New generation oral anticoagulant apixaban enhances embryo implantation by increasing integrin ß3 expression in rats: A pilot study.

OBJECTIVE: The first aim of this study was to investigate the effect of apixaban on endometrial receptivity via immunohistochemical investigation of integrin ß3 expression in pregnant rats. The second aim was to compare the endometrial effects of both subcutaneous and oral anticoagulant drugs in terms of integrin ß3 expressions. METHODS: A total of 24 rats were selected for this study and divided into three equal groups as control, enoxaparin and apixaban groups. Subcutaneous enoxaparin and oral apixaban were applied for 15 days starting on the first day of pregnancy. On the 15th day of pregnancy, all rats were killed by cervical dislocation, and uterine horns, including pregnancy materials, were investigated for pregnancy success and endometrial receptivity by using immunohistochemical integrin ß3 staining. RESULTS: Living, viable fetuses were higher in the apixaban group compared to the control group (p=0.037). Intensity and universality of immunohistochemical staining of integrin ß3 for endometrial stroma were detected statistically higher in the apixaban group than the other groups. (p=0.009 for intensity, p=0.014 for universality). Endometrial epithelial and myometrial integrin ß3 expression were detected to be identical between the groups (p=0.3). CONCLUSIONS: Apixaban enhances endometrial receptivity via increasing integrin ß3 expression in rats. This result can lead to further studies to be done in the future.

The relationship between serum thiol levels and thiol/disulfide homeostasis in women with tubal ectopic pregnancy.

OBJECTIVE: The aim of this study was to investigate the thiol/disulfide homeostasis in tubal ectopic pregnancies in terms of early diagnosis of the disease. DESIGN: A prospective case-control study was carried out between June 2017-February 2018 in the Gynaecology Department of Umraniye Medical and Research Hospital. MATERIALS AND METHODS: A total of 42 women with ectopic pregnancy were compared with 44 healthy women who have intrauterine first trimester pregnancies. The thiol/disulfide homeostasis is evaluated with the spectrophotometric measurement method that was recently developed by Erel&Neselioglu. RESULTS: Disulfide/native thiol and disulfide/total thiol ratios were increased (p = 0.018 and p = 0.023 respectively), while native thiol/total thiol ratios and native thiol levels were decreased in tubal ectopic pregnancy group according to control group (p = 0.023). Between control and tubal ectopic pregnancy groups no differences were measured in disulfide levels (p = 0.350). The area under curve for native thiol and total thiol were 0.937 and 0.927, respectively. The optimum cut off value for native thiol was 379.95 µmol/l with a sensitivity of 90% and specificity of 81%. The optimum cut off value for total thiol was 432.5 µmol/l had 92% sensitivity and 79% specificity. LIMITATIONS: In the study, whether intrauterine pregnancies resulted in miscarriage or delivery can be examined. CONCLUSION: Increased disulfide/native thiol levels, disulfide/total-thiol ratio and decreased native/total thiol ratio were found to be significantly associated with the presence of tubal ectopic pregnancy which can be useful for the early diagnosis of the disease.

Maternal serum thrombospondin-1 is significantly altered in cases with established preeclampsia.

PURPOSE: The aim of the study was to investigate whether maternal serum TSP-1 level was associated with PE. MATERIALS AND METHODS: In our case control study, 84 pregnant women in the third trimester were included. Forty-one of them were healthy and 43 of them were with the diagnosis of PE. The diagnosis was based on the definitions of the National High Blood Pressure Education Program working Group on High Blood Pressure in Pregnancy. Preeclamptic patients were divided into two subgroups as mild and severe. Blood pressure (BP) of pregnant women were obtained in left-side lying position using a mercury sphygmomanometer after at least 10 minutes of rest. Ten milliliters of venous blood was taken from every pregnant women and dispensed into lithium heparin and serum was obtained. Samples were stored at -80 °C until analyzed. Serum TSP-1 level was measured using enzyme-linked immunosorbent assay (ELISA). All tests were two-tailed and p < .05 was considered to be statistically significant. RESULTS: TSP-1 level was significantly lower in PE group than in controls (p = .003). Platelet counts were similar in two groups (p = .26). TSP-1 levels were significantly lower in severe PE than in mild PE cases. According to the subgroup analysis, TSP-1 level was found significantly lower in severe preeclampsia group compared to control group (p = .015). CONCLUSIONS: In light of the association between endothelial dysfunction and preeclampsia, we claim that lower levels of TSP-1 which is released mostly from endothelial cells seem to reflect disease severity in PE. Our study reveals that maternal serum TSP-1 levels decrease in pregnant women presenting with PE and TSP-1 may be a new biomarker for the detection of PE and even severity of it. Further studies especially prospective ones with greater numbers of cases are needed.

