OBJECTIVES: Suppressed immune system and physiological changes in pregnancy put pregnantwomen vulnerable to various viral diseases. Various studies have reported adverse pregnancy outcomes in SARS-CoV-2 infection. This study aimed to evaluate the maternal and fetal outcomes inSARS-CoV-2 affected pregnancies at our set up.STUDY DESIGN: It was a prospective cohort study conducted at a tertiary care Army Hospital, India.The first 50 cases of SARS CoV-2 positive pregnant women and 144 suspected cases that were foundSARS-CoV-2 negative, received and managed at separate set up, during a period extending from 01April 2020 to 15 Sep 2020 were included in our study. Their obstetric and neonatal outcomes along withthe demographic and other clinical data were compared.RESULTS: Total RT-PCR positivity rate of SARS-CoV-2 infection in pregnant women was 2.7%. 96%of our patients were asymptomatic for SARS-CoV-2 infection. Premature rupture of membrane, pretermdelivery, and Neonatal intensive care unit admission was similar in both groups. There were increasedincidences (70%) of cesarean section in SARS-CoV-2 positive pregnant women.CONCLUSION: The study reported comparable maternal and fetal outcomes in SARS-CoV 2 positivepregnant women when compared with SARS-CoV-2 negative pregnant women
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OBJECTIVE: To determine the factors indicating the accuracy of fetal weight estimation in the last prenatal ultrasonography before delivery in preterm newborns with normal amniotic fluid volume.STUDY DESIGN: Three hundred and seventy-one singleton pregnancies with normal amniotic fluid volume and delivered at between 24+0 and 37+0 gestational weeks were evaluated in a retrospectivestudy. Any possible associations between the absolute percentage error of fetal weight estimations andthe maternal and fetal data were examined.RESULTS: In 135 of the 371 women (36%), the absolute percentage error was greater than 10%. Themean absolute percentage error was 8.7±7.5%. The mean absolute percentage errors were 4.1±2.7%and 16.8±6.4% in the accurate and inaccurate estimation groups, respectively.The rate of women examined during labor was significantly higher in the inaccurate estimation groupcompared to the accurate estimation group. There were no significant differences in age, body-massindex, gestational age at delivery, estimated-fetal-weight, actual birth weight, days from the last ultrasound examination to delivery, small for gestational age rate, placenta localization or fetal presentationbetween the two groups.Examination during labor (β=0.224) was the most important factor for the prediction of the absolute percentage error, followed by gestational age at delivery (β=–0.198), presence of (β=–0.158), and bodymass-index (β=0.142).CONCLUSION: In 36% of our study population, the absolute percentage error was >10%. Examinationduring labor was the most important factor for the prediction of the absolute percentage error, followedby gestational age at delivery, presence of small for gestational age, and body-mass-index.
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OBJECTIVE: To determine the indications for termination of pregnancy, and their consistency with autopsy data to offer an insight into termination of pregnancy having regard to conditions in Turkey.STUDY DESIGN: Three hundred and ninety-one pregnancies terminated before the 24th gestationalweek were enrolled in this study. Maternal age, gravidity, parity, abortion, the status of folic acid usage,consanguineous marital status, gestational week, anomalies that led to termination and pathological diagnoses were recorded. Anomalies that led to termination were grouped as central nervous system ,cardiovascular system, gastrointestinal system, genitourinary system, pulmonary, musculoskeletal,head-neck, chromosomal, genetic, multiple anomalies and others. Four groups were formed based onthe consistency of prenatal ultrasound diagnosis with pathological diagnosis.RESULTS: Mean age, gravidity, parity, abortion, and gestational week were 28 years, 3, 1, 1, and 15.7weeks, respectively. One hundred and thirty-eight (35.2%) patients had consanguineous marriage.Three major causes of termination were central nervous system (45.78%), head-neck (17.4%) and multiple anomalies (14%). One hundred and twenty-eight (71.5%) patients with central nervous systemanomalies were not using folic acid. Comparison of prenatal ultrasound findings with pathology results,275 (70.3%) patients had full consistency, 46 (11.8%) had other findings at autopsy besides the confirmed sonographic findings, 34 (8.7%) had some sonographic findings not confirmed at autopsy, and 4(1%) had no consistency between the findings.CONCLUSION: Central nervous system anomalies constitute the most common indication for termination of pregnancy in this retrospective study. Low rate of periconceptional folic acid among those casesis remarkable. First-trimester screening for earlier detection of fetal anomalies may be important in highrisk groups such as those with consanguineous marriages.
