Evaluation of the relationship between HbA1c level and retina choroidal thickness in patients with gestational diabetes mellitus / Avaliação da relação entre o nível de HbA1c e a espessura coroidal da retina em pacientes com diabetes mellitus gestacional

ABSTRACT Purpose: To investigate the effect of hemoglobin A1c level on central macular thickness and central, nasal, and temporal choroidal thickness in patients with gestational diabetes mellitus. Methods: This retrospective study included 41 patients who had been diagnosed with gestational diabetes mellitus and undergone a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation. They were divided into two groups based on their hemoglobin A1c level (group 1: hemoglobin A1c <6.0% and group 2: hemoglobin A1c ≥6.0%). All patients underwent a complete ophthalmologic examination. The central macular thickness and central, nasal, and temporal choroidal thickness were measured using optical coherence tomography. Results: Of the 3,016 pregnant women screened, 7.5% (n=228) were diagnosed with gestational diabetes mellitus during the study period and 41 of these patients were included in the study. Group 1 comprised 48 eyes from 24 patients and Group 2 consisted of 34 eyes of 17 patients. The average body mass index values were 30.8 ± 3.3 and 35.1 ± 9.0, respectively (p=0.002). The insulin use rates were 29.2% and 76.5%, respectively (p=0.000). Mean central macular thickness values were 250.8 ± 14.3 µm and 260.9 ± 18.1 µm, respectively, and the difference was significant (p=0.008). Conclusions: Although the body mass index and central macular thickness values were significantly higher in Group 2, there was no difference in the central, nasal, and temporal choroidal thickness between the two groups.

RESUMO Objetivos: Investigar o efeito do nível de hemoglobina A1c (HbA1c) na espessura macular central e na espessura da coróide central, nasal e temporal em pacientes com diabetes mellitus gestacional. Métodos: Este estudo retrospectivo incluiu 82 olhos de 41 pacientes diagnosticadas com diabetes mellitus gestacional, as quais fizeram um teste de tolerância oral à glicose de 75 g entre 24 e 28 semanas de gestação. As pacientes foram divididas em dois grupos de acordo com o nível de hemoglobina A1c (hemoglobina A1c <6,0% e hemoglobina A1c ≥6,0%). Todas as pacientes foram submetidas a exame oftalmológico completo e, a espessura macular central, a espessura central, nasal e temporal da coroide foram mensuradas por tomografia de coerência óptica. Resultados: Durante o período do estudo, das 3.016 gestantes triadas, 7,5% (n=228) foram diagnosticadas com diabetes mellitus gestacional. Destas, 41 pacientes foram analisadas de acordo com os critérios do estudo. Houve 48 olhos de 24 pacientes no primeiro grupo com hemoglobina A1c <6,0% e 34 olhos de 17 pacientes no segundo grupo com hemoglobina A1c ≥6,0%. Os valores médios do índice de massa corporal foram de 30,8 ± 3,3 e 35,1 ± 9,0, respectivamente (p=0,002). As taxas referentes ao uso de insulina foram de 29,2% e 76,5%, respectivamente (p=0,000). Os valores médios da espessura macular central foram medidos em 250,8 ± 14,3 µm e 260,9 ± 18,1 µm, respectivamente e a diferença foi significativa entre os dois grupos (p=0,008). Conclusões: Embora os valores do índice de massa corporal e da espessura macular central tenham sido significativamente maiores no Grupo 2 com hemoglobina A1c alta, não houve diferenças nas medidas de espessura coroidal central, nasal e temporal entre os dois grupos.

Prenatal diagnosis of a rare isolated thoracic-type ectopia cordis with complete form: a case report.

Ectopia cordis (EC) is a rare malformation that occurs as an isolated lesion or as part of the pentalogy of Cantrell which is characterized by midline closure defects. This was first described by Haller et al. in 1706. EC is seen with a frequency of 5.5-7.9 per 1 million births. It has five types that are: cervical, cervico-thoracic, thoracic, thoraco-abdominal, and abdominal. Its differentiation from the pentalogy of Cantrell, first described by Cantrell in 1958, must be done well. Thoracic type has the worst prognosis and due to this poor prognosis in the postnatal period, termination may be offered to these patients as an option. In this paper, a case of an isolated thoracic-type complete EC detected in the prenatal ultrasonography of a pregnant woman referred to our clinic at the 18 weeks and 3 days of gestation is presented.

