Role of Systemic Immune Inflammatory Index to Predict Intrahepatic Cholestasis of Pregnancy

BACKGROUND

The goal was to investigate the change of systemic immune inflammation index (SII) in high-risk pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP).

METHODS

Between May 2018 and April 2020, we retrospectively enrolled 218 pregnant women who were followed in our hospital from the first trimester to delivery. We looked at the sociodemographics, laboratory data, SII values, Apgar ratings, and newborn birth weights of pregnant women with ICP. We also compared SII values in the first (SII 1), second (SII 2), and third trimesters (SII 3) between ICP and the control group.

RESULTS

In the ICP group, the neutrophil level increased in the second trimester and decreased in the third trimester. The SII 2 was significantly higher in the severe ICP group, and when the SII values of the subgroups were examined, the SII 2 was significantly higher in the severe ICP group. The SII 2 showed a significant cutoff value for ICP with 92% sensitivity and 96% specificity. Again, a positive but weak correlation was found between SII 2 and SII 3 and FBA. When the neonatal outcomes were evaluated between the groups, gestational age at birth, birth weight and Apgar scores at 1 and 5 minutes were significantly lower in the ICP group.

CONCLUSIONS

The relationship between SII and ICP was investigated for the first time in the literature and a significant cutoff value was found with the SII of the 2nd day. This showed that inflammation occupies an important place in the pathophysiology of cholestasis.

Comparison of Cavum Septum Pellucidum Size in Euploid and Aneuploid Fetuses

OBJECTIVE

 The aim of the present study is to compare the cavum septum pellucidi (CSP) z-score in euploid and aneuploid fetuses and to investigate the performance of the CSP width/length and CSP width/biparietal diameter (BPD) ratios as a diagnostic marker in aneuploidy.

METHODS

 A total of 54 patients, 20 aneuploid and 35 euploid fetuses, between 18 and 37 weeks of gestation, were included in this retrospective study. The CSP width z-score was compared between the two groups. Receiver operating characteristic (ROC) curves were calculated for the CSP width/length and CSP width/BPD ratios to predict aneuploidy.

RESULTS

 The median CSP width was 4.8 mm (range, 1.8 to 8.5 mm) in the euploid group, and 5.4 mm (range 3.1 to 8.4 mm) in the aneuploid group. Cavum septum pellucidi width z-score, CSP width/length ratio, and CSP width/BPD ratio were significantly higher in fetuses with aneuploidy than in fetuses with normal karyotype (p = 0.001; p = 0.013; p = 0.028). In the ROC analysis, the CSP width/length ratio had the optimal cutoff value of 0.59, with 72.0% sensitivity and 58.0% specificity, and for the CSP width/BPD ratio, the cutoff value was 0.081 with 83.0% sensitivity and 61.0% specificity for detection of aneuploidy.

CONCLUSION

 CSP width z-score was found to be increased in aneuploid fetuses. The CSP width /BPD ratio can be used as a new marker for predicting aneuploidy.

Clinical Importance of Serum BDNF (Brain-Derived Neurotrophic Factor) Level for the Management of Pregnancies Complicated With Meconium-Stained Amniotic Fluid

Objective The aim of this study was to investigate the association between poor neonatal outcomes and BDNF (brain-derived neurotrophic factor) levels. We aimed to predict the need for an emergency cesarean and prevent unnecessary interventions in cases complicated with meconium-stained amniotic fluid (MSAF). Methods This study was designed as a case-control study including three groups. Group A included pregnant women who underwent cesarean due to fetal distress. Group B included the women who delivered vaginally. Groups A and B had cases with the presence of meconium in the amniotic fluid. Group C as a control group had clear amniotic fluid. Demographic features, fetal outcomes, and maternal serum and fetal cord blood BDNF levels (Human BDNF ELISA Kit; Synonyms: ANON2, BULN2; Catalog no: E-EL-H0010 96T) were evaluated. Results No significant difference was found between patients with meconium and without meconium in terms of BDNF levels. However, the BDNF level was found to be significantly lower if fetal distress had occurred with MSAF. Conclusions In conclusion, the study demonstrated that the level of maternal and fetal cord blood BDNF are both significantly lower when fetal distress occurs with the presence of MSAF.

Longer anogenital distance in female fetus of diabetic and obese pregnant women

OBJECTIVE

Previous studies revealed that prenatal exposure to androgen excess such as polycystic ovary syndrome (PCOS) is associated with offspring's anogenital distance (AGD) length, and AGD is a biomarker of intrauterine androgen exposure. This study aims to investigate a possible relationship of fetal AGD with maternal diabetes and obesity, and to evaluate whether AGD predicts the fetal androgen exposure related to diabetes and obesity in female fetus. This study is the first to focus on the relationship between offspring's AGD and maternal diabetes and obesity.

MATERIALS AND METHODS

This is a prospective study investigating 218 pregnant women (125 in control group and 93 in study group). Fetal AGD was measured from the center of anus to the posterior convergence of the fourchette by ultrasound. Multivariate linear regression analysis was applied to assess the association of the fetal AGD length with maternal diabetes and obesity.

RESULTS

The control patients had significantly shorter fetal AGD (mean:10.7 mm, P < 0.001) compared to diabetic, obese and diabetic obese patients (mean: 12.6 mm, 12.8 mm and 12.9 mm, respectively). The results of regression analysis showed that both maternal diabetes and obesity were significantly correlated with longer AGD in female fetus. The results confirmed also that offspring's AGD measurement in utero by ultrasound is feasible and reliable.

CONCLUSION

The study findings suggest that both maternal diabetes and obesity are associated with intrauterine androgenic milieu during pregnancy, and fetal AGD may be used as a biomarker to predict this effect. This may provide important advantages in terms of early detection of reproductive system abnormalities related to prenatal androgen exposure.

Diagnostic performance of two ultrasound techniques for the detection of cleft palate without cleft lip: axial-transverse and equal sign

OBJECTIVE

There is no study that compares the diagnostic performance of ATV and ESV techniques in detecting cleft palate. We aimed to evaluate the diagnostic accuracy of two ultrasound techniques: axial-transverse (ATV) and "equal sign" view (ESV), in detecting fetal cleft palate without cleft lip.

PATIENTS AND METHODS

This prospective study was conducted from March 2019 to January 2022 in a tertiary referral hospital. Secondary palates were assessed with ATV and ESV by two experienced fetal medicine specialists who were blinded to each other's ultrasound findings. Final diagnosis was done according to postnatal physical examination. The sensitivity and specificity of the two techniques were calculated.

RESULTS

A total of 311 pregnancies which met the study criteria were evaluated. Postnatal physical examination showed that 13 (0.4%) neonates had cleft palate only (CPO). According to final diagnosis the sensitivity, specificity, positive predictive value and negative predictive value for ATV were 100%, 98.7%, 76.4%, 100% and 100% for ESV were 76.9%, 97.8%, 58.9% and 99%, respectively.

