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INTRODUCTION: We aimed to evaluate the etiologic factors and pregnancy outcomes of pregnant women who applied to our antenatal outpatient clinics with the complaint of pruritus. METHODS: A retrospective study was conducted to examine the age, gestational weeks, gravidity, parity, comorbidities, laboratory test results and obstetric outcomes of pregnant women who applied with the complaint of pruritus to the antenatal follow-up outpatient clinics of Ankara City Hospital between 01.01.2020 and 31.12.2020. RESULTS: Medical records of 223 pregnant women who applied to our antenatal outpatient clinic with pruritus were evaluated, and the 181 pregnant with complete accessible data were enrolled in this study. The most common clinical diagnosis was pregnancy-specific dermatoses with a rate of 47.51% (n=86), and a specific diagnosis could not be determined in 80 pregnant women (44.19 %). Intrahepatic cholestasis (IHC) was found to be the most frequent diagnosis among the pregnancy-specific dermatoses with a percent of 25.41 (n=46). The incidence of IHC among specific dermatoses diagnosed ≥ 28 weeks of pregnancy was 30.76 %, and the most common dermatosis < 28 weeks was the atopic eruption of pregnancy (36.84 %). DISCUSSION AND CONCLUSION: Pruritus is a common condition in pregnancy; considering the frequency, especially in the third trimester, IHC should be kept in mind in the differential diagnosis to prevent maternal-fetal morbidity and mortality.

Objectıves: Intrahepatic (also known as obstetric) cholestasis of pregnancy (ICP) is one of the most frequently diagnosed conditions for pregnancy-specific hepatic disease. It has consistently been found to be related to adverse pregnancy outcomes. In recent studies, a relationship between ICP and Gestational Diabetes Mellitus (GDM) was demonstrated. However, the association between serum total BA (TBA) level in ICP and GDM is not fully understood. This study aims to evaluate the association between serum TBA levels in ICP disease with GDM. Study Desıgn: Eighty pregnant women diagnosed with ICP and eighty healthy pregnant women as normal controls were included in the study. Their clinical characteristics and laboratory test results including liver function tests, glucose challenge tests (GCT), glucose tolerance tests (GTT), and fasting and postprandial TBA levels were recorded. Cases with serum TBA levels between 12-40 µmol/L were described as mild disease, >40 µmol/L was described as severe disease. Results: The mean 50-g GCT value was significantly higher in pregnant women with ICP compared to the healthy controls (128.7±28.2, 106.6±27.0; p < 0.0001) and it was slightly higher in women with severe disease than women with mild disease (132.7±30.1, 125.5±26.5; p=0.26). The percent of GDM diagnosis with ICP disease (11.25%) was higher than in healthy pregnant women (6.25%) but the difference was not found to be statistically significant (p=0.187) and it was similar in pregnant women with mild and severe disease (11.1%, 11.4%; p=0.31). Conclusıon: Our current study demonstrated that ICP was not associated with GDM, also, we did not demonstrate a relationship of TBA level with ICP and GDM. It may be due to our study’s small sample size. Further and well-designed studies with larger sample sizes are necessary to determine the relationship between GDM and ICP and also the function of TBA in the pathogenesis of GDM disease.

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.

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 P = 0.771 (independent samples t-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.

Twin-to-twin transfusion syndrome is a fatal complication and twins with monochorionic/diamniotic placentas are affected due to placental vascular anastomoses, producing volume transfer of blood from one twin to the other. The donor twin becomes hypovolemic with oligohydramnios and the recipient becomes hypervolemic with polyhydramnios. Twin-to-twin transfusion syndrome is associated with increased perinatal morbidity and mortality and expresses longstanding health hazards. Serial amnioreduction and fetoscopic laser photocoagulation of the vascular anastomoses are the main therapeutic approaches for twin-to-twin transfusion syndrome. Higher survival rates after fetoscopic laser ablation of the anastomotic vessels in comparison to serial amnioreduction have been reported in multicenter randomized clinical trials. We report the fetoscopic laser coagulation of three twin-to-twin transfusion syndrome cases at Ankara Dr. Zekai Tahir Burak Health Practice Research Center, Perinatology Clinics.

