Objectives: This study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) and to assess the association between preoperative inflammatory and coagulation parameters and intraoperative blood loss. Methods: In this retrospective case-control study, 545 pregnant women were enrolled and divided into five groups: control (n = 251), PP (n = 246), PP with accreta (PPA, n = 18), PP with increta (PPI, n = 27), and PP with percreta (PPP, n = 33). Preoperative serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), delta neutrophil index (DNI), prothrombin time, fibrin degradation products (FDPs), D-dimer, and activated partial thromboplastin time (APTT) were analyzed. Results: The PPP group demonstrated significantly higher values of FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI, and lower APTT values compared to the other groups (p < 0.001). For predicting PAS, SIRI and DNI showed the highest diagnostic performance, each achieving 100% sensitivity and specificity, with optimal cut-off values of 2.01 and 2.45, respectively. For predicting intraoperative blood loss ≥1000 mL, PLR and SIRI exhibited the highest diagnostic accuracy, with optimal cut-off values of 122.5 (sensitivity 76.6%; specificity 72.6%) and 2.25 (sensitivity 73.4%; specificity 74.1%), respectively. Conclusions: FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI may serve as valuable biomarkers for differentiating PP from PAS, thereby enhancing preoperative risk assessment and guiding surgical planning to improve maternal outcomes. Additionally, PT, D-dimer, FDP, NLR, and DNI were identified as significant independent predictors of intraoperative blood loss.

Objectives: To evaluate the association between gestational diabetes mellitus (GDM), including insulin-dependent GDM with pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) and free beta human chorionic gonadotropin (free β-hCG) MoM levels, and to assess their potential as predictive risk factors. Methods: This retrospective study included 2588 women with singleton pregnancies who underwent combined first-trimester screening, along with the 50 g glucose challenge test (GCT) and a 100 g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation. Patients were initially divided into four groups based on the glucose screening results, and PAPP-A and free β-hCG MoMs were compared between these groups. GDM cases managed by diet were then compared with those requiring insulin therapy. Results: Of the study population, 132 women (5.10%) were diagnosed with GDM, 112 (84.8%) managed their glycemia with dietary changes, while 20 (15.2%) required insulin therapy. PAPP-A levels were significantly lower in the GDM group compared to the control group (p < 0.001). In addition, the insulin-dependent GDM group had significantly lower PAPP-A levels than the diet-controlled group (p < 0.001). No significant differences were observed in the free β-hCG MoM levels between the groups (p = 0.292). Receiver operating characteristic analysis identified 0.815 as the optimal PAPP-A cut-off value for predicting GDM, with a sensitivity of 61.4%, specificity of 61.6%, and an area under the curve (AUC) of 0.649 (95% CI: 0.595–0.703). For insulin-dependent GDM, the same threshold yielded an AUC of 0.621 (95% CI: 0.563–0.679), with a sensitivity of 58.6% and a specificity of 59.7%. Conclusions: Low serum PAPP-A MoM levels are significantly associated with the development of GDM, including insulin-dependent cases. Although PAPP-A alone may not be a definitive predictive marker for GDM, low levels could support the recommendation for early screening as part of a broader diagnostic approach.

Background: The aim of this study was to evaluate the diagnostic and prognostic performance of albumin-based inflammatory–nutritional indices in hyperemesis gravidarum (HG) and to determine their associations with disease severity and risk of re-hospitalization. Methods: This retrospective case–control study included 246 women with HG and 246 gestational-age-matched healthy pregnant controls at 6–16 weeks of gestation. Disease severity was classified as mild, moderate, or severe using the Pregnancy-Unique Quantification of Emesis (24 h scale) (PUQE-24) score. A comprehensive panel of albumin-based inflammatory indices—including C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), leukocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), monocyte-to-albumin ratio (MAR), hemoglobin–albumin–lymphocyte–platelet (HALP) score, modified HALP (m-HALP) score, prognostic nutritional index (PNI) score, systemic immune-inflammation index-to-albumin (SII/Alb), and systemic inflammatory response index-to-albumin (SIRI/Alb)—was calculated from routine complete blood count and serum biochemistry results obtained at diagnosis. Receiver operating characteristic analysis, along with univariate and multivariate logistic regression models, was performed to evaluate diagnostic performance and identify predictors of severe HG and re-hospitalization. Results: Albumin-based indices exhibited severity-associated alterations, with an overall trend toward worsening immuno-nutritional status across increasing HG severity. Among these, m-HALP score demonstrated the strongest inverse correlations with PUQE-24 score, ketonuria grade, length of hospital stay, and re-hospitalization risk (r = −0.74 to −0.52; all p < 0.001) and achieved the highest discriminative accuracy for both severe HG (AUC 0.864, 95% CI 0.836–0.892, p < 0.001) and re-hospitalization (AUC 0.722, 95% CI 0.675–0.766, p < 0.001). In multivariable analysis, higher HALP, m-HALP, and PNI were independently associated with a lower likelihood of severe HG. For re-hospitalization, higher m-HALP and HALP were independently associated with a lower risk, whereas higher NPAR, higher ketonuria grade, and higher PUQE-24 score were independently associated with an increased risk of re-hospitalization. Conclusions: Albumin-based indices, particularly m-HALP, demonstrated robust diagnostic and prognostic performance in HG compared with conventional biomarkers. These readily available, cost-neutral composite biomarkers enable objective severity stratification and accurate identification of patients at elevated risk of recurrent hospitalization, offering immediate potential to guide personalized, evidence-based clinical management.

Background/Objectives: This study aimed to evaluate the relationship between maternal systemic inflammatory indices, hematological parameters, and fetal thymus size, as measured by the thymus–thoracic ratio (TTR), among diabetic pregnancies, and to establish predictive cut-off values for reduced thymus size. Methods: This prospective cohort study enrolled 532 pregnant women, divided into four groups: pregestational diabetes mellitus (PGDM, n = 44), diet-controlled gestational diabetes mellitus (GDM, n = 73), insulin-treated GDM (n = 49), and normoglycemic controls (n = 366). Fetal thymus size, alongside serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), fibrinogen-to-albumin ratio (FAR), and C-reactive protein (CRP)-to-albumin ratio, were assessed in the third trimester. Results: All maternal diabetes subgroups demonstrated significantly reduced fetal thymus size compared with controls, with the most pronounced reduction observed in the PGDM group (p < 0.001). NLR, PLR, MLR, SIRI, AISI, and MPV were significantly elevated in the PGDM cohort, whereas CAR, FAR, and fibrinogen levels were markedly increased in the insulin-treated GDM group. Albumin levels were significantly decreased in both the PGDM and the insulin-treated GDM groups (p < 0.001). Among the evaluated biomarkers, AISI and FAR exhibited the highest diagnostic accuracy for predicting reduced fetal thymus size, with optimal cut-off values of 640.3 (sensitivity 82.3%, specificity 86.7%) and 0.114 (sensitivity 74.3%, specificity 88.7%), respectively. Conclusions: Maternal systemic inflammatory burden, as indicated by hematological biomarkers, is significantly associated with reduced fetal thymic size in diabetic pregnancies. These findings suggest that readily accessible blood-derived biomarkers, particularly AISI and FAR, may complement ultrasonographic evaluation, offering a cost-effective, non-invasive approach to predict compromised fetal immune development, especially in settings where direct thymic imaging is impractical.

Aim: Placenta accreta spectrum disorders (PAS) are a global threat to maternal well-being. The aim of this study was to assess differences in clinical characteristics and maternal outcomes between Turkish natives and Syrian refugees giving birth with a diagnosis of PAS at a tertiary centre, and to experience the management of this condition in the unique context of Türkiye, home to one of the world's largest refugee populations. Material and Method: A retrospective study was conducted using the medical records of 228 singleton pregnancies at high risk of PAS, between January 2019 and October 2022. PAS risk assessment was initially performed by ultrasound at mid-trimester, with diagnosis confirmed histologically or clinically, indicating the presence of placental retention following attempted manual removal. The study population was divided into two groups: native and refugee. We investigated disparities in demographic and medical characteristics and primary maternal and neonatal outcomes. Results: The study found an increased prevalence of previous cesarean delivery (p=0.005), anterior placenta (p