Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes; which one is more effective?

In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acibadem Mehmet Ali Aydinlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants.Impact StatementWhat is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia.What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements.What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries.

Outcomes after cesarean myomectomy versus cesarean alone among pregnant women with uterine leiomyomas.

OBJECTIVE: To determine whether myomectomy during cesarean delivery is safe and feasible among pregnant women with leiomyomas. METHODS: In a retrospective study, data were reviewed from pregnant women with uterine leiomyomas who delivered by cesarean at a center in Turkey between May 1, 2007, and April 30, 2014. Women were divided into two groups: cesarean myomectomy (CM) or cesarean only (CO). Data were analyzed for characteristics of the uterine leiomyomas, hematologic changes occurring between the preoperative and postoperative periods, duration of the operation, and length of hospital stay. RESULTS: Overall, 76 women formed the CM group and 60 formed the CO group. The mean diameter of the leiomyomas did not differ between CM and CO groups (4.6±2.5cm vs 5.2±2.2cm; P=0.175). More patients in the CM group than in the CO group had subserous (24 [31.6%] vs 7 [11.7%]; P=0.006) and uterine corpus (57 [75.0%] vs 30 [50.0%]; P=0.003) leiomyomas. Fewer patients in the CM group had intramural (44 [57.9%] vs 49 [81.7%]; P=0.003) and fundal (15 [19.7%] vs 25 [41.7%]; P=0.005) leiomyomas. CONCLUSION: Surgeons were more likely to remove corporal and subserous leiomyomas than other types; size did not seem to affect decision making. CM can be a safe operation for some patients.

GESTATIONAL DIABETES MELLITUS SEEMS TO BE ASSOCIATED WITH INFLAMMATION.

The aim of this study was to investigate whether gestational diabetes mellitus (GDM) is associated with inflammation by comparing serum levels of human chitinase-3-like pro- tein 1 (YKL-40), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). This case control study included 29 pregnant women with GDM and 29 pregnant women with normal glucose tolerance matched for age (± 2 years) and pre-pregnancy body mass index (± 2 kg/m²). The YKL-40/CHI3L1 levels were measured, and NLR and PLR investigated. There were no statisti- cally significant differences in maternal age, gestational age, gravidity and parity. Higher YKL-40 levels were recorded in pregnant women with GDM compared to control subjects (203 (65-300) ng/ mL vs. 159.2 (14-290) ng/mL, p = 0.007). NLR and PLR were significantly higher in GDM com- pared with control group. In conclusion, GDM is associated with high levels of YKL-40, NLR and PLR, which indicate inflammatory status.

Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion.

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

The effect of treatment on pregnancy outcomes in women with one elevated oral glucose tolerance test value.

OBJECTIVE: The aim of the study was to evaluate whether dietary intervention could reduce maternal and perinatal morbidity in pregnancies with one elevated 100 g oral glucose tolerance test (OGTT) value. MATERIAL AND METHODS: The study was conducted among patients with positive 50 g glucose challenge test (GCT) and one elevated 100 g OGTT value. Plasma glucose value of 140 mg/dL was used as the threshold to define an abnormal GCT result. Carpenter and Coustan criteria were used to evaluate the OGTT results. Seventy-four women with normal GCT values comprised group I. Ninety-nine women with one elevated 100 g OGTT value who were given a caloric diet and 102 women with one elevated OGTT value in group III who received antenatal care with no special diet were randomly assigned to groups II and III, respectively. All women were followed up until the end of pregnancy. Poor maternal outcome was defined as: cesarean delivery performed due to cephalopelvic disproportion, failure to progress or fetal distress, preeclampsia, and/or preterm labor. Poor perinatal outcome was defined as: small for gestational age, large for gestational age or admission to a neonatal intensive care unit. The groups were compared in terms of maternal and perinatal outcomes. RESULTS: The rates of macrosomia and large for gestational age incidence were significantly higher in group III as compared to groups I and II. When we examined the multivariate effects of the risk factors considered to be predictive of poor maternal outcomes, group III was the only statistically significant risk factor (OR=3.90, 95% CI:1.95- 7.84; p=<0.001). In terms of poor perinatal outcome, one elevated OGTT value (group III) was the only significant risk factor (OR=2.92, 95% CI:1.56-5.46; p=<0.001). CONCLUSION: Women with one elevated OGTT value benefit from a structured program of diet therapy aimed to reduce adverse maternal and perinatal outcomes.

Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

PURPOSE: To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. METHODS: This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. RESULTS: During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). CONCLUSION: BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

Behçet's disease and pregnancy: a retrospective analysis of course of disease and pregnancy outcome.

