Background: Placenta accreta spectrum (PAS) is a serious pregnancy complication associated with significant hemorrhaging and elevated maternal morbidity. Timely prenatal diagnosis is critical for reducing the risk of adverse outcomes. In this study, we aimed to investigate the association between PAS and first-trimester maternal serum screening markers, as well as selected hematological and inflammatory indices, in pregnancies complicated by placenta previa (PP). Methods: A retrospective study was conducted at a tertiary care center. Pregnant women with singleton pregnancies who had been diagnosed with PP and undergone first-trimester aneuploidy screening and delivered at the same institution were included. The participants were divided into two groups: those diagnosed with PAS (including placenta accreta, increta, and percreta) and those with PP without placental invasion. Data on maternal demographics, the first-trimester serum levels of pregnancy-associated plasma protein-A (PAPP-A), and free β-human chorionic gonadotropin (β-hCG), as well as pre-delivery complete blood count parameters, were collected. Associations between these markers and abnormal placental implantation were analyzed. Results: In total, 181 participants were included in this study, corresponding to 15 cases of PAS and 166 cases of non-invasive PP. The women in the PAS group were significantly younger than those in the non-invasive-PP group (25.3 ± 5.1 vs. 30.0 ± 6.3 years, p < 0.001). The serum levels of PAPP-A and free β-hCG were significantly higher in the PAS cases (p < 0.05). The mean platelet volume (MPV) was significantly lower inF the PAS group (p < 0.05). We did not observe any significant differences in other hematological parameters, including hemoglobin concentration, white blood cell count, neutrophil and lymphocyte counts, platelet count, red cell distribution width, and inflammatory ratios such as the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Conclusions: Elevated first-trimester levels of PAPP-A and β-hCG, along with a reduced MPV, may serve as early indicators of PAS in pregnancies complicated by PP. These biomarkers may assist in early risk stratification and help inform perinatal management strategies.

Objectives. To evaluate the knowledge level and perspectives of female cancer patients regarding fertility preservation techniques before gonadotoxic treatment. Material and Methods. This was a prospective observational survey-based study conducted between 2016 and 2020 in Izmir Economy University Medical Park Hospital. A total of 150 female cancer patients aged 18–42 years were included. The participants completed a 17-item questionnaire, developed by the research team to evaluate their knowledge and perspectives on fertility preservation techniques. Results. The mean age of the patients was 39.5 ± 4.9 years. Only 64.7% of the patients were referred to fertility counseling by a gynecologist, while 72.6% of the patients knew of the risk of infertility after cancer treatment. There was a significant correlation between the health status and cancer stage of the patient ( ). The estimated future chance of becoming pregnant spontaneously or through fertility preservation techniques was significantly higher in patients with a higher education level ( or 0.008, respectively). Satisfaction with the counseling process was reported as high or low by 66.7% or 20% of the patients, respectively. Conclusions. The rate of referral of reproductive-age cancer patients to fertility preservation counseling is still not satisfactory. Education level was the only variable significantly associated with a motivation to become pregnant after cancer treatment, either spontaneously or through fertility preservation techniques.

Objectives: To compare perioperative outcomes and learning curves of robotic hysterectomy and transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) hysterectomy performed for benign gynecological conditions in a high-volume tertiary center. Methods: This retrospective cohort study included 100 patients who underwent either robotic hysterectomy (n = 44) or V-NOTES hysterectomy (n = 56) between January 2024 and July 2025. Demographic data, perioperative parameters, and postoperative outcomes were collected. Learning curves were analyzed using cumulative sum (CUSUM) and quadratic regression models. Results: A total of 100 patients were included (44 robotic, 56 V-NOTES). Baseline demographics were comparable between groups. The postoperative hemoglobin decrease was significantly lower in the robotic group (0.96 ± 0.64 g/dL vs. 1.33 ± 0.93 g/dL, p < 0.05), whereas uterine weight was higher in the V-NOTES cohort (182.6 ± 125.9 vs. 123.2 ± 60.4 g, p < 0.05). Complication rates, including three bladder injuries in the V-NOTES group and one in the robotic group, showed no significant difference. Hospital stay was similar across groups. Conclusions: Both techniques are safe and effective. Robotic hysterectomy offers shorter operative time and less blood loss, while V-NOTES provides cosmetic and recovery advantages. Learning curve analysis indicates a longer adaptation period for V-NOTES, with anterior colpotomy as the most critical step, whereas robotic hysterectomy demonstrates a shorter and more straightforward learning process.

Objectives: To assess the effect of lymphadenectomy on morbidity and survival in patients with early-stage mucinous ovarian cancer. Methodology: Patients with clinical stage-I primary mucinous ovarian cancer who underwent surgery in the gynecological oncology clinic of Tepecik Education and Research Hospital, Izmir, Turkey between January 1998 to December 2018 were analyzed retrospectively. The patients were divided into two groups according to whether lymphadenectomy (pelvic ± para-aortic) was performed or not. The groups were compared in terms of clinical variables. Results: Forty-five patients were examined. Lymphadenectomy was performed in 30 (66.7%) patients. Metastasis was not detected in any of the lymph nodes. There was no significant difference between the groups in terms of age, menopausal status, stage, tumor grade, bilaterality, ascites, tumor size and preoperative cancer antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen. Patients who underwent lymphadenectomy had longer durations of operation time and hospital stay (p<0.001 and p=0.011, respectively). The median follow-up time was 96 (3-240) months. Recurrence developed in two (4.4%) patients. The five-year disease-free survival rates of the groups with and without lymphadenectomy were 96.4% and 92.9%, respectively (p=0.666). The five-year overall survival rates of the groups with and without lymphadenectomy were calculated as 96.4% and 92.9%, respectively (p=0.666). Conclusions: The risk of lymph node metastasis is very low in early-stage mucinous ovarian cancer. Lymphadenectomy causes an increase in the duration of operation and hospital stay and does not contribute to disease-free and overall survival. Therefore, routine lymphadenectomy should be carefully evaluated in clinical early-stage mucinous ovarian cancer to reduce morbidity.

This study aims to assess the surgical practices, learning curve, and outcomes of 2 obstetrics and gynecology specialists during the first 18 months of their careers, focusing specifically on minimally invasive gynecological procedures. Data from 277 procedures performed by 2 recently specialized gynecologists in Turkey during the first 18 months of their specialization were retrospectively analyzed. Procedures included total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), abdominal hysterectomy (TAH), and other gynecological surgeries. Surgical cases were divided into three 6-month periods, and outcomes such as surgical indications, operative time, length of hospital stay, and complications were evaluated. The study included 277 procedures performed during the first 18 months of a newly specialized obstetrics and gynecology specialist’s practice. TLH was the most frequently performed procedure, with 140 cases, followed by VH with 35 cases and total abdominal hysterectomy (TAH) with 22 cases. The study showed a significant reduction in major complications, with only 4 recorded over the 18 months, including bowel injury and bladder injury. Minor complications, such as wound infections and hematuria, were reported in 8 cases (2.9%), and these decreased significantly over time (P = .01). Operation times were shortest in the TLH group (99.6 minutes), and the average hospital stay was shortest for TLH (1.6 days). Overall, 98.6% of surgeries were completed without major complications, with a 100% success rate in the last 6 months. This study highlights the challenges and successes of early surgical practice in gynecology. TLH emerged as the preferred method due to its advantages, while VH was emphasized as the preferred approach when feasible. Regular simulation training, higher case volumes during residency, and mentorship contributed to successful outcomes. These findings underscore the importance of structured training and continuous practice in advancing competency in minimally invasive gynecological surgery.

This study aimed to evaluate and compare pregnancy and neonatal outcomes in women aged ≥ 45 years, categorized as having extremely advanced maternal age (EAMA), and a control group of women aged 25 to 35 years who delivered within the same time period. A retrospective cohort study was conducted at a tertiary referral center in Turkey, including 143 women aged ≥ 45 and 250 women aged 25 to 35 who gave birth between January 2017 and January 2024. Obstetric and neonatal outcomes were compared, including gestational age, mode of delivery, birthweight, Apgar scores, and neonatal intensive care unit (NICU) admissions. Cesarean delivery (71.3% vs 47.6%, P < .001), preterm birth (21.0% vs 9.2%, P = .001), and NICU admissions (21.7% vs 12.8%, P = .02) were significantly more frequent in the EAMA group. The median birthweight was also significantly lower in this group (3000 g vs 3305 g; P < .001), and extremely preterm births (<28 weeks) occurred only in the EAMA group. Women aged ≥ 45 years face significantly higher risks of adverse obstetric and neonatal outcomes, underscoring the need for tailored prenatal care and delivery planning in this growing patient population as delayed motherhood becomes increasingly prevalent.