Use of cervicovaginal PAMG-1 protein as a predictor of delivery within seven days in pregnancies at risk of premature birth.

BACKGROUND: To investigate the utility of vaginal placental alpha microglobulin-1 (PAMG-1) protein as a predictor of preterm delivery within 7 days in pregnancies at risk of premature birth. METHODS: This prospective study was performed in women at risk of premature birth. The levels of vaginal PAMG-1 and foetal fibronectin (fFN) and the transvaginal cervical length measurement (CLM) were investigated and compared. RESULTS: Seventy-two pregnant women were included in this study. The sensitivities of PAMG-1, fFN and CLM were 73.3, 73.6%, and 52.9%, respectively, while the specificities of PAMG-1, fFN and CLM were 92.9%, 94.3%, and 90.9%, respectively. The positive predictive values of PAMG-1, fFN and CLM were 73.3%, 82.3%, and 64.2%, respectively, and the negative predictive values of PAMG-1, fFN and CLM were 92.9%, 90.9%, and 86.2%, respectively. CONCLUSION: The diagnostic accuracy of PAMG-1 is similar to that of fFN in terms of preterm labour detection within 7 days.

The utility of maternal mean platelet volume levels for early onset neonatal sepsis prediction of term infants.

OBJECTIVES: This study is aimed to evaluate the role of maternal mean platelet volume (MPV) levels for antenatal prediction marker of early onset neonatal sepsis in term infants born to mothers who have low infection risk. MATERIAL AND METHODS: A total of 62 pregnant women who gave birth in our hospital and whose neonates were admitted to a third level Neonatal Intensive Care Unit due to confirmed neonatal sepsis between January 2010 and May 2016 were selected as a study group. Within the same period, 68 women who gave birth to healthy neonates were enrolled as a control group. We compared maternal MPV values which were evaluated before delivery. The receiver operating characteristic (ROC) curves were drawn to evaluate the values maternal MPV in the diagnosis of neonatal sepsis. RESULTS: MPV levels were detected statistically higher in the study group than the control group (8.27 ± 1.85 vs. 8.98 ± 1.16) (p = 0.001). CONCLUSION: The maternal serum MPV level is a clinically useful, non-invasive and reliable marker in antenatal prediction of EOS.

Comparison of Amniotic Fluid Cytokine Levels in Postterm and Term Pregnancy: a Prospective Study.

BACKGROUND: To evaluate amniotic fluid pro- and anti-inflammatory cytokine levels in women with postterm and term pregnancies in labor and not in labor. METHODS: The study involved three groups: postterm (Group 1, n = 29), term in labor (Group 2, n = 28), and control (Group 3, n = 30). All groups were compared with respect to age, gravidity, parity, obstetric history, gestation week, cervical dilatation and effacement, maternal serum C-reactive protein and white cell count, amniotic interleukin 4, 6, and 10 levels, birthweight, and cord blood pH. RESULTS: The amniotic fluid interleukin 10 level was 24.4 ± 8.8 pg/mL in the postterm group, 13.5 ± 5.1 pg/mL in the term in labor group, and 19.8 ± 5.4 pg/mL in the control group (p < 0.001). The amniotic fluid interleukin 4 level was 86.5 ± 57.7 pg/mL in the postterm group, 38.2 ± 29.2 pg/mL in the term in labor group, and 81.9 ± 68.4 pg/mL in the control group (p = 0.002). The amniotic fluid interleukin 6 level was 329 ± 135.1 pg/mL in the postterm group, 252.8 ± 138.7 pg/mL in the term in labor group, and 227.9 ± 114.4 pg/mL in the control group (p = 0.02). There was a positive correlation between gestational age and IL-10 levels (p < 0.05). CONCLUSIONS: Amniotic fluid IL-10 and IL-4 cytokine levels were increased in postterm pregnancy and they decreased with active labor.

Maternal serum Netrin-1 levels as a new biomarker of preeclampsia.

