Aims: To investigate whether there is a difference between serum tumor markers panel (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) and tumor size and histopathology in well-staged patients with borderline ovarian tumors (BOTs). Methods: Over the past 20 years (January 2001 to January 2021), the results of four tumor markers (CA 125, CA 19-9, CA 15-3, and carcinoembryonic antigen (CEA)) have been clinically analyzed for for this retrospective cohort study of 156 patients who underwent surgery and were diagnosed with histopathology consistent with a borderline ovarian tumor. Results: The average age of patients with borderline ovarian tumors was determined to be 51.67 (4.726) years. Before the first surgery, high CA 125 levels (>35 U/l) were found in 53 patients (34%), high CEA levels (>4 ng/ml) were found in 24 patients (15.4%), high CA 19-9 levels (>37 U/ml) were found in 29 patients (18.6%), and high CA 15-3 (>30 ng/ml) levels were found in 12 patients (7.7%). The average CA 125 levels in tumors with serous histopathology [372.8 (1805.2)] were higher than those in tumors with mucinous histopathology (p=0.006). There was no statistically significant difference in tumor markers between tumors smaller than 8 cm and larger than 8 cm [(CA 125 p=0,257), (CEA p=0.9), (CA 19-9 p=0.295), (CA 15-3 p=0.404)]. Conclusion: Our primary outcome of the study is an increase in CA 125 levels, which indicates serous histopathology. Our secondary outcome is the higher levels of tumor markers, but it does not suggest larger tumors.

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P < 0.001, P < 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P < 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes. '+st+' Division of Radiology ,Istanbul Health and Technology University Department of Radiology and Medical İmaging Technics, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol. 2016 Feb 15;594(4):807-23. doi: 10.1113/JP271402. Epub 2016 Jan 5. PMID: 26607046. DOI: https://doi.org/10.1113/JP271402 ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):e97-e109. doi: 10.1097/AOG.0000000000003070. PMID: 30681542. DOI: https://doi.org/10.1097/AOG.0000000000003070 Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B. Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand. 2004 Sep;83(9):801-7. doi: 10.1111/j.0001-6349.2004.00602.x. PMID: 15315590. DOI: https://doi.org/10.1080/j.0001-6349.2004.00602.x Monteith C, Flood K, Mullers S, Unterscheider J, Breathnach F, Daly S, et al. Evaluation of normalization of cerebro-placental ratio as a potential predictor for adverse outcome in SGA fetuses. Am J Obstet Gynecol. 2017 Mar;216(3):285.e1-285.e6. doi: 10.1016/j.ajog.2016.11.1008. Epub 2016 Nov 11. PMID: 27840142. Rial-Crestelo M, Martinez-Portilla R, Cancemi A, Caradeux J, Fernandez L, Peguero A, et al. Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a pre- dictor of SGA and FGR in non-selected pregnancies. J Matern Fetal Neonatal Med. 2019 Aug;32(15):2554-60. doi: 10.1080/14767058.2018.1441281. Epub 2018 Mar 4. PMID: 29447050. Ebbing C, Rasmussen S, Godfrey K, Hanson M, Kiserud T. Fetal celiac and splenic artery flow velocity and pulsatility index: longitudinal reference ranges and evidence for vasodilation at a low porto-caval pressure gradient. Ultrasound Obstet Gynecol. 2008 Oct;32(5):663-72. doi: 10.1002/uog.6145. PMID: 18816500. DOI: https://doi.org/10.1002/uog.6145 Devore GR. 2015. The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses. Am J Obstet Gynecol. 2015 Jul;213(1):5-15. doi: 10.1016/j.ajog.2015.05.024. PMID: 26113227. DOI: https://doi.org/10.1016/j.ajog.2015.05.024 Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. 2019. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound Obstet Gynecol. 2019 Apr;53(4):465-72. doi: 10.1002/uog.20157. Epub 2019 Feb 13. PMID: 30353583. DOI:...

