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    A new and more effective feticide technique in late termination of pregnancy: potassium chloride injection into the interventricular septum of the fetal heart
    (Springer Science and Business Media Deutschland GmbH, 2023) Süzen Çaypınar, Sema; Oğlak, Süleyman Cemil; Polat, İbrahim; Kurt Bilirer, Kübra; Sezer, Salim; Gedik Özköse, Zeynep; Karakaş, Sema
    Objective: This study sought to compare the efficacy and outcomes of fetal intracardiac intraventricular and interventricular septal potassium chloride (KCl) injections during the induced fetal demise process in a cohort of pregnant women with severe fetal abnormality who opted for late termination of pregnancy (TOP). Materials and methods: This study consisted of 158 pregnant women who requested late TOP for severe fetal abnormality between 22 and 36 weeks of pregnancy. Participants were randomly assigned with the simple randomization procedure to one of two feticide procedure groups: the intraventricular KCl injection group and the interventricular septal KCl administration group. We studied the clinical outcomes of both the feticide procedures. Results: The median total dose of strong KCl was significantly lower in the interventricular septal KCl administration group (3 mL) than in the intraventricular KCl injection group (5 mL, p < 0.001). The median time to reach asystole and the median total duration of the procedure was significantly shorter in the interventricular septal KCl administration group (42 s and 85 s, respectively) than in the intraventricular KCl injection group (115 s and 150 s, respectively, p < 0.001). We detected a statistically significant correlation between the gestational week at feticide and the total dose of KCl (r = 0.705, p < 0.001), time to reach asystole (r = 0.653, p < 0.001), and total duration of the procedure (r = 0.683, p < 0.001). Conclusion: KCl administered directly into the interventricular septum induces immediate and permanent fetal cardiac asystole with a 100% of success rate without comprising maternal safety. We did not observe any maternal complications related to the procedure in our cases. Since the consequences of failed feticide procedure are challenging for both parents and healthcare providers, and providers are also concerned about potential legal implications regarding an unintended live birth, it is crucial to guide a strict protocol to confirm permanent fetal cardiac asystole. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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    Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational and Gestational Diabetic Mothers: A Prospective Case-Control Study
    (OrtadogŸu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi ve Ticaret A.S., 2023) Sezer, Salim; Oğlak, Süleyman Cemil; Atiş Aydin, Alev; Süzen Çaypinar, Sema; Kaya, Başak; Bestel, Melih
    Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses. Copyright © 2023 by Türkiye Klinikleri.
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    Fetal left ventricular myocardial performance index measured at 11–14 weeks of gestation in fetuses with an increased nuchal translucency
    (John Wiley and Sons Inc, 2023) Sezer, Salim; Oğlak, Süleyman Cemil; Kaya, Başak; Behram, Mustafa; Gedik Özköse, Zeynep; Süzen Çaypınar, Sema; Acar, Züat
    Objective: This study aimed to evaluate the effect of an increase in nuchal translucency (NT) thickness on the myocardial performance index (MPI) in fetuses without cardiac anomaly in the first trimester and to determine whether a difference in MPI between those with and without trisomy 21 in these fetuses could be determined. Methods: The study group consisted of 53 pregnancies complicated with increased NT thickness without any associated structural anomalies. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled as the control group. Results: In the increased NT thickness group, the mean isovolumetric relaxation time (IRT) value (0.050 ± 0.011 s) was significantly higher and the mean ejection time (ET) value (0.149 ± 0.010 s) was significantly lower than those values in the normal NT thickness group (0.045 ± 0.005 and 0.155 ± 0.009 s, p = 0.023 and p = 0.009, respectively). We found a significantly higher mean left MPI value in the increased NT thickness group (0.574 ± 0.153) versus the normal NT thickness group (0.487 ± 0.107, p < 0.001). Within the increased NT thickness group, the mean left MPI value was similar in the fetuses with normal karyotype and those with trisomy 21 (p = 0.419). Conclusion: We demonstrated a significantly greater mean MPI value in the increased NT thickness group than in the normal NT thickness group. Within the increased NT thickness group, no differences in the left MPI value in the fetuses with normal karyotype and the fetuses with trisomy 21 were found. © 2023 Japan Society of Obstetrics and Gynecology.
