Mehmet Efe Namlı

Background/Objectives: We examined the association between the systemic inflammatory response index (SIRI) measured on admission in labour and complete episiotomy wound dehiscence, and whether the SIRI adds useful discrimination beyond available covariates. Methods: This retrospective case–control study included 200 cases and 200 controls attending postpartum clinics at a tertiary maternity unit (September 2019–September 2022). Controls were randomly sampled from eligible attendees on the same clinic days. The SIRI was calculated from pre-delivery blood counts. Unconditional logistic regression adjusted for maternal age, primiparity, education, income, birthweight and gestational age. Important intrapartum and repair variables were unavailable. Results: The median SIRI was 3.00 in cases and 2.52 in controls (p < 0.001). The log-transformed SIRI was associated with dehiscence after adjustment (OR 1.49 per doubling, 95% CI 1.13–1.97; p = 0.005), whereas the untransformed term was not statistically significant (p = 0.063). The SIRI had poor discrimination (AUC 0.601, 95% CI 0.544–0.655). Adding the SIRI increased the reference-model AUC from 0.699 to 0.713 (ΔAUC 0.014, 95% CI 0.001–0.039); adding neutrophil count yielded an AUC of 0.712. Conclusions: In this selected clinic-attending population, the SIRI showed a model-dependent association with dehiscence but insufficient discrimination for individual risk prediction. Residual confounding remains possible. The small incremental gain does not support using the SIRI for clinical risk stratification or treatment decisions.

Hysteroscopy is central to evaluating suspected intrauterine pathology, yet the histopathological yield of referral indications and the predictive value of ultrasound and hysteroscopic impressions in tertiary practice remain insufficiently defined. We retrospectively reviewed consecutive women aged ≥18 years who underwent diagnostic or operative hysteroscopy at a tertiary referral center in Ankara, Türkiye, between January and December 2025. Referral indication, transvaginal ultrasound impression, hysteroscopic impression, and final histopathology were recorded. Category-specific positive predictive values (PPVs) were calculated with Wilson 95% confidence intervals (CIs). The sonographic impression was additionally dichotomized against histopathology at both a strict and a broad threshold, and sensitivity, specificity, and likelihood ratios were derived. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Among 1551 procedures, 1250 women were pre/perimenopausal, and 301 were postmenopausal. Final histopathology was available in 1455 cases (93.8%). The most common diagnoses were endometrial polyp (957; 65.8%), benign endometrium (477; 32.8%), and endometrial carcinoma (21; 1.4%). Indications differed by menopausal status ( P < .001): abnormal uterine bleeding predominated before menopause (908; 72.6%), whereas postmenopausal bleeding predominated after menopause (144; 47.8%). Indication-stratified yield also differed significantly ( P < .001). Endometrial carcinoma was rare before menopause and clustered in postmenopausal women with bleeding. Among postmenopausal women, carcinoma was found in 11.1% (16/144) of those referred with bleeding but in only 1.3% (2/157) of those referred for other reasons; among pre/perimenopausal women, the corresponding figures were 0.3% (3/884) and 0% (0/270). Bleeding, therefore, raised carcinoma yield only after menopause. Ultrasound suggesting an endometrial polyp was confirmed in 86.4% (603/698; 95% CI: 83.6–88.7), while ultrasound suspicious for malignancy predicted carcinoma in 85.7% (18/21; 95% CI: 65.4–95.0). A hysteroscopic impression of an endometrial polyp showed a PPV of 90.2% (202/224; 95% CI: 85.6–93.4). For polyp detection, a definite sonographic impression was specific but insensitive (specificity 80.9%, sensitivity 63.0%); admitting suspected polyps raised sensitivity to 95.0%, while specificity fell to 50.2% (negative likelihood ratio, 0.10). Definite focal or malignancy-suspicious ultrasound and hysteroscopic impressions carried a high PPV. Carcinoma risk was governed by the combination of menopausal status and bleeding rather than by bleeding alone, which supports triage based on both factors jointly. Histopathological confirmation remains indispensable.

