Association between maternal serum 25-hydroxyvitamin D level and pre-eclampsia.

OBJECTIVES: The objective of the study was to evaluate the association of maternal plasma levels of 25-hydroxyvitamin D (25(OH)D) at late second and third trimester and the risk of pre-eclampsia. METHODS: In this prospective cohort study, maternal plasma 25(OH)D levels were measured at late second and third trimester in 77 women who later developed pre-eclampsia (31 non-severe and 46 severe cases) and 180 women without pre-eclampsia. RESULTS: The mean gestational age of the timing of the blood sampling was 31.1 ± 4.4 at control group, 32.6 ± 5.7 at non-severe pre-eclamptic group and 32.3 ± 5.4 at severe pre-eclamptic group. The mean 25(OH)D concentration was significantly low in severe pre-eclampsia group (5.8 ± 4.5 ng/ml) than non-severe pre-eclampsia (11.8 ± 7.3 ng/ml, p = 0.039) and control groups (14.9 ± 12.0 ng/ml, p < 0.0001). There was no statistically significant difference in 25(OH)D concentration between non-severe pre-eclamptic and control groups (p = 0.404). In women with 25(OH)D concentration <20 ng/ml, a 12.45-fold increase in the odds of severe pre-eclampsia were detected. CONCLUSION: Women with severe pre-eclampsia had low serum 25(OH)D levels. The correlation between maternal 25(OH)D levels and aspartate aminotransferase, alanine transaminase, serum creatinine levels, platelet count were not determined. 25(OH)D levels may be used as an independent predictive marker of severe pre-eclampsia.

Prenatal diagnosis and outcome of lymphangiomas and its relationship with fetal chromosomal abnormalities.

OBJECTIVES: Our aim was to evaluate ultrasound findings and perinatal outcome after prenatal diagnosis of lymphangioma. METHODS: This was a retrospective case series study. We searched the archives of our ultrasound database at our center for cases with the prenatal diagnosis of the lymphangioma in the period between January 2008 and November 2014. We described maternal, fetal and perinatal variables for all cases. RESULTS: Nine fetuses with lymphangioma were identified. All cases were diagnosed during the second and third trimesters with the average gestational age of 22.6 ± 3.9 weeks. The average diameter of lymphangioma was 55.4 ± 20.1 mm at the time of diagnosis. Five fetuses (55.6%) had lymphangioma on the neck, and four fetuses (44.4%) had lymphangioma on other localizations. Normal fetal karyotype was detected in all cases. There were a total of six live births, one intrauterine death and two medical terminations of pregnancy following the diagnosis of lymphangioma. No abnormal Doppler finding or hydrops were detected in the antenatal follow-up of remaining six cases. CONCLUSION: The risk of chromosomal abnormalities is very low in pregnancies with isolated lymphangioma. The outcome of pregnancies with lymphangioma is generally favorable and prognosis depends on their locations and size.

The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report.

The Ex-utero intrapartum treatment (EXIT) is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa.

OBJECTIVE: To evaluate the success rate of the Bakri balloon in the event of uncontrollable hemorrhage due to placenta previa. STUDY DESIGN: We evaluated 25 patients who were treated with the Bakri balloon who had severe postpartum hemorrhage with placenta previa and failed medical treatment with uterotonic agents. RESULTS: The Bakri balloon was inserted abdominally during cesarean section in 24 of 25 cases. In only one case was it inserted vaginally. The Bakri tamponade was effective in 22 cases (88%). There were three cases with failure: two patients needed an additional procedure (hypogastric artery ligation and B-Lynch suture) and one patient needed hysterectomy. CONCLUSIONS: The Bakri balloon is the least invasive, rapid method in the management of bleeding due to placenta previa with minimal complications.

Clinical, endocrine, and metabolic effects of acarbose, a alpha-glucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome.

OBJECTIVE: To determine the clinical, endocrine, and metabolic effects of acarbose use in overweight and nonoverweight patients with polycystic ovarian syndrome (PCOS). DESIGN: Prospective analysis. SETTING: Gynecology and infertility clinic of a tertiary care medical center. PATIENT(S): Seventy-four patients with PCOS and 30 healthy women. INTERVENTION(S): Acarbose use. MAIN OUTCOME MEASURE(S): Clinical findings of hyperandrogenism, body mass indices, LH, FSH, DHEAS, total T, PRL, basal insulin, fasting glucose/insulin levels, and lipid profiles. RESULT(S): Acarbose treatment improved LH/FSH levels, decreased total T, DHEAS, basal insulin, low-density lipoprotein, very low-density lipoprotein, and triglyceride levels, and increased high-density lipoprotein levels in patients with PCOS. Basal insulin and fasting glucose/insulin levels reacted more significantly in overweight patients undergoing acarbose treatment. CONCLUSION(S): Acarbose has been found to improve insulin levels and thus glucose/insulin ratios more effectively in overweight patients compared with nonoverweight patients with PCOS. This drug seems to be an effective drug to be used in overweight as well as nonoverweight patients with PCOS.

Iniencephaly: Prenatal diagnosis with postmortem findings.

