Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

The relationship between low back pain, pelvic tilt, and lumbar lordosis with urinary incontinence using the DIERS formetric 4D motion imaging system.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a common public health problem and postural changes may be crucial in women presenting with UI. This study was aimed at evaluating the relationship between low back pain (LBP), pelvic tilt (PT), and lumbar lordosis (LL) in women with and without UI using the DIERS formetric 4D motion imaging system. To date no study has to our knowledge compared postural changes and LBP in women with UI using the DIERS 4D formetric system. METHODS: This was a case-control study. We included 33 women with UI and 33 without incontinence. The severity of urogenital symptoms was assessed by the IIQ-7 (Incontinence Impact Score) and UDI-6 (Urogenital Distress Inventory), and disability owing to LBP was evaluated using the Oswestry Disability Index (ODI). Posture and movement assessment, LL angle, thoracic kyphosis, and PT assessment were performed with the DIERS Formetric 4D motion imaging system. RESULTS: The LL angle and pelvic torsion degree were higher in the incontinence group than in the control group (53.9 ± 9.5° vs 48.18 ± 8.3°; p = 0.012, 3.9 ± 4.1 vs 2.03 ± 1.8 mm; p = 0.018 respectively). The LBP visual analog scale value was also significantly higher in the incontinence group (5.09 ± 2.3 vs 1.7 ± 1.8 respectively, p < 0.0001). The LL angle showed a positive correlation with pelvic obliquity, (r = 0.321, p < 0.01) and fleche lombaire (r = 0.472, p < 0.01) and a negative correlation with lumbar range of motion measurements. Pelvic obliquity correlated positively with pelvic torsion (r = 0.649, p < 0.01), LBP (r = 0.369, p < 0.01), and fleche lombaire (r = 0.269, p < 0.01). CONCLUSIONS: Women with UI were more likely to have lumbopelvic sagittal alignment changes and a higher visual analog scale for LBP. These findings show the need for assessment of lumbopelvic posture in women with UI.

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

SUMMARY OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

Assessment of the COVID-19 Pandemic's Impact on Physical Intimate Partner Violence Against Pregnant Women in Ankara (Turkey): A Hospital-Based Study.

Purpose: A significant increase in physical intimate partner violence (IPV) cases has been reported from many countries during the COVID-19 pandemic, and particularly during lockdown periods. The current study's objectives are to define the COVID-19 pandemic's impact on physical IPV against pregnant women in Ankara. Patients and Methods: During the one-year pre-pandemic and two-year pandemic, records of patients who sent by the judicial authorities to the Obstetrics and Gynecology Emergency Room (ER) at Ankara City Hospital were reviewed, and pregnant women who had been subjected to IPV were identified. Results: Of pregnant women 19.1% in the pre-pandemic period, 29.4% in the first year and 51.5% in the second year of the pandemic period exposed to IPV. The mean age of IPV victims was 28.8 ± 6.5 years. Most ER applications were in the evening hours (48.5%), and majority of assailants were the victim's husband (77.9%). Vast majority of victims were multigravida women (89.7), and most of the traumas were localized in abdomen and genitalia (50%). Three of the women (4.4%) had miscarriage. Conclusion: The increase in cases of IVP against pregnant women during the pandemic was striking, according to the current study. We think that this first study from Turkey on the IPV that pregnant women are exposed to during the pandemic can lead to extensive research focused on measures against IPV during pandemics, such as dissemination of telephone applications for IPV victims, increasing home visits by marriage therapists, and intensifying of education campaigns against violence.

Can Transvaginal Cervical Elastography predict the success of induction of labor with oxytocin?

OBJECTIVE: We aimed to show whether elastography can be analternative, although the Bishop score used in the follow-up of labor induction success with oxytocin is a relative concept. MATERIAL AND METHODS: This prospective case-control study includes 56 cases admitted to a tertiary maternity hospital for induction between March and June 2019. Cervical elastography was applied to patients before induction. Induction success in pregnant women who underwent induction with oxytocin was accepted to be greater than Bishop 9. The cases were divided into two groups as successful (n=28) and unsuccessful (n=28) induction, and their elastosonographic findings were compared. RESULTS: In 28 cases with successful induction (Bishop >9, and vaginal delivery occurred in 28), the mean stiffness of the cervix in measurements from four regions was 13.6 ±3.7 kPa in the measurement of the cervix with the elastography method before induction was started, while this value was measured as 14.9 ± 3.1 in cases where induction was unsuccessful (t- value: -1.321, p=0.194). CONCLUSIONS: Our study showed that pre-induction stiffness of the cervix cannot predict the success of labor induction with oxytocin. More studies with larger samples are needed to arrive at a decent conclusion. In addition, results can be more assuring with the developing technique and sensitivity of elastography.

Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19.

OBJECTIVE: The aim of this study was to evaluate the prognostic value of whole blood parameters, systemic inflammatory indices, and systemic inflammatory markers in pregnant women with COVID-19. METHODS: In this cross-sectional study, the demographic, clinical, and laboratory data (i.e., whole blood parameters, C-reactive protein, procalcitonin, ferritin, and D-dimer) of 464 pregnant women with COVID-19 who attended a tertiary hospital between January and April 2021 were reviewed. Systemic inflammatory indices (i.e., neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, and systemic immune inflammation index) were calculated. Asymptomatic and mildly symptomatic pregnant women were classified as Group 1 (n=413), and those with severe disease were classified as Group 2 (n=51). RESULTS: Lymphocyte count and lymphocyte percentage in whole blood parameters were significantly lower (p<0.05), and C-reactive protein, ferritin, and procalcitonin values were higher in Group 2 (p<0.05). Systemic inflammatory indices [neutrophil/lymphocyte ratio (4.7±2.9 (1.1-21.2) vs 7.5±4.7 (2.13-23.2)), platelet/lymphocyte ratio (191.1±104.3 (53.0-807.1) vs 269.5±118.9 (105.0-756.0)), systemic immune inflammation index (1,000±663 (209-5,231) vs 1,630±1,314 (345-7,006))] were found statistically significantly higher in severe disease group (p<0.001). CONCLUSION: Evidence in this study indicates that neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune inflammation index at first admission are simple, rapid, and inexpensive indices in predicting the prognosis of COVID-19 in pregnant women.

The relationship between diaphragm thickness and the severity of the disease in pregnant patients with Covid-19.

OBJECTIVE: We aimed to investigate whether there is a relationship between diaphragm thickness and disease severity in Covid-19 pregnant subgroups. MATERIAL AND METHODS: In this prospective study 100 pregnant patients were enrolled. Thickness of the diaphragm muscle at end-expiration was measured using B-Mode US. Hemoglobin,WBC, NLR, procalcitonin and LDH levels were measured. RESULTS: There was a statistically significant difference between the groups in terms of diaphragm thickness, and the diaphragm thickness was thinner in the severe disease group (p < 0.001). There was no statistically significant difference between the groups with mild to moderate disease severity (p = 0.708). CONCLUSION: Covid-19 patients who developed serious infection has thinner diaphragms than those who did not. Low diaphragm muscle thickness at the outset of Covid-19 disease, may predispose to poor clinical outcomes. Diaphragmatic ultrasound may be a promising tool to evaluate the risk of Covid-19 disease severity.

The effect of sacral massage on meconium-stained amniotic fluid and the duration of fetal descent in labor: A randomized controlled trial.

OBJECTIVE: The aim of this study was to investigate the effect of sacral massage on the presence of meconium-stained amniotic fluid and the duration of fetal descent during labor in pregnant women. METHODS: A total of 220 nulliparous women with singleton low-risk pregnancies in the vertex position at term were recruited. Eligible women were randomly assigned to either massage group or a control group. The massages were performed with friction and tapotement protocol. The massage was applied for 10 min each time by a midwife who is also an expert in the field, at the onset of contractions during the intrapartum period, when cervical dilatation reached 10 cm. The Wong-Baker faces pain rating scale was evaluated. RESULTS: No significant difference was found between the length of the first stage of labor and the total length of delivery (p = 0.097 and 0.434), respectively. There was a significant difference between the two groups in terms of perineal injuries. Perineal injury was lower in the massaged group (p = 0.005). There was a low percentage of meconium-stained amniotic fluid in the massaged group. The difference between the groups was statistically significant. The duration of fetal descent was shorter in the massaged group (p < 0.001). A significant difference was found in Wong-Baker FACES pain rating scale scores. Lower scores were detected in the massaged group (p < 0.001). CONCLUSION: Sacral massage has beneficial effects on mothers and babies in obstetric practice. In addition, applying massage during labor plays a significant role in reducing the presence of meconium-stained amniotic fluid and the duration of fetal descent.

