Clinicopathological and Survival Characteristics of Mismatch Repair Status and PD-1 Expression in Serous Ovarian Cancer.

OBJECTIVE: To evaluate the clinicopathological characteristics of mismatch repair (MMR) deficiency and its clinical outcomes by performing immunohistochemistry (IHC) for MMR genes in the serous ovarian cancer (SOC) tumour sections. STUDY DESIGN: A retrospective case-control study. Place and Duration of the Study: Gynecology Department of Kanuni Sultan Süleyman Training and Research Hospital, and Department of Medical Oncology of Medipol University, between March 2001 and January 2020. METHODOLOGY: IHC was carried out for MLH1, MSH2, MSH6, and PMS2 on full-section slides from 127 SOCs to evaluate the MMR status. MMR-negative and MMR-low groups together were defined as MMR deficient and called microsatellite instability-high (MSI-H). The MSI status and expression of programmed cell death-1 (PD-1) were compared in SOCs with different MMR statuses. RESULTS: A significantly higher frequency of MMR-deficient SOCs was diagnosed at early stages compared with the patients in the MSS group (38.6% and 20.6%, respectively, p=0.022). The frequency of cases with PD-1 expression was significantly higher in the MSI-H group (76.2%) than in the MSS counterparts (58.8%, p=0.028). Patients in the MSI-H group had significantly longer DFS (25.6 months) and OS (not reached) than those in the MSS group (16 months and 48.9 months, p=0.039 and p=0.026, respectively). CONCLUSION: MSI-H SOCs were diagnosed at an earlier stage as compared to MMR proficient cases. The presence of PD-1 expression was significantly higher in cases presenting MMR deficiency compared with MMR-proficient cases. MSI status was significantly associated with DFS and OS. KEY WORDS: Serous ovarian cancer, Microsatellite instability, Mismatch repair deficiency.

Comparison of enhanced recovery protocol with conventional care in patients undergoing urogynecological surgery.

OBJECTIVE: The impact of enhanced recovery after surgery (ERAS) protocol on postoperative outcomes after urogynecological surgery is yet to be a matter of investigation. This study sought to evaluate this issue by comparing the patients who had conventional or ERAS--guided perioperative care for several clinical end-points including ambulation, length of hospital stay (LOS), readmissions, and postoperative complications. MATERIALS AND METHODS: A total of 121 patients undergoing pelvic organ prolapse surgery were allocated to two study arms, ERAS protocol (Group E) or conventional care (Group C). Variables reflecting the restoration of appetite and bowel movements, bleeding events, other complications, LOS and readmissions were compared between the groups. RESULTS: The patients in Group C significantly received a more intensive intravenous fluid treatment compared to Group E (2,760 ± 656 vs. 1,045 ± 218 mL, P < 0.001). Time required for first flatus, first defecation, eating solid food, and ambulation (P < 0.001) were also longer in the former group of patients. Moreover, LOS was significantly reduced when the ERAS protocol was applied (2.5 ± 1.1 vs. 2.0 ± 0.6 days, P < 0.001). On the other hand, the two groups were similar with respect to the frequency of the postoperative complications, including surgical site infections, cardiovascular complications, non-specific abdominal pain, sub-ileus, blood loss and readmission rate. CONCLUSION: In our sample population, ERAS protocol led to early initiation of oral intake, early recovery of bowel function, early mobilization, and early discharge of patients without compromise in safety concerns after urogynecological surgery.

High expression of CD8 in the tumor microenvironment is associated with PD-1 expression and patient survival in high-grade serous ovarian cancer.

