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Ayhan I, Demirci O, Odacılar AŞ, Yücel İK, Karaman A. Revisiting Atrioventricular Septal Defects: Exploring Chromosomal Abnormalities, Cardiac and Extracardiac Anomalies in a Contemporary Prenatal Cohort. Pediatr Cardiol 2024; 45:1036-1047. [PMID: 38570366 DOI: 10.1007/s00246-024-03477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
To estimate if there is an association between partial AVSD with chromosomal abnormalities, cardiac and extracardiac malformations, and to report the outcomes of prenatally diagnosed AVSD in a large, contemporary cohort. This is a retrospective cohort study of 190 prenatally diagnosed fetal AVSD between 2014 and 2023. Type of AVSD (complete vs partial), additional cardiac findings, extracardiac findings, presence of a heterotaxy, results of prenatal karyotype, and pregnancy outcomes were documented and analyzed. A total of 190 cases of fetal AVSD were analyzed. Complete AVSDs comprised 141 (74.2%) of the cohort, while partial AVSDs comprised 49 (25.7%). Karyotype was completed in 131 cases, and in 98 (74.8%) cases chromosomal abnormalities were identified, with trisomy 21 being the most common (53/131, 40.5%). Complete AVSDs were associated with trisomy 21 (45.5%, p = 0.04), Isolated cases of complete AVSDs (p = 0.03). Partial AVSDs were associated with trisomy 18 (53.1%, p < 0.001). In cases of partial AVSDs with aneuploidies, 7 (70%) had an ostium primum defect and 20 (90.9%) of AV canal type VSD. Isolated partial AVSD had no clear association with aneuploidies. There were additional cardiac anomalies in 96 (50.5%) and extracardiac anomalies in 134 (70.5%) of the cohort. There were no differences between partial and complete AVSD in rate of additional cardiac and extracardiac anomalies. AVSD was part of a heterotaxy in 47 (24.7%) of cases, and heterotaxy was associated with complete AVSD in the majority of cases (43/47, 91.4%, p = 0.003). Fetal partial AVSDs are associated with trisomy 18. Fetal complete AVSDs, even isolated, are associated with trisomy 21. There were no differences in association of other aneuploidies, additional cardiac findings, or extracardiac anomalies between prenatally diagnosed complete AVSDs and partial AVSDs.
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Affiliation(s)
- Işıl Ayhan
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Perinatology, University of Health Sciences, Istanbul, Turkey.
| | - Oya Demirci
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Perinatology, University of Health Sciences, Istanbul, Turkey
| | - Ali Şahap Odacılar
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Perinatology, University of Health Sciences, Istanbul, Turkey
| | - İlker Kemal Yücel
- Siyami Ersek Cardiology and Cardiovascular Surgery Training and Research Hospital, Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Ali Karaman
- Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Medical Genetics, University of Health Sciences, Istanbul, Turkey
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Dizdaroğulları GE, Alpınar A, Demirci O. Prenatal diagnosis of right aortic arch: associated anomalies and fetal prognosis according to different subtypes. J Perinat Med 2024; 52:304-309. [PMID: 38281095 DOI: 10.1515/jpm-2023-0410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/23/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Right aortic arch (RAA) is a rare anomaly with an incidence of 0.1 % in the adult population and low-risk fetuses. Our aim in this study was to evaluate associated anomalies and conditions according to subtypes. METHODS This was a retrospective study examining consecutive pregnancies diagnosed with RAA in our hospital between 2018 and 2022. Fetuses with RAA were divided into three groups, RAA with right-sided ductus arteriosus (RAA-RDA), RAA with left-sided ductus arteriosus (RAA-LDA), and RAA with a double aortic arch (RAA-DAA). RESULTS A total of 81 fetuses were diagnosed as having RAA during the study period. The rate of cardiac anomalies (82.8 %) in the RAA-RDA group was higher than in the RAA-LDA (17.6 %) and RAA-DAA (22.2 %) groups (p<0.001). No statistically significant difference was found between the groups in terms of maternal age, diagnosis week, pregnancy outcome, extracardiac anomalies, and genetic anomalies. Three (8 %) of 36 fetuses with isolated RAA who resulted in live birth developed symptoms related to the vascular ring, and one (2.7 %) newborn with RAA-DAA underwent surgery. CONCLUSIONS The incidence of cardiac anomalies is high in fetuses with RAA-RDA. Ultrasound examinations should be performed for cardiac anomalies and additional structural anomalies. Vascular ring formation is a rare but important complication due to compression risk to the trachea and esophagus.
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Affiliation(s)
- Gizem Elif Dizdaroğulları
- Department of Perinatology, Kartal Dr. Lutfi Kırdar City Hospital, Health Science University, Istanbul, Türkiye
| | - Abdullah Alpınar
- Department of Pediatric Cardiology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Türkiye
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Türkiye
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Öcal A, Demirci O, Kahramanoğlu Ö, Ayhan I, Erol N, Yücel İK. Navigating the spectrum of double-outlet right ventricle presentations: Outcomes from a contemporary cohort based on subtypes. Echocardiography 2024; 41:e15790. [PMID: 38456327 DOI: 10.1111/echo.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Our aim in this study was to investigate the prenatal and postnatal prognosis of double outlet right ventricle (DORV) cases diagnosed prenatally by analyzing the outcomes based on the subtype. METHODS This study is a retrospective chart review. Cases diagnosed with fetal DORV by prenatal ultrasound in the maternal-fetal medicine department of our hospital between 2014 and 2022 were included. Data on maternal characteristics, fetal echocardiographic features (type of DORV), pregnancy and neonatal outcomes (termination of pregnancy [TOP], intrauterine fetal death [IUD], neonatal death [NND], death in infancy (IND), survival) were collected and analyzed. RESULTS Ninety-nine cases of prenatally diagnosed cases of DORV were included. The prenatal diagnosis was right in 97% of the liveborn fetuses. The cases were classified into subtypes, including transposition of great arteries (TGA), Fallot, ventricular septal defect (VSD), remote, and heterotaxy types. The cohort consisted of 32.3% TGA type, 19.1% fallot type, 11.1% VSD type, 2% remote type, and 35.3% heterotaxy type of DORV. An additional cardiac anomaly was observed in 87% and an extra-cardiac anomaly was observed in 54% of the cases. When we excluded the cases with heterotaxy type but without any chromosomal abnormality, additional genetic abnormalities were detected in 42% of the remaining cases. Outcome of pregnancy was livebirth in 68/99 (68.7%), IUFD in 5/99 (5.1%), and TOP in 26/99 (26.3%). Postnatal cardiac surgical repair was performed in 48 cases. Survival among livebirths was 39/68 (57.3%). Twenty-nine neonates or infants who had additional cardiac anomalies and/or genetic abnormalities died before any surgical intervention. The postoperative survival rate was 39/48 (81.2%). CONCLUSION The prognosis in DORV depends on the anatomical subtype, the presence, and severity of associated anomalies. Survival increases in isolated cases without any additional structural or genetic anomalies.
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Affiliation(s)
- Aydın Öcal
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Işıl Ayhan
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - İlker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
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Kahramanoglu O, Demirci O, Uygur L, Erol N, Schiattarella A, Rapisarda AMC. Persistant Left Superior Vena Cava with and Without Right Superior Vena Cava: Significance of Prenatal Diagnosis. Pediatr Cardiol 2024; 45:377-384. [PMID: 38103069 DOI: 10.1007/s00246-023-03353-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
This study aims to define the associated anomalies with PLSVC, and to compare single PLSVC and bilateral superior vena cava in terms of accompanying anomalies and pregnancy outcomes. This was a retrospective study of the fetuses diagnosed with single and/or bilateral SVC at a tertiary fetal medicine center during 8 years. We detected 16 cases of single PLSVC and 84 cases of bilateral SVC. We found an association between the PLSVC and cardiac and extracardiac anomalies. Comparison between single PLSVC and BSVC cases revealed significant differences in the occurrence of heterotaxy and right isomerism. The study highlights the importance of prenatal diagnosis in PLSVC cases. Isolated PLSVC with situs solitus may be considered a benign finding, but larger studies are needed to understand the clinical implications of PLSVC in relation to chromosomal anomalies. Routine screening protocols should include three-vessel and trachea views to detect PLSVC.
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Affiliation(s)
- Ozge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey.
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey
| | - Lutfiye Uygur
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Antonio Schiattarella
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Ayhan I, Demirci O, Uygur L, Odacilar Ş, Özbay Ayvaz OD, Karaman A, Celayir A. An analysis of factors affecting survival in prenatally diagnosed omphalocele. J Perinat Med 2023; 51:1189-1196. [PMID: 37531153 DOI: 10.1515/jpm-2023-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES To estimate factors affecting survival in prenatally diagnosed omphalocele, factors predicting genetic abnormalities, and association of omphalocele and specific groups of anomalies. METHODS A retrospective observational study was performed, analyzing data of all omphalocele cases diagnosed prenatally in the perinatology clinic of a referral center. Demographic data, characteristics of the omphalocele (size, content, associated anomalies), results of genetic testing, pregnancy outcomes and postnatal outcomes were analyzed. RESULTS Sixty-nine fetuses with omphalocele were included. The prevalence of omphalocele in livebirth was 0.007 %. Overall survival during the study period was 73.9 %. Twenty-eight (71.7 %) out of 39 cases with associated anomalies who were born live, survived, whereas survival was 85.7 % in the isolated cases. The most common anomaly associated with omphalocele were cardiac defects with 42 %; followed by placental or umbilical cord anomalies (28.9 %), skeletal defects (27.5), genitourinary anomalies (20.2 %), central nervous system (18.8 %) and facial anomalies (7.2 %), respectively. Eighty-five percent of the fetuses had at least one additional anomaly or ultrasound finding. Skeletal abnormalities and staged surgical repair of omphalocele were associated with survival. Associated skeletal anomalies and staged repair significantly increase the risk of postnatal death (OR: 4.6 95 % CI (1.1-19.5) and (OR: 10.3 95 % CI (1.6-63.9), respectively). CONCLUSIONS Associated skeletal abnormalities and staged surgical repair are negatively associated with postnatal survival.
