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We aimed to determine whether follow-up in the intensive care unit for the postoperative first 8 hours is beneficial for early intervention in postpartum hemorrhage.In our hospital, all patients are admitted to the intensive care unit for the first 8 hours after cesarean section. Patients with postpartum hemorrhage after cesarean delivery who received medical and/or surgical treatment between 2016 and 2020 were reviewed in the presented study retrospectively.36,396 cases who underwent cesarean delivery were reviewed. Three hundred fifty nine patients with postpartum hemorrhage were included in the study. The time between cesarean section and diagnosis of postpartum hemorrhage was 10.1 ± 19.1 hours, and the time between cesarean section and re- laparotomy was 9.26 ± 23.1 hours in the study group. A total of 3 maternal deaths occurred after cesarean section in our hospital. In the last five years, the mortality rate in patients delivered by cesarean section was calculated to be 3.9 per 100,000. The incidence of postpartum hemorrhage in cesarean deliveries at our hospital was calculated to be 1.0%, and the rate of obstetric near-miss events was calculated to be 0.6 per 1000 live births.Follow-up of patients in the intensive care unit in the first postoperative 8 hours after cesarean section may result in a lower number of re-laparotomies due to postpartum hemorrhage, a shortened interval between cesarean section and re-laparotomy, and a lower maternal mortality rate.

Objective: Hydatiform mole (HM) is a non-malignant form of gestational trophoblastic disease (GTD) characterized by failure of normal fetal development and overgrowth of trophoblasts. With this retrospective cohort study, we planned to determine the incidence of PHM, etiology and progression rates to Gestational trophoblastic neoplasia (GTN) during the COVID-19 epidemic. Materials and Method: This retrospective cohort study was conducted in Ankara Etlik Zübeyde Hanım Women’s Health Training and Research Hospital Early Pregnancy Assessment Unit between March 2016 and February 2022. Patients who underwent therapeutic curettage (T/C) with the diagnosis of missed abortion, intrauterine exitus (IUEX), molar pregnancy or incomplete abortion after single spontaneous pregnancy were included in the study. The study group consisted of 138 patients who were diagnosed with partial hydatiform mole as a result of pathological examination in this process. There were 135 patients in the control group. Results: The number of patients who applied during the pandemic period and were diagnosed with PHM was 62 (44.92%). The mean age of the patients in the study group was 31.97±8.26 years. The mean body mass index of these patients was 26.38±5.13 m2/kg. The mean paternal age in the study group was 34.95±8.32 years, and it was higher than the paternal age of the patients in the control group (p=0.028). While the incidence of PHM was 1.22/1000 births in our hospital in 2019, this figure was calculated as 3.79/1000 births in 2020. The incidence of progression to GTN at 4 years before the pandemic was 0.02/1000 births; In 2020-2021, this rate was calculated as 0.25/1000 births. Conclusion: During the pandemic period, along with the increase in the incidence of PHM compared to the pre-pandemic period, an increase in the incidence of progression to GTN disease was detected.

The objective of this study was to estimate the number of oocyte retrieval and cycle cancellation using follicle stimulating hormone (FSH) to anti-Mullerian hormone (AMH) ratio in poor prognosis patients undergoing intracytoplasmic sperm injection treatment.This retrospective study including fresh cycles was conducted in Zekai Tahir Burak Women’s Health Training and Research Hospital, between January 2015 and October 2018. Women aged between 24 and 44 years were recruited and the baseline serum hormone levels, FSH/AMH ratio, and the antral follicle count were recorded. Number of retrieved oocytes, metaphase-II oocytes, fertilised oocytes, and the number and grade of the embryos were also recorded.A total of 108 cycles, corresponding to 92 women with poor prognosis were eligible for analysis. The use of FSH/AMH ratio performed well in predicting retrieved oocyte count5 with an area under the curve (AUC) of 0.82 [95% confidence interval (CI): 0.71-0.92]. A FSH/AMH ratio cut-off of 11.36 was set for the retrieval of5 oocyte at oocyte pick-up (OPU) with 80% sensitivity and 87% specificity. The FSH/AMH cut-off value was 14.22 to differentiate cycle cancellation and no oocyte retrieval at OPU, with a sensitivity of 91% and a specificity of 44% (AUC of 0.71; 95% CI: 0.59-0.83). There was no correlation between FSH/AMH ratio and clinical pregnancy.The assessment of this simple ratio at the beginning of the cycle may help clinicians better anticipate gonadotropin stimulation treatment and better counsel patients about cycle cancellation and the expected oocyte yield.

