Papers by Gokhan Yildirim
Perinatoloji dergisi, 2006
... Gökhan Yıldırım, Halil Aslan, Ahmet Gül, Kemal Güngördük, Fatma Nurgül Aktaş, Demet Çakmak, Y... more ... Gökhan Yıldırım, Halil Aslan, Ahmet Gül, Kemal Güngördük, Fatma Nurgül Aktaş, Demet Çakmak, Yavuz Ceylan. ... Perinatoloji Dergisi 2002; 1: 14 7. 6. Yüce H, Çelik H, Gürateş B, Erol D, Hanay F, Elyas H. Karyotip analizi amacı ile genetik amniyosentez uygulanan 356 ...
The Journal of Maternal-Fetal & Neonatal Medicine, 2018
Aim: To show how uterocervical angles are used for the prediction of second-trimester pregnancy t... more Aim: To show how uterocervical angles are used for the prediction of second-trimester pregnancy terminations in multiparous women. Material and methods: A total of 148 multiparous singleton women in their second trimesters were enrolled in this prospective study. The intracervical Foley catheter was used for the induction of delivery. The cervical length (CL) and the uterocervical angle (UCA) were measured before the beginning of induction. The study population was subdivided into four groups; successful and failed terminations at the end of 24 and 48 h time frames. A stepwise multiple regression analysis was carried out to examine the contribution of UCA and other parameters to the induction-to-delivery time. A survival analysis was conducted to compare two groups defined by the cutoff value. Results: The UCA was broader in the successful termination group compared to the failed termination group in 24 h of induction (112.50 ± 29.00 versus 100.68 ± 27.13 , p ¼ .02). A negative correlation was found between the UCA and the induction-to-delivery time (r ¼ À0.27, p ¼ .0007). A cutoff value of 97.5 was found for the UCA in predicting induction outcomes. During the 24-h period, 63.1% of women with the UCA !97.5 terminated successfully while 36.8% of women with the UCA <97.5 terminated successfully (p ¼ .001). The mean inductionto-delivery time was significantly shorter in the UCA !97.5 group compared to the UCA <97.5 group (38.2 ± 19.5 h versus 47.8 ± 27.5 h, p ¼ .02). The binary logistic regression analysis showed that the UCA was the only contributor to a successful termination (OR ¼ 1.01, 95% CI: 1-1.02, p ¼ .02). Conclusion: The UCA is broader in multiparous women who successfully terminated and is linked to a shorter duration of induction. The UCA by itself is the only significant contributor to the outcome of second trimester pregnancy terminations.
Istanbul Medical Journal, 2018
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 2, 2017
The decreased placental perfusion is the underlying reason for intrauterine growth restriction th... more The decreased placental perfusion is the underlying reason for intrauterine growth restriction that in turn leads to reduced placental perfusion and ischemia. However, there are several issues to be understood in the pathophysiology of intrauterine growth restriction. We aimed to study whether any compensatory response in placental vascular bed occur in pregnancies complicated with intrauterine growth restriction by the immunohistochemical staining of von Willebrand factor and caldesmon in placental tissues. A total of 103 pregnant women was enrolled in the study including 50 patients who were complicated with IUGR and 50 uncomplicated control patients. The study was designed in a prospective manner. All placentas were also stained with von Willebrand factor and caldesmon monoclonal kits. The immunohistochemical staining of von Willebrand factor and caldesmon expressions in placental tissues were different between normal and intrauterine growth restriction group. The percentages of ...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2016
In this study, we aimed to evaluate the detection of pre-eclampsia (PE) by integrating uterine ar... more In this study, we aimed to evaluate the detection of pre-eclampsia (PE) by integrating uterine artery Doppler, placental volume, and pregnancy-associated plasma protein A (PAPP-A) levels in the first trimester. We prospectively recruited 602 women that underwent 11-13weeks&amp;amp;amp;amp;amp;amp;amp;amp;#39; aneuploidy screening. The mean pulsatility index (PI) of the uterine arteries and the placental volume were measured by ultrasonography. Measurement of PAPP-A levels has been performed at the same day of ultrasonographic examinations. The 90th percentile of uterine artery PI and the 10th percentile of placental volume and PAPP-A levels were used as cut-offs. Uterine artery PI, placental volume, and PAPP-A levels had similar sensitivities in predicting PE (53.66%, 63.41%, and 70.73%, respectively). Use of the parameters in combination had better sensitivity. If one parameter was positive, the sensitivity was 92.68% with 85.20% specificity. If at least two parameters were positive, the sensitivity was 85.37% with 98.89% specificity. In conclusion, the combination of increased PI of uterine artery with low placental volume and low PAPP-A levels in the first trimester achieved better results than either test alone in the prediction of PE.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 12, 2015
The aim of this study is to evaluate the efficacy of spiramycin in prevention of mother-to-child ... more The aim of this study is to evaluate the efficacy of spiramycin in prevention of mother-to-child transmission of Toxoplasma gondii infection. Patients within first trimester of their pregnancy with Toxoplasma IgM positivity (>0.65 index, ELISA, VIDAS) and IgG positivity (>8 IU/ml), who had low IgG avidity (<0.50 index, ELISA, Architet) were considered as having acute toxoplasmosis. These patients who had amniocentesis at the 19th-21st week of pregnancy were examined for the detection of Toxoplasma DNA. Detailed ultrasonographic examinations performed between the 20th and 24th gestational weeks and the mothers and babies were followed for at least one year. Out of 61 patients, 55 (90.2%) had received Spy prophylaxis while 6 (9.8%) cases refused Spy prophylaxis. Toxoplasma PCR test was found to be positive in amniotic fluid of 4 (6.6%) patients obtained by amniocentesis at the 19th-21st week of pregnancy. All four of these patients had refused Spy prophylaxis had positive Tox...
