Expression of CD44 and IL-10 in normotensive and preeclamptic placental tissue

Objectives: We aimed to demonstrate cell-cell adhesion and apoptotic changes in preeclamptic placentas by examining the expression of CD44 and IL-10. Material and methods: Placenta samples of 15 preeclamptic and 15 healthy 35–38th week-pregnant women were involved in the study. Tissue samples were taken only from the maternal side of the placenta and fixed in 10% formaldehyde, then blocked in paraffin wax and 5 μm-thick sections were cut and stained with Masson Trichrome. Antigen retrieval was performed for sections, incubated with CD44 antibody and anti-IL-10 antibody. After the application of streptavidin peroxidase followed by AEC chromogen solution, sections were counterstained with Mayer hematoxylin. Results: In the preeclampsia group, increased CD44 positive expression was observed in maternal decidua cells and fibroblast cells close to root villi. CD44 was positively expressed in muscle cells around the blood vessels, mucosal connective tissue areas, syncytial nodes, and syncytial bridges. In the preeclampsia group, significant increased IL-10 expression was seen in subendothelial layers of the medium-sized vessels in the maternal region. IL-10 was also positively expressed in decidua cells outside the vessels, and inflamed connective tissue areas, chorionic villus cells with intense inflammation in intervillous spaces. Conclusions: CD44 was found to be an essential molecule in the regulation of vascular permeability, inflammatory response, activation of the cells, cell-to-cell interaction, and the signaling pathways to which they are associated. Since IL-10 regulates appropriate pregnancy outcomes and contributes to the balance of anti-inflammatory signals via both paracrine and autocrine regulators of trophoblast activity, we proposed that it might be a key to elucidate the etiology of preeclampsia with CD44 receptor

Cesarean scar pregnancy: A case report

Pregnancy implantation to the cesarean scar could be the life threatening, although it is a rare event, its ratio increased along with the increasing rate of cesarean delivery. Early diagnosis and treatment may be lifesaving with preserving fertility in these patients. In transvaginal ultrasonography; presence of an empty uterine and cervical cavity, lack of continuity of myometrial setting at the anterior isthmic region and pregnancy implantation to this region should suggest the diagnosis. In this article, we aimed to present a patient with scar ectopic pregnancy with the review of the literature

Retrospective Evaluation of Placenta Previa Cases: A Secondary-Center Experience

Aim:This study aimed to evaluate the maternal and neonatal outcomes of placenta previa cases managed in our hospital.Materials and Methods:The records of 107 placenta previa cases delivered between 2011 and 2016 were retrospectively reviewed. Age, gravida, parity, red blood cell (RBC)-fresh frozen plasma (FFP) transfusion necessity, the gestational week at birth, birth weight, 1st and 5th minute Apgar score, the number of previous cesarean sections, requiring additional surgical intervention (internal iliac artery ligation [IIAL], peripartum hysterectomy) and maternal complications were examined.Results:RBC-FFP transfusion and IIAL rates were significantly higher in complete placenta previa cases than the partial placenta previa cases. RBC-TDP transfusion, IIAL and peripartum hysterectomy rates were significantly higher in placenta accreata spectrum (PAS) cases compared to those cases with normal placental invasion. Prematurity risk increased in all placenta previa subgroups.Conclusion:Pregnancy complicated by placenta previa increases the risk of adverse maternal and neonatal outcomes, especially if there is concurrent placental invasion anomaly

An investigation of the effect of placental growth factor on intrapartum fetal compromise prediction in terminduced high risk pregnancies

