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Placental mesenchymal dysplasia is an increasingly recognizable abnormality. Early cases have been confused with partial hydatidiform mole. Placental mesenchymal dysplasia is probably under-diagnosed because of being an unfamiliar clinical entity and also mistaken for gestational trophoblastic disease due to the similar sonographic findings of two entities. In this report, we describe the clinical, gross, and histopathological findings of placental mesenchymal dysplasia in two cases. The 33-week-preterm baby of a 26-year-old woman with cardiovascular disease and 342 gram placenta and the 19-week fetus with trisomy 21 of a 40 year-old woman were terminated. Macroscopically thick-walled vessels and microscopically hydropic villous with peripherally localized thick-walled vessels without trophoblastic cell proliferation were observed in both cases. These two cases represent a rare placental anomaly that is benign but it is challenging to distinguish placental mesenchymal dysplasia from an incomplete mole. Placental mesenchymal dysplasia should be included in the differential diagnosis of sonographic findings that show a normal appearing fetus and a placenta with cystic lesions. Placental mesenchymal dysplasia is associated with pregnancy-related hypertension. In conclusion, the most important point is “you can diagnose it if you consider it”.

Ligneous disease involving the female genital tract is a very rare entity. We present a case of a patient who admitted to our clinic with the complaints of dyspareunia, postcoital bleeding and infertility. On speculum examination a nulliparous cervix with white plaques and hemorrhagic lesions around ostium were seen. Multiple samples were taken from the cervical lesions and histopathologic diagnosis was ligneous cervicitis and low grade cervical intraepithelial lesion. According to the characteristics of the disease, a conjunctival examination and biopsy were performed. Similar microscopic features in cervix were also determined and reported as ligneous conjunctivitis. She used cyclosporine and oral contraceptives in the following six months but there was no improvement on either ocular or genital lesions.

Meconium peritonitis refers to rupture of the bowel prior to birth, resulting in fetal meconium escaping into peritoneum leading to inflammation (peritonitis). Meconium periorchitis is an extension of meconium peritonitis into the scrotum via a patent processus vaginalis. The most common causes of meconium peritonitis are ischemic lesions of the small bowel associated with mechanical obstruction (atresia, volvulus, intussusception, congenital bands, Meckel diverticulum and internal hernia). These likely account for 50% of the cases of meconium peritonitis. Meconium peritonitis may also be caused by viral infections (cytomegalovirus or parvovirus B19) and cystic fibrosis. Here, we report of a patient with fetal meconium peritonitis - periorchitis and perinatal management.

Placental chorioangioma constitutes major importance in perinatology practice, as being the most common type of placental tumors, and having the potential of devastating perinatal outcomes. In this review, we report the symptoms, diagnostic findings and recent temporary and definitive treatment choices in patients with chorioangioma.

Objective: To evaluate the presence of any seasonal variation in the frequency of intrahepatic cholestasis of pregnancy (ICP). Study Design: A total of 126 cases with ICP were compared with a cohort of 37614 pregnant women who delivered. The diagnosis ICP was performed on the basis of severe itching and the absence of dermal rash and any other hepatic disease, with the co-existence of elevated serum aminotransferase levels and/or serum bile acid concentration. For each month and season, observed and expected ICP rates were analysed and compared by using chi-square statistics. Multivariate logistic regression was performed to investigate certain parameters on cumulative risk. Results: A significantly lower frequency of ICP in winter (6/126 (4.8%), p=0.001) and a significantly higher frequency in spring (44/126 (34.9%), p=0.034) were detected. A 2.1 and 3.8-fold higher risk were found for the nulliparity and the twin pregnancy, respectively. Logistic regression analysis confirmed the significant (10-fold) decrease in the frequency of ICP in winter. The significance of spring did not persist after the adjustment. Conclusion: Main outcome of the study points at seasonality in ICP frequency. Future studies in different populations may reveal data about factors that interact with seasonality and playing roles in ICP.

