Ayşe Gürbüz

The role of perinatal and intrapartum risk factors in the etiology of cerebral palsy in term deliveries in a Turkish population

Objective. To investigate the relationship between cerebral palsy (CP) and perinatal and intrapartum risk factors and markers of birth asphyxia. Methods. This was a retrospective case–control study of 101 children with CP and 308 controls who were born at the Zeynep Kamil Hospital between 1990 and 2000. The roles of possible perinatal and intrapartum risk factors were investigated in CP development. Chi-square tests, Fishers exact tests, Student t-tests, and regression analysis were used for statistical analysis (p < 0.05). Results. The only significant perinatal risk factor was neonatal weight of <2500 grams. The CP rate in the presence of solely intrapartum risk factors was estimated as 24.7% (n = 25). In 39.6% of cases, no risk factor could be identified. When regression analysis was performed, the following factors were significant: decreased beat-to-beat variability on electronic fetal monitoring (EFM) (p = 0.02), an Apgar score of <7 at 1 and 5 minutes (p = 0.02), and the necessity for neonatal intensive care unit admission (p < 0.0001). Conclusion. Intrapartum risk factors were significantly more frequent in the CP group (p < 0.01). An increased cesarean section rate could not prevent CP, suggesting that the hypoxic insult that causes CP might be of chronic onset. The development of diagnostic tests to detect non-reassuring fetal status in its intrauterine life and interventions at appropriate times may decrease the CP rate.

Can Serum HCG Values Be Used in the Differential Diagnosis of Pregnancy Complicated by Hypertension

Objective: The aim of our study is to determine whether the serum human chorionic gonadotropin (hCG) level is helpful in the differential diagnosis and in the clinical management and follow‐up of preeclampsia, superimposed preeclampsia, and chronic hypertension during the third trimester. Material and Methods: Eighty hypertensive pregnant patients, who had been hospitalized, and 25 normotensive pregnant patients, who attended the outpatient perinatology clinic in Zeynep Kamil Women and Pediatric Diseases Education and Research Hospital between June 2001 and September 2001 were enrolled in the study. These patients were evaluated in five groups: mild preeclamptic, severe preeclamptic, superimposed preeclamptic, chronic hypertensive, and normotensive groups. The geometric means of hCG levels of these groups were compared with each other and cutoff levels for differential diagnosis were determined. Results: The geometric mean of hCG levels was established as 17,361.31 mIU/mL in the mild preeclamptic group, 49,817.59 mIU/mL in the severe preeclamptic group, 41,101.09 mIU/mL in the superimposed preeclamptic group, 12,558.57 mIU/mL in the chronic hypertensive group, and 9647.98 mIU/mL in the normotensive group. When the geometric mean of the severe preeclamptic group was compared with the results of the normotensive patients, mild preeclamptic patients, chronic hypertensive patients, and superimposed preeclamptic patients, the mean hCG value of severe preeclamptic group was statistically significantly higher than all of the other groups (p < 0.001) except for the latter. The geometric mean of hCG levels of severe preeclamptic patients was compared with the geometric mean of hCG levels of superimposed preeclamptic patients (p& > 0.05). The geometric mean of hCG levels in the chronic hypertensive group was lower than that of the superimposed preeclamptic group and the difference was statistically significant (p < 0.001). The geometric mean of hCG levels of the chronic hypertensive group was not significantly different from the results of the mild preeclamptic group and the normotensive group. There was, however, a statistically significant difference between the geometric means of hCG levels of mild preeclamptic patients and normotensive group (p < 0.001). The cutoff value of hCG was determined as 25,000 mIU/mL in differentiation of chronic hypertension from the severe preeclampsia, as 20,000 mIU/mL in differentiation of chronic hypertension from the superimposed preeclampsia, and as 30,000 mIU/mL in differentiation of severe preeclampsia from mild preeclampsia. Conclusion: The maternal serum hCG level is a useful laboratory tool when managing and treating hypertensive disorders that complicate pregnancy. The serum hCG level is especially significant in severe preeclampsia and superimposed preeclampsia. Therefore, a high serum hCG level can be a helpful marker in the diagnosis and clinical management by preventing possible complications resulting from severe and superimposed preeclampsia.

Vaginal fluid creatinine in premature rupture of membranes

Premature rupture of membranes (PROM) is defined as the rupture of chorioamniotic membranes prior to the onset of labor. There is no gold standard diagnostic test for PROM. The nitrazine paper test, positive ferning pattern, injection of intraamniotic dyes, and estimation of vaginal alpha fetoprotein(AFP), human chorionic gonadotropin (hCG), prolactin, and fibronectin have been used in clinical studies to diagnose PROM. However, these tests have low sensitivity and specificity or they are invasivew1–3x. We hypothesized that vaginal fluid creatinine may be helpful in diagnosing PROM because fetal urine is one of the important sources of amniotic fluid volume. The study group consisted of 54 women in their third trimester of pregnancy with the diagnosis of PROM established by inspection of vaginal pooling and the control group consisted of 34 pregnant women with intact membranes. Criteria for exclusion from the study were placenta previa, vaginal

Human chorionic gonadotropin assay in cervical secretions for accurate diagnosis of preterm labor

Objectives: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut‐off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. Methods: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundered and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut‐off concentration for cervical hCG and an optimal cut‐off level for Bishop score. The continous variables were analyzed by the unpaired, independent, two‐tailed t‐test and categorical data were analyzed by the chi‐square test. Results: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores (r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery (r=−0.80, P<0.0001) was detected. The cut‐off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were ≥32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were ≥32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; ≥30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; ≥33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally ≥27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks. Conclusions: Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.

