Association Between Plasma Sclerostin Levels and Body Mass Index in Women With Polycystic Ovary Syndrome.

Background Polycystic ovary syndrome (PCOS) is recognized as one of the most common endocrine pathologies in females of reproductive age worldwide. This study investigated the relationship between serum sclerostin levels and body mass index (BMI) in women with PCOS. Methods Women aged 18-40 years who presented to our clinic between January 1, 2019, and January 1, 2020, and were diagnosed with PCOS were included in this study. The patients' clinical and laboratory data were recorded, and waist circumference, hip circumference, and BMI values were calculated. The patients with a BMI of >25 kg/m2 were evaluated as Group I, those with a BMI of <18.5 kg/m2 as Group II, and those with a BMI of 18.5-25 kg/m2 as Group III. Serum sclerostin levels were compared between the BMI groups. Results The study included 90 patients. The mean BMI values were 32.2±2.1, 17.0±0.9, and 22.9±2.1 kg/m2 for Groups I, II, and III, respectively. We detected a statistically significant difference in serum sclerostin levels between Group II and Group I (p<0.005). There was a significant, positive correlation between the sclerostin level and BMI (r=0.258, p=0.014), weight (r=0.237, p=0.044), waist measurement (r=0.225, p=0.045), and hip measurement (r=0.225, p=0.033). Conclusion This study revealed that abnormal body composition in PCOS could alter circulating sclerostin levels.

Effect of obesity on the time to a successful medical abortion with misoprostol in first-trimester missed abortion.

OBJECTIVE: To evaluate the efficacy of misoprostol used in first-trimester abortion in obese women and to determine whether obesity is associated with time to a successful medical abortion. METHODS: The records of patients diagnosed with missed abortion at our clinic between 2018 and 2021 were retrospectively reviewed. All women aged 18 to 45 years who were diagnosed with missed abortion in the first trimester and treated with misoprostol were included in the study. The cases were divided into two groups: obese (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2). First, they were simultaneously administered 200 µg misoprostol orally and 400 µg vaginally. After the first misoprostol administration, the dose was repeated vaginally at 400 µg every three hours if necessary. The effect of obesity on the time taken to achieve a medical abortion was evaluated. RESULTS: A successful medical abortion occurred in 45.2% of the women in the obese group and 69.0% of those in the non-obese group. The time to uterine evacuation was 8.24 ± 4.03 h in the obese group and 6.35 ± 3.54 h in the non-obese group. The relationship between obesity and time to a successful medical abortion was evaluated using the Kaplan-Meier curve, which showed a significant difference between the two groups (p = 0.028). CONCLUSION: Our findings show that obesity affects time to a successful medical abortion. In addition, the rate of successful medical abortion after misoprostol administration was lower in the obese women.

Drug-induced poisoning during pregnancy: Four-year experience.

OBJECTIVE: The aim of this study was to define the population of pregnant women who presented to our clinic after drug exposure for suicidal purposes and to determine the effect of drug-induced poisoning on maternal and fetal outcomes. METHODS: The records of patients who presented to the emergency department after a suicide attempt with drugs between 2017 and 2021 were retrospectively reviewed. Pregnant women aged 18 years and over who delivered their babies in our hospital were included in the study. Patient data were obtained from the hospital electronic database using the International Classification of Disease-10 code system. Demographic information, clinical characteristics, type of drugs ingested, pregnancy outcomes, and perinatal outcomes were recorded. RESULTS: We found adverse pregnancy outcomes in five of the 28 patients included in the study. The most frequently used drugs for suicidal purposes were non-opioid analgesics, paracetamol, and antibiotics (39.3%, 35.7%, and 28.6%, respectively). Adverse pregnancy outcomes observed in the patients were preterm birth (n = 3), preeclampsia (n = 2), premature rupture of membranes (n = 1), fetal distress (n = 2), small for gestational age (n = 2), Apgar score at 5 min < 7 (n = 1), and requirement of neonatal intensive care (n = 2). CONCLUSION: Pregnant women attempting suicide with drug exposure are at high risk of many adverse obstetric outcomes. Providing these patients with appropriate clinical care is critical for the health of the mother and fetus.

The role of serum netrin-1 level in the detection of early-onset preeclampsia.

OBJECTIVE: To investigate whether serum netrin-1 levels measured in hypertensive pregnant women could predict the development of early-onset preeclampsia (EOP). METHODS: This prospective observational study was conducted at a single academic medical center between August 1, 2019, and July 31, 2021. The study included patients aged >18 years who presented to our clinic because of gestational hypertension at gestational weeks 20-24 and underwent serum netrin-1 level measurements. All the patients were followed up until delivery for the development of preeclampsia. The patients were divided into two subgroups: those who developed EOP and those who developed late-onset preeclampsia (LOP). RESULTS: Ninety-seven patients and 45 healthy controls were included in the study. EOP and LOP developed in 43 (44.3%) and 54 (55.7%) of the patients, respectively. The mean serum netrin-1 level at the time of presentation was significantly higher in the EOP group than in the control group (916.8 ± 370.5 pg/mL vs 487.7 ± 220.4 pg/mL; p < 0.001). A multivariate logistic regression analysis revealed that high serum netrin-1 level (odds ratio: 6.02, 95% confidence interval [CI]: 2.45-18.20, p = 0.001) was an independent predictor of EOP. Serum netrin-1 levels >784.9 pg/mL predicted the development of EOP with a sensitivity of 72.0% (95% CI: 56.3-84.7%) and specificity of 88.8% (95% CI: 75.9-96.3%). CONCLUSION: High serum netrin-1 levels were significantly associated with the development of EOP. The initial serum netrin-1 level may be useful for determining the risk of developing EOP in women with gestational hypertensive disorder.

