The role of the Chitinase 3-Like 1 (CHI3L1) genes in the preeclampsia pathophysiology.

OBJECTIVE: The aim of this study was to investigate the relationship between Chitinase 3-Like 1 gene polymorphisms and the occurrence of preeclampsia in a selected cohort of pregnant women. METHODS: A total of 75 pregnant women participated in the study, 35 of whom were diagnosed with preeclampsia, while 40 served as healthy controls. The preeclamptic group was subdivided based on severity. Real-time polymerase chain reaction was employed to analyze the serum samples for variations in Chitinase 3-Like 1 gene polymorphisms. RESULTS: The rs880633 polymorphism was found to be significantly more frequent in the control group (80%) compared with the overall preeclamptic group (60%) (p<0.05). In the severity-based subgroups, rs880633 appeared in 57.1% of non-severe and 61.9% of severe preeclamptics. Contrarily, the heterozygous form of rs7515776 polymorphism showed a significantly higher prevalence in the preeclamptic cohort (p<0.05), without distinctions in severity subgroups. CONCLUSION: The study suggests that the rs880633 polymorphism may serve a protective role against the development of preeclampsia, whereas the rs7515776 polymorphism may be associated with an elevated risk. Further research is warranted to elucidate the clinical implications of these findings.

Comparison of cases with and without acute liver injury in pregnant women with SARS-CoV-2 infection; obstetric and neonatal outcomes.

Background and objective: The effect of SARS-CoV-2 infection on the liver during pregnancy and the impact of SARS-COV-2-related liver injury during pregnancy on obstetric and neonatal outcomes are not yet clear. The aim of this study was to determine the clinical features of pregnant women at risk of liver injury and to investigate the effect of liver dysfunction on obstetric and perinatal outcomes. Methodology: Pregnant women who were followed up and treated at Selcuk University Medical Faculty Hospital and diagnosed with COVID-19 were determined retrospectively. All pregnant women whose PCR test results were positive between March 1, 2020 and July 31, 2022 were included. A total of 96 PCR positive pregnant women were included in the study. The patients were divided into two groups as those with and without liver damage. Both groups were compared in terms of obstetric and neonatal outcomes. Results: While liver damage findings were observed in 34.4% of the 96 pregnant included in the study; No liver damage was observed in 65.6% of the patients. White blood cell, neutrophil, ferritin, D-dimer, troponin, C-reactive protein, systemic immune-inflammation index, interleukin-6, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels were higher in patients with liver injury compared to pregnant women without liver injury. Prematurity, premature rupture of membranes, preterm premature rupture of membranes, preeclampsia and fetal death were observed relatively more in the patient group with liver injury, there was no statistical significiant difference between the groups in terms of these complications. Unfortunately, maternal death occurred in four mothers with liver injury and in one patient without liver injury. Birthweight, APGAR scores and obstetric complication rates were similar between two groups. Conclusion: Our study showed that pregnant patients with liver damage had worse inflammatory response than those without liver damage. Women with elevated liver enzymes tend to have severe disease, but obstetric and perinatal outcomes were similar between groups with and without liver damage.

An analytical cross-sectional study: determining gestational age using fetal clavicle length during the second trimester.

PURPOSE: To investigate the correlation between fetal clavicle length and gestational age in pregnant patients from 14 and 27 weeks of gestation. METHODS: This was a retrospective cross-sectional study of patients from 14 and 27 weeks of gestation. Ultrasonographic measurements such as abdominal circumference (AC), femur length (FL), humerus length (HL), clavicle length (CL), head circumference (HC), biparietal diameter (BPD), estimated fetal weight (EFW), and transverse cerebellum diameter (TCD) were made and compared. RESULTS: A total of 552 patients were evaluated in our clinic and CL was measured properly and successfully in all fetuses. Fetal AC, FL, HL, CL, BPD, HC, EFW and TCD measurements were significantly and strongly correlated with gestational week, and Pearson's correlation values were 0.964, 0.965, 0.959, 0.965, 0.951, 0.917, 0.925, and 0.954, respectively (p < 0.001). In the regression analysis equation, gestational week = 0.894 + CL × 0.961. CONCLUSION: There was a significant positive correlation between fetal CL (mm) and gestational week. We suggest that the 1 mm = 1 week rule can be used for patients with anomalies of the cerebellum and vermis, as well as for patients with unknown last menstrual period.

