Comparison of Melatonin Levels in the Colostrum between Vaginal Delivery and Cesarean Delivery.

OBJECTIVE: This study aims to compare melatonin levels in colostrum between vaginal and cesarean delivery. STUDY DESIGN: This cross-sectional study was conducted with 139 mothers who gave live births between February 2016 and December 2016. The mothers were divided into three groups according to the mode of delivery: 60 mothers (43.2%) in the vaginal delivery group, 47 mothers (33.8%) in the elective cesarean delivery, and 32 mothers (23.0%) in the emergency cesarean delivery group. Colostrum of the mothers was taken between 01:00 and 03:00 a.m. within 48 to 72 hours following the delivery, and the melatonin levels were measured using the enzyme-linked immunosorbent assay (ELISA) and compared between the groups. RESULTS: The melatonin levels in the colostrum were the highest in the vaginal delivery group, lower in the elective cesarean section group, and the lowest in the emergency cesarean group (265.7 ± 74.3, 204.9 ± 55.6, and 167.1 ± 48.1, respectively; p < 0.001). The melatonin levels in the colostrum did not differ according to the demographic characteristics of the mothers, gestational age, birth weight, newborn sex, the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores, and for the requirement for neonatal intensive care. CONCLUSION: Our study results showed that melatonin levels in the colostrum of the mothers who delivered vaginally were higher than those who delivered by cesarean section. Considering the known benefits of melatonin for the newborns, we believe that vaginal delivery poses an advantage.

Effects of obstetric gel on the process and duration of labour in pregnant women: Randomised controlled trial.

The present study investigated maternal and neonatal outcomes in pregnant women who used obstetric lubricant gels during active labour. This prospective randomised controlled study included 180 pregnant women. Women were randomly assigned to two groups during the first-stage of labour. Pregnant women in the obstetric gel group received standard antepartum care plus vaginal application of obstetric gel. Women in the control group received standard antepartum care without obstetric gel. Mean duration of the second stage of labour was significantly shorter in the obstetric gel group than control group (45 ± 34 min vs. 58 ± 31 min, respectively; p = .005). Mean APGAR values at 5 min were significantly higher in the obstetric gel group (9.5 ± 0.6 vs. 9.2 ± 0.7; p = .0014). Among nulliparous women, mean duration of the second stage of labour was significantly shorter in the gel group than control group (53 ± 52 min vs. 83 ± 45 min, respectively; p = .003). Using obstetric gel at the beginning of the first stage decreases the length of the second stage of labour, particularly in nulliparous women, and may be associated with an improved APGAR score at 5 min. Impact statement A limited number of studies in the literature have demonstrated that obstetric gels shorten the second stage of labour and are protective for the pelvic floor. The results of this study show that using obstetric gel shortens the second stage of labour in only nulliparous, but not multiparous women. In addition, a significant improvement in the 5 min APGAR score was seen in the neonates of women who used obstetric gel. The application of obstetric gels during the labour of nulliparous women may be a useful clinical practice and may have a widespread use in the future.

Is omitting the 3rd hour measurement in the 100 g oral glucose tolerance test feasible?

BACKGROUND: To evaluate the diagnostic value of the 3rd hour plasma glucose level in the 100 g oral glucose tolerance test (OGTT). METHODS: Records of all pregnant patients with abnormal 50 g glucose challenge test (GCT) between January 2005 and December 2013 were reviewed (n=1963). The 100 g OGTT results were analyzed separately for both Carpenter & Couston (CC) and National Diabetes Data Group (NDDG) criteria. RESULTS: The number of patients diagnosed with gestational diabetes mellitus (GDM) was 297 (15.1%) according to CC criteria and 166 (8.4%) according to NDDG criteria. The 1st hour plasma glucose level showed the highest correlation with GDM diagnosis (ρ=0.595 for CC and ρ=0.567 for NDDG). However, the 3rd hour plasma glucose level showed the weakest correlation with GDM diagnosis (ρ=0.216 for CC and ρ=0.213 for NDDG). The 3rd hour value of 100 g OGTT was one of the two elevated measurements in 10.8% of patients when CC criteria are used and in 13.8% of patients when NDDG criteria are used. CONCLUSION: Omitting 3rd hour plasma glucose measurement in 100 g OGTT results in unacceptable rates of underdiagnosed patients.

