Derya Eroglu

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions

Background.  Phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP‐1 in cervical secretions by a rapid bed‐side test could be used to predict preterm delivery in patients with regular uterine contractions.

Black cohosh and fluoxetine in the treatment of postmenopausal symptoms : A prospective, randomized trial

The objective of this study was to evaluate the efficacy of fluoxetine and black cohosh in the treatment of women with postmenopausal symptoms. A total of 120 healthy women with menopausal symptoms were recruited to this prospective study with a follow-up period of 6 mo. They were randomly assigned to 1 of 2 groups and were treated with fluoxetine or black cohosh. After entry into the study, patients were examined at the first, second, third, and sixth months of the treatment period. The women kept diaries in which they reported the daily number and intensity of hot flushes and night sweats. In addition, at the beginning and end of the third month, they completed questionnaires consisting of a modified Kupperman Index, Beck’s Depression Scale, and a RAND-36 Quality-of-Life Questionnaire. Statistically significant differences were noted in the Kupperman Index and Beck’s Depression Scale at the end of the third month in both groups compared with baseline values. In the black cohosh group, the Kupperman Index decreased significantly compared with that in the fluoxetine group by the end of the third month. On the other hand, in the fluoxetine group, Beck’s Depression Scale decreased significantly compared with that in the black cohosh group. Monthly scores for hot flushes and night sweats decreased significantly in both groups; however, black cohosh reduced monthly scores for hot flushes and night sweats to a greater extent than did fluoxetine. At the end of the sixth month of treatment, black cohosh reduced the hot flush score by 85%, compared with a 62% result for fluoxetine. By the sixth month of the study, 40 women had discontinued the study—20 (33%) in the fluoxetine group and 20 (33%) in the black cohosh group. Compared with fluoxetine, black cohosh is more effective for treating hot flushes and night sweats. On the other hand, fluoxetine is more effective in improvements shown on Beck’s Depression Scale.

Prediction of preterm delivery among women with threatened preterm labor.

Background/Aims: To determine predictive values of fetal fibronectin and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) in cervicovaginal secretions and ultrasonographic measurement of cervical length for delivery <35 weeks in patients with uterine contractions. Methods: Our study included 51 women between 24 and 35 weeks’ gestation with uterine contractions and 90 controls. Cervicovaginal samples were analyzed for presence of fetal fibronectin and phIGFBP-1. Cervical length was measured by transvaginal sonography. Results: Preterm birth rate was 19.6% (10/51) in the study group. Negative predictive values of fetal fibronectin, phIGFBP-1 and ultrasonographic cervical length <20 mm, and <25 mm for delivery <35 weeks were 91.9, 92.3, 91.1, and 90.5%, respectively. Positive predictive values were 50, 58.3, 100 and 66.7%, respectively. When results of fetal fibronectin/phIGFBP-1 test and ultrasonographic cervical length <25 mm were combined, specificity and positive predictive values of each test for delivery within 7 days increased. Conclusion: Fetal fibronectin and phIGFBP-1 tests have approximately equivalent ability to predict delivery <35 weeks’ gestation. An ultrasonographic cervical length measurement >20 mm or a negative fetal fibronectin/phIGFBP-1 test obtained from patients with uterine contractions at 24–35 weeks’ gestation may avoid overdiagnosis.

Quality of life and postmenopausal symptoms among women in a rural district of the capital city of Turkey

Objective. To determine menopause-related symptoms and quality of life in women aged 40–80 years living in a rural area of Turkey. Methods. A total of 338 women were evaluated in this cross-sectional study. As data sources we used a questionnaire that elicited information on the descriptive, fertility and menopausal characteristics of the women, the Menopause Rating Scale (MRS) and the Short Form-36 (SF-36). Results. The mean age at menopause was 46.5 ± 0.4 years. The complaint stated most often as ‘severe or very severe’ was ‘hot flushes and sweating’ (50.7%). The physical functioning, physical role, bodily pain, general health, social functioning, emotional role and mental health scores of postmenopausal women were statistically higher (p < 0.05) than those of premenopausal women. Scores on physical function, physical role, general health and social function decreased significantly with age in postmenopausal women (p < 0.05), while none of the quality-of-life domain scores differed significantly with age in premenopausal women. Conclusions. Quality of life is worse in postmenopausal women than premenopausal women, and in older than younger women in the postmenopausal period. Thus rural populations are primarily in need of public health care in the postmenopausal period.

