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OBJECTIVE: To recalculate the estimated fetal weight (EFW) based on ultrasound measurements in patients complicated with isolated polyhydramnios, using 14 current formulas to observe which formula better predicts the EFW. METHODS: This study examined pregnant women who gave birth in the hospital between January 2015 and January 2020. Maximum vertical pocket (MVP) was classified as, mild, moderate, and severe polyhydramnios, and the patients' measurements were reanalyzed using 14 formulas. The estimation of birth weight (EBW) alongside observed birth weight (OBW) facilitated the computation of statistical indices, namely the mean absolute percentage error (MAPE) expressed as [(EBW - OBW)/OBW × 100], the mean percentage error (MPE) denoted as (EBW - OBW)/(OBW × 100), and their corresponding 95% confidence intervals. RESULTS: A total of 564 polyhydramnios patients were included in the study. When looking at the MAPE, the lowest rate (7.65) was found in the Hadlock 2 formula. Hadlock 1, Hadlock 3, and Shinozuka formulas demonstrated MAPE values most closely aligned with Hadlock 2. Weiner I and Thurnau were the formulas with the highest MAPE values. When the cut-off values for MAPE were taken as 10%, 4/14 of the formulas (Weiner I-II, Vintzleos and Thurnau) gave results above 10%. Among 14 formulas, 3 (21.4%) had positive (sonographic overestimation) (Hadlock 3, Shinozuka, and Vintzleos) and the other 11 (78.6%) had negative MPE (sonographic underestimation). CONCLUSION: The Hadlock 2 formula had the lowest MAPE in predicting birth weight in patients with polyhydramnios, closely followed by the Hadlock 1, Hadlock 3, and Shinozuka formulas.
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AIM: Familial Mediterranean fever (FMF) is the most common inherited autoinflammatory disease in the world. There are known triggers to initiate an FMF attack, yet potential effects of intrauterine devices (IUD) in women of reproductive age have not been evaluated before. METHOD: Consecutive female patients with FMF who ever used IUD over the age of 18 were enrolled. Female patients with FMF were sub grouped according to the type of IUD they use. FMF attack frequency, severity, duration, presence of dysmenorrhea, severity of dysmenorrhea, having attacks during menstruation before and after IUD use were questioned. Demographic and clinical data were collected from hospital database. RESULTS: When all patients with IUD use were evaluated, it was found that the frequency of attacks increased after IUD insertion at 3rd and 12th months (median [min-max] attack frequency at 3rd month, 1 (0-3) vs 1 (0-6), p = 0.002, median [min-max] attack frequency at 12th month, 2 (0-12) vs 3.5 (0-18), p = 0.028). Attack severity measured by VAS pain was also significantly increased. Attack duration and menstrual pain was similar before and after IUD use. Attack frequency at 3rd and 12th months, attack severity and menstrual pain was all increased significantly in Cu-IUD users, whereas none of these parameters deteriorated in LNG-IUD group. CONCLUSION: IUD use, especially Cu-IUD, may increase the frequency and severity of attacks in female patients with FMF. Clinicians may benefit from considering LGN-IUD if IUDs are preferred as contraception in women of childbearing age with FMF.
