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Öğe Comparison of IMA, YKL-40, EN-RAGE, and AIM levels in maternal blood and cord blood in patients with preeclampsia(2023) Fındık, Fatih Mehmet; İçen, Mehmet Sait; Tunç, Senem Yaman; Gündüz, Reyhan; Ağaçayak, Elif; Evsen, Mehmet Sıddık; Satıcı, ÖmerAim: Preeclampsia and severe preeclampsia are among the most significant causes of maternal mortality. Preeclampsia’s pathogenesis is not fully understood, and it is a disease with early diagnosis and treatment possibilities. In this study, we aimed to investigate the levels of IMA, YKL-40, EN-RAGE, and AIM in maternal and cord blood. The results will ideally shed light on preeclampsia’s pathogenesis and early diagnosis. Methods: The study was conducted with the following three groups: a severe preeclampsia group (group 1), a preeclampsia group (group 2), and a control group (group 3). IMA, YKL-40, EN-RAGE, and AIM levels were measured in all patients across the groups using blood taken from the mothers before delivery and from the cords during delivery. Statistically descriptive analyses were performed. Specifically, a one-way analysis of variance was performed on group variables, and a Tukey test was used to determine the differences between the groups. Results: The mean age was similar across all groups. The gestational week at delivery was low for the severe preeclampsia group (p=0.001). The IMA and YKL-40 levels in the maternal and cord blood were the same between the groups. The EN-RAGE levels in the maternal blood were found to be significantly higher in the control group (p=0.000). While the AIM levels in the maternal blood were high in the control group (p=0.001), they were significantly lower in the cord blood in the control group (p=0.029). Conclusion: EN-RAGE and AIM levels are parameters that can be used in the early diagnosis of preeclampsia and severe preeclampsia.Öğe Could moesin be a new marker for indicating progression in endometrial cancer?(Dove Medical Press Ltd., 2022) Ağaçayak, Elif; Keleş, Ayşenur; Değer, Uğur; Özçelik, Mehmet Şirin; Peker, Nurullah; Gündüz, Reyhan; Akkuş, Murat; Büyükbayram, HüseyinAim: This study aims to determine an important parameter in progression from pre-invasive lesions of endometrium to endometrial cancer and also evaluate the effect of this parameter on the progression of endometrial cancer. Material and Method: In our study,30 patients with normal endometrial tissue (group 1), 56 patients who had endometrial hyperplasia without atypia (group 2), 36 patients who had endometrial hyperplasia with atypia (group 3), and 63 patients with endometrial cancer (group 4) were included. Age, parity, body-mass index, systemic diseases, and tumor markers of patients were evaluated. Expression levels of Ezrin, Radixin, and Moesin proteins were immunohistochemically evaluated in terms of frequency, intensity, and score value. Results: When we compared hyperplasia cases with or without atypia; frequency, and score value of ezrin expression and frequency, intensity, and score value of moesin expression was significantly higher in patients who had hyperplasia with atypia (p:0.000 p:0.001 p:0.003, p:0.032 p: 0.035 p:0.015 p:0.005, respectively). It was observed that the frequency and score value of moesin expression were significantly higher in patients with endometrial cancer when compared with patients who had hyperplasia with atypia (p:0.003 p:0.045). The frequency of moesin expression was significantly higher in patients who had postoperative mortality (p:0.030 p:0.039). Conclusion: Increased frequency of moesin expression in the preoperative period in patients with atypical hyperplasia should alert the surgeon in terms of malignancy. If the frequency of moesin expression increases in cases with endometrial cancer, the patient should be followed closely in terms of progression in the postoperative period.Öğe Evaluation Of 8-Hydroxy-2-Deoxyguanosine And Malondialdehyde Levels In First-Trimester Miscarriage: A Prospective Cohort Study(2020) Gündüz, Reyhan; Uğur, Mete Gürol; Özcan, Hüseyin; Taysı, Seyithan; Tepe, Neslihan; Demir, Sevgi Sarı; Balat, ÖzcanObjective: This study was aimed to evaluate 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levelsin patients with first trimester miscarriage.Methods: This prospective cohort study included 35 women, who were diagnosed with miscarriage (patient group) and35 healthy pregnant women below 14 weeks of gestation (control group), who did not report any complaints. 