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.

How do contraception preferences change over time? Eight years of experience in a tertiary hospital.

OBJECTIVES: To examine the contraceptive preferences of women based on their age and to track changes in these preferences over time. METHODS: This was an observational, retrospective cross-sectional study. Data from 2742 patients were evaluated for this study. The patient group of the first 4 years was classified as Group I (n=1371) and the last 4 years was classified as Group II (n=1371). The preferred contraception methods between the groups and their changes across the years were examined. RESULTS: Coitus interruptus was found to be the prevailing contraceptive method across all age groups, with 304 (70.9%) in 18-24 age group; 1314 (65.4%) in 25-40 age group; and 148 (48.8%) in 41-53 age group using this method. Breastfeeding rates were also analyzed across age groups, revealing that 11% of patients aged 18-24 years, 5% of patients aged 25-40 years, and 1.7% of patients aged 41-53 years were breastfeeding. Among these patients, 114 (74.5%) were not using any contraception method, while coitus interruptus remained the most popular choice. CONCLUSION: It was determined that there are many couples who do not have sufficient knowledge regarding family planning and birth control in our country. At the same time, the use of birth control methods has increased due to the increase in the education level of women and easier access to sexual health services.

Which treatment should we choose for tubo-ovarian abscesses? Results of an 8-year clinical training in a tertiary center.

OBJECTIVES: Tubo-ovarian abscess (TOA) is inflammation of the pelvic organs, mainly originating from the lower genital tract and intestinal tract. Treatment options include antibiotic therapy, surgical drainage, and radiologically guided (interventional) drainage. In our study, we aimed to evaluate the treatment method to be chosen and thus to manage patients with tuba ovarian abscesses (TOAs) most accurately. MATERIAL AND METHODS: This is a retrospective cohort study, and patients who applied to a tertiary center diagnosed with tuba ovarian abscess (TOA) were included. TOA size (cm), pre-treatment C-reactive protein (CRP) value, pre-treatment white blood cell (WBC) value, previous operation type, postoperative complication, and antibiotics used were screened. RESULTS: 305 patients were included in the study, and medical treatment was applied to 140 patients, organ-sparing surgical drainage to 50 patients, and surgical treatment to 115 patients. TOA dimensions measured at the time of diagnosis were significantly lower in patients for whom only medical treatment was sufficient. Pre-treatment CRP levels, WBC levels, and length of stay were significantly lower in patients for whom only medical treatment was sufficient. There was no significant difference between the pre-and post-procedure CRP difference, antibiotics, and hospitalization time. CONCLUSIONS: Preferring minimally invasive treatment in cases requiring invasive treatment reduces the frequency of complications. Treatment of tuba ovarian abscesses (TOA) with minimally invasive methods will be more beneficial in terms of patient morbidity.

Assessment of D-dimer levels in pregnant women diagnosed with COVID-19: A case-control study.

OBJECTIVE: We aimed to evaluate D-dimer levels in pregnant women diagnosed with COVID-19. METHODS: This single-center study was carried out in a tertiary center hospital serving as a pandemic hospital. 151 pregnant women with COVID-19 diagnosis were included as the study group, and 70 healthy pregnant women as the control group. The data were analyzed separately in 3 different trimesters of pregnancy. RESULTS: Of the 221 pregnant women included in the study, 151 had a diagnosis of COVID-19. 70 healthy pregnant women were taken as the control group. It was observed that D-dimer values in pregnancy increased as the trimesters progressed. No significant difference was observed when this was compared with pregnant women with COVID-19 (p = .428, .75, .927 according to the 1st, 2nd and 3rd trimesters, respectively). CONCLUSION: The diagnosis of pulmonary embolism is difficult due to the lack of reliable alternative D-dimer thresholds for pregnant patients. On the other hand, D-dimer elevation continues to be a sign of poor prognosis in patients with COVID-19. The situation remains uncertain in patients who are pregnant and have COVID-19. Maybe D-dimer value should be removed from being a poor prognosis criterion in pregnant women.

