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Öğe Centile charts of cervical length in singleton and twin pregnancies between 16 and 24 weeks of gestation(Galenos Publ House, 2023) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Kole, Emre; Caliskan, ErayObjective: The aim of this study was to determine the standard mid-trimester cervical lengths of singleton and twin pregnancies.Material and Methods: This study was conducted by retrospective analysis of mid-trimester transvaginal cervical measurements of women with singleton and twin pregnancies that were examined by a single perinatologist in a single center.Results: A total of 4621 consecutive asymptomatic pregnant women admitting for advanced obstetric ultrasound screening were evaluated. Of these 4340 (93.9%) were second trimester singleton pregnancies and 281 (6.1%) were twin pregnancies and were included. Mean cervical length measurements of singleton and twin pregnancies were 6.5 & PLUSMN;38.2 mm and 7.2 & PLUSMN;37.6 mm respectively (p=0.17). Overall, the 5th percentile of cervical length measurement after analysing singleton and twin pregnancies together was 29.4 mm at 16 weeks, 30 mm at 17 weeks, 30 mm at 18 weeks, 30 mm at 19 weeks, 30 mm at 20 weeks, 30 mm at 21 weeks, 30 mm at 22 weeks, 31 mm at 23 weeks, 29 mm at 24 weeks.Conclusion: In our population the 5th precentile value of cervical length which is 30 mm in singletons and 10th percentile cervical length which is 31 mm in twins can be used to follow-up and treat pregnant women at risk for preterm delivers. (J Turk Ger Gynecol Assoc 2023; 24: 114-9)Öğe Cervical cerclage application algorithm in continued cervical shortening cases despite vaginal progesterone(Elsevier Masson s.r.l., 2021) Akar, Bertan; Ceylan, Yasin; Karadağ, Cihan; Çalışkan, ErayObjective: The aim of this study is evaluation of pregnancy outcomes of the asymptomatic cases with vaginal progesterone treatment for the 20?30 mm cervical length detected in the transvaginal ultrasonography for fetal abnormality screening and cervical cerclage after cervical length detected <20 mm in weekly cervical length measures; and present the treatment algorithm of progesterone treatment combined with cervical cerclage application. Methods: Patients who have the inclusion criteria and cervical length more than 30 mm were categorized as group 1(n = 1948). Group 2 were included patients with cervical length shorter than 30 mm (n = 95). All patients of group 2 started to use vaginal natural progesterone 400 mg/day(n = 87). Pregnancies which progressed with cervical length above 20 mm were continued vaginal progesterone until 34. Gestational week and they were named as group 2A (n = 78). Cervical cerclage were applied to patients with cervical length below than 20 mm measured via transvaginal ultrasonography and they were categorized as group 2B (n = 9). Results: Excluding 8 cases (8.42 %) which cervical cerclage were applied, 87 patients were administered vaginal progesterone and in 9 cases (10.34 %) cervical shortening were continued despite progesterone treatment. Four out of these nine cases (44.44 %) had cervical cerclage and their deliveries were delayed after 34 th gestational week. Vaginal progesterone treatment prevented cervical shortening in 89.66 % of patients who had cervical length between 20?30 mm and out of these patients. Conclusion: Cervical cerclage application algorithm in continued cervical shortening cases despite vaginal progesterone is beneficial to delay the delivery after 34 th gestational week and related to low complication rate.Öğe Correlation between fetal central nervous system anomalies with increased lateral ventricle size(2017) Doğan, Ozan; Bender, Rukiye Ada; Akar, Bertan; Gümüştaş, Gökhan; Özcan, Canan; Çalışkan, ErayIntroduction: Ultrasonographic evaluation of the width of the lateral cerebral ventricles during the routine anomaly scan is recommended. The purpose of this study is to establish the correlation between lateral ventricle size and central nervous system(CNS) anomalies at 16-28 weeks of gestation.Methods: 1875 pregnant women at 16-28 gestation weeks who have admitted to our clinic between 2015-2016 were involved in this retrospective study. Fetal lateral ventricles were measured bilaterally at the level of the