Early second trimester retinol-binding protein-4 values in cases with or without gestational diabetes mellitus risk factors: a cross-sectional study.

AIM: Retinol-binding protein-4 (RBP-4) has been correlated with different degrees of insulin resistance including gestational diabetes mellitus (GDM). Presence of risk factors for GDM is an indication for early screening. We studied RBP-4 values in the early second trimester of pregnancy in pregnant subjects with or without GDM risk factors and compared the results by routine GDM screening methodology. METHODS: Seventy-nine patients with at least one GDM risk factor and 46 patients without any GDM risk factors were enrolled in the cross-sectional study as risk and control groups, respectively. In the early second trimester, RBP-4 values were measured, in addition to fasting plasma glucose and 50-g glucose challenge test in all subjects. RESULTS: The RBP-4 values in 16-18th weeks of pregnancy were not significantly different between risk and control groups (95.3 ± 20.1 vs 103.1 ± 24.4 µg/mL, respectively; P = 0.055) although fasting plasma glucose levels and 50-g glucose challenge test results were higher in the risk group than the control group (75.3 vs 69.3 mg/dL and 112.4 vs 97.5 mg/dL, respectively; P < 0.05). CONCLUSION: Presence of GDM risk factors does not have an impact on early second trimester RBP-4 values in pregnant subjects.

Role of cervical length and placental alpha microglobulin-1 to predict preterm birth.

INTRODUCTION: Preterm labor is the leading cause of premature mortality and morbidity. Therefore, to rule-in and rule-out preterm delivery is a very important issue in our clinical practice. OBJECTIVE: The aim of this study was to investigate the value of placental alpha microglobulin-1 (PAMG-1) molecule positivity in cervicovaginal secretions of women who have a CL <25 mm and presenting with preterm labor symptoms to predict spontaneous preterm birth within seven days. MATERIALS AND METHODS: This was a prospective cohort study conducted in Ankara University Department of Obstetrics and Gynecology between August 2017 and February 2019 on the patients who had Preterm labor symptoms, <25 mm transvaginal cervical length (CL), clinically intact membranes. The primary outcome of the study was the power of CL and PAMG-1 positivity on the prediction of preterm birth in seven days. RESULTS: Sensitivity and specificity values of PAMG-1 in our study population to predict spontaneous preterm birth in seven days were calculated 52.94% and 98.84%, respectively, negative predictive value (NPV) and positive predictive value (PPV) were calculated 91.4% and 90%, respectively. When we investigated our data according to different CL cutoffs, sensitivity and NPV for 20 mm cutoff were 88.24% and 96.3% that was better than PAMG-1, but specificity and PPV were 60.47% and 30.61%, respectively, that was more ineffective than PAMG-1. If we calculate the values according to 15 mm and 10 mm CL cutoffs sensitivity values were 58.8% and 23.53%, specificity values were 81.4% and 91.86%, NPV were 90.9% and 85.87%, PPV were 38.46% and 36.36%, respectively. Finally, accuracy value of PAMG-1 to predict spontaneous preterm birth in seven days was 91.26% that was better than other CL cutoffs (20 mm, 15 mm, and 10 mm). CONCLUSION: PAMG-1 molecule with high NPV and PPV (91.4% and 90%) combination will contribute our clinical decision on the population who had preterm labor symptoms and a CL shorter than 25 mm.

Effects of Umbilical Cord Management Strategies on Stem Cell Transfusion, Delivery Room Adaptation, and Cerebral Oxygenation in Term and Late Preterm Infants.

