Does Second Trimester Maternal Serum Zonulin Level Predict Gestational Diabetes Mellitus?

Zonulin, a protein that regulates intestinal permeability, has attracted attention as a potential biomarker for GDM. Therefore, this study aims to investigate whether there are differences in zonulin levels between the GDM group and control groups, especially between those receiving different treatments (diet and insulin). Based on this idea, we included 90 patients with a gestational age between 24 and 28 weeks in our study. While GDM was not detected in 33 of these patients, as a result of OGTT, 57 patients were diagnosed with GDM and these patients were followed throughout their pregnancy. Gestational diabetes was diagnosed by an OGTT performed between 24 and 28 weeks of gestation according to American Diabetes Association (ADA) standards. During follow-up, GDM patients were divided into two groups according to whether they required insulin treatment. Plasma zonulin levels were determined using enzyme-linked immunosorbent assay (ELISA) techniques. The GDM group had significantly higher plasma zonulin levels than the control group (p < 0.005). According to our research, zonulin may be a non-invasive biomarker involved in the etiology of GDM. Large-scale research on this topic is still needed.

Effect of Nifedipine Used in the Treatment of the Threat of Preterm Labor on Total Uterine Artery Blood Volume Flow Rate.

PURPOSE: Evaluation of the effect of maternal nifedipine treatment on total uterine artery blood volume flow rate (TVFR). METHODS: In this prospective study, 43 women who were admitted to the Perinatology Department of the University of Health Sciences Etlik Zübeyde Hanim Gynecology Training and Research Hospital, with the diagnosis of the threat of preterm labor, and 40 healthy pregnant women, who were randomly selected as the control group, were evaluated between July 1, 2018, and September 1, 2018. A transabdominal ultrasound examination of uterine arteries was performed both before and 48 hours after administration of oral nifedipine for TVFR measurement. For the final analysis, the TVFR levels of the group diagnosed with the threat of preterm labor and the control group were compared. RESULTS: There was no significant difference in either uterine artery pulsatility index or resistance index values as well as the diameters of the uterine arteries after nifedipine treatment (p>0.05 for all). Total uterine artery blood volume flow rate (TVFR) was 424.66±236.74 mL/min before and 543.39±309.68 mL/min after treatment with nifedipine and was statistically significantly higher (p < 0.05). CONCLUSIONS: Our study showed a statistically significant increase in total uterine artery blood volume flow rate 48 hours after oral nifedipine treatment.

Effectiveness of Moxibustion for Breech Presentation: A Prospective Study.

OBJECTIVE: To evaluate the moxibustion for turning fetuses from breech to vertex presentation. MATERIALS AND METHODS: This was a single-center prospective study. All pregnant women carrying a fetus in breech presentation between the 32 and 35 gestational weeks were offered moxibustion application. The primary outcomes were vertex presentation at 37 weeks of gestation, vertex presentation at birth, and vaginal birth rates. A secondary analysis was performed to understand the effect of parity, type of breech presentation, body mass index (BMI), placental location, gender, and fetal birth weight on the presentation at birth. RESULTS: There were 63 cases in the study group and 245 cases in the control group. The rate of vertex presentation at term was found to be higher in the moxibustion group compared to controls (66.7 vs. 48.2%, p=0.022). There were 45 (71.4%) and 131 (53.5%) fetuses with vertex presentation at birth in the study and control groups, respectively (p=0.020). Overall, vaginal delivery rate was higher in the study group (50.8 vs. 37.1%, p=0.048). Multiparity and higher birth weight were associated with increased rates of vertex presentation in the moxibustion and control groups. CONCLUSION: Moxibustion application increased the rate of vertex presentation at birth and also vaginal delivery rate compared with expectant management. Offering moxibustion between the 32nd and 36th week of gestation may provide women with a singleton fetus in breech presentation an opportunity for a vaginal birth.

Increased serum delta neutrophil index levels are associated with intrahepatic cholestasis of pregnancy.

OBJECTIVE: This study aims to compare the maternal serum delta neutrophil index (DNI) levels in intrahepatic cholestasis of pregnancy (ICP) and healthy pregnancies. METHODS: This study consisted of a group of patients (n = 40) diagnosed with isolated ICP who gave birth in our hospital and a control group (n = 60) between December 1, 2015, and June 30, 2018. The diagnosis of ICP was made based on pruritus and elevated fasting serum bile acids and liver enzymes. Laboratory tests of both groups in the hospitalization process were retrospectively examined. Maternal and neonatal characteristics, pregnancy outcomes, and DNI values of the two groups were compared. Statistical analyses were performed using SPSS version 20. RESULTS: Mean maternal serum DNI levels were significantly higher in women with ICP than in the control group (0.49 ± 4.8 vs -3.99 ± 3.02, p = <0.01). Receiver operating characteristic (ROC) curve analysis was used to define the DNI value where ICP can be best predicted. CONCLUSION: DNI, a new inflammatory marker, was found to be higher in women with ICP than in normal pregnancies.

Double Foley catheter for labor induction: An alternative method.

