The effects of threatened abortions on pregnancy outcomes

Objectives: The effects of first trimester threatened abortions on prenatal and postnatal pregnancy outcomes.  Material and methods: Data from 24.835 pregnant women were retrospectively analysed. The pregnant women were divided into two groups according to whether they had a first trimester threatened abortion or not. The demographic data and prenatal, postnatal and labour outcomes were compared for the two groups. Those cases with miscarriages during their follow-up, pregnant women with systemic diseases, multiple pregnancies and patients who were diagnosed with cervical erosion and cervical polypoid formation during vaginal bleeding examinations were all excluded.  Results: The age (p < 0.001), ART pregnancy rate (p = 0.03) and nulliparity rate (p = 0.013) in those with the risk of miscar- riage were statistically significantly higher than those without the risk. The gestational weeks (p < 0.001) and birth weights (p < 0.001) were significantly lower for the miscarriage group than in the control group. Hyperemesis gravidarum (p < 0.001), gestational diabetes mellitus (GDM) (p < 0.001) and placenta previa (p = 0.018) rates were statistically significantly and more frequent in the pregnancies with the threatened abortion group than in the control group. The rates of caesarean delivery were statistically significantly higher in the threatened abortion group (p < 0.001).  Conclusions: Threatened abortion between 6- and 14-weeks gestational age is a complication that may cause anxiety in the early weeks of pregnancy. But the treatment, follow-up and cause of threatened abortion all remain unclear.

Evaluation of occult uterine leiomyosarcomas

Objectives: To determine the frequency of occult uterine leiomyosarcomas following hysterectomies and myomectomies performed for benign reasons at our clinic and to draw comparisons with similar studies in the literature.  Material and methods: All hysterectomies and myomectomies that have been performed for benign reasons at our clinic between 2010 and 2017 were retrospectively examined via the hospital’s information system and the patients that were found to have leiomyosarcomas were analysed. The incidence of occult uterine leiomyosarcoma per 1000 surgeries at our clinic was calculated using the Wilson score interval.  Results: A total of 6,173 hysterectomies were performed, and occult uterine leiomyosarcoma was identified in 5 patients. The incidence of occult uterine leiomyosarcoma was calculated to be 0.08% (95% CI 0.03–0.018%). Only 1 of the 771 patients who underwent myomectomy was identified with occult uterine leiomyosarcoma, making its incidence in myomectomy 0.12% (95% CI 0.02–0.073%). When all the patients are considered, occult uterine leiomyosarcoma was identified in 6 of the 6,944 patients, and the general incidence of occult uterine leiomyosarcoma was calculated as 0.08% (95% CI 0.03–0.018%).  Conclusions: In our study, the incidence of occult uterine sarcoma following myomectomy and hysterectomy was found to be lower than that reported in the literature. The reason for this lower incidence includes not only genetic causes and racial differences but also preoperative imaging, endometrial and cervical sampling that is performed on every patient

The prognostic significance of serum CA125 levels with ER, PR, P53 and Ki-67 expression in endometrial carcinomas

Objectives: The present study evaluates the relationship between the expression levels of hormone receptors (HRs), Ki-67, p53 and serum cancer antigen 125 (CA125) levels in endometrial cancer and clinicopathological risk factors, and determines their prognostic values. Material and methods: This retrospective study included 49 patients with endometrial cancer whose estrogen receptor (ER) and progesterone receptor (PR) Ki-67 and p53 expression levels were determined through immunohistochemical methods, and whose preoperative serum CA125 levels were measured. These factors relationship with various clinicopathological factors, progression-free survival (PFS) and overall survival (OS) was investigated. Results: The study included 49 patients with EC with a mean age of 61 ± 10 years. The rate of HR positivity was significantly higher in the endometrioid histology group than in the non-endometroid histology group (p = 0.026). A high level of Ki- 67 expression was found to be associated with a non-endometroid histology (p = 0.016), and a high tumor grade (p < 0.001) and a high p53 expression were found to be associated with advanced disease stage (p = 0.026). A positive correlation was found between p53 and Ki-67, a negative correlation was found between p53 and Ki-67 and the presence of HR. Significant relationship was not found between HR status, p53, Ki-67, CA125 and either other clinicopathological risk factors or survival. Conclusions: While HR positivity indicates favorable clinicopathological prognostic factors, high Ki-67 and high p53 expression indicate unfavorable ones. However, no direct effect of these factors on prognosis was found in this study

The Effect of Dehydroepiandrosterone on Ovarian Reserve in Ovarian Damage Caused by Methotrexate

To determine the possible detrimental effects of multiple methotrexate doses has on the ovarian reserve and to determine the beneficial effects of dehydroepiandrosterone supplementation. The rats (n:24) divided into three groups; Group 1: control group, Group 2: dehydroepiandrosterone and methotrexate group (6mg/kg dehydroepiandrosterone dissolved in 0.1 ml sesame seed oil subcutaneously for ten days and 1mg/kg intramuscular methotrexate at the 1st, 3rd, 5th and 7th days) and Group 3: methotrexate group (1mg/kg intramuscular methotrexate at the 1st, 3rd, 5th and 7th day). The groups compared in regards to their histopathological ovarian damage scores and AMH values. It established that multiple methotrexate applications had a considerable effect on reducing vascular congestion in the ovarian tissue. Both in groups 2 and 3 AMH values found to be significantly lower. When this decline in the ovarian reserve examined comparatively; while both the group 2 and 3 reported having a considerable and continuous reduction in the AMH levels correlative to the control group; the primordial, primary and total follicle counts shown to stay statistically the same in the group 2 (

Reference values for maternal total and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period in western Turkey

The aim of this study was to investigate alterations in the leukocyte and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period. The study population consisted of 40,325 pregnant women. A full blood count and automated differential leukocyte count were performed and all the haemogram results in the different trimesters of pregnancy were recorded. Percentiles were calculated using statistical software. A total of 82,786 complete blood count evaluations were performed in 40,325 subjects from the 6th to 41st week of pregnancy and in the initial postpartum period. The leukocyte counts increased from the 1st to the 3rd trimester and peaked in the initial postpartum period. Our reference values for the total and differential leukocyte counts may assist clinicians in distinguishing between leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period.Impact statementPregnancy requires profound adaptation by multiple systems to accommodate the demands of the developing foetus.Similar to all other systems, many haematological changes occur during pregnancy.Studies of normal variation in leukocyte counts were insufficient to distinguish normal from abnormal leukocyte counts during pregnancy and in the initial postpartum period, due to small numbers of patients and a lack of differential leukocyte counts.Without reference leukocyte levels, infections may be more difficult to assess during pregnancy and in the postpartum period.In this study, we report the 3rd, 5th, 10th, 50th, 95th and 99th percentile values for the total and differential leukocyte counts according to trimester in normal pregnancy and the initial postpartum period.Our reference values for the total and differential leukocyte counts in each trimester and the initial postpartum period may assist clinicians in distinguishing between normal leukocytosis and pathological elevation of the white blood cell count during pregnancy and the initial postpartum period.Our results may prevent misdiagnosis of physiological elevated leukocytes as bacterial infection that leads to unnecessary medication use that may compromise the foetus

Various BhCG monitoring protocols for predicting the success of single-dose methotrexate in the treatment of ectopic pregnancy

We investigated various monitoring protocols on the success of methotrexate therapy in patients with tubal ectopic pregnancy. The data from patients who received single-dose methotrexate therapy as their first-line treatment was reviewed. The Beta-human chorionic gonadotropin (BhCG) days 1–4 and days 1–7 follow-up protocols were compared with the BhCG day 4–7 follow-up protocol, in terms of the treatment. Cut-off values were determined for the reduction of BhCG between the days 1–4 and days 1–7. There were no significant differences between the groups in terms of the demographic data, except for BhCG fourth- and seventh-day values. There was a 21% decrease in BhCG between days 1 and 4 and a 32% decrease for BhCG between days 1 and 7 as good predictors for treatment success. These follow-up protocols allow earlier and more cost-effective methods than the protocol based on a 15% reduction in BhCG levels between days 4 and 7.Impact statement What is already known on this subject? A decrease of 15% BhCG levels between days 4 and 7 is a common protocol for predicting the success of a single-dose methotrexate therapy of an ectopic pregnancy. What do the results of this study add? This clinical study offers the cut-off values for the various BhCG follow-up protocols recently found in the literature for single-dose methotrexate therapy for the treatment of ectopic pregnancy. What are the implications of these findings for clinical practice and/or further research? We identified the importance of fourth-day BhCG for measuring the success of single-dose methotrexate therapy. Therefore, after randomised, multicentre, prospective clinical trials, the most common follow-up protocol can be changed to a single-dose methotrexate therapy for ectopic pregnancy

Obstetric Outcomes of Syrian Refugees and Turkish Citizens

inan, Abdurrahman Hamdi/0000-0003-4782-3955; Beyan, Emrah/0000-0002-1662-5051; Ozgur, Su/0000-0002-8993-674XWOS: 000488286000001PubMed: 31679368Background: To present the differences in prenatal, labor and neonatal outcomes for Syrian refugees and Turkish citizens. Methods: Between January 2013 and December 2016, all patients in our hospital were screened retrospectively. Totally, 17 000 pregnant women included in the study were divided into three groups: group 1: 4802 pregnant in Syrian refugees group; group 2: 6752 pregnant in the low-income Turkish citizens (LI groups); and group 3: 5446 women in high-income Turkish citizens (HI groups). the groups were compared for demographic parameters, prenatal, labor and postnatal results. Results: Age, gestational week, birth weights, antenatal follow-up, antenatal iron supplementation and prenatal hemoglobin (Hb) values were significantly lower in the Syrian refugee group (P < 0.001). Only moderate preterm delivery and moderate low birth weight were higher in the refugee group (P = 0.023 and P = 0.001). Stillbirth rates were similar in all three groups (P = 0.203), but all other neonatal complications were higher in the Turkish citizens group. Conclusion: in comparison to non-refugee control patients, adverse perinatal outcomes were not observed in pregnant refugees. the refugee health policies of the Republic of Turkey seem to be working. However, further larger multicenter studies may provide more convincing data about obstetric outcomes and health results in the Syrian refugee population

Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital

The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35–40 years old. (2) 40–45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate