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Öğe Analysis of Antenatal Sonographic Features of the Fetuses with Trisomy 21(Kowsar Publ, 2018) Uzun, Isil; Sayin, Cenk; Erzincan, Selen; Ivan, Cihan; Sutcu, Havva; Varol, FusunObjectives: To evaluate the second trimester ultrasound findings of the fetuses with Down syndrome. Patients and Methods: We conducted a retrospective analysis of 781 patients who underwent prenatal invasive test between November 2011 and July 2015. Based on the patients' medical records, the demographic data and second trimester ultrasound findings of the fetuses with Down syndrome were retrospectively analyzed. Results: Trisomy 21 was detected in 26 (3.3%) patients. The median (min-max) maternal age of trisomy 21 cases was 31.9 (17 - 41) years. The karyotype indications were high risk in the combined test, triple test, quadruple test and pathologic findings on the ultrasound examination. One case in the ultrasound group had both of combined test and triple test in the low risk area. In this patient, ultrasound examination revealed talipes equinovarus and delayed chorioamniotic fusion at 27 weeks of gestation. Trisomy 21 was detected in four patients by chorion villus biopsy at the first trimester. Second trimester ultrasound was performed in 22 out of these 26 women. However, there were sonographic findings in only 16 (72.7%) patients. Six (27.2%) fetuses had no minor or major anomaly at the detailed ultrasound examination. The frequency of major cardiac anomaly was 22.7%. Choroid plexus cyst and aberrant right subclavian artery were the single findings in two fetuses at the second trimester ultrasound exam. Conclusion: Although the sensitivity of second trimester genetic ultrasound for detection of fetal Down syndrome at our perinatology unit was rather high, nearly one of three patients with Down syndrome had no detectable sonographic finding. Second trimester ultrasound alone is not strong enough to exclude the diagnosis of Down's syndromeÖğe Clinical Significance of Abnormal Results of Second Trimester Hormones in the Absence of Aneuploidy(Kowsar Publ, 2018) Uzun, Isil; Sayin, N. Cenk; Inan, Cihan; Erzincan, Selen; Sutcu, Havva; Varol, FusunBackground: Abnormal levels of hormones during the second trimester of pregnancy may predict genetic disorders and complications of pregnancy. Objectives: This study was performed to evaluate the clinical significance of abnormal results in second-trimester markers in the absence of aneuploidy. Methods: This case-control study was conducted between May 2014 and December 2015 in the maternal-fetal unit, Trakya University Faculty of Medicine in Turkey. Overall, 108 Turkish pregnant females were included in this study. This research recruited patients (n = 46) with normal karyotype, who underwent invasive prenatal tests because of abnormal levels of second-trimester hormones, along with a cohort of controls (n = 31) with hormonal results within normal ranges. For each patient, the researchers recorded the mode of delivery, gestational age at delivery, birth weight, complications, and adverse outcome of the pregnancy. Data were analyzed using Fisher's exact tests and Yates continuity correction tests for qualitative variables, and t- test and Mann-Whitney U test for quantitative variables. Results: Maternal age (mean +/- SD) of the entire group was 31.77 +/- 5.68 years (study group: 31.23 +/- 4.39; controls: 32.13 +/- 6.43, P > 0.05). Preterm delivery and preeclampsia were significantly higher in the study group (P = 0.02). In the study group, Alpha Fetoprotein (AFP) levels were significantly higher in patients with preeclampsia yet not in the controls. The AFP values under 0.77 multiple of the median in patients with elevated test results in the absence of aneuploidy appeared to be associated with the development of preeclampsia later in pregnancy. Conclusions: Although the significance of higher AFP values have been discussed in the literature in terms of the development of adverse outcomes, the present study suggests that lower values must also be taken into account during patient follow-up.