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Objective: Aim of this study was to compare the maternal and neonatal outcomes between adolescent multiparas and adults. Study Design: This retrospective cohort study included over 11 years and singleton multiparous pregnancies from women less than 29 years admitted for delivery after 22nd gestational weeks in tertiary educational hospital. All of patients were divided into two groups as adolescent multipara (under 18 years) and control (19-29 years). Pregnancy outcome and perinatal complications were evaluated. Mann-Whitney U-test, Independent sample t test, Pearson Chi-square test and Fisher Exact test were used for statistical analyses. Results: Gestational week at delivery was significantly lower in adolescent multipara group (38.37 ± 2.17) than control group (38.79 ± 1.684) (p=0.014). Preterm birth rate (12.6%) and postpartum hemorrhage (5.7%) were higher in the adolescent multipara group than in controls as to be statistically significant. The cesarean delivery rate and other pregnancy complications such as diabetes mellitus, preeclampsia, intrauterine growth restriction, oligohydramnios, polyhydramnios, and placental abruption were similar with controls. Conclusion: In conclusion, adolescent multipara pregnancies were associated with higher risks of adverse pregnancy outcomes, in particular preterm birth, lower birthweight and postpartum hemorrhage.

Cystic hygroma is a congenital malformation of the lymphatic system. They are associated with chromosomal abnormalities and major structural anomalies. We describe a case of cystic hygroma associated with monosomy X and termination of pregnancy at 14 weeks of gestation.

Sirenomelia is a rare and lethal congenital malformation. It is associated with a variety of anomalies and oligo/anhydramniosis. We present a case of sirenomelia detected in early second trimester presenting with anhydramniosis.

OBJECTIVE: Pregnancy in renal transplant recipient was considered unsafe in the past. To date, these patients have successful pregnancy outcome. In this study, we aimed to analyze the outcome of pregnancy in kidney transplant recipients and the consequences on renal function. STUDY DESIGN: Retrospective analysis RESULTS: We found that the mean gestational age at delivery for patients were 35.22 weeks and 55.5% patients had preterm delivery and this result is higher than normal pregnant population. CONCLUSION: Pregnant women who renal transplant recipient have higher risk for preterm labor and hypertension compared normal pregnant women.

OBJECTIVE: We retrospectively analyzed previous maternal obstetric characteristics as well as obstetric characteristics regarding the current pregnancy in thirty three consecutive pregnant patients with congenital uterine anomalies (CUA) who gave birth to a live baby at Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology between 2005 and 2013. STUDY DESIGN: Descriptive statistics were used to describe previous maternal obstetric characteristics as well as the outcome of the successful pregnancy among different types of CUA. According to the severity of the CUA, we additionally grouped the sample into two; as minor and major mullerian fusion defect groups (mFD and MFD). We compared obstetric characteristics between these groups. RESULTS: We identified 33 patients with CUA. Among these; 14 (42,4%) were identified as septate; 6 (%18,2) as bicornuate, 7 (%21,2) as arcuate, 4 (%12,1) as didelphic, and 2 (%6,1) as unicornuate uterus. In 32 subjects the delivery procedure was caesarean section. The mFD and MFD groups were not statistically different in terms of maternal gravida, parity, dilatation and curettage (D&C) and abortion history. Besides, the two groups were similar in terms of gestational week of birth, birth weight and type of fetal presentation. CONCLUSION: Previous studies emphasize that the type of mullerian anomaly is one of the determinants of pregnancy outcome in women with CUA. However, we show that, this is not the case in women with CUA who gave birth to a live baby. Our results suggest that, type of the mullerian anomaly - if the anomaly allows a live birth - may lose its' predictive value on negative obstetric consequences.

Limb Body Wall Complex (LBWC) is a rare developmental anomaly which is classified together with midline defects. Despite the anomaly arises from an error occuring during the embryonic folding, the exact pathophysiological mechanisms are poorly understood. The clinical picture is characterized by thoracoabdominoschisis, eventration of the internal organs, limb reduction defects and sometimes craniofacial abnormalities. In this report we present (with the informed consent of the patient) the first trimester ultrasonographic diagnosis of a fetus with the classical findings of LBWC accompanied by exencephaly, megacystis and kyphoscoliosis which are rare in the literature. Today, this mortal anomaly can be diagnosed during the early weeks of gestation by ultrasonography. Prenatal detection of the anomaly is critical since offers an option of pregnancy termination.

