Aydin Tekay

A comparison of intrapartum automated fetal electrocardiography and conventional cardiotocography—a randomised controlled study

Objectiveu2002 To examine whether intrapartum monitoring by means of automatic ST analysis (STAN) of fetal electrocardiography could reduce the rate of neonatal acidemia and the rate of operative intervention during labour, compared with monitoring by means of cardiotocography (CTG).

Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage

Background.u2002 To evaluate indications, efficacy, and complications associated with arterial embolization and prophylactic balloon catheterization in the management of obstetric hemorrhage at a university hospital.

Intraobserver and interobserver variability of ovarian volume, gray-scale and color flow indices obtained using transvaginal three-dimensional power Doppler ultrasonography

To assess intraobserver and interobserver variability in ovarian volume and gray‐scale and color flow index measurements using transvaginal, three‐dimensional, power Doppler ultrasonography.

Transvaginal salpingosonography for the assessment of tubal patency in infertile women: methodological and clinical experiences

OBJECTIVEnTo evaluate the advantages and accuracy of transvaginal salpingosonography in the assessment of tubal patency with regards to laparoscopic chromopertubation.nnnSETTINGnInfertility policlinic of the hospital.nnnDESIGNnThirty-one women suffering from infertility were examined with transvaginal salpingosonography using air and saline as a contrast medium. The results were compared with those obtained with laparoscopic chromopertubation.nnnRESULTSnAltogether 61 fallopian tubes were examined with both transvaginal salpingosonography and laparoscopic chromopertubation. Concordance was 85%. Of the tubes investigated by transvaginal salpingosonography, 45 were found to be patent and 16 were found to be occluded. In chromopertubation, 50 of 61 tubes were patent and 11 were occluded. Bilateral tubal patency was found by transvaginal salpingosonography in 17 cases and by laparoscopy in 22 cases. Unilateral tubal patency was found in 11 and 6 cases, respectively. Bilateral occlusion was found in three cases using either technique.nnnCONCLUSIONnTransvaginal salpingosonography with the combination of air and saline is a low-cost, reliable, safe, and comfortable examination method. It can be used for the primary investigation of infertility on an outpatient basis.

Effectiveness of electronic fetal monitoring with additional ST analysis in vertex singleton pregnancies at >36 weeks of gestation: an individual participant data metaanalysis

OBJECTIVEnThe purpose of this study was to assess the effectiveness of electronic fetal monitoring (EFM) alone and with additional ST analysis (EFM + ST) in laboring women with a singleton term pregnancy that is in cephalic presentation in the prevention of metabolic acidosis by the application of individual patient data metaanalysis.nnnSTUDY DESIGNnWe conducted an individual patient data metaanalysis using data from 4 randomized trials, which enabled us to account for missing data and investigate relevant subgroups. The primary outcome was metabolic acidosis, which was defined as an umbilical cord-artery pH <7.05 and a base deficit that had been calculated in the extra cellular fluid compartment >12 mmol/L. We performed 8 explanatory subgroup analyses for 8 different endpoints.nnnRESULTSnWe analyzed data from 12,987 women and their newborn infants. Metabolic acidosis was present in 57 women (0.9%) in the EFM + ST group and 73 women (1.1%) in the EFM alone group (relative risk [RR], 0.76; 95% CI, 0.53-1.10). Compared with EFM alone, the use of EFM + ST resulted in a reduction in the frequency of instrumental vaginal deliveries (RR, 0.90; 95% CI, 0.83-0.99) and fetal blood samples (RR, 0.49; 95% CI, 0.44-0.55). Cesarean delivery rates were comparable between both groups (RR, 0.99; 95% CI, 0.91-1.09). Subgroup analyses showed that EFM + ST resulted in fewer admissions to a neonatal intensive care unit for women with a duration of pregnancy of >41 weeks (RR, 0.61; 95% CI, 0.39-0.95).nnnCONCLUSIONnEFM + ST does not reduce the risk of metabolic acidosis, but it does reduce the need for instrumental vaginal deliveries and fetal blood sampling.

A longitudinal Doppler ultrasonographic assessment of the alterations in peripheral vascular resistance of uterine arteries and ultrasonographic findings of the involuting uterus during the puerperium

OBJECTIVEnOur purpose was to assess the alterations in peripheral vascular resistance of uterine arteries in the puerperium.nnnSTUDY DESIGNnIn this longitudinal study 42 patients with uncomplicated pregnancies were examined with transabdominal color Doppler ultrasonography before and after delivery for 3 months. A total of 266 evaluations were performed.nnnRESULTSnWithin 2 days after delivery the mean pulsatility index of uterine arteries had increased significantly from 0.73 +/- 0.15 to 1.19 +/- 0.36, and the prediastolic notch had reappeared. After 6 weeks the indexes had started to increase further and reached a level of 1.75 +/- 0.56 by the end of the third puerperal month.nnnCONCLUSIONSnUterine vascular resistance increases soon after delivery. Puerperal changes in pulsatility indexes are triphasic. At the end of the fourteenth puerperal week pulsatility indexes are still much lower than those of nonpregnant women and all flow velocity waveforms represent a continuous end-diastolic component.

