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Öğe Alternative surgical approach for the management of uterine prolapse in young women: Preliminary results(Wiley-Blackwell, 2013) Karatayli, Rengin; Balci, Osman; Gezginc, Kazim; Yildirim, Pinar; Karanfil, Fikriye; Acar, AliAimTo demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. MethodsThe study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. ResultsMean age of patients was 35.54.1 years (range, 28-41). Mean parity in the study group was 2.6 +/- 1.0 (range, 1-5). Mean operation time was 32.0 +/- 5.2min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 +/- 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. ConclusionAbdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results.Öğe Cesarean Scar Pregnancies and Reproductive Outcomes: A Single Center Experience(Türkiye Klinikleri, 2023) Doğru, Şükran; Akkuş, Fatih; Altınordu Atcı, Aslı; Eren, Gülnur; Acar, AliObjective: The rising rate of cesarean delivery increases the occurrence of cesarean scar pregnancies (CSP). Early diagnosis and treatment of CSP have become the subject of considerable interest in recent years because of the risk of life-threatening uterine bleeding and rupture. The aim of this study was to share the results of ultrasonography (USG)-guided dilation and curettage (D&C) and hysterotomy in treating early CSP and the long-term reproductive results in these cases. Material and Methods: Patients diagnosed with CSP admitted to the perinatology clinic between January 2016 and April 2020 were included in this study. USG-guided D&C was recommended for all patients diagnosed with CSP in the first trimester (<= 12 gestational weeks). Hysterotomy was recommended for patients who could not undergo D&C. All patients' demographic data and procedure results were retrieved retrospectively from electronic records, and reproductive anamneses after the procedure were obtained from patient files and telephone calls. Results: Sixty-three patients who underwent USG-guided D&C and hysterotomy were included in the study. While D&C was successful in 93.65% ( n=59) of these patients, 6.35% (n=4) underwent hysterotomy. In the USG-guided D&C group, the infertility rate was 15.78% (n=6), the rate of the recurrent scars was 9.3% (n=3), and the rate of placenta accreta spectrum was 6.25% (n=2). The term healthy pregnancy rate was 64%. Conclusion: In experienced hands, USG-guided D& C can be considered the first choice in early scar pregnancies. We believe that similar reproductive results would be obtained when D&C and other treatment modalities were compared in CSP treatment.Öğe Conservative management of placental invasion anomalies with an intracavitary suture technique(Wiley, 2018) Acar, Ali; Ercan, Fedi; Pekin, Aybike; Atilgan, Adeviye Elci; Sayal, Hasan Berkan; Balci, Osman; Gorkemli, HueseyinObjective: To assess the efficacy and safety of a new surgical suture technique for uterine preservation among patients with placental invasion anomalies. Methods: The present prospective case series included women diagnosed with placental invasion anomalies undergoing cesarean deliveries who desired future fertility at the obstetrics department of a Turkish university hospital between January 10, 2013, and April 20, 2017. Patients were diagnosed with ultrasonography and Doppler ultrasonography; the type of placental invasion anomaly (placenta accreta, increta, or percreta) was confirmed intraoperatively. Surgical management involved an intracavitary suture technique after the proximal branch of the uterine artery was clamped and utero-ovarian anastomoses had been blocked. Outcomes included units of blood transfused, intraoperative and postoperative adverse events, duration of hospital admission, and hysterectomy rate. Results: There were 62 patients included. The mean operative blood loss was 1350 +/- 750mL (range 600-5000 mL). Blood transfusion required a mean of four units (range 2-15). Bleeding was controlled with the intracavitary sutures in 58 (94%) patients. Three patients experienced postoperative wound infections and two patients developed endometritis that required therapy with broad-spectrum antibiotics. The mean length of hospital stay was 3.61.6 days (range 2-11). None of the patients required reoperation after the initial surgery. Conclusion: The novel uterus-sparing suture technique was highly effective among patients with placental invasion anomalies.