8-OHdGlevels were measured with a competitive ELISA (Enzyme-Linked ImmunoSorbent Assay) high sensitivity kit and MDAlevels were also measured in both groups.Results: There wasn’t difference in terms of complete blood count, thyroid-stimulating hormone (TSH), homocysteinevalues, parity, age, body mass index (BMI) and gestational age between the groups. Serum 8-OHdG and MDA levels weresignificantly higher in the patient group (p=0.001). A moderate positive significant correlation between the gestationalweek and MDA values and a weak but significant positive correlation between 8-OHdG values and gestational week weredetected in the patient group.Conclusion: 8-OHdG and MDA could play a role in the etiopathogenesis of first-trimester miscarriage. However, this rolemust be further delineated in large-scaled studies for early diagnosis and management of this condition.Öğe Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience(Makerere University, Medical School, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Okutucu, Gülcan; Alabalık, Ulaş; Evsen, Mehmet SıddıkBackground: Although endometrial polyps are generally benign, there are also risks of malignancy. Objectives: To determine the premalignancy and malignancy prevalence in patients diagnosed with endometrial polyps and to investigate factors affecting premalignancy and malignancy. Methods: In our retrospective study, patients who were diagnosed with endometrial polyp with endometrial samples and who underwent polypectomy by hysteroscopy or hysterectomy within one year were included. Results: Premalignant/malignant histopathological results were detected in 7 (2.8%) patients. There were no statistically significant differences in histopathological results and endometrial sampling indications between premenopausal and postmenopausal patients. Hysterectomy in patients with premalignant/malignant results and hysteroscopy in patients with benign results were found to be significantly different. There was not a statistically significant difference between patients with benign results and those with premalignant/malignant results in menopausal status, symptoms, status of hormone replacement therapy and endometrial polyp size. Conclusion: The possibility of premalignant/ malignant results in patients diagnosed with endometrial polyps should be kept in mind. The menopausal status, symptoms, sizes of endometrial polyps and whether or not the patient is on hormone replacement therapy should be considered while making the management plan. However, these should not be the decisive factors on their own.Öğe Evaluation of factors affecting intrapartum cesarean section rates by comparing the data of patients with vaginal delivery: A retrospective case-control study(Ortadoğu Reklam Tanıtım Yayıncılık, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Sengi, Abdurrahman; Çalışır, Uğur; Gül, TalipObjective: This study aimed to determine intrapartum cesarean section rates of our clinic as well as risk factors for intrapartum cesarean section. We also aimed to identify patients with risk factors beforehand and to reduce the intrapartum cesarean section rates and the complications that might occur due to intrapartum cesarean sections. Material and Methods: A total of 150 patients admitted to our clinic for vaginal delivery that ended up having intrapartum cesarean sections (case group) and 200 patients who had a vaginal delivery (control group) were included in our study retrospectively. Demographic, clinical, and neonatal results of the patients were compared. Results: Intrapartum cesarean section rate was determined to be 23% (150/654). The most common indication for intrapartum cesarean section was fetal distress (48%). We found that low gestational week at delivery, nulliparity, and polyhydramnios were independent risk factors for intrapartum cesarean section. We determined that gravidity and parity were not risk factors for intrapartum cesarean section. It was found that 1st minute APGAR scores of babies of patients with intrapartum cesarean section were significantly lower and that intrapartum cesarean section was an independent risk factor for this particular finding. Conclusion: The possibility of the intrapartum cesarean section should be considered in the labor follow-ups of patients with risk factors. We recommend hospital deliveries where the necessary conditions for the mother and fetus are met.