Melatonin levels and microRNA (miRNA) relative expression profile in the follicular ambient microenvironment in patients undergoing in vitro fertilization process.

PURPOSE: Intrafollicular fluid (IFF) melatonin plays a decisive role in maintaining granulosa cells' DNA integrity and protects them against apoptosis. It reduces oxidative stress and improves the oocyte quality with a higher fertilization rate. METHOD: This prospective study investigated the antioxidant property of IFF melatonin and its impact on IVF outcome parameters. We also explored the relative expression of five microRNAs (miR-663b, miR-320a, miR-766-3p, miR-132-3p, miR-16-5p) and levels of cell-free DNA (cfDNA) by real-time PCR in unexplained infertile patients. We collected 425 follicular fluid (FF) samples containing mature oocytes from 295 patients undergoing IVF. RESULTS: Patients were subgrouped based on IFF melatonin concentration (group A ≤ 30 pg/mL, group B > 70 to ≤ 110 pg/mL, group C > 111 to ≤ 385 pg/mL). Our results showed that patients with ≤ 30 pg/mL IFF melatonin levels have significantly higher oxidative stress markers, cfDNA levels, and lower relative expression of miR-663b, miR-320a, miR-766-3p, miR-132-3p, and miR-16-5p compared to other subgroups (p < 0.001). Similarly, they have a low fertilization rate and a reduced number of high-quality day 3 embryos. CONCLUSION: Findings suggest that the therapeutic use of melatonin produces a considerable rise in the number of mature oocytes retrieved, fertilization rate, and good-quality embryo selection. Furthermore, miRNA signature enhances the quality of embryo selection, thus, may allow us to classify them as non-invasive biomarkers to identify good-quality embryos.

The predictive role of sTWEAK levels in pregnant women with first-trimester vaginal bleeding.

PURPOSE: To investigate the relationships of TNF-related weak inducer of apoptosis (sTWEAK), a cytokine related to the TNF superfamily, its newly described soluble receptor sCD163, and the sTWEAK/sCD163 ratio with perinatal outcomes in women with first-trimester vaginal bleeding. MATERIALS AND METHODS: Seventy (41 threatened abortion and 29 control) gestational-age-matched (6-14 weeks) pregnant women were included in the study. Antenatal complications (gestational diabetes, preeclampsia, intrauterine growth restriction, oligohydramniosis, polyhydramniosis), and perinatal outcomes (delivery mode, birth weight, delivery week) were recorded. Women with vaginal bleeding were divided into subgroups by pregnancy outcome (miscarriage or live birth) and subchorionic hematoma incidence. Statistical analyses were performed using the Student's t test, Mann-Whitney U test, chi-square test, and Pearson's correlation coefficient. p Values <.05 were considered as statistically significant. RESULTS: There were no statistically significant differences in sTWEAK or sCD163 levels, in sTWEAK/sCD163 ratios, or antenatal complications between threatened abortion and control patients. Higher sTWEAK levels were significantly correlated with higher rates of miscarriage in the threatened abortion group (p = .014). sCD163 levels were significantly lower in the subchorionic hematoma subgroup of the threatened abortion group (p = .043). CONCLUSIONS: sTWEAK levels may predict the risk of miscarriage in pregnant women with first-trimester vaginal bleeding.

The Effect of Coasting on Intracytoplasmic Sperm Injection Outcome in Antagonist and Agonist Cycle.

BACKGROUND: Coasting can reduce the ovarian hyperstimulation syndrome (OHSS) risk in ovulation induction cycles before intracytoplasmic sperm injection (ICSI). This study aimed to investigate the effect of gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols to controlled ovarian hyperstimulation (COH) cycles with coasting on the parameters of ICSI cycles and the outcome. MATERIALS AND METHODS: In a retrospective cohort study, 117 ICSI cycles were per- formed and coasting was applied due to hyperresponse, between 2006 and 2011. The ICSI outcomes after coasting were then compared between the GnRH agonist group (n=91) and the GnRH antagonist group (n=26). RESULTS: The duration of induction and the total consumption of gonadotropins were found to be similar. Estradiol (E2) levels on human chorionic gonadotropin (hCG) day were found higher in the agonist group. Coasting days were similar when the two groups were compared. The number of mature oocytes and the fertilization rates were similar in both groups; however, the number of grade 1 (G1) embryos and the number of transferred embryos were higher in the agonist group. Implantation rates were significantly higher in the antagonist group compared to the agonist group. Pregnancy rates/embryo transfer rates were higher in the antagonist group; however, this difference was not statistically significant (32.8% for agonist group vs. 39.1% for antagonist group, P>0.05). CONCLUSION: The present study showed that applying GnRH-agonist and GnRH-antago- nist protocols to coasted cycles did not result in any differences in cycle parameters and clinical pregnancy rates.

