Özgür Dündar

Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia

The aim of this cohort is to investigate whether any haematologic changes detectable by simple complete blood count (CBC) precede pre‐eclampsia development and the diagnostic value of these markers in clinical practice for prediction of pre‐eclampsia.

Increasing the Stimulation Dose of rFSH in Unexpected Poor Responders Is Not Associated with Better IVF Outcome

OBJECTIVES The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better IVF outcome or not. METHODS A total of forty eligible women who fulfilled our definition of poor responders (< or = 3 follicles, < 4 oocytes or E2 levels < or = 500 pg/ml on day of hCG administration) and who did not achieve an ongoing pregnancy in the first cycle and who returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first-low dose cycles and the second-high dose cycles were compared to each other. Each patient functioned as her own control. Main outcome measures of the study were daily and total dose of rFSH, duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection. RESULTS The first-low dose cycles and the second-high dose cycles were comparable regarding patient characteristics. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos and E2 level on day of hCG injection between the first-low and second-high dose cycles. Daily and total dose of rFSH were significantly higher in the second-high dose cycles. Fewer cycles were cancelled during the second higher gonadotrophin dose after first unexpected poor response. CONCLUSIONS Increasing the starting dose of gonadotrophin after an unexpected poor response in the first IVF cycle is not an effective approach. It may increase the oocyte retrieval rates and embryo transfer rates, but will not add any significant improvement in the number of oocytes retrieved and the number of transferable embryos. The only important benefit of increasing the dose was the low cancellation rate.The aim of this retrospective study is to determine whether increasing the stimulation dose of rFSH in unexpected poor responders is associated with better in vitro fertilization (IVF) outcome or not. A total of forty eligible women who fulfilled our definition of poor responders and who did not achieve an ongoing pregnancy in the first cycle and returned for a second higher rFSH dose IVF cycle with a long-agonist protocol were included to the study. The first low-dose cycles and the second high-dose cycles were compared to each other. Main outcome measures of the study were duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection. There were no significant differences in duration of stimulation, number of follicles, number of oocytes retrieved, number of embryos, and E2 level on day of hCG injection between the first low- and second high-dose cycles. Daily dose and total dose of rFSH were significantly higher in the second high-dose cycles. Increasing the dose of rFSH in a second stimulation cycle after first unsuccessful treatment cycle will add only to the cost and discomfort of the treatment and might adversely affect pregnancy rates.

Could mean platelet volume be a predictive marker for gestational diabetes mellitus

Abstract Background: Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Early diagnosis of this complication and appropriate treatment aimed at tight control over maternal glucose levels may positively influence the perinatal outcome. There are studies, which suggest platelets play a role in the pathogenesis of gestational diabetes mellitus. Aim: The aim of this study is to compare the platelet count and other platelet parameters in gestational diabetic and normal pregnant women and to investigate whether these parameters have a predictive significance in gestational diabetes mellitus. Materials and methods: Thirty four women with gestational diabetes mellitus and 45 normal pregnant women were enrolled into the study. Results: Women with gestational diabetes mellitus had lower platelet counts and higher mean platelet volume (MPV) values which were statistically significant (p <0·006 and p <0·0001), respectively. Conclusion: Our results indicate that platelet count and MPV play an important predictive role in gestational diabetes mellitus.

Postabortion Doppler evaluation of the uterus: incidence and causes of myometrial hypervascularity.

Objective. The aim of this study was to investigate the incidence and causes of uterine hypervascular lesions showing low‐impedance, high‐velocity flow on color Doppler sonography (CDS) after first‐trimester dilation and curettage (D&C). Methods. This was a prospective study of 65 consecutive women who underwent first‐trimester termination of pregnancy. Color Doppler sonography of the uterus was performed on days 3 and 10 after D&C. If the myometrial hypervascularity (MH) persisted on day 10, a second D&C was performed, and then the patients were followed with weekly Doppler examinations. Results. In 16 of 65 women (24.6%), MH was detected with CDS on day 3 after D&C. In 3 cases, MH resolved spontaneously by postabortion day 10. In the remaining 13 patients, the second D&C performed on day 10 revealed retained products of conception (RPOC) in 8 patients (61.5%), a hydatidiform mole in 2 (15.4%), endometritis in 1 (7.7%), and no abnormality in 2 (15.4%). Complete resolution of the MH occurred in all cases. The mean period to the resolution of MH after the second D&C ± SD was 16.54 ± 11.06 days (range, 7–48 days). Univariate analysis revealed that gestational age at D&C (P = .012) and a history of any uterine surgery (P = .044) were significantly associated with postabortion MH. On binary logistic regression analysis, gestational age at D&C was the only independent predictive factor for MH (P = .016; odds ratio, 1.47; 95% confidence interval, 1.08–2.02). Conclusions. The presence of hypervascular areas within the myometrium is a common finding in the postabortion period, and in most cases, the cause of this finding is RPOC.

