Plasma metabolomics for diagnostic biomarkers on ectopic pregnancy.

Metabolomics is a relatively novel omics tool to provide potential biomarkers for early diagnosis of the diseases and to insight the pathophysiology not having discussed ever before. In the present study, an ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) was employed to the plasma samples of Group T1: Patients with ectopic pregnancy diagnosed using ultrasound, and followed-up with beta-hCG level (n = 40), Group T2: Patients with ectopic pregnancy diagnosed using ultrasound, underwent surgical treatment and confirmed using histopathology (n = 40), Group P: Healthy pregnant women (n = 40) in the first prenatal visit of pregnancy, Group C: Healthy volunteers (n = 40) scheduling a routine gynecological examination. Metabolite extraction was performed using 3 kDa pores - Amicon® Ultra 0.5 mL Centrifugal Filters. A gradient elution program (mobile phase composition was water and acetonitrile consisting of 0.1% formic acid) was applied using a C18 column (Agilent Zorbax 1.8 µM, 100 x 2.1 mm). Total analysis time was 25 min when the flow rate was 0.2 mL/min. The raw data was processed through XCMS - R program language edition where the optimum parameters detected using Isotopologue Parameter Optimization (IPO). The potential metabolites were identified using MetaboAnalyst 5.0 and finally 27 metabolites were evaluated to be proposed as potential biomarkers to be used for the diagnosis of ectopic pregnancy.

Risk factors for antibiotic therapy failure in women with tubo-ovarian abscess: A systematic review and meta-analysis.

AIM: Medical therapy with antibiotics only and surgical drainage are the treatment options of tubo-ovarian abscess (TOA). It is not yet known exactly which cases need surgical treatment. The aim of this systematic review and meta-analysis was to evaluate the risk factors leading antibiotic therapy failure in women with TOA. METHODS: We searched the following databases from inception to June 1, 2022: PubMed, Ovid MEDLINE, The Cochrane Library, and Scopus. We also searched reference lists of eligible articles and related review articles. The observational cohort, cross-sectional, and case-control studies were included in the meta-analysis. At least four review authors independently selected eligible articles, assessed risk of bias, and extracted data. The random effect model was used in the meta-analysis. RESULTS: A total of 29 studies, including 2890 women, were included in the study. The age, abscess size, history of intrauterine device use, postmenopausal status, history of diabetes mellitus, fever, white blood cell count, erythrocyte sedimentation rate, C-reactive protein level, and history of pelvic inflammatory disease were found as significant risk factors for antibiotic therapy failure in women with TOA. CONCLUSIONS: The findings of this study clarified the risk factors for antibiotic therapy failure in women with TOA.

Comparison of 2-year reproductive outcomes of tubal ectopic pregnancies treated with surgery, methotrexate or expectant management.

INTRODUCTION: To compare the 2-year reproductive outcomes of tubal ectopic pregnancies (EP) treated with surgery, methotrexate (MTX) or expectant management. MATERIALS AND METHODS: This case-control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women's Health Education and Training Hospital. 985 of 1156 patients, who were managed between January 2015 and December 2019 for a tubal EP, tried to conceive in 2 years after treatment: 366 patients underwent surgical treatment; 549 patients were treated with MTX, and 70 patients had expectant management. Clinical data and fertility outcomes were retrieved by medical and hospital records. We compared the three groups based on the 2-year reproductive outcomes of three treatment modalities of tubal EP. RESULTS: There was a significant difference in the frequency of no pregnancy in patients who underwent surgery compared to patients who received expectant management and MTX therapy (p < 0.001). The frequency of no pregnancy was higher in patients who underwent surgery. There was no significant difference between expectant management and MTX therapy (p = 0.411). In the reproductive outcomes of patients who underwent surgery, the incidence of viable pregnancies was statistically lower than in the group treated with expectant management and MTX therapy (p = 0.003). CONCLUSIONS: Patients with an EP often have a future desire to have children, the treatment options are also important. The earlier the diagnosis is made, the more likely it is that expectant management or MTX treatment will be considered. With these two treatment methods, the likelihood of having a child in the future is higher than with surgical treatment.

