BURAYA

(1)

(2)

2015perinatal Kabul:Poster Toplam: 129

[PP-001]

Influence of Maternal BMI on Sonographic Fetal Weight Estimation Prior to Scheduled Delivery

Hüseyin Aksoy¹, Ülkü Aksoy², Özge Idem Karadağ³, Burak Yücel³, Turgut Aydın³, Mustafa Alparslan Babayiğit⁴

1Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey

2Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey

3Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey

4Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey

Objectives: To investigate the possible effect of maternal obesity on the accuracy of

sonographically estimated fetal birth-weight in the third-trimester shortly before induction of labor and to compare the accuracy of the estimation between normal weight, overweight, and class I, classII and class III obese groups.

Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal weight estimation prior to scheduled delivery. Women were classified by their current BMI into five categories: normal, overweight, obese Class I, obese Class II and obese Class III. Estimated fetal weight (EFW) was compared with the actual birth weight (ABW) and the difference between the EFW and the ABW (simple error) was recorded as error in grams.

Findings: The final study included a total of 198 subjects. The mean absolute error for sonographic fetal weight estimations was 106.97±80.83, 198.88±124.32, 248.82±122.75, 308.31±138.97 and 446.00±151.46 g, in groups, respectively (p<0.001). The mean absolute percentage error for sonographic fetal weight estimations was 3.51±2.76, 6.37±3.91, 7.93±4.81, 9.87±4.32 and 14.06±5.83 in groups, respectively (p<0.001).

Conclusions: Our study showed that increasing maternal obesity decreases the accuracy of sonographic fetal weight estimations. Clinicians should be aware of the limitations of sonographic fetal weight estimation in especially obese patients.

Keywords: body mass index, fetal weight, obesity, ultrasonography

[PP-002]

Sonographic fetal weight estimation prior to delivery: analysis of interobserver variability and accuracy

Hüseyin Aksoy¹, Ülkü Aksoy², Fulya Çağlı³, Özge Idem Karadağ⁴, Gökhan Açmaz³, Mustafa Alparslan Babayiğit⁵, Turgut Aydın⁴

3Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey

Objectives: To evaluate the interobserver reliability of sonographic fetal weight estimation between two experience sonographers prior to delivery. We also sought to compare the sonographic EFW accuracies of operators.

Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal weight estimation prior to scheduled delivery. Two experienced sonographers performed all examinations prior to delivery. Sonographic fetal weight estimatios were obtained by each ultrasonographic examination. Estimated fetal weight (EFW) was compared with the actual birth weight (ABW) and interobserver reliability of sonographic fetal weight estimation between two

(3)

sonographers were assessed.

Findings: The final study included a total of 245 subjects. Inter-observer reliability coefficients with 95% confidence intervals for sonographic EFW was 0.864 (0.825-0.894, p<0.001). The median absolute error for sonographic EFW obtained by radiologist and obsterician was 192 (5-862) and 160 (0-590) g, respectively (p < 0.01). The median absolute percentage error for sonographic EFW obtained by radiologist and obsterician was 5.7 (0.1-26.9) and 5.0 (0-19.4), respectively (p<0.01).

Conclusions: Our study showed that interobserver reliability and agreement for sonographic EFW in third-trimester shortly before the delivery were quite high. However, significant difference between sonographic EFW accuracies of both operators was found.

Keywords: interobserver reliability, fetal weight estimation, ultrasonography

[PP-003]

Effect of Threatened Miscarriage on Maternal Mood: A Prospective Controlled Chort Study

Hüseyin Aksoy¹, Ülkü Aksoy², Özge Idem Karadağ³, Yunus Hacımusalar⁴, Gökhan Açmaz⁵, Gülsüm Uysal⁵, Fulya Çağlı⁵, Burak Yücel³, Turgut Aydın³, Mustafa Alparslan Babayiğit⁶

4Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey

Objectives: The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and threatened abortion (TA) and compare the

prevalence of anxiety and depression levels in pregnant women complicated with and without TA.

Methods: Between September 2013 and August 2014, 94 consecutive women with TA who were hospitalized and 120 healthy pregnant women without any signs and symptoms of miscariage, were included in the study. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were administered to patients during the psychiatric interview.

Findingss: The mean BAI scores in TA study and healthy control groups were 18.90±10.52 and 8.24±5.24, respectively (p<0.001). The mean BDI scores in TA study and healthy control groups were 18.07±8.49 and 7.47±6.22, respectively (p<0.001).

Conclusions: The findings of this study indicated a potential link between TA and anxiety and depression disorders. Therefore, patients with TA during pregnancy should be evaluated in terms of anxiety and depression disorders as much as their medical conditions. Medical professionals should be sensitive to psychological consequences of TA.

Keywords: abortion, depression, miscarriage, pregnancy

[PP-004]

Maternal Anxiety and Depression Levels in Patients with Hyperemesis Gravidarum: A Prospective Case-Control Study

Hüseyin Aksoy¹, Ülkü Aksoy², Özge Idem Karadağ³, Yunus Hacımusalar⁴, Gökhan Açmaz⁵, Gülsüm Uysal⁵, Fulya Çağlı⁵, Burak Yücel³, Turgut Aydın³, Mustafa Alparslan Babayiğit⁶

(4)

Objectives: The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and HG and compare the prevalence of anxiety and depression disorders in pregnant women with and without HG.

Methods: A prospective case–control study was performed at our tertiary referral centre. The study group consisted of 78 pregnant women with HG and 82 healthy pregnant women, constituted our control group. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory (BDI) were administered to patients during the psychiatric interview.

Findings: The mean BAI and BDI scores in HG study and healthy control groups were 19.47±10.92 and 7.30±5.35, respectively. The mean BDI scores in HG study and healthy control groups were 18.97±9.85 and 6.36±5.61, respectively (p<0.001). A total of 44 (56.4%) women in HG group had BAI score of >=16 and were classified as moderate or severe anxiety disorder. A total of 8 (9.7%) women in healthy control group had BAI score of >=16 and were classified as moderate or severe anxiety disorder. Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression.

Conclusions: The findings of this study indicated a possible relationship between HG and anxiety and depression disorders. Therefore, patients with HG during pregnancy should be evaluated in terms of anxiety and depression disorders as much as their medical conditions.

Keywords: anxiety, depression, hyperemesis, pregnancy

[PP-005]

Hyperemesis and Threatened Abortion in early pregnancy: relationship with anxiety and depression and review of the literature

Hüseyin Aksoy¹, Ülkü Aksoy², Özge Idem Karadağ³, Yunus Hacımusalar⁴, Gökhan Açmaz⁵, Gülsüm Uysal⁵, Fulya Çağlı⁵, Turgut Aydın³, Mustafa Alparslan Babayiğit⁶

Objectives: This study evaluated the current state of anxiety and depression levels in patients with HG and TA and compared the prevalence of anxiety and depression levels with healthy pregnant controls. The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and HG and TA and compare the results with healthy pregnant controls.

Methods: A prospective case–control study was performed at our tertiary referral centre. 84 consecutive women with HG and 88 consecutive women with TA constituted our study group and 98 healthy pregnant women constituted our control group. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I), was used to evaluate the anxiety and depression. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory (BDI) were administered to patients during the psychiatric interview and were evaluated by the same psychiatrist.

