Role of increased plasminogen activator inhibitor-1 and vitronectin in gestational diabetes mellitus.

OBJECTIVE: The aim of this study was to analyze the second-trimester levels of vitronectin and plasminogen activator inhibitor-1 in gestational diabetes mellitus. METHODS: This study was conducted between September 2020 and December 2020 at the University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology. A total of 30 pregnant women with gestational diabetes mellitus and 60 healthy controls between 24 and 27/6 weeks of gestation were included. The inclusion criteria were as follows: being between 18 and 45 years old and 24-27/6 gestational weeks, having singleton pregnancy, diagnosed with gestational diabetes mellitus by using a two-step challenge test. The exclusion criteria of this study were as follows: chronic inflammatory or infectious disease, fasting blood glucose>126 mg/dL, intolerance to glucose tolerance testing, abnormal liver or kidney function tests, as well as pregnancy with pre-gestational diabetes history of adverse perinatal outcomes. Serum vitronectin and plasminogen activator inhibitor-1 levels were measured using the enzyme-linked immunosorbent assay method. RESULTS: Vitronectin and plasminogen activator inhibitor-1 levels were higher in the gestational diabetes mellitus group compared with controls [91.85 (23.08) vs. 80.10 (39.18) ng/mL, for vitronectin and 6.50 (1.05) vs. 4.35(1.0) ng/mL, for plasminogen activator inhibitor-1 (for both p<0.001)]. vitronectin >84.7 ng/mL was found to predict gestational diabetes mellitus with a sensitivity of 70% and specificity of 63.3%. Moreover, vitronectin had a significant positive correlation with fasting blood glucose (r=0.476, p<0.001), postprandial blood glucose (r=0.489, p<0.001), HbA1c (r=0.713, p<0.001), and plasminogen activator inhibitor-1 (r=0.586, p<0.001). CONCLUSION: This study revealed that second-trimester vitronectin and plasminogen activator inhibitor-1 are increased in gestational diabetes mellitus and vitronectin could be a candidate for the prediction of gestational diabetes mellitus.

Role of increased plasminogen activator inhibitor-1 and vitronectin in gestational diabetes mellitus

SUMMARY OBJECTIVE: The aim of this study was to analyze the second-trimester levels of vitronectin and plasminogen activator inhibitor-1 in gestational diabetes mellitus. METHODS: This study was conducted between September 2020 and December 2020 at the University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology. A total of 30 pregnant women with gestational diabetes mellitus and 60 healthy controls between 24 and 27/6 weeks of gestation were included. The inclusion criteria were as follows: being between 18 and 45 years old and 24-27/6 gestational weeks, having singleton pregnancy, diagnosed with gestational diabetes mellitus by using a two-step challenge test. The exclusion criteria of this study were as follows: chronic inflammatory or infectious disease, fasting blood glucose>126 mg/dL, intolerance to glucose tolerance testing, abnormal liver or kidney function tests, as well as pregnancy with pre-gestational diabetes history of adverse perinatal outcomes. Serum vitronectin and plasminogen activator inhibitor-1 levels were measured using the enzyme-linked immunosorbent assay method. RESULTS: Vitronectin and plasminogen activator inhibitor-1 levels were higher in the gestational diabetes mellitus group compared with controls [91.85 (23.08) vs. 80.10 (39.18) ng/mL, for vitronectin and 6.50 (1.05) vs. 4.35(1.0) ng/mL, for plasminogen activator inhibitor-1 (for both p<0.001)]. vitronectin >84.7 ng/mL was found to predict gestational diabetes mellitus with a sensitivity of 70% and specificity of 63.3%. Moreover, vitronectin had a significant positive correlation with fasting blood glucose (r=0.476, p<0.001), postprandial blood glucose (r=0.489, p<0.001), HbA1c (r=0.713, p<0.001), and plasminogen activator inhibitor-1 (r=0.586, p<0.001). CONCLUSION: This study revealed that second-trimester vitronectin and plasminogen activator inhibitor-1 are increased in gestational diabetes mellitus and vitronectin could be a candidate for the prediction of gestational diabetes mellitus.

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum.

AIM: Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG. METHODS: This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG. RESULTS: The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01). CONCLUSIONS: The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.

Fibrinogen Levels and Total Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy.