CONCLUSIONS

ATV in 2D ultrasound provides higher sensitivity and specificity than ESV in detecting CPO.

Value of shear-wave elastography and cerebral-placental-uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes

PURPOSE

The aim of this study was to measure placental stiffness with shear-wave elastography technique and to evaluate the relationship with cerebral-placental-uterine ratio (CPUR) and adverse perinatal outcomes in patient groups diagnosed with preeclampsia (PE) and fetal growth restriction (FGR) in the second and third trimesters compared to the control group.

MATERIALS AND METHODS

This prospective cross-sectional study was conducted at our hospital between March 2019 and March 2020. The study groups were divided into three groups: PE, FGR, and low risk pregnancy (LRP) group. The study population had singleton pregnancies and the placental site was at the anterior wall. Both shear-wave elasticity (SWE) and shear-wave velocity (SWV) were measured in the placenta during pregnancy. CPUR was calculated for each group.

RESULTS

A total of 147 patients were included in this study. The mean SWE (kilopascals) values in the PE group were significantly higher than in the FGR and controls (difference of means = 3.67, 9.45; 95% CI (1.23-6.1, 7-11.8); p < .05), respectively. The mean SWV values were significantly higher in PE and FGR groups than controls (p < .05). CPUR showed correlation with central maternal surface of placenta (p: .02, r: -0.184), central fetal surface of placenta (p < .001, r: -0.288), peripheral maternal surface of placenta (p: .002, r: -0.252), and peripheral fetal surface of placenta SWE values (p: .03, r: -0.181). NICU admission was correlated with central fetal surface of placenta SWE values (p: .002, r: 0.258).

CONCLUSION

In conclusion, we demonstrated increased placental stiffness in both the PE and the FGR group. Also, this difference was found to be more prominent in preeclampsia. This technique seems useful for assessment of placental function and may strengthen the utility of Doppler parameters for predicting adverse perinatal outcomes in high-risk pregnancies.

Systemic immune-inflammation index to predict placenta accreta spectrum and its histological subtypes

AIM

In this study, we aimed to investigate the role of systemic immune-inflammation index (SII) and other inflammatory parameters in the diagnosis of placenta accreta spectrum (PAS) and its histological subtypes.

METHODS

This retrospective case-control study included patients who underwent surgery for placenta previa (PP). Case group (patients with PAS) included pregnant women diagnosed with histologically confirmed PAS, whereas control group (patients with PP) included pregnant women who underwent cesarean section with a PP diagnosis, required no additional intervention during the operation. Both groups were compared with respect to their demographic data, clinical characteristics, SII, and other laboratory parameters. Cut-off values that can predict PAS were calculated. The PAS group was separated into subgroups based on histology findings, and inflammatory parameters were compared between subgroups.

RESULTS

In this study, data of 273 patients were analyzed. Of these, 68 (24.9%) were included in the PAS group and 205 (75.1%) patients were included in the PP group. Significant differences were observed in SII, platelet distribution width, mean platelet volume, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (p = 0.000, p = 0.006, p = 0.002, p = 0.000, and p = 0.000, respectively). The best SII cut-off value was 985.02109/L (57.4% sensitivity and 72.2% specificity). There was no significant association between the histologic subtypes of PAS and inflammatory parameters.

CONCLUSION

SII can be used to predict PAS in pregnant women with PP. The relationship between the histologic subtypes of PAS and inflammatory parameters should be investigated in more comprehensive studies.

Application of the international classification of diseases-perinatal mortality (ICD-PM) system to stillbirths: A single center experience in a middle income country

OBJECTIVE

The present study is intended to investigate the causes of stillbirth and its relationship with maternal conditions using the International Classification of Diseases-Perinatal Mortality (ICD-PM) system.

MATERIAL AND METHODS

All early and late fetal deaths between 2015 and 2020 were analyzed. Time of death, fetal causes, and the maternal conditions involved were identified using the ICD-PM classification system.

RESULTS

During the study period, out of 74,102 births a total of 475 stillbirths were recorded (6.4 per 1000 births), of which 83.6% of the cases were antepartum and 11.8% were intrapartum fetal deaths, and the time of death could not be determined in 4.6% of the cases. Fetal developmental disorder was the most common cause of antepartum fetal death (24.2%). Intrapartum deaths were mostly due to extremely low birth weight (44.6%). The most common maternal conditions involved were complications of placenta, cord, and membranes (19.8%).

CONCLUSION

The applicability of the ICD-PM classification system for stillbirths is easy. It was observed that fetal deaths mostly occurred in the antepartum period and the cause of death could not be identified in over half of these antepartum fetal deaths. In over half of the stillbirths, there is at least one maternal condition involved. The most common maternal conditions involved are complications of placenta, cord, and membranes. The most common maternal medical problem is hypertensive diseases of pregnancy.

Evaluation of the relationship between placental stiffness measured by shear wave elastography and perinatal outcomes in women with gestational diabetes mellitus

BACKGROUND

Recently, studies on placental elastography in high-risk pregnancies continue to increase. The shear wave technique can contribute to the management of gestational diabetes mellitus (GDM) and improve perinatal outcomes by measuring placental stiffness.Purpose: To evaluate the relationship between placental stiffness measured by shear wave elastography (SWE) and perinatal outcomes in women with GDM.Material and Methods: This prospective cross-sectional study was conducted at our hospital between March and October 2020. The participants were divided into three groups: GDM-A1 group (regulated by dietary modifications); GDM-A2 group (needed pharmacologic treatment); and low-risk pregnancy (LRP) group. Both SWE and shear wave velocity (SWV) were measured in the placenta during pregnancy.

RESULTS

In total, 111 women were included in the study. The mean SWE (kPa) values for the GDM-A1, GDM-A2, and LRP groups were 10.4 (range 3.1-23.3), 13 (range 4.3-29.6), and 8.3 (range 3.2-15.1), respectively. The mean HbA1c and fasting glucose values of diabetes groups showed strongly positive correlation with mean SWE and SWV values (P < 0.001, r=0.875; P < 0.001, r=0.856; P < 0.001, r=0.791; P < 0.001, r=0.740), respectively. The SWE values of central maternal and fetal surfaces of the placenta (P=0.01, r=0.242; P < 0.001, r=0.333) showed a moderately positive correlation with admission to the neonatal intensive care unit.

CONCLUSION

Placental stiffness has increased in the GDM-A2 group when compared to the GDM-A1 and LRP groups. We also observed a strong positive correlation between HbA1c, fasting glucose values, and increased elasticity values in diabetic patients with metabolic dysregulation that may have clinical value.

Assessment of thiol/disulfide and ischemia modified albumin level and oxidative stress in pregnancies complicated by meconium

OBJECTIVE

The purpose of this study is to evaluate antioxidant balance in pregnant women with meconium-stained amniotic fluid.

