Bernard-Soulier Syndrome from the Perspective of the Obstetrician: A Case Report with a Review of the Literature.

OBJECTIVE: Bernard-Soulier syndrome (BSS) is one of the rare inherited platelet disorders that is characterized by macrothrombocytopenia and adhesion abnormality due to the absence or malfunctioning of the membrane GPIb-IX-V complex. There is no high-quality evidence on obstetric management of BSS owing to its rarity. Here we report an uncomplicated delivery of an adolescent with BSS and review the literature on the topic of BSS and pregnancy. METHODS: PUBMED, EMBASE, COCHRANE, and Google Scholar databases were searched up to April 2022 without language and year restriction using the terms "Bernard Soulier" and "Pregnancy". The primary objectives were to evaluate maternal and fetal outcomes. The secondary objectives were to analyze pregnancy complications, gestational age at delivery, mode of delivery, administered prophylaxis, treatment approaches, duration of postpartum hospitalization, and the postpartum requirement of blood and blood product. RESULTS: The patient was a 19-year-old and 39-week pregnant woman who was diagnosed with BSS at the age of 10 by flow cytometry and genetic analysis. Single donor platelet transfusions and oral tranexamic acid were administered as prophylaxis at the peripartum period. She was delivered by cesarean section due to failure of labor. The postpartum period was uneventful for both mother and neonate. In the literature review, postpartum hemorrhage (PPH) was found in 52.9% (27/51) of deliveries. Late PPH occurred more frequently than early PPH (35.3 and 31.4%, respectively). 49% (25/51) of pregnancies had severe thrombocytopenia, and antepartum hemorrhage was observed in 11.8% (6/51) of those. The platelet count was in close relation to antenatal complications. 64.7% (33/51) of the patients were delivered via cesarean section. PPH and late PPH were found to be more common in those who delivered vaginally compared to those who delivered by caesarean section. It was observed that PPH was less common in women who were given prophylaxis in the peripartum period. CONCLUSION: BSS is an inherited macro-thrombocytopathy that may cause adverse maternal and neonatal outcomes. The optimal mode and timing of delivery remain unclear. A multidisciplinary approach with prophylaxis at the peripartum period should be applied.

Placental and Umbilical Cord Blood Oxidative Stress Level and Telomere Homeostasis in Early Onset Severe Preeclampsia.

OBJECTIVE: Although the etiopathogenesis of preeclampsia (PE) is unknown, evidence suggests that it may be associated with increased oxidative stress. Studies have shown that oxidative stress can affect DNA fragments called telomeres. However, the interactions of PE, oxidative stress, and telomere length are not clearly known. This study aims to evaluate the oxidative/anti-oxidative stress balance in the placenta and umbilical cord and examine the effect of oxidative stress on telomeres. MATERIALS-METHOD: Cord blood and placental samples were collected from 27 pregnant women with severe PE (280/7-336/7 gestational weeks) and 53 healthy pregnant women. Telomere length (TL) was measured by real-time PCR in the cord blood and placenta tissue. Total antioxidant status (TAS) and total oxidant status (TOS) levels were measured in the cord blood and placenta tissue using a colorimetric method. RESULTS: No significant differences were found between groups regarding age, BMI, gravida, parity, and newborn gender (p>0.05). Cord blood and placental TL of PE patients were significantly shorter than the control group, while cord blood and placental TAS and TOS levels were higher (p<0.05). The results of a multivariate logistic regression analysis showed that the level of placental TOS in PE patients (OR=1.212, 95% CI=1.068-1.375) was an independent risk factor affecting PE. CONCLUSION: This study found that oxidative stress is an independent risk factor in the development of PE and shortens TL in both placental and umbilical cord blood. Future research on telomere homeostasis may offer a new perspective for the treatment of PE.

The effect of rectus reapproximation on postoperative muscle strength and core endurance in cesarean section: A prospective case-control study.

