Objective:To compare maternal and neonatal outcomes among women undergoing cesarean section (CS) with concomitant myomectomy, women with uterine fibroids managed conservatively at cesarean delivery, and women without uterine fibroids. Material and Methods:This retrospective cohort study included women who delivered by CS between May 2017 and December 2024. Patients were classified into three groups: CS with myomectomy (Group 1), CS with fibroids without myomectomy (Group 2), and CS without fibroids (Group 3). Maternal outcomes included perioperative changes in hemoglobin, hematocrit, and platelet counts, transfusion requirement, and length of hospital stay. Neonatal outcomes included birth weight, birth length, and Apgar scores. Appropriate parametric and non-parametric statistical tests were used for group comparisons. Results:The study cohort numbered 682 with 252 (36.95%), 178 (26.1%) and 252 (36.95%) women in Groups 1, 2 and 3, respectively. Postoperative hemoglobin, hematocrit, and platelet levels differed significantly among the three groups (all p<0.05). However, hemoglobin deficit did not differ significantly between Group 1 and Group 2 (p=0.346), while both groups showed greater hemoglobin deficit than Group 3 (p<0.05). Transfusion rates and hospitalization duration differed significantly between groups (p<0.05), with longer hospital stay observed in transfused patients regardless of group. Maximum myoma volume was higher in Group 1, whereas myoma count was greater in Group 2 and total myoma volume was comparable between these groups (p=0.09). Neonatal birth weight was significantly lower in Group 2 compared with Groups 1 and 3 (p<0.05), while no difference was observed between Groups 1 and 3 (p=0.956). Other neonatal outcomes were similar. Conclusion:Cesarean myomectomy was associated with larger changes in hematologic parameters and transfusion rates; however, hemoglobin deficit appears related to fibroid presence rather than myomectomy itself. Neonatal outcomes were not adversely affected by cesarean myomectomy, whereas untreated fibroids appeared to be associated with lower birth weight.
Objective:Successful vaginal cuff suturing remains a major challenge in robotic hysterectomy. This study compared the vault closure time by using Vicryl (polyglactin 910) and barbed (V-Loc) sutures. Material and Methods:This retrospective study included patients undergoing robotic hysterectomy for benign disease over three years. Patients were grouped according to the suture used for vaginal vault closure. Surgical videos and hospital records were reviewed to obtain operative details, perioperative outcomes, and postoperative complications. Results:A total of 297 patients were included in final analysis with 106 (35.7%) patients in the Vicryl group and 191 (64.3%) patients in the barbed suture group. In the barbed compared to Vicryl group, the robotic vault closure time (6.84±1.42 vs. 9.93±2.77 minutes), average number of stitches used for vault closure (5.02±0.57 vs. 5.61±0.75), and time taken per stitch (1.36±0.3 vs. 1.75±0.43 minutes) were significantly lower. Operative time, anesthesia duration, and hospital stay were also significantly lower in the barbed group. On multivariable linear regression analysis, barbed suture use remained independently associated with shorter vault closure time (β =8.47 minutes, 95% confidence interval 5.46-11.48; p<0.001), while age, body weight, body mass index, parity, and preoperative anemia were not independently associated with vault closure time. On sexual function assessment, the overall score of female sexual function index in barbed (29.02±4.85) was significantly higher than the Vicryl (27.39±7.35) suture group (p=0.049). Conclusion:Barbed sutures may represent a feasible and time-efficient option for robotic vaginal vault closure; however, prospective randomized studies with longer follow-up are required to confirm their safety, and impact on functional outcomes.