Öğe Comparison of the efficacy of the immediate-release and osmotic push-pull system formulations of nifedipine for tocolysis(Wiley, 2019) Iran, Cihan; Sayin, Cenk; Dolgun, Nihal; Uzun, Isil; Erzincan, Selen G.; Sutcu, Havva; Varol, FusunAim To compare the immediate-release (IR) and osmotic push-pull system formulations of nifedipine used for tocolysis in prolonging pregnancy, neonatal outcomes and maternal-fetal adverse effects. Methods We evaluated 140 pregnant women who received the IR (n = 72) and osmotic push-pull system (n = 68) formulations of nifedipine for tocolysis due to threatened preterm labor between 24(0/7) and 33(6/7) weeks of gestation. Groups were compared in terms of efficacy of tocolysis in prolonging pregnancy for more than 48 h, 7 days and up to 37 weeks of gestation, total number of days gained for prolonging pregnancy, delivery weeks, maternal-fetal adverse effects and neonatal outcomes including ventilation support, need for intubation or surfactant, intraventricular hemorrhage, respiratory distress syndrome, necrotizing enterocolitis, admission to neonatal intensive care unit, neonatal death, Apgar scores at the 1st and 5th minutes. Results There was no significant difference between the two groups in prolonging pregnancy for more than 48 h or 7 days, total number of days gained after tocolysis initiation, delivery weeks, the number of births at 34(0/7)-36(6/7) weeks or after 37 weeks of gestation (P > 0.05). Maternal-fetal adverse effects and neonatal outcomes were similar in both groups (P > 0.05). Conclusion The efficacy of IR and osmotic push-pull system formulations of nifedipine have similar effects in terms of tocolysis and neonatal outcomes, adverse effects. Osmotic push-pull system formulation of nifedipine may be an alternative medication in tocolytic therapy due to its ease of use and the absence of loading dose necessity.Öğe Effects of betamethasone on fetoplacental and maternal hemodynamics in preterm pregnancies(Wiley, 2018) Inan, Cihan; Sayin, N. Cenk; Dolgun, Zehra N.; Erzincan, Selen G.; Uzun, Isil; Sutcu, Havva; Sut, NecdetObjective: To evaluate the possible effects of prenatal steroid administration onDoppler parameters of the umbilical artery, uterine artery, middle cerebral artery, and ductus venosus, the cerebroplacental ratio, and the amniotic fluid index in pretermfetuses. Methods: The present prospective observational study was performed at the Perinatology Department of Trakya University, Edirne, Turkey, between June 1, 2015, and September 1, 2016. It included patients with healthy singleton pregnancies who had received betamethasone at 24-34 weeks of pregnancy. Doppler parameters were measured before (0 hours) and 24, 48, and 72 hours after the administration of betamethasone (two intramuscular doses of 12 mg each, administered 24 hours apart). Results: There were 68 patients included. Pairwise comparisons demonstrated that, at 72 hours after betamethasone administration, the umbilical artery resistance index (P=0.038), the middle cerebral artery systolic/diastolic velocity ratio (P=0.007), and the amniotic fluid index (P=0.017) were reduced, whereas the end-diastolic velocity of the middle cerebral artery was increased (P=0.012), compared with baseline values. Conclusion: Betamethasone had favorable effects on fetal cerebral circulation, with increased end-diastolic velocity in the middle cerebral artery; this could represent a positive effect on cerebral blood circulation and decreased flow resistance in the umbilical artery.Öğe Evaluation of maternal serum hypoxia inducible factor-1, progranulin and syndecan-1 levels in pregnancies with early- and late-onset preeclampsia(Taylor & Francis Ltd, 2018) Davutoglu, Ebru Alici; Firat, Asuman Akkaya; Ozel, Aysegul; Yilmaz, Nevin; Uzun, Isil; Yuksel, Ilkbal Temel; Madazli, RizaObjective: To determine the serum levels of HIF-1 , progranulin, and syndecan-1 in preeclampsia (PE) and normal pregnancy, and to compare whether these markers demonstrate any difference between early-onset PE (EO-PE) and late-onset PE (LO-PE).Methods: This cross-sectional study was conducted on 27 women with EO-PE, 27 women with LO-PE, and 26 healthy normotensive pregnant controls matched for gestational age. Maternal levels of serum HIF-1 , progranulin, and syndecan-1 were measured with the use of an enzyme-linked immunosorbent assay kit.Results: Statistical analysis revealed significant differences between the control and the