Evaluation of placenta and fetal lung using shear wave elastography in gestational diabetes mellitus: An innovative approach.

PURPOSE: This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes. MATERIALS AND METHODS: This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE). RESULTS: The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. SWE velocity of peripheral placenta, central placenta, and lung were higher in the gestational diabetes group compared to the control group. Furthermore, SWE velocity of peripheral placenta, central placenta, and lung were higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of gestational diabetes patients the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% in predicting neonatal respiratory morbidity. CONCLUSION: Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity. Zweck: Diese Studie zielt darauf ab, die Lungensteifheit der Plazenta und des Fötus bei schwangeren Frauen mit und ohne Schwangerschaftsdiabetes zu untersuchen, wobei die bekannte Verzögerung der fetalen Lungenreifung im Zusammenhang mit Schwangerschaftsdiabetes berücksichtigt wird. Materialien und Methoden: Diese prospektive Kohortenstudie wurde an einem tertiären Zentrum durchgeführt und umfasste schwangere Frauen, die sich zwischen der 24. und 28. Schwangerschaftswoche einem oralen 75-Gramm-Glukosetoleranztest unterzogen. Elastographiemessungen wurden mittels Punktscherwellenelastographie (pSWE) durchgeführt. Ergebnisse: Die Studie umfasste 60 schwangere Frauen mit diagnostiziertem Schwangerschaftsdiabetes und 60 schwangere Frauen in der Kontrollgruppe. Die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge war in der Gruppe mit Schwangerschaftsdiabetes höher als in der Kontrollgruppe. Darüber hinaus war die SWE-Geschwindigkeit der peripheren Plazenta, der zentralen Plazenta und der Lunge bei Neugeborenen mit neonataler respiratorischer Morbidität höher. Basierend auf der ROC-Analyse von Patienten mit Schwangerschaftsdiabetes betrug die AUC für die Lungen-SWE-Geschwindigkeit 0,88 (Grenzwert 12,4 kPa, 95 %-KI: 0,77-0,99, p < 0,001) mit einer Sensitivität von 71,4 % und einer Spezifität von 95,6 % bei der Vorhersage neonataler Erkrankungen Atemwegsmorbidität. Schlussfolgerung: Die Steifheit der fetalen Plazenta und der Lunge nimmt bei Feten schwangerer Frauen mit Diabetes zu. Darüber hinaus ist eine höhere fetale Lungensteifheit während der Fetalperiode mit einer erhöhten Atemwegsmorbidität bei Neugeborenen verbunden.

Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes.

PURPOSE: To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. METHODS: This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). RESULTS: PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. CONCLUSION: Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.

Third-trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes.

OBJECTIVE: To examine third-trimester sonographic imaging of the fetal pancreas in uncomplicated pregnancies and its association with pregnancy outcomes. METHODS: This was a prospective cohort study including 274 pregnant women. Uncomplicated pregnancies in the third trimester (28-40 weeks) were included in the study. Maternal chronic disease, pregnancy-related disorders such as hypertension, diabetes, cholestasis, smoking, and fetal abnormalities were determined as exclusion criteria. Sonographic fetal pancreatic measurement and echogenicity were evaluated in all participants. For intra-observer reliability, each participant's fetal pancreatic circumference was measured two times. The echogenicity of the pancreas was compared with the liver and ribs and classified as grade 1, 2, and 3. The pregnancy outcomes of all participants were obtained from the hospital digital registration system. RESULTS: The average fetal pancreatic circumference in the third trimester was 70.7 ± 0.6 mm (median, 70 [44-100.7]), with high intra-observer agreement (ICC 0.996 [0.995; 0.997]). A significant positive correlation was found between pancreatic circumference, body mass index (BMI), gestational age, and birth weight. Pancreatic measurements were significantly higher in composite adverse outcomes cases that included at least one of respiratory distress syndrome, hyperbilirubinemia, neonatal pneumonia, infection, and sepsis (p < 0.001). No relationship was found between pancreatic echogenicity and perinatal outcomes. CONCLUSION: Fetal pancreas size was positively correlated with gestational age, BMI, and birth weight, and increased fetal pancreas size was associated with composite adverse neonatal outcomes.

