Turkish Journal of Obstetrics and Gynecology最新文献

To compare the efficacy and safety of single-incision laparoscopic surgery (SILS) versus conventional laparoscopic surgery (CLS) for the surgical management of ectopic pregnancy through a systematic review and meta-analysis. We searched Medline, PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane databases from inception to May, 2023 for studies comparing SILS with CLS in ectopic pregnancy treatment. Included studies were controlled and observational, excluding single-arm studies, meta-analyses, and reviews. Quality was assessed using ROBINS-I for observational studies and the Cochrane tool for randomized trials. Data were analyzed with OpenMetaAnalyst and Review Manager 5.4.1, using odds ratios for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twelve studies involving 880 women (372 SILS, 508 CLS) were included. SILS showed significantly less blood loss (MD=-51.01 mL, p=0.004), shorter postoperative hospital stay (MD=-0.24 days, p=0.003), and faster return of bowel function (MD=-1.03 hours, p<0.01), compared to CLS. No significant differences were found in total operative time, hemoglobin change, blood transfusion requirements, or number of patients needing transfusions. Patient satisfaction data were limited but suggested better cosmetic outcomes with SILS. SILS is a feasible and effective alternative to CLS for ectopic pregnancy, offering reduced blood loss, shorter hospital stays, and quicker bowel function recovery. These benefits, alongside potential cosmetic advantages, make SILS a promising option, particularly for young women. Further research is needed to confirm long-term outcomes and optimize patient selection.

Objective: This study aimed to investigate the relationship between cervical intraepithelial neoplasia associated with human papillomavirus (HPV) infection and the vaginal microbiome.

Materials and methods: In this study, the vaginal microbiota profile was compared among three groups of women: those with HPV infection and no cervical intraepithelial neoplasia (NILM, n=35), those with low-grade squamous intraepithelial lesions (LSIL, n=28), and those with high-grade squamous intraepithelial lesions (HSIL, n=24). Vaginal bacterial diversity was analyzed by deep sequencing of the V3-4 region of the barcoded 16S rRNA gene using the Illumina MiSeq platform, considering alpha diversity, beta diversity, and taxon classifications. Statistical significance was set at p<0.05.

Results: In the analyses performed using Chao1, Inverse Simpson, Shannon, and Observed indices, statistically significant differences were found among the groups in terms of all indices (p<0.05). Among groups, beta diversity did not show any notable differences. According to the "Linear Discriminant Analysis Effect Size" analysis, the taxa enriched in the HSIL group were Roseburia inulinivorans (p=0.0308), Micromonosporaceae family (p=0.0331), and Pirellula genus and species, (Planctomycetes), (p=0.0165); the taxa enriched in the LSIL group were Actinobaculum genus and species (p=0.0183). Lactobacillus helveticus and Faecalibacterium prausnitzii were more abundant in the NILM group, while Prevotella copri, Akkermansia muciniphila, and Fusobacterium species were more abundant in the LSIL and HSIL groups.

Conclusion: Our findings indicate that variations in the severity of cervical lesions are associated with notable alterations in vaginal microbiota composition. Further research is required to conclude which contribute to the formation of the cervical lesion and which are a consequence, among those that cause changes in the vaginal microbiota, of the lesion.

Objective: In cases requiring fetal diagnostic testing, conventional karyotype analysis is initially preferred. However, quantitative fluorescent-polymerase chain reaction (QF-PCR) or fluorescent in situ hybridization methods are used alongside conventional karyotype analysis to obtain rapid results. If results cannot be obtained from conventional karyotype analysis, chromosomal microarray analysis (CMA) is a reasonable option in necessary cases. In this study, we analyzed the conventional karyotype and CMA results from pregnancies reported as having normal karyotypes by QF-PCR and assessed their correlation with ultrasound imaging results.

