Abdullah Karaer

Risk factors for ectopic pregnancy: A case‐control study

Aim:  To identify the risk factors for ectopic pregnancy.

Role of oxidative stress in preeclampsia and intrauterine growth restriction

Aim:  The aim of the present study was to evaluate the role of oxidative stress and DNA damage in preeclampsia and intrauterine growth restriction (IUGR).

Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome

Background. To determine the risk factors for adverse maternal outcome among women with HELLP syndrome. Methods. Sixty‐one pregnancies with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2003 and 2005. Maternal outcomes analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy (DIC), acute renal failure, need for transfusion of blood products, cesarean delivery and maternal death. Risk factors included maternal age, parity, gestational age at diagnosis, mean arterial blood pressure, headache, visual changes, nausea‐vomiting, epigastric pain, blood platelet count (≤50,000 versus>50,000 cells/mm3), and peak serum levels of aspartate aminotransferase. Results. Eclampsia was present in 52%, abruptio placentae in 11%, and DIC in 8% of 61 women with HELLP syndrome. 23% women required transfusion of blood products, 15% had acute renal failure, and 73% had cesarean section. Women with eclampsia had significantly more headache, nausea‐vomiting, visual changes and epigastric pain (p<0.05). Transfusion was significantly more frequent among women with blood platelet counts≤50,000 cells/mm3 (33 versus 21%; p<0.05). Women with a platelet count≤50,000 cells/mm3 had a higher rate of DIC compared to women with a platelet count>50,000 cells/mm3 (33.3 versus 3.8%; p<0.05). In women with acute renal failure and abruptio placentae, there were no significant differences in all the variables studied between those with and without these complications. Conclusions. Clinical symptoms, such as headache, visual changes, epigastric pain and nausea‐vomiting, are more predictive than laboratory parameters for adverse maternal outcomes.

Maternal and fetal adropin levels in gestational diabetes mellitus

Abstract Aim: To evaluate maternal and cord blood serum adropin concentrations in pregnant women with gestational diabetes mellitus (GDM). Study design: Twenty pregnant women with GDM and 20 gestational age-matched healthy pregnant women participated in the study. Maternal serum and cord blood adropin levels were assessed using an enzyme immunosorbent assay, at the time of birth. The relation of maternal serum and cord blood adropin levels with metabolic parameters were also assessed. Results: The mean maternal and cord serum adropin in the GDM group were significantly lower than those of the control women (P=0.01 and P<0.001, respectively). Maternal serum adropin levels did not correlate with either fetal serum adropin levels or maternal metabolic values. Conclusion: The data suggest that low adropin levels may contribute to the underlying pathogenesis of GDM.

Y chromosome azoospermia factor region microdeletions and recurrent pregnancy loss

OBJECTIVE This study was undertaken to determine the prevalence of Y-chromosome microdeletions in couples with recurrent pregnancy loss (RPL) as compared with fertile couples. STUDY DESIGN Forty-three men from couples with recurrent pregnancy loss, and 43 men from couples with a live birth and no history of miscarriages were recruited from Zekai Tahir Burak Woman Health, Education and Research Hospital. The DNA was tested for the presence of 4 sequence tagged sites (STSs) spanning 4 AZF regions: DYS220 (AZFb), DYS235, DYS236, and DYS237 (AZFd). RESULTS Seven (7) of the 43 men (16%) from couples with recurrent pregnancy loss had microdeletions in 1 or more of the 4 segments studied, whereas none of the fertile men had any microdeletions (P < .05). Their microdeletions were all found specifically at locus DYS 220 (AZFb). CONCLUSION The prevalence of the Y chromosome microdeletion in AZF region was much higher in men from couples with recurrent pregnancy loss than men in fertile couples. This study showed that Y chromosome microdeletion in AZF region may be a possible etiologic factor of recurrent pregnancy loss.

The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages

OBJECTIVE To evaluate the capacity of vascular endothelial growth factor (VEGF), pregnancy-associated plasma protein-A (PAPP-A), and progesterone (P) to discriminate ectopic pregnancies (EP) from nonectopic ones. DESIGN Prospective, case-controlled study. SETTING Tertiary care center. PATIENT(S) Twenty-nine women with EP, 29 women with normal intrauterine pregnancy (nIUP), and 28 women with spontaneous miscarriage, all matched for gestational age. INTERVENTION(S) Serum samples were obtained. MAIN OUTCOME MEASURE(S) Serum concentrations of VEGF, PAPP-A, and P were measured. RESULT(S) Serum VEGF concentrations did not show statistically significant differences among women with EP (median, 55.24 pg/mL; range, 0.20-179.24), spontaneous miscarriages (median, 26.24 pg/mL; range, 0.22-365.24), and nIUP (median, 43.24 pg/mL; range, 0.86-101.24). The median level of P was significantly increased in the nIUP group (20.58 ng/mL; range, 13.9-37.04) compared with the other two groups, but there was no statistically significant difference between the spontaneous miscarriage and EP groups. Like P, PAPP-A values were also significantly higher in the nIUP group than in the other two groups, but the difference between PAPP-A values in the EP and spontaneous abortion groups was statistically insignificant. CONCLUSION(S) VEGF, PAPP-A, and P cannot be used to diagnose EPs, but PAPP-A and P can at least be used to differentiate abnormal pregnancies.

