Browsing by Author "Artunc-Ulkumen B."
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Item Normal range of intracranial translucency in healthy Turkish pregnancies and its association with first trimester maternal serum biochemistry and ductus venosus pulsatility index(Via Medica, 2014) Artunc-Ulkumen B.; Pala H.G.; Uyar Y.; Bulbul-Baytur Y.; Koyuncu F.M.Objective: To measure the intracranial translucency (IT) by establishing reference ranges in uncomplicated singleton Turkish pregnancies and to evaluate the association of IT with maternal serum biochemistry, gestational week, crown-rump length (CRL) measurement, nuchal translucency (NT) and ductus venosus Doppler velocimetry. Materials and methods: 190 uncomplicated singleton pregnancies were included in the study. IT, NT and CRL measurements between 11-14 gestational weeks were obtained with mid-sagittal plane. Two independent measurements were taken and averaged to obtain the final measurement used in the calculations. Statistical analysis was performed with SPSS for Windows 20.0 software package. Correlation analysis was used to determine the association between IT and NT, pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (fβ-hCG) and CRL length. A p-value of <0.05 was considered statistically significant. Results: The assessment rate of IT was 167/190 (87.89%). The mean CRL length, gestational week, NT and IT measurements were 63.63±10.05 mm, 12.28±0.75 weeks, 1.23±0.43 mm (range: 0.20-2.68) and 2,29±0,49 mm (range: 0.18-3.80), respectively. There was no significant correlation between IT and maternal serum PAPP-A MoM (r=-0.34, p=0.698) or maternal serum free β-hCG MoM (r=-0.79, p=0.363), respectively. There was weak- but statistically significant correlation between IT with with maternal weight (r=0.172, p=0.047), CRL length (r =0.301, p < 0.001), gestational week (r=0.286, p=0.001) and NT measurement (r=0.224, p=0.007), respectively. There was no significant association between IT with ductus venosus doppler pulsatility index (r=0.108, p=0.213). Conclusion: IT can be easily measured while scanning for NT. This study shows normal range values in healthy Turkish pregnancies. Consistent with recent data, our results show positive correlation with gestational week and CRL length. Maternal serum biochemistry does not have any effect on IT. Besides, our study highlights that IT is correlated with NT and adds newly to the literature that there is no correlation of IT with ductus venosus pulsatility index. © Polskie Towarzystwo Ginekologiczne.Item Premenstrual syndrome in Turkish medical students and their quality of life(Informa Healthcare, 2015) Goker A.; Artunc-Ulkumen B.; Aktenk F.; Ikiz N.This study aimed to analyse the frequency and symptoms of premenstrual syndrome (PMS) and its effect on quality of life in medical students. Sociodemographic data, a symptom calendar for the following consecutive two menstrual periods and SF-36 quality of life questionnaire were collected. A total of 228 students joined the survey. The average age of the students was 20.77 ± 1.90. The frequency of PMS was 91.8%. The most frequent symptoms were abdominal bloating (89.5%), irritability (88.3%) and breast tenderness (82.6%). Quality of life scores ranged from 17.00 to 97.00 and were lowest in the severe PMS group. Alcohol consumption, stress events and fat rich diets increased the severity of PMS. Family history significantly affected the severity of PMS and quality of life scores. Premenstrual syndrome was found to be a frequent entity among medical students and seemed to affect quality of life in a moderate way. © 2015 Informa UK, Ltd.Item De novo reciprocal translocation t(5;11)(q22;p15) associated with hydrops fetalis (reciprocal translocation and hydrops fetalis)(Informa Healthcare, 2015) Pala H.G.; Artunc-Ulkumen B.; Uyar Y.; Bal F.; Baytur Y.B.; Koyuncu F.M.Objective: This is a case of a prenatally diagnosed non-immune hydrops fetalis (NIHF) associated with translocation t(5;11)(q22;p15). An association between NIHF and this translocation has not been reported previously.; Case Report: The patient was referred to the perinatology clinic with hydrops fetalis diagnosis at 23 weeks' gestation. We noted that the fetus had bilateral pleural effusion, ascites, widespread subcutaneous edema, membranous ventricular