Obstetric outcomes of intramural leiomyomas in pregnancy.

AIM: The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group. MATERIALS AND METHODS: The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group. RESULTS: The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5-63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8-66.5), premature rupture of mem- branes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4-20.0), preterm birth (OR: 4.7, 95% CI 1.9-11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8-34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found. CONCLUSIONS: Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

Fetal nasal bone length during the second trimester of pregnancy in a Turkish population.

OBJECTIVE: To determine the distribution of fetal nasal bone length (NBL) according to gestational age during the second trimester of pregnancy in a Turkish population. STUDY DESIGN: Fetal NBL and other routine biometric measurements were evaluated retrospectively in 2327 fetuses between 15 and 24 weeks of gestation. The measurements were obtained via transabdominal ultrasound. The distribution of fetal NBL between 15 and 24 weeks of gestation was established, and percentiles were calculated. Relationships between fetal NBL and other parameters were assessed using regression analysis. RESULTS: Mean (±standard deviation) fetal NBL ranged from 2.95±0.52 at 15 weeks of gestation to 6.26±0.77mm at 24 weeks of gestation. The fifth percentile for fetal NBL was 2.1mm at 15 weeks of gestation and 5.0mm at 24 weeks of gestation. A significant positive correlation was noted between fetal NBL and gestational age (NBL=gestational age×0.37-2.55; R(2)=0.59; p<0.01) and between fetal NBL and biparietal diameter (BPD) (NBL=BPD×0.11-0.33; R(2)=0.61; p<0.01). CONCLUSION: Fetal NBL is less in Turkish subjects compared with non-Turkish subjects.

Avoiding abdominal flank bulge after lumbotomy incision: cadaveric study and ultrasonographic investigation.

OBJECTIVE: The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature seeking to avoid abdominal wall complication after open donor nephrectomy. We dissected four cadavers and retrospectively assessed donor ultrasonographic imaging of anterolateral abdominal muscle atrophy after donor nephrectomy with a lumbotomy incision. METHODS: Anatomic study was performed on four cadavers using bilateral dissections. The 8th, 9th, 10th, 11th, and 12th (subcostal) intercostal nerves were dissected from the intercostal space to the rectus sheath. With the experience gained from anatomic study, we performed 40 living donor incisions 1.5 to 2 cm medial to the tip of 12th rib, toward the lateral border of the rectus muscle and the umbilicus. Donors were invited to the hospital at 1 year postoperative to examine abdominal wall complications. Ultrasonography (USG) was performed to assess the thickness of the abdominal wall muscles bilaterally to ascertain whether there was atrophy. RESULTS: All distal intercostal nerves ran as multiple mixed segmental nerves, communicating with each other widely within the neurovascular plane. The thick 12th nerve was located at 1.5 to 2 cm medial and under the tip of the 12th rib, running to the suprapubic area. Postoperative USG confirmed that the mean percent thickness of the abdominal muscles of the operative side was not significantly different from the other side (P < .05). CONCLUSION: Most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T12. Damage to the intercostal nerves will be minimal if the lombotomy incision is performed above the safe line between the tip of the 12th rib and the umbilicus.