Ebru Alici Davutoglu

Shear wave elastography of the placenta in patients with gestational diabetes mellitus

To evaluate placental elasticty in women with gestational diabetes mellitus (GDM) and non-diabetic controls. Thirty-three pregnant women with GDM according to the current criteria of the American Diabetes Association and 43 healthy pregnant women who were admitted to the antenatal clinic were recruited for this case–control study. Elasticity values of both the peripheral and the central parts of the placentas of the patients in both groups were determined by shear wave elastography (SWE) imaging. Mean elasticity values of both the central and the peripheral part of the placentas were significantly higher in GDM pregnancies (p < 0.001). No difference was observed in the mean elasticity values of the central and the peripheral part of the placentas in two groups (p > 0.05). SWE imaging technology might provide a quantitative assessment of the morphological pathologies of placentas in pregnant women with GDM.

Evaluation of maternal serum hypoxia inducible factor-1α, progranulin and syndecan-1 levels in pregnancies with early- and late-onset preeclampsia

Abstract Objective: To determine the serum levels of HIF-1 α, progranulin, and syndecan-1 in preeclampsia (PE) and normal pregnancy, and to compare whether these markers demonstrate any difference between early-onset PE (EO-PE) and late-onset PE (LO-PE). Methods: This cross-sectional study was conducted on 27 women with EO-PE, 27 women with LO-PE, and 26 healthy normotensive pregnant controls matched for gestational age. Maternal levels of serum HIF-1 α, progranulin, and syndecan-1 were measured with the use of an enzyme-linked immunosorbent assay kit. Results: Statistical analysis revealed significant differences between the control and the PE groups in progranulin (p < .001) and syndecan-1 (p <.001) levels. There were no significant differences in the serum HIF-1 α levels between these groups (p= .069). When PE patients were evaluated by considering subgroups; statistical analysis revealed significant inter-group differences in all biomarkers. Serum progranulin levels were significantly higher in LO-PE compared with the other two groups (EO-PE versus LO-PE and LO-PE versus controls p = .000). Control group presented significantly higher syndecan-1 levels, than EO and LO-PE (p < .001). HIF-1 α levels positively correlated with progranulin levels (r = .439, p= .000). Conclusions: Serum progranulin may have potential to be used as a biomarker for the differentiation of EO-PE and LO-PE. The co-operative action between HIF-1 α and progranulin might play a key role in the pathogenesis of LO-PE. The predominant feature of LO-PE seems to be an inflammatory process, whereas in EO-PE placentation problem seems to be the main pathology.

Maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in gestational diabetes mellitus

Abstract Objective: The aim of the study is to evaluate maternal serum atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) levels in patients with getational diabetes mellitus compared with a control group. Methods: We have measured maternal serum ANP and BNP levels in 35 otherwise healthy and 45 gestational diabetic women between gestational week 24 and 28 referred to our unit in a cross-sectional study. Independent samples t-test or the Mann–Whitney U-test was used for comparison of two groups where appropriate. Results: Mean maternal serum homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, fasting glucose and insulin levels in gestational diabetes mellitus (GDM) group were significantly higher than the control group (p < 0.01). Mean maternal serum ANP and BNP levels of women with GDM were significantly lower than the control group (12.9 ± 9.9 versus 34.8 ± 16.9 pg/ml, p < 0.001; 416.6 ± 209.7 versus 629.7 ± 162.2 mg/dl, p < 0.001, respectively). Maternal serum ANP and BNP levels were negatively correlated with insulin levels, HbA1c and HOMA-IR values (p < 0.05). Conclusions: Maternal serum ANP and BNP levels are significantly lower in patients with GDM. These biomarkers might be valuable in clinical setting for identifying high-risk women for developing diabetes during pregnancy.

