Maternal and foetal risks associated with teenage pregnancy - a comparative retrospective study in Turkey.

BACKGROUND: Adolescent pregnancy is defined as pregnancy occurring in young women between the ages of 10 and 19 years. Adolescent pregnancies, which are among the social healthcare concerns in developed and developing countries, have negative effects on maternal and infant health. Pregnancy in adolescence puts the health of both the mother and child at risk, as adolescent pregnancies have higher rates of eclampsia, systemic infection, low birth weight, and preterm delivery compared to other pregnancies. In this study, the effects of education level, smoking, and marital status on maternal and foetal outcomes in adolescent pregnancies were evaluated. METHODS: The records of a total of 960 pregnant women (480 pregnant adolescents aged 15-19 years and 480 pregnant adult women aged 20-26 years) were examined retrospectively. The demographic data of the groups and maternal and foetal outcomes of the pregnancies were compared. A logistic regression model was established as a statistical method for reducing confounding effects. RESULTS: Unmarried women were statistically significantly more prevalent in the adolescent group (38.3% vs. 7.3%). Among the considered risk factors, preeclampsia (2.9% vs. 0.8%) and smoking (29.8% vs. 9.8%) were statistically significantly more common in the adolescent group. When the groups were compared in terms of risk factors in pregnancy, it was found that pregnancy in adolescence was associated with a 3.04-fold higher risk of smoking, 5.25-fold higher risk of being unmarried, 3.50-fold higher risk of preeclampsia, and 1.70-fold higher risk of intrauterine growth retardation (IUGR). CONCLUSIONS: This study demonstrates an increased risk of preeclampsia, IUGR, and smoking during pregnancy in adolescent pregnant women. These findings can be used to identify adolescent pregnancies requiring specific assistance and to take measures to reduce the probability of adverse outcomes.

In this study, we examine the risks of adolescent pregnancies. Adolescent pregnancy is a public health problem, and it is more common in underdeveloped or developing countries. We believe that non-governmental organisations and governments should take precautions regarding adolescent pregnancies and protect this legally vulnerable sociodemographic group from pregnancy. For healthier and more conscientious pregnancy experiences, mothers must be of appropriate age, having passed the period of adolescence. Adolescent pregnancies, which come with many risks, and especially risks of preeclampsia, premature birth, and maternal death, should be minimised or prevented.

Cervical Dysplasia Distress Questionnaire: Turkish validity and reliability study.

The aim of this study was to determine the validity and reliability of the Turkish adaptation of the Cervical Dysplasia Distress Questionnaire (CDDQ) in women with abnormal Pap smear results. This validation study was conducted using a cross-sectional research design. A total of 115 patients who were being followed up in the obstetrics and gynecology outpatient clinic of a university hospital due to an abnormal Pap smear test were included. In the study, the results of language and content validity, item analysis, exploratory, and confirmatory factor analyses, internal consistency coefficients, and concurrent and convergent validity were assessed in order to adapt the CDDQ to the Turkish language and culture and to determine its reliability and validity. It was determined that all factor loads of the scale ranged from 0.13 to 0.85. The exploratory variance was found to be 29.986 for the first subscale, 19.734 for the second subscale, 16.551 for the third subscale, and 66.271 for the overall scale. Cronbach's alpha values for the tension during the examination, concerns about health consequences, and concerns about sexual consequences were 0.92, 0.91, and 0.87, respectively. The desired level of correlation was achieved between the CDDQ and the Hospital Anxiety and Depression Scale (HADS). In the study, the Turkish adaptation of the CDDQ was found to be a valid and reliable instrument to assess psychological distress in women with abnormal Pap smear results.

Is it possible to predict the success of single dose methotrexate in the treatment of tubal ectopic pregnancies?

OBJECTIVES: In this study, the aim was to determine whether the use of endometrial thickness or neutrophil/lymphocyte and platelet/lymphocyte ratio would be useful in predicting the success of methotrexate in the treatment of ectopic pregnancies located in the fallopian tubes. MATERAL AND METHODS: This study was carried out by retrospectively examining 68 study group cases with an ultrasonographically detectable gestational sac in the fallopian tubes and 189 control group cases with an unruptured ectopic pregnancy diagnosis at any location. The cut-off value of endometrial thickness was calculated as a new marker between the cases in which single-dose methotrexate treatment was successful and the cases with treatment failure. Treatment success was evaluated with different models including endometrial thickness, fetal cardiac activity status, measurable crown-rump length, and ß-hCG. RESULT: The cut-off value of ß-hCG for treatment success was determined as 2960.5 ng/mL, and the cut-off value for endometrial thickness was determined as 10.5 mm. Although NLR seems to be a marker with a cut-off value of 2.49, it does not provide an extra benefit in combined use as it is not a specific predictor. The highest success in predicting treatment success was achieved in the modeling in which crown-rump length + fetal cardiac activity + ß-hCG + endometrial thickness were used together. CONCLUSIONS: The use of endometrial thickness as a marker seems to be quite reliable in predicting treatment success. And we think it would be beneficial to thin the endometrium before using methotrexate.

