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Objective: The management of multiple pregnancies is still a challenge. The aim of this study was to compare the outcome of triplet pregnancies managed expectantly or by multifetal pregnancy reduction to twins. Study design: For this retrospective, comparative and monocentric study, the medical files of all women with triplets who admitted to our institution over a 13-year period were examined. Women requesting multifetal pregnancy reduction to have twins formed the study group, and women with triplets who wished to continue their pregnancies formed the control group. Main outcome measures were durations of pregnancies presented as number of weeks gestation, abortion rates, term and preterm birth rates, fetal loss and live birth rates. Results: During the study period, 171 women with triplets admitted to our institution. One hundred fifty one patients are included in this study. Forty-five women carrying triplets wished to continue their pregnancies and 106 women requested multifetal pregnancy reduction to have twins. Fetal reduction of triplets to twins was associated with a significantly lower incidence of birth before 34th gestational week and higher incidence of late preterm and term birth rates without changing live birth rates. Conclusion: Multifetal pregnancy reduction of triplet pregnancies to twins resulted in a later gestational age at birth compared with the triplet gestations managed expectantly. © 2021 2-s2.0-85119275656

n this review, we reviewed current literature on COVID-19 infection during pregnancy and provided up-to-date information and community/society recommendations. Although it has previous examples such as SARS and MERS and the infection findings appeared at an earlier period and have become known in China, the infection could not be limited and spread worldwide. Until June 8, 2020, a total of 6.8 million cases were reported and 397,000 cases died. As of the same date, the total case number in Turkey is 171,000 and total number of death is 4711. COVID-19 virus spread by droplets and its incubation period varies between 2 and 14 days. The rate of asymptomatic cases is 42% in non-pregnant patients while it is 44–89% in pregnant women. The disease progresses with mild-medium severity in about 80% of the patients, and it recovers by itself. A total of 17 maternal death cases has been reported. Although vertical transmission risk is very low according to a study investigating 265 pregnant women, there are cases showing fetal vertical transmission and we reviewed such cases in detail in this review.

Amaç: Son yıllarda fetal anomalilerin prenatal tanı ve takibinde önemli ilerlemeler olmuştur . Çalışmamızda, fetal anomalilerin tanı ve takibinde ultrasonografi ve serum beta-2 mikroglobulin düzeyinin rolünü araştırdık.Yöntemler: Fetal anomali nedeniyle hastanemizde takip edilen 29 olgu çalışmaya alındı. Gebelere önce ultrasonografi yapıldı. Daha sonra, kordosentez ile fetal kan alınarak beta-2 mikroglobulin düzeyi ölçüldü. Karyotip tayini yapıldı. Postnatal fizik muayene ve ultrasonografi sonuçları ve bazı olgularda postnatal beta-2 mikroglobulin düzeyleri olguların antenatal tanıları ve serum beta-2 mikroglobulin düzeyleri ile karşılaştırıldı.Bulgular : Fetal anomalisi olan toplam 29 olgu prospektif olarak değerlendirildi. En çok multisistem anomalisi ve daha az sıklıkta üriner sistem, santral sinir sistemi ve gastrointestinal sistem anomalileri gözlendi. Fetal serum beta-2 mikroglobulin düzeyi olguların %76,5'inde 3 mg/dl'nin üzerinde tespit edildi. Postnatal ultrasonografi ve fizik muayenede olguların 8'inde herhangi bir anomaliye rastlanmadı. Kordosentez yöntemi ile alınan fetal kanda bakılan karyotiplemede 4 (%14) fetusta kromozomal anomali saptandı. Kromozomal anomalili fetusların %50'sinin anne yaşı 35 yılın üzerinde idi.Sonuçlar: Çalışmamızda, antenatal ultrasonografinin fetal anomalileri saptamadaki duyarlılığı %72 idi. Fetal serum beta-2 düzeyi fetal anomalili olguların %76'sında yüksek saptandı. Sonuç olarak, gebelikte belirli aralıklarla prenatal ultrasonografik incelemenin ve anomalili veya anomali şüphesi olan olgularda serum fetal beta-2 mikroglobulin düzeyinin ölçümü prenatal tanı ve takipte faydalı olabilir. Ancak, serum beta-2 mikroglobulin düzeyinin daha homojen bir anomali grubunda çalışılması daha objektif sonuçlar verecektir.&nbsp

