The effect of medical and social conditions on the mode of delivery: a prospective questionnaire-based study applied to 404 Turkish obstetricians.

PURPOSE: To identify the factors that influence provider's decisions on method of delivery in a country where national cesarean delivery rate (CDR) among all births increased steadily from 21 to 56% in a 16-year period. METHODS: We planned nine birth scenarios, in which both delivery modes were plausible, and we used self-administered questionnaire to ask obstetricians for their preferred mode of delivery in these scenarios. If the choice was cesarean delivery (CD), the provider was asked to state the reason for choosing this method. We grouped respondents according to number of years in their occupation, working sector (state, university or private hospital) and academic degree. RESULTS: Four hundred and four obstetricians completed the questionnaire. Preference for CD in all scenarios was comparable between male and female obstetricians (p = 0.334) and between specialists, associate professors and professors (p = 0.812). The most frequent reason for choice of CD in all nine scenarios was fear of fetal risk and/or fear of litigation. CONCLUSION: Fear of litigation was found to be the major factor influencing CD choice. This fear not only increases the CDR but also results in loss of training in breech delivery and operative vaginal delivery, forming a vicious cycle.

Impact of Syrian refugees on congenital TORCH infections screening in Turkey.

AIM: To demonstrate the effect of the Syrian refugee population on the prevalence of congenital TORCH (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus [CMV] and Herpes) infections and to evaluate the cost-effectiveness of population-based TORCH screening during pregnancy in Turkey. METHODS: Pregnant women (n = 9754) were enrolled. Ultrasonographic findings, immunoglobulin (Ig)M and IgG seropositivity, avidity, amniocentesis and DNA-polymerase chain reaction (PCR) results were compared. Costs were calculated based on invoice amounts from the Health Applications Communique pricing system. RESULTS: The prevalence of TORCH seropositivity in Turkey was not significantly different between all regions (P > 0.05). Overall, 1333 (13.67%) pregnant Syrian refugees were included in the study. Acute CMV, rubella and Toxoplasma gondii infections (according to low IgG avidity in IgM positive patients) were detected in 17.82%, 21.53% and 14.07% of women, respectively. Twenty-four women underwent an amniocentesis procedure and nine of them had positive DNA-PCR and reverse transcription-PCR results. All women with positive results opted to terminate the pregnancy. There was no statistical difference among groups according to the rate of low IgG avidity in IgM-positive patients and termination rates for T. gondii, rubella and CMV (P > 0.05). Total cost for screening the entire study population was presented in US dollars (USD). A total of 71 529 and prenatal diagnosis with positive invasive test results were obtained in nine women: toxoplasmosis in four, CMV in three and rubella in two women. CONCLUSION: Population-based screening for prenatal TORCH infections is not cost-effective in Turkey. Syrian refugees have a limited effect on the increasing prevalence of congenital TORCH infections.

Effects of lisinopril treatment on the pathophysiology of PCOS and plasminogen activator inhibitor-1 concentrations in rats.

RESEARCH QUESTION: Angiotensin-converting enzyme inhibition results in a significant reduction in plasma concentrations of plasminogen activator inhibitor-1 (PAI-1). What are the effects of lisinopril treatment on PAI-1 concentrations and the morphology and function of the ovaries in the letrozole-induced polycystic ovary syndrome (PCOS) rat model? DESIGN: This prospective randomized controlled animal study involved female Wistar albino rats. Twelve rats were assigned as controls (group I). In the study group (n = 48), letrozole (an aromatase inhibitor) was administered for PCOS modelling for 9 weeks. After confirming disrupted oestrous cycles, the study group was randomized into two groups: group II (n = 24; letrozole only) and group III (n = 24; letrozole + lisinopril 15 mg/kg per day). After 12 weeks, each group was divided randomly into two. Biochemical, histopathological and immunohistochemical analyses was performed in subgroups designated A, and fertilization rates were studied in subgroups designated B. RESULTS: Lisinopril treatment reduced the weight and area of the ovaries, the number and wall thickness of cystic follicles, and serum concentrations of LH and testosterone, relative to group II (P < 0.001). Circulating PAI-1 concentrations were significantly different among three groups (7.7 ± 0.9 ng/ml, 9.8 ± 0.7 ng/ml and 8.6 ± 0.7 ng/ml for groups IA, IIA and IIIA; P < 0.001). Pregnancy rates were 100%, 0% and 16.7% in groups IB, IIB and IIIB. CONCLUSIONS: In the letrozole-induced rodent PCOS model, lisinopril modifies the action of letrozole, possibly by inhibition of systemic and ovarian production of PAI-1. The use of PAI-1 inhibitors deserves further investigation in understanding the pathogenesis of PCOS.

Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding.

Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding.Methods: In this retrospective descriptive case-control study, women who underwent RLACD (n = 46) only for bleeding between 2012 and 2017 were reviewed. Factors that could predict relaparotomy and related near-miss event were evaluated. Maternal characteristics, laboratory findings and surgical features were compared with a control group (n = 230) that included noncomplicated cesarean deliveries (CD). Logistic regression analysis was used to identify independent factors for relaparotomy.Results: RLACD for bleeding was required in 0.26% of patients and the incidence increased gradually over years (0.16% in 2013 versus 0.44% in 2017). Mean interval between CD and subsequent relaparotomy was 15.7 ± 3.2 hours. The sources of bleeding in descending order of frequency included; uterine fundus and placental bed (39.1%), cervix (21.7%), undetermined (17.3%), superior epigastric artery (13%), superficial epigastric artery (8.1%). Longer duration of CD (adjusted odd ratio (aOR) 1.82, 95% CI 1.02-2.53), increased number of prior CDs (aOR 2.51, 95% CI 1.09-5.78), preeclampsia (aOR 3.48, 95% CI 1.21-7.19) were found to be independent risk indicators for RLACD. Moreover, longer duration of interval between CD and relaparotomy (p = .005), longer relaparotomy duration (p = .012) and greater drop in hemoglobin level (p = .001) were found to be the predictors of maternal near-miss event.Conclusions: Patients with identified risk factors should be managed properly in order to prevent relaparotomy and near-miss event after CD. Also, urgent decision of surgical intervention might reduce the risk of maternal near-miss event.

The impact of vaginal cone therapy on stress urinary incontinence compared with transobturator tape.

OBJECTIVE: To emphasize the efficiency of vaginal cone (VC) therapy in stress urinary incontinence (SUI) through a comparison with transobturator tape (TOT). MATERIALS AND METHODS: A prospective randomized controlled study was conducted at the Etlik Zübeyde Hanim Maternity and Women Hospital during a one year study period. Forty women were allocated into two equal groups; those treated with VCs for a 3 month period, and women who underwent TOT procedures. These women were followed up at 6 weeks and 6 months after the treatments. Subjective cure was assessed using Wagner's Quality of Life Questionnaire. Objective cure was evaluated through a cough stress and pad test results. RESULTS: Maternal demographic features were comparable among groups. We observed improvement in pad weight test among groups when compared with the pretreatment state (p=0.015, p=0.005). Although the subjective cure rate was similar in both groups at the 6th week and 6th month follow up (65% vs. 75%; 75% vs. 80%) (p>0.05), the objective cure rate was significantly higher in the TOT group than in the VC group, as expected (10% vs. 80%; 30% vs. 75%) (p<0.05). CONCLUSION: The main treatment of SUI is surgery; however, VC could be offered as an alternative treatment for women who refuse surgery, those at high risk for surgery or it could be used temporarily before surgery.

The feasibility of the platelet count and mean platelet volume as markers of endometriosis and adenomyosis: A case control study.

INTRODUCTION: The aim of the study is to investigate the role of platelet count (PC) and mean platelet volume (MPV) in determining adenomyosis and endometriosis. MATERIAL AND METHODS: This was a retrospective case control study that included adenomyosis, endometriosis and control groups. The adenomyosis group included 84 women diagnosed between January 2013 and January 2015 based on hysterectomy specimen. The endometriosis group included 102 patients underwent diagnostic laparoscopy and confirmed by histopathologic examination. Lastly, the control group included 88 women had no medical problem and underwent tubal ligation. RESULTS: MPV (fl) was significantly lower in adenomyosis group (8.5) compared to endometriosis (9, p<0.05) and control groups (9, p<0.01). Modified platelet activity (MPV/PC) was significantly lower in adenomyosis group compared to control group (p<0.01). Bivariate logistic regression model was used to assess the odds ratio of risk factors and serum markers related to endometriosis and adenomyosis. Variables showing significant differences based on post-hoc Bonferroni test were included in the logistic regression model for comparison of each disease with the control group. MPV was not found to be a risk factor both for presence of endometriosis and adenomyosis after adjusting for demographic and clinical characteristics. DISCUSSION: Our study suggested that PC and MPV were not useful diagnostic markers for endometriosis or adenomyosis. Further research on how platelet indices and other inflammatory markers are related to inflammation might help better understand their potential as markers for these diseases.

