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Background/Aim: Urogynecological symptoms, including pelvic pain, lower backache, feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence, are common during pregnancy. But little has been reported regarding possible changes in lower urogenital tract anatomy and its effects in pregnancy. Therefore, the subject of this study is whether the incidence of urogynecological symptoms is higher when the uterus is retroverted in pregnancy. Methods: We enrolled 1432 pregnant women examined before the 20th week of pregnancy between January 2018 and March 2022. Patients were allocated into two groups according to whether the uterus was retroverted (n=226 (15.7%)) or anteverted (n=1206 (84.3%)). These two groups were compared regarding pelvic pain, lower backache, the feeling of bearing down, frequency, nocturia, urgency, stress incontinence, and urge incontinence. Results: Retroverted gravid uterus was noted in 11.8% (n=41) of nulliparae and 17% (n=185) of multiparae (P=0.021), with an overall prevalence of 15.7%. Of 1432 patients, the overall prevalence for frequency, urgency, nocturia, urge incontinence, stress incontinence, lower backache, pelvic pain, and feeling of bearing down were 31%, 26.7%, 18.2%, 5.4%, 7.5%, 6.9%, 56.4% and 7.5%, respectively. Between both groups, there were differences in frequency, urgency, nocturia and lower back pain. There were two patients with incarcerated gravid uterus with urinary retention. Conclusion: Patients with a retroverted uterus are more likely to experience the symptoms of lower back pain, frequency, nocturia, and urgency in the first half of pregnancy.

Aim: To determine second-trimester uterine artery pulsatility index (UA-PI) values and diastolic notch (DN) presences in primigravid, low-risk pregnant women for preeclampsia (PE) prediction. Matherials and Methods: We studied prospectively primigravid, pregnant women between 18 and 24 weeks of gestation who were admitted for routine prenatal care. An ultrasound examination that included measurements of the UA-PI and DN presence was performed and pregnancy outcomes were evaluated. Results: In total 244 primigravid pregnant women were included this study, and 15 (6,1 %) developed PE. When Preeclampsia positive (PEP) group and the preeclampsia negative (PEN) group compared, there was no difference in demographic data. PEP group mean UA-PI value was significantly higher (p< 0,01) when mean time of the delivery week (p< 0,01) and fetal birth weight (p< 0,01) were significantly lower than PEN group. DN was negative (NN) in 163 (66,8 %) pregnant women, and found positive (NP) in 81 (33,2%) pregnant women. NP group had higher PE rates compared to NN group. Bilateral notch positivity increases both PE and early PE rates compared to notch negativity and unilateral notch positivity. The most sensitive and specific value of UA-PI for PE prediction was found 1,13. Conclusion: Uterine artery Doppler is a non-invasive and simple tool to identify high-risk pregnancies and may improve patient-specific practice. Especially pregnant women with a bilateral uterine notch accompanying with abnormal UA-PI values resulted a higher prevalence to develop these severe adverse outcomes. Closer monitoring may help to reduce both maternal and fetal morbidity and mortality in high-risk groups.

Aim: Abruptio placenta is one of the most important causes of antepartum bleeding and is linked to the major (unpleasant) obstetrics consequences leading to the increased risks of fetal and maternal morbidity and mortality. The aim of our study is to establish a prevalence in our tertiary hospital and find out the fetal and maternal outcomes, along with the patient’s demographic characteristics and risk factors of abruptio placenta. Material and Method: This trial was carried out in Profesör Doktor Cemil Taşçıoğlu State Hospital, between January 2018 and March 2022. Patient data were extracted from computer system, and files were retrospectively evaluated. We established the fetal and maternal outcomes, along with the demographic characteristics and risk factors of abruptio placenta. All analysis was performed using SPSS software (Statistical Package for the Social Sciences, version 25.0, SPSS Inc., Chicago, IL, USA). Results: Within the review period there were 7126 deliveries. And 112 cases with abruptio placenta were seen out of the total deliveries. In our population, prevalence of the abruptio placenta was calculated as 1.5%. Because of the incomplete data in certain files, only a total of 102 cases (91%) were eligible for the study. Conclusion: In conclusion, since the abruptio placenta is highly associated with maternal and fetal morbidity and mortality, timely diagnosis is crucial to prevent devastating consequenuces.

