Isolated polyhydramnios in the third trimester or polyhydramnios secondary to late-onset gestational diabetes: is it worth distinguishing?

OBJECTIVE: The aim of this study was to compare pregnancy outcomes of patients with polyhydramnios due to late-onset gestational diabetes mellitus and patients with isolated polyhydramnios. METHODS: Of the women who fully participated in prenatal examinations at Etlik Lady Zübeyde Hospital between January 1, 2018, and December 31, 2019, women with polyhydramnios of nonfetal-placental origin manifesting in the third trimester were retrospectively reviewed. Women with normal 75-g oral glucose tolerance test results between 24 and 28 weeks gestation who met the inclusion criteria were enrolled in the study and divided into two groups based on the results of rescreening with the 75-g oral glucose tolerance test for polyhydramnios in the third trimester: women with isolated polyhydramnios (group 1) and women with late-onset polyhydramnios due to gestational diabetes mellitus (group 2). RESULTS: There were a total of 295 participants, of whom 35 (11.8%) were diagnosed with polyhydramnios due to late-onset gestational diabetes mellitus. There were no differences in the main outcomes. Birthweight and gestational age at birth were identified as independent risk factors for predicting composite maternal outcome {[odds ratio (OR)=1.273, 95% confidence interval (CI) 1.063-1.524, p=0.009]} and composite neonatal outcome (OR=0.606, CI 0.494-0.744, p<0.001), respectively. CONCLUSION: Polyhydramnios in late pregnancy without evidence of pregnancy-related causes leading to polyhydramnios may be a sign of late-onset gestational diabetes mellitus in women with a normal prior oral glucose tolerance test. As pregnancy outcomes and management were indifferent, it does not seem necessary or useful to diagnose whether or not late-onset gestational diabetes mellitus is present.

Importance of hemogram parameters for predicting uterine scar dehiscence

Objective: The pathophysiology of uterine scar dehiscence is not yet clear. The aim of this study was to investigate whether preoperative hemogram parameters can be used as predictive markers of uterine scar dehiscence, thus improving prediction and contributing to management of repeat Cesarean section. Material and Methods: Between 2015 and 2020, 36670 (47.6%) cesarean sections were delivered in our hospital and 16943 of them had a previous Cesarean section. All cases of uterine scar rupture detected during Cesarean section were identified, and a total of 40 patients were included after excluding cases with impairment of the systemic inflammatory response (SIR). Controls consisted of 40 randomly selected, age-and body mass index (BMI)-matched patients, and the groups were compared. Results: Age, BMI, and gravidity were similar (p>0.05). Although the gestational week and Apgar scores were similar between the groups (p>0.05), the birth weight amongst controls was significantly higher than the uterine dehiscence group (p=0.028). Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and other hemogram values were similar in both groups (p>0.05). Mean platelet volume (MPV) in the control group was significantly higher than in the uterine rupture group (p=0.049). Regression analysis found no significant result between hemogram parameters, birth weight, and dehiscence. Conclusion: In this study, which set out to identify predictors of the risk of uterine scar dehiscence with SIR parameters, only the MPV value was lower in the dehiscence group.

A long-term complication of clitoral cyst after female genital mutilation.

Female genital mutilation (FGM) was seen in 30 countries, especially in Africa and also in Asia and the Middle East. According to WHO data, Somalia is where FGM is performed most frequently. Our study aimed to evaluate the recordings of patients with FGM who were diagnosed with a traumatic clitoral cyst. We identified the clitoral cyst cases between February 2015 and August 2020. We collected clinical, surgical, sociodemographic, and histopathological details such as age, marital status, patient resume, age at which FGM was performed, complaints, size of the cyst consultation reasons, FGM procedural long-term complications, sexual function, husband polygamic relationship status, and histological findings. A total of 21 patients diagnosed with clitoral cysts were included in the study. The technique was easily applied in every patient, and the cysts were removed intact, except in 2 patients. There were no intraoperative complications; only minimal bleeding was seen. Except for one patient, all had unilocular cysts, and the final pathological examination revealed an epidermal inclusion cyst. We observed a neuroma developed due to genital trauma due to FGM in one of our patients. Female circumcision and its consequences are not familiar to many healthcare professionals in the developed world. We want to increase awareness of female circumcision and its long-term complication of clitoral cysts among healthcare professionals worldwide.

Short-term Reproductive Outcomes of Nulliparous Women with Previous Ectopic Pregnancy.

