The effect of smoking on placental pendrin expression.

Pendrin is important for transport of iodine across the placenta. Thiocyanate coming from cigarette is a competitive inhibitor of iodine transport. We aimed to evaluate the pendrin immunostaining intensity in placentas of smoker and non-smoker women. Placental tissues from 61 women, of which 28 were in smoking, and 33 were in non-smoking group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Birth weight was significantly lower in the smoker group (p = 0.024). There was a negative correlation between birth weight and intensity of placental pendrin immunostaining in the smoker group (r = -0.44, p = 0.02). Placentas of the smoking women showed significantly higher immunostaining with pendrin than the control group (p = 0.006). Thiocyonate coming from cigarettes may competitively inhibit pendrin mediated iodine transport in the placenta and adversely affect foetal development by this mechanism.

Relationship of maternal serum resistin and visfatin levels with gestational diabetes mellitus.

INTRODUCTION: Adiponectin, resistin and visfatin are thought to play role in the pathophysiology of gestational diabetes (GDM). In this study, we aimed to investigate the association of maternal second trimester serum resistin and visfatin levels with GDM. MATERIALS AND METHODS: Screening and diagnosis for GDM was performed between the 24-28th gestational weeks. About 40 women diagnosed with GDM and 40 non-diabetic women constituted the study and control groups, respectively. Groups were compared for second trimester maternal serum resistin, visfatin and HbA1c levels, HOMA-IR and postpartum 75 g OGTT results. RESULTS: Mean serum resistin (p = 0.071) and visfatin (p = 0.194) levels were similar between the groups. However, mean BMI (p = 0.013), HOMA-IR (p = 0.019), HbA1c (p < 0.0001) and birth weight (p = 0.037) were significantly higher in GDM group compared to controls. Type 2 diabetes and impaired glucose tolerance were detected in 2 (5%) and 7 (20%) women in the GDM group, respectively, with 75 g OGTT performed at the postpartum 6th week. Resistin levels of patients with GDM and postpartum glucose intolerance were higher than those with GDM but no postpartum glucose intolerance (p = 0.012). Visfatin levels in the GDM group showed a positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length (p < 0.05). CONCLUSION: Maternal serum resistin and visfatin levels are unchanged in GDM. In patients with GDM, second trimester resistin levels may be predictive for postpartum glucose intolerance and second trimester visfatin levels may be related with fetal biometric measurements. Further larger studies are needed.

Endothelial nitric oxide synthase gene polymorphisms (promoter -786T/C, exon 894 G/T and intron G10T) in unexplained female infertility.

BACKGROUND/AIMS: Recent investigations in both males and females show that there may also be some genetic risk factors associated with infertility, and endothelial nitric oxide synthase (eNOS) has important functions in implantation. We aimed to investigate the association of three different polymorphisms of eNOS (promoter -786T/C, exon 894 G/T and intron G10T) with unexplained female infertility. MATERIALS AND METHODS: Two groups of patients were included in the study: (1) women with unexplained infertility and (2) healthy, fertile women with normal menstrual cycles. eNOS polymorphisms were studied in genomic DNA of each patient by polymerase chain reaction-restriction fragment length polymorphism method. RESULTS: Forty-one women with unexplained infertility and 40 fertile women were included. Baseline physical characteristics and hormonal parameters of the two groups were similar. For eNOS exon 894 G/T polymorphism, the GG homozygotes were significantly lower and the heterozygotes GT were significantly higher in the infertile group than in the control group (p < 0.05). eNOS gene polymorphism both for promoter and intron were similar in the two groups (p > 0.05). CONCLUSION: Altered eNOS protein caused by eNOS exon 894 G/T polymorphism might cause implantation failure, which may be a possible cause of unexplained female infertility.

Enterobius vermicularis: Can it be a possible pathogen in Bartholin gland abscess formation?

The most frequent disorders of the Bartholin glands are cysts or abscesses. Bartholin gland abscesses occur generally as a result of polymicrobial infections or agents that cause sexually transmitted diseases. But as far as we know, no parasite has been previously reported among the infectious agents that are detected from the abscesses of the Bartholin gland. Here, we report a 45-year-old woman, in the Bartholin abscess aspirate of whom Enterobius vermicularis eggs were detected in between the inflammatory infiltrate by cytological examination.