Correlation of systemic inflammation biomarkers and disease severity in pregnant women with COVID-19

SUMMARY OBJECTIVE: The aim of this study was to evaluate the prognostic value of whole blood parameters, systemic inflammatory indices, and systemic inflammatory markers in pregnant women with COVID-19. METHODS: In this cross-sectional study, the demographic, clinical, and laboratory data (i.e., whole blood parameters, C-reactive protein, procalcitonin, ferritin, and D-dimer) of 464 pregnant women with COVID-19 who attended a tertiary hospital between January and April 2021 were reviewed. Systemic inflammatory indices (i.e., neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, and systemic immune inflammation index) were calculated. Asymptomatic and mildly symptomatic pregnant women were classified as Group 1 (n=413), and those with severe disease were classified as Group 2 (n=51). RESULTS: Lymphocyte count and lymphocyte percentage in whole blood parameters were significantly lower (p<0.05), and C-reactive protein, ferritin, and procalcitonin values were higher in Group 2 (p<0.05). Systemic inflammatory indices [neutrophil/lymphocyte ratio (4.7±2.9 (1.1-21.2) vs 7.5±4.7 (2.13-23.2)), platelet/lymphocyte ratio (191.1±104.3 (53.0-807.1) vs 269.5±118.9 (105.0-756.0)), systemic immune inflammation index (1,000±663 (209-5,231) vs 1,630±1,314 (345-7,006))] were found statistically significantly higher in severe disease group (p<0.001). CONCLUSION: Evidence in this study indicates that neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune inflammation index at first admission are simple, rapid, and inexpensive indices in predicting the prognosis of COVID-19 in pregnant women.

Value of shear-wave elastography and cerebral-placental-uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes.

PURPOSE: The aim of this study was to measure placental stiffness with shear-wave elastography technique and to evaluate the relationship with cerebral-placental-uterine ratio (CPUR) and adverse perinatal outcomes in patient groups diagnosed with preeclampsia (PE) and fetal growth restriction (FGR) in the second and third trimesters compared to the control group. MATERIALS AND METHODS: This prospective cross-sectional study was conducted at our hospital between March 2019 and March 2020. The study groups were divided into three groups: PE, FGR, and low risk pregnancy (LRP) group. The study population had singleton pregnancies and the placental site was at the anterior wall. Both shear-wave elasticity (SWE) and shear-wave velocity (SWV) were measured in the placenta during pregnancy. CPUR was calculated for each group. RESULTS: A total of 147 patients were included in this study. The mean SWE (kilopascals) values in the PE group were significantly higher than in the FGR and controls (difference of means = 3.67, 9.45; 95% CI (1.23-6.1, 7-11.8); p < .05), respectively. The mean SWV values were significantly higher in PE and FGR groups than controls (p < .05). CPUR showed correlation with central maternal surface of placenta (p: .02, r: -0.184), central fetal surface of placenta (p < .001, r: -0.288), peripheral maternal surface of placenta (p: .002, r: -0.252), and peripheral fetal surface of placenta SWE values (p: .03, r: -0.181). NICU admission was correlated with central fetal surface of placenta SWE values (p: .002, r: 0.258). CONCLUSION: In conclusion, we demonstrated increased placental stiffness in both the PE and the FGR group. Also, this difference was found to be more prominent in preeclampsia. This technique seems useful for assessment of placental function and may strengthen the utility of Doppler parameters for predicting adverse perinatal outcomes in high-risk pregnancies.

An evaluation of maternal serum dynamic thiol-disulfide homeostasis and ischemia modified albumin changes in pregnant women with COVID-19.

Objective: It is thought that oxidative stress, free radicals, reactive oxygen species and reactive nitrogen species affect the pathophysiology of coronavirus disease-2019 (COVID-19). This study aimed to evaluate the oxidative status in pregnant patients with COVID-19 infection according to the changes seen in the levels of maternal serum thiol-disulfide and ischemia-modified albumin (IMA). Materials and Methods: A study group was formed of 40 pregnant women with confirmed COVID-19 infection (study group) and a control group of 40 healthy pregnant women with no risk factors determined. In this prospective, case-controlled study, analyses were made of the maternal serum native thiol, total thiol, disulfide, IMA, and disulfide/native thiol concentrations. Results: The maternal serum native thiol and total thiol concentrations in the study group were determined to be statistically significantly lower (p=0.007 and p=0.006, respectively), and the disulfide/native thiol ratio was higher but not to a level of statistical significance (p=0.473). There was no difference between the two groups regarding IMA levels (p=0.731). Conclusion: The thiol-disulfide balance was seen to shift in the oxidant direction in pregnancies with COVID-19, which might support the view that ischemic processes play a role in the etiopathogenesis of this novel disease.

Experience of a tertiary pandemic centre on the labour and delivery of 337 pregnant women with COVID-19: a prospective cohort study from Turkey.

The aim of the present study is to share the experience of a tertiary reference pandemic centre on the labour and delivery of pregnant women with coronavirus disease 2019 (COVID-19). This prospective cohort study was conducted on pregnant women with COVID-19 (n = 337). Patients were divided into two groups based on their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) positivity (n = 103 positive and n = 234 negative) during the delivery. Thereafter, clinical characteristics and perinatal outcomes were compared between the groups. Moreover, delivery characteristics and clinical features were compared between primary caesarean section (n = 117) and normal spontaneous vaginal delivery cases (n = 100). Labour induction was performed in 16% of cases with a failure rate of 35%. Caesarean rate was 70% and the most common indication was worsening in maternal condition. Significant, positive and moderate correlations were observed between COVID-19 severity at admission (r = 0.422, p<.001), radiologic findings consistent with COVID-19 (r = 0.400, p<.001), the necessity for oxygen support during the delivery (r = 0.406, p<.001) and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition (r = 0.176, p<.001). COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery.Impact StatementWhat is already known on this subject? Increased rates of foetal distress and caesarean section were reported in pregnant women with COVID-19. Appropriate management of labour and delivery in infected pregnant women is crucial to obtain favourable perinatal outcomes.What do the results of this study add? COVID-19 seems to be associated with increased rates of obstetric complications and caesarean delivery. PCR positive group had significantly higher primary and prelabor caesarean delivery rates. Severe/critic COVID-19 infection rate was significantly higher in the primary caesarean group. Significant, positive and moderate correlations were observed between COVID-19 severity at admission, radiologic findings consistent with COVID-19, the necessity for oxygen support during the delivery and postpartum worsening in maternal condition. A significant, positive weak correlation was found between caesarean delivery and postpartum worsening in maternal condition.What are the implications of these findings for clinical practice and/or further research? Management and delivery of pregnant women with COVID-19 should be individualised. The findings of the present study may lead to the establishment of future obstetric protocols in this special population.

The Association of Serum Electrolytes with Disease Severity and Obstetric Complications in Pregnant Women with COVID-19: a Prospective Cohort Study from a Tertiary Reference Center.

Introduction To evaluate the association of serum electrolytes with disease severity and obstetric complications in pregnant women with Coronavirus disease 2019 (COVID-19). Materials and Methods This prospective cohort study was conducted on pregnant women with confirmed COVID-19. Study population was divided into two groups: 1) Mild COVID-19 group (n = 811) and 2) Moderate/severe COVID-19 group (n = 52). Demographic features, clinical characteristics, obstetric complications, and serum electrolytes were compared between the groups. Afterward, a correlation analysis was performed to investigate the association between serum electrolyte disturbances with COVID-19 severity and obstetric complications. Results Highest serum sodium, hypernatremia, potassium replacement, hypopotassemia, hyperchloremia, initial serum magnesium, hypermagnesemia, and hypocalcemia were significantly higher in the moderate/severe COVID-19 group. The lowest serum sodium, lowest serum potassium, and initial serum calcium were significantly higher in the mild COVID-19 group (p < 0.05). Statistically significant positive weak correlations were found between hypernatremia, hypopotassemia, hyperchloremia, hypermagnesemia, hypocalcemia and COVID-19 severity (r values were 0.27, 0.20, 0.12, 0.18 and 0.12, p values were < 0.001, < 0.001, 0.02, 0.03 and 0.03, respectively). Furthermore, statistically significant positive weak correlations were found between hypopotassemia, hypochloremia, hypermagnesemia, and obstetric complications (r values were 0.10, 0.10, and 0.28, p values were 0.004, 0.03, and 0.001, respectively). A statistically significant negative weak correlation was found between hypomagnesemia and obstetric complications (r = - 0.23 and p = 0.01, respectively). Conclusion Electrolyte disturbances in pregnant women with COVID-19 seem to be associated with disease severity and obstetric complications.

Serum midkine level might be a diagnostic tool for COVID19 disease in pregnancy: From the disease severity, hospitalization and disease progression respects.

BACKGROUND: New biomarkers for diagnosis and monitoring the COVID-19 disease are the most important topics to be studied recently. We aimed to investigate the association between midkine levels and disease severity in pregnant women with COVID-19. METHODS: Totally 186 pregnant women were participated in this study. 96 of them were healthy pregnant women, 90 of them were pregnant women with COVID19. Pregnant women were evaluated according to their trimesters. Serum midkine level, biochemical profile clinical and disease severity outcomes of pregnant women were obtained. RESULTS: Our results showed that pregnant women with COVID19 have significantly increased serum midkine level compared to healthy pregnant women (1.801 ± 0.977 vs 0.815 ± 0.294 ng/dL). According to the data among each trimester, it was shown that there were significant increase in serum midkine level during all pregnancy trimesters (1st trimester Control Group: 0.714 ± 0.148, COVID-19 group 1.623 ± 0.824, p < 0.0001; 2nd trimester Control Group: 0.731 ± 0.261, COVID-19 group 2.059 ± 1.146, p < 0.0001; 3rd trimester Control Group: 1.0 ± 0.35, COVID-19 group 1.723 ± 0.907, p = 0.001). Serum midkine levels were significantly different between disease severity subgroups of pregnant women with COVID19; moderate and severe/critic groups had significantly higher serum midkine level than mild group. There was also significant correlation between serum midkine level and severity status (p:0.0001, r: 0.468). The most striking results of serum midkine levels were corelation between length of hospitalization (p: 0.01, r: 0.430) and O2 saturation (p < 0.0001, r: -0.521). ROC curve analysis showed that serum midkine level might be a tool for predicting COVID-19 in pregnant women with COVID-19 (AUC: 0.912, 95% CI: [0.871, 0.952], p < 0.0001) CONCLUSION: Our data showed that there is an obvious relation between COVID19 progression and serum midkine level for the first time which might be used for monitoring the disease process.

Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases.

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID-19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID-19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID-19 were evaluated. Twenty-six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID-19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Evaluation of the relationship between placental stiffness measured by shear wave elastography and perinatal outcomes in women with gestational diabetes mellitus.

BACKGROUND: Recently, studies on placental elastography in high-risk pregnancies continue to increase. The shear wave technique can contribute to the management of gestational diabetes mellitus (GDM) and improve perinatal outcomes by measuring placental stiffness.Purpose: To evaluate the relationship between placental stiffness measured by shear wave elastography (SWE) and perinatal outcomes in women with GDM.Material and Methods: This prospective cross-sectional study was conducted at our hospital between March and October 2020. The participants were divided into three groups: GDM-A1 group (regulated by dietary modifications); GDM-A2 group (needed pharmacologic treatment); and low-risk pregnancy (LRP) group. Both SWE and shear wave velocity (SWV) were measured in the placenta during pregnancy. RESULTS: In total, 111 women were included in the study. The mean SWE (kPa) values for the GDM-A1, GDM-A2, and LRP groups were 10.4 (range 3.1-23.3), 13 (range 4.3-29.6), and 8.3 (range 3.2-15.1), respectively. The mean HbA1c and fasting glucose values of diabetes groups showed strongly positive correlation with mean SWE and SWV values (P < 0.001, r=0.875; P < 0.001, r=0.856; P < 0.001, r=0.791; P < 0.001, r=0.740), respectively. The SWE values of central maternal and fetal surfaces of the placenta (P=0.01, r=0.242; P < 0.001, r=0.333) showed a moderately positive correlation with admission to the neonatal intensive care unit. CONCLUSION: Placental stiffness has increased in the GDM-A2 group when compared to the GDM-A1 and LRP groups. We also observed a strong positive correlation between HbA1c, fasting glucose values, and increased elasticity values in diabetic patients with metabolic dysregulation that may have clinical value.

Low Anti-Mullerian Hormone Levels Are Associated with the Severity of Anxiety Experienced by Healthcare Professionals During the COVID-19 Pandemic.

