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    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, Ali
    ObjectiveTo 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.
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    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, Ali
    Purpose 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.
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    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, Ali
    Objective: 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.
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    The relationship between inflammation markers and ketonuria in hyperemesis gravidarum
    (Wiley, 2021) Soysal, Cenk; Isikalan, Mehmet Murat; Biyik, Ismail; Erten, Ozlem; Ince, Onur
    Objective Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients. Material and Methods This retrospective case control study was conducted at Kutahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients' demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated. Results MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001). Conclusion Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.
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    Role of the systemic immune-inflammation index in threatened abortion patients and predicting of abortion
    (Wiley, 2023) Soysal, Cenk; Sari, Hatice; Isikalan, Mehmet Murat; Ozkaya, Eren Berkay; Ulas, Ozlem; Tasci, Yasemin; Keskin, Nadi
    Purpose: Our study aimed to compare the systemic immune inflammation index (SII), one of the hematological inflammation parameters, between pregnant women diagnosed with threatened abortion (TA) and healthy pregnant women, and to evaluate the prediction of abortion in pregnant women with TA. Methods: This retrospective study compared 150 patients with TA group and 150 age- and gestational week-matched healthy pregnant women (control group). Complete blood count parameters were assessed. SII, white blood cells (WBC), neutrophil to lymphocyte ratio (NLR), red cell distribution width (RDW), plateletcrit (PCT), platelet distribution width and monocyte to lymphocyte ratio (MLR) values were calculated. The SII value was calculated as follows: platelet count x (neutrophil/lymphocyte). Results: SII, NLR, MLR, WBC, RDW, and PCT values were significantly higher in the TA group compared to the control group (923 +/- 683 vs. 579 +/- 364 [p < 0.001], 3.3 +/- 2.0 vs. 2.1 +/- 1.1 [p < 0.001], 0.3 +/- 0.1 vs. 0.2 +/- 0.2 [p < 0.001], 9.84 +/- 2.87 vs. 8.6 +/- 1.6 [p < 0.001], 13.9 +/- 1.9 vs. 14.4 +/- 2.3 [p = 0.032] and 0.3 +/- 0.1 vs. 0.2 +/- 0.0 [p < 0.001], respectively). Using receiver operating characteristics curve analysis to predict abortion in AI patients, the highest area under the curve was found for SII (0.727 for SII and 0.666 for NLR). Conclusion: SII, NLR, MLR, RDW, and platelet to lymphocyte ratio (PLR) levels were significantly increased in patients with TA. This study supports the idea that several inflammatory pathways may play an important role in the pathogenesis of this disorder. SII may be a much better marker than NLR and PLR for predicting the inflammatory status of the disease and abortion in an ongoing pregnancy.
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    Ultrasonographic Imaging of the Fetal Duodenal Tract
    (Wiley, 2022) Toprak, Erzat; Isikalan, Mehmet Murat
    Objectives To investigate whether fetal duodenal tract sections can be visualized in the prenatal ultrasonographic examination. Methods This study was designed in cross-section. Healthy singleton pregnant women who applied to the perinatology outpatient clinic for second-level ultrasound scanning between September 2020 and February 2021 were included in the study. Demographic information of the participants was obtained and an ultrasound scan was performed. The fetal duodenal tract was evaluated in three sections, including the pylorus. The fetal duodenal tract was differentiated from adjacent organs by its anatomical location, hyperechoic nature, and presence of fluid in the lumen. Results A total of 278 eligible participants between 18 and 22 weeks of gestation were evaluated. While the fetal pylorus was closed in 76.6% of the participants, it was open in 23.4%. Duodenum pars superior, pars descendens, and pars inferior imaging rates were 99.3%, 98.2%, and 95.7%, respectively. It was possible to distinguish these parts from neighboring organs by 99.6%, 100%, and 100%, respectively. While the first, second, and third parts of the duodenum were observed as solid in 42.0%, 58.2%, and 52.2%, respectively, 57.9%, 41.7%, and 47.7% had fluid in the lumen. Conclusion The fetal duodenal tract can be viewed with prenatal ultrasonography in pregnant women who are not in a dorsoanterior position. This may make an additional contribution to the diagnosis of duodenal obstructions, which is the most common cause of intestinal atresia in prenatal screening.
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    The value of measuring cervical length between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy
    (Taylor & Francis Ltd, 2021) Soysal, Cenk; Isikalan, Mehmet Murat
    Objective The aim of this study was to investigate the value of measuring cervical length (CL) between 24 and 28 weeks of gestation for predicting the risk of late and post-term pregnancy. Methods In this prospective longitudinal study, pregnant women whose CL was measured between 24 and 28 weeks were followed until delivery. The CL was adjusted for confounders and the results are presented using odds ratio and receiver operating characteristic curve (ROC). Results A total of 874 women met the inclusion criteria. The median value of CL measured between 24 and 28 weeks was 34.0 mm (30.0-38.0 25%, 75% interquartile range). The risk of late and post-term pregnancy was 5.8 times higher in pregnant women with a CL above 35 mm between the 24 and 28 weeks of gestation (95% CI: 2.65-12.94 adjusted OR = 5.8, p < .001). For pregnancies exceeding the 38th week, it was observed that the duration of the gestation increases as CL values increase. Conclusions In this study, it has been demonstrated that measuring the CL between 24 and 28 weeks of gestation can predict late and post-term pregnancy. Prolonged pregnancy may cause neonatal and fetal complications and anxiety. CL measurement performed in these weeks can help prepare pregnant women for a possible prolonged pregnancy and cope with prolonged pregnancy anxiety.