Aegean Journal of Obstetrics and Gynecology

The Results of karyotype analysis and 22q11.2 (DiGeorge Syndrome critical region) deletion investigation in fetal cardiac system anomalies

2023-08-15T13:15:50+03:00

The results of karyotype analysis and 22q11.2 ( DiGeorge Syndrome critical region) deletion investigation in fetal cardiac system anomalies

Objective: We aimed to determine the presence of accompanying chromosomal anomalies and 22q11.2 deletion in patients with cardiac system anomalies.

Material and Methods: In our retrospective and cross-sectional study, 99 fetuses born with cardiac anomalies were evaluated in terms of chromosomal anomalies. 36 fetuses were evaluated for 22q11.2 deletion. Fetuses who were diagnosed with prenatal congenital heart defect and underwent invasive prenatal diagnostic tests for fetal karyotyping between 01.01.2010 and 30.06.2017 at a tertiary cancer center were included in the study.

Results: Of 99 cases, 48 (48.4%) had only cardiac anomalies and 51 (51.5%) had non-cardiac anomalies. Chromosomal anomalies were found in 37 (37.4%) of the cases. Autosomal trisomy 18(43.2%) and autosomal trisomy 21(32.4%) were the most common chromosomal anomalies. The study results support the strong association of chromosomal changes and cardiac malformation, especially in septal defects, atrioventricular septal defects, and conotruncal malformations. Deletion was detected in one(2.8%) of 36 cases evaluated for 22q11.2 deletion. The fetus with this deletion had isolated tetralogy of fallot and had no extracardiac anomaly.

Conclusion: In cases with cardiac anomalies, isolated or accompanied by extracardiac anomalies, investigations should be made in terms of underlying chromosomal diseases in the perinatal evaluation. In addition, the investigation of 22q11.2 deletion in fetuses with conotruncal cardiac anomalies should be included in prenatal genetic examination.

Keywords: DiGeorge Syndrome, Fetal Anomalies, karyotype, trisomy, 22q11.2 Deletion Syndrome

Impact of the type of ductus venosus agenesis and the presence of associated anomalies on prognosis

2023-09-02T00:54:27+03:00

Objective: The Ductus Venosus (DV) connects the umbilical vein to the inferior vena cava. With a portocaval pressure gradient, the well-oxygenated blood in the ductus venosus accelerates towards the left sidewall of the inferior vena cava, directing the blood preferentially towards cephalic and coronary circulation through the foramen ovale (1). DV serves as a shunt, expanding to protect the heart and brain in hypoxic conditions. Ductus Venosus Agenesis (DVA) is a rare congenital abnormality with a prevalence of 0.03-0.07%. The type of DVA, along with any additional anatomical or chromosomal anomalies in fetuses with DVA, significantly affects the postnatal prognosis. Some fetuses with DVA develop normally, while others may experience growth retardation, heart defects, or other complications. In this study, we aimed to evaluate the frequency of associated anomalies in DVA cases, examine the impact of each type of DVA (intrahepatic and extrahepatic venous drainage) on prognosis, and contribute to the literature on this rare disease.

Materials and Methods: We conducted a retrospective study of all cases diagnosed prenatally with DVA at a tertiary center between 2016-2019. Our study reviewed obstetric data, associated anomalies, other systemic anomalies, type of DVA, chromosomal or genetic anomalies, and perinatal and postnatal outcomes. Postnatal infants were followed up to the 6th month.

Results: We identified 16 cases with ductus venosus agenesis. The type of DVA (intrahepatic-extrahepatic shunt), presence of chromosomal anomalies, accompanying ultrasonographic findings, and perinatal outcomes were recorded. Generally, in 7 out of the 16 cases, the umbilical vein drained into the portal system (44% - intrahepatic), and in 9 cases, it drained into the systemic venous system.

Conclusion: DVA is a rare congenital abnormality with potentially significant implications for affected fetuses and infants. Early diagnosis, careful monitoring, and appropriate management strategies are crucial to optimize outcomes for these patients. There's a need for future research to better understand the underlying etiology and pathophysiology of DVA and to develop more effective treatment options for affected individuals.

