2015perinatal Kabul:Poster. Toplam: 129

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2 2015perinatal Kabul:Poster Toplam: 129 [PP-001] Influence of Maternal BMI on Sonographic Fetal Weight Estimation Prior to Scheduled Delivery Hüseyin Aksoy 1, Ülkü Aksoy 2, Özge Idem Karadağ 3, Burak Yücel 3, Turgut Aydın 3, Mustafa Alparslan Babayiğit 4 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 4 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: To investigate the possible effect of maternal obesity on the accuracy of sonographically estimated fetal birth-weight in the third-trimester shortly before induction of labor and to compare the accuracy of the estimation between normal weight, overweight, and class I, classii and class III obese groups. Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal weight estimation prior to scheduled delivery. Women were classified by their current BMI into five categories: normal, overweight, obese Class I, obese Class II and obese Class III. Estimated fetal weight (EFW) was compared with the actual birth weight (ABW) and the difference between the EFW and the ABW (simple error) was recorded as error in grams. Findings: The final study included a total of 198 subjects. The mean absolute error for sonographic fetal weight estimations was ±80.83, ±124.32, ±122.75, ± and ± g, in groups, respectively (p<0.001). The mean absolute percentage error for sonographic fetal weight estimations was 3.51±2.76, 6.37±3.91, 7.93±4.81, 9.87±4.32 and 14.06±5.83 in groups, respectively (p<0.001). Conclusions: Our study showed that increasing maternal obesity decreases the accuracy of sonographic fetal weight estimations. Clinicians should be aware of the limitations of sonographic fetal weight estimation in especially obese patients. Keywords: body mass index, fetal weight, obesity, ultrasonography [PP-002] Sonographic fetal weight estimation prior to delivery: analysis of interobserver variability and accuracy Hüseyin Aksoy 1, Ülkü Aksoy 2, Fulya Çağlı 3, Özge Idem Karadağ 4, Gökhan Açmaz 3, Mustafa Alparslan Babayiğit 5, Turgut Aydın 4 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 4 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 5 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: To evaluate the interobserver reliability of sonographic fetal weight estimation between two experience sonographers prior to delivery. We also sought to compare the sonographic EFW accuracies of operators. Methods: This was a prospective study of singleton pregnancies that underwent sonographic fetal weight estimation prior to scheduled delivery. Two experienced sonographers performed all examinations prior to delivery. Sonographic fetal weight estimatios were obtained by each ultrasonographic examination. Estimated fetal weight (EFW) was compared with the actual birth weight (ABW) and interobserver reliability of sonographic fetal weight estimation between two

3 sonographers were assessed. Findings: The final study included a total of 245 subjects. Inter-observer reliability coefficients with 95% confidence intervals for sonographic EFW was ( , p<0.001). The median absolute error for sonographic EFW obtained by radiologist and obsterician was 192 (5-862) and 160 (0-590) g, respectively (p < 0.01). The median absolute percentage error for sonographic EFW obtained by radiologist and obsterician was 5.7 ( ) and 5.0 (0-19.4), respectively (p<0.01). Conclusions: Our study showed that interobserver reliability and agreement for sonographic EFW in third-trimester shortly before the delivery were quite high. However, significant difference between sonographic EFW accuracies of both operators was found. Keywords: interobserver reliability, fetal weight estimation, ultrasonography [PP-003] Effect of Threatened Miscarriage on Maternal Mood: A Prospective Controlled Chort Study Hüseyin Aksoy 1, Ülkü Aksoy 2, Özge Idem Karadağ 3, Yunus Hacımusalar 4, Gökhan Açmaz 5, Gülsüm Uysal 5, Fulya Çağlı 5, Burak Yücel 3, Turgut Aydın 3, Mustafa Alparslan Babayiğit 6 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 4 Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 5 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 6 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and threatened abortion (TA) and compare the prevalence of anxiety and depression levels in pregnant women complicated with and without TA. Methods: Between September 2013 and August 2014, 94 consecutive women with TA who were hospitalized and 120 healthy pregnant women without any signs and symptoms of miscariage, were included in the study. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were administered to patients during the psychiatric interview. Findingss: The mean BAI scores in TA study and healthy control groups were 18.90±10.52 and 8.24±5.24, respectively (p<0.001). The mean BDI scores in TA study and healthy control groups were 18.07±8.49 and 7.47±6.22, respectively (p<0.001). Conclusions: The findings of this study indicated a potential link between TA and anxiety and depression disorders. Therefore, patients with TA during pregnancy should be evaluated in terms of anxiety and depression disorders as much as their medical conditions. Medical professionals should be sensitive to psychological consequences of TA. Keywords: abortion, depression, miscarriage, pregnancy [PP-004] Maternal Anxiety and Depression Levels in Patients with Hyperemesis Gravidarum: A Prospective Case-Control Study Hüseyin Aksoy 1, Ülkü Aksoy 2, Özge Idem Karadağ 3, Yunus Hacımusalar 4, Gökhan Açmaz 5, Gülsüm Uysal 5, Fulya Çağlı 5, Burak Yücel 3, Turgut Aydın 3, Mustafa Alparslan Babayiğit 6 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 4 Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 5 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 6 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey

4 Objectives: The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and HG and compare the prevalence of anxiety and depression disorders in pregnant women with and without HG. Methods: A prospective case control study was performed at our tertiary referral centre. The study group consisted of 78 pregnant women with HG and 82 healthy pregnant women, constituted our control group. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory (BDI) were administered to patients during the psychiatric interview. Findings: The mean BAI and BDI scores in HG study and healthy control groups were 19.47±10.92 and 7.30±5.35, respectively. The mean BDI scores in HG study and healthy control groups were 18.97±9.85 and 6.36±5.61, respectively (p<0.001). A total of 44 (56.4%) women in HG group had BAI score of >=16 and were classified as moderate or severe anxiety disorder. A total of 8 (9.7%) women in healthy control group had BAI score of >=16 and were classified as moderate or severe anxiety disorder. Among the 78 women in the HG study population, 42 (53.9%) of patients had moderate or severe depression disorder. Only 6.1% of patients in the control group had moderate or severe depression. Conclusions: The findings of this study indicated a possible relationship between HG and anxiety and depression disorders. Therefore, patients with HG during pregnancy should be evaluated in terms of anxiety and depression disorders as much as their medical conditions. Keywords: anxiety, depression, hyperemesis, pregnancy [PP-005] Hyperemesis and Threatened Abortion in early pregnancy: relationship with anxiety and depression and review of the literature Hüseyin Aksoy 1, Ülkü Aksoy 2, Özge Idem Karadağ 3, Yunus Hacımusalar 4, Gökhan Açmaz 5, Gülsüm Uysal 5, Fulya Çağlı 5, Turgut Aydın 3, Mustafa Alparslan Babayiğit 6 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 4 Department of Psychiatry, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 5 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 6 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: This study evaluated the current state of anxiety and depression levels in patients with HG and TA and compared the prevalence of anxiety and depression levels with healthy pregnant controls. The aim of this prospective case-control study was to investigate the possible relationship between anxiety, depression and HG and TA and compare the results with healthy pregnant controls. Methods: A prospective case control study was performed at our tertiary referral centre. 84 consecutive women with HG and 88 consecutive women with TA constituted our study group and 98 healthy pregnant women constituted our control group. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I), was used to evaluate the anxiety and depression. Beck Anxiety Inventory (BAI) and Beck Anxiety Inventory (BDI) were administered to patients during the psychiatric interview and were evaluated by the same psychiatrist. Findings: The mean BAI scores in HG, TA and healthy control groups were ± 8.97, ± 8.71 and 7.03 ± 5.45, respectively. The mean BDI scores in HG, TA and healthy control groups were ± 7.81, ± 6.72 and 6.68 ± 5.28, respectively. Conclusions: The findings of this study indicated a potential link between HG, TA and anxiety and depression disorders. Keywords: anxiety, depression, hyperemesis, pregnancy, threatened abortion

5 [PP-006] Decreased pain expectation lowers labour pain experience Hüseyin Aksoy 1, Ülkü Aksoy 2, Burak Yücel 3, Gökhan Açmaz 4, Turgut Aydın 3, Mustafa Alparslan Babayiğit 5 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 4 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 5 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: The pain that women experience during labour is highly modifiable by psychological factors, including expectations. Positive expectations of patients could decrease any decisional difficulties. There is a lack of studies evaluating the correlation between pain expectation and labour pain. The present study was aimed to assess the relationship between pain expectation before labour, labour pain and pain perception after the labour in this study. Methods: Five hundred and twelve pregnant women followed for spontaneous vaginal delivery were included to the study. Patients were asked to rate their pain level on a standard continuous 100- mm a visual analog scale (VAS) pain score at various time points: Pain expectancy(pe), labour pain (LP) and postpartum pain perception (PPP) scores were calculated. Findings: The final study group was composed of 230 subjects after exclusions. Mean age of participants was 26.20±5.79. The mean PE, LP, and PPP scores were 7.01±1.88, 7.57±1.9 and 6.58±1.95, respectively. The difference among pain scores was statistically significant (p<0,001). There was a positive correlation between PE and LP or PPP scores (.270 and.208, respectively) and the correlations were statistically significant (p<0,001). PPP scores decreased with the decrement of LP scores. There was a positive correlation between LP and PPP scores (.869). The correlation was statistically significant (p<0,001). Conclusions: Our study showed that, reducing pain expectations of pregnant women could decrease their pain experience during labour. Thus, multiple tools, such as education programs, relaxation, meditation, etc. that are aimed to decrease pain expectations of pregnant before delivery is essential and critical. Keywords: Labor pain, pain management, visual analog pain scale [PP-007] Relationship Between Maternal C- Reactive Protein Level and Neonatal Outcome in Patients with Preterm Premature Rupture of Membranes Mehmet Serdar Kutuk 1, Osman Bastug 2, Ahmet Ozdemir 2, Mehmet Adnan Ozturk 2, Mahmut Tuncay Ozgun 1, Mustafa Basbug 1, Tamer Gunes 2, Selim Kurtoglu 2 1 Erciyes Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD 2 Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı Objective To assess the relationship between maternal C- reactive protein (CRP) level measured within 48 hours before delivery and neonatal outcome in pregnant women with preterm premature rupture of membranes (PPROM) who were managed conservatively. Methods: We retrospectively rewieved medical records of 70 singleton pregnancies with PPROM with gestational ages between 24 and 34 weeks at the time of rupture of membrane. On the basis of antepartum CRP levels, patients were categorized into two groups (Group1: CRP <= 6mg/ L, N: 31, Group 2: CRP> 6mg/L, N: 39).The groups were compared with regard to demographic characteristic, antenatal complications, postnatal morbidity and mortality. Results: The two group were similiar with regard to baseline demographic data. The mean birth weight was higher in Group1 (p: 0.041). The overall neonatal mortalitiy was 10% (7/70). The two groups were similiar for other neonatal complications and overall neonatal mortality, and composite morbidity (Table 1). The most important difference between

