Gynecology Obstetrics & Reproductive Medicine

Transplantation and Pregnancy

Pinar Erkan Uc, Sermet Sagol — Sun, 28 Apr 2024 00:00:00 +0000

Transplantation is becoming increasingly widespread worldwide as a life-saving treatment for patients with end-stage organ failure. While the woman's quality of life improves rapidly after transplantation, the improvement of the endocrine system helps to regain fertility. The success of conception and successful pregnancy rates are quite low compared to the general population. Particular attention should be paid to obstetric complications such as hypertension, preeclampsia, fetal growth restriction, and preterm delivery during pregnancy. Ideally, preconception counseling should begin in the period before transplantation. Initiating contraception immediately after transplantation is ideal and long-acting reversible methods such as intrauterine devices and subcutaneous implants may be preferable. Factors that influence pregnancy outcomes in women undergoing organ transplantation include good general health within two years of transplantation, no evidence of organ rejection in the last year, stable graft conditions, absence of acute infections affecting the fetus, and adequate doses of immunosuppression drugs. However, factors that may adversely affect pregnancy include the etiology of the disease requiring transplantation, chronic allograft dysfunction, renal failure, cardiopulmonary diseases, hypertension, diabetes, obesity, and infections such as hepatitis B, hepatitis C, and Cytomegalovirus (CMV). Postponing pregnancy for at least 1 year after transplantation is very important to optimize pregnancy outcomes. Pregnancy in the early post-transplant period increases the risk of acute rejection, infection risk, and graft-related problems. In general, transplanted women can have successful pregnancies and live birth rates are above 70% on average. Although perinatal morbidity and mortality rates are high, most newborns are healthy and develop normally. Specific criteria such as pre-pregnancy serum creatinine levels and blood pressure control, as well as adherence to immunosuppressive therapy, significantly influence pregnancy success in transplant patients. In this review, optimizing pregnancy outcomes often involves addressing maternal and fetal risks, regular graft monitoring to detect potential complications such as organ rejection, and regulation of transplant medications to ensure safety and efficacy during pregnancy. Successful management relies on a multidisciplinary approach with contributions from obstetricians, neonatologists, nephrologists, hepatologists, and transplant surgeons.

Does the Serum Vaspin Level Have a Role in the Diagnosis of Primary Ovarian Insufficiency?

Fatma Nur Koyun, Nafiye Yilmaz, Duygu Tugrul Ersak — Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVE: This study was designed to compare the serum vaspin levels between patients with primary ovarian insufficiency (POI) and healthy fertile women.

STUDY DESIGN: Sixty-nine patients diagnosed with idiopathic POI and 70 age-matched healthy fertile women were included in this case-control study. General gynecological and physical examination findings and serum basal hormone levels were recorded. Vaspin levels in serum samples were determined using the Enyzme-Linked ImmunoSorbent Assay (ELISA) method.

RESULTS: The mean age of the patients with POI was 31.9±5.4 years, while it was 31.2±3.8 years in the control group. There were no statistically significant differences in body mass index, gravidity, parity, and cigarette consumption between the groups. However, the mean follicle-stimulating hormone level in POI patients was 55.4±25.1 IU/L, significantly higher than the 6.2±1.8 IU/L observed in the control group. Luteinizing hormone levels were also significantly higher in POI patients, while estradiol and anti-Mullerian hormone values were significantly lower. Furthermore, the mean serum vaspin level in POI patients was 0.79±0.56 ng/mL, compared to 1.08±0.64 ng/mL in the control group (p<0.001).

CONCLUSIONS: Serum vaspin levels were found to be decreased in women with POI. Therefore, monitoring the serum vaspin levels in women with POI may help in the early identification of patients with POI.

Evaluation of Pathology Results of Patients with a History of Breast Cancer who were Operated on for Gynecological Pathologies or Prophylaxis

Sun, 28 Apr 2024 00:00:00 +0000

Objectives: The present study aimed to evaluate the operation results of patients who were followed up due to breast cancer and were operated on due to gynecological pathologies or for prophylactic purposes, and determine the distribution of gynecological pathologies in breast cancer patients

Study design: Patients with breast cancer who had gynecological surgery in our institution between December 2015 and January 2023 were retrospectively analyzed in this cross-sectional study. The pathological reports and medical records of the included patients were obtained from the gynecologic oncology electronic database system and the patient files. The study is approved by the institution’s local ethics committee.