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OBJECTIVE: This study investigated the cases in which the fetal ascending aorta is larger than the main pulmonary artery on the three-vessel view and aimed to determine the relationship between the larger ascending aorta and major cardiac anomalies. STUDY DESIGN: Pregnancies between 18-24 gestational weeks who underwent detailed secondtrimester screening during 2015-2019 were evaluated. Cases whose fetal ascending aorta diameter was larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view were analyzed. Prenatal and postnatal echocardiography studies were performed for each case. RESULTS: Fetal ascending aorta diameter larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view was detected in 21 fetuses in a total of 3810 pregnancies (0.55%), and 10 (47.6%) of them had major congenital heart disease. The diagnosis of Tetralogy of Fallot, double outlet right ventricle, ventricular septal defect, pulmonary valve stenosis, and moderate to severe tricuspid regurgitation were confirmed with prenatal/postnatal echocardiography studies. The highest ratio of ascending aorta/main pulmonary artery was 1.4 in a fetus with a double outlet right ventricle and pulmonary valve stenosis. CONCLUSION: The fetal ratio of ascending aorta/main pulmonary artery larger than 1 on the three-vessel view may be a sign of certain cardiac anomalies. Nevertheless, this rate is not an indicator of a serious cardiac defect in all cases. Fetal advanced echocardiography and early postnatal cardiac evaluation should be done to confirm the diagnosis.
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OBJECTIVES: We aimed to determine whether mean platelet volume value and/or neutrophil/lymphocyte ratio values are useful as a predictive marker for gestational cholestasis. STUDY DESIGN: Retrospective analysis of the data of patients diagnosed with pregnancy cholestasis between 2018-2019 in a perinatology clinic. 352 pregnant women were enrolled in the study (122 pregnant women with Intrahepatic cholestasis as study group and 230 pregnant women with no morbidity as the control group) RESULTS: Mean platelet volume was significantly higher in pregnant women with intrahepatic cholestasis compared to the healthy controls, 9.30 (7-18) and 8.6 (6.7-11.5), respectively. The neutrophil/lymphocyte ratio was significantly higher in pregnant women with intrahepatic cholestasis compared to the healthy controls, 3.93 (0.46-13.75) and 4.25 (0.87-17.1), respectively. There was a statistically significant difference between the two groups for mean platelet volume (p <0.001). In the roc analysis, 8.85 fL for mean platelet volume had a sensitivity of 65% and a specificity of 59%. CONCLUSION: When compared with healthy pregnancies, mean platelet volume value in gestational cholestasis increases significantly. However, the predictive strength of mean platelet volume for cholestasis is not strong enough to recommend its usage as a single parameter in clinical practice.
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OBJECTIVE: We aimed to assess the accuracy of intrapartum transperineal ultrasonography that is non-invasive, easy to learn, rapid to perform, comfortable for pregnant women, and low-cost method to evaluate the progress of labor objectively. STUDY DESIGN: We evaluated two hundred-ten singleton pregnant women at term with cephalic presentation who went into active labor via intrapartum transperineal ultrasonography using the angle of progression and head-perineum distance. Maternal characteristics, conventional vaginal examination findings, mode of delivery, and neonatal results were noted. The data were compared using correlation and regression analysis. RESULTS: The relationships between the descent of clinical fetal head station, the increase of angle of progression (p=0.001), and the decrease of head-perineum distance (p=0.001) were statistically significant. The receiver operating characteristics curve showed that measurement of angle of progression with <110.5 degrees (p=0.001) and measurement of head-perineum distance with >52.5 millimeters (p=0.001) were associated with emergent cesarean delivery. For the prediction of delivery mode, both angle of progression and head-perineum distance had high sensitivity and specificity. CONCLUSIONS: Intrapartum transperineal ultrasonography parameters were in agreement with each other and conventional vaginal examination for determination of delivery mode. Head-perineum distance was a parity-dependent measurement whilst angle of progression was parity-independent.
