An evaluation of serum blood parameters and amyloid A levels in pregnant women with threatened miscarriage.

OBJECTIVE: This study investigated whether serum amyloid A (AA) levels can be used as a biomarker in patients with threatened abortion. MATERIAL AND METHODS: This prospective cohort study was conducted at the Antalya Training and Research Hospital, Department of Obstetrics and Gynecology, Türkiye, between April and October 2023. Eighty-eight pregnant women, 44 diagnosed with threatened miscarriage (Group 1) and 44 healthy individuals (Group 2), were included in the study. Sociodemographic, obstetric, and laboratory parameters were compared between the groups. RESULTS: No statistically significant differences were observed between the groups in terms of sociodemographic data (age, body mass index, education level, economic status, occupation status, smoking, and alcohol consumption). However, obstetric characteristics (number of pregnancies, living children, miscarriages, dilatation and curettage, gestational age on admission, and fetal crown-rump length) and laboratory values including complete blood count, hematocrit, leukocyte, neutrophil, lymphocytes, platelet, hs-C-reactive protein, neutrophil-lymphocyte and platelet-lymphocyte ratio (p > .05), and serum AA values (7.49 ± 3.07 in Group 1 vs. 9.46 ± 4.80 in Group 2, p = .024) differed significantly. Receiver operating characteristic analysis showed that the area under the curve (AUC: 0.662) was statistically significant for serum AA (p = .032), with a cut-off value of ≥7.51 (95% [confidence interval] 0.516-0.749, sensitivity 65%, specificity 51%). The positive predictive value of serum AA for threatened miscarriage was 56.8%, and the negative predictive value 59.4%. CONCLUSION: This study shows that serum AA can be used as a biomarker in the diagnosis of threatened miscarriage. Prospective studies involving more participants are now needed to confirm our results.

Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial.

INTRODUCTION AND HYPOTHESIS: We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse. METHODS: Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery. RESULTS: The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05). CONCLUSIONS: LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.

Investigation of the effects of trophectoderm morphology on obstetric outcomes in fifth day blastocyst transfer in patients undergoing in-vitro-fertilization

Objective: Trophectoderm (TE) cells are the first differentiating cells in embryo development and have epithelial features. TE cells, which associate with implantation of the blastocyst into the uterine endometrium, contribute to the formation of the placenta. Inner cells mass (ICM) together with TE cells are used for determining embryo quality. The aim of this study was to investigate the role of TE and ICM cells on pregnancy outcome in 5th day blastocyst transferred in-vitro-fertilization (IVF) pregnancy. Material and Methods: This was a retrospective study using data from all patients who applied for blastocyst transfer IVF between January 2015 and March 2019 at the Reproductive Endocrinology and Infertility Center of Akdeniz University Faculty of Medicine, Department of Obstetrics and Gynecology. ALPHA Istanbul consensus evaluation system was used for grading of the blastocyst. The embryo quality, expansion, ICM and TE morphology of the 5th day transferred blastocyst was assessed, together with abortion rate, live birth rate, pregnancy complications, and pregnancy outcomes. Results: There was a significantly increased risk of preeclampsia (PE) (7.8% vs 1.1%; p=0.041), preterm delivery (PD) (36% vs 17.7%; p=0.037), and antenatal bleeding rates (13.6% vs 5%; p=0.021) in TE-C compared to the TE-A + TE-B blastocysts. Furthermore, a higher rate of obstetric complications was observed in ICM-C compared to ICM-A and B (p=0.003). There was a significant correlation between TE morphology and implantation success, ongoing pregnancy rate, and abortion incidence. Conclusion: These results suggest that TE cell morphology is related to implantation success and pregnancy outcomes, especially in terms of the risk of abortion, PE, PD, and antenatal bleeding. It may be advisable to counsel women concerning possible poor obstetric outcome due to poor ICM quality. Future prospective and controlled studies are needed to clarify this association.

