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ABSTRACT: Abstract Objective: To compare cord blood oxidative stress markers (OSM) between intrauterine small fetuses with high umbilical artery Doppler indices and normal indices. Methods: Forty women who had oligohydramnios and intrauterine growth-restricted fetuses with abnormal (n=20, group I) or normal Doppler indices (n=20, group II) were included. All patients underwent fetal Doppler ultrasound studies. Cord blood was collected at birth and six OSMs (ischemia modified albumin (IMA), hepatocyte growth factor (HGF), malondialdehyde (MDA)) levels, total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were studied. Results: The mean cord blood IMA, MDA, TOS, and OSI values for group I were significantly increased when compared to the group II (p<0.001 for IMA, MDA, TOS, and OSI). However the mean cord blood HGF and TAS values were statistically significantly decreased in group I, compared with group II (p<0.001 for HGF, and TAS). A significant positive (for IMA, MDA,TOS levels and OSI ratio) and negative (for HGF and TAS levels) correlations between umbilical artery pulsatility index and cord blood oxidative stress markers were found. Conclusion: The correlation between cord blood OSM and Doppler blood flow changes shown in this study may contribute to understanding the underlying oxidative stress-related mechanisms.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 11/2012; · 1.36 Impact Factor
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ABSTRACT: The aim of this study was to compare the efficacy of oxytocin and dinoprostone in achieving successful labor induction and vaginal delivery in postterm women with an unfavorable cervix.
Postterm women with an uncomplicated pregnancy and a Bishop score of ≤6 were randomized to receive either dinoprostone vaginal pessary (Propess®) or low-dose oxytocin. The primary outcomes were the length of the induction-to-delivery period and the incidence of vaginal delivery.
A total of 144 women were available for the analysis. The overall vaginal delivery rates were 75% (54/72) for the dinoprostone group and 80.6% (58/72; p = 0.35) for the oxytocin group; the mean induction-to-vaginal delivery interval was 13.3 and 10.3 h in the dinoprostone and the oxytocin group, respectively (p = 0.003). Uterine hyperstimulation was 7.4% compared with 6.8% (p = 0.8), and abnormal fetal heart rate was 26.4% compared with 18% (p = 0.2), respectively.
Both oxytocin and dinoprostone seem to have similar obstetric outcomes in postterm pregnancies with an unfavorable cervix, except for a significant superiority of oxytocin for delivery in a shorter period.
Gynecologic and Obstetric Investigation 03/2012; 73(3):242-7. · 1.28 Impact Factor
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ABSTRACT: To investigate the relationship between pre-eclampsia (PE) and maternal cardiac risk factors.
A total of 41 pregnant women were included in this study. Patient groups consisted of 25 PE patients and 16 normal pregnant women as a control group. We measured the serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), homocystein, apoprotein A1, apoprotein B100, lipoprotein (a), high sensitivity C-reactive protein (hsCRP), cystatin C levels as cardiac risk factors. Serum low-density lipoprotein (LDL) and very low density lipoprotein (VLDL) cholesterol levels were calculated using Friedwald equation.
The levels of TG, LDL-C, homocysteine, apoprotein B100 and cystatine C were higher in the PE patients than those in the control group (p < 0.05). HDL-C and apolipoprotein's AI levels were lower than those of normotensive pregnants (p < 0.05). HsCRP levels were also higher in the patient group but the difference was not statistically significant.
PE is an important and as yet, incompletely understood disorder of pregnancy. Our study showed that the blood levels for some cardiac risk factors were increased in women with PE, which may contribute to its multisystem pathology. Consideration should be given to monitoring women with PE for these cardiac risk factors in pre-eclamptic women both during pregnancy, as well as later in life.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 08/2011; 25(7):912-4. · 1.36 Impact Factor
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ABSTRACT: The aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) in adolescent pregnancies, associated risk factors, and pregnancy complications.
Retrospective study.
Community-based teaching hospital.