Enuresis in childhood, and urinary and fecal incontinence in adult life: do they share a common cause?

To investigate whether there is any association between urinary or fecal incontinence and childhood bedwetting, and given such a relationship, to detect which type of urinary incontinence (UI) is associated with childhood bedwetting.

Clinicopathologic and immunohistochemical profile of ovarian metastases from colorectal carcinoma

Metastasis of colorectal adenocarcinoma of the ovary is not an uncommon occurrence and ovarian metastases from colorectal carcinoma frequently mimic endometrioid and mucinous primary ovarian carcinoma. The clinical and pathologic features of metastatic colorectal adenocarcinoma involving the ovary is reviewed with particular focus on the diagnostic challenge of distinguishing these secondary ovarian tumors from primary ovarian neoplasm. Immunohistochemical stains that may be useful in the differential diagnosis of metastatic colorectal tumors to the ovary and primary ovarian tumors are detailed.

Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia?

Objective This study aimed to analyze the correlation between the histopathologic results of excisional procedure and cervical punch biopsy and to investigate the accuracy rates of colposcopic punch biopsy and cervical cytology to detect cervical intraepithelial neoplasia (CIN) grade 2 and/or more severe lesions (CIN 2+). Materials and Methods Two hundred six patients who underwent excisional procedure in the gynecologic oncology clinic of the Zeynep Kamil Women and Children Diseases Education and Research Hospital between 2004 and 2011 were enrolled in a retrospective study. Results The correlation between the pathologic findings gained by excisional procedure and punch biopsy was weak ( p = .0001, &kgr; = 0.03). The overall concordance rate between the pathologic findings of cervical biopsy and excisional procedure was 57.29%. The rates of detecting more severe lesions by excisional procedure when compared to biopsies (biopsy underestimation) were 71.42%, 22.91%, 37.03%, and 12.72% for biopsy results with negative, CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. Similarly, the rates of less severe lesions diagnosed by excisional procedure when compared to biopsies (biopsy overestimation) were 29.16%, 40.74%, and 15.45% for biopsy results with CIN 1, CIN 2, and CIN 3/adenocarcinoma in situ lesions, respectively. The rate of CIN 2+ lesions after excisional procedure in cases with previous biopsy results with either negative or CIN 1 was 27.27%. Conclusions Our results suggested that colposcopy-directed biopsy was neither a good diagnostic nor a reliable management method. We think that the indications of conization should be enlarged to avoid overlooking high-grade lesions.

Sacrocervicopexy and Combined Operations Involving Cases of Total Uterine Prolapse

Objective: To determine the outcome of sacrocervicopexy and combined operations in the treatment of uterovaginal prolapse in women with desire to preserving both uterus and fertility. Clinical Presentation and Intervention: Sacrocervicopexy with Prolene mesh and combined operations were performed in 3 women with total uterine prolapse because of the patient’s desire to retain fertility in 2 cases and refusal of hysterectomy in the 3rd patient. The 1st case was a 38-year-old woman, gravida 2, parity 1; the 2nd case a 42-year-old woman, gravida 3, parity 2, and the 3rd a 39-year-old woman, gravida 1, parity 1. Douglas pouch was obliterated with Moschcowitz operation. All of the women underwent sacrocervicopexy with Prolene mesh. The repair of a paravaginal defect and prophylactic Burch urethropexy were accomplished through entering Retzius’ space. Genital hiatus was narrowed via approximating levator muscles transvaginally. No serious intraoperative complications occurred and no recurrence was detected during the follow-up period. There was no postoperative complication except for some degree of pain in the 1st postoperative month in 1 case. Conclusion: The results indicate that sacrocervicopexy and repair of all concomitant defects in the pelvic floor are effective procedures in the treatment of uterovaginal prolapse in cases where there is a desire to retain fertility and uterus.

Prevalence of Cytomegalovirus IgG and IgM Antibodies in the Sera of Postpartum Women and Cord Sera of Newborn Babies and Their Correlation with Socioeconomic Status

Using the ELISA technique, cytomegalovirus (CMV) IgG and IgM values were measured in the sera of 176 subjects who delivered healthy term infants and in the cord sera of their newborn babies. IgG was p

Efficacy of passive uterine straightening during intrauterine insemination on pregnancy rates and ease of technique

Aim:  The aim of the present study was to evaluate the efficacy of passive uterine straightening during intrauterine insemination (IUI).