Findings: The mean BAI scores in HG, TA and healthy control groups were 17.34 ± 8.97, 17.23 ± 8.71 and 7.03 ± 5.45, respectively. The mean BDI scores in HG, TA and healthy control groups were 15.54 ± 7.81, 16.27 ± 6.72 and 6.68 ± 5.28, respectively.

Conclusions: The findings of this study indicated a potential link between HG, TA and anxiety and depression disorders.

Keywords: anxiety, depression, hyperemesis, pregnancy, threatened abortion

(5)

[PP-006]

Decreased pain expectation lowers labour pain experience

Hüseyin Aksoy¹, Ülkü Aksoy², Burak Yücel³, Gökhan Açmaz⁴, Turgut Aydın³, Mustafa Alparslan Babayiğit⁵

Objectives: The pain that women experience during labour is highly modifiable by psychological factors, including expectations. Positive expectations of patients could decrease any decisional difficulties. There is a lack of studies evaluating the correlation between pain expectation and labour pain. The present study was aimed to assess the relationship between pain expectation before labour, labour pain and pain perception after the labour in this study.

Methods: Five hundred and twelve pregnant women followed for spontaneous vaginal delivery were included to the study. Patients were asked to rate their pain level on a standard continuous 100- mm a visual analog scale (VAS) pain score at various time points: Pain expectancy(PE), labour pain (LP) and postpartum pain perception (PPP) scores were calculated.

Findings: The final study group was composed of 230 subjects after exclusions. Mean age of participants was 26.20±5.79. The mean PE, LP, and PPP scores were 7.01±1.88, 7.57±1.9 and 6.58±1.95, respectively. The difference among pain scores was statistically significant (p<0,001).

There was a positive correlation between PE and LP or PPP scores (.270 and.208, respectively) and the correlations were statistically significant (p<0,001).

PPP scores decreased with the decrement of LP scores. There was a positive correlation between LP and PPP scores (.869). The correlation was statistically significant (p<0,001).

Conclusions: Our study showed that, reducing pain expectations of pregnant women could decrease their pain experience during labour. Thus, multiple tools, such as education programs, relaxation, meditation, etc. that are aimed to decrease pain expectations of pregnant before delivery is essential and critical.

Keywords: Labor pain, pain management, visual analog pain scale

[PP-007]

Relationship Between Maternal C- Reactive Protein Level and Neonatal Outcome in Patients with Preterm Premature Rupture of Membranes

Mehmet Serdar Kutuk¹, Osman Bastug², Ahmet Ozdemir², Mehmet Adnan Ozturk², Mahmut Tuncay Ozgun¹, Mustafa Basbug¹, Tamer Gunes², Selim Kurtoglu²

1Erciyes Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD

2Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı

Objective To assess the relationship between maternal C- reactive protein (CRP) level measured within 48 hours before delivery and neonatal outcome in pregnant women with preterm premature rupture of membranes (PPROM) who were managed conservatively.

Methods: We retrospectively rewieved medical records of 70 singleton pregnancies with

PPROM with gestational ages between 24 and 34 weeks at the time of rupture of membrane. On the basis of antepartum CRP levels, patients were categorized into two groups (Group1: CRP <=

6mg/ L, N: 31, Group 2: CRP> 6mg/L, N: 39).The groups were

compared with regard to demographic characteristic, antenatal complications, postnatal morbidity and mortality.

Results: The two group were similiar with regard to baseline demographic data. The mean

birth weight was higher in Group1 (p: 0.041). The overall neonatal mortalitiy was 10% (7/70). The two groups were similiar for other neonatal complications and overall

neonatal mortality, and composite morbidity (Table 1). The most important difference between

(6)

neonates with good outcome and poor outcome were birth weight and gestational age at birth (Table 2). There was no correlation between antenatal CRP levels and postnatal infectious morbidity.

Conclusion: Elevated level of CRP within 48 hours of delivery is a poor predictor of postnatal outcome.

Keywords: Premature rupture of membranes, C- reactive protein, postnatal outcome, neonatal sepsis

[PP-008]

Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating The Vein of Galen Aneurysmal Malformation

Mehmet Serdar Kutuk¹, Selim Doganay², Ahmet Ozdemir³, Sureyya Burcu Gorkem², Mehmet Adnan Ozturk³, Mustafa Basbug¹

2Erciyes Üniversitesi, Tıp Fakültesi, Radyoloji AD, Pediatrik Radyoloji Bilim Dalı

3Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı

26 years old primigravida referred for intracranial cyst, and cardiomegaly. Transabdominal ultrasonography (US) showed vein of Galen aneurysmal malformation (VGAM), and mild

cardiomegaly (Figure 1). Follow- up US at 32 weeks showed progressive cardiomegaly, and heart failure. At 34 weeks, US revealed a hyperechogenic, homogenous mass that was measured 25x25x31mm, at left suprarenal region. The mass had a spherical shape with a central stripe as the character of a normal adrenal gland but with greater thickness(Figure 2). No vascular flow was detected inside the mass by power Doppler study. Fetal magnetic resonance imaging (MRI)

confirmed the sonographic diagnosis. The baby was delivered at 37 weeks by cesrean section, and died of severe heart failure at postpartum 18th hours. Postnatal MRI confirmed the prenatal diagnosis (Figure 3). Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the surrenal gland in affected cases may contribute to the prenatal counselling, and postnatal management.

Keywords: Adrenal hemorrhage, Vein of Galen Aneurysmal Malformation, ultrasonography, prenatal diagnosis

[PP-009]

Evaluation of Fetal Anterior Abdominal Wall Thickness in Gestational Diabetic Pregnancy: A Prospective Case-Control Study

Hüseyin Aksoy¹, Ülkü Aksoy², Sezin Özyurt³, Özge Idem Karadağ⁴, Turgut Aydın⁴, Mustafa Alparslan Babayiğit⁵

Objectives: To investigate patients with gestational diabetes mellitus (GDM) with regard to fetal anterior abdominal wall thickness (AAWT) and other fetal biometric measurements, such as biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW), and to compare the results with healthy pregnant controls.

Methods: A total of 124 pregnant women between 26 and 28 weeks’ gestation were included in the study. These patients were divided into two groups based on their 75-g oral glucose tolerance test (OGTT) results. The study group consisted of 55 pregnant women with GDM, and 69 healthy pregnant women constituted our control group. Each subject underwent a one-step approach using a 75-g OGTT and an obstetric ultrasound examination. The fetal biometrical measurements (BPD, FL, AC, and EFW) and AAWT were obtained from the ultrasonographic examinations.

(7)

Findings: The study groups did not differ with respect to the mean BPD, FL, AC, and EFW;

however, the mean AAWT was significantly higher in the GDM group, 4.07 ± 0.46 mm versus 3.28

± 0.37 mm in the control group (p < 0.001).

Conclusions: The only fetal sonographic measurement found to significantly differ between the study groups was the AAWT, suggesting that measuring the AAWT may have a role in the

evaluation of fetal growth in pregnancies complicated by gestational diabetes. Clinicians should be aware of the limitations of traditional fetal biometric parameters in the detection of early fetal growth changes in patients with GDM.

