Effects of the COVID-19 pandemic on perinatal outcomes: a retrospective cohort study from Turkey.

BACKGROUND: Lockdowns, pregnant women's fear from hospitalization in addition to uncertainties about appropriate birthing practices at the beginning of the pandemic may have affected the health outcomes of mother-infant couples. We aimed to explore whether pregnancy outcomes including the rates of cesarean delivery (CS), preterm, and low birth weight (LBW) births have changed during the pandemic period compared with the pre-pandemic period. METHODS: We applied a population-based retrospective cohort, before-after approach in 2020 vs. similar calendar months in 2019 for five periods [Jan-Feb (pre-pandemic); March-May (1st wave and lockdown); June-August; September-October; November-December (2nd wave and lockdown)]. The data was modelled through multiple logistic regressions using key outcomes; CS, preterm, and LBW births as the dependent variables, and adjustments were made for independent variables in SPSS software. We evaluated the modification of years by periods by adding interaction term (yearXperiod) to the model. RESULTS: The rate of CS in hospital births increased from 57.7% in 2019 to 60.2% in 2020. CS rates were significantly increased during the 3rd and 4th periods. The overall preterm rate was 11%. When singleton pregnancies were considered, adjusted multivariable analyses showed a decrease in preterm proportions during all time periods with respect to the pre-pandemic period. The percentage of LBW was 7.7% during the pandemic period and was found to be significantly reduced compared to the pre-pandemic period. There was a significant reduction in LBW rates in all periods except the second lockdown period. CONCLUSIONS: Our findings suggested significant reductions in preterm and LBW births possibly due to the indirect effects of the pandemic. Moreover, strategies need to be considered to address the increased CS rates and shifting of maternity service utilization to private facilities.

Physical inactivity in nine European and Central Asian countries: an analysis of national population-based survey results.

BACKGROUND: Physical inactivity is a major risk factor for non-communicable diseases. However, recent and systematically obtained national-level data to guide policy responses are often lacking, especially in countries in Eastern Europe and Central Asia. This article describes physical inactivity patterns among adults in Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan. METHODS: Data were collected using the Global Physical Activity Questionnaire drawing nationally representative samples of adults in each country. The national prevalence of physical inactivity was calculated as well as the proportional contribution to total physical activity (PA) during work, transport and leisure-time. An adjusted logistic regression model was applied to analyze the association of age, gender, education, household status and income with physical inactivity. RESULTS: National prevalence of physical inactivity ranged from 10.1% to 43.6%. The highest proportion of PA was registered during work or in the household in most countries, whereas the lowest was during leisure-time in all countries. Physical inactivity was more likely with older age in eight countries, with female gender in three countries, and with living alone in three countries. There was no clear pattern of association with education and income. CONCLUSION: Prevalence of physical inactivity is heterogeneous across the region. PA during leisure-time contributes minimally to total PA in all countries. Policies and programs that increase opportunities for active travel and leisure-time PA, especially for older adults, women and people living alone will be an essential part of strategies to increase overall population PA.

How to triage HPV positive cases: Results of four million females.

OBJECTIVE: To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 4 million screened women. METHODS: Women over age 30 were invited for screening via HPV DNA and conventional cytology. Single visit screen strategy was used to collect for both screening and triage (extended genotyping and conventional pap-smear). RESULTS: A total of 4,099,230 patients had attended to HPV DNA cancer screening. 4.39% were found to be HPV DNA positive. The most common HPV type was 16, followed by 51, 31, 52, 56 and 18 at all age intervals and geographic regions. Cytology results were reported as "normal" in (69.2%), "inadequate sampling" in (16.6%) and as "abnormal (≥ASC-US)" in the remaining. Current Turkish screening with HPV DNA (referral to colposcopy with HPV 16 or 18 or any smear abnormality ≥ASC-US) gives overall PPV of 24.3% for ≥CIN2. Only Pap-Smear triage revealed PPV of 26.4% for ≥ASC-US thresholds. Comparison of different triage methods for ≥CIN2+ according to different HPV genotype revealed a PPV of 32,6% for HPV 16; 15,3% for HPV 18. This figure was 34.4%, 19.3%, 15.3% and 14.0% for HPV 33, 31, 45 and 35; respectively. CONCLUSION: This study involves the largest series in the world summarizing a real-world experience with primary HPV DNA screening and triage with a single visit. The results show the feasibility and applicability of such screening method in developing countries with acceptable colposcopy referral rates. Among triage tests, only pap-smear seems to be effective without a need for extended genotyping.

Health-related quality of life and perceived health status of Turkish population.

