Is polycystic ovary syndrome a risk factor for depression and anxiety?: a cross-sectional study.

OBJECTIVE: The objective of this study was to learn more about the prevalence and pathophysiology of depression and anxiety that may be caused by polycystic ovary syndrome and to make plans for taking necessary precautions for this vulnerable group. METHODS: This case-control study was conducted between January 2022 and October 2022. A total of 120 women with polycystic ovary syndrome and 143 controls were included in the study. All healthy volunteers and women with polycystic ovary syndrome were evaluated using self-administered questionnaires and physical examination. Anthropometric data such as weight and height and laboratory value were documented. RESULTS: There was no significant difference between the groups in terms of demographic characteristics. When the Hospital Anxiety and Depression Scale scores of both groups were compared, both depression and anxiety scores were found to be significantly higher in women with polycystic ovary syndrome compared with the control group (OR: 3.319, 95%CI, 1.563-7.047, p<0.001 and OR: 3.238, 95%CI, 1.659-6.315, p<0.001). In the Hospital Anxiety and Depression Scale questionnaire, the rate of irregular menstruation and Ferriman-Gallwey score were statistically significant in women with polycystic ovary syndrome with high depression and anxiety scores. While serum LH levels and LH/FSH ratios were significantly different in women with polycystic ovary syndrome with high depression scores, serum LH, LH:FSH ratios, and serum total testosterone levels were found significant in women with polycystic ovary syndrome with high anxiety scores. CONCLUSION: It is clear that depression and anxiety are more common in patients with polycystic ovary syndrome than in healthy women. Our findings support previous recommendations regarding routine screening for depression and anxiety in this population.

A randomized, prospective, controlled study comparing uterine preserving laparoscopic lateral suspension with mesh versus laparoscopic sacrohysteropexy in the treatment of uterine prolapse.

OBJECTIVES: Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20-30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively. STUDY DESIGN: The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI). RESULTS: Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. CONCLUSION: Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent.

Comparison of the adolescent pregnancy outcomes between refugees and Turkish citizens.

BACKGROUND: Adolescent pregnant women have significant risk factors in terms of preterm birth, low birth weight, gestational and neonatal complications, and neonatal and infant deaths. In many countries, living as a refugee differs from living as a local citizen regarding education level, access to health services, and lifestyle. We aimed to compare the obstetric, perinatal, and neonatal outcomes of Turkish and refugee adolescent pregnant women admitted to a tertiary maternity center. METHODS: The study was planned as a retrospective cross-sectional. We included adolescent pregnant women who delivered between February 2018 and August 2023. Adolescent pregnant women were divided into two groups, the Turkish group and the Syrian refugee group, and compared with each other. RESULTS: One thousand and fifty-one Turkish and 742 refugee adolescent pregnant women were included in the study. Adolescent pregnancy rates are higher in refugees than in the Turkish group (p < 0.001). We found that maternal age (p < 0.001), preeclampsia rates (p=0.029), gestational age at delivery (p < 0.001), and cesarean delivery rates (p=0.02) were lower in refugee adolescent pregnant women. Furthermore, we found that the anemia rates (p < 0.001) and low birth weight newborn rates (p = 0.011) were higher in refugee adolescent pregnant women. CONCLUSIONS: Enhancing the outcomes of adolescent pregnancies among refugees necessitates a heightened focus on education regarding sexual reproduction, increased prenatal follow-ups, and enhanced training in family planning.

Adolescent pregnancies in Turkey: a single center experience.

