This study compared the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients with a history of gynecologic and obstetric surgery. This cross-sectional study included 100 women who underwent TLH (n = 50) and vNOTES hysterectomy (n = 50) for benign gynecological pathologies. The demographic features and surgical outcomes of all the patients were recorded retrospectively. Postoperative hematocrit values, Visual Analog Scale (VAS) scores (6-24th hour), uterine weights, operation time, hospital stay, postoperative analgesic application requirement, blood transfusion, vaginal cuff closure time, and intraoperative and postoperative complications were assessed. There were no differences in demographic features between the groups. The need for analgesic application was similar between groups (p = 0.590). Vaginal closure time was significantly shorter in the vNOTES group (p < 0.001). The surgery time and hospital stay were significantly shorter in the vNOTES group (p = 0.001 and p = 0.006, respectively), and there was no difference in complication rates between the groups (p = 0.992). The preoperative Htc values were similar in both groups (P = 0.980). There was no significant difference in the postoperative Htc values (p = 0.901). Postoperative 6th hour VAS score of the vNOTES group was significantly lower than that of the TLH group (p = 0.001). The vNOTES hysterectomy procedure has more advantages than TLH in terms of minimally invasive surgery, even in patients with a history of gynecologic and obstetric surgery.

Aim: In our study, we aimed to comprehensively evaluate the surgical parameters of patients who underwent total laparoscopic hysterectomy (TLH) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and their effects on the development of pelvic organ prolapse (POP) and sexual function one year later. Materials and Methods: This retrospective and comparative study involved a review of medical records for 42 patients who underwent total laparoscopic hysterectomy (TLH) for benign conditions and 42 patients who underwent hysterectomy using vaginal natural orifice transluminal endoscopic surgery (vNOTES) at our clinic between January 2023 and January 2024. Evaluations of preoperative and postoperative pelvic organ prolapse and sexual function were conducted, and the anatomical and functional outcomes of both surgical methods were compared. Results: In this study, there was no statistically significant difference between the groups in terms of age (p < 0.299), BMI (p < 0.819), parity (p < 0.615), surgical indications and menopausal status (p < 0.535) (p > 0.05). The vNOTES method was found to be significantly shorter than TLH in terms of surgical time (vNOTES: 58 min, TLH: 80 min, p < 0.001). However, there was no significant difference between the two methods in terms of preoperative and postoperative hematocrit values, hospital stay and FSFI scores (p > 0.05). Among the POP-Q parameters, a significant difference was observed only in the Aa parameter in favor of the vNOTES method (p < 0.003). Conclusions: In our study, the vNOTES method provided a shorter surgical time and better anterior vaginal support compared to TLH, but both methods offered similar results in terms of sexual function. More comprehensive studies are needed to clarify the long-term effects.

This study aimed to assess the feasibility, safety, and perioperative outcomes of the retroperitoneal vaginal natural orifice transluminal endoscopic surge

Background and Objectives: Epidural analgesia remains the gold standard for intrapartum pain relief; however, its influence on labor dynamics and neonatal outcomes in nulliparous women continues to be debated. This prospective cohort study aimed to investigate the effects of epidural analgesia on labor progression and neonatal outcomes among women experiencing spontaneous term labor. Materials and Methods: A total of 100 nulliparous women with singleton, cephalic pregnancies at 37–41 weeks of gestation were prospectively enrolled. Participants self-selected into either the epidural analgesia group (n = 50) or the no epidural analgesia group (n = 50) after standardized counseling on pain management options. Demographic data, labor characteristics, and neonatal outcomes, including the durations of the active and second stages of labor, the use of episiotomy or instrumental delivery, and the 1- and 5-min Apgar scores, were recorded and compared between groups. Group comparisons showed statistically significant differences when p values were below 0.05. Results: The active phase of labor was significantly longer in women receiving epidural analgesia compared with those without it, showing an approximately 60-min difference with a p value less than 0.001. The second stage was also modestly prolonged in the epidural group (p < 0.001). Although the episiotomy rate was higher among women with epidural analgesia, there were no significant differences in perineal tears or instrumental delivery. Neonatal outcomes were comparable between groups, with similar 1- and 5-min Apgar scores. Conclusions: Epidural analgesia modestly prolongs the active and second stages of labor in nulliparous women but does not adversely affect neonatal well-being. These findings support the continued use of epidural analgesia as a safe and effective option for labor pain management, providing substantial maternal comfort without compromising neonatal outcomes.

Background and Objectives: Preeclampsia (PE) is a major cause of adverse perinatal outcomes. Early diagnosis of pregnant women at risk of PE can facilitate disease prevention and management. However, the presence of different phenotypes of the disease complicates its prediction. In particular, the challenges in the early diagnosis of term PE cases necessitate research on PE prediction in the second and third trimesters. This study aims to examine the association between PE development and mid-trimester blood urea nitrogen (BUN), serum creatinine, and the BUN/creatinine ratio in pregnant women. Materials and Methods: This retrospective case–control study was conducted on women diagnosed with PE. Pregnant women who underwent routine biochemical blood tests between the 18th and 24th weeks of gestation and subsequently gave birth at our hospital between January 2022 and May 2023 were categorized into three groups. Accordingly, healthy women who had term deliveries were classified as Group 1 (150 cases), women diagnosed with PE were classified as Group 2 (58 cases), and those diagnosed with severe PE were classified as Group 3 (44 cases). Results: There were no significant differences in age, gravidity, parity, body mass index, or gestational week at blood sampling between the patient and control groups (p > 0.05). When comparing the mean blood urea nitrogen, serum creatinine, and BUN/creatinine ratios, a significant difference was observed between the control group and those who developed PE (p = 0.001, p < 0.001, and p = 0.031, respectively). Univariate analysis revealed a significant association between BUN levels and PE development (OR 1.083; 95% CI, 1.031–1.139; p = 0.002). A stronger association was observed between serum creatinine levels and PE development (OR 112.344; 95% CI, 11.649–1083.416; p < 0.001). However, no significant association was found between the BUN/creatinine ratio and PE in univariate analysis (OR 1.003; 95% CI, 0.979–1.028; p > 0.05). Mid-trimester BUN and serum creatinine levels were significantly higher in patients who developed PE and severe PE. The AUC value for the BUN parameter in predicting PE was 0.614 (AUC 0.614; 95% CI, 0.539–0.689; p = 0.002). A BUN cut-off value of 16.2 mg/dL predicted disease development with a sensitivity of 52.9% and a specificity of 74%. Similarly, the AUC value for the serum creatinine parameter in predicting PE was 0.644 (AUC 0.644; 95% CI, 0.574–0.751; p < 0.001). A serum creatinine cut-off value of 0.58 mg/dL was able to predict disease development with 37.2% sensitivity and 88% specificity. No significant AUC value was obtained for the BUN/creatinine ratio (p > 0.05). Conclusions: Our findings indicate that elevated BUN and serum creatinine levels measured during the mid-trimester (18–24 weeks) are associated with an increased risk of developing preeclampsia.

Objective: To assess the association between advanced maternal age (AMA) and cesarean section (CS) risk in nulliparous pregnant women aged 35 years and older and examine potential confounders to enhance guidance for pregnant women and healthcare providers. Study Design: This retrospective cohort study of singleton, nulliparous pregnant women with a fetus in the cephalic presentation admitted for delivery was carried out from 1 January 2022 to 31 December 2022. Maternal demographics, medical history, delivery records, and neonatal outcomes were collected from electronic medical records. Univariate and multiple logistic regression analyses identified variables independently associated with CS in AMA cases. Results: The study included an AMA group (≥35 years, n=52) and a control group (<35 years, n=487). The CS rate was significantly higher in the AMA group (67.3%) compared to the control group (26.1%, p<0.001). Multiple logistic regression revealed that assisted reproductive technology (ART) pregnancies (OR: 39.0), presence of additional maternal disease or pregnancy complication (OR: 5.34), and fetal heart rate (FHR) category III (OR: 3.34) were significantly associated with increased CS risk in AMA women. Conclusion: The risk of CS is significantly elevated in nulliparous women aged 35 and older, particularly among those who conceived through ART, presented with additional maternal diseases, or exhibited FHR category III. These findings provide essential insights for obstetricians to inform AMA patients on CS risks, aiding decision-making.