Background: The umbilical cord blood contains a high concentration of stem cells. There is not any published study evaluating the amount of stem cells that have the potential to be transferred to the infant through placental transfusion methods as delayed cord clamping (DCC) and umbilical cord milking (UCM). The aim of this study is to measure the concentrations of endothelial progenitor cell (EPC) and CD34+ hematopoietic stem cell (HSC) in the placental residual blood volume (PRBV), and evaluate the delivery room adaptation and cerebral oxygenation of these infants. Methods: Infants with ≥36 gestational weeks were randomized to receive DCC (120 s), UCM, or immediate cord clamping (ICC). EPC and CD34+ HSC were measured by flow cytometry from the cord blood. PRBV was collected in the setup. The cord blood gas analysis and complete blood count were performed. The heart rate (HR), oxygen saturation (SpO2), and cerebral regional oxygen saturation (crSO2) were recorded. Results: A total of 103 infants were evaluated. The amount of PRBV (in ml and ml/kg) was higher in the ICC group (p < 0.001). The number of EPCs in the PRBV content (both ml and ml/kg) were the highest in the ICC group (p = 0.002 and p = 0.001, respectively). The number of CD34+ HSCs in PRBV content (ml and ml/kg) was similar in all groups, but nonsignificantly higher in the ICC group. The APGAR scores at the first and fifth min were lower in the ICC group (p < 0.05). The mean crSO2 values were higher at the 3rd and 10th min in the DCC group (p = 0.042 and p = 0.045, respectively). cFOE values were higher at the 3rd and 10th min in the ICC group (p = 0.011 and p < 0.001, respectively). Conclusion: This study showed that placental transfusion methods, such as DCC and UCM, provide both higher blood volume, more stem cells transfer to the infant, and better cerebral oxygenation in the first minutes of life, whereas many lineages of stem cells is lost to the placenta by ICC with higher residual blood volume. These cord management methods rather than ICC do not require any cost or technology, and may be a preemptive therapeutic source for diseases of the neonatal period.

Cervical varix complicating marginal placenta previa: a unique coexistence.

Uterine cervical varix (CV) is a very rare condition during pregnancy and may cause moderate to severe hemorrhage. We present the third reported case of huge CV coexisting with placenta previa in the English literature. A 40-year-old chronic hypertensive patient with marginal placenta previa also had cervical varix causing hemorrhage. At the 38th gestational week emergent cesarean section was performed because of placental abruption. Placenta previa is a risk factor for CV and patients with placenta previa who have moderate bleeding should be examined for this coexistence. The choice of management is close follow-up and cesarean section close to term.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma.

Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1-2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63-year-old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.

Ultrasound in labor admission to predict need for emergency cesarean section: a prospective, blinded cohort study.

OBJECTIVE: To assess whether assessment with ultrasound could improve the detection of emergency cesarean section (ECS) in laboring women. METHODS: Women who presented with symptoms of active labor or women in need of labor induction were invited to participate in the study. Women included in the study were evaluated with ultrasonography for fetal biometry and vaginal examinations for Bishop score assessment. The main aim in this study was determining factors associated with ECS due to fetal distress and obstructed labor. RESULTS: No fetal biometry variable was associated with ECS due to any indication (fetal distress and obstructed labor combined) in the univariate analysis. In multivariate analyses, biometry variables were adjusted for Bishop score at admission and only abdominal circumference percentile showed a significant association with the odds of ECS due to any indication (OR:1.02, 95% CI: 1.01-1.03). Biparietal diameter and abdominal circumference variables were associated with the odds of ECS due to obstructed labor in both univariate and multivariate analyses (p < .05 for all). However, the predictive accuracy of biparietal diameter percentile (area under the curve (AUC): 0.55, 95% CI: 0.46-0.63) and abdominal circumference percentile (AUC: 0.56, 95% CI: 0.48-0.64) without adjunct variables were poor. Moreover, the addition of fetal biometry parameters to Bishop score did not improve the predictive accuracy of Bishop score. CONCLUSION: Ultrasound assessment at admission, in addition to Bishop score assessment, did not significantly improve the prediction of ECS. Also, the fetal biometry alone had poor predictive capability for ECS. Routine ultrasound assessment at labor admission appears to be ineffective for predicting ECS.PrecisFetal biparietal diameter and abdominal circumference showed an association with emergency cesarean due to obstructed labor but the predictive accuracy of fetal biometry was low. Routine ultrasound examination at admission, in addition to Bishop score assessment, may not useful for assessing the risk of emergency section in unselected populations.