The role of paraoxonase and myeloperoxidase as oxidative stress markers in pregnant women with hypothyroidism.

Objective: This study aims to measure paraoxonase 1 (PON 1) and myeloperoxidase (MPO) levels in patients diagnosed with hypothyroidism during pregnancy by spectrophotometric method and to compare the results with healthy controls. Methods: For the study, the blood samples of 45 hypothyroid pregnant patients and 45 healthy control pregnant individuals who were compatible with the patient group in terms of age were taken. PON 1 and MPO levels in both groups were measured using spectrophotometric methods and statistical analysis was performed. Results: Serum PON 1 activity levels were significantly lower in hypothyroid pregnant patients than in the control group (p=.020). The patients group had significantly higher serum MPO concentrations than in control group (p=.020). MPO/PON-1 ratio was higher in pregnant patients with hypothyroidism than in the control group (p=.030). Conclusion: Decreased levels of PON1 with increased levels of MPO in hypothyroid pregnant patients suggest the critical role of oxidative stress in hypothyroidism during pregnancy.

Predictive value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Vaginitis.

OBJECTIVES: This study was conducted to evaluate the diagnostic value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in vaginitis patients. METHODS: This cross-sectional retrospective study was performed in Afyon Dinar State Hospital between July 2016 to August 2017. A total of 64 bacterial vaginosis (BV) patients, 66 vulvovaginal candidiasis (VVC) patients and 65 age-matched control subjects were enrolled. NLR, PLR, mean platelet volume (MPV), red cell distribution width (RDW) and other conventional inflammatory marker values were recorded for all patients before and after treatment. RESULTS: In the BV group, NLR values were found to be elevated compared to VVC and healthy controls [2.9 (1.2-14.7), 2.1 (1.1-11.7) and 2.1 (0.8-7.0), respectively] (p=0.008). Although not found to be statistically significant, the median NLR levels of BV patients decreased from 2.9 (1.2-14.7) to 2.4 (1.2-7.0) after treatment. PLR levels did not show a statistically significant difference between the three groups (p=0.970). The cut-off value of the NLR for BV was 2.19, with 67.2% sensitivity and 63.8% specificity. CONCLUSIONS: The present study demonstrated that NLR levels are elevated in bacterial vaginosis and NLR levels can be used as a reflection of systemic inflammatory response in vaginosis patients.

The immunohistochemical and histologic effects of contrast medium on uterus, fallopian tubes and ovaries, given during hysterosalpingography: rat study

Objective: Previous studies have shown that damage occurs to internal genital tract during hysterosalpingography (HSG). The aim was to show that endometrial and tubal epithelium underwent free radical damage during HSG in an animal model. Material and Methods: Forty rats were evaluated in five different groups. Two groups received ionizing radiation (15-20 miliRad three times) only. Two further groups received ionizing radiation in combination with iohexol (1-2 mL). The remaining group served as control. Groups were evaluated after seven and forty-two days. Inflammation and cellular changes were evaluated histopathologically. Cellular activity of antioxidant enzymes was assessed immunohistochemically. Results: Inflammation, and cellular changes were detected at certain rates in all groups (p<0.001). Glutathione reductase, catalase, superoxide dismutase, glutathione S-transferase activities were found to be increased after the HSG (p<0.001). Conclusion: It is obvious that the cell suffers acute and chronic damage during HSG due to both radioactivity and chemicals. Although there is a lot of research done before, there is no definitive method yet to protect against the harmful effects of iodinated contrast agents and ionizing radiation. So, new methods need to be explored to protect cells and tissues from reactive oxygen radical damage caused by HSG.

Effects of vitamin B12, folate, uric acid, and serum biomarkers of inflammation on bone mineral density in postmenopausal women.

INTRODUCTION: Despite the accumulating evidence suggesting a possible relationship between femur and lumbar bone mineral density (BMD) and serum uric acid (UA), it is unclear whether alterations in UA levels reflect any underlying subclinical inflammatory conditions in postmenopausal osteoporosis. In addition, the mechanistic link between osteoporosis and dietary factors including vitamin B12 and folate in postmenopausal women is still obscure. The aim of the present study is to investigate the association between serum vitamin B12, folate, UA, and subclinical inflammatory markers and BMD measurements in postmenopausal women. MATERIAL AND METHODS: One hundred and eighty-four postmenopausal women were recruited for the present study. Clinical data, as well as serum vitamin B12, folate, UA, conventional inflammatory markers, and other related biochemical markers, were assessed for each subject. Bone mineral density measurements of proximal femur and lumbar spine were taken using dual-energy X-ray absorptiometry. Correlation analysis was performed between serum vitamin B12, folate, UA and other biochemical and metabolic parameters. RESULTS: Although no association was found between serum inflammatory markers, vitamin B12 and folate levels with femur neck and lumbar spine BMD measurements, elevated UA levels were observed in subjects with normal BMD values. Higher BMD values were obtained in higher UA tertiles. UA (p < 0.001) and BMI (p = 0.003) were found to be correlated with femur neck BMD measurements. CONCLUSIONS: The femoral and lumbar BMD measurements were associated with serum UA levels. Higher serum UA levels were found to have a protective effect on postmenopausal osteoporosis irrespective of inflammation and dietary factors.

