Journal Gynecology Obstetrics & Reproductive Medicine

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Gizem Bektas, Yetkin Karasu, Engin Yurtcu, Cihan Togrul, Sebnem Özyersen, Aylin Onder Dirican, Ozlem Uzunlar, Tayfun Gungor, Muzaffer Caydere
Gynecology Obstetrics & Reproductive Medicine pp 1-6; doi:10.21613/gorm.2018.779

Abstract:Objective: Reperfusion injury occurs when the condition causing ischemia in ovarian torsion is corrected and the blood supply is re-established. The aim of this study is to evaluate whether doxycycline treatment reduces reperfusion injury in a rat model.Study Design: Thirty-five female albino Wistar rats were split into the five groups. Sham: Sham operation; ischemia (I): 2 hours of ischemia; ischemia and reperfusion (I/R): 2 hours of ischemia followed by 2 hours of reperfusion; Sham-Dc: Sham operation and doxycycline 10-mg/kg (2 hours prior to surgery); I/R-Dc: 2-hours of ischemia and doxycycline 10-mg/kg and 2-hours of reperfusion. The groups were compared in terms of histological and biochemical features. A semi-quantitative histological assessment scoring system was used for the histological examination. Follicular cell degeneration, vascular congestion, haemorrhage and inflammatory cell count were evaluated for histological analysis. For biochemical analysis of reperfusion injury, the body's total antioxidant status and total oxidant status were measured using a fully automatic method. The oxidative stress index was calculated by dividing total antioxidant status by total oxidant status.Results: In the sham group the ovaries were histologically normal. Oedema, vascular congestion, bleeding, leukocyte infiltration and follicle degeneration were increased in other groups (p<0.05). There was less leukocyte infiltration in the I/R-Dc group compared to I/R group. Other histological features were similar in these groups. Doxycycline increased the malondialdehyde, total antioxidant and total oxidant status levels in Sham-Dc and I/R-Dc groups. This increase was statistically significant between Sham and Sham-Dc groups. However, although there was an increase in the biochemical markers in the I/R-Dc group, this increase was not significant compared to I/R group.Conclusion: Doxycycline treatment in ovarian torsion does not reduce I/R injury. Doxycycline may even increase reperfusion injury, according to biochemical findings.
Sedat Akgol, Mehmet Sukru Budak
Gynecology Obstetrics & Reproductive Medicine pp 1-4; doi:10.21613/gorm.2018.790

Abstract:Objective: The aim of this study was to evaluate obstetric and neonatal outcomes of pregnancies with mild gestational hyperglycemia diagnosed at gestational diabetes mellitus screening.Study design: Between September 2016 and August 2017, the pregnant women diagnosed as normal glycaemia or mild gestational hyperglycemia according to the results of gestational diabetes mellitus screening with 50 g oral glucose challenge test, and 100 g oral glucose tolerance test were compared [Normal glycaemia: Blood glucose value <140 mg/dL 1 hour after 50 g oral glucose challenge test].Results: The following results were obtained in the normal glycaemia and mild gestational hyperglycemia groups respectively: Mean gestational age at birth, 38.9±1.6 and 39±1.9 weeks; preterm, term, post-term birth rates, 6%, 86.2% 7.8% and 6.8%, 86.4% and 6.8%; cesarean delivery rate, 30.9% and 34.9%; birth weight 3227.9±394.9 and 3241.05±418.5 g; small for gestational age, 4.4% and 2.3%; large for gestational age 4.6% and 7%; without any significant difference between the groups. Five minute APGAR scores were significantly lower in the mild gestational hyperglycemia group compared to the normal glycaemia group.Conclusion: There was no significant increase in adverse pregnancy outcomes such as preterm birth, post-term birth, increased caesarean delivery rate, small for gestational age and large for gestational age, except for a significant decrease in 5 minute APGAR scores in the mild gestational hyperglycemia group compared to the normal glycaemia group in our study.
Cuma Mertoglu, Murat Gunay, Mehmet Gungor, Mehmet Kulhan, Nur Gözde Kulhan
Gynecology Obstetrics & Reproductive Medicine pp 1-5; doi:10.21613/gorm.2018.775