Non-Invasive Management of Fetal Goiter during Maternal Treatment of Hyperthyroidism in Grave’s Disease

There is an increased risk of fetal goiter in patients who have a history of Grave’s disease and undergo propylthiouracil (PTU) treatment during pregnancy. In this report, we describe a case of a fetal goiter detected by antenatal ultrasound at the 26th week of gestation in a mother treated with PTU for Grave’s disease. A 32 × 38 × 20 mm fetal goiter was detected, each lobe measured 30 × 18 × 18 mm and estimated volume was 10 cm3. Subsequently, fetal thyroid function was assessed by umbilical fetal blood sampling. Cord blood showed elevated serum TSH (40.2 mU/l) and normal concentrations of free T4 (9.5 pmol/l) and free T3 (2.6 pmol/l). There were no other ultrasonographic signs of fetal hypothyroidism. Based on the above findings, the mother’s PTU dosage was reduced to 50 mg daily from a total of 150 mg and weekly ultrasonographic examinations were performed. Six weeks after the initial ultrasound, a complete regression of the fetal goiter was noted. At the 34th week of gestation, the patient was delivered due to intrauterine growth restriction and oligohydramnios and gave birth to a male, weighing 1,920 g. The newborn thyroid was not palpable and thyroid ultrasonography was normal. Cord blood TSH was normal (8.4 mU/l) and free T4 was within lower normal limit (9.03 pmol/l). Ten days later, newborn thyroid function was normal and the baby did well afterwards. In conclusion, after the evaluation of fetal thyroid status, selected cases with fetal goiter can be initially managed without intrauterine treatment.

Prenatal diagnosis of bilateral diaphragmatic hernia by fetal sonography

This report describes a case of prenatally diagnosed bilateral diaphragmatic hernia. At 22 weeks’ gestation, ultrasound revealed a cystic structure behind the fetuss heart on the axial image at the level of the cardiac four‐chamber view. This suggested a left‐sided congenital diaphragmatic hernia with herniation of the stomach into the left hemithorax. However, the left‐to‐right midline shift of the heart was minimal, which is not typical of left‐sided congenital diaphragmatic hernia. Throughout the 30th week of gestation, the right and left branches of the pulmonary artery were hypoplastic compared with the values in normal fetuses of the same gestational age. The presumptive diagnosis was bilateral congenital diaphragmatic hernia. A female newborn weighing 2900 g was delivered at 37 weeks’ gestation, and she died at 7 h of age. An autopsy revealed large defects on both sides of the diaphragm. In conclusion, prenatal diagnosis of bilateral diaphragmatic hernia is possible with fetal sonography.

Metabolic disorders in patients with recent gestational diabetes mellitus

Aim:  To determine metabolic disorders in patients with recent gestational diabetes mellitus (GDM) compared with controls.

Second trimester fetal nasal bone length in a low‐risk Turkish population

To define normal values of second trimester fetal nasal bone length (NBL) in a low‐risk Turkish population.

Prenatal diagnosis of a partial monosomy 7q11-->q31 in a fetus with split foot.

Objective: A 27-year-old woman was referred to our laboratory for genetic counseling at 26 weeks of gestation due to abnormal ultrasound findings including intrauterine growth retardation, Dandy-Walker malformation and lower extremity anomalies. Methods: Chromosome analysis was performed on fetal blood sample obtained by cardiocentesis. Result: We observed an abnormal karyotype with a structural abnormality of the long arm of chromosome 7. Both parents’ chromosomes were normal; thus, the fetal karyotype designation was 46,XX, del(7)(pter→q11::q31→qter) de novo. Skin biopsy sample was taken to confirm the karyotype after therapeutic abortion was performed. The result was identical. Postmortem examination and autopsy showed facial dysmorphism, malformations of the lower extremities and central nervous system anomalies. Conclusion: 7q interstitial deletions cause a wide spectrum of congenital abnormalities and syndromes linked to the deleted segments. Our case had a rather wide chromosome region deleted and it is important, because prenatal diagnosis was performed. Thus, the family had the chance to evaluate the situation and decided to terminate the pregnancy after genetic counseling.

Maternal-Fetal Factors That Affected Doppler Waveform Analysis in a Patient Undergoing Hemodialysis

Pregnancy in women having chronic renal insufficiency and undergoing hemodialysis is a rare event with a poor outcome. This is the 1st case in whom pre- and posthemodialysis fetal renal artery Doppler flow velocimetry was used in conjunction with fetal blood sampling which was performed to assess fetal karyotype and blood chemistry. Uteroplacental Doppler measurements were also performed, and a close correlation between maternal-fetal blood creatinine and urea nitrogen levels and fetal renal, umbilical, and uterine artery resistance indexes was observed.