İbRahim Polat

Background and Objectives: Posterior fossa anomalies (PFAs) represent a heterogeneous group of congenital malformations involving the cerebellum and adjacent structures. Prenatal counseling remains challenging because neurodevelopmental outcomes vary substantially according to the specific anomaly. This study aimed to evaluate ultrasonographic and fetal magnetic resonance imaging (MRI) characteristics, associated anomalies, genetic test results, and perinatal and neurodevelopmental outcomes of prenatally diagnosed PFAs in a tertiary care population. Materials and Methods: This retrospective study included 115 fetuses diagnosed with PFAs between 2020 and 2024. PFAs were categorized into “simple” (mega cisterna magna, Blake’s pouch cyst [BPC], and arachnoid cyst) and “complex” (Dandy–Walker malformation [DWM], vermian agenesis/hypoplasia, cerebellar hypoplasia, Joubert syndrome, Walker–Warburg syndrome, and pontocerebellar hypoplasia). Maternal characteristics, associated cerebral and extracerebral anomalies, fetal MRI findings, genetic test results, and pregnancy and postnatal outcomes were analyzed. Results: Among 115 cases, 44.3% were isolated, and 55.6% were non-isolated. Ventriculomegaly was detected in 35.6% of cases and was significantly more frequent in the complex group (47.9% vs. 14.2%). Fetal MRI was performed in 35.6% (n = 41) of cases and demonstrated a 24.3% discrepancy rate with ultrasound, mainly in differentiating DWM from BPC. Genetic testing was performed in 66.9% of cases, revealing chromosomal abnormalities in 15.6% of the total cohort. Complex anomalies, including cerebellar hypoplasia and vermian agenesis/hypoplasia, were more frequently associated with pathogenic copy-number variants and monogenic disorders. The simple group (n = 42) had favorable outcomes, with an 89.2% survival rate and neurodevelopmental delay in 15.2% of survivors. In contrast, the complex group (n = 73) had significantly poorer outcomes (p < 0.001), with a 38.1% survival rate, 42.5% rate of pregnancy termination, and neurodevelopmental delay in 56.3% of survivors. Conclusions: This study highlights the persistent diagnostic challenges associated with PFAs and underscores the importance of multimodal imaging and comprehensive genetic evaluation. The proposed simple–complex classification provides a clinically meaningful framework for prognostication and parental counseling. Future research should prioritize prospective multicenter studies with higher rates of comprehensive genetic testing coupled with standardized long-term neurodevelopmental follow-up to refine the understanding of the natural history and prognostic trajectory of these complex brain malformations.

To evaluate the feasibility and safety of performing myomectomy during cesarean delivery using a novel bleeding-reducing suture technique. This retrospective cohort study included pregnant women with intramural uterine fibroids. A total of 120 patients were divided into two groups: Group A consisted of women who underwent myomectomy during cesarean section between January 2020 and June 2024, and Group B included women who underwent cesarean section alone without myomectomy. The following data were obtained from hospital records and compared between the groups: maternal age, gravidity, parity, myoma size, gestational age at time, preoperative and postoperative hemoglobin (Hb) levels, need for blood transfusion, hospital stay, and duration of surgery. The primary outcome of the study was the change in Hb levels before and after the operation. The demographic and laboratory characteristics of 120 pregnant women with intramural leiomyomas who underwent either cesarean myomectomy or cesarean section alone were analyzed. Of these, 60 underwent cesarean section alone, while 60 underwent cesarean section with myomectomy. No statistically significant difference was found between the two groups in terms of preoperative Hb, postoperative 24-hour Hb, or Hb decrease (p = .240, p = .270, and p = .420, respectively). Similarly, there was no significant difference in operation duration (p = .160). A weak but statistically significant negative correlation was observed between myoma size and gestational age at delivery (r = -0.21, p = .0009). No statistically significant correlations were found between myoma size and either operation time or hospital stay. Cesarean myomectomy appears to be a feasible and safe option when performed using the bleeding-reducing uterine isthmic circumferential suture technique. However, further multicenter studies with larger sample sizes are required to confirm these findings before recommending cesarean myomectomy as a routine approach.

This study aimed to evaluate the prevalence of von Willebrand disease (VWD) among women presenting with menorrhagia and to assess the diagnostic utility of the VWD simple screening tool. A prospective cohort study was conducted involving 70 women, aged 18–48 years, who presented to gynecology clinics with complaints of menorrhagia. Patients were administered an 8-question screening tool, routine tests and underwent further testing for von Willebrand factor antigen (VWF:Ag) and ristocetin cofactor activity (VWF:RCo). Hematologic and coagulation parameters, including hemoglobin, ferritin, activated partial thromboplastin time and prothrombin time were compared between the groups. Of the 70 patients, 22 (31%) were prediagnosed with VWD based on low VWF:Ag and VWF:RCo levels. The VWD group had a higher body mass index (31.19±3.74 vs. 28.20±5.36 kg/m², p<0.05), higher parity (4 vs. 3, p<0.05), and slightly elevated activated partial thromboplastin time levels (26.9 vs. 25.5 seconds, p<0.05) compared to the control group. Hemoglobin, ferritin, and other hematologic parameters were similar between the groups. Using the method applied in this study, 31% of patients with menorrhagia were suspected to have von Willebrand disease, a higher prevalence than reported in other studies. While the VWD simple screening tool was effective in identifying patients with menorrhagia, it fell short in accurately distinguishing those with VWD. Larger prospective studies are needed to enhance the diagnosis of VWD in menorrhagia patients and to better determine its true prevalence.