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Affiliation(s)
- Işıl Ayhan
- Department of Perinatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Lütfiye Uygur
- Department of Perinatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Şahap Odacilar
- Department of Perinatology, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Olga Devrim Özbay Ayvaz
- Department of Pediatric Surgery, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Ali Karaman
- Department of Medical Genetics, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Ayşenur Celayir
- Department of Pediatric Surgery, University of Health Sciences, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Türkiye
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Kalafat E, Güney Esken G, Demirci O, Ayaz R, Çelik E, Can F. Neutralizing antibody levels and cellular immune response against Omicron variant in pregnant women vaccinated with mRNA and inactivated SARS-CoV-2 vaccines. Ultrasound Obstet Gynecol 2023. [PMID: 38011582 DOI: 10.1002/uog.27542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Affiliation(s)
- E Kalafat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Koç University, Istanbul, Turkey
| | - G Güney Esken
- Koç University İş Bank Infectious Diseases Research Center (KUISCID), Istanbul, Turkey
| | - O Demirci
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - R Ayaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - E Çelik
- Department of Obstetrics and Gynecology, Faculty of Medicine, Koç University, Istanbul, Turkey
| | - F Can
- Koç University İş Bank Infectious Diseases Research Center (KUISCID), Istanbul, Turkey
- Department of Clinical Microbiology, Faculty of Medicine, Koç University, Istanbul, Turkey
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Uygur L, Demirci O, Yücel IK. Pulmonary atresia and ventricular septal defect: How accurate is the fetal echocardiography, and do the major aortopulmonary collateral arteries matter? Echocardiography 2023; 40:1259-1268. [PMID: 37878331 DOI: 10.1111/echo.15706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/29/2023] [Accepted: 10/15/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. STUDY DESIGN The cases prenatally diagnosed with PAVSD between 2017 and 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the different pulmonary vascular supply types. RESULTS Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live-born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Postoperative survival was 69.2%. Mortality before surgery and postoperative survival did not differ between pulmonary supply groups. Survival was impaired by the extracardiac anomalies. The need for early interventions was significantly higher in the DA group. CONCLUSION Pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short-term outcomes significantly but it impacts the management. The associated anomalies highly contribute to postnatal mortality.
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Affiliation(s)
- Lütfiye Uygur
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ilker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Kahramanoğlu Ö, Akalin M, Bilir E, Ocal A, Dizdaroğulları GE, Eyisoy G, Demirci O. Assessment of fetal myocardial performance index in pregnant women with SARS-CoV-2 infection: A prospective cohort study. J Clin Ultrasound 2023; 51:1475-1482. [PMID: 37883099 DOI: 10.1002/jcu.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/27/2023] [Accepted: 09/06/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Our aim was to investigate the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetal myocardial performance in women who had it during their pregnancy. MATERIALS AND METHODS In our prospective cohort study including healthy pregnant women and pregnant with SARS-CoV-2 infection, we collected patients' data between June 2021 and April 2022. Maternal characteristics, gestational age at SARS-CoV-2 infection and ultrasound examination, and body mass index were noted. Fetal biometry, fetal anatomy scanning, placenta, amniotic fluid index (AFI), and Doppler parameters were routinely examined in all patients. Left ventricular myocardial performance index (MPI) was measured during fetal echocardiography examination. Doppler parameters, AFI, and MPI values were compared between two groups. RESULTS Compared with the control group (n = 80), MPI values were found within normal limits in fetuses of pregnant women with SARS-CoV-2 infection (n = 80) (MPI: 0.38 ± 0.06 in the control groups vs. 0.39 ± 0.05 in the SARS-COV-2 positive group, p = 0.79). There was no relationship between SARS-CoV-2 infection and changes in AFI and umbilical artery pulsatility index (PI) values. Uterine artery PI values were significantly higher in pregnant women with (SARS-CoV-2) infection (0.81 in the control group vs. 0.97 in the SARS-CoV-2 group, p < 0.05). CONCLUSIONS Fetal cardiac functions were not affected in pregnant women with previous (SARS-CoV-2) infection. Further metaanalyses are warranted to confirm the results.
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Affiliation(s)
- Özge Kahramanoğlu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Munip Akalin
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Esra Bilir
- Department of Global Health, Koc University Graduate School of Health Sciences, Istanbul, Turkey
| | - Aydin Ocal
- Department of Perinatology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | | | - Gokhan Eyisoy
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
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Ocal A, Demirci O, Ozgokce C, Kahramanoglu O, Dizdarogullari GE, Eyisoy OG, Yarsilikal Guleroglu F. Protruding vs. visible prolapsed fetal membranes adversely affects the outcome of cervical insufficiency. Eur Rev Med Pharmacol Sci 2023; 27:9937-9946. [PMID: 37916363 DOI: 10.26355/eurrev_202310_34172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to determine how prolapsed fetal membranes (PFM) affect perinatal outcomes in cases of cervical insufficiency undergoing emergency cerclage or expectant management. PATIENTS AND METHODS This retrospective study analyzed perinatal outcomes in 100 pregnant women with cervical insufficiency, including those with visible PFM at the cervical external os and those with protruding PFM to the vagina. The participants were subjected to either expectant management involving prescribed bedrest or emergency cerclage. RESULTS In the study population, 41 (41%) preferred bedrest, while 59 (59%) chose emergency cerclage. Among those managed expectantly, 10 (10%) had visible PFM, and 31 (31%) had protruding PFM. Among those who underwent emergency cerclage, 32 (32%) had visible PFM, and 27 (27%) had protruding PFM. Delivery after 32 weeks of gestation showed similar rates between women with visible and protruding PFM, regardless of the management approach chosen. These rates were significantly higher compared to those with protruding PFM managed with bed rest and emergency cerclage. Prolongation of pregnancy in protruding-cerclage and protruding-bedrest groups was 42.3±34 and 17.9±22 days, respectively. CONCLUSIONS Our findings provide support for considering emergency cerclage as a viable option when addressing cases involving a visible form of PFM, although the recommendation is somewhat less robust in instances of protruding PFM. The implementation of an emergency cerclage procedure has the potential to extend the time frame between diagnosis and delivery, enhance neonatal survival rates, and increase the likelihood of births occurring after 28 weeks of gestation. However, it does not seem to significantly affect the rate of births taking place after 32 weeks of gestation. This could potentially lead to complications associated with premature births and extended stays in the postnatal neonatal intensive care unit. Therefore, it is crucial to offer families detailed information regarding the pros and cons of emergency cerclage.
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Affiliation(s)
- A Ocal
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital affiliated with the University of Health Sciences, Istanbul, Turkey.
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Gürel S, Ayhan I, Uygur L, Özgit B, Demirci O. What to expect after birth in idiopathic polyhydramnios? An analysis of postnatal diagnoses and their relationship to the polyhydramnios degree. Arch Gynecol Obstet 2023:10.1007/s00404-023-07216-0. [PMID: 37750933 DOI: 10.1007/s00404-023-07216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/03/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To analyze postnatal abnormalities in idiopathic polyhydramnios and to estimate whether there was an association between the severity of polyhydramnios and postnatally diagnosed abnormalities. METHODS This was a retrospective cohort study of all idiopathic polyhydramnios cases delivered at our center between 2017 and 2021. Cases were identified as idiopathic after excluding known fetal genetic or structural abnormalities (including soft markers for aneuploidies), Rh isoimmunization, fetal anemia, multifetal pregnancies, pregestational or gestational diabetes, and known infection with TORCH group agents. The primary outcome was the association between polyhydramnios degree and any abnormalities detected after birth. Additional outcomes were the odds of specific groups of abnormalities based on polyhydramnios degree. RESULTS The prevalence of idiopathic polyhydramnios was 14.7%. Outcomes of 242 pregnancies with idiopathic polyhydramnios were analyzed. At least one neurodevelopmental, structural, or genetic abnormality was diagnosed in 16.1% of children born to women with idiopathic polyhydramnios. Moderate and severe polyhydramnios are significantly associated with at least one abnormality diagnosed after birth (45.9%, and 41.6%, respectively, p < 0.05). Neurodevelopmental disorders were the most frequent abnormality (5.4%), followed by genetic abnormalities (4.1%) and gastrointestinal abnormalities (2%). Odds of genetic abnormalities and neurodevelopmental disorders in moderate polyhydramnios were significantly higher compared to mild [OR 2.6; 95% CI 1.1-4.3 and aOR 2.4 (95% CI 1.1-3.6) respectively]. As expected, gastrointestinal anomalies were significantly associated with severe polyhydramnios [OR 3.2 (95% CI 1.9-5.5)]. CONCLUSION Moderate and severe idiopathic polyhydramnios are associated with anomalies diagnosed after birth. Particularly high risks include neurodevelopmental disorders, genetic abnormalities, and gastrointestinal atresias.
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Affiliation(s)
- Sümeyra Gürel
- Obstetrics and Gynecology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Işıl Ayhan
- Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Lütfiye Uygur
- Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Berk Özgit
- Obstetrics and Gynecology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Eyisoy ÖG, Özgökçe Ç, Uygur L, Eriç Özdemir M, Taşdemir Ü, Öcal A, Demirci O. Clinical and genetic aspects of termination of pregnancy; tertiary center experience. Turk J Obstet Gynecol 2023; 20:234-241. [PMID: 37668046 PMCID: PMC10478725 DOI: 10.4274/tjod.galenos.2023.19677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
Objective The aim of the study was to retrospectively analyze the indications Techniques and complications of pregnancy termination performed in a tertiary center. Materials and Methods All cases between 10 and 33 weeks of gestation between January 2021 and June 2023 were retrospectively analyzed. The patients were divided into two groups as group 1 with 11+0 to 21+6 gestational weeks and group 2 for those at 22+0 and 33+0 gestational weeks. Results A total of 568 pregnancy terminations were included in the study. Among all terminations the most common fetal indications were central nervous system anomalies (148 cases, 26%) and trisomy 21 (53 cases, 9%) and the most common maternal/obstetrical Indication was previable premature rupture of the membranes (179 cases, 31.5%). Abnormal genetic results were found in 50 of 173 cases (28.9%) with a termination indication of Structural malformation who accepted invaziv genetic testing. The number of terminations with fetal indications performed after 22 weeks were 148 (41%) and 11 (7.4%) cases of these late terminations of pregnancy were anomalies expected to be diagnosed in the first trimester. Complication rates (12.4%) and abdominal termination rates (3.5%) were significantly higher in group 2 than in group 1 (p<0.05). Conclusion Improvements in prenatal genetic screening and diagnostic techniques will undoubtedly decrease the gestational ages in terminations of pregnancies. However, there will always be cases that can neither be diagnosed earlier nor can be treated due to the nature of the anomaly. In the management of such cases, terminations will always occupy an important place in prenatal care.
