Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage-indicating scores (albumin-bilirubin [ALBI], Model for End-Stage Liver Disease [MELD], aspartate aminotransferase-to-platelet ratio [APRI]) and inflammatory markers (platelet-to-lymphocyte ratio [PLR] and neutrophil-to-lymphocyte ratio [NLR]). METHODS: Eighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis. RESULTS: Patients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false-positive rate of 10%. CONCLUSION: This study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

A New Antioxidant Marker in Cord Blood of Fetuses with Late Fetal Growth Restriction: Humanin.

Purpose: This study investigated the Humanin levels in the umbilical cord blood of fetuses with late fetal growth restriction (FGR) and -evaluated their association with perinatal outcomes. Materials and Methods: A total of 95 single pregnancies between 32-41 wk (45 with late FGR and 50 controls) were included. Doppler parameters, birth weight and the need for neonatal intensive care unit admission (NICU) were assessed. Correlations between Humanin levels and these parameters were analyzed. Results: Higher Humanin levels were found in fetuses with late FGR compared to the control group (p < 0.05). No significant correlation was observed between Humanin levels and Doppler parameters. Elevated Humanin levels were associated with an increased need for NICU (p < 0.05). Conclusions: The statistically higher levels of Humanin in fetuses with late FGR may suggest the potential of Humanin as an indicator of late FGR. Further research is needed to explore the clinical utility of Humanin.

The evaluation of serum bisphenol A in patients with preeclampsia.

AIMS: High bisphenol A (BPA) concentration may compromise normal placental development. The aim of this study was to determine maternal serum BPA concentrations in pregnant women with complicated preeclampsia (PE) and normal pregnant women, to compare BPA concentrations, and to examine pregnancy outcomes. METHODS: This prospective case-control study was conducted between March 2021 and October 2021. Serum BPA levels of preeclamptic pregnancy and normal pregnancy were statistically evaluated. In addition, the PE group was divided into three subgroups according to the course of pregnancy. Group 1: patients with non-severe PE who delivered at 37 weeks or later, Group 2: patients with severe PE who delivered at less than 34 weeks, Group 3: patients with severe PE who delivered between 34 and 37 weeks. The association between BPA levels and pregnancy outcome was investigated. RESULTS: Forty-six cases in the PE group were compared with 46 cases of normal pregnancies. The median BPA level was 19.46 ng/mL in the PE group and 16.36 ng/mL in the control group. The median BPA levels in the PE group were significantly higher than those in the control group (p = 0.007). Serum BPA levels were significantly lower in women who delivered at 37 weeks or later than in women who delivered at less than 34 weeks due to severe PE (p ≤ 0.018). CONCLUSION: Our study highlights the association between elevated maternal serum levels of BPA and PE. Moreover, knowledge of BPA levels in women with PE may provide information about the prognosis of pregnancy.

Cysts of the fetal abdomen: Antenatal and postnatal comparison.

Background: To evaluate cases diagnosed with fetal abdominal cyst diagnosed in prenatal period. Methods: We retrieved the cases diagnosed with fetal abdominal cyst between the years 2018 and 2020 from hospital's database. The localization, origin, dimensions, properties (simple or complex), and characteristics (solid, cystic, vascularity) were noted both in prenatal and postnatal period. We also tested the diagnostic performance of ultrasonography according to endpoint diagnosis revealed postnatally. Results: During the study period, a total of 29 cases diagnosed as fetal abdominal cyst. Of them, there were 11 (37.9%) gastrointestinal, 9 (31%) ovarian, 6 (20.6%) genitourinary, 3 (10.3%) hepatobiliary system cysts. In our study, we were able to identify 5 (45%) of 11 fetuses with postnatally confirmed gastrointestinal system cysts, 1 (33%) of 3 fetuses with hepatobiliary system cysts, 3 (50%) of 6 fetuses with urinary system cysts and 6 (66%) of 9 fetuses with ovarian cysts. Conclusion: In this study, the most common abdominal cyst was ovarian cysts. The most difficult to diagnose cysts are those that originated from gastrointestinal system and hepatobiliary system.

Retrospective Evaluation of Hydatid Cyst Cases During Pregnancy.

Aim: Zoonotic parasite infections affect many pregnant people around the world. Hydatid cystic disease is also a zoonotic disease caused by Echinococcus sp. This study aims to present the maternal-fetal results and clinical treatment of pregnant women diagnosed with liver hydatid cyst (CH). This zoonotic disease is discussed again in the light of current literature. Materials and Methods: Pregnant women with hydatid cyst monitored in a tertiary health center between 2018 and 2020 were evaluated. Seven cases were included in this study. We retrospectively collected and analyzed clinical data, which did not interfere with medical treatment. Results: Albendazole was started as medical therapy in six patients, and percutaneous drainage was applied to one patient. Three of our six patients who started medical treatment had to undergo surgery due to maternal complications that developed despite medical treatment. Two of our patients were delivered with a cesarean section due to the obstetric indications. Discussion: Hydatid cysts are most commonly caused by Echinococcus granulosus infection and most common in the liver. The diagnosis of liver hydatid cysts is not difficult, but pregnant women's treatment methods have some problems. Although both medical and surgical treatments are available, there is no consensus. We would also like to underscore that echinococcal disease of the liver should be kept in mind in the differential diagnosis of abdominal pain, jaundice, and/or fever, especially in endemic regions. We think that when we increase awareness about this disease, we can improve fetal and maternal outcomes by making an early diagnosis and management.

