Clinical Importance of Serum BDNF (Brain-Derived Neurotrophic Factor) Level for the Management of Pregnancies Complicated With Meconium-Stained Amniotic Fluid.

Objective The aim of this study was to investigate the association between poor neonatal outcomes and BDNF (brain-derived neurotrophic factor) levels. We aimed to predict the need for an emergency cesarean and prevent unnecessary interventions in cases complicated with meconium-stained amniotic fluid (MSAF). Methods This study was designed as a case-control study including three groups. Group A included pregnant women who underwent cesarean due to fetal distress. Group B included the women who delivered vaginally. Groups A and B had cases with the presence of meconium in the amniotic fluid. Group C as a control group had clear amniotic fluid. Demographic features, fetal outcomes, and maternal serum and fetal cord blood BDNF levels (Human BDNF ELISA Kit; Synonyms: ANON2, BULN2; Catalog no: E-EL-H0010 96T) were evaluated. Results No significant difference was found between patients with meconium and without meconium in terms of BDNF levels. However, the BDNF level was found to be significantly lower if fetal distress had occurred with MSAF. Conclusions In conclusion, the study demonstrated that the level of maternal and fetal cord blood BDNF are both significantly lower when fetal distress occurs with the presence of MSAF.

Can Transvaginal Cervical Elastography predict the success of induction of labor with oxytocin?

OBJECTIVE: We aimed to show whether elastography can be analternative, although the Bishop score used in the follow-up of labor induction success with oxytocin is a relative concept. MATERIAL AND METHODS: This prospective case-control study includes 56 cases admitted to a tertiary maternity hospital for induction between March and June 2019. Cervical elastography was applied to patients before induction. Induction success in pregnant women who underwent induction with oxytocin was accepted to be greater than Bishop 9. The cases were divided into two groups as successful (n=28) and unsuccessful (n=28) induction, and their elastosonographic findings were compared. RESULTS: In 28 cases with successful induction (Bishop >9, and vaginal delivery occurred in 28), the mean stiffness of the cervix in measurements from four regions was 13.6 ±3.7 kPa in the measurement of the cervix with the elastography method before induction was started, while this value was measured as 14.9 ± 3.1 in cases where induction was unsuccessful (t- value: -1.321, p=0.194). CONCLUSIONS: Our study showed that pre-induction stiffness of the cervix cannot predict the success of labor induction with oxytocin. More studies with larger samples are needed to arrive at a decent conclusion. In addition, results can be more assuring with the developing technique and sensitivity of elastography.

Myo-inositol oxygenese activity in second trimester of pregnancy: altered myoinositol catabolism in gestational diabetes mellitus.

OBJECTIVE: We aimed to determine myo-inositol oxygenase (MIOX) activity in gestational diabetes mellitus (GDM). MATERIAL AND METHODS: The insulin, HbA1c, and MIOX levels of 80 pregnant women were analysed after 75 g OGTT. Group I included patients with no risk factor for GDM, Group II: patients with high risk for GDM, and Group III: GDM patients. RESULTS: Fasting plasma glucose and Homeostatic Model Assessment for Insulin Resistance index were significantly higher in GDM cases (Group 3). Regarding the MIOX levels, significantly higher levels were recorded at 0-h in Group 3 compared to Groups 1 and 2. Significant alteration in MIOX activity was found between 0- and 2-h in Group 3 compared to Groups 1 and 2 (p < .029). CONCLUSIONS: MIOX levels were higher in GDM cases so, it may be have a role in myo-inositol catabolism.

Prediction of gestational diabetes mellitus in the first trimester by fasting plasma glucose which cutoff is better?

OBJECTIVE: We aimed to predict subsequent gestational diabetes mellitus (GDM) by fasting plasma glucose (FPG) in the first trimester. METHODS: Healthy pregnant women who were screened for GDM at 24-28 gestational weeks and had FPG levels calculated during their first antenatal visit and less than 14 gestational weeks were included in this study. RESULTS: Of the 2605 women who were recruited for the study, 245 (9.4%) were diagnosed with GDM at weeks 24-28. The diagnostic accuracy for FPG predicting GDM was 66.5, 78.4, and 88.2 for the cutoff values of 87.5 mg/dl, 92 mg/dl, and 99.5 mg/dl, respectively. CONCLUSIONS: FPG values which are within the normoglycaemic range constitute an independent risk factor for the development of GDM. The threshold for gestational diabetes diagnosis must be revised.

The Impact of First Trimester TSH Level on Fetal Growth and Post-Term Pregnancy.

Objective:  First trimester thyroid-stimulating hormone (TSH) level is an important determiner of neonatal outcome. In this study we investigated the relationship between first-trimester TSH level and fetal birthweight. Materials-Methods: First-trimester serum TSH, age, gravidity, parity, body mass index (BMI), gestational age, and birth weight were analyzed. Patients were divided two ways. The first division- group 1 with TSH < 2.5 mU/l, group 2 with TSH > 2.5 mU/l). The second division- group 3 with TSH < 4 mU/l and group 4 with TSH > 4 mU/l). Results: The study included 302 patients. High TSH levels are associated with an increased risk of macrosomic and post-term babies. A significant association was found for both thresholds of 2.5 and 4.0 mU/l. However, this relation was not significant after binary logistic regression. Conclusion: High maternal first trimester TSH levels are not associated with birth weight after separating out macrosomia-related factors.

