Zehra Vural Yılmaz

Aims: Placenta accreta spectrum (PAS) is characterized by abnormal trophoblast invasion and is associated with substantial maternal morbidity. This study aimed to evaluate placental NLRP3 protein expression across PAS, placenta previa, and other non-PAS placental pathologies. Methods: This retrospective study included 52 placental specimens: 26 PAS cases, 11 placenta previa cases, and 15 other non-PAS placental pathologies. NLRP3 expression was assessed immunohistochemically using a semi-quantitative scoring system. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the association of NLRP3 with PAS. Results: NLRP3 staining scores differed significantly across the three study groups (p=0.036). However, none of the pairwise comparisons remained statistically significant after Bonferroni correction, although PAS showed a trend toward higher NLRP3 expression than other non-PAS placental pathologies before correction (uncorrected p=0.018), these findings should be considered exploratory. In univariable logistic regression, higher NLRP3 expression was associated with PAS (OR 1.318, 95% CI 1.041–1.669, p=0.022). After adjustment, the number of previous cesarean deliveries remained independently associated with PAS (aOR 8.621, 95% CI 2.325–31.959, p=0.001), whereas NLRP3 expression showed a borderline independent association (aOR 1.480, 95% CI 0.988–2.216, p=0.057). ROC analysis demonstrated modest discriminative performance in this cohort (AUC 0.685, 95% CI 0.540–0.830, p=0.022). Conclusion: Placental NLRP3 expression showed a trend toward higher expression in PAS but pairwise differences did not remain statistically significant after Bonferroni correction. Accordingly, these findings should be considered exploratory and hypothesis-generating. Although NLRP3 may be involved in inflammatory pathways related to abnormal placentation, its diagnostic performance was modest and its independent predictive value appeared limited after adjustment for established clinical risk factors.

Objectives: To evaluate a novel bilateral, segment‐based umbilical artery (UA) Doppler scoring system in pregnancies complicated by early‐ or late‐onset fetal growth restriction (FGR) and to investigate its association with adverse perinatal outcome. Methods: This single‐center prospective cohort study, conducted between May 2025 and December 2025, included singleton pregnancies diagnosed with FGR according to Delphi consensus criteria. Bilateral UA Doppler measurements were obtained from six predefined anatomical sites: the perivesical segment, the free‐loop segment and the placental insertion site in each UA. End‐diastolic flow at each site was categorized as present, absent or reversed and incorporated into a cumulative UA Doppler score (0–18 points). Composite adverse perinatal outcome (CAPO) was defined as the occurrence of at least one of the following: neonatal hypoglycemia, need for phototherapy, neonatal sepsis, respiratory distress syndrome, need for continuous positive airway pressure, need for mechanical ventilation, 5‐min Apgar score < 7 or admission to the neonatal intensive care unit (NICU). Participants were stratified by UA Doppler score (< 3 vs ≥ 3 points). Multivariable logistic regression analysis was used to assess the association between UA Doppler score as a continuous or dichotomized variable and CAPO, adjusting for maternal age, body mass index, parity, mode of conception, estimated fetal weight percentile and gestational age at delivery. In addition, the prevalence of individual markers of fetoplacental hemodynamic deterioration, including abnormal ductus venosus Doppler, cerebroplacental ratio < 5 ^th percentile, intrauterine fetal demise, fetal distress leading to delivery and 5‐min Apgar score < 7, was analyzed across UA Doppler score categories (0–2, 3–5, 6–8, 9–12 and > 12 points). Results: A total of 251 pregnancies with FGR were included, of which 117 were early onset (< 32 weeks' gestation) and 134 were late onset (≥ 32 weeks' gestation). Higher UA Doppler scores (≥ 3 points) were associated significantly with preterm delivery and higher rates of NICU admission and CAPO in both early‐ and late‐onset FGR. In early‐onset FGR, higher scores were associated additionally with lower birth weight. The UA Doppler score remained associated independently with CAPO on multivariable logistic regression analysis. A significant linear trend was observed across increasing UA Doppler score categories for the rate of CAPO and individual markers of fetoplacental hemodynamic deterioration. Conclusions: In pregnancies complicated by early‐onset or late‐onset FGR, a higher UA Doppler score based on a multisite bilateral scoring system is associated independently with adverse perinatal outcome. These findings support the feasibility of a segment‐based approach to UA Doppler assessment. Further studies are required to determine the clinical benefit and feasibility of adoption within current surveillance strategies. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Objective: To evaluate the clinical significance of a flat oral glucose tolerance test (OGTT) pattern and its association with obstetric and perinatal outcomes, focusing on fetal growth. Methods: This retrospective cohort study was conducted at a tertiary referral center between January 2023 and November 2025. A total of 1198 women who underwent a two-step OGTT between 24 and 32 weeks of gestation were screened, and 685 eligible participants were included. A flat OGTT pattern was defined as fasting glucose < 95 mg/dL with all postprandial values < 100 mg/dL. The primary outcome was small-for-gestational-age (SGA); secondary outcomes included fetal growth restriction (FGR) and other obstetric outcomes. Logistic regression analyses were performed to assess independent associations. Results: Thirty-nine women (5.7%) exhibited a flat OGTT pattern. These pregnancies were characterized by a markedly attenuated postprandial glycemic response and lower fasting glucose levels. Most maternal and neonatal outcomes were similar between groups. However, SGA was significantly more frequent in the flat OGTT group (20.5% vs. 6.7%, p = 0.001). In multivariable analysis, a flat OGTT pattern remained independently associated with SGA (aOR 4.05, 95% CI 1.70–9.68, p = 0.002). Both SGA and FGR were more frequent among women with a flat OGTT pattern, although the association appeared stronger for SGA. Conclusions: A flat OGTT pattern appears to represent a distinct glycemic response characterized by an attenuated postprandial glucose response and lower fasting glucose levels. Although this pattern was not associated with a generalized increase in adverse obstetric or neonatal outcomes, it was associated with an increased risk of small-for-gestational-age infants.