Elevated circulating nitric oxide levels correlates with enhanced oxidative stress in patients with hyperemesis gravidarum.

Since the biochemical and molecular mechanisms responsible for ongoing oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been fully elucidated, the aim of this study was to evaluate the possible role of nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers in the disease pathophysiology. Moreover, the relation between oxidative stress markers and Helicobacter pylori (H. pylori) infection was also investigated. Women with pregnancies complicated by HEG (n = 33) were compared with pregnant women without HEG (n = 30) and with healthy non-pregnant women (n = 31). Serum NO, MDA, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori infection status were determined for each subject. Serum NO levels and OSI index were found to be increased (p = .001 and .013, respectively) and TAS levels were decreased (p < .001) in HEG patients compared with both controls regardless of H. pylori infection status. Serum MDA and TOS levels were not different between the study groups. Helicobacter pylori infection rates were similar in each group. The reduced antioxidant activities, as well as the increased OSI and NO levels in HEG patients indicate possible oxidative stress conditions in HEG patients. Moreover, serum NO levels may be used as an adjunctive marker to distinguish HEG patients from other causes of emesis during pregnancy. Impact statement What is already known on this subject? Current evidence suggests that oxidative stress is a significant factor responsible for a number of complications during pregnancy. What do the results of this study add? Hyperemesis gravidarum is an oxidative stress condition, as reflected by increased nitric oxide (NO) and decreased total antioxidant status activity, regardless of H. Pylori infection. What are the implications for clinical practice and/or further research? Full disclosure of the association between circulating NO and hyperemesis gravidarum would shed light on underlying biological mechanisms and could help clinical management of similar pregnancy-associated morbidity states.

Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study.

OBJECTIVES: Current evidence suggests that subclinical inflammation plays a significant role in the development of hyperemesis gravidarum (HEG). Simple hematological markers, such as mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been shown to reflect inflammatory burden and disease activity in several disorders. This study aimed to determine the diagnostic value of these hematological parameters for HEG. MATERIAL AND METHODS: A total of 54 HEG patients and 58 age- and gestational-age-matched control subjects were studied. NLR, MPV, PLR, platelet distribution width (PDW), and red cell distribution width (RDW) values in all patients were calculated and recorded from complete blood cell counts. RESULTS: For HEG patients, the median NLR was 3.2 (1.6-7.1), and the median PLR was 143.7 (78.1-334.6); for control subjects, the values were 2.1 (1.0-4.7) and 93.1 (47.3-194.7), respectively. Although both the NLR and PLR of HEG patients were found to be significantly higher than in the controls, no significant difference was found between the study groups in terms of MPV, RDW, or PDW. Correlation analysis revealed a significant correlation between NLR and CRP (r = 0.872, p < 0.001). CONCLUSIONS: Our results show that peripheral blood NLR and PLR values can reflect inflammatory burden in HEG patients and can be used as markers for HEG.

Early postpartum lactation effects of cesarean and vaginal birth.

OBJECTIVES: Breastfeeding has positive effects for both, the mother and the infant. The purpose of the study was to ex-amine how cesarean delivery and vaginal delivery influenced subsequent breastfeeding. The study was conducted at the Kirikkale University Medical School. MATERIAL AND METHODS: Breastfeeding outcomes after an elective cesarean delivery and after a planned vaginal delivery were compared. The study included 169 consenting mothers who gave birth to healthy infants (86 cesarean deliveries and 83 vaginal deliveries) between March and September 2001. All cesarean deliveries were performed under regional anesthesia. RESULTS: Elective cesarean delivery was performed at a significantly earlier gestational age as compared to vaginal delivery (p = 0.001). Maternal age in the planned vaginal delivery group was significantly lower (p = 0.003). As for the change in prolactin levels, the results were similar but not statistically significant (p = 0.21). The frequency of breastfeeding per day did not differ significantly between the groups (p = 0.20). However, women after cesarean delivery tended to breastfeed more often than after vaginal delivery (p = 0.003). Mean number of points recorded at the first breastfeeding session, according to the LATCH charting system, was lower in the group after cesarean delivery as compared to vaginal labor. The difference between the average point scores of vaginal delivery and cesarean delivery mothers was found to be meaningful in favor of the women after vaginal delivery (p = 0.05). CONCLUSIONS: Elective cesarean section has negative effects on breastfeeding. Our results indicate that cesarean section constitutes a risk factor for delayed lactogenesis.