An unusual case of Meckel–Gruber syndrome (MKS) associated with visceroatrial heterotaxy and facial anomalies

This disorder was first described by German anatomist Johann Friedrich Meckel in 1822, and the same pathological changes in foetuses were described by Georg B. Gruber in 1934. Meckel– Gruber syndrome (MKS) is a lethal, multisystemic and autosomal-recessive disorder (Shetty et al. 2012). It is considered to be a ciliopathic disorder and is characterized by developmental anomalies of the CNS (most frequently, occipital meningoencephalocele), cystic kidneys, postaxial polydactyly, and cystic and fibrotic changes of the liver (Logan et al. 2011). The incidence of MKS varies from 1 in 13,000–400,000 live births (Lurie et al. 1984), and until now, various forms of this syndrome associated with anomalies of different organ systems have been reported. Because of the wide phenotypic spectrum, it is difficult to define the minimum diagnostic criteria (Wright et al. 1994). To the best of our knowledge, there is no reported case of this disorder associated with visceroatrial heterotaxy and facial anomalies thus far. This is a report of a case of MKS associated with visceroatrial heterotaxy (double inlet single ventricle, aorta malposition and right atrial isomerism and midline liver) and facial anomalies.

Maternal copeptin levels in intrahepatic cholestasis of pregnancy

Abstract Purpose: To investigate the copeptin levels in women with intrahepatic cholestasis of pregnancy (ICP) compared to women with uncomplicated pregnancies. Materials and methods: This cross-sectional study was conducted in 40 pregnant women with ICP and 38 randomly selected healthy pregnant women, who formed the control group. Serum copeptin concentrations were measured using an enzyme-linked immunosorbent assay. Results: Maternal age, body mass index at assessment, and gestational age at blood sampling were similar between the two groups. Duration of pregnancy was shorter and mean birth weight was significantly lower in the ICP group compared to the control group. Total bile acid, alanine aminotransferase, aspartate aminotransferase, and gamma glutamyl transferase levels were significantly higher in the ICP group than in the control group. There was no significant difference in copeptin concentrations (2.54 (2.05) versus 2.43 (1.98) ng/ml; p = .5). Conclusions: Serum copeptin concentrations did not vary between the pregnancies complicated by ICP and the healthy pregnancy control group.

In vivo assessment of placental elasticity in intrauterine growth restriction by shear-wave elastography

PURPOSE In this study, we evaluated the placental elasticity in vivo by shear-wave elastography in pregnant women under follow-up for intrauterine growth restriction (IUGR) and compared the elasticity values to normal pregnancies. MATERIAL AND METHODS This prospective study included 42 pregnant women with a possible diagnosis of intrauterine growth restriction based on obstetrical grayscale and Doppler ultrasonography and 42 women with a normal pregnancy during the 2nd and 3rd trimester. During follow-up examinations, seven fetuses showed an increased growth and were delivered with a birth-weight above the 10 percentile. However, for statistical purposes we included these seven patients in the IUGR group due to prospective nature of the study. All patients initially underwent obstetrical grayscale and Doppler ultrasonography with measurement of resistivity and pulsatility indices from uterine arteries. Subsequently, elasticity values of the peripheral and central part of the placentas from fetal and maternal surfaces were measured by shear-wave elastography. Following delivery, Apgar scores at 1st and 5th minute, birth weight were collected. For statistical analysis, Mann-Whitney U test was used. ROC curves were plotted and cut-off values for elasticity values were analyzed. RESULTS Median elasticity values of the central part of the placentas from maternal (28kPa vs 6kPa) and fetal sides (21.5kPa vs 5kPa) were significantly higher in IUGR pregnancies compared to the control group (p<0.001). Similarly, median elasticity values of peripheral part of placentas from maternal (22kPa vs 5.35kPa) and fetal sides (22.5kPa vs 5.3kPa) were significantly higher in IUGR pregnancies compared to the control group (p<0.001). CONCLUSION Placental stiffness values are significantly higher in patients with IUGR. Shear-wave elastography can be used as a non-invasive, complementary method to gray-scale and Doppler ultrasound for diagnosing IUGR.

Prenatal diagnosis of isolated foetal hydrocolpos secondary to congenital imperforate hymen mimicking ambiguous genitalia

Ebru Alici Davutoglu, Mehmet Aytac Yuksel, Aslıhan Yurtkal, Ilkbal Temel Yuksel, Ibrahım Adaletli and Riza Madazli Cerrahpasa School of Medicine Department Of Obstetrics and Gynecology, Istanbul University, Istanbul, Turkey; Department of Obstetrics and Gynecology, Okmeydani Research and Education Hospital, Istanbul, Turkey; Cerrahpasa School of Medicine Department of Radiology, Istanbul University, Istanbul, Turkey