Öğe Evaluation of factors affecting perinatal mortality in patients with HELLP syndrome(Mebas Medikal Basın Yayın, 2021) Gündüz, Reyhan; Tunç, Senem Yaman; İçen, Mehmet Sait; Gül, Talip; Ertuğrul, SabahattinOBJECTIVE: To determine the perinatal mortality rate in patients with HELLP syndrome in our clinic and to investigate the factors affecting perinatal mortality. It also makes recommendations to reduce perinatal mortality and contributes to the literature. STUDY DESIGN: Three-hundred-and-eighty-three patients were retrospectively evaluated in this cohort study. The patients' demographic, clinical data, laboratory results, gestational week at delivery, method of delivery, neonatal birth weight, fetal gender, 1- and 5-minute APGAR scores, place of delivery, maternal morbidity, mortality rates, and perinatal mortality rates were recorded. The relationship of these factors with perinatal mortality was investigated. RESULTS: The rate of perinatal mortality was determined as 6%. Patients with HELLP syndrome who experienced perinatal mortality showed significantly lower birth weight, gestational age at delivery, and 1- and 5-minute APGAR score values (p<0.05). With respect to methods of delivery, we determined that vaginal delivery was linked to a significantly higher rate of perinatal mortality (p<0.001). Gestational age at delivery, birth weight, 1- and 5-minute APGAR scores were negatively correlated with perinatal mortality. Logistic regression revealed the APGAR score at 5 minutes as the most reliable independent predictive finding for perinatal mortality. CONCLUSION: We think that to decrease perinatal mortality rates, maternal and fetal well-being in patients with HELLP syndrome should be closely monitored and delivery and follow-up should take place at tertiary health institutions after maternal and neonatal intensive care arrangements are made. Particularly, neonates with low 5-minute APGAR scores in the postpartum evaluation of neonatal condition are recommended to be followed-up at the neonatal intensive care unit.Öğe Evaluation of Myomectomy During Cesarean Section: A Tertiary Center Experience(2024) Bozbay, Özlem Polat; Arslan, Dorşin Sancar; Gündüz, Reyhan; Bozbay, NizamettinAim: The study aims to investigate the outcomes of patients who underwent myomectomy during cesarean section in our tertiary center. Material and method: This study was conducted between January 1, 2015 and May 31, 2022. The patients included in the study were divided into three groups: patients with myoma uteri and pregnancy who underwent cesarean section and simultaneous myomectomy (Group 1), patients with myoma uteri and pregnancy who underwent cesarean section only (Group 2), and pregnant patients without myoma who underwent cesarean section only (Group 3). The groups were compared in terms of preoperative and postoperative results. Results: A total of 138 patients, 56 40.6% (Group 1), 31 22.5% (Group 2), 51 37% (Group 3) were included in the study. When compared according to demographic characteristics, Group 1 and Group 2 had significantly higher age and significantly lower gravida and parity (p: <0.001, p: 0.048, p: 0.005, respectively). There was no significant difference between Group 1 and Group 2 in terms of myoma size and number (p: 0.162, p: 0.228, respectively). Operative time, laboratory results, and blood transfusion requirements were similar between the groups. Conclusion: Performing a myomectomy during a cesarean section, considering the potential risks based on our data, is a feasible procedure when carried out by experienced surgeons at tertiary hospitals. Precautions should also be taken regarding complications. We believe that the decision to include or exclude a myomectomy during a cesarean section should be discussed with the patient, considering the risk-benefit ratio and the factors mentioned above, and should be made on a case-by-case basis.Öğe Evaluation of Myomectomy During Cesarean Section: A Tertiary Center Experience(Selçuk Üniversitesi, 2024) Bozbay, Özlem Polat; Arslan, Dorşin Sancar; Gündüz, Reyhan; Bozbay, NizamettinAim: The study aims to investigate the outcomes of patients who underwent myomectomy during cesarean section in our tertiary center. Material and method: This study was conducted between January 1, 2015 and May 31, 2022. The patients included in the study were divided into three groups: patients with myoma uteri and pregnancy who underwent cesarean section and simultaneous myomectomy (Group 1), patients with myoma uteri and pregnancy who underwent cesarean section only (Group 2), and pregnant patients without myoma who underwent cesarean section only (Group 3). The groups were compared in terms of preoperative and postoperative results. Results: A total of 138 patients, 56 40.6% (Group 1), 31 22.5% (Group 2), 51 37% (Group 3) were included in the study. When compared according to demographic characteristics, Group 1 and Group 2 had significantly higher age and significantly lower gravida and parity (p: <0.001, p: 0.048, p: 0.005, respectively). There was no significant difference between Group 1 and Group 2 in terms of myoma size and number (p: 0.162, p: 0.228, respectively). Operative time, laboratory results, and blood transfusion requirements were similar between the groups. Conclusion: Although myomectomy can be performed during a cesarean section by an experienced surgeon in a tertiary center, it should be noted that complications may arise and that precautions must, therefore, be taken.