Objective: The aim of this study is to determine bilateral tubal ligation incidence performed during C-section in women with a history of 2 or more C-section and the factors affecting sterilization demand. Study Design: Patients who were admitted to Zekai Tahir Burak Woman's Health, Education and Research Hospital between February 2017 and June 2017 and who had a history of 2 or more C-section between week 37 and 41 were included in this prospective cross-sectional study. These subjects were separated into 2 groups according to whether they wanted bilateral tubal ligation during C-section. Bilateral tubal ligation was performed by means of modified Pomeroy technique. Both groups were compared in terms of age, gravida, number of children living at home, education level and income status. Patients who did not want bilateral tubal ligation were asked to fill a questionnaire involving reasons for not asking for bilateral tubal ligation. Results: The number of patients who wanted bilateral tubal ligation was 51 (43%) while those who did not want bilateral tubal ligation was 67 (57%). Compared with patients who did not want bilateral tubal ligation, patients who wanted bilateral tubal ligation had more number of children at home and a higher number of previous C-section (p

We aimed to report a case of uterine arteriovenous malformation (UAVM) which was successfully treated by uterine artery embolization. A multiparous 23-year-old woman referred to our clinic for 7 weeks scar pregnancy. On ultrasound, incisional 32×37 mm gestational sac surrounded with non-pulsatile high flow vessels was demonstrated. Uterine artery embolization was performed with Gelfoam by interventional radiology. The post-embolization arteriogram showed complete embolization of the UAVM with slow flow of contrast in both uterine arteries. In clinical suspicion, UAVM can be diagnosed with Doppler ultrasonography and can be treated successfully with either uterine artery embolization or uterine surgery. UAVM is commonly diagnosed in women of childbearing age, angiographic embolization should be the firstly preferred treatment.

Objective: The objective of the study is to present the maternal near miss and maternal mortality cases from a tertiary hospital and to evaluate the factors associated with the presence of maternal near miss. Study Design: We performed a retrospective study, including all women who fulfilled the WHO criteria for maternal near miss or death between June 2009 and June 2014 at a tertiary referral education hospital. This study was conducted to evaluate the risk factors’ influence on near miss, multivariate logistic regression was used. Before setting logistic regression, univariate analyses were used to select candidate variables. Results: During the 5-year study, there were 82924 deliveries and 81673 live births. We identified 202 maternal near miss events and 11 maternal deaths. The maternal near miss ratio was 2.47 per 1.000 live births and the maternal mortality ratio was 13.46 per 100.000 live births. There were 213 women with a severe maternal outcome ratio (SMOR) (near miss + maternal death), with a ratio of 2.6 cases/1.000 live birth. Near miss events were associated with length of hospital stay (p

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.

OBJECTIVE: To evaluate clinical characteristics of surgical-site infections (SSIs) following cesarean section (CS) and to identify infection rates and risk factors associated with SSIs following cesarean section. STUDY DESIGN: A total of 197 patients who underwent cesarean and complicated with SSIs was evaluated during hospital stay or within 30 days following cesarean section by readmission to the hospital or by post discharge survey. The clinical characteristics, subsequent microbiological culture results and management were recorded. RESULTS: There were 34 (17.25%) patients complicated with preeclampsia and 26 (13.17%) gestational diabetes mellitus (GDM) in the study group. Preterm rupture of membranes (PROM) rate was 17.31% and mean rupture period were 6.61 hours. In the study population, 66 patients had positive culture results. The most isolated microorganism was S. Aureus (n=13, 19.7%). Preeclampsia, GDM and PROM rates were statically significant high in patients with positive culture results (p