A national wastewater-based epidemiology (WBE) monitoring campaign has been initiated to determine the trends in drug consumption in Turkey since 2019. This study aimed to present the wastewater monitoring results for four periods in 2019 for six major cities with 17 wastewater treatment plants. The study investigated heroin (HER), amphetamine (AMP), methamphetamine (METH), cocaine (COC), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, alcohol, and tobacco to understand the temporal and geographical drug consumption trends. The results indicated a trend of regular cannabis use in all the cities. Considering geographical variations, the drug usage trends were not homogeneous within the country for any of the investigated drugs, except cannabis. HER consumption was predominant in Denizli (1042.48 mg/1000 inh/day), while Izmir and Antalya (154.10 and 79.56 mg/1000 inh/day, respectively) topped for COC consumption. Aydin had the highest consumption levels of AMP (90.03 mg/1000 inh/day) and METH (358.13 mg/1000 inh/day), while MDMA consumption was the highest in Samsun (157.64 mg/1000 inh/day). Tobacco consumption was high in Aydin (8791.69 mg/1000 inh/day) and Antalya (5375.17 mg/1000 inh/day), whereas alcohol consumption was higher in Bursa than in the other cities (53434.61 mL/1000 inh/day). There were no statistically significant differences in the weekend consumption levels of the investigated drugs among these six cities. Although this study included the results of 1 year of consumption monitoring, the data confirms internationally published information on the drug trafficking routes of conventional drugs in this region, especially the Heroin-Balkan route. Results from further sampling will enable accurate evaluation of global drug consumption and trafficking, in addition to alcohol and tobacco use.

These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.

Background:Behçet’s Syndrome (BS) is a vasculitis of unknown origin. Vascular involvement, so-called vascular Behçet’s syndrome (VBS), may involve blood vessels of all sizes belonging to both venous and arterial system, with pulmonary artery involvement (PAI) being the most frequent form of arterial involvement. PAI in BS occurs in the form of aneurysms or thrombosis, and results in significant mortality.Objectives:To report the clinical characteristics of PAI in patients with BS and to define the predictors of relapses.Methods:We performed a retrospective analysis of BS patients with PAI who fulfilled international study group criteria. Among 460 patients with VBS, 66 were diagnosed with PAI. For final analyses, 61 patients with PAI, who had at least 2 follow-up visits (72.1% male, mean age at BS diagnosis 29.34 (SD 10.1) years), were included. The data of the patients were recorded. Relapse was defined as the reoccurrence of vascular event at any vascular structure. Factors associated with relapse were assessed by logistic regression analysis.Results:There were not any differences considering demographic and clinical features of the patients with and without PAI in VBS group except for that intracardiac thrombosis was more common in the patients with PAI than the patients without (19.7% vs 0.3%, respectively) (Figure 1). Among 61 patients with PAI, 50 (82.0%) had isolated pulmonary artery thrombosis (PAT), whereas 11 (18.0%) had pulmonary artery aneurysm (PAA) with or without PAT. The characteristics of 61 patients with PAI were shown in Table 1. A total of 37 relapses occurred in 24 (39.3%) patients during follow-up a median of 65.9 (IQR 20.1-109.0) months. To define the factors associated with relapses, the patients with isolated PAT were analysed. In multivariable logistic regression analysis, older age at BS diagnosis and anticoagulation usage seemed to be protective, even though they could not reach statistical significance (OR: 0.92 95% CI 0.86-1.02, OR: 0.34 95% CI 0.09-1.33, respectively).Table 1.Characteristics of the patients with pulmonary artery involvementAlln= 61Isolated PATn= 50PAAn= 11Sex (male), n (%)44 (72.1)35 (70.0)9 (81.8)Age at diagnosis of BS, years (SD)29.3 (10.1)28.8 (10.4)31.9 (8.0)Age at diagnosis of PAI, years (SD)36.3 (12.83)36.7 (13.8)34.7 (6.7)Symptoms, n (%)Dyspnea28 (45.9)23 (46.0)5 (45.5)Hemoptysis26 (42.6)19 (38.0)7 (63.6)Vascular event before PAI, n (%)21 (34.4)20 (40.0)1 (9.1)Other vascular events at PAI, n (%)33 (54.1)28 (56.0)5 (45.5)Thrombophlebitis, n (%)7 (21.2)6 (21.4)1 (20.0)Upper and/or lower extremity DVT, n (%)20 (60.6)16 (57.1)4 (80.0)SVCS, n (%)1 (3.0)1 (3.6)0 (0)IVCS, n (%)3 (9.1)1 (3.6)2 (40.0)Intracranial thrombosis, n (%)4 (12.1)4 (14.3)0 (0)Intracardiac thrombosis, n (%)8 (24.2)7 (25.0)1 (20.0)Arterial event other than PAI, n (%)4 (12.1)3 (10.7)1 (20.0)Relapse, n (%)24 (39.3)20 (40.0)4 (36.4)Time to the first relapse, median (IQR), month49.8 (13.2-102.6)54.1 (24.4-117.9)3.9 (1.7-67.9)Death, n (%)2 (3.3)0 (0)2 (18.2)BS= Behçet Syndrome, PAI= pulmonary artery involvement, PAT= pulmonary artery thrombosis, PAA= pulmonary artery aneurysm, DVT= deep vein thrombosis, SVCS= superior vena cava syndrome, IVCS= inferior vena cava syndromeFigure 1.A) Axial CT image shows thrombus formation in the left upper lobe pulmonary artery branch. B) Giant thrombus is seen in the right ventricle (black arrow). Note the thrombus formation in the left lower lobe pulmonary artery branches (white arrows).Conclusion:Our results indicate that there is a higher frequency of intracardiac thrombosis in BS patients with PAI and an increasing current trend of PAT in patients with PAI. In addition, there might be a possible efficacy of anticoagulation usage in preventing relapses, which needs confirmation with further studies.Disclosure of Interests:None declared

