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Öğe Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?(Springer Heidelberg, 2011) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, YusufWe designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (chi (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method. Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 a parts per thousand currency sign 3 and Apgar score 5 a parts per thousand currency sign 5) were found to be at significant risk for perinatal mortality (P < 0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively. Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.Öğe Association between adverse perinatal outcomes and amino acid levels measured with nutrient questionnaire in adolescent pregnancies(Lippincott Williams & Wilkins, 2016) Guzel, Ali Irfan; Cinar, Mehmet; Erkilinc, Selcuk; Aksoy, Rifat Taner; Yumusak, Omer Hamid; Celik, Fatma; Celik, YusufBackground: To evaluate the maternal serum amino acid levels in first trimester adolescent pregnancies by using a new developed dietary questionnaire. Methods: A group of 169 pregnant women in the first trimester of their pregnancy were asked to complete the dietary questionnaire. Among all the women, 39 were adolescent pregnancies. The results of the questionnaire were evaluated by a nutrient database program (BeBiS software program) designed to evaluate Turkish traditional foods and commercial processed foods. Results: There was no statistically significant difference between the groups in terms of body mass index and educational and socio-economic status. The mean age and gravidity was statistically significantly lower in adolescent pregnancies. The mean isoleucine, leucine, lysine, methionine, phenylalanine, tyrosine, threonine, valine, arginine, and proline levels were statistically significantly lower in adolescent pregnancies. Receiver operating characteristic (ROC) curve analysis showed the cut-off values of these amino acids. Of these amino acids; lower values of histidine, serine, and alanine were associated with lower birth weight, and lower values of histidine and alanine were associated with preterm delivery. Conclusion: To the best of our knowledge, this is the first study evaluating the amino acid levels in adolescent pregnancies. According to this study, some amino acid levels were lower in adolescent pregnancies and associated with adverse perinatal outcomes. Further studies with maternal and perinatal outcomes are needed to demonstrate the effects of these amino acids in such pregnancies. Copyright (C) 2016, the Chinese Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license.Öğe Chronic Myeloid Leukemia In a Pregnant Woman: A Case Report(Cukurova Univ, Fac Medicine, 2015) Tokmak, Aytekin; Guzel, Ali Irfan; Yalinkaya, AhmetChronic myeloid leukemia (CML) is a rare disease in pregnancy. Our aim is to present a 37 weeks of pregnant woman with chronic myelogenous leukemia. A 27 Years in multigravi (gravida 5, parity: 4), at 37 weeks gestation was admitted with the diagnosis of painful pregnancy and CML. Physical examination findings were normal, complete blood count and peripheral blood smear results were consistent with CML. The patient was diagnosed CML in the 30th week of pregnancy and were treated with hydroxyurea and interferon. Treatment depends on the mother and the fetus did not develop any side effects. Our patient with CML is interesting due to lack of perinatal effects and take the diagnosis at an early age. CML diagnosed during pregnancy requires a multidisciplinary approach and hydroxyurea and interferon treatment on the mother and fetus are at low risk of inducing adverse effects.Öğe Comparison of the risk factors for adverse perinatal outcomes in adolescent age pregnancies and advanced age pregnancies(Studio K, 2012) Kuyumcuoglu, Umur; Guzel, Ali Irfan; Celik, YusufObjectives: To evaluate clinical outcomes of pregnancies in adolescent, advanced and reproductive women maternal age. Materials and methods: A total of 187 pregnant women were included into the study 51 (27.27%) were adolescent pregnancies, mean age 17.7 +/- 3.3 years (range, 14-18 years), 40 (21.29 %) advanced maternal age pregnancies, mean age 41.4 +/- 2.6 years (range, 39-50 years) and 96 (51.33 %), healthy controls, mean age 28.8 +/- 4.3 years (range, 19-37 years). The majority of the adolescent pregnant women were nulliparous, while all of the advanced age pregnant women were multiparous (mean gravidity 4.5 +/- 2.4; range, 6-12). Mean gravidity of the control group was 3.6 +/- 1.7 (range, 1-12). Results: There was statistically significant difference among the groups regarding demographic characteristics. According to the Bonferroni method, there was statistically significant difference among the three groups. Adverse fetal features were statistically different among the groups and the odd ratios were higher in the advanced maternal age group. The odds ratios (95% Cl) for lower Apgar scores (Apgar score 1 and 5) and low birth weight in adolescent maternal age and advanced maternal age group were as follows: 1.88 (127 - 2.78) vs. 2.46 (1.55 - 3.85), 2.17 (1.18 - 4.00) vs. 4.79 (3.02 - 6.69) and 1.39 (1.14 - 1.68) vs. 3.06 (1.59 - 5.88), respectively Gestational age at birth showed minimal risk for adolescent age group but no risk was noted in the advanced age group. Conclusions: The present study showed that pregnancies in adolescent maternal age, advanced maternal age and reproductive maternal age are different from each other in terms of clinical characteristics. According to this study advanced maternal age pregnancies are more risky and more likely to have adverse fetal outcome.