Could maternal serum MFG-E8 level predict adverse first trimester pregnancy outcome? A preliminary study

BACKGROUND

Milk fat globule-epidermal growth factor 8 (MFG-E8) is expressed in the endometrial epithelium and its expression increases during the implantation process. Due to this knowledge, we aimed to investigate the maternal serum MFG-E8 levels on both healthy pregnant women in the first trimester and pregnant women complicated with missed abortion and threatened abortion in the first trimester.

METHODS

This prospective, cross-sectional study was conducted in a tertiary referral hospital, department of obstetrics between July 2020 and February 2021 after ethical committee approval. The study population was consisted of 30 healthy pregnant women (HP) in the first trimester, 30 pregnant women suffering from threatened abortion (TA) in the first trimester and 30 pregnant women suffering from missed abortion (MA) in the first trimester. Maternal serum MFG-E8 levels were analyzed with enzyme linked immunosorbent assay. Delivery and neonatal outcomes of the study population was evaluated. The continuous variables were compared among three groups with variance analysis with post hoc tests. The categorical variables were compared with chi-square and Fisher's exact tests where applicable.

RESULTS

The mean age of the study population was 29.36 ± 5.31 years. There was no significant difference among three groups for parameters of age, body mass index, parity number, and gestational week. Despite being within normal ranges, the mean neutrophil and international normalized ratio values of the three groups showed statistically significant difference (p < 0.05). The mean maternal serum MFG-E8 levels of MA, TA, and HP groups were 270 ± 152.3, 414.7 ± 236.7, and 474 ± 222.5 ng/mL, respectively (p = 0.001). It was found that mean of MFG-E8 of the MA group was statistically significantly lower than those of the other two groups (p < 0.05).

DISCUSSION

Although maternal serum MFG-E8 level seems to be a parameter that differ between live and nonlive pregnancies, studies with large number of cases are needed to discuss our results and to determine a cut-off value for prediction.

Effect of ondansetron for preventing of ovarian hyperstimulation syndrome: in an experimental rat model

Objective: Ovarian hyperstimulation syndrome is an iatrogenic condition that occurs in the treatment of infertility. There is no specific treatment available for OHSS. Cabergoline is a dopamine receptor 2 agonist and VEGF-VEGF2 receptor antagonist . Recently, cabergoline has been widely used to prevent the development of OHSS and reduce its severity Serotonin is known as a neurotransmitter and thought to have a role in the mechanism of angiogenesis and in signaling in endothelial cells. Serotonin is said to have similar effects to VEGF . Ondansetron is Selective Serotonin (5-HT3) Receptor Antagonist . It works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting. In the clinical practice today, there is no choice other than cabergoline, to prevent occurrence and reduce severity of OHSS, and sometimes its effects are limited. Methods: In our study, we compared the effect of cabergoline and ondansetron. 32 immature rats were used and the OHSS model was created. Parameters such as hematocrit value , ovarian size, the number of follicles in the ovary, endometrial capillary congestion and thickness values were evaluated and compared. Results: As a result, in our study, it was seen that ondansetron was effective on OHSS in many parameters. It is thought to be as effective as cabergoline. When we look at the literature, this is the first study in which ondansetron was evaluated for this purpose. It would be good to show this effect of ondansetron with other studies.

Comparison of Serum Ykl-40 and Ischemia Modified Albulmin Levels Between Pregnant Women with Hyperemesis Gravidarum and Normal Pregnant Women

INTRODUCTION

The etiopathogenesis of HG is still unclear.

AIM

The aim of this study was to investigate the levels of YKL-40 protein as an inflammatory marker and evaluate the levels of IMA as an oxidative marker in hyperemesis gravidarum women.

MATERIALS AND METHODS

Totally 35 patients with hyperemesis gravidarum and 35 healthy pregnants were included in the study. Singleton pregnancies between 6+0 week and 13+6 weeks of gestation, with normal fetal anatomy were included in the study. Complete blood count, complete urine analyze, biochemical tests and thyroid function tests were done.

RESULTS

There was no significant difference between groups for demographical features (age, gravidity, gestational age, body mass index). Also, there was no statistically significant difference between groups for IMA levels (p>0.05). The median level of YKL-40 was higher in pregnants with hyperemesis gravidarum than normal pregnants but the difference was not statistically significance (p>0.05).

CONCLUSION

Further comprehensive studies with more number of patients are needed to show the efficacy of YKL-40 and IMA levels for predicting hyperemesis gravidarum and even monitoring of the treatment.

Association of body mass index and weight gain patterns with albumin excretion in pregnancy

AIM

We examined body mass index (BMI) and gestational weight gain (GWG) patterns of pregnant women and investigated the impact of these factors on the urinary albumin-creatinine ratio (ACR) during pregnancy.

METHODS

The data of 163 women whose basal BMI and ACR were measured during the first trimester were used in this study. Body weight alone between 12-16 weeks and body weight together with ACR after 37 weeks of gestation were measured.

RESULTS

Overall, 46% of women were overweight or obese, 60.7% had excessive weight gain and 16.6% had inadequate weight gain. Only 22.7% of women gained weight within the recommended range. There was no difference in weight gain patterns with respect to BMI. ACR during the third trimester was significantly higher than during the first trimester (7.08 [0.00-1180.90] mg/g vs 4.73 [0.00-275.00] mg/g, respectively; P = 0.001). The ACR of obese women was higher than in normal weight subjects during the third trimester (16.79 mg/g [0.01-1180.90] vs 8.07 mg/g [0.10-402.14] respectively; adjusted P = 0.015). Both ACR change and third trimester ACR were weakly but significantly correlated with basal BMI (r: 0.228 P: 0.003 and r: 0.301 P < 0.001, respectively) but not with GWG or GWG rate. Basal BMI was not associated with first-trimester ACR.

CONCLUSION

Obesity is associated with an increase in urinary albumin excretion during the course of pregnancy. Distinction of this relationship during pregnancy offers an opportunity for further research on pathophysiological mechanisms. The alarmingly high rate of non-compliance with IOM guidelines in pregnant women is a concern. Prompt measures for counseling of women before and during pregnancy in order to maintain healthy weight are needed.

Plasma apelin levels in patients with polycystic ovary syndrome

OBJECTIVE

The aim of the study was to evaluate plasma apelin levels in patients with polycystic ovary syndrome (PCOS) and healthy controls.

MATERIAL AND METHODS

Plasma apelin levels, serum lipid levels, serum hormone levels, and homeostasis model assessment-insulin resistance (HOMA-IR) values of 32 patients with PCOS and 31 healthy women forming the control group were checked.

RESULTS

Plasma apelin levels of the PCOS group (0.350±0.083 ng/ml) were significantly higher than those of the control group (0.246±0.045 ng/ml) (p<0.001). No significant correlation was detected between apelin levels and biochemical or clinical data in PCOS group.

CONCLUSION

Plasma apelin levels were significantly higher in PCOS patients.

Total and lipid bound sialic acid levels in patients with polycystic ovary syndrome

OBJECTIVE

To evaluate serum total and lipid bound sialic acid (TSA&LBSA) levels in patients with polycystic ovary syndrome (PCOS).

MATERIAL AND METHODS

Forty women with PCOS and 35 healthy controls were enrolled in the study. Serum TSA, LBSA, follicle stimulating hormone, lutenizing hormone, estradiol, thyroid stimulating hormone, prolactin, dehydroepiandrosterone sulphate, androstenedione, free testosterone, total testosterone, 17-OH progesterone, sex hormone binding globulin, cortisol, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured in each subject. Insulin resistance was estimated by fasting insulin level, fasting glucose: insulin ratio and 75-g glucose tolerance test for 2 hours.

RESULTS

Serum TSA levels were not significantly different between the groups. Serum LBSA levels were higher in patients with PCOS compared to the control group. TSA was correlated with androstenedione and HOMA-IR in the PCOS group. Positive correlations were found between LBSA and dehydroepiandrosterone sulphate in patients with PCOS. After correction for BMI, the only existing significant correlation was between LBSA and follicle stimulating hormone.

CONCLUSION

Serum LBSA levels, which has previously been found to be higher in cardiovascular diseases and diabetes mellitus, are elevated in PCOS.

Comparison of epidural ropivacaine 0.2% and ropivacaine 0.2% in combination with sufentanil 0.75 microg mL-1 for postcaesarean analgesia

Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 microg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 microg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24+/-4.20 mL for Group-I and 81.1+/-6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 microg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period.

The effects of hormone therapy, estrogen therapy and tibolone on apoptosis and cyclin D1 expression in postmenopausal vaginal epithelium

OBJECTIVE

To investigate the effects of hormone therapy, estrogen therapy and tibolone on markers of apoptosis including bcl-2, and bax and cyclin D(1) expression in postmenopausal vaginal epithelium.

STUDY DESIGN

Thirty postmenopausal women were randomized to the treatment protocols (0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA); 2mg estradiol valerate; 2.5mg tibolone). After baseline vaginal biopsy, control biopsies were performed after 70 days following the initiation of the therapy. Bcl-2, bax, Bcl-2/bax ratio, cyclin D(1) measurements were performed immunohistochemically. Data were analyzed by Kruskal-Wallis, Mann-Whitney U and Wilcoxon tests.

RESULTS

After the treatment period the above-mentioned parameters were not different among the groups except for cyclin D(1) levels. Cyclin D(1) expression was found to be strong in patients with treated estradiol valerate.

CONCLUSIONS

The effects of estrogen on cyclin D(1) expression were not detected with tibolone or with the addition of progesterone to estrogen in the vaginal epithelium. Cyclin D(1) appeared to have stronger effects on the estrogen related proliferation compared to apoptotic markers in vaginal epithelial cells.

The effect of treatment on endothelin-1 concentration and mean arterial pressure in preeclampsia and eclampsia

OBJECTIVE

The aim of this study was to determine the effect of treatment on endotelin-1 concentration that is considered to have role in etiopathogenesis of eclampsia and preeclampsia.

METHODS

Nine patients with eclampsia and 12 patients with preeclampsia were included to the study. Endothelin-1 levels were measured before and after magnesium sulfate treatment. After the magnesium sulfate administration, if the blood pressure was still elevated, nifedipine was given.

RESULTS

Endothelin-1 levels of preeclamptic patients before and after magnesium sulfate treatment were 16.9 +/- 2.3 fmol/ml and 14.6 +/- 1.9 fmol/ml respectively (p < 0.05). The same measurements of eclamptic patients were 18.1 +/- 3.2 and 14.7 +/- 3.4 respectively (p < 0.05). The mean blood pressures of preeclamptic patients before and after magnesium sulfate were 125.8 +/- 7.3 mm-Hg, 118.2 +/- 8.7 mm-Hg respectively, and the same measurements of eclamptic patients were 136.0 +/- 12.4 mm-Hg and 123.1 +/- 10.6 mm-Hg respectively (p < 0.05, p < 0.05).

CONCLUSION

Treatment had been found to have negative effects on endothelin-1 levels that is considered to play an important role on etiopathogenesis of eclampsia and preeclampsia.

Ischaemia-reperfusion injury of rat ovary and the effects of vitamin C, mannitol and verapamil

BACKGROUND

In this prospective controlled study, the aim was to examine the effects of vitamin C, mannitol and verapamil on adnexial ischaemia-reperfusion injury in the rat ovary.

METHODS

Thirty-six female Wistar rats were used. In the controls (group 1), only laparotomy was performed. In group 2, ovarian ischaemia was produced and the bilateral ovaries were surgically removed 4 h later. In group 3, an ischaemic period of 4 h was followed by reperfusion for 1 h; the bilateral ovaries were then removed. In groups 4, 5 and 6, after 4 h of ischaemia, either vitamin C, mannitol or verapamil respectively was infused before reperfusion; after 1 h of reperfusion the ovaries were removed. Thiobarbituric acid reactive substance (TBARS) levels were measured in all ovary tissues.

RESULTS

TBARS levels of the reperfusion group were significantly higher than those of groups treated with vitamin C or mannitol (P = 0.013 and P = 0.045 respectively), but not of the verapamil group.

CONCLUSIONS

Vitamin C and mannitol were found to be effective in reducing ischaemia-reperfusion injury of the ovary during its early stages, but verapamil was ineffective.

Effects of oral contraceptives with low-dose estrogen and desogestrel on leptin concentrations

OBJECTIVE

To evaluate short-term leptin concentrations in women who use low-dose oral contraceptives.

STUDY DESIGN

From 15 women without medical problems, venous blood samples were taken: basal, between days 3 and 5 of menstruation, and in the third month. The Human Leptin Radioimmunassay Kit (Linco Research, Inc., St. Charles, Missouri) was used for leptin measurement. Statistical analysis was done with the Wilcoxon test.

RESULTS

The average patient age was 30.1 +/- 6.7 years. The basal leptin concentrations and leptin concentrations at the third month were 22.17 +/- 8.85 and 23.04 +/- 6.77 ng/mL, respectively. This increase was not statistically significant.

CONCLUSION

Oral contraceptives with low-dose estrogen and desogestrel do not affect leptin concentrations in a three-month period.

Pelvic ultrasound measurements in normal girls: relation to puberty and sex hormone concentration

Pelvic ultrasonography was performed on 75 normal girls. Values were obtained for uterine length, fundal/cervical ratio (FCR), ovarian volume and sex hormones. The resultant data were grouped according to age and pubertal stage (Tanner). For uterine length, FCR and ovarian volume, the data were positively skewed, and the variance increased with age and pubertal stage (p < 0.001). The uterus underwent a regular increase in size and the corpus gradually became larger than the cervix. Uterine length, right ovary volume, FCR and hormones (serum estradiol, follicle-stimulating hormone and luteinizing hormone) showed a correlation with the Tanner score (p < 0.001). Although the correlations were significant, the best correlation was between pubertal stage and serum estradiol level.