The Impact of First Trimester TSH Level on Fetal Growth and Post-Term Pregnancy.

Objective:  First trimester thyroid-stimulating hormone (TSH) level is an important determiner of neonatal outcome. In this study we investigated the relationship between first-trimester TSH level and fetal birthweight. Materials-Methods: First-trimester serum TSH, age, gravidity, parity, body mass index (BMI), gestational age, and birth weight were analyzed. Patients were divided two ways. The first division- group 1 with TSH < 2.5 mU/l, group 2 with TSH > 2.5 mU/l). The second division- group 3 with TSH < 4 mU/l and group 4 with TSH > 4 mU/l). Results: The study included 302 patients. High TSH levels are associated with an increased risk of macrosomic and post-term babies. A significant association was found for both thresholds of 2.5 and 4.0 mU/l. However, this relation was not significant after binary logistic regression. Conclusion: High maternal first trimester TSH levels are not associated with birth weight after separating out macrosomia-related factors.

A prelude to the proximity interaction mapping of CXXC5.

CXXC5 is a member of the zinc-finger CXXC family proteins that interact with unmodified CpG dinucleotides through a conserved ZF-CXXC domain. CXXC5 is involved in the modulation of gene expressions that lead to alterations in diverse cellular events. However, the underlying mechanism of CXXC5-modulated gene expressions remains unclear. Proteins perform their functions in a network of proteins whose identities and amounts change spatiotemporally in response to various stimuli in a lineage-specific manner. Since CXXC5 lacks an intrinsic transcription regulatory function or enzymatic activity but is a DNA binder, CXXC5 by interacting with proteins could act as a scaffold to establish a chromatin state restrictive or permissive for transcription. To initially address this, we utilized the proximity-dependent biotinylation approach. Proximity interaction partners of CXXC5 include DNA and chromatin modifiers, transcription factors/co-regulators, and RNA processors. Of these, CXXC5 through its CXXC domain interacted with EMD, MAZ, and MeCP2. Furthermore, an interplay between CXXC5 and MeCP2 was critical for a subset of CXXC5 target gene expressions. It appears that CXXC5 may act as a nucleation factor in modulating gene expressions. Providing a prelude for CXXC5 actions, our results could also contribute to a better understanding of CXXC5-mediated cellular processes in physiology and pathophysiology.

Fasting and post-prandial plasma glucose screening for gestational diabetes mellitus.

BACKGROUND: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy. AIMS: The purpose of this study was to investigate the prevalence of pregnant women who were not screened for gestational diabetes mellitus and compare the maternal and fetal outcomes of women who had undergone GDM screening. METHODS: Women who refused to attend the gestational diabetes screening test (n = 162) at a maternity hospital in Ankara, Turkey, between October 2014 and January 2015 were included in this prospective cohort study. The control group (matched for age and body mass index) was recruited from women who agreed to have the gestational diabetes screening test (n = 194). RESULTS: Just 12% of pregnant women did not attend gestational diabetes screening test; these women were at higher risk for idiopathic polyhydramnios (P = 0.026). Prevalence of GDM was 8.8% (n = 17) in the control group and 30.9% (n = 50) in those who refused GDM screening. The maternal and fetal outcomes of GDM patients were similar in both groups. Women who did not attend GDM screening test had increased risk for mild idiopathic polyhydramnios in late gestation. CONCLUSIONS: Fasting and postprandial plasma glucose screening can replace gestational diabetes mellitus screening in women who refuse to have the glucose load test.

Two cases of acute urinary retention caused by large cervical leiomyoma with review of literature.

OBJECTIVE: Large uterine or cervical leiomyomas may cause acute urinary retention due to bladder outlet obstruction. We report two cases with acute urinary retention caused by cervical leiomyoma. Myomectomies were performed due to their desire of fertility and frozen-section examinations were reported as benign leiomyomas in both cases. The urinary symptoms completely resolved in two patients following myomectomies. In patients who are admitted with the complaint of acute urinary retention, cervical leiomyomas should be considered in differential diagnosis.