Ovarian cancer is frequently diagnosed at an advanced stage, with liver metastases commonly observed, adversely affecting prognosis. Achieving complete cytoreduction (R0) is essential for improving overall survival in advanced ovarian cancer. Liver resections, particularly for isolated and resectable lesions, have demonstrated survival benefits. Non-anatomical resections, while preserving functional liver parenchyma, are increasingly employed in this context. This study showcases a surgical video illustrating a non-anatomical wedge liver resection performed for oligometastatic disease as part of interval cytoreductive surgery in advanced-stage ovarian cancer. A young multiparous woman in her 30 s with high-grade serous carcinoma of the right ovary and multiple hepatic metastases at diagnosis had a persistent dominant residual liver lesion following neoadjuvant chemotherapy. She had undergone prior right salpingo-oophorectomy. Interval cytoreductive surgery included peritoneal wash for cytology, hysterectomy with excision of left tube and ovary, retroperitoneal lymph node sampling, total omentectomy, peritoneal deposit excision, and non-anatomical liver resection. The surgical peritoneal cancer index was 7. Intra-operative ultrasound guided localization of a 2.5×2 cm intraparenchymal lesion in liver segments IVB/V. Wedge resection with adequate margins was performed using the Kelly clamp-crush technique, LigaSure, and monopolar cautery after ligation of the distal middle hepatic vein. The postoperative recovery proceeded without complications. Metastatic carcinoma in the liver lesion and peritoneal deposit, with no residual disease in other specimens were reported from histology. The patient received three cycles of adjuvant chemotherapy and remains disease-free at 18 months of follow-up. Non-anatomical liver resections are feasible and safe in advanced ovarian cancer with resectable oligometastatic hepatic disease and should be integrated into cytoreductive surgery when indicated. While recent evidence supports the safety and survival benefits of liver resections, additional research is needed to clarify their prognostic significance in advanced ovarian cancer.
Objective:To evaluate the continuity and satisfaction rate with contraceptive methods over 12 months in female adolescents with mental disorders (MD). Material and Methods:Prospective cohort study carried out at a reference center for care for adolescents with MD. Adolescents with mild and moderate MD who opted for the hormonal intrauterine device (IUD) or a quarterly injectable contraceptive were included. Sociodemographic data were collected, such as age, education and gynecological data. Follow-up was quarterly for 12 months, with assessment of symptoms, desire to continue and satisfaction with the use of the quarterly injectable or hormonal IUD. Results:One-hundred and three adolescents participated in the study, 34 (33%) of whom chose to use the hormonal IUD and 69 (67%) the quarterly injectable with depot medroxy-progesterone acetate (DMPA). After 12 months, 26 adolescents (76.5%) continued to use the IUD and 34 (49.3%) maintained the use of DMPA. During IUD follow-up, one teenager (2.9%) wanted to have it removed after three months, three (8.8%) developed spontaneous expulsion of the IUD and four (11.7%) were lost to follow-up. Regarding satisfaction after 12 months of use, of the 30 who maintained the method, 29 (96.6%) adolescents were satisfied. Among the 69 adolescents who chose to use DMPA, after 12 months of follow-up, 34 (50.7%) said they were satisfied. Among the 30 (44.7%) who discontinued use, the most frequent causes were irregular bleeding and weight gain. When comparing the two methods, a significant difference was demonstrated for IUD users in terms of continuity (p=0.0001), and satisfaction (p=0.00002). Conclusion:Adolescents using the IUD exhibited significantly higher rate of continuity and reported greater satisfaction at 12 months compared to DMPA users. This result corroborates evidence of the preference for long-acting reversible methods for adolescents, especially for those who are most vulnerable.
Objective:Endometriosis is a chronic inflammatory disorder lacking definitive laboratory diagnostic markers. Angiopoietin-like protein-4 (ANGPTL4) is a protein involved in the regulation of angiogenesis and inflammation. The aim of the present study was to evaluate serum and peritoneal fluid (PF) levels of ANGPTL4 to explore its potential role in the pathogenesis of endometriosis. Material and Methods:This prospective study included women with surgically confirmed endometriosis and age-matched healthy controls with similar demographic characteristics. Clinical and laboratory parameters, including serum ANGPTL4, anti-Müllerian hormone (AMH), and cancer antigen-125 (CA125) levels were compared between groups. In addition, PF ANGPTL4 levels were assessed in the endometriosis group. Results:Serum ANGPTL4 (512.65±46.91 vs. 177.60±11.84 ng/mL, p<0.001) and CA125 (53.52±6.05 vs. 20.10±3.18 U/mL, p<0.001) levels were significantly higher in endometriosis group. Serum ANGPTL4 positively correlated with the severity of pelvic pain and dyspareunia, serum CA125 level and PF ANGPTL4, and negatively correlated with AMH (r=0.743, p<0.001; r=0.624, p<0.001; r=0.444, p<0.001; r=0.841, p<0.001; and r=-0.380, p<0.001, respectively). Receiver operating characteristic analysis identified an optimal serum ANGPTL4 cut-off value of 188.61 ng/mL (area under the curve =0.755, sensitivity 75% and specificity 62.5%, positive predictive value 66.7%, and negative predictive value 71.4%). Conclusion:Serum ANGPTL4 levels were significantly higher in women with endometriosis and were associated with clinical and laboratory parameters. It may serve as a supportive biomarker in the clinical assessment of endometriosis.