Sensitivity of frozen section analysis in patients with ovarian adult granulosa cell tumor, a multi-center study.

INTRODUCTION: We aimed to demonstrate the sensitivity of frozen section for patients with adult granulosa cell tumor (AGCT) and analyze the clinico-pathological factors that may be associated with sensitivity. MATERIAL METHODS: This is a multicenter study including data of 10 Gynecological Oncology Departments. Frozen-section results of patients who had ovarian AGCT at the final pathology report were retrospectively analyzed. The relation between clinico-pathological characteristics such as age, tumor size, Ca-125 level, presence of ascites, omental metastasis, menopausal status and peritoneal cytology, and the sensitivity of frozen section in patients with AGCT were evaluated. The sensitivity of frozen section diagnosis was determined by comparing the frozen section result with the final pathological diagnosis. RESULTS: Frozen section results of 274 patients with AGCT were obtained. The median age of the patients was 52 years (range, 17-82 years). Totally, 144 (52.7%, n = 273) patients were postmenopausal. The median tumour size was 90 mm (range, 9-700 mm). The median preoperative Ca-125 level was 23 IU/mL (range, 2-995 IU/mL). The sensitivity of frozen section for detecting AGCT was 76.3%. Any association between the sensitivity of frozen section and menopausal status, presence of ascites, positive cytology, omental metastasis, tumor size, Ca-125 level, age could not be shown. CONCLUSION: It is important to know the diagnosis of AGCT intraoperatively, and we demonstrated the sensitivity of frozen-section for these tumors as 76.3%.

Prolidase activity in women with polycystic ovarian syndrome undergoing assisted conception.

Background: Prolidase is a manganese (Mn)-dependent cytosolic exopeptidase that degrades imidodipeptides with C-terminal proline or hydroxyproline. Prolidase recycling from imidodipeptides plays a critical role in collagen resynthesis and extracellular matrix (ECM) remodelling. Following an increase in gonadotropins, ovarian and follicular collagen undergo substantial degradation. Abnormal ovarian ECM composition is associated with polycystic ovary syndrome (PCOS). This study aimed to examine prolidase activity in the serum and follicular fluid (FF) of women undergoing in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatment, comparing those with PCOS to those with normal ovarian function.Methods: This prospective study enrolled 50 participants, of whom 44 were included. PCOS diagnosis followed the Rotterdam consensus criteria, with 20 patients constituting the study group. The control group comprised 24 individuals with mild-to-moderate male infertility. Prolidase enzyme activity in serum and FF was measured using the Chinard reagent via spectrophotometric analysis and compared between the groups.Results: Serum and FF prolidase levels were significantly lower in patients with PCOS (p < 0.05). A direct correlation was observed between serum and FF prolidase levels (p < 0.05). Although blastocyst quality scoring (BQS) significantly decreased in PCOS patients, no statistical difference was observed in the clinical pregnancy rate between the groups (p < 0.05) (p > 0.05). A negative correlation existed between serum prolidase levels and total antral follicle (AF) count (p < 0.05). Conversely, both serum and FF prolidase levels positively correlated with BQS (r = 0.574)(p < 0.05) (r = 0.650)(p < 0.05).Conclusions: Patients with PCOS showed lower serum and FF prolidase levels, indicating abnormal degradation of ovarian and follicular collagen, potentially causing anovulation.

