Turkish Journal of Obstetrics and Gynecology最新文献

Objective: This study aimed to compare emergency and planned cesarean section cases in pregnancies complicated with placenta previa (PP) and subgroups with and without placenta accreta spectrum (PAS) in terms of obstetric, neonatal, and surgical outcomes.

Materials and methods: This retrospective cohort study included 128 patients diagnosed with PP who underwent cesarean section. Obstetric, neonatal, and surgical outcomes of all cases with PP and subgroups with and without PAS were compared according to whether they were emergency or planned cesarean section.

Results: Of the 128 women with PP, 60 planned and 68 underwent emergency cesarean section. In all patients with PP and in the PAS and non-PAS subgroups, the neonatal outcomes of patients who underwent emergency cesarean section were more negative than those of patients who underwent planned cesarean section. It was observed that more hysterectomy were performed in the emergency group than in the elective group in all patients with PP and PAS patients (p=0.027 and p=0.012 respectively). It was observed that patients with PP and non-PAS were hospitalized after cesarean section for a longer period of time in the emergency group than in the planned group (p=0.044 and p=0.002 respectively).

Conclusion: Planned cesarean section leads to better obstetric, neonatal, and surgical outcomes compared with emergency cesarean section in pregnancies complicated by PP, especially in those with PAS. Our findings suggest that planned delivery strategies should be considered for patients with PP. Decisions regarding the timing of delivery should balance maternal risks and benefits with fetal and fetal risks and benefits.

Conservative laparoscopic torsioning with or without cystectomy or oophoropexy has emerged as a promising approach for the management of ovarian torsion, particularly in pediatric populations. We sought to understand the efficacy of this approach. We comprehensively reviewed the relevant literature. We formulated a search strategy by combining keywords related to laparoscopic surgery, conservative management, and ovarian torsion in pediatric and adolescent populations. Data were retrieved from Web of Science, PubMed, Medline, Cochrane Library, and ClinicalTrials. The Gov and Scopus databases. Eligible articles met the following criteria: Involved pediatric or adolescent populations with ovarian or adnexal torsion and evaluating the use of any method of laparoscopic torsioning surgery. We included the following outcomes; recurrence, conversion to laparotomy, need for oophorectomy, mean time to the onset of symptoms, abdominal pain at the time of presentation, fever, and evidence of ovarian function on postoperative ultrasound. In our meta-analysis, conducted using OpenMeta[Analyst], we analyzed both continuous and dichotomous data with mean difference and risk ratio, respectively, along with 95% confidence intervals (CI). First, the incidence of recurrence was reported in five studies, where 17 cases experienced recurrence out of 391 cases experienced recurrence. Additionally, instances requiring open surgery were documented in five studies, with 22 out of 360 cases requiring this conversion to open surgery, resulting in a combined ratio of 0.051 [95% CI (0.018, 0.083), p=0.02]. Moreover, six studies provided data on cases necessitating oophorectomy, with 27 out of 437 cases requiring the procedure. Furthermore, the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was prevalent at presentation, affecting 264 out of 324 patients. Fever was less frequently reported, with 19 out of 324 patients experiencing it. Finally, a high percentage of patients showed evidence of ovarian function on postoperative ultrasound, with a pooled proportion of 0.69. Our analysis performed the conservative management of ovarian torsion in young women. Recurrence occurred in 17 out of 391, and 22 out of 360 required conversion to open surgery. Furthermore, oophorectomy was necessary in 27 of 437 patients, and the mean time from symptom onset to surgery was 51.9 h. Abdominal pain was the most common symptom, affecting 264 out of 324 cases, whereas fever was less common.

Objective: Fractalkine (CX3CL1) and macrophage inflammatory protein-1β (MIP-1β)/CCL4 play a role in chemotactic activity, immune response, and inflammatory response. We aimed to investigate the effects of fractalkine and MIP-1β in the development of ovarian hyperstimulation syndrome (OHSS) by considering the inflammatory response during ovulation.

Materials and methods: Two equal groups of 20 immature female rats were created. Given that one of the rats in the group died, the control group was made up of 9 rats. Group 1 (G1) (n=9): Control group; G2 (n=10): OHSS group. Rats in the G2 group were administered 10 IU FSH for 4 days and 30 IU human chorionic gonadotropin on the fifth day. At 34 days old, all rats were sacrificed, and blood and ovarian tissue samples were collected to measure CX3CL1, CX3CL1R, MIP- 1β, tumor necrosis factor-alpha (TNF-α), interleukin (IL-8), hypoxia-inducible factor (HIF-1α), and interferon-gamma (IFN-γ) levels. Immunohistochemical scoring was performed for CX3CL1 and CX3CL1R in other ovarian tissue.

Results: Rat and ovary weights and serum CX3CL1, CX3CLR1, HIF-1α, MIP-1β, TNF-α, IFN-γ and IL-8 levels were significantly higher in G2 than in G1. Tissue IL-8, TNF-α, CX3CL1, CX3CLR1, MIP-1β levels and CX3CL1 and CX3CLR1 immunoreactivity scores were significantly higher in G2 than in G1.

