Cerebroplacental ratio and perinatal outcomes in mild-to-moderate idiopathic polyhydramnios cases.

OBJECTIVE: This study will evaluate whether fetal cerebroplacental ratio (CPR) can predict perinatal adverse outcomes in singleton pregnancies with mild and moderate idiopathic polyhydramnios (IP). METHOD: This study was designed as a prospective case-control study between January 2023 and November 2023. Pregnant women diagnosed with mild-to-moderate IP and low-risk singleton pregnancies were included in the study. In all cases, umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured at 36-40 weeks of gestation, and CPR was calculated. The group with polyhydramnios was divided into two parts according to whether the CPR value was below 1.08 or 1.08 and above. Perinatal outcomes of all groups were compared. RESULTS: A total of 140 patients were included in the study. Seventy of these were IP cases, and 70 were low-risk pregnant women. UA PI in the IP group was not statistically different from that in the low-risk group, but MCA PI and CPR were significantly lower in the IP group (P = 0.07, P = 0.001, and P = 0.004, respectively). IP cases were divided into a low group (<1.08, n = 18) and a normal group (≥1.08, n = 52) according to the CPR value. Cesarean section rates due to fetal distress were significantly higher in the low-CPR group (n = 8 [44.4%] vs 5 [9.6%], P = 0.001). In the low-CPR group, 5-min Apgar <7, and neonatal intensive care unit (NICU) admission rates were significantly higher (P = 0.045 and P = 0.001, respectively). CONCLUSION: It is encouraging that in cases with mild-to-moderate IP, low CPR predicts emergency delivery due to fetal distress, a low Apgar score at 5 min, and NICU admission.

Platelet indices as potential biomarkers of perinatal outcomes in women with SLE during pregnancy.

AIM: This study aimed to assess the platelet parameters and their prognostic value for perinatal outcomes in pregnant women with systemic lupus erythematosus (SLE). METHODS: This retrospective study involved 180 participants, 90 pregnant women with SLE and 90 healthy pregnant women. Clinical and demographic variables including routine first-trimester neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and platelet parameters such as platelet distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT) were compared between the groups. The perinatal outcomes of the whole study group were also compared. RESULTS: SLE patients had lower leukocyte (p = 0.001), lymphocyte (p = 0.001) and platelet counts (p = 0.018), higher PDW (p = 0.002), MPV (p = 0.001), NLR (p = 0.008) and PLR (p = 0.015) and lower PCT (p = 0.015) than the control group. The groups had no significant difference in hemoglobin levels (p = 0.936). SLE patients had higher rates of cesarean section (p = 0.002), small for gestational age (SGA) (p = 0.019) and stillbirth (p = 0.017) and lower birth weight (p = 0.001) than the control group. PCT was a significant predictor of stillbirth with a cut-off value of 0.21, sensitivity of 64.3% and specificity of 83.3% (AUC: 0.843, p < 0.001). CONCLUSION: Pregnant women with SLE have altered platelet parameters and increased inflammatory markers compared to healthy pregnant women. PCT is a simple and useful marker for predicting stillbirth risk in SLE pregnancies.

Fetal Epicardial Fat Thickness in Obese Pregnant Women: Its Effect on Fetal Cardiac Function and Neonatal Outcomes.

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) together with fetal myocardial performance index (MPI) and its effects on neonatal outcomes in obese pregnant women. MATERIALS AND METHODS: A total of 102 pregnant women, 51 obese and 51 of normal weight, were included in this prospective study. Fetal EFT, and MPI measurements were performed for all patients. RESULTS: Fetal EFT and Mod-MPI showed a statistically significant difference between obese pregnant women and the control group (p=0.0001, p=0.001). The optimal fetal EFT predictive cut-off value for the 5th-minute APGAR score below 7 was 1.22 mm, with a sensitivity of 86.96% and a specificity of 54.43% (p=0.001). CONCLUSION: Fetal EFT and mod-MPI were higher in obese pregnant women. It is encouraging that fetal EFT predicts low APGAR, but more important information can be obtained if postnatal follow-up of these cardiac changes caused by obesity can be performed.

