The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies.

OBJECTIVES: Increased placental stiffness is associated with various pathological conditions. Our objective was to evaluate the relation between the second-trimester placental elasticity value in low-risk pregnant women and poor obstetric outcomes. METHODS: A total of 143 pregnant women were enrolled. Placental elasticity values were measured using the transabdominal point shear wave elastography method. 10 random measurements were obtained from different areas of the placenta. The mean was accepted as the mean placental elasticity value. Logistic regression analyses were performed to identify independent variables associated with obstetric outcomes. RESULTS: Second-trimester placental elasticity value was significantly and positively associated with the poor obstetric outcomes (p=0.038). We could predict a poor outcome with 69.2% sensitivity and 60.7% specificity if we defined the placental elasticity cut-off as 3.19 kPa. Furthermore, in the multiple regression model, the placental elasticity value added significantly to the prediction of birth weight (p=0.043). CONCLUSIONS: Our results showed that the pregnancies with a stiffer placenta in the second trimester were associated with an increased likelihood of exhibiting poor obstetric outcomes. Also, placental elasticity was independently associated with birth weight.

The effect of maternal vitamin D levels on placental shear wave elastography findings in the first trimester.

The aim of this study was to investigate the effect of maternal serum Vitamin D levels on the elasticity of placenta. Seventy-four spontaneously conceived singleton pregnancies in their first trimester were enrolled into this study. Fifty-one of them had Vitamin D deficiency (<20 ng/mL), while 23 pregnancies had Vitamin D levels ≥20 ng/mL. The placental elasticity was measured by the transabdominal Point Shear Wave Elastography (pSWE) method. In each case, the mean of 10 consecutive measurements was accepted as the mean placental elasticity value. The mean pSWE values did not significantly differ between the Vitamin D deficient group and the control group (p > .05). Placental elasticity was not found to be different in the pregnancies with Vitamin D deficiency during the first trimester.IMPACT STATEMENTWhat is already known on this subject? The pSWE technique provides opportunity to determine the elasticity of any interested tissue. Placental elasticity has been found to be changed in inflammatory and fibrotic conditions such as in preeclampsia, intrauterine growth restriction or diabetes. On the other hand, Vitamin D deficiency is linked with several comorbidities such as autoimmune disorders, cancer and cardiovascular disorders. Vitamin D also plays a role in placental angiogenesis in the first trimester. Maternal Vitamin D levels are shown to be related with adverse pregnancy outcomes.What do the results of this study add? To the best of our knowledge, this study is the first assessing the association between Vitamin D levels and placental elasticity. Placental elasticity was not found to be changed by Vitamin D deficiency.What are the implications of these findings for clinical practice and/or further research? Our pilot study revealed that Vitamin D deficiency does not have any impact on placental elasticity in the first trimester. However, longitudinal studies concerning placental elasticity in subsequent trimesters are needed to support our findings.

The impact of invasive prenatal testing on anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy.

PURPOSE: Prenatal anxiety has negative effects on pregnancy and neonate. Both screening tests and invasive diagnostic tests are associated with elevated anxiety level. But a normal fetal karyotype result could improve the anxiety level in high-risk patients. We hypothesized that patients who prefer follow-up without karyotyping may experience increased anxiety and sleep impairment until delivery. Our aim was to determine the effect of invasive diagnostic test decision on anxiety and sleep quality in women with a positive screening result. METHODS: 132 women were included for the study and three groups were described. The invasive group consisted of women who underwent invasive procedure after a screen-positive test result, the follow-up group consisted of women who preferred non-invasive follow-up after a screen-positive result and the control group consisted of women with screen-negative test results. Participants were evaluated with the State-Trait Anxiety Inventory (STAI) and the Pittsburgh Sleep Quality Index (PSQI) after genetic counseling. They were asked for completing the same questionnaires in the third trimester to establish the course of anxiety and sleep quality throughout pregnancy. RESULTS: STAI scores were significantly higher in both screen-positive groups than in the control group in the first evaluation (p < 0.001). STAI scores decreased in the invasive group and controls while PSQI scores did not significantly change during the course of the pregnancy. However, the anxiety level and sleep quality were worsened over time in the follow-up group. CONCLUSION: Screen-positive women who preferred to follow up had higher anxiety level and worse sleep quality in the later stages of pregnancy. We concluded that invasive prenatal diagnostic tests could improve anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy.

The Utility of Myometrial and Cervical Ultrasound Shear Wave Elastography in the Diagnosis of Ectopic Pregnancy.