Comparison of Perinatal, Newborn, and Audiometry Results of COVID-19 Pregnant Women.

Objective: There are studies on the perinatal outcomes of COVID-19, but the audiometric effects of the maternal immune system against COVID-19 in the newborn are not clear. In this study, we aimed to investigate the relationship between the perinatal outcomes of COVID-19 positive pregnant women and the audiological outcomes of newborns. Materials and Methods: This retrospective, single-center cohort study was conducted with 65 polymerase chain reaction (PCR) positive pregnant women and newborns and 66 normal pregnant women and newborns who were admitted between January 2020-December 2021. Pregnancy data, perinatal outcomes, and newborn hearing test results of pregnant women and newborns were recorded and compared. Results: A total of 131 patients were enrolled in the study. The number of normal pregnant women was 66 (50.4%) and the number of pregnant women who had COVID-19 disease was 65 (49.6%). In general, gestational week, age, parity, biochemical parameters, duration of hospital stay, week of delivery, fetal weight, and apgar scores were compared between pregnant women with COVID-19 and normal. White blood cell (WBC), neutrophil, aspartate aminotransferase (AST), and C-reactive protein (CRP) parameters were found to be significantly higher, and lymphocyte and neutrophil/lymphocyte (N/L) ratios were significantly lower (p < 0.05). There was no statistically significant difference between the two groups (χ 2=0.001; p = 1,000). The normal delivery status, the normal delivery rate in patients with COVID-19 was found to be statistically significantly higher than the cesarean section delivery status (p = 0.012). In the statistical comparison between the COVID-19 and normal pregnant groups in the cesarean section group, the gestational week, delivery week, and apgar1 scores of the pregnant women with COVID-19 were found to be significantly higher. There was no statistically significant difference between the distributions of the rate of infants with hearing impairment in the comparison with hearing tests in pregnant women with COVID-19 (n=1) and normal pregnant women (n=1) (χ 2=0.001; p = 1,000). Conclusion: Although the negative effects of COVID-19 on pregnancy outcomes are rare, it was determined that there was no increased audiological risk factor, and the most important predictor of COVID-19 was lymphopenia.

The relationship between the helicobacter pylori seropositivity with systemic and local oxidative status and hyperemesis gravidarum: a pilot study.

OBJECTIVES: The aim of study was to determine the helicobacter pylori (HP) seropositivity and oxidative parameters in serum and saliva of pregnant women with poor oral hygiene and hyperemesis gravidarum (HG). METHODS: A case-control study was conducted involving 50 pregnant women in their first trimester of pregnancy. Twenty-five subjects had a diagnosis of HG, and remaining 25 were healthy pregnant women who served as control subjects were included. The groups were adjusted for age, parity and gestational week. All patients were subjected to the measurement of total oxidant status (TOS) and total antioxidant status in serum and saliva. Also HP seropositivity was investigated. RESULTS: Serum TAS and TOS values were similar, although oxidative burden in saliva of women with HG were significantly higher than controls. HP seropositivity was found to be 24% in women with HG and 4% of controls. CONCLUSIONS: Our results suggest that significantly increased oxidative burden and slightly decreased antioxidative capacity of saliva may be involved in the pathogenesis of HG and this condition may be the result of HP infection which was found to be significantly more common in women with poor oral hygiene and HG.

Serum collagenase-2 and BMI levels in pregnant women with striae gravidarum.

