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Öğe Can the systemic immune-inflammation index be a useful marker for the prediction of a missed abortion in the first trimester of pregnancy(Karger Publishers, 2023) Soykan Sert, Zekiye; Bülbül, RamazanWe aimed to predict the efficacy of the systemic immune-inflammatory index (SII) in predicting missed abortions. Methods: In this retrospective study, we analyzed the data of women diagnosed with a missed abortion between gestational weeks 7-12 at our clinic from January 2018 to December 2021. The control group consisted of women in healthy pregnancies who were at the same gestational weeks. The demographic characteristics of participants, SII (neutrophil count x platelet count/lymphocyte count), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) values were evaluated in both groups. Results: A total of 142 missed abortion group and 142 control group were included. SII was found to be statistically significantly higher in the missed abortion group than in the control group (917.1 +/- 549.7 and 557.1 +/- 193.7, respectively; p < 0.001). In the logistic regression model, SII was found to be an independent predictor of a missed abortion (odds ratio = 2.85, 95% confidence interval: 1.34-4.15, p < 0.001). We found that the diagnostic value of SII (area under the curve [AUC]: 0.765) was higher than PLR (AUC: 0.711) or NLR (AUC: 0.703) alone in patients with a missed abortion. We determined that an SII value of >709.75 predicted the development of a missed abortion with 64.0% sensitivity and 80.9% specificity. Discussion: In recent years, complete blood count parameters have been increasingly used as an indicator of systemic inflammation. Although there are many studies in the literature investigating the relationship of a missed abortion with PLR and NLR, there is limited research evaluating the relationship of this clinical condition with SII. We determined that SII obtained from the combination of lymphocyte, platelet, and neutrophil counts was more valuable than evaluating these parameters by dividing them separately. Conclusion: Our results show that there is a significant relationship between SII and a missed abortion, and therefore SII can be used as a predictive marker of this clinical condition.Öğe Comparison of colposcopic biopsy results of cervical cytology-negative and HPV 16/18 or other high-risk HPV subtypes(Annals of Medical Research, 2021) Soykan Sert, ZekiyeThis study aimed to compare the colposcopic biopsy results of patients with negative cervical cytology and positive human papillomavirus (HPV) tests and to investigate the necessity of colposcopy in patients with cytology-negative/other high-risk HPV (non-HPV 16/18) positive results. Materials and Methods: The study included 126 patients aged 30–65 years who underwent HPV DNA testing between 2016 and 2019 and who underwent colposcopic biopsy at our hospital because of their positive results. The patients were divided into three groups: HPV16/18 positivity, other high-risk HPV positivity, and unclassified HPV positivity. Cytology and colposcopy-guided cervical biopsy results were compared with the HPV types. Results: Approximately 44.4% of the patients had HPV 16/18 positivity, 23% had other high-risk HPV positivity, and 32.5% had unclassified HPV positivity. The cytology results revealed that 57.1% of patients were negative for intraepithelial lesions or malignancy (NILM), 22.2% had atypical squamous cells of undetermined significance, 17.5% had low-grade squamous intraepithelial lesions (LGSIL), and 2.4% had high-grade squamous intraepithelial lesions. Colposcopic biopsy results were normal in 15.1% of the patients, showed LGSIL in 15.9%, high-grade squamous intraepithelial lesions (HGSIL) in 10.3%, and cervical cancer in 0.8% of the patients. Evaluation of the biopsy results based on HPV type in the patients with NILM cytology revealed that 12.8% of those with HPV 16/18 positivity had LGSIL and 17.9% had HGSIL, whereas 7.1% of those with other high-risk HPV positivity had HGSIL and 7.1% had LGSIL. Conclusions: The possibility of detecting dysplasia in the colposcopic biopsies of patients who are NILM and HPV 16/18-positive is higher than in the colposcopic biopsies of patients with other high-risk HPV types; therefore, these patients should be evaluated using colposcopic biopsy. Colposcopic biopsy is unnecessary in the presence of NILM and other high-risk HPV types.