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Ongun H, Celik K, Arayici S, Dogan NU, Mendilcioglu I, Ozkan O, Ozkan O. Miracles of science: Birth after uterus transplantation. J Obstet Gynaecol Res 2024; 50:5-14. [PMID: 37922953 DOI: 10.1111/jog.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
AIM The concept of regaining childbearing ability via uterus transplantation (UTx) motivates many infertile women to pursue giving birth to their own children. This article provides insight into maternal and neonatal outcomes of the procedure globally and facilitates quality of care in related medical fields. METHODS The authors searched ISI Web of Science, MEDLINE, non-PubMed-indexed journals, and common search engines to identify peer-review publications and unpublished sources in scientific reference databases. RESULTS The feasibility of the procedure has been proven with 46 healthy children in 88 procedures so far. Success relies upon dedicated teamwork involving transplantation surgery, obstetrics and reproductive medicine, neonatology, pediatrics, psychology, and bioethics. However, challenges exist owing to donor, recipient, and fetus. Fetal growth in genetically foreign uterine allograft with altered feto-maternal interface and vascular anatomy, immunosuppressive exposure, lack of graft innervation leading to "unable-to-feel" uterine contractions and conception via assisted reproductive technology create notable risks during pregnancy. Significant portion of women are complicated by at least one or more obstetric problems. Preeclampsia, gestational hypertension and diabetes mellitus, elevated kidney indices, and preterm delivery are common complications. CONCLUSIONS UTx has short- and long-term satisfying outcome. Advancements in the post-transplant management would undoubtedly lead this experimental procedure into mainstream clinical practice in the near future. However, both women and children of UTx need special consideration due to prematurity-related neonatal problems and the long-term effects of transplant pregnancy. Notable health risks for the recipient and fetus should be discussed with potential candidates for UTx.
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Affiliation(s)
- Hakan Ongun
- Department of Pediatrics, Division of Neonatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Kiymet Celik
- Department of Pediatrics, Division of Neonatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Sema Arayici
- Department of Pediatrics, Division of Neonatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nasuh Utku Dogan
- Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ozlenen Ozkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Omer Ozkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Mendilcioglu I, Dogan NU, Ozkan O, Bahceci M, Boynukalin K, Dogan S, Ozkan O. Pregnancy management and outcome after uterus transplantation. Ultrasound Obstet Gynecol 2023; 62:328-335. [PMID: 36468688 DOI: 10.1002/uog.26134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Uterus transplantation is a novel approach in women whose uterus is absent or severely abnormal. However, it is still an experimental procedure that poses risks to both mother and baby. To date, 32 live births after uterus transplantation have been reported in peer-reviewed journals, with several maternal, fetal and neonatal complications. The most common complications were preterm delivery, hypertensive disorders and placenta previa. Four patients experienced episodes of transplant rejection during pregnancy. The appropriate management of complicated and non-complicated pregnancies following uterus transplantation is still unresolved. In this review, obstetric outcomes after uterus transplantation and optimal management during pregnancy are discussed in light of the available data. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Mendilcioglu
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - N U Dogan
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - O Ozkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University, Antalya, Turkey
| | - M Bahceci
- Bahçeci IVF Center, Istanbul, Turkey
| | | | - S Dogan
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - O Ozkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University, Antalya, Turkey
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Demir N, Yazıcıoglu HF, Mendilcioglu I. Re: 'Turkish turban' sign: a rare phenotype of acrania-exencephaly-anencephaly sequence. Ultrasound Obstet Gynecol 2023; 62:158. [PMID: 37391929 DOI: 10.1002/uog.26280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
Linked article: This Correspondence comments on Tonni et al. Click here to view the article.
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Affiliation(s)
- N Demir
- Department of Obstetrics and Gynecology, Acibadem Kent Hospital, Izmir, Turkey
| | | | - I Mendilcioglu
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
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Erol Deniz M, Deniz A, Mendilcioglu I, Sanhal CY, Ozdem S, Kucukcetin IO, Kandemir H. Serial measurement of soluble endoglin for risk assessment at the diagnosis of fetal growth restriction. Int J Clin Pract 2021; 75:e14840. [PMID: 34528351 DOI: 10.1111/ijcp.14840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
AIM In this study, we aimed to investigate the soluble endoglin (sEng) levels in pregnant women with fetal growth restriction (FGR) and to examine the possible relation of the sEng levels with the time remaining to delivery and maternal and fetal complications. METHODS A total of 42 pregnant women diagnosed with FGR were retrospectively reviewed. Using the maternal blood samples it is at the collected 24-37 gestational weeks, the sEng levels were measured. Fetal biometry measurements, umbilical artery, uterine artery, middle cerebral artery Doppler indices were documented. RESULTS Of all patients, 17 (40%) were diagnosed with early-onset FGR, while 25 (60%) were diagnosed with late-onset FGR. Abnormal Doppler findings were present in 25 (60%) patients. Of 42 newborns, 18 (42%) were hospitalised in the neonatal unit. The mean sEng level calculated by taking the average of the first and second blood samples was 63.24 ± 49.83 ng/mL. There was no statistically significant difference in the mean sEng levels between those who gave birth within four, three, and two weeks after the diagnosis of FGR and those who did not. There was a positive significant correlation between the mean sEng levels and systolic blood pressure (r = 0.319, P = .04). CONCLUSIONS We did not find a statistically significant relationship between the sEng level and the time remaining to the time of delivery in pregnant women with FGR. We found no statistically significant difference in sEng level between the groups in pregnant women with fetuses with FGR with or without maternal and fetal complications.
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Affiliation(s)
- Merve Erol Deniz
- Clinic of Obstetrics and Gynecology, Manavgat State Hospital, Antalya, Turkey
| | - Alparslan Deniz
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University, Alanya, Turkey
| | - Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - Cem Yasar Sanhal
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - Sebahat Ozdem
- Department of Biochemistry, Akdeniz University, Antalya, Turkey
| | | | - Hülya Kandemir
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
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Ozkan O, Dogan NU, Ozkan O, Mendilcioglu I, Dogan S, Aydinuraz B, Simsek M. Uterus transplantation: From animal models through the first heart beating pregnancy to the first human live birth. ACTA ACUST UNITED AC 2017; 12:442-9. [PMID: 27638900 DOI: 10.1177/1745505716653849] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/01/2016] [Indexed: 12/24/2022]
Abstract
Absolute uterine factor infertility affects 3-5% of the general population, and unfortunately this condition is untreatable. There are some available options, including surrogacy or adoption, but neither of these suits each and every woman who desires to have her own genetic child. With recent advances in surgery and transplant immunology, uterus transplantation may be a source of hope for these women with uterine infertility. In the last decade, a number of animal species including rats, mice, rabbits, pigs, sheep, and primates have been used as experimental models, and pregnancies were achieved in some of these. Human data consist of 11 subjects yielding positive pregnancy results with no live births in the second trial from Turkey and, more fortunately, live births from the latest trial from Sweden. In the light of all these studies, uterus transplantation has been proven to be a viable option for women with uterine factor infertility.