Polycystic ovary syndrome (PCOS), the most prevalent endocrinopathy among reproductive-aged women, affects approximately 3­15% of this demographic. Long-term disorders such as cardiovascular disease, type 2 diabetes mellitus, obesity, and infertility are commonly associated with PCOS, with approximately 70% of affected women experiencing infertility. Although the aetiology of PCOS remains unclear, complex multigenic disorders and environmental factors such as abnormal ovarian extracellular matrix composition, disruption of the inflammatory pathway, and lifestyle factors have been found to be related.This study addresses the aetiology of PCOS, focusing on the close association between abnormal ovarian extracellular matrix composition and the syndrome, as seen in previous reports. Prolidase is a manganese-dependent cytosolic exopeptidase that degrades imidodipeptides using the C-terminal proline or hydroxyproline. Proline recycling from imidodipeptides by prolidase plays a critical role in the resynthesis of collagen and remodelling of the extracellular matrix. Our aim was to evaluate prolidase activity in the serum and follicular fluid of women diagnosed with PCOS. Our findings revealed a direct correlation between serum and follicular fluid prolidase levels, both of which were diminished in women with PCOS. Furthermore, a negative correlation was observed between serum prolidase levels and total antral follicle count indicating a potential link between prolidase activity and ovarian follicle development. In contrast, both serum and follicular fluid prolidase levels were positively correlated with blastocyst quality. In conclusion, PCOS patients showed lower serum and follicular fluid prolidase levels, indicating abnormal degradation of ovarian and follicular collagen, and potentially causing anovulation. Future studies measuring manganese levels in larger numbers of participants are required.

Use of Shock Index, Modified Shock Index, and Age-Adjusted Shock Index for Detection of Postpartum Hemorrhage.

PURPOSE: The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes. MATERIAL AND METHODS: In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI - 2nd- or 6th-hour SI) values were calculated. RESULTS: A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%). CONCLUSION: The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.

Efficacy of blood parameters in predicting the severity of gestational hypertension and preeclampsia.

The aim of this retrospective study was to demonstrate the effectiveness of APRI, DNI, NLR, PLR, and PDW in predicting the severity of gestational hypertension (GHT) and PE and to determine whether these factors can be used as screening tools. Normotensive pregnant women (n = 792) served as the control group. 1,213 single pregnant women who met the following criteria for a GHT diagnosis were included in the study group. We found a significantly higher mean PLR and NLR value. The mean PDW value was significantly lower in the control group than in the other groups. The SPE group had a significantly higher mean APRI score. The groups did not differ by their DNI. We determined PDW and APRI as independent parameters that predicted SPE by multiple logistic regression analysis. In retrospective analysis of blood samples taken from these participants below week 20, we found that the APRI value differed significantly between the control and SPE groups. NLR, PLR, DNI, and PDW had no clinical significance. We further suggested that APRI may provide a clinical indication of progression from hypertensive pregnancy disorders to SPE, which seems to be a promising implication that should be verified by further studies.IMPACT STATEMENTWhat is already known on this subject? Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality. Screening pregnant women for risk factors for developing hypertensive disorders and identifying women at high risk in early pregnancy and initiating prophylactic treatment are important for pregnancy monitoring and planning in experienced centres. Because only 30% of women who will develop preeclampsia can be predicted by risk factors, the combined use of laboratory tests and imaging with risk factors to calculate a woman's risk of developing preeclampsia is currently being investigated. However, no proven marker has yet been found.What do the results of this study add? In our study, we found that NLR, PLR, DNI, and PDW have no clinical significance in assessing the risk of developing gestational hypertension and preeclampsia and in predicting the severity of preeclampsia. However, in our study, we found that APRI can provide a clinical indication of the progression of hypertensive pregnancy to SPE.What are the implications of these findings for clinical practice and/or further research? This study represents an important contribution to the literature because it is the first study to examine the association between APRI and HT in pregnancy.

A New Antioxidant Marker in Cord Blood of Fetuses with Late Fetal Growth Restriction: Humanin.

