Pregnancy-associated plasma protein a levels are decreased in obstetric cholestasis.

OBJECTIVE: Obstetric cholestasis is a cholestatic disease usually commencing in the third trimester of pregnancy and characterized by pruritus, elevation of liver enzymes, and increase in bile acids. The objective of this study was to compare the first trimester serum indicators of obstetric cholestasis with normal pregnancies. MATERIALS AND METHODS: Thirty-five patients diagnosed with obstetric cholestasis in a three-year period with first trimester biochemical assessment available were included in the study. Seventy patients with concordant pregnancy weeks, matched-age normal pregnancies were included as the control group. Pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) levels were analyzed. RESULTS: No difference was observed between the two groups in terms of age and week of pregnancy. While the mean PAPP-A level was 0.76 ± 0.31 multiples of the medians (MoM) in the obstetric cholestasis group, it was determined to be 1.5 ± 0.84 in the control group (p = 0.0001). Among the two groups, the hCG levels were found to be higher in the obstetric cholestasis group (1.2 ± 0.79 MoM vs. 0.98 ± 0.53, p = 0.041). CONCLUSION: In this study, the first trimester PAPP-A levels in the obstetric cholestasis cases were found to be significantly lower than the control group. Low PAPP-A levels should be a warning for obstetric cholestasis.

Low cord blood serum levels of vitamin D: cause or effect of fetal macrosomia?

UNLABELLED: Aim: The aim of the study was to compare cord blood vitamin D levels of macrosomic large for gestational age (LGA) and appropriate gestational age (AGA) newborns. MATERIALS AND METHODS: Seventy-nine healthy, normal term newborns were included in the study. They were divided by birth weight into two groups: 37 in the LGA group above 4,000 g, and 42 newborns in the AGA group birth weight between 3,000 g and 4,000 g. Cord blood samples from groups were collected. Circulating 25(OH)D was measured as 25 hydroxyvitamin D3 (25(OH)D3) by high-performance liquid chromatography (HPLC) in serum using a kit. RESULTS: Maternal characterstics (age, body mass index [BMI], and gestational age) did not differ between the AGA and LGA groups. Cord blood 25 OH vitamin D levels were significantly low in neonates with LGA (p = 0,02). CONCLUSIONS: The authors found that macrosomic infants had low levels of vitamin D. Providing vitamin D supplements to pregnant women may prevent macrosomia. Randomized controlled trials are needed to prove this assertion.

Relationship between meconium staining and thymic stromal lymphopoietin.

OBJECTIVE: Epithelium-derived thymic stromal lymphopoietin (TSLP), is a key pro-allergic cytokine that has recently been linked to chronic airway diseases. Our aim is to determine cord blood TSLP levels in pregnancies with meconium stained amniotic fluid. PATIENTS AND METHODS: A total of 44 pregnant women with meconium stained amniotic fluid and a total of 44 healthy pregnant women were enrolled in the study. Cord blood TSLP was measured with TSLP ELISA Kit. RESULTS: We found no statistically significant differences between 2 groups in terms of age and parity. TSLP levels were found to be significantly higher in the cord blood of pregnant women with meconium stained amniotic fluid (104.3 ± 96.9 ng/ml) compared with the control group (63.2 ± 65.3 ng/ml) (p = 0.022). CONCLUSIONS: It seems that TSLP is produced and released in response to meconium.

Clavicular fracture: its incidence and predisposing factors in term uncomplicated pregnancy.

BACKGROUND AND OBJECTIVES: Our aim was to evaluate fetal and maternal predisposing factors associated with clavicular fracture. PATIENTS AND METHODS: In this study we reviewed all term uncomplicated deliveries in our Hospital between January 2009 and April 2010. The diagnosis of clavicular fracture was established by physical examination and in clinically diagnosed patients confirmed by radiology. We compared deliveries with clavicular fracture (study group) with a sample of 150 patients (control group) matched for time at active phase of labor from all vaginal deliveries. The data included maternal age, gestational age, fetal weight, and infant sex, presence of gestational diabetes, labor duration and induction and shoulder dystocia. RESULTS: In the Unit 16819 deliveries occurred during the period. The study included 9700 uncomplicated pregnancies at > or = 37 weeks of gestation delivered vaginally. We identified 73 cases of clavicular fracture with an prevalence of (73/9700) 0.75%. The study group had a significantly higher prevalence of shoulder dystocia (6.8% vs. 0.6%). Logistic regression analysis revealed maternal age and fetal weight as significant risk factors influencing clavicular fractures. CONCLUSIONS: Main risk factors for clavicular fracture identified from our study seem as maternal age and birth weight.  

Anencephalic conjoined twins with mirror-image cleft lip and palate.

This is a case presentation of a conjoined twin (cephalothoracopagus) pregnancy with anencaphaly and mirror-image cleft lip and palate, affecting the left side of one twin and the right side of the other twin. The pregnancy was terminated at 26 weeks. The case is discussed with information in the literature.