6 neonates with good outcome and poor outcome were birth weight and gestational age at birth (Table 2). There was no correlation between antenatal CRP levels and postnatal infectious morbidity. Conclusion: Elevated level of CRP within 48 hours of delivery is a poor predictor of postnatal outcome. Keywords: Premature rupture of membranes, C- reactive protein, postnatal outcome, neonatal sepsis [PP-008] Sonographic Diagnosis of Fetal Adrenal Hemorrhage Complicating The Vein of Galen Aneurysmal Malformation Mehmet Serdar Kutuk 1, Selim Doganay 2, Ahmet Ozdemir 3, Sureyya Burcu Gorkem 2, Mehmet Adnan Ozturk 3, Mustafa Basbug 1 1 Erciyes Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD 2 Erciyes Üniversitesi, Tıp Fakültesi, Radyoloji AD, Pediatrik Radyoloji Bilim Dalı 3 Erciyes Üniversitesi, Tıp Fakültesi, Pediatri AD, Neonatoloji Bilim Dalı 26 years old primigravida referred for intracranial cyst, and cardiomegaly. Transabdominal ultrasonography (US) showed vein of Galen aneurysmal malformation (VGAM), and mild cardiomegaly (Figure 1). Follow- up US at 32 weeks showed progressive cardiomegaly, and heart failure. At 34 weeks, US revealed a hyperechogenic, homogenous mass that was measured 25x25x31mm, at left suprarenal region. The mass had a spherical shape with a central stripe as the character of a normal adrenal gland but with greater thickness(figure 2). No vascular flow was detected inside the mass by power Doppler study. Fetal magnetic resonance imaging (MRI) confirmed the sonographic diagnosis. The baby was delivered at 37 weeks by cesrean section, and died of severe heart failure at postpartum 18th hours. Postnatal MRI confirmed the prenatal diagnosis (Figure 3). Adrenal hemorrhage can complicate VGAM in fetuses with severe heart failure. Evaluation of the surrenal gland in affected cases may contribute to the prenatal counselling, and postnatal management. Keywords: Adrenal hemorrhage, Vein of Galen Aneurysmal Malformation, ultrasonography, prenatal diagnosis [PP-009] Evaluation of Fetal Anterior Abdominal Wall Thickness in Gestational Diabetic Pregnancy: A Prospective Case-Control Study Hüseyin Aksoy 1, Ülkü Aksoy 2, Sezin Özyurt 3, Özge Idem Karadağ 4, Turgut Aydın 4, Mustafa Alparslan Babayiğit 5 1 Department of Obstetrics and Gynecology, Kayseri Military Hospital, Kayseri, Turkey 2 Department of Obstetrics and Gynecology, Kayseri Memorial Hospital, Kayseri, Turkey 3 Department of Obstetrics and Gynecology, Kayseri Education and Research Hospital of Medicine, Kayseri, Turkey 4 Department of Obstetrics and Gynecology, Kayseri Acıbadem Hospital, Kayseri, Turkey 5 Department of Public Health and Epidemiology, Gülhane Military Faculty of Medicine, Ankara, Turkey Objectives: To investigate patients with gestational diabetes mellitus (GDM) with regard to fetal anterior abdominal wall thickness (AAWT) and other fetal biometric measurements, such as biparietal diameter (BPD), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW), and to compare the results with healthy pregnant controls. Methods: A total of 124 pregnant women between 26 and 28 weeks gestation were included in the study. These patients were divided into two groups based on their 75-g oral glucose tolerance test (OGTT) results. The study group consisted of 55 pregnant women with GDM, and 69 healthy pregnant women constituted our control group. Each subject underwent a one-step approach using a 75-g OGTT and an obstetric ultrasound examination. The fetal biometrical measurements (BPD, FL, AC, and EFW) and AAWT were obtained from the ultrasonographic examinations.

7 Findings: The study groups did not differ with respect to the mean BPD, FL, AC, and EFW; however, the mean AAWT was significantly higher in the GDM group, 4.07 ± 0.46 mm versus 3.28 ± 0.37 mm in the control group (p < 0.001). Conclusions: The only fetal sonographic measurement found to significantly differ between the study groups was the AAWT, suggesting that measuring the AAWT may have a role in the evaluation of fetal growth in pregnancies complicated by gestational diabetes. Clinicians should be aware of the limitations of traditional fetal biometric parameters in the detection of early fetal growth changes in patients with GDM. Keywords: abdominal wall thickness, gestational diabetes, ultrasonography [PP-012] Erken Doğum Riski Olan Gebelerde Servikal Pesser Uygulaması Sonuçları: Başkent Üniversitesi Deneyimi Çağrı Gülümser, Nihal Uysal Şahin, Mehmet Tunç, Filiz Bilgin Yanık Başkent Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Ankara GİRİŞ-Amaç: Erken doğum riski yönetimi ve tedavi yöntemleri, sonuçları bakımından henüz tatmin edici bir seviyede değildir. Güncel olarak servikal serklaj uygulanması, progesteron tedavisi ve servikal pesser uygulaması farklı hasta gruplarında yaklaşık olarak aynı başarı şansına (%40) sahiptir. Bu riski taşıyan her hastaya her tedavi yöntemi uygun mudur? Hangi hastaya, hangi tedavi seçilmelidir? Tedavi seçenekleri kombine edilebilir mi? Her birinin etki mekanizmaları nelerdir? Çoğul gebeliklerde başarı oranları nelerdir? Tedavide ki başarı şanslarını arttırmak mümkün müdür? Soruları halen kanıta dayalı olarak cevaplanamamıştır. Bu çalışmamızda Başkent Üniversitesi Kadın Hastalıkları ve Doğum Bölümü Perinatoloji Ünitesinde erken doğum riski taşıyan hastalardan ve belirli kriterlere uyanlar hastalarda servikal pesser uygulamasının başarı oranı, komplikasyonları, doğumu ne kadar süre geciktirebildiği, gebelik boyunca ve sonrasında anne ve yenidoğan mortalite ve morbiditesine etkilerinin araştırılması amaçlanmıştır. Method: Başkent Üniversitesi Ankara Hastanesi'nde yıllarında Perinatoloji Bölümüne yüksek riskli gebelik olarak başvuranlardan, ikinci trimesterde transvajinal ultrasonografi (TVUSG) ölçümünde servikal uzunluğu 25mm altında ölçülen, erken doğum riski tespit edilen gebelerden servikal pesser takılan hastalar çalışmaya dahil edildi. Daha önce servikal invaziv işlem geçirenler, servikal uzunluğu 10mm nin altında ölçülenler, obstetrik hikayesinde üçden daha fazla ikinci trimester gebelik kaybı olanlar, servikal yerleşimli myomları olanlarda pesser uygulanmadı. Servikal pesser uygulanan toplam 18 hastanın demografik özellikler, antepartum risk faktörleri, pesser takıldığı gebelik haftası, doğum haftası ve şekli, progesteron ya da kullandığı diğer ilaçlar, fetal akciğer maturasyonu için steroid yapılıp yapılmadığı, tokoliz uygulanıp uygulanmadığı ve yenidoğan sonuçları değerlendirildi. Erken doğum riskinde pesser uygulamasının etkinliği, gebe ve yenidoğan mortalite ve morbiditesine olumlu katkı sağlayıp sağlamadığı istatistiksel olarak değerlendirildi. Bulgular: Hastaların yaş ortalaması 34,25±5,29, ortalama parite 0.11 ±0,3 idi. Pesser uygulandığı gebelik haftasında (ortalama= 24,93 ±3,71, min-max) servikal uzunluk ortalaması 18,44±2.5 (15mm-24mm min-max) ortalama doğum haftaları 33.1±4,1 idi. Pesser takılması ile doğum haftası arasındaki latent süre 8.13±4.4 (27-38 min-max) idi. Toplam 5 hasta 34 hafta altında doğdu. Bu beş hastada doğuma kadar olan latent sürenin ortalaması 5 hafta idi. Bunlardan sadece bir gebe 27. gebelik haftasında, şiddetli TTTS (ikizden ikize transfüzyon sendromu) olduğu için erken doğurtulmak zorunda kalındı. Diğer dördü 28. gebelik haftası üzerinde doğum yaptılar. Tüm hastalar içinde halen iki hastanın gebelikleri devam etmekteydi. Geri kalan 11 hasta ise 34 hafta üzerinde doğum yaptılar. Toplam dört hasta normal spontan doğum yaptı. Hastaların %67'si (n=12) ikiz gebelikti. Hastaların %28 i spontan yolla, geri kalanları yardımcı üreme teknikleri ile gebe kalmışlardı. Hastaların %83,3 ünde (n=15/18) doğuma kadar haftalık 250mg intramüsküler(im) depo progesteron uygulandı. Hastaların %22 sinde (n=4/18) antibiyok kullanıldı. Bir hasta dışında tüm hastalara 24. Haftadan sonra 24 saat ara ile tek doz IM steroid uygulandı. Hastaların %50 sinde (n=18/9) kalsiyum kanal blokörleri ile tokoliz uygulandı. Hastaların hiçbirisinde pesser takılırken ve/veya çıkartılırken hiçbir komplikasyon olmadı. Yenidoğan ağırlığı ortalama 2223,44±933,34 g (630g 3490g min, max) olup, sadece dört bebek doğum sonrası entübe edilmişti. Yenidoğan bebeklerin %33,3 ünde (n= 6/18) sülfarktan kullanılmıştır. Yenidoğan yoğun bakım ünitesinde TTTS, RDS, sarılığı (fototerapi tedavisine ihtiyaç duyulan) toplam dört bebek doğum sonrasında izlenmiş olup, TTTS olan bebekler eksitus olmuştur. Çalışmaya dahil