Advances in technology and wide used of obstetric ultrasound have allowed an increase in the antenatal identification of fetal problems, such as fetal lung lesions. Technological advances in transducer and software technology have remarkably improved visualization of structures in the fetus. Additionally, newer understanding of the natural course of several malformations and new methods of in utero treatment, the evolution of fetal surgical techniques and anesthesia have made fetal surgery possible and have changed the course of evolution of lung defects before and after birth. Therefore, there is now an increasing demand for an accurate and timely diagnosis, counseling, and planning of appropriate management of the cases whether expectant management or in utero therapy at perinatal care centers with timely perinatal transfer. How to cite this article Sen C, Yayla M, Api O, Goynumer G. Fetal Lung Surgery. Donald School J Ultrasound Obstet Gynecol 2016;10(3):271-296.

In Islamic religion, daytime fasting during the month called Ramadan is an annual practice. In this study, we aimed to investigate the effect of Ramadan fasting and maternal hypoalbuminaemia on neonatal growth parameters. A prospective case-control study was conducted in Diyarbakir and Istanbul, Turkey. The sample size of fasting group was 168 and that of non-fasting group was 170. Demographic characteristics, obstetrics ultrasonographic findings and laboratory parameters of the participants were recorded. Neonatal anthropometric parameters and placental weight were noted. The mean placental weight was significantly higher in the fasting group (p = 0.037). Also, in the fasting group, pregnant women with hypoalbuminaemia had significantly higher placental weight (p = 0.009). In conclusion, the mean placental weight in the fasting group was significantly higher. Also a significant correlation between placental weight and maternal serum albumin level was observed in the fasting group.

Objective: The purpose of this study is to show distribution of risk in pregnancies which underwent first trimester combined tests, and investigate general demographic and clinical characteristics of patients, underwent invasive diagnostic tests after screening tests. Methods: Combined test data of first trimester screening in 20082011 were evaluated retrospectively and cross-sectional. After the measurement of nuchal translucency (NT), double test was applied to complete combined test within the same day. Invasive diagnostic procedures were compared in terms of rate, indications, karyotype and postnatal outcomes. Results: A total of 1109 pregnant women were included. Their mean age was 31.07±3.73 years. Free-βhCG was 1.26±0.94 MoM and PAPPA was 1.16±0.65 MoM. Mean NT value was 1.60±0.67 mm. With threshold of 1/250, screening test was positive in 3.1% of the cases. Additional 22 cases due to first trimester screening and 19 cases due to second trimester screening had invasive procedures (6.4% in total). Invasive procedures revealed karyotype anomaly in 11.3%. Karyotype anomalies were more frequent in group (20%) with positive combined test compared to ones performed for other reasons like maternal anxiety. Conclusion: Although false positive rate is 3.1% in first trimester combined test, rate of total invasive procedures is more than double (6.4%). Number of invasive diagnostic procedures increased due to maternal anxiety of age and physicians evaluating only NT or double tests. With diagnostic procedures, chromosome anomalies reaches 11% and termination need reaches 10%. Invasive procedures performed due to anxiety of mother or physician revealed no chromosomal anomaly requiring termination.

Objective: Our aim was to determine the distribution of chorion and amnion sac types in twin pregnancies during the routine screening procedures during the first trimester, and to investigate their relevance with pregnancy being natural or by assisted reproductive technology. Methods: Twin pregnancies analyzed during routine first trimester screening were evaluated retrospectively. The twins were grouped according to their conception types which are natural birth and by assisted reproductive technologies (ART). The cases which have missing or suspicious information about chorion-amnion types and with unknown conditions for pregnancies whether they were by ART or naturally were excluded from the study. In the sonographic chorionicity distinction, the presence of classic lambda and T signs was considered. The unavailability of amniotic membrane among fetuses was defined as monoamniotic twin. Results: During 14 years, 286 twin pregnancies were considered as appropriate cases to analyze. Mean maternal age was 30.47±5.07 years, and mean week of gestation during sonography was 12.23±0.70. Double placentas were found in 83.2% of all pregnant women, and single placenta in 16.7% of all pregnant women. While 54.5% (n=156) of twin pregnancies were ART pregnancies, 45.5% of them were natural pregnancies. It was determined that 67.7% of natural twins were diamniotic dichorionic, 27.7% of them were diamniotic monochorionic and 4.6% of them were monoamniotic monochorionic while 96.2% of ART pregnancies were diamniotic dichorionic, 3.2% of them were diamniotic monochorionic and 0.6% of them were monoamniotic monochorionic. There was statistically significant difference between ART twins and natural twins in terms of chorionicity distributions (p

