Search

Objective: We investigated the importance of prophylactic administration of low-dose low-molecular-weight heparin (LMWH) in women with risk factors associated with placental inflammation. Materials and methods: This retrospective cohort study included 300 pregnant women with a singleton pregnancy (30 primigravidas and 270 multigravidas) who received prophylactic low-dose LMWH to prevent placental inflammation. Based on maternal risk factors, patients were categorized into 3 groups as follows: Group 1: Patients with metabolic risk factors for placental inflammation (n = 205), Group 2: Patients with immunological risk factors for placental inflammation (n = 42), Group 3: Patients with metabolic and immunological risk factors for placental inflammation (n = 53). Obstetric histories, demographic features, clinical characteristics, and present pregnancy outcomes were compared between groups. Live birth rates, composite adverse obstetric outcomes, and the Beksac obstetric index were compared between present and previous pregnancies in multigravidas. Results: Pregnancy outcomes were significantly better in the present pregnancy than in previous pregnancies. A significant increase was observed in live birth rates (33.4% vs. 69.9%, 27.5% vs. 60.5%, and 30.1% vs. 69.4% in groups 1, 2, and 3, respectively) and in the Beksac obstetric index (0.32 vs. 0.43, 0.33 vs. 0.47, and 0.38 vs. 0.57 in groups 1, 2, and 3 respectively) (p .001 for all). A significant decrease in composite adverse pregnancy outcome rates was observed during the present pregnancy (23.5% vs. 100%, 28.9% vs. 100%, and 24.5% vs. 100% in groups 1, 2, and 3, respectively) (p .001 for all). Live birth and composite adverse obstetric outcome rates were 70% and 33.3%, respectively in primigravidas. Conclusion: Low-dose low-molecular-weight heparin prophylaxis is useful to prevent metabolic and immunological disorders causing placental inflammation, which is the most likely pathophysiological mechanism contributing t

[No abstract available], 127

[No abstract available], 394

Objective To demonstrate the impact of preterm birth on the cytological, cytomorphometrical, and nuclear parameters of neonatal buccal smears. Methods This study consisted of Early Preterm Neonates (EPN; = 34th gestational week [gw]; n = 36), Late Preterm Neonates (LPN; 34th to 37th gw; n = 46), and Term Neonates (control; >= 37th gw; n = 56). Cytological evaluation and buccal cytome assay were performed using Papanicolaou and Feulgen methods, respectively. Results Cytological evaluation demonstrated that smear background was cleaner (P .05) and there were less macrophages in the control group (P .001). Cyto-morphometric analysis showed that the measurements of nuclear diameter, nuclear area, and nucleus-to-cytoplasm ratio were higher in the preterm (EPN and LPN) versus the control groups (P = .016, P .001, and P .001, respectively). We also demonstrated that staining intensity of the nucleus and cytoplasm were less intense in the EPN and LPN groups (P .001). There was no statistically significant difference between the EPN and LPN groups for any parameters (P > .05). Buccal cytome assay showed that nuclear buds were more prevalent in term newborns compared to preterm neonates (P .001). Conclusions Morphological and cytological properties of neonatal buccal cells are influenced by preterm birth status, and buccal smears may be used as a tool to detect biological markers of neonatal health problems., Hacettepe University Scientific Research Projects Coordination UnitHacettepe University [THD-2018--17493], This study was funded by Hacettepe University Scientific Research Projects Coordination Unit, Project number: THD-2018--17493.

Objective: We investigated the importance of prophylactic administration of low-dose low-molecular-weight heparin (LMWH) in women with risk factors associated with placental inflammation. Materials and methods: This retrospective cohort study included 300 pregnant women with a singleton pregnancy (30 primigravidas and 270 multigravidas) who received prophylactic low-dose LMWH to prevent placental inflammation. Based on maternal risk factors, patients were categorized into 3 groups as follows: Group 1: Patients with metabolic risk factors for placental inflammation (n = 205), Group 2: Patients with immunological risk factors for placental inflammation (n = 42), Group 3: Patients with metabolic and immunological risk factors for placental inflammation (n = 53). Obstetric histories, demographic features, clinical characteristics, and present pregnancy outcomes were compared between groups. Live birth rates, composite adverse obstetric outcomes, and the Beksac obstetric index were compared between present and previous pregnancies in multigravidas. Results: Pregnancy outcomes were significantly better in the present pregnancy than in previous pregnancies. A significant increase was observed in live birth rates (33.4% vs. 69.9%, 27.5% vs. 60.5%, and 30.1% vs. 69.4% in groups 1, 2, and 3, respectively) and in the Beksac obstetric index (0.32 vs. 0.43, 0.33 vs. 0.47, and 0.38 vs. 0.57 in groups 1, 2, and 3 respectively) (p .001 for all). A significant decrease in composite adverse pregnancy outcome rates was observed during the present pregnancy (23.5% vs. 100%, 28.9% vs. 100%, and 24.5% vs. 100% in groups 1, 2, and 3, respectively) (p .001 for all). Live birth and composite adverse obstetric outcome rates were 70% and 33.3%, respectively in primigravidas. Conclusion: Low-dose low-molecular-weight heparin prophylaxis is useful to prevent metabolic and immunological disorders causing placental inflammation, which is the most likely pathophysiological mechanism contributing t