Results of 1653 pregnant women age ≤ 19 years in 2005-2007 were reviewed.
All pregnant women screened with 50-g glucose challenge test (GCT) and patients with a GCT result ≥ 140 mg/dl underwent a 3-hour 100-g oral glucose tolerance test (OGTT).
GDM was diagnosed with at least two abnormal results and GIGT was diagnosed with one abnormal result. GDM and GIGT cases were evaluated for the presence of any associated risk factors and effects of presence of risk factors on pregnancy outcomes.
The prevalence of GDM was 0.85% (95% CI, 0.41-1.29), GIGT was 0.5% (95% CI, 0.15-0.81) and GDM+GIGT was 1.35% (95% CI, 0.78-1.88) by Carpenter and Coustan criteria. 68% of patients had at least one of the risk factors including body mass index ≥ 25, family history of diabetes and polycystic ovary syndrome (PCOS). Only 9.1% (n = 2) of them required insulin for glucose regulation during pregnancy with 9.1% (n = 2) macrosomia rate. All patients were primiparous and cesarean delivery rate was 27.3% (n = 6). We could not find any effect of presence of risk factors on pregnancy outcomes in GDM and GIGT cases.
We demonstrated that GDM and GIGT are strongly associated with high BMI before pregnancy, PCOS, and family history of diabetes. Since GDM is a state of prediabetes, it is important to diagnose in adolescent pregnancies considering their life expectancy to take preventive measures to avoid diabetes mellitus.
Journal of pediatric and adolescent gynecology 04/2011; 24(2):62-5. · 0.90 Impact Factor
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ABSTRACT: To investigate relationship between glycemic control in first half of pregnancy by measuring mid-pregnancy HbA1c and neonatal birth weight and amniotic fluid volume.
We prospectively enrolled 220 pregnant women who received oral glucose tolerance test (OGTT) after positive gestational diabetes mellitus screening. We included 102 women with normal OGTT results into final analysis. We measured birth weight and amniotic fluid index (AFI) at 32-34 weeks.
Mean birth weight was 3313±426 g, and 15.7% of neonates were classified as large-for-gestational age (LGA). Mean Hb1Ac was 4.96±0.28%. Median AFI was 145 mm, and polyhydramnios rate was 2.9%. Birth weight was positively correlated with HbA1c level (r=0.373, p<0.001) and pre-pregnancy body mass index (BMI; r=0.351, p<0.001). Linear regression analysis showed that HbA1c and pre-pregnancy BMI were positive independent determinants of neonatal birth weight, and HbA1c was positive independent determinant of AFI. Receiver operating characteristics curve identified HbA1c level of 4.99 as optimal threshold for prediction of LGA with 93.8% sensitivity, 61.6% specificity and positive likelihood ratio (+LR) of 2.45 and pre-pregnancy BMI value of 25.2 as optimal threshold for prediction of LGA with 81.3% sensitivity, 57% specificity and +LR of 1.9.
In non-diabetic pregnant women with abnormal screening test, mid-pregnancy HbA1c level and pre-pregnancy BMI may predict neonatal birth weight. AFI in 32-34 weeks of gestation is related with mid-pregnancy HbA1c level.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 10/2010; 23(10):1193-9. · 1.36 Impact Factor
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ABSTRACT: To assess the plasma and serum maternal total antioxidant status, circulating levels of lipid peroxidation breakdown products (MDA), protein oxidation markers (AOPPs), myeloperoxidase (MPO) and lipid hydroperoxide (LHP) in preeclampsia, gestational diabetes mellitus (GDM) patients and compare them with noncomplicated normal pregnancies between 24 and 36 weeks of gestation.
27 GDM, 27 preeclampsia and 29 noncomplicated singleton pregnancies were included. The blood samples were taken at the diagnosis of disease.
TAS was decreased in GDM and preeclampsia when compared to normal pregnancies. MDA levels were higher only in GDM group than normal pregnancies. AOPP levels were increased but MPO and LHP levels were not changed both in GDM and preeclampsia when compared to normal pregnancies.