PURPOSE: This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. METHODS: The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. RESULTS: In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9-72.1), 66.4 ± 0.2 (95% CI 65.8-66.9) for females (p < 0.05).The most important determinants of having a problem in any of the five dimensions are age, gender, education, diabetes mellitus, coronary heart disease, stroke, alzheimer, cancer, renal failure. The OR of having some or severe problems in any dimensions was 4.6 (95% CI 38-5.4) for over 65-74 and 7.5 (95% CI 5.8-9.6) for over 75 compared to 15-24 age group. CONCLUSIONS: The perceived health level and HRQOL is worse in women, in older age groups, in people from lower socioeconomical status.

Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women.

To evaluate the Turkey's nationwide HPV DNA screening program on the basis of first 1 million screened women. Women over age 30 were invited for population based screening via HPV DNA and conventional cytology. Samples were collected by family physicians and the evaluations and reports had been performed in the National Central HPV laboratories. The acceptance rate for HPV based cervical cancer screening after first invitation was nearly 36.5%. Since HPV DNA tests have been implemented, cervical cancer screening rates have shown 4-5-fold increase in primary level. Through the evaluation of all, HPV positivity was seen in 3.5%. The commonest HPV genotypes were 16, followed by 51, 31, 52 and 18. Among the 37.515 HPV positive cases, cytological abnormality rate was 19.1%. Among HPV positive cases, 16.962 cases had HPV 16 or 18 or other oncogenic HPV types with abnormal cytology (>ASC-US). These patients were referred to colposcopy. The colposcopy referral rate was 1.6%. Among these, final clinico-pathological data of 3.499 patients were normal in 1.985 patients, CIN1 in 708, CIN2 in 285, CIN3 in 436 and cancer in 85 patients and only pap-smear program could miss 45.9% of ≥CIN3 cases. The results of 1 million women including the evaluation of 13 HPV genotypes with respect to prevalence, geographic distribution and abnormal cytology results shows that HPV DNA can be used in primary level settings to have a high coverage rated screening program and is very effective compared to conventional pap-smear.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

Trends of Gynecological Cancers in Turkey: Toward Europe or Asia?

OBJECTIVE: The aim of this study was to evaluate nationwide gynecological cancer trends in Turkey. METHODS: National cancer registry data (2009-2013) of Turkish Ministry of Health were evaluated. Ovarian, cervical, endometrial, vulvar, vaginal, and tubal cancers are evaluated with respect to age of diagnosis, incidence rates within years, stage, histological distributions, and mortality rates. Data were collected from active cancer registry centers, which increased from 23% in 2009 to 47.5% coverage of the whole population by 2012, and mortality data (2010-2015) were obtained from the Turkish Statistical Institute. RESULTS: A total of 16,023 gynecological cancers were evaluated among 116,940 female patients with cancer (13.7%). Average incidence for gynecological cancers was 22.7 of 100,000, representing 8437 total new cases annually. Incidence changes within time were not statistically significant, when evaluated for each tumor type. Estimated risk of gynecological cancer development before the age of 80 years was 3.08% (95% confidence interval, 3.07-3.09). The most common gynecological cancers were uterine corpus cancers, which were followed by ovarian and cervical carcinomas. Ovarian and uterine cancer incidences were closer to European levels rather than Asian countries, whereas cervical cancer incidence was extremely low. Gynecological cancers constituted an important fraction of cancer-related mortality in women by comprising approximately 10.35% of cancer-related deaths. Mortality rates due to gynecological cancers did not show a statistically significant increase within years. CONCLUSIONS: This is the first national cancer registry report to be published for gynecological cancers by the Turkish Governmental Department. As a result, Turkish gynecological cancer epidemiological data were consistent with the data obtained from European and developed countries rather than Asian countries, except for cervical cancer incidence, which is extremely low.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.

Community Palliative Care in Turkey: A Collaborative Promoter to a New Concept in the Middle East.

The Middle East has been struggling with basic issues of cancer care, and in specific, palliative care, at the primary health care level in the communities. The Middle East Cancer Consortium designated this issue as the highest priority of its activities in the region. Following basic and advanced courses and national and international workshops, local governments recognized the essentiality of developing palliative care services in their respective countries. As the result of these training activities, in 2010, the Ministry of Health in Turkey initiated a novel program whereby population-based and home-based palliative care teams were developed throughout the country, including peripheral regions in the countries where appropriate care was not available. This initiative led to a dramatic increase in the number of cancer patients receiving palliative care at their homes. The Turkish initiative can serve as a model to other countries in the Middle East and beyond it.

Cigarette prices and smoking prevalence after a tobacco tax increase--Turkey, 2008 and 2012.