Effects of the etonogestrel contraceptive implant (Implanon®) on bone metabolism during lactation: a prospective study.

AIM: To evaluate the effects of the etonogestrel contraceptive implant (Implanon®) on bone metabolism in lactating women using markers for bone formation and resorption. STUDY DESIGN: This single-centre, prospective cohort study was conducted in Turgut Ozal University Medical Faculty Obstetrics and Gynecology Department with healthy lactating women aged between 24 and 38 years to compare the effect on bone metabolism of 6 months' use of either the implant or a non-hormonal contraceptive method. The study group (n=25) used an implant and the control group (n=25) used a non-hormonal contraceptive intrauterine device inserted 40 days' postpartum. Bone metabolism differences at the time of insertion and after 6 months were assessed quantitatively by biochemical analysis of serum and urine samples. RESULTS: At baseline, serum levels of bone metabolism parameters were similar for the two groups. In the implant group, serum alkaline phosphatase (ALP) levels decreased (p=0.004) and total protein levels increased (p=0.045) at 6 months. In the control group, serum levels of bone metabolism parameters did not change at 6 months compared to baseline. However, serum levels of phosphorus (p=0.013) and ALP (p=0.003) decreased at 6 months compared to baseline. CONCLUSION: Six months' postpartum use of Implanon was found to have no deleterious impact on bone turnover in healthy lactating women.

CRP, HbA1c, lipid, and biochemical parameters and their relation with maternal visceral adipose tissue and subcutaneous fat tissue thickness.

BACKGROUND/AIM: The aim of this study was to find whether maternal visceral tissue (VAT) or subcutaneous fat tissue (SCFT) thicknesses are associated with CRP, HbA1c, lipid, and biochemical parameters in the first trimester of pregnancy. MATERIALS AND METHODS: Ninety pregnant women were enrolled. Body mass index (BMI), VAT, and SCFT were measured. The best cut-off points for grouping subjects were found to be 4 cm for VAT and 2 cm for SCFT. Venous blood samples were collected. RESULTS: VAT was higher than 4 cm in all cases with high BMIs. High CRP and HbA1c were found in 45.5% and 18.2% of cases with VAT over 4 cm, respectively. CONCLUSION: Besides overall obesity, VAT thickness is the most important parameter. Decreasing obesity may prevent pathologies caused by inflammation during pregnancy as well as decrease the risk for future metabolic and cardiovascular disorders.

Adequate iodine levels in healthy pregnant women. A cross-sectional survey of dietary intake in Turkey.

OBJECTIVES: To assess current iodine levels and related factors among healthy pregnant women.  METHODS: In this cross-sectional, hospital-based study, healthy pregnant women (n=135) were scanned for thyroid volume, provided urine samples for urinary iodine concentration and completed a questionnaire including sociodemographic characteristics and dietary habits targeted for iodine consumption at the Department of Obstetrics and Gynecology, School of Medicine,Mugla Sitki Koçman University, Mugla, Turkey, between August 2014 and February 2015. Sociodemographic data were analyzed by simple descriptive statistics. RESULTS: Median urinary iodine concentration was 222.0 µg/L, indicating adequate iodine intake during pregnancy. According to World Health Organization (WHO) criteria, 28.1% of subjects had iodine deficiency, 34.1% had adequate iodine intake, 34.8% had more than adequate iodine intake, and 3.0% had excessive iodine intake during pregnancy. Education level, higher monthly income, current employment, consuming iodized salt, and adding salt to food during, or after cooking were associated with higher urinary iodine concentration.   CONCLUSION: Iodine status of healthy pregnant women was adequate, although the percentage of women with more than adequate iodine intake was higher than the reported literature.

Levels of thrombin-activatable fibrinolysis inhibitor and platelet-activating factor in recurrent pregnancy loss patients.