BACKGROUND: Adolescent pregnancies are more likely to be complicated with adverse perinatal outcomes. OBJECTIVE: Assess the sociodemographic and clinical characteristics of adolescents who have delivered singleton newborns. DESIGN: Retrospective cohort. SETTINGS: A tertiary training and research hospital in Turkey. PATIENTS AND METHODS: This was a review of adolescents and adults who delivered singleton newborns at a tertiary health center between January 2018 and June 2022. Pregnant adolescents were aged <20 years. MAIN OUTCOME MEASURES: Adverse maternal and perinatal outcomes. SAMPLE SIZE: 2233 pregnant women (754 adolescents and 1479 adults). RESULTS: Turkish nationality was significantly less prevalent in pregnant adolescents than pregnant adults (P=.001). Oligohydramnios, fetal growth restriction, perineal injury and postpartum intravenous iron treatment were significantly more prevalent in pregnant adolescents than pregnant adults (P<.05 for all). The neonates born to adolescent mothers had significantly lower birth weight and first minute Apgar score than the neonates born to adult mothers (P=.001 for both). Small for gestational age, need for intensive care and death were significantly more prevalent in neonates born to adolescent mothers than those born to adult mothers (P=.001 for all). Compared with pregnant adults, pregnant adolescents had a significantly higher risk of oligohydramnios (P=.001), preterm delivery (P=.024), intravenous iron treatment (P=.001), and small for gestational age (P=.001). CONCLUSION: Due to the refugee population received by Turkey, it would be prudent to expect more frequent adolescent pregnancies. Adolescent pregnancies are more likely to be complicated with low birth weight, oligohydramnios, preterm delivery, postpartum iron treatment, lower Apgar scores, need for neonatal intensive care and neonatal death. LIMITATION: Retrospective.

Pregnant women's knowledge about and beliefs toward COVID-19 vaccine: a cross-sectional study.

Purpose: The aim of this study was to determine the scope of knowledge, attitudes, and behaviors of pregnant women about the coronavirus disease 2019 (COVID-19) vaccine. Materials and Methods: A total of 886 pregnant women were recruited for the study. A cross-sectional questionnaire was conducted on these selected participants. Data about past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 infection of closely related people, and deaths due to COVID-19 among their relatives were questioned. Results: The rate of vaccination was higher (64.1%) in pregnant women with higher education levels. Informing about the vaccine, especially by health professionals, showed that the rates of vaccination (25%) increased (p<0.001). In addition, a significant increase was observed in vaccination rates with increasing age and financial income (p<0.001). Conclusion: The main limitation of our study is that the vaccine, which was approved for "emergency use", was just started to be administered to pregnant women during the study. Our findings show that our target audience, low-income, low-education, younger pregnant women should be given more attention than those who apply to the doctor for routine follow-up.

Intrapartum ultrasound for fetal head asynclitism: Is it possible to establish a degree of asynclitism to correlate to delivery outcome?

OBJECTIVE: To investigate the role of intrapartum ultrasound (IU) in the diagnosis of asynclitism and the importance of asynclitism degree in labor outcomes. METHOD: This prospective cohort study included 41 low-risk pregnant women with fetus in singleton-vertex. The IU assessment to diagnose asynclitism was performed during labor at two specific steps, including the suspicion and/or diagnosis of labor arrest. The "four-chamber view" and "squint sign without nose" were classified as marked/severe asynclitism. The "midline deviation" and "squint sign with nose" findings were classified as moderate asynclitism. Obstetric outcomes and maternal-fetal complications were compared with the degree of asynclitism. RESULTS: Severe and moderate asynclitism was seen in 17 (41.7%), 10 (58.8%) and seven (41.2%) women, respectively. All pregnant women diagnosed with asynclitism delivered by vacuum extraction (VE) or cesarean section (CS). CS was performed in nine patients with asynclitism (52.9%). The difference between asynclitism type and VE/CS ratios was statistically significant (P = 0.039). Four fetuses with squint sign without nose delivered by VE. A significant correlation was seen between the presence of squint without nose sign and second-/third-degree perineal injury. CONCLUSION: Severe asynclitism is associated with increasing operative birth and maternal-fetal complications. Detection of asynclitism degree by IU could be useful, alerting the obstetrics team to possible perinatal problems during delivery.

Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study.

BACKGROUND: In 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern. METHODS: INTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile. FINDINGS: We enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose. INTERPRETATION: COVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority. FUNDING: None.

Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries.

PURPOSE: The use of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) as the first choice of surgical route for patients scheduled to undergo conventional laparoscopy is still being debated. We aimed to evaluate and compare the outcomes of the "vNOTES first" strategy in benign gynecological cases. METHODS: All benign gynecological surgeries were initiated using vNOTES during the study period, regardless of the difficulty. Surgical outcomes, short-term patient satisfaction and sexual pain were compared between hysterectomies, adnexal and diagnostic procedures. Visual Analog Score (VAS), Patients Global Impressions of Improvements scale (PGI-I) and Female Sexual Function Index (FSFI) were used to assess the postoperative pain, satisfaction and sexual pain, respectively. RESULTS: A total of 105 vNOTES procedures were performed during the study period: 63 (60.58%) adnexal procedures, 36 (34.62%) hysterectomies, 5 (4.81%) diagnostic procedures and one (0.96%) myomectomy. The median 24th hour VAS scores for adnexal, hysterectomy, and diagnostic procedures were 1.29 ± 1.41, 2.06 ± 2.08, and 2.6 ± 2.41, respectively. The satisfaction rate was 96.19% at the 1st postoperative week and 97.14% at the first month. There was either no change or a slight improvement in the patients' total score on the FSFI/pain domain before and after surgery. There were two conversions (1.9%) from vNOTES to laparoscopy and laparotomy, and two (5.56%) bladder injuries in hysterectomy cases. CONCLUSION: Implementing the vNOTES technique as an initial approach for all benign gynecological surgeries seems feasible, safe and satisfactory, even in those with a non-prolapsed or enlarged uterus and those that have previously undergone abdominal surgery. The pain scores were found to be low and patients stated a high satisfaction with no or better change in their sexual life.

COVID-19 related maternal mortality cases in associated with Delta and Omicron waves and the role of lung ultrasound.

Objective: To present coronavirus disease-2019 (COVID-19) related maternal mortality in relation to Delta and Omicron waves and to investigate the role of lung ultrasound (LUS) in estimating mortality. Materials and Methods: This retrospective cohort study was conducted in the obstetrics and gynecology clinic of a tertiary pandemic hospital between March 2020 and January 2022. The hospitalized pregnant women with COVID-19 diagnosis and maternal deaths were studied in relation with Delta and Omicron waves. The relationship between LUS scores of hospitalized patients and maternal mortality was explored. Results: Thousand and sixty-five pregnant women were hospitalized because of COVID-19 infection. Fifty-one (4.79%) of these patients had critical sickness, 96 (9.01%) of them had severe illness, 62 (5.82%) of them were admitted to the intensive care unit and 28 (2.63%) of all hospitalized pregnant women had died. Of the 1.065 patients, 783 (73.5%) were hospitalized before the Delta wave and the maternal mortality rate was 1.28% (10/783), 243 (22.8%) were hospitalized during the Delta wave and the maternal mortality rate was 7% (17/243) [relative risk (RR)=5.478, 95% confidence interval (CI) (2.54-11.8), z=4.342, p<0.001]. During the Omicron wave 39 (3.66%) patients were hospitalized and the maternal mortality rate was 2.56% (1/39). Maternal mortality rates, according to LUS scores, were 0.37% (1/273) for LUS 0, 0.72% (2/277) for LUS 1, 2.58% (10/387) for LUS 2 and 11.72% (15/128) for LUS 3 respectively (LUS 3 vs. others; maternal mortality: RR=8.447, 95% CI (4.11-17.34), z=5.814, p<0.0001). There were no vaccinated patients in the study cohort. Conclusion: The maternal mortality rate was relatively high, particularly during the Delta wave at our referral center. The Delta wave, delayed vaccination and vaccine hesitancy of pregnant women might have important roles in maternal mortality. Higher LUS scores should warn clinicians of an increased risk of maternal death.

