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    Maternal and foetal risks associated with teenage pregnancy - a comparative retrospective study in Turkey
    (Taylor & Francis Inc, 2024) Duran, Mehmet Nuri; Pek, Eren; Demir, Sureyya Saridas; Karacaer, Kubra Ozkan; Demir, Bulent
    BackgroundAdolescent pregnancy is defined as pregnancy occurring in young women between the ages of 10 and 19 years. Adolescent pregnancies, which are among the social healthcare concerns in developed and developing countries, have negative effects on maternal and infant health. Pregnancy in adolescence puts the health of both the mother and child at risk, as adolescent pregnancies have higher rates of eclampsia, systemic infection, low birth weight, and preterm delivery compared to other pregnancies. In this study, the effects of education level, smoking, and marital status on maternal and foetal outcomes in adolescent pregnancies were evaluated.MethodsThe records of a total of 960 pregnant women (480 pregnant adolescents aged 15-19 years and 480 pregnant adult women aged 20-26 years) were examined retrospectively. The demographic data of the groups and maternal and foetal outcomes of the pregnancies were compared. A logistic regression model was established as a statistical method for reducing confounding effects.ResultsUnmarried women were statistically significantly more prevalent in the adolescent group (38.3% vs. 7.3%). Among the considered risk factors, preeclampsia (2.9% vs. 0.8%) and smoking (29.8% vs. 9.8%) were statistically significantly more common in the adolescent group. When the groups were compared in terms of risk factors in pregnancy, it was found that pregnancy in adolescence was associated with a 3.04-fold higher risk of smoking, 5.25-fold higher risk of being unmarried, 3.50-fold higher risk of preeclampsia, and 1.70-fold higher risk of intrauterine growth retardation (IUGR).ConclusionsThis study demonstrates an increased risk of preeclampsia, IUGR, and smoking during pregnancy in adolescent pregnant women. These findings can be used to identify adolescent pregnancies requiring specific assistance and to take measures to reduce the probability of adverse outcomes. In this study, we examine the risks of adolescent pregnancies. Adolescent pregnancy is a public health problem, and it is more common in underdeveloped or developing countries. We believe that non-governmental organisations and governments should take precautions regarding adolescent pregnancies and protect this legally vulnerable sociodemographic group from pregnancy. For healthier and more conscientious pregnancy experiences, mothers must be of appropriate age, having passed the period of adolescence. Adolescent pregnancies, which come with many risks, and especially risks of preeclampsia, premature birth, and maternal death, should be minimised or prevented.
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    PP-07 TAR Syndrome case report
    (2023) Kuşçu, Nur; Kel, Serem; Demir, Süreyya; Sungur, Müge Üstkaya; Öztürk, Menekşe; Duran, Mehmet Nuri; Demir, Bülent
    Objective “Thrombocytopenia - absent radii Syndrome” (TAR) is characterized by hypo-megakaryocytic thrombocytopenia and bilateral absence of the radius bones despite the presence of both thumbs. It is rare and follows an autosomal recessive inheritance pattern. In individuals with TAR syndrome, skeletal, cardiac, gastrointestinal, hematological, renal, and genital abnormalities can also accompany the condition. Skeletal anomalies include varying degrees of ulnar hypoplasia, as well as hypoplasia of phalanges and carpal bones. Thumbs are always present. Thrombocytopenia improves with age and usually resolves by school age. It is associated with a deletion in the proximal region of the gene locus 1q21.1. The syndrome, first described in 1929, has an estimated prevalence of 0.42/100,000. In this case presentation, we aim to discuss the diagnosis and management of TAR syndrome. Case A 28-year-old woman, gravida 4, parity 1, abortion 1, was placed under routine pregnancy surveillance. During first-trimester screening, the absence of bilateral forearm segments and an increased nuchal translucency (3.8mm) were detected, prompting further monitoring. Amniocentesis was performed for the patient. In the second trimester, an obstetric ultrasound revealed the absence of the right forearm during upper extremity examination. Only a single bone consistent with the ulna was observed on the left side. Throughout the ultrasound examination, limited hand movement, significant wrist extension, and flexion contractures at the knees were noted. Additionally, there was pes equinovarus observed on the left foot. Differential diagnoses considered TAR syndrome, Roberts syndrome, and Fanconi syndrome. The amniocentesis yielded a normal fetal karyotype. At 40+1 weeks gestation by last menstrual period, the patient underwent a normal vaginal delivery with a birth weight of 3070g (19th percentile) and an 8-9 APGAR score. In the postnatal period, the infant was admitted to the neonatal intensive care unit due to a platelet count of 12000 and the presence of petechiae on the body. Absence of ulna and radius was observed on the right arm, while only a single bone consistent with ulna was seen on the left side. Postnatal microarray analysis was consistent with TAR syndrome. Conclusion TAR syndrome is an exceedingly rare condition. Prenatal diagnosis can be achieved through ultrasound evaluation of limb anomalies at around 16 weeks of gestation, combined with complete blood count and genetic analysis via cordocentesis. In neonates, when encountering thrombocytopenia and hemolytic anemia, TAR syndrome should be considered as a differential diagnosis.