Purpose In this study, we investigated whether the Triglyceride/Glucose index(TyG) and Triglyceride/HDL-Cholesterol Ratio(TG/HDL-c) are measured in the first trimester, if it can give an idea about gestational diabetes mellitus.Methods Twenty-five patients diagnosed with gestational diabetes and 52 control groups were included in the study. Insulin-controlled diabetes and diet-controlled diabetes were included in the GDM diagnoses. Fasting glucose and plasma lipid profiles measured in the first trimester, including TG, HDL-c, were noted and proportioned and evaluated by ROC analysis.Results Triglycerides (133 ± 40 mg/dL vs 100 ± 54 mg/dL), TyG index (15.0 ± 8.9 vs 8.8 ± 5.0), and TG/HDL-C ratio (3.3 ± 2.6 vs 1.9 ± 2.6) were significantly higher in the GDM group than in the control group (p = 0.01, p = 0.01, and p = 0.01, respectively). Mean newborn birth weight > 90. percentile was significantly higher in the GDM group than in the control group, although preterm births were more common (p = 0.02). The optimal cut off value for TyG index was 10.4, sensitivity was 76% (95% CI; 55–90), specificity was 77% (95% CI; 62–86), positive likelihood ratio was 3.04 (95% CI; 1.81–5.11), negative likelihood ratio was 0.32 (95% CI; 0.16–0.65), and area under the receiver operating characteristic curve (AUC) was 0.765. Optimal cut off value for TG/HDL-C ratio was 2.3, sensitivity was 76% (95% CI; 55–91), specificity was 69% (95% CI; 55–81), positive likelihood ratio was 2.47 (95% CI; 1.55–3.93%), negative likelihood ratio was 0.35 (95% CI; 0.17–0.71), and AUC was 0.697.Conclusions TyG and TG/HDL-C ratio measured in the first trimester are thought to predict GDM better than fasting plasma glucose.

Aim: Aimed to evaluate the role of systemic inflammatory markers and Aspartate aminotransferase to Platelet Ratio Index (APRI) sore in predicting medical treatment failure in patients with Tubo-ovarian abscess (TOA). Materials and Methods: Patients (n=240) hospitalized with a diagnosis of TOA between August 2016 - October 2020 were included in the study. Patients' demographic and clinical characteristics and mean C-Reactive protein (CRP) level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and APRI score measured on admission were also recorded. The role of these parameters was investigated in predicting medical treatment failure in patients who only received medical treatment or who needed surgical treatment. Results: The mean age (40.95 ± 6.96 vs. 38.09 ± 7.69), abscess size (67.57 ± 19.86 mm vs. 52.78 ± 16.63 mm), CRP level, (140.61 ± 110.88 vs. 75.24 ± 36.64 mg/L), white blood cell count (13818.86 ± 5445.80 and 11845.31 ± 4424.39 μL), neutrophil count (11146.81 ± 5284.83 and 9242.03 ± 4278.60 μL) and NLR (9.52 ± 6.88 and 6.64 ± 6.30) of patients who received surgical treatment were significantly higher than those who received only medical treatment. In receiver operating characteristics (ROC) analysis area under the curve (AUC) 0.607 was statistically significant for CRP with a cut-off value of 11.57 to predict medical treatment failure (95% 0.531-0.682, sensitivity 63.3%, specificity 55.4%). Conclusion: NLR, PLR and APRI score are ineffective in predicting the need for surgical treatment. CRP could be used as a marker in predicting the need for surgical treatment in patients with TOA.

The relationship between oxidative stress and unexplained infertility (UEI) has not been studied in detail. This is the first study to evaluate dysfunctional high-density lipoprotein (HDL) by the myeloperoxidase (MPO) and paraoxonase (PON) ratio to investigate the role of oxidative stress in UEI. Materials and Methods: Patients with UEI (study group, n = 40) and male factor infertility (control group, n = 36) were included in this prospective study. Demographics and laboratory assessments were analyzed. Results: Total dosages of gonadotropin were higher in UEI when compared to the control group (p = 0.033). Number of Grade 1 embryos and the quality of blastocysts were lower in UEI than in the control group (p = 0.024, p = 0.020, respectively), whereas serum MPO/PON ratio was higher in UEI (p = 0.042). Stepwise linear regression analysis revealed that serum MPO/PON ratio levels could significantly predict the duration of infertility (p = 0.012). Conclusions: Serum MPO/PON ratio increased in patients with UEI, whereas the number of Grade 1 embryos and the quality of blastocysts decreased. Similar clinical pregnacy rates were found in both groups but the ET on day five is associated with higher clinical pregnancy rate in the male factor infertility.