OBJECTIVE: The aim of this study was to investigate factors associated with thrombosis that may contribute to recurrent pregnancy loss (habitual abortion), specifically differences in serum levels of platelet-activating factor and thrombin-activatable fibrinolysis inhibitor (carboxypeptidase B2) between women with a history of recurrent miscarriage and those with no recurrent miscarriage history. MATERIALS AND METHODS: A case-controlled, prospective study design was adopted to compare women with a history of two or more first-trimester miscarriages (n = 42) with those with no history of recurrent miscarriage (n = 36). Participants were recruited from the Department of Obstetrics and Gynecology of Turgut Ozal University Hospital. Platelet-activating factor and thrombin-activatable fibrinolysis inhibitor levels in serum samples were measured by an enzyme-linked immunosorbent assay. RESULTS: Platelet-activating factor levels were significantly (p = 0.018) higher in the recurrent miscarriage group. There was no difference in levels of thrombin-activatable fibrinolysis inhibitor expression between the groups. CONCLUSION: Platelet-activating factor is significantly higher in serum of patients with a history of recurrent miscarriage than in those without such a history, with potential implications for placental function and fetal growth, which could be relevant to miscarriage recurrence. Larger studies are indicated to further examine these findings.

G-protein-coupled estrogen receptor-30 gene polymorphisms are associated with uterine leiomyoma risk.

The G-protein-coupled estrogen receptor (GPR30, GPER-1) is a member of the G-protein-coupled receptor 1 family and is expressed significantly in uterine leiomyomas. To understand the relationship between GPR30 single nucleotide polymorphisms and the risk of leiomyoma, we measured the follicle-stimulating hormone (FSH) and estradiol (E2) levels of 78 perimenopausal healthy women and 111 perimenopausal women with leiomyomas. The participants' leiomyoma number and volume were recorded. DNA was extracted from whole blood with a GeneJET Genomic DNA Purification Kit. An amplification-refractory mutation system polymerase chain reaction approach was used for genotyping of the GPR30 gene (rs3808350, rs3808351, and rs11544331). The differences in genotype and allele frequencies between the leiomyoma and control groups were calculated using the chi-square (χ2) and Fischer's exact test. The median FSH level was higher in controls (63 vs. 10 IU/L, p=0.000), whereas the median E2 level was higher in the leiomyoma group (84 vs. 9.1 pg/mL, p=0.000). The G allele of rs3808351 and the GG genotype of both the rs3808350 and rs3808351 polymorphisms and the GGC haplotype increased the risk of developing leiomyoma. There was no significant difference in genotype frequencies or leiomyoma volume. However, the GG genotype of the GPR30 rs3808351 polymorphism and G allele of the GPR30 rs3808351 polymorphism were associated with the risk of having a single leiomyoma. Our results suggest that the presence of the GG genotype of the GPR30 rs3808351 polymorphism and the G allele of the GPR30 rs3808351 polymorphism affect the characteristics and development of leiomyomas in the Turkish population.

Association between platelet indices and first trimester miscarriage.

We aimed to measure the effect of several potential risk factors on first trimester miscarriage. A total of 169 cases were included in the present study. Patients were selected from women who had first trimester miscarriage (n = 78) and controls were selected from the women who had given birth at term (> 37 weeks of gestation) to healthy infants (n = 91). Compared with the control group, in the miscarriage group gestational age (8.9 ± 2.8 weeks and 8.1 ± 2.2 weeks, respectively, P = 0.032), mean platelet volume (MPV) (8.8 ± 1 and 9.5 ± 1.1 fl, respectively, P < 0.001), plateletcrit (0.209 ± 0.03% and 0.241 ± 0.05%, respectively, P < 0.001), and platelet/lymphocyte ratio (128 ± 37 and 145 ± 60, respectively, P = 0.027) were significantly higher. Multivariate analysis showed that first trimester miscarriage development ratio was 1.909 times higher when MPV value was over 9.1 fl (P < 0.001); 9.147 times higher when plateletcrit value was over 0.219% (P = 0.022). Receiver operating characteristic analysis was performed to determine diagnostic MPV and plateletcrit values for first trimester miscarriage. MPV value greater than 9.1 fl determined miscarriage with 60% sensitivity and 65% specificity, while plateletcrit value greater than 0.219% determined miscarriage with 64.5% sensitivity and 64.7% specificity. MPV and plateletcrit values were strongly associated with first trimester miscarriage. Platelet indices can be used for prediction of fetal loss.

Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome.