[No abstract available], 127

[No abstract available], 394

Objective To demonstrate the impact of preterm birth on the cytological, cytomorphometrical, and nuclear parameters of neonatal buccal smears. Methods This study consisted of Early Preterm Neonates (EPN; = 34th gestational week [gw]; n = 36), Late Preterm Neonates (LPN; 34th to 37th gw; n = 46), and Term Neonates (control; >= 37th gw; n = 56). Cytological evaluation and buccal cytome assay were performed using Papanicolaou and Feulgen methods, respectively. Results Cytological evaluation demonstrated that smear background was cleaner (P .05) and there were less macrophages in the control group (P .001). Cyto-morphometric analysis showed that the measurements of nuclear diameter, nuclear area, and nucleus-to-cytoplasm ratio were higher in the preterm (EPN and LPN) versus the control groups (P = .016, P .001, and P .001, respectively). We also demonstrated that staining intensity of the nucleus and cytoplasm were less intense in the EPN and LPN groups (P .001). There was no statistically significant difference between the EPN and LPN groups for any parameters (P > .05). Buccal cytome assay showed that nuclear buds were more prevalent in term newborns compared to preterm neonates (P .001). Conclusions Morphological and cytological properties of neonatal buccal cells are influenced by preterm birth status, and buccal smears may be used as a tool to detect biological markers of neonatal health problems., Hacettepe University Scientific Research Projects Coordination UnitHacettepe University [THD-2018--17493], This study was funded by Hacettepe University Scientific Research Projects Coordination Unit, Project number: THD-2018--17493.

Objective: To compare fetal cell microchimerism in normal and immunocompromised gestations. Materials and methods: The study consists of two groups of mature female mice. In the control group and the immunocompromised study group, 5 mg of saline and cyclosporine were injected intraperitoneally, respectively. In the second step, all female mice were mated with “Actine-Luc (+) green fluorescent protein (GFP)” transgenic male mice. Immunohistochemical studies (ALPL-antiluciferase, cytokeratin-antiluciferase, and CD 105-antiluciferase) were carried out on maternal liver, skin, and lung tissues at 6–7th and 14–15th gestational days, and postpartum 3–4th, 12th, and 18–24 months. Results: GFP (+) cells were detected in maternal liver and skin but not in lung tissue. Liver was the most affected tissue. GFP was found to be more intense in the immunocompromised group. Conclusion: Fetal microchimerism was demonstrated in maternal liver and skin and found to be more intensive in the immunocompromised group.

Objectives: To provide information to the government about the budget impact of implementing non-invasive prenatal testing (NIPT) into prenatal screening strategies to detect Down syndrome (DS) in singleton pregnancies in Turkey; the likely costs or savings associated with NIPT in comparison to the current practice were calculated. Methods: A decision-analytic model was developed to calculate the cost estimates for 1,309,771 women who gave birth in 2016; 84.8% of whom were 35-years-of-age. The superior combined test (CT) among current strategies is compared with contingent NIPT for women 35-years-of-age; and usual practice of amniocentesis (AC) for women ? 35 years-of-age was replaced with universal NIPT. Results: When the market price of NIPT (1,077 PPPUS$) is used, contingent NIPT offered to high-risk women 35-years-of-age adds 34,907,225 PPPUS$; and for women-35 ? years-of-age the universal NIPT leads to 142,785,818 PPPUS$ more cost to the government compared to current strategies. The additional costs with NIPT are partially compensated by the cost-savings due to reduction of the number of invasive tests and procedure related losses (17,826,476 PPPUS$ for women 35-years-of-age and 37,070 PPPUS$ for women ? 35-years-of-age). Results are sensitive to the NIPT costs; with a lower cost of NIPT, a total saving would be 33,116,046 PPPUS$ with new strategies. Conclusions: NIPT might be the choice of prenatal screening strategies if its price is lowered to economically acceptable levels. Until that time, currently accepted protocols seem to be more realistic. On the other hand, decision makers should also consider possible savings and the women's quality of life that can be improved with the new technology.