The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone.

PURPOSE: The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

¿Afecta la infección asintomática, leve y moderada por Covid-19 en el primer y segundo trimestre los resultados del embarazo?

Objetivo : Determinar los efectos de la infección Covid-19 asintomática, leve y moderada en el primer y segundo trimestres en los resultados del embarazo. Métodos : El estudio se realizó en las gestantes que acudieron al Departamento de Perinatología de la Universidad de Ciencias de la Salud de Izmir entre octubre de 2021 y julio de 2022. Se registraron las mujeres embarazadas que presentaban infección asintomática, leve y moderada por Covid-19 en el 1º y 2º trimestre y se siguió el desarrollo de la gestación. Resultados : Un total de 437 pacientes participaron en el estudio. El número de pacientes asintomáticos, leves y moderados de Covid-19 fue de 142, 157 y 138, respectivamente. Cada grupo se analizó como subgrupo del 1º y 2º trimestre según el momento de la infección por Covid-19. La edad media de las pacientes con Covid-19 moderado era superior a la de las pacientes con Covid-19 leve/asintomático (p=0,021). Se observó que el índice de masa corporal era mayor en las pacientes con Covid-19 moderado que en las pacientes con infección leve/asintomática (p=0,048). El parto pretérmino (entre las semanas 34 y 37) fue significativamente mayor en los casos con infección moderada por Covid-19 (p=0,041). Este aumento ocurrió principalmente en pacientes con infección por Covid-19 en el 2º trimestre. No hubo modificaciones significativas en las tasas de cesárea, trastornos hipertensivos del embarazo, pérdida fetal, retraso del crecimiento intrauterino, colestasis del embarazo y diabetes gestacional. Conclusiones : Los efectos de la infección por Covid-19 al inicio del embarazo (1º y 2º trimestres) siguen siendo objeto de investigación. La infección moderada por Covid-19, especialmente en el 2º trimestre, puede provocar un aumento de la tasa de partos prematuros.

Objectives: To evaluate the effects of asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters on pregnancy outcomes. Material and methods: The study was performed among patients who applied to the Perinatology Department of Izmir University of Health Sciences, between October 2021 and July 2022. Pregnant women who had asymptomatic, mild and moderate Covid-19 infection in the 1st and 2nd trimesters were registered and their pregnancy processes were followed. Results: A total of 437 patients participated in the study. The numbers of asymptomatic, mild and moderate Covid-19 patients were 142, 157 and 138, respectively. Each group was analyzed as 1st and 2nd trimester subgroups according to the time of Covid-19 infection. The mean age of patients with moderate Covid-19 was higher than with mild/asymptomatic Covid-19 (p=0.021). Body mass index was found to be higher in patients with moderate Covid-19 compared to patients with mild/asymptomatic infection (p=0.048). Preterm labor (between 34th and 37th weeks) was significantly higher with moderate Covid-19 infection (p=0.041). This significant increase was mainly due to the preterm birth rate in patients with previous Covid-19 infection in the 2nd trimester. There was no significant change in the rates of cesarean section, hypertensive disorders of pregnancy, fetal loss, intrauterine growth restriction, cholestasis of pregnancy and gestational diabetes. Conclusions: The effects of Covid-19 infection in early pregnancy (1st and 2nd trimester) are still the subject of research. Moderate Covid-19 infection, especially in the 2nd trimester, may lead to an increase in the rate of preterm birth.

Association of increased fetal epicardial fat thickness with maternal pregestational and gestational diabetes.

