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    Bernard-Soulier Syndrome from the Perspective of the Obstetrician: A Case Report with a Review of the Literature
    (Georg Thieme Verlag Kg, 2023) Saridogan, Erdinc; Onat, Taylan; Duz, Senem Arda; Tuncay, Gorkem; Abdurahmanova, Nuray; Orujova, Lumayat; Karaer, Abdullah
    Objective Bernard-Soulier syndrome (BSS) is one of the rare inherited platelet disorders that is characterized by macrothrombocytopenia and adhesion abnormality due to the absence or malfunctioning of the membrane GPIb-IX-V complex. There is no high-quality evidence on obstetric management of BSS owing to its rarity. Here we report an uncomplicated delivery of an adolescent with BSS and review the literature on the topic of BSS and pregnancy.Methods PUBMED, EMBASE, COCHRANE, and Google Scholar databases were searched up to April 2022 without language and year restriction using the terms Bernard Soulier and Pregnancy . The primary objectives were to evaluate maternal and fetal outcomes. The secondary objectives were to analyze pregnancy complications, gestational age at delivery, mode of delivery, administered prophylaxis, treatment approaches, duration of postpartum hospitalization, and the postpartum requirement of blood and blood product.Results The patient was a 19-year-old and 39-week pregnant woman who was diagnosed with BSS at the age of 10 by flow cytometry and genetic analysis. Single donor platelet transfusions and oral tranexamic acid were administered as prophylaxis at the peripartum period. She was delivered by cesarean section due to failure of labor. The postpartum period was uneventful for both mother and neonate. In the literature review, postpartum hemorrhage (PPH) was found in 52.9% (27/51) of deliveries. Late PPH occurred more frequently than early PPH (35.3 and 31.4%, respectively). 49% (25/51) of pregnancies had severe thrombocytopenia, and antepartum hemorrhage was observed in 11.8% (6/51) of those. The platelet count was in close relation to antenatal complications. 64.7% (33/51) of the patients were delivered via cesarean section. PPH and late PPH were found to be more common in those who delivered vaginally compared to those who delivered by caesarean section. It was observed that PPH was less common in women who were given prophylaxis in the peripartum period.Conclusion BSS is an inherited macro-thrombocytopathy that may cause adverse maternal and neonatal outcomes. The optimal mode and timing of delivery remain unclear. A multidisciplinary approach with prophylaxis at the peripartum period should be applied.
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    Çok düşük B-hCG düzeylerinde rüptüre tubal gebelik: olgu sunumu
    (2016) Duz, Senem Arda; Eraslan, Sevil; Coşkun, Ebru İnci
    Öz: Ektopik gebelik uterin kavitenin dışında oluşan gebeliktir. Sıklıkla tubada olmak üzere abdominal kavite, over ve servikste görülebilir. Ruptüre ektopik gebeliklere bağlı anne ölümleri günümüzde transvajinal sonografi ve serum ?-hCG (beta human koryonik gonadotropin) ölçümleri ile oldukça azalmıştır. Ancak ektopik gebeliğin kliniği ile ?hCGdüzeyi arasında bir korelasyon yoktur. Çok düşük ?-hCG düzeylerinde ektopik gebelik ruptürü gelişen bir olguyu sunmaktayız. Adet rötarı ile başvuran 29 yaşındaki nullipar hastanın serum ?-hCG düzeyi 1051 mIU/ml olup ultrasonografide tubal gebelik düşünülmüş, akut batın bulguları olmaması ve 3. gün serum ?-hCG düzeyi 727 mIU/ml olması üzerine haftalık takibe alınmıştır. Son vizitinden 2 gün sonra şiddetli alt karın ağrısı ile başvurdu. ?-hCG düzeyi 39.8 mIU/ml idi. Ultrasonografide abdomende yaygın mai izlendi, acil laparotomi, sağ salpenjektomi yapıldı. ?-hCG düzeyleri düşük ve azalmakta olsa bile rüptür ihtimali her zaman akılda tutulmalı ve hastalar da bu konuda bilgilendirilerek takip edilmelidir.