OBJECTIVE: Striae gravidarum is a form of scarring on the skin observed during pregnancy and can cause serious cosmetic problems. Striae gravidarum may be influenced by hormonal changes, although the etiology is not clear. The aim of this study was to investigate whether body mass index (BMI) and serum collagenase-2 levels in pregnant women are related to the development of striae gravidarum. METHODS: Thirty pregnant women with striae, 30 pregnant women without striae, and 32 health controls were enrolled in the study. RESULTS: BMI and serum collagenase-2 levels were measured in the participants. CONCLUSION: Pregnant women with striae gravidarum had increased serum collagenase-2 and BMI levels when compared to pregnant women without striae gravidarum and healthy controls (P < 0.05). The increase in serum collagenase-2 levels was related to the development of striae gravidarum alone, or secondary to BMI increase.

Is neutrophil/lymphocyte ratio a useful marker to predict the severity of pre-eclampsia?

OBJECTIVE: To evaluate the relationship of neutrophil/lymphocyte ratio (NLR) with proteinuria and blood pressure level in patients with pre-eclampsia and to investigate whether or not NLR has a role in predicting the severity of pre-eclampsia. STUDY DESIGN: The study comprised 30 healthy pregnant females (Group 1), 37 females with mild pre-eclampsia (Group 2) and 40 with severe pre-eclampsia (Group 3). All the study participants were statistically compared in respect of demographic data, proteinuria levels, and blood pressure levels. RESULT: Age, body mass index, and gestational weeks were similar in all the groups. Maternal NLR was determined to be significantly high in the pre-eclamptic patients (Groups 2 and 3) compared to the healthy pregnant patients (Group 1) (p=0.017). NLR was significantly higher in the severe pre-eclampsia group than in the mild pre-eclampsia group (p=0.032). A significant positive correlation was determined in correlation analysis between NLR and proteinuria (p=0.013, r=0.319). There was also a significant and positive correlation between NLR and systolic/diastolic arterial pressure (p=0.007, r=0.285; p=0.044, r=0.213, respectively). CONCLUSION: In conclusion, while NLR was determined as significantly high in patients with pre-eclampsia, to be able to use this in the classification of the severity of pre-eclampsia, there is a need for further studies on a more extensive population.

The evaluation of Nesfatin-1 levels in patients with and without intrauterine growth restriction.

OBJECTIVE: To evaluate Nesfatin-1 levels in patients with and without intrauterine growth restriction and to analyze the correlation between Nesfatin-1 levels and fetal birth weights. METHODS: This study comprised a total of 81 cases; 41 patients with IUGR and 40 healthy cases. Demographic data, pregnancy weeks, fetal birth weights and Nesfatin-1 levels were all recorded. The Nesfatin-1 levels were compared between the groups and the correlation between fetal birth weights and Nesfatin-1 levels was analyzed. RESULTS: No statistical significant difference was determined between the groups in terms of demographic data (p > 0.05). Average birth weights were determined as 3420 ± 259 g in the control group and 2041 ± 350 g in the IUGR group, which was found to be statistically unequal (p = 0.001). The average Nesfatin levels in the control group were 0.069 ± 0.011 and 0.094 ± 0.042 in the IUGR group. This difference was statistically unequal (p = 0.001). While no correlation was determined between Nesfatin levels and fetal birthweights in the control group (r = -0.034 versus p = 0.836), in the IUGR group and when all the cases were evaluated together, a statistically moderately significant negative correlation was determined (r = -0.469, p = 0.002 and r = -0.251, p = 0.024, respectively). CONCLUSIONS: Although intrauterine growth is a multifactorial process, the effect mechanism has not yet been established. The results of this study offer some indications about the possible effect of Nesfatin 1 on fetal growth.

A comparison of two techniques of uterine closure in caesarean section.