OBJECTIVE: To evaluate the changes of fetal epicardial fat thickness (EFT) in pregnancies with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) and to identify the diagnostic effectiveness of fetal EFT in differentiating PGDM and GDM from normal pregnancies. METHODS: The study was conducted with pregnant women who admitted to perinatology department between October 2020 and August 2021. Patients were grouped as PGDM (n = 110), GDM (n = 110), and control (n = 110) for comparison of fetal EFT. EFT was measured in all three groups at 29 weeks of gestation. Demographic characteristics and ultrasonographic findings were recorded and compared. RESULTS: The mean fetal EFT was significantly higher in PGDM (1.47 ± 0.083 mm, p < .001) and GDM (1.40 ± 0.082 mm, p < .001) groups compared to control group (1.19 ± 0.049 mm) and was also significantly higher in PGDM group than GDM group (p < .001). Fetal EFT was significantly positively correlated with maternal age, fasting, 1st hour, 2nd hour glucose values, HbA1c, fetal abdominal circumference, and deepest vertical pocket of amniotic fluid (p < .001). Fetal EFT value of 1.3 mm diagnosed PGDM patients with a sensitivity of 97.3% and a specificity of 98.2%. Fetal EFT value of 1.27 mm diagnosed GDM patients with a sensitivity of 94% and a specificity of 95%. CONCLUSIONS: Fetal EFT is greater in pregnancies with diabetes than in normal pregnancies, and also greater in PGDM than in GDM. In addition, fetal EFT is strongly correlated with maternal blood glucose levels in diabetic pregnancies.

Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis.

This study aims to evaluate cardiac function in cases of intrahepatic cholestasis of pregnancy (ICP) and compare results with those from healthy controls using the fetal left ventricular modified myocardial performance index (LMPI) and E-wave/A-wave peak velocities (E/A ratio). Moreover, the association between LMPI values, total bile acid (TBA) levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. A prospective cross-sectional study of 120 pregnant women was conducted, with 60 having ICP and the other 60 serving as controls. Doppler ultrasound and two-dimensional gray-scale fetal echocardiography were used to calculate the LMPI values and E/A ratios, respectively. The association between LMPI values and TBA levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. Fetal LMPI values were significantly higher in the ICP group than in the control group (0.54 ± 0.54 vs. 0.44 ± 0.03; p < 0.001), but the E/A ratio was similar in both groups (0.69 ± 0.10 vs. 0.66 ± 0.14; p = 0.203). TBA levels were positively and significantly correlated with LMPI values (r = 0.546, p < 0.01); however, no significant correlation was found between umbilical arterial pulsatility index values and LMPI values (r = 0.071, p > 0.01). LMPI values were not associated with adverse neonatal outcomes in ICP cases. Fetal cardiac function (LMPI) is associated with increased bile acid levels in ICP. However, because it was not associated with adverse neonatal outcomes in ICP cases, the clinical significance of this finding is unclear. Further studies are required to evaluate the implications of increased LMPI.

¿Podría contribuir la resonancia magnética a detectar la ventriculomegalia fetal aislada aparte de otras anormalidades?