Öğe Evaluation of patients with uterine perforation after intrauterine device placement and determination of risk factors: A retrospective case-control study(Yuzuncu Yil University Faculty of Medicine, 2022) Gündüz, Reyhan; Ağaçayak, Elif; Dönmez, Dicle Akkılıç; Fındık, Fatih Mehmet; Evsen, Mehmet Sıddık; Gül, TalipTo determine the risk factors by evaluating patients with uterine perforation after intrauterine devices (IUD) placement. Also, it was to make suggestions and contribute to the literature in order to prevent uterine perforation after the IUDs placement and how we should behave when we encounter these patients.Twenty-two patients with uterine perforation after IUDs placement (patient group) diagnosed and treated at our clinic and 30 patients with IUDs in place in the uterine cavity (control group) were retrospectively ev aluated and compared. IUDs insertion by a midwife and during the breastfeeding and puerperal period significantly increased the frequency of uterine perforation after IUDs placement, while insertion during the menstrual period significantly reduced risk. Uterine perforation after IUDs placement were most frequently localized in the myometrium (54.5%) and the douglas (13.6%). Uterine perforation-related complications were absent in 59.1% of patients. Of patients, 40.9% underwent hysteroscopy, 18.2% laparoscopy. The diagnostic method was ultrasonography alone at a rate of 68.2%. IUDs could be inserted during menstruation where possible, and patients could be informed about the high risk of uterine perforation after IUDs placement associated with the breastfeeding and puerperal periods. We recommend that IUDs be inserted with ultrasonography in this period. Midwives should receive regular training in order to increase their knowledge and experience on this subject. We recommend ultrasonography as the primary d iagnostic method. Those with IUDs embedded in the myometrium can primarily undergo hysteroscopy, and those with IUDs in the abdomen can undergo laparoscopy or laparotomy.Öğe Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?(Makerere University, 2021) Gündüz, Reyhan; Ağaçayak, Elif; Okutucu, Gülcan; Karuserci, Özge Kömürcü; Peker, Nurullah; Çetinçakmak, Mehmet Güli; Gül, TalipBackground: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy. Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility. Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014-January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed. Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction. Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.Öğe İkinci trimester amniyosentez olgularının değerlendirilmesi: Tersiyer bir merkezin 10 yıllık deneyimi(Perinatal Tıp Vakfı, 2021) Gündüz, Reyhan; Tunç, Senem Yaman; Buğday, Rezan; Oral, Diclehan; Tekeş, Selahaddin; Yalınkaya, AhmetAmaç: Kliniğimizdeki amniyosentez uygulanan olguların retrospektif analizini yapmak ve bu konudaki deneyimimizi paylaşarak literatüre katkı sunmaktır.Yöntem: Çalışmamıza ikinci trimesterde amniyosentez uygulanan 632 olgu dahil edildi. Olguların demografik özellikleri, gebelik haftaları, amniyosentez endikasyonları, işleme bağlı komplikasyonları, kültür başarısı, sitogenetik sonuçları, kromozom anomalisi saptanan olguların sonuçları ve endikasyonları değerlendirildi. Kromozom anomalisi, komlikasyonları, kültür başarısızlığı oranları ve en sık amniyosentez endikasyonları belirtildi. Kromozom anomalisi olan olguların sonuçları sayısal ve yapısal anomi olarak belirtildi.Bulgular: Çalışmamıza dahil edilen tüm olguların yaş ortalamaları 33.7±6.8 yıl, gebelik haftaları 17.5±1.0 hafta olarak tespit edildi. Amniyosentez sonucu kromozom anomalisi tespit edilen olgu oranı%22.4, kültür başarısızlığı oranı %2.1 ve komplikasyon oranı %0.5bulundu. En sık amniyosentez endikasyonları ve kromozom anomalisi tespit edilen olgularda amniyosentez endikasyonları aynı olupbunlar sırasıyla; kombine testin yüksek riskli olması, üçlü tarama testinin yüksek riskli olması ve ultrasonografide (USG) anomali olmasıdır. Kromozom anomalisi tespit etme oranı birden fazla endikasyonun birlikte görülüp amniyosentez uygulanan olgularda dahayüksek bulundu.Sonuç: Prenatal tanı için USG ve serum tarama testleri yaygınolarak kullanılmakla birlikte yüksek riskli hastalara kesin tanı içinamniyosentez gibi invazif testlere ihtiyaç vardır. Tarama testlerinde birden fazla kromozom anomalisi riski taşıyan olgularda, prenatal tanı için amniyosentezin daha önemli olduğu sonucuna varıldı.