Keywords: abdominal wall thickness, gestational diabetes, ultrasonography

[PP-013]

MikroTESE ile sperm elde edilerek yapılan icsi vakasında komplet hidatiform mol ve dikoryonik diamniotik ikiz birlikteliği

Nur Dokuzeylül Güngör¹, Aynur Erşahin¹, Betül Görgen¹, Suat Süphan Erşahin², Kağan Güngör³

1Medicalpark Göztepe Hastanesi-Tüp Bebek Ünitesi

2Medicalpark Bahçelievler Hastanesi-Kadın Hastalıkları ve Doğum

3İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi

Gestasyonel trofoblastik hastalıklar(GTH) fetal trofoblastik dokudan köken almaktadır. Mol hidatiform gestasyonel trofoblastik hastalıkların en sık görülen formudur.Bu çalışmada nadir görülen icsi sonrası mol gebelik ve dikoryonik-diamniotik ikiz birlikteliği olgusu sunuldu.24 yasında bayan hasta 9. gestasyonel haftada rutin gebelik kontrolü istemi ile merkezimize başvurdu.Gravida 1, para 1,yaşayan 1 canlı çocuğu mevcut olan hastanın üçüncü tüp bebek denemesiydi.vakanın tüp bebek tedavisine alınma nedeni ise erkekte enfeksiyona sekonder gelişen azospermiydi. Bunun dısında ozgecmisinde ve soygecmisinde ozellik yoktu. Transvajinal ultrasonografi ile yapılan

muayenesinde iki adet gestasyonel kese izlendi.keselerden birinde baş popo mesafesi (CRL) 8 hafta 5 gün ile uyumlu 25.7 mm,kalp atış hızı147/dk olan gebelik izlendi.Diğer kese içerisinde ise kistik komponentleri olan büyük bir plasenta izlenmekteydi.Laboratuar bulgularında BhCG si 250094 mIU/ml.Hematokrit %40, lökosit 10.200 /mm-3, trombosit 258,000 mm-3’ dir. Koagulasyon profili, tiroid fonksiyon testleri ve biyokimyasal parametreler normal sınırlar icindeydi. Akciğer grafisinde metastaz ile uyumlu bulgu saptanmamıstır.Hasta olası komplikasyonlar ve malinite riski ile ilgili bilgilendirildi.Hasta gebeliğe devam kararı aldı.Hasta halen 14 haftalık gebelik olarak devam etmektedir.Yardımcı üreme tekniklerinin daha sık kullanılıyor olması çoğul gebelikleri ve buna bağlı komplikasyonları arttırmaktadır.Yasayan fetuslu molar gebeliklerde ozellikle gebelik devamı

isteniyorsa yonetimi daha zordur. Malign hastalığa progresyon insidansı komplet mol ve canlı fetus varlığında %56-62 iken parsiyal mol ve canlı fetus varlığında %4’dur. Nadiren sağlıklı fetus ve molar gebelik konusunda yayınlar olsa da terminasyon ve seri olarak serum β-hCG olcumlerinin yapılmas en cok tercih edilen protokoldur. Bu vakada hastaya olası

komplikasyonlar hakkında bilgi verilmis, hastanın devam yonunde karar vermesi uzerine takibi yapılmaktadır.Katastrofik komplikasyonlardan kacınmak icin terminasyon ilk secenek olmalıdır.

Anahtar Kelimeler: mol gebelik, icsi, dikoryonik diamniotik ikiz

(8)

1

2

3

(9)

4

(10)

5 [PP-014]

Osteopetrosis Kongenita Olgusunda Preimplantasyon Genetik Tanı Yöntemiyle Gebelik Elde Edilmesi

Nur Dokuzeylül Güngör¹, Aynur Erşahin¹, Betül Görgen¹, Suat Süphan Erşahin², Kağan Güngör³

1Medicalpark Göztepe Hastanesi

2Medicalpark Bahçelievler Hastanesi

3İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi

Malin infantil osteopetrosis otozomal resesif geçiş gösteren,nadir görülen tek gen hastalıklarından birisidir.Vaküoler proton pompalarının TCIRG1 subünitesinde meydana gelen mutasyona

bağlıdır.200 binde bir görülür.Vakamız daha önce bu nedenle 2 kez çocuk kaybı yaşamış bir çiftimizdi.Fertil olan çift bize PGT yaptırmak için başvurdu.35 yaşındaki hastamıza antagonist protokol uygulandı.3 oosit alındı.2 tanesine 3. günde babadaki TCIRG1geni c.2415-2A>g taşıyıcılığı nedeniyle blastomer biyopsisi yapıldı.Sağlıklı çıkan 5AA tek embriyo 5. günde transfer yapıldı.OPU sonrası 14. günde bakılan BhCG 157 geldi.İlk test sonrası 3. haftada yapılan transvajinal

ultrasonografide canlı tekil gebelik izlendi.Hastamızın gebeliğinin 16. haftasında amniosentez ile tanı doğrulandı.Hasta 22 haftalık gebelik olarak kliniğimizde takip edilmektedir.

Anahtar Kelimeler: osteopetrosis, PGT

(11)

[PP-015]

Kardiyoversiyon uygulaması sonrası gelişen ablasyo plasenta: olgu sunumu

Mehmet Serdar Kutuk¹, Murşide Şahin¹, Muhammed Said Coşgun², Mahmut Tuncay Özgün¹, Mustafa Basbug¹

2Erciyes Üniversitesi, Tıp Fakültesi, Kardiyoloji

Gebelikte maternal aritmi insidansı gebelikte 1000 de 1,2 oranındadır ve bunların %50 si

asemptomatiktir. Supraventriküler (SVT) taşikardi ve malign ventriküler aritmiler gebelikte daha sık görülür. SVT tedavisinde Valsalva manevrası, sinus karotis masajı ve medikal tedaviye cevap alınamadığında ya da hemodinamik instabilite olduğunda kardiyoversiyon uygulanır.

29 yaşında G(3),P(2), bilinen ek bir hastalığı olmayan 28 haftalık gebe preterm eylem ve maternal supraventriküler taşikardi nedeniyle kliniğimize sevk edildi. Hastanın nabzı: 116/dakika ve EKG si akut AF ile uyumluydu. Karotis masajı ve digoksin (1 mg) tedavisine yanıt vermeyen hastaya 150 joule ile senkronize kardiyoversiyon yapıldı. İşlem sonrasında hastanın kalp ritmi sinüs ritmine döndü. İşlemden hemen sonra yapılan non- stres test de uzamış fetal bradikardi izlenmesi üzerine hasta acil sezeryana alındı. Operasyonda plasentanın %40 dekole olduğu izlendi. 1090 gr

ağırlığında, 6–7 APGAR lı, bir kız bebek doğurtuldu. Bebek yenidoğan yoğun bakımda takip

edildikten sonra şifa ile taburcu edildi. Hastaya postoperatif, metoprolol 1x 50 mg tedavisi başlandı.

Takiplerinde aritmi izlenmedi.

Kardiyoversiyon sonrası fetal bradikardi gelişebileceği bilinmekle beraber, sunduğumuz vaka, literatürde bildirilen ablasyo plasenta ile komplike olmuş olan ilk olgudur. Kardiyoversiyon sonrasında artmış uterin kontraksyonlar nedeniyle fetal distress ve acil sezaryan ihtiyacı

olabilaceğinden, işlem yakın fetal monitorizasyon altında ve obstetri ekibinin eşliğinde yapılmalıdır.

Anahtar Kelimeler: Kardiyoversiyon, ablasyo plasenta, fetal distress, aritmi

[PP-016]

Treatment of refractory supraventricular tachycardia with amiodarone: a case report

Mehmet Özgür Akkurt, And Yavuz

suleyman demirel university, faculty of medicine, Department of perinatology, Isparta, turkey

Objective: Most fetal tachyarrhythmias are benign but some types cause non-immun hydrops and fetal heart failure and result in prenatal and postnatal death. Amiodarone, a class 3 antiarrhythmic drug, can use treating for refractory fetal arrhytmias.