Objective:Double ovarian stimulation (DuoStim) protocols, in which both follicular and luteal phase stimulations are performed within the same menstrual cycle, have emerged as a promising strategy for patients with diminished ovarian reserve. The aim of this study is to compare the outcomes of follicular and luteal phase stimulations in patients undergoing DuoStim protocols. Material and Methods:This retrospective intra-patient paired comparative study included patients who underwent DuoStim between January 2018 and December 2024 at a university-based infertility clinic. Stimulation protocols, gonadotropin doses and trigger types were evaluated. Primary outcomes were retrieved oocyte and metaphase II (MII) oocyte numbers across both stimulation phases. Clinical pregnancy rates achieved by embryos derived separately from each stimulation phase were evaluated as a secondary outcome. Duration of stimulation, total gonadotropin doses administered, cumulative oocyte yield and embryos obtained, fertilization rates, implantation rates, and live birth rates were also assessed. Results:The study included 120 patients. Retrieved oocytes numbers [2 (1-3) and 2 (1-5) in follicular phase and luteal phase], MII oocytes [1 (1-2) and 2 (0-4)], and frozen cleavage stage embryos [1 (0-1) and 1 (0-2) in follicular phase and luteal phase] were higher in the luteal phase stimulation (p<0.001, p=0.001, and p=0.005 respectively). Oocyte yield, fertilization rates, implantation rates, and clinical pregnancy rates were similar between the two phases. Total gonadotropin doses and stimulation duration were significantly higher during follicular phase stimulation. Conclusion:In patients with diminished ovarian reserve undergoing DuoStim, luteal phase stimulation yielded significantly more retrieved oocytes and MII oocytes despite requiring lower gonadotropin doses and shorter stimulation duration. Fertilization rates, embryo development, and clinical pregnancy rates were comparable between phases, suggesting that luteal phase-derived embryos are equally competent. These findings support DuoStim as an effective strategy to maximize oocyte yield within a single menstrual cycle in this challenging population. Further prospective studies are warranted to evaluate cumulative reproductive outcomes.
Objective:To investigate the prognostic significance of lymphovascular space invasion (LVSI) and its relationship with other prognostic factors in patients with endometrial cancer. Material and Methods:Patients with stage 1a/1b endometrial cancer who underwent hysterectomy and/or staging surgery between January 2016 and December 2020 at a tertiary referral center were retrospectively analyzed. Pathological data including histological type, stage, grade, LVSI (lymphatic invasion, vascular invasion), tumor size, depth of myometrial invasion, cervical involvement, lymph node evaluation (pelvic, paraaortic), and peritoneal wash cytology were analyzed using univariate and multivariate methods. Results:The study included 304 patients. Non-endometrioid tumors were associated with a 6.35-fold higher risk of LVSI. Each 1 mm increase in tumor size raised the risk by 1.03-fold. LVSI was present in 53.3% of cases with lymph node metastasis and was 7.2-fold more frequent in deceased patients (odds ratio: 7.209; 95% confidence interval: 3.137-16.570; p<0.001). Multivariate analysis identified tumor grade and survival as independent predictors of LVSI: grade 3 tumors had a 4.88-fold higher risk (p=0.014), and mortality was associated with a 4.16-fold higher risk (p=0.007). Survival was significantly linked to LVSI, tumor size ≥35 mm, and recurrence, but not to age, histological type, lymph node status, or peritoneal cytology. Conclusion:Our results demonstrated that LVSI was significantly associated with histological grade and survival. Furthermore, LVSI, tumor diameter ≥35 mm, and recurrence were found to significantly affect survival, highlighting their prognostic relevance for risk assessment and postoperative management.
Ureteral injury during advanced gynecologic laparoscopic procedures is an uncommon but potentially serious complication, particularly during para-aortic lymphadenectomy performed for oncologic staging. We describe the laparoscopic management of a proximal right ureteral transection encountered during transperitoneal para-aortic lymphadenectomy in a 56-year-old woman (body mass index 36 kg/m2) with highrisk endometrial carcinoma. The injury was recognized intraoperatively and repaired using a tension-free ureteroureterostomy over a double-J stent. Key technical steps, including exposure in obese patients and preservation of ureteral vascularity, are demonstrated. This report highlights that timely intraoperative recognition and laparoscopic repair of proximal ureteral injury can prevent major morbidity and obviate open surgery, emphasizing the importance of advanced, minimally invasive surgical expertise.
