Assessing the efficacy of a novel sperm-washing medium enriched with serotonin, L-carnitine, and coenzyme Q10: an observational cohort study.

ABSTRACT: This observational cohort study investigated the potential of a novel sperm-washing medium (SWM) enriched with serotonin (5-HT), L-carnitine (L-C), and coenzyme Q10 (CoQ10) to enhance sperm motility and reduce DNA damage. It compared this innovative medium (5-HT/L-C/CoQ10 SWM) with two widely used commercial media (SWM 1 and SWM 2). Ninety-eight volunteers from an infertility clinic provided semen samples, which were divided into three aliquots for analysis in different SWMs: group 1, SWM was composed of hydroxyethyl piperazineethanesulfonic acid (HEPES), sodium bicarbonate, human serum albumin (HSA), taurine, and gentamicin sulfate (SWM 1); group 2, SWM was composed of HEPES, sodium bicarbonate, and HSA (SWM 2); and group 3, SWM was composed of HEPES-buffered human tubal fluid supplemented with 5-HT, L-C, and CoQ10 (5-HT/L-C/CoQ10 SWM). Sperm motility was categorized as progressive, nonprogressive, or immotile. Apoptosis, reactive oxygen species (ROS) production, and DNA fragmentation were also assessed. There were no significant differences in total or progressive sperm motility among the groups. Spermatozoa in group 3 exhibited reduced apoptosis, necrosis, and ROS levels and increased viability. No significant differences were observed in the DNA fragmentation index among groups. The 5-HT/L-C/CoQ10 SWM reduced sperm oxidative stress and apoptosis compared with those of the two commercially available SWMs, suggesting that 5-HT/L-C/CoQ10 SWM could be useful for enhancing in vitro fertilization success rates.

Pre-delivery fibrinogen level is a predictor for severity of placental abruption.

Objective: To determine pre-delivery fibrinogen levels in predicting adverse maternal or neonatal outcomes in patients with placental abruption. Materials and method: We conducted a retrospective study of all women admitted for placental abruption between January 2012 and May 2018. Postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC), massive blood transfusion and hospitalization in intensive care unit parameters were evaluated for maternal outcomes. For the neonatal outcomes, the 5th minute APGAR score, umbilical artery pH and stillbirth were evaluated. Results: The mean predelivery fibrinogen levels were 221.3 ± 111.6 mg/dL. In multivariate logistic regression analysis, fibrinogen level was determined as an independent indicator for PPH, red cell concentrate (RCC) and fresh frozen plasma (FFP) transfusion. When fibrinogen levels decreased below 130 mg/dL, the risk of PPH increased and when fibrinogen levels decreased below 100 mg/dL, the risk of overt DIC and also the risk of red cell concentrate and fresh frozen plasma transfusion increased. In terms of the fetal results, there may be adverse neonatal outcomes when fibrinogen levels are below 250 mg/dL. Conclusion: Predelivery fibrinogen levels are good indicators for predicting adverse maternal outcomes in placental abruption cases. In addition, fibrinogen levels might be a guide for management of placental abruption cases.

Serial progesterone levels more accurately predict the time of ovulation in subfertile women: a prospective cohort study.

PURPOSE: To predict ovulation in subfertile women using serial follicular growth (FG) and serum hormone measures (estradiol (E2), luteinizing hormone (LH), and progesterone (P) levels) in mathematical models. METHODS: This was a prospective observational study of 116 subfertile women aged between 18 and 40 years. FG was assessed by serial transvaginal ultrasonography starting from cycle days 8-12, depending on cycle length. Once the dominant follicle reached 15-16 mm, hormone levels were assessed daily. The primary outcome measure was ovulation (Ov), with a serum LH level ≥15 IU/l defining the start of the LH surge (the day prior to ovulation) and a serum P level >1 µg/ml concurrent with a drop in serum E2 levels indicating Ov. To determine Ov, mathematical models were generated using FG, LH, E2, and P measurements. RESULTS: A mathematical model was constructed using exponential regression to relate days until and after ovulation with P levels. The Ov(P) model was found to be superior to the Ov(LH) model in the prediction of Ov, with high R2 and low RMSE values of 0.9983 and 0.2454, respectively. In the range of [-2, 2] days, the net accuracy of the Ov(P) model was 63.0%, while with an allowed one-day error, the accuracy was 99.6%. CONCLUSION: Serum P levels display a highly predictable linear curve in natural cycles, which enables the prediction of ovulation. The Ov(P) model can be independently used to schedule embryo transfer in natural frozen-thaw cycles and could therefore replace the Ov(LH) model in clinical practice.

Oocyte vitrification for oncological and social reasons.

