Vascular endothelial growth factor I/D variant and postmenopausal osteoporosis risk in the Turkish population.

INTRODUCTION: Postmenopausal osteoporosis (PMOP) is a common metabolic bone disorder manifested by low bone mineral density and increased fracture risks in postmenopausal women. Vascular endothelial growth factor (VEGF) has been shown to play an important role in bone formation. In this study, we investigated the potential association between the VEGF insertion/deletion (I/D) variant (rs35569394) and PMOP in a cohort of postmenopausal Turkish women. METHODS: This study included 300 women, including 150 PMOP patients and 150 healthy postmenopausal women. A T score was used in the diagnosis of OP. DNA was extracted from all subjects. The VEGF I/D polymorphism was analyzed by the PCR method. The Hardy-Weinberg equilibrium (HWE) test and odds ratio (OR) were analyzed, considering CI 95% and p ≤ 0.05. RESULTS: The mean age of patients aged between 40 and 74 was 60.32 ± 8.65. The frequency of the I/I, I/D, and D/D genotypes was 7.34% versus 6.66%; 67.33% versus 65.34%; and 25.33% versus 28%, in patients and the control group, respectively. The allele frequencies were I: 41% (patients) and 39.4% (controls); D: 59% (patients) and 60.66% (controls). There was no statistically significant difference in the VEGF - 2549 I/D allele and genotype distribution between patients with PMOP and control subjects (p = 0.349, p = 0.864, respectively). CONCLUSION: Our results showed that the VEGF I/D variant was not a significant factor in the development of PMOP in a Turkish population sample. These findings need confirmation in other ethnic populations.

MEFV gene pathogenic variants: a risk factor for dysmenorrhea in the Turkish population.

BACKGROUND/AIM: The Mediterranean fever (MEFV) gene codes for protein pyrin, which is among the modulators of inflammasome activity in innate immune cells. It was suggested that there is a relation between MEFV variations and inflammatory diseases. The aim of this study was to investigate MEFV gene variations in the patients with primary dysmenorrhea. METHODS: The prevalence of common MEFV gene variations (M694V, M680I, V726A, E148Q and R202Q) was investigated in 145 young women with primary dysmenorrhea and 135 unrelated healthy controls. MEFV gene variations were genotyped using PCR-based RFLP assay. RESULTS: Number of childbirth and marriage were significantly lower in the study group than the controls, respectvely (p < 0.001, p = 0.001). Family history was statistically higher in the patient group (p < 0.001). In total, MEFV genotype and allele frequencies were significantly higher in patients than controls, respectively (p = 0.008 and p = 0.005, respectively). It was found that MEFV gene E148Q allele was more common in patient group (p = 0.039). MEFV R202Q A allele was higher in the patients than the controls (p = 0.045). A significant association was observed when the patients were compared with the controls according to R202Q variant AA versus GG+GA genotypes (p=0.020). CONCLUSION: Our findings suggest that MEFV variations may be a risk factor for patients with dysmenorrhea in a Turkish cohort.HighlightsThere are very few studies in the literature regarding the relationship between pathological variants of MEFV and dysmenorrhea disease.The common MEFV mutations/variants were evaluated in primary dysmenorrhea patients.Family history was statistically higher in the patient group (p <.001).MEFV gene variations were found 52 (35.9%) in patients and 29 (21.5%2) in controls.MEFV gene allele frequency was significantly higher in-patient group than control (p =.005).

VEGF I/D variant and preeclampsia risk in Turkish women: a case-control study.