Objetivo. Determinar el papel de la resonancia magnética (RM) cerebral en fetos que presentan ventriculomegalia aislada (VMA) en la evaluación ecográfica del cerebro fetal. Métodos. Se evaluaron retrospectivamente los hallazgos por ecografía y RM de 197 fetos diagnosticados con VMA entre noviembre de 2018 y noviembre de 2020. Se excluyeron los fetos con cariotipos anormales, anomalías adicionales o etiologías relacionadas a ventriculomegalia. Se comparó los resultados de ecografía y RM tanto en términos de medidas ventriculares medias como de grado de VMA. Resultados. Las mediciones de la RM fueron significativamente mayores en la VMA leve (10,33±0,38 mm frente a 11,11±0,51 mm, p<0,001) en comparación con la ecografía. En la VMA leve, la RM midió los ventrículos más anchos que la ecografía, con una diferencia media de 0,78 mm. No hubo diferencias significativas en las mediciones por ecografía y RM en cuanto a los valores medios de la VMA moderada y grave. Hubo buena concordancia entre la ecografía y la RM en la detección de la gravedad de la VMA derecha, izquierda y la media (Κ=0,265, Κ=0,324 y Κ=0,261, respectivamente). Los análisis de regresión lineal revelaron una relación estadísticamente significativa entre las mediciones de ecografía y RM de la VMA derecha, izquierda y la media (p<0,001, p<0,001 y p<0,001, respectivamente). La RM mostró una concordancia perfecta con la ecografía en detectar la lateralidad de la VMA (Κ=1,0, p<0,001). Conclusiones. En fetos con VMA leve detectada por ecografía se debe considerar la evaluación por RM del cerebro fetal para un diagnóstico preciso. Este enfoque puede proporcionar una estrategia eficaz en el manejo prenatal y el asesoramiento de estos embarazos.

Objective: To assess the role of brain magnetic resonance imaging (MRI) in fetuses presenting with isolated ventriculomegaly (IVM) in the ultrasound (US) evaluation of the fetal brain. Methods: US and MRI findings of 197 fetuses diagnosed with IVM between November 2018 and November 2020 were retrospectively evaluated. Fetuses with abnormal karyotypes, additional anomalies, or known etiologies for ventriculomegaly were excluded. US and MRI findings were compared both in terms of mean ventricular measurements and IVM grade. Results: MRI measurements were significantly higher in mild IMV (10.33 ± 0.38 mm vs. 11.11 ± 0.51 mm, p< 0.001) compared to US. In mild IVM, MRI measured ventricles larger than US with a mean difference of 0.78 mm. There was no significant difference in US and MRI measurements in terms of mean values in moderate and severe IVM. There was good agreement between US and MRI in detecting right, left and mean IVM severity (Κ=0.265, Κ=0.324, and Κ=0.261, respectively). Linear regression analyses revealed a statistically significant relationship between US and MRI measurements of the right, left, and mean IVM (p<0.001, p<0.001, and p<0.001, respectively). MRI showed perfect agreement with US in detecting IVM laterality (Κ=1.0, p<0.001). Conclusions: In fetuses with mild IVM detected by US, fetal brain MRI evaluation should be considered for accurate diagnosis. This approach may provide effective strategies in the antenatal management and counseling of these pregnancies.

Cesarean delivery rates based on time and indication using the Robson Ten-Group Classification System: Assessment at a Turkish tertiary center.

OBJECTIVE: This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten-Group Classification System (RTGCS). METHODS: Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS. RESULTS: The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre-labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%). CONCLUSION: Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established.

Expected Versus Unexpected Delivery for Placenta Accreta Spectrum (PAS) Disorders with Same Team in Single Tertiary Center.

OBJECTIVES: To evaluate the maternal and neonatal outcomes of expected and unexpected pathologically proven placenta accreta spectrum (PAS) cases in a single multidisciplinary center. MATERIAL AND METHODS: This was a retrospective cohort study of 92 PAS cases from January 2011 until September 2021. Only cases with histopathologically invasive placentation were included in the study. The cases diagnosed at the time of delivery were defined as unexpected PAS (uPAS) and those diagnosed antenatally as expected PAS (ePAS). Maternal and neonatal outcomes of both groups were compared. RESULTS: Thirty-five (38%) of 92 cases were in the uPAS group. Placenta previa and high-grade PAS (percreata) were significantly higher in the ePAS group (p=0.028, p<0.001; respectively). The mean packed red blood cell transfusion was significantly higher in the uPAS group (p=0.030) but transfusions of other blood products were similar in the two groups. There was no significant difference in intraoperative complication rates between the two groups. Preterm delivery (<37 weeks) was significantly higher in the ePAS group (p<0.001), but there was no significant difference between the two groups in terms of adverse neonatal outcomes. CONCLUSIONS: Our single center data show that although ePAS cases include more highly invasive PAS cases, maternal hemorrhagic morbidity is lower than uPAS cases. Reducing maternal morbidity in PAS cases can be achieved by increasing antenatal diagnosis.

