Pregnancy health problems and low birth weight associated with maternal insecure attachment style.

We aimed to determine the association between attachment style and health problems during pregnancy, as well as perinatal health variables. In 122 mothers who were 2-18 months postpartum, hot flushes, vaginal discharge, back pain, breast tenderness, hair changes, and psychological problems were shown to be associated with insecure attachment as measured by the Adult Attachment Style Questionnaires. Babies born to mothers with insecure attachment were more likely to have a low birth weight. It is vital to increase awareness of insecure attachment style as a risk factor among perinatal health care providers to optimize services.

Prenatal early diagnosis of dacryocystocele, a case report and review of literature.

Dacryocystocele (mucocele, amniocele) is a relatively rare variant of nasolacrimal duct obstruction which refers to the cystic dilatation of lacrimal pathway above and below the lacrimal sac. It is a benign pathology and can be treated successfully after birth, but its prenatal detection is important, because it may be seen in numerous syndromes and may serve as their marker. Bilateral cysts have the possibility for intranasal extension and an obstruction to the nasal passages may result in neonatal respiratory distress requiring surgical intervention Unilateral cases are important for the differential diagnosis with serious facial abnormalities. We present a case of early prenatal detection of a 28 year-old G: 1 P: 0 pregnant woman with bilateral dacryocystocele. She presented a live, normally developed singleton fetus on sonographic examination at 12, 16 and 22 weeks. At 25(th) weeks, we diagnosed a hypoechogenic mass, that was situated inferomedially to the eyes in the fetal face with 2 and 3-D ultrasound. A 3850-g live female infant was delivered by Cesarean section due to breech presentation at 39 weeks following preterm rupture of membranes. We report the case with intranasal components studied during fetal life by 2 and 3-D ultrasound and magnetic resonance (MR) imaging.

A template for defining the perinatal care of monochorionic twins: the Istanbul international ad hoc committee.

This template was produced by the Working Group on Multiple Pregnancy and was endorsed by the International Board of the World Association of Perinatal Medicine. The purpose of this document is to expand the 2007 Istanbul international consensus statement on the perinatal care of multiple pregnancy and to focus on the care of monochorionic (MC) twins. The document represents the view and opinion of individuals who composed this ad hoc committee and discusses various aspects that are specific and relevant to the care of MC twin gestations.

Plantar pressure and foot pain in the last trimester of pregnancy.

BACKGROUND: Back and foot pain are common complaints during pregnancy. Progression of symptoms is seen especially in the third trimester as the center of gravity (COP) is altered due to weight gain. The aim of the study was to evaluate plantar pressure changes and postural balance differences of pregnant women. MATERIAL AND METHODS: Thirty-five last trimester pregnant women with complaints of foot pain were included. The control group consisted of 35 non-pregnant women who were age and body mass index (BMI) matched volunteers. All selected cases were overweight. Foot pain in pregnancy was measured by Visual analogue scale (VAS). Percentages of pressure on forefoot and hindfoot were measured using static pedobarography and peak pressures at forefoot, midfoot and hindfoot were measured using dynamic pedobarography. As a measurement of balance, COP sway length and width were also analyzed. RESULTS: Compared to overweight individuals, pregnant patients had higher forefoot pressure on the right side with standing and walking. Also, significant increases in contact times under the forefoot and longer floor contact times were found. VAS scores were correlated with forefoot contact times during walking. Although the sway length from COP was higher than controls, no significant correlation was found in sway length and weight gain. CONCLUSION: These data suggest that forefoot pressures increase in the last trimester of pregnancy during standing and walking. There is prominent increased postural sway in anterior-posterior direction in this period. CLINICAL RELEVANCE: We believe that based on the observed pressure changes, foot pain in pregnancy due to changes in body mass and distribution may be relieved by exercise and shoewear modifications.

The Istanbul international consensus statement on the perinatal care of multiple pregnancy.