Objective:To investigate the relationship between maternal obesity and perinatal and neonatal outcomes in primigravid pregnant women.Methods:A total of 162 primigravid pregnant women were categorized into four groups based on their body mass index (BMI), age, gravida (number of pregnancies), parity (number of births), gestational week, pre-pregnancy body weight, height, prenatal final body weight, delivery patterns and indications, pre-eclampsia, fetuses small for gestational age (SGA), hemoglobin values at the time of hospitalization and after 24 h of delivery, transfusional requirements, birth weight of the babies, neonatal intensive care need, and the babies’ 1st-5th min APGAR scores were compared among the groups.Results:No significant differences were noted among the BMI groups in terms of age, gestational age, delivery type, neonatal intensive care unit needs, and transfusional requirements. The weights of the babies, weight gain during the pregnancy, incidence of pre-eclampsia, incidence of SGA, and APGAR scores were found to be statistically significantly different among the groups.Conclusion:The findings of the present study indicate that maternal obesity is an important factor for increasing risk of pregnancy complications and neonatal morbidity.

Objectives: Preeclampsia (PE), which affecting multi-organ systems, is one of the most common causes of feto-maternal morbidity and mortality. The fetal kidney is one of the vulnerable organs in PE caused by sustained vasospasm of the renal arteries. In this study, it was aimed to reveal the changes in the renal vascular bed with renal artery Doppler examinations in fetuses of pregnant women with PE. Methods: Fifty-five pregnant women with PE and 60 healthy pregnant women were included in this prospective study. Multiple pregnancies, those who did not want to participate in the study, and those with other co-morbidities were excluded from the study. Fetal renal artery Doppler studies included renal artery systolic/diastolic (S/D) ratio, pulsatility index (PI) and resistance index (RI) of the control and PE groups, and findings such as week of birth and birth weight were recorded and analyzed statistically. Results: Fetal renal artery PI values were found to be higher in pregnant women with PE compared to the control group (2.93 in the patient group, 2.28 in the control group, p < 0.001). There was no significant difference between RI values and S/D ratios between the two groups. In the preeclampsia group, gestational week and baby weight at birth were significantly lower. Conclusions: Due to preeclampsia, hypoxia occurs in peripheral tissues and organs at the maternal level. Fetal organs are also affected by these hypoxic conditions. Doppler is an extremely useful examination tool in the evaluation of the status of peripheral organs such as the kidney. This study suggests that PE increases the resistance of renal arteries in fetuses of mothers with PE compared to fetuses of mothers without PE, which may contribute critically to kidney disease later in life.

Aim: The aim of our study is to examine early and late preterm placental calcification (PPC) and compare their relationship with maternal calcium, magnesium and 25(OH) D levels and adverse obstetric outcomes. Material and Method: This prospective cohort study was conducted by examining the pregnant women at their 24th to 36th gestational weeks who applied to the Gynecology Department of Okmeydani Training and Research Hospital. In this study, 207 patients were selected as the study group. Results: When the early and late PPC groups were compared, rates of low birth weight (LBW) was statistically higher in the early PPC group. (p=0.022) Oligohydramnios was more common in the early and late PPC patients compared to non-PPC pregnant women. However, oligohydramnios and LBW were not found statistically significant difference in logistic regression analysis. There was also no statistically significant difference in maternal calcium, magnesium and vitamin D levels between the groups. Conclusion: Preterm placental calcifications might be associated with fetal and maternal complications. But the diagnosis of PPC alone is not effective in determining fetal prognosis.

Objective:To evaluate the demographic patient characteristics, indications, operative findings, preoperative and postoperative histopathology reports in hysterectomies for benign conditions in our clinic.Methods:One thousand four hundred seventeen patients who underwent hysterectomy for benign conditions were included in the study. Patient files and records from the Hospital Information Management system were reviewed. IBM SPSS Statistics 22 program was used for statistical analysis. Shapiro Wilks, One-way ANOVA, Tamhane’s, Kruskal-Wallis, Mann-Whitney U, chi-square and Fisher’s Exact test and Continuity (Yates) Correction were used as statistical tests. Statistical significance was defined as p

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study. Median follow-up time was 25 (6–30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p What is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL. What is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction. What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar. What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

