Fetal cardiac left ventricle functional changes in pregnancies with maternal hypothyroidism.

OBJECTIVES: To evaluate fetal cardiac function in cases with overt and subclinical hypothyroidism and to determine the effect of levothyroxine (LT4) treatment and Anti-thyroid peroxidase (Anti-TPO) antibody status on fetal cardiac functions in cases with subclinical hypothyroidism. METHODS: Within the scope of the study, fetuses of 23 overt hypothyroid, 52 subclinical hypothyroid and 250 control group pregnant women were evaluated. Fetal cardiac function was assessed via cardiac Doppler. RESULTS: Isovolumetric relaxation time (IRT) and myocardial performance index (MPI) values in the overt hypothyroid group were significantly higher than both the subclinical hypothyroid group (p: .006, p: .000, respectively) and the control group (p: .000, p: .000, respectively). In addition, both IRT and MPI were significantly higher in the subclinical hypothyroid group than in the control group (p: .000, p: .000, respectively). In the subclinical hypothyroid group, there was no significant difference in terms of cardiac function parameters in the fetuses of pregnant women who received LT4 therapy and those who did not. When pregnant women with subclinical hypothyroidism were evaluated according to their Anti-TPO antibody status, IRT and MPI values were found to be significantly higher in fetuses of Anti-TPO (+) pregnant women (respectively, p: .005, p: .019). CONCLUSION: In the presence of maternal overt or subclinical hypothyroidism, fetal cardiac functions may be affected as early as the second trimester. Anti-TPO antibody positivity in cases with subclinical hypothyroidism seems to negatively affect fetal cardiac functions.

The utility of foetal splenic artery Doppler measurement in the diagnosis of late-onset foetal growth restriction.

We aimed to examine the contribution of splenic artery (SA) Doppler parameters in the detection of foetuses with late-onset foetal growth restriction (LO-FGR) and to evaluate its power in predicting adverse perinatal outcomes. Within the study's scope, 52 cases in the LO-FGR group and 92 cases in the control group were evaluated. The criteria determined in the Delphi procedure by an international consensus were used to define the LO-FGR. Middle cerebral artery (MCA) pulsatility index (PI) and SA PI were significantly lower in the LO-FGR group (p: .002, p<.001, respectively). Likewise, cerebroplacental ratio (CPR) was significantly lower in the LO-FGR group (p<.001). Decreased CPR and decreased SA PI were significantly and positively associated with an increased likelihood of exhibiting adverse obstetric outcome (p<.001, p: .012, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for SA PI was 1.41 to predict LO-FGR with 70.7% sensitivity and 61.5% specificity (AUC = 0.684; 95% CI, 0.594-0.774).Impact StatementWhat is already known on this subject? The main clinical difficulty in late-onset foetal growth restriction (LO-FGR) is the detection of the disease.What do the results of this study add? The splenic artery (SA) pulsatility index (PI) may contribute to both diagnostic and the prediction of adverse perinatal outcomes in LO-FGR cases. Our results showed that the SA PI value, as well as cerebroplacental ratio (CPR), can be a useful parameter in predicting negative outcomes.What are the implications of these findings for clinical practice and/or further research? Various degrees of uteroplacental insufficiency in foetuses with LO-FGR may be associated with abnormalities in SA Doppler velocimetry. Splenic artery Doppler velocimetry can be used for the clinical management of LO-FGR.

Maternal serum sortilin levels in gestational diabetes mellitus.