We concluded that increased oxidative stress and reduction in antioxidant defense mechanisms may contribute to disease processes both in GDM and preeclampsia.
Diabetes research and clinical practice 09/2010; 89(3):231-8. · 2.16 Impact Factor
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ABSTRACT: We report a case of ovarian cystic teratoma with an important growth during pregnancy and the sonographic appearance of intracystic multiple, mobile, polygonal structures called intracystic "fat balls." Due to the rapid growth of the lesion, which exceeded 15 cm in diameter, a right oophorectomy was performed. Histopathologic diagnosis confirmed the mature cystic teratoma. The presence of floating balls composed of keratin and fat is rarely seen but is pathognomonic of mature cystic teratomas. Growth of a teratoma during pregnancy is a rare condition.
Journal of Clinical Ultrasound 07/2010; 38(6):325-7. · 0.81 Impact Factor
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ABSTRACT: Brucellosis is one of the most common zoonotic diseases that can be encountered during pregnancy. We present two pregnant women with brucellosis. One of them delivered normally and the other patient had an abortion. We reviewed the literature regarding the clinical course of brucellosis in pregnant women. Brucellosis during pregnancy can be associated with abortion, congenital and neonatal infections and infection of the delivery team. Therefore treatment with a combination of rifampicin and trimethoprim-sulfamethoxazole should be started as soon as it is diagnosed to prevent possible complications.
Journal of Obstetrics and Gynaecology Research 04/2010; 36(2):418-23. · 0.94 Impact Factor
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ABSTRACT: Patients with history of gestational diabetes (GDM) are at high risk for developing diabetes mellitus (DM) after pregnancy. This study investigates the rate of GDM patients who received screening and the prevalence of DM in the early post-partum period.
This study included 78 patients diagnosed and treated for GDM between January 2005 and December 2007. They were evaluated whether or not they were screened with 75 g oral glucose tolerance test (OGTT) or fasting blood glucose measurement at post-partum 6-12-week period. The rates of DM and impaired glucose tolerance (IGT) were determined.
Of 78 GDM patients only 10 (12.8%) patients were screened with OGTT and 27 (34.6%) patients were screened with fasting blood glucose (FBG) measurement. 41 (52.6%) patients did not receive any post-partum screening. Insulin treated patients during pregnancy underwent OGTT more frequently (p = 0.008). We found that 61% of the patients who did not receive any screening test were seen by a doctor for any reason during this period. DM was diagnosed in 50% of patients who underwent OGTT and 7.4% of patients who underwent FBG measurement during early post-partum period (p = 0.013).
Despite the fact that GDM is generally strictly and carefully monitored during pregnancy, it is usually neglected in the post-partum period. Insulin treated patients during pregnancy should be informed better for post-partum screening with OGTT. OGTT appears to be a better way of screening to diagnose DM.
Archives of Gynecology 10/2009; 282(6):613-6. · 0.91 Impact Factor
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ABSTRACT: We report three maternal deaths which might be in possible association with the use of intravaginal dinoprostone for cervical ripening and induction of labor. All cases occurred at our institution between January 2006 and December 2007. Uterine atony and profuse bleeding followed by disseminated intravascular coagulation (DIC), characterized by severe hypofibrinogenemia developed shortly after delivery of the first two patients. The third patient developed respiratory symptoms in the active labor followed by hemodynamic changes manifested by tetanic uterine contractions and fetal heart rate decelerations. Cardiac arrest developed in all patients shortly after the occurrence of symptoms with no response to any medical intervention. The pharmacologic induction of labor with dinoprostone may be in association with increased risk of maternal death because of increased risk of postpartum DIC and amnionic fluid embolism. Further investigations seem to be needed.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2009; 23(6):569-72. · 1.36 Impact Factor
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ABSTRACT: To investigate the relation between changes in Doppler parameters of fetal and uterine arteries and development of persistent non-reassuring fetal heart rate (FHR) pattern during induction of labor with dinoprostone (Propess) in pregnancies at >or=41 weeks gestation.