Preeclampsia (PE) is a systemic vascular disorder, is caused by an imbalance of pro- and anti-angiogenic factors that directly affect endothelial function. Vascular endothelial growth factor A (called VGF), a pro-angiogenic factor associated with endothelial dysfunction, plays an important role in the pathophysiology of PE. Therefore, we investigated the relationship between -2549 insertion/deletion (I/D) variant in the VEGF promoter region and PE in pregnant women in Turkey. A total of 100 patients diagnosed with PE and 118 healthy pregnants were recruited. To genotype the VEGF I/D variant, the PCR method was used. The results of analyses were evaluated for statistical significance. The weight of the PE group was found to be higher before and after pregnancy than the control group (p = 0.009, p = 0.012, respectively). The birth weight, and Apgar score (1 min and 5 min) of the PE group was lower than that of the control group (p= <0.001, p= <0.001, p= <0.001, respectively). The mean 24-h urine protein, ALT and AST levels in the PE group were higher than the control group (p= <0.001, p= <0.001, p= <0.001, respectively). There was no significant difference between the patients and the controls in terms of VEGF I/D genotype and allele distribution. There was no deviation from HWA for VEGF I/D variant in patient and control groups. In the patients carrying D/D genotype and the D allele had low gestational week and birth weight. Knowing the risk factors for PE is very important for its prevention and treatment. In conclusion, for the first time, our results supported that the VEGF I/D variant is not a risk factor for the development of PE in a group of Turkish populations. But VEGF I/D variant D/D genotype associated with low gestational week and birth weight while I/D genotype seems to be protective from high systolic blood pressure.

Lack of association of superoxide dismutase I/D variant with osteopenia/osteoporosis in Turkish postmenopausal women.

BACKGROUND: Osteoporosis (OP) is a common systemic, metabolic bone disease that affects 40% of postmenopausal women. Oxidative stress (OS) ìs caused by reactive oxygen species (ROS), inhibits osteoblast differentiation and causes apoptosis in osteoblastic cells. Superoxide dismutase (SOD) reduces OS by playing a role in the reduction and defense of intracellular ROS. Therefore, the purpose of this study was to investigate the relationship between osteopenia/OP and the SOD1 50-bp insertion/deletion (I/D) variant in Turkish postmenopausal women. METHODS: A total of 180 women participated in this study includá¸-ng 89 osteopenia/OP postmenopausal women and 91 healthy postmenopausal women. T-score > -1 standard deviation (SD) defined normal bone mass, T-score between -1 and -2.5 SD defined osteopenia, T-score ≥ -2.5 SD was defined as OP. DNA was extracted from all subjects and the SOD1 I/D variant genotyped by PCR. The results of the analyses were evaluated for statistical significance. RESULTS: The mean age of 89 osteopenia/OP patients aged 45 to 74 was 58.57 ± 6.57. There was no D/D homozygous genotype in the patient and control groups. The prevalence of genotypes of I/I, and I/D, profiles for the SOD1 I/D variant were 76.4%, and 23.6% respectively, in patients, and 72.5%, and 27.5% respectively, in the control group. When the patient group and control group were compared, the SOD1 I/D genotype distribution and allele frequencies did not show a significant difference between the groups (p > 0.05). CONCLUSION: Our results showed that the SOD1 I/D variant may not be considered a determining factor in the development of osteopenia/OP in a Turkish population sample. However, ethnic differences, gene-gene, and gene-environment interactions should not be ignored.

A circadian rhythm gene (PER3) VNTR variant as possible risk factor in cohort of Turkish females with primary dysmenorrhea.

Primary dysmenorrhea (PDM), which is the most prevalent problem related to the menstrual cycle in women of reproductive age, is due to sleep disorders and negative moods. Circadian rhythms, which are the immediate 24-h processes, enable an organism to adapt the suitable physiological responses to the environmental light-dark changes. Disturbed circadian rhythms are closely associated with several diseases, including sleep disorders. It has been reported that variable number tandem repeat (VNTR) variant in the coding region of circadian rhythm gene PERIOD 3 (PER3) affects sleep. Therefore, in the present study, we investigated the association between PDM and PER3 VNTR variant in Turkish females. A sample of 122 females with PDM and 150 healthy females were included in the study. Genoytyping of PER3 VNTR variant was performed on DNA by polymerase chain reaction (PCR) analysis using specific primers. We evaluated the relation between PER3 VNTR variant and PDM by calculating the odds ratios (ORs) and 95% confidence intervals (CIs). In our analyses of genotype data collected from total 272 subjects, we found that the PER3 VNTR variant was associated with development of PDM [codominant model (5/5 vs. 4/4 + 4/5): OR = 0.664; 95% CI, 0.39-1.10; p = 0.05). The three genotypes of the VNTR variant (4/4, 4/5, and 5/5) and their allelic frequencies showed nonsignificant differences between patients and control group (p > 0.05). In summary, PER3 VNTR variant may be associated with PDM in a Turkish female. However, further studies in different ethnic populations are needed to address the full role of this variant in PDM.

