Genetic Burden and Outcome of Cystic Hygromas Detected Antenatally: Results of 93 Pregnancies from a Single Center in the Northern Region of Turkey.

OBJECTIVE: Genetic burden, fetal malformations, and fetal outcomes of 93 fetuses with cystic hygroma (CH) are reported from a single center in Turkey. PATIENTS AND METHODS: Pregnancies, having a diagnosis of fetal CH, detected between January 2010 and October 2016, were included in the study except fetuses having increased nuchal translucency. Fetal age/gender, maternal age, the age of pregnancy, types of fetal malformations, karyotype, and outcomes were evaluated. RESULTS: The average gestational age was 16.2 weeks. Nearly 47% of the pregnancies had multiple congenital anomalies, of which 58% had a chromosomal anomaly. Chromosomal anomaly rate was 68.2% in patients with hydrops fetalis. Aneuploidies were major chromosomal defects. All trisomies were of regular type except one with Robertsonian translocation (46, XY, +13, rob[13;14][q10;q10]). Seventy-four percentage pregnancies were terminated due to either fetal/karyotype anomaly. CONCLUSION: Characteristics of fetal CH were similar in different ethnical backgrounds. Aneuploidy is the dominant chromosomal constitution of fetal CH. Little information was known about the genes involved. Gene dosage effect implies that fetal CH is a complex genetic situation involving multiple genes interactions. For proper genetic counseling, each fetus with CH should be karyotyped, and fetal ultrasound examination should be performed. In the case of normal chromosome set, application of aCGH should be considered.

Long-Term Outcome of Fetuses with Soft Marker and Without Genetic or Structural Abnormality.

PURPOSE: To determine long-term outcome of infants with isolated or multiple soft markers but no structural or chromosomal abnormalities. METHODS: A retrospective study of 78 pregnant women who were referred for amniocentesis and found to have soft markers including echogenic intracardiac focus/foci (EIF), echogenic bowel (EB), unilateral or bilateral choroid plexus cysts, (UCPCs or BCPCs) mild pyelectasis and single umbilical artery but no structural anomalies and outcomes of the liveborns with a 4- to 9-year follow-up was conducted. RESULTS: Among 28 fetuses with EIF, allergic asthma and epilepsy were diagnosed in two liveborns. We followed up nine pregnancies with EB, epilepsy was present in one case. Allergic asthma was detected in both UCPCs and BCPCs, whereas epilepsy and attention-deficit/hyperactivity disorder (ADHD) were diagnosed in two liveborns with BCPCs. Twelve liveborns with multiple soft markers were evaluated; no pathology was detected in most of them except one case of allergic asthma, one case of hearing impairment and one case of ADHD. CONCLUSIONS: This study shows longer-term favorable outcomes of the liveborns with isolated or multiple soft markers without any aneuploidy and may provide insight into this debated point.

Serum VEGF and PGF may be significant markers in prediction of severity of preeclampsia.

OBJECTIVE: The aim of this study evaluate the value of vascular endothelial growth factor (VEGF) and placental growth factor (PGF) serum levels in prediction of preeclampsia, severity and onset time of the disease. METHODS: Twenty five placentas of pregnant women diagnosed with preeclampsia (15 severe preeclampsia, 10 mild preeclampsia) and peripheral venous blood samples were collected. The placental and serum levels of VEGF and PGF were measured. RESULTS: VEGF level was significantly higher in cases and the optimal cut-off point was calculated as 600.5 to differentiate the cases and the controls, with 64% sensitivity and 100% specificity. There was a significant increase in median serum level of VEGF in severe cases compared to the mild cases and the controls. The optimal cut-off point for VEGF was calculated as 673.5 to differentiate mild and severe cases, with 93.3% sensitivity and 90% specificity. Whereas, PGF was significantly lower in severe cases than that in the mild cases and controls. The optimal cut-off point for PGF was calculated as 16.1 to differentiate mild and severe cases, with 66.7% sensitivity and 100% specificity. CONCLUSION: VEGF and PGF may be significant markers in prediction of severity of preeclampsia, and VEGF may also be valuable in prediction of preeclampsia.