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Anticoncepcionais Femininos , Febre Familiar do Mediterrâneo , Dispositivos Intrauterinos de Cobre , Dispositivos Intrauterinos , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Dismenorreia/etiologia , Febre Familiar do Mediterrâneo/complicações , Dispositivos Intrauterinos/efeitos adversos , Anticoncepção , Dispositivos Intrauterinos de Cobre/efeitos adversosRESUMO
OBJECTIVE: Our aim was to investigate the significance of cerebro-placento-uterine ratio CPUR, a new Doppler index, and fetal cardiac parameters (Mod MPI, EFT) in early-onset preeclampsia (EOPE) and to examine whether these parameters are related to perinatal outcome. STUDY DESIGN: Forty participants diagnosed with EOPE (preeclampsia cases diagnosed before 34 weeks of gestation) and 40 healthy pregnant women were included in this study. Demographic data were recorded. Doppler parameters such as middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (Ut-A), and left modified myocardial performance index (Mod-MPI) and epicardial fat thickness (EFT) were measured. Cerebroplacental ratio (CPR) was determined by dividing MCA pulsatility index (PI) by UA PI. CPUR was calculated as the ratio of CPR to mean UtA-PI (CPUR = CPR/UtA-PI). All parameters were compared between the EOPE and control groups. Correlation tests were used to examine the relationship between Doppler parameters and perinatal outcome. p values less than 0.05 were considered statistically significant. RESULTS: The pulsatility index of the middle cerebellar artery, CPUR and CPR values were statistically lower in the EOPE group than in the control group (p = 0.002; p = <0.001; p = <0.001; respectively). No statistical differences were found between groups for isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), left mod-MPI, EFT (p = 0.117; p = 0.093; p = 0.398; p = 0.882; p = 0.202, respectively). Umbilical artery Doppler pulsatility index (PI), mean uterine artery Doppler pulsatility index (PI), were higher in the EOPE group than in the control group (p = 0.006; and p = <0.001, respectively). The CPUR value for predicting EOPE was ≤1.3652 with 74. 4% sensitivity and 94.9% specificity. Positive correlations were found between CPUR, CPR, and some neonatal parameters. CONCLUSION: CPUR, a new index combining fetal and uterine Doppler indices, may add contribution to predict adverse perinatal outcome and EOPE.
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Artéria Cerebral Média , Placenta , Pré-Eclâmpsia , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Artérias Umbilicais , Artéria Uterina , Humanos , Feminino , Gravidez , Ultrassonografia Pré-Natal/métodos , Adulto , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/diagnóstico por imagem , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/fisiopatologia , Ultrassonografia Doppler/métodos , Artérias Umbilicais/diagnóstico por imagem , Artérias Umbilicais/fisiopatologia , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Placenta/diagnóstico por imagem , Placenta/irrigação sanguínea , Coração Fetal/diagnóstico por imagem , Coração Fetal/fisiopatologia , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Fluxo Pulsátil/fisiologiaRESUMO
PROBLEM: In the current study we aimed to investigate Syndecan 1 (SDC1) levels in pregnant women diagnosed with fetal growth restriction (FGR) and the relationship between SDC1 levels and clinical and doppler parameters in FGR cases associated with endothelial dysfunction, angiogenesis and uteroplacental insufficiency METHOD OF STUDY: A total of 90 pregnant women included in the study, (45 with FGR, 45 healthy control) matched by week of gestation and maternal age. Venous blood samples were collected and plasma concentrations of SDC1 were determined by a specific immunoassay. Doppler examination was performed to evaluate the relationship between the SDC1 levels and placental blood supply. RESULTS: Doppler parameters; mean UtA-PI (p < .001), CPR (p = .002) and CPUR (p < .001) were different between the groups, however MCA PI, umbilical artery PI and umbilical artery S/D were not (p > .05). While gestational age at delivery, birth weight, APGAR score at 1 and 5 min were significantly lower (all, p < .001) in the study group, non-reassure fetal heart rate tracing (p = .09) and NICU admission (p = .02) were significantly higher. SDC 1 level was 2,00 ± 1,47 ng/mL and 2,34 ± 1,12 ng/mL in the FGR and control groups, respectively (p = .008). In the study group SDC 1 level was 1,69 ± 2,00 in those with gestational age below 32 weeks and 2,13 ± 1,18 in those with gestational age above 32 weeks and there was a statistically significant difference between the groups (p = .015). Plasma SDC 1 concentration of 2,1850 ng/mL or less had a sensitivity of 70%, a specificity of 72%, area under the ROC curve .65 (p < .005). CONCLUSIONS: Low maternal plasma SDC1 level may be associated with placental insufficiency and FGR. Low levels of SDC1 may be helpful as a predictor for the development of FGR during gestation.
