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2015perinatal Kabul:Poster
Toplam: 129
[PP-001]
Influence of Maternal BMI on Sonographic Fetal Weight Estimation Prior to
Scheduled Delivery
Hüseyin Aksoy1, Ülkü Aksoy2, Özge Idem Karadağ3, Burak Yücel3, Turgut Aydın3, Mustafa Alparslan
Babayiğit4
1
Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey
2
Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey
3
Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey
4
Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara,
Turkey
Objectives: To investigate the possible effect of maternal obesity on the accuracy of
sonographically estimated fetal birth-weight in the third-trimester shortly before induction of labor
and to compare the accuracy of the estimation between normal weight, overweight, and class I,
classII and class III obese groups.
Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal
weight estimation prior to scheduled delivery. Women were classified by their current BMI into five
categories: normal, overweight, obese Class I, obese Class II and obese Class III. Estimated fetal
weight (EFW) was compared with the actual birth weight (ABW) and the difference between the
EFW and the ABW (simple error) was recorded as error in grams.
Findings: The final study included a total of 198 subjects. The mean absolute error for sonographic
fetal weight estimations was 106.97±80.83, 198.88±124.32, 248.82±122.75, 308.31±138.97 and
446.00±151.46 g, in groups, respectively (p<0.001). The mean absolute percentage error for
sonographic fetal weight estimations was 3.51±2.76, 6.37±3.91, 7.93±4.81, 9.87±4.32 and
14.06±5.83 in groups, respectively (p<0.001).
Conclusions: Our study showed that increasing maternal obesity decreases the accuracy of
sonographic fetal weight estimations. Clinicians should be aware of the limitations of sonographic
fetal weight estimation in especially obese patients.
Keywords: body mass index, fetal weight, obesity, ultrasonography
[PP-002]
Sonographic fetal weight estimation prior to delivery: analysis of interobserver
variability and accuracy
Hüseyin Aksoy1, Ülkü Aksoy2, Fulya Çağlı3, Özge Idem Karadağ4, Gökhan Açmaz3, Mustafa
Alparslan Babayiğit5, Turgut Aydın4
1
2
3
Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine,
Kayseri, Turkey
4
5
Turkey
Objectives: To evaluate the interobserver reliability of sonographic fetal weight estimation between
two experience sonographers prior to delivery. We also sought to compare the sonographic EFW
accuracies of operators.
Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal
weight estimation prior to scheduled delivery. Two experienced sonographers performed all
examinations prior to delivery. Sonographic fetal weight estimatios were obtained by each
ultrasonographic examination. Estimated fetal weight (EFW) was compared with the actual birth
weight (ABW) and interobserver reliability of sonographic fetal weight estimation between two
sonographers were assessed.
Findings: The final study included a total of 245 subjects. Inter-observer reliability coefficients with
95% confidence intervals for sonographic EFW was 0.864 (0.825-0.894, p<0.001). The median
absolute error for sonographic EFW obtained by radiologist and obsterician was 192 (5-862) and
160 (0-590) g, respectively (p < 0.01). The median absolute percentage error for sonographic EFW
obtained by radiologist and obsterician was 5.7 (0.1-26.9) and 5.0 (0-19.4), respectively (p<0.01).
Conclusions: Our study showed that interobserver reliability and agreement for sonographic EFW in
third-trimester shortly before the delivery were quite high. However, significant difference between
sonographic EFW accuracies of both operators was found.
Keywords: interobserver reliability, fetal weight estimation, ultrasonography
[PP-003]
Effect of Threatened Miscarriage on Maternal Mood: A Prospective Controlled
Chort Study
Hüseyin Aksoy1, Ülkü Aksoy2, Özge Idem Karadağ3, Yunus Hacımusalar4, Gökhan Açmaz5, Gülsüm
Uysal5, Fulya Çağlı5, Burak Yücel3, Turgut Aydın3, Mustafa Alparslan Babayiğit6
1
2
3
4
Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey
5
Kayseri, Turkey
6
Turkey
Objectives: The aim of this prospective case-control study was to investigate the possible
relationship between anxiety, depression and threatened abortion (TA) and compare the
prevalence of anxiety and depression levels in pregnant women complicated with and without TA.
Methods: Between September 2013 and August 2014, 94 consecutive women with TA who were
hospitalized and 120 healthy pregnant women without any signs and symptoms of miscariage,
were included in the study. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI)
were administered to patients during the psychiatric interview.
Findingss: The mean BAI scores in TA study and healthy control groups were 18.90±10.52 and
8.24±5.24, respectively (p<0.001). The mean BDI scores in TA study and healthy control groups
were 18.07±8.49 and 7.47±6.22, respectively (p<0.001).
Conclusions: The findings of this study indicated a potential link between TA and anxiety and
depression disorders. Therefore, patients with TA during pregnancy should be evaluated in terms of
anxiety and depression disorders as much as their medical conditions. Medical professionals should
be sensitive to psychological consequences of TA.
Keywords: abortion, depression, miscarriage, pregnancy
[PP-004]
Maternal Anxiety and Depression Levels in Patients with Hyperemesis
Gravidarum: A Prospective Case-Control Study
Uysal5, Fulya Çağlı5, Burak Yücel3, Turgut Aydın3, Mustafa Alparslan Babayiğit6
1
2
3
4
5
Kayseri, Turkey
6
Turkey
Objectives: The aim of this prospective case-control study was to investigate the possible
relationship between anxiety, depression and HG and compare the prevalence of anxiety and
depression disorders in pregnant women with and without HG.
Methods: A prospective case–control study was performed at our tertiary referral centre. The study
group consisted of 78 pregnant women with HG and 82 healthy pregnant women, constituted our
control group. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory (BDI) were administered
to patients during the psychiatric interview.
Findings: The mean BAI and BDI scores in HG study and healthy control groups were 19.47±10.92
and 7.30±5.35, respectively. The mean BDI scores in HG study and healthy control groups were
18.97±9.85 and 6.36±5.61, respectively (p<0.001). A total of 44 (56.4%) women in HG group had
BAI score of >=16 and were classified as moderate or severe anxiety disorder. A total of 8 (9.7%)
women in healthy control group had BAI score of >=16 and were classified as moderate or severe
anxiety disorder. Among the 78 women in the HG study population, 42 (53.9%) of patients had
moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate
or severe depression.
Conclusions: The findings of this study indicated a possible relationship between HG and anxiety
and depression disorders. Therefore, patients with HG during pregnancy should be evaluated in
terms of anxiety and depression disorders as much as their medical conditions.
Keywords: anxiety, depression, hyperemesis, pregnancy
[PP-005]
Hyperemesis and Threatened Abortion in early pregnancy: relationship with
anxiety and depression and review of the literature
Uysal5, Fulya Çağlı5, Turgut Aydın3, Mustafa Alparslan Babayiğit6
1
2
3
4
5
Kayseri, Turkey
6
Turkey
Objectives: This study evaluated the current state of anxiety and depression levels in patients with
HG and TA and compared the prevalence of anxiety and depression levels with healthy pregnant
controls. The aim of this prospective case-control study was to investigate the possible relationship
between anxiety, depression and HG and TA and compare the results with healthy pregnant
controls.
Methods: A prospective case–control study was performed at our tertiary referral centre. 84
consecutive women with HG and 88 consecutive women with TA constituted our study group and
98 healthy pregnant women constituted our control group. Structured Clinical Interview for
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I), was used
to evaluate the anxiety and depression. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory
(BDI) were administered to patients during the psychiatric interview and were evaluated by the
same psychiatrist.
Findings: The mean BAI scores in HG, TA and healthy control groups were 17.34 ± 8.97, 17.23 ±
8.71 and 7.03 ± 5.45, respectively. The mean BDI scores in HG, TA and healthy control groups
were 15.54 ± 7.81, 16.27 ± 6.72 and 6.68 ± 5.28, respectively.
Conclusions: The findings of this study indicated a potential link between HG, TA and anxiety and
depression disorders.
Keywords: anxiety, depression, hyperemesis, pregnancy, threatened abortion
[PP-006]
Decreased pain expectation lowers labour pain experience
Hüseyin Aksoy1, Ülkü Aksoy2, Burak Yücel3, Gökhan Açmaz4, Turgut Aydın3, Mustafa Alparslan
Babayiğit5
1
2
3
4
Kayseri, Turkey
5
Turkey
Objectives: The pain that women experience during labour is highly modifiable by psychological
factors, including expectations. Positive expectations of patients could decrease any decisional
difficulties. There is a lack of studies evaluating the correlation between pain expectation and
labour pain. The present study was aimed to assess the relationship between pain expectation
before labour, labour pain and pain perception after the labour in this study.
Methods: Five hundred and twelve pregnant women followed for spontaneous vaginal delivery were
included to the study. Patients were asked to rate their pain level on a standard continuous 100mm a visual analog scale (VAS) pain score at various time points: Pain expectancy(PE), labour pain
(LP) and postpartum pain perception (PPP) scores were calculated.
Findings: The final study group was composed of 230 subjects after exclusions. Mean age of
participants was 26.20±5.79. The mean PE, LP, and PPP scores were 7.01±1.88, 7.57±1.9 and
6.58±1.95, respectively. The difference among pain scores was statistically significant (p<0,001).
There was a positive correlation between PE and LP or PPP scores (.270 and.208, respectively) and
the correlations were statistically significant (p<0,001).
PPP scores decreased with the decrement of LP scores. There was a positive correlation between LP
and PPP scores (.869). The correlation was statistically significant (p<0,001).
Conclusions: Our study showed that, reducing pain expectations of pregnant women could
decrease their pain experience during labour. Thus, multiple tools, such as education programs,
relaxation, meditation, etc. that are aimed to decrease pain expectations of pregnant before
delivery is essential and critical.
Keywords: Labor pain, pain management, visual analog pain scale
[PP-007]
Relationship Between Maternal C- Reactive Protein Level and Neonatal Outcome
in Patients with Preterm Premature Rupture of Membranes
Mehmet Serdar Kutuk1, Osman Bastug2, Ahmet Ozdemir2, Mehmet Adnan Ozturk2, Mahmut Tuncay
Ozgun1, Mustafa Basbug1, Tamer Gunes2, Selim Kurtoglu2
1
Erciyes Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD
2
Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı
Objective To assess the relationship between maternal C- reactive protein (CRP) level
measured within 48 hours before delivery and neonatal outcome in pregnant women with
preterm premature rupture of membranes (PPROM) who were managed conservatively.
Methods: We retrospectively rewieved medical records of 70 singleton pregnancies with
PPROM with gestational ages between 24 and 34 weeks at the time of rupture of membrane. On
the basis of antepartum CRP levels, patients were categorized into two groups (Group1: CRP <=
6mg/ L, N: 31, Group 2: CRP> 6mg/L, N: 39).The groups were
compared with regard to demographic characteristic, antenatal complications, postnatal
morbidity and mortality.
Results: The two group were similiar with regard to baseline demographic data. The mean
birth weight was higher in Group1 (p: 0.041). The overall neonatal mortalitiy was 10% (7/70). The
two groups were similiar for other neonatal complications and overall
neonatal mortality, and composite morbidity (Table 1). The most important difference between
neonates with good outcome and poor outcome were birth weight and gestational age at birth
(Table 2). There was no correlation between antenatal CRP levels and postnatal infectious
morbidity.
Conclusion: Elevated level of CRP within 48 hours of delivery is a poor predictor of
postnatal outcome.
Keywords: Premature rupture of membranes, C- reactive protein, postnatal outcome, neonatal
sepsis
[PP-008]
Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating The Vein of
Galen Aneurysmal Malformation
Mehmet Serdar Kutuk1, Selim Doganay2, Ahmet Ozdemir3, Sureyya Burcu Gorkem2, Mehmet Adnan
Ozturk3, Mustafa Basbug1
1
2
Erciyes Üniversitesi, Tıp Fakültesi, Radyoloji AD, Pediatrik Radyoloji Bilim Dalı
3
Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı
26 years old primigravida referred for intracranial cyst, and cardiomegaly. Transabdominal
ultrasonography (US) showed vein of Galen aneurysmal malformation (VGAM), and mild
cardiomegaly (Figure 1). Follow- up US at 32 weeks showed progressive cardiomegaly, and heart
failure. At 34 weeks, US revealed a hyperechogenic, homogenous mass that was measured
25x25x31mm, at left suprarenal region. The mass had a spherical shape with a central stripe as
the character of a normal adrenal gland but with greater thickness(Figure 2). No vascular flow was
detected inside the mass by power Doppler study. Fetal magnetic resonance imaging (MRI)
confirmed the sonographic diagnosis. The baby was delivered at 37 weeks by cesrean section, and
died of severe heart failure at postpartum 18th hours. Postnatal MRI confirmed the prenatal
diagnosis (Figure 3). Adrenal hemorrhage can complicate VGAM in fetuses with severe heart
failure. Evaluation of the surrenal gland in affected cases may contribute to the prenatal
counselling, and postnatal management.
Keywords: Adrenal hemorrhage, Vein of Galen Aneurysmal Malformation, ultrasonography,
prenatal diagnosis
[PP-009]
Evaluation of Fetal Anterior Abdominal Wall Thickness in Gestational Diabetic
Pregnancy: A Prospective Case-Control Study
Hüseyin Aksoy1, Ülkü Aksoy2, Sezin Özyurt3, Özge Idem Karadağ4, Turgut Aydın4, Mustafa
Alparslan Babayiğit5
1
2
3
Kayseri, Turkey
4
5
Turkey
Objectives: To investigate patients with gestational diabetes mellitus (GDM) with regard to fetal
anterior abdominal wall thickness (AAWT) and other fetal biometric measurements, such as
biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal
weight (EFW), and to compare the results with healthy pregnant controls.
Methods: A total of 124 pregnant women between 26 and 28 weeks’ gestation were included in the
study. These patients were divided into two groups based on their 75-g oral glucose tolerance test
(OGTT) results. The study group consisted of 55 pregnant women with GDM, and 69 healthy
pregnant women constituted our control group. Each subject underwent a one-step approach using
a 75-g OGTT and an obstetric ultrasound examination. The fetal biometrical measurements (BPD,
FL, AC, and EFW) and AAWT were obtained from the ultrasonographic examinations.
Findings: The study groups did not differ with respect to the mean BPD, FL, AC, and EFW;
however, the mean AAWT was significantly higher in the GDM group, 4.07 ± 0.46 mm versus 3.28
± 0.37 mm in the control group (p < 0.001).
Conclusions: The only fetal sonographic measurement found to significantly differ between the
study groups was the AAWT, suggesting that measuring the AAWT may have a role in the
evaluation of fetal growth in pregnancies complicated by gestational diabetes. Clinicians should be
aware of the limitations of traditional fetal biometric parameters in the detection of early fetal
growth changes in patients with GDM.
Keywords: abdominal wall thickness, gestational diabetes, ultrasonography
[PP-012]
Erken Doğum Riski Olan Gebelerde Servikal Pesser Uygulaması Sonuçları:
Başkent Üniversitesi Deneyimi
Çağrı Gülümser, Nihal Uysal Şahin, Mehmet Tunç, Filiz Bilgin Yanık
Başkent Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Ankara
GİRİŞ-Amaç: Erken doğum riski yönetimi ve tedavi yöntemleri, sonuçları bakımından henüz tatmin
edici bir seviyede değildir. Güncel olarak servikal serklaj uygulanması, progesteron tedavisi ve
servikal pesser uygulaması farklı hasta gruplarında yaklaşık olarak aynı başarı şansına (%40)
sahiptir. Bu riski taşıyan her hastaya her tedavi yöntemi uygun mudur? Hangi hastaya, hangi
tedavi seçilmelidir? Tedavi seçenekleri kombine edilebilir mi? Her birinin etki mekanizmaları
nelerdir? Çoğul gebeliklerde başarı oranları nelerdir? Tedavide ki başarı şanslarını arttırmak
mümkün müdür? Soruları halen kanıta dayalı olarak cevaplanamamıştır. Bu çalışmamızda Başkent
Üniversitesi Kadın Hastalıkları ve Doğum Bölümü Perinatoloji Ünitesinde erken doğum riski taşıyan
hastalardan ve belirli kriterlere uyanlar hastalarda servikal pesser uygulamasının başarı oranı,
komplikasyonları, doğumu ne kadar süre geciktirebildiği, gebelik boyunca ve sonrasında anne ve
yenidoğan mortalite ve morbiditesine etkilerinin araştırılması amaçlanmıştır.
Method: Başkent Üniversitesi Ankara Hastanesi'nde 2013-2014 yıllarında Perinatoloji Bölümüne
yüksek riskli gebelik olarak başvuranlardan, ikinci trimesterde transvajinal ultrasonografi (TVUSG)
ölçümünde servikal uzunluğu 25mm altında ölçülen, erken doğum riski tespit edilen gebelerden
servikal pesser takılan hastalar çalışmaya dahil edildi. Daha önce servikal invaziv işlem geçirenler,
servikal uzunluğu 10mm’nin altında ölçülenler, obstetrik hikayesinde üçden daha fazla ikinci
trimester gebelik kaybı olanlar, servikal yerleşimli myomları olanlarda pesser uygulanmadı. Servikal
pesser uygulanan toplam 18 hastanın demografik özellikler, antepartum risk faktörleri, pesser
takıldığı gebelik haftası, doğum haftası ve şekli, progesteron ya da kullandığı diğer ilaçlar, fetal
akciğer maturasyonu için steroid yapılıp yapılmadığı, tokoliz uygulanıp uygulanmadığı ve yenidoğan
sonuçları değerlendirildi. Erken doğum riskinde pesser uygulamasının etkinliği, gebe ve yenidoğan
mortalite ve morbiditesine olumlu katkı sağlayıp sağlamadığı istatistiksel olarak değerlendirildi.
Bulgular: Hastaların yaş ortalaması 34,25±5,29, ortalama parite 0.11 ±0,3 idi. Pesser uygulandığı
gebelik haftasında (ortalama= 24,93 ±3,71, 19-32 min-max) servikal uzunluk ortalaması
18,44±2.5 (15mm-24mm min-max) ortalama doğum haftaları 33.1±4,1 idi. Pesser takılması ile
doğum haftası arasındaki latent süre 8.13±4.4 (27-38 min-max) idi. Toplam 5 hasta 34 hafta
altında doğdu. Bu beş hastada doğuma kadar olan latent sürenin ortalaması 5 hafta idi. Bunlardan
sadece bir gebe 27. gebelik haftasında, şiddetli TTTS (ikizden ikize transfüzyon sendromu) olduğu
için erken doğurtulmak zorunda kalındı. Diğer dördü 28. gebelik haftası üzerinde doğum yaptılar.
Tüm hastalar içinde halen iki hastanın gebelikleri devam etmekteydi. Geri kalan 11 hasta ise 34
hafta üzerinde doğum yaptılar. Toplam dört hasta normal spontan doğum yaptı. Hastaların %67'si
(n=12) ikiz gebelikti. Hastaların %28’i spontan yolla, geri kalanları yardımcı üreme teknikleri ile
gebe kalmışlardı. Hastaların %83,3’ünde (n=15/18) doğuma kadar haftalık 250mg
intramüsküler(IM) depo progesteron uygulandı. Hastaların %22’sinde (n=4/18) antibiyok kullanıldı.
Bir hasta dışında tüm hastalara 24. Haftadan sonra 24 saat ara ile tek doz IM steroid uygulandı.
Hastaların %50’sinde (n=18/9) kalsiyum kanal blokörleri ile tokoliz uygulandı. Hastaların
hiçbirisinde pesser takılırken ve/veya çıkartılırken hiçbir komplikasyon olmadı. Yenidoğan ağırlığı
ortalama 2223,44±933,34 g (630g – 3490g min, max) olup, sadece dört bebek doğum sonrası
entübe edilmişti. Yenidoğan bebeklerin %33,3’ünde (n= 6/18) sülfarktan kullanılmıştır. Yenidoğan
yoğun bakım ünitesinde TTTS, RDS, sarılığı (fototerapi tedavisine ihtiyaç duyulan) toplam dört
bebek doğum sonrasında izlenmiş olup, TTTS olan bebekler eksitus olmuştur. Çalışmaya dahil
edilen diğer tüm bebekler sağlıklı bir şekilde taburcu edilmiştir.
Sonuç: Erken doğum riski olan gebelerde servikal pesser uygulaması güvenilir, invazif olmayan,
ucuz, uygulaması ve çıkartılması kolay etkili bir yöntemdir. Haftalık 250mg IM progesteron
uygulaması ile kombine edilmesi literatürdeki tek başına uygulama verilerine göre daha etkili
bulunmuştur. Sonuçlarımız literatürde ki bazı çalışmaların aksine ikizlerde de başarı oranını yüksek
göstermiştir. Servikal pesser uygulaması için hasta seçimi kriterleri, uygulamanın ilk seferde doğru
şekilde yapılmış olması başarı şansı ile doğru orantılıdır. Erken doğum riskinde servikal pesser
uygulaması halen her yönüyle geniş çaplı randomize çalışmalar yapılarak kanıtların ortaya
konulmasını gerektiren bir tedavi şeklidir.
Anahtar Kelimeler: erken doğum, pesser, serklaj, servikal uzunluk
[PP-013]
MikroTESE ile sperm elde edilerek yapılan icsi vakasında komplet hidatiform mol
ve dikoryonik diamniotik ikiz birlikteliği
Nur Dokuzeylül Güngör1, Aynur Erşahin1, Betül Görgen1, Suat Süphan Erşahin2, Kağan Güngör3
1
Medicalpark Göztepe Hastanesi-Tüp Bebek Ünitesi
2
Medicalpark Bahçelievler Hastanesi-Kadın Hastalıkları ve Doğum
3
İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi
Gestasyonel trofoblastik hastalıklar(GTH) fetal trofoblastik dokudan köken almaktadır. Mol
hidatiform gestasyonel trofoblastik hastalıkların en sık görülen formudur.Bu çalışmada nadir
görülen icsi sonrası mol gebelik ve dikoryonik-diamniotik ikiz birlikteliği olgusu sunuldu.24 yasında
bayan hasta 9. gestasyonel haftada rutin gebelik kontrolü istemi ile merkezimize başvurdu.Gravida
1, para 1,yaşayan 1 canlı çocuğu mevcut olan hastanın üçüncü tüp bebek denemesiydi.vakanın tüp
bebek tedavisine alınma nedeni ise erkekte enfeksiyona sekonder gelişen azospermiydi. Bunun
dısında ozgecmisinde ve soygecmisinde ozellik yoktu. Transvajinal ultrasonografi ile yapılan
muayenesinde iki adet gestasyonel kese izlendi.keselerden birinde baş popo mesafesi (CRL) 8 hafta
5 gün ile uyumlu 25.7 mm,kalp atış hızı147/dk olan gebelik izlendi.Diğer kese içerisinde ise kistik
komponentleri olan büyük bir plasenta izlenmekteydi.Laboratuar bulgularında BhCG si 250094
mIU/ml.Hematokrit %40, lökosit 10.200 /mm-3, trombosit 258,000 mm-3’ dir. Koagulasyon profili,
tiroid fonksiyon testleri ve biyokimyasal parametreler normal sınırlar icindeydi. Akciğer grafisinde
metastaz ile uyumlu bulgu saptanmamıstır.Hasta olası komplikasyonlar ve malinite riski ile ilgili
bilgilendirildi.Hasta gebeliğe devam kararı aldı.Hasta halen 14 haftalık gebelik olarak devam
etmektedir.Yardımcı üreme tekniklerinin daha sık kullanılıyor olması çoğul gebelikleri ve buna bağlı
komplikasyonları arttırmaktadır.Yasayan fetuslu molar gebeliklerde ozellikle gebelik devamı
isteniyorsa yonetimi daha zordur. Malign hastalığa progresyon insidansı komplet mol ve canlı fetus
varlığında %56-62 iken parsiyal mol ve canlı fetus varlığında %4’dur. Nadiren sağlıklı fetus ve
molar gebelik konusunda yayınlar olsa da terminasyon ve seri olarak serum β-hCG olcumlerinin
yapılmas en cok tercih edilen protokoldur. Bu vakada hastaya olası
komplikasyonlar hakkında bilgi verilmis, hastanın devam yonunde karar vermesi uzerine takibi
yapılmaktadır.Katastrofik komplikasyonlardan kacınmak icin terminasyon ilk secenek olmalıdır.
Anahtar Kelimeler: mol gebelik, icsi, dikoryonik diamniotik ikiz
1
2
3
4
5
[PP-014]
Osteopetrosis Kongenita Olgusunda Preimplantasyon Genetik Tanı Yöntemiyle
Gebelik Elde Edilmesi
Nur Dokuzeylül Güngör1, Aynur Erşahin1, Betül Görgen1, Suat Süphan Erşahin2, Kağan Güngör3
1
Medicalpark Göztepe Hastanesi
2
Medicalpark Bahçelievler Hastanesi
3
İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi
Malin infantil osteopetrosis otozomal resesif geçiş gösteren,nadir görülen tek gen hastalıklarından
birisidir.Vaküoler proton pompalarının TCIRG1 subünitesinde meydana gelen mutasyona
bağlıdır.200 binde bir görülür.Vakamız daha önce bu nedenle 2 kez çocuk kaybı yaşamış bir
çiftimizdi.Fertil olan çift bize PGT yaptırmak için başvurdu.35 yaşındaki hastamıza antagonist
protokol uygulandı.3 oosit alındı.2 tanesine 3. günde babadaki TCIRG1geni c.2415-2A>g taşıyıcılığı
nedeniyle blastomer biyopsisi yapıldı.Sağlıklı çıkan 5AA tek embriyo 5. günde transfer yapıldı.OPU
sonrası 14. günde bakılan BhCG 157 geldi.İlk test sonrası 3. haftada yapılan transvajinal
ultrasonografide canlı tekil gebelik izlendi.Hastamızın gebeliğinin 16. haftasında amniosentez ile
tanı doğrulandı.Hasta 22 haftalık gebelik olarak kliniğimizde takip edilmektedir.
Anahtar Kelimeler: osteopetrosis, PGT
[PP-015]
Kardiyoversiyon uygulaması sonrası gelişen ablasyo plasenta: olgu sunumu
Mehmet Serdar Kutuk1, Murşide Şahin1, Muhammed Said Coşgun2, Mahmut Tuncay Özgün1,
Mustafa Basbug1
1
2
Erciyes Üniversitesi, Tıp Fakültesi, Kardiyoloji
Gebelikte maternal aritmi insidansı gebelikte 1000 de 1,2 oranındadır ve bunların %50 si
asemptomatiktir. Supraventriküler (SVT) taşikardi ve malign ventriküler aritmiler gebelikte daha sık
görülür. SVT tedavisinde Valsalva manevrası, sinus karotis masajı ve medikal tedaviye cevap
alınamadığında ya da hemodinamik instabilite olduğunda kardiyoversiyon uygulanır.
29 yaşında G(3),P(2), bilinen ek bir hastalığı olmayan 28 haftalık gebe preterm eylem ve maternal
supraventriküler taşikardi nedeniyle kliniğimize sevk edildi. Hastanın nabzı: 116/dakika ve EKG si
akut AF ile uyumluydu. Karotis masajı ve digoksin (1 mg) tedavisine yanıt vermeyen hastaya 150
joule ile senkronize kardiyoversiyon yapıldı. İşlem sonrasında hastanın kalp ritmi sinüs ritmine
döndü. İşlemden hemen sonra yapılan non- stres test de uzamış fetal bradikardi izlenmesi üzerine
hasta acil sezeryana alındı. Operasyonda plasentanın %40 dekole olduğu izlendi. 1090 gr
ağırlığında, 6–7 APGAR lı, bir kız bebek doğurtuldu. Bebek yenidoğan yoğun bakımda takip
edildikten sonra şifa ile taburcu edildi. Hastaya postoperatif, metoprolol 1x 50 mg tedavisi başlandı.
Takiplerinde aritmi izlenmedi.
Kardiyoversiyon sonrası fetal bradikardi gelişebileceği bilinmekle beraber, sunduğumuz vaka,
literatürde bildirilen ablasyo plasenta ile komplike olmuş olan ilk olgudur. Kardiyoversiyon
sonrasında artmış uterin kontraksyonlar nedeniyle fetal distress ve acil sezaryan ihtiyacı
olabilaceğinden, işlem yakın fetal monitorizasyon altında ve obstetri ekibinin eşliğinde yapılmalıdır.
Anahtar Kelimeler: Kardiyoversiyon, ablasyo plasenta, fetal distress, aritmi
[PP-016]
Treatment of refractory supraventricular tachycardia with amiodarone: a case
report
Mehmet Özgür Akkurt, And Yavuz
suleyman demirel university, faculty of medicine, Department of perinatology, Isparta, turkey
Objective: Most fetal tachyarrhythmias are benign but some types cause non-immun hydrops and
fetal heart failure and result in prenatal and postnatal death. Amiodarone, a class 3 antiarrhythmic
drug, can use treating for refractory fetal arrhytmias.
Case: A pregnant referred to our department at 26 weeks’ with hydrops fetalis. We detected
supraventicular tachiacardia at 220 bpm and there was no further cardiac and structural anomaly.
First of all digoxin treatment was initiated. Oral amiodarone was added when tachicardia and
hydrops fetalis persisted 3 days after digoxin treatment. a pregnant delivered at 32 weeks’ and we
did not see recurrence of supraventicular tachiacardia with treatment of amiodarone 200 mg per a
day.
Conclusion: Untreated SVT can be mortal and treatment should start immediately. Amidarone can
use treating SVT alone or combination with antiarrhythmic drugs considering maternal and fetal
side effects.
Keywords: amiodarone, fetal arrhythmia, hydrops
figure 1
fetus had supraventricular tachycardia with 220_bpm.
figure 2
nonimmun hydrops fetalis in transverse abdominal view
figure 3
31 atrioventricular blok has been developed by amiodarone treatment 400 mg twice a day.
figure 4
fetus had normal heart rate135 bpm after decreasing amiodarone dose 400 mg per a day.
[PP-017]
Cervical Ripening Balloon: a Successful Treatment to Control Massive Bleeding
in Cervical Pregnancy
Mert Turgal, Emine Aydın, Nergis Kender, Zafer Selcuk Tuncer
Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara,
Turkey.
Introduction
Cervical pregnancy (CP) is rare and life-threatening form of ectopic pregnancy. Currently, there is
no consensus optimal treatment for CP. However, general principles in the management of cervical
pregnancy should include the following: minimize the risk of hemorrhage, evacuated the
gestational cervical product, and sparing patient’s fertility. Here, we report a case of 9 weeks of
gestation cervical ectopic pregnancy with positive fetal cardiac activity successfully treated
multimodal therapy which is intraamniotic potassium chloride (KCL), systemic methotrexate (MTX),
curettage of cervix, and cervical ripening balloon (CRP) tamponade for abandoned cervical
bleeding.
Case Presentation
A twenty-eight years old primigravid pregnant woman referred to our clinic for suspicion of CP. On
pelvic examination, cervix was enlarged and appeared “barrel shape” on inspection. Transvaginal
ultrasonography revealed a CP with positive fetal cardiac activity consistent 91/7 weeks of
gestation and endometrial cavity was normal. Magnetic resonance imaging was confirmed
CP.(Figure1) Her quantitative β-hCG concentration was 115,226 mIU/mL on admission.
Considering the patient’s hemodynamic stability and desire to maintain fertility, conservative
expectant management with local KCl and systemic methotrexate administrations were decided.
Then, we performed 2 mL (2 mEq/mL) KCl injection in the cardiac cavity of fetus with
transabdominal approach. Additionally, patient was also treated systemic multidose MTX (1 mg/kg,
days 1, 3, 5, and 7) and leucovorin (0.1 mg/kg, days 2, 4, 6, and 8) rescue therapy. Serially
evaluated β-hCG concentrations were progressively declined during 10 days. In this period
gestational sac was deforming. Fourteen day after treatment, because of β-hCG concentration was
relatively to plateau, we decided surgical intervention.(Table I) In the operating theatre under
ultrasound control, curettage of the cervical canal was performed. The whole conceptus materials
were removed. Intraoperative bleeding was about 900 mL. Two units of red blood cell were
transfused intraoperatively. Because of bleeding was not stopped, we decided a cervical ripening
balloon (Cook Medical, Bloomington, IN, USA) into the cervix. Uterine part of the CRP balloon was
inflated with 70 mL saline solution at under sonography guidance. Thereafter, vaginal part was
then inflated with 80 mL saline solution.(Figure 2) Bleeding was controlled with this procedure. Two
days after the procedure we removed the balloon. Vital sing were stable and she had no complaint
included vaginal bleeding. The patient was discharged in good health. Thirty days after treatment,
serum β-hCG concentration declined continuously to 10,0 mIU/L. Transvaginal ultrasonography
showed a normal uterine cervix in size and contour.
Conclusion
Obstetric hemorrhage is the leading cause of maternal morbidity and mortality. There are different
balloon catheters which can be used such as Bakri balloon, Sengstaken-Blakemore tube, Rusch
balloon, and Foley catheters in obstetric hemorrhage. Although CRB is designed for the induction of
labor, its application was also successfully performed in cases of postabortion massive hemorrhage
and postpartum hemorrhage. To our knowledge, this report describes the first time this approach
has been performed in a CP case. Since it is a safe and valid method, we believed that the use of
CRB in conventional treatment method for CP cases can be used to bleeding control.
Keywords: cervical ectopic pregnancy, cervical ripening balloon, conservative treatment,
methotrexate, obstetric hemorrhage.
Table I: Graphic shows serum β-hCG concentrations course.
Figure 1: MRI show cervical ectopic pregnancy. (arrows: cervical pregnancy with embryo,
arrowhead uterus, B: bladder).
Figure 2: Transabdominal sonographic image of cervical ripening catheter after procedure. Inflated
double-balloon cervical ripening catheter placed cervix (C) and vagina (V). (arrow: uterus)
[PP-018]
Mercury Concentration in Maternal Serum, Cord Blood, and Placenta in Patients
with Amalgam Dental Fillings: Effects on Fetal Biometric Measurements
Rahime Bedir Findik1, Huseyin Tugrul Celik2, Ali Ozgur Ersoy1, Yasemin Tasci1, Ozlem Moraloglu1,
Jale Karakaya3
1
Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and
Research Hospital, Ankara, Turkey
2
Department of Biochemistry, Turgut Ozal University, Ankara, Turkey
3
Department of Biostatistics, Hacettepe University, Ankara, Turkey
Objectives: We aimed to determine the extent to which mercury is transmitted from the mother to
fetus via the umbilical cord in patients with amalgam dental fillings, and its effect on fetal biometric
measurements.
Methods: Twenty-eight patients as the study group with amalgam fillings, and 32 of them as the
control group were included in this prospective case-control study. The mercury levels were
measured in the maternal and cord venous sera, and the placental samples. Two groups were
compared in terms of these and the fetal/neonatal biometric measurements.
Findings: In the study group, the maternal and umbilical cord mercury levels were found to be
significantly higher than those from the control group (p=0.006 and p=0.010, respectively). These
high levels did not affect the fetal biometric measurements.
Conclusions: The presence of high serum mercury levels in pregnant women with amalgam fillings
is important, and warrants further long term studies in order to investigate the fetal neurological
effects as well.
Keywords: Dental amalgam, mercury, maternal-fetal exchange, pregnancy outcome
Comparison of demographic characteristics between two groups.
Without amalgam fillings With amalgam fillings
Characteristics
(n = 32)
(n = 28)
Maternal Age
(year)
25 ± 5.9
P value
25 ± 5.7
0.556
28.28 ± 3.55
0.863
Number of Gravidity
1…n:13 (52 %)
2…n:9 (50 %)
3…n:6 (50 %)
4…n:4 (80 %)
1…n:12 (48 %)
2…n:9 (50 %)
3…n:6 (50 %)
4…n:1 (20 %)
0.725
Mother’s
Occupation
Housewife: 32 (55.2 %)
Working: 0
Housewife: 26 (44.8 %)
0.214
Working: 2 (%100)
Maternal BMI (kg/m2) 28.10 ± 4.26
Mercury levels and neonatal biometric parameters in patients with and without
amalgam dental fillings.
Without amalgam
With amalgam
Characteristics
fillings
fillings
(n = 32)
(n = 28)
Mercury Levels in Maternal Blood
0.27±0.7
0.50±0.7
P
value
0.006
(μg/L)
Mercury Levels in Cord Blood (μg/L) 0.3±0.2
0.5±0.4
0.01
Mercury Levels in Placental Tissue
(μg/g)
1.1±0.8
1.2±0.8
0.644
Birth Weight (gr)
3320±394
3395±492
0.519
Birth Length (cm)
50±1.7
50±1.8
0.962
Head Circumference of the Infant
(cm)
34±1.2
35±1.1
0.398
Gender of the Baby (male=M,
female=F)
M:20 (55.6%)
F:12 (50%)
M:16 (44.4%)
F:12 (50%)
0.874
[PP-019]
Ruptured Endometriotic Cyst Mimicking Acute Appendicitis During Pregnancy
Ali Ozgur Ersoy, Irem Eda Gokdemir, Ebru Ersoy, Aykan Yucel
A twenty-one year-old primigravid pregnant woman of 33 weeks gestation applied to our
Perinatology Clinics with acute abdominal pain. The pain was spreading from midline to right lower
quadrant of the abdomen.Guarding and rebound tenderness existed in the right lower quadrant.
Ultrasonographic examination revealed a single, alive fetus, and normal amniotic fluid. Whole blood
count revealed leukocytosis and there was no sign of preterm labor or placental abruption. Fetal
heart rate decelerations in non-stress test were observed, and a decision for cesarean section and
abdominal exploration were made.
A healthy male baby with Apgar score of 7 and 9 at first and fifth minute (respectively) was
delivered. In the abdominal exploration all peritoneal surfaces were coated with a dark red, brown
colored dense material, like mud, and there were two endometriotic cysts in the left ovary; one of
them with 6 cm mean diameter had been ruptured (Figure 1); the other with 2-3 cm mean
diameter was intact (Figure 2). Both of them were excised and sent for pathologic examination.
Also, there were dark-blue, powder-burn black colored millimetric endometriotic foci spreading over
the peritoneal surfaces (Figure 3). The patient had no problem in postoperative two days and was
discharged. Final pathologic diagnosis was reported as endometriotic cysts. We think that this case
is a nice example of misleading the clinician as if the scene was consistent with acute appendicitis.
Keywords: Pregnancy, endometriotic cyst, rupture
Figure 1
Posterior view of uterus and left ovary which had two endometriotic cysts and one of them
had been ruptured.
Figure 2
Posterior view of the uterus and the smaller and intact endometriotic cyst in the left ovary can
be seen. Note all the peritoneal surfaces was covered by endometriotic material.
Figure 3
One of several millimetric endometriotic foci spreading to different peritoneal surfaces (white
arrow). It can be seen dark-blue, powder-burn black colored and located in front of the right
infundibulopelvic ligament.
[PP-020]
An unusual complication of vesicoamniotic shunt: coiling of the shunt around
lower extremity associated with dislodgement
Mehmet Özgür Akkurt, And Yavuz
Suleyman Demirel University, Faculty of Medicine, Department of Perinatology, Isparta, Turkey
Background: Vesicoamniotic shunt (VAS) is a procedure that aims to reduce intraluminal pressure
of the foetal bladder and the upper urinary tract. Here, we report an unusual complication of VAS,
coiling of the shunt around foetal lower extremity associated with dislodgment.
Case: A 33-year-old multigravida was referred for further evaluation of foetal obstructive uropathy.
The primary diagnosis was posterior urethral valves(PUV), since the ultrasound(US) scan showed a
dilated posterior urethra in line with the typical “keyhole sign” in a male foetus.
Foetal karyotype by amniocentesis demonstrated a 46, XY normal male pattern. Then, a
vesicoamniotic shunt placement via the transabdominal route was performed at 20 weeks.
Following the procedure, foetal amniotic fluid and bladder volume returned to normal within 7
days. Amniotic fluid and foetal bladder volume remained within normal ranges, however began to
decrease by 33 weeks’ gestation, causing redistention of the foetal bladder and oligohydramnios.
US showed a dislodged shunt into the foetal abdominal cavity (Figure 1(a)). At birth, shunt was
observed to be coiled around the left lower extremity (Figure 1(b) and Figure 1(c)), but there was
no limitation of movement at the extremity. At 9 months of age, the infant had no joint deformity,
and he underwent endoscopic ablation of the PUV. He had normal renal function at 12 months of
age.
Conclusion: In utero VAS may be a viable option in carefully selected cases of foetal lower urinary
tract obstructions, it has unpredictable and unavoidable complications such as the present case
reported here.
Keywords: Posterior urethral valve, post-operative complication, vesicoamniotic shunt
figure 1
Figure 1(a): Ultrasound scan showing the migration of the shunt into the foetal abdominal
cavity Figure 1(b): The shunt was coiled around the left knee joint. Figure 1(c): After birth, a
contracture was observed due to coiling of the shunt.
[PP-021]
AKROMEGALİ VE GEBELİK (Olgu Sunumu)
Mehmet Kulhan1, Ümit Naykı1, Gözde Kulhan2, Cenk Naykı1, Paşa Uluğ1, Yusuf Yıldırım1
1
Erzincan Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Erzincan
2
Samsun Kadın Doğum ve Çocuk Hastalıkları Hastanesi, Samsun
Giriş: Aşırı büyüme hormonu salgılanması ile karakterize olan akromegalide, bozuk gonodotropik
aks nedeniyle hastalar, genellikle amenoreik ve infertildirler.Bu nedenle gebelik ve akromegali nadir
bir birlikteliktir ve literatürde oldukça az olgu bildirilmiştir. Ayrıca, diabetes mellitus ve
kardiovasküler hastalıkların prevelansının yüksek olması nedeniyle bu hastalar yüksek riskli gebe
olarak değerlendirilirler.
Olgu: Otuzüç yaşında G4P2Y2A1, 6 hafta 2 günlük gebeliği bulunan hasta Samsun Kadın Doğum ve
Çocuk Hastalıkları Hastanesine başvurdu. Hastanın hikayesinde yaklaşık 2 yıl önce adet
düzensizliği, galaktore, hirsutizm ve görme bozukluğu şikayetleri nedeni ile yapılan fizik
muayenesinde el ve ayaklarda büyüme ve yüzde kabalaşma izlendiği, hipofiz MRG sonucu hipofiz
bezinde yaklaşık 25x25 mm’lik adenom tespit edilmesi ve kan tetkiklerinde GH: 2.6 ng/mL, İGF-1:
1392 olarak normalin üstünde saptanması üzerine akromegali tanısı konulduğu ve sonrasında
transsfenoidal adenektomi uygulandığı öğrenildi. Postoperatif 4.ayda rekürrens tespit edilen
hastaya günlük lanreotid ve haftada 2 kez kabergolin başlanmış. Tedavinin 1.ayında gebe kalan ve
kendi isteği ile gebeliği sonlandırılan hastanın 6 aylık medikal tedavi sonrasında tekrar gebe kaldığı
öğrenildi. Hastada, gebelik öncesi yüksek olan İGF-1’in (500-600 ng/mL) ilk trimesterde tedrici
olarak azaldığı ve 300 ng/mL seviyesinde plato çizdiği gözlendi. Her vizitte kan basıncı, kilo alımı,
ödem varlığı, görme alanı muayenesi, fetal biyometri ve amniyon sıvı indeksi değerlendirildi.
Gebelik boyunca hastada klinik olarak şikayet olmadı ve fetüsün antenatal takibi normaldi. Hasta
gebeliğin 39. haftasında sezaryenle 3600 gram erkek bebek 8 apgarla canlı olarak doğurtuldu.
Postoperatif dönemde anne ve yenidoğanda herhangi bir komplikasyon gözlenmedi.
Sonuç: Akromegalisi olan gebeler çok nadir olmakla birlikte riskli gebelerdir ve yakın takip
edilmeleri gerekmektedir.
Anahtar Kelimeler: Akromegali, Gebelik
[PP-022]
The Relationship of Striae Gravidarum with Cesarean Scar Characteristics and
Peritoneal Adhesions
Esra Yasar Celik, Ali Ozgur Ersoy, Ebru Ersoy, Ozlem Yoruk, Aytekin Tokmak, Yasemin Tasci
Objectives: The aim of this study was to evaluate the relation between striae gravidarum (SG)
score and abdominal scar characteristics together with intraperitoneal adhesion (IPA) grades of
patients who are having their second cesarean deliveries.
Methods: Totally 145 women, hospitalised for cesarean section (CS) were included in this
prospective observational study between November 2013 and January 2014. Groups were
conducted according to the SG status, as women with no SG: Group 1 (n=53), mild SG: Group 2
(n=27) and severe SG: Group 3 (n=65). Groups were compared with various sociodemographic
properties, cesarean scar characteristics and IPA scores.
Findings: No significant difference in the length, width and colour of the scar was detected among
groups. Although flat scar was the most prominent scar form among all groups, elevated scar was
significantly more frequent in group 1 (p=0.009). Intraperitoneal adhesion grade was 0 or 1 in
77.3% of group 1, 81.3% of group 2 and 76% of group 3. There was no significant difference in
IPA scores between groups (p=0.884). With regard to scar properties (flat, depressed and
elevated) and SG status [SG (+) or SG (-)], we found no difference between IPA groups.
Conclusions: SG is found associated with scar characteristics, but not associated with
intraperitoneal adhesions.
Keywords: Striae distensae, cesarean section, scar, focal adhesions
[PP-023]
A brief glance to prenatally diagnosed fetal arrhythmias: Two-year experience
of a tertiary center
Doruk Cevdi Katlan, Bahar Konuralp Atakul, Tuncay Yüce, Acar Koç, Feride Söylemez
Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
Aim
The final common pathway to death in all human beings is an arrhythmia. At no other time in life
cycle, is the human at more risk of unexpected death than during the prenatal period. Although
most lethal cardiac rhythm disturbances occur during apparently normal pregnancies, some
manifest fetal arrhythmias may be recognised prenatally (0,6-2,0% of all pregnancies). Hereby, it
is intended to highlight the importance of some factors that the clinician should pay extra attention
upon encountering fetal arrhythmias.
Methods
Prenatal and postpartum data of the patients, who were prenatally diagnosed to have fetal
arrhythmia between January 2013 and April 2015 at Ankara University Department of Obstetrics
and Gynaecology Perinatology Unit, were presented.
Results
A total of 9 cases were scrutinized. None of the patients had maternal arrhythmia, anemia,
leucocytosis, thyroid hormone or serum electrolyte disturbance and history of previous arrhythmic
children. All were free of any chronic disease except one, who had Systemic Lupus Erythematosus
diagnosed during her gestation before the onset of fetal dysrhythmia. She was the only patient to
deliver preterm at 33 weeks due to intrauterine growth restriction and fetal distress while the rest
reached term. None of the fetuses showed prenatal signs of neither hydrops nor any
echocardiographic structural abnormality. Postpartum fetal serum electrolytes were normal for all.
Prenatally 3 fetuses demonstrate atrial ectopy, 4 demonstrate bradycardia of varying severity (2
severe, < 90 beats/minute; 2 mild, 90-110 beats/minute) and the remaining 2 demonstrate
alternating combination of these two. Both of the 2 severely bradycardic ones had maternal AntiRo/SSA and ANA positivity with relative early onset of arrhythmia (19w6d, 21w3d) and one had
2:1 atrioventricular block (also had Anti-La/SSB positivity). Arrhythmia was stable for 5 of the 9
patients (55,6%) throughout the pregnancy. Among those, 4 (80,0%) persisted postpartum and
the fetuses needed neonatal intensive care unit (NICU) follow up. 2 (40,0%) fetuses had
concomitant extra-cardiac fetal anomalies (1 multicystic dysplastic kidney, 1 cleft lip & palate,
hypospadias, corneal opacity, hypertelorism, flexion contractures).
Conclusions
The detection of a fetal arrhythmia by an obstetrical care provider should prompt referral to a
center of excellence for further assessment. Maternal risk factors should be carefully examined and
fetus should undergo a thorough pre and post natal evaluation. Extra attention should be paid to
sustained arrhythmias since they tend to be persistent postpartum, NICU need is probable and
fetal anomalies may co-exist. Fetal ectopy is a relatively benign condition but severe
bradyarrhythmias may be related to immune-mediated inflammation and fibrosis of the fetal
conduction system by maternal antibodies which can cross the placenta and may end up in fetal
atrioventricular block.
[PP-024]
A challenging threat for the fate of a normal fetus: Placental Mesenchymal
Dysplasia
Doruk Cevdi Katlan 1, Bahar Konuralp Atakul1, Tuncay Yüce 1, Feride Söylemez1, Acar Koç1
1
Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
Background – Aim
Placental mesenchymal dysplasia (PMD) is a rare but benign placental disorder with a reported
incidence of 0,02% and a female preponderance. Although karyotype is normal in most cases, PMD
is associated with many other maternal and fetal risks. Only 9 % of pregnancies with PMD end
uncomplicated. By the accumulation of information from more than 100 cases reported till now and
thanks to the development of high-tech imaging modalities, we are now a bit more successful in
both the early differential diagnosis and foresight of the risks. However, placental pathologic
examination is paramount to establish definitive diagnosis. Herein, we present two cases of PMD in
which the pregnancy concluded in two different points at the negative side of the disease
spectrum: termination and early preterm delivery of non-viable fetus.
Case Reports
28-year old primigravid woman was admitted upon detection of placental cystic structures on
routine ultrasound scan at 23 weeks of gestation. Detailed sonographic evaluation revealed a
completely normal female fetus with diffusely dispersed multiple hypoechoic spaces within the
thickened placenta. Amniocentesis was normal. The patient was informed about the possible
diagnosis of PMD and decided to continue her pregnancy taking full account of the risks. A few
days later, she described bleeding and leakage of amniotic fluid which resulted with the delivery of
a 560 gr dead fetus vaginally. The placenta was bulky weighing 1500 grams. Pathologic
examination documented PMD.
21-year old gravida 2 para 0 woman with a history of previous early miscarriage presented with a
thickened placenta on routine ultrasound scan at 16 weeks of gestation. Detailed examination
demonstrated a normal male fetus with heterogeneous, cystic and thickened placenta almost
entirely filling the uterine cavity. The patient was informed about the risks and she opted for
termination of pregnancy. Post termination karyotype analysis was normal and pathology
documented PMD.
Conclusion
Upon detection of large-cystic placenta by sonography, the initial step is the detailed evaluation of
the fetus. An abnormal fetus may be indicative of a triploid partial mole. A normal fetus however,
requires a closer examination of the placenta. A heterogeneous thickened placenta with partially
solid and hypoechoic cystic areas may indicate PMD as well as a complete mole with co-twin. At this
point a promising recently reported Doppler sign may be distinctive. “Stained-glass” appearance of
various degrees of blood flow under low pulse repetition frequency setting may be suggestive of
PMD. PMD with normal karyotype in a low risk patient may lead to pregnancy follow up after proper
counselling about the risks; however, termination may be an option upon parental consent or in case
of the exact opposite of the above mentioned conditions.
[PP-025]
A rare case of primary lymphedema in pregnancy with subacute venous
thrombosis
Catherine Rose De Guzman Dela Rosa
Obstetrics & Gynecology Department, Delos Santos Medical Center
INTRODUCTION
Primary Lymphedema occurs in 1/6000 live births. This is secondary to lymphatic agenesis,
hypoplasia, or obstruction. Pregnancy has a relative risk of 4.3 % for venous thromboembolism
(VTE) and is characterized by increased thrombin-generating potential, decreased endogenous
anticoagulant effects and impaired fibrinolysis.
CASE PRESENTATION
A 26 year old primigravid, a diagnosed case of primary lymphedema, presented with bilateral leg
swelling on her 22 weeks AOG. AV Dupplex scan of the lower extremity showed subacute venous
thrombosis. Antenatally, she was diagnosed with gestational diabetes mellitus (GDM) controlled by
medical nutrition therapy. At 30 weeks AOG, she was admitted for IV tocolysis with magnesium
sulfate. Anti-coagulation with heparin and unfractionated heparin was maintained until 37 weeks
AOG. Antenatal corticosteroids were administered with weekly surveillance of Biophysical Profile,
Non Stress Test (BPS w/ NST), and glucose monitoring. At 38 weeks AOG, patient delivered
vaginally under epidural anesthesia. Unfractionated heparin was continued at postpartum.
Contraceptive with Medroxy Progesterone Acetate IM was initiated at 6 weeks postpartum.
CONCLUSION
Rigorous antenatal and postnatal surveillance is key in the management of pregnancy complicated
by primary lymphedema and venous thrombosis
Keywords: primary lymphedema, subacute venous thrombosis
[PP-026]
Low Maternal Glucose Levels on 50 g Glucose Challenge Test Support Protective
Effects for Neonatal Outcomes
Hasan Onur Topçu, Can Tekin Iskender, Sevki Celen, Aslı Oskovi, Dilek Uygur, Salim Erkaya
Zekai Tahir Burak Women Health Education and Research Hospital, Department of Obstetrics and
Gynecology, Ankara, Turkey
Objective: To assess the perinatal outcomes in pregnant women with maternal hypoglycemia
following second trimester oral glucose challenge test (GCT).
Study Design: This retrospective case control study consisted of 2091 pregnant women who had
hypoglycemia (glucose levels less than 88 mg/dl 1 hour following 50 gr GCT) on second trimester
pregnancy and control group consisted of 2091 pregnant women with a GCT result between 88 and
130 mg/dl. Perinatal and neonatal characteristics obtained from electronic medical records were
compared between groups.
Results: The rates of pregnancy complications were similar in both groups, except for a lower
incidence of polyhydramnios and higher rate of deliveries before the 34th week of gestation in
patients with hypoglycemia (0.5 vs. 1.1%, p=0.016 vs 2.6 vs. 1.7%, p=0.033); respectively.
Neonates born to mothers with hypoglycemia had significantly less birth trauma (0.3 vs. 0.9%,
p=0.027) and neonatal hypoglycemia. When the data for male and female infants were analyzed
separately, male infants had a 1.5-fold (95% CI: 1.05–2.18) increased chance of being small for
gestational age (SGA), while the risk for female infants did not increase (OR: 0.79, 95% CI: 0.56–
1.11).
Conclusion: Low maternal plasma glucose level on the GCT is associated with favorable outcomes,
such as decreased rates of birth trauma and neonatal hypoglycemia. In addition, male infants have
a higher risk of being SGA than female infants when maternal GCT results were <88 mg/dl.
Keywords: hypoglycemia, 50 g oral glucose challenge test, perinatal outcomes, low birth weight,
gender
Figure 1
Histograms of glucose challenge test results, neonatal birth weight and gestational age at
delivery in patients with hypoglycemia on GCT and control group
Figure 2
Risk of macrosomia in male and female fetuses obtained for different oral glucose challange
test thresholds
Figure 3
Risk of small for gestational age in male and female fetuses obtained for different oral
glucose challange test thresholds
Figure 4
Table 1. Comparison of clinical characteristics and pregnancy outcome between groups.
Hypoglycemia on GCT Control
(n = 2091)
(n = 2091)
p
Age (years)
26.9 ± 5.2
29.6 ± 5.6
<0.001
Pre pregnancy BMI
23.1 ± 3.8
25.7 ± 3.7
<0.001
Parity
0
1-3
>= 4
1042 (49.8 %)
1042 (49.8 %)
7 (0.3 %)
754 (36.1 %) <0.001
1298 (62.1 %) <0.001
39 (1.9 %)
<0.001
GCT (mg/dl)
77.7 ± 8.1
113.8 ± 9.2
<0.001
Systemic disease
109 (5.2 %)
138 (6.6 %)
0.066
Cesarean delivery
846 (38.5 %)
946 (45.2 %)
<0.001
Gestational age at delivery
> 42 weeks
< 37 weeks
< 34 weeks
38.4 ± 1.9
10 (0.5 %)
252 (12.1 %)
55 (2.6 %)
38.3 ± 1.9
12 (0.6 %)
266 (12.7 %)
35 (1.7 %)
0.114
0.669
0.511
0.033
PPROM
26 (1.2 %)
36 (1.7 %)
0.200
Preeclampsia
91 (4.4 %)
111 (5.3 %)
0.170
Polyhydramnios
10 (0.5 %)
24 (1.1 %)
0.016
Cholestasis of pregnancy
12 (0.6 %)
7 (0.3 %)
0.250
Placenta Previa
8 (0.4 %)
16 (0.8 %)
0.101
Ablatio placenta
10 (0.5 %)
8 (0.4 %)
0.637
Data expressed as number (%), mean ± SD. BMI: Body mass index, GCT: Glucose challenge
test, PPROM: Preterm premature rupture of membranes.
Table 2. Comparison of neonatal characteristics between groups.
Hypoglycemia on GCT Control
(n = 2091)
(n = 2091)
p
Neonatal birthweight
Male
Percentile (male)
Female
Percentile (female)
> 4500 gr
> 4000 gr
< 2500 gr
< 1500 gr
> 90th percentile
< 10th percentile
< 5th percentile
< 3rd percentile
3218 ± 534
48.4 ± 20.3
3117 ± 459
48.7 ± 16.7
8 (0.4 %)
86 (4.1 %)
153 (7.3 %)
12 (0.6 %)
146 (7.0 %)
187 (8.9 %)
90 (4.3 %)
57 (2.7 %)
3318 ± 544
52.9 ± 21.9
3155 ± 520
50.5 ± 18.0
11 (0.5 %)
142 (6.8 %)
154 (7.4 %)
18 (0.9 %)
235 (11.2 %)
162 (7.7 %)
87 (4.2 %)87 (4.2 %)
54 (2.6 %)
<0.001
<0.001
0.011
0.021
0.490
<0.001
0.953
0.272
<0.001
0.162
0.818
0.778
Neonatal length
Male
50.0 ± 2.5
49.6 ± 2.0
50.5 ± 2.6
49.7 ± 2.5
<0.001
0.384
Female
Birth trauma
7 (0.3 %)
18 (0.9 %)
0.027
NICU admission
119 (5.7 %)
133 (6.4 %)
0.329
*Neonatal hypoglycemia 32 (1.5 %)
52 (2.5 %)
<0.001
Major fetal anomaly
24 (1.1 %)
14 (0.7 %)
0.103
Stillbirth
10 (0.5 %)
13 (0.6 %)
0.530
Perinatal mortality
21 (1.0 %)
28 (1.3 %)
0.574
Data expressed as number (%), mean ± SD. GCT: Glucose challenge test, NICU: Neonatal
intensive care unit, *: neonatal plasma glucose levels were measured if the infants were
premature, small for gestational age, large for gestational age, or any medical condition that
was indicated.
Table 3. Multivariate logistic regression analyses for prediction of adverse perinatal
outcome in patients with hypoglycemic GCT.
Unadjusted
Adjusted
Adjusted
R
Characteristics
Odds ratio
p
Odds ratio
p
for*
square
(95 % CI)
(95 % CI)
Delivery < 34 weeks
1.59 (1.032.44)
0.033
1.87
(1.202.93)
1-14
0.006
0.240
PolyhydramniosPolyhydramnios
0.41 (0.200.87)
0.016
0.41
(0.200.87)
3, 14
0.019
0.027
Preeclampsia
0.81 (0.611.08)
0.170
0.79
(0.591.06)
1-4
0.110
0.074
ICP
1.72 (0.684.37)
0.250
1.63
(0.624.31)
1-3
0.322
0.050
Placenta previa
0.41 (0.211.17)
0.101
0.61
(0.261.47)
1,2
0.271
0.035
Neonatal Birth weight
> 4000gr
> 90th percentile
< 10th percentile
0.59 (0.450.78)
0.59 (0.480.74)
1.17 (0.941.46)
0.67
(0.510.89)
<0.001 0.66
<0.001 (0.530.162 0.82)
1.06
(0.831.36)
Birth Trauma**
0.34 (0.140.81)
0.015
0.36
(0.13-
1-3,16,17 0.006 0.135
1-3
<0.001 0.024
1-5
0.635 0.016
2,3,16,17 0.024
0.180
0.81)
GCT: Glucose challenge test, CI: Confidence Interval, ICP: Intrahepatic cholestatis of
pregnancy, NICU: Neonatal intensive care unit admission. * 1: Age, 2:Parity, 3: Body mass
index, 4: Maternal systemic disease, 5: Preeclampsia, 6: Preterm premature rupture of
membranes, 7: Polyhydramnios, 8: Oligohydramnios, 9: Placenta previa, 10: Abruptio
placenta, 11: Intrahepatic cholestasis of pregnancy, 12: Neonatal birth weight < 10th
percentile, 13: Stillbirth, 14: Fetal anomaly, 15: Cesarean delivery, 16: Fetal sex, 17: Length
of gestation.** Excluding cesarean deliveries
[PP-027]
No gallbladder on fetal ultrasound: How to counsel patients?
Doruk Cevdi Katlan1, Bulut Varlı1, Bahar Konuralp Atakul1, Tuncay Yüce1, Feride Söylemez1, Acar
Koç1
(1) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara,
Turkey
Background – Aim
Fetal gallbladder is visible by ultrasonography starting from 14 weeks of pregnancy. Nonvisualization of it is rare and occurs in 0,1-0,15% of pregnancies. Almost all isolated ones result in
a normal healthy child. In most cases, it will be imaged later in pregnancy or in the neonatal
period. Rarely, agenesis of the gallbladder, a benign condition with an incidence of 1:6300, is
confirmed postnatally. In some rare cases association with cystic fibrosis has been documented.
Some authors suggest its association with biliary atresia which has been reported as 0,7 per 10000
live births. Biliary atresia (BA) has two types: the “fetal-embryonic form” (10-25%) characterized
by early cholestasis and associated heterotaxy syndrome, and “perinatal-acquired form”
characterized by late onset of jaundice and associated viral infections. According to recent data,
coexistence of absent gallbladder and BA is most likely a chance occurrence. However, if the
absent gallbladder is non-isolated (coexistent with cardiovascular, skeletal anomalies etc.), it is
associated with an increased risk for fetal chromosomal abnormalities. Here, it is aimed to
emphasise the importance of visualization of gallbladder on second trimester ultrasound scan and
patient counselling in case it is non-visible.
Case Reports
Two women, a 36-year old gravida 2, para 1 and a 24-year old gravida 4 para 2, were counselled
due to non-visualization of fetal gallbladder on their routine second trimester ultrasound scan, both
at 22 weeks 5 days, as an isolated abnormality. Their prenatal screening tests assigned low risk for
aneuploidy. Upon counselling, both declined invasive prenatal diagnostic procedures. They are
awaiting the results of parental cystic fibrosis screening tests, fetal gallbladders still non-visible.
Conclusion
Non-visible fetal gallbladder is a diagnosis that must be confirmed by at least two ultrasound
exams performed at an interval of 7-15 days. A thorough examination is mandatory in order to
document any coexistent anomaly necessitating karyotype analysis. In isolated cases of absence,
parental cystic fibrosis screening should be considered. Since, recent literature suggests
coexistence of BA or aneuploidy in isolated cases is a chance association, the parents should be
reassured that the outcome is likely to be good and no further testing is required.
[PP-028]
Correlation of fetal thymus size with cord blood vitamin D
Esra Bahar Gür, Mehmet Serkan Gur, Ozlem İnce, Esin Kasap, Mine Genc, Sümeyra Tatar, Sultan
Bugday, Guluzar Arzu Turan, Serkan Guclu
Sifa University
Aim: The aim of the present study was to evaluate the association of intrauterine vitamin D
deficiency (VDD) with thymus size in full term fetuses.
Methods: In this prospective study we evaluated mid-pregnancy serum 25-hydroxyvitamin D3
(25(OH)D3) concentrations in 162 pregnant women. Fetal thymus size were measured by
ultrasound in third trimester. Fetal 25(OH)D3 levels evaluated by umbilical cord blood sampling.
Correlation of maternal and fetal vitamin D levels, factors effecting vitamin D levels, association
between thymus size and both fetal and maternal vitamin D concentrations were investigated.
Results: Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers
and 10 (13.1%) newborns. Body mass index, duration of seaside holiday and the season were
founded which effecting factor on maternal vitamin D level. A strong correlation was found between
maternal mid-pregnancy and cord blood 25(OH)D3 concentration (r=0.8, p< 0.001). Fetal thymus
perimeter was significantly correlated with the thymic-thoracic ratio (r= 0.4, p<0.01). A significant
linear correlation was observed between both mid-pregnancy and umbilical cord 25(OH)D3
concentration and thymus perimeter length (r= 0.35, p=0.04 and r=0.4, p<0.01, respectively).
Both maternal and fetal vitamin D concentration within the normal range was associated with
increased thymic perimeter relative to fetuses with VDD (p=0.04, p=0.03).
Conclusions: VDD at fetal period may be contributed fetal programming of immune system by
affecting development of thymus.
Keywords: pregnancy, vitamin d, vitamin d deficiency, fetal thymus size, ultrasound
figure 1
Sonogram of the thymus at the level of the 3-vessel view within the fetal thorax. (a) Thymicthoracic ratio. Tymus diameter was measured as its greatest width perpendicular to a line
connecting the spine and sternum. (b) Thymic perimeter.
figure 2
Figure 2. Flow chart of the study design.
Table 1.
Mean (±SD)
Age (years)
29.5±4.3
Mean gestational week
25±0.5
( maternal vitamin D sampling)
Mean gestational week
(thymus measurement)
38.7±0.9
BMI
28.8±2.6
Mothers
n=162
Fetuses
n=76
Severe deficiency
(<=10 ng/mL) (n,%)
57, 35.1
40, 52.6
Mild deficiency
(10-20 ng/mL) (n,%)
57, 35.1
26, 34.2
Normal level
(>=20 ng/mL) (n,%)
48, 29.8
10, 13.1
Average level± SD
15.06±6.9 12.32±4.8
(ng/mL )
General characteristics and vitamin D status of the mothers and fetuses in the study. SD:
standard deviation. BMI: Body mass index.
Table 2.
Variables
ba (SE) P-value
Season
,490
<0.01
Annual income
,001
0.9
Mothers’ dressing style
-,134
0.1
400 IU/day Vitamin d use during gestation
-,003
0.9
1200 IU/day Vitamin d use during gestation ,154
0.07
BMI
-,184
0.04
State of employment
,135
0.2
Skin color
-,002
0.9
Seaside holiday duration
,341
0.01
Sun exposure
-,016 0.8
Multiple linear regression analysis of factors associated with maternal serum 25(OH)D3
concentrations. R2 = 0.27, b is regression coefficient. a All variables are adjusted for one
another. BMI: Body mass index.
Table 3.
Times New
Roman
P
Times New
Roman
P
Severe deficiency,
umbilical cord
(<=10 ng/mL, n=40)
76.9b
Severe deficiency,
0.03 maternal serum
(<=10 ng/mL, n=29)
78.3a
0.04
Mild deficiency
umbilical cord,
(10-20 ng/mL, n=26)
83.7b
Mild deficiency maternal
serum
85.1b
(10-20 ng/mL, n=26)
Normal level,
Normal level,
umbilical cord
94a
maternal serum (>=20
92.9c
(>=20 ng/mL, n=10)
ng/mL, n= 19)
The relationship thymus perimeter with 25(OH)D3 concentrations in both maternal serum at
mid-pregnancy and umbilical cord serum at delivery. p<0.05 statistical significance.
[PP-029]
Fetal vitamin D eksikliği yenidoğanın geçici taşipnesi için bir risk faktörü
müdür?
Esra Bahar Gür1, Esin Kasap1, Mine Genc1, Sümeyra Tatar1, Sultan Buğday1, Gülüzar Arzu Turan1,
Ayda Haksever3, Çiğdem Takma2, Serkan Güçlü1
1
şifa üniversitesi kadın hast ve doğum kliniği
2
ege üniversitesi
3
şifa üniversitesi pediatri kliniği
Amaç: Çalışmamızın amacı, term fetuslarda fetal vitamin D (VD) eksikliğinin yenidoğan geçici
taşipnesi (YGT) için bir risk faktörü olup olmadığını değerlendirmektir.
Gereç ve Yöntemler: Bu çalışmada miadında ve sezaryen ile dünyaya gelmiş 76 sağlıklı ve 34 YGT
izlenen yenidoğan ile bu bebeklerin anneleri değerlendirildi. Annelerden 25-hidroksivitamin D3
(25(OH)D3) düzeylerine bakılmak üzere kan alındı ve VD eksikliğine etki edebilecek faktörler, bir
anket ile sorgulandı. Doğumda umblikal kord 25(OH)D3 düzeyi bakmak üzere kan alındı. 25(OH)D3
düzeyleri izotop dilusyon likid kromatografi-tandem kitle spektrometre (LC-MS/MS) ile ölçüldü.
Yenidoğanlar, doğumdan sonraki ilk 24 saat YGT bulguları açısından izlendi.
Bulgular: Serum 25(OH) D3 düzeyleri, kontrol ve YGT grubunda sırasıyla annelerin 22’sinde (%
32.5) ve 4’ünde (% 11.7 ); fetusların 10’unda (%14.7) ve 2’sinde (%5.8) normal (>=20 ng/mL)
düzeydeydi. Ortalama maternal 25(OH)D3 düzeyi kontrol grubunda15.06±6.9 ve YGT grubunda
11.6±5.4 (p=0.05) ve kord kanı 25(OH)D3 düzeyi kontrol grubunda 12.3±4.8 ve YGT grubunda
7.4±3.8 (p<0.01) olarak heasplandı. Maternal ve umblikal kord 25(OH)D3 düzeyleri arasında güçlü
ve anlamlı bir korelasyon izlendi (r=0.8, p< 0.001). Vücut kitle indeksi (VKİ), deniz kıyısı tatil
süresi ve mevsim maternal vitamin D düzeyi üzerinde etkili faktörler olarak bulundu. YGT gelişen
yenidoğanların kord kanı 25(OH) D3 düzeyi, kontrol grubundan anlamlı olarak düşük izlendi.
Sonuç: Ülkemizde fetal ve maternal VD eksikliği yaygın görülmektedir. Fetal VD eksikliği, YGT için
bir risk faktörü olabilir.
Anahtar Kelimeler: gebelik, Vitamin D eksikliği, yenidoğan geçici taşipnesi
Şekil 1.
Çalışmanın akış şeması.
şekil2
Maternal serum ve umblikal kord 25(OH)D3 düzeyleri arasındaki ilişki (Pearson korelasyon
katsayısı= 0.8, p<0.01)
Tablo 1.
Kontol grubu
(n=76)
YGT grubu
(n=34)
p
Yaş (yıl)
Ortalama (±SD)
29.5±4.3
30.1±3.9
0.6
Doğumdaki gebelik
haftası
Ortalama (±SD)
29.5±4.3
38.6±0.7
0.4
VKİ
Ortalama (±SD)
28.8±2.6
28.3±3.1
0.6
Maternal serum
Umblikal
kord
Maternal
serum
Umblikal
kord
p
Şiddetli VD eksikliği
(<=10 ng/mL) (n,%)
27, 35.5
40, 52.6
18, 52.9
24, 70.5
P1<
0.01
P2<0.01
Ilımlı VD eksikliği
(10-20 ng/mL) (n,%)
27, 35.5
26, 34.2
12, 35.2
8, 23.5
P1= 0.6
P2=0.05
2, 5.8
P1=
0.04
P2<0.01
7.4±3.8
P1=
0.05
P2<0.01
Normal düzey
(>=20 ng/mL) (n,%)
Ortalama 25(OH)D3
düzeyi ± SD
(ng/mL )
22, 28.9
15.06±6.9
10, 13.1
12.32±4.8
4, 11.7
11.6±5.4
Doğumda maternal ve umblikal kord VD (vitamin D) düzeyleri SD: standard deviasyon. VKİ:
Vücut kitle indeksi.P1: gruplar arası maternal serum 25(OH)D3 düzeyleri arasındaki ilşiki;
P2: gruplar arası umblikal kord 25(OH)D3 düzeyleri arasındaki ilşiki.
[PP-030]
Postpartum Dönemdeki Kadınların Sosyal Destek Düzeyleri ve Depresyon
Belirtileri Arasındaki İlişkinin İncelenmesi
Gümrah Duygu Atmaca1, Gülgün Durat1, Kevser Özdemir2, Serhan Cevrioğlu3
1
Sakarya Üniversitesi Sağlık Yüksekokulu, Akıl Sağlığı ve Psikiyatri Ana Bilim Dalı, Sakarya
2
Sakarya Üniversitesi Sağlık Yüksekokulu, Doğum ve Kadın Hastalıkları Hemşireliği Ana Bilim Dalı,
Sakarya
3
Sakarya Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Sakarya
Giriş:
Gebelik ve doğum sonrası süreç, kadında fizyolojik, ruhsal ve sosyal değişimlerin yaşandığı,
psikiyatrik hastalıklara, özellikle de postpartum depresyona yakalanma riskinin en yüksek olduğu
dönemdir.
Yapılan çalışmalarda doğum sonu dönemde görülen psikiyatrik bozuklukların nedenleri arasında
sosyal destek yetersizliği, eşler arasında uyumsuzluk ve stresli yaşam şartları gösterilmektedir.
Çalışmamız, postpartum dönemdeki kadınların ailelerinden algıladıkları sosyal destek ile depresyon
düzeyleri arasındaki ilişkinin incelenmesi amacıyla yapılmıştır.
Gereç-Yöntem:
Çalışmanın örneklemini Sakarya Üniversitesi Eğitim Araştırma Hastanesi lohusa servislerinde yatan
ve çalışmaya katılmayı kabul eden 108 kadın oluşturmuştur.
Veriler; görüşme formu, Aileden Algılanan Sosyal Destek Ölçeği ve Beck Depresyon Envanteri
kullanılarak toplanmış, yüzdelik, korelasyon, Mann Whitney-U, Kruskal Wallis testleri ile
değerlendirilmiştir.
Bulgular:
Çalışmaya katılan kadınların yaş ortalaması 26.86±4.41, evlilik süresi ortalaması 5.06±4.11’dir.
Katılımcıların %52.8’i şehirde yaşamaktadır.
Çalışma grubunu oluşturanların %86.6’sı sosyal destek aldığını; bunların %52.8’i ebeveynlerinden,
%38.9’u kardeşlerinden, %22.2’si eşlerinin anne babasından, %13.9’u eşlerinden destek aldıklarını
belirtmişlerdir.
Kadınlardan çalışan, şehirde yaşayan, ekonomik durumu iyi, çekirdek aile yapısına sahip, eğitim
durumu lisans ve üzeri, sosyal destek aldığını belirten ve gebeliği planlı olanların, sosyal destek
ölçeği puan ortalamaları istatistiksel olarak anlamlı bir şekilde daha yüksek bulunmuştur (p<0.05).
Çalışan, şehirde oturan ve ekonomik durumu iyi olan kadınların Beck Depresyon Ölçeği puan
ortalamaları ise düşük bulunmuştur (p<0.05).
Aileden algıladıkları sosyal destek ölçek puan ortalaması 26.31±5.91, Beck Depresyon
envanterinden aldıkları puan ortalaması 7.69±6.68’dir. Aileden algılanan sosyal desyek düzeyi ile
depresyon arasında negatif yönde orta düzeyde ilişki bulunmaktadır (p<0.05).
Sonuç ve Öneriler:
Çalışmamızda aileden algılanan sosyal destek düzeyi arttıkça depresyon belirti düzeyinin azaldığı
bulunmuştur.
Anahtar Kelimeler: Depresyon, postpartum dönem, sosyal destek
[PP-031]
Gebeliğin son üç ayında çalışmaya devam etmenin postpartum depresyona
etkisi
Esra Bahar Gür1, Gülüzar Arzu Turan1, Sultan Buğday1, Esin Kasap1, Esma Burçak Zengin2,
Sümeyra Tatar1, İrem Hepyılmaz1, Serkan Güçlü1
1
şifa üniversitesi kadın hast ve doğum kliniği
2
şifa üniversitesi psikiyatri kliniği
Amaç: Postpartum depresyon, anneyi, bebeği ve çevresini etkiyen önemli bir sağlık sorunudur. PPD
üzerine etkili faktörler daha önceki çalışmalarda araştırılmıştır. Ancak gebeliğin üçüncü üç aylık
bölümünde uzatılmış iş hayatının postpartum depresyon üzerine etkisini gösteren veri mevcut
değildir. Çalışmamızın amacı, gebeliğin son üç ayında uzatılmış iş yaşantısının postpartum
depresyon üzerine etkisini araştırmaktır.
Yöntem-Gereçler: Kliniğimizde Ekim 2013-Ekim 2014 tarihleri arasında takip edilen çalışan gebeler,
ana kaynağımızı oluşturdu. Çalışma süresinin postpartum depresyona etkisini daha net ortaya
koyabilmek için, postpartum depresyon üzerine etki etmesi olası durumlara sahip gebeler
çalışmadan çıkarıldı. Doğum gerçekleştikten sonra, doğum ve yenidoğan komplikasyonu yaşayan
katılımcılar, ayrıca çalışma dışına alındı. Katılımcılar doğum sonrası 4. haftada telefon ile aranarak
Edinburgh Postnatal Depresyon Ölçeği (EPDÖ) ile değerlendirildi. Postpartum depresyona etki eden
faktörler regresyon analizi ile değerlendirildi. Çalışma süresi ile EPDÖ puanı arasındaki ilişkiyi
değerlendirmek için Pearson Korelasyon analizi yapıldı.
Bulgular: Katılımcıların %21.7’i ( n=48) 12 ve üzerinde puan alması nedeniyle postpartum
depresyon olarak değerlendirildi. Sosyo-demografik veriler gruplara ayrılarak, her bir alt grup için
PPD sıklığı araştırıldığında, eğitim düzeyi, yıllık gelir, sosyal çevre desteği ve gebelikteki çalışma
süresi alt grupları arasında postpartum depresyon sıklığı anlamlı olarak farklı bulundu. EPDÖ puanı
ile çalışılan hafta sayısı arasındaki ilişki araştırıldığında, iki değer arasında güçlü ve pozitif bir ilişki
olduğu görüldü (Pearson korelasyon katsayısı (r)= 0.4, p= 0.03)
Tartışma: Gebeliğin son üç aylık döneminde uzatılmış iş yaşamı postpartum depresyonu etkiyen bir
faktör olabilir.
Anahtar Kelimeler: Postpartum depresyon, etkileyen faktörler, çalışma süresi
tablo 1
Karakteristik
özellikler
guruplar
Kişi
sayısı(%)
n=221
postpartum depresyon (EPDÖ>=12)
kişi sayısı (%) n=48 (%21.7)
P
değeri
Yaş
<25
102 (46.1)
14 (16.6)
0.09
>=25-30
84 (38)
25 (28)
>=30
84 (38)
23 (17.4)
<=8 yıl
89 (40.2)
25 (28)
>8 yıl
132 (59.8)
23 (17.4)
<=10 000$
98 (44.3)
27 (27.5)
>10 000$
123 (55.7)
21 (17)
Vaginal
doğum
101(45.8)
25 (20.8)
C/S
120 (54.2)
23 (22.7)
Tatmin
edici
145 (65.6)
26 (17.9)
Eğitim düzeyi
Yıllık gelir
Doğum şekli
Evlilik tatmini
0.04
0.03
0.4
0.08
Sosyal çevre
desteği
Aktif emzirme
Gebelikteki
çalışma süresi
Orta
düzeyde
57 (25.7)
16 (28)
yetersiz
19 (8.5)
6 (31.5)
Yeterli
destek
108
20 (18.5)
Orta
düzeyde
67
13 (19.4)
yetersiz
50
15 (30)
evet
184
30 (16.3)
hayır
37
7 (18.9)
32. haftaya
kadar
123
19 (15.4)
0.04
0.7
<0.01
37. haftaya
98
29 (29.5)
kadar
Sosyo-demografik özellikler ve postpartum depresyon sıklığı. P<0.05 değeri istatistiksel
anlamlılık olarak kabul edildi.
tablo 2
Regresyon
katsayısı
Standart
hata
OR
değeri
%95 güven
aralığı
P
değeri
Yaş
-1.30
0.79
0.27
0.05-1.29
0.2
Eğitim düzeyi
-0.99
0.45
2.55
1-7.2
0.04
Yıllık gelir
-1.64
0.83
0.16
0.03–0.79
0.01
Doğum şekli
0.78
0.66
2.01
0.49–8.14
0.4
Evlilik tatmini
1.1
0.55
2.6
0.89-6.65
0.05
Sosyal çevre
desteği
-1.1
0.51
1.9
0.03-0.12
0.04
Aktif emzirme
-0.04
0.24
1.8
0.60–1.52
0.8
Çalışma süresi
0.7
0.25
0.7
1.15–3.38
0.03
(hafta olarak)
Postpartum depresyona etki eden faktörler. Çoklu regresyon analizi yapıldı. P<0.05 değeri
istatistiksel anlamlılık olarak kabul edildi.
tablo3
Pearson korelasyon katsayısı p değeri
Çalışma süresi / EPDÖ
r= 0.7
0.03
(hafta olarak)
Çalışma süresi ile EPDÖ arasındaki ilişki. Pearson korelasyon analizi yapıldı.
[PP-032]
Plasenta Akreata Nedeniyle Gelişen Geç Postpartum Kanama Tedavisinde Acar
Usulü Kompresyon Sütürü ile Başarılı Tedavi; Olgu Sunumu
Fedi Ercan1, Fatma Kılıç1, Berkan Sayal1, Damlanur Üstün2, Ali Acar1
1
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı,
Konya
2
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim
Dalı, Konya
GİRİŞ
Plasenta yapışma anomalileri, plasentanın uterin duvar içine doğru anormal şekilde invaze
olmasıdır.Bu anomaliler plasenta akreata, inkreata ve perkreata olmak üzere 3 grupta incelenir.Bu
durum ciddi komplikasyonlara neden olabilir. Burada plasenta akreata nedeniyle postpartum
17.günde başlayan ciddi postpartum kanamanın(PK) tedavisinde kullanılan yeni sütür tekniği(Acar
usulü kompresyon sütürü) ile tedavi edilen olgu sunulmuştur.
OLGU
Hasta 17 gün önce dış merkezde vajinal doğum yapmış ve postpartum 17.günde gelişen abondan
vajinal kanama nedeniyle merkezimize refere edilmiştir.Muayenesinde serviks 2cm kadar açık
olarak gözlenmiş ve kavite içerisine girilerek palpe edildiğinde korpus ön duvarda yaklaşık olarak
3x4cm boyutlarında uterusa dens olarak yapışmış doku palpe edilmiştir.Başvuru esnasında masif
vajinal kanaması olan ve vital bulguları stabil olmayan (tansiyon arteriyel 80/50 mmHg, radial
nabız 118 atım/dakika ritmik-filiform, hemoglobin 6,4gr/dl)hastanın β-Hcg ölçümü
negatifti.Ultrasonografik değerlendirmede intrauterin yaklaşık 42x45 mm boyutlarında düzensiz
kontürlü,Dopplerde vaskülarizasyon gösteren heterojen yumuşak doku kitlesi görülmüştür(Resim
1).Hastaya acil laparotomi kararı alınarak histerotomi yapılmış ve uterus dens şekilde yapışmış
yaklaşık 1 kotiledon büyüklüğündeki doku çıkarılmıştır(Resim 2).Çıkarılan plasental yataktan
gözlenen ciddi kanama Acar Usulü Kompresyon Sütürü konularak kontrol edilmiştir(Resim 3).
