Selim Buyukkurt

Fluorescence background is a persistent limitation in quantitative Raman spectroscopy of biological tissue, and it is pronounced in the pregnant cervix, where weak Raman bands sit on a strong and variable baseline. Baseline correction is a routine step, yet its effect on the final result is rarely tested in a controlled way. We examined how the choice of correction strategy affects spectral metrics and the biological difference inferred between two gestational stages. Ex vivo cervical spectra from a rat model at gestational days 15 and 20 were processed with fixed-degree polynomial fitting from the second to seventh degrees, five-point piecewise linear correction, an automated polynomial routine, and asymmetric least squares. Correction quality was assessed by the ratio of Raman-active to -inactive regions and by whether each method preserved the direction of gestational change. The choice of method altered the quantitative output and, for some methods, reversed the inferred direction, because the automated high degree of fit over-suppressed the spectrum and inflated the metric. Moderate-degree polynomial fitting and asymmetric least squares gave the most coherent and biologically consistent results. Baseline correction therefore determines cervical Raman outputs and should be selected and reported transparently.

Objective: Sonographic evaluation of the fetus and estimation of fetal weight are integral components of modern obstetric practice. Estimated fetal weight (EFW) plays a crucial role in predicting macrosomia, diagnosing intrauterine growth restriction, and monitoring fetal development. This study aimed to improve birth-weight prediction in low-risk term pregnancies by combining conventional fetal biometry with maternal anthropometry and selected fetal soft-tissue and cardiac measurements. Materials and Methods: In 94 low-risk, term singleton pregnancies scheduled for elective cesarean delivery, standardized prenatal ultrasound was performed within 24 h before birth by a single operator. Neonatal anthropometry was obtained within 6 h postnatally. Multiple linear regression was used to develop conventional and extended prenatal birth-weight prediction models with actual birth weight as the dependent variable, and their performance was compared with Hadlock EFW. Results: Mean actual birth weight was 3178.9 ± 359.5 g and mean Hadlock EFW was 3201.6 ± 399.7 g. Hadlock estimation correlated strongly with birth weight (r = 0.826) and had a mean absolute error (MAE) of 181.0 g. Abdominal circumference was the strongest conventional sonographic correlate of birth weight. The conventional prenatal Model 2 achieved R² = 0.710 and MAE = 150.1 g. The extended prenatal Model 5, which combined conventional biometry with symphysis-fundal height, femoral soft-tissue thickness, right atrial area, maternal abdominal fat thickness, and aortic valve diameter, showed the best performance (R² = 0.783; MAE = 133.2 g). Its optimism-corrected and repeated cross-validated R² values were 0.739 and 0.725, respectively. Conclusions: The newly proposed formulas, particularly Model 5, demonstrated better internally validated predictive performance than the Hadlock baseline in this cohort, suggesting that the integration of selected maternal anthropometric and additional fetal ultrasonographic measurements with conventional biometry may improve birth-weight estimation. These findings warrant external validation in larger and more diverse populations prior to clinical implementation.

This review evaluates the applicability of trial of labour after caesarean (TOLAC) and vaginal birth after caesarean (VBAC) in Türkiye within the framework of the national clinical protocol, in comparison with contemporary international guidelines. Over the past half-century, increasing medicalisation of childbirth and widespread use of fetal monitoring have contributed to a substantial rise in caesarean section (CS) rates, without a proportional reduction in perinatal mortality or cerebral palsy. Türkiye remains among the countries with the highest CS rates, with Robson groups involving previous caesarean deliveries (groups 5 and 10) representing a major contribution. International evidence indicates that, in appropriately selected cases, TOLAC achieves a success rate of 60%–80% and is associated with a low risk of uterine rupture. Current guidelines from the American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, and International Federation of Gynaecology and Obstetrics define TOLAC as a reasonable option that should be offered to most women with a prior caesarean. In contrast, the Turkish national protocol appears more restrictive and defensive, including contraindications and risk estimates that are not consistently aligned with the literature and supported by limited or outdated references. Additionally, institutional requirements for offering TOLAC are defined more stringently than in comparable guidelines. Considering the association between rising CS rates and long-term maternal and obstetric complications, strategies aimed at reducing both primary and repeat caesareans are essential. Based on current evidence, there is a clear need to revise the national protocol in Türkiye to ensure alignment with up-to-date scientific data and to promote balanced, evidence-based decision-making in TOLAC/VBAC practice.

Consensus-based recommendations on managing sickle cell disease in pregnancy were recently published in a hematology journal. As this topic is also of great interest to obstetricians and gynecologists, we summarize some of these recommendations, while highlighting the challenges of providing evidence-based medical care to pregnant individuals with sickle cell disease.

Purpose: The aim of this study is to evaluate the neurodevelopmental prognosis of fetuses with congenital heart defects by considering aortic flow and oxygen saturation in the ascending aorta, and to investigate them in terms of cortical developmental delay.Materials and Methods: In this retrospective study, neurosonographic and hemodynamic parameters were measured in fetuses diagnosed with congenital heart defects. These measurements were compared with those of gestational-age-matched low-risk controls in the second and third trimesters. Standard fetal biometry, transcerebellar diameter, Sylvian fissure area, and related ratios were evaluated.Results: The study included 53 fetuses with congenital heart defects and 72 controls in the second trimester, and 72 fetuses with congenital heart defects and 58 controls in the third trimester. In the second trimester, the Sylvian fissure area was lower in the CHD group (50.98 ± 21.02 mm² vs 58.37 ± 16.41 mm²), while the HC/SYL ratio was higher in the CHD group in both the second trimester (4.53 ± 1.69 vs 3.44 ± 0.74) and the third trimester (2.71 ± 1.31 vs 2.09 ± 0.49). Neurodevelopmental parameters showed that the Sylvian fissure area was smaller in the second-trimester congenital heart defects group compared with controls. Consequently, the aortic valve diameter/Sylvian fissure area and head circumference/Sylvian fissure area ratios were higher in the congenital heart defects group. In the third trimester, patients with normal aortic flow and two functional ventricles had higher aortic valve diameter/Sylvian fissure area ratios than other patient groups. Conclusion: Detecting early-onset cortical developmental delay in patients with left cardiac dysfunction using proportional data is crucial for a holistic approach to evaluation. Incorporating head circumference/Sylvian fissure area and aortic valve diameter/Sylvian fissure area ratios into routine prenatal follow-up measurements may help identify fetuses at potential risk for adverse postnatal neurodevelopmental outcomes.

Among the many factors affecting the outcome of pregnancy, the nutrition of the expectant mother plays an important role. Malnutrition is sometimes manifested by nutrient deficiencies and sometimes by over-nutrition. Another problem is the use of non-nutrient products in the hope of supporting nutrition. While some of these non-nutrients are produced and licensed as medicines, a considerable number of them are marketed as food supplements. The ingredients and preparation methods of food supplements are not as strictly controlled as those of medicines. When recommending a drug or product to patients, the goal should be to achieve a concretely defined benefit. It is not enough to simply assume that there will be no harm and that the ingredients of these substances are already naturally present in the body. The benefit/harm assessment of the substance used in terms of possible side effects, undesirable effects and drug interactions should be taken into consideration. When the group in question is pregnant women, it should be kept in mind that the differences in physiology in each week of pregnancy and the needs of the growing fetus and its resistance to external factors also vary. In our article, we tried to examine the products that are frequently used, recommended, prescribed and expected to positively affect pregnancy outcomes in terms of evidence-based medicine. As a result of our review, we found that the only products that have been shown to be beneficial in routine use are folic acid before pregnancy and in the first trimester and iron throughout pregnancy. For the other products, we concluded that it is valid to provide education about the importance of balanced and regular nutrition throughout life. .

Data to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.

Objectives: Placenta accreta spectrum (PAS) is usually treated by hysterectomy performed through a midline incision. We hypothesize that PAS surgery can be performed through a Joel-Cohen incision with adequate sight and safety.Material and methods: The data on women having a hysterectomy due to PAS between 2013-2021 was collected retrospectively. Operation length, baby's pre-delivery general anesthesia exposure time, transfusion rates, complication rates, postoperative admission to the intensive care unit (ICU), postoperative hospital stay, and neonatal outcomes were collected. In addition, the data investigated whether the operation was performed under emergent conditions and in the early (2013-2016) or late (2017-2021) years.Results: 161 patients met the inclusion criteria. The median gestational age at delivery was 34 weeks (27-39). The mean operation length was 150 minutes (75-420), and the anesthesia-to-delivery interval was 32 minutes (5-95). Twenty-three (14%) patients did not receive any blood product, 73 (45%) received less than three packs of erythrocyte, and only seven (4%) had a massive transfusion. Bladder injuries occurred in 24 (15%). Preoperative anemia, hypogastric artery ligation, transfusion, ICU admission, and maternal and neonatal complications were more frequent in emergent cases. Comparison between the early and late groups showed a decrease in the rate of anemia, maternal ICU admission, hypogastric artery ligation, and neonatal complications. In addition, infectious complications were relatively rare in all groups.Conclusions: The Joel-Cohen incision and bladder dissection before the baby's delivery reduce transfusion rates and avoid midline incision, which is prone to complications and unpleasant cosmetic appearance while performing a hysterectomy for PAS surgery.

Background/aim: The aim of this study was to summarize the experiences of a single medical center for genetic diagnosis and treatment of prenatal patients. Materials and methods: This study includes a retrospective data analysis of 2843 prenatally investigated cases using invasive methods during a 6-year period (2013-2019) at a single tertiary care center. Results: Chromosomal abnormalities were detected in 80 out of 1221 amniotic fluid samples;,178 out of 1608 chorionic villus samples, and 1 out of 14 cordocentesis samples. The most common chromosomal abnormality was trisomy 21. At least one mutation was detected in 63 of the 152 molecular tests performed on fetuses. Conclusion: Clinical procedures such as ultrasounds and genetic tests are able to provide a better clinical follow-up for pregnant women about the possible congenital anomalies or any genetic condition, with proper genetic counseling and testing methodology.