The role of second trimester uterine artery Doppler in predicting obstetric and neonatal outcomes in abnormal first trimester maternal serum pregnancy-associated plasma protein-A and free ß-human chorionic gonadotropin values.

AIM: This study aims to determine whether second-trimester uterine artery (UtA) Doppler combined with first-trimester abnormal pregnancy-associated plasma protein-A (PAPP-A) and ß-human chorionic gonadotropin (ß-Hcg) levels predicts adverse obstetric and neonatal outcomes. MATERIALS AND METHODS: This study of 289 pregnant women included 196 with normal PAPP-A and free ß-HCG values (control group) and 93 with abnormal values (study group) in the first-trimester screening test. Second-trimester UtA Doppler sonography was done in these pregnancies. The perinatal prediction and screening potential of UtA Doppler pulsatility index (PI) parameters were examined in the study group. RESULTS: UtA PI >95 percentile increased birth before the 37th week by 4.46 times, birth before the 34th week by 7.44 times, preeclampsia risk by 3.25 times, fetal growth restriction (FGR) risk by 4.89 times, and neonatal intensive care unit (NICU) admission rates by 3.66 times in the study group (p < 0.05 for all). UtA PI >95 percentile had 49.2% sensitivity and 82.1% specificity for birth before 37 weeks. For birth before 34 weeks, sensitivity was 80.0% and specificity 65.0%. FGR has 70.5% sensitivity and 67.1% specificity. Screening for preeclampsia has 66.6% sensitivity and 61.9% specificity. CONCLUSION: Adding UtA Doppler in the second trimester to pregnancies with abnormal PAPP-A and/or free ß-Hcg values in the first trimester may be a useful screening method for adverse outcomes.

In premature rupture of membranes, maternal serum delta neutrophil index may be a predictive factor for histological chorioamnionitis and affect fetal inflammatory markers: A retrospective cross-sectional study.

PROBLEM: We aimed to investigate the predictive value of delta neutrophil index (DNI) for histological choriomanionitis (HCAM) and the effect of maternal inflammatory markers on neonatal outcomes and fetal inflammatory parameters. METHOD OF STUDY: In this retrospective cross-sectional study, 68 pregnant women without HCAM (group 1) and 46 pregnant women diagnosed with HCAM (group 2) were divided into two groups. Demographic stories of the groups; maternal hematological parameters; maternal DNI and systemic inflammatory index (SII) values; outcomes of newborns; fetal inflammatory markers were recorded and compared between groups. RESULTS: Maternal DNI, and SII levels were significantly higher in group 2 (p value < .05 for all). Admission to the neonatal unit (NICU) was higher in group 2 than in group 1 (p = .0001). We found that fetal inflammatory markers were significantly higher in group 2 (p values .001 for CRP, .0001 for DNI, and .002 for leukocyte). Maternal DNI was determined to be significantly diagnostic at a value of ≥1.3 in HCAM (p = .001). We observed that SII had a significant predictive value of 953036.6 (p = .019) for NICU admission. There is also a positive correlation between fetal inflammatory markers and maternal inflammatory markers. CONCLUSIONS: We found that maternal inflammatory markers are high in HCAM, maternal DNI can predict patients who will develop HCAM, maternal SII value can predict NICU admission, fetal inflammatory markers are high in HCAM, and these markers are affected by maternal inflammatory markers.

Comparison of the ratio of second trimester fetal biometric measurements to fetal nasal bone length in fetuses with normal karyotype and trisomy 21.