Case: A pregnant referred to our department at 26 weeks’ with hydrops fetalis. We detected supraventicular tachiacardia at 220 bpm and there was no further cardiac and structural anomaly.

First of all digoxin treatment was initiated. Oral amiodarone was added when tachicardia and hydrops fetalis persisted 3 days after digoxin treatment. a pregnant delivered at 32 weeks’ and we did not see recurrence of supraventicular tachiacardia with treatment of amiodarone 200 mg per a day.

Conclusion: Untreated SVT can be mortal and treatment should start immediately. Amidarone can use treating SVT alone or combination with antiarrhythmic drugs considering maternal and fetal side effects.

Keywords: amiodarone, fetal arrhythmia, hydrops

(12)

figure 1

fetus had supraventricular tachycardia with 220_bpm.

figure 2

(13)

nonimmun hydrops fetalis in transverse abdominal view

figure 3

(14)

31 atrioventricular blok has been developed by amiodarone treatment 400 mg twice a day.

figure 4

(15)

fetus had normal heart rate135 bpm after decreasing amiodarone dose 400 mg per a day.

[PP-017]

Cervical Ripening Balloon: a Successful Treatment to Control Massive Bleeding in Cervical Pregnancy

Mert Turgal, Emine Aydın, Nergis Kender, Zafer Selcuk Tuncer

Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

Introduction

Cervical pregnancy (CP) is rare and life-threatening form of ectopic pregnancy. Currently, there is no consensus optimal treatment for CP. However, general principles in the management of cervical pregnancy should include the following: minimize the risk of hemorrhage, evacuated the

gestational cervical product, and sparing patient’s fertility. Here, we report a case of 9 weeks of gestation cervical ectopic pregnancy with positive fetal cardiac activity successfully treated

multimodal therapy which is intraamniotic potassium chloride (KCL), systemic methotrexate (MTX), curettage of cervix, and cervical ripening balloon (CRP) tamponade for abandoned cervical

bleeding.

Case Presentation

A twenty-eight years old primigravid pregnant woman referred to our clinic for suspicion of CP. On pelvic examination, cervix was enlarged and appeared “barrel shape” on inspection. Transvaginal ultrasonography revealed a CP with positive fetal cardiac activity consistent 91/7 weeks of gestation and endometrial cavity was normal. Magnetic resonance imaging was confirmed CP.(Figure1) Her quantitative β-hCG concentration was 115,226 mIU/mL on admission.

Considering the patient’s hemodynamic stability and desire to maintain fertility, conservative expectant management with local KCl and systemic methotrexate administrations were decided.

Then, we performed 2 mL (2 mEq/mL) KCl injection in the cardiac cavity of fetus with

(16)

transabdominal approach. Additionally, patient was also treated systemic multidose MTX (1 mg/kg, days 1, 3, 5, and 7) and leucovorin (0.1 mg/kg, days 2, 4, 6, and 8) rescue therapy. Serially evaluated β-hCG concentrations were progressively declined during 10 days. In this period

gestational sac was deforming. Fourteen day after treatment, because of β-hCG concentration was relatively to plateau, we decided surgical intervention.(Table I) In the operating theatre under ultrasound control, curettage of the cervical canal was performed. The whole conceptus materials were removed. Intraoperative bleeding was about 900 mL. Two units of red blood cell were transfused intraoperatively. Because of bleeding was not stopped, we decided a cervical ripening balloon (Cook Medical, Bloomington, IN, USA) into the cervix. Uterine part of the CRP balloon was inflated with 70 mL saline solution at under sonography guidance. Thereafter, vaginal part was then inflated with 80 mL saline solution.(Figure 2) Bleeding was controlled with this procedure. Two days after the procedure we removed the balloon. Vital sing were stable and she had no complaint included vaginal bleeding. The patient was discharged in good health. Thirty days after treatment, serum β-hCG concentration declined continuously to 10,0 mIU/L. Transvaginal ultrasonography showed a normal uterine cervix in size and contour.

Conclusion

Obstetric hemorrhage is the leading cause of maternal morbidity and mortality. There are different balloon catheters which can be used such as Bakri balloon, Sengstaken-Blakemore tube, Rusch balloon, and Foley catheters in obstetric hemorrhage. Although CRB is designed for the induction of labor, its application was also successfully performed in cases of postabortion massive hemorrhage and postpartum hemorrhage. To our knowledge, this report describes the first time this approach has been performed in a CP case. Since it is a safe and valid method, we believed that the use of CRB in conventional treatment method for CP cases can be used to bleeding control.

Keywords: cervical ectopic pregnancy, cervical ripening balloon, conservative treatment, methotrexate, obstetric hemorrhage.

Table I: Graphic shows serum β-hCG concentrations course.

(17)

Figure 1: MRI show cervical ectopic pregnancy. (arrows: cervical pregnancy with embryo, arrowhead uterus, B: bladder).

Figure 2: Transabdominal sonographic image of cervical ripening catheter after procedure. Inflated double-balloon cervical ripening catheter placed cervix (C) and vagina (V). (arrow: uterus)

(18)

[PP-018]

Mercury Concentration in Maternal Serum, Cord Blood, and Placenta in Patients with Amalgam Dental Fillings: Effects on Fetal Biometric Measurements

Rahime Bedir Findik¹, Huseyin Tugrul Celik², Ali Ozgur Ersoy¹, Yasemin Tasci¹, Ozlem Moraloglu¹, Jale Karakaya³

1Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey

2Department of Biochemistry, Turgut Ozal University, Ankara, Turkey

3Department of Biostatistics, Hacettepe University, Ankara, Turkey

Objectives: We aimed to determine the extent to which mercury is transmitted from the mother to fetus via the umbilical cord in patients with amalgam dental fillings, and its effect on fetal biometric measurements.

Methods: Twenty-eight patients as the study group with amalgam fillings, and 32 of them as the control group were included in this prospective case-control study. The mercury levels were measured in the maternal and cord venous sera, and the placental samples. Two groups were compared in terms of these and the fetal/neonatal biometric measurements.

Findings: In the study group, the maternal and umbilical cord mercury levels were found to be significantly higher than those from the control group (p=0.006 and p=0.010, respectively). These high levels did not affect the fetal biometric measurements.

Conclusions: The presence of high serum mercury levels in pregnant women with amalgam fillings is important, and warrants further long term studies in order to investigate the fetal neurological effects as well.

Keywords: Dental amalgam, mercury, maternal-fetal exchange, pregnancy outcome

Comparison of demographic characteristics between two groups.

Characteristics Without amalgam fillings (n = 32)

With amalgam fillings

(n = 28) P value

Maternal Age

(year) 25 ± 5.9 25 ± 5.7 0.556

Maternal BMI (kg/m2) 28.10 ± 4.26 28.28 ± 3.55 0.863

Number of Gravidity

1…n:13 (52 %) 2…n:9 (50 %) 3…n:6 (50 %) 4…n:4 (80 %)

1…n:12 (48 %) 2…n:9 (50 %) 3…n:6 (50 %) 4…n:1 (20 %)

0.725 Mother’s Occupation

Housewife: 32 (55.2 %) Working: 0

Housewife: 26 (44.8 %) Working: 2 (%100) 0.214

Mercury levels and neonatal biometric parameters in patients with and without amalgam dental fillings.

