Novel method for trisomy 21 screening in the first trimester of pregnancy: fetal brain angle.

OBJECTIVES: The present study was performed to examine the utility of a new first trimester marker called the "brain angle" (BA) in screening for trisomy 21. We postulate that differences in the midbrain anatomy between euploid fetuses and those that are affected by trisomy 21 are reflected in changes in BA measurements. METHODS: In fetuses at 11+0-13+6 weeks of gestations, which were at high risk for trisomy 21, the angle was measured between the line crossing the thalamus and mesencephalon cranial border tangentially and the line crossing the brainstem lower limit. This angle was compared between fetuses with trisomy 21 (based on karyotyping) and those with a normal karyotype. RESULTS: Trisomy 21 was detected in 45 (8%) of 560 fetuses. Receiver operating characteristic analysis showed that, at BA≥94°, the sensitivity and specificity for determining trisomy 21 were 97.8% (95% CI=88.2-99.9%) and 100% (95% CI=99.2-100%), respectively. CONCLUSIONS: Fetal BA appears to be a promising new first trimester marker in screening for trisomy 21.

Analysis of estrogen and progesterone receptor gene polymorphisms in leiomyoma.

BACKGROUND: Leiomyoma, one of the most common benign tumors, causes morbidity during the reproductive years in women. The molecular pathogenesis of the disease is not clear. Leiomyomas are hormone-sensitive tumors affecting around 20%-25% of women. Gene polymorphism studies could be important and explaining in the evaluation of multifactorial diseases such as leiomyoma. Polymorphisms involving genes responsible for the synthesis and signalization of steroid hormones could be used as genetic markers for hormone-related conditions. The purpose of this study was to analyze the effect of ERα-351 XbaI A/G, ERα-397 PvuII T/C, and progesterone receptor (PGR) PROGINS polymorphisms on the development of leiomyomas. MATERIAL AND METHODS: In this study, 213 samples (103 leiomyoma patients and 110 healthy controls) participated. The ERα-351 XbaI A/G and ERα-397 PvuII T/C gene polymorphisms were analyzed using PCR-RFLP method. PGR PROGINS polymorphism was analyzed by PCR method with specific primers. RESULTS: The genotype distribution and allele frequency of the ERα-351 XbaI A/G, ERα-397 PvuII T/C, and PGR PROGINS polymorphisms were not statistically different between leiomyoma patient and control groups (p > 0.05). CONCLUSION: This study reflects that ERα and PGR PROGINS polymorphisms may not be one of the many genetic factors for leiomyoma susceptibility.

Smooth muscle cell differentiation from rabbit amniotic cells.

Amniotic fluid (AF) is the liquid layer that provides mechanical support and allows movement of the fetus during embryogenesis. Mesenchymal stem cells (MSCs), which have differentiation capacity, are also found in AF-derived cells at a low ratio. Smooth muscle cells (SMCs) play an important role in organ function and are frequently used in tissue engineering. We examined the differentiation of AF-derived MSCs (AMSCs) into SMCs. AMSCs were sorted from cultured amniotic cells and differentiated into SMCs using differentiation agents, including platelet-derived growth factor BB (PDGF-BB) and tumor growth factor ß (TGF-ß). Characterization of differentiated SMCs was confirmed morphologically, molecularly (via quantitative polymerase chain reaction [qPCR] and immunocytochemistry [ICC]), and functionally (using a contractile assay and fluo-4 calcium signaling assay). Poly(lactide-co-glycolide) (PLGA) scaffolds were fabricated, and the attachment capacity of AMSCs was assessed via scanning electron microscopy. AMSCs were successfully differentiated into SMCs. Our results indicate that AMSCs change their morphology and exhibit increased expression of ACTA2 and MYH11, which was confirmed via qPCR and ICC. Furthermore, functional experiments revealed that differentiated SMCs had both contraction ability and increased Ca2 concentration in the cytoplasm. Finally, PLGA scaffolds were prepared and AMSCs were successfully planted onto the scaffolds. The AMSCs fully differentiated into functional SMCs, and the PLGA polymer is a suitable scaffold material for AMSCs. With further clinical trials, AF-derived MSC-based SMC engineering may become a highly efficient treatment option.

Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes?

OBJECTIVES: To determine whether pregnant women who have reactive hypoglycemia during the 100 g oral glucose toler-ance test (OGTT) are at an increased risk of poor pregnancy outcomes. MATERIAL AND METHODS: We retrospectively analyzed perinatal data from 413 women who underwent a 3 h OGTT at 24-28 weeks of gestation and gave birth in our clinics between January 2012 and December 2014. RESULTS: According to OGTT results, the majority of the subjects were normoglycemic (n = 316, 76.5%), while 49 (11.9%) were diagnosed with gestational diabetes, and 33 (8.0%) had single high glucose values. Reactive hypoglycemia was de-tected in only 15 patients (3.6%). The mean age of the women in the reactive hypoglycemia group was significantly lower than that of the women in the gestational diabetes and single high glucose value groups (26.4 ± 4.4 years, 31.4 ± 5.4 years, and 31.8 ± 4.3 years, respectively; p < 0.05). The newborns of the women in the reactive hypoglycemia group had higher rates of APGAR scores < 7, increased admission to the neonatal intensive care unit (NICU), and lower birth weights compared with the other groups (p < 0.001, p < 0.001, and p = 0.009, respectively). CONCLUSION: Reactive hypoglycemia during the 3 h 100 g OGTT is significantly associated with low APGAR scores, low birth weights, and prenatal admission to the NICU. Therefore, pregnant women who develop hypoglycemia during the 100 g OGTT performed at 24-28 weeks of gestation should receive attentive follow-up care to decrease the possibility of adverse perinatal outcomes.

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.

The Evaluation of IL6 and ESR1 Gene Polymorphisms in Primary Dysmenorrhea.

Primary dysmenorrhea is the most common gynecological complaint with painful menstrual cramps in pelvis without any pathology. It affects about half of menstruating women, and it causes significant disruption in quality of life. We investigated the association between IL6 gene promoter and ESR1 gene XbaI and PvuII polymorphisms and primary dysmenorrhea. In this case-control study, 152 unrelated young women with primary dysmenorrhea and 150 unrelated healthy age-matched controls participated. Genomic DNA was isolated and IL6 and ESR1 gene polymorphisms were genotyped using PCR-based RFLP assay. The distribution of genotype and allele frequencies of IL6 gene promoter and ESR1 gene XbaI polymorphisms were not statistically different between patients and controls (p > 0.05). However, the genotype and allele frequencies of ESR1 gene PvuII polymorphism showed statistically significant differences between primary dysmenorrhea patients and controls (p = 0.009 and p = 0.021, respectively). Statistically significant associations were also observed between age and married status of primary dysmenorrhea patients and ESR1 gene PvuII polymorphism (p = 0.044 and p = 0.023, respectively). In combined genotype analyses, AG at ESR1 XbaI and TC at ESR1 PvuII loci encoded a p-value of 0.027. Thus, individuals who are heterozygote at both loci have a lower risk of developing primary dysmenorrhea. Our study suggests no strong association between IL6 gene promoter and ESR1 gene XbaI polymorphisms and primary dysmenorrhea in Turkish women. However, ESR1 gene PvuII polymorphism showed statistically significant differences between primary dysmenorrhea patients and controls. The potential association between ESR1 gene PvuII polymorphism and age and married status of dysmenorrhea patients deserves further consideration.

Do Leukaemia Inhibitory Factor and Vascular Endothelial Growth Factor Have Any Roles in Intrauterine Device Mechanism of Action? An Experimental Rat Study.