OBJECTIVE: To evaluate the serum sortilin levels in pregnant women with gestational diabetes mellitus (GDM) and to compare the results with normoglycemic healthy pregnant women and observe the relationship between serum sortilin levels and biochemical parameters. METHODS: This case-control study consisted of 55 pregnancies with GDM and 32 healthy singleton pregnancies matched for maternal and gestational age. The maternal serum levels of sortilin were measured with enzyme-linked immunosorbent assay and compared between groups. RESULTS: Sortilin levels were significantly higher in GDM group (5.52 ± 3.19 ng/mL versus 3.30 ± 1.47 ng/mL, p < .001). Pairwise comparisons showed that both the diet group and insulin group had significantly higher serum sortilin levels than the control group (p: .022 and p: .002, respectively). Maternal serum sortilin levels were significantly positively correlated with serum insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR) and glycated hemoglobin values (r: 0.277, p: .012, r: 0.306, p: .005, r: 0.267, p: .012, respectively). CONCLUSIONS: Serum sortilin levels were significantly higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR and glycated hemoglobin levels. The present results point to the role of sortilin in glucose homeostasis and suggest that it may be a novel marker for GDM.

Cord blood gas results of pregnancies complicated by preeclampsia and the relationship of these results with the amount of proteinuria.

AIM: To evaluate whether there is a statistically significant difference between the cord blood gas parameters of pregnancies complicated with preeclampsia and uncomplicated pregnancies and to show whether the amount of proteinuria affects fetal cord blood gas parameters in pregnancies complicated with preeclampsia. METHODS: The study was designed retrospectively. Between 2016 and 2019, the neonatal results and cord blood gas results of 109 pregnant women who were diagnosed with preeclampsia and 75 nonpreeclamptic randomly selected pregnant women were compared. The preeclampsia group was divided into groups according to amount of proteinuria. SPSS 21.0 statistics program was used, and comparative analysis was carried out. RESULTS: The data of the 109 preeclampsia cases and 75 control groups included in the study were compared, and there was no statistical difference between the fetal cord blood gas parameters between the groups (p > 0.05). The median first and fifth minute Apgar scores were found significantly lower in the preeclampsia group compared to the control group (6, 8 and 8, 9, respectively; p < 0.001). Also, the amount of proteinuria does not alter cord blood gas parameters (p > 0.05). CONCLUSION: Preeclampsia poses a risk for the neonatal period as it reduces the neonatal Apgar scores due to the chronic hypoxic process it creates. However, it was observed that the amount of proteinuria, which is one of the diagnostic criteria, did not affect neonatal results on Apgar scores or fetal cord blood gas parameters.

Fetal cardiac Doppler changes in gestational diabetic pregnancies and its relationship with perinatal outcomes.

AIM: To examine the structural and functional changes of the fetal heart in gestational diabetes mellitus (GDM) and to evaluate the power of fetal cardiac Doppler parameters in predicting adverse perinatal outcomes in this group of pregnancy. METHODS: Within the study's scope, 36 cases in the A1 GDM group, 33 cases in the A2 GDM group, and 124 cases in the control group were evaluated. The relationship between structural and functional fetal cardiac parameters and perinatal outcomes was evaluated via fetal echocardiography. RESULTS: Fetal left ventricular myocardial performance index (MPI) values were found to be statistically significantly higher when compared between the A1 GDM and A2 GDM groups and the control group (p = 0.000 and p = 0.000, respectively), while the E/A ratio was found to be significantly lower (p = 0.000 and p = 0.000, respectively). It was determined that the maternal blood HbA1c level showed a significant negative correlation with the fetal cardiac E/A ratio and a significant positive correlation with isovolumetric relaxation time and MPI (p = 0.000, p = 0.000, and p = 0.000, respectively). Adverse perinatal outcome rate was higher in the diabetic group (46.4%-22.6%). When the cases with GDM were examined in terms of perinatal outcomes, it was observed that there was a significant difference in HbA1c levels, E/A ratio, and MPI values between the cases in the group with adverse perinatal outcomes and the group with normal results (p = 0.001, p = 0.000, and p = 0.000, respectively). CONCLUSIONS: The strong relationship between abnormal cardiac function and adverse perinatal outcomes suggest that cardiac Doppler may be a valuable tool for fetal monitoring and management for the GDM patient group.

Evaluation of the frequency of coitus interruptus and the effect of contraception counselling on this frequency.

