To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS‐CoV‐2 infection.

BACKGROUND:One of the most vulnerable group to cope with the consequences of COVID-19 pandemic are women, particularly pregnant ones. OBJECTIVE:The aim of this article was to make review of the scientific literature to show clearly that pandemic is not so dangerous neither for mother nor her unborn and newborn children. RESULTS AND DISCUSSION:It should be stated that most of the scientific papers on COVID-19 are currently being conducted in a way that would probably be completely unacceptable to serious science in any other circumstances. Taking into account everything we have learned about the SARS-CoV-2 virus so far it comes as a surprise that there has not been a more intense scientific debate on whether the blind lockdown model, implemented by most national governments, was truly an appropriate response to the challenges posed by the pandemic. CONCLUSION:Deep analysis what science in perinatal medicine did assess and what it recommended to perinatal world it may be followed by principles that the research of the members of the Academy will not be the first to be published, but we certainly aim that the scientific evidence published by Academy is fast, reliable and implementable.

Objective Previous studies have established the association between preeclampsia (PE)-induced stress on fetus and elevated 17-hydroxyprogesterone levels (17-OHP) of which known as a stress markers. The aim of our study was to evaluate the relationship between these markers that were analyzed via cord blood with the severity of PE. Methods Consecutive PE women who were admitted to Dr. Lütfi Kırdar Training and Research Hospital Obstetrics and Gynecology Clinics from August 2009 to December 2009 were recruited. Uncomplicated pregnant women admitted at the same period consisted the control group. Umbilical blood samples were collected from umbilical artery immediately after birth and 17-OHP analyzed. Results The study group consisted of 40 mild PE (n=12) and severe PE patients (n=28) and the control group consisted of 35 patients. Maternal age and body mass index were similar between the study groups, but the fetuses in the severe PE group had a smaller mean gestational age and mean birth weight (p=0.001). Umbilical cord 17-OHP levels were statistically significantly lower in the severe PE patients than the controls [Control group=12.5±4.6 (n=35); mild PE=10.3±6 (n=12, p=0.24), severe PE=9.6±5.2 (n=28, p=0.019)]. Although the patients with mild PE had lower 17-OHP levels, they were not statistically significant (p=0.827). Conclusion In our study, it is found that there is no association between PE severity and the cord blood levels of 17-OHP. The effect of early intervention that prevent feto-maternal complications may lead to normal or low levels of these markers of which was found increased in cord blood of preeclamptic patients in previous studies.

These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.

n this review, we reviewed current literature on COVID-19 infection during pregnancy and provided up-to-date information and community/society recommendations. Although it has previous examples such as SARS and MERS and the infection findings appeared at an earlier period and have become known in China, the infection could not be limited and spread worldwide. Until June 8, 2020, a total of 6.8 million cases were reported and 397,000 cases died. As of the same date, the total case number in Turkey is 171,000 and total number of death is 4711. COVID-19 virus spread by droplets and its incubation period varies between 2 and 14 days. The rate of asymptomatic cases is 42% in non-pregnant patients while it is 44–89% in pregnant women. The disease progresses with mild-medium severity in about 80% of the patients, and it recovers by itself. A total of 17 maternal death cases has been reported. Although vertical transmission risk is very low according to a study investigating 265 pregnant women, there are cases showing fetal vertical transmission and we reviewed such cases in detail in this review.

INTRODUCTION[|]To investigate placental immunohistochemical findings and Doppler parameters in normal pregnancies and women with preeclampsia (PE).[¤]METHODS[|]Doppler measurements of umbilical, uterine, and spiral arteries of 23 PE and 12 normal pregnancies followed and delivered between 2008 and 2010 were performed and recorded. Placental specimens were obtained at birth and the microvessel density of spiral arteries was measured immunohistochemically using placental tissue CD 34 antibody expression. Three vessels with the most intense CD34 density were evaluated.[¤]RESULTS[|]There were no significant differences in the umbilical artery pulsatility index (PI), resistance index (RI), or systolic/diastolic ratio (S/D) between the PE and normal pregnancies. The spiral and uterine artery RI, PI, and SD ratios, however, were significantly higher in the PE group. There was no statistically significant difference in the mean microvessel density between the 2 groups.[¤]DISCUSSION AND CONCLUSION[|]The role of the placenta in the development of PE is unquestionable. Vascular pathologies and blood flow characteristics demonstrate significant differences and deteriorations compared with normal pregnancies. Further research is needed to further define the precise pathology.[¤]

