Prediction of gestational diabetes using deep learning and Bayesian optimization and traditional machine learning techniques.

The study aimed to develop a clinical diagnosis system to identify patients in the GD risk group and reduce unnecessary oral glucose tolerance test (OGTT) applications for pregnant women who are not in the GD risk group using deep learning algorithms. With this aim, a prospective study was designed and the data was taken from 489 patients between the years 2019 and 2021, and informed consent was obtained. The clinical decision support system for the diagnosis of GD was developed using the generated dataset with deep learning algorithms and Bayesian optimization. As a result, a novel successful decision support model was developed using RNN-LSTM with Bayesian optimization that gave 95% sensitivity and 99% specificity on the dataset for the diagnosis of patients in the GD risk group by obtaining 98% AUC (95% CI (0.95-1.00) and p < 0.001). Thus, with the clinical diagnosis system developed to assist physicians, it is planned to save both cost and time, and reduce possible adverse effects by preventing unnecessary OGTT for patients who are not in the GD risk group.

A prospective study for gestational diabetes mellitus: Analysis of risk factors in Turkish women for early prediction.

OBJECTIVE: To define risk factors for the early prediction of gestational diabetes mellitus (GDM) because the risk of pre-eclampsia and preterm birth increases in mothers who are diagnosed with GDM. MATERIALS AND METHODS: A prospective study was designed and the data were collected by physicians prospectively from the patients who came to the clinic between the years 2019 and 2021; informed consent was obtained from the women. The prospective data comprised 489 patient records with 72 variables and the risk factors for early prediction of GDM were determined using logistic regression and random forest (RF), which is an advanced analysis method. RESULTS: The obtained sensitivity and specificity values are 90% and 75% for logistic regression and 71% and 90% for the RF, respectively. CONCLUSION: In this prospective study of GDM in Turkish women; age, body mass index, level of hemoglobin A1c, level of fasting blood sugar, physical activity time in first trimester, gravidity, triglycerides, and high-density lipoprotein cholesterol were confirmed to be risk factors in analysis results.

Comparison of the effect of general anesthesia and spinal anesthesia technique combined with general anesthesia on intraabdominal volume during gynecological laparoscopy.

PURPOSE: We aimed to investigate the effect of spinal anesthesia which will be performed simultaneously with general anesthesia on the site of operation with the same pressure. MATERIAL AND METHOD: This study was conducted as a randomized, prospective clinical study on 40 patients who were randomly divided into two groups. Twenty women underwent general anesthesia (Group GA) and 20 women underwent spinal anesthesia with general anesthesia (Group SGA). For all cases, preoperative height, weight, waist circumference, body mass index (kg/m2 ), the distance between both spina iliaca anterior superior, the distance of the intersection of both ribs with an imaginary line drawn over the anterior axillary line, suprapubic bone-umbilical, umbilical-xiphoid, and suprapubic bone-xiphoid distance from the midline of the abdomen were measured. Moreover, while the patient was lying in the neutral position on the operating table, the height of the highest point of the abdomen to the operating table was also measured. These measurements were repeated at intra-abdominal pressure (IAP) 14 and 25 mmHg. The amount of intra-abdominal insufflated CO2 was also recorded at IAP 14 and 25 mmHg. RESULTS: When the intra-abdominal insufflation volumes of both groups were compared at 14 and 25 mmHg, respectively, there was no statistical difference (p: 0.54, p: 0.40). When 14 and 25 mmHg were compared in all cases, a statistically significant difference was observed in other measurements except in xiphoid-umbilical distance (p < 0.05). CONCLUSION: We found that spinal anesthesia combined with GA had no effect on the abdominal volume and anthropometric measurements in laparoscopic procedures.

Comparison of the effect of isotretionin and alitretionin on endometriotic implants and serum vascular endothelial growth factor level: an experimental study.

