Kadir Atakır

Meckel-Gruber syndrome is a rare, OR-transitive and fatal disease. Prenatal diagnosis is important, especially in regions where consanguineous marriages are common. The classic triad of the disease is occipital meningoencephalocele, renal anomalies and postaxial polydactyly. The diagnosis is made by the presence of two of these three major features. Just over 200 cases have been reported in the world literature. The purpose of presenting our case is that all findings of the disease were detected in both fetuses in a twin pregnancy for the first time, which has not been reported in literature.

Objectives: Preeclampsia (PE), which affecting multi-organ systems, is one of the most common causes of feto-maternal morbidity and mortality. The fetal kidney is one of the vulnerable organs in PE caused by sustained vasospasm of the renal arteries. In this study, it was aimed to reveal the changes in the renal vascular bed with renal artery Doppler examinations in fetuses of pregnant women with PE. Methods: Fifty-five pregnant women with PE and 60 healthy pregnant women were included in this prospective study. Multiple pregnancies, those who did not want to participate in the study, and those with other co-morbidities were excluded from the study. Fetal renal artery Doppler studies included renal artery systolic/diastolic (S/D) ratio, pulsatility index (PI) and resistance index (RI) of the control and PE groups, and findings such as week of birth and birth weight were recorded and analyzed statistically. Results: Fetal renal artery PI values were found to be higher in pregnant women with PE compared to the control group (2.93 in the patient group, 2.28 in the control group, p < 0.001). There was no significant difference between RI values and S/D ratios between the two groups. In the preeclampsia group, gestational week and baby weight at birth were significantly lower. Conclusions: Due to preeclampsia, hypoxia occurs in peripheral tissues and organs at the maternal level. Fetal organs are also affected by these hypoxic conditions. Doppler is an extremely useful examination tool in the evaluation of the status of peripheral organs such as the kidney. This study suggests that PE increases the resistance of renal arteries in fetuses of mothers with PE compared to fetuses of mothers without PE, which may contribute critically to kidney disease later in life.

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P < 0.001, P < 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P < 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes. '+st+' Division of Radiology ,Istanbul Health and Technology University Department of Radiology and Medical İmaging Technics, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016 Feb 15;594(4):807-23. doi: 10.1113/JP271402. Epub 2016 Jan 5. PMID: 26607046. DOI: https://doi.org/10.1113/JP271402 ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):e97-e109. doi: 10.1097/AOG.0000000000003070. PMID: 30681542. DOI: https://doi.org/10.1097/AOG.0000000000003070 Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B. Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand. 2004 Sep;83(9):801-7. doi: 10.1111/j.0001-6349.2004.00602.x. PMID: 15315590. DOI: https://doi.org/10.1080/j.0001-6349.2004.00602.x Monteith C, Flood K, Mullers S, Unterscheider J, Breathnach F, Daly S, et al. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol. 2017 Mar;216(3):285.e1-285.e6. doi: 10.1016/j.ajog.2016.11.1008. Epub 2016 Nov 11. PMID: 27840142. Rial-Crestelo M, Martinez-Portilla R, Cancemi A, Caradeux J, Fernandez L, Peguero A, et al. Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a pre- dictor of SGA and FGR in non-selected pregnancies. J Matern Fetal Neonatal Med. 2019 Aug;32(15):2554-60. doi: 10.1080/14767058.2018.1441281. Epub 2018 Mar 4. PMID: 29447050. Ebbing C, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low porto-caval pressure gradient. Ultrasound Obstet Gynecol. 2008 Oct;32(5):663-72. doi: 10.1002/uog.6145. PMID: 18816500. DOI: https://doi.org/10.1002/uog.6145 Devore GR. 2015. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015 Jul;213(1):5-15. doi: 10.1016/j.ajog.2015.05.024. PMID: 26113227. DOI: https://doi.org/10.1016/j.ajog.2015.05.024 Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. 2019. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019 Apr;53(4):465-72. doi: 10.1002/uog.20157. Epub 2019 Feb 13. PMID: 30353583. DOI:...

Objective: Thyroid hormone is required for normal fetal brain development, neuronal proliferation, migration and structural organization. We aimed to investigate fetal cardiac structure in fetuses of hypothyroid pregnant women receiving thyroid hormone replacement therapy and to compare it with normal pregnancies, including fetal outcome and delivery results. Methods: Singleton pregnant women whose ages were between 18–45 years and weeks of gestation were between 26–34 were included in the study. Their routine laboratory test reports, ultrasonographic measurements (fetal echo) and postnatal follow-up data were recorded. Patients were grouped according to the presence of diagnosis of hypothyroidism. The patients with hypothyroidism during pregnancy were included in Group 1 while healthy pregnancies with similar features were considered as controls and included in Group 2. All women with hypothyroidism were taking thyroid hormone replacement. All ultrasonographic and laboratory data measurements were collected from the system files and were compared between groups. Results: A total of 89 patients (41 hypothyroidism and 48 controls) were recruited to the study. Serum TSH levels of patients with hypothyroidism (Group 1) was significantly higher than the controls. In fetal cardiac examination, left ventricular (LV) and right ventricular (RV) wall thicknesses, and interventricular septum thicknesses at the end of systole and diastole were not statistically significant in both groups. Apgar scores, fetal gender and mean fetal birth weight were all similar between the groups. Conclusion: There is no myocardial structural difference in fetuses of pregnant women who were diagnosed with hypothyroidism and received thyroid hormone replacement therapy compared to healthy controls. Thyroid replacement therapy in hypothyroid mothers might affect and treat fetal cardiac abnormalities.