Abstract:Objective. Gestational Diabetes Mellitus (GDM) is a common disorder of carbohydrate metabolism, with onset or first recognition during pregnancy, resulting in hyperglycemia of variable severity. Insulin resistance and chronic subclinical inflammation are the underlying mechanisms of the disease. Soluble interleukin-2 receptor (sIL2r), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are the markers of inflammatory disease processes such as type 1 and 2 diabetes mellitus, hepatitis, and neoplasms.Methods. In our study, we measured complete blood count, serum sIL2r, serum glucose in blood samples from 52 women with GDM and 50 pregnant women with normal glucose tolerance (NGT). Pregnant women which were tested for oral glucose tolerance test (75 gr load) between 24 and 28 weeks of pregnancy were selected for the study. GDM was defined according to the criteria provided by the National Institute for Health and Care Excellence. Results. In terms of age, GDM patients (mean±SD; 31±6 years) were older than controls (mean±SD; 25±5.3 years). Mean platelet volume (MPV) values were lower in GDM patients (mean±SD; 10.3±1.4 fL) as compared to NGT group (mean±SD; 10.8±1fL). No statistically significant differences in serum glucose concentration, white blood cell count, neutrophil count, lymphocyte count, hemoglobin concentration, platelet count, NLR value, PLR value, and serum sIL2r concentration were found. Conclusion. This study did not reveal an increase in the inflammatory markers, NLR, PLR and serum sIL2r, in GDM. The MPV values were observed to be lower in GDM patients.
Yuksel Oguz, Fatma Gonca Eldem, Barbaros Cil, Cem Sanhal, Gülenay Gençosmanoğlu-Türkmen, Aykan Yücel, Dilek Uygur
Gynecology Obstetrics & Reproductive Medicine pp 1-3; doi:10.21613/gorm.2018.776

Abstract:We aimed to report a case of uterine arteriovenous malformation (UAVM) which was successfully treated by uterine artery embolization. A multiparous 23-year-old woman referred to our clinic for 7 weeks scar pregnancy. On ultrasound, incisional 32×37 mm gestational sac surrounded with non-pulsatile high flow vessels was demonstrated. Uterine artery embolization was performed with Gelfoam by interventional radiology. The post-embolization arteriogram showed complete embolization of the UAVM with slow flow of contrast in both uterine arteries.In clinical suspicion, UAVM can be diagnosed with Doppler ultrasonography and can be treated successfully with either uterine artery embolization or uterine surgery. UAVM is commonly diagnosed in women of childbearing age, angiographic embolization should be the firstly preferred treatment.
Doruk Cevdi Katlan, Atakan Tanacan, Gokcen Orgul, Kemal Leblebicioğlu, Mehmet Sinan Beksac
Gynecology Obstetrics & Reproductive Medicine pp 1-3; doi:10.21613/gorm.2018.798

Abstract:Objective: To introduce an intelligent prenatal screening system, using triple test variables.Study Design: In this study, we have used a backpropagation learning algorithm (a supervised artificial neural network) to develop an intelligent antenatal screening system (heretofore referred as Hacettepe System). Triple test variables were used as input variables, while “Down syndrome” and “non-Down syndrome” fetuses were the output of the algorithm. Unconjugated estriol (E3), beta-human chorionic gonadotropin, and α-feto protein with gestational week and maternal age (triple test) were used as input variables in the training and testing. Multiples of median values of the E3, α-feto protein, and beta-human chorionic gonadotropin were used in this study. The testing group of Hacettepe system consisted of 97 patients who were found to be high-risk (>1/250) during the routine antenatal screening (triple test) and underwent amniocentesis for fetal karyotyping. Results: Amniocentesis was performed in 97 pregnancies with “high-risk” triple test results (>1/250). Fetal karyotyping revealed trisomy 21 in about 9.3% (9/97) of the pregnancies. Our algorithm (Hacettepe System) detected 77.8% (7/9) of Down syndrome cases. Moreover, all of the normal fetal karyotypes were assigned as normal in the Hacettepe System.Conclusion: We have developed an intelligent system using the backpropagation learning algorithm (using triple test variables) to predict trisomy 21.
Sedat Akgol, Mehmet Obut, Ihsan Bağlı, Bekir Kahveci, Mehmet Sukru Budak
Gynecology Obstetrics & Reproductive Medicine pp 1-5; doi:10.21613/gorm.2018.791

