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Öğe Assessment of fetal right ventricular myocardial performance index changes following intrauterine transfusion(Taylor and Francis Group, 2021) Temel Yüksel, İlkbal; Acar, Deniz; Turhan, Uğur; Aslan Çetin, Berna; Köroğlu, Nadiye; Şenol, Gökalp; Tayyar, Ahmet; Yüksel, Mehmet AytaçIntroduction: Severe fetal anemia may cause cardiac ischemia, reduced contractility, and dysfunction. The purpose of our study is to evaluate right ventricular myocardial performance index (MPI) before and after intrauterine transfusion (IUT) in patients who underwent this procedure because of fetal anemia due to Rh-D alloimmunization. Materials and methods: This prospective cohort study was conducted between January 2018 and June 2019 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The pregnant women who were applied IUT because of fetal anemia due to Rh-D alloimmunization in our perinatology clinic were included in the study. Fetal right ventricular MPI before and 24 h after IUT were evaluated. Results: A total of 28 IUTs were performed in 17 pregnant women during the study period. The isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) values measured before IUT, were found to be significantly longer compared to the ICT and IRT values measured after IUT. The MPI values measured after transfusion was found to be higher than before transfusion. Conclusions: The fetal right ventricular MPI increases 24 h after IUT. This increase in the right ventricular MPI might be used as a marker for predicting adverse fetal outcomes following IUT.Öğe Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses(Walter De Gruyter Gmbh, 2019) Kaya, Başak; Tayyar, Ahmet; Kanber Acar, Deniz; Kaya, SerdarBackground: This study aimed to investigate fetal cardiac functions by spectral tissue Doppler imaging (s-TDI) in pregnancies complicated with late-onset fetal growth restriction (LO-FGR) and small-for-gestational age (SGA). Methods: Forty pregnancies complicated with late-onset FCR and 40 pregnancies complicated with SGA between the 34th and 37th weeks of gestation were enrolled in this study. Forty gestational age-matched pregnant women with no obstetrics complication were randomly selected as a control group. Small fetuses were classified as fetal growth restriction or SGA according to estimated fetal weight (EFW), umbilical artery pulsatility index (PI), cerebroplacental ratio (CPR) and uterine artery PI. s-TDI measurements were obtained at the right atrioventricular valve annulus. Results: SGA and LO-FGR fetuses had significantly lower A' and S' values, and higher E'/A' ratio than the control group (P < 0.001). In comparison to controls, significantly prolonged isovolumetric contraction time (ICT') and isovolumetric relaxation time (IRT') and, significantly shortened ejection time (ET') were observed in fetuses with SGA and LO-FGR. Increased myocardial performance index (MPI') values were also found in fetuses with SGA and LO-FGR compared to controls. Conclusion: The signs of cardiac dysfunction were observed both in fetuses with SGA and LO-FGR. The fetal cardiac function assessment with s-TDI could be a valuable method in the diagnosis of true growth restricted fetuses and in the management of these fetuses.Öğe Evaluation of right side foetal myocardial performance index in pregestational and gestational diabetes mellitus(Taylor & Francis Inc, 2022) Şenol, Gökalp; Aslan Çetin, Berna; Esin, Didem; Topbaş Selçuki, Nura Fitnat; Tayyar, Ahmet; Turhan, Uğur; Bütün, Zafer; Yüksel, Mehmet AytaçThe aim of our study is to investigate the myocardial performance index (MPI) of the right side of the foetal heart in pregestational and gestational diabetes mellitus and to compare it with non-diabetic pregnancies. This prospective cross-sectional study was conducted between August 2018 and March 2019 at Kanuni Sultan Suleyman Research and Training Hospital. Women with pregestational or gestational diabetes mellitus at 24-34 weeks of gestation were included in the study and non-diabetic pregnant women were included as the control group. MPI of the right side of the foetal heart were evaluated and compared between the groups. A total of 65 pregestational or gestational diabetic patients and 65 non-diabetic patients were included in the study. Isovolumetric contraction time and isovolumetric relaxation time values were significantly longer in the diabetic group (p < .001). Ejection time values were significantly shorter in the diabetic group (p < .001). MPI values were significantly higher in the diabetic group than the non-diabetic group (p < .001). In conclusion, MPI of the right side of the foetal heart is significantly higher in pregestational and