OBJECTIVE: To assess leukaemia inhibitory factor (LIF) and vascular endothelial growth factor (VEGF) expression as markers of intrauterine device (IUD) efficacy in a rat model. METHODS: Twenty nulliparous female Wistar rats were divided into two groups with 10 animals per group: group I (IUD) and group II (control group, no IUD). In group I, a 2-cm 3-0 silk suture was placed into one horn of the rat bicornuate uterus. On day 20 (after IUD insertion) rats were sacrificed and their uteri removed. The number of vessels and the distribution of LIF and VEGF were compared among the uterine horns. RESULTS: There were no significant differences in LIF and VEGF expression in the groups and all horns (p > 0.05). The number of vessels was higher in the IUD+ horn than in the IUD- horn of group I and in the horn of group II (p < 0.05). There was no significant difference in the number of vessels between the IUD- horns of groups I and II (p > 0.05). CONCLUSION: LIF and VEGF expression did not correlate with IUD efficacy in a rat model. An IUD may increase the number of vessels in the uterine horn independent of VEGF expression. © 2015 S. Karger AG, Basel.

Regression of experimental endometriotic implants in a rat model with the angiotensin II receptor blocker losartan.

AIM: Endometriosis is a common disease in women of reproductive age, and many different treatments have been developed, although none has provided a cure. In this study, the efficacy of losartan, an angiotensin II type 1 receptor blocker and an antiangiogenic and anti-inflammatory agent, on regression of experimental endometriotic implants in a rat model was investigated. METHODS: Peritoneal endometriosis was surgically induced in 16 mature female Sprague-Dawley rats. The peritoneal endometriotic implant was confirmed after 28 days, and the animals were divided randomly into two groups. The control group (n = 8) was given 4 mL/day tap water by oral gavage, and the losartan group (n = 8) was given 20 mg/kg per day losartan p.o. We compared endometriotic implant size, extent and severity of adhesion, as well as plasma and peritoneal lavage fluid cytokine levels including vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α, plasma inflammatory factor pentraxin-3 (PTX-3) and C-reactive protein (CRP) between the treatment groups. RESULTS: Mean surface endometriotic area, histological score of implants, adhesion formation, plasma VEGF, TNF, PTX-3 and CRP levels were significantly lower in the losartan group compared with control (P < 0.05). Furthermore, the peritoneal VEGF level was lower in the losartan group than in the control group (P < 0.001), but peritoneal TNF-α was similar in both groups (P > 0.05). CONCLUSION: Losartan suppressed the implant surface area of experimental endometriosis in rats and reduced the levels of plasma VEGF, TNF-α, PTX-3 and CRP.

Do we need readjustment of the biochemical parameters in first trimester combined aneuploidy screening test in women with polycystic ovary syndrome?

OBJECTIVE: The aim of this study was to determine whether polycystic ovary syndrome (PCOS) affects the biochemical components of first trimester combined aneuploidy screening test. METHOD: A case-control study was performed at a tertiary referral hospital between years 2007-2013. Singleton pregnancies in the first trimester (11(+0) -13(+6) week) who had a history of PCOS and underwent first trimester combined aneuploidy screening test were included in the study. Three hundred and seventeen women met the criteria for inclusion. Control group was formed by 942 healthy pregnant women with similar gestational and maternal ages using a 1 : 3 ratio. Pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (fß-hCG) and fetal nuchal translucency were compared between the study group and the controls. RESULTS: The biochemical components PAPP-A and fß-hCG were significantly lower in the PCOS group compared with the control group (p = 0.001). There was no difference among groups with regard to the nuchal translucency measurements (p = 0.128). CONCLUSION: Our study shows that the levels of biochemical components of first trimester combined aneuploidy screening test (PAPP-A and fß-hCG) are altered in pregnant women with PCOS. Future trials of larger scale are needed to asses any need for readjustment of the risk in the patient population with PCOS.

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial.