The effect of surgical procedure on surgical outcomes in patients undergoing emergency peripartum hysterectomy: a retrospective multicenter study.

OBJECTIVE: To investigate the effect of surgical procedure on the operation's results in patients undergoing emergency peripartum hysterectomy (EPH). METHODS: The records of patients who underwent EPH due to postpartum hemorrhage between 2010 and 2020 in two tertiary centers with a high crude delivery rate were retrospectively analyzed. Surgical data were compared according to the EPH type. RESULTS: During the study period, 115,709 births occurred in these two centers. EPH was administered for 181 (1.6%) of these patients. Sixty-seven (37%) of the EPH cases involved subtotal EPH (SEPH), and 114 (63%) were total EPH (TEPH). Surgical time (107.3 ± 17.6 vs. 134.2 ± 32.3 min, p < 0.001), erythrocyte transfusion count (2.6 ± 1.3 vs. 4.3 ± 6.2, p < 0.001), ureter injury (0.0 vs. 7.9%), bladder injury (1.5 vs. 28.1%), disseminated intravascular coagulation (1.5 vs. 9.6%), need for relaparotomy (4.5 vs. 14%), and intensive care unit admission (19.4 vs. 52.6%) were found to be higher in the TEPH group compared to the SEPH group (p < 0.05). In addition, the total length of hospitalization was longer in the TEPH group (4.5 ± 2.3 vs. 6.1 ± 4.6 day, p = 0.011). CONCLUSION: According to the results, if the bleeding in peripartum hemorrhage requiring EPH can be controlled with SEPH, attempting to remove the cervix completely may be associated with increased surgical time, blood transfusion need, and surgical complications.

The effect of carbamazepine, which increases oestrogen destruction, on the endometriotic implants; an experimental rat model.

We planned this experimental study to investigate the effect of carbamazepine (CMZ) on the endometriotic implants. Rats were randomised into four groups after endometriosis surgery. Drinking water was given to the sham group, 0.2 mg/kg oestradiol valerate (EV) to the EV group, 100 mg/kg/day CMZ to the CMZ group, and 0.2 mg/kg EV and 100 mg/kg/day CMZ to the EV-CMZ group. The endometrium of the rats using CMZ stained more intensely with cytochrome P450-3A4 (CYP3A4) enzyme. No endometrial hyperplasia was found in these rats. Endometriotic implants weight was found to be higher in these rats. There was no difference between the groups in terms of staining of the endometriotic implants with CYP3A4 enzyme. Endometriotic implants were less stained with the CYP3A4 enzyme than the endometrium. According to our results, CMZ does not increase the destruction of oestrogen in the endometriotic implants, unlike the endometrium. It may even cause the lesion to enlarge.Impact statementWhat is already known on this subject? Endometriosis is an oestrogen-dependent, progressive disease. Carbamazepine (CMZ) is known to increase oestrogen degradation by activating the cytochrome P450-3A4 (CYP3A4) enzyme. CMZ can be used in the treatment of endometriosis because it increases oestrogen breakdown in tissues.What do the results of this study add? CMZ can protect the endometrium against hyperplasia by increasing the amount of CYP3A4 enzyme in the endometrium. This effect could not be demonstrated in the endometriotic implants. The presence of CYP3A4 enzyme less in the endometriotic implants than in the endometrium may explain this situation. In addition, the fact that CMZ does not increase the enzyme in the endometriotic implants may contribute to this situation.What are the implications of these findings for clinical practice and/or further research? CMZ may not be a suitable alternative in the treatment of endometriosis. However, it may protect against endometrial hyperplasia. Clinical studies are needed for this effect.

Carbamazepine protects the endometrium against negative effects of estrogen in rats.

