Browsing by Author "Durdag, Gulsen Dogan"

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An analysis of 635 consequetive laparoscopic hysterectomy patients in a tertiary referral hospital
(2020) Yuksel, Seda; Serbetcioglu, Gonca Coban; Alemdaroglu, Songul; Yetkinel, Selcuk; Durdag, Gulsen Dogan; Simsek, Erhan; Celik, Husnu; 0000-0002-5064-5267; 0000-0002-3285-5519; 0000-0003-4335-6659; 0000-0002-2165-9168; 31610294; AAK-7016-2021; AAI-9594-2021; AAI-9974-2021; AAI-8400-2021; AAL-1530-2021
Objective: The objective of this retrospective observational study is to analyse the properties of laparoscopic hysterectomy cases that are performed for benign indications and also endometrial cancer indications. Operation time, postoperative complicaton rate, blood transfusion need, and hospitalization time are compared according to benign and malign indications and also body mass index of the patients. Material and methods: Patients who were operated between September 2012 and December 2017 are included in this study. Patients' age, body mass index, medical histories, operation indications, operation time, pathology reports, pre and postoperative hemoglobine values and postoperative complications are obtained from medical records.Body mass index is classified as underweight for <19 ; normal for 19-25 ; overweight for 25-30 and obese for >= 30. Results: Operation and hospitalization times were significantly higher for high BMI and malign gynecologic indication groups than lower BMI and benign gynecologic indication groups (p:0.0001). Complication rates and transfusion needs were similar in between malign and benign gynecologic disease groups (p :0.443; P:0.670 respectively) and also in between high and lower BMI groups (P:0.813 ; P:0.468 respectively). Conclusion: Laparoscopic approach for hysterectomy operations in high BMI patients and endometrial cancer patients seem to be safe in terms of postoperative complication and bleeding that necessitate transfusion. (C) 2019 Elsevier Masson SAS. All rights reserved.
The clinical outcomes of ovarian cancer in patients with brain metastasis
(2021) Simsek, Seda Yuksel; Guler, Ozan Cem; Durdag, Gulsen Dogan; Sari, Sezin Yuce; Gultekin, Melis; Yildiz, Ferah; Celik, Husnu; Erbay, Gurcan; Onal, Huseyin Cem; 0000-0003-3191-9776; AAK-7016-2021
Objective: To present the clinical characteristics and treatment outcomes of patients with ovarian cancer with brain metastasis. Methods: This study was designed as a retrospective observational study. Patients' data were obtained from hospital records. Patients who were diagnosed with brain metastatic ovarian cancer in two tertiary referral centers between 2012 and 2020 were included in the study. Results: In total, there were 56 patients diagnosed as having brain metastatic ovarian cancer. The median age was 56 years, 91% of patients were at an advanced stage at initial diagnosis. The median time from the initial diagnosis to brain metastasis was 34.0 months. Sixty-seven percent of patients were determined as having multiple brain metastatic lesions. Whole brain radiotherapy (WBRT) , stereotactic radiosurgery (SRS) and combined approach were utilized as primary treatment. The 1 and 2-year survival rates were 38% and 17%, respectively. Patient age and tumor histology were found to be significant prognostic factors that impact the survival in univariate analyses. The 1-year survival of patients aged younger than 55 years was 49.2%, and 28.2% for patients aged over 55 years (p = 0.04). Patients with nonserous histology had significantly longer one year overall survival compared to serous histology (61.4% vs 29.8%) (p= 0.01). Conclusion: The brain is one of the rarest locations for ovarian cancer metastasis. Radiotherapeutic approaches are the mainstay of treatment but survival rates are low. Age and tumor histology were determined as significant parameters that affected survival rates.
Does abnormal ductus venosus pulsatility index at the first-trimester effect on adverse pregnancy outcomes?