Do Leukocyte and Platelet Counts Have Benefit for \Preoperative Evaluation of Endometrial Cancer?

PURPOSE: The aim of this study was to investigate the association between preoperative leukocyte and platelet counts and the stage of the disease in patients with endometrial cancer. MATERIALS AND METHODS: Data for 100 patients undergoing total abdominal hysterectomy and bilateral salpingoophorectomy for benign uterine diseases and 177 patients surgically staged for endometrial cancer at Ondokuz Mayis University, Department of Gynecology and Obstetrics between 2005 and 2013, with preoperative complete blood count in the week prior to surgery including WBC, platelet count, pathologic evaluation for both benign and malign endometrium lesions, tumor stage and presence of lymphovascular space invasion (LVI), were retrospectively analyzed. RESULTS: The preoperative leukocyte count was significantly higher in patients with endometrial cancer when compared to the patients with benign diseases. However, there were no significant differences in platelet counts between the groups. Patients with advanced stage endometrial cancer had higher preoperative leukocyte counts when compared to the early stage disease whereas there was no difference in platelet count. Multivariate regression analysis identified preoperative leukocytosis as an independent prognostic factor for endometrial cancer. The optimal cut-off point for WBC was calculated as 10,500 to differentiate stage 1-2-3 and 4 with 88.9% sensitivity and 86.3% specificity (AUC: 0.901, 95% CI: 0.829-0.973, p<0.001, PPV: 25.8%, NPV: 99.3%). CONCLUSIONS: Preoperative leukocytosis is independently associated with advanced endometrial cancer.

May ratio of neutrophil to lymphocyte be useful in predicting the risk of developing preeclampsia? A pilot study.

OBJECTIVE: The aim of the study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and preeclampsia. METHODS: Demographic data and laboratory tests for NLR of 203 pregnant women (73 normotensive pregnants, 23 pregnants with mild preeclampsia and 107 pregnants with severe preeclampsia) were retrospectively analyzed. Neutrophil to lymphocyte ratios were compared between the study groups. RESULTS: Preeclamptic pregnant women had smaller gestation weeks, lower hemoglobin level and fetal birth weight than that of normal pregnant women. NLR in preeclamptic group was significantly higher than that of normal group (p=0.023) and area under ROC curve was found statistically significant (p=0.023). However, there was no statistically significant relationship between NLR and severity, proteinuria level, subjective symptoms and onset time of the disease. CONCLUSION: The findings showed that the measurement of NLR periodically may be useful to predict high-risk pregnancies in terms of preeclampsia, but further studies are needed to determine its contribution.

May the platelet to lymphocyte ratio be a prognostic factor for epithelial ovarian cancer?

BACKGROUND: The study aimed to evaluate changes in hematologic parameters, including white blood cell, platelet count, platelet indices, the platelet to lymphocyte and neutrophil to lymphocyte ratios in patients with early and advanced stages of epithelial ovarian cancers. MATERIALS AND METHODS: The study included 100 patients with epithelial ovarian cancer who underwent primary staging exploratory laparotomy. Preoperative hematologic parameters, tumor histopathologic type, grade, stage and serum CA-125 levels were retrospectively analyzed. These parameters were compared between the patients with early (stage I-II) and advanced (stage III-IV) ovarian cancer. RESULTS: White blood cell count and platelet indices, including mean platelet volume, platelet distribution width and platelet crit did not show a statistically significant difference between groups with early and advanced ovarian cancer. However, the neutrophil to lymphocyte ratio, platelet count, the platelet to lymphocyte ratio and CA-125 level showed a statistically significant difference between the two groups (p<0.05, p<0.01, p<0.001, p<0.01 respectively). CONCLUSIONS: It was found that the neutrophil to lymphocyte ratio, platelet count and the platelet to lymphocyte ratio increased with the increasing stage of ovarian cancer. Furthermore, it was seen that the platelet to lymphocyte ratio is an independent prognostic factor related to the stage of epithelial ovarian cancer.

Maternal serum interleukin-6 level in preterm labor.