Aim: The aim of the study was to evaluate the incidence of asymptomatic COVID-19 disease in pregnant women withrectal and oropharyngeal/nasopharyngeal swab to compare the efficacy of two samples.Material and Method: This prospective cohort study included 234 asymptomatic pregnant women who had undergoneplanned cesarean section between May 7 and September 24, 2020 in obstetrics unit of a tertiary care center, in Ankara,Turkey. The oropharyngeal/nasopharyngeal swab, rectal swab, placental, amniotic fluid, and cord blood samples wereobtained from all participants. The placental, amniotic fluid, and cord blood samples were tested when any of theoropharyngeal/nasopharyngeal or rectal samples were positive. The real-time reverse transcriptase-polymerase chainreaction (RT-PCR) test was performed to detect SARS-CoV-2 virus in the samples.Results: The incidence of the asymptomatic COVID-19 disease was 0.42% (1/234) in the study population. One of 234oropharyngeal/nasopharyngeal swabs was positive, while none of the rectal swabs including the one positive withoropharyngeal/nasopharyngeal swab were positive for SARS-CoV-2 virus. The RT-PCR test results of the placental,amniotic fluid, and cord blood samples of the COVID-positive case were negative.Conclusion: The incidence of asymptomatic COVID-19 disease in pregnant women who had undergone elective cesareandelivery was low, in Ankara, Turkey. In asymptomatic pregnant women, oropharyngeal/nasopharyngeal swab was foundto be more useful in detecting COVID-19 disease compared to rectal swab. No evidence was found about the intrauterinetransmission of asymptomatic disease., Amaç: Çalışmanın amacı, rektal ve orofaringeal / nazofaringeal sürüntü ile gebelerde asemptomatik COVID-19 hastalıkinsidansını değerlendirerek iki yöntemin etkinliğini karşılaştırmaktı.Gereç ve Yöntem: Bu prospektif kohort çalışmasına, Ankara'da üçüncü basamak bir merkezin obstetri ünitesinde 7Mayıs-24 Eylül 2020 tarihleri arasında planlı sezaryen yapılan 234 asemptomatik gebe dahil edildi. Tüm katılımcılardanorofaringeal / nazofaringeal sürüntü, rektal sürüntü, plasental, amniyotik sıvı ve kordon kanı örnekleri alındı. Orofaringeal/ nazofaringeal veya rektal örneklerden herhangi biri pozitif olduğunda plasental, amniyotik sıvı ve kordon kanı örnekleritest edildi. Örneklerdeki SARS-CoV-2 virüsünü tespit etmek için gerçek zamanlı ters transkriptaz-polimeraz zincirreaksiyonu (RT-PCR) testi yapıldı.Bulgular: Asemptomatik COVID-19 hastalık insidansı çalışma popülasyonunda % 0,42 (1/234) idi. 234 orofaringeal /nazofaringeal sürüntüden biri pozitif iken, orofaringeal / nazofaringeal sürüntü ile pozitif olan dahil rektal sürüntülerinhiçbiri SARS-CoV-2 virüsü için pozitif değildi. COVID pozitif olgunun plasental, amniyotik sıvı ve kordon kanı örneklerininRT-PCR testi sonuçları negatifti.Sonuç: Ankara'da elektif sezaryen ile doğum yapmış gebelerde asemptomatik COVID-19 hastalığı insidansı düşüktü.Asemptomatik hamile kadınlarda, orofaringeal / nazofaringeal sürüntü rektal sürüntü ile karşılaştırıldığında COVID-19hastalığını tespit etmede daha yararlı bulundu. Asemptomatik hastalığın intrauterin geçişine dair bir kanıt bulunamadı.

OBJECTIVE: The objective of this study was to determine the incidence of perioperative “severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)” infection among women, operated during Coronavirus disease-2019 (COVID-19) era. STUDY DESIGN: All patients who were operated on between March 11, 2020, and December 31, 2020, in our gynecology clinic were included in this cross-sectional study. The clinical and demographic characteristics of the patients, preoperative and postoperative SARS-CoV-2 positivity, the progress of the infection, and the survival rates in positive cases were analyzed. COVID-19 cases were diagnosed by reverse transcription-polymerase chain reaction testing for SARS-CoV-2. RESULTS: Operations of 133 (33%) of 406 patients were canceled for various reasons. 275 patients were operated on. Preoperatively three patients were diagnosed with COVID-19. One of these patients died and two were operated on after treatment and self-isolation. Only one (0.4%) patient was diagnosed with COVID-19 30 days postoperatively and completely recovered. We calculated the perioperative SARS-CoV-2 positivity rate as 1.4% (276 surgeries were planned and 4 patients were diagnosed with COVID-19). During the study, 107 physicians worked in our clinic alternately. Two (1.8%) of these physicians were diagnosed with COVID-19 and completely recovered without the need for intensive care. In addition, nine patients who were previously diagnosed with COVID-19 were operated on. Postoperative respiratory and other system complications did not occur in nine patients, previously diagnosed with COVID-19. CONCLUSION: The results of our study show that gynecological surgical procedures do not increase the transmission and mortality rates of SARS-CoV-2 among patients and healthcare professionals as long as infection control measures are followed.

Objective: The aim of this study was to assess the diagnostic values of new biochemical markers that may be an alternative to the oral glucose tolerance test (OGTT) and determine the differences in these markers among three groups of women with varying degrees of glucose homeostasis dysregulation. Material and Methods: This was a prospective study. All women were screened with 50 gram (g) oral glucose and a 100 g OGTT for gestational diabetes mellitus (GDM). The patients were divided into three groups depending on the result of the tests: no evidence of glucose metabolism abnormality (controls); impaired glucose tolerance (IGT); and GDM. All three groups were evaluated for serum human advanced glycation end-products (AGEs) concentrations, carboxymethyl lysine (CML) concentration and receptor for advanced glycation end-product concentrations (RAGE/AGER), body mass index (BMI), age, fasting glucose levels, obstetrical parameters and gestational age. Results: The study included 180 women divided into 59 (32.8%) GDM, 50 (27.8%) IGT and 71 (39.4%) controls. Age was similar among the three groups. Whereas fasting glucose levels and BMI in the three groups was significantly different, AGEs, CML, RAGE/AGER levels were found as significantly different between the groups (p

