Namik Demir

Nifedipine therapy for preterm labor: Effects on placental, fetal cerebral and atrioventricular Doppler parameters in the first 48 hours

To assess the effect of nifedipine tocolysis on Doppler parameters of the uterine, umbilical and fetal middle cerebral arteries and atrioventricular valves in the first 48 h of therapy.

The short‐term effect of nifedipine tocolysis on placental, fetal cerebral and atrioventricular Doppler waveforms

To evaluate the effect of nifedipine on placental and fetal middle cerebral and atrioventricular Doppler waveforms.

A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease

OBJECTIVE To evaluate the effects of removing coils on the treatment of mild and moderate pelvic inflammatory disease (PID). METHODS Of 126 women who had mild to moderate PID during coil usage, 60 were treated following coil removal and 66 without. Clinical symptoms, findings of gynecologic examination, erythrocyte sedimentation rates (mm/h), leukocyte counts (mm(-3)) were recorded before and after treatment and recovery rates of symptoms and findings were compared with Chi-square and Fishers absolute Chi-square tests. Students t-test was used for the comparison of mean sedimentation rates and leukocyte counts. RESULTS Recovery rates of pelvic pain, purulent vaginal discharge, dysuria/frequency and dyspareunia and clinical improvements in abdominal and cervical tenderness were significantly higher (P<0.05) in the coil removed group. CONCLUSIONS Removing the coil before medical therapy, increases the rates of clinical improvement in mild to moderate PID.

Different maternal serum hCG levels in pregnant women with female and male fetuses: does fetal hypophyseal - adrenal - gonadal axis play a role?

Abstract Fetal gender has a significant effect on maternal and cord blood hCG levels, particularly during the last trimester of the pregnancy. However, the reason for this difference is obscure. The aim of the present study was to investigate whether term fetal hypophyseal - adrenal - gonadal axis differs between female and male fetuses thereby causing different hCG levels. The study consisted of 60 women with singleton pregnancies in the third trimester. Thirtyone pregnant women were carrying female fetuses, whereas 29 were carrying male. Human chorionic gonadotropin (hCG), estradiol, progesterone, testosterone, dehydro-epiandrosteron-sulfate (DHEAS), prolactin and growth hormone levels were measured in maternal serum and umbilical cord blood. In female bearing pregnancies maternal and cord blood hCG levels were significantly higher than in male bearing pregnancies (P<0.001). Maternal and cord blood estradiol, progesterone, testosterone, DHEAS, prolactin and growth hormone levels were not significantly different in either fetal gender. When all patients were considered as a group there were no correlations between fetal hCG levels and any of the measured hormones. Term fetal DHEAS, estrogen, progesterone, testosterone, growth hormone and prolactin levels do not contribute to different hCG levels between female and male fetuses. It is possible that fetal hypophyseal-adrenal - gonadal axis does not play a central role as the cause of different hCG levels.

Analysis of perinatal outcome by combination of first trimester maternal plasma homocysteine with uterine artery Doppler velocimetry

To analyse the pregnancy outcome by combining plasma homocysteine with uterine artery Doppler velocimetry at 11 to 14 weeks of gestation.

Prolactin and amniotic fluid electrolytes.

Prolactin (PRL) levels and Na+. K+, Cl−. Ca+ concentrations in maternal serum and amniotic fluid from 64 women in normal term pregnancy were measured by immunoenzymetric assay and flame photometry. The mean amniotic fluid PRL concentration was 597.7 (SE 31.5) ng/ml and the mean amniotic fluid Na+, K+, Cl− and Cd++ levels were 125.6 (SE 0.9) mmol/l, 4.5 (SE 0.1) mmol/l, 109.3 (SE 1.3) mmol/l and 2.0 (SE 7.5 E‐02) mmol/l, respectively. There was no correlation between PRL levels in maternal scrum and amniotic fluid. and the electrolyte concentrations in amniotic fluid. A close correlation was found between the concentrations of Na+ and Cl− in maternal serum and amniotic fluid. Thus, even though PRL may participate in the regulation of electrolytes in the amniotic fluid compartments, our findings provide indirect evidence for the existence of other regulatory mechanisms.

Maternal, fetal and amniotic fluid prolactin levels in term and post‐term pregnancies

Prolactin (PRL) levels in maternal serum, amniotic fluid and mixed cord blood from 11 women with post‐term pregnancies and 64 women with normal term pregnancies were measured by immunoenzymetric assay in order to investigate their possible role in the onset of labor. No differences were found between term and post‐term pregnancies, and it is concluded that PRL probably has no function in triggering labor.