Results: Totally 57 patients with a history of breast cancer had gynecological operations between December 2015 and January 2023. The median age of the patients was 49. Benign pathologies were detected in the majority of patients with a history of breast cancer, this rate was found to be 87.7%. The pathology revealed malignant/premalignant disease in seven (12.2%) patients. Among these seven patients, four patients had malignant disease one patient had microinvasive cervical cancer, one patient had ovarian serous cancer, one patient had cervical and ovarian metastasis of breast cancer, and one patient had ovarian metastasis of breast cancer.

Conclusions: Patients with a history of breast cancer have increased rates of gynecological pathology development compared to the normal population.

Hemoglobin A1c Level is Associated with Lymphovascular Space Invasion in Diabetic Endometrial Cancer Patients

Ayse Rabia Senkaya, Sercan Kantarci, Suna Yildirim Karaca, Muzaffer Sanci — Sun, 28 Apr 2024 00:00:00 +0000

Objective: Our aim in this study is to examine the relationship of hemoglobin A1c (HbA1c) and fasting glucose with the stage, grade and histological type of cancer and its value in predicting the prognosis of endometrial cancer in diabetic endometrial cancer patients.

Study Design: The data of 138 endometrial cancer patients with diabetes who met the study criteria were analyzed. Hemoglobin A1c levels and fasting glucose were compared with cancer stage, grade, histological type, lymphovascular invasion, chemotherapy and radiotherapy data.

Results: A statistically significant difference was found between the groups in terms of HbA1c values only according to the lymphovascular invasion (p=0.02). While there was no significant correlation between endometrial thickness and HbA1c, a low positive correlation was found between the fasting glucose value (r=0.191, p=0.025)

Conclusions: The higher rate of lymphovascular invasion in patients with high HbA1c value alone is insufficient in determining the prognosis when other parameters are considered.

Cervical Cancer Visual Screening Experience in the Republic of Tajikistan

Nilufar Muhsinzoda, Alex Bingjie Yuan, Rustam Tursunov — Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVES: To study the results of the first pilot study of organized visual cervical cancer (CC) screening for the detection of precancerous pathology of the cervix in two pilot districts of the Republic of Tajikistan.

STUDY DESIGN: In this cross-sectional study, the target group included healthy women of reproductive age (30-49 years) from Kushoniyon and B. Gafurov Districts who underwent visual screening. The total study population was 72,574 out of which 68,391 (94.3%) visited primary healthcare facilities for visual inspection with Lugol’s Iodine (VILI). A total of 2958 women with suspicious tests for cervical intraepithelial neoplasia (CIN) were identified (4.3%) and sent to the reproductive health care centers for further diagnostics. Post-screening diagnostic tests were performed to specify cervical lesions, which included colposcopy with acetic acid (VIA) visual inspection, cytology, and biopsy with histological examination. HPV testing wasn’t included in the diagnostic protocol due to its high cost.

RESULTS: A total of 164 histologically confirmed cases of CIN were identified (0.25% of number of women screened). The detection rate of precancerous pathology was 26.9 per 100,000 female population, which is 8.2 times higher than the detection rate of CC. All patients regardless of CIN degree underwent loop electrosurgical excision (LEEP)/conization. In the follow-up period (6-48 months), complete recovery after 136 LEEP, 21 conizations, and 7 hysterectomies were observed in 97% (5 recurrences of non-invasive disease).

CONCLUSION: The visual screening showed high efficiency in detecting CIN. The positive experience suggests the implementation of this program nationwide.

Perinatal Outcome of Previable Premature Rupture of Membranes Before 24 Weeks of Gestation: A Single-Centered Retrospective Cohort Ctudy

Yasemin Dogan, Ercan Kockaya, Muzeyyen Dilsad Eser, Ayla Gunlemez — Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVE: Preterm premature rupture of membranes (PPROM) has unfavorable consequences for the neonate and the mother if it occurs before 24 weeks of gestation. We aim to present our series to elucidate the course of previable PPROM and to detect maternal and neonatal outcomes.