Validation of the Vulvovaginal Symptom Questionnaire in Turkish women with genitourinary syndrome of menopause.

OBJECTIVE: This study aims to psychometrically validate the Turkish version of the Vulvovaginal Symptom Questionnaire (VSQ). METHODS: Postmenopausal women with and without genitourinary syndrome of menopause (GSM) were included as the target population and the control group. Psychometric properties were validated both for sexually active (21 items) and passive women (16 items). Several a priori hypotheses were formulated to assess construct validity. Scores of GSM-Assessment Tool, Female Sexual Function Index, Michigan Incontinence Severity Index, Female Genital Self-Image Scale, and Menopause Rating Scale and their correlation with VSQ scores were compared. RESULTS: A total of 242 postmenopausal women were included. The VSQ showed good internal consistency with a Cronbach alpha coefficient of 0.822 (0.800-0.821) and 0.873 (0.853-0.870) in sexually active and passive women, respectively. Originally proposed model (4-factor model, n = 162) showed adequate fit in women with active sexuality and the 3-factor model (n = 242) showed moderate fit. The test-retest reliability was good for symptoms, emotions, and life impact subscales (intraclass correlation coefficient [ICC]: 0.846, 0.835, and 0.755, respectively) and moderate for sexual impact subscale (ICC: 0.643). More than 75% of hypotheses were confirmed. CONCLUSIONS: Our study shows successful cross-cultural adaptation and validation with sufficient psychometric properties for VSQ to be used in Turkish postmenopausal women with GSM.

Vitamin D status is not associated with clinical severity of COVID-19 in pregnant women.

PURPOSE: To investigate the association between vitamin D status and the clinical severity of COVID-19 in pregnant women. METHODS: This prospective case-control study included 147 pregnant women with COVID-19 and 300 matched controls. Serum 25-hydroxyvitamin (25(OH)D) concentrations were measured on admission. Patients with mild-to-moderate disease (n = 114, 77.6%) and severe-to-critical disease (n = 33, 22.4%) were classified as symptomatic patients who did not require oxygen support and those who received oxygen support, respectively. SARS-CoV-2 positivity rates, clinical severity of COVID-19, and pulmonary involvement were compared according to vitamin D status. RESULTS: Serum 25(OH)D concentrations were found to be 36.6 ± 26.8 and 31.3 ± 20.7 nmol/L in pregnant women infected with SARS-CoV-2 and healthy controls, respectively (p = 0.001). The clinical severity of pregnant women with COVID-19 did not differ concerning vitamin D deficiency (RR = 0.568, 95% CI [0.311-1.036]; p = 0.065), even after excluding patients on vitamin supplementation (RR = 0.625, 95% CI [0.275-1.419]; p = 0.261). Testing positive for SARS-CoV-2 was not related to vitamin D status in the overall cohort of pregnant women (RR = 0.767, 95% CI [0.570-1.030]; p = 0.078). Pulmonary involvement of COVID-19 was found to be similar between patients with vitamin D deficiency and adequate vitamin D levels (RR = 0.954; 95% CI [0.863-1.055]; p = 0.357). CONCLUSION: The clinical severity and pulmonary involvement of COVID-19 may not be associated with vitamin D status in pregnant women. Vitamin D deficiency/adequacy rates were comparable in pregnant women infected with SARS-CoV-2 and healthy pregnant women.

The Comparison of Transvaginal Natural Orifice Transluminal Endoscopic Surgery and Conventional Laparoscopy in Opportunistic Bilateral Salpingectomy for Permanent Female Sterilization.