OBJECTIVE: To determine the role of complete blood count and coagulation function factors as inflammatory markers in intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January 2018 and 2021. METHODOLOGY: This study was conducted with a total of 200 pregnant women, 80 with ICP and 120 control healthy pregnant women. The diagnosis of ICP was made based on elevated liver enzymes and bile acids (≥10 µmol/L) and pruritis. Routine complete blood count parameters and coagulation function tests were compared between both groups. ROC analyses were used to analyse the predictive value of fibrinogen levels in ICP. Spearman's rank correlation analysis assessed the correlation between fasting bile acid value and complete blood count and coagulation parameters. RESULTS: Neutrophil-lymphocyte ratio (NLR), Platelet count, and Platecrit levels were significantly higher in the ICP group, and red blood cell distribution width (RDW) was lower than in the healthy group (p <0.05). The median plasma fibrinogen value was 571 mg/dl which was significantly higher in pregnant women with cholestasis (p <0.001). The prothrombin time and international normalized ratio (INR) values were also significantly different in each group (p <0.001 and 0.013, respectively). In addition, platelet distribution width (PDW), plasma fibrinogen, and prothrombin time (PT) showed significant association with the bile acid values (p values=0.007, 0.03, and 0.04 respectively). Each 1-unit elevation of the fibrinogen increased the risk of cholestasis by 1.02 times. There was a positive correlation of 0.24-fold between the plasma fibrinogen value and acids. CONCLUSION: The plasma fibrinogen value was the highest predictor of cholestasis diagnosis by analyzing blood parameters. Elevated fibrinogen levels correlated with bile acid levels, can potentially detect ICP. KEY WORDS: Bile acids, Cholestasis, Coagulation function parameters, Fibrinogen levels, Inflammation.

Can early pregnancy decorin levels be a potential predictor for preterm birth?

Objective: This study investigates the role of maternal decorin levels measured in the early second trimester of pregnancy in detecting the potential for preterm birth in late pregnancy. Methods: The prospective, case-control study was carried out in tertiary university hospital from June to December 2021.Maternal serum samples were collected from 350 women aged 18-40 years with a singleton pregnancy during early second-trimester screening for aneuploidy, and stored at -80°C. All participants were followed up until delivery and 25 patients diagnosed with preterm birth group and 40 full-term healthy women were included in the study. Results: The median maternal serum decorin level was 3.82 (1.15-12.37) ng/ml in the preterm birth (PTB) group and 4.63 (1.20-10.02) ng/ml in the control group, there was no statistically difference between the groups (p = 0.111). The mean gestational age was statistically significantly lower in the preterm birth group (33.1±2.7 weeks) than in the control (39±1.16 weeks) (p <0.001). The mean fetal weight was statistically significantly lower in the preterm birth group (2023.8±477 g) than in the control group (3309.7±353 g) (p <0.001). Conclusion: Early second-trimester serum levels of decorin alone may not be a sufficiently accurate biomarker as a biochemical model for the prediction of preterm birth in asymptomatic women.

Are women diagnosed with early pregnancy loss at risk for anxiety, depression, and perinatal grief?

OBJECTIVES: To examine the effects of early pregnancy loss on emotions such as depression, grief, or a sense of hopelessness, while investigating different types of diagnoses, hospital stays, and treatments. METHODS: A prospective cohort epidemiological study was carried out in Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey, between January and September 2019. The study included women diagnosed with early pregnancy loss classified into 3 groups: missed abortus, anembryonic pregnancy, and spontaneous abortion. The patients were screened via the Spielberger state-anxiety inventory (STAI-1) before initiating treatment. The Edinburgh postpartum depression scale (EPDS) and Perinatal Grief Scale (PGS) were also carried out in the first week of their hospital discharge. RESULTS: The study was carried out with a total of 116 patients. The median gestational week of the patients was calculated at 9, their median hospital stay was 2 days, and their median dose of misoprostol was 800 mcg. The STAI-1 revealed that median values computed for women in all groups indicated moderate anxiety. The EDPS also demonstrated depression-positive median values for women in all 3 groups (EPDS>13). However, no statistically significant difference was noted in comparisons of the 3 groups apropos STAI-1, EPDS, and PGS. CONCLUSION: Moderate anxiety, depressed mood, and perinatal grief were found in women diagnosed with early pregnancy loss, regardless of the type of abortion.

Evaluation of meibomian gland morphology and anterior segment parameters by Sirius topography systems in polycystic ovary syndrome.

