Turkish Journal of Obstetrics and Gynecology最新文献

Objective: Endometriosis is a benign condition driven by estrogen and inflammation in which endometrial-like tissue develops in ectopic locations. We aimed to determine whether non-steroidal agents acting on the WNT/beta-catenin signaling axis could provide therapeutic benefit in this disease.

Materials and methods: Forty adult female mice underwent surgical creation of endometriotic implants and were then distributed into five experimental arms: untreated controls, early leuprolide (leup1d), early tinzaparin (tnz1d), delayed leuprolide (leup7d), and delayed tinzaparin (tnz7d). Early treatment groups received drug treatment beginning at postoperative hour 24, whereas delayed groups began treatment on postoperative day 8. At two weeks post-surgery, lesions were harvested for RNA extraction and transcript profiling. Tissues were also processed for hematoxylin-eosin staining with semi-quantitative grading. Immunostaining was performed using antibodies against HIF1a and WNT2.

Results: The tnz7d group exhibited decreased inflammatory markers, while the leup7d group displayed reduced epithelial content; both changes resulted in lower disease severity scores. WNT2 and HIF1a immunostaining revealed greater reductions in score in the tnz7d group compared with controls and other treatment arms, but these differences were not statistically significant.

Conclusion: Further investigation is warranted to determine how tinzaparin sodium and leuprolide acetate modulate the WNT/β-catenin axis for the management of endometriosis.

Objective: This study aims to investigate the prevalence of preinvasive lesions in cytology cases of high-risk human papillomavirus (HR-HPV) types other than types 16-18.

Materials and methods: A retrospective file scan of 342 patients with normal cytology was performed between January 2016 and April 2019 in our hospital's obstetrics and gynecology outpatient clinic. In the first group, with the exception of HR-HPV type positivity, normal cytology and preinvasive lesions were present as a result of biopsy. In the second group, women were HPV type 16-18 positive, had normal cervical cytology, and were found to have preinvasive lesions as a result of biopsy. At the end of the study, we calculated the percentages of HPV types seen in preinvasive lesions.

Results: Three hundred and forty-two patients with normal cytology were included in our study. The average age of women was 41.09±10.61. In 58 (16.9%) patients with 342 HR-HPV type positivity, preinvasive lesions were detected as a result of biopsy. High-grade squamous intraepithelial lesion-low-grade squamous intraepithelial lesion was reported in 54 (15.7%) cases, squamous cell carcinoma in 3 (0.92%) cases, and mixed surface epithelial carcinoma (endometrioid adenocarcinoma 95%, clear cell carcinoma 5%) in 1 (0.3%) case. The age variable was not significant in biopsy subgroups (p>0.05).

Conclusion: Among the biopsy results with preinvasive lesions, approximately half were positive for HPV type 16 or 18, and these cases were identified accordingly. Colposcopy and biopsy should be recommended in suspicious lesions, even if cytology is normal, since other HR-HPV types may also have certain rates of preinvasive and invasive lesions.

Objective: This study aimed to evaluate the influence of antenatal diagnosis and surgical management strategies on maternal and neonatal outcomes in placenta accreta spectrum (PAS) disorders, emphasizing risk factors, timing of delivery, and operative approaches.

Materials and methods: A retrospective cohort analysis was conducted on 210 women with histopathologically confirmed PAS managed at İnönü University Faculty of Medicine between January 2014 and March 2024. Demographic data, antenatal findings, delivery type, and surgical details were compared between elective and emergency procedures, as well as between uterus-preserving surgery and peripartum hysterectomy. Uterus-preserving surgery refers to conservative techniques that aim to avoid peripartum hysterectomy while controlling hemorrhage.

Results: Of the total cohort, 66.7% underwent elective surgery, whereas 33.3% required emergency intervention. Emergency deliveries occurred earlier (mean 32.1 vs. 36.0 weeks, p<0.001) and were associated with higher blood loss (799 vs. 511 mL, p<0.001), increased perinatal mortality (20% vs. 1.4%, p<0.001), and greater neonatal morbidity, mainly respiratory distress syndrome (47% vs. 14%, p<0.001). Hysterectomy was required in 45.2% of patients, primarily with placenta percreta (60% vs. 23.5%, p<0.001). Anterior placental location (89.5%) strongly correlated with complete invasion (77.7%) and bladder involvement (27.7%, p=0.038). Bladder injuries were more common in elective cases, while ureteral injuries occurred more often in emergencies (p=0.024). Preoperative hematocrit independently predicted hysterectomy risk (odds ratio: 1.092, p=0.034).

Conclusion: Antenatal diagnosis and well-planned elective management significantly improve maternal and neonatal outcomes in PAS. Individualized surgical planning based on invasion depth and maternal condition remains essential to reduce morbidity and mortality.

Objective: Ovarian tissue (OT) cryopreservation is a useful technique for preserving fertility potential in women with cancer. Vitrification is a relatively new method. Several devices were discussed. Among these methods, cryo-support and needle-immersion vitrification (NIV) stand out as particularly popular. The aim of this study is the comparison of these devices in terms of follicle quality and DNA status.

Materials and methods: The OT from 20 cancer patients was transferred with Dulbecco's Phosphate-Buffered Saline supplemented with 5% serum and maintained at 4 °C for 1 hour. After preparation of OT vitrified by two freezing solutions with different concentrations of cryoprotectant, small fragments of OT (~5×1×1 mm) were attached to an insulin needle, and in another group, the tissue fragments (~5×5×1 mm) were loaded onto the Ova Cryo Device Type M, also called cryo-support, and placed in liquid nitrogen. After warming, small tissue pieces were prepared to assess the quality of primordial, primary, and secondary follicles using eosin-hematoxylin staining. An immune-histochemical investigation, including anti-p53 and anti-Caspase 3, was conducted to examine the apoptosis pathway.

Results: The data showed a larger number of high-quality follicles in the cryo-support group (p<0.05). Also, the level of apoptosis (p53) molecules is higher in the NIV method (p<0.05). However, the levels of caspase 3 were not significantly different between the NIV approach and the cryo-support vitrification group.

Conclusion: A recent study revealed that the cryo-support device is more effective in increasing high-quality follicles and reducing p53, which is associated with early stages of apoptosis. This device may improve clinical outcomes and may be recommended for cryopreservation programs.

Objective: To evaluate the efficacy of secretome in improving the anti-Müllerian hormone (AMH) level and ovarian weight and restoring ovarian function in the premature ovarian insufficiency (POI) model mice.

Materials and methods: A randomized, post-test-only control-group design was conducted on 18 mice, which were divided into three groups: A control group and two case groups injected with a secretome. Blood samples were analyzed for the AMH level with an enzyme-linked immunosorbent assay kit; ovarian weight was measured; and hematoxylin-eosin staining was used to measure and categorize follicles at each stage.

Results: The cyclophosphamide (CTX) group showed significant differences in ovarian weight, AMH, and the numbers of primary, secondary, antral, and atretic follicles compared with the control group, indicating induction of premature ovarian failure. Follicular development was improved in the CTX-secretome group compared to the CTX group, with significantly increased ovarian weight and AMH, increased numbers of primary, secondary, and antral follicles, and decreased numbers of atretic follicles. However, the results showed a significant difference between the CTX-secretome and the control group.

Conclusion: Our findings show that secretome therapy improved POI management, but the results have not yet restored normal ovarian function. It still does not achieve the same functional state as normal ovarian function. Further research, particularly involving different doses of secretome, is necessary to validate these findings.

Objective: This study aimed to investigate the relationship between human papillomavirus (HPV) positivity, genotype, and female sexual dysfunction, particularly anorgasmia and psychosexual stress, among women participating in a cervical cancer screening program. It also examined whether HPV infection or genotype independently contributes to sexual dysfunction after adjusting for sociodemographic and reproductive factors.

Materials and methods: This prospective, cross-sectional study included 1,353 sexually active women aged 25-65 years who underwent HPV testing at Antalya City Hospital between May and September 2025. Participants completed validated questionnaires including the Female Sexual Function Index, Arizona Sexual Experiences Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Sociodemographic, reproductive, and clinical characteristics were recorded, and HPV genotyping was performed using polymerase chain reaction-based assays.

Results: Anorgasmia was identified in 31.5% of participants (n=427). It was significantly more common among unemployed women (84.1% vs. 71.6%; odds ratio =2.09, 95% confidence interval: 1.56-2.82; p=0.0001). Higher gravidity, parity, number of living children, and elevated vaginal pH were all associated with anorgasmia (p<0.05). No significant association was found between HPV positivity or genotype and anorgasmia (p>0.05).

Conclusion: Anorgasmia is primarily influenced by sociodemographic and reproductive factors, such as occupation, education level, parity, and vaginal environment, rather than HPV infection or genotype. These findings emphasize the importance of biopsychosocial and culturally sensitive approaches in evaluating and managing women's sexual health.

Objective: Within the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging framework, stage IC endometrial carcinoma denotes tumors with aggressive histology confined to the endometrium, without myometrial invasion. This study evaluated treatment outcomes and survival following adjuvant radiotherapy (RT).

Materials and methods: Twenty-eight patients diagnosed with FIGO 2023 stage IC endometrial carcinoma who were treated with adjuvant RT were retrospectively analyzed.

Results: The most common histologic subtype was serous carcinoma (39%), followed by clear cell carcinoma (25%), high-grade endometrioid carcinoma (25%), carcinosarcoma (7%), and undifferentiated carcinoma (4%). Half of the patients received RT alone, while the remainder received combined RT and chemotherapy. Vaginal brachytherapy was the predominant adjuvant RT technique (86%). The median duration of observation was 59 months. The 2-and 5-year overall survival (OS) rates were 96% and 87; locoregional recurrence-free survival (LRRFS) rates were 96% and 82; and distant metastasis-free survival (DMFS) rates were 92% and 80%, respectively. The presence of malignant peritoneal cytology during surgical staging predicted significantly poorer 5-year OS (93% vs. 33%), LRRFS (86% vs. 33%), and DMFS (90% vs. 0%). Within this limited cohort, the addition of chemotherapy to adjuvant RT did not confer a clear survival advantage. No severe treatment-related toxicities were observed.

