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OBJECTIVE: Our study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) using maternal serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin-4 (IL-4), and IL-10. METHODS: The case group consisted of 77 patients with placenta previa, and the control group consisted of 90 non-previa pregnant women. Of the pregnant women in the case group, 40 were diagnosed with PAS in addition to placenta previa and 37 had placenta previa with no invasion. The maternal serum VEGF, TNF-alpha, IL-4, and IL-10 levels were compared between the case and control groups. Then the success of these markers in differentiating between PP and PAS was evaluated. RESULTS: We found the VEGF, TNF-alpha, and IL-4 levels to be higher and the IL-10 level to be lower in the case group compared to the control group (p < 0.001). We observed a statistically significantly lower IL-10 level in the patients with PAS than those with PP (p = 0.029). In the receiver operating characteristic analysis, the optimal cut-off of IL-10 in the detection of PAS was 0.42 ng/mL). In multivariate analysis, the risk of PAS was significant for IL-10 (odds ratio (OR) 0.45, 95 % confidence interval (CI) 0.25-0.79, p = 0.006) and previous cesarean section (OR 2.50, 95 % Cl 1.34-4.66, p = 0.004). The model's diagnostic sensitivity and specificity, including previous cesarean section, preoperative hemoglobin (Hb), TNF-alpha, and IL-10 were 75 % and 72.9 %, respectively. CONCLUSION: The study showed that the IL-10 level was lower in patients with PAS than in those with PP. A statistical model combining risk factors including previous cesarean section, preoperative Hb, TNF-alpha, and IL-10 may improve clinical diagnosis of PAS in placenta previa cases. Cytokines may be used as additional biomarkers to the clinical risk factors in the diagnosis of PAS.
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Placenta Acreta , Placenta Prévia , Gravidez , Feminino , Humanos , Placenta Prévia/diagnóstico , Placenta Prévia/patologia , Fator de Necrose Tumoral alfa , Fator A de Crescimento do Endotélio Vascular , Placenta Acreta/diagnóstico , Placenta Acreta/patologia , Interleucina-4 , Estudos Retrospectivos , Cesárea , Interleucina-10 , Placenta/patologiaRESUMO
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.
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COVID-19 , Complicações Infecciosas na Gravidez , Recém-Nascido , Gravidez , Feminino , Humanos , Cesárea , Complicações Infecciosas na Gravidez/epidemiologia , Pandemias , Placenta , COVID-19/epidemiologia , Resultado da Gravidez , Transmissão Vertical de Doenças InfecciosasRESUMO
OBJECTIVE: To evaluate both short and mid-term effects of maternal COVID-19 on cardiac functions of fetuses and children. METHODS: The present case-control study was conducted on 36 pregnant women who had COVID-19 infection in the second trimester of pregnancy and 30 pregnant women as healthy controls. Fetal, neonatal, and infant cardiac functions were compared between the groups. Assessment of fetal cardiac functions were performed in the last trimester of the pregnancy at least 6 weeks after the recovery of infection. The first postnatal echo was performed within the first 2 weeks and the follow-up (second) echo was performed in the 6-8 weeks of life. RESULTS: The demographic data were similar between groups. Interventricular septum and left ventricular posterior wall end-diastolic dimensions were significantly higher in the study group in both fetal, neonatal, and infant periods. Impaired diastolic functions of right and left ventricles were detected and myocardial performance indexes with tissue doppler imaging of both lateral walls and septum were significantly higher than controls at all periods. CONCLUSION: Maternal COVID-19 seems to have a global impact on the cardiac functions of babies in the short and mid-term periods after maternal recovery.