Background: We compared Pfannenstiel and midline skin incisions for cesarean hysterectomy in women with confirmed Placenta Accreta Spectrum Disorders. Aims: A retrospective cohort study was conducted to evaluate the outcomes of Pfannenstiel and midline skin incisions in women undergoing cesarean section hysterectomy for suspected placenta accreta at Akdeniz University Hospital between January 2010 and February 2022. Histopathological confirmation was obtained for all cases. Demographic, perioperative, and postoperative data, along with neonatal outcomes, were extracted from the hospital’s electronic database. Possible complaints related to the incision site or other issues (e.g., vaginal dryness or sexual life) were identified through telephone interviews. Subjects were stratified into Pfannenstiel and midline incision cohorts, with subsequent data comparison. Results: Data from 67 women with a histopathologically confirmed PAS diagnosis were analyzed. Of these, 49 (73.1%) underwent Pfannenstiel incision, and 18 (26.9%) had a midline skin incision. Incisions were based on the surgeon’s experience. Pfannenstiel incision was more common in antepartum hemorrhage, preoperative hemorrhage, and emergency surgery (p = 0.02, p = 0.014, p = 0.002, respectively). Hypogastric artery ligation occurred in 30 cases (61.2%) in the Pfannenstiel group but none in the midline group. Cosmetic dissatisfaction and sexual problems were more prevalent in the midline group (p < 0.05, all). Preoperative and postoperative blood parameters, transfused blood products, and neonatal outcomes were similar between the two groups. Conclusions: Relaparotomy, bladder injury, blood loss, and need for blood transfusion were more prevalent in the Pfannenstiel group, while greater dissatisfaction with the incision was observed in the midline incision group. Midline incision seems to be more favorable in patients with Placenta Accreta Spectrum (PAS). Patients may be informed regarding the worse cosmetic outcomes and possible sexual problems related to vaginal dryness when midline laparotomy is planned. But before opting for a Pfannenstiel incision, patients should receive comprehensive information regarding the potential risks of relaparotomy and bladder injury.

Purpose This study analyzed the safety of myomectomy during the cesarean section (CS). Methods Pregnant women who underwent myomectomy during CS in a tertiary center between January 2015 and November 2019 were included in the study in Group A, and pregnant women who did not have myoma and who underwent only CS were included in the study in Group B. The following information was obtained from patient files in hospital archives and was then recorded and compared: age, gravidity, parity, gestational week, characteristics of the myomas (i.e., location, size, number, and type), duration of surgery, perioperative complications, need for blood transfusion, preoperative and postoperative hemoglobin (Hb) values, duration of surgery, and hospital stay duration. Results A total of 83 patients underwent CS plus myomectomy (Group A), and 80 patients (without myoma) underwent only CS (Group B).There were no statistically significant differences between the groups in terms of preoperative and postoperative Hb values or blood transfusion rates (p > 0.05). Hospitalization and surgery duration were significantly higher in the group that underwent CS myomectomy (p = 0.001 and p = 0.001, respectively). The mean myoma size was 8.3 ± 4.1 cm in Group A. There was a statistically significant and inverse correlation between the size of the myoma and the delivery week (p = 0.035). There was a statistically significant and positive correlation between the myoma size and hospital stay (p = 0.01). Conclusion Myomectomy during CS is safe and can be applied regardless of the location, size, type, and number of myomas. However, to make myomectomy routine during CS, multi-center studies that include more cases are needed.