We aimed to assess the potential utility of myometrial and cervical elasticity measurement in the diagnosis of ectopic pregnancy (EP), which could facilitate the diagnosis process. Myometrial and cervical elasticity values were measured in women with EP, women with early intrauterine pregnancy (IP) and non-pregnant women. Transabdominal point shear wave elastography (pSWE) was used for elasticity measurements. A reliability study was performed in 20 patients of the non-pregnant group. Cervical pSWE showed poor reliability and high measurement failure rate; thus, we excluded cervical elasticity assessment from the study. In this study, 32 women with EP, 28 women with early IP and 38 non-pregnant women were enrolled for myometrial elasticity assessment by pSWE. Myometrial elasticity values were statistically significantly lower in EP (8.31 kPa [5.1-27]) and early IP (8.83 kPa [4.5-46.2]) groups than in non-pregnant women (14.85 kPa [5.1-28]) (p = 0.003). However, myometrial pSWE results were not significantly different between EP and early IP groups. In light of this data, quantitative assessment of the uterus elasticity using pSWE does not seem to be an adequate diagnostic method for EP.

Maternal serum perlecan levels in women with preeclampsia.

Objective: Perlecan is an extracellular matrix proteoglycan suggested to maintain endothelial functions. We aimed to measure maternal serum perlecan levels in different preeclampsia phenotypes.Methods: This study included 50 women with preeclampsia and 30 healthy pregnant women.Results: Serum perlecan levels were significantly higher (p = 0.016) in preeclamptic women with severe features(n = 23) than preeclampsia patients(n = 27). There were no statistically significant differences in serum perlecan levels between the early-onset preeclampsia(n = 25), late-onset preeclampsia(n = 25), and healthy pregnancies.Conclusion: Our findings suggest that preeclamptic women with severe features have higher serum perlecan levels than women with preeclampsia.

Can maternal urinary and serum carbohydrate antigen 19-9 concentrations be utilized in the diagnosis of fetal hydronephrosis?

Objective: Fetal hydronephrosis (FH) is the most common fetal renal pathology encountered in daily obstetric practice. Urinary and serum carbohydrate antigen 19-9 (CA 19-9) concentrations are elevated in obstructive renal pathologies. Our aim was to assess maternal urinary and serum CA 19-9 concentrations in pregnancies with FH and compare results with controls. Material and Methods: Twenty pregnancies with severe FH, 20 pregnancies with mild-moderate FH, and 20 healthy singleton pregnancies were included in this descriptive, case-control study. The diagnosis and classification of FH was based on the anterioposterior diameter of fetal renal pelvis. Maternal urinary and serum CA 19-9 concentrations were measured and compared between groups. Results: Severe FH cases had significantly higher maternal urinary CA 19-9 concentrations compared to controls (median: 75 vs 24 U/mL; respectively; p=0.014). Concentrations of CA 19-9 did not differ between the mild-moderate FH group and control group. No statistically significant difference was found between the groups with respect to maternal serum CA 19-9 concentrations. Conclusion: Our results show that maternal urinary CA 19-9 concentration is significantly higher in pregnancies with severe FH. However, no difference was detected in serum CA 19-9 concentrations between pregnancies with severe FH, mild-moderate FH and controls. If the mechanisms of transplacental passage and maternal urinary excretion are clarified, maternal urinary CA 19-9 may be a potential marker for indicating fetal kidney damage.

Decreased maternal serum cortistatin levels in pregnancies with gestational diabetes mellitus.

Objective: To investigate serum cortistatin levels in women with gestational diabetes mellitus (GDM) and women with uncomplicated pregnancies.Material and methods: This case-control study consisted of 40 pregnancies with GDM and 41 healthy singleton pregnancies matched for maternal and gestational age. The maternal serum levels of cortistatin were measured with enzyme-linked immunosorbent assay and compared between groups.Results: Cortistatin levels were significantly lower in GDM group (48.85 ± 20.18 versus 65.84 ± 33.98 ng/ml, p = .008). There was a statistically significant difference in cortistatin levels between different treatment modalities and control group (χ2(2) = 8.828, p = .012). Pairwise comparisons showed that diet group had significantly lower CST levels than control group (p = .012). Serum cortistatin levels were negatively correlated with serum insulin and glucose levels and HOMA-IR (r = -0.358, p = .001; r = -0.303, p = .006; r = -0.444, p < .001, respectively).Conclusion: Cortistatin levels were significantly lower in GDM pregnancies and related to serum insulin and glucose levels and HOMA-IR in pregnancy. This may help to better clarify the mechanism of GDM pathogenesis.