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COVID-19 , Ecocardiografia Doppler , Recém-Nascido , Lactente , Criança , Gravidez , Feminino , Humanos , Ecocardiografia Doppler/métodos , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Terceiro Trimestre da Gravidez , Ultrassonografia Pré-Natal/métodosRESUMO
OBJECTIVE: To compare the cardiac functions of fetuses with preterm premature rupture of membranes (PPROM) between their control groups and investigate its relationship with perinatal outcomes. METHODS: This prospective study was conducted with 102 pregnant women. Pregnant women with PPROM were divided into two subgroups Group A, between 26 and 30 weeks, and Group B, between 30 and 34 weeks. A control group was formed by randomly including one healthy pregnant woman for each study patient. Sociodemographic, obstetric data, tissue Doppler imaging, and M-mode imaging results were compared. The relationship between echocardiographic parameters and perinatal outcomes was also investigated. RESULTS: Tricuspid annular plane systolic excursion (TAPSE), S', and ET' of systolic cardiac parameters were shortened in both groups compared with their controls. Diastolic function indicator E'/A', and global function indicator myocardial performance index' increased in both groups. Isovolumetric contraction time' did not change between groups. A correlation was found between myocardial performance index', and the length of neonatal intensive care unit stay in Group A and TAPSE and duration of respiratory support and length of neonatal intensive care unit stay in Group B. CONCLUSIONS: The fetal cardiac function seems to be affected by PPROM, and these changes are associated with neonatal outcomes. Therefore, administering fetal cardiac function evaluation in pregnancies complicated by PPROM may help physicians establish more appropriate clinical management protocols in this special population.
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Ruptura Prematura de Membranas Fetais , Nascimento Prematuro , Recém-Nascido , Humanos , Feminino , Gravidez , Estudos de Casos e Controles , Estudos Prospectivos , Feto , Ruptura Prematura de Membranas Fetais/diagnóstico por imagem , Ultrassonografia DopplerRESUMO
OBJECTIVES: To investigate whether fetal cardiac function is affected by underlying heart disease in pregnant women. METHODS: A total of 100 pregnant women who were ≥34 gestational weeks were included in the study, 40 in the maternal heart disease (MHD) group diagnosed with heart disease and 60 in the control group. All cardiac diseases in pregnant women were diagnosed preconceptionally and categorized according to the New York Heart Association (NYHA) classification system. Fetal cardiac functions of study groups were evaluated by M-mode, color tissue Doppler imaging (c-TDI), and pulsed wave Doppler. RESULTS: Tricuspid annular plane systolic excursion and myocardial performance index (MPI) values were significantly higher and isovolumetric relaxation time was prolonged in the MHD group. The MPI value was found higher in MHD group with NYHA Class II compared to those with NYHA Class I. No significant change in any of the fetal tricuspid annular peak velocity values measured by c-TDI in the MHD group. There were no differences in fetal cardiac functions and perinatal outcomes between pregnant women with acquired and congenital heart diseases. Patients in NYHA Class II had lower birth weight, 1st and 5th minute APGAR scores, and higher neonatal intensive care unit admission rates. CONCLUSIONS: Underlying heart diseases in pregnant women can cause alterations in the systolic and diastolic function of the fetal heart. High fetal MPI values detected in cardiac patients may indicate that cardiac pathologies during pregnancy affect fetal cardiac globular myocardial function. Cardiac pathologies that progress with restricted physical activity may cause changes in fetal cardiac function and may be associated with adverse perinatal outcomes.
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Cardiopatias , Recém-Nascido , Humanos , Gravidez , Feminino , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Coração Fetal/diagnóstico por imagem , Sístole , Estudos Prospectivos , Diástole , Ultrassonografia Pré-Natal/métodosRESUMO
OBJECTIVES: To compare the postpartum shock index (SI) values between pregnant women with hypertensive disease of pregnancy (HDP) and normotensive controls. METHODS: The present study was conducted in Ankara City Hospital Perinatology Clinic. Postpartum SI was compared between the pregnant women with HDP (n=217) and normotensive controls (n=219). A logistic regression analysis was performed to assess the independent predictors of maximum SI ≥1. Finally, a ROC analysis was performed to calculate optimal cut-off values for postpartum SI's measured at different periods in the prediction of postpartum Hb (hemoglobin) decrease ≥2â¯g/dL. RESULTS: Peripartum SI (p<0.001), 15th min SI (p<0.001), 30thâ¯min SI (p<0.001), 2ndâ¯h SI (p<0.001), 6thâ¯h SI (p) of the HDP group (p<0.001) and max SI (p<0.001) values were found to be significantly lower in the study group. A weak positive and statistically significant correlation was found between the maximum SI and the decrease in Hb ≥2â¯g/dL (r=0.209; p=0.002). Optimal cutoff values for SI were; 0.7 at peripartum 0.7 at 15â¯min, 0.73 at 30â¯min, 0.6 at 2â¯h, and 0.7 at 6â¯h, respectively. CONCLUSIONS: Clinically significant blood loss may develop at lower SI values in hypertensive pregnant women.
