Expression of pro-apoptotic and anti-apoptotic proteins in granulosa cells of women with diminished ovarian reserve.

PURPOSE: To evaluate the expressions of caspase-3 and cytochrome c and heat shock protein 70 (Hsp70) in granulosa cells (GCs) from women with normal ovarian reserve (NOR) and diminished ovarian reserve (DOR) undergoing intracytoplasmic sperm injection (ICSI). METHODS: GCs were collected from 117 infertile women during oocyte retrieval. Patients were classified into four groups as follows: DOR-COC score of 0, DOR-COC score of I, NOR-COC score of 0, and NOR-COC score of I. The caspase-3, cytochrome c, and Hsp70 analyses were performed immunohistochemically in GCs. The ICSI outcomes were evaluated prospectively. RESULTS: The clinical pregnancy and live birth rates were higher in DOR-COC score of I (15, 30.6%; 14, 38.9%) and NOR-COC score of I (19, 38.77%; 19, 52.7%) groups, compared with DOR-COC score of 0 (12, 24.4%; 3, 6.1%) and NOR-COC score of 0 (3, 6.1%; 0%) groups (p = 0.0001; 0.00002), respectively. Caspase-3 and cytochrome c expression levels were higher in DOR-COC score of 0 (23, 65.7%; 25, 71.4%) and NOR-COC score of 0 groups (19, 61.3%; 20, 64.5%), compared with DOR-COC score of I (8, 32%; 9, 36%) and NOR-COC score of I groups (7, 26.9%; 8, 30.8%) (p = 0.00297; p = 0.002), respectively. Lower expression levels of Hsp70 were found in DOR-COC score of 0 (11, 31.4%) and NOR-COC score of 0 groups (10, 32.3%), compared with DOR-COC score of I (16, 64%) and NOR-COC score of I groups (20, 76.9%) (p = 0.001), respectively. Hsp70 expression levels were positively correlated with the number of day 3 good-quality embryo and negatively correlated with estradiol levels in the DOR group. CONCLUSION: Our data suggest that COC score of 0 is associated with increased expression levels of apoptotic proteins, decreased expression levels of anti-apoptotic protein, and poor ICSI clinical outcomes in women with and without DOR.

Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth?

BACKGROUND: Infants who are born at 340/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of administration of antenatal corticosteroids (ACSs) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHODS: This was a prospective cohort study of singleton gestations at risk of imminent delivery between 340/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. Primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS: During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57, 95% CI 0.35-0.94) and transient tachypnea of newborn (aOR 0.48, 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64, 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery and duration of hospitalization. CONCLUSION: Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.

Does antenatal corticosteroid therapy improve neonatal outcomes in late preterm birth?

BACKGROUND: Infants who are born at 34°/7 to 366/7 weeks of gestation (late preterm) are at greater risk for respiratory and other neonatal morbidities. The objective of this study was to examine the effects of the administration of antenatal corticosteroids (ACS) to women at risk for late preterm delivery on the incidence of neonatal outcomes. METHOD: This was a prospective cohort study of singleton gestations at risk of imminent delivery between 34°/7 and 366/7 weeks. Neonatal outcomes were compared between mothers who received ACS and those who did not. The primary outcome was the rate of composite respiratory morbidity defined as the need for treatment within 72 h of life (continuous positive airway pressure or high flow nasal cannula for least 2 h or supplemental oxygen with a fraction of inspired oxygen of at least 0.30 for at least four continuous hours or mechanical ventilation). RESULTS: During the 3-year study period, 595 subjects were included in this study, comprising 234 subjects that received ACS and 361 that did not. Administration of ACS significantly reduced the rates of composite respiratory morbidity (aOR 0.63 95% CI 0.40-0.99), the use of CPAP or HFNC for at least 2 h (aOR 0.57 95% CI 0.35-0.94), and transient tachypnea of the newborn (aOR 0.48 95% CI 0.28-0.82). Neonatal hypoglycemia was more significantly increased in the ACS group compared with controls (aOR 1.64 95% CI 1.04-2.59). We found no significant between-group differences in the rate of respiratory distress syndrome, surfactant use, need for resuscitation, jaundice requiring phototherapy, admission to neonatal intensive care or special care nursery, and duration of hospitalization. CONCLUSION: Administration of ACS during the late preterm period decreased neonatal respiratory complications, however, increased the rate of hypoglycemia.

