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Introduction: Preeclampsia is a serious complication of pregnancy leading to maternal and perinatal morbidity and mortality. The etiopathogenesis still remains unsolved, however, various theories currently become well-proved. The leading etiopathogenetic mechanisms are impaired placentation, and placental hypoxia, immune mechanisms, systemic inflammatory reaction, endothelial damage and maternal cardiovascular maladaptation. These mechanisms overlap and induce each other. There are some preventive interventions only if the patients at high-risk are identified timely. This study aimed to investigate the relationship between the inflammatory pathway and placental insufficiency in the first trimester, utilizing the clinical markers of both. It also aims to find out a cheap and easy test to identify those who absolutely need to undergo a comprehensive risk assessment. Methods: This retrospective observational study included 28 patients with high uterine artery resistance (pulsatility index gt;90th centile) in the first trimester as study group and 67 patients with normal uterine artery resistance in the first trimester as control group. The two groups were compared in terms of risk factors for preeclampsia. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio as systemic inflammatory markers were compared between the groups. ROC analysis was performed to obtain a cut-off value for predicting high uterine artery pulsatility index. Results: Demographic data, anamnestic and examination risk factors for preeclampsia did not differ between the groups. However, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were significantly higher in the patients with uterine artery pulsatility index above 90th centile. A cut off value of 3.58 and 136.9 of Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio, respectively were determined for predicting first trimester uterine artery pulsatility index above 90th centile. Conclusions: Neutrophil/lymphocyte and platelet/lymphocyte ratio can simply be used to identify the patients who need referral for uterine artery doppler assessment. Keywords: preeclampsia, uterine artery, pulsatil flow, neutrophil, lymphocyte, placenta

Hypertensive disorders of pregnancy are significant contributors to maternal and perinatal morbidity and mortality. The definition, classification, and management of these disorders have evolved over time. Notably, the disease classification enables caretakers to manage the disease as well as safeguard maternal and fetal health. The approach and management for pregnancies with gestational and chronic hypertension or pre-eclampsia with or without severe features should be adequately elucidated to mitigate adverse perinatal outcomes. This review aimed to present the most recent definition and classification of hypertensive disorders of pregnancy to address their management, determine the optimal timing of birth, and establish short- and long-term follow-up protocols following parturition.

Objective: To evaluate fetal anomalies and processes leading to termination of pregnancy in the third trimester. Methods: The study includes all cases who underwent termination of pregnancy after 28 weeks of gestation due to fetal anomalies between 2017 and 2022. Results: Forty four of third trimester terminations were carried out in our clinic due to fetal anomalies incompatible with life or associated with severe sequelae. Structural anomalies including 35 (79.5%) cases were the most common reason of terminations followed by chromosomal or genetic abnormalities in 8 (18.2%) cases and intrauterine cytomegalovirus infection in 1 (2.3%) case. The processes leading to the third trimester termination were evaluated by dividing 44 patients into 5 groups. (1) Delayed diagnosis due to inadequate prenatal care (25 patients, 56.8%); (2) patients diagnosed with late-onset findings (5 patients, 11.4%); (3) patients with abnormal findings in prenatal care or history but delayed diagnosis (5 patients, 11.4%); (4) patients with abnormal findings requiring further evaluation (4 patients, 9.0%); (5) patients with a definitive diagnosis but latency in the decision of family for termination of pregnancy (5 patients, 11.4%). Conclusion: Termination of pregnancy in the third trimester has an important role in countries where unfollowed pregnancies are common and access to health services is poor due to low socio-economic status.