8 edilen diğer tüm bebekler sağlıklı bir şekilde taburcu edilmiştir. Sonuç: Erken doğum riski olan gebelerde servikal pesser uygulaması güvenilir, invazif olmayan, ucuz, uygulaması ve çıkartılması kolay etkili bir yöntemdir. Haftalık 250mg IM progesteron uygulaması ile kombine edilmesi literatürdeki tek başına uygulama verilerine göre daha etkili bulunmuştur. Sonuçlarımız literatürde ki bazı çalışmaların aksine ikizlerde de başarı oranını yüksek göstermiştir. Servikal pesser uygulaması için hasta seçimi kriterleri, uygulamanın ilk seferde doğru şekilde yapılmış olması başarı şansı ile doğru orantılıdır. Erken doğum riskinde servikal pesser uygulaması halen her yönüyle geniş çaplı randomize çalışmalar yapılarak kanıtların ortaya konulmasını gerektiren bir tedavi şeklidir. Anahtar Kelimeler: erken doğum, pesser, serklaj, servikal uzunluk [PP-013] MikroTESE ile sperm elde edilerek yapılan icsi vakasında komplet hidatiform mol ve dikoryonik diamniotik ikiz birlikteliği Nur Dokuzeylül Güngör 1, Aynur Erşahin 1, Betül Görgen 1, Suat Süphan Erşahin 2, Kağan Güngör 3 1 Medicalpark Göztepe Hastanesi-Tüp Bebek Ünitesi 2 Medicalpark Bahçelievler Hastanesi-Kadın Hastalıkları ve Doğum 3 İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi Gestasyonel trofoblastik hastalıklar(gth) fetal trofoblastik dokudan köken almaktadır. Mol hidatiform gestasyonel trofoblastik hastalıkların en sık görülen formudur.bu çalışmada nadir görülen icsi sonrası mol gebelik ve dikoryonik-diamniotik ikiz birlikteliği olgusu sunuldu.24 yasında bayan hasta 9. gestasyonel haftada rutin gebelik kontrolü istemi ile merkezimize başvurdu.gravida 1, para 1,yaşayan 1 canlı çocuğu mevcut olan hastanın üçüncü tüp bebek denemesiydi.vakanın tüp bebek tedavisine alınma nedeni ise erkekte enfeksiyona sekonder gelişen azospermiydi. Bunun dısında ozgecmisinde ve soygecmisinde ozellik yoktu. Transvajinal ultrasonografi ile yapılan muayenesinde iki adet gestasyonel kese izlendi.keselerden birinde baş popo mesafesi (CRL) 8 hafta 5 gün ile uyumlu 25.7 mm,kalp atış hızı147/dk olan gebelik izlendi.diğer kese içerisinde ise kistik komponentleri olan büyük bir plasenta izlenmekteydi.laboratuar bulgularında BhCG si miu/ml.hematokrit %40, lökosit /mm-3, trombosit 258,000 mm-3 dir. Koagulasyon profili, tiroid fonksiyon testleri ve biyokimyasal parametreler normal sınırlar icindeydi. Akciğer grafisinde metastaz ile uyumlu bulgu saptanmamıstır.hasta olası komplikasyonlar ve malinite riski ile ilgili bilgilendirildi.hasta gebeliğe devam kararı aldı.hasta halen 14 haftalık gebelik olarak devam etmektedir.yardımcı üreme tekniklerinin daha sık kullanılıyor olması çoğul gebelikleri ve buna bağlı komplikasyonları arttırmaktadır.yasayan fetuslu molar gebeliklerde ozellikle gebelik devamı isteniyorsa yonetimi daha zordur. Malign hastalığa progresyon insidansı komplet mol ve canlı fetus varlığında %56-62 iken parsiyal mol ve canlı fetus varlığında %4 dur. Nadiren sağlıklı fetus ve molar gebelik konusunda yayınlar olsa da terminasyon ve seri olarak serum β-hcg olcumlerinin yapılmas en cok tercih edilen protokoldur. Bu vakada hastaya olası komplikasyonlar hakkında bilgi verilmis, hastanın devam yonunde karar vermesi uzerine takibi yapılmaktadır.katastrofik komplikasyonlardan kacınmak icin terminasyon ilk secenek olmalıdır. Anahtar Kelimeler: mol gebelik, icsi, dikoryonik diamniotik ikiz