Aim: To share the chorionic villus sampling (CVS) experience of a single surgeon in our institution. Methods: This retrospective study consists of CVS cases performed between 2000 and 2018. A total of 66 types of indications were classified under two main categories, the screening group (SG) and the inherited disease group (IDG). The SG and IDG were compared in terms of clinical characteristics of the patients, Beksaç obstetrics index (BOI), timing of CVS in terms of gestational week, and complications and termination of pregnancy (TOP) rate. Results: CVS was performed at 656 women, 69 and 587 of whom were included in the SG and IDG, respectively. CVS indications of the SG were determined as advanced maternal age, high risk in combined test, fetal anomaly suspicion in ultrasonography, and increased nuchal translucency in 23, 23, 14 and 9 cases, respectively. On the other hand, CVS indications of the IDG were hereditary disorders related to hematological, muscular, and metabolic systems for 233, 179, and 116 cases, respectively. Furthermore, 32 patients had a single-gene disorder and 14 had a neurodegenerative disease. According to the results of CVS, 359 fetuses were found to be normal (54.73%), while 205 (31.25%) and 92 (14.02%) fetuses were found to be disorder-positive or carriers, respectively. Two hundred pregnant women accepted TOP. Eight (1.2%) pregnancies ended with abortion after CVS. Statistically significant differences were observed in BOI and TOP rate between SG and IDG (p: 0.042 and 0.013). Conclusion: Hereditary disorders were the most common CVS indications and the acceptance of TOP was significantly higher in this group.

Objective To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). Study Design This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. Results Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. Conclusion Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

Objectives: To provide information to the government about the budget impact of implementing non-invasive prenatal testing (NIPT) into prenatal screening strategies to detect Down syndrome (DS) in singleton pregnancies in Turkey; the likely costs or savings associated with NIPT in comparison to the current practice were calculated. Methods: A decision-analytic model was developed to calculate the cost estimates for 1,309,771 women who gave birth in 2016; 84.8% of whom were 35-years-of-age. The superior combined test (CT) among current strategies is compared with contingent NIPT for women 35-years-of-age; and usual practice of amniocentesis (AC) for women ? 35 years-of-age was replaced with universal NIPT. Results: When the market price of NIPT (1,077 PPPUS$) is used, contingent NIPT offered to high-risk women 35-years-of-age adds 34,907,225 PPPUS$; and for women-35 ? years-of-age the universal NIPT leads to 142,785,818 PPPUS$ more cost to the government compared to current strategies. The additional costs with NIPT are partially compensated by the cost-savings due to reduction of the number of invasive tests and procedure related losses (17,826,476 PPPUS$ for women 35-years-of-age and 37,070 PPPUS$ for women ? 35-years-of-age). Results are sensitive to the NIPT costs; with a lower cost of NIPT, a total saving would be 33,116,046 PPPUS$ with new strategies. Conclusions: NIPT might be the choice of prenatal screening strategies if its price is lowered to economically acceptable levels. Until that time, currently accepted protocols seem to be more realistic. On the other hand, decision makers should also consider possible savings and the women's quality of life that can be improved with the new technology.

Objective: To compare fetal cell microchimerism in normal and immunocompromised gestations. Materials and methods: The study consists of two groups of mature female mice. In the control group and the immunocompromised study group, 5 mg of saline and cyclosporine were injected intraperitoneally, respectively. In the second step, all female mice were mated with “Actine-Luc (+) green fluorescent protein (GFP)” transgenic male mice. Immunohistochemical studies (ALPL-antiluciferase, cytokeratin-antiluciferase, and CD 105-antiluciferase) were carried out on maternal liver, skin, and lung tissues at 6–7th and 14–15th gestational days, and postpartum 3–4th, 12th, and 18–24 months. Results: GFP (+) cells were detected in maternal liver and skin but not in lung tissue. Liver was the most affected tissue. GFP was found to be more intense in the immunocompromised group. Conclusion: Fetal microchimerism was demonstrated in maternal liver and skin and found to be more intensive in the immunocompromised group.