Comparison of Intrauterine Device Insertion-Related Pain and Ease of Procedure at Different Times During Menstruation.

Objective: Fear of pain during the copper intrauterine device (Cu-IUD) insertion may lead patients to reject this highly effective birth control method. The aim of this study was to investigate the pain scores associated with IUD insertion and the ease of procedure at different times during menstruation. Method: In this prospective cohort trial, eligible women received IUD at three-time segments of menstruation: Group I, at 0.5 to 0.69-time segment (n=53); Group II, at 0.7 to 0.89-time segment (n=67); and Group III, at 0.9 to 1-time segment (n=72). The time segments during menstruation were calculated for each participant by dividing the menstrual cycle day of IUD insertion to total number of menses days. The score of pain experienced at different steps of IUD insertion during and five min. after the procedure measured by Wong-Baker FACES Pain Rating Scale (WBS) and the ease of insertion were compared among groups. Results: There were significant differences in age (p=0.011) and time since the last delivery (p=0.017). After adjusting for potential confounding factors, the mean WBS score and the ease of insertion were not statistically significant among groups, respectively (p=0.664 and p=0.149). The most painful step was observed as uterine sounding (median, 4 [interquartile range {IQR}, 2]). No significant correlation was observed between WBS scores, the ease of insertion, and main characteristics of the participants. Conclusion: The most painful step of IUD insertion was observed as uterine sounding. IUD insertion-related pain and the ease of procedure do not appear to be different at any time in the second half of menstruation.

Is mediolateral episiotomy angle associated with postpartum perineal pain in primiparous women?

OBJECTIVE: Our aim is to elucidate the relationship between mediolateral episiotomy (MLE) angle and postpartum perineal pain. METHODS: This study was designed prospectively. Primiparous women with MLE in the postpartum period were included in the study and divided into three groups according to episiotomy angle ranges (Group 1: <40°, Group 2: 40°-60°, and Group 3: >60°). Postpartum perineal pain was quantified with the short-form McGill Pain questionnaire (SF-MPQ) consisting of the following three parts: Sensory-affective-verbal descriptions, visual pain scale (VPS), and present pain intensity scale (PPI). Postpartum perineal pain scores on days 1 and 7 were compared among the angle group. RESULTS: Overall, 86 eligible women were enrolled in this study. Seventy-three women (85%) scored the perineal pain between 0 and 3 on the VPS and 13 women (15%) rated the pain from 4 to 6 on the 1st postpartum day. No significant differences were noted among the three groups regarding the total pain scores on SF-MPQ and on the each part of form at the 1st postpartum day. At 7 days postpartum, total pain score was found significantly high in Group 1 [Med; IQR (min-max)=0; 4 (0-5)] compared with Group 2 [Med; IQR (min-max)=0; 0(0-5)]. The pain scores obtained from the sensory, affective, VPS, and PPI parts of the questionnaire were [Med; IQR (min-max)=0; 1 (0-2)], [Med; IQR (min-max)=0; 1 (0-1)], [Med; IQR (min-max)=0; 2 (0-2)], and [Med; IQR (min-max)=0; 0.25 (0-1)], respectively, in Group 1. For Group 2, pain scores obtained from the sensory, affective, and PPI were [Med; IQR (min-max)=0; 0(0-1)]; and VPS was [Med; IQR (min-max)=0; 0(0-2)]. No significant differences were observed between Groups 1 and 2 for each part of the questionnaire on day 7. Percentage of need for analgesics on day 7 was found significantly higher in Group 1 (42.9%) than Group 2 (31.2%). CONCLUSION: MLE at an angle <40° to the midline is associated with a higher score of perineal pain and an increase need for analgesics during the early postpartum days.

Differential Expressions of Ki-67, Bcl-2, and Apoptosis Index in Endometrial Cells of Women With and Without Type II Diabetes Mellitus and Their Correlation with Clinicopathological Variables.

