Placenta accreta spectrum surgery with the Joel Cohen incision for abdominal access: a single-center experience.

OBJECTIVES: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety. MATERIAL AND METHODS: The data on women having a hysterectomy due to PAS between 2013-2021 was collected retrospectively. Operation length, baby's pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013-2016) or late (2017-2021) years. RESULTS: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27-39). The mean operation length was 150 minutes (75-420), and the anesthesia-to-delivery interval was 32 minutes (5-95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups. CONCLUSIONS: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery.

Perinatal outcomes of the antenatally diagnosed omphalocele cases: a single tertiary center experience.

OBJECTIVES: To evaluate the perinatal outcomes of antenatally diagnosed omphalocele cases. MATERIAL AND METHODS: This was a retrospective study conducted between July 2014 and February 2020 at the prenatal diagnosis center of a university clinic. Gestational week of diagnosis, associated anomalies, karyotype analysis results, complications during pregnancy, termination/delivery characteristics, and postnatal results were evaluated. RESULTS: The analysis was performed on 58 patients. The median diagnosis time was 14.5 weeks of gestation. Thirty-three cases (57%) were defined in the first trimester. 33 (57%) of 58 patients had one or more concomitant anomalies, while 25 patients (43%) had isolated omphalocele. The most common associated anomaly was a cardiac anomaly which was observed in 17 fetuses (30% of all omphalocele cases). Karyotype analysis was performed in forty-five patients (41 in the prenatal period, 4 in the postnatal period). A normal karyotype was detected in 27 cases (60%). Trisomy 18 was the most common chromosomal anomaly (n = 15, 33.3%). Thirty of 58 patients (52%) requested termination of pregnancy (TOP) in the early pregnancy period. Thirteen of the cases died in-utero (22%). Fifteen pregnancies resulted in live births (26%), of those eight were lost in the first year of life (six of them had additional anomalies, while two of them had isolated omphalocele but the omphalocele pouch was containing the liver in those two babies). CONCLUSIONS: Most of the cases with an omphalocele can be diagnosed in the first trimester. Cardiac anomalies were the most common associated anomalies, while trisomy 18 is the most common chromosomal anomaly. Thus, earlier and effective counseling can be made about the prognosis of pregnancy.

The associtation between aberrant right subclavian artery and trisomy 21 in a tertiary center in Turkey.

OBJECTIVES: We hoped to reveal the frequency of Aberrant Right Subclavian Artery (ARSA) and to find the relationship of isolated/non-isolated ARSA with chromosomal defects and other fetal congenital heart diseases (FCHD) in a heterogeneous population. MATERIAL AND METHODS: This was a retrospective cohort study conducted between December 2015 to September 2018. Women admitted for routine ultrasound examination or referred to our hospital for a suspected fetal anomaly were underwent detailed fetal anomaly ultrasonography scan and tested for the presence of ARSA. RESULTS: ARSA was detected in 27 patients and an isolated finding in 13 (48%) cases. Among 13 cases with isolated ARSA, trisomy 21 was diagnosed in 1 case. In the non-isolated group (n: 14, 52%), five cases presented with trisomy 21. There was no significant difference of trisomy 21 frequency between isolated and non-isolated groups (7.6% vs 35.7%, p = 0.08). In 3 patients, FCHD was diagnosed and 2 of them had trisomy 21. CONCLUSIONS: Our study shows that ARSA can be the only marker in trisomy 21. The examination of the subclavian artery must be a part of the fetal anomaly ultrasonography. Detecting an ARSA should increase the attentiveness of the sonographer to investigate for the other markers of trisomy 21. In the existence of other findings, invasive diagnostic procedures should be offered to the patients, whereas in cases that arsa is the only finding, other risk factors should be investigated to offer karyotyping or cell-free DNA analysis.

Impact of Micronutrient Status during Pregnancy on Early Nutrition Programming.