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Hipertensão Induzida pela Gravidez , Choque , Gravidez , Feminino , Humanos , Estudos de Casos e Controles , Período Pós-Parto , Pressão Sanguínea , Hipertensão Induzida pela Gravidez/diagnóstico , HemoglobinasRESUMO
OBJECTIVES: To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor. METHODS: This prospective cohort study included dichorionic twin pregnancies between 24 and 32 weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded. RESULTS: Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8 ± 0.9â¯mm, compared to 4.6 ± 1.1â¯mm in those with an onset of labor at or after 340/7â¯GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 350/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0 ± 1.0â¯mm in those with an earlier onset of labor and 4.7 ± 1.0â¯mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34â¯GW and p=0.028 for <35â¯GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively). CONCLUSIONS: LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies.
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OBJECTIVES: To examine the fetal thymic-thoracic ratio (TTR) in intrahepatic cholestasis of pregnancy (ICP). METHODS: This prospective case-control study was conducted in a single tertiary center. The sample consisted of 86 pregnant women at 28-37â¯weeks of gestation, including 43 women with ICP and 43 healthy controls. TTR was calculated for each patient using the anterior-posterior measurements of the thymus and intrathoracic mediastinal measurements. RESULTS: The median TTR value was found to be smaller in the ICP group compared to the control group (0.32 vs. 0.36, p<0.001). The ICP group had a greater rate of admission to the neonatal intensive care unit (NICU) (p<0.001). Univariate regression analysis revealed that lower TTR values increased the possibility of NICU admission six times (95â¯% confidence interval: 0.26-0.39, p=0.01). A statistically significant negative correlation was detected between TTR and the NICU requirement (r: -0.435, p=0.004). As a result of the receiver operating characteristic analysis, in predicting NICU admission, the optimal cut-off value of TTR was determined to be 0.31 with 78â¯% sensitivity and 67â¯% specificity (area under the curve=0.819; p<0.001). CONCLUSIONS: We determined that the fetal TTR may be affected by the inflammatory process caused by the maternal-fetal immune system and increased serum bile acid levels in fetal organs in the presence of ICP. We consider that TTR can be used to predict adverse pregnancy outcomes in patients with ICP.
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Colestase Intra-Hepática , Complicações na Gravidez , Timo , Humanos , Feminino , Gravidez , Colestase Intra-Hepática/sangue , Colestase Intra-Hepática/diagnóstico , Estudos de Casos e Controles , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/sangue , Adulto , Estudos Prospectivos , Timo/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Tórax/diagnóstico por imagem , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricosRESUMO
AIMS: The study aims to evaluate the genetic and clinical outcomes of fetal cardiac rhabdomyoma in our tertiary center. METHODS: Data of cases with cardiac rhabdomyoma detected by fetal echocardiography during antenatal follow-up were analyzed retrospectively. RESULTS: Nine cases were included in the study. The incidence of cardiac rhabdomyoma was 0.003%. The median fetal diagnosis time was 26th weeks, the most common location was the LV. There was no hemodynamic disorder requiring cardiovascular intervention in any of the cases. Of the eight genetically tested cases, four were tuberous sclerosis complex (TSC) gene-negative, one hereditary TSC2, one de novo TSC1, and two de novo TSC2 gene mutants. Postnatal first-year survival rate of the cases was 88.8%. CONCLUSIONS: Cardiac rhabdomyoma is a rare fetal and pediatric pathology that generally is a remarkable finding in the clinical process of TSC. Therefore, cases should be evaluated multisystemically and genetic counseling should be given to the family.
