Search

Purpose: Signs of congenital obstruction of the gastrointestinal tract (GIT) organs may present on prenatal ultrasonography. Prenatal detection is influenced by several factors, including obstruction site, lesion degree (partial or complete), the occurrence of associated malformations, and gestational week at screening. Here, we aimed to evaluate the success of prenatal diagnosis of GIT obstructions in a tertiary center in Turkey. Materials and methods: The study included 34 prenatally and 22 postnatally diagnosed babies with different GIT malformations. GIT obstructions were divided into five groups according to the level of obstruction (A. esophagus, B. stomach and proximal duodenum, C. small intestine, D. large intestine, E. multiple obstructions). Results: The prenatal detection rate among all cases was 60.7%. The associated structural malformation and aneuploidy rates were 21.4 and 5.4%, respectively. Twelve neonates died within the first day after birth due to various reasons. The remaining 43 babies underwent surgery at different times according to their clinical conditions. The mean time between birth and surgery was 4.5 days (range, 1-56 days). There were 12 postoperative deaths due to various complications, and one case died at 2 years of age. Overall, 31 of the 56 (55.4%) babies were alive during the follow-up period. The successful prenatal diagnosis rates were 57.2, 85.8, 75, 25, and 80% in groups A, B, C, D, and E, respectively. The median birth weight increased significantly in groups A through D (p = .04). However, there were no intergroup differences in the Apgar scores, associated abnormality rates, time to surgery, and number of babies operated. Conclusions: These findings demonstrate the importance of prenatal ultrasonography and success of prenatal detection especially for upper GIT abnormalities. Although there are some prenatal signs of GIT obstructions, such as double bubble, polyhydramnios, enlarged bowel, and failure to visualize the stomach, early prenatal diagnosis is difficult and can be delayed, resulting in the detection of GIT obstruction after birth. When suspecting GIT obstruction, clinicians should evaluate the fetal anatomy carefully and be aware of associated chromosomal abnormalities. [ABSTRACT FROM AUTHOR]

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

Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms may cause various medical disorders through different mechanisms. We aimed to determine the allelic frequency and the prevalence of homozygous MTHFR polymorphisms in a tertiary university hospital population that necessitated MTHFR polymorphism investigation owing to various reasons. Methods: Our study consisted of 10449 patients who necessitated MTHFR polymorphism investigation owing to various reasons (coronary artery diseases, thrombotic events, epilepsy, migraine, repeated miscarriages, various obstetric complications) during 2008-2017. Results: The allelic frequency of MTHFR 677 and MTHFR 1298 mutations were 0.296 and 0.283 respectively. The prevalence of homozygous MTHFR C677T and MTHFR A1298C polymorphisms were 10.2 % and 11.1 %, respectively. Conclusion: MTHFR polymorphisms are more frequent than was expected and one should be cautious when drawing disorder specific conclusions. [ABSTRACT FROM AUTHOR]

The relationship between Behcet’s disease (BD) and pregnancy is only reported in limited number of studies. We retrospectively collected data of 26 women with BD diagnosis and their 66 pregnancies. We analysed patients according to disease activity, age at BD diagnosis, age at first/last pregnancy, obstetric history, obstetric complications, neonatal birthweight, associated foetal abnormalities and pregnancy-related complications. Sixteen miscarriages (24.2%), two intrauterine deaths (3%) and 48 live births (72.8%) were identified. Preterm labour was observed in 12 (24%) of 50 deliveries. Colchicine was used in six pregnancies, however, there was no drug treatment for BD in the remaining 59. There was a higher rate of preterm labour and low birthweight in patients using colchicine. BD was in remission in 60 (90.9%) of 66 pregnancies, and disease flared up only in six cases. In conclusion, BD patients with altered symptoms during pregnancy carry an increased risk of obstetric complications.IMPACT STATEMENTWhat is already known on this subject: There are limited and conflicting data about the interaction between BD and gestation.What the results of this study add: Our findings indicated that patients who were in an active symptomatic phase of BD and were being treated with colchicine had an increased risk of preterm delivery and low birthweight.What the implications are of these findings for clinical practice and/or further research: Clinicians should consider increased obstetric complication risk among patients with active BD. [ABSTRACT FROM PUBLISHER]