METHODS

Forty pregnant women with meconium-stained amniotic fluid and 40 pregnant women with non-meconium-stained amniotic fluid were included in the study. By checking the ischemia modified albumin (IMA) level and thiol/disulfide homeostasis in the maternal blood during labor and in newborn umbilical cord blood at the first minute after birth, antioxidant/oxidant balance was evaluated.

RESULTS

No statistically significant difference was found between the maternal albumin levels. Maternal IMA level was statistically significantly higher in the meconium group than in the control group (p = .045). Maternal native thiol (SH) and maternal total thiol levels were statistically significantly higher in the control group than in the meconium group (p = .042 and p = .009, respectively). No statistically significant difference was found between maternal disulfide/native thiol (p = .262), maternal disulfide/total thiol (p = .152), maternal native thiol/total thiol (p = .153) rates in both groups. No statistically significant difference was determined between the patients with meconium and the control group in terms of cord blood IMA (p = .474), Albumin levels (p = .664), cord blood Native thiol (p = .944), cord blood total thiol (p = .612) levels and cord blood disulfide/native thiol (p = .240), cord blood disulfide/total thiol (p = .276), cord blood native thiol/total thiol (p = .277) rates.

CONCLUSION

Determination of a decrease in SH and Total Thiol levels in maternal serum and an increase in the meconium group's IMA level was interpreted as a shift of antioxidant balance toward oxidant in this group.

Fetal Genetic Diagnosis by Chorionic Villus Sampling: Evaluation of the Five-Year Experience from a Single Center

We summarized our five-year chorionic villus sampling (CVS) experience with indications, detected chromosomal abnormalities and pregnancy outcomes. Materials and Methods: This retrospective study examined 552 patients underwent CVS for prenatal diagnosis between 2014 and 2018. Results: The most frequent patients undergoing CVS indications were abnormal aneuploidy screening results, increased nuchal translucency, and cystic hygroma/edema. Of 552 CVS, 385 were normal, 141 abnormal. Eight were contaminated with maternal cells, 4 were mosaics, in 12 the culture failed, and in 2 there was inadequate sampling. The most frequent chromosomal abnormalities were trisomy 21, trisomy 18 and 45,X. Of 246 followed pregnancies, there were 165 live-births (67,1%), 58 pregnancy terminations (23,6%), and 23 pregnancy losses (9,3%). There were 5 procedure-related losses (2%), 3 of which were chromosomally normal. Conclusion: Although significant advances have been made in noninvasive methods such as NIPT, CVS is still a reliable technique for cytogenetic diagnosis in early gestation.

Sleep Disorders in Pregnancy, Influencing Factors and Quality of Life

AIM

In our study, the frequency of sleep disturbances in pregnancy, the reasons underlying the low quality of sleep, clinical factors, and the effects on quality of life were investigated.

METHODS

The study was planned as a prospective study and included 189 pregnant women. Clinical features, laboratory results, socio-demographic status, obstetric and medical anamnesis were evaluated. The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the Berlin Questionnaire, Beck Depression Inventory, SF-36 quality-of-life questionnaire, and restless leg syndrome (RLS) diagnosis criteria were used for data collection.

RESULTS

We investigated sleep disorders in 110 pregnant women (58.2%). A history of premenstrual syndrome and patients with hyperemesis gravidarum, obstructive sleep apnea syndrome, Vitamin B12 deficiency, and higher TSH levels in the laboratory were found to be associated with sleep disorders. Sleep disorders and daytime sleepiness were associated with depression, physical and social functioning, pain, and disturbance in general health perception. The number of pregnant women who had two or more RLS complaints was 84 (44%).

CONCLUSION

The results of our study show that sleep disorders in pregnancy can be managed with easily applicable methods according to the risk factors and related problems.

Maternal serum calprotectin level in intrahepatic cholestasis of pregnancy

AIM

This study aimed to investigate maternal serum levels of calprotectin in patients with intrahepatic cholestasis of pregnancy (ICP) and to compare these with serum calprotectin levels in healthy pregnant women.

METHODS

Ninety pregnant women (ICP group, n = 45; healthy control group, n = 45) were included in the study. The gestational age and body mass index of the participants in the two groups were similar. This prospective cross-sectional study was conducted between November 2019 and May 2020 in the perinatology department of University of Health Sciences Doctor Zekai Tahir Burak Women's Education Hospital, Ankara, Turkey. Patients were recruited from those attending the perinatology outpatient and inpatient clinics. Biochemical (alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), total bilirubin), fasting bile acid, hemogram, and calprotectin parameters of maternal blood were evaluated.

RESULTS

The mean fasting bile acid value in the ICP group was 30.3 ± 27.3 μmol, with severe ICP present in 11 (24.4%) patients. ALT, AST, LDH, total bilirubin, and mean platelet volume (MPV) values in the ICP group were higher and the red cell distribution width (RDW) value was lower than those in the control group (p < 0.001). The mean serum calprotectin levels in the control group and ICP group were 48.0 ± 10.4 and 765.4 ± 126.8 μg, respectively (p < 0.001). There was no significant correlation between serum fasting bile acid levels and serum calprotectin levels in the ICP group (p > 0.005).

CONCLUSION

Serum levels of calprotectin in patients with ICP were higher than those in healthy pregnant women. The serum calprotectin level may be an important diagnostic marker of ICP.

A rare case of bilateral proboscis lateralis: Prenatal US and MRI findings

Proboscis lateralis is a very rare congenital craniofacial malformation characterized by a finger-like tubular appendage arising usually from the medial canthal region. It is mostly unilateral and associated with other craniofacial malformations. Occasionally, proboscis lateralis is seen with holoprosencephaly. A rare case of bilateral proboscis lateralis which was diagnosed prenatally by ultrasound and magnetic resonance imaging has been presented. In this case of bilateral proboscis lateralis, both lesions arose from a very lateral location and were associated with various central nervous system anomalies other than holoprosencephaly.

Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome?

OBJECTIVE

To determine whether the ratio of the first-trimester aspartate aminotransferase (AST) to platelet ratio index (APRI) score will be useful as a new determinant of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome that may develop in the later stages of pregnancy Study Design: Descriptive-analytical study.

PLACE AND DURATION OF STUDY

Perinatology Clinic of Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey. The data of patients diagnosed as having HELLP syndrome between 2018 and 2020 were analyzed retrospectively.

METHODOLOGY

Forty-two pregnant women with HELLP syndrome as the study group and 74 pregnant women with no morbidities as the control group were included in the study. First-trimester APRI scores were compared for both the groups. A characteristic curve (ROC) analysis of the study was performed to determine the APRI score levels predicting HELLP syndrome.

