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Aim: We aimed to prospectively investigate the effect of first trimester vaginal bleeding on first trimester screening test, uterine artery (UtA) Doppler results and perinatal outcomes. Material and Methods: Fifty cases that presented with vaginal bleeding in the first trimester between 2019 and 2020 constituted the early vaginal bleeding (abortus imminens-threatened abortion) group and fifty cases without a history of vaginal bleeding in pregnancy constituted the control group. Demographic datas were noted at the first visit. Both groups were followed up until birth. First trimester screening test (double screening test) between 11-14 weeks and UtA Doppler examination between 20-24 weeks of gestation was performed. Perinatal outcomes and values of nuchal translucency (NT), free β human chorionic gonadotropin (f β-hCG), pregnancy-associated plasma protein A (PAPP-A), and UtA Doppler were compared between the two groups. Results: There was no statistically significant difference was found between the two groups in terms of NT and PAPP-A among the first trimester screening test results (p=0.741 and p=0.937, respectively). In the group with threatened miscarriage, f β-hCG value was numerically higher, but there was no statistically significant difference (1.24±0.59 vs. 1.1±0.93, p=0.057). In the Doppler examination of the UtA, there was no statistically significant difference between the groups in terms of systolic/diastolic ratio, pulsatility index, resistive index and the presence of a notch (p=0.713, p=0.528, p=424, p=0.538, respectively). Perinatal complication rate was statistically significantly higher in the study group (p=0.013; Odds Ratio:3.2, 95% CI 1.2-8.3). Conclusion: Contrary to some different studies, we believe that first trimester screening test parameters or uterine artery Doppler flow indices do not have a place in predicting perinatal outcomes of pregnant women with a history of vaginal bleeding in the first trimester. In addition, early vaginal bleeding does not significantly affect screening parameters. Perinatal complication rate was found to be statistically significantly higher in the group with a history of threatened miscarriage.

This study aims to evaluate cardiac function in cases of intrahepatic cholestasis of pregnancy (ICP) and compare results with those from healthy controls using the fetal left ventricular modified myocardial performance index (LMPI) and E-wave/Awave peak velocities (E/A ratio). Moreover, the association between LMPI values, total bile acid (TBA) levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. A prospective cross-sectional study of 120 pregnant women was conducted, with 60 having ICP and the other 60 serving as controls. Doppler ultrasound and two-dimensional gray-scale fetal echocardiography were used to calculate the LMPI values and E/A ratios, respectively. The association between LMPI values and TBA levels, fetal Doppler measurements, and adverse neonatal outcomes was evaluated. Fetal LMPI values were significantly higher in the ICP group than in the control group (0.54 +/- 0.54 vs. 0.44 +/- 0.03; p < 0.001), but the E/A ratio was similar in both groups (0.69 +/- 0.10 vs. 0.66 +/- 0.14; p = 0.203). TBA levels were positively and significantly correlated with LMPI values (r = 0.546, p < 0.01); however, no significant correlation was found between umbilical arterial pulsatility index values and LMPI values (r= 0.071, p > 0.01). LMPI values were not associated with adverse neonatal outcomes in ICP cases. Fetal cardiac function (LMPI) is associated with increased bile acid levels in ICP. However, because it was not associated with adverse neonatal outcomes in ICP cases, the clinical significance of this finding is unclear. Further studies are required to evaluate the implications of increased LMPI.

OBJECTIVES: In this study, we aimed to determine the risk factors in predicting the need for surgical treatment due to medical treatment failure in patients with tubo-ovarian abscess. STUDY DESIGN: This is a retrospective cohort study performed in a university hospital between 2015 and 2020. Sixty-nine patients with tubo-ovarian abscess were treated with parenteral antibiotics. Some of them required surgery because antibiotic treatment was not successful. We compared the group in which parenteral antibiotic treatment was successful with the group that required surgical treatment. The conservative treatment group consisted of 43 (62.3%) patients who responded to antibiotic therapy alone (gentamicin-clindamycin), and the operation group consisted of 26 women (37.7%) who did not reply to antibiotic therapy and required operation. Demographic, clinical, sonographic, and laboratory results were compared between the two groups using univariate and logistic regression analyses. RESULTS: Overall, up to 37.7% (26/69) of the patients underwent surgery after failure of antibiotic therapy. Patients who failed antibiotic therapy had higher infection parameters such as C-reactive protein (205±109 mg/dL vs. 115 ± 90 mg/dL, p=0.002), platelet count (349 ± 108 x 103/mm3 vs. 298 ± 95 x 103/mm3, p=0.042), and neutrophil-to-lymphocyte ratio (18.8 ± 35.7 vs. 8.2 ± 6.9, p=0.022). Also in the same group, larger tubo-ovarian abscess size (61.6±16.6 mm vs 45.8 ± 10.3 mm, p