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Affiliation(s)
- Omer Ozkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University, Antalya, Turkey
| | - Nasuh Utku Dogan
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - Ozlenen Ozkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Akdeniz University, Antalya, Turkey
| | - Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | - Selen Dogan
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
| | | | - Mehmet Simsek
- Department of Obstetrics and Gynecology, Akdeniz University, Antalya, Turkey
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Ozmen A, Unek G, Kipmen-Korgun D, Mendilcioglu I, Sanhal C, Sakıncı M, Korgun ET. Glucocorticoid effects on angiogenesis are associated with mTOR pathway activity. Biotech Histochem 2016; 91:296-306. [PMID: 27007885 DOI: 10.3109/10520295.2016.1161234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Glucocorticoids (GC) often are administered during pregnancy, but despite their widespread use in clinical practice, it remains uncertain how GC exposure affects pro-angiogenic factors and their receptors. We investigated the effects of GC on vascular endothelial growth factor (VEGF), placental growth factor (PIGF), vascular endothelial growth factor receptor 1 (VEGFR1) and vascular endothelial growth factor receptor 2 (VEGFR2) protein and mRNA expressions and investigated the possible association of GC with the Akt/mTOR pathway. We incubated human umbilical vein endothelial cells (HUVECs) with a synthetic GC, triamcinolone acetonide (TA). TA administration caused decreased cellular and soluble VEGF and VEGFR1 protein expressions and increased soluble VEGFR2 expression. VEGF, VEGFR1 and VEGFR2 mRNA expressions were altered in a time and dose dependent manner. PIGF protein expression was unaffected by TA treatment, but PIGF mRNA expression decreased in a dose dependent manner after incubation for 48 and 72 h. Phospho-mTOR and phospho-Akt expressions were unaffected. Phospho-p70S6K and phospho-4EBP1 protein expressions and the vascular network forming capacity of HUVECs decreased in a dose dependent manner. We found that GC exert detrimental effects on angiogenesis by altering cellular and soluble angiogenic protein and mRNA levels, and vascular network forming capacities by the Akt/mTOR pathway.
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Affiliation(s)
- A Ozmen
- a Department of Histology , Embryology, Akdeniz University , Antalya , Turkey
| | - G Unek
- a Department of Histology , Embryology, Akdeniz University , Antalya , Turkey
| | - D Kipmen-Korgun
- b Department of Biochemistry , Akdeniz University , Antalya , Turkey
| | - I Mendilcioglu
- c Department of Obstetrics , Gynecology, Medical Faculty, Akdeniz University , Antalya , Turkey
| | - C Sanhal
- c Department of Obstetrics , Gynecology, Medical Faculty, Akdeniz University , Antalya , Turkey
| | - M Sakıncı
- c Department of Obstetrics , Gynecology, Medical Faculty, Akdeniz University , Antalya , Turkey
| | - E T Korgun
- a Department of Histology , Embryology, Akdeniz University , Antalya , Turkey
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Cetin Z, Sanhal C, Karauzum SB, Mendilcioglu I, Yakut S. Ultrasonographic and Cytogenetic Issues in Prenatal Diagnosis of Pallister Killian Syndrome. Genet Couns 2016; 27:233-237. [PMID: 29485827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Sanhal CY, Mendilcioglu I, Ozekinci M, Simsek M, Bozkurt S. Comparison of pre-procedural anxiety and depression scores for patients undergoing chorion villus sampling and amniocentesis: An alternative perspective on prenatal invasive techniques. Pak J Med Sci 2015; 31:1038-42. [PMID: 26648982 PMCID: PMC4641251 DOI: 10.12669/pjms.315.7477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the pre-procedural anxiety and depression levels of patients undergoing chorion villus sampling (CVS) and amniocentesis (AC). METHODS Patients referred to our department for fetal karyotype analysis with a positive first or second trimester screening test for aneuploidy between January 2013 to June 2015 were included. CVS and AC procedures were performed in patients with gestation periods of between 11-14 and 16-20 weeks, respectively. Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI), and depression was assessed using the Beck Depression Inventory II (BDI-II). RESULTS A total of 1,400 patients were included. Compared to first trimester controls, patients undergoing CVS had significantly higher STAI-state and BDI-II results. Likewise, patients undergoing AC had higher STAI-state and BDI-II scores than controls in the second trimester. In terms of STAI-trait results, no difference was found between the groups. Our results also showed that, compared to AC group, patients undergoing CVS had similar STAI-state, STAI-trait and but higher BDI-II scores. CONCLUSION We conclude that evaluating the stress and depression levels of these patients should be one of the routine procedures in pregnancy follow-up.
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Affiliation(s)
- Cem Yasar Sanhal
- Cem Yasar Sanhal, MD. Dr. Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Inanc Mendilcioglu
- Inanc Mendilcioglu, Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Murat Ozekinci
- Murat Ozekinci, Assistant Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Mehmet Simsek
- Mehmet Simsek, Professor, Gynecology and Obstetrics Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Selen Bozkurt
- Selen Bozkurt, Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Yakut S, Clarck OA, Sanhal C, Nur BG, Mendilcioglu I, Karauzum SB, Cetin Z. A familial interstitial 4q35 deletion with no discernible clinical effects. Am J Med Genet A 2015; 167A:1836-41. [PMID: 25846895 DOI: 10.1002/ajmg.a.37097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/16/2015] [Indexed: 01/08/2023]
Abstract
Small deletions on the long arm of distal chromosome 4 do not appear to result in gross congenital malformations, with the most frequently reported clinical findings including mild to moderate intellectual disability, learning disabilities and minor dysmorphic features. Here we report on a cytogenetically detectable familial interstitial chromosome 4 long arm deletion with no discernible phenotypic effects in a mother and her two daughters. The karyotypes of the mother and her two daughters were: 46,XX,del(4)(q35.1q35.2). Based on the results of FISH analyses using whole chromosome specific and subtelomeric probes, the karyotype was designated as: 46,XX,del(4)(q35.1q35.2). ish del(4)(q35-qter)(WCP4+, 36P21+, dJ963K6-). Array-CGH analysis showed an interstitial deletion encompassing 5.75 Mb in the 4q35.1-q35.2 genomic region (chr4:184,717,878-190,469,337; hg19). This is the first report on a cytogenetically detectable familial interstitial chromosome 4 long arm deletion in which there are no discernible phenotypic effects. Both our findings and a review of the literature suggest that more detailed molecular analyses are needed in cases with distal chromosome 4 long arm deletions especially those with breakpoints in the 4q35 region to establish a more precise genotype-phenotype correlation.
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Affiliation(s)
- Sezin Yakut
- Department of Medical Biology and Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozden Altiok Clarck
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Cem Sanhal
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Banu Guzel Nur
- Department of Pediatric Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Inanc Mendilcioglu
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sibel Berker Karauzum
- Department of Medical Biology and Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Zafer Cetin
- Department of Medical Biology, Faculty of Medicine, Sanko University, Gaziantep, Turkey
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Yakut S, Cetin Z, Sanhal C, Karaman B, Mendilcioglu I, Karauzum SB. PRENATAL DIAGNOSIS OF DE NOVO PERICENTRIC INVERSION INV(2)(p11.2z13). Genet Couns 2015; 26:243-247. [PMID: 26349196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We here report a prenatal case with de novo pericentric inversion inv(2)(p11.2q13). A 20-years-old G1PO woman was referred for amniocentesis at 17 weeks of gestation, because of a positive second trimester screening test for aneuploidy. A de novo pericentric inversion inv(2)(p11.2q13) was detected during conventional cytogenetic analysis. Array-CGH analysis of the fetus showed no subtle chromosomal imbalances at the breakpoints. Genetic counseling was given to the family and the family decided to continue the pregnancy. To our knowledge, our case is the third prenatally detected de novo case with inv(2)(p11.2q13), and also the first case in which molecular karyotyping analysis were also applied.