Evaluation of maternal renal cortical elasticity in pregnancies with early- and late-onset preeclampsia.

Objective: The current study aimed to investigate renal cortical elasticity (RCE) in early- and late-onset preeclampsia patients and compare the results with healthy controls.Materials and methods: The study consisted of 136 pregnant women. Three groups were identified as; the late-onset preeclampsia (LOP) group (n = 40), the early-onset preeclampsia (EOP) group (n = 32) and the control group (n = 64). RCE values were measured by point shear wave elastography (pSWE). Nine measurements were taken for each kidney and the mean of nine measurements was accepted as the mean RCE value for each kidney. The arithmetic mean of left and right RCE values was accepted as the overall RCE value of a subject. Groups were compared in terms of clinical and biochemical parameters, ultrasonography findings and pSWE values.Results: There was a statistically significant difference between groups in terms of overall RCE values (F[2,133] = 17.96, p < .001). Post hoc comparisons indicated that both preeclampsia groups exhibited significantly higher RCE values than the control group. However, overall RCE values were not significantly different between the EOP and LOP groups. Overall RCE values were significantly and positively correlated with systolic blood pressure (r = 0.363, p < .001), diastolic blood pressure (r = 0.347, p < .001), proteinuria (r = 0.343, p < .001), serum creatinine level (r = 0.181, p = .035), serum uric acid level (r = 0.243, p = .004) and blood urea nitrogen (r = 0.27, p = .001).Conclusion: Our study demonstrated that maternal renal cortical stiffness increased in women with preeclampsia. The increased RCE values may be indicative for the severity of preeclampsia due to positive correlations between renal cortical stiffness and systolic - diastolic blood pressure and serum creatinine level.

Serum levels of spexin are increased in the third trimester pregnancy with gestational diabetes mellitus.

Spexin is a peptide that is involved in energy homeostasis and its expression is influenced by altered glucose metabolism. Gestational diabetes mellitus (GDM) is associated with increased insulin resistance (IR) and pregnancy is a progressive insulin resistant state. We hypothesized that spexin may have an effect on the pathophysiology of GDM which further could help to identify the disease. The aim of this study was to investigate spexin levels in the third trimester pregnancies with GDM and healthy controls. Thirty-nine women with GDM and 39 healthy singleton pregnancies were enrolled in this case-control study. Serum spexin concentrations were measured and correlated to biochemical and clinical parameters. Serum spexin levels were significantly higher in women with GDM (3686.25 ± 348.37 vs. 3472.33 ± 293.93 pg/ml, p=.004). Spexin levels ​​did not differ significantly according to treatment modality. Moreover, spexin levels were significantly positively correlated with homeostasis model assessment of IR (HOMA-IR). Spexin levels were significantly higher in women with GDM and closely related to HOMA-IR in the third trimester pregnancy. This may help to better clarify the pathophysiological role of spexin in GDM.

Effect of Pirfenidone on Vascular Proliferation, Inflammation and Fibrosis in an Abdominal Adhesion Rat Model.

AIM: To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model. MATERIALS AND METHODS: Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-ß and interleukin-17 levels in scarred tissue. RESULTS: The degree of vascular proliferation (1.32 ± 0.39 versus 2.34 ± 0.46, p < 0.001), inflammation (1.60 ± 0.70 versus 2.60 ± 0.52, p < 0.01), and fibrosis (1.50 ± 0.53 versus 2.40 ± 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 ± 0.42 versus 2.34 ± 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-ß and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers. CONCLUSION: Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration.

Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus.

OBJECTIVES: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL). METHODS: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%). RESULTS: Placental volume was significantly larger in GDM (411.59 ± 170.82 versus 343.86 ± 128.94 cm(3); p = 0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65 ± 7.02 versus 38.71 ± 7.91, respectively; p = 0.277). Placental volume was significantly correlated with gestational week (r = 0.219, p = 0.035) and parity (r = 0.228, p = 0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r = -0.278, p = 0.007; r = -0.315, p = 0.002; r = -0.322, p = 0.001, respectively). CONCLUSIONS: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.

Normal ranges of biorbital and interorbital distances in healthy Turkish pregnancies at 19-23 weeks of gestation and correlation with craniofacial structures.

