Revisiting Atrioventricular Septal Defects: Exploring Chromosomal Abnormalities, Cardiac and Extracardiac Anomalies in a Contemporary Prenatal Cohort.

To estimate if there is an association between partial AVSD with chromosomal abnormalities, cardiac and extracardiac malformations, and to report the outcomes of prenatally diagnosed AVSD in a large, contemporary cohort. This is a retrospective cohort study of 190 prenatally diagnosed fetal AVSD between 2014 and 2023. Type of AVSD (complete vs partial), additional cardiac findings, extracardiac findings, presence of a heterotaxy, results of prenatal karyotype, and pregnancy outcomes were documented and analyzed. A total of 190 cases of fetal AVSD were analyzed. Complete AVSDs comprised 141 (74.2%) of the cohort, while partial AVSDs comprised 49 (25.7%). Karyotype was completed in 131 cases, and in 98 (74.8%) cases chromosomal abnormalities were identified, with trisomy 21 being the most common (53/131, 40.5%). Complete AVSDs were associated with trisomy 21 (45.5%, p = 0.04), Isolated cases of complete AVSDs (p = 0.03). Partial AVSDs were associated with trisomy 18 (53.1%, p < 0.001). In cases of partial AVSDs with aneuploidies, 7 (70%) had an ostium primum defect and 20 (90.9%) of AV canal type VSD. Isolated partial AVSD had no clear association with aneuploidies. There were additional cardiac anomalies in 96 (50.5%) and extracardiac anomalies in 134 (70.5%) of the cohort. There were no differences between partial and complete AVSD in rate of additional cardiac and extracardiac anomalies. AVSD was part of a heterotaxy in 47 (24.7%) of cases, and heterotaxy was associated with complete AVSD in the majority of cases (43/47, 91.4%, p = 0.003). Fetal partial AVSDs are associated with trisomy 18. Fetal complete AVSDs, even isolated, are associated with trisomy 21. There were no differences in association of other aneuploidies, additional cardiac findings, or extracardiac anomalies between prenatally diagnosed complete AVSDs and partial AVSDs.

Navigating the spectrum of double-outlet right ventricle presentations: Outcomes from a contemporary cohort based on subtypes.

PURPOSE: Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by analyzing the outcomes based on the subtype. METHODS: This study is a retrospective chart review. Cases diagnosed with fetal DORV by prenatal ultrasound in the maternal-fetal medicine department of our hospital between 2014 and 2022 were included. Data on maternal characteristics, fetal echocardiographic features (type of DORV), pregnancy and neonatal outcomes (termination of pregnancy [TOP], intrauterine fetal death [IUD], neonatal death [NND], death in infancy (IND), survival) were collected and analyzed. RESULTS: Ninety-nine cases of prenatally diagnosed cases of DORV were included. The prenatal diagnosis was right in 97% of the liveborn fetuses. The cases were classified into subtypes, including transposition of great arteries (TGA), Fallot, ventricular septal defect (VSD), remote, and heterotaxy types. The cohort consisted of 32.3% TGA type, 19.1% fallot type, 11.1% VSD type, 2% remote type, and 35.3% heterotaxy type of DORV. An additional cardiac anomaly was observed in 87% and an extra-cardiac anomaly was observed in 54% of the cases. When we excluded the cases with heterotaxy type but without any chromosomal abnormality, additional genetic abnormalities were detected in 42% of the remaining cases. Outcome of pregnancy was livebirth in 68/99 (68.7%), IUFD in 5/99 (5.1%), and TOP in 26/99 (26.3%). Postnatal cardiac surgical repair was performed in 48 cases. Survival among livebirths was 39/68 (57.3%). Twenty-nine neonates or infants who had additional cardiac anomalies and/or genetic abnormalities died before any surgical intervention. The postoperative survival rate was 39/48 (81.2%). CONCLUSION: The prognosis in DORV depends on the anatomical subtype, the presence, and severity of associated anomalies. Survival increases in isolated cases without any additional structural or genetic anomalies.

Investigating the blood rheology in the first trimester pregnancies with high risk for preeclampsia.