Preterm birth is an important risk factor for neonatalmorbidity and mortality. Calcium channel blockers (nifedipine) are safe andthese agents are preferred frequently in medical treatment of preterm labor. Dueto lack of license, they may use off-label in the treatment of preterm labor. Inthis review, current literature on tocolytic agents and nifedipine used in thetreatment of preterm delivery is presented., Preterm doğum, neonatal morbidite ve mortalite yönünden önemli bir risk faktörüdür. Kalsiyum kanal blokerleri (nifedipin) preterm doğum medikal tedavisinde kullanımı güvenlidir ve uluslararası kılavuzlarda sık tercih edilen ajanlardan birisidir. Ruhsatlanımı olmaması nedeniyle preterm doğum tedavisinde endikasyon dışı (off-label) kullanılmaktadır. Bu derlemede preterm doğum tedavisinde kullanılan tokolitik ajanlar ve nifedipin ile ilgili güncel literatür sunulmuştur.

Aim: To evaluate the educational level of nurses through a pre and post-test after a gynecologic oncology workshop.Material and method: During the ‘Basic and Advanced Nursing Activities in Gynecologic Oncology’ workshop, pre and post-test were applied to 33 nurses. The lessons consisted of patient care before and after basic surgical procedures in gynecologic oncology; pelvic and paraaortic lymphadenectomy, radical hysterectomy, radical vulvectomy with inguinofemoral lymphadenectomy, with the additional patient care managements for bowel operations, stoma formation, chemotherapy administration, radiotherapy and brachytherapy applications. Additionally, enhanced recovery after surgery and palliative care options were also discussed. Nurses scaled their pre and post-course knowledge ranging between 1-5 points. The post-course evaluation was held at the end of the first month after the workshop.Results: Attending nurses were from all servicing parts of the hospital irrespective of their previous experience, education level or employment in gynecologic oncology. There was a statistically significant improvement of knowledge in all aspects of the course (p, Amaç: Jinekolojik onkoloji çalıştayı sonrası hemşirelerin öğrenim seviyelerinin ön ve son-test ile değerlendirilmesi.Gereç ve Yöntem: ‘Jinekolojik Onkolojide Temel ve İleri Hemşirelik Uygulamaları’ çalıştayı sonrası toplamda 33 hemşireye ön ve son-test uygulandı. Dersler; jinekolojik onkolojide pelvik ve paraaortik lenfadenektomi, radikal histerektomi, radikal vulvektomi ile inguinofemoral lenfadenektomi gibi temel cerrahi prosedürler öncesi ve sonrası hasta bakımı; ve barsak operasyonları, stoma oluşturulması, kemoterapi, radyoterapi ve brakiterapi uygulamaları sonrası hasta bakım yönetimini içermekteydi. Ek olarak, cerrahi sonrası hızlandırılmış iyileşme ve palyatif dönem bakım seçenekleri de tartışıldı. Hemşireler, kurs öncesi bilgi düzeyini ve kurs sonrası 1. ayda bilgi düzeyini 1-5 puan arasında değerlendirdiler.Bulgular: Kursa katılan hemşireler daha önceki tecrübe, eğitim seviyesi ve jinekolojik onkolojide çalışma durumlarından bağımsız olarak hastanenin tüm çalışma alanlarından gelmişti. Kursa ait dersler için, yapılan ön ve son test arasında bilgi durumunda istatistiksel olarak anlamlı bir artış mevcuttu (p

Objective To evaluate the obstetric outcomes of fetuses with cystic hygroma other than karyotype abnormalities and structural malformations. Material and methods We conducted a retrospective study based on the review of medical records of pregnant women in whom ultrasonographic diagnosis of fetal cystic hygroma was established in the first trimester from January 2014 to October 2018. All patients were offered genetic counselling and prenatal invasive diagnostic procedures to obtain fetal karyotype. For ongoing pregnancies fetal echocardiography and detailed second trimester sonographic anomaly screening was performed by a perinatologist/pediatric cardiologist. The demographic characteristics of the women and the results of the karyotype analysis were obtained from the database of our hospital and correlated with the obstetric outcomes. Results Within a five-year period, there were 106 cases of fetal cystic hygroma. Of those, fetal cardiac malformations were detected in four and micrognathia in one fetus. Eighty-five women underwent fetal invasive procedures and karyotype abnormalities were detected in 52 of the cases. Fetal outcomes of 33 cases with normal karyotype and 21 cases in whom karyotyping analysis were not performed due to patient refusal were enrolled into the study. Obstetric outcomes of 21 women who refused karyotyping consisted of 13 livebirths, seven missed abortions, and one fetal death, whereas those of 33 women with normal karyotype were; 12 livebirths, 12 missed abortions, two hydrops fetalis, and five fetal deaths. Nineteen of 33 fetuses with a normal karyotype and eight of 21 fetuses in whom karyotyping was not performed were terminated. Conclusion The presence of cystic hygroma carries a high risk for fetal karyotype abnormalities and cardiac malformations. The postnatal outcomes of the fetuses with cystic hygroma appeared to be correlated with the absence of structural malformations and karyotype abnormalities.