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Toptas T, Mendilcioglu I, Simsek M, Taskin O. Intravaginal misoprostol alone versus intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination: an observational study. Ginekol Pol 2014; 85:577-81. [PMID: 25219136 DOI: 10.17772/gp/1774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND No systematic empirical research exists addressing the question of optimal pregnancy termination method in second trimester pregnancies. OBJECTIVES The purpose of this study was to determine the efficacy and safety of intravaginal misoprostol and extraamniotic Foley catheter combination for second trimester pregnancy termination. METHODS A single center observational study was conducted in a total of 91 pregnancies. Women who met the termination of pregnancy criteria due to feto-maternal indications between 13 to 26 gestational weeks were included into the study. Study participants received intravaginal misoprostol in combination with Foley catheter (n = 46) or intravaginal misoprostol alone (n = 45). RESULTS The efficacy of intravaginal misoprostol and Foley catheter insertion combination was comparable to that of intravaginal misoprostol alone in terms of time to abortion/birth [median (95% Confidential Interval [95% CI]): 14.33 (11.33-17.25) hours and 12.08 (9.50-15.33) hours, respectively Hazard Ratio: 0.73, 95% CI: 0.47 to 1.12, p = 0.14 (log-rank)]. The only serious maternal event was uterine rupture observed in one woman in Foley combination group. CONCLUSION The combination of intravaginal misoprostol and extraamniotic Foley catheter for second trimester pregnancy termination does not provide additional efficacy.
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Erman Akar M, Ozekinci M, Sanhal C, Kececioglu N, Mendilcioglu I, Senol Y, Dirican K, Kocak H, Dinckan A, Suleymanlar G. A Retrospective Analysis of Pregnancy Outcomes after Kidney Transplantation in a Single Center. Gynecol Obstet Invest 2014; 79:13-8. [DOI: 10.1159/000365815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/09/2014] [Indexed: 11/19/2022]
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Ozmen A, Cetinkaya B, Unek G, Sanhal C, Mendilcioglu I, Korgun ET. Hyperglycemia affects angiogenesis by means of mTOR pathway. Placenta 2014. [DOI: 10.1016/j.placenta.2014.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Toru HS, Sanhal CY, Yilmaz GT, Ozbudak IH, Mendilcioglu I, Ozbilim G. Rare congenital pulmonary malformation with diagnostic challenging: congenital pulmonary lymphangiectasia, report of four autopsy cases and review of literature. J Matern Fetal Neonatal Med 2014; 28:1457-60. [PMID: 25142108 DOI: 10.3109/14767058.2014.956719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Congenital pulmonary lymphangiectasia (CPL) is a rare congenital disorder that typically presents with intractable respiratory failure in the first few days of life. There is an association non-immun hydrops and CPL. In this study we reviewed four CPL cases between January 2006 and January 2014 among 684 fetal-pediatric autopsies. All cases were in the second trimester. In light microscopy there were marked dilatated channels in the subpleural -peribronchial-subseptal region of the lungs. The channels were lined with flattened cells which were expressing CD 31 and D2-40, negative for CD34. Although pulmonary interstitial emphysema (PIE) was considered an important differential diagnosis, a giant cell reaction surrounding the interstitial cystic lesions, a histological hallmark of PIE. CPL is characterized by dilatation of the pulmonary lymphatic vessels and occurs as a congenital anomaly. Noonan classified it into three groups. Primary developmental defect of pulmonary lymphatics is group 3. Group 3 is called also as CPL; normal regression of the connective tissue elements fails to occur after the 16th week of fetal life, associated with an aggressive clinical course, poor prognosis. In fetal autopsy examination CPL should be recognized if there is a fetus with pleural effusion, non-immune hydrops. There is no clinical evidence for CPL.
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Affiliation(s)
- Havva Serap Toru
- a Department of Pathology , School of Medicine, Akdeniz University , Antalya , Turkey and
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Sanhal CY, Mendilcioglu I, Ozekinci M, Yakut S, Merdun Z, Simsek M, Luleci G. Prenatal management, pregnancy and pediatric outcomes in fetuses with septated cystic hygroma. ACTA ACUST UNITED AC 2014; 47:799-803. [PMID: 25075572 PMCID: PMC4143208 DOI: 10.1590/1414-431x20143895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/22/2014] [Indexed: 11/22/2022]
Abstract
It has been reported that, compared with simple increased nuchal translucency, fetal cases with septated cystic hygroma (CH) are more likely to face perinatal handicaps. However, pediatric outcomes and proper prenatal counseling for this anomaly have not yet been truly defined. We performed this study to determine pregnancy and pediatric outcomes of fetuses with septated CH. We searched records for cases with septated CH and collected data for structural abnormalities, karyotype analysis, and pregnancy outcomes. Fetuses born with septated CH were also evaluated for their pediatric outcomes. Sixty-nine fetuses with septated CH were enrolled in the study. Results showed that chromosomal abnormalities were present in 28 fetuses (40.6%), and the most common aneuploidy was Turner syndrome (n=14, 20.3%); 16 (23.2%) of the remaining cases, in which aneuploidy was not found, had coexistent structural malformations; 25 (36.2%) cases had normal karyotype and morphology. The total number of live births and infants with unfavorable neurologic follow-up were 13 (18.8%) and 2 (2.9%), respectively. Septated CH is associated with poor perinatal outcomes; therefore, karyotype analysis and ultrasonographic anomaly screening should be performed as initial steps, and expectant management should be offered to couples with euploid fetuses that have normal morphology.
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Affiliation(s)
- C Y Sanhal
- Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - I Mendilcioglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - M Ozekinci
- Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - S Yakut
- Department of Medical Biology and Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Z Merdun
- Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - M Simsek
- Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - G Luleci
- Department of Medical Biology and Genetics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Karadeniz O, Mendilcioglu I, Ozdem S, Ozekinci M, Sanhal CY, Uzun G, Sakinci M, Simsek M. The association between ischaemia-modified albumin levels in umbilical vein and intrauterine growth restriction. J OBSTET GYNAECOL 2014; 35:9-12. [PMID: 24999531 DOI: 10.3109/01443615.2014.930101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intrauterine growth restriction (IUGR) is one of the most common problems in obstetrics. Ischaemia-modified albumin (IMA), a product deriving from albumin as a result of the modification by oxidative free radicals in response to hypoxia, was previously used as a marker of ischaemia in acute coronary syndrome. We performed this study to determine whether umbilical venous IMA levels are associated with IUGR. A total of 40 pregnancies with IUGR were compared with 40 of normal fetal development. Blood samples were obtained from the umbilical vein after delivery. IMA levels in the IUGR group were higher than in the control group (78.74 ± 6.87 vs 74.43 ± 7.84 U/ml, respectively, p = 0.011). An elevated IMA level was associated with IUGR (OR: 1.079, 95% CI: 1.000-1.163, p = 0.049). We suggest that IMA, which was formerly proved to arise in ischaemic conditions, may also be a valuable marker in perinatal hypoxia and IUGR detection.
