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Öğe Centile charts of cervical length in singleton and twin pregnancies between 16 and 24 weeks of gestation(Galenos Publ House, 2023) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Kole, Emre; Caliskan, ErayObjective: The aim of this study was to determine the standard mid-trimester cervical lengths of singleton and twin pregnancies.Material and Methods: This study was conducted by retrospective analysis of mid-trimester transvaginal cervical measurements of women with singleton and twin pregnancies that were examined by a single perinatologist in a single center.Results: A total of 4621 consecutive asymptomatic pregnant women admitting for advanced obstetric ultrasound screening were evaluated. Of these 4340 (93.9%) were second trimester singleton pregnancies and 281 (6.1%) were twin pregnancies and were included. Mean cervical length measurements of singleton and twin pregnancies were 6.5 & PLUSMN;38.2 mm and 7.2 & PLUSMN;37.6 mm respectively (p=0.17). Overall, the 5th percentile of cervical length measurement after analysing singleton and twin pregnancies together was 29.4 mm at 16 weeks, 30 mm at 17 weeks, 30 mm at 18 weeks, 30 mm at 19 weeks, 30 mm at 20 weeks, 30 mm at 21 weeks, 30 mm at 22 weeks, 31 mm at 23 weeks, 29 mm at 24 weeks.Conclusion: In our population the 5th precentile value of cervical length which is 30 mm in singletons and 10th percentile cervical length which is 31 mm in twins can be used to follow-up and treat pregnant women at risk for preterm delivers. (J Turk Ger Gynecol Assoc 2023; 24: 114-9)Öğe Cervical cerclage application algorithm in continued cervical shortening cases despite vaginal progesterone(Elsevier Masson s.r.l., 2021) Akar, Bertan; Ceylan, Yasin; Karadağ, Cihan; Çalışkan, ErayObjective: The aim of this study is evaluation of pregnancy outcomes of the asymptomatic cases with vaginal progesterone treatment for the 20?30 mm cervical length detected in the transvaginal ultrasonography for fetal abnormality screening and cervical cerclage after cervical length detected <20 mm in weekly cervical length measures; and present the treatment algorithm of progesterone treatment combined with cervical cerclage application. Methods: Patients who have the inclusion criteria and cervical length more than 30 mm were categorized as group 1(n = 1948). Group 2 were included patients with cervical length shorter than 30 mm (n = 95). All patients of group 2 started to use vaginal natural progesterone 400 mg/day(n = 87). Pregnancies which progressed with cervical length above 20 mm were continued vaginal progesterone until 34. Gestational week and they were named as group 2A (n = 78). Cervical cerclage were applied to patients with cervical length below than 20 mm measured via transvaginal ultrasonography and they were categorized as group 2B (n = 9). Results: Excluding 8 cases (8.42 %) which cervical cerclage were applied, 87 patients were administered vaginal progesterone and in 9 cases (10.34 %) cervical shortening were continued despite progesterone treatment. Four out of these nine cases (44.44 %) had cervical cerclage and their deliveries were delayed after 34 th gestational week. Vaginal progesterone treatment prevented cervical shortening in 89.66 % of patients who had cervical length between 20?30 mm and out of these patients. Conclusion: Cervical cerclage application algorithm in continued cervical shortening cases despite vaginal progesterone is beneficial to delay the delivery after 34 th gestational week and related to low complication rate.Öğe An effective method of teaching cystoscopy to obstetrics and gynecology specialists(Galenos Publishing House, 2022) Akar, Bertan; Sarıbacak, Ali; Ceylan, Yasin; Çalışkan, ErayObjectives: In this study, it was aimed to evaluate the knowledge and skills of gynecologists and obstetricians about cystoscopy theoretically and practically during the two-day urogynecology course. Materials and Methods: Thirty-eight gynecologists and obstetricians aged 29–55 were simultaneously enrolled in cystoscopy training and evaluation in the urogynecology course, which includes theoretical, fresh cadaver and live surgery training stages. In addition, a theoretical evaluation was made with quizzes