Objective:To evaluate pathological findings in patients positive for human papillomavirus (HPV)-31. Material and Methods:This retrospective study included patients evaluated in a tertiary colposcopy clinic. The 3,546 patients tested for high-risk HPV were evaluated from September 2019 to December 2023. The study comprised 130 (3.7%) patients who tested positive for HPV-31. Isolated HPV-31 positivity indicated the presence of HPV-31 alone. Combined positivity indicated coexistence with other high-risk HPV types. If the following lesions were positive, high-grade squamous intraepithelial lesions (HSILs), adenocarcinoma in situ, microinvasive cancer, and cervical cancer, we classified the final pathology as ≥HSIL. Statistical analysis was performed using IBM SPSS Statistics version 20.0. Results:The mean age was 44.4±9.24 years. Isolated HPV-31 positivity was present in 69 (53.1%) patients. The final pathologic result was ≥HSIL in 9 (6.9%) patients, with only 1 (0.8%) patient had squamous cell cervical cancer. No significant association was observed between HPV-31 positivity type (isolated or combined) and ≥HSIL (respectively, 7.2% vs. 6.6%; p=0.578). Conclusion:Approximately 7% of women positive for HPV-31 have HSIL and higher lesions. The isolated or combined HPV-31 positivity does not affect the existence of HSIL or higher lesions.
A precise understanding of pelvic neurovascular anatomy is essential for minimizing complications during advanced gynecological and pelvic surgery. Retroperitoneal dissection requires a clear appreciation of spatial relationships between vascular, neural, and fascial structures. This pictorial essay provides an anatomically oriented overview of key pelvic compartments and pelvic avascular spaces, including the paraaortic, presacral, pararectal, paravesical, prevesical, and laterovascular spaces, through a curated series of our high-resolution intraoperative and cadaveric dissections. These illustrations emphasize surgical landmarks and neurovascular trajectories that are critical during radical hysterectomy, pelvic lymphadenectomy, deep endometriosis surgery, and other pelvic procedures. The anatomical content correlates with practical surgical applications, including the identification of danger zones, safe dissection planes, and routes for nerve-sparing techniques. Autonomic plexuses, somatic nerves, and vascular variants are also highlighted to support accurate and reproducible dissection. In particular, visual representations of the hypogastric nerve, pelvic splanchnic nerves, and inferior hypogastric plexus aid understanding of the pelvic autonomic pathways involved in continence and sexual function. The presented illustrations offer an operative roadmap that supports surgical planning, enhances intraoperative orientation, and promotes the preservation of neurovascular integrity. This visual anatomical reference aims to improve both surgical safety and functional outcomes in advanced gynecological procedures.
Objective:To evaluate how preserving the cervix and maintaining vaginal length influenced sexual function in patients undergoing hysterectomy for benign disorders. Material and Methods:This retrospective analysis included patients who had either total or subtotal hysterectomy for benign disorders between 2020 and 2022, with vaginal lengths recorded both before and after surgery. The female sexual function index (FSFI) was completed by the patients before surger y and again 24 months postoperatively, while their partners were given the International Index of Erectile Function. Results:Eighty-five patients were included, with 42 (49%) in the total hysterectomy group and the remainder in the sub-total group. While no significant change in vaginal length was observed in women who underwent subtotal hysterectomy (p>0.05), the total hysterectomy group showed a marked reduction in vaginal length postoperatively (10±1 cm vs. 6.6±1.1 cm, p<0.001). The reduction in FSFI scores for the subtotal hysterectomy group was notably lower compared to the total hysterectomy group [1.4 (0.8-2.1) vs. 9.2 (8.2-10.1), p<0.001]. Conclusion:While both total and subtotal hysterectomy procedures were associated with decreased sexual function, patients who underwent total hysterectomy showed lower FSFI scores. Previous research has suggested this may be due to lack of cervical ring protection and loss of erogenous zones in the posterior vagina through nerve damage.
