Elabela levels in pregnancies with intrauterine growth retardation.

OBJECTIVES: The aim of our study is to examine maternal serum Elabela levels in pregnancy with intrauterine growth retardation (IUGR). IUGR is one of the most important causes of perinatal mortality and morbidity. IUGR is also related future comorobidities such as diabetes mellitus, hyperlipidemia, hypertension and coronary artery disease. MATERIAL AND METHODS: Fifty pregnancies diagnosed as IUGR (Group 1) and fifty healthy pregnancies (Group 2) enrolled into the study. Obstetric and demographic characteristics of the patients, serum elabela levels, ultrasound parameters, cord pH value and APGAR scores of the newborns were recorded. In the study, which was planned as a prospective case-control study, an independent t test was used for the evaluation of continuous data and the Mann Whitney U test was used for the statistical evaluation of ordinal data. p < 0.05 was considered significant. RESULTS: The mean gestational age of the cases at delivery was 36.35 ± 1.29 in Group 1 and 38.16 ± 0.94 weeks in Group 2 (p < 0.05). Mean serum Elabela levels were 15.05 ± 9.03 in Group 1 and 8.96 ± 4.33 ng/mL in Group 2 (p < 0.0001). Mean newborn weights were 2498.20 ± 465.92 in Group 1 and 3179.44 ± 387.99 gr. in Group 2 (p < 0.0001). Systolic and diastolic blood pressure measurements taken on the day of delivery were higher in Group 1, and diastolic blood pressure was 77.0 ± 9.53 in Group 1 and 72.60 ± 13.37 mmHg in Group 2 (p < 0.05). Bilateral uterine artery Pulsatile Index (PI) and umbilical artery PI value were significantly higher in Group 1 (p < 0.05), and middle cerebral artery PI and cerebroplacental ratio were significantly lower in Group 1 compared to Group 2 (p < 0.05). Although the cord pH value, 1st and 5th minute APGAR scores were lower in Group 1 compared to Group 2, no statistically significant difference was found (p > 0.05). CONLUSIONS: In our study, it was found that serum Elabela levels increased significantly in pregnancies complicated by IUGR compared to the control group.

Evaluation of the effectiveness of Ampicillin and Lactobacillus casei rhamnosus treatment in cases of preterm premature rupture of membranes remote from term.

OBJECTIVES: Preterm premature rupture of membranes (PPROM) remote from term is an important obstetric cause of maternal and fetal adverse outcomes. The aim of our study is to examine the efficacy of ampicillin and Lactobacillus casei rhamnosus treatment in cases of PPROM remote from term. MATERIAL AND METHODS: The study was carried out by examining the results of cases who were given Ampicillin and Lactobacillus casei rhamnosus treatment. The patients were divided into two groups. Group 1 who didn't develop clinical chorioamnionitis and Group 2 who developed clinical chorioamnionitis. Obstetric characteristics, neonatal outcomes, adverse events were recorded. RESULTS: A total of 46 pregnant women, 40 in Group 1 and six in Group 2, were included in the study. The frequency of clinical chorioamnionitis developing during the treatment was found to be 13.0%. Mean gestational age at diagnosis was 28.43 ± 2.38 and 28.17 ± 1.33 for Groups 1 and Group 2, respectively. Mean gestational age at the time of delivery was 32.38 ± 2.07 31.33 ± 1.63 for Group 1 and Group 2, respectively. The mean latency period for Group 1 and Group 2 was 27.45 ± 1.71 days, 23.66 ± 4.53, respectively. Sepsis developed in six newborns (15%) in Group 1, while it developed in three newborns (50%) in Group 2. While 90% of the babies in Group 1 were discharged from the hospital, this rate was 66.7% in Group 2. CONCLUSIONS: Ampicillin + Lactobacillus casei rhamnosus is an effective treatment method in PPROM cases and positively affects perinatal outcomes.

Comparison of a novel isthmic circumferential suture and Bakri balloon technique for the treatment of uterine atony during cesarean section.