Purpose: This study investigated the Humanin levels in the umbilical cord blood of fetuses with late fetal growth restriction (FGR) and -evaluated their association with perinatal outcomes. Materials and Methods: A total of 95 single pregnancies between 32-41 wk (45 with late FGR and 50 controls) were included. Doppler parameters, birth weight and the need for neonatal intensive care unit admission (NICU) were assessed. Correlations between Humanin levels and these parameters were analyzed. Results: Higher Humanin levels were found in fetuses with late FGR compared to the control group (p < 0.05). No significant correlation was observed between Humanin levels and Doppler parameters. Elevated Humanin levels were associated with an increased need for NICU (p < 0.05). Conclusions: The statistically higher levels of Humanin in fetuses with late FGR may suggest the potential of Humanin as an indicator of late FGR. Further research is needed to explore the clinical utility of Humanin.

A prospective study examining the effect of dienogest treatment on endometrioma size and symptoms.

OBJECTIVE: We aimed to determine the effect of dienogest on cyst volume, symptoms, and quality of life in patients with endometrioma. METHOD: This prospective cohort study included 37 patients diagnosed with endometrioma and planned for medical treatment. Subjects were treated with a 3-month oral dose of dienogest 2 mg/day. Pre-treatment and post-treatment endometriosis measurements were assessed via 3D ultrasonography, pain symptoms via 100-mm visual analog scale (VAS), and quality of life via Short Form-36. RESULTS: The mean age of the patients was 36.0 ± 6.6 years. The mean endometrioma volume was significantly reduced by 31% after treatment (26.7 ± 19.7 mm3) compared to the pre-treatment volume (17.4 ± 11.2 mm3, p < .001). Post-treatment VAS scores of dysmenorrhea, dyspareunia, and chronic pelvic pain VAS values were significantly decreased by 35.5% (p < .001), 37.5% (p < .001), and 38.5% (p < .001), respectively. The mean physical function score and mental health score significantly increased by 15% (p = .009) and 28% (p < .001), respectively. CONCLUSION: Our findings showed dienogest treatment at oral doses of 2 mg/day for 3 months significantly reducing the size of endometrioma, reducing pain level, and increasing quality of life in women with endometriosis.

Is hemoglobin A1c valuable for predicting concurrent endometrial cancer in diabetic women with endometrial intraepithelial neoplasia?

AIM: The purpose of this study was to determine the predictive value of preoperative hemoglobin A1c (HgA1c) level for endometrial cancer in diabetic women with endometrial intraepithelial neoplasia (EIN). MATERIALS AND METHODS: Six hundred patients with EIN were retrospectively studied in a tertiary referral center in Turkey between January 2014 and December 2021. One hundred and thirteen diabetic patients with EIN who met the inclusion criteria were enrolled in the study and divided into three groups according to the final pathological results: Group 1 with benign findings (n = 29), Group 2 with EIN (n = 34) and Group 3 with endometrial cancer (n = 50). Demographic, clinical and biochemical characteristics were compared among the three groups. Receiver operating characteristic analysis (ROC) was used to evaluate the predictive value of HgA1c for concurrent endometrial cancer in EIN. RESULTS: Mean preoperative HgA1c levels were different among three groups (5.41 ± 0.64, 6.01 ± 0.72, 6.65 ± 1.15, p < 0.001, respectively). The highest value of HgA1c level was found in cancer group and difference within pairs was statistically significant (p < 0.001). Age and duration of menopause were also different among groups (p < 0.005). After adjustment of HgA1c level for age and duration of menopause differences were maintained (p < 0.001), the cutoff value was detected as ≥6.05% for HgA1c and sensitivity, specificity was 60%, 70%, respectively (p < 0.001). CONCLUSIONS: HgA1c could be used in prediction of endometrial cancer. The optimal cutoff value determined in our study could be considered in predicting endometrial cancer in diabetic women with EIN.

Increased fetal epicardial fat thickness: A reflecting finding for GDM and perinatal outcomes.

