Publications by authors named "Dilek Uygur"

95 Publications

Is ProBNP a New Marker for Predicting Intrauterine Growth Restriction?

Z Geburtshilfe Neonatol 2021 Mar 10. Epub 2021 Mar 10.

Department of Perinatology, Etlik Lady Zübeyde Gynaecology Education and Research Hospital, Ankara, Turkey.

Purpose: To evaluate the usability of first-trimester maternal serum ProBNP levels in the prediction of intrauterine growth restriction (IUGR). Methods In this prospective study, blood samples taken from 500 women who applied to our polyclinic for routine serum aneuploidy screening between the 11-14th gestational weeks were centrifuged. The obtained plasma samples were placed in Eppendorf tubes and stored at -80+°C. For the final analysis, first-trimester maternal serum ProBNP levels of 32 women diagnosed with postpartum IUGR and 32 healthy women randomly selected as the control group were compared. FGR was defined as estimated fetal weight below the 10th percentile for the gestational age.

Results: The mean ProBNP levels were statistically and significantly higher in the women with intrauterine growth restriction (113.73±94.69 vs. 58.33±47.70 pg/mL, p<0.01). At a cut-off level of 50.93, ProBNP accurately predicted occurrence of IUGR (AUC+= 0.794 (95% confidence interval 0.679-0.910), p+= 0.001) with sensitivity and specificity rates of 78.1 and 69.0%, respectively. Conclusion First-trimester serum ProBNP level was significantly higher in women who developed IUGR compared to healthy controls. First-trimester ProBNP level can be used as a potential marker to predict the development of IUGR in pregnant women.
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http://dx.doi.org/10.1055/a-1382-8787DOI Listing
March 2021

Doppler assessment of the fetus in pregnant women recovered from COVID-19.

J Obstet Gynaecol Res 2021 Mar 1. Epub 2021 Mar 1.

University of Health Sciences, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey.

Objective: The aim of this study was to evaluate the maternal-fetal Doppler patterns in pregnant women recovered from COVID-19.

Methods: This prospective case-control study was conducted in Ankara City Hospital between July 1, 2020 and August 30, 2020. Thirty pregnant women who were diagnosed with COVID-19 and completed the quarantine process were compared with 40 healthy pregnant women in terms of the fetal Doppler parameters. All pregnant women diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were followed up in our clinic and their diagnoses have been confirmed in nasopharyngeal and oropharyngeal samples by quantitative real time reverse transcriptase polymerase chain reaction (RT-PCR) method. Doppler ultrasonographic assessment of the uterine arteries (UtA) and middle cerebral artery (MCA) were used in addition to umbilical artery (UA) Doppler between 23 and 40 weeks of gestation. Also, cerebroplacental ratio (CPR) was calculated according to gestational age.

Results: The pulsatility and resistance indices of umbilical and UtA showed a significant increase in pregnant women in the study group compared to the control group (p < 0.05). Multivariable logistic regression analysis revealed that pulsatility and resistance indices of the mean UtA were independently associated with disease (OR > 1000, 95%CI 9.77 to >1000, p = 0.009; OR 0,000 95%CI 0,000-0,944, p = 0,049), respectively. Medical treatment was given to 16/30 (53%) of pregnant women diagnosed with COVID-19.

Conclusion: In conclusion, uterine artery Doppler indices in the third trimester may have clinical value in pregnant women recovered from COVID-19.
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http://dx.doi.org/10.1111/jog.14726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014281PMC
March 2021

Maternal and Placental Zinc and Copper Status in Intra-Uterine Growth Restriction.

Fetal Pediatr Pathol 2020 Dec 12:1-10. Epub 2020 Dec 12.

Ankara City Hospital, Republic of Turkey Ministry of Health, Cankaya, Turkey.

Background And Aim: Zinc and copper are essential trace elements for cell growth and proliferation. Their deficiency may contribute to intrauterine growth restriction (IUGR). We aimed to determine the zinc and copper status of maternal serum and placenta samples of pregnant women with fetal IUGR and age-matched pregnant women without IUGR.

Method: Serum and placenta samples obtained from 37 IUGR and 21 healthy pregnant women were analyzed at delivery.

Results: Placenta zinc concentrations and placenta zinc/copper ratio were significantly lower in the IUGR group compared to controls (p < 0.05). Placenta zinc concentrations correlated with birth weight (p: 0.01, r: 0.31). Maternal levels of zinc and copper were similar between pregnant women with IUGR and controls.

Conclusions: Lower placental zinc and zinc/copper ratio levels in pregnancies with IUGR may indicate that placenta zinc and placental zinc/copper status might be involved in IUGR.
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http://dx.doi.org/10.1080/15513815.2020.1857484DOI Listing
December 2020

Maternal plasma endocan levels in intrauterine growth restriction.

J Matern Fetal Neonatal Med 2020 Apr 14:1-6. Epub 2020 Apr 14.

Department of Perinatology, Zekai Tahir Burak Women's Research and Tertiary Hospital, Ankara, Turkey.

Intrauterine growth restriction (IUGR) is diagnosed when the estimated fetal weight remains below the 10th percentile of gestational age based on pathological restriction of growth and/or accompanying Doppler abnormalities. Endothelial dysfunction is a common pathogenetic pathway underlying IUGR etiology. Endocan (ESM-1) is a novel marker of endothelial dysfunction and inflammation found in the maternal circulation. This study was designed to compare plasma endocan levels between pregnancies complicated with IUGR and a control group. Forty-four pregnancies complicated with IUGR and 47 healthy pregnancies were included. Maternal plasma endocan levels were detected by ELISA. Parametric data was studied by Student's -test. Mann-Whitney -test was used in analyzing non-parametric data. Categorical variables underwent chi-square test. ROC analysis was performed to define the cutoff value of endocan in detecting IUGR. Spearman correlation test was performed. Maternal plasma endocan level varied significantly between IUGR and healthy pregnancies and was 1.8 fold higher in the IUGR group (793.0 (IQR:544.4-1896.0) ng/L vs. 441.8 (IQR: 408.3-512.4) ng/L,  < .001). There was a weak negative correlation between endocan level and 5th and 10th minute APGAR Scores ( =  -0.256;  = .015 and  =  -0.215;  = .042, respectively), a weak positive correlation with umbilical artery pulsatility index, and a moderate negative correlation with cerebroplacental ratio (  =  0.394;  < .001 and  =  -0.459;  < .001, respectively). There was a significant difference between endocan levels of IUGR and healthy pregnancies. Further studies might be designed to investigate the performance of endocan in predicting neonatal outcomes for pregnancies complicated with IUGR.
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http://dx.doi.org/10.1080/14767058.2020.1749591DOI Listing
April 2020

Do Anti-Factor Xa Levels have any Impact on Pregnancy Outcome in Women with Previous Adverse Outcomes?

