of a Tertiary Center with Thrombocytopenic Pregnancies: Gestational Thrombocytopenia, Idiopathic Thrombocytopenic Purpura and Hypertensive Disorders of Pregnancy

Aim To evaluate thrombocytopenic pregnancies including gestational thrombocytopenia (GT), idiopathic thrombocytopenic purpura (ITP), and hypertensive disorders of pregnancy (HDP).

Materials and Methods We evaluated the pregnancy outcomes and laboratory findings of 385 patients diagnosed with GT, ITP, or HDP whose thrombocyte levels were < 150 000/µL.

Results GT, ITP, and HDP were the final diagnoses in 315 (81.8%), 35 (9.1%), and 35 (9.1%) cases, respectively. Patients diagnosed during the 1st trimester and diagnosed with ITP had significantly lower minimal platelet counts during the antenatal period and prior to delivery (p < 0.001; p < 0.001; p < 0.001; p < 0.001). Transfusion of any kind of blood product was given in 9.9% (n = 38) of all cases. Twelve patients had methylprednisolone and/or intravenous immunoglobulin treatments during the antenatal period. All patients who had undergone medical treatment were also found to have ITP. Four out of 385 patients underwent hysterectomy post partum due to refractory hemorrhage. Analysis of newborn platelet levels showed no statistical differences between any of the groups. Despite the lack of statistical significance, the rate of thrombocytopenia in newborns was 50% in patients with severe thrombocytopenia, while rates were 25.6 and 18.1% in patients with moderate and mild thrombocytopenia, respectively.

Conclusion Thrombocytopenic pregnancies must be carefully evaluated with regard to the severity of thrombocytopenia, gestational period at initial diagnosis, and etiology. In particular, patients with ITP must be evaluated carefully as these patients are more likely to require transfusions and have platelet counts < 50 × 10 ³ /µl.

5-year experience of a tertiary center in major congenital abnormalities in singleton pregnancies

OBJECTIVE

To demonstrate major congenital abnormalities delivered or terminated at our institution between 2014 and 2018.

MATERIALS AND METHODS

Necessary information was retrieved from the registries of the delivery room and electronic database of Hacettepe University Hospital, Ankara.

RESULTS

This study was consisted of 307 major congenital anomalies. The incidence of major congenital anomalies was 2.9 per 1,000 live births, while the majority of the cases were related to cardiovascular, central nervous system, and diaphragmatic hernia with 97, 87, and 25 cases at each group, respectively. Rate of termination of pregnancy (TOP) and live birth were 35.1 and 59.2%, respectively. The overall infant mortality rate was 28.9% in cases with live birth, while this rate was highest in cardiovascular system abnormalities and diaphragmatic hernia. Out of 182 newborns, 92.8% admitted to the neonatal intensive care unit after the delivery. Median gestational week at TOP was 21(20).

CONCLUSION

We have shown that TOP and infant mortality rates were 35.1 and 28.9%, respectively in pregnancies with fetal malformations. Detailed multidisciplinary counseling must be provided for parents in pregnancies with major congenital abnormalities.

PERINATAL OUTCOMES OF PREGNANT WOMEN WITH TYPE 1 DIABETES MELLITUS: COMPARISON OF MULTIDOSE INJECTION AND CONTINUOUS SUBCUTANEOUS INSULIN INFUSION

OBJECTIVE

To evaluate obstetric and neonatal outcomes of patients with type 1 diabetes mellitus (T1DM) and compare multidose injection (MDI) and continuous subcutaneous insulin infusion (CSII).

STUDY DESIGN

Retrospective study of 53 pregnant patients with T1DM reaching at least 24^th gestational week.