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Affiliation(s)
- O Karadeniz
- Department of Obstetrics and Gynecology, Akdeniz University , Antalya , Turkey
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Bingol A, Ertosun M, Artan R, Yilmaz A, Mihci E, Guzel B, Akar ME, Mendilcioglu I, Simsek M, Demir D, Pehlivanoglu S, Yilmaz E, Alper O. 35 Cystic fibrosis transmembrane regulator mutations in Turkish patients with cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Unek G, Ozmen A, Mendilcioglu I, Simsek M, Korgun ET. The expression of cell cycle related proteins PCNA, Ki67, p27 and p57 in normal and preeclamptic human placentas. Tissue Cell 2014; 46:198-205. [DOI: 10.1016/j.tice.2014.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 04/14/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Sanhal CY, Ozekinci M, Mendilcioglu I, Sakinci M, Simsek M. Prenatal diagnosis of total type 1 vertical craniopagus with 3-dimensional sonography. J Ultrasound Med 2014; 33:179-181. [PMID: 24371115 DOI: 10.7863/ultra.33.1.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Erman Akar M, Ozkan O, Uraz B, Dirican K, Cincik M, Mendilcioglu I. Clinical pregnancy following uterus transplantation. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Unek G, Ozmen A, Mendilcioglu I, Simsek M, Korgun ET. Immunohistochemical distribution of cell cycle proteins p27, p57, cyclin D3, PCNA and Ki67 in normal and diabetic human placentas. J Mol Histol 2013; 45:21-34. [DOI: 10.1007/s10735-013-9534-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/12/2013] [Indexed: 12/24/2022]
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Saruhan Z, Ozekinci M, Simsek M, Mendilcioglu I. Association of first trimester low PAPP-A levels with adverse pregnancy outcomes. CLIN EXP OBSTET GYN 2012; 39:225-228. [PMID: 22905470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate whether first trimester low PAPP-A levels are associated with adverse pregnancy outcomes. METHODS A case control retrospective study including 663 pregnant women whose gestational age ranged between 11 and 14 weeks attending prenatal care at Akdeniz University Hospital was carried out. Chromosomal abnormalities, spontaneous abortions, and multiple pregnancies were excluded from the study. Finally 318 singleton pregnancies were included in this study. Pregnant women whose PAPP-A levels were < or =10th percentile were compared with PAPP-A levels > 10'h percentile for the frequency of pregnancy complications such as SGA, preeclampsia, preterm delivery, gestational diabetes mellitus and gestational hypertension. RESULTS The most common complication of pregnancy was SGA (9.4%, n=30). There was no significant association between low PAPP-A levels and incidence of subsequent pregnancy outcomes. Maternal age was found to be a risk factor for gestational diabetes (p = 0.00). Small for gestational age was significantly associated with nulliparity and smoking during pregnancy (p = 0.03 and p = 0.01, respectively). CONCLUSION First trimester of low PAPP-A level (< or = 10th percentile) was not associated with SGA, preeclampsia, preterm delivery, gestational hypertension or gestational diabetes mellitus.
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Affiliation(s)
- Z Saruhan
- Obstetrics and Gynaecology Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
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23
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Mendilcioglu I, Yakut S, Keser I, Simsek M, Yesilipek A, Bagci G, Luleci G. Prenatal diagnosis of β-thalassemia and other hemoglobinopathies in southwestern Turkey. Hemoglobin 2011; 35:47-55. [PMID: 21250881 DOI: 10.3109/03630269.2010.544607] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our aim was to evaluate the prenatal diagnosis of β-thalassemia (β-thal) and other hemoglobinopathies in a region with high frequency. After detection by premarital or antenatal screening, 312 patients underwent 420 prenatal diagnostic procedures for 407 fetuses in a 10-year period. Fetal samples were collected by chorionic villi sampling (CVS) in the first trimester and amniocentesis and cordocentesis in the second trimester. Mutation analyses of β-globin and cytogenetic analyses were performed and the most common mutations detected were: IVS-I-110 (G>A), IVS-II-1 (G>A), IVS-I-6 (T>C) and IVS-II-745 (C>G). Hb S [β6(A3)Glu→Val, GAG>GTG)] was the most common hemoglobin (Hb) variant with a frequency of 6.3%. Among 407 fetuses, 105 (25.8%) were diagnosed as affected, while 201 (49.4%) were carriers and 101 (24.8%) were normal. Cytogenetic analyses revealed nine fetuses (2.3%) with numerical chromosomal abnormalities as regular or mosaicism. Prenatal diagnosis of common hemoglobinopathies is safe and effective. Performing cytogenetic analysis in excess fetal material is an acceptable option.
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Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Yakut S, Cetin Z, Berker-Karauzum S, Mihci E, Mendilcioglu I, Luleci G. De novo supernumerary marker chromosome originating from chromosome 17 resulting in a normal pregnancy outcome. Genet Couns 2011; 22:63-68. [PMID: 21614990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report here a prenatal case with de novo supernumerary marker chromosome originating from chromosome 17 in non-mosaic form resulting in normal pregnancy outcome. In this case, a 26-year-old pregnant woman was referred for amniocenthesis and microdeletion Fluorescence In Situ Hybridization (FISH) testing at 18 weeks of gestation due to history of a previous child with Angelman Syndrome. PWS/AS region deletion was excluded by FISH. A de novo supernumerary, non-satellited, monocentric marker chromosome was detected during conventional cytogenetic analysis. With the use of FISH testing, it was found that the marker chromosome originated from chromosome 17. Additionally, the marker chromosome was found not to contain the Smith-Magenis and Miller Dieker syndrome regions. After detailed review of the literature, genetic counseling was given to the family, and the family decided to continue the pregnancy to term. A female child was born at term without any phenotypical abnormalities and clinical complications. Follow-up at 15 months-of-age revealed no developmental abnormalities. To our knowledge, our patient is the first reported prenatal case with a de novo monocentric, supernumerary marker chromosome derived from chromosome 17 in a non-mosaic form that resulting in normal pregnancy outcome.
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Affiliation(s)
- S Yakut
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, Turkey
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Mendilcioglu I, Karaveli S, Erdogan G, Simsek M, Taskin O, Ozekinci M. Apoptosis and expression of Bcl-2, Bax, p53, caspase-3, and Fas, Fas ligand in placentas complicated by preeclampsia. CLIN EXP OBSTET GYN 2011; 38:38-42. [PMID: 21485723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM To determine whether preeclampsia is associated with an increase in placental apoptosis and altered expression of mediators of apoptosis such as Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax. METHODS Placental samples obtained from 20 women with preeclampsia and 14 normal women were analyzed using the Klenow, Frag-EL DNA fragmentation detection kit for apoptosis. Expression of Fas, Fas ligand, caspase-3, p53 Bcl-2, and Bax was assessed using immunohistochemistry. RESULTS The median percentage of apoptotic nuclei in trophoblasts was significantly higher for the preeclampsia group than for the controls (6.9 vs 0.25; p =.001). Fas ligand expression was significantly higher in the decidua among the subjects with preeclampsia compared with controls (1.2 vs 0; p = .023). Otherwise no difference was observed in the expression of Bax , Bcl-2, p53, caspase-3, and Fas between groups. CONCLUSION Increased apoptosis in preeclampsia may not be associated with significant alterations in Fas, Fas ligand, caspase-3, p53, Bcl-2 and Bax expression.
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Affiliation(s)
- I Mendilcioglu
- Obstetrics and Gynecology Department, Akdeniz University, Antalya, Turkey.