Maternal serum advanced glycation end products level as an early marker for predicting preterm labor/PPROM: a prospective preliminary study.

OBJECTIVE: To evaluate the value of maternal serum advanced glycation end products (AGEs) level at 11-13 weeks' gestation for the prediction of preterm labor and or preterm premature rupture of membranes (PPROM). MATERIALS AND METHODS: This prospective cross-sectional study is performed in a university-affiliated hospital between February and April 2016. The participants of this study are low-risk pregnant women. Blood samples for maternal AGEs level were collected in the first trimester of pregnancy and all women completed their antenatal follow-up and delivered in our center. During the follow-up 21 women developed preterm labor/PPROM. The first trimester maternal AGEs levels of preterm labor/PPROM cases were compared with uncomplicated cases (n = 25) matched for age-parity and BMI. The predictive value of AGEs levels for preterm labor/PPROM was also assessed. RESULTS: First-trimester AGEs levels were significantly higher in cases complicated with preterm labor/PPROM (1832 (415-6682) versus 1276 (466-6445) ng/L, p = .001 and 1722 (804-6682) versus 1343 (466-6445) ng/L, p = .025). According to receiver-operating characteristic curve analysis, the calculated cut off value of AGEs was 1538 ng/L with the sensitivity 91.7%, specificity 73.8%; and the negative and positive predictive values were 91.6% and 29.5%, respectively. CONCLUSIONS: For the prediction of preterm labor/PPROM, the relatively high AGEs levels in the first trimester might be a useful marker.

Dynamic transcriptional events mediated by estrogen receptor alpha.

17beta-estradiol (E2), the main circulating estrogen hormone, is involved in a wide variety of physiological functions ranging from the development to the maintenance of many tissues and organs. The effects of E2 on cells are primarily conveyed by the transcription factors, estrogen receptor (ER) alpha and beta. The regulation of responsive genes by the well-defined ER alpha in response to E2 relies on complex and highly organized processes that dynamically integrate functions of many transcription regulators to induce spatiotemporal alterations in chromatin state and structure. Changes in gene expressions result in cell-specific responses that include proliferation, differentiation and death. Deregulation of E2-ER alpha signaling contributes to the initiation and progression of target tissue malignancies. We aim here to provide a review of recent findings on dynamic transcriptional events mediated by E2-ER alpha with the anticipation that a better understanding of complex regulatory mechanisms underlying ER actions would be a critical basis for the development of effective prognostic tools for and therapeutic interventions against estrogen target tissue malignancies.

Relationship maternal subcutaneous adipose tissue thickness and development of gestational diabetes mellitus.

OBJECTIVE: We investigated whether the ultrasonographic measurement of maternal subcutaneous adipose tissue (SAT) thickness in the second trimester played a role in predicting gestational diabetes. MATERIALS AND METHODS: This was a prospective cross-sectional study in which 223 women were classified as healthy (n = 177) or as gestational diabetes (n = 46) on the basis of a negative or positive two-step oral Glucose Challenge Test (GCT), respectively. The depth of the abdominal SAT was evaluated by two-dimensional ultrasonography. Body mass index (BMI), waist circumference (WC), and waist/hip ratio were determined. RESULTS: There was a positive strong significant correlation between a 50-g GCT level and BMI, WC, and SAT thickness (p < 0.001). Receiver-operating characteristic curve analysis showed SAT thickness above 16.75 mm predicted gestational diabetes mellitus (GDM) with a sensitivity of 71.7%, a specificity of 57.1%, a positive predictive value of 32.3%, and a negative predictive value of 87.6%. There was a good correlation between SAT, BMI, and WC. CONCLUSION: Increased SAT, BMI, and WC measurements may be helpful in predicting the risk of the development of GDM in pregnant women.