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term adapted from aviation—to standardize the identification and analysis of severe maternal complications. In addition to MNM, various indices are used to assess both access to and the quality of healthcare services. Materials and Methods: This retrospective study evaluated all pregnant women who presented at Başakşehir Çam and Sakura City Hospital, including postpartum referrals, between May 2020 and May 2023. Given the ongoing COVID-19 pandemic during the study period, data from COVID-19-positive patients were reported separately. All definitions and classifications were based on the standardized WHO MNM criteria. Results: A total of 45,458 births occurred at our institution during the study period. Among the COVID-19-excluded cohort, we identified 223 life-threatening conditions (LTCs), 206 MNM cases, and 17 maternal deaths. The resulting mortality index was 7.62%. The most frequent primary diagnoses included placental invasion anomalies, severe preeclampsia, and uterine atony. The most common interventions among LTC cases were ICU admission, prolonged hospitalization, hysterectomy, and massive transfusion. Conclusions: Although the rates of LTCs, MNM, and maternal mortality (MM) are gradually declining, they remain essential metrics for assessing healthcare quality. This study reveals that, while tertiary centers may report higher-than-global-average indices, there remains a significant gap between current outcomes and ideal targets. Enhancing diagnostic training, optimizing intervention strategies, and implementing robust clinical algorithms are critical steps toward reducing severe maternal morbidity and mortality.

Although there are several guidelines in the literature on "recurrent abortion", there is no comprehensive guideline on "threatened abortion". The overall purpose of this guideline is to provide healthcare providers with the best available evidence for examination and treatment of pregnant women with threatened abortion. The scope of the guideline and the first version of the questions were prepared by the Perinatology and High Risk Pregnancies Association (PERİDER) guideline development group in January 2024. Meetings were held to discuss key questions and redefine them. A final list of 8 key questions was created. Keywords were defined for each question and ranked in order of importance and used in searches for all English-language publications in PubMed/Medline and Cochrane libraries. These databases were thoroughly scanned for publications that were published until February 1, 2024. Literature reviews were conducted as an iterative process. In the first step, systematic reviews and meta-analyses were collected. If no results were found, the research was expanded to randomized controlled trials and then to cohort studies and case reports, following the hierarchy of evidence levels. This guideline was presented to the board of directors of the Turkish Gynecology and Obstetrics Society (TJOD). With their suggestions, guideline was finalized, and it was decided to be published as a joint guideline of PERİDER-TJOD. This guideline provides an overview of threatened abortion and the recommended treatments. In addition, by recognizing the deficiencies in the literature, suggestions were made regarding research that could help clinicians' decisions in the future.

The aim of this study was to evaluate maternal serological status and fetal sonographic findings of Cytomegalovirus (CMV) infection. This is a retrospective study performed at Perinatology Department of Istanbul Başakşehir Çam and Sakura City Hospital. A computerized search was conducted to identify cases who underwent prenatal diagnosis of fetal CMV infection between September 2020 and December 2023. We identified nine cases with fetal CMV infection. The clinical data of the patients, gestational age at the time of diagnosis, serological, sonographic findings, and pregnancy outcomes were analyzed. A computer search of the database was made for the seroprevalance of CMV-IgM and CMV-IgG in our population. The CMV-IgM and IgG results of the 1235 patients who underwent CMV screening in the first trimester between September 2020 and December 2023 were evaluated. Fetal CMV infection was identified in nine patients. None of the 9 cases showed maternal CMV-IgM positivity. Seven of the 9 patients showed high IgG avidity index. Pregnant population had 98 % positivity for CMV-IgG. The evaluation of serologic tests for CMV is not straightforward in the second and third trimester. IgM and IgG avidity should be interpreted with caution in the second and third trimester. In the presence of ultrasound findings suggesting fetal CMV infection and CMV-IgG positivity, invasive diagnostic tests rather than serological test should be discussed with the patient, and non-primary infections should always be considered to minimize overlooked fetal cytomegalovirus infections and missed antiviral treatment opportunity.

Objective: This study aims to assess Bisphenol-A levels in serum samples from preeclampsia patients and determine potential distinctions by comparing them against samples from healthy pregnant women Material-Methods: This single-center prospective case-control study aimed to investigate the potential differences in serum Bisphenol-A (BPA) levels between pregnant patients diagnosed with preeclampsia and healthy pregnant women. The study encompassed two distinct groups: the study group consisted of 30 pregnant patients diagnosed with preeclampsia, while the control group included 30 healthy pregnant women matched in terms of gestational weeks and demographic characteristics, maintaining a 1:1 ratio. Serum samples were subjected to analysis using a BPA ELISA kit Results: The study encompassed a total of 60 patients, who were categorized into two groups: preeclampsia (n=30) and control (n=30). Upon comparison of the BPA values between the two groups, no statistically significant difference was detected (p=0.579). Conclusion: Clear-cut scientific evidence establishing a conclusive causal link between BPA and preeclampsia is still lacking. Further research is needed in this area