To establish a reference range for the intracranial translucency (IT). In this prospective study, we examined 596 singleton fetuses at 11–14 weeks of gestation using transabdominal ultrasonography. The distribution curves of the anterior–posterior diameter of the IT were established according to the gestational weeks, and the percentiles for 11–14 weeks of gestation were calculated. Regression analysis was performed to estimate the relationship between the anterior–posterior diameter of the IT and other fetal biometric parameters. The mean anterior–posterior diameter of the IT was 1.8 ± 0.4 mm. From 11 to 14 weeks of gestation, the IT diameter increased linearly with advancing gestation. The linear regression equation for the IT × crown–rump length (CRL) was IT = CRL × 0.0184 + 0.575 (R = 0.385, p

A prospective study was conducted to determine the cut-off values of nuchal skin-fold thickness (NFT) with false-positive rates for each gestational week (GW) for chromosomal abnormalities during the 2nd trimester of pregnancy. A total of 2,313 women with normal singleton pregnancies were included in the study. Cases of multiple gestations, aneuploidy and major congenital malformations were excluded. The distribution of NFT between the 15th and 24th GW and the cut-off values of NFT with false-positive rates for chromosomal abnormalities were determined. A significant positive correlation was noted between NFT and GW. Statistically significant differences were observed in NFT for the each GW. The 95th percentile values of NFT between 15 and 24 weeks' gestation were 4.7, 4.77, 5.0, 5.5, 5.76, 5.9, 6.0, 6.1, 6.5 and 6.8 mm, respectively. In all fetuses, if the cut-off value of NFT was considered as 6 mm, the false-positive rate ranged from 1.8% to 37% in 15-24 weeks' gestation. Evaluation of NFT according to cut-off values determined by population-based percentiles for each GW might be a more appropriate screening method for chromosomal abnormalities than accepting NFT ≥ 6 mm for all fetuses as abnormal, regardless of gestational age.

Aims: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women. Methods: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July–7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan. Results: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P Conclusion: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.

Objective: It was aimed to compare the consistency according to genders between clinical weeks of gestation and weeks of gestation calculated based on crown-rump length (CRL) found ultrasonographically at 11 0/7

Objective: Trisomy 8 mosaicism (MT8) is characterized by intracranial, genitourinary and skeletal system anomalies, congenital cardiovascular disorders, deep palmar and plantar creases, and neoplastic and hematological disorders. In the literature, there are only a few antenatal ultrasound (US) and fetal magnetic resonance imaging (MRI) findings reported for MT8. Case: The fetus whose gestational age was 26 weeks and 4 days was referred for fetal MRI due to corpus callosum agenesis suspected in routine US screening. We are presenting the major and minor MRI findings of the fetus in this case report. Conclusion: Fetal MRI can be used in addition to the antenatal ultrasound to evaluate genetic syndromes such as trisomy 8 mosaicism and to identify additional anomalies which cannot be found in the ultrasound screening.

Background: We aimed to compare the second trimester uterine artery Pulsatility Index (PI) measurement in twin pregnancies according to the chorionicity and determine its effect on twin pregnancy outcome in terms of fetal and birth weight. Methods: All medical records of twin pregnancies, whose fetal screening was done between May 1999 and January 2012, were evaluated retrospectively. All twin pregnancies without detected/suspicious anatomical or genetic fetal anomalies, biochemical abnormalities, and familial genetic diseases were included in the data analyses. Ones with missing PI measurements and ones with undetermined chorion types were excluded from the data analyses. Results: A total of 149 twin pregnancies were evaluated. The percentages of chorion types were diamniotic dichorionic in 89.9% (n=134) and diamniotic monochorionic 10.1% (n=15). Mean age of the mothers was 31.56 ± 4.9 years. Mean gestational week of PI measurement was 20.30 ± 2.23 weeks. Mean birth week was 35.5 ± 2.50 weeks. Mean birth weight was 2405 ±437 grams. Correlation analyses related to PI values and second trimester weight and birth weight parameters didn’t show any statistically significant correlation. Mean maternal age, mean gestational week of PI measurements, mean birth week, mean fetal weights and birth weights were indifferent between chorionicity groups. Comparisons of second trimester PI, second trimester weight and birth weight and related parameters showed no statistically significant between groups. Conclusions: Second trimester uterine artery pulsatility index measurements do not differ between chorionicity types. It has no effect on twin pregnancy outcome in terms of fetal weight and birth weight.