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2014
The aim of this study was to determine the relationship between serum concentrations of cancer an... more The aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity. Methods: We evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n = 34) and those with mild pre-eclampsia (n = 24). Females with healthy pregnancies (n = 31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index. Results: The CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p < 0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r = 0.489, p = 0.000), systolic blood pressure (r = 0.503, p = 0.018), and diastolic blood pressure (r = 0.532, p = 0.000). In contrast, CA-125 was negatively correlated with birth weight (r = 0.266, p = 0.012) and gestational age at birth (r = 0.250, p = 0.018). Conclusions: CA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.
İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 2015
Bu retrospektif çalışmada, genetik amniyosentezde saptanan koyu amniyotik sıvının karyotip sonuçl... more Bu retrospektif çalışmada, genetik amniyosentezde saptanan koyu amniyotik sıvının karyotip sonuçlarıyla ve perinatal sonuçlarla ilişkisini değerlendirmeyi amaçladık.
American Journal of Perinatology, 2012
more adverse outcomes in discordant twins. However, if differences do exist, they were small, and... more more adverse outcomes in discordant twins. However, if differences do exist, they were small, and with preterm birth as the primary outcome, these differences may be due to iatrogenic preterm delivery due to discordant growth in twins. With increasing numbers of twin pregnancies, all providers are seeing and caring for more twins. Given the high risks and higher rate of adverse outcomes, they use up a greater amount of health care dollars. Because of the recognized risks, they undergo closer surveillance and are at greater risk of iatrogenic interventions such as preterm delivery. In some circumstances, such interventions are needed to improve outcomes. However, it is likely that with discordant but appropriately grown twins we are unnecessarily intervening for some fetuses that are simply genetically destined to be different sizes rather than being reflective of placental or other pathologic processes. For many such fetuses, iatrogenic prematurity likely increases morbidity more than it improves outcomes.
American Journal of Perinatology, 2013
This study compared two methods of expanding the uterine incision at the time of cesarean deliver... more This study compared two methods of expanding the uterine incision at the time of cesarean delivery, which is associated with the risk of unintended extension. This randomized trial included 1,076 women who underwent elective cesarean delivery. The primary outcome measure was the incidence of unintended extension related to the method used for expanding the uterine incision. Participants in both groups (blunt vs. sharp) had similar demographic and clinical characteristics. The incidence of unintended extension (8.8% vs. 4.8%; p = 0.009), mean estimated blood loss (853.67 ± 42 mL vs. 664.80 ± 38 mL; p = 0.001), and blood loss &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1000 mL (11.4% vs. 6.8%; p = 0.009) was significantly higher in the sharp group compared with the blunt group. No difference in transfusions (7.5% vs. 6.3%; p = 0.440) or the need for additional supertonic agents (16% vs. 12.9%; p = 0.144) was noted. Sharp expansion of the uterine incision was related to a higher risk of unintended extension and maternal blood loss. Because blunt expansion is associated with a lower risk for unintended extension and maternal blood loss, it should be the first option during elective cesarean delivery.