AIM: The necessity of the reapproximation technique of the rectus abdominis muscle in the cesarean section (CS) is a controversial issue. We aimed to investigate the effect of the approximation of the rectus abdominis muscle in CS on postoperative pain intensity, muscle strength, and core endurance. METHODS: Thirty-eight women whose rectus muscle was reapproximated in CS and 36 women whose muscles were not reapproximated were included in the study. All women were called in for evaluation in the postoperative period twice, in the 8th-10th and 24-26th weeks. While muscle strength was assessed by manual muscle test (MMT), core endurance was assessed by core stability tests [trunk flexion test (TFT), trunk extensor endurance test (TEET), lateral right/left bridge test (LRBT/LLBT)]. The distance between inter-rectus diastasis (IRD) and rectus abdominis muscle thickness were evaluated by ultrasonography. RESULTS: In the first evaluation; in the rectus muscle reapproximation (RMR) group, lower and upper IRD values were less than the control group, while muscle strength, TFT, TEET, LRBT, and LLBT times were higher (p < 0.001, <0.001, 0.014, <0.001, <0.001, 0.002, and <0.001, respectively). In the second evaluation; in the RMR group, lower and upper IRD values were lower than the control group, while upper rectus abdominis muscle thickness, TFT, TEET, and LRBT times were higher (p < 0.001, <0.001, 0.046, <0.001, 0.032, and 0.010, respectively). CONCLUSION: RMR in CS increases muscle strength and core endurance in the early postoperative period. RMR can facilitate the daily work of mother by increasing their physical fitness, especially in the early postoperative period.

Increased serum myonectin and irisin levels with myonectin and FNDC5 expressions in polycystic ovary syndrome: a case control study.

The aim of this study is to assess the FNDC5 and myonectin expressions and serum levels of myonectin and irisin in women with PCOS. 90 participants were included in this case-control study. 45 of these participants were with PCOS, and 45 of them were healthy volunteers matched for age and body mass index (BMI). Serum irisin and myonectin levels were measured with commercially available enzyme-linked immune sorbent assay (ELISA) kits. Expression of the myonectin and FNDC5 genes were determined by RT-PCR analysis. It was found out that FSI, HOMA-IR, LH, LH/FSH, TT, serum irisin and serum myonectin levels, myonectin mRNA expression, and FNDC5 mRNA expression were higher in the PCOS group, whereas HDL-C level was lower in the PCOS group (p < .05). When the groups were compared, it was detected that IR and HA were significantly higher in the PCOS group (p < .05). Serum irisin and myonectin levels, and myonectin and FNDC5 mRNA expressions were increased in women with PCOS. These molecules can be target molecules in PCOS pathophysiology and treatment.IMPACT STATEMENTWhat is already known on this subject? Although the aetiology of PCOS is not fully understood, it is thought that insulin resistance may play a critical role. In recent studies, the relationship of cytokines secreted from skeletal muscle with insulin resistance has been shown. The effects of irisin and myonectin, which are members of the myokine family, on lipid and glucose metabolism are known.What do the results of this study add? Although there are many studies in the literature regarding serum irisin levels in women with PCOS, their results are confusing. There is a study in the literature investigating the relationship between myonectin and PCOS. In our study, we evaluated myonectin and FNDC mRNA expressions in addition to serum irisin and myonectin levels. As a result, we found that markers and their mRNA expressions were lower in patients with PCOS compared to controls.What are the implications of these findings for clinical practice and/or further research? We think that the results of our study will shed light on future studies. Due to their effects on adipose tissue, these markers may play a role in the aetiology of long-term complications of PCOS. Moreover, they can become pharmacological targets in preventing these complications.

Circulating Myonectin and Irisin Levels in Gestational Diabetes Mellitus - A Case-control Study.