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11 5 [PP-014] Osteopetrosis Kongenita Olgusunda Preimplantasyon Genetik Tanı Yöntemiyle Gebelik Elde Edilmesi Nur Dokuzeylül Güngör 1, Aynur Erşahin 1, Betül Görgen 1, Suat Süphan Erşahin 2, Kağan Güngör 3 1 Medicalpark Göztepe Hastanesi 2 Medicalpark Bahçelievler Hastanesi 3 İstanbul Medeniyet Üniversitesi Göztepe Eğitim Araştırma Hastanesi Malin infantil osteopetrosis otozomal resesif geçiş gösteren,nadir görülen tek gen hastalıklarından birisidir.vaküoler proton pompalarının TCIRG1 subünitesinde meydana gelen mutasyona bağlıdır.200 binde bir görülür.vakamız daha önce bu nedenle 2 kez çocuk kaybı yaşamış bir çiftimizdi.fertil olan çift bize PGT yaptırmak için başvurdu.35 yaşındaki hastamıza antagonist protokol uygulandı.3 oosit alındı.2 tanesine 3. günde babadaki TCIRG1geni c a>g taşıyıcılığı nedeniyle blastomer biyopsisi yapıldı.sağlıklı çıkan 5AA tek embriyo 5. günde transfer yapıldı.opu sonrası 14. günde bakılan BhCG 157 geldi.ilk test sonrası 3. haftada yapılan transvajinal ultrasonografide canlı tekil gebelik izlendi.hastamızın gebeliğinin 16. haftasında amniosentez ile tanı doğrulandı.hasta 22 haftalık gebelik olarak kliniğimizde takip edilmektedir. Anahtar Kelimeler: osteopetrosis, PGT

12 [PP-015] Kardiyoversiyon uygulaması sonrası gelişen ablasyo plasenta: olgu sunumu Mehmet Serdar Kutuk 1, Murşide Şahin 1, Muhammed Said Coşgun 2, Mahmut Tuncay Özgün 1, Mustafa Basbug 1 1 Erciyes Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD 2 Erciyes Üniversitesi, Tıp Fakültesi, Kardiyoloji Gebelikte maternal aritmi insidansı gebelikte 1000 de 1,2 oranındadır ve bunların %50 si asemptomatiktir. Supraventriküler (SVT) taşikardi ve malign ventriküler aritmiler gebelikte daha sık görülür. SVT tedavisinde Valsalva manevrası, sinus karotis masajı ve medikal tedaviye cevap alınamadığında ya da hemodinamik instabilite olduğunda kardiyoversiyon uygulanır. 29 yaşında G(3),P(2), bilinen ek bir hastalığı olmayan 28 haftalık gebe preterm eylem ve maternal supraventriküler taşikardi nedeniyle kliniğimize sevk edildi. Hastanın nabzı: 116/dakika ve EKG si akut AF ile uyumluydu. Karotis masajı ve digoksin (1 mg) tedavisine yanıt vermeyen hastaya 150 joule ile senkronize kardiyoversiyon yapıldı. İşlem sonrasında hastanın kalp ritmi sinüs ritmine döndü. İşlemden hemen sonra yapılan non- stres test de uzamış fetal bradikardi izlenmesi üzerine hasta acil sezeryana alındı. Operasyonda plasentanın %40 dekole olduğu izlendi gr ağırlığında, 6 7 APGAR lı, bir kız bebek doğurtuldu. Bebek yenidoğan yoğun bakımda takip edildikten sonra şifa ile taburcu edildi. Hastaya postoperatif, metoprolol 1x 50 mg tedavisi başlandı. Takiplerinde aritmi izlenmedi. Kardiyoversiyon sonrası fetal bradikardi gelişebileceği bilinmekle beraber, sunduğumuz vaka, literatürde bildirilen ablasyo plasenta ile komplike olmuş olan ilk olgudur. Kardiyoversiyon sonrasında artmış uterin kontraksyonlar nedeniyle fetal distress ve acil sezaryan ihtiyacı olabilaceğinden, işlem yakın fetal monitorizasyon altında ve obstetri ekibinin eşliğinde yapılmalıdır. Anahtar Kelimeler: Kardiyoversiyon, ablasyo plasenta, fetal distress, aritmi [PP-016] Treatment of refractory supraventricular tachycardia with amiodarone: a case report Mehmet Özgür Akkurt, And Yavuz suleyman demirel university, faculty of medicine, Department of perinatology, Isparta, turkey Objective: Most fetal tachyarrhythmias are benign but some types cause non-immun hydrops and fetal heart failure and result in prenatal and postnatal death. Amiodarone, a class 3 antiarrhythmic drug, can use treating for refractory fetal arrhytmias. Case: A pregnant referred to our department at 26 weeks with hydrops fetalis. We detected supraventicular tachiacardia at 220 bpm and there was no further cardiac and structural anomaly. First of all digoxin treatment was initiated. Oral amiodarone was added when tachicardia and hydrops fetalis persisted 3 days after digoxin treatment. a pregnant delivered at 32 weeks and we did not see recurrence of supraventicular tachiacardia with treatment of amiodarone 200 mg per a day. Conclusion: Untreated SVT can be mortal and treatment should start immediately. Amidarone can use treating SVT alone or combination with antiarrhythmic drugs considering maternal and fetal side effects. Keywords: amiodarone, fetal arrhythmia, hydrops

13 figure 1 fetus had supraventricular tachycardia with 220_bpm. figure 2

14 nonimmun hydrops fetalis in transverse abdominal view figure 3

15 31 atrioventricular blok has been developed by amiodarone treatment 400 mg twice a day. figure 4

16 fetus had normal heart rate135 bpm after decreasing amiodarone dose 400 mg per a day. [PP-017] Cervical Ripening Balloon: a Successful Treatment to Control Massive Bleeding in Cervical Pregnancy Mert Turgal, Emine Aydın, Nergis Kender, Zafer Selcuk Tuncer Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey. Introduction Cervical pregnancy (CP) is rare and life-threatening form of ectopic pregnancy. Currently, there is no consensus optimal treatment for CP. However, general principles in the management of cervical pregnancy should include the following: minimize the risk of hemorrhage, evacuated the gestational cervical product, and sparing patient s fertility. Here, we report a case of 9 weeks of gestation cervical ectopic pregnancy with positive fetal cardiac activity successfully treated multimodal therapy which is intraamniotic potassium chloride (KCL), systemic methotrexate (MTX), curettage of cervix, and cervical ripening balloon (CRP) tamponade for abandoned cervical bleeding. Case Presentation A twenty-eight years old primigravid pregnant woman referred to our clinic for suspicion of CP. On pelvic examination, cervix was enlarged and appeared barrel shape on inspection. Transvaginal ultrasonography revealed a CP with positive fetal cardiac activity consistent 91/7 weeks of gestation and endometrial cavity was normal. Magnetic resonance imaging was confirmed CP.(Figure1) Her quantitative β-hcg concentration was 115,226 miu/ml on admission. Considering the patient s hemodynamic stability and desire to maintain fertility, conservative expectant management with local KCl and systemic methotrexate administrations were decided. Then, we performed 2 ml (2 meq/ml) KCl injection in the cardiac cavity of fetus with