OBJECTIVE: To validate the usability of “Beksaç Obstetrics Index” (BOI/BOIp) in the evaluation of different high risk pregnancy groups. STUDY DESIGN: This study is consisted of 3 groups of patients; 1) Pregnancies without MTHFR polymorphisms (n=65), 2) Pregnancies with methylenetetrahydrofolate reductase (MTHFR; homozygous or compound heterozygous) polymorphisms (n=140), 3) Pregnancies with “autoimmune antibody positivity” without any other type of hereditary thrombophilia (Anti-dsDNA, anti-phospholipid Ig G/M, anti-cardiolipin Ig G/M, ASMA, APA, ENA, anti-mitochondrial antibodies) (n=76). In this study, BOI which is (number of child +π/10)/Gravida is used in order to demonstrate the risk levels/scale of different high risk pregnancy groups. RESULTS: The mean BOIp (±SD) values are 0,41±0,22; 0,29±0,21; and 0,40±0,23 for Control, MTHFR and Autoimmune groups respectively. We have demonstrated statistically significantly decreased BOIp level in MTHFR group compared to the other groups (p:0,002). CONCLUSION: We have demonstrated that BOI/BOIp can be used in the assessment of risk levels of different high risk pregnancy groups.

OBJECTIVE: The objective of our study was to evaluate our experience on pregnancies after cancer treatment and pregnancy-associated cancer. STUDY DESIGN: The clinical records of 96 pregnant women including previously received treatment for cancer and association of cancer with pregnancy who admitted to our department were enrolled between 2002 and 2012. Demographics, pregnancy outcomes, maternal and fetal complications, perinatal outcomes, cancer types and treatments performed were evaluated. RESULTS: The study group was consisting of 96 cases, 59 out of 96 were cancer survivors and 37 were pregnancy-associated cancer patients. Of those thirty seven, 25 were synchronous with the pregnancy and 12 were metachronic. Pregnancies resulted in 77 healthy newborns, 7 abortions and 12 medical terminations. The most common type of cancer was the breast cancer in 25 patients, followed by thyroid, leukemia, osteosarcoma, lymphoma and ovarian cancer. Patients were treated for their cancer with different modalities including surgery, chemotherapy and radiotherapy. We encountered maternal mortality in 8 cases, all occurred after delivery. CONCLUSIONS: Since management of a pregnancy of a cancer survivor and pregnant woman with cancer a hard work, multidisciplinary approach involving gynecologists, pediatricians, oncologists is essential. Interval between cancer and pregnancy and timing of initiation of therapy in cases of pregnancy associated cancer are important issues in the perspective of fetal/neonatal well-being.

OBJECTIVE: LIF (Leukemia İnhibitory Factor) was shown to have an important role in implantation. The aim of this study is to investigate the expression of LIF on extravillous trophoblasts in normal pregnancies and pregnancies with MTHFR (methylenetetrahydrofolate reductase) mutations. This study was also designed to demonstrate the “impaired implantation based” perinatal complications such as early pregnancy losses in pregnancies with hereditary thrombophilia (MTHFR 677 & 1298 mutations; homocystinemia and impaired folat/vitamin B12 metabolisms). STUDY DESIGN: Abortus material until 10th gestational-week were used in this study. The patients were divided into 2 groups as: Group 1; control group (unwanted induced abortions), Group 2; abortus material from pregnancies with hereditary thrombophilia. Hereditary thrombophilia cases were consisted of only MTHFR homozygote mutations (MTHFR 677 & 1298). Indirect ABC (avidin-biotin-peroxidase complex) was applied to all of the abortus material to investigate the expression of LIF. RESULTS: Expression of LIF in extravillous trophoblasts was immünohistochemically stronger (+++) in MTHFR group than the extravillous trophoblasts of the control group (++). This finding was also found to be statistically significant (p≤ 0.05). CONCLUSION: The impaired LIF expression of extravillous trophoblastic cells in MTHFR patients can be one of the reasons of early fetal losses due to impaired implantation. Direct affect of homocystinemia, cell degragates of maternal endothelial cells due to injury and thrombosis and activation of complement system may be the reasons of defective LIF synthesis. Defective LIF expression on extravillous (interstitial) trophoblasts may result in insufficient activation of the LIF receptors in the decidua and limiting their migration during placentation. On the other hand, number of the extravillous trophoblasts developing from cytotrophoblasts may also be negatively affected by the disturbed LIF expression resulting in a shallow placenta.

