Gynecology Obstetrics & Reproductive Medicine

Omphalocele in Both Twins: Revealing Developmental Complexities: A Case Report

Sampath Gnanarathne, Ayodhya Kariyawasam — Sun, 25 Aug 2024 00:00:00 +0300

Omphalocele is a rare congenital anomaly with eviscerated abdominal organs in the proximal segment of the umbilical cord covered by a membranous sac. This case presents omphalocele in both fetuses in a twin pregnancy, discussing the embryological basis, the importance of early detection, and effective management. A 34-year-old primigravida was confirmed to have dichorionic diamniotic twins at 6 weeks of gestation. At 14 weeks, a routine ultrasound revealed omphalocele in both fetuses, complicated by early amniotic rupture, following an uncomplicated preconception period. Omphalocele is a rare occurrence, simultaneously in a twin pregnancy. Among the various theories, this presentation favors the theory based on malformation of the ventral body wall. The exact embryological explanation is yet to be identified.

The Association between Resolvin D1 Levels and Gestational Diabetes Mellitus: Implications for Perinatal Outcomes

Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVE: To evaluate maternal Resolvin D1 levels in women with gestational diabetes mellitus (GDM) and investigate the association between perinatal outcomes.

STUDY DESIGN: This case-control study included 88 singleton pregnancies, conducted from August 2023 to January 2024, at a tertiary care center. Participants were divided into two groups: 44 pregnant women diagnosed with GDM comprised the study group, and 44 healthy pregnant women served as the control group. Additionally, the GDM group was categorized based on management approach into 21 women managed with diet alone and 23 women requiring insulin therapy. Maternal plasma Resolvin D1 levels and maternal-neonatal outcomes were then compared between groups. The analysis involved determining the optimal Resolvin D1 cut-off levels for predicting composite adverse neonatal outcomes in GDM using receiver operating characteristic curve (ROC) analysis.

RESULTS: The plasma Resolvin D1 level in pregnant women with GDM was significantly higher compared to the control group (337±74.1 vs. 297±56.7, p<0.001). Furthermore, maternal plasma Resolvin D1 levels were associated with composite adverse neonatal outcomes [presence of at least one of the following conditions: preterm birth (<37 weeks), low birth weight (LBW) (<2500 grams), neonatal hypoglycemia, hyperbilirubinemia, APGAR score at 5th minute <7, respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU)], with a cut-off of >338.75, showing a sensitivity of 56.3%, a specificity of 79.2%, and an AUC of 0.675 (95% CI: 0.567-0.771, p=0.024).

CONCLUSIONS: This study demonstrated that pregnancies affected by GDM exhibit elevated levels of Resolvin D1, which is associated with a higher incidence of composite adverse neonatal outcomes.

Over-Expression of MicroRNA-210 and MicroRNA-185-5p in Normotensive Late-Fetal Growth Restriction: Preliminary Cohort Study

Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVE: Late Fetal Growth Restriction (LFGR), a condition associated with perinatal and long-term neurodevelopmental problems, is caused by inadequate placental transfer of oxygen and nutrients to the fetus. This preliminary study evaluates the expression profiles and clinical significance of hypoxia-sensitive microRNA-210 (miR-210) and microRNA-185-5p (miR-185-5p) in placental and maternal circulation. The potential clinical implications of this research could significantly enhance the management of LFGR.

STUDY DESIGN: In this prospective cohort study conducted at the Gynecology and Obstetrics Clinic of Trakya University Faculty of Medicine Hospital, miR-210 and miR-185-5p expression was evaluated in the placenta of healthy (n=30) and LFGR (n=30) cases. In healthy (n=15) and LFGR (n=15) cases, miRNA levels in maternal plasma were studied. We determined these two miRNAs using Real-Time Quantitative Polymerase Chain Reaction (RT-qPCR) and statistically analyzed them with clinical data to determine robustness. We provided a comprehensive evaluation.