The aim of this review is to present information related to oocyte cryopreservation, and particularly oocyte vitrification, performed to preserve fertility in oncologic and social indications. The success rates of oocyte cryopreservation have increased with the widespread use of the vitrification technique and are currently similar to those of in vitro fertilization performed with fresh oocytes. Vitrification is the most successful technique for oocyte cryopreservation. The most important factors that influence the success rate are the patient's age at the time of vitrification and the number of mature oocytes frozen. Thus, live birth rates differ for each age depending on the number of oocytes thawed and the freezing method. The American Society of Reproductive Medicine and the American Society of Clinical Oncology recommend presenting the option of oocyte cryopreservation for fertility preservation in cancer patients. Besides cancer patients, use of oocyte vitrification is increasing in women who wish to postpone pregnancy age and to have reproductive freedom with the development of the cryopreservation technique and the achievement of pregnancy rates similar to the use of fresh oocytes. Patients are provided consultancy service in terms of indication, the success rates by age, and the total number of oocytes frozen. It should be emphasized that this procedure is not a type of insurance policy for fertility, especially in elective oocyte cryopreservation.

Skin closure at cesarean section, polypropylene versus polyglactin 910: a randomized controlled study.

AIM: To compare the rates of surgical wound infection in women who have undergone cesarean delivery with subcuticular skin closure with polyglactin 910 or polypropylene. METHODS: Between April 2018 and October 2018, patients who had undergone a cesarean delivery for any reason were randomized with polyglactin 910 or polypropylene for subcuticular skin closure. Participants were evaluated for wound complications on day 7 and 30 postoperatively. The primary outcome was surgical site infection within the first 30 days following delivery. In addition, factors affecting surgical site infections were analyzed by binary regression. RESULTS: A total of 220 women who had undergone cesarean delivery were randomized and 213 were included in the final analysis. The groups were similar in terms of demographic characteristics and perioperative features. No statistically significant difference was observed between the groups in terms of wound complications or superficial site infections (8.3% in the polypropylene group versus 10.6% in the polyglactin 910 group, p = .642). Similarly, no difference was observed between the groups in terms of other wound complications. A binary logistic regression analysis indicated that superficial wound site infection was not affected by gravidity, BMI, duration of operation, repeated or unplanned cesarean delivery. CONCLUSION: It was observed that surgical site infections and other wound complications in skin closures with polyglactin 910 were similar to those with polypropylene.

Maternal serum procalcitonin levels in prediction of chorioamnionitis in women with preterm premature rupture of membranes.

INTRODUCTION: Chorioamnionitis is one of the most important maternal complications in the expectant management of patients with preterm premature rupture of membranes (PPROM). Procalcitonin (proCT), the precursor of the hormone calcitonin, is used to differentiate bacterial infections from non-bacterial ones. The objective of the study was to determine the efficacy of maternal serum procalcitonin levels in the early prediction of chorioamnionitis in women with PPROM. MATERIAL AND METHODS: The study was conducted in 76 pregnant women hospitalized due to PPROM at the maternal-fetal medicine unit of a tertiary center in Istanbul. Patients were followed up with white blood cell (WBC), C-reactive protein (CRP) and proCT levels every 2 days. The values of investigated parameters were recorded at the diagnosis of PPROM and at the time of delivery. The maximum values during the follow-up period were also recorded. RESULTS: Out of the 76 patients with PPROM, 15 (19.73%) developed clinical chorioamnionitis. No significant difference could be detected in the gravidity, parity, duration of hospitalization and gestational week at diagnosis between those patients who developed clinical chorioamnionitis and those who did not. The WBC at the time of hospital admittance and before delivery, and CRP levels before delivery were statistically higher in the chorioamnionitis group (p < 0.05). No difference in the proCT levels could be detected either at the time of hospital admittance or before delivery between the two groups. CONCLUSIONS: Maternal proCT was not found to be predictive of chorioamnionitis. However, since there are reports in the literature that contradict these results, further studies are warranted to determine the true efficacy of proCT in the prediction of clinical chorioamnionitis.

The role of video-based multimedia information in reduction of anxiety before dilatation and curettage.

OBJECTIVE: Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients' education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C. METHODS: Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale. RESULTS: Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027). CONCLUSION: Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital.

OBJECTIVE: To identify changing trends in peripartum hysterectomy (PH), both elective. cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. MATERIALS AND METHODS: A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan Süleyman Training and Research Hospital were analyzed. RESULTS: There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001-2008 and 2009-2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001-2008, whereas that percentage increased to 95.4% during 2009-2017. CONCLUSION: Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality.

