Browsing by Author "Ulkumen B.A."
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Item Prenatal diagnosis of placenta percreta with ultrasound(Aras Part Medical International Press, 2014) Ulkumen B.A.; Pala H.G.; Baytur Y.The incidence of the placental invasion anomalies are increasing, mainly due to repeat cesarean deliveries. Placenta percreta occurs if these villi perforate the serosa and also sometimes into adjacent organs such as the bladder. The prenatal diagnosis is very important because of the high maternal morbidity and mortality rates without the appropriate surgical planning. The adherent placentas will result in severe early postpartum bleeding, just after the delivery of the fetus. Severe hemorrhage usually results rapidly in disseminated intravascular coagulation (DIC), shock, multiorgan failure or death.The surgery is also challenging due to the risk of the adjacent tissue damage, such as bladder or ureteral injury. Approximately 1 in every 3 cases need intensive care. We present here a prenatally diagnosed, 31-year-old gravida 7 para 2 abortus 4 pregnant case with placenta percreta and rewiev the relevant literature about the key aspects in the ultrasonograhic diagnosis and underlie the key points in the diagnosis. © 2014 The Author(s).Item Acute abdomen and massive hemorrhage due to placenta percreta leading to spontaneous uterine rupture in the second trimester(Saudi Arabian Armed Forces Hospital, 2014) Ulkumen B.A.; Pala H.G.; Baytur Y.Placental invasion anomalies are rare obstetrical complications. They cause severe third trimester hemorrhage, severe postpartum bleeding, and maternal morbidity and mortality unless they are diagnosed antenatally. We present a rare case with placenta percreta leading to spontaneous uterine rupture during the second trimester with an acute abdomen and hypovolemia. © 2014, Saudi Arabian Armed Forces Hospital. All rights reserved.Item Can mean platelet volume and platelet distrubition width be possible markers for ectopic pregnancy and tubal rupture? (MPV and PDW in ectopic pregnancy)(2014) Ulkumen B.A.; Pala H.G.; Calik E.; Koltan S.O.Objective: We aimed to evaluate the alterations in serum levels of platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW) in ectopic pregnancy (EP) and discuss the mechanism of the alterations in MPV and PDW. Methods: This retrospective evaluation of 153 tubal EP patients (39 ruptured and 114 non-ruptured) admitted to our clinic between 2009 and 2013 and 67 healthy pregnancies was conducted. The data regarding the maternal age, hemoglobin level, platelet level, MPV, PDW was analyzed. Results: MPV was lower in the EP, especially in ruptured EP, compared to control group. However, no significant difference could be found between the groups (p=0.616). PDW was higher in the EP, especially in ruptured EP, compared to control group, however there was no statistical difference between the three groups (p=0.451). Platelet counts were significantly lower in ruptured EP compared to non-ruptured ectopic pregnancies and control groups (p=0.005). Conclusions: MPV seems to be lower in ruptured EP suggesting the possible high grade inflammation in pathology. Platelet counts tend to be lower in ruptured EP suggesting the consumption of the platelets at the inflammation site. However, further studies are needed to describe the usefulness of the platelet indices in the diagnosis and clinical follow-up of EP. Our preliminary results show that MPV levels may decrease in the ruptured EP cases. At the same time, PDW levels may increase.Item Retrospective analysis of fetal anterior abdominal wall defects(Saudi Arabian Armed Forces Hospital, 2014) Ulkumen B.A.; Pala H.G.; Baytur Y.; Koyuncu F.M.Objective: To analyze fetal abdominal defects diagnosed during the prenatal period in the perinatology department in a tertiary center in Turkey.; Methods: This retrospective study consisted of 27 cases diagnosed with fetal abdominal wall defects between January 2011 and February 2014 in the perinatology outpatient clinic of Celal Bayar University, Manisa, Turkey.; Conclusion: The prenatal diagnosis of fetal abdominal wall defects is important, because they differ greatly in terms of perinatal and neonatal morbidity and mortality due to underlying chromosomal abnormalities and associated structural anomalies.; Results: Eighteen (66.7%) cases were diagnosed with omphalocele, 6 (22.2%) had gastroschisis, and 3 (11.1%) had limb body wall defects. Twenty-one (77.7%) patients diagnosed either as omphalocele or limb body wall defect were offered karyotype analysis; 11 (52.4%) of them accepted the intervention, and 2 of the 11 patients (18.2%) had abnormal karyotype. Regarding the omphalocele cases; 12 (66.6%) cases had isolated omphalocele, whereas 6 of the 18 cases (33.3%) had associated anomalies. Expectant management was performed in 8 (66.7%) of 12 isolated omphalocele cases. Two of the isolated omphalocele group (16.7%) had missed abortion, the other 2 (16.7%) had termination of the pregnancy because of the associated chromosomal anomaly (47,XXY and 45,X0). Three of the gastroschisis group (50%) had missed abortion, and the other 3 (50%) had expectant management with cesarean delivery between 38-39 gestational weeks. Cases with limb body wall defect were