Prospective cohort study.
Etlik Zubeyde Hanim Women's Hospital, Turkey.
One hundred forty-one prolonged pregnancies.
Doppler parameters of umbilical, middle cerebral, and uterine arteries were measured before and 4-6 hours after dinoprostone application between uterine contractions. Non-reassuring FHR pattern and persistent non-reassuring FHR pattern criteria were defined based on NICE 2007 guidelines. Women with successful spontaneous vaginal delivery were recruited as a control group (n=108), while women who underwent cesarean delivery due to persistent non-reassuring FHR pattern were recruited as a study group (n=15).
Prediction of non-reassuring FHR pattern with Doppler analysis of uterine and fetal arteries.
After dinoprostone application there was significant enhancement in uterine artery resistance index (RI) in the study group compared to the control group (p=0.002). Receiver operating characteristics curve analysis identified a uterine artery RI increase value of 0.11 as the optimal threshold for prediction of persistent non-reassuring FHR pattern with 73.3% sensitivity and 69.4% specificity. Logistic regression analysis demonstrated that an increase in the uterine artery RI was predictive for persistent non-reassuring FHR pattern (odds ratio (OR) 4.97; 95% CI 1.5-16.8).
Acute increase in uterine artery RI due to dinoprostone use may end with persistent non-reassuring FHR pattern in prolonged pregnancies. This may allow earlier prediction of persistent non-reassuring FHR pattern development and risk assessment.
Acta Obstetricia Et Gynecologica Scandinavica 07/2009; 88(8):894-900. · 1.77 Impact Factor
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ABSTRACT: To determine the prevalence of gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) using National Diabetes Data Group (NDDG), and Carpenter and Coustan (CC) criteria.
Retrospective study of the prevalence of GDM and GIGT in 21531 pregnant women screened for GDM between 2005 and 2007 using NDDG and CC criteria. Linear trends in prevalence of GDM and GIGT by age were calculated using logistic regression.
Mean prevalence rates for GDM were 3.17% (95% CI, 3.05-3.29; n=683) and 4.48% (95% CI, 4.36-4.6; n=964) according to NDDG and CC criteria, respectively. Mean prevalence rates for GIGT were 1.97% (95% CI, 1.85-2.09; n=426) and 2.46% (95% CI, 2.34-2.58; n=529) according to NDDG and CC criteria, respectively. Prevalence of GDM and GIGT increased with increasing age with both criteria (P<0.001). The prevalence of GDM increased by 41.1% and GIGT increased by 24.2% using the CC criteria compared with the NDDG criteria.
The prevalence of GDM and GIGT was higher when CC criteria were used compared with NDDG criteria, particularly in younger age groups. The prevalence of both GIGT and GDM increased with increasing age with both criteria.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 05/2009; 106(3):246-9. · 1.41 Impact Factor
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ABSTRACT: Pena-Shokeir syndrome phenotype is characterized by neurogenic arthrogryposis, facial anomalies, polyhydramnios and lung hypoplasia. Prenatal US is crucial in showing Pena-Shokeir syndrome phenotype in addition to demonstrating reduced fetal movements or akinesia as an underlying aetiological factor as early as the 14th week of gestation. Several reports of prenatal diagnosis of Pena-Shokeir syndrome phenotype by US have been published. In this report, MRI findings providing prenatal diagnosis are presented.
Pediatric Radiology 03/2009; 39(4):377-80. · 1.67 Impact Factor
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ABSTRACT: The aim of the present study was to compare the effect of three different progestins with differing androgenicity on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women. Additionally, the relationship between testosterone and insulin resistance was assessed.