septal defect, hypoplastic fifth finger middle phalanx, clinodactyly, single umbilical artery. We performed cordocentesis. Chromosomal analysis on blood showed a balanced translocation between the long arm of chromosome 5 and the short arm of chromosome 11 with karyotype of 46,XX,t(5;11)(q22;p15).; Conclusion: We present prenatal diagnosis of a de novo translocation (5;11) in a hydropic fetus with ultrason abnormalities. In our case, karyotype analysis of the fetus, mother and father provided evidence of a de novo translocation, that might explain the NIHF. © 2015 Informa Healthcare USA, Inc.Item Exenatide improves ovarian and endometrial injury and preserves ovarian reserve in streptozocin induced diabetic rats(Informa Healthcare, 2015) Artunc-Ulkumen B.; Pala H.G.; Pala E.E.; Yavasoglu A.; Yigitturk G.; Erbas O.We aimed to evaluate: (1) endometrial and ovarian tissue injury caused by the glucose toxicity in diabetic rat model and (2) the effect of GLP-1 analog (exenatide) on endometrial and ovarian diabetes induced injury with emphasizing the underlying mechanism. The study group composed of 24 female rats assigned randomly into 3 groups. Group 1 was the control group (n=8) and received no treatment. Diabetes was induced by intraperitoneal injection of streptozocin for 16 rats which are further assigned randomly into 2 groups: 1ml/kg intraperitoneal saline was given to Group-2 (diabetic non-treated control group, 8 rats) and 10μg/kg/day of intraperitoneal exenatide was given to Group 3 (exenatide treated group, 8 rats) for four weeks. After four weeks, blood samples were collected and hysterectomy with bilateral oophorectomy was performed for histopathological examination. Diabetes caused endometrial and ovarian tissue injury in rats (p<0.0001). Serum transforming growth factor beta (TGF-ß), malonylaldehyde (MDA), pentraxin-3 (PTX-3) levels were higher in diabetic rats (p<0.0001), whereas antimullerian hormone (AMH) was lower (p<0.001). Serum levels of these markers reflected that Diabetes induced injury in the reproductive tract occured via oxidative stress, fibrosis and severe inflammation. Diabetes diminished ovarian reserve. Exenatide treatment improved the histological degeneration and fibrosis in the endometrium and ovary with concomitant decrease in inflammatory and oxidative stress markers (p<0.05). Exenatide also improved ovarian reserve (p<0.05). Glucose toxicity occured severely in ovary and endometrium in DM. After exenatide treatment; ovarian and endometrial injury and fibrosis seems to decrease significantly. The effects of exenatide in rat models give hope to prevent the women with DM from premature ovarian failure and endometrial dysfunction. © 2014 Informa UK Ltd.Item First trimester ultrasound screening for Down syndrome based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow(John Wiley and Sons Ltd, 2015) Abele H.; Wagner P.; Sonek J.; Hoopmann M.; Brucker S.; Artunc-Ulkumen B.; Kagan K.O.Objective: To examine the performance of screening for Down syndrome based on maternal age, fetal nuchal translucency (NT) and different combinations of the additional ultrasound parameters: nasal bone (NB), tricuspid flow (TF) and ductus venosus (DV). Methods: Retrospective study at the University of Tuebingen, Germany including women who underwent chorionic villous sampling between 2008 and 2014. Prior to invasive testing, the crown rump length, NT, NB, TF and DV were measured. In each case, the added value of the additional markers NB, TF and DV were compared with screening for trisomy 21 based on maternal age (MA) and NT thickness alone. Results: A total of 1916 pregnancies met the inclusion criteria, including 1823 fetuses with a normal karyotype and 93 with trisomy 21. Screening based on MA, fetal NT and one, two and three of the additional ultrasound markers resulted in a detection rate of about 80%, 87% and 94%, respectively for a false positive rate of 3%. Conclusion: Detection rates for trisomy 21 in first trimester ultrasound screening are substantially higher if all three additional markers rather than just one are assessed. © 2015 John Wiley & Sons, Ltd.Item Relationship of neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin levels with the presence and severity of the preeclampsia(Taylor and Francis Ltd., 2015) Artunc-Ulkumen