BACKGROUND: Postpartum bleeding is a life-threatening obstetric complication. The most common cause is uterine atony. There is no method that can treat PPH with 100% effectiveness and therefore, efforts for the development of more effective conservative treatment methods continue. The aim of the study is to compare the effectiveness of the isthmic circumferential suture technique and the Bakri balloon tamponade in the treatment of postpartum bleeding due to uterine atony during cesarean operation. METHODS: This study was conducted by retrospectively evaluating the cases who developed uterine atony during cesarean section. Group 1 (n = 15) consisted of the patients who had undergone the isthmic circumferential suture technique, and Group 2 (n = 15) comprised patients who had undergone the Bakri balloon tamponade. The two groups were compared with regard to obstetric characteristics, operative time, preoperative and postoperative features, and neonatal outcomes. RESULTS: The groups were similar with regard to age, obstetric characteristics, preoperative complete blood count, neonatal outcomes and there was no statistically significant difference between groups. The operative time was significantly shorter in Group 1 (61.86 ± 6.7 vs. 69.53 ± 3.2 min; p < .05). The amount of intraoperative bleeding was lower in Group 1, although there was no statistically significant difference (1793.66 ± 323.96 versus 1886.33 ± 343.23 ml; p > .05). The postoperative blood loss was significantly less in Group 1 compared to Group 2 (101.37 ± 64.6 versus 169.32 ± 50.0 ml; p < .05). The postoperative 24-hour Htc values were significantly higher in Group 1 (28.83 ± 2.1 versus 27.08 ± 2.1 g/dl; p < .05). CONCLUSION: Both methods are effective in the uterine atony during cesarean section. However, due to the shorter operative time and less pre-operative blood loss, the isthmic circumferential suture technique may be a better alternative.

Fetal intracranial structures: differences in size according to sex.

OBJECTIVES: We aimed to compare gender difference on sizes of some structures in the brain of normal male and female fetuses between 20 and 22 week gestations. METHODS: A total of 300 female and 300 male singleton pregnancies with low risk were included in the study. Biparietal diameter, head circumference, transcerebellar diameter, cisterna magna, nuchal fold thickness, anterior and posterior horn of lateral ventricles, length and width of cavum septum pellucidum were measured transabdominally. Mean±SD values were calculated and comparison of measurements were done between male and female fetuses. Kolmogorov-Smirnov and independent samples t-test were used for statistical analysis. A value of p<0.05 were accepted as statistically significant. RESULTS: We determined statistically significant difference in sizes of some structures of the brain of male and female fetuses. Mean±SD value of cavum septi pellucidi width was 3.38±0.61 and 3.85±0.96 in female and males, respectively (p<0.05). Male fetuses were also found to have larger anterior (1.92±0.30 vs. 1.58±0.26, p<0.0001) and posterior horn of lateral ventricles (6.00±0.87 vs. 5.53±1.17, p<0.05). CONCLUSIONS: Difference in sizes of some structures of the brain starts in fetal life. This finding may be important in evaluating the intracranial structures more precisely. These results may also give a contribution to the understanding physiological and pathologic differences between males and females.

Assessment of the Nasal Bone by 2-Dimensional Ultrasound in 2 Different Planes: Do They Give the Same Results?

OBJECTIVES: Measurement of the nasal bone is an important part of the genetic sonogram. This study aimed to compare nasal bone length measurements taken in 2 different planes and to determine whether there is consistency between the measurements. METHODS: The nasal bone was measured in 103 fetuses whose mothers were admitted to our clinic for second-trimester ultrasound examinations and who did not have any accompanying diseases. In this prospective study, the gestational ages of fetuses ranged from 19 to 23 weeks. Nasal bones were measured in both coronal and midsagittal planes, and the similarity between the measurements was evaluated. Pearson correlation, Wilcoxon signed rank, and Kruskal-Wallis tests were used to evaluate the results. RESULTS: The median nasal bone length increased with increasing gestational age in both planes, as expected. There were no statistically significant differences between the fetal nasal bone lengths taken in the midsagittal and coronal planes at 19 to 23 weeks' gestation (P > .05). CONCLUSIONS: The coronal plane may be used as an alternative to evaluate the nasal bone in the second trimester of pregnancy.