OBJECTIVE: The objective of this study was to assess the levels of serum myonectin and irisin in pregnant women with and without gestational diabetes mellitus (GDM). METHOD: A total of 80 pregnant women participated in our study (which consisted of 40 patients with GDM, 40 participants as the control group). Myonectin and irisin levels were analyzed through the ELISA technique, in addition to metabolic parameters in the serum samples of the participants. RESULTS: It was found that the levels of irisin and myonectin were lower in the GDM group compared to the control group. Moreover, it was determined that the values of age (p<0.001), body mass index (p=0.001), gravida (p=0.001), parity (p = 0.016), fasting serum glucose (p=0.001), fasting serum insulin (p=0.007), postprandial serum glucose (p=0.006), HbA1c (p<0.001), HOMA-IR (p<0.001) were higher; HDL cholesterol (p<0.001) was lower. Insulin resistance was significantly higher in the GDM group. CONCLUSIONS: Levels of myonectin and irisin were determined to be low in the GDM group. Our results have demonstrated that myonectin and irisin could play a role in the development of GDM and that irisin as well as myonectin could be a novel biomarker for GDM.

Telomere Length in Idiopathic Recurrent Pregnancy Loss.

OBJECTIVE: Telomere length is used as an indicator of biological aging. It is well known that one of the most remarkable risk factors of recurrent pregnancy losses is advanced maternal age. The objective of this study was to investigate the correlation between idiopathic recurrent pregnancy loss and telomere length. METHOD: The study group included 40 women, while the control group consisted of 41 healthy women whose age and body mass index were matched. A venous blood sample was taken from all participants into EDTA tubes in the early follicular phase, and telomere length was measured through the qPCR technique. RESULTS: When the mean TL of the groups was compared, it was determined that TL was significantly shorter among the iRPL group (7763.89±924.58 base pair) compared to the control group (8398.84±1102.95 base pair) (p<0.006). Whereas FSH and E2 were higher in the iRPL group, TAFC was lower (p<0.001). When the correlation between telomere length and endocrine parameters was statistically tested in the iRPL group, a negative correlation was found between FSH and telomere length (r=-0.437; p<0.001). CONCLUSION: Shortened telomere length might play a role in the etiology of iRPL. We are of the opinion that patients with RPL should be screened for the presence of cardiovascular diseases and other chronic diseases, as is the case for POF.

The Effect of Maternal Pulmonary Function Test Parameters on Umbilical Cord Blood Gas and the Duration of Labor.

OBJECTIVE: To evaluate the relationship between the maternal pulmonary function test (PFT) and the Apgar score of the newborn, umbilical cord blood (UCB) gas values and the duration of delivery. MATERIAL AND METHODS: The present study included 41 volunteer nulliparous pregnant women who presented to our obstetrics clinic and PFTs were performed by using spirometry. RESULTS: A significant positive correlation was observed between 5th-minute Apgar scores and maternal FEV1 (forced expiratory volume in the first second) (lt), FEV1%, FVC (lt), FVC% (r=0.509, p=0.003; r=0.47, p=0.007; r=0.434, p=0.013; r=0.417, p=0.017; respectively). A significant positive correlation was observed between UCB pH value and maternal FEV1 (lt), FVC (lt) (r=0.515, p=0.003; r=0.351, p=0.049; respectively). CONCLUSION: Our results showed that FEV1 and FVC values, which indicate maternal respiratory functions, may affect Apgar scores of the newborn and UCB gas values.

The Effect of Preoperative Anxiety on Fetal Cord Blood Tumor Necrosis Factor-Alpha, Interleukin-6, and Neonatal Outcomes in Pregnant Women.

