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Öğe Analysis of Ear y and Late Cases of Idiopathic Abruptio Placenta in Preterm Patients(Galenos Yayincilik, 2019) Cilingir, Isil Uzun; Varol, Fusun; Sutcu, Havva; Inan, Cihan; Yener, Cem; Sayin, CenkObjective: To evaluate the cases of idiopathic abruptio placenta in early and late preterm period. Methods: Normotansive singleton pregnancies with the diagnosis of abruptio placenta between 23 and 37 weeks of pregnancy were included in the study. The patients with a risk factor for abruptio plaicenta (preeclampsia, travma, heavy smoking, polyhydoamnios etc) were excluded from the study. The patients were divided into two groups according to the gestational weeks at delivery. Group I was consisted of the pregnant patiens between 23 and 32 weeks of gestation and group II was consisted of pregnant patients between 32 and 37 weeks of gestation. Results: Mean maternal age of the pregnant patients was 28.3 years.The demographic characteristics were smilar in the groups. The most common complaint at the admission was bleeding in group I (13/17, 76.4%), whereas pain (5/11, 45.4%) in group II. There were statistically significant difference in breech and transvers position of the fetuses between the early cases and late cases of abruptio placenta (p<0.05). Conclusion: Abruptio placenta may occur even in the patients without any risk factors. It should be borne in mind that abruptio placenta may have may different clinical presentations. It has different clinical symptoms and prognosis in early and late preterm period.Öğe Comparison of postpartum sonographic findings after uneventful vaginal and cesarean section deliveries(Medical Communications, 2018) Cilingir, Isil Uzun; Sayin, Cenk; Sutcu, Havva; Alici, Ebru; Inan, Cihan; Erzincan, Selen; Yener, CemObjective: To prospectively determine the sonographic findings of the postpartum uterus 24 hours after vaginal delivery and cesarean section. Methods: Women who had uneventful vaginal delivery or cesarean section from July 2015 to May 2018 in a tertiary care hospital were prospectively included. Uterine lengths, endometrium, amout of free fluid, the distance between the uterine fundus-promontorium and uterine fundus-L5 were evaluated 24 hours after delivery. Results: The mean (min-max) endometrial thickness in the vaginal delivery and cesarean section groups were 13.3 (4-25) and 12.4 (4-29) mm, respectively. Fundus-cervix length was significantly higher in the vaginal delivery group compared to the cesarean section group (184.05 +/- 16.8 vs 163.6 +/- 6.7 mm, p < 0.001). The measurements of anterior and anterior-posterior walls of the uterus, anteroposterior uterine length and uterine width were similar in both groups. Promontorium-fundus length was significantly higher in patients who delivered vaginally than those by cesarean section (123.3 +/- 13.6 vs 108.7 +/- 23.3 mm, p = 0.005). Conclusion: The measurement of L5-fundus distance is a simple and effective technique to evaluate the size of the uterus. Homogenous endometrium up to 30 mm in asymptomatic patients may be a normal finding 24 hours after delivery. The results of this study may be helpful in the decision-making process in cases of early postpartum hemorrhage or hemodynamic instability.Öğe Conjoined Twins: Unicephalus Non-Janiceps Tetrapus Tetrabrachius(Springer India, 2022) Yener, Cem; Sayin, N. Cenk; Altan, Esra; Varol, FusunConjoined twins are an uncommon type of monoamniotic twins with an incidence of about 1.5 per 100,000 births worldwide. Non-janiceps is the extremely rare sub-type of cephalopagus which is reported as 1 in 58 of all conjoined twins or 1 in 3 million births. We present a G6, P5 31-year-old pregnant who was diagnosed with a unicephalus non-janiceps conjoined twins. Due to its incompatibility with life, the pregnancy was electively terminated. The prognosis of conjoined twins depends on the location and extent of the conjoined area and the accompanying congenital anomalies of the fetuses. Early diagnosis is vital because it can help in assessing the type of conjoined twins and subsequently pre-postnatal decision making. Elective termination of non-janiceps type of conjoined twins which is incompatible with life is a justifiable possibility.Öğe Does emergency cerclage really works in patients with advanced cervical dilatation?