Term gebelikte spontan over hiperstimülasyon sendromu

Gebelik döneminde spontan OHSS son derece nadirdir. Bu çalışmanın amacı, term gebelikte spontan over hiperstimülasyon sendromunu sunmaktır. 29 yaşındaki primigravid kadının 35 haftaya kadar olan gebeliği gözlendi. Bu zaman süresince hastanın normal overlere sahip normal bir gebeliği vardı. Hasta kliniğe 37 haftalık iken hızlı kilo alma, abdominal sıkıntısı ve ağrı ile başvurdu. Ultrason inceleme çoklu foliküllü ve hafif assit içeren büyük multifoliküler overleri gösterdi. Gebeliğin 39. haftasında, overler daha önce tespit edilen ile aynıydı ve fötal makrozomi nedeniyle sezaryen uygulandı. 4060 gr ağırlığında sağlıklı bir kız bebeğin doğumu gerçekleştirildi. Multifoliküler içeren genişlemiş bilateral overler elektrokoter ile delindi. Doğumdan 2 hafta sonra overler normal haline geri döndü. Literatürde geç gebelikte meydana gelen spontan OHSS ile ilgili hiç vaka bildirilmedi. Sezaryen sırasında over delimi ileride yararlı olabilir.Spontaneous OHSS in a term pregnancy is extremely rare. The aim of this study is to present a case of spontaneous ovarian hyperstimulation syndrome (OHSS) in a term pregnancy. A 29-year-old primigravida woman conceived spontaneously and was observed up until 35 weeks of gestation. During this time the patient had a normal pregnancy with normal ovaries. She applied to the current clinic during the 37th week of gestation with complaints of rapid weight gain, abdominal disturbance, and pain. Ultrasound examination showed large bilateral ovaries with multiple follicles and mild ascites. At 39 weeks of gestation, the ovaries were the same as detected previously, and a caesarean section was performed due to fetal macrosomia. A healthy female foetus weighing 4060 gr was delivered. The enlarged bilateral ovaries containing multiple follicles were drilled with electrocautery. The ovaries returned to a near normal state for two weeks after the birth. There are no reported cases of spontaneous OHSS in late pregnancy in the literature. Ovarian drilling may be useful during caesarean section

Serum Ischaemia-modified albumin concentration in hyperemesis gravidarum

Introduction: The role of oxidative stress in the pathogenesis of hyperemesis gravidarum (HEG) has been demonstrated in a lot of studies. The present study aimed to compare the ischaemia-modified albumin (IMA) serum levels of patients diagnosed with HEG with healthy pregnant women, and to investigate whether oxidative stress caused increased serum IMA in HEG. Methods: Pregnant women were classified into a group diagnosed with HEG (n=45) and an age- and body mass index-matched control group without HEG (n=45). Serum IMA levels were assessed by the enzyme-linked immunosorbent assay (ELISA) method. Results: Serum IMA levels were higher in the HEG group than the control group (HEG: 8.2 +/- 0.2 ng/mL, control: 6.9 +/- 03 ng/mL, p<0.001). Conclusion: We found that HEG was related to increased maternal serum IMA levels. The high levels of IMA in HEG can he considered as a reflection of increased oxidative stress

Evaluation of FMR1 gene mutations in Turkish women newly diagnosed with primary ovarian failure

