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Öğe The assessment of nuchal translucency and serum markers for down syndrome screening with ductus venosus Doppler measurements in the first trimester(Galenos Yayincilik, 2010) Ozer, Ozlem; Sayin, Cenk N.; Varol, Fusun G.Objective: The aim of the study was to improve nuchal translucency (NT) and serum marker Down syndrome (Tri21) screening methods by including fetal ductus venosus (DV) Doppler measurements. Material and Methods: A total of 213 pregnant women were screened consecutively by combining maternal age, fetal NT and maternal serum pregnancy associated plasma protein A (PAPP-A) and free 13-human chorionic gonadotropin (f beta-1-1CG) values at 11-14 weeks of gestation. Also, a DV Doppler analysis was performed for the contribution to the screening for Tri21 and other fetal anomalies or adverse pregnancy outcomes. Results: Twelve fetuses had DV PI measurements above the 95th percentile and two (17%) developed intrauterine growth retardation. DV P1 values negatively correlated with birth weight (p=0.013, r=0.171). Two patients had T 21 among the study group (0.9%) with abnormal biochemical screening results. In these with Tri21, the combined test risk was above the suggested limit (>1/250). PAPP-A was <0.4 MoM in 23, and f beta-HCG was >1.91 MoM in 49 patients. The rates of fake positivity were 10% for PAPP-A and 22% for f beta-EICG. The sensitivity, specificity, positive and negative predictive values of the combined test was l00%,95%, 2011/1) and 100%, respectively. Conclusion: The combined test has high sensitivity and specificity for Tri21 detection. The addition of DV Doppler ultrasound in the first trimester might have the advantage of predicting some adverse pregnancy outcomes. However, in the Turkish population, further studies with larger numbers of patients will be needed to establish the usefulness of DV for the detection of Trill or the prediction of some major cardiac anomalies.Öğe Can myometrial thickness/cervical length ratio predict preterm delivery in singleton pregnancies with threatened preterm labor? A prospective study(Springer Heidelberg, 2019) Erzincan, Selen Gursoy; Sayin, N. Cenk; Korkmaz, Selcuk; Sutcu, Havva; Inan, Cihan; Cilingir, Isil Uzun; Varol, Fusun G.ObjectiveTo investigate whether myometrial thickness (MT) to cervical length (CL) ratio could be used in the prediction of preterm birth (PTB) in singleton pregnancies presented with threatened preterm labor (TPL).MethodsAfter 48h of successful tocolysis, MT was measured transabdominally from the fundal, mid-anterior walls and the lower uterine segment (LUS) in 46 pregnancies presented with TPL. MT measurements were divided into CL, individually. The main outcome was PTB before 37weeks of gestation.ResultsThe patients were divided into two groups as women delivered37weeks (38.681.01weeks) (n=25) and those delivered<37weeks (34.28 +/- 2.53weeks) (n=21). The mean +/- SD CL in the preterm delivery group was significantly shorter than the term delivery group (23.77 +/- 9.23 vs 29.91 +/- 7.03mm, p<0.05). Fundal, mid-anterior or LUS MT values were similar in both groups. However, in those who delivered preterm, the ratios of fundal MT-to-CL (p=0.026) and mid-anterior MT-to-CL (p=0.0085) were significantly different compared to those delivered at term. The optimal cutoff values for CL, fundal MT-to-CL and mid-anterior MT-to-CL ratios in predicting PTB were calculated as 31.1mm, 0.19 and 0.20, respectively. Fundal MT-to-CL ratio predicted preterm delivery with 71% sensitivity, 72% specificity, 68% positive and 75% negative predictive values. For mid-anterior MT-to-CL ratio, respective values were 76, 76, 73 and 79%.Conclusion p id=Par4 Measurement of MT along with CL may offer a promising method in the management of women presented with TPL.