The association between placenta previa and leukocyte and platelet indices — a case control study

Objectives: Despite medical advances, rising awareness, and satisfactory care facilities, placenta previa (PP) remains a challenging clinical entity due to the risk of excessive obstetric hemorrhage. Etiological concerns gave way to life-saving concerns about the prediction of maternal outcomes due to hemorrhage. Our study aimed to detect an early predictive marker of placenta previa. Material and methods: Ninety-three pregnant patients diagnosed with PP and 247 controls were recruited for this retro­spective study. Platelet and leukocyte indices were compared between the two groups. Results: The groups were similar with regard to age distribution (31.2 ± 5.1 years [mean ± SD] in the PP group and 31.7 ± 4.2 years in controls), body mass index (BMI) (27.7 ± 3.6 kg/m2 in the PP group and 27.4 ± 4.6 kg/m2 in controls), and most characteristics of the obstetric history. Total leukocyte count, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly higher in the PP group. Mean platelet volume (MPV) and large platelet cell ratio (P-LCR) values were significantly lower in the PP group as compared to controls, with regard to third trimester values. However, patients who were diagnosed postnatally with placenta percreta had lower MPV and P-LCR values than other patients with PP. There were no statistically significant differences between the two groups as far as first trimester values were concerned. Conclusions: Platelet and leukocyte indices in the third trimester of pregnancy may be valuable predictors of placenta previa and placenta percreta. More comprehensive studies are needed to address this issue

Oxidative stress markers in severe preeclampsia and preeclampsia-related perinatal morbidity — preliminary report

Objectives: The aim of the study was to determine maternal serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase levels in severe preeclamptic pregnants and also to investigate whether these parameters are implicated in the occurence of perinatal morbidity or not. Material and methods: A case-control study was carried out including 60 pregnant women (30 with severe preeclampsia and 30 healthy controls). The optimal cut off points of oxidative stress markers for the diagnosis of severe preeclampsia and for the prediction of adverse perinatal outcomes were evaluated by receiver operating characteristic (ROC) analyses. Multi­variate logistic regression analysis was used to determine if a relationship between adverse perinatal outcomes and serum oxidative stress markers was present or not. Results: TAS (OR = 37.486, 95% CI 3.535–397.519, p = 0.003), TOS (OR = 15.588, 95% CI 2.135–113.818, p = 0.007) and ary­lesterase (OR = 31.356, 95% CI 2.284–430.548, p = 0.01) were found to be diagnostic for preeclampsia. Statistically significant positive correlation of adverse perinatal outcomes with serum TAS, PON and arylesterase levels were determined. Besides, a significant negative correlation was found between serum TAS levels and gestational week (r = –0.342, p = 0.007) and also between serum PON levels and birthweight (r = –0.262, p = 0.043). Conclusions: Increased maternal serum TAS, TOS and arylesterase levels are significantly associated with the presence of severe preeclampsia. Furthermore, elevated maternal serum TAS, PON and arylesterase levels are significantly and positively correlated with adverse perinatal outcomes. We suggest that in preeclampsia increased oxidative status may cause adverse perinatal outcomes and antioxidants may be increased in order to protect the fetus against oxidative damage

Relaparotomia po pierwotnym leczeniu chirurgicznym w położnictwie i ginekologii: analiza 113 przypadków

Condensation: Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology. Objective: To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations. Study Design: A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity, and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery. Results: The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n=42, 37.1%), hypogastric artery ligation (n=32, 28.3%), hysterectomy (n=31, 27.5%), and drainage of abscess (n=7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality. Conclusion: Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.Chociaż relaparotomia jest w niektórych przypadkach nie do uniknięcia, powino się podjąć wszelkie środki, takie jak: dokładna technika operacyjna, skrupulatna hemostaza i warunki aseptyczne, aby zapobiec niepotrzebnym interwencjom w położnictwie i ginekologii. Cel: Ocena wskazań, procedur, czynników ryzyka i wyników leczenia relaparotomią po operacjach ginekologicznych i położniczych. Metoda: Przeprowadzono retrospektywne badanie obserwacyjne w ciągu 4 lat w ośrodku III stopnia referencyjności. Dane demograficzne, takie jak: wiek, rodność, wskazania do relaparotomii oraz jej wynik w postaci powikłań i śmiertelności, oceniono u 113 pacjentek operowanych ponownie po pierwotnej operacji położniczej lub ginekologicznej. Wyniki: Ogólna częstość zgonów po relaparotomii wynosiła 3,5%. Wiodącym wskazaniem do pierwotnej operacji było oddzielenia łożyska w 10 przypadkach (8,8%), następnie zespół HELLP i cięcie cesarskie w wywiadzie – oba po 5 przypadków (4,4%), oraz atonia poporodowa w 4 (3,5%). Najczęściej wykonaną pierwotną operacją było cięcie cesarskie – 78 przypadków (69%) i usunięcie macicy – 31 (27,5%). Głównym wskazaniem do relaparotomii było krwawienie i krwiak w 80 przypadkach (70,8%) oraz ropień w 10 przypadkach (8,8%). Najczęściej wykonywanymi procedurami podczas relaparotomii były: drenaż i ponowne założenie szwów na miejsca krwawiące (n=42, 37,1%), podwiązanie tętnicy podbrzusznej (n=32, 28,3%), usunięcie macicy (n=31, 27,5%), i ewakuacja ropnia (n=7, 6,2%). Ponowna relaparotomia była przeprowadzona w 4 przypadkach (3,5%). Powikłania dotyczyły 4 pacjentek i 4 pacjentki ostatecznie zmarły. Wnioski: Powikłania krwotoczne i infekcyjne były głównym wskazaniem do relaparotomii po pierwotnych operacjach ginekologicznych i położniczych. Przypadki z przedwczesnym oddzieleniem łożyska, zespołem HELLP i cięciem cesarskim w wywiadzie były związane z większym ryzykiem relaparotomii. Pomimo korzystnych wyników, powinno się podjąć środki zaradcze w postaci dokładnej techniki operacyjnej, skrupulatnej hemostazy oraz zapewnienie warunków aseptycznych