BACKGROUND: Nutrition status prior to conception and during pregnancy and infancy seems to have an influence on the disease risk in adulthood (early nutrition/developmental programming). We aimed to review the current knowledge on the role of micronutrients in early nutrition programming and its implications for healthcare. SUMMARY OF FINDINGS: Globally and even in high-income countries where a balanced diet is generally accessible, an inadequate maternal micronutrient status is common. This may induce health problems in the mother and foetus/newborn both immediately and in later life. Pregnant women and those who may become pregnant should aim to achieve a satisfactory micronutrient status from a well-balanced diet, and where necessary from additional supplements. Key Messages: We emphasise the need for a call to action for healthcare providers and policymakers to better educate women of child-bearing age regarding the short- and long-term benefits of an appropriate micronutrient status. The role of micronutrient status in early nutrition programming needs to be emphasized more to address the still limited awareness of the potential long-term health repercussions of suboptimal micronutrient supply during pregnancy.

First trimester fetal aortic Doppler for hemoglobinopathies.

OBJECTIVE: To evaluate fetal aortic Doppler for the prenatal diagnosis of hemoglobinopathies in the first trimester of pregnancy. MATERIALS AND METHODS: Between January and November 2014, a total of 108 patients were enrolled in the study. The couples were carriers of either alpha/beta thalassemia, sickle cell disease or combined carriers of these and were admitted to Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology Prenatal Diagnosis Center. One hour before the chorionic villus sampling (CVS), patients were evaluated using fetal aortic Doppler. Pulsatility index, peak systolic velocity, and heart rate were noted. RESULTS: There were no statistically significant differences in Doppler indices between different groups of CVS results when compared with the healthy controls. CONCLUSION: Fetal aortic Doppler investigation was found to be ineffective for the prenatal diagnosis of hemoglobinopathies.

Prenatal diagnosis of pectus excavatum.

Pectus excavatum (PE) is the depression of the lower part of manubrium sterni and xiphoid process. The main problem of PE depends on the cardiopulmonary morbidity caused by the narrowing of the thoracic space. To date, prenatal diagnosis of this deformity has been reported only once and was associated with Down syndrome. We present another case which we diagnosed as PE during a second-trimester fetal anatomic scan. The pectus severity index is used for these patients in postnatal life; however, prenatal adaption of this index is reported for the first time in our case.

Predictive factors for latency period in viable pregnancies complicated by preterm premature rupture of the membranes.

OBJECTIVE: In this study, we aimed to evaluate some laboratory and clinical factors in the prediction of latency period for pregnant patients complicated with preterm premature rupture of the membranes. MATERIALS AND METHODS: Sixty-five pregnant patients between 24 and 34 weeks of gestation, who were admitted to University of Çukurova School of Medicine Hospital with the diagnosis of preterm premature rupture of the membranes (PPROM) between January 01, 2013 and December 31, 2013, were included in this study. Serum CRP, procalcitonin, sedimentation rate, leukocyte count and cervical length (measured with transvaginal ultrasound) of patients were analyzed for the correlation with the latency period. RESULTS: None of the parameters were found to be correlated with the latency period. However, patients with cervical length of <25 mm were found to have shorter duration of latency. CONCLUSION: Although preterm premature rupture of the membranes is thought to be either an infection-based disease or a disease increasing the risk of infectious complications, major infection markers are not found to be helpful criteria for the prediction of latency period. Patients with a cervical length of <25 mm can be expected to deliver earlier and, therefore, can be referred to a tertiary center earlier.

Renal angiomyolipoma during pregnancy: Case report and literature review.

Renal angiomyolipoma is a rare tumor that can be either sporadic or found together with tuberous sclerosis or pulmonary lymphangioleiomyomatosis. These tumors are hormone sensitive and therefore tend to grow during pregnancy and their main complication is the risk of rupture. Optimal management is still controversial because there are very few cases reported in the literature. We expect that the case of our patient, who delivered her baby vaginally at 36 weeks of gestation and underwent definitive treatment (nephrectomy) thereafter, to further enhance the knowledge about the management of these rare tumors during pregnancy.

Diagnosis and treatment of iron deficiency anemia during pregnancy and the postpartum period: Iron deficiency anemia working group consensus report.