Objectives To evaluate the maternal and neonatal outcomes of expected and unexpected pathologically proven placenta accreta spectrum (PAS) cases in a single multidisciplinary center. Material and Methods This was a retrospective cohort study of 92 PAS cases from January 2011 until September 2021. Only cases with histopathologically invasive placentation were included in the study. The cases diagnosed at the time of delivery were defined as unexpected PAS (uPAS) and those diagnosed antenatally as expected PAS (ePAS). Maternal and neonatal outcomes of both groups were compared. Results Thirty-five (38%) of 92 cases were in the uPAS group. Placenta previa and high-grade PAS (percreata) were significantly higher in the ePAS group (p=0.028, p Conclusions Our single center data show that although ePAS cases include more highly invasive PAS cases, maternal hemorrhagic morbidity is lower than uPAS cases. Reducing maternal morbidity in PAS cases can be achieved by increasing antenatal diagnosis.

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.

Objective: To evaluate the changes of fetal epicardial fat thickness (EFT) in pregnancies with pregestational (PGDM) and gestational diabetes mellitus (GDM) and to identify the diagnostic effectiveness of fetal EFT in differentiating PGDM and GDM from normal pregnancies. Methods: The study was conducted with pregnant women who admitted to perinatology department between November 2020 and September 2022. Patients were analyzed as 3 groups: PGDM (n=161), GDM (n=171) and control group (n=170). EFT was measured in all three groups at 29 weeks of gestation. Demographic characteristics and ultrasonographic findings were recorded and compared. Results: The mean fetal EFT was significantly higher in PGDM (1.47±0.083 mm, pConclusions: Fetal EFT is greater in pregnancies with diabetes than in normal pregnancies, and also greater in PGDM than in GDM. In addition, fetal EFT is strongly correlated with maternal blood glucose levels in diabetic pregnancies.

La pandemia de COVID-19 se asocia con resultados mentales negativos en el período posparto temprano. Objetivo. Evaluar la salud mental posparto a largo plazo de las mujeres infectadas con COVID-19 durante el embarazo. Métodos. Estudio transversal en 101 gestantes que dieron a luz en un centro terciario durante la pandemia de COVID-19, entre el 31 de marzo de 2020 y el 30 de noviembre de 2021. Se clasificó a las gestantes en 2 grupos como COVID-19 positivo (grupo de estudio, n=52) y COVID-19 negativo (grupo control, n=49). Se recogieron datos sociodemográficos y obstétricos mediante un cuestionario en los períodos posparto temprano (≤6 meses) y tardío (6 a 18 meses). Se calculó la puntuación del Inventario de Depresión de Beck (IDB) y del Inventario de Ansiedad de Beck (IAB) mediante el análisis de los datos de las participantes. Resultados. La puntuación media del IDB y la tasa de depresión (puntuación del IDB >13) en las pacientes con COVID-19 positivo fueron mayores en el período posparto temprano que en el tardío. Según el análisis de regresión lineal multivariante, existió una correlación significativa entre la puntuación IDB de las pacientes con COVID-19 y el nivel educativo y la situación laboral. Según el mismo análisis, existió una correlación significativa entre la puntuación del IAB de los pacientes con COVID-19 y el apoyo del cónyuge, la relación marital y las enfermedades relacionadas con el nacimiento. Se encontró que las pacientes con COVID-19 positivo y COVID-19 negativo tenían puntuaciones IDB e IAB similares en los periodos postparto temprano (≤6 meses) y tardío (6-18 meses). Además, las tasas de ansiedad y depresión fueron similares en ambos grupos en los mismos períodos posparto. Conclusión. En nuestro estudio, la infección por COVID-19 en el embarazo no tuvo un impacto adicional significativo en la salud mental materna en el posparto a largo plazo.

