Turkish Journal of Obstetrics and Gynecology最新文献

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.

Objective: Radical hysterectomy with parametrectomy remains the standard treatment for early-stage cervical cancer but is associated with significant morbidity. Identifying patients at low risk for parametrial invasion is critical to support less invasive surgical strategies.

Materials and methods: This retrospective study evaluated 177 patients with Federation of Gynecology and Obstetrics 2018 stage IA-IIB cervical cancer who underwent type III radical hysterectomy with lymphadenectomy between 2001 and 2020. Clinical and pathological data were analyzed to identify predictors of parametrial invasion.

Results: Parametrial invasion was observed in 40 patients (22.6%). These patients were significantly older (mean age 56.05±11.16 vs. 49.21±10.80 years, p=0.013), and they were more likely to be postmenopausal. Parametrial invasion was associated with larger tumor size (35.10±13.72 mm vs. 24.15±13.50 mm), greater depth of stromal invasion (>10 mm), lymphovascular space invasion (LVSI), and lymph node metastases, (pelvic and paraaortic), all p<0.01. Bivariate logistic regression identified age ≥55 years [odds ratio (OR): 3.302 95% confidence interval (CI): 1.432-7.614, p=0.005], LVSI positivity [OR: 3.952 (95% CI: 1.641-9.518, p=0.002], and stromal invasion depth >10 mm [OR: 5.326 (95% CI: 2.157-13.153, p<0.001] as independent predictors of parametrial invasion.

Conclusion: Age ≥55, LVSI, and deep stromal invasion are significant independent risk factors for parametrial invasion. Careful evaluation of these parameters may guide the selection of patients suitable for less radical surgery, potentially reducing morbidity without compromising oncologic outcomes.

Objective: Recurrent hydatidiform mole (RHM) is a rare disorder which is characterized by the presence of at least two molar pregnancies. The mutations in the NLRP7 and KHDC3L genes are responsible for the majority of recurrent molar pregnancies. This study aimed to demonstrate the diversity and frequency of NLRP7 and KHDC3L gene mutations in our Turkish cohort with recurrent molar pregnancies, and to establish genotype-phenotype correlation.

Materials and methods: It was aimed to represent the detected NLRP7 and KHDC3L gene variants and reproductive history of 32 recurrent mole hydatidiform patients. We analysed the retrospective clinical and sequence data of 32 patients, who were referred to the laboratory for NLRP7 and KHDC3L sequencing.

Results: Among the detected 32 patients with recurrent molar pregnancy, 18 of 32 patients had no mutation in these two genes; we found 7 cases of homozygous NLRP7 variant, 1 case of heterozygous NLRP77 variant, 3 cases of homozygous KHDC3L gene variant, and 1 case of heterozygous KHDC3L gene variant. Among the detected NLRP7 variants, 3 of 11 variants were classified as pathogenic, 7 of 11 variants were classified as likely pathogenic, and 1 of 11 variants was classified as variant of unknown significance (VUS). Among the detected KHDC3L variants, 1 of 4 was classified as pathogenic, 2 of 4 were classified as likely pathogenic, and 1 of 4 was classified as VUS. Seven unpublished NLRP7 gene variants and two unpublished KHDC3L gene variants were first reported in this study.

Conclusion: Here we report new RHM patients with NLRP7 and KHDC3L mutations. The current study highlights the importance of defining new cases and novel mutations in the pathogenesis and clinical management of RHM. Understanding genotype-phenotype correlations in RHM patients will also contribute to the selection of treatment methods and patient management.

Objective: We aimed to demonstrate the predictive value of morphological assessment of cumulus-oocyte complexes (COCs) prior to denudation in distinguishing mature and immature oocytes.