RESULTS

One hundred and sixteen women with HELLP syndrome had significantly lower fibrinogen levels and platelet (PLT) levels than women without HELLP syndrome (p<0.001). Women with HELLP syndrome had significantly higher ALT, AST, creatinine, and INR levels. These differences were significantly different (p<0.001). Women who developed HELLP syndrome in the third trimester of pregnancy had significantly higher first-trimester APRI scores (0.64±0.10) than the control group (0.40±0.12, p<0.001). In the ROC analysis, 0.55 as a cut-off value for first-trimester APRI scores had a sensitivity of 88.1 % and a specificity of 94.6 % for predicting HELLP syndrome developing in the third trimester of pregnancy.

CONCLUSION

There was an association of first-trimester APRI scores with the prediction of HELLP syndrome, possibly developing in the later weeks of pregnancy. Predicting HELLP syndrome in the early period can assist in proper management and taking necessary precautions. Key Words: HELLP syndrome prediction, First-trimester APRI, APRI scores in pregnancy, APRI score.

Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever

OBJECTIVE

To investigate the association between maternal serum neutrophil-to-lymphocyte ratios (NLRs) and pregnancy outcomes in women with familial mediterranean fever (FMF).

BACKGROUND

FMF exists worldwide, it primarily affects Mediterranean countries METHODS: We retrospectively analysed data from 269 pregnant women, who underwent a routine prenatal follow-up and delivery in our hospital from 2016 to 2020. Clinical and demographic data, including age, gravida, parity, abortus, proteinuria in the first trimester, NLR, obstetrical complications, gestational age at delivery, birthweight were retrieved from the patients' medical records. Data from 67 pregnant women with FMF and 202 healthy pregnant women were compared.

RESULTS

Patients with FMF showed higher rates of preeclampsia and primary caesarean delivery; however, there were no differences between the groups in terms of other obstetric complications or adverse neonatal outcomes. In both the FMF and control groups, NLRs in the third trimester were significantly higher than those in the first trimester. Additionally, patients in the FMF group demonstrated higher NLRs than patients in the control group in the third trimester.

CONCLUSIONS

The NLRs are a haematological parameter that can be used to predict subclinical inflammation and the effects of ongoing subclinical inflammation on the pregnancy outcomes in women with FMF (Tab. 4, Ref. 39).

The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience

BACKGROUND

Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results.

METHODS

This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0-40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1^st-5^th minute APGAR scores, and OAE results were compared between the groups.

RESULTS

1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001).

CONCLUSIONS

Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.

Association between basal proteinuria levels and pregnancy outcomes in familial Mediterranean fever

We aimed to investigate whether proteinuria in the first trimester of pregnancy in Familial Mediterranean fever (FMF) patients has an impact on pregnancy outcome and perinatal and neonatal outcome of pregnancies. A total of 66 pregnant with FMF were compared with healthy controls at the same gestational weeks. Patients with FMF had a higher antenatal hospitalisation rate (34.8% vs. 6.1%, respectively, p < .01) and higher rate of 2 or more miscarriages. FMF patients with or without obstetric complications also had a similar amount of 24-h urine proteinuria in the first trimester. Patients on colchicine therapy during pregnancy had more frequent attacks in pregnancy (59.3% vs. 18.2%, respectively, p: .012). The rates of preeclampsia, preterm delivery, foetal anomalies, small for gestation age neonates and primary caesarean rate were similar between groups. In conclusion; FMF had no significant impact on pregnancy. Neither attacks in pregnancy nor basal proteinuria were associated with adverse outcomes.Impact statementWhat is already known on this subject? Familial Mediterranean fever (FMF) is an autosomal recessive disease characterised by inflammation of the serosal, synovial and cutaneous tissues with recurrent attacks. One of the most serious complications of FMF is amyloidosis that can cause end-stage renal disease. Outcomes of FMF on pregnancy have been analysed by only few studies. Amyloidosis based on the initial renal function may adversely affect pregnancies. It has been reported that FMF patients with renal amyloidosis may suffer pregnancy complications to a greater extent.What do the results of this study add? There have been few studies on the correlation between FMF, proteinuria and pregnancy outcomes. In our study we found that FMF had no significant impact on pregnancy. Neither attacks in pregnancy nor basal proteinuria were associated with adverse outcomes.What are the implications of these findings for clinical practice and/or further research? Our study suggested that FMF had no relationship between pregnancy outcomes. However, our study population is relatively small. It will contribute to comprehensive studies involving a larger population. Future studies should be performed to investigate the effects of basal proteinuria in pregnancy with FMF.

In-vivo Intradermal Delivery of Co-57 labeled Vitamin B-12, and Subsequent Comparison with Standard Subcutaneous Administration

Vitamin B-12 (cobalamin) deficiency in humans is a worldwide problem emanating from varied causes such as insufficient dietary intake or malabsorption of the micronutrient due to an underlying condition (absence or failure of intrinsic factor, atrophic gastritis, post-operative bariatric surgery, inflammatory bowel disease, cobalt deficiency etc.). As oral supplementation is limited by its bioavailability due to the absorptive property of intrinsic factor, clinicians often prescribe parenteral forms of administration to replenish diminished levels rapidly. The gold standard in parenteral delivery of cobalamin is subcutaneous and/or intramuscular injections. The relatively large molecular size of cobalamin (1355.39 Da) makes passive transdermal patch-based delivery via the stratum corneum quite challenging. Hence, the primary goal of this study is to investigate the feasibility of intradermal (ID) delivery of Vitamin B-12 via an almost painless microneedle injection and subsequent comparison with standard subcutaneous (SC) delivery. This work reports on a custom-made microneedle device built from a commercial insulin needle and it's use to perform ID delivery of Co-57 radiolabeled Vitamin B-12 in-vivo in rabbits. The pharmacokinetic profile and bioavailability were studied and compared with SC delivery. It is the first comprehensive study, to our best knowledge, that compares a micronutrient (eg. Vitamin B-12) delivery via ID and SC routes in-vivo. While the bioavailability for the SC route is found to be slightly higher compared to the ID route (99% vs. 96%), the T_max for both are almost identical. Thus, ID delivery of Vitamin B-12 using a microneedle injection could be a viable and minimally invasive alternative to existing parenteral options.

Maternal mortality due to hemorrhage: population-based study in Turkey

Objective: The aim of this study was to determine the epidemiological characteristics of maternal mortality due to postpartum hemorrhage, and to investigate whether national preventative measures of the Maternal Mortality Program have been successful in Turkey. Design: A population-based cohort study. Setting: Turkish National Maternal Mortality Data collected by the Turkish Ministry of Health. Participants: Women who died due to hemorrhage during pregnancy or after delivery within the initial 42 days, from 2012 to 2015, throughout Turkey (N = 812/146). Main outcome measures: The preventability and problems in each maternal death due to hemorrhage. Results: A total of 779 maternal deaths were identified during the study period. Our estimate of the Maternal Mortality Ratio (MMR) in the 3-year period was 19.7 per 100,000 live births. Of the 779 deaths, the report listed 411 as direct and 285 as indirect deaths. Direct obstetric complications were the leading causes of maternal deaths, the most common of which was maternal cardiovascular diseases (21%) and obstetric hemorrhage (20.6%). Conclusion: Improving data surveillance and implementing national guidelines for the prevention and management of major complications of pregnancy, childbirth, and puerperium is necessary to reduce MMR. The healthcare authorities of Turkey should continue to set a sustainable development goal of ≤70 maternal deaths per 100,000 live births by 2030. We believe our results may provide useful information for other developing countries that are aiming to reduce maternal mortality, as well as mobilize global efforts to improve women's health.