gestational diabetes than in the non-diabetic group.IMPACT STATEMENT What is already known on this subject? Gestational diabetes mellitus causes foetal cardiomyopathy and foetal diastolic dysfunction. Myocardial performance index (MPI) is a non-invasive, Doppler-derived myocardial performance assessment that is independent of both heart rate and ventricular anatomy. What do the results of this study add? MPI of the right side of the foetal heart was significantly higher in pregestational and gestational diabetes than in the non-diabetic group. There was no difference in right ventricular MPI between pregestational and gestational groups in diabetic pregnancies, and between insulin using and not insulin using groups. What are the implications of these findings for clinical practice and/or further research? Our study results are promising. MPI of the right side of the foetal heart is significantly higher in pregestational and gestational diabetes than in the non-diabetic group. Prospective cohort studies evaluating serial MPI and evaluating by postpartum foetal echocardiography are needed to evaluate possible adverse effects of diabetes on foetal cardiac functions.Öğe Fetal bronkopulmoner malformasyonlar: Prenatal tanı ve perinatal sonuçlar(Kanuni Sultan Süleyman Eğitim Araştırma Hastanesi, 2020) Kaya, Başak; Kanber Açar, Deniz; Sezer, Salim; Tayyar, Ahmet; Polat, İbrahimAmaç: Bu çalışmada prenatal dönemde konjenital pulmoner hava yolu malformasyonu ve bronkopulmoner sekestrasyon tanısı alan olguların klinik özelliklerinin, prognozu etkileyen faktörlerin ve perinatal sonuçlarının değerlendirilmesi amaçlandı. Yöntem: Ocak 2013-Aralık 2016 tarihleri arasında hastanemiz perinatoloji ünitesinde konjenital pulmoner hava yolu malformasyonu ve bronkopulmoner sekestrasyon tanısı alan 59 olgunun kayıtları incelendi. Torakal kitlenin özellikleri ve doğal seyri ile olguların yönetimleri ve perinatal sonuçları incelendi. Bulgular: Otuz yedi olgu (%71.2) konjenital pulmoner hava yolu malformasyonu ve 15 olgu (%28.8) bronkopulmoner sekestrasyon tanısı aldı. Olguların %17.3’de eşlik eden yapısal anomali saptanırken, eşlik eden yapısal anomalisi olan olguların 4’ünde (%7.7) kromozom anomalisi mevcuttu. Olguların %75’inde canlı doğum gerçekleşti. Yenidoğan döneminde 23 olguda (%59) bronkopulmoner malformasyon varlığı radyolojik olarak gösterildi ve bu olguların 18’i (%78.3) yaşamın ilk bir yılında opere edildi. Sonuç: Eşlik eden anomali ve hidrops yokluğunda fetal bronkopulmoner malformasyon olgularının prenatal dönemde oldukça iyi seyrettiği ve özellikle spontan regresyon izlenen olguların postnatal dönemde operasyon gereksinimi olmadan sorunsuz yaşamlarını sürdürdüklerini saptadık. Fetal bronkopulmoner malformasyonlar ve diğer torakal anomalilerin prenatal tanı sıklığının artırılabilmesi amacıyla temel fetal anatomik tarama sırasında toraks transvers kesitlerden görüntülenmeli ve klinik şüphe varlığında çoklu sonografik planlar kullanılarak ayırıcı tanı yapılmalıdır.Öğe Fetal konotrunkal kalp anomalileri: Prenatal taramada dört oda görünümü yeterli mi?(2019) Kaya, Başak; Kanber Açar, Deniz; Tayyar, Ahmet; Bornaun, Helen; Ayyıldız, Pelin; Polat, İbrahimAmaç: Bu çalışmada hastanemiz perinatoloji ünitesinde konotrunkalkalp anomalisi tanısı alan olguların kayıtları incelenerek prenataldönemde konotrunkal kalp anomalisi tanısına yönlendiren faktörlerindeğerlendirilmesi ve prenatal konotrunkal kalp anomalisitanısı ile ilgili farkındalığın artırılması amaçlandı.Yöntem: Ocak 2015 – Aralık 2016 tarihleri arasında Kanuni SultanSüleyman Eğitim ve Araştırma Hastanesi Perinatoloji Ünitesindekonotrunkal kalp anomalisi tanısı alan olguların yönlendirilmenedenleri, eşlik eden kalp dışı anomali ve kromozom anomalisivarlığı, olguların perinatal sonuçları ve postnatal dönemde tanı-nın doğrulanma başarısı değerlendirildi.Bulgular: Tüm konjenital kalp anomalilerinin içinde konotrunkalkalp anomalisi sıklığı %20.4 idi. Çalışmaya dahil edilen 101 olgunun37’sinde (%36.6) gebelik terminasyonu gerçekleştirildi. ‹ntrauterinfetal ölüm 5 (%5) olguda gözlendi. Olguların %26.7’sindekromozom anomalisi ve %34.7’sinde kalp dışı ek yapısal anomalisaptandı. Canlı doğan 59 (%58.4) olgunun 52’sinde (%88.1) prenataltanı doğrulandı. Olguların yalnızca %27.7’sinde dört oda görünümününanormal olduğu saptandı.Sonuç: Dört oda görünümünün konotrunkal kalp anomalilerindesıklıkla normal olması nedeni ile bu anomalilerin prenatal tanı sıklığının artırılabilmesi için temel fetal kardiyak tarama programlarında üç damar ve üç damar trakea kesitleri rutin olarak görüntülenmelidir.