Comparison of classic single-layer uterin suture and double-layer purse-string suture techniques for uterus closure in terms of postoperative short-term uterine isthmocele: A prospective randomized controlled trial.

Objective: To compare the short-term results of classic single-layer uterine closure and double-layer purse-string uterine closure (Turan technique) techniques in cesarean section in terms of the incidence of ischiocele formation. Materials and Methods: This was a prospective randomized controlled trial study. Participants undergoing first-time cesarean delivery were randomized into two groups. Fifty-eight participants were included in the double-layered uterine closure group (study group), while 53 participants were randomized into the classical single-layered uterine closure group (control group). For comparison of isthmocele formation, transvaginal ultrasound examination was planned in all patients 6 weeks after surgery. The operation data,the formation of isthmocele, its dimensions and volume were recorded. Results: A total of 111 women were included in the study. The incidence of ischiocele at 6 weeks after birth was not significantly different between the groups (p=0.128). Isthmosel was detected in 20.8% of single-layer closures, and this rate was determined as 10.3% in the purse technique. In the Kerr incision made during surgery, the uterine incision size did not differ in either group, but the uterine incision length after suturing was significantly smaller in the purse technique compared with the other group (p<0.001). Conclusion: The incidence of ischiocele formation after cesarean section and the depth of the ischiocele was independent of the uterotomy closure technique.

The effects of dydrogesterone treatment on first-trimester aneuploidy screening markers and nuchal translucency in women with threatened miscarriage.

Objective: To evaluate the effects of dydrogesterone treatment on first-trimester aneuploidy screening markers and nuchal translucency (NT) in women with threatened miscarriage. Materials and Methods: This study is an prospective case-control study. One hundred seven pregnant women who applied for the first-trimester screening test at 11-14th weeks of gestation were included in the study. The study group consisted of 53 pregnant women using oral dydrogesterone due to the threat of miscarriage for at least 2 weeks and without vaginal bleeding for the last 72 h at the time of enrollment. The control group was composed of 54 healty pregnant women. Fetal Crown-rump length (CRL), NT, pregnancy-associated plasma protein-A (PAP-A) level, and free beta-human chorionic gonadotropin (free B-hCG) levels of the patients were measured. Results: One hundred seven patients included in the study, 54 (50.46%) were in the control group, and 53 (49.54%) were in the study group using dydrogesterone. Age, body mass index, gravida, parity and abortion numbers, gestational weeks, and CRL values of the two groups were congruent. In the comparison-free B-hCG, PAPP-A and NT values of both groups, no statistically significant difference was found between the two groups in terms of first-trimester test results and NT (p<0.05). Conclusion: The use of dydrogesterone in first-trimester pregnancies does not affect first-trimester screening tests and nuchal translucency.

The role of serum ADAMTS-1 levels in Hyperemesis Gravidarum.

BACKGROUND: We aimed to investigate the levels of ADAMTS-1, which is secreted from the extracellular matrix during trophoblastic invasion in hyperemesis gravidarum (HEG). METHODS: In this cross-sectional study, we compared 45 HEG patients aged between 21 and 34 in terms of ADAMTS-1 levels with a control group consisting of 44 healthy pregnant women. The demographic characteristics and several laboratory parameters of the patients were recorded. Both groups were also compared in terms of ketonuria. We evaluated the correlation between ADAMTS-1 levels and ketonuria. RESULTS: The 2 groups were matched in terms of age, gestational age, gravidity, parity, and body mass index. Some inflammatory markers, such as neutrophil count, MPV, PDW, and PCT levels, were significantly higher in the HEG groups compared to the control group (all p < 0.05). However, mean MCV and serum TSH levels were statistically significantly lower in this group (both p < 0.001). ADAMTS-1 levels were 12.6 ± 1.4 ng/ml in the HEG group and 6.2 ± 1.6 ng/ml in the control group (p < 0.001). It was significantly and positively correlated with urine ketone, neutrophil count, and PDW, whereas negatively correlated with MCV and TSH value in the HEG group. ROC analysis showed that a threshold value of 11.275 ng/ml for ADAMTS-1 predicted HEG patients with a sensitivity of 60% and specificity of 95.5%. CONCLUSION: ADAMTS-1 serum levels are increased in HEG patients, and there is a positive correlation between ADAMTS-1 levels and ketonuria.

Predictors of adverse maternal and perinatal outcomes in a refugee population from an active conflict country, Syria.

