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Background/aim: To evaluate the prevalence of tetanus vaccination in pregnant women and determine the factors affecting the vaccination and barriers to vaccination. Materials and methods: An observational-descriptive study was conducted on 494 women who gave birth at the Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey. Participants were divided into 2 groups, vaccinated and unvaccinated. Sociodemographic characteristics, obstetric history, and prenatal care status were compared between the 2 groups. Results: There were 242 (48.9%) and 252 (51.1%) women in the vaccinated and unvaccinated groups, respectively. The vaccination rate decreased as the number of pregnancies increased (P = 0.009). As the level of income increased, there was a statistically significant increase in the vaccination rate (P = 0.048). The status of education and having an occupation did not affect the vaccination rate (P > 0.05). The vaccination rate was higher in women with regular follow-ups when compared to those who did not get a regular follow-up (76.5% vs. 38.7%) (P = 0.001). The vaccination rate was significantly higher in women who had knowledge about tetanus vaccine during pregnancy (P < 0.005). Conclusions: All pregnant women should be encouraged to get regular antenatal care to increase vaccination rates. Health care providers should give all pregnant women detailed information about the safety, effectivity, and benefits of vaccines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey. Material and Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed. Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm³ (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery. Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists. [ABSTRACT FROM AUTHOR]

Purpose: Down syndrome screening with first trimester combined test is recommended for all pregnancies. It is unclear, whether thyroid stimulating hormone (TSH) affects secretion of free beta subunit human chorionic gonadotropin (fß-hcg) and pregnancy-related plasma protein (PAPP-A). We aimed to investigate the effect of serum thyroid stimulating hormone (TSH) levels on the combined test results. Materials and Methods: First trimester TSH levels together with nuchal translucency (NT(fß-hcg and PAPPA results of 297 patients were included in this study. Patients were divided into four groups according to their TSH levels; Group 1 (<0.1 µL / ml), Group 2 (0.1-2.5 µlU / ml), Group 3 (2.5-3.5 µlU / ml) and Group 4 (> 3.5 µlU / ml). Groups were compared in terms of NT, PAPP-A and fß-hcg levels. Results: The mean PAPP-A (MoM) value was found to be 0.99 in group 1, 1.12 in group 2, 1.03 in group 3, and 0.95 in group 4. Mean fß-hcg (MoM) value was 1.36 in group 1, 1.29 in group 2, 1.05 in group 3, and 1.32 in group 4. The mean N T measurement was 1.27 ± 0.25, 1.33 ± 0.38, 1.34 ± 0.33 and 1.32 ± 0.37 mm, from group 1 to group 4, respectively. There was no statistically significant difference between groups in terms of PAPP-A, fß-hcg and NT. Conclusion: The present study have shown that first trimester TSH levels do not affect combined test parameters. Prenatal screening by using NT, fß-hCG and PAPP-A seems to be safe for pregnant women with hypothyroidism or hyperthyroidism. [ABSTRACT FROM AUTHOR]

Objectives: To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies.Study Design: A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women ≥35-year of age, 1B) implementing invasive test (amniocentesis -AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies.Results: Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women ≥35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT.Conclusions: NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. [ABSTRACT FROM AUTHOR]

Objective: To evaluate second trimester fetal nasal length measurement results in healthy singleton pregnancies in Turkey. Material and Methods: We analyzed the nasal bone lengths within 19-24 weeks in 661 pregnancies in our hospital. All pregnant women with a single healthy fetus who applied to our perinatology outpatient clinic for detailed obstetric ultrasonography were included in the study. All measurements were performed by the same clinician during routine mid-trimester ultrasound scan. Only the patients who were considered healthy by the examining pediatrician were included in the study. The parents of all fetuses are of Turkish ethnicity. Pearson correlation, regression analysis and P value were calculated between gestational week and nasal bone length. Results: Mean nasal length measurement was 6,21 ± 0,08; 6,66 ± 0,05; 6,88 ±0,05; 7,13 ± 0,08; 7,77 ± 0,11 and 8,33 ± 0,25 mm from 19 to 24 week of pregnancy, respectively. A significant positive correlation was observed between gestational week and nasal bone length. Normal values of nasal bone length measuremens are identified for each gestational weeks acoording to our data and previous 5 studies. Conclusion: In this study, we presented the data of our own center and the results obtained from other studies conducted in our country show significant differences. We are of the opinion that studies conducted by different researchers in different regions remain insufficient to reflect the nomogram of Turkish ethnic origin. For this purpose, multicenter studies are needed to cover the whole society. [ABSTRACT FROM AUTHOR]