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    PP-08 Meckel Gruber Syndrome a case report
    (2023) Kel, Serem; Kuşcu, Nur; Demir, Süreyya; Duran, Mehmet Nuri; Demir, Bülent
    Objective Meckel-Gruber Syndrome is a rare fetal anomaly characterized by multiple anomalies that are inherited in an autosomal recessive manner and are incompatible with life. In our clinic, we aimed to present the findings of a fetus with Meckel-Gruber Syndrome, for which we conducted pregnancy termination. Case A 37-year-old patient with a history of G9P8Y7PPEX1 was referred to our center at 18+2 weeks of gestation due to cranial anomalies identified through a structural anomaly scan. Obstetric ultrasound revealed a single viable fetus consistent with 18+1 weeks of gestation. In intracranial evaluation, the fetus exhibited a single cavity in the lateral ventricles, thalamic fusion, absence of the cavum septum pellucidum, and alobar holoprosencephaly. A cystic hygroma with septations measuring 18x13 mm was observed in the fetal neck. Microcephaly and significant hypertelorism were also present. Ultrasonographic findings were suggestive of Meckel-Gruber Syndrome. Following the decision made by the board and with the consent of the family, the pregnancy termination was carried out. The fetus was aborted vaginally and weighed 110 grams, measuring 18 cm in length. Macroscopic examination of the fetus revealed micrognathia, hypertelorism, flattened nasal bridge, low-set ears, and encephalocele, consistent with female external genitalia. Autopsy examination of the fetus indicated an enlarged liver with absence of the gallbladder, spleen, and pancreas. Other internal organs appeared lithic in appearance. Conclusion Meckel-Gruber Syndrome is a rare fetal anomaly with an autosomal recessive inheritance pattern, occurring at a frequency of 1 in 13,250 to 140,000 births. It follows a severe and lethal course. While the classic triad includes cystic renal dysplasia, encephalocele, and polydactyly, the syndrome can also manifest with additional anomalies. Differential diagnoses should include Trisomy 13 and Smith-Lemli-Opitz syndrome, given their similar clinical presentations. Careful consideration is necessary in making a differential diagnosis due to the overlapping features with these two conditions. Definitive diagnosis requires autopsy, as karyotype analysis might yield normal results. The recurrence rate is 25%, underscoring the importance of prenatal diagnosis and monitoring. Mortality associated with this syndrome is 100%. Families should be counseled about the risk of mortality in the current pregnancy and the possibility of recurrence in subsequent pregnancies. First-trimester ultrasound evaluation between 11 and 14 weeks is strongly recommended for subsequent pregnancies.