OBJECTIVE: To elucidate predictors of adverse maternal and perinatal outcomes in refugees emigrating from an active conflict region (Syria). MATERIALS AND METHODS: This study included Syrian pregnant women who gave birth in Etlik Zübeyde Hanim Training and Research Hospital between 2013 and 2016. Adverse perinatal outcomes were defined as preterm labor, premature rupture of membranes, early membrane rupture, intrauterine growth retardation, hypertension, perinatal excites, and erythrocyte-transfused cases. Factors associated with those adverse outcomes were assessed using multiple logistic regression analysis. RESULTS: Having an active smoking habit [odds ratio (OR): 2.647, 95% confidence interval (CI): 1.767-3.965; p<0.001], obesity (OR: 2.272, 95% CI: 1.396-3.699; p=0.001), and adolescent age (OR: 1.732, 95% CI: 1.204-2.491; p=0.003) were found to be the most important predictors of adverse maternal and perinatal outcomes. Eighty of 129 (62%) smokers, 45 of 81 (55.65%) obese individuals, and 91 of 169 adolescents (53.8%) had adverse maternal and perinatal outcomes. CONCLUSION: Prevention strategies for obesity, smoking, and adolescent pregnancies should be implemented primarily to reduce maternal and antenatal adverse outcomes. Pregnant women with these risk factors in a refugee community emigrating from a conflict-zone nation should be followed up closely.

Protective effect of omega 3 and vitamin D in preventing lung-tissue damage of newborn rats exposed to cigarette smoke during intrauterine period / Efecto protector de omega 3 y vitamina D en la prevención del daño en el tejido pulmonar de ratas recién nacidas expuestas al humo del cigarrillo durante el período intrauterino

SUMMARY: This study aimed to investigate the toxic effects of cigarette smoke exposure on lung and the protective role of Omega 3 and Vitamin D against these toxic effects biochemically and histologically. 28 pregnant Wistar Albino rats were divided into four groups. The first group was control group; the second group was exposed to smoke of 10 cigarette by puff device 2 hours/day after pregnancy; the third group was exposed to cigarette smoke together with Omega 3 (0.5 mg/kg/day) and the fourth group was exposed to cigarette smoke together with vitamin D (42 microgram/kg/day). Finally, lung tissue sections of the newborn rats were stained with Hemotoxilen eosine and Masson tricromite. Malondialdehyde (MDA) and Fluorescent Oxidation Products (FOU) levels were measured. Fetal weights and the number of fetuses were significantly lower in the group received only cigarette smoke (both p<0.001). Histopathologically, pulmonary volume, number of developed alveols and parenchyma elasticity decreased significantly, meanwhile interstitial tissue increased, elastin and collagen did not develop adequately. Histopathologic changes significantly decreased in the group given Omega 3 and Vitamin D. Statistically, MDA and FOU levels were found to be higher in the group exposed to cigarette smoke compared to the control group, and MDA and FOU levels were lower in the group given Omega 3 along with cigarette smoke (p<0.001). Cigarette smoke caused histologically significant damage to fetal lung tissue, oxidative stress and increased MDA and FOU levels. This damage was significantly reduced with Omega 3 and Vitamine D supplementation. Omega 3 is an important antioxidant; vitamin D has no significant antioxidant effect.

RESUMEN: Este estudio tuvo como objetivo investigar los efectos tóxicos de la exposición al humo de cigarrillo en el pulmón, y el papel protector de Omega 3 y la Vitamina D contra esos efectos. 28 ratas Wistar albino preñadas fueron separadas en cuatro grupos. El primer grupo grupo control; el segundo grupo estuvo expuesto al humo de 10 cigarrillos por dispositivo de inhalación 2 horas / día después de la preñez; el tercer grupo se expuso al humo del cigarrillo junto con Omega 3 (0,5 mg / kg / día) y el cuarto grupo se expuso al humo del cigarrillo junto con vitamina D (42 microgramos / kg / día). Secciones de tejido pulmonar de las ratas recién nacidas se tiñeron con Hematoxilina Eosina y tricrómico de Masson. Se midieron los niveles de malondialdehído (MDA) y productos de oxidación fluorescente (POF). Los pesos fetales y el número de fetos fueron significativamente más bajos en el grupo que recibió solamente humo de cigarrillo (ambos p <0,001). Histopatológicamente, el volumen pulmonar, el número de alveolos desarrollados y la elasticidad del parénquima disminuyeron significativamente; mientras que el tejido intersticial aumentó y la elastina y el colágeno no se desarrollaron adecuadamente. Los cambios histopatológicos disminuyeron significativamente en el grupo que recibió Omega 3 y Vitamina D. Estadísticamente, se encontró que los niveles de MDA y POF eran más altos en el grupo expuesto al humo de cigarrillo en comparación con el grupo control, además los niveles de MDA y POF fueron más bajos en el grupo que recibió Omega 3 junto con el humo del cigarrillo (p <0,001). El humo del cigarrillo causó daños histológicamente significativos en el tejido pulmonar fetal, el estrés oxidativo y el aumento de los niveles de MDA y FOU. Este daño se redujo significativamente con los suplementos de Omega 3 y Vitamina D. El omega 3 es un importante antioxidante; la vitamina D no tiene ningún efecto antioxidante significativo.

