Feride Söylemez

Serum zinc, selenium, copper, and lead levels in women with second-trimester induced abortion resulting from neural tube defects

Neural tube defects are important causes of infant mortality and childhood morbidity. We investigated the relationship between zinc, selenium, copper, and lead concentrations and neural-tube-defect occurrence in women with a second-trimester termination due to fetal-neural-tube defects (NTDs) in this case-control study. Fourteen pregnant women whose pregnancies were terminated as a result of second-trimester ultrasonographic diagnosis of neural tube defects were recruited as cases. The control group (n=14) consisted of women who were selected among age-, gravidity-, and socio-economic-state (SES)-matched women who had a normal triple-screen and targeted ultrasound during the second trimester with documented normal fetal outcome. Zinc and copper determinations were made using flame atomic absorption spectrophotometer (AAS). Graphite furnace AAS was used for Pb, and Se levels were measured with hydride generation AAS. Cases had significantly low serum zinc and selenium levels (62.48±15.9 vs 102.6±23.7 and 55.16±11.3 vs 77.4±5.5, respectively, p<0.001). Serum Cu and whole-blood Pb levels were significantly high when compared to controls. There was a negative correlation between serum zinc and selenium levels, and serum copper levels (r=−425 and −0.443, p<0.05). Our results are consistent with some previous reports. The etiology of NTDs cannot be explained with one strict etiologic mechanism. On the contrary, an interaction among environmental, genetic, and nutritional factors such as trace elements and vitamins would explain these anomalies. If folic acid supplementation is given, additional Zn supplementation should be considered for the further decrease in the recurrence and occurrence of NTDs.

Vitamin D Deficiency in Turkish Mothers and Their Neonates and in Women of Reproductive Age

Objective: Materno-fetal vitamin D deficiency (VDD) may occur in the early neonatal period. We aimed to evaluate the vitamin D (vitD) status and risk factors for VDD in healthy newborns and their mothers, and also in fertile women. Methods: Serum 25 hydroxyvitamin D3 (25(OH)D), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) levels were measured in 70 mothers (study group) and their newborns, and in umbilical cord samples. 104 nonpregnant fertile women comprised the control group. Demographic factors such as education and clothing habits of the mother, number of pregnancies and month of delivery were recorded. A serum 25(OH)D level below 11 ng/ml was accepted as severe, 11-25 ng/ml as moderate VDD, and a value over 25ng/ml as normal. Results: Severe VDD was found in 27% of the mothers, and moderate deficiency in 54.3%. Severe VDD was detected in 64.3% of the neonates, and moderate deficiency in 32.9%. Only 18.6% of the mothers and 2.9 % of the neonates had normal vitD levels. In thecontrol group, severe VDD was observed in 26.9%, and moderatedeficiency in 45.2 %. Only 27.8 % of the controls had normal vitD levels. In the control group, the 25(OH)D levels of the women dressed in modern clothes were significantly higher than those of the women wearing traditional clothes. This difference was not observed in the study group because 75% of these 70 mothers wore modern clothes. Mothers giving birth during the summer months and their neonates had significantly higher serum 25(OH)D levels than those of the mothers giving birth during the winter months and their neonates. Conclusion: The study has shown that in Turkey VDD is an important problem in women of reproductive age, in mothers and their neonates. The 25(OH)D levels obtained from the cord may serve as a guide in the determination of the high risk groups. Conflict of interest:None declared.

Plasma zinc levels during pregnancy and its relationship to maternal and neonatal characteristics: a longitudinal study.

Forty consecutive healthy pregnant women aged 17–38 yr who attended the antenatal clinic of the Department of Obstetrics and Gynecology, Ankara University in their first trimester participated in the study. The pregnant women were followed up longitudinally until the end of their pregnancy. Forty healthy age-matched nonpregnant women were used as a control group. Each pregnant woman was interviewed and a special questionnaire recording dietary history (3-d recall) and socioeconomic status (SES) was used. Birth weight, height, and head circumference of the newborn were measured and a complete physical examination was done for each neonate by the same observer. Blood samples were obtained at each trimester and zinc determinations were made using flame atomic absorption spectrophotometer. The results of plasma Zn measurements were available in 39 pregnant women. There were 23 women of low SES (mean plasma Zn level: 59.0 ± 6.9 µg/dL) and 16 of high SES (mean plasma Zn: 70.3 ± 5.2 µg/dL). The difference between the mean plasma Zn levels of these two groups was significant (p<0.001). The nutritional status in our study appeared to be an important factor responsible for low plasma Zn levels during pregnancy. However, we did not find any correlation between plasma Zn levels and anthropometric parameters of the newborn and pregnancy outcome. Further studies using larger sample sizes are needed to clarify the role of plasma Zn levels on maternal features and fetal outcomes in Turkey.

Extremely skewed X‐chromosome inactivation patterns in women with recurrent spontaneous abortion

Background:  The role of extremely skewed X‐chromosome inactivation (XCI) has been questioned in the pathogenesis of recurrent spontaneous abortion (RSA) but the results obtained were conflicting.

Serum concentrations of lipids and apolipoproteins in normal and hyperemetic pregnancies

Objective: Hyperemesis gravidarum (HEG) is intractable nausea and vomiting. The purpose of this study was to test the hypothesis that women with HEG have lower cholesterol and triglyceride levels, to find any role in the etiology of reduced risk of spontaneous abortion in hyperemetic patients. Study design: The study group consisted of 39 women with normal ongoing pregnancy and 35 women with HEG. The concentrations of triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol and apolipoprotein (apo)-A and -B were analyzed. The independent-samples t test, Mann–Whitney U test, χ2 test, Kruskal–Wallis variance analysis and Spearmans correlation were used to examine differences between groups. Results: Serum HDL cholesterol, LDL cholesterol and total cholesterol, apo-A and apo-B were higher in normal pregnancies compared with hyperemetic pregnancies. There were no significant differences in apo-B/apo-A, HDL cholesterol/apo-A and total cholesterol/HDL cholesterol ratios between the hyperemetic patients and controls. A negative correlation was found between total cholesterol and serum thyroxine level. Conclusion: We found decreased levels of total cholesterol, LDL cholesterol, apo-A and apo-B in hyperemetic patients and the same spontaneous abortion rate in the two groups in our study.