Conclusion: While patients with FIGO 2023 stage IC endometrial carcinoma typically achieve favorable outcomes after adjuvant RT, malignant peritoneal cytology remains an adverse prognostic factor. In this subgroup, escalation of adjuvant therapy, such as combination chemotherapy, may be appropriate.

Objective: This study aimed to evaluate the prevalence of asymptomatic bacteriuria (ASB) in the second half of pregnancy, identify causative microorganisms, and assess their antimicrobial resistance and multidrug resistance (MDR) patterns in Kırşehir, Türkiye.

Materials and methods: Between April-December 2024, 182 pregnant women without urinary tract infection symptoms were screened at Kırşehir Training and Research Hospital. Midstream urine samples were cultured, and bacterial isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix™ automated system. Data were interpreted according to EUCAST 2024 criteria.

Results: ASB prevalence was 37.36%. Escherichia coli (51.47%) was the most common pathogen, followed by Candida spp. (17.65%), Klebsiella pneumoniae (8.82%), and Streptococcus agalactiae (7.36%). In Gram-negative isolates, the highest resistance was to ampicillin (72.7%), cefazolin (43.2%), and amoxicillin-clavulanate (40.9%), with universal susceptibility to amikacin, carbapenems, and nitrofurantoin. Gram-positive isolates showed the highest resistance to moxifloxacin and tetracycline (41.7% each). MDR was detected in 20% of Escherichia coli, 16.7% of Klebsiella pneumoniae, 60% of Streptococcus agalactiae, and 66.6% of Staphylococcus epidermidis isolates.

Conclusion: ASB prevalence during second half of pregnancy was high, and a significant proportion of pathogens demonstrated MDR. The findings highlight the necessity of culture-based diagnosis and region-specific empirical therapy. High resistance to ampicillin and trimethoprim-sulfamethoxazole suggests that empirical protocols should be updated according to local antibiograms. Strengthening antibiotic stewardship and expanding routine ASB screening are critical to reducing maternal-fetal complications.

Objective: It has been demonstrated that asprosin, a glucogenic adipokine released by white adipose tissue, contributes to the pathophysiology of cancer and disorders associated with it. The aim of this study was to compare the immunoreactivity of asprosin in grade I endometrial adenocarcinoma and in endometrial hyperplasia (EH) with and without atypia.

Materials and methods: A total of 80 cases previously diagnosed with grade 1 endometrial adenocarcinoma and EH with and without atypia, and for which paraffin blocks were obtained, were included in the study. The resulting paraffin blocks were sectioned again and immunostained for asprosin. A total of 80 cases were divided into 4 groups according to their histopathological diagnoses. Group (G) 1 (n=20): proliferative endometrium, G2 (n=20): EH without atypia, G3 (n=20): EH with atypia, G4 (n=20): Grade 1 endometrial adenocarcinoma. Endometrial samples from 80 patients were sectioned, and asprosin immunoreactivity was evaluated by immunohistochemical staining under a light microscope.

Results: In comparison to the proliferative endometrium group, the grade I endometrial adenocarcinoma group had considerably increased asprosin immunoreactivity. However, between the proliferative endometrium group and the groups with endometrial hyperplasia, without atypia, and endometrial hyperplasia, with atypia, there was no significant difference in asprosin immunoreactivity.

Conclusion: While asprosin immunoreactivity scores are higher in grade I endometrial adenocarcinomas, they are similar to those of the proliferative endometrium in cases of EH with and without atypia, suggesting that energy metabolism contributes to the development of cancer arising from endometrial hyperplasia. Asprosin immunoreactivity can be studied as a marker to predict the progression of EH to cancer.

Objective: This study investigated the relationship between maternal serum growth arrest-specific 6 (Gas6) levels measured in the second trimester of pregnancy and the development of gestational diabetes mellitus (GDM); it also evaluated the possible links between this biomarker and maternal and neonatal outcomes.

Materials and methods: A total of 173 pregnant women were included in this prospective study (89 diagnosed with GDM, 84 healthy controls). Gas6 levels were measured using the ELISA method from blood samples taken during routine screening in the second trimester. The relationships between Gas6 levels and body mass index (BMI), oral glucose tolerance test results, and neonatal data were statistically analysed.

Results: Gas6 levels were significantly higher in the GDM group (p<0.001). A strong positive correlation was found between Gas6 and maternal BMI (r=0.774), and a moderate positive correlation between Gas6 and oral glucose tolerance test 1-hour glucose level (r=0.577). Additionally, high Gas6 levels were found to be statistically significant in association with increased birth weight and intensive care requirements.

Conclusion: Increased Gas6 levels in the second trimester may be a potential biomarker for early prediction of GDM risk and perinatal complications.