The objective of this study is to investigate a possible correlation between anxiety status and anti-Mullerian hormone (AMH) levels among healthcare professionals who provide medical care directly to COVID-19-positive patients during the recent pandemic. Fifty-two healthcare professionals (nurses, midwives, and residents) who provide medical care directly to COVID-19-positive patients in inpatient clinics or intensive care units were enrolled in this study. Serum AMH levels were analyzed to reflect ovarian reserve. The Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI-S and STAI-T, respectively) were completed by participants to assess their anxiety status. A linear regression model with participant age as the constant variable was applied to analyze the relationship between inventory scale scores and AMH levels. P-values less than 0.05 were considered statistically significant. The mean AMH value was significantly lower for the participants in the moderate/severe anxiety group compared to the minimal/mild anxiety group (p = 0.007). A linear regression analysis revealed a significant negative correlation between AMH levels and both BAI (B = -0.030, standard error = 0.010, p = 0.004) and STAI-S and STAI-T scores when age was controlled (both p = 0.003). The severity of anxiety experienced during the recent COVID-19 pandemic among healthcare professionals, who provide medical care directly to COVID-19-positive patients, is found to be related to low AMH levels.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective: To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures. Materials and Methods: A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically. Results: Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation. Conclusion: The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

The effect of real-time polymerase chain reaction cycle threshold values on perinatal outcomes of pregnant women with COVID-19.

OBJECTIVE: To evaluate the effect of cycle threshold (Ct) values on the pregnancy outcomes of women with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This prospective cohort study was conducted on pregnant women with COVID-19. A real-time polymerase chain reaction (RT-PCR) assay of a nasopharyngeal and oropharyngeal specimen was used for the diagnosis. Initial Ct values for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR tests were recorded. 22.9 was the 50th percentile Ct value of the study population. The study population was divided into two groups based on their Ct values: (1) Cases with Higher Ct values (Ct > 22.9)(n = 50) and (2) Cases with lower Ct values (Ct ≤ 22.9)(n = 55). Demographic features, clinical characteristics, disease progression, laboratory test results and pregnancy outcomes were compared between the groups. A receiver operating characteristic (ROC) curve was used to assess the performance of Ct values in predicting obstetric complications. RESULTS: Obstetric complication rate was significantly higher in cases with lower Ct values (p < .001). A significantly lower lymphocyte count together with higher ESR, procalcitonin and IL-6 values were observed in the cases with lower Ct values (p > .05). Additionally, a significantly higher NICU admission rate and longer hospital stays were present in the cases with lower Ct values (p > .05). The value in ROC curves with the best balance of sensitivity/specificity was 22.5 (85.7% sensitivity, 63.6% specificity). CONCLUSION: Lower Ct values may be associated with an increased rate of obstetric complications in pregnant women with COVID-19. Physicians should be cautious in the management of cases with Ct levels below 22.5.

The impact of COVID-19 infection on the cytokine profile of pregnant women: A prospective case-control study.

OBJECTIVE: To compare the levels of various cytokines between pregnant women with confirmed coronavirus disease (COVID-19) infection and pregnant women without any defined risk factor. MATERIALS AND METHODS: Pregnant women with confirmed COVID-19 infection (study group)(n = 90) were prospectively compared to a gestational age-matched control group of pregnant women without any defined risk factors (n = 90). Demographic features, clinical characteristics, laboratory parameters, interferon-gamma (IFN γ), interleukin (IL-2), IL-6, IL-10, and IL-17 levels were compared between the groups. Additionally, a correlation analysis was performed in the study group for the assessment of IFN γ, IL-2, IL-6, IL-10, and IL-17 levels with disease severity and CRP levels. RESULTS: Study group had significantly higher pregnancy complication rate, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, ferritin, D-dimer, lactate dehydrogenase, IFN γ, and IL-6 values (p < 0.05). On the other hand, the control group had significantly higher hemoglobin, leukocyte, platelet, lymphocyte, IL-2, IL-10, and IL-17 values (p < 0.05). Statistically significant differences were found between the groups for IFN γ, IL-2, IL-10, and IL-17 values between the trimesters (p < 0.05). Statistically significant positive correlations were found for IFN γ and IL-6 with disease severity (r = 0.41 and p < 0.001 for IFN γ and r = 0.58 and p < 0.001 for IL-6). On the other hand, a moderate negative correlation for IL-2 and a weak negative correlation for IL-10 were present (r = -0.62 and p < 0.001 for IL-2 and r = -0.19 and p = 0.01 for IL-10). A statistically significant positive moderate correlation was found between IL-6 and CRP (r = 0.40 and p < 0.001) CONCLUSION: COVID-19 infection seems to have an impact on the cytokine profile of pregnant women varying according to pregnancy trimesters and cytokine levels seem to be correlated with disease severity.