First trimester biochemical markers in twin pregnancies

OBJECTIVE

Our aim was to investigate the first trimester serum markers and nuchal translucency (NT) measurements in twin pregnancies in our population.

MATERIALS AND METHODS

We reviewed the results of all double tests that were performed in our hospital over a three-year period. Out of them, we selected all twins and compared them with a group of three times as many singleton controls. NT measurements and the first trimester serum markers from 49 twin pregnancies were compared to those of 147 pregnant women with normal singleton pregnancy

RESULTS

There were no statistically significant differences in age, gestational age and maternal weight between the two groups (p > 0.05). We found similar NT measurements in the two groups. The median MoM of Pregnancy-Associated Plasma Protein A (PAPP-A) and fβ-hCG levels in twins were statistically significantly higher than those in singleton pregnancies. Twelve percent of the twins (12.2%) were the result of assisted reproduction technologies. IVF versus naturally conceived pregnancies showed similar MoM of PAPP-A (2.2 vs. 1.2, respectively) and fβ-hCG (Mann-Whitney U; p = 0.195 and p = 0.958).

CONCLUSIONS

Our study revealed that median PAPP-A and fβ-hCG levels for twins were less than twice those of singleton values.

The unprecedented recurrent diploid/tetraploid mosaicism of trisomy-18 (mixoploidy; 4n+18/2n+18): clinical report

We report on a 32-year-old woman who presented at gestational age of 14 weeks. During ultrasonographic examination, we discovered that her fetus had several important abnormalities, including a cystic hygroma, craniofacial defects (low-set ears, broad nose), heart defects (single atrium, single ventricle), agenesis of corpus callosum, limb defects (clenched hands, pes equinovarus). Chorionic villus sampling and karyotyping revealed diploid/tetraploid mosaicism with trisomy 18 (mixoploidy; 4n+18/2n+18). Her second pregnancy was terminated because of the same clinical manifestations 1 year prior. Her first pregnancy resulted in the birth of an entirely healthy boy. As far as know, no other similar case has been presented in the literature.

Cost-effectivity analysis of one-step versus two-step screening for gestational diabetes

OBJECTIVE

Early diagnosis of gestational diabetes mellitus (GDM) is important for both maternal and fetal health. The literature has varying recommendations about one-step and two-step tests for GDM screening and diagnosis. The present study aimed to investigate the difference in the cost and duration of hospital stay of a one-step procedure compared to a two-step procedure, which is routinely performed in our hospital.

MATERIALS AND METHODS

The two-step procedure was performed in 2,724 pregnant women, and the one-step procedure was performed in 185 pregnant women. The one-step and two-step screening procedures for gestational diabetes were compared with respect to the duration of hospital stay and cost.

RESULTS

The test cost per woman was 0.75 TL less in the one-step procedure; however, the duration of the one-step test was 18.6 min longer, and the number of blood sampling procedures was 1.08 times higher.

CONCLUSION

The one-step method may be preferred over the two-step (or glucose challenge) test due to its diagnostic value and lower cost.

Effect of maternal cervical bacterial colonization on neonatal outcome in high-risk pregnancies: results from a tertiary maternity center in Turkey

PURPOSE

To evaluate and compare the morbidity and mortality of neonates born to pregnant women with positive and negative cervical cultures.

MATERIALS AND METHODS

The demographic and clinical features of mothers included in this study, along with details of the microorganisms isolated on maternal cervical cultures and the number of days between a positive cervical culture and delivery were recorded. Neonates were stratified into two groups based on cervical culture results of their mothers--Group 1, positive cervical culture; Group 2, negative cervical culture.

RESULTS

A total of 216 women who delivered 242 infants were included in the study. Group 1 consisted of 90 neonates while Group 2 had 152 newborns. The difference between the groups with demographic characteristics was statistically insignificant. Mean levels of the acute phase reactants, CRP, and IL-6, obtained six hours after delivery were significantly higher in Group 1 compared to Group 2 (p < 0.05 for C-reactive protein (CRP) andp < 0.001 for IL-6). Although there was no difference between groups in terms of duration of respiratory support, mean duration of hospitalization, as well as mortality rate were significantly higher in Group 1 (p < 0.001, p < 0.05, respectively).

CONCLUSIONS

Women diagnosed with a high-risk pregnancy should be treated with antibiotics immediately after a positive cervical culture result, and delivery should be delayed until the success of antibiotic treatment can be evaluated. Early initiation of maternal antibiotic therapy is associated with shorter durations of hospital stay for newborns. Close follow-up of mothers with high-risk pregnancies and extension of treatment duration are critical for determining prognosis in newborn infants.

Preoperative prediction of poor prognostic parameters and adjuvant treatment in women with pure endometrioid type endometrial cancer: what is the significance of tumor markers?

Summary

PURPOSE OF THE STUDY

The study was conducted to determine whether preoperative serum levels of cancer antigen (CA) 125, CA15- 3, CA19-9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) are associated clinicopathologically with poor prognostic parameters and adjuvant treatment requirements in women with pure endometrioid endometrial cancer (EEC).

MATERIALS AND METHODS

The authors performed a retrospective review of EEC cases that were treated between January 2008 and January 2011. The association between preoperative tumor markers and prognostic parameters, recurrence risk, and adjuvant treatment requirements were investigated. Following univariate analyses, receiver-operating characteristic (ROC) curves were constructed for each marker to assess their capacity to predict prognostic parameters and need for adjuvant treatment.

RESULTS

A total of 166 EEC cases were identified. Mean CA125, CA15-3, and CA19-9 levels were higher in cases that required adjuvant treatment (p < 0.05). CA125 had significant power for prediction of extrauterine disease, tumor size > two cm, lymphovascular space invasion (LVSI), deep myometrial invasion, cervical involvement, adnexal involvement, positive cytology, lymph node metastasis, and adjuvant treatment requirement. CA15-3 was a significant marker for adjuvant treatment prediction. CA19-9 could predict deep myometrial invasion, cervical involvement, and adjuvant treatment requirement. However, CEA and AFP did not have adequate capacity to predict any of the poor prognostic parameters and adjuvant treatment requirements. CONCLUSIONs: CA125 is currently one of the most important preoperative markers for identifying EEC cases that exhibit postoperatively poor prognostic pathologic findings and a consequent need for adjuvant treatment. CA15-3 and CA19- 9 were also significant markers with limited capacity in detecting prognostic parameters.