Objective:To evaluate bone mineral density (BMD) in adolescent girls and young women with hypogonadism from a gynecologic perspective, and to compare their results with those of patients referred for clinical indications associated with bone health, such as fracture history or chronic medication use. Material and Methods:This retrospective study included females aged 12-21 years who underwent dual-energy X-ray absorptiometry (DXA) between January 2020 and April 2025 in a tertiary university hospital. Patients were categorized as hypogonadal or non-hypogonadal according to the indication for DXA. Lumbar spine (L1-L4) Z-scores were compared between these groups, with height adjustment applied for patients below the 3rd percentile. Demographic characteristics, vitamin D levels, and BMD Z-scores were analyzed across groups and among hypogonadism subtypes (hypergonadotropic, congenital hypogonadotropic, and functional hypothalamic amenorrhea). Results:Of the 74 participants, 29 (39.1%) underwent DXA because of hypogonadism. Patients with primary amenorrhea had significantly lower lumbar spine Z-scores than those with secondary amenorrhea (p<0.01). The mean lumbar spine Z-score was numerically lower in the hypogonadism group (-1.95±1.04) compared with others (-1.38±1.31), however; this was not significant (p=0.051). No significant differences were observed among hypogonadism subtypes. Mean serum 25-hydroxyvitamin D levels were low across all groups (12.9±7.7 ng/mL), indicating widespread deficiency. Conclusion:Adolescent girls and young women with hypoestrogenic conditions, particularly those with primary amenorrhea exhibited lower BMD, emphasizing the essential role of estrogen in bone mass accrual during adolescence. Early diagnosis, hormone replacement, and optimization of vitamin D and calcium intake will be important for preserving bone health in this high-risk population.
Objective:This study examined population-level trends in congenital anomalies before and during the coronavirus disease-19 (COVID-19) pandemic in India, which experienced one of the most severe COVID-19 outbreaks with multiple devastating waves. Material and Methods:We conducted a retrospective analysis of prospectively collected data from the Antenatal Detection of Congenital Anomalies registry between pre-pandemic (January 2018-May 2020) and pandemic (June 2020-December 2022). Time series analysis examined temporal trends and seasonal patterns. Results:Among 175,749 prenatal scans, 2.895 congenital anomalies were detected (overall rate 16.5 per 1,000 scans). Detection rates were similar pre-pandemic (14.8 per 1,000 scans, n=1.370) and during the pandemic (18.3 per 1.000 scans, n=1.525; p=0.096). The distribution of anomalies by organ system remained consistent, with head/neck and genitourinary anomalies predominating (19-23% and 14-22% annually, respectively). A persistent seasonal pattern was observed, with peaks in the fourth quarter annually (mean November: 62.7 cases) and troughs at the beginning of each year (mean January: 36.8 cases). The Seasonal Autoregressive Integrated Moving Average model accurately predicted 2023 trends confirming the stability of the epidemiologic process. Conclusion:Our large-scale study provides compelling evidence that the COVID-19 pandemic was not associated with a change in the rate or pattern of congenital anomalies at the population level. The discovery of a robust seasonal variation in anomaly detection represents a significant finding that demands detailed delineation to inform preventive strategies.
Objective:To compare perinatal, neonatal, and early childhood outcomes among pregnant women classified into three groups based on oral glucose tolerance test (OGTT) results: gestational diabetes mellitus (GDM), normal glucose tolerance, and one abnormal OGTT value. Material and Methods:This single-center retrospective cohort study included singleton pregnancies screened between 24 and 28 weeks of gestation and delivered at the same institution. Participants were categorized into GDM, normal glucose tolerance, or one abnormal OGTT value. Maternal demographic data, obstetric outcomes, neonatal outcomes [birth weight, Apgar scores, neonatal intensive care unit (NICU) admission], and early childhood developmental data were collected retrospectively from hospital records. Statistical analyses were performed using the Kruskal-Wallis and chi-square tests. Results:The study included 292 pregnancies categorized into GDM (n=28), normal glucose tolerance (n=224), or one abnormal OGTT value (n=40). Women in the GDM group were significantly older and had higher gravidity and parity than those in the normal glucose tolerance group (p=0.01 and p=0.003, respectively). No significant differences were observed between the groups in terms of birth weight (p=0.651) or NICU admission rates (p=0.29). Although NICU admission rates were higher in the GDM group (12.5%) and in the group with one abnormal OGTT value (10.0%) than in the normal glucose tolerance group (5.8%), these differences did not reach statistical significance. No clinically meaningful differences were identified during early childhood follow-up. Conclusion:Pregnant women with one abnormal OGTT value did not differ significantly from those with GDM or normal glucose tolerance in terms of adverse perinatal outcomes. Larger prospective studies are required to guide clinical management.
