Comparison of Maternal and Perinatal Outcomes Associated with Delta (B.1.617.2) and Other Variants of Severe Acute Respiratory Syndrome-Coronavirus 2.

OBJECTIVE: To compare the frequency of adverse maternal and perinatal outcomes associated with delta (B.1.617.2) and other variants of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). STUDY DESIGN: An observational study. Place and Duration of the Study: Bursa City Hospital, Bursa, Turkey, from March 2020 to February 2022. METHODOLOGY: The study included 423 pregnant women diagnosed with COVID-19 based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing. The patients were divided into the delta variant (n=135) and other variants (n=288) (alpha, beta, gamma) groups, and maternal and perinatal outcomes were compared between the groups. Data including symptoms, laboratory findings, radiological findings, hospital and intensive care unit (ICU) stay, delivery outcomes, and mortality rates were recorded. RESULTS: The delta variant group demonstrated higher rates of moderate and severe pneumonia than the other variant group (p=0.005). According to the World Health Organization (WHO) classification, 49.6% and 18.5% of patients experienced moderate and severe disease, respectively in the delta variant group, compared to 38.5% and 10.1%, respectively in the other variant group (p=0.001). A total of 20.0% of the patients in the delta variant group and 8.3% of the patients in the other variant group required ICU stay. The length of ICU stay was significantly longer in the delta variant group (p=0.001). CONCLUSION: The rates of maternal morbidity and mortality increased in the pregnant population with low rates of vaccination in the period of the fourth wave which was associated with the delta variant. No significant difference was observed in perinatal morbidity between the delta and other variants. KEY WORDS: COVID-19, Delta variant, Maternal morbidity, Perinatal outcomes, Adverse pregnancy outcomes.

The Relationship between Decorin and VEGF in Endometriosis.

OBJECTIVE: To evaluate immunohistochemical (IHC) staining of decorin and vascular endothelial growth factor (VEGF) of ovarian and endometrial tissues in patients with and without endometriosis.  Study Design: Descriptive study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, ZeynepKamil Training and Research Hospital, Istanbul, Turkey, between Istanbul, TurkeyJanuary 2018 and June 2019. METHODOLOGY: Thirty patients, who underwent total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO)/unilateral salpingo-oophorectomy (USO) and were in the proliferative phase of menstrual cycle,were included. The study population consisted of 20 patients (patient group) with an endometriomaand the control group consisted of 10 patients who were operated for benign gynecological pathologies.The ovarian and endometrial tissue specimens were collected from the archives. IHC staining was performed using decorin and VEGF. RESULTS: Decorin analysis showed a significantly higher intensity of staining in both endometrial and ovarian tissues in control group than patient group. Patients with endometriosis had a lower intensity of staining of decorin and a higher intensity of staining of VEGF compared to control group. There was a negative, statistically significant concordance between VEGF and decorin staining of endometrial tissues of both groups (concordance rate -0.560, p=0.001). Therewas a negative, statistically significant concordance between VEGF and decorin staining of ovarian tissues of both groups (concordance rate -0.564, p<0.001). CONCLUSION: Angiogenesis plays a critical role in endometriosisand interaction between decorin and VEGF,which suggests that decorin may be a promising molecule for the treatment of endometriosis. Key Words: Decorin, Endometriosis, Immunohistochemical staining, Vascular endothelial Growth factor.

The effect of gestational age at the time of diagnosis on adverse pregnancy outcomes in women with COVID-19.