According to the World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide. Furthermore, iron deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this report was to present the experiences of a multidisciplinary expert group, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum period. Studies and guidelines on the diagnosis and treatment of IDA published in Turkish and international journals were reviewed. Conclusive recommendations were made by an expert panel aiming for a scientific consensus. Measurement of serum ferritin has the highest sensitivity and specificity for diagnosis of IDA unless there is a concurrent inflammatory condition. The lower threshold value for hemoglobin (Hb) in pregnant women is <11 g/dL during the 1st and 3rd trimesters, and <10.5 g/dL during the 2nd trimester. In postpartum period a Hb concentration <10 g/dL indicates clinically significant anemia. Oral iron therapy is given as the first-line treatment for IDA. Although current data are limited, intravenous (IV) iron therapy is an alternative therapeutic option in patients who do not respond to oral iron therapy, have adverse reactions, do not comply with oral iron treatment, have a very low Hb concentration, and require rapid iron repletion. IV iron preparations can be safely used for the treatment of IDA during pregnancy and the postpartum period, and are more beneficial than oral iron preparations in specific indications.

Prenatal determination of the upper lesion level of spina bifida with three-dimensional ultrasound.

INTRODUCTION: To evaluate the role of three-dimensional (3D) sonography in the prenatal detection of the upper pole in fetuses with spina bifida. MATERIAL AND METHODS: Women admitted to a tertiary center with pregnancies with isolated open spina bifida were enrolled in the study. All fetuses had 3D sonography to predict the lesion level. The exact lesion level was ascertained using radiography and/or autopsy following the delivery at term or abortion. RESULTS: Forty-eight cases were eligible for this study. Twenty-eight fetuses were diagnosed in the second trimester and the lesion level was precisely predicted in 24 (86%) of them. In 14 (70%) of the 20 fetuses diagnosed in the last trimester, the level was accurately determined. The remaining 10 fetuses, from both the second and third trimesters, were found to have a lesion level that was within one segment of the predicted lesion level. The correct matching rate was 38/48 (79%), and agreement within one segment was achieved in all cases. DISCUSSION: According to our data, 3D ultrasound is useful for the prenatal determination of lesion level in spina bifida, which is an important prognostic factor.

The genotoxic effect of nicotine on chromosomes of human fetal cells: the first report described as an important study.

CONTEXT: Recent studies have suggested a direct contribution of nicotine--the addictive component of tobacco and tobacco smoke--to human carcinogenesis, and it remains the most common harmful substance to which pregnant women are exposed. Also, it has deleterious effects on the fetus. The sperm of smoking fathers and newborns of smoking mothers have elevated frequencies of chromosome translocations and DNA strand breaks. OBJECTIVE: We tried to understand the genotoxic effect of nicotine in pregnancies of active or passive smoking mothers. For this reason, we provide the evidence that nicotine exposure in vitro has detrimental effects on fetal cells. MATERIALS AND METHODS: We examined the effect of nicotine sulphate on amniotic cells by designing an experimental setting consisting fetal cells grown in nicotine containing medium (25 ng/mL) in study group and fetal cells grown in control medium, which did not contain nicotine. RESULTS: According to our findings, there is a significant difference of chromosomal aberrations (CAs) between nicotine containing medium grown cells and control medium grown cells, determined by the χ² test (P <0.001). We found CAs in 21.5% of cells analyzed. The 19.4% of the all cells had numerical aberrations. Chromosomes 21, 22, 8, 15 and 20 related numerical abnormalities were found to be the most frequent numerical abnormalities. CONCLUSION: Results of this study confirm that the nicotine leads to significant direct genotoxic effects in human fetal cells in vitro. We speculate that there is an association between prenatal exposure to cigarette smoke and in utero aneuploidies.

The reliability of maternal serum triple test in prenatal diagnosis of fetal chromosomal abnormalities of pregnant Turkish women.