choroid plexus glomus. The widths of the left and right ventricles were compared with gestational age, maternal age and presence of CNS anomalies. The relationship between ventricular asymmetry, isolation and other ultrasonographic anomalies was also analyzed.Results: There was no statistically significant difference between maternal age, gestationalage and fetal sex with CNS anomalies and ventricular width (p>0.05). The presence of CNSanomalies appeared to be strongly related to the size of the lateral ventricle (p<0.001). In theROC curve analysis, cut-off values of the right and left ventricular widths for detecting CNSanomalies were found to be 9.25 mm (61% sensitivity and 98.7% specificity) and 9.15 mm(68.3% sensitivity and 97.4% specificity), respectively. 37.5% (n=15) of cases withventriculomegaly were diagnosed with isolated ventriculomegaly and 42.5% (n=17) ofventriculomegaly cases were found to be asymmetric. 2.1 %(n=41) of all cases had otherultrasonographic abnormalities coexisting with CNS anomalies.Conclusion: Ventriculomegaly can be a prognostic indicator for CNS abnormalities.Pregnancy follow-up examinations should involve the width of the both lateral cerebralventricles. Further investigations to determine the cut-off value of the lateral ventricle sizeshould involve the postpartum period as well.Öğe The effect of hands-on cadaver and live surgery practice on surgeons' performance in urogynecologic operations: one-year follow-up(Mary Ann Liebert, Inc, 2020) Akar, Bertan; Aslancan, Reyhan; Doğan, Ozan; Başbuğ, Alper; Sivaslıoğlu, Akın; Çalışkan, ErayObjective: Surgical procedures need a combination of theoretical knowledge and practical experience to be performed properly. Postresidency education programs provide opportunities to practice new surgical techniques. This article evaluates 2 different educational strategies for learning new techniques in the field of urogynecology. One of the strategies is commonly practiced theoretical education plus observation of live surgeries, and the other strategy is a threefold approach of theoretical education, as well as cadaver training and performing live surgery. Materials and Methods: The study was designed as a prospective cohort study. The occupational experiences of 58 obstetricians and gynecologists were documented prior to the educational interventions. Two groups were created, based on the participants' preferences. Group 1 had theoretical education followed by observation of live surgery through broadcasting. Group 2 had theoretical education, plus a 1-day cadaver-based surgery course, as well as assisting tutors in hands-on operations. At a 1-year follow up, different types of surgeries performed throughout the year by each surgeon were recorded and analyzed using SPSS. Results: Prior to the course, both groups had similar experiences in urogynecologic operations (p > 0.05). In Group 2, significantly more surgeons began to perform tension-free vaginal tape (TVT) interventions regularly after the course (p < 0.001), a procedure considered more technically demanding. Surgeons utilizing any of the midurethral slings including TVT, transobturator tape, or mini-slings increased by 20% in Group 2, a statistically significant increase (p = 0.03). Conclusion: A threefold approach of theoretical education, cadaver practice, and live surgery significantly increases surgeon adaptation to utilization of midurethral slings, compared to exclusively theoretical education with observation of live surgery. (J GYNECOL SURG 20XX:000)Öğe An effective method of teaching cystoscopy to obstetrics and gynecology specialists(Galenos Publishing House, 2022) Akar, Bertan; Sarıbacak, Ali; Ceylan, Yasin; Çalışkan, ErayObjectives: In this study, it was aimed to evaluate the knowledge and skills of gynecologists and obstetricians about cystoscopy theoretically and practically during the two-day urogynecology course. Materials and Methods: Thirty-eight gynecologists and obstetricians aged 29–55 were simultaneously enrolled in cystoscopy training and evaluation in the urogynecology course, which includes theoretical, fresh cadaver and live surgery training stages. In addition, a theoretical evaluation was made with quizzes before and after fresh cadaver training. Finally, 6 months after the training, all