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The aim of this study was to assess the effect of continued smoking before and during pregnancy on mid-trimester fetal head development. A total of 250 pregnant women enrolled in the study. All participants were confirmed to be smokers or non-smokers by verifying breath carbon monoxide readings. Biparietal diameter (BPD), head circumference (HC), lateral ventricle (LV), and cisterna magna (CM) were evaluated by ultrasound between 20–22 weeks of pregnancy. Gender and gestational age-adjusted BPD z- scores were not statistically different between smokers and non-smokers (−0.75 ± 1.6 vs −0.51 ± 1, p =.3). HC measurements and z- scores were significantly lower in the smoking group than in the non-smoking groups (183.38 ± 14.56 vs. 189.28 ± 12.53, p =.003, 0.18 ± 1.39 multiple of median (MoM) vs. 0.56 ± 0.92, respectively, p =.023). At linear regression analysis, maternal smoking was the only independent factor associated with fetal HC z score (p =.041). In conclusion, continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV, or CM measurements at mid-gestation. What is already known on this subject? Smoking during pregnancy is one of the most common environmental factors affecting fetal and neonatal growth and well-being. Despite the well-known effects of smoking on somatic growth, current studies have shown that it selectively affects some parts of the fetal brain, even in appropriately growing fetuses. What do the results of this study add? Continued smoking during pregnancy reduces fetal HC and has no effect on BPD, LV or CM measurements at mid-gestation. Since smoking is well known for its early and late childhood behavioral and neurological consequences, smaller mid-trimester fetal HC measurements should bring maternal smoking to mind as one of the potentially reversible causes. What are the implications of these findings for clinical practice and/or further research? The harmful effects of smoking start before the third trimester and antenatal counseling should be started early in the gestation. Every effort should be made to quit smoking before or early in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: RhD blood group incompatibility between the mother and fetus can sometimes lead to maternal alloimmunization. Maternal alloimmunization can occur in 2 ways: (1) following inappropriate blood transfusion and (2) following fetomaternal hemorrhage between the mother and the incompatible fetus. Fetomaternal bleeding can occur during labor, pregnancy, or delivery. Several predisposing factors cause fetomaternal hemorrhage. Spontaneous or induced abortion, amniocentesis, abdominal trauma, abruptio placenta, fetal death, multiple pregnancy, manual removal of the placenta, and cesarean section. Anti-D resulting from maternal alloimmunization can cross the placenta and attack fetal erythrocytes, which in worse scenarios can cause fetal anemia and ultimately death. The aim of this study was to determine the prevalence and causes of alloimmunization. Method: Between September 2022 and May 2023, multiparous and/or nulliparous pregnant women admitted to Bezmialem Vakıf University Hospital Obstetrics and Gynecology Outpatient Clinic were asked for indirect Coombs test (ICT) at the first antenatal visit. Age, blood type, gravida, parity, previous deliveries (normal spontaneous delivery and cesarean section), gestational week, singleton-twin status, previous abortion status, and history of blood transfusion were noted. Results: Between September 2022 and May 2023, 377 patients underwent ICT. Six patients were excluded because they were not pregnant. Seventeen of 371 patients tested positive (4.3%). The majority of the reasons were Rh incompatibility, but one patient was alloimmunize during blood transfusion (0.0026%). Fetal distress during transfusion resulted in cesarean section, and the fetus died. Conclusion: Maternal alloimmunization was mostly due to previous maternal blood transfusion. Sensitization may also occur during invasive procedures such as abortion, ectopic pregnancy, maternal trauma, and chorionic villus sampling. In our hospital, one patient was sensitized by blood transfusion. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the seroprevalence of toxoplasmosis during pregnancy in our hospital and thus contribute to screening and management strategies. Materials and Methods: In this retrospective cohort study, the records of 607 pregnant women were analyzed. Patients were tested for serum Toxoplasma gondii antibodies at their first antenatal visit. The seronegative cases were rescreened at 32 weeks’ gestation with immunoglobulin (Ig) M and IgG for seroconversion. Demographic, clinical, and serological characteristics of patients were evaluated. Results: During the study period, 461 (75.94%) patients were seronegative for toxoplasmosis. IgG seropositivity was detected in 110 (18.12%) patients, whereas 33 (5.43%) patients had both IgG and IgM seropositivity; low avidity was observed in 6 (0.98%) of these 33 patients. IgM seropositivity was detected in only 3 (0.49%) cases. Toxoplasma IgG and IgM tests were repeated for 93 seronegative patients at 32 weeks’ gestation but seroconversion was not observed in any patient. Acute Toxoplasma infection during pregnancy was found in 9 (1.48%) patients and amniocentesis was performed in four of these. No infant was diagnosed with congenital Toxoplasma infection. Conclusion: Congenital Toxoplasma infection is clearly a preventable and treatable disease that poses a serious public health risk. Educating people on the transmission routes and implementing routine prenatal testing both regionally and globally during gestation are key preventative measures. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare the placental diffusion difference between intrauterine growth restriction (IUGR) patients with worsening Doppler ultrasonography (US) findings and control group with normal Doppler US findings by using diffusion-weighted imaging (DWI).Methods: We performed a prospective study to compare the placental diffusion difference in 63 patients (gestational week, 28-34 weeks), including 50 IUGR patients (mean gestational week, 30 weeks 3 days ±16.2 days) with worsening Doppler US findings and 13 patients with normal Doppler US findings (mean gestational week, 29 weeks 4 days ±12.3 days) by using DWI (b value, 0-1000 s/mm2). We classified IUGR patients into three groups according to the reference values of the umbilical artery pulsatility index (PI) chart. Placenta apparent diffusion coefficient (ADC) calculations were performed by freehand drawn regions-of-interest (ROIs) (min, 8.04 cm2; max, 200 cm2).Results: Placental ADC values in IUGR patients (mean, 1.624±0.181 ×10-³ mm²/s; range, 1.35-1.96 ×10-3 mm2/s) were significantly reduced compared with the control group (mean, 1.827±0.191 ×10-³ mm²/s; range, 1.35-2.84 ×10-3 mm2/s) (P = 0.001). For adjusted ROI area calculation, ADC values were significantly lower in groups 3, 2 and 1, respectively, compared with the control group (P < 0.05); and there was no significant difference between groups 1 and 2 (P > 0.05). Preeclampsia significantly reduced the placental diffusion compared with patients without preeclampsia (P = 0.003). Gestational aging did not significantly affect ADC values in control patients (r=0.08, P = 0.561). The sensitivity, specificity, negative and positive predictive values of ADC to detect IUGR were 72%, 84.6%, 44%, and 94.7% with a cutoff value of 1.727 ×10-3 mm2/s, respectively.Conclusion: The diagnostic estimation of placental ADC values to predict the severity of IUGR is comparable to that of umbilical artery PI. Considering that at the very early onset of IUGR, placental diffusion diminishes, ADC as a marker for IUGR in lieu of umbilical artery PI has the potential to determine the threshold for decreased placental diffusion. Therefore, DWI should be added to routine fetal MRI to show diffusion changes in placenta. [ABSTRACT FROM AUTHOR]

Objective: Placental cysts (PC) are usually benign masses on the surface of the placenta and can be detected with ultrasonography in the early stages of pregnancy. Although PCs are clinically insignificant and don't require additional follow-up in most cases, larger cysts may cause intrauterine growth restriction (IUGR), intrauterine asphyxia, and preterm delivery. In this study, we present a case of a placental surface cyst complicated with intracystic hemorrhage. Case: A 33-year-old, gravida 2 para 1 woman was referred to Bezmialem Vakıf University, Obstetrics and Gynecology clinic at 36 weeks of gestation with the detection of a placental cyst at detailed ultrasound. Besides the rhesus incompatibility and a dermoid cyst, the patient's obstetrics, personal, and family histories were normal. Her detailed ultrasound report showed a thin-walled, anechoic placental surface cyst measuring 2.7x1.8 cm at its widest point, located adjacent to the umbilical cord insertion to the placenta. In our sonographic examination at the 36th week, the fetal development, and the amniotic fluid index were within normal limits. We observed a placental cyst with the dimensions of 6x7.3 cm containing a 5.3x3.8 cm echogenic area suggesting intracystic bleeding. Middle cerebral artery peak systolic velocity was 39 cm/s. A healthy, 3480-g female neonate was born at 38 weeks of gestation via cesarean section. Separation of the placenta resulted in uterine inversion. After the eversion of the uterus, the placenta was sent to pathology. The pathological examination confirmed a placental subchorionic cyst with an undamaged capsule and an area of infarct measuring 8x7x4.5 cm. When the capsule was discharged, brown-colored hemorrhagic fluid was revealed. Conclusion: In this case, we presented the diagnosis and management a subchorionic placental cyst complicated with intracystic hemorrhage. Despite its benign course in most cases, subchorionic placental (surface) cysts are prone to hemorrhage as in our case. The extent of the hemorrhage and the position of the cyst may be predictive for perinatal complication such as IUGR, fetal anemia and fetal distress. Therefore, follow-up US of the cyst with regard to size, echo-texture, MCA-PSV should be implemented in these cases. More cases should be collected and reported to establish antenatal follow-up and delivery protocol for PC cases. [ABSTRACT FROM AUTHOR]