Melih A. Guven

Association of Maternal Serum CRP, IL-6, TNF-α, Homocysteine, Folic Acid and Vitamin B12 Levels with the Severity of Preeclampsia and Fetal Birth Weight

Objective: To assess the levels and clinical significance of high sensitive(hs)-CRP (C‐reactive protein), IL-6(interleukin-6), TNF-α(tumor necrosis factor-α), homocysteine, folic acid and vitamin B12 in normotensive healthy pregnant women, mild and severe preeclamptic patients, and to evaluate the correlations between these markers and the severity of preeclampsia and fetal birth weight. Study design: Using a cross-sectional study design, hs-CRP, IL-6, TNF-α, homocysteine and vitamin B12 were measured in the third trimester of pregnancy from normotensive healthy women with uncomplicated pregnancies (n = 62), mild (n = 61) and severe (n = 60) preeclamptic patients. Results: There were statistically significant differences between three groups for hs-CRP (p = 0.012), TNF- α (p = 0.046), IL-6 (p = 0.015), homocysteine (p < 0.001) and fetal birth weight (p < 0.001). Fetal birth weights in mild (2477 ± 746) and severe (2435 ± 768) preeclamptic patients were significantly lower than controls (3485 ± 365) (p < 0.001). No significant difference was found between the three groups for folic acid (p = 0.066) and vitamin B12 (p = 0.286). Bonferroni adjusted multiple comparison test showed that the statistical differences with respect to TNF-α, IL-6 and homocysteine were mainly created by control and severe preeclampsia groups. Hs-CRP levels still remained higher in severe preeclampsia patients than mild preeclampsia and normotensive patients except for overweight patients in the previous two groups after Bonferroni post hoc adjustment test. Conclusion: Elevated maternal serum levels of hs-CRP, TNF- α, IL-6 and homocysteine in preeclamptic women correlate with fetal birth weight in the early third trimester.

The longitudinal variation in uterine artery blood flow pattern in relation to birth weight.

OBJECTIVE: To investigate the relationship between the timing of disappearance of high-resistance uterine artery waveforms between the first and second trimester of pregnancy and birth weight. METHODS: Uterine artery Doppler recordings were obtained in a cohort of singleton pregnancies at 11–14 weeks of gestation and subsequently at 18–23 weeks. At each examination, the presence or absence of an early diastolic notch was recorded for each side. An abnormal pattern of blood flow was defined as the presence of bilateral notches. Cases complicated by preeclampsia or preterm delivery were excluded. RESULTS: Four hundred eleven pregnancies showed absent or unilateral uterine artery notches at the 11–14–week scan (group 1). All these cases maintained a low-resistance uterine blood flow pattern at the second-trimester scan. Of the 251 pregnancies with bilateral notches at the 11–14–week scan, 222 subsequently displayed a low-resistance blood flow at 18–23 weeks (group 2) whereas only 29 maintained bilateral notches (group 3). The mean birth weight was higher in group 1 (3,452 g) than in groups 2 (3,310 g) and 3 (3,224 g). This difference was confirmed after adjusting for confounding variables. Small-for-gestational-age fetuses were more common in groups 2 (14.9%) and 3 (14%) compared with group 1 (6.8%, P < .001). During the study period, severe preterm preeclampsia was observed in 6 cases only. CONCLUSION: The longitudinal variation in uterine artery blood flow pattern has a statistically significant correlation with birth weight, likely reflecting the timing and degree of trophoblastic invasion of the maternal vessels. LEVEL OF EVIDENCE: II-2

Association of maternal serum high sensitive C‐reactive protein level with body mass index and severity of pre‐eclampsia at third trimester

Aim:  To assess a maternal serum level of high sensitive C‐reactive protein (hs‐CRP) as a useful clinical parameter in prediction of pre‐eclampsia severity and, to evaluate the correlation between hs‐CRP and body mass index (BMI).

Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: Which test is useful during early pregnancy?

OBJECTIVE To investigate the relationship between Helicobacter pylori infection and hyperemesis gravidarum (HG) during early pregnancy by using serologic and stool antigen tests in developing South Anatolia region of Turkey. MATERIALS AND METHODS A prospective cross-sectional study was performed on 40 pregnant women with HG and 40 asymptomatic controls without gastric problems at 7-12 weeks of gestation. The sociodemographic characteristics were recorded. The presence of H pylori was analyzed in the sera of the study-group patients by serology-specific IgG test in serum and by a stool antigen test in fecal samples. RESULTS The rates of serology-specific H pylori IgG positivity were 80% (32 of 40) in patients with HG and 35% (14 of 40) in control group. The difference between the two groups was significant [odds ratio: 6.9 (confidence interval: 2.2-22.1); p<0.01]. The rates of H pylori stool antigen test positivity were 87.5% (35 of 40) in patients with HG and 62.5% (25 of 40) in control groups. The difference between the two groups was significant (odds ratio: 4.5, confidence interval: 1.09-18.5); p=0.028. CONCLUSION Both serology-specific IgG and stool antigen tests seem to be good screening methods to identify H pylori in our pregnant patient population with HG during early pregnancy.