Ameliyat esnasında 2 ünite taze tam kan verilen hasta postop 3.günde taburcu edildi.
TARTIŞMA
PK gelişmekte olan ve gelişmiş ülkelerde maternal morbidite ve mortalitenin en önemli
sebeplerinden biridir.Plasenta yapışma anomalileri PK nedenleri arasında artık çok daha sık bir
nedendir.Geçirilmiş sezaryen doğum ve plasenta previa en başta gelen risk faktörleridir.Tedavide
kompresyon sütürleri son yıllarda popülarite kazanmıştır.Bu vakada kullanılan teknik 2014 yılında
Acar ve arkadaşları tarafından tarif edilen ve literatüre giren ''Acar Usulü Kompresyon Sütürü'' olup
en yeni konservatif cerrahi seçeneklerden biridir.
Anahtar Kelimeler: Postpartum Kanama, Plasenta İnvazyon Anomalisi, Uterin Kompresyon Sütürü
Resim 1
Plasenta Akreata Alanının Transvajinal Ultrasonografi Görüntüsü
Resim 2
Çıkarılan plasenta dokusu. Maternal yüzden görünümü (A) ve nekroze alanlar da içeren diğer
yüz (B).
Resim 3
Kanayan plasenta ayrılma sahasına Acar Usulü Kompresyon Sütürü atılırken
[PP-033]
Uterin Atonide Fundal Serozal Plasental Alan Sütürasyonu; 5 vakanın analizi
Ali Acar, Osman Balcı, Fedi Ercan, Cemre Alan, Berkan Sayal, Fatma Kılıç
Konya
Amaç: Plasentası fundusta yerleşik olan ve uterin atoni(UA) nedeniyle postpartum kanama gelişen
hastalarda yeni bir konservatif cerrahi metod olan fundal plasenta serozal alan sütürasyonunun
etkinliğinin değerlendirilmesidir.
Yöntem-Gereçler: Çalışmada Ocak 2013-Mayıs 2014 tarihleri arasında Necmettin Erbakan
Üniversitesi Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde postpartum kanama tanısı
alan ve plasentası fundusa yerleşmiş fundal plasental serozal alan sütürasyonu uygulanan beş vaka
incelenmiştir. Sütür materyali olarak 80 mm 1/2 yuvarlak iğneli 1 numara poliglaktin 910 sütür
materyali kullanılmış ve şekil 1'de gösterilen şekilde uygulanmıştır.
Bulgular: Postpartum kanama nedeni UA olan beş olgudan dördü sezaryen biri vajinal doğum
yapmış hastalardı. Hastaların yaş ortalaması 27.8±2.3(20-31) idi. Üç hasta(%60) primigravida, iki
hasta(%40) multigravida idi(Tablo 1). Ortalama gravida 2.4(1-5), ortalama parite 1.8(1-4) idi.
Hastaların ortalama gebelik haftaları 37.5±2.0(34-39) idi. Hastaların tamamında plasenta fundus
yerleşimli iken ayrıca iki hastada plasenta akreata mevcuttu(%40). Sütür uygulanan beş hastada
da kanama kontrolü sağlandı(%100). Vaka başına uygulanan ortalama sütür sayısı 2.0±1.0(1-3)
idi. Ameliyatlara ait ortalama kan kaybı 1700±300cc(1400-2000 cc) ve hastalara uygulanan
transfüzyon 2-4 ünite arasında idi. Ortalama ameliyat süresi 55±10 dakika(40-70) idi. Postoperatif
dönemde hastaların hiçbirinde komplikasyon izlenmedi. Hastalar ortalama 3.5±1,5(2-5) günde
taburcu edildiler.
Sonuçlar:Anne ölümlerinin çoğu 1.ya da 2.basamak sağlık kuruluşlarında veya transport sırasında
olmaktadır. Üçüncü basamak sağlık kuruluşlarına (donanımlı tıp fakülteleri ve eğitim
hastaneleri)transport yapılırken geçen zaman hayati önem taşır. Tarif edilmeye çalışılan yöntem
birinci ve ikinci basamak sağlık kuruluşlarında uygulanabilir, etkili, kolay, hızlı ve ciddi bir
komplikasyon ile karşılaşma olasılığı olmayan ideale yakın bir yöntemdir.
Anahtar Kelimeler: Postpartum Kanama, Kompresyon Sütürü, Uterin Atoni
Şekil 1
Sütürün şematik olarak geçtiği noktaların gösterimi
Tablo 1
Sezaryan
4 hasta (%80)
Vajinal Doğum
1 hasta(%20)
Ortalama yaş
27.8±2.3 (20-31)
Ortalama gravite
2.4 (1-5)
Ortalama parite
1.8 (1-4)
Primipar gebe
3 hasta (%60)
Multipar gebe
2 hasta (%40)
Ortalama hastanede kalış süresi 3.5 ± 1,5 (3-6)
Ortalama transfüzyon sayısı
2-4 Ünite
Ortalama operasyon süresi
45±10 dakika
Ortalama sütür sayısı/vaka
2.0±1.0 (1-3)
Ortalama kan kaybı
1700±300 cc
Çalışma grubunun genel özellikleri ve çalışma sonuçları
[PP-034]
Case report: Dandy Walker Syndrom prenatal diangnosis with Ultrasound
Aida Aida Kumnova, Bleta Bleta Domi, Qamil Qamil Hamza, Butrint Butrint Kusari, Ilir Ilir Kadiri
Regional Hospital Gjakova /Kosova. Department of perinatalogy.
Summary
The Dandy-Walker complex is a rare congenital intracranial malformation that comprises a
spectrum of abnormalities of the posterior fossa which are classified as
(a) Dandy-Walker malformation (cystic dilatation of the 4th ventricle, complete or partial agenesis
of the cerebellar vermis and an enlarged posterior fossa)
Findings:
A 28 year old primigravida come in the routin ultrasound of the perinatal at 20 week of
gestation.Ultrasonography revealed a single live intra-uterine gestation with biparietal diameter
and foetal femur length corresponding to 22 weeks of gestation.
The foetal posterior fossa was of normal size but with a large anechoic lesion which was
communicating with the 4thventricle. There was a suggestion of hypoplasia of the cerebellar vermis
(Fig.1) but no evidence of hydrocephalus.
The mesurments of the fetus was normale the FW 270 gr, umbilcal cord with one vein and one
artery,cerebellum was18mm but cysterna magna was large 10mm.In Ultrasound scan it was not
possible to see the vermis.
It was diagnosed Dandy Wlakersyndrome and the patents did not want to do the prenatal diagnosis
with amniocentesis.
The abortion was induced with cytotec tablets 200 mcg every 3 hours and after 36 hours she
aborted the fetus 280 grams with no facial malformations only in each leg was 4 fingers and in
each hend was 6 fingers.
Keywords: Dandy walker syndrome, ultrasound
[PP-035]
Gestasyonel diabetes mellitus tanısı alan gebelerde oksidatif stres markerları,
serbest radikaller ve lipit profilinin maternal serum ve kord kanı düzeyleri
Fatma Beyhekim1, Aybike Pekin2, Tolgay Tuyan Ilhan2, Fikret Akyürek3, Setenay Arzu Yılmaz2,
Özlem Seçilmiş Kerimoğlu2, Abdullah Sivrikaya3, Çetin Çelik2, Ali Ünlü3
1
Doktor Süreyya Adanalı Göksun Devlet Hastanesi, Kadın Hastalıkları ve Doğum Kliniği,
Kahramanmaraş
2
Selçuk Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Konya
3
Selçuk Üniversitesi Tıp Fakültesi, Biyokimya Ana Bilim Dalı, Konya
Amaç: Çalışmamızda gestasyonel diabetes mellitus (GDM) tanısı konulan gebelerde ve normal
glukoz yükleme testi sonuçlarına sahip olan kontrol grubu gebelerde maternal ve fetal kan lipid
profili ve oksidatif stres düzeylerinin değerlendirilmesi amaçlanmıştır.
Gereç-Yöntem: Çalışmaya gestasyonel diabetes mellitus tanısı alan 65 gebe ve 65 kontrol grubu
olmak üzere toplam 130 tekil gebeliğe sahip hasta dahil edilmiştir. Doğumda alınan maternal serum
ve kord kanında LDL (düşük yoğunluklu lipoprotein), okside LDL, TOS (toplam oksidan seviye), TAS
(toplam antioksidan seviye), Lp(a) (lipoprotein (a)), total kolesterol, trigliserid, HDL (yüksek
yoğunluklu lipoprotein) düzeyleri değerlendirilmiştir.
Bulgular: Maternal kanda bakılan TAS, Lp(a), okside LDL, HDL, LDL, total kolesterol, düzeylerinde
GDM ve kontrol grubu arasında anlamlı bir farklılık saptanmamıştır. Ortalama trigliserid ve TOS
düzeyleri ise GDM grubunda daha yüksek olarak ölçülmüştür (p<0,05). GDM‘li gebeler diyet ile
regüle edilen ve insülin kullanan gebeler olarak alt gruplarda değerlendirildiğinde Lp(a) ve LDL
değerleri kan glukoz seviyesi diyet ile regüle olan grupta yüksek olarak ölçülmüştür (p<0,05). Kord
kanı incelendiğinde ise okside LDL değeri GDM grubunda yüksek idi (p<0,05). Yine diyet ile regüle
GDM olan gebelerin kord kanında okside LDL düzeyleri insülin kullanan gebelerden daha yüksek
olarak ölçülmüştür (p<0,05).
Sonuç: Maternal oksidatif stres belirteçlerinin (TOS ve Lp(a)) özellikle, kan glukoz düzeyi diyet ile
regüle edilen GDM grubunda daha yüksek olduğu, yine gestasyonel diyabetik gebelerde kan lipid
profilinde düzensizlik (yüksek trigliserid ve LDL düzeyleri) olduğu görülmüştür. Aynı zamanda diyet
ile regüle GDM’lu gebelerin bebeklerinde doğumda okside LDL düzeyleri daha yüksektir.
Anahtar Kelimeler: Gestasyonel diabates mellitus, okside LDL, toplam antioksidan seviye,
lipoprotein(a)
[PP-036]
Delivery in a Woman With Corrected Tetralogy of Fallot and Pulmonary
Hypertension
Ayşe Altındiş Bal1, Ebru Yüce1, Esra Aktepe Keskin1, İnci Aslı Atar2, Zehra Candan İltemir Duvan1
1
Department of Obstetrics and Gynecology, Turgut Özal University Hospital, Ankara, TÜRKİYE
2
Department of Cardiology, Turgut Özal University Hospital, Ankara, TÜRKİYE
One of the most important cause of morbidity and mortality in pregnancies is cardiac diseases. The
number of pregnant women with congenital heart defect has increased because of early diagnosis
and treatment of many congenital heart defects. Tetralogy of fallot is the most common form of
cyanotic congenital heart disease after 1 year of age. Although pregnancy in patients with
corrected tetralogy of fallot usually have a satisfactory outcome, there may have maternal
cardiovascular complications. Pulmonary arterial hypertension is one of the maternal cardiovascular
complications, which is rare in corrected tetralogy of fallot.
We describe the case of a 27-year-old woman with tetralogy of fallot, with a history of 2 previous
cardiac operations, who underwent a caesarean section on 36th week pregnancy because of
developing pulmonary arterial hypertension.
Keywords: Tetralogy of Fallot, Pregnancy, Delivery, Pulmonary Hypertension
[PP-037]
Ultrasound diagnostic criteria of morbidly adherent placenta (MAP)
Cringu Antoniu Ionescu1, Liana Ples2, Mihai Banacu1, Irina Pacu1
1
UMF Carol Davila Department Obstetrics Gynecology Clinical Emergency Hospital Sf Pantelimon
Bucharest
2
Department Obstetrics Gynecology Bucur Maternity Clinical Emergency Hospital Sf Ioan
Objectives
Postpartum hemorrhage represent an important cause of maternal mortality.There are three forms
of morbidly adherent placenta (MAP) placenta accreta, increta and percreta. Increasing incidence of
cesarean section (CS) in the last ten years correlates with the incresed incidence of MAP. The
pathologic adherent placenta occurs in 9,3% of women with placenta previa, the risk being 24% in
those with a previous CS and 67% in those with three CS.
Methods
Using 2D gray and color doppler ultrasonography we investigated the presence of: 1. thinning or
interruption of the hyperechoic interface between uterine serosa and blader wall termed the bladder line-2. loss ef the echolucent area between the uterus and blader wall, 3. irregular
retroplacental sonolucent areas, 4. presence of turbulent placental lacunae with high velocity flow.
Using 3D power Doppler we can map the vascularization of the intraplacental and serosa-blader
interface and we can investigate: 1. hypervascularity of the uterine-serosa wall interface
2.intraplacental hypervascularity 3. tourtuous vascularity with chaotic branching.
We found that MAP patients have two out of five or more signs were detected. The most effective
ultrasound criteria for detection of MAP were abnormal clear space and uterine serosa-blader wall
interface hypervascularity.Using 3D power Doppler the numerous coherent vessels visualized in the
placenta was best single criterion for diagnosis.
Conclusion
The rewieved ultrasound criteria may be useful for the prenatal diagnosis of MAP and 3D power
Doppler can help to differentiate between placenta accreta and percreta.
Key words:Morbidly adherent placenta, 3D power Doppler,ultrasonography
Keywords: ultrasonography, 3D power Doppler, Morbidly adherent placenta
[PP-038]
Terme Ulaşmış Tanatoforik Displazi; Olgu Sunumu
Fedi Ercan, Ali Acar, Hande Kaçar, Berkan Sayal
Konya
GİRİŞ
İskelet displazileri kalıtsal bağdoku hastalıkları içindeki oldukça heterojen bir grubu oluşturur.
Bunlar arasında Fibroblast Büyüme Faktörü Reseptörü-3 (FGFR-3) geni mutasyonu sonucu
meydana gelen displaziler akondroplazi, hipokondroplazi ve tanatoforik displazi(TD)dir. TD, FGFR-3
geni mutasyonu sonucu oluşan en sık letal iskelet displazisidir, sıklığı 100.000'de 3-6 kadardır.
Ultrasonografi prenatal tanı sağlıyor olsa bile, TD fetusların in utero olarak diğer iskelet
osteokondrodisplazilerinden ayırımı net olamamaktadır. Burada terme ulaşmış TD olgusu
sunulmaktadır.
OLGU SUNUMU
Yirmiüç yaşında sağlıklı bir erkek çocuğu olan hasta SAT'a göre 36 hafta 4 günlük gebe iken
başvurdu. Haftasına göre femur uzunluğu (FL) <2,3 persentil, humerus uzunluğu (HL) <5,0
persentil olarak tespit edildi (Şekil 1 ve 2). Polihidroamnios mevcuttu(Şekil 3). Fetal yüzde frontal
çıkıklık, burun kökü basıklığı ve mikrognati vardı(Şekil 4). Kısa kostalar nedeniyle gelişen dar
toraks mevcuttu(Şekil 5). Femur boyu(FL)/Abdomen çevresi(AC) oranı 0,15 idi (hipoplastik toraks).
37.gebelik haftasında uterin kontraksiyonların başlaması ve hiperekstansiyonda başa sahip makat
geliş nedeniyle sezaryen yapılan hasta 2000gr, 5.dakika APGAR skoru 4, kız bebek doğurdu(Şekil 6
ve 7). Solunum sıkıntısı nedeniyle entübe edidi, yenidoğan yoğunbakım ünitesine alındı ve
postpartum 3. günde ex olan infantın moleküler genetik analizi TD tipI olarak netleşmiştir.
TARTIŞMA
TD dışındaki FGFR-3 ilişkili diğer iskelet displazileri akondroplazi ve hipokondroplazidir.
Prenatal ultrasonografi TD’den süphelenmek için ipuçları sağlar. Ancak bu bulgular tek başına,
moleküler analiz olmadan kesin tanı için yeterli değildir. TD süphesi oluştuğunda intrauterin olarak
tanıyı kesinleştiremek için standart sitogenetik analizin bir parçası olarak FGBR-3 gen lokusundaki
TD spesifik mutasyonun tespit edilmesi ve hastayı bu bilgi projeksiyonunda prognoz ile ilgili
aydınlatmak gerekir.
Anahtar Kelimeler: Tanatoforik Displazi, İskelet Displazisi, Fibroblast Büyüme Faktörü Reseptörü3
Resim 1
Kısa femur (< 2,3 persentil)
Resim 2
Kısa humerus (< 5,0 persentil)
Resim 3
Polihidroamnios (Tek cepta >100 mm amniotik mayi)
Resim 4
Fetal baş 2 boyutlu ultrasonografi ile sagittal planda görüntülenmiş ve belirgin frontal
çıkıklık ile burun kökü basıklığı ile birlikte mikrognati izlenmekte (A), 3 boyutlu
ultrasonografi ile aynı bulgular görülmekte(B).
Resim 5
Belirgin hipoplastik toraks görüntüsü
Resim 6
Çökmüş burun köprüsü ile belirgin frontal çıkıklık ve kısa yukarı dönmüş burun ucu
Resim 7
Brakidaktili ve tipik ‘’3 başlı mızrak’’ el (A), mikromeli (B) ve çan şekilli göğüs kafesine (C)
neden olan ağır kostal gelişim bozukluğu
[PP-039]
Effect of pre-intervention complete blood count testing and use of concomitant
progesterone on pregnancy prolongation in cervical cerclage patients.
Doruk Cevdi Katlan1, Bahar Konuralp Atakul1, Tuncay Yüce1, Dilek Acar Yüksel1, Acar Koç1, Feride
Söylemez1
(1) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara,
Turkey
Aim
Cervical cerclage placement for prevention of prematurity is based on either emergent (physical
examination-indicated, E-C) or non-emergent (history-indicated or ultrasound-indicated, NE-C)
indications. But beforehand, the patient must be evaluated for possible contraindications, including
but not limited to uterine activity or overt chorioamnionitis, especially on the emergent setting.
Although not diagnostic, leucocytosis in a pregnant patient (>15,0x109/L) may be indicative of an
underlying infection, possibly chorioamnionitis. Maternal anemia (Hb <10,0 g/dL) is also related to
poor pregnancy outcome. The aim of this study is to evaluate the effect of maternal leucocytosis
and anemia and the concomitant use of progesterone, another well-documented intervention, on
pregnancy prolongation in cerclage patients.
Methods
Data of the patients who underwent McDonald cerclage procedure at Ankara University Department
of Obstetrics and Gynaecology, between August 2007 and January 2015 were retrospectively
gathered and analysed.
Results
Among 121 patients included in the analysis, complete blood count tests were obtainable for 115.
Patients were grouped according to indication (E-C, n=33 or NE-C, n=82), fetal number (singleton,
n=99 or multifetal, n=16) and possible combinations of these. When leucocytosis was present,
prolongation of pregnancy was significantly lower for both the E-C and NE-C groups. This effect
was much more prominent for singleton pregnancies especially for the E-C group. Among all
groups, maternal anemia, revealed significant negative difference for the singletons. Concomitant
maternal use of progesterone created no significant difference in all the possible combinations of
groups of 121 patients.
Conclusions
Prolongation of pregnancy may not even be desirable with regard to the infective aetiology of
preterm birth. Laboratory evaluation by a simple complete blood count may be helpful to clinical
diagnosis of chorioamnionitis and maternal anemia predicting poor prognosis of pregnancy,
although not diagnostic for cervical insufficiency. As our data suggests, this condition is especially
valid for the literature recommended indications of cerclage; singleton and emergent ones.
Adjunctive progesterone therapy used with cerclage showed no benefit, again consistent with the
current knowledge.
[PP-040]
Posterior reversible encephalopathy syndrome: a case study
Cihan İnan, Füsun G Varol, Selen G Erzincan, Cenk N Sayın
Trakya University, Obstetrics and Gynecology, Perinatology Section
"Posterior reversible encephalopathy syndrome" (PRES) is a condition that occurs due to several
aetiologic causes resulting in vasogenic oedeme in the brain with the disruption of cerebral autoregulation. The diagnosis of PRES is made with clinic and neuro-radiologic imaging techniques.
PRES most commonly covers the posterior cerebral regions. It might present particularly in
pregnant women as a complication of pre-eclampsia and eclampsia, and it is very important to
diagnose PRES in an accurate and rapid manner. This case study focuses on the case of a pregnant
patient, who was diagnosed with PRES after her neuro-radiologic examination that was performed
due to recurrent generalized tonic-clonic seizures and who was preterm and had intrauterine
growth retardation.
Keywords: PRES, Pre-eclampsia
Figure 1. Cranial MR images on the 1 day after C-section
1a. 1b Hyper-intense areas in T2AS-FLAIR in temporal-occipital-parietal lobes 1c 1d Hyperintense areas in subcortical-weighted T2AS-FLAIR in cortico-subcortical regions in frontal
and occipital lobes
Figure 2. Cranial MR image before the C-section
2a. Hyper-intense areas in T2 and FLAIR sequences in cerebellar region 2b. 2c. Hyperintense areas in T2 and FLAIR sequences in both occipital and parietal areas
[PP-041]
Prenatal Diagnosis of Fetal Abnormalities
Aytekin Aydın, Mustafa Öztürk
Etimesgut Military Hospital Obstetrics and Gynecology
Objective: The purposes of this study were to describe the most frequent fetal abnomalities in our
socio-economic conditions and to estimate the frequency of the most common fetal abnormalities
in patients from the Etimesgut Military Hospital Ankara
Materyal-Metod: Fetal abnomalities findings were retrospectively reviewed from 2012 to 2013 in
425 pregnant women. Ultrasound screening had performed at 11–22 weeks in all pregnant women.
Results: Fetal abnormalities were observed in 22 (0.5%) of the remaining 425 cases. The first and
second trimester ultrasonograpy scan detected acrania (2 cases), facial clefts, omphalocele with
megacystis, single artey and vein complications, cerebellar or vermian hypoplasia, high nuchal
translucency (>=3mm 3 cases), lateral ventricular enlargement (>=11mm 3 cases), fetal renal
pyelectesis (>=10mm 3 cases), posterior ürethral valve, talipes deformity (2 cases) and
diaphragmatic hernia. The mean maternal age was 28 years old, and mean gestational age was 18
weeks.
Conclusion: We have reported our prevalence of anomalies as 5 per 1000 births, similar to recent
studies.
Keywords: Prenatal diagnosis, fetal abnormalities, city hospital
[PP-042]
A Trisomy 21 Case With Signs of Non-Immune Fetal Hydrops in 13 Gestational
Week
Mustafa Öztürk, Aytekin Aydın
Etimesgut Military Hospital Obstetrics and Gynecology
Objective: To present a case of non-immune hidrops fetalis due to trisomy 21 in 13. gestational
week.
Case: A 42 year old, gravida 3 para 2, woman was offered early first trimester CVS due to the
findings of advanced age pregnancy, increased nuchal translucency thickness (NT= 6),absent nazal
bone, hyperecojen bowel, generalize hydrops. Indrect coombs, biochemical and immunological
infection markers were all reported as negative. A pregnancy termination was performed majorly
due to a report of trisomy 21 on the analysis of the fetal karyotype, after obtaining an appropriate
genetic counseling of the family. Fetus was macroscopically hydropic.
Conclusion: Chromosomal abnormalities, Cardiovascular diseases and congenital infections can
make generalized edema of the soft tissues with non immun hydrops fetalis. When non-immune
fetal hydrops was detected in the first trimester, abnormalities of fetal karyotype should be
evaluated at first.
Keywords: Trisomy 21, non-immune fetal hydrops
Figure
[PP-043]
Kaybolan İkiz (Vanishing twin)
Aytekin Aydın, Mustafa Öztürk
Etimesgut Asker Hastanesi Kadın Doğum Servisi
Amaç: Birinci trimesterde ikiz gebeliğin yaklaşık % 20 oranında “kaybolan ikiz” nedeniyle tekil
gebeliğe dönebileceğini vurgulamak istedik.
Giriş ve Yöntem: Birinci trimesterdeki ikiz gebelik oranı, doğumdaki ikiz doğum oranından daha fazladır. Fetüslerin ilk trimesterdeki sonografik incelemelerinde, ikiz gebeliklerin % 20 -25 oranında
ikizlerden birinin ikinci trimesterden önce kaybedildiği, spontan redüksiyona uğradığı veya
kaybolduğu bildirilmiştir (vanishing twin). Bazı olgularda gebelik tamamen abortus ile sonuçlanır.
Ancak çoğu zaman bir fetüs kaybedilir. Olgumuzda birinci trimesterin sonuna doğru kaybolan ikiz
“vanishing twin” fetüsün durumunu inceledik.
Bulgular: Gebe 32 yaşında, G2 P1’dir. Ailede ikiz öyküsü ve önceki gebelikte anomali
bulunmamaktadır. Gebenin sonografik incelemesinde, 8 haftalık CRL.1: 11,5 mm ve CRL.2: 10,8
mm ölçülerinde her ikisinde de kardiyak aktivite bulunan ikiz canlı fetüsler izlendi. Gebeye ikiz
gebelik konusunda bilgiler verildi, 3 hafta sonra kontrole çağrıldı. Ancak gebe yaklaşık 4 hafta sonra
geldiğinde 1. Fetüsün 12 haftalık ve canlı olduğu görülürken, 2. Fetüsün büyümesinin durduğu
CRL.10 mm, de 8 haftada kaldığını ve kardiyak aktivitesinin olmadığı görüldü(Resim 1). Gebeye
bebeğinin birinin öldüğü ve diğerinin canlı olduğu ve konun önemi anlatıldı. Gebe 3 hafta sonra
kontrole çağrıldı. 15. Haftada 2. Fetüsün yapısının kaybolması ve kesesinin küçülmesi nedeniyle 2.
Fetüsün spontan redüksiyona uğradığı görülerek “kaybolan ikiz = vanishing twin” kabul edildi. Bir
sonraki kontrolünde 19 haftalık gebe olan hastanın kontrolünde fetüsün 19 haftayla uyumlu olduğu
görüldü.
Sonuç: Çoğul gebelikte birinci ve ikinci trimesterde yapılan sonografik incelemelerin spontan fetal
redüksiyonun belirlenmesinde önemli bir yer tuttuğu görülmektedir. Bu nedenle gebelerin düzenli
rutin antenatal kontrolleri yaptırması gerekliliği unutulmamalı ve bu konuda gebeler eğitilmelidir.
Anahtar Kelimeler: Kaybolan ikiz, Antenatal takip
Resim
[PP-045]
Trisomy 13 ultrasound findings associated with trisomy 18
Uğur Keskin1, Fahri Burçin Fıratlıgil1, Mustafa Ulubay1, Ulaş Fidan1, Mehmet Ferdi Kıncı1, Deniz
Torun2, Kazım Emre Karaşahin1
1
Obstetrics and Gynecology Department, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
2
Department of Genetics, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
Objectives: The aim of this case report is to describe unlikely ultrasound findings of Edwards’
syndrome (trisomy 18).
Patient and Methods: A 39-year-old patient with a history of gravida 3 and para 2 applied to our
clinic for a routine control examination, first trimester screening at her 13th week of pregnancy. In
the patient’s anamnesis and antenatal care, no family history of aneuploidy was observed. In
obstetric ultrasound findings, the fetus had holoprosencephaly, omphalocele and atrioventricular
septal defect generally associated with Patau syndrome (trisomy 13). Therefore, the patient had
been referred to a genetic counselor with the pre-diagnosis of Patau syndrome. Chorionic villus
sampling (CVS) was offered for prenatal diagnosis.
Results: After genetic analysis, CVS material was reported as Edwards’ syndrome, it was noncorrelated with our ultrasonographic findings. The pregnancy was terminated
Conclusions: Patau syndrome as well as Edwards’ syndrome are characterized by a few of various
malformations in the fetus that can be diagnosed by ultrasound. But that characterized ultrasound
findings not only are used for definitive diagnosis but also be supported by genetic analysis.
Keywords: trisomy 13, trisomy 18, omphalocele
[PP-046]
Preeclampsia risk evaluation according to clinical features and thrombophilic
polymorphisms in a group of Romanian patients
Georgiana Nemeti1, Iulian Goidescu1, Madalina Valeanu3, Lucia Maria Procopciuc2, Florin
Stamatian1, Gabriela Caracostea1
1
Department of Obstetrics and Gynecology I, “Iuliu Hatieganu” University of Medicine and
Pharmacy, Cluj-Napoca, Romania
2
Department of Medical Biochemistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, ClujNapoca
3
Department of Medical Informatics, “Iuliu Hatieganu” University of Medicine and Pharmacy, ClujNapoca, Romania
Objective: To establish the extent of the involvement of clinical risk profile features and
thrombophilic polymorphisms in the stratification of risk for preeclampsia in a group of Romanian
pregnant women.
Method: 100 patients with hypertensive disorders of pregnacy were enrolled in the case group and
111 normotensive patients in the control group. Clinical profile features: maternal age, parity,
gestational age, pregestational body mass index (BMI), smoking habit and contraceptive use. The
thrombophilic genetic profile: factor V Leiden, 20210G-A prothrombin gene mutation, 677C-T and
1298A-C metylenetetrahydropholate reductase (MTHFR) gene mutations, was performed for both
cases and controls.
Results: In the case group we had 35 patients with pregnancy induced hypertension, 45 mild
preeclampsias and 20 cases of severe disease. We confirmed the association between severe
disease, nulliparity and obesity. Fetal haemodynamic adaptation was recorded in severe
preeclampsia cases as increased resistivity on the umbilical artery, brain sparing and ductus
venous reverse flow. Moreover, pregnancies with severe preeclampsia had a poor fetal outcome
with low birthweight for the gestational age, Apgar score <7 at 5 minutes. Factor V Leiden &
A1298C MTHFR mutations associated an increased risk of hypertensive disorders of pregnancy.
Factor V Leiden & C677T MTHFR polymorphisms had an increased risk of severe preeclampsia.
Conclusion: In the present study nulliparity and increased pregestational BMI are the clinical
fetures shown to influence the risk of severe preeclampsia, correlating with a poor maternal-fetal
outcome. Factor V Leiden and C677T MTHFR polymorphisms are associated with the risk of severe
outcome preeclampsia.
Keywords: preeclampsia, thrombophilia, polymorphisms, risk profile
[PP-047]
Induction of labor with dinoprostone vaginal insert; is it safe and effective in
term pregnancy with premature rupture of membranes?
Ilke Topdağı Aydın, Halenur Bozdağ, Egemen Aydın, Kadir Güzin, Necdet Süer, Fulya Gökdağlı
Medeniyet University Göztepe Training and Research Hospital
Background/Aims: Controlled-release dinoproston vaginal insert is a locally applicated
prostaglandin E2 formulation which is generally indicated in cervical ripening and induction of labor
especialy in term pregnancies with unfavorable cervix. Although it was not recommended in
patients with premature rupture of membranes in the past, it has been shown in a number of
studies that it can safely be used in patients with premature rupture of membranes as well.
Our aim in this study is to compare the efficacy and safety of controlled-release dinoprostone
vaginal insert in patients with intact membranes and premature rupture of membranes (PROM).
Methods: Eighty-six term pregnant patients with singleton pregnancy, with no prior uterine scar,
vertex presentation, bishop score of 6 or more, were included in the study. Patients were divided
into two groups as PROM patients (n:27) and patients with intact membranes (n:59).
Results: There was significant diffence in cervical ripening time which was achieved at
approximately 4 hours in the PROM group and 6 hours in the intact membrane group. There was no
significant difference in terms of vaginal delivery ratio, Apgar scores and fetal gas parameters
between the two groups.
Conclusion: These data overall suggest that controlled-release dinoprostone insert use is effective
and safe in patients with PROM just like in patients with intact membranes.
Keywords: cervical ripening, induction of labor, dinoproston, premature rupture of membranes
The evaluation of type of delivery
PROM group (n:27) Intact membranes (n:59)
vaginal birth
22(81,5%)
40(67,8%)
cesarean delivery 5(18,5%)
19(32,2%)
There was no siginificant difference in type of delivery between the two groups (p=0,189)
The evaluation of neonatal outcomes
PROM n(%) Intact membranes n(%) p
1.minute apgar score<7
1(3,7%)
8(13,7%)
0,262
5.minute apgar score<7
0(0%)
2(3,4%)
1,000
umbilical artery ph<7,2
2(7,4%)
5(8,4%)
1,000
neonatal intensive care unit administration
0(0%)
4(6,7%)
0,304
operative vaginal delivery (vacuum extraction) 1(3,7%)
0(0%)
There was no significant difference in neonatal outcomes between the two groups
1,000
[PP-048]
Fetal magnetic resonance imaging measurements of midbrain and hindbrain in
agenesis of corpus callosum cases
Tülay Öztürk1, Semir Köse2, Handan Güleryüz1, Sabahattin Altunyurt2
1
Dokuz Eylül University Medical Faculty Radiodiagnostic Department Pediatric Radiology Division
İzmir Türkiye
2
Dokuz Eylül University Medical Faculty Obstetrics and Gynecology Department Perinatology
Division İzmir Türkiye
Summary: MB and HB malformations are commonly associated with cerebral anomalies and found
in patients with intellectual disabilities. There is an increasing interest on the associated MB and HB
anomalies in ACC cases to predict the prognosis and provide proper counselling. By establishing
methodologies and nomograms, previous studies are paved the way for a more standardized
assessment of these parameters.
Objectives: To measure six parameters; 2 midbrain (tectal length, anteroposterior midbrain
diameter), 2 hindbrain (anteroposterior pons diameter, pontine flexure) and 2 vermian
(anteroposterior vermian diameter, superoinferior vermian diameter), in prenatally diagnosed
agenesis of corpus callosum cases by fetal MRI according to newly introduced methodologies and
nomograms.
Method: Fetal MRI archive of 30 ACC cases retrospectively evaluated and true midsagittal sections
used to assess the MB and HB parameters. The targeted measurements could be fulfilled in 22 of
cases. T2 weighted single-shot fast spin echo (HASTE) sequences acquired with 1.5 Tesla Gyroscan
NT Achieva software version (Philips Healthcare, Netherlands) were used for fetal MRI evaluations.
Findings: Less than 5 percentile values for tectal length (TL), anteroposterior MB diameter (APMD),
anteroposterior pons diameter (APPD), superoinferior vermis diameter (SIVD) and anteroposterior
vermis diameter (APVD) were found in 10/22(45%), 5/22(23%), 6/22(27%) and 5/22(23%) of
cases, respectively. In qualitative evaluation of pontine shape, 4/22 cases showed absent pontine
flexure.
Conclusions: Pontine maldevelopment seems to be associated with some ACC cases. Before
counselling the family, MB and HB assessment should be incorporated into routine evaluation of
such cases.
Keywords: agenesis of corpus callosum, midbrain, pons, fetal MRI
[PP-049]
Prenatal diagnosis of meconium peritonitis secondary to ileum volvulus
perforation: a case report
Başak Kaya, Deniz Kanber Acar, Ali Ekiz, Salim Sezer, Gökhan Yıldırım, Halil Aslan
Kanuni Sultan Süleyman Education and Research Hospital, Department of Perinatology, İstanbul,
Türkiye
Objective: Meconium peritonitis is defined as a sterile chemical peritonitis, that is induced by
intrauterine bowel perforation. We aimed to present a case of meconium peritonitis and discuss the
correlation of prenatal ultrasonographic findings and postnatal outcome.
Method: Prenatal diagnosis of meconium peritonitis secondary to ileum volvulus perforation was
discussed.
Findings: A 24 year-old woman, gravida 4, para 1, was referred to our hospital at 35 weeks of
gestation on suspicion of fetal intestinal abnormality. Ultrasound examination showed
polyhydramnios, dilated bowel loops (maximum transverse diameter was 42mm), loculated fluid
between liver serosa and anterior abdominal wall and diffuse intraabdominal calcifications. The
preliminary diagnosis considered were volvulus and meconium peritonitis. Cesarean section was
performed due to nonreassuring fetal heart rate and a 2730 gram female infant was delivered with
apgar scores of 5 and 7 at 1 and 5 minutes. Laparotomy was performed following delivery at 2
hours of life. Intraoperative observation revealed ileal perforation due to volvulus. Ileal resection
and ileostomy were performed. The diagnosis of meconium peritonitis due to ileum volvulus
perforation was confirmed.
Conclusion: Recent studies demonstrated that prenatal ultrasonographic findings of meconium
peritonitis may anticipate the postnatal outcome and the need for postnatal surgery. Persistent
ascites, pseudocyst or dilated bowel loop are defined as the positive findings in prediction of the
need for postnatal surgery with the highest sensitivity and a negative predictive value. In the
presence of these findings the diagnosis of meconium peritonitis should be considered and delivery
should be planned in a tertiary center.
Keywords: meconium peritonitis, volvulus
fetal ascites
fetal bowel dilatation
[PP-050]
Surgical treatment of uterine atony; asessment of final year obstetrics and
gynecology residents with a questionnaire
Baris Kaya1, Burcin Karamustafaoglu Balci2, Korkut Daglar3, Mesut Polat4, Abdullah Tuten5, Onur
Guralp6
1
Near East University Faculty of Medicine, Department of Obstetrics and Gynecology
2
Medeniyet University, Goztepe Research and Training Hospital, Department of Obstetrics and
Gynecology
3
Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
4
Zeynep Kamil Education and Training Hospital, Istanbul, Turkey
5
Istanbul University, Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology,
6
Bozova State Hospital, Sanliurfa
Introduction
Postpartum hemorrhage is the number one cause of maternal mortality in developing countries and
is the cause of 25 percent of maternal deaths worldwide. This study was designed to assess the
attitudes of last-year residents towards surgical treatment of uterine atony. We aimed to find out
which procedures they assisted and/or performed, how many times and to figure out their selfconception about the ability to perform the procedures by him/herself.
Material and Methods
This cross-sectional, descriptive-analytic study was conducted in Turkey. The target population was
senior residents in obstetrics and gynecology. A self-administered questionnaire was used for data
collection.
Results
A total of 162 persons filled the questionnaire. The majority of respondents were female (59.26%).
79.01% of the participants were working in training hospitals, whereas the rest (20.99 %) in
university clinics. 11.11 % of the responders never experienced postpartum atony resistant to
medical treatment, whereas 24.07 % experienced it more than ten times. Intrauterine balloon
insertion from the vaginal route is the first choice of senior residents for the treatment of uterine
atony resistant to medical treatment after vaginal birth. Unfortunately 22.22% of them never
assisted to the insertion of intrauterine balloon, 66.05% never performed it by himself/herself and
12.35% think that he/she is not able to use it if needed.
Conclusion
An important percent of of OB&GYN senior residents did not see or perform keystone surgical
procedures of the treatment of postpartum atony. More care should be taken about the education
of the management of postpartum atony.
Keywords: postpartum atony, senior residents, questionnaire, intrauterine balloon
[PP-051]
Gebelerin İlk Trimesterde NRS 2002 ile nutrisyonel durumunu değerlendirlmesi
Nilüfer Akgün, Ebru Yüce, Müberra Namlıkalem, Ayşe Altındiş Bal, Zehra Candan İltemir Duvan
Turgut Özal Üniversitesi Tıp Fakültesi,Kadın Hastalıkları Ana bilim Dalı, Ankara
Nutrisyon Risk Taramasi-2002 (NRS-2002) ESPEN önerisi doğrultusunda hastaların beslenme
durumunu değerlendirmek için kullanılmaktadır.
Amaç: Bu çalışmanın amacı bir üniversite hastanesine başvuran gebelerin NRS-2002 skorlama
sistemine göre beslenme durumunun değerlendirilmesidir.
Yöntem: Turgut Özal Üniversitesi polikinliğine başvuran ilk trimester gebeliği bulunan hastalar
beslenme durumu malnutrisyon riski açısından NRS 2002 skorlama sistemi ile değerlendirildi.
Çalışma prospektif olarak yapıldı. Hastaların yaş, gravida, parite, boy, BKİ, gebelik başlangıç kilosu,
gebelik haftasına göre vücut ağırlığı kayıt edildi. NRS 2002 skorlama sistemine göre nutrisyon
değerlendirmesi yapıldı. NRS skoru >=3 olan hastalar malnutrisyon riski altında kabul edildi.
Bulgular: Çalışmaya 112 hasta alındı. Yaş ortalaması 28,2±5,1 yıl, gravida 2,0±1,3, parite 0,8±
1,0, abort 0,3±0,6, gebelik haftası 9,8±2,2, boy 162,6±5,2, gebelik başlangıç kilosu 64,8±11,4
(min 46, max112), gebelik kilosu 64,5±10,8 ( min 49,max112), kilo kaybı 1,2±2,1( en fazla 7 kilo
alınmış, en fazla 13 kilo verilmiş) BKİ 24.5±4,2 (min 16, max 41,7) idi. Gebelerin %20,5’inin vücut
ağırlığı hiç değişmemiş, %42,8 olgu ilk trimesterde ağırlık artışı olup, %36.6 olgunun ise ilk
trimesterde kilo kaybı olduğu saptandı. NRS skoru %61,6 gebede sıfır, %16,1 olguda bir puan,
%15,2 olguda iki puan %7,1 olguda ise 3 puan olarak hesaplandı. Olguların BKİ ile kilo değişimi
arasında anlamlı farklılık saptanmadı (p=0.471).