Assessment of fetal right ventricular myocardial performance index changes following intrauterine transfusion.

INTRODUCTION: Severe fetal anemia may cause cardiac ischemia, reduced contractility, and dysfunction. The purpose of our study is to evaluate right ventricular myocardial performance index (MPI) before and after intrauterine transfusion (IUT) in patients who underwent this procedure because of fetal anemia due to Rh-D alloimmunization. MATERIALS AND METHODS: This prospective cohort study was conducted between January 2018 and June 2019 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The pregnant women who were applied IUT because of fetal anemia due to Rh-D alloimmunization in our perinatology clinic were included in the study. Fetal right ventricular MPI before and 24 h after IUT were evaluated. RESULTS: A total of 28 IUTs were performed in 17 pregnant women during the study period. The isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) values measured before IUT, were found to be significantly longer compared to the ICT and IRT values measured after IUT. The MPI values measured after transfusion was found to be higher than before transfusion. CONCLUSIONS: The fetal right ventricular MPI increases 24 h after IUT. This increase in the right ventricular MPI might be used as a marker for predicting adverse fetal outcomes following IUT.

Use of video-based multimedia information to reduce anxiety before office hysteroscopy.

INTRODUCTION: Use of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings. AIM: To investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH). MATERIAL AND METHODS: All consecutive women aged 18-65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale. RESULTS: Fifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 ±8.0 vs. 49.4 ±8.4, p < 0.001, 95% CI for the difference: 1.36-7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups. CONCLUSIONS: A video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients' satisfaction.

Maternal serum mitofusin-2 levels in patients with preeclampsia: the possible role of mitochondrial dysfunction in preeclampsia.

Purpose: Hypoxia alters mitochondria function and our aim was to measure mitochondrial fusion protein mitofusin-2 (Mfn2) in patients with preeclampsia.Materials and methods: This cross-sectional study was conducted including 82 pregnant women, 27 with normal pregnancy and 55 with preeclampsia (27 with early-onset preeclampsia and 28 with late-onset preeclampsia). Maternal serum levels of Mfn2 were measured by using enzyme-linked immunosorbent assay kits.Results: The mean serum mitofusin-2 levels were higher in women with preeclampsia than in the control group (68.02 ± 8.7 pg/mL vs. 99.72 ± 37.27 pg/mL, p < .0001). The mean serum mitofusin-2 level was found to be the highest in the early-onset preeclampsia (EOPE) group (EOPE: 101.6 ± 38.5 pg/mL). Maternal serum mitofusin-2 levels correlated with both systolic and diastolic blood pressures as well as uterine artery pulsatility index. The optimal cutoff value of Mfn2 for determining preeclampsia was 75.3 pg/mL.Conclusion: Mfn2 has regulatory roles in stress response. Maternal serum Mfn2 is higher in patients with preeclampsia suggesting that Mfn2 increases in the maternal system as a stress response against hypoxia and endothelial dysfunction.What do the results of this study add? Hypoxia causes mitochondrial dysfunction that has been linked to the etiology of many diseases including preeclampsia. Mitofusin-2 is a mitochondrial fusion protein, and the levels can be altered in preeclampsia. For the first time, we showed that maternal levels of mitofusin-2 are higher in patients with preeclampsia. Further, we reported the correlation of mitofusin-2 with blood pressures and uterine artery pulsatility index. These findings will open up other avenues for researchers to investigate other mitochondrial molecules while under stress.

Increased pancreatic-derived factor (PANDER) levels in gestational diabetes mellitus.

The aim of the study was to investigate the pancreatic-derived factor (PANDER) levels in healthy pregnant women and in pregnant women with gestational diabetes mellitus (GDM). A total of 50 women consecutively diagnosed with GDM and 30 randomly selected age-matched and gestational-age-matched healthy pregnant women were included in this cross-sectional study. Serum PANDER levels and other variables were analyzed. The age, the gestational age at the time, the blood sample was obtained and the hemoglobin A1c (HbA1c) levels of the GDM and control groups were similar. The body mass index (BMI), fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and serum PANDER levels were significantly higher in the GDM group than the control group. The optimal PANDER cutoff value was 227.2 ng/ml, and the ratios above this value were 100 and 86.6% for sensitivity and specificity, respectively (p=.0001). Serum PANDER levels were higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR, and HbA1c levels. These results suggest that PANDER might be considered a new biomarker for GDM.

Gremlin-1 and gremlin-2 levels in polycystic ovary syndrome and their clinical correlations.