Öğe İkinci trimester amniyosentez olgularının değerlendirilmesi: Tersiyer bir merkezin10 yıllık deneyimi(2021) Gündüz, Reyhan; Oral, Diclehan; Tekeş, Selahaddin; Tunc, Senem Yaman; Yalınkaya, Ahmet; Buğday, RezanAmaç: Kliniğimizdeki amniyosentez uygulanan olguların retrospektif analizini yapmak ve bu konudaki deneyimimizi paylaşarak literatüre katkı sunmaktır.Yöntem: Çalışmamıza ikinci trimesterde amniyosentez uygulanan 632 olgu dahil edildi. Olguların demografik özellikleri, gebelik haftaları, amniyosentez endikasyonları, işleme bağlı komplikasyonları, kültür başarısı, sitogenetik sonuçları, kromozom anomalisi saptanan olguların sonuçları ve endikasyonları değerlendirildi. Kromozom anomalisi, komlikasyonları, kültür başarısızlığı oranları ve en sık amniyosentez endikasyonları belirtildi. Kromozom anomalisi olan olguların sonuçları sayısal ve yapısal anomi olarak belirtildi.Bulgular: Çalışmamıza dahil edilen tüm olguların yaş ortalamaları 33.7±6.8 yıl, gebelik haftaları 17.5±1.0 hafta olarak tespit edildi. Amniyosentez sonucu kromozom anomalisi tespit edilen olgu oranı%22.4, kültür başarısızlığı oranı %2.1 ve komplikasyon oranı %0.5bulundu. En sık amniyosentez endikasyonları ve kromozom anomalisi tespit edilen olgularda amniyosentez endikasyonları aynı olupbunlar sırasıyla; kombine testin yüksek riskli olması, üçlü tarama testinin yüksek riskli olması ve ultrasonografide (USG) anomali olmasıdır. Kromozom anomalisi tespit etme oranı birden fazla endikasyonun birlikte görülüp amniyosentez uygulanan olgularda dahayüksek bulundu.Sonuç: Prenatal tanı için USG ve serum tarama testleri yaygınolarak kullanılmakla birlikte yüksek riskli hastalara kesin tanı içinamniyosentez gibi invazif testlere ihtiyaç vardır. Tarama testlerinde birden fazla kromozom anomalisi riski taşıyan olgularda, prenatal tanı için amniyosentezin daha önemli olduğu sonucuna varıldı.Öğe Is placental localization in the third trimester of pregnancy related to the intrauterine ultrasound and postpartum parameters?(Harran Üniversitesi Tıp Fakültesi, 2022) Gündüz, Reyhan; Turhan, Begümhan; Sizer, Mulaim; Tunç, Senem Yaman; Ağaçayak, ElifBackground: The relationship between placental localization and fetus is unclear. This study was aimed to determine the relationships between placental localization, ultrasound findings and pregnancy outcomes of the third trimester of pregnancies.Materials and Methods: Three-hundred and two women were included in the study. Maternal age, gravidi-ty, parity, abortion and live birth numbers, types of previous births, gestational age, femur length (FL), bipa-rietal diameter (BPD), head circumference (HC), abdominal circumference (AC), placental localization (ante-rior/posterior/lateral/fundus), umbilical artery systolic/diastolic ratio (S/D), fetal presentation, type of deliv-ery, post-partum parameters of infant were obtained from archive records.Results: The placentas were located in the anterior, posterior, fundal and lateral uterine wall in 38.1%, 30.1%, 19.9%, and 11.9% of individuals, respectively. Measurements of the HC in the third trimester were differed according to the localization of the placenta, and the HC measurements were significantly higher if the placental localization was anteriorly (p=0.045). There were no differences in other ultrasonographic measurements (S/D, BPD, AC ve FL), in the height, weight, and gender of the baby, gestational week at delivery, APGAR scores and type of delivery according to the placental localization (p>0.05).Conclusions: In this study, we found that placental localization did not affect pregnancy outcomes, type of delivery and gender of the baby in risk-free, spontaneous and single pregnancies in the third trimester. Also, we stated that the previous birth type did not give an idea about placental localization. We think that placenta implantations, except placental location anomaly and invasion anomaly,do not provide precise information about pregnancy outcomes and type of delivery.