Comparison of the success rates of a single dose and an additional dose of methotrexate on the 4th day in patients whose ß-hCG values do not fall after a single dose of methotrexate (Day 0-4).

INTRODUCTION: This study's aim is to investigate whether the rise in ß-hCG levels between days 0 and 4 in patients with tubal ectopic pregnancy who have received a single dose of methotrexate has prognostic value in treatment success, and to investigate whether administering a second dose on day 4 enhances treatment success. MATERIAL AND METHODS: Patients diagnosed with ectopic pregnancy and experiencing an increase in ß- hCG levels on day 4 after initiation of methotrexate treatment were included in our study. Patients treated with a single dose Methotrexate (MTX) protocol until December 2019 were retrospectively screened from January 2018 to December 2019. Patients receiving a second dose on day 4 until September 2021 were prospectively enrolled from January 2020 to September 2021. A decrease of over 15 % in the ß-hCG value after the 4th dose was considered as treatment success. RESULTS: Treatment success rates were compared between these two groups. 115 patients with ectopic pregnancy were included in the study. A single dose methotrexate protocol was applied in 67 of the patients (Group 1), while an additional dose methotrexate was applied in 48 (Group 2). The treatment was successful in 40 patients (59.7 %) in Group 1 and in 39 patients (81.3 %) in Group 2. The success rate of the treatment was significantly higher in patients who received an additional dose methotrexate protocol (p = 0.014). DISCUSSION: This study shows that; it is possible to increase success rates by applying an additional MTX dose on the 4th day in cases with an increase in ß-hCG on the 4th day.

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

AIM: To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. MATERIAL AND METHODS: A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. RESULTS: In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96 mm vs. 17,34 ± 9,87 mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic inflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). CONCLUSION: The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Prediction of Rupture by Complete Blood Count in Tubal Ectopic Pregnancies Treated with a Single-Dose Methotrexate Protocol.

OBJECTIVE: The availability of reliable and inexpensive markers that can be used to determine the risk of rupture during methotrexate (MTX) treatment in ectopic pregnancies (EPs) is considerable. The aim of the present study is to investigate the role of systemic inflammatory markers such as leukocytes (or white blood cells, WBCs), the neutrophil-to-lymphocyte ratio (NLR), and platelet distribution width (PDW), which are among the parameters of the complete blood count (CBC), in the prediction of rupture of EPs under MTX treatment. MATERIALS AND METHODS: A total of 161 patients with tubal EP who underwent a single-dose methotrexate (MTX) protocol were retrospectively analyzed, and the control group (n = 83) included patients cured by MTX, while the ruptured group (n = 78) included patients who were operated on for tubal rupture during the MTX treatment. The features of EP, beta-human chorionic gonadotropin (ß-hCG) levels, sonographic findings, and CBC-derived markers such as WBC, NLR, and PDW, were investigated by comparing both groups. RESULTS: The NLR was found to be higher in the ruptured group, of 2.92 ± 0.86%, and significantly lower in the control group, of 2.09 ± 0.6%. Similarly, the PDW was higher (51 ± 9%) in the ruptured group, and it was significantly lower a (47 ± 13%) in the control group (p < 0.05). Other CBC parameters were similar in both groups (p > 0.05). CONCLUSION: Systemic inflammation markers derived from CBC can be easily applied to predict the risk of tubal rupture in Eps, since the CBC is an inexpensive and easy-to-apply test, which is first requested from each patient during hospitalization.

