A retrospective analysis of amniocenteses performed for advanced maternal age and various other indications in Turkish women

Objective: Prenatal cytogenetic diagnostic methods for the diagnosis of fetal chromosomal anomalies have been used reliably over the last 40 years. Advanced maternal age has become a basic indication for amniocentesis. Methods: We examined the results of the chromosome analyses of 3485 women that had amniocentesis for any reason during their antenatal care in our perinatology clinic in 2007–2009. Amniocentesis was performed for advanced maternal age in 1456 women (41.8%) and for other reasons in the remaining 2029 women (58.2%). Chromosomal anomalies were examined numerically and structurally. Results: When the amniocentesis results of the patients were reviewed as numerically normal or abnormal; 40 (2.7%) of 1456 amniocentesis procedures performed for advanced maternal age, 5 (0.9%) of 531 procedures performed for an increased double-test risk and 14 (1.3%) of 1095 procedures performed for an increased triple test risk were found to have chromosomal aneuploidy. Conclusions: Maternal age is still the most prevalent indication for genetic amniocentesis other than positive prenatal screening tests. Among women with advanced maternal age, prenatal ultrasonography for soft markers of chromosomal aneuploidy accompanied with maternal serum biochemical screening tests should be evaluated during the decision making process of genetic amniocentesis

Periviable Preterm Premature Rupture of Membranes: A Retrospective Study on Determinants of Neonatal Mortality

Purpose: The present study aimed to determine the risk factors for fetal and neonatal mortality in the context of Periviable Preterm Premature Rupture of Membranes (PPROM). Patients and Methods: This was a retrospective cohort study conducted at perinatology department of Zekai Tahir Burak Research and Training Hospital. The study population consisted of patients with PPROM before completing the 23rd gestational week were opted for expectant management. Maternal and Neonatal characteristics were recorded. Multivariate Logistic Regression with backward elimination is performed to investigate the effect of certain parameters on neonatal mortality. Results: In multivariate logistic regression model, gestational age <21 weeks at onset of PPROM (Odds Ratio (95% confidence interval): 8.58 (2.41–30.5), p<0.01) and nulliparity (Odds Ratio (95% confidence interval): 4.47 (1.25–15.9), p: 0.02) were independently associated with stillbirth or delivery before 23rd weeks. According to Cox regression model, the significant determinants of survival were: completed gestational weeks at delivery, sepsis in the first neonatal week and presence of pulmonary hypoplasia. Conclusion: The present data suggest that favorable outcomes can be anticipated in periviable PPROM that has occurred after 22th gestational weeks. Completed gestational weeks at delivery and nulliparity are other important determinants of mortality

Comparison of Bishop's score and cervical length in determining the need for cervical maturation before labor induction

Objectives: The aim of this study is to compare the evaluation of cervical length measured by the Bishop score and transvaginal ultrasonography in determining the need for prostaglandin application for cervical ripening in term nulliparous pregnancies. Material and methods: In our study, a total of 120 patients who were admitted to our hospital between February 2015 and August 2015 were divided into two groups as cervical length group and Bishop score group according to hospitalization order by applying the Permuted Block Randomization method, which is one of the Restricted Randomization methods. Each patient included in the study was evaluated with both the Bishop score and transvaginal ultrasonography. Groups were compared according to the APGAR scores in the 1st and 5th minutes, transition within 12 hours, birthing within 24 hours, birthing with only dinoprostone, birthing with only oxytocin, duration of administration of dinoprostone, duration of oxytocin administration, type of birth, rate of cesarean section, and need for neonatal intensive care. Results: While cervical ripening with dinoprostone was applied to 28 (46.7%) of 60 pregnant women in the Bishop group, labor induction with oxytocin was applied to the remaining 32 (53.3%) pregnant women. In the cervical length group, these values were 33 (55.0%) and 27 (45.0%), respectively. There was no statistically significant difference between study groups in terms of the need for dinoprostone for cervical ripening (p = 0.361). Of those with a Bishop score of 4 or below, 78.6% (n = 22) had a cervical length of over 28 mm, and 71.4% (n = 20) needed oxytocin. Of those with a Bishop score above 4, none of them had a cervical length greater than 28 mm. A statistically significant difference was found between those with a Bishop score of 4 or below and those above 4 in terms of cervical length (p &lt; 0.05). Among those with a Bishop score of 4 or below, the percentage of those with a cervical length above 28 mm was significantly higher than that of those with a Bishop score above 4. Conclusions: In our study, the delivery time of those with a cervical length of 28 mm and above was significantly higher than those with a cervical length of less than 28 mm, while the bishop score was significantly lower. In order to develop a more objective method that can replace the Bishop scoring system in determining the need for cervical ripening before labor induction, prospective randomized studies that screen larger numbers of patients are needed

Platelet and Endothelial Cell Adhesion Molecule Expression in Pregnant Women with Preeclampsia