Öğe MATERNAL AND NEONATAL OUTCOMES OF CESAREAN SECTION IN OBESE AND MORBID OBESE TERM PREGNANT WOMEN(Rojan GÜMÜŞ, 2022) Altın, Abdulbari; Gündüz, Reyhan; Fındık, Fatih Mehmet; Buğday, Rezan; Tunç, Senem Yaman; Gül, TalipObjectives: To compare preoperatively, intraoperatively and postoperatively the maternal and ne-onatal outcomes of normal-weight, obese and morbid obese pregnant women who delivered by cesarean section in our clinic. Methods: This study retrospectively included 151 singleton pregnancies delivered at ?37 weeks of gestation by cesarean section. Demographic, clinical and neonatal results of the patients were not-ed and compared between the groups. Results: Among the pregnant women included in this study, length of postoperative hospital stay and presence of chronic diseases were determined to be significantly higher in the morbid obese group compared with other groups (p<0.05). In the morbid obese group, the average infant birth weight and the number of infants monitored due to respiratory distress as a neonatal complication were determined to be significantly higher (p<0.05). The presence of pregnancy complications, particularly the presence of gestational diabetes mellitus and preeclampsia were found to be signif-icantly higher in the morbid obese group (p<0.05). Conclusions: We determined that the incidence of maternal and neonatal complications increases as the body mass index (BMI) increases. Therefore, it is evident that monitoring the BMI and pre-venting obesity would be effective in avoiding complications.Öğe Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019(Elsevier, 2021) D'Antonio, Francesco; Şen, Cihat; Di Mascio, Daniele; Galindo, Alberto; Villalain, Cecilia; Herraiz, Ignacio; Gündüz, Reyhan; Ağaçayak, ElifBACKGROUND: It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations. OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection. STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data. RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes. CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.Öğe Maternal and perinatal outcomes of pregnant women with SARS-CoV-2 infection(Wiley, 2021) Saccone, Gabriele; Sen, Cihat; Di Mascio, Daniele; Galindo, Alberto; Grunebaum, Amos; Yoshimatsu, Jun; Stanojevic, Milan; Kurjak, Asim; Chervenak, Frank; Rodriguez Suarez, Maria Jose; Maria Gambacorti-Passerini, Zita; Anaya Baz, Maria de los Angeles; Aguilar Galan, Esther Vanessa; Cunarro Lopez, Yolanda; De Leon Luis, Juan Antonio; Cueto Hernandez, Ignacio; Herraiz, Ignacio; Villalain, Cecilia; Venturella, Roberta; Rizzo, Giuseppe; Mappa, Ilenia; Gerosolima, Giovanni; Hellmeyer, Lars; Koenigbauer, Josefine; Ameli, Giada; Frusca, Tiziana; Volpe, Nicola; Luca Schera, Giovanni Battista; Fieni, Stefania; Esposito, Eutalia; Simonazzi, Giuliana; Di Donna, Gaetana; Youssef, Aly; Della Gatta, Anna Nunzia; Di Donna, Mariano Catello; Chiantera, Vito; Buono, Natalina; Sozzi, Giulio; Greco, Pantaleo; Morano, Danila; Bianchi, Beatrice; Marino, Maria Giulia Lombana; Laraud, Federica; Ramone, Arianna; Cagnacci, Angelo; Barra, Fabio; Gustavino, Claudio; Ferrero, Simone; Ghezzi, Fabio; Cromi, Antonella; Lagana, Antonio Simone; Longo, Valentina Laurita; Stollagli, Francesca; Sirico, Angelo; Lanzone, Antonio; Driul, Lorenza; Cecchini, Fabiana; Xodo, Serena; Rodriguez, Brian; Mercado-Olivares, Felipe; Elkafrawi, Deena; Sisti, Giovanni; Esposito, Rosanna; Coviello, Antonio; Cerbone, Marco; Morlando, Maddalena; Schiattarella, Antonio; Colacurci, Nicola; De Franciscis, Pasquale; Cataneo, Ilaria; Lenzi, Marinella; Sandri, Fabrizio; Buscemi, Riccardo; Gattei, Giorgia; della Sala, Francesca; Valori, Eleonora; Rovellotti, Maria Cristina; Done, Elisa; Faron, Gilles; Gucciardo, Leonardo; Esposito, Valentina; Vena, Flaminia; Giancotti, Antonella; Brunelli, Roberto; Muzii, Ludovico; Nappi, Luigi; Sorrentino, Felice; Liberati, Marco; Buca, Danilo; Leombroni, Martina; Di Sebastiano, Francesca; Franchi, Massimo; Ianniciello, Quintino Cesare; Garzon, Simone; Petriglia, Giuliano; Borrello, Leonardo; Nieto-Calvache, Albaro Jose; Burgos-Luna, Juan Manuel; Kadji, Caroline; Carlin, Andrew; Bevilacqua, Elisa; Moucho, Marina; Pinto, Pedro Viana; Figueiredo, Rita; Morales Rosello, Jose; Loscalzo, Gabriela; Martinez-Varea, Alicia; Diago, Vincente; Jimenez Lopez, Jesus S.; Aykanat, Yeliz; Cosma, Stefano; Carosso, Andrea; Benedetto, Chiara; Bermejo, Amanda; May Feuerschuette, Otto Henrique; Uyaniklar, Ozlem; Ocakouglu, Sakine Rahimli; Atak, Zeliha; Gündüz, Reyhan; Haberal, Esra Tustas; Froessler, Bernd; Parange, Anupam; Palm, Peter; Samardjiski, Igor; Taccaliti, Chiara; Okuyan, Erhan; Daskalakis, George; Moreira de Sa, Renato Augusto; Pittaro, Alejandro; Gonzalez-Duran, Maria Luisa; Concheiro Guisan, Ana; Genc, Serife Ozlem; Zlatohlavkova, Blanka; Luengo Piqueras, Anna; Esteban Oliva, Dolores; Cil, Aylin