(Elsevier Masson, Corp Off, 2019) Cilingir, Isil Uzun; Sayin, Cenk; Sutcu, Havva; Inan, Cihan; Erzincan, Selen; Yener, Cem; Varol, FusunObjective: To asses the efectivity of emergency cerclage in the patients with advance cervical dilatation and prolapsed membranes. Material methods: The patients who have >= 4 cm cervical dilatation with protruding membranes were included in the study. The patients were divided into two groups. Group I was consisted of the patients who had emergency cerclage procedure and group II was consisted of the patients who denied the operation and expectantly managed. The physical examination, pregnancy outcomes and the complications were compared between the groups. The results of the patients with emergency cerclage were analysed. Results: 21 patients were referred with a >= 4 cm cervical dilatation with protruding membranes 33.3% of women with emergency cerclage were delivered within one week from the admission. One patient, who was a grand multiparous (G6P4A1), was delivered a healthy infant at 40 weeks of gestation. The remaining five patients were delivered between 21 and 24 weeks, but all the infants were died due to extreme prematurity. Two patients (22.2%) developed chorioamnionitis that necessitated long hospitalization (14-21 days). In group II (expectant management) 83,3% of the patients were delivered within the 48 h from the admission. There were no case of chorioamnionitis in group II. Conclusion: Emergency cervical cerclage is not a rationale option for the patients with an advanced cervical dilation (>4 cm) together with protruding membranes in early second trimester because of the short prolongation time and high complication rate. (C) 2019 Elsevier Masson SAS. All rights reserved.Öğe Emergency cerclage in twins during mid gestation may have favorable outcomes: Results of a retrospective cohort(Elsevier Masson, 2018) Cilingir, Isil Uzun; Sayin, Cenk; Sutcu, Havva; Inan, Cihan; Erzincan, Selen; Yener, Cem; Varol, FusunPurpose. - Cervical cerclage treatment for cervical changes at mid trimester is a very controversial topic in twins. The aim of the study was to present our maternal and fetal outcomes of mid-trimester cervical cerclage in twin pregnancies. Basic procedures. - This study was performed using data extracted from the medical files of the twin pregnancies whom performed emergency cervical cerclage between January 2012 and March 2018 at Trakya University, Facuty of Medicine, Department of Perinatology. Main findings. - Mean (min.-max.) gestational age at delivery was [27.3 (21-34) weeks]. The median time between cervical cerclage and delivery was 6.4 weeks, while the maximum prolongation of the pregnancy was 11 weeks. The median prolongation period of pregnancy was 4.1 weeks in patients with bulging membranes, but 10 weeks in patients with cervical effacement and cervical shortening. Eight infants died at the neonatal period. Two patients (20%) developed late abortions at 21 and 22 weeks of gestation, and 2 women (20%) delivered extremely premature neonates at the 24th weeks. Overall neonatal mortality rate was 40% (8/20 neonates). Twelve out of twenty were born alive (60%). Principal conclusions. - Despite the lack of randomized controlled trials, it seems reasonable to offer emergency cervical cerclage to twin pregnancies with cervical shortening (<15 mm). For the twin pregnancies with advanced cervical dilatation and protruding membranes, emergency cervical cerclage should be an option only for carefully selected patients after informing about the complications and low success rate. (C) 2018 Elsevier Masson SAS. All rights reserved.Öğe Intrahepatic Cholestasis and Adverse Perinatal Outcomes in the Third Trimester: A 10-year Case-control Study(2022) Yener, Cem; Sayın, Cenk; Erbilen, Esra Altan; Ateş, Sinan; Varol, FüsunBackground: To evaluate the perinatal outcomes in women whom developed intrahepatic cholestasis of pregnancy (ICP). Materials and Methods: Medical records of 76 patients who were followed up in a tertiary center due to ICP between January 2010 and December 2019 were evaluated retrospectively. Women with ICP (n=76) and age matched controls (n=228) were included to our study. Bile acid (BA) values could be reached in 42 of 76 patients. Results: There was no significant difference in terms of family history, fetal gender, or the presence of meconium in the amniotic fluid between the groups (p>0.05) except cesarean rates were significantly higher in ICP group (p<0.001). The median gestational weeks at delivery, fetal weight and Apgar scores at the 1st- and at the 5th-minutes in the ICP group were significantly lower than those in the controls (p<0.05). Gestational weeks at delivery was similar in women with BA values above or under 40 ?mol/L (p>0.05). Conclusion: ICP has important fetal implications. There is an increased risk for poor fetal outcomes, including preterm delivery and fetal demise. Therefore, close follow-up and meticulous observation is indispensable. Keywords: Intrahepatic cholestasis, neonatal outcome, pregnancy, ursodesoxycholic acidÖğe İntravajinal Mizoprostolün Gebelik Sonlandırılmasında Etkinliğinin