Hakan Erenel

Systemic lupus erythematosus and pregnancy.

We present a retrospective study of 42 consecutive cases of systemic lupus erythematosus (SLE) and pregnancy followed and delivered during the period 2002–2007 in our department. The mean patient age was 28.6 years and the nulliparity rate was 45.2%. Disease flare up occurred in 9.5% of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 33%, 16.6% and 19% of patients, respectively. Mean gestational age at delivery was 36.9 ± 4.2 and mean birth weight was 2,750 ± 844 g. Stillbirth, fetal growth restriction, pre-eclampsia and pre-term delivery rates were 7.1%, 14.3%, 2.4% and 23.1%, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes. Antiphospholipid antibodies, renal involvement and lupus activation did not have any significant influence on poor obstetric outcome. Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.

Characteristics and outcome of 102 fetuses with fetal cerebral ventriculomegaly: Experience of a university hospital in Turkey

The aim of this study was to evaluate the incidence of associated structural anomalies and the outcome of fetuses with ventriculomegaly. We retrospectively collected 102 cases of antenatally diagnosed ventriculomegaly examined between 2000 and 2008. Ventricular width measurements were 10–12 mm, 12.1–14.9 mm and ≥ 15 mm in 24.5%, 20.6% and 54.9% of the cases, respectively. Associated structural malformations were detected in 77.4% of the fetuses. Mortality rate of fetuses with associated malformations and isolated ventriculomegaly was 86.1% and 55.7%, respectively (p < 0.001). The mortality rate was significantly lower in mild (10–12 mm) than in moderate (12.1–14.9 mm) and severe (≥ 15 mm) cases (p < 0.05). All of the fetuses with mild isolated ventriculomegaly were alive at >12 months of age, without morbidity. Our results suggest that the prognosis of fetuses with ventriculomegaly mainly depends on the aetiology and on the presence of associated abnormalities. Fetuses with mild isolated ventriculomegaly have a favourable outcome.

Maternal serum autotaxin levels in early- and late-onset preeclampsia

ABSTRACT Purpose: We aimed to compare the serum autotaxin levels in early- and late- preeclamptic and healthy pregnant patients at a university hospital. Methods: A total of 55 singleton preeclamptic women who delivered at Cerrahpasa Medical Faculty were included in the study. The patients were subdivided into two groups: early-onset preeclampsia (n = 31) and late-onset preeclampsia (n = 24). Demographic and clinical data were compared between early-onset and late-onset preeclamptic patients. The control group was composed of 32 healthy pregnant patients. Results: The mean autotaxin levels were 1.16 ± 0.97 and 0.7 ± 0.35 ng/ml in the early- and late-onset preeclampsia groups, respectively. Autotaxin levels were significantly higher in early-onset preeclampsia group compared with late-onset preeclampsia group. Autotaxin levels were found to be significantly higher in preeclamptic patients compared with control group. Serum autotaxin levels showed a significant positive correlation with maternal systolic, diastolic blood pressures and uric acid levels. Conclusion: Autotaxin might be a promising marker for detecting early-onset preeclampsia. However, further studies are necessary to confirm this hypothesis.

Risk factors for recurrence of borderline ovarian tumours: A tertiary centre experience.

abstract The aim of this study was to evaluate the risk factors for recurrence of borderline ovarian tumours. This study investigated 127 women who were finally diagnosed with borderline epithelial ovarian tumours. Most of them were diagnosed in stage I (83.4%). With a median follow-up of 81.8 months (range: 14–205), the median time to recurrence was 22.4 months (range: 3–74). Five-year recurrence-free survival (RFS) and overall survival (OS) rates were 85.8% and 97.6%, respectively. In multivariate analysis, invasive implants and fertility-sparing surgery were found to be independent prognostic factors for 5-year RFS. Overall, 20 patients (15.7%) experienced relapse within the observation period. Although there is no consensus about high-risk category of borderline ovarian tumours, invasive implants and conservative surgery were closely related to the recurrence. Patients presenting these risk factors should undergo closer follow-up.

Usefulness of Serum Procalcitonin Levels in Predicting Tubo-Ovarian Abscess in Patients with Acute Pelvic Inflammatory Disease

We aimed to investigate the clinical importance of serum procalcitonin (PCT) levels in the diagnosis of tubo-ovarian abscess (TOA). Patients diagnosed with pelvic inflammatory disease (PID; n = 36) and patients diagnosed with TOA (n = 42) were included in the study. Sociodemographic characteristics, laboratory and clinical parameters were compared between the 2 groups. Mean PCT level was higher in the TOA group (p = 0.004). Mean length of stay in hospital was longer in patients with TOA (p < 0.001). White blood cell count, neutrophil count, percentage of neutrophils and C-reactive protein levels were higher than normal limits in all patients; however, no differences in these parameters were observed between the groups. A cutoff level of 0.330 ng/ml for PCT revealed 62% sensitivity and 75% specificity in predicting TOA. Serum PCT is a promising inexpensive marker for the diagnosis of TOA in PID patients.

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.

Are complicated monochorionic twins more susceptible to indomethacin-induced fetal ductal constriction? Two cases of laser surgery for Twin-Twin Transfusion syndrome

Indomethacin is a commonly used medication against preterm delivery. Several reports of fetal ductal constriction have been described after indomethacin use in the literature; however, there are no previously documented reports describing an association between Twin-Twin Transfusion syndrome and a constrictor effect of indomethacin on the ductus arteriosus. Two patients were referred to our department for Twin-Twin Transfusion syndrome and each underwent placental laser surgery. Constriction of the ductus arteriosus occurred as early as 20 and 24 weeks’ gestation following maternal use of indomethacin after laser surgery. Spontaneous amelioration was observed after discontinuation of the drug. The constrictor effect of indomethacin on the ductus arteriosus can be observed even after a single dose and as early as 20 weeks of gestation in complicated monochorionic twin pregnancies. We emphasize meticulous use of indomethacin in complicated monochorionic twin pregnancies because the constrictive effect seems to be independent of gestational age.

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.

Serum procalcitonin levels in incisional surgical site infections requiring a secondary suture after cesarean sections

Abstract Purpose: Surgical site infections (SSIs) after cesarean section cause maternal morbidity and economic and emotional burdens on society. Our aim is to measure procalcitonin (PCT) levels in patients who developed incisional SSIs after cesarean section while also comparing PCT concentrations between patients who underwent a secondary suture and who did not require a secondary suture. Methods: Ninety-four patients who developed incisional SSI after cesarean section were enrolled in our study. At the time of admission, serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured. The study population was grouped into two, based on the need of a secondary suture and the patients baseline blood tests were compared. Results: The mean serum CRP level was not significant among the groups; however, the median serum PCT level was significantly higher in patients who required a secondary suture (0.21 vs. 0.05 ng/ml, p ≤ .0001). Serum PCT levels were positively correlated with the length of hospital stay (r = 0.72, p = .0001). Area under the curve (AUC) for PCT in predicting the need of a secondary suture was 0.85 (95% CI: 0.772–0.922) and the cutoff point was 0.142 ng/ml with a sensitivity of 75% and specificity of 97.8% (p = .0001). Conclusion: Serum PCT is a promising marker for both diagnosing and predicting the severity of SSIs after cesarean sections.