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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.

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9

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.

Purpose: To evaluate the clinicopathological characteristics and surgical outcomes in patients with pure ovarian immature teratomas (POITs). Materials and Methods: In this multicenter study, a retrospective review was made of the databases of six Gynecology Oncology Departments in Turkey to identify patients with POITs who had undergone surgery between 1993 and 2019. Results: Evaluation was made of 48 patients with a median age at diagnosis of 22.5 years (range, 15-37 years). In 40 (83%) patients, stage I was determined and in eight patients, an advanced stage (IIIB, IIIC, and IVB) was determined. Tumors were found to be grade I in 17 (35.4%) cases, grade II in 12 (25%), and grade III in 19 (39.6%). Fertility-sparing surgery was applied to 42 (87.5%) patients and radical surgery to 6 (12.5%). The median follow-up was 60 months (range, 3-246 months). Recurrence was seen in seven patients, all with grade III tumors. In the final pathological examination of recurrent tumors, mature teratoma was reported in five patients, and immature teratoma in one patient. Salvage surgery was not performed in one patient as the tumor was unresectable and so a regimen of bleomycin, etoposide, and cisplatin (BEP) was administered. Conclusion: POITs are rare tumors seen at a young age, and benign or malignant relapse can be seen in these tumors. In this cohort, the malignant recurrence rate was 4.1%, and the benign recurrence rate was 10.4%. All the recurrences were in grade III tumors. Benign recurrences can be treated with surgery alone and the malignant group should be treated with surgery followed by chemotherapy.

The aim of this study is to investigate the TyG index and TG/HDL-C ratio and their relationships with insulin resistance in LGA infants.A prospective controlled study was conducted including 65 LGA and gestational age, gender-matched appropriate for gestational age (AGA) neonates. Serum TG, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), insulin and glucose levels were measured within two hours after birth, TyG index and HOMA-IR values were calculated.TyG index and TG/HDL- C ratio were higher in LGA neonates compared to AGA ones (p = 0.03; p = 0.00, respectively). Compared with AGA newborns, LGA newborns had higher levels of insulin and HOMA-IR (p = 0.00; p = 0.00, respectively). TyG index and TG/HDL-C ratio showed moderate correlation with HOMA-IR (r = 0.59 R

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.

AIM We aimed to compare weekly methotrexate (MTX) regimen and methotrexate-folinic acid (MTX-FA) 8-day regimen in the first line treatment of low-risk gestational trophoblastic neoplasia (GTN). METHODS The study included 73 patients with low-risk GTN according to FIGO risk score (FIGO risk score

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

To evaluate the predictive value of the first-trimester aspartate aminotransferase (AST)/platelet count ratio [AST to platelet ratio index (APRI) score] for intrahepatic cholestasis in pregnancy (ICP).This study consisted of a patient group diagnosed with ICP (n = 37) and a control group (n = 66) who presented to the hospital perinatology clinic between 2018 and 2020. Laboratory tests of both groups were analysed retrospectively. Age, gravida, parity, body mass index, third-trimester laboratory tests and first-trimester APRI scores were compared between the two groups. A receiver operating characteristic (ROC) analysis of the study was performed to determine the cut-off value for APRI score that is predictive of ICP.Patients with ICP had significantly higher first-trimester APRI scores compared with controls (p0.001). In the ROC analysis, the cut-off value for APRI score was 0.57, with 86.5 % sensitivity and 77.3 % specificity. Spearman's correlation indicated that there was a significant positive association between first-trimester APRI score and third-trimester fasting bile acid level (r = 0.641, p0.001). The demographic characteristics of patients in the third trimester did not differ, except for AST and alanine transferase values.The APRI score calculated in the first trimester of pregnancy seems to be predictive of the development of ICP in the third trimester.

This study was conducted to examine the levels of vitamin D in postterm pregnancy. The study consisted of two groups: Group 1: women with postterm pregnancy in whom labour has not started (n = 40). Group 2: pregnant women with spontaneous labour between 37 and 41 weeks of gestation (n = 40). Demographic characteristics of individuals, age, body mass index, gravida, parity, living child, number of abortions and birth characteristics were recorded. Prepartum and postpartum haemoglobin (Hb) and haematocrit (Hct) values and vitamin D levels of pregnant women were measured. We found no significant differences in vitamin D levels, smoking, mode of delivery, induction of labour, methods of cervical ripening and maternal and perinatal complications between the groups (p > .05). D vitamin in the model had a statistically significant effect on prepartum Hb (p < .05). Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb.IMPACT STATEMENT What is already known on this subject? The aetiology of post term pregnancy is not clearly known, factors such as foetal anencephaly, foetal sex, placental sulfatase deficiency, genetic factors, and high pre-pregnancy body mass index play a role. What do the results of this study add? Vitamin D levels seem not to be associated with postterm pregnancy. Vitamin D had a statistically significant effect on prepartum Hb. What are the implications of these findings for clinical practice and/or further research? Further studies are needed to clarify the relationship between vitamin D levels and postterm pregnancy.

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.

Objective: To study the value of fetal epicardial fat thickness (EFT) in gestational diabetes mellitus in the third trimester of pregnancy and its relationship with clinical parameters and perinatal outcomes. Methods: A total of 80 participants, including 40 with diagnosed GDM and 40 healthy pregnant women, were included in the study. Demographic data were obtained from medical records. Sonographic examinations were performed, such as amniotic fluid value, fetal biometric measurements, and Doppler parameters of the umbilical artery. Fetal EFT values were measured at the free wall of the right ventricle using a reference line with echocardiographic methods. Correlation tests were performed to evaluate the relationship between fetal EFT and clinical and perinatal parameters. P < 0.05 were interpreted as statistically significant. Results: The fetal EFT value was statistically higher in the GDM group than in the control group (p:0.000). Spearman correlation tests revealed statistically significant but weak positive correlations between fetal EFT value, 1-hour 100-gr OGTT, birth weight, and BMI (r: 0.198, p:0.047; r:0.395, p:0.012; r:0.360, p:0.042, respectively). The optimal fetal EFT threshold for predicting GDM disease was found as 1.55 mm, with a specificity of 74.4% and sensitivity of 75.0%. Statistically significant differences between the two groups in umbilical artery Doppler resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) were not found (p:0.337; p:0.503; p:0.155;). BMI and amniotic fluid volume were higher in the GDM group compared to the control group (p:0.009; p:0.000). Conclusion: This study demonstrated that increased fetal EFT may occur as a reflection of changes in glucose metabolism in intrauterine life. Future studies with larger series, including the study of neonatal metabolic parameters, will contribute to the understanding of the importance of fetal EFT in determining the metabolic status of the fetus.

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]

Endometrial polyps are one of the common reasons of abnormal uterine bleeding in women. Industrialisation, urbanisation and increased air pollution cause increased heavy metal exposure. Heavy metals that have oestrogenic effects in human body are named as metalloestrogens. The aim of this study was to investigate the serum metalloestrogen levels such as copper (Cu), zinc (Zn), aluminium (Al), lead (Pb), nickel (Ni) and Cu/Zn ratio and their possible relationship with the occurrence of endometrial polyps. Eighty women with abnormal uterine bleeding were divided into two groups: 40 women diagnosed with endometrial polyp (study group) and 40 women without endometrial polyp (control group). Ages, body mass indices, smoking behaviours, drinking water choices, chronic diseases and intrauterine device histories were noted for all patients. Blood levels of Cu, Zn, Al, Pb, Ni and Cu/Zn ratio were analysed by inductively coupled plasma-mass spectrometry method for both groups. No statistically significant differences were observed in terms of serum median levels of Cu and Pb between the study and the control groups. The serum median levels of Zn, Ni and Al were found to be statistically lower in the study group when compared with the control group. The Cu/Zn ratio was statistically higher in the study group. High Cu/Zn ratio, as a biomarker of oxidative stress, suggests the role of oxidative stress in etiopathogenesis of endometrial polyps.IMPACT STATEMENTWhat is already known on this subject? Studies demonstrate that oestrogen and progesterone play an important role in pathogenesis of endometrial polyps. Inorganic heavy metal ions that bind and activate oestrogen receptors are referred to as 'metalloestrogens'. Apart from toxic effects, metalloestrogens have been linked to the aetiology of oestrogen-dependent diseases such as breast and endometrium cancer and endometriosis. However, serum levels of heavy metals were not investigated in a large group of endometrial polyp patients.What do the results of this study add? This is the first study investigating the serum levels of heavy metals in a large group of endometrial polyp patients. We did not observe any increased serum levels of heavy metals in endometrial polyp patients. Our results might suggest that oestrogenic heavy metal exposure has no role in the appearance of endometrial polyps. However, increased Cu/Zn ratio due to low serum levels zinc suggests oxidative stress might play a role in endometrial polyps.What are the implications of these findings for clinical practice and/or further research? Further research of heavy metals in endometrial polyps with simultaneous blood and tissue samples could show the precise effect of environmental exposure of metalloestrogens in aetiopathogenesis of endometrial polyps.

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.