OBJETIVO: A disponibilidade de marcadores confiáveis e baratos que podem ser usados para determinar o risco de ruptura durante o tratamento com metotrexato (MTX) em gestações ectópicas (GEs) é considerável. O objetivo do presente estudo é investigar o papel de marcadores inflamatórios sistêmicos, como leucócitos (ou glóbulos brancos, glóbulos brancos), a relação neutrófilo-linfócito (NLR) e largura de distribuição de plaquetas (PDW), que estão entre os parâmetros do hemograma completo (hemograma), na predição de ruptura de PEs sob tratamento com MTX. MATERIAIS E MéTODOS: Foram analisados retrospectivamente 161 pacientes com EP tubária submetidas a protocolo de dose única de metotrexato (MTX), sendo que o grupo controle (n = 83) incluiu pacientes curadas com MTX, enquanto o grupo roto (n = 78) incluíram pacientes operadas por ruptura tubária durante o tratamento com MTX. As características de EP, beta-gonadotrofina coriônica humana (ß-hCG), achados ultrassonográficos e marcadores derivados de CBC, como WBC, NLR e PDW, foram investigados comparando os dois grupos. RESULTADOS: A RNL foi maior no grupo roto, de 2,92 ± 0,86%, e significativamente menor no grupo controle, de 2,09 ± 0,6%. Da mesma forma, o PDW foi maior (51 ± 9%) no grupo roto, e foi significativamente menor a (47 ± 13%) no grupo controle (p < 0,05). Outros parâmetros do hemograma foram semelhantes em ambos os grupos (p > 0,05). CONCLUSãO: Marcadores inflamatórios sistêmicos derivados do hemograma podem ser facilmente aplicados para predizer o risco de ruptura tubária na Eps, uma vez que o hemograma é um exame de baixo custo e fácil aplicação, solicitado primeiramente a cada paciente durante a internação.

Evaluation of the effect of a nurse navigation program developed for postpartum mothers on maternal health: A randomized controlled study.

OBJECTIVE: This study aimed to determine the effects of a nurse navigation program on the capability for self-care, quality of life, risk of anxiety and depression, and severity of the physical symptoms of postpartum mothers. METHODS: This prospective, parallel-group, randomized controlled study included 64 primiparous pregnant women (32 women each in the intervention and control groups) at ≥36 gestational weeks admitted to the pregnancy outpatient clinic of a public hospital in Turkey. The intervention group received navigation program-based nursing care comprising three home visits, four phone calls, and five text messages aside from the standard hospital care during delivery and the postpartum period. Meanwhile, the control group received only the standard hospital care during delivery and the postpartum period. Data were collected using a sociodemographic data form, the Self-Care Power Scale, the Maternal Postpartum Quality of Life Instrument (MPQoL-I), the Postpartum Specific Anxiety Scale (PSAS), the Edinburgh Postnatal Depression Scale (EPDS), and the Postpartum Physical Symptom Severity Scale. RESULTS: Mean scores for the capability for self-care and quality of life were higher, while those for the risk of depression and anxiety were lower for the intervention group than the control group (p < .05). CONCLUSIONS: Navigation program-based care provided to primiparous mothers improved maternal health.

Do the change in ß-hCG values between the 0th and 4th days in tubal ectopic pregnancy treatment with a single-dose methotrexate (MTX) protocol predict the need for a second dose of MTX?

AIM: The single-dose methotrexate (MTX) regimen is effective and minimizes side effects but an additional second dose is needed in case of failure in an ectopic pregnancy (EP). We aimed to predict the additional MTX dose by evaluating the change in ß-hCG values between day 0 and day 4 in EPs with administered single-dose MTX regimen. METHOD: A total of 454 tubal EPs between 2013 and 2019 were evaluated retrospectively. Cases cured with a single dose of MTX without an additional dose were accepted as the control group, and cases under a single-dose regimen were cured by applying a second dose of MTX on the 7th day were accepted as the study group. Obstetric and demographic characteristics and the change in ß-hCG values compared in both groups. RESULTS: Age, body mass index (BMI), gravida, smoking, abdominal surgery, presence of IUDs, initial ß-hCG levels (0th day), and EP size were similar in both groups, but the presence of previous EP history was significantly higher in the study group. The change of ß-hCG from days 0 and 4 determined that a 20% increase predicts the need for a second dose of MTX with 72.4% sensitivity, and 87.8% negative predictive value (NPV). CONCLUSION: The single-dose MTX protocol is successful in 83.3% of convenient cases (as the control group), but an increase of 20% in ß-hCG between days 0 and 4 predicts the patients who need to be administered second-dose MTX, and thus, a double-dose MTX protocol will be achieved early.

A retrospective analysis of the women hospitalized and treated due to anemia caused by gynecological pathologies: the role of intravenous iron (ferric carboxymaltose) and blood transfusion in clinical practice.