We aimed to determine the risk factors of vaginal delivery after caesarean section (VDAC) that may be effective on maternal and neonatal outcomes and compare the pregnancy outcomes of VDAC with the results of the previous caesarean delivery. 36 women, who had VDAC in Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009-2014 years, were included in this study. Mean age of patients was 32.53± 3.595, mean birth week of previous caesarean was 38.21 ± 1.84 and mean birth week of present vaginal delivery was 36,10 ± 3,99. Birth weeks of previous caesarean and present vaginal deliveries were significantly different. Neonatal birth weight was not significantly different between these groups. Gravida and parity of the patient, and the number of previous vaginal deliveries, have been identified as factors that reduce adverse pregnancy outcomes by lineer regression analysis. Increased number of previous vaginal deliveries, gravida and parity reduce the adverse pregnancy outcomes in women having VDAC. [Med-Science 2016; 5(4.000): 957-60]

We aimed to determined; affect of clinical, laboratory, and ultrasonographic factors the time elapsed until the birth in midtrimester PPROM and PTE. Total 448 PPROM and PTE patients were conceived which applicant the Perinatology Department of zekai Tahir Burak Women's Health Education And Research Hospital between 2012-2014 years. PPROM group consisted of 237 patients, PTE group consisted of 211 patients. PPROM and PTE groups were divided into subgroups as cervical culture positive and negative PPROM and PTE groups. Risk factors of until the time of birth was determined by multivariate regression analysis in cervical culture positive PPROM and PTE groups. Cervical length measured by TVUSG=0,907, 95% Cl = 0,823-0,999 (p=0,047) and amniotic fluid index (or= 0,962, 95% Cl= 0,946-0,980 (p [Med-Science 2016; 5(2.000): 468-83]

Abstract Purpose The amniotic fluid volume (AFV) is known as a predictor for the wellness of a fetus. We aimed to investigate whether N-terminal pro-brain natriuretic peptide (NTproBNP) levels reflect AFV abnormalities in otherwise normal fetuses. Methods We recruited 24 women with isolated oligohydramnios, 23 women with isolated polyhydramnios, and 36 women with normal AFV at a tertiary referral center. NT-proBNP levels in umbilical venous samples and the individual characteristics of the three groups were compared. One-way ANOVA and Kruskal-Wallis analysis of variance were used for multi-group comparisons of continuous variables. When a significant difference was detected, the Scheffe test was performed as a post-hoc analysis. Proportions were compared using the Chi-square (2) test. Results Maternal age, body mass indices, weight gained in pregnancy and NT-proBNP levels were similar among the three groups. Apgar scores at 1 and 5 minutes significantly correlated with NT-proBNP levels in all newborns (Spearman's r = 0.23 ; p = 0.03 and Spearman's r = 0.24; p = 0.02, respectively). The umbilical venous NTproBNP levels did not differ between newborns who needed mechanical ventilation and those who didn't (p = 0.595). Conclusions NT-proBNP is a biomolecule that may provide insights into the pathogenesis of fetal circulatory problems and subsequent renal failure. Further investigations are warranted.

Objective: To compare fetal fibronectin (fFN) assessment, ultrasound parameters, and Bishop score in the prediction of successful induction of labor at term when cervix is unfavorable. Materials and Methods: Seventy-three nulliparous women undergoing labor induction at term with Bishop score less than 5 were enrolled in this study. Successful labor induction was defined as vaginal delivery occurring within 24 hours of initiation of induction. fFN obtained from vaginal secretion was measured by immunoassay. Results: Patients who delivered within 24 hours (n = 33) differed significantly from the remaining patients by a positive fFN (84.8% vs. 15.2%, p = 0.002). The mean cervical length or Bishop scores were not statistically different between women who delivered vaginally before 24 hours of induction and those who did not (28.9 mm vs. 27.9 mm, p = 0.468 and 3.3 vs. 3.2, p = 0.928, respectively). Binary logistic regression analysis showed only the fFN immunoassay to be an independent statistically significant predictor of vaginal delivery within 24 hours of induction (odds ratio 6.168; 95% confidence interval 1.897–20.059; p = 0.002). A positive fibronectin assay had a sensitivity and specificity of 84.9% and 50%, respectively. Conclusions: In cases with unfavorable cervix, presence of vaginal fFN predicts the success of labor induction.