Objective Cardiovascular disease (CVD) is the leading cause of death during pregnancy. Therefore, its detection early in pregnancy is of great importance. In this study, we aimed to investigate the rate and spectrum of CVD among healthy women in the first trimester of pregnancy. Methods A total of 900 women in the first trimester of pregnancy, who attended the antenatal outpatient clinic of a tertiary care center in Ankara, Turkey, for a routine pregnancy examination, were recruited into this prospective study. Patients with a history of chronic systemic diseases, CVD, and/or a family history of an early onset CVD, and multiple pregnancies were excluded. Patients who were included in the study underwent electrocardiography and transthoracic echocardiography by the same cardiologist. Results The rate of newly diagnosed CVD cases among asymptomatic pregnant women without any cardiac or clinical risk factors was 5.2% (n=47). The following CVDs were detected: rheumatic heart disease (n=26; 55.3%), congenital heart disease (n=13; 27.6%), and isolated valve disease (moderate and severe) (n=8; 17%). The mitral valve prolapse was detected in 32 women (3.5%) and atrial septal aneurysm in 51 women (5.67%). Thirty women (3.3%) had arrhythmia. Conclusion The CVD rate of 5.2% among healthy women in the first trimester of pregnancy shows that the clinicians must keep in mind that during pregnancy, physiological changes in the cardiovascular system may aggravate an undiagnosed disease, and they should be alert even in case of mild cardiac symptoms that may interfere with pregnancy complaints.

İlk olarak Çin'in Wuhan kentinde tanımlanan yeni tip koronavirüs hastalığı (COVID-19), küresel bir halk sağlığı sorunu olan, bir çeşit solunum yolu enfeksiyonudur. Vaka raporları ve küçük kohort çalışmalarından oluşan, gebelikte COVID-19 ile ilgili veriler sınırlıdır. Doğum sonrası ürosepsis de küresel olarak yaygın bir hastalıktır ve pekçok yayın bulunmaktadır. Sepsis bulguları olan postpartum hastalar, salgın sırasında; halk sağlığı ve hastanın kendi iyiliği açısından COVID-19 için test edilmelidir. Ürosepsisin klinik özellikleri, doğum sonrası hastalarda COVID-19 hastalığına benzer olabilir. Bu olgu sunumu ile; postpartum dönemde ani akut solunum bozukluğu ve septik şok bulguları geliştiren bir vakada COVID-19 enfeksiyonu ve ürosepsis ayırıcı tanısının ve tedavisinin nasıl yönetildiğini anlatmak amaçlanmıştır.

Objectives: To investigate whether serum levels of inflammatory markers including high sensitive C-reactive protein (hs-CRP) and mean platelet volume (MPV) to platelet count ratio (MPR) were altered in patients with hyperemesis gravidarum (HEG) compared to asymptomatic pregnant women. Methods: Ninety pregnant women, 46 with HEG and the other 44 with healthy uncomplicated pregnancies were included the study. MPR was calculated as the MPV value to the platelet count obtained from the same blood sample. The clinical information and the laboratory results of the hematologic and biochemical parameters and hs-CRP levels of each participant were recorded. Results: Platelet counts were didnt differ between the groups. MPV, MPR and hs-CRP values were significantly higher in HEG group than in the control (p=0.01, p=0.05 and p=0.03, respectively). Conclusions: The etiopathogenesis of HEG is still obscure and its likely multi-factorial. Although we didnt demonstrate the statistically significant differences in terms of platelet counts between the groups we find elevated levels of MPV, MPR and hs-CRP which conclude inflammatory basis of the disease. [Med-Science 2019; 8(4.000): 866-9]

OBJECTIVE: The objective of the study was to investigate the effect of immersion in water strategy during labor on postpartum bleeding by calculating the postpartum reduction rates of the hematocrit values of the patients.STUDY DESIGN: The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (group 1) and the control group (group 2) of 84 women undergoing normal vaginal delivery. Patients who have received additional medical and surgical interventions for alleviation of postpartum hemorrhage, patients who have undergone an episiotomy and/or perineal trauma were not included in the study. All data were taken from patients who have delivered with spontaneous vaginal delivery. Postpartum hematocrit fall rates of the groups have been compared and the effect of immersion in water on postpartum hemorrhage has been evaluated.RESULTS: The study groups consisted of 84 women undergoing vaginal delivery with immersion in water during labor (Group 1) and the control group (Group 2) of 84 women undergoing vaginal delivery at the hospital. The women in the two groups were matched with respect to age, parity, birth weight and gestational age. The mean age of the women was 29.8±4.8 and 30.5±4.9 respectively. The mean hematocrit difference in the first group was 2.08 ± 1.88 and in the second group was 3.81 ± 1.55. The mean percentage of hematocrit reduction in the first group was 5.71% and in the second group 10.23%.CONCLUSION: Our data showed that mean hematocrit level decreases among women following vaginal delivery more than women who give birth vaginally within immersion in water during labor. The percentage of hematocrit reduction in the water birth group was lower than in the control group. Water birth seems to facilitate uterine contractions more efficiently following vaginal delivery.

Introduction In polycystic ovary syndrome, serum vitamin D levels are known to correlate with metabolic conditions such as diabetes mellitus, metabolic syndrome and cardiovascular disease. However, there are not enough studies showing such a relationship with female fertility. We aimed to compare serum vitamin D levels in fertile and infertile women with polycystic ovary syndrome to evaluate whether vitamin D may play a role in the pathogenesis of fertility problems in women with polycystic ovary syndrome. Materials and Methods 274 infertile and 111 fertile women with polycystic ovary syndrome were included in this retrospective study. Infertile and fertile groups were matched by age, body mass index and homeostasis model assessment of insulin resistance. Anthropometric, clinical and laboratory characteristics of the women were recorded. Serum 25(OH)D3 levels were used to assess serum vitamin D levels. Results No significant differences were detected between groups in terms of anthropometric, clinical and laboratory features except for serum 25(OH)D3 levels and the incidence of vitamin D deficiency. Vitamin D levels were significantly lower and vitamin D deficiency was more common in the infertile group compared to the fertile group. When the groups were stratified into obese/non-obese or insulin resistance positive/negative, infertile obese and infertile insulin resistance-positive women had the lowest serum 25(OH)D3 levels. Conclusion Serum vitamin D levels are lower in infertile women with polycystic ovary syndrome compared to fertile women. When insulin resistance or obesity was present, vitamin D levels were reduced further. Thus, in polycystic ovary syndrome, lower vitamin D levels may play a role in the pathogenesis of fertility problems.

Amaç: Çalışmamızda intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş gebe kadınlara ait antenatal tarama testi parametrelerinin retrospektif incelenerek maternal yaş ve doğum haftalarına göre fetal ölüm üzerine olan prediktivitesinin değerlendirilmesi amaçlandı. Gereç ve yöntemler: Bu retrospektif kohort çalışmaya, 1 Ocak 2017-15 Haziran 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi, Ankara Dr. Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi’nde 20. gebelik haftası ve üzerinde intrauterin fetal ölüm nedeniyle ölü doğum gerçekleştirmiş olan toplam 394 gebe kadın dahil edildi. Hastalara ait demografik özellikler, doğum karakteristikleri ve antenatal tarama testi (ikili, üçlü test) parametreleri (nukal saydamlık [NT], serbest beta insan koryonik gonadotropin [β-hCG], gebelikle ilişkili plazma protein-A [PAPP-A], hCG, ankonjuge östriol [uE3], serum alfa fetoprotein [ΑFP] ortalamanın katları [MoM] değerleri) 35 yaş altı ve üstü ile 20-34. ve 34 üzeri gebelik haftalarına göre ayrı ayrı gruplar şeklinde karşılaştırıldı. Ayrıca antenatal tarama test parametrelerinin doğum haftası ile korelasyonu değerlendirildi. Verilerin analizi SPSS 26.0 istatistik paket programı kullanılarak yapıldı. İstatistiksel analizlerde Kolmogorov-Smirnov, Mann-Whitney U ve Pearson Ki-Kare testleri kullanıldı. Korelasyon analizi Spearman testi ile yapıldı. p, Objective: It was aimed to evaluate the predictivity of antenatal screening test parameters of pregnant women who had stillbirth due to intrauterine fetal demise according to maternal age and gestational birth weeks by retrospectively analysis in our study. Material and Methods: This retrospective cohort study included a total of 394 pregnant women who had a stillbirth due to intrauterine fetal demise at 20 weeks of gestation or later at the University of Health Sciences, Ankara Dr. Zekai Tahir Burak Women Health Education and Research Hospital between January 1, 2017, and June 15, 2019. Patients' demographic characteristics, birth characteristics, and antenatal screening test (combined, triple test) parameters (nuchal transparency [NT], free beta-human coronic gonadotropin [β-hCG], plasma protein-A [PAPP-A], hCG, unconjugated estriol [uE3], serum alpha-fetoprotein [ΑFP] multiples of median [MoM] values) were compared in separate groups of under and above 35 years of age and 20-34 weeks and above 34 weeks of gestation. Additionally, the correlation of antenatal screening test parameters with gestational week was evaluated. Data analysis was carried out using the SPSS version 26.0 statistical software package. Kolmogorov-Smirnov, Mann-Whitney U and Pearson Chi-Square tests were used for statistical analyses. Correlation analysis was performed using Spearman's correlation test. A p-value of

Objectives: This study aimed to evaluate the effect of SARS-CoV-2 on pregnancy complications, which increased compared to the same period before the pandemic. Material and methods: This prospective study was conducted at Etlik Zubeyde Hanim Women's Health Practices & Research Center between June 2020 and July 2020. The asymptomatic term PROM and miscarriage pregnant women were screened for SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) positivity by using IgM and IgG antibody tests. All the positive cases were confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). All the patients answered 12 questions to determine their approach to COVID-19. Result: Four of the 205 (2%) term PROM patients had positive anti-SARS-CoV-2 IgM antibody tests, one of the 205 (0.5%) term PROM patients had a positive anti-SARS-CoV-2 IgG antibody test, and one of the 205 (% 0.5) term PROM patients had positive anti-SARS-CoV-2 IgM and IgG antibody tests. All 230 miscarriage patients had negative IgM/IgG antibody tests. Four of the positive antibody cases had positive RT-PCR tests (2%) and were referred to a pandemic hospital. The patients thought that 93.2% and 95.6% of pregnant women with term PROM and miscarriage, respectively, SARS-CoV-2 would infect themselves, and 89.8% and 92.6%, respectively, would infect their children. The number of patients who would not consider pregnancy if they were not pregnant during this period was significantly higher in the term PROM (48.3%) compared to the miscarriage (27.8%) patients (p < 0.005). Conclusions: No COVID-19 cases were determined in the asymptomatic miscarriage patients. In the asymptomatic term PROM patients, the effects of COVID were not observed.

Pregnancy is a period that requires a continual interaction of pregnant women with healthcare. According to the current data, 13.7% of pregnant women favour the SARS-CoV-2 virus without any symptoms. This data emphasizes the importance of personal preventive measures. This case reported the vaginal delivery of an asymptomatic pregnant woman reported as COVID19 positive soon after birth. The newborn tested following this contact, PCR resulted negative with our novel preventive measure: “a face shield for the newborn.”, Hamilelik, hamile kadınların sağlık hizmeti ile sürekli etkileşimini gerektiren bir dönemdir. Mevcut verilere göre hamile kadınların %13,7'si SARS-CoV-2 virüsü taşımasına rağmen semptomsuzdur. Bu veri, kişisel önleyici tedbirlerin önemini vurgulamaktadır. Bu vaka sunumu, doğumdan hemen sonra COVID-19 pozitif olarak bildirilen asemptomatik hamile bir kadının vajinal doğumunu ve hastanemizde alınan önlemleri özetlemektedir. Testi pozitif annesi ile temas sonrası test edilen yenidoğanın, yeni önleyici tedbirimiz olan “yenidoğan için yüz siperi” ile bulaştan korunduğu gözlenmiştir.

Objective There is a role of inflammatory processes on the pathophysiology of rheumatic heart valve disease (RHVD). The neutrophil-lymphocyte ratio (NLR) as an inflammatory marker is associated with some clinical situations in pregnancy. In this study, we aimed to investigate the predictive role of NLR in pregnant women with NLR. Materials and Methods First-trimester pregnant women, who were referred to cardiology outpatient clinic and diagnosed with RHVD (n=24) were enrolled in this study and age-matched healthy pregnant women (n=24) were taken as control groups. The two groups were compared in terms of clinical characteristics, echocardiographic findings, and NLR. The role of NLO in predicting RKKH has been examined. Results Groups were similar in terms of demographic features. NLR was higher in pregnant women with RHVD than the control group (3.68 ±1.74 vs. 2.68±1.14, p=0.00239). NLR (OR: 0,597, p= 0,037, 95% CI: 0,343-0,921) and neutrophil count (OR: 0,609, p= 0.013, 95% CI: 0,390-0,863) were possible independent predictors of RHVD. Conclusion NLR was significantly higher among pregnant women with RHVD. As it is not possible to provide routine cardiac check-up to all pregnant women; markers for specific risk groups need to be defined to reduce the risks associated with heart diseases during pregnancy. According to these findings, pregnant women with high NLR may need extra attention in terms of CVD like RHVD. Further studies with large patient groups are needed to define the predictive value of NLR.

Aim: This study aimed to investigate the potential increase in the pregnancy complications during the pandemic period. Materials and Methods: Data of the pregnant women who were admitted between April/May2019 and April/May2020 for stillbirth, preterm labor, term prelabor rupture of membranes (PROM), preterm premature rupture of membranes (PPROM), placental abruption, miscarriage and abortion imminens were collected from the hospital database and retrospectively analyzed. Results: During the COVID-19 pandemic period between April/May2020, 1604 deliveries occurred in our hospital. Totally 1401 deliveries had occurred in the same monthly interval of 2019. In the early pregnancy unit, 566 patients were admitted to be monitored in 2019 whereas that number is 466 in 2020. In the pandemic period, a statistically significant difference was found between 2019 and 2020 regarding the rates of admission after 22nd gestational week and admission to the Early Pregnancy Assessment Unit. Bonferroni tests were performed to determine which group of the patients generated this difference and it was determined that the rates of term PROM and miscarriage increased statistically significantly in 2020 compared with 2019. Conclusion: We concluded that the effect of COVID-19 on symptomatic and asymptomatic pregnant women will be further clarified by switching to routine screening program for pregnant women in our country. COVID-19 antibody testing is important to confirm our results in the cases with term PROM and miscarriage who are asymptomatic with respect to COVID-19.

Amaç: Bu çalışmada konizasyon cerrahisi sonrası servikal intraepitelyal neoplazi nüksünü öngörmede preoperatif nötrofil-lenfosit oranının prediktif değerinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Bu retrospektif çalışmada, servikal intraepitelyal neoplazi patolojisine bağlı konizasyon uygulanan hastalar analiz edildi. Çalışmaya konizasyon materyalinde servikal intraepitelyal neoplazi saptanıp cerrahi sınırları negatif olan ve klinik veri tabanımızda en az 12 aylık takip süresi olan hastalar dahil edildi. Hastaların demografik, klinik, patolojik verileri ve preoperatif tam kan sayımı bulguları tıbbi dosyalardan çıkarıldı.Bulgular: Toplamda mevcut olan 105 hasta iki gruba ayrıldı: rekürrens grubu (n = 30) ve kontrol grubu (n = 85). İki grup arasında servikal intraepitelyal neoplazi patoloji dereceleri açısından istatistiksel olarak anlamlı fark yoktu. Rekürrens grubunda kontrol grubuna göre endoservikal küretaj pozitif sonuç sayısı artmıştı. Nüks grubunda rekürrenssiz sağkalım ortalaması 10.5 aydı. İki grup arasında preoperatif nötrofil-lenfosit oranı ve diğer hematolojik parametreler açısından istatistiksel olarak anlamlı fark yoktu. Lojistik regresyon analizinde rekürrens tahmininde sadece endoservikal küretaj pozitifliği belirleyici idi (p = 0.002,% 95 CI 0.084-0.365). Sonuç: Preoperatif nötrofil-lenfosit oranı ve diğer inflamatuar belirteçler cerrahi sınırları temiz konizasyon olgularında nüksü öngörmede etkin bulunmamıştır. Pozitif postkonizasyon endoservikal küretaj, eksizyonel tedaviden sonra nüks ile ilişkili tek prognostik faktör olarak bulunmuştur., Objective: This study aimed to evaluate the predictive value of preoperative neutrophil-lymphocyte ratio in cervical intraepithelial neoplasia recurrence after conization surgery.Materials and Methods: In this retrospective study, patients who underwent conization due to cervical intraepithelial neoplasia were analyzed. Inclusion criteria were cervical intraepithelial neoplasia in the conization specimen with negative surgical margins and at least 12 months follow-up period at our clinical database. Demographic, clinical, pathological data, and preoperative complete blood count findings of the patients were extracted from medical files. Results: There were a total of 105 patients divided into two groups: the recurrence group (n = 30) and the control group (n =85). There were no statistically significant differences between the two groups in terms of cervical intraepithelial neoplasia pathology grades. There was statistically increased number of postconization endocervical positive results in the recurrence group. In the recurrence group, the mean of recurrence free survival was 10.5 months. There were no statistically significant differences in the preoperative neutrophil-lymphocyte ratio and in other hematologic parameters between the groups. In logistic regression analysis, only endocervical curettage positivity was predictive in estimating recurrence (p=0.002, %95 CI 0.084-0.365). Conclusion: Preoperative neutrophil-lymphocyte ratio and other inflammatory markers were not predictive of recurrence after conization in women with negative surgical margins. Positive postconization endocervical curettage was the only prognostic factor associated with recurrence after excisional therapy.

A global public health problem with a high rate spread and transmission, Coronavirus outbreak has become the most talkedabout matter throughout the world. We are severely affected by the nations with vast numbers of deaths; it was hard to predict such a colossal pandemic with terrifying consequences. Elective surgeries are limited, but situations requiring an urgent gynaecological or obstetric surgical approach must still be performed during the COVID-19 pandemic. Concerns regarding surgical safety and the risk of viral transmission during surgery are of great importance. In this review, we aimed to summarize the concepts related to laparoscopic gynecological surgery during COVID-19 pandemic in the light of current literature.

Background: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). Methods: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. Results: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. Conclusion: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable. Keywords: Cause of death, Hypertensive disorders, In vitro fertilization, Maternal death, Perinatal outcome, Pulmonary embolism

Objective: Meconium stained amniotic fluid is a frequently encountered situation, it can really disturb an obstetrician, as it increases the rates of neonatal morbidity and mortality and it is difficult to prevent meconium passage in utero. Noninvasive tests are needed to predict the meconium staining of the amnion fluid without making amniotomy or making a fetal invasive procedure. Non stress test is a commonly used method to determine the status of intrapartum fetal wellbeing. The purpose of this study was to predict fetal meconium release during labor by examining the fetal heart rate traces without performing an amniotomy procedure. Materials and Methods: A total of 280 patients who have been diagnosed with active labor were included in the study. 140 of them demonstrated meconium stained fluid and 140 of them clear amniotic fluid. The patients’ labor courses have been watched and non-stress test results have been recorded besides obstetric outcomes. Results: Non-stress tests performed before amniotomy; 52 (37.1%) of the non-stress tests in the meconium group were non-reactivated, whereas in the control group this count was 19 (13.5%) before amniotomy. When we accepted the deceleration entity as fetal distress; fetal distress was seen in 62(44.3%) of the patients in the meconium group and in 21(15.1%) of the patients in the control group. Conclusion: In the presence of non-reactive non stress test pattern; we should be suspicious of meconium-stained amniotic fluid. In this case, caution should be taken in terms of fetal distress.