RESUMEN La colestasis intrahepática del embarazo (CIE) conduce a resultados perinatales adversos y estos resultados se ven afectados por los niveles elevados de ácido biliar total (ABT). Los estudios han demostrado que las hormonas tiroideas regulan el metabolismo de los ácidos biliares. Sin embargo, pocos estudios han evaluado el papel de las hormonas tiroideas en la CIE. Objetivo: Evaluar la función tiroidea junto con los niveles de ABT en la CIE. Métodos. En este estudio retrospectivo, se evaluaron 252 mujeres embarazadas, incluyendo 126 CIE y 126 controles. Se determinaron los niveles de ABT, hormona estimulante de la tiroides (TSH) y tiroxina libre (fT4) del tercer trimestre de todas las embarazadas. Se examinó la correlación entre los niveles de ABT, fT4 y TSH. Además, se estudiaron los resultados perinatales de ambos grupos. Resultados. Los niveles de fT4 fueron significativamente mayores en la CIE. También hubo una correlación positiva entre los niveles de fT4 y ABT. Los niveles de TSH fueron similares en ambos grupos y no hubo una correlación significativa con los niveles de ABT. No hubo diferencias significativas entre los dos grupos en cuanto a enfermedades tiroideas en el tercer trimestre. Conclusiones. Un mayor nivel de fT4 se asoció a un mayor nivel de ABT y el nivel de fT4 se asoció a un mayor riesgo de CIE y a la gravedad de la CIE, pero el nivel de TSH no se asoció a un mayor riesgo de ABT y de CIE. ABSTRACT Intrahepatic cholestasis of pregnancy (ICP) leads to adverse perinatal outcomes and these outcomes are affected by high total bile acid (TBA) levels. Studies have shown that thyroid hormones regulate bile acid metabolism. However, few studies have evaluated the role of thyroid hormones in ICP. Objective: To evaluate thyroid function along with TBA levels in ICP. Methods: In this retrospective study, 252 pregnant women, including 126 ICP and 126 controls, were evaluated. Third trimester TBA, thyroid-stimulating hormone (TSH), and free thyroxine (fT4) levels of all pregnant women were assessed. Correlation between TBA and fT4, TSH levels were examined. In addition, the perinatal outcomes of both groups were determined. Results: fT4 levels were significantly higher in ICP. There was also a positive correlation between fT4 and TBA levels. TSH levels were similar in both groups and there was no significant correlation with TBA levels. There was no significant difference between the two groups in thyroid diseases in the third trimester. Conclusions: Higher fT4 level was associated with higher TBA level and fT4 level was associated with higher ICP risk and ICP severity, but TSH level was not associated with higher TBA and higher ICP risk.