BACKGROUND: Abnormal uterine bleeding (AUB) affects approximately 14% to 25% of women of reproductive age. The most common use of office hysteroscopy is to evaluate pathologies related to AUB and reproductive health, but office hysteroscopy can also be used for the diagnosis and treatment of other intrauterine pathologies. OBJECTIVE: Investigate the effects of the temperature of the distension fluid on pain severity in patients undergoing diagnostic office hysteroscopy due to AUB. DESIGN: Randomized controlled clinical trial. SETTING: Tertiary care center in Turkey. PATIENTS AND METHODS: One hundred perimenopausal patients with AUB were randomly allocated according to the temperature of the distension fluid used in office hysteroscopy (37°C or 25°C). Pain intensity was assessed using a visual analog scale (VAS). Six VAS measurements were compared over the course of the hysteroscopy: pre-treatment (VAS-1), at vaginal entry (VAS-2), at the cervical ostium transition (VAS-3), while in the cavity (VAS-4), at the end of the procedure (VAS-5), and 30 minutes after the end of the procedure (VAS-6). MAIN OUTCOME MEASURE: VAS SAMPLE SIZE: Fifty in each group enrolled, one drop out. RESULTS: The VAS-3, VAS-4, and VAS-5 scores were significantly lower for patients in the warm fluid group than in the room temperature group (P<.05), whereas the VAS-1, VAS-2, and VAS-6 scores were similar in both groups. CONCLUSION: The application of warm distension fluid in office hysteroscopy reduces pain severity compared with the application of an unheated fluid. LIMITATIONS: The main limitations of the study were that a subgroup analysis could not be performed due to an insufficient number of cases, and we were unable to evaluate vasovagal symptoms. CONFLICT OF INTEREST: None.

Obstructive sleep apnea syndrome is associated with maternal complications in pregnant women.

OBJECTIVES: This study was performed to evaluate the relationship between obstructive sleep apnea syndrome and pregnancy complications. MATERIAL AND METHODS: A total of 500 women (18-45 years) who had delivered (vaginal delivery or caesarean section) between January 2017 and March 2017 in our clinic were included in the study. Patients at high risk for obstructive sleep apnea syndrome were identified using the Stop Bang questionnaire. Based on the results of the questionnaire, pregnancy complications were compared between high-risk pregnant women (Group 1) and low-risk pregnant women (Group 2). RESULTS: Age, body mass index, smoking rate, and the rate of systemic disease (e.g., diabetes and/or hypertension) were higher in Group 1 than in Group 2 (p < 0.05). Rates of preeclampsia, gestational diabetes, preterm labor, premature rupture of the membranes, and cesarean section were significantly higher in Group 1 than in Group 2 (p < 0.05). CONCLUSIONS: Obstructive sleep apnea syndrome is associated with a higher rate of maternal complications among pregnant women. Affected patients should be carefully monitored.

Relationship between anemia and depressive mood in the last trimester of pregnancy.

OBJECTIVE: To compare the relationship between the severity of anemia and depressive mood in the last trimester of pregnancy. METHODS: A cross-sectional study, enrolled a total of 450 pregnant women who attended the antenatal clinics in their third trimester for their routine antenatal follow-up. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale. The study group was divided into two groups according to presence of anemia; anemic group (Hb < 11 gr/L; n = 150) and non-anemic group (Hb ≥ 11 gr/L; n = 300) and depression scores were compared. RESULTS: One hundred and fourteen (25.3%) women scored ≥13 points which were considered the cutoff value for depression on the EPDS. Anemia frequency was found as 33.3%. The total EPDS score was significantly higher in the anemic group (EPDS score 11 [min-max 0-29]) compared with the non-anemic group (EPDS score 7 [min-max 0-21]) (p = 0.000). Multiple regression analysis also revealed that serum Hb level was an independent factor for antenatal depressive mood. CONCLUSIONS: As anemia is associated with higher depressive symptom levels, it should be carefully considered during pregnancy. Prospective studies are needed to confirm our results.