terminated due to the lethal condition. © 2014, Saudi Arabian Armed Forces Hospital. All rights reserved.Item The effect of parity on first trimester uterine artery doppler waveforms in low-risk singleton pregnancies(Studio K Krzysztof Molenda, 2014) Ulkumen B.A.; Pala H.G.; Uyar Y.; Baytur Y.B.; Koyuncu F.M.Objectives: The aim of the study was to evaluate the effect of parity on uteroplacental blood flow during the first trimester in low-risk singleton pregnancies. Materials and methods: Uterine artery Doppler examinations were performed in 190 singleton pregnancies between 11-14 gestational weeks. Twenty-five pregnancies were excluded from the study due to history of preeclampsia, diabetes mellitus or inherited thrombophilia. A total of 165 low-risk singleton pregnancies were included in the study. Mean uterine artery pulsatility index (PI) was recorded and compared between nulliparous and multiparous women. The relation between maternal age, gestational week, maternal weight, parity, biochemical markers and abnormal uterine artery Doppler flows was evaluated. T-test and logistic regression analyses were used for the statistical analysis. Results: A total of 165 singleton pregnancies without any risk factors for uteroplacental insufficiency were included in the study. Of them, 58 (36.7%) were nulliparous and 107 (63.3%) were parous. Correlation analysis revealed that the uterine artery pulsatility indices during the first trimester were not affected by maternal age and parity. Conclusions: Mean uterine artery pulsatility indices are not different in nulliparous and multiparous low risk pregnancies at 11-14 weeks of gestation. © Polskie Towarzystwo Ginekologiczne.Item Sexual dysfunction in Turkish women with dispareunia and its impact on the quality of life(S.O.G. CANADA Inc., 2014) Ulkumen B.A.; Erkan M.M.; Pala H.G.; Baytur Y.B.Purpose of Investigation: The authors aimed to determine the prevalence of female sexual dysfunction (FSD) among Turkish dyspareunic women and to establish the associated factors with FSD. Furthermore, they aimed to investigate if dyspareunia and possible ssociated sexual complaints were related to impaired quality of life (QoL). Materials and Methods: The study included 154 women admitted to the present gynecology department at a tertiary center in the west region of Turkey, 67 of which suffered from dyspareunia. The remaining 87 sexually healthy women were included in the control group. FSD was assessed with 19-item validated female sexual function index (FSFI). QoL was assessed using short form 36 (SF-36). The chi-squared test and t-test were used for analysing the group differences. Pearson's correlation test was used to determine the effect of the variables of FSFI on the SF-36. Multivariate analysis and logistic regression was used to determine independent risk factors for FSD and to estimate odds ratio (OR) with 95% confidence interval (CI). Results: The incidence of FSD in dyspareunic group and control group was 86.57% and 36.8%, respectively (p < 0.001). Dyspareunic women had lower scores with regards to sexual desire, arousal, lubrication, orgasm, satisfaction, and pain domains at significant level (p < 0.001). Education level, time period after the last delivery, duration of marriage, parity, and dyspareunia were significantly related to FSD. However, dyspareunia was an independent risk factor for FSD (OR 11.49; 95% CI 4.95-26.67). Regarding the impact on the QoL, dyspareunic women had lower scores with regards to the physical role, social function, bodily pain, and vitality domains. Conclusion: The present results show that dyspareunia has a major impact on women's sexual ftinction and QoL. Clinicians have an important role for encouraging women to report their sexual complaints. Identifying dyspareunia and treating FSD may positively affect women's sexual function and overall QoL.Item The effects of sunitinib on endometriosis(Informa Healthcare, 2015) Pala H.G.; Erbas O.; Pala E.E.; Ulkumen B.A.; Akman L.; Akman T.; Oltulu F.; Yavasoglu A.The aim of the present study was to evaluate the effect of sunitinib on endometriotic implants and adhesions in a rat endometriosis model. An experimental endometriosis model was created in 21 rats. These rats were randomly divided into three groups: Group 1 (control group, 7 rats) was given no medication; Group 2 (sunitinib group, 7 rats) was given 3 mg/ kg per day of oral sunitinib; and Group 3 (danazol group, 7 rats) was given 7.2 mg/kg per day of oral danazol. The volume of endometriotic implants was calculated. The extent and severity of adhesions were evaluated. The groups were compared by the Student's t-test, analysis of variance (ANOVA) and the Mann-Whitney U test. There was no statistically significant difference in the mean volume of endometriotic implants before medication between three groups. The volume of implants and extent, severity, total score of adhesions were significantly decreased after medication in Group 2 and Group 3. We noted that the volume of the endometriotic implants and adhesion formation were decreased both after sunitinib and danazol treatment. As a result, sunitinib seems to be effective for endometriotic peritoneal lesions. The effects of sunitinib in rat models give hope for improving the treatment of human