Measurement of intracranial translucency (IT), which is a recent earlier recognizable sonographic marker, has been suggested for detection of spina bifida. In this prospective study we aimed to determine normative values of IT in the population of Turkish singleton pregnant women during the first trimester of pregnancy.Between January 2011 and July 2011, all consecutive singleton pregnant women were screened for intracranial translucency. Pregnancies were followed until birth. Pregnancies with any detected/suspicious anatomical or genetic fetal anomalies, biochemical abnormalities, increased nuchal translucency measurements, pregnancies of artificial reproduction techniques and anomaly detected at birth were set to be excluded from the data analyses. Mean±standard deviation, median and percentile values of intracranial translucency were calculated. Linear regression analyses were done between the length of intracranial translucency and gestational week and CRL.Data analyses included 201 fetuses. Median maternal age was 31 years. Median CRL was 62 mm. Median gestational week was 12.57 weeks. Median IT value for the first trimester was 1.7 mm (range 1.00-2.40). Calculated formulae are; IT (mm)=[0.237×Gestational Week)]-1.27, R(2)=0.302; p0.001 and IT (mm)=[0.020×CRL (mm)]+0.44, R(2)=0.381; p0.001). IT measurements increased with increasing CRL and advancing gestational weeks. During follow up none of the fetuses was found to have any anatomical abnormality or anomaly.This study presents normative values of intracranial translucency in the first trimester screening of normal singleton pregnancies of the Turkish population. In accordance with previous reports, intracranial translucency increases linearly with advancing CRL.Yeni erken saptanabilen sonografik bir marker olan intrakraniyel translüsensi ölçümü sipina bifida varlığının saptanması için önerilmektedir. Prospektif olan çalışmamızda Türk popülasyonundaki tekil gebeliklerde birinci trimester fetal intrakraniyel translüsensi (IT) ölçümlerinin normal dağılımının saptanması amaçlandı.Ocak 2011 ve Temmuz 2011 tarihleri arasında tüm ardışık tekil gebelerde intrakraniyel translüsensi ölçümleri bakıldı. Gebeler doğuma kadar takip edildi. Şüpheli veya gösterilen anatomik/genetik fetal anomalileri, biyokimyasal değer anormalliği, artmış nukal kalınlığı yada doğumda anomali saptanan fetuslar ve yardımcı üreme teknikleri uygulanmış fetuslar değerlendirme dışında tutuldu. İntrakraniyel translüsensi için ortalama±standart deviasyon, medyan ve persentil değerleri hesaplandı. Lineer regresyon analizleri ile intrakraniyel translüsensi ve gebelik haftası ve CRL arasındaki ilişki saptandı.Veri analizlerine 201 fetus dahil edildi. Medyan anne yaşı 31 yıl, medyan CRL 62 mm ve medyan gebelik haftası 12.57 hafta saptandı. Birinci trimester için medyan IT değeri 1.7 mm (aralık 1.00–2.40) bulundu. Hesaplanan formüller; IT (mm)=[0.237×Gebelik Haftası]−1.27, R2=0.302; p0.001 ve IT (mm)=[0.020×CRL (mm)]+0.44, R2=0.381; p0.001. IT ölçümleri artan CRL ve ilerleyen gebelik haftası ile birlikte artıyor olarak saptandı. Takip esnasında hiçbir fetusta anomali saptanmadı.Mevcut çalışmada Türk popülasyonundaki tekil gebeliklerde birinci trimester fetal intrakraniyel translüsensi normal dağılımları gösterilmektedir. Literatür ile uyumlu olarak, intrakraniyel translüsensi ilerleyen gebelik haftası ve CRL ile lineer olarak artmaktadır.

Evaluation of nasal bone improves the performance of first-trimester screening for trisomy 21. In this retrospective study we aimed to determine normative values related to the measurement of nasal bone length of the Turkish population during the first trimester ultrasonographic fetal screening.Medical records of singleton pregnancies, whose first trimester fetal screening was performed between 2004 and 2010, were evaluated retrospectively. Pregnancies with any detected/suspicious anatomical or genetic fetal anomalies, biochemical abnormalities, increased nuchal translucency measurements, and pregnancies of artificial reproduction techniques were excluded from data analyses. Mean±standard deviation, median and percentile values of the length of nasal bone were calculated separately for 11(0-6), 12(0-6) and 13(0-6) gestational weeks.Nasal bone could be visualized in 99.6% of the included 1762 singleton pregnancies. In 16.5% of the cases nasal bones were only noted as present or absent. Mean maternal age was 29.67±4.50 years and mean gestational age was 12.54±0.61 weeks. Median values of nasal bone lengths were 1.7, 1.9, and 2.2 mm for 11(0-6), 12(0-6) and 13(0-6) gestational weeks respectively. Nasal bone length (NBL) increased linearly with advancing gestational age and CRL. NBL (mm)=[0.298xGestational Age (week)]-1.779, R(2)=0.318; p0.001; NBL (mm)= [0.023 × CRL (mm)] + 0.520, R(2)=0.331; p0.001.The present study presents normative values of nasal bone in the first trimester screening of normal singleton pregnancies of Turkish population. Nasal bone length increases with advancing gestational age and CRL.Birinci tirmester trizomi 21 taramasında nazal kemik değerlendirmesi performansı arttırmaktadır. Bu retrospektif çalışmada Türk popülasyonundaki tekil gebeliklerde birinci trimester fetal nazal kemik ölçümlerinin gebelik haftalarına göre persentil dağılımlarının saptanması amaçlandı.Retrospektif olarak 2004 ve 2010 tarihleri arasında taraması yapılmış olan anatomik anomali, biyokimyasal değer anormalliği, aile öyküsünde genetik hastalığı olmayan, nukal kalınlığı normal olan spontan tekil gebelikler değerlendirmeye alındı. 11Dahil edilen 1762 tekil gebeliğin %99.6’sında nazal kemik görüntülenmişti; bunların %16.5’inde nazal kemik sadece var ya da yok olarak not edilmiştir. Ortalama anne yaşı 29.67±4.50 yıl ve ortalama gebelik haftası 12.54±0.61 idi. Nazal kemik ölçümlerinin medyan değerleri 11