Iodine deficiency in pregnant women at first trimester in Ankara

Objective: Iodine deficiency in pregnant woman in Ankara was shown in previous studies. We aimed to conduct a study in a tertiary center to investigate the need for iodine replacement in our population. Material and Methods: This was a single tertiary center, non-interventional, retrospective, cross-sectional study. Data were retrieved retrospectively from 440 women who were in the first trimester in gestational age. Maternal iodine status, thyroid-stimulating hormone (TSH) levels and T4 levels were examined. Urinary iodine concentration (UIC) was calculated based on the Sandell-Kolthoff reaction, which is a colorimetric method. We excluded patients with previous or current thyroid disease. Thyroid hormones and TSH were measured using chemiluminescence immunoassays. Results: Iodine deficiency prevalence (urinary iodine <150 µg/L) was 84.7% in first trimester of pregnancy in our population. The median UIC was 81.6 (1-450) µg/L, indicating iodine insufficiency. All the patients declared iodized salt use. None of the patients were taking iodine replacement. The mean TSH level was 1.53±1.27 mIU/L, (0.01 mIU/L-14.74 mIU/L) and the mean T4 level was 12.51±5.01 mIU/L (7.09 mIU/L-23.7 mIU/L). The TSH levels of 56 patients were higher than 2.5 mIU/L. According to these results, 12.72% of the patients had subclinical hypothyroidism based on serum TSH and free thyroxine levels. Isolated hypothyroxinemia was present in one patient. Conclusion: Our study demonstrated that pregnant women still develop iodine deficiency in Ankara despite mandatory iodine salt use. Iodized salt use does not provide enough iodine supplement, especially in pregnant women. Iodine supplementation has been shown to enhance neurologic development and psychomotor performance. We suggest that iodine should be a part of routine laboratory evaluation at the first prenatal visit for its importance in early pregnancy. Also, iodized salt use education should be provided to women to eradicate iodine deficiency. Iodine supplements should be recommended to all pregnant women in addition to iodized salt.

Double balloon catheters: A promising tool for induction of labor in multiparous women with unfavorable cervices

Objective: To compare the effectiveness and safety of oxytocin and a cervical ripening balloon in women with unfavorable cervices for inducing labor. Material and Methods: A total of eighty pregnant women between 37-41 gestational weeks having singleton pregnancies and intact membranes with unfavorable cervices were randomized into two groups, cervical ripening balloon (n=40) and oxytocin infusion (n=40). The primary outcomes were the labor time and the route of delivery. Secondary outcomes were the effect of parity on time of labor, and obstetric and perinatal outcomes. Results: The median time to delivery was 9.45 hours in cervical ripening balloon group and 13.2 hours in the oxytocin group in multiparous women. The differences were statistically significant (p<0.001). The median time until delivery was 11.48 hours in cervical ripening balloon group and 13.46 hours in the oxytocin group; the differences were statistically significant (p<0.001). Cesarean delivery ratios were similar in both groups (p=0.431). Conclusion: The results of the present study are promising for balloon use, especially in multiparous women. It is beneficial to support these data with wide ranging population-based studies.

ADAMTS 1, 4, 12, and 13 levels in maternal blood, cord blood, and placenta in preeclampsia.

The aim of this study is to compare ADAMTS (A Disintegrin and Metalloprotease Domains with Thrombospondins motifs) 1, 4, 12, and 13 levels in maternal and cord blood and placental tissue between preeclampsia and uncomplicated pregnancies. The enzyme-linked immunosorbent assay (ELISA) results showed that ADAMTS 1, 4, 12, and 13 levels in the maternal and cord blood were lower in the preeclampsia group than in the control group. Based on the immunohistochemistry (IHC) results, ADAMTS 1, 4, and 12 levels in placental tissues were higher in the preeclampsia group. According to the polymerase chain reaction (PCR) results, ADAMTS 1, 4, and 12 were higher, whereas ADAMTS 13 was lower in the preeclampsia group than in the control group.