Can placental elasticity predict the time of delivery in cases of threatened preterm labor?

AIM: We aimed to evaluate placental elasticity for the short-time prediction of delivery in cases of threatened preterm labor (TPL). METHODS: We performed a prospective study with consented pregnant women diagnosed with TPL (24th to 34th gestational week). According to the birth time, the patients were grouped into two groups, whether the delivery happened in the following first week or not. We compared the placental strain ratio (PSR) values between these two groups. RESULTS: A total of 108 pregnant women divided into two groups according to the delivery time were enrolled in our study. The pregnant women who had a delivery in 1 week after hospitalization have increased PSR values when compared to those who have not delivered within 1 week (P < 0.001). Multivariate logistic regression analysis showed that cervical length and PSR were significantly associated with delivery in 1 week after hospitalization. When the cervical length was entered as a covariate (control) variable, PSR was significantly associated with delivery time (B = 0.504, odds ratio: 1.655, 95% confidence interval: 1.339-2.045, P < 0.001). A PSR value of 4.04 had a sensitivity of 77.78% and a specificity of 87.04% in terms of short-time prediction of the delivery time, in the receiver-operator curves analysis to determine the cut-off point PSR value. CONCLUSION: Elastography may contribute to predict the delivery time in high-risk pregnants with TPL.

What is the effect of the early follicular phase FSH/LH ratio on the number of mature oocytes and embryo development?

Background/aim: Basal level of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and antral follicle count are used as predictors of ovarian reserve before starting ovulation induction. We aimed to investigate the predictor potential of early follicular phase FSH/LH ratio on controlled ovarian hyperstimulation-intracytoplasmic sperm injection (COH-ICSI) cycle outcomes. Materials and methods: This retrospective cohort study was conducted with 648 COH-ICSI cycles performed between 2012 and 2014. Cycles were classified according to their basal FSH/LH ratio, group 1(G1) = FSH/LH ratio < 2, N = 473 and group 2(G2) = FSH/LH ratio ≥ 2, N = 175. Demographic characteristics and stimulation parameters were evaluated. Retrieved total oocyte count (TOC), mature oocyte count (MOC), transferred embryo number, and pregnancy results were obtained and transferred to computer by SPSS 21.0 programme. Results: TOC and MOC of G1 were significantly higher than those of G2. The total gonadotrophin doses of G2 were significantly higher than G1. There was no significant difference between groups for transferred embryo number. Pregnancy and live birth rates were similar in both groups. Conclusion: In our population, increased FSH/LH ratio did not affect the rates of pregnancy and live birth negatively.

The efficacy of ampicillin and Lactobacillus casei rhamnosus in the active management of preterm premature rupture of membranes remote from term.

BACKGROUND: We aimed to investigate the treatment efficacy of ampicillin prophylaxis accompanied by Lactobacillus casei rhamnosus over the latency period following preterm premature rupture of membranes (PPROM). METHODS: Records of 40 patients who presented with PPROM between 23(0/7)-31(6/7) weeks were analyzed retrospectively. Patients were divided into two groups: group 1 (n=20), treated with ampicillin; and group 2 (n=20), treated with ampicillin plus L. casei rhamnosus. Clinical and laboratory parameters were compared. Delta (Δ) values of each laboratory parameter were calculated by subtracting the value at delivery from the values at admission to the clinic. RESULTS: Gestational weeks at delivery (28.1 ± 0.3 weeks versus 31.5 ± 0.4 weeks), latency periods (12.3 ± 1.5 days versus 41.4 ± 4.4 days), 5-minute APGAR scores (6.8 ± 0.1 versus 7.8 ± 0.1), and birth weights (1,320 ± 98 g versus 1,947 ± 128 g) were significantly higher in group 2. White blood cell (WBC) (12,820 ± 353/mm(3) versus 11,107 ± 298/mm(3)), and neutrophil counts (10.7 ± 0.5 × 10(3)/L versus 8.2 ± 0.5 × 10(3)/L) were significantly lower in group 2 at delivery. The ΔWBC (2,295 ± 74/mm(3) versus -798 ±- 406/mm(3)), ΔC-reactive protein (5 ± 0.04 mg/L versus 1.6 ± 0.2 mg/L), and Δneutrophil (3 ± 0.2 × 10(3)/L versus 0.2 ±- 0.1 × 10(3)/L) were significantly lower in group 2. CONCLUSION: It seems that addition of L. casei rhamnosus to ampicillin prolongs the latency period in patients with PPROM remote from term.