RESUMEN Antecedentes. El efecto del hipotiroidismo subclínico (HSC) en los resultados perinatales adversos no está claro, y los valores de referencia de la hormona tiroestimulante (TSH) en el embarazo son controvertidos. Objetivo. Evaluar los efectos del HSC negativo para los anticuerpos de la peroxidasa tiroidea (TPOAbs) sobre los resultados perinatales según los diferentes valores de referencia de la TSH. Métodos. Un total de 554 mujeres embarazadas, incluyendo 509 eutiroideas y 45 gestantes hipotiroideas subclínicas (TSH > 3 mIU/L), fueron incluidas en este estudio prospectivo de casos y controles. Todas las gestantes estaban en el tercer trimestre y eran negativas a los TPOAbs. Las funciones tiroideas fueron evaluadas utilizando los valores de referencia específicos para el trimestre recomendados por el Colegio Americano de Obstetricia y Ginecología (ACOG) (TSH > 3 mIU/L) y la Asociación Americana de Tiroides (ATA) (TSH > 4 mIU/L). Resultados. La mortalidad neonatal en el hipotiroidismo subclínico con un límite superior de TSH de 4 mIU/L fue significativamente menor que en el grupo eutiroideo (2 (0,4%) frente a 1 (4,5%); p=0,009). No hubo diferencias significativas en resultados maternos y perinatales adversos en las gestantes con HSC y eutiroideas en ambos valores de referencia de la TSH. No hubo correlación significativa entre los valores de TSH y las semanas de parto de las gestantes con parto prematuro (r=0,169, p=0,146). Conclusiones. En este estudio, utilizando los diferentes valores basales de TSH recomendados por las directrices del ACOG de 2020 y de la ATA de 2017 en el tercer trimestre del embarazo para el diagnóstico de hipotiroidismo subclínico, no hubo una relación significativa entre los casos de hipotiroidismo subclínico con TPOAbs negativos y los resultados perinatales adversos. ABSTRACT Background: The effect of subclinical hypothyroidism (SCH) on adverse perinatal outcomes is unclear, and thyroid-stimulating hormone (TSH) reference values in pregnancy are controversial. Objective: To evaluate the effects of thyroid peroxidase antibody (TPOAbs) negative SCH on perinatal outcomes according to the different TSH reference values. Methods: A total of 554 pregnant women, including 509 euthyroid and 45 subclinical hypothyroid (TSH > 3 mIU/L) pregnant women, were included in this prospective case-controlled study. All pregnant women were in the third trimester and were TPOAbs negative. Thyroid functions were evaluated using trimester-specific reference values recommended by the American College of Obstetrics and Gynecology (ACOG) (TSH > 3 mIU/L) and the American Thyroid Association (ATA) (TSH > 4 mIU/L) guidelines. Results: Neonatal mortality in subclinical hypothyroidism with a TSH upper limit of 4 mIU/L was significantly lower than in the euthyroid group (2 (0.4%) vs 1 (4.5%); p=0.009). There was no significant difference in terms of adverse maternal and perinatal outcomes in SCH and euthyroid pregnant women in both TSH reference values. There was no significant correlation between TSH values and delivery weeks of pregnant women with preterm delivery (r=0.169, p=0.146). Conclusions: In this study, using different baseline TSH values recommended by the 2020 ACOG and 2017 ATA guidelines in the third trimester of pregnancy for the diagnosis of subclinical hypothyroidism, it was shown that there was no significant relationship between cases of subclinical hypothyroidism with negative TPOAbs and adverse perinatal outcomes.

OBJECTIVE: This study was conducted to evaluate the relationship of p53 and Ki67 expression with prognostic factors in patients who underwent surgery due to a diagnosis of endometrial cancer, and to evaluate their use as molecular markers that can help with survival prediction. STUDY DESIGN: This retrospective cohort study included patients who underwent surgery for endometrial cancer indication at the Gynecologic Oncology Clinic of the University of Health Sciences Tepecik Training and Research Hospital between 2011 and 2019, and whose p53 and Ki67 from the dissected material were pathologically studied and who underwent pelvic/paraaortic lymph dissection between the relevant dates. RESULTS: The study included 140 patients who met the inclusion criteria, 60% (n=84) of whom had endometrioid type endometrial carcinoma and 40% (n=56) had non-endometrioid type endometrial carcinoma. Estrogen and progesterone receptor positivity was significantly higher in the endometrioid type endometrial carcinoma group (p

OBJECTIVE: In this study, we aim to compare the maternal and obstetric outcomes between local adolescent Turkish citizens and adolescent Syrian refugees admitted to a tertiary care center in Turkey. STUDY DESIGN: Between January 2014 and December 2019, a total of 57,049 births were performed in our hospital. The study included a total of 6,021 patients aged 19 years or younger pregnancy who gave birth at our hospital. Of this number, 5,164 (1,792 Syrian adolescent refugee cases and 3,372 local adolescent Turkish cases) were live singleton pregnancies. Our primary aim was to compare the maternal and obstetric outcomes between the two groups. RESULTS: In the pregnant refugee women, the maternal age was younger (p