Perinatal outcomes of 126 pregnancies with Sistemic lupus erythematosus

Objective: To evaluate maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE). Materials and Methods: This retrospective clinical study included 126 consecutive cases of pregnant women with SLE and was performed in the perinatology clinic of our university hospital. We evaluated lupus pregnancies that were followed and delivered from 2002 to 2016. Results: The mean patient age was 29.1 ± 4.6 years, and the nulliparity rate was 45.2%. Disease flare-up occurred in 11.1% of patients. Lupus anticoagulants and anticardiolipin IgG and IgM antibodies were positive in 23.8%, 18.2%, and 18.2% patients, respectively. The mean gestational age at delivery was 37.2 ± 3.7, and the mean birth weight was 2813 ± 856 g. Fetal growth restriction, preterm delivery, stillbirth, and preeclampsia rates were 16.6%, 10.3%, 10.3%, and 9.5%, respectively. Conclusion: A multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes.

Outcome after prenatal diagnosis of fetal urinary tract abnormalities: A tertiary center experience

Objective: With the widespread use of ultrasonography for fetal screening, the detection and management of congenital urinary tract abnormalities has become crucial. In this study, we aimed to describe the clinical approaches in patients with prenatally detected urinary tract abnormalities. Material and Methods: This study is a retrospective, single-center study performed at a perinatology unit of a university hospital, between 2010 and 2016. The outcomes of 124 patients who were prenatally diagnosed as having urinary tract abnormalities are reported. Variables included in the analysis were fetal sex, birth week and weight, persistency, and necessity surgery after birth for renal pelvic dilatation. Low-risk renal pelvic dilatation was determined as an anterior-posterior (AP) diameter of 4-7 mm at 16-28 weeks, 7-10 mm after 28 weeks, whereas high-risk dilatation was defined as AP measurements of ≥7 mm at 16-28 weeks, ≥10 mm after 28 weeks, respectively. Results: The majority of patients consisted of male fetuses with bilateral pelviectasis (62.9%, 20.2%, respectively). The mean age was 28.8±6.4 years. The mean gestational age at birth was 34.2±7.8 weeks. The mean birth weight was 2593±1253.3 g. The need for surgery was greater in high-risk patients than in low-risk patients (58.3% vs. 8.7%) (p<0.002). Conclusion: Patients with high-risk antenatal renal pelvic dilatation require surgical treatment after delivery. Close prenatal and postnatal follow-up is mandatory in specialized centers. Perinatologists, neonatologists, pediatricians and pediatric nephrologists, and radiologists should treat these children with a multidisciplinary approach.

Maternal serum irisin levels in early and late-onset pre-eclamptic and healthy pregnancies

Abstract The aim of the study was to investigate whether plasma irisin concentrations differ between uncomplicated, early-onset and late-onset pre-eclamptic pregnancies. This cross-sectional study was conducted on 27 women with early-onset, 27 women with late-onset pre-eclampsia (PE) and 26 healthy pregnant women. Maternal levels of serum irisin were measured with the use of an enzyme-linked immunosorbent assay kit. The mean maternal serum irisin level of early-onset PE was significantly lower than late-onset PE (1.14 ± 0.56 vs. 1.46 ± 0.59, p < .05) and control subjects (1.14 ± 0.56 vs. 3.14 ± 0.81, p < 0.001). The mean maternal serum irisin level of late-onset PE was significantly lower than the control group (1.46 ± 0.59 vs. 3.14 ± 0.81, p < 0.001). Maternal serum irisin levels are decreased in pre-eclamptic pregnancies. Low levels of irisin may be the result or the cause of pathologic changes in PE. Impact statement What is already known on this subject? There are only two studies in the literature evaluating maternal serum irisin levels in pre-eclamptic pregnancies. One study demonstrated decreased maternal serum irisin levels in pre-eclamptic patients and the other found no significant difference between pre-eclamptic and control pregnancies. What do the results of this study add? The present study demonstrates that serum irisin levels were significantly lower in pre-eclampsia than normotensive pregnancies. Furthermore, we have also demonstrated for the first time that women with EO-PE had significantly lower levels of serum irsin than women with LO-PE. What are the implications of these findings for clinical practice and/or further research? Low levels of irisin may be the result or the cause of pathologic changes in pre-eclampsia. More studies are needed to evaluate the relationship between irisin and pre-eclampsia.