Objective To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). Study Design This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients' feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. Results Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. Conclusion Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing women's decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

Aim: To share the chorionic villus sampling (CVS) experience of a single surgeon in our institution. Methods: This retrospective study consists of CVS cases performed between 2000 and 2018. A total of 66 types of indications were classified under two main categories, the screening group (SG) and the inherited disease group (IDG). The SG and IDG were compared in terms of clinical characteristics of the patients, Beksaç obstetrics index (BOI), timing of CVS in terms of gestational week, and complications and termination of pregnancy (TOP) rate. Results: CVS was performed at 656 women, 69 and 587 of whom were included in the SG and IDG, respectively. CVS indications of the SG were determined as advanced maternal age, high risk in combined test, fetal anomaly suspicion in ultrasonography, and increased nuchal translucency in 23, 23, 14 and 9 cases, respectively. On the other hand, CVS indications of the IDG were hereditary disorders related to hematological, muscular, and metabolic systems for 233, 179, and 116 cases, respectively. Furthermore, 32 patients had a single-gene disorder and 14 had a neurodegenerative disease. According to the results of CVS, 359 fetuses were found to be normal (54.73%), while 205 (31.25%) and 92 (14.02%) fetuses were found to be disorder-positive or carriers, respectively. Two hundred pregnant women accepted TOP. Eight (1.2%) pregnancies ended with abortion after CVS. Statistically significant differences were observed in BOI and TOP rate between SG and IDG (p: 0.042 and 0.013). Conclusion: Hereditary disorders were the most common CVS indications and the acceptance of TOP was significantly higher in this group.

Objective: The goal is to explore the effects of age, education, obstetric history and information sources on the (Beck) anxiety levels of pregnant women attending invasive prenatal testing.Methods: Questionnaire results from 152 pregnant women are utilized. Results are analyzed through an independent samples t-test and a two-step cluster analysis attempting to categorize patients in terms of the chosen variables.Results: t-Tests reveal that age, education and bad obstetric history do not significantly affect anxiety levels. Descriptive statistics indicate that almost 60% of patients feel anxious mostly because of the fear of receiving bad news, followed by the fear of miscarriage, the fear of pain and the fear of hurting the baby. According to the cluster analysis, patients who use doctors or nurses as information sources have significantly lower anxiety levels, while those who do not receive information from any source have the second lowest level of anxiety. Patients who receive information from personal sources (i.e. friends and family) have the highest level of anxiety. Anxiety levels do not change according to test type.Conclusions: Doctors and nurses should allocate enough time for providing information about prenatal diagnosis before the procedure. This will reduce the anxiety level as well as the felt necessity to search for information from other sources, such as personal or popular which will further increase the level of anxiety.

What's already known? Prenatal diagnosis of lysosomal storage diseases is important to avoid high morbidity and mortality. What does this study add? Enzyme analysis may be alone used safely for the prenatal diagnosis of lysosomal storage disases. In populations with a high rate of consanguinity such as ours, prenatal diagnosis of lysosomal storage diseases is also more important due to increased rates of the disease, and enzyme analysis may be chosen for the prenatal diagnosis.

Objective: To evaluate the impact of type-1 diabetes mellitus (DM) and methylenetetrahydrofolate reductase (MTHFR) polymorphisms on impaired placentation leading to early pregnancy loss. Methods: Miscarriage materials were obtained from eight pregnant women with type-1 DM without MTHFR polymorphism, eight with MTHFR polymorphisms without type-1 DM, and eight controls with neither DM nor MTHFR polymorphisms. Insulin-like growth factor-1 (IGF-1), leukemia inhibitory factor (LIF), and Beclin-1 expression were assessed to evaluate placentation. Results: Cytoplasmic LIF, IGF-1, and Beclin-1 expression were decreased in the superficial and glandular epithelial cells of the decidua in both study groups. LIF expression was increased in interstitial trophoblasts in the MTHFR group. IGF-1 expression was decreased in the decidual cells and interstitial trophoblasts in both study groups, while the decrease in stromal cells was noted only in type-1 DM group. Beclin-1 expression was increased in interstitial and villous trophoblasts in both study groups. Conclusion: The expression of IGF-1, LIF, and Beclin-1 are altered in both the decidua and the trophoblasts in pregnancies of women with type-1 DM and MTHFR polymorphisms, compared to normal pregnancies undergoing (elective) terminations., This study was supported by the Hacettepe University Research fund (Project no: 011D071010122012).