Serum levels of adenosine deaminase and pregnancy-related hormones in hyperemesis gravidarum.

Abstract Objectives: We investigated the correlation between pregnancy-related hormones and serum adenosine deaminase (indicator of cellular immunity) level in women with hyperemesis gravidarum. Materials and methods: Twenty patients with hyperemesis gravidarum and 20 normal pregnancies were included in this prospective, case-control study. Serum adenosine deaminase levels, hematological parameters (white blood cells, neutrophil, monocyte and lymphocyte counts) and hormone levels (prolactin, progesterone, thyroid stimulating hormone, human chorionic gonadotropin β subunit, estradiol (E2)) were measured in all women. Interrelations of blood cell counts and hormone levels with serum adenosine deaminase levels were also investigated. Results: Serum adenosine deaminase, human chorionic gonadotropin β subunit, thyroid stimulating hormone, E2, progesterone and prolactin levels, and lymphocyte and monocyte counts in women with hyperemesis gravidarum were significantly higher than in controls but white blood cells, neutrophil, T3 and T4 levels were not different. Serum adenosine deaminase level correlated with E2, progesterone, lymphocyte, and monocyte levels for all patients. Conclusion: Elevated serum adenosine deaminase in patients with hyperemesis gravidarum may relate to high levels of E2 and progesterone.

The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion.

OBJECTIVE To assess the effects of ultrasonographically detected subchorionic hematomas on pregnancy outcomes in patients with vaginal bleeding within the first half of pregnancy. MATERIAL AND METHODS Patients diagnosed with threatened abortion due to painless vaginal bleeding and who were followed up in an in-patient service during the first vaginal bleeding between January 2009 and December 2010 were included in this retrospective cohort study. Patients were divided into two groups according to the presence of subchorionic hematoma. Miscarriage rates and pregnancy outcomes of ongoing pregnancies were compared between the groups. RESULTS There were no statistically significant differences between the groups regarding demographic parameters, including age, parity, previous miscarriage history, and gestational age at first vaginal bleeding. While 13 of 44 pregnancies (29.5%) with subchorionic hematoma resulted in miscarriage, 25 of 198 pregnancies (12.6%) without subchorionic hematoma resulted in miscarriage (p=.010). The gestational age at miscarriage and the duration between first vaginal bleeding and miscarriage were similar between the groups. The outcome measures of ongoing pregnancies, such as gestational week at delivery, birth weight, and delivery route, were also similar between the groups. CONCLUSION Ultrasonographically detected subchorionic hematoma increases the risk of miscarriage in patients with vaginal bleeding and threatened abortion during the first 20 weeks of gestation. However, it does not affect the pregnancy outcome measures of ongoing pregnancies.

Cervical varix complicating marginal placenta previa: A unique coexistence

Uterine cervical varix (CV) is a very rare condition during pregnancy and may cause moderate to severe hemorrhage. We present the third reported case of huge CV coexisting with placenta previa in the English literature. A 40‐year‐old chronic hypertensive patient with marginal placenta previa also had cervical varix causing hemorrhage. At the 38th gestational week emergent cesarean section was performed because of placental abruption. Placenta previa is a risk factor for CV and patients with placenta previa who have moderate bleeding should be examined for this coexistence. The choice of management is close follow‐up and cesarean section close to term.

Determination of risk factors and perinatal outcomes of singleton pregnancies complicated by isolated single umbilical artery in Turkish population

OBJECTIVE To address the possible risk factors, eventual pregnancy outcomes, and probable troubles in follow-ups of pregnancies complicated by an isolated single umbilical artery and to provide data on Turkish cases in such an aspect that ethnic divergences may have influence. MATERIAL AND METHODS A total of 16568 singleton pregnancies that were delivered between May 2006 and May 2013 were retrospectively screened. Ninety-three fetuses were found to have an isolated single umbilical artery. One-hundred pregnancies that did not show any structural or chromosomal abnormalities were randomly selected from the rest of the cases to establish the control group. IBM SPSS Statistics 20.0 software was utilized for statistical analysis. Non-parametric data were analyzed with Mann-Whitney U test and were presented as means±standard deviations. P values less than 0.05 were statistically significant. For the adjustment of confounding factors, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression analysis. RESULTS The incidence of small for gestational age (SGA) fetuses and hypertensive disorders in pregnancy was found to be significantly higher in cases with an isolated single umbilical artery (p<0.001 and p=0.022, respectively). Maternal smoking was found to be independently associated with the occurrence of an isolated single umbilical artery (OR: 3.556; 95% CI: 1.104-11.45). The risk of preterm birth was not higher in the study group (OR: 0.538; 95% CI: 0.576-2.873). The incidence of cases who underwent cesarean delivery because of non-reassuring fetal heart trace was similar in the study and control groups (p=0.499). CONCLUSION Attention should be paid to the development of hypertensive disorders in cases with a diagnosis of an isolated single umbilical artery, and parents should be counseled properly, including the information on increased risk of SGA. Strict follow-up of pregnancies complicated with an isolated single umbilical artery in terms of preterm birth seems unfeasible except in cases with accompanying risk factors for preterm labor.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma

Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1–2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63‐year‐old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.