Objectıves: Intrahepatic (also known as obstetric) cholestasis of pregnancy (ICP) is one of the most frequently diagnosed conditions for pregnancy-specific hepatic disease. It has consistently been found to be related to adverse pregnancy outcomes. In recent studies, a relationship between ICP and Gestational Diabetes Mellitus (GDM) was demonstrated. However, the association between serum total BA (TBA) level in ICP and GDM is not fully understood. This study aims to evaluate the association between serum TBA levels in ICP disease with GDM. Study Desıgn: Eighty pregnant women diagnosed with ICP and eighty healthy pregnant women as normal controls were included in the study. Their clinical characteristics and laboratory test results including liver function tests, glucose challenge tests (GCT), glucose tolerance tests (GTT), and fasting and postprandial TBA levels were recorded. Cases with serum TBA levels between 12-40 µmol/L were described as mild disease, >40 µmol/L was described as severe disease. Results: The mean 50-g GCT value was significantly higher in pregnant women with ICP compared to the healthy controls (128.7±28.2, 106.6±27.0; p < 0.0001) and it was slightly higher in women with severe disease than women with mild disease (132.7±30.1, 125.5±26.5; p=0.26). The percent of GDM diagnosis with ICP disease (11.25%) was higher than in healthy pregnant women (6.25%) but the difference was not found to be statistically significant (p=0.187) and it was similar in pregnant women with mild and severe disease (11.1%, 11.4%; p=0.31). Conclusıon: Our current study demonstrated that ICP was not associated with GDM, also, we did not demonstrate a relationship of TBA level with ICP and GDM. It may be due to our study’s small sample size. Further and well-designed studies with larger sample sizes are necessary to determine the relationship between GDM and ICP and also the function of TBA in the pathogenesis of GDM disease.

Background Higher Fetuin-A (FA) concentrations were found to be associated with obesity and there is an interest to the relation between maternal FA and pregnancy outcomes. Objective In this study, our aim was to evaluate the association of maternal plasma levels of FA with fetal growth restriction (FGR). Materials and Methods 41 pregnant women with FGR and 40 controls were recruited in this case-control study between July and November 2015. At the diagnosis of FGR, venous blood samples (10 cc) were obtained for FA analysis. Results Maternal plasma FA levels were significantly higher in fetal growth-restricted pregnant women compared with controls (19.3 ± 3.0 ng/ml vs 25.9 ± 6.8 ng/ml, p = 0.001). Area under receiver operating characteristic curve analysis of FA in FGR was 0.815 (95% confidence interval (CI): 0.718-0.912, p < 0.001). The maternal FA levels with values more than 22.5 ng/ml had a sensitivity of about 73.17% (95% CI: 56.79-85.25) and a specificity of about 82.5% (95% CI: 66.64-92.11) with positive and negative predictive values of about 81.08% (95% CI: 64.29-91.45) and 75% (95% CI: 59.35-86.30), respectively. Therefore, the diagnostic accuracy was obtained about 77.78%. Conclusion The results of this study show higher maternal plasma levels of FA in FGR. Further studies are needed in order to demonstrate the long-term effects of FA in pregnancies complicated with FGR and early prediction of FGR.

Preeclampsia (PE) and intrauterine growth restriction (IUGR) are still among the most commonly researched titles in perinatology. To shed light on their etiology, new prevention and treatment strategies are the major targets of studies. In this study, we aimed to investigate the relation between gene polymorphism of one of the products of trophoblasts, pregnancy-associated plasma protein A (PAPP-A) and PE/IUGR.A total of 147 women (IUGR, n = 61; PE, n = 47; IUGR + PE, n = 37; eclampsia, n = 2) were compared with 103 controls with respect to the sequencing of exon 14 of the PAPP-A gene to detect (rs7020782) polymorphism. Genotypes “AA” and “CC” were given in the event of A or C allele homozygosity and “AC” in A and C allele heterozygosity. Our findings revealed that the rate of AA, CC homozygotes, and AC heterozygotes did not differ between groups. Moreover, there was no difference in the distribution of PAPP-A genotypes among the patients with IUGR, PE, IUGR + PE, or eclampsia. Finally, birth weight, rate of the presence of proteinuria, and total protein excretion on 24-hour urine were similar in the subgroups of AA, AC, and CC genotypes in the study group. Our study demonstrated no association between PAPP-A gene rs7020782 polymorphism and PE/IUGR.