STUDY DESIGN: A single-centered retrospective cohort study that involves singleton patients diagnosed with spontaneous PPROM before 24 weeks. Data were retrieved from medical records, and maternal and neonatal outcomes were noted.

RESULTS: Seventy-eight women were diagnosed with PPROM before 24 weeks, 42 patients (54%) opted for termination of pregnancy, and seven patients (9%) had spontaneous abortion. Twentynine patients (37%) gave live birth after a median latency of 47 days. Neonatal complications were respiratory distress syndrome (n=19; 65%), early sepsis (n=10; 34%), late sepsis (n=5; 17%), bronchopulmonary dysplasia (n=5;17%), retinopathy of prematurity (n=3; 10%), pneumothorax (n=5; 17%), intracranial hemorrhage (n=2; 6%), necrotizing enterocolitis (n=1; 3%) and meningitis (n=1; 3%). In the liveborn group, the neonatal survival rate was 62%. Of the survivors, twelve babies (66%) were discharged without composite neonatal morbidity. Maternal complications in the expectant management group included clinical chorioamnionitis (n=12, 33%) and placental abruption (n=2, 5%).

CONCLUSION: In previable PPROM, overall half of the babies survive after expectant management. While a prolonged latency period and subsequent delivery at advanced gestational ages improve neonatal outcomes, such a conservative approach poses a substantial risk for chorioamnionitis.

Placental Vimentin Expression in Preeclampsia and Gestational Diabetes Mellitus

Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVE: This study investigated vimentin expression in placentas of patients with preeclampsia and gestational diabetes mellitus (GDM).

STUDY DESIGN: Placentas of preeclamptic women (n=25), women with GDM (n=25), and control cases (n=25) were enrolled in this study. Placental samples were fixed in zinc-formalin and further processed for paraffin wax tissue embedding. Demographic and laboratory parameters of patients were recorded. Vimentin immune activity was analyzed in the placental sections with immunohistochemistry. Sections were imaged and analyzed under a light microscope. A semiquantitative measurement was done between groups by comparing the Vimentin signal and significance was calculated. Network construction and pathway enrichment analysis were conducted using Cytoscape (v3.10.1) and ShinyGO, respectively.

RESULTS: Vimentin expression was high in the placental sections of the control group. The preeclampsia group showed positive Vimentin expression in cytotrophoblast and syncytiotrophoblast cells and connective tissue of placental villi in the preeclampsia group. Vimentin expression was generally recorded as negative in placental villi, fibrinoid substances, and connective tissue cells in the GDM group. Bioinformatic analysis showed that the AGE-RAGE signaling pathway and cancer-related pathways were mainly observed in Vimentin-associated pathways, which finally activate inflammatory pathways in both preeclampsia and GDM.

CONCLUSION: Vimentin expression patterns in placental tissue sections reveal nuanced regulatory mechanisms, emphasizing the need for further exploration into the functional roles of vimentin in placental physiology and pathology.

Harlequin Ichthyosis: Case Series

Huriye Ezveci, Sukran Dogru, Fatih Akkus, Kazim Gezginc — Sun, 28 Apr 2024 00:00:00 +0000

Objective: Harlequin ichthyosis (HI) is an autosomal-recessive inherited disorder. The incidence is extremely rare and is reported to range from 1/300 000 to 1/1 000 000. Some risk factors include preterm births and consanguinity. Prenatal DNA testing for the ABCA12 mutation aids in diagnosis. Although ultrasonography helps the diagnosis, the diagnostic value of a single ultrasound is low. It is fatal for the affected newborn after the first few days after birth, but few long-term survivals have been recorded. The hallmark of with disease is severely keratinized skin. This study aims to evaluate the prenatal and postnatal outcomes of cases with HI.

Study Design: The study includes instances of HI that were diagnosed at the clinic throughout 2018–2023. The week of diagnosis, ultrasonographic findings, week of birth, and findings at the time of delivery for all patients were acquired via electronic reports and archival data. Data regarding the condition of viable fetuses was acquired using telephonic means.