Objective: In the present study, we aimed to evaluate the impact of vaginal birth after cesarean (VBAC) on quality of life, sexual function, sleep quality, and urinary incontinence and compare the results with those of vaginal birth (VB) and cesarean delivery (CD) via validated questionnaires. Methods: A single‐center retrospective cross‐sectional observational study was conducted at the Bezmialem Vakıf University between 2017 and 2022. The participants were classified into three groups: VB ( n = 49), CD ( n = 54), and VBAC ( n = 55). Postpartum maternal health outcomes were assessed via validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Postpartum Quality of Life (PP‐QoL), and International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF). Statistical analyses were performed using SPSS version 29.0. Results: There were no significant differences among the groups in terms of total PSQI scores or ICIQ‐SF scores. However, the total FSFI and PP‐QoL scores were significantly higher in the VBAC group ( P < 0.001). Among the FSFI subdomains, only desire and pain scores remained significantly different after Bonferroni correction. Conclusion: Our findings suggest that while sleep quality and urinary incontinence symptoms did not significantly differ among the delivery groups, PP‐QoL and FSFI scores were higher in the VBAC group than in the VB and CD groups.

Objectives: This study aimed to compare the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), and fibrosis-5 index (FIB-5) between women with threatened miscarriage and healthy pregnant controls, and to evaluate their discriminative performance. Methods: This single-center retrospective case–control study included 100 women with threatened miscarriage and 100 gestational-age-matched healthy pregnant controls within the first 12 weeks of gestation. Demographic, obstetric, ultrasonographic, and laboratory data were retrieved from electronic records. APRI, FIB-4, and FIB-5 were calculated from routine laboratory parameters. Group comparisons, binary logistic regression, and ROC analyses were performed. Results: AST, ALT, ALP, APRI, and FIB-4 were higher, while hemoglobin, platelet count, albumin, and FIB-5 were lower in the threatened miscarriage group (all p < 0.001). APRI (OR = 6.937), FIB-4 (OR = 89.114), and FIB-5 (OR = 0.766) were independently associated with case status. FIB-4 showed the highest discriminative performance (AUC = 0.929), followed by APRI (AUC = 0.903) and FIB-5 (AUC = 0.761). Conclusions: APRI and particularly FIB-4 showed good apparent discrimination between women with threatened miscarriage and healthy controls in this retrospective dataset. However, these indices should be interpreted as exploratory laboratory-derived markers rather than disease-specific biomarkers until validated in prospective multicenter studies.

Objective: To evaluate the association of salivary progesterone and estradiol levels and the progesterone-to-estradiol ratio (P4/E2 ratio) in early pregnancy with threatened miscarriage and pregnancy outcome. Methods: This single-center prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Ankara Atatürk Sanatorium Training and Research Hospital, between 10 January 2025 and 10 January 2026. Primigravid women with a confirmed live intrauterine pregnancy were included. Saliva samples were collected at 6–7 and 8–9 weeks of gestation; in pregnancies remaining viable to 12 weeks, salivary estradiol was also measured at week 12. Progesterone and estradiol levels were measured by immunoassay, and the P4/E2 ratio was calculated. Participants were classified as healthy ongoing pregnancies to 12 weeks (n = 102), threatened miscarriage with viability preserved to 12 weeks after progesterone treatment (n = 63), and miscarriage (n = 29). Group comparisons were performed using the Kruskal–Wallis test, one-way ANOVA, Mann–Whitney U test, and paired-samples t-test, as appropriate. Results: At both 6–7 and 8–9 weeks, progesterone, estradiol, and the P4/E2 ratio differed significantly among groups. Values were highest in uncomplicated ongoing pregnancies, lowest in pregnancies ending in miscarriage, and generally intermediate in progesterone-treated threatened miscarriage with preserved viability. The progesterone-to-estradiol ratio increased significantly from 6–7 to 8–9 weeks in uncomplicated ongoing pregnancies (p = 0.005), whereas no significant longitudinal change was observed in the threatened miscarriage group. Among pregnancies viable at 12 weeks, estradiol levels at week 12 remained significantly lower in women with prior vaginal bleeding (p < 0.001). Conclusions: Salivary progesterone, estradiol, and the progesterone-to-estradiol ratio were significantly associated with early pregnancy outcome in this prospective cohort. These findings suggest that salivary hormonal assessment may provide a non-invasive adjunct for characterizing early hormonal patterns in threatened miscarriage; however, it should not be interpreted as a stand-alone prognostic tool without further validation in larger cohorts.

