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    Association of maternal serum high sensitive C-reactive protein level with body mass index and severity of pre-eclampsia at third trimester
    (Wiley, 2010) Ertas, Ibrahim E.; Kahyaoglu, Serkan; Yilmaz, Bulent; Ozel, Murat; Sut, Necdet; Guven, Melih A.; Danisman, Nuri
    Aim: To assess a maternal serum level of high sensitive C-reactive protein (hs-CRP) as a useful clinical parameter in prediction of pre-eclampsia severity and, to evaluate the correlation between hs-CRP and body mass index (BMI). Material & Methods: Using cross-sectional study design, CRP was measured by a high sensitive immunoturbidimetric method between 24 and 40 weeks of gestation in normotensive controls (n = 115), in mild (n = 63) and severe (n = 34) pre-eclamptic patients. The receiver operating characteristic analysis was used to estimate the optimal threshold score of hs-CRP. Results: For disease severity evaluation, a hs-CRP concentration of 9.66 mg/L was determined as cut-off point with 88% sensitivity, 81% specificity, 71% positive predictive value and 92% negative predictive value. When all three groups of patients were adjusted for gestational age [24 degrees/7-27,6/7 28 degrees/7-33,6/7 34 degrees/7-406/7] and BMI, hs-CRP levels of severe pre-eclamptic patients were significantly higher than mild ones and controls in the study group with BMI < 25 kg/m2 (P < 0.001). In the study group with BMI >= 25 kg/m2, only severe pre-eclamptic patients between 28 degrees/7 and 336/7 weeks of gestation had significantly higher hs-CRP levels when compared with control and mild pre-eclamptic group (P < 0.001). When the patients were subgrouped as high (>= 9.66 mg/L) and low hs-CRP group (< 9.66 mg/L), adverse outcomes for hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and intrauterine growth-restricted baby were statistically significant higher in high hs-CRP group (P = 0.004 and P < 0.001, respectively). Conclusion: Elevated level of hs-CRP is a useful parameter in the severity of clinical risk of pre-eclampsia in patients with BMI < 25 kg/m2 at third trimester.
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    Moistening of misoprostol tablets with acetic acid prior to vaginal administration for mid-trimester termination of anomalous pregnancy: A randomised comparison of three regimens
    (Taylor & Francis Ltd, 2010) Yilmaz, Bulent; Ertas, Ibrahim Egemen; Kelekci, Sefa; Sut, Necdet; Mollamahmutoglu, Leyla; Danisman, Nuri
    Methods A total of 118 women requiring second-trimester pregnancy termination were randomly assigned to one of three treatment groups: 400 mu g 3-hourly in group A (n = 39), 600 mu g 6-hourly in group B (n = 39), and 800 mu g 12-hourly in group C (n = 40). Misoprostol tablets moistened with 3 ml of 5% acetic acid were placed into the posterior vaginal fornix. Results The median induction-abortion times in groups A (8 h [range: 3-64]) and B (9 h [4-81]) were significantly shorter (p < 0.01 and p < 0.05, respectively) than in group C (12.5 [3-72]). Moreover, expulsion rates within 24 hours in groups A (92.3%) and B (92.3%) were significantly higher (p < 0.05 in both cases) than that of group C (75%). Expulsion rate within 48 hours, number of tablets used, number of patients with retained placenta and side effects did not differ between groups. Conclusions Misoprostol moistened with acetic acid is effective for second-trimester pregnancy termination when given vaginally 3-hourly, 6-hourly or 12-hourly. The former two regimens are significantly more effective than the latter.