Ahmet Gul

A cross-sectional study was conducted to evaluate the efficacy of rescue cerclage in patients with a dilated cervix and prolapsed foetal membranes. Thirty-five patients presenting with cervical dilatation and prolapsed foetal membranes were included in the study. A McDonald cerclage was placed in 27 patients. The duration of pregnancy prolongation and the number of deliveries after 28 weeks were evaluated. The median prolongation of pregnancy after cerclage placement differed significantly between the cerclage and bed-rest groups (64 days versus 13.5 days). Of the 27 patients who had cerclage, 17 (63%) delivered after 28 weeks of gestation, whereas all patients in the bed-rest group delivered before 28 weeks of gestation. The take-home baby rate was 63% in the cerclage group. When pregnancies were complicated by cervical dilatation with membrane prolapse into the vagina, placement of a McDonald cerclage in appropriately selected patients can be a beneficial therapeutic option. Impac...

Objective: To investigate the prevelance of CIN in postmenopausal women in our region. Material and Methods: Between 1997 and 2000 years, 12783 women who applied Menopause Clinic for taking hormone replacement therapy with or without complaints were retrospectively evaluated. Results: Of the 349 cases with abnormal smear findings, 265 were CIN I (%75.8 ), 40 were CIN II (%11.4 ), 6 were CIN III (%2), 2 were carsinoma insituf %0.6 )and 36 were koilocytosis (%10.2 ). General prevelance of abnormal cervical findings in this age group was determined aproximately % 3. Conclusios: Although in women of postmenopausal age early stage servical intraepithelial lesions is seen not rare, it is clearly that they must be evaluated for transformation zone even if they are asymptomatic.

This study reviews maternal and fetal outcomes in HELLP syndrome complicated with acute renal failure (ARF), and compares clinical and laboratory findings of the cases of HELLP syndrome that did not develop ARF. All pregnant women with hypertensive disorders admitted or referred to the maternal and fetal unit were recorded into a perinatal database between January 15, 2002 and September 15, 2003. During the study period, out of 615 cases of hypertensive pregnancy, we followed and delivered 347 cases of severe preeclampsia, of them 132 cases were diagnosed as HELLP syndrome. ARF was defined as creatinine level > or =1.2 mg/dL and/or oliguria <400 mL/24 hr. The cases were divided into three groups on the basis of the highest creatinine level recorded during hospitalization: creatinine <1.2 mg/dL, creatinine > or =1.2 to 2.0 mg/dL, and creatinine > or =2.0 mg/dL. Statistical comparisons were performed by Student t test, X2 analysis, and Fisher's Exact test as appropriate. The value of P < .05 was considered significant. ARF developed in 8.9% (n:31) of severe preeclampsia (n:347); of them, 15 (4.3%) cases were nonoliguric, and all had mildly elevated creatinine levels between 1.2 and 1.9 mg/dL. Moderately elevated creatinine levels were 2 to 3.9 mg/dL in 10 cases, and severely elevated creatinine levels were 4 to 8.4 mg/dL in 6 cases, for a total of 16 (4.6%) cases; creatinine levels were > or =2.0 mg/dL (range: 2.0-8.4 mg/dL). HELLP syndrome was the most frequent cause of ARF, 64.5% (n:20/31), and was observed in 15% (n:20) of 132 cases of HELLP syndrome. Fourteen (88%) of 16 cases that had oliguria and creatinine levels > or =2 mg/dL were detected in HELLP syndrome (n:14/132; 10.6%). Major maternal complications in HELLP syndrome with ARF and creatinine level > or =2 mg/dL in the study group were abruptio placentae (42.8%; n:6/14), incisional hematoma (21%; n:3/14), pulmonary edema (14%; n:2/14), cesarean hysterectomy (7%; n: 1/14), and dialysis (50%; n:7/14). There was no maternal mortality. All patients complicated with ARF were discharged without renal impairment. Perinatal mortality was 26.1% in the cases of HELLP syndrome with…

Joubert syndrome is a rare, autosomal recessive condition, first described by Joubert in 1969. We present a case of Joubert syndrome from a consanguineous family in which, apart from the cerebellar vermis agenesis, ventriculomegaly, bilateral postaxial polydactyly of hands and right foot and micropenis, episodes of fetal breathing pattern with an increased respiratory rate were also demonstrated by prenatal ultrasound scan. At birth the infant showed an odd face and bilateral fleshy nodules of the tongue. He had an abnormal breathing pattern of alternating tachypnea and apnea. Cranial MRI showed molar tooth sign, hydrocephalus and Dandy-Walker malformation. He had nystagmus, and electroretinography showed retinal dystrophy.

A ranula is a mucous extravasation cyst which appears as a swelling in the submental and submandibular regions. We describe a case of congenital ranula or retention salivary cyst diagnosed at 22 weeks' gestation. The fetal growth was normal, as was the amniotic fluid volume. Follow-up ultrasound scans revealed no changes in the size or the position of the cyst. Surgical treatment was performed two days after the delivery. There were no complications and no recurrences have occurred to date.

We describe a case of VACTERL syndrome associated with type 1 unilateral caudal regression syndrome. The abnormal sonographic findings at 26 weeks included hemivertebrae, scoliosis, hypoplastic and deformed lumbar spine and sacrum, preaxial polydactyly on the left hand, duplicated hallux on the left foot and hemihypoplasia of the left lower limb, bilateral club foot, and single umbilical artery. Postmortem examination confirmed prenatal sonographic findings with additional findings of supernumerary rib at the lumbar level and anal atresia.