trainees were called by phone and detailed information about their surgical experiences was obtained after the course. Results: After the cadaver training, it was observed that the time and motion scores and instrument handling scores of the trainees increased significantly on the patients. Conclusion: With surgical courses and simulations, the use of cystoscopy should be increased in the diagnosis and management of complications in urogynecological surgical procedures during and after the residency training of gynecologists and obstetricians. © 2022 by the International Society for Pelviperineology / Pelviperineology published by Galenos Publishing House.Öğe The evaluation of uterine leiomyoma prevalence and its effect on cervical length during mid-trimester ultrasound scan(2019) Karadağ, Cihan; Akar, Bertan; Gönenç, Gökçenur; Çalışkan, ErayObjective: This study aims to investigate the effects of uterine leiomyomas’ on cervical length in pregnant women during mid-trimester ultrasound scan. Material and Methods: In this study, 1908 pregnant women aged 18-44 years were evaluated via abdominal and transvaginal ultrasounds in the mid-trimester (18-24 weeks). The number, size, type and location of the leiomyomas were screened and recorded. Cervical length was measured transvaginally on an empty bladder. Short cervix was defined as lower than 25 mm. Pregnant women with leiomyoma were compared with pregnant women without leiomyoma regarding cervical length and short cervix incidence. Results: Eighty (4.2%) patients were diagnosed with uterine leiomyoma and the mean diameter of uterine leiomyomas was 31.4 mm. The mean cervical length of the leiomyoma group was significantly lesser than that in pregnant women without leiomyomas (p=0.001). The number of women with a short cervix was higher in the leiomyoma group than the controls (p=0.001). There was a significant positive correlation between age and leiomyoma prevalence (r=0.294, p=0.021). There was a significant negative correlation between myoma size and cervical length in women with only one leiomyoma (r=-0.325, p=0.015). Conclusion: Pregnant women with leiomyoma have higher incidence of short cervix. Leiomyomas could negatively affect cervical length.Öğe Female genital aesthetic surgery: comparison of cadaver and live surgery training models(Galenos Publishing House, 2022) Akar, Bertan; Ceylan, Yasin; Ellibeş Kaya, Aşkı; Çalışkan, ErayObjective: In this study, it was aimed to search the efficiency of fresh cadaver course and live surgical operations for female genital aesthetic surgery application. Materials and Methods: Seventy-three obstetrics and gynecology specialists underwent a two-day course about genital cosmetic surgery that includes theoretical lectures, fresh cadavers and live surgeries. These surgeons divided into two group. First group trained on cadavers (n=33), second group was involved in live surgeries (n=40). Skills in genital cosmetic surgery, applied procedures, number of participating colleagues in a procedure, ability to learn and motivations to take the course were compared before and after the training course. At the 6th month of education every trainee were called and interviewed about the progress they got after the education. Results: After the fresh cadaver and live surgery training, numbers of trainees who performed genital cosmetic procedures (GCP) before the course and 6 months after the course were compared. A meaningful increase on numbers of trainees after the course who performed all GCP applications was observed. According to the statistics of participants, it was observed that a live surgical course is more beneficial than a cadaver course. Numbers of trainees who performed genital aesthetic surgery before and 6 months after the course were compared. A meaningful raise was observed in the statistics of trainees’ numbers who performed all surgical applications apart from anterior and posterior compartment repair. Conclusion: Fresh cadaver and live surgical courses have positive effects in the long term for the surgeons who have lack of surgical confidence and skills. © 2022 by the International Society for Pelviperineology / Pelviperineology published by Galenos Publishing House.