Publications by authors named "Cuneyt Eftal Taner"

34 Publications

Long-term outcomes and quality of life effects of single incision mini sling procedure in stress urinary incontinence patients.

Eur J Obstet Gynecol Reprod Biol 2019 Mar 6;234:10-13. Epub 2019 Jan 6.

Republic of Turkey, Ministry of Health University of Health Sciences Tepecik Education and Research Hospital, Turkey.

Objective: We aimed to evaluate the long-term outcomes and quality of life of patients who underwent single incision minisling (SIMS) procedure.

Study Design: 62 patients who were diagnosed with stress urinary incontinence (SUI) and received treatment with SIMS procedure (Ophira, Promedon, Argentina) were included in the study. Mean age was 50.73 ± 9.28 years and mean follow-up duration after surgery was 30.68 ± 7.52 months. Preoperative urological and gynecological features of the patients were recorded. Gynecological examination, pelvic ultrasonography, stress test, Q-tip test, cystometry were performed and incontinence and quality of life questionnaires (ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI) were completed by all patients before and after the operation.

Results: Stress urinary incontinence was observed in all patients during pre-op evaluations. 62 patients aged between 35-85 (mean age 50.73 ± 9.28) years were included and follow up duration ranged between 12-44 (average 30.68 ± 7.52) months. In regard to patient evaluations, 27 patients (43.5%) felt that the surgery was very effective, 25 (40.3%) felt surgery was effective and 10 (16.1%) did not report any difference after surgery. In the long-term postoperative follow up; 2 (3.2%) patients had dyspareunia and 7 (11.3%) patients had vaginal tape erosions which were diagnosed 2-40 months postoperatively. According to Q-tip test results, proximal urethral mobility was significantly decreased after surgery. All questionnaire scores were also significantly improved at post-operative evaluations. (P < 0.001) CONCLUSIONS: Our study confirmed that the Ophira mini sling technique provided high subjective cure rate and improved symptoms and quality of life in patients with SUI. These results suggest that the single incision mini sling procedure is an advisable alternative to other surgical procedures due to its low complication rates and ease of learning and applying the procedure. This procedure also demonstrated excellent tolerability, minimal pain, low morbidity and increased quality of life scores, in ICIQ-SF, IIQ-7, UDI-6, VAS-QOL, FSFI.
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http://dx.doi.org/10.1016/j.ejogrb.2018.12.030DOI Listing
March 2019

Asprosin: a novel peptide hormone related to insulin resistance in women with polycystic ovary syndrome.

Gynecol Endocrinol 2019 Mar 16;35(3):220-223. Epub 2018 Oct 16.

a Department of Obstetrics and Gynecology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey.

Asprosin associated with insulin resistance is a newly discovered peptide hormone. The peptide promotes hepatic glucose production. Polycystic ovary syndrome (PCOS) is a metabolic disorder. Insulin resistance plays a vital role in the pathogenesis of the disease. The aim of this study was to discover the association between insulin resistance and asprosin in women with PCOS. We recruited 78 subjects with PCOS and 78 age-matched and body mass index (BMI)-matched controls into this cross-sectional study. Circulating asprosin levels were validated using ELISA method. We also determined metabolic and hormonal parameters of the involved subjects. We found that circulating asprosin levels were elevated in women with PCOS with respect to controls. Asprosin levels showed a positive correlation with insulin resistance, BMI, and free androgen index (FAI). Moreover, subjects with the highest tertile of asprosin levels represented increased odds of having PCOS as compared to those subjects with the lowest tertile asprosin levels. Increased asprosin levels resulted to high possibility of having PCOS risk associated with insulin resistance.
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http://dx.doi.org/10.1080/09513590.2018.1512967DOI Listing
March 2019

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

Turk J Med Sci 2018 Jun 14;48(3):602-610. Epub 2018 Jun 14.

Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligament fixation (SSLF), and iliococcygeus fixation due to apical prolapse. Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgery performed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeus fixations. Patients' short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed. Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in the SSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter in the iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period, no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominal sacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332). Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedures were not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-related morbidity.
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http://dx.doi.org/10.3906/sag-1712-203DOI Listing
June 2018

QF-PCR in invasive prenatal diagnosis: a single-center experience in Turkey.

Turk J Med Sci 2017 Feb 27;47(1):142-147. Epub 2017 Feb 27.

Genetic Diagnostic Center, Tepecik Training and Research Hospital, İzmir, Turkey.

Background/aim: QF-PCR has been used for more than 20 years. It is based on investigation of polymorphic short tandem repeats (STRs) and is widely used for prenatal rapid aneuploidy detection.

Materials And Methods: We report retrospectively our prenatal diagnosis results between January 2012 and May 2014 in Tepecik Training and Research Hospital Genetic Diagnostic Center. Prenatal diagnosis was recommended in 6800 high-risk pregnancies and 2883 patients agreed to invasive diagnosis. Chromosome analysis and QF-PCR were performed in all patients.

Results: Normal results were reported in 2711 cases by fetal karyotyping and in 2706 cases by QF-PCR. Anomaly detection rates were similar for the two methods (5.09% for karyotyping and 4.02% for QF-PCR).

Conclusion: QF-PCR is a fast and reliable prenatal diagnosis method in all indication groups and may be preferred as the sole prenatal investigation in patients without fetal ultrasonographic findings.
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http://dx.doi.org/10.3906/sag-1511-157DOI Listing
February 2017

Can the Myocardial Performance Index Be Used as a New Predictive Factor for a Poor Prognosis in Fetuses With Idiopathic Polyhydramnios?

J Ultrasound Med 2016 Dec 7;35(12):2649-2657. Epub 2016 Nov 7.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Objectives: The purpose of this study was to determine whether there are any changes in cardiac function in fetuses with idiopathic polyhydramnios and also to evaluate the value of the myocardial performance index for prediction of adverse perinatal outcomes.