Objective: Isolated gestational proteinuria (IGP) has traditionally been considered a benign condition; however, emerging evidence suggests that it may represent an early stage in the spectrum of preeclampsia. This study aimed to evaluate clinical and laboratory predictors of progression from IGP to preeclampsia. Methods: This retrospective cohort study included pregnant women diagnosed with proteinuria ≥ 300 mg/day after 20 weeks of gestation between January 2023 and December 2024. After applying predefined exclusion criteria, 319 women with isolated gestational proteinuria (IGP) were included and stratified according to progression to preeclampsia (n = 42, 17.8%). Baseline clinical and laboratory parameters were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of progression, and receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of significant variables. Results: Preeclampsia developed in 17.8% of women with IGP. In multivariable analysis, higher maternal body mass index (aOR 1.085, p = 0.028) and earlier gestational age at diagnosis (aOR 0.883, p = 0.011) were identified as independent predictors of progression. Although neutrophil count and systemic inflammatory indices were elevated in univariate analyses, they did not retain independent predictive value after adjustment. Conclusions: In pregnancies complicated by isolated gestational proteinuria, clinical parameters appear to be more informative than inflammatory and renal markers for predicting progression to preeclampsia. Laboratory-derived indices offer limited additional value and should be interpreted cautiously in risk assessment.

Background/Aim: To assess the sensitivity of the fetal aortic isthmus (AoI) Doppler changes in predicting the adverse perinatal outcome with pregestational and gestational diabetes mellitus compared with other Doppler parameters. Materials and methods: This prospective case–control study was undertaken between Agust 2023 and May 2024 in Ankara Etlik City Hospital perinatology department. Maternal age, gravidity, parity, maternal body mass index (BMI), gestational age at ultrasonographic examination, fetal AoI, umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) Doppler parameters were compared between four groups: Pregestational diabetes mellitus (PGDM) ( n = 30), diet-regulated gestational diabetes mellitus (DRGDM) ( n = 30), insulin-regulated GDM (IRGDM) ( n = 30), and controls ( n = 75). HbA1c values were evaluated only in pregnancies complicated by diabetes mellitus. The composite adverse perinatal outcomes (CAPO) was defined as Apgar score at 5 min < 7, cord blood pH < 7, sepsis, phototherapy for neonates, respiratory distress syndrome (RDS), mechanical ventilation, neonatal intensive care unit (NICU) admission, hypoglycemia. Results: Maternal age and BMI levels were significantly higher in the PGDM group ( p < 0.001). HbA1c levels were significantly higher in the PGDM group compared to other diabetic groups ( p < 0.001). While most Doppler parameters were similar across groups, PGDM cases had higher rates of prematurity (40%), cesarean delivery (90%), NICU admission (60%), and CAPO (63.3%) compared to controls ( p < 0.01 for all). HbA1c was positively correlated with MCA S/D, AoI-PSV, and AoI S/D ( p < 0.05). ROC analysis showed that AoI Ta-max and EDV had modest predictive value for CAPO (AUC = 0.627 and 0.638, respectively; p < 0.05). Conclusions: The AoI Doppler flow measurements may serve as a potential adjunctive marker in the assessment of adverse perinatal outcomes in pregnancies complicated by diabetes mellitus. However, further large-scale prospective studies are warranted to validate its clinical applicability and establish its role in routine obstetric practice.