To determine the distribution of fetal nasal bone length (NBL) according to gestational age during the second trimester of pregnancy in a Turkish population.Fetal NBL and other routine biometric measurements were evaluated retrospectively in 2327 fetuses between 15 and 24 weeks of gestation. The measurements were obtained via transabdominal ultrasound. The distribution of fetal NBL between 15 and 24 weeks of gestation was established, and percentiles were calculated. Relationships between fetal NBL and other parameters were assessed using regression analysis.Mean (±standard deviation) fetal NBL ranged from 2.95±0.52 at 15 weeks of gestation to 6.26±0.77mm at 24 weeks of gestation. The fifth percentile for fetal NBL was 2.1mm at 15 weeks of gestation and 5.0mm at 24 weeks of gestation. A significant positive correlation was noted between fetal NBL and gestational age (NBL=gestational age×0.37-2.55; R(2)=0.59; p0.01) and between fetal NBL and biparietal diameter (BPD) (NBL=BPD×0.11-0.33; R(2)=0.61; p0.01).Fetal NBL is less in Turkish subjects compared with non-Turkish subjects.

Purpose: This study was planned to answer the management of cases with translocated intrauterine devices (IUDs) into the abdomen or into the wall of the uterus. Materials and Methods: This study was a retrospective analysis of patients' records at the training and research hospital during the years 2001–2005, which required an admission to the hospital for the removal of an IUD that had translocated to the outside of the uterus. Thirteen (13) cases that were diagnosed and treated as migrated IUDs in our clinic were evaluated retrospectively. IUDs were inserted in 1788 patients at the hospital in which the study was performed during the study interval. Results: In 10 patients, removal of the IUDs at laparoscopy succeeded, whereas, in 1 case, laparotomy proved necessary, and 2 IUDs were removed via hysteroscopy. Three (3) IUDs were in the Douglas space, 7 of them were embedded in the omentum, 1 was inside the broad ligament, and 2 had perforated the wall of the uterus. In 6 cases, mild adhesion, an...

Jarcho-Levin syndrome (JLS) causes severe vertebral and thoracic deformity and has an autosomal-recessive mode of inheritance. Prenatal diagnosis may be difficult in some cases without the history of an affected baby. We present 4 cases of JLS with neural tube defects as the prominent finding. In 2 of them the deformity of the thorax was minimal and was not detected by ultrasonography. Rib anomalies were revealed with radiological and pathological examinations after the termination. The location of the vertebral defect may be the determinant factor for the severity of the thoracic deformity. The real recurrence risk could only be found out after postnatal examinations in cases with neural tube defects.

Objectives To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. Methods A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. Results The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. Conclusions The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.

Objective To describe a new surgical technique to treat prophylactic gonadectomy in patients with androgen insensitivity syndrome. Design Prospective study. Setting University hospital. Patient(s) Six patients with androgen insensitivity syndrome. Intervention(s) Laparoscopy-assisted transinguinal or suprapubic extracorporeal gonadectomy. Main outcome measure(s) Accessibility, operation time, and cost-effectiveness. Result(s) Laparoscopy-assisted transinguinal extracorporeal gonadectomy under general anesthesia was performed successfully, with no complications, in all patients as a one-day procedure. The operation times were 12 to 22 minutes (average, 16 minutes). Histopathologic examination revealed testicles in all cases. The cost of each operation was approximately $500 to $1,000. Conclusion(s) Laparoscopy-assisted transinguinal or suprapubic and extracorporeal gonadectomy has several advantages over laparotomy and operative laparoscopy, including short operating time, safety, simplicity, and cost-effectiveness.

