Browsing by Author "Akar, Bertan"

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Citation Count: 0
Ambiguus Genitalya ve Böbrek Agenezisi ile Birlikte Görülen Heterofagusun en Nadir Formu Olan İskiofagus Vakası
(2020) Çalışkan, Eray; Haqverdiyev, Emin; Akar, Bertan; Gümüştaş, Gokhan; Aslancan, Reyhan
Parazit iki kiz parsiyel olarak rezorbe olmuş ve normal fetus üzerinde yerleşmiş inkomplet fetüsü tariflemek için kullanılan bir terimdir. İskiofagus normal fetuse ileumdan bağlanmış parazitik fetüsü ifade edip parazit ikiz vakalarının en nadir görülen formudur. Bu vakada on üç haftalık fetus birinci trimester ultrasonografik incelemesinde iskiofagus, ambiguus genitalya ve böbrek agenezisi tanısı almıştır. Ailenin kararı sonucu terminasyon uygulanmıştır. Parazitik ikiz vakaları eşlik edebilecek multisistemik anomaliler açısından dikkatli incelenmelidir. Aileyi fetüsün durumunun yaşamla bağdaşırlığı açısından bilgilendirmek gereksiz terminasyonları önlemek açısından önemlidir.
Citation Count: 17
Aspirin, low molecular weight heparin, or both in preventing pregnancy complications in women with recurrent pregnancy loss and factor V Leiden mutation
(Taylor & Francis Ltd, 2020) Karadag, Cihan; Akar, Bertan; Gonenc, Gokcenur; Aslancan, Reyhan; Yilmaz, Nagihan; Caliskan, Eray
Objective: The aim of this study was to compare the effects of low molecular weight heparin (LMWH), LMWH plus low dose aspirin, or low dose aspirin only on pregnancy outcomes in recurrent pregnancy loss (RPL) patients with factor V Leiden mutation (FVLM). Materials and methods: A total of 2764 RPL patients were evaluated in for the etiology of RPL. Mutations in factor V Leiden homozygous and heterozygous were determined. Subsequently, 196 of these patients were diagnosed with FVLM and included in the study; of these 174 completed the study. At the sixth week of gestation of subsequent pregnancy participants were randomly distributed into three groups. Group A (n?=?61) was composed of patients with an oral dose of 100?mg aspirin daily, Group B (n?=?59) consisted of patients using 40?mg enoxaparin and 100?mg orally aspirin daily, and Group C (n?=?54) included patients using 40?mg enoxaparin daily during pregnancy. Results: Among the 174 patients who completed the study, the live birth and miscarriage rates were similar for the three groups (p?=?.843 and p?=?.694, respectively). There was no significant difference among the groups in rates of eclampsia, placental abruption, intrauterine fetal growth restriction and gestational diabetes mellitus. The number of preeclamptic patients was significantly higher in Group A than Groups B and C. The levels of preterm birth was significantly higher in Group A than Groups B and C. Conclusion: Using low dose aspirin, LMWH plus aspirin, or LMWH alone yielded comparable live birth rates in RPL patients with FVLM. However, LMWH decreased the risk of preeclampsia in this group of patients. LMWH might therefore have a preventive role regarding preeclampsia.
Citation Count: 0
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, Eray
Objective: 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)
Citation Count: 4
Cervical cerclage application algorithm in continued cervical shortening cases despite vaginal progesterone
(Elsevier Masson, Corp off, 2021) Akar, Bertan; Ceylan, Yasin; Karadag, Cihan; Caliskan, Eray
Objective: 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. (c) 2020 Elsevier Masson SAS. All rights reserved.
Citation Count: 0
Ciddi Asherman Sendromunun Histeroskopik Tedavisi Sonrası Ivf Gebeliklerde Görülen İnce Endometrium Zemininde Gerçekleşen Plasenta İnvazyon Anomalileri: Olgu Serisi
(2020) Çalışkan, Eray; Yalçınkaya, Leylim; Akar, Bertan; Haqverdiyev, Emin; Gümüştaş, Gokhan; Aslancan, Reyhan
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
Citation Count: 0
ÇOCUKLAR İÇİN ÖZEL GEREKSİNİM RAPORU (ÇÖZGER)’NA BAŞVURAN OLGULARIN PSİKİYATRİK TANI VE ÖZEL GEREKSİNİM DÜZEYLERİNİN ÖNCEKİ YÖNETMELİKTEKİ TANI VE ÖZÜR ORANLARI İLE KARŞILAŞTIRILMASI: RETROSPEKTİF ÇALIŞMA
(2022) Akar, Bertan; Doğan, Ozan; Kole, Emre; Çalışkan, Eray
Amaç: Tekrarlayan implantasyon başarısızlığı (RIF) zorlu bir gerçek olduğundan, bu sorunun üstesinden gelmek için farklı terapötik immünomodülatör ajanların etkileri araştırılmaktadır. Bu çalışma, intralipidin RIF'li IVF hastalarının gebelik sonuçları üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem: Katılımcıların 116'sı sadece kısa antagonist protokolünü alan kontrol grubuna, 106'sı ise intravenöz lipid (SMOFlipid®) verilerek intralipid grubunda yer aldı. İntralipid, embriyo transferinin olduğu gün, pozitif gebelik testinin olduğu gün verildi ve gebeliğin onuncu haftasına kadar haftalık olarak devam edildi. İmplantasyon oranı, biyokimyasal gebelik oranı, klinik gebelik oranı ve canlı doğum oranı değerlendirildi. Bulgular: Pozitif gebelik testi, klinik gebelik oranı ve canlı doğum oranı İntralipid grubunda istatistiksel olarak anlamlıydı (p<0,001) (sırasıyla %50,9'a karşı %22,4, %41.5'e karşı %19,8, %29,2'ye karşı %10,3) ). İmplantasyon, spontan abortus, çoğul gebelik ve kimyasal gebelik oranları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Sonuç: Bu çalışma, intralipid tedavisinin, sadece standart IVF protokolü uygulanan hastalara kıyasla RIF'li hastalarda daha iyi gebelik sonuçlarına sahip olduğunu ortaya koymuştur. RIF'li hastalarda intralipidin rutin kullanımını önermek için daha ileri prospektif çalışmalara ihtiyaç vardır.
Citation Count: 2
Comparative surgical resection of the ligamentum teres hepatis in a cadaveric model and a patient with ovarian cancer
(Galenos Yayincilik, 2019) Selcuk, Ilker; Basarir, Zehra Ozturk; Ohri, Nurian; Akar, Bertan; Caliskan, Eray; Gungor, Tayfun
Resection of all tumor implants with the aim of maximal cytoreduction is the main predictor of overall survival in ovarian carcinoma. However, there are high risk sites of tumor recurrence, and the perihepatic region, especially the point where the ligamentum teres hepatis enters the liver parenchyma under the hepatic bridge (pont hepatique), is one of them. This video demonstrates the resection of the ligamentum teres hepatis both in a cadaveric model and in a patient with ovarian cancer.
Citation Count: 0
Comparison of the localization of intrauterine adhesions in pregnant and infertile women Gebe ve infertil kad?nlarda intrauterin adezyonlar?n lokalizasyonlar?n?n kar??la?t?r?lmas?
(Galenos Publ House, 2022) Bender, Rukiye Ada; Ozcan, Canan; Akar, Bertan; Caliskan, Eray
Objective: Intrauterine adhesion (IUA) is the formation of band-shaped fibrotic tissues in the endometrial cavity due to uterine procedures. Most adhesions remain asymptomatic and do not affect fertility or pregnancy conditions. However, they may lead to infertility and pregnancy complications in some women. This study aimed to determine which localization and type of IUA may lead to infertility. Materials and Methods: Seventy-six women with IUA were retrospectively scanned. Thirty-nine women with IUA with uterine factor-related infertility were included in the infertility group. Thirty-seven pregnant women, who had adhesions in the second-trimester ultrasonography and who had a live birth via cesarean section at term, were included in the pregnancy group. The localization of adhesions was determined as the fundus, corpus, isthmus, and cornu. Concerning the type of adhesion, the adhesions were classified as dense-and film-type adhesions. Results: The infertility group was compared with the pregnancy group according to the type and localization of the adhesions. Fundal adhesions were significantly higher in the infertility group compared to the pregnancy group (p<0.05). The isthmic adhesions, however, were more common in the pregnancy group than in the infertility group (p<0.05). Dense-type adhesions were more common in the infertility group than in the pregnancy group (p<0.05). Conclusion: According to the localization and types of adhesions, fundal and dense-type adhesions are among the features of uterine factor-related infertility. However, isthmus-located and film-type adhesions may not cause infertility.
