Search

Abstract Objective The study aimed to determine the level of anemia in pregnant women in the first trimester and in the preconception period by conducting nationwide research. Methods The study was designed as retrospective, cross-sectional, and multicenter research. A total of 17 centers from 13 provinces were included in the study. The study was conducted with the participation of two groups of patients who applied to the obstetrics polyclinic between 1 January 2023 and 1 July 2023, who were in the first trimester of pregnancy and who were in the preconception period planning pregnancy. Results In total 4,265 women were included in the study. Of these women, 3,884 (91%) were in the first trimester of their pregnancy and 381 (9%) were in the preconception period. Anemia was detected in 24.1% (n=1030) of the patients. Of these patients, 20.6% (n=877) were pregnant women in the first trimester and 3.6% (n=153) were in the preconception period. A statistically significant and positive relationship was found between anemia and meat consumption frequency, educational status, and socioeconomic status of the patients (p=0.000, p=0.000, p=0.000). In addition, a statistically significant and negative correlation was determined between anemia and the number of pregnancies and the parity number (p=0.001, p=0.000) in both groups. Conclusion Anemia is a public health problem. Anemia has been determined to be an important problem both in the preconception period and early periods of pregnancy. It is necessary to revise the programs and interventions to reduce the prevalence of anemia and redesign them in line with current conditions.

Objective: Vitamin B12, an essential micronutrient, plays a vital role in various physiological processes, particularly during pregnancy and fetal development. The growing popularity of vegetarian diets and socioeconomic barriers to consuming animal-based products contributes to Vitamin B12 deficiency becoming a global issue. Understanding the B12 status in pregnant women and its potential impact on newborns is of utmost significance as it can have far-reaching implications for both maternal and infant health. This research aims to investigate the vitamin B12 and homocysteine levels in pregnant women admitted for delivery and analyze corresponding cord blood samples from their newborn babies. Methodology: This prospective study was conducted in three tertiary care hospitals and included pregnant women aged ≥16 years admitted for delivery and their newborns ≥34 weeks. The demographic data and the results of complete blood counts performed within the previous 24 hours before birth were recorded. The levels of vitamin B12 and homocysteine were measured in blood samples and cord blood samples taken from pregnant women and their newborns, respectively. The study parameters were compared between the two groups based on the mothers' and babies' homocysteine and B12 levels. Results: The study included 615 Turkish and 217 foreign pregnant women. Anemia affected 36% of pregnant, with a higher frequency in mothers with B12 deficiency. The mean B12 level in pregnant women was 157±75.3 pg/ml, with 14.8% having elevated homocysteine levels. The levels of B12 and homocysteine of the newborns were 234.7±13.2 pg/ml and 9.13±5.75 mol/L, respectively. Vitamin B12 deficiency was found in 48.9% of newborns, while homocysteine levels were slightly elevated or elevated in 19.1%; both findings were significantly more common in babies born to B12-deficient mothers. Conclusion: In our study, vitamin B12 deficiency was significant in pregnant mothers and their neonates, with a substantial connection to cord blood homocysteine levels. Further study is needed to determine the impact of this deficit on mother and newborn health. Implementing approaches to timely detecting Vitamin B12 deficiency and, if necessary, providing adequate Vitamin B12 supplementation during pregnancy could play a pivotal role in enhancing the health and well-being of both the mother and the child.

Objective: The aim of our study was to investigate the relationship between extreme values of first trimester screening markers and adverse obstetric outcomes. Materials and methods: Our study was conducted by examining the prenatal and postnatal perinatal records of 786 singleton gestations between the ages of 18–40, who applied to Prof. Dr. Cemil Taşçıoğlu City Hospital outpatient clinics for first-trimester screening for aneuploidy, between January 1, 2017 and December 31, 2019. Results: The presence of small for gestational age (SGA) was found to be statistically significant for the

Objective: To evaluate the clinical and surgical outcomes of the total hysterectomy cases performed with the laparoendoscopic single site surgery. Study Design: A total of 24 women who underwent total hysterectomy by the laparoendoscopic single site technique due to benign gynecological disorders were retrospectively evaluated. The duration of the operation, estimated blood loss, weight of the uterus, intra- and postoperative complications, pre- and postoperative day 1 hemoglobin and hematocrit levels, postoperative 6- and 24-hour visual analogue scale scores, duration of hospital stay, and postoperative complications were evaluated. Results: The mean total operation time was 112.1±24 minutes. The average time between the umbilical incision and starting the hysterectomy was 10±2.1 minutes. Estimated blood loss was 50±25 ml. The average duration of the hospital stay was 1.5±0.4 days. The mean uterus weight was 135 g. The mean difference between the pre- and postoperative hemoglobin values was 1.1 g/dl. The mean visual analogue scale scores were 4.1 (0-7) and 1.9 (0-4) in 6- and 24-hour postoperative periods. None of the women had an intraoperative complication. One patient (4.2%) had a port site hernia 6 months after the operation. Conclusion: The total hysterectomy with laparoendoscopic single site technique is a reasonable method in selected patients with similar safety and feasibility, especially for women who prefer a single incision in umbilicus. The patient should be informed before the operation about potential complications such as a port-site hernia.

