Background: Globally, including in Türkiye, caesarean section (C-section) rates have been rising steadily, largely due to changes in clinical practices, maternal preferences, medico-legal concerns, and healthcare system dynamics. This study aims to investigate the impact of a high patient load on C-section rates and their indications within a tertiary care setting. Methods: This retrospective study was conducted on women with deliveries over four years, from June 1, 2020, to May 1, 2025. For pairwise comparisons, numerical and nominal variables were analysed with independent t-test or Pearson’s chi-squared test, respectively. A p-value < 0.05 was accepted as statistically significant. All variables were expressed with 95% confidence intervals (CI). Results: A total of 68,944 deliveries were eligible for analysis, with an overall C-section rate of 55.0%. Among the indications C-section, the most common was previous uterine surgery, including prior C-section and/or myomectomy, accounting for 56.2% of cases. This was followed by foetal distress (24.3%). Other foetal-related indications included multiple gestation (6.2%), foetal malpresentation (4.2%), and macrosomia (1.9%).Compared with women who had a normal vaginal delivery (NVD), those undergoing C-section had significantly higher percentage of male neonates, maternal age >35 years, multiparity, all categories of preterm birth, early-term birth, low birth weight, and macrosomia. Conclusion: Our findings indicate that the overall C-section rate was 55.0%. Among the indications for C-section, the most common was previous uterine surgery, which includes prior C-section and/or myomectomy, followed by foetal distress.

Globally, including in Turkiye, increasing caesarean section (CS) rates are a crucial public health concern. The Robson 10-group classification system, which is based on obstetric features, is the global standard for monitoring, evaluating, and comparing CS rates in various healthcare settings. Documenting CS rates in tertiary referral centre using the Robson 10-group classification system was the goal of this study. This retrospective study was conducted on women with deliveries over four years, from June 1, 2020, to October 1, 2024, and categorised according to the Robson 10-group classification system. For pairwise comparisons, numerical and nominal variables were analysed with independent t-test and Pearson’s chi-squared test, respectively. A p-value of less than 0,05 was accepted as statistically significant. All variables were expressed with 95% confidence intervals (CI). A total of 63.809 deliveries were eligible for analysis. The overall CS rate was 54,2%, with variations across different years. The rates ranged from 42,2% in 2020 to 59,9% in 2024. Turkish cases showed a higher rate of CS at 56,2%, compared to 49,6% for refugees. Group 5 was the largest contributor among these groups in terms of (23,9%) CSs, followed by corresponding contributions, Group 10 with 7,7%, and Group 2 with 6,0%. Our findings suggest that the overall caesarean section rate was 54,2%, with Group 5 being the primary contributor, followed by Groups 10, 2, and 1.

Background/aim: Laparoscopic surgery has become the preferred minimally invasive technique for both diagnostic and therapeutic procedures in gynecology. Although it is associated with lower overall complication rates compared to open surgery, most serious complications occur during the initial step of abdominal entry. Therefore, developing faster and safer entry methods is critical to improving surgical outcomes. This study aimed to compare the surgical results of the Median Umbilical Ligament Lift-Up (MULU) technique routinely used in our clinic with the commonly preferred Veress needle (VN) entry technique. Materials and methods: This randomized, controlled, prospective study included 124 patients: 64 underwent abdominal entry with the MULU technique and 60 with the VN technique. Demographic data such as age, BMI, obstetric and surgical history, and menopausal status were recorded. Key perioperative outcomes, including abdominal entry time, number of attempts, insufflation failure, vascular or visceral injury, bleeding at the trocar site, infection, hematoma, and hernia were documented and analyzed. Results: The VN group had a significantly higher mean age (50.03 years) compared to the MULU group (45.42 years) (p<0.05). No significant differences were observed in height, weight, or BMI. The MULU technique demonstrated a significantly shorter mean entry time (71.5 vs. 146.3 seconds; p<0.05). Extraperitoneal insufflation occurred in 6.7% of VN cases and was absent in the MULU group (p=0.036). Gastric or intestinal injury occurred in 3.3% of VN patients, with none observed in the MULU group. Omental injury was seen only in the MULU group (3.1%). No significant differences were found in vascular injury, bleeding, or prior surgical history. Conclusions: The MULU technique, based on anatomical guidance via the median umbilical ligament, is a safe and effective method for abdominal entry. It offers faster access and may reduce the risk of major complications, making it a viable alternative to conventional techniques.

Background: This study aimed to compare female sexual function and male partner sexual satisfaction between endometrial cancer patients treated with surgery alone and those receiving additional brachytherapy. Methods: Sixty-nine patients were included. Group 1 ( n = 34) received adjuvant brachytherapy after surgery; Group 2 ( n = 35) underwent surgery only. Participants completed a structured questionnaire including socio-demographic and clinical data, along with validated instruments: the Female Sexual Function Index and the New Sexual Satisfaction Scale for partners. Results: The mean age was significantly higher in the brachytherapy group (61.71 ± 7.88 vs. 56.54 ± 8.74 years; p = 0.012). Gravidity ( p = 0.029) and parity ( p = 0.013) were also higher in this group, while body mass index was similar ( p = 0.118). Female sexual function index scores [2 (2–20.3) vs. 2 (2–19.6); p = 0.459] and new sexual satisfaction scale scores [20 (20–83) vs. 20 (20–90); p = 0.492] showed no significant differences. Female sexual function index subdomain scores were also comparable. Tumor grade and stage significantly differed between groups, as did surgical approach and lymphadenectomy rates. Conclusion: Sexual function was negatively affected in all endometrial cancer patients, with a more pronounced impact among those receiving brachytherapy and their partners. These findings highlight the need to consider sexual health in treatment planning and to implement supportive interventions such as psychosexual counseling, particularly for patients undergoing adjuvant radiotherapy.

Objectives: Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict a successful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. Methods: This prospective study included consecutive nulliparous pregnant women whose gestational age was 41 weeks and 1–6 days (late-term). The AoP was measured at least three times and their means were calculated. Results: During the study period, data of 150 women were included in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration of labour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. Conclusions: AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100° is associated with a high rate of vaginal delivery.

Caesarean section (C-section) rates are rising globally, including in Türkiye, indicating a significant shift in obstetric practices. To standardise monitoring, the World Health Organization (WHO) advocates for the Robson 10-group classification system (RTGCS), with categorises all deliveries into ten distinct groups based on obstetric history and current pregnancy characteristics, such as parity, previous C-section, and foetal presentation. This study evaluated C-section rates at a Turkish tertiary referral centre using this classification to identify targets for clinical quality improvement. This retrospective study analysed deliveries over 12 years, between 1 July 2012 and 1 October 2024, stratified based on RTGCS. Pairwise comparisons utilised independent t-tests for numerical data and Pearson's chi-squared tests for nominal variables. Statistical significance was set at p < 0.05, with results presented alongside 95% confidence intervals (CI). A total of 119,767 deliveries were evaluated. Of these, 84.5% (n = 101,252) involved Turkish nationals and 15.5% (n = 18,515) involved refugees. Overall, 56,986 deliveries (47.6%) were performed by C-section, with a higher rate among Turkish women (49.6%) compared with refugee women (36.4%). Within the four largest Robson groups, Group 5 provided the highest absolute contribution to the total C-section count at 21.0%. The absolute contributions for Groups 1, 3, and 10 were 5.9%, 5.8%, and 5.5%, respectively. Collectively, these four groups accounted for 38.2% of all deliveries and 80.2% of all C-section cases recorded in the study. This study indicated that the overall C-section rate was 47.6%, predominantly driven by Group 5, followed by Groups 10, 3, and 1.