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This study aimed to determine cavum septum pellucidum (CSP) nomogram values between 15-28 weeks of gestation. Routine biometric measurements and CSP width were measured by transabdominal ultrasonography in 6042 structurally normal foetuses between 15-28 weeks of gestation. Distribution of CSP width by the week of pregnancy and percentile values were calculated. The mean week of gestation (GW) was 21 ± 1.7, and the mean biparietal diameter (BPD) was 50.2 ± 5.8 mm. The CSP width range was 1.6-7.7 mm at 15-28 weeks, and the mean CSP width was 4.1 ± 0.8 mm. CSP width was found to have a significant correlation between a gestational week (CSP = GW X 0.2705-1.6121; R = 0.62

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

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.

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.

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.

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.

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

Holoprosencephaly (HPE) is commonly associated with facial malformations. We present a case of semilobar HPE associated with distal limb defect which was detected at 12 weeks of gestation.The fetus had a crown-rump length of 60 mm (12 weeks-4 days), had nuchal translucency thickness of 1.5 mm. Initial two-dimensional (2D) ultrasound revealed the absence of nasal bone, decreased BPD and abnormal profile. Transvaginal 2D ultrasound was effective in the detection of HPE (partially absence of the interhemispheric fissure, fused thalami, the choroid plexuses were not visualized bilateraly: absent 'butterfly' sign), cylopia, absence of the nose and unilateral radial aplasia. Three dimensional (3D) ultrasound provided a better visualization of the associated anomalies. The necropsy result confirmed the sonographic findings: the diagnosis was semilobar HPE, cyclopia, absence of the nose, and the absence of the radius and the thumb in the left arm.Transvaginal 2D sonographic examination is effective in detection of the cases with HPE at first trimester. Fetal morphological study through 3D ultrasound may facilitate the diagnosis of associated anomalies.

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.

Glanzmann's thrombasthenia is an inherited hemorrhagic disorder characterized by a severe reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists due to qualitative or quantitative abnormalities of platelet glycoprotein IIb-IIIa. Glanzmann's thrombasthenia is characterized by potentially major mucocutaneous bleeding and prolonged bleeding time. Platelet counts, platelet morphology, prothrombin, and activated thromboplastin times are all within normal ranges in patients with Glanzmann's thrombasthenia. Pregnancy and delivery are rare in Glanzmann thrombasthenia patients and have been associated with immediate postpartum hemorrhage. We describe the peripartum management of a 31-year-old primipara with Glanzmann's thrombasthenia who underwent spontaneous vaginal delivery. Four units of single-donor platelets, two units of packed red blood cells, 36 microg/kg recombinant human coagulation Factor VIIa (rFVIIa) were given during peripartum management.

The goal of antenatal care is to help the mother to maintain her well-being and achieve a healthy outcome for herself and her infant. Education about pregnancy, child-bearing and childrearing is an important part of antenatal care. Because of the perception that pregnancy is a physiologic event, even today lots of women do not seek medical care until a problem occurs during their pregnancy. There are still unacceptable differences in the extent of perinatal problems in developed and developing countries. Over the last century almost all countries have accepted antenatal care principles. However, insufficiency of resources and a lack of women's compliance have proved to be obstacles in developing countries and have compelled the application of various standard programs. Unfortunately, these programs are not sufficiently effective in preventing and treating maternal mortality. A safe pregnancy and delivery is a human right. Maternal mortality and morbidity should not be ranked with other diseases, because child bearing is not a disease. For this reason a global ethical consideration imposes an obligation upon society to avoid these almost totally preventable deaths. Ensuring access to family planning is an important way of decreasing maternal death. Maternal morbidity and mortality as well as perinatal mortality can be reduced through the synergistic effect of combined interventions, without first attaining high levels of economic development. These interventions include: education for all, universal childbirth, access to family planning services, attendance at birth by professional health workers, access to good quality care in case of complications, and policies that raise women's social and economic status and increase their access to property and the labor force.

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.