Hicran Şi̇ri̇noğlu

Aim: Tubo-ovarian abscesses (TOA) are among the common emergency gynecological pathologies. Diagnosis remains controversial due to limitations in laboratory and imaging methods. In this study, we evaluated the demographic characteristics, laboratory parameters, and the correlation between the C-reactive protein (CRP) level at the time of diagnosis and the success of antibiotic therapy in patients treated in our hospital with a diagnosis of TOA. Methods: A total of 71 women followed up with a diagnosis of TOA in our hospital between May 2018-May 2021 were evaluated retrospectively. The physical examination findings, laboratory parameters, and imaging methods used during the patients' initial presentation and treatment were assessed. Results: The mean age of the 71 women was 36.2±8.0 years. Of the women, 97.3% were of reproductive age, 28.2% were using an intrauterine device (IUD), and 52.1% were smokers. The mean CRP level at presentation was 173.9 mg/L, and it was ≥100 mg/L in 73.2% of patients. On ultrasonography (USG), the abscess/mass was located on the left in 52.1%, on the right in 42.3%, and in the pouch of Douglas in 5.6%. While 50.7% of the cases recovered with antibiotics alone, 49.3% underwent surgery. Abscess diameter (63±23 vs 46±24 mm; p

Cervical fibroids are rare neoplasms of uterine origin whose management has not been standardized. Cervical fibroids, which can be challenging in surgical management, can become a difficult problem for the surgeon when neglected or asymptomatic and reach gigantic dimensions. Suspending the aorta abdominalis or arteria illiaca communis with vascular tapes and balloting the uterus with the help of vaginal taping while searching for the correct cleavage may reduce the risk of intraoperative hemorrhage and adjacent organ injury, as well as may be guide for the steps of the operation. Management of neglected giant cervical fibroids may not be suitable for testing alternative treatment methods to surgery used in the treatment of uterine neoplasms. However, surgical management will also be challenging. For this reason, the technique we describe can help the surgeon with clues that should be considered in the surgical management of these patients.

Aim: Determining the relationship between clinical and pathological features in endometrial cancer is essential for both prognostic and potential therapeutic benefits. In this study, we aimed to investigate the relationship between pelvic and paraaortic lymph node (PLN and PALN) metastasis and prognostic factors in patients with endometrial cancer (EC). Material and Method: Medical records of patients who underwent primary surgery for EC in our gynecological oncology center between the 2016 and 2018 were reviewed retrospectively. The relationship between pelvic and paraaortic lymph node metastasis was evaluated with data such as patient age, body mass index, serum CA 125 level, macroscopic tumor diameter, and patients’ risk groups. Results: Fifty-seven patients with EC were evaluated. Lymph node involvement was detected in 10 patients (17.5%). Acording to Modiffied Mayo criterias ; the patients with grade 3 EC had a higher risk of metastasis compared to other grades (p=0.025). Patients with lymph node metastases had a greater depth of invasion (p=0.001). There was no relationship between tumor size and lymph node metastasis (p=0.494). In the logistic regression analysis, the depth of invasion was found to be an independent risk factor for lymph node metastasis. There was no significant relationship between the presence of PLN and PALN metastases in patients with high-risk endometrial cancer, but the presence of PALN metastasis was significant in patients with low-risk endometrial cancer with PLN metastasis (p=0.002). Conclusion: These findings support the idea that routine evaluation of tumor invasion depth during endometrial cancer surgery may be useful in predicting lymph node metastasis and guiding the operation.

Objectives: Preeclampsia (PE), which affecting multi-organ systems, is one of the most common causes of feto-maternal morbidity and mortality. The fetal kidney is one of the vulnerable organs in PE caused by sustained vasospasm of the renal arteries. In this study, it was aimed to reveal the changes in the renal vascular bed with renal artery Doppler examinations in fetuses of pregnant women with PE. Methods: Fifty-five pregnant women with PE and 60 healthy pregnant women were included in this prospective study. Multiple pregnancies, those who did not want to participate in the study, and those with other co-morbidities were excluded from the study. Fetal renal artery Doppler studies included renal artery systolic/diastolic (S/D) ratio, pulsatility index (PI) and resistance index (RI) of the control and PE groups, and findings such as week of birth and birth weight were recorded and analyzed statistically. Results: Fetal renal artery PI values were found to be higher in pregnant women with PE compared to the control group (2.93 in the patient group, 2.28 in the control group, p < 0.001). There was no significant difference between RI values and S/D ratios between the two groups. In the preeclampsia group, gestational week and baby weight at birth were significantly lower. Conclusions: Due to preeclampsia, hypoxia occurs in peripheral tissues and organs at the maternal level. Fetal organs are also affected by these hypoxic conditions. Doppler is an extremely useful examination tool in the evaluation of the status of peripheral organs such as the kidney. This study suggests that PE increases the resistance of renal arteries in fetuses of mothers with PE compared to fetuses of mothers without PE, which may contribute critically to kidney disease later in life.

