Mehmet Çınar

Evaluation of maternal and perinatal outcomes among overweight women who experienced stillbirth

Abstract Objective: To investigate associations between overweight and adverse clinical outcomes among women who experienced stillbirth. Methods: 234 pregnant women (stillbirth group, n = 115; live birth group, n = 119) were included in this retrospective case-control study. Recorded risk factors were age, gravidity, parity, gestational weeks, fetal birth weight, gestational diabetes mellitus (GDM), preeclampsia (PE), intrauterine growth restriction (IUGR), levels of prenatal test markers (alpha-fetoprotein (AFP), pregnancy-associated plasma protein, human chorionic gonadotropin (β-hCG) and E3) and body mass index (BMI). Results: Statistically significant differences were observed between the groups in terms of birth weight, IUGR, GDM, PE, AFP level, β-hCG level, maternal E3 level and BMI (p < 0.05). Subgroup analyses revealed that 34 and 81 patients in the stillbirth group were of normal weight and overweight, respectively, fetal birth weight, IUGR, GDM, PE, AFP level, β-hCG level and E3 level differed significantly between these subgroups and the live birth group (p < 0.05). Conclusions: Women who experience stillbirth tend to be more overweight than those who experience live birth. Additionally, IUGR, GDM and PE are more common among overweight women. Therefore, overweight women should be encouraged to lose weight before pregnancy. If they become pregnant without losing weight, they should be followed up closely to avoid adverse perinatal outcomes.

Association of clinical outcomes and complications with obesity in patients who have undergone abdominal myomectomy

Background This study aimed to evaluate the association between complications and clinical parameters with obesity in 273 women who have undergone abdominal myomectomy during the study period. Methods The patients were classified into two groups according to body mass index (BMI) (≤30 kg/m2 and >30 kg/m2). Demographic, preoperative and postoperative clinical parameters were evaluated. Results Demographic, preoperative and postoperative clinical parameters were evaluated. The results showed statistically significant differences between the obese and non‐obese groups in terms of age, gravidity, diameter of fibroid (DOF), postoperative hemoglobin, duration of hospital stay, and complications. Patients in the obese group had greater DOF and complications such as hemorrhage, postoperative fever, wound infection and ileus (p < 0.05). Conclusion Based on our results, we conclude that obesity adversely affects the clinical outcomes of patients who undergo abdominal myomectomy.

Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score ≤ 5

Background We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score ≤ 5. Methods This was a prospective case–control study, which included 104 consecutive women with a Bishop score ≤ 5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score ≤ 5 underwent induction of labor with a vaginal insert containing 10‐mg timed‐release dinoprostone (prostaglandin E2; Group A, n = 40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index ≥ 5 cm) and Bishop score ≤ 5, and was matched for patients age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. Results The mean time interval from induction to delivery was not different between the two groups (p = 0.849), but there was a statistically significant difference between the groups in terms of the CS rate (p = 0.005). There were no differences between the groups in neonatal outcome or perinatal morbidity or mortality. Conclusion Dinoprostone appears to be a safe alternative for induction of labor in pregnancies with oligohydramnios. Induction of labor with dinoprostone in term pregnancies with isolated oligohydramnios is associated with increased rate of CS but there is no higher risk of perinatal complications.

Increased oxidative stress markers may be a promising indicator of risk for primary ovarian insufficiency: a cross-sectional case control study