RESULTS

Fourteen patients (26.4%) hospitalized for insulin dose regulation. Ten patients had hypertensive diseases. Perinatal mortality occurred in 2 neonates owing to cardiac malformations. Neonatal hypoglycemia, small for gestational age, large for gestational age, and neonatal jaundice were demonstrated in 8, 4, 12 and 19 newborns, respectively. Sixteen newborns were admitted to the NICU for various reasons. Congenital malformations were detected in 7 newborns (6 cardiovascular and 1 central nervous system anomaly). Despite lack of statistical significance, total daily insulin doses were higher in the MDI group than in the CSII group with doses of 62 IU (18-166) and 51 IU (20-114), respectively (p=0.119). Gestational and perinatal outcomes also showed no statistical significance. However, all congenital abnormalities and perinatal deaths occurred in the MDI group.

CONCLUSION

T1DM in pregnancy is a challenging problem in terms of having better obstetric and perinatal results. CSII may be used safely instead of MDI in appropriate patients.

Effect of hypocomplementemia on perinatal outcomes of pregnancies with autoimmune disorders

OBJECTIVE

To demonstrate the effect of preconceptional complement levels on perinatal outcomes of pregnancies with autoimmune disorders.

METHODS

Pregnant women with autoimmune disorders (autoimmune disease and/or autoimmune antibody positivity) who were screened for complement levels (C3 and C4) prior to their pregnancies were enrolled in a special antenatal care program. These patients were administered low-dose low-molecular-weight heparin (enoxaparine, 1 × 2000 Anti-XA IU/0.2 mL/day), low-dose salysilic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1 × 4 mg/day orally) as soon as their pregnancies were confirmed according to the institutional protocol. We have compared hypo- and normocomplement pregnancies with autoimmune disorders in terms of their obstetric and perinatal outcomes. We have also used Beksac Obstetric Index (BOI) which is "[living child + (π/10)]/gravidity" for the comparison of their previous obstetric histories.

RESULTS

Obstetric and neonatal outcomes showed no significant difference between hypocomplement patients (n= 38) and control group (n= 157) (p> 0.05). "Composite obstetric and perinatal adverse outcome" rates were 26.2% and 27.3% in study and control groups, respectively (p> 0.05). BOI was significantly lower in hypocomplement patients (p: 0.002). Then, we have classified hypocomplement patients into 3 subgroups according to the type of complement (C3, C4 or both). Comparison inbetween these groups revealed no statistical significance in any of the analyzed parameters (p> 0.05).

CONCLUSION

Low complement levels in pregnant women with autoimmune disorders may be associated with gestational problems and poor obstetric history. Immunomodulatory treatment modalities such as ours may be beneficial for improving the obstetric and neonatal outcomes.

Chorionic villus sampling experience of a reference perinatal medicine center

AIM

To share the chorionic villus sampling (CVS) experience of a single surgeon in our institution.

METHODS

This retrospective study consists of CVS cases performed between 2000 and 2018. A total of 66 types of indications were classified under two main categories, the screening group (SG) and the inherited disease group (IDG). The SG and IDG were compared in terms of clinical characteristics of the patients, Beksaç obstetrics index (BOI), timing of CVS in terms of gestational week, and complications and termination of pregnancy (TOP) rate.

RESULTS

CVS was performed at 656 women, 69 and 587 of whom were included in the SG and IDG, respectively. CVS indications of the SG were determined as advanced maternal age, high risk in combined test, fetal anomaly suspicion in ultrasonography, and increased nuchal translucency in 23, 23, 14 and 9 cases, respectively. On the other hand, CVS indications of the IDG were hereditary disorders related to hematological, muscular, and metabolic systems for 233, 179, and 116 cases, respectively. Furthermore, 32 patients had a single-gene disorder and 14 had a neurodegenerative disease. According to the results of CVS, 359 fetuses were found to be normal (54.73%), while 205 (31.25%) and 92 (14.02%) fetuses were found to be disorder-positive or carriers, respectively. Two hundred pregnant women accepted TOP. Eight (1.2%) pregnancies ended with abortion after CVS. Statistically significant differences were observed in BOI and TOP rate between SG and IDG (p: 0.042 and 0.013).

