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P Kirkinen

Publications and source records attributed to P Kirkinen.

At least 19 recordsLinked to original sources
PubMed2005

Macrocephaly-cutis marmorata telangiectatica congenita syndrome--prenatal signs in ultrasonography.

A new case of macrocephaly-cutis marmorata telangiectatica congenita (M-CMTC) syndrome is described. The patient presented typical congenital findings in utero, although the syndrome was diagnosed postnatally. The M-CMTC syndrome should be considered when there is a marked fetal overgrowth and progressive macrocephaly with no indications of maternal hyperglycemia or fetal hyperinsulinism. Our patient also had unilateral pleural effusion, curved femur and frontal bossing.

Abnormalities, Multiple↗
PubMed2004

Massive multicystic dilatation of the uterine wall with myometrial venous thrombosis during pregnancy.

We present a pregnancy complicated by multicystic dilatation of the uterine wall during the second trimester, leading to massive uterine distension, anemia and preterm Cesarean section. The cystic changes detected by ultrasound and magnetic resonance imaging involved the whole uterine wall surrounding the entire amniotic cavity. Histopathological examination revealed the benign nature of the cystic changes, which represented dilated and thrombosed venous lacunae. Disturbed venous drainage, combined with local thrombosis, was likely to have led to the collection of a large volume of blood in the uterine wall and the subsequent multicystic change of the myometrium.

Adult↗
PubMed2001

Elevated maternal serum hCG in the second trimester increases prematurity rate and need for neonatal intensive care in primiparous preeclamptic pregnancies.

OBJECTIVE: This study was designed to investigate the association between the serum concentrations of maternal second trimester human chorionic gonadotropin (hCG) and the severity of preeclampsia. METHODS: At Kuopio University Hospital, a total of 487 preeclamptic primiparas had undergone maternal serum screening for Down's syndrome between January 1993 and December 1998. Of these, 37 women had unexplained elevated serum hCG concentrations [> 2.5 multiples of the median (MoM)], whereas the remaining 450 preeclamptic women had normal hCG results. Pregnancy characteristics and outcome measures in these groups were evaluated using logistic regression. RESULTS: Elevated midtrimester hCG concentrations were associated with higher rates of low-birth-weight infants, preterm delivery, and need for neonatal intensive care. The adjusted odds ratios was 2.11 [95% confidence interval (CI): 1.03-4.32], 2.08 (95% CI: 1.10-4.30), and 2.27 (95% CI: 1.14-4.51), respectively. CONCLUSIONS: In primiparous preeclamptic pregnancies, an elevated maternal serum hCG concentration is a marker of early-onset and severe disease with significant maternal and perinatal morbidity. This finding, in turn, reinforces the association between elevated hCG concentrations and placental damage in early pregnancy. Elevated maternal serum hCG levels identify a subgroup of preeclamptic patients who deserve more intensive observation.

Chorionic Gonadotropin↗
PubMed2001

Apolipoprotein E alleles in women with pre-eclampsia.

AIMS: To investigate the frequency of three apolipoprotein E (apoE) alleles among women with pre-eclampsia. METHODS: The presence of the three most common apoE alleles (epsilon 2, epsilon 3, epsilon 4) was determined by polymerase chain reaction-restriction fragment length polymorphism in two groups of women: healthy pregnant women (n = 91) and pregnant women with a diagnosis of pre-eclampsia (n = 133). In addition, the frequencies of the alleles in the general population in this area are presented for comparison. RESULTS: The frequency of the apo epsilon 4 allele was 18.4% among women with pre-eclampsia and 18.7% among healthy pregnant women (Fisher's exact test; p = 0.941), which is close to the rate in the general population in this area (19%). None of the apolipoprotein E genotypes was significantly over-represented, and homozygous genotype epsilon 4 was not associated with more severe clinical disease than were the other genotypes. CONCLUSION: The observed profiles of allele and genotype frequencies confirm an equilibrium state between apoE polymorphism and pre-eclampsia and suggest that apoE does not play a major role in the development of pre-eclampsia.

Adult↗
PubMed2000

Maternal serum second trimester AFP and hCG in pregnancies with placenta previa.

