Mustafa Albayrak

Protein oxidation markers in women with and without gestational diabetes mellitus: a possible relation with paraoxonase activity.

AIMS To clarify the levels of protein oxidation markers such as protein carbonyl (PCO), protein hydroperoxides (P-OOH), advanced oxidation protein products (AOPP) and nitrotyrosine (NT), as well as antioxidative enzymes such as paraoxonase (PON-1) in women with and without gestational diabetes mellitus (GDM). METHODS The study was conducted on 23 women with GDM and 22 women without GDM. The levels of the P-OOH, AOPP, and PON-1 were determined by colorimetric methods; whereas NT and PCO levels were measured by ELISA. RESULTS The concentrations of protein oxidation markers were significantly increased and PON1 activity was significantly decreased in GDM group compared to those of normal pregnant women. The control group showed a significant negative correlation between PON-1 and PCO (r=-0.451, p=0.027); whereas in GDM group, there was a significant positive correlation between P-OOH and HbA1c (r=0.89, p=0.001). There was no significant correlation between AOPP, PON-1, P-OOH, PCO, and HbA1c in either group. CONCLUSIONS There is evidence of a possible association between protein oxidation and decreased PON1 activity in GDM. The increase in protein oxidation parameters in the GDM group leading to decreased PON1 activity might, we think, create a predisposition for clinical complications in GDM group.

Comparison of the diagnostic efficacy of the two rapid bedside immunoassays and combined clinical conventional diagnosis in prelabour rupture of membranes

OBJECTIVE Diagnosis of prelabour rupture of membranes (PROM) may be challenging. Conventional diagnostic methods such as speculum examination, ferning pattern, and pH detection are not satisfactorily accurate. Two relatively new, commercially available rapid bedside immunoassay strip tests, for placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (ILGFBP-1), are alleged to be more accurate. We compared the diagnostic efficacy of PAMG-1 and ILGFBP-1 immunoassay tests and combined conventional clinical diagnostic methods in PROM. STUDY DESIGN 167 pregnant women with signs and/or symptoms of PROM were prospectively evaluated with a combination of conventional clinical tests including speculum examination, nitrazine, ferning pattern, and pooling, in addition to PAMG-1 and ILGFBP-1 immunoassays. Differences in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the diagnostic methods were compared. RESULTS Although the PAMG-1 assay was more accurate, the PAMG-1 immunoassay, ILGFBP-1 immunoassay, and combined conventional clinical diagnosis were, in fact, all highly accurate with no significant difference in sensitivity, specificity, PPV, NPV, or accuracy. CONCLUSION Both rapid bedside strip tests may be used in clinical practice with similar efficacy in diagnosing PROM, particularly as a backup when diagnosis is still in doubt following a combination of conventional diagnostic methods.

Post‐partum haemorrhage from the lower uterine segment secondary to placenta praevia/accreta: Successful conservative management with Foley balloon tamponade

Profuse bleeding from the lower uterine segment secondary to placenta praevia/accreta during caesarean delivery is a challenging problem in obstetrics. We present our experiences using intrauterine Foley balloon tamponade for the conservative management of post‐partum haemorrhage from the lower uterine segment. Intraoperative haemostasis was achieved in all women who were unresponsive to other conservative methods. Foley balloon tamponade may be considered in the management of lower uterine segment bleeding at caesarean delivery.

Alterations in placental pendrin expression in pre-eclampsia.

Abstract Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue. Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense. Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p < 0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r = 0.533, p = 0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group. Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia.

Atypical preeclampsia and eclampsia: report of four cases and review of the literature

Classically, most women who develop preeclampsia (hypertension and proteinuria) present some time after 20 weeks of gestation up to 48 h postpartum;and this is especially true in otherwise healthy, nulliparous pregnancies. Recent data suggest that in some women, preeclampsia and even eclampsia may develop in the absence of hypertension or proteinuria. Here, we report four atypical cases: eclampsia in the absence of hypertension and proteinuria (case 1), a partial seizure following eclampsia with antecedent proteinuria, but no hypertension (case 2), a case presenting with fetal distress, but no hypertension (case 3), and a case with unusually rapid progression and massive proteinuria that was unresponsive to therapy (case 4). Problems with atypical forms of eclampsia lie in its unpredictable onset; timely diagnosis and management are critical in avoiding complications. The purpose of this review is to increase the awareness of atypical forms of hypertensive disorders during pregnancy.

Oxytocin versus sustained‐release dinoprostone vaginal pessary for labor induction of unfavorable cervix with Bishop score ≥4 and ≤6: A randomized controlled trial

To compare the efficacy and safety of high‐dose intravenous oxytocin and sustained‐release dinoprostone vaginal pessaries for cervical ripening and labor induction in pregnant patients at term with poor Bishop scores.

