Investigation of Serum Cardiotrophin-1 Concentrations in Pregnant Women with Gestational Diabetes Mellitus.

OBJECTIVE: We aimed to investigate cardiotrophin-1 (CT-1) concentrations in the serum of pregnant women with gestational diabetes mellitus (GDM). MATERIALS AND METHODS: This prospective non-interventional cohort study was conducted with 160 pregnant women who applied to the Umraniye Training and Research Hospital, Department of Obstetrics and Gynecology between October 2022 and May 2023. The GDM group was formed from 80 pregnant women who were diagnosed with GDM according to the 75-g OGTT. The control group consisted of 80 healthy pregnant women who were matched with the GDM group in terms of age and body mass index and had a normal 75-g OGTT result. Two groups were compared in terms of maternal serum CT-1 concentrations. RESULTS: Both groups were similar in terms of demographic features and the gestational week at blood sampling for CT-1 (p>0.05 for each). The mean maternal serum CT-1 concentration was found to be 1420.9 pg/ml in the GDM group, while it was determined as 1455 pg/ml in the control group (p=0.738). When the GDM and control groups were divided into two subgroups, normal weight and overweight according to the participants' BMI, serum CT-1 concentrations were found to be similar in these four groups (p=0.084). When the GDM group was divided into two groups of diet-only and the insulin-using group for blood glucose regulation and compared with the control group, the three groups were also similar in terms of serum CT-1 concentrations (p=0.189). CONCLUSION: CT-1 is an adipokine involved in the regulation of glucose metabolism and has been suggested to be associated with the pathophysiology of diabetes mellitus. In this study, serum CT-1 concentrations were found to be similar in the group with GDM and the group with normal glucose tolerance. Whether CT-1 contributes to the development of GDM is currently unclear and requires further investigation.

Investigation of maternal serum cardiotrophin-1 concentrations in pregnant women with preeclampsia; a prospective case-control study.

OBJECTIVE: We aimed to investigate the cardiotrophin-1 (CT-1) concentrations in the serum of pregnant women with preeclampsia. METHODS: This cross-sectional study was conducted with 88 pregnant women who applied to the Umraniye Training and Research Hospital Gynecology and Obstetrics Clinic between May 2022 and September 2022. The preeclampsia group consisted of 44 pregnant women diagnosed with preeclampsia, and the control group consisted of 44 healthy pregnant women matched with the preeclampsia group in terms of age and body mass index. Demographic characteristics, ultrasound and laboratory findings, perinatal outcomes, and maternal serum CT-1 concentrations were recorded. RESULTS: Both groups were similar in terms of demographic features and the gestational week at blood sampling for CT-1. Preeclampsia and control groups were compared in terms of maternal serum CT-1 concentrations and no significant difference was found between the two groups (2061.4 pg/ml, 2168.5 pg/ml, respectively, p = .516). The preeclampsia group was divided into subgroups as mild and severe preeclampsia according to the severity of the disease and early-onset and late-onset preeclampsia according to the time of onset and compared with the control group in terms of maternal serum CT-1 concentration, no significant difference was found between the groups (p > .005, for all). CONCLUSION: The serum CT-1 concentration of women whose pregnancy was complicated with preeclampsia was found to be similar to that of healthy controls. Although it has been shown in the literature that high serum CT-1 concentrations are associated with hypertensive heart diseases, its role in the pathophysiology of preeclampsia remains unclear.

Outcomes of a GnRH Agonist Trigger Following a GnRH Antagonist or Flexible Progestin-Primed Ovarian Stimulation Cycle.

A suggested explanation for the pituitary-suppressive effects of progestin-primed ovarian stimulation cycles (PPOS) is pituitary luteinizing hormone (LH) depletion with progestin exposure during the follicular phase. The GnRH agonist (GnRHa) trigger releases endogenous LH from the pituitary, and if the LH depletion theory is correct, the response to the agonist trigger would be dampened in PPOS cycles. In this study, we compared the performance of the GnRHa trigger after PPOS and GnRH antagonist ovarian stimulation cycles. All women who underwent ovarian stimulation with the GnRH antagonist or flexible PPOS (fPPOS) and received a GnRH agonist trigger were eligible for inclusion. Outcomes included number of metaphase-II (MII) oocytes retrieved per cycle, rates of empty follicle syndrome, maturation, fertilization, blastulation, and cumulative clinical pregnancy per stimulation cycle. During the screening period, there were 166 antagonists and 58 fPPOS cycles triggered with a GnRH agonist. Groups were matched for potential confounders using propensity score matching. Progestin-downregulated cycles had 19% high mature oocyte yield (median: 14 vs. 19 MII oocytes, P = 0.03). Cumulative ongoing pregnancy or live birth rates were estimated after matching for transferred embryo count, and rates were similar between GnRH antagonist and fPPOS group (57.0% vs. 62.1%, P = 0.68). However, the number of remaining blastocysts was higher in the fPPOS group (median: 5.0 vs. 6.0, P < 0.001). LH levels were higher in fPPOS cycles compared to GnRH antagonist cycles up to the trigger day (P < 0.001). After the GnRHa trigger, fPPOS cycles were associated with a steeper LH surge compared with antagonist cycles (P = 0.02). Higher endogenous gonadotropin levels through the stimulation period and an LH surge of higher magnitude following a GnRHa trigger suggest a milder pituitary suppression by fPPOS, which needs to be confirmed in larger samples. It appears that progestins do not deplete pituitary LH reserves and a GnRHa trigger is usable after PPOS in women with high ovarian reserve.