The objective of this study was to investigate proliferation, apoptosis, and antiapoptotic molecule expression in endometrial cells of reproductive-aged women with and without type II diabetes mellitus (T2D). In this case-control study, a total of 80 endometrial tissue specimens from reproductive-aged women (35 in the proliferative phase and 45 in the secretory phase) were examined. The age and body mass index (BMI) were matched between the groups. Formalin-fixed and paraffin-embedded endometrial tissue samples were used for immunohistochemistry analysis. The presence of proliferation was evaluated with Ki-67 expression, antiapoptotic function of cells was evaluated with Bcl-2 expression, and apoptosis was evaluated with terminal deoxynucleotidyl transferase (TUNEL) immunoreactivity in both the glandular epithelium and stroma of endometrial tissue samples from women with and without T2D. Ki-67 expression in the glandular epithelium and Bcl-2 expression in both the glandular epithelium and stroma were significantly higher in endometrial tissue samples of women in the T2D group than the control group (p = 0.0008, p = 0.0022, and p = 0.0261, respectively). TUNEL immunoreactivity was significantly lower in the glandular epithelium of women in the T2D group than the control group (p = 0.0001). Glandular Ki-67 expression correlated positively with BMI, use of insulin, and hemoglobin A1c level (p = 0.0034, p = 0.0154, and p = 0.0011, respectively). Glandular Bcl-2 expression correlated positively with BMI and duration of T2D (p = 0.0090 and p = 0.0109, respectively). Stromal Bcl-2 expression correlated positively with duration of T2D (p = 0.0069). TUNEL immunoreactivity in the glandular epithelium correlated negatively with duration of T2D (p = 0.0340) and positively with the use of oral antidiabetic agents (p = 0.0226). Compared to age and BMI-matched controls, women with T2D experienced increased cell proliferation and decreased apoptosis in the glandular epithelium and increased antiapoptotic function in both the glandular epithelium and stromal cells. High BMI values in women with diabetes seemed to contribute to increased cell proliferation and increased antiapoptotic function in the glandular epithelium but not the stromal cells.

Prenatal ultrasonographic findings of adhesion-membrane complex and its relation with obstetric history.

Background: Intrauterine adhesions are usually detected incidentally during routine obstetric ultrasound and remain one of the reasons for concern for both clinicians and patients.Objective: Our objective was to document ultrasonographic findings of intrauterine adhesions detected in obstetric ultrasound and to investigate their correlation with obstetric history.Study Design: Detailed scans were performed in 685 singleton pregnancies at 16-24 weeks' gestation. Intrauterine adhesion was referred to as "adhesion-membrane complex'' (AMC). Patients were divided into three groups: Group I consisted of patients with ≥1 therapeutic D&C associated with pregnancy but with neither vaginal delivery nor Cesarean section (CS). Group II consisted of patients with ≥1 CS but with neither vaginal delivery nor therapeutic D&C associated with pregnancy. Group III consisted of patients who were in their first pregnancy. Ultrasonographic properties of AMC and relationship between AMCs and obstetric history were investigated.Results: The incidence of AMC in Group I (n = 108), Group II (n = 189), and Group III (n = 388) was 11.1% (n = 12), 1.05% (n = 2) and 1.03% (n = 4), respectively. Positive history of D&C is associated with significantly increased risk of AMC (risk ratio:10.778; 95% confidence interval: 3.55-32.75). Also, previous history of CS is not associated with significantly increased risk of AMC (risk ratio: 1.026; 95% confidence interval: 0.19-5.55). The AMCs were located in the upper half in 7 (38,9%) and in the lower half of the uterus in 11 (61.1%) patients. The midpoint thickness of the AMC was between 0.75 and 5.10 mm (mean: 2.65 mm; SD ± 1.2). The width of the AMC was between 2 and 52 mm (mean: 20.98; SD ± 15.3), the heights of the AMCs were 5-60 mm (mean: 33.27 mm; SD ±17.0). In ten of the AMC positive patients (55.6%) a thick and bulbous free end and in eleven of them (61.1%) a "Y image" was detected. The mean gestational age at birth was 37.4 (SD ± 3.3) weeks in 18 patients with AMC. There were no intrauterine fetal or perinatal deaths. None of the neonates had congenital abnormalities.Conclusions: Intrauterine adhesions detected in obstetric ultrasonography were redefined and renamed in a more comprehensible manner. Our results pointed out that while the positive history of D&C is associated with significantly increased risk of AMC, previous history of CS is not associated with significantly increased risk of AMC.