OBJECTIVE: The aim of this study was to measure interleukin-6 (IL-6) levels in maternal serum of women undergoing preterm labor without a clear infection. MATERIALS AND METHODS: Twenty two pregnant women with diagnosis of preterm labor who presented to the outpatient clinic of 19 Mayis University Faculty of Medicine from July 2011 through December 2011 were enrolled in the study group. Twenty two healthy pregnant women who were at the same gestational age as the study group were selected as the control group. RESULTS: Gestational age in the study and control groups varied from 24 weeks and 4 days to 34 weeks and 6 days. In the study group, 11 patients (50%) underwent preterm birth. Pregnant women in preterm labor were compared to healthy pregnant women with regards to serum IL-6 levels. No significant difference was found in the IL-6 levels of maternal serum between the 2 groups. CONCLUSION: In this study we have shown that there is no increase in lL-6 levels in patients undergoing preterm labor without clinical or biochemical infection signs.

Chromosomal anomalies and additional sonographic findings in fetuses with open neural tube defects.

OBJECTIVE: To evaluate the results and the necessity of chromosome analysis in fetuses prenatally detected with a neural tube defect and to determine the significance of ultrasonographic evaluation for the identification of underlying or accompanying chromosomal anomalies. METHODS: Ninety fetuses that underwent prenatal and/or postnatal chromosome analysis after being diagnosed with open neural tube defects (NTD) between the years 2006 and 2010 in the Department of Obstetrics and Gynecology at Ondokuz Mayis University School of Medicine were included in this study. Detailed fetal ultrasonography was performed in all cases in order to investigate any additional anomalies. Karyotype was determined in the prenatal period by amniocentesis in 72 (80%) of the 90 fetuses, and by cordocentesis in 5 (5.5%). In 13 (13.3%) fetuses, karyotype was determined in the postnatal period by blood sampling. RESULTS: Fourteen (15.5%) of the 90 fetuses were diagnosed with acrania/anencephaly, 14 (15.5%) with encephalocele, 2 (2.2%) with iniencephaly, 60 (66.6%) with open spina bifida. None of the 90 fetuses with open NTD who had undergone chromosome analysis was diagnosed with chromosomal anomalies. None of the 19 (21.1%) fetuses diagnosed with additional ultrasound findings had a chromosomal abnormality, either. Seventy-one (78.9%) fetuses having sonograhically isolated NTD were also isolated in postmortem examination. CONCLUSION: In fetuses with open NTD, we could not find the chromosomal anomaly rate as high as reported in previous literature. The necessity of fetal karyotyping should be questioned especially in isolated cases.

Successful pregnancy and delivery in a patient with bladder exstrophy.

Bladder exstrophy (BE) is a rare congenital anomaly. Owing to the advanced reconstructive surgical techniques and effective antibiotics, the incidence of urinary and systemic complications in patients with BE has decreased and the life expectancy has increased. However, this brings along social, sexual, and psychological problems; particularly, successful pregnancy and delivery is extremely rare in females with BE. We present a pregnancy of an 18-year-old female with BE, who has been followed at our university hospital since birth.

Satisfactory urethral coitus in a patient with vaginal stenosis: case report.

Urethral coitus is a very rare sexual disorder seen in women either with intact or anomalous vagina such as vaginal agenesis or imperforate hymen. Only about 25 cases have been reported in the literature. We report a case of urethral coitus in a patient with surgically corrected ambiguous genitalia due to congenital adrenal hyperplasia. The patient had megalourethra and stenotic vaginal introitus. Megalourethra was corrected by plication technique. Correction of megalourethra with this technique has not been reported in literature up to now. To the best of our knowledge, the present case is the 26th of total cases with urethral coitus reported so far and the first case of urethral coitus associated with a stenotic vaginal introitus developing due to surgically corrected ambiguous genitalia.

A randomized controlled study investigating the necessity of routine cervical dilatation during elective cesarean section.