American Journal of Obstetrics and Gynecology, 2012
The aim of this randomized study was to compare 2 protocols for inducing labor in women with prem... more The aim of this randomized study was to compare 2 protocols for inducing labor in women with premature rupture of membranes (PROM) at term. STUDY DESIGN: Women with PROM and a Bishop score Յ5 were randomly assigned to receive either an intravenous oxytocin infusion (n ϭ 223) or a dinoprostone pessary followed 6 hours later by an intravenous oxytocin infusion (n ϭ 227). RESULTS: Vaginal delivery within 24 hours of labor induction increased significantly with sustained-released dinoprostone followed by oxytocin infusion (78.5% vs 63.3%; relative risk, 1.23; 95% confidence interval, 1.09-1.39; P ϭ .001). Maternal and neonatal outcomes were similar between the groups. CONCLUSION: Sustained-released dinoprostone followed 6 hours later by an oxytocin infusion in term women with PROM was associated with a higher rate of vaginal delivery within 24 hours, and no difference in maternal-neonatal complications was observed compared with oxytocin infusion alone.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Digital cervical evaluation has been used to determine the likelihood of vaginal deli... more Background: Digital cervical evaluation has been used to determine the likelihood of vaginal delivery which is considered by many women to be non-tolerable. Recently, transperineal ultrasound allowing direct visualization of the fetal skull has been using for the prediction of labor route. Authors aimed to study whether measurements on transperineal ultrasound are predictive for vaginal delivery in pregnant women induced with dinoprostone at 40.0-42.0 gestational weeks.Methods: A total of 55 pregnant women at 40.0-42.0 gestational weeks were enrolled in this prospective observational study. All participated women were examined before the induction with dinoprostone to measure the head-perineum distance (HPD), the head-pubis distance and the angle of progression of fetal head (AOP).Results: The greater AOP, the shorter HPD and the head-pubis distance were associated with vaginal delivery in the nulliparous women. The HPD and the head-pubis distance were shorter, whereas the AOP was g...
Pakistan Journal of Medical Sciences, 2017
Objective: Neonatal jaundice is the most common condition that requires hospital admission and ou... more Objective: Neonatal jaundice is the most common condition that requires hospital admission and outpatient follow-up after discharge in neonates. The values of more than 17 mg/dL in term infants are accepted as neonatal significant hyperbilirubinemia. We aimed to define if there is any relationship between second trimester serum markers and neonatal severe hyperbilirubinemia to protect the neonates from its neurological damage. Methods: Total 1372 pregnant women were enrolled who had done triple test between April 2014 and 2015 and then given birth at our hospital. Our primary outcome was neonatal significant hyperbilirubinemia. Results: The mean age of our study population was 27.9±5.6. A total of 59 patients had babies with neonatal hyperbilirubinemia after exclusion of Rh incompatibility. We detected that the presence of in vitro pregnancy, maternal health problems or poor obstetric history had no effect on the risk for neonatal hyperbilirubinemia. Neonatal hyperbilirubinemia was related with low E 3 levels. The ratios of AFP/E 3 and hCG/E 3 were the most helpful to predict the neonatal hyperbilirubinemia. Conclusions: According to our results, low E 3 levels in the triple test result can be helpful to predict the development of the neonatal hyperbilirubinemia. However, this is a bit expensive and many developing countries may not afford it.
Gynecology Obstetrics & Reproductive Medicine, 2016
The aim of the study was to determine whether it is possible to differentiate submucosal fibroids... more The aim of the study was to determine whether it is possible to differentiate submucosal fibroids before interventional procedures based on mean platelet volume (MPV), in reproductive-age patients presenting with endometrial thickening and abnormal uterine bleeding. STUDY DESIGN: This study included 581 reproductive-age women who underwent diagnostic procedures (curettage or operative hysteroscopy) and were subsequently divided into two groups based on clinico-pathological findings. The first group included those with benign endometrial pathology (control group, n=438), and the second group consisted of those with submucosal leiomyomas (n=143). The demographic characteristics and complete blood count (CBC) data of these patients were collected retrospectively, and comparisons were made between groups. RESULTS: No statistically significant difference was found between the groups according to demographic features and CBC parameters such as hemoglobin levels and white blood count (p>0,05). Platelet counts were significantly higher and MPV values were significantly lower in submucosal leiomyoma patients compared with the control subjects (p<0,05). CONCLUSIONS: MPV may be a useful predictive marker when differentiating submucosal leiomyoma from other benign causes of abnormal uterine bleeding. The ability to predict the possibility of the presence of submucosal leiomyoma before surgery can assist in determining the most appropriate type of invasive procedure.