The purpose of this document is to expand the 1995 ISTS/COMBO Declaration of Rights which was initially produced to promote awareness of the special needs of multiple birth infants, children, and adults. It addresses the clinical and ethical dimensions of perinatal care of multiple pregnancy. The ad hoc committee was chaired by Isaac Blickstein. The following individuals were present (in alphabetical order): Birgit Arabin (Zwolle, Netherlands/Berlin, Germany), Isaac Blickstein (Rehovot, Israel), Frank A. Chervenak (NY, USA), Zehra Nese Kavak (Istanbul, Turkey), Louis G. Keith (Chicago, USA), Eric S. Shinwell (Rehovot, Israel) and Yves Ville (Paris, France). Secretary of the meeting was Alin Basgul (Istanbul, Turkey). This statement was endorsed by the International Society of Twin Studies (Ghent, Belgium, June, 2007) and by the World Association of Perinatal Medicine (Florence, Italy, September, 2007).

Extrahepatic abdominal hydatid disease caused by Echinococcus granulosus: imaging findings.

OBJECTIVE: The classical findings in hydatid disease caused by Echinococcus granulosus with liver or lung involvement are well known. However, diagnosing hydatid disease at unusual locations may be challenging because of variable imaging appearances depending on the host reaction. The purpose of this pictorial essay is to review the sonographic, CT, and MRI features of extrahepatic abdominal hydatid disease including intraperitoneum, retroperitoneum, diaphragma, bone, and soft tissue of the abdomen. CONCLUSION: Extrahepatic abdominal hydatid lesions have nearly identical imaging features, including the presence of cyst wall calcification, daughter cysts, and membrane detachment. The combinations of radiologic and serologic tests especially in patients living in the endemic areas contribute to the diagnosis. Despite their rarity, being familiar with the spectrum of radiologic findings in these unusual sites is helpful to improve diagnostic accuracy.

Drug utilization and teratogenicity risk categories during pregnancy.

A limited number of studies have investigated in detail the use of drugs during pregnancy. Researchers in the present study investigated the details of drug utilization in pregnant women during the month before pregnancy, at the time that they became aware of the pregnancy, and during the first trimester. Face-to-face interviews were conducted with 359 pregnant women who were admitted to the fetal medicine unit at a university hospital for diagnosis and follow-up. A questionnaire was used to document sociodemographic characteristics and details of drug use. Drugs were categorized according to the US Food and Drug Administration fetal risk classification. Mean maternal age was 29.9+/-5.1 y, and mean gestational age was 19.6+/-9.5 wk. Many of the pregnant women studied (46.6%) were university graduates, and most (61.9%) had a relatively high annual income. Mean gestational age when participants first learned of their pregnancy was 39.8+/-16.4 d. One hundred seventeen participants (32.6%) used drugs during the month before conception, 54 (15%) at the time when they learned of their pregnancy, 180 (50.1%) at the time of the interview, and 289 (80.5%) during the first trimester. The percentages of drugs in categories D and X used by these subjects were 14%, 13.5%, 2.9%, and 5.9%, respectively. Most of the drugs were hormones. The total rate of drug utilization was not high before and during the first trimester of pregnancy. A considerable number of women were using drugs from the D and X categories; however, these numbers decreased significantly when women learned of their pregnancies. Intake of folic acid, vitamins, and iron was very low during the preconception period and was not high enough during the first trimester; this suggests that particular attention should be paid to the use of beneficial "safe" drugs during the preconception and early pregnancy periods.

Three-dimensional ultrasound power Doppler assessment of the cervix: comparison between nulliparas and multiparas.