OBJECTIVE: To investigate if it was necessary to dilate the cervix routinely during elective cesarean section and to determine the effects of this traditional maneuver on maternal morbidity. METHODS: A total of 150 patients meeting eligibility criteria were enrolled in this prospective, randomized controlled study. Patients were allocated randomly into cervical dilatation group or non-dilated group. In the cervical dilatation group, the surgeon performed cervical dilatation by inserting a double-gloved index finger into the cervical canal of the patients after extraction of placenta and membranes. Endometrial cavity thickness of the patients at postoperative 24 h, development of postoperative febrile-infectious morbidity and postoperative hemoglobin levels were evaluated and compared between the groups. RESULTS: The two groups were comparable with regard to demographic and clinical properties. Mean postoperative endometrial cavity thickness of the dilated group was significantly less than the non-dilated group (6.87 ± 2.50, 9.51 ± 3.35 respectively, p < 0.0001). The level of hemoglobin reduction was comparable between the groups (p = 0.37). Febrile morbidity was seen in one patient in the dilated group. Endometritis or wound infection was not encountered in either group during the puerperium. CONCLUSIONS: Cervical dilatation seems to be an unnecessary intervention during the cesarean section.

Maternal and umbilical serum levels of interleukin-6, interleukin-8, and tumor necrosis factor-alpha in normal pregnancies and in pregnancies complicated by preeclampsia.

OBJECTIVES: The aim of this study was to investigate the relationship of maternal and umbilical cord interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-alpha) serum levels with the existence and severity of preeclampsia. A particular objective was the comparison of normal umbilical serum levels to preeclamptic values. MATERIALS AND METHODS: The study group consisted of 24 patients with third trimester singleton pregnancies complicated by preeclampsia (15 severe and 9 mild preeclampsia). The gestational age-matched 19 healthy pregnant women were compared by study group. Maternal and umbilical serum IL-6, IL-8, and TNF-alpha were calculated by using enzyme-linked immunosorbent assay. RESULTS: Significantly increased maternal and umbilical serum levels of IL-6, IL-8, and TNF-alpha were found in preeclamptic patient group in comparison with the control group. Maternal serum IL-8 and TNF-alpha concentration were significantly higher in patients with severe preeclampsia than in mild preeclampsia. Increased umbilical serum levels of IL-6 and IL-8 were found in severe preeclampsia than in mild preeclampsia. There were significantly higher levels of maternal serum IL-8 and TNF-alpha in patients with preeclampsia with IUGR than in patients with preeclampsia with normal fetal growth. CONCLUSION: Our findings suggest that increased concentrations of IL-6, IL-8, and TNF-alpha in the maternal and umbilical serum play a significant role in pathogenesis of preeclampsia. Alterations in maternal and umbilical serum levels of IL-6, IL-8, and TNF-alpha may also play role in preeclampsia complicated by intrauterine growth retardation. These associations may offer insight into the etiology and pathogenesis of preeclampsia.

Comparison of single and double courses of antenatal corticosteroid administration on neonatal mortality and morbidity.

OBJECTIVE: We aimed to evaluate the effects of single and double courses of antenatal corticosteroid administration on neonatal mortality and morbidity. MATERIALS AND METHODS: 232 preterm babies delivered between 01. April 2007 and 31. March 2008 with gestational ages of 26-34 weeks were evaluated prospectively. Infants were divided into three groups. The first group did not receive any antenatal betamethasone therapy. The second group received single (two doses of 12 mg betamethasone administered at 24 hour intervals) and the third group received double (repeated course after one week) courses of betamethasone therapy. RESULTS: 156 (67.2%) infants received at least one dose of corticosteroid treatment whereas 76 (37.8%) did not. Of 156 infants who had received antenatal betamethasone, 36 (23.1%) developed respiratory distress syndrome (RDS), while the incidence of RDS was 35.5% in 76 preterms who received no antenatal betamethasone (27/76) (p<0.05). When single and double courses of bethamethasone administration were compared, 20 (24.7%) infants with single course and 16 (21.3%) infants with two course developed RDS (p>0.05). CONCLUSION: When single and two courses of antenatal steroid therapy were compared, there was no statistically significant difference between groups regarding the incidence of RDS and mechanical ventilator treatment.

Metastasis of adenocarcinoma of the gall bladder to an endometrial polyp detected by endometrial curettage: case report and review of the literature.