Öğe Diagnostic value of screening tests in subgroups of women with recurrent pregnancy loss(Taylor & Francis Ltd, 2015) Guzel, Ali Irfan; Erkilinc, Selcuk; Ozer, Irfan; Celik, Yusuf; Yilmaz, Nafiye; Doganay, MelikeObjective: To evaluate the diagnostic value of screening laboratory tests in women who had recurrent pregnancy loss (RPL). Methods: A total of 252 women with RPL managed in our tertiary referral research and education hospital were included in the study. Risk factors recorded involved age, gravidity, parity, number of prior live births, number of pregnancy losses, and thrombophlia tests. The cases were divided into three different groups and each group was analyzed separately. Results: There was no statistically significant difference between the first and second groups in terms of clinical and laboratory parameters (p>0.05). In the third group, there was a statistically significant difference among cases in terms of parity, gravidity, number of pregnancy losses, serum AT III levels, APCR, and age of the women. According to the logistic regression model, odds ratios (95% CI) were 6.116 (3.797-9.852), 5.665 (2.657-12.079), 4.763 (3.099-7.321), 4.729 (3.080-7.260), 2.820 (1.836-4.333), and 1.911 (1.232-2.965), respectively. Conclusions: We do not recommend the screening of all women with RPL, but in women with high parity and those who had prior live birth pregnancies, increased AT III, and APCR may be diagnostic markers for subsequent pregnancy loss.Öğe Emergency Peripartum Hysterectomy: 16-year Experience of a Medical Hospital(Lippincott Williams & Wilkins, 2010) Yalinkaya, Ahmet; Guzel, Ali Irfan; Kangal, KadirBackground: We conducted this retrospective study to evaluate the outcomes and indications of emergency peripartum hysterectomy (EPH) as a life-saving procedure. Methods: We analyzed a series of 140 cases of EPH, between January 1993 and December 2008 in our clinic, retrospectively. The data were collected from the patients' files. The incidence, demographic characteristics, risk factors, indications and outcomes of hysterectomy, peripartum complications, the operation types, maternal morbidity and mortality and fetal mortality were evaluated. Results: A total of 26,015 of women were delivered. The incidence of EPH was 5.38 per 1,000 deliveries. The mean age was 34.19 +/- 6.04 years (range, 21-49 years), gravidity was 6.84 +/- 3.38 (1-17) and parity was 5.58 +/- 3.04 (0-15). Of the 140 cases, 90 were delivered by cesarean section [29 (20.71%) of these had had a previous cesarean section] and 50 were vaginally delivered. One hundred and five cases had subtotal hysterectomy and 35 had total abdominal hysterectomy. The most common indications for EPH were uterine atony followed by uterine rupture and abnormal placentation. Mean operation time was 142.23 +/- 43.70 minutes. The average blood transfusion was 4.79 +/- 3.36 (1-14) units. Relaparotomy was performed in 23 cases. Maternal mortality was seen in 13 cases. Seventy-nine of the cases delivered at an outside center and were referred to our clinic for the intensive care unit. Sixty-one of the cases delivered at our clinic and 31 had stillbirths. Conclusion: This study suggests that the most common indications for EPH are uterine atony, uterine rupture and abnormal placentation. This is probably due to the advanced age of pregnancies and multiparity in our region. Therefore, we believe that the risk of EPH may be decreased with appropriate and closer prenatal care as well as education of the pregnant women. [J Chin Med Assoc 2010;73(7):360-363]Öğe Factors affecting the degree of hirsutism in patients with polycystic ovary syndrome(Springer Heidelberg, 2012) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, YusufTo investigate the clinical features of patients with polycystic ovary syndrome (PCOS) and compare the patients with hirsutism to those without. In total, 304 consecutive females with PCOS were evaluated. The cases were divided into two groups of hirsute or non-hirsute. The risk factors recorded were age, age at menarche, body mass index (BMI), luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, and total testosterone (tT) levels and hirsutism scores. Statistical analyses were performed using the Student's t test and logistic regression. Of all the cases, 