Background: Ectopic pregnancy treatment with a single dose of methotrexate, causes patients to stay in hospital for a long time, increases the cost of treatment, decreases the compliance of the patient, and leads to loss of work force. Aim and Objectives: The aim of this study was to predict the success of single dose Methotrexate (MTX) treatment in ectopic pregnancy at an early period. Material and Methods: Between 1st January 2018 –31st December 2019 at the University of Health Sciences, Tepecik Education and Research Hospital, ectopic pregnancy patients who were treated with single dose MTX (50 mg/m2) were included in the study. Clinical and laboratory parameters were evaluated. Results: The data of 100 patients that met our criteria were analyzed. Patients enrolled in the study, were divided into 2 groups. Group 1 MTX treatment failed group (n = 50) and Group 2 MTX treatment successful group (n = 50). Pre-treatment of beta-human Chorionic Gonadotrophin (β-hCG) values of the patients was of the MTX treatment failed group to be higher than those of the MTX treatment successful group (p < 0.001). Although the pretreatment β-hCG change within 24 hour was higher in the MTX treatment failed group, the difference was not significant in the groups. The β-hCG change between 1st and 4th days, the average β-hCG value in the treatment failed group tended to increase, whereas in the group where the treatment successful, it tended to decrease and the results were significant (p = 0.004). Conclusion: Ectopic pregnancy is a serious obstetric complication that causes maternal morbidity and mortality. Therefore, early diagnosis and treatment is important. Especially, a single dose MTX treatment is an effective and safe option in the treatment of ectopic pregnancy. In this study, pre-treatment β-hCG values were significantly higher in the MTX failed group. The β-hCG values 24 hour before the start of the treatment and the β-hCG change at the beginning of the treatment were examined, and no difference was found between the groups in terms of predicting success in a single dose of MTX. On the other hand, the β-hCG change between the 1st and 4th days was an early predictor of the medical treatment success.

Purpose: Zonulin has been shown to be associated with many metabolic disorders, including type 2 diabetes mellitus, metabolic syndrome, and obesity. In this study, we aimed to evaluate the association between maternal plasma zonulin levels and gestational diabetes mellitus (GDM) and its perinatal outcomes. Materials: A total of 100 pregnant women, 56 with GDM and 44 controls, were included in this prospective case-control study. Maternal plasma zonulin levels were evaluated in each trimester. The association between zonulin levels and GDM, body mass index (BMI) and adverse perinatal outcomes was evaluated. The GDM predictability of zonulin levels for each trimester was analyzed with the receiver operator curve (ROC). Results: Plasma zonulin levels were significantly higher in pregnant with GDM in all trimesters (p < 0.001; for all). Optimum cut-off values of plasma zonulin levels in predicting GDM: first trimester: 6.27 ng/mL, second trimester: 12.71 ng/mL, and third trimester: 18.38 ng/mL. BMI was significantly higher in pregnant women with GDM (30.5 vs 26.1; p < 0.001). Zonulin levels were significantly higher in pregnant women with GDM with overweight BMI [≥ 25-30 (kg/m2)] in all trimesters (p < 0.05; for all). Zonulin levels were significantly higher in pregnant women with composite adverse outcomes that included at least one of neonatal intensive care unit (NICU) admission, meconium-stained amniotic fluid, and 1st minute APGAR score < 7. Conclusion: Increased maternal plasma zonulin levels were associated with increased risk of GDM and adverse perinatal outcomes. Zonulin may be a potential marker to predict GDM risk and perinatal outcomes.

This study aimed to evaluate increasing cesarean delivery (CD) rates, their causes, and changes over the years in a Turkish tertiary center using the Robson Ten-Group Classification System (RTGCS).Data of deliveries involving birth weight of ≥500 g or ≥24 weeks of gestation period from 2013 to 2020 were retrospectively collected and classified from the hospital digital record system using obstetric concepts and parameters described in the RTGCS.The overall CD rate for all births (69051) from 2013 to 2020 was 55.5%. Groups 3, 5, and 1 were the most represented groups (29.1%, 23.9%, and 19.4%, respectively). The major contributors to the overall CD rate were Groups 5, 2, and 10 (23.8%, 9.9%, and 5.6%, respectively). Groups 2 and 4 (nullipara, multipara, single cephalic at term) had high CD rates associated with high rates of pre-labor CD (88.9% and 73.3%, respectively). The CD rate was 99.7% in Group 5, which showed recurrent CD, and 67.2% in Group 10. The overall CD rate was 60.8% in 2020 owing to the significant increase in the contributions by Groups 5, 8, and 10. The most common indication for CD was previous CD (46.1%), fetal distress (13.2%), and cephalopelvic disproportion (CPD) (8%).Groups 1, 2, 5, and 10 were the major contributors to the overall CD rate at this tertiary center. To reduce overall CD rates, policies that reduce primary CD and support vaginal delivery after cesarean section should be established.