Aim: The aim of this study was to determine whether early second trimester amniotic fluid prolactin level were associated with pregnancy outcome. Material and Method: This study included 125 women who underwent amniocentesis for variable indications. Healthy subjects with no history of drug use were included in this study. The gestational age was determined by ultrasonic examination before 10 weeks in all cases. Amniotic fluid specimens were taken while performing amniocentesis for other indications. Amniotic fluid was collected by transabdominal amniocentesis. Amniotic fluid prolactin concentrations were utilized to predict pregnancy complication among women who underwent amniocentesis due to the variable indications. Results: Among all study population, pregnancy was unremarkable in 102 (81.6%) cases, on the other hand, most common fetal abnormality was found to be the fetal hydrops fetalis and the second most commonly encountered fetal anomaly was trisomy, intrauterine growth restriction and intrauterine fetal demise. All study population was divided into two groups as complicated (n=23) and uncomplicated (n=102) pregnancies. Amniotic fluid prolactin concentration did not have any predictive value for complicated pregnancies (AUC=0.479). Conclusion: Our data showed; there is no relationship between early second trimester amniotic fluid prolactin level and pregnancy outcome.

Background: Endometrial cancer (EC) is often presents in the postmenopausal period. Among the risk elements are obesity, early menarche, late menopause, unopposed estrogen exposure associated with nulliparity, diabetes, advanced age (>55 years), and tamoxifen use. Endometrial biopsy is the gold standard diagnostic method. The typical surgical process comprises a complete removal of the uterus, a bilateral salpingo-oophorectomy, and cytological examination of peritoneal washing. Invasion of the myometrium (MI) is intricately linked to lymph node metastasis, which is observed in approximately 20% of deep MI cases and in 5% of cases with superficial MI. Therefore, a comprehensive assessment of women with EC, especially those with MI, is important before treatment. The assessment for myometrial invasion (MI) and cervical stromal invasion often involves the use of transvaginal ultrasound (TVUS). The diagnostic accuracy of TVUS varies in reported studies, and some findings are comparable to those obtained through magnetic resonance imaging (MRI). The size of intraoperative tumors and MI is provided to surgeons by frozen section examination, offering crucial information. This study aimed to compare the preoperative TVUS and MRI findings, intraoperative frozen sections, and postoperative final results for 321 patients diagnosed with EC. Methods: Individuals who underwent surgery at the third-stage tertiary gynecologic-oncology clinic for EC were included in the study. The study excluded cases lacking preoperative biopsy, TVUS, and magnetic resonance imaging (MRI), as well as cases featuring obvious extrauterine lesions. Non-endometrioid cases, endometrial hyperplasia, and cases with an identification of organ involvement outside the uterus during surgery were also excluded. The TVUS and MRI findings were compared with the intraoperative frozen sections using McNemar’s test. The concordance of the assessments was determined using the kappa coefficient. The statistical significance level, represented by alpha (α), was set at p < 0.05. Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values for TVUS were 100%, 94.3%, 21.7%, 100%, and 0.34, respectively. For MRI, these values were 100%, 97.8%, 41.7%, 100%, and 0.579, and for frozen section, they were 100%, 99.7%, 83.3%, 100%, and 0.908, respectively. Conclusions: In addition to the gold standard frozen section, TVUS and MRI played an important preoperative role in determining the depth of invasion. While MRI is expensive, TVUS stands out for its practical nature and easy accessibility. In the preoperative examination, TVUS provided acceptable results in guiding intraoperative decisions for lymphadenectomy, with similar sensitivity to MRI and frozen sections.