AIM: The aim of this study was to investigate whether the Netrin-1 levels in maternal serum was associated with the presence of preeclampsia (PE). METHODS: Total 72 patients, including 28 normal pregnant women and 44 patients with PE, were included in this study. Maternal serum Netrin-1 concentration was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Maternal serum Netrin-1 levels were detected statistically higher in preeclamptic group than control group (p < 0.05). When compared with subgroups, Netrin-1 levels were also higher in severe PE group than mild PE group but this was not detected statistically significant (p > 0.05). CONCLUSION: Maternal serum Netrin-1 has a potential to be a new marker for the detection of PE.

Re:Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure.

The Integral Theory consists of nine specific sites three main compartments which are supporting the female pelvis. Stress urinary incontinence (SUI) is caused due to laxity in the vaginal supporting ligaments in especially anterior pelvic compartment which consists of pubourethral ligament, external urethral ligament, and hammock. The diagnose of each failure should be distinguished for the choose of the most effective treatment. Neurourol. Urodynam. 36:1218-1218, 2017. © 2016 Wiley Periodicals, Inc.

An animal model of effects of nicotine exposure on endometrial receptivity and embryo implantation in pregnancy.

OBJECTIVE: This study aims at evaluating the endometrial receptivity in uterus of pregnant rats exposed to nicotine via examination of integrin expression by immunohistochemical effect. METHODS: In this study, 16 healthy pregnant rats were divided into two groups of control and study groups each comprising eight rats. The rats randomised to study group were given a certain amount of nicotine before and during the pregnancy. Integrin expression was detected in uterus of all rats by immunohistochemical staining. The effect of nicotine exposure on embryo implantation and the endometrial receptivity were immunohistochemically and pathologically evaluated. RESULTS: Comparison of both groups revealed no difference in living, viable foetuses. Intensity and universality of immunohistochemical staining of Integrin ß3 for endometrial epithelium and endometrial stroma were detected to be identical between the groups. CONCLUSION: No immunochemical effect was observed on integrin expression, which is a very important part of receptivity in an animal model created with pregnant rats that were transdermally exposed to nicotine. Our study demonstrated that the harmful effect of nicotine use before and pregnancy on implantation is limited at the level of integrin expression, in a dose-dependent manner and also by considering the method of administration.

Relationship between anemia and depressive mood in the last trimester of pregnancy.

OBJECTIVE: To compare the relationship between the severity of anemia and depressive mood in the last trimester of pregnancy. METHODS: A cross-sectional study, enrolled a total of 450 pregnant women who attended the antenatal clinics in their third trimester for their routine antenatal follow-up. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. The study group was divided into two groups according to presence of anemia; anemic group (Hb < 11 gr/L; n = 150) and non-anemic group (Hb ≥ 11 gr/L; n = 300) and depression scores were compared. RESULTS: One hundred and fourteen (25.3%) women scored ≥13 points which were considered the cutoff value for depression on the EPDS. Anemia frequency was found as 33.3%. The total EPDS score was significantly higher in the anemic group (EPDS score 11 [min-max 0-29]) compared with the non-anemic group (EPDS score 7 [min-max 0-21]) (p = 0.000). Multiple regression analysis also revealed that serum Hb level was an independent factor for antenatal depressive mood. CONCLUSIONS: As anemia is associated with higher depressive symptom levels, it should be carefully considered during pregnancy. Prospective studies are needed to confirm our results.

A case of endocervical adenocarcinoma detected 16 months after vaginal delivery.

The "rapid-onset" cervical carcinoma is described as the diagnosis of invasive cervical carcinoma within 3 years of a "normal" Pap smear and it is a rare entity. In our case, we aimed to draw attention toward rapid progression of these endocervical adenocarcinomas to macroscopic sizes.

Does metoclopramide exposure alter endometrial receptivity and decrease pregnancy rates?

OBJECTIVE: The aim of this study was to investigate the effect of metoclopramide on endometrial receptivity with an immunohistochemical investigation of integrin ß3 expression in pregnant rats. MATERIALS AND METHODS: In the present study, the pregnant mice administrated by different doses of metoclopramide were used to explore the effect of metoclopramide on embryo implantation, especially on the endometrial receptivity. RESULTS: The statistical results showed that the number of implanted embryos was gradually declining along the increasing dose of metoclopramide. When the administrated dose of metoclopramide was 3 mg/kg per day, great changes were observed in the exposed uterine morphology and down-regulated integrin ß3 were also found in high dose metoclopramide-exposed mice. CONCLUSION: Metoclopramide exposure, especially in high doses may alter endometrial receptivity by effecting integrin expression on decidual tissue which can decrease pregnancy rates. This drug should only be recommended for use during pregnancy when benefit outweighs the risk.

