Evaluation of Intracranial Structures of Fetuses With Congenital Heart Defects.

OBJECTIVES: We classified congenital heart defects (CHDs) according to cerebral blood flow oxygenation and aimed to evaluate the effect on the size of brain structures in these fetuses. METHODS: The study which was designed retrospectively, included 28 patients with fetal CHDs and 76 patients without fetal anomalies. RESULTS: The width and length of the cavum septum pellucidum significantly increased in the CHD group (P = .002, P = .004). The biparietal diameter and z scores were significantly lower in the single ventricle (SV) (P = .006, P = .019), and the head circumference (HC) and z scores were significantly lower in the transposition of great arteries (TGA) (P = .013, P = .038). The transverse cerebellar diameter, the cerebellar HC and the cerebellar hemisphere area values were lower in the SV (P = .005, P = .017, P = .044). CONCLUSIONS: Brain structure changes are more pronounced in groups with low cerebral oxygenation, especially in the SV and the TGA.

Fetal cardiac morphology and geometry in pregnancies with class A1 and A2 gestational diabetes mellitus.

OBJECTIVE: To evaluate whether certain parameters on fetal cardiac morphology and geometry measured at 20-22 weeks of gestation differ in subsequently diagnosed gestational diabetes mellitus (GDM) pregnancies and whether these changes are associated with disease severity as indicated by class A1 and A2 GDM. METHOD: It was designed as a retrospective study. All measurements were taken between 20 and 22 weeks of gestation. We compared fetal cardiac structural measurements of 200 uncomplicated pregnancies (control group) with those of 307 GDM patients (160 of the them were regulated with diet (GDM A1) and 147 of them received insulin treatment (GDM A2) during pregnancy). GDM were diagnosed between 24-28 weeks of gestation with 75 gram (g) oral glucose tolerance test. RESULTS: The interventricular septum (IVS) was thicker in both in GDM A2 and GDM A1 than control (p < .001, p < .001), and there was statistically significant difference between GDM A2 and GDM A1 (p = .012). In both left and right wall thickness in GDM A1 and GDM A2 were remarkably higher than control group (p < .001, p < .001, p < .001, p < .001). The left and right spherical indices were higher in both GDM A1 and GDM A2 groups than controls (p = .021 and p = .028). Left and right area in GDM A1 and GDM A2 groups were significantly smaller than control groups (p < .001 and p = .001). CONCLUSION: Gestational diabetes is a common obstetric morbidity, which causes fetal cardiac structural changes. Our study shows that these changes can occur during the early weeks of pregnancy.

Comparison of cardiac morphology and function in small for gestational age fetuses and fetuses with late-onset fetal growth retardation.

OBJECTIVES: To compare cardiac structural and functional findings of fetuses with fetal growth restriction (FGR) and small for gestational age (SGA). METHODS: In this prospective cohort study, patients were classified into three groups using Delphi procedure according to fetal weight, umbilical, uterine artery Doppler and cerebroplacental ratio. Fetal cardiac ultrasonographic morphology and Doppler examination was performed to all pregnant women at 36 weeks of gestation. RESULTS: Seventy three patients were included in the study. There were one (6.7%) patient in the control group, 2 (13.3%) in the SGA group and 12 (80%) in the FGR group who needed neonatal intensive care unit (NICU) and NICU requirement was significantly higher in FGR fetuses (p<0.001). Left spherical index was found to be lower only among FGR fetuses (p=0.046). Left ventricular wall thickness was decreased and the right/left ventricular wall ratio was increased in FGR fetuses (p=0.006, p<0.001). Tricuspid/mitral valve ratio and mitral annular plane systolic excursion value was lower in FGR fetuses (p=0.034, p=0.024 respectively). Also, myocardial performance index was remarkably higher in FGR group (p=0.002). CONCLUSIONS: We detected cardiac morphological changes in cases of both SGA and FGR-more pronounced in the FGR cases. Findings related to morphological changes on the left side in FGR cases were considered secondary to volume increase in FGR cases as an indicator of a brain-protective effect. In the FGR group, both systolic and diastolic dysfunctions were detected in the left heart.