Introduction: Hemoglobin Brockton is indicated by the hemolytic anemia, which is rare qualitative variant of aspect of the hemoglobinopathies. Hemoglobin disorders in pregnancy are associated intrauterine growth retardation, premature birth, and low birth weight. One of the unstable hemoglobinopathies, Hb Brockton associated with pregnancy has not been previously mentioned in the literature. In this case presentation and things to be done in case of a pregnant patient with rare hemoglobinopathy have been reviewed in reference to the literature. Case Report: Twin pregnancy of a 26-year-old patient with Hb Brockton disorder which was diagnosed at the age of 11, and has led to minor hemolytic anemia crisis over the years, was observed. Due to decrease in hemoglobin level, 8 units of transfusion were made. A twin pregnancy continued without any problems until the 38th week when a caesarean section was performed due to breech-breech presentations. The hemoglobin pattern of the newborn was studied at birth and after 1 year; the variant in the mother was not found. Discussion: During pregnancies with unstable hemoglobinopathy, observation of hemoglobin levels every 3 weeks and carrying out blood transfusions when below 8 g/dl can stabilize the pregnancy in terms of the development of the baby and the mother. Patients with hemoglobinopathy carry an increased risk for complications and should therefore seek medical care early in pregnancy and be managed by a multidisciplinary team of specialists.

Preterm delivery (PTD), defined as birth before 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Evaluation of the cervical morphology and biometry with transvaginal ultrasonography at 16–24 weeks of gestation is a useful tool to predict the risk of preterm birth in low- and high-risk singleton pregnancies. For instance, a sonographic cervical length (CL) > 30 mm and present cervical gland area have a 96-97% negative predictive value for preterm delivery at

In this report, we describe a rare cause of in utero fetal death, a complex entanglement of the umbilical cord around the fetal neck. At the 16th gestational week of pregnancy, routine fetal ultrasonography showed no fetal heartbeat. Thereafter, the fetus was delivered vaginally in the breech presentation. The neck was found to be encircled by multiple tight loops of the umbilical cord. Other than a thin and elongated neck, there were no dysmorphic features and no chromosomal abnormality on cytogenetic analysis.

Objective: To determine whether maternal plasma fibronectin and advanced oxidative protein products (AOPP) can be used for the prediction of preeclampsia in high-risk women. Study Design: One hundred pregnant women at high risk of preeclampsia were enrolled in this prospective cohort study. Maternal plasma total fibronectin and AOPP levels were measured at 19–25 weeks of gestation. AOPP levels were also measured in 23 normal non-pregnant women. After delivery, the pregnant cohort was assigned to either the normotensive or preeclamptic group depending on their clinical course. Results: Among the 78 pregnant women who completed the study, 19 (24.3%) developed preeclampsia between 36 and 39 (36.8 ± 1.0) weeks of gestation. AOPP levels, which are significantly higher in normotensive pregnant women compared to nonpregnant controls (42.55 ± 15.94 vs. 27.95 ± 10.5; p = 0.0001) were not significantly different between normotensive and preeclamptic women (42.55 ± 15.94 vs. 47.45 ± 14.19 μM; p = 0.23). Plasma fibronectin levels were significantly higher in women who continued to develop preeclampsia rather than remain normotensive (383.68 ± 19.07 vs. 227.65 ± 97.39; p < 0.0001). ROC curve analysis shows that total fibronectin ≥360 mg/l is predictive for the development of preeclampsia. The sensitivity, specificity, positive and negative predictive values are 57, 92, 73 and 85%, respectively, with a likelihood ratio of 7.38. Conclusion: Second trimester plasma concentrations of AOPP are not altered in women that develop pre-eclampsia later in pregnancy. However, total fibronectin levels are significantly increased and may be used to predict the onset of clinical symptoms of preeclampsia.

Background: To establish the effect of parity on uteroplacental Doppler findings during midgestation in uncomplicated and low-risk pregnancies. Methods: Color flow pulse Doppler imaging of uterine arteries was performed on 760 uncomplicated singleton pregnancies fulfilling the study criteria at 19–24 weeks of gestation. Pulsatility indices (PIs) and bilateral notching were compared in nulliparous and parous pregnant women during various gestational weeks. The effects of maternal age, gestational age and parity on abnormal Doppler findings were assessed. Results: We found a significant difference in the prevalence of bilateral diastolic notch between nulliparous and parous women. From 19 to 24 weeks of gestation, a significant decrease in the PI values was observed (p < 0.001). The decrease in the PI values was significant in nulliparous, in contrast to parous women (p < 0.001). Parity had no effect on the mean PI, but parity was found to decrease the risk of bilateral notching (p < 0.05, R2 = 0.031). Conclusion: The mean indices are similar when the first and subsequent pregnancies are compared, especially after the 21st gestational week. Notching is more prominent in the first pregnancy. Parity has an effect on PIs in earlier weeks, and this effect is more pronounced in the appearance of bilateral notches.