BACKGROUND: Gynecological pathologies are an important cause of anemia in women. In this study, we aimed to evaluate women who had been hospitalized because of anemia (Hb level <10 g/dL) caused by gynecologic pathologies and treated with either intravenous iron (ferric carboxymaltose) or blood transfusion. METHODS: This retrospective cross-sectional study was performed in a tertiary care center. Women who were hospitalized with the diagnosis of anemia with Hb level<10 g/dL and abnormal uterine bleeding between March 2015- September 2017 in the gynecology clinic were enrolled in the study. Hemoglobin levels, hemoglobin changes, uterine pathology and treatment of patients were recorded and compared. RESULTS: One hundred and fifteen women received red blood cell transfusion and 100 women were treated with intravenous ferric carboxymaltose. The mean age of the women was 45.1±6.1 (22-57) years. Although the mean Hb levels were higher in the iv-iron replacement group at the end of the one month (P=0.001), the mean increase in Hb levels was similar between two treatment modalities (P=0.101). Among the anemic women who required surgery, iv iron replacement was the first choice in 75.9% of women; 34.1% received red blood cell transfusion in the preoperative period. CONCLUSIONS: Gynecological pathologies are a common cause of anemia in reproductive age women and intravenous carboxymaltose treatment is a safe and cheaper alternative of blood-transfusion in appropriate cases to elevate the Hb levels in the preoperative period.

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.

Do First-Trimester Subchorionic Hematomas Affect Pregnancy Outcomes?

OBJECTIVE: The aim of this study is to investigate the relationship between first trimester subchorionic hematomas and pregnancy outcomes in women with singleton pregnancies. MATERIAL AND METHODS: Between January 2018 and January 2019, patients who had a single pregnancy between the 6th and 14th weeks of their pregnancy and were hospitalized with the diagnosis of abortus imminens in the early pregnancy service were included in the study. According to the ultrasonographic examination, those with subchorionic hematoma and those with no hematoma were compared in terms of demographic data, pregnancy outcomes and pregnancy complications. RESULTS: 400 abortus immines cases with subchorionic hematoma and 400 abortus imminens cases without subchorionic hematoma were compared. Preterm delivery percentages were similar in both groups, however abortus percentage was significantly higher in the hematoma group (34.2 vs. 24.7%; p=0.007). In addition, it was revealed that the presence of subchorionic hematoma before the 20th gestational week increased the risk of miscarriage 1.58 times. However, no data could be found in the study that could correlate the size of the hematoma with pregnancy loss. CONCLUSION: The presence of subchorionic hematoma increases abortion rates in abortus imminens cases. And the presence of subchorionic hematoma in cases with ongoing pregnancy does not increase the complications of delivery.

Prediction of Rupture by Complete Blood Count in Tubal Ectopic Pregnancies Treated with a Single-Dose Methotrexate Protocol / Predição de ruptura por hemograma completo em gestações ectópicas tubárias tratadas com protocolo de dose única de metotrexato

Abstract Objective The availability of reliable and inexpensive markers that can be used to determine the risk of rupture during methotrexate (MTX) treatment in ectopic pregnancies (EPs) is considerable. The aim of the present study is to investigate the role of systemic inflammatory markers such as leukocytes (or white blood cells, WBCs), the neutrophil-to-lymphocyte ratio (NLR), and platelet distribution width (PDW), which are among the parameters of the complete blood count (CBC), in the prediction of rupture of EPs under MTX treatment. Materials and Methods A total of 161 patients with tubal EP who underwent a single-dose methotrexate (MTX) protocol were retrospectively analyzed, and the control group (n = 83) included patients cured by MTX, while the ruptured group (n = 78) included patients who were operated on for tubal rupture during the MTX treatment. The features of EP, beta-human chorionic gonadotropin (β-hCG) levels, sonographic findings, and CBC-derived markers such as WBC, NLR, and PDW, were investigated by comparing both groups. Results The NLR was found to be higher in the ruptured group, of 2.92 ± 0.86%, and significantly lower in the control group, of 2.09 ± 0.6%. Similarly, the PDW was higher (51 ± 9%) in the ruptured group, and it was significantly lower a (47 ± 13%) in the control group (p < 0.05). Other CBC parameters were similar in both groups (p > 0.05). Conclusion Systemic inflammation markers derived from CBC can be easily applied to predict the risk of tubal rupture in Eps, since the CBC is an inexpensive and easy-to-apply test, which is first requested from each patient during hospitalization.