before and after fresh cadaver training. Finally, 6 months after the training, all trainees were called by phone and detailed information about their surgical experiences was obtained after the course. Results: After the cadaver training, it was observed that the time and motion scores and instrument handling scores of the trainees increased significantly on the patients. Conclusion: With surgical courses and simulations, the use of cystoscopy should be increased in the diagnosis and management of complications in urogynecological surgical procedures during and after the residency training of gynecologists and obstetricians. © 2022 by the International Society for Pelviperineology / Pelviperineology published by Galenos Publishing House.Öğe Female genital aesthetic surgery: comparison of cadaver and live surgery training models(Galenos Publishing House, 2022) Akar, Bertan; Ceylan, Yasin; Ellibeş Kaya, Aşkı; Çalışkan, ErayObjective: In this study, it was aimed to search the efficiency of fresh cadaver course and live surgical operations for female genital aesthetic surgery application. Materials and Methods: Seventy-three obstetrics and gynecology specialists underwent a two-day course about genital cosmetic surgery that includes theoretical lectures, fresh cadavers and live surgeries. These surgeons divided into two group. First group trained on cadavers (n=33), second group was involved in live surgeries (n=40). Skills in genital cosmetic surgery, applied procedures, number of participating colleagues in a procedure, ability to learn and motivations to take the course were compared before and after the training course. At the 6th month of education every trainee were called and interviewed about the progress they got after the education. Results: After the fresh cadaver and live surgery training, numbers of trainees who performed genital cosmetic procedures (GCP) before the course and 6 months after the course were compared. A meaningful increase on numbers of trainees after the course who performed all GCP applications was observed. According to the statistics of participants, it was observed that a live surgical course is more beneficial than a cadaver course. Numbers of trainees who performed genital aesthetic surgery before and 6 months after the course were compared. A meaningful raise was observed in the statistics of trainees’ numbers who performed all surgical applications apart from anterior and posterior compartment repair. Conclusion: Fresh cadaver and live surgical courses have positive effects in the long term for the surgeons who have lack of surgical confidence and skills. © 2022 by the International Society for Pelviperineology / Pelviperineology published by Galenos Publishing House.Öğe A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta(GALENOS YAYINCILIK, 2021) Çalışkan, Eray; Akar, Bertan; Ceylan, Yasin; Karadağ, CihanObjective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel "lower uterine sandwich" technique to control post-cesarean hemorrhage due to PP accreta. Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely "Caliskan's uterine sandwich technique". Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy. Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.Öğe A novel low uterine segment sandwich technique (Caliskan’s technique) for the management of postcesarean hemorrhage due to placenta previa accreta(2021) Ceylan, Yasin; Karadağ, Cihan; Çalışkan, Eray; Akar, BertanObjective: Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel “lower uterine sandwich” technique to control post-cesarean hemorrhage due to PP accreta. Materials and Methods: Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely “Caliskan’s uterine sandwich technique”. Results: All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy. Conclusion: This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.