Methods: A prospective case-control study was conducted with a total of 134 fetuses between 24 and 40 weeks' gestation. Polyhydramnios was defined as an amniotic fluid index of greater than 24 cm. Seventy-three fetuses of healthy mothers were assigned as the control group whereas 36 fetuses with an amniotic fluid index of 24 to 34 cm constituted the nonsevere polyhydramnios group, and 31 fetuses with an amniotic fluid index of 35 cm or greater constituted the severe polyhydramnios group. Fetal echocardiography was performed to compare cardiac function parameters among groups. To determine which perinatal outcomes were independently associated with an increased myocardial performance index, a multivariate logistic regression analysis was performed.

Results: The myocardial performance index was significantly higher in polyhydramnios groups compared with controls (P < .001). Among fetuses with polyhydramnios, the myocardial performance index was significantly higher in severe polyhydramnios compared with nonsevere polyhydramnios (P = .003). An increased myocardial performance index in polyhydramnios was independently associated with nonreassuring fetal status (odds ratio, 2.12; 95% confidence interval, 1.41-4.53; P = .005), emergency cesarean delivery (odds ratio, 1.54; 95% confidence interval, 1.12-2.37; P= .025), and respiratory distress syndrome (odds ratio, 1.79; 95% confidence interval, 1.21-3.87; P = .012).

Conclusions: An increased myocardial performance index is an early indicator of adverse perinatal outcomes in pregnancies complicated by idiopathic polyhydramnios.
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http://dx.doi.org/10.7863/ultra.15.11086DOI Listing
December 2016

High first-trimester neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios are indicators for early diagnosis of preeclampsia.

Ginekol Pol 2016 ;87(6):431-5

Objectives: The aim of our study is to determine whether first-trimester neutrophil-to-lymphocyte ratio (NLR) and plate-let-to-lymphocyte ratio (PLR) would be useful as new predictors of subsequent preeclampsia.

Material And Methods: Medical records of women with preeclampsia and healthy controls from a tertiary referral center were retrospectively evaluated. The two groups were compared in terms of clinical characteristics and first-trimester levels of hemoglobin, leukocyte, neutrophil, lymphocyte, platelet, NLR and PLR. Receiver operating characteristic curve (ROC) analysis was performed to identify the optimal NLR and PLR levels predicting preeclampsia.

Results: Neutrophil (p < 0.001), platelet (p < 0.001), NLR (p < 0.001) and PLR (p < 0.001) levels were significantly elevated, whereas hemoglobin concentration (p = 0.003) was significantly lower in the group with preeclampsia as compared to the control group. On multivariate regression analysis, NLR (OR 1.43; 95% CI 1.21-1.76; p = 0.005) and PLR (OR 1.38; 95% CI 1.15-1.63; p = 0.008) were the most powerful predictive variables. The area under the ROC was 0.716 and 0.705 for NLR and PLR, respectively. The cut-off values of NLR ≥ 3.08 and PLR ≥ 126.8 predicted preeclampsia with the sensitivity of 74.6% and 71.8% and specificity of 70.1% and 72.4%, respectively.

Conclusions: High NLR and PLR during the first trimester are independent predictors of subsequent preeclampsia.
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http://dx.doi.org/10.5603/GP.2016.0021DOI Listing
July 2018

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques.

J Perinat Med 2017 Feb;45(2):199-203

Objective: To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.

Methods: In this case-control study, 412 women who underwent CVS at 11-14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.

Results: The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4-2.7, P=0.008].

Conclusion: The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.
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http://dx.doi.org/10.1515/jpm-2015-0360DOI Listing
February 2017

Use of urea and creatinine levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes and delivery interval after membrane rupture.

J Matern Fetal Neonatal Med 2017 Apr 26;30(7):772-778. Epub 2016 May 26.

a Department of Perinatology and.

Objective: To determine whether urea and creatinine measurements in vaginal fluid could be used to diagnose preterm premature rupture of membranes (PPROM) and predict delivery interval after PPROM.

Methods: A prospective study conducted with 100 pregnant women with PPROM and 100 healthy pregnant women between 24 + 0 and 36 + 6 gestational weeks. All patients underwent sampling for urea and creatinine concentrations in vaginal fluid at the time of admission. Receiver operator curve analysis was used to determine the cutoff values for the presence of PPROM and delivery within 48 h after PPROM.

Results: In multivariate logistic regression analysis, vaginal fluid urea and creatinine levels were found to be significant predictors of PPROM (p < 0.001 and p < 0.001, respectively) and delivery within 48 h after PPROM (p = 0.012 and p = 0.017, respectively). The optimal cutoff values for the diagnosis of PPROM were >6.7 mg/dl for urea and >0.12 mg/dl for creatinine. The optimal cutoff values for the detection of delivery within 48 h were >19.4 mg/dl for urea and >0.23 mg/dl for creatinine.

Conclusion: Measurement of urea and creatinine levels in vaginal fluid is a rapid and reliable test for diagnosing and also for predicting delivery interval after PPROM.
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http://dx.doi.org/10.1080/14767058.2016.1188072DOI Listing
April 2017

Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction.

J Ultrasound Med 2016 Mar 9;35(3):511-7. Epub 2016 Feb 9.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey (A.E., C.G., C.E.T., U.S., M.O.); and Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey (N.S.G.).

Objectives: Our aim was to evaluate the size of the fetal thymus by sonography in pregnancies with intrauterine growth restriction (IUGR) and to search for a possible relationship between a small fetal thymus and adverse perinatal outcomes.

Methods: The transverse diameter of the fetal thymus was prospectively measured in 150 healthy and 143 IUGR fetuses between 24 and 40 weeks' gestation. The fetuses with IUGR were further divided according to normal or abnormal Doppler assessment of the umbilical and middle cerebral arteries and ductus venosus. Measurements were compared with reference ranges from controls. To determine which perinatal outcomes were independently associated with a small fetal thymus, a multivariate logistic regression analysis was performed.