STUDY OBJECTIVE: To compare the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) approach with conventional laparoscopy (CL) in opportunistic bilateral salpingectomy (BS) alone for permanent female sterilization as an opportunistic cancer prevention strategy. DESIGN: Prospective cohort study. SETTING: Two-centered tertiary hospitals. PATIENTS: Ninety-six women with a nonprolapsed uterus seeking definitive surgical permanent contraception. INTERVENTIONS: Patients were scheduled for BS and assigned to a study arm in a 2:1 fashion (CL:vNOTES allocation ratio) concerning patient's choice. MEASUREMENTS AND MAIN RESULTS: Patients were followed at their postoperative first week and first month. The visual analog score (VAS), Patient Global Impression of Improvement, and Female Sexual Function Index scales were used to assess the pain, patient satisfaction, and discomfort/pain after vaginal penetration, respectively. Patients who underwent to vNOTES had a significantly higher number of previous abdominal surgery (median difference, 1.97; 95% confidence interval [CI], 1.12-3.48; p = .016). Compared with CL, vNOTES was associated with lower 6-hour (rate ratio [RR], 0.63; 95% CI, 0.50-0.77) and 24-hour (RR, 0.33; 95% CI, 0.23-0.46) postoperative VAS scores and less amount of postoperative analgesics (RR, 0.54; 95% CI, 0.36-0.78). The slope of change in postoperative VAS scores was in a shorter time in the vNOTES group (RR, 0.47; 95% CI, 0.36-0.60). The rate of postoperative improvement was higher in the vNOTES group than the CL group at the postoperative first week (87.5% vs 68.2%, χ2 = 4.232, p = .032) and first month (96.9% vs 87.9%, χ2 = 2.091, p = .140). The rate of patients reporting postoperative decline in Female Sexual Function Index /pain scores (RR, 0.97; 95% CI, 0.47-1.96) was found to be similar in both of the study groups, and no postoperative complication was observed in either group. CONCLUSION: Women seeking permanent sterilization and who underwent BS for ovarian cancer risk reduction purposes had higher satisfaction, less postoperative pain, lower analgesic requirement, and similar surgical outcomes in the vNOTES group than the CL group, even in patients with previous surgeries and a nonprolapsed uterus. vNOTES approach could be the preferred method for the opportunistic BS in female sterilization.

An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women.

BACKGROUND: Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association of COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. OBJECTIVE: The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection. STUDY DESIGN: This was a multicenter retrospective cohort study including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, and Turkey). The data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. The secondary outcomes included maternal death, preeclampsia, and stillbirth. The association between the primary outcome and 12 candidate predictors having a known association with severe COVID-19 in pregnancy was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios. All the potential predictors were evaluated in 1 model and only the baseline factors in another. The predictive accuracy was assessed by the area under the receiver operating characteristic curves. RESULTS: Of the 793 pregnant women who were positive for SARS-CoV-2 and were symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The 'mini-COvid Maternal Intensive Therapy' model included the following demographic and clinical variables available at disease onset: maternal age (adjusted risk ratio, 1.45; 95% confidence interval, 1.07-1.95; P=.015); body mass index (adjusted risk ratio, 1.34; 95% confidence interval, 1.06-1.66; P=.010); and diagnosis in the third trimester of pregnancy (adjusted risk ratio, 3.64; 95% confidence interval, 1.78-8.46; P=.001). The optimism-adjusted area under the receiver operating characteristic curve was 0.73. The 'full-COvid Maternal Intensive Therapy' model included body mass index (adjusted risk ratio, 1.39; 95% confidence interval, 1.07-1.95; P=.015), lower respiratory symptoms (adjusted risk ratio, 5.11; 95% confidence interval, 1.81-21.4; P=.007), neutrophil to lymphocyte ratio (adjusted risk ratio, 1.62; 95% confidence interval, 1.36-1.89; P<.001); and serum C-reactive protein (adjusted risk ratio, 1.30; 95% confidence interval, 1.15-1.44; P<.001), with an optimism-adjusted area under the receiver operating characteristic curve of 0.85. Neither model showed signs of a poor fit. Categorization as high-risk by either model was associated with a shorter diagnosis to intensive care unit admission interval (log-rank test P<.001, both), higher maternal death (5.2% vs 0.2%; P<.001), and preeclampsia (5.7% vs 1.0%; P<.001). A spreadsheet calculator is available for risk estimation. CONCLUSION: At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high- and low-risk for progression to critical disease, even where resources are limited. This can support the nature and place of care. These models also highlight the independent risk for severe disease associated with obesity and should further emphasize that even in the absence of other comorbidities, vaccination is particularly important for these women. Finally, the model also provides useful information for policy makers when prioritizing national vaccination programs to quickly protect those at the highest risk of critical and fatal COVID-19.