(2020) Baran, Safak Yilmaz; Kalayci, Hakan; Durdag, Gulsen Dogan; Yetkinel, Selcuk; Arslan, Alev; Kilicdag, Esra Bulgan; 0000-0002-2165-9168; 0000-0002-5064-5267; 0000-0002-0942-9108; 0000-0003-4444-0027; 0000-0001-5874-7324; 32623067; AAL-1530-2021; AAI-9594-2021; AAK-8872-2021; V-1112-2019
Aim: The ductus venosus pulsatility index for veins (DV PIV) has become a popular marker of the first-trimester scan. The aim of this study is to search for any difference between groups with normal and abnormal DV PIV values in terms of adverse pregnancy outcomes. Methods: We retrospectively evaluated 556 women whose first-trimester scan was performed. The ductus venosus pulsatility indices were examined at singleton pregnancies between 11 and 14 weeks of gestation. Patients were categorized as Group-I with normal DV PIV (DV PIV >= 0.73, <= 1.22) and as Group-II with abnormal DV PIV. Group-II was subgrouped as Group-IIA which composed of patients with DV PIV < 0.73 and as Group-IIB with DV PIV > 1.22. Results: There were 451 subjects in Group-I and 105 subjects in Group-II (Group-IIA = 32 and Group-IIB 73). The comparisons between major groups revealed a statistically significant increase about miscarriage (p = 0.002), stillbirth (p < 0.001), small for gestational age (p = 0.033), low birth weight (p < 0.001), fetal growth restriction (p = 0.048), and major congenital heart defect (p=<0.001) in Group-II. This difference is mainly due to Group-IIB. There is no difference in preterm delivery, preeclampsia and gestational diabetes between Group I and II. Conclusion: Routinely monitoring DIV PIV as a first-trimester screening should provide valuable information regarding adverse pregnancy outcomes such as miscarriage, stillbirth, small for gestational age, low birth weight, fetal growth restriction and major congenital heart defect. (C) 2020 Elsevier Masson SAS. All rights reserved.
The Effect of Suture Materials with Different Absorption Times on Isthmocele: A Retrospective Study
(2023) Yetkinel, Selcuk; Aytac, Pinar Caglar; Kalayci, Hakan; Cok, Tayfun; Durdag, Gulsen Dogan; Yaginc, Didem Alkas; Baran, Safak Yilmaz; Alemdaroglu, Songul; Kilicdag, Esra Bulgan; 0000-0002-2165-9168; 0000-0002-5064-5267; 37306162; AAL-1530-2021; AAC-9940-2020; AAI-9594-2021
Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches.Material and methods:This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl center dot in 49 patients and Vicryl center dot in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate.Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002).Conclusions:The formation of niches and associated PMS rates were less with suture materials that were absorbed faster.
The Effect of the Cause of Delivery on Neonatal Outcomes in Early Preterm Deliveries
(2019) Baran, Safak Yilmaz; Torer, Birgin; Kalayci, Hakan; Durdag, Gulsen Dogan; 0000-0001-5874-7324; 0000-0002-5505-8707
The aim of this study was to evaluate the effect of causes of delivery on short-term neonatal morbidities and mortality in EPD (< 34 gestational weeks). We retrospectively analysed the deliveries occurring between 23 + 0 and 33 + 6th gestational weeks at our tertiary center during 2014-2018. A total of 290 deliveries were evaluated, and 369 newborns [singletons (56.4%), twins (36.6%) and triplets (7.1%)] were included in the study. The causes of deliveries were defined as spontaneously preterm birth (n = 107, 29%), preterm premature rupture of membranes (PPROM) (n = 131, 35.5%) or iatrogenic preterm birth (n = 131, 35.5%). The rate of neonatal respiratory distress syndrome (RDS), patent ductus arteriosus, bronchopulmonary dysplasia (BPD), intraventricular haemorrhagia (IVH), necrotising enterocolitis, retinopathy of prematurity, neonatal resuscitation, sepsis and death were similar between groups. However; neonatal RDS, BPD, IVH and sepsis were found to be higher in cases with chorioamnionitis, which could be considered as subcategory of PPROM. Preterm deliveries have an adverse effect on perinatal outcomes. Also, such causes of labor might be related to varied neonatal morbidities. However, splitting to early preterm deliveries into subgroups, according to cause of delivery, did not provide further information to predict such complications except chorioamnionitis.