PURPOSE: To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS). METHODS: PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment. RESULTS: The median 25(OH)D levels were 9.40 (range 4.40-24.50) µg/l and 7.00 (5.00-13.50) µg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055). CONCLUSION: This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.

Serum Copeptin, Pentraxin 3, Anti-Mullerian Hormone Levels With Echocardiography and Carotid Artery Intima-Media Thickness in Adolescents With Polycystic Ovary Syndrome.

BACKGROUND: The aim of the study was to investigate the presence of possible markers in the prediction of polycystic ovary syndrome (PCOS)-related metabolic alterations and cardiovascular events in adolescent PCOS cases and also to investigate the applicability of anti-Mullerian hormone (AMH) levels for the diagnosis of PCOS. METHODS: In this cross-sectional study, a total of 75 non-obese women (adolescent PCOS group, n = 25; adult PCOS group, n = 25; control group, n = 25) were included. Measurements of copeptin, pentraxin 3 (PTX3), and AMH serum levels were performed. RESULTS: Serum copeptin, PTX3 and echocardiographic indices were not significantly different in PCOS subjects and they did not have higher common carotid artery intima-media thickness (CIMT) measurement. AMH levels were significantly higher in PCOS patients. There was a positive correlation between AMH and mean ovarian volume (r = 0.58, P < 0.001) and between AMH and total testosterone level (r = 0.63, P < 0.001). In order to predict a threshold value for the diagnosis of PCOS by using AMH, the receiver operating characteristic (ROC) method was used. Area under the curve was 0.820 and cut-off point was 6.66 ng/mL for AMH with a sensitivity of 62% and specificity of 76%. CONCLUSIONS: Possible markers for PCOS-related metabolic alterations may not present in the adolescent years. Serum AMH may be useful as a diagnostic test for adolescents.

Is the level of maternal serum prohepcidin associated with preeclampsia?

OBJECTIVE: The objective of the study was to compare pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), C-reactive protein (CRP), IL-6 and iron status parameters in preeclamptic (PE) and healthy pregnant women, and to examine the relationship between serum pro-hepcidin levels and iron parameters of preeclampsia (PE). METHODS: In a prospective controlled study, we collected serum from women with normal pregnancy (n = 37) and from women with PE (n = 30) at the Department of Obstetrics and Gynecology at Turgut Ozal University between February 2010 and January 2013. Pro-hepcidin, hemoglobin (Hb) concentration, hematocrit (Hct), CRP, IL-6 and iron status parameters were measured in all patients and compared between groups. RESULTS: Levels of serum prohepcidin in PE and control groups were similar and amount 69.4 ± 19.7 and 71.9 ± 22.1 ng/ml, respectively. The difference was not statistically significant (p: 0.694). On the other hand, the study group had a statistically lower iron binding capacity (IBC), total iron binding capacity, transferin, total protein, albumin levels (p < 0.05). No significant differences were found among prohepcidin, Hb concentration, Hct, iron, ferritin, IL-6, urea and creatine in both the groups. CONCLUSION: In pregnancies complicated by PE with normal values of hemoglobin and hematocrit, serum prohepcidin concentrations are similar to those observed in healthy pregnant women. The analysis revealed no significant correlations between prohepcidin level and serum iron, serum ferritin or transferrin in the PE.

Do the first, second and third trimester maternal serum hepcidin concentrations clarify obstetric complications?

OBJECTIVE: To evaluate whether first, second, and third-trimester maternal serum hepcidin levels are different in pregnancies with and without adverse pregnancy outcomes (APO). METHODS: A 165 nullipar pregnant women were included in this prospective cohort study. Serum hepcidin, ferritin, IL-6, C-reactive protein (CRP) and Hb values were measured at 11-14, 24-28, and 30-34 weeks of gestation. The relation between these parameters and APO and neonatal outcomes were investigated. Preterm delivery, intrauterine growth restriction, pre-eclampsia, gestational hypertension and placental abruption were determined as adverse pregnancy outcomes. RESULTS: The risk of APO was three times higher in women with high IL-6 levels in the second trimester. High hepcidin levels in the second trimester were associated with a 1.6 times increased risk of APO. Newborns of women with high IL-6 levels in the third trimester had a 1.6-fold increased risk of neonatal complications. High ferritin levels in the third trimester were associated with minimally increased risk of neonatal complications. CONCLUSIONS: Mean serum hepcidin levels were similar in all pregnant women, however, elevated second trimester serum hepcidin and IL-6 levels were associated with a higher risk of APO and high third trimester hepcidin, ferritin and IL-6 levels were associated with higher risk of neonatal complications.