Sonuç: Çalışmada ilk trimesterde gebelerin %7,1’inin malnutrisyon açısından riskli grupta olduğu
saptandı. Gebelikte bulantı, kusma, iştah değişikliklerinin gebeliğe bağlı normal durumlar olarak
kabul edilmesi nutrisyonel durumu ileri derecede bozuk olan gebelerin tanımlanma ve tedavi
edilmesinde ileri derecede bir sorun oluşturmaktadır. Gebelikte malnutrisyon unutulmamalı
nutrisyonel değerlendirme göz ardı edilmemelidir.
Anahtar Kelimeler: Gebelik, NRS-2002, nutrisyonel değerlendirme
[PP-053]
Modifiye Shirodkar Serklaj Olgularının Retrosepktif Analizi
Ayça Nazlı Bulut, Mehmet Serdar Kutuk, Mehmet Dolanbay, Gunel Eliyeva, Mahmut Tuncay Ozgun,
Mustafa Basbug
Erciyes Üniversitesi Kadın Hastalıkları ve Doğum
Giriş: Bu çalışmanın amacı Modifiye Shirodkar Servikal Serklaj uygulamasının gebelik sonuçları
üzerindeki etkisini incelemektir.
Materyal-Metod: Erciyes Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde Ocak
2012-Şubat 2015 tarihleri arasında Modifiye Shirodkar servikal serklaj uygulanan hastalar
retrospektif olarak tarandı.
Sonuç: Çalışmaya toplamda 78 hasta dahil edildi. Hastaların ortalama yaşı 30.4±4.5 yıl ve BMI
27.4±4.2 kg/m2 idi. En sık endikasyon önceki preterm doğum + önceki ikinci trimester kayıpları
(48/78, %61.5) olup, hastaların 14’ünde (%17.9) servikal dilatasyon, 10’unda (%12.8) uterin
anomali, 6’sında (%7.7) USG’de kısa serviks izlenmesi nedeniyle serklaj uygulandı. 39 hastanın
önceki gebeliklerinde ikinci trimester kaybı öyküsü olup, ortalama kayıp sayısı 2.25±1.79 (1-9
aralığında) idi. TVUSG ile hastaların ortalama servikal uzunlukları 22.2±10.1 mm olup, 38 hastada
funneling vardı (%48.7). Çalışmaya dahil edilen hastalarda, serklaj işlemi ortalama 16+5±3+0’ıncı
(12+1-24+0 aralığında) gestasyonel haftada yapıldı. İşlem esnasında hiçbir hastada erken
membran rüptürü (EMR), koryoamnioit, servikal laserasyon, ya da mesane yaralanması gibi bir
komplikasyon gelişmedi. 42 hastaya (%53.8) tokolitik tedavi verildi ve ortalama hastanede yatış
süresi 2.85 gün idi. 9 hastanın gebeliği halen devam etmekte olup ortalama gebelik haftası
31+1’dir. 55 (%70.5) hastada canlı doğum elde edildi. Çalışmaya dahil edilen ve gebeliği sonlanan
tüm hastalarda ortalama doğum haftası 30+0 idi.
Sonuç: Modifiye shirodkar serklaj operasyonu, mesane hasarı, kanama ve yara iyileşmesi açısından
risk içermemektedir. Bu nedenle özellikle kısa serviksli olgularda serklaj operasyonunun etkinliğini
artırmak için kullanılabilir.
Anahtar Kelimeler: serklaj, shirodkar, erken doğum
[PP-055]
The effect of low molecular weight heparin or oral folic acid on pregnancy
outcomes in patients with recurrent pregnancy loss and MTHFR mutations
Mahmut Tuncay Ozgun1, Mehmet Serdar Kutuk1, Hatice Durmus1, Semih Uludag1, Mehmet
Dolanbay1, Tolga Atakul2
1
Erciyes University, School of Medicine, Departments of Obstetrics and Gynecology
2
Karabuk University, of Medicine, Departments of Obstetrics and Gynecology
Objectives: The purpose of the study was to evaluate the effect of low molecular weight heparin
(LMWH) or oral folic acid treatment on pregnancy outcomes in patients with recurrent pregnancy
loss and MTHFR mutations.
Materials-Methods: The study included 89 pregnant patients with two or more previously
pregnancy loss and MTHFR C667T and A1298C mutations. Before pregnancy the patients were
evaluated due to recurrent pregnancy loss. The patients were grouped into two as LMWH group,
starting the LMWH treatment within the first 7 weeks of pregnancy, and the folic acid group, only
folic acid were supplemented. Obstetric outcomes were followed.
Results: In the LMWH group, 49 women, and 40 pregnant women in the folic acid group were
included. First trimester abortion rate was similar in two grups (LMWH group n= 10 (20.4%) folic
acid group n= 9 (22.5%). (p = 1.00). Live birth rate was similar in both groups (79.6% vs 77.5%)
(p = 1.00). In both groups during pregnancy, there was no significant difference in the incidence of
preeclampsia, IUGR, postpartum DVT and postpartum hemorrhage.
Conclusions: In the treatment of patients having recurrent pregnancy loss with MTHFR mutations,
the choice of treatment should be oral folic acid instead of LMWH due to ease of use and lower
cost.
Keywords: LMWH, MTFR, pregnancy loss, folic acid
[PP-056]
Monokoryonik monoamniotik ikiz gebelik ve ikiz eşinde kloaka anomalisi – olgu
sunumu
Burcin Karamustafaoglu Balci1, Ibrahim Halil Kalelioğlu2, Recep Has2
1
Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum ABD
2
İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kadın Hastalıkları ve Doğum ABD
Giriş
Monozigotik ikizlerde konjenital anomali oranı artmıştır. Kliniğimizde takip edilen kloaka anomalisi
olan bir monokoryonik monoamniotik (MK-MA) ikiz gebelik olgusunu sunmaktayız.
Vaka Sunumu
27 yaşındaki hasta 12+3 haftalık gebe iken çoğul gebelik endikasyonu ile başvurdu. 13+4 gebelik
haftasında 2. düzey ultrasonografi yapıldı; MK-MA ikiz gebelik saptandı, fetusların birinde
megasistis görüldü ve infravezikal obstrüksiyon düşünüldü, her iki fetusun da kız olduğu saptandı.
17. gebelik haftasında amniosentez yapıldı. 22+4 gebelik haftasında tekrarlanan 2. düzey
ultrasonografide anomali saptanmış olan fetusun bir böbreğinde obstrüksiyona sekonder kistik
displazi ve karşı böbrekte ekojenite artışı ile beraber şüpheli displastik böbrek izlendi. Diğer fetusta
anomali saptanmadı. 25+4 gebelik haftasında fetal kromozom analizinin sonucunun normal olduğu
öğrenildi, sağ ve sol böbrekte subkortikal kistler izlendi, kolon ansı dilate idi, kloaka anomalisi
olabileceği düşünüldü. 29+4 gebelik haftasında anomalisi olan fetusun anal sfinkteri görülemedi,
her iki böbrek displastik, barsaklar dilate idi. 34. gebelik haftasında hasta fetal distres endikasyonu
ile operasyon salonuna alındı. İki kız bebek doğurtuldu. Prenatal anomali tanısı olan fetusun
postnatal üriner sistem ultrasonografisinde her iki böbrek atrofik izlendi (sağ 16 mm, sol 25 mm).
Sol böbrekte birkaç adet en büyüğü 7*9 mm olmak üzere anekoik kistler izlendi. Hasta Çocuk
Cerrahisi ve Çocuk Sağlığı ve Hastalıkları ekipleri tarafından tedavi edilmektedir.
Sonuç
Monozigotik ikizler artmış konjenital anomali ihtimaline sahiptir ve ikinci düzey ultrasonografik
inceleme ve fetal ekokardiyografi gerektirirler. Kloaka anomalisi prenatal tanısı önemli olan bir
patolojidir. Orta hatta kistik kitle görüldüğünde, bu kistin mesane olduğu kanıtlanırsa rektuma da
bakarak mekonyum varlığı incelenmelidir. Bu tür vakalarda rektumda mekonyum yokluğu kloaka
anomalisi tanısı koydurmaktadır.
Anahtar Kelimeler: monokoryonik monoamniotik ikiz gebelik, kloaka anomalisi, fetal anomali
[PP-057]
Isolated fetal ascites: A case report
Deniz Karçaaltıncaba, Murat Aykut Özek, Fırat Büyüktaşkın
Gazi University, Department of Perinatology
A 29-year-old woman was referred to our perinatology unit at 31 weeks of gestation with new
onset fetal hydrops. On the sonogram, we observed isolated fetal ascites. The patient’s blood type
is A Rh (–), antibody screening test was negative. She was tested negative for Parvovirus B19 and
VDRL test. MCA Doppler PSV was between 1,3-1,5 MoM. Cordocentesis was performed to exclude
the possible diagnosis of severe anemia. Complete blood count revealed mild fetal anemia. Then
intrauterine transfusion was performed with the aim to relieve ascites. Karyotype analysis was
reported to be normal. MRI scan revealed isolated fetal ascites (Figures 1 and 2). At 34 weeks of
gestation, 150cc of the fetal intraabdominal fluid was punctured, and weekly aspirations were
performed twice thereafter. Laboratory results of the fluid was compatible with chylous ascites. At
38 weeks of gestation elective cesarean delivery was performed and 4090gr male neonate was
born with an APGAR score of 5/8 and was transferred to neonatal intensive care unit. 500cc of
ascites was drained with paracentesis. Intravenous somatostatin analogue treatment was started
after confirmation of chylous ascites. The last abdominal sonography was reported to be normal
and he was sent home with subcutaneos injections of somatostatin analogue. Isolated fetal ascites
is an infrequent condition. It’s prevelance has not been established exactly yet. Most of the isolated
fetal ascites cases have shown to be associated with congenital lymphatic abnormalities leading to
chylous ascites. Biopsy of the small intestine is recommended for definitive diagnosis during
postnatal period.
Keywords: Fetal ascites, fetal paracentesis, lymphangiectasis
Figure 1
MRI image of the fetus displaying fetal ascites on sagittal view
Figure 2
MRI image of the fetus displaying fetal ascites on transverve view.
[PP-058]
Achondrogenesis Type 1b (Parenti Fraccaro): A Case Report
Murat Aykut Özek, Yaman Değirmenci, Merih Bayram
A 21 year-old primigravid woman was referred to our clinic at 21 weeks of gestation with the
diagnosis of micromelia. The patient and her husband were not consanguineous, there was no
teratogen exposure during pregnancy. Prenatal screening tests were in normal range. On fetal
sonogram we detected thoracic hypoplasia, tetramicromelia (Figures 1&2) and hypomineralizition
at calvarium. The patient was counselled about lethality of the condition and the family opted for
termination of pregnancy. After termination of pregnancy, it was observed that the female fetus
had short extremities, a small thorax, a bigger head ratio to thorax and micrognathia (Figure 3).
Radiologic examination of the fetus confirmed hypomineralizition of the cranium (Figure 4) and
micromelia.
Achondrogenesis totally occurs approximately in 1/40.000 births. The main cause is the mutation
in the gene which is responsible for collagen type II structure. Type 1 is inherited in an autosomal
recessive mode, but type 2 is mostly caused by de novo autosomal dominant mutations of the
gene coding collagen structure (COL2A1). The genetic cause of achondrogenesis type 1a is TRIP11
gene mutation. The cause of type 1b achondrogenesis is the recessive mutation of gene DTDST
and it is the most severe type. The diagnosis of achondrogenesis can be made as early as 13 to
14th weeks of gestation by detecting short femur length. The major finding is mostly micromelia.
In our case, hypomineralization was prominent at calvarium, indicating type 1 achondrogenesis.
There is no antenatal treatment for achondrogenesis and this disorder is always lethal.
Keywords: Achondrogenesis, antenatal diagnosis
Figure 1
Severe micromelia on sonogram
Figure 2
Thoracic hypoplasia, transverse view
Figure 3
The fetus had short extremities, a small thorax, a bigger head ratio to thorax and micrognatia
Figure 4
Fetogram. Hypomineralization of cranium and micromelia can be seen.
[PP-059]
Fetal akinesia deformation sequence: A case with early diagnosis
Murat Aykut Özek, Deniz Karçaaltıncaba
A 39-year-old woman (G5P3) was referred because of increased nuchal translucency (NT: 4,3
mm). Her first and third pregnancies were terminated because of arthrogryposis and hydrops
fetalis; at gestational ages of 20 and 16, respectively. But, in neither of the cases, they gave
consent to necropsy or genetic testing. She had also two healthy children with ages 9 and 3. The
patient and her husband were consanguineous (2nd degree). Ultrasound examination at 11th week
revealed increased nuchal translucency (NT: 4,2 mm) and no fetal movements were observed.
Chorion villus sampling was performed and karyotype analysis was normal. On the ultrasound
examination at 13th week; the fetus had cystic hygroma at the nuchal region, diffuse subcutaneous
edema, micromelia and ankyloses affecting upper and lower extremities and bilateral clubfeet
(Figures 1-4). The family was counselled about high lethality of the condition and they opted for
termination of pregnancy (Figures 5&6). Fetal akinesia deformation sequence (FADS) is consisted
of heterogenous group of conditions characterized with diffuse arthrogryposis. It’s incidence is
estimated to be 1/15,000. Ultrasonographic findings include absence of fetal motions, limb
contractures, micrognathia, thoracic hypoplasia, increased nuchal translucency, cystic hygroma and
hydrops fetalis. Because FADS is mainly inherited in an autosomal recessive mode, it has a
recurrence risk of 25 % and the condition is lethal in most of the cases. Early diagnosis of fetal
akinesia as 12 weeks of gestation is possible. Genetic mutations associated with the condition have
been reported and analysis of those could help counseling and management.
Keywords: Fetal akinesia deformation sequence, early diagnosis
Figure 1
Cystic hygroma
Figure 2
Short femur
Figure 3
Short humerus
Figure 4
Limb contractures (upper and lower extremities)
Figure 5
Fetus after termination. Limb contractures and tetramicromelia can be seen.
Figure 6
Fetogram displaying short lims and contractures
[PP-060]
Spontaneous Ovarian Hyperstimulation Syndrome Complicating Natural
Conception
Murat Aykut Özek, Gizem Işık, Merih Bayram
A 23 year-old primiparous woman admitted at 5 weeks of gestation. She had no symptoms
regarding OHSS and the ultrasound scan revealed viable intrauterine pregnancy and normal
appearing ovaries. At 11 weeks of gestation she attented with complaints of abdominal pain and
distention. On sonography intrauterine pregnancy of 11 weeks of gestation and bilaterally enlarged
ovaries 164 x88mm(right ovary), 105x105mm (left ovary) with multiple cysts were seen. Mild
ascites was seen (Figure-1). Hemoglobine value was 15,7g/dl, hemotocrite was % 44,7, albumin
level was 2,5 gr/dl and liver enzymes were increased (AST: 63u/l, ALT:96u/l). Thyroid function
tests were normal. Abdominal circumference of the patient was 90cm. Management including close
monitoring of vital signs, daily laboratory tests, intravenous hydration, thromboembolic prophylaxis
with low molecular weight heparin and albumine replacement were initiated. At 12 weeks 1 day of
gestation, abdominal ultrasound was performed, ovarian sizes were decreased bilaterally (right
ovary: 119x116mm, left ovary: 83x84mm) and volume of ascites was relatively reduced (Figure
2). Laboratory results came up with the results of hemoglobine 10,4 g/dl, hemotocrite %32, AST:
27u/l, ALT: 52u/l, albumin level was 3,7 gr/dl. The abdominal circumference was also reduced (79
cm). OHSS only rarely occurs spontaneously. It has been associated with hypotyroidism, polycystic
ovary syndrome, gonadotropin-producing adenoma, multiple pregnancy and Down syndrome.
There are also cases which were reported to be idiopathic. Although spontaneous OHSS is rare; its
diagnosis and treatment is important because it has high morbidity in its severe forms.
Keywords: Ovarian Hyperstimulation Syndrome, Spontaneous
Figure 1
Initial abdominal sonographic findings of OHHS: A. Mild ascites and viable intrauterine
pregnancy B. Right ovary C. Left ovary
Figure 2
At 12 weeks 1 day of gestation sonographic findings: A. Volume of ascites is relatively
reduced B. Right ovary C. Left ovary
[PP-061]
Giant cystic hygroma: Report of two cases
Murat Aykut Özek, Tuncay Nas
Our first case was a 26 year-old primigravid woman. She was referred with the diagnosis of cystic
hygroma. At first trimester screening, NT was 1,3 mm. During the fetal anatomical screening,
cystic hygroma at the posterior of the neck was detected (55x50 mm). Amniocentesis and fetal
echocardiography were normal. No signs of hydrops developed, the dimensions of the mass were
80x70 mm at the last sonogram (Figure1). At 39 weeks of gestation, elective cesarean delivery
was performed and male fetus weighing 2840 gr was delivered. After completion of postnatal first
month, intralesional bleomycine therapy was performed. Our second case was a 34 year-old
primigravid woman. At first trimester, NT was 1,6 mm. During the fetal anatomical screening,
cystic hygroma located at the right anterolateral region of the neck was detected (35x25 mm).
Amniocentesis and fetal echocardiography were normal. No signs of hydrops or polyhydramniosis
developed. The dimensions of the mass were 110x95 mm at the last sonogram (Figure 2). At 34
weeks of gestation, the patient presented with preterm labor. Cesarean delivery was performed
and male fetus weighing 2440 gr was delivered. Intralesional bleomycine injection was performed
and the newborn is being followed in the neonatal intensive care unit. Cystic hygroma is a
congenital malformation of the lymphatic system. They are associated with chromosomal
abnormalities and major structural anomalies. Their birth prevalence is approximately 1 in 5000.
Complete excision of the mass is the treatment of choice but intralesional sclerosing agents is
being used with success also.
Keywords: Cystic hygroma, intralesional therapy
Figure 1
Cystic hygroma at the posterior neck region, first case
Figure 2
Cystic hygroma during the last sonogram of the second case
[PP-062]
A sudden onset late hemorrhagic complication of HELLP syndrome
Ömer Demirtaş, Ömer Tolga Güler, Özer Öztekin, Serkan Karayiğit, Ibrahim Veysel Fenkci
Pamukkale üniversitesi tıp fakültesi kadın hastalıkları ve doğum anabilim dalı
Summary: HELLP syndrome is a life-threatening condition that should be managed delicately in
order to minimize maternal morbidity.
Objectives: To present a late hemorrhagic complication of HELLP syndrome in a patient after
caesarean section.
Methods: Patient file along with laboratory and clinical findings were analyzed.
Findings: An 18 years old woman was referred to our centre at 30 weeks of pregnancy with severe
preeclampsia-HELLP. She also had signs of cerebral dysfunction. An emergent C-section was
performed after stabilization of the patient. There was no abnormal coagulation status during
surgery and the bleeding control was achieved. The first post-operative 24 hours of the patient was
uneventful and the total peritoneal drainage was below 100 cc. However, a sudden increase in
drainage (400 ml/hour) was observed at the 26st hour along with anuria. A second laparotomy was
performed but no active bleeding vessel was observed. On the other hand, oozing type of bleeding
was observed from peritoneal surfaces. Abdominal washing was performed and support of fresh
frozen plasma was initiated. Postoperative follow showed no active drainage and the patient
eventually discharged after 10 days later.
Conclusions: Late complications of HELLP syndrome are not uncommon. Disseminating
intravascular coagulation may result in serious suddenhemorrhagic complications even after 24
hours from termination of the pregnancy.
Keywords: HELLP, postpartum complication, thrombocytopenia
[PP-063]
The association of impaired gestational glucose tolerance with maternal and
fetal outcomes
Esin Kasap1, Mine Genc1, Arzu Turan1, Fatma Eskicioglu2, Ali Saklamaz3, Nur Sahin1, Serkan Guclu1
1
Department of Obstetrics and Gynecology, Sifa University School of Medicine, İzmir, Turkey.
2
Department of Obstetrics and Gynecology,Merkez Efendi State Hospital,Manisa,Turkey
3
Department of Endocrinology, Sifa University School of Medicine, İzmir, Turkey
Aim:
The aim of the present study was to examine the associations of gestational diabetes mellitus
(GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.
Methods:
A total of 200 pregnant women were included in this cross-sectional study. A 50 g oral glucose
challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose
tolerance test (OGTT) with 100 g of oral glucose in those with an abnormal 1-hour test result.
Obstetric and perinatal outcomes were recorded.
Results:
No significant difference was observed in BMI, parity and age. While FBG did not differ significantly
between IGT and GDM groups, subjects in GDM group had significantly higher 1, 2 and 3-hour
blood glucose levels in 50 g GCT and OGTT tests.The following were not significantly different
between groups.Preterm labour (PL); pregnancy induced hypertension (PIH),preeclampsia,polyhydramnios,macrosomia. However, a significant increase was noted in the fetal birth
weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were
also similar between the two groups as suggested by the absence of significant differences in the
proportion of newborns with hyperbilirubinemia, hypoglycemia, or RDS.
Conclusion(s):
In conclusion, our results suggest that single high glucose readings in OGTT may be as important
as a diagnosis of GDM in terms of fetomaternal complication risk.Well-designed, larger prospective
studies involving borderline GDM patients are warranted to further clarify this association.
Keywords: Gestational diabetes, Impaired Glucose Tolerance, pregnancy
Table 1. Comparative descriptive statistics in IGT and GDM groups
Variables
IGT (n=21)
GDM (n=28)
p-Value
26.43 ± 2.25
26.00 ± 2.25
0.521
Fasting blood glucose (mg/dl) 96.43 ± 4.24
98.43 ± 5.60
0.083
29.05 ± 4.02
30.32 ± 3.74
0.239
50 Gr. Glucose Ghallenge Test 157.57 ± 12.82
168.07 ± 12.99
0.007 *
OGTT 1.HOUR
202.10 ± 11.55
220.43 ± 20.04
0.001 *
OGTT 2.HOUR
158.95 ± 8.63
174.46 ± 10.45
0.0001 *
OGTT 3.HOUR
135.14 ± 4.07
143.89 ± 8.57
0.0001 *
Neonatal birth weight (kg)
3433.33 ± 379.91 3748.21 ± 381.39 0.006 *
Parity
IGT (%)
GDM (%)
p-Value
1
8 (38.1)
5 (17.9)
0.379
2
9 (42.9)
13 (46.4)
0.379
3
3 (14.3)
7 (25.0)
0.379
4
1 (4.8)
3 (10.7)
0.379
BMI
Age(years)
* p<0.05 was accepted for statistical significance.OGTT, oral glucose tolerance test;GDM,
gestational diabetes mellitus;IGT, impaired fasting glucose tolerance
Table 2. Comparative categorical data in IGT and GDM groups
Variables
IGT
GDM
p-Values
Yes (%)No (%)
Yes (%)No (%)
Polyhydramnios
3 (14.3) 18 (85.7) 9 (32.1) 19 (67.9) 0.192
Delivery before 37 weeks
0 (0) 21 (100)
Vaginal birth
12 (57.1) 9 (42.9) 6 (21.4) 22 (78.6) 0.010 *
Cesarean delivery
9 (42.9) 12 (57.1) 22 (78.6) 6 (21.4) 0.010 *
Macrosomia
3 (14.3) 18 (85.7) 9 (32.1) 19 (67.9) 0.192
Pre-eclampsia
3 (14.3) 18 (85.7) 4 (14.3) 24 (85.7) 1.000
PIH
0 (0) 21 (100)
3 (10.7) 25 (89.3) 0.250
3 (10.7) 25 (89.3) 0.250
Neonatal hyperbilirubinemia 4 (19.0) 17 (81.0) 7 (25.0) 21 (75.0) 0.737
Neonatal hypoglycemia
0 (0) 21 (100)
4 (14.3) 24 (85.7) 0.125
RDS
3 (14.3) 18 (85.7) 6 (21.4) 22 (78.6) 0.714
* p<0.05 was accepted for statistical significance.; RDS: Respiratory Distress Syndrome;
PIH: Pregnancy Induced Hypertension; GDM, gestational diabetes mellitus;IGT, impaired
fasting glucose tolerance
[PP-064]
Prenatal dönemde tanısı konulan Trizomi 18 ve Klinefelter Sendromunun birlikte
olduğu çift anöploidi (48, XXY, +18) olgusu
Sebahat Atar Gürel1, Betül Yorgunlar1, Esra Tuğ2
1
İstanbul Medipol Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD, Perinatoloji BD,
İstanbul
2
Gazi Üniversitesi Tıp Fakültesi Tıbbi Genetik AD, Ankara
Amaç: Çift anöploidi aynı kişide birden fazla sayıda farklı kromozomda anöploidinin bulunmasıdır.
Trizomi 18 ve Klinefelter Sendromunun birlikte olduğu çift anöploidi (48, XXY, +18) olguları oldukça
nadir olup burada kliniğimizde 17+5 gebelik haftasında tanısı konulan 48, XXY, +18 çift anöploidi
olgusu sunularak literatür eşliğinde tartışılmıştır.
Olgu: 41 yaşındaki olgunun ilk gebeliği olup ikili testinde trizomi 13/18 riskinin yüksek (risk:1/6)
gelmesi nedeniyle 17+5 gebelik haftasında başvurdu. Gebeye amniyosentezden hemen önce
yapılan genetik sonogramda fetal gelişim 16+2 hf ile uyumlu olup hipoplazik burun kemiği, inlet tipi
VSD ile ductus venosusda diyastol sonu ters akım ile karakterize patolojik akım saptanıldı.
Amniyosentez sonrası fetal karyotip Trizomi 18 ve Klinefelter Sendrom çift anöploidi (48, XXY, +18)
geldi. Ailenin isteği ile gebelik dış merkezde sonlandırıldı.
Sonuç: Bilgimiz dahilinde, kendi olgumuz ile birlikte prenatal dönemde tanı konulan toplam beş 48,
XXY, +18 çift anöploidi olgusu bildirilmiş olup bunlardan sadece ikisinin tanısı previabl dönemde
yapılmıştır. Previabl dönemde tanı konulan iki olguda da ultrason ile saptanılan bulgular çift
anöploidi bulunmasına rağmen kolayca saptanılabilecek, ciddi anomaliler olmayıp kromozom
anomalilerinin prenatal tanısında tarama testi ile genetik sonogramın önemini göstermektedir.
Anahtar kelimeler: Çift anöploidi, trizomi 18, Klinefelter Sendromu, prenatal tanı, ultrasonografi
Anahtar Kelimeler: ultrasonografi, prenatal tanı, trizomi 18, Klinefelter Sendromu, çift anöploidi
[PP-065]
A case with tetra-amelia syndrome
Gülenay Gencosmanoğlu Türkmen, Yüksel Oğuz, Mehmet Aytaç Yüksel, Enes Bil, Mehmet Seçkin
Özışık, Eyüp Sabri Şeyhanlı
şanlıurfa obstetrics and gynecology hospital
Aim: to report a fetus with tetra-amelia syndrome
A 26 years old Syrian woman who had a history of four times abortion at 20 weeks was referred
our clinic for further investigation.
On the routine antenatal ultrasound examination bilateral fetal extremities were not detected. BPD
was measured as compatible with 16 weeks. In the sacral region a protrusion that was thought to
be a tail was seen. Additionally a median cleft limb and palate, low located ears were detected.
Iliac bones were not seen on the examination.
Initially amniocentesis for chromosome analysis was offered to the patient; but not accepted by the
family. Termination was done by oral and vaginal misoprostol.. After termination the observed
findings at fetus were compatiple with ultrasound findings.
Keywords: Tetra-amelia syndrome, anomaly screening
figure 1
figure 2
figure 3
figure 4
[PP-066]
On the track of gestational sac: An unusually located ectopic Pregnancy
Doruk Cevdi Katlan1, Bulut Varlı1, Betül Yakıştıran1, Tuncay Yüce1, Salih Taşkın1, Esra Çetinkaya1,
Fulya Dökmeci1
(1) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
Background – Aim
Ectopic pregnancy, still a leading cause of morbidity and mortality despite the technological
improvement in medicine, is mostly found to be localized in the fallopian tubes. However, there are
rarely some that are implanted within the uterus but outside the endometrial cavity. The rarest of
all, representing less than 1%, is the “intramural ectopic pregnancy” (IEP). It may be a “dangerous
criminal” and sometimes a “killer”, suspicion being the mainstay of early diagnosis. Recent
advances in sono-technology also help its detection before the occurrence of life-threatening
complications and its treatment with less invasive procedures thus, improving the patients’ future
fertility. Here, we aim to emphasise, even in the setting of a normally elevating β-hCG level, the
inability to visualise intrauterine normally located gestational sac in the presence of alerting risk
factors may end up with a surprising diagnosis.
Case Report
26 year-old women with history of a healthy in vitro fertilization (IVF) twin delivery via caesarean
section and a laparoscopic left salpingectomy due to a tubal ectopic pregnancy was admitted to our
clinic with consecutive β-hCG levels of 800, 1841 and 3020 IU/L every other day. Ultrasound exam
at first sight demonstrated no evidence of intrauterine pregnancy but careful work up revealed a
8,6 mm gestational sac with a CRL: 2,5 mm heart-beating embryo implanted to left
superoposterior intramural-subserosal portion of the uterus. The sac was observed to be
independent from endometrial lining covering uterine left cornu and in close vicinity to abdominal
viscera and great vessels rendering a percutaneous local intervention risky. The patient was
informed about all the possible conservative and surgical treatment options. Upon her request,
intramuscular methotrexate 80 mg was injected. At the fourth day of injection, her β-hCG level
rised to 5226 IU/L with 10 mm sac and a still heart-beating embryo. Although stable
hemodynamically, she did not want to comply with the follow up and requested laparotomic
surgery at the fifth day. Intraoperatively, about-to-rupture ectopic sac was located in close
proximity to left uterine cornu just adjacent to previous salpinjectomy stump, interpreted as
cornual ectopic pregnancy. Wedge resection was performed and her postoperative follow up was
uneventful.
Conclusion
The exact aetiology and pathogenesis of IEPs are unclear. One theory proposes invasion of
myometrium through microscopic tracts caused by uterine trauma from surgical instrumentation or
following IVF transfers. Therefore, when there is a suspicion of a “pregnancy of unknown location”,
a careful patient history and a thorough ultrasonographic evaluation is mandatory. However,
although it is possible to diagnose an IEP with ultrasound, it may be difficult to distinguish it from a
cornual pregnancy.
[PP-067]
The first trimester ultrasonographic diagnosis of the mesomelic dysplasia in a
previously affected family
Uğur Keskin1, Fahri Burçin Fıratlıgil1, Mustafa Ulubay1, Ulaş Fidan1, Mehmet Ferdi Kıncı1, Ali Ergün2,
Müfit Cemal Yenen1
1
Obstetrics and Gynecology Department, Gulhane Military Medical Academy, Etlik, Ankara, Turkey
2
Obstetrics and Gynecology Department, Liv Hospital, Çankaya, Ankara, Turkey
Objectives: The aim of this case report is to describe the sonographic findings of the upper limb
mesomelia in the patient with previously affected pregnancy.
Patient and Methods: A 34-year-old patient with a history of gravida 3, para 2 applied to our clinic
for a routine control examination, at her 12th week of pregnancy. In the patient’s anamnesis and
antenatal care, a history of previous mesomelic term delivery and one with 27th gestastional week
termination with anencephaly was observed. In obstetric ultrasound findings of the fetus; no
visceral abnormalities was seen. The fetal biometric measurements were generally associated with
12th gestastional week. The humeral (6.5 mm) length was in 44.6th centile whereas the radial and
ulnar lengths were under the 5th centile. Therefore, the patient had been referred to a genetic and
orthopedic counselor with the diagnosis of upper limb mesomelia for information in detail.
Results: After multidisciplinary information, the family decided to continuation of pregnancy.
Conclusions: The mesomelic dysplasias are heterogeneous diseases characterized by irrational
shortness of the radioulnar and/or tibiofibular segments of the distal limbs. The family should be
evaluated by multidisciplinary approach and then the family should be informed in detail. It should
be also explained to the family that even if the fetus having mesomelia is born, he can expose to
several orthopedic surgical examination after newborn period, and it can be possible not to get the
level for pursuing normal daily life even with the physical treatment procedures.
Keywords: mesomelia, intermarriage, 5th centile
[PP-068]
Aberrant right subclavian artery (ARSA) in unselected population at second
trimester ultrasound scan
Selen Gürsoy Erzincan1, Burcin Karamustafaoglu Balcı1, Cengiz Tokgöz3, Ibrahim Halil Kalelioglu1
1
Selen Gursoy Erzincan, Istanbul University Faculty of Medicine, Department of Obstetrics and
Gynecology, Perinatology Division, Istanbul, Turkey
Istanbul, Turkey
2
Cengiz Tokgöz, Bilge Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
Objectives: The aim of this study was to assess the incidence of aberrant right subclavian artery
(ARSA) among unselected population.
Methods: Presence or absence of ARSA was assessed in a population of 1913 second-trimester
fetuses of unselected pregnant women. We searched for the ARSA on the three vessel trachea view
using color Doppler. The patients with ARSA were offered invasive test for karyotype analysis and
fluorescence in situ hybridization (FISH) for 22q11.2 microdeletion. For the patients do not accept
invasive test prenatally, the karyotype was considered normal if the newborn appeared clinically
normal.
Results: Among 1913 patients, an ARSA was found in 20 fetuses, who were all chromosomally
normal. So, the incidence of ARSA was 1.04% in this current study. There was only 1 patient with
trisomy 21, who did not have ARSA. Multiple other markers of trisomy 21 was seen on this fetus;
intracardiac echogenic focus, tetralogy of Fallot (TOF) and pyelectasis. Among 20 cases of ARSA,
12 were isolated and 8 were associated with other markers. Other markers were intracardiac
echogenic focus (n=3), choroid plexus cyst (1), prefrontal edema (n=1), hydrocephaly (n=1), TOF
(n=2). One of the cases of TOF was also associated with persistent left superior vena cava,
hydrocephalus, rhombencephalosynapsis and unilateral renal agenesis. The patient opted to
terminate the pregnancy.
Conclusion: In our study, all fetuses with ARSA were chromosomally normal. Isolated ARSA is not a
sufficient indication for karyotype analysis.
Keywords: Aberrant right subclavian artery, trisomy 21, prenatal diagnosis
Table 1. Demographic data of 20 patients with ARSA.
matern gestational other
patie
al
age at
cardiac
nt
additional markers
age(ye diagnosis(w anomal
no
ars)
eeks)
ies
prior
invasi
screen NIP
ve
ing
T
test
test
1
39
22
ICEF
negati
ve
-
2
31
20
ICEF
negati
ve
-
3
38
23
positiv
e
-
4
35
22
ICEF
negati
ve
-
5
36
25
choroid plexus cyst
negati
ve
norm
al
6
26
20
negati low
ve
risk
7
28
20
negati
ve
-
8
29
21
negati
ve
-
9
39
20
negati
ve
-
10
35
22
negati
ve
-
11
20
21
negati -
-
ve
12
24
24
negati
ve
-
13
25
23
positiv
e
norm
al
14
25
25
negati
ve
-
15
28
20
negati
ve
-
16
20
21
negati
ve
-
17
31
21
negati
ve
-
18
25
24
negati
ve
-
19
22
23
negati
ve
-
prefrontal edema
TOF
TOF,
rhombencephalosynapsis,hydrocep negati
norm
PLSV
haly,unilateral renal agenesis
ve
al
C
ICEF: intracardiac echogenic focus. TOF: Tetralogy of Fallot. PLSVC: persistent left
superior vena cava. NIPT: Non-Invasive Prenatal Testing
20
23
27
[PP-069]
Adverse perinatal outcomes of adolescent pregnancies in one center Istanbul,
Turkey
Ali Ekiz1, Elif Ciler Eren2, Sezcan Mumusoglu3, Dogukan Yildirim1, Burchan Aydiner1, Melih Bestel1,
Burak Ozkose1, Hasan Cemal Ark1
1
Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey.
2
Medipol Hospital
3
Istanbul Zeynep Kamil Maternity and Children Training and Research Hospital
Purpose
The objective of this study was to evaluate fetal and perinatal outcomes of pregnancies of
adolescents and compare them with adult pregnancies.
Material and Method
This retrospective case-control study was carried out at Bakirkoy Maternity and Children's Diseases
Education and Research Hospital in Istanbul, Turkey. 2491 pregnancies who delivered between
2005-2010 enrolled the study, 998 were adolescent pregnancies (Table 1) and 1493 were adults as
controls.
Results
The mean age of the adolescent group was 17,10 and in the control group the mean age was found
to be 26,73. Intermarriage, vaginal delivery, preterm rupture of membranes, preterm birth and
preeclampsia were significantly higher in adolescent pregnancies than the control group.
Gestational diabetes was more common with increasing age. There was no statistically meaningful
difference between the groups in terms of intrauterine growth restriction(IUGR), low birth weight,
anemia, 5 minute APGAR score and intrauterine fetal demise (Table 2).
Conclusion
Young maternal age is a risk factor for preterm birth, preterm rupture of membranes and
preeclampsia. According to this study adolescent pregnancies are more risky and more likely to
have adverse fetal outcomes.
Keywords: Adverse Perinatal Outcomes, Adolescent Pregnancies
Table 1
Age
Number Of Patients %
13
2
0.20
15
35
3.50
16
191
19.13
17
369
36.97
18
392
39.27
TOTAL 998
100.0
Distribution of pregnancies according to the age
Table 2
Obstetric Complications
And Neonatal Results
<= 18 age
(adolescent)
20-35 age
(control)
p value
PPROM
54 (5,41 %)
35 (2,34 %)
<0.001
Preterm Delivery(<37 w)
95 (9,51 %)
75 (5,02 %)
<0.001
Preeclampsia
47 (4,70 %)
44 (2,94 %)
<0.05
HELLP
1 (0,10 %)
3 (0,20 %)
NS
IUGR
39 (3,90 %)
52 (3,48 %)
NS
Intrauterine Demise
8 (0,80 %)
23 (1,54 %)
NS
Gestational Diabetes (GDM)
9 (0,90 %)
68 (4,55 %)
<0.001
Placental Disorders
10 (1,00 %)
9 (0,60 %)
NS
5th min APGAR <7
18 (1,80 %)
17 (1,13 %)
NS
Small for Gestational Age (<2500gr) 135(13,52 %) 160(10,71 %) NS
Obstetric Complications And Neonatal Results
[PP-070]
Kell Alloimmunizasyonundan Etkilenmiş Gebeliğin Yönetimi; Olgu Sunumu
Ali Ekiz1, Deniz Kanber Açar1, Halil Aslan1, Ahmet Gül2, Melih Bestel1, Gökhan Yıldırım1
1
Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi
2
İstanbul Prenatal
Fetus ve Yeni doğanın Hemolitik Hastalığı (FYHH), fetusun veya yeni doğanın eritrositlerinin
maternal antikorlar aracılığı ile yıkılmasından kaynaklanır. En sık neden Rh (D)
alloimmunizasyonudur. En sık görülen minör kan grubu antikorları Kell` e karşı oluşmaktadır ve
insidansı % 0.1-0.3 arasındadır.
32 yaşında Gravida 5 Parite 4 yaşayan çocuk sayısı 1 olan hastanın ikinci ve üçüncü gebeliklerinde
tanı konamayan hidrops fetalis nedeniyle yeni doğan döneminde kayıp hikayesi mevcut. Hasta
dördüncü gebeliğinde kliniğimize ilk defa 29. Gebelik haftasında hidrops fetalis bulguları ile
başvurdu. Yapılan eritrosit minör grup değerlendirmesinde anne Kell negatif, baba ve ilk çocuğunun
ise Kell pozitif olduğu tespit edildi. Ağır hidrops fetalis bulguları ile gelen hastanın orta serebral
arter doppler bulguları fetal anemi ile uyumlu saptanmış ve intrauterin transfüzyon yapıldı. Ancak
posttransfüzyonel fetüs intrauterin ex olarak saptandı.
Hastanın beşinci gebeliğinde 6. Gebelik haftasından itibaren kliniğimizin takibine alındı. Rutin
antenatal takibe ek olarak hastamıza 18. Gebelik haftasından başlayarak orta serebral arter
doppleri ile fetal anemi değerlendirmesi yapıldı. 31. Gebelik haftasında yapılan değerlendirmede;
fetal biyometrik ölçümler 30 hafta 1 gün ile uyumlu tahmini fetal kilo 1606 gr (50. persantil), MCA
dopplerinde PSV (peak sistolik velosite) 75 cm/sn, 1.5 MoM üzerinde saptandı. Hasta iki kez
intrauterin transfüzyon (Şekil 1) sonrasında gebeliğinin 34. Haftasında sezaryen ile 2740 gr, 50 cm
boyunda, baş çevresi 34 cm olan kız bebek doğum yaptı. Bu sürede hiperbiluribinemi nedeniyle
aralıklı fototerapi tedavisi aldı. Postpartum 8. Günde Hb 8.2 gr/dl ve Hct % 25.5 ile taburcu edildi.
Yeni doğana hiç transfüzyon ihtiyacı olmadı.
Anahtar Kelimeler: Fetus ve Yeni doğanın Hemolitik Hastalığı, Kell Alloimmunizasyonu,
İntrauterin transfüzyon
Şekil 1
İntrauterin transfüzyon umblikal kord plasenta insersiyon bölgesinden yapıldı
[PP-071]
Lateral Cervical Mass: Prenatally detected Lymphangioma and postnatal
management: a case report
Selen Gürsoy Erzincan1, Cihan Inan1, N. Cenk Sayın1, Mustafa Inan2, Füsun G. Varol1
1
Trakya University Faculty of Medicine, Department of Obstetrics & Gynecology, Division of
Perinatology, Edirne, Turkey
2
Trakya University, Faculty of Medicine, Department of Pediatric Surgery, Edirne, Turkey
Introduction: Lymphangiomas are commonly located in the soft tissue at the posterior neck region.