Materials and methods: The study consisted of two stages. Five embriologists were enrolled to the first stage of the study and they divided COCs into two groups according to the morphologic features of the COS's: COCs with mature oocytes and COCs with immature oocytes. The process was overseen by one embryologist. Two hours later, COCs were denuded, and the maturity of oocytes was evaluated by another embryologist. The results were recorded. The first stage was terminated when each embryologist had evaluated a minimum of 100 COCs. In the second stage, three embryologists applied the procedure continuously for one more month. At the end of the study, the effects of continuous assessment on the prediction success were evaluated.

Results: Eighty patients were enrolled in the study, and a total of 1039 COCs were examined. In the first stage of the study, 69% of immature and 80% of mature oocytes were identified correctly by the embryologists. There was no significant difference among the embryologists in terms of success rates. In the second stage of the study, the success rates of immature oocyte prediction increased for all three embryologists. However, a statistically significant increase was observed for only one embryologist (p<0.05). However, the prediction rates of mature oocytes were comparable with the results of the first stage of the study. There was no significant relationship between the number of COCs and the prediction value.

Conclusion: Morphological assessment of COCs before denudation does not provide accurate results in identifying mature and immature oocytes.

Objective: N-acetylcysteine (NAC), an aminothiol compound, eliminates free radicals and enhances glutathione (GSH) synthesis, thereby strengthening intracellular antioxidant defenses. Although its protective effects against ovarian injury have been reported, its efficacy in doxorubicin (DOX)-induced ovarian failure has not been demonstrated. This study aimed to investigate whether NAC exerts a protective role against DOX-induced ovarian toxicity in female rats.

Materials and methods: Twenty-one adult female rats were randomly assigned to three groups: Control, DOX (10 mg/kg, i.p., single dose), and DOX+NAC (150 mg/kg, i.p., for 5 days; DOX administered on day 3, one hour after NAC). Serum and tissue oxidative stress parameters, histopathological changes, proliferating cell nuclear antigen (PCNA) immunoreactivity, and TUNEL assay were evaluated.

Results: DOX significantly reduced serum anti-Müllerian hormone (AMH) (6.75 → 5.31 ng/mL; p<0.001) and GSH (422.64 → 280.98 mg/L; p<0.001), while increasing tumor necrosis factor alpha (TNF-α) (175.87 → 260.77 ng/L; p<0.001) and total oxidant status (TOS) (7.18 → 11.84 U/mL; p=0.002). NAC treatment reversed these alterations, namely: AMH (6.51 ng/mL; p=0.004), GSH (363.86 mg/L; p=0.018), TNF-α (184.55 ng/L; p<0.001), TOS (7.88 U/mL; p=0.003). In ovarian tissue, DOX reduced GSH (123.63 → 80.64 mg/L; p=0.001) and total antioxidant status (14.88 → 10.57 U/mL; p<0.001), while elevating TOS (7.14 → 12.64 U/mL; p<0.001) and caspase-3 (2.06 → 3.14 ng/mL; p<0.001). NAC significantly improved all these parameters (p≤0.005). Histologically, DOX caused edema, hemorrhage, infiltration, and a reduction in the percentage of healthy follicles, whereas NAC markedly ameliorated these alterations. Furthermore, NAC enhanced PCNA expression and reduced TUNEL-positive granulosa cells, supporting its anti-apoptotic effect.

Conclusion: NAC preserved ovarian reserve and follicular integrity by suppressing oxidative stress, inflammation, and apoptosis induced by DOX. These findings highlight NAC as a promising protective agent against chemotherapy-induced ovarian toxicity.

Objective: Toxoplasmosis is an intracellular parasite and one of the most common congenital infections. Currently, there is no clear consensus on routine screening for toxoplasma infection during pregnancy. This study aimed to discuss the results of antenatal toxoplasma screening in a tertiary center.

Materials and methods: A retrospective study including the data of the antenatal toxoplasmosis screening test results over four years. Toxoplasma immunoglobulin M (IgM), toxoplasma immunoglobulin G (IgG), anti-IgG avidity test results, amniocentesis, and toxoplasma polymerase chain reaction (PCR) were obtained from the hospital records. Patients with missing toxoplasma IgM, IgG, anti-IgG avidity, test results were excluded from the study. In addition, the fetal outcomes and follow-up information for the newborns of pregnant women who gave birth in our hospital were recorded.