Amaç: Preeklampsi (PE), gebe kadınları etkileyen en önemli sağlık sorunlardan biri olmasına rağmen, hastalığın ortaya çıkmasındaki etiyopatogenetik faktörler hala net değildir. Çalışmamızda preeklamptik ve kontrol grubu sağlıklı plasentalarda trombosit endotel hücre adezyon molekülü-1’in (PECAM-1) ekspresyon düzeylerini araştırmayı amaçladık. Yöntemler: Plasental doku örnekleri, PE tanısı konan hastalardan ve sağlıklı normal gebelerin doğum sonrası plasentalarından elde edildi ve adhezyon molekülü PECAM-1’in ekspresyon seviyeleri için immünohistokimyasal yöntemlerle analizleri yapıldı. Bulgular: Subkoryonik hematomu olan abortus imminensi kadınlar ile subkoryonik hematomu olmayan abortus imminensli kadınlar arasında yaş, parite ve gravite açısından anlamlı bir fark saptanmadı. Subkoryonik hematomu olan kadınlarda anti-kardiyolipin antikor pozitifliği subkoryonik hematomu olmayan kadınlara göre istatistiksel olarak anlamlı daha yüksek saptandı. Ayrıca araştırmamızda anti-kardiyolipin antikor pozitif olan gebelerde anti-kardiolipin pozitif olmayan gebelere göre olumsuz gebelik sonuçları daha sık görüldü. Sonuç: Kontrol grubunun plasentalarında plasental villusun damar duvarlarını kaplayan endotelyal hücrelerde PECAM-1’in zayıf bir tutulumu bulunmuş, ancak PE grubunun plasentalarında ise PECAM-1 tutulumu yüksek seviyede saptanmıştır.Objective: Despite the fact that preeclampsia (PE) is one of the most important health problems which affect pregnant women, the etiopathogenetic factors which lead to the illness are still yet to be known. Hereby in this study, we have aimed to investigate the expression levels of the platelet and endothelial cell adhesion molecule, PECAM-1, in the healthy placentas of preeclamptic and control group patients. Methods: The placental tissue samples have been obtained from the patients diagnosed with PE and from the postnatal placentas of the healthy pregnant women; and analyzed through immunohistochemical methods for the expression levels of the adhesion molecule, PECAM-1. Results: In the placentas of the control group, a weak involvement of PECAM-1 has been observed in the endothelial cells covering the vein walls of the placental villus; yet in the placentas of the PE group, the involvement level has been observed to be high. Conclusion: Due to the increase in the expression levels of PECAM-1 in preeclamptic placenta, the functional roles of these adhesion molecules are thought to be present in the pathophysiology of PE. And with this fact being known, decent treatment approaches will emerge in the future in order to avoid PE symptoms

A Link Between Pregnancy Outcomes and Anticardiolipin Antibody in Subjects with Abortus İmminens

Amaç: Düşük tehdidi (abortus imminens) tüm gebelerin %10-20’sinde görülebilen önemli bir komplikasyondur. Subkoryonik hematom abortus imminensin prognozunda önemli bir parametredir ancak subkoryonik hematomun neden oluştuğu tam olarak bilinmemektedir. Anti-kardiyolipin antikorları ile subkoryonik hematom arasında ilişki olduğu düşünülmektedir. Bu nedenle bizde araştırmamızda subkoryonik hematomu olan ve olmayan abortus imminensli kadınlarda anti-kardiyolipin antikorlarının pozitifliğini karşılaştırdık. Ayrıca doğum sonuçları ile antikardiolipin pozitifliği arasında bir ilişki olup olmadığını inceledik. Yöntemler: Araştırmamız olgu-kontrollü bir araştırma olarak planlandı. Araştırmaya 41 subkoryonik hematomu olan kadın ve 29 subkoryonik hematomu olmayan abortus imminensli kadın dahil edildi. Araştırmaya dahil edilen kadınların demografik verileri tanımlandı. Anti-kardiyolipin antikorlarının (IgG, IgM) düzeyi ELISA yöntemi ile ölçüldü. Bulgular: Subkoryonik hematomu olan abortus imminensi kadınlar ile subkoryonik hematomu olmayan abortus imminensli kadınlar arasında yaş, parite ve gravite açısından anlamlı bir fark saptanmadı. Subkoryonik hematomu olan kadınlarda anti-kardiyolipin antikor pozitifliği subkoryonik hematomu olmayan kadınlara göre istatistiksel olarak anlamlı daha yüksek saptandı. Ayrıca araştırmamızda anti-kardiyolipin antikor pozitif olan gebelerde anti-kardiyolipin pozitif olmayan gebelere göre olumsuz gebelik sonuçları daha sık görüldü. Sonuç: Subkoryonik hematomu olan kadınlarda abortus imminensli subkoryonik hematomu olmayan abortus imminensli kadınlara göre anti-kardiyolipin pozitifliği daha sık görülmektedir ve antikardiyolipin antikor pozitifliği ile olumsuz gebelik sonuçları arasında bir ilişki vardır.Objective: Abortus imminens is a critical complication observed 10-20% of all pregnant women. Subchorionic hematoma is an important parameter in the diagnosis of abortus imminens; however, it is yet to be known the exact cause of subchorionic hematoma. A relation is thought to exist between anti-cardiolipin antibodies and subchorionic hematoma. So, we hereby in this study have compared the positiveness of the anti-cardiolipin antibodies in women with and without subchorionic hematoma. We have as well examined whether there is a relation between pregnancy outcomes and anti-cardiolipin positiveness. Methods: The study has been planned as a case-controlled one, in which 41 women with abortus imminens and subchorionic hematoma; and 29 women with abortus imminens and without subchorionic hematoma were included and where the demographic data of those women were defined. The level of anti-cardiolipin antibodies (IgG, IgM) was measured by ELISA method. Results: No substantive difference has been detected between women with abortus imminens having subchorionic hematoma; and women with abortus imminens not having subchorionic hematoma in terms of age, parity and gravity. Compared to the women without subchorionic hematoma, the anti-cardiolipin antibody positiveness has been observed to be higher in the women with subchorionic hematoma in statistical terms. Furthermore, unfavorable pregnancy outcomes have been seen at a higher rate in pregnant women with positive anti-cardiolipin antibody compared to the nonpositive ones in the study. Conclusion: The circulating anti-cardiolipin antibody levels were found to be elevated in women with abortus imminens having subchorionic hematoma compared to those women with abortus imminens not having subchorionic hematoma and there was a relationship between anti-cardiolipin antibody and unfavorable pregnancy outcome