Materials and methods: Between 2020 and 2023, pregnant women with fetal structural anomalies detected by ultrasound and magnetic resonance imaging at the Eskişehir City Hospital, Clinic of Perinatology were referred to our prenatal diagnosis center. In samples obtained using appropriate diagnostic methods, QR-PCR and conventional karyotype analysis were performed initially. Pregnancies with chromosomal anomalies detected by QF-PCR were excluded from the study. For pregnancies with normal karyotypes, CMA was applied.

Results: In 203 pregnancies with a normal karyotype result from QF-PCR, 202 (99.5%) were reported as normal in conventional karyotype analysis, while 1 (0.5%) case showed deletion of chromosome 7. Among the remaining pregnancies, CMA examination revealed abnormal karyotype results in 25 (12.3%) cases. A relationship was found only between ventriculomegaly detected by ultrasound and CMA results. The prevalence of ventriculomegaly was higher in those with CMA abnormalities (16%) compared to those with normal CMA (4.5%), and this difference was statistically significant (p=0.045).

Conclusion: The benefit of CMA analysis in detecting chromosomal anomalies such as copy number variations, especially in cases reported as having a normal karyotype by QF-PCR and karyotype analysis, is evident. To evaluate the relationship between ultrasound anomalies and CMA results, each community should assess its own results.

Objective: The aim of this study is to assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) in detecting pelvic and paraaortic lymph node involvement in cervical cancer patients by correlating imaging results with surgical pathology findings.

Materials and methods: A retrospective analysis was conducted on cervical cancer patients treated at İstanbul Medeniyet University Prof. Dr. Süleyman Yalçın City Hospital from 2016 to 2022. Patients who underwent preoperative PET/CT or MRI imaging and subsequent lymph node dissection were included. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each imaging modality.

Results: Of the 75 cases reviewed, 52 met the inclusion criteria. PET/CT had higher specificity (94.1%) than MRI (82.4%), while MRI demonstrated greater sensitivity (55.6% vs. 50%). False-negative rates were 15.3% for MRI and 17.3% for PET/CT. Receiver operating characteristic analysis indicated an area under the curve of 0.78 for PET/CT and 0.69 for MRI. No statistically significant differences in sensitivity or specificity were observed, with both modalities showing complementary strengths.

Conclusion: MRI and PET/CT each contribute significantly to preoperative cervical cancer evaluation, with MRI favored for local assessment and PET/CT for nodal detection. Combining both modalities enhances diagnostic accuracy. Further prospective research is required to confirm and strengthen these results. and improve imaging strategies for clinical practice.

Objective: One of the most common chromosomal abnormalities seen during pregnancy is Down syndrome (Trisomy 21). To determine the risk of Down syndrome, first-trimester combined screening tests are essential. Using data from the first-trimester screening test, this study compares machine learning and deep learning models to forecast the risk of Down syndrome.

Materials and methods: Within the scope of the study, biochemical and biophysical data of 959 pregnant women who underwent first-trimester screening tests at Çukurova University Obstetrics and Gynecology Clinic between 2020-2024 were analyzed. After cleaning missing and erroneous data, various preprocessing and normalization techniques were applied to the final dataset consisting of 853 observations. Down syndrome risk prediction was performed using different machine learning models, and model performances were compared based on accuracy rates and other evaluation metrics.

Results: Experimental results show that the CatBoost model provides the highest success rate, with an accuracy rate of 95.31%. In addition, the XGBoost and LightGBM models exhibited high performance, with accuracy rates of 95.19% and 94.84%, respectively. The study also examines the effects of the class imbalance problem on model performance in detail and evaluates various strategies to reduce this imbalance.

Conclusion: The findings show that gradient boosting-based machine learning models have significant potential in Down syndrome risk prediction. This approach is expected to contribute to the reduction of unnecessary invasive tests and improve clinical decision-making processes by increasing the accuracy rate in prenatal screening processes. Future studies should aim to increase the generalization capacity of the model on larger data sets and to provide integration with different machine learning algorithms.

