Turkish Journal of Obstetrics and Gynecology最新文献

Objective: Although there are several guidelines in the literature on "recurrent abortion", there is no comprehensive guideline on "threatened abortion". The overall purpose of this guideline is to provide healthcare providers with the best available evidence for examination and treatment of pregnant women with threatened abortion.

Materials and methods: The scope of the guideline and the first version of the questions were prepared by the Perinatology and High Risk Pregnancies Association (PERİDER) guideline development group in January 2024. Meetings were held to discuss key questions and redefine them. A final list of 8 key questions was created. Keywords were defined for each question and ranked in order of importance and used in searches for all English-language publications in PubMed/Medline and Cochrane libraries. These databases were thoroughly scanned for publications that were published until February 1, 2024. Literature reviews were conducted as an iterative process. In the first step, systematic reviews and meta-analyses were collected. If no results were found, the research was expanded to randomized controlled trials and then to cohort studies and case reports, following the hierarchy of evidence levels.

Results: This guideline was presented to the board of directors of the Turkish Gynecology and Obstetrics Society (TJOD). With their suggestions, guideline was finalized, and it was decided to be published as a joint guideline of PERİDER-TJOD.

Conclusion: This guideline provides an overview of threatened abortion and the recommended treatments. In addition, by recognizing the deficiencies in the literature, suggestions were made regarding research that could help clinicians' decisions in the future.

Objective: To determine urinary incontinence (UI) inquiry forms to be used in the follow-up of incontinence according to UI type.

Materials and methods: This prospective cohort study was conducted at the University of Health Science Hospital between 2020 and 2022. A total of 449 patients referred for urodynamic evaluation for UI were included herein, and clinical results regarding UI types were collected and reviewed. The validated urogenital distress inventory 6 (UDI-6), incontinence impact questionnaire (IIQ-7), and incontinence quality of life (I-QOL) questionnaires were completed by all patients. The demographic data of the patients, total questionnaire scores, and urodynamic results were compared between the groups according to UI type.

Results: Forty-nine percent of the participants were in the menopausal period, and 41% required regular ped use. A total of 52.1% of patients experienced 5 years of UI. Stress incontinence was reported in 4.2% of patients, urge incontinence in 10%, stress-predominant mixed UI in 59.2%, and urge-predominant mixed UI in 24.7%. The mean ± standard deviation values were 59.62±20.62 for the UDI-6, 54.72±24.84 for the IIQ-7, 62.41±23.52 for the total I-QOL, 21.85±8.55 for the I-QOL limitation of behaviors subscale, 27.99±10.86 for the I-QOL psychological influence subscale, and 12.64±5.72 for the I-QOL social isolation subscale. A statistically significant difference was assessed between the urodynamics results and the UDI-6, IIQ-7, total I-QOL, I-QOL limitation of behaviors subscale, I-QOL psychological influence subscale, and I-QOL social isolation subscale scores (p<0.001 for all variables).

Conclusion: In patients diagnosed with UI, when each of the 3 questionnaires for UI diagnosis was compared, the best inquiry questionnaire for the prediction of mixed-type UI was the UDI-6.

Objective: Fetal cardiac anomalies are among the leading causes of infant mortality due to congenital anomalies. The prenatal diagnosis of congenital heart diseases allows for the acquisition of prognostic information before birth and provides insights into treatment options either before or after delivery. This study aims to observe the correlation between the prenatal and postnatal diagnoses of fetuses with cardiac anomalies detected in our perinatology clinic. The goal, by tracking postnatal outcomes and identifying risk factors, is to assist in selecting the most appropriate approach, prioritizing maternal and fetal health.

Materials and methods: The records of 188 fetuses diagnosed during the prenatal period by the Perinatology Department of Obstetrics and Gynecology at Çukurova University Faculty of Medicine, delivered and admitted to the Çukurova University Neonatal Intensive Care Unit, and undergoing fetal echocardiography by the Pediatric Cardiology Clinic between January 2016 and December 2021, were retrospectively evaluated. Postnatal transthoracic echocardiography results of the infants were also reviewed.

Results: Our study was conducted with 188 pregnant women. The most frequently detected cardiac anomalies in the fetuses were conotruncal anomalies, followed by right heart anomalies. The concordance between prenatal and postnatal findings was 88.8%, with a sensitivity of 96.55% and a specificity of 100%. Among the live-born infants with congenital heart disease, significant differences were observed between the group that survived the neonatal period and those who did not, in terms of parental consanguinity, gestational age at birth, birth weight, APGAR scores, and the rate of chromosomal anomaly assessment.

Conclusion: Our study emphasized several risk factors. A high concordance was found between our prenatal and postnatal echocardiography findings. In conclusion, we believe that increasing awareness and making screening a routine practice are essential to contributing to healthier future generations. This can be achieved by reducing perinatal mortality and morbidity through appropriate management and equipment, thereby optimizing the well-being of affected individuals in society.

Objective: Recurrent spontaneous abortion (RSA), characterized by multiple miscarriages without a known cause, includes both genetic and non-genetic factors. In this research, we studied the association between two polymorphisms of the interleukin (IL)-10 and P53 genes and RSA for the first time in the southwest of Iran.

Materials and methods: This was a case-control study involving 62 patients with a history of at least two RSA of unknown etiology, as well as 66 healthy individuals. Clinical factors were analyzed. Genomic DNA was extracted from whole blood. Genotyping was performed using amplification refractory mutation system-polymerase chain technique to investigate two single nucleotide polymorphisms (SNPs) of P53 and IL-10 genes. Gene-gene interactions were analyzed by logistic regression. Statistical analysis was performed using a significance level of p<0.05.

Results: Allelic and genotypic frequencies as well as dominant, recessive and over dominant models for two SNPs, rs1042522 and rs1800871, were investigated. No significant association with RSA (p>0.05) was found. The combination of the homozygote CC for the polymorphism rs1042522 in the P53 gene and the homozygote CC for the polymorphism rs1800871 in the homozygote CC for the polymorphism rs1800871 in the IL-10 gene was associated with an increased risk of spontaneous abortion (p=0.01). Meanwhile, the phenotypic frequency of individuals with a history of consanguineous marriage was statistically significant between the case and control groups (p=0.003).

Conclusion: Limited studies have been conducted on the association between these two polymorphisms and RSA, and conflicting results have been obtained. Further investigation with a larger sample size may confirm results. Genetic research, such as this, helps understand genetic factors associated with the risk of RSA.

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.