The efficacy of dydrogesterone use to suppress premature luteinizing hormone surge on cycle outcomes in controlled ovarian stimulation
(2021) Durdag, Gulsen Dogan; 33389927
Objective: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. Material and Methods: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. Results: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.
Importance of Laparoscopy in Predicting Complete Cytoreduction at Advanced Stage Ovarian Cancer
(2022) Durdag, Gulsen Dogan; Alemdaroglu, Songul; Baran, Safak Yilmaz; Serbetcioglu, Gonca Coban; Ozmete, Ozlem; Ezer, Ali; Celik, Husnu; https://orcid.org/0000-0003-4335-6659
Purpose Laparoscopy has been used in evaluation of ovarian cancer to assess the extent and surgical resectability of the disease, and to avoid futile laparotomy, where primary cytoreduction is not suitable. Aim of this study is to investigate the contribution of laparoscopy in predicting 'no gross residue' in advanced stage ovarian cancer. Methods Data of advanced stage ovarian cancer patients, who underwent diagnostic laparoscopy for prediction of complete cytoreduction due to an alternative model, are analyzed retrospectively. Accordingly, in the absence of obvious mesenteric retraction or extensive tumoral implants on small intestine in laparoscopic assessment, cases were deemed surgically resectable, and the operation was continued with laparotomy to achieve complete cytoreduction. Clinical features of the patients, surgical details, complete and optimal cytoreduction rates, and perioperative complications were evaluated. Results Out of 243 patients with advanced stage ovarian/tubal/peritoneal cancer, laparoscopy was performed at 93 patients, 77 of whom underwent primary cytoreduction subsequently. Complete cytoreduction (no gross residue) and optimal cytoreduction (< 1 cm residual tumor) rates were 75.3 and 100%, respectively. None of the patients had suboptimal surgery. Morbidity and mortality rates were acceptable. Conclusion Laparoscopic evaluation prior to cytoreductive surgery can highly contribute to prediction of complete or optimal cytoreduction in suitable patients. However, experience and skills of the surgeon, as well as technical equipment of the center, may affect surgery; therefore, the model to predict residual tumor should be individualized according to the set up and the surgical team of each center.
Intrahepatic cholestasis of pregnancy: are in vitro fertilization pregnancies at risk?
(2020) Alemdaroglu, Songul; Yilmaz Baran, Safak; Durdag, Gulsen Dogan; Yuksel Simsek, Seda; Yetkinel, Selcuk; Alkas Yaginc, Didem; Kalayci, Hakan; Simsek, Erhan; 0000-0002-5064-5267; 0000-0002-2165-9168; 0000-0003-4335-6659; 32419565; AAI-9594-2021; AAL-1530-2021; ABF-6439-2020; AAI-8400-2021; AAK-7016-2021
Aim: Single pregnancy patients with intrahepatic cholestasis of pregnancy (ICP) were divided into two groups according to the conception method, as spontaneous and in vitro fertilization (IVF). We aim to compare the maternal, laboratory and perinatal characteristics of both groups. Materials and method: The records of 10,929 patients who gave birth in the center between October 2011 and July 2019 were analyzed retrospectively from the data processing system records. Maternal, laboratory and perinatal characteristics of 109 single pregnancies (spontaneous n: 91; IVF n: 18) diagnosed with ICP were compared. Findings: The maternal demographic data of both groups were similar (p: .05). In both groups, gestational week, gestational age at birth, birth weight, neonatal intensive care admission rate, meconium-stained amniotic fluid, umbilical cord pH, the 5-minute APGAR score, and the presence of pregnancy complications were similar (p > .05). Result: Although ICP is reported with a higher incidence in IVF pregnancies, ICP findings and prognosis are similar to those of spontaneous pregnancies.