Serum levels of apelin, salusin-alpha, and salusin-beta in normal pregnancy and preeclampsia

Objective: The purpose of this study was to investigate the relationship between the serum apelin, salusin-alpha and salusin-beta levels and preeclampsia. Method: Twenty-one healthy pregnant women (control group) and 48 patients with preeclampsia (study group) were included in the study between August 2010 and February 2011. Serum apelin, salusin-alpha and salusin-beta levels of the groups were compared. Results: The patients in the study group were divided into two categories: mild preeclampsia and severe preeclampsia. The mild preeclampsia group consisted of 31 patients, and the severe preeclampsia group consisted of 17 patients. Serum salusin-alpha and salusin-beta levels of the control and study groups were not significantly different (p > 0.05). Apelin levels were statistically significantly higher in the study group. No statistically significant difference was detected between the mild and severe preeclampsia groups in terms of the mean serum apelin levels. Conclusion: The serum levels of apelin were higher in the pregnant women with preeclampsia; however, there was no positive relationship between serum salusin-alpha and salusin-beta levels and the disease. Larger prospective studies are needed to validate our findings.

Serological investigation of the role of selected sexually transmitted infections in the aetiology of ectopic pregnancy

ABSTRACT Objectives To investigate the association between selected sexually transmitted infections (STIs) and the later occurrence of ectopic pregnancy. Methods A total of 125 women with ectopic pregnancy and 125 pregnant controls were recruited between January 2003 and February 2005 at Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital, in Ankara, Turkey. Enzyme-linked immunosorbent assay was used to determine the prevalence of serum antibodies to Chlamydia (C.) trachomatis and to Herpes simplex virus (HSV)-2 IgG and, indirect immunofluorescence test was used to determine the prevalence of serum antibodies to Mycoplasma (M.) hominis and Ureaplasma (U.) urealyticum. Results The prevalence of C. trachomatis Ig G antibody in women with ectopic pregnancy (31/125; 25%) was significantly higher than in controls (12/125; 9.6%) (crude Odds Ratio [OR]: 3.1, 95% confidence interval [CI]: 1.51–6.38; p = 0.001). However, there was no significant association between C. trachomatis IgM; M. hominis IgG, IgM; U. urealyticum IgG, IGM; and HSV-2 IgG, and ectopic pregnancy. Conclusions Previous chlamydial infection plays an important role in the aetiology of ectopic pregnancy. There was no association between M. hominis, U. urealyticum and HSV-2 infections, and ectopic pregnancy.

Surgical Removal of Endometrioma Decreases the NF-kB1 (p50/105) and NF-kB p65 (Rel A) Expression in the Eutopic Endometrium During the Implantation Window

We aimed to investigate whether the surgical removal of endometrioma alters the nuclear factor-kappa B1 (NF-kB1; p50/105) and NF-kB p65 (Rel A) expression in the eutopic endometrium of infertile women with endometrioma before and after laparoscopic removal of the ovarian endometrioma during the mid-secretory phase. Infertile women with endometrioma (n = 15) were enrolled. Infertile patients with nonendometriotic ovarian cyst (n = 10) and healthy fertile women (n = 10) were recruited as controls. Endometrial samples were obtained before and 3 months after the laparoscopic cystectomy. The NF-kB1 (p50/105) levels were analyzed by enzyme-linked immunosorbent assay (ELISA) in the endometrium of all groups before and after laparoscopic ovarian cystectomy during implantation window. Expression of NF-kB1 (p50/105) in eutopic endometrium was significantly higher in infertile women with endometrioma compared to nonendometriotic cyst and fertile controls (P < .05). Laparoscopic cystectomy resulted in a significant decrease in NF-kB1 expression in women with endometrioma. The NF-kB p65 (Rel A) immunoreactivity of eutopic endometrium decreased significantly subsequent to the surgical removal of the endometrioma. In conclusion, increased endometrial NF-kB expression may contribute to endometriosis-associated infertility.

Genetic evaluation of severe male factor infertility in Turkey: A cross-sectional study

Objective: To determine the frequency, types of chromosomal abnormalities and Y chromosome microdeletions in patients with severe male factor infertility, and the association between clinical background and genetic abnormality. Study design: A total of 322 infertile men; 136 men with severe oligozoospermia (sperm count <5 million/ml) and 196 with nonobstructive azoospermia were studied between April 2004 and November 2006 at the Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital, Ankara, Turkey. Blood, semen samples, and testicular biopsies of patients were obtained. Hormonal analysis (follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels), semen analysis, karyotype analysis, and PCR screening for Y chromosome microdeletions were performed. Result(s): Forty-eight out of 332 (14%) infertile men had a genetic abnormality. Twenty-four (7.2%) cases with karyotype abnormality were detected. The frequencies of karyotype abnormalities were Klinefelter’s syndrome 17/24 (71%), translocation 3/24 (12%), mix gonadal dysgenesis 2/24 (8%), XX male 1/24 (4%), and 46XYY 1/24 (4%). Twenty cases (6%) infertile men had only Y chromosome microdeletions. The frequencies of the deleted areas were azoospermia factor (AZF)c 42%, AZFb 25%, AZFa 21%, AZFb, c 8%, and AZFa, c 4%. Four of the cases with Y chromosome microdeletions also had a concurrent karyotype abnormality. Conclusion(s): All patients with nonobstructive azoospermia and severe oligozoospermia (sperm count <5 million/ml) should undergo genetic screening.