The changes in fear of childbirth in pregnancy during and before the COVID-19 pandemic.

We aimed to investigate how factors such as age, education level, planned delivery method and fear of childbirth were affected in pregnant women before and during the pandemic. This cross-sectional study compared a pre-pandemic pregnant group (July 2019 and December 2019) and a pandemic group (November 2020 and May 2021) of patients at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital. A total of 696 pregnant women in their second trimester were included in the study. All of them were literate and voluntarily agreed to participate in the study. Data were collected with the Wijma delivery expectancy/experience questionnaire (WDEQ-A), and the outpatient doctor asked the questions face-to-face. The mean age of the pregnant women participating in the study was 31.6 ± 6.8 years. While the total Wijma score was 62.1 ± 25.1 in the pre-pandemic group, it was 61.3 ± 26.4 in the pandemic group, and there was no significant difference between the two groups (p = 0.738). Upon analyzing the fear of childbirth among groups based on education level, no statistically significant differences were observed between the pre-pandemic and pandemic periods within any of the groups. While 25.7% (n = 179) of all participants had a normal fear of childbirth, 22% (n = 153) had a mild fear of childbirth, 27% (n = 188) had a moderate fear of childbirth, and 25.3% (n = 176) had a severe fear of childbirth (Wijma score of 85 and above). When the pre-pandemic and the pandemic period were compared, the fear of childbirth was unchanged in pregnant women at all education levels (p = 0.079, p = 0.957, p = 0.626, p = 0.539, p = 0.202). When comparing fear of childbirth before and after the pandemic, it was found that patients with a high school education level have a significantly higher fear of childbirth. To alleviate the fear of childbirth in pregnant women who have completed high school, training or psychosocial support interventions may be prioritized.

Role of the systemic immune-inflammation index in threatened abortion patients and predicting of abortion.

PURPOSE: Our study aimed to compare the systemic immune inflammation index (SII), one of the hematological inflammation parameters, between pregnant women diagnosed with threatened abortion (TA) and healthy pregnant women, and to evaluate the prediction of abortion in pregnant women with TA. METHODS: This retrospective study compared 150 patients with TA group and 150 age- and gestational week-matched healthy pregnant women (control group). Complete blood count parameters were assessed. SII, white blood cells (WBC), neutrophil to lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), platelet distribution width and monocyte to lymphocyte ratio (MLR) values were calculated. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). RESULTS: SII, NLR, MLR, WBC, RDW, and PCT values were significantly higher in the TA group compared to the control group (923 ± 683 vs. 579 ± 364 [p < 0.001], 3.3 ± 2.0 vs. 2.1 ± 1.1 [p < 0.001], 0.3 ± 0.1 vs. 0.2 ± 0.2 [p < 0.001], 9.84 ± 2.87 vs. 8.6 ± 1.6 [p < 0.001], 13.9 ± 1.9 vs. 14.4 ± 2.3 [p = 0.032] and 0.3 ± 0.1 vs. 0.2 ± 0.0 [p < 0.001], respectively). Using receiver operating characteristics curve analysis to predict abortion in AI patients, the highest area under the curve was found for SII (0.727 for SII and 0.666 for NLR). CONCLUSION: SII, NLR, MLR, RDW, and platelet to lymphocyte ratio (PLR) levels were significantly increased in patients with TA. This study supports the idea that several inflammatory pathways may play an important role in the pathogenesis of this disorder. SII may be a much better marker than NLR and PLR for predicting the inflammatory status of the disease and abortion in an ongoing pregnancy.

Ultrasonographic Imaging of the Fetal Pyloric Sphincter.

OBJECTIVES: In this study, we hypothesized that the pyloric sphincter can be directly visualized by ultrasonography in the prenatal period. METHODS: This study was designed as a cross-section. Single, healthy pregnancies between 18 and 22 weeks of gestation who applied to the Perinatology outpatient clinic for second-level ultrasonography were included in the study. In addition to the demographic characteristics of the participants, fetal pyloric mucosa, fetal pyloric sphincter length, and fetal pyloric sphincter thickness were measured by ultrasonography. Intrarater variability was calculated. RESULTS: A total of 93 eligible patients were evaluated in the study. The mean age of the participants was 27.25 ± 6.23, and the gestational age was 21.18 ± 0.98. Pylorus imaging and measurements were possible in all fetuses that were in the optimal position. Mean pyloric sphincter length (mm) was 5.32 ± 0.93, pyloric sphincter thickness (mm) was 2.13 ± 0.44, and sphincter muscle thickness (mm) was 1.05 ± 0.24. CONCLUSIONS: The pyloric sphincter can be easily visualized on a second-trimester ultrasound scan when the appropriate technique is used. This may make an additional contribution to the diagnosis of fetal gastrointestinal tract pathologies.