Dermoid cyst (Mature cystic teratoma), the most common type of primordial germ cell ovarian tumors is usually benign and asymptomatic. It can be malignant for only 5 per cent. Giant ones can be symptomatic. Torsion is the most common complication. Ovarian (adnexal) torsion is defined that is twisting of ovarian(adnexal) mass around itself and compression of its vascular pedicle. Unless it's diagnosed and treated quickly, ovarian torsion can give a way to haemorrhagic infarct and necrosis of that ovary. Torsion occurs and progesses in a few hours. The most important entities are early diagnosis and early treatment. Clinical signs are similar in pregnant and non-pregnant cases. Approximately 20 per cent can give symptoms during pregnancy. It can occur in any trimester, but especially in first trimester. The patient complains about severe lower abdominal and pelvic pain, nausea and vomiting. Ultrasound and Doppler scan are first choices to make a diagnosis. For an exact assessment and treatment, it is warranted to detorsion of that adnex-ovary, visualize and observe its vitality during the operation. Here we are presenting a case that is pregnant in ten weeks' gestation with bilateral dermoid cyst and unilateral ovarian torsion. [Cukurova Med J 2015; 40(4.000): 814-817]

Amaç: Gebelik kolestazlı gebelerin gebelik sonuçlarının ve postprandial serum safra asit seviyelerinin perinatal komplikasyonları ile ilişkisinin değerlendirilmesi. Materyal ve Metod: Bu retrospektif çalışma Ocak 2008 ve Haziran 2013 arasında gebelik kolestazı tanısı alan 103 hastayı içermektedir. Hastaların yaşları, obstetrik hikayeleri, gebelik sonuçları, maternal ve neonatal komplikasyonları, ursedeoksikolik asit tedavisi ve serum labaratuar testleri hastaların medikal kayıtlarından elde edildi. Receiver operating karakteristik analizleri açlık ve postprandial safra asitleri seviyelerinin perinatal komplikasyonları tahmin etme gücünü değerlendirmek için kullanıldı. Araştırma Makalesi / Research Article 212 Cilt/Volume 40 Yıl/Year 2015 Postprandial Bile Acids in ICP Bulgular: Gestasyonel diyabet ve preterm doğum intrahepatik kolestazlı gebelerde daha sıklıkla izlendi. Primer sezeryan oranı intrahepatik kolestazlı hastalarda daha yaygındı. Gelişme geriliği oluşan fetusların oranı ursodeoksikolik asit kullanan kadınlarda daha yüksekti. Ursodeoksikolik asit kullanımından bağımsız olarak intrahepatik kolestazlı tüm gebelerde neonatal yoğun bakım ihtiyacı ve spontan preterm doğumların dahil olduğu tüm neonatal komplikasyonların görülme oranı benzerdi. Receiver operating karakteristik analizinde postprandial ve açlık safra asit seviyelerinin gebelik kompliksayonlarını tahmin etme gücü sırasıyla 0,64 ve 0,70 idi. Sonuç: Gebelik kolestazı preterm doğum ve neonatal morbiditi gibi perinatal komplikasyonları kesin olarak arttırmaktadır. Postprandial safra asit seviyesi açlık safra asit seviyesine göre obstetik komplikasyonları tahmin etmede daha değersiz bulunmuştur ve ursodeoksikolik asit tedavisi perinatal sonuçların üzerinde etkili bulunamamıştır