OBJECTIVE: We aimed to investigate the incidence of adverse pregnancy outcomes including preterm birth, preeclampsia (PE), and fetal growth restriction (FGR) in pregnant women with COVID-19 according to the gestational age. METHODS: This retrospective study included 167 pregnant women who were hospitalized with confirmed COVID-19. The patients were divided into three groups according to the time of diagnosis as follows: <12 weeks of gestation (first trimester, n = 10), 12-24 weeks of gestation (n = 28), and >24 weeks of gestation (n = 129). Medical records of the patients were reviewed retrospectively and adverse pregnancy outcomes were analyzed. RESULTS: A total of 49 (29.3%) patients had an active COVID-19 infection at the time of delivery, while 118 (70.7%) gave birth after the infection was cleared. Twenty-three patients had preterm birth and the gestational age was <34 weeks in only four of these patients. There was no significant difference in the preterm birth, PE, FGR, HELLP syndrome, and gestational diabetes mellitus among the three gestation groups (p = 0.271, 0.394, 0.403, 0.763, and 0.664, respectively). Four (2.39%) patients required intensive care unit stay. Maternal death was seen in only one (0.59%) patient. CONCLUSION: Our study showed no significant correlation between the gestational age at the time of COVID-19 infection and the frequency of adverse pregnancy outcomes such as preterm birth, PE, FGR, and gestational diabetes mellitus. However, further studies are needed to draw a firm conclusion on this topic.

Optical Coherence Tomography Angiography Findings in Polycystic Ovary Syndrome.

OBJECTIVE: To evaluate microstructure and vascularity of macula and optic disc in polycystic ovary syndrome (PCOS) by optical coherence tomography (OCT) and OCT angiography (OCTA). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Ophthalmology and Department of Obstetrics and Gynecology, University of Health Sciences, Yüksek lhtisas Training and Research Hospital, Bursa, Turkey between January and June 2019. METHODOLOGY: Fifty-nine patients with PCOS and 35 healthy controls were enrolled in the study. Foveal avascular zone (FAZ), the capillary density assessed in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macula and was also measured in optic disc using the OCTA. The thicknesses of the retinal nerve fiber (RNFL), ganglion cell complex (GCC), and macula were measured by OCT. RESULTS: The capillary density in the macula and optic disc region were not a significant difference between the PCOS patients and healthy controls.The parafoveal superior, inferior, and temporal quadrant thickness was significantly higher in the study group compared to control group (p=0.047, p=0.033,and p=0.033, respectively). In patients with PCOS, there were negative correlations between IR and inferior RNFL, total and superior GCC thickness (r=-0.29 p= 0.027, r=-0.27 p=0.050, r=-0.31 p=0.029, respectively). CONCLUSION: Although no microvascular macular abnormalities were seen in PCOS patients, the parafoveal thickness significantly increased in all quadrants, except the nasal quadrant. In patients with PCOS, IR, dyslipidemia may affect the structural integrity of the retina. Further longitudinal follow-up studies are needed to determine whether PCOS has any effect on OCTA findings. Key Words: Polycystic ovary syndrome, Retina, Optical coherence tomography, Optical coherence tomography angiography.

Decorin expression in tubal ectopic and intrauterine pregnancies.

OBJECTIVE: Decorin is a leucine-rich proteoglycan, affects the proliferation, migration, and invasion of extravillous trophoblasts (EVTs). In this study, we aimed to determine the localization of decorin in the implantation site in human tubal ectopic pregnancy, to compare decorin expression levels in ectopic and intrauterine pregnancy, and to investigate the relationship between implantation depth of the tubal wall and expression levels of decorin. METHODS: 15 patients underwent salpingectomy for tubal ectopic pregnancy and 15 underwent curettage for voluntary interruption of pregnancy were included. All blocks were stained with decorin immunohistochemical staining. Trophoblastic cells of tubal Stage I-III and tubal epithelial and stromal cells were analyzed in terms of presence and intensity of decorin staining. RESULTS: Decorin was expressed in both tubal and intrauterine trophoblasts, stroma, and surface epithelium during the first trimester of pregnancy. Decorin staining intensity was significantly lower in the villous cytotrophoblasts and syncytiotrophoblasts in tubal ectopic pregnancies, compared to intrauterine pregnancies (p = 0.001 for both). Decorin staining intensity also significantly lower in the extravillous cytotrophoblasts and syncytiotrophoblasts in the tubal ectopic pregnancies (p = 0.002 and p = 0.001, respectively). There was no significant difference in the staining intensity of the trophoblasts and surface epithelial between Stage II and Stage III tubal invasion; however, the decorin expression was lower in the stroma in Stage III (p = 0.094). CONCLUSION: Decorin expression is significantly lower in trophoblastic cells of tubal ectopic pregnancies than the intrauterine pregnancies. Although it remains limited to explain the underlying cellular mechanisms, decorin seems to play a role in the development of tubal pregnancy.