Öğe Fetal brain lactate peak measurement by magnetic resonance spectroscopy for prediction of fetal hypoxia in a case of unexplained third trimester recurrent fetal loses(7847050 Canada Inc, 2019) Akar, Bertan; Aslancan, Reyhan; Şimşek, Hakkı; Çakır, Pınar; Çalışkan, ErayBackground: The fetal brain lactate level which is measured by magnetic resonance spectroscopy (MRS) is a compelling indicator for hypoxic/ischemic brain damage. Aim: The authors present a case of MRS diagnosed fetal brain lactate peak despite normal fetal development and Doppler indices which lead to a preterm delivered hypoxic fetus. Case Report: A 37-year-old woman admitted to this clinic at 30 weeks six days of her gestation because of previous recurrent three unexplained fetal death at third trimester and one neonatal death. At 33 weeks one day of pregnancy. MRS examination showed lactate peak in the fetal brain, despite bi-weekly normal Doppler indices and fetal biophysical profile follow-up. After eight days of daily follow-up since lactate peak measurement, her biophysical profile was 6 despite normal Doppler indices. She developed mild preeclampsia after four days following lactate peak. She had imminent cesarean section at 34th week of gestation and a 1,980-gram neonate with Apgar scores of 5 and 7 at the first and fifth minute was delivered. Fetal hypoxia was diagnosed due to base excess of -14 and a cord blood pH of 7.16. The newborn was discharged in a healthy state after five days of neonatal intensive care. Conclusion: The case presents that fetal brain lactate peak can be the only first warning sign in cases of unexplained fetal losses predicting oncoming fetal hypoxia despite normal fetal Doppler and biophysical profile evaluation.Öğe Gebelerde bakteriyel vajinozisin oral ve oral + vajinal tedavisinin gebelik komplikasyonları üzerine etkisi(2017) Başbuğ, Alper; Çalışkan, Seyda; Ellibeş Kaya, Aşkı; Bender, Rukiye Ada; Akar, Bertan; Özcan, Canan; Çalışkan, ErayAmaç: Bakteriyel Vaginosis (BV), anormal vajinal flora ile karakterize, iyi bilinen bir hastalıktır. Preterm doğum için önemli bir risk faktörüdür. Amacımız BV'si olan gebelerde preterm doğum riskini azaltmada hangi tedavi seçeneğinin daha iyi olduğunu bulmaktı.Materyal ve Metod: Bu prospektif çalışmada 24-28. Gebelik haftalarında antenatal polikliniğimize vajinal akıntı şikâyeti ile başvuran toplam 60 gebe kadını değerlendirdik. 60 hastanın 25'i nitroimidazol + mikonazol nitrat intravajinal, diğer hastalara ise oral imidazol + vajinal mikonazol ile tedavi edildi.Bulgular: Tedavi seçenekleri arasında servikal uzunluk, preterm doğum riski ve PPROM arasında anlamlı bir farklılık bulunmadığını saptadık.Sonuç: Gebeliğin erken dönemlerinde saptanan BV'nin tedavisi, gebelik sonuclarını olumlu yönde etkileyebilir. Nitroimidazolidin oral veya vajinal kullanımı BV'nin tedavisinde etkilidir. Vaginal veya oral kullanım ile elde edilen fayda benzerdirÖğe Histeroskopi sonrası gebelikte uterin rüptür: Olgu serisi(2017) Başbuğ, Alper; Akar, Bertan; Çalışkan, Eray; Bender, Rukiye Ada; Zeteroğlu, Şahin; Aslan, MelisaGebelik sırasında uterin rüptürü hem anne hem fetüs için yüksek mortalite ve morbidite ile ilişkilidir. Miyomektomi ve septum rezeksiyonu gibi histeroskopik operasyonlar, bu operasyonu takip eden gebeliklerde uterin rüptür için bilinen risk faktörleridir. Bu çalışmada Şubat 2014 ve Kasım 2016 arasında Kocaeli Medical Park Hastanesi'ne başvuran dört infertil hasta sunulmaktadır. Üç hastanın histeroskopik septum rezeksiyonu komplikasyonsuz olarak tamamlanmış olup, dördüncü hastada histeroskopik miyomektomi sırasında 7-8 mm boyutunda bir rüptür tespit edilmiştir. Hastaların hepsi histeroskopiden bir yıldan daha az süre sonra gebe kalmışlardır. Uterin rüptürler ilk üç hastada 22., 38. ve 10. haftalarda gerçekleşirken, sonuncu hasta sorunsuz bir gebelik geçirmiş ve rüptür sezaryen sırasında fark edilmiştir. Histeroskopi ve gebelik arasında geçen sürenin kısalığı uterin rüptür riskini artırıyor olabilir. Uterusta bulunan bir rüptüre rağmen gebe kalmak ve tüm gebeliği sorunsuz geçirmek mümkün olabilirÖğe Ischiopagus which is the rarest form of heteropagus along with ambiguous genitalia and kidney agenesis: a case report(2020) Haqverdiyev, Emin; Aslancan, Reyhan; Gümüştaş, Gökhan; Çalışkan, Eray; Akar, BertanParasitic twin (heteropagus) is a term to describe an incomplete fetus which is partially resorbed and located on a normal fetus. Ischiopagus which defines the parasitic twins connected from ileum is the rarest form of heteropagus abnormalities. In this case, a thirteen week old fetus was diagnosed with ischiopagus, ambiguous genitalia, and left kidney agenesis during the first trimester ultrasonography screening. Termination was applied with the family decision. These cases should be evaluated together with accompanying multisystem anomalies. Informing the family with details about the viability of the fetus is important to prevent unnecessary termination.