Objective: The current study assesses programmed death-1 (PD-1) receptor expression and CD3, CD4, and CD8 tumor-infiltrating lymphocytes (TILs) in high-grade serous ovarian cancer (HGSOC) and associates our results with neoadjuvant chemotherapy history and disease prognosis. Materials and Methods: We included cases diagnosed with primary HGSOC with biopsy or surgical resection materials in this study. The immunoreactivity of CD3, CD4, CD8, and PD1 was assessed immunohistochemically in tumor tissue. We analyzed TILs in two predetermined groups of high and low TIL. The relationships between clinical characteristics, PD-1, and TIL were assessed. by the χ(2) test or Fisher's Exact test. We used Kaplan-Meier survival analysis and Cox proportional hazards regression model to the connection between survival and the amounts of TIL, and PD1. Results: Univariate analysis demonstrated that optimal debulking (p<0.001), early International Federation of Gynecology and Obstetrics stage (p=0.046), and higher scores of stromal CD8+ TIL expression (p=0.028) in tumor cells were all substantially correlated with longer disease-free survival (DFS), whereas the remaining variables analyzed, including PD-1 positivity, stromal CD3+, and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs, were not correlated with DFS. Also, univariate analysis revealed that optimal debulking (p=0.010), and higher scores of stromal CD8+ TIL expression (p=0.021) in tumor cells were all substantially correlated with longer overall survival (OS). Conclusion: Higher scores of stromal CD8+ TILs are substantially correlated with DFS and OS in univariate analyses, whereas scores of stromal CD3+ and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs are not correlated with DFS and OS in both univariate and multivariate analyses. Also, we found a significant association between PD-1 positivity and the scores of stromal CD3+ TILs and intraepithelial CD8+ TILs. However, no remarkable relationship was revealed between PD-1 positivity and the survival of HGSOC cases.

Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa.

Background: The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 360/7 and 376/7 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery. Methods: This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated. Results: Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, P=0.013) and first antepartum bleeding episode ≤28 weeks of gestation (36.1% and 14.4%, P<0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, P=0.042), first antepartum bleeding episode ≤28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, P=0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, P<0.001) were the independent predictors significantly associated with emergency cesarean delivery. Conclusion: Three factors-antepartum bleeding episode during pregnancy, first antepartum bleeding episode ≤28 weeks of gestation, and lower preoperative hemoglobin level-might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.

The Value of First-trimester Maternal Abdominal Visceral Adipose Tissue Thickness in Predicting the Subsequent Development of Gestational Diabetes Mellitus.

OBJECTIVE: To examine the performance of first-trimester visceral (pre-peritoneal), subcutaneous, and total adipose tissue thickness (ATT) to predict the patients with subsequently developing gestational Diabetes mellitus (GDM). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Training and Research Hospital from January 2021 to July 2021. METHODOLOGY: A total of 100 pregnant women underwent sonographic measurement of subcutaneous and visceral ATT at 11-14 weeks' gestation. A 75-g oral glucose tolerance test (OGTT) was conducted between 24-28 weeks of pregnancy for the diagnosis of GDM. RESULTS: The mean visceral, subcutaneous, and total ATT were significantly higher in the GDM group (24.75 ± 10.34 mm, 26.33 ± 5.33 mm, 51.08 ± 14.4 mm) than in the group without a GDM diagnosis (16.68 ± 6.73 mm, 17.68 ± 4.86 mm, 34.25 ± 11.04, respectively, p<0.001). A pre-gestational BMI >30 kg/m2 (Odds ratio [OR]=10.20, 95% CI=2.519-41.302, p=0.001), visceral ATT (OR=33.2, 95% CI=7.395-149.046, p<0.001), subcutaneous ATT (OR=4.543, 95% CI=1.149-17.960, p=0.031), and total ATT (OR=10.895, 95% CI=2.682-44.262, p=0.001) were the factors that were found to be significantly associated with the subsequent development of GDM after adjusting for potential confounders (maternal age, and parity). The most significant risk factor for the prediction of GDM is visceral ATT with an OR of 33.2. CONCLUSION: US measurement of maternal visceral ATT during first-trimester fetal aneuploidy screening is a reliable, reproducible, cost-effective, and safe method to identify pregnant women at high risk for GDM. KEY WORDS: Gestational diabetes mellitus, Visceral adipose tissue thickness, Subcutaneous adipose tissue thickness.

The reduced serum concentrations of ß-arrestin-1 and ß-arrestin-2 in pregnancies complicated with gestational diabetes mellitus.