Is Cryotherapy Friend or Foe for Symptomatic Cervical Ectopy?

OBJECTIVE: To evaluate the success rates and clinical outcomes of cervical cryotherapy applied to cervical ectopy for symptomatic relief. SUBJECTS AND METHODS: A total of 124 women who underwent cryotherapy for symptomatic treatment of cervical ectopy were included in this study. Indications for treatment were: abundant leucorrhoea (n = 114), post-coital bleeding (n = 22), recurrent cervicitis (n = 30) and pelvic pain (n = 12). Cryotherapy consisted of the use of carbon dioxide at -89°C to destroy the ectopic columnar epithelium by freezing, and it was transmitted to the ectopy through a flat cryoprobe. No routine anaesthesia or analgesia was administered. All patients were questioned about the status of their symptoms after 6 weeks of treatment. RESULTS: The highest success rate was obtained in patients with abundant leucorrhoea (n = 102; 89.5%), while the lowest success rate was achieved in subjects with pelvic pain (n = 7; 58%). After treatment, no severe complications were observed, except for hydrorrhoea for a few days. Success rates were 9 times lower in patients who had 3 or more cervicitis episodes per 6 months. CONCLUSION: In this study, the success rate of cryotherapy was highest in patients with abundant leucorrhoea and lowest in patients with pelvic pain and recurrent cervicitis. Hence, we recommend that clinicians perform the procedure in such patients without much delay.

Placenta percreta with concomitant uterine didelphys at 18 weeks of pregnancy: a case report and review of the literature.

AIM: The aim of this paper is to draw the attention of the clinicians on placenta percreta detected along with uterine anomalies in early second trimester. CASE PRESENTATION: A 35-year-old, gravida 2 parity 1 woman at 18 weeks of pregnancy was admitted to our emergency unit with abdominal pain. In ultrasound exam, a live fetus compatible with 18 weeks of gestation, hemoperitoneum and a solid mass adjacent to the uterus were detected. An emergent laparotomy was decided because of hemorrhagic shock findings. In the operation, uterine didelphys and an active bleeding area from placenta percreta on the anterior wall of the uterus where pregnancy was settled were detected. In the simultaneous vaginal examination two cervixes and a longitudinal vaginal septum were seen. Supracervical hemihysterectomy was performed. CONCLUSION: Placenta percreta is a rare clinical entity with an elevated perinatal mortality. Uterine anomalies are risk factors for placental adhesion anomalies. Clinical suspicion is vital for early diagnosis and timely management.

Comparison of maternal and fetal outcomes of IVF and spontaneously conceived twin pregnancies: three year experience of a tertiary hospital.

OBJECTIVES: The aim of this study was to compare maternal and fetal outcomes of spontaneously conceived and in-vitro fertilization (IVF) twin pregnancies that were admitted to our obstetric clinic and delivered between January 1, 2011 to November 1, 2014. MATERIAL METHOD: A total of 84 twin pregnancies were enrolled for the study and divided into two groups: group 1 as IVF (n = 19) and group 2 as spontaneously conceived (n = 65) twin pregnancies. Data of neonatal various morbidities needs neonatal intensive care unit (NICU) such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity (ROP), and intraventricular hemorrhage (IVH) and maternal morbidities such as preeclampsia, eclampsia, postpartum bleeding, gestational diabetes mellitus(GDM) were collected by hospital records. RESULTS: There were no statistical difference between two groups regarding hypertension related to pregnancy, intrauterine growth retardation, Apgar scores, NICU needs, birth weight and height (P > 0.05). The rate of premature rupture of membranes, maternal age, antenatal anemia and premature birth were detected higher in IVF group when compared with the other group (P < 0.05). CONCLUSION: Although twin pregnancies, regardless of conception method are high risk pregnancies in terms of obstetric and perinatal outcomes, premature rupture of membranes, maternal age, antenatal anemia and premature birth risks are higher in IVF twin pregnancies.

A hidden reason for menopausal symptoms in premenopausal aged women: depression.

