Journal of the Turkish German Gynecological Association最新文献

Objective: Non-functioning pituitary adenomas (NFPAs) are a group of hormonally inactive adenomas. The aim of this study was to investigate the possible effects of NFPAs on pregnancy.

Material and methods: Thirty patients with NFPAs and without hormone deficiency or excess were included. We retrospectively evaluated anterior pituitary hormone levels, follow-up periods, pituitary imaging findings, symptoms associated with adenoma size increase during pregnancy, adverse pregnancy outcomes, delivery procedures, pregnancy week at delivery, birth weight, and lactation duration.

Results: The mean age of the patients was 41.26±9.06 years, and the mean follow-up after diagnosis was 92.8 months. Seven were diagnosed with macroadenomas (defined as the largest diameter >10 mm) and 23 had microadenomas. There were 92 pregnancies in total. The incidence of nausea-vomiting and visual impairment during pregnancy were more common in the macroadenoma group (p=0.016 and p=0.042, respectively). Spontaneous pregnancy rates were high. The patients with NFPAs did not have an increased risk of pregnancy-related complications compared to the general population, and there were no obvious negative effects on fetal development or lactation. NFPAs were not associated with an increased cesarean section rate.

Conclusion: These findings suggest that NFPAs, even macroadenomatous NFPAs, have no negative effects on pregnancy outcomes, fetal development, or lactation.

Objective: The transition nuclear protein 1 (TNP1) gene is a member of the TNP family and is abundantly expressed during spermatogenesis. Protamine 1 (PRM1), another sperm nuclear protein, is abundant in many species. The present study aimed to evaluate transition nuclear protein 1 (TNP1) and protamine 1 (PRM1) gene expression in infertile male patients with low and high sperm DNA fragmentation (SDF).

Material and methods: Semen samples (n=100) were obtained from male participants undertaking treatment with intracytoplasmic sperm injection. The expression levels of TNP1 and PRM1 were measured using real-time quantitative polymerase chain reaction. The data were compared with statistical tests, (independent samples T- or Mann-Whitney U) as appropriate. A p<0.05 was considered significant.

Results: Patients with low-SDF exhibited a significantly lower sperm concentration compared to those with high-SDF (p=0.002). There was significant down regulation of TNP1 (p=0.036) and PRM1 (p=0.04) in patients exhibiting high-SDF levels compared to those with low-SDF levels. A significant moderate positive correlation was observed between the relative expression levels of TNP1 and PRM1 (r=0.459, p<0.001).

Conclusion: In the present study TNP1 and PRM1 were differentially expressed in male patients being treated for infertility and who had low or high-SDF.

Objective: The aim of this study was to identify preoperative factors that predict concurrent endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN), focusing on inflammatory markers, such as hemoglobin, albumin, lymphocyte, and platelet (HALP) score, prognostic nutritional index (PNI), the modified systemic inflammatory score (mSIS), clinical characteristics, and imaging findings.

Material and methods: A retrospective review was conducted of patients diagnosed with EIN who underwent hysterectomy and bilateral salpingo-oophorectomy between 2019 and 2024. Data collected included demographic details, cancer antigen-125 levels, hematological parameters, HALP score, PNI, mSIS, and preoperative endometrial thickness. Statistical analyses were performed to evaluate the associations between these factors and concurrent endometrial carcinoma.

Results: Concurrent endometrial carcinoma was identified in 39 (19.9%) of the total of 196 patients included. Significant predictors included older age (p<0.001), lower platelet count (p<0.001), and endometrial thickness greater than 13 mm (p=0.044). Inflammatory markers such as the HALP score, PNI, and mSIS did not show significant associations. The majority of cases with carcinoma were International Federation of Gynecology and Obstetrics stage IA (76.9%) and grade 1 endometrioid tumors (94.9%).

Conclusion: Advanced age, reduced platelet count, and increased endometrial thickness are key predictors of concurrent endometrial carcinoma in patients with EIN. These findings may be useful for improved preoperative risk stratification and inform surgical planning. Further research is needed to explore the role of inflammatory biomarkers in this context.

