Impact of SARS-CoV-2 infection and vaccination on cesarean section outcomes: a retrospective analysis.

BACKGROUND: Pregnant individuals have faced unique challenges during the COVID-19 pandemic, necessitating a closer examination of maternal and fetal health outcomes. OBJECTIVES: Investigate the morbidity and mortality associated with SARS-CoV-2 infection among pregnant individuals, considering vaccination status and variant strains. DESIGN: Retrospective cohort. SETTING: Tertiary state hospital. PATIENTS AND METHODS: Patients who underwent cesarean sections were categorized into three periods: pre-vaccination (before 31 August 2021), early post-vaccination (from September 2021), and late post-vaccination (aligned with 70% immunization coverage by 2 September 2021). Data collected included demographic information (age, gravidity, parity count, gestational age, newborn APGAR scores), cesarean section indications, chronic diseases, vaccination status, vaccine type and doses, SARS-CoV-2 variant status, ICU admission, and mortality due to COVID-19. MAIN OUTCOME MEASURES: ICU admission and mortality rates, focusing on the impact of SARS-CoV-2 infection and vaccination status. SAMPLE SIZE: 297 COVID PCR-positive symptomatic patients who underwent cesarean sections. RESULTS: In the pre-vaccination group, there were 13 mortalities (8.1%) compared to 9 (6.6%) post-vaccination (P=.610). Maternal ARDS was seen in 46.2% of pre-vaccination mortalities versus 11.1% post-vaccination (P=.045). COVID-19 delta variant patients had higher ICU admission (80%) and mortality rates (40%). Rates of COVID-19 PCR-positive cesarean sections, ICU admissions, and mortality declined significantly in early (P=.021, P=.004, P=.009), respectively and late post-vaccination periods (P<.001, P<.001, P=.0019), respectively. Vaccinated patients had no ICU admissions or mortality. CONCLUSIONS: Vaccination against COVID-19 is crucial for pregnant individuals as it significantly reduces the risk of severe illness. While vaccines offer substantial protection, the pandemic's acute phase might be waning, yet COVID-19 remains a global threat, particularly in regions with limited vaccine access. Continued vigilance and proactive measures are essential to mitigate ongoing risks and the emergence of new variant strains. LIMITATIONS: Retrospective observational design and the single-center setting, which may affect the generalizability of the findings.

The comparison of 2D and 3D systems in total laparoscopic hysterectomy: a systematic review and meta-analysis.

PURPOSE: To evaluate the existing evidence regarding the comparison between 2 and 3D systems in Total Laparoscopic Hysterectomy (TLH) in terms of surgical outcomes. METHODS: A systematic review of electronic databases, including PubMed/MEDLINE and Web of Science, was conducted to identify relevant studies comparing 2D and 3D systems in TLH. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to the topic. Studies meeting predefined criteria were included, while case reports and studies not directly comparing 2D and 3D systems were excluded. Two independent reviewers evaluated study eligibility and performed quality assessment. The quantitative synthesis was conducted using meta-analysis techniques. RESULTS: A statistically significant longer operation time in the 2D group compared to the 3D group (7 studies, mean difference [MD]: 13.67, 95% confidence interval [CI] 9.35-18.00, I2 = 16%). However, no statistically significant differences were found between the groups in terms of vaginal cuff closure time (2 studies, MD: 3.22, CI - 6.58-13.02, I2 = 96%), complication rate (7 studies, odds ratio [OD]: 1.74, CI 0.70-4.30, I2 = 0%), blood loss (3 studies, MD: 2.92, CI - 15.44-21.28, I2 = 0%), and Hb drop (3 studies, MD: 0.17, CI - 0.08-0.42, I2 = 1%). CONCLUSION: Our results revealed a significant difference favoring 3D systems in operation time, while clinical outcomes between the two systems were found to be comparable in TLH. However, further research, particularly prospective studies with larger cohorts and longer-term follow-up, along with economic analyses, is needed to provide clinicians and healthcare decision-makers with essential guidance for practice and resource allocation.

Evaluation of a scoring system to predict treatment success with single-dose methotrexate in ectopic pregnancy.