The outcomes of surgical treatment modalities to decrease "near miss" maternal morbidity caused by peripartum hemorrhage

BACKGROUND

The treatment of patients with peripartum hemorrhage is unfortunately characterized by inadequate treatment that does not adhere to standard therapeutic measures.

AIM

Assessment of different management strategies among patients with severe hemorrhage, particularly the ones with "near-miss" maternal morbidity and mortality to establish clinically useful guidelines for the prevention and management of peripartum hemorrhage.

PATIENTS AND METHODS

In this study, the medical records of 458 patients who have experienced peripartum hemorrhage between March 2009 and March 2012 in a tertiary perinatal center were retrospectively reviewed. Specific surgical treatment modalities utilized to 61 patients with severe peripartum hemorrhage with respect to the procedure timing and effectivity were compared according to the outcomes and efficiency.

RESULTS

Sixty-one patients who have been diagnosed as severe peripartum hemorrhage have been included to the study. Six (75%) of the 8 patients who were treated with B-Lynch brace suture for uterine atony and 9 (60%) of the 15 patients who were treated with the Bakri balloon tamponade system for uterine atony or placenta accreta required hysterectomy following the initial therapeutic measures. The patients who have been treated with bilateral hypogastric artery ligation and B-Lynch brace suture or Bakri balloon uterine tamponade system were less likely to need a complementary hysterectomy for definitive treatment of peripartum hemorrhage when compared with patients treated with either B-Lynch brace suture or Bakri uterine tamponade balloon system alone.

CONCLUSIONS

The efficiency of B-Lynch compression brace sutures and the Bakri balloon uterine tamponade system is unpredictable in terms of the need for hysterectomy for peripartum hemorrhage patients diagnosed as either uterine atony or placenta previa. Regardless of the initial diagnosis, these modalities seem to be more effective in alleviating peripartum hemorrhage when accompanied by hypogastric artery ligation.

Does drug compliance change in asthmatic patients during pregnancy?

Background: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. Methods: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. Results: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. Conclusions: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

Predictive value of umbilical artery Doppler for adverse perinatal outcome in patients with HELLP syndrome

OBJECTIVE

In this study, we aimed to evaluate in a prospective design the importance of pathologic umbilical artery (UA) Doppler findings as a predictive marker for neonatal outcome in patients with HELLP syndrome.

PATIENTS AND METHODS

A total of 45 pregnant women at 24-42 weeks of gestation with a diagnosis of HELLP syndrome were included. The study group consisted of 20 patients with abnormal UA Doppler results, and the remaining 25 HELLP syndrome patients with normal UA Doppler results were assigned to the control group. All patients were followed up until delivery, and the neonatal characteristics were compared.

RESULTS

Baseline characteristics of the groups were similar. In the study group, gestational week at delivery and infant birth weight were significantly lower (p < 0.05). The rates of significant neonatal morbidity, neonatal mortality, and neonatal intensive care unit (NICU) admission were significantly higher in study group patients (p < 0.05).

CONCLUSIONS

UA Doppler abnormalities can be considered predictive of poor neonatal prognosis in patients with HELLP syndrome, as they were significantly related with higher rates of neonatal mortality and significant morbidity.

Preclinical evaluation of [(18)F]JNJ42259152 as a PET tracer for PDE10A

Phosphodiesterase-10A (PDE10A) is implicated in several neuropsychiatric disorders involving basal ganglia neurotransmission, such as schizophrenia, obsessive-compulsive disorder and Huntington's disease. To confirm target engagement and exposure-occupancy relationships of clinical candidates for treatment, and to further explore the in vivo biology of PDE10A, non-invasive imaging using a specific PET ligand is warranted. Recently we have reported the in vivo evaluation of [(18)F]JNJ41510417 which showed specific binding to PDE10A in rat striatum, but with relatively slow kinetics. A chemically related derivative JNJ42259152 was found to have a similar in vivo occupancy, but lower lipophilicity and lower PDE10A in vitro inhibitory activity compared to JNJ41510417. (18)F-labeled JNJ42259152 was therefore evaluated as a potential PDE10A PET radiotracer. Baseline PET in rats and monkey showed specific retention in the PDE10A-rich striatum, and fast wash-out, with a good contrast to non-specific binding, in other brain regions. Pretreatment and chase experiments in rats with the selective PDE10A inhibitor MP-10 showed that tracer binding was specific and reversible. Absence of specific binding in PDE10A knock-out (KO) mice further confirmed PDE10A specificity. In vivo radiometabolite analysis using high performance liquid chromatography (HPLC) showed presence of polar radiometabolites in rat plasma and brain. In vivo imaging in rat and monkey further showed faster brain kinetics, and higher striatum-to-cerebellum ratios for [(18)F]JNJ42259152 compared to [(18)F]JNJ41510417. The arterial input function corrected for radiometabolites was determined in rats and basic kinetic modeling was established. For a 60-min acquisition time interval, striatal binding potential of the intact tracer referenced to the cerebellum showed good correlation with corresponding binding potential values of a Simplified Reference Tissue Model and referenced Logan Plot, the latter using a population averaged reference tissue-to-plasma clearance rate and offering the possibility to generate representative parametric binding potential images. In conclusion we can state that in vivo imaging in PDE10A KO mice, rats and monkey demonstrates that [(18)F]JNJ42259152 provides a PDE10A-specific signal in the striatum with good pharmacokinetic properties. Although presence of a polar radiometabolite in rat brain yielded a systematic but reproducible underestimation of the striatal BPND, a Logan reference tissue model approach using 60 min acquisition data is appropriate for quantification.

The association of a cervical length of <25 mm in high-risk pregnancies on neonatal morbidity and mortality in preterm infants

PURPOSE

To evaluate and compare the effects of a short cervix (<25 mm) on neonatal morbidity and mortality as opposed to a normal cervical length (≥25 mm). The predictive value of a short cervix on neonatal outcome is also investigated.

METHODS

Preterm infants who were admitted to the neonatal intensive care unit and whose mothers had undergone a pre-delivery evaluation for cervical length (CL) and cervical cultures were included in the study. Infants were stratified into two groups based on CL measurements (Group 1, CL < 25 mm; Group 2, CL ≥ 25 mm).

RESULTS

A total of 203 infants were included in the final analysis. Group 1 consisted of 105 neonates while Group 2 had 98 newborns. Cervical culture positivity rate was 46.7 % (n = 49) in Group 1 compared to 19.4 % (n = 19) in Group 2 (p = 0.0001). Frequencies of early onset neonatal sepsis (EOS) in Group 1 and Group 2 were 31.5 and 18.4 %, respectively (p = 0.032), whereas respective frequencies of proven sepsis in the two groups were 18.1 and 8.2 % (p = 0.037). A CL < 25 mm was found to increase the risk of cervical culture positivity, EOS and proven EOS by odds ratios of 3.63, 2.03 and 2.48, respectively.