Pelin; Api, Olus; Antsaklis, Panos; Ples, Liana; Kyvernitakis, Ioannis; Maul, Holger; Malan, Marcel; Lila, Albert; Granese, Roberta; Ercoli, Alfredo; Zoccali, Giuseppe; Villasco, Andrea; Biglia, Nicoletta; Madalina, Ciuhodaru; Costa, Elena; Daelemans, Caroline; Pintiaux, Axelle; Cueto, Elisa; Hadar, Eran; Dollinger, Sarah; Brzezinski-Sinai, Noa A.; Huertas, Erasmo; Arango, Pedro; Sanchez, Amadeo; Alfonso Schvartzman, Javier; Cojocaru, Liviu; Turan, Sifa; Turan, Ozhan; Di Dedda, Maria Carmela; Molpeceres, Rebeca Garrote; Zdjelar, Snezana; Premru-Srsen, Tanja; Kornhauser-Cerar, Lilijana; Druskovic, Miriam; De Robertis, Valentina; Stefanovic, Vedran; Nupponen, Irmeli; Nelskyla, Kaisa; Khodjaeva, Zulfiya; Gorina, Ksenia A.; Sukhikh, Gennady T.; Maruotti, Giuseppe Maria; Visentin, Silvia; Cosmi, Erich; Ferrari, Jacopo; Gatti, Alessandra; Luvero, Daniela; Angioli, Roberto; Puri, Ludovica; Palumbo, Marco; D'Urso, Giusella; Colaleo, Francesco; Rapisarda, Agnese Maria Chiara; Carbone, Ilma Floriana; Manzoli, Lamberto; Flacco, Maria Elena; Nazzaro, Giovanni; Locci, Mariavittoria; Guida, Maurizio; Sardo, Attilio Di Spiezio; Panici, Pierluigi Benedetti; Khalil, Asma; Berghella, Vincenzo; Bifulco, Giuseppe; Scambia, Giovanni; Zullo, Fulvio; D'Antonio, FrancescoObjectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS-CoV-2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory-confirmed SARS-CoV-2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia and Australia, between 1 February 2020 and 30 April 2020. Confirmed SARS-CoV-2 infection was defined as a positive result on real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit (ICU), use of mechanical ventilation and death. Results In total, 388 women with a singleton pregnancy tested positive for SARS-CoV-2 on RT-PCR of a nasopharyngeal swab and were included in the study. Composite adverse maternal outcome was observed in 47/388 (12.1%) women; 43 (11.1%) women were admitted to the ICU, 36 (9.3%) required mechanical ventilation and three (0.8%) died. Of the 388 women included in the study, 122 (31.4%) were still pregnant at the time of data analysis. Among the other 266 women, six (19.4% of the 31 women with first-trimester infection) had miscarriage, three (1.1%) had termination of pregnancy, six (2.3%) had stillbirth and 251 (94.4%) delivered a liveborn infant. The rate of preterm birth before 37 weeks' gestation was 26.3% (70/266). Of the 251 liveborn infants, 69/251(27.5%) were admitted to the neonatal ICU, and there were five (2.0%) neonatal deaths. The overall rate of perinatal death was 4.1% (11/266). Only one (1/251, 0.4%) infant, born to a mother who tested positive during the third trimester, was found to be positive for SARS-CoV-2 on RT-PCR. Conclusions SARS-CoV-2 infection in pregnant women is associated with a 0.8% rate of maternal mortality, but an 11.1% rate of admission to the ICU. The risk of vertical transmission seems to be negligible. (C) 2020 International Society of Ultrasound in Obstetrics and Gynecology.Öğe Obstetrik ve jinekolojik cerrahilerden sonra relaparotomi yapılan hastaların değerlendirilmesi: Tersiyer bir merkezin 5 yıllık deneyimi(Dicle Üniversitesi Tıp Fakültesi, 2021) Gündüz, Reyhan; Ağaçayak, Elif; Tunç, Senem Yaman; Sizer, Mulaim; Yalınkaya, Ahmet; Gül, TalipAmaç: Kliniğimizde relaparotomi yapılan hastaların verilerini retrospektif olarak incelemek, relaparotomi insidansını, endikasyonlarını ve mortalite oranını belirtmektir. Yöntemler: Çalışmamıza çalışma tarihleri arasında kliniğimizde relaparotomi yapılan 47 hasta dahil edildi. Hastaların demografik özellikleri, ilk operasyon endikasyonları ve ilk operasyon sırasında yapılan cerrahi işlem, ilk operasyonun hangi merkezde yapıldığı, relaparotomi endikasyonları ve relaparotomi sırasında yapılan cerrahi işlem, iki operasyon arasındaki süre, verilen kan transfüzyon ürünlerinin sayısı ve relaparotomi sonrası mortalite olup olmadığı not edildi. Kliniğimizin obstetrik ve jinekolojik relaparotomi insidansı ve relaparotomi sonrası mortalite oranı hesaplandı. Bulgular: Çalışmamıza dahil edilen hastaların %89,4’ü obstetrik relaparotomi, %10,6’sı jinekolojik relaparotomi yapılan hastalardan oluşmaktadır. Kliniğimizin obstetrik relaparotomi insidansı %0,1, jinekolojik relaparotomi insidansı %0,06 olarak tespit edildi. Kliniğimizin relaparotomi sonrası mortalite oranını %2,1 (1/47) olarak tespit ettik. Obstetrik relapatomi yapılan hastaların ilk operasyonlarının en sık %81 (34) oranında sezaryen olduğu, endikasyon olarak en sık %23,8 (10) geçirilmiş sezaryen olduğunu tespit ettik. Jinekolojik relaparotomi yapılan hastaların ilk operasyonlarının en sık %80 (4) oranında total abdominal histerektomi