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Affiliation(s)
- Ömer Gökhan Eyisoy
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Çağdaş Özgökçe
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Lütfiye Uygur
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Mucize Eriç Özdemir
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Ümit Taşdemir
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Aydın Öcal
- University of Health Sciences Turkey, İstanbul Haseki Training and Reseasch Hospital, Clinic of Obstetrics, Division of Perinatology, İstanbul, Turkey
| | - Oya Demirci
- University of Health Sciences Turkey, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
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Şimşek OK, Baser U, Özgünler Ö, Demirci O, Aydin AF, Kucukgergin C, Yalcin F. Comparison of oxidative stress markers in the saliva, gingival crevicular fluid, and serum samples of pregnant women with gestational diabetes and healthy pregnant women. J Periodontal Res 2023. [PMID: 37154237 DOI: 10.1111/jre.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVE To compare oxidative stress (OS) markers in the saliva, gingival crevicular fluid (GCF), and serum samples of pregnant women with gestational diabetes (GDM) and healthy pregnant women and to investigate the association between periodontal health/diseases and OS and GDM. METHOD Eighty women with GDM and 80 healthy pregnant women were included in the study. Medical and clinical anamnesis was obtained from all the pregnant women included in the study, and their plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL) measurements were performed. GCF, saliva, and serum samples were collected for the measurements of the local and systemic total antioxidant status (TAS) and total oxidant status (TOS). RESULTS Clinical periodontal parameters were found to be significantly higher in the GDM group compared to the control group. The serum and saliva TAS, TOS, and TAS/TOS values were significantly lower in the GDM group than in the control group. In the analysis of the GCF samples, the mean TAS and TAS/TOS values were significantly lower and the TOS value was significantly higher in the GDM group than in the control group. The multivariate reduced model indicated that gravidity, salivary TAS/TOS, and GCF TAS were significant independent variables in the development of GDM (p < .05). CONCLUSION Our results indicated that the OS of serum, saliva, and GCF samples increased in patients with GDM compared to healthy pregnant women. The role of local OS parameters in GDM may be associated with elevated clinical periodontal parameters.
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Affiliation(s)
- Oya Kaya Şimşek
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Ulku Baser
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Özgür Özgünler
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
| | - Oya Demirci
- Perinatology Clinic, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Abdurrahman Fatİh Aydin
- Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Canan Kucukgergin
- Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Funda Yalcin
- Faculty of Dentistry, Periodontology Department, Istanbul University, Istanbul, Turkey
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13
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Eyisoy ÖG, Uygur L, Taşdemir Ü, Özgökçe Ç, Cambaztepe B, Demirci O. Analysis of the process leading to termination of pregnancy in the third trimester. Perinat J 2023. [DOI: 10.2399/prn.23.0311011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective: To evaluate fetal anomalies and processes leading to termination of pregnancy in the third trimester. Methods: The study includes all cases who underwent termination of pregnancy after 28 weeks of gestation due to fetal anomalies between 2017 and 2022. Results: Forty four of third trimester terminations were carried out in our clinic due to fetal anomalies incompatible with life or associated with severe sequelae. Structural anomalies including 35 (79.5%) cases were the most common reason of terminations followed by chromosomal or genetic abnormalities in 8 (18.2%) cases and intrauterine cytomegalovirus infection in 1 (2.3%) case. The processes leading to the third trimester termination were evaluated by dividing 44 patients into 5 groups. (1) Delayed diagnosis due to inadequate prenatal care (25 patients, 56.8%); (2) patients diagnosed with late-onset findings (5 patients, 11.4%); (3) patients with abnormal findings in prenatal care or history but delayed diagnosis (5 patients, 11.4%); (4) patients with abnormal findings requiring further evaluation (4 patients, 9.0%); (5) patients with a definitive diagnosis but latency in the decision of family for termination of pregnancy (5 patients, 11.4%). Conclusion: Termination of pregnancy in the third trimester has an important role in countries where unfollowed pregnancies are common and access to health services is poor due to low socio-economic status.
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14
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Uygur L, Demirci O, Celayir A. Fetal hydrometrocolpos: Challenges of prenatal differential diagnosis on ultrasound. J Clin Ultrasound 2023; 51:426-431. [PMID: 36152021 DOI: 10.1002/jcu.23345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/03/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to a lower genital tract obstruction causing accumulation of utero-cervical-vaginal secretions or urine in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and differential diagnosis of the underlying etiologies is quite challenging in the prenatal period. We present three cases of female fetuses with hydrometrocolpos and discuss the prenatal differential diagnoses in the light of ultrasound findings along with postnatal diagnoses and outcomes.
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Affiliation(s)
- Lütfiye Uygur
- Department of Obstetrics and Gynecology, Division of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Obstetrics and Gynecology, Division of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ayşenur Celayir
- Department of Pediatric Surgery, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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15
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Akalın M, Demirci O, Dizdaroğulları GE, Çiftçi E, Karaman A. Contribution of chromosomal microarray analysis and next-generation sequencing to genetic diagnosis in fetuses with normal karyotype. J Obstet Gynaecol Res 2023; 49:519-529. [PMID: 36316250 DOI: 10.1111/jog.15486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
AIM The aim of this study was to investigate the contribution of chromosomal microarray analysis (CMA) and next-generation sequencing (NGS) to genetic diagnosis in fetuses with normal karyotype who underwent invasive testing for different indications. METHODS The results of invasive genetic testing performed at a tertiary center between September 2020 and March 2022 were retrospectively analyzed. Indications for invasive tests were classified as fetal structural malformation, presence of soft markers, and high risk in screening tests. CMA results were classified as pathogenic or likely pathogenic (pCNVs), benign (bCNVs), and variants of unknown clinical significance (VOUS). RESULTS A total of 830 invasive tests were performed and aneuploidy was detected in 11.2% of the fetuses. CMA was performed in 465 fetuses with normal karyotype, and pCNVs were detected in 6.9%. pCNVs were detected in 8.2% of fetuses with structural malformations, 6.5% in soft markers, and 4.7% in high risk in screening tests. Pathogenic variants were detected by NGS in 33.8% of fetuses with bCNVs. CONCLUSIONS pCNVs can be significantly detected not only in fetuses with structural malformations, but also in invasive testing with other indications. NGS significantly contributes to genetic diagnosis in fetuses with structural malformations.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Gizem E Dizdaroğulları
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Erman Çiftçi
- Department of Obstetrics and Gynecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Karaman
- Department of Medical Genetics, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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16
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Ocal A, Demirci O, Dizdaroğulları GE, Kahramanoğlu Ö, Ayhan I, Akalın M, Eriç Özdemir M, Odacılar AŞ, Taşdemir Ü, Celayir A. Can we predict the need for postnatal surgery in patients with prenatal fetal lung masses detected by CVR value? J Gynecol Obstet Hum Reprod 2023; 52:102526. [PMID: 36565926 DOI: 10.1016/j.jogoh.2022.102526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
AIM The purpose of this study is to evaluate whether CPAM-volume ratio (CVR) can predict postnatal management (follow up for resolution and surgical treatment) in fetuses with fetal lung masses in the prenatal period. MATERIALS AND METHODS 44 patients who presented at our center with prenatally diagnosed CPAM (Congenital Pulmonary Airway Malformation) and BPS (Bronchopulmonary Sequestration) were analyzed. Obstetric history and outcomes, karyotype results, CVR, additional sonographic findings, characteristics of masses were recorded. CVR was calculated for all cases. İn the study we sought to identify a CVR threshold and did not use the thresholds classically used in the literature. RESULTS 20 fetal BPS and 24 CPAM cases were analyzed. After excluding 5 patients, 46% of the patients were diagnosed with BPS and 54% with CPAM. İn this study the cut off < 0,53 for CVR is taken, it predicts the no need for postnatal surgery with a sensitivity of 85% and a specificity of 88%. When we take the > 0,76 cut-off value for patients who will require emergency surgery within the first 10 days, it predicts the need for surgery with 90% sensitivity and 89% specificity. In addition, it was determined that all patients with mediastinal shift were operated. CONCLUSION We believe that the CVR value and the presence of mediastinal shift should be evaluated in all cases of CPAM and BPS for prediction of the surgery. Proper counseling about the prognosis could be given to the family in cases with mediastinal shift and CVR value above 0,76.
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Affiliation(s)
- Aydın Ocal
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey.
| | - Oya Demirci
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Gizem Elif Dizdaroğulları
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Işıl Ayhan
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Münip Akalın
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey; Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ali Şahap Odacılar
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ümit Taşdemir
- Department of Obstetrics and Gynecology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital,Istanbul, Turkey
| | - Ayşenur Celayir
- Department of Pediatric Surger, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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17
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Akalın M, Demirci O, Kaygusuz E, Dizdaroğulları GE. Prenatally diagnosed fetal thoraco-lumbar spine duplication associated with lipomyelomeningocele: An extremely rare case of split cord malformation. Turk J Obstet Gynecol 2022; 19:333-337. [PMID: 36511649 DOI: 10.4274/tjod.galenos.2022.85453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Spine duplication is considered rare, a more serious form of split cord malformation. Ultrasonographic evaluation of the spine in the second trimester is central to the antenatal diagnosis of spinal malformations. Here, we report a case of thoraco-lumbar spine duplication associated with lipomyelomeningocele diagnosed by ultrasonography at 19 weeks of gestation. To the best of our knowledge, this is the first case report of spine duplication diagnosed by antenatal ultrasonography.