Identification of miR-16-5p and miR-155-5p microRNAs differentially expressed in circulating leukocytes of pregnant women with polycystic ovary syndrome and gestational diabetes.

INTRODUCTION: Pregnant women with polycystic ovary syndrome (PCOS) are at increased risk of gestational diabetes (GDM). We aimed to assess the expressions of candidate microRNAs (miRs) in leukocytes of pregnant women with PCOS and GDM. Methods: Using real-time quantitative PCR method, miR-16-5p and miR-155-5p were examined from PCOS (n = 17), GDM (n = 14), GDM + PCOS (n = 11), and controls (n = 27). The relative expression levels of the candidate miRNAs were compared between patient and control samples. The results were calculated as relative quantification values (RQ). Results: After adjusting for potential confounding variables using ANCOVA, no significant differences were observed in miR-16-5p (p = .154) and miR-155-5p (p = .702) expressions among four groups. We found significantly upregulated miR-16-5p expression in PCOS patients (RQ = 12.97 ± 1.94; p = .0001), compared to controls (RQ = 2.32 ± 1.46). Decreased miR-155-5p was found in GDM women (RQ = 0.80 ± 0.36; p = .04), compared to controls (RQ = 1.78 ± 0.25). Body mass index had a positive correlation with 155-5p in the GDM group (r = 0.55; p = .038). We found strong positive correlation between 1-hour glucose and miR-155-5p in PCOS patients (r = 0.71; p = .001). Fasting glucose (r= -0.63, p = .03) presented significant inverse association with miR-16-5p in the GDM + PCOS group. Discussion: The present study shows for the first time that increased miR-16-5p expression is associated with PCOS in pregnancy. Moreover, downregulated miR-155-5p expression was found in relation with GDM.

The role of abnormal cerebroplacental ratio in predicting adverse fetal outcome in pregnancies with scheduled induction of labor.

OBJECTIVE: To investigate the role of abnormal cerebroplacental ratio (CPR) in predicting adverse fetal outcome in pregnancies with induction of labor. METHODS: This prospective observational study conducted at Medeniyet University Göztepe Training and Research Hospital between December 1, 2018 and October 31, 2019 enrolled women with scheduled induction of labor at or beyond 37 weeks of pregnancy. Women with singleton non-anomalous fetuses with cephalic presentation and who had Bishop scores of 5 or less in pelvic examination were included in the study. Exclusion criteria were the presence of uterine scar history, non-cephalic presentation, multiple pregnancy, vacuum- or forceps-assisted delivery, and shoulder dystocia. Using fetal Doppler ultrasound, CPR was calculated (the ratio of umbilical artery to middle cerebral artery pulsatility index) and categorized into abnormal CPR (<1) and normal CPR (≥1). Data on maternal and delivery characteristics, fetal birth weight, and fetal complications were compared between the groups. RESULTS: A total of 145 women were included, 28 in the abnormal CPR group and 117 in the normal CPR group. Multivariate analysis revealed labor induction at a later week of pregnancy (odds ratio [OR] 10.33, P = 0.001), lack of intrauterine growth restriction (IUGR) (OR 13.21, P = 0.001), fetal distress (OR 8.14, P = 0.003) or meconium aspiration (OR 159.91, P = 0.001), and umbilical artery pH values greater than 7.31 (OR 17.51, P = 0.015) to be associated with an increased likelihood of having normal (≥1) CPR values. Receiver operating characteristic analysis revealed association of normal CPR values with later labor induction (cut-off value of >38.3 weeks, P = 0.001), higher birth weight (cut-off value of >2460 g, P = 0.022) and higher umbilical artery pH (cut-off value of >7.31, P = 0.007). CONCLUSION: Our findings revealed the significant role of abnormal CPR in predicting adverse fetal outcome in singleton pregnancies with scheduled induction of labor.