CONCLUSION

Hereditary disorders were the most common CVS indications and the acceptance of TOP was significantly higher in this group.

Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow Coma Scale

Objective To evaluate the characteristics of obstetric admissions to an intensive care unit (ICU) and assess the utility of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and the Glasgow Coma Scale (GCS). Methods This study is consisted of 160 patients admitted to an ICU during the antenatal period or within 7 days at the postpartum period. Clinical characteristics and ICU scores were evaluated. Results The rate of admission to the ICU was 7.8/1000 deliveries. Four cases ended with maternal mortality (2.5%). The most common hospitalization indications were hypertensive disorders of pregnancy, cardiovascular disorders and obstetric hemorrhage, at 40 (25%), 34 (21.2%), and 31 (19.3%) cases, respectively. The receiver operating characteristics (ROC) curve analysis for prediction of maternal mortality revealed area under curve (AUC) values as 0.971 both for APACHE II and predicted mortality rate (PMR), and 24.5 and 47.1 were determined as the cut-offs with sensitivities of 100%. AUCs were also 0.901 and 0.929 for the initial and worst SOFA score, respectively. The cut-off value for the initial and worst SOFA score was 3.5, with a sensitivity of 100%, and was 10 with a specificity of 98.9%, respectively. Conclusion APACHE II and PMR overpredict maternal mortality, but those higher scores predict maternal mortality. Higher SOFA scores are related with maternal mortalities with high specificity.

Retrospective evaluation of pregnancies with ankylosing spondylitis in a tertiary center in Turkey

BACKGROUND

To evaluate obstetrical and perinatal outcomes of pregnancies with ankylosing spondylitis (AS).

METHODS

This was a retrospective study evaluating obstetric outcomes of 52 patients with AS who were followed up at our institution between 2006 and 2019. Patients were classified as having disease greater than or less than 5 years, and according to disease-related medical treatment during pregnancy, as drug free, single medication or multiple medication.

RESULTS

Overall rates of preterm delivery, intrauterine growth retardation and preeclampsia were 17.3%, 13.4% and 7.7%, respectively. Thirty-three of the patients were followed up without any medication, while 19 patients used drugs during pregnancy. Seven patients used a single drug and 12 patients had multiple drugs. There was no significant difference in terms of obstetrical and neonatal outcomes. However, a higher rate of neonatal intensive care unit (NICU) admission was observed in the group using medication for AS, despite a lack of statistical significance (31.5% vs 15%, P = .162). On the other hand, patients having disease more than 5 years had higher rates of Apgar scores less than <7 and admission to the NICU despite a lack of statistical significance (4% vs 7.4% and 16% vs 26%; P = .267 and P = .297, respectively).

CONCLUSION

In conclusion, pregnancies of patients with AS must be considered as high risk due to increased rates of adverse outcomes such as preterm delivery, intrauterine growth retardation or preeclampsia.

Gestational Outcomes of Pregnancies with Prenatally Detected Gastroschisis and Omphalocele

Objective: To evaluate and compare the outcomes of pregnancies with prenatally detected gastroschisis and omphalocele. Materials and Methods: We retrospectively evaluated prenatally detected gastroschisis and omphalocele cases. Cases were compared in terms of maternal demographic and clinical characteristics as well as pregnancy and neonatal outcomes. Results: This study consisted of 17 gastroschisis and 30 omphalocele cases. Only one case with gastroschisis was terminated due to additional severe limb deformities. Seventeen out of 30 cases of omphalocele were terminated for various reasons (56.7%). All patients with gastroschisis had surgical repair, while 8 out of 13 omphalocele cases had surgery. One patient with an omphalocele died after surgery due to sepsis. Six cases of gastroschisis also died in the neonatal period due to various reasons (6/16, 37.5%). Conclusion: Additional genetic disorders are more frequent in those with omphalocele cases, and they are more frequently terminated during gestation that the gastroschisis fetuses.

Clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies

Objective To demonstrate clinical importance of the 75-g glucose tolerance test (GTT) in the prediction of large for gestational age (LGA) fetuses in non-diabetic pregnancies. Methods We retrospectively evaluated 75-g GTT screening results of 356 pregnancies without prompt diagnosis of gestational diabetes mellitus (GDM) between January 2013 and December 2017. Newborns with a birthweight greater than the 90th percentile were evaluated as LGA. Pregnancies with LGA and non-LGA fetuses were compared by demographic and historical factors - maternal age, gravidity, parity, birthweight, birthweek, GTT results and birthweight percentiles - via Student's t-test. Multiple linear regression using the backward elimination method was performed to define the correlation between parameters and LGA (P-value of <0.20 was identified as the threshold). Receiver operator characteristics (ROC) curve analysis was performed for further analysis. Results The cohort was consisted of 45 (12.6%) and 311 (87.4%) pregnancies with LGA and non-LGA fetuses, respectively. Maternal age and 2nd-h GTT results were found to be significantly higher in patients with LGA newborns (P<0.001 and P=0.016, respectively). Fasting glucose levels and GTT 1st-h results were also higher (P=0.112, P=0.065). The coefficient of multiple determination (R2) was 0.055 by multiple linear regression analysis. Accordingly, GTT 2nd-h result and maternal age were statistically significant and contributed to the explanation of LGA, although the R2 value was not that much higher (P=0.016; P=0.001). Maternal age and GTT 2nd-h results were found to be associated with LGA fetuses with area under the curve (AUC) values of 0.662 and 0.608 according to ROC curve analysis. Conclusion Maternal age and 75-g GTT 2nd-h results were significantly higher in gestations with LGA newborns without GDM.

Effect of viral load on pregnancy outcomes in chronic hepatitis B infection

AIM

This study aimed to evaluate perinatal and neonatal outcomes in pregnant women with chronic hepatitis B virus infection based on infection status and to identify cut-off values based on hepatitis B virus DNA viral load to predict composite adverse perinatal/neonatal outcomes.

METHODS

Pregnant women with chronic hepatitis B virus who delivered at Hacettepe University between 2010 and 2018 were evaluated retrospectively. We included 95 patients. The patients were classified into two groups based on laboratory findings and viral load: group 1 (n = 63), immune inactive; and group 2 (n = 32), immune active. Maternal age, gravidity, parity, gestational week at birth, birth weight, 5th minute APGAR scores and composite perinatal and neonatal outcomes were compared between groups.

RESULTS

Gestational week at birth, birth weight and 5th minute APGAR score in group 2 were lower than those in group 1 (P < 0.001, P < 0.005 and P < 0.001, respectively). The rates of composite adverse perinatal/neonatal outcome, preterm birth, fetal growth restriction, oligohydramnios, pre-eclampsia, admission to the neonatal intensive care unit, small for gestational age and 5th minute APGAR score less than 7 were significantly higher in group 2 (P < 0.001). Hepatitis B virus DNA viral load of 17 515 IU/mL (72.7% sensitivity, 78.1% specificity) and 17 515 IU/mL (81.8% sensitivity, 80.8% specificity) were determined to be cut-off values for composite adverse perinatal and neonatal outcomes, respectively.

CONCLUSION

Care should be taken in patients with a viral load of greater than 17 515 IU/mL, and pregnancy should be postponed until the inactive phase of the disease for optimal results.

Non-Ionizing Radiation Created by Mobile Phone Progresses Endometrial Hyperplasia: An Experimental Rat Study

BACKGROUND

Non-ionizing radiation is related with many pathologies.

AIM

Determine association between non-ionizing radiation and endometrial hyperplasia.