Characteristics

Without amalgam fillings

(n = 32)

With amalgam fillings

(n = 28)

P value

Mercury Levels in Maternal Blood 0.27±0.7 0.50±0.7 0.006

(19)

(μg/L)

Mercury Levels in Cord Blood (μg/L) 0.3±0.2 0.5±0.4 0.01 Mercury Levels in Placental Tissue

(μg/g) 1.1±0.8 1.2±0.8 0.644

Birth Weight (gr) 3320±394 3395±492 0.519

Birth Length (cm) 50±1.7 50±1.8 0.962

Head Circumference of the Infant

(cm) 34±1.2 35±1.1 0.398

Gender of the Baby (male=M, female=F)

M:20 (55.6%) F:12 (50%)

M:16 (44.4%)

F:12 (50%) 0.874

[PP-019]

Ruptured Endometriotic Cyst Mimicking Acute Appendicitis During Pregnancy

Ali Ozgur Ersoy, Irem Eda Gokdemir, Ebru Ersoy, Aykan Yucel

Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey

A twenty-one year-old primigravid pregnant woman of 33 weeks gestation applied to our

Perinatology Clinics with acute abdominal pain. The pain was spreading from midline to right lower quadrant of the abdomen.Guarding and rebound tenderness existed in the right lower quadrant.

Ultrasonographic examination revealed a single, alive fetus, and normal amniotic fluid. Whole blood count revealed leukocytosis and there was no sign of preterm labor or placental abruption. Fetal heart rate decelerations in non-stress test were observed, and a decision for cesarean section and abdominal exploration were made.

A healthy male baby with Apgar score of 7 and 9 at first and fifth minute (respectively) was delivered. In the abdominal exploration all peritoneal surfaces were coated with a dark red, brown colored dense material, like mud, and there were two endometriotic cysts in the left ovary; one of them with 6 cm mean diameter had been ruptured (Figure 1); the other with 2-3 cm mean diameter was intact (Figure 2). Both of them were excised and sent for pathologic examination.

Also, there were dark-blue, powder-burn black colored millimetric endometriotic foci spreading over the peritoneal surfaces (Figure 3). The patient had no problem in postoperative two days and was discharged. Final pathologic diagnosis was reported as endometriotic cysts. We think that this case is a nice example of misleading the clinician as if the scene was consistent with acute appendicitis.

Keywords: Pregnancy, endometriotic cyst, rupture

(20)

Figure 1

Posterior view of uterus and left ovary which had two endometriotic cysts and one of them had been ruptured.

Figure 2

(21)

Posterior view of the uterus and the smaller and intact endometriotic cyst in the left ovary can be seen. Note all the peritoneal surfaces was covered by endometriotic material.

Figure 3

(22)

One of several millimetric endometriotic foci spreading to different peritoneal surfaces (white arrow). It can be seen dark-blue, powder-burn black colored and located in front of the right infundibulopelvic ligament.

[PP-020]

An unusual complication of vesicoamniotic shunt: coiling of the shunt around lower extremity associated with dislodgement

Mehmet Özgür Akkurt, And Yavuz

Suleyman Demirel University, Faculty of Medicine, Department of Perinatology, Isparta, Turkey

Background: Vesicoamniotic shunt (VAS) is a procedure that aims to reduce intraluminal pressure of the foetal bladder and the upper urinary tract. Here, we report an unusual complication of VAS, coiling of the shunt around foetal lower extremity associated with dislodgment.

Case: A 33-year-old multigravida was referred for further evaluation of foetal obstructive uropathy.

The primary diagnosis was posterior urethral valves(PUV), since the ultrasound(US) scan showed a dilated posterior urethra in line with the typical “keyhole sign” in a male foetus.

Foetal karyotype by amniocentesis demonstrated a 46, XY normal male pattern. Then, a vesicoamniotic shunt placement via the transabdominal route was performed at 20 weeks.

Following the procedure, foetal amniotic fluid and bladder volume returned to normal within 7 days. Amniotic fluid and foetal bladder volume remained within normal ranges, however began to decrease by 33 weeks’ gestation, causing redistention of the foetal bladder and oligohydramnios.

US showed a dislodged shunt into the foetal abdominal cavity (Figure 1(a)). At birth, shunt was observed to be coiled around the left lower extremity (Figure 1(b) and Figure 1(c)), but there was no limitation of movement at the extremity. At 9 months of age, the infant had no joint deformity, and he underwent endoscopic ablation of the PUV. He had normal renal function at 12 months of age.

Conclusion: In utero VAS may be a viable option in carefully selected cases of foetal lower urinary

(23)

tract obstructions, it has unpredictable and unavoidable complications such as the present case reported here.

Keywords: Posterior urethral valve, post-operative complication, vesicoamniotic shunt

figure 1

Figure 1(a): Ultrasound scan showing the migration of the shunt into the foetal abdominal cavity Figure 1(b): The shunt was coiled around the left knee joint. Figure 1(c): After birth, a contracture was observed due to coiling of the shunt.

[PP-021]

AKROMEGALİ VE GEBELİK (Olgu Sunumu)

Mehmet Kulhan¹, Ümit Naykı¹, Gözde Kulhan², Cenk Naykı¹, Paşa Uluğ¹, Yusuf Yıldırım¹

1Erzincan Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Erzincan

2Samsun Kadın Doğum ve Çocuk Hastalıkları Hastanesi, Samsun

Giriş: Aşırı büyüme hormonu salgılanması ile karakterize olan akromegalide, bozuk gonodotropik aks nedeniyle hastalar, genellikle amenoreik ve infertildirler.Bu nedenle gebelik ve akromegali nadir bir birlikteliktir ve literatürde oldukça az olgu bildirilmiştir. Ayrıca, diabetes mellitus ve

kardiovasküler hastalıkların prevelansının yüksek olması nedeniyle bu hastalar yüksek riskli gebe olarak değerlendirilirler.

Olgu: Otuzüç yaşında G4P2Y2A1, 6 hafta 2 günlük gebeliği bulunan hasta Samsun Kadın Doğum ve Çocuk Hastalıkları Hastanesine başvurdu. Hastanın hikayesinde yaklaşık 2 yıl önce adet

düzensizliği, galaktore, hirsutizm ve görme bozukluğu şikayetleri nedeni ile yapılan fizik

muayenesinde el ve ayaklarda büyüme ve yüzde kabalaşma izlendiği, hipofiz MRG sonucu hipofiz bezinde yaklaşık 25x25 mm’lik adenom tespit edilmesi ve kan tetkiklerinde GH: 2.6 ng/mL, İGF-1:

1392 olarak normalin üstünde saptanması üzerine akromegali tanısı konulduğu ve sonrasında transsfenoidal adenektomi uygulandığı öğrenildi. Postoperatif 4.ayda rekürrens tespit edilen hastaya günlük lanreotid ve haftada 2 kez kabergolin başlanmış. Tedavinin 1.ayında gebe kalan ve kendi isteği ile gebeliği sonlandırılan hastanın 6 aylık medikal tedavi sonrasında tekrar gebe kaldığı öğrenildi. Hastada, gebelik öncesi yüksek olan İGF-1’in (500-600 ng/mL) ilk trimesterde tedrici olarak azaldığı ve 300 ng/mL seviyesinde plato çizdiği gözlendi. Her vizitte kan basıncı, kilo alımı, ödem varlığı, görme alanı muayenesi, fetal biyometri ve amniyon sıvı indeksi değerlendirildi.