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Toptas T, Mendilcioglu I, Simsek M, Taskin O. 305: Comparison of intravaginal misoprostol alone to combination of intravaginal misoprostol and extraamniotic Foley catheter for the second trimester termination of pregnancies. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mendilcioglu I, Bilgen T, Arikan Y, Keser I, Simsek M. 788: The association between inherited thrombophilias and pregnancy-related hypertension recurrence. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simsek M, Mendilcioglu I, Mihci E, Karagüzel G, Taskin O. Prenatal diagnosis and early treatment of fetal goitrous hypothyroidism and treatment results with two-year follow-up. J Matern Fetal Neonatal Med 2009; 20:263-5. [PMID: 17450461 DOI: 10.1080/14767050601134728] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mendilcioglu I, Mihci E, Pestereli E, Simsek M. Prenatal diagnosis of Gollop-Wolfgang complex (tibial agenesis and femoral bifurcation). Prenat Diagn 2009; 29:182-6. [PMID: 19180625 DOI: 10.1002/pd.2204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Mendilcioglu I, Simsek M. Conjoined Twins in a Trichorionic Quadruplet Pregnancy after Ovulation Induction with Clomiphene Citrate. Fetal Diagn Ther 2008; 24:51-4. [DOI: 10.1159/000132407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 03/23/2007] [Indexed: 11/19/2022]
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31
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Onoglu A, Taskin O, Inal M, Sadik S, Simsek M, Akar M, Kursun S, Mendilcioglu I, Postaci H, Ispahi C. Comparison of the long-term histopathologic and morphologic changes after endometrial rollerball ablation and resection: A prospective randomized trial. J Minim Invasive Gynecol 2007; 14:39-42. [PMID: 17218227 DOI: 10.1016/j.jmig.2006.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 06/19/2006] [Accepted: 06/24/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To compare long-term histologic features of endometrial rollerball ablation versus resection. DESIGN Randomized clinical trial (Canadian Task Force classification I). SETTING Akdeniz University School of Medicine. PATIENTS Women with menorrhagia undergoing endometrial ablation. INTERVENTION Comparison of patients with menorrhagia undergoing endometrial resection and ablation. MEASUREMENTS AND MAIN RESULTS Endometrial rollerball ablation (n = 23 women) and resection (n = 25) were followed by second-look office hysteroscopy with endometrial biopsy. Mean follow-up to second look hysteroscopy after rollerball ablation and loop resection was 33.4 +/- 2.1 and 31.1 +/- 2.6 months, respectively. Complete atrophy and partial adhesion or obliteration of the cavity and fibrosis were observed at second-look hysteroscopy and were similar in both groups. Whereas all random biopsy specimens after both ablation and resection revealed diminished endometrial glands with varied necrosis and scarring, the number of endometrial glands per field was not correlated with amount of bleeding or menstrual pattern. Bleeding patterns were similar between the groups. No precancerous or malignant lesion was found after the procedures. CONCLUSION Although efficacy of both endometrial ablation and resection is related to initial thermal destruction and correlated with postablation hysteroscopic and histologic findings, endometrial regrowth may be expected and is not a failure of ablation. Both procedures revealed histopathologically and clinically similar results.
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Mendilcioglu I. Recurrent periclitoral abscess: treatment of a rare cause of vulvar pain. Eur J Obstet Gynecol Reprod Biol 2006; 131:101-102. [PMID: 16735087 DOI: 10.1016/j.ejogrb.2005.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 10/06/2005] [Accepted: 11/29/2005] [Indexed: 10/24/2022]
Affiliation(s)
- Inanc Mendilcioglu
- Akdeniz University, School of Medicine, Department of Obstetrics and Gynecology, Dumlupinar Bulvari, Arapsuyu, Antalya 07070, Turkey.
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Alimoglu E, Simsek M, Ceken K, Mendilcioglu I, Kabaalioglu A, Sindel T. Umbilical cord pseudocyst in a fetus with Down syndrome. Prenat Diagn 2006; 26:193-4. [PMID: 16470563 DOI: 10.1002/pd.1376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Mendilcioglu I, Ozcan M, Bagci G, Simsek M, Kursun S, Luleci G, Taskin O. Triploidy in a Growth Discordant Twin Pregnancy after Intracytoplasmic Sperm Injection Treatment. Fetal Diagn Ther 2005; 21:65-7. [PMID: 16354978 DOI: 10.1159/000089050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 12/08/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We report on a case of a triploidy in one fetus of a twin pregnancy who presented with the findings of growth discordance. METHODS Three weeks' difference between fetuses in ultrasonographic measurements in the first trimester was observed in a twin pregnancy following intracytoplasmic sperm injection (ICSI) treatment for male infertility. Hydrocephaly developed in the growth-discordant fetus subsequently. Amniocentesis for both fetuses and selective feticide for the abnormal one was performed at 19 weeks' gestation through a single insertion. Fetal karyotype of the abnormal one was 69,XXX and the healthy one was 46,XX. CONCLUSION Early developed growth discordance in a twin pregnancy may be a sign of chromosomal abnormality such as triploidy. Those cases should be karyotyped without delay to decrease preterm delivery risk of possible selective feticide.
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Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynaecology, Akdeniz University, School of Medicine, Antalya, Turkey.
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Abstract
The genetic sonogram is a composite algorithm combining multiple individual markers to increase Down syndrome risk prediction. Transformation of sonographic information into a standard mathematical format represented an early challenge that has now been surmounted. Using increasingly sophisticated mathematical techniques, individual patient risk can be estimated. High diagnostic accuracy comparable to standard mid-trimester serum algorithms has been reported. Most recently, a few studies have reported the ability to combine serum and biochemical markers to achieve diagnostic accuracy comparable to first-trimester screen. Even fewer studies have reported combinations of ultrasound and maternal urine markers. While it is clear that consistently high sensitivity and specificity for Down syndrome can be achieved, almost all the studies are based on high-risk groups. Studies in low-risk populations have suffered from lack of standardization. The relevance of genetic sonogram in a low-risk population thus remains to be proven. The most significant challenge, however, remains the development of uniform and reproducible sonographic and measurement standards. This is likely to be the most important factor in optimizing the accuracy of the mid-trimester genetic sonogram.