Conclusion: CX3CL1 and MIP-1β contribute to the pathophysiology of OHSS by playing a role in the development of inflammation.

Objective: Cessation of gonadotropin stimulation might affect follicular growth in patients in POSEIDON groups 3 and 4, which are unresponsive to high-dose stimulation.

Materials and methods: In this retrospective study, data were extracted from the medical records of patients treated at the Acıbadem Maslak Hospital Assisted Reproductive Technologies Unit between November 2010 and December 2020. Eighty-five patients who fulfilled the inclusion criteria were included in the study. Gonadotropin stimulation was discontinued if the follicle diameter increased by 2 mm within 7 days after the initiation of stimulation in patients in groups 3 and 4. The outcomes of the treatment strategy and pregnancy were recorded.

Results: Follicular growth was observed in 40% (34/85) of patients, of whom 52.9% (18/34) had 2pn embryos. Ten of the 85 patients (11.8%) underwent embryo transfer, resulting in biochemical pregnancy for two patients and healthy live birth for one patient.

Conclusion: When high-dose stimulation is ineffective, discontinuing gonadotropin administration during ovarian stimulation may provide patients with the opportunity to conceive using their own biological oocytes. To the best of our knowledge, this is the first study to report a live birth rate using this strategy.

Objective: To comprehensively analyze the expression and prognostic value of selenoprotein in ovarian cancer (OV).

Materials and methods: GEPIA and cBioPortal were used to analyze selenoprotein expression and mutations and copy number variations. Kaplan-Meier plotter and the tumor immune estimation resource were used to evaluate the impact of these genes on clinical prognosis and their correlation with tumor immune infiltration.

Results: Compared with normal tissues, the expression of iodothyronine deiodinase 3 (DIO3), glutathione peroxidase 4, SECISBP2, SELM, and SELP was decreased in the four gynecological malignancies. In OV, selenoprotein had the highest number of mutations (309) and mutation frequency (52.91%), whereas the lowest was observed in endometrial cancer (29.72%). DIO3, selenoprotein O (SELO), and selenoprotein T (SELT) are significantly related to the prognosis of OV. Immune infiltration analysis showed that DIO3 was associated with tumor-associated macrophages, SELO with CD4+ T-cells and monocytes, and SELT with T-cells. Enrichment analysis revealed that DIO3 is mainly involved in inflammatory immune responses and the Ras signaling pathway, SELO is primarily related to innate immune responses, and SELT is closely associated with mitochondrial oxidative phosphorylation.

Conclusion: This study explored the expression characteristics of 25 selenoprotein in patients with gynecological malignancies and found that DIO3, SELO, and SELT were significantly associated with the prognosis and clinical features of OV, which are potential therapeutic targets.

Objective: To assess whether alterations in maternal serum apelin-13 levels differ between early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE).

Materials and methods: A prospective case-control study included 90 preeclamptic cases and 90 normotensive healthy pregnant women as controls. Preeclampsia cases were subclassified as EO-PE and LO-PE. Blood samples were collected, centrifuged, and the separated serum was stored at -80°C for further testing. Ethylenediamine tetraacetic acid blood was used for complete blood count. Serum sample was used for analysis of biochemical parameters. Maternal serum apelin-13 concentrations were measured using ELISA. Demographic details and fetal outcomes were recorded.

Results: Results indicated significantly lower gestational age at sampling and delivery in preeclampsia cases. Blood pressure (systolic, diastolic, and mean arterial pressure) was elevated in preeclampsia. Maternal serum apelin-13 levels (261.7±110.6 pg/mL) were significantly reduced in preeclamptic cases compared to controls (575.3±164.7 pg/mL). Adverse fetal outcomes were more prevalent in preeclampsia. Regarding EO-PE and LO-PE, gestational age at sampling and delivery was lower in EO-PE compared to LO-PE. Maternal serum apelin-13 levels (371.3±116.0 pg/mL) were higher in EO-PE. A 40.9% reduction in apelin-13 levels was observed in LO-PE compared to EO-PE, indicating a gradual reduction in apelin-13 levels in preeclampsia. Adverse fetal outcomes, such as birth weight (1.8±0.5 kg), were lower, and other adverse outcomes were higher in EO-PE compared to LO-PE.

Conclusion: Circulating serum apelin-13 concentration was reduced in preeclampsia and was higher in EO-PE than in LO-PE. Apelin-13 serves as a potential indicator for discriminating early-onset preeclampsia.

Objective: To evaluate the indications and methods of termination of pregnancy (TOP) and to identify maternal complications that occur during TOP.

Materials and methods: This retrospective study was conducted at a single tertiary center with a total of 231 patients who underwent TOP from April 2019 to March 2023. The patients were divided into two groups based on gestational age at the time of TOP and the presence of complications. Group 1 consisted of patients with a gestational age of 11-22+6 weeks (n=196), while Group 2 comprised patients with a gestational age of 23-30 weeks (n=35). Additionally, the patients were categorized based on complications into those with complications (n=63) and those without complications (n=168). The TOP protocol involves misoprostol, a uterine balloon, a combination of misoprostol and balloon, or oxytocin. Procedure-related complications included the following: Rehospitalization, rest placenta, infection, uterine rupture, blood transfusion, and repeated manual vacuum curettage.