Prediction of gestational diabetes mellitus and perinatal outcomes by plasma zonulin levels.

PURPOSE: Zonulin has been shown to be associated with many metabolic disorders, including type 2 diabetes mellitus, metabolic syndrome, and obesity. In this study, we aimed to evaluate the association between maternal plasma zonulin levels and gestational diabetes mellitus (GDM) and its perinatal outcomes. MATERIALS: A total of 100 pregnant women, 56 with GDM and 44 controls, were included in this prospective case-control study. Maternal plasma zonulin levels were evaluated in each trimester. The association between zonulin levels and GDM, body mass index (BMI) and adverse perinatal outcomes was evaluated. The GDM predictability of zonulin levels for each trimester was analyzed with the receiver operator curve (ROC). RESULTS: Plasma zonulin levels were significantly higher in pregnant with GDM in all trimesters (p < 0.001; for all). Optimum cut-off values of plasma zonulin levels in predicting GDM: first trimester: 6.27 ng/mL, second trimester: 12.71 ng/mL, and third trimester: 18.38 ng/mL. BMI was significantly higher in pregnant women with GDM (30.5 vs 26.1; p < 0.001). Zonulin levels were significantly higher in pregnant women with GDM with overweight BMI [≥ 25-30 (kg/m2)] in all trimesters (p < 0.05; for all). Zonulin levels were significantly higher in pregnant women with composite adverse outcomes that included at least one of neonatal intensive care unit (NICU) admission, meconium-stained amniotic fluid, and 1st minute APGAR score < 7. CONCLUSION: Increased maternal plasma zonulin levels were associated with increased risk of GDM and adverse perinatal outcomes. Zonulin may be a potential marker to predict GDM risk and perinatal outcomes.

Asociación entre el hipotiroidismo subclínico de anticuerpos antiperoxidasa tiroidea negativos y los resultados perinatales adversos diagnosticados con diferentes criterios en el tercer trimestre del embarazo

Antecedentes. El efecto del hipotiroidismo subclínico (HSC) en los resultados perinatales adversos no está claro, y los valores de referencia de la hormona tiroestimulante (TSH) en el embarazo son controvertidos. Objetivo. Evaluar los efectos del HSC negativo para los anticuerpos de la peroxidasa tiroidea (TPOAbs) sobre los resultados perinatales según los diferentes valores de referencia de la TSH. Métodos. Un total de 554 mujeres embarazadas, incluyendo 509 eutiroideas y 45 gestantes hipotiroideas subclínicas (TSH > 3 mIU/L), fueron incluidas en este estudio prospectivo de casos y controles. Todas las gestantes estaban en el tercer trimestre y eran negativas a los TPOAbs. Las funciones tiroideas fueron evaluadas utilizando los valores de referencia específicos para el trimestre recomendados por el Colegio Americano de Obstetricia y Ginecología (ACOG) (TSH > 3 mIU/L) y la Asociación Americana de Tiroides (ATA) (TSH > 4 mIU/L). Resultados. La mortalidad neonatal en el hipotiroidismo subclínico con un límite superior de TSH de 4 mIU/L fue significativamente menor que en el grupo eutiroideo (2 (0,4%) frente a 1 (4,5%); p=0,009). No hubo diferencias significativas en resultados maternos y perinatales adversos en las gestantes con HSC y eutiroideas en ambos valores de referencia de la TSH. No hubo correlación significativa entre los valores de TSH y las semanas de parto de las gestantes con parto prematuro (r=0,169, p=0,146). Conclusiones. En este estudio, utilizando los diferentes valores basales de TSH recomendados por las directrices del ACOG de 2020 y de la ATA de 2017 en el tercer trimestre del embarazo para el diagnóstico de hipotiroidismo subclínico, no hubo una relación significativa entre los casos de hipotiroidismo subclínico con TPOAbs negativos y los resultados perinatales adversos.

