Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage-indicating scores (albumin-bilirubin [ALBI], Model for End-Stage Liver Disease [MELD], aspartate aminotransferase-to-platelet ratio [APRI]) and inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]). METHODS: Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis. RESULTS: Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false-positive rate of 10%. CONCLUSION: This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

Factors Affecting Obstetric Outcomes in Patients Who Underwent Cold-Knife and Loop Electrosurgical Excision Procedure Conization Due to CIN 2 or CIN 3.

Objective: To determine factors affecting obstetric outcomes in pregnancies after conization by loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC) due to cervical intraepithelial neoplasia (CIN). Material and Methods: The maternal and clinical characteristics and obstetric outcomes of CKC, LEEP and control groups were evaluated and compared. Risk factors for adverse pregnancy outcomes were evaluated using multiple logistic regression analyses. Results: The incidence of preterm delivery, PPROM, low APGAR scores, fetal mortality, and late-period spontaneous abortus was highest in patients who underwent CKC (p<0.05). Cone depth of CKC was longer than LEEP (p=0.025). Cervical length (CL) at pregnancy was CKC

Is There a Predictable Cost-Benefit Ratio in Preeclampsia?

Background Preeclampsia (PE) is one of the highest-risk pregnancies and a complicated condition that occurs in 2% to 8% of pregnancies and is associated with markers of a systemic inflammatory response (SIR). In this study, we aimed to determine the role of these markers in predicting PE. Methodology A total of 300 women with singleton pregnancies and cephalic presentation were included in the study. Normotensive pregnant women (n = 149) who met this criterion were included as the control group Pregnant women who met the inclusion criteria for a diagnosis of preeclampsia (n = 151) were included in the study group. Results The baseline characteristics of the study groups showed no significant difference. The hypertensive group was hospitalized significantly earlier than the control group (p < 0.001). We found significantly higher systolic and diastolic blood pressure values in the PE group than in the other group (p < 0.001). The mean neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and aspartate aminotransferase-to-platelet ratio index (APRI) values at hospitalization did not differ significantly between groups (p = 0.639, p = 0.709, and p = 0.066, respectively). In the receiver operating characteristic analysis curves compared with the control group and PE, none of the parameters could predict PE. Conclusions We found that NLR, PLR, and APRI have no clinical significance in assessing developmental risk and predicting PE.

The evaluation of serum brain-derived neurotrophic factor levels in pregnant women with hyperemesis gravidarum.

OBJECTIVES: The aim of this study was to investigate the relationship between levels of brain-derived neurotrophic factor (BDNF), which is considered a cause of conditions such as depression and eating disorders, and hyperemesis gravidarum (HG). MATERIAL AND METHODS: This study was conducted as a prospective study at Ankara Ataturk Training and Research Hospital in the Department of Obstetrics and Gynecology. The study included 73 pregnant women with singleton pregnancies (32 pregnant women with HG and 41 pregnant women without hyperemesis). Serum BDNF levels were compared between the two groups. RESULTS: The mean age of the study group was 27.3 ± 3.5 years and the body mass index (BMI) was 22.4 ± 2.7 kg/m². There is no statistically significant difference between the study group and the control group in terms of demographic data (p > 0.05). The pregnant women with HG were found to have significantly higher serum BDNF levels compared to the control group (349.1 ± 94.6 pg/mL vs 292. 3± 86.01, p = 0.009) CONCLUSIONS: Serum BDNF levels that are low in psychiatric disorders such as depression or anxiety were found as high in pregnant women with HG.

Postoperative care in the caesarean intensive care unit: experience from a tertiary maternity hospital

Objective: The aim was to determine whether follow-up in the intensive care unit (ICU) for the postoperative first eight hours was beneficial for early intervention in postpartum hemorrhage. Material and Methods: In our hospital, all patients are admitted to the ICU for the first eight hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively. Results: All cases (n=36,396) who underwent cesarean delivery were reviewed. Three hundred and fifty-nine patients with postpartum hemorrhage were identified and included. In the study group the time between cesarean section and diagnosis of postpartum hemorrhage was 10.1±19.1 hours, and the time between cesarean section and re-laparotomy was 9.26±23.1 hours. A total of three maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivering by cesarean section was 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births. Conclusion: Follow-up of patients in the ICU in the first eight postoperative hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.

Human epididymis protein 4 and fetal lung maturity.

OBJECTIVES: To document the maternal and fetal cord blood levels of human epididymis protein 4 (HE-4) in term and preterm newborns in order to investigate the possible physiological role of HE-4 in fetal lung development. METHODS: This cross-sectional study was conducted in a university-affiliated hospital between April 2018 and September 2018. The study population consisted of cesarean section (C-section) deliveries after 24 weeks of pregnancy. Both maternal and umbilical cord HE-4 levels (mHE-4 and uHE-4, respectively) were measured using chemiluminescent microparticle immunoassay. Amniotic fluid was sampled from each case to determine the lamellar body count (LBC) as the gold standard test for lung maturation. All the parameters, including the uHE-4 levels, were compared between the term delivery (≥37 weeks) (n=52) and preterm delivery (24-37th weeks) (n=30) groups. The best cut-off value of uHE-4 was calculated for fetal lung maturity. RESULTS: There were no statistically significant differences between the groups regarding the demographic data. The mHE-4 levels did not statistically significantly differ between the groups (p>0.05) whereas the uHE-4 level of the preterm newborns was significantly higher than that of the term newborns (p<0.05). There was a significant negative association between the uHE-4 level and LBC (r=-0.389; p<0.001). The uHE-4 level was the only statistically significant fetal parameter indicating fetal lung maturity confirmed by LBC. At a cut-off value of 281 pmol/L, uHE-4 had 96.8% sensitivity, 45% specificity, 84.5% positive predictive value, and 81.8% negative predictive value for fetal lung maturity. CONCLUSIONS: Although the exact physiological role of HE-4 has not yet been elucidated, this preliminary study supports the idea that HE-4 plays a role in fetal lung maturation to some extent.