M. Arslan

Treatment of viable cesarean scar ectopic pregnancy with suction curettage

Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy.

Endothelin 1 and leptin in the pathophysiology of intrauterine growth restriction

Objectives: To evaluate the relationship of endothelin 1 (ET‐1) and leptin concentrations in women and newborns following a pregnancy complicated with intrauterine growth restriction (IUGR). Methods: Twenty‐five women with a pregnancy complicated with IUGR at 19 different gestational ages were matched with women with uncomplicated pregnancies. Blood samples from the umbilical artery and maternal peripheral venous circulation were collected at delivery, and ET‐1 and leptin levels were determined from the blood samples. Data relating to obstetric complications (e.g., pregnancy‐induced hypertension), delivery (e.g. mode, birth weight, signs of intrapartum fetal distress, and Apgar scores) were also recorded. Results: Mean maternal ET‐1 (13.4±6.2–9.9±2.9 pmol/l) and mean fetal ET‐1 (14.5±4.2–11.7±3.1 pmol/l) concentrations were significantly higher when women had experienced pregnancies complicated with IUGR than when they had had normal pregnancies. Mean fetal leptin concentration was significantly lower in the study group (6.8±2.2 ng/ml) than in the control group (10.6±3.6 ng/ml (P<0.05). However, fetal leptin per kilogram of fetal weight was not significantly different in the study group (3.16±1.18 ng/ml) than in the control group (3.23±0.96 ng/ml) (P>0.05, paired t‐test). However, a statistically significant correlation was observed between fetal leptin concentrations per kilogram of fetal weight and fetal endothelin concentrations in pregnancies complicated with IUGR (r=0.546; P<0.05). Conclusions: These results suggest the intertwined roles of ET‐1 and leptin in the pathophysiology of IUGR. Further studies concerning interaction between these peptides in different pregnancy conditions may provide important information about the actions of ET‐1 and leptin on fetal growth.

The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin, hemoglobin and ferritin levels in mothers and newborns.

Objective: Maternal and fetal serum erythropoietin levels were correlated with hemoglobin, mean corpuscular volume and serum ferritin in a group of anemic pregnant women to evaluate the effect of maternal anemia on fetal erythropoiesis. Methods: Serum erythropoietin, ferritin, hemoglobin and mean corpuscular volume were investigated in 33 pregnant women with anemia, 11 women with normal hematological parameters and in their newborns. Results: Maternal serum erythropoietin concentration (mean ± SEM) was significantly higher in the anemic group (145.2 ± 42.9 mU/ml) as compared to the control group (37.3 ± 7.6 mU/ml) (p < 0.05). In newborns, all parameters were comparable in both groups except cord serum erythropoietin concentration (mean ± SEM) which was significantly higher in newborns born to anemic women (43.9 ± 5.3 mU/ml) than controls (29.4 ± 3.7 mU/ml) (p < 0.05). In the anemic group, maternal serum erythropoietin was inversely correlated to maternal hemoglobin (r = -0.375, p = 0.03), maternal hemoglobin was inversely correlated to cord serum erythropoietin (r = -0.552, p = 0.001) and maternal ferritin was correlated to fetal ferritin (r = 0.521, p = 0.002). Conclusion: Although cord hemoglobin and mean corpuscular volume were not affected by maternal anemia, increased cord serum erythropoietin levels related to low maternal hemoglobin levels suggest an induced fetal erythropoiesis in maternal anemia.

Maternal and fetal plasma endothelin levels in intrauterine growth restriction: relation to umbilical artery Doppler flow velocimetry.

Abstract The objective of this study was to examine maternal and fetal endothelin-1 (ET-1) in pregnancies complicated with intrauterine growth restriction (IUGR) and to correlate these data with umbilical artery Doppler flow velocity waveforms (FVW). Higher mean maternal (13.8±6,4 vs 9.2±3,4 pmol/L, p < 0.05 ) and fetal (18.5±9.6 vs 11.7±6.9 pmol/L, p < 0.05) ET-1 levels were found in pregnancies complicated with IUGR than in controls. Fetal ET-1 level was related to birth weight percentile for gestational week. Maternal and fetal ET-1 concentrations were not related to umbilical artery Doppler flow S/D ratio, PI and RI. Maternal or fetal ET- 1 concentrations were also not related to umbilical artery pH, PO2 and PCO2. Pregnancy-induced hypertenXsion was significantly associated with an elevated fetal and maternal ET-1 concentration. In conclusion, increased production and secretion of ET-1 may play a role in the pathophysiology of idiopathic IUGR. Over-production of ET-1 in IUGR is not associated with increased placental resistance as reflected in abnormal umbilical artery Doppler FVW.

Transvaginal color Doppler ultrasonography for prediction of pre-cancerous endometrial lesions

Objective: To determine whether measurements of blood flow in endometrial and uterine vessels by transvaginal color Doppler ultrasonography was valuable in the diagnosis of a neoplastic endometrial pathology (hyperplasia and carcinoma) in women with abnormal bleeding. Methods: This is a prospective study and included 105 post‐menopausal women and 33 pre‐menopausal women with abnormal uterine bleeding. All subjects underwent transvaginal color Doppler ultrasonography. We investigated whether obtained results were correlated with histopathological findings. Results: There was no significant difference in the mean±S.D. RI of the left and the right uterine arteries, intramyometrial arteries and endometrial arteries between patients with neoplastic and non‐neoplastic endometrium on histopathological examination. Dopplers velocity waveforms of small endometrial blood vessels could be detected in 9% of the women with non‐neoplastic endometrium and in 42% of the women with neoplastic endometrium (P<0.05). The mean±S.D. of the endometrial thickness was significantly higher in the women with neoplastic endometrium than that of the women with non‐neoplastic endometrium (16.6±6.1 mm vs. 9.5±4.7 mm, P<0.05). Conclusion: Dopplers velocity waveforms of uterine vessels coupled with transvaginal ultrasonography are not valuable enough to replace histopathological examination in the diagnosis of a neoplastic endometrial pathology. However, it may be helpful in cases in which invasive techniques are difficult to perform and in the differentiation of a certain group of patients at little risk of endometrial carcinoma.

Thyroid function in hyperemesis gravidarum and correlation with serum leptin levels

The association of hyperthyroidism with hyperemesis in non-molar pregnancies is traditionally called ‘transient hyperthyroidism of hyperemesis gravidarum’ (THHG) and it has been found that biochemical hyperthyroidism was associated with hyperemesis gravidarum in most patients. The etiology of transient hyperthyroidism of hyperemesis gravidarum is unclear. Some have argued that the hyperthyroidism is the cause of the hyperemesis whereas others have argued the reverse. There are also some reports which have demonstrated that serum leptin concentrations were increased in patients with hyperthyroidism. In this study we aimed to investigate the role of leptin which has an important regulating effect on balance of energy and eating habits in the etiology of hyperemesis gravidarum and to reveal the correlation between leptin and thyroid hormones. (excerpt)

Incidental tubo-ovarian abscess at abdominal delivery: a case report

Tubo-ovarian abscess in the third trimester of pregnancy is extremely rare. In this report, an unusual case with asymptomatic tubo-ovarian abscess, diagnosed incidentally during Cesarean section performed for an obstetric indication, is presented. Unlike other reported cases, no signs or symptoms attributable to pelvic abscess throughout the pregnancy were observed in our patient. To our knowledge, this is the first report of such a case in the literature.