OBJECTIVE: To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. METHODS: A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. p < .05 were interpreted as statistically significant. RESULTS: The fetal EFT value was statistically higher in the GDM group than in the control group (p: .000). Spearman and Pearson correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-h 100-g OGTT, birth weight, and BMI (r: .198, p: .047; r: .395, p: .012; r: .360, p: .042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p: .337; p: .503; p: .155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p: .009; p < .01). CONCLUSION: This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.

The effect of anterior uterocervical angle and cervical length on the development of pelvic inflammatory disease.

This study aims to compare the uterine body longitudinal axis, uterine body transverse axis, uterine cervix longitudinal axis and anterior cervical axis angle measured ultrasonographically between women with pelvic inflammatory disease (PID) and healthy controls. Women aged 18-45 years with PID and healthy controls were included in the study. Demographic characteristics, uterine body long axis, uterine body transverse axis, uterine cervix long axis and anterior cervical axis angle of PID patients and healthy controls were evaluated. Gravida, parity, history of smoking were significantly higher in the PID group (n = 75) than the control group (n = 74). The uterine body longitudinal axis (p = 0.001) and transverse axis (p = 0.005) were significantly lower, and the cervix longitudinal axis (p < 0.001) and the anterior uterocervical angle (p < 0.001) were significantly higher in the PID group than the control group. Binary logistic regression analysis showed that uterine body (UTX) longitudinal axis (p = 0.005), uterine cervix longitudinal axis (p < 0.001) and UCA (p < 0.001) were significant predictors of PID. Uterine body longitudinal axis, uterine cervix longitudinal axis, and UCA can be associated to PID.

Maternal plasma levels of vitamin D in postterm pregnancy.

This study was conducted to examine the levels of vitamin D in postterm pregnancy. The study consisted of two groups: Group 1: women with postterm pregnancy in whom labour has not started (n = 40). Group 2: pregnant women with spontaneous labour between 37 and 41 weeks of gestation (n = 40). Demographic characteristics of individuals, age, body mass index, gravida, parity, living child, number of abortions and birth characteristics were recorded. Prepartum and postpartum haemoglobin (Hb) and haematocrit (Hct) values ​​and vitamin D levels of pregnant women were measured. We found no significant differences in vitamin D levels, smoking, mode of delivery, induction of labour, methods of cervical ripening and maternal and perinatal complications between the groups (p > .05). D vitamin in the model had a statistically significant effect on prepartum Hb (p < .05). Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.IMPACT STATEMENTWhat is already known on this subject? The aetiology of post term pregnancy is not clearly known, factors such as foetal anencephaly, foetal sex, placental sulfatase deficiency, genetic factors, and high pre-pregnancy body mass index play a role.What do the results of this study add? Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.What are the implications of these findings for clinical practice and/or further research? Further studies are needed to clarify the relationship between vitamin D levels and postterm pregnancy.

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients.

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4-9.6; p = .007).IMPACT STATEMENTWhat is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential.What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival.What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings.

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.

Different pre-analytical techniques and the results of 50 g oral glucose challenge tests.

OBJECTIVE: We aimed to analyse the pre-analytical process and its effect of 50 g of oral glucose challenge test results for screening gestational diabetes mellitus. RESEARCH DESIGN AND METHODS: The 50 g oral glucose challenge test was performed to 30 pregnant women, and the blood was collected as two samples for three tubes containing; serum separating jell (SSJ), sodium fluoride-potassium oxalate (NaF - KOx) and sodium citrate-containing tube. The first samples of the three tubes were centrifuged within 30 minutes, and second samples were centrifuged after 60 minutes and were analysed. One sample in SSJ tube and was analysed in the same day according to hospitals routine practice. The results were compared. RESULTS: Among the 30 samples, the mean decrease in glucose levels was highest in the SSJ tube (0.38 mmol/L), followed by 0.16 mmol/L in Na citrate tube and 0.14 mmol/L in NaF-KOx tube. The hospital routine assessment with SSJ was 6.36 ± 1.90 mmol/L. The <30 and >60 minutes glucose results were 6.80 ± 1.88 mmol/L vs 6.42 ± 1.97 mmol/L for SSJ, 5.95 ± 1.60 mmol/L vs 5.78 ± 1.51 mmol/L for Na Citrate and 6.90 ± 1.86 mmol/L vs 6.75 ± 1.90 mmol/L for NaF-KOx mg/dL groups, respectively, and both the changes within time and the results between the tubes showed a statistically significant difference (P < .001). CONCLUSION: In cases with longer assessment time and with different blood sample tubes, the clinician should also keep in mind that, especially with results under but close to the cut-off levels, an underdiagnosed gestational diabetes might be present.