Öğe A case of cebocephaly associated with abnormal genitalia(Elsevier Ireland Ltd, 2007) Duran, Ridvan; Aladag, Nukhet; Vatansever, Ulfet; Acunas, Betul; Puyan, Fulya Oz; Varol, Fusun G.Holoprosencephaly is frequently accompanied by midline facial abnormalities such as hypotelorism, cyclopia, etmocephaly, and cebocephaly. Cebocephaly is a very rare congenital anomaly combining alobar holoprosencephaly, ocular hypotelorism, and a proboscis-like nose with single nostril. There is only one cebocephaly case with abnormal genitalia. We report to our knowledge the second case of cebocephaly associated with abnormal genitalia in the relevant literature. (C) 2007 Elsevier Ireland Ltd. All rights reserved.Öğe Complex Nature of Neural Tube Defects: A Regional Experience(2018) Turhan, Emrah; Varol, Fusun G.; Gurkan, Hakan; Sayın, N. CenkOBJECTIVE: The underlying gene-environment interaction of fetal neural tube defects is affected byseveral factors including geography, ethnicity and time. Local features of fetal neural tube defects weredescribed.STUDY DESIGN: A prospective cohort study of 48 fetal neural tube defects in a single tertiary medicalcenter at the northwestern region of Turkey (2013-2015) was done via ultrasound, magnetic resonanceimaging (MRI), conventional karyotyping, maternal methylenetetrahydrofolate reductase c.677C>T(rs1801133) single-nucleotide polymorphism and maternal serum levels of folic acid, vitamin B12 andzinc. For comparison of means, a Student’s T-Test was used.RESULTS: The prevalence of neural tube defects was 11.4 per 10000 births (48/42000) in northwesternTurkey. The defects on the cranium (n=23; 47.9%) and spine (n=25; 52.1%) were ultrasonographicallydetected. MRI did not give additional benefit over the ultrasonography. The ratio of associated anomaliesin neural tube defect group was 25%. Two fetal neural tube defects with Down syndrome were remarkable. The rate of homozygous methylenetetrahydrofolate reductase c.677C > T SNPs among the mothersof neural tube defect fetuses (n=20) was 15%. Comparing with gestationally matched healthy pregnancies, although maternal BMIs and periconceptional folate intake of neural tube defect group were significantly different, maternal serum folic acid, vitamin B12 and zinc levels were similar.CONCLUSION: The northwestern region appeared to be a relatively low prevalence area of Turkey forfetal neural tube defects. Any association with maternal serum folic acid, vitamin B12 and zinc levelscould not be shown in this region.Öğe The effects of ritodrine and magnesium sulfate on maternal and fetal Doppler blood flow patterns in women with preterm labor(Elsevier Science Bv, 2010) Sayin, N. Cenk; Arda, Sezer; Varol, Fusun G.; Sut, NecdetObjective: To determine the effects of ritodrine and magnesium sulfate on maternal-fetal blood flows. Study design: A total of 85 pregnant women between 26th and 36th weeks with preterm labor, and 83 healthy pregnant women were included. Patients in the study group were randomly assigned to receive either ritodrine (with the addition of verapamil) (n = 46) or magnesium sulfate (n = 39). Blood flow examinations on the umbilical artery (UA), middle cerebral artery (MCA), bilateral uterine arteries (Ut.A) and ductus venosus (DV) were performed before and 48 h after initiating therapy. Results: UA pulsatility index (PI) significantly differed in women receiving tocolysis compared to controls after 48 h. DV PI increased in women receiving MgSO(4), whereas it decreased in the ritodrine and control groups. Ut.A values did not significantly change after 48 h in the groups. In women between the 26th and 32nd weeks, UA, MCA and DV PI did not significantly change after 48 h in the three groups. However, in women between the 32nd and 36th weeks UA and MCA PI significantly differed in the treatment groups compared to controls after 48 h. DV PI increased in women receiving MgSO4, whereas it decreased in the ritodrine and control groups. Conclusions: MgSO4 and ritodrine affect blood flow patterns after 48 h in some maternal-fetal vessels. These effects on blood flow are particularly significant in women between 32nd and 36th weeks. The effects of both drugs on fetal and maternal Doppler flows seem similar, except the increased resistance to flow in DV in women receiving MgSO4. Crown Copyright (c) 2010 Published by Elsevier Ireland Ltd. All rights reserved.