Is there a relationship between high birth weight and umbilical vein diameter?

OBJECTIVE: The aim of the study was to evaluate the associations between sonographical measurements of the umbilical cord and birth weight in 20-24 weeks of gestations. METHODS: This cross-sectional study was conducted with the participation of 220 low-risk pregnant women between 20-24 gestational weeks. Biparietal diameter, head and abdominal circumference, and femur length were measured for anthropometric calculations. Umbilical cord including umbilical vein diameters, placental thickness, umbilical artery. Doppler measurements (RI, PI) were recorded. RESULTS: In accordance with the results of statistical computations, an inverse relationship was found between umbilical vein diameter and birth weight of a large gestational age (LGA) newborn in 20-24 gestational weeks (p < .05). There was no significant relationship between other parameters and birth weight of LGA newborns. CONCLUSION: There is an inverse relationship between birth weights of newborns with LGA and umbilical vein diamater at 20-24 weeks of pregnancy. The umbilical vein diameter in the second trimester may be a promising measurement on predicting LGA fetus. The researches have not confirmed the physiopathology of this finding yet, but it is paving the path for future studies.

A comparison of two different oral contraceptives in patients with severe primary dysmenorrhoea.

Pain relief of two different oral contraceptive pills (OCPs) in severe primary dysmenorrhoea (PD) was compared. Sixty-six nulliparous patients with severe PD requiring contraception were evaluated. Group 1 comprised 33 healthy controls. Patients with severe PD were divided into two groups. Patients in Group 2 were administered oestradiol valerate/dienogest and patients in Group 3 were administered ethinylestradiol/drospirenone. Doppler indices of both uterine arteries (left and right) including systolic/diastolicrates (S/D), pulsatility index (PI) and resistance index (RI) were measured, and a visual analogue scale (VAS) was applied to patients before treatment. VAS scores and Doppler indices were repeated after 3 months of OCP treatment and the changes in values were compared. The demographic and clinical characteristics of the patients were similar. The mean value of RI was significantly lower after therapy in Groups 2 and 3 in the right and left uterine arteries (p = .001 and p = .039, respectively). The clinical trial number was NCT03124524. Impact Statement What is already known on this subject: OCPs are the most appropriate treatment option for PD. There is no clear data about OCP containing dienogest for treatment in PD. Dienogest has been reported to be highly effective in the treatment of endometriosis and is also recommended as first-line therapy for pelvic pain-associated endometriosis. What the results of this study add: In this study, although there was no superiority in pain relief between the treatment groups, lower VAS scores and lower RI values of uterine arteries were seen after treatment. Both OCPs relieve pain in severe PD. There was no serious adverse effect in the patients. What the implications are of these findings for clinical practice and/or further research: Estradiol valerate/dienogest, which is a routinely prescribed drug for heavy menstrual bleeding in women who desire oral contraception, is as effective as ethinylestradiol/drospirenone in pain relief.

Is there any relationship between low PAPP-A levels and measures of umbilical vein and placental thickness during first trimester of pregnancy?

OBJECTIVE: Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks. METHODS: UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10th percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10th percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement. RESULTS: Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03). CONCLUSION: Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.

Prenatal diagnosis of upper extremity malformations with ultrasonography: Diagnostic features and perinatal outcome.

OBJECTIVE: The aim of this study was to assess the sonographic (US) characteristics, associated malformations, chromosomal status, and perinatal outcomes of fetuses with an upper extremity malformation (UEM) detected by US examination. METHODS: The data of all patients evaluated in the Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit between 2010 and 2015 were searched for UEM. RESULTS: A total of 51 cases with UEM were detected. Eighteen cases (35.2%) had defects in the formation of body parts (absence of hand/forearm/digits); 25 cases (49%) had defects in differentiation (contractures, syndactyly), and 8 cases (15.6%) had duplication defects (polydactyly). The specificity of prenatal US for UEM was 96.2%. Ten cases (19.7%) had isolated UEM, and 41 cases (80.3%) had additional anomalies, most of which were cardiac, central nervous system, or facial malformations. Although chromosomal structure in isolated cases was normal in 9 of 10 cases (90%), 15 of 41 cases (36.5%) with multiple defects showed abnormal karyotypes. The chromosomal constituents of nine cases (17.6%) were not available. Although the postnatal outcome of isolated cases was favorable except for the presence of orthopedic problems, complex UEMs with or without abnormal karyotypes were always lethal (97.5%). CONCLUSIONS: UEMs associated with other malformations are usually a sign of underlying severe chromosomal abnormalities, and the prognosis is poor. In contrast, chromosomal structure in isolated cases is normal, and the perinatal and postnatal outcomes are good. In general, US is an effective tool in differentiating fetuses with isolated UEM from those with UEM associated with additional malformations. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:267-276, 2017.