PURPOSE The aim of this study was to evaluate serum levels of inducible nitric oxide synthase (INOS), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidative status (TOS) in women with primary ovarian insufficiency (POI) and to compare them with healthy fertile women. We also examined the possible risk factors associated with POI. METHODS This cross-sectional case control study was conducted in Zekai Tahir Burak Womens Health Education and Research Hospital. The study population consisted of 44 women with POI (study group) and 36 healthy fertile women (control group). In all patients, serum levels of INOS, MPO, TAS, and TOS were determined. INOS and MPO levels were measured by enzyme-linked immunosorbent assay whereas colorimetric method was used for evaluating TAS and TOS levels. Age, body mass index (BMI), obstetric history, smoking status, family history, comorbidities, sonographic findings, complete blood count values, C-reactive protein and baseline hormone levels were also analyzed. Students t-test or Mann-Whitney U test was used to compare continuous variables between the groups; categorical data were evaluated by using Pearson χ2 or Fisher exact test, when appropriate. Binary logistic regression method was used to identify risk factors for POI. RESULTS We found significantly elevated levels of INOS (234.1±749.5 versus133.8±143.0; p=0.005), MPO (3,438.7±1,228.6 versus 2,481.9±1,230.1; p=0.001), and TOS (4.3±1.4 versus 3.6±1.4; p=0.02) in the sera of the study group when compared to the BMI-age matched control group. However, difference in serum levels of TAS were not significant between the 2 groups (1.7±0.2 versus 1.6±0.2; p=0.15). Logistic regression method demonstrated that BMI <25 kg/m2, nulliparity, family history of POI, smoking, and elevated serum levels of INOS, MPO, and TOS were independent risk factors for POI. CONCLUSION We found an increase in INOS, MPO, and TOS in women with POI. These serum markers may be promising in early diagnosis of POI. Further large-scale studies are required to determine whether oxidative stress markers have a role in diagnosing POI.

Does intrauterine insemination timing matter for achieving pregnancy during ovulation induction using gonadotropins? A retrospective cohort study

Background Intrauterine insemination (IUI) is a commonly used procedure to increase the infertile couples’ chance of pregnancy. Single or double insemination and different timing choices are modifications of this intervention. The aim of this study was to elucidate the effect of the IUI procedure on clinical pregnancy rates when performed at 24 hours or 36 hours after ovulation triggered by human chorionic gonadotropin (hCG) following ovulation induction with gonadotropins. Methods One hundred and thirteen women diagnosed with polycystic ovarian syndrome (PCOS) (as per Rotterdams criteria) or unexplained infertility, who were treated using gonadotropins for ovulation induction and IUI for increasing fertilization potential, were recruited from the medical records of the infertility clinic. Demographic features, cycle outcomes, and clinical pregnancy rates of the patients were compared based on two different timing strategies of IUI (24 hours and 36 hours) following ovulation trigger using hCG. Results Clinical pregnancy rates per cycle were 22.9% in the PCOS group and 26.9% in the unexplained group. The clinical pregnancy rates according to the timing of IUI were found to be similar for PCOS patients, unlike patients with unexplained infertility whose clinical pregnancy rates were significantly better when the IUI procedure was performed 24 hours following the hCG trigger. The cycle day of hCG trigger was also found to be significantly related to clinical pregnancy rate as utilizing a later hCG trigger day appeared to positively affect the odds of clinical pregnancy establishment. Conclusion IUI performed at either 24 hours or 36 hours after ovulation triggered by hCG injection does not change clinical pregnancy rates for PCOS patients. Patients with unexplained infertility seem to benefit from earlier IUI procedures, which increases their fertility potential during ovulation induction with gonadotropins. Avoiding earlier than physiologically needed artificial‐hCG triggering before IUI procedures results with better pregnancy rates.

Association between adverse perinatal outcomes and amino acid levels measured with nutrient questionnaire in adolescent pregnancies

Background To evaluate the maternal serum amino acid levels in first trimester adolescent pregnancies by using a new developed dietary questionnaire. Methods A group of 169 pregnant women in the first trimester of their pregnancy were asked to complete the dietary questionnaire. Among all the women, 39 were adolescent pregnancies. The results of the questionnaire were evaluated by a nutrient database program (BeBiS software program) designed to evaluate Turkish traditional foods and commercial processed foods. Results There was no statistically significant difference between the groups in terms of body mass index and educational and socio‐economic status. The mean age and gravidity was statistically significantly lower in adolescent pregnancies. The mean isoleucine, leucine, lysine, methionine, phenylalanine, tyrosine, threonine, valine, arginine, and proline levels were statistically significantly lower in adolescent pregnancies. Receiver operating characteristic (ROC) curve analysis showed the cut‐off values of these amino acids. Of these amino acids; lower values of histidine, serine, and alanine were associated with lower birth weight, and lower values of histidine and alanine were associated with preterm delivery. Conclusion To the best of our knowledge, this is the first study evaluating the amino acid levels in adolescent pregnancies. According to this study, some amino acid levels were lower in adolescent pregnancies and associated with adverse perinatal outcomes. Further studies with maternal and perinatal outcomes are needed to demonstrate the effects of these amino acids in such pregnancies.