SUMMARY: Polyps are the most common benign lesions in the endometrium. Metastasis to the endometrial polyp from a distant primary tumor is rare. Breast carcinoma is the most frequent extragenital cancer that metastasizes to the endometrial polyp. We report the case of a 63-year-old with metastatic gall bladder adenocarcinoma involving endometrial polyps detected by endometrial curetting. It was the first sign of her metastatic disease. After this diagnosis, bone metastases were detected during radiologic screening. Gastrointestinal tumor metastasis to an endometrial polyp is a very rare event, but if a patient with a known primary extragenital tumor has abnormal vaginal bleeding, the possibility of metastasis should be included in the differential diagnosis.

CA-125 levels in ruptured and unruptured tubal ectopic pregnancies.

AIM: This prospective, single-blind and controlled clinical study aimed to research if CA-125 levels could be a useful test in the differential diagnosis of intact and ruptured tubal ectopic pregnancy. METHODS: Sixty-five women with tubal ectopic pregnancy of 5-10 weeks' duration (27 women with ruptured tubal ectopic pregnancy [REP] and 38 women with unruptured tubal ectopic pregnancy [UREP]) and 65 women with normal intrauterine pregnancy (NIUP) of the same gestational age were studied prospectively. Serum CA-125 levels were measured in all women and these levels were compared among the REP, UREP, and NIUP groups. RESULTS: The mean CA-125 levels didn't show any significant difference between the REP and NIUP groups (P > 0.05). The mean CA-125 levels of these two groups were higher than that in the UREP group (P < 0.01, P < 0.001, respectively). The dispersion ratios of the CA-125 levels had a statistically significant difference between the REP and UREP groups (chi(2): 42.44, P < 0.0001). CA-125 levels weren't correlated with gestational weeks in the REP and UREP groups (r: 0.005, P > 0.05; r: 0.008, P > 0.05, respectively). CONCLUSION: In intact tubal ectopic pregnancies, expectant or managed with medical treatment, the increase of CA-125 levels in the serial measurements could be a supplementary test for an early diagnosis of tubal rupture.

Maternal mortality rates in the last eight years: A university hospital-based study from Turkey.

OBJECTIVE: To analyze the cause of changing maternal mortality ratios (MMRs) in a tertiary women's health center in Turkey in the last eight years. MATERIALS AND METHODS: Charts of patients seen between 1998 and 2005 were retrospectively reviewed. Statistical analysis was performed using the Chi-square test. The results were accepted to be significant when the p value was <0.05. RESULTS: During this period, 27 pregnancy-related deaths were identified via hospital death records. The MMR was found to have decreased in rate by approximately 50% from 822.2/100,000 live births in the previous report including the years 1978-1997 to 412.0/100,000 during the last eight years (p < 0.01). Pregnancy-induced hypertension was still the most frequent cause of maternal death. The decrease in MMR was due to the decrease in the ratio of maternal infection (26.4% in 1978-1997 to 7.4% in 1998-2005, p < 0.01). CONCLUSION: Although treatment in the antenatal care and health service has decreased maternal deaths, it was discovered that the MMR has not reached the optimum levels found in developed countries in the last eight years. Also the percentage of direct obstetric deaths (with the exception of those caused by infection) showed no change and was similar to that found in the previous report (1978-1997).

Do basal inhibin A and inhibin B levels have value in the diagnosis of polycystic ovary syndrome?

In the present study we aimed to investigate whether basal inhibin A and B levels in women with polycystic ovary syndrome (PCOS) would be used in diagnosis of the condition. Forty women with PCOS and 40 women with normal cycles (control group) were evaluated. There was no statistically significant difference in mean age and mean body mass index between the two groups (p > 0.05). Serum levels of inhibin A and B, follicle-stimulating hormone (FSH), luteinizing hormone and total testosterone, and total ovarian volume, were determined in the PCOS group and the control group on day 3. In the PCOS group, total follicle number was obtained by counting follicles of diameter > or =2 mm in both ovaries. Results were evaluated using Student's t test, Pearson correlation and regression tests. There was no significant difference in mean basal inhibin A or inhibin B levels between the two groups. Basal inhibin B levels showed a statistically significant negative correlation with basal FSH levels and a positive correlation with total follicle number in the PCOS group (p < 0.05 and p < 0.01, respectively). We conclude that basal inhibin A or B levels cannot be used in the diagnosis of PCOS.