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Doenças Fetais , Neoplasias Cardíacas , Rabdomioma , Esclerose Tuberosa , Criança , Gravidez , Humanos , Feminino , Rabdomioma/diagnóstico por imagem , Rabdomioma/genética , Estudos Retrospectivos , Doenças Fetais/diagnóstico por imagem , Doenças Fetais/genética , Esclerose Tuberosa/complicações , Esclerose Tuberosa/genética , Feto/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/genéticaRESUMO
OBJECTIVES: To evaluate the effect of idiopathic thrombocytopenic purpura (ITP) on pregnancies and the role of the delta hemoglobin indices in the evaluation of treatment effectiveness. METHODS: This case-control study was conducted with 23 ITP and 115 low-risk pregnancies. Obstetric outcomes (fetal growth retardation (FGR), preterm delivery) and neonatal outcomes (weights, APGAR scores, NICU admissions, thrombocytopenia) were recorded. ITP group was subgrouped based on the platelet ratio at the admission for delivery and evaluated the impact of platelet ratios on blood loss amounts at delivery by using delta hemoglobin indices. RESULTS: Eleven patients received treatment during pregnancy. The gestational age at birth and fetal APGAR scores were lower, and the preterm delivery and FGR rates were higher in the ITP group. Four newborns (17.4%) had thrombocytopenia. There were two postpartum hemorrhages. Newborn platelet counts did not correlate with maternal platelet counts. The study showed no difference in delta hemoglobin counts between the ITP and control groups. CONCLUSIONS: ITP is associated with an increased risk of maternal and fetal complications. The presented study showed by using the delta hemoglobin indices that, hemorrhagic complications could be prevented with appropriate management. Neonatal thrombocytopenia should be considered for all ITP patients.
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AIM: We aim to compare the maternal serum thiol and ischemia-modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP). METHODS: Fifty-five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated. RESULTS: The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05). CONCLUSIONS: Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases.
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Placenta Prévia , Albumina Sérica Humana , Compostos de Sulfidrila , Feminino , Humanos , Gravidez , Biomarcadores , Estudos de Casos e Controles , Dissulfetos/sangue , Dissulfetos/química , Estresse Oxidativo , Placenta Prévia/diagnóstico , Albumina Sérica , Albumina Sérica Humana/metabolismo , Compostos de Sulfidrila/sangue , Compostos de Sulfidrila/química , Compostos de Sulfidrila/metabolismoRESUMO
PURPOSE: The aim of this study was to evaluate perinatal outcomes between the uncontrolled asthma group and the mild asthma group and to reveal the relationship between disease severity and adverse maternal-fetal outcomes in this study. METHODS: This retrospective cohort study analyzed 180 pregnant women diagnosed with asthma, hospitalized, and delivered at our center between September 1, 2019, and December 1, 2021. We compared two groups: 160 with mild asthma and 20 with uncontrolled asthma. Data encompassed maternal characteristics, obstetrical complications, medication use, emergency department admissions for exacerbations, smoking status, and neonatal outcomes. RESULTS: In the uncontrolled asthma group, hospitalization rates, use of inhaled short-acting ß-agonist (SABA), and systemic corticosteroids were significantly higher compared to the mild asthma group (p < 0.01). Maternal and fetal complications were more prevalent in the uncontrolled group, including asthma exacerbations (45% vs. 1.2%), anemia (10% vs. 4.4%), prematurity (25% vs. 9.6%), and intrauterine fetal demise (IUFD) (10% vs. 0.6%). Neonatal outcomes in the uncontrolled group showed higher rates of admission to the neonatal intensive care unit (NICU) (50% vs. 25%), respiratory distress syndrome (RDS) (30% vs. 14%), and intraventricular hemorrhage (IVH) (5% vs. 0%) compared to the mild asthma group. CONCLUSION: Uncontrolled asthma during pregnancy is associated with higher adverse maternal-fetal and neonatal outcomes compared to mild asthma.
