The analysis of pregnancies terminated before and after the limit of viability: A medicolegal view.

PURPOSE: In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. MATERIAL AND METHOD: The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10-22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. RESULTS: A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3-21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4-26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1-25 + 4], the difference was not found to be statistically significant. CONCLUSION: Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries.

Investigation of Demodex folliculorum frequency in patients with polycystic ovary syndrome

Abstract: Background: Background: Demodex mites are acari that reside in the pilosebaceous unit of the skin and have been associated with skin disorders. Objective: The objective of this study was to investigate the prevalence of Demodex folliculorum (D. folliculorum) mites in polycystic ovary syndrome patients as well as to examine the relationship between Demodex infestation and the presence of acne and oily or dry skin types in polycystic ovary syndrome patients. Methods: 41 polycystic ovary syndrome patients and 47 non-polycystic ovary syndrome control subjects were enrolled in the study. polycystic ovary syndrome was diagnosed according to the revised 2003 ESHRE/ASRM polycystic ovary syndrome Consensus Workshop Group diagnostic criteria. Microscopic examination of D. folliculorum mites was carried out by standardized skin surface biopsy. The result was considered positive when there were more than 5 mites per cm2. Results: D. folliculorum was positive in 53.7% of the polycystic ovary syndrome patients and 31.9% of the non-polycystic ovary syndrome group (p=0.052). Demodex positivity was significantly associated with acne (p=0.003) and oily skin (p=0.005) in the polycystic ovary syndrome patients but not in the controls. Study limitation: Our study is limited by the relatively small number of subjects and the observational nature of the study design. Conclusion: Demodex mites might have a role in acne pathogenesis in patients with polycystic ovary syndrome. Anti-Demodex treatment may increase the response to treatment of acne. Further studies are indicated.

Investigation of Demodex folliculorum frequency in patients with polycystic ovary syndrome.

BACKGROUND: Background: Demodex mites are acari that reside in the pilosebaceous unit of the skin and have been associated with skin disorders. OBJECTIVE: The objective of this study was to investigate the prevalence of Demodex folliculorum (D. folliculorum) mites in polycystic ovary syndrome patients as well as to examine the relationship between Demodex infestation and the presence of acne and oily or dry skin types in polycystic ovary syndrome patients. METHODS: 41 polycystic ovary syndrome patients and 47 non-polycystic ovary syndrome control subjects were enrolled in the study. polycystic ovary syndrome was diagnosed according to the revised 2003 ESHRE/ASRM polycystic ovary syndrome Consensus Workshop Group diagnostic criteria. Microscopic examination of D. folliculorum mites was carried out by standardized skin surface biopsy. The result was considered positive when there were more than 5 mites per cm2. RESULTS: D. folliculorum was positive in 53.7% of the polycystic ovary syndrome patients and 31.9% of the non-polycystic ovary syndrome group (p=0.052). Demodex positivity was significantly associated with acne (p=0.003) and oily skin (p=0.005) in the polycystic ovary syndrome patients but not in the controls. STUDY LIMITATION: Our study is limited by the relatively small number of subjects and the observational nature of the study design. CONCLUSION: Demodex mites might have a role in acne pathogenesis in patients with polycystic ovary syndrome. Anti-Demodex treatment may increase the response to treatment of acne. Further studies are indicated.

Hyperemesis gravidarum and its relation with maternal body fat composition.

The objective of this study was to determine if maternal body fat composition and body mass index were associated with hyperemesis gravidarum (HG) in the first trimester of pregnancy. Healthy pregnant women (n = 30) without nausea and vomiting (control group) and women with HG (n = 54; study group), all with singleton pregnancy at 6-14 weeks gestational age, were included. Body mass index was measured before and during pregnancy. Visceral adipose tissue (VAT) and subcutaneous fat thickness were measured during pregnancy. Comparison of the groups revealed that VAT and pre-pregnancy body mass index but not subcutaneous fat thickness were significantly higher in the HG group versus controls. VAT and pre-pregnancy body mass index predicted 83.8% and 67.1% of HG cases, respectively. VAT and pre-pregnancy body mass index were correlated with the development of hyperemesis gravidrum and hence could be considered as predictive markers for HG.

Nail alterations during pregnancy: a clinical study.

During pregnancy, cutaneous and appendageal alterations manifest and may cause concern in the subject. The nails may be affected by pregnancy. This study investigated the frequency and nature of nail changes occurring during pregnancy in 312 healthy, 18-40-year-old pregnant women in gestation weeks 16-40. After a routine obstetric examination at the obstetrics and gynecology clinic at the study institution, all subjects submitted to an examination of all fingernails and toenails. Only nail alterations that had developed during pregnancy were recorded. Any nail changes that had occurred before the start of gestation were not considered. Data were presented as percentages. The Shapiro-Wilk and chi-squared tests were used to make categorical comparisons. A P-value of < 0.05 was considered to indicate statistical significance. No nail pathologies were detected in 116 (37.2%) of the 312 subjects. The most commonly found nail change was leukonychia (24.4%). Ingrown toenail (9.0%) and onychoschizia (9.0%) represented the second most common nail changes. Rapid nail growth and subungual hyperkeratosis were observed in 6.7% and 4.2%, respectively, of subjects. When the alterations were evaluated according to gestational age, the most common nail pathology was leukonychia at both 14-28 weeks (16.3%) and 29-42 weeks (27.4%) of pregnancy. Leukonychia, onychoschizia, onycholysis, and brittle nail pathologies were frequently observed at 29-42 weeks of pregnancy (P = 0.047). A large proportion of nail changes that occur during pregnancy are benign and do not require treatment. However, these changes may cause significant cosmetic stress in women.

