Background: Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is timeconsuming. As an alternative, random spot sampling for a urine protein to creatinine (P/C) ratio has been investigated. Aims: The aim of the study was to determine the diagnostic accuracy of the protein to creatinine ratio (P/C) compared with 24-hour urine collection for the detection of remarkable proteinuria and to evaluate the P/C ratio for different proteinuria ranges in patients with preeclampsia. Study Design: Case-control study. Methods: Two hundred and eleven pregnant women who met the criteria of preeclampsia comprised the study group and fifty three pregnant women were taken as the control group. Spot urine specimens for measuring P/C ratio were obtained taken immediately before 24-hour urine collection. The correlation between the P/C ratio in the spot urine samples and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test. Results: It was found a good positive correlation between the P/C ratio and 24-hour protein excretion, with a correlation coefficient (r) of 0.758. The best cut-off which gave the maximum area under the curve was 0.45 for 300 mg, 0.9 for 1000 mg, 1.16 for 2000 mg, 1.49 for 3000 mg, 2.28 for 4000 mg and 2.63 for 5000 mg per 24h. A P/C ratio above 0.9 strongly predicts significant proteinuria for more than 1 gram (AUC 0.97, 95% CI: 0.94-0.99 and sensitivity, specificity, positive and negative predictive value of 91%, 95.4%, 95.2%, and 91.2%, respectively). Conclusion:The P/C ratio can be used as a screening test as a good predictor for remarkable proteinuria. The P/C ratio seems to be highly predictive for diagnosis to detect proteinuria over one gram and it could be used as a rapid alternative test in preeclamptic patients not to delay implementation treatment. Keywords: Preeclampsia, proteinuria, urine proteincreatinine ratio : 27.05.2014 Accepted: 26.11.2014 • DOI: 10.5152/balkanmedj.2015 Increased rate of maternal and fetal mortality and morbidity(1, 2) is associated with preeclampsia. Proteinuria is a main component of preeclampsia and one of the diagnostic criteria of its severity. Protein measurement in the 24-hour urine sample is the traditional standard method for the detection of proteinuria (3). Twenty-four-hour urine collection is timeconsuming and inconvenient, and results may be inaccurate when the collection of urine is missed, depending upon the individual. The management of patients may be delayed during the urine collection. A more rapid test that enables the accurate

Cystic hygroma (CH) is a lymphatic malformation occurring different parts of fetal body, typically in the region of the fetal neck and axillary, abdominal wall, mediastinal, inguinal and retroperitoneal areas. CH has been associated with fetal aneuploidy, hydrops fetalis, structural malformations and intrauterine fetal death.A 24-year-old gravida 1, para 1 was admitted to our hospital at 28 weeks of gestation. Ultrasonographic examination determined 28 weeks of gestation, singleton, alive fetus who had a mass derived from the right axillary region which was extending to the anterior and posterior thoracic wall with fluid-filled cavities about 12 cm in size. There was no evidence of intrathorasic or intraabdominal extension of mass. Cordocentesis was performed and karyotype examination was normal 46 XY. The fetal demise was found after the first visit. The patient was delivered vaginally after labor induction with oxytocin infusion. The fetal autopsy confirmed the diagnosis of CH.The fetal CH carries high risk of aneuploidy and fetal malformations. Patients that have been diagnosed with CH in antenatal follow-ups should be assessed in terms of other anomalies. Fetal karyotyping should be done and the patient should be monitored for fetal hydrops. The birth should be planned in a multidisciplinary hospital and as neonatal resuscitation could be needed, pediatricians should be consulted.

Background: Caudal regression syndrome (CRS) is a rare complex congenital anomaly which is characterized by agenesis of the sacral and lumbar spine. Pelvis, lower extremity, genitourinary, cardiac anomalies and lower extremity neurological and motor development deficits may be accompanied. The exact etiology is unclear but the maternal insulindependent diabetes mellitus (hyperglycaemia during embryogenesis seems to act as a teratogen), genetic factors, vascular hypoperfusion may play a role in the etiology. Case: A 41-year-old gravida 4, para 2, live 1, abortus 1 patient with 35 weeks of gestation. The patient had 12-year history of type 1 diabetes mellitus. In ultrasonographic examination we found the length of the bones (all the upper and lower bones) 8 weeks underdeveloped and didn’t observe the lumbar, sacral vertebrae and iliac bones. Lower extremities were crossed in froglike position, there wasn’t lower extremity movements. Due to sacral agenesia the head of the femurs were closer. Also pes equinovarum deformity, single umbilical artery, kidneys in contact at the midline were present. All of these findings indicated the diagnosis of caudal regression syndrome. Conclusion: Diabetes is increased fetal anomalities in pregnancy. Diabetic pregnancy should be more evaluated than pregnancies with no risk. Antenatal care should be done more carefully. Especially, prenatal maternal blood glucose levels and HbA1cis most important for prevention of fetal anomalities.

Background:Presepsin is an inflammatory marker released from monocytes and macrophages as an acute reaction to microbial infection. We hypothesized that it may be useful in pregnancies with preterm premature rupture of the membranes (PPROM) for early diagnosis of subclinical chorioamnionitis. Aims: To determine whether the plasma presepsin level has any diagnostic or prognostic value for subclinical chorioamnionitis in pregnancies complicated with PPROM. Study Design: Prospective cohort study. Methods: Fifty-three singleton pregnancies between 23 and 28 weeks of gestation diagnosed with PPROM were prospectively included in the study. Venous blood samples were collected at admission, at the 48 th hour of admission, and at the time of delivery to determine presepsin and C-reactive Protein (CRP) levels and white blood cell (WBC) counts. Chorioamnionitis was diagnosed by microscopic examination of the placenta and cords. Results: Of the 53 PPROM cases included in the study, 41 (77.4%) had histologically confirmed chorioamnionitis. Neonatal sepsis developed in 24 (45.3%) of the newborns. The median presepsin level at admission was 135.0 pg/mL for pregnancies with subclinical chorioamnionitis and 113.5pg/mL for pregnancies without chorioamnionitis (p=0.573). There was also no significant difference between subclinical chorioamnionitis (+) and (−) cases in terms presepsin levels at the 48 th hour and at delivery. However, chorioamnionitis (+) cases showed a significant decrease in both presepsin level and WBC count at the 48 th hour after the administration of antibiotics, which increased significantly at delivery (p<0.001 and p=0.011, respectively). Conclusion:The striking fluctuations in presepsin level after the diagnosis of PPROM can be used to predict subclinical chorioamnionitis and determine the optimal timing of delivery before the clinical signs of chorioamnionitis are established. However, presepsin level itself was neither diagnostic nor prognostic for neonatal sepsis. Keywords: Premature rupture of the membranes, preterm, chorioamnionitis, neonatal sepsis

The balance of thiol-disulfide homeostasis was shifted and native and total thiol levels were decreased only in preeclamptic FGR pregnancies. The serum disulfide level was increased in idiopathic FGR pregnancies compare to preeclamptic FGR pregnancies which may be a sign of oxidative stress in idiopathic FGR pregnancies with normal thiol pool.