Z Geburtshilfe Neonatol 2020 Dec 1;224(6):355-359. Epub 2020 Apr 1.

Perinatology, Zekai Tahir Burak Health Practice Research Center, University of Health Sciences, Ankara, Turkey.

Objective: Low-molecular-weight heparin (LMWH) is used during pregnancy in women diagnosed with thrombophilia for prevention of thromboembolic events and prevention of recurrent pregnancy loss. Prophylactic dosing does not always achieve target anti-FXa levels of 0.2-0.6 IU/ml. We aimed to determine if anti-FXa levels, measured in the first trimester, have an influence on pregnancy outcome.

Material And Methods: Eighty-one first-trimester women with a history of adverse pregnancy outcomes under LMWH therapy during pregnancy were enrolled in this study. Anti-FXa levels were measured in the first trimester, and fetal and maternal outcomes were recorded.

Results: The mean age of women was 28±4 (19-40) and mean anti-FXa level 0.44±0.93 IU/ml. No bleeding or clotting complications were associated with LMWH administration. Anti-FXa levels did not have a relationship with gestational age at birth, fetal weight, type of delivery, cesarean indications, postpartum bleeding, APGAR scores, or admission to the neonatal intensive care unit (p>0.005). Anti-FXa levels were not correlated with live birth rates.

Conclusion: Anti-FXa levels did not have an influence on pregnancy and fetal outcomes. The effect of LMWH on pregnancy outcomes may not be due to anticoagulant activity but other mechanisms.
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http://dx.doi.org/10.1055/a-1130-2017DOI Listing
December 2020

The Effect of Antenatal Neuroprotective Magnesium Sulfate Treatment on Cerebral Oxygenation in Preterm Infants.

Am J Perinatol 2020 Mar 6. Epub 2020 Mar 6.

Division of Neonatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Altındağ, Ankara, Turkey.

Objective:  Antenatal magnesium sulfate (MgSO) treatment is associated with reduced risk of cerebral palsy in preterm infants. We aimed to investigate whether this treatment leads to any alterations on cerebral hemodynamics which could be detected by near-infrared spectroscopy (NIRS) readings in early postnatal life.

Study Design:  Infants with gestational ages (GAs) ≤ 32 weeks were divided into two groups regarding their exposure to antenatal neuroprotective MgSO treatment or not. NIRS monitoring was performed to all infants, and readings were recorded for 2 hours each day during the first 3 days of life. The primary aim was to compare regional cerebral oxygen saturation (rcSO) and cerebral fractional tissue oxygen extraction (cFTOE) between the groups.

Results:  Sixty-six infants were exposed to antenatal MgSO, while 64 of them did not. GA and birth weight were significantly lower in the treatment group ( < 0.01). No difference was observed in rcSO and cFTOE levels in the first, second, and the third days of life ( > 0.05). An insignificant reduction in severe intraventricular hemorrhage rates was observed (8 vs. 15%,  = 0.24).

Conclusion:  We could not demonstrate any effect on cerebral oxygenation of preterm infants in early postnatal life that could be attributed to antenatal neuroprotective MgSO treatment. Future studies are warranted to clarify the exact underlying mechanisms of neuroprotection.
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http://dx.doi.org/10.1055/s-0040-1705148DOI Listing
March 2020

There is No Association between Premature Ovarian Insufficiency and Levels of Fetuin-A/α2-Heremans-Schmid Glycoprotein.

J Hum Reprod Sci 2019 Oct-Dec;12(4):299-302. Epub 2019 Dec 17.

Ankara Dr. Zekai Tahir Burak Health Practice Research Center, University of Health Sciences, Ankara, Turkey.

Objective: Fetuin-A is a well-known negative acute-phase protein and has been used liberally to predict vascular disease. The aim of this study was to evaluate the association between serum human fetuin-A/alpha2-Heremans-Schmid glycoprotein levels and idiopathic premature ovarian insufficiency (POI).

Methods: A total of 75 women were included in this case-control study between January 2013 and December 2013. Serum fetuin-A concentrations were measured in 36 women with idiopathic POI and 39 healthy women with regular cycles. Blood samples were drawn after a 12-h overnight fast and were kept at -80°C for subsequent assay. The serum levels of fetuin-A were assessed by commercial ELISA kits (BioVendor Laboratory Medicine Inc., Brno, Czech Republic) and serum concentration values were expressed as μg/ml.

Results: The mean serum fetuin-A levels of idiopathic POI and control women were 229.02 ± 27.79 and 232.37 ± 65.56, respectively, with = 0.771 (independent samples -test). Our results showed no statistically significant difference between serum fetuin-A levels of idiopathic POI women and controls.

Conclusion: The mean values of serum fetuin-A in idiopathic POI women were not significantly different from controls, which implies that there is no significant association between serum fetuin-A levels and idiopathic POI.
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http://dx.doi.org/10.4103/jhrs.JHRS_104_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937773PMC
December 2019

Plasma Endocan Levels in Early and Late-Onset Preeclampsia.

Fetal Pediatr Pathol 2019 Nov 26:1-8. Epub 2019 Nov 26.

Etlik Zübeyde Hanım Women's Health and Research Hospital, Ankara, Turkey.

Preeclampsia (PE) may represent an inflammatory process. Endocan (ESM-1) is a marker of endothelial inflammation. We compared plasma endocan levels between PE and control groups and between early and late-onset PE. Maternal plasma endocan levels were measured in 41 preeclampsia (PE) pregnancies - 25 early-onset (<34 weeks); 16 late-onset (≥34 weeks), and 37 non-complicated pregnancies (22 matched with early-onset PE, 15 with late onset). There was no significant differences between plasma endocan levels of patients with PE and control group (468.8(IQR: 169.7)ng/L vs 462.4(IQR: 321.1)ng/L,  > 0.05), between early and late-onset PE (458.8(221.8)ng/L vs 469.8(122.6)ng/L,  > 0.05), between early-onset PE and corresponding control group (458.8(221.8)ng/L vs 506.2(1481.9)ng/L,  > 0.05), or late-onset PE and corresponding control group (469.8(122.6)ng/L vs 451.0(85.1)ng/L,  > 0.05). There was no significant difference between endocan levels of early or late-onset PE compared with their corresponding control groups, nor between early and late-onset preeclampsia groups.
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http://dx.doi.org/10.1080/15513815.2019.1693674DOI Listing
November 2019

Metabolomic identification of novel diagnostic biomarkers in ectopic pregnancy.

Metabolomics 2019 10 19;15(11):143. Epub 2019 Oct 19.

Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA.

Introduction: Ectopic pregnancy (EP) is a potentially life-threatening condition and early diagnosis still remains a challenge, causing a delay in management leading to tubal rupture.

Objectives: To identify putative plasma biomarkers for the detection of tubal EP and elucidate altered biochemical pathways in EP compared to intrauterine pregnancies.

Methods: This case-control study included prospective recruitment of 39 tubal EP cases and 89 early intrauterine pregnancy controls. Plasma samples were biochemically profiled using proton nuclear magnetic resonance spectroscopy (H NMR). To avoid over-fitting, datasets were randomly divided into a discovery group (26 cases vs 60 controls) and a test group (13 cases and 29 controls). Logistic regression models were developed in the discovery group and validated in the independent test group. Area under the receiver operating characteristics curve (AUC), 95% confidence interval (CI), sensitivity, and specificity values were calculated.

Results: In total 13 of 43 (30.3%) metabolite concentrations were significantly altered in EP plasma (p < 0.05). Metabolomic profiling yielded significant separation between EP and controls (p < 0.05). Independent validation of a two-metabolite model consisting of lactate and acetate, achieved an AUC (95% CI) = 0.935 (0.843-1.000) with a sensitivity of 92.3% and specificity of 96.6%. The second metabolite model (D-glucose, pyruvate, acetoacetate) performed well with an AUC (95% CI) = 0.822 (0.657-0.988) and a sensitivity of 84.6% and specificity of 86.2%.

Conclusion: We report novel metabolomic biomarkers with a high accuracy for the detection of EP. Accurate biomarkers could potentially result in improved early diagnosis of tubal EP cases.
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http://dx.doi.org/10.1007/s11306-019-1607-1DOI Listing
October 2019

Evaluation of the Effects of Delayed Cord Clamping in Infants of Diabetic Mothers.

Am J Perinatol 2021 02 28;38(3):242-247. Epub 2019 Sep 28.

Department of Neonatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara 06230, Turkey.

Objective: This study aimed to investigate the effect of delayed cord clamping (DCC) in infants of diabetic mothers.

Study Design: Women who had diabetes throughout their pregnancy and gave birth at 37 weeks of gestation or later were included in the study along with their babies. Early cord clamping was performed as soon as possible after birth, while DCC was performed by clamping 60 second after birth. The two groups were compared in terms of venous hematocrit (htc) levels and rates of hypoglycemia, jaundice requiring phototherapy, and respiratory distress.

Results: Venous htc levels at postnatal 6 and 24 hours were significantly higher in the DCC group ( = 0.0001). Polycythemia rates were higher in the DCC group at both 6 and 24 hours, but partial exchange transfusion (PET) was not needed in either group. There were no differences between the groups with regard to the rates of hypoglycemia or jaundice requiring phototherapy. Rate of admission to the neonatal intensive care unit (NICU) was lower in the DCC group.

Conclusion: Although DCC increased the rate of polycythemia, it did not result in PET requirement. Moreover, DCC reduced the severity of respiratory distress and the rate of admission to NICU due to respiratory distress.
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http://dx.doi.org/10.1055/s-0039-1695799DOI Listing
February 2021

Are serum levels of ADAMTS5, TAS and TOS at 24-28 gestational weeks associated with adverse perinatal outcomes in gestational diabetic women?

J Obstet Gynaecol 2020 Jul 17;40(5):619-625. Epub 2019 Sep 17.

Department of Perinatology, Acıbadem Acıbadem University Medical School, Istanbul, Turkey.

We aimed to determine the role of placental A Disintegrin and Metalloproteinase with thrombospondin motifs 5 (ADAMTS5), and maternal serum ADAMTS5, total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels at 24-28th gestational weeks in GDM. This study included 57 patients, who had been diagnosed as having GDM at their 24-28th gestational week, and 29 controls. The maternal blood samples were collected at the 24-28th gestational week and ADAMTS5 was studied with the enzyme-linked immunosorbent assay (ELISA) method, whereas an automated colorimetric method was used to study TAS, TOS, and OSI. The level of ADAMTS5 in maternal serum of patients with GDM were significantly lower than the controls ( .017); whereas TOS and OSI levels were significantly higher 003 and 008). Multivariable logistic regression analysis revealed ADAMTS5 and TOS levels were independently associated with adverse perinatal outcomes (004 and 018). We found that serum ADAMTS5 levels decreased and TOS level increased in GDM pregnant at 24-28th gestational weeks. In addition, we found that increased levels of serum ADAMTS5 and decreased TOS levels at 24-28th weeks were associated with adverse perinatal outcomes independent of the mode of treatment in GDM.Impact statement Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. The insulin resistance, which starts at the 24-28th gestational weeks, increases during gestation. GDM increases maternal complications like preeclampsia, cesarean rate, cardiovascular disease, obesity, and diabetes after pregnancy; and neonatal complications like macrosomia, hypoglycemia, hyperbilirubinemia, delivery trauma, shoulder dystocia, and adult-onset obesity, and diabetes. A significant relationship between ADAMTS5, TOS levels and adverse perinatal outcome. insulin resistance and was observed. Based on this finding, we concluded that increased levels of oxidative stress and decreased ADAMTS5 levels are associated with GDM and predictive for adverse perinatal outcomes. The results of the present study were consistent with the previous reports and indicated that increased oxidative stress in GDM patients are related to adverse perinatal outcomes.
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http://dx.doi.org/10.1080/01443615.2019.1634025DOI Listing
July 2020