AIM: In this study, we compared the ratio of second trimester fetal biometric measurements to nasal bone length (NBL) in fetuses with normal karyotype and trisomy 21 to determine their diagnostic prognostic value. MATERIALS AND METHODS: The study included 148 pregnant women who obtained second-trimester ultrasonographic fetal anatomy and had amniocentesis (AS) for fetal karyotyping. The fetal karyotype results divided the groups into normal and trisomy 21 fetuses. Age, obstetric history, first and/or second trimester screening test risk ratios, fetal biometric measurements, and NBL mm, median (MoM) multiples, and percentile values were recorded and compared between groups. RESULTS: BPD/NBL ratios above 9.26 predict trisomy 21 in fetuses with 77.6% sensitivity and 86.1% specificity (p = 0.001). HC/NBL ratios above 34.50 predict trisomy 21 in fetuses with 77.8% sensitivity and 88.8% specificity (p = 0.001). FL/NBL ratios above 6.02 predict trisomy 21 in fetuses with 69.6% sensitivity and 72.2% specificity (p = 0.001). HL/NB ratios above 6.56 predict trisomy 21 in fetuses with 95.5% sensitivity and 47.2% specificity (p = 0.001). The NBL MoM value demonstrated a high diagnostic accuracy for normal-karyotype fetuses (p = 0.021). CONCLUSION: We found that BPD/NBL, HC/NBL, FL/NBL, and HL/NBL ratios differed between fetuses with a normal karyotype and those with trisomy 21, specifically the HC/NBL ratio, which predicted trisomy 21 with good diagnostic accuracy. In identifying normal-karyotype fetuses, the NBL MoM was highly accurate.

Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries.

OBJECTIVE: This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP). METHODS: Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared. RESULTS: A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037). CONCLUSION: Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.

The Association of Dysfunctional Attitudes and Adult Separation Anxiety in Pregnancy: A Cross-Sectional Study.

Background This study aims to examine adult separation anxiety in pregnant women and its relationship with dysfunctional attitudes from the perspective of cognitive theory. Methods The sociodemographic data, Adult Separation Anxiety Questionnaire (ASA-27), and Dysfunctional Attitudes Scale-Revised (DAS-R) questionnaire were utilised to examine the correlation between sociodemographic factors and the ASA and dysfunctional attitudes in women attending antenatal obstetric clinics. Results The study included 190 pregnant women. Of these, 45.8% (n=87) had significant adult separation anxiety disorder (ASAD) symptoms. There was no significant difference between the ASAD (+) and ASAD (-) groups in terms of sociodemographic characteristics (p>0.05). However, a significant association was found between ASAD and the gestational period (p=0.02). DAS-R scores were higher in patients with ASAD symptoms (p<0.001). Positive correlations were observed between DAS-R and perfectionism or achievement and between DAS-R and the need for approval or dependency (p=0.001). DAS-R and gestational week showed potential as predictors of ASAD positivity (Area under the ROC curve (AUC)=0.725 vs. 0.632, respectively). Conclusion Pregnancy can be a sensitive period for the development of separation anxiety in adults. The development and treatment of separation anxiety in adults may benefit from cognitive-behavioural interventions that address dysfunctional attitudes during pregnancy.

Predictability of Hematological Parameters in the Diagnosis of Cesarean Scar Pregnancy.

Introduction Cesarean scar pregnancy (CSP) is an increasing clinical condition that causes serious maternal morbidity and mortality. This study aimed to evaluate if inflammation markers measured by hemogram can aid in the diagnosis of CSP. Materials and Methods A total of 86 patients were included in the study. The cases were divided as CSP ( n : 42) and normal pregnancy (NP) ( n : 44). At the time of admission, peripheral blood neutrophils, lymphocytes, monocytes, thrombocytes, systemic inflammatory index (SII) (neutrophil × platelet/lymphocyte), neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were all measured. CSP and NP diagnoses were made by transabdominal or vaginal ultrasonography. Results In the CSP group, mean age ( p < 0.001), gravida ( p < 0.001), parity ( p < 0.001), number of surviving children ( p < 0.001), number of abortions ( p < 0.001), cesarean number ( p < .001), dilatation and curettage count ( p = 0.013), monocyte (M) value ( p = 0.039) and monocyte/lymphocyte value (MLR) ( p = 0.035) were significantly higher than the control group. The optimal M value cut-off value was found to be > 0.40, the sensitivity value was 78.57, and the specificity value was 50.00. AUC = 0.632 (SE = 0.061) for the MLR value. The optimal MLR cut-off value was found to be > 0.232, the sensitivity value was 61.90, and the specificity value was 63.64. Conclusion Hemogram parameters, which are simple, inexpensive, and easily accessible, M and MLR are significantly higher in the diagnosis of CSP and can be used as an auxiliary parameter for ultrasonography.

The initial number of fetuses in multiple pregnancy before reduction affects perinatal outcomes.

