Gynecology Obstetrics & Reproductive Medicine

The Effects of the COVID-19 Pandemic on Abnormal Uterine Bleeding According to the PALM-COEIN Classification

Onur Bektas — 2024-12-30

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on abnormal uterine bleeding (AUB) according to the PALM-COEIN classification.

STUDY DESIGN: Patients who underwent surgical intervention due to AUB were categorized according to the PALM-COEIN classification, and the pandemic period was compared with the pre-pandemic period.

RESULTS: During the COVID-19 pandemic, an increase in abnormal uterine bleeding (AUB) was observed. This was statistically shown to be due to ovulatory dysfunction and endometrial problems (with p-values of 0.033 and 0.024, respectively). No significant changes were detected in categories including polyp, adenomyosis, leiomyoma, malignancy, and iatrogenic causes (p>0.05).

CONCLUSIONS: In the relationship between COVID-19, ovulatory dysfunction, and endometrial issues, several factors should be considered. These include direct inflammation of the ovarian and endometrial tissues, potential defects in endometrial repair mechanisms secondary to inflammation, changes in the hypothalamic-pituitary-ovarian axis, immunological effects of vaccination, systemic inflammatory responses affecting the ovary and endometrium, changes in inflammatory and immune mediators, and immune cell activation. Additionally, increased production of vasodilatory substances such as prostaglandin E2 and prostacyclin, decreased production of local vasoconstrictors like prostaglandin F2α and endothelin-1, as well as increased plasminogen activator activity leading to enhanced thrombolysis and disruptions in endometrial hemostatic mechanisms.

Comparison of Frozen and Final Pathology Results in Patients Operated for Endometrial Hyperplasia

Gonca Turker Ergun — 2024-12-30

OBJECTIVE: Our study aimed to determine the frequency of endometrial cancer in patients undergoing surgery with a diagnosis of endometrial hyperplasia and to evaluate the concordance between preoperative diagnosis, frozen section examination, and final pathology results.

STUDY DESIGN: The clinical findings, imaging results, and all pathology reports of patients who underwent total abdominal hysterectomy for endometrial hyperplasia (atypical or non-atypical) between January 2020 and January 2023 at our hospital were retrospectively evaluated. Demographic and clinical characteristics (age, menopausal status, parity, body mass index, presence of diabetes and hypertension) and pathology results were recorded from patient records.

RESULTS: 144 patients diagnosed with endometrial hyperplasia were included in the study. The frozen section and final pathology results of all patients diagnosed with non-atypical endometrial hyperplasia were reported as benign lesions. In the atypia group, the intraoperative frozen section results of 80.7% of the patients were classified as benign lesions, while the results of 19.3% were reported as malignant pathology. A statistically significant difference was found between the benign and malignant lesion groups, which were classified based on the final pathology results, with respect to age, menopausal status, and average endometrial thickness before biopsy.

CONCLUSION: In cases of endometrial hyperplasia with atypia, the possibility of cancer appearing in the final pathology results should be taken into consideration. In the preoperative evaluation of patients, characteristics such as endometrial thickness, age, and menopausal status may suggest the likelihood of encountering endometrial cancer during surgery in this patient group.

The Effect of Prognostic Nutritional Index and Systemic Inflammatory Index in Endometrioid Type Endometrial Cancer

Varol Gulseren — 2024-12-30

OBJECTIVES: The primary goal of the cohort was to show the relationship between systemic inflammatory index (SII) and prognostic nutritional index (PNI) values and the prognostic factors of endometrial cancer (EC), especially lymph node (LN) involvement, and lymphovascular space invasion (LVSI), which can not generally be evaluated preoperatively.

STUDY DESIGN: This is a retrospective cohort study on reviews of patient records who were diagnosed with EC and underwent treatment between January 2014 and 2021. Complete blood counts and albumin level measurements were performed within 2 weeks before treatment

RESULTS: Two hundred twenty-seven patients with endometrioid type EC were included in the cohort. The mean follow-up was 35.4 ± 19.6 months. LVSI positivity was 8.2% in the presence of low SII and 44.1% in the presence of high SII (p<0.001). LVSI positivity was 23.3% in the presence of low PNI and 11.1% in the presence of high PNI (p=0.025). Low and high PNI values do not affect disease-free (DFS) and overall survival (OS) significantly. 5-year mean DFS and OS differ significantly with low and high SII values.

