Vakkas Korkmaz

Impairment of thiol-disulfide homeostasis in preeclampsia

Abstract Aim: To investigate the effects of severity of preeclampsia on thiol-disulfide homeostasis (TDH). Material and methods: A total of 108 participants were divided into three groups: Group 1 was composed of pregnant women with no obstetric complications, Group 2 included pregnant women with mild preeclampsia, and Group 3 consisted of pregnant women with severe preeclampsia. TDH parameters were determined, and comparisons of clinical and routine laboratory test findings were made in all groups. Results: The serum native thiol level was 347.9 ± 27.4 in the control group, 237.2 ± 44.2 in the mild preeclampsia group, and 227.9 ± 53.1 in the severe preeclampsia group (p < 0.001). The serum total thiol level was 376.1 ± 31.9 in the control group, 261.8 ± 49.4 in the mild preeclampsia group, and 248.3 ± 57.4 in the severe preeclampsia group (p < 0.001). The disulfide level was 14.1 ± 5.6 in the control group, 12.3 ± 5.1 in the mild preeclampsia group, and 10.2 ± 4.8 in the severe preeclampsia group (p = 0.001). A significant correlation between impairment in degree of TDH and severity of preeclampsia was observed. Conclusion: TDH was impaired in women with preeclampsia, and this impairment increased with disease severity. Therefore, impaired TDH may have a role in the etiopathogenesis of the disease.

Does diurnal rhythm have an impact on fetal biophysical profile

Objectives. To investigate whether parameters in fetal biophysical profile (BPP) testing exhibit a diurnal rhythm and to discuss the probable factors associated with these variables. Methods. Thirty healthy primigravid patients carrying pregnancies between 35 and 40 completed weeks were enrolled for the study. Fetal BPP testing was performed for each patient both in the early morning (08:00–10:00 am) and in the late evening (08:00–10:00 pm), and the scoring parameters were compared between morning and evening tests. Results. BPP scores in the evening were significantly higher than that in the morning (p < 0.05). Deepest vertical amniotic pocket measurements and fetal breathing absence in the morning mostly contributed to this variation (p < 0.001). Fetal movement counts were also significantly lower in the morning tests (p < 0.001). Conclusions. The parameters of BPP exhibit circadian variations in healthy fetuses, which may be associated with many factors such as fetomaternal hormones. It is essential for the clinician to be aware of these changes when interpreting the results, as interventions based on false-positive results may have deleterious effects on both the mother and her fetus.

Comparison of oxidative stress in pregnancies with and without first trimester iron supplement: a randomized double-blind controlled trial

Abstract Objective: Iron supplementation was found to be a cause of oxidative stress. The aim of this study was to compare oxidative stress in pregnancies with and without iron supplementation in the first trimester pregnancies. Methods: One hundred and eight women in the first trimester of normal pregnancies were randomly assigned to three groups. Patients were grouped as following: Group 1 received placebo (n = 36), group 2 received folate supplementation (n = 36) and group 3 was directed to the iron supplementation (n = 36). Oxidative stress was assessed at 14th week of gestation by the utilization of serum γ-glutamyl transferase level. Pregnancies were followed until delivery. Relationship between the oxidative stress and pregnancy outcome was assessed among groups. Results: Mean age was similar among groups, mean gravidity and parity were significantly lower in group with Fe supplementation (p < 0.05). Maternal weight and weight gain during pregnancy were also significantly lower in group 3 (p < 0.05). Mean serum albumin levels were similar among groups while serum γ-glutamyl transferase (GGT) levels were significantly higher in group 3. There were 10 cases of oligohydramnios in group 3, two cases in group 2 and no cases in group 1 (p < 0.001). Conclusion: Iron supplementation during first trimester pregnancy was found to be associated with an increased oxidative stress.

