Ramazan Denizli

Objectives: To compare the effects of leukocyte- and platelet-rich plasma (L-PRP) and pure platelet-rich plasma (P-PRP), both among themselves and with the control group, in preventing intra-abdominal adhesions in an experimental rat model study. Materials and Methods: 34 Sprague-Dawley rats were randomized and divided into the control group (n=8), L-PRP (n=8), and P-PRP (n=8) treatment groups. The fourth group was used only for PRP preparation (5 rats for L-PRP and 5 rats for P-PRP) and was not included in the outcome analysis. All of the rats were operated on by the same two surgeons under general anesthesia for the uterine horn adhesion modeling. Apart from the control group, 1 mL of L-PRP and P-PRP solutions prepared for the other two treatment groups were applied to the lesion. Postoperative adhesion evaluation was performed on the 14th postoperative day. Adhesions were evaluated both macroscopically (presence, severity, and degree of adhesion) and histopathologically (levels of inflammation and fibrosis), and the evaluation was blinded by two similar surgeons. Results: One rat was lost during the study in each treatment group. There was a statistically significant difference in terms of the extent of adhesions among the groups (P = 0.025), the tenacity of the adhesions (P = 0.045), and total adhesion scores (7.13±2.7, 3.86±1.5, and 6.71±2.1; control, L-PRP, and P-PRP, respectively, P = 0.028). This difference was due to Group 2 during binary comparisons. However, the statistical difference between the groups after Bonferroni correction disappeared, apart from the tenacity of adhesions category. In the tenacity of adhesion category, the difference was only between the control group and L-PRP (12.5% in the gentle traction separation control group vs. 85.7% in L-PRP; P = 0.005). On histopathological examination, there was no difference between the groups in inflammation or fibrosis. Conclusions: In the experimental rat uterine horn adhesion modeling, neither L-PRP nor P-PRP was effective in preventing postoperative adhesion formation. However, the adhesion formed in the L-PRP group was more readily separated by gentle traction than in both the control and P-PRP groups.

Aim: To predict fetal growth restriction (FGR) and its effect on prognosis according to changes in systemic inflammation indexes, such as the neutrophil-to-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), and the systemic inflammation response index (SIRI). Materials and Methods: The study group consisted of 200 women with singleton pregnancies diagnosed with FGR, and the control group comprised 280 obstetrically and demographically matched healthy pregnant women. The NLR, SII, and SIRI were compared between the groups according to the first-trimester complete blood count results. Results: When the groups were compared in terms of systemic inflammation indexes, the NLR, SII, and SIRI were found to be statistically lower in the FGR group (p

Retrospective analysis of the indications, methods, and complications of pregnancy termination - Turkish Journal of Obstetrics and Gynecology

Aim: To investigate the role of the fetal modified myocardial performance index (Mod-MPI) and fetal cardiac output index measurement in predicting adverse perinatal outcomes among preterm dichorionic twins. Materials and Method: This prospective cohort study was conducted at the X Clinic and included 34 dichorionic twin fetuses born early preterm and 40 dichorionic twin fetuses born late preterm. The early preterm group was divided into two according to whether they were admitted to the neonatal intensive care unit (NICU). The groups' cardiac function and Mod-MPI measurements were compared regarding their predictive ability for adverse perinatal outcomes. Results: The Mod-MPI values were similar between the early and late preterm groups (p=0.144). The left ventricular cardiac output Z-score was lower in the preterm group (p=0.014). The Mod-MPI and left ventricular outflow tract-isovolumetric contraction and isovolumetric relaxation times were significantly higher among the newborns admitted to the NICU in the early preterm group (p=0.002, p=0.003, and p=0.001, respectively). Conclusion: Our study suggests that the Mod-MPI measurement can be used to predict adverse perinatal outcomes in dichorionic twin fetuses born in the early preterm period.

