Melike Sevde Harmancı

Objective: To investigate circulating C1q/TNF-related protein-1 (CTRP-1) levels in women with polycystic ovary syndrome (PCOS) and evaluate its potential association with metabolic and reproductive features of the syndrome. Methods: A prospective cross-sectional case–control study was conducted between October 2021 and March 2022 including 96 women (48 with PCOS and 48 controls) aged 15–40 years. PCOS was diagnosed according to the 2003 Rotterdam criteria. Anthropometric measurements and fasting venous blood samples were obtained during the early follicular phase. Serum CTRP-1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Metabolic and hormonal parameters, including HOMA-IR, AMH, and androgen levels, were analyzed. Receiver operating characteristic (ROC) analysis and analysis of covariance (ANCOVA) adjusted for age and body mass index (BMI) were performed. Results: Serum CTRP-1 levels were significantly higher in women with PCOS compared with controls (54.9 ± 5.2 vs. 26.6 ± 4.8 ng/mL, p < 0.001). CTRP-1 concentrations were associated with several metabolic and hormonal parameters, including BMI, fasting insulin, triglyceride levels, HDL cholesterol, and AMH. ROC curve analysis demonstrated excellent discriminatory ability within this cohort, although these findings should be interpreted cautiously given the relatively small sample size and case–control design. In multivariable analysis adjusting for age and BMI, CTRP-1 remained independently associated with PCOS (β = 28.97, p < 0.001). Conclusion: Circulating CTRP-1 levels are elevated in women with PCOS and appear to be associated with both metabolic and reproductive characteristics of the syndrome. CTRP-1 may represent a potential biomarker related to metabolic dysregulation in PCOS; however, larger prospective and multicenter studies are required to validate its clinical and diagnostic utility.

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.

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.

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 and compare maternal and fetal outcomes between pregnancies in women aged 40 and over and those in women under 40 years of age at a tertiary care hospital. Methods: A retrospective cohort study was conducted at Necmettin Erbakan University Medical Faculty Hospital, analyzing data from 345 women aged 40 and over and 366 women under 40 who delivered between January 2015 and December 2024. Maternal and perinatal outcomes—including mode of delivery, gestational age, birth weight, and complications such as gestational diabetes, preeclampsia, and postpartum hemorrhage—were compared between the two groups. Results: Women aged 40 and over had significantly higher rates of cesarean section (73% vs. 36.1%, p < 0.0001), preterm delivery (27.8% vs. 18%, p = 0.002), and gestational diabetes (14.8% vs. 7.7%, p = 0.002). Additionally, these women had a higher incidence of preeclampsia (13% vs. 5.7%, p = 0.001) and postpartum hemorrhage (18% vs. 10.5%, p = 0.003). Despite these increased risks, the 5 min APGAR score was significantly higher in the ≥40 age group (median 8 vs. 7, p < 0.0001). The incidence of chromosomal abnormalities was significantly higher in patients≥ 40 years, with 5 cases (1.4%) reported, compared to no cases (0%) in the p = 0.025). Conclusions: This study shows that pregnancies in women aged 40 and above carry higher maternal and fetal risks compared to younger women. Complications such as preterm labor, cesarean delivery, gestational diabetes, and preeclampsia occur more frequently in this group. However, with careful prenatal care, positive neonatal outcomes are often achievable, highlighting the need for age-specific management and early risk detection.

Toxoplasmosis is the most common congenital parasitic infection. The birth prevalence of congenital toxoplasmosis varies between 1 and 10 in 10,000 live births. While 74-81% of infected fetuses have only subclinical infection, up to 19-26% develop fetal/childhood disease even with treatment. Fetuses with congenital toxoplasmosis usually appear normal on prenatal ultrasound. Ultrasonographic findings suggestive of congenital disease include intracranial calcifications, ventriculomegaly, hepatic enlargement, ascites, and increased placental thickness. Neonatal clinical manifestations of congenital toxoplasmosis are highly variable. They include hydrocephalus, microcephaly, intracranial calcifications, chorioretinitis, strabismus, blindness, epilepsy, psychomotor or mental retardation, petechiae due to thrombocytopenia, and anemia. The classic triad of chorioretinitis, hydrocephalus, and cerebral calcifications is extremely rare. None of the findings described in neonates with congenital disease are pathognomonic of toxoplasmosis and may mimic congenital infection with other pathogens, such as cytomegalovirus, herpes simplex virus, rubella, and syphilis.Diagnosis is usually confirmed by toxoplasma DNA PCR from amniocentesis material after 18 weeks of gestation. Prevention has been shown to reduce the incidence of disease and remains the most important intervention. A more careful follow-up process can be established by careful monitoring of ultrasonographic markers.

From Diagnosis to Treatment: Polycystic Ovary Syndrome Mehmet Efe NAMLI Cytomegalovirus (CMV) Infectıon and Intrauterine Ultrasonography Findings Huriye EZVECİ Metabolic Syndrome With Polycystic Ovary Syndrome Duygu LAFCI Toxoplasmosis Infection During Pregnancy Melike Sevde HARMANCI Rhd Alloimmunization in Pregnancy Refaettin SAHIN Ectopic Pregnancy Tahir ERYILMAZ Uterine Myoma: Definition, Clinical Characteristics, and Treatment Approaches Ecem Dilan DUMAN