[Comparison of effects of the administration of intraperitoneal local anesthetics for postoperative analgesia and prevention of shoulder pain]. / Laparoskopi sonrasi analjezi ve omuz agrisinin önlenmesinde intraperitoneal lokal anestezik uygulamasinin etkinliginin karsilastirilmasi.

Postoperative abdominal and shoulder pain are common complications after laparoscopy. The aim of this study is to compare the effects of intraperitoneal local anesthetics on postoperative abdominal and shoulder pain after laparoscopy. 55 women, physical status ASA I, who were undergoing diagnostic or minor gynecologic surgery, was enrolled to the study. In Group 1 (Bupivacaine, n: 17) and Group 2 (Ropivacaine, n: 18), 80 ml solution which contains one of the local anesthetics (60 ml saline and 20 ml %0.5 bupivacaine in Group 1, 60 ml saline and 20 ml %0.75 ropivacaine in Group 2), was injected into the right subdiaphragmatic (30 ml) and abdominopelvic space (50 ml) at the beginning of the surgical procedure. Patients in Group 3 (Control, n: 20) didn't received any solution intraperitoneally. Shoulder and abdominal pain was assessed with a visual analogue scale, and any other complications were noted during the first 24 hours after surgery. Shoulder and abdominal pain intensity and frequency were significantly less in the local anesthetic groups than control group, similar between ropivacaine and bupivacaine groups.

Serum leptin and body composition in polycystic ovarian syndrome.

BACKGROUND: The role of leptin in polycystic ovarian syndrome (PCOS) is unclear. We investigated the relationship between serum leptin levels, body composition and insulin resistance in polycystic ovarian syndrome (PCOS). METHODS: We analyzed differences between 27 patients with PCOS and 25 control subjects in serum glucose and leptin levels, insulin resistance, body fat mass, lean body mass, and water volume. RESULTS: Serum leptin was significantly correlated with basal insulin levels, BMI and IR in both groups (P<0.01). Fat mass, fat percentage, lean mass and water volumes were positively correlated and lean percentage and water percentage were negatively correlated with leptin levels (P<0.05). Leptin levels were significantly different between the groups in a multivariate regression analysis after correcting for the difference in BMI and body fat percentage (P<0.05). When the effects of fat percentage on serum leptin were eliminated, the levels were significantly different between the PCOS and control groups, and were statistically more powerful than BMI (P<0.01). CONCLUSION: These findings support the idea that factors other than excess fat mass or fat-free mass might be important in the regulation of serum leptin levels in PCOS.

Inhibin B levels on cycle day 3 to predict the ovulatory response in women with PCOS undergoing ovulation induction via low dose step-up gonadotropin protocol.

BACKGROUND: In this prospective clinical single blind study, we aimed to investigate whether day 3 serum inhibin B levels in women with polycystic ovarian syndrome(PCOS) are of predictive value for the estimation of the ovarian response to gonadotropins. METHODS: Ovulation induction with low dose step-up gonadotropin protocol, starting with 75 IU/day, was performed for 30 cycles on 25 patients with PCOS. Day 3 serum inhibin B, follicle-stimulating hormone(FSH) and estradiol, and midluteal serum progesterone levels were measured during each cycle. The correlations between day 3 inhibin B levels and day 3 FSH, day 3 estradiol and midluteal progesterone measurements, as well as the amount of gonadotropin required to provide an ovulatory cycle were investigated. RESULTS: Five (27.8%) out of 18 cycles with day 3 inhibin levels <50.0 pg/ml; and 11 (91.7%) out of 12 cycles with levels > or = 50.0 pg/ml were ovulatory (chi(2)=9.38, p<0.01). Moreover, day 3 inhibin B levels had statistically significant negative correlation with the gonadotropin used; and significant positive correlation with the midluteal progesterone levels (p<0.05). There wasn't any significant relation between day 3 FSH and estradiol levels with the gonadotropin used and progesterone levels. CONCLUSIONS: It has been observed that as day 3 serum inhibin B levels increased in women with PCOS, the ovulatory response to gonadotropins and the rate of ovulatory cycles increased significantly.