Postural balance and the risk of falling during pregnancy.

Pregnancy is a physiological process and many changes occur in a woman's body during pregnancy. These changes occur in all systems to varying degrees, including the cardiovascular, respiratory, genitourinary, and musculoskeletal systems. The hormonal, anatomical, and physiological changes occurring during pregnancy result in weight gain, decreased abdominal muscle strength and neuromuscular control, increased ligamentous laxity, and spinal lordosis. These alterations shift the centre of gravity of the body, altering the postural balance and increasing the risk of falls. Falls during pregnancy can cause maternal and foetal complications, such as maternal bone fractures, head injuries, internal haemorrhage, abruption placenta, rupture of the uterus and membranes, and occasionally maternal death or intrauterine foetal demise. Preventative strategies, such as physical exercise and the use of maternity support belts, can increase postural stability and reduce the risk of falls during pregnancy. This article reviews studies that have investigated changes in postural balance and risk of falling during pregnancy.

Does diurnal variation affect the first trimester fetal aneuploidy screening test biochemical parameters of fetuses with normal nuchal translucency?

OBJECTIVE: The purpose of this study was to investigate the effect of diurnal variation on biochemical results of first trimester aneuploidy screening test. METHODS: A total of 2725 singleton pregnant female, who had normal fetal nuchal translucency (NT) thickness, were included in the study during this period. Individuals were divided into two groups according to the sampling time (morning group: 09:00-11:00 am and afternoon group: 02:00-04:00 pm). Hormonal parameters (free-beta human chorionic gonadotropin [free ß-hCG] and pregnancy-associated plasma protein-A [PAPP-A] multiples of median [MoM] levels) of first trimester (11(+0)-13(+6) weeks) combined aneuploidy screening test were compared between morning and afternoon groups. RESULTS: PAPP-A MoM levels were significantly lower in the afternoon group when compared to the morning group (p = 0.001), whereas free ß-hCG MoM levels were similar in the both groups (p = 0.392). Rate of high risk for Down syndrome (Combine risk >1/300) and amniocentesis ratio were found higher in the afternoon group than morning group, but there were no difference between groups for the number of fetuses with Down syndrome. CONCLUSION: Receiving the venous blood sample for first trimester aneuploidy screening test in the afternoon causes low PAPP-A MoM levels.

Nausea and Vomiting in Early Pregnancy of Adolescents: Relationship with Depressive Symptoms.

STUDY OBJECTIVE: To determine the relationship between severity of nausea and vomiting during pregnancy (NVP) and depressive symptoms in pregnant adolescents. DESIGN: Prospective cross-sectional study. SETTING: A maternity research hospital outpatient clinic, Ankara, Turkey. PARTICIPANTS: A total of 200 pregnant adolescents. INTERVENTIONS AND MAIN OUTCOME MEASURES: Demographic features and obstetric histories of the participants were assessed. The Rhodes test was performed to determine nausea and vomiting severity in a face-to-face interview, and the self-reported Edinburgh Postnatal Depression Scale was administered with supervision. RESULTS: The Rhodes test results showed that 52/200 patients (26%) were classified with none, 83/200 patients (41.5%) with mild, 48/200 patients (24.0%) with moderate, and 17/200 patients (8.5%) with severe symptoms. The mean depression score in the severe vomiting group was significantly higher than that in the no NVP and mild NVP groups (P = .028 and .041, respectively). No differences were found between the other groups. CONCLUSION: Severe nausea and vomiting was associated with greater depressive symptom severity in pregnant adolescents.

Investigating the effect of rose essential oil in patients with primary dysmenorrhea.

