Tolga Ergin

New rapid bed-side test to predict preterm delivery: phosphorylated insulin-like growth factor binding protein-1 in cervical secretions

Background.  Phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) is secreted by decidual cells and leaks into cervical secretions when fetal membranes detach from decidua. Our aim was to assess whether detection of phIGFBP‐1 in cervical secretions by a rapid bed‐side test could be used to predict preterm delivery in patients with regular uterine contractions.

Demographic and epidemiologic features of female adolescents in Turkey

OBJECTIVES To determine the average menarcheal age and menstrual cycle pattern, prevalence of dysmenorrhea, frequency of smoking, alcohol and drug use, sexual education level, and the gynecologic problems in female adolescents in Turkey. METHODS A questionnaire consisting of 43 questions were given to 13,665 high school girls between the ages 13-18 years. RESULTS The results showed that average menarcheal age was 13.28 +/- 1.09 years and 77.8% of the girls had menstrual cycles between 20-35 days; 10,688 (78.1%) of the girls complained about pain during their menstruation and 25.6% frequently missed school for this reason. That notwithstanding, only 0.4% of the adolescents with dysmenorrhea had sought medical consultation. Out of 13,665 girls, 19.7% smoked cigarettes, 14.9% used alcohol, and 0.63% used other drugs. Although 50.8% of the students believed that their knowledge about sexuality was adequate, on evaluating the results, this was not confirmed. Girlfriends were found to be the most important source of sexual knowledge. The study indicated that 88.8% of the girls wanted to have sexual education at schools and 60.5% of those preferred to take such a lecture together with boys. The study also revealed that 10.5% of the girls previously consulted a gynecologist and menstrual disorders (26.1%) and dysmenorrhea (23.4%) were the most common complaints. The results showed that 68.7% of the girls preferred a woman gynecologist and 66.3% wanted to be alone with the doctor during examination. CONCLUSION We provided data about demographic and epidemiologic features of Turkish female adolescents.

Laparoscopic management of heterotopic cesarean scar pregnancy with preservation of intrauterine gestation and delivery at term: case report

OBJECTIVE To present a case of laparoscopic removal of a heterotopic cesarean scar pregnancy under ultrasound guidance. DESIGN Case report. SETTING Private hospital. PATIENT(S) A 34-year-old woman with heterotopic cesarean scar pregnancy. INTERVENTION(S) Laparoscopic removal of heterotopic cesarean scar pregnancy. MAIN OUTCOME MEASURE(S) Delivery at term after laparoscopic management of heterotopic cesarean scar pregnancy. RESULT(S) An ongoing intrauterine pregnancy ended with a live birth after successful removal of the heterotopic gestational mass by a laparoscopic approach. CONCLUSION(S) Surgical removal of the ectopic mass by laparoscopy may be a radical approach in cases of heterotopic cesarean scar pregnancy. Laparoscopic excision of the cesarean scar pregnancy gives the opportunity to preserve the viable intrauterine gestation while maintaining a strong lower uterine segment. Ultrasound is an adjunctive tool that enables precise location of the ectopic mass during the operation.

High maternal hemoglobin and ferritin values as risk factors for gestational diabetes.