CONCLUSİON: SII and PNI values can be used to predict the presence of LVSI in the preoperative period, and to determine the extent of LN dissection and the surgical procedure Patients with high SII values had worse survival outcomes.

The Analysis of the Fetal Abdominal Wall and Gastrointestinal Tract Abnormalities in a Single Tertiary Center

Gokhan Bolluk — 2024-12-30

OBJECTIVE: We aimed to evaluate the fetuses with gastrointestinal anomalies and anterior abdominal wall defects detected in the prenatal period in our clinic and to analyze their perinatal outcomes.

STUDY DESIGN: This retrospective study analyzed the data of 67 cases evaluated by the perinatology department of the Basaksehir Cam and Sakura City Hospital between January 2021 and May 2023 with a diagnosis of fetal anterior abdominal wall and gastrointestinal tract abnormalities.

RESULTS: A total of 67 cases were included in our study with a mean maternal age of 26.4 ± 3.1 years and a median gestational week of first assessment at our center of 22 weeks (12-39 weeks). The most common anterior abdominal wall malformations were omphalocele (n=29, 43.3%) and gastroschisis (6 cases, 9.0%), and the most common fetal gastrointestinal tract anomalies were duodenal atresia (n=10, 14.9%), dilated bowel (n=5, 7.4%), and intestinal atresia (n=4, 5.9%). While genetic testing was carried out in 18 cases (27%), chromosomal abnormality was found in 6 (9.0%) cases. Termination of pregnancy was performed in 6 cases (9.0%). Postnatally, surgery was performed in 49 cases (73.1%) with a diagnosis of postpartum omphalocele, duodenal atresia, gastroschisis, intestinal and anal atresia. An uneventful surgical course was recorded for 47 cases that underwent surgery.

CONCLUSION: The most common abdominal wall defects are omphalocele and gastroschisis, and the most frequent gastrointestinal anomalies are small bowel abnormalities (duodenal atresia, dilated bowel, intestinal atresia) in our study cohort. These abnormalities might be an isolated anomaly or part of a syndrome or associated with chromosomal abnormalities. The prognosis for infants with gastrointestinal malformation depends on the presence of associated anomalies or karyotype anomalies.

First-Trimester Threatened Abortion: Can Red Blood Cell Distribution Width-Standard Deviation Predict Miscarriage?

Sebnem Karagun — 2024-12-30

OBJECTIVE: The objective of the study was to investigate the predictive value of red blood cell distribution width-standard deviation (RDW-SD) and another complete blood count (CBC) derived blood markers in patients presenting with threatened abortion concerning miscarriage.

STUDY DESIGN: This retrospective cross-sectional study included a cohort of 222 women with threatened abortion in the first trimester. The study group consisted of 114 patients who underwent miscarriage, and the control group included 108 pregnant women who delivered at term. The prognostic potential of RDW-SD and other CBC indices, readily obtainable from blood counts at the presentation of threatened abortion, was examined in the context of miscarriage development. The predictive value was calculated using the Receiver Operating Characteristic (ROC) curve.

RESULTS: The analysis revealed a statistically significant decline in RDW-SD within the miscarriage cohort compared to the control group. Notably, no statistically significant differences were identified in the neutrophil-lymphocyte ratio (NLR), derived NLR (DNLR), systemic inflammatory immune index (SII), platelet-to-lymphocyte ratio (PLR), and delta neutrophil index (DNI).

CONCLUSION: In this study, we found that RDW-SD, as a novel inflammatory mediator may be a useful marker for miscarriage in first trimester bleeding. However, it should be noted that traditional CBC indices, including NLR, DNLR, SII, PLR, and DNI, were found to be unsuitable indicators for miscarriage in threatened abortion.

Tyrosine Kinase-2, Angiopoietin-2, and Thrombomodulin Axes in the Late-Onset Fetal Growth Restriction: A Prospective Cohort Study

Esra Altan Erbilen — 2024-12-30

OBJECTIVE: Investigating the interaction among three interconnected proteins, namely receptor Tyrosine Kinase-2 (Tie-2), the vascular remodeling cytokine Angiopoietin-2 (Ang-2), and the coagulation inhibitor Thrombomodulin (TM), may offer fresh insights into the multifactorial origins of late-onset fetal growth restriction (LFGR).

