The effect of progesterone supplementation in women with threatened miscarriage on fetal fraction in non-invasive prenatal testing: A matched case-control study.

AIM: To evaluate the effect of progesterone use on fetal fraction (FF) in non-invasive prenatal testing (NIPT) due to the threat of first trimester miscarriage. METHODS: This case control study included the pregnant who were referred to our clinic for non-invasive prenatal testing. The patients were categorized into three groups: Pregnant women with vaginal bleeding and using progesterone, pregnant women with vaginal bleeding and not using progesterone, and pregnant women without bleeding. The groups were formed by matching gestational week. Women with multiple pregnancy, BMI (body mass index) ≥25, abnormal fetal karyotype, and chronic disease were excluded from the study. Maternal characteristics, FF of the NIPT were recruited from the computer based medical records. RESULTS: A total of 10,275 NIPT tests were performed during the study period. 3% of the patients (n = 308) were found at risk of miscarriage. 100 patients with a vaginal bleeding and 50 control patients were matched. The median value of the fetal fraction ratio was found to be 6.55 in pregnant women without vaginal bleeding, 7.05 in pregnant women who had vaginal bleeding and using progesterone, and 7.3 in pregnant women who had vaginal bleeding and did not use progesterone. Although the fetal fraction ratio was found to be higher in pregnant women with vaginal bleeding and lower in progesterone users, this situation could not reach the level of statistical significance (p = 0.351). CONCLUSIONS: The fetal fraction rate in maternal blood is not affected in pregnant women who use progesterone due to vaginal bleeding in early gestational weeks.

Diagnostic accuracy of pre-induction cervical elastography, volume, length, and uterocervical angle for the prediction of successful induction of labor with dinoprostone.

PURPOSE: The study's aim is to define among a group of ultrasonographic cervical measurements a candidate parameter predictive of successful of induction of labor in term pregnancies with unfavorable cervix. METHODS: This prospective observational study included 141 pregnant women at term with an unfavorable cervix (Bishop score ≤ 6). All patients underwent clinical and ultrasonographic cervical evaluation before dinoprostone induction. Pre-induction cervical assessments included the Bishop score, cervical length, cervical volume, uterocervical angle, and cervical elastographic parameters. Vaginal delivery (VD) was accepted as successful dinoprostone induction. Multivariate logistic regression was conducted to identify the potential risk factors significantly associated with CS while controlling for possible confounding variables. RESULTS: The vaginal delivery rate was 74% (n = 93) and the cesarean section (CS) rate was 26% (n = 32). Sixteen patients who had a cesarean section due to fetal distress before the active phase of labor were excluded from the study. The mean induction-to-delivery interval was 1176.1 ± 352 (540-2150) for VD and 1359.4 ± 318.4 (780-2020) for CS (p = 0.01). Bishop score was lower in women with cesarean section (p = 0.002). When both groups were compared in terms of delivery type, no difference was found between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. Multivariable logistic regression model failed to show significant differences between cervical elastography values, cervical volume, cervical length, and uterocervical angle measurements. CONCLUSION: Cervical length, cervical elastography, cervical volume, and uterocervical angle measurements did not provide a clinically useful prediction of outcomes following labor induction in our study group with unfavorable cervix. Cervical length measurements significantly predicted the time interval from induction to delivery.

Modified myocardial performance index for evaluation of fetal heart function and perinatal outcomes in intrahepatic pregnancy cholestasis.

This study aims to evaluate cardiac function in cases of intrahepatic cholestasis of pregnancy (ICP) and compare results with those from healthy controls using the fetal left ventricular modified myocardial performance index (LMPI) and E-wave/A-wave peak velocities (E/A ratio). Moreover, the association between LMPI values, total bile acid (TBA) levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. A prospective cross-sectional study of 120 pregnant women was conducted, with 60 having ICP and the other 60 serving as controls. Doppler ultrasound and two-dimensional gray-scale fetal echocardiography were used to calculate the LMPI values and E/A ratios, respectively. The association between LMPI values and TBA levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. Fetal LMPI values were significantly higher in the ICP group than in the control group (0.54 ± 0.54 vs. 0.44 ± 0.03; p < 0.001), but the E/A ratio was similar in both groups (0.69 ± 0.10 vs. 0.66 ± 0.14; p = 0.203). TBA levels were positively and significantly correlated with LMPI values (r = 0.546, p < 0.01); however, no significant correlation was found between umbilical arterial pulsatility index values and LMPI values (r = 0.071, p > 0.01). LMPI values were not associated with adverse neonatal outcomes in ICP cases. Fetal cardiac function (LMPI) is associated with increased bile acid levels in ICP. However, because it was not associated with adverse neonatal outcomes in ICP cases, the clinical significance of this finding is unclear. Further studies are required to evaluate the implications of increased LMPI.

