Turkish Journal of Obstetrics and Gynecology最新文献

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.

Objective: This study aimed to investigate whether Fourier transform infrared (FTIR) spectroscopy applied to cervical swab samples could detect meaningful biochemical differences between women diagnosed with endometriomas and healthy controls, thereby assessing its potential as a non-invasive diagnostic tool.

Materials and methods: A total of 104 cervical swab samples-52 from women with endometriomas diagnosed via transvaginal ultrasonography and 52 from healthy controls-were initially collected and processed. Following an optimization process and quality control of spectral data, 24 endometrioma and 20 control samples were included in the final analysis. FTIR spectra were obtained in the 4000-600 cm^-1 range, and the primary outcomes included comparative peak intensities and areas under specific wavenumbers reflecting various bio-organic molecules.

Results: Statistically significant differences were observed at 2350 cm^-1 and 1050 cm^-1, indicative of alterations in carbon dioxide and carbohydrate metabolism, respectively, in the endometrioma group compared with healthy controls (p<0.05). No significant differences were detected in other spectral regions associated with lipids (2950, 1460, 1400 cm^-1) and proteins (e.g., amid-I and amid-II regions), suggesting that endometrioma may primarily affect carbohydrate metabolism and carbon dioxide balance rather than lipid and protein pathways. Both groups were comparable in demographic and hormonal characteristics, thus bolstering the validity of the findings.

Conclusion: FTIR spectroscopy of cervical swab samples revealed distinctive biochemical profiles in women with endometriomas, particularly related to carbon dioxide and carbohydrate metabolism. These data suggest that FTIR analysis, which is rapid and minimally invasive, holds promise for the future development of non-invasive diagnostic strategies for endometrioma. However, larger multicenter studies that include surgical confirmation and disease staging are needed to establish its clinical utility definitively.

Objective: To evaluate the bleeding degree with objective indices and treatment interventions in the delivery of inherited factor deficiency pregnancies.

Materials and methods: The presented case-control study was conducted with pregnancies with factor deficiencies. Maternal obstetrical history, disease characteristics (factor levels, duration of disease, and bleeding history), and treatment features during pregnancy were evaluated. Obstetric (delivery mode, antepartum/postpartum bleedings) and neonatal outcomes (birth weights, birth weeks, APGAR scores) of the study group were compared to those of the control group. The Delta hemoglobin/hematocrit (prepartum - postpartum hemoglobin/hematocrit), and hemoglobin and hematocrit % change [(prepartum - postpartum hemoglobin/hematocrit)/prepartum hemoglobin/hematocrit] indices were used to assess the extent of bleeding during delivery.

Results: None of the patients had an early postpartum hemorrhage. The delta hemoglobin and hematocrit values were increased in the factor deficiency group, with p-values of 0.019 and <0.001. The hemoglobin and hematocrit percentage changes were also found to increase, associated with p-values of <0.001 and 0.010. Three of the patients (16.7%) had postpartum complications. Gestational age at birth, APGAR scores at 1 and 5 minutes were lower in the factor deficiency group with p-values of 0.016, <0.001, and <0.001, respectively. There was one stillbirth. Most patients received peripartum tranexamic acid treatment, with factor derivatives and desmopressin in required cases.

Conclusion: Hemoglobin/hematocrit delta and change rate indices were increased, although none of the patients were recorded as having early peripartum hemorrhage or needing transfusion. New delta bleeding indices are promising for objectively identifying bleeding and regulating treatment in clinical practice. The experience of this clinical study might guide future studies.

Objective: The study aims to evaluate the transaminase complex-platelet ratio (TACPR), a novel composite biomarker derived from routine laboratory parameters, in its ability to serve as a predictor of intrahepatic cholestasis of pregnancy (ICP) and related adverse perinatal outcomes.

Materials and methods: This retrospective study included 98 pregnant women diagnosed with ICP and 100 matched healthy controls at a tertiary referral center between January 2024 and March 2025. TACPR was calculated as (alanine aminotransferase x aspartate aminotransferase)/platelet count. Groups were compared in terms of clinical characteristics, TACPR values (first trimester and diagnosis), and perinatal outcomes. Receiver operating characteristic analysis and multivariate logistic regression were used to assess predictive performance and independent risk factors for ICP and composite adverse perinatal outcomes (CAPO).

Results: TACPR values were significantly higher in the ICP group at both time points (p<0.001). In the first trimester, a TACPR >1.35 predicted ICP [area under curve (AUC)=0.806], while a TACPR >1.81 predicted CAPO (AUC=0.759). At diagnosis, a TACPR >27.7 predicted severe ICP and a TACPR >7.15 predicted CAPO. TACPR >1 in the first trimester was independently associated with ICP [odds ratio (OR)=5.49, p<0.001], and TACPR >50 at diagnosis was independently associated with CAPO (OR=4.38, p=0.009). A weak yet statistically significant correlation was identified between first trimester TACPR and peak serum bile acid levels (r=0.325, p=0.001).

Conclusion: TACPR is a novel, cost-effective biomarker for early identification and risk stratification of ICP and associated perinatal complications. Its integration into routine prenatal screening may enhance timely diagnosis and intervention, particularly in resource-limited settings.