OBJECTIVE: We aimed to determine the normal ranges for biorbital (BOD) and interorbital distances (IOD) during the second trimester in Turkish women with normal pregnancies and to assess the correlation between BOD, IOD, and other fetal craniofacial structures and biometric parameters. MATERIAL AND METHODS: Our retrospective study comprised 1328 women with singleton normal pregnancies who had undergone ultrasonography (USG) examinations at 19-23 weeks of gestation in the second trimester screening. The measurements of BOD and IOD were obtained with the coronal section of the fetal face at the plane of orbits. RESULTS: Mean BOD was 3.4±0.33 cm, whereas mean IOD was 1.28±0.24 cm. Correlation analysis revealed that BOD was significantly correlated with IOD, transcerebellar diameter (TCD), cisterna manga (CM), nuchal fold (NF), nasal bone (NB), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and gestational week. There was a significant relation between IOD and the lateral ventricle posterior horn, TCD, CM, NF, NB, BPD, HC, AC, and FL. CONCLUSION: The reference ranges obtained in our study enabled accurate evaluation of BOD and IOD in the second trimester of normal pregnancies. USG detection of fetal orbital biometric anomalies may alert the clinician for different anomalies associated with abnormal development of eye.

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure.

Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography.

OBJECTIVES: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL). METHODS: This case-control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm(3)) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%). RESULTS: Preeclamptic and control group consisted of 27 (mean age: 28.90 ± 5.95 years, mean gestation: 32.0 ± 4.55 weeks) and 54 (mean age: 29.48 ± 5.78 years, mean gestation: 32.61 ± 4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62 ± 91.69 versus 370.98 ± 167.82 cm(3); p = 0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24 ± 8.41 versus 33.50 ± 8.90%; p = 0.043). Placental volume was significantly correlated with the estimated fetal weight (r = 0.319; p = 0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r = -0.244, p = 0.024; r = -0.283, p = 0.005; r = -0.241, p = 0.024, respectively). CONCLUSIONS: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.

De novo reciprocal translocation t(5;11)(q22;p15) associated with hydrops fetalis (reciprocal translocation and hydrops fetalis).

OBJECTIVE: This is a case of a prenatally diagnosed non-immune hydrops fetalis (NIHF) associated with translocation t(5;11)(q22;p15). An association between NIHF and this translocation has not been reported previously. CASE REPORT: The patient was referred to the perinatology clinic with hydrops fetalis diagnosis at 23 weeks' gestation. We noted that the fetus had bilateral pleural effusion, ascites, widespread subcutaneous edema, membranous ventricular septal defect, hypoplastic fifth finger middle phalanx, clinodactyly, single umbilical artery. We performed cordocentesis. Chromosomal analysis on blood showed a balanced translocation between the long arm of chromosome 5 and the short arm of chromosome 11 with karyotype of 46,XX,t(5;11)(q22;p15). CONCLUSION: We present prenatal diagnosis of a de novo translocation (5;11) in a hydropic fetus with ultrason abnormalities. In our case, karyotype analysis of the fetus, mother and father provided evidence of a de novo translocation, that might explain the NIHF.

Normal range of intracranial translucency in healthy Turkish pregnancies and its association with first trimester maternal serum biochemistry and ductus venosus pulsatility index. .

OBJECTIVE: To measure the intracranial translucency (IT) by establishing reference ranges in uncomplicated singleton Turkish pregnancies and to evaluate the association of IT with maternal serum biochemistry, gestational week, crown-rump length (CRL) measurement, nuchal translucency (NT) and ductus venosus Doppler velocimetry. MATERIALS AND METHODS: 190 uncomplicated singleton pregnancies were included in the study. IT, NT and CRL measurements between 11-14 gestational weeks were obtained with mid-sagittal plane. Two independent measurements were taken and averaged to obtain the final measurement used in the calculations. Statistical analysis was performed with SPSS for Windows 20.0 software package. Correlation analysis was used to determine the association between IT and NT pregnancy-associated plasma protein-A (PAPP-A), free ß-human chorionic gonadotropin (ß-hCG) and CRL length. A p-value of <0.05 was considered statistically significant. RESULTS: The assessment rate of IT was 167/190 (87.89%). The mean CRL length, gestational week, NT and IT measurements were 63.63±10.05 mm, 12.28±0.75 weeks, 1.23±0.43 mm (range: 0.20-2.68) and 2.29±0.49 mm (range: 0.18-3.80), respectively There was no significant correlation between IT and maternal serum PAPP-A MoM (r=-0.34, p=0.698) or maternal serum free ß-hCG MoM (r=-0.79, p=0.363), respectively. There was weak but statistically significant correlation between IT with with maternal weight (r=0.172, p=0.047), CRL length (r =0.301, p<0.001), gestational week (r=0.286, p=0.001) and NT measurement (r=0.224, p=0.007), respectively. There was no significant association between IT with ductus venosus Doppler pulsatility index (r=0.108, p=0.213). CONCLUSION: IT can be easily measured while scanning for NT. This study shows normal range values in healthy Turkish pregnancies. Consistent with recent data, our results show positive correlation with gestational week and CRL length. Maternal serum biochemistry does not have any effect on IT. Besides, our study highlights that IT is correlated with NT and adds newly to the literature that there is no correlation of IT with ductus venosus pulsatility index.