Gebelik boyunca hastada klinik olarak şikayet olmadı ve fetüsün antenatal takibi normaldi. Hasta gebeliğin 39. haftasında sezaryenle 3600 gram erkek bebek 8 apgarla canlı olarak doğurtuldu.

Postoperatif dönemde anne ve yenidoğanda herhangi bir komplikasyon gözlenmedi.

Sonuç: Akromegalisi olan gebeler çok nadir olmakla birlikte riskli gebelerdir ve yakın takip edilmeleri gerekmektedir.

Anahtar Kelimeler: Akromegali, Gebelik

(24)

[PP-022]

The Relationship of Striae Gravidarum with Cesarean Scar Characteristics and Peritoneal Adhesions

Esra Yasar Celik, Ali Ozgur Ersoy, Ebru Ersoy, Ozlem Yoruk, Aytekin Tokmak, Yasemin Tasci Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey

Objectives: The aim of this study was to evaluate the relation between striae gravidarum (SG) score and abdominal scar characteristics together with intraperitoneal adhesion (IPA) grades of patients who are having their second cesarean deliveries.

Methods: Totally 145 women, hospitalised for cesarean section (CS) were included in this prospective observational study between November 2013 and January 2014. Groups were conducted according to the SG status, as women with no SG: Group 1 (n=53), mild SG: Group 2 (n=27) and severe SG: Group 3 (n=65). Groups were compared with various sociodemographic properties, cesarean scar characteristics and IPA scores.

Findings: No significant difference in the length, width and colour of the scar was detected among groups. Although flat scar was the most prominent scar form among all groups, elevated scar was significantly more frequent in group 1 (p=0.009). Intraperitoneal adhesion grade was 0 or 1 in 77.3% of group 1, 81.3% of group 2 and 76% of group 3. There was no significant difference in IPA scores between groups (p=0.884). With regard to scar properties (flat, depressed and elevated) and SG status [SG (+) or SG (-)], we found no difference between IPA groups.

Conclusions: SG is found associated with scar characteristics, but not associated with intraperitoneal adhesions.

Keywords: Striae distensae, cesarean section, scar, focal adhesions

[PP-023]

A brief glance to prenatally diagnosed fetal arrhythmias: Two-year experience of a tertiary center

Doruk Cevdi Katlan, Bahar Konuralp Atakul, Tuncay Yüce, Acar Koç, Feride Söylemez

Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Aim

The final common pathway to death in all human beings is an arrhythmia. At no other time in life cycle, is the human at more risk of unexpected death than during the prenatal period. Although most lethal cardiac rhythm disturbances occur during apparently normal pregnancies, some manifest fetal arrhythmias may be recognised prenatally (0,6-2,0% of all pregnancies). Hereby, it is intended to highlight the importance of some factors that the clinician should pay extra attention upon encountering fetal arrhythmias.

Methods

Prenatal and postpartum data of the patients, who were prenatally diagnosed to have fetal arrhythmia between January 2013 and April 2015 at Ankara University Department of Obstetrics and Gynaecology Perinatology Unit, were presented.

Results

A total of 9 cases were scrutinized. None of the patients had maternal arrhythmia, anemia, leucocytosis, thyroid hormone or serum electrolyte disturbance and history of previous arrhythmic children. All were free of any chronic disease except one, who had Systemic Lupus Erythematosus diagnosed during her gestation before the onset of fetal dysrhythmia. She was the only patient to deliver preterm at 33 weeks due to intrauterine growth restriction and fetal distress while the rest

(25)

reached term. None of the fetuses showed prenatal signs of neither hydrops nor any

echocardiographic structural abnormality. Postpartum fetal serum electrolytes were normal for all.

Prenatally 3 fetuses demonstrate atrial ectopy, 4 demonstrate bradycardia of varying severity (2 severe, < 90 beats/minute; 2 mild, 90-110 beats/minute) and the remaining 2 demonstrate alternating combination of these two. Both of the 2 severely bradycardic ones had maternal Anti- Ro/SSA and ANA positivity with relative early onset of arrhythmia (19w6d, 21w3d) and one had 2:1 atrioventricular block (also had Anti-La/SSB positivity). Arrhythmia was stable for 5 of the 9 patients (55,6%) throughout the pregnancy. Among those, 4 (80,0%) persisted postpartum and the fetuses needed neonatal intensive care unit (NICU) follow up. 2 (40,0%) fetuses had

concomitant extra-cardiac fetal anomalies (1 multicystic dysplastic kidney, 1 cleft lip & palate, hypospadias, corneal opacity, hypertelorism, flexion contractures).

Conclusions

The detection of a fetal arrhythmia by an obstetrical care provider should prompt referral to a center of excellence for further assessment. Maternal risk factors should be carefully examined and fetus should undergo a thorough pre and post natal evaluation. Extra attention should be paid to sustained arrhythmias since they tend to be persistent postpartum, NICU need is probable and fetal anomalies may co-exist. Fetal ectopy is a relatively benign condition but severe

bradyarrhythmias may be related to immune-mediated inflammation and fibrosis of the fetal conduction system by maternal antibodies which can cross the placenta and may end up in fetal atrioventricular block.

[PP-024]

A challenging threat for the fate of a normal fetus: Placental Mesenchymal Dysplasia

Doruk Cevdi Katlan ¹, Bahar Konuralp Atakul¹, Tuncay Yüce ¹, Feride Söylemez¹, Acar Koç¹

1Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Background – Aim

Placental mesenchymal dysplasia (PMD) is a rare but benign placental disorder with a reported incidence of 0,02% and a female preponderance. Although karyotype is normal in most cases, PMD is associated with many other maternal and fetal risks. Only 9 % of pregnancies with PMD end uncomplicated. By the accumulation of information from more than 100 cases reported till now and thanks to the development of high-tech imaging modalities, we are now a bit more successful in both the early differential diagnosis and foresight of the risks. However, placental pathologic examination is paramount to establish definitive diagnosis. Herein, we present two cases of PMD in which the pregnancy concluded in two different points at the negative side of the disease

spectrum: termination and early preterm delivery of non-viable fetus.

Case Reports

28-year old primigravid woman was admitted upon detection of placental cystic structures on routine ultrasound scan at 23 weeks of gestation. Detailed sonographic evaluation revealed a completely normal female fetus with diffusely dispersed multiple hypoechoic spaces within the thickened placenta. Amniocentesis was normal. The patient was informed about the possible diagnosis of PMD and decided to continue her pregnancy taking full account of the risks. A few days later, she described bleeding and leakage of amniotic fluid which resulted with the delivery of a 560 gr dead fetus vaginally. The placenta was bulky weighing 1500 grams. Pathologic

examination documented PMD.

21-year old gravida 2 para 0 woman with a history of previous early miscarriage presented with a thickened placenta on routine ultrasound scan at 16 weeks of gestation. Detailed examination demonstrated a normal male fetus with heterogeneous, cystic and thickened placenta almost entirely filling the uterine cavity. The patient was informed about the risks and she opted for termination of pregnancy. Post termination karyotype analysis was normal and pathology documented PMD.