  • Küçük Resim
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    Successful treatment with eculizumab in a patient with pregnancy-associated atypical hemolytic uremic syndrome
    (SAGE Publications Inc., 2023) Duran, Mehmet Nuri; Beyazit, Fatma; Erbaş, Mesut; Özkavak, Onur; Acar, Celal; Bakırdöğen, Serkan
    Pregnancy‐associated atypical haemolytic uraemic syndrome is a rare and potentially lethal complement-mediated disorder. It can mimic preeclampsia, gestational hypertension, thrombotic thrombocytopenic purpura and hemolysis, elevated liver enzymes and low platelets syndrome. Thus, it can be hard to distinguish pregnancy‐associated atypical haemolytic uraemic syndrome from other causes in peri/post-partum women presenting with features of microangiopathic haemolytic anemia, thrombocytopenia and acute kidney injury. We present a case of a 35-year-old woman in her third pregnancy at 32 weeks’ gestation who underwent caesarean section due to fetal distress. She developed severe renal impairment, thrombocytopenia and neurologic symptoms within 24 hours after delivery. A diagnosis of pregnancy‐associated atypical haemolytic uraemic syndrome was provided, and treatment with plasma therapy followed by eculizumab was initiated. A rapid improvement of both clinical and laboratory parameters was observed. This case demonstrates the significance of early initiation of anti-complement therapy to prevent irreversible renal damage and possible death in women with pregnancy‐associated atypical haemolytic uraemic syndrome.
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    The Effect of Full and Empty Bladders on Uterine Artery Doppler Parameters in the First Trimester
    (Imr Press, 2025) Duran, Mehmet Nuri; Demir, Sureyya Saridas; Demirkaya, Lokman Semih; Ilgin, Serem Kel; Pek, Ibrahim Eren; Demir, Bulent
    Background: The presence of increased resistance in uterine artery Doppler measurements is associated with preeclampsia and other adverse pregnancy outcomes. Therefore, this study aimed to evaluate whether a full or empty bladder affects uterine artery Doppler results. Methods: This study included 213 women with singleton pregnancies between 11-13 weeks. The first measurement for bilateral uterine artery Doppler parameters was performed while the patients experienced a full bladder, while the second measurement was conducted immediately following urination. Results: Uterine artery notching presented statistically significant results when the bladder was evaluated as full and empty. While the mean values calculated for the left uterine artery pulsatility index were 1.82 +/- 0.04 before micturition, this value was calculated as 1.74 +/- 0.04 after micturition (p = 0.011). The mean value for the right uterine artery while the mean value was 1.85 +/- 0.042 before micturition, it was calculated as 1.81 +/- 0.041 after micturition (p < 0.001). Uterine artery resistance indices were also statistically different before and after micturition. The mean values calculated for the left uterine artery resistance index were 0.77 +/- 0.008 before micturition and 0.74 +/- 0.007 after micturition (p = 0.003). For the right uterine artery, it was calculated as 0.76 +/- 0.008 before micturition and 0.75 +/- 0.01 after micturition (p = 0.047). Conclusions: Although there are minimal studies on this subject in the literature are limited, physiological principles and the results of the present study show that emptying the bladder before arterial Doppler evaluation of spaces such as the abdominal compartment, will provide more accurate results.
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    Ulipristal Asetatın Ratlarda Oluşturulan Cerrahi Endometriozise Etkisi
    (Mardin Artuklu University, 2022) Duran, Mehmet Nuri; Şahin, Hacı Öztürk; Kılınç, Nihal; Demir, Bülent