Resumo Objetivo A disponibilidade de marcadores confiáveis e baratos que podem ser usados para determinar o risco de ruptura durante o tratamento com metotrexato (MTX) em gestações ectópicas (GEs) é considerável. O objetivo do presente estudo é investigar o papel de marcadores inflamatórios sistêmicos, como leucócitos (ou glóbulos brancos, glóbulos brancos), a relação neutrófilo-linfócito (NLR) e largura de distribuição de plaquetas (PDW), que estão entre os parâmetros do hemograma completo (hemograma), na predição de ruptura de PEs sob tratamento com MTX. Materiais e Métodos Foram analisados retrospectivamente 161 pacientes com EP tubária submetidas a protocolo de dose única de metotrexato (MTX), sendo que o grupo controle (n = 83) incluiu pacientes curadas com MTX, enquanto o grupo roto (n = 78) incluíram pacientes operadas por ruptura tubária durante o tratamento com MTX. As características de EP, beta-gonadotrofina coriônica humana (β-hCG), achados ultrassonográficos e marcadores derivados de CBC, como WBC, NLR e PDW, foram investigados comparando os dois grupos. Resultados A RNL foi maior no grupo roto, de 2,92 ± 0,86%, e significativamente menor no grupo controle, de 2,09 ± 0,6%. Da mesma forma, o PDW foi maior (51 ± 9%) no grupo roto, e foi significativamente menor a (47 ± 13%) no grupo controle (p < 0,05). Outros parâmetros do hemograma foram semelhantes em ambos os grupos (p > 0,05). Conclusão Marcadores inflamatórios sistêmicos derivados do hemograma podem ser facilmente aplicados para predizer o risco de ruptura tubária na Eps, uma vez que o hemograma é um exame de baixo custo e fácil aplicação, solicitado primeiramente a cada paciente durante a internação.

The effect of pre-pregnancy obesity on gut and meconium microbiome and relationship with fetal growth.

OBJECTIVE: To investigate the effect of pre-pregnancy obesity on maternal and newborn microbiomes and fetal growth. METHODS: Individuals who gained body weight in accordance with the recommendations during pregnancy and normal gestastional age are included in the study and were separated into two groups, normal (n = 20) and obese (n = 20), based on their body mass index (BMI) value of pre-pregnancy. Maternal stool samples collected during the first trimester of pregnancy and meconium samples collected at birth were evaluated using 16S rRNA gene-based microbiome analysis. RESULTS: The stool samples of mothers who were obese before pregnancy harbored a higher (59.9 versus 52.3%) relative abundance of Firmicutes and a lower (7.1 versus 4.1%) relative abundance of Proteobacteria than the stool samples of mothers with normal body weight pre-pregnancy. In contrast, in the meconium samples of mothers who were obese pre-pregnancy, compared to those of mothers who had a normal body weight pre-pregnancy, the phylum Firmicutes was less (56.0 versus 69.0%) abundant and Proteobacteria (9.0 versus 8.5%) was more abundant. There was a negative correlation between pre-pregnancy BMI, birth weight, weight/height ratio and alpha diversity indices (Shannon and Chao1). CONCLUSIONS: Pre-pregnancy obesity can affect pregnant and newborn gut microbiota, which might related to fetal growth of the newborn.

The effect of gestational weight gain on serum total oxidative stress, total antioxidant capacity and gut microbiota.

This study aimed to investigate the effect of gestational weight gain on total oxidative stress (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), dietary antioxidant intake, and the gut microbiome. The study was carried out on 40 pregnant women divided as follows: a) normal prepregnancy weight and gestational weight gain of 11.5-16.0 kg (n=10) b) normal prepregnancy weight and gestational weight gain of >16.0 kg (n=10) c) obese before pregnancy and gestational weight gain of 5-9 kg (n=10) and d) obese before pregnancy and gestational weight gain of >9.0 kg (n=10). Serum TOS and TAC levels, dietary antioxidant intake, and microbiome diversity of the gut microbiome were evaluated during the third trimester of pregnancy. A positive correlation was found between body mass index (BMI) in the third trimester and serum TOS levels and OSI. In women with normal prepregnancy weight, an increase in the Firmicutes and Bacteroidetes phyla was observed when gestational weight gain was above the recommended values (p<0.05). In women who were obese before pregnancy, an increase only in the Bacteroidetes phylum was observed when gestational weight gain was above the recommended values (p<0.05). A positive correlation was found between Firmicutes/Bacteroidetes and OSI, and a negative correlation was found between Firmicutes/Bacteroidetes and dietary antioxidant intake (p<0.05). Prepregnancy body weight, high serum TOS level, and dietary antioxidant intake are determinant factors for microbial diversity, with increased serum TOS levels caused by increased gestational weight gain.