Results: The median gestational age at TOP was 18.0±3.3 weeks for women without complications and 19.5±5.1 weeks for those with complications, it was 19.5±5.1 weeks (p=0.037). In the group with complications, the combined misoprostol-balloon method was used significantly more frequently, and the rate of previous cesarean sections was higher (p<0.05). The induction time was longer in the oxytocin group (p<0.05). The misoprostol-balloon combination group had the highest rate of uterine rupture (p<0.05).

Conclusion: TOP during advanced gestation is associated with increased rates of maternal complications, such as increased transfusion, uterine rupture, and hysterotomy. Higher gestational age and previous uterine surgery are the main causes of TOP-related maternal complications.

Objective: Copeptin is a glycopeptide that increases under stress and is present in polycystic ovary syndrome (PCOS) patients with metabolic system disorders. We examined the relationship between copeptin and reproductive function in patients with normoglycemic PCOS with anovulatory cycles and normal weight.

Materials and methods: Women with unexplained infertility (n=52) and women with PCOS (n=57) were included in the study. PCOS was determined using the Rotterdam criteria. Biochemical tests including estradiol, follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone (AMH), insulin, and copeptin were performed. Serum copeptin concentrations were measured using enzyme immunoassay.

Results: There were no significant differences in demographic data, insulin levels, and insulin resistance between the PCOS and healthy volunteers. Copeptin levels were lower in the PCOS group (p<0.001). A significant negative correlation was observed between AMH and copeptin in the control group (r=-0.402, p= 0.013). In the PCOS group, a negative correlation was observed between antral follicle count and copeptin, as well as between AMH and copeptin (r=-0.544, p<0.01). Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of copeptin levels. The estimated areas under the ROC curves for serum concentration were found to be statistically significant (p<0.001) with a cut-off value of 2.78 (95% confidence interval 0.701-0.896), sensitivity of 0.87, and specificity of 0.70.

Conclusion: This study showed that copeptin levels are lower in patients with PCOS in the absence of insulin resistance and obesity than in healthy volunteers, and there is a negative correlation between copeptin and reproductive markers.

Objective: To evaluate the potential advantages of combined general and epidural anesthesia for major gynecological oncological surgeries.

Materials and methods: The data of 690 gynecological cancer were retrospectively examined, and 223 patients who met the inclusion criteria were included in the study. The patients were divided into two groups: Group G (123 patients who received general anesthesia only) and Group C (100 patients who received combined epidural and general anesthesia. The perioperative follow-up data were comparatively analyzed.

Results: Operation times in Group G were significantly lower than those in Group C (p=0.018). The blood product replacement rate was higher in Group G (p<0.05). Additionally, intraoperative bleeding rates were lower in Group C (p<0.05). Postoperatively, the analgesic requirement time of Group C was significantly later than that of Group G (p=0.0001). The first mobilization time of Group C was substantially earlier (p=0.0001). Thrombosis and cardiac complications were considerably less frequent in group C, although allergic complications were more common (p<0.05). The length of hospital stay was shorter in Group C (p<0.05).

Conclusion: Combined epidural and general anesthesia in gynecological oncological surgeries may improve postoperative outcomes, including reduced analgesic requirements, earlier patient mobilization, shorter hospitalization, and decreased rates of complications, particularly cardiovascular and thrombotic events.

Objective: To review the outcomes of in vitro maturation (IVM) and in vitro fertilization (IVF) in women with empty follicle syndrome (EFS). The study evaluated the genetic underpinnings of EFS by analyzing mutations.

Materials and methods: This retrospective case series involving 17 women with EFS over at least 2 IVF cycles was conducted. The study also employed whole-exome sequencing to analyze the genetic mutations. The treatment approaches included letrozole-primed IVM, follicle-stimulating hormone (FSH)-human chorionic gonadotrophin (hCG)-primed IVM, and conventional IVF.

Results: The average female age was 31.5±4.6 years, and the duration of infertility was 7.3±3.5 years. Four patients underwent IVF. IVM oocyte collections yielded oocytes in 12 of 13 subjects. Of these, 75% (9/12) yielded MII oocytes after 48 h of IVM media incubation. Six subjects had fertilized embryos, resulting in a 40.9% intracytoplasmic sperm injection (ICSI) fertilization rate (9 embryos/22 MII oocytes). Genetic analysis revealed mutations in seven patients. This study demonstrated the partial efficacy of letrozole-primed IVM plus growth hormone and FSH-hCG primed IVM protocols. No pregnancies or live births were recorded after IVM. One ongoing pregnancy post-IVF and one spontaneous live birth were observed.

Conclusion: Inter-cycle variabilities were observed in women with oocyte maturation abnormalities (OMAs). Almost all patients with EFS had oocytes collected during IVM following IVF. These oocytes have limited potential for maturation, fertilization, and live birth, as demonstrated by the low rates observed after IVM culture and ICSI. These conditions are observed in OMAs due to defects in the oocyte machinery. The proposed flowchart provides a comprehensive classification approach for various forms of EFS.