OBJECTIVE: To compare the results of two different techniques of uterine closure in caesarean section operations in which assistant surgeons participated. METHODS: A total of 765 patients were separated into two groups.In Group1(n = 380), the assistant surgeon, while pulling the suture in a caudal direction with the left hand, held the uterine wall from the joined site with the right hand to prevent upward tension of tissue. In Group 2 (n = 385), the suture was placed by the assistant surgeon by pulling it in the cephalic direction with the right hand. These two techniques were evaluated in respect of the postoperative decrease in haemoglobin level ,the need for additional sutures and operative outcomes. RESULTS: The need for additional sutures was determined as statistically high in Group 2 at mean 0.5 ± 0.6 compared to mean 0.2 ± 0.5 in Group1 (p < 0.001). The mean operating time was determined as statistically significantly longer in Group 2 (Group1, 38.0 ± 5.6 mins and Group2, 41.3 ± 4.3 mins) (p < 0.001). The postoperative decrease in hb was statistically significantly greater in Group 2 (Group1, 1.1 ± 0.4, Group2, 1.2 ± 0.4) (p = 0.002). CONCLUSION: The cephalic direction placement of the suture with the right hand of the assistant surgeon in uterine closure leads to bleeding due to tissue cuts in the lower wound lip and thereby creating a need for additional sutures. Therefore, the suture should be placed in a caudal direction with the left hand.

Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy.

OBJECTIVE: To compare vaginal length and sexual function after total laparoscopic hysterectomy (TLH), total abdominal hysterectomy (TAH), and vaginal hysterectomy (VH). METHODS: The present cross-sectional study at a single center in Turkey compared vaginal length and sexual function among women who received TLH, TAH, VH, or no surgery (groups 1, 2, 3, and 0, respectively) between January 2011 and April 2014. All women underwent hysterectomy for benign reasons at least 3months before the study and were sexually active. Vaginal length was measured between the hymenal ring and vaginal apex. Sexual function was assessed via the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, short form (PISQ-12). RESULTS: Vaginal length in groups 0, 1, 2, and 3 was 10.9±1.5, 8.9±1.4, 8.5±1.2, and 8.1±0.7cm, respectively; it was significantly longer in the control group (P<0.001), and significantly shorter in group 3 than in group 1 (P=0.03). The mean PISQ-12 score in groups 0, 1, 2, and 3 was 18.6±5.2, 12.9±3.0, 13.8±4.4, and 11.5±4.4, respectively, and was significantly higher in group 0 (P<0.001). CONCLUSION: Total hysterectomy shortened vaginal length and compromised sexual function regardless of the technique used.

Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women.

The aim of this study is to assess vitamin D levels in eclampsia, preeclampsia and healthy pregnant women and the role of vitamin D deficiency in the etiology of preeclampsia (PE). Forty healthy pregnant women, 83 preeclamptic and 32 eclamptic pregnant women were included. Maternal and infant medical records were reviewed. Blood samples were obtained from all groups. Demographics and serum vitamin D levels were compared between the groups. No statistical differences were observed in age, gravidity, parity, weight, height and BMI between the three groups. Week of pregnancy and weight at birth in eclamptic and preeclamptic patients were lower compared to the healthy patients (P<0.001 and P<0.001, respectively). Systolic and diastolic blood pressures were higher in eclamptic (P<0.001) and preeclamptic patients (P<0.001) compared to the healthy pregnant group. The rate of cesarean section was found to be higher in preeclamptic and eclamptic patients (P<0.001). Vitamin D levels were lower in both preeclamptic and eclamptic patients compared to healthy normotensive pregnant women (P<0.001). Preeclamptic and eclamptic women were similar in terms of the data compared. Vitamin D supplementation is considered to decrease the risk of both preeclampsia and eclampsia in the patient population at risk for vitamin D deficiency.

Comparison of solifenacin and fesoterodine in treatment of overactive bladder.