OBJECTIVE: To determine the characteristics and subsequent pregnancy outcomes in patients with a previous ectopic pregnancy (EP). STUDY DESIGN: Descriptive-cross sectional study. PLACE AND DURATION OF STUDY: Department of Obstetrics-Gynaecology, Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey, between January 2014 and December December 2018. METHODOLOGY: The data of nulliparous patients diagnosed with tubal ectopic pregnancy (EP) was analysed retrospectively. Reproductive outcomes within the first two years after ectopic pregnancy diagnosis were used as "short-term" reproductive outcomes. Their EP treatment and pregnancy outcome were determined. RESULTS: Expectant management was chosen in 5.8% of the patients, while the surgical intervention was 32.3%. Medical therapy involving methotrexate (MTX) was given to the remaining patients (61.9%). The tubal rupture was confirmed in 12% of the cases that received MTX. In the 2-year follow-up period after the ectopic event, the most common outcome of the subsequent pregnancies was a live birth (47.7%). Recurrent EP occurred in 4.6%. CONCLUSION: The subsequent short-term pregnancy outcomes in this study were not related to the chosen treatment modality. KEY WORDS: Ectopic pregnancy, Nulliparity, Reproductive outcomes, Treatment modalities, Expectant management.

Retrospective Evaluation of Hydatid Cyst Cases During Pregnancy.

Aim: Zoonotic parasite infections affect many pregnant people around the world. Hydatid cystic disease is also a zoonotic disease caused by Echinococcus sp. This study aims to present the maternal-fetal results and clinical treatment of pregnant women diagnosed with liver hydatid cyst (CH). This zoonotic disease is discussed again in the light of current literature. Materials and Methods: Pregnant women with hydatid cyst monitored in a tertiary health center between 2018 and 2020 were evaluated. Seven cases were included in this study. We retrospectively collected and analyzed clinical data, which did not interfere with medical treatment. Results: Albendazole was started as medical therapy in six patients, and percutaneous drainage was applied to one patient. Three of our six patients who started medical treatment had to undergo surgery due to maternal complications that developed despite medical treatment. Two of our patients were delivered with a cesarean section due to the obstetric indications. Discussion: Hydatid cysts are most commonly caused by Echinococcus granulosus infection and most common in the liver. The diagnosis of liver hydatid cysts is not difficult, but pregnant women's treatment methods have some problems. Although both medical and surgical treatments are available, there is no consensus. We would also like to underscore that echinococcal disease of the liver should be kept in mind in the differential diagnosis of abdominal pain, jaundice, and/or fever, especially in endemic regions. We think that when we increase awareness about this disease, we can improve fetal and maternal outcomes by making an early diagnosis and management.

Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome?

OBJECTIVE: To determine whether the ratio of the first-trimester aspartate aminotransferase (AST) to platelet ratio index (APRI) score will be useful as a new determinant of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome that may develop in the later stages of pregnancy Study Design: Descriptive-analytical study. PLACE AND DURATION OF STUDY: Perinatology Clinic of Etlik Zübeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey. The data of patients diagnosed as having HELLP syndrome between 2018 and 2020 were analyzed retrospectively. METHODOLOGY: Forty-two pregnant women with HELLP syndrome as the study group and 74 pregnant women with no morbidities as the control group were included in the study. First-trimester APRI scores were compared for both the groups. A characteristic curve (ROC) analysis of the study was performed to determine the APRI score levels predicting HELLP syndrome. RESULTS: One hundred and sixteen women with HELLP syndrome had significantly lower fibrinogen levels and platelet (PLT) levels than women without HELLP syndrome (p<0.001). Women with HELLP syndrome had significantly higher ALT, AST, creatinine, and INR levels. These differences were significantly different (p<0.001). Women who developed HELLP syndrome in the third trimester of pregnancy had significantly higher first-trimester APRI scores (0.64±0.10) than the control group (0.40±0.12, p<0.001). In the ROC analysis, 0.55 as a cut-off value for first-trimester APRI scores had a sensitivity of 88.1 % and a specificity of 94.6 % for predicting HELLP syndrome developing in the third trimester of pregnancy. CONCLUSION: There was an association of first-trimester APRI scores with the prediction of HELLP syndrome, possibly developing in the later weeks of pregnancy. Predicting HELLP syndrome in the early period can assist in proper management and taking necessary precautions. Key Words: HELLP syndrome prediction, First-trimester APRI, APRI scores in pregnancy, APRI score.

Can placental elasticity predict the time of delivery in cases of threatened preterm labor?