OBJECTIVE: This study aimed to analyze maternal serum ß-arrestin-1 and ß-arrestin-2 concentrations in pregnant women complicated with gestational diabetes mellitus (GDM) and compare them with the normoglycemic uncomplicated healthy control group. METHODS: A prospective case-control study was conducted, including pregnant women complicated with GDM between 15 February 2021, and 31 July 2021. We recorded serum ß-arrestin-1 and ß-arrestin-2 concentrations of the participants. Receiver operating characteristic (ROC) curves were used to describe and compare the performance of diagnostics value of variables ß-arrestin-1, and ß-arrestin-2. RESULTS: The mean ß-arrestin-1 and ß-arrestin-2 levels were found to be significantly lower in the GDM group (41.0 ± 62.8 ng/mL, and 6.3 ± 9.9 ng/mL) than in the control group (93.1 ± 155.4 ng/mL, and 12.4 ± 17.7, respectively, p < .001). When we analyze the area under the ROC curve (AUC), maternal serum ß-arrestin-1 and ß-arrestin-2 levels can be considered a statistically significant parameter for diagnosing GDM. ß-arrestin-1 had a significant negative correlation with fasting glucose (r = -0.551, p < .001), plasma insulin levels (r = -0.522, p < .001), HOMA-IR (r = -0.566, p < .001), and HbA1C (r = -0.465, p < .001). ß-arrestin-2 was significantly negatively correlated with fasting glucose (r = -0.537, p < .001), plasma insulin levels (r = -0.515, p < .001), HOMA-IR (r = -0.550, p < .001), and HbA1C (r = -0.479, p < .001). CONCLUSION: ß-arrestin 1 and ß-arrestin 2 could be utilized as biomarkers in the diagnosis of GDM. The novel therapeutic strategies targeting these ß-arrestins may be designed for the GDM treatment.

Serum neutrophil gelatinase-associated lipocalin concentrations are significantly associated with the severity of COVID-19 in pregnant patients.

OBJECTIVES: To evaluate serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations of pregnant women complicated with coronavirus disease 2019 (COVID-19) and investigate its diagnostic value for the severity of COVID-19. METHODS: Of the 46 pregnant women with COVID-19 included in the study, we further classified these women into 2 subgroups: the non-severe COVID-19 group (n=25) and the severe COVID-19 group (n=21). RESULTS: Neutrophil gelatinase-associated lipocalin plasma concentrations were significantly higher in pregnant women complicated with severe COVID-19 (90 [53.1-207.7] ng/ml) compared to those from pregnant women with non-severe COVID-19 (51.8 [39.6-70.3] ng/ml) and healthy pregnant women (44.3 [32.2-54.1] ng/ml, p<0.001). Also, at a cutoff value of 72 ng/ml, NGAL predicted severe COVID-19 with a sensitivity rate of 57% and a specificity rate of 84%. Serum NGAL level (adjusted hazard ratio [aHR]=1.020, 95% confidence interval [CI]= [1.006-1.035], p=0.007), and D-dimer level (aHR=2.371, 95% CI= [1.085-5.181], p=0.030) were the variables that were revealed to be significantly associated with the disease severity. CONCLUSION: We demonstrated that NGAL was highly associated with COVID-19 severity. We consider that NGAL might be a useful biomarker to diagnose the disease severity in patients with COVID-19.

The Implication of Aquaporin-9 in the Pathogenesis of Preterm Premature Rupture of Membranes.

OBJECTIVE: This study aimed to detect aquaporin-9 (AQP9) concentrations in the serum of patients with preterm premature rupture of membranes (PPROM) and compare them with the healthy control group with intact membranes. MATERIAL AND METHODS: We conducted this prospective case-control study from March 2021 to August 2021. Of the 80 pregnant patients included in the study, we enrolled 42 singleton pregnant patients with PPROM as the study group and 43 healthy gestational age-, and body mass index (BMI)-matched healthy pregnant women with intact fetal membranes as the control group. We compared demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations of the participants. We constructed an ROC curve to illustrate the sensitivity and specificity performance characteristics of AQP9 and calculated a cutoff value by using the Youden index. RESULTS: Maternal serum AQP-9 concentrations were significantly higher in patients with PPROM (804.46±195.63 pg/mL) compared to the healthy pregnant women in the control group (505.97±68.89 pg/mL, p<0.001). When we examine the area under the ROC curve (AUC), the AQP-9 value can be reflected as a statistically significant parameter for diagnosing PPROM. According to the Youden index, a 654.78 pg/mL cut-off value of AQP-9 can be utilized to diagnose PPROM with 80.5% sensitivity and 100% specificity. CONCLUSION: Maternal serum AQP9 concentrations were significantly higher in PPROM patients than healthy pregnant women with an intact membrane. We suggest that AQP9 might be an essential biomarker of the inflammatory process and energy homeostasis in PPROM.

