The importance of first trimester screening of cranial posterior fossa in predicting posterior fossa malformations which may be identified in the following weeks of gestation

PURPOSE

We aimed to investigate the value of posterior fossa ultrasonography measurements in predicting fetal posterior fossa anomaly at 11-14 weeks of gestation.

METHODS

The study was performed at Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in two groups: the control group consisted of 328 fetuses with normal postnatal outcome and the study group consisted of 22 fetuses with enlarged 4^th ventricle. In the study group, we questioned the value of intracranial translucency (IT) and brainstem (BS) measurements and the BS/brainstem-to-occipital bone (BSOB) ratio in order to predict possible posterior fossa anomalies that may be identified in advanced gestational weeks. The differences of ultrasonographic measurements between groups with p < 0.05 were considered statistically significant.

RESULTS

IT value, BSOB value, and BS/BSOB ratio were determined as ultrasonographic variables in predicting normal development of the fetal posterior fossa, with cutoff values of 2.7, 5.1, and 0.3. Negative predictive values of these three measurements for posterior fossa abnormalities were 100%. There was no statistically significant difference between the three variables for other diagnostic accuracy values (specifities and positive predictive values) (p > 0.05).

CONCLUSION

IT, BSOB, and BS/BSOB ratio can be used as ultrasonographic markers to predict the normal development of the fetal posterior fossa.

What Is the Role of the Maternal Ophthalmic and Cervical Internal Carotid Arteries in Predicting Maternal Adverse Outcomes in Preeclampsia?

OBJECTIVES

We aimed to investigate the efficacy of maternal ophthalmic artery (OA) and cervical internal carotid artery (CICA) in predicting adverse maternal outcomes and gestational age at birth in preeclampsia (PE).

METHODS

The study was performed at the Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in 2 groups consisting of 50 pregnant women with PE and 50 healthy pregnant women. The peak systolic velocity (PSV), end-diastolic velocity, PI, RI, first diastolic peak velocity, systolic/diastolic (S/D) ratio, and peak ratio of the maternal OA were measured by a transorbital Doppler ultrasound (US) scan. The PSV, end-diastolic velocity, PI, RI, and S/D ratio of the CICA were measured. The differences of Doppler indices between groups with P < .05 were considered statistically significant. Cutoff values were calculated, which could be used to predict adverse maternal outcomes and gestational age at birth.

RESULTS

The RI and PI values of the OA were lower, and the first diastolic peak velocity, PSV, and peak ratio values were higher among the PE group. The RI and S/D values of the CICA were significantly lower in the PE group compared to the healthy group. The OA RI was determined to be the strongest US variable in predicting adverse maternal outcomes and gestational age at birth, with a cutoff value of 0.72, 76% sensitivity, and 76% specificity.

CONCLUSIONS

Maternal OA Doppler indices can be used as US markers to predict adverse maternal outcomes.

The effect of the systematic birth preparation program on fear of vaginal delivery and quality of life

PURPOSE

The aim of this study was to assess the impact of systematic birth preparation program on fear of vaginal delivery and quality of life (QoL) in pregnant women who request elective cesarean delivery without any obstetric indication.

METHODS

This study was conducted prospectively. A total of 100 women who requested elective cesarean delivery due to psychosocial reasons were included into the study. Women were divided into two groups according to their desire to participate in the systematic birth preparation program. Group A: case group (n = 50) consisted of women who participated in the systematic birth preparation program. Group B: control group (n = 50) received usual antenatal care. All patients were interviewed with questionnaires including the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) and Edinburgh Postnatal Depression Scale (EPDS) at postpartum 6th week. Type of delivery, maternal request for cesarean section, scores for QoL, and postpartum depression were compared between the two groups.

RESULTS

Vaginal delivery rate was significantly higher in among the patients who received the systematic birth preparation program (group A: 78%, group B: 56%). Maternal request for elective cesarean section significantly decreased after the systematic birth preparation program (group A: 8%, group B: 28%). In group A, the WHOQOL-BREF-TR mean scores (SD) for physical domain, psychological domain, and environmental domain were significantly higher than the values exhibited in group B. In scores of the postpartum depression scale, there were no significant differences between the two groups (p = 0.075).

CONCLUSIONS

The current study indicates that systematic birth preparation program may decrease the rate of elective cesarean delivery by reducing fear of vaginal delivery and improve the quality of life at postpartum period.