The study included 125 postmenopausal women. Estradiol (E(2)) 2 mg/day was given to 20 hysterectomized women and the remaining 105 women were randomized into three treatment groups: E(2) 2 mg/day plus dienogest 2 mg/day (n=35); E(2) 2 mg/day plus norethisterone acetate (NETA) 1 mg/day (n=35); E(2) 2 mg/day plus medroxyprogesterone acetate (MPA) 2.5 mg/day (n=35). A 75-g oral glucose tolerance test was performed at the initial and 3-month visit. Serum glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were measured before and after treatment.
A significant treatment-related increase was observed only in the E(2)/MPA group for insulin resistance (p=0.031). When the change in the insulin/glucose ratio was compared, the E(2) group was significantly different from the E(2)/MPA and E(2)/NETA groups (p=0.008 and 0.02, respectively). Only the E(2)/dienogest group showed a treatment-related increase in fasting glucose level (p=0.037). A decrease in total cholesterol and LDL-C levels was observed in all groups (p=0.004 and 0.012, respectively). The only significant decrease in HDL-C level was observed in the E(2)/NETA group (p=0.005).
Estrogen therapy had a positive effect on carbohydrate and lipid metabolism in overweight-obese postmenopausal women. The addition of progestin to estrogen therapy attenuated estrogen's positive effects slightly; however, the biological actions of the three different androgenic progestins used did not result in any variation.
Gynecological Endocrinology 07/2008; 24(6):347-53. · 1.58 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2007; 26(9):1243-9. · 1.25 Impact Factor
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ABSTRACT: Infants whose mothers had low serum pregnancy-associated plasma protein-A (PAPP-A) in the first trimester were observed to have intrauterine growth retardation.
Suggesting that PAPP-A plays an important role in the availability and activity of insulin-like growth factors (IGFs), which affect growth, we aimed to investigate cord blood PAPP-A levels of infants with different birth lengths and weights. STUDY DESIGN AND OUTCOME MEASURES: The study included 97 full-term, live-birth neonates. After birth, their lengths and weights were measured. Cord blood PAPP-A levels were measured with an ultra sensitive enzyme-linked immunosorbent assay (ELISA).
There was a significant negative correlation between cord blood PAPP-A levels and birth weight (r=-0.23; P=0.023) and length (r=-0.24; P=0.016). Using the classification made according to their length, it was found that newborns with short lengths had significantly higher mean PAPP-A levels than neonates with normal and long lengths (P=0.022; P=0.002, respectively), whereas the difference between infants with normal lengths and infants with long lengths was not found to be statistically significant (P>0.05). On the other hand, there was a difference between the mean PAPP-A levels of the neonate groups classified according to weight; however, these differences were not statistically significant (P>0.05).
We concluded that increased cord blood PAPP-A levels were associated with birth length and weight decreases; however, PAPP-A levels affected birth length more than birth weight.
Early Human Development 08/2007; 83(7):479-82. · 2.05 Impact Factor
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ABSTRACT: To evaluate cases of partial hydatidiform mole coexisting with a live fetus, including an observation of our own, and to discuss the proper antenatal management of women wishing to continue with a partial molar pregnancy.
A PubMed search was then undertaken, extending over the time period from 1975 to 2006, using the keywords 'partial hydratidiform mole', 'hydatidiform mole' and 'coexisting fetus'.
At 16 weeks of gestation, an ultrasonographic examination revealed a normal fetus with an extremely large, multicystic placenta. The woman was informed of future risks but wished to continue with the pregnancy. The pregnancy progressed until 28 weeks without any complication but ended spontaneously with a vaginal delivery; the fetus had died in utero. Pathologic examination of the placenta revealed areas of hydropic degeneration and necrosis. Including our own observation, 17 cases of partial hydatidiform mole associated with a fetus of normal karyotype have been documented.
Although the rate of adverse perinatal outcome is high, we still believe that if amniocentesis or fetal blood sampling reveals a normal karyotype, then continuing the affected pregnancy with close follow-up in tertiary centers is a feasible choice.