Maternal and neonatal outcomes of expectantly managed pregnancies with previable preterm premature rupture of membranes.

PURPOSE: This study aimed to describe the maternal and fetal outcomes associated with expectant management following previable preterm premature rupture of membranes (PPROM) before 24 weeks of gestation. We also analyzed the risk estimates of potential confounders to clarify whether these variables are contributed to the risk of postnatal mortality among these neonates. METHODS: This retrospective cohort study included all pregnant patients who experienced previable PPROM before 24 weeks of gestation at a tertiary maternal-fetal medicine center. We used the neonatal data from birth until discharge. RESULTS: A total of 128 women were enrolled. The survival to discharge rate was 60.9%. The median latency period (80 vs. 20 days, respectively, p < 0.001) was significantly longer, the median gestational week at delivery (34 vs. 25 weeks, respectively, p < 0.001) and median birth weight (2100 vs. 710 g, p < 0.001) was significantly higher in the survivor group than the non-survivor group. Surviving neonates had significantly lower frequencies of anhydramnios at any time during the latency period than the non-survivor neonates (38.4% vs. 86.0%, respectively, p < 0.001). CONCLUSION: This study demonstrated an opposite correlation between the duration of latency period and gestational age at PPROM with earlier membrane rupture in pregnancies having a longer latency period, which additionally clarifies the higher gestational age at delivery. The antepartum factors that increased the possibility of postnatal mortality within our study included the gestational week at delivery, duration of the latency period, anhydramnios at any time during the latency period, and birth weight.

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.

The evaluation of the antepartum and intrapartum risk factors in predicting the risk of birth asphyxia.

PURPOSE: This study aimed to determine the related antepartum and intrapartum factors of birth asphyxia among neonates born in a tertiary referral hospital. METHODS: A total of 45 singleton pregnant women who delivered live births with a gestational age of ≥35 weeks and their neonates who suffered from birth asphyxia from June 2016 to June 2021 were included in this retrospective study. Data regarding maternal demographic features, maternal laboratory values, pregnancy complications, and obstetric and neonatal outcomes were collected. RESULTS: Significant risk factors associated with birth asphyxia were nulliparity (odds ratio [OR] = 5.357, 95% confidence interval [CI] = 2.169-24.950, p = 0.001), placental abruption (OR = 8.667, 95% CI = 2.223-33.784, p = 0.002), intrauterine growth restriction (OR = 1.394, 95% CI = 1.109-8.631, p = 0.012), the prolonged second stage of labor (OR = 6.121, 95% CI = 2.120-17.595, p = 0.001), meconium-stained amniotic fluid (OR = 7.615, 95% CI = 2.394-24.223, p = 0.001), bloody amniotic fluid (OR = 9.423, 95% CI = 2.885-35.232, p = 0.001), the presence of FHR category II (OR = 12.083, 95% CI = 7.081-48.849, p <0.001) and FHR category III before labor (OR = 15.500, 95% CI = 8.394-56.176, p <0.001). CONCLUSION: We identified that nulliparity, placental abruption, intrauterine growth restriction, the prolonged second stage of labor, meconium-stained or bloody amniotic fluid, and FHR tracings categories II and III were significantly associated with birth asphyxia.

Predictor Factors in the Success of Slow-Release Dinoprostone Used for Cervical Ripening in Pregnancies with Premature Rupture of Membranes.