Abstract Background Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition and is not common outside Japan. The incidence is between 0.025–0.1% for each pregnancy. GIS malignancies are diagnosed late in pregnancy and detected at an advanced stage. The most common cause of this condition is that the symptoms such as vomiting, nausea, loss of appetite and abdominal growth are mistaken with pregnancy and malignancy is overlooked. Especially in the second trimester, symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia should suggest malignancy. Upper GIS endoscopy and colonoscopy are the recommended screening methods in these patients, especially in the third trimester. Case presentation We present a rare case presenting to our emergency room with the complaint of bloody vomiting, at the 36th week of gestation with a live singleton pregnancy, and receiving the diagnosis of undifferentiated gastric carcinoma from the biopsy taken from the ulcerated lesion on the stomach cardia, with upper GIS endoscopy performed due to deep anemia, who underwent simultaneous cesarean section and subtotal gastrectomy. Conclusion Gastrointestinal system (GIS) malignancy with pregnancy is a very rare condition, but it should be considered when symptoms such as nausea and vomiting, weight loss, melena, hematemesis and deep anemia occur, especially in the second trimester, and endoscopic screening should be recommended. Because of the delay in diagnosis of malignancy and the detection in advanced stages, patients should be referred for treatment without delay.

Objective: This study aimed to compare the clinical characteristics of pregnant women diagnosed with gestational diabetes mellitus (GDM) based on a 75-g oral glucose tolerance test (OGTT) with those of pregnant women who had normal test results and to evaluate the potential role of serum fibroblast growth factor-21 (FGF-21) levels in the diagnosis of GDM. Method: This prospective, controlled cohort study a total of thirty-six pregnant women diagnosed with GDM based on a 75-g OGTT and thirty-six pregnant women with normal test results who presented to the Department of Obstetrics and Gynecology at University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital between 01/12/2021 and 01/04/2022 were included in the study. The participants’ age and obstetric outcomes Neonatal characteristics, and laboratory results, including FGF-21 levels, were recorded. Results: When the general characteristics of the participants in our study were evaluated, no statistically significant differences were found between the groups with and without gestational diabetes in terms of age, gravidity, parity, weight, birth weight, birth length, gestational week, hemoglobin, platelet count, and alanine transaminase and aspartate transaminase levels, indicating that the two groups were similar (p0.05). However, a statistically significant difference was found between FGF-21 levels and amniotic fluid index (AFI) increase (p=0.003). It was observed that participants with increased AFI had higher mean FGF-21 levels than those with normal AFI. Conclusion: In this study, serum FGF-21 levels were higher in pregnant women with GDM than in those without GDM.

Objective: Fatty liver, which is increasingly common in pregnancy, is associated with maternal health risks. This study aimed to explore the association between ultrasound-detected fatty liver, maternal lipid levels, and adverse obstetric outcomes Method: This prospective cohort study included pregnant women who attended the Gynecology Department of University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital between 24 and 42 weeks of gestation for their antenatal visit. The study period was from February 1, 2020, to December 31, 2020. Results: The 232 participants were divided into two groups based on ultrasound findings: Group 1 (n=121) with grade 0-1 fatty liver, and Group 2 (n=111) with grade 2-3 fatty liver. Statistically significant increases in maternal age, pregestational body mass index (BMI), and fetal weight were observed among women diagnosed with fatty liver on ultrasound. Regarding BMI, a cut-off value of ≥27.2 kg/m2 exhibited a sensitivity of 58.6%, specificity of 66.12%, positive predictive value (PPV) of 61.30%, negative predictive value (NPV) of 63.50%, and LR(+) of 1.73%. Similarly, for triglycerides, a cut-off value of ≥240 mg/dL showed sensitivity of 62.16%, specificity of 87.60%, PPV of 82.10%, NPV of 71.60%, and LR(+) of 5.01%. Multivariate logistic regression analysis revealed a decreased risk of small for gestational age [0.98 (0.96-1.00) odds ratio (OR) 95% confidence interval (CI); p=0.016)] and an increased risk of gestational diabetes mellitus [0.98 (0.96-0.99) OR 95% CI; p=0.045)]. Conclusion: Fatty liver in pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM), but not with other adverse obstetric outcomes.

