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Objective: The aim of this study was to reduce maternal death rates and contribute to the literature by evaluating maternal near-miss (MNM) profiles, the prevalence, treatment approach, outcomes, and prognostic factors. Material and Methods: A total of 217 MNM patients and 19 cases of maternal death were included in this study. The criteria of organ dysfunction, revised by the World Health Organization (WHO) in 2009, was accepted as the criterion for patients defined as MNM. According to WHO's criteria, the patients were classified in 4 groups. These groups were classified as hypertensive pregnancies, hemorrhagic diseases, placental abruption and disseminated intravascular coagulation and other systemic diseases, respectively. Results: The MNM incidence was 2.31 per 100 live births, and the maternal mortality incidence was 202.4 per 100,000 births. The mortality rate of patients transferred to our hospital because of insufficient intervention at another centre was found to be statistically significantly higher. A statistically significant difference was determined in the laboratory parameters between the MNM cases and patients with maternal mortality in Group 1, 2, and Group 3. The rate of blood and blood products transfusion given to MNM patients was statistically significantly higher in Group 3 than in Group 2. Conclusion: The laboratory parameters found to be significant in MNM and maternal mortality cases could have a negative effect on prognosis and could be of guidance in the prediction of mortality. For patients with an insufficient treatment at other centres, transport to suitable centres would reduce maternal mortality by enabling appropriate interventions. [ABSTRACT FROM AUTHOR]

Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality. Relaparotomy (RL) is the most serious complication after delivery (normal delivery or cesarean section). RL is very rarely required and mostly performed due to intra-abdominal bleeding. This study aims to show the indications for obstetric RL due to hemorrhage and reveal hemorrhage areas. Material and Methods: A total of 120 patients with an RL history due to cesarean and vaginal postpartum hemorrhage were included in the study. Data such as age, gravida, parity, the procedure performed in an RL, the time between surgeries, complications, and the need for blood transfusion were obtained from clinical files. Descriptive statistical analysis was performed. Results: The RL incidence was 0.44%. Of all RLs, 18.3% (n=22) occurred after vaginal delivery while 81.7% (n=98) occurred after cesarean sections. The indications for an RL were intra-abdominal hemorrhage (83.4%, n=100) and atony (16.6%, n=20). Surgical procedures during an RL were hysterectomy (37.5%, n=45), vascular ligation (19.1%, n=23), secondary suturing (24.1%, n=29), rectus muscle repair (13.3%, n=16), and uterine rupture repair (5.8%, n=7). Conclusion: Close follow-up of the patient after delivery is vital in terms of postpartum hemorrhage. The postpartum RL requirement is 0.44% and it is life-saving. Active management during this period is very significant in terms of reducing maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

This study investigated patients who underwent bilateral hypogastric artery ligation (BHAL) due to postpartum haemorrhage (PPH). Patients who underwent BHAL because of PPH following a conservative treatment were included in this study. Placental abnormalities were referred to as placenta accreta. A total of 130 BHAL procedures took place at the study hospital as a result of PPH. Of these, 39 (30%) were referred to the hospital. The rate of BHAL requirement was 62 out of 10,000 births. Among the 130 patients, the most frequent indication for BHAL was placenta accreta (58.5%). Haematological parameters were poorer among the referral patients. Four of the exitus patients (80%) were referral patients. The mortality rate among the referral patients was 10.25%, whereas this rate was only 1.01% among the patients who gave birth at the hospital. PPH is a life-threatening condition that requires immediate medical attention. BHAL, with its fertility-preserving features, is a good option that can be employed in all PPH patients. BHAL not only preserves patients' fertility, but it also gives them a higher chance of survival.IMPACT STATEMENTWhat is already known on this subject? PPH is a life-threatening condition. Due to the worldwide increase in caesarean sections, placenta accreta has also increased. BHAL is a vital treatment method for PPH.What do the results of this study add? Placenta accreta is one of the most common causes of PPH. Traditional hysterectomy rates can be reduced by replacing this treatment with BHAL in this group of patients. Without early intervention in PPH, a patient's mortality risk can increase by up to 10 times. As research and surgeons' experience grows, PPH can be controlled with treatments with less complex modalities without the need for BHAL.What are the implications of these findings for clinical practice and/or further research? The need for BHAL should be kept in mind when addressing PPH, especially in cases of placenta accreta. The need for hypogastric artery ligation, which is a more aggressive treatment for the surgical correction of the pathology, can be reduced as surgeons' experience increases. Early intervention and/or referral in cases of PPH is of great importance. [ABSTRACT FROM AUTHOR]

Objective: Placenta accreta spectrum (PAS) is defined as the attachment of the placenta to the uterine wall in varying degrees. However, the studies have explored that the underlying molecular mechanisms of the PAS are very limited. Sirtuins 1 (SIRT1) is associated with placental development by controlling trophoblast cell invasion and remodeling of spiral arteries. We aimed to determine the expression level of SIRT1 in placentas, and maternal and umbilical cord serum of patients with PAS., Methods: In total, 30 individuals in control, 20 patients in the placenta previa group, and 30 patients in the PAS group were included in this study. The expression levels of SIRT1 in the placentas were determined by Western blot and immunohistochemistry. Serum levels of SIRT1 in maternal and umbilical cord blood were determined by ELISA., Results: SIRT1 was significantly lower in placentas of the PAS. However, maternal and umbilical cord serum samples were not significantly different between groups., Conclusion: SIRT1 may play an important role in the pathogenesis of the PAS.