Şükran Doğru

Background:The safety and efficacy of the dinoprostone vaginal insert for labor induction in women with prelabor rupture of membranes (PROM) remains uncertain. This study compared clinical outcomes between women with PROM and those with intact membranes.Methods:In this single-centre retrospective study, singleton pregnancies at ≥37 weeks of gestation induced with a dinoprostone vaginal insert between January 2020 and June 2025 were categorized as PROM (n = 42) or controls (n = 84). Demographic characteristics, cervical status, labor characteristics, delivery mode, maternal complications, as well as neonatal outcomes were analyzed using the t-test or Mann-Whitney U test for continuous variables and the chi-square or Fisher’s exact test for categorical variables, with a significance level of α = 0.05. The study was approved by the institutional ethics committee (Approval No.: 2026/6295; Application ID: 29133).Results:Gestational age at delivery was significantly lower in the PROM group than in the control group (37.70 ± 1.17 vs. 39.54 ± 1.39 weeks; p < 0.001). Although pre-induction cervical dilatation was greater in the PROM group, post-induction cervical dilatation and cervical effacement were significantly lower than those in the control group (both p < 0.001). The overall cesarean delivery rate was higher in the PROM group, primarily driven by an increased incidence of cesarean delivery due to fetal distress (35.7% vs. 16.7%; p = 0.008). Tachysystole was rare in both groups (0% vs. 1.2%; p = 0.478). No cases of postpartum hemorrhage or third-degree perineal lacerations occurred, and hemoglobin concentration and blood transfusion rates were comparable between groups. Neonates in the PROM group had significantly lower birth weights (2770.60 ± 447.30 g vs. 3321.20 ± 344.50 g; p < 0.001) and lower 5-minute Apgar scores (8.33 ± 1.00 vs. 9.25 ± 0.65; p < 0.001).Conclusions:Pregnancies complicated by PROM were associated with a reduced cervical response to dinoprostone, higher cesarean delivery rates, primarily due to fetal distress, and less favorable neonatal outcomes, whereas maternal safety outcomes appeared acceptable. Careful patient selection and close intrapartum monitoring are recommended when using dinoprostone for labor induction in women with PROM.

Pre-eclampsia is a pregnancy-specific hypertensive disorder characterized by new-onset hypertension accompanied by maternal organ dysfunction after 20 weeks of gestation. Despite substantial advanc...

Objective: This study aimed to investigate the effects of delivery mode and anesthesia type on fetal cord blood levels of nerve growth factor (NGF) and brain‐derived neurotrophic factor (BDNF), which are neurotrophins involved in neuronal survival, differentiation, and stress adaptation during the perinatal period. Materials Methods: In this cross‐sectional, prospective study conducted from December 2023 to May 2024 at a single tertiary center, pregnant women were categorized based on delivery mode—vaginal delivery (VD) or cesarean section (CS). The CS group was subdivided according to anesthesia type: spinal or general. Cord blood NGF, BDNF, pH levels, and neonatal clinical outcomes were evaluated. Pregnant women with comorbidities and those receiving prenatal medical induction were excluded. Results: The study included 150 pregnant women. Fifty of these patients had VD and 100 had CS. Sixty of the pregnant women who had a CS received spinal anesthesia, and 40 received general anesthesia. Cord blood NGF (54.20 ± 32.04 vs. 47.01 ± 27.28, p = 0.176) and BDNF (80.98 ± 41.94 vs. 70.08 ± 37.53, p = 0.123) values were not different in those who delivered with CS and VD. Cord blood NGF and BDNF values were higher in the spinal anesthesia group ( p = 0.002, p = 0.003). The cord blood pH value was higher in the spinal anesthesia group than in the VD and general anesthesia groups ( p = 0.004). Conclusion: Cord blood NGF and BDNF values were higher in the spinal anesthesia group. These findings support the hypothesis that regional anesthesia may be associated with reduced fetal stress and improved biochemical adaptation at birth.

This study aims to evaluate the clinical outcomes of prenatally diagnosed fetal ovarian cysts, identify predictive factors for surgical intervention, and provide evidence to guide postnatal management strategies. This retrospective study included 15 cases of fetal ovarian cysts diagnosed between January 2022 and February 2025 at a tertiary referral center. Sonographic features, cyst size, laterality, and complexity were recorded. Cysts were classified as simple or complex based on ultrasonographic characteristics. Postnatal follow-up data and surgical interventions were analyzed. Of the 15 cases, 53.3% required surgical intervention, while 46.7% resolved spontaneously. The mean gestational age at diagnosis was 34 weeks, and the mean cyst size was 44 mm. Simple cysts accounted for 80% of cases. Cyst size≥40 mm was significantly associated with increased likelihood of surgery (p=0.025). ROC analysis identified 39 mm as the optimal cut-off for predicting surgical need (AUC: 0.875, sensitivity: 87.5%, specificity: 71.4%, p=0.015). Torsion occurred in 13.3% of cases. A larger prenatal cyst diameter was associated with an increased likelihood of postnatal surgical intervention. The ROC-derived threshold of approximately 39 mm corresponds closely to our institutional management criteria and may serve as a practical reference point rather than a definitive universal cut-off.