Anxiety and Post-Traumatic Stress Disorder Symptoms in Pregnant Women during the COVID-19 Pandemic's Delay Phase.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China and has spread all over the world and affected global mental health. Pregnant women may be particularly vulnerable and experience high levels of distress during an infectious disease outbreak. The aim of this study was to determine anxiety and post-traumatic stress disorder (PTSD) symptoms in pregnant women during the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional study surveyed a total of 283 pregnant women within the period of May 11 to May 28,2020. During their regular antenatal visit, pregnant women were invited to participate in the study. The self-created personal information form was used to assess the main characteristics of the participants. Anxiety and PTSD symptoms of the pregnant women were measured by the Spielberger State-Trait Anxiety Inventory (STAI) and Impact of Events Scale-Revised (IES-R), respectively. RESULTS: The mean age of the pregnant women was 29.20±5.55 years. Regarding gestational age, 72 (25.4%), 86 (30.4) and 125 (44.2) were in the first, second and third trimesters, respectively. The mean gestational age was 23.82±11.05 weeks. The mean STAI-S and STAI-T scores were 39.52±10.56 within the cut-off value (39-40) of the instrument and 42.74±8.33, respectively. Furthermore, the mean total IES-R score was 36.60±15.65 within the cut-off value (24) of the instrument. Multiple regression analysis revealed that pregnancy complication (p=0.01) and employment status of husband (p=0.04) were the best predictors of state anxiety. Additionally, the presence of COVID-19-related symptoms (p=0.01) and educational level (p=0.01) were found to predict PTSD symptoms. CONCLUSIONS: Pregnant women would be likely to experience high levels of anxiety and PTSD symptoms during the COVID-19 pandemic's delay phase. The results should sensitize the medical team to increased anxiety and PTDS symptoms of the pregnant women in order to prevent negative outcomes for women and their fetuses.

The association of the amniotic fluid index (AFI) with perinatal fetal and maternal outcomes in pregnancies complicated by preterm premature rupture of membranes (PPROM).

OBJECTIVES: To investigate association of amniotic fluid index (AFI) with perinatal fetal and maternal outcomes in pregnancies complicated by preterm premature rupture of membranes (PPROM) MATERIAL AND METHODS: A total of 70 singleton pregnancies complicated by PPROM at 23-33 weeks' gestation were enrolled in this prospective observational study. Data on maternal clinical and obstetric characteristics [maternal age, gravidity, parity, PPROM time, and AFI (cm), latency period, treatments, type of delivery, length of hospital stay (LOS, day)], fetal characteristics (gestational age at delivery, birth weight (g), gender) and maternal and fetal complications were recorded and compared in AFI < 5 cm (n = 27) and AFI ≥ 5 cm (n = 21) groups. RESULTS: Overall AFI was ≤ 5 cm in 27 (56.3%) patients and > 5 cm in 21 (43.7%) patients. No significant difference was noted in maternal clinical and obstetric characteristics, gestational age at delivery and gender of the newborn as well as in maternal and fetal complications rates with respect to AFI groups. AFI was correlated positively with latency period (r = 0.399, p = 0.018) and negatively with postpartum LOS (r = -0.314, p = 0.030). CONCLUSIONS: In conclusion, our findings seems to indicate increased likelihood of shorter latency to delivery and longer postpartum LOS with decrease in AFI after PPROM between 23-33 weeks' gestation, whereas no impact of AFI on mode of delivery and fetal or maternal complications.

Anxiety and depression symptoms in the same pregnant women before and during the COVID-19 pandemic.