Purpose: To compare findings in specular microscopy, corneal topography, and noncontact meibography in polycystic ovary syndrome (PCOS) patients with healthy controls. Methods: A total of 40 women with PCOS and 32 healthy controls were enrolled in the study. Schirmer's test, Ocular Surface Disease Index (OSDI), noninvasive tear break-up time (NITBUT), the mean keratometry (Km), maximum keratometry (Kmax), central (CCT), thinnest (TCT) and apical (ACT) corneal thicknesses, meibomian gland (MG) loss, meiboscores, morphology of MGs, endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (PHEX) were analyzed. Correlations between anti-Mullerian hormone (AMH) and sex hormones and the findings of PCOS patients were evaluated. Results: Mean OSDI score, intraocular pressure, Km and Kmax values, the mean MG loss of upper and lower eyelids, lower eyelid meiboscore, and degree of morphological abnormalities of MGs were higher in cases with PCOS than healthy controls. There were no significant differences between groups in Schirmer results, first and average NITBUT, mean values of TCT, ACT, CCT, ECD, CV, and PHEX (P > 0.05, for all). There were correlations between plasma AMH level and Kmax, back Km and PHEX, and between estradiol (E2) and PHEX; there were negative correlations between E2 and total MG loss and CV and between total testosterone and ACT. Conclusion: Loss and morphological deterioration of the MGs are observed in PCOS patients, even if the tear parameters are not impaired yet. In eyes with PCOS, keratometry values become steeper in proportion to AMH levels. The PCOS patients should be followed carefully for the development of corneal ectasia.

Adjuvant Hypnotherapy for Hyperemesis Gravidarum: A Randomized Pilot Study.

Hyperemesis gravidarum, which requires hospitalization in approximately 1% to 5% of patients, is characterized by severe nausea and vomiting in pregnancy. This study investigated the effects of hypnosis on nausea, vomiting, use of antiemetic medications, and hospital stay among patients diagnosed with hyperemesis gravidarum. Patients were randomized to receive either conventional therapy alone (control condition, n = 23) or adjuvant hypnotherapy plus conventional therapy (treatment group, n = 18). Sociodemographic data, severity of nausea, frequency of vomiting per day, rescue medications used, and length of hospital stay were recorded. Participants in the treatment group received 2 sessions of hypnosis and were instructed in daily self-hypnosis practice. Those in the control group received treatment as usual. Results from this study indicated that adjunctive use of hypnotherapy with patients diagnosed with hyperemesis gravidarum experienced significantly reduced severity of nausea and frequency of vomiting compared to treatment-as-usual alone. Also, hospital stay was found to be shorter in the treatment group as compared to the control group. These findings are encouraging and suggest it is feasible and potentially beneficial to include adjunctive hypnotherapy to treat hyperemesis gravidarum.

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.

The effect of glucose tolerance test on fetoplacental circulation.

OBJECTIVE: Acute hyperglycemia affects the fetoplacental circulation. This study aims to investigate the possible effect of acute hyperglycemia induced by 50 g oral glucose tolerance test (OGTT) on fetoplacental circulation in women between 24 and 28 weeks of gestation. MATERIALS AND METHODS: Between January 2019 and April 2019, a total of 29 women who were between 24 and 28 weeks of gestation with a singleton gestation and were in low-risk group were included in this prospective study. All patients underwent fetal biometric measurements using ultrasonography (USG) and were administered 50 g OGTT. Before and 1 h after the test, Doppler USG was used to measure uterine artery, umbilical artery (UA), middle cerebral artery (MCA), pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio. The cerebroplacental ratio (CPR) was calculated as the ratio of the MCA-PI/UA-PI. RESULTS: There was a decline in the MCA-RI (p = 0.008) and UA-PI (p = 0.021) at 1 h after the administration of 50 g OGTT. Z-scores of the mean UA-PI, MCA-PI, and CPR were calculated and a statistically significant increase in the Z-scores of the mean UA-PI was observed (p = 0.028). CONCLUSION: Our study results show that acute hyperglycemia induced by OGTT significantly increases the Z-scores of the UA-PI, affecting the fetoplacental circulation.

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 anthropometric and ultrasonographic adipose tissue measurements in gestational diabetes mellitus.