This study was performed to determine the incidence, symptomatology, complications, mode of delivery, treatment modalities, and risk factors for maternal outcome and perinatal outcome in women with HELLP syndrome. A total of 303 pregnancies with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2002 and 2009. Demographic data, including age, parity, gestational age, and clinical and laboratory findings, were recorded from the medical files. In addition, delivery route, indication of cesarean section, and fetal and maternal complications were determined. Acute renal failure (20.5%) was the most common complication. Eclampsia was present in 303 women with HELLP syndrome (52%). There were four maternal deaths (1.4%). The perinatal mortality rate was 20.3%. The percentages of intracerebral hemorrhage and maternal death were higher in women with eclampsia than in those without (6.3% vs. 0.8%, p = 0.01 and 4.8% vs. 0.4%, p = 0.02, respectively). A nadir platelet count of ≤50,000 cells/mm(3), a peak serum AST of >150 IU/L, and a peak serum LDH of ≥1400 IU/L were not independent risk factors of an adverse outcome. We concluded that the incidence rates of serious maternal and fetal morbidities and mortalities are increased in HELLP syndrome. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse neonatal-maternal outcome. Adequate and prompt diagnosis and management are crucial in patients with HELLP syndrome.

Objective: The purpose of this study was to determine the frequency of chromosomal anomalies among the fetuses with isolated and non-isolated aberrant right subclavian artery (ARSA), and to evaluate the sonographic findings associated with ARSA. Methods: This is a retrospective study conducted during the period between January 2008 and December 2012 at the maternal fetal medicine units of three different referral centers. Results: Among the 148 cases of ARSA, 98 were isolated and 50 were associated with cardiac anomalies, extracardiac malformations or soft markers. Trisomy 21 was the only chromosomal anomaly with a prevalence of 6.8% (10/148). The corresponding rate was 6.1% (6/98) and 8% (4/50) for isolated and non-isolated ARSA, respectively. Cardiac anomalies, extracardiac findings and soft markers were detected in 5.4% (8), 10.8% (16) and 24.3% (36) of cases, respectively. Among the 10 fetuses with trisomy 21, 6 were isolated, 4 were associated with soft markers, 2 were associat...

The aim of this study was to examine prenatal diagnosis of double-outlet right ventricle (DORV)-associated anomalies and prognosis of each case. Medical records were reviewed of fetuses with DORV who had fetal echocardiography at our institution from 2002 to 2006. Pre- and postnatal diagnosis and outcome were compared and evaluated. Twenty-one fetuses were diagnosed with DORV. The pregnancy was terminated in seven cases. Three cases had chromosomal abnormalities; three cases, hypoplastic left ventricle; and one case, encephalocele. Accurate prenatal diagnosis of the ventricular septal defect, outflow obstruction, and great artery relationship was achieved in 14 of 16 cases (87.5%). Only 2 of 13 live-born cases survived beyond 6 months. The overall prognosis for fetuses with DORV is poor. DORV is found in fetuses with a huge spectrum of associated cardiac and extracardiac anomalies. Careful assessment by fetal echocardiography can determine important anatomic details with adequate correctness for precise counseling.

To assess the indications and distribution of cases chosen for termination of pregnancy and reasons delaying until third trimester termination. Retrospective study of cases between 2002 and 2006 in the hospital council. Cases were divided in two groups, as early termination (<23 weeks of gestation) and late termination (≥23 weeks of gestation). All pregnant women who underwent termination were classified according to related systemic pathology and chorionicity. Reasons for delaying until third trimester termination were evaluated in four groups. During this five year period 1.449 complicated pregnancies were counseled and in 713 cases termination was offered. Of 677 cases (94.95%) with termination, 412 cases (60.09%) had early and 265 cases (39.91%) late termination. The most frequent indications were central nervous system abnormalities (51.7%), chromosomal abnormalities (11.7%), and urogenital abnormalities (8.4%). The main reason for delaying termination was failure of screeni...

To compare maternal and perinatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzyme levels, and low platelets) syndrome. Maternal and neonatal charts of 1,222 consecutive pregnancies complicated by severe preeclampsia, eclampsia, or HELLP syndrome at our maternal-perinatal unit were reviewed. Patients were divided into three groups: 903 (73.9%) with severe preeclampsia, 123 (10.1%) with eclampsia, and 196 (16.0%) with HELLP syndrome. The overall incidence of adverse maternal outcome was 5.9%. The rates of adverse maternal outcomes for women with HELLP syndrome and eclampsia were higher than for severe preeclampsia (13.8% vs. 11.4% vs. 3.4%, respectively) (p=0.000). Birth weight was lower in patients with HELLP syndrome than in patients with eclampsia and severe preeclampsia (p=0.005). No significant difference in neonatal morbidity was found among the three groups. Perinatal mortality tended to be higher in the severe ...

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n= 429; 2137g and 34.71 weeks), DC study group,n= 37; 2117g (p= .338) and 33.97 weeks (p= .311), and DC study group with major malformations,n= 30; 2019g (p= .289) and 33.3 weeks (p= .01), and showed only significance for gestational age. There was no statistical significance between MC control group,n= 86; 2097g and 34.93 weeks, and MC study group,n= 18; 2237g (p= .338), and 34.42 weeks (p= .50...

We report a case of schizencephaly diagnosed prenatally at 23 weeks of gestational age with two-dimensional (2D) and three-dimensional (3D) sonography and fetal brain MRI, confirmed by autopsy. The diagnostic method of choice is 2D transabdominal and transvaginal sonography, whereas additional 3D sonography and MRI may provide a better understanding of the pathology and related findings.

Objective: Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome. Methods: Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student’s t test, χ2 analysis and Fisher’s exact test as appropriate. Results: Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 ± 6.1 vs. 33.0 ± 5.8 weeks (p = 0.119) and 1,886 ± 764 vs. 1,724 ± 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statisti...