Short-term Reproductive Outcomes of Nulliparous Women with Previous Ectopic Pregnancy.

OBJECTIVE: To determine the characteristics and subsequent pregnancy outcomes in patients with a previous ectopic pregnancy (EP). STUDY DESIGN: Descriptive-cross sectional study. PLACE AND DURATION OF STUDY: Department of Obstetrics-Gynaecology, Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey, between January 2014 and December December 2018. METHODOLOGY: The data of nulliparous patients diagnosed with tubal ectopic pregnancy (EP) was analysed retrospectively. Reproductive outcomes within the first two years after ectopic pregnancy diagnosis were used as "short-term" reproductive outcomes. Their EP treatment and pregnancy outcome were determined. RESULTS: Expectant management was chosen in 5.8% of the patients, while the surgical intervention was 32.3%. Medical therapy involving methotrexate (MTX) was given to the remaining patients (61.9%). The tubal rupture was confirmed in 12% of the cases that received MTX. In the 2-year follow-up period after the ectopic event, the most common outcome of the subsequent pregnancies was a live birth (47.7%). Recurrent EP occurred in 4.6%. CONCLUSION: The subsequent short-term pregnancy outcomes in this study were not related to the chosen treatment modality. KEY WORDS: Ectopic pregnancy, Nulliparity, Reproductive outcomes, Treatment modalities, Expectant management.

Maternal obesity and intra-abdominal adhesion formation at cesarean delivery.

OBJECTIVE: The aim of the study was to evaluate whether maternal obesity increases the risk of intra-abdominal adhesion formation at cesarean delivery. METHODS: Two hundred and two pregnant women of at least 37 weeks' gestation and who had undergone only one prior cesarean delivery were included in this prospective observational study. The study population was divided into two groups according to body mass index (BMI) upon cesarean delivery (<30 kg/m2 and ≥30 kg/m2). The intra-abdominal adhesion incidence and the scar characteristics of the groups were compared. RESULTS: Intra-abdominal adhesions were more common in women ≥30 kg/m2 than in those <30 kg/m2 (OR 2.0, 95% CI 1.1-3.6). BMI upon cesarean delivery (32.6 ± 6.2 kg/m2 vs. 30.5 ± 4.8 kg/m2, p = .018) and pre-pregnancy BMI (27.9 ± 6.8 kg/m2 vs. 25.7 ± 5.2 kg/m2, p = .026) were higher in women with dense adhesions than in those with either filmy or no adhesions. The omentum was the most adherent tissue, and the omental adhesion rate was also higher in women ≥30 kg/m2 than in those <30 kg/m2 (39.6% vs. 23.7%, p = .016). When the scar characteristics were compared, it was observed that the hyperpigmented scar rate was significantly lower (17.8% vs. 39.6%, p = .001) in women ≥30 kg/m2 with intra-abdominal adhesions (16.7% vs. 35.4%, p = .005). CONCLUSION: Intra-abdominal adhesion formation following cesarean delivery is more common in obese women.

Is there any role of interleukin-6 and high sensitive C-reactive protein in predicting IVF/ICSI success? A prospective cohort study.

OBJECTIVES: Studies have established a relationship between proinflammatory factors and implantation failure in IVF/ICSI cycles. Likewise, low-grade chronic inflammation is generally blamed for predisposing infertility. In the present study, we aimed to find a relationship between serum IL-6 and hs-CRP levels and IVF/ICSI cycle outcomes. METHODS: A total of 129 patients who consented to participate and attended the IVF unit of our department for the treatment of infertility have been enrolled in this prospective cohort study. Serum levels of high sensitive C-reactive protein and interleukin 6 have been detected at the beginning of the IVF/ICSI ovulation induction cycle. Cycle outcomes have been compared between patients with and without clinical pregnancy achievement following ART treatments. IVF/ICSI cycle outcomes of these two groups were also comparable except the number of >14 mm follicles, retrieved oocytes, metaphase II oocytes, and fertilized oocytes (2 pronuclei) which were in favor of the clinical pregnancy group. RESULTS: Mean serum hs-CRP levels were 3.08 mg/L (0.12-35.04) and 2.28 mg/L (0.09-22.52) patients with and without clinical pregnancy respectively. Mean serum IL-6 levels were 2 pg/mL (1-10.2) and 2 pg/mL (1-76.9) patients with and without clinical pregnancy respectively. Both tests were found to be statistically insignificant in predicting the success of the ART cycle in terms of implantation, clinical pregnancy, miscarriage, and live birth. CONCLUSIONS: In the present study, we have not found any significant effect of hs-CRP and IL-6 levels in the IVF cycle. However, in the light of this and previous studies, large-scale research may prove the exact influence of these markers on IVF success.

Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women

Objective: To compare the psychological resilience and anxiety levels of patients diagnosed with hyperemesis gravidarum (HG) and healthy pregnant women. Materials and Methods: A sociodemographic data form and the Resilience scale for Adults (RSA) and the State-Trait Anxiety Inventory (STAI) were administered. The sociodemographic data form was completed by the physician, and the RSA and STAI were completed by the participant. The sample of the study consisted of 60 pregnant women with HG and hospitalized and 97 healthy voluntary pregnant women with similar characteristics to the research group without any pregnancy complications. Data were evaluated using descriptive statistical analyses, the independent samples t-test, the Mann-Whitney U test and Pearson's correlation analysis. Results: The age range was 18-42 years for HG group and 20-43 years for control group. The average age of the HG group was 28.17±5.96 years and that of the control group was 29.45±5.83 years. There was no statistically significant difference between the groups in terms of pregnancy week. Regarding the prevalence of state and trait anxiety between the groups, it was found that 66.7% of the HG group had a high level of trait anxiety and 51.7% had a high level of state anxiety. It was found that 61.9% of the control group had a high level of trait anxiety and 38.1% had a high level of state anxiety. There was no difference between the healthy pregnant group and the HG group in terms of anxiety (p=0.125). It was found that there was a significant difference between the groups in terms of only sub-dimensions of RSA, which were perception of self (U=2385.00, p=0.044) and perception of future (U=2350.50, p=0.030). The perception of self and perception of future scores of the healthy control group were higher. Conclusion: There was no difference between the healthy pregnant group and the HG group in terms of anxiety. It was observed that the HG group had a lower perception of self and future. Apart from the usual increase in anxiety levels during pregnancy, HG accompanied by stubborn nausea and vomiting does not create an extra psychological burden, either as a cause or a result.

Histopathological examination of the curettage material in nonviable pregnancies and evaluation of the frequency of hydatidiform mole.

AIM: The study aimed to determine the frequency of possible missed diagnosis of gestational trophoblastic disease in nonviable pregnancies and to evaluate the importance of histopathological examination. METHODS: In this retrospective study, the results of the histopathological assessment of patients undergoing uterine surgery with a diagnosis of nonviable pregnancy were analyzed before 14 weeks of gestation. Nonviable pregnancy was defined as anembryonic pregnancy and intrauterine exitus (IU-ex) based on ultrasound findings. The frequency and sonographic characteristics of molar pregnancy in nonviable pregnancy were analyzed. RESULTS: Molar pregnancy was detected in 24 (1.62%) of 1481 patients diagnosed with nonviable pregnancy on ultrasound. One thousand one hundred and twenty-one of the cases were IU-ex (75.69%) and the remaining were anembryonic pregnancy (24.31%). The mean crown-rump length of pregnancies in the IU-ex group was 16.7 mm and the mean gestational age was 8 weeks. The average gestational sac diameter was found to be 26 mm in anembryonic pregnancy patients. The hydatidiform mole ratio was significantly higher in anembryonic pregnancy patients (3.06%) than in IU-ex patients (1.16%) (p = 0.013). CONCLUSIONS: The appearance of early molar pregnancy on ultrasound evaluation may mimic anembryonic pregnancies. Therefore, histopathological examination of anembryonic pregnancies may be useful in early diagnosis and for the treatment of gestational trophoblastic neoplasia.

The Effect of Disulfiram in the Prevention of Postoperative Adhesion Formation in an Experimental Rat Uterine Horn Model.