Baseline serum vitamin A and vitamin C levels and their association with disease severity in COVID-19 patients.

AIM: We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19.  Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed.  Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001). CONCLUSION: COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.

Predictive value of prenatal ultrasound in foetal intraabdominal cystic lesions and evaluation of perinatal outcomes: a single-centre study results.

The prenatal diagnosis of intra-abdominal cystic lesions is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound in identifying the aetiology of foetal intra-abdominal cysts and to describe the prenatal and postnatal outcomes. This study is a retrospective analysis of 137 foetuses diagnosed with intraabdominal cysts during the prenatal period, except those originating from the urinary system, conducted from April 2015 to August 2018. Among 137 intraabdominal cysts identified as antenatal, ovarian cysts had the highest rate of prenatal diagnosis. The most frequently misdiagnosed pathologies were gastrointestinal system obstructions with 6 cases. There were 129 (94.2%)cases of intraabdominal cysts born alive. Intrabdominal cystic lesions resolved spontaneously in 23(16.8%) cases in the intrauterine period and 28 cases within 12 (20.4%) months after birth during follow-up. Postpartum surgical treatment was performed in 44 (%32.1) cases. The overall neonatal mortality was 21/137 (15.3%),with no death in the intrauterine period; 8(5.8%) of these were death following termination of pregnancy, 6(4.4%) were postpartum, and 7(5.1%) were post-surgical death. Postnatal results of intraabdominal cysts are variable. Therefore, individual assessing and managing each case is of clear benefit due to cyst's variable course. IMPACT STATEMENTWhat is already known on this subject? The prenatal diagnosis of intra- abdominal cystic lesions is relatively common and prenatal ultrasound is the main screening tool. The diagnosis of a foetal intra-abdominal cyst might represent a diagnostic and management dilemma due to the wide variety of potential diagnosis.What the results of this study add? The accuracy of prenatal ultrasound in identifying the origin of a foetal intra-abdominal cyst seems to be high with detailed ultrasonographic examinations and the perinatal outcome of these foetuses is favourable in most of them.What the implications are of these findings for clinical practice and/or future research? Regardless of the cyst's origin, it should be kept in mind that prenatal and postnatal clinical courses can be variable in each case, and every pregnant woman with a foetus with an intraabdominal cyst must be managed individually in every aspect.

Fetal intracranial hemorrhage: prenatal sonographic diagnosis criteria and postnatal outcomes

Objective: The aim of this study was to improve knowledge of prenatally diagnosed fetal intracranial hemorrhage (ICH), defining the ultrasound (US) examination results, the contribution of fetal magnetic resonance imagination (MRI) to the diagnosis, and the pregnancy outcomes, from a series of fetal ICH cases. Material and Methods: This retrospective, observational study included eleven fetuses diagnosed with ICH from April 2016 to August 2020. The data regarding the medical records, prenatal US and MRI findings, treatment, and prognosis of fetal ICH cases were collected from the hospital database and analyzed. Results: Fetal ICHs were grade 3 in six cases, and grade 4 in the remaining five cases. The mean gestational age at diagnosis was 30.2 weeks. Nine (81.8%) of the cases were diagnosed in the third trimester and two (18.2%) in the second trimester. Fetal cranial MRI was performed in 7/11 (63.6%) following ultrasonographic diagnosis. MRI confirmed fetal ICH diagnosis and previous US findings regarding location and grade in all cases. Five patients (45.5%) diagnosed with grade 3 (n=1) and grade 4 (n=4) ICH underwent pregnancy termination. Of the remaining six cases, one (9.1%) diagnosed with grade 3 fetal ICH resulted in an intrauterine fetal demise. Four cases classified as grade 3 fetal ICH and one case with grade 4 fetal ICH were born alive at term. Conclusion: The clinical manifestations of fetal ICH are diverse and have a wide spectrum of severity and prognostic implications. Fetal ICH cases were mainly detected in the third trimester, with a minority detected in the second trimester. These cases can be safely diagnosed and graded by US examination, but the underlying etiology frequently cannot be determined. Fetal cranial MRI may aid in diagnosis confirmation if this is unclear from US in order to provide appropriate counseling to the parents.