Raising the price of tobacco products has been shown to reduce tobacco consumption in the United States and other high-income countries, and evidence of this impact has been growing for low- and middle-income countries as well. Turkey is a middle-income country surveyed by the Global Adult Tobacco Survey (GATS) twice in a 4-year period, in 2008 and 2012. During this time, the country introduced a policy raising its Special Consumption Tax on Tobacco and implemented a comprehensive tobacco control program banning smoking in public places, banning advertising, and introducing graphic health warnings. The higher tobacco tax took effect in early 2010, allowing sufficient time for subsequent changes in prices and smoking to be observed by the time of the 2012 GATS. This report uses data from GATS Turkey to examine how cigarette prices changed after the 2010 tax increase, describe the temporally associated changes in smoking prevalence, and learn whether this smoking prevalence changed more in some demographic groups than others. From 2008 to 2012, the average price paid for cigarettes increased by 42.1%, cigarettes became less affordable, and smoking prevalence decreased by 14.6%. The largest reduction in smoking was observed among persons with lower socioeconomic status (SES), highlighting the potential role of tax policy in reducing health disparities across socioeconomic groups.

The reported impact of non-communicable disease investment cases in 13 countries.

Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced 'language' across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.

Use of ten-group Robson Classification in Türkiye to discuss cesarean section trends.

BACKGROUND: The aim of this study was to analyze and discuss the obstetric data of Türkiye in 2016 according to the Robson 10 Group Classification System. METHODS: Data related to classification according to The 10-Group Classification System were prospectively collected in university hospitals, private hospitals and public hospitals in 2016 in Türkiye. All pregnant women admitted to labour and delivery wards were included in the study and were classified according to the Robson classification. RESULTS: According to 2016 data in Türkiye, 649,212 of 1,189,578 deliveries were performed by cesarean section and the rate of cesarean section in overall was 54.6%. The cesarean section rates were 38.6%, 68.9%, 70.6%, in public hospitals, university hospitals, private hospitals, respectively (P<0.001). Robson 1 and 2 groups constitute 33.4%, Robson 3 and 4 groups 30.4% and of Robson 5 group 25.1% of all births. The contribution rate of the Robson 5 group to the cesarean section burden is 24.3/54.6%. CONCLUSIONS: Türkiye 2016 cesarean section data revealed the necessity of taking initiatives (establishing vaginal birth clinics after cesarean, developing clinical protocols, providing physical and emotional support) to reduce the cesarean section burdens seen in Robson 1, 2 and 5 groups.

Endocervical polyps in high risk human papillomavirus infections.

OBJECTIVES: Human papillomavirus (HPV) positive patients with and without endocervical polyps is compared with respect to HPV genotypes and presence of pre-invasive diseases. To our knowledge, this is the first and largest report in the literature examining the endocervical polyps in HPV positive cases. MATERIAL AND METHODS: Clinicopathological data for the first one million screening patients (n = 1060 992) from around the entire country during 2015 and 2016 were targeted for this research. Colposcopy, colposcopic surgical diagnostic procedures and final pathology results of 3499 patients with high-risk (HR) HPV-positive were obtained from reference colposcopy centers. Patients with endocervical polyps (n = 243 [6.9 %]) were accepted as experimental arm while patients without any endocervical polyp (n = 3256 [93.1%]) were regarded as the control group. Age, HPV genotype, Pap smear abnormality, and final pathological results were compared between two groups using Student's t-test and cross-tabulation chi-square test. RESULTS: The incidence of endocervical polyp was found to be 6.9 % in HR HPV-positive women. The most common HPV genotypes observed in both groups were HPV 16 or 18. Abnormal cytology reports (≥ ASC-US) were not significantly different between both groups. However, with respect to final pathological diagnosis, patients with endocervical polyp had significantly lower numbers of pre-invasive diseases (31.3% vs 44.2%; p < 0.10). CONCLUSIONS: Endocervical polyps may be more common in patients with HR HPV infections. HPV 18 is observed significantly more, in the HR HPV positive endocervical polyp group. Patients with endocervical polyps do not have increased risk for preinvasive cervical diseases.

Maternal mortality due to valvular heart disease: a population-based study in Turkey.

BACKGROUND/AIM: To assess the clinical and demographic features of maternal mortality cases among patients with cardiac valvular diseases between 2012 and 2019. METHODS: Maternal mortality due to valvular heart disease between January 2012 and December 2019 in Turkey was retrospectively analyzed. The cases were classified according to New York Heart Association (NYHA) classification based on the severity of the heart disease. NYHA classification groups were divided into two; as class I-II (n = 34) and class III-IV (n = 31). Two groups were compared in terms of demographic and clinical characteristics. RESULTS: Valvular heart disease was diagnosed in 41 (63.1%) of the cases before pregnancy. It was found that 100% (n = 21) of the warfarin users had switched to low molecular weight heparin treatment due to concerns about warfarin embryopathy after the diagnosis of pregnancy, and only 14.2% (n = 3) of them had been monitorized with Antifactor Xa activity to evaluate the effectiveness of the medication. Two NYHA groups had similar clinical characteristics. Intensive care unit admission rate, frequency of prosthetic valve, rate of thromboprophylaxis, type of valvular disease and reasons of maternal death were similar between the NYHA groups (p < 0.05). CONCLUSION: Maternal mortality may be observed in cases with NYHA class I-II in almost similar rates with NYHA class III-IV. Therefore, it is crucial to adequately assess the mortality risk of pregnant women with cardiac valvular pathologies and to achieve early diagnosis and appropriate treatment in order to reduce maternal mortality.

