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    Association between fetal fraction of cell-free DNA and adverse pregnancy outcomes
    (Springer Heidelberg, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Adiyaman, Duygu; Alkan, Kaan Okan; Ozdemir, Taha Resid
    Purpose To determine the association between fetal fraction (FF) levels in cell-free fetal DNA (cffDNA) testing and adverse pregnancy outcomes. Methods This retrospective cohort study, conducted at a single center, involved 2063 pregnant women with normal 1st and 2nd trimester non-invasive prenatal test (NIPT) results between 2016 and 2021. Pregnancy outcomes were examined by determining the < 4% and < 5th percentile (3.6%) cut-off values for low fetal fraction (LFF). Pregnancy outcomes were also examined by dividing the FF into population-based quartiles. Adverse pregnancy outcomes were pregnancy-induced hypertensive diseases (PIHD), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), intrahepatic cholestasis of pregnancy (ICP), small for gestational age (SGA), large for gestational age (LGA), low birth weight (LBW), macrosomia, and 1st and 5th minutes low APGAR scores (< 7). Results PIHD was significantly higher in LFF (< 4% and < 5th percentile) cases (p = 0.015 and p < 0.001, respectively). However, in population-based quartiles of FF, PIHD did not differ significantly between groups. Composite adverse maternal outcomes were significantly higher in the FF < 4% group (p = 0.042). When analyzes were adjusted for maternal age, BMI, and gestational age at NIPT, significance was maintained at < 4%, < 5th percentile LFF for PIHD, and < 4% LFF for composite adverse maternal outcomes. However, there was no significant relationship between LFF with GDM, ICP and PTB. Additionally, there was no significant association between low APGAR scores, SGA, LGA, LBW, macrosomia, and LFF concerning neonatal outcomes. Conclusion Our study showed that LFF in pregnant women with normal NIPT results may be a predictor of subsequent PIHD.
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    Öğe
    Could magnetic resonance imaging contribute to detecting isolated fetal ventriculomegaly other than additional abnormalities?
    (Soc Peruana Obstetricia & Ginecologia, 2023) Omeroglu, Ibrahim; Golbasi, Hakan; Sever, Baris; Golbasi, Ceren; Oztekin, Deniz; Oztekin, Ozgur; Ekin, Atalay
    Objective: To assess the role of brain magnetic resonance imaging (MRI) in fetuses presenting with isolated ventriculomegaly (IVM) in the ultrasound (US) evaluation of the fetal brain. Methods: US and MRI findings of 197 fetuses diagnosed with IVM between November 2018 and November 2020 were retrospectively evaluated. Fetuses with abnormal karyotypes, additional anomalies, or known etiologies for ventriculomegaly were excluded. US and MRI findings were compared both in terms of mean ventricular measurements and IVM grade. Results: MRI measurements were significantly higher in mild IMV (10.33 +/- 0.38 mm vs. 11.11 +/- 0.51 mm, p< 0.001) compared to US. In mild IVM, MRI measured ventricles larger than US with a mean difference of 0.78 mm. There was no significant difference in US and MRI measurements in terms of mean values in moderate and severe IVM. There was good agreement between US and MRI in detecting right, left and mean IVM severity (Kappa=0.265, Kappa=0.324, and Kappa=0.261, respectively). Linear regression analyses revealed a statistically significant relationship between US and MRI measurements of the right, left, and mean IVM (p<0.001, p<0.001, and p<0.001, respectively). MRI showed perfect agreement with US in detecting IVM laterality (Kappa=1.0, p<0.001). Conclusions: In fetuses with mild IVM detected by US, fetal brain MRI evaluation should be considered for accurate diagnosis. This approach may provide effective strategies in the antenatal management and counseling of these pregnancies.
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    Evaluation of placenta and fetal lung using shear wave elastography in gestational diabetes mellitus: An innovative approach
    (Georg Thieme Verlag Kg, 2024) Bayraktar, Burak; Golbasi, Hakan; Omeroglu, Ibrahim; Golbasi, Ceren; Can, Sevim Tuncer; Ince, Onur; Bayraktar, Miyase Gizem
    Purpose This study aims to investigate placental and fetal lung stiffness in pregnant women with and without gestational diabetes, considering the well-established delay in fetal lung maturation associated with gestational diabetes. Materials and Methods This prospective cohort study was conducted at a tertiary center and included pregnant women who underwent a 75-gram oral glucose tolerance test between 24-28 weeks of gestation. Elastography measurements were performed using point shear wave elastography (pSWE). Results The study included 60 pregnant women diagnosed with gestational diabetes and 60 pregnant women in the control group. The SWE velocity of the peripheral placenta, central placenta, and lung was higher in the gestational diabetes group compared to the control group. Furthermore, the SWE velocity of the peripheral placenta, central placenta, and lung was higher in newborns with neonatal respiratory morbidity. Based on the ROC analysis of patients with gestational diabetes, the AUC for lung SWE velocity was 0.88 (cut-off 12.4 kPa, 95% CI: 0.77-0.99, p<0.001) with a sensitivity of 71.4% and specificity of 95.6% for predicting neonatal respiratory morbidity. Conclusion Fetal placental and lung stiffness increase in fetuses of pregnant women with diabetes. Moreover, higher fetal lung stiffness during the fetal period is associated with increased neonatal respiratory morbidity.