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P < 0.001, P < 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P < 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes. '+st+' Division of Radiology ,Istanbul Health and Technology University Department of Radiology and Medical İmaging Technics, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016 Feb 15;594(4):807-23. doi: 10.1113/JP271402. Epub 2016 Jan 5. PMID: 26607046. DOI: https://doi.org/10.1113/JP271402 ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):e97-e109. doi: 10.1097/AOG.0000000000003070. PMID: 30681542. DOI: https://doi.org/10.1097/AOG.0000000000003070 Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B. Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand. 2004 Sep;83(9):801-7. doi: 10.1111/j.0001-6349.2004.00602.x. PMID: 15315590. DOI: https://doi.org/10.1080/j.0001-6349.2004.00602.x Monteith C, Flood K, Mullers S, Unterscheider J, Breathnach F, Daly S, et al. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol. 2017 Mar;216(3):285.e1-285.e6. doi: 10.1016/j.ajog.2016.11.1008. Epub 2016 Nov 11. PMID: 27840142. Rial-Crestelo M, Martinez-Portilla R, Cancemi A, Caradeux J, Fernandez L, Peguero A, et al. Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a pre- dictor of SGA and FGR in non-selected pregnancies. J Matern Fetal Neonatal Med. 2019 Aug;32(15):2554-60. doi: 10.1080/14767058.2018.1441281. Epub 2018 Mar 4. PMID: 29447050. Ebbing C, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low porto-caval pressure gradient. Ultrasound Obstet Gynecol. 2008 Oct;32(5):663-72. doi: 10.1002/uog.6145. PMID: 18816500. DOI: https://doi.org/10.1002/uog.6145 Devore GR. 2015. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015 Jul;213(1):5-15. doi: 10.1016/j.ajog.2015.05.024. PMID: 26113227. DOI: https://doi.org/10.1016/j.ajog.2015.05.024 Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. 2019. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019 Apr;53(4):465-72. doi: 10.1002/uog.20157. Epub 2019 Feb 13. PMID: 30353583. DOI:...

Aim: The aim of this study was to determine whether early second trimester amniotic fluid prolactin level were associated with pregnancy outcome. Material and Method: This study included 125 women who underwent amniocentesis for variable indications. Healthy subjects with no history of drug use were included in this study. The gestational age was determined by ultrasonic examination before 10 weeks in all cases. Amniotic fluid specimens were taken while performing amniocentesis for other indications. Amniotic fluid was collected by transabdominal amniocentesis. Amniotic fluid prolactin concentrations were utilized to predict pregnancy complication among women who underwent amniocentesis due to the variable indications. Results: Among all study population, pregnancy was unremarkable in 102 (81.6%) cases, on the other hand, most common fetal abnormality was found to be the fetal hydrops fetalis and the second most commonly encountered fetal anomaly was trisomy, intrauterine growth restriction and intrauterine fetal demise. All study population was divided into two groups as complicated (n=23) and uncomplicated (n=102) pregnancies. Amniotic fluid prolactin concentration did not have any predictive value for complicated pregnancies (AUC=0.479). Conclusion: Our data showed; there is no relationship between early second trimester amniotic fluid prolactin level and pregnancy outcome.

Aim: The aim of our study is to examine early and late preterm placental calcification (PPC) and compare their relationship with maternal calcium, magnesium and 25(OH) D levels and adverse obstetric outcomes. Material and Method: This prospective cohort study was conducted by examining the pregnant women at their 24th to 36th gestational weeks who applied to the Gynecology Department of Okmeydani Training and Research Hospital. In this study, 207 patients were selected as the study group. Results: When the early and late PPC groups were compared, rates of low birth weight (LBW) was statistically higher in the early PPC group. (p=0.022) Oligohydramnios was more common in the early and late PPC patients compared to non-PPC pregnant women. However, oligohydramnios and LBW were not found statistically significant difference in logistic regression analysis. There was also no statistically significant difference in maternal calcium, magnesium and vitamin D levels between the groups. Conclusion: Preterm placental calcifications might be associated with fetal and maternal complications. But the diagnosis of PPC alone is not effective in determining fetal prognosis.