Levels of thrombin-activatable fibrinolysis inhibitor and platelet-activating factor in recurrent pregnancy loss patients.

OBJECTIVE: The aim of this study was to investigate factors associated with thrombosis that may contribute to recurrent pregnancy loss (habitual abortion), specifically differences in serum levels of platelet-activating factor and thrombin-activatable fibrinolysis inhibitor (carboxypeptidase B2) between women with a history of recurrent miscarriage and those with no recurrent miscarriage history. MATERIALS AND METHODS: A case-controlled, prospective study design was adopted to compare women with a history of two or more first-trimester miscarriages (n = 42) with those with no history of recurrent miscarriage (n = 36). Participants were recruited from the Department of Obstetrics and Gynecology of Turgut Ozal University Hospital. Platelet-activating factor and thrombin-activatable fibrinolysis inhibitor levels in serum samples were measured by an enzyme-linked immunosorbent assay. RESULTS: Platelet-activating factor levels were significantly (p = 0.018) higher in the recurrent miscarriage group. There was no difference in levels of thrombin-activatable fibrinolysis inhibitor expression between the groups. CONCLUSION: Platelet-activating factor is significantly higher in serum of patients with a history of recurrent miscarriage than in those without such a history, with potential implications for placental function and fetal growth, which could be relevant to miscarriage recurrence. Larger studies are indicated to further examine these findings.

Adipokine, adropin and endothelin-1 levels in intrauterine growth restricted neonates and their mothers.

Intrauterine growth retardation/restriction (IUGR) is associated with fetal malnutrition. It has consequences for later life including increased incidence of obesity, diabetes mellitus, cardiovascular disease (CVD), and metabolic syndrome. Adipokines (adiponectin and leptin), adropin, and endothelin-1 are associated with obesity and metabolic syndrome regulation. Intrauterine changes in these mediators could affect programming of later adult obesity and metabolic syndrome. Our objectives were to compare the levels of these mediators in both cord and maternal blood between IUGR pregnancies and control, healthy pregnancies, and to study the correlation of adipokines with adropin and endothelin-1 in maternal and cord blood in IUGR pregnancies as well as in healthy control pregnancies. Maternal and cord blood samples were taken from 16 women with IUGR pregnancies and 16 women with healthy pregnancies. Serum levels of leptin, adiponectin, adropin, and endothelin-1 were measured by ELISA. Maternal blood adropin levels were significantly lower in the IUGR group than in the control group; the other mediators did not differ significantly. There was a positive correlation between maternal blood adropin and endothelin levels. (r=0.731, P=0.001) in the control but not the IUGR group. Cord blood adropin and adiponectin levels were significantly lower in the IUGR group compared with the control group, while leptin or endothelin-1 did not differ significantly. There was a negative correlation between adropin and leptin (r=-0.704, P=0.001) in the IUGR but not the control group cord blood. There were also positive correlations between endothelin and adropin for both groups (r=0.594, P=0.006; r=0.560, P=0.010, respectively); to the best of our knowledge, this is the first report of such a correlation. Differences in fetal expression of adropin and adiponectin in IUGR could influence programming of obesity, metabolic syndrome, diabetes, and CVD in later life.

Is There a Relationship Between Pelvic Organ Prolapse and Tissue Fibrillin-1 Levels?

PURPOSE: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. METHODS: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. RESULTS: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). CONCLUSIONS: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.

Effects of curcumin on ovarian ischemia-reperfusion injury in a rat model.

Ischemia-reperfusion injury is a significant problem following reperfusion treatment for ovarian torsion. It is generally caused by reactive oxygen species-induced damage. Antioxidant agents, such as curcumin, may protect ovaries from this adverse effect. The aim of the present randomized, controlled study was to evaluate the short-term protective effect of curcumin on a rat model of ovarian ischemia-reperfusion injury. A total of 30 female Wistar albino rats, weighing 160-230 g, were divided into 2 groups depending upon the time of unilateral, left ovary ischemia/reperfusion (group 1, 2 h ischemia/2 h reperfusion and group 2, 4 h ischemia/4 h reperfusion). These groups were subdivided into 3 subgroups (sham, control and curcumin). The sham subgroups were not subjected to ischemia/reperfusion. Control and curcumin subgroups were performed under ischemia for 2 h plus 2 h reperfusion or 4 h ischemia plus 4 h reperfusion. Curcumin, 200 mg/kg, was intraperitoneally administered simultaneously with reperfusion to the curcumin subgroups. Serum nitric oxide (NO), NO synthase (NOS), xanthine oxidase (XO), total antioxidant status (TAS), total oxidant status (TOS) and histological scores were measured and compared between subgroups. For group 1, no significant differences were observed between NO, NOS, XO, TAS or TOS. The left ovary histological grade was significantly higher in the control and curcumin subgroups compared with the sham subgroup (P=0.036). For group 2, TOS was significantly higher in the control group compared with the sham and curcumin groups (P=0.023). However, TAS was also significantly higher in the control subgroup compared with the other 2 subgroups (P=0.005). Left ovary histological grade was significantly higher in the control and curcumin subgroups compared with the sham subgroup (P=0.038). No significant differences were observed between NO, NOS or XO between the group 2 subgroups. The results showed that curcumin exerted no major significant protective effect on ischemia-reperfusion injury in the rat ovary.