PE groups in progranulin (p<.001) and syndecan-1 (p<.001) levels. There were no significant differences in the serum HIF-1 levels between these groups (p=.069). When PE patients were evaluated by considering subgroups; statistical analysis revealed significant inter-group differences in all biomarkers. Serum progranulin levels were significantly higher in LO-PE compared with the other two groups (EO-PE versus LO-PE and LO-PE versus controls p=.000). Control group presented significantly higher syndecan-1 levels, than EO and LO-PE (p<.001). HIF-1 levels positively correlated with progranulin levels (r=.439, p=.000).Conclusions: Serum progranulin may have potential to be used as a biomarker for the differentiation of EO-PE and LO-PE. The co-operative action between HIF-1 and progranulin might play a key role in the pathogenesis of LO-PE. The predominant feature of LO-PE seems to be an inflammatory process, whereas in EO-PE placentation problem seems to be the main pathology.Öğe Fetal cloacal dysgenesis sequence presented with first trimester megacystis and associated umbilical cord abnormalities(Wiley, 2020) Erzincan, Selen Gursoy; Sayin, N. Cenk; Inan, Cihan; Uzun, Isil; Ugurlar, Ozge Yapici; Varol, Fusun G.Cloacal dysgenesis sequence occurs as a result of complete developmental failure of the urorectal septum. Typically, the sequence is featured by a smooth perineum, without any urethral, genital or anal openings. Its clinical manifestation differs throughout gestation. We report an interesting case of first trimester megacystis with associated umbilical cord abnormalities in a female fetus having cloacal dysgenesis sequence. This rare association reflecting high urinary pressure should first suggest urethral atresia. Our case highlights the importance of routine inspection of umbilical cord in the workup of early megacystis in terms of both etiology and fetal diagnosis.Öğe Hemorrhagic cyst of the canal of Nuck after vaginal delivery presenting as a painful inguinal mass in the early postpartum period(Elsevier Science Bv, 2017) Uzun, Isil; Inan, Cihan; Varol, Fusun; Erzincan, Selen; Sutcu, Havva; Sayin, Cenk[Abstract Not Available]Öğe Inevitable Myomectomy of a Huge Submucous Myoma During Cesarean Section A Case Report(Sci Printers & Publ Inc, 2018) Uzun, Isil; Sayin, Cenk; Inan, Cihan; Erzincan, Selen; Varol, FusunBACKGROUND: Submucous myoma during pregnancy is a very rare clinical entity. CASE: A 39-year-old woman was able to carry her pregnancy to term despite a huge submucous myoma and inevitable myomectomy during cesarean section. CONCLUSION: Cesarean section is indicated in patients with myomas obstructing the birth canal, and myomectomy during cesarean section is not only a reasonable option, but sometimes inevitable.Öğe A large posterior encephalocele associated with severe ventriculomegaly, cerebellar atrophy and transposition of the great arteries(Wiley, 2018) Inan, Cihan; Sayin, Niyazi Cenk; Gurkan, Hakan; Erzincan, Selen Gursoy; Uzun, Isil; Sutcu, Havva; Atli, Emine Ikbal; Varol, FusunPosterior encephalocele is a neural tube defect, which is a sac-like protrusion of the neural tissue and cerebrospinal fluid through a defect in the occipital bone. This embryonic anomaly may coexist with cortical dysplasia, agenesis of the corpus callosum, hydrocephalus, microcephaly, craniofacial abnormalities, ventricular and atrial septal defect. We report a case of a large posterior encephalocele in a fetus accompanied by unexpected major abnormalities including transposition of the great arteries, severe ventriculomegaly and cerebellar atrophy. Postnatal surgical corrections of the posterior encephalocele and then of the transposition of the great arteries were performed but the neonate died 2 months after delivery.Öğe Placental chorioangioma complicated with preterm delivery: A case report(Modestum Ltd, 2017) Inan, Cihan; Sayin, N. Cenk; Tastekin, Ebru; Erzincan, Selen Gursoy; Uzun, Isil; Sarikas, Nurtac; Varol, Fusun G.Chorioangioma is the most common tumor of the placenta. Since these tumors generally have small sizes, they cannot be detected during the routine ultrasonography (USG) examination and might not present any symptom. When they become larger in size, they can cause various maternal and fetal complications. We presented a patient whose obstetric USG examination revealed a placental mass compatible with chorioangioma and who had preterm delivery at the 34th gestational week. The size of the mass increased rapidly in last four weeks. The pathological examination indicated that the placental mass was 9x8 cm in size and compatible with angiomatous type chorioangioma.