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Affiliation(s)
- Münip Akalın
- Marmara University Pendik Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Oya Demirci
- University of Health Sciences Turkey, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Ecmel Kaygusuz
- University of Health Sciences Turkey, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Clinic of Pathology, İstanbul, Turkey
| | - Gizem Elif Dizdaroğulları
- University of Health Sciences Turkey, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
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18
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Akalın M, Yalçın M, Demirci O, İsmailov H, Sahap Odacilar A, Dizdarogulları GE, Kahramanoğlu Ö, Ocal A, Akalın EE, Dizdaroğulları M. Positive effects of fetal echocardiography on maternal anxiety: a prospective study in a tertiary center in Turkey. J Psychosom Obstet Gynaecol 2022; 43:585-592. [PMID: 36137219 DOI: 10.1080/0167482x.2022.2124911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aim: The aim of this study was to determine the anxiety levels of pregnant women who were referred to a tertiary center for fetal echocardiography (FE) and the effect of FE results on maternal anxiety.Methods: This prospective study was conducted between January 2020 and February 2021 and included 118 pregnant women. The anxiety levels of the participants were evaluated with the Spielberger State-Trait Anxiety Inventory, which evaluates state (STAI-I) and trait (STAI-II) anxiety. STAI-I and STAI-II were administered to participants at first admission using a standard interview technique prior to FE. After the FE was completed, a structured interview was performed and the state anxiety index (STAI-I-R) was re-administered to the participants.Results: Severe congenital heart disease (CHD) was detected in 63 (53.4%) fetuses. The participants' mean STAI-I scores were significantly higher than their mean STAI-II scores (44.19 ± 8.56 and 41.98 ± 5.98, respectively, t = 2.59 and p = 0.011). In pregnant women with fetuses with severe CHD, STAI-I-R scores were significantly lower compared to STAI-I scores (43.48 ± 7.97 and 46.28 ± 7.18, respectively, t = 2.13 and p = 0.037).Conclusion: Referral for FE is associated with increased maternal anxiety, and a structured interview may result in reduced anxiety levels even in those with abnormal FE.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Murat Yalçın
- Department of Psychiatry, University of Health Sciences Erenköy Mental and Nervous Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Hayal İsmailov
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Gizem Elif Dizdarogulları
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aydın Ocal
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Emine Eda Akalın
- Department of Obstetrics and Gynaecology, Bahcesehir University School of Medicine, Istanbul, Turkey
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19
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Akalın M, Demirci O, Dizdaroğulları GE, Çiftçi E, Oğuz S, Karaman A. Advantages and limitations of QF-PCR analysis in invasive prenatal genetic diagnosis: a tertiary center experience from Turkey. Perinat J 2022. [DOI: 10.2399/prn.22.0303002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to investigate the success and reliability of QF-PCR analysis in detecting chromosomal abnormalities and to determine its advantages and limitations. Methods: Patients who underwent karyotype and QF-PCR analysis as a prenatal invasive diagnostic test in a tertiary center were retrospectively analyzed. Invasive genetic test indications, ultrasonographic fetal screening reports, karyotype and QF-PCR analysis results of the patients were obtained from the electronic data system. Karyotypes were classified as normal, common aneuploidies (trisomies 21, 18, 13, and sex chromosome aneuploidies) and other aneuploidies. QF-PCR analysis and karyotype results were compared for inconsistency. Results: A total of 426 cases (41 [9.6%] chorionic villus sampling, 339 [79.6%] amniocentesis and 46 [10.8%] cordocentesis) were included in the study. The most common indication for prenatal invasive diagnostic testing was fetal structural anomalies (36.7%). Aneuploidy was detected in 61 (14.3%) of the fetuses. Fifty-nine (96.7%) of 61 fetuses with aneuploidy were common aneuploidies. The sensitivity and specificity of the QF-PCR analysis in detecting common aneuploidies was 100%. QF-PCR analysis was indicative if not diagnostic in all fetuses with mosaic trisomy or sex chromosome aneuploidies. Conclusion: QF-PCR analysis is a rapid, robust, and reliable test for the prenatal detection of common aneuploidies. Although QF-PCR analysis has high sensitivity and specificity in detecting common aneuploidies, it should be used for rapid preliminary information and the result of karyotype analysis should be awaited for important clinical decisions.
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20
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Akalın M, Demirci O, Gokcer O, İsmailov H, Sahap Odacilar A, Dizdarogulları GE, Kahramanoğlu Ö, Ocal A, Bolat G, Eriç Özdemir M. Intraamniotic digoxin administration versus intracardiac or funic potassium chloride administration to induce foetal demise before termination of pregnancy: a prospective study. J OBSTET GYNAECOL 2022; 42:3477-3483. [PMID: 36369861 DOI: 10.1080/01443615.2022.2144173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Different foeticide techniques and pharmacological agents have been used to achieve foetal asystole. This study aimed to compare the success of intraamniotic digoxin, intracardiac potassium chloride (KCl), and funic KCl in achieving foetal asystole and discuss procedural difficulties for physicians and clinical outcomes. This prospective observational study included 124 patients who received foeticide at 22-31 weeks of gestation. All procedures were performed transabdominally, and 1 mg of intraamniotic digoxin, funic KCl, or intracardiac KCl was administered. Procedure times, procedural difficulty scores, patient pain scores, decrease in haematocrit levels, induction and hospitalisation times, and the presence of chorioamnionitis were recorded. The foeticide success rates were 93.0, 95.1, and 97.5% for intraamniotic digoxin, intracardiac KCl, and funic KCl, respectively. Intraamniotic digoxin was associated with shorter procedure times, lower procedural difficulty scores, and lower patient pain scores (p < 0.001). Decreases in haematocrit, induction times, and chorioamnionitis were similar in all three procedures. Success rates and clinical results were similar for all three procedures. Foeticide with intra-amniotic digoxin has a high success rate, the procedure is easier to perform, and patients experience less procedural pain.IMPACT STATEMENTWhat is already known on this subject? Different foeticide techniques and pharmacological agents have been used to achieve foetal asystole. Pharmacological agents used in the foeticide procedure can be injected as intracardiac, funic, intrafetal, or intraamniotic, and the most commonly used are potassium chloride (KCl), digoxin, and lidocaine.What do the results of this study add? The success rates and clinical outcomes in achieving foetal asystole are similar for intracardiac KCl, funic KCl, and intra-amniotic digoxin procedures. Foeticide with intra-amniotic digoxin is less difficult to perform, and patients experience less pain associated with the procedure. All three techniques appear to be safe and have similar short-term obstetric outcomes.What are the implications of these findings for clinical practice and/or further research? Physicians may prefer foeticide with intra-amniotic digoxin as the procedure is technically simpler and has similar success rates to intracardiac or funic KCl administration. A prospective randomised study could better compare the advantages and limitations of the foeticide techniques.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Gokcer
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Hayal İsmailov
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Gizem Elif Dizdarogulları
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Aydın Ocal
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Guher Bolat
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women’s and Children’s Disease Training and Research Hospital, Istanbul, Turkey
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21
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Dizdaroğulları GE, Demirci O, Akalın M, Kahramanoğlu Ö, Öcal A, Karaman A. Importance of isolated minor findings on fetal ultrasound examinations in the diagnosis of Down syndrome. Perinat J 2022. [DOI: 10.2399/prn.22.0303011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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22
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Kumru P, Hidiroglu S, Cogendez E, Ayvaci H, Yilmazer B, Erol H, Demirci O, Ay P. Does asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy increase the risk of spontaneous preterm birth? Ginekol Pol 2022:VM/OJS/J/87877. [PMID: 36134763 DOI: 10.5603/gp.a2022.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/29/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyze the perinatal outcomes of asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy and the relationship between gestational age at the time of infection and spontaneous preterm birth (PTB). MATERIAL AND METHODS This was a retrospective cohort study. The study population included pregnant women who were 19-45 years old and who had been admitted to a Research and Training Hospital for singleton birth delivery. Women who had contracted SARS-CoV-2 during their pregnancy (n = 102) were compared to those who were not infected (n = 378) for the development of spontaneous PTB and other perinatal outcomes. The factors associated with spontaneous PTB were analyzed through univariate and multivariate methods. RESULTS Spontaneous PTB developed in 22.5% of the pregnant women with a history of SARS-CoV-2 infection and in 5.3% without a history of the infection (p < 0.001). The multivariate model determined that compared to the non-infected women, the OR of spontaneous PTB among those who had contracted the virus in the first, second, and the third trimesters were 9.13 (p < 0.001), 1.85 (p = 0.292) and 7.09 (p < 0.001), respectively. Pregnancy cholestasis (3.9% vs 0.5%; p = 0.020) and placental abruption (3.9% vs 0.5%; p = 0.040) were significantly higher in cases with a history of SARS-CoV-2 infection compared to the non-infected women. CONCLUSIONS Asymptomatic or uncomplicated SARS-CoV-2 infection during pregnancy increases the risk of spontaneous PTB. This risk is higher particularly among pregnant women who develop the infection in the first and the third trimesters.