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Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
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Salfelder A, Lueken RP, Bormann C, Gallinat A, Moeller CP, Busche D, Nugent W, Krueger E, Nugent A, Caglar G, Tasci Y, Kayikcioglu F, Haberal A, Hasskamp T, Krichbaum M, Aka N, Köse G, Sabah G, Sayharman ES, Kumru P, Aka N, Karaca K, Köse G, Kumru P, Sayharman ES, Haydardedeoglu B, Simsek E, Kilicdag E, Tarim E, Bagis T, Dede FS, Dilbaz B, Dede H, Ilhan AK, Haberal A, Dede FS, Dilbaz B, Oral S, Erten A, Ilhan AK, Haberal A, Ertas IE, Kahyaoglu S, Turgay I, Tug M, Kalyoncu S, Batioglu S, Zorlu G, Arici C, Akar ME, Ari ES, Ari E, Erbay OU, Caliskan MO, Akar ME, Simsek M, Taskm O, Gümüs I, Turhan NO, Arikan G, Giuliani A, Kelekci S, Yorgancioglu Z, Yilmaz B, Yasar L, Savan K, Sonmez S, Kart C, Vural M, Tanriverdi HA, Cinar E, Barut A, Özbay K, Yardim T, Demir B, Kilinc N, Gul T, Erden AC, Turgay I, Kahyaoglu S, Kokanali MK, Batioglu S, Haydardedeoglu B, Simsek E, Kilicdag EB, Tarim E, Aslan E, Bagis T, Seval M, Taskin S, Özmen B, Kahraman K, Yarci A, Tasci T, Unlü C, Taskin S, Seval M, Özmen B, Kahraman K, Gözükücük M, Kurt S, Unlü C, Taskin S, Özmen B, Bozaci EA, Seval M, Ortac F, Yasar L, Sönmez AS, Zebitay AG, Gezer N, Yazicioglu HF, Mehmetoglu G, Dede FS, Dilbaz B, Kocak M, Dede H, Haberal A, Erten A, Ilhan AK, Algül YL, Erden AC, Yasar L, Zebitay AG, Ozcan J, Duman O, Sonmez S, Yazicioglu F, Sensoy Y, Koc S, Cebi Z, Yasar L, Zebitay AG, Özcan J, Duman O, Sönmez S, Yazicioglu F, Sensoy Y, Cebi Z, Zebitay AG, Yasar L, Özcan J, Duman O, Sönmez S, Yazicioglu F, Sensoy Y, Koc S, Cebi Z, Zebitay AG, Yasar L, Özcan J, Duman O, Sönmez S, Yazicioglu F, Sensoy Y, Cebi Z, Simsek M, Mendilcioglu I, Özekinci M, Ulukus M, Ulukus EC, Seval Y, Cinar O, Zheng W, Arici A, Erkan L, Soylu F, Tatli O, Ozkent V, Dilbaz B, Ilhan AK, Oral S, Dede H, Dogan AR, Gün I, Erdemoglu E, Sargin H, Kamaci M, Dede FS, Erten A, Sendag F, Akman L, Yucebilgin S, Karadadas N, Oztekin K, Bilgin O, Topuz S, Cigerli E, Iyibozkurt CA, Akhan ES, Saygili H, Berkman S, Bezircioglu I, Karakaya E, Baran N, Baloglu A, Aydin C, Hizli N, Cetinkaya B, Kavas A, Baloglu A, Cukurova K, Köksal A, Yetimalar H, Yildiz A, Ivit H, Keklik A, Pinar F, Aka N, Köse G, Tosun N, Kumru P, Tuncel T, Boynukalin K, Salman MC, Ozyuncu O, Bozdag G, Ayhan A, Ates U, Usta T, Seyhan A, Ata B, Sidal B, Guler OT, Salman MC, Bozdag G, Ozyuncu O, Esin S, Ozyuncu O, Salman MC, Bozdag G, Guven S, Gürban A, Gürban G, Özen S, Kirecci A, Özkesici B, Yücel S, Süer N, Erdemoglu E, Gün I, Sargin H, Erdemoglu CE, Kamaci M, Akhan SE, Citil I, Topuz S, Iyibozkurt C, Kesim MD, Atis A, Aydin Y, Özpak D, Tashan F, Zeteroglu S, Kolusari A, Altunay H, Sahin HG, Kamaci M, Kayikcioglu F, Erol O, Sarici S, Haberal A, Dingiloglu BS, Güngör T, Özdal B, Cavkaytar S, Bilge Ü, Mollamahmutoglu L, Toprak KM, Özsoy S, Hekim N, Özel E, Senates M, Yener C, Göker N, Caliskan E, Filiz T, Yucesoy G, Coskun E, Vural B, Corakci A, Narin MA, Caliskan E, Kayikcioglu F, Haberal A, Meydanli MM, Kamaci M, Sahin HG, Kolusari A, Yildizbas B, Bolluk G, Ates U, Usta T, Ata B, Seyhan A, Ozdemir B, Sidal B, Ünlü BS, Aytan H, Evsen S, Tapisiz ÖL, Zergeroglu S, Zeteroglu S, Sahin HG, Guler A, Kolusari A, Kamaci M, Altay MM, Can A, Ungormus A, Polat A, Haberal A. General gynecology. Arch Gynecol Obstet 2005. [DOI: 10.1007/bf02954776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mihci E, Simsek M, Mendilcioglu I, Tacoy S, Karaveli S. Evaluation of a Fetus with Neu-Laxova Syndrome through Prenatal, Clinical, and Pathological Findings. Fetal Diagn Ther 2005; 20:167-70. [PMID: 15824491 DOI: 10.1159/000083898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Accepted: 01/27/2004] [Indexed: 11/19/2022]
Abstract
We report a case of Neu-Laxova syndrome in a fetus at 22 weeks with the ultrasonographic findings of characteristic facial findings, limb contractures, kyphosis and polyhydramnios. Pathological and ultrasonographic studies are discussed.
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Affiliation(s)
- Ercan Mihci
- Department of Pediatric Medical Genetics, Akdeniz University School of Medicine, Antalya, Turkey
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Sargin CF, Nal N, Manguoglu AE, Keser I, Mendilcioglu I, Yesilipek A, Luleci G. The phenotypic effect of Hb G-Coushatta [beta22 (B4) Glu-Ala] and association with IVS.II.1(G-A) in a Turkish family. Genet Couns 2005; 16:307-8. [PMID: 16259329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Mendilcioglu I, Karaveli S, Erdogan G, Simsek M, Taskin O. Apoptosis and p53, Bcl-2, Bax, Fas, Fas-ligand and caspase-3 expressions in preeclamptic cases. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mendilcioglu I, Trak B, Uner M, Umit S, Kucukosmanoglu M. Recurrent preeclampsia and perinatal outcome: a study of women with recurrent preeclampsia compared with women with preeclampsia who remained normotensive during their prior pregnancies. Acta Obstet Gynecol Scand 2004; 83:1044-8. [PMID: 15488119 DOI: 10.1111/j.0001-6349.2004.00424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of preeclampsia recurrence on perinatal outcome. MATERIALS AND METHODS A case-controlled study was performed in multiparous women who developed preeclampsia in index pregnancy (n = 64). Among these, women who had preeclampsia in previous pregnancies (n = 21) were compared to those who remained normotensive during their prior pregnancies (n = 43). Maternal and fetal variables were compared. Multivariate logistic analyses were performed to examine the impact of preeclampsia recurrence on fetal loss, preterm delivery, small for gestational age (SGA) occurrence and respiratory distress syndrome adjusted for confounding variables. RESULTS No statistical significant difference was observed between the two groups in terms of age, delivery weeks, steroid use and laboratory markers. Fetal loss was higher in women with recurrent preeclampsia (19.0%) than in women with preeclampsia who had a normotensive pregnancy history (4.7%), with adjusted odds ratio (OR) of 5.77 [95% confidence interval (CI) 0.84-39.54]. CONCLUSION Women with recurrent preeclampsia had a higher rate of perinatal loss compared to women with preeclampsia who were normotensive in their prior pregnancies.