Öğe Labial cutaneous flap interposition in the treatment of recurrent vesicovaginal fistula(Mary Ann Liebert, Inc, 2019) Başbuğ, Alper; Doğan, Ozan; Kaya, Aşkı Ellibeş; Akar, Bertan; Gümüştaş, Gökhan; Çalışkan, ErayBackground: Recurrent vesicovaginal fistula (VVF) repair can be very difficult. Most gynecologists prefer the vaginal route because of the complexity of the abdominal approach. This article presents a simple procedure-a minimally invasive approach-labial cutaneous flap intertposition, that was used to treat an elderly patient with VVF. A cutaneous flap has good vascularity, allows augmentation of the bladder, and permits a vaginal approach. Case: A 72-year-old woman had VVF due to prolonged obstructed labor 30 years prior and had undergone transvaginal primary layered repair for this reason. Later on, she underwent total abdominal hysterectomy (TAH) and sacrocolpopexy to address uterine prolapse and cystocele. VVF developed after the TAH and sacrocolpopexy procedures. After the first postoperative month, she had recurrent urinary incontinence. A fistula between the bladder neck and vagina was noted when she had a vaginal examination and cystoscopy. A cutaneous labial flap was used to repair this recurrent VVF. Results: The labial cutaneous flap for repair of this patient's VVF was used successfully. The patient had no more evidence of recurrent VVF or voiding abnormalities after this procedure. Conclusions: Labial cutaneous tissue can be used to create a successful interposition flap during repair of recurrent VVF, particularly in elderly patients.Öğe Lateral Ventrikül Boyutundaki Artış İle Fetal Merkezi Sinir Sistemi Anormallikleri Arasındaki Korelasyon(2017) Gümüştaş, Gökhan; Akar, Bertan; Çalışkan, Eray; Bender, Rukiye Ada; Özcan, Canan; Doğan, OzanGiriş: Rutin anomali taraması sırasında lateral serebral ventriküllerin genişliğinin ultrasonla değerlendirilmesi önerilmektedir. Bu çalışmada 16-28 gebelik haftasında lateral ventrikül boyutları ile merkezi sinir sistemi (MSS) anormallikleri arasındaki ilişkinin saptanması amaçlanmıştır. Yöntem: Bu retropektif çalışmaya 2015-2016 yılları arasında kliniğimize ileri tetkik için başvuran 16-28 gebelik haftasındaki 1875 kadın dahil edildi. Fetal lateral ventriküller koroid pleksus glomus seviyesinde bilateral olarak ölçüldü. Ventriküllerin genişliği gestasyonel yaş, anne yaşı ve MSS anomalilerinin varlığı ile karşılaştırıldı. Ventriküler asimetrisite, izolasyon ve diğer ultrasonografik anomalilerle olan ilişki de analiz edildi. Bulgular: Anne yaşı, gestasyonel yaş ve fetal cinsiyet ile MSS anomalileri ve ventrikül genişliği arasında istatistiksel olarak anlamlı farklılık bulunmadı. (p>0.05). MSS anomalilerinin varlığı ile lateral ventrikülün büyüklüğü arasında kuvvetli bir ilişki saptandı (p<0.001). ROC eğrisi analizinde MSS anomalilerini saptamada anlamlı sağ ve sol ventrikül genişliğinin cut-off değerleri sırasıyla 9,25 mm (sensitivite % 61 ve spesifite % 98,7) ve 9,15 mm (sensitivite % 68,3 ve spesifite % 97,4) bulundu. Ventrikülomegali olan olguların %37.5'inde(n=15) izole ventrikülomegali ve %42,5'ünde(n=17) asimetrik ventrikülomegali saptandı. Tüm vakaların %2,1'inde(n=41) MSS anomalileri ile birlikte diğer ultrasonografik anormallikler saptandı. Sonuç: Ventrikülomegali MSS anomalileri için prognostik bir gösterge olabilir. Gebelik takibi sırasındaki kontrol muayenelerde her iki lateral serebral ventrikül genişliği de ölçülmelidir. Lateral ventrikül büyüklüğü cut-off değerinin belirlenmesi için ileri araştırmalara postpartum dönemi de dahil edilmelidir.