Iniencephaly is a rare but almost always lethal neural tube defect with the following cardinal features: occipital bone defect, partial or total absence of cervicothoracal vertebrae and fetal retroflexion. Iniencephaly is associated with malformations of the central nervous system, gastrointestinal and cardiovascular system. Prenatally diagnosed cases of iniencephaly are rare because careful and early ultrasonographic evaluation is necessary. The present cases of iniencephaly were found to carry associated malformations such as atrioventricular septal defect and club foot. We present an iniencephaly prenatally diagnosed by sonography, in which therapeutic abortion was induced, with a review of the published literature.

Comparison of two forms of continuous combined hormone replacement therapy with respect to metabolic effects.

OBJECTIVE: To compare the metabolic effects of two frequently used continuous hormone replacement therapies. MATERIALS AND METHODS: Two hundred and forty-six menopausal women, aged between 41 and 57 years were enrolled in the present study. They were randomized to receive either estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA) or 1 mg 17 estradiol + 0.5 mg norethindrone acetate (E2/NETA). Women in group I (n = 139) and group II (n = 107) were followed up for 1 year and compared with respect to total cholesterol, triglycerides, HDL, LDL, VLDL, weight gain during this period. RESULTS: The basal and 12th month weight of the patients of two groups were not statistically different (P = 0.57 and P = 0.17, respectively, in the groups I and II). No changes were detected in the levels of triglycerides, HDL and VLDL, while total cholesterol (P = 0.01) and LDL (P = 0.003) levels significantly decreased in the CEE/MPA group. In group 2, total cholesterol and triglyceride levels showed no significant change, however, levels of HDL cholesterol (P = 0.001) increased and LDL (P = 0.001) and VLDL cholesterol (P = 0.006) decreased significantly. CONCLUSION: Administration of E2/NETA regimen has better results on lipid profile when compared to CEE/MPA regimen. No weight gain is recorded in E2/NETA group.

Effects of epidural analgesia using ropivacaine on the mother and the newborn during labor.

OBJECTIVE: To evaluate the effects of epidural analgesia using 0.2% Ropivacaine on the mother, newborn and during labor. METHODS: This study was conducted at the Zeynep Kamil Obstetric, Gynecology, and Pediatric Research and Training Hospital in Istanbul, Turkey, between July 2003 and April 2004. Eighty pregnant women of 37-41 weeks' gestation were enrolled in the study. Forty cases received epidural analgesia (group 1) and the control group composed 40 cases (group 2). Duration of labor, systolic and diastolic blood pressures at initial, 15th, 30th, 45th and 60th minutes, and number of breathing per minute, pulse rates, fetal heart rates and presence of motor block were recorded. Blood gas assessments from the umbilical cord, 1st and 5th minute Apgar scores were noted following the delivery. Way of delivery, adverse effects and complications of the epidural analgesia were recorded. RESULTS: Mean age of the cases was 24.79 +/- 4.72 years. Duration between full cervical dilation and delivery (phase 2) was significantly longer in group 1 (p<0.01). Sixty minutes systolic arterial pressure was significantly lower in group 1 (p<0.05). In group 1, diastolic arterial pressures at 15th, 45th, 60th minutes (p<0.01) and 30th minute (p<0.05) were significantly lower when compared to the initial values. No significant differences were recorded in terms of breathing rates, umbilical cord CO2, O2, pH levels and Apgar scores between the 2 groups. The most common adverse effect of epidural analgesia was sedation (59%). The second dose of Ropivacaine was needed in 24 (61.5%) cases in group 1. In group 1, 29 (74.4%) patients expressed their pleasure as very good regarding the epidural analgesia. CONCLUSION: Epidural analgesia, if administered by a specialist to a properly selected patient at proper time, leads to a comfortable delivery by relieving the pain. It can be performed safely after taking an informed consent.

The effects of oxidative stress on outcomes of assisted reproductive techniques.

PURPOSE: To investigate the impact of oxidative stress on pregnancy success by monitoring malondialdehyde levels in follicular fluid. METHODS: Forty five couples were enrolled in this prospective study. Following long protocol of GnRH analogues and r-FSH treatment, oocyte retrieval and intracytoplasmic sperm injection were performed. Malondialdehyde levels were assayed by thiobarbutiric acid reacting substances test. Student's t-test and chi(2) test were used for statistical analysis. RESULTS: Patients were divided into two groups; group I (pregnancy positive, n = 20), group II (pregnancy negative, n = 25). There was no statistical significant difference in terms of age, infertility period, FSH levels on the third day, number of oocytes retrieved and fertilization rates between the two groups. Pregnancy rates were found to be decreasing in higher malondialdehyde levels. CONCLUSION: Malondialdehyde can be used as a marker of oxidative stress and a potential marker in predicting assisted reproductive techniques outcome.

Effects of two different regimens of continuous hormone replacement therapy on endometrial histopathology and postmenopausal uterine bleeding.