Polycystic ovary syndrome (PCOS), affecting 5-10% of reproductive-aged women, is linked to metabolic disturbances such as insulin resistance, obesity, and lipid imbalance, which may elevate cardiovascular disease (CVD) risk. The relationship between PCOS and clinical cardiovascular events remains unclear. This meta-analysis evaluates the association between PCOS and cardiovascular and cerebrovascular events, including myocardial infarction (MI), stroke, ischemic heart disease (IHD), and overall CVD. We conducted a systematic review and meta-analysis of observational cohort studies published up to August 2024. Studies investigating the association between PCOS and cardiovascular or cerebrovascular events were included. Hazard ratios (HR) were used to assess mortality risk, while odds ratios (OR) evaluated CVD incidence. Statistical analyses were performed using STATA software, with publication bias assessed via funnel plots. Nineteen cohort studies, involving 1,222,912 participants, were analyzed. Women with PCOS had a significantly higher risk of stroke [OR: 1.89, 95% confidence interval (CI): 1.22-2.55]. However, no significant associations were found between PCOS and overall CVD (HR: 1.80, 95% CI: 5.43-9.04), MI (HR: 2.68, 95% CI: 0.69-4.82), or IHD (HR: 2.68, 95% CI: 0.69-4.67). Additionally, there was no significant increase in cardiovascular or all-cause mortality. This meta-analysis highlights that women with PCOS are at an increased risk of stroke, but no conclusive evidence links PCOS to other cardiovascular outcomes or mortality. Clinicians should prioritize stroke prevention in this population. Further large-scale, long-term studies are needed to clarify the cardiovascular risks associated with PCOS.

Objective: Sexual function and quality of life are significantly reduced in endometriosis patients, particularly those with deep infiltrative endometriosis (DIE). The purpose of this study was to compare the effects of endometriosis excision and excision techniques on sexual function among individuals with DIE to those of healthy females in an objective manner.

Materials and methods: Our study included 140 individuals who were diagnosed as having DIE and reported dyspareunia in our clinic between January 2018 and 2024, and 70 patients who presented to our family planning clinic. The preoperative and 6-month post-surgery scores of the female sexual function index (FSFI), quality of sexual experience scale (QSES), and visual analog scale (VAS) values of all patients who described preoperative dyspareunia were examined retrospectively from the patient files.

Results: In our study, the FSFI score of healthy groups was seen to be significantly greater than the pre-surgery and post-surgery groups (p<0.001 and p<0.001, respectively). The QSES scores of the healthy group were found to be significantly higher than the pre-surgery and post-surgery groups (p<0.001 and p<0.001, respectively). The VAS dyspareunia values of the healthy group were discovered to be significantly lower than the pre-surgery and post-surgery groups (p<0.001 and p<0.001, respectively). The FSFI and QSES scores of the post-surgery group were significantly higher than those of the pre-surgery group (p<0.001 and p<0.001, respectively). The VAS dyspareunia score of the post-surgery group was seen to be significantly lower than that of the pre-surgery group (p<0.001). The FSFI and QSES scores of patients who underwent laparotomy were discovered to be significantly greater than that of individuals who underwent laparoscopic surgery (p<0.001 and p=0.01, respectively).

Conclusion: The surgical approach may have a positive effect on both organ dysfunction and sexual function in women with DIE; this issue should be considered carefully.

Objective: This study aims to compare the effects of three-dimensional (3D) laparoscopic ovarian cystectomy on ovarian reserve according to different types of ovarian cysts.

Materials and methods: Participants who underwent surgical treatment for ovarian cysts between 2018 and 2020 were included in this study. Anti-müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels were measured before surgery and six months postoperatively. All procedures were performed under general anesthesia using 3D laparoscopy. Participants were classified into three groups based on histopathological findings: group 1, endometriomas; group 2, mature cystic teratomas (dermoid cysts); and group 3, serous or mucinous cystadenomas.

Results: A total of 51 women were included in the study. No significant differences were observed between the groups in terms of perioperative variables such as operation time, intraoperative blood loss, postoperative hemoglobin decrease, and maximum cyst diameter. There were also no significant differences among the groups in preoperative AMH (p=0.97) and FSH (p=0.22) levels. Postoperative AMH levels were significantly lower than preoperative values in both the endometrioma group (p<0.001) and the dermoid cyst group (p=0.004). The reduction in AMH levels was more pronounced in the endometrioma group compared to the other groups. Postoperative FSH levels tended to increase in all groups compared to preoperative levels; however, this increase was not statistically significant (p=0.092).