Öğe MATERNAL AND NEONATAL OUTCOMES RELATED TO IRON DEFICIENCY ANEMIA AND SERUM FERRITIN STATUS: A MULTICENTER PROSPECTIVE STUDY FROM EASTERN MARMARA, TURKEY(2019) Başbuğ, Alper; Çakır, Pınar; Çalışkan, Eray; Pulatoglu, Cigdem; Şimşek, Hayal; Başbuğ, Derya; Akar, BertanAim: The aim was to evaluate the incidence of iron deficiencyanemia in pregnancy in the East Marmara region of Turkey in orderto determine its prevalence along with the effects and associationsof iron supplementation on maternal and neonatal outcomes.Materials and Methods: This study was conducted in sixcenters and included a total of 1102 pregnant women.Blood samples were collected for hematological status andserum ferritin levels during pregnancy, and the adversematernal and perinatal outcomes were determined. Irondeficiency anemia was diagnosed according to the WorldHealth Organization criteria as hemoglobin level of < 11g/dl and ferritin level of <15 ?g/dL.Results: The rate of anemia was 19.8%, with 44% of themreceiving iron supplementation. The maternal age was lower in theanemic group (26.5 vs. 27.7, p = 0.01). Selective iron use wasmore frequent in the anemic group, while routine iron use wasmore frequent in the non-anemic group (47.1% vs. 29.3%; p =0.01).Conclusion: Iron deficiency anemia is a frequent problem inpregnancy. However, many anemic pregnant women do notreceive iron therapy. Iron supplementation may have positiveeffects on maternal and perinatal outcomes. In order to combat irondeficiency anemia in pregnancy, wide spread use of ironsupplements should be established.Öğe Maternal and neonatal outcomes related to iron deficiency anemia and serum ferritin status: a multicenter prospective study from Eastern Marmara, Turkey(2019) Pulatoğlu, Çiğdem; Başbuğ, Derya; Akar, Bertan; Şimşek, Hayal; Çakır, Pınar; Başbuğ, Alper; Çalışkan, ErayThe aim was to evaluate the incidence of iron deficiency anemia in pregnancy in the East Marmara region of Turkey in order to determine its prevalence along with the effects and associations of iron supplementation on maternal and neonatal outcomes. Materials and Methods: This study was conducted in six centers and included a total of 1102 pregnant women. Blood samples were collected for hematological status and serum ferritin levels during pregnancy, and the adverse maternal and perinatal outcomes were determined. Iron deficiency anemia was diagnosed according to the World Health Organization criteria as hemoglobin level of < 11 g/dl and ferritin level of <15 ?g/dL. Results: The rate of anemia was 19.8%, with 44% of them receiving iron supplementation. The maternal age was lower in the anemic group (26.5 vs. 27.7, p = 0.01). Selective iron use was more frequent in the anemic group, while routine iron use was more frequent in the non-anemic group (47.1% vs. 29.3%; p = 0.01). Conclusion: Iron deficiency anemia is a frequent problem in pregnancy. However, many anemic pregnant women do not receive iron therapy. Iron supplementation may have positive effects on maternal and perinatal outcomes. In order to combat iron deficiency anemia in pregnancy, wide spread use of iron supplements should be established.Öğe Mikro besin takviyesinin maternal–fetal sonuçlara etkisi: d vitamini, kalsiyum ve magnezyum(2018) Doğan, Ozan; Ellibeş Kaya, Aşkı; Pulatoğlu, Çiğdem; Akar, Bertan; Başbuğ, Alper; Çalışkan, ErayAmaç: Fetal ve maternal sağlığa olumlu etkileri olması nedeniyle gebelik döneminde artan ihtiyaçla orantılı olarak vitamin ve mineral desteğine ihtiyaç vardır. Bu çalışmada mikro besin takviyesi olarak D vitamini, Kalsiyum (Ca) ve Magnezyum (Mg) desteği alan gebelerin postnatal sonuçlarını ve gebelik komplikasyonlarını araştırmak amaçlandı. Gereçler ve Yöntem: Yapılan bu prospektif, longitudinal ve kalitatif çalışmaya Ocak 2016 ve Ocak 2018 tarihleri arasında 18-40 yaş arası toplam 2114 hasta dahil edilmiştir. Bulgular: Maternal yaş aralığı tüm hasta grupları için 28.11 ± 6.12‘ dir. Multivitamin kullanan grubun yaş ortalaması D vitamini grubuna göre daha düşük saptandı(p= 0.001). Yalnızca Mg ve D vitamini kullanan grupta yüksek lisans seviyesinde eğitim görenler daha fazlaydı(p=0.001). Mg, Ca, D vitamini ve multivitamin kullananımı ile gebelik komplikasyonları arasında anlamlı ilişki bulunamadı. Multivitamin kullanan gebelerde LGA daha fazla görüldü(p=0.038). İlk gebelik yaşı Ca ve mulivitamin kullanan grupta Mg ve D vitamini kullanan gruba göre daha düşük bulunmuştur(p=0.001). Sonuç: Annenin sağlıklı bir gebelik geçirmesi, maternal komplikasyonlardan korunması, fetusun büyüme ve gelişmesi için annenin düzenli beslenmesinin yanı sıra vitamin ve mineral takviyesi önemlidir. Bu takviyelerin literatürde gösterilmiş olan yararlarını desteklemek ve rutin kullanımda yer vermek için daha çok prospektif çalışmaya ihtiyaç vardır.