Maternal plasma fetuin-A levels in fetal growth restriction: A case-control study.

Int J Reprod Biomed 2019 Jul 31;17(7):487-492. Epub 2019 Jul 31.

University of Health Sciences, Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey.

Background: Higher Fetuin-A (FA) concentrations were found to be associated with obesity and there is an interest to the relation between maternal FA and pregnancy outcomes.

Objective: In this study, our aim was to evaluate the association of maternal plasma levels of FA with fetal growth restriction (FGR).

Materials And Methods: 41 pregnant women with FGR and 40 controls were recruited in this case-control study between July and November 2015. At the diagnosis of FGR, venous blood samples (10 cc) were obtained for FA analysis.

Results: Maternal plasma FA levels were significantly higher in fetal growth-restricted pregnant women compared with controls (19.3 3.0 ng/ml vs 25.9 6.8 ng/ml, p = 0.001). Area under receiver operating characteristic curve analysis of FA in FGR was 0.815 (95% confidence interval (CI): 0.718-0.912, p 0.001). The maternal FA levels with values more than 22.5 ng/ml had a sensitivity of about 73.17% (95% CI: 56.79-85.25) and a specificity of about 82.5% (95% CI: 66.64-92.11) with positive and negative predictive values of about 81.08% (95% CI: 64.29-91.45) and 75% (95% CI: 59.35-86.30), respectively. Therefore, the diagnostic accuracy was obtained about 77.78%.

Conclusion: The results of this study show higher maternal plasma levels of FA in FGR. Further studies are needed in order to demonstrate the long-term effects of FA in pregnancies complicated with FGR and early prediction of FGR.
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http://dx.doi.org/10.18502/ijrm.v17i7.4860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718885PMC
July 2019

Association of Higher Maternal Serum Levels of Plac1 Protein with Intrauterine Growth Restriction.

Z Geburtshilfe Neonatol 2019 Oct 28;223(5):285-288. Epub 2018 Sep 28.

Dr. Zekai Tahir Burak Health Practice Research Center, University of Health Sciences, Ankara, Turkey.

The aim of this study was to determine the maternal PLAC1 protein levels in infants with IUGR. A total of 40 pregnant women with IUGR and 40 controls were recruited in this case control study between June 2014 and November 2014. Maternal serum PLAC1 levels were established as significantly higher in IUGR cases compared to the control groups (8.42±3.59 ng/ml vs. 6.27±4.04 ng/ml, p<0.001). Area under ROC curve (AUC) analysis of PLAC1 in IUGR was 0.708, (95% confidence interval (CI): 0.593-0.823, p=0.001) (Figure 1). Maternal PLAC1 levels above 7.41 ng/ml had a sensitivity of 62.5% (95% C1: 45.81-76.83), a specificity of 77.5% (95% CI: 61.15-88.6); positive and negative predictive values (PPV and NPV) were 73.53% (95% CI: 55.35-86.49) and 67.39% (95% CI: 51.86-80.03), respectively, with a diagnostic accuracy of 70%. In conclusion, we were able to demonstrate a significantly important link between IUGR and higher maternal serum levels of the PLAC1 protein.
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http://dx.doi.org/10.1055/a-0743-7403DOI Listing
October 2019

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey.

J Chin Med Assoc 2018 Nov 11;81(11):985-989. Epub 2018 Aug 11.

Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Ministry of Health, Ankara, Turkey.

Background: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs).

Methods: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed.

Results: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality.

Conclusion: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.
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http://dx.doi.org/10.1016/j.jcma.2018.05.006DOI Listing
November 2018

Low serum vitamin D level is associated with intrahepatic cholestasis of pregnancy.

J Obstet Gynaecol Res 2018 Sep 6;44(9):1712-1718. Epub 2018 Jul 6.

Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.

Aim: Intrahepatic cholestasis of pregnancy (ICP) is a unique hepatic disorder of pregnancy and is related to adverse maternal and perinatal outcomes. The pathogenesis of the disease is not clear and appears to be multifactorial. There is increasing evidence that vitamin D (Vit D) plays a role in hepatobiliary homeostasis and in various liver diseases. We aimed to investigate the association between serum Vit D level and ICP.

Methods: A total of 40 pregnant women with ICP and 40 healthy pregnant women were included in this controlled cross-sectional study. Their demographic characteristics, including age, body mass index (BMI), gestational week, gravidity and parity, and laboratory parameters, including 25(OH) Vit D levels, liver function tests, fasting and postprandial bile acid concentrations, were recorded. Gestational age at delivery, birth weight (BW), neonatal intensive care unit (NICU) admission, meconium staining of amniotic fluid and appearance pulse grimace activity respiration (APGAR) score at 5 min were obtained from medical records for assessment of perinatal outcomes.

Results: There was no significant difference between groups in terms of demographic characteristics. The mean serum 25(OH) Vit D level was significantly lower in pregnant women with ICP compared to control pregnant women (8.6 ± 4.9, 11.3 ± 6.1; P =0.033), and it was significantly lower in severe disease than mild disease (6.9 ± 2.1, 10.3 ± 6.2, respectively; P =0.029). We also found that lower serum 25(OH) Vit D levels were significantly and inversely correlated with fasting and postprandial bile acid levels. However, in subgroup analyses in ICP pregnant women, there was no difference in mean 25(OH) Vit D levels for women with or without perinatal complications.