Copper and levonorgestrel containing intrauterine devices: comparison of their effect on oxidative stress markers.

OBJECTIVE: We aimed to evaluate the oxidative stress by measuring the thiol-disulfide balance in women who use either T380A or LNG-IUD as a contraceptive method. Material and method: The study included two groups; 30 women with LNG-IUD and 30 women with copper-IUD. Thiol-disulfide homeostasis as a marker of oxidative stress was analyzed before the IUD insertion and on the 6th month after insertion. Results: The LNG-IUD group had similar native thiol levels with Cu-IUD (293.1 ± 43.5 µmol/l vs. 290.4 ± 42.4 µmol/l respectively, p = 819). In the copper-IUD group total thiol levels were higher than LNG-IUD group (345.5 ± 58.2 µmol/l vs. 319.5 ± 52.4 µmol/l, p = .031). A significant increase was observed after 6 months in LNG-IUD patients in terms of disulfide/native thiol (7.9 ± 4.4% vs. 11.2 ± 2.6%, p = .006), disulfide/total thiol (6.2 ± 1.8% vs. 8.7 ± 1.9%, p = .004) and Native thiol/total thiol (87.1 ± 12.1% vs. 82.3 ± 8.2%, p = .004) levels. After 6 months in copper-IUD patients, disulfide (22.3 ± 7.3 µmol/l vs. 27.5 ± 6.9 µmol/l respectively, p = .006), disulfide/native thiol (7.7 ± 3.8% vs. 9.8 ± 2.4% respectively, p = .007), disulfide/total thiol (6.4 ± 2.03% vs. 8.2 ± 1.8% respectively, p = .007) and native thiol/total thiol (86.3 ± 9.4% vs. 83.8 ± 10.6% respectively, p = .007) levels were increased. Conclusion: An increase in oxidative stress markers were observed in both groups. Studies evaluating the long term subclinical risks of IUD's are needed to understand the outcomes of the increased oxidative stress.

Do follicular fluid advanced glycation end products levels affect the ovarian response in unexplained infertility?

OBJECTIVE: To compare the advanced glycation end products (AGEs) levels in follicular fluid according to the different ovarian responses of women who underwent controlled ovarian stimulation due to unexplained infertility and to examine the relationship between these levels and pregnancy outcomes. METHODS: Sixty-three women who underwent fresh IVF/ICSI cycles with GNRH antagonist protocol were divided into 3 groups according to the number of retrieved oocytes as suboptimal (4-9 oocytes), optimal (10-15 oocytes) and high (>15 oocytes) responders. AGEs levels in follicular fluid were measured by ELISA method. RESULTS: AGEs levels were 6.81 ± 2.20 µg/ml, 5.30 ± 2.01 and 6.44 ± 1.43 µg/ml in suboptimal, optimal and high response group, respectively. AGEs level was significantly higher in suboptimal response group than in optimal response group. The cutoff level of 6.19 µg/ml had a sensitivity of 59.3% and a specificity of 66.7% in distinguishing the suboptimal response group from the optimal response group. However, there were no statistically significant difference between AGEs levels and clinical pregnancy and live birth rates. CONCLUSION: Increased AGEs level in follicular fluid may be associated with decreased ovarian response during controlled ovarian stimulation in unexplained infertility case, however, it does not provide information about pregnancy outcomes.