Objective: Gremlin 1 and 2 regulate oocyte primordial follicle transition in animal models. The main objective of this study is to measure the blood levels of Gremlin 1 and 2 in the women with Polycystic Ovary Syndrome (PCOS). We also aimed to evaluate the association of these markers with hormonal and biochemical parameters of PCOS as interrupted folliculogenesis in those women is related to metabolic dysfunction. Material and methods: Fifty women with PCOS were diagnosed according to Rotterdam criteria, and thirty age-matched female controls were included in this prospective study. Gremlin 1 and 2 levels along with hormonal and metabolic parameters were compared between PCOS and control groups. Results: Serum Gremlin 1 levels were significantly higher in the PCOS group than in the control group (p = .001). Gremlin 2 levels were similar between the groups. Besides, there was a significant positive correlation between Gremlin 1 and insulin levels, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) and waist to hip ratio (WHR) (r = 0.305; r = 0.297; r = 0.303, respectively). Conclusion: Our data suggest that Gremlin 1 may be the key regulator in the pathogenesis of PCOS. In future, Gremlin 1 may be a novel therapeutic target for the treatment of PCOS.

Inflammatory marker YKL-40 levels in intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy is a diagnosis of exclusion and presents with unexplained pruritus, abnormal liver function tests, and increased serum bile acid levels, particularly in the third trimester of pregnancy. Serum YKL-40 levels are increased in liver diseases and our aim was to investigate YKL-40 levels in pregnant women with ICP. 40 women with intrahepatic cholestasis of pregnancy and 40 healthy pregnant women were included in this cross-sectional study. Serum YKL-40 levels were measured in both groups and correlation analysis were performed between the YKL-40 and other liver function tests. Serum YKL-40 concentrations were higher in the intrahepatic cholestasis of pregnancy group than in the control group (103.46 ± 53.03 vs. 57.60 ± 30.30 ng/ml, p = .002). The cutoff YKL-40 serum concentration was 84.80 ng/ml for the diagnosis of intrahepatic cholestasis of pregnancy. There was no correlation between fasting bile acids and YKL-40 levels. However, there was a significant positive correlation between the YKL-40 levels and aspartate aminotransferase (r = 0.22, p = .04) and alanine aminotransferase (r = 0.24, p = .02). Raised YKL-40 levels might support the evidence on inflammatory processes in intrahepatic cholestasis of pregnancy.

Evaluation of FGF-19 and ß-klotho as biomarkers in patients with intrahepatic cholestasis of pregnancy.

INTRODUCTION: Fibroblast growth factor-19 (FGF-19) and its co-receptor, beta-klotho, regulate bile acid synthesis in the liver as an enterohepatic feedback mechanism. In this study, our aim was to investigate the circulating FGF-19 and ß-klotho levels in intrahepatic cholestasis of pregnancy (ICP) cases. MATERIAL AND METHODS: A cross-sectional study including 40 women whose pregnancies were complicated with ICP were recruited for the study group. Forty randomly selected healthy pregnant women comprised the control group. The patient characteristics, including maternal age, gravidity, parity, gestational age at the time of diagnosis, body mass index (BMI), and obstetric history, were recorded. The serum FGF-19 and ß-klotho concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS: Maternal age, gravidity, parity, body mass index at assessment, and gestational age at blood sampling were similar between the two groups (p > 0.05). Moreover, there were no significant differences in the FGF-19 and ß-klotho concentrations between the two groups (p = 0.341 and p = 0.086, respectively). A positive correlation was detected between the ß-klotho and FGF-19 levels, as well as between the FGF-19 level and BMI (r = 0.368, p = 0.020 and r = 0.389, p = 0.013, respectively). CONCLUSIONS: The serum FGF-19 and ß-klotho concentrations did not differ between the pregnancies with ICP and the healthy controls. However, in some cases, abnormalities in the FGF-19, ß-klotho, and FGFR4 signaling system may play roles in the pathogenesis of ICP.

Advanced maternal age and risk of non-chromosomal anomalies: data from a tertiary referral hospital in Turkey.

PURPOSE: The purpose of this study is to determine if there is a relationship between non-chromosomal fetal anomalies of various organ systems and advanced maternal age. MATERIALS AND METHOD: This study was conducted in 387 women aged 20-53 years who underwent fetal karyotype testing due to positive prenatal test results or advanced maternal age at the Kanuni Sultan Süleyman Training and Research Hospital between September 2011 and March 2015. Fetuses with chromosomal anomalies were excluded from the study. The relationship between non-chromosomal anomalies and maternal age of women aged <35 or ≥35 years was studied. RESULTS: More than 80% (81.7%) of non-chromosomal anomalies were detected in patients aged <35 years, and 18.3% were found in those ≥35 years. There were no statistically significant differences found between the incidence of non-chromosomal anomalies in women aged over 35 years and those under 35 years. When congenital major anomalies were evaluated with respect to various organ systems, the risk of musculo-skeletal system anomalies decreased with advancing maternal age. However, there was no statistically significant difference between the <35 and ≥35-year age groups in the incidence of central nervous system, craniofacial, cardiac, gastrointestinal system, urogenital, respiratory, and limb anomalies. CONCLUSION: The incidence of non-chromosomal anomalies does not increase in fetuses of pregnant women aged over 35 years, in contrast to chromosomal anomalies.

