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Öğe Centile charts of cervical length in singleton and twin pregnancies between 16 and 24 weeks of gestation(2023) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Çalışkan, 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±38.2 mm and 7.2±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. © 2023 by the Turkish-German Gynecological Education and Research Foundation. Journal of the Turkish-German Gynecological Association is published by Galenos Publishing House.Öğe Do the Levels of cffDNA Fraction Change in Pregnancies with Placental Problems?(2022) Akar, Bertan; Köle, Emre; Özcan, Canan; Çakır Köle, MerveObjective: To investigate the value of the cell free fetal DNA (cffDNA) for determining the important obstetric complications such as preeclampsia, intrauterine growth retardation (IUGR) and, preterm labor other than prenatal screening of fetal aneuploidies. Methods: Our single center- retrospective study included 131 pregnant women in their 10-24th weeks of gestation, between the dates September 2019 and March 2020 who applied for cffDNA analysis (HarmonyTM Prenatal Test; Ariosa Diagnostics Inc., San Jose, Calif., USA) with indications including advanced maternal age (?40) and high risk for trisomy 13.18 and 21 according to the results of the first trimester prenatal screening or solely on their own desire. Results: Oligohydraamnios was observed in 10 (8.1%) patients, gestational diabetes in 10 patients (8.1%), preeclampsia in 7 (8.6%) patients and ablatio plasenta in 2 (1.2%) patients in this study. Increasing levels of the extracellular fetal DNA fractions in 10-24th gestational weeks showed statistically significant correlation for predicting the risk for IUGR (p<0.01). There was not a statistically significant difference between the level of extracellular fetal DNA fractions and the other obstetric complications (preeclampsia, preterm labor, GDM, oligohydraamnios). Conclusion: Although cff-DNA has many valuable implications as a novel biomarker for prenatal screening for special fetal aneuploidies, the association between the levels of cff-DNA and the risk of obstetric complications in clinical practice has not been clarified yet . Further studies should aim to investigate the cff-DNA levels in patients with pathological obstetric conditions in order to detect its potential predictive value and diagnostic implementation.Öğe Female sexual function outcomes in patients operated for pelvic floor dysfunction: Comparison of synthetic mesh with native tissue repair(2023) Akar, Bertan; Köle, Emre; Karagün, Gaye; Aslan, Erdoğan; Çalışkan, ErayObjectives: We aimed to evaluate the impact of urogynecologic mesh implantations on sexual function using female sexual function index (FSFI) questionnaire Materials and Methods: In this cross-sectional retrospective study, a total of 187 patients which found to have pelvic organ prolapse or stress urinary incontinence (SUI) surgery were investigated between 2015 and 2022. Patients whose main complaint was SUI and had tension free vaginal tape operation (n=21) or transobturator tape operation (n=17) constituted the “Midurethral mesh group” (n=38). Those who had cystocele repair with double obturator trapezoid mesh formed the “Cystocele repair with mesh’’ group (n=35). Patients who had cystocele repair with natural tissue repair without any mesh implant in the vagina or elsewhere in the pelvis constituted the “Natural tissue repair’’ group (n=79). The patients were informed about the study and their consent was obtained. Results: The mean time elapsed since surgery till FSFI measurement was 32±6.5 months in Midurethral Mesh group; 34±7.1 months in the “Cystocele repair with mesh group and 33±7 months in the natural tissue repair group (p>0.05). Total FSFI scores 22.8±6.8, 22.2±7.5, 22.5±7.9 and the frequency of patient with scores lower than 26.5, which is the cut-off for disfunction, was 27 (71.1%), 20 (57.1%) and 47 (59.5%) similar in the three groups (p>0.05). The FSFI subdomain scores such as desire, arousal, lubrication, orgasm, satisfaction, pain was similar in the three groups (p>0.05 for all comparisons). Discussion: Our study demonstrated that surgical repair of symptomatic pelvic organ prolapse and SUI surgery using mesh implants or natural tissue repair had similar results of major parameters of sexual function after surgery.Öğe Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral(2022) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Köle, Emre; Çalışkan, ErayObjective: In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists. Materials and Methods: This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or not, before commencing the course and 1 year after attending the course. Results: Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tamponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%). Conclusion: Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.