Öğe A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta(GALENOS YAYINCILIK, 2021) Çalışkan, Eray; Akar, Bertan; Ceylan, Yasin; Karadağ, CihanObjective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel "lower uterine sandwich" technique to control post-cesarean hemorrhage due to PP accreta. Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely "Caliskan's uterine sandwich technique". Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy. Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.Öğe A novel low uterine segment sandwich technique (Caliskan’s technique) for the management of postcesarean hemorrhage due to placenta previa accreta(2021) Ceylan, Yasin; Karadağ, Cihan; Çalışkan, Eray; Akar, BertanObjective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel “lower uterine sandwich” technique to control post-cesarean hemorrhage due to PP accreta. Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely “Caliskan’s uterine sandwich technique”. Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy. Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.Öğe Nuchal fold nomogram and relationship with heart and central nervous system anomalies(2017) Kaya, Aşkı Ellibeş; Başbuğ, Alper; Akar, Bertan; Bender, Rukiye Ada; Doğan, Ozan; Çalışkan, ErayIntroduction: Nuchal fold thickness is the first trimester continuation of nuchal translucency in the second trimester. Thick nuchal fold is important in relation to some systemic diseases, including abnormal karyotype fetus.Material-Method: This is a cross-sectional retrospective study that has been performed among 1625 singleton pregnant women with gestational ages between 16-24 weeks that has taken place in Kocaeli Medical Park Hospital from years 2011-2017. We calculated nuchal fold lenght %5, %50, %95 percentile per week and draw nuchal fold nomogram. Results: It has been shown that there is a weak positive correlation between nuchal fold thickness and the gestational week (p: 0,001, r:0,18). In 1625 analysed patients, 50 patients had cardiovascular system (CVS) diseases and 32 patients had central nervous system (CNS) diseases. There was not a statistically significant relationship between nuchal fold thickness and CVS diseases (p= 0.98 and p<0.05). No statistically significant relationship was found between nuchal fold thickness and CNS diseases (p=0.55 and p<0.05).Conclusion: The increased nuchal fold thickness in fetuses with normal karyotype does not increase with fetal heart and central nervous system diseasesÖğe Nukhal Fold Nomogramı, Kalp ve Santral Sinir Sis- tem Hastalıkları ile İlişkisi(2017) Kaya, Aşkı Ellibeş; Doğan, Ozan; Başbuğ, Alper; Çalışkan, Eray; Akar, Bertan; Bender, Rukiye AdaAmaç: Nukhal fold kalınlığı birinci trimesterda ölçülen ense saydamlığının ikinci trimesterda devamı niteliğindedir. Özellikle anormal karyotip olan vakalar dâhil edilirse bazı sistemik hastalıklarla ilişkisi ve detaylı ultrasound için bir uyarı niteliği taşıması açısından önemlidir. Yöntem: Çalışmamız 2011-2017 yılları arasında Kocaeli Medikal Park hastanesinde takipleri yapılmış 16-24 haftalar arasındaki 1625 tekil normal karyotipli gebelerden oluşmaktadır. Gebelerin detaylı ultrasonografileri yapıldı. Her hafta için %5, %50, %95 percentil nukhal fold kalınlıkları hesaplanarak nukhal fold nomogramı oluşturuldu. Bulgular: Gebelik yaşı ile nukhal fold kalınlığı arasında pozitif korelasyon tespit edildi (p: 0,001, r:0,18). Tüm hastalar içinde 50 fetusta kardiak hastalık, 32 fetusta santral sinir sistemi patolojisi saptandı. Nukhal fold kalınlığı ile kardiovasküler hastalık arasında istatistiksel olarak anlamlı bir ilişki saptanmadı (p= 0.98 and p<0.05). Nukhal fold kalınlığı ile santral sinir sistemi hastalıkları arasında da istatistiksel olarak anlamlı bir ilişki saptanmadı (p=0.55 and p<0.05).Sonuç: Normal karyotipli fetuslarda nukhal fold kalınlığındaki artış, fetal kalp ve santral sinir sistemi hastalıkları ile artış göstermemektedir
