Comparison of delivery characteristics and early obstetric outcomes between Turkish women and Syrian refugee pregnancies.

BACKGROUND: Until September 1, 2016, Turkey hosted around 2.7 million Syrian refugees. However, data investigating the pregnancy health concerning the refugees are still limited. AIM: In the present study, we aimed to compare the delivery characteristics and short-term obstetric outcomes in Turkish women and Syrian refugees. SUBJECTS AND METHODS: The study included 1556 singleton pregnancies which comprised 940 Turkish women and 616 Syrian women between January 2016 and January 2017. The groups were compared for demographic data, obstetric features, and pregnancy outcomes. RESULTS: There were significant differences between Turkish women and the refugees in terms of preterm (18.94% vs. 11.00%, P = 0.003) and post-term delivery rates (11.49% vs. 2.91%, P < 0.001), caesarian delivery rates (33.4% vs. 23.95%, P = 0.002), newborn weights <1000 g (2.55% vs. 0.97%, P = 0.006) and >4000 g (5.32% vs. 3.24%, P = 0.006), pre-eclampsia (5.32% vs. 1.62%, P = 0.009), HELLP (1.28% vs. 0.00%, P = 0.046), and placental anomalies (1.91% vs. 0.00%, P = 0.014), respectively. Being a Turkish resident (P = 0.015) was an important risk factor for the development of unfavorable pregnancy outcomes. Moreover, maternal education of at least 12 years (P = 0.028) and receiving a regular antenatal visit at a tertiary center (P = 0.031) were preventative for the development of unfavorable pregnancy outcomes. Adverse pregnancy outcomes were less prevalent in Syrian refugees compared to that in the Turkish residents which was likely due to the contribution of maternal education and regular antenatal visits which were higher in Syrian refugees. CONCLUSIONS: We suggest that providing adequate education particularly for women in undeveloped countries and facilitating access to the tertiary hospitals have the potential to reduce unfavorable pregnancy outcomes in immigrant women.

The combination of tumour necrosis factor-α -308A and interleukin-10 -1082G gene polymorphisms and increased serum levels of related cytokines: susceptibility to vitiligo.

BACKGROUND: The aetiopathogenesis of vitiligo is still under investigation. AIM: To assess the role of single nucleotide polymorphisms (SNPs) of the genes for tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, as well as the serum levels of these three cytokines in the pathogenesis of vitiligo. METHODS: The study enrolled 105 patients with vitiligo, and 211 age- and sex-matched controls. TNF-α (-308), IL-6 (-174) and IL-10 (-1082) promoter polymorphisms were investigated by LightSNiP assay and analysed by χ(2) test. Subsequently, the serum cytokine levels were assessed by ELISA and evaluated by Mann-Whitney U-test and Kruskal-Wallis test. RESULTS: The frequency of the GG genotype of the IL-10 -1082 polymorphism was significantly higher in the vitiligo group compared with the healthy control group (P = 0.02). Further investigations using combinations of these variant alleles detected a significant risk for vitiligo for individuals carrying both the IL-10 -1082G and TNF-α -308A alleles (OR = 12.57, 95% CI 1.44-110.0, P < 0.01). Serum IL-10 and TNF-α levels were higher in the vitiligo group (P = 0.001). In addition, TNF-α levels in patients with active disease were significantly higher than in patients with stable disease (P < 0.02). CONCLUSIONS: The concomitant presence of IL-10 -1082G and TNF-α -308A alleles significantly raises the risk for vitiligo. Furthermore, in accordance with these findings, serum IL-10 and TNF-α were also increased in this study, confirming the role of these cytokines in the pathogenesis of vitiligo.

The evaluation of cord blood interleukin-1ß levels in normal and caesarean deliveries.

OBJECTIVE: The aim of this prospective study was to establish the cord blood interleukin 1ß (IL-1ß) levels and asphyxia enzymes in term newborns and their relationship between delivery modes. We investigated whether cord blood level of IL-1ß could be used as a reliable marker for detecting hypoxic stress and to determine the optimal cut-off level for IL-1ß. METHODS: The study was designed prospectively. Cord blood samples were obtained at the time of delivery from 75 noninfected full-term neonates for the purpose of measuring cord blood levels of IL-1ß. Women were classified into three groups according to the mode of delivery (20 vaginal delivery, 29 urgent caesarean section (with foetal distress) and 26 elective caesarean section). All cases were followed-up by hospitalization. Umbilical cord sampling was carried out for IL-1ß, umbilical artery gas parameters and other asphyxia enzymes at the time of delivery. Cord blood IL-1ß was measured by enzyme-linked immunosorbent assay. The perinatal outcomes of the cases were recorded after birth. Demographic characteristics, neonatal outcomes and laboratory findings were compared in all the three groups. RESULTS: IL-1ß levels showed statistically significant difference between groups (p < 0.01). The relationship was found between IL-1ß cord blood levels and the mode of delivery. IL-1ß levels of urgent caesarean section group were significantly higher than elective caesarean section and normal delivery group (p:0.001 and p:0.001, respectively). Normal delivery levels were significantly higher than the elective caesarean group (p:0.001). CONCLUSION: Urgent section (foetal distress) and vaginal delivery (labour) were each associated with elevated IL-1ß cord blood levels in noninfected full-term neonates, while only elective caesarean section was associated with decreased IL-1ß levels. For the evaluation of newborns at high risk for perinatal hypoxic stress, cord blood IL-1ß levels may lead the way. On the other hand, the mode of delivery may be associated with the effects on the immune system. Further investigations with larger patient groups are required to confirm our results.

Novel NLRP7 mutations in familial recurrent hydatidiform mole: are NLRP7 mutations a risk for recurrent reproductive wastage?

OBJECTIVE: Familial recurrent hydatidiform mole is an exceedingly rare clinical condition. Affected women are predisposed to molar pregnancies of diploid, biparental origin rather than androgenetic origin. At present, NLRP7 and KHDC3L (C6orf221) are the only genes known to be associated with familial recurrent hydatidiform mole. This study investigated the genetic dispositions in two large Turkish families with recurring molar conceptuses. STUDY DESIGN: Copy number variation analysis was performed followed by NLRP7 gene sequencing. The finding of a mono-allelic condition in one family led to investigation of the adjacent NLRP2 gene and recently associated KHDC3L gene. Sampled molar tissues were genotyped using microsatellite markers. RESULTS: In one family, a homozygous single nucleotide insertion that caused a frameshift leading to an early stop codon, c.2940_2941insC (p.Glu981ArgfsX13), was identified in the affected sisters. In the other family, a heterozygous 60-kb deletion eliminating substantial portions of the NLRP2 and NLRP7 genes on one allele was found. Screening of NLRP2 and KHDC3L genes revealed no alterations that were considered to be pathological. Genotyping of six independent molar conceptions revealed that five were of diploid, biparental origin and one was of diandric, triploid origin. CONCLUSIONS: Two novel protein-truncating mutations in the NLRP7 gene were found to be associated with familial recurrent hydatidiform mole. Mutations in the NLRP7 gene causing recurrent biparental hydatidiform mole may also be associated with other forms of recurrent reproductive wastage.

Placental mesenchymal dysplasia: a rare clinicopathologic entity confused with molar pregnancy.

Placental mesenchymal dysplasia (PMD) is a rare placental abnormality characterised by placentomegaly and grape-like vesicles resembling partial mole by ultrasonography, but in contrast to partial mole can co-exist with a viable fetus. Although the karyotype is normal, the fetus is at increased risk for intrauterine growth restriction, intrauterine fetal demise or perinatal death and Beckwith-Wiedemann syndrome. Prenatal diagnosis is difficult and the final diagnosis is usually achieved by postpartum histological examination of the placenta. We present two recent cases of placental mesenchymal dysplasia with poor obstetric outcome. One fetus presented with reduced growth parameters, while the other fetus showed hepatosplenomegaly and early hydropic changes that appear to be associated with Beckwith-Wiedemann syndrome. In this report, the clinico-pathological features of two cases of PMD are discussed and the differentiation from a partial mole is highlighted. This study also supports the utility of cytogenetic ploidy analysis and p57KIP2 protein staining in the evaluation of pregnancies with PMD.

Characteristics and prognosis of ovarian metastatic tumors: review of a single-institution experience.

BACKGROUND: To evaluate the clinico-pathological characteristics and role of surgery in patients with ovarian metastasis. MATERIALS AND METHODS: Clinical data from 51 patients with pathologically confirmed ovarian metastasis were reviewed. RESULTS: Ovarian metastasis accounted for 14% of all malignant ovarian neoplasms (51/364). Of the 51 metastatic ovarian tumor cases, 24 originated from gynecologic malignancies, while 27 originated from non-gynecologic malignancies. Optimal cytoreduction was performed in 88% and 37% of patients with metastases of gynecologic and non-gynecologic origin, respectively. Patients with ovarian metastasis had a two-year survival rate in 82% of the gynecologic group and 70% of the non-gynecologic group (p = 0.35). The five-year survival rate of patients with non-gynecologic tumor origin (29%) was significantly worse (p = 0.04) than the survival rates of those with tumors of gynecologic origin (61%). In the non-gynecologic group, the five-year survival rates were significantly different between patients who were performed optimal cytoreductive surgery vs those without this procedure (42% and 20%, respectively; p = 0.04). CONCLUSION: Although complete surgical resection is not achievable in approximately two-thirds of patients with metastases of non-gynecological origin, optimal tumor cytoreduction appears to improve survival, which is statistically significant in all patients with ovarian metastatic tumors.

Urine endothelin-1 levels as a predictor of renal scarring in children with urinary tract infections.

AIMS: Endothelin-1 (ET-1) contributes to renal fibrogenesis in several manners such as increasing collagen synthesis in mesangium, decreasing extracellular matrix (ECM) degradation by mesangial cells and stimulating mesangial contraction. The aim of our study was to investigate whether urine level of ET-1 (uET-1) could represent a useful biomarker of renal scarring and if so, to determine the optimal cutoff level for uET-1 to predict a renal scar. METHODS: 44 children with renal scarring and 32 children without renal scarring were enrolled in the study. Urine ET-1 was measured by enzyme-linked immunosorbent assay. RESULTS: Mean uET-1 level was significantly higher in the scar group than in controls (2.75 ± 1.35 fmol/ml vs. 0.68 ± 0.41 fmol/ml, p = 0.001). The optimal cut-off level was 1.064 fmol/ml for uET-1 to predict renal scarring. Using this cut-off point, sensitivity and specificity were 97.73% and 93.91%, respectively. AUC was found 0.975 (95% CI 0.917 - 0.996) for uET-1. Mean urine Endothelin-1/Creatinine ratio (uET-1/Cr) was also significantly higher in the scar group than in the control group (4.04 ± 2.29 fmol/mg Cr vs. 1.09 ± 0.67 fmol/mg Cr, p = 0.0001). Using 1.67 fmol/mgCr as optimal cut-off level, sensitivity and specificity were 95.45% and 84.09%, respectively. AUC was 0.945 (95% CI 0.875 - 0.982) for uET-1/Cr. CONCLUSION: Our study suggests that both uET-1 and uET-1/Cr can be used for prediction of renal scarring in children with normal renal function. Measuring urine level of ET-1 can help us to avoid unnecessary DMSA studies if the patient's uET-1 level is found to be under the determined cut-off point.

Detection of fetal RHD pseudogene (RHDΨ) and hybrid RHD-CE-Ds from RHD-negative pregnant women with a free DNA fetal kit.

Hemolytic disease of the newborn is a clinical condition in which maternal and paternal Rh blood group antigens are incompatible and the mother is negative for the antigen whereas the father is positive. Analysis of fetal cells recovered from maternal plasma can provide a highly sensitive prenatal diagnosis. The fetal RHD gene in plasma DNA is detected by real-time PCR amplification of two different segments of the RHD gene (exons 7 and 10). Each amplicon is revealed with specific probes. We examined 40 female blood samples to verify the specificity of RHD exons (7 and 10) amplified by real-time PCR. Thirty fetuses were predicted to be RHD-positive based on analysis of plasma DNA. Seven fetuses were predicted to be RHD-negative. One fetus was negative for RHD on exon 10, and positive for RHD on exon 7 (early gestation age); two fetuses were RHD-negative on exon 7, and RHD-positive on exon 10 (RHD-CE-D(s) or RHDΨ), indicative of a maternal RHD allele. We conclude that it is necessary to analyze at least two exon regions in the RHD gene.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy.

We aimed to compare the accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) for uterine pathologies among infertile women. A total of 346 patients were selected for operative hysteroscopy, following SIS after TVS. SIS was performed with a Cook Soft 500 IVF catheter. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated to compare the accuracy of TVS, SIS and hysteroscopy for uterine abnormalities. SIS showed a sensitivity of 87%, specificity of 100% and PPV of 100% for endometrial hyperplasia, and a sensitivity and NPV of 100% for polypoid lesions. For submucosal myoma SIS showed a sensitivity of 99% with PPV of 96%. Hysteroscopy had a sensitivity, specificity, PPV and NPV of 98%, 83%, 96% and 91%, respectively for overall uterine pathologies. Finally, SIS seems to be superior to TVS, for uterine pathologies, with respect to hysteroscopy as the gold standard.

Serum adiponectin levels in high school girls with polycystic ovary syndrome and hyperandrogenism.

OBJECTIVE: To compare the serum adiponectin levels together with metabolic and hormonal parameters among teenage girls at the early onset of polycystic ovary syndrome (PCOS) and hyperandrogenism with controls. DESIGN: Prospective study. SETTINGS: Education and research hospital, outpatient gynecological endocrinology clinic. PARTICIPANTS: Four hundred seventy-nine teenage girls from a school of nursing were interviewed for the signs and symptoms of PCOS. Among them, 42 cases who had a definitive diagnosis of PCOS with hyperandrogenism based on Rotterdam diagnostic criteria were recruited for the study and other causes of hyperandrogenemia had been excluded. The controls were recruited from regularly cycling healthy teenage girls from the same high school of nursing; none of those who agreed to join the study met any of the diagnostic criteria for PCOS (n = 44). INTERVENTIONS: Cases were selected as group I: PCOS with body mass index (BMI) < 25 kg/m² (n = 20), group II: PCOS with BMI > 25 kg/m² (n = 22), group III: Controls with BMI < 25 kg/m² (n = 21) and group IV: Controls with BMI > 25 kg/m² (n = 23). Serum adiponectin, metabolic and hormonal parameters were compared in PCOS patients with BMI matched controls. MAIN OUTCOME MEASURES: Difference of serum adiponectin levels, metabolic and hormonal parameters between teenage girls with PCOS and controls. RESULTS: Serum adiponectin levels were not significantly different in group I and group II. Serum adiponectin levels were significantly decreased in group I and group II compared with both control groups (III and IV). CONCLUSION: Serum adiponectin levels were lower in teenage girls with PCOS and this reduction was independent from BMI.