Clinical and cytogenetic results of a large series of amniocentesis cases from Turkey: report of 6124 cases.

AIM: The aim of this study was to document the clinical and cytogenetic results of a large series of amniocentesis (AS) cases from Turkey. MATERIAL AND METHODS: Second-trimester amniocentesis cases performed in Suleymaniye Maternity Hospital for Research and Training between January 2007 and December 2011 were included. RESULTS: During this period, 6124 AS were performed. Indications were increased risk in maternal serum screening (MSS) (56%), advanced maternal age (29%) and pathologic ultrasound finding (11.5%). Most frequent MSS abnormality was abnormal triple test result (58%). Overall culture success rate was 98.8%. Chromosomal abnormality was detected in 215 (3.6%) of the 6052 cytogenetic results (74.9% numerical, 25.1% structural). Most frequent numerical chromosomal abnormality was trisomy 21 (61.9%). Clinically insignificant polymorphisms were the most frequent structural changes (n = 571). Most frequent polymorphism was increase in heterochromatin region in the 1st chromosome (n = 158). Advanced maternal age had a positive predictive value of 5.2%. Among the MSS tests, the combined test had the highest positive predictive value (5.2%). CONCLUSIONS: In our study, abnormal MSS (and among these, abnormal triple test result) was the most frequent indication for amniocentesis. Our overall culture success rate was 98.8%. Frequency of major chromosomal abnormality was 3.2% and trisomy 21 was the most frequent abnormality.

Fetal isolated short femur in the second trimester and adverse pregnancy outcomes.

OBJECTIVE: This study aims to evaluate the association of isolated short femur (ISF) in the second trimester ultrasound with adverse pregnancy outcomes. METHOD: All obstetric scans between 16 and 24 weeks of gestation from 1 January 2006 to 1 June 2012 were retrospectively evaluated. Multiple pregnancies, major congenital or chromosomal anomalies and subjects with incomplete outcome data were excluded. Femur length (FL) measurement from the earliest scan of singleton pregnancies was selected. An ISF was defined as a FL less than the tenth percentile in a fetus with an abdominal circumference greater than or equal to the tenth percentile. The primary outcomes were small for gestational age (SGA), birth weight below the third and fifth percentiles, low birth weight (LBW), preterm birth (PTB) and preeclampsia (PE). A 5-min Apgar score of less than 7 and a neonatal intensive care unit admission were secondary outcomes. RESULTS: Of the 4992 eligible fetuses, 312 (6%) had an ISF. Mothers in the short femur group were shorter and had a lower prepregnancy and delivery weight than the group with normal FL (p < 0.05). Multiple logistic regression revealed a significant increase in birth weight below fifth percentile, SGA, LBW infants and PTB (<32, <34 and <37 weeks) in the ISF group (p < 0.05). The incidence of PE was similar in both groups. CONCLUSION: Isolated short femur in the second trimester increases the risk of LBW, SGA and PTB, but not of PE.

Frequency of MEFV mutation and genotype-phenotype correlation in cases with dysmenorrhea.

AIM: We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. MATERIAL AND METHODS: A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene (MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. RESULTS: The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% (n = 109), compound heterozygous mutations were found in 27% (n = 136), and heterozygous mutations were found in 52% (n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% (n = 60) of the families in whom mutations were found had consanguinity. CONCLUSION: Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF.

Use of progestogens in pregnant and infertile patients.

Progesterone is an essential hormone in the occurence and maintenance of pregnancy. Natural or synthetic progestogens are commonly used in pregnant patients or patients undergoing infertility treatments for various indications. Most frequently put indications for the use of progestogens in these patient populations are the prevention of spontaneous preterm birth, the prevention of pregnancy loss in pregnancies with an unexplained recurrent pregnancy loss and in patients with threatened abortion. It is also used in pregnant women undergoing nonobstetric surgery, for infertility or recurrent pregnancy loss that is thought to be due to luteal phase defect or as a luteal support in stimulated IVF cycles. We aimed to review the current evidence for the use of progestogens in each of these settings.

Severe factor X deficiency in a twin pregnancy.

Factor X deficiency is a rare bleeding disorder inherited in an autosomal recessive fashion. In severe cases with a definitive bleeding phenotype, prophylaxis with prothrombin complex concentrate appears to prevent bleeding very effectively. Management of factor X-deficient pregnant patients continues to be a challenge. We present a new case of successful twin pregnancy in a severe factor X-deficient patient.