Evaluation of the relationship between HbA1c level and retina choroidal thickness in patients with gestational diabetes mellitus.

PURPOSE: To investigate the effect of hemoglobin A1c level on central macular thickness and central, nasal, and temporal choroidal thickness in patients with gestational diabetes mellitus. METHODS: This retrospective study included 41 patients who had been diagnosed with gestational diabetes mellitus and undergone a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation. They were divided into two groups based on their hemoglobin A1c level (group 1: hemoglobin A1c <6.0% and group 2: hemoglobin A1c ≥6.0%). All patients underwent a complete ophthalmologic examination. The central macular thickness and central, nasal, and temporal choroidal thickness were measured using optical coherence tomography. RESULTS: Of the 3,016 pregnant women screened, 7.5% (n=228) were diagnosed with gestational diabetes mellitus during the study period and 41 of these patients were included in the study. Group 1 comprised 48 eyes from 24 patients and Group 2 consisted of 34 eyes of 17 patients. The average body mass index values were 30.8 ± 3.3 and 35.1 ± 9.0, respectively (p=0.002). The insulin use rates were 29.2% and 76.5%, respectively (p=0.000). Mean central macular thickness values were 250.8 ± 14.3 µm and 260.9 ± 18.1 µm, respectively, and the difference was significant (p=0.008). CONCLUSIONS: Although the body mass index and central macular thickness values were significantly higher in Group 2, there was no difference in the central, nasal, and temporal choroidal thickness between the two groups.

A prospective cohort study of shock index as a reliable marker to predict the patient's need for blood transfusion due to postpartum hemorrhage.

OBJECTIVE: This study was aimed to compare the shock index (SI) values between patients who required blood transfusion due to postpartum hemorrhage (PPH) and patients who received no blood transfusion. METHODS: We conducted this cross-sectional study at a tertiary center between January 2019 and June 2019. A total of 2534 patients who underwent vaginal delivery were included in this study. We measured SI values upon admission, 30 minutes, 1-hour, and 2-hours after delivery. We identified women who required blood transfusion as the study group. Control patients who delivered in the same period and received no blood transfusion were identified in the medical record system and randomly selected. Age, parity, BMI, and SI values at each one prepartum and three postpartum periods of the groups were analyzed. RESULTS: A total of 2534 patients were included in the study. A varying amount of blood transfusion was performed in 54 patients (2.13%). When we compared with patients who did not receive blood transfusion after delivery, patients who received any amount of blood transfusion after vaginal delivery had significantly higher SI values 30 minutes after delivery (0.99±0.20, and 085±0.11, p=0.0001), at 1-hour (1.00±0.18, and 0.85±0.11, p=0.0001), and 2-hours (1.09±0.16, and 0.87±0.11, p=0.0001). CONCLUSION: SI value could be a reliable and consistent marker to predict the requirement for any amount of blood transfusion due to PPH.

PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding.

OBJECTIVES: To evaluate the FIGO's novel classification system versus the classic terminology in patients with abnormal uterine bleeding. MATERIAL AND METHODS: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yasargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. RESULTS: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis: 196 (38.1%), local adenomyosis: 32 (6.2%)], leiomyoma in 386 [submu-cous: 161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). CONCLUSIONS: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers.

The ability of various cerebroplacental ratio thresholds to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction.