PURPOSE: This study sought to assess the efficacy of a newly developed scoring system in predicting treatment outcomes for ectopic pregnancy among patients undergoing single-dose methotrexate therapy. The primary research question centered on the reliability and predictive accuracy of objective parameters in determining methotrexate therapy success. METHODS: Conducted as a retrospective single-center cohort study, data from 172 ectopic pregnancy patients treated with methotrexate between January 2021 and January 2023 were analyzed. Parameters including adnexal mass size, peritoneal fluid presence, yolk sac identification, endometrial thickness, ectopic pregnancy location, and initial B-hCG levels were meticulously evaluated for their association with treatment outcomes. RESULTS: Following the exclusion of 21 emergency surgery cases, the final analysis comprised 151 patients. Notable associations were observed between specific parameters (fetal cardiac activity, adnexal mass size > 3.5 cm, peritoneal fluid presence, yolk sac identification, endometrial thickness > 10 mm, and initial B-hCG levels) and treatment outcomes (p < 0.001). Additionally, the novel scoring system demonstrated promising predictive performance. At a cutoff of 2.50, it achieved a sensitivity of 91.7% and a specificity of 59.7%. Increasing the cutoff to 3.50 resulted in a sensitivity of 94.0%, with a specificity of 46.3%. CONCLUSION: Objective parameters, particularly those integrated into the developed scoring system, exhibited substantial associations with methotrexate therapy outcomes in ectopic pregnancy. These findings underscore the potential of an objective scoring model to significantly influence clinical decision-making in therapy, offering avenues for enhanced prognostication and patient care in treatment outcomes.

The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study.

PURPOSE: 2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. METHODS: In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. RESULTS: The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). CONCLUSION: In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.

Evaluation of Perinatal and Neonatal Outcomes of Syrian Refugees Compared to Turkish Population: A Snapshot During the COVID-19 Pandemic.

BACKGROUND: The perinatal and neonatal outcomes of Syrian refugees during the coronavirus disease 2019 (COVID-19) pandemic are unknown. Therefore, in this study, we aimed to evaluate these outcomes. METHODS: Turkish (n = 303) and Syrian refugees (n = 303) who delivered in our hospital between June 1, 2020 and December 31, 2020 were included in the study. Demographic, perinatal, and neonatal data were obtained by retrospectively evaluating hospital records. RESULTS: Adolescent pregnancy was more common in Syrian refugees (p < 0.001). The rates of antenatal visits, performed combined test, triple test, quadruple test, fetal anatomy ultrasound, and glucose tolerance test were lower in all refugees (p < 0.01). Furthermore, there was no difference in the mode of delivery, Hb after delivery, gestational age, birth weight, Apgar score, stillbirth, and fetal anomaly (p > 0.05 for all). CONCLUSION: Despite poorer antenatal care during the COVID-19 pandemic, Syrian refugee pregnant women had similar perinatal and neonatal outcomes compared with the Turkish pregnant population.

The role of maximal urethral closure pressure in predicting the outcomes of trans-obturator tape operation.

OBJECTIVE: To investigate the role of preoperative maximal urethral closure pressure (MUCP) in predicting postoperative outcomes of trans-obturator tape (TOT) operation. STUDY DESIGN: 82 patients who underwent TOT surgery due to urodynamically proven stress urinary incontinence were retrospectively analyzed. Preoperative and 6th month postoperative results of cough stress tests (CST), Turkish validated Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6) quality of life (QOL) questionnaires were recorded. Patients who had negative CST and more than 50% improvement in the QOL questionnaires in the postoperative evaluation were classified as cured. RESULTS: 14 (17.1 %) patients had MUCP ≤ 20 cmH2O, 68 (83 %) patients had MUCP > 20 cmH2O. The postoperative IIQ-7 and UDI-6 QOL scores were significantly improved compared to preoperative values in both MUCP ≤ 20 cmH2O and MUCP > 20 cmH2O groups. However, cure rate was lower in the MUCP ≤ 20 cmH2O group than in MUCP > 20 cmH2O group (35.7 % vs 83.8 %, respectively). Preoperative MUCP measurement and urethral mobility assessment were found to be independent factors associated with surgical outcome. A preoperative MUCP ≥ 28.5 cmH2O could predict surgical success after TOT with 92.6 % sensitivity and 85.7 % specificity. CONCLUSIONS: TOT is a reliable method that has a high efficacy in the surgical treatment of stress urinary incontinence in short-term. Patients with low MUCP can also benefit from TOT. However, the success rate of TOT surgery decreases in the presence of low MUCP and absence of hypermobile urethra.