Maternal deaths with epilepsy: A population-based study in Turkey.

OBJECTIVE: To evaluate the clinical characteristics of maternal deaths with epilepsy in Turkey. STUDY DESIGN: This epidemiological population-based study was conducted on all consecutive early maternal deaths with epilepsy in Turkey from 2012 to 2019. Maternal deaths accompanied by epilepsy as a comorbidity (n = 13) were evaluated separately. Epilepsy related maternal deaths were divided into two groups: 1) status epilepticus (n = 19) and 2) Sudden unexpected death in epilepsy (n = 19). Two groups were compared in terms of demographic features and clinical characteristics. RESULTS: Maternal deaths with epilepsy ranged between 2.5 % and 5.3 % among total maternal deaths. Pulmonary embolism (32 %), cerebrovascular event (23 %), and cerebral vein thrombosis (15.4 %) were the leading mortality reasons in maternal deaths accompanied by epilepsy. Epilepsy duration, the time interval between pregnancy and the last epileptic seizure, compatibility with medication, rates of preconceptional counseling, and regular antenatal follow-up were all significantly higher in the sudden unexpected death in epilepsy group. The perinatal complication rate was significantly higher in the status epilepticus group (p > 0.05). CONCLUSION: Physicians who deal with pregnant women with epilepsy should be attentive for severe complications and the increased risk of maternal mortality in these cases should be kept in mind.

Immigration and screening programs for hemoglobinopathies in Italy, Spain and Turkey.

Sickle cell disease (SCD) and thalassemias are the most common monogenic diseases in the world. The number of migrants and refugees in Europe and Turkey, in the past decade, has increased dramatically due to war, violence or prosecutions in their homeland. Prevention and management of haemoglobin disorders is well established and managed in countries where these conditions were traditionally endemic or in countries that have a longstanding tradition of receiving migrants. Therefore, preventive and diagnostic programmes regarding hemoglobinopathies in immigrant populations have been implemented. The purpose of this paper it to report a summary of the experience gained in Italy, Spain and Turkey in migrants, asylum seekers and refugees.

A Resilient Health System in Response to Coronavirus Disease 2019: Experiences of Turkey.

Turkey's response experience thus far with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic affords the globe and the region a unique opportunity for and distinctive insights into combating this novel virus. The country's pandemic response, having one of the lowest case fatality ratio (2.8%; 52.5 infections/million population), particularly among the elderly (the high-risk group), rising to the occasion to shoulder its long-standing role in global solidarity and humanitarian support by providing personal protective equipment (globally scarce) to many countries in their desperate time of fight against the pandemic while also meeting its own critical domestic needs, stands out. This paper aims to highlight key decisions, actions, and partnerships behind Turkey's successful fight against the SARS-CoV-2 pandemic that have enabled the country to turn the corner, as well as the components of its success story.

Mega Hpv laboratories for cervical cancer control: Challenges and recommendations from a case study of Turkey.

Cervical cancer is the fourth most common cancer among women in the world. It is estimated that one woman dies every 2 min from cervical cancer. Nearly all cervical cancers are preventable by early detection and treatment through screening or HPV vaccination. In 2018, World Health Organization (WHO) made a global call for action toward the elimination of cervical cancer. Cervical cancer screening involves a complex organized program, which begins with a call/recall system based on personal invitation of eligible women, followed by participation in screening, and leading to diagnosis, treatment, and management as appropriate. An effective cervical screening program with high coverage is dependent on each country's infrastructure and human resource capacity. Efforts to develop an effective program is particularly challenging in low and middle income countries (LMIC) where resources are limited. For an effective strategy, Turkey redesigned the country's cervical screening program. The local call/recall system and centralized monitoring system of individual women were re-vamped with an automated evaluation system. The revised screening program includes the use of primary HPV testing with a well-defined protocol outlining the algorithms of management (i.e., screening intervals and referral), a single nationwide centralized diagnostic laboratory, and a sustainable agreement with the HPV diagnostics industry. This system allows for traceable, real-time monitoring of screening visits and specimens. Turkey reports on the first four years of this re-vamped organized program and shares lessons learnt from the implementation of this new program.

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey.

BACKGROUND: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). METHODS: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. RESULTS: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. CONCLUSION: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.