Comparison of the maternal and neonatal outcomes of pregnant women whose anemia was not corrected before delivery and pregnant women who were treated with intravenous iron in the third trimester.

AIM: Anemia is one of the most common problems of pregnancy. In this study, we aimed to compare the maternal and fetal outcomes in labor and delivery in women whose anemia was treated with intravenous iron and women who delivered with uncorrected anemia. MATERIALS: METHODS: This retrospective case-control study was carried out in a tertiary obstetric care center. Term (> 37 weeks), singleton, low-risk pregnant women who were admitted for delivery were evaluated. Seventy-two pregnant women who had intravenous ferric carboxymaltose treatment in the third trimester were compared with 72 women who were anemic (Hb < 10 g/dL) at the time Queryof admission for delivery. RESULTS: The groups were similar in terms of age, parity, and gestational age. The mean gestational age of the study group was 38.6 weeks. Their mean Hb of 8.2 ± 0.8 g/dL improved to 11.1 ± 1.3 g/dL prior birth. The mean Hb of the anemic group was 9.1 ± 0.5 g/dL upon admission for birth. The mean APGAR scores, admission to neonatal intensive care unit, and the rates of preterm delivery, small for gestational age, and low-birth weight infant were similar between groups. The primary cesarean section rate was significantly higher in anemic women (4.2% vs. 19.4%; p < 0.001) and the need for postpartum blood transfusion also decreased with iv iron treatment (8.3% vs. 29.2%; p = 0.02). CONCLUSION: Correction of anemia with intravenous ferric carboxymaltose in the third trimester does not significantly change neonatal outcomes but it is effective in reducing maternal morbidity.

Echogenic particles in the amniotic fluid of term low-risk pregnant women: does it have a clinical significance?

In this study, we aimed to analyse the clinical features of the third-trimester pregnant women, with echogenic amniotic fluid and to compare their obstetric and neonatal outcomes with pregnant women with normal amniotic fluid echogenicity. This case-control study was conducted in a tertiary antenatal care centre. A total of 560 term (37-42 weeks of gestation) singleton women; 280 with echogenic particles in amniotic fluid and 280 with clear amniotic fluid, who delivered within 24 h after the ultrasound scan were evaluated. The women in the two groups were similar in terms of age, parity, body mass index, foetal birth weight, and gestational age. More patients in the particulate amnion group had lower Apgar scores (<7) in 1st and 5th minutes than controls (p = .006, p = .031 respectively) however the rate of admission to neonatal intensive care was similar. Vernix stained amniotic fluid was more common in the study group (48.8%, p = .031), the rate of meconium-stained amniotic fluid was similar in the study and control groups (9.6-9.2%, p = .881). The primary caesarean section rate was higher in women with particulate amnion (18.4%, p = .037). Echogenic particles in the amniotic fluid in the third trimester could not be attributed to meconium, however, higher rates of primary caesarean section may require further attention.IMPACT STATEMENTWhat is already known on this subject? Previous studies showed that high-density intra-amniotic particles were possibly related to vernix caseosa, intra-amniotic bleeding, and meconium. The number of study groups in these studies was also limited.What do the results of this study add? Additional to other previous studies, we found an increased rate of intra-amniotic echogenic particles in male foetuses.What are the implications of these findings for clinical practice and/or further research? The presence of echogenic particles on ultrasound was not related to increased risk for the presence of meconium. Significantly more neonates born to mothers with intra-amniotic echogenic particles tended to have lower Apgar scores (<7), however, this significant difference did not affect the need for NICU admission. The presence of echogenic particles in the amniotic fluid of the third-trimester pregnant women could not be attributed to meconium and adverse perinatal outcomes, however, the higher rates of primary caesarean section may require further attention.