17 transabdominal approach. Additionally, patient was also treated systemic multidose MTX (1 mg/kg, days 1, 3, 5, and 7) and leucovorin (0.1 mg/kg, days 2, 4, 6, and 8) rescue therapy. Serially evaluated β-hcg concentrations were progressively declined during 10 days. In this period gestational sac was deforming. Fourteen day after treatment, because of β-hcg concentration was relatively to plateau, we decided surgical intervention.(table I) In the operating theatre under ultrasound control, curettage of the cervical canal was performed. The whole conceptus materials were removed. Intraoperative bleeding was about 900 ml. Two units of red blood cell were transfused intraoperatively. Because of bleeding was not stopped, we decided a cervical ripening balloon (Cook Medical, Bloomington, IN, USA) into the cervix. Uterine part of the CRP balloon was inflated with 70 ml saline solution at under sonography guidance. Thereafter, vaginal part was then inflated with 80 ml saline solution.(figure 2) Bleeding was controlled with this procedure. Two days after the procedure we removed the balloon. Vital sing were stable and she had no complaint included vaginal bleeding. The patient was discharged in good health. Thirty days after treatment, serum β-hcg concentration declined continuously to 10,0 miu/l. Transvaginal ultrasonography showed a normal uterine cervix in size and contour. Conclusion Obstetric hemorrhage is the leading cause of maternal morbidity and mortality. There are different balloon catheters which can be used such as Bakri balloon, Sengstaken-Blakemore tube, Rusch balloon, and Foley catheters in obstetric hemorrhage. Although CRB is designed for the induction of labor, its application was also successfully performed in cases of postabortion massive hemorrhage and postpartum hemorrhage. To our knowledge, this report describes the first time this approach has been performed in a CP case. Since it is a safe and valid method, we believed that the use of CRB in conventional treatment method for CP cases can be used to bleeding control. Keywords: cervical ectopic pregnancy, cervical ripening balloon, conservative treatment, methotrexate, obstetric hemorrhage. Table I: Graphic shows serum β-hcg concentrations course.

18 Figure 1: MRI show cervical ectopic pregnancy. (arrows: cervical pregnancy with embryo, arrowhead uterus, B: bladder). Figure 2: Transabdominal sonographic image of cervical ripening catheter after procedure. Inflated double-balloon cervical ripening catheter placed cervix (C) and vagina (V). (arrow: uterus)

19 [PP-018] Mercury Concentration in Maternal Serum, Cord Blood, and Placenta in Patients with Amalgam Dental Fillings: Effects on Fetal Biometric Measurements Rahime Bedir Findik 1, Huseyin Tugrul Celik 2, Ali Ozgur Ersoy 1, Yasemin Tasci 1, Ozlem Moraloglu 1, Jale Karakaya 3 1 Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey 2 Department of Biochemistry, Turgut Ozal University, Ankara, Turkey 3 Department of Biostatistics, Hacettepe University, Ankara, Turkey Objectives: We aimed to determine the extent to which mercury is transmitted from the mother to fetus via the umbilical cord in patients with amalgam dental fillings, and its effect on fetal biometric measurements. Methods: Twenty-eight patients as the study group with amalgam fillings, and 32 of them as the control group were included in this prospective case-control study. The mercury levels were measured in the maternal and cord venous sera, and the placental samples. Two groups were compared in terms of these and the fetal/neonatal biometric measurements. Findings: In the study group, the maternal and umbilical cord mercury levels were found to be significantly higher than those from the control group (p=0.006 and p=0.010, respectively). These high levels did not affect the fetal biometric measurements. Conclusions: The presence of high serum mercury levels in pregnant women with amalgam fillings is important, and warrants further long term studies in order to investigate the fetal neurological effects as well. Keywords: Dental amalgam, mercury, maternal-fetal exchange, pregnancy outcome Comparison of demographic characteristics between two groups. Characteristics Maternal Age (year) Without amalgam fillings (n = 32) With amalgam fillings (n = 28) P value 25 ± ± Maternal BMI (kg/m2) ± ± Number of Gravidity Mother s Occupation 1 n:13 (52 %) 2 n:9 (50 %) 3 n:6 (50 %) 4 n:4 (80 %) Housewife: 32 (55.2 %) Working: 0 1 n:12 (48 %) 2 n:9 (50 %) 3 n:6 (50 %) 4 n:1 (20 %) Housewife: 26 (44.8 %) Working: 2 (%100) Mercury levels and neonatal biometric parameters in patients with and without amalgam dental fillings. Characteristics Without amalgam fillings (n = 32) With amalgam fillings (n = 28) P value Mercury Levels in Maternal Blood 0.27± ±

20 (μg/l) Mercury Levels in Cord Blood (μg/l) 0.3± ± Mercury Levels in Placental Tissue (μg/g) 1.1± ± Birth Weight (gr) 3320± ± Birth Length (cm) 50±1.7 50± Head Circumference of the Infant (cm) Gender of the Baby (male=m, female=f) 34±1.2 35± M:20 (55.6%) F:12 (50%) M:16 (44.4%) F:12 (50%) [PP-019] Ruptured Endometriotic Cyst Mimicking Acute Appendicitis During Pregnancy Ali Ozgur Ersoy, Irem Eda Gokdemir, Ebru Ersoy, Aykan Yucel Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey A twenty-one year-old primigravid pregnant woman of 33 weeks gestation applied to our Perinatology Clinics with acute abdominal pain. The pain was spreading from midline to right lower quadrant of the abdomen.guarding and rebound tenderness existed in the right lower quadrant. Ultrasonographic examination revealed a single, alive fetus, and normal amniotic fluid. Whole blood count revealed leukocytosis and there was no sign of preterm labor or placental abruption. Fetal heart rate decelerations in non-stress test were observed, and a decision for cesarean section and abdominal exploration were made. A healthy male baby with Apgar score of 7 and 9 at first and fifth minute (respectively) was delivered. In the abdominal exploration all peritoneal surfaces were coated with a dark red, brown colored dense material, like mud, and there were two endometriotic cysts in the left ovary; one of them with 6 cm mean diameter had been ruptured (Figure 1); the other with 2-3 cm mean diameter was intact (Figure 2). Both of them were excised and sent for pathologic examination. Also, there were dark-blue, powder-burn black colored millimetric endometriotic foci spreading over the peritoneal surfaces (Figure 3). The patient had no problem in postoperative two days and was discharged. Final pathologic diagnosis was reported as endometriotic cysts. We think that this case is a nice example of misleading the clinician as if the scene was consistent with acute appendicitis. Keywords: Pregnancy, endometriotic cyst, rupture