AIM: Behçet's disease (BD) is a rare, chronic, multisystemic disease of unknown cause. BD is characterized by mucocutaneous, ocular, vascular and central nervous system manifestations and is also associated with thrombogenicity. In this retrospective analysis we investigated the relation between gestation and BD. MATERIAL AND METHODS: This retrospective study consisted of 49 pregnancies in 24 patients with BD between January 2008 and June 2013. The following clinical and demographic data were obtained: maternal age, obstetric history, pregnancy outcome, and maternal and neonatal complications during pregnancy following diagnosis of BD. To avoid recall bias, the following data were collected only in the recent pregnancy of each patient: disease activity and use of medications during pregnancy. RESULTS: Sixty-three pregnancies occurred in this group and 52 of them were after the diagnosis. Mean age of the patients at diagnosis was 21.4 years. The duration of BD during pregnancy was 7.2 years. Fourteen patients (58.3%) had no symptoms during recent pregnancy. No change was observed in the disease activity during pregnancy in eight patients. Disease activity was aggravated in two patients. The rate of vascular complications was higher in pregnancies of patients with BD. The rates of stillbirth, pre-eclampsia, preterm delivery and intrauterine growth restriction did not differ between the groups. Perinatal mortality and neonatal intensive care unit admissions as well as low birthweight infants were also similar between groups. CONCLUSION: Patients with BD had a higher rate of vascular complications during pregnancy; however, other obstetric complications were not increased and neonatal outcomes were not negatively influenced by BD.

A comparative study of obstetric outcomes in electively or spontaneously reduced triplet pregnancies.

PURPOSE: This study aimed at evaluating the pregnancy outcomes of IVF triplets which are spontaneously or electively reduced to twins and to compare them with non-reduced triplets and twins. METHODS: Retrospective analysis of trichorionic triplets and dichorionic twins of IVF pregnancies. RESULTS: Preeclampsia rate was significantly higher in triplet group (p = 0.014). Premature contractions requiring tocolysis were seen more often in spontaneous reduction and triplet groups compared to elective reduction and twin groups (p < 0.001). Elective reduction and twin groups had significantly lower rate of infants weighing less than 1,500 g than those of triplets (p < 0.001). Highest rate for infants weighing over 2,500 g was found in primary twin group. Preterm delivery rates were significantly lower in both twin and elective reduction groups compared to triplet and spontaneous reduction groups (p < 0.001). Proportion of women giving birth at term was not different in elective reduction and twin groups, and they were significantly higher compared to spontaneous reduction group (p = 0.024). Perinatal mortality rates of both elective reduction and twin groups were significantly less than those in the triplet group (p = 0.045 and p < 0.001, respectively). CONCLUSIONS: Obstetric outcomes of triplets from IVF or ovulation induction cycles undergoing elective reduction are better than ongoing triplet and spontaneous reduction groups and are similar to that of dichorionic twins.

Retrospective evaluation of pregnancy outcomes in women with familial Mediterranean fever.

AIM: Familial Mediterranean fever (FMF) is an autosomal recessive condition characterized by periodic attacks of fever, aseptic serositis and synovitis. In this study, we investigated maternal and neonatal outcomes in pregnant patients with FMF. METHODS: This retrospective study consisted of 46 pregnant patients with FMF who attended the perinatology clinic of Dr Zekai Tahir Burak Research and Training Hospital between January 2008 and December 2012. The following clinical and demographic data were obtained by reviewing the patients' medical records: maternal age, colchicine use during pregnancy, obstetric history, pregnancy outcome and maternal and neonatal complications during the current pregnancy. RESULTS: The patients with FMF had higher rates of premature rupture of membranes (PROM) and Cesarean delivery as well as low birth weight infants; however, rates of stillbirth, gestational diabetes, preeclampsia did not differ between the groups. Preterm delivery rates were higher in the study group, but this difference did not reach statistical significance. Patients with pregnancy complications had significantly more basal proteinuria than did patients without complications. Nine patients did not receive colchicine therapy in the previous or current pregnancies. Within this subgroup, four (44.4%) of the patients had a history of two or more previous miscarriages. However, there were only three cases (8.1%) of two or more miscarriages among 37 patients who received colchicine; this difference was statistically significant CONCLUSIONS: FMF leads to higher rates of PROM, recurrent miscarriage and preterm deliveries. Colchicine treatment is safe in pregnancy and may lead to a decreased miscarriage rate.

Awareness of Turkish female adolescents and young women about HPV and their attitudes towards HPV vaccination.