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Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Taskin O, Muderrisoglu H, Akar M, Simsek M, Mendilcioglu I, Kursun S. Comparison of the effects of tibolone and estrogen replacement therapy on echocardiographic basic cardiac functions in post-menopausal women: a randomized placebo controlled study. Maturitas 2004; 48:354-9. [PMID: 15283927 DOI: 10.1016/j.maturitas.2003.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2002] [Revised: 05/01/2003] [Accepted: 08/09/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study is designed to investigate and compare the effects of synthetic steroid tibolone and HRT on systolic and diastolic heart functions in post-menopausal women. METHODS This prospective, randomized placebo controlled double blind study was conducted in a university clinic. Fifty-eight non-smoking, otherwise healthy post-menopausal women who did not receive any kind of HRT at least for 3 years within the onset of menopause were included in the study. The patients were randomly allocated to either 2.5 mg per day tibolone (OD, n = 18), daily combined 0.625 mg of conjugated estrogens 2.5 mg-1 of medroxy progesterone acetate pill (EP, n = 20) or a vitamin pill (n= 20) in a double blinded fashion. Their basic systolic and diastolic functions were investigated with HP Sonos-1000 echocardiography using standard positions and windows before and 6 months after the initiation of HRT. RESULTS Mean age, weight, length of post-menopausal period, heart rate, systolic and diastolic pressures were similar between the groups. At the initiation of the study all groups had similar echocardiographic measurements. However, at the end of 6 months, left ventricular end-systolic and -diastolic volumes were decreased significantly compared to pretreatment and placebo in both EP and OD treated groups. (55.5 +/- 18.4 and 53.7 +/- 19.1.8 ml; 109.9 +/-19.9 and 110.7 +/- 20.8 ml versus 74.5 +/- 14.9 and 142.7 +/- 19.1 ml, respectively; P < 0.05). Improvement in diastolic functions was significant in EP/OD groups compared to pre-treatment period and the placebo groups (E/A 1.34 +/- 0.1 and 1.38 +/- 0.1 versus 1.18 +/-.09, deceleration time 204 +/- 11.1 and 202.8 +/- 27.1 ms versus 237.6 +/- 26.9 ms, respectively). Besides increase in left ventricular mass adjusted for height, decrease in left ventricular relative wall thickness, and systemic vascular resistance were significant in EP and OD treated groups than placebo and the pre-treatment measurements. Although improved in both OD and EP groups, the changes in systolic and diastolic functions were significantly higher in the OD treated group. Based on our preliminary results, we may conclude that both EP and OD regimens may improve cardiac performance and age related dysfunctions. CONCLUSION The present results may further support that both OD and EP exert many direct effects on cardiovascular system other than metabolic changes regarding lipoproteins. The greater improvement in the OD group may be explained by its weak androgenic activity which is consistent with the in vitro data that androgens are potent relaxing agents on coronary arteries and restores cardiac myosin isoenzyme and ATPase patterns which mandates further clinical studies.
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Affiliation(s)
- Omur Taskin
- Department of Obstetrics/Gynecology, Division of Reprod. Endoc., Akdeniz University School of Medicine, Antalya, Turkey.
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Keser I, Sanlioglu AD, Manguoglu E, Guzeloglu Kayisli O, Nal N, Sargin F, Yesilipek A, Simsek M, Mendilcioglu I, Canatan D, Luleci G. Molecular analysis of beta-thalassemia and sickle cell anemia in Antalya. Acta Haematol 2004; 111:205-10. [PMID: 15153712 DOI: 10.1159/000077567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2003] [Accepted: 01/19/2004] [Indexed: 11/19/2022]
Abstract
We have studied 918 chromosomes for mutations leading to beta-thalassemia and sickle cell anemia, which are the two most frequently found monogenic disorders in Antalya, Turkey. Three hundred and seventy-seven postnatal and 82 prenatal cases were studied between 2000 and May 2003 in our center using reverse dot blot hybridization (RDBH) with 22 probes specific for Mediterranean populations. In this study, IVSI-110 (G-->A) appeared to be the most common mutation with an occurrence rate of 44.4% among the 16 different mutations found to be associated with beta-thalassemia. Heterozygosity for IVSI-110 was the most prevalent combination, whereas 34 of our 377 postnatal cases showed homozygosity for this mutation, a genotype leading to beta-thalassemia major. The total percentage of postnatal patients clinically diagnosed as beta-thalassemia major was 18.6%, whereas 5% of the cases were diagnosed clinically as beta-thalassemia intermedia. One new Hb variant, Hb Antalya, and one new mutation, Cod 3 (+T) were found. HbS accounted for 10.3% of all mutations; homozygosity was found in 1.9% of all cases. Of the 82 cases analysed prenatally for beta-globin gene mutations and by cytogenetic techniques for possible chromosomal abnormalities, 21 fetuses were found to be affected with beta-globin gene mutations. One of these fetuses was also found to have a 45,X karyotype, and 1 had a 46,XY/47,XY,+22 karyotype. Quite a high rate of consanguineous marriages in Antalya (35.17%) renders mutation screening, genetic counseling, and educational programs held by our Thalassemia Unit essential. This study was the first to be performed specifically in our region where hemoglobinopathies are most frequent as a consequence of migrations of racially and culturally distinct groups to the area in the distant past.
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Affiliation(s)
- I Keser
- Department of Medical Biology and Genetics, Akdeniz University School of Medicine, Antalya, Turkey
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Mendilcioglu I, Kilicarslan B, Gurkan Zorlu C, Karaveli S, Uner M, Trak B. Placental biopsy by frozen section: does it have a role in evaluation of fetal well-being? Aust N Z J Obstet Gynaecol 2004; 43:433-7. [PMID: 14712946 DOI: 10.1046/j.0004-8666.2003.00128.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To assess the effectiveness of post-partum placental biopsy and frozen section evaluation in diagnosing pregnancy disorders. STUDY DESIGN Between January and July 1998, biopsies were carried out on 100 newly delivered placentas. Biopsies were carried out using a 14-gauge needle, and frozen section evaluations were reviewed. These were compared to the standard evaluation of histological evaluation of the whole placenta sections. Specimens were evaluated by standard placental pathologic criteria. RESULTS Villous oedema which is associated with antenatal hypoxia was observed with a sensitivity of 78%, and specificity of 97%, yielding a positive predictive value of 84% in frozen section compared to standard placental evaluation. No statistical difference was observed in the evaluation of dysmaturity, intravillous fibrin agglutination and chronic villitis between frozen sectioning and whole placenta sections. Increased syncytial knots were detected with a sensitivity of 45% and specificity of 98%. CONCLUSION Placental biopsy by frozen sectioning might be a useful and quick method of evaluation for placental pathology. Theoretically, fetal status could be more precisely evaluated by combining prenatal placental biopsy by permanent section with conservative ante-partum well-being tests.
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Affiliation(s)
- Inanc Mendilcioglu
- Department of Obstetrics and Gynecology, Medical School, Akdeniz University, Arapsuyu, Antalya, Turkey.
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Bahado-Singh RO, Choi SJ, Oz U, Mendilcioglu I, Rowther M, Persutte W. Early second-trimester individualized estimation of trisomy 18 risk by ultrasound. Obstet Gynecol 2003; 101:463-8. [PMID: 12636949 DOI: 10.1016/s0029-7844(02)03078-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report two second-trimester ultrasound algorithms for trisomy 18 prediction. METHODS Femur length, gross anomaly, choroid plexus cysts, two-vessel cord, and maternal age were documented in pregnancies undergoing genetic amniocentesis. Stepwise logistic regression was used to identify 1) the significant markers for predicting trisomy 18 when gross anomaly was not considered (algorithm 1) and 2) when gross anomaly was also considered (algorithm 2). Patient-specific risk was calculated based on the significant ultrasound markers plus maternal age. The diagnostic accuracy of each algorithm was determined. RESULTS There were 1167 normal and 47 trisomy 18 cases. The mean gestational ages were 16.5 weeks (standard deviation [SD] 1.5) and 17.9 weeks (SD 1.6), respectively. Algorithm 1 consisted of maternal age, choroid plexus cyst, femur length, and two-vessel cord. The sensitivity and false positive rates were 61.7% and 1.5%, respectively, with an area under the receiver operating characteristics curve of 0.880 (P <.001). Algorithm 2 (age, femur length, gross anomaly, and choroid plexus cyst) had a sensitivity of 72.3% and false positive rate of 0.9% with an area under the curve of 0.956 (P <.001). Comparable detection rates were achieved in early gestation at up to and including 17.5 weeks (72.4% and 82.8%, algorithms 1 and 2, respectively, at a 4.0% false positive rate). CONCLUSION The ultrasound markers were sensitive for trisomy 18 detection in the early second trimester.