Guillain Barre Syndrome following delivery in a pregnant woman infected with SARS-CoV-2.

Effects of SARS-CoV-2 on the neurological system have been investigated. Evidence of Guillain-Barre Syndrome (GBS) cases associated with SARS-CoV-2 infection have recently been reported. A 34-year-old multiparous woman with COVID-19 infection at her 37th (4/7) gestational week was presented here. She was diagnosed with Guillain Barre Syndrome at postpartum. As we know recently this was the first case mentioned in the literature. The clinical course of GBS with COVID-19 after childbirth may be similar to GBS patients not infected with COVID-19.

Clinical and radiologic characteristics of symptomatic pregnant women with COVID-19 pneumonia

Objective: To describe the radiological features, diagnostic accuracy and features of imaging studies and their relation with clinical course of Coronavirus disease-2019 (COVID-19) pneumonia in pregnant women. Material and Methods: The clinical, laboratory and radiological features of symptomatic pregnant women suspected of COVID-19 were retrospectively reviewed. Chest radiography (CXR) and chest computed tomography (CT) findings of COVID-19 in pregnant women were identified. Results: Fifty-five of eighty-one pregnant women were included in the final analysis. The most common admission symptoms were dry cough (45.4%), fever (29.1%) and dyspnea (34.5%). Radiological imaging studies were performed in 34 (61.8%) patients. Fourteen (66.7%) of the laboratory-confirmed COVID-19 patients had parenchymal abnormalities on CXR, and most common abnormalities were airspace opacities (61.9%) and prominent bronchovascular shadows (28.6%). Seventeen (85.0%) of the patients had parenchymal abnormalities consistent with COVID-19 on their chest CT. Chest CT most commonly showed bilateral (88.2%), multilobe (100%) involvement; peripheral and central distribution (70.6%); patchy-shape (94.1%) and ground-glass opacity (94.1%). The sensitivity of CXR and chest CT was calculated as 66.7% and 83.3%, respectively. Preterm birth rate was 41.2% (n=7/17). Five (9.1%) of the 55 pregnant women admitted to the intensive care unit, three of those developed acute respiratory distress syndrome and one died. Conclusion: This study describes the main radiological features of symptomatic pregnant women infected with COVID-19. The refusal rate among pregnant women for the imaging modalities involving ionizing radiation was high but these had high sensitivity for COVID-19 diagnosis. The preterm birth and cesarean section rates were observed as remarkably increased.

Incomplete healing of the uterine incision after elective second cesarean section.