We present the prenatal sonographic findings and postnatal outcome of a fetus with a huge lateral
cervical lymphangioma.
Case: A 21-year-old patient, gravida 1,para 0, was referred to our antenatal clinic at 28 weeks of
gestation. Prenatal ultrasound and magnetic resonance imaging revealed a 83x62x74 mm cystic,
septated, multilocular mass in the left lateral cervical region. On second level ultrasound no
additional abnormality was detected except the edematous face of the fetus. The patient did not
accept karyotype analysis. Although the mass increased in size (to 121x68x101 mm), no
remarkable change was observed in the shape and texture of the mass. Cardiac failure,
polyhydramnios or hydrops were not developed in the antenatal period. A male baby weighing
3715 gr was delivered by cesarean section with classical incision at 39 weeks’ of gestation, but
EXIT procedure did not needed. Chromosomal analysis revealed normal karyotype and the
newborn was operated by pediatric surgeons because of respiratory difficulty and feeding problems
on the X0rd day. He is alive and gocondition in the 2nd month of life.
Discussion: Multidisciplinary team approach is necessary for dealing with giant neck masses.
Delivery of the fetus should be planned in a center capable of both managing potential immediate
breathing and feeding problems.
Keywords: lymphangioma, pregnancy, prenatal diagnosis
Figure 1
Figure 2
Figure 3
Figure 4
[PP-072]
Neurodevelopmental outcomes of premature infants
Curteanu Ala, Pinzari Ludmila, Jitarciuc Ala, Caraus Tatiana
Mother and Child Institute, Chisinau, Republic of Moldova
The study’s objective was to assess neurodevelopment in premature infants.
Methods. The case notes of 155 babies with 6 follow-ups done, the last done at 2 years corrected
age (c.a.), were analyzed. Children were divided into two groups: I - 128 children with birth weight
(BW) less then 1500g and II - 27 children with BW more than 1500g. We used the Bayley Scales of
Infant Development III to evaluate neurodevelopment.
Findings. Severity of neurodevelopmental impairment at 2 years c.a. was more advanced in
children from group I due to a more complicated evolution of neonatal period because of infectious
complications, respiratory (respiratory distress syndrome) and cerebral (intraventricular
hemorrhage (IVH), p<0,05, periventricular leukomalacia (PVL), p<0,05 and seizures, p <0,05)
complications associated with prematurity. Evolution of the neurodevelopmental diagnoses at 2
years showed 71 (66,36%) children from group I and 17 (73.91%) children from group II were
diagnosed as healthy. Severe neurological disorders prevailed also in the group I of children in
13,08% (14) cases being represented in 9,35% of cerebral palsy, hydrocephaly / ventriculomegaly
and microcephaly both per 1,87% of cases.
Conclusions. Neurodevelopment outcomes in children with BW less than 1500g was more
compromised compared to children with a bigger weight due to extreme prematurity cases,
prematurity severe complications, which led to the development of more frequent CP, posthemorrhagic hydrocephalus and microcephaly.
Keywords: Neurodevelopment, premature baby, cerebral palsy
[PP-073]
Electronic register for monitoring congenital malformations and hereditary
diseases in Moldova
Curteanu Ala, Caraus Tatiana
Mother and Child Institute, Chisinau, Republic of Moldova
In Moldova about 700 children with various forms of congenital malformations (CM) and hereditary
diseases (HD) are born annually. Monitoring is one of preventive measures aimed to reduce CM.
The objective of this study was to determine prevalence, structure and risk factors for CM and HD
recorded in the Electronic Register for monitoring CM in the country in 2013.
Methods. The object of the study were children (live and dead) and fetuses with isolated or multiple
CM reported by maternity wards. Thus, 721 cases of CM and HD were registered, of which - 252
cases were suspected at ultrasound examination, 28 cases - after interruption of pregnancy at 28
weeks of gestation and 693 cases were detected during postnatal period during physical
examination, instrumental examinations, screening, surgical interventions in children or
pathological examination of deceased children at 1 year of life.
Findings. The prevalence of CM was 16 per 1000 births. Congenital malformations structure
included: cardiac defects (21,1%), malformations of musculoskeletal (17,2%), urogenital and
reproductive (14,3%) and gastrointestinal systems (13,3%). The major risk factors include:
maternal age greater than 35 years, Gagauz and Ukrainian ethnicity.
Conclusion. The unique Electronic Register on CM monitoring allows increasing the complexity of
CM collection, as well to analyzing all cases of CM registered by different parameters such as: age,
ethnicity, maternal occupation, harmful habits, etc.
Keywords: Congenital malformation, Electronic Register, monitoring
[PP-074]
Dandy walker syndrome prenatal diagnosis with ultrasound
Ilir Kadiri, Bleta Domi, Butrint Kusari, Qamil Hamza, Aida Kumnova
Regional Hospital Gjakova /Kosova. Department of perinatalogy.
The Dandy-Walker complex is a rare congenital intracranial malformation that comprises a
spectrum of abnormalities of the posterior fossa which are classified as
(a) Dandy-Walker malformation (cystic dilatation of the 4th ventricle, complete or partial agenesis
of the cerebellar vermis and an enlarged posterior fossa)
Findings:
A 28 year old primi gravida come in the routine ultrasound of the perinatal at 20 week of gestation.
Ultrasonography revealed a single live intra-uterine gestation with biparietal diameter and fetal
Femur length corresponding to 22 weeks of gestation. The fetal posterior fossa was of normal size
but with a large anechoic lesion which was communicating with the 4thventricle. There was a
suggestion of hypoplasia of the cerebellar vermis (Fig.1) but no evidence of hydrocephalus.
The measurements of the fetus was normal the FW 270 gr, umbilical cord with one vein and one
artery,cerebellum was18mm but cysterna magna was large 10mm.In Ultrasound scan it was not
possible to see the vermis.
It was diagnosed Dandy Walker Syndrome and the patents did not want to do the prenatal
diagnosis with amniocentesis.
The abortion was induced with cytotec tablets 200 mcg every 3 hours and after 36 hours she
aborted the fetus 280 grams with no facial malformations only in each leg was 4 fingers and in
each hand was 6 fingers.
Keywords: Dandy walker syndrome, ultrasound
2D Dandy Walker Syndrome
This figure is for 2 D Dandy Walker Syndrome
4D Dandy Walker
in this figure is presented the 4 D Dandy Walker Syndrome
Baby Dandy Walker
This figure presents the Dandy Walker Baby after abortion.
[PP-075]
Preeklampsili Gebeler ile Normal Gebelerde Ortalama Trombosit Hacmi
Değerinin (MPV) Karşılaştırılması
Zehra Yılmaz, Elif Yılmaz, Duygu Doğdu, Ismail Burak Gültekin, Osman Fadıl Kara, Tuncay
Küçüközkan
Dr.Sami Ulus Kadın Doğum,Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma
Hastanesi,Ankara,Türkiye
Giriş
Preeklampsi hem maternal hem de fetal morbidite ve mortalitenin en önemli nedenlerinden bir
tanesidir. Preeklampsi patogenezinde en sık maternal spiral arterlerin yetersiz invazyonu
suçlanmakla birlikte, trombosit fonksiyonlarındaki değişikliklerin de preeklampsiye neden
olabileceğini gösteren çalışmalar mevcuttur. MPV (Ortama Trombosit Hacmi ) platelet aktivasyonu
ve fonksiyonunu gösteren bir belirteçtir aynı zamanda inflamatuar belirteçi olarak da
kullanılmaktadır. Biz bu çalışmamızda preeklampsi ve normal gebelerdeki MPV değerini
karşılaştırmayı amaçladık.
Yöntem
Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları E.A.H. Yüksek Riskli Gebelik servisine
Ocak 2013-Ocak 2015 tarihleri arasında preeklampsi tanısı ile yatırılan hastaların bilgileri tarandı.
Hastaların yaşı, gestasyonel yaşı, idrardaki protein miktarı, kan sayımı parametreleri kaydedildi.
Kontrol grubu olarak aynı dönemde polikliniğimize rutin kontrole gelen gebe hastalar seçildi.
Preeklampsi hastaları ile kontrol; aynı zamanda hafif preeklampsi ile şiddetli preeklampsi
grubundaki hastaların MPV değerleri karşılaştırıldı.
Bulgular
Toplam 94 preeklampsi 91 kontrol olmak üzere 185 hasta çalışmaya dahil edildi. Kontrol grubunda
ortalama yaş 27,17±6,26; preeklampsi grubunda ortalama yaş 27,90±6,71 idi (p=0,44).
Preeklampsi grubunda ortalama gestasyonel hafta 34,62±3,55; kontrol grubunda 35,26±3,33 idi
(p=0,21). Preeklampsi grubunda ortalama MPV değeri 9,76±1,09; kontrol grubunda 9,46 ± 1,14
idi her iki grupta istatistiksel olarak anlamlı fark yoktu (p=0,074).Toplam 63 hasta hafif, 32 hasta
şiddetli preeklampsi olarak değerlendirildi. Her iki grupta da MPV değerleri arasında fark
saptanmadı. (9,66±1,12, 9,85±1,035,p=0,44,sırasıyla)
Sonuç
MPV değerinin bazı sistemik hastalıklarda prognostik faktör olarak kullanılabileceği ile ilgili
çalışmalar mevcuttur. Literatürde MPV değeri ile preeklampsi şiddeti arasında sınırlı sayıda çalışma
mevcut olup, sonuçlar çelişkilidir. Biz bu çalışmamızda MPV değeri ile preeklampsi ve preeklampsi
şiddeti arasında fark saptamadık.
Anahtar Kelimeler: Preeklampsi, Gebelik, MPV
[PP-077]
Single Dose Antenatal Corticosteroid Application for Women at Risk of Preterm
Labor
Mehmet Sinan Beksaç1, Taner Kasapoğlu2, Ayşe Korkmaz3, Ergun Karaağaoğlu4
1
Department of Obstetrics and Gynecology, Perinatology Unit, School of Medicine, Hacettepe
University, Ankara, TURKEY
2
Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara,
TURKEY; Department of Epidemiology, Institute of Health Sciences, Hacettepe University, Ankara,
TURKEY
3
Department of Pediatrics, Neonatology Unit, School of Medicine, Hacettepe University, Ankara,
TURKEY
4
Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, TURKEY
This study population consisted of 1252 preterm birth cases inbetween January2006December2008 at the Ob/Gyn Department of Hacettepe University, Turkey. This retrospective
cohort study is consisted of 547 preterm neonates delivered inbetween 24-34thgestational weeks.
Average gestational week was 30,5±3,1. Study group (n:291) is consisted of the neonates of the
pregnancies treated with a single course of steroid treatment defined as the use of 12mg doses of
betamethasone twice, with births occurring between 24hours and 7days after the first dose.
Viceversa, control group (n:202) consisted of neonates who had no antenatal corticosteroids.
Patients with fetal abnormalities or medically terminated for another reasons weren’t included.
Patients were divided into three groups; 24th-28 thweeks(Group1), 28th-32ndweeks(Group2),
32nd-34thweeks(Group3). In 24th-34thgestational weeks singleton pregnancies, pneumonia and
sepsis frequency was higher in the study group (10,8%vs25,7% respectively) according to the
control(3,6%vs14,5%)(p=0,033;p=0,030). In Group2, IVH and sepsis frequency was higher in
study group(14,4%vs32,6%) according to the control(3,2%vs16,1%)(p=0,020;p=0,017). In
Group3, sepsis frequency was higher in study group(10,2%) according to the control(6,6%). No
overall decrease was seen in the incidence of RDS, conversely an increase in the incidence of RDS
was obviously noted in the study group(p=0,021,OR:1.672, 95%[CI] 1.080-2.590). Multivariate
logistic regression analysis showed no statistical difference regarding the associated factors with
the incidence of RDS. As a conclusion, the current regimen of antenatal corticosteroids utilized in
singleton pregnancies does not reduce the overall incidence of RDS. Large population based and
well-designed prospective cohort studies are needed to reveal the exact effects of antenatal
corticosteroid administration on perinatal mobidity and mortality.
Keywords: antenatal corticosteroid, preterm labor, respiratory distress syndrome, neonatal
morbidity
[PP-078]
Maternal and fetal outcome of renal diseases
Nergis Kender1, Anil Erturk1, Sinan Beksac2
1
Hacettepe University, Department of Gynecology and Obstetrics
2
Hacettepe University, Department of Gynecology and Obstetrics, Division of Perinatology
Renal diseases are associated with both increased risk for adverse maternal outcomes, including
gestational hypertension, preeclampsia, eclampsia, and death, and also adverse fetal outcomes,
including preterm birth, intrauterine growth restriction, small for gestational age, and still birth.
To reveal the different effects of groups of renal diseases on pregnancy, 44 pregnancies with renal
diseases were evaluated at Hacettepe University Perinatology Clinic between January 2001 and
March 2014. These pregnancies were divided into three groups, renal cystic diseases, primary
glomerulonephritis and secondary glomerulonephritis due to systemic diseases. Infants’ birth
weight, gestation age, 24-hour urine protein excretion just before delivery were detected
significantly different among these groups. It was determined that 21 of these 44 pregnancies were
complicated with comorbidities such as preeclampsia, hypertension, HELLP syndrome.
Patients with renal disease should be monitored jointly by a nephrologist and by an obstetrician.
Delivery should be planned before and ideally actualized at a tertiary referral center.
Keywords: renal disases, pregnancy, glomerulonephritis, proteinuria
Characteristics among three groups of renal diseases
[PP-079]
Perinatal Outcomes of Papillary Thyroid Cancer During Pregnancy
Fatih Aktoz, Mert Turgal, Emine Aydın, Mehmet Sinan Beksaç
Hacettepe University, School of Medicine, Departmant of Obstetrics and Gynecology, Ankara,
Turkey.
Summary
Thyroid cancer is the most common endocrine malignancy and it’s seen more often in women than
men. Togetherness of pregnancy and thyroid cancer is not frequent but 10% of thyroid cancers of
reproductive people are seen during pregnancy. No matter it has an effect on pregnancy or not, a
cancer during pregnancy is a major stress for a woman. Therefore it is a powerful reason to
research about it. However two individuals, mother and the fetus, are vulnerable. Because of this
reason, there are limited data on this subject. One of them is a large retrospective study on 595
pregnancy associated thyroid cancer and there is no difference between pregnant and nonpregnant thyroid cancer in outcome, survival or morbidity. In the light of these informations, we
want to evaluate our cases.
Methods
A retrospective evaluation was conducted Hacettepe University, Faculty of Medicine, Division of
Maternal Fetal Medicine, Ankara, Turkey. Patient’s surgical history, gestational history(gestational
age, gravidity and parity), pregnancy outcomes(birth weight, sex), and pathological findings of
baby and patient were recorded.
Conclusion
Overall, our case series has shown that there is no clear difference in perinatal outcomes of
papillary thyroid cancer patients’ pregnancies and it’s compatible with literature.
Keywords: Thyroid cancer, papillary, pregnancy
[PP-081]
Fetal Şizensafalinin Prenatal Tanısı
Esra Esim Büyükbayrak1, Tufan Hiçdönmez2, Aylin Ege Gül3
1
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği,
Perinatoloji Ünitesi
2
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği
3
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Patoloji Kliniği
Şizensefali serebral kortikal gelişimin oldukça nadir bir patolojisi olup ventriküllerden korteks
yüzeyine kadar derin bir yarığın tek ya da çift taraflı olarak olmasıdır. Bu yarığın gri cevher ile
örtülü duvarlarının birbirine yakın olması Tip 1 (kapalı dudak şizensefali), birbirinden uzak olması
ise Tip 2 (açık dudak şizensefali) olarak adlandırılır.
Prenatal fetal şizensefali tanısı ultrasonografi ile konan, fetal kraniyal MRI ile teyid edilen ve
terminasyon sonrası otopsiyle doğrulanan bir olgu sunulmuştur.
Olgu
Yirmidört yaşında G1P0 olan olgu 24. gebelik haftasında, dış merkezden ayrıntılı ultrasonografi
isteğiyle polikliniğimize refere edildi. Özgeçmiş ve soygeçmişinde özellik tespit edilmedi. Başvuru
haftasına kadar dış merkezden problemsiz olarak takip edilmişti. İkili testi yapılmamış, üçlü
testinde ise AFP 0.6 MoM olup kombine riski 1:2946 olarak tespit edilmişti.
Kliniğimizde yapılan fetal ultrasonografide; kraniyumda frontoparietal bölgede kama şeklinde
parenkim defekti saptandı (Resim 1,2). Talamus ve serebellar yapılar normal izlendi. Fetal
vertebralarda ve diğer organ sistemlerinde anomali saptanmadı. Ultrasonografi bulgularıyla çift
taraflı açık dudaklı şizensefali düşünüldü. Eşlik edebilecek anomalileri ortaya koyabilmesi açısından
fetal kraniyal MRI istendi. MRI görüntülerinde bilateral frontoparietal parenkim defektinin
ventrikülden başlayarak kortekse kadar devamlılığı izlendi (Resim 3,4,5). Tanı bilateral açık dudak
şizensefali olarak kesinleştirildi. TORCH belirteçleri negatif olarak tespit edildi. Aile bebeğin
postnatal nörogelişimsel durumu hakkında bilgilendirildi ve ailenin isteği üzerine gebelik
sonlandırıldı. Yapılan fetal otopside bilateral frontoparietal şizensefali tanısı doğrulandı ayrıca sol
lateral ventrikül içinde hemoraji tespit edildi (Resim 6). Terminasyon sonrası alınan fetal dokunun
genetik incelemesi sonucu sayısal ve yapısal karyotip anomalisi tespit edilmedi.
Prenatal ultrasonografi şizensefali tanısında oldukça değerlidir. Ancak fetal MRI altın standart tanı
yöntemidir.
Anahtar Kelimeler: şizensefali, prenatal tanı, fetal MRI, fetal otopsi
Fetal Kraniyal MRI görüntüsü, axiyal kesit
Bilateral büyük açık dudak şizensefali
Fetal Kraniyal MRI görüntüsü, koronal kesit
Bilateral büyük açık dudak şizensefali
Fetal kraniyal MRI görüntüsü, sagital kesit
Büyük açık dudak şizensefali görüntüsü
Otopsi Görüntüsü, koronal kesit
Prenatal fetal kraniyal ultrasonografi, axiyal kesit
Posterior fossa normal izlenmektedir. Bilateral ventrikulle birleşen BOS klefti görülmektedir.
Prenatal fetal kraniyal ultrasonografi, axiyal kesit
Kafatasından ventrikule kadar uzanan geniş, kama şekilli yarık
[PP-082]
Postnatally Diagnosed Triplody Case Who Is Alive For More Than 3 Months
Esra Esim Büyükbayrak1, Ilke Tanır1, Fatma Kaya Narter2, Yasemin Karageyim Karşidag1
1
Dr. Lütfi Kırdar Kartal Training and Education Hospital, Department of Obstetrics and Gynecology,
Perinatology Unit
2
Dr. Lütfi Kırdar Kartal Training and Education Hospital, Department of Pediatrics, Neonatal Care
Unit
Triploidy has been estimated to occur in 1-2% of all clinically recognized conceptions and most of
them are aborted. Live birth rate for triploidy is 1/50,000 live births. We report a postnatally
diagnosed triploidy case who is alive for more than 3 months.
Case
39 year old, G6P3A2 pregnant patient was referred to our clinic for severe intrauterin growth
retardation on her 30th week of gestation. Upon patient’s request first and second trimester
screening tests and amniocentesis weren’t performed.On ultrasonographic examination;biometric
measurements of the fetus were compatible with 25 weeks. There was big, cystic
plasenta,polihydramnios, cleft lip and facial dysmorphism. On umblical doppler measurements
there was increased resistance. The patient was informed about possible genetic aberations and
offered amniocentesis again, but she refused any intervention. The patient followed up twice
weekly. On 36th week of gestation, patient was hospitalised and delivered by caeserean section
(1595gr, 48cm male fetus with 7-8 apgar scores ). There was a big cleft lip and palate, sydromic
face ( Picture 1,2) and bilateral overlapping of the fingers of the feet on phisical examination(
Picture 3). Chromosomal analysis demonstrated a karyotype of 69,XXY. The karyotypes of both
parents were normal. Now the newborn is 98 days old and corrective operation for cleft lip and
palate is being planned.
Triploidy is lethal, with no survivors reported beyond 10.5 months of age. Postnatal survivors
usually have type II phenotype with extra chromosomes of maternal origin. Infants with mosaicism
will have longer survival than infants with true triploidy.
Keywords: Triploidy, 69XXY, live born
appearence of the toes
facial appearence of the newborn
general appearence of the newborn
[PP-083]
Nadir Görülen Bir Fetal Anomali, Meckel-Grubel Sendromu: Olgu sunumu
Fedi Ercan, Berkan Sayal, Melike Bayman, Hüseyin Görkemli, Ali Acar
Konya
GİRİŞ
Meckel-Gruber Sendromunun(MGS)ilk olarak 1822’de Meckel tarafından tanımlanmış ancak Gruber
tarafından 1934 yılında bir sendrom olarak tariflenmiştir.Otozomal resesif geçişli kalıtsal bir
hastalıktır.Karakteristik anomali triadı;multikistik displastik böbrek(%100),oksipital
ensefalosel(%90) ve postaksiyel polidaktili(%83)’dir.Tanı için bu bulgulardan en az ikisinin tespit
edilmesi gerekmektedir.Ailede etkilenmiş çocuk olması durumunda tekrarlama riski %25’tir.Daha
önce etkilenmiş ailelerde erken prenatal tanı açısından dikkatli olunmalıdır.Yapılan genetik
incelemeler MGS için 11 ayrı lokus tanımlamıştır.Standart karyotip incelemeler normal olup gen
düzeyinde incelemeler yapılması gerekmektedir.MGS insidansı değişken olup 3000 ile 140,000
doğumda bir görülür.
OLGU SUNUMU
Otuzbeş yaşında G4Y2A1 kadın,kliniğimize 13.gebelik haftasında fetal anomali şüphesi ile
yönlendiriliyor.Daha önce 1 kez 18.haftada düşük yapan ve fakat düşük materyali ile ilgili tıbbi
kayıtlara ulaşılamayan hastanın eşi ile 2.derece akrabalığı mevcuttur(teyze hala çocukları; kuzen
evliliği).İlk trimester transvajinal ultrasonografi muayenesinde bilateral polikistik böbrekler ve
ensefalosel(Şekil 1) tespit edilen hastaya multible fetal anomali ve muhtemel MGS açısından bilgi
verilerek terminasyon önerildi.Ancak çift bu seçeneği kabul etmedi.Karyotip anomalisi açısından
koryon villus biyopsisi(CVS)önerildi.İşlemi kabul eden hastaya yapılan CVS'nin QF-PCR sonucu
13,18,21,X ve Y kromozomları açısından normaldi.Çiftle yapılan ikinci görüşmede çift terminasyon
isteğini beyan etti.Bunun üzerine 14.haftada terminasyon gerçekleştirildi.Abort materyalinin
eksternal muayenesinde cinsiyeti belirsiz fetusta ensefalosel ile birlikte her iki el ve ayaklarda
polidaktili tespit edildi(Şekil 2).Çift fetal otopsiyi kabul etmedi.
SONUÇ
MGS tekrarlama riskinin %25 olması ve ölümcül seyretmesi nedeniyle önemlidir.MGS'li bebekler
doğumda veya doğumdan hemen sonra kaybedilir.Fetal otopsinin tanının doğrulanmasına yardımcı
olur.Bu sendrom riskini taşıyan aileler bilgilendirme yapıldıktan sonra perinatoloji kliniklerinde
takibe edilerek 11-14.haftalarda erken prenatal tanı almaları ve erken haftalarda gebelik
terminasyonu yapmaları sağlanabilir.
Anahtar Kelimeler: Meckel-Gruber sendromu, ensefalosel, multikistik displastik böbrek, polidaktili
Resim 1
Üstte ensefalosel, altta ise bilateral polikistik böbrekler izlenmektedir.
Resim 2
(A) Ensefalosel (Ok) (B) Distandü fetal abdomen (Ok) (C) Ellerde postaksiyal polidaktili (D)
Ayaklarda postaksiyal polidaktili.
[PP-084]
Spontan Gebelikte Gelişen Spontan Overyan Hiperstimülasyon Sendromu
(OHSS) Olguları
Esra Esim Büyükbayrak, Murat Korkmaz
Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği,
Perinatoloji Ünitesi
Spontan ovulasyon sırasında overyan hiperstimülasyon sendromu (OHSS) çok nadirdir ve genellikle
gebelik ile beraberdir. Bu yazıda spontan gebelikte gelişen spontan OHSS olguları sunulmuştur.
OLGU1
32 yaşında G2P1olup ikili test isteğiyle başvuran hastanın özgeçmişinde özellik yoktu. İlaç kullanım
öyküsü yoktu. Yapılan ultrasonografisinde CRL 13+1, FKA pozitif, sol overi 110x57 mm, sağ over
69x70 mm ve heriki over hiperstimule görünümde izlendi, batında asit izlenmedi (Resim 1,2).
Laboratuar tetkiklerinde estradiol yüksekliği (E2> 4854pg/ml) ve hafif hemokonsantrasyon (hct:
%40,4) izlenirken, elektrolit imbalansı, hipotiroidi ve albumin düşüklüğü saptanmadı.
Hastaya spontan gebelikte spontan OHSS tanısı konularak takibe alındı. Laboratuar bulgularında
bozulma izlenmedi, USG takiplerinde 10 gün sonra over boyutlarında küçülme (sol over:36x25mmsağ over:50x23mm) izlendi. 2 ay sonra over boyutları normale geriledi ve hasta sorunsuz bir
hamilelik geçirdi.
OLGU2
28 yaşında G5P2A2 olup kasık ağrısı şikayetiyle başvuran hastanın özgeçmişinde özellik yoktu, ilaç
kullanımı öyküsü yoktu. Yapılan USG de CRL:11+1, FKA:+, sağ over boyutu 140x130 mm, sol over
boyutu 198x119 mm ve batında yaygın asit izlendi(Resim 3,4,5,video 1). Yapılan laboratuar
tetkiklerinde estradiol yüksekliği (E2> 5110pgr/ml), hemokonsantrasyon (hct:44,7%) ve albumin
düşüklüğü (2,5gr/dl )izlenirken, elektrolit imbalansı ve hipotiroidi saptanmadı.
Hastaya spontan gebelikte spontan OHSS tanısı konularak belirgin asiti olduğu için hospitalize
edildi. IV sıvı replasmanı ve profilaktik dozda düşük moleküler ağırlıklı heparin tedavisi başlandı.
Hastanın gebeliği komplikasyonsuz devam etmektedir.
TARTIŞMA
OHSS spontan olarak ortaya çıkması nadirdir. Sunduğumuz iki olguda olduğu gibi hiçbir risk faktörü
taşımayan hastalarda da spontan gebelikte OHSS ortaya çıkabileceği akılda tutulmalıdır. Yönetim
destekleyici tedavi şeklindedir. Sendrom genellikle sınırlı kaldığı ve gerilediği için gebeliğin devamı
önerilir.
Anahtar Kelimeler: Spontan OHSS, Spontan gebelik
olgu 1, sağ over
Olgu 1, sol over
Olgu 2, batında asit görüntüsü
Olgu 2, sağ over
Olgu 2, sol over
[PP-085]
The Effect of Prenatal Invasive Tests on Neonatal Birthweight
Atakan Tanacan, Emine Aydın, Mehmet Sinan Beksaç
Turkey.
Objective: To investigate the effect of prenatal invasive tests on neonatal birth weight
Method: Two hundred and thirty three patients were retrospectively assessed and patients were
divided into three groups:1) patients who were diagnosed by amniocentesis, 2) patients who were
diagnosed by chorionic villi sampling,3) patients without prenatal invasive testing. There were
ninety seven patients in the first,thirty six patients in the second and a hundred patients in the
third group.The data is gained from the records between January 2013 and January 2014 at
Hacettepe University Hospital Maternal and Fetal Medicine Unit retrospectively.
Results: The mean age,birthweeks and fetal birth weight of the patients were calculated. There
was a slight statistically significant differance between the patients without prenatal invasive
testing and amniocentesis group which was approximately one hundred and seventy one grams
heavier in the former group. Also there was an approximately one hundred and fifty eight grams
difference between the chorionic villus sampling and amniocentesis group which was not
statistically significant.
Conclusion: The amniocentesis group had the lowest birth weights.
Keywords: amniocentesis, chorionic villi sampling, birth weight
[PP-086]
Is The Mean Platelet Volume a Predictive Marker of a Low Apgar score and
Insulin Resistance In Gestational Diabetes Mellitus?
Ayşe Gül Kebapcılar1, Süleyman Hilmi Ipekçi2, Setenay Arzu Yılmaz1, Aybike Pekin1, Özlem Seçilmiş
Kerimoğlu1, Süleyman Baldane2, Çetin Çelik1
1
Selçuk Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD,Konya
2
Selçuk Üniversitesi Tıp Fakültesi,İç Hastalıkları AD,Endokrinoloji ve Metabolizma bölümü,Konya
The present study was designed to determine firstly the MPV could be evaluated as diagnostic of
GDM; whether there was any association between mean platelet volume and poor fetal outcome
with insulin resistance and neonatal Apgar scores in women with GDM.
In this retrospective study, we enrolled 101 pregnant women with GDM together with a group of
138 healthy control. All blood parameters were measured at 24–28 weeks of the pregnancy. There
was a significant positive correlation between the MPV values, the HOMA-IR, insulin levels and
negatively with Apgar score at 1 min and 5, in the GDM group(r=0.227,p=0.02, and
r=0.206,p=0.03, r=-0.485, p<0.001; and r=-0.399, p<0.001, respectively).In the multivariate
logistic regression analysis, the MPV value was most consistently associated with the Apgar 1 min
score (β=-0.387, p=0.003) in the GDM group. The area under the receiver operating characteristic
(ROC) curve (AUC) for the MPV used to diagnose GDM was 0.906, (p<0.001; 95%confidence
interval (CI), 0.871–0.942). An MPV of >8.0 fL had a sensitivity of 82% and a specificity of 75%
for the prediction of GDM. We investigated the correlation of MPVs with insulin resistance and
neonatal Apgar scores in the patients with GDM. Our result seems that MPV relates to severity of
GDM and this has implications for identification of adverse fetal outcome.
Keywords: Gestational diabetes mellitus, MPV, Insulin Resistance, Apgar score
[PP-087]
The Effect Of Cell Growth And Proliferation Factors On The Etiopathogenesis of
IUGR
Serhan Can Işcan1, Merih Bayram1, Erhan Demirdağ2, Emin Umit Bağrıaçık3
1
Department of Obstetrics and Gynecology, Gazi University Ankara, Türkiye
2
Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health
Teaching and Research Hospital, Ankara, Türkiye
3
Department of ımmunology, Gazi University Ankara, Türkiye
Intrauterine growth restriction is defined as inability of the fetus to use its growth potential
because of various pathological issues. IUGR is observed in 3-8% of all pregnancies and it is an
important reason of fetal morbidity and mortality.
It is highly probable that the subgroups of EGF/PDGF signaling pathway may be involved in the
etiopathogenesis of IUGR.
In our study, EGF/PDGF signaling pathway gene profile was studied comprehensively with RT-PCR
by using "Human EGF / PDGF Signaling PCR Array" in plasentas obtained from 6 women with
healthy pregnancies and 6 women with IUGR. The genes related with cell survival and growth were
studied as apoptosis, cell cycle, cell differentiation cell growth, cell motility, cell proliferation gene
groups.
The parity, gestational week at delivery, Apgar scores at first and fifth minutes were not
significantly different between the IUGR and control groups. However, the women in IUGR group
were younger and slimmer. Additionally, AFP values were higher in IUGR group.
It seems that PRKCA gene is the only gene which shows a significant expression difference
between the IUGR and control groups.
It is probable that the expression variations in the genes in pregnancy cause changes onto
placental and fetal development by affecting apoptosis and cellular events on different aspects
At the present time, the progressing studies of diseases and gene therapy are individualized. We
believe that different genetic origins of IUGR for different individuals will be found and individual
gene therapies for them will be generated in the near future.
Keywords: Intrauterine growth restriction (IUGR), Cell survival and growth, apoptosis, EGF /
PDGF, PCR Array
Differences in P values of genes expressions between IUGR and control groups
EGF Pathway
(http://www.qiagen.com/geneglobe/static/images/Pathways/EGF%20Pathway.jpg)
PDGF Pathway
(http://www.qiagen.com/geneglobe/static/images/Pathways/PDGF%20Pathway.jpg)
Characteristics Of Study And Control Groups
IUGR (n:6) Control (n:6) P values
Age
26.50±4.93
33.17 ± 1.94 0.026‫٭‬
Parity
0.50±0.83
1.00 ± 0.63
0.240
BMI** before pregnancy 20.22±2.75
25.22 ± 3.46 0.026‫٭‬
BMI after pregnancy
24.90±2.76
30.96 ± 2.51 0.009‫٭‬
Alpha-fetoprotein
(double test)
(ng/ml)
59.2 ± 44.54 28.95 ± 4.71 0.015‫٭‬
Gestational age at birth
37.6 ± 1.98
38.4 ± 0.36
0.699
Apgar score (1.minute)
8.83 ± 0.98
8.83 ± 0.40
0.818
Apgar score (5.minute)
9.67 ± 0.51
9.83 ± 0.40
0.699
weight of neonatal
2193 ± 506 3323 ± 324 0.002‫٭‬
(gr)
* p < 0.05= statistically significant **BMI: Body mass index
[PP-088]
Comparison of the effect of emergent versus non-emergent cervical cerclage in
multifetal gestations on pregnancy prolongation and preterm birth rates
Söylemez1
Aim
Multifetal pregnancies have increased dramatically in the recent years markedly elevating preterm
delivery and their associated perinatal morbidity rates. Although very recent literature have not
proven any benefit of non-emergent (history-indicated or ultrasound-indicated) cervical cerclage in
multifetal pregnancies, it has been one of the widely used therapeutic approaches especially for the
hardly obtained assisted gestations. However, there are other cases diagnosed to have cervical
dilation at the time of admission and treated by emergency cerclage. Hereby, it is intended to
compare the effect of emergent versus non-emergent cerclage in multifetal gestations on
pregnancy prolongation and preterm birth rates.
Methods
Data of the multifetal pregnant patients who underwent McDonald cerclage procedure at Ankara
University Department of Obstetrics and Gynaecology, between February 2008 and January 2015
were retrospectively gathered and analysed.
Results
Among the 19 multifetal pregnant patients (14 twins, 5 triplets) included in the analysis, 14
(73,7%) underwent non-emergent cerclage (NE-C). Emergent cerclage (E-C) was performed for
the remaining 5 (26,3%). The NE-C and E-C groups were statistically similar in terms of maternal
age, number of gravida, parity, and abortion, presence of maternal chronic disease, vaginal culture
positivity, mean gestational week of cerclage application (23,0 ± 4,7 vs. 24,0 ± 3,7) and
unpreventable abortion percentage. For the E-C group, although not reaching statistical
significance, median gestational week at birth (34,3 (18,1-35,3) vs. 31,0 (23,1-35,6)), percentage
of patients reaching 34 or 32 weeks (for the latter; n=4, 80,0% vs. n=4, 28,6%) and median
interval between the procedure and delivery (53,0 days (2,0-76,0) vs. 37,5 days (0,0-120,0)) were
revealed to be higher when compared to NE-C group.
Conclusions
Recent literature and guidelines suggest that history-indicated cerclage is of no benefit and
ultrasound-indicated one may even increase the risk of preterm birth for multifetal pregnancies.
However, physical examination-indicated cerclage is associated with similar outcomes in singleton
and multifetal gestations. These are consistent with the presented data and may explain the
“relative insignificant supremacy” of E-C group over the NE-C group in terms of prolongation of
pregnancy and gestational week at birth.
[PP-089]
Effects of breast sıze, maternal age and parıty on lastıng tıme of breastfeedıng
perıod
Rahime Bedir Fındık, Selen Taflan, Huriye Kaan Güven, Esin Merve Erol Koç,, Sinem Ceylan, Özlem
Moralıoğlu
Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health
Objectives: Lactation and breastfeeding periods affect human through physical, social and
phscyhological parameters. Based on the belief that women with small sized breast produce
inadequate amount of milk and have short lasting breastfeeding period, we sought whether there
has been any relationship between the size of breast and lasting time of breastfeeding period.
Additionally we investigated the effects of maternal age and parity of patients on lasting
breastfeeding period.
Methods: 943 patients were included in this study. According to data of patients, 275 of the
patients had 75 unit or less sized (29.2%), 524 had 80-85 unit sized (55.6%) and 144 had 90 unit
or over sized (15.3%) breasts. 193 of the patients have been excluded from the study due to lack
of the data on these patients’ lasting time of breastfeeding period. Mean lasting time of
breastfeeding period of remaining 750 patients was calculated as (mean±SD) 3.8±8.4 months.
Findings: When lasting time of breastfeeding period in 3 groups of patients according to unit breast
size were compared, difference was not statistically significant (p=0,698). Also it was shown that
maternal age and parity of patients had no statistically significant effect on lasting time of
breastfeeding period (p=0,094; p=0,070).
Conclusions: As s result, we demonstrated that factors such as breast size, young maternal age
and primiparity have no unfavourable effect on lasting time of breastfeeding period.
Keywords: lactation, breast size, breastfeeding
[PP-090]
The densıty of amnıon partıcles on ultrasonography and ıts Influence on
perınatal outcomes
Rahime Bedir Fındık, Yeksin Helvacıoğlu, Esin Merve Erol Koç, Yasemin Taşçı, Özlem Moralıoğlu
Zekai Tahir Burak Women’s Health Education and Research Hospital, Maternity Service
Objectives: We investigated the relation between amniotic density on ultrasound and maternal age,
maternal weight and height, last menstrual period, parity, delivery type, plasental grade, reactivity
of NST, fetal sex and other fetal parameters (fetal height, weight and head circumference).
Methods: 105 pregnant women of active labour were included in our study. Fetal development was
evaluated on ultrasound. The relation between the ultrasonic density of amniotic fluid and the
maternal age, maternal weight and height, last menstrual period, parity, delivery type,plasental
grade, reactivity of NST, fetal sex and other fetal parameters (fetal height, weight and head
circumference). Using the same magnification, for the homogeneous amniotic fluid particle number
less than 10 was classified as less particulated group, particle number more than 10 was evaluated
as more particulated group.
Findings: Mann-Whitney U Test, Chi-Square test, One Sample Kolmogorov-Smirnov tests were
used. When we evaluated the relation betwen particule density of amnion and amniotic fluid index
(p=0,553), plasental grade (p=0,152), delivery type (p=0,770) and NST results (p=0,331), no
statistically significant differences were observed. There is also no statistically significant difference
in terms of fetal sex, parity, fetal weight. Labour time was significantly longer in the group with
more particulated amnion (p=0,051). None of the babies were admitted to neonatal intensive care
unit.
Conclusions: For uncomplicated term pregnancies, although particle density of amniotic fluid on
ultrasonography seem to be clinically important factor guiding the physician for management of the
labour, is not a statistically important parameter for outcome.
Keywords: echogenic amnion, meconium, ultrasonography, fetal morbidity
[PP-091]
Pregnancy Outcomes of Patients who Gave a Live Birth with Celiac Disease: a
Case Series
Duygu Altin Baskak, Emine Aydin, Mehmet Sinan Beksaç
Hacettepe University Faculty of Medicine, Obstetrics and Gynaecology, Ankara, Turkey
Celiac disease (CD) is a multifactorial chronic autoimmune disease triggered by gluten consumption
in genetically predisposed individuals. It is characterised by an immune response to gliadin. It
causes inflammatory injury and pathological changes in the small intestinal mucosa. It affects
female more than male.
Severe cases present with diarrhea within the first years of life. On the other hand, many affected
individuals are asymptomatic or subtle symptoms mainly of gastrointestinal origin are experienced
until adulthood.
Controversy exists regarding the association between celiac disease and pregnancy outcome. While
some authors suggested that there is higher rates of abortion, intra-uterine growth restriction,
stillbirth and preterm labor among celiac patients; most studies indicated comparable pregnancy
outcomes with healthy population.
In order to further clarify the impact of CD on pregnancy outcomes, we aimed to examine patient
registry records at the Hacettepe University Obstetrics and Gynecology Department from January
2009 to March 2015. Our primary interest was to assess pregnancy outcomes in women with CD
who gave a live birth.
Eight subjects with CD were detected within the assessment period. Pregnancy outcomes and type
of delivery among these subjects are summarized in Table 1.
Our results demonstrate that high prevalance of preterm delivery and high cesarean section rate in
CD pregnancies may be considered as risk factors for obstetrical/perinatal outcome. On the other
hand, good fetal outcome is observed in our patient group. The reason behind this fact may be the
high concentration of CD patients on their personal medical cares.
Keywords: Celiac disease, Pregnancy Outcome
Table.1 Descriptives of the Patients who Gave Birth with Celiac Disease
[PP-092]
Comparison of the effect of emergent versus non-emergent cervical cerclage in
singleton gestations on pregnancy prolongation and preterm birth rates
Söylemez1
Aim
Preterm birth, defined as delivery before 37 weeks of pregnancy, is associated with significant
morbidity and is the single most important determinant of quality of life. Cervical cerclage, the
insertion of a suture into the cervix in an attempt to maintain its competence, is a common and
established obstetric procedure performed for prevention of prematurity. Cerclage placement is
based on either emergent (physical examination-indicated) or non-emergent (history-indicated or
ultrasound-indicated) indications in singleton gestations. Hereby, it is intended to compare the
effect of emergent versus non-emergent cerclage in singleton gestations on pregnancy
prolongation and preterm birth rates.