Posterior reversible encephalopathy syndrome (PRES) is an uncommon disorder. PRES presents with clinical findings such as headache, seizures, visual disturbances, and altered consciousness. Here, we present a PRES case in the second trimester of pregnancy with intrauterine fetal demise. A 40-year-old woman, gravida 4 para 3, was diagnosed with HELLP syndrome based on the clinical and laboratorial findings. An emergent caesarean section was performed under magnesium sulphate (MgSO4) treatment. She had suffered vision loss with normal fundoscopic findings at postpartum period. All the clinical, laboratory and imaging findings (MRI) confirmed the diagnosis of PRES. Careful observation of the clinical findings and prompt treatment is necessary for pregnancies complicated by PRES to prevent undesirable outcomes. [ABSTRACT FROM AUTHOR]

Major depression (MD) is one of the common mood disorders. MD prevalence is 8-16% among reproductive women in United States of America and studies show that the prevalence of MD in pregnant women is lower than in non-pregnant women (Ko et al. [7]). In conclusion, ECT appears to be an effective treatment modality for pregnant women with MD which is unresponsive to medical therapy. [Extracted from the article]

Introduction. Intrahepatic cholestasis of pregnancy (ICP) is characterized by acute onset pruritus, elevation of liver enzymes and increase in bile acids. This pregnancy-specific disease is related with adverse pregnancy outcome. The objective of this study is to compare the first-trimester biochemical markers between ICP and healthy pregnancies. Materials and method. In this retrospective study, 30 women with ICP diagnosis and 60 healthy pregnant women were analyzed in terms of β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels. Results. The mean age, BMI and obstetric history were similar between groups (p>0.05 for all). The median gestational week at birth was 39 (37-41) and 37 (34-40) in ICP and controls (p<0.05). No difference was observed between birth weights (3300 g [2500-3970] and 3260 g [2360-4080]; p=0.239). There was no statistically significant difference in terms of PAPP-A and β-hCG levels between groups, while the mean PAPP-A level (2.18+1.1 versus 2.89+1.84) and MoM values (0.73+0.53 versus 1.05+0.49) were found to be decreased in ICP group. Conclusions. A decrease in PAPP-A levels in first-trimester aneuploidy screening may be a potential indicator of ICP in ongoing pregnancies. However, clinicians should remember that decreased levels may also be detected in healthy pregnancies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the role of systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios calculated in the first trimester as inflammatory markers in predicting gestational diabetes mellitus diagnosis., Methods: This study was conducted retrospectively at a tertiary center between January 2020 and June 2023. A total of 111 pregnant women with gestational diabetes and 378 pregnant women in the control group were included in the study. Systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios values were compared between the gestational diabetes mellitus group patients and the healthy group. Receiver operating characteristic analysis curve was used for predicting gestational diabetes mellitus using systemic immune-inflammation index and lymphocyte-monocyte ratio., Results: In pregnant women in the first trimester, systemic immune-inflammation index and lymphocyte-monocyte ratio values based on routine complete blood count parameters were found to be statistically significantly higher in gestational diabetes mellitus patients compared to healthy patients, while neutrophil-lymphocyte ratio and platelet-lymphocyte ratios values were found to be similar (p=0.033, p=0.005, p=0.211, and p=0.989). For predicting gestational diabetes mellitus, a cut-off value of 655.75 for systemic immune-inflammation index resulted in 80.2% sensitivity and 34.4% specificity, and a cut-off value of 3.62 for lymphocyte-monocyte ratio resulted in 56.8% sensitivity and 63.2% specificity, indicating good discriminatory ability., Conclusion: We believe that systemic immune-inflammation index and lymphocyte-monocyte ratio values measured in the first-trimester complete blood count parameters are effective in predicting gestational diabetes mellitus but are not effective in determining insulin requirement.