METHODS

Fifty oopherectomized Wistar albino rats were administered Estradiol hemihydrate (4 mg/kg) to induce hyperplasia, and were exposed to 1800 MHz radiation created by a mobile phone and a signal generator working as base station. This study was carried out with 5 groups in two phases. The study groups were. Control group without any exposure; group receiving estrogen in first phase of the study; group receiving estrogen in both phases; group receiving estrogen in the first phase and exposed to non-ionizing radiation during second phase and group taking estrogen in both phases and exposed to non-ionizing radiation during the second phase. Following both phases, uterine horns were excised and evaluated based on glandular density (GD), epithelial cell height (ECH), and luminal epithelial cell height (LECH).

RESULTS

Estrogen increased all parameters during both phases (LECH, GD, and ECH values were 12,2 vs. 16,5 (p = 0.001), 34 vs. 47 (p <0.001), and 201 vs. 376.6 (p = 0.001), respectively during the first phase; LECH, GD and ECH values were 13,2 vs. 20,3 (p <0.001), 35.5 vs. 65,5 (p <0.001), 219.9 vs. 419.6 (p <0.001), respectively, during the second phase).Non-ionizing radiation increased all values without estrogen exposure (LECH, GD and ECH values were 13,2 vs. 17,2 (p = 0,074), 35,5 vs. 59 (p = 0.074), and 219 vs. 318.3 (p <0.001), respectively) or with estrogen exposure (LECH, GD, and ECH, values were 20,3 vs. 22,8 (p = 0,168), 65,5 vs. 77 (p = 0,058), and 419,6 vs. 541,6 (p = 0.004), respectively).

CONCLUSION

Non-ionizing radiation progressed endometrial hyperplasia in an experimental rat model with/without estrogen exposure.

A Cut-off Value for Gestational Week at Birth for Better Perinatal Outcomes in Early- and Late-Onset Fetal Growth Restriction

OBJECTIVE

Prediction of cut-off value for gestational week at birth for better perinatal outcomes in early- and late-onset fetal growth restriction (FGR).

MATERIALS AND METHODS

This study consists of 83 singleton pregnancies with FGR that were diagnosed antenatally and confirmed postnatally between January 2017-April 2018. We used the 34^th gestational week as a cut-off for early- and late-onset FGR discrimination.

RESULTS

Early- and late-onset FGRs were detected in 22 (26.5%) and 61 (73.5%) of the cases, respectively. Expectant management significantly improved birth weight and Apgar scores at the 1^st, 5^th, and 10^th minute in early-onset FGR cases (p=0.001, p=0.019, p=0.002, and p=0.001,respectively). Similar analysis revealed no significant improvements in late-onset FGR (p=0.151, p=0.727, p=0.951 and p=0.477, respectively). Umbilical cord blood gas pH was found to be similar between management modalities in both the early- and late-onset groups (p=0.186 and p=0.456, respectively). Gestational week 33.5 was found to be the threshold for better Apgar scores at the 1^st, 5^th, and 10^th minute according to ROC curve analysis. Percentiles of 4.5, 2.5, and 4.5 were cut-off values for better Apgar scores at the 1^st, 5^th, and 10^th minute, respectively.

CONCLUSION

Expectant management must be the first choice to improve Apgar scores in early-onset FGR cases, and gestational week 33.5 must be considered as a threshold for delivery. Immediate delivery might be the choice in late-onset FGR in necessary cases. However, etiology-based management and perinatal surveillance might also be considered to improve prematurity-related neonatal complications.

Myasthenia gravis and pregnancy: retrospective evaluation of 27 pregnancies in a tertiary center and comparison with previous studies

BACKGROUND AND AIM

To share our experience with the management of pregnancies in women with myasthenia gravis (MG) in a tertiary center.

METHODS

The study retrospectively evaluated 27 pregnancies in 12 patients. The pregnancies were divided into 3 groups on the basis of the clinical course of MG during pregnancy: improvement (n = 7), disease-stable (n = 9), and deterioration (n = 11). The groups were compared with respect to patient characteristics, clinical features, and obstetric outcomes.