OBJECTIVE:To assess the correlation between the number of excised neural fibers and degree of pain relief following laparoscopic presacral neurectomy (LPSN).MATERIALS AND METHODS:In this before and after study, 20 patients with severe midline dysmenorrhea [Visual Analogue Scale (VAS) >80 mm] unresponsive to medical therapy were consecutively enrolled. All patients underwent LPSN. The superior hypogastric plexus was excised and sent for histologic confirmation. Two pathologists counted the number of neural fibers in the surgically removed tissue. VAS was used for pain assessment before and 2nd, 3rd, 6th, and 12th months after the operations.RESULTS:Out of the initial 20 patients undergoing LPSN, eight were excluded from the final analysis due to intraoperative diagnosis of endometriosis; therefore, the remaining 12 patients were evaluated. The pain scores significantly decreased at each follow-up visit compared with the preoperative period (p=0.002). The pathologists, who were blinded, reported the median (minimum-maximum) neural fiber count as 46 (20-85) and 47 (18-83). No significant correlation was demonstrated between the number of excised neural fibers and the amount of pain relief following LPSN.CONCLUSION:LPSN is an effective surgical procedure to control primary dysmenorrhea. Our preliminary results revealed that the degree of pain relief in cases of severe midline dysmenorrhea was not related to the amount of excised neural tissue in LPSN.

While the routine approach for the diagnosis of gestational diabetes is 50-g glucose tolerance test and 100-g OGTT in cases of a positive screen, a new approach was brought to agenda after it was found in the study of Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study that there is a linear relationship between blood glucose levels and gestational outcomes, and this was found to be closely associated with each value increase. It was shown that the approach of establishing diagnosis based on a single value at once with 75-g OGTT which is recently common in clinical practice helps 18% of pregnant population to get diagnosed, and the diet and exercise following the diagnosis improved gestational outcomes and affected gestational outcomes even in obese cases without gestational diabetes. Pregestational obesity having effect on gestational outcomes even though there is no diagnosis of gestational diabetes and finding that keeping weight gain during pregnancy under control is improving gestational outcomes reveal the importance of this matter. While 75-g OGTT procedure based on single value increases the number of cases who are established the diagnosis of gestational diabetes compared to the two-step screening and diagnosis test, dietexercise practice in cases with such diagnosis is a condition which keeps weight gain during pregnancy under control and also has a positive impact on gestational outcomes. Glycemia being above the desired range with 1–2 weeks of follow-up of the blood glucose will require medical treatment. This is an expected and desired target. Therefore, applying 75-g OGTT based on single value has become the new clinical practice and it is recommended. This clinical practice guideline was prepared by the Diabetes and Pregnancy Study Group of Turkish Perinatology Society.

ABSTRACTPrenatal screening for fetal aneuploidies has been focused on mainly Down syndrome in the last 40 years. The method of screening has changed from maternal age in the 1970s, with a detection rate of 30 and 5% false positive rate (FPR), to a combination of maternal age and second-trimester serum biochemical markers (triple test and quadruple test) in the 1980s and 1990s, with 60 to 75% detection rate and 5% false positive rate (FPR). Following this, the era of first trimester screening for Down syndrome has started with the clinical implementation of fetal nuchal translucency screening. The combination of maternal age, NT thickness and serum free beta-human chorionic gonadotropin (â-hCG) and pregnancy-associated plasma protein A (PAPP-A) in the first trimester has yielded a 90% detection rate with a 5% FPR. Starting from the year 2008, studies have shown that the performance of screening may be improved by analysis of cell-free deoxyribonucleic acid (DNA) (cfDNA) in maternal blood. Several studies in the last few years have reported the clinical validation of cell free fetal DNA test in the maternal serum in screening for trisomies 21, 18, and 13 and sex chromosome aneuploidies.Its widespread use is limited by the relatively high cost of the test and the lack of consensus about the optimal way for its clinical implementation. Until the optimal way of incorporating cfDNA into the clinical practice gets identified, it would be wise not to substitute cfDNA testing in place of first-trimester screening for fetal defects and other major complications of pregnancy. Furthermore, it would be preferable for clinicians managing individual patients not to counsel them for their result as positive or negative, rather the clinicians should use the risk estimate from the first-line method of screening as the prior risk and modify this by the appropriate positive or negative likelihood ratio from the cfDNA test.How to cite this articleSen C, Api O, Yayla M, Goynumer G. Cell-free DNA Testing: Where are We now? Donald School J Ultrasound Obstet Gynecol 2016;10(2):172-177.