Effect of Prolonged Fasting Duration on 50 Gram Oral Glucose Challenge Test in the Diagnosis of Gestational Diabetes Mellitus.

The aim of this study was to investigate the association between fasting duration before screening with 50 g glucose challenge test (GCT) and the test outcome. For this cross-sectional study, we enrolled 508 low-risk pregnant women who underwent 50 g GCT between the 24 and 28 weeks of gestation. We excluded women with pregestational diabetes, multiple gestations or a history of gestational diabetes mellitus (GDM), and macrosomia. We evaluated fasting durations, GCT results, and demographic features. A significant positive correlation was found between fasting duration and 50 g GCT values (r=0.122; p=0.006), and the best cut-off value was found to be 6.5 h, with 85.85% sensitivity and 38.61% specificity (relative risk, 2.73; 95% CI, 1.893-3.936; p<0.0001). Further, we divided the patients into two groups: study (fasting, <6.5 h; n=146) and control (fasting,>6.5 h; n=362) groups. Notably, the mean glucose levels, number of patients with GCT>140 mg/dl, and rates of unnecessary 100 g loadings were significantly higher in the study group. We found no significant differences between the groups in terms of the fasting plasma glucose levels and GDM prevalence. According to our findings, fasting duration of>6.5 h resulted in 2.7 times more unnecessary 100 g glucose tolerance tests (GTT). We recommend that patients having fasted for>6.5 h receive a one-step 75 g GTT after completing 8-h fasting.

Second-trimester urinary neutrophil gelatinase-associated lipocalin levels in gestational diabetes: preliminary results.

OBJECTIVE: The objective of this study is to investigate the urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in the second trimester of pregnant patients at the time of gestational diabetes mellitus (GDM) screening. MATERIALS AND METHODS: Urinary samples from 88 pregnant women who underwent gestational diabetes screening test were collected in late second trimester (24-28 weeks) prospectively. After an overnight fasting, 75 g GTT was performed. The blood samples were drawn for measurement of glucose, insulin, and HbA1c. The urinary and blood parameters were compared for pregnant women with or without gestational diabetes. RESULTS: uNGAL levels were significantly elevated in pregnant women with gesting compared with the control groups (p < .014). There was a positive correlation between uNGAL and HbA1c levels (p = .001). CONCLUSIONS: In the second trimester, at the time of GDM screening, high levels of uNGAL indicate tubular injury in GDM cases which seems to be a result of hyperglycemia. uNGAL may correlate with an inflammatory renal involvement in GDM.

Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women / Avaliação de massas anexiais benignas em mulheres pós-menopáusicas

Abstract Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

Resumo Introdução É fundamental identificar o potencial maligno de massas anexiais pósmenopáusicas no período pré-operatório. Objetivo Avaliar a efetividade do risco de malignidade (risk of malignancy index-2, RMI2) em massas anexiais benignas presumíveis em mulheres na pós-menopausa. Desenho do Estudo Estudo observacional retrospectivo. Métodos Este estudo foi conduzido em nossa clínica de cirurgia de endoscopia e endoscopia de nosso hospital entre janeiro de 2013 e setembro de 2015. Um total de 119 mulheres com massas anexiais pós-menopausa com diagnóstico preliminar de tumores benignos de acordo com o RMI-2. A idade, a duração da menopausa, os achados ultrassonográficos e os níveis séricos de CA-125 foram registados no préoperatório. O diagnóstico definitivo foi baseado no exame histopatológico pósoperatório. Resultados A média de idade dos pacientes foi de 55,4 6,71 anos. O exame histopatológico revelou que 8,4% das massas anexiais eram tumores malignos ou limítrofes, enquanto 91,6% eram benignos. Não houve diferença estatisticamente significante quanto ao tamanho do tumor e do tamanho das lesões entre patologias malignas e benignas. Não houve diferença estatisticamente significativa entre pacientes benignos e malignos quanto à idade e tamanho do tumor. Os dois parâmetros ultrasonográficos estatisticamente significativos entre os grupos foram a presença de área sólida na massa e bilateralidade. Além disso, se o ponto de corte para CA-125 sérico fosse ajustado para 14,75 UI/mL de acordo com a curva receiver operating characteristic (ROC), um valor de sensibilidade de 80% e um valor de especificidade de 72% poderiam ser conseguidos para discriminar cistos benignos e malignos (área sob a curva [ASC]: 0,89). Conclusão No diagnóstico diferencial de massas anexiais benignas e malignas em mulheres pós-menopáusicas, a presença de um componente sólido, bilaterais com base na ultra-sonografia e valores elevados de CA-125 podem ser utilizados como critério discriminatório. Parece que não há relação direta entre o tamanho da massa anexial eo potencial maligno. Portanto, nos índices de malignidade de mulheres pósmenopáusicas, recomendamos valores de corte mais baixos de CA-125 para aumentar a sensibilidade dos testes de avaliação pré-operatória sem ter grande impacto em valores preditivos negativos.

Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women.

Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

Introdução É fundamental identificar o potencial maligno de massas anexiais pós-menopáusicas no período pré-operatório. Objetivo Avaliar a efetividade do risco de malignidade (risk of malignancy index-2, RMI2) em massas anexiais benignas presumíveis em mulheres na pós-menopausa. Desenho do Estudo Estudo observacional retrospectivo. Métodos Este estudo foi conduzido em nossa clínica de cirurgia de endoscopia e endoscopia de nosso hospital entre janeiro de 2013 e setembro de 2015. Um total de 119 mulheres com massas anexiais pós-menopausa com diagnóstico preliminar de tumores benignos de acordo com o RMI-2. A idade, a duração da menopausa, os achados ultrassonográficos e os níveis séricos de CA-125 foram registados no pré-operatório. O diagnóstico definitivo foi baseado no exame histopatológico pós-operatório. Resultados A média de idade dos pacientes foi de 55,4 ± 6,71 anos. O exame histopatológico revelou que 8,4% das massas anexiais eram tumores malignos ou limítrofes, enquanto 91,6% eram benignos. Não houve diferença estatisticamente significante quanto ao tamanho do tumor e do tamanho das lesões entre patologias malignas e benignas. Não houve diferença estatisticamente significativa entre pacientes benignos e malignos quanto à idade e tamanho do tumor. Os dois parâmetros ultra-sonográficos estatisticamente significativos entre os grupos foram a presença de área sólida na massa e bilateralidade. Além disso, se o ponto de corte para CA-125 sérico fosse ajustado para 14,75 UI/mL de acordo com a curva receiver operating characteristic (ROC), um valor de sensibilidade de 80% e um valor de especificidade de 72% poderiam ser conseguidos para discriminar cistos benignos e malignos (área sob a curva [ASC]: 0,89). Conclusão No diagnóstico diferencial de massas anexiais benignas e malignas em mulheres pós-menopáusicas, a presença de um componente sólido, bilaterais com base na ultra-sonografia e valores elevados de CA-125 podem ser utilizados como critério discriminatório. Parece que não há relação direta entre o tamanho da massa anexial eo potencial maligno. Portanto, nos índices de malignidade de mulheres pós-menopáusicas, recomendamos valores de corte mais baixos de CA-125 para aumentar a sensibilidade dos testes de avaliação pré-operatória sem ter grande impacto em valores preditivos negativos.

The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women.

OBJECTIVES: To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women. METHODS: This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n = 51), or a supine position modified to 45 degree of semi-fowler (n = 51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups. RESULTS: The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p < 0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit. CONCLUSIONS: In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions.

Comparing neonatal respiratory morbidity in neonates delivered after 34 weeks of gestation with and without antenatal corticosteroid.