OBJECTIVE: To introduce a new handmade device, the double Foley catheter (DFC), and compare it with the Foley catheter (FC) and Cook cervical ripening balloon for its effectiveness in labor induction. METHODS: This prospective randomized controlled trial included 222 patients with unfavorable cervices. The patients were randomly allocated to the DFC, FC, and Cook cervical ripening balloon groups (n = 74 patients per group). The outcomes were evaluated using SPSS v. 23. RESULTS: Bishop scores successfully increased with all three methods (P = 0.000 for all groups), and the rates of vaginal delivery within 24 and 48 h were similar (P = 0.101 and P = 0.390, respectively). The pain scores of the DFC and Cook cervical ripening balloon groups were similar, but were lower than those of the FC group (P = 0.011). The overall maternal satisfaction scores of the DFC and Cook cervical ripening balloon groups were not significantly different but were higher than those of the FC group (P = 0.014). CONCLUSION: The maternal safety and success rate of labor induction were comparable between groups. However, the FC group had a higher pain score during catheter insertion and a lower maternal satisfaction rate. Moreover, considering the high cost of the Cook cervical ripening balloon, the DFC has an advantage, especially in low-resource countries.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders.

OBJECTIVE: We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa. METHODS: The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements). RESULTS: Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

A rare case of bilateral proboscis lateralis: Prenatal US and MRI findings.

Proboscis lateralis is a very rare congenital craniofacial malformation characterized by a finger-like tubular appendage arising usually from the medial canthal region. It is mostly unilateral and associated with other craniofacial malformations. Occasionally, proboscis lateralis is seen with holoprosencephaly. A rare case of bilateral proboscis lateralis which was diagnosed prenatally by ultrasound and magnetic resonance imaging has been presented. In this case of bilateral proboscis lateralis, both lesions arose from a very lateral location and were associated with various central nervous system anomalies other than holoprosencephaly.

Comparison of postprandial 90th-minute plasma glucose level with 60th- and 120th-minute levels in patients with gestational diabetes: a prospective cohort study.

PURPOSE: The objective of the present study is to compare postprandial 90th-minute plasma glucose measurement with fasting, postprandial 60 and 120 min in gestational diabetes mellitus (GDM). METHODS: One hundred and thirty-one pregnant women with GDM were hospitalized for regulation of maternal plasma glucose levels. Plasma glucose levels were daily recorded for every patient and treatment option arranged without considering the 90th-minute plasma glucose level. All patients were followed up until birth and pregnancy results were compared. RESULT: At the admission, 69% of our patients were on diet and 31% were on insulin with diet therapy. The highest postprandial mean plasma glucose was seen at 90 min after breakfast (137.50 mg/dl), at 60 min after lunch (137.80 mg/dl), and 60 min after dinner (134.50 mg/dl). The cut-off level for postprandial glucose at 90th minute was determined as 130 mg/dl. The upper limit plasma glucose levels were most frequently exceeded at 90th minute for each meal. High plasma glucose levels and the need for neonatal intensive care unit were correlated (p < 0.05). CONCLUSIONS: The highest plasma glucose level was seen at 90 min after breakfast, 60 min after lunch, and 60 min after dinner. The upper limit plasma glucose levels were most frequently exceeded at the 90 min.

Immunohistochemical and ultrastructural analysis of the effect of omega-3 on embryonic implantation in an experimental mouse model.

OBJECTIVE: Implantation is the first step to a healthy pregnancy. Omega-3 supplementation is common to use during pregnancy, for its antioxidant and membrane stabilising effect. In this study we have aimed to study the effect of Omega-3 supplementation on implantation in a mouse model by immunohistochemical methods and electron microscopic evaluation. MATERIALS AND METHODS: Mice were randomized into three groups to receive standard food, Omega-3 400 mg/kg and Omega-3 1000 mg/kg one menstrual cycle before mating. Mice were sacrificed on third day of estimated implantation and uterine horns were evaluated immunohistochemically for staining of Laminin and Leukemia Inhibitory Factor (LIF) and ultrastructural morphology. RESULTS: Laminin and LIF immunoreactivity were increased signifcantly in the high dose group when compared to the control and low-dose groups in lumen epithelium basal membrane, gland epithelium basal membrane and endometrial stroma. Electron-microscopic evaluation showed a decrease in epithelial height and microvilli loss in the high dose groups. CONCLUSION: Omega-3 supplementation increased implantation markers Laminin and LIF and decreased epithelial height and microvilli thus seems to prepare the endometrium for a favorable environment of implantation.

Rectus abdominis muscle endometriosis.

Endometriosis is characterized by an abnormal existence of functional endometrial tissue outside the uterine cavity, typically occuring within the pelvis of women in reproductive age. We report two cases with endometriosis of the abdominal wall; the first one in the rectus abdominis muscle and the second one in the surgical scar of previous caesarean incision along with the rectus abdominis muscle. Pre-operative evaluation included magnetic resonance imaging. The masses were dissected free from the surrounding tissue and excised with clear margins. Diagnosis of the excised lesions were verified by histopathology.