Delivery and postpartum management of a patient with Pompe disease: Case report and review of the literature.

Pompe disease is an autosomal-recessive disorder caused by acid alpha-glucosidase deficiency due to mutations in the GAA gene. There are two forms of the disease: infantile-onset Pompe disease and late-onset Pompe disease. The worldwide incidence of both forms of the disease is commonly reported to be 1 in 40,000. Adult patients are affected by limb-girdle muscular weakness and respiratory insufficiency. Enzyme replacement therapy with alglucosidase-alpha is available since 2006. There is little knowledge about pregnant woman with Pompe disease. These women should be considered as high-risk pregnant women. Here, we aim to present Cesarean delivery and postpartum management of a case with an interrupted enzyme replacement therapy during pregnancy.

Third trimester anemia extends the length of hospital stay after delivery.

OBJECTIVE: To assess the relationship between maternal third trimester anemia and hospital stay after delivery. MATERIALS AND METHODS: In this retrospective cross-sectional study, 695 women aged 18-42 years were included between January 2016 and June 2016. Obstetric outcomes and fetal outcomes were measured. Statistical analysis was performed using SPSS, version 19.0 (SPSS, Chicago, Illinois). RESULTS: The prevalence of anemia in this study was 15.2%. The study population was divided into three groups according to hemoglobin (Hb) levels. Group 1 consisted of patients with Hb <8.5 g/dL, group 2 Hb 8.5-11 g/dL, and group 3 Hb >11 g/dL. Higher levels of Hb were associated with shorter stay in hospital (p=0.028). In binary comparison, no significant difference was observed between groups 2 and 3, whereas it was statistically different from group 1. Fetal weight (p=0.562), neonatal intensive care unit admission (p=0.596), APGAR score 1st (p=0.674) and 5th minute (p=0.876), type of delivery (p=0.831), and gestational age (p=0.798) were not statistically different between the groups; however, hospitalization time was significantly different (p=0.028). CONCLUSION: Maternal anemia in the third trimester prolongs hospitalization time after delivery. Anemia effects pregnancy and the fetus in the postpartum period in addition to the prenatal period.

Effects of nutrition on zinc, folic acid, and vitamin B12 levels during pregnancy.

In this article, we report the results of a case control study carried out on 290 Turkish pregnant women at 5-24 wk of gestation to determine their zinc, folic acid, and vitamin B12 levels in relation to their nutritional and socioeconomic status. The women were divided into two groups (n=145 each), depending on the stage of gestation. Group I consisted of women in the first trimester of gestation; those in the second trimester were allocated into group II. Twenty-five age-matched, healthy nonpregnant women were selected as controls. The nutritional status of the subjects was determined by means of a survey. Based on this, the women were subdivided into three subgroups: malnourished (PN), moderately nourished (MN), and well nourished (WN). Also from the survey, the socioeconomic status was classified as good (G) or bad (B). A statistically significant decrease on zinc and folic acid was observed in group I women, as their socioeconomic status worsened. In group II, zinc decreased only in the PN and MN subgroups, p<0.001. The folic acid and vitamin B12 levels did not change significantly during the second trimester of gestation in all subgroups. Regarding zinc, nutrition, or dietary habits are more relevant than socioeconomic status, but poor nutrition affects folic acid levels only during the first trimester of gestation.

Pessary use in pregnant women with short cervix.