Öğe Discussion on Provincial Evaluation Results of Maternal Mortality in Terms of Preventability: Commission Decision Differences in Konya(2018) Durduran, Yasemin; Soysal, Sema; Başaran, Mustafa; Çelik, Çetin; Acar, Ali; Doğan, Canan; Kaya, Hüsnü Murat; İzgi, Şule; Öznavruz, HasanObjective: The objective of this study was to investigate the risk factors of maternalmortality in Konya province, as well as the preventability of deaths in cases where the central andlocal commissions differed in their decisions. Material and Methods: Maternal mortality between2009 and 2014 in the Konya province was screened for the cases, where the central and local MaternalMortality Investigation Commissions gave different decisions. These differences pertain towhether the deaths were ‘preventable’ or ‘not-preventable’, differences in the first, second andthird delay models, and indirect, direct and incidental deaths. The data were evaluated electronicallyalong with a descriptive statistical analysis, differences in the decisions and compliance inthe mortality rates were evaluated. Results: The median age of the deceased mothers was 28 (21–44) years and 83.3% of the mothers had at least one mortality risk factor. While the overall maternalmortality rate was 36.7% within the first 48 h after birth, the rates were highest within thefirst 48 h after birth (26.7%) and between the 1st and 42nd day after birth (26.7%) in indifferentlyassessed cases. The cause in 30% of all deaths and 33.3% of deaths with differential assessmentswas postpartum hemorrhage, as per the results of central Maternal Mortality InvestigationCommissions. The decisions of the central and local commissions differed in terms of preventability,delay models or death classification in 50% of the deaths. Taken together, the compliancebetween central and local decisions was not precise in investigating maternal mortality. Conclusion:The first 48 h after birth and the postpartum period are particularly critical. The causes ofdeath, particularly postpartum hemorrhage, should be thoroughly investigated. We recommendperiodic re-evaluations of cases where different decisions were made, in order to lower the rate ofpreventable maternal mortality.Öğe Does mild thrombocytopenia increase peripartum hemorrhage in elective cesarean deliveries? A retrospective cohort study(Wiley, 2021) Isikalan, Mehmet Murat; Ozkaya, Eren Berkay; Ozkaya, Busra; Ferlibas, Enes; Sengul, Nurullah; Acar, AliObjectiveTo investigate the effect of mild thrombocytopenia (platelet count: 100 000-149 000/mu l) on peripartum hemorrhage in elective cesarean deliveries. MethodsThis study was conducted between January 2018 and May 2019 in a hospital, located in Konya, Turkey. Uncomplicated pregnancies undergoing elective cesarean section were included. Of 1992 eligible patients, 201 women were determined as the mild thrombocytopenia group, 48 women as the severe thrombocytopenia group, and 1743 women as the control group. The estimated blood loss volume (EBLV), the need for blood transfusion, and excessive blood loss rates were compared among groups. Logistic regression analysis was performed for potential confounding factors. ResultsThe EBLV and excessive blood loss ratios were significantly higher in the mild thrombocytopenia group compared with the control group (P < 0.001 and P < 0.05, respectively). There was no significant difference between the mild thrombocytopenia and control groups in terms of the number of patients receiving a blood transfusion. The probability of excessive blood loss was significantly higher in the mild thrombocytopenia group, even after adjusting the odds ratio for confounding factors (adjusted odds ratio 1.94, 95% confidence interval 1.27-2.95, P = 0.002). ConclusionMild thrombocytopenia appears to increase the likelihood of peripartum hemorrhage in elective cesarean deliveries in uncomplicated pregnancies. Mild thrombocytopenia can increase estimated blood loss volume and the rate of excessive blood loss in elective cesarean operations.