Is fetal magnetic resonance imaging indicated in patients with isolated ventriculomegaly?
(2019) Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Kalayci, Hakan; Alkan, Ozlem; 0000-0001-5874-7324; 31228676; ABF-6439-2020
Objective: Ventriculomegaly is one of the most common anomalies encountered at obstetric ultrasound and it necessitates follow up. Fetal magnetic resonance imaging (MRI) can be used to confirm the ultrasound diagnose or to detect additional anomalies. Aim of this study is to assess follow up and management of fetal ventriculomegaly shown by ultrasound, and to evaluate additional diagnostic contribution of MRI. Study Design: This study was conducted retrospectively including 89 patients who had fetal MRI subsequent to ultrasound diagnose of ventriculomegaly in between 2011-2017. Medical records of patients were investigated and accompanying anomalies, congenital infection. chromosomal examination, degree and progression of ventriculomegaly, neonatal imaging and diagnose, and neurodevelopmental findings on follow up were evaluated. Patients were classified in two groups as isolated and nonisolated ventriculomegaly, and subgroups mild, moderate, severe were formed according to their findings. SPSS 23.0 programme was used for statistical analysis. Results: Ultrasound and following MRI was performed in a range of 18-35 th gestational weeks, diagnoses were isolated ventriculomegaly for 56 patients and nonisolated ventriculomegaly for 33 patients. Progression and neurodevelopmental delay was higher in severe nonisolated ventriculomegaly group. There was not significant contribution of MRI in the follow up of isolated ventriculomegaly (p < 0.001), and diagnostic imaging findings declined in neonatal period with proceeding normal neurodevelopment in 92.7% of patients followed with diagnosis of isolated ventriculomegaly. Conclusion: When isolated ventriculomegaly is detected, ultrasound performed by an experienced team is mostly sufficient. MRI can be used in suspicious cases or when ventriculomegaly progresses. (C) 2019 Elsevier B.V. All rights reserved.
Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy
(2020) Durdag, Gulsen Dogan; Alemdaroglu, Songul; Durdag, Emre; Simsek, Seda Yuksel; Turunc, Tuba; Yetkinel, Selcuk; Baran, Safak Yilmaz; Celik, Husnu; 0000-0001-6939-5491; 0000-0002-2165-9168; 0000-0002-5064-5267; 0000-0003-4335-6659; 32500164; AAK-1734-2021; AAL-1530-2021; AAI-9594-2021; AAK-7016-2021; AAI-8400-2021; ABF-6439-2020
Introduction and hypothesis Sacrocolpopexy is considered to be the gold-standard procedure for apical compartment prolapse. However, complications such as sacral hemorrhage, small bowel obstruction, port site herniation, mesh erosion, mesh exposure, and occasionally discitis may occur. The aim of this study is to show laparoscopic treatment of L5-S1 discitis 3 months following laparoscopic sacrocolpopexy. Methods Two surgical interventions of a case with narrated video footage is presented. Results Laparoscopic sacrocolpopexy following hysterectomy in the first part and re-laparoscopy because of a diagnosis of discitis refractory to medical treatment, and removal of mesh along with anterior L5-S1 discectomy for curative debridement in the second part is demonstrated. Conclusion Frequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary.
Pregnancy and immune thrombocytopenia: New trends Response
(2020) Kalayci, Hakan; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Alemdaroglu, Songul; Ozdogan, Serdinc; Kilicdag, Esra Bulgan; 0000-0002-5064-5267; 0000-0002-0942-9108; 0000-0003-4335-6659; AAI-9594-2021; AAK-8872-2021; AAI-8400-2021; AAK-7016-2021; ABF-6439-2020
Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes
(2020) Kalayci, Hakan; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Alemdaroglu, Songul; Ozdogan, Serdinc; Kilicdag, Esra Bulgan; 0000-0003-4335-6659; 0000-0002-0942-9108; 0000-0002-5064-5267; 0000-0001-5874-7324; 0000-0002-1767-1527; 31397144; AAK-7016-2021; AAI-8400-2021; ABF-6439-2020; AAK-8872-2021; AAI-9594-2021
Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodies can cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy, and to investigate neonatal outcomes. Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITP diagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed. Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar. Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients should be followed closely in cooperation with the hematology department.
Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures
(2021) Simsek, Seda Yuksel; Simsek, Erhan; Durdag, Gulsen Dogan; Alemdaroglu, Songul; Baran, Safak Yilmaz; Kalayci, Hakan; 0000-0003-3191-9776; 0000-0002-1505-5288; 0000-0002-5064-5267; 0000-0003-4335-6659; 0000-0001-5874-7324; 32517429; AAK-7016-2021; AAI-9594-2021; AAI-8400-2021
Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes. Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center. Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6 +/- 4.5 and 33.6 +/- 5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery >= 34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery. Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.
Prognostic factors of endometrial cancer in elderly patient group and their effects on survival
(2021) Alemdaroglu, Songul; Durdag, Gulsen Dogan; Baran, Safak Yilmaz; Simsek, Seda Yuksel; Yetkinel, Selcuk; Yaginc, Didem Alkas; Guler, Ozan Cem; Celik, Husnu; 0000-0003-4335-6659; 34585068; AAI-8400-2021
OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4- 24.7) and lymph node metastasis (HR: 6.4; 95% CI: 1.6-25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0-32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.
Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes
(2020) Yilmaz Baran, Safak; Alemdaroglu, Songul; Durdag, Gulsen Dogan; Yetkinel, Selcuk; Yuksel Simsek, Seda; Kalayci, Hakan; Simsek, Erhan; 0000-0003-4335-6659; 0000-0002-5064-5267; 0000-0002-2165-9168; 32037908; AAK-7016-2021; AAK-7016-2021; AAK-7016-2021; AAK-7016-2021; AAK-7016-2021
Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications. Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia. Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery. Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.
Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13(+6) weeks of gestation
(2020) Kalayci, Hakan; Baran, Safak Yilmaz; Durdag, Gulsen Dogan; Yetkinel, Selcuk; Alemdaroglu, Songul; Ozdogan, Serdinc; Simsek, Seda Yuksel; Kilicdag, Esra Bulgan; 0000-0002-0942-9108; 0000-0003-4335-6659; 0000-0002-5064-5267; 0000-0002-2165-9168; 0000-0001-5874-7324; 0000-0002-1767-1527; 30157671; AAK-8872-2021; AAK-7016-2021; AAI-8400-2021; ABF-6439-2020; AAI-9594-2021; AAL-1530-2021
Purpose: The ductus venosus pulsatility index velocity (DV PIV) has become a popular ultrasonographic measurement during the first trimester of pregnancy. The value of the DV PIV has been the topic of ongoing discussion in the literature, and its reference value in the normal population has not yet been established. Therefore, we aimed to determine a reference value for the DV PIV. Materials and Methods: We retrospectively evaluated our records of first-trimester ultrasonography performed between 2016 and 2017. Our inclusion criteria were as follows: singleton pregnancy; crown-rump length (CRL) between 45 and 84 mm; absence of structural abnormalities on the ultrasound examination; and absence of chromosomal abnormalities. Records of 820 patients were evaluated. According to the inclusion criteria, records of 458 patients were included in this study. All ultrasound examinations were performed by a single operator with the Voluson E8 (5- to 8-MHz 3 D transducer; General Electric Healthcare, Little Chalfont, UK) via the transabdominal route. Gestational weeks were designated according to CRL measurements at the beginning of the examination. Nuchal translucency (NT), nasal bone visualization (NB), tricuspid valve regurgitation (TR), "a"-wave pattern, DV