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Öğe Diagnostic sign of intra uterine extra amniotic adhesions with 4D ultrasonography: sheet on string(Galenos Yayincilik, 2018) Çalışkan, Eray; Bender, Rukiye Ada; Aslancan, ReyhanIntra uterine adhesions seen in pregnancy, which were defined in 1894 by Joseph G. Asherman, are divided into two groups as intra amniotic and extra amniotic adhesions. Intra uterine intra amniotic adhesions, which are also known as intra amniotic bands, are easily detectable in first and second trimester ultrasonographic examinations; therefore, close follow-up could provide an appropriate approach.Öğe Diagnostic sign of intra uterine extra amniotic adhesions with 4D ultrasonography: Sheet on string(Galenos Yayınevi, 2018) Çalışkan, Eray; Bender, Rukiye Ada; Aslancan, ReyhanDear editor; Intra uterine adhesions seen in pregnancy, which were defined in 1894 by Joseph G. Asherman, are divided into two groups as intra amniotic and extra amniotic adhesions. Intra uterine intra amniotic adhesions, which are also known as intra amniotic bands, are easily detectable in first and second trimester ultrasonographic examinations; therefore, close follow-up could provide an appropriate approach. Also intrauterine extra amniotic adhesions are a causative factor of infertility, early pregnancy loss, preterm delivery, cesarean section due to malpresentation, placental invasion abnormalities, and intra uterine fetal death(1,2) . There are no ultrasonographic diagnostic signs for intrauterine extra-amniotic adhesions in the literature, and the presumption of negative pregnancy outcomes and following up these patients is difficult for obstetricians. The aim of this study was to provide a handy method to distinguish intrauterine extra- amniotic adhesions for pregnancy outcomes and postpartum follow-up. Based on second trimester detailed ultrasonography outcomes, twenty-four patients were identified as having intrauterine extra amniotic adhesions through 4D ultrasonographic investigations. Sixteen patients had cesarean deliveries; the indications were previous cesarean section for ten, presentation abnormality for four, and placentation abnormality for two of the pregnant women. The intrauterine extra amniotic adhesions were verified during cesarean operations. Eight of the pregnant women had vaginal deliveries and six months after the delivery, adhesions were verified via hysteroscopic imaging. The locations of the adhesions were observed as following: fifteen of the women who had cesarean section had isthmic adhesions (93.75%), and one had cornual adhesion (6.25%). All eight women who had vaginal deliveries had adhesions in the uterine cornu (100%). In conclusion, intrauterine extra-amniotic adhesions can be identified by a specific ultrasonographic appearance known as “sheet on string,” because it looks like a sheet spread out on a string (Figure 1, 2). Intra uterine adhesions that have not been identified in the preconception period but are important for pregnancy follow-up can be determined using 4D ultrasonography during anomaly screening with the advantage of amniotic fluid’s image quality increasing effect.Öğe The effect of hands-on cadaver and live surgery practice on surgeons' performance in urogynecologic operations: one-year follow-up(Mary Ann Liebert, Inc, 2020) Akar, Bertan; Aslancan, Reyhan; Doğan, Ozan; Başbuğ, Alper; Sivaslıoğlu, Akın; Çalışkan, ErayObjective: Surgical procedures need a combination of theoretical knowledge and practical experience to be performed properly. Postresidency education programs provide opportunities to practice new surgical techniques. This article evaluates 2 different educational strategies for learning new techniques in the field of urogynecology. One of the strategies is commonly practiced theoretical education plus observation of live surgeries, and the other strategy is a threefold approach of theoretical education, as well as cadaver training and performing live surgery. Materials and Methods: The study was designed as a prospective cohort study. The occupational experiences of 58 obstetricians and gynecologists were documented prior to the educational interventions. Two groups were created, based on the participants' preferences. Group 1 had theoretical education followed by observation of live surgery through broadcasting. Group 2 had theoretical education, plus a 1-day cadaver-based surgery course, as well as assisting tutors in hands-on operations. At a 1-year follow up, different types of surgeries performed throughout the year by each surgeon were recorded and analyzed using SPSS. Results: Prior to the course, both groups had similar experiences in urogynecologic operations (p > 0.05). In Group 2, significantly more surgeons began to perform tension-free vaginal tape (TVT) interventions regularly after the course (p < 0.001), a procedure considered more technically demanding. Surgeons utilizing any of the midurethral slings including TVT, transobturator tape, or mini-slings increased by 20% in Group 2, a statistically significant increase (p = 0.03). Conclusion: A threefold approach of theoretical education, cadaver practice, and live surgery significantly increases surgeon adaptation to utilization of midurethral slings, compared to exclusively theoretical education with observation of live surgery. (J GYNECOL SURG 20XX:000)Öğe Fetal brain lactate peak measurement by magnetic resonance spectroscopy for prediction of fetal hypoxia in a case of unexplained third trimester recurrent fetal loses(7847050 Canada Inc, 2019) Akar, Bertan; Aslancan, Reyhan; Şimşek, Hakkı; Çakır, Pınar; Çalışkan, ErayBackground: The fetal brain lactate level which is measured by magnetic resonance spectroscopy (MRS) is a compelling indicator for hypoxic/ischemic brain damage. Aim: The authors present a case of MRS diagnosed fetal brain lactate peak despite normal fetal development and Doppler indices which lead to a preterm delivered hypoxic fetus. Case Report: A 37-year-old woman admitted to this clinic at 30 weeks