Öğe Does wearing double surgical masks during the COVID-19 pandemic reduce maternal oxygen saturation in term pregnant women?: A prospective study(Springer Heidelberg, 2022) Isikalan, Mehmet Murat; Ozkaya, Busra; Ozkaya, Eren Berkay; Gumus, Meryem; Ferlibas, Enes; Acar, AliPurpose This study aimed to compare the effects of using single and double surgical masks (SM) on maternal oxygen saturation in pregnant women. Methods In this prospective study, single or double SM were worn by term pregnant women who applied for routine controls. The vital signs of the participants such as oxygen saturation, pulse, respiratory rate, fever, systolic and diastolic blood pressure were measured at admission and 30 min later. Results There were 223 participants in the single SM group and 231 participants in the double SM group. Thirty minutes after putting on the mask, there was no significant difference in the proportion of patients whose oxygen saturation fell below 95 (3.6 vs 5.6%, p = 0.301). No significant difference was observed between the admission and 30 min oxygen saturation levels of the pregnant women in the single SM group. However, maternal oxygen saturation after 30 min of the pregnant women in the double SM group was significantly lower (97.4 +/- 1.1 vs 96.6 +/- 1.3, p < 0.001). No significant changes were observed in the vital signs of either groups. Conclusion When using double SM, oxygen saturation is significantly reduced compared to pre-mask values. Nevertheless, it seems difficult to say that these decreases have clinical significance.Öğe Effect of cervical changes on the cesarean scar area and niche formation after preterm and term cesarean sections(Springer Int Publ Ag, 2023) Dogru, Sukran; Akkus, Fatih; Atci, Asli Altinordu; Erdogan, Kubra Memnune; Acar, AliObjectiveThe purpose of this study is to assess the scar area and niche formation after cesarean section in women who had preterm or term deliveries and underwent cesarean section at various stages of labor. MethodThis prospective cohort study consists of cases who underwent the first cesarean section for different obstetric reasons. The patients were divided into four groups regarding gestational age and cervical dilatation. After a cesarean section, all patients were called for vaginal ultrasonography control at 12 weeks. The location of the scar and the presence of a niche were evaluated. The residual (RMT), proximal, and distal myometrial thicknesses were evaluated where the scar and niche were located. ResultsA total of 87 cases were included in the study. There was no difference in the prevalence of niche between the groups (p > 0.05). RMT and proximal and distal myometrial thickness were not different between the 37 >= week and 37 < week groups, while RMT and proximal and distal myometrial thickness were significantly lower in women with active labor (p =0.001, p= 0.006, p =0.016). The location of the scar was the isthmus at 37 weeks and above (p= 0.002), it was in the cervical canal in the group below 37 weeks (p= 0.017). ConclusionThe gestational week and cervical changes did not affect the prevalence of the niche. In cases of active labor and preterm deliveries, the CS scar defect was located in the cervical canal; however, in cases of term deliveries, it was located in the isthmic area.