OBJECTIVES: Late-onset preeclampsia (LO-PE) is a major cause of maternal–perinatal morbidity. Noninvasive liver fibrosis indices, the AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and Fibrosis-5 (FIB-5), may capture subclinical hepatic injury in preeclampsia. We assessed the association of these indices with LO-PE and their diagnostic performance. STUDY DESIGN; In this single-center, retrospective, case-control study, we compared pregnant women with LO-PE (defined as preeclampsia onset at or after 34 weeks of gestation, with no chronic hypertension; n=84) with healthy pregnant controls matched by gestational age (n=84). Demographics, obstetric features, and laboratory parameters (AST, ALT, ALP, platelet count, and albumin) were obtained from medical records. APRI, FIB-4, and FIB-5 indices were calculated using standard formulas. Differences between groups were assessed using statistical tests. For normally distributed data, parametric tests (such as the independent-samples t-test) were used. For nonnormally distributed data, we used nonparametric tests (such as the Mann-Whitney U test). The ability of each index to distinguish between cases and controls was evaluated using ROC curve analysis. ROC analysis plots sensitivity versus 1-specificity to assess diagnostic performance. RESULTS: ALT, AST, ALP, FIB-4, and APRI levels were significantly higher, whereas FIB-5, platelet, and albumin levels were significantly lower in patients with preeclampsia than in controls (p<0.05). APRI, FIB-4, and FIB-5 values were found to be important parameters affecting disease status (p<0.05). When APRI and FIB-4 values increase by 1 unit, the risk of disease will increase 23.683 and 59.402 times, respectively. In contrast, for each additional unit increase in the FIB-5 score, the risk of disease decreases by 13.3%. CONCLUSION: APRI and FIB-4 are independent predictors of LO-PE and provide robust discrimination between affected and unaffected patients. While FIB-5 offers limited diagnostic accuracy, APRI and FIB-4, available from routine antenatal labs, can be leveraged for timely risk stratification and early detection of LO-PE. However, prospective validation and clear thresholds are needed to enable effective clinical implementation.

Aim: The aim of this study is to determine the association between hyperemesis gravidarum and the non-invasive liver fibrosis indices APRI, FIB-4, and FIB-5, in order to evaluate whether these indices could be used as predictive markers for the presence and severity of the disease. Materials and Methods: This cross-sectional retrospective study was conducted on 100 pregnant women diagnosed with HG, and 100 gestational age- and age-matched healthy pregnant women, at a tertiary hospital between December 2022 and December 2024. Demographic data, laboratory parameters, and PUQE scores were collected from the hospital database and APRI, FIB-4, and FIB-5 scores were calculated using standard formulas. Comparisons were made between the two groups, and any correlations between disease severity and these indices were determined. Logistic regression and ROC analysis were performed to identify the predictive value of these scores. Results: Mean APRI and FIB-4 scores were significantly higher in the HG group compared to controls, while FIB-5 scores were significantly lower (p

Ejmi Eurasian Journal of Medical Investigation

Ejmi Eurasian Journal of Medical Investigation

Tekrarlayan gebelik kayıpları (TGK), çiftler için büyük bir psikolojik ve fizyolojik yük oluşturan karmaşık bir durumdur. En az üç ardışık gebelik kaybı olarak tanımlanan bu durum, immünolojik, genetik ve anatomik faktörlerden kaynaklanabilir. İmmünolojik nedenler arasında antifosfolipid sendromu, otoimmün hastalıklar ve alloimmün faktörler yer alır. Genetik faktörler ise kromozomal anomaliler, tek gen hastalıkları ve trombofili gibi bozuklukları içerir. Anatomik faktörler arasında uterus anomalileri, servikal yetmezlik ve myomlar bulunur. Ayrıca, plasenta yerleşim bozuklukları da gebeliğin erken döneminde kayıplara yol açabilir. TGK’nin nedenlerinin belirlenmesi, çiftlerin başarılı bir gebelik elde edebilmesi için multidisipliner bir yaklaşım gerektirir. Bu doğrultuda, uygun teşhis ve tedavi yöntemleri ile tekrarlayan gebelik kayıpları önlenebilir ve sağlıklı bir gebelik süreci desteklenebilir. Recurrent pregnancy loss (RPL) is a complex condition that poses significant psychological and physiological challenges for couples. Defined as the loss of at least three consecutive pregnancies, RPL can result from immunological, genetic, and anatomical factors. Immunological causes include antiphospholipid syndrome, autoimmune diseases, and alloimmune factors. Genetic factors such as chromosomal abnormalities, single-gene disorders, and thrombophilia can also contribute to pregnancy loss. Anatomical factors, including uterine anomalies, cervical insufficiency, and fibroids, may prevent a successful pregnancy. Additionally, placental implantation abnormalities can lead to early pregnancy losses. Identifying the underlying causes of RPL requires a multidisciplinary approach to improve pregnancy outcomes. Through proper diagnosis and treatment, recurrent pregnancy loss can be managed effectively, enabling couples to achieve a successful pregnancy.