Journal of the Turkish German Gynecological Association最新文献

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.

Objective: To evaluate patients who underwent Burch colposuspension due to stress-type urinary incontinence (SUI) in terms of laparoscopic (L/S) and laparotomy (L/T) approaches.

Material and methods: Women aged 40-70 years who were admitted to our hospital with symptoms of SUI between 2017 and 2024, who underwent surgical treatment for SUI, and who met the inclusion criteria were included. The women were divided into two groups, those who received L/T and those who underwent L/S Burch colposuspension. To assess the impact of SUI on quality of life, several quality-of-life questionnaires, including the urinary distress inventory (UDI-6), the incontinence impact questionnaire (IIQ-7), the short-form-36 (SF-36) physical component summary, and the mental component summary (MCS), were evaluated. Post-operative pain was assessed with a Visual Analog Scale (VAS).

Results: The cohort consisted of 74 patients. The surgical time and estimated blood loss in the L/S group was significantly lower than in the L/T group (both p<0.001). The sixth and 48^th-hour VAS score in the L/S group was significantly lower than in the L/T group (both p<0.001). There was a significant decrease in UDI-6 and IIQ-7 score in patients who underwent L/S-Burch colposuspension and L/T-Burch colposuspension at the 6^th-month follow-up (p<0.001 and p<0.001, respectively). At the sixth-month follow-up, the SF-36 MCS score was significantly lower in the L/S group compared with the L/T group (p=0.014).

Conclusion: In our study, the results of Burch colposuspension methods were consistent with the literature. L/S-Burch colposuspension is superior in terms of surgical time, blood loss, hospital stay, pain management, and recovery time. The significant decrease in UDI-6 and IIQ-7 scores at the 6-month follow-up shows that both methods provide improvement in urinary incontinence symptoms and increase quality of life.

Objective: Cervical cancer is the second leading cause of cancer mortality among Mexican women aged 20-39 years, driven primarily by persistent human papillomavirus (HPV) infection. To determine the prevalence of high-grade squamous intraepithelial lesions (HSIL) in women under 40 years of age and identify associated risk factors.

Material and methods: An observational, cross-sectional study was conducted, including 359 women under 40 years old who were evaluated at the Gynecology and Obstetrics Medical Unit of Centro Médico Nacional de Occidente. Cervicovaginal cytology results indicative of HSIL were analyzed to determine prevalence and assess correlations with demographic and gynecological factors.

Results: The prevalence of HSIL was 39%, with the highest proportion of cases observed in women aged 35-39 years. The average age of sexual debut was 18.5 years, with an average of 2.93 sexual partners. Women diagnosed with HSIL were more likely to be older, married, and homemakers. HPV infection was highly prevalent across both low-grade squamous intraepithelial lesion and HSIL groups.

Conclusion: A high prevalence of HPV infection was found, mostly in a relatively young population. A significant association between infection and risk factors, like marital status and gynecological/obstetric history, was also demonstrated. The findings also confirmed a relationship between HPV and HSIL.

The phenomenon of transplacental transmission of cancer, where cancer cells pass from a pregnant mother to her fetus is an extremely rare occurrence. This phenomenon has significant implications for maternal and fetal health, challenging our understanding of cancer biology and maternal-fetal interactions. The literature on transplacental cancer transmission is sparse, consisting mainly of case reports, small cohort studies, and reviews. Examples of cancers that have been transmitted in this way include melanoma, choriocarcinoma, leukaemia, and lymphoma. Understanding this phenomenon is important because it has direct clinical implications for managing pregnant women with cancer and the infant, raises questions about the placental barrier and immune interactions between mother and fetus, and offers insights that could influence cancer biology and treatment strategies. This review aims to evaluate existing data, identify and synthesize evidence on transplacental cancer transmission cases, evaluate cancer types involved, their transmission mechanisms, and clinical outcomes for both mothers and infants. A comprehensive electronic search of databases was conducted for relevant case reports and series, using specific keywords related to vertical and transplacental transmission of cancer. The review elucidates comprehensive information from the reports to understand how cancer transmission occurred and was confirmed as vertical transmission, aiming to enhance knowledge in this critical area of maternal-fetal medicine.