RESULTS: Both the placenta and maternal plasma samples exhibited significant correlations with miR-210 and miR-185-5p expression (r=0.615; r=0.771, p<0.01). The expression levels in both placenta and plasma were significantly higher in the LFGR group. Placental miR-210 demonstrated an AUC (0.908), sensitivity (93.3%), and specificity (96.7%), while plasma miR-210 showed AUC (0.738), sensitivity (86.7%), and specificity (66.7%). In contrast, placental miRNA 185-5p displayed a diagnostic performance with AUC (0.926), sensitivity (76.1%), and specificity (63.8%); plasma miRNA 185-5p exhibited an AUC (0.778), sensitivity (86.7%), and specificity (86.7%). However, placental miR-210 and miR-185-5p did not fully correlate with birth weight, placental weight, and fetal cerebroplacental Doppler ratio.

CONCLUSION: Placental miRNA-210 showed superior diagnostic performance over placental miRNA 185-5p in LFGR pregnancies. However, it is crucial to emphasize that further studies are needed to validate these findings and correlate them with clinical data, underscoring the ongoing importance of research in this field.

Evaluation of the Screening Performance of Ultrasonographic Abdominal Circumference and Estimated Fetal Weight in Predicting Small for Gestational Age Newborns

Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVES: We aimed to evaluate the screening performance of estimated fetal weight (EFW) and abdominal circumference (AC) measurements in predicting newborns with birth weight (BW) less than the 10th percentile for birth age (BW <10p).

STUDY DESIGN: Three hundred thirty-one pregnant women who met the inclusion and exclusion criteria were included in the study. The groups were divided into two groups: those diagnosed with FGR (FGR group) and those not diagnosed (non-FGR)after the 32nd week of gestation. Demographic and obstetric histories, ultrasonographic and clinical features, and neonatal outcomes of the groups were recorded, and comparisons between the groups were conducted. The screening performances of AC and EFW were compared for predicting newborns with BW<10p and assessing neonatal outcomes.

RESULTS: AC or EFW measures below 10% (AC<10p or EFW<10p) demonstrated the highest screening performance for BW<10p, with 91.7% sensitivity and 91% specificity. AC<10p demonstrated the highest performance in predicting neonatal intensive care unit (NICU) admission, with 75.9% sensitivity and 89.1% specificity. For neonates with a 5-minute APGAR score of less than 7, AC<10p or EFW<10p had 88.2% sensitivity and 69.7% specificity.

CONCLUSION: This study shows that AC and EFW measurements can be used together or separately to predict newborns who are small for their gestational age (SGA). Using values below 10% of either AC or EFW together gives the best results in terms of sensitivity and specificity.

How Does Listening to “Fetal Heartbeats” Affect the Feelings of Pregnant Women?

Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVES: This study was conducted to evaluate the impact of listening to fetal heartbeats (FHBs) on the feelings of normal and high-risk pregnancies (HRPs), and to learn the colors and geometrical figures representing their feelings.

STUDY DESIGN: This retrospective cohort study consisted of 291 pregnant women who applied for a non-stress test (NST). Participants were divided into two groups; 1: Normal pregnancies (Group1) and 2: HRPs (Group2). Demographic variables, feelings in response to listening to FHBs (negative, neutral, positive), grade mark (0-10) of feelings, color (warm, neutral, cold), and figure (simple, complex) preferences were retrospectively evaluated.

RESULTS: Of the 291 women, 172 (59.1%) Group 1 participants were compared to 119 (40.9%) Group 2 participants. Group 1 and Group 2 had similar feelings (p>0.05), however, the rate of negative feelings was higher in Group 2 (11.6% vs. 20.2%). Higher marks were observed in Group 2 with happiness and peace/relaxation after listening to FHBs. Fear was the lowest mark in women with positive/neutral feelings in both groups. Women in Group 1 preferred warm colors regardless of their feelings. Women in Group 2 who have positive feelings chose warm colors, whereas women who felt neutral or negative more commonly chose cold (55.5%) and neutral (41.7%) colors (p=0.017). Independent of feelings, simple figures were predominately preferred (p=0.04).

CONCLUSION: NST is more than a perinatal surveillance method and listening to FHBs has a positive impact on the feelings of pregnancies. Warm colors were commonly related to positive feelings. Simple figures were preferred regardless of feelings.

Cord Blood pH and Lactate- A Step Ahead in Diagnosis of Fetal Acidaemia in Patients with Abnormal Cardiotocography

Indrani Mukhopadhyay, Sanjay Singh, Sushila Kachatti — Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVES: Electronic fetal monitoring (EFM) is used to identify early signs of fetal deterioration. However, caution is advised when interpreting cardiotocographic parameters. A promising alternative is umbilical cord blood sampling. The analysis of blood gases and lactate levels in the cord within the ini-tial minutes of life is a recommended approach.