AIM: We aimed to evaluate placental elasticity for the short-time prediction of delivery in cases of threatened preterm labor (TPL). METHODS: We performed a prospective study with consented pregnant women diagnosed with TPL (24th to 34th gestational week). According to the birth time, the patients were grouped into two groups, whether the delivery happened in the following first week or not. We compared the placental strain ratio (PSR) values between these two groups. RESULTS: A total of 108 pregnant women divided into two groups according to the delivery time were enrolled in our study. The pregnant women who had a delivery in 1 week after hospitalization have increased PSR values when compared to those who have not delivered within 1 week (P < 0.001). Multivariate logistic regression analysis showed that cervical length and PSR were significantly associated with delivery in 1 week after hospitalization. When the cervical length was entered as a covariate (control) variable, PSR was significantly associated with delivery time (B = 0.504, odds ratio: 1.655, 95% confidence interval: 1.339-2.045, P < 0.001). A PSR value of 4.04 had a sensitivity of 77.78% and a specificity of 87.04% in terms of short-time prediction of the delivery time, in the receiver-operator curves analysis to determine the cut-off point PSR value. CONCLUSION: Elastography may contribute to predict the delivery time in high-risk pregnants with TPL.

First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study.

OBJECTIVE: To evaluate the predictive value of the first-trimester aspartate aminotransferase (AST)/platelet count ratio [AST to platelet ratio index (APRI) score] for intrahepatic cholestasis in pregnancy (ICP). METHODS: This study consisted of a patient group diagnosed with ICP (n = 37) and a control group (n = 66) who presented to the hospital perinatology clinic between 2018 and 2020. Laboratory tests of both groups were analysed retrospectively. Age, gravida, parity, body mass index, third-trimester laboratory tests and first-trimester APRI scores were compared between the two groups. A receiver operating characteristic (ROC) analysis of the study was performed to determine the cut-off value for APRI score that is predictive of ICP. RESULTS: Patients with ICP had significantly higher first-trimester APRI scores compared with controls (p < 0.001). In the ROC analysis, the cut-off value for APRI score was 0.57, with 86.5 % sensitivity and 77.3 % specificity. Spearman's correlation indicated that there was a significant positive association between first-trimester APRI score and third-trimester fasting bile acid level (r = 0.641, p < 0.001). The demographic characteristics of patients in the third trimester did not differ, except for AST and alanine transferase values. CONCLUSIONS: The APRI score calculated in the first trimester of pregnancy seems to be predictive of the development of ICP in the third trimester.

Helicobacter Pylori Infection in Amniotic Fluid May Cause Hyperemesis Gravidarum.

Objectives: Limited data are available from recent trials involving pregnant women to guide Helicobacter pylori infection diagnosis. There are no data about the presence of H. pylori in the amniotic fluid as well. Furthermore, the relation between amniotic fluid H. pylori and hyperemesis gravidarum (HG) has not been characterized yet. Materials and Methods: This is a prospective study conducted after obtaining approval from the Ethics Committee. Pregnant women undergoing amniocentesis were enrolled in the study. The stool antigen test assessed the presence of H. pylori in amniotic fluid. A perinatologist independently performed an amniocentesis. The obtained amniotic liquid was sent to the laboratory to evaluate H. pylori infection by stool H. pylori antigen assay. We determined the rate of H. pylori in amniotic fluid and assessed relations between H. pylori infection and pregnancy outcome, including HG. Results: Between May and September 2017, we enrolled 48 pregnant women who underwent amniocentesis to detect possible fetal malformations. Patients were divided into two groups regarding the HG status. There were significant differences between the groups in terms of H. pylori infection presence. Among them, 28 (58.3%) were found to have a positive H. pylori test in their amniotic fluid. The rate of HG was significantly higher (71.4%) in patients who tested positive for H. pylori in amniocentesis than the H. pylori-negative group (20%), (p<0.001). Conclusions: The study's main new finding is that presence of H. pylori in the amniotic fluid is possible. Our data suggest that H. pylori-infected amniotic fluid is associated with the experience of past HG. The current study may have important implications for HG detection and help identify patients who would benefit from future preventive strategies.

Evaluation of first-trimester neutrophil-lymphocyte ratio and platelet-lymphocyte ratio values in pregnancies complicated by intrauterine growth retardation.

OBJECTIVE: The objective of this study is to compare the first-trimester hemogram parameters [neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR)] of pregnant women complicated by intrauterine growth retardation (IUGR) and normal pregnant women. MATERIALS AND METHODS: We retrospectively evaluated the medical records of pregnant women (n=50) complicated with IUGR and pregnant women in the control group (n=50). RESULTS: The first-trimester NLR and PLR values of the pregnant women complicated by IUGR were 6.59±1.12 and 117.2±16.00, respectively. The first-trimester NLR and PLR values of the pregnant women in the control group were 2.84±0.55 and 112.80±13.01, respectively. There was a statistically significant difference between the two groups with respect to NLR (p<0.001). CONCLUSION: Pregnancies complicated by IUGR have high neonatal mortality and morbidity rates. Therefore, the early diagnosis of disease and appropriate management are extremely crucial for both fetal and maternal prognoses. High NLR values in the first trimester may contribute to the early diagnosis of IUGR.