Changes of sFas and sFasL, oxidative stress markers in serum and follicular fluid of patients undergoing IVF.

PURPOSE: The Fas-Fas Ligand interaction is one of the essential events for the induction of apoptosis whereas the exact role of their soluble forms in the reproductive system is still not fully understood. Also oxidative stress in the pathogenesis of infertility causing diseases in women and has been suggested as one of the important factors that negatively affect IVF outcome. In this study, our aim was to evaluate serum and follicular fluid levels of soluble Fas soluble Fas Ligand, malondialdehyde, superoxide dismutase and total antioxidant capacity in patients undergoing IVF and compared with controls. METHODS: This study included 109 patients. Patients were classified as unexplained infertility (N = 31), PCOS (N = 19), tubal factor (N = 9) and endometriosis (N = 10) and compared with male factor infertility (N = 40) that was the control group. sFas and sFasL levels were measured by immunoassay method. MDA, SOD and TAC levels were measured by colorimetric method. RESULTS: Patients with unexplained infertility, PCOS and tubal factor had significantly lower sFas levels compared with their controls (respectively, p < 0.01, p < 0.05, p < 0.05). However, SOD activity in unexplained infertility, PCOS and endometriosisgroupswere significantly higher than control group (p < 0.01).Decreased follicular fluid TAC levels were found in all patient groups compared with controls (respectively, p < 0.01, p < 0.05, p < 0.01, p < 0.01).Patients with tubal factor had significantly higher serum sFasL (p < 0.05), but lower follicular fluid sFasL levels (p < 0.05) compared with unexplained infertility. Tubal factor and endometriosis groups had lowerfollicular fluid TAC levels compared to unexplained infertility and PCOSgroups (p < 0.01). CONCLUSION(S): In this study, serum and follicular fluid sFas levels were decreased and antioxidant activity was impaired in infertility, possibly implying increased apoptosis. Especially in unexplained infertility group changes in this parametres more remarkable.

Relation between abdominal subcutaneous fat tissue thickness and inflammatory markers during pregnancy.

INTRODUCTION: Subcutaneous abdominal fat thickness (SCFT) is important for predisposition to metabolic and cardiovascular diseases. Our aim was to evaluate maternal SCFT and metabolic changes (such as insulin resistance and high inflammatory markers) during pregnancy. MATERIAL AND METHODS: A total of 92 pregnant women between 24-28 weeks of gestation were enrolled in the study. The SCFT was measured by ultrasonography and patients were divided into 2 groups according to thickness of maternal SCFT and body mass index (BMI). Groups were compared with each other for oral glucose loading test (OGL) results, and for haematological, biochemical and fetal biometric parameters. RESULTS: After analysis of frequency for SCFT, the most appropriate cut-off value for grouping patients was found to be 15 mm for SCFT. In 48 cases SCFT was over 15 mm. High C reactive protein (CRP) was found in 47.9% (23) of cases with SCFT over 15 mm. Serum haemoglobin A1c (HbA1c) level was significantly correlated with SCFT thickness. The most important factors for determination of OGL level were found to be serum HbA1c level, BMI and SCFT. In obese subjects (BMI ≥ 25 kg/m(2)), levels of inflammatory markers and SCFT thickness were higher. The CRP and γ-glutamyltransferase (GGT) levels were significantly correlated with BMI and SCFT. CONCLUSIONS: High SCFT during pregnancy is associated with elevated inflammatory marker levels and HbA1c. Pregnant women with thicker SCFT may be susceptible to the development of metabolic complications of pregnancy, such as gestational diabetes mellitus (GDM) and hypertension, as well as risk of future metabolic and cardiovascular disease.

Totally inverted cervix due to a huge prolapsed cervical myoma simulating chronic non-puerperal uterine inversion.

