Mustafa Bakırcı

Objective: The aim of this study is to identify clinical and obstetric factors associated with acute postoperative pain in pregnant women undergoing primary elective cesarean section and, in particular, to investigate the relationship between intraoperative subcutaneous tissue thickness and the severity of postoperative pain. Materials and Methods: This prospective cohort study included 82 pregnant women who underwent primary elective cesarean section between August 2025 and April 2026. All patients underwent cesarean delivery under spinal anesthesia by the same surgeon using a Pfannenstiel incision and received the clinic’s standard postoperative analgesia protocol. Subcutaneous tissue thickness was measured along the Pfannenstiel incision line during cesarean section using a sterile millimeter ruler. Postoperative pain intensity was assessed using the Visual Analog Scale (VAS) at 0, 2, 6, 12, and 24 h. Relationships between variables were examined using Spearman’s correlation analysis. Multivariate linear regression analyses were performed for the 12th- and 24th-hour VAS scores to evaluate the independent predictors of postoperative pain. Results: The participants’ mean age was 26.1 ± 4.6 years, and their mean BMI was 30.4 ± 5.1 kg/m². The median subcutaneous tissue thickness was 20 mm (interquartile range (IQR): 15–25). No significant association was found between subcutaneous tissue thickness and postoperative pain scores or changes in hemoglobin levels (all p > 0.05). A moderate positive correlation was observed between subcutaneous tissue thickness and BMI (r = 0.501, p < 0.001) and fetal weight (r = 0.428, p < 0.001). In multivariate regression analyses, subcutaneous tissue thickness, age, BMI, fetal weight, gestational age, hemoglobin change, and parity were found not to be independent predictors of VAS scores at 12 or 24 h (all p > 0.05). Conclusions: Subcutaneous tissue thickness was not found to be associated with the severity of postoperative pain in patients undergoing primary elective cesarean section. Furthermore, none of the clinical and obstetric variables evaluated were shown to be independent predictors of acute postoperative pain. These findings suggest that local anatomical measurements alone may not be sufficient to explain postoperative pain following cesarean delivery and that postoperative pain is likely influenced by multiple non-anatomical factors.

The intrauterine device (IUD), is a commonly utilized contraceptive technique among multiparous women. Based on the available literature, the incidence of uterine perforation and migration in IUD applications has been documented to range from 0.05 to 13 per 1000 cases. If an IUD is not identified during an ultrasound examination of the uterus and uterine cavity in patients with a history of IUD usage who are seeking examination, further investigation should be conducted to determine the position of the IUD. Following ultrasonography, it is imperative to assess using X-Ray as well as pelvis and abdominal imaging techniques. We report a case of an IUD that was not found in its expected location within the uterus during inspection and ultrasonographic examination. It was detected outside the uterus on X-Ray imaging. The patient had the IUD placed 22 years ago. A pelvic radiograph is necessary for evaluating cases of missing IUDs.

Depression and anxiety among women with unwanted pregnancies seeking termination - Turkish Journal of Obstetrics and Gynecology

Objectives: To evaluate the diagnostic value of hematological and biochemical inflammatory markers in distinguishing missed abortions from healthy pregnancies during the first trimester. Methods: This retrospective case-control study was conducted between May 2022 and May 2024, included 61 women diagnosed with missed abortion by ultrasound and 100 healthy pregnant women who acted as controls. The following inflammatory markers were calculated from routine blood and biochemistry results: neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII) and C-reactive protein-albumin ratio (CAR). Intergroup comparisons and receiver operating characteristic (ROC) curve analyses were performed. Results: The platelet count was significantly lower in the missed abortion group than in the control group (p = 0.049). No significant differences were found in NLR, PLR, LMR, SII and CAR levels. Only the MLR value was close to the threshold of statistical significance (p = 0.054). Conclusion: In our study, most systemic inflammation markers showed limited diagnostic utility for diagnosing missed abortions. These findings suggest that inflammation in the pathophysiology of missed abortion may be localised or time-dependent rather than systemic. Further prospective studies with larger cohorts are required to confirm these findings.

Objective: This study aimed to evaluate the diagnostic value of the ratio of red blood cell distribution width (RDW) to platelet count (PLT) in the diagnosis of incomplete abortion in patients presenting to obstetric practice. Methods: This retrospective study includes 289 patients. Of these, 126 were in the incomplete abortion group and 163 were in the elective abortion group, which was terminated without medical indication. Patients who were not between 5 and 12 weeks of gestation, those with signs of infection, those with chronic disease or those taking regular medication, and those without complete blood count data were excluded from the study. Hemoglobin, RDW and PLT values recorded at the time of the initial pregnancy diagnosis were examined. Blood samples were obtained during the initial pregnancy visit before the diagnosis of incomplete abortion and prior to curettage in the elective abortion group. The RDW/PLT ratio was subsequently calculated and included in the statistical analyses. Receiver operating characteristic (ROC) analysis was used to assess the risk of incomplete abortion, and binary logistic regression analysis was used to examine independent predictors. The level of statistical significance was set at p< 0.050. Results: A total of 289 patients were included in the study, comprising 126 patients with incomplete abortion and 163 women undergoing elective abortion. The incomplete abortion and elective abortion groups showed similar baseline characteristics. In binary logistic regression analysis, gestational age, RDW, PLT, and the RDW/PLT ratio were significant predictors of incomplete abortion in the univariate model. In the multivariate model, only maternal age, gestational age, and the RDW/PLT ratio remained independently associated with incomplete abortion. ROC analysis demonstrated no diagnostic value for hemoglobin, while RDW and PLT showed moderate predictive performance. The RDW/PLT ratio exhibited the highest discriminatory ability (AUC = 0.824), with a cut-off value of ≥ 0.054 yielding 71.4% sensitivity and 79.1% specificity. The overall diagnostic accuracy of the RDW/PLT ratio index was 75.78%. Conclusion: This study demonstrates that the RDW/PLT ratio is a simple and accessible hematological marker that may represent a complementary hematological marker associated with early pregnancy loss risk. The findings suggest that this index may provide complementary support to clinical decision-making processes.