OBJECTIVE: To investigate the effect of antenatal corticosteroid prophylaxis on neonatal respiratory morbidity between 34 and 37 weeks of gestation. METHODS: This retrospective study evaluated the neonatal respiratory complications of 683 low risk singleton pregnancies delivered at 34-37 weeks of gestation in a tertiary care center between Jan 2012 and Sept 2015. Group-I (n=294) comprised data of woman who did not receive betamethasone and Group-II(n=396) comprised those who received betamethasone after 34 weeks of gestation for cases at risk of preterm birth. Primary outcome was neonatal respiratory morbidity (NRM). NRM was defined as any respiratory disease that required medical support including supplemental oxygen, nasal continuous positive airway pressure, endotracheal intubation, or exogenous surfactant, with more than 25% oxygen for > 10 minute to maintain neonate oxygen saturation >90% Demographic characteristics, mode of delivery, fetal birth weight and neonatal respiratory complications was compared between the two groups. RESULTS: There was no statistically significant difference for neonatal respiratory morbidity development rate between patients who received betamethasone or those who did not receive it. The incidence of neonatal respiratory morbidity was similar (15.3% in the control group and 14.9% in the intervention group; p=0.88). CONCLUSION: We found no improvement with betamethasone administration empirically in late preterm birth as regards prevention of Neonatal Respiratory Morbidity(NRM).

To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women.

OBJECTIVE: To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women. METHODS: We conducted this prospective cross-sectional study on 365 singleton adolescent pregnancies (aged between 16 and 20 years) at a Maternity Hospital, between December 2014 and March 2015. We divided participants into two groups based on pre-pregnancy body mass index (BMI): overweight and obese adolescent (BMI at or above 25.0 kg/m) and normal weight (BMI between 18.5 and 24.99 kg/m) adolescent. We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI. RESULTS: The prevalence of maternal overweight/obesity and normal weight was 34.6% (n = 80) and 65.4% (n = 261) in the study population, respectively. Compared with normal-weight teens (n = 234), overweight/obese teens (n = 71) were at higher risk for cesarean delivery (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.4-1.4), preeclampsia (adjusted odds ratio [OR] 0.1, 95% confidence interval [CI] 0.02-0.9) and small of gestational age (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1-0.9). CONCLUSION: BMI increased during pre-pregnancy could be an important preventable risk factor for poor obstetric complications in adolescent pregnancies, and for these patients prevention strategies (e.g., nutritional counseling, weight-loss, regular physical activity) for obesity are recommended before getting pregnant.

Alternative tumor markers in the diagnosis of ovarian cancer.

OBJECTIVES: The aim of the study was to assess the usefulness of various tumor markers (CA125, HE4, bcl2) measured in serum, urine and saliva in the differential diagnosis of adnexal masses. MATERIAL AND METHODS: Our study was conducted at the Baskent University Medical School, Department of Obstetrics and Gynecology, Ankara, Turkey, between November 2010 and March 2011. Fifty patients with a suspicion of malignant adnexal mass and 30 controls were included in the study. Serum and urine CA-125, HE4, and bcl2 levels were evaluated for their role in the diagnosis of epithelial ovarian cancer (EOC). RESULTS: Serum CA-125 and HE4 levels, and urine HE4 levels were significantly higher in malignant cases as compared to controls (p < 0.05). Mean levels of bcl2 in saliva and urine were similar in malignant cases and controls (p > 0.05). CONCLUSIONS: We demonstrated that serum CA125, serum HE4 and urine HE4 levels were elevated in patients with ovarian cancer. These findings should be assessed in future studies with larger sample sizes in order to reach more definite conclusions.

Does progesterone therapy increase nuchal translucency in women with threatened miscarriage?