Predictive Role of First-trimester ELABELA Levels for Late-onset Preeclampsia.

OBJECTIVE: To determine the predictive role of first trimester maternal serum ELABELA (ELA) levels in late-onset preeclampsia (PE). STUDY DESIGN: Comparative descriptive study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey between January and September 2019. METHODOLOGY: A total of 600 pregnant women, whose maternal serum samples were collected through the first trimester screening test, were recruited. Twenty-three patients with late-onset PE group and 47 without PE group were included. All participants in whom maternal serum samples were collected between 11th and 14th weeks of pregnancy were followed until delivery. RESULTS: Median ELA level was 654.53 [217.67-870.20] pg/mL in the PE group and 645.80 [367.25-1833.17] pg/mL in the control group, indicating no significant difference between the groups (p=0.408). There was a statistically significant difference between the two groups in terms of frequency of history of hypertension, intrauterine growth restriction (IUGR) and acute fetal distress (AFD), (p=0.003, p=0.016, and p=0.005, respectively). Three patients had preterm delivery in the PE group which was non-significant, while seven patients had gestational diabetes mellitus in PE group that was significantly higher compared to controls (p<0.001). CONCLUSION: Only ELA level in the first trimester of pregnancy may not be of much value in predicting late-onset PE. Key Words: ELABELA, Preeclampsia, Late-onset, Predictive marker.

The Predictive Value of First-trimester Thiol/Disulfide Homeostasis in Preeclampsia.

OBJECTIVE: To investigate the efficacy of first-trimester thiol/disulfide homeostasis (t/dh), a new oxidative stress marker, in predicting preeclampsia. STUDY DESIGN: Prospective cohort study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey, Department of Obstetrics and Gynecology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey, from March 2016 to February 2019. METHODOLOGY: In this multi-centre,serum samples of women with839 singleton pregnancies were collected between 11+0 to 13+6gestational weeks. A total of 215 singleton pregnant women were included in the study. The patient group consisted of 38 women, who were diagnosed with preeclampsia; while the control group consisted of 177 healthy pregnant women without any complication during pregnancy and after delivery. Totalthiol (TT) was estimated by the sum of existing thiol groups and reduced thiol groups (S-S and -SH). After the native thiols (-SH) and (TT) were determined, the disulfide (-SS) amounts, disulfide/total thiol percent ratios (-SS/-SH + -SS), disulfide/native thiol percent ratios (-SS/-SH), and native thiol/total thiol percent ratios (-SH/-SH + -SS) were calculated. RESULTS: There were no statistically significant differences between the groups in terms of[(-SH), (TT), (-SS), (-SS/-SH), (-SS/-SH + -SS), and (-SH/-SH + -SS)] six t/dh variables(p>0.05).The first-trimester body mass index (BMI) was statistically different between the two groups (p<0.001). In the receiver operating characteristic curve analysis, none of the concentrations of thiol levels and ratios was found to have a significant predictive value for preeclampsia. The BMI was a significant predictor for preeclampsia (area under curve: 0.749, p<0.001). CONCLUSION: Maternal serum t/dh at 11+0 to 13+6 weeks of gestation does not predict preeclampsia and t/dh may be the consequence rather than a cause in the pathogenesis of preeclampsia. Key Words: First-trimester, Preeclampsia, Sulfhydrylcompounds, Thiols.