BACKGROUNDS: In this study, we aimed to investigate the relationship in pregnant women who undergo elective cesarean section between the preoperative anxiety (POA) levels and neonatal results and TNF-α, IL-6 and IL-8 levels, the pro-inflammatory cytokines in cord blood. SUBJECTS AND METHODS: Sixty-six volunteer patients, aged 18 to 40, who underwent elective cesarean surgery were included in the study. Trait Anxiety Inventory (TAI) was evaluated at the anesthesia outpatient clinic and State Anxiety Inventory (SAI) was determined one hour before cesarean section. Plasma levels of TNF-α, IL-6 and IL-8 in the umbilical cord blood were determined using the ELISA method. Fetal cord blood gas, birth weight, and APGAR scores at the 1st and 5th minutes after birth were recorded. RESULTS: The mean preoperative maternal SAI and TAI scores were 46.6±10.9 and 41.4±7.8, respectively. There was a significant correlation between POA and fetal birth weight and fetal cord blood TNF-α, IL-6 and IL-8 parameters. The inflammatory marker levels in the cord blood of fetuses in the high anxiety groups were significantly higher (p<0.001). Fetal birth weight was significantly lower in the high anxiety groups (p<0.05), whereas there was no significant difference in cord blood gas values. CONCLUSIONS: Our results show that an increase in the levels of TNF-α, IL-6, and IL-8 cytokines in fetal cord blood in pregnant women with high anxiety levels and this situation causes negative effects on the newborn.

Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

PURPOSE: To compare the rates obtained from hematological parameters in cases of late-onset idiopathic fetal growth restriction (FGR) with healthy pregnancies and to evaluate the effect on neonatal outcomes. METHODS: The study group consisted of 63 pregnant women with late-onset idiopathic FGR and the control group consisted of 91 healthy pregnant women. The determined rates were calculated from the control hemograms of patients at 28 weeks. Both groups were compared for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other parameters. RESULTS: NLR, leukocyte and neutrophil levels were significantly higher in the FGR group (p<0.05). There was no significant difference in PLR, platelet and lymphocyte levels between the groups (p>0.05). To predict FGR, the best cut-off value of NLR was determined to be 4.11 with 56% sensitivity and 88% specificity values. CONCLUSION: Neutrophil, lymphocyte and platelet interactions have an important role in FGR development. Inflammation can be involved in the etiopathogenesis in late-onset FGR.

Environmental Exposures in the Etiology of Abortion: Placental Toxic and Trace Element Levels.

PURPOSE: Intensive research has been conducted on the effects of toxic and trace elements on pregnancy. Previous studies indicated a possible relationship between placental levels of these elements and first-trimester abortion; however, their effects on the further gestational weeks are not clear. This study aimed to investigate the effect of changes in the levels of placental trace and toxic elements on second-trimester abortion. METHODS: The patient group consisted of 30 women with missed abortion. The control group comprised 60 healthy term and singleton pregnant women who gave birth. Placental samples were obtained from the patients and the healthy controls, and the concentrations of placental elements were measured using inductively coupled plasma mass spectrometry. RESULTS: In the abortion group, placental arsenic, cadmium, mercury, lead, antimony, tin, cobalt, manganese, and selenium levels were significantly higher than those of the control group (p<0.05). Antimony was determined as an independent predictor with an odds ratio of 6.1 in toxic elements (p=0.025), and selenium was determined as an independent predictor with an odds ratio of 2.3 in trace elements (p=0.015). CONCLUSION: The changes in trace element and toxic element levels, especially an increase in antimony and selenium, in placental tissue due to environmental exposure may play an important role in second-trimester abortion.

Can the negative effects of ketamine abuse on female genital organs be prevented by nimesulide? An experimental study.

The objective of this study is to investigate the effects of nimesulide on ketamine-induced ovarian and uterine toxicity by biochemical and histopathological examinations. Ketamine is an anesthetic agent whose use leads to overproduction of catecholamines. Nimesulide is a cyclooxygenase-2 inhibitor, which has also been reported to exert a significant antioxidant effect. Wistar albino female rats were randomly divided into three groups as follows: ketamine group (60 mg/kg), ketamine (60 mg/kg) + nimesulide (50 mg/kg) group, and a healthy control group. Then, the biochemical levels and histopathological findings in the ovaries and uteri of the rats were examined for malondialdehyde, myeloperoxidase, total glutathione and superoxide dismutase. The study demonstrated that, in the uterine and ovarian tissues of rats that have been administered ketamine, there was a decrease in the levels of total glutathione and superoxide dismutase, while malondialdehyde and myeloperoxidase was increased: however it was observed that these ratios were reversed in the ketamine+nimesulide group. It was also proved that the negative effects of ketamine can be corrected with nimesulide when the myometrial and endometrial thicknesses are compared. Antioxidants such as nimesulide may protect against the damage caused by ketamine to the genital organs in young women.