Objectives With clinical experience from previous coronavirus infections, public health measures and fear of infection may have negative psychological effects on pregnant women. This study aimed to compare the level of anxiety and depression in the same pregnant women before and during the COVID-19 pandemic. Methods The pregnant women continuing pregnancy who participated in the first study which was undertaken to clarify the factors associated with mental health of pregnant women before the COVID-19 pandemic, were included for the current study during the outbreak. Anxiety and depression symptoms of the same pregnant women were evaluated by using the Inventory of Depression and Anxiety Symptoms II and Beck Anxiety Inventory twice before and during the pandemic. Results A total of 63 pregnant women completed questionnaires. The mean age of the women and the mean gestational age was 30.35±5.27 years and 32.5±7 weeks, respectively. The mean total IDAS II score was found to increase from 184.78±49.67 (min: 109, max: 308) to 202.57±52.90 (min: 104, max: 329) before and during the SARS-CoV-2 pandemic. According to the BAI scores the number of patients without anxiety (from 10 to 6) and with mild anxiety (from 31 to 24) decreased and patients with moderate (from 20 to 25) and severe anxiety (from 2 to 8) increased after SARS-CoV-2 infection. Multivariate linear regression analysis revealed that obesity and relationship with her husband are the best predictors of IDAS II scores. Conclusions This study indicated that COVID-19 outbreak affects the mental health of pregnant women negatively which leads to adverse birth outcomes. The level of anxiety and depression symptoms of pregnant women during the COVID-19 infection significantly increased. Healthcare professionals should establish comprehensive treatment plans for pregnant women who are highly vulnerable population to prevent mental trauma during the infectious disease outbreaks.

Comparative Analysis of Maternal and Fetal Outcomes of Pregnancies Complicated and Not Complicated with Hyperemesis Gravidarum Necessitating Hospitalization.

OBJECTIVE: To compare maternal and fetal outcomes of pregnancies complicated and not complicated with hyperemesis gravidarum (HG) necessitating hospitalization. METHOD: A total of 386 women with singleton deliveries between March 2015 and January 2018 were included in this retrospective single-center study. Of 386 women, 186 women (mean±SD age: 30.7±5.9 years) who were hospitalized with HG within the first 20 weeks of gestation comprised the hyperemetic pregnancy group, while 200 women without HG during pregnancy served as a control group. RESULTS: No significant difference was noted between the HG and control groups in terms of maternal characteristics, gestational age (median 38.6 and 39.0 weeks, respectively), type of delivery (normal spontaneous delivery in 78.0% vs 80.0%), fetal gender (female: 53.2% vs 48.5%), birthweight (median 3250 g vs 3275 g) and 5-min APGAR scores (≥7 in 97.3% vs 97.5%, respectively). Adverse pregnancy outcomes were also similar between groups including preterm birth (8.1% vs 11.0%, respectively), SGA (5.9% vs 9.5%), hypertensive disorder (5.4% vs 7.5%), placental abruption (1.1% vs 0.5%,), stillbirth (0.0% vs 0.5%) and GDM (3.8%vs 2.5%). Weight loss during pregnancy was evident in 91.3% of women in the HG group, while none of women in the control group had weight loss during pregnancy (p<0.001). CONCLUSIONS: The findings of this study indicate that HG may not be related with adverse fetal and prenatal outcomes and this conclusion needs to be clarified with large-scale investigations.

Comparison of maternal and fetal complications in pregnant women with breech presentation undergoing spontaneous or induced vaginal delivery, or cesarean delivery.

OBJECTIVE: Breech presentation is the most common form of malpresentation, and associated with perinatal asphyxia and mortality, and maternal morbidity. Data associated with labor induction in breech presentation are limited. The aim of this study was to compare maternal and fetal complication rates in induced and spontaneous vaginal, and cesarean delivery with breech presentation. MATERIALS AND METHODS: Pregnant women with breech presentation were grouped: spontaneous vaginal delivery (Group 1, n = 72) induced or augmented vaginal delivery (Group 2, n = 32), and cesarean delivery (Group 3, n = 253). Fetal complications were as follows: clavicle fracture, femur fracture, humerus fracture, brachial plexus injury, cephalic hematoma, pneumothorax, need for intensive care unit (ICU), and 5th minute APGAR <7. Maternal complications were as follows: vaginal hematoma, deep vaginal laceration, perineal injury (≥3rd degree), decline in hemoglobin level (>2 g/dL), and postpartum endometritis. Data were collected and analyzed retrospectively. RESULTS: The highest fetal complication rate was in Group 2, and the lowest in Group 3 (p = 0.001). Clavicle fracture was significantly less in Group 3 compared with the other groups (p = 0.024). The rate of lower APGAR scores at the 5th minute was similar in all groups. Maternal complications were significantly higher in Group 2 compared with the other groups (p = 0.001). Fetal complications were 5.66-fold higher in Group 1 than in Group 3 (p = 0.002). Fetal and maternal complications were 9.48-fold and 7.48-fold higher, respectively, in Group 2 than in Group 3 (p < 0.001). CONCLUSION: This study is the first in literature to have investigated and analyzed neonatal complications in breech delivery according to different delivery modes including induced vaginal delivery. Due to possible complications, the risks and benefits of a specific type of delivery should be considered in breech presentation.