Ductus Venosus Doppler Flow Velocity after Transplacental and Non-transplacental Amniocentesis during Midtrimester.

OBJECTIVE: We aimed to evaluate ductus venosus Doppler waveforms before and after amniocentesis in order to investigate any effect of amniocentesis on fetal myocardial hemodynamics. We also evaluated the umbilical artery, uterine artery and fetal mid-cerebral artery Doppler waveforms in order to investigate any relationship with ductus venosus Doppler changes. METHODS: The study population consisted of 56 singleton pregnancies having genetic amniocentesis. Twenty seven of them had transplacental needle insertion; whereas 29 of them had non-transplacental amniocentesis. Uterine artery, umbilical artery, mid-cerebral artery and ductus venosus pulsatiliy index and resistance index were measured just before and after amniocentesis. RESULTS: Amniocentesis does not cause any significant changes in fetal ductus venosus Doppler waveforms. There is also no significant changes in uterine artery, umbilical artery, mid-cerebral artery pulsatility and resistance index. CONCLUSION: Amniocentesis-whether transplacental or not- does not cause any significant effect on fetal myocardial hemodynamics.

The effect of parity on first trimester uterine artery Doppler waveforms in low-risk singleton pregnancies.

OBJECTIVES: The aim of the study was to evaluate the effeot of parity on uteroplacental blood flow during the first trimester in low-risk singleton pregnancies. MATERIALS AND METHODS: Uterine artery Doppler examinations were performed in 190 singleton pregnancies between 11-14 gestational weeks. Twenty-five pregnancies were excluded from the study due to history ci preeclampsia, diabetes mellitus or inherited thrombophilia. A total of 165 low-risk singleton pregnancies were included in the study Mean uterine artery pulsatility index (P1) was recorded and compared between nulliparous and multiparous women. The relation between maternal age, gestational week, maternal weight, parity biochemica, markers and abnormal uterine artery Doppler flows was evaluated. T-test and logistic regression analyses were used for the statistical analysis. RESULTS: A total of 165 singleton pregnancies without any risk factors for uteroplacental insufficiency were includec in the study Of them, 58 (36.7%) were nulliparous and 107(63.3%) were parous. Correlation analysis revealed that the uterine artery pulsatifity indices during the first trimester were not affected by maternal age and parity: CONCLUSIONS: Mean uterine artery pulsatility indices are not different in nulliparous and multiparous low nisA pregnancies at 11-14 weeks of gestation.

Recent advances in the diagnosis and management of gestational diabetes.

Gestational diabetes is a condition which is seen in 7% of pregnancies and have potential risks for both mother and fetus. Despite its importance, there is not any golden standard approaches to the diagnosis and management of the disease. The aim of this review was to investigate the advances in the diagnosis and management of gestational diabetes in recent years.

Knowledge about cervical cancer, pap test and barriers towards cervical screening of women in Turkey.

We aimed to identify knowledge about cervical cancer (CC) and Pap test (PT) and the barriers why women do not have Pap test done. The study was conducted with a sample of 1,036 women. Overall, 64.4 % had heard of CC, 43.1 % had heard about PT and 24.7 % had had a test at least once. It was determined that women had moderate knowledge of cervical cancer but poor knowledge of Pap test. Knowledge of CC and PT was significantly better among employed and single women, who had higher education, no prior delivery, a higher income level and regular gynaecological examination. Common barriers to PT were lack of awareness, being uncomfortable with the procedure and not knowing where to go for a PT. Utilization of the PT will not increase unless knowledge is improved and barriers are eliminated. Healthcare professionals are the key persons to provide both knowledge and facilities towards the goal of CC prevention.