Results: Thymus size was significantly lower in IUGR fetuses compared to controls (P < .05). Among IUGR fetuses, thymus size was significantly smaller in IUGR fetuses with abnormal Doppler flow compared to normal flow (P < .05). A small thymus in IUGR fetuses was independently associated with early delivery (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.05-1.49; P= .023), respiratory distress syndrome (OR, 1.36; 95% CI, 1.09-1.78; P= .005), early neonatal sepsis (OR, 1.65; 95% CI, 1.11-2.42; P= .001), and a longer stay in the neonatal intensive care unit (OR, 1.33; 95% CI, 1.08-1.71; P = .017).

Conclusions: Intrauterine growth restriction is associated with fetal thymic involution, and a small fetal thymus is an early indicator of adverse perinatal outcomes in pregnancies complicated by IUGR.
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http://dx.doi.org/10.7863/ultra.15.05039DOI Listing
March 2016

Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery.

J Turk Ger Gynecol Assoc 2015 2;16(4):231-6. Epub 2015 Nov 2.

Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, İzmir, Turkey.

Objective: The aim of this study was to identify the prevalence of anemia and predisposing factors contributing to anemia in pregnant women prior to delivery.

Material And Methods: A retrospective case-control study was conducted on 1221 women who delivered between 37 and 42 weeks of gestation between July 2014 and January 2015. Data on the subjects' socioeconomic and demographic characteristics, pregnancy outcomes, and hemoglobin levels within 24 h prior to delivery were collected. The study population was divided into two groups on the basis of the presence of anemia within 24 h prior to delivery. Anemia was defined as a hemoglobin level of <11 g/dL. The prevalence of pre-delivery anemia was estimated, and antenatal predictors of anemia were determined using multivariate logistic regression analysis.

Results: The prevalence of anemia in women attending our center for delivery was 41.6% [95% confidence interval (CI) =38.84-44.37]. After multivariate logistic regression analysis, parity >3 [odds ratio (OR) =1.82, 95% CI=1.24-2.96, p=0.002], illiterate (OR=2.23, 95% CI=1.35-3.45, p=0.001) and primary educational level (OR=2.01, 95% CI=1.28-3.39, p=0.008), household monthly income per person <250 Turkish liras (OR=2.34, 95% CI=1.49-3.89, p<0.001), first admission at second (OR=1.63, 95% CI=1.24-2.81, p=0.006) and third trimester (OR=2.45, 95% CI=1.41-4.06, p<0.001), number of antenatal visits <5 (OR=1.45, 95% CI=10.5-2.11) and 5-10 (OR=1.3, 95% CI=1.03-2.09), duration of iron supplementation <3 months (OR=2.62, 95% CI=1.51-4.17) and 3-6 months (OR=1.68, 95% CI=1.13-2.91), and occurrence of preeclampsia (OR=1.55, 95% CI=1.03-2.1, p=0.041) were independently associated with anemia.

Conclusion: Socioeconomic determinants constitute most of the anemia cases and, hence, should be considered as major risk factors of anemia in women attending for delivery at term.
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http://dx.doi.org/10.5152/jtgga.2015.15071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664215PMC
December 2015

Effect of antenatal betamethasone administration on Doppler velocimetry of fetal and uteroplacental vessels: a prospective study.

J Perinat Med 2016 Mar;44(2):243-8

Objectives: To examine the effect of antenatal betamethasone administration on Doppler parameters of fetal and uteroplacental circulation.

Methods: Seventy-six singleton pregnancies that received betamethasone therapy were prospectively evaluated. Doppler measurements of pulsatility indices (PI) in fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus and maternal uterine arteries were performed before (0 h) and 24, 48, 72 and 96 h after the first dose of betamethasone. Women with positive end-diastolic flow (EDF) in UA and those with absent or reversed EDF in UA were evaluated separately.

Results: Fifty-two women with EDF in UA and 24 women with absent or reversed flow in UA were examined. Administration of maternal betamethasone was followed by a significant decrease in the PI of the MCA at 24 h (P<0.05). Additionally, return of absent to positive, reversed to absent or from reversed to positive diastolic flow in UA was detected within 24 h in 19 (79.2%) fetuses with absent or reversed UA-EDF. All alterations were transient and maintained up to 72 h.

Conclusions: Antenatal administration of betamethasone is associated with significant but transient changes in the fetal blood flow. Hence, intensive surveillance of fetuses with Doppler ultrasonography is warranted following betamethasone therapy.
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http://dx.doi.org/10.1515/jpm-2015-0194DOI Listing
March 2016

Impact of interpregnancy interval on the subsequent risk of adverse perinatal outcomes.

J Obstet Gynaecol Res 2015 Nov 14;41(11):1744-51. Epub 2015 Jul 14.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Aim: The aim of this study was to investigate the impact of interpregnancy interval as a risk factor on multiple adverse perinatal outcomes.

Material And Methods: Interpregnancy intervals and confounding factors were determined for healthy pregnancies (controls [n = 357]) and for pregnancies complicated by adverse perinatal outcomes. Interpregnancy interval was categorized as <6, 6-11, 12-17, 18-23, 24-35 and ≥36 months. Adverse outcomes included spontaneous labor leading to preterm birth (n = 265), preterm premature rupture of membranes (n = 245), pre-eclampsia (n = 286), gestational diabetes (n = 302), abnormal placentation (n = 154), anemia (n = 314), congenital anomalies (n = 459), post-partum hemorrhage (n = 326) and small for gestational age (n = 168). Multivariate logistic regression analysis was performed to assess the association of each outcome with the interpregnancy interval categories.

Results: Spontaneous labor leading to preterm birth (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.13-1.97), preterm premature rupture of membranes (OR, 1.69; 95%CI, 1.28-2.39), congenital anomalies (OR, 1.38; 95%CI, 1.09-1.76) and small for gestational age (OR, 1.68; 95%CI, 1.14-2.34) were significantly associated with intervals of <6 months. Among congenital anomalies, short interpregnancy interval represents an increased risk for cardiac defects (OR, 1.55; 95%CI, 1.09-5.46), neural tube defects (OR, 2.06; 95%CI, 1.32-7.64) and central nervous system anomalies (OR, 1.45; 95%CI, 1.12-3.65).

Conclusion: Short interpregnancy interval is an independent risk factor for adverse perinatal outcomes.
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http://dx.doi.org/10.1111/jog.12783DOI Listing
November 2015

Predictors of severity in primary postpartum hemorrhage.

Arch Gynecol Obstet 2015 Dec 4;292(6):1247-54. Epub 2015 Jun 4.

Department of Perinatology, Tepecik Training and Research Hospital, Izmir, Turkey.

Purpose: To identify risk factors and etiologies leading to severe primary postpartum hemorrhage (PPH) in women with PPH.

Methods: Women who experienced PPH within the first 24 h after delivery over a 3-year period were retrospectively evaluated. Patients were divided into two groups on the basis of severe PPH (n = 125) or non-severe PPH (n = 411). Risk factors and etiologies for severe PPH were explored using univariate and multivariate logistic regression analyses.

Results: PPH and severe PPH complicated 2.1 and 0.49 % of all deliveries, respectively. Previous cesarean delivery (OR = 3.15, 95 % CI = 1.02-10.3; p = 0.001), prolonged labor (OR = 3.62, 95 % CI = 3.21-4.03; p < 0.001), oxytocin augmentation (OR = 3.32, 95 % CI 2.05-5.93; p < 0.001) and emergency cesarean delivery (OR = 4.75, 95 % CI 1.32-12.96; p < 0.001) were the factors independently associated with severe PPH. Etiologies significantly associated with severe PPH are uterine atony (OR = 2.72, 95 % CI 1.64-4.55; p < 0.001) and abnormal placentation (OR = 3.05, 95 % CI 1.56-6.27; p = 0.006).

Conclusion: Previous cesarean delivery, prolonged labor, oxytocin augmentation and emergency cesarean delivery are strongest predictors of severe blood loss in women with PPH. In addition, uterine atony and abnormal placentation are the etiologies significantly associated with severe PPH.
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http://dx.doi.org/10.1007/s00404-015-3771-5DOI Listing
December 2015

The effect of associated structural malformations in the prediction of chromosomal abnormality risk of fetuses with echogenic bowel.

J Matern Fetal Neonatal Med 2016 5;29(1):41-5. Epub 2014 Dec 5.

a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey.

Objective: Our aim is to determine the frequency of chromosomal abnormalities and also to identify the role of structural malformations on the chromosomal abnormality risk among fetuses with echogenic bowel.

Methods: Over a 6-year period fetuses with echogenic bowel (FEB) were retrospectively evaluated. The pregnancies with intra-amniotic bleeding history, congenital infection, cystic fibrosis and intrauterine growth retardation were excluded from the study. Types and frequency of sonographically detected fetal malformations were identified. Chromosomal abnormality incidences according to association with soft markers and major fetal abnormalities were compared.

Results: Of the 281 fetuses with echogenic bowel, 105 (37.37%) were isolated, 78 (27.76%) were associated with soft markers and 98 (34.87%) were associated with major abnormalities. There were 30 (10.7%) fetuses with abnormal karyotypes. The chromosomal abnormality rate of the groups of isolated FEB, FEB + soft markers and FEB + major abnormalities were 6.7%, 7.7% and 17.4%, respectively.

Conclusions: Chromosomal abnormality risk in fetuses with echogenic bowel should be evaluated according to additional sonographic findings. Association of structural malformations increases the chromosomal abnormality risk, although this risk is not significant with the presence of soft markers alone.
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http://dx.doi.org/10.3109/14767058.2014.986091DOI Listing
September 2016

Perinatal outcomes in pregnancies with oligohydramnios after preterm premature rupture of membranes.

J Matern Fetal Neonatal Med 2015 Nov 28;28(16):1918-22. Epub 2014 Oct 28.

a Department of Perinatology , Izmir Tepecik Training and Research Hospital , Izmir , Turkey.

Objective: Our purpose was to determine whether singleton pregnancies complicated by preterm premature rupture of membranes (PPROM) and oligohydramnios are at an increased risk of having maternal and neonatal morbidity.

Methods: We performed a retrospective analysis of 389 women with PPROM between 24 and 34 weeks of gestation in a single tertiary center during 2008-2014. Patients were divided into two groups on the basis of amniotic fluid index (AFI) < 5 cm (n = 188) or AFI ≥ 5 cm (n = 201). Perinatal outcomes were compared according to amniotic fluid volume. The Student's t-test and Mann-Whitney U test were used to compare variables with normal and abnormal distribution, respectively. Categorical variables were examined by the chi-square test.

Results: Patients with an AFI < 5 cm demonstrated a significantly shorter latency to delivery (p < 0.001), a higher rate of clinical chorioamnionitis (p = 0.029) and emergency cesarean delivery (p = 0.043) and a lower neonatal Apgar score at first minute (p = 0.004).

Conclusion: Initial oligohydramnios after PPROM is associated with shorter latency to delivery, higher rate of clinical chorioamnionitis, higher rate of emergency cesarean delivery, and lower 1-min Apgar score.
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http://dx.doi.org/10.3109/14767058.2014.972927DOI Listing
November 2015

Perioperative and postoperative complications after Ophira mini sling operations.

Arch Gynecol Obstet 2015 Feb 20;291(2):341-6. Epub 2014 Aug 20.

Ministry of Health Tepecik Education and Research Hospital, Izmir, Turkey.

Aim: To evaluate perioperative and postoperative complications of mini sling operations in the surgical treatment of female urinary incontinence.

Methods: The study was comprised of 151 female patients with stress urinary incontinence (SUI) or mixed incontinence (MUI) with predominant SUI patients who underwent the mini sling procedure. The duration of the follow-up ranged from 6 to 21 months. All women had positive cough stress tests preoperatively. The procedure was performed under local (86.1 %) or spinal anesthesia (13.9 %) with the same mini slings for all cases. Patients were examined in the outpatient clinic at 1 and 6 months after surgery.

Results: The mean age was 49 years old (SD 10) with a range of 26-82. Of the 151 patients, 42 (27.8 %) presented MUI, while 109 (72.2 %) presented SUI. Mean parity was 3 ± 1. Mean body mass index was 28.9 ± 3.5. 60 (39.7 %) of the cases were postmenopausal. There were 73 women who participated in 6 months follow-ups and 78 women who did 1-year follow-ups. The mean operating time was 13 ± 3.1 min. There were no major intraoperative complications due to mini sling surgery. 120 (79.5 %) patients were discharged the day following the surgery. Ten patients (6.1 %) had de novo urge incontinence in their post-operative follow-ups which was resolved using anti-cholinergic drugs. Two patients (1.2 %) required sling sections due to prolonged bladder outlet obstruction. There were 15 patients that complained about de novo dyspareunia (9.9 %). Vaginal mesh extrusion was reported in 18 (11.9 %) patients. The mean preoperative and postoperative hemoglobin concentrations were 12.9 ± 1.3 and 12.5 ± 1.3 g/dL, respectively.

Conclusion: The mini sling system can be considered an easy and effective method for treating stress urinary incontinence without major complication rates.
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http://dx.doi.org/10.1007/s00404-014-3402-6DOI Listing
February 2015

Can platelet count and mean platelet volume during the first trimester of pregnancy predict preterm premature rupture of membranes?

J Obstet Gynaecol Res 2015 Jan 11;41(1):23-8. Epub 2014 Aug 11.

Department of Perinatology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.

Aim: The aim of our study was to evaluate the values of platelet count and mean platelet volume (MPV) obtained from maternal serum during the first trimester to predict subsequent preterm premature rupture of membranes (PPROM).

Material And Methods: The records of 318 women with PPROM and 384 healthy controls in a single center between 2009 and 2013 were retrospectively evaluated. Platelet count and MPV values between 7 and 14 weeks of gestation were compared. Receiver-operator curve analysis was performed to identify the optimal platelet count and MPV cut-off levels predicting PPROM.

Results: Compared with controls, women with PPROM had significantly increased levels of platelet count and significantly decreased levels of MPV in the first trimester (P < 0.001). The area under the receiver-operator curve was 0.642 for MPV and 0.579 for platelet count. The cut-off values of MPV ≤ 8.6 fL and platelet count ≥216 × 10(3) /μL predicted PPROM with a sensitivity of 58% and 65% and specificity of 62% and 44%, respectively.

Conclusion: MPV can be used as a more efficient predictor for an early diagnosis of PPROM than platelet count. However, further research combining other markers is needed to increase the efficiency of prediction.
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http://dx.doi.org/10.1111/jog.12484DOI Listing
January 2015

Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation.

Arch Gynecol Obstet 2014 Sep 3;290(3):449-55. Epub 2014 Apr 3.

Department of Perinatology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey,

Purpose: To identify risk factors and perinatal outcomes associated with the duration of latency period in women who experience preterm premature rupture of membranes (PPROM).

Methods: A retrospective study of women who experienced PPROM between 24 and 34 weeks of gestation was performed in a single tertiary center between 2009 and 2013. Patients were divided into two groups based on the duration of the latency period after PPROM: Group 1 ≤72 h and Group 2 >72 h. Risk factors and perinatal outcomes were compared according to latency period. Student's t test and Chi-square test were used to compare continuous and categorical variables, respectively, between the two groups. Multivariate regression analysis was performed to control for potential confounding variables.

Results: In total, 3,257 patients presented with PPROM during the study period; of these, 204 (6.3 %) met the inclusion criteria. Higher gestational age upon admission (odds ratio [OR] = 0.83, 95 % confidence interval [CI] = 0.79-0.87; p < 0.001), oligohydramnios (OR = 0.47, 95 % CI = 0.25-0.91; p = 0.018), and twin gestation (OR = 0.67, 95 % CI = 0.45-0.89; p = 0.032) were independently associated with a shortened latency period. In addition, prolonged latency significantly increased the occurrence of chorioamnionitis (OR = 2.23, 95 % CI = 1.48-3.14; p = 0.002), placental abruption (OR = 1.9, 95 % CI = 0.95-3.53; p = 0.033), and decreased the length of stay of neonates in the intensive care unit (OR = 0.85, 95 % CI = 0.39-1.79; p = 0.021).

Conclusion: Gestational age at PPROM, twin gestation, and oligohydramnios significantly affected the latency period. Although a latency period >72 h was associated with chorioamnionitis and placental abruption, adverse neonatal outcomes were not affected.
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http://dx.doi.org/10.1007/s00404-014-3227-3DOI Listing
September 2014

Use of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated heavy menstrual bleeding.

J Pak Med Assoc 2013 Nov;63(11):1349-52

Department of Obstetrics and Gynaecology, Seferihisar Necat Hepkon State Hospital, Izmir, Turkey.

Objective: To evaluate the effects of a levonorgestrel-releasing intrauterine device in the treatment of adenomyosis associated with heavy menstrual bleeding.

Methods: The retrospective study was conducted at a tertiary referral hospital in Izmir, Turkey, and comprised data on adenomyosis patients who were implanted with a levonorgestrel-releasing intrauterine device for heavy menstrual bleeding between December 2004 and January 2008. After the insertion of the device, all patients were followed up by transvaginal ultrasonography and serum haemoglobin levels and menstrual patterns were determined at the 6th and 12th month. Data was analysed using SPSS 10.

Results: The mean age of the 42 women in the study was 43.2 +/- 0.8 years. At the sixth month, amenorrhoea, oligomenorrhoea, spotting and regular menstrual flow were 9.5% (n = 4), 7% (n = 3), 19% (n = 8), and 64% (n = 27), respectively. At the 12th month, the same parametres were 9.5% (n = 4), 7% (n = 3), 12% (n = 5), and 71% (n = 30), respectively. Haemoglobin levels had increased and endometrial thickness had decreased, and these differences were statistically significant (p < 0.001).