Effect of calcium and vitamin D supplementation on the clinical, hormonal, and metabolic profile in non-obese women with polycystic ovary syndrome.

BACKGROUND: In this study, we investigated the effect of calcium and vitamin D (Ca/Vit D) supplementation on the clinical, hormonal, and metabolic profile of patients with low vitamin D levels. In addition, we investigated the effect of Ca/Vit D supplementation on asymmetric dimethylarginine (ADMA) level in patients with polycystic ovary syndrome (PCOS). METHODS: In total, 75 patients aged 19-35 years, with a normal body mass index and a diagnosis of PCOS and Vit D deficiency/insufficiency, were included in the study. Patients received 50,000 IU of vitamin D3 once a week for 8 weeks. Afterward, 2500 mg calcium carbonate equivalent to 1000 mg calcium ion and 9.68 mg cholecalciferol equivalent to 880 IU vitamin D3 were administered orally as a maintenance treatment once a day. RESULTS: The mean age of the patients was 21.7 ± 3.5. After Ca/Vit D supplementation, Vit D levels significantly increased compared to baseline (8.6 ng/ml) levels. An increase in SHBG levels (p < 0.001), a decrease in total testosterone, FAI (p = 0.042), and ADMA levels (p < 0.001) were observed in the first and third months compared to the onset. Significant improvement compared to baseline was observed in menstrual irregularity and median mFG score. CONCLUSION: Ca/Vit D supplementation can improve PCOS symptoms such as menstrual dysfunction, hirsutism, and hyperandrogenism. It may be effective in reducing the risk of cardiovascular disease in patients with PCOS later in life by decreasing ADMA levels, which is an indicator of endothelial dysfunction.

Prognostic capacity of inferior vena cava diameter for severe postpartum hemorrhage.

PURPOSE: This study sought to evaluate whether or not the sonographic measurement of the inferior vena cava (IVC) diameter predicts severe bleeding in women with postpartum hemorrhage (PPH). It further compared the efficacy of the IVC diameter, shock index, and serum lactate levels in this prediction. METHODS: This prospective study included female patients with ≥500 mL of bleeding after vaginal delivery between September 1, 2019 and May 31, 2021. The IVC diameter during inspiration (IVCmin) and expiration (IVCmax), shock index and serum lactate levels of the patients were measured. The patients were divided into two groups according to the postpartum vaginal blood loss [non-severe PPH and severe PPH (SPPH)]. After multivariate logistic regression analysis revealed the significant parameters, we constructed the receiver operating characteristic (ROC) curves to determine their power in predicting SPPH. RESULTS: Of the 201 patients included in the study, SPPH developed in 21.4% of the population, while non-severe PPH occurred in 78.6%. The area under the curve (AUC) values ​​of shock index, lactate, IVCmin and IVCmax for SPPH prediction were 0.772, 0.791, 0.851 and 0.874, respectively. According to the ROC analysis, at the cut-off value of 7.3 mm, IVCmax had 90.7% sensitivity and 70.8% specificity in predicting SPPH. IVCmax was independently associated with SPPH (Odds ratio: 0.74, 95% CI: 0.63-0.86). CONCLUSION: We found that the ultrasonographic measurement of IVC diameter is more valuable than the shock index and lactate parameters in the early detection of SPPH. Therefore, IVC diameter may be a useful prognostic marker for SPPH.

Predictors of obstetric complications following traumatic injuries in pregnancy.

BACKGROUND: After a traumatic injury, the provision of appropriate, timely care to pregnant women jury is crucial for the health of both the mother and fetus. The aim of this study was to identify risk factors predicting post-traumatic obstetric complications in pregnant women who presented to the emergency department (ED) with traumatic injuries. METHODS: We conducted a retrospective cohort study of pregnant women aged 18 y and older who were admitted to the trauma unit of our ED between 2017 and 2020. The data collected included maternal demographics, trauma mechanism, and pregnancy outcome. The patients were divided into two subgroups according to the presence or absence of trauma-related complications, and clinical features were compared between the two groups. RESULTS: In total, 241 pregnant trauma patients were included in the study. The mean maternal age was 26.1 ± 4.4 y, and the mean gestational age the time of the trauma was 28.4 ± 6.8 wk. In the study, 17.8% (43/241) of patients experienced obstetric-related complications within the first 24 h post-trauma. The risk factors associated with obstetric complications were aged older than 35 y (odds ratio [OR] = 5.31,95% confidence interval [CI]: 1.77-15.96, p = 0.003), third trimester trauma (OR = 2.41,95% CI:1.14-5.12, p = 0.021), and abnormal obstetric ultrasonography (OR = 6.25,95% CI:2.03-19.22, p = 0.001). CONCLUSION: Among pregnant patients who present to the ED after a traumatic injury, advanced maternal age, trauma in the third trimester, and abnormal obstetric ultrasonography findings should alert physicians to the possibility of post-traumatic complications (within the first 24 h after trauma) and the need for close monitoring.