OBJECTIVES: Our primary aim was to evaluate the ability of various cerebroplacental ratio (CPR) reference values suggested by the Fetal Medicine Foundation to predict adverse neonatal outcomes in term fetuses exhibiting late-onset fetal growth restriction (LOFGR). Our secondary aim was to evaluate the effectiveness of other obstetric Doppler parameters used to assess fetal well-being in terms of predicting adverse neonatal outcomes. METHODS: This was a retrospective cohort study of 317 pregnant women diagnosed with LOFGR at 37-40 weeks of gestation between January 1, 2016, and September 1, 2019. Receiver operating characteristic (ROC) curves were drawn to determine the predictive performance of CPR <1, CPR <5th or <10th percentile, and umbilical artery pulsatility (PI) >95th percentile in terms of predicting adverse neonatal outcomes. RESULTS: Pregnant women exhibiting LOFGR who gave birth in our clinic during the study period at a mean of 38 gestational weeks (minimum 37+0; maximum 40+6 weeks); the median CPR was 1.51 [interquartile range (IQR) 1.12-1.95] and median birthweight 2,350 g (IQR 2,125-2,575 g). The CPR <5th percentile best predicted adverse neonatal outcomes [area under the curve (AUC) 0.762, 95% confidence interval (CI) 0.672-0.853, p<0.0001] and CPR <1 was the worst predictor (AUC 0.630, 95% CI 0.515-0.745, p=0.021). Of other Doppler parameters, neither the umbilical artery systole/diastole ratio nor the mid-cerebral artery to peak systolic velocity ratio (MCA-PSV) predicted adverse neonatal outcomes (AUC 0.598, 95% CI 0.480-0.598, p=0.104; AUC 0.521, 95% CI 0.396-0.521, p=0.744 respectively). CONCLUSIONS: The CPR values below the 5th percentile better predicted adverse neonatal outcomes in pregnancies complicated by LOFGR than the UA PI and CPR <1 by using Fetal Medicine Foundation reference ranges.

The effect of vaginal disinfection on reducing post-caesarean endometritis: A prospective, randomised controlled trial.

PURPOSE: We aimed to evaluate the efficacy of vaginal disinfection using 10 % povidone-iodine on rates of endometritis from post-caesarean infectious diseases before elective caesarean section (CS). METHODS: A total of 270 pregnant women who chose to undergo elective CS were recruited for this prospective randomised controlled study. The experimental group comprised 130 patients who had preoperatively undergone vaginal disinfection with 10 % povidone-iodine for 30 s. The control group consisted of 140 patients who had not undergone any vaginal implication before CS. The primary outcome measure was the rate of postpartum endometritis for each group. Intraoperatively, all patients who had closed uterine cervical canals underwent a digital opening of the internal and external cervical canal to equalise the groups. All of the participants were checked for endometritis one week after CS at the hospital. Additionally, for the week before and after surgery, C-reactive protein (CRP) and white blood cell (WBC) values were assessed for both groups. Ethics committee approval number: 339. Statistical analysis was performed using R version 3.5.1 (R statistical Software, Institute for Statistics and Mathematics, Vienna, Austria). RESULTS: The groups were balanced in terms of the patients' demographic characteristics. There were no significant differences between the two groups according to endometritis rates: 4.6 % in the study group versus 6.4 % in the control group (p > 0.05). The CRP and WBC values before CS were similar in both groups. In the study group, the CRPand WBC values after CS were lower, whereas they were higher in the control group after CS; these differences were significant (p = 0.01 for CRP and p = 0.001 for WBC). CONCLUSION: Vaginal disinfection with povidone-iodine solution 10 % before elective CS does not significantly reduce post-caesarean endometritis rates; however, it does significantly reduce inflammatory markers such as CRP and WBC.

Unscarred uterine rupture and subsequent pregnancy outcome - a tertiary centre experience.

OBJECTIVES: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. RESULTS: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. CONCLUSIONS: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Evaluation of catalase, myeloperoxidase and ferroxidase values in pregnant women with hyperemesis gravidarum.