Reference ranges for flow velocities and the indices of the ductus venosus in low-risk pregnancies

Objective: Ductus venosus blood flow velocity measurements are mandatory in many clinical indications. The evaluation of the flow is performed either by comparing results with general reference tables or by qualitative assessment of the "a" flow, in regard to reversed or absent flow in the spectral waveforms. The aim was to develop normal reference ranges in low-risk pregnancies in our population. Material and Methods: Measurements of flow velocities (S, v, D, a) and indices (pulsatility index for veins, peak velocity index for veins, a/S, S/a) were performed by a single experienced specialist in 1279 singleton, uncomplicated pregnancies between 11 and 40 weeks gestation. The absolute flow velocities (S, v, D, a, VmPeak) and indices were obtained from spectral waveforms using the equipment producer's inbuilt system. The still images were stored in the picture archiving and communication system. Results: The predicted reference ranges of the ductus venosus blood flow velocities according to the gestational age are shown in tables and graphics. Predicted reference curves based on the 5th and 95th percentiles according to gestational week were plotted and are given in tables and figures. Conclusion: Normal reference ranges for absolute flow velocities and indices were calculated from a population of uncomplicated pregnancies attending a tertiary care center. The measurements were made from both the classic patterns of the waveforms and also considered variants of the spectral waveforms, which have recently been reported, for the first time in the medical literature.

Does fresh or frozen embryo transfer affect imprinted gene expressions in human term placenta?

Our research aimed to compare the epigenetic alterations between placentae of in vitro fertilization (IVF) patients and spontaneous pregnancies. Additionally, the expression levels of proliferation markers (PCNA, Ki67) and glucose transporter proteins (GLUT1, GLUT3) were assessed in control and IVF placentae to examine the possible consequences of epigenetic alterations on placental development. Control group placentae were obtained from spontaneous pregnancies of healthy women (n = 16). IVF placentae were obtained from fresh (n = 16) and frozen (n = 16) embryo transfer pregnancies. A group of maternal and paternal imprint genes H19, IGF2, IGF2, IGF2R, PHLDA2, PLAGL1, MASH2, GRB10, PEG1, PEG3, and PEG10 were detected by Real-Time PCR. Additionally, PCNA, Ki67, GLUT1, and GLUT3 protein levels were assessed by immunohistochemistry and western blot. In the fresh embryo transfer placenta group (fETP), gene expression of paternal PEG1 and PEG10 was upregulated compared with the control group. Increased gene expression in paternal PEG1 and maternal IGFR2 genes was detected in the frozen embryo transfer placenta group (FET) compared with the control group. Conversely, expression levels of H19 and IGF2 genes were downregulated in the FET group. On the other hand, GLUT3 and PCNA expression was increased in FET group placentae. IVF techniques affect placental imprinted gene expressions which are important for proper placental development. Imprinted genes are differently expressed in fresh ET placentae and frozen ET placentae. In conclusion, these data indicate that altered imprinted gene expression may affect glucose transport and cell proliferation, therefore play an important role in placental development.

The types of connections between the portal sinus and main portal vein in foetuses / Tipos de conexiones entre el seno portal y la vena porta principal en fetos

In the prenatal period, the three types of connections between the portal sinus and main portal vein have been published in the literature: T, X and H-shaped. The T type is the most frequent in the literature, and the aim of our study is to define the percentage of the connection types during the prenatal period in our population. In this prospective study, 237 women between 20 and 38 weeks of pregnancy without a foetal anomaly or pregnancy-related complications were included, and the precordial veins of the foetuses were examined using a wide-band color Doppler technique. The types of connections were determined by two specialists according to the shape of the colour coded vessels in Doppler examinations. The criteria of Czubalski & Aleksandrowicz (2000) were used. All of the connection types in patients were confirmed using video clips and were stored in the picture archiving and communication system. In 237 patients, the types of connection were determined by the first specialist as 189 foetuses (79.7 %) with the X-shaped or side-to-side connection, 16 foetuses (6.8 %) with the T-shaped or end-to-side type and 32 foetuses (13.5 %) with the H-shaped or parallel-coursed vessels connected with a short segment. The most common types of connections between the portal sinus and main portal vein in foetuses are X shaped or side-to-side, which is contrary to previous studies.