BACKGROUND: Pregnancy is a dynamic process associated with changes in vascular and rheological resistance. Maternal maladaptation to these changes is the leading cause of pregnancy complications such as preeclampsia. OBJECTIVE: This study aimed to assess the hemorheological alterations in pregnancies with a high risk for preeclampsia in the first trimester. METHODS: Ninety-two pregnant women were allocated into the high preeclampsia risk group (37 cases) and control groups (55 cases). Plasma and whole blood viscosity and red blood cell morphodynamic properties, including deformability and aggregation were assessed by Brookfield viscometer and laser-assisted optical rotational cell analyzer (LORRCA) at 11-14 gestational weeks. RESULTS: Whole blood viscosity was significantly higher in the high-risk group at all shear rates. Plasma viscosity and hematologic factors showed no differences between the groups. Hematocrit levels positively correlated with high blood viscosity only in the high-risk group. There were no significant changes in the other deformability and aggregation parameters. CONCLUSIONS: Changes in the whole blood viscosity of pregnant women with high preeclampsia risk refer to impaired microcirculation beginning from the early weeks of gestation. We suggest that the whole blood viscosity is consistent with the preeclampsia risk assessment in the first trimester, and its measurement might be promising for identifying high-preeclampsia-risk pregnancies.

What to expect after birth in idiopathic polyhydramnios? An analysis of postnatal diagnoses and their relationship to the polyhydramnios degree.

PURPOSE: To analyze postnatal abnormalities in idiopathic polyhydramnios and to estimate whether there was an association between the severity of polyhydramnios and postnatally diagnosed abnormalities. METHODS: This was a retrospective cohort study of all idiopathic polyhydramnios cases delivered at our center between 2017 and 2021. Cases were identified as idiopathic after excluding known fetal genetic or structural abnormalities (including soft markers for aneuploidies), Rh isoimmunization, fetal anemia, multifetal pregnancies, pregestational or gestational diabetes, and known infection with TORCH group agents. The primary outcome was the association between polyhydramnios degree and any abnormalities detected after birth. Additional outcomes were the odds of specific groups of abnormalities based on polyhydramnios degree. RESULTS: The prevalence of idiopathic polyhydramnios was 14.7%. Outcomes of 242 pregnancies with idiopathic polyhydramnios were analyzed. At least one neurodevelopmental, structural, or genetic abnormality was diagnosed in 16.1% of children born to women with idiopathic polyhydramnios. Moderate and severe polyhydramnios are significantly associated with at least one abnormality diagnosed after birth (45.9%, and 41.6%, respectively, p < 0.05). Neurodevelopmental disorders were the most frequent abnormality (5.4%), followed by genetic abnormalities (4.1%) and gastrointestinal abnormalities (2%). Odds of genetic abnormalities and neurodevelopmental disorders in moderate polyhydramnios were significantly higher compared to mild [OR 2.6; 95% CI 1.1-4.3 and aOR 2.4 (95% CI 1.1-3.6) respectively]. As expected, gastrointestinal anomalies were significantly associated with severe polyhydramnios [OR 3.2 (95% CI 1.9-5.5)]. CONCLUSION: Moderate and severe idiopathic polyhydramnios are associated with anomalies diagnosed after birth. Particularly high risks include neurodevelopmental disorders, genetic abnormalities, and gastrointestinal atresias.

An analysis of factors affecting survival in prenatally diagnosed omphalocele.

OBJECTIVES: To estimate factors affecting survival in prenatally diagnosed omphalocele, factors predicting genetic abnormalities, and association of omphalocele and specific groups of anomalies. METHODS: A retrospective observational study was performed, analyzing data of all omphalocele cases diagnosed prenatally in the perinatology clinic of a referral center. Demographic data, characteristics of the omphalocele (size, content, associated anomalies), results of genetic testing, pregnancy outcomes and postnatal outcomes were analyzed. RESULTS: Sixty-nine fetuses with omphalocele were included. The prevalence of omphalocele in livebirth was 0.007 %. Overall survival during the study period was 73.9 %. Twenty-eight (71.7 %) out of 39 cases with associated anomalies who were born live, survived, whereas survival was 85.7 % in the isolated cases. The most common anomaly associated with omphalocele were cardiac defects with 42 %; followed by placental or umbilical cord anomalies (28.9 %), skeletal defects (27.5), genitourinary anomalies (20.2 %), central nervous system (18.8 %) and facial anomalies (7.2 %), respectively. Eighty-five percent of the fetuses had at least one additional anomaly or ultrasound finding. Skeletal abnormalities and staged surgical repair of omphalocele were associated with survival. Associated skeletal anomalies and staged repair significantly increase the risk of postnatal death (OR: 4.6 95 % CI (1.1-19.5) and (OR: 10.3 95 % CI (1.6-63.9), respectively). CONCLUSIONS: Associated skeletal abnormalities and staged surgical repair are negatively associated with postnatal survival.

Amnioinfusion vs. standard management for the second trimester PPROM: a systematic review and meta-analysis of observational studies and RCTs.