STUDY DESIGN: This prospective cohort study, conducted over eighteen months from June 2021 to December 2022, enrolled 70 patients with non-reactive and 70 with reactive cardiotocograph (CTG) pat-terns. APGAR scores were recorded at 1 and 5-minute intervals. 1 ml of umbilical artery blood was as-sessed in an arterial blood gas machine and fetal acidosis was defined as pH <7.0 and a lactate con-centration exceeding 4 mmol/L.

RESULTS: In the non-reactive CTG group, 35.7% had early decelerations, 37.1% had variable decel-erations, and 17.1% had late decelerations (p<0.001). The mean cord blood lactate was 5.220±1.970 mmol/L in the non-reactive CTG group and 3.400±0.228 mmol/L in the reactive CTG group. Similarly, the mean cord blood pH was 7.030±0.007 in the non-reactive CTG group and 7.170±0.076 in the reac-tive CTG group (p<0.001). 14.3% of cases in the non-reactive CTG group had a 5-minute APGAR <7, with a higher APGAR score in the reactive group.

CONCLUSION: The study suggests that abnormal or indeterminate CTG readings are linked to a higher risk of intrapartum fetal acidosis. Non-reactive CTG results were associated with higher mean cord blood lactate and pH levels and more number of Neonatal Intensive Care Unit (NICU) admissions. There is a definite correlation between abnormal CTG patterns and poorer neonatal outcomes.

Determining the Burden of Dysmenorrhea on Women's Quality of Life: The Dysmenorrhea Symptom Interference Scale

Syed Muhammad Ashraf Jahangeer, Meerab Fatima, Hifza Iqbal, Areeba Sheikh — Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVE: Dysmenorrhea negatively impacts a woman's quality of life. The lack of proper awareness results in poor coping mechanisms in females. This study aims to determine the association of dysmenorrhea with quality of life using the Dysmenorrhea Symptom Interference (DSI) Scale and the management choices of females.

STUDY DESIGN: This cross-sectional study was conducted among females studying at various universities in Karachi from March 2023 to May 2023. The calculated sample size was 270. A non-probability, convenience sampling technique was applied. A web-based, structured, self-administered questionnaire was used to collect data.

RESULTS: 278 females completed the survey. The Numeric Rating Scale (NRS) score (1–10) indicated the degree of dysmenorrhea. The majority of the females, 40.6% (n=113), had moderate dysmenorrhea. Quality of life was measured according to the DSI Score (maximum score=5). The mean DSI score recorded was 2.75. Most participants (27%; n=75) were found in the mood component of DSI. Most of the females used lifestyle modifications, followed by home remedies and medications. A significant positive correlation between the NRS score and the DSI score (p<0.001) suggests that an increased degree of dysmenorrhea led to a significant decline in the quality of life.

CONCLUSION: We conclude that dysmenorrhea is associated with a decreased quality of life and the DSI Scale is a valid tool for assessing its impact on quality of life. There is a general lack of knowledge about adequate pain management.

The Evaluation of Uterine Sarcomas: Tertiary Center Experience

Onur Yavuz, Kadir Alper Mankan, Asli Akdoner, Sultan Ot, Hasan Bahadir Saatli — Sun, 25 Aug 2024 00:00:00 +0300

BJECTIVES: To elucidate prognostic factors, determine the best course of treatment methods, and assess oncological results in individuals diagnosed with uterine sarcoma.

STUDY DESIGN: Between January 2001 and August 2023, 30 patients with uterine sarcomas (US) were included and analyzed in this cross-sectional study. Sixteen patients (53.3%) had uterine leiomyosarcoma, 6 patients (20%) had high-grade endometrial stromal sarcoma, 8 patients (26.7%) had low-grade endometrial stromal sarcoma.

RESULTS: The median follow-up of all participants was 50 months. Recurrence was detected in 43.3% of the patients. 5-year survival ratio was 73.3%, 5-year disease-free survival ratio was 66.7%, the overall survival ratio was 70% and the overall disease-free survival rate was 56.6%. No difference was observed between groups in terms of survival comparisons. No statistically significant effect of adjuvant systemic chemotherapy, adjuvant radiotherapy, and combined treatments on median overall survival and median disease-free survival was detected (p>0.05).