AIM: Previous studies in pregnant women reported a strong correlation between first-trimester ultrasonographic visceral adipose tissue (VAT) measurements and gestational diabetes mellitus (GDM) during the following weeks. In this study, we aimed to evaluate the clinical utility of ultrasonographic subcutaneous and visceral adipose tissue measurements between 11th and 14th weeks of gestation to predict GDM during the 24th to 28th gestational weeks. MATERIALS AND METHODS: This prospective study included a total of 142 pregnant women. Between 11th and 14th gestational weeks, we performed blinded measurements of intraperitoneal, perirenal, and subcutaneous adipose tissue thicknesses using ultrasonography. Between 24th and 28th gestational weeks, each participant underwent one-step GDM screening, and the measurement data were assessed for prognostic significance. RESULTS: Of the 142 women included, 19 (8.8%) were diagnosed with GDM. The mean intraperitoneal and maximum subcutaneous fat thickness were 51.59 ± 22.49 and 19.79 ± 12.52 mm, respectively for the GDM group and 39.88 ± 13.73 and 13.24 ± 5.70 mm, respectively for the non-GDM group. Although we observed statistically significant differences between the GDM and non-GDM groups in terms of current body mass index (BMI), subcutaneous and intraperitoneal fat thicknesses, and waist and hip circumference values, the logistic regression model showed that only current BMI had a significant association with the increasing GDM frequency. CONCLUSION: In this study investigating the clinical utility of first-trimester ultrasonographic VAT measurements during the 24th to 28th gestational weeks for the diagnosis of GDM, BMI seems to be a more useful predictor than the other anthropometric tools. However, further large-scale studies are needed to confirm these findings.

The role of oligohydramnios and fetal growth restriction in adverse pregnancy outcomes in preeclamptic patients.

OBJECTIVES: We aimed to compare perinatal outcomes of oligohydramnios or fetal growth restriction with normal amniotic fluid index and fetal growth in preeclampsia and to compare the outcomes of only oligohydramnios, only fetal growth restriction and oligohydramnios with fetal growth restriction preeclamptic groups. MATERIAL AND METHODS: A total of 743 preeclamptic patients were evaluated between June 2016 and 2020. Patients were divided into two groups: preeclampsia with oligohydramnios or fetal growth restriction (n = 237) and preeclampsia with normal amniotic fluid index and fetal growth (n = 506). Then, the first group was divided subgroups as only oligohydramnios (n = 55), only fetal growth restriction (n = 125) and oligohydramnios with fetal growth restriction (n = 57). Demographic characteristics and perinatal outcomes were recorded. RESULTS: Gestational age at delivery (p < 0.001), birth weight (p < 0.001), Apgar scores (p < 0.001) and eclampsia (p < 0.001) were lower whereas impaired doppler findings (p < 0.001), cesarean rates (p < 0.001), preterm delivery (p < 0.001), abruptio placenta (p < 0.001), acute fetal distress (p < 0.001), RDS (p < 0.001), NICU requirement (p < 0.001) and neonatal death (p < 0.001) were higher in oligohydramnios or fetal growth restriction preeclamptic group. In subgroup analysis, there were differences between three groups according to the gestational age (p < 0.001), cesarean rates (p = 0.002), preterm delivery (p < 0.001), intensive care unit requirement (p = 0.039), birth weight (p < 0.001), Apgar scores (p < 0.001), RDS (p < 0.001) and NICU requirement (p < 0.001). In pairwise comparison, there was significant difference between only oligohydramnios and only fetal growth restriction group and between only oligohydramnios and oligohydramnios with fetal growth restriction group according to birth weight, Apgar scores, preterm delivery and cesarean rates, presence of RDS, maternal and neonatal intensive care unit requirement. No significant difference was detected between only fetal growth restriction group and oligohydramnios with fetal growth restriction group in terms of all parameters. CONCLUSIONS: We suggest that patients with only oligohydramniosis have more favorable pregnancy outcomes than pregnants with only fetal growth restriction and coexistence of two conditions in preeclamptic patients. We claim that it could be appropriate to recommend close monitorization in preeclamptic patients with only fetal growth restriction and oligohydramniosis and fetal growth restriction.

Recurrent sigmoid volvulus: Cause of colon perforation, sepsis, and fetal death.

Sigmoid volvulus is one of the most common reasons for intestinal obstruction. Recurrent sigmoid volvulus occurred in only a few cases. Torsion of the sigmoid colon around the mesenteric portion initiates ischemia, gangrene, and perforation. Here, we presented a case with recurrent sigmoid volvulus. A 19-year-old Syrian refugee has been admitted to emergency room during 30th gestation week with acute abdomen, constipation, and lack of gas passage. She had a medical history of rectosigmoidoscopy and detorsion of sigmoid volvulus 6 days ago. Her vital signs showed tachycardia, hypotension, and tachypne, and her body temperature was 35.6°C. Sonography revealed nonviable fetus. Emergency laparotomy has been performed. Sigmoid volvulus and contaminated intraperitoneal area with feces was evaluated. A cesarean section, total colectomy, and end-ileostomy have been performed. Patient stayed 3 days in intensive care unit and was discharged on the 17th day. Sigmoid volvulus is a real emergency. Delayed treatment of sigmoid volvulus is related to maternal and fetal mortality.

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.

The first-trimester serum decorin levels as a potential predictor of preeclampsia.

