Objective: To present the reference range of the fetal thymus gland according to gestational age groups.
Methods: In this prospective study, fetal thymus size was assessed in singleton, uncomplicated pregnancies between 19 and 38 weeks of gestation in our outpatient clinic between 2019 and 2020. Based on their monthly pregnancy follow-ups, fetal thymus measurement was divided into 5 gestational age groups (Group 1: 19–22 weeks, Group 2: 23–26 weeks, Group 3: 27–30 weeks, Group 4: 31–34 weeks, and Group
5: 35–38 weeks).
Results: Fetal thymus measurements of 210 patients were performed over one year, and as a result, 184 pregnant patients were included for
assessment. Fetal thymus could be visualized at a rate of 93.5%. The 5th percentile of thymus transverse diameter, antero-posterior diameter, perimeter, thymus anterior-posterior diameter to thoracic diameter, and thymus perimeter to thoracic circumference were 11.03 mm,
5.60 mm, 32.52 mm, 0.33, and 0.32 in Group 1; 13.53 mm, 7.66 mm, 43.67 mm, 0.34, and 0.32 in Group 2; 20.43 mm, 11.22 mm, 47.72
mm, 0.33, and 0.32 in Group 3; 27 mm, 12.98 mm, 55.88 mm, 0.32, and 0.30 in Group 4; 28 mm, 13.59 mm, 63.4 mm, 0.32, and 0.30 in
Group 5; respectively. Spearman’s rho correlation coefficients for the thymic measurements were 0.879, 0.869, 0.846, 0.236, and 0.267
respectively, and all p-values were less than 0.001. As a result of linear regression analysis between thymus measurements and BPD; the equations for the optimal models are as follows: thymus transverse diameter= -3.49+0.4×BPD (mm) (r=0.826, R2
=0.682, p<0.001), thymus anterior-posterior diameter= -2.48+0.22×BPD (mm) (r=0.808, R2
=0.653, p<0.001), thymus perimeter= -14.37+1.21×BPD (mm) (r=0.814,
R2
=0.663, p<0.001), thymus anterior-posterior diameter /thoracic diameter= 0.38+7.76E-4×BPD (r=0.213, R2
=0.045, p=0.004) and thymus
perimeter/thoracic circumference= 0.35+1.02E-3×BPD (r=0.263, R2
=0.069, p<0.001). Thymus transverse diameter, anterior-posterior diameter, and perimeter increased linearly with increasing biparietal diameter (BPD).
Conclusion: We established the reference ranges of fetal thymus size. Thymus transverse diameter, antero-posterior diameter, and thymus
perimeter have a strong relationship with gestational age and are easy and reproducible. Therefore, the knowledge of reference ranges of
fetal thymus will enable the evaluation of thymic aplasia/hypoplasia
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Amaç: Gebeliğin sürdürülmesi için gerekli olan progesteron, gebeliğin 10. haftasına kadar korpus luteum ve sonras›nda plasenta tarafından üretilir. Bu çalışmanın amacı, gebeliğin 6–8 ile 12. haftasındaölçülen serum progesteron konsantrasyonları ile üçüncü trimesterdeplasental disfonksiyonu ortaya koyabilecek parametreler arasındakiilişkiyi araştırmaktır.Yöntem: Gebeliğin 6–8. haftaları ve 12. haftasında ölçülen progesteron değerleri ile gebelikte hipertansif bozukluklar, intrauterin gelişme geriliği, preterm doğum ve düşük doğum ağırlığı gibi plasentaldisfonksiyon belirtileri arasındaki ilişki değerlendirildi. Ayrıca, dahaönceki bir çalışmaya dayanarak, erken gebelik döneminde 11ng/mL’nin üzerindeki ve altındaki progesteron seviyelerine göre ikigrup oluşturuldu ve gestasyonel sonuçlar yönünden bu gruplar arasındaki farklılık incelendi.Bulgular: Gebeliğin 6–8. haftaları ve 12. haftasındaki progesteronkonsantrasyonları, plasental disfonksiyona işaret eden gebelik komplikasyonlarına sahip olan ve olmayan alt gruplar arasında anlamlı şekilde farklı değildi (tüm parametreler için p>0.05). Gebeliğin 6–8. haftalarındaki 11 ng/mL’lik progesteron eşik değeri nedeniyle üçüncütrimester komplikasyonları yönünden iki grup arasında anlaml farklılık bulunmadı.Sonuç: Bu çalışmada, birinci trimesterin erken ve geç dönemlerinde ölçülen progesteron değerlerinin üçüncü trimesterdeki plasental disfonksiyon ile ilişkili olmadığı sonucuna ulaştık. Ayrıca, gestasyonel sonucu öngörmek için daha önce önerilen eşik değeri valide etmedik. Bu nedenle, rutin birinci trimester progesteron taraması gebelik takibini yönlendirmede uygun olmayabilir.