OBJECTIVES: To investigate maternal serum catalase, myeloperoxidase and ferroxidase levels in pregnant women withHyperemesis Gravidarum and to compare the results with healthy pregnancies. MATERIAL AND METHODS: In this study, 60 female patients admitted to the Health Sciences University, Gazi Yasargil Trainingand Research Hospital, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups:Group 1 included 30 pregnant women with hyperemesis gravidarum; Group 2 included 30 healthy pregnant women.Pregnancies over 14 weeks were excluded from the study. RESULTS: The laboratory and laboratory characteristics of both groups are shown in Table 1. No significant differences werefound between the groups in terms of the maternal age, gestational age, gravidity, parity, fasting glucose level, and BMI.The maternal blood CAT levels were significantly higher in the HG group (219.6 ± 111.3 kU/L) when compared to the controlgroup (71.5 ± 52.5 kU/L) (p < 0.001). The maternal blood MPO levels were lower in the control group (121.5 ± 36.3 U/L)than in the study group (90.9 ± 56.4 U/L) (p = 0.016). However, the ferroxidase levels were similar between the twogroups. The independent variables BMI, age, parity, gravidity and gestational week effects were adjusted according to thelogistic regression method with groups. Significant differences were observed between the two groups in the levels ofCAT (0.001), MPO (0.005) values. CONCLUSIONS: This study suggests that antioxidants in response to oxidative stress gave different reactions with differentmechanisms; Also, we believe that insufficient food intake suppresses the immune system and this has an important roleon antioxidants.

Maternal abdominal subcutaneous fat thickness as a simple predictor for gestational diabetes mellitus.

Background To date, only a limited number of studies have evaluated the importance of abdominal subcutaneous fat thickness (ASFT) on gestational diabetes mellitus (GDM) screening. The aim of this study was to investigate the effectiveness of ASFT measurement during routine obstetric ultrasound performed between 24 and 28 weeks of gestation in predicting cases with GDM. Methods This prospective comparative study was conducted on 50 cases with GDM and 50 cases without GDM in the GDM screening program at 24-28 gestational weeks between January 2018 and May 2018. The most accurate ASFT cut-off point values were determined for the prediction of cases with GDM by performing receiver operator characteristic (ROC) curve analysis. Results The ASFT was higher in those with GDM compared to those without GDM (P < 0.05). For an ASFT cut-off point value of 18.1 mm for the prediction of cases with GDM, the sensitivity, specificity, negative and positive predictive values were 72.0%, 60.0%, 64.2% and 68.1%, respectively. The risk of GDM increased 3.86-fold in those with ASFT level >18.1 mm (P = 0.001). Conclusion The ASFT value measured by routine obstetric ultrasound performed at 24-28 weeks of gestation was found to be significantly higher in patients with GDM in comparison to those without GDM. However, further multi-centered and comprehensive prospective studies are required to better demonstrate this relationship.

The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies.

BACKGROUND: Pregnancy at advanced maternal age has become more common in both developed and developing countries over the last decades. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. The objective of this study is to investigate the impact of advanced maternal age on perinatal and neonatal outcomes of nulliparous singleton pregnancies. METHODS: Records of patients admitted to the Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, between January 2011 and July 2015 for routine mid-trimester fetal ultrasonography were retrospectively reviewed. The control (age: 18-34 years), advanced maternal age (35-39 years), and very advanced maternal age (> 40 years) groups included 471, 399, and 87 women, respectively. RESULTS: Gestational diabetes, gestational hypertension, and cesarean delivery rates were more common in the very advanced maternal age group, with compared with the advanced maternal age and the younger age group. There were no significant differences in regarding rates of spontaneous preterm delivery before 34 weeks of gestation, prolonged rupture of membranes, large for gestational age infants, and operative vaginal delivery rates between the groups. Also, there were no significant differences regarding in APGAR scores, the rate of low birth weight infants, and neonatal morbidity rates between the groups. However, admission to the neonatal intensive care unit requirement was more common in the two advanced maternal age groups compared with the control group. CONCLUSION: Advanced maternal age is a risk factor for gestational diabetes mellitus, gestational hypertension, preeclampsia, small for gestational age infants, spontaneous late preterm delivery, and cesarean section, with significant potential clinical implications.

Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012.

OBJECTIVE: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. METHODS: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics's (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. RESULTS: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. CONCLUSIONS: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.