Öğe Effect of previous cesarean sections on second-trimester uterine artery Doppler(Wiley, 2020) Isikalan, Mehmet M.; Yeniceri, Hacce; Toprak, Erzat; Guleroglu, Filiz Y.; Acar, AliAim In this study, we investigated the effects of previous cesarean sections on uterine artery Doppler indices. Methods This prospective cohort study included 153 healthy pregnant women between 18 and 24 weeks of gestation. Seventy-three pregnant women without previous cesarean sections (control group) and 80 pregnant women with previous cesarean sections (study group) were compared in terms of uterine artery Doppler indices. Results The mean uterine artery pulsatility index (PI) MoM value was 1.18 +/- 0.40 in the study group and 1.07 +/- 0.35 in the control group (P= 0.046). The number of patients with uterine artery PI values above 95 percentile was 18 (22.5%) in the study group and 5(6.8%) in the control group (P= 0.007). The mean gestational age at birth was significantly lower in the study group (38.2 +/- 1.3 vs. 39 +/- 1.0,P < 0.001). There was no significant difference between the mean PI, resistance index (RI) and systolic/diastolic (S/D) ratio values of the uterine artery (P= 0.16, 0.11, 0.08, respectively). When the comparison was made with the number of previous cesarean sections, all three index values of the patients who had had more than two cesarean sections were found to be significantly higher. Conclusion The Doppler flow indices of the uterine artery significantly increased in patients with more than two previous cesarean sections. When evaluating uterine artery Doppler indices in pregnant women with a history of previous cesarean sections, these factors should be considered.Öğe Fetal Kan Örneklemesi: Derleme(2016) Acar, Ali; Ercan, Fedi; Sayal, BerkanFetal kan örneklemesi ilk olarak perinatal toksoplazmozis olgusunu değerlendirmek için Daffos tarafından 1983 yılında tarif edilmiştir. Teknik hızla kabul görmüş ve birçok başka endikasyonla da kullanılmaya başlanmıştır. Özellikle izoimmünizasyonun tanı ve tedavisinde devrim niteliğinde bir gelişime neden olmuştur. Diğer yaygın endikasyonları ise fetal anomlali tespit edildiğinde hızlı karyotip değerlendirmesi, gelişme gerilkiklerinin değerlendirilmesi, fetal trombosit anomalilerinin değerlendirilmesi (maternal immün trombositopenik purpura, fetal alloimmün trombositopeni, TAR sekansı gibi), fetal hidropsun değerlendirilmesi, potansiyel fetal infeksiyonların değerlendirilmesi ve genetik risk altındaki fetuslarda fetal hemoglobinopatilerin değerlendirilmesidir. Komplikasyonları arasında fetal bradikardi, koriyoamniyonit, erken membran rüptürü ve preterm travay, fetal kanama, fetal distres ve kordonda hematom oluşumuna bağlı fetal ölüm, ablasyo plasenta ve hava embolisi yer almaktadır.Öğe Fetoscopic surgery for amniotic band syndrome: Case series(Wiley, 2023) Dogru, Sukran; Acar, AliWe aimed to evaluate the fetoscopic procedure indications, procedure-related complications, and neonatal outcomes in cases diagnosed with amniotic band syndrome (ABS). Stage II and III cases according to Husler classification were included for fetoscopic surgery. Scissors were used to release the amniotic band in six cases, and a diode laser was used in one case. A single entry was made in all cases. The majority of the children acquired a functional limb (71.4%). Fetal morbidity was mainly linked to the consequences of preterm premature rupture of the membranes (57.1%) and preterm birth (28.5%). Excluding complicated cases, fetoscopic band release is encouraging in cases of ABS in the limbs.Öğe Genetic Amniocentesis Results: Analysis of the 3721 Cases(2016) Acar, Ali; Ercan, Fedi; Yıldırım, Selman; Görkemli, Hüseyin; Gezginç, Kazım; Balcı, Osman; Toy, Harun; Zamani, Ayşegül; Sarıkaya, Sevcan; Sayal, Berkan; Çapar, Metin; Çolakoğlu, Mehmet CengizAmaç: İkinci trimester genetik amniyosentez ile fetal kromozomal anomalileri saptamada 7 yıllık prenatal tanı verilerinin retrospektif olarak analizi.Gereç ve Yöntem: Veriler Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda Ocak 2007 ile Ocak 2014 tarihleri arasında yapılan ikinci trimester genetik amniyosentezlerin amniyosit kültürü sitogenetik analizi verilerinden oluşturulmuştur. Amniyosentez için ana endikasyonlar ileri anne yaşı, anormal maternal serum taraması sonuçları ve anormal ultrason bulgularından oluşmaktadır. Kromozomal anomaliler; otozomal anöploidiler, seks kromozomu anöploidileri, poliploidiler ve yeniden düzenlenmeleri kapsamaktadır. Bulgular: Kromozomal anomalilerin teşhisi için toplam 3721 amniyosentez yapıldı. Bunların 1677'si (%45.1) anormal maternal serum taraması sonuçları, 1332'si (%35.8) ileri anne yaşı, 586'sı (%15.8) anormal ultrason bulguları ve 126'sı da (%3.3) diğer nedenlerle yapıldı. Kromozomal anomali toplam 131 (%3.6) vakada tespit edildi. Bunların 53'ü ileri anne yaşı, 37'si anormal serum tarama testi sonucu, 34'ü anormal ultrason bulguları ve 7'si diğer nedenlerle amniyosentez yapılan vakalardı. Kromozomal anomali teşhis edilen hastaların 106'sında (%80.9) sayısal kromozomal anomali vardı. Diğer 25 (%19.1) hastada ise yapısal kromozomal anomali tespit edildi. Sonuçlar: Verilerimiz terminasyon konuları ve sonraki gebelikler ile ilgili olarak günlük pratikte uygun genetik danışmanlık sağlanabilmesi için bir veritabanı sağlayabilir.