Niyazi Cenk Sayın

Background/Objectives: International guidelines recommend risk-adapted postoperative management in early-stage cervical cancer; however, the extent to which these recommendations are implemented in routine clinical practice remains incompletely characterized, particularly among patients without high-risk pathological features. This study evaluated real-world concordance with the 2023 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) recommendations and investigated the clinical implications of potential overtreatment. Methods: We retrospectively evaluated a single-center cohort of 135 patients treated with primary radical hysterectomy for early-stage cervical cancer at our institution. Postoperative pathological risk factors were used to stratify patients in accordance with the 2023 ESGO/ESTRO/ESP guidelines. Postoperative management was classified as guideline-concordant or potential overtreatment. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis and univariable Cox proportional hazards regression. Results: The high-risk group comprised 50 patients (37.0%), and the non-high-risk group comprised the remaining 85 patients (63.0%). Among non-high-risk patients, 28 (32.9%) received guideline-concordant postoperative management, whereas 57 (67.1%) received treatment classified as potential overtreatment. The distribution of postoperative treatment intensity differed significantly according to guideline-concordance status (p < 0.001). However, DFS did not differ significantly between the guideline-concordant and potential overtreatment groups (log-rank p = 0.62; hazard ratio [HR] = 1.38, 95% confidence interval [CI] 0.38–5.06), nor did OS (log-rank p = 0.85; HR = 1.09, 95% CI 0.42–2.84). Conclusions: Postoperative management showed substantial variation among patients without high-risk pathological features, with potential overtreatment observed in approximately two-thirds of this cohort. No statistically significant differences in DFS or OS were observed between the groups; however, the limited number of events and wide confidence intervals preclude exclusion of clinically meaningful treatment effects.

OBJECTIVES: We aimed to evaluate thyroid function disorders and determine C-peptide, CA 19-9, and CA-125 levels in pregnant women diagnosed with gestational diabetes mellitus. STUDY DESIGN: Data were collected from 80 women aged 18-45 years who were admitted to the Perinatology outpatient clinic of Trakya University Faculty of Medicine at 24-28 weeks of gestation. Sociodemographic characteristics, general health information, pre-pregnancy weight, and current weight were obtained. All participants underwent a 75 g oral glucose tolerance test. Based on the test results, the participants were divided into two groups: those with (n=40) and without gestational diabetes mellitus (GDM) (n=40). Thyroid function tests were assessed by measuring thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), anti-thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (anti-TPO) levels. Additionally, amniotic fluid index, complete blood count parameters, blood C-peptide, CA 19-9, and CA-125 values were evaluated. RESULTS: Fasting blood glucose, 1-hour and 2-hour OGTT values, and HbA1c values were higher in pregnant women with GDM. There was no significant difference in mean amniotic fluid index values or in thyroid function test results between pregnant women with GDM and those without. While CA 19-9 values were higher in the GDM group, there was no significant difference in C-peptide and CA-125 levels. Also, higher mean corpuscular volume (MCV) and erythrocyte distribution width (RDW) values were observed in the GDM group. CONCLUSION: Women with GDM have higher CA 19-9 levels than healthy pregnant women. The clinical significance of this finding should be expressed with long-term follow-up studies.

Hypertensive disorders of pregnancy are significant contributors to maternal and perinatal morbidity and mortality. The definition, classification, and management of these disorders have evolved over time. Notably, the disease classification enables caretakers to manage the disease as well as safeguard maternal and fetal health. The approach and management for pregnancies with gestational and chronic hypertension or pre-eclampsia with or without severe features should be adequately elucidated to mitigate adverse perinatal outcomes. This review aimed to present the most recent definition and classification of hypertensive disorders of pregnancy to address their management, determine the optimal timing of birth, and establish short- and long-term follow-up protocols following parturition.

Conjoined twins are an uncommon type of monoamniotic twins with an incidence of about 1.5 per 100,000 births worldwide. Non-janiceps is the extremely rare sub-type of cephalopagus which is reported as 1 in 58 of all conjoined twins or 1 in 3 million births. We present a G6, P5 31-year-old pregnant who was diagnosed with a unicephalus non-janiceps conjoined twins. Due to its incompatibility with life, the pregnancy was electively terminated. The prognosis of conjoined twins depends on the location and extent of the conjoined area and the accompanying congenital anomalies of the fetuses. Early diagnosis is vital because it can help in assessing the type of conjoined twins and subsequently pre-postnatal decision making. Elective termination of non-janiceps type of conjoined twins which is incompatible with life is a justifiable possibility.

OBJECTIVE: To examine early pregnancy levels of serum heme oxygenase-1, soluble vascular endothelial growth factor receptor-1, B-cell lymphoma/leukemia-2 in relation to unfavorable pregnancy outcomes, including preeclampsia, fetal growth restriction, spontaneous preterm birth, gestational diabetes mellitus and fetal macrosomia. STUDY DESIGN: A total of randomly selected 140 pregnancies were included in this prospective study. Peripheral blood samples were obtained between 110/7 and 136/7 gestational weeks. All pregnancies were followed up until the outcomes were obtained and classified as preeclampsia, fetal growth restriction, spontaneous preterm birth, gestational diabetes mellitus, fetal macrosomia, and uncomplicated ones. RESULTS: Significantly high levels of early serum heme oxygenase-1 were found in the cases who subsequently developed preeclampsia, spontaneous preterm birth, and fetal macrosomia (p<0.05), in concordance with high soluble vascular endothelial growth factor receptor-1 levels of the preeclampsia group, however, B-cell lymphoma/leukemia-2 s were similar in all groups. As soluble vascular endothelial growth factor receptor-1 predicted preeclampsia at a value of 11.905 ng/mL, the cutoff values for the heme oxygenase-1 to predict preeclampsia, spontaneous preterm birth, and fetal macrosomia were 0.372 ng/mL, 0.354 ng/mL and 0.494 ng/ml, respectively. CONCLUSION: Elevated first trimester heme oxygenase-1 levels are remarkable in the pregnancies associated with preeclampsia, spontaneous preterm birth, and fetal macrosomia in comparison with uncomplicated ones.

The aim of the study was to improve nuchal translucency (NT) and serum marker Down syndrome (Tri21) screening methods by including fetal ductus venosus (DV) Doppler measurements. A total of 213 pregnant women were screened consecutively by combining maternal age, fetal NT and maternal serum pregnancy associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (f β-HCG) values at 11-14 weeks of gestation. Also, a DV Doppler analysis was performed for the contribution to the screening for Tri21 and other fetal anomalies or adverse pregnancy outcomes. Twelve fetuses had DV PI measurements above the 95th percentile and two (17%) developed intrauterine growth retardation. DV PI values negatively correlated with birth weight (p=0.013, r=0.171). Two patients had T 21 among the study group (0.9%) with abnormal biochemical screening results. In these with Tri21, the combined test risk was above the suggested limit (>1/250). PAPP-A was 1.91 MoM in 49 patients. The rates of false positivity were 10% for PAPP-A and 22% for f β-HCG. The sensitivity, specificity, positive and negative predictive values of the combined test was 100%, 95%, 20% and 100%, respectively. The combined test has high sensitivity and specificity for Tri21 detection. The addition of DV Doppler ultrasound in the first trimester might have the advantage of predicting some adverse pregnancy outcomes. However, in the Turkish population, further studies with larger numbers of patients will be needed to establish the usefulness of DV for the detection of Tri21 or the prediction of some major cardiac anomalies.

Introduction Adnexal masses ≥5 cm in diameter are rare during pregnancy. Materials and methods We present our experience on six pregnant women with adnexal masses diagnosed and operated during pregnancy and/or at the time of cesarean section. Results Carefully selected cases with a unilateral mass and a solid component with normal tumor marker result can be followed until term and adnexectomy can be performed during cesarean section. On the contrary, gross adnexal masses, even with normal tumor marker levels should be operated when diagnosed, but these women might deliver small for gestational age infants. Conclusion By depending upon restricted criteria according to tumor markers, ultrasound or other radiological imaging techniques, some patients with an adnexal mass carrying an important risk factor for malignancy may be overlooked.