Gorkem Arica

Background: Gestational duration is influenced by multiple factors, with placental function being one of the key determinants. First-trimester serum biomarkers reflect the quality of placentation and may be associated with the duration of pregnancy. Aims: To investigate the association between first-trimester serum placental biomarkers and gestational duration, and to evaluate the independent effects of nulliparity and fetal sex on gestational length. Methods: This retrospective, single-center study included 346 singleton pregnancies delivered between 34 + 0 and 41 + 0 weeks of gestation following spontaneous labor. First-trimester PAPP-A and free β-hCG multiples of the median (MoM) values were measured. Gestational length was calculated as the interval between the estimated last menstrual period and the date of delivery. Spearman correlation analysis and multiple linear regression were used to assess associations with gestational duration. Results: The mean gestational duration was 271 ± 10.5 days. Pregnancy duration was significantly longer in the PAPP-A MoM ≥ 0.6 group compared to the < 0.6 group (273 vs. 269 days, p = 0.001). In multiple linear regression analysis, PAPP-A MoM (B = 2.08, p = 0.034), nulliparity (B = 2.96, p = 0.013), and fetal sex (B = 2.63, p = 0.022) were identified as independent predictors of gestational duration. No significant association was observed between free β-hCG MoM and gestational duration. Conclusions: Higher first-trimester PAPP-A MoM levels are independently associated with longer gestational duration, even after adjustment for parity and fetal sex, suggesting that early placental function may play a role in regulating the timing of parturition with modest effect.

This narrative review synthesizes the current literature on the pathogenesis and management of Intrahepatic Cholestasis of Pregnancy (ICP). ICP is a multifactorial liver disorder characterized by intense pruritus and elevated serum bile acids (SBA) and/or liver enzyme levels, typically emerging in the second or third trimester and resolving postpartum. Its etiology involves a complex interplay of genetic factors, hormonal influences (e.g., elevated estrogen and progesterone levels), and environmental factors, supported by varied global prevalence (9.2–15.6% in South America vs. 0.1–0.5% in Europe) and high recurrence rates (45–90%). Diagnosis requires the exclusion of other hepatobiliary diseases and the presence of pruritus with a random peak SBA concentration ≥10 μmol/L (or ≥19 μmol/L, depending on the specific guideline used). Ursodeoxycholic acid (UDCA) (10–20 mg/kg/day) is the first-line treatment, reducing maternal symptoms and transaminase levels, though its effect on stillbirth is debated. Vitamin K supplementation is advised for a prolonged prothrombin time. Antenatal surveillance includes monitoring liver function and SBA every 1–2 weeks. Fetal monitoring, while necessary, has limited predictive value for sudden fetal death. The risk of stillbirth correlates strongly with SBA levels (3.44% for ≥100 μmol/L). Management focuses on risk-stratified delivery timing: ≥100 μmol/L warrants delivery at 35–37 weeks; 40–99 μmol/L suggests 37 weeks; and <40 μmol/L may continue to 39 weeks. Postpartum, SBA, and liver function should be reassessed at 6–8 weeks.

Purpose: Surgical-site infections (SSI) remain a major complication of cesarean delivery, increasing maternal morbidity, hospital stay, and healthcare costs. Although several risk factors have been identified, the role of maternal nutritional status—particularly the Prognostic Nutritional Index (PNI)—has not been well established in obstetric surgery. Methods: This retrospective case–control study included 190 women who underwent cesarean delivery at a tertiary referral center between 2020 and 2025. Preoperative PNI was calculated using serum albumin and lymphocyte counts obtained within 24 h before surgery. SSI was defined according to the Centers for Disease Control and Prevention criteria. Demographic, perioperative, and postoperative variables were analyzed to evaluate associations between PNI, SSI status, infection severity, and inflammatory markers. Results: A total of 190 women were analyzed, including 98 cases with surgical-site infection (SSI) and 92 controls without SSI. Although preoperative PNI was not an independent predictor of SSI, lower PNI values were associated with more severe infections requiring broad-spectrum antibiotics, longer hospitalization, and higher postoperative C-reactive protein (CRP) levels. A significant inverse correlation was observed between PNI and CRP among patients with SSI ( r = − 0.338, p = 0.001). Longer operative duration and smoking were also associated with an increased risk of SSI. Conclusion: Although PNI was not an independent predictor of SSI, lower values were strongly associated with infection severity and systemic inflammation. Integrating PNI into preoperative risk assessment—alongside body mass index and operative time—may help identify high-risk women. Larger prospective studies are warranted to confirm these findings and to evaluate the impact of nutritional optimization on postoperative outcomes.