Background. Vitamin B12, an indispensable micronutrient, is pivotal in numerous physiological processes, with particular significance during pregnancy and fetal development. The increasing adoption of vegetarian diets and the economic challenges associated with accessing animal-based food sources contribute to the prevalence of vitamin B12 deficiency. This study aims to examine the levels of vitamin B12 and homocysteine in pregnant women upon admission for delivery and to analyze corresponding cord blood samples from their newborn infants in a substantial sample within the Istanbul metropolitan area. Materials and Methods. This cross-sectional multicenter study included women aged ≥16 years admitted for delivery and their newborns ≥34 weeks. The demographic data and the results of complete blood counts within the previous 24 hours before birth were recorded. Vitamin B12 and homocysteine levels were measured in maternal and cord blood samples. The study parameters were compared between the groups based on the mothers’ and babies’ homocysteine and vitamin B12 levels. Results. The study included 832 pregnant women and 832 neonates. Anemia affected 36% of pregnant women, with a higher frequency in mothers with vitamin B12 deficiency. Seventy-eight mothers and 48.9% of neonates showed Vitamin B12 levels below 200 pg/mL, while elevated homocysteine levels were observed in 30% of mothers and 26% of neonates. Maternal vitamin B12 deficiency was significantly correlated with cord blood B12 deficiency and elevated homocysteine. The median cord blood vitamin B12 level was inversely correlated with the number of previous pregnancies. Conclusion. Vitamin B12 deficiency is extremely common in pregnant women before delivery, significantly correlating to cord blood homocysteine and vitamin B12 levels. However, homocysteine alone is not a reliable marker for maternal vitamin B12 status. Implementing strategies to detect vitamin B12 deficiency and supplying adequate vitamin B12 supplementation during pregnancy holds the potential to enhance maternal and neonatal health in Türkiye.

Objective: There is no daily practical method for the diagnosis and follow-up of premature rupture of membranes (PPROM). In this study, we examined the association between PPROM and platelet/lymphocyte (PLR) and neutrophil/lymphocyte (NLR) ratios. Method: Eighty women with a diagnosis of PPROM between the 24th and 34th weeks of gestation were included in the study. Eighty-three women without membrane rupture between the same gestational weeks constituted the control group. Information about the women included in the study was collected retrospectively from hospital medical records. For each patient, gravida, parity, age, week of gestation, week of birth, and mode of delivery were examined. To evaluate perinatal outcomes, sex, 1st and 5th minute Apgar scores, birth weight, and neonatal death were examined. The patients’ white blood cells, lymphocyte neutrophil, and platelet counts, PLR, NLR ratios, hemoglobin, and C-reactive protein values were examined. Results: The mean NLR of the PPROM group was 30.96±2.55 [mean ± standard deviation (SD)] and mean PLR was 148.06±72.18 (mean ± SD). In the control group, these values were calculated as 30.91±2.43 (mean ± SD) and 126.74±45.85 (mean ± SD), respectively. Both rates were higher in the PPROM group (p=0.026). Conclusion: PLR and NLR ratios were higher in the study group. Therefore, PLR and NLR can be used in the management of PPROM.

Objective: The purpose of this study was to evaluate the maternal and perinatal outcomes of pregnancies beyond 40 weeks gestation. Method: The study included 476 patients who gave birth between October 2016 and October 2017 at the Obstetrics and Gynecology Clinic of Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences Turkey. Of the patients included in the study, 342 had delivered between 400/7 and 406/7 gestational weeks, 115 between 410/7 and 416/7 gestational weeks, and 19 between 420/7 and 426/7 gestational weeks. Statistical analysis was conducted using the SPSS software, Windows version 24.0, and a p-value

Objective:To evaluate the efficacy of preoperative positron emission tomography/computed tomography (PET/CT) to detect lymph node metastasis in gynecologic malignancies.Method:This study included a total of 78 patients who underwent surgery for gynecological cancer at the Gynecology and Obstetrics Clinic, University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital between January 2016 and November 2017. Data on age, menopausal status, clinical diagnoses, definitive pathology reports and PET/CT findings were obtained from the Hospital Information Management System and the patient files. The histological type and pelvic and/or paraaortic lymph node involvement status of the tumor based on a definitive pathology report, and the maximum standardized uptake value (SUVmax) values of the primary tumor and lymph nodes with pathological involvement in the PET/CT were recorded.Results:Of the 78 patients, 42 had endometrial cancer, 10 had uterine sarcoma, 14 had cervical cancer and 12 had ovarian cancer. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT in predicting lymph node metastasis were 54.5%, 96.7%, 85.7%, 85.7%, and 85.7%, respectively, in patients with endometrial cancer; 100%, 89.9%, 90%, 50%, and 100%, respectively, in patients with uterine sarcoma; 0%, 92.3%, 85.7%, 0%, and 92.3%, respectively, in patients with cervical cancer; and 62.5%, 75%, 66.7%, 83.3%, and 50%, respectively, in patients with ovarian cancer. When all of the patients were assessed together, these values were found to be 57.1 %, 92.9%, 83.3%, 75%, and 85.4%, respectively.Conclusion:The highest diagnostic yield of PET/CT was obtained for uterine sarcoma. Furthermore, among the metabolic parameters, the mean SUVmax value was found to be associated with lymph node metastasis only in patients with ovarian cancer and was not predictive in other gynecologic malignancies.

Objective: Thyroid hormone is required for normal fetal brain development, neuronal proliferation, migration and structural organization. We aimed to investigate fetal cardiac structure in fetuses of hypothyroid pregnant women receiving thyroid hormone replacement therapy and to compare it with normal pregnancies, including fetal outcome and delivery results. Methods: Singleton pregnant women whose ages were between 18–45 years and weeks of gestation were between 26–34 were included in the study. Their routine laboratory test reports, ultrasonographic measurements (fetal echo) and postnatal follow-up data were recorded. Patients were grouped according to the presence of diagnosis of hypothyroidism. The patients with hypothyroidism during pregnancy were included in Group 1 while healthy pregnancies with similar features were considered as controls and included in Group 2. All women with hypothyroidism were taking thyroid hormone replacement. All ultrasonographic and laboratory data measurements were collected from the system files and were compared between groups. Results: A total of 89 patients (41 hypothyroidism and 48 controls) were recruited to the study. Serum TSH levels of patients with hypothyroidism (Group 1) was significantly higher than the controls. In fetal cardiac examination, left ventricular (LV) and right ventricular (RV) wall thicknesses, and interventricular septum thicknesses at the end of systole and diastole were not statistically significant in both groups. Apgar scores, fetal gender and mean fetal birth weight were all similar between the groups. Conclusion: There is no myocardial structural difference in fetuses of pregnant women who were diagnosed with hypothyroidism and received thyroid hormone replacement therapy compared to healthy controls. Thyroid replacement therapy in hypothyroid mothers might affect and treat fetal cardiac abnormalities.

Background: Carpal tunnel syndrome (CTS) is a prevalent condition during gestation. The recent ability of ultrasound to provide comparable results with electrodiagnostic tests (EDx) has opened the door for investigating new parameters. The objective of this investigation is to explore the clinical importance of a new anthropometric independent parameter called the nerve/tendon ratio (NTR) when compared to EDx and to determine whether it has the utility to be used in clinical practice. Methods: In this prospective case-control study conducted between April 2023 and September 2023, 160 pregnant women displaying clinical symptoms of CTS who presented to the outpatient clinic underwent evaluation employing the Boston Carpal Tunnel Questionnaire, Visual Analog Scale, and provocative tests (Phalen and Tinnel). The pregnant women with clinical symptoms were divided into two groups: those with positive CTS in the EDx results (mild/moderate/severe) and those without EDx findings (control group). All pregnant women participating in the study had their median nerve cross-sectional area (MN-CSA), flexor carpi radialis (FCR), and MN-CSA/FCR ratio (expressed as a percentage called NTR) values examined. The sonographers were unaware of the clinical and EDx results. Subsequently, the data were examined utilizing logistic regression models, with a significance threshold established at p < 0.05. Results: In pregnant women with CTS, the MN-CSA values were observed to surpass those in the control cohort (10.03 ± 3.28 vs. 7.80 ± 2.50) (p < 0.001). The NTR values in the pregnant women with CTS were also higher than those in the control group (0.94 ± 0.39 vs. 0.81 ± 0.28) (p = 0.045). The best cut-off for MN-CSA values was calculated to be >8.5 mm2. The best cut-off point for MN-CSA/FCR values was found to be >0.82%. A receiver operating characteristic curve was generated, and the NTR cut-off point of 0.82% showed a sensitivity of 51.9% and a specificity of 67.9%. The positive predictive value and the negative predictive value were 61.2% and 59.1%, respectively, with the mentioned point as the diagnostic threshold (area under the curve 0.592 (95% confidence interval [CI]: 0.503–0.680)). Among ultrasound-related factors, patients with symptoms of CTS exhibited an association with MN-CSA (odds ratio [OR] of 6.396, 95% CI: 2.981–13.722). NTR was not identified as a risk factor for CTS (p > 0.05). Conclusions: Ultrasonography of the wrist may serve as an alternative diagnostic tool for CTS in pregnant women due to its rapid, non-invasive, and reproducible characteristics. Further research should focus on investigating the response to treatment. Clinical Trial Registration: the study was registered at https://clinicaltrials.gov (registration number NCT05839769).