Association between serum 25-hydroxyvitamin D levels and the presence and severity of striae gravidarum in primigravid women.

BACKGROUND: Striae gravidarum (SG) are a form of scarring on the skin observed during pregnancy and an important cosmetic problem. Vitamin D plays an important role in the skin. AIMS: To assess the association between serum 25-hydroxyvitamin D (25(OH)D) levels and the presence and severity of SG in primigravid women. METHODS: The study included 91 primigravid women at the gestational age of 36-41 weeks. Patients were examined and divided into two groups with respect to whether they had SG or not. Striae were scored using the numerical scoring system of Atwal et al. The serum 25(OH)D levels were evaluated. RESULTS: While 55 patients (60.5%) had SG, 36 (39.5%) did not. The mean serum 25(OH)D level of women with SG was 17.69 ± 9.81 ng/mL and of women without SG was 21.18 ± 11.71 ng/mL. There was no statistically significant difference between two groups (P = .144). Multivariate logistic regression analysis has shown that women who have normal values of serum 25(OH)D (≥30 ng/mL) have a lower risk of having SG than women who have scarce levels of serum 25(OH)D (<20 ng/mL) after adjusting for confounding factors (adjusted odds ratio = 0.18, 95% confidence interval: 0.04-0.72, P = .015). According to the results of the linear-by-linear test, the association between serum 25(OH)D levels and the severity of SG was not found significant (P = .82). CONCLUSIONS: This is the first study to show that having normal values of serum 25(OH)D is linked to a lower risk of having SG than scarce levels. Therefore, management of vitamin D deficiency might help prevent SG in primigravid women.

Expression profiles of candidate microRNAs in the peripheral blood leukocytes of patients with early- and late-onset preeclampsia versus normal pregnancies.

OBJECTIVES: Maternal leucocytes play an important role in the pathogenesis of preeclampsia (PE). Circulating microRNAs (miRNAs) are small, noncoding RNA molecules. The purpose of this study was to investigate miR-518b, miR-155-5p, and miR-21-3p in the peripheral blood leukocytes of patients with PE, compared to controls. STUDY DESIGN: Using real-time quantitative PCR method, the selected miRNAs which have been associated with PE were examined from early- onset PE (EOPE) (<34 weeks) (n = 48), late- onset PE (LOPE) (≥34 weeks) (n = 48), total cases of PE (n = 96), and healthy controls (n = 52). MAIN OUTCOME MEASURES: The relative expression of the target miR in patient samples was compared to the calibrator and the results were expressed as relative quantification values. RESULTS: Gestational age (GA) was significantly different between PE and controls. Univariate logistic regression analysis adjusted for GA at blood draw were fit to compare miR-518b, miR-155-5p, and miR-21-3p between PE and controls. The expression of miR-518b, miR-155-5p, and miR-21-3p were not significantly different in PE, compared to controls. The expression of miR-518b was upregulated in the EOPE and LOPE group, compared to controls, and the area under the receiver operating characteristic curve (AUC) of miR-518b was 0.65 and 0.62, respectively. miR-518b was positively correlated with WBC count, platelet count, serum levels of AST, ALT, LDH in EOPE. miR-21-3p expression level was negatively correlated with body mass index at blood draw and systolic blood pressure in the LOPE group. CONCLUSIONS: Increased miR-518b expression levels were found to be associated with EOPE and LOPE.

