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    Comparison of epidural and general anaesthesia for elective Caesarean delivery according to the effects on Apgar scores and acid-base status
    (Australian Nz J Obstet Gynaec, 1999) Sendag, F; Terek, C; Oztekin, K; Sagol, S; Asena, U
    The objective of this study was to determine the effects of lumbar epidural anaesthesia on the Apgar score and acid-base status of the newborn. Umbilical artery blood gases were obtained in 85 singleton, term, uncomplicated pregnancies delivered by elective Caesarean section. The umbilical artery blood pH, PaCO2, PaO2 and HCO3 values and Apgar scores (1 and 5 minutes) were compared between lumbar epidural and general anaesthesia groups. General anaesthesia was used in 45 (52.9%) women and lumbar epidural anaesthesia in 40 (47.1%). Only 2 of the newborns exposed to epidural anaesthesia had umbilical artery blood pH values 7.19 or less. The mean umbilical artery blood pH was found to be significantly lower in the newborns exposed to lumbar epidural anaesthesia (p = 0.011), None of the newborns in the 2 groups were severely depressed (Apgar scores less than 4). The mean umbilical artery blood PaCO2, PaO2 and HCO3 values did not show any significant difference between the groups. In conclusion, lumbar epidural anaesthesia is associated with lower umbilical artery blood pH values, occasionally with severe fetal acidaemia.
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    Role of apoptosis, bcl-2 and bax protein expression in premature rupture of fetal membranes
    (Sci Printers & Publ Inc, 2002) Sagol, S; Sagol, O; Ozkal, S; Asena, U
    OBJECTIVE: To examine the degree of apoptosis in human fetal membranes associated with premature rupture Of membranes (PROM) as compared with normal pregnancies and to evaluate the expression of proapoptotic bax and antiapoptotic bcl-2 gene products. STUDY DESIGN: Fetal membranes from 50 pregnancies were included in the study. Thirty of 50 pregnancies had PROM. Twenty pregnancies with intact membranes served as controls. Chorioamniotic membrane biopsies were taken from the rupture site of the membrane and periphery of the rupture side. In the control group, membrane biopsies were taken from the artificial rupture site, cervical pole of the membranes and, membranes close to the edge of the placenta. In recognizing apoptotic figures, routinely processed samples were stained with hematoxylin and eosin for light microscopic evaluation. Quantification of the apoptotic cells was performed with high-power fields and expressed as the number per 100 cells. The membranes of both groups were then stained with bcl-2 and bax antibodies by using the standard steptavidin-biotin-immunoperoxidase method. Staining with both antibodies were compared between two groups. RESULTS: Apoptotic cells were detected in the amniotic epithelium, in chorionic cells and fibroblastic layer of the fetal membranes. Apoptotic cells were found mostly in the chorionic cells. There was a statistically significant difference between the apoptotic index in PROM and the control group in both rupture and peripheral sites (P<.05), although within each group peripheral and rupture sites showed no difference in terms of apoptotic cell counts. Both bax and bcl-2 expression was observed in 40% of control cases and in 57% and 50% of cases with PROM, respectively, mostly in the chorionic trophoblastic cells. The PROM and control groups showed no statistically significant difference in terms of bcl-2 and bax protein expression. CONCLUSION: Apoptosis may play a role in the pathogenesis of PROM, but the changes in apoptosis do not seem to be mediated by bcl-2 and bax genes in the amniotic membrane. Other regulatory mechanisms must be investigated.
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    Value of cervicovaginal prolactin in the prediction of spontaneous preterm delivery
    (Parthenon Publishing Group, 1999) Koca, ZD; Oztekin, MK; Karadadas, N; Ozsener, S; Asena, U
    Objective Our purpose was to determine whether decidual prolactin could be identified in cervicovaginal secretions during pregnancy and whether its occurrence was associated with preterm delivery. Methods A prospective cohort: study was performed in 75 pregnant women. The study group comprised 35 patients hospitalized with the diagnosis of preterm labor or threatened preterm labor (11 and 24 patients, respectively) and the control group consisted of 40 asymptomatic outpatients. The cervicovaginal samples were collected with cervicovaginal washing and were then centrifuged. The supernatant was stored at -50 degrees C and the cervicovaginal prolactin levels were determined by radioimmunoassay. A prolactin concentration greater than the cut-off value calculated from the control group was considered positive. Results The median prolactin values in the 11 patients diagnosed with preterm labor were higher than in the control group (p < 0.05). The proportion of inpatients delivered at < 37 weeks' gestation was significantly greater in the group with positive prolactin values than in those testing negative in both the study and the control groups (p<0.01). The cervicovaginal prolactin assessment had an 82.3% positive predictive value and a 66.6% negative predictive value for delivery at <37 weeks' gestation in the symptomatic patients. Conclusions Cervicovaginal prolactin assessment as a biochemical marker may be used for the prediction of preterm delivery. It may also be used as a screening method for asymptomatic gravidas. Although there are not enough conclusive studies proving the use of cervicovaginal prolactin as a practical clinical assessment tool, there should be further studies of the biochemical markers of the decidual membranes, and of the cytotrophoblasts.