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

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

Are neutrophil to lymphocyte ratio and platelet to lymphocyte ratio clinically useful for the prediction of early pregnancy loss?

Objectives: Red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have all been identified as systemic inflammatory markers. The aim of this study to investigate whether the use of systemic inflammatory markers can predict early pregnancy loss.Material and methods: A total of 137 patients with early pregnancy loss was compared with 148 participants in the control group who had given birth at term. In the study group, CBC values were included in the study at the time of referral to the hospital for routine follow-up, while patients did not experience early pregnancy loss. In the control group, CBC values of the patient before the seventh week of pregnancy were included in the study. Results: There was no significant difference between the two groups in terms of RDW, MPV, PCT and PDW values. The NLR and PLR values were significantly higher in the early pregnancy loss group than the control group (p < 0.05).Conclusion: Our findings suggest that high NLR and PLR values are potent markers for the prediction of early pregnancy loss

Abnormal liver function tests in pregnant patients with COVID-19 — a retrospective cohort study in a tertiary center

Objectives: The current study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant COVID-19 patients, explore the association between LFTs with current medication, and provide a reference for medical therapy of pregnant patients with COVID-19. Material and methods: This retrospective single tertiary center cohort study included 122 pregnant patients with confirmed COVID-19 admitted and treated from April 1, 2020, to May 31, 2020. We defined abnormal LFTs as the elevation of the following liver enzymes in serum per our hospital’s laboratory reference range standards: AST > 35 U/L, ALT > 35 U/L, and TBIL > 1.2 mg/dL. We evaluated patients for demographic and clinical features, laboratory parameters, medications, and hospital length of stay (LOS). Results: Patients in this cohort had clinical presentations of fever (84.4%), dry cough (78.6%), and shortness of breathing (6.5%). In total, 17 (13.9%) patients had abnormal LFTs during hospitalization. Critically ill patients were three-fold higher in the abnormal LFTs group (11.8%) than in the normal LFTs group (3.8%, p = 0.16). The proportion of patients who used hydroxychloroquine and lopinavir/ritonavir were significantly higher in patients with abnormal LFTs (88.2% and 35.3%, respectively) than those with normal LFTs (62.9% and 15.2%, p = 0.04 and p = 0.04, respectively). The hospital length of stay (LOS) was significantly longer in the abnormal LFTs group (8.2 ± 5.8 days) than in the normal LFT group (6.0 ± 2.8 days, p = 0.02). Conclusions: SARS-CoV-2 may induce liver injury and the LFT abnormality was generally mild in pregnant patients with COVID-19. Abnormal LFTs are associated with prolonged hospital LOS. Drug use was the most crucial risk factor for liver injury during hospitalization. The use of lopinavir/ritonavir and hydroxychloroquine were significantly higher, and the course of treatment of these drugs was significantly longer in pregnant women with abnormal LFTs than the patients with normal LFTs. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating LFTs

Prenatal diagnosis of tetralogy of Fallot with an absent pulmonary valve: is this malformation still associated with a poor prognosis? A 5-year single-center experience

Objective: This study sought to assess the prenatal features and clinical outcomes of cases with a fetal diagnosis of tetralogy of Fallot (TOF) with an absent pulmonary valve (APV) at our maternal-fetal medicine unit. Methods: Twelve cases of TOF and APV prenatally diagnosed at Kanuni Sultan Süleyman Training and Research Hospital between 2015 and 2020 were retrospectively reviewed. Prenatal characteristics, additional cardiac and extracardiac anomalies, and postnatal outcomes of the cases were examined. Results: The median gestational age at diagnosis was 22 weeks (range: 18–24 weeks). The absence of ductus arteriosus was found in all cases (100%). Karyotype analysis was performed in 5 cases. A chromosomal abnormality was detected in 3 of these cases (60%); 2 cases with 22q11 microdeletion, and 1 case with trisomy 21. Parents opted for termination of pregnancy in two of these cases; 1 case with 22q11 microdeletion, and 1 case with trisomy 21. Two patients experienced spontaneous intrauterine fetal demise. Finally, 8 live-born fetuses underwent total correction surgery during the postnatal period. Four (33.3%) out of 12 cases survived at the end of the 4-years follow-up period. Conclusion: While TOF with APV cases were predominantly associated with poor prognoses in the past, more promising results have been obtained in recent years in parallel with the developments in surgery and postnatal care. For this reason, we think that the prognosis will be even better in the coming years as the developments in surgical technique and care continue

Altered right portal and umbilical vein doppler parameters in fetal macrosomia resulting from pregestational and gestational diabetic mothers: A prospective case-control study

Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows.Material and Methods: This prospective case-control study was con- ducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal cir- cumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestatio nal weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured.Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age pro gressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macro- somic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilic al vein and right portal vein blood flow in macrosomic fetuses

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

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

Tümör mikroçevresinde CD8’in yüksek ekspresyonu, yüksek dereceli seröz over kanserinde PD-1 ekspresyonu ve hasta sağkalımı ile ilişkilidir