Öğe Drug-induced poisoning during pregnancy: Four-year experience(W.B. Saunders, 2022) Soykan Sert, Zekiye; Sanalp Menekşe, TuğbaThe aim of this study was to define the population of pregnant women who presented to our clinic after drug exposure for suicidal purposes and to determine the effect of drug-induced poisoning on maternal and fetal outcomes. Methods: The records of patients who presented to the emergency department after a suicide attempt with drugs between 2017 and 2021 were retrospectively reviewed. Pregnant women aged 18 years and over who delivered their babies in our hospital were included in the study. Patient data were obtained from the hospital electronic database using the International Classification of Disease-10 code system. Demographic information, clinical characteristics, type of drugs ingested, pregnancy outcomes, and perinatal outcomes were recorded. Results: We found adverse pregnancy outcomes in five of the 28 patients included in the study. The most frequently used drugs for suicidal purposes were non-opioid analgesics, paracetamol, and antibiotics (39.3%, 35.7%, and 28.6%, respectively). Adverse pregnancy outcomes observed in the patients were preterm birth (n = 3), preeclampsia (n = 2), premature rupture of membranes (n = 1), fetal distress (n = 2), small for gestational age (n = 2), Apgar score at 5 min < 7 (n = 1), and requirement of neonatal intensive care (n = 2). Conclusion: Pregnant women attempting suicide with drug exposure are at high risk of many adverse obstetric outcomes. Providing these patients with appropriate clinical care is critical for the health of the mother and fetus.Öğe Effect of calcium and vitamin D supplementation on the clinical, hormonal, and metabolic profile in non-obese women with polycystic ovary syndrome(Springer Science and Business Media Deutschland GmbH, 2022) Soykan Sert, Zekiye; Yılmaz, Setenay Arzu; Seçilmiş, Özlem; Abuşoğlu, Sedat; Ünlü, Ali; Çelik, ÇetinIn this study, we investigated the effect of calcium and vitamin D (Ca/Vit D) supplementation on the clinical, hormonal, and metabolic profile of patients with low vitamin D levels. In addition, we investigated the effect of Ca/Vit D supplementation on asymmetric dimethylarginine (ADMA) level in patients with polycystic ovary syndrome (PCOS). Methods: In total, 75 patients aged 19–35 years, with a normal body mass index and a diagnosis of PCOS and Vit D deficiency/insufficiency, were included in the study. Patients received 50,000 IU of vitamin D3 once a week for 8 weeks. Afterward, 2500 mg calcium carbonate equivalent to 1000 mg calcium ion and 9.68 mg cholecalciferol equivalent to 880 IU vitamin D3 were administered orally as a maintenance treatment once a day. Results: The mean age of the patients was 21.7 ± 3.5. After Ca/Vit D supplementation, Vit D levels significantly increased compared to baseline (8.6 ng/ml) levels. An increase in SHBG levels (p < 0.001), a decrease in total testosterone, FAI (p = 0.042), and ADMA levels (p < 0.001) were observed in the first and third months compared to the onset. Significant improvement compared to baseline was observed in menstrual irregularity and median mFG score. Conclusion: Ca/Vit D supplementation can improve PCOS symptoms such as menstrual dysfunction, hirsutism, and hyperandrogenism. It may be effective in reducing the risk of cardiovascular disease in patients with PCOS later in life by decreasing ADMA levels, which is an indicator of endothelial dysfunction.Öğe Effect of inadequate antenatal care during the pandemic on maternal and fetal outcomes(Ondokuz Mayıs Üniversitesi, 2022) Soykan Sert, ZekiyeTo evaluate the effects of inadequate antenatal care (ANC) caused by the COVID-19 pandemic on pregnant women. In this retrospective study, pregnant women were divided into two groups as those presenting during the pandemic and non-pandemic periods. The pandemic period was selected as March 11, 2020- December 10, 2020 and the pre-pandemic period as March 11, 2019- December 10, 2019 corresponding to the same period a year earlier. Pregnant women receiving ANC three times or less was defined as inadequate ANC. The pregnant women were evaluated in terms of obstetric complications, including premature rupture of membranes, premature