Objective: To evaluate the effect of age on the neutrophil-lymphocyte ratio (NLR), a marker of systemic inflammation, and other hematological parameters in women diagnosed with polycystic ovary syndrome (PCOS). Materials and Methods: This retrospective study examined 280 women aged 18–43 who had been diagnosed with PCOS according to the Rotterdam criteria between May 2022 and May 2024. The patients were divided into four groups according to their age: Group 1 (18–24 years, n = 100); Group 2 (25–30 years, n = 130); Group 3 (31–35 years, n = 37); and Group 4 (36–43 years, n = 13). The Kruskal–Wallis test was used to compare neutrophil, lymphocyte, and NLR levels between groups. Spearman correlation analysis was used to evaluate the relationship between age and inflammatory parameters. The independent effect of age on NLR was examined using multivariate linear regression analysis. Results: No significant difference in NLR levels was found between age groups (p = 0.160). However, the neutrophil count was significantly lower in Group 3 than in the other groups (p = 0.013). A weak negative correlation was found between age and neutrophil count (r = -0.142, p = 0.024), but no significant correlation was found between age and NLR (r = 0.084, p = 0.162). Multivariate regression analysis revealed that age had no independent effect on NLR (β = -0.088, p = 0.156), whereas BMI positively affected NLR (β = +0.176, p = 0.005). Conclusion: In this cohort of women with PCOS, NLR did not show a significant association with age, whereas it was associated with BMI. These findings emphasise the importance of considering metabolic factors when evaluating the inflammatory process in PCOS.

Amaç: Bu çalışmanın amacı, üniversite öğrencilerinin cinsellik konusundaki bilgi düzeylerini, tutumlarını ve davranışlarını kapsamlı bir şekilde değerlendirmektir. Gereç ve Yöntemler: Bu araştırma, Yozgat Bozok Üniversitesi Tıp Fakültesi'nde Jinekoloji ve Obstetrik eğitimi almamış toplam 166 öğrenci ile gerçekleştirilmiş bir kesitsel çalışmadır. Araştırma verileri, cinsel sağlıkla ilgili bilgi ve tutumları ölçmek amacıyla oluşturulmuş 20 sorudan oluşan bir anket aracılığıyla toplanmıştır. Bulgular: Katılımcıların %22,9'u cinsel deneyim yaşadığını belirtirken, bu oran kadınlarda %10,6, erkeklerde ise %43,5 olarak bulunmuştur. Erkeklerin cinsel deneyime sahip olma oranı, kadınlara göre istatistiksel olarak anlamlı derecede yüksektir (p=0.001). Öğrencilerin %83,7'si okullarda cinsel eğitimin verilmesini desteklerken, %4,8'i bunun gereksiz olduğunu ifade etmiştir. Cinsellik konusundaki bilgilerin en yaygın kaynağı sosyal medya ve internet (%42,2) olarak belirtilmiştir. Katılımcıların en fazla bildiği doğum kontrol yöntemleri prezervatif (%42,2) ve oral kontraseptifler (%35,5) olmuştur. Öğrencilerin %41,6'sı oral kontraseptif kullanırken, %33,1'i prezervatif kullanmaktadır. Sonuç: Çalışma bulguları, üniversite öğrencilerinin büyük bir kısmının cinsel sağlık bilgilerini sosyal medya ve internetten edindiğini ortaya koymaktadır. Öğrenciler cinsel deneyimler yaşamış olsalar da cinsel sağlıkla ilgili yanlış anlamalar ve riskli korunma yöntemlerinin kullanımına dair ciddi bir eğitim eksikliği bulunmaktadır. Bu durum, ülkemizde cinsel sağlık eğitimine dair politikaların güçlendirilmesi gerektiğini göstermektedir.

Composition of the vaginal microbiota in relation to cervical intraepithelial lesions - Turkish Journal of Obstetrics and Gynecology

Aim We aimed to evaluate systemic inflammation in patients with postmenopausal osteoporosis using C-reactive protein (CRP)/albumin ratio, blood neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI) and to determine its relationship with bone mineral density (BMD). Methods Our study has a retrospective design. A total of 363 postmenopausal female patients admitted to physical medicine and rehabilitation outpatient clinics were evaluated. Patients were divided into three groups as osteoporosis, osteopenia and normal BMD. Demographic data, femoral neck and lumbar total T scores, BMD values, complete blood count parameters, CRP and albumin results were recorded. CRP/albumin ratio, NLR and PNI were calculated. Results Osteoporosis was found in 102, osteopenia in 167 and normal BMD in 94 patients. In the osteoporosis group, albumin, CRP and CRP/albumin ratio were lower than the normal BMD group (p = 0.017; p < 0.001; p = 0.032, respectively). In the osteoporosis group, PNI was lower than the other groups (p < 0.001). NLR was higher in the osteoporosis group than the other groups, but not statistically significant (p = 0.723). We found a positive correlation between BMD with albumin and PNI. Conclusion The effect of inflammatory response in postmenopausal osteoporosis is not prominent. CRP/albumin ratio does not seem to be an appropriate index for osteoporosis. In the light of our data, nutritional factors seem to be more effective on osteoporosis.

OBJECTIVE: The aim of this study was to evaluate serum B-type natriuretic peptide levels in pregnant women with hyperemesis gravidarum and compare them with healthy pregnant women.