Objective: To compare the levels of oxidative stress markers in the umbilical cord blood between pregnant women diagnosed with iron deficiency anemia (IDA) and low‐risk controls.Methods: The sample consisted of 131 patients, including 55 pregnant women with IDA and 76 controls with similar demographic characteristics. Participants were selected from patients delivered at ≥37 weeks. We compared the two groups in terms of the native thiol, total thiol, disulfide, and ischemia‐modified albumin (IMA) levels measured in pregnant women's umbilical cord venous blood.Results: The native thiol and total thiol values were statistically significantly lower in the anemia group, and the disulfide and IMA values were statistically significantly higher in the IDA group (P < 0.001). Perinatal outcomes were similar between the groups.Conclusion: In the present study, pregnant women with IDA had lower native and total thiol values and higher disulfide and IMA values in umbilical cord blood. Iron deficiency anemia in pregnancy may be a potential cause of increased oxidative stress.

Aim: To investigate midkine levels in women diagnosed with intrahepatic cholestasis of pregnancy (ICP). Materials and Method: This study was conducted with 112 pregnant women, 40 of whom had ICP (study group) and 72 were in the control group. The two groups were compared regarding demographic characteristics, obstetric data, laboratory parameters, and serum midkine levels. In addition, a correlation analysis was undertaken between the midkine level and aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum bile acid (SBA) values in the study group. Results: The midkine value was determined to be 0.495 ng/ml in the study group and 0.275 ng/ml in the control group. It was statistically significantly higher in the patients with cholestasis (p

Aim: We aim to compare the maternal serum thiol and ischemia-modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP). Methods: Fifty-five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated. Results: The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05). Conclusions: Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases.

Aim: To evaluate the effect of monocyte count and monocyte-based whole blood cell indices in the prediction of intrahepatic cholestasis of pregnancy (ICP) in the first trimester. Materials and Method: The clinical data of patients who presented to the Perinatology Clinic of the Turkish Ministry of Health ----xxxxxxx--- ICP between January 1, 2021, and October 1, 2022, were evaluated retrospectively. Maternal demographic parameters, gestational age at birth, fetal birth weight, first-trimester white blood cell, neutrophil, platelet, monocyte, lymphocyte, and basophil counts, lymphocyte-to-monocyte ratio (LMR), platelet-to-monocyte ratio (PMR), neutrophil-to-monocyte ratio (NMR), and basophil-to-monocyte ratio (BMR) were recorded. These parameters were compared between the ICP and control groups. The relationship between monocyte count, monocyte-based blood cell indices, and fasting bile acid levels was evaluated in the ICP group. The cut-off values of the first-trimester monocyte count and monocyte-based blood cell indices for the prediction of ICP were determined. Results: Gestational week at birth and fetal birth weight were significantly lower, and the neonatal intensive care requirement was significantly higher in the ICP group (p<0.05) compared to the control group. The ICP group had a significantly higher monocyte count (p=0.002), a significantly lower platelet count (p=0.002), and significantly lower values for monocyte-based complete blood cell indices (NMR, LMR, and PMR) compared to the control group (p=0.005, p=0.001, and p<0.001, respectively). Conclusion: A high monocyte count and low monocyte-based inflammatory indices measured in the first trimester of pregnancy seem to be associated with ICP. These novel indices can be used in the prediction of ICP and its adverse perinatal outcomes. Özet Amaç: İlk trimesterde gebeliğin intrahepatik kolestazının (GİK) öngörüsünde monosit sayısı ve monosit bazlı kan hücre indekslerinin etkisini değerlendirmek. Gereçler ve Yöntem: Bu çalışmaya 01/01/2021 ile 01/10/2022 tarihleri arasında Sağlık Bakanlığı –xxxxxxxx- Hastanesi Perinatoloji kliniğinde değerlendirilen GİK tanılı hasta grubu (n=65) ve kontrol grubu (n=107) dahil edildi. Her iki grubun laboratuvar testleri retrospektif olarak incelendi. Grupların maternal demografik özellikleri, ilk trimester monosit sayıları ile lenfosit-monosit oranı (LMO), platelet-monosit oranı (PMO), bazofil-monosit oranı (BMO), nötrofil-monosit oranı (NMO) indeksleri karşılaştırıldı. GİK grubunda monosit sayıları ve monosit bazlı kan hücre indeksleri ile açlık safra asidi düzeyleri arasındaki ilişki değerlendirildi. GİK'i öngörmede ilk trimester monosit sayısı ve monosit bazlı kan hücre indeksleri için eşik değeri belirlendi. Bulgular: GİK grubunda doğum haftası, doğum ağırlığı daha düşük ve yenidoğan yoğun bakım ihtiyacı daha yüksek ve istatistiksel olarak anlamlıydı (p < 0.05). GİK grubunda monosit sayısı daha yüksek (p=0.002), trombosit sayısı daha düşük (p=0.002) ve monosit bazlı tam kan hücre indeksleri sırasıyla NMO, LMO, PMO daha düşük ve istatistiksel olarak anlamlıydı (sırasıyla p=0.005, p=0.001, p<0.001). Sonuç: Sonuç olarak, gebeliğin ilk trimesterinde daha yüksek monosit sayıları ve düşük monosit bazlı tam kan hücre indeks değerleri GİK ile ilişkili görünmektedir. Bu yeni indeksler, GİK'in ve bunun olumsuz perinatal sonuçlarının tahmininde kullanılabilir.