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OBJECTIVE: Placenta previa may cause massive hemorrhage at antenatal, intrapartum or postpartumperiods and is one of the leading causes of maternal morbidity and mortality. Anterior or posterior location of placenta previa can change cesarean technique and management of the operation. Aim of thisstudy is to assess factors increasing intraoperative complications in patients with placenta previa and investigate the significance of anterior placenta location apart from other factors.STUDY DESIGN: This is a retrospective cohort study which was conducted in one center including 83patients followed with placenta previa in three years’ duration. Placental location, presence, and depthof myometrial invasion, previous uterine surgery and the type of uterine incision were evaluated.Intraoperative hemorrhage, need for blood transfusion and hysterectomy, complete blood count parameters of mother and newborn were compared between the anterior and posterior placenta previa.RESULTS: Previous uterine surgery, abnormally invasive placenta and need for blood transfusion weresignificantly higher in patients with anterior placenta previa. The increasing number of previous cesareanoperations enhanced placental invasion to cesarean scar area in anterior placentation, leading to higherrates of blood transfusion, classical incision, and hysterectomy. Also, when the patients with previouscesarean or classical incision were excluded, anterior placentation differed significantly when comparedwith posterior placentation with respect to hemoglobin differences between preoperative and postoperative values.CONCLUSION: Anterior location of placenta previa increases hemorrhagic complications. Placental location, presence, and depth of invasion should be assessed and timing of delivery should be plannedwith appropriate preparation of blood products before delivery.
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Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures. (J Turk Ger Gynecol Assoc 2021; 22: 22-8)
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OBJECTIVE: This study investigated the cases in which the fetal ascending aorta is larger than the main pulmonary artery on the three-vessel view and aimed to determine the relationship between the larger ascending aorta and major cardiac anomalies. STUDY DESIGN: Pregnancies between 18-24 gestational weeks who underwent detailed secondtrimester screening during 2015-2019 were evaluated. Cases whose fetal ascending aorta diameter was larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view were analyzed. Prenatal and postnatal echocardiography studies were performed for each case. RESULTS: Fetal ascending aorta diameter larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view was detected in 21 fetuses in a total of 3810 pregnancies (0.55%), and 10 (47.6%) of them had major congenital heart disease. The diagnosis of Tetralogy of Fallot, double outlet right ventricle, ventricular septal defect, pulmonary valve stenosis, and moderate to severe tricuspid regurgitation were confirmed with prenatal/postnatal echocardiography studies. The highest ratio of ascending aorta/main pulmonary artery was 1.4 in a fetus with a double outlet right ventricle and pulmonary valve stenosis. CONCLUSION: The fetal ratio of ascending aorta/main pulmonary artery larger than 1 on the three-vessel view may be a sign of certain cardiac anomalies. Nevertheless, this rate is not an indicator of a serious cardiac defect in all cases. Fetal advanced echocardiography and early postnatal cardiac evaluation should be done to confirm the diagnosis.
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Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which isan autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodiescan cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy,and to investigate neonatal outcomes.Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed betweenOctober 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITPdiagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route ofdelivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed.Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperativeand postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenitalanomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancywere mostly treated for preparation of delivery. Treatment modalities were similar.Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy whencompared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients shouldbe followed closely in cooperation with the hematology department. (J Turk Ger Gynecol Assoc 2020; 21: 97-101)
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Amaç: Düflük riskli bir popülasyonda ikinci trimester fetal korpus
kallozum (KK) uzunlu¤unun ve geniflli¤inin normal de¤erlerinin
belirlenmesi ve sunulan nomogramlar›n literatür ile karfl›laflt›r›lmas›.
