Habibe Ayvaci

Area under curve of temporal estradiol measurements for prediction of the detrimental effect of estrogen exposure on implantation

To assess whether the area under the curve of temporal estradiol measurements (AUCEM) during cycles of assisted reproductive technology (ART) can be used to predict failure of implantation and clinical pregnancy.

Spot Protein/Creatinine Ratio in Preeclampsia as an Alternative for 24-Hour Urine Protein

BACKGROUND Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, random spot sampling for a urine protein to creatinine (P/C) ratio has been investigated. AIMS The aim of the study was to determine the diagnostic accuracy of the protein to creatinine ratio (P/C) compared with 24-hour urine collection for the detection of remarkable proteinuria and to evaluate the P/C ratio for different proteinuria ranges in patients with preeclampsia. STUDY DESIGN Case-control study. METHODS Two hundred and eleven pregnant women who met the criteria of preeclampsia comprised the study group and fifty three pregnant women were taken as the control group. Spot urine specimens for measuring P/C ratio were obtained taken immediately before 24-hour urine collection. The correlation between the P/C ratio in the spot urine samples and urinary protein excretion in the 24-hour collections was examined using the Spearman correlation test. RESULTS It was found a good positive correlation between the P/C ratio and 24-hour protein excretion, with a correlation coefficient (r) of 0.758. The best cut-off which gave the maximum area under the curve was 0.45 for 300 mg, 0.9 for 1000 mg, 1.16 for 2000 mg, 1.49 for 3000 mg, 2.28 for 4000 mg and 2.63 for 5000 mg per 24h. A P/C ratio above 0.9 strongly predicts significant proteinuria for more than 1 gram (AUC 0.97, 95% CI: 0.94-0.99 and sensitivity, specificity, positive and negative predictive value of 91%, 95.4%, 95.2%, and 91.2%, respectively). CONCLUSION The P/C ratio can be used as a screening test as a good predictor for remarkable proteinuria. The P/C ratio seems to be highly predictive for diagnosis to detect proteinuria over one gram and it could be used as a rapid alternative test in preeclamptic patients not to delay implementation treatment.

Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores

IntroductionIt was aimed to investigate the effects of short-term maternal fasting on fetal biophysical profile (BPP) scores and obstetric doppler indices.Materials and methods Thirty healthy uncomplicated singleton pregnancy cases were enrolled into the study.Results and conclusionFasting decreased BPP reversibly, but not to a level below 8/10. AFI, umbilical and MCA impedances were unchanged while pulsatility, resistance and systolic/diastolic values of uterine arteries were increased.

Genotoxicity profiles in exfoliated human mammary cells recovered from lactating mothers in Istanbul; relationship with demographic and dietary factors

We have investigated the presence of DNA damage in human mammary epithelial cells collected from healthy lactating mothers (age, 20-35 years) who were resident in the Istanbul area. Breast milk (10ml) was collected from 30 women between one and two weeks post-partum. Demographic information (parity, breast cancer, occupation, duration of residency in Istanbul, consumption of fish, beef and poultry) was also obtained. Milk samples were diluted 1:1 with RPMI 1640 medium and centrifuged to collect cells. The cells were re-suspended and cell viability was determined by use of 0.4% trypan blue. DNA damage was assessed by use of the comet assay (alkaline single-cell gel electrophoresis). Fifty cells per slide and two slides per sample were scored to evaluate DNA damage. The cells were visually classified into four categories on the basis of extent of migration: undamaged (UD), lightly damaged (LD), moderately damaged (MD) and highly damaged (HD). Total comet scores (TCS) were calculated as: 1× UD+2× LD+3× MD+4× HD. Exfoliated mammary cells of the donors showed high (TCS≥150a.u.), moderate and low DNA damage in 10 (33.3%), 8 (26.7%) and 12 (40%) mothers, respectively. There was no significant correlation between TCS for DNA damage and the duration of previous breastfeeding, parity or age. None of the mothers was vegetarian, smoker or on any medication. Meat and chicken consumption did not significantly correlate with the TCS values. Fish consumption was significantly correlated with TCS results (Spearmans rho=0.39, p<0.05). No significant correlation was found between the DNA-damage scores and the period of residency in Istanbul, but fish consumption increased as the duration of stay was longer (Spearmans rho=0.53, p<0.01). These findings suggest that the primary causes of differences in genotoxicity detected in lactating mothers in Istanbul may be of dietary origin. Our experience also confirms that sampling breast milk from lactating mothers provides a valuable and non-invasive tool to study DNA damage in mammary cells.