endometriosis and prevention of pain symptoms. © 2014 Informa UK, Ltd.Item Outcomes and management strategies in pregnancies with early onset oligohydramnios(S.O.G. CANADA Inc., 2015) Ulkumen B.A.; Pala H.G.; Baytur Y.B.; Koyuncu F.M.Objective: To evaluate the outcomes and management options in pregnancies with early onset oligohydramnios. Materials and Methods: The file datas of all pregnancies diagnosed as oligohydramnios or anhydramnios before 27 gestational weeks between January 2006 and September 2013 were evaluated retrospectively. The underlying pathology and associated anomalies, karyotype analysis, the outcome of the pregnancy (either termination or labour), and gestational week at the time of diagnosis were analyzed. Results: A total of 54 pregnancies were evaluated; mean gestational week at the time of the diagnosis was 19.8 ± 4.6. Mean maternal age was 27.28 ± 6.03. Thirty-seven pregnancies were anhydramniotic, 13 fetuses had associated anomalies, five of them had multicyctic dysplastic kidney, five had bilateral renal agenesis, one had hypoplastic right heart syndrome, one had clubfoot, and one had ventricular septal defect and cleft palate. Karyotyping was normal regarding the fetuses with structural anomalies. Nineteen patients had premature preterm rupture of membranes and 39 patients had termination of pregnancy. Conclusion: The prognosis of early onset oligohydramnios is poor. Main determinant is gestational week at the time of the diagnosis.Item Complete blood count parameters may have a role in diagnosis of gestational trophoblastic disease(Professional Medical Publications, 2015) Eskicioglu F.; Ulkumen B.A.; Calik E.Objective: The goal of this study was to investigate whether gestational trophoblastic disease (GTD) and healthy pregnancy differ with respect to complete blood count parameters and these parameters can be used both to explain the pathophysiologic mechanisms and differentiate the two conditions from each other. Methods: The data obtained from 37 women with GTD and 61 healthy pregnancies (control group) regarding platelet (PLT), mean PLT volume (MPV) and PLT distribution width (PDW), and white blood cell (WBC) levels were evaluated. Patients with GTD were further subdivided into two groups composed of 20 partial mole (PM) and 17 complete mole (CM) cases. Results: PDW and WBC were lower in the GTD than the control. There were no differences for PLT and MPV. WBC was lower in PM and both WBC and PDW were lower in CM compared with control. ROC curve analysis revealed an area under curve (AUC) 75.5% for WBC and AUC 69.3% for PDW. A cut-off value was determined 8.19 for WBC with 81.0% sensitivity and 54.1% specificity. While, 15.85 were accepted for PDW, with 87.9% sensitivity and 44.4% specificity. Conclusion: Lower WBC in GTD may suggest that molar pregnancy requires a lower inflammatory reaction facilitating trophoblastic invasion. Lower PDW as an indicator of platelet activation in CM may suggest that CM requires less PLT activation than healthy pregnancy that needs stronger trophoblast invasion for normal placental development. Decreased PDW levels especially < 15.85 and WBC levels < 8.19 may alert clinicians for risk of GTD. © 2015, Professional Medical Publications. All rights reserved.Item The relationship between placental elasticity and prenatal serum screening markers and Doppler indices(Yuzuncu Yil Universitesi Tip Fakultesi, 2020) Akbaş M.; Koyuncu F.M.; Erenel H.; Ulkumen B.A.; Mete T.O.It has been shown that placental elasticity values were higher in pregnant women with preeclampsia and intrauterine growth restriction. The studies have been reported that prenatal serum screening markers and uterine artery Doppler parameters could be useful in the prediction of preeclampsia and intrauterine growth restriction. In this study, we aimed to investigate the relationship between placental elasticity values and these serum markers and Doppler indices in the first and second-trimester. 108 cases between 11-14 gestational weeks were enrolled for this study. Placental elasticity measurements were performed after the first-trimester combined test and Doppler assessment. The same procedures were repeated with the second-trimester triple test for 71 pregnant women who were followed-up. Correlation analysis of demographic characteristics, biochemical parameters and Doppler findings with placental elasticity values were performed. In the first-trimester, we found a statistically significant and positive correlation between placental elasticity values and bilateral uterine artery notching (r =0.193, p =0.045) and mean arterial pressure (r =0.398, p <0.001). Likewise, positive correlation was found between placental elasticity values and bilateral uterine artery notching (r =0.303, p =0.023) and mean arterial pressure (r =0.274, p =0.041) in the second-trimester. Our study showed that placental elasticity values were positively correlated with mean arterial pressure and bilateral uterine artery notching in the first and second-trimesters. In light of these findings, the utility of placental elasticity measurement in early gestation to predict pathologies due to insufficient placentation has to be proven with comprehensive studies. © 2020, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.