Methods
Data of the patients who underwent McDonald cerclage procedure at Ankara University Department
of Obstetrics and Gynaecology, between August 2007 and January 2015 were retrospectively
gathered and analysed.
Results
Among the 102 singleton pregnant patients included in the analysis, 74 (72,5%) underwent nonemergent cerclage (NE-C). Emergent cerclage (E-C) was performed for the remaining 28 (27,5%).
The groups were statistically similar in terms of maternal age, number of gravida, fetal gender,
presence of maternal chronic disease and vaginal culture positivity. The median gestational week of
cerclage application (18,9 (12,0-29,0) vs. 21,9 (16,3-27,9), p:0,018) and unpreventable abortion
percentage (n=5, 6,8% vs. n=7, 25,0%, p:0,017) were significantly lower in the NE-C group.
Median gestational week at birth (37,1 (13,6-40,3) vs. 24,3 (16,6-40,0), p<0,001), fetal birth
weight (2985g (400-4500) vs. 820g (300-3450), p<0,001), percentage of patients reaching 32, 34
or 37 weeks (for the latter; n=41, 55,4% vs. n=2, 7,1%, p<0.001) and median interval between
the procedure and delivery (106,5 days (1,0-198,0) vs. 22,0 days (0,0-120,0), p<0,001) were
significantly higher for the NE-C group.
Conclusions
Cervical cerclage is a well established effective intervention for singleton pregnancies providing
meaningful prolongation of gestation, thus reducing the morbidities of prematurity. However,
better focusing on patient history and concomitant shortening of cervix on trans-vaginal ultrasound
scan (<25 mm) will provide timely non-emergent intervention. This will result in keeping the fetus
in utero for a longer time when compared to the emergent condition of cervical dilation, unless any
other contraindication exists.
[PP-093]
Predictive value of Procalcitonin and IL-6 versus cervical length for the
admission-to-delivery interval in preterm labour
Sümeyra Nergiz Avcıoğlu1, Sündüz Özlem Altınkaya1, Selda Demircan Sezer1, Mert Küçük2, Hasan
Yüksel1
1
Adnan Menderes University, School of Medicine, Department of Gynecology and Obstetrics
2
Muğla Sıtkı Koçman University, School of Medicine, Department of Gynecology and Obstetrics
Objective: We aimed to determine whether concentrations of IL-6 and procalcitonin in maternal
circulation can be used and compare with cervical length to predict the admission-to-delivery
interval in preterm labour.
Material-Methods: Fourty patients complicated with preterm labour between 24-34 weeks of
gestation and having preterm birth were included in the study. Maternal concentrations of IL-6 was
measured by an enzyme-linked immunosorbent assay (ELISA) and procalcitonin was measured by
immunoturbidimetry with using human procalcitonin reagent kit. Transvaginal ultrasound to assess
cervical length was performed.
Results: Receiver operator characteristic (ROC) analysis results of IL-6 and procalcitonin for
prediction of preterm delivery <48h, <7 days, <32 weeks, <34 weeks and <37 weeks were not
statistically significant (p>0.05). ). It was shown that in ROC analysis, only cervical length had
Area Under Curve (AUC); 0.692 (0.511-0.873,p=0.044) at cut off value <=3.64cm, AUC;0.758
(0.574-0.943, p=0.015) at cut off value <=3.50cm, AUC;0.716 (0.553-0.879, p=0.032) at cut off
value <3.80cm, in predicting preterm delivery within 7 days, <32 weeks and <37 weeks
respectively.
Conclusion: This study suggests that in preterm labour, although IL-6 and procalcitonin have
unsatisfactory predictive value for the admission-to-delivery interval, cervical length have better
predictive values for the admission-to-delivery interval.
Keywords: Procalcitonin, IL-6, cervical length, preterm labour, preterm delivery
[PP-094]
Sonographic Assessment of Fetal Penile Development in Turkish Population
Saynur Yilmaz1, Funda Akpinar1, Fulya Kayikcioglu1, Berna Dilbaz1, Husniye Yucel2, Orhan Gelisen1
1
Etlik Zubeyde Hanim Womens’ Health Training and Research Hospital, Department of Obstetrics
and Gynecology, Ankara, Turkey
2
Etlik Zubeyde Hanim Womens’ Health Training and Research Hospital, Department of Pediatrics,
Ankara, Turkey
Background: Evaluation of external genitalia is a routine part of prenatal ultrasonographic
assessment. In addition to diagnosis of gender, determination of micropenis is important, since it
can be the only apparent manifestation of some disorders such as hypothalamo- hypophysial
hormone deficiencies.
Purpose: To establish reference ranges for fetal penile length and penile width between 17 to 37
weeks of gestational ages in Turkish population.
Materials-Methods: This prospective cross sectional study was conducted between December
2013 to March 2014 at Etlik Zubeyde Hanim Women’s Health Training and Research Hospital.
Study included 179 singleton male pregnancy between 17 to 37 gestational weeks. Penile length
and penile width were measured by trans-abdominal ultrasound. The correlation coefficients of
gestational age with penile measurements were calculated.
Results: As gestational age increased both penile length and penile width increased (p<0.0001,
correlation coefficients R2=0.854 and R2=0.883; respectively).
Conclusion: Reference values of penile length in Turkish Population were similar to other
populations. Penile width measurement is a convenient way to diagnose penile anomalies.
Keywords: Ultrasonography, prenatal diagnosis, fetal penile length, micropenis
Figure 1
Figure 1: Correlation between penile length and gestational week
Figure 2
Figure 2: Correlation between penile width and gestational week.
[PP-095]
Plasenta İnvazyon Anomalisi Olan Olgularda Konservatif Yönetim
Mehmet Serdar Kutuk, Menşure Tonguç, Mehmet Dolanbay, Semih Uludag, Mahmut Tuncay Özgün,
Mustafa Basbuğ
Amaç: Bu çalışmanın amacı plasenta akreata ve perkreata gibi plasental invazyon bozukluklarında,
plasentanın uterin kavite içerisinde bırakılarak bekleme yönteminin tedavi sonuçlarını incelemektir.
Materyal-Metod: Erciyes Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde Ekim
2012 – Şubat 2015 tarihleri arasında konservatif olarak (plasentanın yerinde bırakıldığı) yönetilen
yedi plasenta akreata/inkreata olgusunun verileri retrospektif olarak analiz edildi.
Bulgular: Hastaların yaş ortalaması 32.4±4.6 (min-maks: 27- 41) ortanca gravida değeri 3,
ortanca parite değeri 2, ortanca sezaryen sayısı 2 (min-maks:1-4) idi Ortalama sezaryen haftası
35±2 hafta ve hastanede yatış süresi 10(min-maks: 4-19) gün idi. Olguların ikisinde bilateral
hipogastrik arter ligasyonu işlemi yapıldı, beş olguda pelvik devaskularizasyon prosedürü
uygulanmadı. Ortalama β-hCG negatifleşme süresi 70±15.6 gün (min-maks:48-93), plasentanın
atılma süresi ise 143.1±47.7 gün (min-maks:48-180) idi. Altı olguda ek cerrahi müdahele
gereksinimi olmaksızın tam iyileşme sağlanırken (6/7, %83.8), bir olguda postoperatif 12. saatte
kanama nedeniyle acil histerektomi operasyonu yapıldı (1/, %14.2). İzlem süresince üç hasta
toplam dört kez yeniden hospitalize edildi ve en sık hospitalizasyon nedeni vaginal kanama idi (3/4,
%75).
Sonuç: Derin plasental invazyon anomalisi olan ve fertiletesini/uterusunu korumak isteyen
olgularda, konservatif yönetim sezeryan histerektomiye iyi bir alternatifdir.
Anahtar Kelimeler: plasenta akreata, plasenta inkreata, konservatif yönetim
[PP-096]
Prediction of Adverse Pregnancy Outcomes with First Trimester Down Syndrome
Screening Markers
Aslıhan Yazıcıoğlu1, Mert Turğal2, Özgür Özyüncü3
1
Golbası State Hospital, Ankara, Turkey
2
Doctor Sami Ulus Training and Research Hospital, Ankara, Turkey
3
Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara,
Turkey
Objectives: Down syndrome is the most common form of non-fatal trisomy. Our aim in this study is
to investigate the relationship between certain major adverse pregnancy outcomes including
pregnancy hypertension, placenta related complications, preterm rupture of membranes, diabetic
complications of pregnancy and preterm delivery and first trimester Down syndrome screening
markers.
Methods: Patients whose Down syndrome screening tests within the scope of routine pregnancy
follow-up and delivery performed at Hacettepe University Faculty of Medicine, Department of
Obstetrics and Gynecology Outpatient Clinic, between 1 January 2002 and 31 December 2012 were
enrolled. 8394 patients who met the criteria were included.
Findings: Of those 2804 (33.4%) had first trimester Down syndrome screening test. Mean age of
these patients was 30.51 ± 4.94, mean number of pregnancies was 2.06 ± 1.31, gestational weeks
at an average of 37.81 ± 2.12 weeks and mean birth weight was 3198.61 ± 570, 64 g. Preterm
birth was identified as the most common complication (10.3%).
Conclusions: The study concluded that there is a relationship between first trimester Down
syndrome screening markers and adverse pregnancy outcomes, however the low levels of
sensitivity and specificity of these markers made us to conclude that routine screening of adverse
pregnancy outcomes with serum markers is not advisable.
Keywords: Maternal serum marker, adverse pregnancy outcome, pregnancy, Down syndrome
screening, trisomy 21
[PP-097]
Prediction of Adverse Pregnancy Outcomes with Second Trimester Down
Syndrome Screening Markers
Aslıhan Yazıcıoğlu1, Mert Turğal2, Özgür Özyüncü3
1
2
Doctor Sami Ulus Training and Research Hospital, Ankara, Turkey
3
Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara,
Turkey
Objectives: Down syndrome is the most common form of non-fatal trisomy. Our aim in this study is
to investigate the relationship between certain major adverse pregnancy outcomes including
pregnancy hypertension, placenta related complications, preterm rupture of membranes, diabetic
complications of pregnancy and preterm delivery and second trimester Down syndrome screening
markers. Methods: Patients whose Down syndrome screening tests within the scope of routine
pregnancy follow-up and delivery performed at Hacettepe University Faculty of Medicine,
Department of Obstetrics and Gynecology Outpatient Clinic, between 1 January 2002 and 31
December 2012 were enrolled. 8394 patients who met the criteria were included.
Findings: Of those 5590 (66.6%) had second trimester Down syndrome screening test. Mean age
of these patients was 29.24 ± 5.07, mean number of pregnancies was 2.22 ± 1.28, gestational
weeks at an average of 38.04 ± 10.15 weeks and mean birth weight was 3172,40 ± 578.45 g.
Preterm birth was identified as the most common complication (12.5%).
Conclusions: The study concluded that there is a relationship between second trimester Down
syndrome screening markers and adverse pregnancy outcomes, however the low levels of
sensitivity and specificity of these markers made us to conclude that routine screening of adverse
pregnancy outcomes with serum markers is not advisable.
Keywords: Maternal serum marker, adverse pregnancy outcome, pregnancy, Down syndrome
screening, trisomy 21
[PP-098]
Analysis of the Association Between Gestational Weight Gain and Substantial
Weight Retention 1-year Postpartum
Aslıhan Yazıcıoğlu1, Özge Senem Yücel Çiçek2
1
2
Kecioren Training and Research Hospital, Ankara, Turkey
Objectives: Postpartum weight retention is an important reason of obesity in reproductive age
women. This study examined the association between GWG and substantial postpartum weight
retention (SPPWR).
Methods: The participants (n = 149) in the study were healthy, mature and fed their infants whose
ages were 1, 6 and 12 months, respectively. They self-reported their socio-demographic, clinical
prenatal and behaviors via questionnaires. We collected their weight data including pre-pregnancy
and prior to delivery, as well as weight at 1, 6 and 12 months postpartum. The major outcomes
included weight gain during pregnancy and substantial weight retention 1 year postpartum.
Findings: Mean age of the participants was 28.6±8.9. The participants were mostly housewife (
71.1%), graduated from high school (36.9%). Of the 149 participants, the mean weight retention
was 3.23 kg at 12 months postpartum. GWG categories were established as follows: inadequate
weight gain (n = 7, 4.7%), adequate weight gain (n = 47, 31.5%), and excessive weight gain (n =
95, 63.8%). 49 of them (32.9%) reported substantial weight retention (>=5 kg). Substantial
weight retention was observed as more common in excessive weight gain group.
Conclusions: Excessive GWG would increase the risk of substantial weight retention 1-year
postpartum. The interventions to prevent postpartum obesity should consider the strategies how to
attain optimal maternal GWG.
Keywords: Gestational weight gain, postpartum, weight retention, pregnancy
[PP-099]
Knowledge, Attitudes and Practices Towards Family Planning Among Women in
a Secondary Referral Center
1
2
Objectives::The choice of available contraceptive methods has increased in recent years; however,
recent data on women’s awareness of methods and reasons for their method choice, is limited.The
aim of this study was to examine the use and awareness of contraceptive methods in women
admitted to secondary referral center.
Methods: Quantitative survey of sexually active ever-married women (n=250).Questions related to
demographic properties, knowledge and use of contraceptive methods, reasons for choice and for
changing methods, and sources of advice.
Findings: Mean age of the participants was 36.3±10.6.The participants were mostly housewife (
80.8%), graduated from elementary school (64.8%).There was generally good awareness of most
forms of contraception.Awareness was greatest for the intrauterine device (89.6%), and
contraceptive pill (84.4%).The most common contraceptive methods ever used were intrauterine
device (48.4%) and oral contraceptive pills (24.0%).Of the women interviewed, 23.6% were
currently using intrauterine device.Concerns about side effects (46%) and dislocation of the
intrauterine device (11.3%) were the most reported reasons for quitting contraceptives.The most
common reported side effect was menstruel irregularities (15.6%).Doctors and other health
workers have the greatest influence on women’s choice of contraceptive method (52.4%).About
76% of the women agreed that using family planning had positive advantages for health.
Conclusions: The study concluded that sexually active women are aware of a wide variety of
contraceptive methods, and knowledge and usage of the contraceptive pill intrauterine device
predominates.Changing contraception method is frequent, occurring for a variety of reasons,
including dislocation of intrauterine device and for pill users, concerns about side effects.
Keywords: Contraception, Contraceptive pill, intrauterine device, family planning
[PP-100]
Knowledge and Attitudes Towards Cervical Cancer and Associated Risk Factors
Among Women in a Secondary Referral Center
1
2
Objectives:: Cervix cancer is worldwide the second most frequent gynecologic cancer and the first
most frequent one in developing countries. The present study aims to investigate knowledge,
attitude and behavior of women admitted to a secondary referral center towards cervical cancer,
associated risk factors, HPV and prevention methods.
Methods: Quantitative survey of sexually active women (n=250). Questions related to demographic
properties, knowledge about cervical cancer, associated risk factors, HPV and prevention methods.
Findings: Mean age of the participants was 37.0±8.9. The participants were mostly housewife (
83.6%), graduated from elementary school (64.4%). Of the subjects 78.4% knew the pap-smear
test as a screening method and 61.6% underwent such investigation, while only 20.6% knew the
appropriate initiation time for this test. Association between cervix cancer and multiple sexual
partners, smoking, first sexual intercourse at an early age and HPV are known by 49.6%, 70.4%,
46.8% and 40.0% of the participants, respectively. While 50.0% of the subjects knew that HPV is
transmitted with sexual intercourse, only 15.2% knew about the appropriate genital lesion.
Although only 33.2% of all the participants knew that there is a vaccine for preventing HPV lesion,
89.6% were ready to use the vaccine.
Conclusions: The study concluded that the knowledge level of women regarding cervical cancer and
HPV was remarkably low. There is an urgent need for education.
Keywords: Cervix Cancer, HPV, Prevention, Pap-smear
[PP-101]
Olgu sunumu: Koryoamniyonit sonrası ovaryan ven trombozu
Tugba Sarac Sivrikoz, Emircan Ertürk, İbrahim Halil Kalelioğlu, Aytül Çorbacıoğlu Esmer, Recep
Has, Alkan Yıldırım, Hayri Ermiş, Lemi İbrahimoğlu, Atıl Yüksel
İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, KADIN HASTALIKLARI VE DOĞUM ANABİLİM
DALI, PERİNATOLOJİ BİLİM DALI
Ovaryan ven trombozu (OVT) gebelik veya erken postpartum dönemde görülebilen nadir ve çok
ciddi bir komplikasyondur. Trombofiliye zemin hazırlayan klinik durumların varlığında görülme
sıklığı artar. sık görülür. Klinik olarak en sık bulgusu cerrahi akut batını taklit edebilen alt kadran
ağrısı olmakla birlikte tanıda klinik şüphe en önemli basamaktır. Fetuste güven vermeyen kalp atım
paterni varlığı nedeniyle sezaryen ile doğum yapan primigravid hastanın, postpartum erken
dönemde antibiyotiklere dirençli subfebril ateş nedeniyle kontrastlı bilgisayarlı tomografi ile tetkik
edilmesi sonucu septik ovaryen ven trombozu tanısı konuldu. Nonkomplike POVT olgularında
günümüzde kabul edilen tedavi modalitesi düşük moleküler ağırlıklı heparin ve geniş spektrumlu
antibiyotiklerdir.
Anahtar Kelimeler: postpartum, sezaryen, koryoamniyonit, heparin, tromboz
BT-kontrastlı
BT kesitinde, Sağ ovaryen veni, vena kava inferiora kadar dolduran trombus izlenmektedir.
MRG
Kontrastlı batın MRG'nde, sagital planda, sağ ovaryen veni, vena kava inferiora döküldüğü
yere kadar dolduran trombüs izlenmektedir.
[PP-102]
Alt ekstremiteyi tutan arteriyovenöz malformasyona sekonder gelişen hidrops
olgusu: Klippel Trenaunay-Weber Sendromu
Tugba Sarac Sivrikoz1, Recep Has1, İbrahim Kalelioğlu1, Aytül Çorbacıoğlu Esmer1, Hülya Kayserili2,
Alkan Yıldırım1, Hayri Ermiş1, Lemi İbrahimoğlu1, Atıl Yüksel1
1
İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, KADIN HASTALIKLARI VE DOĞUM ANABİLİM
DALI, PERİNATOLOJİ BİLİM DALI
2
İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ, ÇOCUK SAĞLIĞI VE HASTALIKLARI
ANABİLİM DALI, GENETİK BİLİM DALI
Klippel Trenaunay Weber sendromu; multipl hemanjiyomlar, arteriyovenöz fistüller, ekstermite
hipertrofileri ile giden vaskülokutanöz sendromlar grubundan nadir görülen bir hastalıktır. 30.
gebelik haftasında kliniğimize fetal hidrops nedeniyle başvuran hastaya yapılan detaylı fetal
ultrasonografi değerlendirmesinde, kardiyomegali ve batında asit saptandı. Ayrıca fetusun sağ alt
ekstremitesinde, cilt-cilaltı dokusunda belirgin kalınlık artışına yol açan, renkli dopplerde
arteriyovenöz malformasyon ile uyumlu sonografik bulgular mevcuttu. Klippel Trenaunay Weber
sendromunda prenatal tanının ultrason aracılığı ile mümkün olması ve bu konuda uygun
danışmanlık verilmesi, bu hastaların postnatal dönemde olası tedavi seçeneklerinden fayda
görmesine katkı sağlayabilmektedir.
Anahtar Kelimeler: arteriyovenöz malformasyon, prenatal, hidrops
KTW
Alt ekstremitede belirgin kalınlık artışı ve renkli dopplerde düşük akımlı vasküler patern
dikkat çekmektedir.
[PP-103]
Six years incidence and some features of brachial plexus injury cases in tertiary
referral center
Meryem Eken1, Mehmet Çınar2, Enis Özkaya1, Dilşad Herkiloğlu1, Tuna Erekul1, Ateş Karateke1
1
Zeynep Kamil Educational and Research Hospital Obstetric and Gynecology Department
2
Zekai Tahir Burak Educational and Research Hospital Obstetric and Gynecology Department
Purpose: To present some features and incidence of brachial plexus injury cases in deliveries at
Department of obstetrics and Gynecology of the Zeynep Kamil Maternity and Children's Training
and Research Hospital, from January 2010 to December 2015.
Methods: Totally 38.896 deliveries at Department of Obstetrics and Gynecology of the Zeynep
Kamil Maternity and Children's Training and Research Hospital, from January 2010 to December
2015 were screened from prospectively collected database. Gravidity, parity, body mass index,
maternal diabetes, labor induction, gestational age at delivery, operative deliveries,
malpresentations, prolonged second stage of deliveries, shoulder distocies, clavicle, humerus
fructures, estimated fetal weight, biparietal diameter, abdominal circumference, femur length, fetal
sex, route of delivery, maternal age and fetal anomalies were all recorded.
Results: There were 29 (75/100000) cases of brahial plexus injury cases among 38896 deliveries,
18363 of them delivered via c-section whereas 20533 cases via vaginal route in 6 years period.
Conclusion: Sonographic fetal weight estimation, clinical examination, performed by experienced
obstetricians and active appropriate management of shoulder distocias seem to attenuate the
incidence of brachial plexus injury in risky population at tertiary referral center.
Keywords: Neonatal brachial plexus injury, Shoulder dystocia, Incidence
[PP-104]
Spinal Muskuler Atrofinin Prenatal Tanısı: Bir Olgu Sunumu
Deniz Kulaksız, Mehmet Armağan Osmanağaoğlu, Turhan Aran
Karadeniz Teknik Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Trabzon
GİRİŞ: Spinal Muskuler Atrofi (SMA) spinal kordun anterior boynuzundaki motor nöronların
dejenerasyonundan kaynaklı otozomal resesif, ekstremite ve gövdenin ilerleyici simetrik paralizisi,
muskuler atrofi ve jeneralize hipotoni ile karakterize bir hastalıktır.
Olgu: 26 yaşında, G:3 olarak ilk trimesterde başvurdu. Birinci dereceden akraba evliliği olup ilk iki
bebeği yaşamıyordu. Birinci bebeğe primipar makat tanısı ile sezaryen uygulandığı, canlı bir kız
bebek doğurtulduğu, doğum sonrası bebeğin ellerinde kollarında güçsüzlük ve haraketsizlik şikayeti
olduğu, EMG de yaygın myopati sendromu ile birlikte motor lifleri etkilemiş bir nöropati rapor
edildiği, kas biyopsisinin yetersiz materyal olarak rapor edildiği, genetik inceleme yapılmadığı ve
bebeğin 13 aylıkken pnömoni ve sepsis tanısı ile ex olduğu öğrenildi. İkinci gebeliğinde gebeliğin
12. haftasında ense kalınlığının 7mm ölçüldüğü, multiple fetal anomali tespit edilip gebelik
terminasyonu önerildiği, ailenin terminasyonu kabul etmediği ve ikinci gebeliğinde miadında C/S ile
sonlandırıldığı ve bebeğin doğar doğmaz öldüğü, bebekte hidrosefali ve meningomyelosel olduğu
öğrenildi. Babanın kız kardeşinin ikiz kız çocuklarında benzer bir kas hastalığı öyküsü alındı.
Elde edilen raporlarında ön tanı SMA olup DNA analizinde telomerik SMN geninde ekson 7, ekson 8
homozigot delesyonu ve NAIP geninde ekson 5, ekson 6 homozigot delesyonu olduğu görüldü.
Amniyosentez yapılması önerildi, sonucunda; telomerik SMN geni ekson 7-8 ve NAIP geni ekson 56 homozigot delesyonu rapor edildi. Ailenin isteği ve etik kurul onayı ile 23. gebelik haftasında tıbbi
indüksiyon uygulanarak gebeliği sonlandırıldı.
Sonuç: akraba evliliğinin sık görüldüğü toplumumuzda hastalar genel olarak bilinçsiz ve genetik
danışmanlık almamış olduğundan, genetik geçişli hastalıklar açısından daha dikkatli olmamız
gerekmektedir.
Anahtar Kelimeler: Spinal Muskuler Atrofi, Prenatal tanı, Akraba evliliği
[PP-105]
Pregnancy Outcome of Women With Epilepsy: A Retrospective Analysis of 12
years
Esra Nuhoğlu, Mert Turğal, Dila Kasapoğlu, Emine Aydın, Mehmet Sinan Beksaç
Hacettepe University Faculty of Medicine Obstetrics and Gynegology
Aim: The prevalence of epilepsy in pregnant women ranges between 0.2-0.4 %. Fetal and obstetric
complications related with epilepsy are higher than pregnancies without epilepsy. Evaluation and
management of them varies in different centers. In this study, we aimed to describe the outcome
of pregnancy in women with epilepsy in Hacettepe University.
Material-Methods: We scanned all of the birth records pregnancies between December 2002 and
January 2014 at Hacettepe Universty Departmant of Obstetrics. We examined patients’ files who
had epilepsy and excluded the patients who are not fully followed at our institute during pregnancy.
At the end 114 pregnant women with epilepsy (PWWE) were included the study. Patients’
demographics, gestational week, birth weight, type of delivery, APGAR scores (1st and 5th min.)
and pregnancy outcome were described.
Results: Mean maternal age was 29 (±5) years. We found that the mean gestational age at
delivery were 37.5 weeks (263 days±15days). And mean birth weight was 2922gr (±641gr).
70.2% of these patients delivered with c-section. Percentage of 1st min. APGAR scores less than 7
was %0.02, and 5th min APGAR score less than 7 was 0.01%.
Conclusion: According to our findings mean gestational age was not in preterm range. Birthweight
was well-matched with the gestational week. The high proportion of c-section delivery was
attributed to the management of high risk population. As a result this study is an example of well
established perinatal care.
Keywords: epilepsy, pregnancy, outcome
[PP-106]
Cantrell pentalojisine eşlik eden akrani olgusunun erken tanısı: Olgu sunumu
Tuncay Yüce, Seda Şahin Aker, Doruk Cevdi Katlan, Acar Koç
Ankara Üniversitesi Tıp fakültesi Kadın Hastalıkları ve Doğum Ana Bilim Dalı,Ankara
Cantrell pentalojisi 1958 yılında Cantrell ve arkadaşları tarafından tanımlanmıştır. Cantrell-HallerRayitsch Sendromu olarak da adlandrılmaktadır. Pentalojiyi supraumblikal karın ön yüzü defekti,
kardiyak anomaliler, sternum alt uç defekti, diafragmanın anterior kısmında yetmezlik ve
diafragmatik perikard yokluğu oluşturur. Cantrell sendromu oldukça nadir görülür. 1/650001/200000 doğumda rastlanmaktadır.
37 yaşında üçüncü gebeliği olan hasta kliniğimize gebeliğin 11.haftasında başvurdu. Birinci
trimester taraması esnasında kranial kemiklerin olmadığı ve fetal kalp, karaciğer, barsaklar,
mesane fetal batının dışında izlendi.(Resim1) Hastaya gebeliğin terminasyonu önerildi ve gebeliği
sonlandırıldı. Makroskopik görünümde bulgular doğrulandı (Resim 2).
Cantrell pentalojisi nadir görülen ağır bir konjenital anomalidir. Cantrell pentalojisinde olgular çoğu
zaman sporadik olmakla birlikte ventral orta hat gelişim bozukluklarında X geçişli kalıtımdan
bahsedilmektedir ve bazı vakalar trizomi 18 ile ilişkilendirilmiştir. Cantrell Pentalojisinin ayrıcı
tanısında amniyotik bant sendromu, limb body wall defekt, izole ekstrofia kordis, basit omfalosel
akılda tutulmalıdır.Cantrell Pentalojisinin prenatal tanısı artık ilk trimesterde bile konabilmektedir.
Bu dönemde görülen ekstropia kordis ve omfalosel birlikteliği, Cantrell Pentalojisini akıla
getirmelidir. Bizim vakamızda Cantrell Penatalojisine eşlik eden akrani mevcuttu. Bu durumda çok
nadir görülen bir durumdur. Tanı durumunda, aileye prognoz ile ilgili bilgi verme ve terminasyon
seçeneğini konuşmak yönetimin belirlenmesinde önemli rol oynar.
Anahtar Kelimeler: akrani, cantrell pentalojisi, ektrofia kordis
Cantrell pentalojisi makroskopik görünümü
Cantrell pentalojisi USG
[PP-107]
Üreterosel olgusunun prenatal tanısı: Olgu sunumu
Tuncay Yüce, Seda Şahin Aker, Erkan Kalafat, Acar Koç
Üreterosel intravezikal submukozal üreterin kistik dilatasyonudur. Üreterosel'in insidansına
bakıldığında 1/500 'dür. Beyazlarda daha sık ve kadınlarda 4-6 kat daha sık görülmektedir.
Olgumuz 35 yaşında G3 P2’dir. Gebeliğin 24. Haftada yapilan ayrıntılı ultrasonografide sol böbrekte
çift toplayıcı sistem ve üreterosel saptanması üzerine kliniğimize başvurdu. Perinatolojik
incelemede sol böbrekte çift toplayıcı sistem, kistik displazi ve üreteroseli olan kız fetus izlendi.
Hastanın takiplerinde yapılan değerlendirmede fetal gelişimin gebelik haftasına göre geri kalması
nedeniyle (SGA) hasta 39. gebelik haftasında doğum indüksiyonu uygulandı. İndüksiyon esnasında
geç deselarasyonları olaması üzerine sezeryan ile 2190 gr APGAR 1.dakika 9, 5. dakika 10 ile kız
bebek doğurtuldu. Doğumda fizik muayenesi normal olan yenidoğanın neonatal dönemde renal
ultrasonografi yapıldı ve sol böbrekte obstrükte duplikasyon, kistik displazi ve mesane lümenine
protrüze üreterosel saptandi. Sistoskopi ile doğrulanan üreterosele çocuk cerrahisi eksizyon
planladı. Akut pyelonefrit atağı geciren hastaya antibiyotik tedavisi baslandı takiben üreterosel
eksizyonu planlandı.
Üreteroselin prenatal tanısının konması önemlidir. Bizim hastamızda bile prenatal tanının erken
konmasına ragmen postpartum dönem takiplerde bebekte 2 defa pyelonefrit atağı olmuştur.
Geçirilen her pyelonefrit yenidoğan ve çocukluk döneminde renal hasara neden olmakatadır. Uzun
dönemde böbrek yetmezliği açısından risk oluşturmaktadır. Özellikle prenatal tanısı olmayan
yenidoğanlarda erken tanı olmaması nedeniyle bu duruma daha fazla maruz kalabileceğini
düşünmekteyiz.
Anahtar Kelimeler: antenatal tanı, renal duplikasyon, üreterosel
üreterosel
[PP-108]
Meckel-Gruber Sendromu: Olgu Sunumu
Zehra Yılmaz, Gülenay Gençosmanoğlu Türkmen, Özgür Kara, Cem Sanhal, Turhan Çağlar, Dilek
Uygur
Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi,Ankara
Meckel-Gruber sendromu (MGS) otozomal resesif geçişli nadir bir hastalıktır. MGS insidansı
değişken olup 3000 ile 140.000 doğumda bir görüldüğü bildirilmiştir. Klasik triadı renal displazi,
ensefolosel ve postaksial polidaktilidir.Kesin tanı için bu bulgulardan ikisi bulunmalıdır. Bunun
dışında mikrosefali, serebral ve serebellar hipoplazi, yarık damak, ambigious genitalia,
kriptorşidizm, karaciğerde duktal malformasyon gibi eşlik eden diğer malformasyonlar da
görülebilir.Moleküler genetik incelemeler ile 6 ayrı MKS lokusu tanımlanmıştır. Biz de kliniğimizde
ensefolosel ve bileteral polikistik böbrek saptadığımız ve MGS ön tanısı ile terminasyon
planladığımız olguyu sunmayı amaçladık.
24 yaşında G4P3, SAT’a göre 24 haftalık gebeliği olan hasta rutin kontrol amaçlı polikliniğimize
başvurdu. Hasta gebeliğinde sadece bir kez 8.haftada kontrole gelmişti.Yapılan ultrasonografide
BPD 19 hafta ile uyumlu, AC 25 hafta ile uyumlu, FL 23 hafta ile uyumlu idi. Obstetrik
ultrasonografide posterior ensefolosel, biletaral polikistik böbrek ve anhidramnios saptandı.
Hastada eşiyle akrabalık öyküsü yoktu.Hastaya Meckel Gruber Sendromu ön tanısı ile terminasyon
önerildi.
MGS %25 tekrarlama riski olan, yaşamla bağdaşmayan nadir bir sendromdur. Antenatal olarak
vaginal ultrasonografi ile gebeliğin 11-12. Haftası kadar erken bir dönemde tanı koymak
mümkündür. Daha önceki gebeliklerinde malformasyonlu bebek öyküsü olan ve risk altında olduğu
bilinen ailelerde bu inceleme özellikle önemlidir. Olgumuz takipsiz gebelik olduğundan erken
prenatal tanısı mümkün olmamıştır. Sonuç olarak; Meckel-Gruber sendromunun tekrarlama riskinin
yüksek olması ve çoğunlukla ölümcül seyretmesi nedeniyle, ailenin çocuk sahibi olmak istemesi
durumunda diğer gebeliklerinde mutlak surette yakın takip edilmesi ve gebelik öncesinde genetik
danışmanlık almaları gerekmektedir.
Anahtar Kelimeler: Meckel-Gruber Sendromu, Ensefolosel, Polikistik Böbrek
Ensefalosel
polikistik böbrek
[PP-109]
Iron Status in First Trimester Pregnancies
Deniz Karçaaltıncaba, Melis Altuğ, Fırat Büyüktaşkın, Murat Aykut Özek, Onur Karabacak, Merih
Bayram
Gazi University, Department of Obstetrics and Gynecology
Iron deficiency is thought to be the most common nutrient deficiency among pregnant women
(1).It is the most common cause of anemia during pregnancy. Anemia is defined as hemoglobin of
<11 g/dL in the first trimester and ferritin levels of <12 μg/L is consistent with iron depletion
(2).Iron deficiency anemia during pregnancy has been associated with an increased risk of low
birth weight, preterm delivery, and perinatal mortality.It is recommended that pregnant women
should be screened for anemia at first prenatal visit (3).The purpose of this study was to
investigate the status of iron in first trimester pregnancies. Ferritin and hemoglobin levels were
measured at first antenatal visit among 166 healthy pregnant women.Anemia rate was 4,8%
(n=8).All the patients had iron deficiency anemia,only one patient had both iron and B12 deficiency
anemia. All the anemic patients had mild anemia with hemoglobin level of 9-11 g/dL. Among nonanemic pregnants, 15,1% had iron depletion (ferritin <12 μg/L). 47,9% had ferritin levels between
12-30 μg/L, 27,8% had ferritin levels between 30-70 μg/L and only 6,8% of cases had ferritin
levels above 70 μg/L (table 1).Ferritin levels of <=30 μg/L, is accepted as an unfavourable iron
status with respect to upcoming pregnancy and ferritin of >70 μg/L accepted as adequate iron
reserves and they can carry through pregnancy without developing IDA even though they do not
take iron supplements. Our study showed that,63 % of our pregnant population has inadequate
iron reserve and they may need iron replacement to prevent anemia during pregnancy.
Keywords: deficiency, iron, pregnancy
• Table 1. Ferritin levels at first antenatal visit.
Serum Ferritin Levels
n
%
<12 μg/L
22
15,1
12-30 μg/L 70
47,9
30-70 μg/L 44
27,8
>=70 μg/L 10
6,8
Total
100
146
[PP-110]
Levels of Vitamin D in Early Pregnancy
Deniz Karçaaltıncaba, Murat Aykut Özek, Melis Altuğ, Fırat Büyüktaşkın, Onur Karabacak, Merih
Bayram
Vitamin D has impact on immune regulation and inflammatory processes during implantation and
placental development.The latest studies concerning vitamin D status of Turkish pregnant women
revealed high incidences of vitamin D deficiency reaching 82% in different regions. In this study,
we aimed to reveal the levels of vitamin D in early pregnancy.Levels of vitamin D were tested
among 148 healthy pregnant women whom admitted to their first prenatal visit (< 12 weeks of
gestation).Patients were classified as “deficient” if serum 25(OH)D level was between 10-20 ng/ml,
and as “severe deficiency” if below 10 ng/ml. Levels above 20 ng/ml were considered to be normal.
Among those 148 pregnant women; only 50 (33,8 %) had normal levels. 89 cases (60,1 %) had
vitamin D deficiency and 9 cases (6,1 %) were diagnosed with severe deficiency (Table 1).Vitamin
D deficiency is a common health problem among Turkish pregnant women.Our findings are
compatible with the results of previous studies performed in Turkish population.Vitamin D
deficiency has been associated with various pregnancy complications including preeclampsia,
gestational diabetes mellitus, increased risk of delivering fetus small for gestational age, and
preterm birth. That said, it is controversial that supplementation of vitamin D could prevent them.
There is need for more studies concerning those issues. Besides, routine screening of all pregnant
women has not been recommended yet. But in populations at high risk for vitamin D deficiency,
screening may prove beneficial. Daily doses of 1000 to 2000 IU vitamin D is recommended when
deficiency is diagnosed during pregnancy.
Keywords: pregnancy, vitamin D
Distribution of 25 (OH) Vit D Levels
Serum 25(OH) Vit D Levels
< 10 ng/dl
n
%
9
6,1
10-20 ng/ml 89
61
>20 ng/dl
50
33,8
Total
148
100
[PP-111]
Cobalamin and Folate Deficiency During Early Pregnancy
Deniz Karçaaltıncaba, Murat Aykut Özek, Fırat Büyüktaşkın, Melis Altuğ, Onur Karabacak, Merih
Bayram
Because pregnancy is a state of rapid cell growth and differentiation, there is an incresed
physiological need for cobalamin and folate intake. Both cobalamin and folate are essential for fetal
growth and development. Overt deficiency of cobalamin is associated with various complications
including megaloblastic anemia, hyperhomocysteinemia, nerological impairment in both the mother
and fetus, and also neural tube defects. On the other hand, folate deficiency is associated with
neural tube defects, conotruncal defects, cleft lip/palate in fetus.
In this study, we aimed to define cobalamin and folate status of healthy pregnant women at their
first antenatal visit (< 12 weeks of gestation on admission). Cobalamin and folate levels were
measured at first antenatal visit among 159 healthy pregnant women. 13 (8,1 %) cases had
cobalamin deficiency (vit B12 level < 191 pmol/L) and 14 (%8,2) cases were shown to be folate
deficient (folate level < 4,6 ng/ml)(Table 1).Cobalamin and folate deficiency is a common problem
in our cases. The results of our study is consistent with previous reports performed among Turkish
pregnant women. We are in opinion that food fortification and/or supplementation programs should
be considered in order to prevent vitamin B12 and folate deficiencies [6]. Prenatal screening of all
pregnant women has not proven to be effective, but in regions with high incidence of deficiency, it
may be reasonable to do so.
Keywords: cobalamin, folate, pregnancy
Cobalamin and folate levels of cases at the first prenatal visit
Serum Cobalamin Levels
Serum Folate Levels
< 191 pmol/L
n
%
13
8,1
< 4,6 ng/ml
n
%
14
8,8
191-663 pmol/L 146
91,9 4,6-18,7 ng/ml 145
91,2
Total
100
100
159
159
[PP-112]
Subclinical Hypothyroidism in Early Pregnancy
Murat Aykut Özek, Deniz Karçaaltıncaba, Melis Altuğ, Fırat Büyüktaşkın, Merih Bayram
Subclinical hypothyroidism is defined as increased TSH level accompanying normal levels of
thyroxine. Although the ranges vary among different regions, guidelines recommend that the
normal range for thyrotropin in first trimester of pregnancy to be between 0,1-2,5 mIU/L [1, 2].
This condition is more common than clinical hypothyroidism with reported incidences reaching and
above 15 % [3-6]. Subclinical hypothyroidism has been associated with pregnancy loss, preterm
birth, gestational diabetes, and impaired neurologic/intellectual development in the offspring [7].
In their randomised controlled trial; Negro et al (2010) revealed that treatment of subclinical
hypothyroidism reduced those maternal and fetal adverse outcomes [8].
In this study, we aimed to assess the thyroid status of pregnant women admitting to our clinic at
their first prenatal visit (< 12 weeks of gestation). Thyrotropin and free thyroxine levels were
measured at first antenatal visit among 152 healthy pregnant women. 42 (27,6 %) cases had
subclinical hypothyroidism (TSH>2,5 mIU/L with normal thyroxine levels)(Table 1).We are in
opinion that, when compared with previous studies, our patient population has a significantly
higher frequency of subclinical hypothyroidism. This could be due to the serious ongoing problem of
low dietary iodine intake. More studies with larger sample sizes needed to enlighten the magnitude
of subclinical hypothyroidism during pregnancy in Turkey.
Keywords: hypothyroidism, pregnancy
Table 1. TSH levels of cases at the first prenatal visit
Serum TSH Levels
n
%
< 2,5 mIU/L 110
72,4
>2,5 mIU/L 42
27,6
Total
100
152
[PP-113]
Plasental koryoanjiom: Olgu sunumu
Seda Şahin Aker, Dilek Acar, Tuncay Yüce, Acar Koç
Koryoanjiomlar plasental dokudan köken alan non-trofoblastik tümörlerin en sık görülenidir.Sıklıkla
boyutları küçük olmakla birlikte dikkatli ultrason incelemesinde saptanırlar.