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    The Definition of the Upper Limit of Adolescent Age in Terms of Adverse Pregnancy Outcomes
    (Springernature, 2021) Duz, Senem Arda; Tuncay, Gorkem; Cengiz, Murat; Karaer, Abdullah
    Introduction This study aims to reveal the maternal and neonatal adverse outcomes, associated with adolescent pregnancies in our country, to investigate whether the 20 to 21-year-age group, which is very close to the adolescent age, is similar to the adolescent age group in terms of adverse outcomes, and so to contribute to the definition of the upper limit in adolescent age for pregnancy. Methods Four hundred and twenty-four pregnant women under the 20-year-age, 450 pregnant women at 20 to 21year-age, and 450 pregnant women between 22 and 25-year-age were included in this retrospective study. Maternal demographic features, clinical characteristics, obstetric complications, maternal outcomes, neonatal complications, and neonatal outcomes were collected from the medical records of the participants. Results There were statistically significant differences between under 20-year-age and 22 to 25-year-age, regarding gestational age at birth, maternal duration of hospitalization after delivery, mode of delivery, preterm delivery rate, very low birth weight, and low birth weight, first minute Apgar score, the presence of transient tachypnea of the newborn. Conclusion The upper age limit for the adolescent age, which is considered risky in terms of maternal and neonatal adverse outcomes, was found to be compatible with the upper age limit, which is 19 years, defined by World Health Organization.
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    FERTILITY OUTCOMES AFTER MEDICAL AND SURGICAL MANAGEMENT OF TUBAL ECTOPIC PREGNANCY
    (Sestre Milosrdnice Univ Hospital, 2021) Duz, Senem Arda
    The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (EP). Information on patients treated in our hospital between 2013 and 2014 for EP was retrieved from the computerized patient records. Data on whether these patients achieved pregnancy after EP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. In addition to descriptive analysis, the chi(2)-test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after EP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with EP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.
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    Metabolomic analysis of endometrial cancer by high-resolution magic angle spinning NMR spectroscopy
    (Springer Heidelberg, 2022) Duz, Senem Arda; Mumcu, Akin; Dogan, Berat; Yilmaz, Ercan; Coskun, Ebru Inci; Saridogan, Erdinc; Tuncay, Gorkem
    Purpose To analyze endometrial metabolite profiles between patients with endometrial cancer and controls. Methods Seventeen (17) women with endometrium cancer and 18 controls were enrolled in this study. H-1 HR-MAS (High Resolution-Magic Angle Spinning) NMR (Nuclear Magnetic Resonance) spectroscopy data obtained from endometrial tissue samples of patients with endometrial cancer and control group were analyzed with bioinformatics methods. Results Principal component analysis (PCA) and the partial least squares discriminant analysis (PLS-DA) score plots obtained with the multivariate statistical analysis of pre-processed spectral data shows a separation between the samples from patients with endometrial cancer and controls. Analysis results suggest that the levels of lactate, glucose, o-phosphoethanolamine, choline, glycerophosphocholine, phosphocholine, leucine, isoleucine, valine, glutamate, glutamine, n-acetyltyrosine, methionine, taurine, alanine, aspartate and phenylalanine are increased in patients with endometrial cancer compared to the controls. Conclusion The metabolomics signature of patients with endometrial cancer is different from that of benign endometrial tissue.