B.; Guvenc Y.; Goker A.; Gozukara C.Objective: The aim of the present study was to evaluate changes in maternal serum neutrophil gelatinase-associated lipocalin (NGAL) and procalcitonin (PCT) concentrations in preeclampsia.Material and method: This case-control study consisted of 40 preeclamptic and 40 healthy singleton pregnancies matched for age and body mass index. Serum NGAL and PCT levels were compared between the groups. Diagnostic performance and clinical association of these markers were evaluated.Results: NGAL and PCT concentrations were significantly higher in preeclamptic group (p < 0.0001 and p = 0.001, respectively) and their levels were correlated with the severity of the preeclampsia. There were significant positive correlation between these markers and mean arterial pressure (MAP) and spot urine protein excretion. There was negative correlation between NGAL and apgar scores and fetal birth weight. Pregnancies with higher NGAL (OR: 4.89; 95% CI: 1.81-13.21) and higher PCT (OR: 6.67; 95% CI: 2.44-18.21) concentrations had higher risk for preeclampsia.Conclusion: NGAL and PCT may be potential biomarkers for preeclampsia. Their levels increase significantly in preeclampsia and they are related to the severity of the disease. These results are in agreement with the generalized endothelial damage and persistant inflammatory status in preeclampsia. NGAL may also be an indicator for adverse neonatal outcomes with decreased placental hypoperfusion. © 2014 Informa UK Ltd.Item Maternal Serum S100-B, PAPP-A and IL-6 levels in severe preeclampsia(Springer Verlag, 2015) Artunc-Ulkumen B.; Guvenc Y.; Goker A.; Gozukara C.Aim: We aimed to investigate the relationship of maternal serum levels of S100-B, PAPP-A and IL-6 with severe preeclampsia. Materials and methods: This prospective case–control study consisted of 27 severe preeclamptic and 36 healthy singleton pregnancies. The groups were matched for parity, maternal age and body mass index. Maternal blood sampling for S100B, PAPP-A and IL-6 was performed at the morning after an overnight fasting. Results: S100-B concentrations were significantly higher in severe preeclampsia group (0.09 ± 0.05 vs. 0.13 ± 0.01 µg/L; p = 0.025). PAPP-A levels were higher (196.54 ± 21.56 vs. 208.80 ± 23.97 mIU/ml; p = 0.707) and IL-6 levels were lower in severe preeclamptic group (68.79 ± 29.89 vs. 37.30 ± 6.46 pg/ml; p = 0.372). AUC value for S100-B was calculated as 0.712. When cutoff level for serum S100-B for predicting severe preeclampsia was regarded as 0.0975 µg/L, sensitivity and specificity were found to be 81.4 % and 58.3 %, respectively. Pregnancies with ≥0.0975 µg/L S100-B levels had 12.75-fold increased risk for having CNS symptoms (OR 12.75; 95 % CI 2.69–60.28) and 3.27-fold increased risk for having HELLP syndrome (OR 3.27; 95 % CI 0.62–17.36). Conclusion: Our results suggest that serum S100B levels may be a potential marker in severe preeclampsia for the severity of hypoperfusion both in placenta and brain pointing at subsequent risk of organ failure. © 2015, Springer-Verlag Berlin Heidelberg.Item Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus(Taylor and Francis Ltd, 2016) Pala H.G.; Artunc-Ulkumen B.; Koyuncu F.M.; Bulbul-Baytur Y.Objectives: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL).Methods: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm3) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%).Results: Placental volume was significantly larger in GDM (411.59 ± 170.82 versus 343.86 ± 128.94 cm3; p = 0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65 ± 7.02 versus 38.71 ± 7.91, respectively; p = 0.277). Placental volume was significantly correlated with gestational week (r = 0.219, p = 0.035) and parity (r = 0.228, p = 0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r = -0.278, p = 0.007; r = -0.315, p = 0.002; r = -0.322, p = 0.001, respectively).Conclusions: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better. © 2015 Informa UK Ltd.Item Maternal serum ADAMTS-9 levels in gestational diabetes: a pilot study(Taylor and Francis Ltd, 2017) Artunc-Ulkumen B.; Ulucay S.; Pala H.G.; Cam S.Objective: Gestational diabetes mellitus (GDM) is characterized with insulin resistance which is diagnosed during pregnancy. Although pregnancy is a diabetogenic state, not all women develop GDM. Genetic factors together with enviromental factors cause the maladaptation of maternal pancreas to this diabetogenic state and GDM develops. ADAMTS-9 is a recently recognized molecule whose genetic variants have risk of GDM. Decreased levels have already been shown in fetal membranes. Maternal serum levels of this protein have not been studied yet. We hypothesized that the alteration of ADAMTS-9 expression should cause changes in maternal serum levels which further could help to identify the disease and develop new treatment strategies. Materials and methods: This prospective case–control study is consisted of 27 pregnancies with GDM and 30 healthy singleton pregnancies matched for matenal age, gestational week, and maternal weight. GDM diagnosis was made with 2-h 75 g oral glucose tolerance test. ADAMTS-9 levels were compared between groups. Results: ADAMTS levels were 3.62 ± 0.33 ng/dL (range: 3.04–4.23) in GDM group and 4.65 ± 1.70 ng/dL (range: 3.07–8.21) in control group (p < 0.001). ADAMTS levels were not affected by maternal age, gestational age, and maternal weight. Conclusion: ADAMTS-9 levels were significantly lower in GDM pregnancies. This may help to understand the mechanism of GDM pathogenesis. In future, target treatments with ADAMTS proteins may help to improve the severity of diabetes pathogenesis. © 2016 Informa UK Limited, trading as Taylor & Francis Group.Item Maternal serum perlecan levels in women with preeclampsia(Taylor and Francis Ltd, 2020) Akbas M.; Koyuncu F.M.; Artunc-Ulkumen B.; Taneli F.; Ozdemir H.Objective: Perlecan is an extracellular matrix proteoglycan suggested to maintain endothelial functions. We aimed to measure maternal serum perlecan levels in different preeclampsia phenotypes. Methods: This study included 50 women with preeclampsia and 30 healthy pregnant women. Results: Serum perlecan levels were significantly higher (p = 0.016) in preeclamptic women with severe features(n = 23) than preeclampsia patients(n = 27). There were no statistically significant differences in serum perlecan levels between the early-onset preeclampsia(n = 25), late-onset preeclampsia(n = 25), and healthy pregnancies. Conclusion: Our findings suggest that preeclamptic women with severe features have higher serum perlecan levels than women with preeclampsia. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.Item The impact of invasive prenatal testing on anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy(Taylor and Francis Ltd., 2021) Akbas M.; Koyuncu F.M.; Bülbül Y.; Artunc-Ulkumen B.; Çetin A.Purpose: Prenatal anxiety has negative effects on pregnancy and neonate. Both screening tests and invasive diagnostic tests are associated with elevated anxiety level. But a normal fetal karyotype result could improve the anxiety level in high-risk patients. We hypothesized that patients who prefer follow-up without karyotyping may experience increased anxiety and sleep impairment until delivery. Our aim was to determine the effect of invasive diagnostic test decision on anxiety and sleep quality in women with a positive screening result. Methods: 132 women were included for the study and three groups were described. The invasive group consisted of women who underwent invasive procedure after a screen-positive test result, the follow-up group consisted of women who preferred non-invasive follow-up after a screen-positive result and the control group consisted of women with screen-negative test results. Participants were evaluated with the State-Trait Anxiety Inventory (STAI) and the Pittsburgh Sleep Quality Index (PSQI) after genetic counseling. They were asked for completing the same questionnaires in the third trimester to establish the course of anxiety and sleep quality throughout pregnancy. Results: STAI scores were significantly higher in both screen-positive groups than in the control group in the first evaluation (p < 0.001). STAI scores decreased in the invasive group and controls while PSQI scores did not significantly change during the course of the pregnancy. However, the anxiety level and sleep quality were worsened over time in the follow-up group. Conclusion: Screen-positive women who preferred to follow up had higher anxiety level and worse sleep quality in the later stages of pregnancy. We concluded that invasive prenatal