Results: The study included a total of five patients. There were prenatal ultrasonography findings in three cases. There were no prenatal ultrasound findings in the remaining two patients. Cordocentesis was applied to a single case using prenatal ultrasound diagnosis, and a normal genetic result was obtained. The remaining two cases refused to opt for the option of prenatal invasive testing. The termination option was not accepted in three cases with an intrauterine diagnosis. Prenatal ultrasonography revealed features showing skin thickening, ectropion, eclabion, oligohydramnios, and fetal growth restriction (FGR). Histological examination results of fetal skin biopsies in three cases showed consistent findings of epidermolytic HI, thus confirming the diagnosis of HI. The histological diagnosis of the remaining two patients was inconclusive. All cases are alive.

Conclusion: It is advisable to conduct a methodical evaluation based on the clinical manifestations of the condition during the third trimester of gestation to diagnose HI, particularly in instances where there is no familial predisposition.

Additive Effect of Fetal Magnetic Resonance Imaging to Prenatal Ultrasonography in Fetal Congenital Anomalies

Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVES: In this study, we aimed to assess the diagnostic accuracy of prenatal Ultrasonography (USG) and Magnetic Resonance Imaging (MRI) in fetal congenital anomalies.

STUDY DESIGN: A retrospective cross-sectional analysis was conducted on 148 patients who had previously undergone prenatal MRI between January 2013 and May 2023. A total of 185 anomalies in 148 fetuses were evaluated using USG and MRI. The prenatal diagnoses were compared with definitive diagnoses and were classified as diagnosed, partially correct, questionable, or undiagnosed. In addition, USG and MRI findings were compared in terms of their consistency and consolidation.

RESULTS: The postnatal evaluation revealed a total of 185 anomalies in 148 fetuses. USG diagnosed 94% of these anomalies, while MRI diagnosed 95.1% of them. Both USG and fetal MRI were able to diagnose 91.9% (n=170) of anomalies during the prenatal period. Fetal MRI provided an additional contribution to USG in the diagnosis of six anomalies (3.24%).

CONCLUSION: In fetuses undergoing detailed ultrasonography and specialized neurosonography by experienced professionals, additional fetal anomalies exclusively detected through MRI are now found to be lower than previously documented. However, fetal MRI is presently employed to offer supplementary information, and advice, and assist in clinical decision-making. In the future, extensive prospective studies with standardized protocols for ultrasound imaging of the fetal brain are necessary to better understand the true role of fetal MRI in cases where fetal neurosonography has already been performed.

Investigation of Serum Cartonectin Concentrations in Pregnant Women with Gestational Diabetes Mellitus; a Prospective Non-Interventional Cohort Study

Onur Gebes, İbrahim Kale, Tuba Beser Gebes, Murat Muhcu — Sun, 28 Apr 2024 00:00:00 +0000

OBJECTIVE: To investigate serum cartonectin concentrations in pregnant women diagnosed with Gestational Diabetes Mellitus (GDM).

STUDY DESIGN: This prospective non-interventional cohort study was conducted on 176 pregnant women. The study group consisted of 88 pregnant women diagnosed with GDM, and the control group consisted of 88 pregnant women with normal 75-g OGTT results. First, the study and control groups, and then the subgroups were compared in terms of serum cartonectin concentrations.

RESULTS: The study and control groups were similar in terms of BMI and gestational age at blood sampling (p=0.599, p=0.854). The study and control groups were similar in terms of median serum cartonectin concentrations (6.28 ng/ml and 7.13 ng/ml, respectively, p=0.165). In the subgroup analysis, the normal weight control group, overweight control group, normal weight study group, and overweight study group were compared in terms of serum cartonectin concentrations. The lowest median cartonectin concentration was detected in the overweight study group, followed by the overweight control group, normal weight study group, and normal weight control group (5.8 ng/ml, 6.5 ng/ml, 6.9 ng/ml, and 8.2 ng/ml, respectively, p=0.235).

CONCLUSION: Serum cartonectin concentrations were found to be similar in the GDM and control groups. However, the number of participants in this study is limited to draw a definitive conclusion. Many studies with larger series are needed to reveal whether serum cartonectin is involved in the pathophysiology of GDM.