Postoperative adhesions can cause serious complications, including intestinal obstruction, chronic abdominopelvic pain, and infertility in women. Here we investigate the effects of disulfiram on the postoperative adhesion model. Female Wistar rats were used (n = 72). The animals were separated into six groups (12 rats per group): group 1 (control), group 2 (300 mg/kg disulfiram administered for 3 days preoperatively), group 3 (50 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 4 (300 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 5 (50 mg/kg disulfiram administered 14 days postoperatively only), and group 6 (300 mg/kg disulfiram administered 14 days postoperatively only). A histopathologic examination was performed. Immunohistochemical stainings for matrix metalloproteinase-2 and 9 (MMP-2, and MMP-9) and vascular endothelial growth factor (VEGF) were evaluated. The macroscopic adhesion scores were significantly lower in the disulfiram groups (groups 3, 4, and 6) compared to the control group (p < 0.05). Inflammation scores were lower in all groups receiving disulfiram, but only reached statistical significance in group 4 (p < 0.05). In the immunohistochemical evaluation of the groups, MMP-9 was significantly lower in group 5 than group 4 (p < 0.05). There was no significant difference between the groups for MMP-2 and VEGF. We found that disulfiram reduced postoperative adhesion formation. Disulfiram becomes more effective (by directly reducing inflammation) when initiated during the preoperative period at high doses.

Levels of glucagon-like peptide 1 in hyperemesis gravidarum.

Objective: Glucagon-like peptide 1 (GLP-1), a gut-derived peptide has been reported to have insulin-like effects. Our aim is to examine GLP1 levels in hyperemesis gravidarum (HEG). Materials-methods: The study population consisted of 2 groups: Group 1 (control subjects) consisted of 22 women with uncomplicated singleton pregnancies in the first trimester. Group 2 consisted of 22 singleton pregnancies complicated by HEG. Glucose and GLP1 levels were determined. Enzyme-linked Immunosorbent Assay Kit for Glucagon like Peptide 1 (GLP1) was used (Uscn, Life Science Inc.). Results: No significant differences in maternal age, gestational age and gravida were observed between hypermetric and control groups. Maternal serum GLP1 levels were significantly higher in HEG compared with control group (P = 0.004). Conclusion: The results of our study revealed that the presence of increased GLP1 levels in women with HEG could contribute to the pathogenesis of the disease. Our results indicated that increased GLP1 levels may be associated with hyperemesis gravidarum. The limitation of our study was the restricted number of patients. Large prospective and randomized studies are required to evaluate the effect of GLP1 levels on hyperemesis gravidarum.

The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to 404 Turkish obstetricians.

PURPOSE: To identify the factors that influence provider's decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. METHODS: We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. RESULTS: Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. CONCLUSION: Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Recurrent implantation failure is associated with increased levels of fetuin-A/alpha2-Heremans-Schmid-glycoprotein.

OBJECTIVE: Recurrent implantation failure is defined as the absence of implantation, after two or three consecutive cycles of in-vitro fertilization (IVF), intracytoplasmic sperm injection or frozen embryo replacement. Human fetuin-A/alpha2-Heremans-Schmid-glycoprotein is a plasma protein secreted by the liver that modulates insulin action in adipocytes. Increased fetuin-A promotes adipocyte dysfunction which results in decreased adiponectin and increased fatty acids and inflammatory cytokines. Fatty acids and inflammatory cytokines were previously reported in implantation failure. Also, fetuin-A inhibits receptor tyrosine kinase activity in trophoblast growth factors which decrease trophoblast viability and invasion. In this study, we aimed to find the association between fetuin-A and implantation failure. STUDY DESIGN: A total of 78 women were included in this case-control study. Serum fetuin-A concentrations were measured in 42 women with recurrent IVF failure and 36 healthy women with regular cycles. RESULTS: The mean serum fetuin-A levels of implantation failure and control women were 257.77 ± 32.18 and 219.59 ± 48.86 respectively with a p-value <0.001 (independent samples t-test). Our results showed a statistically significant difference between serum fetuin-A levels of implantation failure women and controls. CONCLUSION: So far reasons for implantation failure are only partially understood. The current study reveals the association between implantation failure and fetuin-A. Further studies with large population sizes are needed to investigate whether fetuin-A can be used as a marker before controlled ovarian stimulation began or regulation of fetuin-A levels with treatment or lifestyle interventions can improve implantation success.