Purpose: To determine the outcomes of Iintrahepatic cholestasis of pregnancy and the role of postprandial serum bile acid levels in the prediction of perinatal complications. Material and Methods: This retrospective study consisted of 103 patients with intrahepatic cholestasis of pregnancy between January 2008 and June 2013. Maternal age, obstetric history, pregnancy outcome, maternal and neonatal complications, ursodeoxycholic acid treatment during pregnancy and serum laboratory tests were retrieved from patients' medical records. Receiver operating characteristic analysis was used to evaluate the performance of fasting and postprandial serum bile acid levels to predict perinatal complications. Results: Gestational diabetes and preterm delivery occurred more frequently in patients with intrahepatic cholestasis of pregnancy patients. The rate of primary cesarean delivery was more common in in patients with intrahepatic cholestasis of pregnancy patients. The rate of growth-restricted infants was higher in the patients who received ursodeoxycholic acid. Nenoatal intensive care unit admissions and overall neonatal complications, as well as spontaneous preterm deliveries, were similar among in patients with intrahepatic cholestasis of pregnancy regardless of ursodeoxycholic acid therapy. In the receiver operating characteristic analysis, the area under curve values for postprandial and fasting bile acids to predict neonatal complications were 0.64 and 0.70, respectively. Conclusion: Intrahepatic cholestasis of pregnancy patients increases certain perinatal complications, such as preterm deliveries and neonatal morbidity. Postprandial serum bile acid levels are inferior to fasting serum bile acid levels in the prediction of obstetric complications. ursodeoxycholic acid does not seem to improve perinatal outcomes. [Cukurova Med J 2015; 40(2.000): 212-220]

We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT). The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17) and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34). The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC) count (57% vs. 16%, p = 0.04) and serum D-dimer levels (77% vs. 21%, p < 0.01) on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each); whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively). This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

If one of the fetuses is determined to be death in a twin pregnancy, chorionicity and amniotic number should be detected. Early birth should be planned when MCMA twin pregnancy is encountered. As a result, serial ultrasound and Doppler examinations are not enough to detect any fetal complications or fetal death in MCMA twin pregnancy

Pulmonary embolism is a major cause of death during pregnancy or the puerperium. The hemostatic changes in pregnancy creates a prothrombotic milieu. Hyperemesis gravidarum is one of the recognised risk factors for venous tromboembolism.Two cases of maternal mortality were attributed to PE associated with severe hyperemesis gravidarum in 2014 in Turkey. These two cases have been reported and discussed in the literature review. We aimed to alert clinicians that thromboprophylaxis should be considered when a pregnant woman suffers vomiting leading to clinical evidence of dehydration.

Postpartum hemorrhage due to uterine atony is a condition that may be life-threatening unless immediate intervention is made. Oxytocin, ergot derivatives, and prostaglandin (PG) E1 are first-line medical treatment options besides an effective uterine fundal massage. If the patient is unresponsive to the medical management approach, surgical intervention is required. All medications have potential side effects. We present a case that developed uncontrolled tonic body movements and mild disorientation accompanying fever after sublingual PG E1 administration for treatment of uterine atony.

In this paper, we report a case of materno-fetal C-subgroup incompatibility that was managed at our institution. A 41-year-old woman was admitted to our prenatal outpatient unit for the first time at 29th week of a singleton pregnancy. After an indirect coombs test result of 1/64 positive, cordocentesis was performed. Fetal blood group was reported as AB Rh(-), and Direct coombs test was reported to be +3 positive. A 3040 gr live fetus was delivered by cesarean section, on the 34th week of pregnancy. Maternal blood samples revealed C(-), c(4+), E(-), e (4+) and Kell (-), and the fetus had direct coombs 3+, C(4+), c(3+), E (-), e (4+) and Kell (-). No fetal complications occurred.

Prophylactic drainage of the peritoneal cavity after obstetrical and gynecological surgery is widely practiced. The idea of “when in doubt, drain” is accepted and applied clinically by many surgeons. However, surgically placed drains are not without risk. The present case describes herniation of fallopian tube during the removal of a surgical drain placed after a cesarean section.