Objectives: To date, there is no available test to predict the risk of intrapartum fetal compromise (IFC) during labor, either starting spontaneously or induced due to obstetrics indications. The aim of this study was to examine the effectiveness of placental growth factor (PIGF) in identifying cases that develop intrapartum fetal compromise (IFC) in term high-risk pregnancies induced for labor.Material and methods: This prospective cross-sectional study was conducted on 40 IFC+ cases and 40 IFC- cases withhigh-risk term pregnancy and labor induction started in the Health Sciences University Gazi Yaşargil Training and Research Hospital, between January 2018 and April 2018. Comparisons were made between the groups in respect of placental growth factor (PIGF) levels, and obstetric and neonatal outcomes.Results: The PIGF level was found to be statistically significantly lower in the IFC+ cases compared to the IFC- cases. For a PIGF cutoff value of 32 pg/mL for the prediction of IFC+ cases, sensitivity was 74.4%, specificity 73.2%, NPV 75% and PPV 72.5%, with a statistically significant difference determined between the groups. The IFC+ development risk increased 7.91-fold in patients with PIGF ≤ 32 pg/mL.Conclusions: The PIGF levels in cases of IFC+ high risk pregnancies were found to be statistically significantly lower than those of IFC- cases. However, further, large-scale randomized controlled research is necessary to demonstrate this relationship better

Retrospektywna analiza 41 przypadków łożyska wrośniętego – strategie postępowania

Objective: The aim of the study was to evaluate maternal characteristics, surgical treatment options, and morbidity of patients with placenta accreta. Methods: We retrospectively reviewed the medical records of placenta accreta patients who were diagnosed and hospitalized between 2006 and 2010 at the Obstetrics and Gynecology Clinics of the Dicle University Hospital (Center A) and Maternity Hospital (Center B) in Diyarbakir, Turkey. The data were retrieved from medical charts of both hospitals. Maternal demographic features, clinical outcomes, type of surgical intervention, and complicationswere evaluated. Results: The incidence of placenta accreta was 1/426 deliveries in Center A and 1/7573 deliveries in Center B over a 5-year period. Thirty-nine (95.1%) patients had placenta previa, and 32 (78.0%) patients had at least one previous cesarean delivery. Hysterectomy was performed in 28 (68.3%) of 41 women with placenta accreta and uterine preservation was achieved in 13 (31.7%) of them. One (2.4%) maternal death occurred. Estimated blood loss was >2 liters and all patients required blood products transfusion. Conclusion: Placenta accreta is highly associated with the existence of placenta previa, especially in cases with previous cesarean delivery. When placenta accreta is diagnosed or suspected, the patient should be referred to a tertiary center for optimum care, where the obstetrical team should include experienced pelvic surgeons who are capable of performing emergent hysterectomy, internal iliac artery ligation, and uterine devascularization procedures.Cel: Celem badania była analiza czynników matczynych, metod leczenia chirurgicznego i zachorowalności pacjentek z łożyskiem wrośniętym. Metody: Retrospektywnie przeanalizowano historie chorób pacjentek z łożyskiem wrośniętym, które zdiagnozowano i leczono w latach 2006 do 2010 w Klinice Ginekologiczno-Położniczej w Dicle University Hospital (ośrodek A) oraz Maternity Hospital (ośrodek B) w Diyarbakir, Turcja. Dane do analizy uzyskano z dokumentacji obu szpitali. Oceniono czynniki matczyne, demograficzne, wyniki leczenia, rodzaj zastosowanej interwencji chirurgicznej i jej powikłania. Wyniki: Częstość występowania łożyska wrośniętego wynosiła 1/426 porodów w ośrodku A i 1/7573 porodów w ośrodku B w okresie 5 lat obserwacji. Trzydzieści dziewięć (95,1%) pacjentek miało łożysko przodujące a 32 (78%) kobiety podawały co najmniej jedno cięcie cesarskie w przeszłości. Usunięcie macicy wykonano w 28 przypadkach (68,3%) spośród 41 kobiet z łożyskiem wrośniętym, natomiast u 13 z nich (31,7%) udało się zachować macicę. Jedna (2,4%) pacjentka zmarła. Szacowana utrata krwi wynosiła ponad 2 litry i wszystkie pacjentki wymagały przetoczeń preparatów krwi. Wnioski: Łożysko wrośnięte jest istotnie związane z łożyskiem przodującym, zwłaszcza w przypadkach cięcia cesarskiego w wywiadzie. W sytuacji rozpoznania lub podejrzenia łożyska przodującego, należy przekazać pacjentkę do ośrodka trzeciego stopnia referencyjności celem uzyskania optymalnej opieki nad chorą. Do ośrodka, w którym wśród położników będą doświadczeni chirurdzy miednicy mniejszej będący w stanie wykonać natychmiastowe usunięcie macicy, podwiązanie tętnicy biodrowej wewnętrznej i inne procedury zmniejszające unaczynienie macicy