Öğe Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral(GALENOS YAYINCILIK, 2022) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Köle, Emre; Çalışkan, ErayObjective: In this study, we aimed to evaluate the effects of obstetric emergencies workshops combining theoretical lectures, simulation trainers and fresh cadaver models on daily practices and referrals of obstetrics and gynecology specialists. Materials and Methods: This is a prospective observational study involving obstetrics and gynecology specialists attending the Turkish Society of Obstetrics and Gynecology endorsed obstetrics hemorrhage management courses held in 2018 and 2019. The training course is an annually organized two-day course, one day allotted to theoretical lectures and the other day to practical training on both simulators and fresh cadavers. Trainees participating in the course was surveyed with an anonymous questionnaire on their motivation to attend the course and their juridical history of obstetric patient management. Attendees were asked to disclose whether they had ever independently performed the procedures stated in the questionnaire or riot, before commencing the course and 1 year after attending the course. Results: Among the attendees 22% (n=32) had at least one obstetrical malpractice lawsuit and 36.1% (n=52) were accused of Health Care Complaints Comission. The main motivation of the attendees for taking this course was Professional development followed by reducing maternal mortality and morbidity and avoiding malpractice. One year after the course, attendees applying uterine devascularization surgery increased by 36.1% (52/144), uterine compression sutures increased by 52.7% (76/144), and ability to apply uterine balloon tarnponade increased by 59.7% (86/144). Besides improvement in other obstetric surgical skills an indirect effect seen that the attandees operated on high-risk cases increased in placenta previa (15.3%), placenta acreata spectrum (30.5%), operative deliveries (27.7%), peripartum hysterectomy (24.9%) and relaparotomy for postpartum hemorrhage (34.7%). Conclusion: Opportunities of attending well organized fresh cadaveric workshops on managing postpartum hemorrhage and other obstetric surgeries, can quickly adapt to daily practice, restore the professional confidence of obstetric and gynecology specialists, and eventually decrease patient referral.Öğe Prenatal diagnosis of a rare type of conjoined twin, cephalothoracoomphalopagus : a case report(2021) Ceylan, Yasin; Akar, Bertan; Yaman, İlteriş; Akkaya, SelimConjoined twins are a rare outcome of a monoamniotic and monochorionic gestation. We present a case of cephalothoracoomphalopagus conjoined twin diagnosed by prenatal ultrasonographic examination. A 26-yearold gravida 2, para 1 woman was referred to our perinatology unit for evaluation because of suspected conjoined twins at 24 weeks of gestation. Her medical history was unremarkable. There was no family history of genetic abnormalities. The diagnosis of conjoined twins was confirmed by prenatal ultrasonographic examination. Conjoined twins occur when two identical individuals are joined by part of their anatomy and share their vital one or more organs. The incidence of conjoined twins ranges from 1:50,000 to 1:250,000 live births. We present a case of male cephalothoracoomphalopagus conjoined twin, which is extremely rare type of conjoined twins. A prenatal diagnosis of shared organs dictates pregnacy termination or possible surgical separation strategies.Öğe Prenatal diagnosis of twin reversed arterial perfusion (trap) sequence: a case report(2021) Ceylan, Yasin; Akar, Bertan; Yaman, İlteriş; Akkaya, SelimTwin reversed arterial perfusion (TRAP) sequence is a rare condition of monochorionic twin pregnancy. It has an incidence of 1:35.000 pregnancies and constitutes 1% all monochorionic pregnancies. The etiopathogenetic mechanisms are not well defined. There is co-existence of a normal pump twin and an acardiac recipient twin. A 22-year-old nulliparous woman was referred with TRAP sequence. The prognosis in TRAP sequence is lethal for acardiac twin and the fetal mortality of the pump twin is very high due to the cardiac failure. The obstetrician should be aware of TRAP-sequence in twin/multiple pregnancies.