Öğe Maternal serum galectin-1 and galectin-3 levels in pregnancies complicated with preterm prelabor rupture of membranes(Taylor and Francis Ltd, 2020) Kaya, Başak; Turhan, Uğur; Sezer, Salim; Kaya, Serdar; Dağ, İsmail; Tayyar, AhmetObjective: To investigate maternal serum galectin-1 and galectin-3 levels in pregnancies complicated with preterm prelabor rupture of membranes (PPROM) and to compare with pregnancies delivered at term. Materials and methods: In this cross-sectional study, 40 women with singleton pregnancies complicated with PPROM between 24 and 34 weeks of gestation were compared with gestational age-matched 40 pregnant women with no obstetrics complications, who delivered at term. The maternal serum galectin-1 and galectin-3 levels were measured. Results: Patients complicated with PPROM had significantly higher levels of galectin-1 (p = .001) and galectin-3 (p = .003) than the control group. Maternal serum galectin-3 levels were found significantly negatively correlated with the gestational age at delivery and birth weight. Conclusion: Maternal serum galectin-1 and galectin-3 levels were significantly higher in pregnancies complicated with PPROM. Galectin-1 and galectin-3, with their regulatory effects in key biological processes, may be both an initiating factor in the pathophysiology of PPROM, a marker in the prediction, and a target of preventing strategies of PPROM.Öğe Maternal serum sestrin 2 levels in preeclampsia and their relationship with the severity of the disease(Taylor & Francis Inc, 2019) Tayyar, Ahter Tanay; Tayyar, Ahmet; Kozalı, Şükran; Karakuş, Resul; Eser, Ahmet; Yayla, Çiğdem Abide; Yalçın, Emel Tuğçe; Dağ, İsmail Dağ; Eroğlu, MustafaObjective: To investigate sestrin 2 (SESN2) levels in preeclampsia (PE) cases and uncomplicated pregnancies. Methods: Cross-sectional study including 26 pregnant women with PE, 24 with severe-PE, and 30 randomly selected healthy pregnant women. Results: The mean arterial pressure, severe proteinuria, number of HELLP syndrome cases, and serum SESN2 levels in the severe PE group were significantly higher than those in the other groups (p <0.001, p <0.001, p = 0.006, and p = 0.004, respectively). Negative correlation was found between the birth interval (r =-.262, p = 0.019) and the SESN2 level. Conclusion: SESN2 seems to play a role in the pathophysiology of PE, especially in severe PE cases.Öğe Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation(Taylor & Francis Ltd, 2020) Şavklı, Ayşe Özge; Aslan Çetin, Berna; Acar, Zuat; Özköse, Zeynep; Behram, Mustafa; Süzen Çaypınar, Sema; Tayyar, Ahmet; Yüksel, Mehmet AytaçThe aim of this study was to evaluate the maternal and neonatal outcomes of patients who underwent intrauterine transfusion (IUT) for foetal anaemia due to red blood cell alloimmunisation and to determine the factors that affected the outcomes. All pregnancies that were treated with IUT due to Rh immunisation between January 2015 and June 2018 in the Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynaecology, were evaluated retrospectively. IUT due to non-Rh alloimmunisation, parvovirus B19 infection, chronic fetomaternal haemorrhage and foetal anaemia due to homozygous alpha-thalassemia were not included in the study. The perinatal and neonatal outcomes of the patients were retrospectively analysed. The gestational age, ultrasonography findings before and after IUT, laboratory results, complications related to IUT, and data on the newborns were recorded. The cases were divided into two groups, those with complication and those without complications, and their perinatal outcomes were compared. A total of 110 IUTs were performed in 42 foetuses. The survival rate after transfusion was 80.95%. Procedure-related complications were found in 12.7% of cases. There were no significant differences between the demographic and clinical characteristics of the patients with and without complications. The survival rate was lower and perinatal mortality was higher in foetuses with hydrops fetalis. IUT is a safe and effective procedure that can be used in the treatment of foetal anaemia in experienced centres. Survival rates can be increased by referring patients to experienced perinatology centres, by improving the IUT technique, and by reducing technique-related complications.Impact statement What is already known on this subject? The predominant use of IUT is to treat foetal anaemia due to red blood cell alloimmunisation. Despite the decrease after anti-D immune globulin prophylaxis, Rh immunisation is still a major cause of foetal anaemia. However, foetal survival rates have increased with the use of IUT. What do the results of this study add? The survival rates were increased after the development of a high-resolution ultrasound. Because foetal monitoring can be performed by ultrasonography, cord accidents and overload findings can be detected during transfusion, which allows for early interventions and increases survival rates.