21 Figure 1 Posterior view of uterus and left ovary which had two endometriotic cysts and one of them had been ruptured. Figure 2

22 Posterior view of the uterus and the smaller and intact endometriotic cyst in the left ovary can be seen. Note all the peritoneal surfaces was covered by endometriotic material. Figure 3

23 One of several millimetric endometriotic foci spreading to different peritoneal surfaces (white arrow). It can be seen dark-blue, powder-burn black colored and located in front of the right infundibulopelvic ligament. [PP-020] An unusual complication of vesicoamniotic shunt: coiling of the shunt around lower extremity associated with dislodgement Mehmet Özgür Akkurt, And Yavuz Suleyman Demirel University, Faculty of Medicine, Department of Perinatology, Isparta, Turkey Background: Vesicoamniotic shunt (VAS) is a procedure that aims to reduce intraluminal pressure of the foetal bladder and the upper urinary tract. Here, we report an unusual complication of VAS, coiling of the shunt around foetal lower extremity associated with dislodgment. Case: A 33-year-old multigravida was referred for further evaluation of foetal obstructive uropathy. The primary diagnosis was posterior urethral valves(puv), since the ultrasound(us) scan showed a dilated posterior urethra in line with the typical keyhole sign in a male foetus. Foetal karyotype by amniocentesis demonstrated a 46, XY normal male pattern. Then, a vesicoamniotic shunt placement via the transabdominal route was performed at 20 weeks. Following the procedure, foetal amniotic fluid and bladder volume returned to normal within 7 days. Amniotic fluid and foetal bladder volume remained within normal ranges, however began to decrease by 33 weeks gestation, causing redistention of the foetal bladder and oligohydramnios. US showed a dislodged shunt into the foetal abdominal cavity (Figure 1(a)). At birth, shunt was observed to be coiled around the left lower extremity (Figure 1(b) and Figure 1(c)), but there was no limitation of movement at the extremity. At 9 months of age, the infant had no joint deformity, and he underwent endoscopic ablation of the PUV. He had normal renal function at 12 months of age. Conclusion: In utero VAS may be a viable option in carefully selected cases of foetal lower urinary

24 tract obstructions, it has unpredictable and unavoidable complications such as the present case reported here. Keywords: Posterior urethral valve, post-operative complication, vesicoamniotic shunt figure 1 Figure 1(a): Ultrasound scan showing the migration of the shunt into the foetal abdominal cavity Figure 1(b): The shunt was coiled around the left knee joint. Figure 1(c): After birth, a contracture was observed due to coiling of the shunt. [PP-021] AKROMEGALİ VE GEBELİK (Olgu Sunumu) Mehmet Kulhan 1, Ümit Naykı 1, Gözde Kulhan 2, Cenk Naykı 1, Paşa Uluğ 1, Yusuf Yıldırım 1 1 Erzincan Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Erzincan 2 Samsun Kadın Doğum ve Çocuk Hastalıkları Hastanesi, Samsun Giriş: Aşırı büyüme hormonu salgılanması ile karakterize olan akromegalide, bozuk gonodotropik aks nedeniyle hastalar, genellikle amenoreik ve infertildirler.bu nedenle gebelik ve akromegali nadir bir birlikteliktir ve literatürde oldukça az olgu bildirilmiştir. Ayrıca, diabetes mellitus ve kardiovasküler hastalıkların prevelansının yüksek olması nedeniyle bu hastalar yüksek riskli gebe olarak değerlendirilirler. Olgu: Otuzüç yaşında G4P2Y2A1, 6 hafta 2 günlük gebeliği bulunan hasta Samsun Kadın Doğum ve Çocuk Hastalıkları Hastanesine başvurdu. Hastanın hikayesinde yaklaşık 2 yıl önce adet düzensizliği, galaktore, hirsutizm ve görme bozukluğu şikayetleri nedeni ile yapılan fizik muayenesinde el ve ayaklarda büyüme ve yüzde kabalaşma izlendiği, hipofiz MRG sonucu hipofiz bezinde yaklaşık 25x25 mm lik adenom tespit edilmesi ve kan tetkiklerinde GH: 2.6 ng/ml, İGF-1: 1392 olarak normalin üstünde saptanması üzerine akromegali tanısı konulduğu ve sonrasında transsfenoidal adenektomi uygulandığı öğrenildi. Postoperatif 4.ayda rekürrens tespit edilen hastaya günlük lanreotid ve haftada 2 kez kabergolin başlanmış. Tedavinin 1.ayında gebe kalan ve kendi isteği ile gebeliği sonlandırılan hastanın 6 aylık medikal tedavi sonrasında tekrar gebe kaldığı öğrenildi. Hastada, gebelik öncesi yüksek olan İGF-1 in ( ng/ml) ilk trimesterde tedrici olarak azaldığı ve 300 ng/ml seviyesinde plato çizdiği gözlendi. Her vizitte kan basıncı, kilo alımı, ödem varlığı, görme alanı muayenesi, fetal biyometri ve amniyon sıvı indeksi değerlendirildi. Gebelik boyunca hastada klinik olarak şikayet olmadı ve fetüsün antenatal takibi normaldi. Hasta gebeliğin 39. haftasında sezaryenle 3600 gram erkek bebek 8 apgarla canlı olarak doğurtuldu. Postoperatif dönemde anne ve yenidoğanda herhangi bir komplikasyon gözlenmedi. Sonuç: Akromegalisi olan gebeler çok nadir olmakla birlikte riskli gebelerdir ve yakın takip edilmeleri gerekmektedir. Anahtar Kelimeler: Akromegali, Gebelik