The purpose of this case series is to provide preliminary evidence on the efficacy of pessary application in women with short cervix and at risk for preterm labor. Between May 2015 and July 2015, four pregnant women were followed-up with Arabin pessaries. The gestational age at the time of diagnosis was between the 23(th) and 29(th) weeks. Pessary application was associated with a prolongation of pregnancy lasting between 28 and 98 days. The gestational age at the time of delivery was between the 33rd and 39th weeks. Pessary use is non-invasive for the prolongation of pregnancy in pregnant women with shortened cervix. The major advantage of pessary use is its easy application without requiring anesthesia.

Association of first trimester serum uric acid levels gestational diabetes mellitus development.

OBJECTIVE: To investigate the association of first trimester serum uric acid levels with the development of gestational diabetes mellitus (GDM) in low-risk pregnant women. MATERIALS AND METHODS: In this retrospective data analysis, the results of pregnant women who completed both first trimester biochemical panel and two-step GDM screening were compared with an age-, body mass index, and gestational age-matched control group. The women were grouped as either GDM or impaired glucose tolerance (IGT) according to 100-g oral glucose challenge results. Uric acid levels were compared between the groups and diagnostic utility was tested with receiver-operating characteristics curves. RESULTS: Sixty-six women in GDM group and 358 women in the IGT group were compared against 202 healthy pregnant women. The groups did not differ significantly in terms of parity, pre-gestational body mass index and gestational age. Serum samples for uric acid levels were obtained. The mean serum uric acid levels were significantly higher in the GDM and IGT groups (5.95 mg/dL (±0.97 mg/dL) and 4.76 mg/dL (±1.51 mg/dL), respectively) compared with the control group (3.76 mg/dL (±1.07 mg/dL) (p<0.001). The area under the curve for uric acid levels was 0.92 (95% confidence interval 0.88-0.95) for diagnosis of GDM. At a diagnostic threshold of 3.95 mg/dL, uric acid levels predicted development of GDM with 60% specificity and 100% sensitivity. CONCLUSION: First trimester serum uric acid has a linear association with the development of GDM and IGT.

Placental, hepatic, and supraclavicular lymph node metastasis in pancreatic adenocarcinoma during pregnancy: A case report.

The occurrence of coexisting cancer in pregnant women is not a common phenomenon. It complicates approximately 1 in 1000 to 1500 pregnancies. We present a multiparous woman aged 27 years in her 28th week of pregnancy who was admitted to our clinic with right upper quadrant pain and was finally revealed to have multiple metastatic pancreatic adenocarcinoma. To the best of our knowledge, this is the first documented case of pancreatic adenocarcinoma to metastasize both to the placenta and multiple maternal sites (liver, supraclavicular, para-aortic lymph nodes) in a pregnant patient. Unpredictable metastases to the placenta may be encountered and may even lead to definitive diagnosis, as in our case. Therefore, the placenta in any patient with known malignancy should be sent for pathologic evaluation.

The role of thrombofilia related to Factor V Leiden and Factor II G20210A mutations in recurrent abortions.

OBJECTIVE: To study, the impact of thrombophilia caused by Factor V, Factor ll G20210A mutations on recurrent abortions, the prevelance of Factor V Leiden and Factor II G20210A mutation in patients with habitual abortions. METHODS: Forty one patients with a diagnosis of habitual abortion were enrolled in the study. Control group consisted of 50 women without a history of poor obstetric outcome. 10 ml. peripheral venous blood was taken from study and control groups and transferred to EDTA tubes, and were tested for Factor V Leiden and Factor II G20210A mutations by PCR in genetics laboratory. RESULTS: Phenotypes of 91 cases were determined by PCR for Factor V Leiden. It was established that of 41 patients in the study group, 31 (75.6%) had GG genotype, 9 (22%) had GA genotype and 1 (2.4%) had AA genotype. In the control group, 45 (90%) of 50 women had GG genotype and 5 (10%) had GA genotype. A allele carrier status was found to be 24.4% in study group and 10% in the control group. The difference between them was not statistically significant (p = 0.06). CONCLUSIONS: The results obtained from patients and control group have no difference in Factor V Leiden and Factor II G20210A mutations.These results suggest that mutations have no role in etiology of 1. and 2. trimester recurrent abortions.