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OBJECTIVE: Dinoprostone is a drug of choice in our daily practice for the induction of labor. The aim of our study; to compare the use of oxytocin with dinoprostone (PGE2- Propess©) used in term multiparous pregnant women to ripen the cervix. STUDY DESIGN: A total of 507 patients were included in the study. Group A, consisted of 262 women with term multiparous pregnancy Bishop score ≤6 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (Propess© -prostaglandin E2). Group B, consisted of 245 cases of pregnancy with Bishop score ≤6 underwent induction of labor with iv oxytocin and was matched for the patient's age and parity. The following data were recorded: age, gestational age, body mass index, the time from the drug administration to the vaginal labor, delivery mode, indications of induction, cesarean indication, birth weight, Apgar score, and need of neonatal intensive care unit. RESULTS: The primary outcome of the in group B interval from induction to vaginal delivery was similar between the two groups. In group A, 41 patients and in group B, 23 patients had a cesarean section. Cesarean section rate was lower in the oxytocin group (cesarean rate 15.6% versus 9.3%, p<0.05). CONCLUSION: It appears; Dinoprostone ovule increases the cesarean rate in terms, multiparous cases with inappropriate cervical score and does not shorten the duration of delivery. Therefore, the use of oxytocin for cervical ripening in multiparous women may be a more appropriate option.
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OBJECTIVE: Despite the availability of better biomarkers, basal day 3 follicle-stimulating hormone is widely available and often used as the first-line test in ovarian reserve evaluation. The aim of this study was to evaluate the outcomes of cycles with elevated (>12 IU/mL) basal follicle-stimulating hormone values. STUDY DESIGN: Cycles with basal day 3 follicle-stimulating hormone values >12 IU/mL were divided into four cohorts according to follicle-stimulating hormone levels: group I, follicle-stimulating hormone between 12-15 IU/m, group II between 15-20 IU/mL, group III between 20-25 IU/mL and group IV >25 IU/mL. Both demographic characteristics and controlled ovarian stimulation parameters were retrospectively reviewed. RESULTS: Total antral follicle count was significantly higher in group I compared to the other three groups (p=0.001). Number of follicles ≥17 mm on human chorionic gonadotropin (hCG) day, number of retrieved oocytes, mature oocytes and fertilized oocytes were significantly higher in group I compared to the other groups (p=0.003, p=0.001, p=0.001, and p=0.001, respectively). No significant difference was found between groups regarding cancellation rates. The rate of embryo transfer per started cycle was significantly higher in group I compared to group III and group IV (p=0.001). Clinical pregnancy rates per embryo transfer were comparable among the groups. CONCLUSION: Despite the retrieval of lower quantities of oocytes, reasonable pregnancy rates could be achieved if embryo transfer was performed in cycles with follicle-stimulating hormone values over 12 IU/mL.
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OBJECTIVE: To compare some cycle characteristics and outcomes using a protocol consisting of a GnRH agonist trigger or hCG trigger after cotreatment with GnRH antagonist. STUDY DESIGN: Thirty-three patients under 35 years of age with polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by GnRH agonist trigger and 132 patients under 35 years of age with the polycystic ovarian syndrome, polycystic ovarian morphology, or previous high response who underwent ovulation trigger by hCG for IVF treatment. Patients were non-randomly assigned to an ovarian stimulation protocol consisting of either GnRH agonist trigger after cotreatment with GnRH antagonist (study group) or hCG trigger after antagonist protocol (control group). RESULTS: The positive pregnancy test was obtained in 70 women in the control group whereas in 13 cases in the study group (p=0.161). No case in the study group needed hospitalization whereas there were 15 cases in the control group who were required to be hospitalized due to ovarian hyperstimulation related symptoms (p=0.04). CONCLUSIONS: The use of a protocol consisting of a GnRH agonist trigger after GnRH antagonist cotreatment and freeze-all strategy reduces the risk of ovarian hyperstimulation syndrome in high-risk patients undergoing IVF without affecting pregnancy rates.
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OBJECTIVE: To investigate the association of bacterial vaginosis and skin disorders in patients with autoimmune antibody positivity. STUDY DESIGN: This retrospective study consisted of 80 patients with autoimmune antibody positivity. All patients were evaluated for the presence of bacterial vaginosis and skin disorders. Cervicovaginal smears were used for the definitive diagnosis of bacterial vaginosis. RESULT: We found bacterial vaginosis in 13.75% (11/80) of the cases. 1 (9.1%) and 10 (90.9%) cases had skin disorders in bacterial vaginosis positive and negative groups respectively (p=0.531). CONCLUSION: There is no relationship between bacterial vaginosis and the presence of skin disorders in patients with autoimmune antibody positivity.
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