AIM: The purpose of this article was to evaluate the reliability of maternal serum triple marker screening of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol for the prenatal diagnosis of fetal chromosomal abnormalities in Turkish pregnant women. METHOD: Medical records were used to analyze indications of amniocentesis and quantitative fluorescent-polymerase chain reaction. Anomaly screening was performed for all patients between 13 and 22 weeks of pregnancy. A total of 1725 pregnancies with chromosomal abnormality risk according to triple test screening were accepted for fetal chromosome analysis and quantitative fluorescent-polymerase chain reaction. RESULTS: Chromosomal aberrations were observed in 56 (3.2%) cases. About 44.6% of the abnormalities detected were numerical aberrations; however, 55.3% of the abnormalities were structural aberrations. Abnormalities detected were inversion of chromosome 9 in 20 cases, trisomy 21 in 14 cases, 46,XX/47,XX, +21 in 1 case, trisomy 18 in 2 cases, trisomy 13 in 1 case, 47,XXY, in 1 case, 45,X, in 1 case, structural abnormalities in 12 cases, and mosaic or tetraploidy in 6 cases. CONCLUSION: Second trimester triple test is an effective screening tool for detecting fetal Down syndrome in Turkish women.

Prevalence and distribution of structural heart diseases in high and low risk pregnancies.

OBJECTIVE: To establish and compare the frequency of intrauterine congenital heart defects in high-risk and low-risk pregnancies for congenital heart diseases. METHODS: Records of 3782 patients who underwent fetal echocardiography at the Pediatric Cardiology Unit were reviewed for reasons of referral and results of echocardiography retrospectively. The categorical variables between the groups were analyzed using a Chi-square test. RESULTS: Structural heart defects were found in 213 (5.6%) fetuses in both high and low risk groups. Most common defects were ventricular septal defect (36.2%) and atrioventricular septal defect (14.1%). Frequency of congenital heart diseases was 7.8% (169 fetuses) in high-risk group: 4.1% were complex, 2.3% significant and 1.4% were minor. In low-risk group, the frequency was 2.7% (44 fetuses): 0.6% were complex, 0.8% significant and 1.3% were minor. In this group, rates of congenital defects were high regarding particular reasons: intrauterine fetal death in previous pregnancy (6.3%), abnormal first or second trimester screening tests (4.3%), and multiple gestations (3.4%). The sensitivity and specificity of fetal echocardiography according to transthoracic echocardiography were found to be 86% and 99%, respectively. CONCLUSION: Congenital heart diseases rate, as expected, was found to be higher in high-risk group. However, regarding intrauterine fetal death in previous pregnancy, abnormal first or second trimester screening tests and multiple gestation, no statistically significant difference was observed between low-risk and high-risk groups. Therefore, we suggest the routine use of fetal echocardiography in cases we have mentioned above if the staff and equipment of the pediatric cardiology clinic are eligible.

Inheritance of pericentric inversion in chromosome 7 through the three progenies and a newborn with congenital hydronephrosis diagnosed prenatally by fetal urine sampling.

OBJECTIVE: To report the inheritance of a pericentric inversion in chromosome 7 through the three progenies, congenital hydronephrosis, and recurrent miscarriages in an extended family. DESIGN: Case report. SETTING: Medical Faculty of Cukurova University in Turkey. PATIENT(S): Referred by obstetrics and gynecology clinic. INTERVENTION(S): Fetal urine and lymphocytic karyotype. MAIN OUTCOME MEASURE(S): Chromosomal analysis from fetal urine and peripheral blood lymphocytes were performed according to standard cytogenetic methods. RESULT(S): We assessed an extended family in which a large pericentric inversion in chromosome 7 is segregating; one of the three progenies with the karyotype 46,XY,inv(7)(p22;q22) was heterozygote for the inversion and presented with congenital hydronephrosis. His mother, mother's brother, grandfather, grandfather's brother, and his daughter were similar for the inversion. CONCLUSION(S): This case describes the further molecular characterization of these breakpoints on the short or long arm of chromosome 7(p22-q22). The inv(7) is also associated with fetal wastage and may be playing a role in the etiology of the family's miscarriages. These findings can be used in clinical genetics and may be an effective tool for reproductive guidance and genetic counseling.