Preoperative and postoperative complete blood cell counts and prediction of surgical site infection after cesarean delivery: a retrospective case-control study.

BACKGROUND: Cesarean delivery (CD) is the most frequently performed surgery. Surgical site infection (SSI) is a common complication after CD. PURPOSE: To evaluate the role of complete blood count parameters in predicting the development of SSI after CD. METHODS: Patients who were hospitalized because of SSI after CD were included in the SSI group (n = 48). A control group (n = 45) was formed with healthy postpartum women who had also undergone CD. Preoperative and postoperative hemoglobin (Hb), white blood cell count (WBC), neutrophil count, lymphocyte count, platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were recorded. RESULTS: WBC, neutrophil count, and NLR levels increased while Hb, PLT, and lymphocyte count levels decreased after CD in both the SSI and control groups. PLR increased after CD in the SSI group but remained stable in the control group. However, the difference in PLR could not predict SSI after CD. CONCLUSION: Complete blood count parameters were not useful to predict SSI after CD. Larger prospective studies are needed.

What are the advantages of clock position method to determine fetal heart axis for inexperienced resident physicians? A comparative study

Objective: Residency training programs are challenging for young physicians with heavy workloads. Although ultrasonography (USG) is an imaging method that is frequently used in obstetrics practice, some basic USG skills can be acquired late in this intensive learning process. Likewise determining the fetal heart axis is an elementary evaluation but can turn into a challenging and time-consuming process, especially for inexperienced clinicians. Material and Methods: Pregnant women between 20 and 37 weeks of gestation were recruited. Two observers assessed the axis of fetal heart by standard, Bronshtein and clock position methods. Fetal heart axis evaluation times were compared. Inter-observer and intra-observer agreements of the three methods were measured. One factor learning rates were calculated. Results: A total of 31 pregnant patients between the ages of 18 and 40 years were included in the study. Fetal heart axis evaluation time by the clock position method was shorter than the Bronshtein and standard method in both observers. Furthermore diagnostic accuracy for both observers was 100% with the clock position method, while this fell to 100% in observer-1 and 96.8% in observer-2 using the Bronshtein method. The clock position method was learned faster than either of the other methods. Conclusion: Clock position method is an easy and feasible method for inexperienced resident physicians in terms of learning and application to determine the fetal heart axis. The advantages of this method increase when patient numbers are higher.

Comparison of laparoscopic hysterectomy videos on YouTube and WebSurg platforms in terms of educational reliability and quality.

INTRODUCTION: This study aimed to compare the educational reliability of laparoscopic hysterectomy videos on YouTube and WebSurg platforms. MATERIALS AND METHODS: We performed an online search with the keyword "laparoscopic hysterectomy" on YouTube and WebSurg. On WebSurg, the surgical interventions in gynecology section were selected. On YouTube, the most relevant surgical videos according to algorithm of YouTube were included. 22 YouTube and 22 WebSurg videos were included in the study. Technical analysis were performed via calculation of ratios such as view/day, like/view, like/subscriber, view/subscriber, and Video Power Index. The videos were evaluated with usefulness and laparoscopic surgery video educational guidelines (LAP-VEGaS) scoring systems. RESULTS: View/day ratio was higher on YouTube than WebSurg [8.8 (42.1) and 2.5 (5.1), respectively; p = 0.02]. Like/view ratio was lower on YouTube than WebSurg [0.006 (0.01) and 0.01 (0.02), respectively; p = 0.001]. A significant difference was obtained only in the treatment section of usefulness scoring system [0 (0-2), and 0 (0-1) for YouTube and WebSurg, respectively; p = 0.04]. According to LAP-VEGaS, the scores of patient positioning, step-by-step approach, demonstration of intraoperative findings and anatomy, commentary in English parameters were significantly lower on YouTube compared to WebSurg [1(0-2) and 2(2-2), p < 0.001; 2 (0-2) and 2 (2-2), p = 0.004; 2(0-2) and 2(2-2), p < 0.001; 2(0-2) and 2(2-2), p = 0.009, respectively]. The total LAP-VEGaS score of YouTube was lower than WebSurg videos [10(4-16) and 13(10-15), respectively; p = 0.001). DISCUSSION: WebSurg was found to be more reliable platform in terms of educational value and quality of laparoscopic hysterectomy videos compared to YouTube.