Öğe Efficacy of Alpha-methyldopa and Nifedipine in the Treatment of Postpartum Hypertension(Galenos Yayincilik, 2005) Sayin, N. Cenk; Altunda, Gonul; Varol, Fusun G.Objective: To evaluate the efficacy of alpha-methyldopa and nifedipine on postpartum hypertension in women who had various hypertensive disorders of pregnancy. Materials and Methods: A total of 83 women with preeclampsia, eclampsia and superimposed preeclampsia on chronic hypertension who had delivered in our department and also exhibited persistent hypertension over 160/110 mmHg after the postpartum 24th hours were included in the study. The patients were randomly divided into two groups. The patients in Group 1 (n=41) received alpha-methyldopa (750 mg/d) and in Group 2 (n=42) nifedipine (40 mg/d) in divided doses. Another antihypertensive drug was added to the therapy if the therapy was insufficient, and a third if needed. Antihypertensive therapy was discontinued after normotensive values were observed after 48 hours during therapy. The number of drugs were lessened and then discontinued in women taking two or more antihypertensive drugs. Mann-Whitney U and Chi-squaretests were applied for statistical analysis. Results: The patients were 17 to 41 years old, and the mean +/- SD age was similar between two groups (28.1 +/- 5.9 vs. 27.1 +/- 5.9 years, P=0.48). Women in Group 1 required antihypertensive therapy for 8.6 +/- 5.5 days, whereas Group 2 patients required therapy for 6.7 +/- 2.5 days (P=0.13). Twenty-one patients (51.2%) taking alpha-methyldopa did not need another antihypertensive drug, however 19 women (46.3%) received two and one patient (2.4%) received three different antihypertensive drug combinations. Twenty-nine patients (69%) taking nifedipine did not need another antihypertensive drug, however 11 women (26.1%) received two and two patients (4.7%) received three different antihypertensive drug combinations. There was no significant difference in single agent (P=0.15), double agent (P=0.09) or triple agent (P=1) antihypertensive therapy between two groups. Conclusion: Nifedipine and alpha-methyldopa treatment had similar effectiveness on postpartum hypertension in women with various hypertensive disorders of pregnancy. Also, the required duration of antihypertensive therapy was short.Öğe Efficiency of Cervical Sonography for the Determination of Preterm Birth in Singleton and Twin Pregnancies After 25 Weeks' Gestation(Galenos Yayincilik, 2005) Sayin, N. Cenk; Varol, Fusun G.; Yilmaz, Ozlem; Kurt, ImranObjective: To evaluate the efficiency of cervical sonography in determination of preterm birth in singleton and twin pregnancies. Materials and Methods: A total of 78 women (56 with singleton and 22 with twin pregnancies) with preterm labor who were admitted to our department between 25 and 36 weeks' gestation were enrolled in the study. Cervical length and the presence of cervical funneling were evaluated by transvaginal sonographic scan. For singleton and twin pregnancies reaching >= 37 and >= 34 weeks' gestation respectively, were accepted as good perinatal outcome. The cut-off values for cervical length were set at <35 mm for singleton and <25 mm for twin pregnancies. Results: Sonographic evaluation and delivery weeks for singleton and twin pregnancies were 33 (25-36) and 36 (26-40) weeks, and 31 (25-33) and 34 (31-36) weeks, respectively. A cervical length <35 mm for singleton pregnancies, <25 mm for twins have 67.9% and 57.1% sensitivity, 46.4% and 86.7% specificity, 55.9% and 66.7% positive predictive and 59.1% and 81.3% negative predictive values for the determination of preterm birth, respectively. The presence of cervical funneling for singleton and twin pregnancies determined preterm birth with sensitivity of 83.3% and 55.6%, specificity of 50% and 84.6%, positive predictive value of 44.1% and 71.4%, negative predictive value of 86.4% and 73.3%, respectively. Conclusion: Cervical sonography after 25 weeks' gestation can determine preterm birth with high sensitivity and negative predictive value in twin pregnancies presented with preterm labor. However, for singleton pregnancies the presence of cervical funneling has high sensitivity and negative predictive values for the determination of preterm birth.