Could sestrin protein in serum be a new marker of oxidative stress in patients with polycystic ovary syndrome?

OBJECTIVE: PCOS (polycystic ovary syndrome) is one of the most common endocrinological disorders and it is the threshold of many systemic disorders. There are many studies in the literature on the mechanisms that cause increased oxidation in PCOS. Sestrin protein is known to regulate the oxidation. In this study, it is aimed to examine the changes in the level of sestrin protein in women with PCOS. METHODS: A total of 60 women participated the study, 30 of whom were diagnosed with PCOS according to the Rotterdam criteria. Also, 30 women were included in the study as the control group. Demographic information, biochemical analysis results, and sestrin levels of the patients in each group were compared. RESULTS: The median sestrin level was 6.2 ± 0.8 in the PCOS group and 3.38 ± 0.4 in the control group (p < 0.001). As a result of the evaluation made with ROC analysis, it is observed that serum sestrin levels may be meaningful in the diagnosis of polycystic ovary syndrome. The area under the curve (AUC) value for the 4.69 level was 99.4% (p < 0.001, 95% CI: 96.7% vs. 100%, sensitivity: 100%, specificity: 96.7%). CONCLUSIONS: Sestrin protein is associated with oxidative stress. Sestrin protein can be used as an indicator of increased oxidative stress in PCOS.

Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women

Objective: To compare the psychological resilience and anxiety levels of patients diagnosed with hyperemesis gravidarum (HG) and healthy pregnant women. Materials and Methods: A sociodemographic data form and the Resilience scale for Adults (RSA) and the State-Trait Anxiety Inventory (STAI) were administered. The sociodemographic data form was completed by the physician, and the RSA and STAI were completed by the participant. The sample of the study consisted of 60 pregnant women with HG and hospitalized and 97 healthy voluntary pregnant women with similar characteristics to the research group without any pregnancy complications. Data were evaluated using descriptive statistical analyses, the independent samples t-test, the Mann-Whitney U test and Pearson's correlation analysis. Results: The age range was 18-42 years for HG group and 20-43 years for control group. The average age of the HG group was 28.17±5.96 years and that of the control group was 29.45±5.83 years. There was no statistically significant difference between the groups in terms of pregnancy week. Regarding the prevalence of state and trait anxiety between the groups, it was found that 66.7% of the HG group had a high level of trait anxiety and 51.7% had a high level of state anxiety. It was found that 61.9% of the control group had a high level of trait anxiety and 38.1% had a high level of state anxiety. There was no difference between the healthy pregnant group and the HG group in terms of anxiety (p=0.125). It was found that there was a significant difference between the groups in terms of only sub-dimensions of RSA, which were perception of self (U=2385.00, p=0.044) and perception of future (U=2350.50, p=0.030). The perception of self and perception of future scores of the healthy control group were higher. Conclusion: There was no difference between the healthy pregnant group and the HG group in terms of anxiety. It was observed that the HG group had a lower perception of self and future. Apart from the usual increase in anxiety levels during pregnancy, HG accompanied by stubborn nausea and vomiting does not create an extra psychological burden, either as a cause or a result.

A case of corpus callosum dysplasia with different development of the corpus callosum in the right and left brain hemispheres.

The corpus callosum (CC) is a thick band of nerve fibers that divides the cerebral cortex lobes into the left and right hemispheres. Prenatal diagnosis of corpus callosum agenesis (partial/total) has been described frequently in the literature. In this case report, a case of corpus callosum dysplasia with different development of the halves of the corpus callosum in the right and left brain hemispheres, which was not previously discussed in the literature, will be described. Whenever we have any doubts about CC, axial, coronal, and sagittal scans of the fetal brain should be performed with TVUSG (transvaginal ultrasonography) or TAUSG (transabdominal ultrasonography) according to the position of the fetal head, and both length and thickness should be measured.