Does wearing double surgical masks during the COVID-19 pandemic reduce maternal oxygen saturation in term pregnant women?: A prospective study.

PURPOSE: This study aimed to compare the effects of using single and double surgical masks (SM) on maternal oxygen saturation in pregnant women. METHODS: In this prospective study, single or double SM were worn by term pregnant women who applied for routine controls. The vital signs of the participants such as oxygen saturation, pulse, respiratory rate, fever, systolic and diastolic blood pressure were measured at admission and 30 min later. RESULTS: There were 223 participants in the single SM group and 231 participants in the double SM group. Thirty minutes after putting on the mask, there was no significant difference in the proportion of patients whose oxygen saturation fell below 95 (3.6 vs 5.6%, p = 0.301). No significant difference was observed between the admission and 30 min oxygen saturation levels of the pregnant women in the single SM group. However, maternal oxygen saturation after 30 min of the pregnant women in the double SM group was significantly lower (97.4 ± 1.1 vs 96.6 ± 1.3, p < 0.001). No significant changes were observed in the vital signs of either groups. CONCLUSION: When using double SM, oxygen saturation is significantly reduced compared to pre-mask values. Nevertheless, it seems difficult to say that these decreases have clinical significance.

Ultrasonographic Imaging of the Fetal Duodenal Tract.

OBJECTIVES: To investigate whether fetal duodenal tract sections can be visualized in the prenatal ultrasonographic examination. METHODS: This study was designed in cross-section. Healthy singleton pregnant women who applied to the perinatology outpatient clinic for second-level ultrasound scanning between September 2020 and February 2021 were included in the study. Demographic information of the participants was obtained and an ultrasound scan was performed. The fetal duodenal tract was evaluated in three sections, including the pylorus. The fetal duodenal tract was differentiated from adjacent organs by its anatomical location, hyperechoic nature, and presence of fluid in the lumen. RESULTS: A total of 278 eligible participants between 18 and 22 weeks of gestation were evaluated. While the fetal pylorus was closed in 76.6% of the participants, it was open in 23.4%. Duodenum pars superior, pars descendens, and pars inferior imaging rates were 99.3%, 98.2%, and 95.7%, respectively. It was possible to distinguish these parts from neighboring organs by 99.6%, 100%, and 100%, respectively. While the first, second, and third parts of the duodenum were observed as solid in 42.0%, 58.2%, and 52.2%, respectively, 57.9%, 41.7%, and 47.7% had fluid in the lumen. CONCLUSION: The fetal duodenal tract can be viewed with prenatal ultrasonography in pregnant women who are not in a dorsoanterior position. This may make an additional contribution to the diagnosis of duodenal obstructions, which is the most common cause of intestinal atresia in prenatal screening.

The relationship between inflammation markers and ketonuria in hyperemesis gravidarum.

OBJECTIVE: Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients. MATERIAL AND METHODS: This retrospective case control study was conducted at Kütahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients' demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated. RESULTS: MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001). CONCLUSION: Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.

Peripartum hemorrhage and other obstetric and neonatal outcomes in pregnant women with epilepsy: A single-center study.

OBJECTIVE: There are inconsistent results in different studies on maternal and fetal complications of pregnant women with epilepsy (PWWE). The differences may be in part due to racial characteristics. The aim of this study was to investigate if there is an increase in obstetric and neonatal complications, especially postpartum hemorrhage, in pregnant women with epilepsy in the Turkish population. METHODS: In a tertiary center, PWWE and the control group were compared in terms of obstetric and neonatal complications as well as postpartum hemorrhage. Among 46,789 deliveries, 154 eligible PWWE were matched 1: 3 with the control group. RESULTS: There was no increase in the possibility of peripartum hemorrhage and blood transfusion in PWWE. However, the probability of cesarean delivery was higher in PWWE (adjusted OR: 3.24 CI: 1.95-5.42, p < 0.001). Moreover, an increase in the possibility of fetal growth restriction, fetal death, admission to the neonatal intensive care unit and lower APGAR scores were found in PWWE. CONCLUSION: Although the risk of peripartum hemorrhage does not appear to be increased in PWWE, cesarean rates and fetal complications do increase. There is also a need for prospective studies examining long-term neonatal outcomes in pregnancies complicated by epilepsy.