The Utility of Feticide Procedure to Shorten the Induction-to-Abortion Interval in Medical Abortion.

AIM: To evaluate the effect of intracardiac potassium chloride feticide procedure (FP) on the induction-to-abortion (I-to-A) interval for various indications in the termination of pregnancy. METHOD: Medically indicated abortions between 17 and 28 weeks' gestation were retrospectively evaluated and allocated into 2 groups: Cases with (group 1, n = 58) or without an FP (group 2, n = 60). I-to-A intervals were compared across the groups, considering different baseline parameters and fetal abnormality categories. RESULTS: There were no differences among the groups except in gestational age (GA; mean, 21.2 vs. 19.6 weeks, p = 0.01) in group 1. Overall, the I-to-A interval was shorter (900 ± 233 vs. 1,198 ± 375 min, p = 0.001) and prolonged medical abortion (I-to-A interval > 48 h) was less common (2% vs. 6%, p = 0.03) in group 1. The facilitating effect of FP persisted when indications were categorized as central nervous system, chromosomal, other structural abnormalities, and unclassified conditions. Logistic regression analyses demonstrated the following features to be associated with expulsion of fetus after 24-h: (1) advanced GA (> 24 week; aOR 6.9, 95% CI 3.24-14.72), (2) central nervous system abnormalities (aOR 5.3, 95% CI 2.6-11.4), (3) lack of feticide (aOR 3.67, 95% CI 2.24-10.72). CONCLUSION: FPs seem to shorten the I-to-A interval and decrease prolonged I-to-A interval rates. This facilitating effect remains unchanged for various medical indications.

The role of anti-Mullerian hormone in predicting the response to clomiphene citrate in unexplained infertility.

OBJECTIVE: To determine the role of anti-Mullerian hormone (AMH) levels in predicting the response to clomiphene citrate (CC) therapy for ovulation induction in women with unexplained infertility. MATERIALS AND METHODS: For this retrospective study, fifty consecutive patients who responded to CC were taken as Group 1, while fifty consecutive patients who failed to show adequate ovulatory response with CC were taken as Group 2. We compared the AMH levels of the two groups and receiver operating characteristic (ROC) curve was used to determine the threshold for AMH in predicting the ovulatory response to CC therapy. RESULTS: Mean age, body mass index, luteinizing hormone, prolactin, and thyroid-stimulating hormone values were similar in the two groups. AMH and antral follicle count (AFC) values were higher in Group 1 than in Group 2 (p = 0.001 and p = 0.001, respectively). There was a statistically significant negative correlation between FSH and AFC (r = -0.339, p = 0.001), while AFC and AMH displayed a statistically significant positive correlation (r = 0.713 and p = 0.001). AMH values and AFC were found to be predictors of the adequate ovulatory response to CC. The area under the ROC curve was 0.86 vs 0.80, respectively. At an AFC cutoff value of 14, the sensitivity and specificity for prediction of ovulation were 68% and 80%, respectively. CONCLUSION: The AMH and AFC cut-off values for the prediction of positive ovarian response to CC in patients with unexplained infertility were 2.78 ng/mL and 14, respectively. If further prospective and randomized studies confirm our results, these thresholds may be useful to predict successful ovulation induction and reduce the unresponsive cycles.

The impact of concurrent pelvic organ prolapse reconstructive surgery on midurethral sling procedure outcome.

OBJECTIVES: To evaluate the effect of concurrent pelvic organ prolapse (POP) reconstructive surgery on midurethral sling (MUS) procedure outcome. MATERIAL AND METHODS: The present retrospective study included 300 women with urodynamically diagnosed stress urinary incontinence that underwent MUS procedures with or without concurrent POP reconstructive surgery. Patients were divided into four groups according to the performed surgery; 1) transobturator tape (TOT), 2) TOT with POP surgery (anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy), 3) tension free vaginal tape (TVT), 4) TVT with POP surgery. Outcomes of surgeries for each group were evaluated postoperatively at the end of the first and sixth month by performing a cough stress test and also using the Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory (UDI-6) questionnaires. Presence of a negative cough stress test was defined as "Cure". Multivariate regression was used to identify the parameters for surgical failure. RESULTS: Forty-two, 70, 49 and 139 women underwent isolated TOT, concurrent TOT and POP, isolated TVT and concurrent TVT and POP surgery, respectively. Postoperative UDI-6 score and postoperative cure rate were significantly higher in the only TOT group as compared to the TOT + POP group. However, in multiple regression analysis, women's age, parity, body mass index, menopausal status, preoperative urodynamic parameters, MUS types and presence of any concomitant POP reconstructive surgery were found to have no significant effect on surgical outcome. CONCLUSIONS: Concurrent POP reconstructive surgery including anterior colporrhaphy, posterior colporrhaphy and vaginal hysterectomy have no affect MUS procedure outcomes.

Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey.

AIM: To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP). METHODS: We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features. RESULTS: Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n = 5), bladder injury (n = 4), pelvic abscess (n = 1), and uterine rupture (n = 1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8-75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24-43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32-26.69), and (4) transvaginal cervical length (CL) measurement <10th percentile (aOR 5.5, 95% CI 2.1-15.4). CONCLUSION: Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.

Maternal serum ferritin as a clinical tool at 34-36 weeks' gestation for distinguishing subgroups of fetal growth restriction.

OBJECTIVE: To compare maternal ferritin levels across pregnancies with fetal growth restriction including SGA and IUGR compared to appropriate for gestational age (AGA). METHODS: Three groups were enrolled: AGA, SGA (birth weight below 10th percentile for gestational age with no placental insufficiency findings), and IUGR (birth weight below 5th percentile for gestational age accompanied by abnormal umbilical artery Doppler waveforms and/or oligohydramnios). Maternal serum ferritin samples were obtained at gestational weeks 34 through 36, and delivery occurred at or beyond 36 weeks. RESULTS: A total of 126 pregnancies with AGA (36%), SGA (40%), and IUGR (24%) were enrolled. The mean maternal serum ferritin level was higher in the IUGR group than in the AGA group (59 µg/l versus 32.5 µg/l, p < 0.001). A maternal serum ferritin cutoff of 48 µg/l was found to be optimal for distinguishing between IUGR and AGA with a sensitivity of 67.7%, specificity of 92%, PPV of 84%, NPV of 82%, diagnostic accuracy of 82.7%, LR + of 8 and LR- of 0.3, respectively. CONCLUSION: Maternal serum ferritin levels differ in pregnancies with IUGR. The role of maternal serum ferritin measurements as a clinical tool for distinguishing different forms of fetal growth restriction warrants further investigation.

Depression and anxiety disorder in hyperemesis gravidarum: A prospective case-control study.

OBJECTIVE: To assess the anxiety and depression status of women with hyperemesis gravidarum (HG); the risk factors for developing both depression and anxiety in women with HG were evaluated. MATERIALS AND METHODS: A total of 200 women, 100 diagnosed as having HG before the 20th week of gestation at a tertiary referral center and 100 gestational-age-matched controls were enrolled. The socio-demographic data and the depression and anxiety scores, as assessed using the Beck depression and anxiety inventory were compared between the two groups. RESULTS: The median depression and anxiety scores were significantly higher in the HG group compared with controls (19.5 vs. 9.0 and 22.0 vs. 10.0). Women with HG have the highest relative risks for moderate depression and severe anxiety [relative risk (RR): 16.88 and RR: 20.50, respectively]. In the univariate analysis, having HG, low education level, low income and poor social relationships were significant predictors of depression and having HG. Moreover, poor social relationships significantly predicted the presence of anxiety disorder. However, having HG and poor social relationships were found as the only independent predictors of both depression and anxiety. Patients with HG were 5.5 and 6.7 times more prone to having depression and anxiety disorder compared with controls, respectively. CONCLUSION: Both depression and anxiety disorder were more frequent in women with HG who have weak family and social relationships, lower education and income levels. Therefore, the determination of the psychological status of women with HG should be an integral part of the evaluation.