A prospective study to assess the clinical impact of interobserver reliability of sonographic measurements of fetal nuchal translucency and crown-rump length on combined first-trimester screening.

OBJECTIVE: To examine the interobserver variability for fetal biometric parameters and to focus on how this variability affects the combined first-trimester screening test results. METHODS: Sixty-four singleton pregnancies who were scheduled for combined first-trimester screening were investigated. Two experienced sonographers performed all examinations at the same visit. The risk calculations of screening were performed according to the each operator's individual ultrasonographic fetal measurements. Interobserver variability in measurements of fetal nuchal translucency (NT) and crown-rump length (CRL) and the effect of this interobserver variability on the screening results were assessed. RESULTS: Interobserver reliabilities for NT and CRL were 0.687 and 0.945 (p<0.001), respectively. Interobserver reliability coefficients for trisomy 21 and trisomy 13/18 were 0.945 and 0.963 (p<0.001), respectively. CONCLUSION: Our study demonstrated quite high interobserver reliability for CRL measurement, while interobserver agreement for NT was lower. Despite this lower reliability and agreement for NT measurement, interobserver reliability for chromosomal abnormalities was quite high.

The effect of impaired 50-gram oral glucose challenge test on fetal abdominal wall thickness.

BACKGROUND: Patients with impaired 50-g oral glucose challenge test (OGCT) have not been investigated for fetal anterior abdominal wall thickness until now. We aimed to investigate patients with impaired 50-g OGCT, but not gestational diabetes and match them with healthy uneventful pregnant participants for anterior abdominal wall thickness, estimated fetal weight, fetal gender, biparietal diameter, femur length and abdominal circumference. METHODS: A total of 99 pregnant women between 26 and 28 weeks of gestation were enrolled in the study. These patients were divided into two groups according to their 50-g OGCT results. Fifty-one pregnant women with uncomplicated healthy singleton pregnancies constituted our control group, and 48 singleton pregnant women with impaired 50-g OGCT but normal 100-g oral glucose tolerance test constituted our study group. RESULTS: We detected statistically significant high body mass index in impaired 50-g glucose test group. Biparietal diameter, femur length, abdominal circumference and estimated fetal weight values were not significantly different between groups; however, anterior abdominal wall thickness value was significantly width in impaired 50-g glucose test group. Moreover, there were no statistically significant differences between two groups for gender of fetuses. CONCLUSION: Impaired 50-g glucose test in pregnancy is related not only to increased maternal body mass index but also to fetal fat distribution. Although fetal abdominal circumference measurement and estimated fetal weight were not different between study and control group, increased anterior abdominal wall thickness can be detected in impaired 50-g OGCT group.

Evaluation and prevalence of major central nervous system malformations: a retrospective study.

OBJECTIVE: Central nervous system (CNS) anomalies are the most common abnormalities of all malformations and can be diagnosed on routine prenatal ultrasonography (US). We aimed to find out fetal CNS anomaly rate in our clinic which is the referral center in the region. METHODS: This is a retrospective study of 15000 pregnant women who were scanned for routine obstetric follow-up from January 2012 to July 2013 in our referral center. We diagnosed CNS anomalies in 41 fetuses by using high resolution ultrasound unit with 3.5 MHz transabdominal and 6 MHz transvaginal transducers. RESULTS: CNS anomalies included 12 Chiari malformations, 2 Dandy-Walker malformations (DWM), 1 variant of Dandy-Walker syndrome (DWS), 3 iniencephalies, 15 anencephalies, 1 alobar holoprosencephaly, 2 isolated hydrocephalies, 3 hydrocephalies with cerebellar hypoplasia, 1 occipital encephalocele, 1 lumbosacral myelomeningocele accompanied with microcephaly. There were some associated anomalies in the groups that included club-foot deformities in 6 cases, ventricular septal defect (VSD) in 2 cases, polycystic kidney in 2 cases, scoliosis in 1 case, hypoplasic left ventricle in 1 case; alone atrium, single umbilical artery, echogenic focus, hydronephrosis and cleft lip and palate in the same case, and omphalocele in one. CONCLUSION: Prognosis and early detection of CNS abnormalities have become an important issue because the most serious complications of major CNS anomalies are disability and getting bedridden and this situation is inevitably related to health economy. On the other hand prognosis of the fetus and family counseling is another important issue. Parents should decide whether to continue their pregnancies or not.