OBJECTIVE: The study aimed to evaluate the factors affecting successful vaginal delivery in induction with slow-release dinoprostone at term pregnancy with premature rupture of membranes. MATERIALS AND METHODS: Pregnancies between 370/7 and 416/7 gestation weeks with premature rupture of membranes in which slow-release dinoprostone was used for cervical ripening were sought for inclusion in the study. Pregnancies with previous uterine surgery, multiple fetal gestations, chorioamnionitis, non-cephalic presentation, fetal distress at the time of admission, HIV positivity, and estimated fetal weight >4500 on ultrasonographic evaluation were excluded. The primary outcome of measures were factors affecting the success of vaginal delivery including maternal age, gestational weeks at delivery, initial Bishop score, parity, induction time, and induction-delivery time interval. To reduce the risk of overfitting in the study, penalized maximum likelihood estimation was performed instead of traditional logistic regression in the statistical analysis. RESULTS: A total of 1266 participants who met the study criteria were included in the study. Among the parameters evaluated for the prediction of successful vaginal delivery in cases with premature rupture of membranes, maternal age (P < .001), Bishop score (P < .001), parity (P=.01), induction time (P < .001), and induction-delivery time interval (P < .001) had an impact on success. The mean gestational week of the participants who had cesarean deliveries was lower than in those who had vaginal deliveries (P=.03); however, this was not a predictor factor of penalized maximum likelihood estimation (P=.70). CONCLUSION: Basic parameters such as maternal age, induction time, parity, and Bishop score can be used to predict successful vaginal birth following dinoprostone slow-release vaginal insert administration.

Abnormal liver function tests in pregnant patients with COVID-19 - a retrospective cohort study in a tertiary center.

OBJECTIVES: The current study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant COVID-19 patients, explore the association between LFTs with current medication, and provide a reference for medical therapy of pregnant patients with COVID-19. MATERIAL AND METHODS: This retrospective single tertiary center cohort study included 122 pregnant patients with confirmed COVID-19 admitted and treated from April 1, 2020, to May 31, 2020. We defined abnormal LFTs as the elevation of the following liver enzymes in serum per our hospital's laboratory reference range standards: AST > 35 U/L, ALT > 35 U/L, and TBIL > 1.2 mg/dL. We evaluated patients for demographic and clinical features, laboratory parameters, medications, and hospital length of stay (LOS). RESULTS: Patients in this cohort had clinical presentations of fever (84.4%), dry cough (78.6%), and shortness of breathing (6.5%). In total, 17 (13.9%) patients had abnormal LFTs during hospitalization. Critically ill patients were three-fold higher in the abnormal LFTs group (11.8%) than in the normal LFTs group (3.8%, p = 0.16). The proportion of patients who used hydroxychloroquine and lopinavir/ritonavir were significantly higher in patients with abnormal LFTs (88.2% and 35.3%, respectively) than those with normal LFTs (62.9% and 15.2%, p = 0.04 and p = 0.04, respectively). The hospital length of stay (LOS) was significantly longer in the abnormal LFTs group (8.2 ± 5.8 days) than in the normal LFT group (6.0 ± 2.8 days, p = 0.02). CONCLUSIONS: SARS-CoV-2 may induce liver injury and the LFT abnormality was generally mild in pregnant patients with COVID-19. Abnormal LFTs are associated with prolonged hospital LOS. Drug use was the most crucial risk factor for liver injury during hospitalization. The use of lopinavir/ritonavir and hydroxychloroquine were significantly higher, and the course of treatment of these drugs was significantly longer in pregnant women with abnormal LFTs than the patients with normal LFTs. Therefore, pregnant women with COVID-19 who received antiviral treatment should be closely monitored for evaluating LFTs.

The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum.