Myometrial elasticity determined by elastosonography to predict preterm labor

Abstract Aim: To determine the utility of elastosonography (ES) combined to cervical length measurement to predict preterm labor. Methods: One hundred twenty-seven women with pregnancies between 21 to 36 weeks of gestation without any risk factor for preterm labor were included in the study. All subjects underwent sonographic evaluation including fetal biometry, cervical length measurement and ES of uterine myometrium. Subcutaneous tissue was the reference point for ES evaluation. Tissue strain ratio values were obtained from all patients. Results: Cervical length was a significant predictor for preterm delivery (AUC = 0.958, p < 0.001). Optimal cut-off value was obtained at 30 mm with 92% sensitivity and 81% specificity. Elastosonographic strain ratio was also a significant predictor for preterm delivery (AUC = 0.827, p < 0.001). Optimal cut-off value was obtained at 4.7 with 79% sensitivity and 91% specificity. In linear regression analysis, strain ratio (R2 = 0.61, beta = 0.171, p = 0.03) and cervical length (R2 = 0.61, beta = −0.516, p < 0.001) were significantly associated with preterm delivery. Cervical length < 30 mm [39.1 (95 CI, 6.6–231.5, p < 0.001)] and strain ratio > 4.7 [24.5 (95 CI, 4.1–146.5, p < 0.001)] were the risk factors for preterm delivery. Conclusion: Elastosonographic evaluation of uterine myometrium was found to be significantly correlated with cervical length but cervical length measurement is a better predictor for preterm labor than ES.

Proadrenomedullin and Serum Amyloid A as a Predictor of Subclinical Chorioamnionitis in Preterm Premature Rupture of Membranes

Preterm premature rupture of membranes (PPROM) is defined as a spontaneous membrane rupture that occurs before the onset of labor and 37 weeks gestation. Subclinical intrauterine infection has been suggested as a very important etiological factor in the pathogenesis and subsequent morbidity related with PPROM. This study was performed to assess the levels of maternal proadrenomedullin (pro-ADM) and serum amyloid A (AA) in PPROM and its association with fetomaternal infectious morbidity. A total of 63 pregnant women, of which 43 with PPROM between 24 and 34 weeks gestation and 20 normal pregnant women without PPROM were included in the study. The study group was separated into 2 subgroups as PPROM and PPROM-histological chorioamnionitis (PPROM-HC). The blood samples were taken before the administration of any medication. The mean serum interleukin-6 (IL-6), AA, and pro-ADM values in the PPROM-HC group were significantly higher than the PPROM and control group. The cutoff values of pro-ADM and AA were determined as 4.2 nM and 69 μg/mL, respectively. Both of them showed similar sensitivity, specificity to IL-6 and a better sensitivity and specificity as compared to C-reactive protein and white blood cell count. We determined the predictive value of pro-ADM and serum AA measurements in PPROM and PPROM with histological chorioamnionitis. We suggest using pro-ADM and serum AA biomarkers for detecting the histological chorioamnionitis at an earlier stage in PPROM without any clinical signs.

A rare case of leiomyosarcoma localized in the Bartholin's gland area and review of the literature

Sarcomas of the vulva in the Bartholins gland area are extremely rare in adults and only a few cases have been reported in the literature. A 65‐year‐old female patient without any previous complaint presented to our hospital complaining of a genital lump with progressive enlargement over the last six months. Pelvic examination revealed a 6 × 5 cm solid mass lesion with irregular margins localized in the left Bartholins gland. Preoperative pathology results indicated a benign lesion, which was subsequently totally excised. Histopathological examination of the lesion revealed leiomyosarcoma. When a lesion is localized in the Bartholins gland area, preoperative biopsy may suggest benign cytology, which can lead to a delay in diagnosis and curative treatment. Total local excision is the first choice for vulvar‐complicated masses in the Bartholins gland area. The present case is the ninth well‐documented case reported in the literature.

Ultrasonographic endometrial thickness measurement is predictive for treatment response in simple endometrial hyperplasia without atypia

OBJECTIVE We sought to determine the predictors of treatment response in simple endometrial hyperplasia without atypia. MATERIAL AND METHODS We prospectively treated 67 women with simple endometrial hyperplasia without atypia who were administered cyclic oral medroxyprogesterone acetate 10 mg/day for 12 days of luteal phase for 3 months and underwent control endometrial sampling after treatment. All subjects were evaluated in terms of age, gravidity, parity, body mass index (BMI), menstrual cycle, endometrial thickness, uterine fibroids, ovarian cysts, serum CA 125 levels, systemic disorders and cigarette smoking. All parameters were used to predict treatment success. RESULTS Persistent hyperplasia was observed in 11 subjects. Endometrial thickness was significantly correlated with treatment failure (r=0.293, p=0.015). In ROC analysis, endometrial thickness was found to be predictive for persistent hyperplasia (area under curve: 0.724, P=0.019). Optimal cut off value was calculated to be 16.5 mm with 64% sensitivity, 72% specificity and 91% negative predictive value. The number of persistent hyperplasia in women with and without endometrial thickness greater than 16.5 mm was significantly different (7/23 vs. 4/45, p=0.029). Odds ratio of endometrial thickness higher than 16.5 mm for treatment failure was 4.4 (95% CI, 1.2-17.4, p=0.03). CONCLUSION Results of this study suggest treatment modification according to the baseline endometrial thickness in patients with simple endometrial hyperplasia without atypia.

Unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years after fallopian tube ligation.

Abstract Aim: We sought to study the effect of tubal ligation on lipid profile, ovarian reserve and hot flashes during perimenopausal years. Methods: A total of 210 perimenopausal women complaining of abnormal vaginal bleeding were enrolled for the study. Subjects’ menstrual, reproductive and medical histories were recorded. Serum FSH, LH and estradiol levels were screened in all women to determine menopausal status. In order to rule out any gynecologic pathology, all subjects underwent transvaginal sonography. Women were divided into two groups according to presence (study group, n = 68) or absence (control group, n = 142) of tubal ligation history. Lipid profiles and ovarian reserve tests were compared between groups. Results: Mean age, parity, serum hemoglobin (Hb), high density lipoprotein (HDL-C), triglyceride, estradiol levels, endometrial thickness and frequency of hot flashes were significantly different between groups (p < 0.05). Mean age was 42.8 ± 1.9 years in women with tubal ligation and 45.9 ± 3.5 years in control group. Mean serum estradiol level was lower in group with tubal ligation (41.4 versus 92.5 pg/ml). Mean endometrial thickness was higher in control group (10.2 versus 7.5 mm). Age-adjusted serum Hb, HDL-C, triglyceride, estradiol, FSH level, endometrial thickness and frequency of hot flashes remained significantly different between groups (p < 0.05). Conclusion: Tubal ligation is associated with unfavorable lipid profile and higher frequency of hot flashes during perimenopausal years.

Comparison of Amniotic Fluid Cytokine Levels in Postterm and Term Pregnancy: a Prospective Study

BACKGROUND To evaluate amniotic fluid pro- and anti-inflammatory cytokine levels in women with postterm and term pregnancies in labor and not in labor. METHODS The study involved three groups: postterm (Group 1, n = 29), term in labor (Group 2, n = 28), and control (Group 3, n = 30). All groups were compared with respect to age, gravidity, parity, obstetric history, gestation week, cervical dilatation and effacement, maternal serum C-reactive protein and white cell count, amniotic interleukin 4, 6, and 10 levels, birthweight, and cord blood pH. RESULTS The amniotic fluid interleukin 10 level was 24.4 ± 8.8 pg/mL in the postterm group, 13.5 ± 5.1 pg/mL in the term in labor group, and 19.8 ± 5.4 pg/mL in the control group (p < 0.001). The amniotic fluid interleukin 4 level was 86.5 ± 57.7 pg/mL in the postterm group, 38.2 ± 29.2 pg/mL in the term in labor group, and 81.9 ± 68.4 pg/mL in the control group (p = 0.002). The amniotic fluid interleukin 6 level was 329 ± 135.1 pg/mL in the postterm group, 252.8 ± 138.7 pg/mL in the term in labor group, and 227.9 ± 114.4 pg/mL in the control group (p = 0.02). There was a positive correlation between gestational age and IL-10 levels (p < 0.05). CONCLUSIONS Amniotic fluid IL-10 and IL-4 cytokine levels were increased in postterm pregnancy and they decreased with active labor.

Should we change our mind about second trimester biochemical aneuploidy screening markers of patients with polycystic ovary syndrome

test, it is still used as some patients only present for the first time in the second trimester. Therefore, the quadruple test has started to be used for Down syndrome screening in the second trimester of pregnancy. In addition to triple test parameters, the quadruple test includes inhibinA. However, Segal et al. found that serum inhibin-A concentration in women with PCOS was lower than normalovulatory women [1, 2]. In addition, Karsli et al. investigated biochemical parameters in the first trimester aneuploidy screening test in the pregnant women with and without PCOS. The biochemical components PAPP-A and fβ-hCG were found to be significantly lower in the PCOS group compared to control group [3]. Although there are studies on human participants in literature about the first trimester aneuploidy screening test to detect Down syndrome, to the best of our knowledge, there have been no studies related to the biochemical parameters in the second trimester aneuploidy screening test in patients with polycystic ovary syndrome. Analysis of the enzymatic steps in the synthesis of estriol, inhibin-A, and the serum levels of biochemical parameters can be recommended for pregnant women with PCOS. These biochemical parameters are also affected by multiple gestation, in vitro fertilization, maternal weight, ethnicity, smoking and parity. The validated software can make adjustments to calculate the risk of Down syndrome for these parameters. PCOS should be added to the parameters.