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    Evaluation of placenta in patients with gestational diabetes using shear wave elastography and superb microvascular imaging
    (Sage Publications Ltd, 2024) Celik, Ahmet Onur; Gunay, Burak; Coker, Gonca Busra; Ustabasioglu, Fethi Emre; Ates, Sinan; Tuncbilek, Nermin
    Background: Gestational diabetes mellitus (GDM) is a common disease, and the placenta shows various functional and morphological changes in these patients. Superb microvascular imaging (SMI) and shear wave elastography (SWE) are innovative ultrasound (US) methods that provide detailed information about tissue vascularization and elasticity.Purpose: To evaluate placental changes in patients with GDM with SMI and SWE methods.Material and methods: For this case-control study, 20 healthy and 20 women with GDM were included. Women at >21 weeks of pregnancy were evaluated with SMI and SWE by two independent radiologists. Mean SMI values and mean SWE values from three different region of interest-based measurements were compared between the two groups.Results: We identified that the mean SMI and SWE value of the GDM group was found to be significantly higher than that of the control group (P = 0.002, P = 0.001 respectively). Using a receiver operating characteristic curve, the cutoff value of the SMI ratio, which maximizes the prediction of the presence of GDM, was 0.1234279750 (95% confidence interval [CI] = 0.625-0.920), the SWE cut-off value was 15.5 kPa (95% CI = 0.794-0.989).Conclusion: We have demonstrated that evaluation with SMI and SWE might allow quantitative assessment of the morphological changes of placentas in women with GDM. We believe that the use of innovative methods such as SMI and SWE in addition to conventional US examinations in daily practice and studies will provide significant clinical benefits to patient management.
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    Letter to the editor related to the article Surgical outcomes of cesarean scar pregnancy: an 8-year experience at a single institution published by Xu et al.
    (Springer Heidelberg, 2022) Yener, Cem; Sayin, Cenk; Inan, Cihan; Altan, Esra; Ates, Sinan; Varol, Fusun
    [Abstract Not Available]
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    Linguistic and clinical validation of the Turkish version of Acute Cystitis Symptom Score for the diagnosis and patient-reported outcome in acute uncomplicated cystitis
    (Korean Urological Assoc, 2023) Arda, Ersan; Alidjanov, Jakhongir; Ates, Sinan; Cek, Mete; Piatz, Adrian; Wagenlehner, Florian M.; Naber, Kurt G.
    Purpose: The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for diagnosing and monitor-ing acute uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Turkish from the original Uzbek including its linguistic, cognitive and clinical validation.Materials and Methods: After forward and backward translation of the ACSS from Uzbek to Turkish and vice versa, the cognitive assessment of the Turkish ACSS was performed on 12 female subjects to achieve the final study version.Results: The clinical validation was performed on a total of 120 female respondents including 64 Patients with AC and 56 controls without AC. For clinical diagnosis of AC, the predefined summary score of the typical symptoms of >6 showed high values (95% confidence interval) for sensitivity (0.88 [0.77-0.94]), specificity (0.98 [0.91-1.00]), and diagnostic accuracy (0.93 [0.86-0.97]). All patients were followed up between five to nine days after the baseline visit. Forty-four (68.75%) patients used antimicrobial treat-ment, whereas the rest (31.25%) preferred non-antimicrobial treatment. The severity scores of the typical symptoms and the qual-ity of life were reduced significantly at follow-up. Using different (favored) thresholds for successful and non-successful treatment a clinicalsuccess rate between 54.7% and 64.1% (60.9%) was achieved.Conclusions: After translation from the original Uzbek and cognitive assessment, the Turkish ACSS showed similar good results for clinical diagnosis and patient-reported outcome as in other languages validated so far and could therefore now be used for clinical studies as well as in everyday practice.
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    Quadruplet Pregnancy with Complete Mole and Three Viable Fetuses
    (Taylor & Francis Inc, 2022) Yener, Cem; Sayin, N. Cenk; Keskin, Fatma Elif Usturali; Altan, Esra; Ates, Sinan; Varol, Fusun
    Background: The coexistence of a hydatidiform mole and a fetus can occur in a multiple pregnancy, being less frequent in triplets and quadruplets because of their infrequency. With assisted reproduction, multiple pregnancies are becoming more frequent, and we can expect more frequent coexistence with a molar pregnancy. Case report: This G3, P1 30-year-old mother, after assisted conception, was diagnosed with a quadruplet pregnancy, one of which was a molar conceptus. Due to the potential for malignancy, the pregnancy was electively terminated. Conclusion: Despite the difficulty in conceiving, elective termination of a multiple pregnancy associated with a molar pregnancy may be the most judicious course of action to protect the mother's life.