Background Preeclampsia (PE) is a multisystem disease and is still among the leading causes of maternal and neonatal morbidity and mortality. Inadequate trophoblast invasion plays a key role in the PE pathogenesis. The proliferation, migration, and invasion of extravillous trophoblasts (EVTs) is primarily controlled by the decidua-derived transforming growth factor beta (TGF-ß) and decorin. In this study, we aimed to investigate the clinical utility of serum decorin levels measured in the 11th to 14th gestational weeks to predict preeclampsia during the following weeks of gestation. Materials and Methods A total of 600 pregnant women, whose age and gestational age ranged from 18 to 40 years and 11 to 14 weeks, were included. Venous blood samples were obtained and stored at -80 °C. Subsequently, the patients who developed preeclampsia and healthy controls with a similar body mass index were identified and their first-trimester blood samples were analyzed for serum decorin levels. Results The mean serum decorin level was 8.76 ± 6.88 ng/mL for the PE group while 9.75 ± 9.82 ng/mL for the control group. No statistically significant difference was found between the two groups (p=0.838). Conclusion We observed that the serum decorin levels during the 11th to 14th weeks of gestation showed no predictive value for preeclampsia in pregnant women. However, more accurate conclusions about the clinical utility of decorin as a biomarker of preeclampsia would require further studies with larger samples including more patients with EOS-PE.

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.

Decorin levels in early- and late-onset preeclampsia.

OBJECTIVES: Preeclampsia (PE) is a pregnancy complication caused by typically limited proliferation, apoptosis, migration, and invasion of extra-trophoblast cells. Decorin (DCN) is a decidua-derived transforming growth factor (TGF)-binding proteoglycan which exerts multiple physiological functions such as collagen fibrillogenesis, myogenesis, angiostasis, and restraining placental invasiveness by adversely regulate proliferation, migration, and invasiveness of human extravillous trophoblast cells. Preeclampsia is mainly classified as early- and late-onset PE according to the timing of the disease onset. In the present study, we aimed to investigate the DCN levels in early-onset PE (EOPE, < 34 weeks) and late-onset severe PE (LOPE, ≥ 34 weeks) and uncomplicated pregnancies. MATERIAL AND METHODS: In this case-control study, serum samples were obtained from 21 pregnant women with EOPE and 29 pregnant women with LOPE, as well as from 38 healthy controls (n = 12 early-onset controls and n = 26 late-onset controls) with uncomplicated pregnancies. RESULTS: The mean DCN level was statistically significantly higher in the early-onset PE controls than late-onset PE controls (p = 0.040). Although the mean DCN level was higher in the early-onset PE controls than EOPE and LOPE groups, it did not reach statistical significance (p = 0.119 and p = 0.117, respectively). CONCLUSIONS: Although DCN has been thought to play a role in the pathophysiology of PE, our study results show that DCN is not a useful predictive marker of EOPE and LOPE. Further large-scale studies are needed to draw a definitive conclusion.

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.

Comparative study of low-dose versus standard single-dose methotrexate: A novel approach for medical treatment of ectopic pregnancy.

AIM: Methotrexate (MTX) treatment at a dose of 50 mg/m2 of body surface area (BSA) is an effective and widely used treatment method in ectopic pregnancy. However, there is a limited number of studies investigating lower MTX doses. In this study, we aimed to investigate the efficacy of lower MTX doses in the treatment of ectopic pregnancy. METHODS: This retrospective study included a total of 112 patients who were hospitalized due to ectopic pregnancy and administered single-dose MTX. The patients were divided into three groups according to the dose given as 22-40 mg/m2 of BSA (n = 17), 41-49 mg/m2 of BSA (n = 81) and ≥ 50 mg/m2 of BSA (n = 14). Data including demographic characteristics of the patients, previous history of ectopic pregnancy, previous gynecological surgeries, the use of in vitro fertilization techniques, ultrasonographic findings, beta-human chorionic gonadotropin hormone (ß-hCG) levels, pre-treatment endometrial sampling, MTX doses applied, and the need for a surgical intervention during follow-up were retrieved from the hospital records. RESULTS: Of the patients, 16.96% (n = 19) were operated at the end of treatment, irrespective of the pre-treatment ß-hCG levels with a success rate of 83% (n = 93). Fourteen (12.5%) of the patients received the second dose of MTX. The overall success rate was 89.2% in patients with a ß-hCG level of ≤5000 mIU/mL. CONCLUSION: This study shows that lower MTX doses than 50 mg/m2 , which has been considered standard treatment and widely used in the treatment of ectopic pregnancy for nearly three decades, are effective with similar success rates.