Conclusion: The easy-to-use levonorgestrel-releasing intrauterine device can be added to the treatment options as a well-tolerated alternative in cases where a woman who has completed her fertility and does not request a hysterectomy has anaemia associated with adenomyosis.
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November 2013

The impact of thrombocytosis on clinicopathological prognostic factors and survival in patients with vulvar cancer.

Ginekol Pol 2013 Jun;84(6):450-5

Canakkale Onsekiz Mart University, Obstetrics and Gynecology Department, Canakkale, Turkey.

Purpose: Reactive thrombocytosis in many solid tumors has widely been studied. In the present study we aimed to investigate whether thrombocytosis is a common and prognostic factor in women with vulvar cancer

Material & Methods: The preoperative platelet counts of 41 women, treated for vulvar cancer in our onco-gynecology center between March 1994 and January 2007, were retrospectively reviewed and correlated to clinical and pathological prognostic factors and 5-year survival. The chi-square or Fisher exact tests were used to compare categorical variables. P value < 0.05 was accepted for statistical significance.

Results: The mean age was 65.4 +/- 11.3 years (range 39-83y). All patients had squamous histology The mean platelet count was 335.42 x 109/L +/- 82.03 (range 142-1155x109/L). Thrombocytosis was detected in 8 (19.5%) patients. No correlation was found between thrombocytosis and grade (p = 0.65), LVSI (p = 0.82), tumor size (p = 0.73), depth of invasion (p = 0.18), lymph node metastasis (0.93), and FIGO stage (p = 0.78). The mean follow up time was 118.0 +/-43.1 months (range 60-213 months). At the end of the study period 14 patients (34.2%) had died, 8 (19.5%) had recurrence, 19 (46.3%) were disease-free. General 5-year survival was 68.3% (28/41). The 5-year survival rate for patients with thrombocytosis was 75.0% (6/8), which was not significantly different from the 5-year survival of patients with normal platelet counts (22/33; 66.7%) (p = 0.75).

Conclusion: Our study showed that, overall, thrombocytosis was found in about 20% of patients with vulvar cancer and proved to be not linked to the best known prognostic factors and survival. Thus, disease stage and inguinofemoral lymph node status continue to be the best prognostic factors for this disease.
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http://dx.doi.org/10.17772/gp/1603DOI Listing
June 2013

Evaluation of tissue Doppler-derived myocardial performance index in fetuses with intracardiac echogenic focus.

J Matern Fetal Neonatal Med 2013 Nov 23;26(16):1662-6. Epub 2013 May 23.

MH Aegean Maternity, Teaching and Training Hospital .

Objective: To compare cardiac function between fetuses with and without intracardiac echogenic foci (IEFs) by conventional echocardiography and tissue Doppler (TD) imaging.

Methods: Fetuses having IEF and no additional cardiac or extracardiac anomaly between 20 and 28 weeks (median 22 weeks) of gestation (n = 61) were compared with healthy fetuses between 18 and 29 weeks (median 23 weeks) of gestation (n = 55). Pulmonary artery and aortic peak velocities, atrioventricular (AV) early diastole (E) and atrial contraction (A) velocities and E/A ratios were measured. TD-derived myocardial performance index (MPI) was also measured.

Results: Tricuspid valve E/A ratios, which were 0.634 ± 0.07 versus 0.639 ± 0.06 (p = 0.697), mitral valve E/A ratios, which were 0.604 ± 0.08 versus 0.612 ± 0.07 (p = 0.600), aorta peak velocities, which were 0.709 ± 0.11 versus 0.697 ± 0.11 (p = 0.592) and pulmonary artery peak velocities, which were 0.699 ± 0.12 versus 0.694 ± 0.11 (p = 0.800) in the study and the control groups, respectively. TD-derived measurements in the study and control groups included tricuspid valve MPI, which were 0.452 ± 0.08 versus 0.473 ± 0.09 (p = 0.221) and mitral valve MPI values, which were 0.444 ± 0.1 versus 0.445 ± 0.09 (p = 0.965), respectively, and this difference was not statistically significant.

Conclusion: An isolated IEF is not associated with abnormal cardiac function. We suggest that the presence of an isolated IEF should not be an indication for fetal cardiac function examination either with conventional Doppler or TD imaging techniques, unless there is a coexisting cardiac or extracardiac anomaly.
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http://dx.doi.org/10.3109/14767058.2013.797957DOI Listing
November 2013

Relationship between mean platelet volume and low-grade systemic coagulation with vitamin D deficiency in primary ovarian insufficiency.

Arch Gynecol Obstet 2013 Jul 2;288(1):207-12. Epub 2013 Feb 2.

Clinic of Obstetrics and Gynecology, Beyhekim State Hospital, Konya, Turkey.

Objective: Premature menopause in young women is associated with an increased incidence of cardiovascular disease. The present study was designed to determine vitamin D (vit D) and the coagulation parameters such as activated partial thromboplastin time (APTT), PT, D-dimer, white blood cell (WBC), and mean platelet volume (MPV) levels, in primary ovarian insufficiency (POI) patients and control women with a normal menstrual cycle.

Materials And Methods: A total of 43 patients with non-diabetic POI were studied in order to evaluate and compare with the control group comprising 33 women with a normal menstrual cycle.

Results: There was no significant difference between the groups for age and body mass index (BMI). D-dimer, WBC, MPV, PT, total cholesterol, and LDL cholesterol were higher in women with POI. APTT levels were also increased but missed the significance in POI group. Women with POI had significantly lower serum vit D levels compared with healthy control group. FSH level was positively correlated with D-dimer, WBC, MPV, and negatively correlated to vit D and serum D vit level was inversely correlated with MPV, APTT, D-dimer, FSH levels in individual women.

Conclusions: The obtained results seem to indicate that POI patients had low-grade systemic coagulation and fibrinolytic activation as evidenced by elevated D-dimer, WBC, MPV, PT values potentially be used as indicators of risk factor for thrombosis and atherosclerosis in POI women. All of our patients with POI were deficient in vit D. These results also suggest that vit D deficiency plays important roles of POI women and associated with coagulation, independently from age and BMI.
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http://dx.doi.org/10.1007/s00404-013-2735-xDOI Listing
July 2013

Prolonged breast-feeding is an independent risk factor for postmenopausal osteoporosis.