RESULTS

There were 4 miscarriages (14.8%), 3 preterm births (11.1%), and 4 cases of preterm premature rupture of the membranes (PPROM) (14.8%). Exacerbation was observed in 25.9% of the cases; the remission rate during the postpartum period and after miscarriage was 37%. The cesarean section (CS) rate was 78.3%. Pregnancies with deterioration of MG were statistically more likely to have higher miscarriage, preterm birth, PPROM, CS, and transient neonatal MG rates, in addition to a lower gestational age at birth, birth weight, and 5-min Apgar score than pregnancies with improved or stable disease (p values < 0.001, 0.04, 0.03, 0.009, 0.02, < 0.001, 0.002, and 0.043, respectively).

CONCLUSION

Physicians who manage pregnant women with MG must be familiar with the clinical features of the condition; a multidisciplinary approach is necessary for a better prognosis.

Human papillomavirus infection and autoimmune disorders: a tertiary center experience

This study aimed to investigate the relationship between HPV and autoimmune disorders. We retrospectively evaluated 62 women who had HPV-DNA positivity in terms of autoimmune disorders (autoimmune antibody positivity, chronic inflammatory diseases and autoimmune diseases). The patients were divided into two groups according to autoimmune disorder positivity (autoimmune positive (n = 30), autoimmune negative (n = 32)) and compared with each other in terms of single and multiple HPV-DNA types, high and low-risk HPV-DNA types, and Pap smear findings. We determined that 48.4% of the HPV-DNA positive patients had autoimmune disorders. We found that 15 of 62 (24.2%) women had more than one type of HPV and HPV type 16 was the dominant type in this study (58.2%). A total of 27.4% of HPV-DNA positive patients had abnormal cytological findings. There was no statistically significant difference between autoimmune groups in terms of the presence of high-risk HPV types, multiple HPV types and abnormal cytological findings (P = 0.531, P = 0.558 and P = 0.234, respectively). The prevalence of autoimmune disorders was high among HPV-DNA positive women. On the other hand, the rate of high-risk HPV type positivity, multiple HPV infections and cytopathological findings were similar between the autoimmune positive and negative groups.

The importance of proteinuria in preeclampsia and its predictive role in maternal and neonatal outcomes

OBJECTIVE

To evaluate impact of 24-h proteinuria level in preeclampsia on maternal/perinatal outcomes.

METHODS

Singleton pregnancies with preeclampsia delivered after 24 weeks of gestation were included. Patients were divided into mild (0.3 to <2 g) (n=72), severe (2 to <5 g) (n=30), and massive (≥5 g) (n=24) proteinuria groups, and cut-off values of 24-h proteinuria for composite adverse maternal and neonatal outcomes were calculated.

RESULTS

Twenty-four hour  proteinuria level cut-offs for composite adverse outcomes were 3275 mg (72.2% sensitivity, 85.6% specificity) and 2395 mg (72.7% sensitivity, 78% specificity) respectively.

CONCLUSION

Severe and massive proteinuria were related to poor maternal, perinatal, and neonatal outcomes.

Management and the pregnancy outcomes of patients positive for anti-parietal cell antibody

BACKGROUND

Autoimmunity is related to poor obstetric outcomes in previous studies.

OBJECTIVE

To evaluate the management and the pregnancy outcomes of patients positive for anti-parietal cell antibody (APCA).

METHODS

We retrospectively evaluated obstetric, neonatal outcomes and Beksac Obstetrics Index (BOI) of pregnancies with APCA positivity. Coexisting Methylentetrahydrofolate reductase (MTHFR) polymorphisms, other autoimmune antibody positivities, or thrombophilias were also evaluated in terms of obstetric outcomes.