Objective: Surgical site infection (SSI) is a common complication, especially following emergency caesarean section (CS) leading to maternal morbidity and prolonged hospital stay. Results are conflicting regarding the ideal method of skin closure after abdominal surgery in clean contaminated and contaminated wound. To compare the outcome of wound health between primary and delayed primary closure (DPC) of skin incision in emergency CS.

Material and methods: A total of 70 pregnant women undergoing emergency caesarean deliveries with a history of membrane rupture were randomized into group A (n=40) and group B (n=30). In group A monofilament sutures were placed in skin incision but the wound was left open for daily dressing with normal saline. It was closed by tying the monofilament sutures on fifth day and stitches were removed on seventh day. In group B skin was apposed by a routine primary closure procedure.

Results: No patient in group A required secondary wound closure following SSI (p<0.001) and duration of hospital stay was also significantly reduced (p<0.05).

Conclusion: This trial demonstrated that DPC is effective in reduction of requirement of secondary stitches due to SSI in emergency CS.

Objective: Recurrent cesarean deliveries are associated with intra-abdominal adhesions, and these adhesions affect maternal and neonatal morbidity. The aim of this study was to evaluate the relationship between the severity of striae gravidarum (SG) and intra-abdominal adhesions detected during cesarean section (CS).

Material and methods: In this prospective, case-control study, women undergoing a second CS were divided into three groups according to the severity of SG (group 1 - no SG; group 2 - mild SG; group 3 - moderate to severe SG). Demographic and clinical characteristics, grade of intra-abdominal adhesions, Fitzpatrick skin type (FST), and serum 25-hydroxy vitamin D [25(OH)D] levels were assessed in all groups.

Results: A total of 150 cases were divided into three equal groups. There was no significant difference in body mass index among the groups (p=0.155). Although lower vitamin D levels were observed in group 3 compared to the other groups (p=0.034), the grade of adhesions was not associated with vitamin D level (p=0.281). All of the grade 2-4 adhesions occurred in mild to moderate cases of SG. Intra-abdominal adhesion was absent in 92% of CS (p<0.001) in pregnancies where SG was not detected. No intra-abdominal adhesions were observed in women with FST type 1 and in 80% of cases with type 6 skin, grade 2-4 adhesions were found (p<0.001).

Conclusion: Pregnant women with moderate SG and dark skin are at high-risk of increased incidence of intra-abdominal adhesions in subsequent CS.

Objective: The aim of this study was to evaluate the effectiveness of emergency cervical cerclage (EmC) in twin pregnancies with a fully dilated cervix and amniotic membrane prolapse.

Material and methods: This retrospective study examined records from December 2015 to December 2022 and included 20 twin pregnancies. The patients were divided into two groups, the EmC group (EmC group) and the no EmC (control) group, and pregnancy outcomes were compared.

Results: EmC was performed after amnioreduction in 11 twin pregnancies. Nine patients who refused EmC were followed up with expectant management. The mean gestational age at first examination was similar between the EmC (21.36±1.62 weeks) and control group (21.00±3.16 weeks, p=0.372). The median (range) volume of removed amniotic fluid was 151.82 (120-420) mL. Cases in the EmC group gained a significantly longer delay until delivery (47.72±28.14 days) compared to controls (2.33±0.5 days, p<0.001). All of the women in the control group gave birth within three days following admission to hospital. The mean gestational age at birth was significantly higher in the EmC group (28.18±4.53 weeks) than in the control group (21.57±3.53 weeks, p<0.001). Thirteen (59.09%) infants survived in the EmC group while only two infants (22.22%) of one patient survived in the control group (p<0.001).

Conclusion: EmC increases the survival rate of infants by prolonging the gestational age at delivery in twin pregnancies. Clinicians and patients should be encouraged regarding the use of EmC in twin pregnancies with a fully dilated cervix and prolapsed amniotic membranes.