224 were hirsute (hirsutism score a parts per thousand yen8). No significant difference was observed between the groups for age or age at menarche. BMI and hormone levels, including LH, FSH, estradiol and tT, were higher in hirsute patients than those in non-hirsute patients (p < 0.05). The logistic regression model showed that BMI, tT, LH, and estradiol were significant risk factors with odds ratios and 95% confidence intervals of 5.81 (2.22-15.18), 4.57 (2.34-8.90), 2.61 (1.73-3.94), and 2.29 (1.30-4.05), respectively. Hirsute patients with PCOS have different clinical characteristics from those that are non-hirsute in terms of BMI, LH, FSH, estradiol, and tT levels. We also determined the odds ratios of these different parameters. BMI was the most important risk factor for the degree of hirsutism.Öğe Two cases of placental site trophoblastic tumor(Elsevier Taiwan, 2011) Yalinkaya, Ahmet; Guzel, Ali Irfan; Kangal, Kadir; Buyukbayram, Huseyin; Firat, Ugur[Abstract Not Available]Öğe Ultrasound findings in aneuploidy fetusus: Evaluation of 332 cases(Galenos Yayincilik, 2010) Yalinkaya, Ahmet; Guzel, Ali Irfan; Kangal, Kadir; Turkyilmaz, Aysegul; Savas, ZelalObjective: To evaluate the ultrasound findings found on ultrasound examination among cases that had aneuploidy at amniocentesis. Material and Methods: This prospective study was performed at Dicle University, School of Medicine, Department of Obstetrics and Gynecology. 332 cases applied to our department for prenatal diagnosis and amniocentesis (AC) was performed. Of these cases, twenty were found to have aneuploidy evaluated. The factors recorded were; mean age, gestational weeks, AC indications, ultrasound findings (by Toshiba 140A and GE Voluson 730 Pro 4D ultrasound device) and fetal anomalies. Results: 332 cases have had AC by an experienced specialist, in a two year period. The mean age of the cases was 32.20 +/- 6.03 years (22-44), and gestational weeks 16.45 +/- 1.46 (13-19). AC indications were; high double and/or triple test with ultrasound findings and abnormal ultrasound findings. In 8 (2.40%) cases there was no reproduction on cell culture. In 14 (4.21%) cases, different types of chromosomal anomalies were detected. In these cases, peripheral blood was taken from the parents and if, at least in one of them this situation was present, this would be accepted as normal. In 20 (6.02%) cases aneuploidy (numerical chromosomal anomalies) were detected and 11 of them (55.00%) were trisomy 21. In all of these aneuploidy cases, different types of ultrasound findings were detected; most of them had multiple ultrasound findings, and some of them had one anomaly. Of all 20 aneuploidy cases; termination of pregnancy was decided in 17 (85%) of them. 3 (15%) of these cases decided to carry on their pregnancy. Of the 3 cases; one baby was delivered spontaneously and live, one had died in utero and labor was induced and the third pregnancy is ongoing. Conclusion: The importance of ultrasound in fetal anomaly screening is incontrovertible and positive ultrasound findings are the most important indications of amniocentesis. For this reason, before amniocentesis, we advise a detailed ultrasound examination by an experienced specialist.Öğe Vaginal douching practice and related symptoms in a rural area of Turkey(Springer Heidelberg, 2011) Guzel, Ali Irfan; Kuyumcuoglu, Umur; Celik, YusufPurpose To investigate vaginal douching habits and associated factors among women living in rural Turkey. Methods This study was performed in the gynecology department of a government hospital in a rural area of Turkey, from February to March 2010. The study included 393 women admitted to the gynecology clinic. The age, marital status, education, socioeconomic status, reason for vaginal douching, douching frequency, symptoms, and previous treatments were investigated. All of the subjects were asked about the use of, frequency, and reason for vaginal douching. Significant risk factors in the vaginal douching group and odds coefficients were found using binary logistic regression. Results The major symptoms of the subjects were itching and vaginal discharge. Of the 393 women, 317 (80.66%) performed vaginal douching and all of them had recurrent or treatment-resistant mixed agent vulvovaginitis. The majority of the women douched for ritual cleansing or washing before prayer (n = 278; 91.6%). The majority of the cases (n = 354; 90.1%) were of lower socioeconomic and educational status. The odds ratios and 95% confidence interval (CI) of the risk variables vaginal douching frequency, cervical motion tenderness, dyspareunia, and vaginal itching were 9.39 (2.07-42.48), 7.31 (2.08-25.64), 6.52 (2.26-18.78), and 1.46 (1.22-1.74), respectively. Conclusions In our region, vaginal douching is a common practice among women, especially those of lower socioeconomic and educational status. Clinicians should inform patients about the risks of vaginal douching to minimize the risks associated with this behavior.