Is the expression of placental epithelial and lymphoid markers associated with the perinatal outcomes in preeclampsia?

Objectives: This study aimed to investigate the association of the epithelial and lymphoid immune markers with the adverse perinatal conditions such as early-onset preeclampsia (EOPE), fetal growth restriction (FGR) and intrauterine fetal death (IUFD) in preeclampsia in the placentae of preeclamptic patients. Material and methods: A total of 60 pregnant patients were included in this study. The immunohistochemistry method was used to determine the expression levels of CD4, CD8, CD4 / CD8, CD68, P53, MDM2, CK18, CK19, E-cadherin, and [1-catenin. Results: In our study, the increase in E-cadherin expression in the preeclamptic fetal-maternal placental region was associated with EOPE and FGR development preeclampsia and the decrease in the expression of CD4 and CD8, which are involved in the local immunomodulation, was associated with IUFD. Conclusions: Our data reveal that the increase in the expression of CK18, CK19, E-cadherin, and [1-catenin and the decrease in CD4 and CD8 play a role in the pathogenesis of preeclampsia

Association of adverse outcomes of intrahepatic cholestasis of pregnancy with zonulin levels

Our aim was to investigate serum zonulin levels in intrahepatic cholestasis of pregnancy (ICP) and to determine the usefulness of zonulin in ICP follow-up. A prospective case-control study was carried out which included 88 pregnant women (44 patients with ICP and 44 controls). Maternal serum samples obtained from all participants and zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Compared with controls, women with ICP had significantly higher zonulin levels (mean 0.728 ± 0.520 ng/mL vs. 1.303 ± 0.63 ng/mL, p <.001). According to the receiver operating characteristic (ROC) analysis performed for the predictive value of zonulin levels for ICP, the area under the curve (AUC) was 0.761 (95% CI: 0.661–0.860). Multivariable logistic regression analysis revealed serum zonulin levels was independently associated with adverse perinatal outcomes (OR = 1.278, 95% CI: 0.232–7.041), severity ICP (OR: 7.535, 95% CI: 1.597–13.553) and also unresponsiveness to treatment in ICP (OR: 4.178, 95% CI: 0.929–8.784).IMPACT STATEMENT What is already known on this subject? Zonulin is a regulator protein that increases the intestinal permeability by modulating the intercellular tight junctions (TJ). It is the only physiological protein known to control intestinal permeability and damage of the intestinal barrier is one of the causes of absorption disorders, inflammation and autoimmunity. ICP is a relatively non-threatening condition to women but is linked with a higher risk of preterm delivery, foetal distress and foetal death. What do the results of this study add? This study showed that increased levels of zonulin are associated with adverse perinatal outcomes, severity of ICP and unresponsiveness to treatment in ICP. What are the implications of these findings for clinical practice and/or further research? Focussing on preservation of intestinal permeability may be an alternative preventive strategy to reduce the adverse perinatal outcomes and severity of ICP. Further longitudinal studies are needed to verify the relationships among zonulin levels and pregnancy-related diseases

Are body roundness index and a body shape index in the first trimester related to foetal macrosomia?

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126–1.917, p = .005; OR = 4.289, % CI: 0.178–1.030, p = .012, OR = 6.277, %Cl: 1.233–31.948, p = .027, and OR = 1.393, %Cl: 1.060–1.832, p = .017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women.Impact statement What is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution. What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women. What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women

The role of thyroid-stimulating hormone and thyroglobulin antibody in abnormally invasive placenta

© 2021 Informa UK Limited, trading as Taylor & Francis Group.Purpose: Thyroid hormones and antibodies are known to participate in angiogenesis and invasion and also thyroid hormone receptors are expressed in the placenta. We aimed to evaluate the relationship of serum levels of thyroid-stimulating hormone (TSH), thyroid hormones (TH), and anti-thyroid antibodies with abnormally invasive placenta (AIP). We also aimed to investigate whether they are related with cesarean hysterectomy and massive blood transfusion need in AIP cases. Methods: A total of 88 pregnant patients were enrolled in this prospective case-control study (30 with AIP, 28 with non-adherent placenta previa totalis (PPT) and 30 controls). Serum TSH, thyroid hormone [T3 (triiodothyronine) and T4 (thyroxine)] and thyroid antibodies against thyroglobulin (TgAb) and thyroid peroxidase (TPOAb) levels were studied in maternal serum at initial admission to our Perinatology Unit (at early third trimester). The factors associated with increased risk of AIP, cesarean hysterectomy, massive blood transfusion, and adverse perinatal outcomes were evaluated with multiple logistic regression analysis. Adjusted odds ratios and 95% confidence intervals were also calculated. Results: Serum TSH and TgAb levels were significantly lower in the AIP group than both PPT and control groups (p =.01, p <.001 and p <.001, p <.001 respectively). Decreased serum levels of TSH (<2.16 mIU/L) and TgAb (<2.70 mIU/L) levels and high previous cesarean section rates were found to be independently associated with AIP in pregnant women with PPT (OR: 0.4, 95% CI: 0.1–0.9; p =.04, OR: 0.7, 95%CI: 0.4–1.3, p =.02 and OR: 0.1, 95% CI: 0.1–0.5, p =.01). Decreased serum TSH and TgAb levels were found to be independently associated with an increased rate of cesarean hysterectomy and massive blood transfusion in AIP cases (OR: 3.7, 95% CI: 1.4–9.8; p =.01, OR: 1.8, 95% CI: 1.1–3.1; p =.03 and OR: 2.6, 95% CI: 1.0–6.5; p =.05, OR: 2.2, 95% CI: 1.1–4.1 p =.02). Decreased TSH and TgAb serum levels were also found to be independently associated with adverse perinatal outcomes in AIP cases (OR: 3.4, 95% CI: 1.3–11.0; p =.01 and OR: 1.978, 95% CI: 2–3.6; p =.03). Conclusion: Decreased serum TSH and TgAb levels, and previous history of cesarean section were all found to be significantly associated with AIP in cases with PPT. We suggest that maternal serum TSH and TgAb levels can provide additional contribution to obstetric Doppler ultrasound in the diagnosis of AIP and thus can reduce the risks of unplanned cesarean hysterectomy in cases with PPT

Can We Determine The Time Elapsed Until The Birth In Preterm Premature Rupture Of Membranes (Pprom) And Preterm Labor (Pte) ? [Preterm Prematur Erken Membran Rupturu (Pprom) Ve Preterm Eylem (Pte)De Doguma Kadar Gecen Sureyi Belirleyebilir Miyiz?]

We aimed to determined; affect of clinical, laboratory, and ultrasonographic factors the time elapsed until the birth in midtrimester PPROM and PTE. Total 448 PPROM and PTE patients were conceived which applicant the Perinatology Department of zekai Tahir Burak Women's Health Education And Research Hospital between 2012-2014 years. PPROM group consisted of 237 patients, PTE group consisted of 211 patients. PPROM and PTE groups were divided into subgroups as cervical culture positive and negative PPROM and PTE groups. Risk factors of until the time of birth was determined by multivariate regression analysis in cervical culture positive PPROM and PTE groups. Cervical length measured by TVUSG=0,907, 95% Cl = 0,823-0,999 (p=0,047) and amniotic fluid index (or= 0,962, 95% Cl= 0,946-0,980 (p [Med-Science 2016; 5(2.000): 468-83

Maternal and perinatal effects of vaginal delivery after caesarean section

We aimed to determine the risk factors of vaginal delivery after caesarean section (VDAC) that may be effective on maternal and neonatal outcomes and compare the pregnancy outcomes of VDAC with the results of the previous caesarean delivery. 36 women, who had VDAC in Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009-2014 years, were included in this study. Mean age of patients was 32.53± 3.595, mean birth week of previous caesarean was 38.21 ± 1.84 and mean birth week of present vaginal delivery was 36,10 ± 3,99. Birth weeks of previous caesarean and present vaginal deliveries were significantly different. Neonatal birth weight was not significantly different between these groups. Gravida and parity of the patient, and the number of previous vaginal deliveries, have been identified as factors that reduce adverse pregnancy outcomes by lineer regression analysis. Increased number of previous vaginal deliveries, gravida and parity reduce the adverse pregnancy outcomes in women having VDAC. [Med-Science 2016; 5(4.000): 957-60

Comparison of liquid based cytology results with conventional cytology results in screening cervical cancer

Our objective is to compare and evaluate the liquid based cytology (LBC) results with the conventional cytology (CC) results for cervical cancer. Cross sectional study. The results of 1531 women, applied to our outpatient clinic, for cervical cancer screening between the years 2012- 2015, were evaluated. We have applied liquid based cytology on 958 (62.6%) of the patients, and conventional cytology on 573 (37.4%) of the patients. Unsatisfactory smear results for examination were found to be significantly lower in LBC compared to CC (20.3% vs. 0.4%, p [Med-Science 2016; 5(4.000): 919-27