Objective: To explore the incremental prognostic information of fetal Doppler measurements beyond maternal and fetal biometric characteristics for adverse perinatal outcomes in pregnancies with suspected fetal smallness. Methods: This retrospective cohort study included 606 singleton pregnancies assessed for suspected or diagnosed fetal growth restriction. The principal analysis was restricted to 429 pregnancies with estimated fetal weight (EFW) or abdominal circumference (AC) below the 10th percentile at the index examination. A composite adverse perinatal outcome comprised five-minute Apgar score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit (NICU) admission, respiratory support, neonatal death, or stillbirth. Baseline clinical–biometric, Doppler-integrated, and delivery-week sensitivity logistic models were assessed using stratified 10-fold out-of-fold predictions. Additional robustness analyses evaluated component frequencies, a hard-outcome sensitivity composite less directly influenced by clinical management, paired uncertainty in out-of-fold performance differences, and model performance across alternative cohort definitions. Results: Among 429 pregnancies in the principal cohort, 111 (25.9%) met the composite adverse perinatal outcome, and 206 (48.0%) had abnormal Doppler findings. Event rates were 85/206 (41.3%) among pregnancies with abnormal Doppler and 26/223 (11.7%) among those with normal Doppler. The baseline and Doppler-integrated out-of-fold areas under the receiver operating characteristic curve (AUCs) were 0.642 and 0.690, respectively; corresponding Brier scores were 0.183 and 0.174. Elevated umbilical artery pulsatility index with forward flow and absent or reversed end-diastolic flow (AEDF/REDF) were independently associated with the composite outcome, with adjusted odds ratios of 2.61 (95% confidence interval [CI], 1.58–4.32) and 6.60 (95% CI, 2.40–18.18), respectively, compared with normal umbilical artery flow. The adjusted estimate for the AEDF/REDF subgroup was imprecise because this subgroup included only 19 pregnancies. The paired out-of-fold AUC increment for the Doppler-integrated model was 0.049 (95% CI, 0.005–0.094); the corresponding Brier-score improvement was 0.009 (95% CI, −0.0004 to 0.0179). Sensitivity analyses supported a modest incremental contribution but did not establish the superiority of the integrated model over alternatives based on the cerebroplacental ratio (CPR) or umbilical artery (UA) Doppler. Conclusions: In pregnancies with suspected fetal smallness defined by EFW or AC below the 10th percentile, fetal Doppler assessment provided modest incremental prognostic information beyond maternal and fetal biometric characteristics. Umbilical artery abnormalities were associated with the composite adverse perinatal outcome, although this association should be interpreted in the context of delivery timing and clinical management. External validation and assessment of clinical utility are required before clinical implementation of the model.

Background/Objectives: Preeclampsia is a heterogeneous hypertensive disorder of pregnancy, and accessible hematologic indices may reflect maternal physiologic differences before the clinical syndrome becomes evident. This study evaluated whether the first-trimester hemoglobin-to-red cell distribution width (Hb/RDW) ratio was associated with later documented preeclampsia and assessed its discrimination, relation to disease severity, and association with maternal–neonatal outcomes in a tertiary-care cohort. Methods: This retrospective cohort study included 224 singleton pregnancies managed at a tertiary referral center between January 2024 and December 2025. Data extraction, anonymization, and analysis were performed after ethics approval (Approval No. 72; 2 March 2026). Participants were categorized as preeclampsia-negative (n = 131) or preeclampsia-positive (n = 93). Preeclampsia and severe features were defined according to American College of Obstetricians and Gynecologists criteria. The Hb/RDW ratio was calculated from routine first-trimester complete blood count parameters obtained before clinical diagnosis or final outcome classification. ROC analysis, multivariable logistic regression, multicollinearity assessment, events-per-variable evaluation, calibration testing, and exploratory incremental discrimination analyses were performed. Results: The first-trimester Hb/RDW ratio was higher in pregnancies later complicated by preeclampsia. Single-marker ROC analysis showed moderate discrimination (AUC = 0.687; bootstrap 95% CI: 0.618–0.755). At the 0.63 cut-off, sensitivity was 89.2%, specificity 47.3%, positive predictive value 54.6%, and negative predictive value 86.1%. In the primary multivariable model, Hb/RDW remained associated with later preeclampsia (adjusted OR per 0.1-unit increase = 1.45; 95% CI: 1.22–1.72; p < 0.001). However, Hb/RDW was not independently associated with severe preeclampsia among affected patients, fetal growth restriction, or composite maternal morbidity. VIF values ranged from 1.00 to 1.07. Secondary models for fetal growth restriction and composite maternal morbidity had borderline events-per-variable values and were interpreted as exploratory. Conclusions: First-trimester Hb/RDW was associated with later documented preeclampsia in this retrospective tertiary-care cohort, but its single-marker performance was modest and specificity was limited. The ratio should be interpreted as an inexpensive research marker of hematologic phenotype rather than a stand-alone screening, diagnostic, or management tool. Prospective multicenter validation with standardized first-trimester sampling and adjustment for hematinic and nutritional variables is required before clinical implementation.