Hydrosonography in screening for intracavitary pathology in infertile women

Objectives: We evaluated the value of hydrosonography in screening for intracavitary pathologies in infertile patients. Methods: A total of 93 infertile women with suspected intracavitary lesions on transvaginal ultrasonography (TVS) underwent hydrosonography. Specimens obtained either by dilatation and curettage or hysteroscopic resection were compared with findings on TVS and hydrosonography. Results: Pathology confirmed the presence of sonographically diagnosed intracavitary lesions in 40 out of 66 (60%) women. The sensitivity, specificity, positive predictive value, and negative predictive value of TVS for the detection of endometrial cavity lesions were 78%, 38%, 61%, and 59%, respectively. Forty‐six out of 71 (65%) women who were found to have intracavitary lesions on hydrosonography were pathologically confirmed. The sensitivity, specificity, positive and negative predictive value of hydrosonography in the detection of endometrial cavity lesions were 90%, 40%, 65%, and 77%, respectively. Conclusions: Hydrosonography is a useful procedure in screening for intracavitary pathologies and allows differentiation of intracavitary, endometrial, and submucosal abnormalities.

Single umbilical artery and congenital heart disease in selected and unselected populations

A variable association between single umbilical artery (SUA) and congenital heart disease (CHD) has been reported previously. Discrepancies in the results may be related to the populations studied. In this study we assessed the relationship between SUA and CHD in two well‐defined selected and unselected populations.

Chlamydia pneumoniae seropositivity in women with pre-eclampsia.

Pre-eclampsia a multisystem disorder and a major cause of maternal and perinatal mortality characterized by widespread endothelial cell dysfunction and uteroplacental ischemia is more common among women with pre-existing endothelial cell damage. One of the pathognomonic findings in the pre-eclampsia placenta is that of acute atherosis with a pathogenesis similar to that of atherosclerosis especially regarding inflammation and endothelial cell damage. Women who develop pre-eclampsia may have an inflammatory response more intense than healthy pregnant women and it may be caused by a concurrent or preceding inflammatory stimulus such as infection. (excerpt)

The demographic and behavioural profile of women with cervicitis infected with Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum and the comparison of two medical regimens.

Objective: The aim of this study was to compare the therapeutic effect of single dose oral azithromycin with twice-daily, 7-day doxycycline in women with chlamydial, mycoplasmic or ureaplasmic cervicitis and to demonstrate the demographic and behavioral profile of infected women. Materials and methods: Five hundred and thirty-three women with various gynecologic complaints were recruited for this study. All women were screened for Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) by enzyme immune assay tests. Patients positive for Neisseria gonorrhoeae were excluded. Women treated for these infections were tested after completing medical therapy. Educational levels of infected women were similar in each group. The prevalence of CT, UU and MH was 3.4% (18/533), 11.8% (63/533) and 0.9% (5/533), respectively. In 452 patients, no treatment was administered. The remaining patients were either treated with azithromycin (n=41) or doxycycline (n=40). The eradication rate for the infectious agents was 87.3% and 93.5% in the group of azithromycin and doxycycline, respectively (P>0.05). There was no statistically significant difference in efficacy between single dose azithromycin and a 7-day course of doxycycline with respect to the treatment of culture-positive cases. Recurrences were observed in five cases in azithromycin group (12.5%) and in three cases in doxycycline group (7.5%) . Conclusions: The treatment of uncomplicated chlamydial, mycoplasmic and ureaplasmic cervicitis with a single dose of azithromycin administered under supervision in the clinic is as effective as a 7-day course of doxycycline. This regimen may overcome the problem of compliance with the standard twice-daily, 7-day regimen of doxycycline.

Volume of sampled amniotic fluid and prenatal cytogenetic diagnosis

Amniocentesis is the most frequently used method of invasive prenatal cytogenetic diagnosis [1]. Nearly 20 mL of amniotic fluid (AF) is drawn in most cases, but it is sometimes difficult to obtain an adequate sample volume [1,2] and repeated amniocentesis – i.e., multiple needle insertion – may increase the risk of fetal loss [3]. In this study, the relationship between sample volume and amniocyte culture outcome was investigated. To assess culture outcome with low volumes, excess AF from 7 amniocenteses that provided sample volumes between 22 and 25 mL were used to culture aliquots of 0.5, 0.8, 1.0, and 2.0 mL. All cultures from the 1.0and 2.0-mL groups were

Prenatal and Postnatal Findings in a Case with the Autosomal Recessive Type of Robinow Syndrome

Objective: Our aim was to present a prenatally diagnosed case with Robinow syndrome in a consanguineous couple and discuss possible differential diagnosis in view of the literature. Methods: A 28-year-old pregnant woman gravida 2 para 1 was referred to the obstetric clinic of Kahramanmaras Sutcu Imam University presenting with a fetus having shortened upper and lower limbs at 33 weeks of gestation. Her medical history was unremarkable except for consanguinity. Prenatal ultrasonographic examination revealed a reduced humerus and femur length. Further, shortening of the forearm, frontal bossing, mild hypertelorism, reduced thoracic perimeter and hemivertebrae at the thoracic level were present. Results: Meticulous neonatal examination was performed following an uncomplicated vaginal delivery at 39 weeks of gestation. Distinct facial appearance in addition to the prenatal findings argued in favor of the diagnosis of Robinow syndrome. Additionally, radiological survey revealed and confirmed shortening of the upper extremities and thoracic hemivertebrae. Conclusion: We are documenting the case on the account of its rarity and additional features. The main approach in the differential diagnosis of Robinow syndrome should determine whether hemivertebrae is isolated or part of a syndrome or association.