The importance of blood-count-derived inflammatory markers in predicting methotrexate success in patients with tubal ectopic pregnancy.

OBJECTIVE: To investigate the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) in predicting a successful methotrexate response in tubal ectopic pregnancy (TEP). METHODS: Women treated for TEP at a tertiary hospital between 2017 and 2021 were retrospectively reviewed. A total of 502 (100%) eligible patients who received methotrexate were included and divided into two groups based on whether or not they were successfully treated with methotrexate alone. Inflammatory parameters derived from the patients' hemograms at hospital admission were compared. RESULTS: In total, 434 (86.4%) patients were successfully treated with methotrexate alone (Group 1), while 68 (13.6%) patients underwent surgery after methotrexate failure (Group 2). Median neutrophil count, NLR, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, largest ectopic mass diameter, and ß-human chorionic gonadotropin (ß-hCG) were significantly lower, whereas median lymphocyte and platelet counts were significantly higher in Group 1. According to the receiver operating characteristic analysis performed for the discriminatory power of NLR, ß-hCG, and SII for methotrexate response, the area under the curve values were 0.742, 0.730, and 0.699, respectively. CONCLUSION: Low NLR and SII are associated with methotrexate success and could be used to refine decision making regarding ß-hCG for predicting successful response to methotrexate in patients with TEP.

The use of late preterm antenatal corticosteroids in women with gestational diabetes : a puzzle worth solving.

BACKGROUND: To investigate the association between late preterm antenatal corticosteroid treatment and outcome in late preterm neonates born to mothers with gestational diabetes mellitus, METHODS: All patients with gestational diabetes mellitus who had a late preterm delivery at Etlik Lady Zübeyde Hospital between 2017 and 2021 were included. Women who met the inclusion criteria and were not given antenatal corticosteroid treatment during current pregnancy before 34 0/7 weeks of gestation were divided into two groups according to whether or not they received late preterm antenatal corticosteroid treatment. The two groups were compared in terms of adverse neonatal complications. The main outcomes were composite respiratory outcome and composite neonatal outcome. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. RESULTS: This retrospective cohort study included a total of 400 participants with gestational diabetes mellitus who had a late preterm delivery within the study period. Of these women, 196 (49%) received late preterm antenatal corticosteroid treatment. Main outcomes showed no difference. Decreasing gestational age at birth was identified as an independent risk factor predicting both composite respiratory outcome and composite neonatal outcome in multivariate logistic regression analysis. CONCLUSIONS: Antenatal corticosteroid treatment at or after 34 0/7 weeks of gestation in women with gestational diabetes mellitus who had a late preterm delivery was not associated with improvement in adverse neonatal outcomes. Decreasing gestational age at birth was the only independent risk factor predicting composite neonatal and composite respiratory outcomes.

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

SUMMARY OBJECTIVE: This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. METHODS: This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. RESULTS: Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). CONCLUSION: Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

Investigation of human papilloma virus frequency in pregnant women.

OBJECTIVE: The aim of this study was to determine the frequency of human papillomavirus (HPV), HPV types, and the association with age, pregnancy, and childbirth in pregnant women. METHOD: Four hundred and forty-eight pregnant women who visited our clinic were enrolled in the study. Polymerase chain reaction was used to determine HPV DNA and typing by cervical smear in the initial applications of patients with detailed history. Statistical Package for the Social Sciences (SPSS) 13.0 was used to analyze the data. RESULTS: HPV DNA was positive in 26 (5.8%) of 448 patients who participated in the study. High-risk HPV types were detected in 77% of HPV-positive cases and low-risk HPV types in 23% of cases. Only one HPV type was detected in 13 patients (50%), while multiple HPV types were detected in 13 patients (50%) of the HPV-positive cases. A significant negative association was found between gravidity and positivity of HPV DNA. HPV is more common in women with lower parity and gravidity. CONCLUSION: Studies conducted in different populations in different regions of Turkey have shown that the incidence of HPV in women ranges from 2.2% to 26%. In our study, the incidence of HPV DNA in pregnant women was 5.8%. It was found that there was an inverse relationship between parity and HPV DNA positivity. The HPV DNA positivity decreased with the number of births.

Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance.

AIM: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound-guided vacuum aspiration method as an effective treatment option for CSP. METHODS: We undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018. All of the operations were carried out under general anesthesia, with patients in the lithotomy position, using suprapubic ultrasonography guidance. A vacuum aspirator was used to aspirate the whole pregnancy material without perforating the previous cesarean section scar. RESULTS: Ten women with CSP were managed successfully by ultrasound-guided vacuum extraction without complications or further interventions, such as reoperation or methotrexate administration. Three of the 10 patients needed uterine Foley catheter tampon (50 cc) for 4 h after vacuum extraction alone was applied. During the study period, two additional patients who did not meet the criteria for the vacuum extraction method alone were managed with methotrexate plus vacuum application. Because of the rarity of the condition, the majority of CSPs are case reports or small case series reported in published works, with no consensus on the preferred course of treatment. CONCLUSION: The vacuum extraction method seems to be a good and practical way of treating CSP. Comparisons of efficacy should be undertaken but large sample sizes are required. We hope this study brings a new perspective for larger sample-sized studies, considering the technique is feasible and applicable.