Alin Başgül Yiğiter

Normal standards of fetal behavior assessed by four-dimensional sonography

Objective. In this prospective randomized study, fetal behavior was investigated in order to determine the standard parameters of fetal movements and facial expressions in all three trimesters of normal pregnancy. Methods. Sixty-three pregnant women with singleton pregnancies in all trimesters were included in the investigation. Four-dimensional (4D) ultrasound was performed for each patient over a 30-minute period. Variables of maternal and fetal characteristics including gestational age, eight fetal movement patterns in the first trimester, and sixteen parameters of fetal movement and fetal facial expression patterns in the second and third trimesters were recorded for the construction of fetal neurological charts. Results. In the first trimester, a tendency towards an increased frequency of fetal movement patterns with increasing gestational age was noticed. Only the startle movement pattern seemed to occur stagnantly during the first trimester (p > 0.05). At the beginning of the second trimester, the frequency of fetal movement patterns tended to increase. During the second and third trimester, multiple regression and polynomial regression revealed statistically significant changes in tongue expulsion (p < 0.05), smiling (p < 0.05), grimacing (p < 0.05), swallowing (p < 0.05), eye blinking (p < 0.01), head movements, and all hand to body contact movements (p < 0.01), except for head anteflexion (p > 0.05). There were no statistically significant changes during the second and third trimesters in mouthing, yawning, and sucking (p > 0.05). At the middle of the third trimester, the fetuses displayed decreasing or stagnant incidence of fetal facial expressions except for eye blinking, which showed increased frequency with increasing gestational age. A statistically significant correlation was found between all head movements and hand to body contact patterns during the second and third trimesters except for head anteflexion (r = −0.231; p > 0.05). Conclusions. The full range of quantitative fetal facial expressions and fetal movement patterns can be assessed successfully by 4D sonography. It is important to be able to assess normal fetal behavior throughout gestation to identify abnormal behavior before birth.

Placental volume and vascularization flow indices by 3D power Doppler US using VOCAL technique and correlation with IGF-1, free beta-hCG, PAPP-A, and uterine artery Doppler at 11–14 weeks of pregnancy

Abstract Aims: The purpose of this study was to investigate correlations between first trimester placental volume (PV) and blood flow indexes (FIs), bilateral uterine artery pulsatility indexes, notching, and biochemical parameters: pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (f-β-hCG), and insulin-like growth factor-1 (IGF-1) to predict the high-risk pregnancies in the first trimester. Methods: We prospectively examined 310 patients at 11–14 weeks of pregnancy using transabdominal 3D gray scale and power Doppler ultrasound for assessing PV, vascularization index, FI, and vascularization FI (VFI). The acquired volumes were analyzed using VOCAL™ imaging software. The results were correlated with biochemical parameters. Results: We found significant correlations between PV and biochemical parameters, and between placental blood flow studies and other parameters. Finally, PV/crown-rump length so called the placental quotient is also related to both PAPP-A and VFI. Conclusions: Placental volumetry, uterine artery Doppler studies, blood flow calculations and biochemical parameters, such as f-β-hCG, PAPP-A, and IGF-1 could be important in the early and rapid diagnosis of high-risk pregnancies. Thus, they may be useful in first trimester prediction of fetal growth restriction presenting with alterations in PV and vascularity.

Effect of smoking on pregnancy-associated plasma protein A, free β-human chorionic gonadotropin, and nuchal translucency in the first trimester of pregnancy

Data were collected from 1275 pregnant Turkish women screened prospectively for chromosomal anomalies to determine whether first-trimester levels of maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) and the thickness of nuchal translucency are affected by smoking and other covariables. Only normal singleton pregnancies were included. After weight correction, comparisons were made between smokers and nonsmokers. Mean values of PAPP-A and β-hCG were reduced in women who smoked 5 or more cigarettes a day compared with nonsmokers. The median β-hCG level decreased significantly as gravidity and parity increased; no effect was noted on PAPP-A. Median PAPP-A and β-hCG levels tended to increase, but not significantly in women who had had 2 or more miscarriages. Smoking alters maternal levels of serum analytes, with the magnitude of the impact related to the number of cigarettes smoked per day. This effect can be detected in the first trimester of pregnancy.

Serum visfatin levels in women with polycystic ovary syndrome

The aim of this study is to determine the serum levels of visfatin in patients with polycystic ovary syndrome (PCOS) and to understand its correlations with other metabolic and hormonal parameters. Thirty-seven patients with PCOS and 30 women without concomitant disease were included in this study. Serum visfatin levels were similar in patients with PCOS and control group. Visfatin levels were higher in normal weight PCOS when compared with obese PCOS, but it did not reach statistical significance. Visfatin levels correlated negatively with fasting blood glucose, total cholesterol (TC), low-density lipoprotein (LDL) and lipoprotein-a levels in PCOS patients. CRP levels increased both in obese PCOS and in obese controls. Plasma visfatin levels had no correlation with homeostasis model assessment-insulin resistance and fasting insulin levels, but the negative correlation between plasma visfatin levels and lipoprotein-a, fasting plasma glucose, TC and LDL levels may indicate a role for visfatin in cardiovascular disease independent of insulin resistance.