The effect of anti-phospholipid syndrome on pregnancy outcomes in patients with habitual abortus

2023-08-18T21:38:49+03:00

Objective: The aim of this study was to research the pregnancy outcomes of women with anti-beta2 glycoprotein 1 and anti-cardiolipin antibody positivity and to determine the association with pregnancy morbidity.

Materials and methods: This retrospective study contained pregnant women with anti-beta2 glycoprotein 1 and anti-cardiolipin antibody positivity and a control group without these antibodies. Totally 190 serum samples sent from Obstetrics and Gynecology clinics between January 2019 and January 2023 were analyzed in the medical microbiology laboratory of xx.

Results: In a patient population separated into antibody-positive and antibody-negative groups, the gravida was found to be 3.8±0.1 and 3.5±0.3 respectively (p=0.333). Parity was 1.1±0.1 and 0.8±0.1 (p=0.071), abortion rates were 2.3±0.1 and 2.5±0.2 (p=0.659), and gestational age was 35.7±0.8 and 34±1.5 (p=0.047). Intrauterine fetal death was found to be higher in the antibody-positive group compared to the antibody-negative group (p=0.03). There was no noteworthy distinction noted between the two groups regarding additional pregnancy complications such as intrauterine growth restriction, oligohydramnios, gestational diabetes, and gestational hypertension (respectively p=0.623, 0.074, 0.312, 0.626). However, smoking was significantly higher in the antibody-positive group (p=0.049).

Conclusion: Antiphospholipid syndrome adversely affects pregnancy outcomes. During the initial visit, a thorough patient history should be obtained, and in pregnant women with a history of poor obstetric outcomes or habitual abortions, this syndrome should be considered.

The association between cervical HPV and female fertility

2023-08-30T20:41:45+03:00

Objective: Genital human papillomavirus (HPV) infection is the most common sexually transmitted viral infection worldwide with a prevalence of 10-12% in the female population in the reproductive age; few studies addressed the effect of HPV infection on fertility. It is aimed to investigate the presence of HPV infection in infertile women in the present study.

Materials and methods: In this retrospective cross-sectional study; the outpatient infertility clinic records between July 2020 and January 2023, were evaluated. Infertility examination and evaluation were performed following the guidelines. Infertile female individuals and control group’s HPV results were analyzed.

Results: 234 infertile and 340 non-infertile females were included in the study, HPV positivity was found %11.5 for all infertile women. No significant relationship was found between and HPV (p=0.850).

Conclusion: No significant association was found between female infertility and HPV. Still HPV may play a role in infertility with different genotypes. Further studies should include HPV genotypes.

The Effect of an antioxidant agent-multivitamin complex food supplement on spermiogram in infertile men

2023-09-11T20:43:25+03:00

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Oxidative stress (OS) occurs due to overproduction of reactive oxygen radicals (ROS) or weakening of anti-oxidant mechanisms and may harm fertility. Our study aimed to investigate the effects of combined support therapy containing antioxidant agents and vitamin complexes on fertility.

Material method

In this retrospective case-control study, 300 randomly selected infertile men were included. For four months, the effect of daily intake of an antioxidant-multivitamin complex containing astaxhantin (5mg), Coenzyme Q10 (100mg), L-Arginine (250mg), L-Carnitine (250mg), Selenium (100mcg), Zinc (10mg), Folic acid (400mcg), Vitamin E (100mg) and Vitamin C (100mg) on spermiogram parameters was investigated.

Results

Semen hacminde (2.21 ml -3.05 ml; p=.004), sperm konsantrasyonunda (9.60 milyon/ml -14.10 milyon/ml; p=.000), ileri hareketli sperm sayısında (%16.50 -%26.65; p=.000) ), sperm canlılık oranında (%48 - %68; p=.001) beslenme desteği alan hastalarda istatistiksel olarak anlamlı artış bulundu. Ayrıca tedavinin anormal morfolojiye sahip hasta sayısında (Kruger kriterlerine göre normal morfolojiye ulaşamayan hastaların en az %4'ü) anlamlı azalma (%77 - %61; p=.002) sağladığı belirlendi. ).

Çözüm

Astaxhantin, KoQ10, L-arjinin, L-karnitin, selenyum, çinko, E ve C vitaminleri içeren antioksidan-multivitamin içerikli besin takviyelerinin semen hacmi, sperm morfolojisi, canlılık ve motilite üzerinde anlamlı iyileşme sağladığı belirlendi. Bu bağlamda antioksidan-multivitamin kompleksinin erkek kısırlığında destekleyici tedavi için gıda takviyesi olarak kullanılabileceğini öngörüyoruz.