Objectives: Diagnosis and management of non-obstetric acute abdomen during pregnancy is a cause of concern both for the obstetricians and the general surgeons. A resistance against operation during pregnancy leads to unnecessary delay which may increase both maternal and fetal morbidity, even mortality. In this study we present our experience in surgical management of pregnant patients with non-obstetric acute abdomen. Study Design: Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2004 to 2012. Women were excluded from the analysis if the surgical procedure was obstetric in nature. Demographics, gestational age, symptoms, operative results, postoperative complications, pregnancy outcome and imaging studies were assessed. Results: There were 24 patients with a mean age of 28,25±3.51 years. Operations are often performed in the second trimester. Most common symptoms were abdominal pain (100%) and nausea (83%). Ovarian torsion and appendicitis were the most common etiologies causing non-obstetrical acute abdomen (33% and 25%, respectively). All patients tolerated surgery well, 11 of them had no postoperative complications, however 3 fetal losses, 4 preterm deliveries, 3 PPROM, 1 re-operation and 1 vaginal bleeding were observed. One patient died from acute respiratory distress syndrome in the 24th day of the surgery. Ultrasonography was performed in 22 patients, MR imaging was used in 11 patients. Sonographic findings were diagnostic in 59%, while MR was successful in assigning the correct diagnosis in 100%. Conclusions: The issue of surgical management of non-obstetric acute abdomen during pregnancy is an important concern for clinicians who care women. Prompt diagnosis and appropriate surgical approach are the cornerstones of the management. Due to the diagnostic limitations of ultrasonography, MR imaging has become increasingly popular and gave direction to management strategy.

Benign gynecological pathologies in patients with Turner’s syndrome were described in the medical literature. Herein, we present a 39-year-old woman with mosaic Turner’s syndrome (45,0X/46,X,i(X)q10) complaining about bleeding and persistent pelvic pain. In physical examination, she presented normal secondary sex development, normal breast, normal pubic and axillary hair. The external genitalia were also normal. Her laboratory examination showed elevated gonadotropin levels, decreased 17betaestradiol levels and normal plasma androgens and cortisol levels. At transabdominal ultrasonography multiple myoma and irregular thickening of the endometrium were suspected. At laparotomy, total abdominal hysterectomy and bilateral salpingectomy were performed. Histopathological examination revealed multiple leiomyoma, secretory endometrium and ectopically localized adrenal tissue. Since its known that both myoma uteri and secretory changes in endometrium develop primarily in woman of reproductive age and their growth is estrogen dependent, the source of estrogen in the present case was thought to be the ectopic adrenal tissue located just beneath the left salpinx. This seems to be the first report of the occurence of benign gynecological pathologies due to the ectopic adrenal tissue in a mosaic Turner’s syndrome patient without hormone replacement therapy.

Goldenhar Syndrome also known as oculoauriculovertebral spectrum (OAVS) is a rare syndrome characterized by hemifacial microsomi, microtia, epibulbar dermoids, ear malformations and hemivertebrae. The mode of inheritance is clearly unknown and mostly polygenic etiology. The aim of this presentation is to present this young mother with oculoauriculovertebral spectrum and related problems. Most of the individuals with this syndrome do not notice themselves before the time of diagnosis. For that reason, we followed this patient’s pregnancy and performed cesarian section due to cephalopelvic disproportion. The enlighting of these patients with this syndrome is very important for the evaluation of this family and for the future pregnancies.

The cystic formation of the rete ovarii has been described rarely in the medical literature. Before performing pathologic examination they are mostly confused with other ovarian cystic structures. Currently, with the help of the certain distinguishing features of the rete ovarii tumors, diagnosing a primary tumor of the rete ovarii is much easier. Herein we describe a case of a postmenopausal patient presenting with a right sided adnexal mass, a rare tumor of t he rete ovarii, the cystadenoma.