En el período prenatal, se han publicado en la literatura los tres tipos de conexiones entre el seno portal y la vena porta principal: en forma de T, X y H. El tipo T es el más frecuente, y el objetivo de nuestro estudio fue definir el porcentaje de tipos de conexión durante el período prenatal en nuestra población. En este estudio prospectivo, se incluyeron 237 mujeres entre 20 y 38 semanas de embarazo, sin anomalías fetales o complicaciones relacionadas con el embarazo, y se examinaron las venas precordiales de los fetos utilizando una técnica Doppler de banda ancha. Los tipos de conexiones fueron determinados por dos especialistas según la forma de los vasos codificados por color en los exámenes Doppler. Se utilizaron los criterios del estudio de Czubalski & Aleksandrowicz. Todos los tipos de conexión en los pacientes se confirmaron mediante videoclips y se almacenaron en el sistema de comunicación y en archivo de imágenes. En 237 pacientes, el primer especialista determinó en 189 fetos (79,7 %) la conexión en forma de X o de lado a lado; en 16 fetos (6,8 %) la forma de T o Tipo de extremo a lado; y en 32 fetos (13,5 %) los vasos en forma de H o paralelos, conectados con un segmento corto. Los tipos más comunes de conexiones entre el seno portal y la vena porta principal en los fetos son en forma de X o de lado a lado, lo que es contrario a estudios anteriores.

The proliferation mechanism of normal and pathological human placentas.

The placenta, which is a regulator organ for many metabolic activities between mother and fetus, is critical in influencing the outcome of pregnancy. Therefore, fetal growth is directly related to the placental development. Placental development depends on the coordinated action of trophoblast proliferation, differentiation and invasion. Studies on cell cycle related proteins that control these events are limited. Abnormal placental development is linked to various pregnancy pathologies such as preeclampsia, intrauterine growth restriction, diabetes mellitus and gestational trophoblastic diseases. The cell cycle mechanism of human placenta should be well understood for a healthy pregnancy outcome. Moreover, how cell cycle related proteins that control placental development are affected in pregnancy pathologies is not fully understood yet. Therefore, the aim of this review is to address the currently available knowledge on cell cycle regulatory proteins involved in human placental development and on the expression differences of these proteins in pathological placentas.

Irisin as an early marker for predicting gestational diabetes mellitus: a prospective study.

OBJECTIVE: The objective of this study is to evaluate maternal serum irisin levels in the first and second trimesters of pregnancy in women diagnosed with and without gestational diabetes mellitus (GDM). METHODS: We performed a prospective, nested case-control study in 258 pregnant women who were enrolled at the time of the first prenatal visit (6-11th weeks of gestation) and followed until delivery. Among the entire population, we selected 20 women who subsequently developed GDM and 30 women with uneventful pregnancies. Blood samples were collected once from each participant at 6-11th weeks of gestation during the fetal viability scan and at 24-28th weeks of gestation during screening for GDM. RESULTS: In the first trimester, irisin levels were significantly lower in women who later developed GDM (median = 453 ng/mL, range: 257-811 ng/mL) than in controls (median = 721 ng/mL, range: 700-786 ng/mL). In the second trimester, the difference in irisin levels between the GDM group (median = 749 ng/mL; range: 456-910 ng/mL) and controls (median = 757 ng/mL; range: 703-898 ng/mL) was not statistically significant. CONCLUSIONS: Irisin may be a useful biomarker in early pregnancy to predict the development of GDM.

Maternal and umbilical cord copeptin levels in pregnancies complicated by fetal growth restriction.

OBJECTIVE: The aim of this study was to compare maternal and fetal serum copeptin concentrations in pregnancies complicated by isolated fetal growth restriction (FGR), and uncomplicated pregnancies, and to investigate relationships between copeptin levels and clinical parameters. METHODS: Maternal and fetal serum copeptin levels were measured in 21 women with pregnancies complicated by isolated FGR and 20 women with normal pregnancies (control group). Doppler assessment of the uterine and umbilical arteries was performed in each patient. RESULTS: Maternal serum copeptin levels were significantly higher in women with isolated FGR compared to controls (p = 0.042). In addition, maternal copeptin levels were inversely correlated with the uterine artery pulsatility and resistance indices and positively correlated with neonatal birth weight. Umbilical vein copeptin levels were significantly increased in neonates with adverse outcomes (p = 0.001). CONCLUSIONS: Increased maternal copeptin concentration may reflect a response to stress, thus serving as a compensatory mechanism in pregnancies complicated by FGR.