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    Splenic Artery Doppler Waveforms in Gestational Diabetes and Association with Fetal Pancreas: A Prospective Case-Control Study
    (Karger, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Cakir, Zubeyde Emiralioglu; Can, Sevim Tuncer; Pehlivanoglu, Osman Caglar
    Introduction: This study evaluated fetal pancreas size and echogenicity, and splenic artery (SA) waveforms in pregnant women with gestational diabetes mellitus (GDM). Methods: This prospective case-control study was performed from October 2022 to November 2023 and included 124 pregnant women (62 with GDM and 62 controls). Pancreatic circumference, pancreatic echogenicity, umbilical artery Doppler measurements (systolic/diastolic ratio [S/D] and pulsatility index [PI]), SA Doppler measurements (S/D, PI, peak systolic velocity [PSV], time-averaged maximum velocity, and pressure gradient [PG] mean and maximum) values were compared between the GDM and control groups. Results: The mean pancreatic circumference was higher and grade 2/3 echogenicity was more common in the GDM group, while grade 1 echogenicity was more common in the control group (p < 0.001 and p < 0.001, respectively). SA S/D and PI measurements were significantly higher in the GDM group than in the control group (p < 0.001 and p = 0.001, respectively). Moreover, PG(max) was significantly higher in the GDM group than in the control group (p = 0.038). Pancreatic circumference was positively correlated with SA PSV (p = 0.004). Additionally, pancreatic circumference was positively correlated with PG(mean) and PG(max) (p = 0.010 and p = 0.016, respectively). The increase in pancreas echogenicity was positively correlated with SA S/D and PI measurements (p = 0.007 and p = 0.002, respectively). PG(max) was also positively correlated with increased pancreas echogenicity (p = 0.023). Conclusion: This study showed that fetal pancreas size and echogenicity were significantly higher in pregnant women with GDM than in controls. SA Doppler waveforms were consistent with an increase in vascular resistance associated with elevations of both S/D and PI in the GDM group.
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    Third-trimester fetal pancreas imaging in uncomplicated pregnancies and association with pregnancy outcomes
    (Wiley, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Atakul, Bahar Konuralp; Cakir, Zubeyde Emiralioglu; Toka, Ilknur Gumus
    Objective: To examine third-trimester sonographic imaging of the fetal pancreas in uncomplicated pregnancies and its association with pregnancy outcomes. Methods: This was a prospective cohort study including 274 pregnant women. Uncomplicated pregnancies in the third trimester (28-40 weeks) were included in the study. Maternal chronic disease, pregnancy-related disorders such as hypertension, diabetes, cholestasis, smoking, and fetal abnormalities were determined as exclusion criteria. Sonographic fetal pancreatic measurement and echogenicity were evaluated in all participants. For intra-observer reliability, each participant's fetal pancreatic circumference was measured two times. The echogenicity of the pancreas was compared with the liver and ribs and classified as grade 1, 2, and 3. The pregnancy outcomes of all participants were obtained from the hospital digital registration system. Results: The average fetal pancreatic circumference in the third trimester was 70.7 +/- 0.6 mm (median, 70 [44-100.7]), with high intra-observer agreement (ICC 0.996 [0.995; 0.997]). A significant positive correlation was found between pancreatic circumference, body mass index (BMI), gestational age, and birth weight. Pancreatic measurements were significantly higher in composite adverse outcomes cases that included at least one of respiratory distress syndrome, hyperbilirubinemia, neonatal pneumonia, infection, and sepsis (p < 0.001). No relationship was found between pancreatic echogenicity and perinatal outcomes. Conclusion: Fetal pancreas size was positively correlated with gestational age, BMI, and birth weight, and increased fetal pancreas size was associated with composite adverse neonatal outcomes.