Citation Count: 0
Demir Eksikliği Anemisi ve Serum Ferritin Düzeyi ile İlgili Maternal ve Neonatal Sonuçlar: Doğu Marmara Bölgesine Ait Çok Merkezli Bir Prospektif Çalışma, Türkiye
(2019) Başbuğ, Alper; Çakır, Pınar; Çalışkan, Eray; Pulatoglu, Cigdem; Şimşek, Hayal; Başbuğ, Derya; Akar, Bertan
Amaç: Bu çalışmanın amacı, demir takviyesi ve demir durumunun maternal ve neonatal etkileri ile birlikte Türkiye'nin Doğu Marmara bölgesinde gebelikte görülen demir eksikliği anemisi insidansını değerlendirmektir. Materyal ve Metot: Bu çalışma Doğu Marmara Bölgesi'nin (Türkiye) üç ilinde altı merkezde gerçekleştirilmiş ve toplam 1102 gebeyi kapsamıştır. Gebelik sırasında hematolojik durum ve serum ferritin düzeyleri için kan örnekleri toplandı ve olumsuz maternal ve perinatal sonuçlar belirlendi. Demir eksikliği anemisi, Dünya Sağlık Örgütü kriterlerine göre hemoglobin<11g/dl ve ferritin< 15 μg/dL olarak tanımlandı. Bulgular: Çalışmaya dahil edilen kadınlarda anemi oranı % 19.8 idi ve bunların % 44'ü demir desteği alıyordu. Maternal yaş anemik grupta daha düşüktü (26.5'e karşı 27.7, p = 0.01). Anemik grupta selektif demir kullanımı daha sık görülürken, anemik olmayan grupta rutin demir kullanımı daha sık görüldü (% 47.1'e karşılık% 29.3; p = 0.01). Sonuç: Demir eksikliği anemisi gebelikte sık görülen bir problemdir. Bununla birlikte, birçok anemik gebeye demir tedavisi verilmez. Demir takviyesi, bazı maternal ve perinatal sonuçlar üzerinde olumlu etkileri olabilir. Gebelikte demir eksikliği anemisiyle mücadele etmek için demir takviyelerinin yaygın kullanımı sağlanmalıdır.
Citation Count: 1
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; Dogan, Ozan; Basbug, Alper; Sivaslioglu, Akin; Caliskan, Eray
Objective: 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)
Citation Count: 0
Expectant management vs. cerclage in cases with prolapsed or visible membranes in the second trimester: is 24 weeks gestation threshold critical?