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 Long-term postpartum health problems in Turkish women: prevalence and associations with self-rated health(Routledge Journals, Taylor & Francis Ltd, 2017) Aksu, Sevde; Varol, Fusun G.; Sahin, Nevin HotunObjective: To examine the frequency of physical and emotional health problems associated with labor and their relationship with self-rated health measures. Methods: Four hundred women were enrolled. Data collection was accomplished through the completion of a form on sociodemographic and obstetric characteristics, a questionnaire that measured the self-rated health level as well as physical health problems, and Edinburgh Postpartum Depression Scale. Results: Most commonly reported health problems in the initial six-week period were fatigue (77.5%), sleep disturbance (76.0%), and dysuria (61.3%). At one-year postpartum, fatigue (33.9%), sleep disturbance (32.8%) and constipation (15.5%) were the most commonly reported complaints. Those who self-reported a poor health at six weeks and one year comprised of 40.0% and 19.8% of the participants, respectively. Conclusion: Further studies in other populations are warranted to better delineate the prevalence rates, which will provide useful data for developing policies aimed at improving postpartum care.Öğe Perinatal Outcome in Women Screened for Gestational Diabetes Mellitus With Normal or With One Elevated Glucose Tolerance Test Value(Galenos Yayincilik, 2007) Sayin, N. Cenk; Varol, Fusun G.; Duran, Ridvan; Acunas, Betul; Kurt, ImranObjective: To investigate the perinatal outcome of women screened for gestational diabetes mellitus (GDM) who had abnormal screening and normal oral glucose tolerance test (OGTT) results or women with a single abnormal test value in OGTT. Materials and Methods: We screened 576 pregnant women with a 50 gr oral glucose challenge test between the 24th and 26th weeks' of gestation. Women with abnormal diabetes screening test results were followed up with standard OGTT with a 100 gr oral glucose load. According to the results, 360 women were with a normal screening test (Group 1), 87 with a positive screening and all normal test values on OGTT (Group 2), 50 with a positive screening but a single abnormal test value on OGTT (gestational impaired glucose tolerance, Group 3) and 79 were diagnosed as with GDM (Group 4). Diet or diet plus insulin therapy was initiated to patients in Groups 3 and 4 as indicated. We compared perinatal outcome between these four groups. Statistical data were calculated with post hoc multiple comparison, Kruskal-Wallis and c 2 tests for comparison of means, medians or for nominal variables. Results: Women with GDM had significantly higher glycosylated hemoglobin levels, large for gestational age infants, macrosomia, neonatal jaundice, neonatal intensive care unit (NICU) admission and neonatal mortality rates but lower gestational age at delivery and 1-minute Apgar scores compared to controls. Also, there were significant differences in neonatal jaundice and NICU admission rates between Groups 1 and 3, or between 2 and 3. There were significantly more macrosomic babies in Groups 3 and 4, compared to Group 2. Discussion: Women with abnormal diabetes screening tests and negative OGTT or with gestational impaired glucose tolerance seem not to be prone to develop severe adverse perinatal outcome.