A number of studies have linked high maternal serum hemoglobin (Hb) levels in pregnancy with increased incidence of adverse pregnancy outcomes such as low birth weight and small-for-gestational-age newborns pre-term births increased perinatal mortality and pre-eclampsia. Lao et al. Identified high maternal hemoglobin at the initial prenatal visit as a risk factor for gestational diabetes mellitus (GDM). This protective study was conducted on 253 non-diabetic Turkish women with singleton pregnancies whose serum Hb level and mean corpuscular volume (MCV) at the initial visit were > 10 g/dl or > 80 fl respectively. The exclusion criteria were first prenatal visit later than 14 weeks of gestation; pre-existing anemia or hemoglobinopathy chronic disease; such as diabetes mellitus renal or gastrointestinal disorder hypo- or hyper-thyroidism GDM diagnosed before 28 weeks gestation. Values signifying the 50th percentile for Hb (12.2 g/dl) and ferritin (Fe) (19.7 µg/l) were established based on these data and two sets of groups were formed based on the initial-visit-findings (Hb above and below the 50th percentile; Fe above and below the 50th percentile). The pairs of groups were compared with respect to maternal pregnancy and infant characteristics and incidence of GDM. At the first trimester prenatal visit; a blood sample from each subject was analyzed for complete blood count MCV fasting serum glucose level and serum levels of Fe vitamin B12 folic acid and insulin. Insulin sensitivity was calculated using the HOMA index. [(Formula: fasting glucose (mmol/l) X fasting insulin (µunits/ml)/22.5]. All women were screened for GDM between 24 and 28 weeks of gestation with a 50-g oral glucose any subject with serum glucose level > 135 mg is subjected to a 3-h 100-g load OGTT. All the OGTT results at 24-28 weeks gestation were interpreted according to the criteria of Carpenter and Coustan. (excerpt)

Non-invasive early prenatal diagnosis using fluorescent in situ hybridization on transcervical cells: comparison of two different methods for retrieval.

OBJECTIVE We compared the efficiencies of uterine and endocervical lavage to retrieve fetal cells from first trimester pregnancies for further analysis with fluorescent in situ hybridization (FISH). STUDY DESIGN Transcervical cell (TCC) samples were collected at 7-10 weeks of gestations by uterine lavage (13 women) and by endocervical lavage (12 women) who were scheduled for volunteer termination of pregnancy. A sample of placenta was also obtained for cytogenetic analysis to confirm the sex or genotype in the end of the procedure. FISH was performed using probes for the chromosomes 18, X and Y in a three color hybridization protocol. The statistical analysis included chi(2)-analysis, and t-test. RESULTS Sufficient cells were obtained in 12 of the 13 (92.3%) in uterine lavage and 10 of the 12 (83.3%) in endocervical lavage group for FISH procedures for fetal sex prediction. The mean success rate of signal detection for FISH procedure was 91.7% (range 83-97%). Fetal sex was correctly predicted in 11 of 12 (91.6%) with uterine lavage and 8 of 10 (80.0%) in endocervical lavage and the difference was statistically insignificant. CONCLUSION This study demonstrated that there are available cells of fetal origin in the lower part of the uterus and these cells may be collected successfully as early as 7 weeks of the gestation. In addition, our results show that endocervical lavage method is as effective as uterine lavage. FISH has been successfully used to detect status of aneuploidy and sex of the fetus from TCC.

Endocrinological and Clinical Analysis of Hyperprolactinemic Patients with and without Ultrasonically Diagnosed Polycystic Ovarian Changes

In the present study we aimed to identify the relationship of hyperprolactinemia and polycystic ovarian changes. We retrospectively analyzed the endocrinological and clinical features of 79 hyperprolactinemic patients detected during a 3-year period ending in March 1995. Patients who had hypothyroidism, macroprolactinoma and drug-induced hyperprolactinemia were excluded from the study. Among 61 hyperprolactinemic patients, 41 (67.2%) had ultrasonographically diagnosed polycystic ovaries (PCO). Prolactin levels in the PCO and non-PCO groups were 32.8 +/- 5.8 and 36.7 +/- 5.1 ng/dl, respectively, which was a significant difference (p < 0.05). Hirsutism was associated with hyperprolactinemia in 55.7% of the patients and was found to be more frequent in the PCO (58.8%) than the non-PCO group (41.2%). The mean Ferriman Gallwey scores and both total and free testosterone levels were significantly higher in the PCO group in comparison to the non-PCO group. In addition, a significantly higher body mass index was detected in patients with PCO. We documented a frequent association between hyperprolactinemia and polycystic ovarian changes and suggested that hyperprolactinemia in PCO is most likely related to a pathologic-endocrinologic milieu.