OBJECTIVES: The effect of exogenous progesterone on fetal nuchal translucency (NT) has been proposed recently. In this study, we aimed to compare the thickness of NT of patients receiving and not receiving progesterone for threatened miscarriage. MATERIAL AND METHODS: This study was designed as a retrospective comparative study. Ninety five women treated with progesterone constituted the study group whereas 97 women who were not treated with progesterone constituted the control group. An ultrasonographic examination was performed on all of the women to measure NT. All patients were treated with oral micronized progesterone in the study group. The main parameters recorded for each woman were; age, body mass index (BMI), obstetrical characteristics, and gestational age at first examination, treatment duration of progesterone therapy, and results of combined and triple tests. RESULTS: A total of 192 pregnant women with threatened miscarriage were included in this study. The mean NT thickness was statistically significantly higher in the study group (p < 0.001), and mean serum level of human chorionic gonadotropin (hCG) was also higher in this group (p < 0.05). There was no statistically significant difference between groups in terms of age, BMI, and gestational age at first examination. ROC curve analysis demonstrated that only increased NT (area under the curve: 0.634, p = 0.005, 95% CI: 0.541-0.727) was a discriminative factor for women receiving progesterone for threatened miscarriage. Also there was a positive correlation between NT and treatment duration (r = 0.269; p < 0.001). CONCLUSIONS: We think that oral progesterone therapy may increase NT depending on treatment duration without causing abnormal prenatal screening test results.

Neoadjuvant chemotherapy followed by cesarean radical hysterectomy in a triplet pregnancy complicated by clear cell carcinoma of the cervix: a case presentation and literature review.

OBJECTIVE: To report a triplet pregnancy complicated by clear cell cervical carcinoma that was managed using neoadjuvant chemotherapy followed by caesarean radical hysterectomy. PATIENT HISTORY: A 26-year-old woman had a diagnosis of cervical clear cell carcinoma, which was International Federation of Gynecology and Obstetrics stage IB1, at 18 weeks of gestation during a triplet pregnancy. Owing to the patient's strong desire for full-term pregnancy, 3 cycles of neoadjuvant chemotherapy was administered after magnetic resonance imaging evaluation of the tumor. The patient underwent cesarean delivery and radical hysterectomy at gestational week 32. The hysterectomy specimen revealed stage IB1 clear cell adenocarcinoma of the cervix. The neonates and the mother did not have any complications related to the treatment during 36 months of follow-up. CONCLUSION: To the best of our knowledge, this is the first report of a triplet pregnancy complicated by cervical clear cell carcinoma that was successfully treated with neoadjuvant chemotherapy and cesarean radical hysterectomy. Our experience and literature review suggest that neoadjuvant chemotherapy for cervical carcinoma diagnosed during pregnancy is associated with excellent oncologic and fetal outcome; therefore, it may be considered as a temporary fertility-sparing approach in selected patients with a strong desire for full-term pregnancy. Nonetheless, additional research and long-term follow-up are needed to reach a more definitive conclusion.

Second trimester fetal nasal bone length in a low-risk Turkish population.

OBJECTIVE: To define normal values of second trimester fetal nasal bone length (NBL) in a low-risk Turkish population. METHOD: Prenatal records of singleton fetuses who underwent second trimester ultrasonographic examination in the 16 to 23 weeks of pregnancy were retrospectively analyzed for NBL and biometric measurements (BPD, FL and HL). The relationship among NBL and gestational age (GA), biparietal diameter (BPD), femur length (FL) and humerus length (HL) was determined. Additionally, percentile values of NBL for each gestational week were provided. RESULTS: A total of 1467 fetuses were included in this study. There was a significant linear association among NBL and GA (R(2) = 0.709), BPD (R(2) = 0.752), FL (R(2) = 0.742) and HL (R(2) = 0.747). Fifth percentile values of fetal NBL were 3.11 mm for 16th, 3.50 mm for 17th, 3.70 mm for 18th, 4.10 mm for 19th, 4.50 mm for 20th, 4.62 mm for 21st, 5.24 mm for 22nd and 5.37 mm for 23rd gestational weeks. CONCLUSION: The study provides normal ranges of NBL between 16 and 23 weeks of pregnancy in a low-risk Turkish population. Future studies with larger sample sizes including pregnancies carrying high risk for aneuploidy are needed to define cut-off values for NBL.