Journal of the Turkish German Gynecological Association最新文献

Unicornuate uterus results from incomplete Müllerian duct development and often includes a rudimentary horn. Pregnancy in such a rudimentary horn is rare. The video presents the robotic management of a 21-week, ruptured rudimentary horn pregnancy, emphasizing preoperative planning and surgical excision using a robotic platform, highlighting a novel minimally invasive technique for this rare obstetric emergency. A primigravida with a unicornuate uterus presented with a ruptured rudimentary horn pregnancy at 21 weeks and 4 days of gestation. Imaging confirmed fetal expulsion into the peritoneal cavity with moderate hemoperitoneum. The patient underwent right internal iliac artery embolization to minimize blood loss, followed by robotic excision of the ruptured horn, fetus, and placenta through posterior colpotomy. The procedure was completed using a multiport robotic setup with minimal intraoperative blood loss. The surgery was completed in 45 minutes with minimal complications. The patient had an uneventful postoperative recovery. Robotic-assisted surgery provides a safe, minimally invasive alternative to laparotomy for ruptured rudimentary horn pregnancies in well-selected patients. Meticulous planning, patient selection, and a multidisciplinary approach are key to success.

A 51-year-old woman presented with two years of postmenopausal spotting, mainly postcoital. Although vaginal atrophy was considered, prior use of vaginal estrogen at another center had not improved her symptoms. She had a history of persistent human papillomavirus (HPV) 16 infection and abnormal cytology. Initial colposcopy showed CIN 1 but one year later, a biopsy revealed CIN 2, and loop electrosurgical excision procedure (LEEP) was performed with negative margins. At 6-month follow-up, HPV positivity and low-grade squamous intraepithelial lesion persisted, with CIN 2 on colposcopy. Despite being offered repeat LEEP, the patient opted for definitive surgery. Due to a family history of ovarian cancer, she also requested bilateral salpingo-oophorectomy. This case highlights an individualized approach to recurrent cervical dysplasia and postmenopausal bleeding. Despite long-term follow-up, cervical dysplasia persisted, necessitating surgical intervention. The procedure was completed laparoscopically without complications. Cervical stump excision is a rare but important option in patients experiencing persistent symptoms or premalignant lesions after subtotal hysterectomy (SH). This case highlights careful patient selection and thorough counseling regarding potential long-term risks, including bleeding, dysplasia, and cervical malignancy, following SH.

Objective: To investigate the potential influence of serum estradiol (E₂) and progesterone (P₄) levels, measured one day before artificially prepared frozen embryo transfer (FET), on pregnancy rates in women who received combined vaginal and injectable P₄.

Material and methods: This retrospective cohort study analyzed the association between serum E₂ and P₄ levels on the day before FET in 167 cases prepared with hormone replacement therapy between February 2022 and October 2023. The primary outcomes assessed were the pregnancy and live birth rates. We modeled a cut-off serum value based on luteal support for pregnancy. Luteal support was through a combination of vaginal suppositories and subcutaneous injections. Multivariate logistic regression was used to test relationships between pregnancy outcomes and independent variables. Cut-off values were evaluated using receiver operating characteristic (ROC) analysis and percentile analysis.

Results: No significant relationships were found between serum E₂ or P₄ levels on the day before FET and pregnancy rates. The mean E₂ level was 169.0±51.9 pg/mL for individuals who achieved conception and 177.7±56.9 pg/mL for individuals who did not conceive (p=0.45). The corresponding values for P₄ were 28.1±18.4 ng/mL and 31.2±25.4 ng/mL, respectively (p=0.73). No differences were observed in body mass index (BMI) or endometrial thickness between the groups. Cut-off values for predicting pregnancy using E₂ and P₄ could not be determined using ROCs. However, no one in the lowest 10^th percentile of serum P₄ levels conceived (range 10.0-15.6 ng/mL). When multivariate logistic regression was used, this finding lost significance suggesting that low serum levels are related to age, BMI, and/or other factors.

Conclusion: In artificially prepared FET cycles, the serum E₂ and P₄ levels one day before embryo transfer do not significantly affect pregnancy rates in women with serum E₂ levels between 150-300 pg/mL and P₄ between 10-40 ng/mL when ROC was used for evaluation. However, percentile analysis suggests that serum P₄ levels should be more than 15.6 ng/mL when combined injectable and vaginal P₄ is used for programmed FET. Although this finding may be due to the confounding effects of age, BMI, and other factors affecting steroid metabolism, when controlled for in the multivariate logistic regression.

Objective: Obstetric brachial plexus injury is a significant cause of neonatal morbidity. The aim of this study was to evaluate the maternal and perinatal factors associated with plexus injury and to analyze clinical follow-up outcomes and parental caregiving burden.

Material and methods: This study was conducted as a retrospective descriptive study at the maternity center of a tertiary hospital. Deliveries resulting in obstetric plexus injury between February 2018 and December 2023 were included in the study. Out of 27,695 live births, 28 infants with plexus injury were identified and analyzed.

Results: Of the women who gave birth to infants with brachial plexus injury, 25 (89.3%) were aged 21-34 years, and 22 (78.6%) had a body mass index between 25 and 29.99 kg/m2. Of the cohort, 16 (57.1%) were multiparous, and 3 (10.7%) had gestational diabetes. In addition, 15 (53.6%) women underwent labor induction, and all had vaginal deliveries. Shoulder dystocia occurred in 11 deliveries (39.3%). Of the newborns with brachial plexus injury, 25 (89.3%) had Erb's palsy. The mean follow-up period for the infants was 12 (3-31) months. Injury recovery occurred in 24 babies (85.7%), while four babies (14.3%) experienced permanent injury. Regarding parental caregiving burden, 22 parents (78.6%) reported "no to mild burden," while six parents (21.4%) reported a "mild to moderate burden." No parents reported "moderate to severe" or "severe burden". All newborns with permanent damage developed shoulder dystocia at delivery (p=0.007).