PIV, S-wave (peak systolic velocity), D-wave (peak diastolic velocity), a-wave (atrial contraction in late diastole), and time-averaged maximum velocity (TAMXV) measurements were performed. To evaluate the DV Doppler images, a mid-sagittal view of the fetal profile was obtained. Color Doppler and pulse Doppler gate were used in the distal portion of the umbilical sinus, and at least three typical DV waveforms were detected. The SPSS 21.0 statistical program (IBM, Armonk, NY) was used to analyze variables. Results: The mean age, body mass index, CRL, gestational age, and NT values were 30.3 years (range, 18-45), 23.9 kg/m(2) (range, 15.5-46.6), 59.5 mm (range, 45-79), 12.3 weeks (range, 11.2-13.6), and 1.58 mm (range, 0.73-2.62), respectively. The median gravidity and parity were 2 (1-8) and 0 (0-4), respectively. The "a"-wave pattern was identified in all cases, but TR was not detected in any of the cases. Measurements of DV PIV with a Gaussian distribution were suitable according to the Shapiro-Wilk test (p = .252). The mean DV PIV was 0.98, and the fifth and 95th percentiles were 0.73 and 1.22 (+/- 2 SD), respectively. A statistical analysis of our cohort revealed that DV PIV values less than 0.73 and more than 1.22 were beyond the normal range. The mean S-wave, D-wave, a-wave, and TAMXV values were 31.18, 25.64, 8.68, and 22.72 cm/s, respectively. Conclusions: The value of DV PIV measurements is debated in the literature. Using our cohort, we defined the means and ranges of DV PIV. Determining the normal ranges of DV PIV could be helpful to anticipate congenital or chromosomal abnormalities. Further studies are needed to demonstrate the clinical importance of DV PIV, especially for patients with abnormal DV PIV measurements.
Reproductive outcomes of office hysteroscopic metroplasty in women with unexplained infertility with dysmorphic uterus
(2018) Haydedeoglu, Bulent; Durdag, Gulsen Dogan; Simsek, Seda; Aytac, Pinar Caglar; Cok, Tayfun; Kilicdag, Esra Bulgan; 30202621
Objective: The correlation between dysmorphic uterus and infertility still remains enigmatic. We evaluated the reproductive outcomes of metroplasty via office hysteroscopy in unexplained infertile women with dysmorphic uteri. Materials and Methods: In this retrospective cohort study, metroplasty via office hysteroscopy using a bipolar system was performed to 272 women with unexplained infertility with dysmorphic uteri from January 2013 to January 2016. Of all the patients, 162 had primary infertility, and 110 had secondary infertility. Results: In the primary infertility group, the clinical pregnancy rate was 45.68% (74/162) and the live birth rate was 38.9% (63/162), and in the secondary infertility group, the clinical pregnancy rate was 55.45% (61/110) and the live birth rate was 49% (54/110) after metroplasty. In the secondary infertility group, the miscarriage rate and especially the ectopic pregnancy rate declined dramatically [from 84.5% (93/110) to 9.8% (6/61) and from 15.5% (17/110) to 1.6% (1/61), respectively] (p<0.01). Conclusion: Reproductive outcome can be impaired by Mullerian anomalies, hence, infertile women with dysmorphic uteri should undergo hysteroscopy to improve reproductive outcomes. Our study demonstrated that office hysteroscopic metroplasty of a dysmorphic uterus might improve fertility, particularly in patients with unexplained infertility with dysmorphic uteri, which was an ignored factor previously. Office hysteroscopy is an alternative option in terms of non-invasive procedure.
