The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women.

PURPOSE: The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women. MATERIALS AND METHODS: One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant. RESULTS: The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05). CONCLUSION: The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Ultrasound-guided intrauterine insemination versus blind intrauterine insemination: a randomized controlled trial.

PURPOSE: This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate. MATERIALS AND METHODS: This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman. RESULTS: The pregnancy rates were similar in both the ultrasound-guided (USG) (16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386). CONCLUSIONS: The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.

Adverse perinatal outcomes of adolescent pregnancies in one center in Istanbul, Turkey.

PURPOSE: The objective of this study was to evaluate fetal and perinatal outcomes of pregnancies of adolescents and compare them with adult pregnancies. MATERIALS AND METHODS: This retrospective case-control study was carried out at Bakirkoy Maternity and Children's Diseases Education and Research Hospital in Istanbul, Turkey. It enrolled 2,491 pregnancies who delivered between 2005-2010, of which 998 were adolescent pregnancies and 1,493 were adults as controls. RESULTS: The mean age of the adolescent group was 17.10 years and in the control group the mean age was found to be 26.73 years. Intermarriage, vaginal delivery, preterm rupture of membranes, preterm birth, and preeclampsia were significantly higher in adolescent pregnancies than the control group. Gestational diabetes was more common with increasing age. There was no statistically meaningful difference between the groups in terms of intrauterine growth restriction (IUGR), low birth weight, anemia, 5-minute APGAR score, and intrauterine fetal demise. CONCLUSIONS: Young maternal age is a risk factor for preterm birth, preterm rupture of membranes, and preeclampsia. According to this study, adolescent pregnancies are more risky and more likely to have adverse fetal outcomes.

Diagnosis and management of cesarean scar pregnancy.

OBJECTIVE: To evaluate the diagnosis and management modalities of cesarean scar pregnancy according to our experience. DESIGN AND SETTING: Retrospective study at the Women's Health Research and Education Hospital. PATIENTS: Six patients were diagnosed and treated for cesarean scar pregnancy (CSP) with dilatation and curettage, methotrexate (MTX), or laparatomy. RESULTS: One patient chose the surgical option due to her desire to have a tubal ligation. In the second case methotrexate was applied initially, but two weeks later suction curretage was applied due to abdominal pain and vaginal bleeding. Suction curettage was used as an initial treatment for four patients. There were not any complications in three of four patients. One patient had heavy vaginal bleeding which started after curettage. On ultrasonographic examination, increasing hemorrhage was seen between the uterus and the bladder so subtotal hysterectomy was performed. DISCUSSION: Ultrasound should be used effectivelly in evaluation of pregnant patients with previous cesarean deliveries. There is still no unique treatment modality for CSP, so treatment should be tailored for each patient. Before the 7th week, abortion should be considered. After the 7th week, MTX and/or surgical options should be preferred.

Exaggerated placental site reaction detected during caesarean delivery: a case report.

Exaggerated placental site (EPS) reaction is an exuberant physiologic process in which intermediate trophoblasts infiltrate the underlying endometrium and myometrium at the implantation site. During a caesarean section, we noted a polypoid well shaped smooth lesion, about 3 cm in diameter on the anterior wall of the uterus apart from the placenta. The histopathologic examination revealed an exuberant proliferation of trophoblastic cells in the placental site, a low Ki-67 labelling index and the absence of mitotic activity. Distinguishing EPS reaction from the other intermediate trophoblastic tumours is critical, as the latter may likely involve surgical intervention and/or chemotherapy, although no specific treatment and follow-up is required for EPS reaction. It is necessary to be aware of this pathology and take biopsies from suspicious lesions in the placental site for pathologic examination.