Sleep Disorders in Pregnancy, Influencing Factors and Quality of Life.

AIM: In our study, the frequency of sleep disturbances in pregnancy, the reasons underlying the low quality of sleep, clinical factors, and the effects on quality of life were investigated. METHODS: The study was planned as a prospective study and included 189 pregnant women. Clinical features, laboratory results, socio-demographic status, obstetric and medical anamnesis were evaluated. The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the Berlin Questionnaire, Beck Depression Inventory, SF-36 quality-of-life questionnaire, and restless leg syndrome (RLS) diagnosis criteria were used for data collection. RESULTS: We investigated sleep disorders in 110 pregnant women (58.2%). A history of premenstrual syndrome and patients with hyperemesis gravidarum, obstructive sleep apnea syndrome, Vitamin B12 deficiency, and higher TSH levels in the laboratory were found to be associated with sleep disorders. Sleep disorders and daytime sleepiness were associated with depression, physical and social functioning, pain, and disturbance in general health perception. The number of pregnant women who had two or more RLS complaints was 84 (44%). CONCLUSION: The results of our study show that sleep disorders in pregnancy can be managed with easily applicable methods according to the risk factors and related problems.

The effects of water immersion and epidural analgesia on cellular immune response, neuroendocrine, and oxidative markers

Background/aim: Water immersion and epidural analgesia are the most preferred pain relief methods during the labor process. Adverse effects related to these methods, impact on the labor, and perception of pain is well studied in the literature. We aimed to investigate the cord blood level of copeptin, total serum oxidant (TOS), antioxidant (TAS), interleukin (IL)-1, IL-6, and oxytocin after the labor with water immersion, epidural analgesia, and vaginal birth without pain relief. Materials and methods: The study was conducted with 102 healthy pregnant women admitted to the obstetric delivery unit for noncomplicated term birth. Copeptin, oxytocin, TAS, TOS, IL-1, and IL-6 levels of cord blood and obstetric and neonatal results after vaginal birth were compared. Results: The study included a total of 102 patients (group 1 = 30, group 2 = 30, and group 3 = 42). We found no significant difference between the three groups in terms of BMI, age, gravidity, parity, birth week, birth weight, interventional birth, perineal trauma, breastfeeding, duration of labor, oxytocin, IL-1 and IL-6 levels (p > 0.05). Neonatal intensive care unit (NICU) need, TAS, TOS, and copeptin levels were higher. Apgar scores were lower in the epidural group (p = 0.011, p = 0.036, p = 0.027, p < 0.001, and p < 0.001 respectively). Conclusion: Epidural analgesia has deteriorated oxidative stress status and lower neonatal Apgar scores with higher NICU administration compared with water birth and vaginal birth without pain relief.

Water Immersion During the Labour and Effects on Oxidative Stress.

Objective: The study aims to investigate maternal serum thiol/disulfide homeostasis and ischemia-modified albumin (IMA) levels of women who were submerged during labor. Material and methods: Sixty-four pregnant women were enrolled in this study. Thirty-four women were submerged during the first stage of labor and 30 women were not. Native thiol, total thiol, disulfide, albumin, IMA, disulfide/native thiol, disulfide/total thiol and native thiol/total thiol concentrations were measured and demographic data were obtained. Results: Cord blood pH, serum disulfide levels and (disulfide/total thiol) × 100 levels were significantly lower in the water immersion group (P < 0.01, P = 0.01 and P < 0.01, respectively). Native thiol, total thiol, albumin and IMA levels were higher in the water immersion group P < 0.01, P < 0.01, P = 0.001 and P < 0.01, respectively). Conclusion: Water immersion during the first stage of labor was found to be associated with deterioration of thiol-disulfide homeostasis with respect to antioxidant status while IMA levels were higher, suggesting an ischemic condition.

Herpes Simplex Infection During Pregnancy, Results of a Tertiary Referral Center in Turkey.

OBJECTIVE: The present study aimed to determine herpes simplex virus (HSV) infection during pregnancy, serologic status of symptomatic patients, and the frequency of PCR and culture positivity and neonatal disease in an obstetric population. MATERIALS AND METHODS: Sera of 1,690 women with genital lesions were tested for HSV IgM and/or HSV IgG between 2008 and 2017. All the patients were evaluated by PCR and viral culture to demonstrate genital herpes infection. RESULTS: The frequency of HSV IgG and IgM seropositivity was 73.8% (1245/1685) and 28.6% (484/1690). The number with a positive viral culture was 288, whereas positive PCR was 305. Five infants had localized skin lesions of HSV infection at the time of birth. CONCLUSION: This study shows the serologic status, viral culture and PCR testing results of pregnant women who had a symptomatic genital HSV infection and efficacy of management strategies to prevent neonatal herpes infection.