Micronutrients in COVID-19 Positive Pregnancies.

Pregnant women are considered among the high-risk population for COVID-19. Therefore, research for methods of treatment and prevention of COVID-19 positive pregnancies carries an importance. The aim of this study was to measure serum 25(OH)D, vitamin B12, and zinc levels in COVID-19 positive pregnant women to evaluate the role of these micronutrients in treatment and prevention. A total of 44 COVID-19 positive pregnant women who were hospitalized and treated at a tertiary clinic were included in this study. The mean serum 25(OH)D level was measured to be 9.70 ± 59.14. The mean serum zinc level was 62.58 ± 2.63, and the mean serum vitamin B12 level was 295.55 ± 302.48. All these variables were significantly lower than the accepted cut-off values (p < 0.001). These low values might have contributed to a deficiency in their immune response and thus made these patients susceptible to COVID-19 infection. Supplementation of micronutrients during the pandemic could be beneficial during pregnancy for prevention.

Evaluating the effects of the COVID-19 pandemic on the physical and mental well-being of obstetricians and gynecologists in Turkey.

OBJECTIVE: To apply online surveying to assess the general physical and mental well-being of obstetricians/gynecologists (OB/GYNs) working in COVID-19 designated hospitals in Turkey. METHODS: A prospective survey-based study using an online survey platform. Three hundred participants working at COVID-19 designated hospitals in Turkey identified from a hospital database were sent a link to the survey by email between April 29 and May 20, 2020. RESULTS: A total of 253 OB/GYNs (31 consultants and 222 residents) completed the survey, for a response rate of 84.3%. Of respondents, 191 (76.4%) were anxious about coming into contact with pregnant women infected with COVID-19. 74.4% stated that they were afraid of getting sick. 64.8% reported that they had fallen into despair at times because of the pandemic. 66.5% stated that their family lives were affected. 72.4% started living separately from their families because of the pandemic. CONCLUSION: Despite the difficulties in patient care during the pandemic, OB/GYNs continued providing for their patients, which reflected positively on their perceptions of the profession. The importance of trust in the national healthcare system, presence of adequate PPE, finding a suitable coping mechanism, and family support were essential for Turkish OB/GYNs during the COVID-19 pandemic. ClinicalTrials.gov identifier: NCT04327531. Turkish obstetricians/gynecologists reported anxiety and stress caused by the current situation and future implications of the COVID-19 pandemic.

Maternal serum TXNDC5 levels and thiol/disulfide homeostasis in preeclamptic pregnancies.

Objective: To investigate thiol/disulfide homeostasis (TDH) and thioredoxin domain-containing 5 (TXNDC5) level in early and late-onset preeclampsia.Material and methods: In this cross-sectional study, 24 pregnant women with early-onset preeclampsia and 26 pregnant women with late-onset preeclampsia were compared with 30 pregnant women with no obstetric complications. The serum TXNDC5 levels and thiol/disulfide homeostasis were measured.Results: Serum TXNDC5 levels were significantly higher in the early-onset and late-onset preeclampsia groups compared with the control group (p < .05). Native thiol and total thiol levels were significantly lower in the early-onset and late-onset preeclampsia groups than control group. The disulfide levels were found as significantly high in early preeclamptic patients compared to control group (p < .05). The highest levels of TXNDC5 and the lowest levels of native thiol and total thiol were found in early-onset preeclampsia group. No significant difference was found between the patients with early onset and late onset preeclampsia regarding TXNDC5 levels and thiol/disulfide homeostasis (p > .05).Conclusion: Serum TXNDC5 levels were significantly higher in patients with early-onset and late-onset preeclampsia. The dynamic thiol/disulfide homeostasis was impaired in favor of the oxidized state in patients with preeclampsia.

Single-layer versus double-layer closure of the vaginal cuff with barbed sutures in laparoscopic hysterectomy.