OBJECTIVE: To compare the effects of alitretionin and isotretionin on endometrial peritoneal implants and serum vascular endothelial growth factor (VEGF) levels. STUDY DESIGN: Forty-eight female Sprague Dawley rats were used. Initially surgical rat endometriosis model was done. The endometrial implant volume was measured and rats were randomly divided into four groups. Group 1: Control group (rats did not get any drug but having endometriotic implants), group 2: rats receiving po isotretionin 10 mg/kg per day for 10 d, group 3: rats receiving po isotretionin 20 mg/kg per day for 10 d and group 4: rats receiving po alitretionin 80 mg/kg per day for 10 d. After 1-week medication, rats were sacrificed and size, histopathology of endometriotic implant and levels of VEGF were evaluated. RESULTS: Volumes of peritoneal endometrial implants were significantly decreased in Group 2 and Group 3 compared with initial values. However, there were no significant changes in histopathological scores and serum VEGF levels in all groups. CONCLUSIONS: This study finding may suggest the possible medical treatment modality of isotretionin on endometriosis. However, alitretionin (potent retinoid) does not have potent regressive effect on endometriotic implants as in isotretionin.

Status of vitamin D, antioxidant enzymes, and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy.

OBJECTIVE: To investigate the concentration of vitamin D (VD), glutathione peroxidase (GP), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) in neonates with hypoxic-ischemic encephalopathy (HIE). MATERIAL AND METHODS: This study was performed prospectively in term neonates treated for HIE. Samples were collected from the neonates in study and control groups at 6-14 h and on day 5 of their lives for 25-OH vitamin D3, antioxidant enzymes including GP and SOD and oxidants substances including MDA and AOPP. RESULTS: This study was performed with 31 term neonates with HIE and 30 healthy term neonates. Maternal VD level was statistically lower in the study group (9.8 ± 6.8 ng/mL) than the control (16.4 ± 8.7 ng/mL) (p = 0.002). SOD and MDA levels were significantly high, and VD level was significantly low in the study group on the first day of life (p = 0.001 and p = 0.028, respectively). SOD and GP levels were significantly high in the study group on day 5 (p < 0.05). VD was significantly low in the study group on day 5 and the proportion of subjects with VD below 5 ng/ml was significantly lower in the control group (p= <0.05). CONCLUSION: VD has neuroprotective and antioxidant properties. We detected VD levels were low in infants with HIE and their mothers. This finding may be useful for decreasing of brain damage.

Is the measurement of serum ischemia-modified albumin the best test to diagnose ovarian torsion?

AIM: The aim of this study is to evaluate the diagnostic value of serum oxidative stress marker levels (ischemia-modified albumin, IMA; malondialdehyde, MDA) and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) levels that occur in ovarian torsion and to determine the threshold value of these markers in the diagnosis of ovarian torsion. METHODS: In this prospective case-control study, 34 women (the study group) with acute pelvic pain (20 with and 14 without ovarian torsion) and 40 control subjects were included. The diagnosis of ovarian torsion was confirmed with laparoscopy in all cases. Preoperative serum samples were collected in the study group. Serum oxidative stress marker levels (IMA and MDA) and TOS, TAS and OSI levels were measured. RESULTS: Serum MDA, TOS and IMA concentrations were significantly higher in women with ovarian torsion than in the healthy control group. However, serum TAS, TOS and OSI concentrations were significantly higher in women without ovarian torsion than within the healthy control group. Only IMA significantly distinguished patients with or without ovarian torsion. The best IMA value, according to the receiver operating characteristic curve, was 0.7045 absorbance units, with 90.00% sensitivity and 92.31% specificity. The patients in the ovarian torsion group had significantly lower serum TAS and OSI levels compared with patients without ovarian torsion. CONCLUSION: The elevated serum IMA levels with high sensitivity-specificity values observed in women with ovarian torsion seem to have a potential role as a serum marker in the preoperative diagnosis of ovarian torsion in emergency settings.

Endometrial injury may increase the clinical pregnancy rate in normoresponders undergoing long agonist protocol ICSI cycles with single embryo transfer.

OBJECTIVE: To investigate the effect of endometrial injury on the clinical pregnancy rate in normoresponders undergoing long agonist protocol intracytoplasmic sperm injection (ICSI) cycles with single embryo transfer. STUDY DESIGN: Prospective case-control study. METHODS: One hundred and eighteen women (age <35 years, normoresponders with Grade I or II embryos for transfer) were included. Women in the intervention group (n=56) underwent endometrial biopsy on Day 3 of the menstrual cycle following downregulation. Women in the control group (n=62) did not undergo endometrial biopsy. RESULTS: The clinical and embryological characteristics were comparable in the two groups, and no significant difference was found in the fertilization rates (66.32% in the intervention group vs. 70.23% in the control group). The clinical pregnancy rate was 48.2% in the intervention group and 29.0% in the control group (p=0.025). Endometrial injury may increase the clinical pregnancy rate (odds ratio 2.27). The 'take home baby' rates were 33.9% and 17.7% in the intervention and control groups, respectively (p=0.035). CONCLUSION: Assisted reproductive technology treatment that is preceded by endometrial injury may increase the clinical pregnancy rate in women undergoing long agonist protocol ICSI cycles with single embryo transfer.