Objective: To evaluate the presence of any seasonal variation in the frequency of intrahepatic cholestasis of pregnancy (ICP). Study Design: A total of 126 cases with ICP were compared with a cohort of 37614 pregnant women who delivered. The diagnosis ICP was performed on the basis of severe itching and the absence of dermal rash and any other hepatic disease, with the co-existence of elevated serum aminotransferase levels and/or serum bile acid concentration. For each month and season, observed and expected ICP rates were analysed and compared by using chi-square statistics. Multivariate logistic regression was performed to investigate certain parameters on cumulative risk. Results: A significantly lower frequency of ICP in winter (6/126 (4.8%), p=0.001) and a significantly higher frequency in spring (44/126 (34.9%), p=0.034) were detected. A 2.1 and 3.8-fold higher risk were found for the nulliparity and the twin pregnancy, respectively. Logistic regression analysis confirmed the significant (10-fold) decrease in the frequency of ICP in winter. The significance of spring did not persist after the adjustment. Conclusion: Main outcome of the study points at seasonality in ICP frequency. Future studies in different populations may reveal data about factors that interact with seasonality and playing roles in ICP.

OBLECTIVE: We aimed to evaluate maternal serum nitric oxide (MSNO) levels in adolescent pregnancies. STUDY DESIGN: A total of forty five pregnancies were included to the study, of these eight were adolescent pregnancies (age range, 18-19 years old). Factors analyzed between adolescent pregnancies and reproductive age pregnancies (age range 20-35 years old) were; age, gravidity, parity, gestational weeks, umbilical and middle cerebral artery Doppler velocimetry values, birth weigts, APGAR 5. minute scores and MSNO levels. Statistical analyses were carried out by using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA) with Chi-square (χ2) test and Student’s t test. The receiver operator characteristic (ROC) curve analysis was used to establish the cutoff values for MSNO levels. RESULTS: Demographic and clinical characteristics showed no statistically significant difference among the groups (p>0.05). MSNO levels were statistically significantly lower in adolescent age pregnancies. CONCLUSION: According to current study, MSNO levels were statistically significantly different from reproductive age pregnancies. MSNO levels may be a discriminative marker in adolescent age pregnancies but further studies with larger participants are needed to get more definite results.

Obstetric cholestasis (OC) is a pregnancy specific liver disease characterized by increased levels of bile acid (BA) and pruritus. Raised maternal BA levels could be associated with intrauterine death, fetal distress, and preterm labor and also alter the rate and rhythm of cardiomyocyte contraction and may cause fetal arrhythmic events. We report a case of drug resistant fetal supraventricular tachycardia and concomitant OC. Conclusion. If there are maternal OC and concomitant fetal arrhythmia, possibility of the resistance to antiarrhythmic treatment should be kept in mind.

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia.This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia.During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34).BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

OBJECTIVE: To determine the efficacy of luteal phase support with human chorionic gonadotropin (hCG) or micronised progesterone (MP) during exogenous gonadotropin induced cycles. STUDY DESIGN: A prospective randomised cross ov er study was perf ormed to ev aluate the effects of different luteal phase support treatments. Each women receiv ed luteal support either with hCG, (after ov ulatory hCG injection, on day s 3, 6 and 9, injection of 1500 IU hCG), or with v aginal MP (200 mg vaginal MP progesterone suppository twice a day, starting 3 days after the ovulation triggering hCG injection) or no luteal support in consequent cycles with different orders. Thirty women underwent a total of 83 cycles using gonadotropin f or ovulation induction. Groups were compared according to their luteal phase lengths, midluteal progesterone lev els, complications, the time of hCG administration and estradiol value at the time of hCG administration. RESULTS: In the group of hCG luteal support, the midluteal progesterone (MLP) was signif icantly higher and the luteal phase length was significantly longer compared to MP and control group. Pregnancy rates were not statistically different f or the groups. CONCLUSION: Luteal phase support, during gonadotropin induced cycles, affect luteal phase positiv ely. But, no improvement in pregnancy rates was achiev ed with the use of luteal phase support.