Expression of P-cadherin (cadherin-3) and E-selectin in the villous trophoblast of first trimester human placenta.

OBJECTIVE: Although trophoblastic invasion has a critical role in human placental development, very little is known about them. The aim of the present study was to localise the expression of P-cadherin (cadherin-3) and E-selectin in first trimester placenta. MATERIAL AND METHODS: This study was conducted on 140 patients who had applied to Gülhane Military Medical Academy, Haydarpasa Education Hospital, Department of Obstetrics and Gynaecology between 2005 and 2006. The patients were divided into three groups: ectopic pregnancy group (Group 1), spontaneous abortion group (group 2) and curettage group (group 3 and/or control group). Patients with a history of systemic diseases (such as thrombophilia), a disease or anatomical diagnosis that may cause recurrent abortion or an aetiological factor for ectopic pregnancy were excluded from the study. Paraffin blocks were stained with E-selectin and P-cadherin in accordance with the procedure. Demographic characteristics of patients (patient age, gravida, parity, number of previous abortions, and last menstrual period) and staining intensities were compared using Analysis of Variance (ANOVA) among groups. RESULTS: According to the average scale score of P-cadherin staining of cells, the three groups were statistically different from each other (p=0.0001). This difference stems from statistically significantly lower scores in the spontaneous abortion group than in both the ectopic pregnancy group (p<0.001) and the control group (p<0.001). E-selectin immunostaining showed no positive staining in the groups. CONCLUSION: In placental trophoblasts, decreased P-cadherin immunoreactivity plays a role in the aetiopathogenesis of spontaneous abortion.

Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia.

OBJECTIVES: The aim of this cohort is to investigate whether any haematologic changes detectable by simple complete blood count (CBC) precede pre-eclampsia development and the diagnostic value of these markers in clinical practice for prediction of pre-eclampsia. METHODS: All pregnant women, in the first trimester, attending to GATA Haydarpasa Teaching Hospital Obstetric Outpatient Clinic for routine obstetric care were enrolled. Routine obstetric care consisted of monthly visits until 32nd week, bimonthly visits between 32nd and 36th week, and weekly thereafter. According to the study, protocol CBC was taken from women at each visit and recorded. After delivery, outcome data were obtained. RESULTS: A total of 1336 women were included into the statistical analysis and 107 (8%) of them developed pre-eclampsia. Parameters of CBC were similar between groups other than mean platelet volume (MPV) values. MPV values of pre-eclamptic women were significantly higher than normotensive counterparts from 24th gestational week up to gestational week at birth. In pre-eclamptic group, mean gestational age of diagnosis was 33.8 weeks and significant MPV increase was detected to precede the diagnosis by approximately 4.6 weeks (range 2.8-5.9 weeks). CONCLUSIONS: Our study provides evidence that MPV gradually increases in pregnant women affected by pre-eclampsia compared to women with normal pregnancies.

Second trimester amniotic fluid annexin A5 levels and subsequent development of intrauterine growth restriction.

OBJECTIVE: The purpose of this study was to investigate the levels of annexin A5 in second trimester amniotic fluid, and evaluate its correlation with subsequent development of intrauterine growth restriction (IUGR). METHOD: A total of 264 women undergoing mid-trimester amniocentesis between January 2007 and December 2007 were enrolled for the study. Amniocentesis was performed for routine indications. After delivery, outcome data were obtained. RESULTS: Maternal age, frequency of nulliparity, fetal sex and gestational week at amniocentesis were similar between groups. As expected, prevalence of smoking was higher in IUGR developing mothers. Significant positive correlations were present between annexin A5 levels and gestational age at amniocentesis (P = 0.02) and maternal age (P = 0.01). Linear regression analysis revealed that annexin A5 levels were positively correlated with patient's age. Smoking women had significantly lower annexin A5 levels in the mid-trimester amniotic fluid (9.9 +/- 2.3 and 10.7 +/- 1.3 ng/mL, P = 0.01). Logistic regression analysis demonstrated that after controlling for gestational age at amniocentesis, smoking, maternal age, and maternal hypertension, annexin A5 was not significantly associated with IUGR (P = 0.07). CONCLUSION: Amniotic fluid annexin A5 levels in the mid-trimester are not associated with IUGR at birth after controlling for maternal smoking and other confounders.