CONCLUSION: Uterine sarcomas are uncommon malignancies characterized by a poor prognosis, even in early stages, and they are associated with a high recurrence ratio. The most effective treatment method remains unclear to date.

Investigation of the Predictive Factors of Recurrent Ovarian Mucinous Cystadenoma

Aykut Ozcan, Meric Balikoglu, Kaan Okan Alkan, Varol Gulseren — Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVE: Rapid growth patterns and recurrence with variable rates have been reported in the literature, making mucinous cystadenomas different from other ovarian benign neoplasms. The study aimed to predict and prevent recurrence based on the obtained results.

STUDY DESIGN: In this case-control study among the 2,341 patients who underwent surgery for ovarian cysts, 221 met the inclusion criteria. The 221 patients diagnosed with mucinous cystadenoma were categorized into two groups: 14 patients (6.3%) with recurrence and 207 patients (93.7%) without recurrence. Patients in these groups were compared in terms of demographic characteristics, ovarian cyst size, operative technique, type of surgery (oophorectomy or cystectomy), Ca19-9, CA125, and CEA values of the patients, and duration of postoperative follow-up.

RESULTS: The mean age was statistically lower in the group with recurrence (27 ± 5 vs 44 ± 14; p<0.001). The follow-up period of recurrent cases was significantly longer (6.8 ± 3.5 vs 4.9 ± 2.2 years; p=0.045). The recurrence rate was significantly higher in patients who underwent cystectomy (p<0.001; odds ratio: 22.8). When all patients were examined, cystectomy was preferred in younger patients [31 (18-65) vs 48 (18-81); p<0.001]. According to regression analysis, cystectomy alone is an independent risk factor (p=0.041).

CONCLUSION: Unlike conventional ovarian cystadenomas, mucinous cystadenomas should be followed up owing to the possibility of recurrence, especially when detected at an early age. Since cystectomy is the only independent risk factor, oophorectomy should be the primary treatment for patients >40 years of age who have no desire for childbearing.

Semen Parameters Can be Used as a Credible Marker with Doppler Ultrasonography in the Diagnosis of Subclinical Varicocele Cases

Tulay Irez, Bahar Sarikaya, Mine Erguven, Emre Salabas — Sun, 25 Aug 2024 00:00:00 +0300

OBJECTIVES: The link between varicoceles and male infertility has been a problem of debate for more than half a century. A substantial amount of data about varicocelectomies’ effects has been provided, but inadequate study designs and heterogeneity of current studies make these data rarely conclusive. This article investigates whether semen and sperm analysis in subclinical varicocele patients without any clinical signs diagnosed by Doppler Ultrasonography (USG) can be used as a diagnostic tool.

STUDY DESIGN: The current prospective cohort study included infertile male patients (n=44) enrolled in the Urology Clinic of Biruni University Hospital from January 2017 to January 2018. Patients were divided into two groups: 1st group as the control group (CG) (n=22): No varicocele as determined by Doppler USG, and 2nd group as the test group (TG) (n=22): Subclinical varicocele (SCV) as determined by Doppler USG. A semen analysis was done. Sperm were dyed with aniline blue and chromomycin A3 (CMA3), acridine orange (AO), propidium iodide (PI), and Rhodamine 123 (Rh123) for the determination of sperm maturation, sperm DNA fragmentation, apoptosis, and sperm mitochondrial membrane potential, respectively. Student-t Test was used for statistical analysis. p<0.05 was considered significant.

RESULTS: The sperm concentration of the CG was higher than the TG (p=0.98, p>0.05). Forward sperm motility in the CG was higher than in the TG (p<0.001, p<0.05). Sperm with normal morphology in the TG was lower than in the CG (p<0.001, p<0.05). Sperm neck anomalies were higher in varicocele cases (p<0.001, p<0.05). Sperm maturation at the TG was lower than the CG (p<0.001, p<0.05). A high apoptotic sperm rate was found at the TG (p<0.001, p<0.05). Sperm mitochondria potential at the TG was lower than the CG (p<0.001, p<0.05). Sperm chromatin condensation at the TG was higher than the CG (p<0.001, p<0.05).

CONCLUSIONS: The analysis of sperm DNA and apoptosis in SCV cases can be used as a reliable diagnostic tool to confirm Doppler USG.