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    Nuclear transcription factor-kappa beta-dependent ultrastructural alterations within the placenta and systemic inflammatory activation in pregnant patients with hemolysis, elevated liver functions and low thrombocyte count (HELLP) syndrome: a case-control study
    (Taylor & Francis Inc, 2013) Simsek, Yavuz; Gul, Mehmet; Celik, Onder; Aydin, Nasuhi Engin; Duz, Senem Arda; Celik, Ebru; Ozerol, Elif
    Objective: Preeclampsia appears to be associated with a higher extent of inflammation than in uncomplicated pregnancies. We aimed to test whether this was the case in patients with hemolysis, elevated liver functions and low platelet count (HELLP) syndrome and to clarify the contribution of placental and systemic inflammatory variables in the development of this syndrome. Materials and methods: Thirty healthy pregnant women (control group) and 20 patients with HELLP syndrome (study group) were included in the study. Placental inflammatory activity was evaluated by quantifying immunohistochemically the levels of p65/RelA expression of nuclear transcription factor-kappa beta (NF-kB) in paraffin-embedded tissue samples. In addition, ultrastructural changes in placental morphology in HELLP patients were evaluated by transmission electron microscopy (TEM). The serum concentrations of myeloperoxidase (MPO) and C-reactive protein (CRP) were also measured and compared. Results: p65/RelA immunoexpression and serum MPO and CRP levels were significantly higher in patients with HELLP syndrome (p < 0.05). TEM of placenta in the study group revealed severely vacuolized syncytiotrophoblasts, irregular basal lamina and damaged capillary endothelium when compared with the placenta of control subjects. Conclusion: Our results suggest that over-expression of placental NF-kB is correlated with elevation of serum inflammatory markers and placental ultrastructural changes, which may point to an important role of local and systemic inflammatory activation in the pathogenesis of HELLP syndrome.
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    Risk Factors for Gestatıonal Diabetes in Women with Polycystic Ovarian Syndrome
    (2016) Duz, Senem Arda; Türkçüoğlu, Ilgın
    Abstract: We aimed to compare the pre-gestational metabolic states of the women who were previously diagnosed with policystic ovarian syndrome and had gestational diabetes mellitus in the subsequent pregnancy and who did not have gestational diabetes mellitus in subsequent pregnancy and to determine the independent variables that predict the gestational diabetes mellitus risk for policystic ovarian syndrome patients in the subsequent pregnancy. Between the dates 2007 and 2012, the patients who were diagnosed with policystic ovarian syndrome in our outpatient gynecology clinic were searched retrospectively. Then these patients were called for pregnancy states. All of these patients have pregnancy spontaneously. The patients’ pre-gestational mean age, body mass index, metabolic and hormonal profiles and pregnancy outcomes were compared between policystic ovarian syndrome cases who developed gestational diabetes mellitus or not. We found some differences in pregestational metabolic states between the policystic ovarian syndrome patients who developed gestational diabetes mellitus in pregnancy or not. The mean age, body mass index, very low density lipoprotein, triglyceride, fasting insulin, fasting c-peptide levels, 1st and 2nd hour glucose levels in 75 gr oral glucose tolerance test, homeostatsis model assessment –insulin resistance measures and neonates’ birth weights were higher in gestational diabetes mellitus group than non-gestational diabetes mellitus group. But high density lipoprotein was lower in gestational diabetes mellitus group than non- gestational diabetes mellitus group. There were no differences between the mean levels Creactive protein, hormonal profile, mean fasting glucose, low density lipoprotein cholesterol, total cholesterol levels and mode of delivery. Glucose intolerance was significantly higher in the gestational diabetes mellitus group (%74,07 vs %6,66). With the multipl logistic regression analysis we found the body mass index as the strongest independent predictor of gestational diabetes mellitus in policystic ovarian syndrome patients (OR: 2,831, %95 CI: 1,234-6,495). The second independent predictor was the high 2nd hour glucose level in oral glucose tolerance test (OR: 1,119, %95 CI: 1,026-1,221). The pre-gestational metabolic variables including the age, body mass index, lipid profile, and glucose metabolism are significantly different in the gestational diabetes mellitus group than the non-gestational diabetes mellitus group. The obesity and glucose intolerance are the independent predictors of gestational diabetes mellitus in policystic ovarian syndrome cases