Abstract:Objectives: The aim of this study was to compare the obstetric and neonatal outcomes of pregnant women who were screened with one or two-step screening programs for diagnosis of gestational diabetes mellitus.Study Design: A retrospective evaluation was made of pregnant women who were screened with one step [75 g oral glucose tolerance test] or two-step screening programs [50 g oral glucose challenge test and 100 g oral glucose tolerance test] depending on the preference of the physician between September 2016 and August 2017.Results: The one-step screening program was applied to 34.1% (n:1358) of the pregnancies and the remaining 65.9% (n=2623) were screened using the two-step program. The following results were obtained for the pregnant women applied with the one and two-step screening programs, respectively; mean age: 29.37±7.6 years and 28.1 ± 6.2 years, gestational diabetes mellitus: 8.8% and 4.8%, pre-term birth:5.2% and 6.9%, term birth: 89.8% and 85.5%, post-term birth: 5% and 7.6%, vaginal delivery: 74.8% and 67.5%, caesarean section delivery: 25.2% and 32.5%, birth weight: 3389±432 gr and 3234.1 ± 415.9 gr, and mean 5-minute APGAR score: 9.1 ± 0.4 and 9.2 ± 0.7. Comparisons showed statistically significant differences between the groups. Conclusion: The study results showed a significantly higher rate of gestational diabetes mellitus diagnosis for the pregnant women screened with the one-step screening program than the two-step screening program. Although the mean maternal age was significantly higher in the pregnant women screened with the one-step screening program, these pregnancies were observed to have better outcomes (low rates of preterm birth, post-term birth, caesarean delivery and high rates of term birth, vaginal delivery). These results can be attributed to the early referral to a treatment program and follow-up, even though more cases of gestational diabetes mellitus were diagnosed with the one-step screening program.
Betul Yakistiran, Doruk Cevdi Katlan, Yüce Tuncay, Feride Söylemez
Gynecology Obstetrics & Reproductive Medicine pp 1-3; doi:10.21613/gorm.2018.789

Abstract:Objective: Cystic hygromas of nuchal origin are reported to be associated with fetal aneuploidy and structural anomalies in 50-80% of the cases. We aimed to report our experience on cystic hygromas via 18 cases.Study Design: We conducted a retrospective study based on a review of medical records of patients who had fetal septated cystic hygroma, diagnosed by ultrasonography, in the Ankara University School of Medicine, Department of Obstetrics and Gynecology, between 2012 and 2016. All patients were provided with genetic counselling and prenatal invasive diagnostic procedures were applied to obtain fetal karyotype.Results: We observed 18 cases of fetal cystic hygroma among these patients (0.39%). The abnormal karyotypes were: Turner syndrome (45X0) in 3 (16.7%), trisomy 21 in 2 (11.1%), trisomy 18 in 1 (5.6%) and mosaic Turner syndrome in 1 (5.6%) patient.Conclusion: The presence of cystic hygroma carries a high risk for aneuploidy and major structural malformations. Invasive prenatal diagnostic procedures for fetal karyotype analyses and parental counselling about poor perinatal prognosis is mandatory.
Mehmet Sukru Budak, Sedat Akgol
Gynecology Obstetrics & Reproductive Medicine pp 1-3; doi:10.21613/gorm.2018.783