Prediction model for residual high-grade cervical intraepithelial lesions.

BACKGROUND: The aim of the study was to evaluate risk factors associated with high-grade cervical intraepithelial lesions (HSIL) in patients undergoing a second cervical excision procedure due to positive surgical margins and to create a prediction model for residual disease. METHODS: This study included patients with HSIL positive surgical margins following loop electrosurgical excision procedures (LEEP) between March 2015 and August 2019. HSIL in the second cervical excision pathology in these patients was accepted as residual disease. For residual disease prediction, a multivariate logistic regression and stepwise elimination analysis of 14 variables including demographic characteristics, clinical characteristics, pathology results and HPV genotypes of the patients was performed. RESULTS: Second cervical excision procedures were performed in 290 patients 85(29.4%) of these patients had CIN 2 (cervical intraepithelial neoplasia) and 205 (70.6%) had CIN 3. In the second excision procedure, 166 patients (57.2%) had ≤CIN 1, 124 patients (42.8%) had ≥CIN2. The prediction model of residual disease includes only 3 variables out of the 14 different clinical characteristics (AUC=0.605 [0.539-0.671]). These variables are gravida (adjusted OR: 1.15 [0.97-1.38], P=0.107), CIN2-3 presence in the endocervical canal in the first LEEP specimen (adjusted OR: 1.52 [0.94-2.47], P=0.091) and the presence of HR-HPV except 16/18 lesions (adjusted OR: 0.64 [0.38-1.06], P=0.083). CONCLUSIONS: A prediction model was designed with our data, from variables reported to be risk factors for residual disease in previous studies. While this model was statistically significant, it was poor at distinguishing residual disease. A prediction model can be designed to guide clinicians with future studies.

Could laparoscopic cystectomy improve intrauterine insemination with controlled ovarian hyperstimulation outcomes in women with endometrioma?

OBJECTIVES: To clarify the effects of laparoscopic cystectomy of endometriomas on intrauterine insemination with controlled ovarian hyperstimulation (COH + IUI) success in women with the disease. MATERIAL AND METHODS: We performed a retrospective study with endometrioma patients having at least one patent fallopian tube. The study group consisted of 57 infertile patients with a history of laparoscopic cystectomy who underwent 83 COH + IUI cycles. The control group consisted of 88 patients with endometrioma who underwent 161 COH + IUI cycles without surgery. RESULTS: The total number of antral follicles was significantly lower in the study group than in the control group (10.1 ± 5.1 vs 11.9 ± 5.0; p = 0.008). No significant difference was observed in the clinical pregnancy and live birth rates per cycle ((9.6% vs 7.6%; p=0.7175 OR: 1.195% CI: 0.6-2.1) and (7.2% vs 6.2%; p = 0.9544 OR: 1.1 95% CI: 0.5-2.1), respectively) between the operated and non-operated groups. CONCLUSIONS: The results of the study show that the presence of an endometrioma with at least one patent fallopian tube does not require any cystectomy before COH+IUI treatment because no improvement was observed in the treatment outcomes of the patients who underwent preceding surgery. We conclude that an operation may be taken into consideration when malignancy cannot be ruled out or severe pelvic pain related to endometrioma cannot be relieved.

Can platelet indices be of value in pregnant women with malaria?

Malaria infection in pregnancy is a serious disease with feto-maternal adverse outcomes. In this study we evaluated and compared the haematologic parameters of pregnant women with and without malarial infection. This case-control study included a total of 145 participants (59 pregnant women with malaria and 86 aparasitemic pregnant women). Haematological parameters were evaluated using an automated hemo-analyser. Haemoglobin, platelet, white blood cell and platelet distribution width (PDW) of pregnant women with malaria were found to be significantly lower than pregnant without malaria. However, the mean platelet volume (MPV) of pregnant women with malaria was significantly higher than those without infection.Impact StatementWhat is already known on this subject? Malaria infection in pregnancy is a serious disease and may affect haematological parameters.What do the results of this study add? Platelet indices were significantly changed in malaria. Especially mean platelet volume (MPV) with malaria was significantly higher than those without infection.What are the implications of these findings for clinical practice and/or further research? Among the expected differences in haematologic parameters of pregnant women with malaria, the increase in MPV has been a novel finding. The increase in MPV level of pregnant with malaria should be investigated further to address the value of MPV as a prognostic factor.