STUDY DESIGN: In this prospective cohort study, we assessed the maternal serum concentrations of Tie-2, Ang-2, and TM in pregnancies that developed LFGR (n=30) and a control group (n=59) within the gestational weeks of 32-39 gestational weeks at Trakya University Hospital (January 2021-December 2021). Concentrations were quantified using ELISA, and data analysis was conducted using the SPSS 22.0 Windows software package.

RESULTS: The 75th percentile concentrations of these proteins were significantly lower in cases of LFGR. Among heavy smokers, the risk of LFGR increased by 2.37-fold. A significant correlation was observed between these proteins in both LFGR and healthy pregnancies. However, the sensitivity and specificity of these proteins within the Tie-2, Ang-2, and TM axes were 51%, 56%, 51%, and 45%, 52%, and 50%, respectively. When we examined cases where all three proteins exhibited a consistent trend, LFGRs accounted for 23.33% with reduced levels and 30% with elevated levels, whereas this pattern was observed in 40.67% with reduced levels and 42.37% with elevated levels in healthy pregnancies.

CONCLUSION: Although our study underscores the significance of the intricate interactions between Tie-2, Ang-2, and TM proteins in LFGR pregnancies, it is evident that a more comprehensive investigation is required to make meaningful contributions to the clinical applicability of this subject.

The Role of Aspartate Aminotransferase/Platelet Ratio Index Score in Predicting Intrahepatic Cholestasis of Pregnancy and its Relationship with Total Bile Acid Level: A Case-Control Study from a Tertiary Center

Merve Demir — 2024-12-30

OBJECTIVES: The aim of this study is to examine the value of the first-trimester aspartate aminotransferase to platelet ratio index (APRI) score in predicting intrahepatic cholestasis of pregnancy (ICP) occurring later in pregnancy. Another aim of the study is to determine the relationship between APRI scores and total bile acid (TBA) levels in pregnant women with ICP.

STUDY DESIGN: This retrospective case-control study was conducted by examining the hospital records of women diagnosed with ICP (n=66) and healthy controls (n=70) among women followed during pregnancy. Hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) values of all patients were obtained from routine blood test data taken in the first and third trimesters. The first and third-trimester APRI scores of the patients were calculated. Demographic data, laboratory findings, and APRI scores of women with and without ICP during pregnancy were compared. Using Roc analysis, the values of AST, ALT, PLT values, and APRI scores were examined in predicting ICP among the first trimester findings of the patients. In addition, TBA levels of patients with ICP at the time of diagnosis were obtained from hospital records. The relationship between the first and third-trimester APRI scores and TBA levels in patients with ICP was evaluated using correlation analysis.

RESULTS: In the first and third-trimester laboratory values, AST and ALT levels and APRI scores were found to be higher and PLT values were lower in patients with ICP compared to healthy controls. Among the first trimester measurements of these data, the APRI score had the highest predictive value in predicting ICP (AUC values are 0.648 for AST, 0.655 for ALT, 0.633 for PLT, and 0.705 for APRI). In an examination of patients with ICP, the APRI score calculated in the first and third trimesters showed a positive correlation with the TBA level at diagnosis (r=0.435 p<0.001 for the first trimester and r=0.433 p<0.001 for the third trimester in the Spearman analysis).

CONCLUSIONS: In the future, the APRI score calculated in the first trimester of pregnancy may be used as a tool to predict ICP that may occur in the following weeks. There may be a positive correlation between APRI score and serum TBA level in patients with ICP.

Parity-Driven Disparities in Placenta Previa: A Comprehensive Analysis of Obstetric and Perinatal Factors

Fikriye Karanfil Yaman — 2024-12-30

OBJECTIVE: This retrospective cohort study aimed to investigate the incidence of known risk factors for placenta previa in primiparous patients and assess the maternal and fetal outcomes associated with this condition in a tertiary hospital setting.