Objectives: To study the association between thickness of the umbilical cord at 11 + 0 to 14 + 6 gestational weeks and perinatal outcome. Methods: We studied 216 pregnant women between 11 + 0 and 14 + 6 weeks' gestation with singletons, intact membranes, normal volumes of amniotic fluid and a regular menstrual period. Patients with umbilical cord measurements below the 5 th centile were defined as thin umbilical cord group and those between the 5 th and 95 th or above 95 th centile were defined as non-lean umbilical cord group. Abortion or fetal demise, preeclampsia, mode of delivery, gestational age at delivery, birth weight, and 5-min Apgar scores were noted. Results: A statistically significant difference existed between the mean gestational age, mode of delivery, birth weight and adverse perinatal outcome of the two groups. The relative risk of the adverse perinatal outcome in lean umbilical cords was 6.92 (2.71-17.67; 95% Cl). The umbilical cord thickness correlated with birth weight (P < 0.05). Conclusions: Sonographic finding of a lean umbilical cord at 11 + 0 to 14 + 6 weeks' gestation should prompt the physician to strict monitoring of pregnancy.

Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. Results. The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20) had fever while only 2.4% (2/83) of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma. Fifty percent of patients (3/6) with large-sized hematoma, as compared to only 35% (5/14) with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. Conclusion. Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.

Antenatal Bartter syndrome typically presents with marked fetal polyuria that leads to polyhydramnios and premature delivery. In our case, polyhydramnios was detected at 26 weeks of gestation and amniotic fluid chloride level was high. Serial amnion-drains were performed. During indomethacine treatment, fetal bradycardia developed. The mother was given daily oral potassium to maintain normal serum level and prevent fetal arrhythmias. After birth, hypokalaemic alkalosis, low chloride, hyper-reninemia and hyperaldosteronemia were detected.

Of all health statistics mentioned by the World Health Organization (WHO), maternal mortality is unique in showing the largest discrepancy between developed and developing countries. Approximately 90% of maternal deaths (more than 0.5 million each year) occur in developing countries. Over the last century, almost all countries have accepted antenatal care principles. However, insufficiency of resources and lack of women's compliance were the main handicaps in developing countries and compelled these countries to apply various standard programs. Unfortunately, these programs are not sufficiently effective in the prevention and treatment of maternal mortality. Fixing the number (quantity) of antenatal visits and the static approach affect the "quality" of antenatal care. Bleeding, chronic anemia, hypertensive disorders, obstructed labor, unsafe abortions and infections are the main factors leading to maternal mortality. The majority of these factors are preventable. It is important to suspect the presence of any of these factors and to intervene promptly both during antenatal care and immediately after delivery. The evidence-based approach is a way of reaching this solution. Antenatal care is a concept that extends from pre-pregnancy to postpartum, leading to effective emergency care for unpredictable and predictable complications during pregnancy and childbirth. Worldwide policies are not always applicable to each country, coercing national policies. There is still a need for prospective randomized trials to clarify this concept and the relevant policies.

Objective The aim of this study is to describe a fetus with androgen insensitivity syndrome diagnosed at mid-second trimester. Case and Methods Nuchal translucency was measured thick and double test was found higher. The patient referred to our center at 16th weeks of gestation. Fetal ultrasound examination and amniocentesis was performed. Results The nuchal translucency (NT) of fetus in present pregnancy was measured approximately 10 mm at 13 weeks and Down syndrome risk was calculated 1 in 10 by double test. On ultrasound examination; thick nuchal fold (NF) and short fetal limbs were found, and the fetus was seen a female and amniocentesis was performed. Three weeks later the fetal karyotype was reported normal as 46,XY. Thereupon the fetus reexamined for 2D and 4D ultrasound, and confirmed previous findings. The fetus was terminated at 19th weeks and seen a female phenotype. The fetal gonads removed in abdomen and testicles confirmed histopatologically. Conclusion In generally, diagnosis of AIS is most made postnatally. This is the second case in English literature, which diagnosed mid-second trimester. In this situation, the fetus with thick NT/NF and short limbs may be AIS, therefore appearance of fetal sex on ultrasound should be compared with genetic sex Copyright © 2007 John Wiley & Sons, Ltd.

Objective To report a case of successful pregnancy after hypogastric artery ligation and the B-Lynch brace suturing technique. Design Case report. Setting Education and research hospital. Patient(s) A 22-year-old woman, whose first pregnancy was terminated by cesarean section owing to abruptio placenta and intrauterine fetal demise diagnosed at the 26th week of gestation, referred to our clinic for uterine atony. Intervention(s) Hypogastric artery ligation and the B-Lynch brace suturing technique. Main Outcome Measure(s) Clinical pregnancy and live birth. Result(s) Two years after the surgery, the patient conceived spontaneously and delivered a healthy infant after an uneventful pregnancy. Conclusion(s) This is the first reported case of successful pregnancy after hypogastric artery ligation and B-Lynch suturing technique. This life-saving therapeutic option for severe postpartum hemorrhage appears to be a safe procedure that does not impair subsequent fertility and pregnancy outcomes. The B-Lynch suturing technique seems to be simple and has the capability of preserving the uterus; therefore it may be considered as the first-line surgical treatment for uterine atony before considering hysterectomy.