Is ultrasonographic evaluation essential for diagnosis of retained products of conception after surgical abortion?

AIM: The aim of this study was to evaluate the predictive value of symptomatic evaluation with transvaginal ultrasonographic findings for diagnosis of retained products of conception (RPOC) after voluntary pregnancy termination via manual vacuum aspiration (MVA). METHODS: A total of 466 patients with a gestational age < 10 weeks were followed up at the 7th day after MVA of unwanted pregnancies. The patients who had intense or moderate bleeding and other symptoms related to RPOC had a re-evacuation and all the patients were followed up until the next menstruation. Ultrasonographic evaluation was repeated weekly in asymptomatic patients with abnormal ultrasonographic findings (increased endometrial thickness, presence of hyperechogenic, mixed and hypoechogenic material) until a normal endometrial cavity was visualized. RESULTS: Out of the 466 patients, 15 (3.2%) had symptoms of RPOC at day 7 while the remaining 451 (96.8%) were asymptomatic and 20 (57.9%) had normal ultrasonographic findings. The 15 symptomatic patients (3.2%) had a repeated MVA. Nine of these 15 patients (60%) had endometrial echogenicity with mixed patterns, two (13.3%) had endometrial echogenicity with hyperechoic patterns, and the remaining four (26.7%) had normal endometrial echogenicity at day 7. Histopathologic examination of 12 of these 15 patients (80%) showed chorionic villi while no gestational tissue was noted in the remaining three of these patients. Endometrial thickness ≥ 10 mm on day 7 had 75% sensitivity and 100% specificity for diagnosis of RPOC in symptomatic women. None of the 451 asymptomatic patients developed any symptoms or needed any further intervention. CONCLUSION: As abnormal ultrasonographic findings return to normal over time in asymptomatic patients, the diagnosis of RPOC should not be based on ultrasonographic findings.

A comparison of the effects of the most commonly used tocolytic agents on maternal and fetal blood flow.

OBJECTIVE: To investigate the effects of two tocolytics, nifedipine and magnesium sulfate, on Doppler indices in maternal and fetal vessels. MATERIALS AND METHODS: We recruited 100 pregnant women with preterm birth between 24-36 gestational weeks who were admitted to our tertiary center over a two-year period. Patients were allocated to nifedipine (n=49) and magnesium sulfate (n=51) groups and Doppler indices of umbilical, middle cerebral, uterine arteries, and ductus venosus were measured before and after tocolysis. RESULTS: There were no differences between the groups in terms of maternal age, gestational week, body mass indexes, cervical dilation, effacement at admission, birth weights and latency periods until birth. Nifedipine decreased resistance indexes in uterine arteries but magnesium sulfate increased resistance especially in the right uterine artery. Nifedipine significantly decreased systole to diastole and resistance index in the umbilical artery, magnesium sulfate increased systole to diastole and resistance index but this was not statistically significant. Nifedipine acted variably on resistance index and pulsatility index in the ductus venosus; however, magnesium sulfate increased resistance. Nifedipine decreased pulsatility index in the middle cerebral artery, contrary to magnesium sulfate with which it increased. CONCLUSION: Nifedipine had favorable effects on maternal and fetal vessel indexes but magnesium sulfate increased resistance. Despite the proposed neuroprotective benefits of magnesium sulfate, nifedipine seems to be a better and safer tocolytic agent than magnesium sulfate due to its positive beneficial effects on maternal and fetal vessels.

Neutrophil to Lymphocyte ratio in the diagnosis of adnexal torsion.