BACKGROUND: The aim of the study was to assess the knowledge about HPV and HPV vaccines and attitudes towards vaccination among the females aged 9-24 years in Turkey. MATERIALS AND METHODS: Self-administered questionnaires were filled out individually by the participants covering demographic information, knowledge about HPV infection and HPV vaccines, attitudes towards vaccination, and the perceptions of them about their parental attitudes about vaccination. RESULTS: Of the 408 subjects participating in the study, 41.6% (n=170) had heard of HPV. Thirty-three percent (n=136) knew the causal relationship between HPV and cervical cancer. Only 27.9% (n=114) of them knew that HPV vaccines can prevent cervical cancer. Eleven percent (n=46) of the females participating in the study were willing to be vaccinated, and only 1.4% (n=6) were already vaccinated at the current time. The main reason listed among the participants who were not willing to be vaccinated was lack of information. CONCLUSIONS: Awareness and knowledge of Turkish female adolescents and young women about HPV, relation with cervical cancer and prevention of cervical cancer by Pap smear and vaccine are still limited. If the most important barrier to vaccination, which is reported as lack of information, were to be addressed, it would greatly impact the decision-making and vaccine acceptance.

Can transvaginal ultrasonographic evaluation of the endocervical glandular area predict preterm labor among patients who received tocolytic therapy for threatened labor: a cross-sectional study.

OBJECTIVE: Increased neonatal morbidity and mortality rates resulting from preterm delivery (PTD) remain as a problem despite increasing evidence about the physiology of uterine contractility process. More predictive signs of preterm labor detected on prenatal ultrasonography like the presence of cervical gland area (CGA) on transvaginal ultrasonography can be a reassuring finding among patients with threatened labor risk. METHODS: In this prospective study, 85 pregnant patients at 24-34 weeks of gestation who attended to our high risk pregnancy clinic for threatened labor between March 2011 and March 2012 have been examined by transvaginal ultrasonography to evaluate CGA located around the endocervical canal. Following discharge, the gestational week at birth, birth weight and birth route of patients have been recorded. RESULTS: Among patients with a cervical length (CL) <30 mm and ≥30 mm measured by transvaginal ultrasonography on admission, 82.4% of the patients with a short cervix exhibiting echolucent endocervical glandular area and 42.3% of the patients with short cervix exhibiting echogen endocervical glandular area on sonography delivered at term (p = 0.013). CONCLUSION: The presence of CGA detected on transvaginal ultrasonography especially when combined with the evaluation of CL during the management of patients with threatened labor can be a reassuring sign for actual probability of PTD.

The impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age.

OBJECTIVE: The purpose of this study was to investigate the impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age. MATERIAL AND METHODS: A total of 11 587 pregnancies were reviewed retrospectively from patient medical records. Singleton pregnancies greater than 24 weeks of gestation were included. The study group consisted of women ≥40 years old at the time of delivery, and the control group consisted of women aged between 20 and 30 years old. Data regarding age, parity, gestational age, mode of delivery, and obstetric and neonatal complications were collected. Firstly, pregnancies ≥40 years and the younger control group were compared altogether with respect to the obstetric and neonatal complications. Secondly, both groups were divided into subgroups according to parity, and a second comparison was made with controls. RESULTS: Mean maternal age in the study and control groups was 43±2.2 and 24±2.8 years, respectively. In women ≥40 years old, all of the investigated obstetric and neonatal complications except postpartum haemorrhage and foetal malformations were higher when compared to younger controls (p<0.05). In the nulliparous ≥40 year old group, the most significant complications were preterm delivery (45.3%), low 5-minute Apgar score (15.2%), and neonatal intensive care unit admission (15.2%). On the other hand, in the multiparous group, preeclampsia (16.6%), abruptio placentae (5.1%), foetal demise (7.2%), and macrosomia (9.6%) were found to be significantly higher when compared to controls. CONCLUSION: The study suggests that pregnancies of maternal age ≥40 years carry increased risks for both neonatal and obstetric complications, and these risks seem to be effected by parity.

Cost-effectivity analysis of one-step versus two-step screening for gestational diabetes.

OBJECTIVE: Early diagnosis of gestational diabetes mellitus (GDM) is important for both maternal and fetal health. The literature has varying recommendations about one-step and two-step tests for GDM screening and diagnosis. The present study aimed to investigate the difference in the cost and duration of hospital stay of a one-step procedure compared to a two-step procedure, which is routinely performed in our hospital. MATERIALS AND METHODS: The two-step procedure was performed in 2,724 pregnant women, and the one-step procedure was performed in 185 pregnant women. The one-step and two-step screening procedures for gestational diabetes were compared with respect to the duration of hospital stay and cost. RESULTS: The test cost per woman was 0.75 TL less in the one-step procedure; however, the duration of the one-step test was 18.6 min longer, and the number of blood sampling procedures was 1.08 times higher. CONCLUSION: The one-step method may be preferred over the two-step (or glucose challenge) test due to its diagnostic value and lower cost.

Retrospective evaluation of perinatal outcome in women with mild gestational hyperglycemia.

AIM: To assess maternal and perinatal complications associated with mild gestational hyperglycemia (MGH). MATERIAL AND METHODS: This retrospective study was conducted in the perinatology division of Zekai Tahir Burak Women's Hospital between January and June 2009. Four hundred and eighty one patients with MGH and 212 patients with pre-gestational diabetes or gestational diabetes mellitus (GDM) were recruited in the study. The control group consisted of 479 patients with normal glucose challenge test. Patients with MGH and the control group were compared in terms of maternal and neonatal complications. RESULTS: The rates of large-for-gestational-age (LGA) or macrosomic infants, pregnancy induced hypertension, primary cesarean delivery, preterm delivery and neonatal hypoglycemia were significantly higher in patients with MGH, GDM or preexisting diabetes. The rates of spontaneous preterm labor, shoulder dystocia, hyperbilirubinemia, low 1-min Apgar score, fetal malformations and neonatal morbidity did not differ between the groups. CONCLUSION: MGH is associated with an increased risk of primary cesarean delivery, preterm delivery, pregnancy induced hypertension, and macrosomic and LGA infants.

Ectopic pregnancy following levonorgestrel emergency contraception: a case report.

Hormonal contraceptive pills containing 750 microgram levonorgestrel are the most commonly used postcoital contraceptive method because of their high efficacy and fewer side effects. Emergency contraceptive pills containing levonorgestrel present their effects by several mechanisms, including delayed tubal transport of the ovum. A delay of tubal transportation of an ovum is also one of the possible etiologic factors of tubal ectopic pregnancies. There are limited data on the risk of ectopic pregnancy following levonorgestrel treatment as an emergency contraception. Here, a case of tubal pregnancy associated with the use of levonorgestrel containing emergency contraceptive pills has been presented along with discussion of the relevant literature.

Role of transvaginal sonography in the diagnosis of retained products of conception.

INTRODUCTION: The aim of this study was to evaluate the criteria of endometrial thickness to detect retained products of conception following first trimester spontaneous abortion or elective pregnancy termination. METHODS: This was a retrospective study on 116 patients who underwent uterine re-evacuation with a diagnosis of retained products of conception based on clinical and sonographic findings. Pathologic reports of samples obtained during re-evacuation were reviewed for the presence of gestational tissue. Endometrial thickness determined by transvaginal sonography and certain clinical features (gestational age and interval between initial curettage and re-evacuation, which may affect presence or absence of gestational tissue, parity, indication for initial curettage) were noted. The sensitivity and specificity of sonographic measurement of endometrial thickness for detecting retained products of conception were assessed. RESULTS: Histopathologic reports confirmed the diagnosis of retained products of conception in 66 of 116 patients (56.9%). Percentage of nulliparity and the time elapsed between initial curettage and re-evacuation were significantly high in patients with retained products of conception. The sensitivity and specificity of endometrial thickness greater than 13 mm for detecting retained products of conception were 85 and 64%, respectively. CONCLUSION: An endometrial thickness of 13 mm or more, detected by transvaginal sonography, has the best diagnostic efficiency for detection of retained products of conception following first trimester spontaneous abortion or elective pregnancy termination.

Does hysteroscopic polypectomy without cycle cancellation affect IVF?

Endometrial polyp (measuring <2 cm) was diagnosed by transvaginal ultrasonography performed on days 7 and 9 of the cycle in six patients who underwent IVF. These six patients were treated by hysteroscopic polypectomy preceding oocyte retrieval under general anaesthesia after informed consent was obtained. The cause of infertility was male factor in three patients, tubal factor in one, and two cases were unexplained. All patients had undergone ovulation induction and luteal support according to the long luteal protocol. As a result, in three cases pregnancy was achieved (one multiple and two singleton) and three cases were unsuccessful. One of the pregnant women gave birth at term, while the other two pregnancies are still ongoing. There is still no consensus regarding the management of patients diagnosed with endometrial polyp in IVF cycles. Cryopreservation, cycle cancellation and embryo transfer preceding polypectomy is the current management choice. The treatment modalities will be clarified only if embryo transfer preceding polypectomy in the same cycle is proven to be safe. This approach has been used in only six patients so far, and further studies with more patients are needed to confirm these findings.