Aim: This study aimed to evaluate the impact of nonstress test (NST) findings on perinatal outcomes in pregnancies complicated by premature rupture of membranes (PROM) managed expectantly.Materials and Methods: This retrospective study included pregnant women with preterm premature rupture of membranes (PPROM) between 26 and 34 weeks of gestation who were admitted to Konya City Hospital from January 2018 to January 2024.Patient data, including gestational age, maternal age, gravidity, parity, and comorbidities, were analyzed. NST results were classified into three categories based on the NICHD 2008 guidelines. A total of 96 patients were included in the study. Among them, 68 were classified as NST Category 1, 4 as NST Category 2, and 24 as NST Category 3. Since only four cases were identified in Category 2, this group was excluded from the analyses due to the inability to achieve statistical significance. Therefore, comparisons were conducted solely between Category 1 (n=68) and Category 3 (n=24) groups. Cases with abnormal Doppler findings, fetal anomalies, or intrauterine growth restriction were excluded. Perinatal outcomes were evaluated by recording birth weights, blood gas parameters, Apgar scores, NICU admission rates, NICU stay duration, and neonatal mortality rates.Results: In our study, the parameters that demonstrated statistically significant differences in blood gas analysis were pH and base excess. The pH was 7.36 in Category 1 and 7.30 in Category 3 (p =0.003), while base excess was found to be significantly lower in Category 3 compared to Category 1 (-3.90 vs. -2.27; p = 0.028). The mean 1-minute Apgar scores were 7.64 for Category 1 and 7.33 for Category 3 (p = 0.253), while the mean 5-minute scores were 8.72 and 8.45, respectively (p = 0.306). There were 3 neonatal deaths (4.4%) in Category 1 and 1 death (4.2%) in Category 3; no significant difference was observed. NICU admission rates were 58.8% for Category 1 and 66.7% for Category 3.Conclusion: Although NST is a useful method for assessing fetal well-being, its ability to predict perinatal outcomes in PPROM cases is limited. Since basing delivery decisions solely on NST findings may lead to unnecessary preterm births, clinical evaluation should be comprehensive and multidisciplinary. In pregnancies complicated by PPROM, an individualized management strategy should be adopted, and further studies are warranted to validate these findings.

Twin Reversed Arterial Perfusion (TRAP) sequence is a rare complication of monochorionic twin pregnancies characterized by reversed blood flow from the pump twin to a nonviable acardiac twin. This study aims to share the clinical outcomes and procedural details of TRAP sequence cases managed at our tertiary fetal therapy center, with emphasis on various intrauterine treatment modalities. We conducted a retrospective review of 20 pregnancies diagnosed with TRAP sequence and managed at a tertiary fetal therapy unit between January 2018 and July 2025. Diagnosis was confirmed via prenatal ultrasonography and Doppler imaging. Patients underwent intrauterine intervention—radiofrequency ablation (RFA), microwave ablation (MWA), intrafetal laser (IFL), or bipolar cord coagulation—based on gestational age, acardiac twin size, and hemodynamic status of the pump twin. Twenty pregnancies diagnosed with TRAP sequence were included. The median maternal age was 32 years (range: 22–47). Both diagnosis and intervention occurred at a median gestational age of 20 weeks (range: 12–29). Invasive treatment was performed in 19 cases: RFA ( n = 10), IFL ( n = 4), cord coagulation ( n = 3), and MWA ( n = 2). The median time from procedure to delivery was 98 days (range: 1–135). Overall live birth rate was 80% (16/20), and neonatal survival rate was 75% (15/20). Fetal interventions can significantly enhance survival in TRAP pregnancies, including those referred at advanced gestational ages. Early identification of risk indicators and tailored procedural planning are critical for improving outcomes. Our findings underscore the efficacy of minimally invasive therapies in optimizing prognosis for the pump twin.

Objective: This study aimed to evaluate the impact of different treatment modalities—expectant management, methotrexate (MTX), and laparoscopic salpingectomy—on the future fertility of women treated for tubal ectopic pregnancies (EP). The primary outcome was to evaluate the mean time to conception, and the secondary outcome was to evaluate live birth rates and the risk of recurrent ectopic pregnancy (REP) between treatment groups. Methods: A retrospective analysis was conducted involving 121 women treated for tubal EP from January 2020 to November 2024. The study analyzed fertility outcomes based on the treatment modality received, which included expectant management, MTX, and laparoscopic salpingectomy. Data were collected through hospital records. Results: The time to clinical pregnancy was 255 (60–390) days in the expectant group, 270 (60-1080) days in the MTX group, and 255 (90-1440) days in the laparoscopic salpingectomy group. Median time to achieve pregnancy was 270 (95% CI: 222–318) days for all the treatment groups. No significant differences were found in the time to pregnancy across the treatment groups ( p = 0.274). Out of 121 patients, 58 (47.9%) achieved pregnancy, of which 33 (27.2%) resulted in live births. Live birth rates were 75%, 58.3%, and 50% in the expectant management, MTX, and laparoscopic salpingectomy groups, respectively. Live birth rates also did not differ between the three treatment groups ( p = 0.437). All the three treatment modalities did not show a statistically significant impact on the rates of REP ( p = 0.42). Conclusion: We found no significant differences in time-to-pregnancy or live birth rates among expectant, MTX, and laparoscopic salpingectomy management for tubal EP. Given EP’s significant impact on fertility in reproductive-aged women, studies comparing treatment effects on future fertility are clinically valuable.