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Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0526, USA.
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Mendilcioglu I, Simsek M, Seker PE, Erbay O, Zorlu CG, Trak B. Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies. Int J Gynaecol Obstet 2002; 79:131-5. [PMID: 12427397 DOI: 10.1016/s0020-7292(02)00224-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the effectiveness of a prostaglandin E1 analog, misoprostol, using different regimens compared with dinoprostone in termination of pregnancies in second and early third trimester complicated by either congenital fetal anomalies or intrauterine fetal demise. METHODS A retrospective review of 59 pregnancies between 15 and 30 weeks was performed which were terminated due to congenital fetal anomalies or intrauterine fetal demise. In group 1 (n=29) 400 microg oral and 600 microg vaginal misoprostol, in group 2 (n=12) 600 microg vaginal misoprostol and in group 3 (n=18) 0.5 mg dinoprostone gel were given for the termination of the pregnancies. All these groups were evaluated for demographic characteristics and delivery findings. Statistical analysis were performed by one-way ANOVA, Kruskal-Wallis and chi(2)-test. RESULTS No significant statistical difference was observed in terms of age, gravidity, parity, previous abortion, gestational week, frequency of prostaglandin usage, and birth weights among the three groups. The time intervals between the first administration and delivery were 20.3 h for oral vaginal misoprostol, 17.3 h for vaginal misoprostol and 22.5 h for the dinoprostone group (P=0.594). Evacuation rates after single doses were similar in all groups (83%, 73% and 72%, respectively). Uterine tachysystole was the only major side effect encountered in the oral-vaginal misoprostol group. CONCLUSIONS All three regimens yielded similar results for termination of pregnancies in second and third trimester. The major advantage of misoprostol was the cost.
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Affiliation(s)
- I Mendilcioglu
- Department of Obstetrics and Gynecology, School of Medicine, Akdeniz University, Antalya, Turkey.
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Bahado-Singh RO, Rowther M, Bailey J, Mendilcioglu I, Choi SJ, Oz U, Copel J. Midtrimester nuchal thickness and the prediction of postnatal congenital heart defect. Am J Obstet Gynecol 2002; 187:1250-3. [PMID: 12439514 DOI: 10.1067/mob.2002.128025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study was performed to determine the sensitivity of nuchal thickness measurements for the detection of congenital heart defects (CHD) and to develop an algorithm for estimating patient-specific risk of CHD. STUDY DESIGN Nuchal thickness measurements (expressed as multiples of the median) were obtained in 3,003 midtrimester fetuses in which postnatal evaluation of the heart was available. The sensitivity and false-positive rate of nuchal thickness threshold values for detecting CHD were used to calculate the area under the receiver operating characteristics curve. Stepwise logistic regression analysis was used to determine the significant predictors of heart defect among nuchal thickness and epidemiologic risk factors. Individual risk of CHD was calculated on the basis of background population risk of major CHD (estimated at 4.4 of 1,000) and the product of the likelihood ratios of the significant risk factors from the logistic regression. RESULTS There were 95 cases of confirmed CHD. Nuchal thickness was statistically significant for the prediction of CHD with an area under the curve = 0.58, P =.01. Nuchal thickness and prior child with CHD were the only significant predictors among the multiple risk factors for this disorder. Patient-specific risk estimates for CHD based on these two "markers" were calculated. It was accurate and improved the prediction of CHD, area under the curve = 0.63, P <.001, compared with nuchal thickness alone. CONCLUSION Midtrimester nuchal thickness measurement significantly detected postnatally confirmed CHD in chromosomally normal fetuses. We report for the first time a method for estimating individual patient risk of CHD.
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Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Akdeniz University, Cincinnatti, Ohio, USA
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Abstract
OBJECTIVE The purpose of this study was to determine the Down syndrome sensitivity of early genetic sonography (14-<16 weeks of gestation) and to compare its diagnostic accuracy with that later in the mid trimester (16-24 weeks of gestation). STUDY DESIGN Nuchal thickness, humerus and femur lengths, hyperechoic bowel, hypoplastic fifth digit (clinodactyly), and any gross anatomic defects were measured or ascertained in singleton pregnancies that were undergoing genetic amniocentesis. Multiple stepwise logistic regression analysis was used to determine the significant sonographic markers for Down syndrome detection in each group. Multivariate gaussian algorithms that included maternal age were used to estimate patient-specific Down syndrome risk. Sensitivity and false- positive rates, receiver-operating characteristic curves, and area under the curves were calculated and compared for both groups. RESULTS There were 1,727 pregnancies with 22 Down syndrome fetuses (1.27%) in the early group versus 3,914 pregnancies with 86 Down syndrome fetuses (2.2%) in the later group. The mean +/- SD ages were 15.5 +/- 0.4 weeks versus 17.6 +/- 1.4 weeks, respectively. Early genetic sonography (14-<16 weeks) had a 100% detection rate, with a 21.2% false-positive rate. The early versus later genetic sonography had an 81.8% versus 61.6% detection rate, respectively, at a fixed 4.8% false-positive rate. Early sonography had significantly higher diagnostic accuracy (area under the curve, 0.962 vs 0.871, respectively; P =.005). In fetuses at 14 to 15 weeks, the genetic sonography was also highly accurate, with 100% detection with a 21.9% false-positive rate. CONCLUSION Early genetic sonography is highly sensitive and statistically superior to later ultrasonography for Down syndrome detection. Early midtrimester sonography achieved a diagnostic accuracy similar to that currently reported for first-trimester nuchal translucency.
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Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics, Yale University School of Medicine, New Haven, Conn, USA.
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Abstract
OBJECTIVE To investigate the etiology of oligohydramnios in postterm pregnancy using Doppler velocimetry. METHODS Renal and umbilical artery Doppler velocimetry were performed in women with singleton postterm (287 days' or more gestation) pregnancies. The renal and umbilical artery Doppler resistance index (RI) and end-diastolic velocity were measured. Stepwise logistic regression and the two-tailed t test were used to determine whether the Doppler indices correlated with oligohydramnios (amniotic fluid index less than 5 cm). RESULTS We studied 147 well-dated, singleton, postterm pregnancies, of which 21 (14.3%) had oligohydramnios. For the study cohort, the mean (+/-standard deviation) gestational age at Doppler was 41.4 +/- 0.45 weeks and at delivery 41.8 +/- 0.47 weeks. Stepwise logistic regression using renal and umbilical artery Doppler indices found the renal RI to be the only significant predictor of oligohydramnios: beta = -10.4186, P <.05 (odds ratio [95% confidence interval (CI)] = 0, 0.88). The renal artery RI was significantly higher in cases with oligohydramnios (RI: mean (+/-standard error) = 0.8843 +/- 0.11 versus 0.8601 +/- 0.05, P <or= 0.05). A renal artery Doppler end-diastolic velocity below the mean for gestation significantly increased the risk of oligohydramnios: relative risk (95% CI), 1.5 (1.1, 2.0). CONCLUSION Renal artery Doppler was more predictive of oligohydramnios than the umbilical RI. The reduced renal artery end-diastolic velocity suggests that increased arterial impedance is an important factor in the development of oligohydramnios in prolonged pregnancies.
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Affiliation(s)
- A U Oz
- Department of Obstetrics and Gynecology, Mersin University, Mersin, Turkey
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