Objectives: Gestational diabetes mellitus (GDM) is a multifactorial metabolic disorder associated with altered glucose metabolism and systemic physiological adaptations during pregnancy. Subtle changes in renal-related biochemical parameters may reflect underlying metabolic alterations accompanying GDM. This study aimed to evaluate the association between maternal creatinine-to-body weight (Cre/BW) and urea-to-creatinine (Urea/Cre) ratios and GDM, with a particular focus on their potential role as renal–metabolic indicators during pregnancy. Methods: This retrospective case–control study included 1,064 pregnant women (532 with GDM and 532 matched controls) who underwent a 75 g oral glucose tolerance test between 24 and 28 weeks of gestation. Propensity score matching was applied to reduce baseline differences between groups. Maternal serum creatinine, urea, and body weight were recorded in the first and second trimesters, and Cre/BW and Urea/Cre ratios were calculated. Group comparisons, receiver operating characteristic (ROC) analyses, and multivariate logistic regression were performed. Results: In the second trimester, the Cre/BW ratio was significantly lower, and the Urea/Cre ratio was significantly higher in women with GDM compared with controls (both P<0.001). The Cre/BW ratio demonstrated moderate discriminatory ability for distinguishing GDM status (Area under the curve [AUC]=0.774), whereas the Ure/Cre ratio showed modest performance (AUC=0.614). In multivariate analysis, second-trimester Cre/BW and Urea/Cre ratios remained independently associated with GDM after adjustment for clinically relevant covariates. These results suggest a potential association; however, the discriminatory performance of the Cre/BW and Urea/Cre ratios should be regarded as exploratory rather than diagnostically definitive. Conclusions: Lower Cre/BW and higher Urea/Cre ratios were associated with GDM in this retrospective cohort. These findings suggest that simple renal-related biochemical ratios may reflect metabolic–renal adaptations in pregnancies complicated by GDM. However, given the modest diagnostic performance and retrospective design, these parameters should be considered exploratory indicators rather than standalone clinical tools. Further prospective studies are required to clarify their clinical relevance.

Objective: To evaluate hepatic artery Doppler parameters in fetuses with fetal growth restriction (FGR) and to investigate their relationship with composite adverse neonatal outcomes (CANO). Methods: This prospective cohort study included 108 pregnancies (54 FGR; 54 appropriate-for-gestational-age controls) between 34 and 37 weeks’ gestation. Hepatic artery (HA), umbilical artery (UA), middle cerebral artery (MCA), and uterine artery Doppler indices were recorded. Logistic regression and ROC analyses were used to determine predictors of FGR and CANO. Results: HA pulsatility index (PI), systolic/diastolic ratio, and peak systolic velocity (PSV) were significantly higher in FGR fetuses (p < 0.05). In multivariate regression, HA-PI remained independently associated with FGR (aOR 1.74, 95% CI 1.07–2.87, p = 0.025). For predicting CANO, HA-PSV was the only independent predictor (aOR 1.05, 95% CI 1.00–1.10, p = 0.020). ROC analysis demonstrated moderate discriminative ability for HA-PI (AUC 0.681) and HA-PSV (AUC 0.703). Conclusions: Increased HA-PSV in FGR reflects activation of the hepatic arterial buffer response as an adaptive mechanism to maintain hepatic perfusion under hypoxic stress, whereas elevated HA-PI may represent evolving microvascular resistance. Hepatic artery Doppler evaluation may serve as a complementary tool for assessing fetal well-being and identifying fetuses at risk for adverse neonatal outcomes, particularly in late-onset FGR.

OBJECTIVE: To investigate the value of the systemic inflammation response index (SIRI) in predicting prognosis in pregnant women with abortus imminens (AI). STUDY DESIGN: The study included 203 pregnant women (≤12 weeks) who presented and were hospitalized with AI in our hospital. Eighty-three pregnant women with spontaneous abortions comprised the study group, and 120 women with healthy pregnancies comprised the control group. Demographic and laboratory parameters were obtained from the patients' medical records. SIRI was calculated using the formula: neutrophil count × monocyte count/lymphocyte count. SIRI values were compared between groups. RESULTS: The rate of spontaneous abortion in pregnant women with AI was 40.9% in our study population. The SIRI level was found to be significantly higher in the study group than in the control group (p<0.001). The regression analysis showed that the SIRI level is an independent marker for spontaneous abortion, and it was found that when the SIRI level increases by 1 unit, the risk of abortion increases by 25.4% (OR=1.254, p=0.003). We found that, with a cut-off value of 2.11, SIRI predicted spontaneous abortion with 68.7% sensitivity and 65.8% specificity. CONCLUSION: The SIRI level, a non-invasive, simple, and cheap marker, could be used to assess the spontaneous abortion risk of pregnant women presenting with AI. However, future studies with a larger number of patients and serial measurements of the SIRI level are needed to determine the optimal value for predicting the disease.

Background: Gestational hypertension (GHT) is associated with adverse maternal and perinatal outcomes, and reliable biomarkers for risk stratification remain limited. Thrombospondin-4 (TSP-4), a matricellular glycoprotein implicated in vascular remodeling, may play a role in hypertensive disorders of pregnancy. This study aimed to investigate maternal serum TSP-4 levels in GHT and their associations with obstetric and neonatal outcomes. Methods: This prospective cohort study included 44 women with GHT and 44 normotensive controls. Maternal serum TSP-4 levels were measured between 20–30 weeks’ gestation, and demographic, obstetric, and neonatal data were recorded. The development of preeclampsia (PE) and composite adverse perinatal outcomes (CAPO) was subsequently compared between the groups. Results: TSP-4 levels were significantly higher in the GHT group compared with controls (9.50 vs. 7.92 ng/mL, p < 0.001). Women with GHT had lower gestational age at delivery and birth weight, with higher rates of preterm delivery, fetal distress, NICU admission, and composite adverse perinatal outcomes (all p < 0.01). Within the GHT group, patients who developed PE had notably higher TSP-4 levels (13.45 vs. 9.33 ng/mL, p < 0.001). Conclusions: Elevated maternal serum TSP-4 is independently associated with GHT and progression to PE. TSP-4 may serve as a novel biomarker for risk assessment in hypertensive disorders of pregnancy.

To evaluate the predictive value of maternal and umbilical cord blood triglyceride-glucose (TyG) index for adverse neonatal outcomes in pregnancies complicated by preeclampsia. This prospective case-control study included 43 pregnant women diagnosed with preeclampsia and 45 normotensive controls. Maternal and umbilical cord blood samples were collected at the time of delivery to measure glucose and triglyceride levels. TyG index was calculated for both maternal and cord blood. Neonatal outcomes including Apgar scores, NICU admission, and composite neonatal morbidity were recorded. ROC analysis was performed to assess the predictive accuracy of TyG indices. Maternal and cord blood TyG indices were significantly higher in the preeclampsia group compared to the control group (p < 0.001). ROC analysis revealed that a cord blood TyG index > 7.59 predicted composite adverse neonatal outcomes with 92% sensitivity and 72% specificity (AUC: 0.853, 95% CI: 0.74–0.96, p < 0.001). NICU admission rates and low Apgar scores were more frequent in the preeclampsia group, indicating a significant association between elevated TyG indices and adverse neonatal outcomes. The TyG index, particularly when measured in umbilical cord blood, may serve as a useful predictor of adverse neonatal outcomes in pregnancies affected by preeclampsia. This easily accessible metabolic marker could support perinatal risk stratification and clinical decision-making.