Conclusion: Our study suggests that low levels of 25(OH) Vit D were associated with ICP disease and its severity. However, further larger studies are needed to evaluate the effect of Vit D in the pathogenesis and outcome of the disease.
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http://dx.doi.org/10.1111/jog.13693DOI Listing
September 2018

Maternal placi protein levels in early- and late-onset preeclampsia.

Ginekol Pol 2018 ;89(3):147-152

Dr Zekai Tahir Burak Women's Health Care, Education And Research Hospital, Ankara, Turkey.

Objectives: The objective of this study was to determine the maternal PLAC1 protein levels in early and late onset preec-lampsia.

Material And Methods: A total of 135 pregnant women were included in the study, of which 55 were at < 34 weeks of gesta-tion and 80 were at ≥ 34 weeks of gestation, between June and November 2014 were recruited in this case control study.

Results: Analysis of maternal serum PLAC1 levels did not reveal any significant differences between early onset PE and controls (p = 0.422). However, late onset PE patients exhibited significantly elevated levels of PLAC1, in comparison with healthy controls (p = 0.026). The difference in PLAC1 levels between early onset PE and late onset PE was also significant (p = 0.001). Area under ROC curve of PLAC1 for early and late onset PE was 0.563 and 0.646 with p values of 0.422 and 0.026 respectively. Area under ROC curve of PLAC1 in PE was 0.613 with p value = 0.024. The cutoff value for PLAC1 was 6.19 ng/mL with sensitivity: 56% (95% CI 44.1-67.3) and specificity: 63 %; (95% CI 49.9-75.1) and diagnostic odds ratio: 2.2 (95% CI 1.1-4.4) (p value = 0.037). The cutoff value for PLAC1 was 7.2 ng/mL with sensitivity: 43% (95% CI 31.5-54.6) and specificity: 78% (95% CI 65.5-87.5) and diagnostic odds ratio: 2.69 (95% CI 1.25-5.79) (p value = 0.016) CONCLUSION: In conclusion, the results of the current study showed that PLAC1 protein levels were significantly elevated in pregnant women with late onset PE in comparison with healthy control group.
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http://dx.doi.org/10.5603/GP.a2018.0025DOI Listing
July 2018

Maternal and perinatal outcomes of dichorionic diamniotic twin pregnancies diagnosed with vanishing twin syndrome: a retrospective analysis from a single clinical center.

Ginekol Pol 2018 ;89(1):30-34

University of Health Sciences, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.; Ordu university.

Objectives: Multiple pregnancies are known to be associated with adverse maternal and perinatal complications. How-ever, data regarding the outcomes of spontaneously reduced twin pregnancies are limited. In the current study we aimed to evaluate the consequences of the vanishing twin syndrome (VTS) in dichorionic diamniotic twin pregnancies for both mother and baby in our perinatal center.

Material And Methods: A total of 711 pregnancies were included into the study. 51 cases of vanishing twin syndrome constituted Group 1, 235 cases of normal twins constituted Group 2, and 425 singleton pregnancies formed Group 3. The pregnancies that had multifetal reduction and monochorionic twinning were excluded from both study group and twin control group. The collected data were as follows: age, gravidity, parity, gestational week at birth, delivery route, birth weight, obstetric complications, and maternal and perinatal outcomes.

Results: No significant difference was observed between the groups regarding mean maternal age (p > 0.05). Mean birth weight, gestational age at birth and preterm birth ratio were significantly lower in the Group 2 when compared with Group 1 and Group 3 (all p < 0.001). Adverse perinatal outcomes including very low birth weight (VLBV) and low Apgar scores were more common in Group 1 (p < 0.05), but no significant difference was found between the groups in terms of neona-tal intensive care unit admission and perinatal mortality ratios (p > 0.05). Obstetric complications such as preeclampsia, gestational diabetes and intrauterine growth restriction were significantly higher in Group 2 than in Group 1 and Group 3 (all p < 0.05). However, severe maternal morbidities were similar among three groups (p = 0.141).

Conclusions: VTS is seems to be associated with VLBV and low Apgar scores. However, the incidence of severe maternal and perinatal morbidity and mortality in pregnancies with VTS is similar to other pregnancies.
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http://dx.doi.org/10.5603/GP.a2018.0006DOI Listing
August 2019

Decreased oxidative stress may contribute to the disease process in placenta accreta

Turk J Med Sci 2017 08 23;47(4):1180-1184. Epub 2017 Aug 23.

Background/aim: The main aim of this study was to investigate serum total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and arylesterase levels in pregnant women with placenta accreta and to compare those with age-matched healthy pregnant women. Materials and methods: A total of 27 pregnant women who had clinically and pathologically proven placenta accreta and 30 age- and BMI- matched healthy pregnant women were enrolled in this case control study. Maternal serum TOS, TAS, OSI, and arylesterase levels were evaluated using logistic regression analysis to determine if there was an association with abnormal placental invasion or not. Results: Decreased OSI (OR= 0.999, 95%CI: 0.998-1.000, P = 0.035) and increased arylesterase levels (OR= 0.981, 95%CI: 0.970-0.993, P = 0.001) were significantly associated with the presence of placenta accreta. Maternal serum TOS, TAS, OSI, and arylesterase levels were not predictive for adverse perinatal outcomes (P > 0.05). Conclusions: Decreased OSI and increased arylesterase levels are significantly associated with placenta accreta and may contribute to the abnormal invasion process.
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http://dx.doi.org/10.3906/sag-1605-141DOI Listing
August 2017

Influenza infections in the 2014-2015 season and pregnancy outcomes.

J Infect Dev Ctries 2017 Oct 31;11(10):766-771. Epub 2017 Oct 31.

Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.