birth, placental abruption. gestational diabetes mellitus (GDM), preeclampsia, fetal or neonatal death, and maternal death. The study included 276 patients presenting during the pandemic period and 229 patients presenting during the non-pandemic period. When the pandemic and non-pandemic periods were compared, it was determined that the rates of fetal death, preeclampsia and GDM statistically significantly increased in the former. The rate of adequate ANC was 72.5% (n=166) in the non-pandemic period and 58.3% (n=161) in the pandemic period. When pregnancy complications were compared according to ANC during the pandemic, it was observed that the rates of fetal death, preeclampsia and GDM were higher among the pregnant women with inadequate ANC. Complications due to inadequate ANC may have more significant consequences than complications caused by a possible COVID-19 infection. During the pandemic period, healthcare professionals should ensure that women receive safe and effective care during both pregnancy and childbirth.Öğe Effect of obesity on the time to a successful medical abortion with misoprostol in first-trimester missed abortion(Springer Science and Business Media Deutschland GmbH, 2024) Bertizlioğlu, Mete; Soykan Sert, ZekiyeTo evaluate the efficacy of misoprostol used in first-trimester abortion in obese women and to determine whether obesity is associated with time to a successful medical abortion. Methods: The records of patients diagnosed with missed abortion at our clinic between 2018 and 2021 were retrospectively reviewed. All women aged 18 to 45 years who were diagnosed with missed abortion in the first trimester and treated with misoprostol were included in the study. The cases were divided into two groups: obese (body mass index [BMI] ? 30 kg/m2) and non-obese (BMI < 30 kg/m2). First, they were simultaneously administered 200 ?g misoprostol orally and 400 ?g vaginally. After the first misoprostol administration, the dose was repeated vaginally at 400 ?g every three hours if necessary. The effect of obesity on the time taken to achieve a medical abortion was evaluated. Results: A successful medical abortion occurred in 45.2% of the women in the obese group and 69.0% of those in the non-obese group. The time to uterine evacuation was 8.24 ± 4.03 h in the obese group and 6.35 ± 3.54 h in the non-obese group. The relationship between obesity and time to a successful medical abortion was evaluated using the Kaplan–Meier curve, which showed a significant difference between the two groups (p = 0.028). Conclusion: Our findings show that obesity affects time to a successful medical abortion. In addition, the rate of successful medical abortion after misoprostol administration was lower in the obese women.Öğe Predictive value of systemic immune-inflammation index in patients with preterm labor(Çukurova Üniversitesi, 2022) Soykan Sert, Zekiye; Bülbül, RamazanPurpose: The aim of this study was to investigate whether the systemic immune-inflammatory index (SII) could predict the development of preterm labor in pregnant women. Materials and Methods: Pregnant women aged 18 years and over who presented to our clinic with spontaneous labor between January 1, 2018, and December 31, 2021, had intact membranes, and had a single living fetus were retrospectively evaluated. The women were divided into two groups, preterm and term delivery, according to the week of delivery. The clinical and laboratory characteristics of the women were assessed. The patients' platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and SII (neutrophil count x platelet count/lymphocyte count) were calculated. Results: The study included 171 women with preterm labor and 173 women with healthy term labor. The PLR, NLR, and SII values were statistically significantly higher in the preterm group than in the term group. The multivariate logistic regression analysis showed that SII (odds ratio [OR]: 3.65, 95% confidence interval [CI]: 2.21-10.07) was an independent predictor of the development of preterm labor. We found that the power of SII to predict preterm labor (area under the curve [AUC]: 0.792) was higher than that of NLR (AUC: 0.725) or PLR (AUC: 0.716) alone. SII values higher than 789.3 predicted preterm labor with 68.4% sensitivity and 81.5% specificity. Conclusion: We found that SII was more valuable than NLR and PLR in the early detection of preterm labor. SII can help identify pregnant women at risk of developing preterm labor in the early stages of pregnancy.Öğe Predictive value of the HALP score for pre-eclampsia with severe features(Taylor and Francis Ltd., 2024) Soykan Sert, Zekiye; Bertizlioğlu, MetePredictive tests are needed to ensure the development and subsequent follow-up of pre-eclampsia, which is responsible for significant rates of morbidity and mortality during pregnancy. This study aimed to evaluate the predictive value of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for the severity of preeclampsia. Methods: We retrospectively analyzed the data of women diagnosed with pre-eclampsia at our clinic from January 2019 to January 2023. The control group consisted of normotensive, healthy pregnant women. Women diagnosed with preeclampsia were further evaluated in two groups: those with severe features and those without severe features. The clinical and demographic data of the cases were evaluated. The HALP score was calculated using the first trimester blood parameters of the cases and compared between groups. Results: The study included 229 patients with preeclampsia and 142 normotensive healthy controls. Of the patients with preeclampsia, 104 (28.1%) had severe features of the disease. The HALP score was significantly higher in the preeclampsia group with severe features than in the control group (6.18 ± 2.66 vs. 3.75 ± 1.86; p = 0.006). In multivariate logistic regression analysis, the HALP score (odds ratio: 2.02, 95% confidence interval: 1.10–3.32, p = 0.017) was found to be an independent indicator for preeclampsia with severe features. A HALP score of > 4.61 predicted the development of preeclampsia with severe features with a sensitivity of 74.5% and a specificity of 81.3%. Conclusion: We found a significant correlation between the HALP score and preeclampsia with severe features. The HALP score may be useful in predicting the severity of preeclampsia.Öğe Predictors of adverse outcomes in pregnant women with intrauterine hematoma(Ondokuz Mayıs Üniversitesi, 2022) Soykan Sert, ZekiyeTo investigate the relationship between clinical features evaluated at presentation and the presence of adverse maternal or perinatal outcomes in pregnant women with intrauterine hematoma (IUH). Pregnant women aged 18 years and over who were diagnosed with IUH and had a single live fetus of six to 12 weeks at that time were retrospectively reviewed for the period from January 1, 2019 to July 30, 2021. The patients were divided into two groups according to the presence or absence of adverse pregnancy outcomes after IUH. The clinical features of the patients were evaluated. The effect of clinical factors on adverse pregnancy outcomes was determined using the logistic regression analysis. We found adverse pregnancy outcomes in 31.6% (n=42) of 133 patients included in the study. According to the multiple logistic regression analysis, age?35 years [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.16-4.37, p<0.001], presence of vaginal bleeding (OR: 2.53, 95% CI: 1.34-3.89, p=0.001), hematoma size?4 cm (OR: 2.38, 95% CI: 1.08-4.15, p=0.023) and presence of retroplacental hematoma (OR: 2.44, 95% CI: 1.68-3.56, p<0.001) were risk factors for adverse pregnancy outcomes. In the presence of IUH, pregnant women aged ?35 years and those with vaginal bleeding, hematoma size of ?4 cm, and retroplacental hematoma are at risk of adverse pregnancy outcomes. These factors can help identify pregnant women who require close monitoring.Öğe Predictors of obstetric complications following traumatic injuries in pregnancy(W.B. Saunders, 2021) Soykan Sert, Zekiye; Sert, Ekrem Taha; Kokulu, KamilBackground: After a traumatic injury, the provision of appropriate, timely care to pregnant women jury is crucial for the health of both the mother and fetus. The aim of this study was to identify risk factors predicting post-traumatic obstetric complications in pregnant women who presented to the emergency department (ED) with traumatic injuries. Methods: We conducted a retrospective cohort study of pregnant women aged 18 y and older who were admitted to the trauma unit of our ED between 2017 and 2020. The data collected included maternal demographics, trauma mechanism, and pregnancy outcome. The patients were divided into two subgroups according to the presence or absence of trauma-related complications, and clinical features were compared between the two groups. Results: In total, 241 pregnant trauma patients were included in the study. The mean maternal age was 26.1 ± 4.4 y, and the mean gestational age the time of the trauma was 28.4 ± 6.8 wk. In the study, 17.8% (43/241) of patients experienced obstetric-related complications within the first 24 h post-trauma. The risk factors associated with obstetric complications were aged older than 35 y (odds ratio [OR] = 5.31,95% confidence interval [CI]: 1.77–15.96, p = 0.003), third trimester trauma (OR = 2.41,95% CI:1.14–5.12, p = 0.021), and abnormal obstetric ultrasonography (OR = 6.25,95% CI:2.03–19.22, p = 0.001). Conclusion: Among pregnant patients who present to the ED after a traumatic injury, advanced maternal age, trauma in the third trimester, and abnormal obstetric ultrasonography findings should alert physicians to the possibility of post-traumatic complications (within the first 24 h after trauma) and the need for close monitoring.Öğe The role of inflammatory markers and βhCG levels in predicting the success of single-dose methotrexate treatment in tubal ectopic pregnancy(John Wiley and Sons Ltd, 2024) Soykan Sert, Zekiye; Bertizlioğlu, MeteTo evaluate the predictive ability of serum beta human chorionic gonadotropin (βhCG) levels and inflammatory markers derived from hemogram parameters in the success of methotrexate (MTX) treatment for tubal ectopic pregnancy. Methods: This retrospective study involved the examination of patients diagnosed with tubal ectopic pregnancy and treated with a single dose of MTX at our clinic between 2018 and 2023. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from blood samples taken at the time of presentation. βhCG levels were recorded on days 1, 4, and 7 of treatment. The patients were categorized into successful and unsuccessful treatment groups based on their response to MTX. Results: No statistically significant differences were found between the two groups regarding MLR, NLR, PLR, or SII values (P = 0.284, P = 0.097, P = 0.455, and P = 0.061, respectively). In the receiver operating characteristic analysis of serum βhCG from day 1 to day 4, the area under the curve value was calculated as 0.832. The cutoff value for the serum βhCG change from days 1 to 4 was −0.093 (−9.3%), with a sensitivity of 85.53% and specificity of 74.14%, and a positive predictive value (PPV) of 87.5%. Conclusion: There were no significant differences in inflammatory markers (MLR, NLR, PLR, and SII) between the successful and unsuccessful MTX treatment groups. The change in serum βhCG levels between days 1 and 4 can be used as an early predictor of MTX treatment success in tubal ectopic pregnancy.Öğe The role of serum netrin-1 level in the detection of early-onset preeclampsia(Elsevier Ireland Ltd, 2022) Soykan Sert, ZekiyeObjective: To investigate whether serum netrin-1 levels measured in hypertensive pregnant women could predict the development of early-onset preeclampsia (EOP). Methods: This prospective observational study was conducted at a single academic medical center between August 1, 2019, and July 31, 2021. The study included patients aged >18 years who presented to our clinic because of gestational hypertension at gestational weeks 20–24 and underwent serum netrin-1 level measurements. All the patients were followed up until delivery for the development of preeclampsia. The patients were divided into two subgroups: those who developed EOP and those who developed late-onset preeclampsia (LOP). Results: Ninety-seven patients and 45 healthy controls were included in the study. EOP and LOP developed in 43 (44.3%) and 54 (55.7%) of the patients, respectively. The mean serum netrin-1 level at the time of presentation was significantly higher in the EOP group than in the control group (916.8 ± 370.5 pg/mL vs 487.7 ± 220.4 pg/mL; p [removed]784.9 pg/mL predicted the development of EOP with a sensitivity of 72.0% (95% CI: 56.3–84.7%) and specificity of 88.8% (95% CI: 75.9–96.3%). Conclusion: High serum netrin-1 levels were significantly associated with the development of EOP. The initial serum netrin-1 level may be useful for determining the risk of developing EOP in women with gestational hypertensive disorder.