olduğu, endikasyon olarak en sık %60 (3) anormal uterin kanama olduğu tespit edildi. Relaparotomi yapılan hastaların hem obstetrik hem de jinekolojik relaparotomilerde en sık endikasyonunun hematom-hemoraji olduğunu belirledik (sırasıyla %64,3 ve %40 oranında). Relaparotomi operasyonunda yapılan işlem olarak hem obstetrik hem de jinekolojik relaparotomilerde en sık olarak hematom boşaltımı- kanama kontrolü yapıldığını tespit ettik (sırasıyla %52.4 ve %40 oranında). Sonuç: Relaparotomi kararı gerekli hazırlıklar yapıldıktan sonra gecikmeden verilmelidir. Risk faktörü olan hastalar önceden bilgilendirilip ilk operasyonlarının mümkün olduğunca üçüncü basamak hastanelerde olmasını önermeliyiz. İlk operasyon sırasında gerekli kanama kontrolünü yaparak relaparotomi ihtiyacını azaltabileceğimizi düşünmekteyiz.Öğe OHVIRA syndrome presenting with acute abdomen findings treated with minimally invasive method: three case reports(Taylor & Francis, 2021) Gündüz, Reyhan; Ağaçayak, Elif; Evsen, Mehmet SıddıkOne of the least common forms of Mullerian anomalies is Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis (OHVIRA). HWWS is also known as OHVIRA syndrome. Patients with OHVIRA syndrome generally present with increasing pelvic pain, dysmenorrhoea, and pelvic mass during puberty, shortly after menarche. These patients may be treated successfully with a minimally invasive method. Case report We present three previously asymptomatic patients with OHVIRA syndrome who presented with acute abdomen shortly after menarche. These patients were treated with a minimally invasive method. Conclusion Patients with OHVIRA syndrome may be treated with minimally invasive method after definitive diagnosis and, laparoscopy and laparotomy should be avoided as much as possible. Minimally invasive treatment modality is not only cost-effective, but also provides symptomatic relief and preserves fertility.Öğe Pregnancy during the Covid-19 pandemic: what an obstetrician needs to know(Aves, 2020) Gündüz, Reyhan; Ağaçayak, Elif; Tunç, Senem Yaman; Gül, TalipIn February 2020, the World Health Organization identified the coronavirus disease 2019 (COVID-19). The virus that causes COVID-19 is known as severe acute respiratory syndrome coronavirus 2. Nations worldwide have reported high death tolls and are adopting measures, particularly in Turkey wherein efforts are made to ensure that pregnant women are minimally affected by this epidemic that has such terrible effects. To date, a total of 206,844 cases have been confirmed in Turkey in approximately 115 days. However, the exact number of pregnant COVID-19 patients in Turkey or worldwide is not yet known. There are no conclusive data that confirm whether pregnant women are at a higher risk of acquiring this infection compared to the rest of the population. It is also not yet known if or how fetuses will be affected by this infection. However, the body of research evidence concerning COVID-19 is rapidly growing, and multiple organizations are constantly updating and expanding resources for interim guidance. In this review, we aimed to summarize the latest available research on COVID-19 virology and epidemiology as well as the status of pregnant healthcare workers together with the reported data on pregnant women and other recent findings and to discuss COVID-19 during pregnancy based on the available data.Öğe Prenatal diagnosis of fetal goiter and successful treatment with intraamniotic levothyroxine: a case report(Perinatal Medicine Foundation, 2024) Yalınkaya, Ahmet; Oğlak, Süleyman Cemil; Gündüz, Reyhan; Ağaçayak, Elif; Yayla, MuratObjective: Fetal goiter is rare and may cause polyhydramnios, fetal growth restriction, and congenital hypothyroidism. We aimed to report a rare case of fetal goiter complicated by polyhydramnios in a pregnant woman. Case(s): A 32-year-old woman with a 32-week pregnancy was referred to us because of polyhydramnios. Ultrasound examination revealed fetal asymmetric growth restriction and severe polyhydramnios. The fetal stomach was smaller, and pharyngeal dilatation and approximately 50x45 mm fetal neck mass (goiter) were observed. Also, mild hypothyroidism was detected in maternal thyroid function tests. In-utero treatment was initiated with 200 µg of levothyroxine injected into the amniotic sac. This treatment was repeated every 10 days for 2 doses following the initial dose. After levothyroxine treatment, fetal goiter and amniotic fluid volume completely recovered until birth. Conclusion: Fetal goiter can be successfully treated with an intraamniotic injection of levothyroxine. © 2024 Perinatal Medicine Foundation.