Hearing Evaluation in Preeclamptic Patients

Objective: To evaluate the pathological effects of preeclampsia on hearing levels in pregnant women by pure-tone audiometry and brainstem auditory-evoked potentials (BAEPs). Methods: Both ears in 30 preeclamptic patients and 38 women with uncomplicated pregnancy matched by maternal age and gestational age were investigated based on BAEPs and pure-tone audiometry. Hearing thresholds were within the normal ranges in all subjects prior to pregnancy. We compared the results of hearing levels and auditory pathway functions between the two groups. Results: Statistically significant differences in pure-tone audiometry results were found between the two groups (p < 0.05). However, these results were not clinically significant because all pure-tone thresholds were lower than 20 dB (normal hearing abilities). The differences between BAEPs were not statistically significant (p > 0.05). Conclusion: This study suggests that preeclampsia does not markedly affect hearing function unless it causes secondary vascular occlusion of microcirculation related to hearing.

Can maternal height predict shorter cervical length in asymptomatic low-risk pregnant women?

OBJECTIVE To evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women. STUDY DESIGN Maternal height and cervical length of 146 asymptomatic women with singleton pregnancies at low risk for preterm birth were measured during the first and second trimesters. Preterm birth was defined as birth before <37 gestational weeks. Correlations between maternal height and cervical length measurements were determined using Pearson correlation analysis. The women were also divided into three groups based on height percentiles: <25% (Group I), 25-75% (Group II) and >75% (Group III). Cervical lengths were compared among groups. Correlations between cervical length and maternal height and statistically significant differences in cervical length among height percentile groups were the main outcomes. RESULTS Maternal height was positively but weakly correlated with first and second trimester cervical lengths (p=0.047, r=0.167 and p=0.039, r=0.197 respectively). The mean first trimester cervical lengths were significantly different between the groups (p=0.04). There were no significant differences, however, in the mean second trimester cervical lengths among the three groups although the difference was close to significance (p=0.06). CONCLUSION Although our results indicate a relationship between maternal height and cervical length in our population, maternal height seems to have only limited value in identifying women to be screened for shorter cervical length in a low risk asymptomatic population.

In vivo Comparison of the Effects of Bupivacaine and Levobupivacaine on the Pregnant Rat Myometrium Using Electrohysterogram

Background and Aims: The effect of local anesthetics on myometrial contractility during labor analgesia is debatable. We aimed to compare the effects of bupivacaine and levobupivacaine on rat uterine contractility in an in vivo setting. Methods: Electrical activities of 40 pregnant rat uteruses were recorded on electrohysterogram after dividing the rats into bupivacaine and levobupivacaine groups. Uterine contraction frequencies were recorded at each 5-min interval. The first 5-min recording was considered the control, which was immediately followed by intramyometrial administration of either bupivacaine or levobupivacaine. The recordings were continued for 30 min. The changes in frequencies at each time interval of the groups were compared with each other and the control recording. Results: The frequencies from both groups at each interval were lower than the control values, but not different between the groups. The frequencies of the bupivacaine group during the 5–10 min and 10–15 min intervals were lower than the control time interval, but no significant differences were present between the control and the other time intervals. However, no significant differences were found at any time interval for the levobupivacaine group. Conclusion: Levobupivacaine led to less muscle relaxation compared to bupivacaine and may be a better option for labor analgesia and anesthesia considering uterine contractility.

Acute Respiratory Insufficiency Due to Peripartum Cardiomyopathy After Caesarean Section in a Term Pregnancy With Twins

We report a case of acute respiratory insufficiency due to peripartum cardiomyopathy after Caesarean section in a term pregnancy with twins. The patient was a 30-year-old woman with a spontaneous twin pregnancy at 32 weeks of gestation who was admitted to our obstetrics department with preterm premature rupture of membranes. After 48 hours, the tocolysis was stopped and an uneventful Caesarean was performed under general anesthesia. As the patient was waking up, her SPO2 decreased to 32%, and she became cyanotic and tachypneic. Auscultation revealed rales in her lower lung lobes bilaterally. Her oxygen saturation did not increase in the hours that followed, and her cyanosis persisted, so we decided to admit her to the Intensive Care Unit. She was mechanically ventilated. Her chest X-ray showed an enlarged cardiac silhouette and pulmonary infiltrates in the lower lobes. On the second postoperative day, transthoracic echocardiography was performed and revealed an EF of 45%, mild left ventricular systolic dysfunction and moderate mitral valve failure. Lisinopryl and furosemide were started. On postoperative day four, her symptoms and radiological signs had resolved. She was weaned from mechanical ventilation and discharged from the obstetric ward on postoperative day seven.