BACKGROUND: The relationship between depression and reproductive hormone changes in menopausal women is well konown but recent animal studies showed that depression can also cause changes in reproductive hormone levels. According to this, we aimed to eveluate the impact of depression on circulating follicle-stimulating hormone and estradiol levels in premenopausal women in terms of menopausal symptoms. MATERIAL-METHOD: A total of 120 premenoupausal women (age ranges 41-45) were divided into two groups as: study group consisted of patients (n = 60) with depression and the control group (n = 60) involved healthy women. Psychometric assessment of study group was done by the Turkish version of Structured Clinical Interview for DSM-IV Diagnosis.The presence of menopausal symptoms of all subjects was assessed by the Turkish version of Menopause Rating Scale and hormonal activity by estimating estradiol and follicle-stimulating hormone levels. RESULTS: Study group had significantly lower mean concentration of estradiol and higher intensity of menopausal symptoms than control group. Presence and severity of menopausal symptoms were not associated with follicle-stimulating hormone concentrations. CONCLUSION: The results of this study confirm the connection between menopausal symptoms and depression both on clinical and physiological level.The current study is unique in its ability to assess the effects of depression on menopausal symptoms in women as they are still reproductive.

A Rare Reason for Pelvic Pain in Pregnancy: Infectious Sacroiliitis.

Introduction. Although the incidence of pregnancy-associated sacroiliitis is low, it is associated with significant morbidity and mortality. Timely diagnosis of the disease is confusing due to its nonspecific clinical features. Case. A 28-year-old woman at 34 weeks of gestation with severe pain in her right buttock radiating down the backside of the right thigh was admitted to our hospital. White blood cell (WBC) count and C-reactive protein (CRP) were elevated. The pelvic magnetic resonance imaging (MRI) scan revealed right sacroiliitis. Conclusion. Infectious sacroiliitis should be considered as a differential diagnosis even in low-risk women who present with debilitating pelvic pain in pregnancy and medical treatment should not be delayed.

Congenital cytomegalovirus infections and glycoprotein B genotypes in live-born infants: a prevalence study in Turkey.

BACKGROUND: Cytomegalovirus (CMV) infections are the leading cause of infectious hearing loss and central nervous system disease among children worldwide. In this study, we aimed to determine the birth prevalence of congenital CMV infection in live-born infants in Turkey. METHODS: In total, 944 consecutive live-born infants born from 926 pregnant women were included in this study. CMV-DNA was investigated in saliva samples of all newborns within the first 3 days after birth using TaqMan-based real-time PCR. RESULTS: The birth prevalence of congenital CMV infection in live-born infants was 1.91% (18/944), and all congenitally infected infants were asymptomatic at birth. The prevalence of congenital CMV infection was 16.7% (3/18) in twin pregnancies and 1.32% (12/908) in single pregnancies (p = 0.002). Genotyping analysis showed glycoprotein B-1 (gB1) to be the most frequently detected genotype at 83.3%. CONCLUSION: The study results suggest that the majority of congenital CMV infection in Turkey occurs following nonprimary maternal infection. We believe that congenital CMV infection and its long-term effects have been underestimated in our country, as infected infants are usually asymptomatic at birth.

The Diagnostic Role of Vitamin D and Cathelicidin Levels in Pelvic Inflammatory Disease.

BACKGROUND: The aim of this study was to evaluate the effect of 25-hydroxyvitamin D [25(OH)D] and cathelicidin levels on pelvic inflammatory disease [PID] in reproductive aged women. METHODS: A total of 81 reproductive aged women, 43 with PID and 38 without PID, were included in the study. Five millilitres of venous blood were collected from subjects and controls for complete hemogram and serum for CRP, IL-6, 25(OH)D and cathelicidin. RESULTS: There were significant differences between the study group and the control group for 25(OH)D (study group, 47.3 ± 2.01 ng/mL, control group, 28.38 ± 1.35 ng/mL, p = 0.001), for cathelicidin (study group, 165.56 ± 65.92 ng/mL, control group, 10.34 ± 6.48 ng/mL, p = 0.001). There was a positive correlation between 25(OH)D, cathelicidin, and other markers (WBC, CRP, and IL-6). Receiver operator curve analysis showed that the best cutoff value for 25(OH)D was 34.25 ng/mL, sensitivity 88%, and specificity 89%, and for cathelicidin 15 ng/mL, sensitivity 91%, specificity 90%. CONCLUSIONS: 25(OH)D and cathelicidin can be used as acute phase reactants like conventional markers in PID. Future studies are needed to understand the roles of these molecules in both diagnosis and follow-up of infectious situations.