OBJECTIVES: The utilization of barbed sutures in laparoscopic hysterectomy has become popular among gynecologic sur-geons. Our aim was to compare the outcomes of two different techniques for closing the vaginal cuff with barbed sutures in laparoscopic hysterectomies. MATERIAL AND METHODS: A retrospective study was completed on 202 patients who underwent laparoscopic hysterectomy for benign diseases at Istanbul Kanuni Sultan Suleyman Training and Research Hospital from April 2014 through June 2016. In group 1 (n = 139), a single-layer continuous suturing method was used; each bite contained the pubocervical fascia and vaginal mucosa anteriorly, and vaginal mucosa and rectovaginal fascia posteriorly. In group 2 (n = 63), a double-layer continuous suturing method was used; only vaginal mucosa was included in the first layer, and a second layer incorporated the pubocervical and rectovaginal fascias. RESULTS: Patient characteristics (age, body mass index, parity, previous abdominal surgery, smoking, comorbidity) were similar between the two groups. There were also no differences in total operation time, length of hospitalization, intraop-erative complications, and perioperative change in hemoglobin levels. There was no difference between the two groups in terms of vaginal cuff dehiscence, which was the primary outcome measure of the study. Secondary outcome measures (presence of granulation tissue, spotting, cuff cellulitis) were also similar between the two groups. CONCLUSIONS: We observed no differences in outcomes between single- or double-layer vaginal closure techniques with barbed sutures.

Flecainide as first-line treatment for fetal supraventricular tachycardia.

OBJECTIVE: The aim of this study was to evaluate utilization, efficacy, and side effects of flecainide treatment as first-line agent in patients with fetal supraventricular tachycardia (SVT). METHOD: This retrospective review was conducted on 23 consecutive fetal tachyarrhythmia cases that met inclusion criteria. If the treatment was necessary, then flecainide was used as first-line treatment in all cases. RESULT: Among the study group, there were 21 (91.3%) cases of SVT and 2 (8.6%) cases of Atrial Flutter (AF). Sixteen fetuses had persistent SVT and five fetuses had intermittent SVT. We treated 17 fetuses with flecainide monotherapy and 15 of them converted to sinus rhythm and remaining two fetuses were refractory to monotherapy. The median time to conversion to sinus rhythm was 3.8 ± 1.6 days. Only one fetus (20%) among the intermittent SVT cases required anti-arrhythmic treatment. CONCLUSION: Our study has demonstrated that flecainide is an effective first-line treatment for fetal SVT with high success rate (88.2%), low side effect profile and relatively easy utilization. Based on the current study and recently published article results, flecainide can be recommended as the drug of first choice for treatment of fetal SVT cases.

Why do multiparous women with a history of vaginal delivery give birth by cesarean section?

OBJECTIVE: A cesarean section (C-section) is performed to deliver a baby through the mother's abdomen. In recent years, the rate of incidences requiring a C-section is steadily increasing all over the world. Advanced maternal age, chronic health problems, multiple pregnancies as a result of the development of assisted reproductive technologies, and an insufficient supplementary health network can be considered as the reasons why mothers and obstetricians prefer a C-section. Our study aimed to identify the risk factors for the need of C-section in women with a history of vaginal delivery. MATERIAL AND METHODS: 238 multiparous women with a history of vaginal birth at 37-42 gestational weeks were enrolled in our study. 110 women had underwent C-section. Control group was chosen randomly from women giving birth by vaginal route. RESULTS: Overall, 238 multiparous women with a history of vaginal delivery at 37-42 gestational weeks were enrolled in our study. The history of operative delivery, that of labor induction and presence of meconium and the indication of admission to the delivery room were different between groups. A lower Bishop score and biophysical profile, smaller gestational period, and lower birth weight were associated with the group requiring a C-section, whereas older age and a long time interval from the previous birth were associated with the group not requiring a C-section. CONCLUSION: A strategy involving either labor induction or not could be individualized for each patient to eliminate the risk factors for adverse outcomes. To identify criteria for the standardization of labor management, further studies are needed.