An unusual complication of uterine prolapse. Bilateral severe hydronephrosis.

Obstructive uropathy with bilateral hydronephrosis may be seen in uterine procidentia cases. Early recognition and treatment can prevent irreversible renal damage. Although this association has been known for a long time, it is clinically under evaluated most of the time. Here, we present a neglected case of total uterine procidentia in a 64-year-old woman who was detected also to have renal dysfunction. After surgical correction of procidentia, renal function tests returned to normal.

Safe vaginal delivery in a renal transplant recipient: A case report.

Here, we aimed to present a case of safe vaginal delivery in a renal transplant recipient and to mention the possible additional risks of caesarean section in such cases. A 40 year-old patient (G4P3), who had undergone renal transplantation 5 years ago, was admitted to our clinic at 39(2/7) weeks of pregnancy. The transplanted kidney at right iliac fossa was sonographically normal except for grade 1 hydronephrosis; the proximity of vascular anastomoses between the transplanted kidney and iliac vessels to the lower segment of the uterus was remarkable. There was no contraindication for vaginal delivery and it was believed that there would be a possible risk of injury to the transplanted kidney with caesarean delivery. The patient delivered a healthy baby weighing 3540 grams. There is a risk of injury to the renovascular and ureter anastomoses in renal transplant recipients during caesarean delivery. Normal vaginal delivery without abdominal compression is the safest method of delivery in these patients. If a situation that can necessitate internal iliac artery ligation or caesarean hysterectomy such as placenta accreata is expected, surgery should be performed in a centre where the renal transplant surgeon can oversee the surgery.

Bicuspid aortic valve and severe aortic stenosis in a newborn exposed to carbamazapine during pregnancy.

The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. Transthoracic echocardiography revealed bicuspid aortic valve, mild aortic stenosis, patent ductus arteriosus, patent foramen ovale and the renal ultrasound revealed mild left hydronephrosis. Follow-up echocardiography performed 14 weeks later showed increased severity of aortic stenosis and percutaneous balloon aortic valvuloplasty was performed. To our knowledge, there is only one case report in the literature mentioning the association of a bicuspid aortic valve and aortic stenosis with oxcarbazepine exposure, which is a structural derivative of carbamazepine. However, there are no reports for association with carbamazepine itself. Bicuspid aorta and aortic stenosis may be among the cardiac malformations that result from the teratogenic effect of carbamazepine.

Evaluation of chromosomal abnormalities and common trombophilic mutations in cases with recurrent miscarriage.

BACKGROUND: Recurrent miscarriage (RM) is a frequent obstetric problem. Its' pathophysiology is poorly understood. Infections, genetic, endocrine, anatomic and immunologic problems have been suggested as causes for RM. OBJECTIVE: To evaluate the frequency of chromosomal abnormalities and 3 common thrombophilic mutations in couples with RM. METHODS: A retrospective data collection was performed for the results of the cytogenetic analysis of the couples and Methylenetetrahydrofolate Reductase (MTHFR) C677T, Factor V Leiden (FVL) G1691A and Prothrombin (PTm) G20210A mutations of the mother in 142 couples suffering from RM. RESULTS: Prevalence of FVL, MTHFR, and PTm gene mutations were similar between cases shaving 2 or ≥3 abortions (P=0.528; P=0.233; P=0.375). In patients with FVL, MTHFR and PTm gene mutations, the OR's of having ≥3 abortions when compared to having 2 abortions were 1.515 (95% CI: 0.414-5.552), 0.573 (95% CI: 0.228-1.441), and 2.848 (95% CI: 0.355-22.871). All cases with PTm mutation had ≥3 abortions and all abortions occurred between 6-8 gestational weeks. CONCLUSION: Chromosomal abnormalities and thrombophilic mutations (especially PTm) seem to have an important role in RM. Additional larger studies involving investigation of more genes that may have a role in pregnancy are needed to assess this association.

Alterations in placental pendrin expression in pre-eclampsia.

INTRODUCTION: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. METHODS: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. RESULTS: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p<0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r=0.533, p=0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. CONCLUSIONS: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia.

Intraperitoneal Nigella sativa for prevention of postoperative intra-abdominal adhesions in rats.