OBJECTIVE: This meta-analysis aims to review the effect of serial transabdominal amnioinfusion (TAI) on short-term and long-term perinatal outcomes in mid-trimester preterm premature rupture of membranes (PPROM). METHODS: Literature searches of PubMed, Web of Sciences, Scopus, and Cochrane Library were performed from their inception to April 2022. Studies comparing conventional treatment with serial TAI in women with proven PPROM at less than 26 + 0 weeks of gestation with oligohydramnios were included. Studies that included oligohydramnios due to other reasons such as fetal growth retardation or renal anomalies were excluded. Risk of bias in observational studies was assessed using the tool of the Cochrane Review group identified as risk of bias in non-randomized studies - of interventions. The risk of bias assessments for RCTs were performed according to the Cochrane risk-of-bias tool for randomized trials. An I2 score was used to assess the heterogeneity of included studies. The analyses were performed by using random-effect model, and the results were expressed as relative risk (RR) or mean difference with 95% confidence intervals (CIs). RESULTS: Overall, eight relevant studies including five observational studies (n = 252; 130 women allocated to the intervention) and three RCTs (n = 183; 93 women allocated to the intervention) were eligible. The pooled latency period was 21.9 days (95% CI, 13.1-30.8) and 5.8 days (95% CI, -11.6-23.2) longer in the TAI group in the observational studies and RCTs, respectively. The perinatal mortality rate reduced in the intervention group when tested in observational studies (RR 0.68; 95% CI, 0.51-0.92), but not in RCTs (RR 0.79; 95% CI, 0.56-1.13). The rate of long-term healthy survival was higher in the children whose mothers were treated with the TAI (35.7%) than those were treated with the standard management (28.6%) (RR 1.30, 95% CI 0.47-3.60, "best case scenario"). CONCLUSIONS: The efficacy of serial TA on early PPROM associated morbidity and mortality is not attested. Additional randomized control trials with adequate power are needed.

Can we predict the need for postnatal surgery in patients with prenatal fetal lung masses detected by CVR value?

AIM: The purpose of this study is to evaluate whether CPAM-volume ratio (CVR) can predict postnatal management (follow up for resolution and surgical treatment) in fetuses with fetal lung masses in the prenatal period. MATERIALS AND METHODS: 44 patients who presented at our center with prenatally diagnosed CPAM (Congenital Pulmonary Airway Malformation) and BPS (Bronchopulmonary Sequestration) were analyzed. Obstetric history and outcomes, karyotype results, CVR, additional sonographic findings, characteristics of masses were recorded. CVR was calculated for all cases. In the study we sought to identify a CVR threshold and did not use the thresholds classically used in the literature. RESULTS: 20 fetal BPS and 24 CPAM cases were analyzed. After excluding 5 patients, 46% of the patients were diagnosed with BPS and 54% with CPAM. In this study the cut off < 0,53 for CVR is taken, it predicts the no need for postnatal surgery with a sensitivity of 85% and a specificity of 88%. When we take the > 0,76 cut-off value for patients who will require emergency surgery within the first 10 days, it predicts the need for surgery with 90% sensitivity and 89% specificity. In addition, it was determined that all patients with mediastinal shift were operated. CONCLUSION: We believe that the CVR value and the presence of mediastinal shift should be evaluated in all cases of CPAM and BPS for prediction of the surgery. Proper counseling about the prognosis could be given to the family in cases with mediastinal shift and CVR value above 0,76.

Dietary supplements for treatment of endometriosis: A review.

As search for optimal therapy continues for endometriosis, aid of dietary supplements is gaining attention. Supplements can be used for their anti-inflammatory, anti-oxidant, anti-proliferative and immune modulatory charactheristics. We reviewed the literature, evaluated and synthesized effects of vitamin D, zinc, magnesium, omega 3, propolis, quercetin, curcumin, N-acetylcysteine, probiotics, resveratrol, alpha lipoic acid, vitamin C, vitamin E, selenium and epigallocatechin-3-gallate. Based on results of in vitro, animal and human studies, it might be safe to say that dietary supplements can be used as a complementary treatment for endometriosis.

Can Serum Vitamin B12 and Folate Levels Predict HPV Penetration in Patients with ASCUS?

In the process of progression to cancer from atypical squamous cells of undetermined significance (ASCUS), mostly Human Papilloma Virus (HPV) is responsible. Additionally, patients with cell cycle disorders are thought to be at risk. The aim of this prospective cohort trial was to analyze the association between presence of ASCUS and HPV persistence with folate and vitamin B12 levels. 200 patients who had Papanicolaou (PAP) smear test were divided into a ASCUS group (n:100) and control group (n:100). Control group consisted of women who did not have intraepithelial neoplasia, based on PAP smear results. HPV testing was also done in study group. Serum vitamin B12 and folate levels in ASCUS (+) HPV (+) patients were significantly lower than that of ASCUS (-) or ASCUS (+) HPV (-) patients (p < 0.01). In our study, there was no statistically significant difference between folate levels in patients with different types of HPV (p > 0.05), however vitamin B12 levels of patients with other high-risk HPV types were significantly lower than patients with positive HPV16-18 (p = 0.01). The positivity of HPV in women with ASCUS is associated with low serum vitamin B12 and folate levels.

Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial.

Objective: To investigate the effects of chewing xylitol-free gum at different intervals after cesarean sections.Study design: One hundred fifty patients undergoing cesarean sections were randomized into a gum chewing group (n = 75) and a control group (n = 75). Patients in the gum group chewed one sugarless gum for 30 min at 3, 5, and 7 h postoperatively. The two groups were compared in terms of time to first bowel movement, first feeling of hunger, first passage of flatus, and defecation time. Postoperative satisfaction with bowel movements was rated on a scale of 1-5.Results: First bowel movement time (4.93 ± 1.05 versus 7.97 ± 2.33 h postoperatively, p = .0001), first feeling of hunger (5.51 ± 1.68 versus 6.30 ± 1.58 h postoperatively, p = .004), first passage of flatus (11.73 ± 4.61 versus 14.10 ± 2.71 h postoperatively, p = .001), and mean length of hospital stay (2.30 ± 0.49 versus 2.50 ± 0.50 d, p = .015) were significantly reduced in the gum group compared with the control group. Postoperative satisfaction scores for overall bowel function were better in the patients who chewed gum.Conclusion: Gum chewing at frequent intervals in the early postoperative period promotes the early return of bowel movements, shortens hospitalization, and increases patient satisfaction regarding bowel function.

Primary Pure Uterine Lipoma: A Report of two Cases and Review of the Literature.

Pure uterine lipomas are rare diagnoses despite lipoma being a common entity. The histogenesis of these lesions remains unknown, and its clinical symptoms are similar to those of uterine leiomyomas. In this report, two cases of uterine lipomas were presented with their histopathological and clinical aspects.

Clinical characteristics and pregnancy outcomes of Syrian refugees: a case-control study in a tertiary care hospital in Istanbul, Turkey.

PURPOSE: We aimed to compare the clinical characteristics and pregnancy outcomes in women who are Syrian refugees and Turkish women who are non-refugees at a maternity center in Istanbul, Turkey. METHODS: A total of 600 singleton pregnancies who delivered at Sisli Hamidiye Etfal Training and Research Hospital were included in the study. Demographic data, obstetrical history, clinical findings, obstetrical and neonatal outcomes were compared between 300 Syrian refugees and 300 control patients. RESULTS: The Syrian refugee patients were significantly younger than Turkish patients. The percentage of adolescents aged 12-19 years were significantly higher in the Syrian patients (14.3 vs. 5.3 %, p < 0,001). 41.3 % of the refugee patients had no antenatal care. However, this ratio was only 7.7 % for the control group (p < 0.001). Preterm birth rates showed no difference between the groups, however, postterm birth rates were significantly higher in the control group. Low Birthweight (<2500 gr), oligohydramnios, stillbirth and fetal anomaly rates were not different between the two groups. CONCLUSIONS: In comparison to non-refugee control patients, refugee women in our study had poor antenatal care but no adverse perinatal outcomes were observed. Further larger multicenter studies may provide more convincing data about obstetric outcomes in the Syrian refugee population as well as adolescent pregnancies in this population.

Usefulness of Serum Procalcitonin Levels in Predicting Tubo-Ovarian Abscess in Patients with Acute Pelvic Inflammatory Disease.

We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.

The effect of peritoneal cavity saline irrigation at cesarean delivery on maternal morbidity and gastrointestinal system outcomes.

OBJECTIVE: The objective of this study is to investigate the effect of peritoneal cavity saline irrigation during cesarean section (CS) on gastrointestinal disturbance and postoperative infectious morbidity (PIM). METHODS: This prospective randomized clinic trial included 430 women who underwent elective or primary CS. The participants were randomized to either an irrigation of the abdominal cavity or the control group. The primary outcome measured was the rate of antiemetic drugs required in the postoperative period following CS. Secondary outcome measures included the rate of PIM. RESULTS: Participants in both groups had similar demographic and clinical characteristics. The rate of antiemetic drugs required by patients was significantly higher in the irrigation group when compared with the control group (15.8% versus 8.4%, p = 0.018). The rate of intraoperative nausea and emesis (p ≤ 0.001) and the rate of postoperative nausea and emesis (p ≤ 0.001 and p = 0.018, respectively) were significantly higher in the irrigation group compared with the control group. CONCLUSIONS: Irrigation with saline at the time of CS increases both intraoperative and postoperative nausea and emesis without any beneficial effects on PIM. Routine use of saline irrigation in the abdominal cavity does not seem to be reasonable.