Background: The effect of subclinical hypothyroidism (SCH) on adverse perinatal outcomes is unclear, and thyroid-stimulating hormone (TSH) reference values in pregnancy are controversial. Objective: To evaluate the effects of thyroid peroxidase antibody (TPOAbs) negative SCH on perinatal outcomes according to the different TSH reference values. Methods: A total of 554 pregnant women, including 509 euthyroid and 45 subclinical hypothyroid (TSH > 3 mIU/L) pregnant women, were included in this prospective case-controlled study. All pregnant women were in the third trimester and were TPOAbs negative. Thyroid functions were evaluated using trimester-specific reference values recommended by the American College of Obstetrics and Gynecology (ACOG) (TSH > 3 mIU/L) and the American Thyroid Association (ATA) (TSH > 4 mIU/L) guidelines. Results: Neonatal mortality in subclinical hypothyroidism with a TSH upper limit of 4 mIU/L was significantly lower than in the euthyroid group (2 (0.4%) vs 1 (4.5%); p=0.009). There was no significant difference in terms of adverse maternal and perinatal outcomes in SCH and euthyroid pregnant women in both TSH reference values. There was no significant correlation between TSH values and delivery weeks of pregnant women with preterm delivery (r=0.169, p=0.146). Conclusions: In this study, using different baseline TSH values recommended by the 2020 ACOG and 2017 ATA guidelines in the third trimester of pregnancy for the diagnosis of subclinical hypothyroidism, it was shown that there was no significant relationship between cases of subclinical hypothyroidism with negative TPOAbs and adverse perinatal outcomes.

Asociación de los niveles de ácidos biliares y hormonas tiroideas en la colestasis intrahepática del embarazo

La colestasis intrahepática del embarazo (CIE) conduce a resultados perinatales adversos y estos resultados se ven afectados por los niveles elevados de ácido biliar total (ABT). Los estudios han demostrado que las hormonas tiroideas regulan el metabolismo de los ácidos biliares. Sin embargo, pocos estudios han evaluado el papel de las hormonas tiroideas en la CIE. Objetivo: Evaluar la función tiroidea junto con los niveles de ABT en la CIE. Métodos. En este estudio retrospectivo, se evaluaron 252 mujeres embarazadas, incluyendo 126 CIE y 126 controles. Se determinaron los niveles de ABT, hormona estimulante de la tiroides (TSH) y tiroxina libre (fT4) del tercer trimestre de todas las embarazadas. Se examinó la correlación entre los niveles de ABT, fT4 y TSH. Además, se estudiaron los resultados perinatales de ambos grupos. Resultados. Los niveles de fT4 fueron significativamente mayores en la CIE. También hubo una correlación positiva entre los niveles de fT4 y ABT. Los niveles de TSH fueron similares en ambos grupos y no hubo una correlación significativa con los niveles de ABT. No hubo diferencias significativas entre los dos grupos en cuanto a enfermedades tiroideas en el tercer trimestre. Conclusiones. Un mayor nivel de fT4 se asoció a un mayor nivel de ABT y el nivel de fT4 se asoció a un mayor riesgo de CIE y a la gravedad de la CIE, pero el nivel de TSH no se asoció a un mayor riesgo de ABT y de CIE.