Olgumuz 19 yaşında ve ilk gebeliği olan, 7 5/7 haftasında başvuran bir hastadır. Obstetrik
hikayesinde bir özellik yoktu.12. haftada yapılan 2’li tarama testi normal olarak izlendi. 18.haftada
yapılan 4’lü tarama testinde AFP MoM:2,41 olarak gelen hastanın açık spina bifida riski 1:149
olarak geldi. 19. haftada yapılan detaylı USG incelemesinde bilateral koroid pleksus kisti ve
plasenta üst yarıda orta hattın hemen solunda lokalize 4X2,5 cm boyutunda plasental koryoanjiom
ile uyumlu hipoekoik kitle lezyonu ve RDUS kontrolünde hipervasküler karakterde içerisinde
arteryal vasküler oluşumlar izlenmiş olup yapılan ölçülerde RI: 0,51 izlenmiştir. Takipte 24.haftada
yapılan kontrol USG’de lezyon boyutu 7,2X5,3 cm ölçülmüştür. Takiplerde koryonajiom boyutunda
büyüme izlenmemiştir. Fetal biyometri haftasıyla uyumlu seyretmiştir. Yapılan fetal doppler
incelemeleri normal olarak izlenmiştir. 35. haftada tansiyon yüksekliği tespit edilen hastanın bakılan
spot idrar protein 100 mg olarak gelmiş 24 saatlik proteinuria ise 700 mg olarak gelmiştir. Gebelik
takibinde hastanın 38 2/7 haftasında yapılan USG'de oligohidroamniyoz saptanması üzerine
indüksiyon başlanmış olup hasta normal vajinal yolla 3260 gr APGAR 9/10 erkek bebek
doğurmuştur. Postpartum plasenta patolojisi koryoanjioma olarak raporlanmıştır.
Koryoanjiomlar plasental hemanjiomlardır ve non-trofoblastik tümörlerin en sık görülenidir.
İnsidansı tüm doğumlarda %1 dir. Koryoanjıomların bir çoğunun boyutu küçüktür ve genellikle
doğumdan sonra plasentanın dikkatli olarak kesitleri incelendiğinde izlenebilir.Nadir vakalarda
birkaç mm den 10 cm yada daha büyük olan boyutları izlenmiştir.Geniş koryoanjiomlar 4cm den
büyük olarak tanımlanırlar klinik olarak önemli komplikasyonlara yol açabilirler. Koryoanjiomla
ilişkili gebelik komplikasyonları polihidramnios, oligohidramnios, preeklampsi,IUGR,preterm
doğum,ablasyo plasentadır.
Anahtar Kelimeler: koryoanjiom, oligohidroamnioz, plasenta, preeklampsi
Plasental koryoanjiom
[PP-114]
Gebelikte sistosel ile karışan Gartner kisti: Olgu sunumu
Betül Yakıştıran, Tuncay Yüce, Cem Somer Atabekoğlu
Vajinal kistler gerçek sıklığı tahmin edilememekle beraber yaklaşık 1/200 oranında görülmektedir.
Embriyolojik gelişimin sekizinci haftasında Mülleryan kanaldan uterus, serviks ve vajen üst 1/3 ü
gelişmektedir. Wolfian kanal dişi cinste regrese olur ve kalıntılarından Gartner kanalı, epoöforon,
paraöforon oluşabilir. Glanduler epitelin kalıcı sekresyonları kistik dilatasyona ve sonrasında
Gartner kanal kisti oluşmasına neden olmaktadır. Birçoğu asemptomatik ve benign niteliktedir ve
cerrahi eksizyon gerektirmez. Jinekolojik veya ürolojik muayene esnasında insidental olarak tanı
alırlar. Semptomatik olduğunda hastalar vajinal dolgunluk, baskı hissi, ağrı, disparoni ya da üriner
inkontinans tarifleyebilirler. Vajinal kistler genel olarak üçüncü ve dördüncü dekatta tanı alırlar
nadiren de prepubertal kız çocuklarında ve gebelikte saptanabilir.
Olgumuz 40 yaşında ve ilk gebeliği olan bir hastadır. Gebeliğin 25.haftasında vajende ele gelen
kitle nedeniyle başvurmuştur. Ilk değerlendirmede bunun kistik bir oluşum olduğu ve vajen sol yan
duvarından kaynaklandığı tespit edildi. Servikal uzunluğu normaldi. Hasta takibe alındı. 29.haftada
kist spontan rüptüre oldu. Kçüldü. Ancak takiplerde tekrar kisti tekrar büyüyerek 36X25 cm’e kadar
büyüdü. 39.gebelik haftasına kadar takibi yapılan hasta sezeryan ile doğurtuldu.
Kadınlarda vajende şişlik şikayeti ile başvuruda ilk olarak fizik muayene ile değerlendirmek gerekir.
Ayırıcı tanıda başta malignite olmak üzere daha sık gördüğümüz sistosel, enterosel, rektosel,
vajinal abse ve kistler açısından dikkatli değerlendirme yapılmalıdır. Biz de hastamızı
değerlendirirken gebe olması nedeniyle ilk olarak erken doğum açısından değerlendirdik ve daha
sonra diğer ayırıcı tanıları düşündük. Gebelikle birlikte Gartner kisti bulunması doğum yolu
problemlerine neden olabilir. Bu hastalarda kist aspirasyonu yapılarak vajinal doğum denenebilir.
Anahtar Kelimeler: gebelik, Gartner kisti, sistosel
Gartner kistinin ultrasonografik görüntüsü
Makroskopik görünümü
[PP-115]
Maternal mortality cases from pulmonary embolism;a nation-wide study from
Turkey
Sema Sanisoğlu, Dilek Uygur, Bekir Keskinkılıç, Yaprak Engin Üstün, Hüseyin Levent Keskin, Selma
Karaahmetoğlu, Ayşe Özcan, Meral Esen, Veli Ongun, Seçil Özkan
Turkish Public Health Agency, Preliminary Investigation Committee for Maternal Deaths,
Government of Health, Ankara, Turkey
Objective
We aimed to report the maternal mortality cases attributed to pulmonary embolism in Turkey, to
evaluate the associated risk factors, to consider whether these maternal deaths were preventable
or not.
Methods
In this retrospective study, case files of all maternal deaths recorded between January 1, 2013 and
December 31, 2013 in Turkey were reviewed.
The data obtained from the medical records included maternal age, parity, prepregnancy body
mass index, gestational age, pregnancy related conditions, delivery mode, timing of diagnosis of
pulmonary embolism, clinical course, treatment and maternal outcome.
Results
Seventeen cases of maternal deaths attributed to PE occurred during this period. Pulmonary
embolism occurred in postpartum period after cesarean delivery in 9 (52.9%) patients. Risk factors
for pulmonary thromboembolism were present in 15 (88.2%) of the women. The mean BMI of
women before pregnancy were 29,89 ±7,89. Five women (29.4%) were overweight, and two
(11.7%) were obese and 3 (17.6%) were morbidly obese. Four women (23.5%) had cardiac
diseases. Eleven (64.7%) of the maternal deaths due to pulmonary embolism were recognized as
preventable.
Conclusion
Maternal deaths attributed to PE occurs more in postpartum period, mostly preventable and
cesarean section, obesity and cardiac diseases was important risk factors.
Keywords: Maternal mortality, pulmonary embolism, venous thromboembolism, risk factors,
Turkey
[PP-116]
IVF gebeliğinde ilk trimesterde over torsiyonu: vaka takdimi
Seda Şahin Aker, Tuncay Yüce, Erkan Kalafat, Batuhan Özmen
Over torsiyonu, overin kendi vasküler ekseni veya pedikül etrafında adneksin tamamen veya
kısmen rotasyonudur. Gebelikte, over torsiyonu riski % 13,7-25 arasında bildirilmektedir.
gebelikteki over torsiyonlarının %75’i ilk trimesterde görülmektedir ve bunların %30’unda overyan
teratom görülmektedir. Akut batın gibi semptomlar olabileceği gibi non-spesifik bulgularla da klinik
prezentasyon görülebilir. Tanının atlanması overyan nekroz, sepsis ve gebelik kaybına neden
olabilmektedir.
Olgu: 31 yaşında G1 P0 12 hafta IVF gebeliği şiddetli sağ alt kadran ağrısı,gaz gayta çıkaramama
nedeniyle başvurdu. Fizik muayenede sağ alt kadranda defans(+), rebound(+) idi. Laboratuar
incelemesinde Hb: 10 g/dl,beyaz küresi 9400/ µL idi.Yapılan ultrasonografide sağ over boyutlarında
artış ve kanlanma olmaması üzerine hastaya laparoskopi ile sağ overian detorsiyon yapıldı.
Detorsiyon sonrası overyan kanlanma izlenen hasta postoperatif 3. gününde şifa ile taburcu edildi.
Gebelikte adneksiyal kitlelerin görülme oranı 1/81 ile 1/8000 arasında olup, gebelikte görülen bu
kitlelerin toplam malignite riski ise % 1-8 dir. Overyan torsiyon riski yardımcı üreme teknikleri
kullanılarak gebelik elde edilen hastalarda overin boyutlarındaki artış nedeniyle artmaktadır ve
gebelikte en sık 10 ve 17. haftalar arasında rastlanmaktadır. Over torsiyonu tanısında
ultrasonografi ve doppler en çok kullanılan methoddur. Doppler ultrasonografide overyan kan
akımının izlenmemesi tanıyı desteklemektedir. Tedavide özellikle birinci ve ikinci trimesterde
laparoskopik overyan detorsiyon ve/veya overiopeksi konservatif olarak uygulanabilir. Gebelikte
overyan kitlelerin basit görünümde dahi olsa gebeliği torsiyon ile komplike edebileceği
unutulmamalı ve 6-8 cm üzerindeki kistlerin torsiyon riski göz ardı edilmemelidir.
Anahtar Kelimeler: gebelik, ilk trimester, overyan torsiyon
intraoperatif laparoskopik görüntü
Sağ overin postoperatif Doppler görünümü
Sağ overin preoperatif görünümü
[PP-117]
Evaluation of the risk factors and the results of preventive measures for
preterm delivery in singleton pregnancies
Cagri Gülümser, Cagla Kocberber, Deniz Serim Korkmaz, Irmak Tahmaz, Irem Hazal Toroslu, Elif
Unal, Nihal Sahin Uysal, Filiz Bilgin Yanik
Baskent University School of Medicine, Department of Obstetrics & Gynecology Ankara - TURKEY
Objective: To assess the risk factors and the preventive measures(PM)associated with preterm
delivery(PTD) in singleton pregnancies.
Method: Between 2013-2014 at Başkent University Ankara Hospital singleton pregnancies with or
without PTD risk factors constituted the study(n=557) and control(n=896) groups. The study group
was subdivided according to the PTD risk factors and the subgroups were evaluated with respect to
the PM against PTD
Results: PTD rates were 15.8% and 6.3% in the study and control groups(p<0,05). The most
common risk factors in the study group were advanced maternal age(AMA) (74.5%), in-vitrofertilization(IVF) pregnancy(29.4%) and placenta previa(3.9%). PM used were progesterone
(%7.5),tocolytic agents(%3.8),cervical cerclage(%1.8) and cervical pessary(%0.9).PTD rate of the
group with AMA as the only risk factor, was not significantly different from that of the
control(p>0,05); whereas it was significantly higher in the group with IVF pregnancy as the only
risk factor(12.5%, p<0,05).Cases with the history of late abortion/PTD and with short cervix had
all received PM, but still had significantly higher PTD rates compared to the control group (55.6%
and 56.3%, p<0,05).
Conclusions: PTD rate was significantly higher among the singleton pregnancies with PTD risk
factors. IVF pregnancy was a risk factor for PTD by itself. History of late abortion/PTD and short
cervix are known to be the most important risk factors for PTD. Although all of the pregnant
women with those risk factors have used PM against PTD, the PTD rates were still significantly
higher compared to the control group. These PM might not completely prevent PTD but perhaps
delay it.
Keywords: Pessary, cervical cerclage, preterm delivery, preterm bith, risk factors
[PP-118]
Agenesis of the Ductus Venosus- A case with Noonan Syndrome
Oya Demirci, Taner Yavuz, Resul Arısoy, Oya Pekin, Hicran Acar, Hatip Aydın, Arda Çetinkaya, Ali
Karaman, Emre Erdoğdu, Pınar Kumru
Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi
A 39-years-old women, gravida 2, para 1 was referred to our center for evaluation of cardiomegaly
at the 22th gestational week. In the echocardiographic examination, the four-chamber view
revealed moderate cardiomegaly, increased left cardiac axis and small pericardial effusion. We cant
visualize the umbilical vein and ductus venosus in their usual location. We demonstrated agenesis
of venous duct with extrahepatic shunt from umbilical vein (UV) to the right internal iliac vein.
There was a dilatation of iliac vein and the whole inferior vena cava. We did not find cardiac and
extracardiac anomalies without agenesis of venous duct. Also, we found polyhydramnios. The
parents did not agree to undergo chromosomal analysis. We followed patients for possible fetal
hearth failure every two or three weeks. At 34th week dysplastic pulmonary valve and mild
pulmonary stenoses was found. After this findings and suspicious maternal facial apperance, we
have received genetic counseling for the parents because the considering that Noonan syndrome.
The molecular genetic testing for PTPN11 gene mutation, typical for Noonan Syndrome, was
determined in mother. The baby was delivered at 36th week of pregnancy because of spontan
labor. A 2425 gram male infant was born by ceserean section due to fetal malpresentation.
Postnatal confirmation of ductus venosus agenesis and abnormal course of umbilical vein was done
with the umbilical vein cannulation and the path of the agitated saline showen by the ultrasound
simultaneously. The same mutation of Noonan syndrome in the mother was detected in the baby
postnatally.
Keywords: agenesis of ductus venosus, Noonan syndrome
[PP-119]
Fetal goiter caused by maternal antithyroid therapy can be resolved with
decreasing propylthiouracil dose
And Yavuz, Mehmet Özgür Akkurt
Süleyman Demirel Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Ana Bilim Dalı Isparta
Objective: We report a fetal goiter, which was diagnosed by detailed sonography.
Case: 33 year old woman, gestational age of 20 weeks was referred to our hospital for detailed
ultrasonography. A fetal goiter was identified (Figure 1, 2). She was receiving propylthiouracil
(PTU) 100 mg daily for Graves’ disease. Amniocentesis was performed and fetal thyroid function is
evaluated as normal. Her recent thyroid function tests were normal but anti-thyroid antibodies
were positive. The dose of PTU was reduced to 50 mg. However, at 26 weeks of gestation,
maternal thyroid-related autoantibodies became undetectable. A fetal magnetic resonance imaging
(MRI) demonstrated a slight shrinkage of the fetal goiter at 30 weeks (Figure 3). The fetus was
delivered vaginally. Thyroid function tests of the neonate were normal, and neonatal goiter was
nonpalpable.
Conclusion: Fetal goiter is a rare disease. It can be spontaneously resolved by decreasing the
maternal dose of PTU.
Keywords: fetal goitre, Graves’, propylthiouracil, thyrotoxicosis
Figure 1.
Homogeneously, symmetric, bilobular fetal goiter viewed at the 20th week of gestation.
Figure 2.
Figure 2: Enlarged thyroid gland (1.67x1.45x2.15 cm) images at sagittal plane.
Figure 3.
Figure 3: Fetal MRI demonstrated slight shrinkage of the goiter after the treatment.
[PP-120]
In Vitro Fertilizasyon (IVF) ve Spontan İkiz Gebeliklerin Maternal ve Neonatal
Sonuçlarının Karşılaştırılması
Merve Ozturk, Melis Altuğ, Merih Bayram, Aykut Özek, Mine Dağğez
Gazi Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Ankara
Amaç: Yardımcı üreme teknikleri ile elde edilen gebeliklerin %20 sinden fazlası çoğul gebelik ile
sonuçlanmaktadır. Ikiz gebeliklerde maternal komplikasyon daha sık rastlanmasına ek olarak,
yardımcı üreme tekniği ile elde edilen ikiz gebeliklerin, spontan ikiz gebeliklere göre daha yüksek
obstetrik risk taşıdığı hala tartışmalı bir konudur.
Materyal-metod: Aralık 2014 - Mart 2015 tarihleri arasında kliniğimizde 28. gebelik haftasından
sonra doğum yapan 17 tane IVF, 17 tane spontan olmak üzere toplam 34 ikiz gebelik çalışmaya
dahil edildi.
Sonuç: IVF ikiz gebeliklerin %6 sı, spontan gebeliklerin %24’ü 35 yaşından büyüktü. IVF
gebeliklerinin %82 si, spontan ikiz gebelerin %52 pirimipardı. Preterm doğum IVF gebeliklerin %82
sinde meydana gelirken, spontan ikiz gebeliklerde preterm doğum oranı % 42 idi. Yüksek preterm
doğum oranlarına bağlı olarak, IVF ikiz gebeliklerinden doğan bebeklerin %73 ünde, spontan ikiz
gebeliklerden doğan bebeklerin %53 ünde düşük doğum ağırlığı mevcuttu. Major konjenital
anomali olarak spontan ikiz gebelikte bir bebekte gastroşizis , IVF gebeliklerden bir bebekte koanal
atrezi saptandı. Minor konjenital anomalilerin (pulmoner yetmezlik, trikuspid yetmezlik, pda,) oranı
IVF gebeliklerinde daha yüksekti (%6 ya %3). Yenidoğan yoğun bakım ünitesinde yatış oranı
preterm doğum oranının daha yüksek olmasıyla orantılı olarak IVF ikiz gebeliklerde spontan ikiz
gebeliklere göre daha yüksek saptanmıştır (%23’e %17)
Tartışma: Literatürde IVF gebeliklerinde göreceli olarak daha yüksek oranda prematürite, düşük
doğum ağırlığı ve perinatal komplikasyonlar belirtilmektedir. Çalışmamızda IVF ikiz gebeliklerde,
spontan ikiz gebeliklere göre erken doğum oranı daha yüksektir ve buna bağlı prematüriteya bağlı
neonatal komplikasyonlarında artış görülmektedir.
[PP-121]
Differential Expression of Leukemia Inhibitory Factor and Insulin like Growth
Factor-1 Between Normal Pregnancies, Partial Hydatidiform Moles and
Complete Hydatidiform Moles
Özge Senem Yücel Çiçek1, Rümeysa Hekimoğlu2, Mert Turgal3, Pergin Atilla2, Alp Usubütün4, Ayşe
Nur Çakar2, Sinan Beksaç3
1
Department of Obstetrics and Gynecology, Keçiören Research and Training Hospital, Ankara,
Turkey
2
Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Ankara,
Turkey
3
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe
University Faculty of Medicine, Ankara, Turkey
4
Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
Introduction:
Hydatidiform moles (HM) may be complete or partial hydatidiform moles and are differentiated by
their karyotype and histologic appearance. There is an uncontrolled trophoblastic proliferation and
invasion in case of HMs, in contrast to limited invasion and proliferation of trophoblasts in normal
pregnancies. Leukemia inhibitory factor (LIF) and insulin like growth factor-1 (IGF-1) are two of the
most important growth factors mediating trophoblast actions. We hypothesized that the localization
and expression patterns of LIF and IGF-1 in partial and complete HMs compared with normal first
trimester placentas may provide an understanding of the invasive and proliferative processes in
HMs.
Material and methods:
The study population included curettage material of women diagnosed as complete or partial HM as
a result of histopathological and immunohistochemical (targeting p57KIP2 nuclear protein)
examination (complete HM group, n=8; partial HM group, n=8) and women undergoing dilatation &
curettage for unwanted pregnancies before 10th gestational week (control group, n=8).
Expression of LIF, IGF-1 among placental cell groups were evaluated immunohistochemically and
given a score depending on the percentage of immunostaining intensity of the cell type: score 0 =
no staining; 1 = 1% to 30%; 2= 31% to 60%; 3= 61% to 100%.
Results:
Strong cytoplasmic LIF immunostaining was observed in endometrial glands both in normal
placentas and HMs. Decidual LIF expression was significantly weaker in both complete molar
(p=0.026) and partial molar placentas (p=0.045) in comparison to normal first trimester placentas.
LIF was strongly expressed in EVTs of molar placentas compared to normal placentas (p=0.042). A
significantly lower level of LIF expression was present in villous trophoblasts of complete HM group
compared to control and partial HM groups (p<0.001). Glandular IGF-1 expression was significantly
weaker in both complete HM (p<0.001) and partial HM groups (p=0.019) in comparison to control
group (Fig. 1). A significantly lower level of IGF-1 expression was present in VTs of complete HM
group compared to control group (p=0.023)(Table 1).
Conclusion:
These findings suggest that decreased endometrial expression of IGF-1 and LIF are efforts by
decidua to limit uncontrolled trophoblast proliferation and invasion in HMs. Furthermore, LIF may
be a mediator of abnormal trophoblast proliferation and invasion in molar pregnancies regulated in
an autocrine fashion by EVTs.
Keywords: Hydatidiform mole, leukemia inhibitory factor (LIF), insulin like growth factor-1 (IGF1), decidua, immunohistochemistry
[PP-122]
Puerperiumda pandemik influenza A (H1N1) enfeksiyonu olan bir olgunun
sunumu
Özlem Bozoklu Akkar1, Çağlar Yıldız1, Savaş Karakuş1, Seyit Ali Büyüktuna2, Aynur Engin2, Sinan
Gürsoy3, Muhammed Emin Öz1, Meral Çetin1
1
Cumhuriyet Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Sivas
2
Cumhuriyet Üniversitesi Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı, Enfeksiyon Hastalıkları Bilim
Dalı, Sivas
3
Cumhuriyet Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı, Sivas
Giriş: H1N1 virüsü, influenza A’nın subtipidir. Hastalık çoğunlukla ateş, öksürük, boğaz ağrısı ile
seyretmektedir. Gebelikte, puerperium döneminde influenza enfeksiyonuna bağlı hospitalizasyon
süresi, hastalığın şiddeti genel popülasyona göre daha yüksektir.
Olgu: Otuz yaşında, gravida 3, parite 2, 33 haftalık gebeliği, yüksek tansiyon yakınması olan olgu
kliniğimize başvurdu. Anamnezinden bronşit tanısıyla ampisilin-sulbaktam 2x1 gram, budesonid
2x400 mikrogram kullandığı öğrenildi. Tansiyon arteriyel 150/90 mmHg, diğer vital bulguları
normaldi. Laboratuvarında +1 proteinüri dışında özellik izlenmedi. Fetal biyometri 35-36 hafta ile
uyumlu izlendi. Fetal distres endikasyonuyla sezaryen ile 3110 gram, 1. ve 5. dakika Apgar skorları
8/10 olan erkek bebek doğurtuldu. Öksürük şikayeti devam eden olgunun balgam gram
boyamasında lökosit, gram (+) kok görüldü. Balgam ve kan kültürleri negatifti. Parsiyel oksijen
basıncı 70 mmHg’ya düşen olgu yoğun bakım ünitesine devredilerek bifazik aralıklı pozitif havayolu
basıncına (BIPAP) bağlandı. Enfeksiyon hastalıkları kliniği tarafından meropenem 3x1 gram
başlandı. H1N1 ön tanısıyla boğaz ve nazofarengeal sürüntü örnekleri Ankara Hıfzıssıhha
Enstitüsü’ne gönderildi. Revers-transkriptaz polimeraz zincir reaksiyonu ile H1N1 pozitif tespit
edilmesi üzerine oseltamivir 2x75 mg eklendikten sonra BIPAP’tan ayrıldı. Tedavisi tamamlandıktan
sonra şifayla taburcu edildi.
Tartışma: H1N1 enfeksiyonu postpartum dönemde gebelikte olduğu gibi yüksek morbidite ve
mortaliteyle seyredebilir. Hastalık, solunum yolu enfeksiyonlarının ayırıcı tanısında, özellikle
verilmiş olan ampirik antibiyotik tedavisine dirençli vakalarda düşünülmelidir. Hastalığın
multidisipliner yaklaşımla tanısının erken konulması ve tedavisinin uygulanması hayat kurtarıcıdır.
Keywords: Puerperium, influenza A, H1N1 enfeksiyonu
[PP-123]
Bir fetal sakrokoksigeal teratom olgusunun antenatal tanısı ve yönetimi
Özlem Bozoklu Akkar1, Savaş Karakuş1, Çağlar Yıldız1, Cengiz Güney2, İrfan Oğuz Şahin3, İsmail
Akkar4, Gülizar Özer1, İsmail Şalk5, Ali Çetin1
1
2
Cumhuriyet Üniversitesi Tıp Fakültesi, Çocuk Cerrahisi Ana Bilim Dalı, Sivas
3
Cumhuriyet Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Sivas
4
Sivas Devlet Hastanesi, Çocuk Sağlığı ve Hastalıkları Kliniği, Sivas
5
Cumhuriyet Üniversitesi Tıp Fakültesi, Radyoloji Ana Bilim Dalı, Sivas
Giriş: Sakrokoksigeal teratom, en sık görülen fetal neoplazidir. Prenatal görüntüleme yöntemleri,
tümörün erken gebelik haftalarında tespit edilmesine, boyutlarındaki artışın takip edilmesine ve
uygun doğum yönteminin belirlenmesine katkı sağlar.
Olgu: 32 yaşında, gravida 3 parite 2 olan olgu 20. gebelik haftasında rutin kontrolü için başvurdu.
Özgeçmişinde 2 kez sezaryen ile doğum dışında özellik saptanmadı. 2. düzey ultrasonografisinde 21
haftayla uyumlu gebelik, fetal sakrokoksigeal bölgede 26x16 mm boyutlarında, multipl kistik
lezyonlar içeren lezyon izlenmesi üzerine yapılan fetal manyetik rezonans görüntülemede
sakrokoksigeal bölgede ağırlıklı ekstrapelvik yerleşim gösteren, intrapelvik komponenti bulunan
yaklaşık 25x27 mm boyutunda semisolid-kistik alanlar içeren ekspansil, yumuşak doku kitle
lezyonunun sakrokoksigeal teratomla uyumlu olduğu saptandı (Resim 1). 38. gebelik haftasında
sancılanma şikayeti olan olgunun obstetrik ultrasonografisinde sakrokoksigeal bölgede 115x90 mm
boyutlarında heterojen kitle imajı izlenmesi üzerine sezaryen ile doğum kararı alındı. Genel anestezi
altında göbek altı midline insizyonla batına, longitudinal insizyonla uterusa girildi. Baş basküle
edilerek 3500 gram, 48 cm, 1. ve 5. dakika Apgar skorları 7/9 olan kız bebek doğurtuldu. Postnatal
muayenede 12x9 cm boyutlarında düzgün yüzeyli kitlenin sakrokoksigeal teratomla uyumlu olduğu
düşünüldü (Resim 2). Yenidoğan, pediatrik cerrahi kliniğine yatırıldı. Anne postpartum 3. günde
taburcu edildi.
Tartışma: Fetal sakrokoksigeal teratom, perinatal morbidite ve mortalitede artışa neden olur.
Doğum sırasında teratomun rüptürüne bağlı olarak masif kanama olabileceğinden, tümörün
boyutları değerlendirilerek en uygun doğum yöntemi ve sezaryen ile doğum kararı alındıysa uygun
insizyon tipi seçilmelidir.
Keywords: Sakrokoksigeal teratom, manyetik rezonans görüntüleme, sezaryen
Resim 1. 21. gebelik haftasında sakrokoksigeal teratomun fetal manyetik rezonans görüntüsü
Resim 2. Yenidoğanda tümörün görünümü
[PP-124]
Kornual ektopik gebelik: olgu sunumu
Özlem Bozoklu Akkar1, Çağlar Yıldız1, Savaş Karakuş1, Gülizar Özer1, Buğra Okşaşoğlu1, Ali Çetin1,
Ali Yanık1
1
Giriş: Kornual ektopik gebelik, ektopik gebeliğin nadir bir formudur. Ultrasonografiyle normal bir
intrauterin gebelikten ayırt edilmesi zordur. Olguların %20-50’si rüptür bulgularıyla başvurur.
Rudimenter horn, geçirilmiş salpenjektomi, tubal yapışıklıklar en sık risk faktörleridir.
Olgu: 30 yaşında, gravida 2 parite 1 olan olgu tubal faktör nedeniyle uygulanan yardımla üreme
teknikleri (in vitro fertilizasyon (IVF)) sonrasında adet rötarı olması üzerine kliniğimize başvurdu.
Özgeçmişinde pelvik tüberküloza bağlı laparoskopik bilateral salpenjektomi, altı ay süreyle
antitüberküloz tedavi, IVF sonrası canlı doğumla sonuçlanan ilk gebeliği dışında özellik saptanmadı.
Son adet tarihine göre 5 haftalık gebeliği olan olgunun ultrasonografisinde endometrial kalınlık ince
düzenli, sağ kornual bölgede, içerisinde yolk sak olan 5 haftayla uyumlu gestasyonel kese izlendi
(Resim 1). Pelvik muayenede sağ adneksiyel alanda hassasiyet dışında özellik yoktu.
Laboratuvarında serum β-hCG 5579 mIU/mL olarak tespit edilen olguya 50 mg/m2 metotreksat
intramuskuler uygulandı. 4. gün serum β-hCG 10529 mIU/mL olan olguya ikinci kez 50 mg/m2
metotreksat intramuskuler yapıldı. 7. gün serum β-hCG 9346 mIU/mL olarak saptanan olguya
operasyon planlandı. Laparoskopide sağ kornual alanda yaklaşık 4x3 cm boyutlarında kitle izlendi
(Resim 2). Laparoskopik sağ kornual eksizyon yapıldı. Komplikasyon olmadı.
Tartışma: Kornual gebelik tedavisinde, özellikle fertilite arzusu olan olgularda multidoz metotreksat
tedavisi ilk seçenektir. Medikal tedaviye yanıt vermeyen, rüptür riski olan olgularda cerrahi tedavi
düşünülmelidir. Laparoskopik cerrahi, tecrübeli bir cerrah tarafından yapıldığı takdirde açık
cerrahiye göre minimal invaziv, daha güvenli ve fertiliteyi korumaya yönelik bir tedavi yaklaşımıdır.
Keywords: Kornual ektopik gebelik, tanı, metotreksat, laparoskopik kornual eksizyon
Resim 1. Kornual ektopik gebelik odağı ve intrauterin kavitenin ultrasonografik görünümü.
Resim 2. Kornual ektopik gebelik odağının laparoskopik görünümü
[PP-125]
First trimester bleeding and pregnancy outcomes; case-control study
Betül yakıştıran, Tuncay Yüce, Feride Söylemez
Ankara University Faculty of Medicine, department of Obstetric and Gynecology
First trimester bleeding is a common symptom and 16-25% of all pregnancies are complicated with that.
Abortus imminens is diagnosed with first trimester vaginal bleeding, closed cervix and confirmed with
fetal heart beat on ultrasound.
Nearly % 50 pregnancies end with pregnancy loss; if pregnancy continues, poor maternal and fetal
outcomes may be occur like preterm delivery, preterm prelabour ruptur of membrane
(PPROM), pre-eclampsia, plasental abruption and intrauterine growth restriction (IUGR). In literature;
lots of study emphasize poor fetal outcomes but very few have commented on adverse maternal effect.
The purpose of this study was to investigate if threatened abortion makes pregnancies high risk and
what is poor neonatal outcome and which maternal characteristics change these results.
A total of 963 patients attended the study. Of these, 493 women with threatened miscarriage ( group A).
The control group ( group B) included 470 pregnants without first trimester vaginal bleeding. We
compared two groups according to maternal age, gravida, parity, spontaneous or induced abortion
history, pregnancy period, livebirth or pregnancy loss, newborn weight and APGAR values after 1 and 5
minutes, newborns’ gender for livebirth, preterm deliveries. Results for the two groups are presented
table 1.
This study indicates that women who have vaginal bleeding in the first trimester are at increased risks of
later pregnancy complications; especially preterm delivery or mean pregnancy period, lower gestational
fetal weight and preterm rupture of membrane.
Although mean pregnancy period in threatened miscarriage group is 243 day; in control group is 263
days. And adverse influence of maternal age and abortion history on outcomes in pregnancies with
threatened miscarriage. However sex of the fetuses and APGAR values after 1 and 5 minutes similar
between two groups.
In conclusion threatened miscarriage is an important situation to predict late pregnancy results both
maternal and fetal outcomes. Maternal obstetric history about previous pregnancies should be questioned
. It is therefore acceptable to consider these pregnancies high risk group, should be performed antenatal
care carefully.
Abortus imminens
(n:493)
Control (n:470)
P values *
Maternal age
33,5±5,4
28,8±5,2
<0,001 *
Gravida
2,1±1,2
1,9±1,1
0,077
Parity
0,51±0,75
0,68±0,94
0,006*
Spontaneous Abortion
0,51±0,86
0,18±0,5
<0,001*
Induced abortion
0,14±0,47
0,09±0,42
0,11
Livebirth
0,46±0,71
0,65±0,78
0,002*
Pregnancy period
243±59
263±35
<0,0001*
Fetal weight
3115±665
3239±619
0,005*
Sex of fetuses (f/m)
180/206
188/262
0,147
APGAR 1.min
8±(0-9)
8±(0-9)
0,080
APGAR 5.min
9±(0-10)
9(0-10)
0,060
Preterm delivery
94/493
40/470
<0,001*
Abortion
58/493
20/470
<0,001*
(< 0,05)
Keywords: threatened abortion, perinatal outcomes, complication
[PP-126]
Cervical pessary in pregnancy women with a short cervix; four cases
Tuncay Yüce, Bahar Konuralp, Erkan Kalafat, Feride Söylemez
Ankara University Faculty of Medicine, Ankara, Turkey
Preterm birth refers to a delivery that occurs before 37 weeks of gestation. Preterm birth is a major
health problem and causes of perinatal morbidity and mortality. Cervical incompetence is one of the
common causes of preterm birth. Ultrasound examination during pregnancy shorting cervical length (less
than 25 mm) or funneling of the cervix during the second or early third trimester of pregnancy have
been suggested to be signs of cervical incompetence. The traditional treathment of a short cervix has
been the progesteron administration or the cerclage in addition with progesteron adminisration. Cervical
pessary is an alternative non-invasive technique that may replace cervical cerclage for the prevention of
preterm birth and has adventage that is not required anesthesia and that insertion or removal is easy. In
the late 1970s, Hans Arabin in Germany designed a silicon pessary that is applied around cervix and
works through a mechanical approach by changing the uterocervical angle and displacing it more
posteriorly. Compared with other pessaries the Arabian is flexible and more easily inserted in the vagina
and cerviks.
Our results are shown in Table 1.
Preterm birth is a major health concern in developed and developing countries. Preterm birht is not only
cause of neonatal mortality, but also preterm birth continues to be a major determinant of short- and
long-term morbidity in infants and children. Different management strategies like as cervical cerclage
have been tried for preventing preterm birth in women with risk factors for cervical incompetency.
Cervical cerclage is an invasive technique that needs anaestesia and may be associated complications.
Table 1
GA
Maternal
age
GA at first
G
P
examination
Case
1
23
1
0
29
3 cm
pessary
pessary
replacement
removing
Last
GA at
delivery
Prolongation of
Birth
Weight
(weeks)
(weeks)
examination
(weeks)
pregnancy (day)
(g)
29
33
6 cm
33
28
2110
23 2/7
33 4/7
7 cm, PROM
33 4/7
72
1610
27 5/7
39
5 cm, PROM
39
76
3300
Cervikal length:
29
2
1
23 1/7
Case
3
GA at
Cervical dilatation:
Case
2
First examination
at
14 mm
Cervical length:
29
2
1
27 4/7
15mm, funneling+
Cervical dilatation:
5cm,
Case
4
Cervikal length:
31
3
2
23
1/7
15 mm
3200
23
3/7
37
2/7
5 cm
37
3/7
98
GA: Gestational age
Keywords: pessary, preterm birth
[PP-127]
Plasma Exchange Therapy in A Patient With Highly Elevated Liver Enzymes
Kazibe Koyuncu, Özgür Kan, Tuncay Yüce, Salih Taşkın, Feride Söylemez
Ankara University Faculty of Medicine, Ankara, Turkey
HELLP is an acronym that refers to a syndrome characterized by Hemolysis with a microangiopathic
blood smear, Elevated Liver enzymes, and a Low Platelet count. The most common symptom is
abdominal pain and tenderness in the midepigastrium, right upper quadrant, or below the sternum . The
pathogenesis of HELLP syndrome is unclear. It probably represents a severe form of preeclampsia . But
the relationship between the two disorders remains controversial. Delivery is curative and the only
effective treatment . Plasmapheresis is a treatment of choice which improves clinical outcomes in
complicated cases.
34 year old ,37 weeks and 4 days pregnancy , G3P2 , had an history of two caesarian section .presented
with hypertension (200/120 mm/hg ) . Laboratory results were consistent with severe preeclampsia . she
had +3 proteinuria in urine .Ultrasound examination showed 34 week ,oligohydroamniotic fetus .
Pregnancy terminated with caesarian section immediately . After labor patient developed HELLP
syndrome . Blood smear showed microangiopathic hemolytic anemia . Hepatic ultrasound scan showed
necrosis in liver escpecially in the right lobe . Nitroprusside ,doxazosin and alfametildopa was initiated for
antihypertensive treatment . To prevent embolism enoxiparine 0,4 MI /day was used . Postpartum day 2
her laboratory test show that AST > 4000 IU/L and ALT > 2500 IU/L platelet levels dropped to 20x106
. Because of the persistant trombositopenia and liver enzyme elevation , plasmaferesis was initiated
.After 3 sessions, the patient was discharged in good general condition and normalized laboratory tests
HELLP syndrome can cause several feto-maternal complications and the mortality rate of pregnacy
reported to be 1.1-25% . Sometimes HELLP syndrome occurs after delivery . Previous studies showed
controversial results of 10 mg dexamethasone every 12 hours treatment. Plasmapheresis might reduce
the maternal mortality rate in HELLP syndrome .The need and the indications of plasmapheresis is still
remains unclear .
Table1. Laboratory results before and after plasmaferesis
Before
plasmafere
sis
After
plasmaferesis
Hb
9,1
7,9
Platelet
22
69
Protrombin time
28,3
35,5
INR
0,94
1,01
AST IU/L
4099
1332
ALT
IU/L
2515
717
LDH IU/L
6443
2288
BUN mg/dL
15
8
Cr
0,68
0,64
Total bilurubin
mg/dL
2,71
3,0
Direct bilurubin
mg/dL
1,39
1,25
mg/dL
Keywords: HELLP syndrome, pregnancy, plasmaferesis
[PP-134]
Case Report: A new subgroup of acromesomelic syndromes is about to be
discovered in a Turkish family
Başak Güler, Uğur Keskin, Davut Gül, Ali Ergün
Liv Hospital, Department of Obstetrics and Gynecology.
Gülhane Military Medical Academy, Department of Genetics
Abstract
Acromesomelic syndromes resembles a group of skeletal displasias, causing dwarfism. They are rarely
observed, so can easily be missed in the routine ultrasound examination. When there is an index case in
the family, more attention is paid on the skeletal formation of the new fetus; but the sporadic cases have
high risk of unrecognition. We would like to present one of the earliest diagnoses of acromesomelic
syndromes in the literature, and emphasize the importance of taking detailed medical history and careful
examination of the fetus by the ultrasound in the diagnosis
Introduction
There are more than 450 types of skeletal dysplasias according to our current knowledge (1) and new
entities are added day by day. Acromesomelic syndromes are one of the rare kinds of hereditary skeletal
dysplasias, having autosomal recessive trait. The affected phenotype demonstrates dwarfism due to
shortening of intermediate bones like ulna and radius in the forearm and tibia and fibula in the leg (2,3).
Robinow syndrome, Hunter- Thompson syndrome, Du pan syndrome and Grebe syndrome are
acromesomelic syndromes showing some similar features (4, 5). Correct categorization of cases in these
subgroups can be challenging and the presentation of new cases may lead to discovery of new
syndromes. In this report, we would like to present a case having significant shortening in the ulnar and
radial bones; and deformity in the hand. The family has an affected child suspected of having Grebe
syndrome but lacking genetic confirmation. Besides, the consanguinity of the parents and the
inadaptable phenotype of the living child to known acromesomelic syndromes, made us consider that this
may be a new type of acromesomelic syndrome.
Case Report
33 year- old female patient seeking for medical help, was evaluated in our outpatient clinic. She and her
husband were cousins of first degree; and had no medical problems. She had a medical abortion due to
hydrocephalus and encephalocele in her first pregnancy. In the year 2002, by the reason of intrauterine
growth retardation, she had C section for her son, who was suspected as a variant patient of Grebe
syndrome; had agenesia of both forearms; flexion deformity in knees; hypertelorism; frontal bossing
sign; epicanthus; depressed nasal bridge; but the related gene for Grebe syndrome could not be
detected. The child has no mental problems (Picture 1, 2 and 3).
picture 1
picture 2
picture 3
In her present pregnancy, the patient was pregnant for 16 weeks and 4 days, when her last menstruel
period was considered. Ulna, radius and fibula were measured to be significantly shorter when compared
to the gestational week of the fetus. In one of the hands of the fetus, deformity in the index finger was
observed and one phalanx was missing in the fifth finger (Picture4, 5, 6). Parameters evaluated by
ultrasound examination were as follows; BPD: 34, 8mm (16w 4d), HC: 131,2mm (16w 5d), AC: 95,9mm
(15w 4d), FL: 22,9 mm (16w 5d), HL: 19,4 mm (15w, 4d), ulna: 12,4mm (14w), radius: 8,6mm (12w
4d), tibia: 16,5mm (15w 5d), fibula: 12,1mm (14w). The cranium, face, brain, thorax, heart, and the
abdominal organs were found to be normal. Placenta was localized posteriorly and the amniotic fluid was
in normal range. No other sign of aneuploidy could be detected by the ultrasound. Detailed information
about the fetus was given to the couple. Sampling of amniotic fluid was not favored because of the
unknown localization of the responsible gene defect for this family.
picture 4
picture 5
picture 6
The family decided to continue the Pregnancy.