Conclusion: 3D laparoscopic cystectomy for the removal of endometriomas and dermoid cysts significantly reduces ovarian reserve. In contrast, laparoscopic cystectomy for serous or mucinous cysts appears to have no significant impact on ovarian reserve.

Objective: This study aimed to investigate the relationship between serum vitamin D levels and the severity of symptoms in individuals with hyperemesis gravidarum (HG).

Materials and methods: A cohort of eighty patients exhibiting vomiting three or more times daily, positive ketones on complete urinalysis, and oral feeding difficulties were recruited. Symptom severity was assessed using the 8-question Rhodes index, categorizing patients into non-symptomatic, mild, moderate, and severe groups. Serum vitamin D levels were measured using venous blood samples; a deficiency was defined as less than 10 ng/mL, an insufficiency as 10-20 ng/mL, and a normal level as more than 20 ng/mL.

Results: The distribution of symptom severity revealed 14 (17.5%) with mild, 38 (47.5%) with moderate, and 28 (35%) with severe symptoms. Groups showed no significant differences in demographic or obstetric characteristics except for ketone positivity rates (p<0.05). There was a significant difference in vitamin D levels between the severity groups: mild symptoms (32.12±4.02 ng/mL), moderate symptoms (19.98±6.37 ng/mL), and severe symptoms (8.11±3.06 ng/mL) (p<0.001). Vitamin D and the Rhodes index mean score showed a significant negative relationship (r=-0.844, p=0.001). With 96.4% sensitivity and 89.5% specificity, receiver operating characteristic analysis showed that symptom intensity rose when blood vitamin D levels were less than 11.54 ng/mL.

Conclusion: These results highlight a negative relationship between the severity of HG symptoms and serum vitamin D levels. Screening pregnant women with nausea, vomiting, and severe symptoms for serum vitamin D deficiency is recommended. Appropriate pre-pregnancy treatment should be initiated for those deficient or insufficient in serum vitamin D to potentially alleviate HG symptom severity and frequency.

Objective: Evaluating the therapeutic effect of detorsion, resveratrol, and nifedipine on ovarian viability assessed by biochemical, histopathological and immunohistochemical parameters and markers of oxidative stress.

Materials and methods: Twenty-four Sprague-Dawley rats were included in 4 groups, namely: sham operation, ischemia-reperfusion (I/R), I/R+10 mg/kg nifedipine (NIF), I/R+100 mg/kg resveratrol (RSV). In the study groups, bilateral 720º ovarian torsion was performed and continued for 3 hours, followed by detorsion for another 3 hours. Thirty minutes before the detorsion, NIF and RSV groups received respective treatments. Adnexectomy was performed, and evaluations were made for the expression of anti-müllerian hormone (AMH), vascular endothelial growth factor receptor 2 (VEGFR-2), markers of oxidative stress, and follicle counts. Blood AMH levels were measured.

Results: No change in AMH levels was detected. Although the expression of AMH was significantly reduced following I/R alone, it remained similar to the control group in the NIF group. Meanwhile, the RSV group exhibited slightly lower expression than the control, although it was still higher than that observed with the I/R injury group. VEGFR-2 staining was similar in the I/R and NIF groups, but reduced in the RSV group. Markers of oxidative stress were similar between groups. Primordial follicle count was lower in the untreated I/R injury group compared to the control group (p<0.05). The NIF group had more secondary follicles than the I/R injury and RSV groups (p<0.05).

Conclusion: Nifedipine and resveratrol treatments did not influence AMH levels and antioxidant-oxidant system parameters in rats exposed to I/R injury. However, nifedipine had a positive effect on AMH expression and secondary follicle count, and resveratrol decreased the expression of VEGFR-2 in tissues, which can be an indicator of their clinical potential.