The Potential of JWH-133 to Inhibit the TLR4/NF-κB Signaling Pathway in Uterine Ischemia-Reperfusion Injury.

In recent years, significant progress has been made in understanding the biological and molecular pathways that regulate the effects of ischemia-reperfusion (I/R) injuries. However, despite these developments, various pharmacological agents are still being tested to either protect against or mitigate the damage caused by the IR's harmful consequences. JWH133 is a CB2R-selective agonist and belongs to the class of Δ8-tetrahydrocannabinol. The present study aimed to determine the in vivo effect of JWH-133 on uterine IR injury via the TLR4/NF-κB, pathway. Female Wistar albino rats (n = 40) were randomly divided into five groups. Three different doses of JWH-133 (0.2, 1, and 5 mg/kg) were administered to the rats. RNA was isolated from uterine tissue samples, and gene expression was measured by RT-PCR using specific primers. The interaction energies and binding affinities of JWH-133 with IL-1ß, IL-6, NF-κB, TLR-4, and TNF-α were calculated through molecular docking analysis. The expression analysis revealed that JWH-133 administration significantly reduced the expression levels of IL-1ß, IL-6, NF-κB, TLR-4, and TNF-α (p < 0.05). Notably, in the 1 mg/kg JWH-133 group, all of the gene expression levels decreased significantly (p < 0.05). The molecular docking results showed that JWH-133 formed hydrogen bonds with GLU64 of IL-1ß, SER226 of IL-6, and SER62 of TNF-α. This study highlights the molecular binding affinity of JWH-133 and its potential effects on inflammation in IR injury. These results pave the way for future research on its potential as a therapeutic target.

2-Arachidonoylglycerol Activity in Over Ischemia Reperfusion Damage: Can Endocannabinoids Protect Ovarian Reserve?

Objective: The present study aimed to demonstrate the possible effects of increased 2-arachidonoylglycerol (2-AG) by applying the monoacylglycerol lipase inhibitor KML-29 on rats with ovarian ischemia-reperfusion (IR) model. Methods: Forty-eight female Wistar albino rats were divided into six groups. Group 1: Sham, Group 2: Ischemia, Group 3: IR, Group 4: IR + KML-29 (2 mg/kg), Group 5: IR + KML-29 (20 mg/kg), and Group 6: IR + vehicle (dimethyl sulfoxide). Three hours of ischemia followed by 3 h of reperfusion. Two different doses of KML-29 (2 and 10 mg/kg) were administered intraperitoneally in Groups 4 and 5, 30 min before reperfusion. Ovarian IR injury and ovarian reserve were evaluated histopathological and by using nuclear factor (NF)-κB, interleukin (IL)-1ß, tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-ß1, superoxide dismutase, glutathione peroxidase pre-/postoperative blood antimullerian hormone, and inhibin B. Results: In the KML-1 and KML-2 groups, this damage was significantly reduced compared to the ischemia group. NF-κB, IL-1ß, TNF-α, and TGF-ß1 immunoreactivities increased statistically significantly in the ischemia group compared to the control group (p<0.001). Immunoreactivities of these proteins were significantly decreased in the KML-1 and KML-2 groups (p<0.001). It was observed that the number of these apoptotic cells decreased significantly in the KML-1 and KML-2 groups compared to the ischemia group (p<0.001). The postoperative inhibin level showed a significant decrease in the ischemia group compared to the sham group, while a significant increase was observed in the KML-1 and KML-2 groups compared to the ischemia group. Conclusion: It was seen that anti-inflammatory, antioxidant, and antiapoptotic activity was formed, and the ovarian reserve was preserved with 2-AG in ovarian IR damage. The protective effect of endocannabinoids on the ovaries may create a promising new treatment strategy for many pathologies that will affect the ovarian reserve.

