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    The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns
    (Springer Heidelberg, 2008) Sayam, N. Cenk; Canda, M. Tunc; Ahmet, Newze; Arda, Sezer; Suet, Necdet; Varol, Fuesun G.
    Objective This study was designed to investigate the relationship between the second trimester maternal serum markers and adverse pregnancy outcomes in healthy newborns. Materials and methods A total of 749 women who delivered in our institution with complete follow up and second-trimester triple marker test data available were included in the study. Women with multiple pregnancies, chronic diseases, diabetes mellitus, obesity, smokers and infants with chromosomal and congenital abnormalities were excluded. Maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated estriol (uE(3)) values were investigated in our cohort who developed preeclampsia (n = 28), gestational diabetes (GM) (n = 69), preterm labor-birth (n = 100), oligohydramnios n = 37) and macrosomia (n = 59) by using receiver operating characteristic (ROC) curve analysis, with chi-square and Pearson's correlation tests. Results Women with uE(3) <= 1.26 MoM (P = 0.001, AUC = 0.666), HCG > 1.04 MoM (P = 0.032, AUC = 0.599) or AFP <= 0.69 MoM (P = 0.049, AUC = 0.600) values significantly developed oligohydramnios. Also, macrosomic infants were observed in women who had HCG values > 0.86 MoM (P = 0.047, AUC = 0.578). Patients with HCG > 1.04 MoM (P = 0.04, AUC = 0.565) and uE(3) <= 0.88 MoM (P = 0.049, AUC = 0.571) developed GDM. HCG levels, 2.5 or, 3 MoM were significantly associated with the development of oligohydramnios [P = 0.005; OR = 4 (95% CI: 1.7-9.7)], [P = 0.008; OR = 4.9 (95% CI: 1.7-13.7)], respectively. When women with adverse (n = 237) and normal (n = 512) outcomes were compared there were significant differences in maternal serum AFP (1.40 +/- 0.84 vs. 1.23 +/- 0.75 MoM, P = 0.006) and uE(3) values (1.38 +/- 1.42 vs. 1.45 +/- 0.98 MoM, P = 0.001). Conclusions Serum estriol, AFP or HCG values in triple test results may be associated with development of oligohydramnios, gestational diabetes and macrosomia in women with healthy and normal appearing fetuses.
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    Transient pituitary insufficiency in the acute postpartum state mimicking Sheehan syndrome
    (Lippincott Williams & Wilkins, 2006) Sayin, N. Cenk; Canda, M. Tunc; Ugur-Altun, Betul; Ozden, Gulsah; Yarol, Fusun G.
    A 34-year-old woman was referred to our obstetrics department because of severe postpartum hemorrhage. She had undergone a cesarean delivery in another hospital earlier in the day. The patient's hemoglobin (Hb) level was 7 g/dL. Blood transfusions were begun, but the bleeding continued and an emergent total abdominal hysterectomy was performed. Postoperatively, the Hb level returned to normal by 3 days with ongoing transfusion. Her lactation could not be induced. To assess the level of pituitary damage, an insulin tolerance test was performed. Growth hormone and cortisol levels were measured. These tests revealed attenuated responses for both cortisol and growth hormone. Three months later, thyroid function tests revealed secondary hypothyroidism. However, these findings were transient. By 15 months, however, all hormonal levels were normal. We report the case as an example of spontaneous recovery from hypopituitarism caused by obstetric hemorrhage.