Purpose: This study was conducted to evaluate the effects of epilepsy on pregnancy and delivery outcomes. It aimed to assess the relationship of seizure type, the presence of seizures during pregnancy, and the timing of the last seizure before conception on perinatal outcomes for pregnant women with epilepsy (WWE). Methods: The research included 300 participants, comprising 100 pregnant WWE and a control group of 200 healthy pregnant women. The study analyzed demographic and clinical data for all subjects. Perinatal outcomes were evaluated according to seizure type, seizure status during pregnancy, and the last seizure before pregnancy. Results: The results showed a high rate of cesarean sections in the epilepsy group, at 71%. The number of babies born small for gestational age (SGA) was also significantly higher among WWE (p = 0.001). While there was no significant difference in most maternal and fetal outcomes between women with generalized and non-generalized seizures, the study identified pre-conception presence of seizures as a critical factor. Women who had experienced a seizure within the year before becoming pregnant had babies born at an earlier gestational week (p = 0.021) and with a lower birth weight (p = 0.018) compared to those whose last seizure was more than a year ago. Furthermore, 45% of the WWE had seizures during their pregnancy. Conclusion: The most important predictor of seizures during pregnancy is the presence of seizures before pregnancy. Presence of seizures during gestation is strongly associated with adverse perinatal outcomes, whereas the specific type of epilepsy is not.

Background: This study explores the role of inflammatory hematological markers from complete blood count (CBC) parameters in predicting the in vitro fertilization (IVF) treatment success of patients. It focuses particularly on the immature granulocyte (IG) percentage, a novel inflammatory marker. To our knowledge, this is the first study in the literature examining the relationship between IG percentage and pregnancy outcomes in IVF. Methods: Conducted retrospectively, this study included 311 IVF cycles from 311 distinct patients. A binomial logistic regression model identified factors affecting pregnancy outcomes. Various predictors were analyzed, including embryo quality, white blood cell (WBC) count, IG percentage, systemic inflammatory index (SII), endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, number of mature (MII) oocytes, and the number of embryos generated. Results: The IG percentage significantly impacted clinical pregnancy and live birth outcomes (OR = 0.40, 95% CI (confidence interval): 0.317–0.51, p < 0.001), unlike other inflammatory markers. Each millimeter increase in endometrial thickness measured on the day of hCG administration was associated with a slight increase in the likelihood of IVF success (OR: 1.20, 95% CI 1.004–1.44, p = 0.044). Neither SII nor mature oocyte count significantly affected pregnancy outcomes. Conclusions: A low IG percentage correlates positively with clinical pregnancy and live birth outcomes. Measuring IG percentage offers a rapid, inexpensive, and readily available method to predict IVF success.

Introduction: Tubal ligation reversal is a surgical option for restoring fertility, with outcomes influenced by technique, surgeon expertise, and patient factors. Objective: This study evaluates the fertility outcomes of macroscopic tubal reanastomosis through mini-laparotomy. Methods: This retrospective study analyzed medical records of women who had previously undergone tubal ligation either during cesarean sections or through laparoscopic electrocoagulation at a tertiary hospital in Türkiye between 2019 and 2022. The primary surgical approach involved a mini-laparotomy, and the anastomosis was performed macroscopically—without the use of an operating microscope—relying instead on direct visual inspection to access and reconnect the fallopian tubes. The suitability of the tubes for reanastomosis was assessed based on the length of the tubes, the presence of adhesion, and the condition of the fimbriae. Fertility outcomes, including live birth rates and time to conception, and surgical success rates, were measured. Results: The data of 23 patients were retrospectively reviewed. The surgical success rate was 78.2% (unilateral or bilateral reanastomosis of the tubas), with a pregnancy rate of 43.5% and a live birth rate of 34.8%. The mean time to conception was 3.73 months. Conclusion: Despite lower pregnancy rates compared with the broader literature, these outcomes are deemed acceptable, particularly for centers lacking facilities for more advanced surgical options. Therefore, macroscopic tubal reanastomosis through mini-laparotomy emerges as a feasible alternative for surgeons with limited experience in more intricate microsurgical techniques, providing a viable pathway to restoring fertility with reasonable success.