Öğe The assessment of cardiac function with tissue Doppler imaging in fetuses with congenital diaphragmatic hernia(Taylor & Francis, 2020) Kaya, Başak; Tayyar, Ahmet; Sezer, Salim; Kaya, SerdarIntroduction: This study aimed to evaluate the cardiac function of fetuses with congenital diaphragmatic hernia by conventional echocardiography and spectral tissue Doppler imaging (s-TDI) and to evaluate the relationship between cardiac function and the severity of pulmonary hypoplasia. We also aimed to investigate the effect of diaphragmatic hernia side on fetal cardiac function. Methods: Fetal cardiac function were evaluated in 28 fetuses (20 with left-sided and 8 with right-sided) complicated with isolated congenital diaphragmatic hernia (CDH) and 56 gestational age matched control in this single center prospective study. s-TDI measurements were obtained at the right atrioventricular valve annulus. The annular peak velocities and their ratios, the time periods of cardiac cycle and myocardial performance index were calculated. Results: In comparison to controls, significantly prolonged isovolumetric contraction time (ICT ') and isovolumetric relaxation time (IRT ') and, significantly shortened ejection time (ET ') were observed in fetuses with CDH by s-TDI. Fetuses with CDH also had higher myocardial performance index (MPI ') z-scores compared to controls. There were no significant differences in terms of s-TDI cardiac function parameters between fetuses with right- and left-sided CDH. In correlation analysis, a significant positive correlation was found between ET ' value and o/e LHR. Conclusion: The signs of both systolic and diastolic altered function were observed in fetuses with CDH with s-TDI independent of the side of the hernia, and a significant positive correlation was observed between fetal cardiac systolic function and the severity of pulmonary hypoplasia.Öğe Type-IV laryngotracheoesophageal cleft detected during fetoscopic endoluminal tracheal occlusion in fetus with severe congenital diaphragmatic hernia(Wiley, 2020) Yüksel, Mehmet Aytaç; Tayyar, AhmetLaryngotracheoesophageal (LTE) clefts are rare congeni-tal defects caused by the failure of the tracheoesophagealseptum to form. They are classi?ed into four types basedon the extent of the cleft. Type I involves a small cleftbetween the arytenoid cartilages, whereas Type IV refersto a complete cleft of the larynx, trachea and esopha-gus that extends to the carina and results in a commonesophageal and tracheal lumen1. We report here a case ofa presumed isolated severe left-sided congenital diaphrag-matic hernia (CDH) in which a Type-IV LTE cleft wasdiagnosed incidentally during fetoscopic endoluminal tra-cheal occlusion (FETO).Öğe Wnt signaling pathway in early- and late-onset preeclampsia: Evaluation with Dickkopf-1 and R-Spondin-3 glycoproteins(Springer Heidelberg, 2019) Tayyar, Ahter Tanay; Karakuş, Resul; Eraslan Şahin, Mefkure; Topbaş, Nura Fitnat; Şahin, Erdem; Karakuş, Seren; Yalçın, Emel Tuğçe; Tayyar, AhmetObjective Wnt signaling has been identified as an essential pathway that can direct cell proliferation, migration, and tissue homeostasis. This study aimed to evaluate the role of Wnt signaling pathway in early-onset and late-onset preeclampsia (PE) using serum Dickkopf-1 and R-Spondin-3 glycoproteins. Study design A total of 80 pregnant women were included in this study. The patients were divided into three groups: (1) control (2) early-onset PE, and (3) late-onset PE. The serum levels of Dickkopf-1 and R-Spondin-3 were measured using an enzyme-linked immunosorbent assay. Results Of the 80 pregnant women enrolled in the study, 27 were control, 27 had early-onset PE, and 26 had late-onset PE. No differences were found in the maternal age, gravida, parity, and body mass index among the groups (P = 0.536, 0.230, 0.202, and 0.642, respectively). The serum level of Dickkopf-1 was significantly higher in the early-onset PE group compared with the control group (P = 0.006). The serum level of Dickkopf-1 was statistically similar in control group compared to lateonset PE group (P = 0.064). However, no significant difference was found in the serum levels of Dickkopf-1 and R-Spondin-3 between the early-and late-onset PE groups (P> 0.05). Additionally, the Spearman's correlation analysis revealed a significant negative correlation between maternal serum level of Dickkopf-1 and maternal age (r =- 0.522, P = 0.005). Conclusion The increased serum level of Dickkopf-1 might be associated with the process of pathogenesis of early-onset PE. Further studies would elucidate their exact roles in the pathogenesis of PE.