Öğe Hirsutism'de ketokonazol kullanımının hormonal ve klinik etkileri(Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, 1998) Acar, Ali; Onur, ErgünHetokonazol, oral kullanılan imidazol türevi antimikotik bir ajandır. Gonodal ve adrenal steroid sentezi Üzerine stok- rom p-450 enzimlerini bloke etmek suretiyle inhibitor etki yapar. Düşük dozlarda 17-alfa hidroksi laz ve 17-20 l yase enzimleri üzerine selektif inhibisyon ile androjen sentezini engellediğinden hirsutism' 1 i hastalarda kullanılabileceği ileri sürülmüştür. Çalışmamızda, ket okonazol ' ü 1 ay 1000 mg/gün yüksek dozda, 2 ay 400 mg/gün düşük dozda kullanarak, 58 hirsutism' 1 i kadında hormonal ve klinik etkilerini inceledik. Hastalarımızın 5£ si tedavi yi tamamladı. 3 Ay sonunda free testesteron, total testesteron, DHEfiS değerlerinde ve Ferriman-Gal lway skorunda düşme tespit edildi. £9 Hastada çeşitli yan etki 1er, 5 hastada ise transami nazlarda yükselme gözlendi. Ketokonazol' ün,hirsutism tedavisinde kullanılan diğer preparatlara bir üstünlüğü bulunamamıştır. fiksine, bu tedavide uzunca bir süre kullanımı gerektiğinden başta karaciğer olmak üzere gastroent est inal sisteme de yan etkileri mevcuttur. Bu nedenle hirsutism tedavisinde kullanımının bir avantaj sağlamadığı kanaatine varılmıştır.Öğe İniensefali clausus: Olgu sunumu(2017) Ercan, Fedi; Sarıkaya, Müslüm; Tazegül Pekin, Aybike; Sarıkaya, Sevcan; Acar, Aliİniensefali başın fikse hiperekstansiyonu ve kısa, immobil boyun ile karakterize nadir bir nöral tüp defektidir. Bu bozukluk servikal veya torakal vertebrayı içine alan vertebra defekti (rachischisis) ve servikal omurga ile boynun hiperekstansiyonu gibi iki karakteristik bulgu ile tanımlanmaktadır. Sıklığı 0.1-10/10,000 arasında değişir ve fetusların %90'dan fazlası kızdır. İniensefali apertus ve iniensefali clausus olmak üzere iki tipi vardır. Erken tanı ve terminasyon ile maternal riskler azalır. Anneye gelecekteki gebelikleri için folik asit takviyesi alması yönünde önerileride bulunulmalıdır. Burada prenatal dönemde tanı alan iniensefali clausus olgusunu sunulmaktadır.Öğe The initial number of fetuses in multiple pregnancy before reduction affects perinatal outcomes(Wiley, 2023) Akkus, Fatih; Dogru, Sukran; Atci, Asli Altinordu; Dal, Yusuf; Arici, Elifsena Canan Alp; Acar, AliObjective: In this study, we aimed to evaluate the perinatal outcomes of dichorionic diamniotic (DCDA) twin pregnancies reduced by the fetal reduction (FR) procedure and cases with continuing DCDA twin pregnancies without FR. Materials and Methods: FR performed in a university hospital in the last 10 years was evaluated. Pregnancies reduced to DCDA twin pregnancies by reduction from three or more pregnancies and pregnancies that started with DCDA twins and continued with DCDA twins were compared in terms of perinatal outcomes. In the subgroup analysis, those who were reduced from three-chorionic three-amniotic (TCTA) triplets to DCDA twins and those who were reduced to DCDA twin pregnancies from four or more were compared in terms of perinatal outcomes. Results: A total of 119 pregnant women were included in the study, 36 patients underwent FR, while 83 patients were DCDA twins who did not undergo FR. The groups were similar in terms of preterm delivery (p = 0.370). There was a higher rate of miscarriage (21.4% vs. 0.0%, p = 0.019) in the group that was reduced to DCDA twins from quadruplet and above pregnancies compared to the group that was reduced from TCTA triplets to DCDA twins. The gestational week at birth was lower in the group reduced to DCDA twins from quadruplets and above pregnancies (31.00 +/- 4.31 vs. 34.64 +/- 2.88, p = 0.019). Conclusion: The study's results show that the perinatal outcomes of multiple pregnancies with and without FR are the same As the number of reduced fetuses increases, the rates of preterm birth and miscarriage also increase.