Değerlendirilmesi(2020) Yener, Cem; Ateş, Sinan; Sayın, Cenk; Görmez, Süheyla; Varol, FüsunAmaç: Çalışmamızın amacı Trakya Üniversitesi Tıp Fakültesi Doğum Kliniğinde Mayıs 2016 –Aralık 2018 tarihleri arasındaki 2,5 yıllık zaman aralığında terminasyon yapılan gebeliklerin endikasyonlarının dağılımını değerlendirmek ve 10 (on) hafta üzeri gebelik sonlandırmasında dört saatte bir intravajinal ve yirmi dört saatte bir vajinal yolla uygulanan sırasıyla 400 ?g ve 600 ?g mizoprostolün etkinliğini karşılaştırmak. Gereç ve Yöntem:Retrospektif dosya incelemesi şeklinde planlanan çalışmamızda kliniğimizde terminasyon kararı verilen 10 (on) hafta üzeri gebeliklerin sonlandırılma endikasyonları ve uygulanmakta olan mizoprostol tedavi protokollerinin etkinliği incelendi. 18-45 yaş arası, 10 (on) hafta ve üzeri olan gebeliklerin sonlandırılmasının planlandığı toplam 128 kadının dosyası değerlendirildi. 63 hastaya (Grup 1) 4 saat ara ile tekrarlanan 400 ?g vajinal yolla mizoprostol uygulandı. 65 hastaya (Grup 2) 24 saat ara ile tekrarlanan 600 ?g vajinal yolla mizoprostol uygulandı. Her iki grupta yeterli uterin kontraksiyon elde edilene kadar doz tekrarlanıp 48 saat sonrasında abortus/doğum gerçekleşmemesi halinde yöntem başarısız olarak kabul edildi. Bulgular: Çalışmamızda termine edilen 128 hastanın terminasyon endikasyonları belirlendi. Gebelik terminasyon endikasyonları: Missed Abort ve IUGR (in utero mort fetus) 32(%25), santral sinir sistemi anomalileri 30(%23,4), anhidramniyoz 28(%21,8), kromozal anomaliler 11(%8,5), kardiyak anomaliler 7(%5,4), çoklu sistem anomalileri 6(%4,6), kas iskelet anomalileri 5 (%3,9), gastrointestinal ve genitoüriner sistem anomalileri 5(%3,9), teratojen ilaç kullanımı ve radyasyona maruz kalma 4(%3,1) bulundu. Grup 1 olgularda 48 saatte abortus oranı (%90.4) idi. Grup 2 olgularda 48 saatte başarı oranı ise (%92,3) bulundu.Sonuç: İlk trimester ve ikinci trimesterde yapılan obstetrik ultrasonografi fetal yapısal anomalilerin tanısında tek yöntemdir. Santral sinir sistemi anomalileri fetal anomaliler içerisinde en büyük grubu oluşturmaktadır. Hastanemizde 10 (on) hafta ve üzeri gebelik sonlandırılmasında kullanılan mizoprostolün etkili ve güvenilir olduğu düşünülmektedir.Öğe 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]Öğe MEASUREMENT OF FETAL NASAL BONE LENGTH, PRENASAL THICKNESS AND CORPUS CALLOSUM LENGTH OF FETUSES IN THRACE REGION OF TURKEY(2020) Varol, Füsun; Yener, Cem; Sütçü, Havva; Altan, Esra; Ateş, Sinan; Sayın, CenkAim: The nasal bone can be imaged with ultrasonography from the 10th week of pregnancy. In situations where the nasal bone isaplastic or hypoplastic, the risk of chromosomal anomalies increases. Thickening of the prenasal soft tissue is also apparent in the vastmajority of second-trimester fetuses with Down syndrome. In addition to these, corpus callosum is an another fetal structure that can bevisualized from 18th weeks of the gestation by ultrasound. Agenesis or dysgenesis of it is related with neuro-disabilities. In this study ourobjective was to provide reference charts for fetal nasal bone length, prenasal thickness and corpus callosum length obtained byprenatal sonography between 19th and 23rd weeks of pregnancy.Materials and Methods: The medical records of pregnant women who were followed-up in Trakya University School of Medicine,Department of Obstetrics & Gynecology, Division of Perinatology during the time period of 1st of January 2018 to 31st of December2019 were reviewed retrospectively. We studied 167 patients in between 19th and 23rd weeks of pregnancy.Results: Nasal bone length, prenasal thickness and corpus callosum length increased as the gestation proceeded. Mean±SD for nasalbone length, prenasal thickness and corpus callosum length (mm) between 19th and 23rd weeks were 6.65±0.7, 4±0.5, 20.1±1.4respectively.Conclusion: Ultrasound measurements of nasal bone length, prenasal thickness and corpus callosum can be performed within thesecond-trimester anomaly scan, and these measurements appear to be highly necessary because these measurement sensitive forprenatal diagnosis of chromosomal abnormalities and genetic syndromes.Öğe Measurement of Fetal Penile Length in Thrace Region of Turkey(2021) Yener, Cem; Varol, Füsun; Erbilen, Esra Altan; Ateş, Sinan; Sayın, CenkAim: To provide a reference range for fetal penile length obtained by prenatal sonography between 19th and 23rd weeks of pregnancy. Material and Method: The medical records of pregnant women who were followed-up in our department of Perinatology during the time period of 1st of January 2019 to 31st of December 2019 were reviewed retrospectively. Total 103 patients between 19th and 23rd weeks of gestation were included in the study. Results: Fetal penile length increased as the gestation proceeded. Mean ± SD penile length (cm) between 19th and 23rd weeks of gestation was found to be 0.81±0.23. Conclusion: Ultrasound measurements of fetal penile length can be performed within the second-trimester anomaly scan, and these measurements appear to be necessary because identification of true penile maldevelopment obligates further diagnostic workup.