PURPOSE: To evaluate the possible associations between the single-layer locked- and unlocked-uterine closure technique and closure area biometry, and cesarean scar healing in recurrent cesarean section. MATERIAL AND METHODS: In this randomized prospective study, elective second cesarean section of 120 singleton pregnant women were randomized into the single-layer locked- and unlocked-continuous uterus closure technique. During the operation, the upper and lower edge thickness of the uterine incision were measured. In order to evaluate the healing in the cesarean scar area, all women were examined with vaginal ultrasonography 6-8 months after the cesarean section. The possible associations between locked- and unlocked-uterine closure technique and closure area biometry and cesarean scar healing were evaluated. RESULTS: After the drop-outs, a total of 86 women, 45 in the locked-continuous closure group and 41 in the unlocked-continuous closure group were evaluated. There was no statistically significant difference between the groups in terms of demographic and clinical parameters, such as perioperative uterine closure area biometry, need for additional suture, duration of operation and amount of bleeding. However, a significantly greater number of additional sutures for hemostasis was necessary in the unlocked-continuous compared to the locked-continuous closure group. The rate of cesarean scar defect (CSD) and residual myometrium thickness were comparable whereas the healing rate was significantly higher in the locked-continuous closure group compared to the unlocked-continuous closure group (0.71 ± 0.90 vs. 0.64 ± 0.10, p = .032). In women with CSD, the lower edge was 4 mm thinner than the women without CSD (10.48 ± 6.13 mm vs. 14.53 ± 7.13 mm, p = .006). Moreover, the thickness difference between the lower and upper edge was significantly greater if CSD was present compared to the absence of CSD (5.88 ± 4.04 mm vs. 3.70 ± 3.00 mm, p = .006). CONCLUSIONS: There was no association between CSD and locked versus unlocked suture technique used for the closure of uterine incision in the second cesarean section. The biometric evaluation of the scar area has shown that the thin lower wound edge and unevenness between the lower and the upper wound edges may play a role in incomplete healing of the uterine incision.

Lung Ultrasound Can Influence the Clinical Treatment of Pregnant Women With COVID-19.

Lung ultrasound (LUS) is an effective tool to detect and monitor patients infected with 2019 coronavirus disease (COVID-19). The use of LUS on pregnant women is an emerging trend, considering its effectiveness during the outbreak. Eight pregnant women with a diagnosis of COVID-19 confirmed by nasal/throat real-time reverse transcription polymerase chain reaction testing who underwent point-of-care LUS examinations after routine obstetric ultrasound are described. A routinely performed LUS examination revealed serious lung involvement in 7 cases: 2 were initially asymptomatic; 3 have chest computed tomography; 1 had initial negative real-time reverse transcription polymerase chain reaction results; and 1 had initial negative computed tomographic findings. Treatment for COVID-19 was either commenced or changed in 87.5% of the patients (n = 7 of 8) on LUS findings. Among patients with abnormal LUS findings, treatment was commenced in 5 patients (71.5%) and changed in 2 patients (28.5%). One normal and 7 abnormal LUS cases indicate the impact of routine LUS on the clinical outcome and treatment of pregnant women.

Pregnancy worsens the morbidity of COVID-19 and this effect becomes more prominent as pregnancy advances.

OBJECTIVE: To investigate pregnancy outcomes and compare the clinical characteristics of coronavirus 2019 (COVID-19) disease in pregnant and agematched non-pregnant women. MATERIALS AND METHODS: Hospital records of four tertiary care centers were reviewed retrospectively. The subjects comprised 188 pregnant patients and 799 non-pregnant women who were admitted to these hospitals. RESULTS: Pregnancy significantly affected the clinical severity of COVID-19 and this effect was more prominent in pregnant women at >20 weeks gestation (p<0.001). Rates of oxygen support (10.1% vs 4.8%; p≤0.001), intensive care unit admission (3.2% vs 0.6%; p=0.009), presence of fever (12.8% vs 4.4%; p<0.001), tachypnea (7.0% vs 2.4%; p=0.003) and tachycardia (16.0% vs 1.9%; p<0.001) were significantly more frequent in pregnant women compared with non-pregnant women. Pregnancy was strongly associated with the need for oxygen support [relative risk (RR), 2.125; 95% confidence interval (CI): 1.25-3.60] and admission to the intensive care unit (RR, 5.1; 95% CI: 1.57-16.53) compared with non-pregnant women. Some 14.4% of the pregnant women had co-morbidities. Sixty of the 188 pregnant women (31.9%) delivered during the Severe Acute Respiratory syndrome coronavirus-2 infection, 11 (18.3%) had vaginal deliveries and 49 (81.7%) were by cesarean section. Of these 60 deliveries, 40 (66.7%) were <37 weeks gestation. CONCLUSION: Pregnancy worsens the morbidity of COVID-19 and this effect seems to increase as the pregnancy advances, but not the mortality rate.