The Influence of Maternal Obesity on Pregnancy Complications and Neonatal Outcomes in Diabetic and Nondiabetic Women.

INTRODUCTION: This study aimed to investigate the influence of obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women. MATERIALS AND METHODS: This retrospective case control study was conducted on 1193 pregnant women and their neonates at a tertiary level maternity hospital between March 2007 and 2011. The pregnant women were classified into 2 groups according to the presence of diabetes mellitus. Six hundred and seven patients with gestational diabetes or pregestational diabetes formed the diabetic group (study group) and 586 patients were in the nondiabetic group (control group). Demographic characteristics, body mass index, gestational weight gain, obstetric history, smoking status, type of delivery, gestational ages, pregnancy complications, neonatal outcomes were recorded for each patient. Multivariable logistic regression analysis was performed to evaluate the effect of obesity and diabetes on the pregnancy complications and neonatal outcomes. RESULTS: The mean age and pre-pregnancy body mass indices of women with diabetes mellitus were significantly higher than the control group's (p < 0.001). Gestational weight gain and number of smokers were similar among the groups. Multiparity and obesity were more prevalent in the diabetic group compared to controls (both p < 0.001). Although gestational age at birth was earlier in the diabetic group, birth weights were higher in this group than in the control group (both p < 0.001). Cesarean delivery rates, the incidence of macrosomia, and neonatal intensive care unit admission rates were significantly higher in the diabetes group both with normal and increased body mass index (all p < 0.001). However, adverse pregnancy outcomes were comparable between the groups (p = 0.279). Multivariable logistic regression analysis showed that obesity is a significant risk factor for pregnancy complications (OR = 1.772 [95% CI, 1.283 - 2.449], p = 0.001) but not for adverse neonatal outcomes (OR = 1.068 [95% CI, 0.683 - 1.669], p = 0.773). CONCLUSION: While obesity increases risk of developing a pregnancy complication, diabetes worsens neonatal outcomes.

Serum betatrophin/angiopoietin-like protein 8 (ANGPTL8) levels in pregnancies affected by hyperemesis gravidarum.

OBJECTIVE: The association between serum betatrophin levels and hyperemesis gravidarum (HEG) remains unknown. The aim of this study was to determine and understand the alterations in serum betatrophin levels in pregnancies complicated by HEG compared with unaffected normal pregnancies. STUDY DESIGN: A cohort study was carried out to evaluate serum betatrophin levels in patients with HEG. Serum betatrophin concentrations were measured with other metabolic markers for lipids and glucose metabolism in 40 singleton pregnancies affected by HEG and 40 gestational age- and body mass index-matched controls. RESULTS: The serum betatrophin concentrations were significantly higher in pregnant women with HEG than in the controls (1000 [600-1100] vs. 900 [500-1000] pg/ml, p = 0.003). The serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels were significantly higher in patients with HEG than in the healthy counterparts at the first trimester of pregnancy (158.5 ±â€¯29.4 vs. 143.8 ±â€¯29.7 mg/dl and 47.3 ±â€¯14.2 vs. 40.1 ±â€¯8.6 mg/dl, p = 0.031 and p = 0.007, respectively). Receiver operating characteristic (ROC) analyses demonstrated that the area under the curve (AUC) indicative of the betatrophin value for discriminating HEG patients was 0.690 (95% CI: 0.574-0.806, p = 0.003). The optimal cutoff value was 976 pg/ml with a sensitivity of 50% (95% CI: 33.80-66.20%) and a specificity of 82.5% (95% CI: 67.22-92.66%). We also found a positive correlation between betatrophin levels and HDL-C (r = 0.311; p = 0.005). Logistic regression analyses demonstrated that increased levels of betatrophin and HDL-C were risk factors for HEG with odds ratios (95% confidence interval) of 4.884 (1.589-15.009) and 5.346 (1.044-27.366), respectively. CONCLUSION: We conclude that serum betatrophin concentrations were increased in pregnancies affected by HEG. Furthermore, HDL-C levels seem to be associated with alterations in serum betatrophin levels.