OBJECTIVE: In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with continuing DCDA twin pregnancies without FR. MATERIALS AND METHODS: FR performed in a university hospital in the last 10 years was evaluated. Pregnancies reduced to DCDA twin pregnancies by reduction from three or more pregnancies and pregnancies that started with DCDA twins and continued with DCDA twins were compared in terms of perinatal outcomes. In the subgroup analysis, those who were reduced from three-chorionic three-amniotic (TCTA) triplets to DCDA twins and those who were reduced to DCDA twin pregnancies from four or more were compared in terms of perinatal outcomes. RESULTS: A total of 119 pregnant women were included in the study, 36 patients underwent FR, while 83 patients were DCDA twins who did not undergo FR. The groups were similar in terms of preterm delivery (p = 0.370). There was a higher rate of miscarriage (21.4% vs. 0.0%, p = 0.019) in the group that was reduced to DCDA twins from quadruplet and above pregnancies compared to the group that was reduced from TCTA triplets to DCDA twins. The gestational week at birth was lower in the group reduced to DCDA twins from quadruplets and above pregnancies (31.00 ± 4.31 vs. 34.64 ± 2.88, p = 0.019). CONCLUSION: The study's results show that the perinatal outcomes of multiple pregnancies with and without FR are the same As the number of reduced fetuses increases, the rates of preterm birth and miscarriage also increase.

Superior mesenteric artery Doppler parameters in the evaluation of fetal hyperechogenic bowel.

OBJECTIVE: The aim of this study was to evaluate the efficacy and clinical effects of superior mesenteric artery (SMA) Doppler indices such as the systole diastole ratio (S/D), Pulsatility (PI), and resistance index (RI) in the diagnosis of hyperechogenic bowel. METHODS: A total of 133 pregnant women, including 66 with hyperechogenic bowel and 67 controls, were enrolled in the study. All participants were evaluated in the second trimester by an experienced obstetrician. Doppler measurements were performed, including superior mesenteric artery peak systolic velocity, S/D ratio, PI, and RI. Statistical analysis was conducted to compare the Doppler parameters between the hyperechogenic bowel and control groups. RESULTS: No significant differences were found between the hyperechogenic bowel and control groups in terms of age, body mass index, gestational week, and fetal measurements. While SMA peak systolic velocity (PSV) showed no significant difference between the groups (p = 0.074), the S/D ratio (4.01 ± 0.59 vs. 3.27 ± 0.57, p = 0.0001), PI (1.51 ± 0.15 vs. 1.29 ± 0.06, p = 0.0001), RI (0.76 ± 0.05 vs. 0.67 ± 0.04, p = 0.0001) were significantly higher in the hyperechogenic bowel group compared to the control group. Screening tests based on Doppler parameters also demonstrated significant differences. The S/D ratio, PI, and RI exhibited good to excellent diagnostic accuracy, as indicated by the area under the curve values. Pregnant women with a high RI value of 0.72 were 101 times more likely to be diagnosed with HB. The odds ratio (OR) for diagnosing HB is 101.66 (CI 95%, 31.04-332.97). CONCLUSION: Doppler indices, specifically the S/D ratio, PI, and RI, showed strong predictive ability and diagnostic accuracy in identifying cases of hyperechogenic bowel. These findings suggest that Doppler ultrasound can serve as a valuable tool for evaluating hyperechogenic bowel and may provide important clinical implications. Further diagnostic tests are warranted to determine the underlying cause of hyperechogenic bowel in individual cases.

The role of the systemic inflammatory index in determining the length of hospital stay in patients with hyperemesis gravidarum.