Intrahepatic cholestasis of pregnancy (ICP) leads to adverse perinatal outcomes and these outcomes are affected by high total bile acid (TBA) levels. Studies have shown that thyroid hormones regulate bile acid metabolism. However, few studies have evaluated the role of thyroid hormones in ICP. Objective: To evaluate thyroid function along with TBA levels in ICP. Methods: In this retrospective study, 252 pregnant women, including 126 ICP and 126 controls, were evaluated. Third trimester TBA, thyroid-stimulating hormone (TSH), and free thyroxine (fT4) levels of all pregnant women were assessed. Correlation between TBA and fT4, TSH levels were examined. In addition, the perinatal outcomes of both groups were determined. Results: fT4 levels were significantly higher in ICP. There was also a positive correlation between fT4 and TBA levels. TSH levels were similar in both groups and there was no significant correlation with TBA levels. There was no significant difference between the two groups in thyroid diseases in the third trimester. Conclusions: Higher fT4 level was associated with higher TBA level and fT4 level was associated with higher ICP risk and ICP severity, but TSH level was not associated with higher TBA and higher ICP risk.

Can sonographic imaging of the fetal pancreas predict perinatal outcomes in gestational diabetes mellitus?

OBJECTIVES: To evaluate whether fetal pancreatic echogenicity and its measurements are associated with gestational diabetes mellitus (GDM) and perinatal outcomes. METHODS: A prospective cohort study was conducted with 150 pregnant women with a singleton pregnancy. The study included pregnant women between 30 and 41 weeks with or without GDM. Fetal pancreatic circumference was measured using the free-hand tracking function. The echogenicity of the fetal pancreas was compared with the echogenicity of the liver and bone (ribs, spine) and classified as Grades 1, 2 and 3. The relationship between maternal characteristics and perinatal outcomes with fetal pancreas measurements and echogenicity was evaluated. RESULTS: Pregnant women with 75 GDM and 75 without GDM were included in the study. Mean fetal pancreas circumference measurements were significantly higher in pregnant women with GDM than in those without GDM (p=0.001). Hyperechogenic (Grade 3) fetal pancreas was significantly higher in pregnant women with GDM than in pregnant women without GDM, and there was a positive correlation between pancreatic echogenicity and HbA1c levels in pregnant women with GDM (r=0.631, p<0.01). There was a significant relationship between pancreatic echogenicity, measurements and adverse neonatal outcomes in pregnant women with GDM, and pancreas measurements were significantly higher in pregnant women with cesarean delivery. CONCLUSIONS: Fetal pancreatic echogenicity and measurements in pregnant women with GDM can give an idea about glucose regulation and adverse perinatal outcomes.

Role of Vitamin B12 and Vitamin D levels in intrahepatic cholestasis of pregnancy and correlation with total bile acid.

This study aimed to evaluate the relationship between intrahepatic cholestasis of pregnancy (ICP) and Vitamin D and B12 levels. The study was a retrospective, cross-sectional, case-control study that evaluated 92 ICP cases and 102 pregnant women without any additional disease. ICP cases were grouped as mild and severe according to their total bile acid (TBA) levels, and their relationship with Vitamin D and B12 levels and perinatal outcomes was evaluated. Vitamin D and B12 levels of the ICP group were significantly lower than those of the control group. There was a moderate negative correlation between TBA and Vitamin D levels and a low negative correlation between TBA and Vitamin B12 levels. Adverse neonatal outcomes were significantly higher in the severe ICP group than in the mild ICP group. IMPACT STATEMENTWhat is already known on this subject? The pathophysiology of ICP, which can lead to adverse perinatal outcomes, is not yet fully understood, and there is no preventive treatment.What do the results of this study add? This study showed that Vitamins B12 and D levels were low in women with ICP and that TBA levels were negatively correlated with Vitamin D and B12 levels.What are the implications of these findings for clinical practice and/or further research? This study may guide future studies in terms of explaining the etiopathogenesis of ICP and developing treatment options.

Effectiveness and perinatal outcomes of history-indicated, ultrasound-indicated and physical examination-indicated cerclage: a retrospective study.