Carbamazepine (CMZ) increases estrogen metabolism by inducing cytochrome P450 (CYP3A4). We investigated whether CMZ is protective against endometrial hyperplasia (EH). We used 32 female Wistar albino rats divided into four equal groups: the control group received drinking water, the estradiol valerate (EV) group was given EV, the CMZ group was given CMZ, and the EV + CMZ group was given both EV and CMZ. After 30 days the uteri of the rats were removed and serum estrogen and progesterone levels were measured, and endometrial tissue characteristics were evaluated. CYP3A4 expression was assessed using immunohistochemistry. Serum estrogen levels were lowest in the EV group and highest in the CMZ group. Serum progesterone levels were similar among all groups. Glandular density, a proxy measure of EH, was highest in the EV group and lowest in the EV + CMZ group. EH was detected in six of eight rats (75%) in the EV group and two of eight rats (25%) in the EV + CMZ group. Immunohistochemical staining revealed no significant difference in CYP3A4 expression among the four groups. CMZ reduced the negative effect of high dose estrogen that is not balanced by progesterone on the endometrium in rats. The effect likely is probably due to the CYP3A4 enzyme activator effect. CMZ may be protective against EH in high risk women, although confirmation is required.

Can complete blood count parameters that change according to trimester in pregnancy be used to predict severe preeclampsia?

We aimed to evaluate the effectiveness of changes over time in complete blood count (CBC) parameters to estimate the diagnosis of preeclampsia. Data on 161 severe preeclampsia patients and 161 healthy pregnant patients who met the study criteria of pregnant women whose CBC had been measured at 10-12, 22-24 and 28-30 weeks of pregnancy were compared. In the preeclampsia group, an increase in the mean platelet volume (MPV) value and a decrease in the number of platelets were statistically significant in the transition from the second to the third trimester. MPV and lymphocyte counts were more significant in the third trimester and neutrophil lymphocyte ratio (NLR) were more significant in the second trimester. We found that evaluation of the changes in lymphocyte, MPV and NLR values in three different trimesters of pregnancy rather than a single trimester was more meaningful to predict severe preeclampsia.Impact StatementWhat is already known on this subject? Studies have shown that MPV and NLR can predict preeclampsia. However, a clear cut off value could not be determined. The reasons for this may be that the gestational week during which the measurement is made is not standard and the patient groups are not homogeneous.What the results of this study add? In this study, CBC parameters at different stages of the preeclampsia process were compared in the severe preeclampsia group. According to our results, lymphocytes, NLR and MPV can be used to predict severe preeclampsia. In addition, NLR measurements in the second trimester and MPV and lymphocyte measurements in the third trimester were found to be more significant in predicting severe preeclampsia.What the implications are of these findings for clinical practice and/or further research? In order to predict severe preeclampsia, instead of a single measurement of CBC parameters, new calculations should be made that add change over time.

The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder.

OBJECTIVE: This study aimed to evaluate the parameters affecting the treatment success of conservative surgery in cases with placental invasion anomaly. METHODS: Archive files and digital image records of 67 patients with placental invasion anomaly were studied. The patients were divided into two groups, a conservative surgery group and a cesarean hysterectomy group. Demographic data, cervical length, placental localization, placental surface area adhering to previous cesarean section line, preoperative and postoperative hematocrit values, transfused blood products, and surgical complications were compared between the two groups. RESULTS: In the conservative surgery group, the cervical length was longer (p < .001) and the surface area of the placenta in the previous cesarean scar line was smaller (p < .001). For cervical length, the sensitivity and specificity values were 97 and 81%, respectively, when the cut-off value was 35.5 mm. When the cut-off value for the placental surface area in the previous cesarean scar line was 85.5 cm2, the sensitivity and specificity values were 68 and 72%, respectively. In the caesarean hysterectomy group, the preoperative and postoperative hematocrit values were lower (p < .001, p = .003, respectively), and the amount of transfused erythrocyte suspension and fresh frozen plasma were higher (p < .001, p = .001, respectively). CONCLUSION: In this study, it was concluded that the presence of the nondestructive intact cervical tissue, in the cases with placental invasion anomaly and/or the small size of the placental surface area adhering to the previous cesarean scar line, increase the feasibility of conservative surgery.