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 Risk Assessment of Trisomy 21 by Probabilistic Classifiers(IEEE, 2013) Uzun, Omer; Kaya, Heysem; Gurgen, Fikret; Varol, Fusun G.This study proposes a probabilistic approach to evaluate prenatal risk of Down syndrome. In this study, we address the decision-making problem in diagnosing Down syndrome from the machine learning perspective aiming to decrease invasive tests. We employ Naive Bayes and Bayesian Networks classification algorithms as probabilistic methods. This probabilistic classification approach is one of the leading work in medical domain. We use George Washington University dataset in our study. We also benchmark our probabilistic classifiers with widely used non-probabilistic classifiers in machine learning literature. Finally the results of the experiments show that probabilistic classifiers enable acceptable prediction of Trisomy 21 case and the classification performance can be improved by using the proposed techniques in this study.Öğe Relationship between second-trimester amniotic fluid levels of Prokineticin-1 and Matrix Metalloproteinase-2 with adverse pregnancy outcome(W B Saunders Co Ltd, 2018) Erzincan, Selen G.; Varol, Fusun G.; Inan, Cihan; Sayin, N. CenkTo investigate the levels of Prokineticin-1 (PROK1) and matrix metalloproteinase-2 (MMP-2) in second-trimester amniotic fluid (AF). AF samples were investigated in 81 patients. AF-PROK1 and AF-MMP-2 were not significantly associated with adverse pregnancy outcomes (preeclampsia, intrauterine growth retardation, spontaneous preterm birth, gestational diabetes, gestational hypertension). AF-PROK1 levels in patients with abnormal first-trimester screening were significantly higher than those who underwent amniocentesis due to abnormal second-trimester screening tests (p = .04). AF-PROK1 or AF-MMP-2 do not have a role in the prediction of adverse pregnancy outcomes. (c) 2017 Elsevier Ltd. All rights reserved.Öğe SEROPREVALANCE OF TOXOPLASMA GONDII ANTIBODIES IN ANTENATAL POPULATION OF TRAKYA REGION(Galenos Yayincilik, 2011) Varol, Fusun G.; Sayin, N. Cenk; Soysuren, SeyitObjective: To investigate the distribution of toxoplasma gondii antibodies retrospectively among the first trimestr antenatal population in Trakya region. Material and methods: This study retrospectively analyzes seroprevalance of toxoplasma gondii IgM and IgG antibodies in the sera of 1646 first trimester pregnancies attended to the Obstetrics & gynecology Antenatal Care Unit in Trakya University, Faculty of Medicine between January 2000 and June 2009. For this purpose IgM, IgG and if necessary, IgG avidity results were evaluated. Besides, hepatitis B surface antigen (HBsAg), human inmmunodeficieny virus type 1 and 2 antibodies (Anti HIV), cytomegalovirus (AntiCMV) IgG and IgM antibodies, hepatitis C antibody (AntiHCV), rubella (antirubella) IgM and IgG antibodies and venereal disease research laboratory (VDRL) results evaluated in the same period were also investigated. Results: Although the status of seroprevalance is not known in 313 (19%) women, 876 pregnant women (65.71%) were IgG and IgM seronegative, 426 (31.95%) were IgG seropositivite, 13 (0.97%) were IgM positivite and 18 (1.35%) were both IgG and IgM seropositivite. On the other hand, 13 of 18 patients with both IgG and IgM seropositivity showed high avidity but avidity could not be evaluated in 4 patients. HBsAg positivity was found in 3% (47/1526), AntiHCV positivity in 0.8% (12/1474), VDRL in 0.4% (5/1056), rubella IgM antibody in 0.7% (9/1254), rubella IgG antibody in 76.6% (940/1227), according to the other serologic tests. AntiCMV IgM antibody was positive in 17 (17/1284, 1.3%) and IgG was positive in 1027 (1027/1279, 80.3%) patients. Conclusion: As well as toxoplasma exposure rate in the pregnant women from Trakya region of Turkey is high (% 30), nearly half of first trimester women were found seronegative. Screening during the first trimester would be appropriate, particularly for women who are under risk of infection.