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    Recurrence of premature rupture of membranes among pregnancies admitted to a Tertiary Hospital: a retrospective cohort study
    (Springer Heidelberg, 2022) Suzme, Deniz; Ates, Sinan; Yener, Cem; Varol, G. Fusun
    Purpose The recurrence of PPROM (Preterm Premature Rupture of Membranes) has multifactorial etiology. The aim of this study is to discuss outcome measures of subsequent PPROMs after pregnancy with PPROM before 37 weeks 'gestation. Method One hundred fifty-one patients were identified with PPROM between 20 (+ 0)- 36 (+ 6) weeks of gestation between 2012 and 2017 in Trakya University Hospital. The subsequent pregnancy (n = 68) outcomes were retrospectively analyzed. Results The rate of PPROMs among all deliveries was 4.7%. The recurrence rate of PPROM in the next pregnancies was 13.2%. No differences in smoking, comorbidity, latency, antibiotic use, levels of leucocytes and C-Reactive Protein were observed between women with PPROM and without PPROM in previous and subsequent pregnancies. The interpregnancy intervals in subsequent pregnancies with PPROM were significantly longer than those without PPROM (p = 0.015). The subsequent pregnancies without PPROM had longer gestational weeks of PPROM and birth according to previous pregnancies (p = 0.049; p = 0.014). Conclusion The short interpregnancy interval may be considered in the planning of pregnancies of these women who had previous PPROM.
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    Relationship between second-trimester amniotic fluid and plasma levels of angiopoietin-2 and thrombomodulin with adverse pregnancy outcome
    (Taylor & Francis Inc, 2022) Yener, Cem; Varol, Fusun; Inan, Cihan; Sutcu, Havva; Ates, Sinan; Sayin, Cenk
    Our objective is to investigate maternal midtrimester plasma and amniotic fluid (AF) levels of angiopoietin-2 (Ang-2) and thrombomodulin (TM), which are involved in vascular remodelling and endothelium activation, in placental disorders including foetal growth restriction (FGR) and preeclampsia (PE). This prospective multiparametric pilot study was conducted at the Perinatology Division of Trakya University in a population undergoing genetic amniocentesis. Both AF and plasma aliquots were kept in -80 degrees C until ELISA assay. The pregnancies were followed up until the end of gestation in terms of obstetric results. Amniotic fluid and plasma aliquots from 127 pregnancies who underwent genetic amniocentesis between 16 and 24 weeks of gestation were analysed. During the final data evaluation, 39 were excluded with various reasons. Twelve subsequently developed FGR and 11 complicated with PE. The control group (n = 65) was consisted of women delivered >37th week with an uncomplicated outcome. The midtrimester maternal Ang-2 levels in both AF and plasma and also TM levels in plasma were found to be significantly increased in pregnancies who subsequently developed FGR or PE (p< .05). The midtrimester Ang-2, which rises in both plasma and AF and the midtrimester TM, which only significantly increase in plasma compartment in PE group, as compensatory mechanism may be the precursors of placental disorders including FGR and PE.Impact Statement What is already known on this subject? It is known that angiopoietin-2 (Ang-2) has important role in placental angiogenesis and vascular remodelling. TM which is a receptor for Ang-2 plays a protective role in pregnancy by preventing the uteroplacental circulation from thrombosis. What do the results of this study add? The present study demonstrates that both midtrimester maternal plasma Ang-2/TM and amniotic fluid (AF) Ang-2 levels were significantly higher in PE and FGR group than uncomplicated group. Midtrimester AF TM levels were not significantly higher in PE group than the control group. What the implications are of these findings for clinical practice and/or further research? In the clinical practice, high levels of midtrimester Ang-2 and TM in plasma may be used for the prediction of FGR and PE. Although amniocentesis is not practical in the clinical use, the levels of these two markers in both AF and plasma compartments may contribute to explain the pathophysiology of FGR and PE.