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Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Uludag University Medical Faculty / Uludağ Üniversitesi Tıp Fakültesi Dergisi is the property of Journal of Uludag University Medical Faculty and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The main objective of this study is to assess the relationship between the level of Health Literacy and the patient's decision to refuse the Gestational diabetes mellitus screening test. Methods: This cross-sectional study was conducted at a high-volume public hospital from March 2020 to September 2020 with women between 24-28 weeks of gestation. Demographic characteristics and gestational diabetes mellitus screening status were recorded for each woman. The European Health Literacy Survey Questionnaire was used to assess health literacy. Results: A total of 364 women were included in the study. Two hundred and three (55.7%) women accepted the gestational diabetes mellitus screening test, and 44.2% did not. Health care, disease prevention, health promotion subscales, and the general scale scores were higher in the gestational diabetes mellitus screening group (P=0.001, P=0.024, P=0.01, and P=0.003, respectively). It was determined that a 1-point increase in the health care score decreased the probability of rejecting the gestational diabetes mellitus screening by 1.03 times (P=0.003). Conclusions: Lower health literacy levels were associated with higher rates of gestational diabetes mellitus screening test rejection. [ABSTRACT FROM AUTHOR]

Objective: Initially, medical treatment options are preferred in patients with abnormal uterine bleeding (AUB) who are hemodynamically stable. The aim of the present study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in reducing bleeding symptoms in patients with AUB stratified by underlying pathology. Material and Methods: In line with the polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia), coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified classification system, patients who were administered LNG-IUD due to adenomyosis, endometrial hyperplasia, leiomyoma and AUB due to not otherwise classified causes were included in the study. Results: A total of 172 otherwise patients with a mean age of 42.58±5.00 years were included. The distributions in the adenomyosis, endometrial hyperplasia, leiomyoma and otherwise unclassified groups were 30.8%, 12.8%, 26.2%, and 30.2%, respectively. Overall effectiveness of LNG-IUD in reducing menstrual bleeding was 82%. The proportion whose bleeding decreased was 95.50% in the endometrial hyperplasia group, 88.70% in the adenomyosis group, 55.60% in the leiomyoma group and 92.30% in the not otherwise classified group. The power of the current study was 99%. The efficacy of LNG-IUD was significantly less in the leiomyoma group (p<0.05) and thus this group were more likely to require surgical intervention. The overall incidence of spotting was 50%. Amenorrhea developed in 14% of patients. Conclusion: While LNG-IUD was more effective in reducing symptoms of AUB in patients with adenomyosis, endometrial hyperplasia and not otherwise classified causes, LNG-IUD was less effective in cases of leiomyoma. [ABSTRACT FROM AUTHOR]

The aim of this study was to demonstrate the poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in unvaccinated pregnant women. In this retrospective study, the clinical and laboratory parameters of 26 pregnant or immediately postpartum patients, who were hospitalised and needed intensive care unit (ICU) follow-up due to coronavirus disease 2019 (COVID-19) infection were reported. All pregnant patients who followed up in the ICU were unvaccinated. The mortality rate was calculated as 34.62% in the patients included in the study who were admitted to the ICU. Among patients hospitalised in the ICU, the maternal mortality and stillbirth rates associated with COVID-19 infection were found to be 156.28/100,000 and 11.54%, respectively. Preterm birth occurred in 58.33% of the patients who delivered. 79.17% of the patients were delivered by caesarean section. Lymphopenia, high ferritin, interleukin-6, lactate dehydrogenase, D-dimer and C-reactive protein values were found to be associated with mortality. The course of pregnant patients with COVID-19 infection is not always predictable. Clinical and laboratory data should be evaluated in combination for disease prognosis. Adequate information should be given about the importance of vaccination. What is already known on this subject? The SARS-CoV-2 infection has caused a public health crisis worldwide. As a result of studies on coronavirus disease 2019 (COVID-19) infected pregnant women, it was observed that there was an increase in maternal and perinatal mortality. There has been an increase in intensive care unit (ICU) admissions, especially after patients infected with the Delta variant. The pandemic continues with an unpredictable course of the new variants. What do the results of this study add? Compared to the pre-pandemic period, COVID-19 infection caused a more than 10-fold increase in maternal mortality, particularly after the Delta variant. In intensive care follow-up, low lymphocyte count, high lactate dehydrogenase, D-dimer, C-reactive protein, ferritin and interleukin-6 values are indicators of poor prognosis. What are the implications of these findings for clinical practice and/or further research? COVID-19 infection causes increased maternal mortality. Considering that all of the patients admitted to the ICU in our study were unvaccinated, pregnant women should be encouraged to get vaccinated. [ABSTRACT FROM AUTHOR]