The effect of vaginal bleeding and non-spesific pelvic pain on pregnancy outcomes in subchorionic hematomas cases.

OBJECTIVES: To determine the clinical differences and factors affecting early pregnancy outcome in the first and early secondtrimester subchorionic hematoma cases. MATERIAL AND METHODS: This study involved with the retrospective analysis and evaluation of 81 cases diagnosed withsubchorionic hematoma. The patients were grouped according to the gestational periods, symptoms at the time of admission,ratio of surrounding hematoma to the gestational sac, and whether there was a pregnancy loss. The groups werecompared according to the clinical features and pregnancy outcomes. RESULTS: The ratio of surrounding hematoma to the gestational sac in the group with pregnancy loss was significantly higher(p = 0.002). When the cut-off value was 35.5%, it could determine the possibility of a complication in pregnancy with 70%sensitivity and 75% specificity. Nonspecific pelvic pain were significantly higher in the pregnancy loss group than in theother group. Logistic regression analysis was performed to determine the effect of these two parameters on the pregnancyoutcome. Although the presence of non-specific pelvic pain is more in the group with pregnancy loss; there was no effectof on pregnancy outcome (p = 0.141). The risk of pregnancy loss increased 4.5 fold if the ratio of ScH to gestational sacwas above 35% (p = 0.027). CONCLUSIONS: In the cases of subchorionic hematoma, we concluded that when the ratio of surrounding hematoma tothe gestational sac increased and when it was accompanied by nonspecific pelvic pain, the hospitalization period of thepatients increased and the ratio of pregnancy loss was higher.

The Evaluation of IL6 and ESR1 Gene Polymorphisms in Primary Dysmenorrhea.

Primary dysmenorrhea is the most common gynecological complaint with painful menstrual cramps in pelvis without any pathology. It affects about half of menstruating women, and it causes significant disruption in quality of life. We investigated the association between IL6 gene promoter and ESR1 gene XbaI and PvuII polymorphisms and primary dysmenorrhea. In this case-control study, 152 unrelated young women with primary dysmenorrhea and 150 unrelated healthy age-matched controls participated. Genomic DNA was isolated and IL6 and ESR1 gene polymorphisms were genotyped using PCR-based RFLP assay. The distribution of genotype and allele frequencies of IL6 gene promoter and ESR1 gene XbaI polymorphisms were not statistically different between patients and controls (p > 0.05). However, the genotype and allele frequencies of ESR1 gene PvuII polymorphism showed statistically significant differences between primary dysmenorrhea patients and controls (p = 0.009 and p = 0.021, respectively). Statistically significant associations were also observed between age and married status of primary dysmenorrhea patients and ESR1 gene PvuII polymorphism (p = 0.044 and p = 0.023, respectively). In combined genotype analyses, AG at ESR1 XbaI and TC at ESR1 PvuII loci encoded a p-value of 0.027. Thus, individuals who are heterozygote at both loci have a lower risk of developing primary dysmenorrhea. Our study suggests no strong association between IL6 gene promoter and ESR1 gene XbaI polymorphisms and primary dysmenorrhea in Turkish women. However, ESR1 gene PvuII polymorphism showed statistically significant differences between primary dysmenorrhea patients and controls. The potential association between ESR1 gene PvuII polymorphism and age and married status of dysmenorrhea patients deserves further consideration.

Do Leukaemia Inhibitory Factor and Vascular Endothelial Growth Factor Have Any Roles in Intrauterine Device Mechanism of Action? An Experimental Rat Study.

