Mehmet Özeren

Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia

OBJECTIVE To compare changes in Doppler ultrasound studies of fetal circulation in normal pregnancies with those of a group of preeclamptic patients both with and without intrauterine growth retardation and to demonstrate the best index for predicting adverse perinatal outcome or IUGR. STUDY DESIGN A cross-sectional study was performed on 125 normal pregnancies and 62 preeclamptic patients at 31-40 weeks of gestation. The umbilical artery systolic-diastolic ratio (UA S/D), UA pulsatility index (PI), the middle cerebral artery (MCA) PI, and the ratio of MCA PI to UA PI were measured. The mean values of the Doppler indices were compared. Different cut-off values (mean +/-2 S.D.) were used for the 31st-35th and the 36th-40th weeks. RESULTS Significant differences were found between normal pregnancies and preeclamptic patients without IUGR using the mean MCA PI and the MCA PI/UA PI ratio. In the preeclamptic patients with IUGR, all the mean Doppler indices were different from those of the normal pregnancies. In the preeclamptic patients with IUGR the values were different from the preeclamptic patients without IUGR, except for the MCA PI at 31-35 weeks. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The MCA PI/UA PI ratio showed the highest predictive value in determining IUGR by a sensitivity of 84% and a diagnostic accuracy of 87%. CONCLUSION Both abnormal umbilical Doppler indices and cerebral-umbilical ratio are strong predictors of IUGR and of adverse perinatal outcome in preeclampsia. The MCA PI alone is not a reliable indicator. The combination of umbilical and fetal cerebral Doppler indices may increase the utility of Doppler ultrasound in preeclamptic subjects.

Coagulation inhibitors in preeclamptic pregnant women.

ObjectiveOur objective was to detect clinical evaluation of coagulation inhibitors in preeclamptic and normotensive pregnant women and to determine their important role in pathogenesis of preeclampsia.MethodsA total of 20 mild, 20 severe preeclamptic and 45 normotensive pregnant women were included in this study. The plasma value of antithrombin III (AT-III) activity, proteins C and S activity, PT, PTT, fibrinogen and platelet counts were determined.ResultsThe values AT-III were lower in women with severe preeclampsia than in controls (p<0.05). In all groups, there was no significantly difference in the concentration of protein C activity, protein S and fibrinogen (p>0.05). The plasma thrombocyte counts were significantly lower in severe preeclamptic women than in normotensive women (p<0.05). There was no significant difference in the prothrombin time value in all groups, but a significantly difference with regard to partial thromboplastin time between severe preeclamptic and the control group (p<0.0001). It was longer than the control.ConclusionThe markers of hemostasis activation such as protein S, protein C activity together with fibrinogen levels are not useful tools but the reduction of AT-III and platelet counts would seem useful in different pathological situations in pregnancy to predict and monitor the severity of the condition.

Effect of single-dose methotrexate on ovarian reserve in women with ectopic pregnancy

OBJECTIVE To evaluate ovarian reserve in women with ectopic pregnancy treated with single-dose systemic methotrexate in the early post-treatment period. DESIGN Prospective study. SETTING Womens health education and research hospital. PATIENT (S) Eighty-two patients with ectopic pregnancy and 80 healthy women in the same age group were included in the study. Of the 82 patients, 49 with ectopic pregnancy were treated with single-dose systemic methotrexate (MTX) and 33 were treated surgically with laparoscopy or laparotomy (salpingectomy or salpingostomy). INTERVENTION(S) Ovarian reserve testing. MAIN OUTCOME MEASURE(S) Basal FSH on the 3rd day of the menstrual cycle, E₂, basal antral follicle count (AFC), and ovarian volume. RESULT(S) There were no differences among the groups in terms of basal FSH, E₂, AFC, and ovarian volume. CONCLUSION(S) The single-dose MTX treatment had no effect on ovarian reserve in women with ectopic pregnancy as measured by the above-mentioned parameters.

Methotrexate and misoprostol used alone or in combination for early abortion

The purpose of this study was to compare the outcome and side effects of using the drugs methotrexate and misoprostol, alone or in combination, to induce abortion. A total of 108 subjects who had requested elective termination of pregnancy and medical abortion at 9 weeks gestation or less were randomized into three groups. The first group received 50 mg/m2 intramuscular (i.m.) methotrexate on day 1 and, if the hCG level had risen by > 50% of the initial level on day 4, a second dose was given. They were then followed-up at weekly intervals up to day 21. Group 2 received 800 micrograms vaginal misoprostol on day 1 and, if ultrasound showed a gestational sac on day 4, they received a repeat dose and were re-examined on day 7. Group 3 received 50 mg/m2 methotrexate intramuscularly followed 3 days later by 800 micrograms vaginal misoprostol and were re-examined on day 7. Complete abortion occurred in 25 (69%) of the 36 subjects in group 1, 21 (58%) of the 36 subjects in group 2, and 32 (89%) of the 36 subjects in group 3. The complete abortion rate in group 3 was significantly higher than that of both group 1 and group 2 (p < 0.05). The incomplete abortion rate was significantly higher in group 2 as compared with both of the other groups (p < 0.05). There were significant differences between the mean gestational age of the successful abortions and the failures in group 1 (no abortion occurred at more than 49 days gestation), but not in groups 2 or 3. Vaginal bleeding in subjects who successfully aborted began within 16 +/- 4 days in group 1 after the first dose, and within 24 h in 18 (86%) of the 21 subjects in group 2 and 27 (84%) of the 32 subjects in group 3 after the misoprostol dose. The drugs caused no serious or prolonged side effects. The combination of methotrexate and misoprostol is a more effective abortifacient regimen than when either drug is used alone.