Maturitas 2013 Mar 24;74(3):270-5. Epub 2013 Jan 24.

Aegean Maternity and Women's Health Hospital, Department of Obstetrics and Gynecology, Izmir, Turkey.

Objectives: This study investigated the effects of parity and age at first pregnancy and breast-feeding, as well as duration of BF for total and per child on postmenopausal osteoporosis.

Study Design: The study was conducted among 542 cases who were divided based on the presence or absence of osteoporosis. Patients were separated according to their first pregnancy and breast-feeding age as before or after 27 years. Osteoporosis was defined as a T score of -2.5 or lower.

Main Outcome Measures: Parity, age at first pregnancy and breast-feeding, breast-feeding period for total and average duration per child according to a questionnaire were assessed.

Results: Osteoporosis group had significantly lower parity compared to non-osteoporosis group. The age at first pregnancy and breast-feeding<27 age were significantly more frequent in osteoporosis group. They also had prolonged breast-feeding period. Women who had a breast-feeding period per child>1 year under age 27 was higher in osteoporosis group. In multivariate analysis, women who breast-fed>1 year per child had the highest risk for osteoporosis (odds ratio: 12.92; 95% confidence interval, 3.1-52.6) and osteoporosis risk for women who breast-fed>1 year per child under age 27 was 7.1. Increased parity was associated with a significant protective effect for osteoporosis.

Conclusions: Extended breast-feeding period per child>1 year is the highest risk factor for osteoporosis independent of first breast-feeding age. However, high parity has a protective effect.
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http://dx.doi.org/10.1016/j.maturitas.2012.12.014DOI Listing
March 2013

Effects of infertility and infertility duration on female sexual functions.

Arch Gynecol Obstet 2013 Apr 24;287(4):809-12. Epub 2012 Nov 24.

Department of Obstetrics and Gynecology, Sebinkarahisar State Hospital, Giresun, Turkey.

Objective: The objective was to evaluate the effects of infertility and its duration on female sexual functions.

Materials And Methods: One-hundred and seventy-four (21.5 %) primary infertile cases, who attended the infertility outpatient clinic of our hospital, with a mean age of 31.2 ± 3.8 (range 20-45), have been determined as study group. In addition, 635 (78.5 %) cases with a mean age of 32 ± 3.2 (range 17-45) years, which attended the gynecology outpatient clinic with various complaints, were included as the control group. Infertile cases were grouped into three according to infertility duration: less than 2 years (Group I), 2-5 years (Group II), and 5 years and longer (Group III). Sexual dysfunction was evaluated via Turkish version of female sexual function index (FSFI) in the women who accepted to participate in this research.

Results: All the 809 cases incorporated in our study were found to be at risk for sexual dysfunction. Upon comparison between infertile and fertile groups, no meaningful statistical difference was determined within the scores of desire, arousal, lubrication, orgasm, sexual satisfaction, pain and total FSFI parameters (p > 0.05). The assessment on infertility durations showed that only sexual satisfaction scores were similar, whereas all other parameter scores and total FSFI scores were different significantly between all three groups. The scores got meaningfully lower as infertility duration of the couples extends (p < 0.05).

Conclusions: As the infertility duration extends, the scores of all parameters, except sexual satisfaction, decreases. But as many factors play a role in female sexual dysfunction, to blame prolonged infertility as a situation that negatively affects female sexual life, prospectively designed studies should be performed.
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http://dx.doi.org/10.1007/s00404-012-2633-7DOI Listing
April 2013

Is there a link between premature ovarian failure and serum concentrations of vitamin D, zinc, and copper?

Menopause 2013 Jan;20(1):94-9

Clinic of Obstetrics and Gynecology, Beyhekim State Hospital, Konya, Turkey.

Objective: The risk of primary ovarian insufficiency (POI) increases in association with autoimmune conditions. Adequate intake of vitamin D (vit D) and trace elements is required for the immune system to function efficiently. The aim of this study was to evaluate vit D, zinc, and copper blood levels in women with POI who had given birth to at least one child and in women with normal menstrual cycles.

Methods: This was a cross-sectional, case-control study involving 63 participants divided into two groups: the study group, which is composed of 35 women with POI, and the control group, which is composed of 28 women with normal menstrual cycles. Serum concentrations of zinc, vit D, and copper were determined for each participant.

Results: Women with POI had significantly higher serum copper levels and copper-to-zinc ratio but significantly lower serum vit D and zinc levels when compared with the healthy control group. Serum follicle-stimulating hormone levels were inversely correlated with zinc and vit D levels and positively correlated with the copper-to-zinc ratio and copper levels. Vit D levels were inversely correlated with follicle-stimulating hormone levels, copper-to-zinc ratio, and copper levels and positively correlated with zinc levels.

Conclusions: Most women with POI are deficient in vit D. Zinc, copper, and vit D seem to correlate with hormonal status in the participants. The present study may generate hypotheses for future studies that will investigate the possible mechanisms behind alterations in trace elements and vit D deficiency in women with POI and whether these changes could be used to screen for the risk of developing POI.
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http://dx.doi.org/10.1097/gme.0b013e31826015caDOI Listing
January 2013

Prevention of infectious morbidity after elective abdominal hysterectomy.

Arch Gynecol Obstet 2012 Oct 24;286(4):959-63. Epub 2012 May 24.

Ministry of Health, Seferihisar Necat Hepkon State Hospital, Izmir, Turkey.

Objective: Our aim was to investigate whether posthysterectomy infectious morbidity could be reduced by intravaginal therapy before operations.

Materials And Methods: Women expected to undergo elective total abdominal hysterectomy were included. Vaginal flora was evaluated by preoperative Gram-stained vaginal smears up to Nugent's criteria. Study group were administered vaginal combination therapy including 500 mg metronidazole and 100 mg miconazole nitrate two times a day for 7 days. Control group were not given any preoperative vaginal therapy. Postoperative infectious morbidity was evaluated and compared.