Atypical squamous cells of undetermined significance - Clinical experience in a Turkish university hospital

OBJECTIVE To assess the significance of atypical squamous cells of undetermined significance (ASCUS) in predicting the presence of underlying squamous intraepithelial lesion (SIL) of the uterine cervix, and to determine the best follow-up method for these patients. STUDY DESIGN We reviewed 76 cases with cervical smears that had been labeled ASCUS over a 41-month period, 64 of which were also examined colposcopically. RESULTS The 76 reported ASCUS cases represented 1.2% of all gynecologic cases diagnosed at our center during the same time period. Of the 64 patients who underwent colposcopy, 9 (14%) had low-grade SIL and 7 (11%) had high-grade SIL. CONCLUSION Based on this study, ASCUS on a cervical smear is a good marker for detecting underlying SIL, and immediate colposcopy and directed biopsy are the most appropriate follow-up procedures.

Transient osteoporosis of pregnancy: case report.

Transient osteoporosis of pregnancy is a rarely observed skeletal pathology developing in the last months of pregnancy. Meticulous evaluation is important for the differential diagnosis of severe and progressive hip and/or groin pain in pregnant patients. MRI is a valuable and safe technique for demonstrating bone marrow edema and skeletal abnormalities during pregnancy. Avoidance of vaginal delivery and non-weight bearing measures are essential in order to prevent complications such as hip fractures related to transient osteoporosis of pregnancy. We present the diagnostic evaluation and treatment of an uncommon case of transient osteoporosis of pregnancy with resolution of symptoms and postpartum.

Maternal-Fetal Factors That Affected Doppler Waveform Analysis in a Patient Undergoing Hemodialysis

Pregnancy in women having chronic renal insufficiency and undergoing hemodialysis is a rare event with a poor outcome. This is the 1st case in whom pre- and posthemodialysis fetal renal artery Doppler flow velocimetry was used in conjunction with fetal blood sampling which was performed to assess fetal karyotype and blood chemistry. Uteroplacental Doppler measurements were also performed, and a close correlation between maternal-fetal blood creatinine and urea nitrogen levels and fetal renal, umbilical, and uterine artery resistance indexes was observed.

OP10.05: Can multifetal pregnancy reduction alter uterine artery Doppler velocimetry?

Objectives: To determine whether the risk of fetal loss following trans-abdominal multifetal pregnancy reduction (TA-MFPR) of a monochorionic twin pair is similar to the one in dichorionic pairs. Study Design: A retrospective review of all TA-MFPR performed in our institution (1999–2007) was conducted. The procedurerelated fetal loss, defined as pregnancy loss prior to completion of 24 weeks, in pregnancies involving reduction of a monochorionic pair i.e. ‘‘Mono group’’ was compared to the loss rate in all other TA-MFPR i.e. ‘‘Non-mono group’’. This comparison was further stratified according to the specific pre and post reduction number of fetuses. Additionally, association between the number of needle insertions performed and the procedure related fetal loss was sought. Results: 394 TA-MFPR were eligible for analysis and an overall loss rate of 2.5% (10 of 394) was detected. The procedure related loss in the ‘‘Mono’’ and ‘‘Non-mono’’ groups as well as the impact of the pre and post reduction number of fetuses on the fetal outcome is displayed in table 1. Information regarding number of needle insertions was available on 182 TA-MFPR of which in 22 ‘‘Nonmono’’ and 16 ‘‘mono’’ cases the same needle insertion was used to reduce more than a single fetus. The loss rate for single, two and three needle insertions was 3/165, 0/11 and 1/6 respectively (pnon significant). Conclusions: Fetal loss following TA-MFPR is independent of the chorionicity of the pair reduced. Additionally, we noted a trend suggesting an increased risk for fetal loss with increased number of needle insertions. Since monochorionic twins carry an increased pregnancy-related complication rate, it is our practice to attempt reduction of such pairs, preferably by using a single needle insertion. This can be achieved by a careful selection of the needle pathway to reach both fetuses.