OBJECTIVE: In this study, we aimed to investigate the role of peripheral blood parameters and the systemic inflammatory index (SII) in the diagnosis of hyperemesis gravidarum (HG) and whether they have a predictive value in determining the length of hospital stay and the risk of rehospitalization in HG cases. MATERIALS AND METHODS: In the retrospective study, pregnant women who were hospitalized due to HG (n = 112) and pregnant women who were completely healthy (n = 112) were matched for gestational age. Peripheral blood inflammation parameters of the entire study group were evaluated. The length of hospital stay and rehospitalization rate for HG cases were recorded. A total of 224 patients, 112 (50%) in the control group and 112 (50%) in the HG group were included in the study. There was a positive correlation between increased ketonuria and length of hospitalization, peripheric blood parameters, and SII. The degree of ketonuria was found to be statistically insignificant in determining the risk of rehospitalization (p = 0.927). About 28.57% (n = 32) of all HG cases were readmitted to the hospital. When the length of hospital stay was considered, SII was found to be statistically significant in hospitalizations lasting more than 2 days (p = 0.001), but not in rehospitalizations (p = 0.3). CONCLUSION: SII is significant in diagnosing and determining hospitalization of HG. It is sufficient to determine the length of hospital stay but not rehospitalization risk, which is an indicator of disease severity.

Fetal epicardial fat thickness in non-severe idiopathic polyhydramnios: Its impact on fetal cardiac function and perinatal outcomes.

OBJECTIVE: This study aimed to evaluate fetal epicardial fat thickness (EFT) along with fetal myocardial performance index (MPI) and its effects on perinatal outcomes in non-severe idiopathic polyhydramnios (IP). MATERIALS AND METHODS: This prospective study included 92 participants, 32 diagnosed with non-severe IP, and 60 healthy pregnant women. Amniotic fluid indices (AFI), umbilical and middle cerebral artery Doppler, EFT, and MPI measurements were performed for all patients. RESULTS: The fetal EFT and MPI values were statistically higher in the non-severe IP group than in the control group (p = 0.0001, p = 0.014, respectively). The optimal fetal EFT cutoff value for predicting non-severe IP disease was found as 1.3 mm with a specificity of 81.7% and sensitivity of 59.4%. The EFT cutoff for predicting cesarean section in non-severe IP cases was 1.25 mm (p = 0.038). Apgar scores, neonatal intensive care unit, respiratory distress syndrome, and stillbirth rates were not different between groups. CONCLUSION: In this study, EFT and MPI were found to be higher in non-severe IP cases compared to controls. It was observed that the increase in MPI and EFT was associated with the increase in cesarean rates, but not with adverse fetal outcomes.

Effect of cervical changes on the cesarean scar area and niche formation after preterm and term cesarean sections.

OBJECTIVE: The purpose of this study is to assess the scar area and niche formation after cesarean section in women who had preterm or term deliveries and underwent cesarean section at various stages of labor. METHOD: This prospective cohort study consists of cases who underwent the first cesarean section for different obstetric reasons. The patients were divided into four groups regarding gestational age and cervical dilatation. After a cesarean section, all patients were called for vaginal ultrasonography control at 12 weeks. The location of the scar and the presence of a niche were evaluated. The residual (RMT), proximal, and distal myometrial thicknesses were evaluated where the scar and niche were located. RESULTS: A total of 87 cases were included in the study. There was no difference in the prevalence of niche between the groups (p > 0.05). RMT and proximal and distal myometrial thickness were not different between the 37 ≥ week and 37 < week groups, while RMT and proximal and distal myometrial thickness were significantly lower in women with active labor (p =0.001, p= 0.006, p =0.016). The location of the scar was the isthmus at 37 weeks and above (p= 0.002), it was in the cervical canal in the group below 37 weeks (p= 0.017). CONCLUSION: The gestational week and cervical changes did not affect the prevalence of the niche. In cases of active labor and preterm deliveries, the CS scar defect was located in the cervical canal; however, in cases of term deliveries, it was located in the isthmic area.

Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum?

AIM: Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients. MATERIAL AND METHOD: This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded. RESULTS: There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05). CONCLUSION: This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.

Are the serum delta neutrophil index and systemic inflammatory index useful as predictive parameters for preeclampsia and HELLP syndrome?