Antenatal follow-up, anesthesia management and perinatal outcomes in pregnancy with renal transplant

Objective: Due to the recent increase in the successful pregnancies after renal transplant, the number of renal transplant recipients having vaginal or cesarean delivery possibly associated with high maternal, fetal and/or neonatal risk requiring team approach increased. We aimed to evaluate antenatal follow-up, perinatal outcomes, and anesthesia management in pregnancies with renal transplantation and to compare them with the current literature. Materials and Methods: After ethics committee approval, renal transplant recipients who gave birth in our hospital between January 2010 and December 2019 were documented in this retrospective study. Demographic characteristics, comorbidities, antenatal follow-up, anesthesia management, and maternal, fetal, and neonatal outcomes were presented. Results: A total of 20 pregnant women who underwent renal transplant were identified. The mean age of the parturients was 31±5 years. The median interval from transplantation to conception was 8.15±4.8 years. Antenatal mean serum creatinine level and proteinuria were 1.48±1.39 mg/dL and 1.397±1.316 mg/dL, respectively. No allograft rejection was recorded. Comorbidities including hypertension (n=12), preeclampsia (n=6), and preterm delivery (n=10) were noted. The median gestational age was 35±3 weeks and the median newborn weight was 2.520±832 gram. There was one abortion, two pregnancy terminations, and 17 deliveries (3 vaginal and 14 cesareans). Cesarean sections (11/14; 78.6%) were mostly performed under spinal block and general anesthesia was performed in three (21.4%) women. Epidural analgesia for vaginal delivery was recorded in one parturient. Conclusion: Despite the presence of preterm delivery and comorbidities, antenatal/peripartum follow-up and analgesia/anesthesia management of renal transplant recipients revealed good perinatal outcomes.

Obstetric and long-term graft outcomes in pregnant kidney transplant recipients: A single-center experience.

BACKGROUND: Kidney transplantation (KT) is the best option for many women with end-stage renal disease desiring pregnancy. The aim of this study was to investigate obstetric and graft outcomes among KT recipient women in our center. METHODS: Maternal and fetal data were assessed in 29 pregnancies of 18 female KT recipients. Each patient was matched with two controls without pregnancy history for factors known to affect graft function. According to pre-pregnancy levels, serum creatinine and eGFR slope in the gestational and postpartum periods were calculated as percentages. RESULTS: The main maternal and fetal complications were preeclampsia (38%) and preterm births (38%), respectively. Pregnancy (odds ratio [OR]: 5.09; p = .02), proteinuria in the third trimester (OR: 5.52; p = .02), proteinuria in postpartum third months (OR: 7.4; p = .008) and stable creatinine levels in the first 6 months of pregnancy (OR: 11.25 p = .03) were associated with graft dysfunction. Postpartum first year eGFR decline (-16.8% vs. -6.7%; p = .04) and second-year eGFR decline (-18.5% vs. -8.3%; p = .04) were significantly higher in the pregnancy group than those matched controls. CONCLUSION: Pregnancy after KT is associated with high rates of maternal and fetal complications. The sustained decline of eGFR may suggest an increased risk of graft loss compared to recipients with similar clinical characteristics.

Is cervical swab an efficient method for developing a new noninvasive prenatal diagnostic test for numerical and structural chromosome anomalies?

Background/aim: Prenatal diagnosis is vital to obtain healthy generation for risky pregnancies. There have been several approaches, some of which are routinely applied in clinics to evaluate the possible prenatal deficiencies and/or diseases. In the present study, we aimed to isolate the fetal cells from endocervical samples and try to identify possible anomalies which were proved by Amniocentesis (AS) and chorionic villus sampling (CVS) methods. Materials and methods: Endoservical specimens were collected from 100 pregnant women. Cells were separated in parallel by fluorescence-activated cell sorting (FACS) and magnetic-activated cell sorting (MACS) using human leukocyte antigen (HLA) G233 and placental alkaline phosphatase (PLAP) antibodies. CMA (comprehensive meta-analysis) were carried out and male fetuses were confirmed with Sex determining region Y (SRY) amplification. Results: The percent of HLA G233 and placental and placental alkaline phosphatase (PLAP) positive cells were 4.55% and 84.59%, respectively. The percent of cells positive for both markers was 14.75%. CMA analyses were not informative. (SRY) was amplified in 67% of the samples. Conclusion: However, the success rate of the both cell sorting and scanning of DNA anomalies by aCGH and/or RT-PCR was limited, preventing the applicability of this proposal in the clinics. Still, the success of the proposed method depends on the development of the novel fetal cell-specific antibodies and the improvements in the sorting systems.