The role of genetic mutations in intrahepatic cholestasis of pregnancy.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder of pregnancy characterized by pruritus, elevated liver enzymes and fasting serum bile acids. Genetic predisposition has been suggested to play a role in its etiology and mutations in the ATP8B1(OMIM ∗602397) (FIC1), ABCB11(OMIM ∗603201) (BSEP), and ABCB4(OMIM ∗171060) (MDR3) genes have been implicated. In the present study, we aimed to investigate the possible role of ATP8B1, ABCB11, and ABCB4 gene mutations in the patients with ICP. MATERIALS AND METHODS: A total of 25 patients who were diagnosed with ICP were included in the study. Genetic test results and mutation status of the patients as assessed by the next-generation sequencing technology were retrospectively retrieved from the hospital database. RESULTS: Of all patients, significant alterations in the ATP8B1 (n = 2), ABCB11 (n = 1), and ABCB4 (n = 7) genes were observed in 10 patients using the molecular analysis testing. All these alterations were heterozygous. Of these alterations, four were reported in the literature previously, while six were not. Using the in-silico parameters, there was a pathogenic alteration in the ABCB4 gene in one patient, while there was no clinically relevant alteration in the other gene mutations in the remaining nine patients. CONCLUSION: Considering the fact that the alterations were compatible with clinical presentations of the ICP patients and the incidence of these mutations is low in the general population, we believe that our study results are clinically relevant. Further molecular genetic tests in ICP patients and functional studies supporting the results would shed light into the clinical importance of these alterations.

Effectiveness of Intrauterine Bakri Balloon® Tamponade for Placenta Previa and Placenta Accreta Spectrum.

OBJECTIVE: To investigate the effectiveness and success rate of Bakri balloon tamponade (BBT) for postpartum haemorrhage (PPH) in patients with placenta previa and placenta accreta spectrum (PAS). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynaecology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey, from June 2016 to June 2019. METHODOLOGY: Patients treated with BBT for severe PPH and uncontrollable bleeding due to treatment failure with uterotonic agents were retrospectively analysed. Exclusion criteria were age <18 years and >46 years, having multiple pregnancies, less amount of bleeding than indicated in the definition of PPH and requiring no BBT and those with hemodynamic instability before BBT requiring emergency postpartum hysterectomy, and having missing obstetric and laboratory data. The main outcome was the rate of surgical exploration and peripartum hysterectomy following the use of BBT as an adjunct treatment for refractory PPH. Secondary outcome was the need for blood transfusion. The BBT was considered to fail, if the bleeding from drainage catheter was continued and more than 100 mL during failure was 10 minutes. In case of BBT failure, C-section hysterectomy was performed. RESULTS: Of the 128 patients, 14 (10.9%) had vaginal birth and 109 (85.2%) had Cesarean section delivery. Of patients with cesarean section delivery, 84 (65.6%) had multiple repeat cesarean deliveries and 22 (17.2%) were previous cesarean cases. Ninety-one patients (71.1%) had placental site abnormality. Twenty patients (15.6%) underwent hypogastric and uterine artery ligation. Eleven patients (8.7%) with persistent uterine bleeding and hemodynamic instability underwent hysterectomy. Success rate of BBT was found to be 91.3% in PPH. No mortality was observed. CONCLUSION: BBT is an effective tool for management of postpartum uterine atony and prevention of persistent PPH in patients with placenta previa and placenta accreta spectrum due to increased cesarean section and uterine surgeries in recent years. Key Words: Placenta previa, Placenta accreta spectrum, Postpartum haemorrhage, Balloon tamponade, Bakri balloon.