Role of prophylactic and therapeutic red blood cell exchange in pregnancy with sickle cell disease: Maternal and perinatal outcomes
(2020) Baran, Safak Yilmaz; Kozanoglu, Ilknur; Korur, Asli; Durdag, Gulsen Dogan; Kalayaci, Hakan; Alemdaroglu, Songul; Asma, Suheyl; Kilicdag, Esra Bulgan; Boga, Can; 0000-0002-0942-9108; 0000-0002-5086-5593; 0000-0002-5268-1210; 0000-0003-4335-6659; 0000-0001-5335-7976; 0000-0002-5064-5267; 0000-0002-8902-1283; 0000-0001-5874-7324; 0000-0002-9680-1958; 32797735; ABF-6439-2020; AAK-8872-2021; AAD-5616-2021; AAD-6222-2021; AAE-1241-2021; AAI-8400-2021; AAI-7831-2021; AAI-9594-2021; AAD-5542-2021
Background and Aim The incidence of fetomaternal complications during pregnancy is high for women with sickle cell disease (SCD), which is the most common hematologic genetic disorder worldwide. Prophylactic red blood cell exchange (pRBCX) has been shown to be efficient, safe, and feasible for preventing complications. The aim of this study was to observe maternal, perinatal, and neonatal outcomes of pregnancies in which pRBCX was. Method This was a single-center, retrospective, cross-sectional study, which recruited 46 consecutive adult pregnant women with SCD between January 2012 and June 2019. Obstetric features, SCD-related complications, and fetomaternal outcomes were compared between the 27 patients who received prophylactic exchange and the 19 who did not (therapeutic exchange was performed in 7 and was not performed in 12 cases). Results Painful crises, preeclampsia, and preterm birth rates were significantly higher in the group that did not receive prophylactic exchange (control group;P= .001,P= .024, andP= .027, respectively). There was one maternal mortality in the control group (P= .41). Incidence of adverse fetal or maternal complications was significantly higher in the control group (P= .044 andP= .007, respectively). Conclusions Our center's experience over a 7.5-year period, as described above, demonstrates that pRBCX in SCD affects the course of pregnancy positively by ameliorating negative fetomaternal outcomes.
Safety of Laparoscopic Surgery in the Management of Endometrioid Endometrial Cancer
(2023) Durdag, Gulsen Dogan; Alemdaroglu, Songul; Simsek, Seda Yuksel; Yetkinel, Selcuk; Celik, Husnu; 36861713
Background: Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods: Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results: Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions: Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.
The Values of First-trimester Maternal Serum Markers in Predicting Poor Obstetric Outcomes
(2019) Baran, Safak Yilmaz; Kalayci, Hakan; Durdag, Gulsen Dogan; Simsek, Seda Yuksel; Yetkinel, Selcuk; Simsek, Erhan; 0000-0001-5874-7324
Introduction: The effects of pregnancy-associated plasma protein A (PAPP-A) and maternal serum free beta-human chorionic gonadotropin (beta-hCG), which are first trimester maternal serum markers, on assisting in the diagnosis of chromosomal abnormalities and perinatal outcome are discussed. The aim of the presented study was to investigate the predictive value of first-trimester PAPP-A and beta-hCG) levels in predicting poor obstetric outcomes. Methods: A total of 549 patients who underwent first trimester screening in Perinatalogy Outpatient Clinic of our hospital between January 2016 and March 2018 were included in this study. Patients with crown-rump length (CRL) measurements in the range of 45-84 mm, patients with singleton pregnancy and patients who delivered at 24 weeks or later were included in the study. CRL, nuchal translucency, mean uterine artery pulsatility index, PAPP-A and free beta-hCG levels were recorded. The 5th and 10th percentile values of PAPP-A and free beta-hCG levels were designated according to the literature. Results: There was no difference between PAPP-A percentile groups in terms of mean birth weight or gestational age at delivery. However, mean gestational age at delivery was lower in patients with free beta-hCG levels below 10th percentile. Preterm delivery was significantly higher in the group with PAPP-A levels below 5th percentile (p=0.049). Also, preeclampsia (PE) was higher in the group with free beta-hCG below 10th percentile (p=0.003). Conclusion: The risk poor obstetric outcome such as preterm delivery, low birth weight and PE may be associated with low PAPP-A and free beta-hCG levels. However, further studies are needed to explain the relationship between first trimester screening markers and neonatal outcomes.