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Biomarcadores , Retardo do Crescimento Fetal , Sindecana-1 , Humanos , Sindecana-1/sangue , Retardo do Crescimento Fetal/sangue , Feminino , Gravidez , Adulto , Biomarcadores/sangue , Idade Gestacional , Recém-Nascido , Artérias Umbilicais/diagnóstico por imagem , Placenta/metabolismo , Endotélio Vascular/fisiopatologiaRESUMO
OBJECTIVE: The aim of this study was to investigate the predictive value of inflammation parameters and indices measured in the first trimester for the detection of preeclampsia. MATERIALS AND METHODS: In this retrospective analysis, we examined the medical records of 276 eligible pregnancies at a tertiary referral center from 2022 to 2023. The cases were categorized into the Control group (n = 171), the Mild Preeclampsia group (n = 63), and the Severe Preeclampsia group (n = 42). We examined the demographic characteristics and perinatal outcomes of all participants. Additionally, we analyzed laboratory parameters, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII) (neutrophil*platelet/lymphocyte), systemic inflammation response index (SIRI) (neutrophil*monocyte/lymphocyte), pan-immune inflammation value (PIV) (neutrophil*platelet*monocyte/lymphocyte), and the ß-hCG to PAPP-A ratio in the first trimester. Receiver operating characteristic curve (ROC) analysis was conducted to identify the optimal cut-off levels for inflammatory markers in predicting preeclampsia. RESULTS: SIRI and PIV exhibited statistical significance in differentiating between the preeclampsia and control groups for predicting preeclampsia. The determined cut-off value for SIRI was 1.5, providing a sensitivity of 56.2% and a specificity of 55.6% (p = 0.012). Likewise, the cut-off value for PIV was 394.4, with a sensitivity of 55.2% and a specificity of 55% (p = 0.013). NLR, PLR, MLR, SII, and ß-hCG to PAPP-A ratio could not predict preeclampsia. CONCLUSIONS: This study suggests that SIRI and PIV hold promise as potential tools for predicting the risk of preeclampsia during the first trimester.
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Monócitos , Pré-Eclâmpsia , Feminino , Gravidez , Humanos , Neutrófilos , Pré-Eclâmpsia/diagnóstico , Primeiro Trimestre da Gravidez , Proteína Plasmática A Associada à Gravidez , Estudos Retrospectivos , Inflamação/diagnóstico , LinfócitosRESUMO
OBJECTIVE: While there's a growing data on the comparison of GnRH agonist and GnRH antagonist protocols, no clear study exists on the effects of both protocols on the same patient. The aim of the present study was to compare the success rates of protocol shift and proceeding with the same protocol after an unsuccessful intracytoplasmic sperm injection (ICSI) cycle. MATERIALS AND METHODS: Three hundred and forty-five normal responder patients who had a previously failed ICSI cycle between January 2011 and December 2015 were reviewed. The study (n = 73) and control (n = 93) groups in the first cohort were composed of patients whose protocol were shifted to antagonist and who proceeded with agonist. The study (n = 33) and control (n = 146) groups in the second cohort were composed of patients whose protocol were shifted to agonist and who proceeded with antagonist. RESULTS: Total dose of gonadotropins, maximum estradiol levels, and number of oocytes collected were significantly higher in agonist protocol than in antagonist protocol (P = 0.021, P = 0.013, and P = 0.003, respectively). Cycle cancellation rates were significantly lower in agonist protocol than antagonist protocol (P = 0.005). The pregnancy rates in patients who shifted to antagonist and proceeded with agonist were 57.8% and 50.8%, respectively (P = 0.399). The pregnancy rates in patients who shifted to agonist and proceeded with antagonist were 33.3% and 47.9%, respectively (P = 0.202). CONCLUSION: Protocol shift following a failed ICSI cycle with either agonist or antagonist protocol does not affect outcome.