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 dec

Background: The major obstacle against wider use of cord blood (CB) hematopoietic stem cells (HSC) is low level of HSC counts causing delay in both hematopoietic and immunological recovery. In recent years, HSC expansion strategies with small molecules ie Valproic acid (VPA) or nicotinamide (NAM) have yielded the most promising results. In Ankara University Cord Blood Bank, we have previously demonstrated increase in CD34 content and CFU-GM in the presence of VPA and/or NAM. Aims: To ascertain the functionality of expanded HSCs, we have initiated a mice stem cell transplant model using non-obese diabetic (NOD)Cg-Prkdcscid IL2rgtmWjl stocks of Rag2null mice (NSG mice). Methods: Following consent CD34+ cells were isolated by positive selection using MACS CD34 MicroBead Kit-UltraPure system (Miltenyi Biotec) from fresh CBUs collected at Ankara University or Hacettepe University, Departments of Obstetrics and Gynecology. Subsequently, 3.500 CD34+ cells per ml were plated in StemSpan medium in the presence of cytokine cocktail containing SCF, Flt3L, IL-3 and IL-6 (StemCell Technologies) w/wo VPA (1 mM) and/or NAM (5 mM). VPA, NAM and VPA + NAM added cultures were incubated at 37 °C and 5% CO2 for 8 days, 21 days and either 8 or 21 days, respectively. Following incubation CD34+ cells were washed and evaluated against their colony forming capacities using MethoCult Enriched wo EPO (StemCell Technologies) medium and cell viabilities were detected with 7-AAD and HSC phenotyping were performed by flow cytometry (Beckman Coulter) using labeled CD34 and CD45 monoclonal antibodies. Expanded cells were transplanted to 8- to 12 weeks old NOD.Cg-Prkdcscid IL2rgtmWjl/Sz (NSG) mice, purchased from The Jackson Laboratory and maintained under specific pathogen- free conditions at Laboratory of Animal Research Center in Ankara University. 24 hours prior to transplantation, mice were injected with busulfan through the tail vein (25 mg/kg, 50-100 g per dose). The next day, stem cell harve

Leukemia inhibitory factor (LIF) and insulin like growth factor-1 (IGF-1) are two of the most important growth factors mediating trophoblast actions. We hypothesized that the localization and expression patterns of LIF and IGF-1 in partial and complete hydatidiform moles (HM) compared with normal first trimester placentas may provide an understanding of the proliferative processes in HMs. Methods: The study population included curettage material of women diagnosed as complete or partial HM as a result of histopathological and immunohistochemical examination (complete HM group, n = 8; partial HM group, n = 8) and women undergoing dilatation;curettage for unwanted pregnancies (control group, n = 8). Expression of LIF and IGF-1 among placental cell groups was evaluated immunohistochemically and given a score depending on immunostaining intensity. Results: In normal chorionic villi strong expression of LIF and IGF-1 was present. Both LIF and IGF-1 expressions were weaker in the chorionic villi of complete HMs. In complete mole decidua there was a significant decrease in glandular and endothelial IGF-1 expression along with a decrease in decidual cell LIF expression compared to normal first trimester decidua. LIF expression in extravillous trophoblasts was stronger in complete molar placentas compared to normal placentas. Discussion: LIF and IGF-1 are important regulators of trophoblast proliferation and invasion. Differential expression of LIF and IGF-1 in molar trophoblasts and chorionic villi might have a role in regulation of trophoblasts in complete moles. Decreased expression of glandular IGF-1 and decidual LIF might be related to the decidual changes during trophoblastic proliferation and invasion of decidua in complete HMs.

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.

What's already known? Prenatal diagnosis of lysosomal storage diseases is important to avoid high morbidity and mortality. What does this study add? Enzyme analysis may be alone used safely for the prenatal diagnosis of lysosomal storage disases. In populations with a high rate of consanguinity such as ours, prenatal diagnosis of lysosomal storage diseases is also more important due to increased rates of the disease, and enzyme analysis may be chosen for the prenatal diagnosis.