Comparison of Maternal, Perinatal, and Neonatal Outcomes of Asymptomatic and Symptomatic Pregnant Women with Coronavirus Disease-2019.

Objective: This study aimed to compare the postpartum outcomes of asymptomatic and symptomatic patients with coronavirus disease-2019 (COVID-19). Methods: This retrospective cohort study included pregnant women with COVID-19. Pregnant women were categorized into two sets as asymptomatic and symptomatic according to their clinics at the time of application. COVID-19 was diagnosed using the real-time reverse transcriptase-polymerase chain reaction on the oropharyngeal and nasopharyngeal swabs. Asymptomatic and symptomatic patients were compared in terms of maternal and perinatal outcomes. Results: Our study population consisted of 20 asymptomatic and 41 symptomatic patients with laboratory-confirmed COVID-19. The rate of primary cesarean section was more than twice in the symptomatic group (51.2%) than that of the asymptomatic group (20%) (p=0.019). Both groups are quite similar in terms of maternal [respiratory support, COVID-19- related treatment, and intensive care unit (ICU) admission], perinatal (preterm delivery, preterm premature rupture of membrane, preeclampsia, and mode of delivery), and neonatal outcomes [birth weight, Apgar scores, neonatal ICU (NICU) admission]. The rate of total cesarean section in the asymptomatic group (75%) was statistically similar to the symptomatic group (83%) (p=0.464). The NICU admission rate was found to be similar in the asymptomatic (54.2%) and symptomatic groups (50%) (p=0.858). However, NICU admissions were more frequent in the symptomatic group due to respiratory distress (p=0.032). The breastfeeding rate is higher in the asymptomatic pregnant group as expected (p=0.015). Additionally, the ferritin level was significantly lower in the asymptomatic group (p=0.006). Conclusions: The rate of primary cesarean section is quite high in symptomatic patients with COVID-19. Additionally, the total cesarean section rate was extremely high in both groups. We expected more adverse outcomes in symptomatic patients; however, we found similar maternal, perinatal, and neonatal outcomes between both groups.

Can prepartum platelet indices be a parameter to predict postpartum hemorrhage?

OBJECTIVE: Postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide. It has been demonstrated that certain platelet parameters are indicative of platelet reactivity. The aim of this study was to determine whether antenatal platelet indices can be used as risk factors in the prediction of primary PPH. METHODS: This comparative case-control study involved 3207 pregnant women at term who were recruited over one year period in Istanbul. Postpartum hemorrhage, defined as blood loss ≥1000 mL within 24 h after delivery. The study group consisted of 42 patients who developed primary PPH after vaginal delivery without defined risk factors. The patients in the control group were matched with age, parity, body mass index (BMI), and hemoglobin value. Platelet indices - platelet count, mean platelet volume (MPV), platelet distribution width, and plateletcrit were measured prior to delivery and evaluated for the prediction of PPH. RESULTS: Prepartum MPV and PDW values were determined to be lower in the patients with in the PPH group, when compared to the healthy group (respectively, p < .001 and p < .004). By receiver-operating characteristic analysis, MPV and PDW were able to distinguish between patients with and without any bleeding (respectively, AUC 0.823, 95% confidence interval (CI) 0.735-0.912, (AUC) 0.682, 95% CI 0.569-0.795). Prepartum MPV (cutoff = 10.95 fL) had a high AUC (>0.8) for predicting PPH, with a specificity of 81% and sensitivity of 69%. CONCLUSION: Results suggest a novel hypothesis that pre-delivery lower MPV value may be used predicting PPH.

The effects of exogenous oral micronized progesterone on first trimester aneuploidy screening markers in women with threatened miscarriage: a matched case control study.