Results: During the study period, a total of 49,292 toxoplasma IgM tests were examined. Fifty pregnant women whose toxoplasma IgM was positive with a low-anti-toxoplasma IgG avidity index were enrolled in the study group. Forty percent of the pregnant women are expected to have amniocentesis. There was only one termination of pregnancy with specific ultrasonographic findings. Toxoplasma PCR was found to be negative in the other pregnant women. Of the pregnant women who were followed up, 23 gave birth in our hospital and the Sabin Feldman test was positive in 65.2 percent (15/23) of the newborns.

Conclusion: Antenatal toxoplasmosis screening should be preserved for pregnant women with fetal ultrasonographic findings which may be related to toxoplasmosis. Further studies are needed.

Objective: Prognostic biomarkers in patients with advanced cervical cancer treated with immune checkpoint inhibitors remain unclear. An evaluation of combined positive score (CPS) and tumor proportion score (TPS), and a comparison of their usefulness with inflammatory biomarkers in real-world data could be informative.

Materials and methods: We analyzed 28 patients who were treated with the KEYNOTE-826 regimen between November 2022 and June 2024. The complete cohort (group 1), patients with no prior chemotherapy (group 2), and treatment-naïve (group 3) were evaluated as follows: 1) CPS, TPS, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hemoglobin, albumin, lymphocyte, and platelets (HALP score) in peripheral blood samples were obtained prior to initial treatment and KEYNOTE-826 regimen, and receiver operating curve analysis was used to compare them. The optimal cut-off values that showed the highest level of discrimination for progression-free survival were identified.

Results: The areas under the curve (AUC) for progression-free survival in group 2 were measured for CPS, TPS, NLR, PLR, and HALP scores before the KEYNOTE-826 regimen. The AUC values for these scores were 0.644, 0.662, 0.852, 0.667, and 0.700, respectively. The lower NLR (≤5.52) group had a significantly longer median survival than the higher NLR (>5.52) group (p˂0.001), with median survivals of 14.0 vs. 7.6 months, respectively. In group 3, CPS and TPS were highest at 0.700 for predicting progression-free survival, compared to NLR, PLR, and HALP score. CPS and TPS appear positively correlated with progression-free survival.

Conclusion: CPS and TPS showed a modest correlation with progression-free survival and NLR prior to immunotherapy demonstrated the best treatment efficacy for advanced cervical cancer.

Objective: Urinary incontinence (UI) is a common issue during pregnancy. Pelvic floor muscle training (PFMT) may offer an effective solution for managing this condition. This study aimed to evaluate the effect of PFMT on reducing UI symptoms in pregnant women.

Materials and methods: This study was conducted on 40 UI pregnant women with gestational diabetes mellitus (GDM) and 40 UI pregnant women without GDM. The participants in the experimental group were treated for 10 weeks in the third trimester, whereas the control groups received an educational pamphlet. Quality of life and UI severity were assessed using questionnaires, and pelvic floor muscle performance was measured through ultrasound-based bladder base displacement. Assessments were performed before treatment, after 10 weeks, and 2 weeks postpartum.

Results: In the non-diabetic group, significant reductions in UI symptoms were observed at the end of the third trimester and 2 weeks postpartum [adjusted difference -7.56, 95% confidence interval (CI) -10.62 to -4.49, p<0.001]. However, in the diabetic group, a reduction was noted, but it was not statistically significant. Additionally, the intervention positively impacted quality of life in the non-diabetic group (adjusted difference 30.8, 95% CI 17.6 to 44.1, p<0.001) but not in the diabetic group. Notably, no significant improvement in pelvic floor muscle performance was observed in either group.

Conclusion: This study suggests that PFMT can be more effective than routine pamphlets in reducing UI symptoms and improving the quality of life in pregnant women, both with and without GDM. Further research is needed to explore effects on pelvic floor muscle performance.