Sağlık çalışanları, tıp öğrencileri ve hemşirelik öğrencilerinde insan papilloma virüsü, servikal kanser ve HPV aşısı farkındalığı

Objectives: Establishment of the knowledge and the need to make conscious in medicine students, nursing students and nurses due to the effective role of updating conscious of the health workers, we aimed to assess the knowledge of nurses and students of Istanbul Bilim University and affiliated hospitals about HPV and cervical cancer. Materials and methods: Because healthcare personnel illuminate and influences the public, the survey was conducted to medicine students of the first three years, nursing students and nurses. The reason of choosing the first three years of medicine students is with the begining of the gynecology courses at the 4th year of education in medical faculty, learning takes the place of awareness. Totally 743 participants were asked to survey but 603 subjects responded (81.2%) then the surveys that was not asked for the identity information were taken into consideration Results: Nurses and students of nursing had better knowledge about smear test when compared to students of medicine (first 3 years) and other healthcare person nel. Only 52% accepted to get a daughter vaccinated. The main reasons for vaccine rejection were the concerns about vaccine safety (41%), cost of the vaccine (10%) and sexual promiscuity (5%) after vaccination. Religious aspects were not considered as an obstacle. Conclusions: The awareness of HPV, cervical cancer and HPV vaccination should be increased. J Clin Exp Invest 2012; 3(3): 318-325

C-reactive protein and lipoprotein-a as markers of coronary heart disease in polycystic ovary syndrome

OBJECTIVE The aim of this study was to investigate the risk factors of coronary heart disease, CRP and Lipoprotein-a in polycystic ovary syndrome patients. MATERIAL AND METHODS Prospectively collected data of polycystic ovary syndrome patients (n=62) and control group (n=40) were compared. RESULTS PCOS patients had higher HOMA-IR, CRP, DHEAS, free testosterone, FAI, LH and prolactin levels when compared to the control group. Lipoprotein-a levels did not differ between the groups. The obese PCOS group had statistically significantly higher fasting blood glucose, total cholesterol, triglyceride, free testosterone, insulin, CRP and HOMA-IR and statistically significantly lower HDL and SHBG when compared to normal weight PCOS persons. Fasting blood glucose, total cholesterol, LDL, SHBG, CRP, Lipoprotein-a, FSH, LH, TSH, DHEAS and prolactin levels did not differ between the normal weight and obese control groups. CONCLUSION CRP levels increase in polycystic ovary syndrome patients and can be used as a marker of coronary heart disease. Future studies can be directed at treatments to decrease CRP levels, including antiinflammatory treatments.

İlk trimester serum PAPP-A düzeyleri ve gebelik yaşına göre küçük bebeklerin tahmin edilmesi

J Clin Exp Invest www.jceionline.org Vol 3, No 2, June 2012 Correspondence: Dr. Nilgün Güdücü İstanbul Bilim University, Department of Obstetrics and Gynecology İstanbul, Turkey, E-mail: nilgun.kutay@gmail.com Received: 06.03.2012, Accepted: 05.05.2012 Copyright

Gestasyonel diabetes mellitusu olan gebelerde ortalama trombosit hacmi

Amac: Bu calismada saglikli kontrol grubunu olusturan gebeler ve gestasyonel diabetes mellitus olanlarin ortalama trombosit hacimleri karsilastirildi ve ortalama trombosit hacmi ile aclik kan sekeri arasindaki iliski arastirildi.Gerec ve yontemler: Tibbi kayitlari retrospektif olarak arastirilarak gestasyonel diabetes mellitusu olan hastalar (n=43), saglikli gebe kontrol grubu (n=43) ile karsilastirildi. Bulgular: Kontrol grubunu olusturan saglikli gebelerde ve gestasyonel diabetes mellitusu olanlarda yapilan trombosit sayimi ve ortalama trombosit hacmi arasinda istatistiksel olarak anlamli fark bulunmadi. Gestasyonel diabetes mellitusu olan hastalarin aclik kan sekeri ve ortalama trombosit hacmi arasinda da istatistiksel olarak anlamli iliski bulunmadi (r=-0,207, p=0.189). Her iki grubun tum kan sayimi parametreleri karsilastirildiginda, sadece hemoglobin seviyelerinde istatistiksel olarak anlamli farklilik bulundu.Sonuc: Kontrol grubunu olusturan saglikli gebeler ve gestasyonel diabetes mellitus olan hastalardaki ortalama trombosit hacmi arasinda anlamli bir fark yoktur. Ayrica gestasyonel diabetes mellitus olan hastalarin aclik kan sekerleri ile ortalama trombosit hacmi arasinda bir iliski bulunamamistir

Endometriyal polip zemininde gelişen endometriyum kanserleri: 3 yıllık klinik deneyimimiz

Endometrial carcinomas based on polyp: 3 years single center experience Objective: The incidence of endometrial polyp is 16-34% within the whole population nonetheless increases after menopause. The incidence of cancer involvement through the endometrial polyp is 0.8-4.8%. Material and Methods: Study is designed as a retrospective descriptive study. Medical records of the patients which were diagnosed to have endometrial polyp within January 2009-January 2012 were reviewed. The patients which were diagnosed to have malignancy based on endometrial polyp were included. Results: 325 patients were obtained to have endometrial polyp, and 11 of them (3.4%) were found to be appropriate for study. 140 patients (59%) were postmenopousal and 285 patients (41%) were premenopousal 67 (43%) of the postmenopausal patients had endometrial sampling due to thickened endometrium (10mm) although they were asymptomatic. 73 (57%) of the postmanopausal patients were symptomatic. Six of this postmenouposal patients (4.2%) had malignancy based on the endometrial polyp, all of this patients were in symtomatic group. 192 of the 325 patients (59%) were symptomatic and 10 of this patients (5.2%) had malignancy based on endometrial polyp. Only one patient was asymptomatic. Histopathologic type was endometrioid and except one patient who has stage 1B disease, all patients have stage 1A disease. Two patients’ carcinoma were limited to the polyp, endometrial tissue had no sign of malignancy. Conclusion: We conclude that endometrial biopsy should be performed at the patients known to have endometrial polyp after menopause and symptomatic patient, regardless the menopausal status. Eventhoug malign endometrial polyps are diagnosed at eraly stages, with the advanced age grade of the tumor increases.