The Medical Journal of Okmeydani Training and Research Hospital, 2016
Çalışmanın amacı adenomiyozis için risk faktörlerinin saptanması ve beraberinde eşlik eden jineko... more Çalışmanın amacı adenomiyozis için risk faktörlerinin saptanması ve beraberinde eşlik eden jinekolojik patolojilerle ilişkisinin değerlendirilmesidir. Gereç ve Yöntem: Çalışmamız, 2012 ve 2015 tarihleri arasında 3. basamak referans merkez olan hastanemizde benign nedenlerle histerektomi yapılmış olan 601 hastanın dosyalarının retrospektif olarak taranmasıyla oluşturulmuştur. Histopatolojik inceleme sonucu çalışmaya 236 adenomiyozisi bulunan ve 365 adenomiyozisi bulunmayan olgu dâhil edilmiştir. Gruplar operasyon endikasyonları, demografik ve reprodüktif özellikler ile eşlik eden patolojiler açısından karşılaştırılmıştır. Bulgular: Altı yüz bir olgunun değerlendirildiği çalışmamızda, leiomiyoma (%56,7) ve desensus uterin (%20,9) en sık operasyon endikasyonlarını oluşturmaktaydı. Adenomiyozise en sık eşlik eden patolojiler leiomiyoma iken, endometriyal polip ve hiperplazinin kontrol grubuna göre daha yüksek oranda beraberlik gösterdiği saptandı. Adenomiyozisin en sık saptandığı yaş grubu 40-49 yaş olarak bulundu. Geçirilmiş sezaryen, abortus ve küretajın adenomiyozis için bir risk faktörü olduğu gözlendi. Sonuç: Özellikle tedaviye dirençli menometroraji ve kronik pelvik ağrısı bulunan 40 yaş üstü hastalarda ayırıcı tanıda adenomiyozis akla gelmelidir. Geçirilmiş sezaryen, abort ve küretaj adenomiyozis için risk faktörüdür. Endometriyal hiperplazi ve polipin de sıklıkla eşlik etmesi nedeniyle adenomiyozis olduğu düşünülen hastalara endometriyal örnekleme yapılması gerekmektedir.
Turkiye Klinikleri J Gynecol …, 2007
Genetics in Medicine, 2001
The development of fluorescence in situ hybridization (FISH)-and polymerase chain reaction (PCR)-... more The development of fluorescence in situ hybridization (FISH)-and polymerase chain reaction (PCR)-based assays for the detection of deletions of chromosome 22q11.2 has enabled the medical community to offer couples at risk prenatal diagnostic testing. Current indications for testing include a previous child with a 22q11.2 deletion or DiGeorge/velocardiofacial syndrome, an affected parent with a 22q11.2 deletion, and in utero detection of a conotruncal cardiac defect. Antenatal knowledge of the deletion status provides couples and clinicians with an accurate diagnosis, prognostic information, and recurrence risk, which may assist couples with their reproductive decisions. However, there are limitations to prenatal testing, which should be reviewed prior to testing. Genetics
Turkiye Klinikleri J Gynecol …, 2007
ünümüzde fetal sağlığın değerlendirilmesi, doğum hekiminin başlıca uğraşları arasındadır. Bu değe... more ünümüzde fetal sağlığın değerlendirilmesi, doğum hekiminin başlıca uğraşları arasındadır. Bu değerlendirme, fetusta olası hastalıkları önceden tanıma ve intrauterin G ORĐJĐNAL ARAŞTIRMA / ORIGINAL RESEARCH.
Objective: We have aimed to evaluate perinatal outcome of selective fetocide in monochorionic dia... more Objective: We have aimed to evaluate perinatal outcome of selective fetocide in monochorionic diamniotic twins discordant for major fetal anomalies. Materials and Methods: The study group included nine cases of monochorionic diamniotic twin (triplet) pregnancies discordant for major fetal anomalies including anencephaly (n=2), inencephaly (n=1), lumbar meningomyolocele (n=1), hydrops fetalis (n=1), acardiac twin (n=2), twin-to-twin transfusion syndrome (stage III, n=1) and monochorionic triamniotic triplet discordant for anencephaly (n=1). For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forcep. The procedures were performed under the guidance of transabdominal ultrasonography. Results: The mean gestational age of the cases at intervention and at delivery were 20 weeks (R=16-24) and 34 weeks (R=22-38), respectively. The procedure of bipolar coagulation was carried out in mean 20 min (R=15-40 min) without maternal complication. One ...
İstanbul Kanuni Sultan Süleyman Tıp Dergisi, 2018
Preterm erken membran rüptürü (PEMR) olgularında amnion sıvısı laktat konsantrasyonunun, kendiliğ... more Preterm erken membran rüptürü (PEMR) olgularında amnion sıvısı laktat konsantrasyonunun, kendiliğinden doğum eylemi üzerine öngörüsü araştırılarak; böylesi olgularda maternal ve fetal yaklaşım standardı açısından bilgi sağlanması amaçlandı. Gereç ve Yöntem: Bu çalışma prospektif gözlemsel bir çalışma olarak dizayn edilmiştir. Yirmi dört-otuz dört gebelik haftaları arası aktif su gelişi olan PEMR olguları steril spekulum muayenesi sırasında elde edilen amnion sıvı laktat düzeyi açısından test edildi ve lojistik regresyon analizi kullanılarak amnion mayii laktat düzeyi ile olguların 48 saat ve 7 gün içinde kendiliğinden doğum eylemine girme açısından en iyi kesme değerleri belirlendi.
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Papers by Gokhan Yildirim