Aims: To evaluate the placental pathologies of pregnant women diagnosed with COVID-19 according to disease severity. Materials and method: This retrospective study was conducted at a tertiary center between April 2020 and February 2023. The placentas of 125 pregnant women in their third trimester who were positive for SARS-CoV-2 were examined. Placental pathologies were classified according to the modified Amsterdam criteria. According to the disease severity, the patients were divided into two groups: non-severe COVID-19 (n=104) and severe COVID-19 (n=21). Placental pathology results were compared between the two groups. Results: The rates of maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM) were 90.4% and 45.2% in the non-severe COVID-19 group. Whereas it was significantly lower at 71.4% and 19% in the severe COVID-19 group (p=0.018 and p=0.026, respectively). The rate of delayed villous maturation (DVM) was 9.5% in the severe COVID-19 group and 1% in the non-severe COVID-19 group, indicating a statistically significant difference (p=0.019). Inflammatory pathologies and other pathological findings were similar between the two groups. Intensive care unit (ICU) admission, presence of accompanying maternal diseases, and postpartum complications were statistically significantly higher in the severe COVID-19 group (p<0.05). Conclusion: Whereas MVM and FVM lesions were observed at a higher rate in patients with non-severe COVID-19, DVM lesions and normal placentas were more common in those with severe COVID-19. The presence of different placental pathologies in SARS-CoV-2 patients according to the severity of the disease may be associated with the acute or chronic course of the disease. Amaç: COVID-19 tanılı gebelerde hastalığın şiddetine göre plasental patolojileri değerlendirmeyi amaçladık. Gereçler ve yöntem: Bu retrospektif çalışma Nisan 2020 ile Şubat 2023 tarihleri arasında üçüncü basamak bir merkezde gerçekleştirildi. SARS-CoV-2 pozitif olan 3. trimesterdaki 125 gebenin plasentası incelendi. Plasental patolojiler modifiye edilmiş Amsterdam kriterlerine göre sınıflandırıldı. 104 hasta şiddetli olmayan COVID-19 hastalarından, 21 hasta ise şiddetli COVID-19 hastalarından oluşturularak 2 gruba ayrıldı. Hastalığın şiddetine göre plasental patoloji sonuçları karşılaştırıldı. Bulgular: MVM (maternal vasküler malpergüzyon) ve FVM (fetal vasküler malperfüzyon) patolojileri şiddetli olmayan grupta 90.4% ve 45.2% olarak izlendi. Şiddetli COVID-19 grubunda ise 71.4% ve 19% ile anlamlı olarak daha düşük izlendi (sırasıyla p=0.018 ve p=0.026). Şiddetli grupta gecikmiş villöz olgunlaşma (GVO) oranı 9.5% olarak izlenirken, şiddetli olmayan grupta 1% olarak izlendi ve bu istatistiksel olarak anlamlıydı (p=0.019). İnflamatuar patolojiler ve diğer patolojik bulgular her iki grupta benzer izlendi. Yoğun bakım ünitesine kabul (YBÜ), eşlik eden maternal hastalık, doğum sonrası komplikasyon şiddetli grupta istatistiksel anlamlı olarak daha yüksek izlendi (p<0.05). Sonuç: MVM ve FVM lezyonları şiddetli olmayan SARS-CoV-2 hastalarında daha yüksek oranda izlenirken GVO lezyonları ve normal plasentalar şiddetli grupta daha fazla izlendi. SARS-CoV-2 hastalarında hastalığın şiddetine göre farklı plasenta patolojilerinin bulunması, hastalığın akut veya kronik seyri ile ilişkilendirilebilir.