The association of dynamic thiol-disulfide homeostasis and inflammatory markers in patients with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age characterized by irregular menstruation and hirsutism and is associated with an increased risk for cardiovascular diseases. Increased inflammatory response and oxidative stress may also present in these patients. In this study, we aimed to compare the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and dynamic thiol-disulphide homeostasis (dTDH) between the patients with PCOS and healthy individuals and to investigate the correlation between these parameters and cardiovascular risk factors in patients with PCOS. MATERIALS AND METHODS: A total of 60 participants were included in this study. The patient group consisted of 36 patients who were diagnosed with PCOS and the control group consisted of 24 healthy individuals without PCOS. Complete blood count and hormonal tests were performed using blood samples. The NLR, MPV, and dTDH were compared between the patient and control groups. RESULTS: There was no statistically significant difference in the native thiol, total thiol, disulphide levels and disulfide/native, disulfide/total and native/total thiol ratios between the patient and control groups (p = 0.494, p = 0.446, p = 0.338, p = 0.717, p = 0.723, and p = 0.717, respectively). In addition, there was no statistically significant difference in NLR and MPV between the groups (p = 0.531 and p = 0.196). CONCLUSION: Our study results showed no significant difference in the NLR, MPV, dTDH levels, and inflammatory biomarkers including leukocyte count between the PCOS patients and healthy controls. Based on these findings, we conclude that the diagnosis of PCOS alone in overweight patients has no considerable effect on these biomarkers.

Adenomyosis and urinary system symptoms.

OBJECTIVE: This study aims to investigate the presence and incidence of overactive bladder (OAB) syndrome in patients diagnosed with adenomyosis and to evaluate the impacts of urinary symptoms on the quality of life of the patients. MATERIALS AND METHODS: A total of 108 individuals including 50 patients with adenomyosis and 58 controls who were admitted to the Obstetrics and Gynecology Department of Bursa, Cekirge State Hospital and Derince Training and Research Hospital between April 2015 and December 2015 were included. The Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to evaluate symptoms. RESULTS: Irritative urinary symptoms such as nocturia and frequency were seen more frequently in the adenomyosis group (p = 0.001 and p = 0.035). Overactive bladder symptoms were more common in the adenomyosis group (p = 0.0001). CONCLUSION: Our study showed that symptoms of urinary tract symptoms are common in patients with adenomyosis, which adversely affect the quality of life.

Assessment of the relationship of basal serum anti-mullerian hormone levels with oocyte quality and pregnancy outcomes in patients undergoing ICSI.

BACKGROUND: Anti-Mullerian hormone (AMH) is constantly secreted during menstrual cycles and may offer several advantages over traditional biomarkers of ovarian reserve. OBJECTIVE: To assess the relationship of anti-Mullerian hormone (AMH) values, which are used to evaluate ovary reserves, with oocyte and embryo quality and with ART outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: This cross sectional study was performed using 50 women undergoing ICSI in IVF center of Zeynep Kamil Women's and Children's Hospital, Istanbul, Turkey. All patients received the long protocol. Follicle-stimulating hormone, luteinizing hormone, estradiol, and AMH levels were measured and antral follicle counts were obtained on the 3(rd) day of menstruation. A cut-off value based on the number of oocytes was determined for AMH, and women were evaluated after being divided into two groups as bad responders and good responders, according to their AMH levels. RESULTS: Twelve (27.3%) women were in bad responders group and 32 (72.7%) women were in good responders group. AMH measurements were statistically significantly different between the two groups (p<0.01). Based on this significance, the researchers used ROC analysis to estimate a cut-off point for AMH. The researchers detected the good responders with an AMH level 1.90 or above, with 87.50% sensitivity, 66.67% specificity, 87.50% positive prediction, and 66.67% negative prediction (AUC=0.777, p<0.01). CONCLUSION: Basal AMH levels can be used as an indicator to determine the ovarian response in women undergoing ICSI. AMH can be used to predict the number of mature oocytes that can be collected during treatment and the number of oocytes that can be fertilized. However, AMH is not a valuable tool to evaluate oocyte quality, the development of high-quality embryos, or pregnancy conception.