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    Increased maternal serum aquaporin 9 levels in pregnancies complicated with gestational diabetes mellitus
    (Taylor & Francis Ltd, 2022) Sezer, Salim; Kaya, Serdar; Behram, Mustafa; Dag, Ismail
    Introduction This study aimed to examine maternal serum aquaporin 9 levels in pregnant women with gestational diabetes mellitus and to compare them with non-diabetic pregnant women. Methods Forty-one pregnant women between 37 and 39 weeks of gestation complicated with gestational diabetes mellitus and 39 non-diabetic pregnant women at similar gestational weeks without additional obstetric complications were included in this cross-sectional study. Maternal serum aquaporin 9 levels and leptin levels of the cases were measured. Results Maternal serum leptin and aquaporin 9 levels in pregnant women with GDM were found to be significantly higher than in the control group (p < .001). In the study group, first-minute Apgar scores were significantly lower and birth weight significantly higher (p = .001 and .005, respectively). A weak but significant positive correlation between aquaporin 9 levels and maternal body mass index (r = 0.279, p = .012), birth weight (r = 0.433, p < .001), and hemoglobin A1c (r = 0.354, p = .001) levels was detected. A significant positive correlation was detected between maternal serum aquaporin 9 levels and leptin levels (r = 0.331, p = .003). Conclusion The increased aquaporin 9 levels detected in cases with gestational diabetes mellitus might be a marker of the poor maternal metabolic environment specific to diabetes and might contribute to the pathophysiology of gestational diabetes.
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    Serum autotaxin levels correlate with the severity of pruritus in intrahepatic cholestasis of pregnancy
    (John Wiley and Sons Inc, 2022) Süzen Çaypınar, Sema; Oğlak, Süleyman Cemil; Behram, Mustafa; Gedik Özköse, Zeynep; Sezer, Salim; Karakaş, Sema
    Purpose: This study aimed to examine autotaxin (ATX) concentrations in the serum of pregnant women complicated with intrahepatic cholestasis of pregnancy (ICP) and compare them with individuals with uncomplicated healthy pregnancies. Methods: This prospective case–control study took place with 83 pregnant women. The study group included 43 pregnant women presenting with a singleton pregnancy diagnosed with ICP in their third trimester of pregnancy. The diagnostic power of the ATX variable was examined by receiver operating characteristic analysis, and the cut-off value calculated according to the Youden index was summarized with the related sensitivity and specificity points. Results: The mean serum concentration of maternal ATX was significantly higher in the ICP cases (8.91 ± 2.69 pg/mL) compared to the pregnant women in the control group (3.59 ± 1.39 ng/mL, p < 0.001). According to the Youden index, a 5.80 ng/mL cut-off value of serum ATX concentrations can be used to diagnose ICP with 97.7% sensitivity and 97.5% specificity. A significant highly positive correlation was found between maternal serum ATX levels and maternal serum total bile acid levels (r = 0.633 and p < 0.001) and itch intensity, which was objectified by the visual analog scale score (r = 0.951 and p < 0.001). Conclusion: Maternal serum ATX levels were significantly increased in ICP patients as compared with healthy pregnant women. Also, serum ATX activity was highly correlated with the itch intensity. We consider that ATX might represent a robust, accurate, and reliable circulating biomarker to diagnose ICP. © 2022 Japan Society of Obstetrics and Gynecology.
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    The Importance of Screening Tests and Amniocentesis in Approach to Pregnant Women Over the Age of Thirty-Five
    (Galenos Publ House, 2022) Sezer, Salim; Bestel, Melih; Bolluk, Gokhan; Gezdirici, Alper
    Objective: Our goal was to evaluate the approach to the increased risk of fetal chromosomal anomaly in pregnant women over thirty-five years of Methods: We retrospectively examined pregnant women over the age of 35 who underwent interventional procedures for fetal karyotype analysis in the Perinatology Clinic of University of Health Sciences Turkey Kanuni Sultan Suleyman Training and Research Hospital. Regardless of the indication for karyotype analysis, pregnant women over the age of 35 who underwent karyotype analysis were included in the study. Results: Abnormal karyotype was detected in 76 (8.7%) of a total of 867 pregnant women examined in the study. Of 76 abnormal karyotypes, 51 were found as trisomy 21 (67.7%), 15 as trisomy 18 (21%), and 3 as trisomy 13 (4%). Three fetal karyotype analyzes revealed Turner syndrome (4%), 1 Klinefelter syndrome (1.3%), 2 mosaic trisomy 21 (2.6%) and 1 mosaic Turner syndrome (1.3%). In the patients who underwent interventional procedures primarily because of advanced maternal age, abnormal karyotype was detected in 6 (1.9%) of them. The rates of abnormal karyotype results for double, triple and quadruple tests were 6.4%, 1.9% and 5.8%, respectively. Conclusion: The use of a triple test has no definite impact on the results of pregnant women of older age. When there is no fetal abnormality in the ultrasound, double and quadruple tests may be requested or since the fetal death rate is minimal in amniocentesis, it can be recommended directly without performing any screening tests in pregnant women with older age.