This study was undertaken to investigate the association between placenta previa and Down syndrome screening analytes-alpha-fetoprotein (AFP) and hCG-during the second trimester. Measurements of maternal serum AFP and hCG concentrations were retrospectively analysed in relation to placenta previa in a cohort of 46 consecutive singleton pregnancies affected by placenta previa from January 1993 through December 1997 at the University Hospital of Kuopio, Finland, and then compared with those in healthy singleton control pregnancies (N=9560) from the same clinic over the same period of time. Geometric means of maternal serum AFP and hCG concentrations in pregnancies with placenta previa were 1.13 and 0. 85 multiples of the median (MoM), respectively. The mean maternal age was higher in the subjects than in the controls (30.9 years compared with 28.8 years) (p<0.01). In relation to Down syndrome risk assessment, the pattern of the two markers together with maternal age indicated high risk as often in the study subjects as in the controls. Even though the maternal serum AFP and hCG differences were not statistically significant, they may be of some clinical importance, and further studies are needed to evaluate whether placental site should be taken into account in maternal serum screening.

Chorionic Gonadotropin↗
PubMed2000

Antepartum findings in fetal protein C deficiency.

A pregnancy with fetal homozygous protein C deficiency was complicated in the third trimester by fetal ventriculomegaly, intraorbital thrombosis and placental infarcts, which could be imaged by combined use of ultrasonography and MRI.

Adult↗
PubMed2000

Laparoscopic ultrasonography during conservative ovarian surgery.

BACKGROUND: Most surgery for benign ovarian mass is now performed laparoscopically. Our purpose was to evaluate the usefulness of laparoscopic ultrasonography (LUS) in these operations. METHODS: Forty patients treated by laparoscopic extirpation of a benign ovarian tumor were examined perioperatively using an Aloka 7.5-MHz laparoscopic probe. Findings of preoperative vaginal and perioperative laparoscopic ultrasonography were compared with histologic diagnoses. The accuracy of LUS in localizing the tumor in the ovary and ensuring surgical radicalness was evaluated. RESULTS: LUS enabled correct diagnosis in 34/40 and vaginal ultrasonography in 27/40 cases. Localization of the tumor was possible by LUS in all and visually in 21 ovaries. In 2 patients a radical tumor extirpation was not possible without laparoscopic ultrasonographic guidance. CONCLUSIONS: Diagnostic accuracy in LUS is better than in vaginal ultrasonography. LUS facilitates exact tumor localization and can be useful in confirming the radicalness of operation.

Adolescent↗
PubMed2000

Pregnancy outcome after previous stillbirth resulting from causes other than maternal conditions and fetal abnormalities.

BACKGROUND: An adequate fetomaternal circulatory system may be compromised by a variety of disturbances leading to stillbirth. The purpose of this study was to assess subsequent pregnancy outcome in women with a history of stillbirth as a result of causes other than maternal conditions and fetal abnormalities. METHODS: Ninety-two deliveries after stillbirth were identified among 11,910 deliveries of parous women recorded in the birth registry at Kuopio, Finland. Using logistic regression, pregnancy outcome measures were compared with those of a parous healthy obstetric population (n = 11,818). RESULTS: Women with a history of stillbirth as a result of causes other than maternal conditions and fetal abnormalities were older than their unaffected controls (32.4 yr vs 30.3 yr). Stillbirth in an earlier pregnancy was associated with a significantly higher (p < 0.001) frequency of placental abruption in subsequent pregnancy (5.4% vs 0.7%). A history of stillbirth was predictive of preterm delivery (OR = 2.25) and low-birthweight infants (OR = 2.70). No recurrence was reported. CONCLUSIONS: Pregnancy with a history of stillbirth as a result of causes other than maternal conditions and fetal abnormalities is a moderate risk state, with prematurity and low-birthweight rates somewhat higher than those in the general population. The overall probability of a favorable outcome is good. These findings may be useful in counseling pregnant women with a history of stillbirth.

Adolescent↗
PubMed2000

Intrauterine inflammation at term: a histopathologic study.

This study was undertaken to examine the presence of inflammation of the uterine and gestational tissues as defined by histopathology in clinically noninfected women with term gestation and intact fetal membranes and to evaluate its correlation with measured clinical variables and neonatal and maternal clinical outcome. Two hundred sixteen clinically noninfected term parturients who underwent cesarean section with intact membranes were analyzed for the presence of inflammatory lesions of the gestational tissues and uterus. Nine hundred eighty-one histologic samples were studied, including 212 samples from both chorion membranes and umbilical cords, and 209 placental, 192 myometrial, and 156 decidual samples. In 208 (96%) cases, either amniotic fluid (AF) or endometrial swab samples were cultivated for bacteria. In 148 (69%) cases, the AF leukocyte count was analyzed by the Gram stain method, and in 77 (36%), AF leukocyte esterase activity (LEA) was evaluated. Leukocytic infiltrations were present in samples from 41 (19%) women, varying from 2% to 10% in the different anatomic sites examined. However, after onset of labor, low-grade decidual inflammation was observed in 29% of cases. Cervical dilation (odds ratio, 4.7; 95% confidence interval, 2.4 to 9.3; P < .00003) and meconium-stained AF at the operation (odds ratio, 5.3; 95% confidence interval, 2.2 to 12.5; P < .00015) were associated with the histologic inflammatory lesions observed in decidual samples, independently of AF or endometrial microbial detection, AF leukocytes, or LEA.

