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Öğe Can the cell-free DNA test predict placenta accreta spectrum or placenta previa totalis?(Georg Thieme Verlag Kg, 2021) Adıyaman, Duygu; Kuyucu, Melda; Atakul, Bahar Konuralp; Can, Dilara; Özeren, Mehmet; Koç, Altuğ; Öztekin, DenizBackground Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks. Aim To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages. Materials and Methods This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test. Results The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6-10), 6.8 (6.7-10.7), and 7.1 (4.7-9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587). Conclusions According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.Öğe Could laparoscopic cystectomy improve intrauterine insemination with controlled ovarian hyperstimulation outcomes in women with endometrioma?(Via Medica, 2022) Güleç, Ebru Şahin; Öztekin, Deniz; Karaca, Suna YıldırımObjectives: To clarify the effects of laparoscopic cystectomy of endometriomas on intrauterine insemination with controlled ovarian hyperstimulation (COH + IUI) success in women with the disease. Material and methods: We performed a retrospective study with endometrioma patients having at least one patent fallopian tube. The study group consisted of 57 infertile patients with a history of laparoscopic cystectomy who underwent 83 COH + IUI cycles. The control group consisted of 88 patients with endometrioma who underwent 161 COH + IUI cycles without surgery.Results: The total number of antral follicles was significantly lower in the study group than in the control group (10.1 +/- 5.1 vs 11.9 +/- 5.0; p = 0.008). No significant difference was observed in the clinical pregnancy and live birth rates per cycle [(9.6% vs 7.6%; p=0.7175 OR: 1.195% CI: 0.6-2.1) and (7.2% vs 6.2%; p = 0.9544 OR: 1.1 95% CI: 0.5-2.1], respectively) between the operated and non-operated groups. Conclusions: The results of the study show that the presence of an endometrioma with at least one patent fallopian tube does not require any cystectomy before COH+IUI treatment because no improvement was observed in the treatment outcomes of the patients who underwent preceding surgery. We conclude that an operation may be taken into consideration when malignancy cannot be ruled out or severe pelvic pain related to endometrioma cannot be relieved.Öğe Do fetal isolated mild venticulomegaly make any difference in regional ADC values at magnetic resonans imaging?(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2021) Öcal, Zeynep Ayvat; Öztekin, Özgür; Öztekin, DenizObjective: Ventriculomegaly may not only develop secondary to a process,but it may also be in the form of isolated ventriculomegaly with no specific reason. MRI is performed to show the presence of accompanying pathologies.In this study, we measured ADC values in mild ventriculomegaly cases and aimed to investigate the role of ADC value measurements in predicting neurological prognosis in isolated mild ventriculomegaly during MRI. Methods: In our study, ADC values were measured of 37 patients detected to be present with mild ventriculomegaly and 17 fetuses in the control group who had no additional central nervous system patology. For the measurement, ROI was placed in differtent brain regions (frontal lobe white matter,occipital lobe white matter, basal ganglia, thalamus, cerebellum and pons). The analysis of the data obtained was performed using the SPSS (20th version) program. MannWhitney U test was applied. Statistical significance level was set as p<0.05. Results: There was no statistically significant difference between the isolated mild ventriculomegaly and the control group in terms of the mean maternal age (p=0.160). Also, no statistically significant difference was observed between the mean gestational age in the ventriculomegaly group and the control group (p=0.890). There was also no statistically significant difference between ADC measurements in different brain regions in the isolated mild ventriculomegaly and the control group (p=0.807). Conclusion: In order to determine the prognosis in isolated mild ventriculomegaly, other quantitative parameters such as ADC measurement, beyond morphological evaluation and diameter measurement should be determined, and also we need more studies comprising more cases in this field.