Results: Ninety-five women in the study group and 97 women in the control group completed the study protocol. Women with abnormal flora had significantly more wound and vaginal cuff infections than the women with normal flora in the control group. Urinary infections were significantly higher in the study group (38.9 vs. 23.7 %) and vaginal cuff infections were significantly higher in the untreated control group (2.1 vs. 8.2 %).

Conclusions: We concluded that postoperative vaginal cuff infections can be decreased by treating abnormal vaginal flora before elective abdominal hysterectomies.
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http://dx.doi.org/10.1007/s00404-012-2382-7DOI Listing
October 2012

Cytomegalovirus and rubella seroprevalence in pregnant women in Izmir/Turkey: follow-up and results of pregnancy outcome.

Arch Gynecol Obstet 2012 Sep 1;286(3):605-8. Epub 2012 May 1.

Obstetric and Gynecology, SB Seferihisar Necat Hepkon State Hospital, Izmir, Turkey.

Purpose: It is aimed to determine the Rubella and CMV prevalence in the pregnant women in Izmir and to research the effect of these infections on the course of pregnancy in the pregnant women exposed to infection during pregnancy.

Methods: The pregnant women applied to pregnancy outpatient department during 2001-2008 have been examined with enzyme-linked fluorescent assay (VIDAS; bioMérieux) method in terms of Rubella and CMV IgM and IgG antibodies and CMV IgG avidity test.

Results: Totally 5,959 pregnant women were included in the study. The seropositivity rates for Rubella and CMV were found as 97.8 and 98.3 %, IgM positivity rates were found as 0.37 and 0.18 %, respectively. Curettage was recommended to the pregnant women in which Rubella IgM positivity was detected in the first trimester of the pregnancy. Eight of the pregnant women in which IgM was found as positive after the 20th week of pregnancy were examined and three intrauterine growth retardation, one hypospadias and three normal deliveries were seen in these pregnant women. Any congenital anomaly finding was not detected in the pregnant women with positive CMV IgM.

Conclusions: Seroprevalence values are high for Rubella and CMV in our region. It can be recommended not to check the pregnant women routinely for this purpose with the good implementation of Rubella vaccine programs.
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http://dx.doi.org/10.1007/s00404-012-2353-zDOI Listing
September 2012

Metformin plus oral contraceptive may decrease plasma sCD40 ligand in women with PCOS patients.

Gynecol Endocrinol 2011 Feb 8;27(2):91-5. Epub 2010 Jun 8.

Izmir Bozyaka Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey.

Aim: To evaluate sCD40L levels in women with polycystic ovary syndrome (PCOS) who use combination therapy with metformin and oral contraceptives.

Methods: Total of 60 patients with PCOS was studied to evaluate and compare with a non-PCOS group consisting of 30 subjects. A low-dose oral contraceptive containing ethinyl oestradiol-cyproterone acetate (EE/CA) and metformin (M; 850 mg metformin twice a day) were given for three cycles. Plasma sCD40L was measured before and after the treatment of 3 months.

Results: At baseline, the sCD40L levels of the patients with PCOS was significantly higher than those of control subjects (3.1 ± 2.0 vs. 2.05 ± 1.0, respectively; p=0.002). An average of 3 months of EE/CA-M therapy induced a significant decrease of sCD40L levels in the PCOS group (3.1 ± 2.0 vs. 2.5 ± 1.0; p=0.026). After having treated patients with PCOS, the sCD40L level was not completely normalised when compared to the healthy controls (2.5 ± 1.0 vs. 2.05 ± 1.0; p=0.039).

Conclusions: PCOS is associated with elevated levels of sCD40L. Adding metformin therapy to EE/CA may decrease sCD40L levels in women PCOS. However, after the treatment for PCOS subjects, the sCD40L was not completely normalised when compared patients to healthy controls.
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http://dx.doi.org/10.3109/09513590.2010.491164DOI Listing
February 2011

Is increased maternal endothelin-1 concentration associated with neonatal asphyxia and preterm delivery in intrahepatic cholestasis of pregnancy?

Arch Gynecol Obstet 2010 Dec 28;282(6):617-21. Epub 2009 Oct 28.

Izmir Aegean Obstetrics and Gynecology Teaching Hospital, Izmir, Turkey.

Objectives: To evaluate plasma endothelin-1 (ET-1) and fetuin-A concentrations in women with intrahepatic cholestasis of pregnancy (ICP) and to determine whether there is any association between these parameters and fetal asphyxia.

Methods: We carried out a prospective case-control study consisting of 32 women with ICP at third trimester of pregnancy and 32 pregnant women without ICP. Blood samples from maternal peripheral venous circulation were collected and ET-1 and fetuin-A levels were determined from the plasma samples. Pulse-wave Doppler and Apgar scores were also recorded.

Results: ET-1 concentrations were significantly higher in ICP patients. No difference was observed in fetuin-A levels between the two groups. Six newborns were declared as asphyctic (APGAR score at the 5 min <7). Maternal ET-1 levels did not correlate with the APGAR score at 5 min, total bile acid (TBA) and umbilical artery systolic/diastolic ratio with ICP patients. TBA levels were positively correlated with umbilical artery systolic/diastolic ratio negatively correlated with APGAR score at the 1' and 5'-Apgar score in all subjects. Plasma ET-1 concentration was higher in the preterm neonates of mothers with ICP compared with normal term neonates of mothers.

Conclusions: Although these data did not show evidence that maternal ET-1 would be associated with fetal distress, we can speculate that maternal ET-1 may be playing a role in the underlying pathology regarding microvascular dysfunction especially in the preterm neonates of mothers with ICP. Elevated TBA levels may increase the risk of asphyxia whereas fetuin-a (as an anti-inflammation marker) does not seem to have effect in women with ICP.
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http://dx.doi.org/10.1007/s00404-009-1261-3DOI Listing
December 2010
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