Gizem Aktemur’s research while affiliated with T.C. Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesi and other places

Objectives: This study aims to identify the risk factors associated with massive transfusion in obstetric hemorrhage and evaluate their predictive value to facilitate early intervention and improve maternal outcomes. Methods: A retrospective cohort study was conducted on 1305 women who received blood transfusions for obstetric hemorrhage at Etlik City Hospital between October 2022 and December 2024. Patients were categorized into two groups: those who required massive transfusion (≥10 units of blood products) and those who received at least one unit of transfusion. Demographic, clinical, obstetric, and hematological parameters were analyzed. Statistical comparisons were performed using chi-square, Fisher's exact, Mann-Whitney U, and independent sample t-tests. Results: A history of recurrent miscarriage, two or more previous cesarean sections, congenital uterine abnormalities, and uterine rupture were significantly associated with massive transfusion (P<0.01). Severe anemia (Hb<9 g/dL) and thrombocytopenia were also identified as critical hematological predictors (P<0.001). Socioeconomic factors, including low educational attainment and unemployment, were significantly correlated with the need for massive transfusion (P<0.001). Obstetric complications such as postpartum atony (P<0.001) and premature rupture of membranes (P=0.04) also contributed to increased transfusion risk. Conclusions: Identifying key risk factors for massive transfusion can aid in early recognition and timely intervention for obstetric hemorrhage. Integrating these predictors into clinical protocols may enhance maternal care by improving preparedness and reducing maternal morbidity and mortality.

Background/Objectives: This study evaluated the prognostic value of corpus luteum Doppler findings in predicting pregnancy outcomes in patients with threatened abortion, with or without subchorionic hemorrhage. Methods: A prospective cohort study included 180 pregnant women diagnosed with threatened abortion in the first trimester—120 without subchorionic hemorrhage and 60 with subchorionic hemorrhage. Corpus luteum Doppler parameters, including systole/diastole ratio, Resistance Index, and Pulsatility Index, were measured via transvaginal ultrasonography. Pregnancy outcomes were categorized as first-trimester abortion or continuation into the second trimester. Results: Corpus luteum Doppler parameters were significantly higher in patients with first-trimester abortion compared to those with ongoing pregnancies (p < 0.001). Among patients with subchorionic hemorrhage, those who experienced abortion also showed higher Doppler values (p < 0.001). ROC analysis indicated that corpus luteum Doppler parameters effectively predicted first-trimester abortion, with a systole/diastole ratio > 2.87 achieving 77% sensitivity and 75% specificity (AUC = 0.767, p < 0.001). Conclusions: Corpus luteum Doppler is a valuable, non-invasive tool for predicting pregnancy outcomes in threatened abortion, particularly with subchorionic hemorrhage. Increased resistance in Doppler parameters may indicate luteal insufficiency and reduced progesterone levels. Larger studies are needed to confirm these findings and explore underlying mechanisms.

Background: Preeclampsia is a serious pregnancy complication known to be related to the pathophysiology of platelet dysfunction and inflammation. The aim of this study was to investigate the role of platelet indices and inflammatory markers in preeclampsia and their importance in predicting adverse neonatal outcomes. Methods: A total of 118 preeclampsia cases (84 with mild preeclampsia and 34 with severe preeclampsia) and 118 healthy pregnant women were included in the study. Blood samples obtained at the time of preeclampsia diagnosis were analyzed for platelet indices (platelet count (PC), platelet distribution width (PDW), mean platelet volume (MPV), and platelet/large cell ratio (P-LCR)) and inflammation indices (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume-to-lymphocyte ratio (MPVLR)). Results: The PC and PLR were lower in the severe preeclampsia group compared to the other groups. The PDW was higher in both mild and severe preeclampsia groups compared to the control group. A PDW value above 13.15 was identified as a significant predictor of composite adverse neonatal outcomes (area under the curve (AUC): 0.633; sensitivity: 60.9%; specificity: 58%). Conclusions: PC and PLR decrease in severe preeclampsia. This study highlights the potential of PDW as a marker for predicting adverse neonatal outcomes in preeclampsia.