Öğe Long-Term Results of an Imperforate Hymen Procedure that Leaves the Hymen Intact(Springer India, 2021) Acar, Ali; Ercan, Fedi; Balci, Osman; Elci Atilgan, Adeviye; Alan, Cemre; Niftiyev, KemalPurpose of the Study The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period. Methods A Foley's catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley's catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days. Results The mean age of the patients at the time of this study was 28.3 +/- 2.6 years, and the mean age at diagnosis was 13.2 +/- 2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse experience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus. Conclusion A circular incision with insertion of Foley's catheter prevents many social problems by preserving the hymen's architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.Öğe Management of Adnexal Torsion: A 13-Year Experience in Single Tertiary Center(Mary Ann Liebert, Inc, 2019) Balci, Osman; Energin, Hasan; Gorkemli, Hueseyin; Acar, AliPurpose: Adnexal torsion constitutes 2.7% of gynecological emergencies, it is more frequently seen in reproductive age. Delay in diagnosis and treatment may lead to loss of the ovary. In this study, we aimed to assess patients who had adnexal torsion and compare laparoscopy with laparotomy in the treatment of these patients and point the most appropriate surgery according to age groups of the patients and comparison of patient characteristics and management between adnexal torsion in postmenopausal and premenopausal patients. Materials and Methods: This study was carried out in Necmettin Erbakan University, Meram Medicine Faculty, Department of Obstetrics and Gynecology. The study retrospectively analyzed 380 patients presented to our clinic with abdominal pain between January 2005 and December 2017 and had surgery for adnexal torsion. Results: The study included 380 patients who had surgery for adnexal torsion. A total of 220 patients had laparoscopy and 160 patients had laparotomy. Laparoscopy group consisted of young patients with low parity, whereas laparotomy group consisted of 160 patients of which 92 (57.5%) were in menopause. Teratomas were the most common pathological finding followed by follicular cysts. Fourteen ovarian malignancies and 11 borderline tumors had been reported. Eleven ovarian malignancies had been reported in postmenopausal patients and three in premenopausal patients. Conclusion: Laparoscopic surgery is preferred for young patients who want to preserve their fertility, but postmenopausal ovarian masses presenting with torsion should be analyzed with frozen section whenever possible, if not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.Öğe Nadir Görülen Bir Fetal Anomali, Meckel-Gruber Sendromu: Olgu Sunumu(2016) Ercan, Fedi; Sayal, Berkan; Bayman, Melike; Görkemli, Hüseyin; Acar, AliMeckel-Gruber sendromu nadir görülen, otozomal resesif geçiş gösteren ve ana bulguları renal kistik displazi, ensefalosel ve polidaktili olan ölümcül seyreden kalıtsal bir hastalıktır. Bunlardan üçünden en az ikisinin olması tanıyı koydurur. Nadir görülmekle birlikte tekrarlama riski yüksektir. Gebeliğin 11-14. haftalarında yapılan rutin ultrasonografik tarama ile Meckel-Gruber sendromu tanısı konulabilir. Sendroma yönelik bulgular aranarak tanı mümkün olduğunca erken konmalıdır. %25 tekrarlama riski nedeniyle bu hastalar sonraki gebeliklerinde yakın takip edilmelidirler. Bu yazıda intrauterin Mecgel Gruber Sendromu saptanan bir olgu sunulmasını amaçladık.