A cross-sectional study in non-anaemic pregnant women in Turkey to assess necessity of iron supplementation.

BACKGROUND: Iron deficiency is the most common cause of anaemia in pregnancy. Guidelines recommend different threshold values for iron supplementation. AIMS: To determine trimester-specific reference ranges for haematological values (haemoglobin, hematocrit and ferritin) in healthy pregnant women who have not used any iron supplementation during pregnancy to guide future iron treatment. METHODS: A prospective cross-sectional study was carried out on 168 pregnant women aged 18-45 years, with singleton pregnancies in the first trimester, Hb ≥ 11 g/dL and ferritin ≥ 12 µg/L, and not using iron supplementation. Multiple pregnancies, pregnancies with obstetric complications and smokers were excluded from the study. Mean haemoglobin (Hb) and ferritin values, trimester-specific reference ranges and percentile values of Hb and ferritin were determined for each trimester. The normality of the variables was tested using the Kolmogorov-Smirnov test. RESULTS: Mean Hb decreased significantly between trimesters from 12.6 to 11.9 and then 11.5 g/dL. In addition, Hb, hematocrit and ferritin decreased significantly from the first to the second trimester (P < 0.001 for all) but stayed comparable between the second and third trimesters (P = 0.246, P = 0.575, P = 0.408, respectively). The lower reference value for Hb was calculated as 10.67, 10.08 and 9.18 g/dL for 10-14, 20-24 and 30-34 gestational weeks respectively. CONCLUSION: This pioneer study allows us to understand that iron supplementation may not be needed as any decrease is due to physiological haemodilution. These results may prevent unnecessary iron prescription during pregnancy.

Prevalences of subclinical and overt hypothyroidism with universal screening in early pregnancy.

PURPOSE: To reveal the prevalence of subclinical and overt hypothyroidism among Turkish population during pregnancy. Also to investigate the prevalence of hypothyroidism using ATA 2017 criteria. METHODS: This is a cross-sectional study. Patients were consisted of 1416 consecutive pregnant women who were universally screened for thyroid disease in their first trimester between 2013 and 2015. Thyroid-stimulating hormone (TSH) and free T4 (FT4) levels were analyzed during the first antenatal visit (before 12 weeks of gestation). We compared different cutoffs for TSH. We further determined the 2.5th and 97.5th percentiles for TSH and FT4. RESULTS: Initially, the cutoff of 2.5 IU/ml was selected. Accordingly, 305 women (22.3%) had subclinical hypothyroidism and 22 (1.6%) was diagnosed with overt hypothyroidism. When the cutoff was increased to 4 IU/ml, only 40 (2.9%) women were diagnosed with hypothyroidism. Prevalences of overt hypothyroidism and subclinical hypothyroidism were 0.6% and 2.3%, respectively. CONCLUSION: Universal screening of pregnant women with TSH, using the 2.5 mIU/L cutoff; one in four women was found to be a candidate for thyroid hormone replacement in our cohort. When the cutoff was determined to be 4 mIU/L, prevalence of hypothyroidism decreased approximately 10 times.

Fetal intraabdominal umbilical vein varix: antenatal diagnosis and management.

OBJECTIVE: Fetal intraabdominal vein varix (FIUVV) is a sonographic finding with unknown prevalence. We aimed to point out this particular abnormality and review possible associations and complications which may arise. METHOD: We performed an unrestricted literature search via PubMed and included all cases diagnosed with FIUVV. CASE PRESENTATION: A 24-year-old, gravida 1 para 0 woman was referred to our clinic with possible diagnosis of FIUVV. We confirmed the diagnosis and detailed sonogram was normal. Beyond the gestational age of 32 weeks, intruterine growth restriction became evident. Close fetal surveillance was performed. We did not detect any thrombus formation within the varix or signs of cardiac decompansation during these visits. Delivery was planned after completion of 37 weeks. A healthy baby weighing 2100 g was delivered and discharged without any complications. CONCLUSION: It is generally accepted that fetal anatomic survey is necessary after detection of FIUVV. Karyotyping could be performed for those cases associated with additional structural malformations. Close surveillance of fetal well being and growth is important. Possibility of thrombus formation within the varix should be kept in mind.