(Walter de Gruyter Gmbh, 2024) Kole, Emre; Akar, Bertan; Dogan, Yasemin; Yalcinkaya, Leylim; Doger, Emek; Caliskan, Eray
Objectives: The aim of this study was to compare the efficacy of cervical cerclage with spontaneous follow-up strategy on pregnancy duration and neonatal outcomes in women with visible or prolapsed fetal membranes. Methods: Patients who were referred to a single tertiary care centre between 1st January 2017 and 31st December 2022 were included in this comparative, retrospective cohort study. Patients were divided into two groups, those undergoing cerclage and those followed with no-cerclage. The range of pregnancy weeks for cerclage is between 18th and 27+6 weeks. Results: A total of 106 cases were reviewed and nine were excluded. Based on shared decision making, cervical cerclage was performed in 76 patients (78.3 %) and 21 patients (21.6 %) were medically treated in no-cerclage group if there was no early rupture of the fetal membranes. The gestational age at delivery was 29.8 +/- 6 [Median=30 (19-38)] weeks in the cerclage group and 25.8 +/- 2.9 [Median=25 (19-32)] weeks in the no-cerclage group (p=0.004). Pregnancy prolongation was significantly longer in the cerclage group compared to the no-cerclage group (55 +/- 48.6 days [Median=28 (3-138)] vs. 12 +/- 17.9 days [Median=9 (1-52)]; p<0.001). Take home baby rate was 58/76 (76.3 %) in cerclage group vs. 8/21 (38 %) in no-cerclage group. In the post-24 week cerclage group the absolute risk reduction for pregnancy loss was 50 % (95 % CI=21.7-78.2). Conclusions: Cervical cerclage applied before and after 24 weeks (until 27+6 weeks) increased take home baby rate in women with visible or prolapsed fetal membranes without increasing adverse maternal outcome when compared with no-cerclage group.
Citation Count: 3
A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta
(Galenos Publ House, 2021) Caliskan, Eray; Akar, Bertan; Ceylan, Yasin; Karadag, Cihan
Objective: 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.
Citation Count: 1
Obstetric hemorrhage and surgical emergencies training workshops on fresh cadavers and simulators result in high application in daily practices and decreased patient referral
(Galenos Publ House, 2022) Akar, Bertan; Ceylan, Yasin; Kahraman, Alper; Kole, Emre; Caliskan, Eray
Objective: 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.
Citation Count: 0
Plasenta previa accreta nedeniyle sezaryen sonrası kanama yönetiminde yeni alt uterin segment sandviç tekniği (Çalışkan tekniği)
(2021) Ceylan, Yasin; Karadağ, Cihan; Çalışkan, Eray; Akar, Bertan
Amaç: Plasenta previa (PP) ve plasenta akreta spektrum (PAS) bozuklukları postpartum kanamanın (PPK) başlıca nedenleridir. Açıkça bildirilmemiş başarı oranları ile çeşitli cerrahi tedavi seçenekleri vardır. Uterin sandviç, hemostazı sağlamak için uterin kompresyon sütürleri ve uterus içi balon yerleştirilmesinin bir kombinasyonudur. Bu çalışmanın amacı, PP akretaya bağlı sezaryen sonrası kanamayı kontrol etmek için yeni bir “alt uterin sandviç” tekniği ile tedavi edilen yedi kadına ilişkin deneyimimizi sunmaktır. Gereç ve Yöntemler: PP totalis akreta tanısı konulan ve uterin arter, utero-ovaryan arter ve internal iliak arterin bilateral ligasyonu ile sezaryen sonrası işlem uygulanan yedi gebe kadın, uterin istmusa Pereira kompresyon sütürleri, Foley kateterinin alt uterin segmente yerleştirilmesi ve transvajinal servikal serklaj uygulaması, “Çalışkan’ın Uterin Sandviç Tekniği”, yapıldı. Bulgular: Bu çalışmaya dahil edilen tüm kadınlarda farklı derecelerde plasental invazyon anormallikleri vardı. Postoperatif difüzyon manyetik rezonans incelemesi, tamamen normal ve korunmuş uterus kan akımını ortaya çıkardı. Tüm kadınlar postoperatif takiplerinde düzenli olarak adet gördüler ve 2 kadın tekrar gebe kaldı ve sorunsuz doğum yaptı. Hastaların hiçbiri morbid komplikasyon yaşamadı ve histerektomi gerektirmedi. Sonuç: Bu yeni prosedür, inatçı PPK olgularında, özellikle alt uterin segment kanamalarında makul bir doğurganlık ve organ koruma seçeneği gibi görünmektedir. Bu uterin sandviç tekniği, kliniğin uterusu ve fonksiyonlarını büyük bir komplikasyon olmaksızın koruyarak PAS’ye bağlı masif kanamaları konservatif olarak yönetmesine izin verebilir.