    Amaç: Ulipristal Asetat'ın ratlarda oluşturulan endometriozis odakları üzerindeki etkisinin araştırılması hedeflendi. Gereç ve Yöntem: Çalışma, yaklaşık 280 gram ağırlığında 12 haftalık ratlarla yürütüldü. Otolog endometriozis modeli oluşturulduktan sonra, ulipristal asetat almayan gruba günlük oral salin, ulipristal asetat verilen gruba ise 4 hafta süreyle 0.5 mg/kg (0.125 mg/rat/gün) oral yolla verildi. Histopatolojik ve immünohistokimyasal değerlendirmeler için ektopik endometriyal dokular çıkarıldı. Boyama Hematoksilen-Eozin, Ki-67 ve Siklooksijenaz-2 ile yapıldı. Bulgular: Ektopik endometrium yüzey epitelinin Hematoksilen-Eozin Boyama skoru ulipristal asetat negatif grubunda 2,5 puan, ulipristal asetat pozitif grubunda 0,5 puan olarak bulundu. İmmünhistokimyasal değerlendirmede ektopik endometriyal yüzey epitelinin Ki-67 pozitifliği ulipristal asetat negatif grubunda %71.2, ulipristal asetat pozitif grubunda ise %31,7 olarak bulundu. Siklooksijenaz-2 pozitifliği ulipristal asetat negatif grubunda %67, ulipristal asetat pozitif grubunda ise %27 olarak tespit edildi. Sonuçlar: Hematoksilen-Eozin boyaması, ulipristal asetat negatif grubunun 2.5 (iyi-orta derecede korunmuş epitel) ve ulipristal asetat pozitif grubunun 0.5 (epitel nadiren var veya yok) olduğunu ortaya koydu. Ulipristal asetat pozitif grubunda Ki-67 ve Siklooksijenaz-2 immünohistokimyasal pozitiflik yüzdesinin ulipristal asetat negatif grubuna göre istatistiksel olarak anlamlı düzeyde azaldığı bulundu. Bu konuda daha fazla literatür verisine ihtiyaç vardır
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    Ulipristal asetatın ratlarda oluşturulan cerrahi endometriozise etkisi
    (Çanakkale Onsekiz Mart Üniversitesi, 2021) Duran, Mehmet Nuri; Şahin, Hacı Öztürk
    Amaç: Endometriozis, endometrial dokunun endometriyum veya myometriyum dışında bulunması olarak tanımlanmaktadır. Reprodüktif dönemde görülme insidansı %6- 10'dur (1). Ki-67 proteini hücre proliferasyonu ile ilişkilidir. Siklooksijenaz-2 (COX-2) anjiyogenezi arttırarak endometriozin patogenezinde rol oynar. Selektif progesteron reseptör modülatörleri (SPRM) grubundan olan Ulipristal asetat (UPA), endometriyal proliferasyonu seçici olarak inhibe ederek endometriyal prostaglandin üretimini baskılar. Çalışmamızda UPA'nın ratlarda oluşturulan ektopik endometriyum dokusu üzerindeki etkisini değerlendirmek amacıyla UPA kullanan grup ile kontrol grubu arasındaki ektopik endometriyum dokusundaki histolojik değişiklikleri, COX-2 ve Ki-67 immunohistokimyasal(IHC) boyanma yüzdelerini karşılaştırdık. Yöntem: Çalışmamız ÇOMÜDAM bünyesinde deneye tabi olan 12 haftalık ve yaklaşık 280 gram ağırlığında ratlarla gerçekleştirildi. Otolog endometriozis modeli oluşturulduktan sonra kontrol grubu (UPA -, 11 rat): serum fizyolojik peroral (po), çalışma grubu (UPA +, 13 rat): UPA (ella® ABDIIBRAHIM) 0,5 mg/kg (günlük doz 0.125 mg/rat/gün) 4 hafta po uygulandı. Sonrasında ektopik endometrium dokuları histopatolojik ve IHC değerlendirme için çıkarıldı. Hematoksilen eozin(H&E), Ki-67 ve COX-2 ile boyama işlemi uygulandı. H&E boyanma skoru, Ki-67 ve COX-2 IHC ekspresyon oranları değerlendirildi. Bulgular: Ektopik endometrium yüzey epitelinin H&E boyanma skoru UPA verilmeyen (UPA-) grupta 2,5 iken UPA+ grupta 0,5 puan olarak değerlendirildi. Yapılan IHC değerlendirmede ektopik endometriyum yüzey epitelinin Ki-67 pozitifliği UPA– ve UPA + grupta sırasıyla %67,5 ve %36,6 iken COX-2 pozitifliği yine sırasıyla %65 ve %25 olarak saptandı. Sonuç: 'Ulipristal asetatın ratlarda oluşturulan cerrahi endometriozise etkisi' çalışmamızda UPA' nın endometriotik odakların regresyonu üzerine kontrol grubuna kıyasla istatistiksel olarak anlamlı etkinliğini H&E boyama, Ki-67 ve COX-2 IHC değerlendirmelerinde gösterdik. Etki mekanizması tam olarak açıklanamamış olmakla beraber gelecekte endometriozis tedavisinde ilaç olarak kullanılma potansiyeli taşımaktadır. Bu konuda daha fazla literatür bilgisine ihtiyaç vardır.