Adnexal torsion (AT) is a condition in which there is sometimes difficulty in making a preoperative diagnosis since there are no routine laboratory markers and this condition is usually intraoperatively diagnosed. Many of the studies have indicated that the neutrophil-to-lymphocyte ratio (NLR) is a significant inflammatory marker in various diseases. In this study, we aimed to investigate the diagnostic efficacy of the NLR on the diagnosis of AT. Patients surgically treated for AT were analysed retrospectively. A total of 27 AT patients were included in the study (Group 1). Another 30 patients who were surgically treated for a unilateral ovarian mass and did not have torsion or malignity on the final histopathological examination were assigned to the control group (Group 2). White blood cells (WBCs), neutrophils, lymphocytes and the NLR were compared between groups. The mean WBC values for Groups 1 and 2 were 9.7 ± 1.8 and 7.6 ± 1.5 K/µL (P < 0.001), respectively. The mean neutrophil values were also significantly higher in Group 1 (P < 0.001). However, the mean lymphocyte values were significantly higher in Group 2 (P < 0.001). Mean NLR was significantly higher in Group 1 (P < 0.001). Sensitivity and specificity of WBC > 8.8 were 83.3% and 74.1%, respectively. Sensitivity and specificity of NLR > 3 were 88.9% and 100%, respectively. Furthermore, the area under the ROC curve (AUC) was 0.933 for the NLR and 0.830 for WBC. With respect to the diagnosis of adnexal torsion, an NLR > 3 was identified as a more sensitive marker than the high WBC count. Therefore, an NLR > 3 seems to be a valuable marker in cases where it is difficult to diagnose AT.

Comparison of solifenacin and fesoterodine in treatment of overactive bladder.

OBJECTIVE: To compare the use of solifenacin and fesoterodine in treatment of overactive bladder (OAB). METHODS: This prospective study was conducted on patients diagnosed with OAB who presenting to the Department of Obstetrics and Gynecology and Urology, School of Medicine, Kahramanmaras Sütçü Imam University, Kahramanmaras, Turkey between October 2013 and August 2014. Patients were randomized into 2 groups. Group 1 (n=60) received 5 mg solifenacin per day, while Group 2 (n=59) received 4 mg fesoterodine per day. All the patients' OAB symptom scores (OABSS) in weeks 0, 4, and 12 were recorded. In addition, treatment costs and side effects of the drugs were evaluated. RESULTS: Average OABSS (score 1) was determined as: 9.5 ± 2.8 for Group 1 and 10.7 ± 1.8 for Group 2 at week 0; 2.2 ± 1.2 (Group 1) and 2.4 ± 1.3 (Group 2) at week 4 (score 2); and 1.3 ± 0.5 for Group 1 and 1.3 ± 0.6 for Group 2 at week 12 (score 3). In addition, no statistically significant difference was found between the scores (p=0.062 (score 1), p=0.464 (score 2), and p=0.527 (score 3). The discontinuation rate of medication due to its side effects was 0 (0%) for Group 1, and 6 (10.2%) for Group 2. Intragroup changes in the scores 1-2, 1-3, and 2-3 values was statistically significant in both groups (p less than 0.001). CONCLUSION: No significant difference was found between the OABSS of these 2 drugs. However, discontinuation of drugs due to side effects was more frequent in fesoterodine.

Analysis of the effectiveness of ultrasound and clinical examination methods in fetal weight estimation for term pregnancies.

OBJECTIVE: To compare the accuracy of clinical and ultrasonographic (USG) estimation of fetal weight in non-complicated, term pregnancies. MATERIALS AND METHODS: Two hundred term pregnant women were included in the study. We used three formulae for the estimation of fetal weight at term; the Hadlock formula for the USG method, and two different formulas for clinical methods, maternal symphysis-fundal height and abdominal circumference at the level of umbilicus. Accuracy was determined by mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight (birth weight ±10%). Patients were divided into two groups according to actual birth weight, the normal birth weight group (2500-3999 g) and high birth weight group (≥4000 g). RESULTS: All three methods statistically overestimated birth weight for the high and normal birth weight groups (p<0.001, p=1.000, p=0.233) (p=0.037, p<0.001, and p<0.001). For both groups, the mean absolute percentage errors of USG were smaller than for the other two clinical methods and the number of estimates were within 10% of actual birth weight for USG was greater than for the clinical methods; the differences were statistically significant (p<0.001). No statistically significant difference of accuracy was observed for all three methods for the high birth weight group (p=0.365, p=0.768, and p=0.540). However, USG systematically underestimated birth weight in this group. CONCLUSION: For estimation of fetal birth weight in term pregnancies, ultrasonography is better than clinical methods. In the suspicion of macrosomia, it must be remembered that no method is better than any other. In addition, if ultrasonography is used, careful management is recommended because ultrasonography overestimates in this group.