OBJECTIVES: To evaluate the effect of using progesterone due to early vaginal bleeding on aneuploidy screening markers in the first trimester. MATERIAL AND METHODS: This case control study includes the pregnant women who applied to our clinic in order to have a screening test for Down syndrome in the weeks of 11°/7-136/7. The patients were divided into three groups. Self reported vaginal bleeding with progesterone therapy (Bl+, Prg+, n:70), Self reported vaginal bleeding without progesterone therapy (Bl+, Prg-, n:70) and as a control group pregnant women who had no vaginal bleeding. (NoBl, NoPrg, n:70). In all patients, free beta-human chorionic gonadotrophin (ß-hCG), pregnancy associated plasma protein-A (PAPP-A) levels and nuchal translucency (NT) thickness were analyzed. Mean MoMs of the markers were compared between three groups. RESULTS: In the two groups with vaginal bleeding (Bl+, Prg + and Bl+, Prg-) the free ß-Hcg MoM values were statistically higher (1.22 ± 0.72, 0.98 ± 0.45, respectively) compared to the No Bleeding/No Progesterone group (0.81 ± 0.52) (p ≤ 0.001, p ≤ .01, respectively). However, no significant difference was found between the free ß-hCG MoM value of women with Bl+, Prg + group (1.22 ± 0.72) and Bl+, Prg - group (0.98 ± 0.45). (p: .053, significance level limitation with Bonferroni correction p: .017). PAPP-A and NT thickness did not differ significantly between the groups. CONCLUSION: Our data did not find an association between the use of oral progesterone and any alternations in first trimester screening parameters. Regardless of the progesterone usage, vaginal bleeding in the first trimester pregnancies increased the free ß-hCG MoM values compared to pregnancies without vaginal bleeding during pregnancy.

Comparison of transendometrial myomectomy versus conventional myomectomy in cesarean section.

OBJECTIVE: To compare the surgical results of transendometrial myomectomy (TEM) and conventional myomectomy (CM) procedures for fibroid in cesarean section. MATERIAL AND METHODS: This retrospective study was conducted with computer-based medical records of patients who underwent myomectomy during cesarean section between January 2013 and March 2019. During the study period, 41 patients underwent transendometrial myomectomy, and 52 patients with had conventional myomectomy. In all patients included in the study, myoma was single, intramural, and localized in the anterior of the uterus. RESULTS: The total duration of surgery was shorter in the TEM group than in the CM group (50,5 ± 10 min vs 63,6 ± 15,2, p = 0,001). There was no difference in terms of length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement and postoperative fever (respectively, p = 0,65, p = 0,81, p = 0,33 and p = 0,9). Patients who underwent TEM (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent CM (1,76 ± 1,1) (p = 0,001). CONCLUSION: Transendometrial myomectomy technique seems to be more advantageous in selected patients compared to the conventional technique due to the shorter operation time.

Comparison of life quality between geriatric patients who underwent reconstructive surgery and obliterative surgery for pelvic organ prolapse.

OBJECTIVES: Pelvic organ prolapse (POP) adversely affects women's quality of life. The aim of this study is to compare the life quality after obliterative surgery and reconstructive surgery for geriatric patients with advanced pelvic organ prolapse. MATERIAL AND METHODS: This matched case control study included sexually inactive women aged 65 years or older who had vaginal surgery for pelvic organ prolapse in Tepecik Education and Research Hospiltal between August 2012 and June 2019. Life quality of women who had undergone obliterative or reconstructive vaginal surgery were evaluated and then compared by Turkish validated prolapse quality of life questionnaire (P-QOL). Patients in obliterative and recontructive surgical procedures were matched according to age, body mass index and POP stage and each group included 49 women. RESULTS: P-QOL scale domains, including prolapse impact (26.6 ± 12.1 vs 34.1 ± 16.2; p = 0.01), physical/social limitations (28.3 ± 12.8 vs 34.8 ± 14.4; p = 0.02) and severity measures (24.9 ± 12.6 vs 30.5 ± 13,4; p = 0.035) revealed significantly lower postoperative deterioration in the obliterative group. No significant difference was found in other P-QOL domains. The mean operation time in the obliterative group was shorter than the reconstructive group (respectively; 69.2 ± 21.5 min, 79.7 ± 29.4, p = 0.04). There were no significant differences in estimated blood loss, length of hospital stay and intraoperative complications. CONCLUSIONS: Obliterative surgery is a suitable option in the treatment of advanced pelvic organ prolapse in elderly patients.

Educational Features of YouTube Videos Depicting Breastfeeding: Quality, Utility, and Reliability Analysis.