Öğe Prenatal diagnosis of chromosomal polymorphisms: most commonly observed polymorphism on Chromosome 9 have associations with low PAPP-A values*(Taylor & Francis Ltd, 2019) Inan, Cihan; Sayin, N. Cenk; Dolgun, Z. Nihal; Gurkan, Hakan; Erzincan, Selen Gursoy; Uzun, Isil; Sutcu, HavvaIntroduction: To identify the prevalence and types of fetal chromosomal polymorphisms in pregnant women and to examine possible associations with screening test parameters. Materials and methods: Fetal chromosomal polymorphism rate was investigated in pregnant women who had been implemented for invasive prenatal test in a tertiary reference center in Thrace Region of Turkey. Fetal chromosomal polymorphisms were determined and their effects on screening tests' parameters were investigated. Possible differences in the first and second-trimester screening test parameters between women; with fetal chromosomal polymorphism who had screening test results (Group 1) and those with a normal karyotype (Group 2) were evaluated. Results: Fetal chromosomal polymorphism prevalence was 5.3% (n = 101). The most common polymorphisms were identified on chromosome 9, 1, and 16 [54.5% (n = 55); 8.9% (n = 9), and 6.9% (n = 7), respectively]. The most common polymorphic variant was 9qh+ (n = 23; 22.8%). Among the screening test parameters, significantly lower pregnancy-associated plasma protein-A (PAPP-A) (p = .028) and higher unconjugated estriol (uE3) (p = .019) values were found in Group 1. In patients having fetuses with polymorphic variants on chromosome 9, a significantly lower PAPP-A values were observed compared to women with other fetal polymorphic variants (p = .048) or women having fetuses with normal karyotype (p = .007). Conclusions: Lower PAPP-A and higher uE3 levels were observed in women having fetuses with chromosomal polymorphisms, which might affect screening test results. Lower PAPP-A levels were apparent in women having fetuses with polymorphism on chromosome 9.Öğe The relation of fetal colon and rectum diameters with labor in healthy late-third trimester pregnancies(Elsevier Science Bv, 2018) Inan, Cihan; Sayin, N. Cenk; Dolgun, Z. Nihal; Erzincan, Selen Gursoy; Uzun, Isil; Sutcu, Havva; Varol, FusunObjective: To investigate the associations of fetal colon-rectum diameters with labor and fetal distress or meconium passage in healthy pregnancies in the late 3rd trimester. Study design: A total of 162 healthy, singleton pregnant women at >= 36(0/7) weeks who were in the latent phase of labor (n = 69) or those not in labor (n = 93, controls) at the time of ultrasound examination were enrolled. Fetal colon (ascending, transverse, descending, sigmoid) and rectum diameters, Doppler indices of materno-fetal vessels were measured. Data were analyzed according to the mode of delivery. Results: Fetal colon-rectum diameters were smaller in women in labor compared to controls (p = 0.001). Positive correlations were observed between fetal colon-rectum diameters and interval between ultrasound and labor onset in the control group except for those who had scheduled cesarean sections (C/S) (p = 0.001). Similar colon-rectum measurements were obtained in fetuses delivered via cesarean section due to fetal distress or to other indications (p>0.05). In women who had uterine contractions during ultrasound examination; later delivered by vaginal route, no association was observed between Apgar scores and colon-rectum diameters during latent-phase (p > 0.05), and also there were significant positive correlations between different segments of colon-rectum diameters and duration of neonatal meconium passage (p < 0.05). Conclusion: Fetal colon and rectum diameters are smaller during labor and the measurements tend to diminish as the labor approaches, but do not indicate fetal distress. (C) 2018 Elsevier By. All rights reserved.