Does mild thrombocytopenia increase peripartum hemorrhage in elective cesarean deliveries? A retrospective cohort study.

OBJECTIVE: To investigate the effect of mild thrombocytopenia (platelet count: 100 000-149 000/µl) on peripartum hemorrhage in elective cesarean deliveries. METHODS: This study was conducted between January 2018 and May 2019 in a hospital, located in Konya, Turkey. Uncomplicated pregnancies undergoing elective cesarean section were included. Of 1992 eligible patients, 201 women were determined as the mild thrombocytopenia group, 48 women as the severe thrombocytopenia group, and 1743 women as the control group. The estimated blood loss volume (EBLV), the need for blood transfusion, and excessive blood loss rates were compared among groups. Logistic regression analysis was performed for potential confounding factors. RESULTS: The EBLV and excessive blood loss ratios were significantly higher in the mild thrombocytopenia group compared with the control group (P < 0.001 and P < 0.05, respectively). There was no significant difference between the mild thrombocytopenia and control groups in terms of the number of patients receiving a blood transfusion. The probability of excessive blood loss was significantly higher in the mild thrombocytopenia group, even after adjusting the odds ratio for confounding factors (adjusted odds ratio 1.94, 95% confidence interval 1.27-2.95, P = 0.002). CONCLUSION: Mild thrombocytopenia appears to increase the likelihood of peripartum hemorrhage in elective cesarean deliveries in uncomplicated pregnancies.

The value of measuring cervical length between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy.

OBJECTIVE: The aim of this study was to investigate the value of measuring cervical length (CL) between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy. METHODS: In this prospective longitudinal study, pregnant women whose CL was measured between 24 and 28 weeks were followed until delivery. The CL was adjusted for confounders and the results are presented using odds ratio and receiver operating characteristic curve (ROC). RESULTS: A total of 874 women met the inclusion criteria. The median value of CL measured between 24 and 28 weeks was 34.0 mm (30.0-38.0 25%, 75% interquartile range). The risk of late and post-term pregnancy was 5.8 times higher in pregnant women with a CL above 35 mm between the 24 and 28 weeks of gestation (95% CI: 2.65-12.94 adjusted OR = 5.8, p < .001). For pregnancies exceeding the 38th week, it was observed that the duration of the gestation increases as CL values increase. CONCLUSIONS: In this study, it has been demonstrated that measuring the CL between 24 and 28 weeks of gestation can predict late and post-term pregnancy. Prolonged pregnancy may cause neonatal and fetal complications and anxiety. CL measurement performed in these weeks can help prepare pregnant women for a possible prolonged pregnancy and cope with prolonged pregnancy anxiety.

Effect of previous cesarean sections on second-trimester uterine artery Doppler.

AIM: In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. METHODS: This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. RESULTS: The mean uterine artery pulsatility index (PI) MoM value was 1.18 ± 0.40 in the study group and 1.07 ± 0.35 in the control group (P = 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P = 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 ± 1.3 vs. 39 ± 1.0, P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P = 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. CONCLUSION: The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.

The Possibly Reversible Isotretinoin Effect of Decreased Ovarian Reserve in Sprague-Dawley Albinos: Part I, Biochemical Analyses.

BACKGROUND: The study aims to determine the detrimental effects of 7.5 mg/kg/day isotretinoin treatment on the anti-Mullerian hormone (AMH) levels in an experimental study to see whether the effects on ovarian reserve are reversible. METHODS: Blood was sampled in 16 Sprague-Dawley albinos before any treatment to see baseline AMH levels. Then, the rats were randomly divided into 2 groups. Control group received only 1.0 ml soybean oil per oral for 30 days, whereas the study group received 7.5 mg/kg/day isotretinoin suspended in soybean oil. AMH levels were measured at the 30th day - immediately after the last medication - and on 60th day - 1 month after the last medication. RESULTS: The mean values of AMH levels were 8.16 ± 1.47, 6.95 ± 1.87, 6.27 ± 0.71 and 8.20 ± 1.48, 6.56 ± 1.45, 7.07 ± 0.96 ng/ml before, immediately after and 1 month after the last medication in the control and isotretinoin treatment group, respectively. The mean AMH levels significantly decreased (p = 0.02) immediately after isotretinoin administration. The mean AMH levels 1 month after the last dose of isotretinoin therapy were higher than the levels immediately after the medication; however, the difference was not statistically significant. CONCLUSION: This study indicates that exposure to isotretinoin is responsible for decreased AMH levels in experimental rat model and this effect seems to be reversible.