Öğe İnsan göbek kordonu wharton jölesinden mezenkimal kök hücrelerin eldesinde izolasyon yöntemlerinin ve antioksidatif kültür koşullarının etkisi(2021) Sayın, Özge; Akan, Pınar; Şan, Tuğba; Öztekin, Deniz; Güneş, Mehmet Emin; Ergür, Bekir Uğur; Baysal, Kemalçoğaltılması rejeneratif tıp uygulamalarının ilk aşamalarından biridir. Terapötik amaçlar için in vitro hücre çoğaltmada, mezenkimal kök hücreleri (MKH)’ nin muhtemelen oksidatif stresi içeren erken yaşlanmaya hızla girmeleri önemli bir sorundur. Klinikte tedavide en yaygın kullanılan hücreler, kemik iliği MKH (Kİ-MKH) olmakla birlikte, göbek kordonu çevresinde yer alan Wharton jölesi MKH (WJ-MKH)’ nin invaziv olmayan şekilde elde edilebilmeleri, doku reddine yol açan proteinleri eksprese etmemeleri ve immünosupresif özellikleri nedeni ile Kİ-MKH’ nden daha kullanışlı olabilecekleri ileri sürülmektedir. Çalışmamız ile WJ-MKH’nin eldesi ve çoğaltılmasında kullanılan izolasyon yöntemlerinin etkinliğinin karşılaştırılması ve anti-oksidatif kültür koşullarının hücre canlılığı ve kök hücrelere özgü yüzey antijen ekspresyonlarına etkisinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmaya dahil etme kriterlerine uyan toplam 17 sağlıklı gebeden doğum sonrası kordon örnekleri alındı. Wharton jölesinden enzimatik ve eksplant yöntemi ile kök hücreler elde edilerek, hücre canlılıkları ve proliferasyon kapasiteleri karşılaştırıldı. Bulgular: Kök hücrelerin, osteoblastlara, kondrositlere ve adipositlere farklılaşma kapasiteleri immunohistokimyasal olarak gösterildi. Hücrelerin çoğaltılması sürecinde CD44, CD73, CD90, CD105 yüzey antijenlerinin dördüncü pasaja kadar anlamlı değişmeden eksprese edildiği saptandı. Antioksidan moleküller N-asetil sistein ve askorbik asit ilavesi ile sağlanan kültür koşullarının hücre canlılığı ve hücre yüzey antijen ekspresyonları üzerine etkisi gösterildi. Sonuç: Wharton jölesinden MKH’lerin izolasyonunda eksplant yönteminin yüzey antijen ifadeleri anlamlı değişmeksizin, daha kısa zaman diliminde elde edilen toplam hücre sayısı nedeni ile enzimatik yönteme göre daha avantajlı olduğu sonucuna varıldı.Öğe Maternal and neonatal outcomes of couvelaire uterus(2021) Ileri, Alper; Karaca, Suna Yildirim; Öztekin, Deniz; Umut, Fethiye; Şenkaya, Ayşe Rabia; Aytaç, HakkıCouvelaire uterus is a life-threatening condition in which placental abruption causes bleeding that penetrates the uterine myometrium. The objective of this study was to determine the risk factors of Couvelaire uterus and maternal and neonatal outcomes. Obstetrics emergency clinic data between January 2013 – December 2019 were screened and placental abruption patients confirmed by pathology or surgery note were recruited. Patients were divided into two groups; with or without Couvelaire uterus. Clinical features; such as maternal age, gravida, parity, gestational age at delivery, comorbidities, chief complaint, ultrasonography examination, placental pathology, degree of placental separation, DIC (disseminated intravascular coagulation), required hysterectomy and transfusion, maternal hemoglobin, maternal or fetal ICU (intensive care unit) admission, neonatal birth weight, APGAR 1’ and 5’ scores were compared. Age, gravida, and parity were significantly higher in patients with couvelaire uterus (p<0.001, p=0.017, p=0.034 respectively). The degree of placental separation was significantly larger and APGAR 1’ and 5’ scores significantly lower in the Couvelaire uterus group (p <0.001). Incident of Couvelaire uterus increases with higher age, gravida, and parity. Neonatal APGAR scores were lower and intrauterine fetal death rates were higher in Couvelaire uterus patients.Öğe Risk factors and prevalance of postpartum depression during the COVID-19 pandemic ın a universıty hospital in western Turkey: a crosssectional study(2022) Kurtulmuş, Seçil; Şahin, Zekiye; Güleç, Ebru Şahin; Adıyaman, Duygu; Öztekin, DenizAim: This study aimed to examine the prevalence and risk factors of postpartum depression in a university hospital in Turkey during the COVID-19 pandemic. Methods: A cross-sectional study was performed from November 2020 to December 2020. Totally 517 women, who are all in the first month of the postpartum period were evaluated by using the Edinburgh Postpartum Depression Scale (EPDS). A total score equal to or above 13 was accepted as PPD. Multivariant