Severe 25-OH vitamin D deficiency as a reason for adverse pregnancy outcomes.

Objective: There is a growing concern about the unfavorable effects of vitamin D deficiency in general population, including pregnant women, worldwide. The aim of this study is to evaluate the effect of severe maternal serum 25-OH vitamin D levels on adverse pregnancy outcomes in first trimester.Material and methods: Serum samples of 86 pregnant women in first trimester were collected prospectively from May 2017 to June 2017. Serum 25-OH vitamin D levels were analyzed by enzyme immunoassay method. Patients were classified according to maternal serum 25-OH vitamin D levels as group 1 (n = 34) <10 ng/ml and group 2 (n = 52) >10 ng/ml. The two groups were compared in terms of adverse pregnancy outcomes.Results: The mean 25-OH vitamin D levels of the total 86 pregnant women were 13.83 (6-48) ng/ml. 40% of the pregnant women had low level of 25-OH vitamin D levels (<10 ng/ml). The adverse pregnancy outcomes were significantly increased in group 1 (p<.018).Conclusions: Maternal serum 25-OH vitamin D levels <10 ng/ml is a risk factor for adverse pregnancy outcomes. 25-OH vitamin D levels should be screened in high-risk pregnant women and treated in case of deficiency.

Toxoplasma Screening Results of 84587 Pregnant Women in a Tertiary Referral Center in Turkey.

Aim: To determine the seroprevalence of Toxoplasma in a tertiary referral center in Turkey and to discuss the benefits and drawbacks of routine antenatal screening. Materials and methods: A serologic test for Toxoplasma is free of charge for all pregnant women as part of routine antenatal care at their first prenatal visit. The study was conducted between 2008 and 2017. Results: The frequency of Toxoplasma IgG and IgM seropositivity was 22.3% and 0.64%, respectively. Low avidity was detected in 142 patients and 60 PCR tests were performed with no positive result. A total of 33 mothers with low IgG avidity and negative PCR received prophylactic treatment, and no congenital toxoplasmosis was documented in this study. Conclusion: Universal screening for Toxoplasma in pregnancy is a subject of debate. As the prevalence in Turkey is higher compared to other countries, more studies are needed to identify the necessity of routine screening.

Prevalence of gestational diabetes mellitus and results of the screening tests at a tertiary referral center: A cross-sectional study.

OBJECTIVE: This study aimed to identify the gestational diabetes mellitus (GDM) prevalence of low risk pregnant population at a tertiary referral center by different approaches. MATERIAL AND METHODS: A cross-sectional study using retrospective data between 2007-2017 was conducted. During this period 77227 patients underwent either two step or one step glucose tolerance tests. RESULTS: The median age of the study population was 27 (15-49). Fasting plasma glucose (FPG) testing was evaluated in 144,113 women at the initial antenatal care visit which %21 of these were between 92-126 mg/dL. Of these women %1.25 had FPG>126 mg/dL which showed the prevalence of pregestational diabetes in our cohort. During the study period 74412 women underwent 50-g glucose challenge test where %18 were screen positive and % 2.9 was defined as gestational diabetic without need for further testing (>180 mg/dL). The screening positive patients were sent to 100-g oral glucose tolerance test and the prevalence of GDM with two-step screening was 5.5%. A total of 2815 patients were screened by 75-g glucose tolerance test and the prevalence of GDM with one-step screening was 21%. Overall 4684 patients have been diagnosed as gestational diabetes mellitus with the prevalence of 6.07%. CONCLUSION: Fasting plasma glucose >92 mg/dL is challenging in our population due to improper fasting. The FPG dependent GDM prevalence is almost four times higher than two-step glucose screening test results (21.8% vs 5.5%). If FPG levels will be used for diagnosing GDM then the values must be checked in a second laboratory analysis.

The Prevalence of Anti-Rubella Antibodies in Pregnant Women of Turkey, Results of 94508 Patients in a Tertiary Referral Center.

AIM: To determine the seroprevalence of rubella in a tertiary referral center inAnkara,Turkey. MATERIALS AND METHODS: A retrospective, cross-sectional study was performed from 2008 to 2017 at the outpatient clinic of Zekai Tahir Burak Women Health Care, Training and Research Hospital in Ankara, Turkey. The study included 94508 pregnant women and the patients were evaluated in terms of IgG and IgM status, IgG avidity and amniotic fluid PCR testing if needed. RESULTS: Seropositivity for anti-rubella IgG and IgM were 89% and 0.19% respectively. 175 patients with IgM positivity were tested by avidity test, 114 patients were found to have high avidity and 57 patients with low avidity. 4 patients have accepted PCR testing and no positive result was found. CONCLUSION: In our sample of Turkish population, the rate of rubella IgG seropositivity was high suggesting that routine national vaccination programme for rubella is successful. Screening and vaccination of childbearing aged women and updating the national vaccination policy would be effective for the periodic decreases in the immunity.