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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 ÇOCUKLAR İÇİN ÖZEL GEREKSİNİM RAPORU (ÇÖZGER)’NA BAŞVURAN OLGULARIN PSİKİYATRİK TANI VE ÖZEL GEREKSİNİM DÜZEYLERİNİN ÖNCEKİ YÖNETMELİKTEKİ TANI VE ÖZÜR ORANLARI İLE KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA(2022) Akar, Bertan; Doğan, Ozan; Köle, Emre; Caliskan, ErayAmaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (p<0,001) (sırasıyla %50,9'a karşı %22,4, %41.5'e karşı %19,8, %29,2'ye karşı %10,3) ). İmplantasyon, spontan abortus, çoğul gebelik ve kimyasal gebelik oranları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Sonuç: Bu çalışma, intralipid tedavisinin, sadece standart IVF protokolü uygulanan hastalara kıyasla RIF'li hastalarda daha iyi gebelik sonuçlarına sahip olduğunu ortaya koymuştur. RIF'li hastalarda intralipidin rutin kullanımını önermek için daha ileri prospektif çalışmalara ihtiyaç vardır.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 Expectant management vs. cerclage in cases with prolapsed or visible membranes in the second trimester: is 24 weeks gestation threshold critical?(Walter De Gruyter Gmbh, 2024) Kole, Emre; Akar, Bertan; Dogan, Yasemin; Yalcinkaya, Leylim; Doger, Emek; Caliskan, ErayObjectives: The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes. Methods: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks. Results: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 +/- 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 +/- 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 +/- 48.6 days [Median=28 (3-138)] vs. 12 +/- 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2). Conclusions: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.Öğe Female Sexual Function Index Outcome After Posterior Vaginal Tightening Approach and Anterior Cervical Ring Repair when Indicated(Springer, 2025) Kole, Emre; Akar, Bertan; Deniz, Alparslan; Kole, Merve Cakir; Aslan, Erdogan; Caliskan, ErayBackgroundFemale sexual dysfunction is believed to be associated with pelvic floor dysfunction in most cases. However, correcting prolapse does not always necessarily correct sexual function. The reason for this might be secondary to disregarding anatomically relevant structures during surgical interventions. We aimed to demonstrate that posterior vaginal tightening approach avoiding anteriorly located structures, such as clitoral complex, would yield better results in terms of sexual function.MethodsFifty-seven postmenopausal women with primary complaints of vaginal laxity and Grade I and II prolapse were operated. All patients received posterior vaginal tightening operation, and a cervical ring repair was utilized when indicated (n:25). Perineal repair was done if there was any defect (n:13). Levator plication is not done in any patients. FSFI (Turkish Version) was applied to each patient prior to surgery and at 6th month postoperatively. A Likert-type scale is also utilized to assess the patient satisfaction from the procedures.ResultsAll the domains and the total score of FSFI were observed to be improved. Only the improvement in the pain domain scores was not statistically significant. Satisfaction of the patients from the surgery on a Likert scale was so as to: very satisfied 27 (47.4%), satisfied 12 (21.1%), neither satisfied nor dissatisfied 8 (14%), dissatisfied 5 (8.8%), very dissatisfied 1(1.7%).ConclusionSexual function of women with vaginal laxity can be improved when vulvovaginal erotogenic complex is not disrupted. This can be achieved via a posterior approach while maintaining successful anatomic correction of both posterior and anterior compartments.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.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 Importance of Structural Abnormalities Detected by Array-Comparative Genomic Hybridization in Recurrent Miscarriage: A retrospective Study(Aydin Adnan Menderes University, 2023) Akar, Bertan; Köle, Emre; Akkoyunlu, Deniz Sünnetçi; Köle, Merve Çakır; Çine, Naci; Savlı, Hakan; Çalışkan, ErayObjective: Chromosomal anomalies are among the most important risk factors of recurrent miscarriage. In 5.5% of the cases, one of the parents has cytogenetic anomaly in contrast to 0.55% of the general population. Recent literature data have used a?CGH for detection of cause of abortion, but there are few studies specifically conducted to evaluate the correlation of chromosomal rearrangement and recurrent miscarriages; yet there is no clear evidence on this issue. In this study, we aimed on the correlation of chromosomal rearrangement in couples with unexplained recurrent miscarriage by a-CGH. Methods: The karyotyping and aCGH data of 74 patients with more than five abortions were analyzed retrospectively. Cell cultures, harvesting, and G-banding at the level of 400-550 bands for karyotyping were performed following standardized procedures. The extracted maternal or paternal DNA concentration and quality were measured with the spectrophotometer and gel electrophoresis, respectively. Results: A total of 74 patients, 50 women with male partners of 24 were included in the study. The results of a-CGH were normal for 22 males (91.7%) and 46 females (92%) and the distribution of the normal patients were not significant between the genders when patients with duplication and deletion anomalies (Duplication: 4q12, 2(p15-p14), 17q12; Deletion: 1(q21.1-q21.2), 16p11.2, Xp22.31) were compared (p > 0.05). Conclusion: The maternal and paternal aCGH analysis yielded low rate of duplication and deletion anomalies of the chromosomes. The clinical significance of the yielded abnormalities need to be evaluated for patient consultation.Öğe Is it possible to predict severe postpartum hemorrhage and the need for massive transfusion in placenta previa cases?(Via Medica, 2025) Kole, Emre; Akar, Bertan; Doger, Emek; Kole, Merve Cakir; Anik, Yonca; Caliskan, ErayObjectives: The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI). Material and methods: Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The placenta accreata index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage (> 2000 mL) and massive transfusion [> 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically. Results: In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy. Conclusions: Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.Öğe KALİTELİ EMBRİYO TRANSFERİNE RAĞMEN BAŞARISIZ IVF SİKLUSU OLAN KADINLARDA İN VİTRO FERTİLİZASYON (IVF) TEDAVİSİ BOYUNCA İV LİPİD (SMOFLIPID®) KULLANIMININ ETKİSİ: VAKA KONTROL ÇALIŞMASI(Kocaeli Üniversitesi, 2022) Akar, Bertan; Doğan, Ozan; Köle, Emre; Çalışkan, ErayAmaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntemler: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (pÖğe 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.