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Asma , Complicações na Gravidez , Resultado da Gravidez , Índice de Gravidade de Doença , Humanos , Feminino , Gravidez , Asma/epidemiologia , Asma/tratamento farmacológico , Asma/complicações , Estudos Retrospectivos , Adulto , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Recém-Nascido , Hospitalização/estatística & dados numéricos , Morte Fetal/etiologia , Corticosteroides/uso terapêutico , Corticosteroides/efeitos adversos , Corticosteroides/administração & dosagem , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Antiasmáticos/administração & dosagem , Nascimento Prematuro/epidemiologiaRESUMO
PURPOSE: To evaluate the utility of a novel ultrasound index "combined utero-cervical index (CUCI)" in the prediction of preterm delivery. METHODS: The present prospective cohort study was conducted in Ankara Bilkent City Hospital Perinatology Clinic between January 1, 2023, and March 31, 2023. Pregnant women with uterine contractions between 24 and 36th gestational weeks but did not have dilatation or effacement were included. CUCI was calculated as: (utero-cervical angle)/(anterior cervical lip thickness + fundal thickness + lower uterine segment thickness + cervical length). In the presence of cervical funneling, one point was added to the final result. A ROC analysis was conducted to determine the potential of CUCI in predicting delivery <37 weeks of gestation, <34 weeks of gestation, and <4 weeks after the first admission to the hospital for uterine contractions, respectively. RESULTS: Optimal cut-off values of CUCI were found to be 1.4 (67.1% sensitivity, 67.2% specificity) for predicting delivery at <37th weeks, 1.7 (72.7% sensitivity, 65.7% specificity) for predicting delivery at <34th weeks, and 1.4 (62.5% sensitivity, 61.7% specificity) for predicting delivery at <4 weeks. CONCLUSION: CUCI may be used in the prediction of preterm delivery for pregnant women admitted to hospital with preterm uterine contractions.
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Colo do Útero , Nascimento Prematuro , Ultrassonografia Pré-Natal , Contração Uterina , Humanos , Feminino , Gravidez , Adulto , Estudos Prospectivos , Colo do Útero/diagnóstico por imagem , Contração Uterina/fisiologia , Útero/diagnóstico por imagem , Valor Preditivo dos Testes , Trabalho de Parto Prematuro , Curva ROC , Idade Gestacional , Adulto Jovem , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To investigate the effect of inflammation on the fetal thymus-thoracic ratio (TTR) in pregnant women with systemic lupus erythematosus (SLE), Sjögren's syndrome (SS) and antiphospholipid antibody syndrome (APS). METHOD: This prospective case-control study included 45 pregnant women with SLE, SS, and APS and 90 gestational age-matched healthy pregnant women between 24 and 37 gestational weeks. The ratio of the anteroposterior fetal thymus length to the transverse mediastinal length was calculated as the TTR in the study groups. RESULTS: Fetal TTR was significantly lower in the case group (p < 0.001). Fetal TTR in the APS group was significantly lower than SS group (p = 006). The patients using hydroxychloroquine (HCQ) had significantly higher fetal TTR compared to patients not using HCQ (p = 0.004). A moderate negative correlation was found between the disease duration and fetal TTR (r = - 0.552, p < 0.001). In predicting admission to the neonatal intensive unit care (NICU), a value of 0.31 was found for the fetal TTR with a sensitivity of 83.3% and a specificity of 69% CONCLUSION: Maternal inflammation in pregnancies with autoimmune diseases may affect the intrauterine milieu of the fetus and cause a lower fetal TTR. Additionally, the lower level of fetal TTR may be more effective and beneficial for the clinician if combined with other risk factors in predicting NICU admission.