PALM-COEIN classification system of FIGO vs the classic terminology in patients with abnormal uterine bleeding

Objectives: To evaluate the FIGO’s novel classification system versus the classic terminology in patients with abnormal uterine bleeding. Material and methods: A retrospective study was carried out between August 2015 and September 2019 in the Health Sciences University Gazi Yaşargil Training and Research Hospital. The pathology reports of the patients were classified according to the PALM-COEIN method and were compared with classical terminology. The operated patients with fibroids reported in the pathology results were classified as subgroups of fibroids. Results: Evaluation was made of a total of 515 women with abnormal uterine bleeding. According to the classical terminology, 137 (26.6%) patients were defined with hypermenorrhea, 74 (14.4%) with menorrhagia, 57 (11.1%) with metrorrhagia, and 246 (47.8%) with menometrorrhagia. In the PALM-COEIN classification system, polyps were determined in 84 (16.3%) cases, adenomyosis in 228 [diffuse adenomyosis: 196 (38.1%), local adenomyosis: 32 (6.2%)], leiomyoma in 386 [submu-cous: 161 (31.1%), other types: 225 (43.9%)], and malignancy and hyperplasia in 47 (9.1%). Conclusions: The classical terminology for abnormal uterine bleeding is insufficient in terms of etiological pathologies in non-pregnant women of reproductive age. The widespread use of this novel system for the abnormal uterine bleeding classification will provide a more useful communication between physicians and researchers

Ektopik Gebelik Olgularında Methotrexatın Tedavi Etkinliğinin Değerlendirilmesi

Aim: Our aim in this study was to assess efficacy of singledose methotrexate (MTX) as medical treatment for ectopic pregnancy (EP) by evaluating the results of patients given this treatment. Materials and Methods: Between September 2016 and August 2017, the treatment outcomes of EP cases treated with MTX at Gazi Yaşargil Training and Research Hospital of Health Sciences University were evaluated retrospectively. Results: In total, 126 cases treated for EP were evaluated and 65 cases were included in the study. In cases administered a single dose of MTX, the success rate was 80%, the failure rate was 13.8%, and the emergency surgery rate was 6.2%. The overall success rate of the medical treatment was 90.7% for a second dose of MTX. An unsuccessful result was considered as less than a 15% reduction in the beta-human chorionic gonadotropin (?-hCG) level between 4 and 7 days after single dose MTX administration. In all cases, the rate of emergency surgery after treatment was 9.3%. Conclusions: In our study, success rates in patients with EP treated with MTX were 80% after a single dose and as high as 90.7% when a second dose was addedAmaç: Bu çalışmadaki amacımız ektopik gebelik’ te (EP) medikal tedavi olarak tek doz methotrexat (MTX) tedavisi verilen olguların sonuçlarının değerlendirilmesidir. Materyal ve Metot: Eylül 2016 ile Ağustos 2017 arasında Sağlık Bilimleri Üniversitesi Gazi Yaşargil Eğitim ve Araştırma Hastanesinde tedavi edilen EP olgularında MTX tedavisi uygulanmış olanların tedavi sonuçları retrospektif olarak değerlendirildi. Bulgular: Çalışmanın yapıldığı tarihler arasında EP nedeniyle tedavi edilen 126 olgu çalışmaya dahil edildi. Tek doz MTX tedavisi başlanan olgularda başarı oranı %80, başarısızlık %13.8 ve acil cerrahi oranı %6.2 olarak gerçekleşti. Tek doz MTX uygulaması sonrasında 4 ve 7 günler arsında betahuman chorionic gonadotropin (?-hCG) seviyesinin %15 ten az düşmesi sonucunda başarısız olarak kabul edilen olgularda yapılan 2. doz MTX sonucunda, medikal tedavinin toplam başarı oranı %90.7 olarak gerçekleşirken, bu olguların tümünde tedavi sonrası acil cerrahi oranı %9.3 olarak gerçekleşti. Sonuç: Çalışmamızda uygun endikasyonla MTX tedavisi uygulanan EP olgularında medikal tedavinin başarı oranı %90.7 gibi oldukça yüksek bir oranda gerçekleşmiş olup olguların sadece %9.3 de MTX tedavisi sonrasında acil cerrahi tedavi gerekmiştir