Aim: We aimed to evaluate the endometrial sampling results and to determine the frequency of non diagnostic endometrial sampling in the postmenopausal patient population. Materials and Method: In this retrospective study, endometrial biopsy results obtained from 825 postmenopausal women who applied to Bursa City Hospital's Obstetrics and Gynecology Department between July 2019 and March 2021 were evaluated. Results: 922 endometrial sampling results from 825 postmenopausal patients were evaluated. The mean age of the patients was 56.96±7.21 and the mean menopause time was 7.43±7.14 years. When the histopathological evaluation of the first endometrial sampling taken from the patients was performed, 25.45% of the patients had insufficient endometrial sampling, while this rate was 21.61% in the group of patients who presented with the complaint of postmenopausal bleeding. The most common endometrial pathology was endometrial polyp (22.1%), and the incidence of malignancy in our study group was 6.67%. In subgroup analyzes, the incidence of malignancy was higher (18.80%) in the age group >60 years, and it was also determined that insufficient endometrial sampling increased with age. Re-biopsy was obtained from only 20% of the patients whose first endometrial sampling result was insufficient. Endometrial cancer was detected in 3 of these patients and the presence of a typical endometrial hyperplasia in 1 patient. Conclusion: It has been observed that in addition to the increase in the incidence of endometrial cancer with advancing age, the frequency of insufficient endometrial sampling also increases. Considering the risk factors for endometrial cancer, these patients should be encouraged to continue their follow-up. [ABSTRACT FROM AUTHOR]

Objective: Based on the fact that Coronavirus Disease 2019 (COVID-19) is associated with many hemocytometric changes, we aimed to investigate the effect of this underlying inflammatory process on the frequency of early pregnancy loss (EPL) in this clinical trial. Methods: This is a retrospective cohort study. The patients with laboratory-confirmed COVID-19 infection before the 20 weeks of gestation were determined as the study group. Healthy pregnant women in their early pregnancy were determined as the control group. Hematological parameters of all patients included in the analysis were evaluated. Results: A total of 176 pregnant women with confirmed COVID-19 infections were evaluated, of which 117 were included in the analysis. One hundred and seventeen healthy pregnant women were determined as the control group. There was no difference between the groups according to demographic characteristics. The median white blood cell (WBC) and lymphocyte levels were lower in patients with COVID-19 infection (p<0.001 and p<0.001, respectively). The value of platelet/lymphocyte ratio (PLR) was higher in the group with COVID-19 infection (160.95 vs. 132.42, p<0.001). It was also determined that the median plateletcrit level was lower in the group with COVID-19 infection (p<0.001). The rate of EPL in the COVID-19 infection group and control group was 14.2% and 9.4%, respectively (p=0.220). Conclusion: COVID-19 infection presents with low lymphocyte count and plateletcrit values in pregnant women, and an increase in PLR rates in relation to the severity of the disease is observed. Although not statistically significant, COVID-19 infection was associated with increased EPL rates in our study. [ABSTRACT FROM AUTHOR]

Objectives: Endometrial hyperplasia is a pathology that often represents with abnormal uterine bleeding and develops under the influence of unopposed estrogen. In this study, the response to cyclic medroxyprogesterone acetate (MPA) treatment in endometrial hyperplasia without atypia, which is known to have a good response to progestagen agents, was retrospectively evaluated. Methods: Control endometrial biopsy results of 111 patients who were initiated cyclic MPA treatment due to endometrial biopsy results of endometrial hyperplasia without atypia were evaluated after 3 months of treatment. Endometrial hyperplasia free biopsy results after treatment were accepted as a successful treatment in those patient. Results: Control biopsies revealed proliferative endometrium in 37 (33.3%) patients, secretory endometrium in 34 (30.6%) patients, inactive endometrium in 9 (8.1%) patients, endometritis in 4 (3.6%) patients, endometrial hyperplasia without atypia in 26 (23,4%) patients, and endometrial hyperplasia with atypia in 1 (0.9%) patient. Our response rate to treatment was 75.7% (84/111) and the persistence was found to be 23.4% (26/111). In patients with a positive response to treatment (n = 84), the mean age was 45.15 ± 5.19 years and in patients with no response to treatment (n = 27) the mean age was 45.56 ± 6.41 years, and there was no difference between the two groups in terms of average age. Conclusions: Although the use of cyclic MPA in the treatment of endometrial hyperplasia without atypia is an effective treatment method, we believe that better results will be achieved in the use of more than 3 months duration [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare Ki-67 expression in endometrial polyps that present with different abnormal uterine bleeding patterns.Study Design: A total of 120 women diagnosed with endometrial polyps were included in the study. In this prospective study, tissue samples taken by hysteroscopic polypectomy method between September 2019 and September 2020 at Bursa City Hospital were examined. The main study groups were determined as premenopausal and postmenopausal patients. The patients' complaints at first admission to the hospital, demographic, histopathological and immunohistochemical features were recorded.Results: Ki-67 glandular and stromal expressions were higher in the premenopausal patient group (p = 0.016 and p = 0.005 respectively). Median Ki-67 gland and stroma measurements; was higher in patients with heavy menstrual bleeding (HMB) than in patients with intermenstrual bleeding (IMB), patients with postmenopausal bleeding (PMB), and patients who were asymptomatic [(p = 0.012, p = 0.011 and p = 0.009 respectively); (p < 0.001, p < 0.001 and p = 0.004 respectively)]. The median Ki-67 stroma measurement was found to be higher in the patient group whose complaint persisted after polypectomy (p = 0.034). In the estimation of response to treatment, the cut-off value for Ki-67 stromal expression was determined as ≤ 6%.Conclusion: High Ki-67 expression in endometrial polyps is associated with HMB and may predict the continuation of abnormal uterine bleeding after polypectomy. [ABSTRACT FROM AUTHOR]

Physiological changes in hormone levels occur in thyroid gland during pregnancy. Screening of the thyroid hormone levels and determining trimester-specific reference intervals in pregnancy are important. Guidelines recommend the use of trimester-specific reference ranges for each country. The aim of this study is to determine trimester-specific thyroid function reference intervals for pregnancy in Turkish population. In total, 5000 patients were screened out of which 1258 patients have all of fT3, fT4 and TSH levels measured, were included in the study. Patients were grouped as follows: 482 women were in first trimester, 361 women were in second trimester, and 415 women were in third trimester. All analyses were performed by means of chemiluminescence methods (Liaison®; DiaSorin S.p.A., Saluggia, Italy). The TSH reference intervals were 0.005–3.65, 0.01–3.63, and 0.2–3.46 mIU/L at the first, the second, and the third trimesters of pregnancy, respectively. The fT4 reference intervals were 0.72–1.79, 0.71–1.26, and 0.65–1.12 ng/dL at the first, the second, and the third trimesters, respectively. The fT3 reference intervals were 2.45–4.03, 2.37–3.85, and 2.31–3.77 ng/dL at the first, the second, and the third trimesters, respectively. It is crucial to determine population- and gestational-specific reference intervals for trustworthy treatment of pregnants. [ABSTRACT FROM AUTHOR]

Background/Aims: Gestational Diabetes Mellitus (GDM) is a prevalent medical concern among pregnant women. The study aimed to explore maternal characteristics that could lead to an isolated increase in the 50 g Glucose Challenge Test (GCT) levels and to assess the impact of elevated 50 g GCT levels on fetal and neonatal outcomes. Methods: This retrospective trial included 177 pregnant women and 177 infants. All pregnant women who applied to the antenatal clinic and screened for GDM were included in the study. Patients were divided into two groups: patients with abnormal GCT (50 g levels) but normal 100 g-OGTT results (study group) and those with normal 50 g results (control group). Results: The advanced maternal age (AMA) rate (14.80% vs. 4.80%, p=0.028) and maternal weight measurements at the first pregnancy visit were higher in the study group. The rate of overweighted patients (more than 80 kg at the first pregnancy visit) was higher in the study group (35.20% vs. 5.80%, p<0.001). The rate of fetal macrosomia was higher in the study group (10.20% vs. 0, p<0.05). It was determined that the neonate's head circumference (HC) was larger in the study group (35.15 cm vs. 34.69 cm, p=0.029). Emergent (primary) cesarean section (C/S) rate with cephalopelvic disproportion (CPD) indication was higher in the fetal macrosomia group (p<0.05). The power of the current study was determined as 87% Conclusions: According to the study result, the patients with isolated elevation of the 50 g Glucose Challenge Test are at risk of fetal macrosomia, which increases the risk of C/S. In overweight patients over 35 years old, 75 g OGTT may be more sensitive in detecting glucose metabolism disorders. [ABSTRACT FROM AUTHOR]

The incidence of premalignant and malignant endometrial disorders increases during the postmenopausal period. In the literature, endometrial disorders are usually discussed in the context of menopausal status. But there are limited data regarding endometrial disorders in geriatric patients. Early diagnosis of endometrial cancers with aggressive behaviour that increases during the geriatric period may allow simpler treatment options and also decrease the treatment-associated morbidity risk. Records of geriatric patients who underwent an endometrial histopathological evaluation between 2011 and 2016 were evaluated. Clinical findings, transvaginal ultrasonography findings, endometrial sampling methods, and histopathological results were evaluated. A total of 188 patients were included in the study (mean age 70.3 ±5.6 years). The most common histopathological results were endometrial polyp, atrophic endometrium, and surface epithelium (26.6%, 22.3%, and 12.8%, respectively). None of the 57 patients without vaginal bleeding had endometrial cancer. In 131 patients with vaginal bleeding, mean endometrial thickness was 9.8 ±8.1 mm (2-49 mm) and the rate of endometrial disorders was 56.5% (74 patients). Endometrial cancer was diagnosed in 19 patients (10.1%), and 36.8% of them had non-endometrioid cancers. The presence of vaginal bleeding was significantly associated with the diagnosis of endometrial cancer and any endometrial disorder (p = 0.001 and p = 0.000, respectively). The incidence of non-endometrioid endometrial cancers increased in the geriatric period. An endometrial histopathological examination should be considered, especially for patients with a history of vaginal bleeding. Further investigation of the endometrial thickness cut-off levels in the geriatric period will contribute to the literature. [ABSTRACT FROM AUTHOR]