Amaç: Femoral arter ve diğer ultrasonografik Doppler ölçümlerini geç başlangıçlı fetal büyüme geriliği olan fetüsler ile komplike olmayan fetüsler arasında karşılaştırmak. Gereç ve yöntem: Bu prospektif kohort çalışması geç başlangıçlı fetal gelişme geriliği saptanan 83 çalışma grubu gebe ile benzer gebelik haftasına sahip 85 komplike olmayan kontrol grubu gebe dahil olmak üzere 168 hasta ile gerçekleştirilmiştir. Aynı zamanda yenidoğan yoğun bakım ünitesi gereksinimine göre çalışma grubu ikiye ayrıldı. Gruplar arasında demografik özellikler, obstetrik özellikler, femoral arter ve diğer ultrasonografik doppler ölçümleri ve gebelik sonuçları karşılaştırıldı. Bulgular: Uterin arter pulsatilite indeksi, umbilikal arter sistolik/diyastolik oranı ve orta serebral arterin pik sistolik hızı çalışma ve kontrol grupları arasında benzerdi. Ancak çalışma grubunda orta serebral arter pulsatilite indeksi anlamlı olarak düşük bulunurken, femoral arter pulsatilite indeksi anlamlı olarak yüksekti (sırasıyla, p<0.001 ve p=0.002). Çalışma grubunda yenidoğan yoğun bakım ünitesi gereksinimine göre iki grup karşılaştırıldığında femoral arter ve diğer doppler ölçümleri benzer izlendi. Tahmini fetal ağırlık, yenidoğan yoğun bakım ünitesi gerektiren grupta istatistiksel olarak daha düşüktü (p=0,033). Sonuç: Geç başlangıçlı fetal büyüme geriliği olgularında femoral arter pulsatilite indeksi sağlıklı kontrollere göre daha yüksekti. Femoral arterin Doppler incelemesinin olumsuz perinatal sonuçları göstermede etkili olmadığı bulundu. Objective: To compare the femoral artery and other ultrasonographic Doppler measurements between fetuses with late-onset fetal growth restriction and uncomplicated fetuses. Material and method: This prospective cohort study was conducted with 168 patients, including 83 pregnancies presenting with late-onset fetal growth restriction and 85 uncomplicated control pregnancies at similar gestational weeks. The study group was further divided into two according to the neonatal intensive care unit requirements. Demographic characteristics, obstetric characteristics, femoral artery and other ultrasonographic Doppler measurements, and pregnancy outcomes were compared between the groups. Results: Uterine artery pulsatility index, umbilical artery systolic/diastolic ratio, and peak systolic velocity of the middle cerebral artery were similar between the study and control groups. However, while the middle cerebral artery pulsatility index was significantly lower in the study group, the femoral artery pulsatility index value was significantly higher (p<0.001 and p=0.002, respectively). When the two subgroups of the study group were compared according to the neonatal intensive care unit requirements, their femoral artery and other Doppler measurements were similar. Estimated fetal weight was statistically lower in the group requiring neonatal intensive care unit (p=0.033). Conclusion: The femoral artery pulsatility index measurement was higher in the late-onset fetal growth restriction cases than in the healthy controls. The Doppler examination of the femoral artery was not found to be effective in demonstrating adverse perinatal outcomes.