Introduction: The most recent influenza season saw a prominent infectious burden over a period of six months in the Turkish capital, reminding observers of the pandemic in 2009 year. The aim of the present study was to investigate the consequences of seasonal outbreaks in pregnant women during the 2014-2015 influenza season.

Methodology: Forty-seven pregnant female patients with symptoms of influenza-like illness who were admitted to tertiary perinatal care center in Ankara, Tukrey, between October 2014 and May 2015 were included in this case-control study. The subtype determination of influenza was performed with real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing. Clinical observations and pregnancy outcomes were compared with respect to subtypes.

Results: Classifications were available for 35 patients, of whom 12 were determined to have influenza A infection, while 10 had influenza B infection. The remaining 13 patients were influenza-negative. Eight of the 22 (36.4%) influenza-positive patients delivered their babies in the preterm period (< 37 weeks). The corresponding rate was 8.3% (1/12) in the influenza-negative group. This difference was not statistically significant (p = 0.077).

Conclusions: Preterm deliveries in pregnant women did not differ significantly among influenza-postive and influenza-negative pregnant women in non-vaccinated study population. Further studies with larger sample sizes may provide more supporting results.
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http://dx.doi.org/10.3855/jidc.8461DOI Listing
October 2017

Do vitamin D and high-sensitivity-C reactive protein levels differ in patients with hyperemesis gravidarum? A preliminary study.

Turk J Obstet Gynecol 2016 Sep 15;13(3):123-126. Epub 2016 Sep 15.

Zekai Tahir Burak Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey.

Objectives: The high sensitivity-C reactive protein (hs-CRP) is an inflammatory marker and vitamin D is an immune modulator that might play a critical role in the pathogenesis of hyperemesis gravidarum. Therefore, in the current study, we tested the hypothesis that suggests women with hyperemesis gravidarum have lower 25-hydroxyvitamin D levels and higher hs-CRP levels, compared to controls.

Materials And Methods: This prospective case-control study included 30 women with hyperemesis gravidarum (study group) and 30 age- and body mass index-matched healthy women (control group). The levels of 25-hydroxyvitamin D and hs-CRP were compared between two groups.

Results: Both the serum 25-hydroxyvitamin D (5.30 μg/L vs. 6.44 μg/L; p=0.09) and hs-CRP levels (0.29 mg/dL vs. 0.47 mg/dL; p=0.93) were not significantly different between the study and control groups. Vitamin D deficiency was present in 27 (90.0%) women in the study group and 22 (73.3%) women in the control group (p=0.181). There was also no correlation between 25-hydroxyvitamin D and hs-CRP levels in both groups.

Conclusion: Although it did not reach statistical significance, vitamin D levels were lower in the study group compared with controls. Therefore, vitamin D might be speculated to play a crucial role in controlling the inflammatory status associated with hyperemesis gravidarum. Larger studies are required to clarify whether there is a relation between vitamin D deficiency and hyperemesis gravidarum.
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http://dx.doi.org/10.4274/tjod.76753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558301PMC
September 2016

An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: thiol/disulphide homeostasis.

J Matern Fetal Neonatal Med 2018 Jun 2;31(11):1477-1482. Epub 2017 May 2.

a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey.

Purpose: The aim of our study was to evaluate the oxidative stress (OS) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) by evaluating thiol/disulphide homeostasis using an alternative technique.

Methods: A total of 57 pregnant women with ICP were compared with 50 gestational age and body mass index matched controls. A recently defined method was used for the measurement of plasma native-total thiol and disulphide levels. The independent two-sample t test, Mann-Whitney-U test, Chi-square test, binary logistic regression with backward elimination and receiver operating characteristic (ROC) curve was performed for statistical analyses.

Results: Pregnant women with ICP (n = 57) versus controls (n = 50) had significantly lower serum levels of native thiol (233.8 ± 47.4 μmol/L vs. 308.5 ± 51.7 μmol/L, p < .001), total thiol (258.4 ± 46.5 μmol/L vs. 328.0 ± 52.0 μmol/L, p < .001) and higher levels of disulphide (12.3 ± 3.6 μmol/L vs. 9.7 ± 3.4 μmol/L, p < .001). Binary logistic regression showed that the most important variables related to ICP were native thiol and total thiol. According to the ROC curve, the optimal cut-off level for native thiol was 280.0 μmol/L (sensitivity: 86%, specificity: 84.2%, area under the curve (AUC):0.896, 95% CI: 0.831-0.962, p < .001), and the optimal cut-off level for total thiol was 300.0 μmol/L (sensitivity: 86%, specificity: 80.7%, AUC: 0.883, 95% CI: 0.815-0.951, p < .001).

Conclusions: To our knowledge, this is the first study in the literature exploring thiol/disulphide balance in ICP. We found that thiol/disulphide balance indicate OS in pregnant woman with ICP.
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http://dx.doi.org/10.1080/14767058.2017.1319922DOI Listing
June 2018

Elevated red blood cell distribution width is associated with intrahepatic cholestasis of pregnancy.

Ginekol Pol 2017 ;88(2):75-80

Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.

Objectives: Intrahepatic cholestasis of pregnancy is the most common pregnancy specific liver disease and related with adverse maternal and perinatal outcome. Red blood cell distribution width, an anisocytosis marker in a complete blood count, has been used as an inflammation marker in various diseases. However the association of red blood cell distribution width with intrahepatic cholestasis of pregnancy is unknown. We aimed to evaluate the relationship between red blood cell distribution width and intrahepatic cholestasis of pregnancy.

Material And Methods: Ninety pregnant women with intrahepatic cholestasis of pregnancy and ninety healthy pregnant women were included in the study. Their clinical and laboratory characteristics including red blood cell distribution width, liver function tests, fasting and postprandial bile acid concentrations were analyzed.

Results: Serum red blood cell distribution width cell levels were significantly higher in pregnants with intrahepatic cholestasis of pregnancy than healthy pregnants. We also demonstrated that red blood cell distribution Width levels were higher in severe disease than mild disease and was significantly correlated with fasting and postprandial bile acid concentration in intrahepatic cholestasis of pregnancy group.