Objective: The current study assesss programmed death-1 (PD-1) receptor expression and CD3, CD4, and CD8 tumor-infiltrating lymphocytes (TILs) in high-grade serous ovarian cancer (HGSOC) and to associate our results with neoadjuvant chemotherapy history and disease prognosis. Materials and Methods: We included cases diagnosed with primary HGSOC with biopsy or surgical resection materials in this study. The immunoreactivity of CD3, CD4, CD8, and PD1 was assessed immunohistochemically in tumor tissue. We analyzed TILs in two predetermined groups of high and low TIL. The relationships between clinical characteristics, PD-1, and TIL were assessed. by the χ(2) test or Fisher’s Exact test. We used Kaplan-Meier survival analysis and Cox proportional hazards regression model to the connection between survival and the amounts of TIL, and PD1. Results: Univariate analysis demonstrated that optimal debulking (p<0.001), early International Federation of Gynecology and Obstetrics stage (p=0.046), and higher scores of stromal CD8+ TIL expression (p=0.028) in tumor cells were all substantially correlated with longer disease-free survival (DFS), whereas the remaining variables analyzed, including PD-1 positivity, stromal CD3+, and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs, were not correlated with DFS. Also, univariate analysis revealed that optimal debulking (p=0.010), and higher scores of stromal CD8+ TIL expression (p=0.021) in tumor cells were all substantially correlated with longer overall survival (OS). Conclusion: Higher scores of stromal CD8+ TILs are substantially correlated with DFS and OS in univariate analyses, whereas scores of stromal CD3+ and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs are not correlated with DFS and OS in both univariate and multivariate analyses. Also, we found a significant association between PD-1 positivity and the scores of stromal CD3+ TILs and intraepithelial CD8+ TILs. However, no remarkable relationship was revealed between PD-1 positivity and the survival of HGSOC cases.Amaç: Çalışmamızın amacı, yüksek dereceli seröz over kanserinde (HGSOC) programlanmış ölüm-1 (PD-1) reseptör ekspresyonunu ve CD3, CD4 ve CD8 tümör infiltre edici lenfositleri (TIL) değerlendirmek ve bulgularımızın neoadjuvan kemoterapi öyküsü ve hastalık prognozu ile ilişkisini incelemektir. Gereç ve Yöntemler: Biyopsi veya cerrahi rezeksiyon materyalleri ile primer HGSOC tanısı alan olgular çalışmaya dahil edildi. CD3, CD4, CD8 ve PD1’in immünoreaktivitesi, tümör dokusunda immünohistokimyasal olarak değerlendirildi. TIL, önceden tanımlanmış iki grup olan düşük ve yüksek TIL grubunda analiz edildi. Klinik özellikler, PD-1 ve TIL arasındaki ilişkiler χ(2) testi veya Fisher’s Exact test ile değerlendirildi. TIL, PD1 ve hayatta kalma arasındaki ilişki için Kaplan-Meier hayatta kalma analizi ve Cox oransal hazard regresyon modeli kullanıldı. Bulgular: Tek değişkenli analiz, tümör hücrelerinde optimal debulking (p<0,001), erken Uluslararası Jinekoloji ve Obstetrik Federasyonu evresi (p=0,046) ve daha yüksek stromal CD8+ TIL ekspresyonu skorlarının (p=0,028) tümünün daha uzun hastalıksız sağkalım (DFS) ile önemli ölçüde ilişkili olduğunu gösterdi; oysa ki kalan değişkenler, PD-1 pozitifliği, stromal CD3+ ve CD4+ TIL’ler ve intraepitelyal CD3+, CD4+ ve CD8+ TIL’ler dahil olmak üzere, analiz edildiğinde DFS ile korele değildi. Ayrıca, tek değişkenli analiz, tümör hücrelerinde optimal debulking (p=0,010) ve daha yüksek stromal CD8+ TIL ekspresyonu skorlarının (p=0,021) tümünün daha uzun genel sağkalım (OS) ile önemli ölçüde ilişkili olduğunu ortaya koydu. Sonuç: Daha yüksek stromal CD8+ TIL skorları, tek değişkenli analizde DFS ve OS ile anlamlı şekilde ilişkiliyken, stromal CD3+ ve CD4+ TIL’lerin ve intraepitelyal CD3+, CD4+ ve CD8+ TIL’lerin skorları, hem tek değişkenli hem de çok değişkenli analizlerde DFS ve OS ile ilişkili değildi. Ayrıca, PD-1 pozitifliği ile stromal CD3+ TIL’lerin ve intraepitelyal CD8+ TIL’lerin skorları arasında anlamlı bir ilişki bulundu. Ancak, PD-1 pozitifliği ile HGSOC hastalarının sağkalımı arasında anlamlı bir ilişki gözlenmedi

The comparison of systemic inflammatory response markers and Doppler ultrasound parameters between pregnancies with intrahepatic cholestasis and control cases

Objective: This study aims to detect a relationship between inflammatory markers, ductus venosus (DV) pulsatility index (PI), middle cerebral artery (MCA) PI, and umbilical artery (UA) systole to diastole ratio (S/D) and PI between pregnancies with intrahepatic cholestasis and control cases. Methods: This prospective study included 82 cases having intrahepatic cholestasis of pregnancy (ICP) and 80 gestational age-matched healthy control cases. The Doppler measurements (DV PI, MCA PI, and UA S/D and PI), inflammatory markers (neutrophil to lymphocyte ratio [NLR], platelet to lymphocyte ratio [PLR], mean platelet volume [MPV], and red blood cell distribution width [RDW]), and fetal and maternal outcomes were compared. Results: Patients with ICP had increased PLR value (p=0.019) and decreased lymphocyte count (p=0.004) compared to control cases. Also, there was a positive correlation between PLR value and the presence of ICP (χ2=5.774, p=0.016). There were no significant differences between ICP and control groups concerning NLR, RDW, MPV, and UA PI values. We found higher UA S/D, and DV PI values and lower MCA PI values in pregnancies with ICP compared to controls (p<0.001, p=0.026, and p=0.003, respectively). Conclusion: In ICP cases, the PLR value was significantly increased than the controls, but the NLR, RDW, MPV, and UA PI values were found to be similar to control cases. The UA S/D, and DV PI values were increased, and MCA PI was significantly decreased in the ICP group compared to healthy pregnancies. However, we could not demonstrate the benefit of Doppler measurements in predicting neonatal outcomes in ICP cases