Wos Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10754
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Item 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-8400-2021Objective: 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.Item 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-1530-2021Purpose: 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.Item 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-9594-2021Objective: 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.Item Single- or double-layer uterine closure techniques following cesarean: A randomized trial(2020) Yilmaz Baran, Safak; Kalayci, Hakan; Dogan Durdag, Gulsen; Yetkinel, Selcuk; Alemdaroglu, Songul; Cok, Tayfun; Bulgan Kilicdag, Esra; 0000-0002-5064-5267; 0000-0002-2165-9168; 0000-0003-4335-6659; 0000-0002-0942-9108; 0000-0002-7854-2921; 0000-0001-5874-7324; 33029804; AAI-9594-2021; AAL-1530-2021; AAI-8400-2021; AAK-8872-2021; A-8208-2008; ABF-6439-2020Introduction Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long-term negative consequences. This prospective, randomized study examined the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery. Material and methods This study assessed a total of 282 women aged 18-45 years who were in gestational weeks 24-41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6-9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique. Results Of the 225 final participants, 109 received the single-layer closure technique, whereas 116 received the double-layer technique. The niche rates were 37% (n = 40) for the single-layer group and 45.7% (n = 53) for the double-layer group (P = .22, relative risk 1.4, 95% CI = 0.8-4.4). Conclusions The single- and double-layer closure techniques did not produce different impacts on uterine scar niche development.Item 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; 0000-0001-5874-7324Introduction: 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.Item The effect of preserving prepared sperm samples at room temperature or at 37 C-circle before intrauterine insemination (IUI) on clinical pregnancy rate(2015) Cok, Tayfun; Aytac, Pinar Caglar; Simsek, Erhan; Haydardedeoglu, Bulent; Kalayci, Hakan; Ozdemir, Halis; Kilicdag, Esra Bulgan; 28913033Objective: The comparison of the effect of preserving prepared sperm samples at room temperature or at 37(circle)C before intrauterine insemination (IUI) on clinical pregnancy rate. Materials and Methods: Retrospective clinical research. University hospital, infertility clinic. Patients with one or two follicles, between the ages of 20 and 40, whose infertility period was less than 6 years and the injected total motile sperm count was more than 10 million. Preserving sperm samples prepared for IUI at 37(circle)C or at room temperature before IUI. The clinical pregnancy rate of IUI cycles between 1st of January 2004 and 1st of December 2011 in which prepared sperm samples were preserved at 37(circle)C and the clinical pregnancy rate of IUI cycles between 1st of December 2011 and 31st of May 2014 in which prepared sperm samples preserved at room temperature. Results: Clinical pregnancy rates were similar in IUI cycles in which prepared sperm samples were preserved at 37(circle)C and at room temperature (9.3% vs. 8.9%). Clinical pregnancy rates in IUI cycles with 2 follicles were higher than IUI cycles with 1 follicle (10.8% vs. 7.6%) (p=0.002). Further statistical analysis after splitting data according to the number of the follicles revealed that there was no statistical difference between clinical pregnancy rates after IUI cycles in which prepared sperm samples were preserved at 37(circle)C or at room temperature in both one follicle (7.6% vs. 7.6%), and two follicle cycles (11.5% vs. 10.1%). Conclusions: Preserving prepared sperm samples at room temperature had no negative effect on clinical pregnancy rates when compared with reserving prepared sperm samples at 37(circle)C during IUI cycles.Item Effect of pigtail catheter application on obstetric outcomes in in vitro fertilization/intracytoplasmic sperm injection pregnancies following hyperstimulation syndrome(2017) Aytac, Pinar Caglar; Kalayci, Hakan; Yetkinel, Selcuk; Alkas, Didem; Simsek, Seda Yuksel; Haydardedeoglu, Bulent; Kilicdag, Esra Bulgan; 28913144Objective: To evaluate the effects of percutaneous pigtail catheter drainage on the outcomes of intracytoplasmic sperm injection (ICSI) pregnancies following moderate or severe ovarian hyperstimulation syndrome (OHSS). Materials and Methods: This retrospective study included 189 patients hospitalized for OHSS following ICSI treatment in a tertiary in vitro fertilization unit between 2006 and 2014. Pigtail catheters were applied in 63 patients; the other 126 patients did not need that treatment. The obstetric reports of 173 patients could be accessed and were examined to investigate the pregnancy outcomes of those with and without catheters. Results: No complications such as infection or vascular or intra-abdominal organ trauma were observed related to the pigtail application. There were no differences in abortus, preterm labor, gestational diabetes mellitus, and preeclampsia ratio between the pigtail and control groups (p>0.05). The rate of readmission to hospital for OHSS was lower in the pigtail group than in the control group although not statistically significant (p=0.08). Conclusion: Pigtail application is a safe and effective method for draining ascites in patients with OHSS after ICSI treatment. The use of pigtail catheters had no adverse effects on the perinatal outcomes of patients hospitalized with OHSS who became pregnant after ICSI treatment. In addition, the percutaneous drainage of ascites via a pigtail catheter helped prevent the readmission of patients with moderate or severe OHSS.