Prevalence of gestational diabetes mellitus evaluated by universal screening with a 75-g, 2-hour oral glucose tolerance test and IADPSG criteria.

OBJECTIVE: To determine the prevalence of gestational diabetes mellitus (GDM) and its association with maternal age among Turkish women diagnosed by International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. METHODS: A cross-sectional study was conducted in 2013-2015 among non-diabetic pregnant women aged 18-49 years who were universally screened for GDM by IADPSG criteria. The percentage of women meeting each diagnostic threshold and the prevalence of GDM by age group were calculated. Linear trends were evaluated by logistic regression. RESULTS: Among 1434 women screened, 159 (11.1%, 95% confidence interval 9.5%-12.7%) were diagnosed with GDM; eleven of these women had been diagnosed according to a fasting glucose level in the first trimester. The prevalence of GDM was 6.6% (10/151), 7.3% (37/507), 8.8% (42/479), 16.7% (45/270), and 35.2% (25/71) among women aged younger than 25, 25-29, 30-34, 35-39, and 40 years or older, respectively. GDM prevalence increased with age (P<0.001). The numbers of women diagnosed with GDM in the second trimester who exceeded one, two, and three thresholds of the 2-hour oral glucose tolerance test were 66 (44.6%), 52 (35.1%), and 30 (20.3%), respectively. CONCLUSION: Prevalence of GDM was correlated with maternal age. Most women diagnosed in the second trimester exceeded the threshold at only one of the three timepoints.

Retrospective analysis of maternal, fetal, and neonatal outcomesof intrahepatic cholestasis of pregnancy at Gazi University.

BACKGROUND/AIM: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period. MATERIALS AND METHODS: After ethics committee approval, data from 1 January to 31 December 2015 were collected to identify parturients with ICP. RESULTS: Ten out of 37 patients underwent normal spontaneous vaginal delivery (NSVD), and the remaining 27 parturients underwent cesarean section (CS). Five of 27 parturients underwent nonelective cesarean section, while 22 had elective cesarean delivery. As for NSVD deliveries, only one parturient received combined spinal and epidural anesthesia (CSE) for labor. Neuraxial (n = 22 for spinal and n = 1 for CSE) and general anesthesia (n = 4) rates for CSs were 85% and 15%, respectively. Approximately 96% of neuraxial anesthesia choices were spinal anesthesia. Nearly 18.5% of CSs were not elective. Adverse outcomes included 2 preterm births, 2 preterm labors, 2 newborns with hepatitis, and one perinatal fetal death. CONCLUSION: Parturients with ICP who had normal coagulation parameters despite increased liver enzymes preoperatively underwent cesarean delivery under spinal anesthesia without complication. Although maternal outcomes were generally positive, adverse fetal and neonatal outcomes are more likely to occur, particularly in cases with severe ICP.

The role of TWIST, SERPINB5, and SERPIN1 genes in uterine leiomyomas.

OBJECTIVE: The aim of this study is investigate the role of the Twist homolog 1 (TWIST), serine peptidase inhibitor (SERPINB5), and plasminogen activator inhibitor 1 (SERPIN1) genes in uterine leiomyoma etiopathogenesis. MATERIAL AND METHODS: Twelve patients, aged between 39 and 58, and had a hysterectomy, were included in the study. The size of the leiomyomas was between 20 and 130 mm based on gross pathology after hysterectomy. Tissue samples were obtained from normal myometrium and leiomyoma (1 cm(3)) tissue of the uterus of the patients and stored at -86°C. Samples were divided to two groups after histopathological evaluation of the uterus: normal myometrial tissues as control group (Group 1) and leiomyoma tissue as the study group (Group 2). The TWIST, SERPINB5, and SERPIN1 genes were studied for uterine leiomyoma etiopathogenesis. RESULTS: TWIST gene expression was significantly higher in the uterine leiomyoma tissue (p<0.001). SERPINB5 and SERPIN1 gene expression was decreased in the uterine leiomyoma tissue, but the differences were not statistically significant. CONCLUSION: TWIST gene activity is significantly increased in leiomyoma tissue when compared to normal myometrium. In spite of the fact that the development of uterine leiomyomas is estrogen- and progesterone-dependent, myometrial cells could be triggered by the TWIST gene for uterine leiomyoma development.

The effect of maternal serum sFAS/sFASL system on etiopathogenesis of preeclampsia and severe preeclampsia.

Abstract Objective: The objective of the study is to evaluate whether there is a difference in serum soluble free acid synthesis (sFas)/sFasL levels between patients with preeclampsia, severe preeclampsia and normal healthy pregnancy. Methods: This is a case control study comparing serum sFas and sFasL concentrations in patients with mild preeclampsia (n=26) and patients with severe preeclampsia (n=22) in the second and the third trimester pregnancy to normal healthy pregnant controls (n=21). Maternal serum sFas and sFasL was collected at the time of diagnosis of preeclampsia or severe preeclampsia and obtained using ELISA assay. The control group's characteristics of gestational age, maternal age, BMI, parity, smoking status, and history of hypertension were matched with the study groups. While evaluating the results, mean±SD for quantitaive data, the statistical methods of Kruskal Wallis and Mann-Whitney U tests for comparements between groups were used. Results: Maternal mean serum levels of sFas and sFasL were evaluated and statistical difference was not found in both preeclamptic pregnancies (846,65±96,74pg/ml and 17,48±15.60 pg/ml) and severe preeclamptic pregnancies ( 864,29±106,30 pg/ml and 99,92±336,69 pg/ml) versus control group (830,58±127,21 pg/ml and 30,13±22,69 pg/ml). For all demographic characteristics, there was also no statistical difference between study groups and control group. Conclusions: The finding of this study showed no difference in maternal serum levels of sFas and sFasL in preeclampsia and severe preeclampcia versus control group.

Evaluation of adrenomedullin and endothelin-1: are they factors in the adaptation of maternal vascular system in normotensive pregnancy.

INTRODUCTION: The aim of our study was to analyse the role of adrenomedullin (AM) and endothelin-1 (ET-1) in the adaptation of the maternal vascular system in normotensive pregnancy. METHODS: Twenty-eight pregnant women, who were normotensive throughout the duration of their pregnancy, were recruited into the study. Plasma levels of AM and ET-1 at each trimester were measured and the AM/ET-1 ratio was calculated. RESULTS: Our experiment showed a significant decrease in plasma concentrations of AM in the first trimester for the study group (n=28) compared with the non-pregnant control group (n=16). There was also a significant decrease in plasma concentrations of ET-1 in all three trimesters (P<0.05) and a significant increase in the AM/ET-1 ratio in all three trimesters (P<0.05) for the study group compared with the control group. CONCLUSION: An alteration in vascular equilibrium between AM and ET-1, favouring AM, may be a reason why the physiological adaptation of the maternal vascular system to pregnancy occurs during normotensive pregnancy.

Evaluation of hormone replacement therapy which may have an adrenomedullin-mediated protective effect on cardiovascular disorders.

BACKGROUND AND AIMS: This study aimed to determine whether there is an adrenomedullin (AM)-mediated protective effect of postmenopausal estrogen/progestin therapy (HRT) against cardiovascular disorders. METHODS: A total of 22 post-menopausal women without hysterectomy undergoing postmenopausal symptoms (aged 43-52) were treated with conjugated equine estrogen (0.625 mg/die) plus medroxyprogesterone acetate (2.5 mg/die) for six months. The flow velocity of the right middle cerebral artery [measured as resistance index (RI) and pulsatility index (PI)], plasma levels of adrenomedullin and endothelin- 1 (ET-1), mean baseline ratio of AM to ET-1, and lipid profiles were assessed before and after HRT. RESULTS: A statistically significant difference was found for triglycerides, total cholesterol, AM/ET-1 ratio and right middle cerebral artery PI (p<0.05), without any significant differences in HDL, LDL, AM, ET-1, systolic blood pressure, diastolic blood pressure, a right middle cerebral artery RI (p>0.05) between pre- and post- HRT. CONCLUSIONS: Adrenomedullin may be added to other vasoactive peptides as a new potential candidate for HRT-mediated vascular protection. The ratio of AM/ET-1 vs AM or ET-1 alone may be a useful biological marker of this protection.

Analysis of heavy metals in the endometrial tissue using electron microscope.

OBJECTIVE: This study was done to estimate whether heavy metals in the air may affect endometrial chemical composition. MATERIALS AND METHODS: A total of 30 albino Wistar rats were employed and randomly divided into three groups. The rats of Group 1 and 2 were acutely and sub-chronically exposed to the gas form of heavy metals, respectively. Group 3 was used as a control group. Endometrial tissue worth of heavy metals of the groups was measured in through using scanning electron microscope. RESULTS: A statistically no significant difference was found for endometrial chemical composition of all of the heavy metals (chrome, manganese, iron, cobalt, nickel, zinc and lead) between group 1 and 2 (p>0.05). On the other hand, there was statistically significant difference for all of the heavy metals between group 1 and group 3 (p<0.05), while there was statistically significant difference for chrome, manganese, iron, cobalt and nickel (p<0.05), but zinc and lead (p>0.05) between group 2 and 3. CONCLUSION: Air pollutants of Pb and Zn resulting mostly from combustion of fossil fuels and certain special industrial process in Kirikkale may be a risk factor for the high pregnancy loses by changing endometrial homeostasis.

Examination of the rescue effects of folic acid on derangement of the tubo-ovarian ultrastructural architecture caused by methotrexate.

The purpose of this examination was to observe the effects of folic acid (FA) on methotrexate (MTX)-induced derangements in the fallopian tubes. Investigators in this study sought to explore whether MTX-induced dysfunction in the fallopian tubes would be lessened by the addition of FA to MTX treatment. For this study, 18 albino Wistar rats were randomly divided into 6 groups, each of which comprised 3 rats; 0.1 mg/kg FA, 1 mg/kg MTX + 0.1 mg/kg FA, 5 mg/kg MTX + 0.1 mg/kg FA, 1 mg/kg MTX, and 5 mg/kg MTX were given to groups 2, 3, 4, 5,and 6, respectively; group 1 was the control group. After MTX injection, fallop-ian tube samples from all groups were prepared for examination under electron microscopy. The findings observed in groups 1 and 2 were similar. The level of cellular destruction was greater with the higher doses of MTX without FA; in particular, loss of cilia in the epithelium was prominent in groups 5 and 6. However, there was less cellular destruction observed in groups 3 and 4 than in groups 5 and 6. As a result, the addition of FA should not be overlooked, even when a single-dose MTX regimen is chosen for the treatment of patients with unruptured ectopic pregnancy.

Assessment of DNA damage in postmenopausal women under osteoporosis therapy.

OBJECTIVE: The following study was designed to examine possible DNA damage levels in peripheral blood leukocytes, using the alkaline Comet assay, isolated from postmenopausal women undergoing osteoporosis treatment. STUDY DESIGN: Thirty-two postmenopausal women were randomized into two groups of 16. A dosage of 2.5 mg/day of tibolone (Livial) and 10mg/day of alendronate sodium (Fosamax) were administered to Group 1 over a 12-month period while Group 2 took 10 mg/day of alendronate alone over the same period. The control group consisted of 16 postmenopausal women who did not receive any treatment. Genotoxicity was assessed by the standard method of alkaline Comet assay. RESULTS: When the results of the study groups were compared with those of the control group, significant differences in terms of DNA damage levels were found (p<0.05). However, no difference was detected between Groups 1 and 2 (p>0.05). CONCLUSION: Although, no statistical difference in terms of DNA damage levels between tibolone plus alendronate as opposed to alendronate alone was found, an increase in DNA damage levels was observed in Groups 1 and 2 compared with the control group. Consequently, it can be asserted that the frequency of DNA damage in postmenopausal women with osteoporosis increases under alendronate treatment with or without tibolone.