Amniotic fluid angiogenin levels are decreased in pregnancies with fetal trisomy 21

Trisomy 21 is the most common chromosomal abnormality among newborns, and it is one of the most important causes of mental retardation in the population (Goshen, 1999). Angiogenin is a 14-kDa, nonglycolized polypeptide with angiogenetic and ribonucleic activities and plays a key role in the complex process of angiogenesis (Shapiro et al., 1986). Large amount of angiogenesis is required for the growth of placenta and development of vascular structures. Angiogenin expression, placental secretion and maternal plasma levels increase between the first trimester and birth. The existence of angiogenin in placental villi and increase in angiogenin levels toward birth point out that its production depends on the developmental stage (Rajeshekhar et al., 2002). Thus, changes in the level of angiogenin during placental development raise the probability of its possible role in the angiogenetic and morphological changes that are required in the placenta for a healthy gestation. Syncytiotrophoblast is a major component of the human placenta, and it plays a leading role in fetal– maternal exchanges and the secretion of pregnancyspecific hormones. In the normal placenta, multinucleated syncytiotrophoblasts are formed by the fusion of mononuclear cytotrophoblasts (Roberts et al., 2000). A defect exists in the formation of syncytiotrophoblasts in the placentas of fetuses with trisomy 21: histopathologic analysis of placentas of trisomy 21 fetuses shows trophoblastic hypoplasia and villus hypovascularity throughout pregnancy (Qureshi et al., 1997). This may lead to a decrease in the production of pregnancyspecific hormones (Massin et al., 2001). Considering the possible role of angiogenin on placental characteristics, the aim of the present study was to explore whether an association existed between Down syndrome and this angiogenetic factor. Therefore, we compared amniotic fluid angiogenin levels of fetuses with normal karyotype and those with trisomy 21. In the Perinatology Division of Department of Obstetrics and Gynecology Clinic at Dokuz Eylül University,

Assessment of Chlamydia trachomatis Prevalence by Cell Culture and Transcription-Mediated Amplification in Symptomatic Women

Objective: The frequency of Chlamydia trachomatis in women with mucopurulent discharge was determined by a cell culture technique and a transcription-mediated amplification (TMA) assay in endocervical swab specimens. Subjects and Methods: Endocervical swab specimens were obtained from 116 symptomatic patients with genitourinary complaints or abdominal pain. All of the women were married, with an age range of between 19 and 44 (median 29) years. The cell culture assay was used in all specimens. For 75 specimens the TMA assay was also performed. Results: Positive cell culture test results were obtained in 6 (5.2%) patients. Among 75 specimens, 2 were positive by both TMA and culture assays, while 1 specimen was positive only by the culture assay. Of those positive for C. trachomatis, 5 were in the 19- to 25-year age group, and 1 was in the >25-year age group. All of the patients with positive results were of low socioeconomic status. Conclusions: This study revealed a relatively low rate of C. trachomatis infections in symptomatic married women in Turkey. A commercial TMA assay failed to identfy all positive patients, in contrast to a ‘gold standard’ culture assay used in patients having such infections.

Fetal Nasal Bone Length as a Novel Marker for Prediction of Adverse Perinatal Outcomes in the First-Trimester of Pregnancy

Background: Adverse outcomes of pregnancy are a challenging health-care problem. Prediction of adverse pregnancy outcomes is important to prevent the morbidities of the foetus and the mother. Aims: To study the clinical interest of fetal nasal bone length in predicting adverse pregnancy outcomes in the first trimester of pregnancy. Study Design: A population-based retrospective cohort study. Methods: Data from 868 women with first-trimester fetal nasal bone length and birth records available were enrolled. Fetal nasal bone length percentiles were determined and evaluated for their ability to predict adverse pregnancy outcomes such as preterm birth, preterm labour, preterm premature rupture of membranes, early preterm birth, gestational diabetes mellitus, gestational hypertension-preeclampsia, small-for-gestational age foetuses, macrosomia, oligohydramnios, polyhydramnios and fetal distress. Results: Fetal nasal bone length >95th percentile was significantly associated with preterm labor and preterm premature rupture of membranes (p=0.02, accuracy 0.91 and p=0.001, accuracy 0.94, respectively), whereas nasal bone length >99th percentile was significantly associated with preterm labor and oligohydramnios (p=0.006, accuracy 0.95 and p=0.014, accuracy 0.97). Conclusion: Fetal nasal bone length at high percentiles in the first trimester of pregnancy may aid in the prediction of adverse outcomes such as preterm labour, preterm premature rupture of membranes and oligohydramnios.