Intramural leoimyoma without endometrial cavity distortion may negatively affect the ICSI - ET outcome.

BACKGROUND: To assess the impact of intramural fibroids on the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycle outcome, when there is no compression of the endometrial cavity. METHODS: In this retrospective, matched control study, the ICSI-ET outcome of sixty-two patients (Group I) with intramural fibroid (mean diameter <7 cm) and normal endometrial cavity demonstrated by office hysteroscopy was compared with matched-control group of patients (n = 301) with no fibroid (Group II). The diagnosis of fibroids was done by transvaginal ultrasonography. RESULTS: The mean age in fibroid group was 32.66 +/- 5.30 while this figure was 32.95 +/- 3.98 in control group. The clinical pregnancy rate was significantly lower in the fibroid group although fibroids not distorting the uterine cavity (25.8% vs. 39.9%, p = 0.04). In fibroid group the implantation rate was significantly lower than control group (20.97 +/- 37.93 vs.32.89 +/- 43.18%, p = 0.04). However, spontaneous abortion rate was higher in fibroid group but it did not reach the significant level (12.5% vs. 9.2%, p > 0.05). CONCLUSION: Women having intramural leiomyomas not encroaching on the uterine cavity have unfavorable ICSI/ET outcomes comparable to those of women without such leiomyomas. Therefore, myomectomy may be a good option for such patients with intramural fibroids even they do not have any endometrial distortion.

The effect of ethinyl estradiol and drospirenone-containing oral contraceptives upon mucoprotein content of cervical mucus.

OBJECTIVE: To report the effect of oral contraceptives (OC) on cervical mucoprotein content by evaluating quantitatively mucoprotein 1 (MUC1), mucoprotein 2 (MUC2), mucoprotein 5AC (MUC5AC) and mucoprotein 5B (MUC5B) levels. STUDY DESIGN: This prospective controlled study included 20 women of reproductive age who had requested OC. Cervical mucus samples were obtained from the women before use of the OC and after 2 months of OC use. The mucus samples were then evaluated quantitatively for MUC1, MUC2, MUC5AC and MUC5B by ELISA by using specific antibodies. RESULTS: MUC5AC mucoprotein predominated quantitatively both before and after OC use. After OC use, compared to before OC use, variable increases in the levels of all studied mucoproteins were recorded, but the increases in MUC1, MUC2 and MUC5B were statistically significant. The difference in the level of MUC2 was remarkable (+54.36 ± 31.88 ng/mL). CONCLUSION: OC use may change the mucoprotein content (especially for MUC2) of cervical mucus and thus, may cause a highly viscous pattern of cervical mucus which may enhance the contraceptive efficacy of OC pills.

Failed labor induction in nulliparous women at term: the role of pelvic floor muscle strength.

INTRODUCTION AND HYPOTHESIS: The prolongation, protraction or complete cessation of labor is called failed labor. It is one of the leading indications for cesarean delivery. The goal of this study was to measure pelvic floor muscle strength and investigate its effect on labor in nulliparous pregnant women. METHODS: A total of 88 patients were included in the study. The study was conducted in nulliparous pregnant women with a low Bishop score (≤ 7). A low-dose intravenous oxytocin protocol was used for labor induction in all patients. Evaluation of pelvic floor muscle (PFM) strength was performed using a vaginal pressure measurement device just before labor induction. The duration of labor stages and the rate of failed labor were considered the main outcomes. The study group consisted of patients whose labor failed and who subsequently underwent cesarean delivery. The control group consisted of patients who delivered vaginally. The pelvic floor muscle strength and main outcome measures of the two groups were compared. RESULTS: No differences were found in age, weight, height, body mass index (BMI), and neonatal birth weight between the study and control groups. The mean resting and maximum squeeze pressures in the study group were 29.6 ± 9.8 and 56.4 ± 12.1 cm H(2)O respectively, significantly higher than in the control group. The best predictor of failed labor was a maximum squeeze pressure value of 59 cm H(2)0 (51.6% sensitivity and 87.7% specificity). CONCLUSIONS: Pelvic floor muscle strength appears to play a role in predicting failed labor.

Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study.

OBJECTIVE: To investigate the effect of carbon dioxide pneumoperitoneum on systemic oxidative stress by using serum oxidative stress markers (ischemia modified albumin (IMA), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI)) and to compare their effectiveness at clinically accepted safe intra-abdominal pressure levels (<12 mmHg). STUDY DESIGN: A total of 33 consecutive patients who had a unilateral ovarian cyst were enrolled for this prospective clinical study. All women underwent a laparoscopic ovarian cystectomy procedure. Venous blood was collected from patients preoperatively, 10 min after induction of anesthesia and 30 min after insufflation. Preoperative, 10(min), and 30(min) serum IMA, MDA, TOS, OSI and TAS levels were compared. RESULTS: The mean age was 29.3 ± 6.4 and the range of operation time was 45-80 min. The mean serum IMA levels showed a significant increase 30 min later from CO(2) insufflation (p<0.05). Significant alterations were not observed in serum MDA, TOS, OSI or TAS levels. CONCLUSIONS: Laparoscopic surgery causes systemic ischemia and this ischemic effect can be revealed by measuring serum ischemia modified albumin. IMA is more sensitive than MDA, TOS, OSI and TAS in early detection of systemic oxidative stress.

Life-threatening intraabdominal bleeding after oocyte retrieval successfully managed with angiographic embolization.

OBJECTIVE: To report the first case of massive intraabdominal hemorrhage after transvaginal ultrasonographically guided oocyte retrieval that was successfully managed with angiographic uterine artery embolization. DESIGN: Case report. SETTING: Assisted reproduction unit of a tertiary university hospital. PATIENT(S): A 40-year-old woman with a history of primary infertility presented 10 days after oocyte retrieval because of severe abdominal pain, vomiting, and vaginal bleeding for 3 days. She had a history of mild factor VIII deficiency for 3 years. INTERVENTION(S): Evaluation of the intraabdominal hemorrhage with ultrasonography and angiography. Management of oocyte pickup complicated with intraabdominal hemorrhage. MAIN OUTCOME MEASURE(S): Treatment of massive life-threatening intraabdominal hemorrhage with bilateral uterine artery embolization. RESULT(S): After transfusion with 2 units of fresh-frozen plasma and packed red blood cell, an interventional radiologist performed percutaneous transcatheter pelvic angiography to detect abnormal vascularization and vascular blush consistent with hemorrhage and then immediate bilateral uterine artery embolization was done. The patient was discharged from the hospital 5 days later without any remarkable complications. CONCLUSION(S): Angiographic uterine artery embolization under fluoroscopic guidance is a successful nonsurgical approach for the treatment of oocyte pickup-induced life-threatening hemorrhage.

Thoracopagus conjoined twins: a case report.

Objective. Conjoined twin is a rarely seen congenital anomaly together with severe mortality and morbidity. The more common types of conjoined twins include the thoracopagus type, where the fusion is anterior, at the chest, and involves the heart. We are reporting one case of conjoined thoracopagus twins diagnosed by ultrasonography at 11 weeks. Case Report. In a multigravid pregnant woman who has been admitted to our clinic with a diagnosis of conjoined twins, thoracopagus, by ultrasonography at an 11-week gestation, termination of the pregnancy was performed. Conclusion. Making an early diagnosis with ultrasonographic examination gives the parents a chance to elect pregnancy termination.

Acute increase in plasma D-dimer level in ovarian torsion: an experimental study.

BACKGROUND: Torsion of the ovary is a rare but serious cause of gynecologic surgical emergency. Specific laboratory markers that support the preoperative diagnosis of ovarian torsion are not currently available in the clinical routine. The aim of this study was to investigate the diagnostic value of plasma D-dimer level as an early indicator of ovarian torsion in an experimental rat ovarian torsion model. METHODS: Sixteen female adult Sprague-Dawley rats were used for this controlled experimental study. Eight rats in the sham operation group (Group I) underwent a surgical procedure similar to Group II but the ovary was not occluded. In Group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary for a 2-h period of ischemia. Right ovaries were surgically removed at the end of the procedure in each group. Blood was sampled before and after operation to assess plasma D-dimer levels. The main outcome measure was ovarian histopathologic findings scores and plasma D-dimer levels. RESULTS: There was no significant difference in pre-operative plasma D-dimer levels (0.5963 ± 0.2047 mg/l in Group I, 0.6344 ± 0.1348 mg/l in Group II, P = 0.815, Mann-Whitney U-test). However, mean plasma D-dimer value for Group II was significantly higher than that in the control group (1.2267 ± 0.3099 versus 0.6213 ± 0.2346 mg/l, respectively, Mann-Whitney U-test, P < 0.001), following 2 h of ovarian torsion. Ovarian tissue damage scores were also statistically significantly different among groups. CONCLUSIONS: If the observations made in a rat model are extended to humans, plasma D-dimer measurement may be a valuable parameter in the early diagnosis of ovarian torsion.

Meperidine versus valethamate bromide in shortening the duration of active labor.

OBJECTIVE: To compare the efficacy and safety of meperidine hydrochloride and valethamate bromide against placebo in shortening the duration of active labor. METHOD: We randomly assigned 160 nulliparous women with a singleton pregnancy at term who needed induction of labor to one of 3 treatments: 50 mg of meperidine (n=53), 16 mg of valethamate bromide (n=53), or a normal saline solution as placebo (n=54). All medications were given by slow intravenous infusion. Labor duration was the main outcome measure. RESULTS: The intervals between infusion and complete cervical dilation and between infusion and delivery were significantly reduced (P<0.001 and P<0.01) in the meperidine group (103.0+/-64.5 minutes and 119.8+/-70.2 minutes), in contrast to the placebo group (173.9+/-74.8 minutes and 192.2+/-82.8 minutes). However, differences were not significant between the 2 treatment groups (139.6+/-63.1 minutes and 160.6+/-71.9 minutes), or between the valethamate bromide and the placebo group. CONCLUSION: Meperidine, but not valethamate bromide, significantly shortened the duration of active labor in nulliparous women with a singleton pregnancy at term.

The underlying cause of cervical cancer in oral contraceptive users may be related to cervical mucus changes.

Oral contraceptives (OCs) remain among the most effective reversible methods of birth control available today, providing almost 100% effectiveness with an impressively high margin of safety and other important health benefits. However, concerns have been raised about the role that the hormones in OCs might play in the pathogenesis of cervical cancer. Evidence shows that long-term use of OCs (five or more years) may be associated with an increased risk of cancer of the cervix. The mechanism of increased risk of cervical cancer in OCs users has long been debated, and remains uncertain. Our hypothesis is that scanty, thick, and highly viscous cervical mucus obtained in OCs users intimately involved in the pathogenesis of cervical cancer. Possibly, this architecture of cervical mucus may modulate and prolong the effect of carcinogenic agents, which have been carried by coitus and stored in posterior vaginal fornix, on squamocolumnar junction of cervix by not permitting them to be removed because of its highly viscous pattern. The role of cervical mucus changes by means of specific mucin protein changes on the pathophysiology of cervical cancer in OCs users should be investigated.

The role of reoperation in the management of endometrial carcinoma found in simple hysterectomy.

OBJECTIVE: To evaluate our experience in patients with endometrial cancer found in simple hysterectomy. METHODS: Forty patients treated for endometrial cancer after simple hysterectomy were evaluated, retrospectively. Twenty-one patients (Group 1) underwent surgical staging procedure while 19 patients were not subjected to complementary surgical staging procedure (Group 2). RESULTS: The mean age was 53.80 years. Residual disease following reoperation was found in only four patients (19.0%). The three of them who were considered Stage IC (two Grade 1, one Grade 2) were found to be Stage IIIC and one patient who was considered Stage IB (Grade 2) was found to be Stage IIIC. The overall recurrence rates in Groups 1 and 2 were 4.8% versus 10.5% (P > 0.05). The overall disease-free survival rates were 95.24% in Group 1 and 87.50% in Group 2 (P > 0.05). Considering the patients who received postoperative adjuvant radiotherapy (RT), the overall disease-free survival rates were 88.89% in Group 1 and 84.62% in Group 2 (P > 0.05). CONCLUSION: We believe that complementary surgical staging may have benefit in patients with incompletely staged endometrial carcinoma excluding Stage IA G1 cases, since the recurrence rate has rising and disease-free survival estimate has decreasing tendencies in incompletely staged patients than that in complementary surgically staged ones.