Journal of Maternal-Fetal and Neonatal Medicine 03/2007; 20(2):175-81. · 1.50 Impact Factor
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ABSTRACT: A normotensive pregnant woman who had no historical risk factors for abruption placenta and found to have Breus' mole that indicates the pattern of single or multiple hematoma protrude above the chorionic plate was encountered. The case resembled a large fetal abdominal wall defect coexisting with a singleton live-born fetus at 27 weeks of gestational age is presented. The obstetric ultrasound showed that multiple coiled masses in the amniotic cavity, both the fetus and the placenta were normal. After two courses of tocolysis therapy, a healthy and, 1,400 g live-born infant was delivered through cesarean section due to fetal distress. Apgar scores at 1 and 5 min were 5 and 8, respectively. The infant died on postnatal day 6 due to severe respiratory distress and prematurity. This rare condition probably occurs frequently in missed abortion and the etiology is unknown, but is probably related to circulatory disturbance on maternal site. We report a rare clinical presentation and review the literature of Breus' mole.
Fetal Diagnosis and Therapy 02/2006; 21(6):540-3. · 1.05 Impact Factor
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ABSTRACT: The aim of this study was to compare the efficacy of intravenous iron to oral iron in the treatment of anemia in pregnancy.
In this randomized open-label study, 90 women with hemoglobin levels between 8 and 10.5 g/dL and ferritin values less than 13 microg/L received either oral iron polymaltose complex (300 mg elemental iron per day) or intravenous iron sucrose. The iron sucrose dose was calculated from the following formula: weight before pregnancy (kg) x (110 g/L - actual hemoglobin [g/L]) x 0.24 + 500 mg. Treatment efficacy was assessed by measuring hemoglobin and ferritin on the 14th and 28th days and at delivery, and the hemoglobin on the first postpartum day. Adverse drug reactions, fetal weight, hospitalization time, and blood transfusions were also recorded.
Hemoglobin values varied significantly with time between groups (interaction effect, P < .001). The change in hemoglobin from baseline was significantly higher in the intravenous group than the oral group at each measurement; the changes with respect to subsequent hemoglobin were significantly higher on the 14th (P = .004) and 28th (P = .031) days. Ferritin values were higher in patients receiving intravenous iron throughout pregnancy. No serious adverse drug reactions were observed. Fetal weight and hospitalization time were similar in the 2 groups. Blood transfusion was required for only one patient in the oral group.
Intravenous iron treated iron-deficiency anemia of pregnancy and restored iron stores faster and more effectively than oral iron, with no serious adverse reactions.
Obstetrics and Gynecology 01/2006; 106(6):1335-40. · 4.73 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy (HT) on climacteric symptoms in women inadequately responsive to HT alone.
The study included 100 postmenopausal women who were allocated into one of four groups: (1) citalopram, (2) placebo, (3) citalopram+HT, or (4) placebo+HT. The women who were unable or unwilling to take HT were randomly placed in groups 1 and 2. The women who were inadequately responsive to HT were randomly placed in groups 3 and 4. The initial dose of citalopram was 10 mg/day in groups 1 and 3. After 1 week, the dose was increased to 20 mg/day. After starting the medication, follow-up visits took place during the fourth and eighth weeks of treatment. During the first and eighth weeks, women completed two questionnaires: a modified Kupperman index and the Menopause-Specific Quality of Life Questionnaire.
Mean hot flash scores significantly improved in all groups (P<0.05). The reduction rates were 37% in group 1, 13% in group 2, 50% in group 3, and 14% in group 4. Psychosocial complaints and mean values on the Kupperman index significantly decreased in all groups (P<0.05). Physical well-being significantly improved in groups 1, 3, and 4 (P<0.05). The decrease in all scores was significantly greater in groups 1 and 3 compared to groups 2 and 4 (P<0.01).
Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms. Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT for the treatment of climacteric symptoms in women who had responded inadequately to HT.
Menopause 14(2):223-9. · 3.76 Impact Factor