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Affiliation(s)
- Pınar Kumru
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children's Disease Training and Research Hospital, Zeynep Kamil, Dr. Burhanettin Üstünel Sokağı, Üsküdar/İstanbul, Turkey, Turkey.
| | - Seyhan Hidiroglu
- Department of Public Health, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ebru Cogendez
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children's Disease Training and Research Hospital, Zeynep Kamil, Dr. Burhanettin Üstünel Sokağı, Üsküdar/İstanbul, Turkey, Turkey
| | - Habibe Ayvaci
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children's Disease Training and Research Hospital, Zeynep Kamil, Dr. Burhanettin Üstünel Sokağı, Üsküdar/İstanbul, Turkey, Turkey
| | - Betül Yilmazer
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children's Disease Training and Research Hospital, Zeynep Kamil, Dr. Burhanettin Üstünel Sokağı, Üsküdar/İstanbul, Turkey, Turkey
| | - Hümeyra Erol
- Division on Nursing, University of Health Sciences, Zeynep Kamil Women and Childrens Diesease Training and Research Hospital, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Oya Demirci
- Department of Obstetrics and Gynecology, University of Health Sciences, Zeynep Kamil Women and Children's Disease Training and Research Hospital, Zeynep Kamil, Dr. Burhanettin Üstünel Sokağı, Üsküdar/İstanbul, Turkey, Turkey
| | - Pınar Ay
- Department of Public Health, Marmara University Faculty of Medicine, Istanbul, Turkey
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Akalın M, Demirci O, Yücel İK, Erol N. Fetal Echocardiographic Findings to Predict Early Surgical Repair and Neonatal Outcomes in Fetuses with Isolated Coarctation of the Aorta. Am J Perinatol 2022. [PMID: 35858644 DOI: 10.1055/a-1904-9519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to investigate fetal echocardiographic findings in predicting the need for surgical repair in fetuses with coarctation of the aorta (CoA) and to evaluate perinatal outcomes. STUDY DESIGN In this retrospective study, fetuses diagnosed with CoA in a tertiary center between January 2015 and June 2021 were analyzed. Fetal echocardiographic measurements and quantitative findings, middle cerebral artery (MCA) and umbilical artery (UA) Doppler indices, and perinatal outcomes were recorded. RESULTS A total of 57 fetuses with CoA were included in the study. In total, 51 (89.5%) pregnancies resulted in live births and 32 (62.8%) of the neonates underwent surgical repair. The left ventricle/right ventricle width ratio and aortic isthmus z-score were significantly lower in fetuses who underwent surgical repair (p = 0.004 0.001, respectively). Retrograde flow in the aortic isthmus (odds ratio [OR]:7.43; 95% confidence interval [CI]: 1.98-27.76), left-to-right foramen ovale shunt (OR: 8.50; 95% CI: 1.68-42.98), and ventricular septal defect (OR: 9.63; 95% CI: 1.90-48.74) were associated with the need for surgical repair. A new scoring system integrating these echocardiographic findings had 89% specificity and 54% sensitivity in predicting surgical repair. Fetal growth restriction rates, preterm birth rates, mean MCA pulsatility index (PI), and mean UA PI were similar in fetuses with and without surgical repair. CONCLUSION A scoring system integrating echocardiographic findings in fetuses with CoA may improve the prediction of surgical repair need. There is no evidence of an increased risk of FGR, preterm birth, and brain sparing effect in fetuses with CoA who require surgical repair. KEY POINTS · Coarctation of the aorta is one of the most difficult congenital heart defects to diagnose.. · A new scoring system may improve the prediction of surgical repair need.. · There is no increased risk of fetal growth restriction in fetuses requiring early surgical repair..
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - İlker K Yücel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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Eyisoy ÖG, Taşdemir Ü, Eriç Özdemir M, Eyisoy S, Kahramanoğlu Ö, Öçal A, Demirci O. Aspartate aminotransferase to platelet ratio index (APRI) score: is it useful in patients with intrahepatic cholestasis of pregnancy? J Matern Fetal Neonatal Med 2022; 35:10137-10142. [DOI: 10.1080/14767058.2022.2122036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ömer Gökhan Eyisoy
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Ümit Taşdemir
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Seden Eyisoy
- Department of Obstetrics and Gynecology, Ümraniye Education and Research Hospital, İstanbul, Turkey
| | - Özge Kahramanoğlu
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Aydın Öçal
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Obstetrics, Division of Perinatology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
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Kahramanoglu Ö, Schiattarella A, Demirci O, Sisti G, Ammaturo FP, Trotta C, Ferrari F, Rapisarda AMC. Preeclampsia: state of art and future perspectives. A special focus on possible preventions. J OBSTET GYNAECOL 2022; 42:766-777. [PMID: 35469530 DOI: 10.1080/01443615.2022.2048810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Preeclampsia (PE) is characterised by the new onset of hypertension after the 20th week of pregnancy, with or without proteinuria or hypertension that leads to end-organ dysfunction. Since the only definitive treatment is delivery, PE still represents one of the leading causes of preterm birth and perinatal mobility and mortality. Therefore, any strategies that aim to reduce adverse outcomes are based on early primary prevention, prenatal surveillance and prophylactic interventions. In the last decade, intense research has been focussed on the study of predictive models in order to identify women at higher risk accurately. To date, the most effective screening model is based on the combination of anamnestic, demographic, biophysical and maternal biochemical factors. In this review, we provide a detailed discussion about the current and future perspectives in the field of PE. We will examine pathogenesis, risk factors and clinical features. Moreover, recent developments in screening and prevention strategies, novel therapies and healthcare management strategies will be discussed.
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Affiliation(s)
- Özge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Education and Research Hospital, İstanbul, Turkey
| | - Giovanni Sisti
- Department of Obstetrics and Gynecology, New York Health and Hospitals/Lincoln, Bronx, NY, USA
| | - Franco Pietro Ammaturo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Trotta
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federico Ferrari
- Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Agnese Maria Chiara Rapisarda
- Department of General Surgery and Medical Surgical Specialties, Obstetrics and Gynecology Unit, University of Catania, Catania, Italy
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Akalın M, Demirci O, Kumru P, Yücel İK. Heterotaxy syndrome: Prenatal diagnosis, concomitant malformations and outcomes. Prenat Diagn 2022; 42:435-446. [PMID: 35102577 DOI: 10.1002/pd.6110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this study is to define cardiac and extracardiac malformations in fetuses with heterotaxy syndrome and to determine perinatal and childhood prognosis. METHODS In this retrospective study, fetuses diagnosed with heterotaxy syndrome on antenatal ultrasonography in a tertiary center between January 2014 and January 2021 were analyzed. Fetuses with heterotaxy syndrome were grouped as right atrial isomerism (RAI) and left atrial isomerism (LAI). RESULTS A total of 62 fetuses, 32 (51.6%) with RAI and 30 (48.4%) with LAI, were included in the study. Extracardiac anomaly was detected in 25% of fetuses with RAI and 44% of fetuses with LAI (p = 0.13). Patients with univentricular repair had a higher childhood mortality than patients with biventricular repair (p = 0.031). The presence of conotruncal anomaly was an independent factor affecting mortality (HR = 5.09, CI 95% 1.09-23.71, p = 0.039). CONCLUSION Hydrops fetalis, univentricular physiology and conotruncal anomalies are associated with poor outcomes in heterotaxy syndrome. The severity of the cardiac malformation is the main determinant of the outcomes. The presence of extracardiac malformations is associated with increased morbidity and mortality.
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Affiliation(s)
- Münip Akalın
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Pınar Kumru
- Department of Obstetrics and Gynaecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - İlker Kemal Yücel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey
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Demirci O, Tosun Ö, Bolat G. Prenatal Diagnosis and Management of Fetal Supraventricular Tachyarrhythmia and Postnatal outcomes. J Gynecol Obstet Hum Reprod 2022; 51:102323. [DOI: 10.1016/j.jogoh.2022.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Eric Ozdemir M, Demirci O, Ayvaci Tasan H, Ohanoglu K, Akalin M. The importance of first trimester screening of cranial posterior fossa in predicting posterior fossa malformations which may be identified in the following weeks of gestation. J Clin Ultrasound 2021; 49:958-962. [PMID: 34403530 DOI: 10.1002/jcu.23057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE We aimed to investigate the value of posterior fossa ultrasonography measurements in predicting fetal posterior fossa anomaly at 11-14 weeks of gestation. METHODS The study was performed at Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in two groups: the control group consisted of 328 fetuses with normal postnatal outcome and the study group consisted of 22 fetuses with enlarged 4th ventricle. In the study group, we questioned the value of intracranial translucency (IT) and brainstem (BS) measurements and the BS/brainstem-to-occipital bone (BSOB) ratio in order to predict possible posterior fossa anomalies that may be identified in advanced gestational weeks. The differences of ultrasonographic measurements between groups with p < 0.05 were considered statistically significant. RESULTS IT value, BSOB value, and BS/BSOB ratio were determined as ultrasonographic variables in predicting normal development of the fetal posterior fossa, with cutoff values of 2.7, 5.1, and 0.3. Negative predictive values of these three measurements for posterior fossa abnormalities were 100%. There was no statistically significant difference between the three variables for other diagnostic accuracy values (specifities and positive predictive values) (p > 0.05). CONCLUSION IT, BSOB, and BS/BSOB ratio can be used as ultrasonographic markers to predict the normal development of the fetal posterior fossa.
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Affiliation(s)
- Mucize Eric Ozdemir
- Perinatology Department, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Perinatology Department, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Habibe Ayvaci Tasan
- Perinatology Department, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Karolin Ohanoglu
- Obstetrics and Gynaecology Department, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Munip Akalin
- Perinatology Department, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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Aydin GA, Ayvaci H, Koc N, Tarhan N, Demirci O. The Relationship between Decorin and VEGF in Endometriosis. J Coll Physicians Surg Pak 2021; 31:1285-1290. [PMID: 34689484 DOI: 10.29271/jcpsp.2021.11.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate immunohistochemical (IHC) staining of decorin and vascular endothelial growth factor (VEGF) of ovarian and endometrial tissues in patients with and without endometriosis. Study Design: Descriptive study. PLACE AND DURATION OF STUDY Department of Obstetrics and Gynecology, ZeynepKamil Training and Research Hospital, Istanbul, Turkey, between Istanbul, TurkeyJanuary 2018 and June 2019. METHODOLOGY Thirty patients, who underwent total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO)/unilateral salpingo-oophorectomy (USO) and were in the proliferative phase of menstrual cycle,were included. The study population consisted of 20 patients (patient group) with an endometriomaand the control group consisted of 10 patients who were operated for benign gynecological pathologies.The ovarian and endometrial tissue specimens were collected from the archives. IHC staining was performed using decorin and VEGF. RESULTS Decorin analysis showed a significantly higher intensity of staining in both endometrial and ovarian tissues in control group than patient group. Patients with endometriosis had a lower intensity of staining of decorin and a higher intensity of staining of VEGF compared to control group. There was a negative, statistically significant concordance between VEGF and decorin staining of endometrial tissues of both groups (concordance rate -0.560, p=0.001). Therewas a negative, statistically significant concordance between VEGF and decorin staining of ovarian tissues of both groups (concordance rate -0.564, p<0.001). CONCLUSION Angiogenesis plays a critical role in endometriosisand interaction between decorin and VEGF,which suggests that decorin may be a promising molecule for the treatment of endometriosis. Key Words: Decorin, Endometriosis, Immunohistochemical staining, Vascular endothelial Growth factor.