Second trimester amniotic fluid annexin A5 levels and subsequent development of intrauterine growth restriction

The purpose of this study was to investigate the levels of annexin A5 in second trimester amniotic fluid, and evaluate its correlation with subsequent development of intrauterine growth restriction (IUGR).

First trimester screening for Down syndrome in rhesus negative women.

To explore the effect of maternal rhesus status on first‐trimester screening markers for Down syndrome.

The status of telomerase enzyme activity in benign and malignant gynaecologic pathologies.

BACKGROUND Telomeres are essential for the function and stability of eukaryotic chromosomes. Telomerase consists of three subunits: human telomerase reverse transcriptase (hTERT), human telomerase RNA (hTR), and telomerase protein 1 (TP1). The hTERT subunit determines the activity of telomerase as an enzyme and is detected in most human tumors and regenerative cells. Telomerase activity is a useful cancer-cell detecting marker in some types of cancers. AIMS The aim of this study was to assess of telomerase hTERT mRNA in gynaecological tumors for diagnosis of malignancy. STUDY DESIGN Cross-sectional study. METHODS A total of 55 gynaecologic tumor samples (35 ovarian, 13 endometrial, 6 cervical and 1 placental site trophoblastic tumor tissue) were obtained at the time of surgery. Quantification of hTERT mRNA was performed in a real-time reverse transcriptase polymerase chain reaction (RT-PCR) using the LightCycler TeloTAGGG hTERT Quantification Kit. RESULTS It was histopathologically detected that 18 of the tissue samples were malignant and 37 of the samples were benign. 16 of the malignant tissue samples (88.9%) and 3 (8.1%) (endometrial tissue in proliferative phase, mucinous cyst adenoma and endometriosis) of the benign tissue samples were found to be hTERT positive. With the presence of these data, sensitivity and specificity of hTERT for the diagnosis of malignancy were calculated to be 88.9% and 91.9%, respectively. CONCLUSION It was suggested that the measurement of telomerase activity in gynaecologic tumors, except for endometrial tissue in the reproductive phase, is a valuable method for pathological investigation.

Recurrent pregnancy loss is associated with increased red cell distribution width and platelet distribution width.

The present study aims to evaluate how components of complete blood count are altered in women with a history of recurrent pregnancy loss.

Comparison of the Risk of Malignancy Index and Self-Constructed Logistic Regression Models in Preoperative Evaluation of Adnexal Masses

Objective. The aim of this study was to evaluate women with adnexal masses in the preoperative period by creating 2 logistic regression models, 1 including sonographic morphologic characteristics and the other including both morphologic and color Doppler characteristics, to compare the diagnostic accuracy of these 2 models with the risk of malignancy index (RMI). Methods. This prospective study included 38 malignant, 7 borderline, and 244 benign ovarian masses. The menopausal status, presence of septa, presence of papillary projections, location of the tumor, presence of ascites, presence of metastases, cancer antigen 125 level, tumor volume, septa thickness, and percentage of the solid component were included in the initial analysis. A second regression analysis was performed with the addition of Doppler parameters (location of blood flow and lowest resistive index) in the data set. Diagnostic performance of the 2 regression models and RMI were described and compared by generating receiver operating characteristic curves for each model. Results. The area under the curve values for the morphologic model (model 1), Doppler model (model 2), and RMI were 0.907, 0.971, and 0.889, respectively. Significance levels of model 1 and the RMI were similar (P = .23), whereas model 2 had a significantly higher area under the curve compared with both model 1 (P = .037) and the RMI (P = .018). Conclusions. The addition of Doppler parameters in the regression model significantly increases the predictive performance. Nevertheless, in low‐resource settings, the RMI remains the method of choice for distinguishing adnexal masses and referral to gynecologic oncology clinics

Early predictors of preterm labor and preeclampsia: a prospective study

Aims: This study aimed to investigate various clinical/biochemical parameters as potential predictors of preeclampsia and preterm labor. mmP-2, mmP-9, pregnancy-associated plasma protein A (PAPP-A), fms-like tyrosine kinase 1, and beta human chorionic gonadotropin (β-HCG) levels were measured and Doppler ultrasonography measurements were made in pregnant women at 11-14 weeks of gestation. Findings were recorded and patients were followed until delivery. Results: Patients consisted of preeclampsia and/or preterm labor cases (n=40) and selected controls were pregnant women with a normal pregnancy period who delivered between 37 and 40 weeks of gestation (n=55). multivariate analysis identified high fms-like tyrosine kinase 1 level (Or, 1.004; 95% CI: 1.001-1.007, p= 0.005), high UtA PI (Or, 30.6; 95% CI: 1.1-852, p= 0.044) and presence of any notch (Or, 36.4; 95% CI: 1.6-826, p= 0.024) as independent predictors of preeclampsia; whereas only maternal mmP-9 level emerged as a significant predictor of preterm birth, (Or, 1.001; 95% CI: 1.000-1.001, p< 0.001). Conclusions: These parameters deserve further investigation for their potential use (either alone or in combination) in the prediction of preeclampsia and preterm birth in the clinical setting.