OBJECTIVE: To assess leukaemia inhibitory factor (LIF) and vascular endothelial growth factor (VEGF) expression as markers of intrauterine device (IUD) efficacy in a rat model. METHODS: Twenty nulliparous female Wistar rats were divided into two groups with 10 animals per group: group I (IUD) and group II (control group, no IUD). In group I, a 2-cm 3-0 silk suture was placed into one horn of the rat bicornuate uterus. On day 20 (after IUD insertion) rats were sacrificed and their uteri removed. The number of vessels and the distribution of LIF and VEGF were compared among the uterine horns. RESULTS: There were no significant differences in LIF and VEGF expression in the groups and all horns (p > 0.05). The number of vessels was higher in the IUD+ horn than in the IUD- horn of group I and in the horn of group II (p < 0.05). There was no significant difference in the number of vessels between the IUD- horns of groups I and II (p > 0.05). CONCLUSION: LIF and VEGF expression did not correlate with IUD efficacy in a rat model. An IUD may increase the number of vessels in the uterine horn independent of VEGF expression. © 2015 S. Karger AG, Basel.

Regression of experimental endometriotic implants in a rat model with the angiotensin II receptor blocker losartan.

AIM: Endometriosis is a common disease in women of reproductive age, and many different treatments have been developed, although none has provided a cure. In this study, the efficacy of losartan, an angiotensin II type 1 receptor blocker and an antiangiogenic and anti-inflammatory agent, on regression of experimental endometriotic implants in a rat model was investigated. METHODS: Peritoneal endometriosis was surgically induced in 16 mature female Sprague-Dawley rats. The peritoneal endometriotic implant was confirmed after 28 days, and the animals were divided randomly into two groups. The control group (n = 8) was given 4 mL/day tap water by oral gavage, and the losartan group (n = 8) was given 20 mg/kg per day losartan p.o. We compared endometriotic implant size, extent and severity of adhesion, as well as plasma and peritoneal lavage fluid cytokine levels including vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α, plasma inflammatory factor pentraxin-3 (PTX-3) and C-reactive protein (CRP) between the treatment groups. RESULTS: Mean surface endometriotic area, histological score of implants, adhesion formation, plasma VEGF, TNF, PTX-3 and CRP levels were significantly lower in the losartan group compared with control (P < 0.05). Furthermore, the peritoneal VEGF level was lower in the losartan group than in the control group (P < 0.001), but peritoneal TNF-α was similar in both groups (P > 0.05). CONCLUSION: Losartan suppressed the implant surface area of experimental endometriosis in rats and reduced the levels of plasma VEGF, TNF-α, PTX-3 and CRP.

Postural balance in pregnancies complicated by hyperemesis gravidarum.

OBJECTIVE: To assess postural balance in females with pregnancies complicated by hyperemesis gravidarum (HG). METHODS: In this observational study, postural balance during the first trimester was measured using the Biodex Balance System (BBS) in 41 pregnant females (20 females with pregnancies complicated by HG and 21 healthy controls). The overall stability index (OA), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and fall risk test (FRT) scores were obtained from the mean scores of three trials on the BSS. The four measurements obtained from the BBS (OA, APSI, MLSI and FRT) were compared between healthy pregnant females and those with pregnancies complicated by HG (HG group). RESULTS: The mean OA and APSI scores were significantly higher in the HG group compared to healthy pregnant controls (p < 0.01). There was no significant difference in the MLSI between the two groups (p > 0.05). The FRT scores of HG patients were higher than healthy pregnant females (p = 0.001). CONCLUSIONS: Pregnant females with HG have poor postural stability/balance and high fall risk test scores. HG causes decreased postural equilibrium in the first trimester of pregnancy.

Incidence of gestational trophoblastic disease in Tokat province, Turkey.

OBJECTIVE: This study investigated the incidence of gestational trophoblastic disease (GTD) in Tokat province, Turkey. MATERIAL AND METHODS: The medical records of patients who had been diagnosed and treated at one university hospital, six government hospitals, and one specialist hospital in Tokat province between January 2005 and December 2012 were evaluated retrospectively. RESULTS: During the study period, there were 59,754 births and GTD was diagnosed in 73 cases. The calculated GTD incidence was 1.22/1000. The mean age of the patients diagnosed with GTD was 28.6±7.3 (range 17-51) years. In GTD, complete moles occurred in 26%, partial moles in 74%, and no invasive moles, choriocarcinomas, or placental site trophoblastic tumours were found. Only two patients received chemotherapy (methotrexate). There was no mortality associated with the disease during follow-up. CONCLUSION: The incidence of GTD in Tokat province was 1.2 per 1000 births. Early diagnosis, treatment, and follow-up play a critical role in preventing the morbidity and mortality associated with disease. The incidence of GTD, which has a high recovery rate with adequate treatment and follow-up, can be determined from regional and community-based research.