Recurrent idiopathic nonimmune hydrops fetalis: A case report.

A recurrent idiopathic nonimmune hydrops fetalis case in two subsequent pregnancies was observed in a woman with no child. In both pregnancies, all the detailed analysis, including a high level of ultrasonography, amniocentesis, serologic evaluation, routine blood work, hemoglobin electrophoresis, and glucose 6-phosphate/dehydrogenase level and postdelivery autopsy, was done, and after no clue of etiologic agent, pregnancy termination was applied for both. This case report illustrates the importance of recurrence of nonimmune hydrops fetalis in the absence of any etiology. Mostly, it is hard to establish an etiologic diagnosis for adequate management of subsequent pregnancies.

The effect of hormone therapy on plasma homocysteine levels: a randomized clinical trial.

OBJECTIVE: An elevated plasma homocysteine level is a risk factor for cardiovascular diseases. Hormone therapy (HT) may reduce fasting plasma homocysteine levels. We studied 80 postmenopausal women to determine the effect of medroxyprogesterone acetate (MPA) combined with conjugated equine estrogens (CEE) on fasting plasma homocysteine levels. DESIGN: In a randomized, double blind, prospective, placebo-controlled study, we randomly assigned 80 healthy postmenopausal women between CEE 0.625 mg/d combined with MPA 2.5 mg/d (n = 20), CEE 0.625 mg/d combined with MPA 5 mg/d (n = 20), unopposed CEE 0.625 mg/d (n = 20), and placebo (n = 20) all given for a duration of 6 months. Fasting plasma homocysteine levels were measured before and at the end of the treatment. RESULTS: Before treatment, plasma homocysteine concentrations were similar in all groups. After 6 months of unopposed CEE, the mean fasting plasma homocysteine levels decreased by 19.02% when compared with baseline levels (P < 0.05). The mean fasting plasma homocysteine concentrations decreased by 17.63% and 19.56% from baseline in both the CEE plus MPA 2.5 mg/d and CEE plus MPA 5 mg/d groups, respectively (P < 0.05 for each group). In contrast, plasma homocysteine levels increased by 11.66% in the placebo group. The homocysteine lowering effect did not differ significantly among the three groups of women receiving unopposed CEE alone and CEE plus MPA at two different doses. CONCLUSION: Six months of estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) significantly lower fasting plasma homocysteine levels in healthy postmenopausal women with equal efficacy.

Sperm maturity and treatment choice of in vitro fertilization (IVF) or intracytoplasmic sperm injection: diminished sperm HspA2 chaperone levels predict IVF failure.

OBJECTIVE: To reexamine whether low sperm HspA2 ratios (formerly sperm CK-M ratio) are predictive for failure to cause pregnancies by in vitro fertilization (IVF) and to explore whether there are other male or female factors that may be predictive for IVF pregnancy outcome. DESIGN: Retrospective, cohort study. SETTING: University-based IVF program. PATIENT(S): In 119 IVF cycles, three patient groups were studied: 25 men had a <10% sperm HspA2 ratio and a lack of pregnancies (HS <10% group), 50 men had a >10% sperm HspA2 ratio and no pregnancies (HS >10%NP group), and another 44 couples had a >10% sperm HspA2 ratio but did achieve pregnancies (HS >10%P group). INTERVENTION(S): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters. MAIN OUTCOME MEASURE(S): Sperm HspA2 ratio determinations within 1 year of the IVF cycles and analysis of male and female IVF cycle parameters. RESULT(S): In the three groups, male and female ages, number and maturation level of oocytes, and morphology of embryos were similar. In the HS < 10% group, mean sperm concentration and motility were close to normal, the fertilization and cleavage rates were lower, and cycles without any oocyte fertilization were higher. These parameters were similar in the two HS > 10% groups. The receiver operating characteristic curve in men with sperm HspA2 ratios of <17% (diminished and borderline sperm maturity) provided a cutoff value of 10.84% HspA2 ratio with a 100% positive predictive value for failure to achieve pregnancy, whether the men were oligospermic or normospermic. CONCLUSION(S): HspA2 ratios of <10% in the diminished sperm maturity range predict the failure to cause pregnancies by IVF. Thus, IVF should be bypassed in favor of ICSI. The occurrence of pregnancy with ICSI depends on the maturity of sperm selected, and it may not be as likely as in other indications for ICSI.