Magnesium: does it reduce ischemia/reperfusion injury in an adnexal torsion rat model?

AIM: The aim of the present study was to assess the protective effects of magnesium sulfate (MgSO4) on ischemia/reperfusion (I/R) induced ovarian damage in a rat ovarian torsion model. METHODS: Forty-two female Sprague Dawley rats were included in the study. They were divided into six groups as Group 1, sham; Group 2, bilateral ovarian torsion; Group 3, bilateral ovarian torsion-detorsion; Group 4, MgSO4-sham; Group 5, MgSO4-bilateral ovarian torsion; Group 6, bilateral ovarian torsion-MgSO4-detorsion. Both torsion and detorsion periods lasted 3 hours. In Groups 4, 5 and 6, MgSO4 (600 mg/kg) was administered by intraperitoneal route 30 minutes before sham operation, torsion and detorsion, respectively. At the end of the study period, both ovaries were removed. One of the ovaries was used for histopathological analyses and the other for biochemical analyses. RESULTS: In the torsion-detorsion group, all the histopathological scores were higher compared to the sham and torsion only group (p<0.05). Administration of MgSO4 only caused significant decrease in the inflammatory cell scores of the torsion-detorsion group (p<0.05). MgSO4, whether given before torsion or before detorsion, suppressed malondialdehyde levels when compared to the untreated groups (p<0.01 and p<0.001, respectively). Glutathione peroxidase activities were significantly higher in the MgSO4 applied torsion and detorsion groups than Groups 2 and 3 (p<0.05, for both). Administration of MgSO4 also caused an increase in glutathione levels in the torsion and detorsion groups compared to the torsion only and detorsion only groups (p<0.05, for both). Also, total oxidant status levels decreased in the MgSO4 applied torsion and detorsion groups compared to the untreated corresponding ones (p<0.01 and p<0.001, respectively). MgSO4 significantly decreased the Oxidative Stress Index levels in the torsion-detorsion group compared to Group 2 (p<0.001). CONCLUSION: Histopathological and biochemical analysis revealed that prophylactic treatment with MgSO4 reduces the changes observed in I/R injury in a rat model.

Tenascin C levels in patients with mild and severe preeclampsia.

OBJECTIVE: To determine the serum tenascin-C (TN-C) levels in cases with mild and severe preeclampsia. METHODS: Pregnant women were divided into three groups, namely healthy pregnants (Group 1, n = 20), pregnants with mild preeclampsia (Group 2, n = 20) and pregnants with severe preeclampsia (Group 3, n = 20). The groups were formed so as to match each other in terms of gestational week. From each pregnant woman, pre- and post-delivery blood samples were obtained to measure serum TN-C levels. The data were evaluated using the Kruskall-Wallis variance analysis. For the obtained values of p < 0.05, the groups were compared in pairs. A p value of < 0.017 was accepted as significant. RESULTS: In Groups 1, 2 and 3, the prepartum TN-C levels were 5.02 ± 0.4 µg/ml, 12.8 ± 2.9 µg/ml and 33.8 ± 11.7 µg/ml, and in the postpartum TN-C levels were 4.7 ± 0.1 µg/ml, 11.7 ± 1.8 µg/ml and 50.6 ± 33.8 µg/ml, respectively. There was a significant difference between the groups in terms of the prepartum and postpartum TN-C levels (p < 0.017, Mann-Whitney U [MWU] test). There was also a significant difference in the prepartum TN-C levels between Groups 2 and 3 (p < 0.017, MWU test). CONCLUSIONS: The prepartum and postpartum TN-C levels were significantly higher in mild and severe preeclampsia than those in healthy pregnants.

Application of talcum powder, trichloroacetic acid and silver nitrate in female rats for non-surgical sterilization: evaluation of the apoptotic pathway mRNA and miRNA genes.