Differential expression of candidate circulating microRNAs in maternal blood leukocytes of the patients with preeclampsia and gestational diabetes mellitus.

OBJECTIVES: Preeclampsia (PE) is diagnosed in women presenting with new onset hypertension accompanied by proteinuria. Gestational diabetes mellitus (GDM) is the carbohydrate intolerance that can occur in pregnancy. Neutrophil activation is related to PE and GDM. Circulating microRNAs (miRs) are small, noncoding RNA molecules. The aim of this study was to verify the expression levels of three candidate miRs in blood leukocytes of the patients with PE, GDM, and PE-GDM compared to healthy controls. STUDY DESIGN: We selected miR-21-3p, miR-155-5p, and miR-16-5p which have been associated with GDM and PE. Using real-time quantitative PCR, the expression levels of miR-21-3p, miR-155-5p, miR-16-5p were analyzed in PE (n = 23), GDM (n = 19), PE, and GDM (n = 9) compared to healthy controls (n = 28). MAIN OUTCOME MEASURES: The relative expression of the target miR in patient samples was compared to the calibrator and the results were expressed as relative quantification values. RESULTS: There was a significant decrease in the expression levels of miR-21-3p in GDM and PE and miR-155-5p in PE group. No significant differences were observed in the expression levels of miRs in PE-GDM group. On receiving operator characteristic (ROC) analysis, areas under the curve (AUC) of the expression ratio of miR-21-3p in GDM was 0.73, and miR-21-3p, miR-155-5p in PE were 0.69 and 0.81, respectively. CONCLUSIONS: Our findings indicated that decreased miR-21-3p and miR-155-5p expression levels are associated with PE and miR-21-3p levels are associated with GDM. Our study for the first time revealed that miR-21-3p, miR-16-5p and miR155-5p are not related to PE-GDM group.

Why some pregnant women refuse glucose challenge test? Turkish pregnant women's perspectives for gestational diabetes mellitus screening.

OBJECTIVE: Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women's opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test. METHODS: This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT. RESULTS: Among women who were ≤28 weeks of gestation, 42.5% (n=82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n=79/193) pointed out their reluctance, and 16.6% (n=32/193) indicated that they had no opinion about the subject. Women who were ≤28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n=62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n=45/119) had GCT in the ongoing pregnancy, while 62.2% (n=74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n=37/74, 50%). CONCLUSION: This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.

The Usefulness of CD34, PCNA Immunoreactivity, and Histopathological Findings for Prediction of Pain Persistence After the Removal of Endometrioma.

Endometriosis is an estrogen-dependent inflammatory disease that causes infertility and chronic pelvic pain. Ovarian endometrioma is the most common form of endometriosis, and conservative surgery is the main preferred therapeutic approach for endometrioma-associated symptoms. The aim of this study was to investigate the persistence of cyclic and noncyclic pelvic pain (NCPP) after endometrioma excision and their relationship to clinical and histopathological findings. In this prospective observational study, 41 symptomatic patients were evaluated for the presence of pain symptoms 3 to 6 months after endometrioma excision. Tissue specimens of endometrioma were collected during the operation and embedded in paraffin. The persistence of pain was 41.4%. Surgical excision of endometrioma significantly decreased NCPP and dysmenorrhea, but not dyspareunia ( P < .0001, P = .0001, and P = .25, respectively). Histopathological changes, including depth of endometriosis penetration into the cyst wall, the presence of macrophage infiltration, and vascularity of endometrioma cyst walls were significantly higher in patients with pain persistence than in patients without pain persistence ( P = .0034, P = .0042, and P = .0007, respectively). Moreover, proliferating cell nuclear antigen (PCNA) and CD34 immunoreactivity in both glandular and stromal cells and vascular endothelium were significantly higher in patients with pain persistence ( P = .0079 and P = .0025, respectively). Additionally, these histopathological changes and PCNA and CD34 immunoreactivity were significantly correlated with the persistence of NCPP and dysmenorrhea. The discovered differences in patients with endometrioma with or without pain persistence may indicate a possible relationship between endometrioma-associated pain and histopathological variability of endometrioma.