Discussion
This case report represents one of the earliest intrauterine diagnosis of an acromesomelic fetus, at
the 17th gestational week (6). The living child of this family was suspected of having Grebe
syndrome which causes dwarfism due to displasia in the long bones. Lower limbs are more affected
than upper ones; and also distal parts of the extremities have more prominent changes than the
proximal ones (7). Some of the heterozygotes were shown to have anatomical defects in their
phalanges; talipes equinovarus, double halluces; and some had polydactyly whereas some did not
have any phalanges (3,8). The affected individuals have normal intelligence levels. The fetus
resembles similar deformities as its brother; and the pattern of the acromesomelia, the normal
appearance of the spinal column and the ribs, and the normal intelligence level of the sibling fits for
Grebe syndrome. But in this syndrome, hands and feet show more globular pattern whereas in our
case, they are less effected, as in the cases of Hunter- Thompson syndrome. The abnormal
articulation of the knee joint also resembles the Hunter-Thompson syndrome. Hypoplastic or
dysplastic forearms and fibula supports Du Pan syndrome; but the absence of very short fingers,
rubbin like toes and the carpal and tarsal fusions, maintains the inconsistency with this group (4).
Frontal bossing and depressed nasal ridge of the living child fits for Robinow syndrome; but the
normal apperance of spinal column, ribs and skull, and lack of genital abnormality excludes it (9).
Human cartilage derived morphogenetic protein 1 (CDMP 1) gene is located on chromosome
20q11.2, and mutations of it are thought to be responsible for the development of Grebe and
Hunter- Thompson syndromes (2, 10). This gene mutation could not be demonstrated in the son of
the family.
Correct diagnosis of this kind of cases is very important for the parents to prepare themselves for
the affected, abnormal looking baby. When there is an affected individual in the family, more
attention for the lengths of the bones is paid. In order not to miss the sporadic cases of skeletal
displasias, we recommend measuring of not only the lengths of femur and humerus but also of the
ulna, radius, tibia and fibula. The examination of the positions and relations of the phalanges,
carpal and metacarpal bones is quite necessary, in order not to miss any configurational
abnormality. Termination of the pregnancy is another understandable option for many couples,
when the long term difficulties which their child will face are considered.
Conclusion
Here in this case presentation, we would like to emphasize the importance of early diagnosis of
skeletal abnormalities and introduce one of the earliest diagnoses of an acromesomelic syndromic
fetus. The case does not fit in any of the subgroups of known acromesomelic syndromes. Because
of the consanguinity of the parents and the lack of responsible gene mutation for Grebe and Hunter
Thompson syndromes, the presented fetus and its elder sibling may resemble a new/ unknown
subgroup of acromesomelic syndrome.
Conflict of Interest The authors declare that there is no conflict of interests
References
1. Panda A, Gamanagatti S, Jana M, Gupta AK. Skeletal dysplasias: A radiographic approach and review of
common non-lethal skeletal dysplasias. World J Radiol. 2014; 28;6(10):808-25.
2. Cordero DR, Goldberg Y, Basel D, Kilpatrick MW, Klugman S, Tsipouras P, Gross S. Prenatal sonographic
diagnosis of Grebe syndrome. J Ultrasound Med 2006; 25:115-118.
3. Costa T, Ramsby G, Cassia F, Peters KR, Soares J, Correa J, Quelce- Salgado A, Tsipouras P. Grebe
syndrome: Clinical and radiographic findings in affected individuals and heterozygous carriers. Am J Med Genet.
1998;75: 523-529.
4. Demirhan O, Türkmen S, Schwabe GC, Soyupak S, Akgül E, Taştemir D, Karahan D, Mundlos S, Lehmann K.
A homozygous BMPR1B mutation causes a new subtype of acromesomelic chondrodysplasia with genital
anomalies. J Med Genet 2005;42:314–317.
5. Mundlos S, Horn D. Grebe dysplasia; Hunter- Thopmson dysplasia; Du Pan dysplasia; Chondrodysplasia;
Acromesomelic; BMPR1B type. 2014; Limb Malformations, 247- 250.
6. Honorio JC, Bruns RF, Gründtner LF, Raskin S, Ferrari LP, Arauio Junior E, Nardozza LM. Diastrophic
dysplasia: prenatal diagnosis and review of the literature. Sao Paulo Med J. 2013;131(2):127-32.
7. Kulkami ML, Kumar B, Nasser A, Kulkami BM. Grebe syndrome: a very severely affected case. J Med Genet.
1995 Apr; 32(4): 326- 7.
8. Quelce-Salgado A. A rare genetic syndrome. Lancet 1968;1: 1430.
9. Suresh S. Robinow syndrome. Indian J Orthop. 2008 Oct; 42 (4): 474-6.
10. Graul- Neumann LM, Deichel A, Wille U, Kakar N, Koll R, Bassir C, Ahmad J, Cormier- Daire V, Mundlos S,
Kubisch C, Borck G, Klopocki E, Mueller TD, Doelken SC, Seemann P. Homozygous missense and nonsense
mutations in BMPR1B cause acromesomelic chondrodysplasia- type Grebe. Eur J Hum Genet. 2014; 22: 726733.
Keywords: Acromesomelic syndromes, Grebe syndrome
[PP-136]
Maternal Near Miss Morbidity and Maternal Mortality in a Tertiary Referral
Center in Turkey
Dilek Uygur*, Yaprak Engin-Ustun*, Kudret Erkenekli*, Ozgur Kara*, Aykan Yucel*, Selcen
Yuksel**, Salim Erkaya*, Nuri Danisman*, Sema Sanisoglu***, Ozge Tuncalp****
*Zekai Tahir Burak Women’s Health Care, Training and Research Hospital
**Yıldırım Beyazıt University, Biostatistics Department
***General Directorate of Mother and Child Health and Family Planning, Ministry of Health of
Turkey, Ankara, Turkey
****Department of Reproductive Health and Research, World Health Organization
Running Title: “Maternal near miss data from Turkey”
Objective: The objective of the study is to present the maternal near miss and maternal mortality cases
from a tertiary referral education hospital and to evaluate the factors associated with the presence of
maternal near miss.
Design: Retrospective study.
Setting: Zekai Tahir Burak Women’s Health Care, Training and Research Hospital, Ankara
Population or Sample: Women who fulfilled the World Health Organization criteria for maternal near miss
or death between June 2009 and June 2014 at a tertiary referral education hospital.
Methods: A retrospective study was conducted to evaluate the risk factors’ influence on near miss,
multivariate logistic regression was used. Before setting logistic regression, univariate analyses were
used to select candidate variables.
Main Outcome Measures: The maternal near miss morbidity.
Results: In the 5-year study period, there were 82924 deliveries and 81673 live births. We identified 202
maternal near miss events and 11 maternal deaths. The maternal near miss ratio was 2.47 per 1,000
live births and the maternal mortality ratio was 13.46 per 100,000 live births. There were 213 women
with a severe maternal outcome ratio (SMOR) (near miss + maternal death), with a ratio of 2.6
cases/1,000 live birth. Near miss events were associated with length of hospital stay (p<0.001),
hemoglobin level (p=0.003).
Conclusion: By
associated with
countries with
opportunities to
the help of the WHO near miss approach, we identified that near miss events were
length of hospital stay, hemoglobin level, cesarean section deliveries and parity. In
low maternal mortality, such as Turkey, examining maternal near miss provides
evaluate the quality of care provided to pregnant women in the facilities.
Keywords: Near miss, potentially life threatening, maternal mortality, maternal morbidity.
[PP-137]
Dead fetus with a cystic placenta: Partial mole or other pathology?
Özlem Irak1, Doruk Cevdi Katlan1, Hüner Azimli1, Tuncay Yüce1, Feride Söylemez1, Acar Koç1
(1)Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey
Background - Aim
Partial mole (PM), one of the gestational trophoblastic diseases, is generally triploid with one maternal
and two paternal haploid sets, either from dispermic fertilization or from fertilization with an unreduced
diploid sperm. It has usually a fetus and a large placenta. Generally fetus dies after conception but if it
survives, ultrasound may indicate signs consistent of triploidy, such as abnormal early growth restriction
or developmental abnormalities. Also β-hCG level is significantly higher than a normal pregnancy. PM can
be misdiagnosed mostly as placental mesencyhmal dysplasia (PMD), chorioangioma or twin gestation
with complete mole and co-existing fetus. Hereby, it is intended to focus on possible diagnostic approach
when ultrasound reveals placental cystic structures indicative of possible molar pregnancy with
coexistent fetal demise.
Case reports
A healthy 26-year old gravida 2, para 1 woman was examined at 12 weeks 6 days and sonography
revealed a nuchal translucency of 5,9 mm, maxillofrontal angle of 101 degrees, tricuspid regurgitation,
reverse “a” waves on ductus venosus Doppler and generalised subcutaneous edema. Chorion villus
sampling was performed for karyotype analysis. Two weeks later control sonography showed intrauterine
fetal demise with prominent placental cystic areas. Post abortion pathology demonstrated partial molar
pregnancy and the genetic analysis revealed triploidy.
Ultrasound examination of another 29-year old healthy gravida 1, para 0 woman at 12 weeks 4 days of
pregnancy showed fetal demise with placental cystic areas. The level of initial β-hCG was 37,909 IU/L.
Pathologic diagnosis was PM, however, due to possible loss of viability of tissue sample, genetic workup
failed to conclude the chromosomal analysis.
Conclusion
A possible method for differential diagnosis between molar pregnancy and PMD in the presence of a
viable fetus may be low pulse repetition frequency (PRF) Doppler examination. In molar pregnancy, there
is absence of flow within molar cysts since these areas represent hydropic villi. But in PMD, cysts show
varying degrees of flow, with the corresponding varying degrees of color leading to a “stained-glass”
appearance. Real challenge for sonographic differential diagnosis emerges when the fetoplacental
circulation ceases. Therefore, in case of fetal demise, the diagnosis and thus the follow up depend solely
on pathologic examination for which genetic analysis may be supportive.
[PP-138]
Placenta Percreata with Bladder Invasion: Two Consecutive Cases
Aykut Özek, Pınar Çalış, Mine Dağgez Keleşoğlu, Merih Bayram
The incidence of placenta percreata is 0.008 %. It is a life threatening condition and multi-disciplinary
approach is needed for appropriate management. There are various techniques for delivery and
management. Although these cases were managed successfully, there is need for further studies to
recommend routine methotrexate treatment after delivery.
Our first case was a 36 year-old, G6P1A4 woman. She was referred with the diagnosis of placenta previa
at at the gestational age of 28 weeks. She had undergone myomectomy and cesarean section. Sonogram
revealed placenta percreata with bladder mucosal infiltration. At the gestational age of 30 weeks she had
intractable contractions and vaginal bleeding. Cesarean section was performed. It was seen that the
rectus fascia was also invaded by placental tissue. Apgar scores were 8, 9 and she weighed 1400 gr.
Posterior wall of bladder was infiltrated. Complete excision of placental tissue was thought to result in
bladder problems and because of the possibility of residual placental tissue at rectus fascia and bladder
mucosa, we performed total hysterectomy with the plan of subsequent methotrexate treatment. Multidose methotrexate injections of 50 mg were administered with subsequent decrease in serum B-hcg
levels. Our second case was a 32 year-old G2P1 woman with a history of cesarean section. She was
referred with the diagnosis of placenta previa at 33 weeks of gestation. We detected placenta previa with
bladder wall invasion. At the gestational age of 35 weeks, cesarean section was performed. Female fetus
with apgar scores of 8, 9 weighing 2400 g was delivered. Mucosal layer of the bladder was infiltrated by
placental tissue. Because of the critical involvement of the trigone of the bladder, we opted hystecectomy
followed by postnatal multi-dose methotrexate injections (50 mg/injection).
[PP-139]
THSR Expression on Mesenchymal Stem Cells Isolated from Umblical Cord of a
Baby Born with Congenital Hypothyroidism
1
1
Merih Bayram, 1Aykut Özek, 2Melek Yaman, 2Nihan Örüklü, 2Emin Umit Bagriacik
Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey
2
Department of Immunology, Gazi University Faculty of Medicine, Ankara, Turkey
A 27 year-old woman (gravida 2 para 1) showing normal pregnancy untill 30 weeks of gestational
age was diagnosed to have fetal goitrous thyroid with umblical cord blood sampling of TSH: 49,4
µIU/mL (normal limits 7 ± 3,7 µIU/mL), fT4: 4,25 pmol/L (normal limits 18,6 ± 5,5 pmol/L).
Intraamniotic L-thyroxine injections of 150-200 µg /week and sonographic evaluation of thyroid
gland were performed between 30 and 34 weeks of gestation (Table 1). At 35 weeks of gestation,
the patient was hospitalized for detected oligohydramniosis and intrauterine growth restriction but
normal umblical artery doppler flow. Two days later, due to spontaneous repetative decelerations
on non-stress test, a 2120 gr, male infant with apgar scores of 9 and 10 at 1 and 5 minutes,
respectively was delivered by a cesarean section.
The newborn having a small goiter with no sign of respiratory obstruction and thyroid function tests
of TSH: 269 µIU/mL (normal limits 1-20 µIU/mL), fT4: 4,8pmol/L (11,5-28,3 pmol/L) was put on
oral thyroxine treatment. We also demonstrated the TSHR expression of the MSCs derivated from
the umbilical cord.
Fetal goiter with its very rare incidence of 1 in 40,000 deliveries [1,2], If left untreated,
pathological enlargement and dysfunction of fetal thyroid gland is associated with both short and
long-term complications [3].Although the exact mechanism of congenital hypothyroidism is not
clear in our case, we are in the opinion that the diagnosis is thyroid dyshormonogenesis and to the
best of our knowledge, this is the first report showing TSHR expression on umblical cord-derived
MSCs .(Supported by Grant No: TUBITAK-SBAG-112S451).
References
1
Corral E, Reascos M, Preiss Y, Rompel SM, Sepulveda W: Treatment of fetal goitrous hypothyroidism:
Value of direct intramuscular l-thyroxine therapy. PrenatDiagn 2010;30:899-901.
2
Bianchi DW, Crombleholme TM, D'Alton ME: Fetology : Diagnosis & management of the fetal patient.
New York ; London, McGraw-Hill, 2000.
3
Namouz-Haddad S, Koren G: Fetal pharmacotherapy 4: Fetal thyroid disorders. J ObstetGynaecol Can
2014;36:60-63.
Table 1. Fetal thyroid gland measurements and doses of L-thyroxine injections.
Gestational Weeks
Thyroid Dimensions (mm)
Right Lobe
Left lobe
L-Thyroxine Dose, µg
30
19,9 x 11,2
18,5 x 9,9
150
31
19 x 10,6
18 x 10
200
32
20,5 x 11
19,5 x 11
200
33
19,7 x 10
18,7 x 10
200
34
20,5 x 11,2
19,5 x 11
200
[PP-140]
Prenatal Diagnosis and Outcomes of Fetal Cardiac Rhabdomyomas: Evaluation
of Seven Cases
Emine Aydın, Mert Turgal, Esra Nuhoglu, Ozgur Ozyuncu
Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey
In this case series, we aimed to determine the outcome of prenatally diagnosed fetal cardiac
rhabdomyoma. This case series is a retrospective evaluation of seven cases of fetal cardiac
rhabdomyoma determined during pregnancy. Only one of these cases has been associated with
tuberous sclerosis (TS). Four of the cases had just a single tumor whereas the others were found
to have multiple tumors. Termination was performed to one fetus due to hydrops fetalis. The
presence of risk factors of TS in a family and multifocal or large tumors, appear to be the most
important factors affecting neonatal outcomes.
[PP-141]
Different Dose Intravaginal Misoprostol Administration in Second Trimester
Pregnancy Termination
Ozgur Ozyuncu, Emine Aydin, Gul Sema Can, Mert Turgal
Hacettepe University Faculty of Medicine, Department of Obstetrics and Gynaecology, Ankara, Turkey
Objective:
To evaluate the effectivity and safety of misoprostol induced second trimester
termination of pregnancy (ToP) in women with or without a history of previous caesarean section.
Methods: This was a retrospective cohort study of 519 women who underwent termination of
pregnancy from 2005 to 2014. The study group (Group I) consisted of 85 women with a previous
caesarean delivery and the control group (group II) was composed of 434 women without such a
history. All the terminations were performed between 14 and 26 weeks of gestation. Two different
vaginal misoprostol protocols were performed. In Group I, misoprostol was inserted vaginally every
6 hours, a 50 μg misoprostol until regular uterine contraction. In Group II, misoprostol was
inserted vaginally every 6 hours, a 200 μg tablet for the first 24 hours, subsequently was given
800 µg/day vaginally until regular uterine contractions. Patient’s demographics, indications of ToP,
efficacy, side effects and complication rates were evaluated.
Results: There were no statistically significant differences detected induction to abortion interval in
both groups (p=0,371). A vaginal abortion occurred in 78 women (91.8%) in the Group I and 430
(100%) in the Group II (99,1%) (P=0.01).Abortion rates of procedures were 91,8% and 99,1% in
Group I and II, respectively (p <0,001). Only one ruptured uterus in the Group I was occurred
(1,2%). Transfusion requiring hemorrhage was higher Group I when compared Group II (5,9% vs
1,6%, p: 0,032).
Conclusion: The use of vaginal misoprostol for second trimester ToP is not contraindicated in
women with cesarean delivery history. This method is effective and comparable with those in
women without cesarean delivery history.
Keywords: caesarean delivery, misoprostol, pregnancy termination, uterine rupture
[PP-142]
Prediction of gestational diabetes mellitus in low risk pregnacies: Prospective
cohort study
Pinar Kumru1,Resul Arisoy1,Emre Erdogdu1,Oya Demirci1,Müstecep Kavrut2,Cem Ardic1,Nihan
Aslaner1,Aysen Özkoral1,Nazan Tarhan1,Habibe Ayvaci1,Aktug Ertekin1
1
Zeynep Kamil Maternity and Children's Training and Research Hospital, Obstetrics and Gynecology,
Istanbul, Turkey
2
Bahçeci Health Group’s Fulya IVF Center, Istanbul, Turkey
Objectives:
The purpose of our study is to evaluate the relationship of sex hormone-binding globulin (SHBG),
homeostasis model assessment (HOMA), glycosylated haemoglobin (HbA1c) and Cholesterol panel
for subsequent GDM prediction in low risk pregnancies.
Methods:
Thirty-eight and 295 pregnant women were included in study as GDM and low-risk patients nonGDM with, respectively. Maternal blood samples were collected during the first trimester
examination for SHBG, HbA1c, fasting blood glucose, insulin, TSH, ft4, total cholesterol,
triglycerides (TG), high density lipoprotein cholesterol and low density lipoprotein cholesterol (LDLC).
Findings:
SHBG, HOMA, LDL and TG were detected to be the significant independent predictors for GDM
(Adjusted (OR): 0.991, 95% CI 0.986-995; OR: 1.56; 95% CI 1.24-1.98; OR: 1.02; 95% CI 1.011.04; OR:1.01, 95% 1.00-1.02, respectively). HbA1c, BMI and MAP were detected to be nonindependent predictors. The area under the ROC for the predictive accuracy of SHBG, HOMA, TG
and LDL-C were 0.73, 0.75, 0.70 and 0.72 respectively.At a false positive rate of 5% for the
prediction of GDM, the values of sensitivities were 21.1, 26.3, 21.1 and 18.4% respectively.
Conclusion:
The levels of HOMA,SHBG,TG and LDL-C are independent predictors of subsequent development of
GDM in low risk pregnancies, but they have a low senstivitiy.
Keywords: Gestational diabetes mellitus, low-risk pregnancy, prediction, screening
[PP-143]
Prenatal diagnosis of a choroid plexus papilloma
Resul Arısoy, Emre Erdogdu, Pınar Kumru, Oya Demirci, Mesut Polat, Oya Pekin
Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Perinatology,
Istanbul, Turkey
We reported a rare case of choroid plexus papilloma detected at 35 weeks. A 25 years old gravida
2, para 1 was referred to our unit with a sonographically suspected intrakranial mass at 35 weeks'
gestation. A detailed ultrasound scan revealed a single live fetus with biparietal diameter of 93
mm, head circumference of 325 mm femur length of 68 mm and abdominal circumference 320
mm. There was a large mixed echoic mass measuring 37 × 32 mm (figure-1) seen in the brain and
it was associated with lateral ventricular atrium and unilateral ventricular dilatation (17 mm) was
identified. Amniotic fluid index index was 60 mm, umblical doopler and middle cerebral artery index
were normal.No other fetal anomalies were detected. The female newborn was delivered by normal
vaginal delivery at 38 weeks of gestation. The neurological development of the newborn was
normal during the follow-up. She was operated at two years old due to hydrocephalus and
pathologic examination of the mass confirmed a choroid plexus papilloma.
Keywords: prenatal diagnosis, choroid plexus papilloma
2015perinatal Kabul:Video
Toplam: 6
[V-001]
Meckel Gruber Syndrome in One of Twins, A Rare Coincidence
Ali Ozgur Ersoy, Didem Kaymak, Sibel Ozler, Nuri Danisman
Zekai Tahir Burak Women's Health Care Training and Research Hospital
Introduction: Primary cilia function as chemosensor, mechanosensor and photosensors. Loss of
ciliary protein causes many different diseases such as situs inversus, retinitis pigmentosa,
polycystic renal disease, polydactyly, dysgenesis of the nervous system.
Case: Thirty-six year-old multiparous pregnant woman at her 32 weeks of gestation was referred
to our perinatology care center because of oligohydramnios in one of her twins. Ultrasound
revealed that the right-sided male twin had uneventful anatomic structure. The left-sided twin had
breech presentation, bilateral lateral ventriculomegaly, lemon sign on the fetal calvarium, a cystic
mass gone out from a defect on the midline of her occipital bone, and bilateral polycystic kidneys
which had severely large, hyperechoic and sponge like view. There was no sign of deformity on
extremities. Examination revealed threatened preterm labor. The intravenous sedation, hydration
and betamethasone (intramuscular, 12 mg) were prescribed. Two weeks later, at 34 weeks of
gestation, amniotic membrane of the healthy seen fetus was ruptured and a decision for cesarean
section was made because of fetal anomaly and active labor. Neonatal examination confirmed the
prenatal diagnosis. The female anomalous neonate weighed 3210 gram had apnea and
bradycardia, so immediate tracheal intubation and mechanical ventilation were performed. She
died on the fourth postpartum day. The second twin weighed 2580 gram had normal neonatal vital
signs.
Conclusions: This rare coincidence of twin pregnancy and Meckel Gruber syndrome in one of twins
prompted us to think that loss of ciliary proteins in one twin occurred with a mutation which
effected that twin, separately.
Keywords: Twin pregnancy, Meckel-Gruber Syndrome, polycystic renal disease, occipital
encephalocele
[V-002]
Plasenta previa prekreata tanı ve yönetimi: Olgu sunumu
Cem Yaşar Sanhal, Aykan Yücel, Ayşe Kırbaş, Dilek Uygur
Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi
Anormal plasental implantasyon özellikle sezaryen ve küretaj gibi uterin girişimler sonrasında
desidua bazalis ve Nitabuch tabakasında oluşan hasar sonucu oluşur. 34 yaşında gravida 3 parite 2
yaşayan 2 tanılı hasta 36. gebelik hastasında kliniğimize plasenta previa tanısıyla sevk
edilmiştir.Yaptığımız ultrasonografi muayenesinde ölçümleri yaklaşık olarak 36-37 gebelik haftası ile
uyumlu olan canlı baş geliş bir fetus saptandı. Plasenta posterior anterior doğrultudaydı, servikal
internal os’u tamamen kapatıyor ve önde uterovezikal plika’nın üzerine kadar uzanıyordu.
Plasentanın içerisinde birçok lakün saptandı, Doppler incelemede hipervaskülarizasyon görüldü ve
plasenta ile myometrium arasındaki sonolüsan alan net olarak izlenemiyordu (Figür 1). Aynı hafta
içerisinde elektif şartlarda sezeryan ile doğum yaptırılan hastanın operasyonu, genel anestezi
altında göbekaltı median kesi ile başladı.Katlar geçildikten sonra yapılan gözlemde plasenta
perkreata hali gözlendi. Plasental kesiden kaçınmak amacıyla uterusa klasik vertikal kesi yapıldı. Bir
adet canlı 3410 gr erkek bebek ayaklarından çekilerek doğurtuldu. Mevcut hasta özellikleri ve
plasenta perkreata hali düşünülerek histerektomi kararı alındı. Bilateral round, ovarii proprium,
uterin arter ve kardinal ligamanlar tutularak, kesilerek ve bağlanarak histerektomi işlemi
tamamlandı (Figür 2). Vajinal kaf oluşturuldu. Mesane kontrolü esnasında posterior duvarda 3 adet
tam kat defekt izlendi. Usulüne uygun mesane onarımı yapıldı. Hastaya intraoperatif 5 Ü eritrosit
süspansiyonu, 4 adet taze donmuş plazma (TDP) ve 2 gr fibrinojen replasmanı yapıldı. Post operatif
takibinde vital bulguları ve kan – biokimyasal parametreleri stabil olan hasta serviste ikili
antibioterapi ile takip edildi. Sezaryen sonrası 7. günde sondası çekilen hasta önerilerle taburcu
edildi.
Anahtar Kelimeler: hemoraji, plasenta perkreta, histerektomi, transfüzyon
Figur 1
Figür 1. Hipervaskülarizasyon ve lakünlerin USG ile görünümü
Figur 2
Figur 2. Histerektomi spesimeni. (Okbaşı: uterin insizyon; ok: plasenta invazyon)
[V-003]
A Case of Pulmonary Sequestration Resulting in Termination
Emine Aydın, Dila Kasapoğlu, Mert Turgal, Özgür Özyüncü, Mehmet Sinan Beksaç
Turkey.
Summary
Pulmonary sequestration (PS) is a rare anomly that consists of an island of lung parenchyma that
does not communicate with the bronchial tree and is fed by the systemic rather than the
pulmonary circulation. There are two types of PS: intralobar and extralobar. Prenatal diagnosis
concerns the latter type only, because intralobar sequestration is not visible on US. The extralobar
variant is further subdivided into a supradiaphragmatic and a subdiaphragmatic subtype, the
former accounting for 90% of extralobar PS and the latter for the remaining 10%. The lesion is
characteristically unilateral, and involves the left lower lobe in 90% of cases. Typically, extralobar
sequestrations present a feding artery branching off the descending thoracic or abdominal aorta.
The etiology of PS is unknown.
Case presantation
A 25 year-old women reffered us with fetal PS on her 21th gestational week. Her combine test was
normal. She had no internal diseaes. In detailed sonography, we dedected 68x36x49 mm mass
which was pushing the heart rightwards. It was originated from left lung. Its vascularity was from
descenden aorta directly. And also fetus was hydropic.With these findings, we thought that the
diagnosis was PS. We informed the family about PS’s prognosis. Accompanying hydrops fetalis was
a bad prognostic factor for PS. And the family responded with termination. Termination was
performed succesfully and autopsy results confirmed our diagnosis.
Conclusion
Existence of hydrops fetalis was a bad prognostic factor in this case. Termination should be
recommended in accordance with the family's wishes.
Keywords: Bronchopulmonary Sequestration, Congenital Abnormalities, Hydrops Fetalis
thoracic mass
Mass vascularity was from descenden aorta directly
[V-004]
Three-Dimensional Sonography of Fetal Iniencephaly Clausus
Taner Kasapoğlu1, Füsun Bocutoğlu2, Serdar Yalvaç3, Ömer Kandemir3
1
Department of Obstetrics and Gynecology, Perinatology & High-Risk Pregnancy Clinic, Etlik
Zubeyde Hanım Women’s Health Education and Research Hospital, Ankara, TURKEY; Department of
Epidemiology, Institute of Health Sciences, Hacettepe University, Ankara, TURKEY.
2
Department of Obstetrics and Gynecology, Etlik Zubeyde Hanım Women’s Health Education and
Research Hospital, Ankara, TURKEY
3
Department of Obstetrics and Gynecology, Perinatology & High-Risk Pregnancy Clinic, Etlik
Zubeyde Hanım Women’s Health Education and Research Hospital, Ankara, TURKEY.
An eighteen-year old, gravida2, para1, at the 28th weeks of gestation woman visited our
emergency room with complaints of abdominal pain indicating preterm labor. The previous scan
performed at the 12th week of this pregnancy had revealed intauterine live gestation accompanied
by polyhydramnios. CVS had been performed to find out whether any chromosomal abnormalities
exist or not. Test results showed that it was 46XY, normal karyotype. There was no history of
radiation exposure or any drug, alchol or nicotine intake during the pregnancy. She was pregnant
from a non-consanguineous marriage. In terms of neural tube defects, there was no adverse family
history. She hadn’t got any antenatal care or hadn’t taken folic acid supplementation previously.
On transabdominal ultrasound, polyhydramniosis and a single-live male fetus with hyperextansion
of cervical spine was observed. The neck was short and hyperextended, the face was upturned,
corresponding to the description of a stargazing fetus.The head was found to be in continuity with
the shoulders because of the extreme dorsiflexion of the head accompanied by an abnormally short
and deformed spine.Bilateral clubfoot deformity, low set ears and polyhydramnios was also
noted.Umbilical cord showed single artery.No cephalocele or meningocele was detected.It was
notable that head and thorax was seen at the same section on ultrasound.Finally, she delivered a
male baby weighing 1570gr at the 31st week gestation by caesarean section and he died 10
minutes after delivery.Severe retroflexion of head, short neck, scoliotic spine, low-set ears and
bilateral clubfoot deformity were the other characteristics of iniencephaly clausus.
Keywords: three-dimensional sonography, iniencephaly clausus, prenatal diagnosis, neural tube
defect, fetal anomaly
fetal iniencephaly
fetal iniencephaly-abdomen and fetal head at the same planar section
fetal iniencephaly 3D USG photo
fetal iniencephaly 3D USG photo demonstrating the star-gazing fetus
[V-005]
Gebelik Kesesi İçine Metotreksat Verilerek Tedavi Edilen Sezaryen Skar Gebeliği
Ali Ozgur Ersoy, Dilek Uygur, Aykan Yücel
Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği,
Ankara
Amaç: Sezaryen skarında yerleşmiş gebeliğin yönetimine dair olgu sunumu.
Olgu: 30 yaşında, 8 haftalık gebe olan bir kadın hasta Perinatoloji polikliniğimize alt karın
bölgesinde ağrı ile başvurdu. Hipogastrik bölgenin orta hattında hafif hassasiyet mevcuttu.
Ultrasonografik muayenede, ortalama 13 mm çaplı ölçülen tek gebelik kesesinin uterus ön
duvardaki önceki sezaryen kesi bölgesine yerleşmiş olduğu izlendi. Kese içinde embriyo izlenmedi.
Hastanın 3 sezaryen doğum öyküsü vardı. Tam kan sayımı, böbrek fonksiyon testleri (kan üre ve
kreatinin düzeyleri), karaciğer fonksiyon testleri (transaminazlar, laktat dehidrogenaz) ve
pıhtılaşma testleri (Protrombin zamanı, Aktive parsiyel tromboplastin zamanı) tümüyle normal
sınırlar arasındaydı. Hemoglobin değeri 10.5 g/dL, β-hCG hormon değeri 30413 U/L idi. 50 mg/m2
vücut yüzey alanına göre hesap yapılarak, 85 mg metotreksat (MTX), 20 kalibreli iğneyle,
abdominal ultrasonografi rehberliğinde amniyon sıvısı aspire edildikten sonra gebelik kesesi içine
uygulandı. Bir gün sonraki ultrasonografik muayenede, gebelik kesesinin serviksin iç ağzına kadar
indiği görüldü. Kan tetkikleri stabil devam eden hastanın, minimal vajinal kanaması olduğu
gözlendi. Tedavinin 4. gününde β-hCG değeri 12280 U/L, hemoglobin değeri 7.8 g/dL idi. 2 ünite
eritrosit süspansiyonu transfüzyonu yapıldı. Tedavinin 7. gününde β-hCG değeri 9000 U/L olup,
hemoglobin değeri 11.6 g/dL idi. Tedavinin 17. gününde, gebelik kesesinin serviksin iç ağzından
aşağıya yer değiştirmediği, β-hCG değerinin 3449 U/L olduğu görüldü. Vajinal kanaması mevcut
olan hastaya küretaj uygulandı. Müdahale sonrası 2 günlük sürede takiplerde sorunu olmayan hasta
taburcu edildi. Halen takipte olan hastanın ek bir sağlık sorunu gözlenmedi.
Sonuç: Sezaryen skar gebeliğinde medikal tedavi, cerrahi tedaviye göre daha uzun süre takip
gerektiren bir yöntemdir.
Anahtar Kelimeler: Sezaryen skar gebeliği, ektopik gebelik, tedavi, metotreksat
[V-006]
Posterior Üretral Valv Prenatal Tanısı
Doruk Cevdi Katlan
Posterior Üretral Valv (PÜV), gebelikte 1/5000-8000 sıklıkla görülen ve erkek fetusları
etkileyen bir sorundur. Erkek yeni doğanlarda üriner trakt tıkanıklığının en sık nedenidir. Çocuk hasta
grubunda, tıkanıklığa bağlı kronik böbrek hastalığının en sık nedeni de PÜV’dir.
Erkek üretrasının normal embriyonik gelişimi 9-14 hafta arasında gerçekleşir. 4-6 haftalarda
kloaka, ürogenital sinüs ve anorektal kanalı oluşturacak şekilde ayrılır. Ürogenital sinüs, mezonefrik
(Wolffian) kanal ile birleşir. Bu yapının yukarı kısmı vezikoüretral kanalı ve sonrasında mesane ve
pelvik üretrayı oluşturur. Aşağı kısmı ise, genital tüberkülü ve sonrasında fallik-penil üretrayı
meydana getirir. PÜV oluşumunun mekanizması tam olarak bilinmemekle birlikte, obstrüktif
persistan bir ürogenital zar oluşumuna yol açan bir gelişim sorunu olduğu düşünülmektedir. Bu
konuda çeşitli teoriler mevcuttur. Bunlar arasında; ürogenital zarın persistansı ve eşlik eden anormal
üretral kanalizasyon, üretrovajinal katlantıların fazla gelişimi, mezonefrik kanalın posterior üretraya
anormal entegrasyonu sayılabilir. PÜV, 1919 yılında Young tarafından üç tipe ayrılmıştır. Bunlardan
en sık rastlanılan Tip 1, vakaların %90’ını oluşturmaktadır. 1990 sonrasında, bu tiplerin aslında tek bir
patolojik durum kaynaklı olduğu ve PÜV’in veru montanum ile ilişkili oblik bir zardan kaynaklandığı
kabul edilmiştir (Congenital Obstructive Posterior Urethral Membrane, COPUM).
PÜV olgularının %50’si prenatal ultrasonografi ile tanınmaktadır. Temel bulgu, megasistis
görünümüdür. İlk trimester ( 10-14 hafta) mesane çapının, normal sınır olan 6 mm’yi veya fetal
CRL’nin %10’unu aşması megasistis olarak tanımlanır ve 1/1800 sıklıkta görülür. Çoğu spontan
çözülmekle birlikte, mesane çapı 17 mm üzeri olan durumlarda alt üriner trakt tıkanıklığı düşünülür.
Megasistis, %25 anöploidi ve %33 diğer anomaliler (üretra atrezisi, Prune Belly Sendromu vb.) ile
ilişkilidir. Megasistis’in ancak %25’i PÜV kaynaklıdır.
PÜV, erkek fetuslara özgü ve tipik ultrason bulguları olan bir patolojidir. Sonografik
incelemede, megasistis + dilate arka üretra görünümü (anahtar deliği bulgusu = keyhole sign),
mesane duvar kalınlaşması (>3mm), mesane divertikülü, patent urakus, hidronefroz, artmış renal
ekojenite, kortikal kistler, renal displazi, üriner asit, perinefrik ürinom, oligohidramnioz sık rastlanılan
bulgulardır. 24 haftadan daha erken ortaya çıkan, hidronefroz, renal displazi veya oligohidramniozun
eşlik ettiği PÜV olgularında perinatal mortalite %90-95’lere çıkmaktadır. Oligohidramnioza bağlı
pulmoner hipoplazi ve postnatal kronik böbrek hastalığı en önemli morbiditeler olarak sayılabilir.
Veziko-amniyotik şant ile tedavi edilen olgularda dahi postnatal renal yetmezlik oranı %57 olarak
bildirilmiştir.
Bu sunumda, kliniğimizde takip edilen 2 PÜV olgusuna yer verilmiştir. Bunlardan ilki erken
başlangıçlı olup ilk trimesterde intrauterin spontan ölüm sonrası tahliye edilmiştir. Diğerine ise, geç
başlangıçlı olması nedeniyle başarılı bir veziko-amniyotik şant uygulaması yapılmış ancak gebelik
işlemden 1 ay kadar sonra spontan intrauterin ölüm nedeniyle sonlanmıştır.
2015perinatal Kabul:Sözel
Toplam: 1
[SS-001]
Fetal Iniensefali
Doruk Cevdi Katlan
İniensefali, 1/1000 – 1/100 000 sıklıkta görülen ciddi ve çoğunlukla yaşamla bağdaşmayan bir
anomalidir. Adı, Yunanca “ense” anlamına gelen “inion” kelimesinden gelmektedir. İlk kez 1836
yılında Sainte-Hilaire tarafından tanımlanmıştır. Temel bulguları, foramen magnum genişlemesiyle
birlikte değişken derecelerde oksipital kemik defekti, kafanın ciddi retrofleksiyonu ve bu nedenle
yukarı bakan yüz (kısa omurga, boyun yokluğu, aşırı lordoz), servikal ve torakal vertebraların yokluğu
veya var olanların düzensiz füzyonu ile beraber seyreden spinal defekt olarak sayılabilir. İniensefali
sıklıkla kız fetusların hastalığıdır. Her ne kadar tam anlamıyla bir nöral tüp defekti olmasa da, birçok
kaynakta bu grupta ele alınır. Postmenstrual 3. hafta civarında gelişimin duraklaması, buna bağlı
embriyonik servikal retrofleksiyonun persistansı ve üst torakal-servikal omurlar seviyesinde “nöral
oluk” kusurundan kaynaklandığı düşünülmektedir.
1897 yılında Lewis tarafından ensefalosel eşlik eden olgular iniensefali apertus; etmeyenler
ise iniensefali klasus olarak sınıflanmıştır. Howkins ve Lawrie 1939 yılında iniensefalileri, anensefali ile
birlikte olanlar ve olmayan basit iniensefaliler olarak ikiye ayırmıştır. Bazı yeni yayınlarda (Guala,
2013) iniensefalinin bir sendromun bileşeni olabileceği vurgulanmaktadır.
İniensefaliye, başta merkezi sinir sistemi ile ilgili olmak üzere birçok anomali eşlik
edebilmektedir. Bunlar arasında; anensefali (%42), spina bifida (%34), ventrikülomegali (%21),
raşişizis (anensefali + spina bifida, %17), ensefalosel (%17), diyafragma hernisi, omfalosel (%21), tek
umbilikal arter (%13), holoprozensefali, yarık damak-dudak, duodenal atrezi, kistik higroma, pes
ekinovarus sayılabilir. Bir seride iniensefali olgularının %31’inde Trizomi 18, Trizomi 13, Monozomi X
gibi kromozomal anomaliler de bildirilmiştir.
Multifaktöriyel bir hastalık olan iniensefalinin başlıca risk faktörleri arasında düşük sosyoekonomik seviye, kötü beslenme, folik asit eksikliği gibi çevresel etkenler, obezite, ilaç kullanımı,
düşük parite, hiperhomosisteinemi sayılabilir. Önceki gebelikte iniensefalili çocuk hikayesi olan
kadınların sonraki gebeliklerinde aynı problem ile karşılaşma ihtimalleri %5 olarak bildirilmektedir.
İniensefalinin prenatal tanısı dikkatli yapılan bir ilk trimester ultrasonografi taraması ile
konulabilir. Literatürde bildirilmiş en erken olgu 9. gebelik haftasında tanınmıştır. Hastalığın bazı
özellikler açısından benzer ancak farklı prognoz gösteren diğer patolojilerden doğru ayırıcı tanısının
yapılması esastır. Fetal servikal hiperekstansiyon, nukal kitleler (teratom, guatr, lenfanjiyom), KlippelFeil Sendromu (servikal vertebra segmentasyon kusuru), Jarcho-Lewin Sendromu (Spondilokostal
Disostoz), servikal meningomiyelosel ve ensefalosel iniensefaliye benzer bulgular verebilir.
İniensefali, vakaların yaklaşık tamamında intrauterin veya erken postpartum dönemde ölüm ile
sonuçlanır. Literatürde çok nadiren, bazı hafif formlarda yaşayan vakalar bildirilmiştir.
Bu sunumda, kliniğimize son 2 yıl içerisinde başvuran 6 iniensefali olgusuna yer verilmiştir.

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