OBJECTIVE: To compare the use of solifenacin and fesoterodine in treatment of overactive bladder (OAB). METHODS: This prospective study was conducted on patients diagnosed with OAB who presenting to the Department of Obstetrics and Gynecology and Urology, School of Medicine, Kahramanmaras Sütçü Imam University, Kahramanmaras, Turkey between October 2013 and August 2014. Patients were randomized into 2 groups. Group 1 (n=60) received 5 mg solifenacin per day, while Group 2 (n=59) received 4 mg fesoterodine per day. All the patients' OAB symptom scores (OABSS) in weeks 0, 4, and 12 were recorded. In addition, treatment costs and side effects of the drugs were evaluated. RESULTS: Average OABSS (score 1) was determined as: 9.5 ± 2.8 for Group 1 and 10.7 ± 1.8 for Group 2 at week 0; 2.2 ± 1.2 (Group 1) and 2.4 ± 1.3 (Group 2) at week 4 (score 2); and 1.3 ± 0.5 for Group 1 and 1.3 ± 0.6 for Group 2 at week 12 (score 3). In addition, no statistically significant difference was found between the scores (p=0.062 (score 1), p=0.464 (score 2), and p=0.527 (score 3). The discontinuation rate of medication due to its side effects was 0 (0%) for Group 1, and 6 (10.2%) for Group 2. Intragroup changes in the scores 1-2, 1-3, and 2-3 values was statistically significant in both groups (p less than 0.001). CONCLUSION: No significant difference was found between the OABSS of these 2 drugs. However, discontinuation of drugs due to side effects was more frequent in fesoterodine.

Changes in Copper, Zinc, and Malondialdehyde Levels and Superoxide Dismutase Activities in Pre-Eclamptic Pregnancies.

BACKGROUND: Preeclampsia (PE) is a hypertensive disorder that occurs in 2% to 8% of pregnancies. Although numerous studies have investigated the etiology and pathophysiology of preeclampsia, the precise pathological mechanisms remain poorly understood. Hence, in the present study malondialdehyde (MDA) levels and SOD expression, and Cu and Zn concentrations and ratios were correlated with birth weights in pregnant women with and without PE, and in non-pregnant females of reproductive age. MATERIAL AND METHODS: Malondialdehyde (MDA) levels and superoxide dismutase (SOD) activities were determined spectrophotometrically, and Cu and Zn levels were determined using atomic absorption spectrometry in serum from 42 non-pregnant women (NP), 40 healthy pregnant women (HP), and 38 pre-eclamptic pregnant (PE) women. Subsequently, Cu/Zn ratios were calculated and associations with birth weights were analyzed using Spearman correlations. RESULTS: Cu, Zn, and MDA levels and Cu/Zn ratios were significantly higher in the PE group than in the HP and NP groups, and were significantly higher in the HP than in the NP group (p<0.001 and p<0.001; respectively). In contrast, serum Zn and SOD levels were significantly lower in the PE group than in HP and NP groups, and were significantly lower in the HP group than in the NP group (p<0.001 and p<0.001; respectively). However, only Cu and Zn levels were significantly associated with fetal birth weights (r=-0.433, p<0.001). CONCLUSIONS: Serum Cu/Zn ratios may reflect vascular complications of PE, and the ensuing increases in lipid peroxidation may play important pathogenic roles.

The effect of Ramadan fasting on fetal development.

OBJECTIVE: To evaluate the effects of Ramadan fasting on fetal development and outcomes of pregnancy. METHODS: We performed this study in Antakya State Hospital of Obstetrics and Child Care, between 28 June 2014 and 27 July 2014 (during the month of Ramadan). A total of two hundred forty healthy pregnant women who were fasting during Ramadan, were included in the groups. The three groups were divided according to the trimesters. The each group was consisted of 40 healthy pregnant women with fasting and 40 healthy pregnant women without fasting. For evaluating the effects of Ramadan on fetus, ultrasonography was performed on all pregnant women in the beginning and the end of Ramadan. We used the essential parameters for the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), and umbilical artery systole/diastole (S/D) ratio. RESULTS: No significant difference was found between the two groups for the fetal age, maternal weight gain (kilogram), estimated fetal weight gain (EFWG), fetal BPP, AFI, and umbilical artery S/D ratio. On the other hand, a statistically significant increase was observed in maternal weight in the second and third trimesters and a significant increase was observed in the amniotic fluid index in second trimester. CONCLUSION: In Ramadan there was no bad fetal outcome between pregnant women with fasting and pregnant women without fasting. Pregnant women who want to be with fast, should be examined by doctors, adequately get breakfast before starting to fast and after the fasting take essential calori and hydration. More comprehensive randomized studies are needed to explain the effects of fasting on the pregnancy and fetal outcomes.