Öğe Recombinant FSH versus highly purified urinary FSH in patients with polycystic ovary syndrome undergoing ICSI cycles: a prospective randomized study(Galenos, 2022) Aynıoğlu, Öner; Ceylan, Yasin; Akar, Bertan; Özkan, Sabiha; Çalışkan, ErayObjective: To compare efficacy and safety of recombinant follicule stimulating hormone (r-FSH) and highly purified urinary FSH (HP-uFSH) in polycystic ovary syndrome (PCOS) patients undergoing intracytoplasmic sperm injection (ICSI). Method: This was a prospective randomized study conducted at Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, in vitro fertizilization (IVF) Unit. A total of 91 PCOS patients undergoing ICSI were randomly assigned to receive either r-FSH (n = 46) or HPuFSH (n = 45) with a gonadotropin releasing hormone (GnRH) antagonist protocol. The main outcome measures were the number of mature oocytes retrieved, embryo quality, pregnancy rates, implantation rates. Results: The number of mature oocytes retrieved, fertilization rates, the number of cryopreserved embryos were significantly higher in r-FSH group (p = 0.024, p = 0.023, p = 0.026 respectively) while the total dose of FSH used was significantly lower in the same group (p = 0.023). Pregnancy rates, clinical pregnancy rates were higher in r-FSH group although not statistically significant (52.2% versus 35.6%, p = 0.11, 37% versus 28.9%, p = 0.41 respectively). Overall therapy costs per clinical pregnancy were associated with a 9.94% increase in r-FSH group whereas costs per pregnancy were not different between groups. Conclusion: r-FSH is superior than HP-uFSH in PCOS regarding fertilization rates, the number of mature oocytes retrieved and cryopreserved embryos, pregnancy rates although overall therapy costs per clinical pregnancy are higher. Keywords: ART, HP-uFSH, PCOS, rec-FSH Amac: ICSI uygulanan PCOS hastalarinda rekombinant FSH (r-FSH) ve yuksek oranda saflastirilmis uriner FSH'nin (HP-uFSH) etkinligini ve guvenligini karsilastirmaktir. Yontem: Kocaeli Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Anabilim Dali Tup Bebek Unitesi'nde yurutulen prospektif randomize bir calismadir. ICSI uygulanan toplam 91 PCOS hastasi, bir GnRH antagonist protokolu ile r-FSH (n = 46) ve HP-uFSH (n = 45) almak uzere rastgele belirlendi. Ana sonuc olcutleri; alinan olgun oosit sayisi, embriyo kalitesi, gebelik oranlari, implantasyon oranlariydi. Bulgular: Alinan olgun oosit sayisi, dollenme oranlari, dondurularak saklanan embriyo sayisi r-FSH grubunda anlamli olarak daha yuksek (sirasiyla p = 0,024, p = 0,023, p = 0,026), ayni grupta kullanilan toplam FSH dozu ise anlamli olarak daha dusuktu (p = 0,023). Gebelik oranlari, klinik gebelik oranlari r-FSH grubunda istatistiksel olarak anlamli olmamakla birlikte daha yuksekti (sirasiyla %52,2'ye karsi %35,6, p = 0,11, %37'ye karsi %28,9, p = 0,41). Klinik gebelik basina genel tedavi maliyetleri, r-FSH grubunda %9,94'luk bir artisla iliskilendirilirken, gebelik basina maliyetler gruplar arasinda farkli degildi. Sonuc: r-FSH, PCOS'de fertilizasyon oranlari, alinan olgun oosit sayisi ve dondurularak saklanan embriyolar, gebelik oranlari acisindan HP-uFSH'den ustundur, ancak klinik gebelik basina genel tedavi maliyetleri daha yuksektir. Anahtar kelimeler: ART, HP-uFSH, PCOS, rec-FSHÖğe Review of a challenging clinical issue: acute biliary pancreatitis during pregnancy(2021) Ceylan, Yasin; Akar, BertanAcute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstone. Approximately 70% cases of acute pancreatitis during pregnancy are secondary to gallstones or sludge. Acute pancreatitis is a rare complication with a reported incidence of one per 1.500-4.500 pregnancies. Gallstones cause bile duct obstruction and pancreatic hyperstimulation. These processes lead to increased hydrostatic pressure, trypsin reflux and activation of digestive enzymes within the pancreas and cause autodigestion of pancreas, followed by local inflammation. During pregnancy, the steroid hormones of pregnancy affect the gallbladder motility and bile content. Progesterone induces gallbladder smooth muscle relaxation and estrogens increase bile cholesterol level, enhancing bile stasis. The clinical symptoms include pain in the right upper abdominal area and/or epigastric area, which can radiate to the right flank, scapula and shoulder, anorexia, nausea, vomiting, dyspepsia, low-grade fever and sinus tachycardia, hyperventilation and smell of acetone in the breath. The diagnosis of acute pancreatitis in pregnancy is confirmed by laboratory investigations and imaging methods. The management of acute biliary pancreatitis during pregnancy is similar on a large scale