(26)

Conclusion

Upon detection of large-cystic placenta by sonography, the initial step is the detailed evaluation of the fetus. An abnormal fetus may be indicative of a triploid partial mole. A normal fetus however, requires a closer examination of the placenta. A heterogeneous thickened placenta with partially solid and hypoechoic cystic areas may indicate PMD as well as a complete mole with co-twin. At this point a promising recently reported Doppler sign may be distinctive. “Stained-glass” appearance of various degrees of blood flow under low pulse repetition frequency setting may be suggestive of PMD. PMD with normal karyotype in a low risk patient may lead to pregnancy follow up after proper counselling about the risks; however, termination may be an option upon parental consent or in case of the exact opposite of the above mentioned conditions.

[PP-025]

A rare case of primary lymphedema in pregnancy with subacute venous thrombosis

Catherine Rose De Guzman Dela Rosa

Obstetrics & Gynecology Department, Delos Santos Medical Center

INTRODUCTION

Primary Lymphedema occurs in 1/6000 live births. This is secondary to lymphatic agenesis, hypoplasia, or obstruction. Pregnancy has a relative risk of 4.3 % for venous thromboembolism (VTE) and is characterized by increased thrombin-generating potential, decreased endogenous anticoagulant effects and impaired fibrinolysis.

CASE PRESENTATION

A 26 year old primigravid, a diagnosed case of primary lymphedema, presented with bilateral leg swelling on her 22 weeks AOG. AV Dupplex scan of the lower extremity showed subacute venous thrombosis. Antenatally, she was diagnosed with gestational diabetes mellitus (GDM) controlled by medical nutrition therapy. At 30 weeks AOG, she was admitted for IV tocolysis with magnesium sulfate. Anti-coagulation with heparin and unfractionated heparin was maintained until 37 weeks AOG. Antenatal corticosteroids were administered with weekly surveillance of Biophysical Profile, Non Stress Test (BPS w/ NST), and glucose monitoring. At 38 weeks AOG, patient delivered vaginally under epidural anesthesia. Unfractionated heparin was continued at postpartum.

Contraceptive with Medroxy Progesterone Acetate IM was initiated at 6 weeks postpartum.

CONCLUSION

Rigorous antenatal and postnatal surveillance is key in the management of pregnancy complicated by primary lymphedema and venous thrombosis

Keywords: primary lymphedema, subacute venous thrombosis

[PP-026]

Low Maternal Glucose Levels on 50 g Glucose Challenge Test Support Protective Effects for Neonatal Outcomes

Hasan Onur Topçu, Can Tekin Iskender, Sevki Celen, Aslı Oskovi, Dilek Uygur, Salim Erkaya Zekai Tahir Burak Women Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey

Objective: To assess the perinatal outcomes in pregnant women with maternal hypoglycemia following second trimester oral glucose challenge test (GCT).

Study Design: This retrospective case control study consisted of 2091 pregnant women who had hypoglycemia (glucose levels less than 88 mg/dl 1 hour following 50 gr GCT) on second trimester pregnancy and control group consisted of 2091 pregnant women with a GCT result between 88 and 130 mg/dl. Perinatal and neonatal characteristics obtained from electronic medical records were compared between groups.

(27)

Results: The rates of pregnancy complications were similar in both groups, except for a lower incidence of polyhydramnios and higher rate of deliveries before the 34th week of gestation in patients with hypoglycemia (0.5 vs. 1.1%, p=0.016 vs 2.6 vs. 1.7%, p=0.033); respectively.

Neonates born to mothers with hypoglycemia had significantly less birth trauma (0.3 vs. 0.9%, p=0.027) and neonatal hypoglycemia. When the data for male and female infants were analyzed separately, male infants had a 1.5-fold (95% CI: 1.05–2.18) increased chance of being small for gestational age (SGA), while the risk for female infants did not increase (OR: 0.79, 95% CI: 0.56–

1.11).

Conclusion: Low maternal plasma glucose level on the GCT is associated with favorable outcomes, such as decreased rates of birth trauma and neonatal hypoglycemia. In addition, male infants have a higher risk of being SGA than female infants when maternal GCT results were <88 mg/dl.

Keywords: hypoglycemia, 50 g oral glucose challenge test, perinatal outcomes, low birth weight, gender

Figure 1

Histograms of glucose challenge test results, neonatal birth weight and gestational age at

delivery in patients with hypoglycemia on GCT and control group

(28)

Figure 2

Risk of macrosomia in male and female fetuses obtained for different oral glucose challange test thresholds

Figure 3

(29)

Risk of small for gestational age in male and female fetuses obtained for different oral glucose challange test thresholds

Figure 4

Table 1. Comparison of clinical characteristics and pregnancy outcome between groups.

(30)

Hypoglycemia on GCT (n = 2091)

Control

(n = 2091) p

Age (years) 26.9 ± 5.2 29.6 ± 5.6 <0.001

Pre pregnancy BMI 23.1 ± 3.8 25.7 ± 3.7 <0.001 Parity

0 1-3

>= 4

1042 (49.8 %) 1042 (49.8 %) 7 (0.3 %)

754 (36.1 %) 1298 (62.1 %) 39 (1.9 %)

<0.001

GCT (mg/dl) 77.7 ± 8.1 113.8 ± 9.2 <0.001

Systemic disease 109 (5.2 %) 138 (6.6 %) 0.066 Cesarean delivery 846 (38.5 %) 946 (45.2 %) <0.001 Gestational age at delivery

> 42 weeks

< 37 weeks

< 34 weeks

38.4 ± 1.9 10 (0.5 %) 252 (12.1 %) 55 (2.6 %)

38.3 ± 1.9 12 (0.6 %) 266 (12.7 %) 35 (1.7 %)

0.114 0.669 0.511 0.033

PPROM 26 (1.2 %) 36 (1.7 %) 0.200

Preeclampsia 91 (4.4 %) 111 (5.3 %) 0.170

Polyhydramnios 10 (0.5 %) 24 (1.1 %) 0.016

Cholestasis of pregnancy 12 (0.6 %) 7 (0.3 %) 0.250

Placenta Previa 8 (0.4 %) 16 (0.8 %) 0.101

Ablatio placenta 10 (0.5 %) 8 (0.4 %) 0.637

Data expressed as number (%), mean ± SD. BMI: Body mass index, GCT: Glucose challenge test, PPROM: Preterm premature rupture of membranes.

Table 2. Comparison of neonatal characteristics between groups.

Hypoglycemia on GCT (n = 2091)

Control

(n = 2091) p

Neonatal birthweight Male

Percentile (male) Female

Percentile (female)

> 4500 gr

> 4000 gr

< 2500 gr

< 1500 gr

> 90th percentile

< 10th percentile

< 5th percentile

< 3rd percentile

3218 ± 534 48.4 ± 20.3 3117 ± 459 48.7 ± 16.7 8 (0.4 %) 86 (4.1 %) 153 (7.3 %) 12 (0.6 %) 146 (7.0 %) 187 (8.9 %) 90 (4.3 %) 57 (2.7 %)

3318 ± 544 52.9 ± 21.9 3155 ± 520 50.5 ± 18.0 11 (0.5 %) 142 (6.8 %) 154 (7.4 %) 18 (0.9 %) 235 (11.2 %) 162 (7.7 %)

87 (4.2 %)87 (4.2 %) 54 (2.6 %)

<0.001

<0.001 0.011 0.021 0.490

<0.001 0.953 0.272

<0.001 0.162 0.818 0.778 Neonatal length

Male

50.0 ± 2.5

49.6 ± 2.0 50.5 ± 2.6 49.7 ± 2.5

<0.001

0.384

(31)

Female

Birth trauma 7 (0.3 %) 18 (0.9 %) 0.027

NICU admission 119 (5.7 %) 133 (6.4 %) 0.329

*Neonatal hypoglycemia 32 (1.5 %) 52 (2.5 %) <0.001

Major fetal anomaly 24 (1.1 %) 14 (0.7 %) 0.103

Stillbirth 10 (0.5 %) 13 (0.6 %) 0.530

Perinatal mortality 21 (1.0 %) 28 (1.3 %) 0.574

Data expressed as number (%), mean ± SD. GCT: Glucose challenge test, NICU: Neonatal intensive care unit, : neonatal plasma glucose levels were measured if the infants were* premature, small for gestational age, large for gestational age, or any medical condition that was indicated.

Table 3. Multivariate logistic regression analyses for prediction of adverse perinatal outcome in patients with hypoglycemic GCT.

Characteristics

Unadjusted Odds ratio (95 % CI)

p

Adjusted Odds ratio (95 % CI)

Adjusted

for* p R

square

Delivery < 34 weeks 1.59 (1.03-

2.44) 0.033

1.87 (1.20- 2.93)

1-14 0.006 0.240

PolyhydramniosPolyhydramnios 0.41 (0.20-

0.87) 0.016

0.41 (0.20- 0.87)

3, 14 0.019 0.027

Preeclampsia 0.81 (0.61-

1.08) 0.170

0.79 (0.59- 1.06)

1-4 0.110 0.074

ICP 1.72 (0.68-

4.37) 0.250

1.63 (0.62- 4.31)

1-3 0.322 0.050

Placenta previa 0.41 (0.21-

1.17) 0.101

0.61 (0.26- 1.47)

1,2 0.271 0.035

Neonatal Birth weight

> 4000gr

> 90th percentile

< 10th percentile

0.59 (0.45- 0.78) 0.59 (0.48- 0.74) 1.17 (0.94- 1.46)

<0.001

<0.001 0.162

0.67 (0.51- 0.89) 0.66 (0.53- 0.82) 1.06 (0.83- 1.36)

1-3,16,17 1-3 1-5

0.006 <0.001 0.635

0.135 0.024 0.016

Birth Trauma** 0.34 (0.14-

0.81) 0.015 0.36

(0.13- 2,3,16,17 0.024 0.180

(32)

0.81)

GCT: Glucose challenge test, CI: Confidence Interval, ICP: Intrahepatic cholestatis of pregnancy, NICU: Neonatal intensive care unit admission. 1: Age, 2:Parity, 3: Body mass* index, 4: Maternal systemic disease, 5: Preeclampsia, 6: Preterm premature rupture of membranes, 7: Polyhydramnios, 8: Oligohydramnios, 9: Placenta previa, 10: Abruptio placenta, 11: Intrahepatic cholestasis of pregnancy, 12: Neonatal birth weight < 10th

percentile, 13: Stillbirth, 14: Fetal anomaly, 15: Cesarean delivery, 16: Fetal sex, 17: Length *of gestation.** Excluding cesarean deliveries*

[PP-027]

No gallbladder on fetal ultrasound: How to counsel patients?

Doruk Cevdi Katlan¹, Bulut Varlı¹, Bahar Konuralp Atakul¹, Tuncay Yüce¹, Feride Söylemez¹, Acar Koç¹

(¹) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey

Background – Aim

Fetal gallbladder is visible by ultrasonography starting from 14 weeks of pregnancy. Non-

visualization of it is rare and occurs in 0,1-0,15% of pregnancies. Almost all isolated ones result in a normal healthy child. In most cases, it will be imaged later in pregnancy or in the neonatal period. Rarely, agenesis of the gallbladder, a benign condition with an incidence of 1:6300, is confirmed postnatally. In some rare cases association with cystic fibrosis has been documented.

Some authors suggest its association with biliary atresia which has been reported as 0,7 per 10000 live births. Biliary atresia (BA) has two types: the “fetal-embryonic form” (10-25%) characterized by early cholestasis and associated heterotaxy syndrome, and “perinatal-acquired form”

characterized by late onset of jaundice and associated viral infections. According to recent data, coexistence of absent gallbladder and BA is most likely a chance occurrence. However, if the absent gallbladder is non-isolated (coexistent with cardiovascular, skeletal anomalies etc.), it is associated with an increased risk for fetal chromosomal abnormalities. Here, it is aimed to emphasise the importance of visualization of gallbladder on second trimester ultrasound scan and patient counselling in case it is non-visible.

Case Reports

Two women, a 36-year old gravida 2, para 1 and a 24-year old gravida 4 para 2, were counselled due to non-visualization of fetal gallbladder on their routine second trimester ultrasound scan, both at 22 weeks 5 days, as an isolated abnormality. Their prenatal screening tests assigned low risk for aneuploidy. Upon counselling, both declined invasive prenatal diagnostic procedures. They are awaiting the results of parental cystic fibrosis screening tests, fetal gallbladders still non-visible.

Conclusion

Non-visible fetal gallbladder is a diagnosis that must be confirmed by at least two ultrasound exams performed at an interval of 7-15 days. A thorough examination is mandatory in order to document any coexistent anomaly necessitating karyotype analysis. In isolated cases of absence, parental cystic fibrosis screening should be considered. Since, recent literature suggests

coexistence of BA or aneuploidy in isolated cases is a chance association, the parents should be reassured that the outcome is likely to be good and no further testing is required.

(33)

[PP-028]

Correlation of fetal thymus size with cord blood vitamin D

Esra Bahar Gür, Mehmet Serkan Gur, Ozlem İnce, Esin Kasap, Mine Genc, Sümeyra Tatar, Sultan Bugday, Guluzar Arzu Turan, Serkan Guclu

Sifa University

Aim: The aim of the present study was to evaluate the association of intrauterine vitamin D deficiency (VDD) with thymus size in full term fetuses.

Methods: In this prospective study we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in 162 pregnant women. Fetal thymus size were measured by ultrasound in third trimester. Fetal 25(OH)D3 levels evaluated by umbilical cord blood sampling.

Correlation of maternal and fetal vitamin D levels, factors effecting vitamin D levels, association between thymus size and both fetal and maternal vitamin D concentrations were investigated.

Results: Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) newborns. Body mass index, duration of seaside holiday and the season were founded which effecting factor on maternal vitamin D level. A strong correlation was found between maternal mid-pregnancy and cord blood 25(OH)D3 concentration (r=0.8, p< 0.001). Fetal thymus perimeter was significantly correlated with the thymic-thoracic ratio (r= 0.4, p<0.01). A significant linear correlation was observed between both mid-pregnancy and umbilical cord 25(OH)D3

concentration and thymus perimeter length (r= 0.35, p=0.04 and r=0.4, p<0.01, respectively).

Both maternal and fetal vitamin D concentration within the normal range was associated with increased thymic perimeter relative to fetuses with VDD (p=0.04, p=0.03).

Conclusions: VDD at fetal period may be contributed fetal programming of immune system by affecting development of thymus.

Keywords: pregnancy, vitamin d, vitamin d deficiency, fetal thymus size, ultrasound

figure 1

Sonogram of the thymus at the level of the 3-vessel view within the fetal thorax. (a) Thymic- thoracic ratio. Tymus diameter was measured as its greatest width perpendicular to a line connecting the spine and sternum. (b) Thymic perimeter.

figure 2

(34)