regression analysis was used to identify factors associated with PPD during the pandemic. Results: The prevalence of PPD was 15.7%. Patients who were delivered by the vaginal route, who were at earlier gestational age at delivery, and who needed neonatal intensive care unit (NICU) care for their babies were significantly more likely to develop PPD. The risk of PPD during the COVID-19 pandemic was 5.5 times higher in patients who had a previous depressive episode. The PPD risk was 44% lower in women who properly attend regular antenatal care visits. Conclusion: Identification of pregnant women who had a previous depressive episode in their first prenatal visit and ensuring regular attendance of pregnant women to antenatal care visits may help early detection of women who are at high-risk for PPD and taking timely preventive approaches.Öğe The role of fetal MRI-based texture analysis in differentiating congenital pulmonary airway malformation and pulmonary sequestration(Galenos Yayincilik, 2022) Sarioilu, Orkun; Sarioilu, Fatma Ceren; Atakul, Bahar Konuralp; Öztekin, Deniz; Oztekin, OzgurAim: The purpose of our study was to evaluate the diagnostic performance of fetal magnetic resonance imaging (MRI)-based texture analysis (TA) to differentiate the two most common lung malformations, congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS). Materials and Methods: This retrospective single-center study included 24 patients with CPAM and 8 patients with PS who had a fetal MRI examination between January 2015 and December 2020. T2-weighted coronal images were used for TA. One reader designated the malformation borders and drew a region-of-interest for TA. The differences in values of the texture features between the groups were assessed and receiver operating characteristic curves were calculated for each statistically significant feature. P-value<0.05 was considered statistically significant. Results: Forty-eight texture features were calculated for each malformation. Twenty features on T2-weighted images were significantly different between the CPAMSs and PSs. Among these, short-run high gray-level emphasis and long-run emphasis, which are gray-level run length matrix features parameters, had the largest area under the curves: 0.956 (sensitivity 87%, specificity 95%) and 0.943 (sensitivity 87%, specificity 85%), respectively. Conclusion: Our results suggest that fetal MRI-based TA may be used to distinguish CPAMs from PSs in fetuses with uncertain pulmonary findings prior to birth.Öğe The role of the fetal MRI to predict the postnatal survival in fetuses with congenital diaphragmatic hernia(Dr Behcet Uz Cocuk Hastaliklari Ve Cerrahisi, 2021) Sarioğlu, Fatma Ceren; Sarıoğlu, Orkun; Yılmaz İnci Turkan; Atakul, Bahar Konuralp; Öztekin, Deniz; Öztekin, ÖzgürObjective: To assess the role of the magnetic resonance imaging (MRI) to predict the postnatal survival in patients with congenital diaphragmatic hernia (CDH). Method: 25 patients with CDH who had fetal MRI between 2015 and 2020 were enrolled in this retrospective study. Patients were divided into two groups according to the postnatal survival at 30 days of age: alive and dead. The fetal MRI images were assessed to calculate the lung-to-liver signal intensity ratio (LLSIR), and the total lung volume (TLV). In addition, the site of the defect (right or left), accompanying liver herniation (present or absent), detectable-ipsilateral lung parenchyma at the apex (present or absent) were also recorded. MRI images were evaluated by two pediatric radiologists. A p value lesser than 0.05 was considered statistically significant. Results: Among 25 fetuses, 6 were alive and 19 were dead within 30 days after birth. The detectable lung parenchyma had a relationship with the alive group (p = 0.023). Observed-to-expected TLV (p = 0.001) and LLSIR (p = 0.023) were significantly lower in the dead group. Using the cutoff values for the observed-to-expected TLV as 0.27 (a sensitivity of 84%, a specificity of 84%) and for the LLSIR as 2.02 (a sensitivity of 89%, a specificity of 67%) were found as predictors for death. Conclusion: The postnatal survival in CDH may be predicted using the observed-to-expected TLV and LLSIR on the fetal MRI. The presence of the detectable-ipsilateral lung parenchyma at the apex may also be associated with the postnatal survival.