BACKGROUND: To evaluate the doubling rate of maternal serum serial β-hCG and a single initial serum progesterone level to predict fetal viability before ultrasonography in women diagnosed with intrauterine pregnancy of undetectable viability. METHODS: 336 pregnant women who applied to the outpatient clinic at Istanbul Okmeydanı City Hospital between March and December 2018 were evaluated on a “Prospective observational” basis. 236 women were excluded from the study for various reasons. The study was completed with 100 pregnant women diagnosed with intrauterine pregnancy (IUP) involving suspected fetal viability by transvaginal ultrasonography only, who met the inclusion criteria with CRL: < 7mm and mean gestational sac diameter: < 25mm. Serum β-hCG and progesterone were taken at the first admission. After 48 hours, control serum β-hCG was taken and the increase rates were calculated. Early pregnancy loss was diagnosed by (transvaginal) TV-USG performed after the days 7, 11 and 14. Patients were divided into two groups as fetal heart rate (FHR) positive (viable) and FHR negative (early pregnancy loss). Pregnancy results were compared with β-hCG increase rates and progesterone value. SPSS 22.0 software was used for statistical analysis and PRESULTS: No statistically significant result was obtained between the viable and early pregnancy loss (FHR +/-) groups in terms of maternal age, previous pregnancy anamnesis, nationality, presenting symptoms, or ultrasound findings. According to the last menstrual period, the mean gestational age was 45.1±14 days in the viable (FHR+) group and 51.3±14 days in the Early pregnancy loss (FHR-) group, and this difference was found to be statistically significant. Estimation modality was developed in terms of viability with the serum progesterone values and increase rates of β-hCG. The study, which was conducted with a confidence interval of 95%, found the viability rate to be 70% with a β-hCG increase rate of 31%, 80% in the case of an increase by 49%, 90% in the case of an increase by 73%, 95% in the case of an increase by 97%, and 100% in the case of an increase by 181%. For progesterone, when the value was 5.9 ng/ml, the viability rate was 49%, and it was 69% at 10.5 ng/ml, 80% at 13.4 ng/ml, 90% at 18.0 ng/ml, 95% at 21.7 ng/ml, 99% at 29.3 ng/ml, and 100% at 37.5 ng/ml and above. In conclusion, the significant efficacy values of β-hCG increase and first progesterone level in predicting viability were found to be ROC AUC: [0.748 (0.621-0.874)] and ROC AUC: [0.796 (0.685-0.907)], respectively.CONCLUSION: Either Serial β-hCG ratio or serum progesterone level can be used alone to predict pregnancy outcome in early pregnancy. With dissemination of similar studies, estimation modalities can be improved and TV-USG examinations can help shortening the waiting time for results to reduce anxiety of families, hospital admissions and health expenses.

Adolescent pregnant women should be considered as a high risk patient group. The aim of our study is to compare pregnancies in adolescent with adult age group pregnancies and to evaluate maternal and fetal obstetric outcomes. Patients were admitted to Gynecology Department of Okmeydani Training and Research Hospital between January 1, 2015 and December 31, 2019. Pregnant women were divided into 3 groups as Group 1 (aged ≤16 years: n: 280), Group 2 (aged 17-19 years; n: 956) and Group 3 (aged 25-35 years; n: 656). Demographic characteristics of the patients and maternal and obstetric outcomes were recorded.In adolescent age groups,numbers of gravida, parity and abortus, and gestational age, fetal weight, and rates of cesarean delivery were found to be significantly lower relative to age group of 25-35 years Adolescents aged ≤16 years had a significantly lower risk than adults as for preeclampsia (AOR: 9,23 (6,36-11,82) p=0,001),had a significantly higher risk than adults as for low birth weight (AOR: 4,75 (2,26-9,21) p=0,001). and prematurity (AOR: 7,54 (5,12-9,43) p=0,001). Adolescents aged 17-19 years had a significantly higher risk than adults regarding small for gestational age (AOR: 4,48 (1,89-10,67) p=0,001), oligohidramnios (AOR: 2,29 (1,16-4,54) p=0,017), prematurity (AOR: 4,97 (3,1-7,97) p=0,0001) and LBW (AOR: 2,14 (2,71-9,74) p=0,0001).Our study was conducted with a large pregnant group, Since pregnant women in adolescent group are closely associated with preterm birth, delivery of small for gestational age and low birth weight infants, it is important to improve health services to reduce adverse pregnancy outcomes.

Aim To examine the characteristics of pregnancies at a very advanced maternal age and the effect of parity on adverse obstetric outcomes. Methods We retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydani Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%). Results Significantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher. Conclusion Since primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

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.

Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association of COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events.The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection.This was a multicenter retrospective cohort study including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, and Turkey). The data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. The secondary outcomes included maternal death, preeclampsia, and stillbirth. The association between the primary outcome and 12 candidate predictors having a known association with severe COVID-19 in pregnancy was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios. All the potential predictors were evaluated in 1 model and only the baseline factors in another. The predictive accuracy was assessed by the area under the receiver operating characteristic curves.Of the 793 pregnant women who were positive for SARS-CoV-2 and were symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The 'mini-COvid Maternal Intensive Therapy' model included the following demographic and clinical variables available at disease onset: maternal age (adjusted risk ratio, 1.45; 95% confidence interval, 1.07-1.95; P=.015); body mass index (adjusted risk ratio, 1.34; 95% confidence interval, 1.06-1.66; P=.010); and diagnosis in the third trimester of pregnancy (adjusted risk ratio, 3.64; 95% confidence interval, 1.78-8.46; P=.001). The optimism-adjusted area under the receiver operating characteristic curve was 0.73. The 'full-COvid Maternal Intensive Therapy' model included body mass index (adjusted risk ratio, 1.39; 95% confidence interval, 1.07-1.95; P=.015), lower respiratory symptoms (adjusted risk ratio, 5.11; 95% confidence interval, 1.81-21.4; P=.007), neutrophil to lymphocyte ratio (adjusted risk ratio, 1.62; 95% confidence interval, 1.36-1.89; P.001); and serum C-reactive protein (adjusted risk ratio, 1.30; 95% confidence interval, 1.15-1.44; P.001), with an optimism-adjusted area under the receiver operating characteristic curve of 0.85. Neither model showed signs of a poor fit. Categorization as high-risk by either model was associated with a shorter diagnosis to intensive care unit admission interval (log-rank test P.001, both), higher maternal death (5.2% vs 0.2%; P.001), and preeclampsia (5.7% vs 1.0%; P.001). A spreadsheet calculator is available for risk estimation.At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high- and low-risk for progression to critical disease, even where resources are limited. This can support the nature and place of care. These models also highlight the independent risk for severe disease associated with obesity and should further emphasize that even in the absence of other comorbidities, vaccination is particularly important for these women. Finally, the model also provides useful information for policy makers when prioritizing national vaccination programs to quickly protect those at the highest risk of critical and fatal COVID-19.

Objective: The aim of this study was to evaluate the value of quantitative spectral Doppler ultrasound (DUS) flow measurements in ovarian tumors in postmenopausal women. Material and Method: This prospective study included 23 postmenopausal women with preoperative diagnosis of ovarian tumor. Patients were examined with transvaginal DUS 2 to 4 days before surgery. The resistive index (RI) and pulsatility index (PI) of the mass were evaluated by transvaginal DUS examination. Results: The histopathologic examination of the surgical specimens revealed 8 malignant, 13 benign and 1 borderline tumor. The mean RI and PI for malignant tumors were 0.37 (range 0.35-0.45) and 0.61 (range 0.43-0.85), respectively. The mean RI and PI for benign tumors were 0.61 (range 0.30-0.91) and 1.21 (range 0.36-3.02), respectively. The Mann-Whitney U test revealed a statistically significant (p

Background Heterotopic pregnancy is a condition in which intra- and extrauterine pregnancies occur at the same time. Spontaneous heterotopic pregnancy is a rare event, with incidences ranging from 1 in 30,000 pregnancies to as high as 1 in 6 pregnancies assisted by reproductive technology. Case Report A 34-year-old woman presented with a 10-week history of amenorrhea, pelvic pain, and generally feeling unwell. Ultrasonography revealed a 10-week intrauterine viable pregnancy and free fluid in the abdominal cavity. Emergency laparotomy was performed and a ruptured tubal ectopic pregnancy was encountered on the right tube with hemoperitoneum. Salpingectomy was performed. Her intrauterine pregnancy was intact with positive fetal cardiac activity when she was discharged. Why Should an Emergency Physician Be Aware of This? Heterotopic pregnancy should be kept in the differential diagnosis of any patient with an intrauterine pregnancy presenting with abdominal pain, abdominal tenderness, or free fluid in the abdominal cavity.

The aim of the present study was to assess the safety of myomectomy for intramural fibroids during caesarean section. A retrospective study of 63 women who underwent myomectomy during caesarean section and 63 women who underwent caesarean delivery without myomectomy was conducted. The study group was divided into subgroups according to the volume of fibroids and total incision count. The volume of fibroids, the preoperative and postoperative haemoglobin values and the difference between them, incidence of haemorrhage and blood transfusion, duration of operation and postoperative fever of patients were investigated. Duration of operation was longer (p .001) and haemoglobin loss was higher (p = .01) in the myomectomy group. There was no difference between one incision and two incisions subgroups in terms of mean haemoglobin change (p = .068). Haemoglobin loss was higher in volume50 cm