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Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Síndrome de Sjogren , Recém-Nascido , Humanos , Feminino , Gravidez , Lactente , Síndrome Antifosfolipídica/complicações , Síndrome de Sjogren/complicações , Estudos de Casos e Controles , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , InflamaçãoRESUMO
PURPOSE: To develop a new cost-effective marker named creatinine-fibrinogen ratio (CFR) for the prediction of composite adverse outcomes (CAO) in placental abruption cases. METHODS: A total of 109 placental abruption patients (30 with adverse outcomes, 79 without adverse outcomes) were enrolled in this retrospective cohort study. Patients with at least one of the features listed below were included in the abruption with CAO group: requirement of blood product transfusion (erythrocyte suspension, fresh frozen plasma, pooled thrombocyte, thrombocyte apheresis), development of acute kidney injury or disseminated intravascular coagulation, and need for intensive care unit. Laboratory parameters and CFR values at admission to the hospital were compared between the two groups. RESULTS: Higher creatinine and lower fibrinogen levels were found in the CAO group (p = 0.007 and p < 0.001 respectively). The CFR value of the CAO group was significantly higher (p < 0.001). In the ROC curve analysis performed to investigate the value of CFR in CAO prediction, the area under the curve (AUC) was calculated as 0,802 (95% CI 0.709-0.895, 77% sensitivity, 65% specificity). CONCLUSION: CFR seems to be a practical marker for the prediction of CAOs in pregnant women with ablatio placenta.
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Descolamento Prematuro da Placenta , Biomarcadores , Creatinina , Fibrinogênio , Humanos , Feminino , Gravidez , Descolamento Prematuro da Placenta/sangue , Descolamento Prematuro da Placenta/diagnóstico , Estudos Retrospectivos , Adulto , Biomarcadores/sangue , Creatinina/sangue , Fibrinogênio/análise , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Curva ROC , Valor Preditivo dos Testes , Coagulação Intravascular Disseminada/sangue , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Transfusão de Sangue , Adulto JovemRESUMO
PURPOSE: To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes. METHODS: This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated. RESULTS: CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity). CONCLUSION: Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.
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Resultado da Gravidez , Gravidez em Diabéticas , Ultrassonografia Pré-Natal , Humanos , Feminino , Gravidez , Estudos Prospectivos , Adulto , Ultrassonografia Pré-Natal/métodos , Placenta/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Recém-Nascido , Diabetes Mellitus Tipo 1/complicaçõesRESUMO
PURPOSE: To determine the effects of gestational diabetes mellitus (GDM) on fetal frontal lobe development. METHODS: This study was conducted prospectively between May 2023 and August 2023 in Ankara City Hospital perinatology clinic. Maternal age, maternal body mass index (BMI), gestational week (GW), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW), frontal antero-posterior diameter (FAPD), occipito-frontal diameter (OFD), FAPD/OFD ratio, and FAPD/HC ratio, were compared between GDM (n = 40) and low risk controls (n = 56). RESULTS: The mean maternal age was found higher in the GDM group compared to control group (p = 0.002). Maternal BMI was significantly higher in the GDM group than the control group (p = 0.01). Abdominal circumference (AC) was significantly higher in the GDM group compared to control group (p = 0.04). EFW was significantly higher in the GDM group compared to control group (p = 0.04). FAPD/OFD ratio was found to be higher in the GDM group than in the control group (p = 0.001). Among GDM patients, no statistically significant difference was found in the ultrasound measurements between the groups receiving insulin treatment and those without treatment. According to the correlation analysis results a moderate, positive, and statistically significant correlation was present between FAPD/OFD and GDM. In perinatal outcomes, the rate of neonatal intensive care unit admission was significantly higher in the GDM group. DISCUSSION: Fetal frontal lobe development seems to be affected by GDM.
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Diabetes Gestacional , Gravidez , Recém-Nascido , Feminino , Humanos , Estudos de Casos e Controles , Desenvolvimento Fetal , Feto , Peso Fetal , Idade Gestacional , Ultrassonografia Pré-Natal/métodosRESUMO
PURPOSE: This study aims to investigate the fetal Evans Index and establish a nomogram for fetuses without any additional fetal anomalies detected during the prenatal period. METHODS: We conducted our research at Ankara City Hospital, including 894 patients who were admitted and evaluated between gestational weeks 16-40. These patients had no fetal anomalies detected in subsequent gestational weeks. Descriptive data, such as age, gravidity, parity, and body mass index (BMI), were recorded. Gestational week and Evans Index (mean, median, standard deviation, minimum, maximum, and percentile) were also documented. The Evans index was calculated as the ratio between the maximal width of the frontal horns and the maximal width of the inner diameter of the cranium. RESULTS: We evaluated 894 fetuses in pregnant women had no fetal anomalies detected throughout the pregnancy. The evaluation took place at different gestational weeks, and a nomogram for the Evans Index was created. CONCLUSIONS: It is relevant for clinicians and researchers to be aware of the range of fetal Evans Index values across different gestational weeks as a prognostic criterion.