Thiol-disulfide homoestasis in pregnancies with fetal growth restriction

Abstract Aim: To investigate the role of dynamic thiol-disulfide homeostasis in preeclamptic and idiopathic fetal growth restricted (FGR) pregnancies. Material and method: In this prospective case-control study, a total of 110 singleton pregnancies with FGR (study group) (51 preeclamptic and 59 idiopathic FGR’s cases) were compared with 68 healthy pregnant controls at the same gestational weeks (control group). For serum disulfide-thiol homeostasis, a newly used method described by Erel and Neselioglu was used. Results: Serum native thiol and total thiol levels were lower in FGR pregnancies (285.63 ± 55.92 µmol/L, 324.41 ± 44.18 µmol/L, respectively) than control group (324.41 ± 44.18 µmol/L, 362.98 ± 51.43 µmol/L, p < .001, p = .004, respectively). In subgroup analysis, only preeclamptic FGR’s have lower native and total thiol levels (254.41 ± 59.55, 324.41 ± 44.18 µmol/L, respectively) compare to both idiopathic FGR’s and control’s. There was no difference in native and total thiol levels with idiopathic FGR’s with controls. Idiopathic FGR’s have higher levels of disulfide than preeclamptic FGR’s (21.72 ± 17.72 versus 16.80 ± 11.20 µmol/L). The serum albumin and total protein levels were positively and spot urine protein/creatinine ratio, 24-h urine protein levels were negatively correlated with native thiol and total thiol levels. Conclusion: The balance of thiol-disulfide homeostasis was shifted and native and total thiol levels were decreased only in preeclamptic FGR pregnancies. The serum disulfide level was increased in idiopathic FGR pregnancies compare to preeclamptic FGR pregnancies which may be a sign of oxidative stress in idiopathic FGR pregnancies with normal thiol pool.

Repair of a First Trimester Uterine Dehiscence with Continuation of Pregnancy: Case Report

ABS TRACT Spontaneous uterine rupture and dehiscence are rare complications of pregnancy. While uterine rupture refers to full thickness disruption of the uterine wall, uterine dehiscens is an incomplete separation of the uterine wall with intact serosa. The dehiscence of a uterus in fetal viability limit creates a dilemma because there is not any clear treatment approach. Although rare, pregnancy continuation with the expectant approach or defect repair in the second trimester has been published. We report a first trimester uterine scar dehiscence. Ultrasound examination during valsalva maneuver and synchronous elevation of uterus by manual examination helped us in correct diagnosis. The dehiscence has been repaired with laparotomy and the pregnancy continued until 32 weeks of gestation.

Clinical analyses of successful and previously failed intracytoplasmic sperm injection cycle parameters in patients with poor ovarian reserve

Objective: To determine some major characteristic differences between two consecutive successful and unsuccessful intracytoplasmic sperm injection (ICSI) cycles in poor responders. Materials and Methods: Sixty women with poor ovarian response as determined using the Bologna criteria underwent ICSI cycles following an unsuccessful trial. Some parameters of both cycles including age, body mass index (BMI), serum follicle-stimulating hormone (FSH) and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, antagonist starting day, duration of antagonist administration, endometrial thickness at trigger day, number of total and fertilized oocytes, embryo transfer day, number of embryo cells, and fertilization rate were compared in the same patients to identify predictors of cycles with clinical pregnancy. Results: The mean age, BMI, serum FSH, estradiol concentrations, and antral follicle count were 35.9 years (range, 30-42 years), 25.9 kg/m2 (range, 18.4-33.5 kg/m2), 10.9 IU/mL (range, 7-13 IU/mL), 52.9 pg/mL (range, 11.6-75 pg/mL), and 4.7 (range, 2-10), respectively. A comparison of cycle characteristics showed a significantly higher total number of mature and fertilized oocytes in successful cycles. The fertilization rate was also significantly higher in cycles with clinical pregnancy. Early initiation of antagonist was shown to result in favorable outcomes. A comparison of embryo characteristics showed that transfer of higher-stage embryos and embryos with higher numbers of cells had a significant impact on cycle outcomes. Conclusion: Our comparison of parameters of failed and successful ICSI cycles in poor responders revealed significantly earlier antagonist initiation, higher total number of mature and fertilized oocytes, fertilization rate, and significantly higher stage of embryo development and cell numbers at transfer in cycles that resulted in clinical pregnancy.

Acute fetal heart rate tracing changes secondary to cigarette smoking in third trimester pregnancies

Abstract Objective: In this study, we aimed to assess the acute alterations on some features of fetal heart rate (FHR) tracings in third trimester pregnancies. Methods: Data of FHR tracing records were obtained from 79 otherwise healthy pregnant women aged between 18 and 41. Among 79 women, 39 were nonsmokers while the remaining were chronic smokers (six or more cigarettes per day, with an average of 10 cigarettes per day). The baseline of tracings, the number of accelerations and decelerations of FHR, as well as the FHR mean, standard deviation, short-term variability of FHR were all calculated for each participant. The results of smokers and nonsmokers, then the results of smokers before and after smoking were compared. Results: Comparison of some demographic and FHR tracing characteristics between smoker and nonsmoker groups indicated significantly decreased variability in smoker group. All FHR tracing characteristics were compared before and, immediately after cigarette smoking and revealed significantly higher mean baseline, lower variability and acceleration after smoking a cigarette. Conclusion: Even in a short time period, smoking is associated with some changes in FHR monitorization characteristics, detailed analyses of these changes may clarify the pathophysiology of smoking associated perinatal outcome.

Bilateral tubal ligasyon sonrası ektopik gebelik; olgu sunumu

Ectopicpregnancy after bilateral tubal ligation; A case report Tubal ligation is a common method of contraception and ectopic pregnancy is one complication of tubal sterilization. We present a case ofectopic pregnancy after bilateral tubal ligation in a 33 year old female suffering from pelvic pain and vaginal bleeding.

Broad ligamente yayılım gösteren intravasküler leiomyomatozis olgusu

Intravenous leiomyomatosis is a rare benign neoplasm that commonly grows into the pelvic veins and inferior vena cava and rarely, the right side of the heart. It is important to recognize and report this tumor, because of the possibility of recurrence. We present a case of intravenous leiomyomatosis growing to the broad ligament.