The Effect of Seasonal Temperature Changes on Gestational Diabetes Mellitus Prevalence

Aim:The aim of this study was to investigate the effect of seasonal changes in ambient temperature on the prevalence of gestational diabetes mellitus (GDM).Materials and Methods:A retrospective evaluation was performed on the results of patients at 24-28 weeks gestation who underwent a GDM screening at the University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital in Diyarbakır, which is a city that is warm and dry in summer and cold and rainy in winter, between January 2017 and December 2017. Pregnant women were divided into four groups according to the season they were screened for GDM. A comparison was made in terms of the prevalence of GDM among pregnant women screened for diagnosis of GDM in different seasons.Results:Of 3,618 pregnant women screened, 7.5% (n=272) were diagnosed with GDM. The seasonal distribution of the GDM cases was 6.4% (n=54) in winter, 8.3% (n=78) in spring, 9.2% (n=84) in summer, and 6.1% (n=56) in autumn. A significant difference was observed in terms of seasonal distribution (p<0.05).Conclusion:The results of this study have demonstrated that seasonal temperature changes have a significant effect on GDM prevalence. However, further studies are needed to better demonstrate this relationship

Maternal near-miss patients and maternal mortality cases in a Turkish tertiary referral hospital

Objectives: This study aimed to estimate the incidence of maternal near-miss (MNM) morbidity in a tertiary hospital setting in Turkey. Material and methods: In this retrospective study, we concluded 125 MNM patients who delivered between January 2017 and December 2017 and fulfilled the WHO management-based criteria and severe pre-eclamptic and HELLP patients which is the top three highest mortality rates due to pregnancy. Two maternal death cases were also included. The indicators to monitor the quality of obstetric care using MNM patients and maternal deaths were calculated. Demographic characteristics of the patients, the primary diagnoses causing MNM and maternal deaths, clinical and surgical interventions in MNM patients, shock index (SI) value of the patients with obstetric hemorrhage and maternal death cases were evaluated. Results: The MNM ratio was 5.06 patients per 1000 live births. Maternal mortality (MM) ratio was 8.1 maternal deaths per 100 000 live births. SMOR was 5.14 per 1000 live births. The MI was 1.57%, and the MNM/maternal death ratio was 62.4:1. The SI of MNM patients with obstetric hemorrhage was 1.36 ± 0.43, and the SI of the patient who died due to PPH was 1.74. Conclusion: The MNM rates and MM rates in our hospital were higher than high-income countries but were lower than in low- and middle-income countries. Hypertensive disorders and obstetric hemorrhage were the leading conditions related to MNM and MM. However, the MIs for these causes were low, reflecting the good quality of maternal care and well-resourced units. Adopting the MNM concept into the health system and use as an indicator for evaluating maternal health facilities is crucial to prevent MM

Assessment of Methotrexate Efficacy in The Treatment of Ectopic Pregnancy

Aim:Our aim in this study was to assess efficacy of single-dose methotrexate (MTX) as medical treatment for ectopic pregnancy (EP) by evaluating the results of patients given this treatment.Materials and Methods:Between September 2016 and August 2017, the treatment outcomes of EP cases treated with MTX at Gazi Yaşargil Training and Research Hospital of Health Sciences University were evaluated retrospectively.Results:In total, 126 cases treated for EP were evaluated and 65 cases were included in the study. In cases administered a single dose of MTX, the success rate was 80%, the failure rate was 13.8%, and the emergency surgery rate was 6.2%. The overall success rate of the medical treatment was 90.7% for a second dose of MTX. An unsuccessful result was considered as less than a 15% reduction in the beta-human chorionic gonadotropin (β-hCG) level between 4 and 7 days after single dose MTX administration. In all cases, the rate of emergency surgery after treatment was 9.3%.Conclusions:In our study, success rates in patients with EP treated with MTX were 80% after a single dose and as high as 90.7% when a second dose was added