The Comparison of Fixed and Flexible Progestin Primed Ovarian Stimulation on Mature Oocyte Yield in Women at Risk of Premature Ovarian Insufficiency.

While gonadotrophin releasing hormone (GnRH) antagonists have been the standard of pituitary suppression during ovarian stimulation for ART, progestin primed ovarian stimulation (PPOS) has emerged as an alternative. Progestins can be started simultaneously with gonadotrophins (fixed PPOS) or later in the cycle depending on follicle growth (flexible PPOS). However, the flexible and fixed PPOS regimens have not been directly compared as of yet. This was a retrospective cohort study including women with diminished ovarian reserve who underwent oocyte cryopreservation. All women underwent ovarian stimulation with a fixed 300 IU daily dose of FSH. The primary outcome was the number of MII oocyte retrieved per cycle. Secondary outcome measures included the incidence of premature LH surge (>10ng/mL) and number of follicles larger than 14mm on the day of maturation trigger. During the screening period 2 out of 97 cycles were cancelled before oocyte retrieval, one in each group yielding an overall cancelation rate of 2%. Among women who had oocyte retrieval, 65 underwent flexible and 30 fixed PPOS. At baseline women on fixed and flexible PPOS had similar age (mean difference: -2.17 years, 95% CI: -4.46 to 0.11) and serum AMH levels (mean difference: 0.10 ng/mL, 95% CI: -0.24 to 0.47). Slight imbalances between the groups were rectified with propensity score matching using age and AMH levels. The incidence of premature LH surge (RR: 1.47, 95% CI: 0.51 - 5.27, p = 0.50), follicle count larger than 14mm on hCG day (RR: 1.14, 95% CI: 0.93 - 1.42, p = 0.22), number of MII oocytes retrieved (RR: 0.95, 95% CI: 0.79 - 1.15, p = 0.61) were similar between flexible and fixed PPOS. The rate of no oocyte retrieval was same between the groups (0.0% both) but no formal estimation was possible. Flexible and fixed PPOS regimens had no appreciable differences regarding MII oocyte yield and the incidence of premature LH surges. Cycles without oocyte retrieval were rare in both groups and ultrasonographic parameters of gonadotropin response were similar. Our study suggests the performances of either progestin regimen are comparable in this group of women.

A new operation technique for uterine prolapse: Vaginally-assisted laparoscopic sacrohysteropexy.

OBJECTIVE: To describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH). MATERIALS AND METHODS: Thirty-three women with stage 3 or more uterine prolapse underwent VALSH operation. Patients were followed up for 12 months for mesh-related complications and improvements of symptoms. The operation had three sections; 1st laparoscopic, 2nd vaginal, 3rd laparoscopic. RESULTS: The mean age, gravidity, and parity of the study population were 46.5 years (range, 25-68 years), 4.3 (1-9), and 2.9 (1-6), respectively. The mean duration of operation was 59.5 min (range, 20-120 min). There were significant differences between the pre- and post-operative values of pelvic organ prolapse quantification parameters, which were favorable in the latter evaluation (p<0.001); total vaginal length was preserved after surgery (p>0.05). CONCLUSION: VALSH is a safe and minimally-invasive procedure in uterovaginal prolapse, with favorable anatomic and functional outcomes at 12 months post-operatively.

Use of cervicovaginal PAMG-1 protein as a predictor of delivery within seven days in pregnancies at risk of premature birth.

BACKGROUND: To investigate the utility of vaginal placental alpha microglobulin-1 (PAMG-1) protein as a predictor of preterm delivery within 7 days in pregnancies at risk of premature birth. METHODS: This prospective study was performed in women at risk of premature birth. The levels of vaginal PAMG-1 and foetal fibronectin (fFN) and the transvaginal cervical length measurement (CLM) were investigated and compared. RESULTS: Seventy-two pregnant women were included in this study. The sensitivities of PAMG-1, fFN and CLM were 73.3, 73.6%, and 52.9%, respectively, while the specificities of PAMG-1, fFN and CLM were 92.9%, 94.3%, and 90.9%, respectively. The positive predictive values of PAMG-1, fFN and CLM were 73.3%, 82.3%, and 64.2%, respectively, and the negative predictive values of PAMG-1, fFN and CLM were 92.9%, 90.9%, and 86.2%, respectively. CONCLUSION: The diagnostic accuracy of PAMG-1 is similar to that of fFN in terms of preterm labour detection within 7 days.