OBJECTIVE: To compare the effects of frequently used two different regimens of combined continuous hormone replacement therapy; 0.625 mg conjugated equine estrogen (CEE) + 2.5 mg medroxyprogesterone acetate (MPA) and 1 mg 17beta estradiol (E2) + 0.5 mg norethindrone acetate (NETA), on endometrial histopathology and postmenopausal uterine bleeding. MATERIALS AND METHODS: Two hundred and forty-six outpatient subjects aged 41-57 years were enrolled in the study conducted at the menopause clinic between November 2003 and November 2004. One hundred and thirty-nine patients were assigned to receive 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone acetate (CEE/MPA), whereas 107 patients were to receive 17beta estradiol + 0.5 mg norethindrone acetate (E2/NETA). Inclusion criteria of the study were: normal values of endometrial thickness at basal evaluation, women with intact uterus, at least 12 months of amenorrhea, normal vaginal smear, bilateral mammography and biochemical blood parameters. All women were questioned every 3 months for vaginal bleeding/spotting. Endometrial sampling was performed by Pipelle catheter in the 12th month of therapy. RESULTS: For the first 3 months, vaginal bleeding/spotting rate for the CEE/MPA group was 38.7%, whereas it was higher (45%) in the E2/NETA group. For the second 3-month period, vaginal bleeding/spotting frequencies were 41.1 and 37.8%, respectively. In the third 3-month period 30.6 and 29.6%, and in the fourth 3-month period, 18.5 and 12.5% of the patients reported vaginal bleeding or spotting. None of the results of endometrial sampling have shown findings of cancer histopathology. CONCLUSION: Compared to CEE/MPA regimen, E2/NETA therapy has not shown more favorable effects on postmenopausal bleeding abnormalities. Irregular endometrial proliferation was seen more with the E2/NETA regimen.

The duration of use, causes of discontinuation, and problems during removal in women admitted for removal of IUD.

OBJECTIVE: Our aim was to determine the duration of intrauterine device (IUD) use, reasons for discontinuation, and problems encountered during removal in patients who were admitted to our clinic for removal of IUD. MATERIALS AND METHODS: We studied 321 cases of IUD removal with respect to duration of use, cause of removal, type of IUD used, and sociodemographic characteristics. The relationships among duration of use, patient's level of education, medical facility where the IUD was inserted, and number of children were analyzed. The reasons for removal and their relationship to duration of use were investigated. We also investigated the problems encountered during removal. FINDINGS: The mean age of cases included in the study was 34.8+/-1 years, mean number of children was 2.3+/-1.5, and mean duration of use was 5.8+/-3.9 years. The type of IUD most frequently removed was TCu-380A (86.3%). Although there was no correlation between the duration of use and the type of medical facility where the IUD was inserted, we observed that women with more children used IUDs for longer periods. When cases were evaluated for level of education, there was a statistically significant difference between university graduates and illiterate/primary school graduate women (p = .032 and .029, respectively). The reasons for removal were frequently side effects related to IUD use, expired date of use, and desire for conception. Pregnancy during IUD use was observed in 16 cases (5%). Removal of IUD was achieved without problems in 263 cases (81.9%), whereas alligator forceps needed to be used in 44 cases (13.7%). CONCLUSION: IUD is the most frequently used contraceptive method in our country. We have observed a long duration of use in the women studied, with minimal problems during removal.

Norplant insertions at the Zeynep Kamil Gynecologic and Pediatric Training Research Hospital in Istanbul.

OBJECTIVE: This study was conducted to determine sociodemographic characteristics and usage interval according to insertion period, observed side effects and reasons for discontinuation in 756 cases where Norplant was inserted and removed for any reasons at our hospital since 1994. METHODS: Seven-hundred and fifty-six cases in whom Norplant was inserted and removed since 1994 were included in our study. Sociodemographic characteristics, former contraception method, reasons for choosing this method and side effects seen during the usage period were determined. In all cases, reasons for discontinuation, sociodemographic characteristics and usage interval according to the insertion period were investigated. Statistical analysis of this study was performed with SPSS 9.0 (analysis of variance). RESULTS: Mean age of cases was 26.5 +/- 4.9 years, mean number of living children was 2.0 +/- 1.2, and 50.4% of cases had no health insurance. Most of the cases used coitus interruptus previously as a contraceptive method and chose Norplant use because of its effectiveness. Insertion periods were as follows: interval, n = 513 (67.9%); postpartum, n = 127 (16.8%) and postabortion, n = 116 (15.3%). Various side effects were detected in 79.8% of the cases. Bleeding problems were seen in 69.8%. Pregnancy occurred in only one case. Mean Norplant usage interval was 3.08 +/- 1.68 years. The longer usage interval was seen in cases with lower educational level. When we compared the usage intervals between interval, postpartum and postabortion periods, we found that the interval group had a shorter mean duration of Norplant use. Discontinuation because of bleeding problems occurred in 38.1%. Removal of all Norplant implants was performed at a single session in 731 cases (96.4%). After Norplant removal, most cases selected either condom or IUD as the contraceptive method. CONCLUSION: It is concluded that despite the frequent occurrence of side effects, Norplant is a modern, long-acting, highly effective, reversible, easy-to-use, satisfactory form of birth control, especially in selected cases.