Factors affecting general sleep pattern and quality of sleep in pregnant women.

OBJECTIVE: To investigate factors affecting general sleep pattern and sleep quality in pregnant women. MATERIALDS AND METHODS: We assessed all pregnant women applied to Department of Obstetrics and Gynecology in Training and Research Hospital, School of Medicine, Kahramanmaras Sütçü Imam University between 01 January 2014 and 01 March 2014. The participants were informed prior to the study and 100 pregnant women who gave their informed consent were included in the study. Questionnaires consisting sociodemographic characteristics, pregnancy history and the Epworth sleepiness scale were applied to the patients. Factors affecting general sleep pattern and sleep quality in pregnant women were compared. RESULTS: The mean age of 100 pregnant women was 27.9 years (min=16, max=42). The mean gestational age of participants was found to be 24.8 weeks (min=5, max=40). In obstetric history, 9% of women previously had a stillbirth and also 25% of women previously had curettage performed. There were tobacco use in 6% of participants and 6% of patients previously had been to the hospital due to a sleep disorder. The mean excessive daytime sleepiness scale score of pregnant women were found to be 4.56. There were no significant difference among the patients regarding regular exercise (p=0.137), tobacco use (p=0.784), accompanying disease (p=0.437) and excessive daytime sleepiness scale score. CONCLUSION: In our study, patients who had a complaint of sleep disorder before and who were previously admitted to a health center for this problem, were also found to suffer from the same problem during pregnancy. Treatment of sleep disorders in preconception period for women planning pregnancy is important in terms of mother and the baby's health. Pregnant women should be informed about factors reducing sleep quality during pregnancy.

The effect of maternal hemoglobin concentration on fetal birth weight according to trimesters.

OBJECTIVE: To investigate the relationship between fetal birth weight and maternal hemoglobin concentrations in different trimesters. METHODS: This prospective cross-sectional study comprised 329 women, monitored and delivered between January 2013 and January 2014 in our clinic. Hemoglobin concentrations in all trimesters and all birth weights of the newborns were recorded. Comparisons and correlations were made of the maternal hemoglobin concentrations and birth weights in each trimester. RESULTS: A positive correlation was determined between fetal weight and increased first trimester maternal hemoglobin concentration (p: 0.025). No correlation was found between fetal weights and second and third trimester hemoglobin concentrations (p = 0.287, p = 0.298, respectively). When the effect of independent factors on fetal weight was investigated, it was determined that birth week and first trimester hemoglobin levels were the factors of most influence. CONCLUSIONS: Low hemoglobin concentrations in the first trimester of gestation seem to be associated with low fetal birth weights. Anemia can directly cause poor in utero fetal growth due to inadequate oxygen flow to the placental tissue or it can be an indirect indicator of maternal nutrition deficiency. In both circumstances, this study reveals that treatment of anemia before and in the early stages of pregnancy is directly correlated with better fetal outcomes.

Management of hematometrocolpos due to dysfunctional uterine bleeding following progestin use: a case report.

Hematometrocolpos is accumulation of blood in the vagina and uterine cavity due to intra-uterine hemorrhage. A 20-year-old female presented to our clinic with massive menorrhagia at menarche after progestin usage. Hematometrocolpos was detected by transabdominal ultrasonography. She was pale because of heavy bleeding for 5 days and hemoglobin level was measured as 5.1 g/dl. Initial treatment was blood transfusion and medical drug therapy. After resolution of the hematometrocolpos was shown by transabdominal ultrasound 2 days later, the patient, who was stable, was discharged without complication. Obstruction of the female genital outflow tract is rarely seen. Hematocolpos has been reported in elderly women following vaginal occlusion due to radiotherapy, vaginal fibroma and labial synechiae causing infection or inflammatory conditions. The case is presented here because of the successful management of hematometrocolpos due to massive dysfunctional uterine bleeding in a young virgin patient.