The effect of a pre-procedure information video on anxiety levels in patients undergoing hysterosalpingography: A prospective case-control study

Objective: To evaluate the effect of a pre-procedural information video on anxiety levels in patients undergoing hysterosalpingography (HSG). Material and Methods: Among a total of 131 primary or secondary infertile patients, 66 were shown an information video and 67 control patients received standard care between August 2014 and January 2016. The video included information on the procedure, personnel, and the room for the procedure; the video was shown on the morning of the procedure. Patients were randomized using the complete randomization technique through which patients were included in the study and control groups week by week, randomly. The Beck Anxiety Inventory scale was conducted to the patients one hour before the procedure Results: There were no differences in demographic data. The history of previous gynecologic operations was higher in the control group. The Beck Anxiety score was significantly lower in the study group compared with the control group (6 vs 10). Conclusion: Our findings suggest that as an easy intervention to implement, a pre-procedural video education may be a beneficial tool for the management of HSG-related anxiety.

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey

Background: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). Methods: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. Results: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. Conclusion: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.

Maternal second trimester blood levels of selected heavy metals in pregnancies complicated with neural tube defects

Abstract Purpose: Neural tube defects (NTDs) are the most common malformations of the central nervous system (CNS). There is continuing research for the identification of risk factors and interventions for prevention of NTDs. The aim of this study was to investigate the maternal second trimester blood levels of selected heavy metals namely, arsenic (As), cadmium (Cd), mercury (Hg), manganese (Mn), nickel (Ni), and lead (Pb) and their possible relation with the occurrence of NTDs. Methods: Twenty-one healthy second trimester pregnant women with fetuses affected with NTD (cases) were matched with 21 healthy pregnant women with unaffected fetuses (controls) with respect to age, body mass index (BMI), and gestational age. Maternal blood levels of heavy metals were measured after an overnight fasting period. Results: No significant differences were observed in terms of maternal blood levels of As, Cd, Hg, and Ni between NTD-affected and unaffected pregnancies. The blood Pb and Mn levels were found to be higher in pregnant women with a fetus affected with NTD when compared with pregnant women with unaffected fetuses (for Pb, in cases 12.3 ± 5.5 µg/L, in controls 7.8 ± 2.4 µg/L; for Mn in cases 3.6 ± 1.4 µg/L, in controls 2.4 ± 1.0 µg/L, p < .05). Conclusions: High maternal second trimester blood levels of Pb and Mn during pregnancy are associated with NTDs in the newborn.

Maternal serum advanced glycation end products level as an early marker for predicting preterm labor/PPROM: a prospective preliminary study

Abstract Objective: To evaluate the value of maternal serum advanced glycation end products (AGEs) level at 11–13 weeks’ gestation for the prediction of preterm labor and or preterm premature rupture of membranes (PPROM). Materials and methods: This prospective cross-sectional study is performed in a university-affiliated hospital between February and April 2016. The participants of this study are low-risk pregnant women. Blood samples for maternal AGEs level were collected in the first trimester of pregnancy and all women completed their antenatal follow-up and delivered in our center. During the follow-up 21 women developed preterm labor/PPROM. The first trimester maternal AGEs levels of preterm labor/PPROM cases were compared with uncomplicated cases (n = 25) matched for age-parity and BMI. The predictive value of AGEs levels for preterm labor/PPROM was also assessed. Results: First-trimester AGEs levels were significantly higher in cases complicated with preterm labor/PPROM (1832 (415–6682) versus 1276 (466–6445) ng/L, p = .001 and 1722 (804–6682) versus 1343 (466–6445) ng/L, p = .025). According to receiver-operating characteristic curve analysis, the calculated cut off value of AGEs was 1538 ng/L with the sensitivity 91.7%, specificity 73.8%; and the negative and positive predictive values were 91.6% and 29.5%, respectively. Conclusions: For the prediction of preterm labor/PPROM, the relatively high AGEs levels in the first trimester might be a useful marker.