INTRODUCTION: Inversion of the uterus is an extremely rare complication of the non-puerperal period and is commonly caused by benign submucous, especially fundal, leiomyomas. A case of a totally inverted cervix due to a prolapsed huge cervical leiomyoma mimicking chronic non-puerperal uterine inversion in a perimenopausal woman is presented. PRESENTATION OF CASE: A 52-year-old perimenopausal woman was admitted to our clinic with an ulcerated, necrotic, infected and swollen prolapsed mass. Gynecologic history revealed that she was advised myomectomy because of her cervical myoma 2 years ago but she refused to have an operation as she believed that her positive thoughts would shrink the myoma. Presumed diagnosis before surgery was chronic non-puerperal uterine inversion. An intraoperative diagnosis was totally inverted cervix due to a huge cervical leiomyoma. Vaginal hysterectomy without adnexectomy, was performed. CONCLUSION: This is the first case in the literature which a totally inverted cervix due to a prolapsed huge cervical leiomyoma. Cervical fibroids can grow in perimenopausal period and in extremely rare cases can cause total cervical inversion.

Does vitamin E prevent tubal damage caused by smoking? A light microscopy and animal study.

OBJECTIVE: To assess the histomorphological effects of smoking on the cilia of fallopian tubes in mice and the effect of vitamin E on the negative effects of smoke. STUDY DESIGN: Eighteen 12-14 week-old Swiss albino type female mice were randomly divided into three groups, each consisting of six mice: Group A: control group; Group B: mice exposed to cigarette smoke; Group C: mice exposed to cigarette smoke together with vitamin E. Groups B and C were exposed to cigarette smoke for 10 weeks. After 10 weeks, tubal excision was performed in all animals. Histopathologic examination of excised tubal tissue was conducted under light microscopy. RESULTS: The number of cilia was significantly lower in Group B. Although not statistically significant, the median number of cilia in Group C was measured to be higher than in Group B but lower than in Group A. CONCLUSION: Based on the results, it can be concluded that smoking decreases tubal cilia numbers. Supplementation by vitamin E may treat or at least help to slow down the decrease in number of cilia caused by smoking; therefore it could be used therapeutically in the treatment of smoking-related tubal damage.

Transcervical intrauterine levobupivacaine or lidocaine infusion for pain control during endometrial biopsy.

BACKGROUND: Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction. OBJECTIVES: To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double-blinded trial in pre- and postmenopausal women. METHODS: Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged. RESULTS: Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group. CONCLUSION: Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intrauterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.

Relation between serum PAPP-A level and umbilical cord thickness during first trimester of pregnancy.

PURPOSE: To evaluate the relation between umbilical cord diameter versus pregnancy associated plasma protein-A (PAPP-A) level in first trimester women. METHOD: Cord diameter were measured and patients were divided into two groups according to frequency distribution analysis as below or above 3.7 mm for free loop diameter (FCD) and below or above 3.4 mm for cord measurement at umbilicus (ACD). Groups were compared with each other. RESULTS: Strong correlations were found between ACD versus PAPP-A. CONCLUSION: By using strong correlation between ACD versus PAPP-A, it may be possible to reduce unnecessary amniocentesis due to false positive screening results.

Hepcidin, iron status, and inflammation variables among healthy pregnant women in the Turkish population.

PURPOSE: To investigate hepcidin levels in each trimester and their association with other haematological variables and inflammation markers during normal pregnancy among low-risk pregnant women in rural Turkey. METHOD: The series comprised 103 healthy Turkish primigravida women with a normal pregnancy. Blood samples were obtained at 11-14, 24-28 and 30-34 weeks of gestation. Haemoglobin, hematocrit, red cell indices, white blood cell count, platelet count, iron status indicators (plasma iron, transferrin, ferritin levels and iron binding capacity), serum hepcidin, interleukin-6 and C-reactive protein levels were analysed. The proportions were compared using Pearson's χ2 test or Friedman's test. RESULTS: The mean serum hepcidin concentrations at 11-14, 24-28 and 30-34 weeks of gestation were as follows: 7.8 ± 3.4 ng/mL, 8.6 ± 3.1 ng/mL and 7.3 ± 3.0 ng/mL, respectively. The mean serum ferritin concentrations with median values at each trimester were 14.2 (11.5), 9.5 (8.8) and 11.2 (9.3), respectively. The mean serum CRP values at each trimester were 5.1 (4.0), 5.5 (4.6) and 6.0 (5.5), respectively. The serum hepcidin levels were not related to iron status or the haemoglobin, IL-6 or C-reactive protein levels. CONCLUSIONS: There was no association between serum hepcidin and serum ferritin, IL-6 or CRP concentrations in each trimester among low-risk pregnant women.