Perinatal outcomes in pregnancies with oligohydramnios after preterm premature rupture of membranes

Abstract Objective: Our purpose was to determine whether singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) and oligohydramnios are at an increased risk of having maternal and neonatal morbidity. Methods: We performed a retrospective analysis of 389 women with PPROM between 24 and 34 weeks of gestation in a single tertiary center during 2008–2014. Patients were divided into two groups on the basis of amniotic fluid index (AFI) < 5 cm (n = 188) or AFI ≥ 5 cm (n = 201). Perinatal outcomes were compared according to amniotic fluid volume. The Students t-test and Mann–Whitney U test were used to compare variables with normal and abnormal distribution, respectively. Categorical variables were examined by the chi-square test. Results: Patients with an AFI < 5 cm demonstrated a significantly shorter latency to delivery (p < 0.001), a higher rate of clinical chorioamnionitis (p = 0.029) and emergency cesarean delivery (p = 0.043) and a lower neonatal Apgar score at first minute (p = 0.004). Conclusion: Initial oligohydramnios after PPROM is associated with shorter latency to delivery, higher rate of clinical chorioamnionitis, higher rate of emergency cesarean delivery, and lower 1-min Apgar score.

Chromosome abnormality incidence in fetuses with cerebral ventriculomegaly

Abstract Ventriculomegaly (VM) is a marker of aneuploidy and warrants a detailed examination of fetal anatomy. Chromosomal abnormalities worsen the fetal and neonatal prognosis significantly and karyotyping of fetuses is critically important when accompanying anomalies are detected. Here, we report the genetic results of 140 fetuses with isolated and non-isolated VM detected during a second trimester ultrasound examination followed by invasive in utero diagnostic procedures for karyotyping. VM was diagnosed in seven (5%) fetuses with abnormal karyotype and the chromosomal abnormality incidence was higher in severe VM (6.8%) than mild (4.2%). Higher chromosomal abnormality rates were detected when VM was isolated (8.6%), rather than associated with any anomaly (3.8%). These results suggest that karyotype analysis should be offered to all patients with any degree of VM, regardless of its association with structural anomalies.

Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer.

OBJECTIVE The aim of this study is to investigate the influence of pregnancy on prognosis of thyroid cancer. METHODS A total of 72 patients aged between 15-45 years who underwent total or subtotal thyroidectomy and subsequently radioablation were followed up under suppression. Individuals who had term pregnancies after diagnosis of cancer (group 1, n: 36) and who were non-pregnant (group 2, n:36) were included in the study. Both groups were compared in terms of scintigraphic relapse and metastasis, ultrasonographic relapse, stage change of lympadenopathy at the beginning and at the end of the study. RESULTS Relapse was detected in 4 out of 36 pregnant patients (11.1%) and in 5 out of 36 non-pregnant patients (13.9%) with no significant difference between groups (p=1.00). Pathologic lymphadenopathy was detected in 2 out of 36 pregnant patients (5.6%) and in 2 out of 36 non-pregnant patients (5.6%) (p=1.00), and metastasis in 3 (8.3%) and in 1 (2.8%), respectively (p=0.61). While stage change was detected in only one pregnant patient (2.8%), and none of the non-pregnant again there was no significant difference (p=1.00). CONCLUSIONS We conclude that pregnancy does not have an influence on prognosis of thyroid cancer.

FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health

The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health considers the ethical aspects of issues that impact the discipline of Obstetrics, Gynecology and Women’s Health. The following documents represent the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership. Definition of Pregnancy

Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes

The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes.

Primary retroperitoneal liposarcoma.

A retroperitoneal liposarcoma that marginally involved the right kidney and ovary was presented clinically as an adnexial mass in a 61-year-old woman. At laparatomy a large retroperitoneal mass in addition to the right kidney and ovary was removed totally. A well-differentiated retroperitoneal liposarcoma was detected in histological speciment. Adjuvant irradiation was given. The 5-year survival rate of retroperitoneal liposarcoma is low. Curative resection remains the main treatment for primary and recurrent liposarcomas.