Objective: Osteopontin (OPN) is a multifunctional molecule involved in embryo implantation and blastocyst adhesion. Given its role at the maternal-fetal interface, OPN has been proposed as a potential biomarker for early pregnancy outcomes. The aim of this study was to evaluate the association between serum OPN levels and missed abortion in women presenting with early pregnancy bleeding. Material and Methods: In this prospective study, primigravid women between 6 and 11 weeks of gestation with confirmed fetal cardiac activity were enrolled. Participants were classified into three groups according to clinical presentation: normal pregnancy, threatened abortion, and missed abortion. Blood samples were obtained at admission, and serum OPN levels were measured using an enzyme-linked immunosorbent assay. Inflammatory markers including white blood cell count, neutrophil-to-lymphocyte ratio, C-reactive protein levels, and body mass index were also recorded. Results: The study cohort numbered 198 women, aged 18-42 years, with 38, 80 and 80 women in the normal pregnancy, threatened and missed abortion groups, respectively. OPN levels showed a significant and progressive increase with the lowest levels observed in normal pregnancies, higher levels in threatened abortion, and the highest levels in missed abortion (p<0.001). Receiver operating characteristic curve analysis demonstrated strong discriminative capacity of OPN for pregnancy loss (area under the curve =0.846, p<0.001). A cut-off value of 1.15 ng/mL was associated with 100% sensitivity, whereas a cut-off value of 2.15 ng/mL was associated with 100% specificity. Conclusion: Elevated serum OPN levels are associated with early pregnancy loss and may serve as a potential biomarker in missed abortion. However, these findings should be interpreted with caution given the exploratory nature of the analysis.
Objective: Gestational diabetes mellitus (GDM) is significantly associated with short-and long-term adverse maternal and perinatal outcomes. Despite the important role of neudesin in modulating glucose metabolism and insulin sensitivity, extant literature is scarce on the link between neudesin and GDM. This study investigated neudesin in GDM and its potential as a diagnostic marker and future therapeutic target. Material and Methods: We conducted a case control study at our department. Forty-five Pregnant women with GDM were included in the study group, while an equal number of healthy pregnancies constituted the controls. The enzyme-linked immunosorbent assay technique was employed to quantify the concentration of neudesin in both maternal and cord samples. Results: Women with GDM (n=45) exhibited significantly higher maternal and umbilical cord serum neudesin levels compared to controls (median maternal neudesin: 4.9 ng/mL vs. 1.9 ng/mL; median umbilical cord neudesin: 2.6 ng/mL vs. 1.2 ng/mL). Maternal neudesin levels correlated positively with body mass index, fasting insulin, measures of insulin resistance, and neonatal birth weight and inversely with APGAR scores. A maternal neudesin cut-off of 5.25 ng/mL demonstrated high diagnostic accuracy for GDM (area under the curve =0.967, 91.1% sensitivity, 93.3% specificity, 92.2% accuracy). Conclusion: Neudesin may serve as a potential diagnostic tool for GDM. Future investigations into neudesin as a novel GDM biomarker and potential therapeutic target are urgently warranted.
Objective: Prokineticin-1 (PROK-1), known as endocrine gland-derived vascular endothelial growth factor, is an angiogenic peptide mostly produced in endocrine and placental organs. It is important for placental vascular remodeling and trophoblast control. This study sought to investigate the potential of maternal serum PROK-1 levels as a diagnostic or prognostic marker in preeclampsia (PE). Material and Methods: This prospective case-control study included women diagnosed with PE and normotensive pregnant controls. Serum samples were collected at hospital admission, and PROK-1 concentrations were quantified using a commercial ELISA kit. Clinical characteristics and perinatal outcomes were compared between groups. Receiver operating characteristic analyses were used to assess the diagnostic and prognostic performance of PROK-1 for PE, disease severity, and composite adverse perinatal outcomes (CAPO). Results: There were 45 women in the PE group and an equal number of controls. PROK-1 levels were significantly higher in PE than in controls [8.37 (10.51) vs. 4.89 (3.26) ng/mL, p<0.001). PROK-1 predicted PE with an area under the curve (AUC) of 0.721 (cut-off >5.40 ng/mL; sensitivity 75.6%, specificity 60.0%; positive predictive value 65.5%, negative predictive value 71.4%). Furthermore, severe PE cases had significantly higher PROK-1 levels than mild PE cases. PROK-1 predicted severe PE with an AUC of 0.716 (cut-off >9.80 ng/mL) and CAPO with an AUC of 0.673 (cutoff >6.53 ng/mL). Conclusion: Maternal serum PROK-1 was elevated in PE and correlated with disease severity and adverse perinatal outcomes. Although inadequate as a stand-alone marker, PROK-1 may complement existing angiogenic biomarkers in multimarker prediction models.