Background: One of the known causes of ovarian dysfunction is fragile X mental retardation gene 1 (FMR1) premutation. The prevalence of FMR1 premutation in primary ovarian failure (POF) cases may differ between the studies due to some reasons including POF definition, definition of premutation, and determination of study population, ethnicity, genetic and environmental factors. In this study authors aimed to determine the prevalence of FMR1 mutations in patients who applied to present clinic and diagnosed as POF.Methods: This retrospective cohort study was conducted on 200 women who had been newly diagnosed with POF in present clinic between 2013 and 2014. The presence of cytogenetic fragility was firstly investigated in all patients by using the lymphocyte culture method, and molecular analysis of the FMR1 gene was then performed. Genomic DNA’s of cases were isolated using standard protocols, followed by polymerase chain reaction amplification with an appropriate program. Fragment analysis of the amplification products were performed by agarose gel electrophoresis.Results: Cytogenetic analysis results in 200 cases were numerically and structurally normal in all patients, and as a result of molecular genetic analysis of FMR1 gene; 1 (0.5%) patient had complete mutation and 9 (4.5%) patients had premutation carriage.Conclusions: FMR1 gene mutations are common in women with POF. These mutations should be investigated in all patients presenting with POF, particularly in cases with early onset and family history of POF, and also genetic counseling should be given to those patients

Oxidative stress markers in severe preeclampsia and preeclampsia-related perinatal morbidity — preliminary report

Objectives: The aim of the study was to determine maternal serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase levels in severe preeclamptic pregnants and also to investigate whether these parameters are implicated in the occurence of perinatal morbidity or not. Material and methods: A case-control study was carried out including 60 pregnant women (30 with severe preeclampsia and 30 healthy controls). The optimal cut off points of oxidative stress markers for the diagnosis of severe preeclampsia and for the prediction of adverse perinatal outcomes were evaluated by receiver operating characteristic (ROC) analyses. Multi­variate logistic regression analysis was used to determine if a relationship between adverse perinatal outcomes and serum oxidative stress markers was present or not. Results: TAS (OR = 37.486, 95% CI 3.535–397.519, p = 0.003), TOS (OR = 15.588, 95% CI 2.135–113.818, p = 0.007) and ary­lesterase (OR = 31.356, 95% CI 2.284–430.548, p = 0.01) were found to be diagnostic for preeclampsia. Statistically significant positive correlation of adverse perinatal outcomes with serum TAS, PON and arylesterase levels were determined. Besides, a significant negative correlation was found between serum TAS levels and gestational week (r = –0.342, p = 0.007) and also between serum PON levels and birthweight (r = –0.262, p = 0.043). Conclusions: Increased maternal serum TAS, TOS and arylesterase levels are significantly associated with the presence of severe preeclampsia. Furthermore, elevated maternal serum TAS, PON and arylesterase levels are significantly and positively correlated with adverse perinatal outcomes. We suggest that in preeclampsia increased oxidative status may cause adverse perinatal outcomes and antioxidants may be increased in order to protect the fetus against oxidative damage

Does progesterone therapy increase nuchal translucency in women with threatened miscarriage?

Objectives: The effect of exogenous progesterone on fetal nuchal translucency (NT) has been proposed recently. In this study, we aimed to compare the thickness of NT of patients receiving and not receiving progesterone for threatened miscarriage. Material and methods: This study was designed as a retrospective comparative study. Ninety five women treated with progesterone constituted the study group whereas 97 women who were not treated with progesterone constituted the control group. An ultrasonographic examination was performed on all of the women to measure NT. All patients were treated with oral micronized progesterone in the study group. The main parameters recorded for each woman were; age, body mass index (BMI), obstetrical characteristics, and gestational age at first examination, treatment duration of progesterone therapy, and results of combined and triple tests. Results: A total of 192 pregnant women with threatened miscarriage were included in this study. The mean NT thickness was statistically significantly higher in the study group (p &lt; 0.001), and mean serum level of human chorionic gonadotropin (hCG) was also higher in this group (p &lt; 0.05). There was no statistically significant difference between groups in terms of age, BMI, and gestational age at first examination. ROC curve analysis demonstrated that only increased NT (area under the curve: 0.634, p = 0.005, 95% CI: 0.541–0.727) was a discriminative factor for women receiving progesterone for threatened miscarriage. Also there was a positive correlation between NT and treatment duration (r = 0.269; p &lt; 0.001). Conclusions: We think that oral progesterone therapy may increase NT depending on treatment duration without causing abnormal prenatal screening test results

Diagnostic value of CA 19-9 in pregnancies complicated by spinal neural tube defects: a preliminary study

Objectives: Various physiological and pathological conditions can induce significant variations in plasma concentrations of tumor markers, such as CA 19-9, which is present in the serum and amniotic fluid of pregnant women. Herein, we aimed to determine the clinical importance of maternal serum CA 19-9 levels in the diagnosis of neural tube defects (NTDs). Material and methods: A total of 100 women were included in this controlled cross-sectional study. Thirty-three patients whose pregnancies were complicated by isolated meningocele or meningomyelocele constituted the study group, whereas 33 normal, healthy pregnant women constituted the control group, and 34 age- and body mass index (BMI)-matched non-pregnant women were chosen for the validation group. Results: The mean maternal serum CA 19-9 levels were 17.2 ± 17.0 IU/mL, 7.1 ± 5.9 IU/mL, and 4.7 ± 3.6 IU/mL in the study, control, and validation groups, respectively (p &lt; 0.001). ROC analyses showed that elevated CA 19-9 values may predict NTDs (p &lt; 0.001). The cut-off value for CA 19-9 was found to be 9.6 IU/mL at 70% (51%–84%, 95% CI) sensitivity and 84% (74%–92%, 95% CI) specificity. Conclusions: CA 19-9 may be a promising noninvasive marker for NTDs. Further studies are needed to reveal the clinical applicability and diagnostic potential of maternal serum CA 19-9 levels in the identification of NTDs

Maternal serum amyloid A levels in pregnancies complicated with preterm prelabour rupture of membranes

Objective: The aim of the study was to investigate a possible association between maternal serum amyloid A levels (SAA) and maternal and fetal parameters in pregnancies complicated with preterm prelabor rupture of membranes (PPROM). Material and methods: A total of 88 pregnant women (PPROM group, n=44 and control group, n=44) were included into this prospective case control study. Serum blood samples for SAA were obtained from both groups within 1h since the rupture of the membranes and before administration of any medicine. The samples were kept frozen at -70°C until the analysis. The recorded risk factors were: age, gravidity, parity, delivery mode, gender, fetal birth weight, APGAR scores, white blood cell count, microCRP, neutrophil/lymphocyte ratio (NLR), and maternal serum SAA levels. Results: Demographic characteristics showed no statistically significant differences between the groups (p>0.05). The mode of delivery mode was cesarean section: 41% and 43.2% in the study and the control group, respectively, and this difference was statistically significant between the groups (

Risk factors for hysterectomy among patients with placenta previa totalis

Objective: The aim of the study is to assess risk factors for hysterectomy among patients with placenta previa totalis (PPT). Methods: The medical records of all patients delivered by cesarean section (CS) for PPT were retrospectively reviewed. Eligible cases were divided into those who underwent peripartum hysterectomy (PH) and those who did not. The two groups were compared in terms of demographics, operative features and perinatal outcomes. Logistic regression analysis was used to identify risk factors associated with hysterectomy. Results: PH was performed in 43 (44.7%) patients with PPT. Referral patients were older when compared with those without hysterectomy (p: 0.029). The median values for gravidity, parity, number of live children and previous CS were statistically significantly higher in the hysterectomy group (p<0.05). Perioperative need for blood transfusion, anteriorly placed placenta and abnormal placental invasion were statistically significantly more frequent in the hysterectomy group (p<0.001). Intraoperative complication rate was higher in this group, and bladder injury was the most common complication. No significant differences were observed between the groups in terms of perinatal outcomes. In binomial logistic regression analysis; advanced maternal age (≥ 31 years), number of previous CS (≥2), preoperative need for blood transfusion, and abnormal placental invasion were found to be independent risk factors for PH in patients with PPT. Conclusion: The findings of this study suggest that placenta invasion anomaly, advanced maternal age, increased number of previous CS, and increased need for blood transfusion are important risk factors for PH in patients with PPT