Öğe PLASENTA PREVİA PERKREATA TANI VE YÖNETİMİ: OLGU SUNUMU(2018) Yener, Cem; Sayın, Niyazi Cenk; Uzun, Işıl; Sütcü, Havva; Ateş, Sinan; Varol, Gülizar FüsunPlasenta perkreata, sezaryen ile doğum ve diğer uteringirişimlerdeki artış ile beraber olarak son yıllarda dahayaygın görülür hale gelmiştir. Gebelik esnasındaki doğrutanının çok büyük önemi vardır. Doğru yönetilenhastalarda morbidite ve mortalite oranları daha düşüktür.Bu olgu sunumunda perinatoloji kliniğimize yönlendirilenbir plasenta perkreata olgusunun yönetimini sunmaktayız.Öğe Prenatal diagnosis of 20p13 microdeletion syndrome(Elsevier Taiwan, 2021) Yener, Cem; Say, Cenk; Inan, Cihan; Gurkan, Hakan; Atli, Emine Ikbal; Atli, Engin; Altan, EsraObjective: The objective of this study was to report the first case of prenatal diagnosis of the fetal 20p13 microdeletion syndrome in the literature. Case report: The mother was 31 years old and had a first trimester serum screening that indicated the fetus was at low risk. The prenatal ultrasound at 23 weeks of gestation showed mild ventriculomegaly (10.2 mm) and absent septum pellucidum. She underwent amniocentesis because of the abnormal imaging results. Karyotype analysis revealed normal results. Chromosome microarray analysis (CMA) was then performed to provide genetic analysis of the fetus and parents. CMA detected 317.902 kb deletion of 20p13 in fetus. Finally, pregnancy was terminated at 32 weeks of gestation. Conclusion: This study is the first to report the prenatal diagnosis of a 20p13 microdeletion syndrome. Our results further confirmed that genes in this region, including SOX12, NRSN2 are essential for normal fetal growth and TBC1D20 for normal brain development. (c) 2021 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe Prenatal Sonographic Diagnosis of Limb-BodyWall Complex: One Case of a Rare Congenital Anomaly(2019) Varol, Gülizar Füsun; Sayın, Niyazi Cenk; Uzun, Işıl; Yener, CemLimb Body Wall Complex is also known as the body-stalk syndrome. It is a rarely seenclinical entity. In this case report we represent a 30 year old woman with 18 weeks of pregnancyassociated with rare congenital anomaly “limb-body wall complex” also known as “body stalk syndrome”with prenatal ultrasonographic diagnostic features and immediate after delivery evaluation.Öğe 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, FusunBackground: 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.Öğe 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. FusunPurpose 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.Öğe 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, CenkOur 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.Öğe Seroprevalence of Toxoplasma Gondii Antibodies in Pregnant Women in Thrace Region of Turkey - A Tertiary Center Experience(2021) Yener, Cem; Varol, Füsun; Uzun, Işıl; Sütcü, Havva; Yeşildağ, Burcu; Başar, Birsen; Ateş, SinanIntroduction: The objective of the study is to investigate Toxoplasma gondii antibody seroprevalence in pregnancies who applied for prenatal care to the tertiary center in Trakya (Thrace) Region of Turkey between January 01, 2014, and December 31, 2018, retrospectively. Methods: This study retrospectively analyzes seroprevalence of T. gondii IgM and IgG antibodies of 2.317 pregnant patients in their first trimester attended to the Obstetrics and Gynecology Antenatal Care Unit in Trakya University, Faculty of Medicine between January 01, 2014, and December 31, 2018. For this purpose, IgM, IgG and if necessary, IgG avidity results were evaluated. Results: In our study period 2.317 pregnant women were analyzed. 1.630 pregnant women (70.3%) were IgG and IgM seronegative, 607 (26.1%) were IgG seropositive, 61 (2.6%) were both IgG and IgM seropositive and 19 (0.9%) were only IgM positive. 30 of 61 patients with both IgG and IgM seropositivity showed low avidity. After 2 weeks for seroconversion control, in 16 of the patients with just IgM positivity, only 3 18.7%) showed seroconversion. We excluded patients who did not participate our routine follow-ups. Discussion and Conclusion: Even toxoplasma exposure rate in the pregnant women from the Trakya Region of Turkey is high (26.1%) before pregnancy, about 70% of first-trimester pregnant patients were found seronegative. Screening during the first trimester would be appropriate and prenatal education should be given to the patients.