six days of her gestation because of previous recurrent three unexplained fetal death at third trimester and one neonatal death. At 33 weeks one day of pregnancy. MRS examination showed lactate peak in the fetal brain, despite bi-weekly normal Doppler indices and fetal biophysical profile follow-up. After eight days of daily follow-up since lactate peak measurement, her biophysical profile was 6 despite normal Doppler indices. She developed mild preeclampsia after four days following lactate peak. She had imminent cesarean section at 34th week of gestation and a 1,980-gram neonate with Apgar scores of 5 and 7 at the first and fifth minute was delivered. Fetal hypoxia was diagnosed due to base excess of -14 and a cord blood pH of 7.16. The newborn was discharged in a healthy state after five days of neonatal intensive care. Conclusion: The case presents that fetal brain lactate peak can be the only first warning sign in cases of unexplained fetal losses predicting oncoming fetal hypoxia despite normal fetal Doppler and biophysical profile evaluation.Öğe Ischiopagus which is the rarest form of heteropagus along with ambiguous genitalia and kidney agenesis: a case report(2020) Haqverdiyev, Emin; Aslancan, Reyhan; Gümüştaş, Gökhan; Çalışkan, Eray; Akar, BertanParasitic twin (heteropagus) is a term to describe an incomplete fetus which is partially resorbed and located on a normal fetus. Ischiopagus which defines the parasitic twins connected from ileum is the rarest form of heteropagus abnormalities. In this case, a thirteen week old fetus was diagnosed with ischiopagus, ambiguous genitalia, and left kidney agenesis during the first trimester ultrasonography screening. Termination was applied with the family decision. These cases should be evaluated together with accompanying multisystem anomalies. Informing the family with details about the viability of the fetus is important to prevent unnecessary termination.Öğe Ischiopagus Which is the Rarest Form of Heteropagus Along With Ambiguous Genitalia and Kidney Agenesis: A Case Report(İzmir Hastaneline Yardım ve Bilimsel Araştırmaları Teşvik Derneği, 2020) Akar, Bertan; Haqverdiyev, Emin; Aslancan, Reyhan; Gümüştaş, Gokhan; Çalışkan, ErayParasitic twin (heteropagus) is a term to describe an incomplete fetus which is partially resorbed and located on a normal fetus. Ischiopagus which defines the parasitic twins connected from ileum is the rarest form of heteropagus abnormalities. In this case, a thirteen week old fetus was diagnosed with ischiopagus, ambiguous genitalia, and left kidney agenesis during the first trimester ultrasonography screening. Termination was applied with the family decision. These cases should be evaluated together with accompanying multisystem anomalies. Informing the family with details about the viability of the fetus is important to prevent unnecessary termination.Öğe Thin Endometrium After Hysteroscopic Treatment Of Severe Asherman’s Syndrome in Ivf Pregnancies: Case Series(İzmir Hastaneline Yardım ve Bilimsel Araştırmaları Teşvik Derneği, 2020) Akar, Bertan; Haqverdiyev, Emin; Aslancan, Reyhan; Gümüştaş, Gokhan; Çalışkan, ErayPrevious uterine surgery is the most important risk factor for Asherman’s syndrome which is an important risk factor for placenta invasion abnormalities. In this study, it is presented three IVF pregnancy outcomes which had obtained from the base of consistent thin endometrium (≤7 mm) following the hysteroscopic adhesiolysis treatment for severe intrauterine adhesions. Variable degrees of placenta invasion abnormalities had detected in the cesarean section deliveries. First two cases with placenta percreta had been managed via cesarean hysterectomy because of the failure of conservative technique, and the third case with less placental invasion had been managed via conservative approach. Pregnancies with the history of hysteroscopicadhesiolyis due to severe intra uterine adhesions must be categorized as high risk pregnancy and they should be followed up closely according to this risky situationÖğe Thin endometrium after hysteroscopic treatment of severe asherman’s syndrome in ıvf pregnancies: case series(2020) Hakverdiyev, Emin; Aslancan, Reyhan; Gümüştaş, Gökhan; Çalışkan, ErayPrevious uterine surgery is the most important risk factor for Asherman’s syndrome which is an important risk factor for placenta invasion abnormalities. In this study, it is presented three IVF pregnancy outcomes which had obtained from the base of consistent thin endometrium (?7 mm) following the hysteroscopic adhesiolysis treatment for severe intrauterine adhesions. Variable degrees of placenta invasion abnormalities had detected in the cesarean section deliveries. First two cases with placenta percreta had been managed via cesarean hysterectomy because of the failure of conservative technique, and the third case with less placental invasion had been managed via conservative approach. Pregnancies with the history of hysteroscopicadhesiolyis due to severe intra uterine adhesions must be categorized as high risk pregnancy and they should be followed up closely according to this risky situation. Keywords: Asherman’s syndrome, adhesiolysis, placenta invasion abnormalities Öz Geçirilmiş uterin cerrahi, plasenta invazyon anomalileri için en önemli nedenlerden olan Asherman sendromu için önemli bir risk faktörüdür. Bu çalışmada ciddi intra uterin adhezyonların tedavisi için yapılan histeroskopik adhezyolizis sonrası persiste eden ince endometriyum (<7 mm) zemininde gerçekleşen üç IVF gebeliğinin sonuçları sunulmaktadır. Değişik seviyelerde plasenta invazyon anomalileri sezaryen doğum sırasında tespit edilmiştir. Konservatif yaklaşımla kontrol edilemeyen ilk iki plasenta perkreata vakası sezaryen histerektomi ile sonlandırılırken, daha azinvazyon gözlenen üçüncü vaka da uterus koruyucu cerrahi tercih edilmiştir. Ciddi uterus adhezyonları sebebiyle histeroskopik adhezyolizis geçirmiş hastaların gebelikleri yüksek riskli gebelik Kabul edilmeli ve bu riskli durumdan ötürü yakından takip edilmelidir