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OBJECTIVE: To evaluate the utility of the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic immune-response index (SIRI) in the prediction of adverse pregnancy outcomes in pregnant women with Familial Mediterranean fever (FMF) MATERIAL AND METHODS: This retrospective case-control study was conducted between 2019-2023. First-trimester NLR, SII (NLR X platelet count), and SIRI (NLR X monocyte count) values were compared between pregnant women with FMF (n=85) and without FMF (n=105). Thereafter, pregnant women with FMF were divided into two groups: 1) FMF with perinatal complications (n=30), and 2) FMF without perinatal complications (n=55). NLR, SII, and SIRI values were compared between the two subgroups. Finally, an ROC analysis was performed to determine optimal cut-off values for NLR, SII, and SIRI in the prediction of composite adverse pregnancy outcomes. RESULTS: The FMF group had significantly higher first-trimester NLR, SII, and SIRI values compared to the controls. The FMF with perinatal complications group had significantly higher NLR, SII, and SIRI values than the FMF group without perinatal complications (p<0.05). Optimal cut-off values were 4.89 (80% sensitivity, 78.2% specificity), 1180.6 (76.7% sensitivity, 72.7% specificity), and 1.9 (83.3% sensitivity,72.7% specificity) for NLR, SII, and SIRI, respectively. CONCLUSION: SII, SIRI, and NLR may be used to predict adverse pregnancy outcomes in pregnant women with FMF.
Assuntos
Febre Familiar do Mediterrâneo , Neutrófilos , Gravidez , Humanos , Feminino , Gestantes , Estudos Retrospectivos , Estudos de Casos e Controles , Febre Familiar do Mediterrâneo/diagnóstico , Primeiro Trimestre da Gravidez , Linfócitos , InflamaçãoRESUMO
OBJECTIVE: To assess midkine (MK) levels in pregnant women with preterm premature rupture of membranes (PPROM) and compare them to healthy pregnant women. We also assessed the performance of the maternal serum MK level in predicting neonatal intensive care unit (NICU) requirement in the PPROM group. METHODS: Forty pregnant women who presented to our clinic at 24-37 gestational weeks and were diagnosed with PPROM were included in the study group. During the same period, 40 healthy pregnant women at similar gestational weeks were randomly selected as the control group. Clinical characteristics, inflammatory markers, and serum MK levels were compared between the groups. The same parameters were then compared between the PPROM cases with and without NICU requirement. Finally, the receiver operating characteristic (ROC) analysis was performed to assess the predictive value of MK for NICU requirement. RESULTS: The PPROM and control groups were similar in terms of demographics. The MK level of the pregnant woman with PPROM was significantly higher than that of the controls. No statistically significant difference was found between the MK levels of the cases with and without NICU requirement in the PPROM group. In the ROC analysis, the optimal cut-off value of was found to be 0.287, at which it had 63 % sensitivity and 65 % specificity (area under the curve(AUC): 0.78, 95 % confidence interval(CI): 0.683-0.881, p < 0.001) for the prediction of NICU requirement in cases with PPROM. In the same analysis performed for the prediction of PPROM, when the optimal cut-off value was taken as 0.298, MK had 56 % sensitivity and 60 % specificity (AUC: 0.65, 95 % CI: 0.522-0.770, p = 0.037). CONCLUSION: Serum MK seems to be associated with complicated inflammatory processes leading to PPROM, and this novel marker has the potential to predict NICU requirement in PPROM cases.