diagnostic tests could improve anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy. © 2020 Informa UK Limited, trading as Taylor & Francis Group.Item The effect of maternal vitamin D levels on placental shear wave elastography findings in the first trimester(Taylor and Francis Ltd., 2021) Artunc-Ulkumen B.; Kirteke K.; Koyuncu F.M.The aim of this study was to investigate the effect of maternal serum Vitamin D levels on the elasticity of placenta. Seventy-four spontaneously conceived singleton pregnancies in their first trimester were enrolled into this study. Fifty-one of them had Vitamin D deficiency (<20 ng/mL), while 23 pregnancies had Vitamin D levels ≥20 ng/mL. The placental elasticity was measured by the transabdominal Point Shear Wave Elastography (pSWE) method. In each case, the mean of 10 consecutive measurements was accepted as the mean placental elasticity value. The mean pSWE values did not significantly differ between the Vitamin D deficient group and the control group (p >.05). Placental elasticity was not found to be different in the pregnancies with Vitamin D deficiency during the first trimester.IMPACT STATEMENTWhat is already known on this subject? The pSWE technique provides opportunity to determine the elasticity of any interested tissue. Placental elasticity has been found to be changed in inflammatory and fibrotic conditions such as in preeclampsia, intrauterine growth restriction or diabetes. On the other hand, Vitamin D deficiency is linked with several comorbidities such as autoimmune disorders, cancer and cardiovascular disorders. Vitamin D also plays a role in placental angiogenesis in the first trimester. Maternal Vitamin D levels are shown to be related with adverse pregnancy outcomes. What do the results of this study add? To the best of our knowledge, this study is the first assessing the association between Vitamin D levels and placental elasticity. Placental elasticity was not found to be changed by Vitamin D deficiency. What are the implications of these findings for clinical practice and/or further research? Our pilot study revealed that Vitamin D deficiency does not have any impact on placental elasticity in the first trimester. However, longitudinal studies concerning placental elasticity in subsequent trimesters are needed to support our findings. © 2020 Informa UK Limited, trading as Taylor & Francis Group.Item Impact of pregnancy on voice: a prospective observational study(Taylor and Francis Ltd., 2022) Ulkumen B.; Artunc-Ulkumen B.; Celik O.Purpose: We aimed to assess if there is a significant change in voice of pregnant women by the end of third trimester. Materials and methods: Forty-nine pregnant women were enrolled in this study between April 2019 and March 2020. Subjective and objective voice evaluation was conducted in the third trimester and three months after delivery. The Turkish version of the VHI-10 questionnaire was filled out by every participant. GRBAS scale was used for perceptual voice evaluation. Acoustic analyses were conducted by Multi-Dimensional Voice Program (MDVP) (Computerized Speech Lab, Kay Elemetrics Corporation, Lincoln Park, NJ). Fundamental frequency (fo), Jitter percent (Jitt), Shimmer percent (Shim), noise to harmonic ratio (NHR), maximum phonation time (MPT), voice turbulence index (VTI), vocal intensity, and scale parameters were categorized as predelivery (a) and postdelivery (b). Results: Comparison of acoustic parameters of the third trimester with the third month postpartum revealed statistically significant increases for fo (p =.013), MPT (p =.008), and vocal intensity (p≤.001) as well as a significant decrease for VTI (p≤ .001). No statistically significant difference was found for NHR, Jitt, and Shim. Comparison of both VHI-10 and GRBAS scores revealed statistically significant decreases. Conclusions: Disturbances in certain vocal parameters suggest that vocal abnormalities observed during pregnancy are mainly due to anatomical alterations of the lower respiratory system. It would be appropriate to warn pregnant women about bad vocal habits and vocal hygiene. In addition, it would be appropriate to recommend professional voice support to pregnant women who use their voices intensively due to their profession. © 2021 Informa UK Limited, trading as Taylor & Francis Group.