Tanju Pekin

Screening for pre-eclampsia by using maternal serum inhibin A, activin A, human chorionic gonadotropin, unconjugated estriol, and alpha-fetoprotein levels and uterine artery Doppler in the second trimester of pregnancy.

Aims:  To analyse the predictive power of maternal serum inhibin A, activin A, human chorionic gonadotropin (hCG), unconjugated estriol (uE3), alpha‐fetoprotein (AFP) levels and uterine artery Doppler in the second trimester of pregnancy in screening for pre‐eclampsia.

Antral follicle assessment after down-regulation may be a useful tool for predicting pregnancy loss in in vitro fertilization pregnancies

Women with diminished ovarian reserve (OR) have a high rate of pregnancy loss. The relationship between hormonal OR tests and pregnancy loss has been studied previously, but, to our knowledge, that between the antral follicle count (AFC) and pregnancy loss has not. Therefore, we aimed to determine whether OR tests, including the AFC, can predict pregnancy loss in women achieving pregnancy by means of in vitro fertilization (IVF), and also to compare their predictive value. All women underwent a fresh cycle of intracytoplasmic sperm injection with a long protocol with mid-luteal start of the gonadotropin-releasing hormone analog, and antral follicles were counted on cycle day 3 following down-regulation. Pregnancy losses up to 12 gestational weeks (n = 28) were compared with apparently healthy deliveries (n = 34) in this retrospective analysis. Receiver operating characteristic analysis of consecutive pregnancies (n = 71) was performed to analyze the optimum cut-off value for the significantly different OR tests. Women with a pregnancy loss had a lower AFC than those with healthy deliveries. Age and hormonal OR tests were comparable between groups. The optimum cut-off value for the AFC to predict pregnancy loss was 7.5. AFC may be a useful tool for predicting pregnancy loss in IVF pregnancies.

Maternal serum, amniotic fluid and cord leptin levels at term: their correlations with fetal weight.

Abstract Aims: To investigate the relationship between fetal weight and leptin levels in maternal serum, amniotic fluid and umbilical cord. Methods: Forty pregnant women presenting for antenatal care at early weeks of gestation were enrolled for the study. Maternal and cord blood samples for leptin measurement were obtained at birth. Amniotic fluid samples were recovered by amniotomy performed during labor. Maternal body mass index and placental weight were also recorded. Leptin measurement was carried out using the ELISA method. Spearmans correlation test was used for comparison of non-parametric data. Results: Leptin concentration in venous cord blood correlated significantly with birth weight and placental weight whereas maternal serum and amniotic fluid leptin levels did not show correlation with birth weight. There were no significant correlations between leptin levels in maternal serum, cord blood and amniotic fluid. Conclusion: We conclude that lack of correlation between leptin levels in mother, cord and amniotic fluid suggest that these compartments may be non-communicating separate units or have different mechanisms regulating leptin synthesis or degradation, and that leptin in maternal blood and amniotic fluid may not have a direct effect on fetal growth but rather a different role in pregnancy.

The impact of insulin resistance on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome

Abstract This study was performed to assess insulin resistance (IR) in lean women with polycystic ovary syndrome (PCOS). Retrospective analysis of 100 consecutive lean (body mass index <25 kg/m2) PCOS subjects was performed. Subjects were divided into two groups according to homeostasis model assessment IR index (HOMA-IR), as IR + and IR−. A HOMA-IR value >2.5 was used to indicate IR. A total of 100 lean PCOS subjects were enrolled in the study, of which 47% were insulin resistant. Comparison of group means showed significantly higher values for waist-to-hip ratio (WHR), diastolic blood pressure and Ferriman–Gallwey score (FGS) in IR + group. HOMA-IR values were found to be positively correlated with WHR (r = 0.500, p < 0.01), systolic blood pressure (r = 0.265, p < 0.01), diastolic blood pressure (r = 0.273, p < 0.01), estradiol levels (r = 0.218, p < 0.05), FGS (r = 0.456, p < 0.01) and total testosterone levels (r = 0.291, p < 0.01). When evaluating PCOS subjects, the insulin resistant group should be separated as unique and IR should also be evaluated in lean women with PCOS.

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

Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women

Objective This study was performed to compare the vasomotor symptoms and bone mineral density of postmenopausal women with and without metabolic syndrome. Methods We performed a cross-sectional study of 200 postmenopausal women attending routine health check-ups at Marmara Faculty of Medicine Pendik Training and Research Hospital from June 2015 to December 2015. The vasomotor symptoms scored were hot flashes and night sweats. Metabolic syndrome was defined using the consensus criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Women with vasomotor symptoms had no metabolic syndrome and were younger than those without vasomotor symptoms. There was no significant difference in vasomotor symptoms between patients with osteopenia in the femoral neck, total femur, and spine and patients with normal bone mineral density. The vasomotor symptoms were similar between smokers and nonsmokers. Conclusion The presence of metabolic symptoms is inversely associated with metabolic syndrome in postmenopausal women. Lipid abnormalities and a high body mass index may be important metabolic components associated with these symptoms. No relationship is present between vasomotor symptoms and the bone mineral density of the spine, femoral neck, and total femur.

The impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal and metabolic parameters in lean women with polycystic ovary syndrome

Abstract This study was performed to assess the impact of lipid accumulation product (LAP) and visceral adiposity index (VAI) on clinical, hormonal, and metabolic parameters in lean women with PCOS. Retrospective analysis of 120 consecutive lean PCOS subjects was performed. Subjects were divided into two groups according to HOMA-IR, as IR + and IR−. A HOMA-IR value above 2.5 was used to indicate IR. Clinical, hormonal and metabolic parameters were compared between the two groups. Correlations between LAP and VAI and clinical, hormonal, metabolic features in women PCOS were analyzed. One hundred twenty lean PCOS subjects were enrolled, of which 39 were insulin resistant. Comparison of group means showed significantly higher values for TG levels, FAI, FGS, TG/HDL-c, TyG, LAP, and VAI indexes and lower values for glucose/insulin ratio and QUICKI in the IR + group. LAP and VAI were both found to be positively correlated with each other and with WC, FAI, FGS, TG, TC levels, lipid ratios, TyG index, and HOMA-IR and negatively correlated with Glucose/Insulin ratio, QUICKI, and HDL-c in lean women with PCOS. LAP and VAI may be promising in early identification of IR and cardiometabolic risk and may be useful for the assessment of hyperandrogenism in lean women with PCOS.

Cardiotrophin-1 as a new metabolic biomarker in women with PCOS

Abstract The objective of this study was to investigate cardiotrophin-1 (CT-1) levels as a new metabolic biomarker in women with polycystic ovary syndrome (PCOS). One hundred consecutive women with PCOS were divided into two groups according to presence of metabolic syndrome as MetS+ and MetS−. Clinical, hormonal and metabolic parameters in addition to CT-1 levels were compared between the groups. Correlation analyses were performed between CT-1 and clinical and metabolic parameters in women with PCOS. One hundred PCOS subjects were enrolled in the study, of which 29 subjects were diagnosed with metabolic syndrome. WHR, systolic and diastolic blood pressures, triglyceride, total cholesterol, HOMA-IR, FAI, FGS and CT-1 levels were significantly higher in the MetS+ group compared with the MetS− group. HDL cholesterol was significantly higher in the MetS− group than the MetS+ one. CT-1 levels were found to be positively correlated with diastolic blood pressure, TG levels and FGS. Cardiotrophin-1 may be a promising new metabolic biomarker in women with PCOS. CT-1 may be beneficial for estimating the risk of long-term adverse health consequences and establishing early intervention and preventation strategies.

Cystatin C, a novel cardiometabolic risk marker in women with polycystic ovary syndrome

Abstract Objective: To investigate the impact of urinary albumin excretion (UAE) and cystatin C on the metabolic components of polycystic ovary syndrome (PCOS). Methods: Seventy-five women with PCOS were divided into two groups according to metabolic syndrome as MetS + and MetS−. Clinical, metabolic and renal parameters were compared between the groups. Correlation analyses were performed between cystatin C, microalbuminuria and clinical and metabolic parameters in women with PCOS. Results: Waist/hip ratio (WHR), body mass index, LDL cholesterol, triglyceride, total cholesterol, cystatin C, UAE were significantly higher in the MetS + group compared with the MetS − one. HDL cholesterol was significantly higher in the MetS − group than the MetS + one. The UAE positively correlates with LDL cholesterol, triglyceride and total cholesterol levels. Cystatin C positively correlates with UAE, WHR, LDL cholesterol, triglyceride, total cholesterol levels. Conclusions: Evaluating UAE and cystatin C may be important for the detection of target subjects at high risk for future metabolic syndrome and cardiovascular disease.

P024: Comparing the first trimester and second trimester screening programmes for the screening of Down's Syndrome

Methods: This is a retrospective study of 83 fetuses referred to our center for nuchal abnormalities with a normal karyotype. The study included 58 cases with increased nuchal translucency ≥ 3.5 mm (71%), 15 cases with cystic hygroma (18%) and 10 cases with generalized hydrops (12%). All fetuses were followed up by serial detailed ultrasound examination. Post-natal follow-up was obtained from the paediatricians or general practitioners. Results: The median gestational age at the time of screening was 13 [11 to 14] weeks with a median maternal age of 31 [19–49] years. 40 of the 58 cases with increased NT (77%) delivered at a median gestational age of 38 weeks with a median birthweight of 3299 g. There were 3 spontaneous miscarriages and 2 cases of unexplained intrauterine death. 5 terminations of pregnancy were performed for fetal abnormalities. Outcome of pregnancy is unknown for 8 cases. 32 infants were follow-up to 14 [3–24] months and 66% of them are thought to be healthy. However various anomalies were found in 11 cases (34%): 2 cases with cardiacdefects and one with cleft palate were detected on antenatal US, a case of Noonan syndrome was diagnosed during the neonatal period, one child developed convulsions related to epidural hemorrhage and 3 children showed transient developmental delay but are developing normally at 12 to 14 months. Of the 10 cases with generalized hydrops and normal karyotype, 9 miscarried or underwent termination of pregnancy and of the 15 cases with cystic hygroma, 11 delivered of liveborn babies which follow-up led to the diagnosis of developmental delay in one and cardiac defect in another. Conclusion: Around 70% of pregnancies with increased nuchal translucency and normal karyotype have a good prognosis. Although most structural abnormalities are most commonly associated with hydrops or cystic hygroma, about 30% of them will show other anomalies including cardiac defects, intrauterine growth retardation, cleft palate and cerebral ventriculomegaly. Cystic hygroma without hydrops diagnosed in the first trimester carries a better prognosis as any few of them will evolve into a hydropic form in the second trimester.