In this prospective study, the aim was to determine the frequency and effectiveness of the coitus interruptus method, to compare the demographic characteristics of women using modern contraception methods and those using the coitus interruptus method and to demonstrate how effective contraceptive counselling is in choosing a contraception method. The researchers collected data from 1000 sexually active women in their reproductive period at the gynaecological clinic of a university hospital in Turkey. The researchers used an introductory information contraceptive counselling form, which they prepared for the data collection tool. The rate of the coitus interruptus method use among the interviewed women was 42.8%. There was a statistically significant difference between the coitus interruptus group and the group using modern contraceptive methods regarding mean age, educational status, smoking, awareness of last menstrual period, number of pads used during the menstrual period, and information sources. Following effective contraception counselling, the rate of switching to a modern and proven contraceptive method was found to be 73.8%.Impact statementWhat is already known on this subject? Although the traditional method of coitus interruptus has been used for many years, its incidence is not clearly known. What we know about the subject is based on ancient research. All the studies on the subject are very old and need to be updated.What do the results of this study add? With the help of the data obtained from this study, it is understood that withdrawal method is still widely used today, it is still not known that it is not a modern contraceptive method and the rate of transition to modern methods with effective contraception counselling is very high.What are the implications of these findings for clinical practice and/or further research? In the outpatient clinic conditions, even a very short period of time for contraception counselling will be very beneficial for women and will contribute to family planning and prevent unwanted pregnancies.

The relationship of menopausal symptoms with the type of menopause and lipid levels.

INTRODUCTION: Many postmenopausal women experience hot flashes, night sweats, decreased sexual desire and vaginal dryness. In this study, we aimed to compare the menopause symptom levels of surgical menopause patients and natural menopause patients by using a Menopause Rating Scale (MRS) and investigate whether there is a relationship between lipid levels and menopausal symptoms in surgical menopause patients. MATERIAL AND METHODS: This cross-sectional study was conducted on postmenopausal women who applied to the gynecology outpatient clinic. A total of 187 patients were analyzed. Of these,112 were the surgical menopause group and the remaining 75 were the natural menopause group. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were measured by using an enzymatic color test. In order to evaluate the postmenopausal symptoms of postmenopausal women included in the study, the MRS questionnaire adapted to the Turkish population was used. RESULTS: Considering the results of the MRS of the two groups, the results of surgical menopause patients were found to be statistically significantly higher. The results were statistically significantly higher in both the total score and in the two subgroups(somatic and psychological subgroups)in the surgical menopause group. When the MRS results(subgroups and total score)of women in the surgical menopause group were classified as mild and severe, no statistically significant relationship was found between symptom severity and blood lipid levels. CONCLUSIONS: In the surgically induced menopause group, it was shown by this study that menopausal symptoms were more severe than the natural menopause group. Unlike natural menopausal patients, no relationship was found between lipid levels and severity of menopausal symptoms in surgical menopausal patients.

Examination of the change in sexual functions and anxiety as the pregnancy progresses and the effect of nulliparity on this change.

OBJECTIVE: The objective of the study is to examine the sexual functions and anxiety levels of the same pregnant women during the three periods of pregnancy, and to observe how they change between trimesters and also the effect of nulliparity on these changes. METHODS: This prospective clinical study was conducted between 2019 and 2021 in the University Hospital. Healthy, heterosexual pregnant women were included in this study and were consecutively interviewed regarding their anxiety levels and sexual function in the three trimesters of pregnancy. Participants in the study filled out two questionnaires, the Female Sexual Function Index (FSFI) form and the beck anxiety inventory (BAI). All data were analyzed using SPSS 21 statistical software. RESULTS: There were a total of 35 pregnant women who met the inclusion criteria and completed the questionnaire forms in the three trimesters of pregnancy. Nineteen of the study group were nulliparous (54.3%). FSFI scores were found to be below the cutoff value required to diagnose sexual dysfunction in all three trimesters. The anxiety scores were found to be statistically significantly compatible with mild anxiety in all three periods. In the variance analysis of the survey scores over the three periods, a statistical significance was found for both the FSFI scores and the BAI scores. It was observed that nulliparity had no effect on the change between periods. CONCLUSION: Sexual functions decrease and anxiety increases as we approach the 3rd trimester of pregnancy. There was no significant effect of the parity on the significant change in sexual functions and anxiety between trimesters.