Yöntem: Gebeli¤in 18–22. haftalar›nda ikinci trimester anomali taramas›
yap›lan tekil fetüslerin prenatal kay›tlar› KK geniflli¤i ve
uzunlu¤u yönünden retrospektif olarak analiz edildi. Yaln›zca anomali
taramalar› tamamen normal bulunan toplam 710 fetüs çal›flmaya
dahil edildi. KK ile bipariyetal çap (BPÇ), bafl çevresi (BÇ) ve gestasyonel
yafl (GY) aras›ndaki korelasyonlar de¤erlendirildi.
Bulgular: Gebeli¤in 18–22. haftas›nda ortalama KK uzunlu¤u
19.7±2.8 mm ve ortalama KK kal›nl›¤› 1.98±0.4 mm olarak bulundu.
KK uzunlu¤u ve kal›nl›¤› ile BÇ, BPÇ ve GY de¤erleri aras›ndaki
korelasyonlar›n Pearson korelasyon katsay›s› ile de¤erlendirilmesinde,
KK uzunluk ölçümleri ile BPÇ, BÇ ve GY de¤erleri aras›
nda güçlü bir korelasyon tespit edildi (r=0.233’e karfl› r=0.505,
p<0.001).
Sonuç: Rutin fetal anomali de¤erlendirmesinde korpus kallozumun
varl›¤›n›n yan› s›ra uzunlu¤unun ve kal›nl›¤›n›n de¤erlendirilmesi,
korpus kallozum ölçümleri ile belirli nörolojik bozukluklar
aras›ndaki iliflki nedeniyle önemli olabilir. Yap›lan çal›flmalar,
literatürde bildirilen farkl› de¤erler nedeniyle her popülasyona özgü
nomogramlar oluflturulmas› gerekti¤ini göstermektedir.
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Amaç: Klini¤imizde yap›lm›fl olan 10 hafta ve üzeri gebelik terminasyonlar›n›n endikasyonlar›n› ve obstetrik özelliklerini inceleyerek, bu olgular› daha iyi yönetebilmeyi ve do¤ru yaklafl›mlar› gelifltirebilmeyi amaçlad›k.
Yöntem: Ocak 2012 – Ocak 2019 aras›nda klini¤imizde gerçekleflmifl 379 terminasyon olgusunun maternal verileri, obstetrik özellikleri ve endikasyonlar› de¤erlendirildi. Endikasyonlar; maternal
nedenler, amniyotik s›v› anomalileri, izole yap›sal, çoklu konjenital ve genetik bozukluklar olarak grupland›r›ld›. Gruplar özelliklerine göre s›n›fland›r›ld› ve kendi aralar›nda karfl›laflt›r›ld›.
Bulgular: Ortalama yafl 30.2±6, ortalama gebelik haftas› 17.4±3.5,
ortalama terminasyon süresi 16.4±14.5 saatti. En s›k amniyotik s›-
v› anomalileri nedeniyle terminasyon yap›ld›¤› izlendi (n=126,
%33.2). Fetal nedenler içerisinde en s›k izole yap›sal anomaliler
(n=114, %30.1) tespit edildi. Santral sinir sistemi anomalileri en
çok görülen izole yap›sal anomaliler idi (n=60, %15.8). Terminasyonlar›n 25/379’u (%6.6) maternal nedenli idi. Genetik bozukluklar için invaziv tetkik istenme oran› %49.6 (n=197), yap›lma oran›
%31.7 (n=120) idi. En s›k trizomi 21 (n=39, %55.7) olmak üzere
kromozomal anomali 69 (%18.2) olguda tespit edildi. Kromozomal anomalilerin daha ileri maternal yafl ve daha erken gebelik haftalar›nda tespit edildi¤i izlendi. ‹zole yap›sal ve çoklu konjenital
anomalilerin ise daha genç yaflta ve daha ileri gebelik haftalar›nda
saptand›¤› görüldü (özellikle kardiyak ve ürogenital anomaliler)
(maternal yafl, p=0.002; gebelik haftas›, p<0.001).
Sonuç: Terminasyon olgular›n›n yönetiminde fetal ve maternal
nedenlerin ve terminasyon komplikasyonlar›n›n analizi, takip eden
gebeliklerin tan› ve terminasyon süreçlerinin yönetiminde örnek
olacakt›r. Gebelik terminasyonlar›n›n etik, psikolojik, ekonomik
ve yasal boyutlar›n›n dikkate al›nmas›, aile ile hekim iflbirli¤i içerisinde bu konuda standart yaklafl›mlar›n oluflturulmas›nda etkili
olaca¤› görüflündeyiz.
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