We aimed to re-evaluate the 'two-step' antenatal glucose screening programme in relation to maternal and foetal outcomes in pregnant women screened for gestational diabetes mellitus and to compare maternal and foetal outcomes between different groups divided according to glucose tolerance test results. Two-thousand four-hundred and two pregnant women attending for antenatal care were recruited retrospectively for the study. Mean birthweight for pregnancies with single-value abnormality (SVA) in 100-g oral glucose tolerance test (OGTT) was significantly higher than the control group [3420 ± 378 vs. 3294 ± 444]. We found a significantly higher rate of macrosomia in the subgroup of 50-g glucose challenge test (GCT) between 130 and 140 mg/dl [9.7% vs. 4.8%]. Pregnant women whose 50-g GCT results are between 130 and 140 mg/dl or who have SVA in 100-g OGTT not only have gestational diabetes, but are also at increased risk for diabetic complications. [ABSTRACT FROM AUTHOR]

Endometriosis of the uterine cervix is a rare lesion that is generally asymptomatic in gynaecological practice. We present a case with postcoital bleeding due to a cervical mass mimicking cervical polyp or fibroma which was histologically proven as cervical endometriosis later. Cervical endometriosis should be considered in the differential diagnosis of cervical masses with postcoital bleeding. [ABSTRACT FROM AUTHOR]

Objective: This study explored the relationship between reduced ovarian reserve and the psychological state of infertile women., Materials and Methods: This cross-sectional, single-center study was conducted with 106 infertile women. The Beck Depression Inventory (BDI) was used to assess patients' propensity for depression. The data relating to infertility, such as causes of infertility, type of infertility (primary or secondary), duration of infertility, and treatment status [previous assisted reproductive technologies (ART) treatment and ART treatment failure] were recorded for each patient. The ovarian reserve was determined using laboratory tests [anti-Mullerian hormone (AMH); follicle-stimulating hormone (FSH)] and transvaginal ultrasonography to measure the antral follicle count (AFC) in each ovary., Results: There was no significant relationship between the total score obtained from the Beck depression scale and AFC, AMH, thyroid-stimulating hormone, FSH, estradiol, and prolactin measurements (p>0.05). There was no significant difference between the groups regarding depression levels based on the cause of infertility (p=0.412). Additionally, the type of infertility (primary, secondary) did not differ between the groups (p=0.586). There were no differences on the BDI scale regarding the level of depression between patients who underwent in vitro fertilization (IVF) treatment (history of previous IVF treatment failure) and those who did not., Conclusion: There was no significant association between AFC and AMH levels and the depression state of infertile patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright© 2024 The Author. Published by Galenos Publishing House on behalf of Turkish Society of Obstetrics and Gynecology.)

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Objective: To determine the effects of fibroids on pregnancy and neonatal parameters., Study Design: A total of 12,855 consecutive pregnant women admitted to a tertiary care university hospital between January 2002 and December 2009 were retrospectively reviewed. Of those, 267 patients with fibroids and 267 age- and parity-matched controls were included. The Clavien-Dindo classification was used to grade postoperative complications., Results: Mean gestational age at delivery (p<0.001) and mean neonatal birthweight (p=0.034) were significantly different between the 2 groups. We recorded a higher rate of pain-related hospitalization in the large fibroid group (38.2% and 7.8%, p <0.001). Myomectomy was performed in 124 of 267 patients during cesarean section (C/S). The myomectomy group was associated with lower postoperative hemoglobin levels (p=0.01) and higher need for transfusion (p=0.009). When postpartum hemoglobin levels of the control group and fibroid group without myomectomy were compared, hemoglobin levels were higher in favor of the control group (p = 0.009)., Conclusion: Beyond lower gestational age and mean birthweight, perinatal complications did not increase with fibroids during pregnancy. Performing myomectomy increases the need for transfusion (Grade 2) without an increase in the risk of hysterectomy (Grade 3) and other life-threatening complications (Grade 4-5). Leaving fibroids in situ during C/S did not prevent a fall in post-partum hemoglobin levels.