OBJECTIVE: To evaluate the effectiveness and perinatal outcomes of cerclage procedure according to indication. METHODS: The pregnancy and neonatal outcomes of the patients who underwent cerclage with the diagnosis of cervical insufficiency between January 2016 and December 2020 were retrospectively analyzed. Patients were categorized into three groups: a history-indicated group, an ultrasound-indicated group and a physical examination-indicated group. RESULTS: Seventy-three patients who underwent cerclage were included in the study. Of these, 41 (56.2%) had history-indicated, 17 (23.3%) had ultrasound-indicated and 15 (20.5%) had physical examination-indicated cerclages. Compared to history- and ultrasound-indicated cerclage group, duration from cerclage to delivery (18.6 ± 6.9 weeks vs 17.8±5.9 weeks vs 11 ± 5.3 weeks, p = 0.003) was significantly lower and delivery < 28 weeks (9.8% vs 5.9% vs 33.3%, p = 0.042) and delivery < 34 weeks of gestation (26.8% vs 11.8% vs 60%, p = 0.009) were significantly higher in physical examination-indicated cerclage group. In physical examination-indicated cerclage, compared with history- and ultrasound-indicated cerclage low birth weight, low APGAR score, neonatal intensive care unit admission and neonatal mortality were higher, although not statistically significant (p > 0.05). CONCLUSION: Pregnant women who underwent physical examination-indicated cerclage had higher risks for preterm delivery < 28 weeks and < 34 weeks than history- and ultrasound-indicated cerclage.

Ischemia modified albumin levels in intrauterine growth restriction: levels are increased in fetal cord blood but not in maternal blood.

OBJECTIVES: In this study, our aim was to determine the differences between intrauterine growth restriction (IUGR) and normal birth weight fetuses in terms of ischemia modified albumin (IMA) levels. For this purpose, we measured ischemia modified albumin levels in the cord blood of fetuses and venous blood of mothers. MATERIAL AND METHODS: This study is a prospective study conducted at University of Health Sciences Tepecik Training and Research Hospital between January 2018 and December 2019. According to the inclusion/exclusion criteria, 227 patients were included in the study. Participants were divided into two groups according to the presence (patient group) or absence (control group) of intrauterine growth restriction (IUGR). In addition to routine parameters recorded during pregnancy, the IMA levels and Doppler USG findings of all participants were recorded. RESULTS: The mean cord blood serum IMA levels of the patient group were significantly elevated compared to controls (p = 0.038). Whereas mean maternal blood serum IMA levels were similar among groups (p = 0.453). The cord blood and mother blood serum IMA levels were not significantly different with regard to the presence or absence of perinatal asphyxia. CONCLUSIONS: In the literature, studies evaluating IMA levels in the cord and maternal blood of IUGR fetuses are limited. In IUGR patients, IMA level is expected to increase and in our study, IMA levels were significantly increased but the presence of oxidative stress has not been found to affect IMA levels.

How COVID-19 pandemic is changing the practice of prenatal screening and diagnosis?

OBJECTIVES: To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. METHODS: We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. RESULTS: A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. CONCLUSIONS: The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

Surgical management and clinical follow-up of post-coital severe vulvar hematoma in a 14-year-old adolescent girl: A case presentation.

BACKGROUND: Vulvar hematoma is often puerperal. A case of non-puerperal vulvovaginal hematoma is rare in the literature. There is no consensus on the management of vulvovaginal hematoma. In this study, we discussed the approach to a rare case of non-puerperal vulvar hematoma. CASE: We present the case of a 14-year-old adolescent female with a severe vulvar non-obstetric hematoma that occurred after she had been illegally and voluntarily married. CONCLUSION: In conclusion; vulvar hematoma is the most common non-obstetric cause of perineal trauma and carries the risk of mortality by causing hypovolemic shock. The conservative approach is preferred for small and non-growing hematomas; however, surgical hematoma drainage is used for large and enlarging hematomas. Selective arterial embolization procedure is not common as the required equipment is not available in all healthcare facilities.