Objectives To evaluate whether fetal pancreatic echogenicity and its measurements are associated with gestational diabetes mellitus (GDM) and perinatal outcomes. Methods A prospective cohort study was conducted with 150 pregnant women with a singleton pregnancy. The study included pregnant women between 30 and 41 weeks with or without GDM. Fetal pancreatic circumference was measured using the free-hand tracking function. The echogenicity of the fetal pancreas was compared with the echogenicity of the liver and bone (ribs, spine) and classified as Grades 1, 2 and 3. The relationship between maternal characteristics and perinatal outcomes with fetal pancreas measurements and echogenicity was evaluated. Results Pregnant women with 75 GDM and 75 without GDM were included in the study. Mean fetal pancreas circumference measurements were significantly higher in pregnant women with GDM than in those without GDM (p=0.001). Hyperechogenic (Grade 3) fetal pancreas was significantly higher in pregnant women with GDM than in pregnant women without GDM, and there was a positive correlation between pancreatic echogenicity and HbA1c levels in pregnant women with GDM (r=0.631, p Conclusions Fetal pancreatic echogenicity and measurements in pregnant women with GDM can give an idea about glucose regulation and adverse perinatal outcomes.

Follicle-stimulating hormone (FSH) plays a key role in fertility and shows its effect through the FSH receptor (FSHR), which is localized in cells.The aim of this study was to examine pregnancy outcomes and responses to controlled ovarian stimulation according to FSHR polymorphism types.The study was retrospective, and included patients who applied to the University of Health Sciences Tepecik Training and Research HospitalPatients who underwent IVF-intracytoplasmic sperm injection and at the same time studied FSHR gene polymorphism in the genetic unit of our hospital were included in the study.The Kruskal-Wallis test was used for multiple comparisons of continuous variables. The Chi-square test was used for categorical variables between groups.A total of 143 patients who met our criteria were included in the study. 14% (Ser/Ser polymorphism is characterised by a poor ovarian response. Despite this, polymorphisms in the FSHR gene do not seem to affect the results of pregnancy per started cycle, ongoing pregnancy per started cycle, ongoing pregnancy per embryo transfer and live birth per embryo transfer.

Objectives To evaluate the impact of the COVID-19 pandemic on prenatal screening and diagnostic tests. Methods We conducted a retrospective study with pregnant women attending to the perinatology department of a tertiary referral center. The pre-COVID-19 period between 11 March 2019 and 10 March 2020 and COVID-19 period between 11 March 2020 and 10 March 2021 were evaluated. Both periods were compared in terms of outpatient visits, ultrasound examinations, prenatal screening and diagnostic tests. The correlation of deaths related to COVID-19 pandemic on these parameters was also assessed. Results A total of 38,918 patients were examined and 28,452 ultrasound examinations, 26,672 prenatal screening tests and 1,471 prenatal diagnostic tests were performed over two years. During COVID-19 pandemic, number of outpatient visits decreased by 25.2%, ultrasound examinations decreased by 44.2%, prenatal screening tests decreased by 36.2% and prenatal diagnostic tests decreased by 30.7%. Statistically significant correlation was not observed between deaths related to COVID-19 and outpatient visits (p=0.210), ultrasound examinations (p=0.265), prenatal screening (p=0.781) and diagnostic tests (p=0.158). Among indications of prenatal diagnostic tests, maternal anxiety was significantly higher in COVID-19 period (p=0.023). There was significant decrease in the detection of fetuses with trisomy 21 (p=0.047) and a significant increase in the detection of fetuses with Turner syndrome (p=0.017) during COVID-19 period. Conclusions The COVID-19 pandemic has severely impacted antenatal care. Prenatal fetal screening and diagnosis was adversely affected by the pandemic in terms of detecting genetic and structural anomalies.