Objective: To show celiac disease (CD) and its poor pregnancy outcome relationship, and to demonstrate the importance of a gluten-free diet together with low-dose low-molecular-weight heparin (LMWH) and low-dose corticosteroid (LDC) in the management of pregnancies with CD. Material and Methods: This study consisted of 2 groups of patients. Six patients with CD (control group) on a gluten-free diet were monitored during their first pregnancies within the framework of antenatal care program and their pregnancy outcomes were compared with eight poorly-treated pregnant patients with CD (study group) who were referred from other medical institutions. LMWH (enoxaparine 1x2000 Anti-XA IU/0.2 mL/day), and LDC (methylprednisolone 1x4 mg p.o/day) were used in the control group. Their obstetric histories and outcomes of their last pregnancies were compared. The patients' obstetric risk levels were evaluated using the "Beksac Obstetrics Index" (BOI). Results: There were miscarriages in 50% of the study group. There were also 50% and 75% preterm deliveries in the control and study groups, respectively. The BOI of the study group was significantly worse than the control group (1.31 vs. 0.31 ±0.21, p<0.01). There were no statistically significant differences between age (24±4.7 vs 31.7±6 years, p=0.448), gestational day of birth (259.3±8.5 vs 246.6±24.3), birthweight (2691 ±698 vs 2262±359 g, p=0.394), and cesarean section rates (p=0.118). Conclusion: CD is a risk factor for adverse pregnancy outcome. Miscarriage and preterm labor are critical complications in pregnancies complicated by CD. A gluten-free diet is important in the treatment. LMWH and LDC seem to be helpful in the management of pregnant women with CD. [ABSTRACT FROM AUTHOR]

Zonulin, a protein that regulates intestinal permeability, has attracted attention as a potential biomarker for GDM. Therefore, this study aims to investigate whether there are differences in zonulin levels between the GDM group and control groups, especially between those receiving different treatments (diet and insulin). Based on this idea, we included 90 patients with a gestational age between 24 and 28 weeks in our study. While GDM was not detected in 33 of these patients, as a result of OGTT, 57 patients were diagnosed with GDM and these patients were followed throughout their pregnancy. Gestational diabetes was diagnosed by an OGTT performed between 24 and 28 weeks of gestation according to American Diabetes Association (ADA) standards. During follow-up, GDM patients were divided into two groups according to whether they required insulin treatment. Plasma zonulin levels were determined using enzyme-linked immunosorbent assay (ELISA) techniques. The GDM group had significantly higher plasma zonulin levels than the control group (p < 0.005). According to our research, zonulin may be a non-invasive biomarker involved in the etiology of GDM. Large-scale research on this topic is still needed. [ABSTRACT FROM AUTHOR]

Objective: To evaluate "papillary thyroid carcinoma-pregnancy" interaction among cancer survivors. Material and Methods: The clinical records of 8 pregnant women who received treatment for papillary thyroid cancer before their pregnancy were evaluated. Clinical features, pregnancy/perinatal outcomes and high-risk factors were compared with 45 controls who were randomly assigned from the institutional perinatal medicine database. Results: Patients in the cancer group were older than the control group (34.3 vs 29.8 years). The cesarean section rate was higher (62.5% vs 33.3%) and the APGAR scores at the 1st and 5th minutes were lower in the cancer group. Conclusion: Management of pregnancies with papillary thyroid cancer treatment and follow-up requires a multidisciplinary approach with careful antenatal care and perinatal surveillance. Patients who have received papillary thyroid cancer treatment can safely undergo pregnancy. [ABSTRACT FROM AUTHOR]