OBJECTIVES: This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency cesarean delivery (ECD) in placenta previa (PP) patients without placenta accreata spectrum (PAS) in a tertiary referral hospital. MATERIAL AND METHODS: This retrospective cohort study included 237 singleton pregnant women who were diagnosed with PP without PAS at the time of delivery. PP patients who were delivered at the scheduled time were included in the PCD group. Patients with PP delivered in an emergency setting before the scheduled date were assigned to the ECD group. We recorded demographic and clinical characteristics, maternal and neonatal outcomes. RESULTS: Of the 237 patients who met the inclusion criteria, 157 patients (66.8%) underwent PCD, and 80 patients required ECD (33.2%). Patients' hospitalization and pre-discharge hemoglobin levels were significantly lower in the ECD group (11.25 ± 1.97 g/dL and 9.74 ± 2.09 g/dL, respectively) than in the PCD group (10.77 ± 2.67 g/dL and 9.27 ± 2.70, p = 0.002 and p = 0.004, respectively). While six patients (7.5%) were required intensive care unit (ICU) admission in the ECD group, no patient was required to follow up in ICU in the PCD group (p < 0.001). The hospital length of stay (LOS) was tended to be significantly longer in the ECD group (2.8 ± 0.7 days) than in the PCD group (2.4 ± 0.6 days, p < 0.001). Neonatal outcomes of birth weight, Apgar scores, NICU admission, and neonatal death were significantly better in the PCD group than in the ECD group. CONCLUSIONS: The PCD group has better maternal outcomes, including preoperative and discharge hemoglobin levels, ICU admission and hospital LOS, and better neonatal outcomes than the ECD group. Clinicians should pay regard to that scheduling the delivery to advanced pregnancy weeks has a failure possibility, and patients could not reach the scheduled day due to the emergency states.

Increased maternal serum aquaporin-9 expression in pregnancies complicated with early-onset preeclampsia.

OBJECTIVES: We aimed to evaluate maternal serum aquaporin-9 (AQP9) concentrations in patients with early-onset preeclampsia and compare them with the uncomplicated control group with normal blood pressure. METHODS: This was a prospective case-control study including pregnant women who were diagnosed with early-onset preeclampsia between 200/7 -340/7 weeks of gestation. Demographic and clinical characteristics, complete blood count and biochemical parameters, and serum AQP9 concentrations were documented. A receiver operating characteristic (ROC) curve was constructed to illustrate the sensitivity and specificity performance characteristics of AQP9 and a cut-off value was estimated by using the Youden index. RESULTS: The mean serum concentrations of maternal AQP9 were significantly increased in the early-onset preeclampsia group (722.22 ± 211.80 pg/mL) than the control group (499.97 ± 68.89 pg/mL, p < 0.001). When we analyze the area under the ROC curve (AUC), the serum AQP9 value can be considered a statistically significant parameter for diagnosing preeclampsia. According to the Youden index, a 587.70 ng/mL cut-off value of serum AQP9 level can be used to diagnose early-onset preeclampsia with 80.0% sensitivity and 89.7% specificity. CONCLUSION: Maternal serum AQP9 concentrations were significantly increased in early-onset preeclampsia patients than healthy normotensive pregnant patients. We suggest that AQP9 might be a crucial biomarker of the inflammatory process in early-onset preeclampsia.

Can maternal abdominal fat thickness predict antenatal insulin therapy in patients with gestational diabetes mellitus?

PURPOSE: This study aimed to investigate the effectiveness of abdominal subcutaneous fat thickness (ASFT) in predicting antenatal insulin therapy (AIT) in patients with gestational diabetes mellitus (GDM). METHODS: A prospective study was conducted on patients with regulated blood sugar levels (n = 50) and those with unregulated blood sugar (n = 50) although medical nutrition therapy (MNT) was initiated and then AIT was applied. Using receiver operator characteristic (ROC) curve analysis, appropriate ASFT cut-off point values were found for the prediction of cases that required AIT after MNT in GDM pregnancies. RESULTS: Patients with GDM who needed AIT had a significantly higher ASFT value compared to those with GDM who did not need AIT. The optimal ASFT cutoff was 21.7 mm in predicting cases that required AIT after MNT (sensitivity, specificity, negative, and positive predictive values were 68.0%, 64.0%, 65.8%, and 66.6%, respectively). The risk of AIT increased 3.77-fold in those with ASFT > 21.7 mm in GDM pregnancies (p = 0.001). CONCLUSION: The ASFT value was significantly higher in cases with GDM, with blood glucose levels not regulated despite MNT and AIT being then needed, compared to patients with blood glucose levels regulated by MNT, and who did not need AIT. Also, patients requiring AIT can be determined with moderate to high sensitivity and specificity using a cut-off value of ASFT > 21.7 mm. The ASFT > 21.7 mm cut-off point was seen to be more effective than BMI ≥ 30 kg/m2 in the determination of cases where AIT is required.