Amniotic Fluid↗
PubMed2000

Obstetric prognosis in second pregnancy after preeclampsia in first pregnancy.

OBJECTIVE: To assess obstetric outcomes in women in their second pregnancy after preeclampsia in the first pregnancy. METHODS: We utilized population-based birth registry data of Kuopio University Hospital to investigate pregnancy outcome measures in 123 nonpreeclamptic parous women with prior preeclampsia and 21 women with repeat preeclampsia in their second pregnancy. The general obstetric population was used as a reference group in logistic regression. RESULTS: The development of recurrent preeclampsia in 15% of women is associated with adverse neonatal outcomes. A first preeclamptic pregnancy may offer protection against disease recurrence and a history of preeclampsia has no significant effects on birth weight, fetal distress, or prematurity rate. However, they have a higher rate of pregnancy-induced hypertension and abdominal deliveries, and, therefore, a greater proportion of newborns are referred to neonatal units for observation. CONCLUSIONS: Women in whom preeclampsia does not recur have good obstetric outcomes in their second delivery, almost comparable to that in the general obstetric population. A genetic susceptibility to preeclampsia alone has minor effects on pregnancy outcome in a second pregnancy if the disease does not recur.

Adolescent↗
PubMed2000

Maternal drug abuse and human term placental xenobiotic and steroid metabolizing enzymes in vitro.

We evaluated the impact of maternal drug abuse at term on human placental cytochrome P450 (CYP)-mediated (Phase I) xenobiotic and steroid-metabolizing activities [aromatase, 7-ethoxyresorufin O-deethylase (EROD), 7-ethoxycoumarin O-deethylase (ECOD), pyrene 1-hydroxylase (P1OH), and testosterone hydroxylase], and androstenedione-forming isomerase, NADPH quinone oxidoreductase (Phase II), UDP-glucuronosyltransferase (UGT), and glutathione S-transferase (GST) activities in vitro. Overall, the formation of androstenedione, P1OH, and testosterone hydroxylase was statistically significant between control and drug-abusing subjects; we observed no significant differences in any other of the phase I and II activities. In placentas from drug-abusing mothers, we found significant correlations between ECOD and P1OH activities (p < 0. 001), but not between ECOD and aromatase or P1OH and EROD activities; we also found significant correlations between blood cotinine and UGT activities (p < 0.01). In contrast, in controls (mothers who did not abuse drugs but did smoke cigarettes), the P1OH activity correlated with ECOD, EROD (p < 0.001), and testosterone hydroxylase (p < 0.001) activities. Our results (wider variation in ECOD activity among tissue from drug-abusing mothers and the significant correlation between P1OH and ECOD activities, but not with aromatase or EROD activities) indicate that maternal drug abuse results in an additive effect in enhancing placental xenobiotic metabolizing enzymes when the mother also smokes cigarettes; this may be due to enhancing a "silent" CYP form, or a new placental CYP form may be activated. The change in the steroid metabolism profile in vitro suggests that maternal drug abuse may alter normal hormonal homeostasis during pregnancy.

Adult↗
PubMed2000

Contrast-enhanced sonography in the examination of benign and malignant adnexal masses.

Our objective was to characterize the properties of an intravascular ultrasonographic contrast agent in examination of adnexal masses and to compare contrast agent properties between benign and malignant adnexal tumors. Fifty-eight consecutively examined women with suspected ovarian tumors were examined preoperatively by power Doppler ultrasonography, first without and then with contrast agent enhancement (Levovist). Fourteen women had ovarian cancer, 3 had borderline ovarian tumors, 18 had benign ovarian neoplasms, and 23 had functional adnexal cystic masses or endometriomas. The effect of the contrast agent was evaluated visually and by using computerized power Doppler signal intensity measurements. In visual evaluation, the brightness of the power Doppler signal and the amount of recognizable vascular areas increased in each tumor after contrast agent administration. The number of vessels in power Doppler ultrasonograms, both before and after contrast agent enhancement, was significantly higher in malignant than in benign adnexal masses, as also was the increase in the number of recognizable vessels after contrast agent administration. Contrast agent uptake time was significantly shorter in malignant than in benign tumors. No significant differences were found in the power Doppler signal intensities or their changes between benign and malignant tumors. In conclusion, use of sonographic contrast agent facilitates imaging of tumor vessels. For differentiation of benign and malignant tumors, the kinetic properties of the contrast agent, such as uptake and washout times, may have more potential than the use of the contrast agent in anatomic imaging of the tumor vessels.

Abscess↗
PubMed2000

Etiology and outcome of second trimester non-immunologic fetal hydrops.

BACKGROUND: This investigation was undertaken to study the conditions resulting in midtrimester fetal hydrops and to evaluate its overall prognosis as regards counseling purposes. MATERIAL AND METHODS: The etiology of midtrimester non-immune fetal hydrops was retrospectively evaluated as regards cases detected in singleton pregnancies (n=58) from January 1987 through December 1996. The condition was diagnosed by way of routine biochemical and ultrasonographic screening of a pregnant population. RESULTS: The rate of diagnosed midtrimester fetal hydrops was 1 in 1700 pregnancies and the overall survival rate in this usually unexpected condition was less than 10%. Various chromosomal and fetal structural abnormalities dominated as a cause of fetal hydrops, representing 44.8% and 43.1% of the cases, respectively. Infection caused only 6.9%. The underlying etiology remained unknown in only three cases. However, in 78% the diagnosis was already known prenatally. DISCUSSION: Although the overall prognosis is poor, knowledge of the primary etiology is important to determine a rational therapeutic strategy. If the results of routine investigations rule out malformation and abnormal chromosomes, follow-up serial ultrasonographic assessment may indicate that the hydropic state is transient, carrying a somewhat better prognosis.

Female↗
PubMed2000

Diagnosing fetal urinary tract abnormalities: benefits of MRI compared to ultrasonography.

BACKGROUND: To compare antepartum ultrasonography with magnetic resonance imaging for prenatal diagnosis of malformations in the fetal urinary tract in high risk patients during the last trimester. MATERIALS AND METHODS: The study involved 22 women and 24 fetuses with either severe oligohydramnios or ultrasonographically or clinically suspected abnormality of urinary tract. Ultrasound examination was carried out with 5 MHz abdominal convex probe and magnetic resonance imaging with superconductive 1.5 T equipment. Postnatal findings were used as reference. RESULTS: Correct diagnosis of urinary tract anomaly was done in 15 fetuses on ultrasound and in 20 fetuses on magnetic resonance imaging. Both methods enabled correct diagnosis in 12, only ultrasound in three and only magnetic resonance imaging in eight fetuses. Both methods imaged equivocally in one case. The additional information by magnetic resonance imaging was gained from five fetuses out of 12 pregnancies with oligohydramnios and from three fetuses out of ten pregnancies with normal amount of amniotic fluid. CONCLUSIONS: MRI is a valuable additional method to ultrasonography of fetal urinary tract if resolution of ultrasound is impaired for reason of oligohydramnios or technical deterioration.

Congenital Abnormalities↗
PubMed2000

Intrahepatic cholestasis of pregnancy has no effect on maternal serum second trimester alpha-fetoprotein and hCG.

OBJECTIVE: To investigate the association between intrahepatic cholestasis and Down's syndrome screening analytes (alpha-fetoprotein [AFP] and hCG) during the second trimester. DESIGN: Measurements of maternal serum AFP and hCG concentrations were retrospectively analyzed in relation to intrahepatic cholestasis in a cohort of 33 consecutive singleton pregnancies affected by cholestasis from January 1995 through December 1997 at the University Hospital of Kuopio, and then compared with those in healthy singleton control pregnancies (n=5680) from the same clinic over the same period of time. RESULTS: Geometric means of maternal serum AFP and hCG concentrations in pregnancies affected by cholestasis were 1.12 and 0.98 multiples of the median [MoM], respectively. Mean maternal age was significantly higher in the subjects than in controls (30.6 years compared with 28.8 years). In relation to Down's syndrome risk assessment, the pattern of the two markers together with maternal age indicated high risk as often in the study subjects as in the controls. CONCLUSION: Median serum AFP and hCG concentrations in pregnancies complicated by intrahepatic cholestasis were not significantly different from those in unaffected pregnancies. There is no need to take the hepatic disorder into account in maternal serum screening.

Adult↗