Öğe Schizencephaly accompanied by occipital encephalocele and deletion of chromosome 22q13.32: a case report(Taylor & Francis Inc, 2019) Inan, Cihan; Sayin, N. Cenk; Gurkan, Hakan; Atli, Engin; Erzincan, Selen Gursoy; Uzun, Isil; Sutcu, HavvaBackground: Schizencephaly is a neuronal migration anomaly characterized by presence of a cleft between ependymal layer of the ventricle and pia mater of the cerebral cortex. It may be associated with additional cerebral abnormalities, including polymicrogyria, pachygyria, gray matter heterotopy, ventriculomegaly and corpus callosum agenesis. Case Report: We present a female fetus with schizencephaly accompanied by occipital encephalocele, polymicrogyria, agenesis of the corpus callosum, dysmorphic facies and cardiac muscular ventricular septal defect. Array comparative genomic hybridization (array-cGH) analysis revealed a deletion of chromosome 22q13.32 including FAM19A5 gene that is a member of TAFA family. Conclusions: Schizencephaly may be accompanied by unexpected structural and genetic anomalies as in our case with occipital encephalocele, dysmorphic facies, cardiac ventricular septal defect and chromosome 22q13.32 deletion.Öğe Tetrasomy 18p in a Twin Pregnancy with Diverse Expression in Both Fetuses(Taylor & Francis Inc, 2016) Inan, Cihan; Sayin, N. Cenk; Atli, Emine; Ulusal, Selma; Erzincan, Selen; Uzun, Isil; Gurkan, HakanTetrasomy 18p, characterized by the presence of four copies of the short arm of chromosome 18, is considered to occur with the nondisjunction in meiosis II after the errors in the meiotic and early postmeiotic mitotic division in the centromere. It is accompanied by various abnormalities including congenital heart defects, lower extremity abnormalities, micrognathia, high arched palate, kyphoscoliosis, microcephaly, myelomeningocele, hernia and renal anomalies. We present the first case of a dichorionic diamniotic twin pregnancy in which both fetuses were affected by tetrasomy 18p, but with discordant morphology, detected in one twin in the first but in the other in the second trimester.Öğe Unusual facio-upper arm band of a fetus mimicking amniotic band syndrome(Wiley, 2019) Inan, Cihan; Sayin, N. Cenk; Gurkan, Hakan; Erzincan, Selen G.; Uzun, Isil; Sutcu, Havva; Atli, EnginAmniotic band syndrome can lead to a wide spectrum of congenital abnormalities including orofacial and visceral defects. It is associated with malformations in truncal, craniofacial regions and the limbs, whereas it sometimes may imitate some genetic disorders. Here, we present an atypical case mimicking amniotic band syndrome with a facio-upper arm band that was having multiple fetal structural abnormalities including scoliosis, bilateral cleft lip and palate, upper limb abnormality, unilateral anophthalmia with contralateral microphthalmia, left hypertrophic kidney and severe ventriculomegaly.Öğe Use of prokineticin-1 (PROK1), pregnancy-associated plasma protein A (PAPP-A) and PROK1/PAPP-A ratio to predict adverse pregnancy outcomes in the first trimester: a prospective study(Taylor & Francis Ltd, 2018) Inan, Cihan; Varol, Fusun Gulizar; Erzincan, Selen Gursoy; Uzun, Isil; Sutcu, Havva; Sayin, N. CenkIntroduction: To compare the predictive effectiveness levels of prokineticin-1 (PROK1), pregnancy-associated plasma protein A (PAPP-A) and the PROK1/PAPP-A ratio in the first trimester for preeclampsia (PE), foetal growth restriction (FGR), gestational diabetes mellitus (GDM) and spontaneous preterm birth (SPB).Materials and methods: A total of randomly selected 162 pregnant women were included. Peripheral blood samples were obtained between 11(0/7) and 13(6/7) gestational weeks (GWs). All women were followed throughout the pregnancy and classified into five groups as having PE, FGR, GDM, SPB and uncomplicated pregnancies. The cut-off levels of the markers were identified to predict adverse outcomes.Results: PROK1 predicted PE with 83.3% sensitivity, 85.7% specificity at a value of >293.4pg/mL; at a value of >260.2pg/mL, PROK1 predicted FGR with 85.7% sensitivity, 72.5% specificity in the first trimester. The area under receiver operating characteristic (ROC) curve of PAPP-A was lower than that of PROK1 and PROK1/PAPP-A in differentiating PE and FGR from the uncomplicated group (p<.001). PROK1 levels and the PROK1/PAPP-A ratios in the SPB and GDM groups were lower than in the uncomplicated group (p<.01).Conclusions: Elevated PROK1 in the first trimester is a more effective marker than PAPP-A in the prediction of PE and FGR. Lower PROK1 levels are associated with the development of SPB and GDM.