Serum levels of mu-opioid receptor according to menstrual cycle phases are associated with postoperative pain and opioid consumption in laparoscopic gynecological surgeries: a prospective observational study.

AIMS: In this prospective observational clinical study, we aimed to evaluate the relationship between serum mu-opioid receptor (MOR) levels according to menstrual cycle phases on postoperative pain scores and analgesic requirements. METHODS: A total of 80 female patients undergoing laparoscopic surgery were divided into two groups according to the phases of the menstrual cycle as follicular and luteal. Postoperative pain scores, total tramadol consumptions, and numbers of demands on patient-controlled analgesia (PCA) of the patients were recorded at 5 time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour in the ward, T3: 12th hour in the ward, T4: 24th hour in the ward). Serum MOR concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: The mean serum MOR levels were significantly higher in the follicular group (275 ± 32 pg/ml) compared to the luteal group (254 ± 28 pg/ml) (p = 0.003). Total tramadol consumption (T0, T2, and T3) was significantly higher in the luteal group (p = 0.031, p = 0.012, p = 0.017, respectively). Postoperative pain scores did not differ significantly between the groups. With the exception of T4 (p = 0.057), the number of demands on PCA was significantly higher in the luteal group. However, multivariate logistic regression analysis showed that serum MOR levels were affected by the menstrual cycle phase (follicular) (ß = 0.361) (p = 0.001). CONCLUSIONS: Our study revealed that patients during the follicular phase with higher serum MOR levels consumed less opioid analgesic postoperatively. More comprehensive studies are needed to determine the relationship between serum MOR levels and menstrual cycle phases as well as postoperative pain. (Trial registration number: NCT04690491 www. CLINICALTRIALS: gov ).

Can pycnogenol prevent cisplatin-induced damage in uterus and ovaries?

Introduction: Cisplatin is an antineoplastic agent, which is thought to act on tissues with increased levels of reactive oxygen species and decreased levels of antioxidants. Pycnogenol is a potent antioxidant that is used in medical conditions caused by oxidative stress. The aim of our study is to demonstrate the effects of pycnogenol on cisplatin-induced uterine and ovarian damage in rats. Material and methods: Wistar albino female rats were randomly divided into 3 groups before the experiment as follows: a 2.5 mg/kg cisplatin group (CG; n = 10), a 40 mg/kg pycnogenol + 2.5 mg/kg cisplatin group (PCG; n = 10), and a healthy control group (HG; n = 10). Then, the ovaries and uteri of the rats were examined to determine malondialdehyde (MDA), total glutathione (tGSH) and superoxide dismutase (SOD) biochemical levels and the histopathological findings. Results: Our study demonstrated that, in uterine and ovarian tissues of rats administered with cisplatin, there was a decrease in the levels of tGSH and SOD, while MDA was increased; however, it was observed that these ratios were reversed in the PCG group (p < 0.05). The number of follicles in the ovarian tissues was examined in all 3 groups. When the CG group was compared with the other two groups, the number of primordial, developing and atretic follicles was low, but there was no difference in the corpus luteum count. Conclusions: Pycnogenol pretreatment alleviates cisplatin-induced uterine and ovarian injury in rats because of its antioxidative effect.

Brucellosis in pregnancy and its response to the changing immunoglobulin A: A prospective controlled study.

Objective: This study aimed to define the rare Brucella infection in pregnancy and its effects on immunoglobulins (Ig). Materials and Methods: This prospective study has conducted Brucella screening using the Rose Bengal test on pregnant and non-pregnant outpatients who did not show any specific Brucella symptoms. The immunoglobulin levels were measured using the enzyme-linked immunosorbent assay. The study group consisted of pregnant women who were at 20 weeks or below gestation and applied to our hospital outpatient clinic for routine check-ups. The control group consisted of healthy patients who applied for routine controls. Results: This study included a total of 584 participants, 293 of whom were controls and 291 were the study (pregnant) participants. The study revealed a 1.5% incidence of Brucella during pregnancy. In acute and chronic Brucella infection, lower levels of IgA response were observed in pregnant cases compared to the control group. Conclusion: Brucella infection is a disease that can cause fetal problems, especially in endemic areas. The role of the altered IgA response in pathologies that are associated with Brucella infection stands out as a new target for disease pathophysiology.

Behaviors and Attitudes of Obstetricians in Turkey Related to Cord Clamping, Cord Milking, and Skin-To-Skin Contact.

Objective This study was planned to evaluate obstetricians' practices of umbilical cord clamping, milking, and skin-to-skin contact applications and to determine the related variables. Material and methods A total of 522 obstetricians participated in the study. Participants were reached via the internet and a 15-item questionnaire was applied about umbilical cord clamping, cord milking, and skin-to-skin contact. Mann-Whitney U test and Student's t-test were used for continuous data and Chi-square test or Fisher's exact test for categorical data in determining the difference between groups. For the multivariate analysis, the possible factors identified with univariate analyses were entered into the logistic regression analysis to determine further independent predictors of delayed clamping. Statistical analysis was performed using the SPSS software (version 20, IBM Corp, Armonk, USA). Results It was determined that 234 (44.8%) of the participants clamped the umbilical cord early whereas 288 (55.2%) clamped it late. It was found that the delayed clamping rates of physicians working in public hospitals were significantly lower than those working in private (p<0.001). It was observed that 132 of the participants (25.3%) did not milk the cord and 180 (34.5%) of them applied it continuously, and no significant difference was found between physicians working in the public and private sectors (p=0.130). It was observed that 384 (73.6%) physicians applied skin-to-skin contact. In the multivariate regression analysis, it was determined that working status in a private hospital with a 3.6 odds ratio (OR) (95% CI = 2.0-6.3) and a low number of patients examined daily with a 1.2 OR (95%CI= 1.0-1.4) were the most important independent factors affecting the choice of delayed clamping. Conclusion It is seen that the most important parameter affecting the birth practices of physicians in our country is the employment status in public or private institutions. The age and professional experience of the physicians who clamp the umbilical cord late were found to be higher. Obstetricians are at the key point in obstetrics practice, and the experience of physicians and the type of institution they work with affect these practices.

Concordance of HPV, conventional smear, colposcopy, and conization results in cervical dysplasia.

BACKGROUND: Cervical cancer screening algorithms are increasingly focused on Human Papillomavirus (HPV)-based screening while the accuracy of using abnormal cytological findings to detect dysplastic lesions still remains important. This retrospective study correlated the results of conventional cervical cytology, colposcopy guided biopsy, and cold knife conization (CKC) procedures performed in a tertiary center. MATERIALS AND METHODS: Data from 9399 patients who underwent screening with conventional cervical cytology between 2010 and 2019 was obtained from the hospital registry. Abnormal cervical cytology and high-risk HPV DNA genotypes were recorded and their colposcopic and CKC pathology was determined. RESULTS: Two hundred and ninety two patients underwent colposcopy for abnormal cervical cytology and/or high-risk HPV positivity. One hundred and twenty three patients were positive for High-risk HPV. Abnormal cervical cytology was detected in 216 patients. The most common cytological anomaly was atypical squamous cells of undetermined significance (ASCUS) found in 9399 patients (1.39%). It was determined that conventional cytology had a sensitivity of 70.8% and a specificity of 62.2% for the detection of low-grade lesions, while it had a sensitivity of 72.4% and a specificity of 86.0% for the detection of high-grade lesions. CKC was applied to 68 patients who were diagnosed with high-grade squamous intraepithelial lesions (HSIL) as a result of the colposcopy. As a result of CKC, a high-grade lesion was detected in 73.5% of these patients. CONCLUSION: Conventional cervical cytology and colposcopy exhibited higher accuracy as the severity of lesions increased. Detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS.