Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

Do follicular fluid advanced glycation end products levels affect the ovarian response in unexplained infertility?

Objective: To compare the advanced glycation end products (AGEs) levels in follicular fluid according to the different ovarian responses of women who underwent controlled ovarian stimulation due to unexplained infertility and to examine the relationship between these levels and pregnancy outcomes. Methods: Sixty-three women who underwent fresh IVF/ICSI cycles with GNRH antagonist protocol were divided into 3 groups according to the number of retrieved oocytes as suboptimal (4–9 oocytes), optimal (10–15 oocytes) and high (>15 oocytes) responders. AGEs levels in follicular fluid were measured by ELISA method. Results: AGEs levels were 6.81 ± 2.20 mg/ml, 5.30 ± 2.01 and 6.44 ± 1.43 mg/ml in suboptimal, optimal and high response group, respectively. AGEs level was significantly higher in suboptimal response group than in optimal response group. The cutoff level of 6.19 mg/ml had a sensitivity of 59.3% and a specificity of 66.7% in distinguishing the suboptimal response group from the optimal response group. However, there were no statistically significant difference between AGEs levels and clinical pregnancy and live birth rates. Conclusion: Increased AGEs level in follicular fluid may be associated with decreased ovarian response during controlled ovarian stimulation in unexplained infertility case, however, it does not provide information about pregnancy outcomes

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

WOS: 000405108100009PubMed: 28727133Objectives: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. Material and methods: This study was carried out at Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. Results: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. Conclusions: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes

GnRH agonist versus HCG triggering in different IVF/ICSI cycles of same patients: a retrospective study

The aim of this study was to assess Gonadotropin Releasing Hormone agonist (GnRHa) trigger results of fresh in vitro fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) cycles in high-responder patients. Thirty-six high-responder patients, undergoing GnRH antagonist protocol combined with GnRHa trigger for final oocyte maturation, were included. All cycles were autologous fresh transfer cycles. Fifteen of 36 patients had previous IVF/ICSI cycles triggered with human chorionic gonadotropin (hCG) and both cycles of these patients were compared. The mean fertilisation rate, blastocyst development and clinical pregnancy rates were 67%, 44.4% and 44.4%, respectively. The hCG and GnRHa trigger cycles of the same patients were compared as two groups (n: 15). 2PN oocyte counts were significantly higher in agonist trigger cycles (p .048). There were no differences in terms of M2 oocyte count and fertilisation rate. The blastocyst formation and clinical pregnancy rates for hCG and GnRHa trigger cycles were 33.3–66.7% and 13.3–46.7%, respectively. These results were found to be 2-fold and 3.5-fold higher, but not statistically significant. GnRHa trigger in combination with LPS is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.IMPACT STATEMENT What is already known on this subject? Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of Ovarian Hyperstimulation Syndrome (OHSS) on IVF cycles using antagonist protocol. What do the results of this study add? The main strength of this study is the comparison of different triggers in different cycles of the same patients. GnRHa trigger in combination with Luteal Phase Support (LPS) is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks. What are the implications of these findings for clinical practice and/or further research? We suppose that GnRHa trigger combined with modified LPS is clinically more successful than Human Chorionic Gonadotropin (hCG) in regard to OHSS prevention and reproductive outcomes on fresh IVF/ICSI cycles. More extensive studies are needed to draw firm conclusions

Alterations of Ionized and Total Magnesium Levels in Pregnant Women with Gestational Diabetes Mellitus

Background/Aims: The aim of this prospective study was to determine ionized and total magnesium (Mg) levels in pregnant subjects with and without gestational diabetes mellitus (GDM). Methods: Eighty-five women, 26-28 weeks pregnant, were recruited for routine oral glucose tolerance tests (OGTT); 45 had normal OGTT results and 40 were diagnosed with GDM. Electrolyte levels, including ionized and total Mg, were analyzed. Results: Gestational age and BMI were similar between the two groups (p = 0.800, p = 0.025). Multivitamin use was higher in the control group (p = 0.036). Fasting blood glucose was higher in the GDM group (p < 0.001). The median total Mg levels were 1.9 mg/dl (range 1.6-2.2) in the control group and 1.8 mg/dl (range 1.2-2.1) in the GDM group (p < 0.001). The median ionized Mg levels were 0.5 mmol/l (range 0.4-0.6) in the control group and 0.4 mmol/l (range 0.4-0.5) in the GDM group (p < 0.001). Conclusion: Our study revealed a relationship between low total and ionized Mg levels and GDM, as in type 2 diabetes mellitus (DM). The literature regarding type 2 DM and our findings suggest that Mg is the key ion in the pathophysiology of GDM. Low-dose Mg supplementation was not related to GDM; however, pharmacological doses in the various stages of pregnancy could be beneficial and should be investigated. (C) 2014 S. Karger AG, Base

Coasting Versus GnRH Antagonist Salvage for the Prevention of Ovarian Hyperstimulation Syndrome

OBJECTIVE: The purpose of the present study is to compare the use of GnRH antagonist salvage versus coasting for the prevention of OHSS in patients undergoing IVF/ICSI cycles with long GnRH agonist protocol. STUDY DESIGN: Medical records of 91 patients (41 in coasting and 49 in GnRH antagonist group) identified as at high risk of developing OHSS were reviewed retrospectively. Groups were compared for occurrence of moderate and severe OHSS, serum estradiol on the day of HCG and IVF outcomes. RESULTS: There were no differences between the groups in terms of moderate and severe OHSS and clinical pregnancy rates. Serum estradiol levels were decreased significantly in GnRH antagonist group. Quality of the transferred embryos was better in the coasting group. CONCLUSION: Our results represent that both coasting and GnRH antagonist salvage are effective strategies to prevent OHSS in women undergoing long GnRH agonist IVF/ICSI cycles

Success of Systemic Methotrexate Administration Versus Laparoscopic Salpingostomy in Ectopic Pregnancy

OBJECTIVE: In this study, we tried to compare the efficacies of laparoscopic salpingostomy and medication with a single dose of Methotrexate (50mg/m2) in ectopic pregnancy to determine the differences between the two methods in terms of treatment outcomes. STUDY DESIGN: In this study, 64 patients with ectopic pregnancy who had been administered an MTX therapy between August 2007 and July 2010 (Group A) were compared with another 64 patients with matching ages who had undergone a laparoscopic salpingostomy (Group B). The two groups were compared in terms of age, gravida, parity, initial hCG value, hCG measured at the time of being discharged from the hospital, hCG values checked a week later and the number of hospitalization days. The number of repeating doses and the rate of undergoing a laparoscopy salpingostomy were calculated in patients receiving MTX. RESULTS: The hCG values of the patients in the MTX and laparoscopy groups respectively were as follows: Initial hCG measurement; 670.5±1027.5 vs. 5511.3± 7293.0 (p=0.0001), hCG measured at the time of discharge; 352.3±627.0 vs. 869.7±599.1 (p=0.016), and hCG value after a week; 292.5±617.4 vs 864.1±1531.8 (p=0.023). The difference in the number of hospitalization days between the two groups came out to be significant; 2.4±4.2 for the MTX group and 1.3±1.6 for the laparoscopy group with p=0.01. Repetition of the dose became necessary in 14.1% (9/64) of the patients receiving medical treatment (MTX) as their hCG values did not decrease. Success was achieved in treating 4.7% (6/64) of these patients after the second dose and the rate of undergoing a laparoscopic salpingostomy due to MTX failure was calculated to be 4.6%. CONCLUSION: We found in this study that MTX used as a medical treatment in ectopic pregnancy was as successful as a laparoscopic salpingostomy. MTX failure can be minimized by firmly determining the criteria for the patients who will be given a medical treatment

Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis

Objectives: This study aimed to compare the outcome of pregnancies with retained or removed intrauterine devices (IUDs) and the effect of IUD location on pregnancy outcome. Study design: In a retrospective cohort study, we searched 27,578 records of women who had CuT380 IUD inserted, and 144 pregnancies with IUD were analyzed. IUDs were removed from 114 patients and retained for 30 patients. Results: The combined risk of adverse pregnancy outcomes (miscarriage, intrauterine fetal death, intrauterine growth retardation, preterm birth and preterm premature rupture of membranes) was 36.8% in the IUD-removed group and 63.3% in the IUD-retained group [p<.01; relative risk (RR)=2.0; 95% confidence interval (CI) 1.3-3.3]. Newborns of the IUD-retained women had significantly lower Apgar scores and significantly higher admission rate to the neonatal intensive care unit (p=.01; RR=10.8; 95% CI 1.04-111.6 and p<.01; RR=4.5; 95% CI 1.5-12.9, respectively). There were more miscarriages and adverse pregnancy outcome when the IUD was retained (16.9% vs. 66.7%) in patients with an IUD in low-lying position (p<.01; RR=3.9; 95% CI 1.8-8.6). Conclusion: Women who conceived with an IUD in place and chose to continue the pregnancy without removing the IUD need close followup, as there appears to be higher risk of adverse pregnancy and neonatal outcome. Furthermore, when the IUD is retained in the low-lying position, there is increased risk of miscarriage and adverse pregnancy outcome compared to removal of the IUD. Future randomized controlled studies are needed to determine the outcome of pregnancies with retained or removed IUD. Implications: In this study, we have evaluated the IUD location and its effect on pregnancy outcome in women with a retained or removed IUD. This study is the first to investigate the relationship between IUD location and pregnancy outcome in women who conceived with an IUD. We need evidence from a collaborative multicenter randomized trial to answer the question of whether the IUD should be removed in case of pregnancy. (C) 2014 Elsevier Inc. All rights reserved

Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5

Background: We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. Methods: This was a prospective case–control study, which included 104 consecutive women with a Bishop score≤5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score≤5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n=40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index≥5 cm) and Bishop score≤5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. Results: The mean time interval from induction to delivery was not different between the two groups (p=0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p=0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. Conclusion: Dinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications