Karolin Ohanoglu Cetinel

Aims: This study aimed to evaluate prenatal care satisfaction among migrant pregnant women in Turkiye using a multidimensional questionnaire and to identify demographic and healthcare-related factors independently associated with satisfaction.Methods: This cross-sectional study included 525 migrant pregnant women receiving routine antenatal care at a tertiary referral hospital. Data were collected using a questionnaire comprising 12 demographic and obstetric questions and 40 satisfaction items covering communication and information, language and interpreter support, respect and cultural sensitivity, accessibility, emotional support and trust, and overall satisfaction and healthcare rights awareness. Internal consistency was assessed using Cronbach’s alpha, and the structural properties of the questionnaire were examined using factor-analytic methods. Group comparisons were performed using nonparametric tests. Independent factors associated with overall satisfaction were evaluated using multivariable linear regression with HC3 robust standard errors. Results: The mean maternal age was 27.54±5.20 years, and 71.2% of participants were Syrian. The questionnaire demonstrated excellent internal consistency (Cronbach's α=0.963). The prespecified six-component solution explained approximately 70.0% of the total variance, while parallel analysis suggested a four-factor empirical structure. The mean overall satisfaction score was 150.0±28.9 out of 200 (3.75±0.72/5). In multivariable analysis, Afghan and Azerbaijani nationality, parity of one or >3, General Health Insurance, Green Card coverage, and unknown insurance status were independently associated with lower satisfaction, whereas postgraduate education, moderate Turkish language proficiency, having an occupation other than housewife, and obtaining healthcare information from social media or interpreters were associated with higher satisfaction. Several household income categories were also associated with higher satisfaction compared with the lowest income category. Conclusion: Migrant pregnant women reported generally favorable overall satisfaction with prenatal care; however, language and interpreter support remained the lowest-rated aspect. These findings highlight the importance of considering language support, access to healthcare information, and culturally responsive care when evaluating prenatal care experiences among migrant women.

Background and Objectives: To evaluate the association between the newly defined cerebroplacental–renal ratio (CPRR) and adverse perinatal outcome (APO) in pregnancy-induced hypertension (PIH), and to compare its discriminative performance with the cerebroplacental ratio (CPR) and cerebroplacental–uterine ratio (CPUR). Materials and Methods: This prospective, single-center cohort study included 105 women with PIH (preeclampsia, n = 63; gestational hypertension, n = 42). Doppler assessment was performed at ≥34 + 0 weeks and within 7 days before delivery. CPR was calculated as middle cerebral artery pulsatility index (PI)/umbilical artery PI, CPUR as CPR/mean uterine artery PI, and CPRR as CPR/right renal artery PI. APO was defined by the presence of any of the following: non-reassuring fetal status, a 5 min Apgar score Results: APO occurred in 37 pregnancies (35.2%). CPUR and CPRR were significantly lower in the APO group, whereas CPR did not differ significantly. CPRR showed a higher apparent AUC for APO than CPR and CPUR (AUC 0.786, 95% CI 0.698–0.875), with significantly higher AUCs on pairwise DeLong comparisons. After adjustment, CPRR was the only Doppler index independently associated with APO (adjusted OR 1.423 per 0.1-unit decrease; 95% CI 1.162–1.743; p = 0.001). Conclusions: CPRR was independently associated with APO in PIH and showed higher discriminative performance than CPR and CPUR; however, these findings require validation in independent, multicenter studies before clinical application.

Background and Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder characterized by distinct phenotypic presentations. This study aimed to compare androgenic and metabolic characteristics across Rotterdam-defined PCOS phenotypes, with particular emphasis on insulin resistance. Materials and Methods: This prospective observational study included 261 nulliparous women with PCOS who were prospectively enrolled and classified according to the Rotterdam criteria as phenotype A (n = 101), B (n = 39), C (n = 55), or D (n = 66). Clinical hyperandrogenism, biochemical androgen parameters, hormonal parameters, lipid profiles, and insulin resistance assessed using the homeostasis model assessment of insulin resistance (HOMA-IR) were compared across phenotypes. Insulin resistance was defined as HOMA-IR ≥ 2.5. Multivariable logistic regression was performed to evaluate the association between PCOS phenotype and insulin resistance after adjustment for age and body mass index (BMI). Results: Significant differences were observed among phenotypes in sex hormone-binding globulin (SHBG), free androgen index (FAI), and Ferriman–Gallwey scores (p = 0.005, p < 0.001, and p < 0.001, respectively). Median HOMA-IR differed significantly among phenotypes (p < 0.001) and was lowest in phenotype D. The prevalence of insulin resistance was 58.3%, 56.4%, 49.1%, and 22.6% in phenotypes A, B, C, and D, respectively (p < 0.001). After adjustment for age and BMI, phenotypes A (adjusted odds ratio [aOR] 4.56, 95% CI 2.20–9.42), B (aOR 4.54, 95% CI 1.90–10.87), and C (aOR 3.29, 95% CI 1.47–7.38) were associated with higher odds of insulin resistance compared with phenotype D. HDL-C also differed among phenotypes (p = 0.006), whereas other conventional lipid parameters, the TG/HDL ratio, and AIP were comparable. Conclusions: Rotterdam-defined PCOS phenotypes exhibit distinct androgenic and metabolic profiles. Hyperandrogenic phenotypes, particularly A and B, were associated with greater insulin resistance, whereas phenotype D showed a more favorable metabolic profile. These findings reflect cross-sectional metabolic differences between PCOS phenotypes and should not be interpreted as evidence of future cardiometabolic risk.

Respiratory Rate at Admission as an Independent Predictor of Intensive Care Requirement in Pregnant Women with COVID-19: A Retrospective Cohort Study - Bagcilar Medical Bulletin

Background: Gestational duration is influenced by multiple factors, with placental function being one of the key determinants. First-trimester serum biomarkers reflect the quality of placentation and may be associated with the duration of pregnancy. Aims: To investigate the association between first-trimester serum placental biomarkers and gestational duration, and to evaluate the independent effects of nulliparity and fetal sex on gestational length. Methods: This retrospective, single-center study included 346 singleton pregnancies delivered between 34 + 0 and 41 + 0 weeks of gestation following spontaneous labor. First-trimester PAPP-A and free β-hCG multiples of the median (MoM) values were measured. Gestational length was calculated as the interval between the estimated last menstrual period and the date of delivery. Spearman correlation analysis and multiple linear regression were used to assess associations with gestational duration. Results: The mean gestational duration was 271 ± 10.5 days. Pregnancy duration was significantly longer in the PAPP-A MoM ≥ 0.6 group compared to the < 0.6 group (273 vs. 269 days, p = 0.001). In multiple linear regression analysis, PAPP-A MoM (B = 2.08, p = 0.034), nulliparity (B = 2.96, p = 0.013), and fetal sex (B = 2.63, p = 0.022) were identified as independent predictors of gestational duration. No significant association was observed between free β-hCG MoM and gestational duration. Conclusions: Higher first-trimester PAPP-A MoM levels are independently associated with longer gestational duration, even after adjustment for parity and fetal sex, suggesting that early placental function may play a role in regulating the timing of parturition with modest effect.

Purpose: Surgical-site infections (SSI) remain a major complication of cesarean delivery, increasing maternal morbidity, hospital stay, and healthcare costs. Although several risk factors have been identified, the role of maternal nutritional status—particularly the Prognostic Nutritional Index (PNI)—has not been well established in obstetric surgery. Methods: This retrospective case–control study included 190 women who underwent cesarean delivery at a tertiary referral center between 2020 and 2025. Preoperative PNI was calculated using serum albumin and lymphocyte counts obtained within 24 h before surgery. SSI was defined according to the Centers for Disease Control and Prevention criteria. Demographic, perioperative, and postoperative variables were analyzed to evaluate associations between PNI, SSI status, infection severity, and inflammatory markers. Results: A total of 190 women were analyzed, including 98 cases with surgical-site infection (SSI) and 92 controls without SSI. Although preoperative PNI was not an independent predictor of SSI, lower PNI values were associated with more severe infections requiring broad-spectrum antibiotics, longer hospitalization, and higher postoperative C-reactive protein (CRP) levels. A significant inverse correlation was observed between PNI and CRP among patients with SSI ( r = − 0.338, p = 0.001). Longer operative duration and smoking were also associated with an increased risk of SSI. Conclusion: Although PNI was not an independent predictor of SSI, lower values were strongly associated with infection severity and systemic inflammation. Integrating PNI into preoperative risk assessment—alongside body mass index and operative time—may help identify high-risk women. Larger prospective studies are warranted to confirm these findings and to evaluate the impact of nutritional optimization on postoperative outcomes.

Background: Maternal thyroid hormones are essential for fetal development and the maintenance of pregnancy. While thyroid dysfunction earlier in gestation has been extensively studied, the clinical relevance of thyroid function assessed at labor admission remains unclear. This study investigated the association between maternal thyroid function parameters measured at labor ward admission and obstetric and neonatal outcomes in term pregnancies. Methods: In this retrospective observational study, 664 women with singleton term pregnancies (≥37 weeks) admitted to the labor ward of a tertiary referral center were included. Maternal thyroid-stimulating hormone (TSH), free thyroxine (FT4), and admission complete blood count parameters (hemoglobin, hematocrit, white blood cell count, and platelet count) were recorded. Obstetric and neonatal outcomes were compared across FT4 tertiles using univariable and multivariable regression analyses adjusted for key obstetric confounders. Results: Gestational age at delivery differed significantly across FT4 tertiles, with higher FT4 levels associated with a greater proportion of late-term deliveries. Lower FT4 levels were independently associated with lower neonatal birth weight categories after adjustment for gestational age and parity. Admission complete blood count parameters did not differ significantly across FT4 tertiles or gestational age categories. Maternal TSH levels were not independently associated with obstetric or neonatal outcomes, and no significant associations were observed with Apgar scores or NICU admission. Conclusions: In term pregnancies, maternal FT4 levels measured at labor admission are associated with delivery timing and neonatal birth weight but do not independently predict intrapartum fetal distress or adverse immediate neonatal outcomes.

Background: Maternal thyroid hormones play an essential role in fetal growth and pregnancy maintenance. While thyroid dysfunction earlier in pregnancy has been widely studied, the clinical relevance of thyroid function assessed at the time of labor admission remains unclear. This study aimed to evaluate the association between maternal thyroid function parameters measured at labor ward admission and obstetric and neonatal outcomes in term pregnancies. Methods: This retrospective observational study included 664 women with singleton term pregnancies (≥37 weeks) admitted to the labor ward of a tertiary referral center between May 2020 and May 2025. Maternal thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were measured at admission. Obstetric outcomes included gestational age at delivery and mode of delivery, while neonatal outcomes comprised birth weight, Apgar scores, and neonatal intensive care unit (NICU) admission. Univariable analyses and multivariable logistic and ordinal regression models adjusted for key obstetric confounders were performed. Results: Gestational age at delivery differed significantly across FT4 tertiles, with higher FT4 levels associated with a greater proportion of late-term deliveries (p = 0.018). Lower FT4 levels were independently associated with lower neonatal birth weight categories after adjustment for gestational age and parity (adjusted OR per 1 SD decrease: 1.19; 95% CI: 1.02–1.38; p = 0.025). Although an inverse association between FT4 tertiles and cesarean delivery due to fetal distress was observed in unadjusted analyses, this association was not retained after multivariable adjustment. Maternal TSH levels were not independently associated with obstetric or neonatal outcomes. No significant associations were observed with Apgar scores or NICU admission. Conclusions: In term pregnancies, maternal FT4 levels measured at labor admission are associated with delivery timing and neonatal birth weight but do not independently predict cesarean delivery due to fetal distress or adverse immediate neonatal outcomes.

Background: In the literature, there is no study investigating the relationship between thyroid hormones in pregnancies at 41 weeks and above and the birth timing, labor duration, frequency of fetal distress, premature rupture of membranes (PROM), and maternal hemogram values. Methods: A total of 68 nulliparous pregnant women who were admitted to Basaksehir Cam and Sakura City Hospital with indications of delivery between August 2023 and January 2024, between the ages of 20 and 38 and with no comorbidities, were included in the study. Pregnant women with ≥41 weeks of gestation were classified as the late-term pregnancy group (n = 37), and those between 37 and 38 weeks were classified as the control group (n = 31). The thyrotropin (TSH), free thyroxine (FT4), and hemoglobin levels and relevant parameters were evaluated. Results: The FT4 values of pregnant women diagnosed with fetal distress in the entire population were observed to be statistically significantly lower (p < 0.05). A statistically significant negative linear relationship was detected between the FT4 values of the entire population and the weights of newborns (p < 0.05). It was determined that, as the FT4 values decreased, the newborn weights increased. There was no statistically significant difference between the two groups in terms of the TSH/FT4 values, birth types, labor duration, or postpartum Hb/Htc decrease (p > 0.05). No statistically significant relationship was found between the TSH/FT4 values of the entire population and the diagnosis of PROM, labor duration, or Hb/Htc decrease amount (p > 0.05). Conclusions: TSH/FT4 levels may be important in the mature and late–mature periods of pregnancy. There may be an association between the FT4 levels and the fetal distress risk, type of birth, and newborn weight.

Aims: Studies showing that synthetic oxytocin (SO) used for induction during labor increases the risk of postpartum maternal depression are increasing day by day in literature. Objective was to investigate the effect of SO administered for induction during labor on the tendency to maternal depression in early postpartum period. Methods: The study encompassed nulliparous women, all of whom delivered at gestational weeks 37 to 41 between 2020 and 2022 and underwent standard postpartum assessments on the 10th day following delivery. Exclusion criteria comprised pregnant individuals with predisposing factors for depression before conception, during gestation, or in the postpartum period. Pregnants who were admitted to delivery room due to labor and gave birth without any induction method were classified as group C (n=137), and who were induced with SO were classified as group O (n=122). Edinburgh Postnatal Depression Scale (EPDS) scores on 0th day and 10th day postpartum of two groups were compared. Additionally, relationship between duration of induction and EPDS scores was analyzed. Results: No statistically significant difference was detected between two groups in terms of age, gestational week, or educational status (p>0.05). No statistically significant difference was detected between the groups in EPDS scores on 0th or 10th day postpartum (p>0.05). There was no significant difference between induction time and EPDS scores on 0th or 10th day postpartum (p>0.05). Conclusion: SO used for labor induction may not primary affect the tendency to postpartum depression in the early period. Further studies in populations without risk factors for depression are needed.