There are several methods used for non-surgical sterilization in birth control including quinacrine, trichloroacetic acid (TCA), erythromycin, tetracycline, silver nitrate and talcum powder. Among these, talcum powder, TCA and silver nitrate are the most commonly used. However, the toxic and carcinogenic activities of these chemicals in ovarian tissue have been poorly elucidated. This study demonstrates the expression levels of antioxidant, apoptotic and anti-apoptotic genes after administration of talc powder, TCA and silver nitrate for non-surgical sterilization in female rat models. The expression changes of some microRNAs (miR-15b, miR-21, miR-34a and miR-98) that play key roles in the apoptosis pathway were also included. All expression analyses were evaluated with real-time PCR. The expression levels of all genes appeared to be upregulated in the talcum powder group, but the results were not statistically significant. Increased expression of Gsr and Sod1 genes was statistically significant in the talcum powder group. In TCA and silver nitrate group, expression of all genes was appeared to be elevated but only the Gsr expression was statistically significant in the TCA-administrated group; there were no statistically significant changes in the silver nitrate group. miRNA expression levels were increased in talcum powder and TCA-administrated groups, but these results were not significant. Expression levels of miR-15b, miR-21 and miR-98 in the silver nitrate group were significantly increased. Consequently, these chemicals appear to be non-carcinogenic agents for rat ovarian tissue which do not induce apoptosis. However, talcum powder and TCA can be considered as agents that are toxic to ovarian tissue.

Effect of varying doses of tamoxifen on ovarian histopathology, serum VEGF, and endothelin 1 levels in ovarian hyperstimulation syndrome: an experimental study.

OBJECTIVE: To examine the effects of low-to-high doses of tamoxifen on ovarian histopathology, serum VEGF, and endothelin 1 levels in ovarian hyperstimulation syndrome (OHSS) in an experimental setting. MATERIALS AND METHODS: A total of 20 female Wistar albino rats, 22 days of age, were randomly divided into four groups. Follicle-stimulating hormone 10 IU was administered subcutaneously in 15 rats on 4 consecutive days, with OHSS induction on day 5 by 30 IU of human chorionic gonadotropin. Group 1 (n=5) comprised 35-day-old control rats, group 2 (n=5) 35-day-old OHSS rats, group 3 (n=5) 27-day-old OHSS rats receiving 1 mg/kg of oral tamoxifen for 7 days, group 4 (n=5) 27-day-old OHSS rats receiving 3 mg/kg of oral tamoxifen for 7 days. All rats were decapitated on day 35. Serum VEGF, endothelin 1, and ovarian follicular reserve were assessed in all rats. Kruskal-Wallis variance analysis and the Mann-Whitney U-test were used for statistical comparisons. A Bonferroni correction was performed to control the inflation of significance, with a significance level set at a P-value of less than 0.025. RESULTS: Despite higher serum VEGF, endothelin 1, follicular reserve, and angiogenesis and fibrosis of the corpus luteum in the OHSS group compared to controls, these differences were not significant (P>0.025, Mann-Whitney U-test). There was a significant reduction in the ovarian follicular reserve in tamoxifen groups compared to controls (P<0.025, Mann-Whitney U-test), while angiogenesis of the corpus luteum, number of atretic follicles, fibrosis, and serum VEGF were significantly higher in rats receiving tamoxifen (P<0.025, Mann-Whitney U-test). Also, significantly lower follicular reserve and fibrosis were observed among rats in the low-dose tamoxifen group in comparison with rats in the high-dose tamoxifen group (P<0.025, Mann-Whitney U-test). No groups had a significant change in endothelin 1 levels (P>0.025, Mann-Whitney U-test). CONCLUSION: Tamoxifen 1 g and 3 g resulted in a dose-dependent increase in VEGF and endothelin 1 levels, and ovarian follicle reserves were significantly reduced in our experimental model.

Evaluation of vitamin C and vitamin E for prevention of postoperative adhesion: a rat uterine horn model study.

AIM: To investigate the effectiveness of intraperitoneal vitamin C (VC) and vitamin E (VE) in the prevention of postoperative adhesion formation in a rat uterine horn model. METHODS: Twenty-eight Wistar albino rats were divided into four groups in which: control group, the abdomen was opened and closed without any intervention; adhesion group, a 2-cm linear incision was performed on the uterine horn and closed; VC group, VC was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed; and VE group, VE was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed. Re-laparotomy was performed 15 days later. Right uterine horn adhesions were evaluated according to macromorphological characteristics and tissue sections were further examined for fibrosis, angiogenesis and vascular endothelial growth factor (VEGF), type I collagen and malondialdehyde (MDA) scoring. Kruskal-Wallis anova and Mann-Whitney U-test were utilized for statistical analysis. RESULTS: Adhesion area and also strength were significantly lower in the VC group and the VE group compared with the adhesion group. Fibrosis and angiogenesis scores were observed to be significantly higher in the adhesion group compared with the VC group and the VE group. MDA and VEGF immunoreactivity were also found to be significantly lower in the VC group and the VE group compared with the adhesion group. However, there was no significant difference between the VC group and the VE group with respect to all the above parameters. CONCLUSION: Administration of VC or VE i.p. was observed to be effective in the prevention of postoperative adhesion formation in an experimental model.

The efficacy of ampicillin and Lactobacillus casei rhamnosus in the active management of preterm premature rupture of membranes remote from term.

BACKGROUND: We aimed to investigate the treatment efficacy of ampicillin prophylaxis accompanied by Lactobacillus casei rhamnosus over the latency period following preterm premature rupture of membranes (PPROM). METHODS: Records of 40 patients who presented with PPROM between 23(0/7)-31(6/7) weeks were analyzed retrospectively. Patients were divided into two groups: group 1 (n=20), treated with ampicillin; and group 2 (n=20), treated with ampicillin plus L. casei rhamnosus. Clinical and laboratory parameters were compared. Delta (Δ) values of each laboratory parameter were calculated by subtracting the value at delivery from the values at admission to the clinic. RESULTS: Gestational weeks at delivery (28.1 ± 0.3 weeks versus 31.5 ± 0.4 weeks), latency periods (12.3 ± 1.5 days versus 41.4 ± 4.4 days), 5-minute APGAR scores (6.8 ± 0.1 versus 7.8 ± 0.1), and birth weights (1,320 ± 98 g versus 1,947 ± 128 g) were significantly higher in group 2. White blood cell (WBC) (12,820 ± 353/mm(3) versus 11,107 ± 298/mm(3)), and neutrophil counts (10.7 ± 0.5 × 10(3)/L versus 8.2 ± 0.5 × 10(3)/L) were significantly lower in group 2 at delivery. The ΔWBC (2,295 ± 74/mm(3) versus -798 ±- 406/mm(3)), ΔC-reactive protein (5 ± 0.04 mg/L versus 1.6 ± 0.2 mg/L), and Δneutrophil (3 ± 0.2 × 10(3)/L versus 0.2 ±- 0.1 × 10(3)/L) were significantly lower in group 2. CONCLUSION: It seems that addition of L. casei rhamnosus to ampicillin prolongs the latency period in patients with PPROM remote from term.

Double-balloon tamponade in the management of postpartum hemorrhage: a case series.

UNLABELLED: To show the efficacy of double-balloon cervical ripening catheter in the management of postpartum hemorrhage originating from the lower segment of the uterus or the upper parts of the vagina. METHODS: Patients with intractable bleeding from the lower segment of the uterus and the upper parts of the vagina after Cesarean or vaginal deliveries were treated by double-balloon cervical ripening catheter. RESULTS: Double-balloon catheter was used in seven patients, and it was properly placed in all of them. No other intervention was needed to control bleeding. Two patients were delivered vaginally, and five patients were delivered by Cesarean section. Length of hospitalization was longer in the vaginal delivery patients (average hospitalization was 12 days in the vaginal delivery patients and 5 days in the Cesarean section patients). The need for blood and blood products transfusion (average of blood and blood products transfusion was 30 U in the vaginal delivery patients and 6 U in the Cesarean patients) was also higher in the vaginal delivery patients. CONCLUSION: Although double-balloon cervical ripening catheter is designed for the induction of labor, it can successfully control intractable bleedings from the lower segment of the uterus and the upper parts of the vagina. This procedure can save patients from undergoing more morbid procedures.

Endouterine hemostatic square suture vs. Bakri balloon tamponade for intractable hemorrhage due to complete placenta previa.

AIM: To compare the efficiency of endouterine hemostatic square suture and the Bakri balloon tamponade in the treatment of bleeding due to complete placenta previa (CPP). METHODS: Thirteen patients with the diagnosis of CPP and intractable bleeding were randomly divided into two groups in a single blind study. Group 1 (n=6) included patients in whom endouterine hemostatic square suture was applied, while group 2 (n=7) included patients in whom Bakri balloon tamponade was applied. The two groups were compared according to the maternal outcomes, the duration of caesarean section, the preoperative and the postoperative hemoglobin and hematocrit (Htc) values, the intraoperative and postoperative blood loss, as well as the newborn characteristics. RESULTS: The duration of operation and the amount of intraoperative bleeding were significantly higher in group 1 (time: 78.3 ± 8.1 vs. 62.8 ± 3.9 min; P<0.05; intraoperative bleeding: 1946 ± 242 vs. 1520 ± 92 mL; P<0.05). The postoperative 24th h Htc values were found to be significantly lower in group 1 than in group 2 (25.6 ± 3.7 vs. 29.5 ± 1.3 g/dL; P<0.05). The postoperative blood loss was higher in group 1 than in group 2. (351 ± 70 vs. 120 ± 56 mL; P<0.05). CONCLUSION: There are two methods that are effective in preventing bleeding in CPP. However, the Bakri balloon tamponade may be a better alternative due to a shorter operation time and less blood loss.

Ghrelins, obestatin, nesfatin-1 and leptin levels in pregnant women with and without hyperemesis gravidarum.

OBJECTIVES: The goal of this study was to compare levels of acyl and des-acyl ghrelin, obestatin, nesfatin-1 and leptin in healthy gravidas to hyperemesis gravidarum (HG) patients. DESIGN AND METHODS: Twenty pregnant women with HG and twenty healthy pregnant women all of similar ages, BMI and all at similar pregnancy development comprised the study cohort. Fasting serum samples were obtained and measured for acyl and des-acyl ghrelin, leptin, obestatin and nesfatin-1. RESULTS: Nesfatin-1 concentrations in the HG group were higher compared to the control group whereas; leptin concentrations during pregnancy were lower in the HG group as compared to the control group. The two groups did not differ with regard to acyl and des-acyl ghrelin and obestatin. CONCLUSION: This pilot study suggests a possible role of leptin and nesfatin-1, which might be involved in the pathology of the disease.

Anesthesia and Intensive Care Management in a Pregnant Woman with PRES: A Case Report.

Posterior reversible encephalopathy syndrome (PRES) is a temporary condition that is diagnosed clinically, neurologically, and radiologically. Its symptoms vary, and nonspecific headaches, confusion, impairment of consciousness, nausea, vomiting, and visual impairment may occur. Acute hypertension often accompanies these symptoms. Patients can also suffer from convulsions, cortical visual impairment, and coma. Diagnosis can be difficult due to focal neurologic signs. Nevertheless, knowing the clinical risk factors can lead to the right diagnosis. It has been reported that this condition may also occur during organ transplantation, immunosuppressive treatment, and autoimmune diseases and chemotherapy, and also patients with eclampsia. In this paper, a 21-year-old, 31-week pregnant woman, who had been diagnosed with PRES and thanks to early diagnosis and treatment had fully recovered and discharged from the intensive care unit, is presented, and the relevant literature is discussed.