Trauma in pregnancy: An analysis of the adverse perinatal outcomes and the injury severity score.

BACKGROUND: Trauma during pregnancy is one of the most important causes of non-obstetric maternal and fetal mortality and morbidity. The aim of our study is to evaluate the adverse perinatal outcomes that may occur according to the type and severity of the trauma. METHODS: In this retrospective cohort study, pregnant traumatized women aged 18-50 years and referred for consultation to the Prof. Dr. Cemil Tascioglu City Hospital's emergency services of the departments of gynecology and obstetrics, between January 1, 2017, and December 31, 2022, were evaluated. Demographic characteristics, trauma findings, Injury Severity Scoring (ISS), and obstet-ric outcomes were recorded. RESULTS: A total of 1825 trauma patients, including 900 pregnants were referred to our emergency gynecology clinic for consulta-tion. One hundred and fifty three pregnant patients, whose birth information we reached, were selected as the study group. The mean age of the patients was 25.56±5.99 years and the mean gestational week at the time of trauma was 21.59±9.89 weeks, the patients had fallen (67.97%), had been exposed to violence (30.07%), and had a traffic accient (1.96%). The patient's delivery and hospitalization status on the day of trauma, fracture and ISS ≥9 were statistically significantly at a higher rate in the 3rd trimester. Rates of hospitaliza-tion and 3rd trimester traumas were found to be significantly higher in the ISS ≥9 group. (P=0.0001, P=0.028, respectively). CONCLUSION: Compared to the general population, the rates of preterm premature rupture of membranes-premature rupture of membranes, fetal death, fetal distress, cesarean delivery, placental abruption, and preterm delivery increased in traumatized pregnant women. Patients with low ISS scores should also be followed closely during pregnancy in terms of perinatal complications, as well as the severe trauma group.

Effect of COVID-19 pandemic process on prenatal diagnostic procedures.

OBJECTIVE: To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies. MATERIALS AND METHODS: As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020-30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019-30 June 2019) in the previous year. RESULTS: A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p: .041 and p < .001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p = .023, p < .001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p < .05). CONCLUSIONS: The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care.

The role of maternal serum catestatin in the evaluation of preeclampsia and fetal cardiac functions

Objective: To compare the maternal serum catestatin (CST) levels in pregnant women with preeclampsia (PE) and with normal blood pressure and evaluate the relationship between the maternal serum CST levels and fetal cardiac functions. Materials and Methods: This cross-sectional study was conducted on 27 women with early-onset PE (EOPE), 28 women with late-onset PE (LOPE), and 28 healthy pregnant women. Maternal serum CST levels were measured using the enzyme-linked immunosorbent assay kits. Fetal cardiac functions were evaluated using the cardiac Doppler. Results: Maternal serum CST levels were lower in the EOPE group; however, no statistically significant difference was found between the groups. Compared with the other two groups, a statistically significant difference was found in the fetal E/A ratio and myocardial performance index (MPI) values of the EOPE group (p=0.013, p=0.002, p=0.005, p<0.001, respectively). The fetal E/A ratio was positively correlated with the maternal serum CST levels in both the PE and control groups (p<0.001, p<0.001). The fetal isovolumetric relaxation time and MPI values were negatively correlated with maternal serum CST levels in both the PE and control groups (p<0.001, p=0.001, p<0.001, and p=0.002, respectively). Conclusion: Lower CST levels are associated with fetal cardiovascular dysfunction, thus CST can be a critical biochemical marker in fetal cardiac function evaluation.