Abstract:Objective: The aim of this study was to evaluate the risk factors and outcomes of umbilical cord prolapseStudy Design: In this descriptive retrospective study, 94 cases of umbilical cord prolapse between January 2013 and December 2014 in our department were analyzed.Results: 45.166 births occurred in our hospital during the study period, and the prevalence of umbilical cord prolapse was 2.08 (n=94) per 1000 live births, and the perinatal mortality rate was 1.1%. In all pregnant women, the delivery had been performed by emergent caesarean section. The average age, gravida, parity and gestational week of pregnant women were 29.11±6.17, 3.69±2.48, 2.69±2.48 and 37.61±3.17, respectively. Singleton pregnancies were 95.7% (n=90) of all pregnancies and twin pregnancies were 4.3% (n=4). Presentation of the cases were vertex, breech or transverse at 75.5% (n=71), 16% (n=15) and 8.5% (n=8) of all cases respectively. Polyhydramnios complicated 13.8% (n=13) of all cases and average birth weight was 3138.62±759.89 grams. 16% (n=15) of the cases had a birthweight lesser than 2500 gr. 1st and 5th minute APGAR scores were 6.89±2.05 and 8.69±1.39, respectively. The time period between the diagnosis and delivery was demonstrated as 8.24±1.22 minutes.Conclusion: Breech presentation, polyhydramnios, multiple pregnancies and low birth weight are risk factors for umbilical cord prolapse. Shortening the time interval between diagnosis and delivery significantly reduces perinatal mortality. It can be provided at clinics that presenting the appropriate infrastructures for rapid intervention.
Bülent Emre Bilgiç, Enis Özkaya, Çiğdem Yayla Abide, Semra Kayatas Eser, Ilhan Şanverdi, Tayfun Kutlu
Gynecology Obstetrics & Reproductive Medicine pp 1-6; doi:10.21613/gorm.2018.780

Abstract:Objective: The objective of this study was to investigate the effect of total or partial assisted hatching on the clinical pregnancy rates in assisted reproduction technology.Study Design: This was a case-control study conducted from the beginning of January 2016 to the end of June 2017. A total of 404 cycles were included in this case-control study. Study population was divided into 3 groups: Group 1: Partial assisted hatching (n=118), Group 2: Total assisted hatching (n=81) and Control group (n=205).Results: In women of all ages, clinical pregnancy rates were similar between groups with total or partial assisted hatching compared to control group (p>0.05). The rates were also similar in subgroups of women with blastocyst or cleavage stage embryo transfers (p>0.05). Partial or total embryo hatching did not result in favorable outcome compared to control group either in women over 35 or younger than 35 years of age (p>0.05). In whole study group pregnancy rate was significantly higher in group with blastocyst stage embryo transfers (22.4 % versus 48.8%, p<0.05)Conclusion: Partial or total assisted hatching do not have any impact on the clinical pregnancy rates, no significant impact was determined in subgroup of women either.
Hilal Uslu Yuvaci, Tuba Duzcan, Nermin Akdemir, Erman Sever, Selçuk Özden, Arif Serhan Cevrioglu, Orhan Unal, Funda Tozlu, Havva Sayhan
Gynecology Obstetrics & Reproductive Medicine pp 1-5; doi:10.21613/gorm.2018.749

Abstract:Objective: The aim of this study was the evaluation of the characteristics and treatment results of women, who were brought to the intensive care unit due to severe obstetric morbidity, together with severe and acute complications in pregnancy.Study Design: Pregnant and puerperal women treated in the intensive care unit of a tertiary care center during two years of time were included in this study, and their files were scanned retrospectively. Patients’ demographic characteristics, length of stay, point of entry, neonatal results, birth statuses and modes of delivery, hemodynamic data, and histories were recorded. The qualitative data were evaluated by the Pearson Chi-squared, Fisher Freeman Halton, and Fisher’s Exact tests.Results: In the two-year period, 16,728 births occurred at our hospital. 68 cases among them were accompanied with severe maternal morbidity, and 2 maternal deaths were observed in our clinic. Of the cases, 58.8% (n=40) had severe hypertensive diseases, whereas 35.3% of the cases (n=24) had obstetric complications that developed due to bleeding. While 40% of the cases (n=16) with hypertension had severe pre-eclampsia, 35% of the cases (n=14) had eclampsia and 25% (n=10) had HELLP.Conclusions: The most important reasons for severe maternal morbidity are the complications related to obstetric bleeding and hypertensive diseases related to pregnancy. Early diagnosis of the obstetric complication risk factors is necessary for preventing maternal morbidity. Antenatal follow-ups and the births of high risk pregnancy patients should be performed in tertiary centers.
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