In this study, our aim was to determine the differences between intrauterine growth restriction (IUGR) and normal birth weight fetuses in terms of ischemia modified albumin (IMA) levels. For this purpose, we measured ischemia modified albumin levels in the cord blood of fetuses and the mothers.This study is a prospective study conducted at University of Health Sciences Tepecik Training and Research Hospital between January 2018 and December 2019. According to the inclusion/exclusion criteria, 227 patients were included in the study. Participants were divided into two groups according to the presence (patient group) or absence (control group) of intrauterine growth restriction (IUGR). In addition to routine parameters recorded during pregnancy, the IMA levels and Doppler USG findings of all participants were recorded.The mean cord blood serum IMA levels of the patient group were significantly elevated compared to controls (p = 0.038). Whereas mean maternal blood serum IMA levels were similar among groups (p = 0.453). The cord blood and mother blood serum IMA levels were not significantly different with regard to the presence or absence of perinatal asphyxia.In the literature, studies evaluating IMA levels in the cord and maternal blood of IUGR fetuses are limited. In IUGR patients, IMA level is expected to increase and in our study, IMA levels were significantly increased but the presence of oxidative stress has not been found to affect IMA levels.

Methotrexate (MTX) is an effective, economical and safe drug used in the treatment of ectopic pregnancy. Complications are very rare. Herein, we reported a case of febrile neutropenia following single low-dose methotrexate for the treatment of ectopic pregnancy. Febrile neutropenia developed on day 4 of single-dose methotrexate administered intramuscularly. Although methotrexate single-dose regimen is quite effective and safe in ectopic pregnancy, febrile neutropenia can occur very rarely.

Her seyden once size tesekkur etmek istiyorum, bilgi caginda, bilgiden yoksun, bilgiden uzak isini yapadurmak yerine, saglik alanindaki inovasyon, teknoloji ve yapay zeka kulvarlarindaki merakiniz ve hekimseniz hastaniza en dogru taniyi koyup, en dogru tedaviyi vermek gayesi yada alan uzmani iseniz de bu alanlarda gelisime inanarak okumayi sectiginiz, konfor alaninizi bozmayi kabul ettiginiz icin.Bu kitapta sagligimizin geleceginin buyuk bir kismini olusturacak olan, sagligin son trendlerini sunduk. Gelecegin hekimlik ve saglik anlayisindaki son gelismeleri, literatur destegi ile bilimin getirdigi sarsici etkiler ve gelecek perspektifini en guncel bilgiler isiginda bu kitapta bulacaksiniz.

OBJECTIVE In this study, we aim to compare obstetric and perinatal outcomes between Turkish citizens and Syrian refugees who applied to a tertiary center in Izmir. MATERIALS AND METHODS Demographic characteristics, obstetric and neonatal outcomes of 8103 Syrian refugee pregnant women and 47 151 Turkish citizen pregnant women between January 2013 and December 2018 were retrospectively compared. Our primary aim was to compare the cesarean rates and obstetrical results between two groups and to decide antenatal care secondarily. RESULTS Syrian refugee pregnant women are statistically younger (p

This study of twin deliveries aimed to examine the effect of fetal sex and fetal sex of the co-twin on fetal anthropometry and length of gestation.Pregnancies were grouped as male/male, male/female, and female/female. Birth weight, head circumference, body length and delivery time of newborns were compared between unlike-sex and like-sex twin pregnancies.A total of 1028 pregnant women who met the inclusion criteria were enrolled in the study. Of these pregnancies, 32.6% (n = 335) were male/male, 33.4% (n = 343) were male/female, and 34.0% (n = 350) were female/female. The discordant (male/female) newborns had a higher total birth weight than concordant twins (P = 0.015). Compared with male newborns from male/female twin pregnancies, male newborns from male/male pregnancies were found to be 129 grams heavier, 0.7 cm longer, and had a 0.4 cm larger head circumference (P0.001, P=0.023, and P = 0.039, respectively). Pregnancies with male/female fetuses had statistically significantly longer gestations than pregnancies with male/male and female/female fetuses (P = 0.003 and P = 0.004, respectively). The shortest mean gestation was observed in the male/male group. Male/male pregnancies had a 1.53 times higher risk of preterm delivery than male/female pregnancies and a 1.51 times higher risk than female/female pregnancies (OR 1.53; 95% CI 1.07-2.19 and OR 1.51; 95% CI 1.06-2.16, respectively).This study suggests that, in twin pregnancies, birth weight, head circumference, and body length are affected by the sex of the co-twin. Male sex is associated with shorter gestation and male/male twin pregnancies are at higher risk for preterm labour.

Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication. In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment. 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy. The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%). The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

Abdominal pregnancy is a rare form of ectopic pregnancy. maternal deaths due to an abdominal ectopic pregnancy are 8 times higher than tubal ectopic pregnancy. Greater awareness is required in the diagnosis and treatment of abdominal pregnancy. Thirtyseven years old and the multiparous patient who was admitted to the emergency room with the findings of the acute abdomen. In the evaluation, ectopic pregnancy focus was not detected clearly in the patient who had bleeding in the abdomen. In the laparoscopic surgery of the patient who was hypotensive, abdominal pregnancy in the posterior surface of uterine was resected successfully. Due to abdominal pregnancy can be observed on the surface of the spleen, omentum and appendix, the laparoscopic approach should be preferred in the treatment because it provides a wide field of vision.

Background and aim: Vulvar hematoma is often puerperal. A case of non-puerperal vulvovaginal hematoma is rare in the literature. There is no consensus on the management of vulvovaginal hematoma. In this study, we discussed the approach to a rare case of non-puerperal vulvar hematoma. Case: We present the case of a 14-year-old adolescent female with a severe vulvar non-obstetric hematoma that occurred after she had been illegally and voluntarily married. Conclusions: In conclusion; vulvar hematoma is the most common non-obstetric cause of perineal trauma and carries the risk of mortality by causing hypovolemic shock. The conservative approach is preferred for small and non-growing hematomas; however, surgical hematoma drainage is used for large and enlarging hematomas. Selective arterial embolization procedure is not common as the required equipment is not available in all healthcare facilities.

Objective: The aim of this study is to investigate the effect of detecting one or more positive values in 75 g oral glucose tolerance test (OGTT) performed between 24 and 28 gestational weeks on neonatal biometry (macrosomia, newborn weight, head circumference, and body length of newborn), obstetric results, and treatment requirement. Materials and Methods: Between January 2019 and December 2020 at the University of Health Sciences Tepecik Training and Research Hospital, pregnant women who underwent 75 g OGTT between 24 and 28 gestational weeks and had singleton pregnancy were included in the study. Multiple pregnancies, pregnancies with gestational age

The aim of this study was to investigate the effects of hypoglycemia measured using 2-h 75-g oral glucose tolerance test (OGTT) on neonatal biometrics (birth weight, head circumference and body length of newborns) and perinatal outcomes.According to the definition of hypoglycemia by the American Diabetes Association, women with blood glucose levels of ≤70 mg/dL after fasting or at 1 or 2 h after eating measured using on 2-h 75-g OGTT were grouped into a hypoglycemia group. In accordance with the criteria of World Health Organization and the International Association of Diabetes and Pregnancy Study Groups, as per the 2-h 75-g OGTT performed in the second trimester, women with gestational diabetes and were excluded from the study. Also, women meeting the following criteria were excluded from the study: missing records, aged19 or ≥35 years, multiple pregnancies, delivery before the 24A total of 625 pregnant women who met the inclusion criteria were included in the study. Hypoglycemia was found in 71 pregnant women according to 2-h 75-g OGTT. The remaining 554 women were grouped into the normoglycemia group. The birth weight, head circumference, and body length of newborns were significantly lower in the hypoglycemia group (p0.001, p = 0.004, and p = 0.006, respectively). There was no significant difference between both groups in terms of body mass index, parity, fetal sex, delivery type, and Apgar scores.Glycemia with blood glucose levels of ≤70 mg/dL measured using 75-g OGTT during pregnancy is associated with lower birth weight, small head circumference, and short body length in newborns compared to the normoglycemic group. Hence, pregnant women who are diagnosed with blood glucose levels of ≤70 mg/dL using 2-h 75-g OGTT should be carefully managed.