ABSTRACT Advances in technology and wide used of obstetric ultrasound have allowed an increase in the antenatal identification of fetal problems, such as fetal lung lesions. Technological advances in transducer and software technology have remarkably improved visualization of structures in the fetus. Additionally, newer understanding of the natural course of several malformations and new methods of in utero treatment, the evolution of fetal surgical techniques and anesthesia have made fetal surgery possible and have changed the course of evolution of lung defects before and after birth. Therefore, there is now an increasing demand for an accurate and timely diagnosis, counseling, and planning of appropriate management of the cases whether expectant management or in utero therapy at perinatal care centers with timely perinatal transfer. How to cite this article Sen C, Yayla M, Api O, Goynumer G. Fetal Lung Surgery. Donald School J Ultrasound Obstet Gynecol 2016;10(3):271-296.

Amac: Levonorgestrel salan rahimici sistemin, ostrojen replasman tedavisi altindaki ovariektomize sicanlarin endometriumu uzerindeki etkilerini arastirmak. Yontem: Yirmidort adet Sprague-Dawley sicani 4 gruba bolunerek, levonorgestrel salan intrauterin sistemin (3 µg/day) ve plasebo-iceren rahimici aracin (RIA) yerlestirilmesi icin operasyona alindi. Operasyonu takiben, sicanlar 30 gun sureyle ostrojen (0.01 mg./kg.) ve plasebo replasman tedavisi almak uzere gruplara randomize edildi. Calismanin sonunda deneklerden endometrial ornekleme yapildi. Alinan endometrial dokular morfolojik kriterler acisindan incelenmek uzere isik mikroskopisi ile incelendi. Grup I levonorgestrel salan RIA ve sistemik ostrojen alan, Grup II levonorgestrel salan RIA ve plasebo alan, Grup III plasebo iceren RIA ve sistemik ostrojen alan, Grup IV ise plasebo iceren RIA ve plasebo alan sicanlar olarak belirlendi. Bulgular: Grup I'e ait endometrial morfoloji %50'sinde aktif olmayan endometrium, %33'unde odem, %16'sinda atrofi olarak gorulurken. Grup II'ye ait morfoloji %66'sinda aktif olmayan endometrium, %33'unde atrofi olarak saptandi. Grup III'te ise % 66'sinda epitelyal hiperplazi, %16'sinda odem, %16'sinda myometrial hiperplazi bulunurken, Grup IV’ un. %83'unde atrofi, % 16'sinda ise aktif olmayan endometrium tespit edildi. Sonuc: Sistemik ostrojen replasman tedavisi altindaki sicanlarin endometriumlarini hiperplaziden korumada, progestagen iceren rahimici sistemin yeterli oldugu sonucuna ulasilmistir. Elde edilen veriler, sistemik ostrojen alan postmenopozal kadinlarin endometriumlarini korumada gestagen icerem rahimici aracin yeterli olabilecegi yonunde cesaret vericidir. Bu tip RIA kullanimi ile hastalar sistemik gestagenlerin istenmeyen etkilerinden korunmus olacaklardir. Anahtar Kelimeler: Sican endometriumu, levonorgestrel, intrauterin sistem, ostrojen replasman tedavisi

Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment.

According to the World Health Organization (WHO), anemia is the most common disease, affecting >1.5 billion people worldwide. Furthermore, iron deficiency anemia (IDA) accounts for 50% of cases of anemia. IDA is common during pregnancy and the postpartum period, and can lead to serious maternal and fetal complications. The aim of this report was to present the experiences of a multidisciplinary expert group, and to establish reference guidelines for the optimal diagnosis and treatment of IDA during pregnancy and the postpartum period. Studies and guidelines on the diagnosis and treatment of IDA published in Turkish and international journals were reviewed. Conclusive recommendations were made by an expert panel aiming for a scientific consensus. Measurement of serum ferritin has the highest sensitivity and specificity for diagnosis of IDA unless there is a concurrent inflammatory condition. The lower threshold value for hemoglobin (Hb) in pregnant women is <11 g/dL during the 1st and 3rd trimesters, and <10.5 g/dL during the 2nd trimester. In postpartum period a Hb concentration <10 g/dL indicates clinically significant anemia. Oral iron therapy is given as the first-line treatment for IDA. Although current data are limited, intravenous (IV) iron therapy is an alternative therapeutic option in patients who do not respond to oral iron therapy, have adverse reactions, do not comply with oral iron treatment, have a very low Hb concentration, and require rapid iron repletion. IV iron preparations can be safely used for the treatment of IDA during pregnancy and the postpartum period, and are more beneficial than oral iron preparations in specific indications.