RESULTS

Of 39 pregnancies, three resulted in abortions (7.6%). The median gestational week and birthweight was 37 weeks and 2795 g. The median APGAR scores were 8, 9, and 9 for first, fifth, and tenth minute, respectively. Analysis involving additional risk factors showed no significant difference between the groups, evaluating APCA titers, MTHFR polymorphisms, or thrombophilia status. Significant difference was only observed for the fifth minute APGAR scores between the groups with other autoantibody positivities (p= 0.036). Despite lack of significant differences, patients with positivity for more than one autoimmune antibody had lower APGAR scores for the first and tenth minute, respectively (p= 0.727; p= 0.083). BOI analysis showed a statistically significant difference between the groups, demonstrating that more than one "antibody positivity" indicated a worse obstetric history.

CONCLUSIONS

Patients with more than one autoantibody positivity, including APCA, must be considered as high-risk patients.

Pregnancy outcomes of the patients with anti-smooth muscle antibody positivity

BACKROUND AND AIMS

To evaluate the management and the pregnancy outcomes of patients positive for anti-smooth muscle antibody (ASMA).

METHODS

We retrospectively evaluated the pregnancy outcomes of the patients with ASMA positivity compared to patients without any known autoantibody positivity and/or autoimmune diseases. We have also evaluated the obstetric outcomes of the patients with ASMA positivity in terms of existence of MTHFR polymorphisms, other hereditery thrombophilias and other autoantibody positivities.

RESULS

In this study, 40 ASMA positive patient were evaluated and compared with 80 control cases. Gestational week at delivery, birthweight and APGAR scores for the 1st, 5th, 10th were significantly lower at patients with ASMA positivity (p< 0.01; p< 0.01; p< 0.01; p< 0.01; p: 0.030 respectively). Further analysis regarding to existence of additional risk factors revealed no significant difference between each pair of groups in terms of any obstetric outcome.

CONCLUSIONS

ASMA positivity may be associated with adverse pregnancy outcomes.

Prenatal Diagnosis of Merosin-Deficient Muscular Dystrophy

GOAL

We evaluated the potential for prenatal diagnosis of merosin-negative muscular dystrophies by immunohistochemistry.

MATERIALS AND METHODS

This is a retrospective study of 12 pregnancies with merosin-negative muscular dystrophy in a prior child. Chorionic villus sampling (CVS) was performed between 11th to 13th gestational weeks. Merosin immunohistochemical studies were performed on trophoblastic cells.

RESULTS

Two of 12 were "merosin-negative," both were from the same family. Fetal ultrasonographies were evaluated as normal in these pregnancies. Eight of the 10 merosin-positive cases delivered healthy babies. Two were lost to follow-up.

CONCLUSION

Prenatal diagnosis of merosin-negative muscular dystrophies can be accomplished by immunohistochemical analysis.

Retrospective analysis of indications for termination of pregnancy

This is a retrospective study of 139 termination of pregnancies (TOPs) between November 2015 and November 2017 to demonstrate the indications. We have shown that 60.4%, 34.5% and 5% of the terminations were performed because of genetic disorders, foetal or obstetrical problems, and maternal causes, respectively. Congenital abnormalities (43.8%), anhydramniosis (17.2%) and chromosomal abnormalities (15.1%) were the most frequent causes of the TOPs. The central nervous system seemed to be the most frequent indicator found in our study. The critical finding is the presence of nine (6.4%) terminations because of foetal reasons beyond the 24th gestational week. A vaginal termination occurred in 91.4% of cases, whereas a hysterotomy was performed in 8.6% of the cases. Previous uterine surgery was the most significant risk factor for a hysterotomy. Knowing the foetal indications is essential to know the aetiological and medico-legal backgrounds of the TOPs for better planning and medical counselling. Impact statement What is already known on this subject? Congenital anomalies are most common cause of termination of wanted pregnancies. Terminations beyond 24 weeks are also evaluated as unethical and create an ethical concern. The legal limitations differ between countries in terms of the legal limit in pregnancy for terminations. What do the results of this study add? We have demonstrated the congenital anomalies are the most common reason for pregnancy terminations after excluding fetal demise and unwanted pregnancies. We also showed that congenital anomalies and chromosomal abnormalities are most common indications for terminations of pregnancies beyond 24 weeks. The legal arrangements related to the termination of pregnancies in Turkey are described. Prior uterine surgery is a significant risk factor for hysterotomies in the termination of pregnancies. What are the implications of these findings for clinical practice and/or further research? It is critical to know the aetiological background of termination of pregnancies for better planning and consultation.