OBJECTIVE: To evaluate intraperitoneal administration of Nigella sativa (NS) to prevent postoperative intraperitoneal adhesion (PPA) after surgical manipulation of rat uterine horn. MATERIALS AND METHODS: Two forms of NS were used in the study (Volatile oil (NSVO) and the ethanolic extract (NSEE)). A total of 50 rats were randomly assigned to the sham group (n = 10), control group (n = 10), NSVO group (n = 10), NSEE group (n = 10), and the Seprafilm group(n = 10). After 14 days, rats were sacrificed. Adhesions were examined macroscopically, and degree of adhesions was scored. A part of horn was excised, and superoxide dismutase (SOD) and glutathione peroxidase activities as well as malondialdehyde levels were evaluated, and histological score was calculated. RESULTS: Total microscopic score of the NSEE group was significantly lower than the control group (p = .001) and was marginally significantly lower than the seprafilm group (p = .005). Collagen formation score was higher in the seprafilm group compared to the sham and NSEE groups (p < 0.001, p = .003, respectively). Apoptotic cells were lower in the NSEE group compared to the control group (p = .003) and also lower in the NSEE and NSVO groups compared to the seprafilm group (p = .001, p < .001, respectively). Only SOD activity was higher in the NSVO and seprafilm groups compared to the control group (p < .001). CONCLUSION: NSEE form seems to have a possible effect in the prevention of PPAs. This may occur by its effect in decreasing collagen formation and by decreasing apoptosis in the injured tissues. NSVO form seems to induce SOD. Therefore, combined use of NSVO with seprafilm may increase the adhesion preventive effect of seprafilm.

Predictive role of prenasal thickness and nasal bone for Down syndrome in the second trimester.

OBJECTIVE: To assess the efficacy of prenasal thickness (PNT) and nasal bone (NB) for prediction of Down syndrome (DS) fetuses in the second trimester ultrasound examination. STUDY DESIGN: PNT was measured from stored two-dimensional fetal profile images taken at 15-23 weeks in 242 fetuses with normal karyotype (Group 1) and 24 fetuses with DS (Group 2). It was measured as the shortest distance from the anterior edge of the lowest part of the frontal bone to the skin. The efficacy of PNT, NB, PNT/NB and biparietal diameter (BPD)/NB was evaluated for prediction of DS. RESULTS: PNT values increased with gestational age in normal fetuses. PNT measurement was ≥95th percentile in 54.2% (13/24) of the DS cases and 2.9% of the normal cases. Receiver operator curve analysis showed that PNT/NB ratio had the best area under the curve with a detection rate of 80% for a false positive rate of 5% at a cut-off value of 0.76. CONCLUSIONS: PNT is increased in fetuses with DS as compared to normal fetuses. PNT/NB≥0.76 in the second trimester is a better predictor of DS than the use of PNT or NB alone.

Preeclampsia: is it because of the asymptomatic, unrecognized renal scars caused by urinary tract infections in childhood that become symptomatic with pregnancy?

Preeclampsia is an important disease of pregnancy whose exact etiology is still unknown despite continuing developments in medicine. Although most commonly it is believed to be caused by a defective placentation, in this paper, we hypothesize that the primary underlying problem in the development of preeclampsia can be in kidneys in a greater proportion of cases than it is believed today. The increased intravascular volume and the increased work load of kidneys together with the resulting glomerular hypertrophy may precipitate nephrotic syndrome, which in this case is called "preeclampsia" in a previously affected kidney. Urinary tract infections in childhood leaving silent, unrecognized small scars in the kidneys may be the underlying renal cause which disrupts its silence with an increased work load of kidneys prominently occurring after the midtrimester. The histopathologic finding in kidneys with renal scars after childhood urinary tract infections and in preeclampsia is focal segmental glomerulosclerosis in the majority of cases and this similarity strengthens our hypothesis.

Forearm compartment syndrome owing to being stuck in the birth canal: a case report.

Neonatal compartment syndrome is a rare condition mainly involving the upper extremity associated with necrotic lesions. It is often initially misdiagnosed because the skin lesions mimic several other conditions of the newborn. Early diagnosis and timely intervention are of paramount importance to achieve the best outcome. In the present case, we describe a newborn with forearm compartment syndrome owing to being stuck in the birth canal.