Objective: In this study, we aimed to evaluate the quality, reliability, and utility of breastfeeding videos on YouTube. Materials and Methods: We conducted a YouTube search with the keyword "breastfeeding education" and limited our search results to the first 200 videos. After exclusion criteria, 165 videos were investigated. The viewer parameters including likes, dislikes, the total number of views, comments, and source of the videos were evaluated. The educational content of the videos was evaluated with the Global Quality Score. In addition, the popularity of the videos was assessed with the video power index (VPI). Upload sources were categorized as the academic institutions and individual users. Results: There were 134 (81.2%) videos in group 1 (poor and suboptimal quality videos) and 31 (18.8%) videos in group 2 (good and excellent quality videos). The mean number of views, likes, and comments were 96.212 ± 198.445, 241.2 ± 310.2, and 45.3 ± 67.9, respectively, in group 1, and 203.057 ± 388.722, 474.1 ± 560.6, and 63.6 ± 98, respectively, in group 2. Comparing both groups, the length of good-excellent videos was longer than poor-suboptimal videos. There were no differences between groups based on number of comments and number of dislikes. In addition, VPI values in group 2 were statistically higher than those in group 1 (p < 0.001). Conclusions: Only ∼18.8% of YouTube videos presenting breastfeeding education were good or excellent. YouTube videos depicting breastfeeding were a limited source for the patients.

The impact of concurrent HPV infections on the presentation of high grade cervical intraepithelial lesions.

OBJECTIVES: We investigate how concurrent high-risk (hr) HPV (human papillomavirus) genotypes affect CIN2-3 risk and evaluate the relationship of different genotype combinations with cervical epithelial lesions. MATERIAL AND METHODS: This study included HPV positive patients between the ages of 30 and 60 who underwent liquid-based cervical smears and HPV screening through community-based, cervical cancer screening programs between June 2015 and June 2017. The impact of the increase in hrHPV types was calculated by estimating how it changed the odds ratio of CIN2-3 risk. RESULTS: The rate of multiple concurrent HPV infections was 48.7% in the CIN2-3 group and 58.4% in the CIN1 group. Among patients in the CIN2-3 and CIN1 groups, the most common HPV coinfection was respectively HPV 16+31 and HPV 16+51. The HPV 51 ratio in CIN1 patients was 28.9% and the HPV 51 ratio in the CIN2-3 patient was 6.6%. With every increase in the number of hrHPV infection types, the frequency of CIN2-3 decreased [OR: 0.72, 95% CI: 0.54-0.95]. For all hrHPV combinations, the addition of HPV 16 was associated with a higher risk of CIN2-3. CONCLUSIONS: An increase in number of hrHPV types is associated with lower CIN2-3 risk. Further cohort studies with larger samples are needed to clarify this relationship. The available evidence suggests that HPV 16 genotype plays an important role in patients with high-grade cervical lesions and has a negative impact on the cervix in concurrent multiple HPV infections.

Evaluation of maternal serum ischemia modified albumin and total antioxidant status in ectopic pregnancy.

BACKGROUND: Ectopic pregnancies constitute about 2% of all pregnancies which are the leading cause of pregnancy-related deaths and a considerable cause of maternal morbidity. Oxidative stress can lead to a number of pregnancy related diseases including miscarriage, eclampsia and preterm labor. Ischemia modified albumin (IMA) which reflects the oxidative stress may be used as a marker for ectopic pregnancy. Our aim was to compare the levels of IMA and total antioxidant status (TAS) in ectopic and normal pregnancies and to understand if IMA can be used as a marker to diagnose ectopic pregnancy. MATERIALS AND METHODS: Our case-control study consisted of 38 women with ectopic and 42 women with normal pregnancy. IMA and TAS levels were determined in serum samples with an albumin-cobalt binding test and by commercially available kits, respectively. IMA levels were adjusted according to serum albumin levels. Index of oxidation (IOS) was calculated by dividing adjusted IMA (A-IMA) levels with TAS. A receiver operating characteristics (ROC) curve analysis was made and cut-off values for the biomarkers were investigated in SPSS 21.0 program (SPSS, Chicago, IL). Data were presented as mean ± standard deviation and a p value < .05 was accepted as statistically significant. RESULTS: There was a statistically significant difference in IMA, A-IMA, and IOS levels between ectopic and normal pregnancies. Although TAS level was not different statistically, it was lower in ectopic pregnancy. According to ROC curve analysis, IOS had the largest area under curve. A cut-off value of 0.545 for IOS had 81.6% sensitivity and 59.5% specificity. CONCLUSIONS: According to our study, oxidative stress plays an important role in ectopic pregnancy and either A-IMA or IOS can be evaluated as a marker of ectopic pregnancy after further studies.