Conclusions: Our study showed that red blood cell distribution width, an easy and inexpensive marker; were associated with intrahepatic cholestasis of pregnancy and can be used as a diagnostic and prognostic marker in intrahepatic cholestasis of pregnancy.
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http://dx.doi.org/10.5603/GP.a2017.0015DOI Listing
July 2018

Influence of Behçet's disease on first and second trimester serum screening markers.

J Obstet Gynaecol Res 2017 Mar 17;43(3):511-515. Epub 2016 Dec 17.

Department of Perinatology, Zekai Tahir Burak Women's Health Education and Training Hospital, Ankara, Turkey.

Aim: Behçet's disease (BD) is a rare and multisystemic vasculitis disease. In this study, we investigated whether BD had any effect on the biochemical components of first and second trimester aneuploidy screening tests.

Methods: A case-control retrospective study was conducted with 32 pregnant women with BD and 60 healthy pregnant women as controls. All pregnant womens' first trimester maternal serum pregnancy-associated plasma protein-A, free β-human chorionic gonadotropin and second trimester serum alpha-fetoprotein, unconjugated estriol and total human chorionic gonadotropin levels were examined from medical records. First and second serum screening markers were compared between pregnancies with BD and without.

Results: There was no difference in age, body mass index and obstetric history between the groups. No significant difference was observed between the groups in terms of first and second trimester serum screening test results in the absence of aneuploidy or neural tube defect. Gestational age at birth, birth weight and neonatal intensive care admission rate were also similar between the groups.

Conclusion: Both first and second serum screening tests for Down syndrome may be recommended to pregnant women with BD without the need to readjust these markers. Pregnancy with BD was not associated with adverse perinatal outcome with respect to gestational age at birth or birth weight.
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http://dx.doi.org/10.1111/jog.13237DOI Listing
March 2017

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

J Obstet Gynaecol 2017 Feb 15;37(2):151-156. Epub 2016 Dec 15.

a Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths, Government of Health , Ankara , Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.
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http://dx.doi.org/10.1080/01443615.2016.1217509DOI Listing
February 2017

Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.

J Obstet Gynaecol Res 2017 Jan 12;43(1):65-72. Epub 2016 Nov 12.

Department of Perinatology, Zekai Tahir Burak Women's Health Care, Training and Research Hospital, Ankara, Turkey.

Aim: Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio.

Methods: Seventy pregnant women with either pregestational or gestational diabetes mellitus and with no other systemic or pregnancy related disorders were compared with 70 gestational age matched healthy controls by means of fetal left ventricular MPI and E/A ratio. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods: ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT), which were employed in the calculation of MPI (MPI = [ICT + IRT]/ET). Statistical analyses were conducted using receiver operating characteristic analysis and independent two-sample t, Mann-Whitney U and chi-square tests.

Results: Fetal left ventricular MPI values were significantly higher in the diabetic group compared with controls (0.56 ± 0.09 vs 0.36 ± 0.04, P < 0.001), whereas E/A ratio was lower (0.66 ± 0.11 vs 0.69 ± 0.09, P = 0.049). The adverse perinatal outcome rate was also higher in the diabetic group. Receiver operating characteristic analysis revealed > 0.39 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 90.9%, specificity: 47.7%, area under the curve: 0.690, 95% confidence interval: 0.598-0.782, P < 0.001).

Conclusions: We conclude that fetuses of diabetic mothers have significant left ventricular systolic and diastolic dysfunction. MPI may be used in the prediction of adverse perinatal outcome in diabetic pregnancies.
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http://dx.doi.org/10.1111/jog.13174DOI Listing
January 2017

Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia.

Hypertens Pregnancy 2017 Feb 11;36(1):77-83. Epub 2016 Nov 11.

a Zekai Tahir Burak Women's Health Education and Training Hospital , Department of Perinatology , Ankara , Turkey.

Objectives: In this study, we hypothesized that dietary salt and potassium intake may be related with blood pressure, kidney damage and perinatal outcome in pregnants with preeclampsia (PE).

Methods: In total, 200 women (50 control women with healthy pregnancy, 150 women with PE) were recruited for the study. Daily salt and potassium intake was estimated based on calculation of 24-hour urinary sodium U[Na+] and potassium U[K+] excretion. U[Na+]/[K+] was calculated by dividing U[Na+] by U[K+]. At the end of the measurements, the pregnant women with PE (n=150) were divided into tertiles according to U[Na+]/[K+]: low Na/K group (n=50, mean U[Na+]/[K+]: 1,04±0,32), medium Na/K group (n=50, mean U[Na+]/[K+]: 2,49± 0,54), high Na/K group (n=50, mean U[Na+]/[K+]: 6,62±3,41).

Results: The mean SBP and DBP levels were significantly lower in low Na/K group compared with medium or high Na/K groups (p=0.024, p=0.0002; respectively). Serum creatinine was significantly lower in low Na/K group than high Na/K group (p=0.025). Frequency of severe preeclampsia is lower in low Na/K group than medium or high Na/K groups (p=0.002, p=0.0001; respectively). Birth weight and gestational age at birth were higher in low Na/K group compared with high Na/K group (p=0.045, p=0.0002; respectively). After adjusting for covariates, SBP and DBP and creatinine levels were independently associated with 24 hours urinary [Na+]/[K+] Conclusion: These findings suggest that pregnant with PE with high dietary salt and low potassium intake may have greater maternal and neonatal morbidity risk than pregnant with PE under low dietary salt and high potassium intake.
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http://dx.doi.org/10.1080/10641955.2016.1239734DOI Listing
February 2017

Impact of Gestational Diabetes Mellitus and Maternal Obesity on Cord Blood Dynamic Thiol/Disulfide Homeostasis.

Fetal Pediatr Pathol 2017 Feb 14;36(1):8-15. Epub 2016 Sep 14.

a Zekai Tahir Burak Women's Health Education and Research Hospital , Department of Perinatology , Ankara , Turkey.