STUDY DESIGN: Data were collected from electronic medical records of pregnant women with confirmed placenta previa who were monitored at our clinic and delivered between January 2016 and June 2024. Demographic characteristics, obstetric history, and perinatal outcomes were analyzed. Statistical analysis was conducted using SPSS version 22, and comparisons between multiparous and nulliparous women were made using appropriate tests.

RESULTS: A total of 674 pregnant women were included in the study, comprising 542 multiparous and 132 nulliparous women. Significant differences were observed between the two groups in terms of anesthesia type, transfusion rates, operation duration, and hemoglobin levels. Neonatal outcomes, including APGAR scores, showed variations between multiparous and nulliparous women. However, certain outcomes such as birth weight did not differ significantly between the groups.

CONCLUSION: This study provides valuable information on maternal and neonatal outcomes associated with placenta previa in multiparous and nulliparous women. The findings highlight the complex interplay between maternal parity, anesthesia choice, and clinical outcomes and underscore the importance of tailored management approaches in this population.

Extra-Hepatic Portal Venous Obstruction in Pregnant Women of South-Asian Descent: A Case Series

Nimmi Amala — 2024-12-30

Liver diseases complicate approximately 3% of pregnancies worldwide, and require specialized care to ensure optimal pregnancy outcomes. Extra-hepatic portal venous obstruction (EHPVO), even though asymptomatic in a majority of the cases, has a higher risk of variceal bleeding in pregnancy and adverse pregnancy outcomes. In this series, we describe five cases of EHPVO presenting during pregnancy at our tertiary care hospital, their antenatal management, and delivery outcomes. In our case series on EHPVO in pregnancy, a majority of the women were diagnosed during childhood and adequately asymptomatic before pregnancy. Two women underwent Endoscopic band ligation for esophageal varices and one woman underwent splenectomy before pregnancy for disease control. One woman was Anti-nuclear antibody (ANA) positive and another was Anti-phospholipid antibody (APLA) positive, while the other three did not have pre-existing thrombotic tendencies. One patient required Endoscopic band ligation during pregnancy. Pregnancy complicated by hypertension was noted in two of the five women (40%). Four of the five women (80%) had thrombocytopenia requiring blood products during delivery. Two women underwent preterm vaginal delivery, and one woman underwent preterm Caesarean section because of placental abruption. Three women had a post-partum hemorrhage, which was effectively managed with uterotonics and blood products. All five women and their neonates were discharged in good health. Multi-disciplinary approach with standardized antenatal care can give positive pregnancy outcomes in women with EHPVO.

Effect of Low-Dose Hormone Therapy on Metabolic Parameters and Bone Mineral Density

Ufuk Atlihan — 2024-12-30

OBJECTIVE: Early menopause causes several health concerns that are related directly to the deficiency of ovarian hormones, especially estrogen insufficiency. The purpose of the research was to investigate the impact of low-dose hormone therapy on metabolic parameters and bone densitometry in patients with early menopause.

STUDY DESIGN: A total of 98 patients aged 38-42 years with an early-menopause and followed up were evaluated retrospectively in this cohort study. After the diagnosis of early menopause, combined oral contraceptive (COC) treatment including 3 mg Drospirenone + 0.02 mg Ethinylestradiol was recommended to the patients. After 1 year of COC treatment, metabolic, ultrasonographic, and bone densitometry measurements of patients who did and did not use COC regularly were compared.

RESULTS: At the 12th-month follow-up, endometrial thickness was significantly higher in the COC group (3.8±0.4 mm) compared with the non-COC group (3.5±0.4 mm) (p<0.01). At the 12th month follow-up, the estradiol value was significantly higher (16.1±1.5 pg/mL) in the COC group compared with the non-COC group (14.8±2.5 pg/mL) (p<0.01). At the 12th month follow-up, the total cholesterol value was found significantly lower in the COC group (197±24.2 mg/dL) compared with the non-COC group (211±28 mg/dL) (p<0.01). At the 12th month follow-up, the Z-score was found significantly higher in the COC group (0.02±0.3) compared with the non-COC group (0.2±0.3) (p<0.01).

CONCLUSION: Hormone replacement therapy is very important for women who enter early menopause, and adequate estrogen therapy must be taken to maintain bone density and reduce menopausal symptoms.