OBJECTIVE: This study aimed to evaluate the effects of rose essential oil on primary dysmenorrhea. METHODS: One hundred patients were randomly divided into two groups; Group D received diclofenac sodium (75 mg/im) and Group A administered diclofenac sodium with aromatherapy (2% rose essential oil). The visual analog scale (VAS) scores in all subjects at baseline, 10th min, and 30th min were recorded. RESULTS: When the two groups were compared before and after the treatment, there were significant decreases in VAS values at the 10 min and 30 min compared to baseline values in both groups (p < 0.001). However, the 30th min mean VAS value in Group D was higher than in Group A (p = 0.019). CONCLUSION: The present study suggests that aromatherapy with rose essential oil, which is a nonpharmacologic treatment method, as an adjuvant to conventional treatment methods may be beneficial for pain relief in individuals with primary dysmenorrhea.

Do Urgent Caesarean Sections Have a Circadian Rhythm?

OBJECTIVE: The primary goal of the present study was to demonstrate the existence of a possible circadian variation in urgent operative deliveries. METHODS: All urgent caesarean sections between 1 January 2014 and 1 January 2015 with known exact onset times of operation were included in this retrospective study. Cases that were previously scheduled for elective caesarean section were excluded. Information regarding age, delivery date, onset time of operation and type of anaesthesia was collected from the database. Analyses were completed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0 software. The statistical significance for all analyses was set at p<0.05. RESULTS: A total of 285 urgent caesarean section deliveries were included in the study. There were 126 (44.2%) deliveries during the day shift and 159 (55.8%) during the night shift. 80 patients (28.1%) received general anaesthesia and 65 (22.8%) received spinal anaesthesia in the morning shift, whereas 54 patients (18.9%) received general anaesthesia and 86 (30.2%) received spinal anaesthesia during the night shift. CONCLUSION: The present study suggested that urgent caesarean sections revealed a circadian rhythm during the day.

Postural balance in pregnancies complicated by hyperemesis gravidarum.

OBJECTIVE: To assess postural balance in females with pregnancies complicated by hyperemesis gravidarum (HG). METHODS: In this observational study, postural balance during the first trimester was measured using the Biodex Balance System (BBS) in 41 pregnant females (20 females with pregnancies complicated by HG and 21 healthy controls). The overall stability index (OA), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and fall risk test (FRT) scores were obtained from the mean scores of three trials on the BSS. The four measurements obtained from the BBS (OA, APSI, MLSI and FRT) were compared between healthy pregnant females and those with pregnancies complicated by HG (HG group). RESULTS: The mean OA and APSI scores were significantly higher in the HG group compared to healthy pregnant controls (p < 0.01). There was no significant difference in the MLSI between the two groups (p > 0.05). The FRT scores of HG patients were higher than healthy pregnant females (p = 0.001). CONCLUSIONS: Pregnant females with HG have poor postural stability/balance and high fall risk test scores. HG causes decreased postural equilibrium in the first trimester of pregnancy.

Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia.

OBJECTIVE: The purpose of present study was to evaluate association between neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) and endometrial hyperplasia (EH). METHODS: One hundred and ten women with abnormal uterine bleeding were included into the study. Blood samples were drawn from all patients to obtain complete blood cell counts, neutrophil-leukocyte ratio and platelet-leukocyte ratio before endometrial curettage procedure initiated. The patients were divided into three groups due to their pathological results: group 1, patients with EH without atypia (n=40); group 2, patients with EH with atypia (n=15); and group 3, patients with neither hyperplasia nor cancer as control group (n=55). Blood cell counts, NLRs and PLRs were compared among these groups. RESULTS: Based on hemoglobin and platelet counts, there was no significant difference among these groups (P>0.05). Leukocyte and neutrophil counts were higher in group 2 (EH with atypia) than group 1 and group 3 (P<0.01). NLR of group 2 was significantly elevated when compared to group 1 and group 3 (P=0.004). PLR was higher in group 1 and group 2 than control group (P=0.024). CONCLUSION: Non-specific inflammatory markers such as NLR and PLR were elevated in women with atypical EH. These markers may be used as a predictor of atypical EH in patients with abnormal uterine bleeding.