Effect of reproductive characteristics, body mass index, and anterior/posterior vaginal compartment defects on the short-term success of abdominal sacrocolpopexy.

OBJECTIVE: Vaginal vault prolapse is caused by the loss of apical support in the cardinal-uterosacral ligament complex. Abdominal sacrocolpopexy (ASCP) is one means of repairing vaginal vault prolapse. In the present study, we investigated the effects of reproductive factors, body mass index (BMI), and anterior or posterior vaginal compartment defects on short-term outcomes of ASCP. METHOD: We retrospectively studied 70 women who had undergone ASCP between February 2012 and November 2012 in our clinic. RESULT: There were no significant differences in the complication rate among menopausal, nonmenopausal women, and grand multiparous patients. Operational success was not significantly affected by menopausal status. The long-term rate of grade ≥ 2 prolapse in the apical, anterior, or posterior vaginal wall after ASCP did not differ significantly by menopausal status. Correlation analysis showed that BMI was not associated with operational success in the early postoperative period in patients with vaginal prolapse and was not associated with the detection of grade ≥ 2 prolapse in apical, anterior, and posterior compartments after 1 year. CONCLUSION: ASCP should be the first-line treatment for obese/overweight, menopausal, or grand multiparous patients with additional anterior or posterior vaginal vault prolapse.

Irisin in idiopathic foetal growth restriction.

PURPOSE: The aim of the present study was to compare maternal serum and cord blood irisin levels in females whose pregnancies were or were not complicated by idiopathic foetal growth restriction. METHODS: A total of 30 subjects participated. The study group consisted of 15 female patients who were referred to our perinatology clinic for delivery because of foetal growth restriction developing in the third trimester. Fifteen females with uncomplicated singleton pregnancies constituted the control group. Irisin levels were assessed in maternal serum, as well as in serum from the umbilical vein and artery. RESULTS: The demographic features of the two groups were similar (p > 0.05). Gestational age at delivery and birth weight were higher in females with uncomplicated pregnancies (p = 0.001). Umbilical artery irisin levels were significantly lower in pregnancies complicated by foetal growth restriction compared to controls (p = 0.003). Umbilical artery irisin levels were positively correlated with foetal weight (p = 0.01) and foetal abdominal circumference (measured by ultrasonography) (p = 0.01). Maternal and umbilical vein irisin levels did not differ between the two groups (p > 0.05). CONCLUSIONS: The data suggest that umbilical artery irisin levels were lower in pregnancies complicated by foetal growth restriction. Such lower irisin levels may contribute to the pathogenesis of this common condition, and metabolic syndrome may be a long-term consequence of idiopathic FGR.

Prenatal diagnosis of fetal ovarian cyst: case report and review of the literature.

Foetal ovarian cysts are the most frequently encountered intra-abdominal cystic masses diagnosed prenatally. The aetiology of foetal ovarian cysts is still unknown, but hormonal stimulation is generally considered to be responsible for the disease. The diagnosis is made by the exclusion of other cystic lesions confined to the foetal abdomen. In this article we report antenatally-detected foetal ovarian cyst with a review of the available literature. Antenatal ultrasonography (USG) revealed an abdominal cystic mass 41×33 mm in diameter in a 33-week gestation female foetus. The normal anatomy of other foetal abdominal organs suggested that an ovarian cyst was the most likely diagnosis. In the antenatal follow-up period, the cyst diameter increased with time. After delivery, USG scan confirmed the antenatal findings. Due to abdominal distension and respiratory distress, ovarian cystectomy was performed on the second postnatal day. The histopathological evaluation of the surgical material reported a serous cystadenoma of the ovary with non-malignant properties.