AIM: To assess the sonographic cervical characteristics between nulliparous and multiparous women. SUBJECT AND METHODS: Transvaginal three-dimensional ultrasound and power Doppler using the virtual organ computer-aided analysis (VOCAL) program were performed on 71 nulliparas and 59 multiparas at a mean gestational age of 25.3+/-7.9 weeks. We compared the cervical volume and power Doppler vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) between nulliparas and multiparas. RESULTS: The mean cervical volume and mean VI, VFI, FI measurements were not significantly different between multiparas and nulliparas. CONCLUSION: Our observations suggest that the morphological changes in the cervix of parous women are merely configurational without a change in cervical mass and vascularization. These configurational changes might result from the inevitable cervical stretching during labor and represent a healing process that does not involve a subsequent change in mass or vascularity.

Thoraco-omphalopagus conjoined twins detected at as early as 9 weeks of gestation: transvaginal two-dimensional ultrasound, color Doppler and fetoplacental Doppler velocity waveform findings.

Here we report a case of conjoined twins that were diagnosed antenatally by routine two-dimensional transvaginal ultrasound examination at as early as the 9th week of gestational age. The fetuses were of the thoraco-omphalopagus type and were sharing the liver, as confirmed by color Doppler. There was a reversed flow in the single ductus venosus of the twins. Umbilical arterial and venous blood flow waveform did not show any abnormality for this gestational age. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins in the first trimester by transvaginal two-dimensional ultrasound and color Doppler examination. Although conjoined twins were described at first trimester before, fetoplacental Doppler waveform findings at this gestational age have been described very rarely. This case demonstrated the possibility of making an accurate diagnosis of conjoined twins and delineating the extent of organ sharing in the first trimester, and early diagnosis can help the parents with the option for pregnancy termination. The importance of expert early vaginal sonography and color Doppler findings is emphasized.

The efficacy of first-trimester PAPP-A and free beta hCG levels for predicting adverse pregnancy outcome.

OBJECTIVE: To determine whether first-trimester measurements of maternal serum PAPP-A and free beta hCG levels were associated with adverse pregnancy outcomes. STUDY DESIGN: First trimester maternal serum free beta hCG and PAPP-A were measured in 490 singleton pregnancies. Pregnancies were followed by the fetal-maternal unit, and predictive efficacy of these markers for small for gestational age (SGA) babies, gestational diabetes mellitus and hypertensive disorders were analyzed by cut-off values determined by using a ROC analysis, and also, by using the fifth percentile as the cut-off value. RESULTS: The sensitivities for PAPP-A in predicting pregnancies with a SGA baby and those complicated by a hypertensive disorder were 49% and 73%, respectively, when optimal cut-off values were used. Specificities were 76% and 65%, respectively. Serum free beta hCG had no predictive value for individual pregnancy outcomes. CONCLUSION: Efficacy of first trimester maternal serum markers in predicting adverse pregnancy outcome is low. Even after optimization of cut-off values, these markers do not appear to be clinically acceptable as an effective tool for screening for adverse pregnancy outcomes.

Intra- and interobserver agreement on cervical volume and flow indices during pregnancy using transvaginal 3-dimensional ultrasonography and Doppler angiography.

OBJECTIVES: To assess intra- and interobserver agreement in cervical volume and flow indices measurements. METHOD: We prospectively examined 126 patients by two seperate observers using transvaginal 3D gray-scale and power Doppler ultrasound. The two acquired volume datasets were analyzed using the VOCAL imaging program for assessing cervical volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Reproducibility of volume and vascularity measurement was assessed by calculating intraclass (intra-CC) and interclass (inter-CC) correlation coefficients (ICCs). RESULTS: Both intraobserver and interobserver cervical volume measurements were in perfect agreement with intra-CC values of 0.95, 0.96 for both examiners and with an inter-CC value of 0.95. Intraobserver agreement for VI, FI and VFI measurements were as good as the interobserver agreement for VI, and VFI measurements were adequate but less for FI measurements (inter-CC 0.67). Overall, volumetric data were more reliably acquirable than power Doppler measurements. CONCLUSIONS: 3D ultrasound gray-scale and power Doppler measurement of cervical volume and vascularization have acceptable intra- and interobserver variations and thus may be used in clinical research of cervical physiology and pathophysiology during pregnancy.