OBJECTIVE: We aimed to determine whether the serum delta neutrophil index and other systemic inflammatory index parameters can have an auxiliary effect in the diagnosis when used with other bio chemical markers in preeclampsia and HELLP syndrome and to determine the role of inflammation in the pathogenesis of these diseases. MATERIALS AND METHODS: 121 pregnant women who met the inclusion and exclusion criteria were included in the study. 52 pregnant women diagnosed with preeclampsia and 19 pregnant women diagnosed with HELLP syndrome were included in the study group, and 50 healthy pregnant women were included in the control group. Demographic data, hematological and bio chemical parameters, and inflammatory markers (serum delta neutrophil index - DNI - and systemic inflammatory index parameters) of the groups were recorded and compared between groups. RESULTS: In terms of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and DNI, the HELLP group was different from both groups. The control and preeclampsia groups were similar. In terms of monocyte-to-lymphocyte ratio, the preeclampsia group was different from both groups. The control and HELLP groups were similar. In terms of the systemic inflammatory index, all groups were similar. CONCLUSION: In our study, we found that when maternal serum DNI values are used together with other bio chemical parameters, it can help in the diagnosis of preeclampsia and HELLP syndrome, and inflammation may play a role in the pathogenesis of these diseases.

Pregnancy termination indications and outcomes before 24 weeks of gestation - a case series.

OBJECTIVE: This study aimed to assess termination of pregnancy (TOP) indications and obstetric outcomes before the 24th gestational week. MATERIALS AND METHODS: This is a retrospective study that includes terminations performed in singleton pregnancies between December 2021 and December 2022 in the Perinatology Clinic of Necmettin Erbakan University Meram Medical Faculty. According to the reasons for TOP, all patients were divided into three groups: maternal, fetal, and obstetric reasons. The termination approach and outcomes were evaluated in all cases. RESULTS: A total of 210 patients were included in the study. Considering termination indications, 18 (8.5%) patients had maternal causes, 127 (60.5%) had fetal causes, and 65 (31%) had obstetric causes. Maternal causes were significantly higher in the 1st trimester and fetal causes in the 2nd trimester (P = 0.001). In the maternal group, 77.8% dilatation and curettage were used, 70.1% misoprostol and 29.9% misoprostol + Foley catheter in the fetal group, and 66.2% misoprostol in the obstetric group (P = 0.0001). The length of hospital stay and recurrent revision curettage were not statistically different between the fetal, maternal, and obstetric groups (P = 0.099, P = 0.8, respectively). CONCLUSION: Termination options should be offered for complicated pregnancies due to fetal, maternal, or obstetric reasons. Pregnancy termination week and indication affect morbidity.

Effect of using magnifying loupe glasses on lymphocele formation and surgical outcomes in gynecologic oncology.

OBJECTIVE: To investigate the effect of using magnifying loupes during surgery on surgical outcomes and lymphocele formation. MATERIALS AND METHODS: We prospectively enrolled 36 patients with gynecologic cancer who underwent pelvic and para-aortic lymphadenectomy. Age, body mass index, menopausal status, type of cancer, comorbid diseases, preoperative albumin and albumin replacement therapy, performance status, serum CA125, hemoglobin, platelets and white blood cells, surgical procedure, blood loss, blood transfusion, the count of removed lymph nodes, presence of metastatic lymph nodes, total amount of drainage, postoperative complications, operation length, and count of used hemoclips were recorded. Patients were randomized into two groups: group 1 operated using loupe glasses, and group 2, without loupes. RESULTS: In the loupe-negative group, total drainage volume was 6698 mL, whereas in the loupe-positive group, it was only 1049 mL (p<0.01). Postoperatively, the mean drainage duration was 10.6±5.1 days in loupe-negative group and 4.8±2.4 days in the loupe-positive group (p=0.0001). There were no differences between the two groups in terms of surgical site infections, fascial defects, and pulmonary thromboembolism (p=0.39, 0.33, 0.59, respectively). There was no significant difference in the number of harvested lymph nodes in patients who underwent surgery with or without loupes being used. The count of used hemoclips were 50.22±8.05 and 41.38±9.7 for the loupe-negative and positive groups, respectively (p<0.01). There was no lymphocele in the loupe-positive group, but we detected 5 (27.8%) lymphocele in the loupe-negative group (p=0.05). CONCLUSION: Gynecologic oncologic surgeons can add magnifying loupe glasses to their armament and benefit from this technical device; lymphocele development, total drainage volume, length of drainage time, and clip counts can be decreased by using loupe glasses in gynecologic cancer surgery.