Blake's pouch cyst: Prenatal diagnosis and management.

OBJECTIVE: This study aimed to present the characteristic features of 19 patients who were diagnosed as having Blake's pouch cyst (BPC) at our center. MATERIALS AND METHODS: Nineteen patients diagnosed as BPC between 2015 and 2019 were included in this retrospective study. Follow-up examinations were performed using ultrasonography (US) every three weeks up to 35 weeks of gestation. Prenatal magnetic resonance imaging (MRI) was performed at the time of diagnosis or during follow-up in 13 patients. MRI or transfontanellar US was performed to confirm the diagnosis of BPC after delivery. Karyotype results of eight patients were recorded. RESULTS: Isolated BPC was observed in 9 (47%) patients, and associated anomalies were detected in 10 (53%) patients, including seven (36%) with the central nervous system and four (21%) with cardiac anomalies. Two fetuses had abnormal karyotype analysis as trisomy 21 and 13. The MRI report of eight patients was "differential diagnosis required for Dandy-Walker complex" and only in five (26%) patients, it was reported to be compatible with BPC. Spontaneous resolution was seen in four patients. Postnatal MRI was performed in five patients, and transfontanellar US in two patients, and all MRI and US results were consistent with BPC. During the neonatal period, abnormal neurologic development was observed in four (21%) patients, and one (5%) died. CONCLUSION: Although the prognosis of isolated BPC is very good with healthy neurologic development until advanced ages, death in the early neonatal period and abnormal neurologic development may be observed depending on the condition of the associated anomalies.

First Trimester Mean Platelet Volume, Neutrophil to Lymphocyte Ratio, and Platelet to Lymphocyte Ratio Values Are Useful Markers for Predicting Preeclampsia.

Background: Preeclampsia complicates 2% to 8% of all pregnancies. Systemic inflammatory response (SIR) markers are widely used in the diagnosis of many inflammatory diseases and in the prediction of complicated pregnancies. This study examined the diagnostic value of SIR markers during the first trimester of pregnancy to predict preeclampsia development. Methods: This retrospective case-control study was conducted from January 2020 to May 2020. We included 94 patients diagnosed with mild preeclampsia, 107 patients diagnosed with severe preeclampsia, and 100 normotensive pregnant patients as controls. We obtained the first trimester (6 to 14 weeks) complete blood cell counts for all patients. We used a receiver operating characteristic curve to evaluate the cutoff, sensitivity, and specificity values. Results: First trimester mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) values were significantly higher in patients who developed preeclampsia in later pregnancy weeks. The optimal cutoff value for MPV was 10.65 fL, with a sensitivity of 63.7% and a specificity of 65.0%. The best predictor for preeclampsia was NLR at an optimal cutoff value of 4.12, with a sensitivity of 82.1% and specificity of 62.0%. At a cutoff value of 131.8, PLR predicted preeclampsia with a sensitivity rate of 65.0% and a specificity rate of 60.2%. Conclusion: The results of this study suggest that first trimester MPV, NLR, and PLR values are clinically useful markers in the prediction of preeclampsia. The increased first trimester values of MPV, NLR, and PLR also indicate that inflammation may play a crucial role in preeclampsia pathogenesis.

Shoulder Tip Pain After Cesarean Section.

AIM: The aim of this study was to investigate the frequency of postoperative shoulder tip pain (STP) after cesarean section and compare spinal and general anaesthesia with respect to STP. MATERIALS AND METHODS: Three hundred patients who underwent cesarean section were randomly assigned to either spinal anaesthesia group (Group SA, n=143) or general anaesthesia group (Group GA, n=157). Postoperative STP was assessed at 8 hours and 24 hours after operation by Visual Analogue Scale of Pain (VAS). RESULTS: There were no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. The overall incidence of STP in study population was 35.7%. The incidence of STP in group SA (26.6%) was lower than that in group GA (43.9%)(p=0.005). Moreover VAS scores for STP at 6 hours and 24 hours were significantly lower in Group SA (p=0.001 and p<0.001, respectively). CONCLUSION: Shoulder tip pain is a common complaint after cesarean section, which is more prevalent in general anaesthesia.