Problems of modern approaches to management of early pregnancy failure.

In the last 20 to 30 years, early diagnosis of pregnancy has markedly decreased ectopic pregnancy-related maternal mortality, and the necessity for surgical treatment. With modern approaches in the treatment of ectopic pregnancy, surgical therapy has been replaced by medical therapy and medical treatment by spontaneous follow-up in appropriate cases. However, this current trend has led to some problems, including the maximization of ultrasonographic interpretations, misunderstandings in serial human koryonik gonadotropin hormon measurements, and complications due to inappropriate methotrexate use. The aim of the present study was to review the literature relating to the diagnosis and follow-up of early pregnancies, to underline some of the important considerations, and to help avoid possible iatrogenic errors.

Effects of cesarean section on mean platelet volume.

Mean platelet volume (MPV) is a risk factor for cardiovascular complications, cerebrovascular disorders, and low-grade inflammatory conditions prone to arterial and venous thromboses. Cesarean delivery is the most important risk factor for pulmonary embolism, stroke, and intracranial venous thrombosis. The hypothesis is that increase in the prevalence of cesarean section and high MPV may be associated with cardiovascular complications such as stroke along with intracranial complications in addition to known systemic and surgical complications. In this study, platelet counts and MPV for postpartum women who delivered by cesarean section and normal vaginal parturition are compared. The subjects were divided in two groups, one was study group consisting of 118 patients giving birth by cesarean section and the other was the control group consisting 94 patients giving birth by normal vaginal parturition. Peripheral venous blood samples in EDTA tubes were collected from all the subjects 1 week before and after the delivery for their prenatal and postpartum periods, respectively. The values were compared between the groups and also before and after the delivery. In the cesarean group, while the MPV level was 8.60 (1.64) fl in the prenatal period, it increased to 9.10 (2.00) fl in the postnatal period (p < 0.001). Group effect, time effect (independent from group effect), and group*time interaction effect were statistically significant for MPV variable (p = 0.032, p < 0.001, and p = 0.012, respectively). This study concluded that MPV, along with several other factors, may be used as a prognostic, independent, and therapeutic marker in patients who are inclined to thrombotic events after cesarean section.

Effect of anti-vascular endothelial growth factor antibody during early fetal development in rats.

OBJECTIVE: To examine the effect of anti-vascular endothelial growth factor (VEGF) antibody Bevacizumab during early fetal development in rats. METHODS: Presumed-pregnant rats received single intraperitoneal injection of Bevacizumab (0-20 mg/kg) on gestational day (GD) 3, 7, and 14 (n = 2 rats/group). After Study 1 (dose range finding study), Study 2 performed with intraperitoneal 20 mg/kg bevacizumab or saline on GD 7 (n = 6 rats/group including the Study 1). Blood samples were collected 3 and 7 d after the injection. Uterus and ovarian tissues were obtained 7 d after the injection. Number of gestational sacs (GS), size of GS and fetus, serum rat ß chorionic gonadotropin (ß-CG), and platelet endothelial cell adhesion molecule (PECAM) for immunohistochemical assessment of angiogenesis were evaluated. RESULTS: Number of GS, size of GS, and fetus were lower in the study group than the control group. Serum rat ß-CG levels were significantly increased in the control group and significantly decreased in the study group. Staining densities for PECAM in vascular structures in both corpus luteum and placenta were lower in the study group than the control group. CONCLUSION: Anti-VEGF antibody has an inhibitory effect on pregnancy development and caused litter death.

Effects of oral hormone replacement therapy on mean platelet volume in postmenopausal women.

BACKGROUND/AIM: To examine the effects of hormone replacement therapy (HRT) on mean platelet volume (MPV), lipid profile, and C-reactive protein (CRP) levels in postmenopausal women who have a high risk and incidence of cardiovascular disease. MATERIALS AND METHODS: This study was performed retrospectively. Twenty-seven healthy postmenopausal women received 1 mg estradiol and 2 mg drospirenone orally for 6 months. Twenty-eight healthy postmenopausal women not taking any HRT were admitted to the study as the control population. RESULTS: Time effect (independent from group effect) was statistically significant for the MPV variable (P = 0.025), but there was no significant change in MPV levels and other cardiovascular disease risk markers in women receiving HRT compared to women in the control group. CONCLUSION: Younger postmenopausal women taking HRT and women who initiated hormone therapy close to menopause are not at increased risk of cardiovascular disease.