Öğe Uterine Arcuate Artery Calcification on Transvaginal Sonography May Correlate With Known Risk Factors for Atherosclerosis(Amer Inst Ultrasound Medicine, 2016) Ozdemir, Mucize; Uzun, Isil; Ozel, Aysegul; Cakar, Hatice; Inan, Cihan; Yazicioglu, FehmiObjectives-Uterine arcuate artery calcification is an incidental finding on transvaginal sonography. We conducted this study to evaluate the clinical importance of arcuate artery calcification and its association with the serum lipid profile and carotid artery atherosclerosis. Methods-Serum lipid profiles, carotid artery intima thicknesses, and Doppler parameters of uterine arteries were examined in 25 patients with uterine arcuate artery calcification and 25 control participants. The parameters were compared between the groups. Results-The mean pulsatility indices, mean resistive indices, and systolic-to-diastolic ratios of the right and the left uterine arteries were significantly higher in the calcification group (P < .01). Serum total cholesterol and low-density lipoprotein cholesterol levels were significantly higher, whereas the serum high-density lipoprotein cholesterol level was significantly lower in patients with uterine arcuate artery calcification than controls (P < .01). Right and left common carotid artery intima thicknesses were also significantly higher in the calcification group (P < .01). Conclusions-Uterine arcuate artery calcification is an incidental finding on transvaginal and transabdominal pelvic sonography, and it is correlated with an abnormal lipid profile and increased thicknesses of the intimal layers of the carotid arteries. We suggest that an incidental finding of arcuate artery calcification during vaginal sonography is a reason to screen for generalized atherosclerosis and related disorders.Öğe The utility of maternal serum endocan level to predict preterm delivery within seven days in patients with threatened preterm labor(Taylor & Francis Ltd, 2021) Davutoglu, Ebru Alici; Firat, Asuman Akkaya; Ozel, Aysegul; Uzun, Isil; Ozer, Nida; Madazli, RizaObjective: The aim of the current study was to determine serum endocan levels in patients with threatened preterm labor and to assign whether endocan levels in patients with true preterm labor who give birth within 7 days differ from those of false preterm labor and uncomplicated pregnancy. Materials and methods: This cross-sectional study was conducted on 58 patients diagnosed with threatened preterm labor and 31 healthy pregnant women matched for gestational age. Patients with threatened preterm labor were divided into two groups; preterm delivery (28) and term delivery (30) groups. Maternal serum endocan levels were measured with the use of an enzyme-linked immunosorbent assay kit. Results: The median serum endocan level (pg/mL) in patients with threatened preterm labor was significantly higher than that of women with uncomplicated pregnancies (725, IQR 619-823 versus 310, IQR 218-423; p < .001 Figure 1). Subgroup analysis performed among threatened preterm labor group revealed that median serum endocan level (pg/mL) in preterm delivery group was higher compared with the other two groups (preterm 823, IQR 718-905 versus term 637, IQR 590-729 p < .001 and preterm 823, IQR 718-905 versus control 310, IQR 218-423 p < .001). The threshold value of maternal serum endocan level for predicting delivery within 7 days after admission was calculated 655 pg/mL, (the area under curve was 0.934, 95% CI 0.88-0.98, p < .001) with 85.7% sensitivity and 78.7% specificity. The mean cervical length measurement was significantly higher in the control group (p < .001); there was no significant difference in cervical length between the term and preterm delivery groups. Maternal characteristics including age, BMI, gravidity, gestational age at blood sampling, CRP and Hb levels were not significantly different between groups (p > .05). Conclusions: The maternal serum endocan level may be a useful marker to define high risk group for preterm delivery in patients with threatened preterm labor and similar cervical length measures.