A pregnant woman with an operated bladder extrophy and a pregnancy complicated by placenta previa and preterm labor

Background

Bladder exstrophy (BE) is a complex congenital anomaly that affects the urinary, reproductive, musculoskeletal and intestinal systems.

Highlights

This pregnancy case was complicated by BE, methylenetetrahydrofolate reductase (MTHFR) A1298C and plasminogen Activator inhibitör-1 (PAI) 4G/4G homozygous polymorphisms, placenta previa, preterm labor and preterm premature rupture of the membranes. The fetus was evaluated by ultrasonography daily and anhydramnios was detected on the 2nd day of the patient’s hospitalization. A cesarean section (C/S) was performed at 27 weeks and 6 days of gestation and a 1330 g male infant was delivered.

Conclusions

Adult female patients with BE can have successful pregnancy outcomes if they receive appropriate antenatal care. However, the follow-up of these patients must be carried out at experienced tertiary reference centers with a multidisciplinary approach. This difficult process must be managed by obstetricians, neonatologists, urologists and pediatric surgeons working together.

Consecutive successful pregnancies of a patient with nail-patella syndrome

Nail-patella syndrome is a genetic disorder with some characteristic features (nail dysplasia, patellar hypoplasia, elbow dysplasia, iliac horns and renal symptoms). Renal involvement of these patients requires close follow-up in pregnancy to avoid complications like preeclampsia. In this report, we have presented two consecutive successful pregnancies of a patient with nail-patella syndrome. The first pregnancy resulted with a newborn with nail-patella syndrome and the second pregnancy resulted in a healthy newborn without any obstetric complications. Renal functions were closely followed-up during both pregnancies, and basal renal functions were normal in the pregestational period, which seems to be the most important predictor of obstetric hypertensive complications. Prenatal diagnosis of nail-patella disease is also challenging due to several possible mutations and a wide range of phenotypes of the disease. Ultrasonographic examination findings may be suspicious for the disease in the fetus like patellar hypoplasia or joint contractures.

Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer

BACKGROUND

To determine the efficacy of lymphadenectomy and adjuvant radiotherapy in patients with endometrioid-type cancer confined to the uterine corpus.

METHODS

A total of 323 patients were evaluated. Patients were stratified according to depth of myometrial invasion (DMI) and tumor grade.

RESULTS

Lymphadenectomy was performed in 83% of the entire cohort. Age (<60 vs. ≥60) and DMI affected disease-free survival. Addition of lymphadenectomy improved the disease-specific survival. The improved effect of lymphadenectomy was only observed in DMI ≥½ and grade 2 tumor (78.5% vs. 95.4%). However, that effect in this group was determined in patients with more than 50 removed lymph nodes. Performing adjuvant radiotherapy and the type of the radiotherapy (vaginal brachytherapy vs. external beam radiotherapy) were not significant for disease-free and disease-specific survival. In the entire cohort, loco-regional recurrence occurred in 3.1% and 4.4% of patients with or without adjuvant radiotherapy, respectively. However, these rates were 2.6% and 13.6% for patients with DMI ≥½ and grade 2 who were older than 60 years, respectively.

CONCLUSION

Lymphadenectomy should be performed in patients with DMI ≥½ and grade 2 to improve survival. Adjuvant vaginal brachytherapy may only be given to patients who are older than 60 years old with moderate differentiation and deep myometrial invasion to reduce loco-regional recurrence.