The fetal liver is perfused by the umbilical vein (UV) and the main portal vein (MPV), both of which are crucial for nutrient delivery. The configuration of the umbilicoportal anastomosis may influence MPV blood flow and potentially affect fetal liver perfusion in fetuses with fetal growth restriction (FGR). To evaluate absolute and normalized UV and MPV blood flows in fetuses with normal growth and FGR, and to investigate the effect of umbilicoportal anastomosis type on MPV flow. This prospective case-control study included 108 appropriate-for-gestational-age (AGA) fetuses and 43 FGR fetuses between 18 and 37 weeks of gestation, evaluated over nine months. Ultrasound was used to measure UV and MPV diameters, while Doppler ultrasound assessed time-averaged maximum velocities. Flow volumes were calculated as time-averaged maximum velocity volume and normalized to estimated fetal weight (TAMXVVN) and abdominal circumference. Anastomoses were categorized as T-, X-, or H-shaped. Z-scores were derived from AGA nomograms. Compared with AGA fetuses, FGR fetuses exhibited significantly smaller UV diameters, lower absolute UV flow, UV-TAMXVVN, and UVTAMXVV/ AC (p < 0.05), but higher MPV-TAMXVVN (p < 0.05), suggesting compensatory redistribution. Both UV and MPV flows showed strong correlations with gestational age (r > 0.7, p < 0.001). UV-TAMXVVN Z-scores decreased with gestation, whereas MPV-TAMXVVN Z-scores increased until 32 weeks before plateauing. Blood flow parameters did not differ significantly across anastomosis types in either group. FGR fetuses demonstrate reduced UV perfusion with compensatory increases in MPV flow. The type of umbilicoportal anastomosis does not significantly affect MPV blood flow.

Objective: To establish gestational age-specific nomograms for the corpus callosum (CC) and cerebellar vermis (CV) using two-dimensional (2D) ultrasound in a Turkish population between 18 and 36 weeks of gestation. Study Design: This cross-sectional study was conducted at the Maternal–Fetal Medicine Unit of a tertiary care centre. A total of 714 low-risk singleton pregnancies between 18+0 and 36+0 weeks of gestation were included. Standardised midsagittal cranial sections were obtained using 2D ultrasound, and measurements were performed by maternal–fetal medicine specialists. Assessed parameters included CC length; thickness of the genu, body, and splenium; and CV anteroposterior (CVAPD) and craniocaudal (CVCCD) diameters. Statistical analysis included descriptive statistics and polynomial regression. Pearson correlation coefficients were calculated to assess the relationship between gestational age and each measurement. Results: Nomograms with 5th, 50th, and 95th percentiles were created for each parameter. All measurements showed significant positive correlations with gestational age (p<0.001). The CC length increased from a mean of 15.96 mm at 18 weeks to 43.12 mm at 36 weeks. The 50th percentile values for CVAPD and CVCCD were 8.91 mm and 10.17 mm at 18 weeks, rising to 20.13 mm and 22.10 mm, respectively, at 36 weeks. Thicknesses of the genu, body, and splenium also showed consistent growth patterns. Conclusion: The nomograms developed in this study provide normative data for fetal midline brain structures and may aid in the prenatal detection of neurodevelopmental abnormalities.

The purpose of this study was to evaluate the effect of third-trimester maternal iron deficiency and iron deficiency anemia on neonatal cord-blood hemoglobin (Hgb), and serum ferritin levels. Pregnant women who gave birth between 370/7 and 406/7 weeks of gestation, and their neonates were included. Maternal hemoglobin and ferritin levels were assessed. They were divided into two groups based on Hgb values as anemic and non-anemic. Furthermore, the anemic group was classified as mild, moderate, and severe anemia. Maternal and cord Hgb, hematocrit and ferritin levels were compared between groups. The study population was stratified into two groups according to iron supplementation status. Among 627 women included, 226(36%) were diagnosed as anemic, of which 130(57.5%) had mild, 94(41.6%) moderate, and 2(0.9%) severe anemia. Mean maternal Hb levels were 9.9±0.9 g/dl and 12.1±0.9 g/dl in the anemic and non-anemic groups, respectively. The mean maternal serum ferritin of anemic and non-anemic mothers were 11.7 ng/ml and 15.8 ng/ml, respectively (p < 0.001). The mean cord-blood serum ferritin of neonates born from anemic and non-anemic mothers was 113±68.8 ng/ml and 134±95.0 ng/ml, respectively (p = 0.012). Cord-blood Hb levels of neonates born from anemic and non-anemic mothers were 15.1±1.8 g/dl and 15.5±2.0 g/dl, respectively (p = 0.006). The 5th, 25th, 50th, 75th, and 95th percentiles of cord blood serum ferritin concentrations were 32.6, 72.2, 107.5, 154.1, and 272.6 ng/ml, respectively. Among neonates born from mild, moderate, and severe anemic mothers, there was no significant difference regarding cord-blood serum ferritin and blood count parameters (p > 0.05). Cord-blood serum ferritin concentrations were found to be 119 ± 85.7 ng/ml and 136.4 ± 87.9 ng/ml in the low and normal maternal serum ferritin groups, respectively (p = 0.015). Maternal anemia is common and associated with lower neonatal cord blood hemoglobin and ferritin levels. However, lack of iron supplementation during pregnancy, rather than anemia itself, was the strongest independent predictor of neonatal anemia. These findings highlight the importance of routine antenatal iron supplementation to support fetal iron status and improve perinatal outcomes. Further randomized controlled trials are needed to evaluate the effects of maternal iron supplementation on fetal iron stores and long-term outcomes.