Interobserver agreement in the assessment of intrapartum automated fetal electrocardiography in singleton pregnancies

Objective. To study interobserver agreement in the assessment of intrapartum automated fetal electrocardiogram ST interval analysis (STAN). Design. Observational study. Setting. Labor ward in tertiary level university hospital. Sample. Two hundred (140 reassuring and 60 non‐reassuring) STAN recordings on non‐selected women with singleton, vertex, term pregnancies were selected from our archive. Samples of 60‐min were analysed from the end of each recording, excluding the last 30 min before delivery. Methods. Three consultants, who had undergone STAN training and had clinical experience in using STAN, reviewed the recordings using cardiotocography (CTG) and ST information with no clinical data. The reviewers were asked to follow STAN guidelines and (1) to classify the CTG as normal, intermediary, abnormal, or preterminal, and (2) to make a clinical decision on labor management. Main outcome measures. Interobserver agreement evaluated by weighted kappa (κw) values and the proportion of agreement. Results. In CTG classification, the interobserver agreement between three observers was moderate (κw, 0.47–0.48). The proportion of agreement was 56–59%. In clinical decision‐making, κw values varied from 0.47 to 0.60, and the proportion of agreement was 80–86%. Conclusions. In non‐selected term pregnancies, the interobserver agreement among experienced obstetricians in the classification of CTG and clinical decision‐making according to STAN guidelines is moderate at best.

The secretion of PAPP-A, ADAM12, and PP13 correlates with the size of the placenta for the first month of pregnancy

OBJECTIVESnPregnancy Associated Protein A (PAPP-A), A Disintegrin and Metalloproteinase 12 (ADAM12) and Placental Protein 13 (PP13) are secreted from the placental trophoblastic tissue and are involved in normal implantation and placental development. The aim of the study was to assess the connection between the secretion of these proteins and the growth of the gestational sac and the placenta.nnnSTUDY DESIGNnIn an observational longitudinal study at Oulu University Hospital, women with naturally conceived pregnancies were followed-up weekly to pregnancy week 11.nnnMAIN OUTCOME MEASURESnPAPP-A, ADAM12 and PP13 serum concentrations and their correlation with the volumes of the gestational sac and the placenta were assessed using three-dimensional ultrasonography.nnnRESULTSnThe study group consisted of 41 women. The PAPP-A, ADAM12 and PP13 serum concentrations increased continuously from pregnancy week 4 to week 11 and correlated closely with each other. The serum concentrations of PAPP-A, ADAM12 and PP13 also correlated with the volumes of the gestational sac and the placenta up to pregnancy week 8.nnnCONCLUSIONSnThe secretion of PAPP-A, ADAM12 and PP13 is closely related to the size of the placenta in the beginning of pregnancy. After 8 weeks of pregnancy, which is the time for luteoplacental shift, the correlation disappears, possibly reflecting the morphologic transformation in the placenta.

Effect of rising hCG levels on the human corpus luteum during early pregnancy.

BACKGROUNDnDuring early pregnancy, the most important task of the corpus luteum (CL) is to produce sufficient progesterone until the luteoplacental shift occurs. Progesterone production is closely related to the extensive vasculature surrounding and supplying the CL. The synthesis of both progesterone and factors controlling the vasculature in the CL is regulated by hCG, which is released initially at rising levels from the placenta. The primary aim of this research was to evaluate changes in the CL vasculature during early pregnancy.nnnMETHODSnTwenty naturally conceived pregnancies were examined weekly from weeks 5 to 11. At each visit, blood samples were obtained to determine the concentrations of hCG, progesterone and 17-OH progesterone (17-OHP). The vasculature in the ovaries was assessed using three-dimensional power Doppler ultrasonography.nnnRESULTSnThe vascular supply in the ovary containing the CL was greatest at week 5, and thereafter, declined continuously until week 11. The decrease in the vasculature correlated with the decrease in 17-OHP. Mean hCG levels reached a maximum at week 8, progesterone levels reached the nadir at week 7 and increased after that.nnnCONCLUSIONSnVasculature in the CL appears to be created already by the fifth week of pregnancy and it does not enlarge despite rising hCG levels. The activity of the CL during pregnancy may be measured non-invasively by assessing its vasculature with three-dimensional ultrasonography.

Effect of parity and fetal sex on placental and luteal hormones during early first trimester.

Earlier studies have shown that maternal hormone secretion during late first or second trimester may be affected by gravidity. We examined the luteoplacental hormone secretion during 5–11u2009weeks of gestation in relation to gravidity.