The predictive effect of serum AMH and FSH levels alone or in combination on fertility outcome

2023-09-12T16:04:34+03:00

Objective: To explore the roles of anti-mullerian hormone (AMH) and follicle stimulating hormone (FSH) in predicting clinical pregnancy.

Materials and Methods: Forty patients who were decided on IVF/ICSI due to different infertility etiologies were included in the study. The patients were divided into two groups according to their AMH and FSH values as having a good prognosis or a poor prognosis. The clinical pregnancy and miscarriage rates of 33 cycles with good prognosis and 17 cycles with poor prognosis were compared.

Results: In the good prognosis group, the FSH value was significantly lower than the poor prognosis group (5.98±1.04 mIU/mL vs. 13.6±3.07 mIU/mL, p<0.01), while the serum AMH level was significantly higher. (3.80±1.32 ng/mL vs 0.54±0.02 ng/mL, p<0.01). The rate of chemical pregnancy in the group with good prognosis was twice as high and significant compared to the group with poor prognosis (12 (36.3%) vs 5 (29.4%), p<0.02). In terms of clinical pregnancy rates, the group with good prognosis showed a higher frequency (33.3% vs. 23.5%, p<0.001), while miscarraige rates were higher in the group with poor prognosis (9.0% vs. 25%, p<0.003).

Conclusions: Evaluation of AMH and FSH together is critical in determining clinical pregnancy rates.

Evaluation of maternal and neonatal outcomes of emergency cesarean deliveries in cases of placenta previa uncomplicated with placenta acreata spectrum

2023-09-11T20:40:45+03:00

Objective: The management and surgery of placenta previa describe a challenging process that requires experience. It is important to decide on the timing of planned cesarean section in women with placenta previa, taking into account the balance between possible maternal severe bleeding and possible neonatal morbidities.

Material and methods: In the present study, the data of 349 singleton pregnant women with a diagnosis of placenta previa uncomplicated by placenta accreta spectrum were analyzed. Patients who underwent planned (68%, n=236) or emergency cesarean section (32%, n=113) were divided into two groups. In this study, maternal demographic and clinical information, surgical procedures and maternal/neonatal outcomes were studied.

Results: The proportion of patients who underwent uterine compression suture and Bakri balloon was found to be significantly higher in the emergency cesarean section group compared to the planned cesarean deliveries group (p<0.001). The operation time, hospital stay, urinary tract infection rate, decrease in hemoglobin and need for blood transfusion were found to be significantly higher in the emergency cesarean section group compared to the planned cesarean section group (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, respectively). In addition, a significant association was detected between emergency cesarean section and prematurity, low birth weight, low APGAR score, increased neonatal intensive care unit hospitalization and neonatal mortality.

Conclusion: Cases of placenta previa are at risk of emergency cesarean delivery, which can be complicated by poor maternal and neonatal outcomes. Equipped centers and experienced teams are of great importance in reducing fetomaternal morbidity and mortality caused by placenta previa.

Hysteroscopic management of infected and partially discharged desidual cast in an adolescent: A case report and review of the literature in adolescents

2023-08-27T13:17:17+03:00

Objective: Decidual cast in other words membranous dysmenorrhea is a rare entity. Hereby, we report the first infected case caused by drospirenon containing contraceptive use and managed successfully by hysteroscopy.

Case presentation: A13 year-old girl started on drospirenon containing contraceptive theraphy since her menarche resulted in menorrhagia and anemia that requires transfusion. On follow up, she developed a partially discharged infected mass revealed to be a decidual cast on pathological review.

Discussion: Membranous dysmenorrhea occurs more frequently in the adolescent and young adult population. All cases in this review were on hormonal theraphy except one occured spontaneously. Cast formation of the immature uterus after menarche is an exaggerated response to dose-independent increased progestin levels.

Conclusion: We conclude that diagnosis of decidual cast/membranous dysmenorrhea should be kept in mind for colicky pain with bleeding of adolescents under hormonal contraceptive therapy and partially discharged cases may be managed successfully by hysteroscopy.