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.

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.

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.

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.

Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital.

CONTEXT AND OBJECTIVE: Despite the development of tertiary care facilities, intensive care and advanced blood banking techniques, pregnancy-related hypertensive disorders are the main cause of maternal mortality in most countries. Our purpose was to determine maternal outcome in pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) that required intensive care management. DESIGN AND SETTING: Retrospective study at Department of Obstetrics and Gynecology, and Department of Anesthesiology and Reanimation, Karadeniz Technical University, Trabzon, Turkey. METHODS: 37 patients with HELLP syndrome admitted to the obstetric intensive care unit were analyzed retrospectively from 1992 to 2004. RESULTS: All patients were hypertensive, with mean Glasgow coma score (GCS) of 11 +/- 3.96. Mean gestational age at delivery was 32 +/- 4.09 weeks. Delivery was vaginally in nine and by cesarean section in 27 patients. General anesthesia was used in 12 and spinal anesthesia in 25 patients. Maternal morbidity included acute renal failure (11%), disseminated intravascular coagulation (5%), acute lung edema (3%), severe ascites (11%), pleural effusion (3%), adult respiratory distress syndrome (11%), abruptio placenta (11%), cerebral edema (8%) and cerebral hemorrhage (40%). All patients required transfusions using blood products. There were 11 maternal deaths (30%). CONCLUSION: Because of high maternal mortality and morbidity found among patients with HELLP syndrome, standard antenatal follow-up protocols should be applied, so as to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.

Maternal outcome in HELLP syndrome requiring intensive care management in a Turkish hospital

CONTEXTO E OBJETIVO: Apesar do desenvolvimento de instalações terciárias de cuidado e tratamento intensivo e de técnicas avançadas de transfusão de sangue, desordens hipertensivas da gravidez são a causa principal de mortalidade materna na maioria dos países. Nosso objetivo foi determinar o resultado materno nas gravidezes complicadas pela síndrome HELLP (hemólise, enzimas hepáticas elevadas e contagem de plaquetas baixa) que exigiram cuidados intensivos. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado na Karadeniz Technical University, Department of Obstetrics and Gynecology, and Department of Anaesthesiology and Reanimation, Trabzon, Turquia. MÉTODOS: 37 pacientes com a síndrome HELLP admitidas à unidade de cuidado intensivo obstétrico foram analisadas retrospectivamente entre 1992 e 2004.RESULTADOS: Todas as pacientes eram hipertensas, com escala Glasgow de coma média de 11 ± 3,96. A idade gestacional média no parto foi de 32 ± 4,09 semanas. O parto foi vaginal em 9 e por cesárea em 27 pacientes. Anestesia geral foi usada em 12 e loco-regional em 25 pacientes. Morbidades maternas incluíram a falência renal aguda (11%), coagulação intravascular disseminada (5%), edema agudo do pulmão (3%), ascite grave (11%), o derrame pleural (3%), síndrome respiratória aguda grave (11%), descolamento prematuro de placenta (11%), edema cerebral (8%) e hemorragia cerebral (40%). Todas as pacientes necessitaram de transfusão de produtos do sangue. Ocorreram 11 (30%) mortes maternas. CONCLUSÕES: Devido à alta morbidade e mortalidade maternas encontradas nas pacientes com síndrome HELLP, protocolos antenatais de acompanhamento devem ser aplicados de modo a se obter diagnóstico precoce e a de apressar a transferência para um departamento obstétrico onde a equipe de profissionais tenha perícia no campo.