Light and electron microscopic evaluation of cardinal ligaments in women with or without uterine prolapse.

INTRODUCTION AND HYPOTHESIS: This study investigated light and electron microscopic findings in cardinal ligaments of women with or without uterine prolapse. METHODS: Cardinal ligament samples were obtained from hysterectomy specimens of ten women with and ten women without uterine prolapse. RESULTS: Light microscopy showed altered connective tissue properties in eight of ten women with prolapse and in only three of ten women without prolapse (p = 0.025). The alterations included loosely arranged connective tissue fibers and less dense extracellular matrix with sparsely distributed fibroblasts. Under electron microscopy, collagen fibers were more sparsely distributed and thicker in women with prolapse. Mean diameter of collagen fibers was 61.2 +/- 11.4 nm in women with prolapse while it was 52.5 +/- 6.1 nm in women without prolapse (p < 0.001). CONCLUSIONS: Uterine prolapse is associated with connective tissue alterations including total amount of connective tissue components and diameter and distribution of collagen fibers.

Perinatal features and umbilical cord blood gases in newborns complicated with nuchal cord.

Presence of nuchal cord (NC) is associated with transient decrease of umbilical cord blood flow. However, the exact perinatal effect of presence of NC in a newborn is still under debate. The aim of this study was to evaluate the perinatal complications and umbilical cord blood gases of deliveries complicated with NC and summarize the associated literature. Gestational age-matched term singleton pregnancies complicated with NC (n=160) were compared with neonates without NC (n=160). Patients' files and Labor and Delivery Unit database were used to extract maternal age, gestational age, presence of NC, number of nuchal loops around fetal neck, intrapartum complications and umbilical cord blood gases. pH, pO2, pCO2, HCO3-, O2 saturation, and base excess were determined in all patients. Mean maternal age, mean gestational age, and birth weight were not significantly different between the two groups (p > 0.05). Occurrence of oligohydramnios, intrauterine growth retardation (IUGR), intrapartum abnormalities and Apgar scores < 7 at 1 minute were not significantly different between the groups (p>0.05). However, umbilical cord blood pH (7.32 vs. 7.30, p = 0.048), pO2 (37.4 +/- 18.1 vs. 31.7 +/- 14.4, p = 0.01) and O2 saturation (57.4 +/- 21.8 vs. 48.3 +/- 20.4, p = 0.005) were significantly lower in the NC group compared with the controls. Furthermore, the number of Apgar scores < 7 at 1 minute was significantly higher in neonates with multiple NC (28.1% vs. 9.2%, p = 0.007), and intrapartum abnormalities were more frequently seen in newborns with multiple NC (31.3% vs.15.6%, p = 0.04). The results of this study suggest that presence of single NC may negatively affect the umbilical cord blood gases without significant perinatal complications. However, multiple NC may also increase the development of intrapartum complications and lower Apgar scores. Perinatal effects of NC should be investigated with a large prospective study.

An unusual complication of uterine prolapse. Bilateral severe hydronephrosis.

Obstructive uropathy with bilateral hydronephrosis may be seen in uterine procidentia cases. Early recognition and treatment can prevent irreversible renal damage. Although this association has been known for a long time, it is clinically under evaluated most of the time. Here, we present a neglected case of total uterine procidentia in a 64-year-old woman who was detected also to have renal dysfunction. After surgical correction of procidentia, renal function tests returned to normal.

A case of acromegaly in pregnancy: concomitant transsphenoidal adenomectomy and cesarean section.

The case of a 32-year-old woman at 29 weeks gestational age with acromegaly initially diagnosed in pregnancy is presented. During follow-up at 34 weeks of gestation, concomitant emergency cesarean section and transsphenoidal surgery were performed because of advancing vision loss. In tertiary centers, success in pregnancy can be made possible for a patient with acromegaly under the constant supervision of an obstetrician and neurosurgeon.

Placental findings of IUGR and non-IUGR.

This study aims to define the placental findings in intrauterine growth restriction (IUGR). The study group consisted of 40 neonates without IUGR and 24 neonates with IUGR, including their placentas. The cases were separated into three groups according to gestational age. Group A (n=21): 37 ≤ weeks, Group B (n=27): 32≤ - <37 weeks, Group C (n=16): < 32 weeks. Each group had two subgroups, IUGR and non-IUGR. The placentas from the non-IUGR subgroup were heavier than the IUGR subgroup placentas in the term group (p<0.05). Infarct (over 5%), increased syncytial knots and histiocytic intervillositis were more common in the IUGR cases (p<0.05). This study shows that chronic patterns of injury are significantly increased in placentas from pregnancies complicated by IUGR. If the injury in the placenta is acute or mild, fetal adaptation can compensate and prevent fetal growth restriction.

Alcohol injection for the intrauterine treatment of chorioangioma in a pregnancy with transfusion resistant fetal anemia: a case report.

Chorioangiomas are usually small, clinically inevident, benign vascular lesions of the placenta, but larger ones may cause serious perinatal and neonatal complications. There is need for in utero intervention in these fetuses. Several interventions are described to relieve pathophysiologic insult on fetus. Alcohol injection is one of the therapeutic interventions. In this case, we present a patient with chorioangioma and early onset of hydrops fetalis and polyhydramnios at 24th week of gestation. Successful intratumoral injection of absolute ethyl alcohol relieved hydrops fetalis and polyhydramnios. Unfortunately, pregnancy ended at 28th week and a 1,330 g fetus was delivered.

Mega-dose carbamazepine complicating third trimester of pregnancy.

A case of coma due to carbamazepine ingestion with the intention of committing suicide at 33 weeks' gestation is presented. Management included activated charcoal administration and exchange plasmapheresis. A fetal non-stress test was non-reassuring but the Apgar score, cord blood gases and early neonatal outcome were normal. Differential diagnosis of coma in pregnancy should include investigation for drug intoxication.