Objective: To evaluate the impact of type-1 diabetes mellitus (DM) and methylenetetrahydrofolate reductase (MTHFR) polymorphisms on impaired placentation leading to early pregnancy loss. Methods: Miscarriage materials were obtained from eight pregnant women with type-1 DM without MTHFR polymorphism, eight with MTHFR polymorphisms without type-1 DM, and eight controls with neither DM nor MTHFR polymorphisms. Insulin-like growth factor-1 (IGF-1), leukemia inhibitory factor (LIF), and Beclin-1 expression were assessed to evaluate placentation. Results: Cytoplasmic LIF, IGF-1, and Beclin-1 expression were decreased in the superficial and glandular epithelial cells of the decidua in both study groups. LIF expression was increased in interstitial trophoblasts in the MTHFR group. IGF-1 expression was decreased in the decidual cells and interstitial trophoblasts in both study groups, while the decrease in stromal cells was noted only in type-1 DM group. Beclin-1 expression was increased in interstitial and villous trophoblasts in both study groups. Conclusion: The expression of IGF-1, LIF, and Beclin-1 are altered in both the decidua and the trophoblasts in pregnancies of women with type-1 DM and MTHFR polymorphisms, compared to normal pregnancies undergoing (elective) terminations., This study was supported by the Hacettepe University Research fund (Project no: 011D071010122012).

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 dec

Background: The major obstacle against wider use of cord blood (CB) hematopoietic stem cells (HSC) is low level of HSC counts causing delay in both hematopoietic and immunological recovery. In recent years, HSC expansion strategies with small molecules ie Valproic acid (VPA) or nicotinamide (NAM) have yielded the most promising results. In Ankara University Cord Blood Bank, we have previously demonstrated increase in CD34 content and CFU-GM in the presence of VPA and/or NAM. Aims: To ascertain the functionality of expanded HSCs, we have initiated a mice stem cell transplant model using non-obese diabetic (NOD)Cg-Prkdcscid IL2rgtmWjl stocks of Rag2null mice (NSG mice). Methods: Following consent CD34+ cells were isolated by positive selection using MACS CD34 MicroBead Kit-UltraPure system (Miltenyi Biotec) from fresh CBUs collected at Ankara University or Hacettepe University, Departments of Obstetrics and Gynecology. Subsequently, 3.500 CD34+ cells per ml were plated in StemSpan medium in the presence of cytokine cocktail containing SCF, Flt3L, IL-3 and IL-6 (StemCell Technologies) w/wo VPA (1 mM) and/or NAM (5 mM). VPA, NAM and VPA + NAM added cultures were incubated at 37 °C and 5% CO2 for 8 days, 21 days and either 8 or 21 days, respectively. Following incubation CD34+ cells were washed and evaluated against their colony forming capacities using MethoCult Enriched wo EPO (StemCell Technologies) medium and cell viabilities were detected with 7-AAD and HSC phenotyping were performed by flow cytometry (Beckman Coulter) using labeled CD34 and CD45 monoclonal antibodies. Expanded cells were transplanted to 8- to 12 weeks old NOD.Cg-Prkdcscid IL2rgtmWjl/Sz (NSG) mice, purchased from The Jackson Laboratory and maintained under specific pathogen- free conditions at Laboratory of Animal Research Center in Ankara University. 24 hours prior to transplantation, mice were injected with busulfan through the tail vein (25 mg/kg, 50-100 g per dose). The next day, stem cell harve

Leukemia inhibitory factor (LIF) and insulin like growth factor-1 (IGF-1) are two of the most important growth factors mediating trophoblast actions. We hypothesized that the localization and expression patterns of LIF and IGF-1 in partial and complete hydatidiform moles (HM) compared with normal first trimester placentas may provide an understanding of the proliferative processes in HMs. Methods: The study population included curettage material of women diagnosed as complete or partial HM as a result of histopathological and immunohistochemical examination (complete HM group, n = 8; partial HM group, n = 8) and women undergoing dilatation;curettage for unwanted pregnancies (control group, n = 8). Expression of LIF and IGF-1 among placental cell groups was evaluated immunohistochemically and given a score depending on immunostaining intensity. Results: In normal chorionic villi strong expression of LIF and IGF-1 was present. Both LIF and IGF-1 expressions were weaker in the chorionic villi of complete HMs. In complete mole decidua there was a significant decrease in glandular and endothelial IGF-1 expression along with a decrease in decidual cell LIF expression compared to normal first trimester decidua. LIF expression in extravillous trophoblasts was stronger in complete molar placentas compared to normal placentas. Discussion: LIF and IGF-1 are important regulators of trophoblast proliferation and invasion. Differential expression of LIF and IGF-1 in molar trophoblasts and chorionic villi might have a role in regulation of trophoblasts in complete moles. Decreased expression of glandular IGF-1 and decidual LIF might be related to the decidual changes during trophoblastic proliferation and invasion of decidua in complete HMs.

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.