Aim: Our aim in this study was to investigate the effect of maternal obesity and gestational diabetes mellitus (GDM) on cord blood dynamic thiol/disulfide homeostasis.

Methods: A prospective case-control study was carried out in 125 pregnant women (27 GDM, 30 obese, 68 controls). Cord blood samples were collected from all participants and native thiol-disulfide exchanges were examined with automated method enabling the measurement of both sides of thiol-disulfide balance.

Results: Disulfide amounts, disulfide/native thiol and disulfide/total thiol ratios were increased (p < 0.001), while native thiol/total thiol was decreased in the cord blood of babies born to an obese or diabetic mother (p < 0.001). Moreover, increased disulfide amounts, disulfide/native thiol, disulfide/totalthiol ratios and decreased native/total thiol were found to be significantly associated with adverse outcomes in GDM.

Conclusion: The current study suggests that the offsprings born to obese or diabetic mothers are exposed to increased oxidative stress.
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http://dx.doi.org/10.1080/15513815.2016.1223237DOI Listing
February 2017

Obstetric Outcomes in Non-Gynecologic Cancer Patients in Remission.

Eurasian J Med 2016 Jun;48(2):130-4

Clinic of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey.

Objective: The aim of the present study was to evaluate the obstetric and perinatal outcomes in treated women who were diagnosed with non-gynecologic cancer and to compare these findings with pregnant women with no history of cancer.

Materials And Methods: This retrospective study was conducted on 21 pregnant women with non-gynecologic cancer who were in remission (study group) and 63 pregnant women with no history of cancer (control group). The women were admitted to the high-risk pregnancy clinic of Zekai Tahir Burak Women's Health Training and Research Hospital with a diagnosis of pregnancy and cancer between January 2010 and January 2015. Obstetric outcomes and demographic characteristics of the patients were recorded. Age, gravida, parity, abortus, body mass index (BMI), gestational week, smoking, mode of delivery, gestational weight, and perinatal outcomes were examined for each woman.

Results: The most common cancer types were thyroid (28.5%) and breast cancers (23.8%), which constituted just over half of the non-gynecologic cancer cases during pregnancy. The time elapsed after the diagnosis was 3.8±2.2 (1-9) years. No statistically significant differences were found between the two groups with regard to age, obstetric history, BMI, gestational week, smoking, and obstetric and perinatal outcomes (p>0.05).

Conclusion: Negative perinatal outcomes in non-gynecologic cancer patients in remission were found to be within acceptable levels.
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http://dx.doi.org/10.5152/eurasianjmed.2015.15263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970551PMC
June 2016

Oxidative stress markers in severe preeclampsia and preeclampsia-related perinatal morbidity - preliminary report.

Ginekol Pol 2016 ;87(6):436-41

Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.

Objectives: The aim of the study was to determine maternal serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), paraoxonase (PON) and arylesterase levels in severe preeclamptic pregnants and also to investigate whether these parameters are implicated in the occurence of perinatal morbidity or not.

Material And Methods: A case-control study was carried out including 60 pregnant women (30 with severe preeclampsia and 30 healthy controls). The optimal cut off points of oxidative stress markers for the diagnosis of severe preeclampsia and for the prediction of adverse perinatal outcomes were evaluated by receiver operating characteristic (ROC) analyses. Multi-variate logistic regression analysis was used to determine if a relationship between adverse perinatal outcomes and serum oxidative stress markers was present or not.

Results: TAS (OR = 37.486, 95% CI 3.535-397.519, p = 0.003), TOS (OR = 15.588, 95% CI 2.135-113.818, p = 0.007) and ary-lesterase (OR = 31.356, 95% CI 2.284-430.548, p = 0.01) were found to be diagnostic for preeclampsia. Statistically significant positive correlation of adverse perinatal outcomes with serum TAS, PON and arylesterase levels were determined. Besides, a significant negative correlation was found between serum TAS levels and gestational week (r = -0.342, p = 0.007) and also between serum PON levels and birthweight (r = -0.262, p = 0.043).

Conclusions: Increased maternal serum TAS, TOS and arylesterase levels are significantly associated with the presence of severe preeclampsia. Furthermore, elevated maternal serum TAS, PON and arylesterase levels are significantly and positively correlated with adverse perinatal outcomes. We suggest that in preeclampsia increased oxidative status may cause adverse perinatal outcomes and antioxidants may be increased in order to protect the fetus against oxidative damage.
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http://dx.doi.org/10.5603/GP.2016.0022DOI Listing
July 2018

Prediction of the length of repeat post C-section hospital stay and comparison of perinatal outcomes in patients with ≥3 versus <3 previous C-section.

J Matern Fetal Neonatal Med 2017 May 21;30(10):1207-1212. Epub 2016 Jul 21.

a Department of Perinatology , Zekai Tahir Burak Women's Health Care, Training and Research Hospital , Ankara , Turkey and.

Objective: To create a model for prediction of repeat post cesarean section (CS) length of hospital stay (LOHS) in patients undergoing repeat CS. Our other aim was to compare the perinatal outcomes in patients with ≥3 versus <3 previous CS procedures.

Methods: Individual characteristics, pre-, intra- and post-operative data of 186 pregnant women who had ≥3 previous CS were compared with 195 pregnant women with <3 previous CS.

Results: Regression analyses revealed that models can be used to predict the dependents "postpartum LOHS" and "needed units of erythrocyte suspension", both pre-operatively and intra-operatively. Patients with ≥3 previous CS procedures were older, delivered earlier and had lower Apgar 1 and Apgar 5 values than patients with <3 previous CS. The rate of elective CS operations was lower in patients with ≥3 previous CS. Pregnant women ≥3 previous CS had significantly more severe intraperitoneal adhesion (IPA) and higher rate of bladder injury.

Conclusions: Prediction models can be conducted for LOHS and other perinatal and operative parameters in patients with previous CS. Pregnancy and repeat CS, even in patients with ≥3 previous CS procedures, are both safe conditions with optimal follow-up and management.
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http://dx.doi.org/10.1080/14767058.2016.1209647DOI Listing
May 2017