Underage mothers in Turkey.

BACKGROUND: All individuals under the age of 18 are considered as children by the Convention on the Rights of Children. Underage mothers are a pediatric-age group of children that become pregnant and give birth. It may be unfamiliar in Western countries, but in Middle-Eastern countries ruled by religious laws and old-fashioned traditions, it is common for an older man to marry a girl. The aim of this study was to describe the status of underage mothers within the framework of children's rights and to draw attention to this issue. We presented this study to increase awareness and sensitivity, and to scrutinize and discuss these topics. MATERIAL AND METHODS: We retrospectively investigated cases of underaged pregnant girls who applied to Forensic Science Department outpatient clinics and Obstetrics and Gynecology Department outpatient clinics of Gaziosmanpasa University Faculty of Medicine between 2003 and 2013. Results We accessed records of 163 underage mothers (≤ 18 age). Mean age was 16.9 ± 0.83 (14-18 years). Gravida and parity rates increased proportionately with increasing age. Most of our cases were 16 and 17 years of age (n: 117, 71.8%). CONCLUSIONS: Underage motherhood is not only a medical issue; it is a multi-dimensional problem with social, economic, traditional, religious, and legal aspects.

The effect of maternity support belts on postural balance in pregnancy.

OBJECTIVE: The purpose of this study was to evaluate the effect of maternity support belts (MSB) on postural balance during pregnancy. DESIGN: Prospective, observational cohort study. SETTING: Outpatient visits at a university hospital, obstetrics and gynecology clinic. PARTICIPANTS: A total of 90 pregnant women in first, second, and third trimesters of pregnancy; 30 pregnant women for each trimester. METHODS: Dynamic and postural stability by using a Biodex Stability System and comparing pregnant women with and without an MSB in each cohort group. MAIN OUTCOME MEASURES: Overall, anterior-posterior stability index, medial-lateral stability index, and fall risk test (FRT) scores were obtained with 1 stance at platform stability of level 8. Four measurements from the Biodex Stability System were compared between pregnant women with and without an MSB in each group. RESULTS: The scores of anterior-posterior stability index and FRT were significantly lower in the first-trimester group with an MSB than without an MSB (P < .05). Medial-lateral stability index and FRT scores were significantly lower in the second-trimester group with an MSB than without an MSB (P < .05). In the third-trimester group, overall, medial-lateral stability index, and FRT scores were lower for participants with an MSB compared with participants without an MSB (P < .05). In all trimester groups, FRT scores were detected to be lower in pregnant women with an MSB than in those without an MSB (P < .05). CONCLUSIONS: MSB use improves impaired balance and FRT scores during all periods of pregnancy, especially in the third trimester. MSB is useful for fall prevention during pregnancy, especially during the third trimester.

Late Postpartum HELLP Syndrome 60 Hours after Delivery Associated with Mild Pre-eclampsia.

The purpose of this report is to present a case of mild Pre-eclampsia which was complicated with postpartum HELLP syndrome. A 25-years-old pregnant woman with mild Pre-eclampsia at 36 weeks of gestation was admitted to our clinic with uterine contractions. A caesarean section was performed, due to her previous caesarean section history. Postpartum period was uneventful until the 2nd day after the caesarean section. Epigastric pain, nausea and vomiting appeared two days after her delivery. In evaluation of the case, laboratory findings which were associated with HELLP syndrome were found to include haemolysis, elevated liver enzymes and low platelet counts. The general condition and laboratory findings of the case returned to normal with supportive and steroid treatment after 3 days. It should be noted that HELLP syndrome can develop in the postpartum period. Therefore, caution should be exercised in patients with pre-eclampsia, for the development of the postpartum HELLP syndrome.