CONCLUSIONS

This is the first clinical study to demonstrate a significant link between CL and each of cervical culture positivity, EOS and neonatal morbidity and mortality. Preterm infants born to high-risk mothers with short CL should be monitored closely for the risk of EOS.

Placental growth factor: as an early second trimester predictive marker for preeclampsia in normal and high-risk pregnancies in a Turkish population

OBJECTIVE

Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

MATERIALS AND METHODS

In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

RESULTS

In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

CONCLUSION

Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.

Utility of First Trimester Ultrasonography before 11 Weeks of Gestation: A Retrospective Study

We showed the utility of first trimester ultrasonography before 11 weeks of gestation for antenatal followup. We retrospectively analyzed 1295 records of patients who underwent first trimester ultrasonography (transvaginal/abdominal) in our antenatal clinic in Ankara, Turkey. Maternal age, parity, gestational age, and maternal gestational history were compared with ultrasonographic findings. Patients were divided into 12 groups based on ultrasonographic diagnoses in the first ultrasonographic scan, and called for a control examination within 10 days if the diagnostic findings were abnormal. The data were statistically analyzed using Kruskal-Wallis and chi-square tests. We noted 81.3% patients to have single, viable, intrauterine pregnancies, while 18.7% had abnormal or complicated pregnancies with uterine anomalies, ovarian cysts, fibroids, or subchorionic hematomas. Normal and anembryonic pregnancies had significantly lower median diagnostic period in the control ultrasonography than in the first examination. First trimester ultrasonography before 11 weeks of gestation is valuable in determining pregnancy outcomes.

A retrospective analysis of amniocenteses performed for advanced maternal age and various other indications in Turkish women

OBJECTIVE

Prenatal cytogenetic diagnostic methods for the diagnosis of fetal chromosomal anomalies have been used reliably over the last 40 years. Advanced maternal age has become a basic indication for amniocentesis.

METHODS

We examined the results of the chromosome analyses of 3485 women that had amniocentesis for any reason during their antenatal care in our perinatology clinic in 2007-2009. Amniocentesis was performed for advanced maternal age in 1456 women (41.8%) and for other reasons in the remaining 2029 women (58.2%). Chromosomal anomalies were examined numerically and structurally.

RESULTS

When the amniocentesis results of the patients were reviewed as numerically normal or abnormal; 40 (2.7%) of 1456 amniocentesis procedures performed for advanced maternal age, 5 (0.9%) of 531 procedures performed for an increased double-test risk and 14 (1.3%) of 1095 procedures performed for an increased triple test risk were found to have chromosomal aneuploidy.

CONCLUSIONS

Maternal age is still the most prevalent indication for genetic amniocentesis other than positive prenatal screening tests. Among women with advanced maternal age, prenatal ultrasonography for soft markers of chromosomal aneuploidy accompanied with maternal serum biochemical screening tests should be evaluated during the decision making process of genetic amniocentesis.

Alarming rise of cesarean births: a single center experience

BACKGROUND AND OBJECTIVES

The increase in cesarean section rates requires detailed investigation worldwide. The goal of this study was to analyze the distribution of indications and rates of cesarean sections in a developing country and to introduce the measures for controlling increased cesarean deliveries.

MATERIAL AND METHODS

Electronic medical records of the patients who underwent cesarean section were retrospectively evaluated between the years of 2006 and 2008.

RESULTS

Total of 42,547 vaginal delivery, 104 instrumental vaginal delivery and 28357 cesarean section were performed. The instrumental delivery and cesarean section rates were 0.14 and 39.9%, respectively. The most common indication was repeat cesarean that was present in 9224 patients (32.5%) followed by fetal distress in 6427 patients (22.6%).

CONCLUSIONS

Encouraging vaginal delivery for patients with previous cesarean by community based national approaches seems the leading measure to control the increased rates of cesarean section in developing countries.

Rapidly progressing A/H1N1 (09) pandemic influenza virus infection in pregnancy

We presented a pandemic H1N1 2009 influenza virus infection in two pregnant women who were referred to the intensive care unit (ICU) with a rapidly progressive disease course. Both women had unremarkable past medical history. The first woman had the symptoms of fever, cough, dyspnea and tachypnea lasting for four days. The second woman refused to take oseltamivir treatment. They were both referred to ICU with the diagnosis of pneumonia and acute respiratory distress syndrome. The second woman was intubated for two days in ICU. Both women showed a gradual improvement in their follow up and were discharged. Early admission, prompt diagnosis and early recourse to antiviral treatment gives better results in H1N1 infected pregnant women (Fig. 2, Ref. 10).

Pandemic influenza H1N1 2009 virus infection in pregnancy in Turkey

OBJECTIVES

To describe the clinical characteristics of the pregnant women who were hospitalized in a tertiary referral hospital with pandemic influenza H1N1 2009 virus infection and neonatal outcomes from October 2009 to December 2009 during which the pandemic influenza cases peaked in Turkey.

MATERIALS AND METHODS

Twenty-five pregnant women who were hospitalized with influenza-like illness and who had laboratory confirmation for pandemic influenza H1N1 virus infection were evaluated prospectively.

RESULTS

Of the 25 patients, 4 (16%) were in the first trimester, 8 (32%) were in the second trimester, and 13 (52%) were in the third trimester. The median time from the onset of symptoms to the initiation of antiviral therapy was 1 day (range 1-9 days). Nineteen (76%) patients received oseltamivir treatment. It took 1.6 days on the average for the fever defervescence after the initiation of treatment or hospitalization. Of the 14 patients who underwent chest radiography, three had findings consistent with pneumonia. The mean duration of hospitalization was 4.8 days. Four women (16%) were admitted to an intensive care unit, but there were no maternal or neonatal deaths in this series. At the time of their H1N1 hospitalization, seven women delivered by cesarean at 33-40 weeks gestation, two vaginally at 38 weeks gestation, and two had an abortion at 10 weeks and 16 weeks of gestation, respectively. None of the infants had any evidence of influenza infection.

CONCLUSION

Pregnant women are at increased risk for complications from pandemic influenza H1N1 virus infection. Timely medical attention with early recourse to antiviral therapy is associated with a better outcome in H1N1-affected pregnant women.

Removal of uterine fibroids during cesarean section: a difficult therapeutic decision

PURPOSE OF INVESTIGATION

Myoma excision during cesarean delivery has traditionally been discouraged, however controversy persists among studies of myomectomy being performed during cesarean section. In this study, medical records of patients who underwent cesarean section our institution were evaluated retrospectively.

METHODS

A total of 70 cases of cesarean myomectomy done during this period were included (group 1) and compared with the patients who underwent cesarean section alone (group 2).