Maternal serum AMP-activated protein kinase levels in mild and severe preeclampsia.

OBJECTIVE: To investigate Phosphorylated adenosine monophosphate activated protein kinase (AMPK) levels in healthy pregnant women and pregnant women with preeclampsia (PE). METHODS: Twenty-eight women with mild-PE, 22 with severe-PE, and 30 normotensive controls were included in this cross-sectional study. The serum AMPK levels of these patients were analyzed. The patients were followed up to delivery. RESULTS: No statistically significant difference was found between the groups for age, gravida, parity, and gestational age at the time the blood samples were obtained (p > .05). No significant difference between the group with mild-PE and the control group was found, while in the severe-PE group, serum AMPK levels were significantly higher relative to both the mild-PE and control groups (p < .001 and p < .001, respectively). No correlation was detected between serum AMPK levels and age, body mass index (BMI), and gestational age at the time the blood samples were collected. A negative correlation was found between AMPK levels and gestational week and birthweight at delivery, while a positive correlation was detected between systolic and diastolic blood pressures and AMPK levels. CONCLUSIONS: Serum AMPK was higher in patients with severe-PE compared with healthy pregnant women and patients with PE without severe features so it might be a new biomarker for the prediction of disease and its severity.

The predictive nature of uterocervical angles in the termination of second trimester pregnancy.

AIM: To establish how useful and the predictive capacity of uterocervical angles (UCA) in the termination of second trimester pregnancies. MATERIAL AND METHODS: This prospective cohort study was conducted at a tertiary center with a total of 120 singleton pregnancies delivered between 14 and 24 gestational weeks. Before the beginning of misoprostol induction, patients were screened for both cervical length (CL) and uterocervical angles (UCA). The UCA is defined as an angle constructed by the measurement of the cervical canal and lower uterine segment. The study population was subdivided into four groups; successful and failed terminations at the end of 24 hours of induction and successful and failed terminations at the end of 48 hours of induction. We decided to further evaluate our study population based on their UCAs, and placed them into four categories; UCA ≥95°, UCA <95°, UCA ≥105°, and UCA <105°. RESULTS: In the 24-hour time frame group, the mean UCA was 105.50 ± 15.38 degrees in the successful termination group and was 100.22 ± 11.12 degrees in the failed group (p = .001). In the 48-hour time frame group, the mean UCA was 104.19 ± 13.51° in the successful termination group and was 93.52 ± 7.84° in the failed group (p = .007). The mean hour of induction was shortest in the UCA ≥105° group. CONCLUSIONS: Regardless of the time frames, patients who had successful terminations had a broader angle, less amount of misoprostol use and shorter duration of induction as compared to the failed termination groups. What do the results of this study add? The uterocervical angle has never been measured in second trimester pregnancies to predict the timing of termination. Our study demonstrated the useful application of this ultrasonographic finding in the prediction of successful second trimester terminations.

Increased levels of the novel hepatokine fetuin B in patients with intrahepatic cholestasis of pregnancy.

OBJECTIVES: To investigate liver-derived plasma protein fetuin B levels in healthy pregnant women and pregnant women with intrahepatic cholestasis of pregnancy (ICP). MATERIALS AND METHODS: Forty women with ICP and 40 healthy pregnant women were included in this cross-sectional study. The serum fetuin B levels of these patients were analyzed. The patients were followed up to delivery. RESULTS: Maternal age, gravida, parity, BMI at assessment, and gestational age at blood sampling were similar between the ICP and control groups (p > .05). However, the gestational age at delivery and the birth weight were significantly lower in the ICP group (p < .05). Total bile acid (TBA) levels and liver function tests were significantly higher in the ICP group than in the control group (p < .0001 and < .0001, respectively). In addition, serum fetuin B concentrations were significantly higher in the ICP group than in the control group (p < .0001). The best cutoff for fetuin B serum concentration was 5540.2 pg/mL. Serum values greater than this threshold had 80% sensitivity and 65% specificity for the diagnosis of ICP. CONCLUSIONS: Serum fetuin B was higher in patients with ICP compared to healthy pregnant women and might be a new biomarker.