Objective: To evaluate the maternal and perinatal outcomes of pregnancies with preterm premature rupture of membranes (PPROM) and to explore the perinatal and obstetric outcomes according to gestational age at the time of PPROM.Methods: This retrospective study included 316 singleton pregnancies with PPROM between 16+0 and 36+6 weeks of gestation. Perinatal and maternal outcomes according to gestational age at the time of PPROM are evaluated.Results: The mean latency duration was 7.5 ± 13.8 days and the incidence of latency ≥15 days was 14.6%. There was a significant negative correlation between the gestational week at diagnosis of PPROM and the duration of the latent period (r = −0.422, P < .001). Incidences of survival were 6.2%, 80.5%, 91.8%, and 100% in pregnancies with an onset of PPROM at 16+0 to 23+6, 24+0 to 27+6, 28+0 to 32+6, and 33+0 to 36+6 weeks’ gestation, respectively. Among the 249 liveborn infants, 4.4%, 3.1% and 1.3% had vision impairment, bronchopulmonary dysplasia, and cerebral palsy respectively at 2 years’ corrected age. Incidences of survival without long-term sequelae were 6.2%, 55.6%, 73.8%, and 100% in pregnancies with an onset of PPROM at 16+0 to 23+6, 24+0 to 27+6, 28+0 to 32+6, and 33+0 to 36+6 weeks’ gestation, respectively. There was a significant negative correlation between chorioamnionitis and gestational age at diagnosis of PPROM (r = −0.173, P = .002).Conclusion: Expectant management if not otherwise contraindicated is the choice of treatment in pregnancies after 24 weeks of gestation, and perinatal survival rates reaching 95% can be achieved with proper management.Cite this article as: Alakbarlı K, Arıca G, Bayraktar E, Alıcı-Davutoğlu E, Madazlı R. Perinatal and maternal outcomes of pregnancies with preterm premature rupture of membranes. Cerrahpaşa Med J. 2025; 49, 0114, doi: 10.5152/cjm.2025.23114.

Introduction: To establish nomograms for the bilateral fornix-hippocampus complex (FHC) length and hippocampus height (HH) in fetuses between 18 + 0 and 36 + 0 weeks of gestation using two-dimensional (2D) sonography and assess potential laterality differences. Methods: A prospective study was conducted on 725 singleton pregnancies at the Maternal–Fetal Medicine Department from January to December 2024. Gestational age was confirmed via first-trimester crown-rump length measurements. Exclusion criteria included maternal chronic diseases, multiple pregnancies, fetal anomalies, and growth restriction. Transabdominal 2D sonography captured FHC and HH measurements in the parasagittal plane. Laterality was determined before imaging, and each measurement was repeated twice for reliability. Percentiles (5th, 50th, and 95th) were calculated, and Pearson correlation coefficients assessed relationships with gestational age. The independent samples t-test compared left and right measurements, and intraobserver reliability was evaluated with the intraclass correlation coefficient (ICC). Results: Nomograms with 5th, 50th, and 95th percentiles were established for both sides. The Pearson correlation coefficients for the left and right sides of the FHC length and HH with advancing gestational age were 0.808, 0.808, 0.725, and 0.734, respectively. The correlation coefficients between FHC length and HH for the left and right sides were 0.814 and 0.818, respectively. No significant laterality differences were found (p > 0.05). Discussion: These nomograms provide reference data for assessing fetal neurodevelopment. They may aid in detecting abnormalities, particularly in corpus callosum agenesis and ventriculomegaly.

Perinatal outcomes of antenatally diagnosed omphalocele and gastroschisis: a survey from a university hospital - Journal of the Turkish-German Gynecological Association

Purpose: To assess the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections, and perinatal outcomes of fetuses with ventriculomegaly (VM), also to evaluate the role of fetal magnetic resonance imaging (MRI) in detecting associated intracranial anomalies. Methods: Retrospective cohort study of 149 prenatally diagnosed pregnancies with fetal VM. VM was classified as mild (Vp = 10–12 mm), moderate (Vp = 12.1–15 mm), and severe (Vp > 15 mm). Fetal MRI was performed to 97 pregnancies. Results: The incidences of an associated CNS, non-CNS, chromosomal anomaly, genetic abnormality and fetal infection were 42.3%, 11.4%, 6.1%, 2.1% and 1.3%, respectively. Fetal MRI identified additional CNS anomalies in 6.7% of cases, particularly in severe VM. The incidences of perinatal outcomes were 18.8% termination of pregnancy, 4% intrauterine and 8.1% neonatal or infant death. The rates of fetuses alive at > 12 months of age with neurological morbidity were 2.6%, 11.1% and 76.9% for mild, moderate and severe isolated VM, respectively. Conclusion: The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. Mild to moderate isolated VM generally have favorable outcomes. Fetal MRI is particularly valuable in fetuses with isolated severe VM.