RESULTS

Mean surgical time of the myomectomy group was 58.1 +/- 23 minutes which was significantly increased (p < 0.01). Mean postoperative hemoglobin value was 9.6 +/- 1.5 in the myomectomy group and 10.8 +/- 1.01 in controls (p = 0.01). Length of hospital stay was significantly longer in the myomectomy group (p < 0.05).

CONCLUSION

This study shows that myomectomy during cesarean section is a feasible procedure without any serious complications. The procedure is related with increased blood loss that does not require blood transfusion.

Severe preeclampsia and fetal virilization in a spontaneous singleton pregnancy complicated by hyperreactio luteinalis

BACKGROUNDŕ: Hyperreactio luteinalis is a rare condition that stems from theca cell hyperplasia in the ovaries due to a high level of human chorionic gonadotropin during gestation. It occurs commonly in pregnant patients with trophoblastic disease, occasionally in multiple pregnancies, and rarely in normal singleton pregnancy.

CASE REPORT

A 24-year-old pregnant woman, G3 P0, who was admitted to the Perinatology Clinic with increasing findings of virilization during pregnancy was presented. The patient had bilaterally enlarged multicystic ovaries on sonographic examination and elevated serum androgen levels She was managed conservatively until 38th week of gestation as a presumptive diagnosis of hyperreactio luteinalis. Elevated blood pressure and prominent proteinuria were detected during the follow-up of the patient and labor was induced. She underwent an emergency caesarean delivery because of fetal distress. During caesarean section, ovarian biopsies were taken and a histopathological diagnosis of hyperreactio luteinalis was determined. The female fetus also presented virilization.

CONCLUSION

Although infrequent, hyperreactio luteinalis with both maternal and fetal virilization can occur in women with spontaneous singleton pregnancies. The clinical manifestations in such women may be complicated by severe preeclampsia.

Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.

Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report

OBJECTIVE

To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey.

DESIGN

A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection.

SETTING

Nationwide in Turkey.

POPULATION

Thirty-six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection.

METHODS

Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009.

MAIN OUTCOME MEASURE

Maternal mortality as a result of H1N1 virus infection.

RESULTS

The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one-fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause-specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77-5.43).

CONCLUSIONS

Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause-specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.

Asymptomatic bacteriuria and antibacterial susceptibility patterns in an obstetric population

Introduction. Asymptomatic bacteriuria (ASB), occurring in 2–11% of pregnancies, is a major predisposition to the development of pyelonephritis, which is associated with obstetrical complications, such as preterm labor and low birth weight infants. The aim of this study was to determine the prevalence of ASB, the antibacterial susceptibilities of the isolated microorganisms and the associated risk factors in an outpatient clinical setting in Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey. Material and Methods. Between December 2009 and May 2010, pregnant women admitted to the antenatal outpatient clinic were included in this study. The results of a complete urine analysis, midstream urine culture and antibacterial susceptibility were evaluated. Results. Of the 2011 pregnant women included, 171 had ASB (8.5%). E. coli was the most frequently isolated microorganism (76.6%), followed by Klebsiella pneumonia (14.6%). Both microorganisms were highly sensitive to fosfomycin, sensivity being 99.2% for E. coli and 88% for Klebsiella pneumonia. Conclusions. In this certain geographical region, we found E. coli as the most common causative agent of ASB in the obstetric population and it is very sensitive to fosfomycin. We recommend fosfomycin for ASB in pregnant women due to its high sensitivity, ease of administration and safety for use in pregnancy.

Effectiveness of emergency cervical cerclage in patients with cervical dilation in the second trimester

OBJECTIVE

Efficacy of emergency cerclage commensed in the second trimester is a controversial issue. In this study, we aimed to assess the success and associated complications of emergency cerclage in patients with cervical dilatation in the second trimester.

MATERIAL AND METHODS

In this retrospective study, medical records of 75 pregnant women who had clinically and ultrasonographically confirmed cervical dilatation in the second trimester who had undergone cervical cerclage were analyzed. Pregnancy prolongation was the main outcome measure.

RESULTS

Seventy-five women were included to the study. Mean age was 27 and mean gravidity of the patients was three. Mean cervical length was 28.5 mm (12-41 mm). The rate of spontaneous abortion, immature deliveries, prematurity and deliveries after 34 weeks were 2.7% (n = 2), 8% (n = 6), 12 (n = 9) and 77.7 (n = 58), respectively. Fetal survival rate was 89.1% (n = 65). Serious vaginal bleeding from the suture area was noted in two patients (2.6%). No postoperative complications occurred.

CONCLUSION

Emergency cerclage is a simple surgical procedure with lower complication rates and can effectively prolong gestation to viability. It can be considered as a useful measure for patients with evidence of cervical changes in the second trimester.

Two-year experience of obstetric cholestasis: outcome and management

PURPOSE

Our aim was to evaluate the management and outcome of obstetric cholestasis in our perinatology unit.

METHODS

We analyzed 44 pregnant women complicated by cholestasis. Data were collected retrospectively. Details of patient demographics and outcomes of pregnancy were recorded. Patients were randomized due to their decision to take ursodeoxycholic acid (UDCA) therapy or not.

RESULTS

Forty-four women of age 28.09 +/- 4.6 years delivered 45 newborns. The mean gestational age at diagnosis of obstetric cholestasis was 32.36 +/- 3.75 weeks. The mean delivery time was 38.25 +/- 1.5 weeks. Spontaneous premature delivery occurred in five (11.4%) of the patients. No stillbirths were observed. Serum transaminases decreased significantly in 26 of the patients who were treated with oral UDCA therapy. Twelve (27.2%) babies were admitted to the neonatal intensive care unit (NICU). Out of 12 mothers whose babies were admitted to NICU, nine patients had not received UDCA (p = 0.07).

CONCLUSION

UDCA is effective in lowering transaminases.

Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations

OBJECTIVES

To evaluate iatrogenic urinary tract system injuries in obstetrics and gynecology operations and compare the results with the literature.

PATIENTS AND METHODS

We examined the records of patients who had obstetric and gynecology operations at the Ministry of Health, Dr. Zekai Tahir Burak Women's Health, Training and Research Hospital between June 2007 and June 2010. All the patients who were diagnosed as having urinary system injuries in either the intraoperative or postoperative period were determined.

RESULTS

During this period, 25,998 gynecologic and obstetrical operations were performed, 0.03% ureteric, 0.20% bladder, and one case of urethral injury, in a total of 0.24% urinary tract injuries were observed. The bladder was the most frequently injured organ. Total urinary tract injury rates were 0.79% (0.49% bladder, 0.24% ureteral) in gynecologic operations and 0.19% (0.18% bladder and 0.01% ureteral) in obstetric operations.

CONCLUSION

Urinary system injuries are seen in approximately 1% of all gynecologic and obstetric surgeries. The complication rates observed in our patients were comparable with the other studies in the literature. A gynecologic surgeon must become familiar with the anatomy of the urinary tract and must be aware of common intraoperative and postoperative complications to decrease the risk of morbidity.