Conclusion: Most infants with plexus injury recovered, while permanent injury was linked to shoulder dystocia, and parental caregiving burden was generally low.

Objective: Various nations, and this could create a new era of very young mothers which apply an additional pressure on obstetrical and neonatal health system. In cases of twin pregnancy, the burden would be maximized. The aim was to highlight the differences of obstetrical and neonatal outcomes of twin adolescent pregnancy compared to adults.

Material and methods: Data were collected prospectively over five years from a tertiary obstetric and neonatal center. Two categories of twin pregnancies were formed from adolescents as the case group and adults as controls.

Results: The adolescent group included 59 women and adults numbered 782. The adolescents had significantly higher rates of very preterm delivery, defined as gestational age [(GA) 28≤32 weeks] [odds ratio (95% confidence interval) 2.64 (1.26-3.92)], p<0.05], and significantly lower mean GA than adults (36.6±4.1 versus 37.8±2.6, weeks respectively). Babies delivered to adolescents had significantly lower mean birth weight (1936.5±0.604 g), birth height (43.4±4.3 cm), and occipitofrontal circumference (OFC) (30.8±3.3 cm). Moreover, there was a significantly higher frequency of neonates with APGAR score <7 at the fifth minute [31 (52.54)], low birth weight [53 (89.83)], and neonatal intensive care unit (NICU) admission [38 (64.41)].

Conclusion: Twin adolescent pregnancy had significantly elevated metrics for obstetric and neonatal complications, which were especially notable for very preterm delivery, low neonatal birth weight and short birth length, and reduced OFC, APGAR score <7 at the fifth minute, and NICU admission rate.

Vulvar intraepithelial neoplasia (VIN) represents a heterogeneous group of premalignant lesions arising through distinct human papillomavirus (HPV)-associated and HPV-independent pathways. Despite well-characterized differences in etiology, prognosis, and progression risk, current management remains largely uniform and predominantly surgical. This one-size-fits-all approach neglects opportunities for individualized care and exposes patients, particularly younger women and those with multifocal disease, to potentially avoidable psychosexual morbidity. Recent advances in molecular pathology, including immunohistochemistry, genomic profiling, DNA methylation analysis, and copy number alteration detection, offer promising avenues for refining diagnostic precision and enabling risk stratification. Integration of markers such as p16INK4a, p53, and emerging methylation panels into diagnostic workflows may improve differentiation between lesion subtypes, guide surveillance, and identify candidates for conservative therapy. Moreover, the unique pathogenesis of vulvar high-grade squamous intraepithelial neoplasia, which diverges from squamocolumnar junction (SCJ)-driven models seen in other HPV-associated cancers, highlights the need for focused research on host-virus interactions and early oncogenic events in non-SCJ epithelium. Future directions include non-invasive sampling methods, molecularly-guided surveillance protocols, therapeutic HPV vaccines, and combined immunomodulatory treatments to reduce the burden of excisional therapy. Establishing precision-based approaches for VIN could not only preserve vulvar integrity and function but also improve oncological outcomes through targeted prevention and early intervention strategies.

Objective: The aim of this retrospective cohort study was to evaluate the relationship between leading follicle size at the time of human chorionic gonadotropin (hCG) trigger and live birth rates in Patient-Oriented Strategies Encompassing Individualised Oocyte Number (POSEIDON) groups 3 and 4 undergoing assisted reproductive technology cycles using a gonadotropin releasing hormone (GnRH) antagonist protocol. The objective was to identify the optimal leading follicle size for maximizing live birth outcomes in this challenging patient population.

Material and methods: This retrospective cohort study included POSEIDON groups 3 and 4 poor responders aged 20-42 years undergoing intracytoplasmic sperm injection with GnRH antagonist protocol between January 2015 and July 2021. Patients were categorized based on the occurrence of premature ovulation. The primary outcome measures were number of oocytes retrieved, number of metaphase II (MII) oocytes, MII oocyte ratio and follicle oocyte index (FOI). These outcomes were compared across different leading follicle size categories at the time of hCG trigger.

Results: Among the 294 subjects included, 47 (16.2%) had premature ovulation between the trigger and oocyte pick-up days. The mean size of the leading follicle on the day of trigger was significantly higher in the premature ovulation group (19.8±2.4 mm vs.18.7±2 mm, respectively; p<0.001). Multivariate logistic regression analyses identified baseline luteinizing hormone [odds ratio (OR) 1.144, 95% confidence interval (CI) 1.052-1.243; p=0.002], number of follicles >11 mm on the day of trigger (OR 0.580, 95% CI 0.438-0.767; p<0.001), and leading follicle size (OR 1.361, 95% CI 1.130-1.641; p=0.001) as independent predictors of premature ovulation. The FOI and MII/antral follicle count ratios peaked when the leading follicle size was between 16-17 mm.

Conclusion: Individualized triggering based on leading follicle size may provide optimal oocyte retrieval after ovarian stimulation in POSEIDON expected poor responders. While a late trigger may result in premature ovulation, an early trigger may also result in less MII. Triggering when the leading follicle size is between 16.5 and 17 mm may help to prevent these negative outcomes and achieve optimal cycle outcome.