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Affiliation(s)
- Gultekin Adanas Aydin
- Department of Obstetrics and Gynecology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Habibe Ayvaci
- Department of Obstetrics and Gynecology, Bursa City Hospital, Bursa, Turkey
| | - Nermin Koc
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Nazan Tarhan
- Department of Obstetrics and Gynecology, Bursa City Hospital, Bursa, Turkey
| | - Oya Demirci
- Department of Obstetrics and Gynecology, Bursa City Hospital, Bursa, Turkey
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Akalin M, Demirci O, Dayan E, Odacilar AS, Ocal A, Celayir A. Natural history of fetal ovarian cysts in the prenatal and postnatal periods. J Clin Ultrasound 2021; 49:822-827. [PMID: 34245032 DOI: 10.1002/jcu.23044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/01/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To determine the natural history of fetal ovarian cysts and to investigate whether the prognosis can be predicted by prenatal ultrasonography (US). METHODS This retrospective study includes cases of fetal ovarian cysts diagnosed by prenatal US over a 6-year period. Cases were divided into four subgroups of cysts (small and simple, small and complex, large and simple, large and complex) according to their size and echotexture. US examinations were repeated every 2 weeks from the time of diagnosis to treatment. RESULTS A total of 37 cases were included in the study. 32.4% of the cases regressed spontaneously in the prenatal period and 32.4% did so in the infantile period. Prenatal resolution occurred more frequently with small cysts than with large cysts (p = 0.03). Neonates with complex cysts required surgical treatment more often than neonates with simple cysts (p = 0.009). 27.0% of the cases underwent surgery due to ovarian torsion. The torsion rate of fetal ovarian cysts that progressed in the prenatal period was significantly higher than in the case of stable cysts (p = 0.001). CONCLUSION The size of the fetal ovarian cysts, their US appearance and the progression of the cysts during follow-up are the main determinants of the neonatal outcome.
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Affiliation(s)
- Munip Akalin
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Eda Dayan
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aydin Ocal
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Aysenur Celayir
- Department of Pediatric Surgery, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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Akalin M, Demirci O, Bolat G, Kahramanoglu O, Eric Ozdemir M, Karaman A. Foetal thoracic hypoplasia: concomitant anomalies and neonatal outcomes. J OBSTET GYNAECOL 2021; 42:848-853. [PMID: 34579606 DOI: 10.1080/01443615.2021.1945014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the current study was to determine the frequency of concomitant anomalies in foetal thoracic hypoplasia and the neonatal outcomes of these pregnancies. This retrospective study included 49 cases of foetal thoracic hypoplasia. All of the cases had skeletal system anomalies. Head and face anomalies (36.7%) were the second most frequent accompanying foetal anomaly, and the least common anomaly was genital system anomalies (4.1%). During the follow-ups, 52.6% (n = 10) of the newborns died in the first 24 h of life, 10.5% (n = 2) in the neonatal period and 36.8% (n = 7) in the infantile period.IMPACT STATEMENTWhat is already known on this subject? Foetal thoracic hypoplasias are lethal anomalies due to inadequate pulmonary development. Data on the other system anomalies that accompany foetuses with thoracic hypoplasia are quite limited in the literature. Moreover, even if the lethal course of thoracic hypoplasia is known, the information on how long newborns will survive is unclear.What do the results of this study add? In this study, most of the cases have additional anomalies, especially skeletal system and head-face anomalies. Approximately half of the newborns with thoracic hypoplasia die within the first 24 h.What are the implications of these findings for clinical practice and/or further research? When we need to consult a family considering the outcome of thoracic hypoplasia, this study can be guiding and helpful. On the other hand, the effects of additional anomalies on the prognosis of foetal and neonatal period are not clear. More studies are needed to better understand the prognosis of thoracic hypoplasias.
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Affiliation(s)
- Munip Akalin
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Guher Bolat
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ozge Kahramanoglu
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Mucize Eric Ozdemir
- Department of Perinatology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Ali Karaman
- Department of Medical Genetics, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
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Kahramanoglu O, Demirci O, Eric Ozdemir M, Rapisarda AMC, Akalin M, Sahap Odacilar A, Ismailov H, Dizdarogullari GE, Ocal A. Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction. J OBSTET GYNAECOL 2021; 42:894-899. [PMID: 34569419 DOI: 10.1080/01443615.2021.1954148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to determine whether gestational age-specific levels of the cerebroplacental ratio (CPR) as a third-trimester ultrasound marker has benefits in the prediction of perinatal morbidity and mortality on foetuses with late-onset foetal growth restriction (FGR). A retrospective study of singleton pregnancies diagnosed with late-onset FGR was performed. Of 407 pregnancies meeting our inclusion criteria, 313 had normal (Group 1) and 94 had abnormal CPR (Group 2). Both groups were similar in age, gestational age at diagnosis, body mass index and parity. There was a significant association between the presence of oligohydramnios and abnormal CPR. Mean gestational age at delivery and mean neonatal birth weight were significantly lower in Group 2. Neonatal intensive care unit admission, foetal distress, low 5-minute Apgar score <7, and low cord pH < 7.1 rates were significantly higher in Group 2. There was one neonatal death in both groups. Multivariable regression analysis demonstrated that, in the prediction of APO, there was a significant contribution from neonatal birth weight <10th percentile, CPR <5th percentile and oligohydramniosis. Our findings revealed that CPR value less than 5th centile can be used as a predictor of APO in late-onset FGR.IMPACT STATEMENTWhat is already known on this subject? Low cerebroplacetal ratio (CPR) is a marker of failure to reach the growth potential regardless of foetal weight.What do the results of this study add? The CPR can be used as an adequate predictor of adverse perinatal outcome in pregnancies with late-onset foetal growth restriction.What are the implications of these findings for clinical practice and/or further research? Routine calculation and report of CPR during basic ultrasound examination may help to identify foetuses with FR with a higher risk of adverse perinatal outcome. Future prospective studies on pregnancies with FGR with oligohydroamnios or normal amniotic fluid volume should focus on determining CPR threshold.
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Affiliation(s)
- Ozge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Mucize Eric Ozdemir
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | | | - Munip Akalin
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Ali Sahap Odacilar
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Hayal Ismailov
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Gizem Elif Dizdarogullari
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Aydin Ocal
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
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Ayvacı H, Koç N, Tarhan N, Aydın GA, Demirci O. Decorin expression in tubal ectopic and intrauterine pregnancies. J Gynecol Obstet Hum Reprod 2021; 50:102213. [PMID: 34469778 DOI: 10.1016/j.jogoh.2021.102213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/01/2021] [Accepted: 08/27/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Decorin is a leucine-rich proteoglycan, affects the proliferation, migration, and invasion of extravillous trophoblasts (EVTs). In this study, we aimed to determine the localization of decorin in the implantation site in human tubal ectopic pregnancy, to compare decorin expression levels in ectopic and intrauterine pregnancy, and to investigate the relationship between implantation depth of the tubal wall and expression levels of decorin. METHODS 15 patients underwent salpingectomy for tubal ectopic pregnancy and 15 underwent curettage for voluntary interruption of pregnancy were included. All blocks were stained with decorin immunohistochemical staining. Trophoblastic cells of tubal Stage I-III and tubal epithelial and stromal cells were analyzed in terms of presence and intensity of decorin staining. RESULTS Decorin was expressed in both tubal and intrauterine trophoblasts, stroma, and surface epithelium during the first trimester of pregnancy. Decorin staining intensity was significantly lower in the villous cytotrophoblasts and syncytiotrophoblasts in tubal ectopic pregnancies, compared to intrauterine pregnancies (p = 0.001 for both). Decorin staining intensity also significantly lower in the extravillous cytotrophoblasts and syncytiotrophoblasts in the tubal ectopic pregnancies (p = 0.002 and p = 0.001, respectively). There was no significant difference in the staining intensity of the trophoblasts and surface epithelial between Stage II and Stage III tubal invasion; however, the decorin expression was lower in the stroma in Stage III (p = 0.094). CONCLUSION Decorin expression is significantly lower in trophoblastic cells of tubal ectopic pregnancies than the intrauterine pregnancies. Although it remains limited to explain the underlying cellular mechanisms, decorin seems to play a role in the development of tubal pregnancy.
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Affiliation(s)
- Habibe Ayvacı
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Nermin Koç
- Haydarpaşa Numune Training and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Nazan Tarhan
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | | | - Oya Demirci
- Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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Abstract
Pulmonary artery (PA) anomalies are very rare congenital cardiac malformations, a significant number of which remain unrecognized or misdiagnosed during the prenatal period. We report the prenatal diagnosis and outcome of pregnancy with fetal PA anomalies and discuss the related management issues. We identified four cases of prenatally diagnosed rare PA anomalies that were seen and confirmed in the newborn period by echocardiography and computed tomographic angiography at our center from 2018 to 2020. The course of the pregnancy, perinatal outcome, and the postnatal course in each case were analyzed. Three fetuses were born by repeat cesarean section approximately at 39 weeks of gestation and the other woman delivered vaginally. Of the abnormal origin of the left PA (LPA) in two patients, the first had right PA abnormalities derivating from the ascending aorta, and in the second, the LPA originated from the right PA. Two patients had agenesis of ductus arteriosus (DA), the first was accompanied with tetralogy of Fallot (TOF) and right aortic arch with a normal pulmonary valve, the second patient presented with an Absent Pulmonary Valve syndrome with TOF. Prenatal ultrasonography can be used to correctly diagnose the abnormal origin of the PA branches. Branching of the PA, presence of DA, location of the aortic, and ductal arch by the trachea should be routinely screened in the prenatal anatomic examination and the three-vessel and trachea view can determine the primary clues of PA malformations.
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Affiliation(s)
- Reyhan Ayaz
- İstanbul Medeniyet University Faculty of Medicine, Department of Perinatology, İstanbul, Turkey
| | - Oya Demirci
- Zeynep Kamil Maternity and Children Training and Research Hospital, Clinic of Perinatology, İstanbul, Turkey
| | - Özgür Aydın Tosun
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Öykü Tosun
- İstanbul Medeniyet University Faculty of Medicine, Department of Pediatric Cardiology, İstanbul, Turkey
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Fide Pişirgen E, Akalın M, Demirci O, Kumru P, Akalın EE. The comparison of the perinatal outcomes in monochorionic twin pregnancies with and without selective intrauterine growth restriction. Perinatal J 2021. [DOI: 10.2399/prn.21.0291004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Both fetuses may be affected negatively as a result of the non-equal share of the placenta and vascular anastomoses in monochorionic pregnancies with selective intrauterine growth restriction (sIUGR). In our study, we aimed to investigate the perinatal outcomes of both larger and smaller fetuses in monochorionic pregnancies with and without sIUGR (non-sIUGR) separately. Methods A total of 196 monochorionic twin pregnancies were evaluated retrospectively between January 2013 and January 2019. The cases were grouped as sIUGR and non-sIUGR pregnancies. The pregnancies with sIUGR were also separated into sub-groups as the cases with normal umbilical flow pattern and the cases with abnormal umbilical flow pattern. The perinatal outcomes were investigated separately between the groups for larger and smaller fetuses. Results Of 153 monochorionic pregnancies included in the study, 17.6% (n=27) were sIUGR cases and 82.4% (n=126) were non-sIUGR cases. While the umbilical artery flow pattern was normal in 59.3% (n=16) of the pregnancies which developed sIUGR, 40.7% (n=11) of them had abnormal umbilical artery flow pattern. The preeclampsia rate was found significantly higher in sIUGR pregnancies than non-sIUGR pregnancies (25.9% vs. 11.1%, p=0.042). The need for intensive care for both larger and smaller newborns was significantly higher in sIUGR pregnancies compared to non-sIUGR pregnancies (p<0.001). Three (11.1%) of newborns in sIUGR pregnancies passed away during neonatal period. All of the newborns that passed away were the smaller newborns from sIUGR pregnancies with abnormal umbilical artery flow pattern. Conclusion The pregnancies with selective intrauterine growth restriction (sIUGR) are more associated with high risks in terms of perinatal outcomes compared to the pregnancies with non-sIUGR. In pregnancies developing sIUGR, the risk increases for larger fetus as well as smaller fetus. More prospective studies are needed to investigate whether this increased risk in the pregnancies with sIUGR is associated with prematurity which is more common or is a result of sIUGR.
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Demirci O, Eriç Özdemir M, Kumru P, Celayir A. Clinical significance of prenatal double bubble sign on perinatal outcome and literature review. J Matern Fetal Neonatal Med 2021; 35:1841-1847. [PMID: 33455511 DOI: 10.1080/14767058.2021.1874338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of the double bubble sign in predicting duedonal obstruction, the prevalence of anomalies associated with congenital duedonal obstruction, and to evaluate the outcome of these pregnancies and review the literature. METHODS We analyzed that the cases with double bubble sign were detected in prenatal ultrasonography between January 2014 and December 2019. Ultrasound reports, karyotyping results, surgical confirmed diagnoses and long-term results were extracted from the hospital database. RESULTS Duodenal obstruction was detected in all operated cases with double bubble sign detected in prenatal ultrasonography. Karyotype anomaly was found in 63.9% and additional congenital anomaly was found in 69.4%. Adverse perinatal outcome was seen in 51.1% of cases. Adverse perinatal outcome was found significantly higher in abnormal karyotype and congenital anomaly groups than isolated group. 81.8% of the isolated cases lived after the operation. Only two isolated cases died. CONCLUSION The prenatal double bubble sign is a highly reliable predictor for duodenal obstruction and structural anomalies and/or genetic abnormalities are present in the majority of cases. Duodenal obstruction is isolated, the outcomes appear favorable.
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Affiliation(s)
- Oya Demirci
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Mucize Eriç Özdemir
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Pınar Kumru
- Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Aysenur Celayir
- Pediatric Surgery Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
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Ayaz R, Demirci O, Tosun ÖA, Tosun O. Prenatal diagnosis and postnatal course in four fetuses with very rare pulmonary artery anomalies. Turk J Obstet Gynecol 2021. [DOI: 10.4274/tjod.galenos.2020.40035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Demirci O, Akay HÖ. Prenatal diagnosis of abnormality of the umbilical portal DV complex: difficulty in universal classification due to various alternative routes in hepatic circulation for placental drainage. J Matern Fetal Neonatal Med 2020; 35:3872-3884. [PMID: 33138669 DOI: 10.1080/14767058.2020.1842870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review our experience with fetal abnormality of the umbilical-portal-DV complex and to discuss the new classification system for umbilical portal systemic venous shunts (UPSVS) according to our cases. METHODS This study was a retrospective analysis of fetuses with a prenatal diagnosis of abnormality of the umbilical-portal-DV complex. The integrity of the fetal umbilical-portal ductus venosus complex and the hepatic venous system were evaluated using two-dimensional color Doppler sonography. The origin of the shunt, the location of the drainage, and the presence or absence of intrahepatic portal venous system and DV were noted. RESULTS 35 cases of abnormality of the umbilical-portal-DV complex were identified. Agenesis of ductus venous was detected in 33 of them. Based on the abnormality of the umbilical-portal-DV complex, we divided the cases into five groups. Group 1, ductus venosus agenesis with normal hepatic venous anatomy (n = 11); Group 2 downward displacement of the umbilical-portal-DV complex (n = 13); Group 3, umbilical-systemic shunt (n = 5); Group 4, intrahepatic portosystemic shunt (n = 4), Group 5, hepatic arteriovenous malformation (n = 2). Three different intrahepatic portosystemic shunt and one different downward displacement of the umbilical-portal-DV complex cases were detected. CONCLUSIONS Disruption of the normal anatomy of the umbilical-portal-DV complex causes various alternative pathway of the placental drainage. This illustrates highlights the challenge of creating a universal classification.
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Affiliation(s)
- Oya Demirci
- The Perinatology Department, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Ozdemir ME, Demirci O, Ozturkmen HA, Ulusoy NB, Ohanoglu K, Cilingir IU. What Is the Role of the Maternal Ophthalmic and Cervical Internal Carotid Arteries in Predicting Maternal Adverse Outcomes in Preeclampsia? J Ultrasound Med 2020; 39:1527-1535. [PMID: 32049383 DOI: 10.1002/jum.15241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES We aimed to investigate the efficacy of maternal ophthalmic artery (OA) and cervical internal carotid artery (CICA) in predicting adverse maternal outcomes and gestational age at birth in preeclampsia (PE). METHODS The study was performed at the Zeynep Kamil Women and Children's Diseases Training and Research Hospital. Measurements were made in 2 groups consisting of 50 pregnant women with PE and 50 healthy pregnant women. The peak systolic velocity (PSV), end-diastolic velocity, PI, RI, first diastolic peak velocity, systolic/diastolic (S/D) ratio, and peak ratio of the maternal OA were measured by a transorbital Doppler ultrasound (US) scan. The PSV, end-diastolic velocity, PI, RI, and S/D ratio of the CICA were measured. The differences of Doppler indices between groups with P < .05 were considered statistically significant. Cutoff values were calculated, which could be used to predict adverse maternal outcomes and gestational age at birth. RESULTS The RI and PI values of the OA were lower, and the first diastolic peak velocity, PSV, and peak ratio values were higher among the PE group. The RI and S/D values of the CICA were significantly lower in the PE group compared to the healthy group. The OA RI was determined to be the strongest US variable in predicting adverse maternal outcomes and gestational age at birth, with a cutoff value of 0.72, 76% sensitivity, and 76% specificity. CONCLUSIONS Maternal OA Doppler indices can be used as US markers to predict adverse maternal outcomes.
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Affiliation(s)
- Mucize Eric Ozdemir
- Departments of Perinatology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Departments of Perinatology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Hatice Akay Ozturkmen
- Department of Radiology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Nuray Bakal Ulusoy
- Department of Radiology, Health Science University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Karolin Ohanoglu
- Health Science University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Isil Uzun Cilingir
- Health Science University, Istanbul Training and Research Hospital, Istanbul, Turkey
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Demirci O, Celayir A. Prenatal diagnosis and treatment of intrahepatic arteriovenous fistulas: case reports and the literature review. J Matern Fetal Neonatal Med 2020; 35:837-845. [PMID: 32241194 DOI: 10.1080/14767058.2020.1731466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Congenital arteriovenous intrahepatic fistulas, which are hepatic hemangiomas and arteriovenous malformations (AVMs) are rare and they confused with each other. Knowledge of prenatal medical treatment of AVMs is insufficient.Objectives: First is to emphasize the distinction between hepatic hemangioma and AVMs. Second is discussion of the first case of hepatic AVM that responded well to steroid-propranolol treatment in the prenatal period.Methods: Color Doppler ultrasonography, fetal and postnatal MR were used for diagnosis.Results: The first case is a giant hepatic hemangioma diagnosed and progressively growing in the prenatal period and gradually shrinking in the postnatal period. The second case was hepatic AVM with no signs of heart failure during the prenatal period and postnatal right extended hepatectomy was performed as the anastomosis was enlarged and intraportal collateral vessels were developed. The third case is the first hepatic AVM which reaches a term that was prenatally diagnosed and responded to treatment with marked reduction.Conclusion: Color flow and pulse Doppler imaging have a key role in the prenatal diagnosis of arteriovenous fistulas. Intrahepatic AVM are abnormal intrahepatic vascular network formation primarily fed by the hepatic artery or its branches and drained by the hepatic venous system. This vascular region looks like a mass, but it does not contain a solid area, which allows the separation of hepatic AVMs from hepatic hemangiomas. Steroid and propranolol therapy should be considered in management.
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Affiliation(s)
- Oya Demirci
- Perinatology Unit, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Aysenur Celayir
- Pediatric Surgery Unit, Zeynep Kamil Gynecologic and Pediatric Training Research Hospital, Health Sciences University, Istanbul, Turkey
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Eriç Özdemir M, Demirci O. Isolated levocardia with situs inversus without cardiac abnormality in fetus: prenatal diagnosis and management. Perinatal J 2020. [DOI: 10.2399/prn.20.0281004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Isolated levocardia is a situs abnormality that the heart is in the normal levo position, but the abdominal viscera are in dextro position. Most cases are accompanied by structural heart anomalies. In this case, we aimed to present a fetus with isolated levocardia without cardiac abnormality. Case(s) The mother was referred to our clinic with a suspicion of fetal dextrocardia at 22 weeks of gestation. When detailed examination was planned by ultrasonography isolated levocardia was detected in fetus. There were no cardiac abnormalities in fetal echocardiography. Fetus was followed up until delivery and newborn was examined again at postnatal period. No problem was detected until the age of 2 years. Conclusion Fetal situs should be assessed by ultrasonography in all pregnant women.
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Ayaz R, Demirci O. Perinatal outcomes in the fetuses diagnosed with hydrops fetalis and isolated pleural effusion. Perinatal J 2019. [DOI: 10.2399/prn.19.0273010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Demirci O, Eriç Özdemir M, Bolat G, Tuncer T. Long QT syndrome diagnosed by premature atrial extrasystoles: a case report. Perinatal J 2018. [DOI: 10.2399/prn.18.0261010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Eriç Özdemir, M, Demirci O, Bolat G, Celayir A, Cesur S. Prenatal diagnosis and follow-up of giant sacrococcygeal teratoma: a case report. Perinatal J 2018. [DOI: 10.2399/prn.18.0261002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tayyar AT, Tayyar A, Kozali S, Karakus R, Karakus S, Yuksel IT, Dag I, Yildirim GY, Demirci O. Maternal cytoglobin (CYGB) serum levels in normal and preeclamptic pregnancies. J Matern Fetal Neonatal Med 2017; 32:1859-1863. [PMID: 29278960 DOI: 10.1080/14767058.2017.1421927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate cytoglobin levels in women with preeclampsia and women with uncomplicated pregnancies. MATERIALS AND METHODS A cross-sectional study including 26 pregnant women complicated with early-onset preeclampsia (EO-PE) and 26 pregnant women complicated with late-onset preeclampsia (LO-PE) were recruited for the study group. Twenty-seven healthy pregnant women selected randomly were included in the control group. The serum CYGB concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS Gestational age at delivery and mean birth weight were significantly lower in the preeclampsia groups than in the control group and were found to be the lowest in the EO-PE group (p < .001). Serum CYGB levels were significantly higher in the EO-PE and LO-PE groups as compared with the control group (9.99 (6.08) ng/ml (EOPE), 10.04 (7.04) ng/ml (LOPE) versus 2.84 (0.82) ng/ml), (p < .001). However, a significant difference was not found between the EO-PE and LO-PE groups regarding CYGB levels (p = 1.000). CONCLUSIONS Serum CYGB levels were significantly higher in patients with EO-PE and LO-PE as compared to healthy pregnant women.
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Affiliation(s)
- Ahter Tanay Tayyar
- a Department of Obstetrics and Gynecology , Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital , İstanbul , Turkey
| | - Ahmet Tayyar
- b Department of Obstetrics and Gynecology , Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital , Istanbul , Turkey
| | - Sukran Kozali
- a Department of Obstetrics and Gynecology , Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital , İstanbul , Turkey
| | - Resul Karakus
- a Department of Obstetrics and Gynecology , Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital , İstanbul , Turkey
| | - Seren Karakus
- a Department of Obstetrics and Gynecology , Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital , İstanbul , Turkey
| | - Ilkbal Temel Yuksel
- b Department of Obstetrics and Gynecology , Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital , Istanbul , Turkey
| | - Ismail Dag
- c Department of Clinical Biochemistry , Eyup State Hospital , Istanbul , Turkey
| | - Gonca Yetkin Yildirim
- b Department of Obstetrics and Gynecology , Health Sciences University, Kanuni Sultan Süleyman Education and Research Hospital , Istanbul , Turkey
| | - Oya Demirci
- a Department of Obstetrics and Gynecology , Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital , İstanbul , Turkey
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Kumru P, Arisoy R, Erdogdu E, Demirci O, Kavrut M, Ardıc C, Aslaner N, Ozkoral A, Ertekin A. Prediction of gestational diabetes mellitus at first trimester in low-risk pregnancies. Taiwan J Obstet Gynecol 2017; 55:815-820. [PMID: 28040126 DOI: 10.1016/j.tjog.2016.04.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We aimed to assess the relationship among the sex hormone-binding globulin (SHBG), homeostasis model assessment (HOMA), glycosylated hemoglobin (HbA1c), and cholesterol panel values to predict subsequent gestational diabetes mellitus (GDM) in low-risk pregnancies. MATERIALS AND METHODS Thirty-eight pregnant women with GDM and 295 low-risk pregnant women without GDM were included in this study. Maternal blood samples were obtained during the first trimester examination to determine the SHBG, HbA1c, fasting blood glucose, insulin, thyroid stimulating hormone (TSH), free thyroxine, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (LDL-C) levels. The variables that exhibited statistically significant differences between the groups and independent predictors for GDM were examined using logistic regression analysis. The risk of developing GDM, according to cutoff values, was determined using receiver operating characteristic (ROC) curve analysis. RESULTS The SHBG, HOMA, LDL, and TG levels were found to be the significant independent markers for GDM [adjusted odds ratio (OR) = 0.991; 95% confidence interval (CI), 0.986-995; OR = 1.56; 95% CI, 1.24-1.98; OR = 1.02; 95% CI, 1.01-1.04; and OR = 1.01; 95% CI, 1.00-1.02, respectively]. The HbA1c, body mass index, and mean arterial pressure values were nonindependent predictors of GDM. The areas under the ROC curve used to determine the predictive accuracy of SHBG, HOMA, TG, and LDL-C for development of GDM were 0.73, 0.75, 0.70, and 0.72, respectively. For a false positive rate of 5% for the prediction of GDM, the values of the sensitivities were 21.1, 26.3, 21.1, and 18.4%, respectively. CONCLUSION The HOMA, SHBG, TG, and LDL-C levels are independent predictors for subsequent development of GDM in low-risk pregnancies, but they exhibit low sensitivity.
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Affiliation(s)
- Pınar Kumru
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Resul Arisoy
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey.
| | - Emre Erdogdu
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Mustecep Kavrut
- Department of Gynecology and Obstetrics, Liv Hospital, Istanbul, Turkey
| | - Cem Ardıc
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Nihan Aslaner
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Aysen Ozkoral
- Deparment of Biochemistry, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
| | - Aktug Ertekin
- Department of Perinatology, Zeynep Kamil Gynecologic and Pediatric Training and Research Hospital, Istanbul, Turkey
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Ozer OF, Kacar O, Demirci O, Eren YS, Bilsel AS. PLASMA CONCENTRATIONS AND CORRELATIONS OF NATRIURETIC PEPTIDES AND OXYTOCIN DURING LABOR AND EARLY POSTPARTUM PERIOD. Acta Endocrinol (Buchar) 2017; 13:65-71. [PMID: 31149150 DOI: 10.4183/aeb.2017.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Natriuretic peptides (NP) and oxytocin (OT) play an important role in cardiovascular and hydro-electrolytic homeostasis. Changes in NP levels and their roles in cardiovascular adaptations in pregnancy and labor have not been clear. Objective The present study aimed to investigate the changes and correlations in plasma levels of atrial natriuretic peptide (ANP), C-type natriuretic peptide (CNP), B-type natriuretic peptide (BNP) and OT during labor and the postpartum period. Study design Blood samples were collected from 29 healthy pregnant women in the active phase of spontaneous labor, 15 minutes after delivery and 3 hours postpartum. Plasma levels of OT and the stable N-terminal fragments of NPs (NT-proANP, NT-proCNP, NT-proBNP) were measured using enzyme or electrochemiluminescence immunoassays. Results The plasma levels of NT-proANP and NT-proCNP significantly decrease 3 hours postpartum compared to the active phase of labor and to 15 minutes after delivery. The plasma NT-proBNP levels significantly higher after delivery and 3 hours postpartum compared to the active phase of labor. A significant correlation exists between OT and NT-proANP levels during the active phase of labor and 15 minutes after delivery. Conclusions The data show that during labor and postpartum, the plasma concentrations of the NPs change differently. Elevations in NT- proBNP after delivery suggest that BNP may be involved in postpartum adaptations. The correlations between OT and ANP levels indicate that OT may be partly responsible for the increased levels of ANP and may have a role in the modification of the cardiovascular system.
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Affiliation(s)
- O F Ozer
- Marmara Universty, Faculty of Medicine, Dept of Biochemistry, Istanbul, Turkey
| | - O Kacar
- TUBITAK Marmara Research Center, Genetic Engineering and Biotechnology Institute, Kocaeli, Turkey
| | - O Demirci
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Istanbul, Turkey
| | - Y S Eren
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Istanbul, Turkey
| | - A S Bilsel
- Marmara Universty, Faculty of Medicine, Dept of Biochemistry, Istanbul, Turkey
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Arisoy R, Erdogdu E, Bostancı EB, Ergin R, Kumru P, Demirci O, Polat M, Pekin O. Obstetric outcomes of intramural leiomyomas in pregnancy. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog3058.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Mutlu MB, Cetinkaya A, Koc N, Ceylaner G, Erguner B, Aydın H, Karaman S, Demirci O, Goksu K, Karaman A. A novel missense mutation, p.(R102W) in WNT7A causes Al-Awadi Raas-Rothschild syndrome in a fetus. Eur J Med Genet 2016; 59:604-606. [DOI: 10.1016/j.ejmg.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/20/2016] [Accepted: 09/11/2016] [Indexed: 01/15/2023]
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50
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Arısoy R, Pekin O, Pakay K, Erdoğdu E, Demirci O, Muhçu M. Intrafetal laser therapy in acardiac twin pregnancy: a case report. Perinatal J 2016. [DOI: 10.2399/prn.16.0242008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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