Aim: We compared maternal serum and fetal cord blood proBNP levels in healthy pregnancies to those with intrauterine growth restriction (IUGR). Methods: Prospectively, maternal and cord blood samples at childbirth of 40 pregnant women with isolated IUGR and 40 healthy pregnant women were evaluated for ProBNP levels. Results: The mean serum ProBNP level was significantly higher in newborn cord blood with IUGR than in the control group (181.28 ± 145.37 vs. 91.41 ± 49.77 pg/mL, p = <0.01). Mean serum ProBNP level trended higher in women with IUGR compared to the controls, but was not statistically significant (124.21 ± 113.32 vs. 88.73 ± 85.18 pg/mL, p= >0.05). Conclusion: Third trimester mean proBNP in fetal cord blood are increased in IUGR fetuses at term birth compared to pregnancies with normal fetal growth. [ABSTRACT FROM AUTHOR]

Background/aim: This study aimed to evaluate the effects of certain maternal, fetal, and umbilical cord blood unit factors on storage and/or discard incidence of collected cord blood units from perinatal medicine patients. Materials and methods: A total of 273 cord blood units collected between January 2011 and December 2016 in the Division of Perinatology of Hacettepe University Hospital were evaluated retrospectively in this study. Results: Of the collected cord blood units, 53.8% (147/273) were stored. Infant birth weight, cord blood unit volume, total nucleated cell count, and CD34+ cell count were statistically significantly different between the eligible and discarded cord blood unit groups (P < 0.001 for all). No cord blood units were discarded owing to contamination-related issues. The mean gestational age for pregnant women whose umbilical cord blood was stored was 36.6 ± 1.0 weeks. Conclusion: Infant birth weight, cord blood unit volume, total nucleated cell count, and CD34+ cell count were significantly different between the eligible and discarded cord blood unit groups. The low rate of specimen storage was most likely because of the unique characteristics of perinatal medicine patients. Physicians should choose appropriate donors for cord blood collection to increase the rate of cord blood utilization. [ABSTRACT FROM AUTHOR]

Fetal cardiac magnetic resonance imaging (FCMR) can be used as an imaging modality in fetal cardiovascular evaluation as studied in recent years. We aimed to evaluate cardiovascular morphology using FCMR and to observe the development of cardiovascular structures according to gestational age (GA) in pregnant women. In our prospective study, 120 pregnant women between 19 and 37 weeks of gestation in whom absence of cardiac anomaly could not be excluded by ultrasonography (US) or, who were referred to us for magnetic resonance imaging (MRI) for suspected non-cardiovascular system pathology, were included. According to the axis of the fetal heart, axial, coronal, and sagittal multiplanar steady-state free precession (SSFP) and 'real time' untriggered SSFP sequence, respectively, were obtained. The morphology of the cardiovascular structures and their relationships with each other were evaluated, and their sizes were measured. Seven cases (6.3%) contained motion artefacts that did not allow the assessment and measurement of cardiovascular morphology, and three (2.9%) cases with cardiac pathology in the analysed images were excluded from the study. The study included a total of 100 cases. Cardiac chamber diameter, heart diameter, heart length, heart area, thoracic diameter, and thoracic area were measured in all fetuses. The diameters of the aorta ascendens (Aa), aortic isthmus (Ai), aorta descendens (Ad), main pulmonary artery (MPA), ductus arteriosus (DA, superior vena cava (SVC), and inferior vena cava (IVC) were measured in all fetuses. The left pulmonary artery (LPA) was visualised in 89 patients (89%). The right PA (RPA) was visualised in 99 (99%) cases. Four pulmonary veins (PVs) were seen in 49 (49%) cases, three in 33 (33%), and two in 18 (18%). High correlation values were found for all diameter measurements performed with GW. In cases where US cannot achieve adequate image quality, FCMR can contribute to diagnosis. The very short acquisition time and parallel imaging technique with the SSFP sequence allow for adequate image quality without maternal or fetal sedation. [ABSTRACT FROM AUTHOR]