Objectives: This study aimed to evaluate the relationships between maternal and neonatal outcomes and the Fibrosis-4 Index (FIB-4) and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in healthy pregnancies, late-onset preeclampsia (LOP), and early-onset preeclampsia (EOP). Methods: A retrospective study was conducted on 239 pregnant women diagnosed with EOP (n=62), LOP (n=56), and healthy pregnancies (n=121) at Etlik City Hospital. Maternal and neonatal outcomes, as well as APRI, and FIB-4 scores were compared. Statistical analyses included ANOVA, chi-square tests, and ROC curve analysis. Results: EOP was associated with lower gestational age at birth, lower fetal birth weight, and higher NICU admission rates compared to LOP and control groups. APRI scores were significantly elevated in LOP compared to controls (P=0.012). FIB-4 scores were significantly higher in LOP than controls (P=0.005). ROC analysis showed modest predictive power for APRI (AUC=0.614) and FIB-4 (AUC=0.617) in distinguishing LOP from controls. The best cut-off values for APRI and FIB-4 were 0.2347 and 0.65, respectively. Conclusions: Elevated APRI and FIB-4 scores in LOP suggest their potential roles as complementary markers in preeclampsia management. However, their moderate predictive performance indicates the need for further studies.

Objectives: The aim of this study is to evaluate the effect of colchicine use on maternal inflammatory markers and pregnancy outcomes in pregnant women diagnosed with Familial Mediterranean Fever (FMF) and receiving colchicine therapy. Methods: This retrospective analysis included 42 pregnant women diagnosed with FMF who underwent colchicine treatment and 126 healthy pregnant controls. Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), and Monocyte/Lymphocyte Ratio (MLR) rates in the blood of the groups in the first trimester, obstetric morbidities and pregnancy outcomes were compared. Results: The patient cohort had markedly reduced hemoglobin levels (12.15±1.36 vs. 12.80±1.02 g/dL, P=0.001), an elevated prevalence of anemia (19% vs. 3%, P=0.002), and diminished monocyte counts (0.55 vs. 0.61 ×10⁹/L, P=0.022) as well as decreased MLR values (0.27 vs. 0.29, P=0.020) in comparison to the control group. Other inflammatory markers, pregnancy complications, and neonatal outcomes were similar between the groups (p>0.05). Conclusions: Colchicine seems to be useful in managing inflammation during FMF pregnancies without negatively affecting pregnancy or neonatal outcomes. Thorough prenatal care, encompassing anemia monitoring, is crucial for enhancing mother and fetal health.

Aim This study aims to evaluate the relationship between systemic inflammatory markers, derived from complete blood count (CBC) parameters, and spontaneous preterm labor. By comparing these markers between preterm and term pregnancies, the study seeks to determine their potential predictive value for adverse neonatal outcomes, including birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) scores, and neonatal intensive care unit (NICU) admission. Methods This study evaluated inflammatory markers in 478 women with spontaneous preterm labor and a gestational age‐matched control group. Blood samples were collected prior to the onset of labor to assess CBC parameters (white blood cells [WBC], red blood cells [RBC], neutrophils, lymphocytes, and platelet counts), as well as various inflammatory ratios, such as the systemic immune‐inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Neonatal outcomes, such as birth weight, APGAR scores, and NICU admission, were recorded. Results The preterm group showed significantly higher WBC, RBC, neutrophil, lymphocyte, and platelet counts compared to the control group. MLR, MPR, and MPVLR were notably lower in the preterm group. However, these hematological parameters and inflammatory markers demonstrated limited predictive value for adverse neonatal outcomes, with area under the curve (AUC) values hovering around 0.5. Conclusions WBC, RBC, neutrophils, lymphocytes, and platelet counts, along with inflammatory markers such as MLR, MPR, and MPVLR differ between preterm and term groups and can be derived from a simple CBC test. However, their predictive value for adverse neonatal outcomes remains limited.

Introduction Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes. Methods This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36 weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2 weeks. Patients were classified into two subgroups based on whether labor occurred within 7 days of PPROM diagnosis. Statistical analyses included the Mann–Whitney U test, Student’s t test, Chi-square test, Friedman test, Durbin–Conover test, generalized estimating equations (GEE), and ROC analysis. Results Gestational age at admission was significantly lower in patients who delivered later than 7 days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811). Conclusions Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.

Background: The aim of this study was to examine the relationship between conventional and novel Doppler parameters, including cerebroplacental ratio (CPR), cerebral–placental–uterine ratio (CPUR), umbilical-to-cerebral ratio (UCR), and amniotic-to-umbilical-cerebral ratio (AUCR), with the diagnosis of preeclampsia (PE) and adverse neonatal outcomes in PE cases. Methods: This prospective case-control study was conducted at the Ankara Etlik City Hospital Perinatology Clinic between November 2023 and May 2024. The study population was divided into two groups: Group 1, consisting of 74 patients diagnosed with preeclampsia, and Group 2, consisting of 80 healthy control patients. Composite adverse perinatal outcomes (CANOs) include presence of at least one adverse outcome: 5th-minute APGAR score < 7, transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), need for continuous positive airway pressure (CPAP), need for mechanical ventilation, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, need for phototherapy, intraventricular hemorrhage (IVH), and neonatal sepsis. Results: The CPR, CPUR, and AUCR were significantly lower in the PE group compared to the control group, while the UCR was notably higher in the PE group. Among the combined ratios, the CPUR exhibited the highest diagnostic performance for both PE diagnosis and the prediction of CANOs. Additionally, while the UCR, CPR, and AUCR were significant for PE diagnosis, only AUCR demonstrated a significant association with the prediction of CANOs. Conclusions: Combined Doppler parameters, especially CPUR and AUCR, offer valuable insights into diagnosing PE and predicting CANOs. CPUR demonstrated the highest diagnostic accuracy, underscoring its potential utility in clinical settings.

Problem Fetal growth restriction (FGR) is a critical pregnancy complication linked to increased perinatal morbidity and mortality. Inflammation plays a key role in FGR's pathophysiology, and systemic inflammation markers may serve as predictors. This study evaluates the role of various inflammation indices; systemic immune‐inflammation index (SII), systemic inflammatory response index (SIRI), pan‐immune‐inflammation value (PIV), neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), monocyte‐to‐lymphocyte ratio (MLR), lymphocyte‐to‐platelet ratio (LMR), monocyte‐to‐platelet ratio (MPR), aggregate systemic inflammation index (AISI), systemic coagulation inflammation index (SCII), and immature granulocyte percentage (IG%) in predicting FGR. Methods of Study This retrospective study included 403 pregnant women treated at Ankara Etlik City Hospital between August 2022 and May 2024. The study population comprised 202 women with uncomplicated pregnancies (control group) and 201 women diagnosed with FGR per the Delphi Consensus Criteria. Second‐trimester blood samples were used to calculate the inflammatory indices. Results SII and NLR levels were significantly higher in the FGR group compared to controls ( p = 0.020, p = 0.028, respectively). However, no significant associations were found between these indices and adverse neonatal outcomes. Cut‐off values for SII and NLR were 896 and 3.91, respectively, with moderate sensitivity and specificity. Conclusions SII and NLR, measured in the second trimester, may be useful in predicting FGR. Although these indices did not correlate with adverse neonatal outcomes, further prospective studies with larger populations are needed to validate their clinical utility.

Aims: The aim is to evaluate the association between intestinal permeability, as assessed by zonulin levels, and preterm premature rupture of membranes (PPROM). Methods: A prospective case-control study was conducted involving 44 pregnant women: 22 with PPROM and 22 matched controls. High-risk pregnancies (gestational diabetes, preeclampsia, multiple pregnancies), chronic diseases, and smoking were exclusion criteria. Demographic and clinical data were collected from medical records. Venous and umbilical cord blood samples were obtained post-delivery, centrifuged at 3000 rpm for 10 min, and stored at -80°C. Results: No significant differences were found between the PPROM and control groups regarding age, body-mass index, gravidity, previous abortions, history of preterm rupture of membrane (PROM), or PPROM. Maternal and cord blood zonulin levels were comparable between groups (p>0.05). In the PPROM group, maternal and fetal cord zonulin levels correlated positively with newborn birthweight (r=0.607, p=0.003; r=0.617, p=0.002, respectively). A strong positive correlation was observed between maternal serum and fetal cord blood zonulin levels (r=0.837, p