Öğe Peripartum hemorrhage and other obstetric and neonatal outcomes in pregnant women with epilepsy: A single-center study(Elsevier, 2021) Isikalan, Mehmet Murat; Gundogan, Kubra Memnune; Acar, AliObjective: There are inconsistent results in different studies on maternal and fetal complications of pregnant women with epilepsy (PWWE). The differences may be in part due to racial characteristics. The aim of this study was to investigate if there is an increase in obstetric and neonatal complications, especially postpartum hemorrhage, in pregnant women with epilepsy in the Turkish population. Methods: In a tertiary center, PWWE and the control group were compared in terms of obstetric and neonatal complications as well as postpartum hemorrhage. Among 46,789 deliveries, 154 eligible PWWE were matched 1: 3 with the control group. Results: There was no increase in the possibility of peripartum hemorrhage and blood transfusion in PWWE. However, the probability of cesarean delivery was higher in PWWE (adjusted OR: 3.24 CI: 1.95?5.42, p < 0.001). Moreover, an increase in the possibility of fetal growth restriction, fetal death, admission to the neonatal intensive care unit and lower APGAR scores were found in PWWE. Conclusion: Although the risk of peripartum hemorrhage does not appear to be increased in PWWE, cesarean rates and fetal complications do increase. There is also a need for prospective studies examining long-term neonatal outcomes in pregnancies complicated by epilepsy.Öğe Plasenta Akreata Nedeniyle Gelişen Geç Postpartum Kanama Tedavisinde Acar Usulü Kompresyon Sütürü ile Başarılı Tedavi; Olgu Sunumu(2016) Kılıç, Fatma; Acar, Ali; Ercan, Fedi; Sayal, Hasan Berkan; Üstün, DamlanurPlasenta yapışma anomalileri, plasentanın uterin duvar içine doğru anormal şekilde invaze olmasıdır. Plasenta akreata, inkreata ve perkreata olmak üzere 3 grupta incelenir. Burada plasenta akreata nedeniyle postpartum 17. günde başlayan ciddi postpartum kanamanın tedavisinde kullanılan yeni sütür tekniği (Acar usulü kompresyon sütürü) ile tedavi edilen bir olgu sunulmuştur. Hasta 17 gün önce dış merkezde vajinal doğum yapmış ve postpartum 17. günde gelişen abondan vajinal kanama nedeniyle kliniğimize sevk edilmiştir. Ultrason ve litotomi pozliyonunda yapılan jinekolojik muayenesinde kavitede uterus korpus ön duvarda yaklaşık olarak 3x4 cm boyutlarında uterusa dens olarak yapışmış doku palpe edilmiştir. Abondan vajinal kanaması olan hastaya laparotomi ve histerotomi yapılmış, çıkarılan plasental doku sonrası plasental yataktan gözlenen ciddi kanama Acar Usulü Kompresyon Sütürü konularak kontrol edilmiştir.Öğe Predictability of Hematological Parameters in the Diagnosis of Cesarean Scar Pregnancy(Thieme Medical Publ Inc, 2023) Dogru, Sukran; Atci, Asli Altinordu; Akkus, Fatih; Erdogan, Arif Caner; Acar, AliIntroduction Cesarean scar pregnancy (CSP) is an increasing clinical condition that causes serious maternal morbidity and mortality. This study aimed to evaluate if inflammation markers measured by hemogram can aid in the diagnosis of CSP.Materials and Methods A total of 86 patients were included in the study. The cases were divided as CSP ( n : 42) and normal pregnancy (NP) ( n : 44). At the time of admission, peripheral blood neutrophils, lymphocytes, monocytes, thrombocytes, systemic inflammatory index (SII) (neutrophil x platelet/lymphocyte), neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were all measured. CSP and NP diagnoses were made by transabdominal or vaginal ultrasonography.Results In the CSP group, mean age ( p < 0.001), gravida ( p < 0.001), parity ( p < 0.001), number of surviving children ( p < 0.001), number of abortions ( p < 0.001), cesarean number ( p < .001), dilatation and curettage count ( p = 0.013), monocyte (M) value ( p = 0.039) and monocyte/lymphocyte value (MLR) ( p = 0.035) were significantly higher than the control group. The optimal M value cut-off value was found to be > 0.40, the sensitivity value was 78.57, and the specificity value was 50.00. AUC = 0.632 (SE = 0.061) for the MLR value. The optimal MLR cut-off value was found to be > 0.232, the sensitivity value was 61.90, and the specificity value was 63.64.Conclusion Hemogram parameters, which are simple, inexpensive, and easily accessible, M and MLR are significantly higher in the diagnosis of CSP and can be used as an auxiliary parameter for ultrasonography.