25 [PP-022] The Relationship of Striae Gravidarum with Cesarean Scar Characteristics and Peritoneal Adhesions Esra Yasar Celik, Ali Ozgur Ersoy, Ebru Ersoy, Ozlem Yoruk, Aytekin Tokmak, Yasemin Tasci Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Care Training and Research Hospital, Ankara, Turkey Objectives: The aim of this study was to evaluate the relation between striae gravidarum (SG) score and abdominal scar characteristics together with intraperitoneal adhesion (IPA) grades of patients who are having their second cesarean deliveries. Methods: Totally 145 women, hospitalised for cesarean section (CS) were included in this prospective observational study between November 2013 and January Groups were conducted according to the SG status, as women with no SG: Group 1 (n=53), mild SG: Group 2 (n=27) and severe SG: Group 3 (n=65). Groups were compared with various sociodemographic properties, cesarean scar characteristics and IPA scores. Findings: No significant difference in the length, width and colour of the scar was detected among groups. Although flat scar was the most prominent scar form among all groups, elevated scar was significantly more frequent in group 1 (p=0.009). Intraperitoneal adhesion grade was 0 or 1 in 77.3% of group 1, 81.3% of group 2 and 76% of group 3. There was no significant difference in IPA scores between groups (p=0.884). With regard to scar properties (flat, depressed and elevated) and SG status [SG (+) or SG (-)], we found no difference between IPA groups. Conclusions: SG is found associated with scar characteristics, but not associated with intraperitoneal adhesions. Keywords: Striae distensae, cesarean section, scar, focal adhesions [PP-023] A brief glance to prenatally diagnosed fetal arrhythmias: Two-year experience of a tertiary center Doruk Cevdi Katlan, Bahar Konuralp Atakul, Tuncay Yüce, Acar Koç, Feride Söylemez Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Aim The final common pathway to death in all human beings is an arrhythmia. At no other time in life cycle, is the human at more risk of unexpected death than during the prenatal period. Although most lethal cardiac rhythm disturbances occur during apparently normal pregnancies, some manifest fetal arrhythmias may be recognised prenatally (0,6-2,0% of all pregnancies). Hereby, it is intended to highlight the importance of some factors that the clinician should pay extra attention upon encountering fetal arrhythmias. Methods Prenatal and postpartum data of the patients, who were prenatally diagnosed to have fetal arrhythmia between January 2013 and April 2015 at Ankara University Department of Obstetrics and Gynaecology Perinatology Unit, were presented. Results A total of 9 cases were scrutinized. None of the patients had maternal arrhythmia, anemia, leucocytosis, thyroid hormone or serum electrolyte disturbance and history of previous arrhythmic children. All were free of any chronic disease except one, who had Systemic Lupus Erythematosus diagnosed during her gestation before the onset of fetal dysrhythmia. She was the only patient to deliver preterm at 33 weeks due to intrauterine growth restriction and fetal distress while the rest

26 reached term. None of the fetuses showed prenatal signs of neither hydrops nor any echocardiographic structural abnormality. Postpartum fetal serum electrolytes were normal for all. Prenatally 3 fetuses demonstrate atrial ectopy, 4 demonstrate bradycardia of varying severity (2 severe, < 90 beats/minute; 2 mild, beats/minute) and the remaining 2 demonstrate alternating combination of these two. Both of the 2 severely bradycardic ones had maternal Anti- Ro/SSA and ANA positivity with relative early onset of arrhythmia (19w6d, 21w3d) and one had 2:1 atrioventricular block (also had Anti-La/SSB positivity). Arrhythmia was stable for 5 of the 9 patients (55,6%) throughout the pregnancy. Among those, 4 (80,0%) persisted postpartum and the fetuses needed neonatal intensive care unit (NICU) follow up. 2 (40,0%) fetuses had concomitant extra-cardiac fetal anomalies (1 multicystic dysplastic kidney, 1 cleft lip & palate, hypospadias, corneal opacity, hypertelorism, flexion contractures). Conclusions The detection of a fetal arrhythmia by an obstetrical care provider should prompt referral to a center of excellence for further assessment. Maternal risk factors should be carefully examined and fetus should undergo a thorough pre and post natal evaluation. Extra attention should be paid to sustained arrhythmias since they tend to be persistent postpartum, NICU need is probable and fetal anomalies may co-exist. Fetal ectopy is a relatively benign condition but severe bradyarrhythmias may be related to immune-mediated inflammation and fibrosis of the fetal conduction system by maternal antibodies which can cross the placenta and may end up in fetal atrioventricular block. [PP-024] A challenging threat for the fate of a normal fetus: Placental Mesenchymal Dysplasia Doruk Cevdi Katlan 1, Bahar Konuralp Atakul 1, Tuncay Yüce 1, Feride Söylemez 1, Acar Koç 1 1 Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Background Aim Placental mesenchymal dysplasia (PMD) is a rare but benign placental disorder with a reported incidence of 0,02% and a female preponderance. Although karyotype is normal in most cases, PMD is associated with many other maternal and fetal risks. Only 9 % of pregnancies with PMD end uncomplicated. By the accumulation of information from more than 100 cases reported till now and thanks to the development of high-tech imaging modalities, we are now a bit more successful in both the early differential diagnosis and foresight of the risks. However, placental pathologic examination is paramount to establish definitive diagnosis. Herein, we present two cases of PMD in which the pregnancy concluded in two different points at the negative side of the disease spectrum: termination and early preterm delivery of non-viable fetus. Case Reports 28-year old primigravid woman was admitted upon detection of placental cystic structures on routine ultrasound scan at 23 weeks of gestation. Detailed sonographic evaluation revealed a completely normal female fetus with diffusely dispersed multiple hypoechoic spaces within the thickened placenta. Amniocentesis was normal. The patient was informed about the possible diagnosis of PMD and decided to continue her pregnancy taking full account of the risks. A few days later, she described bleeding and leakage of amniotic fluid which resulted with the delivery of a 560 gr dead fetus vaginally. The placenta was bulky weighing 1500 grams. Pathologic examination documented PMD. 21-year old gravida 2 para 0 woman with a history of previous early miscarriage presented with a thickened placenta on routine ultrasound scan at 16 weeks of gestation. Detailed examination demonstrated a normal male fetus with heterogeneous, cystic and thickened placenta almost entirely filling the uterine cavity. The patient was informed about the risks and she opted for termination of pregnancy. Post termination karyotype analysis was normal and pathology documented PMD.

27 Conclusion Upon detection of large-cystic placenta by sonography, the initial step is the detailed evaluation of the fetus. An abnormal fetus may be indicative of a triploid partial mole. A normal fetus however, requires a closer examination of the placenta. A heterogeneous thickened placenta with partially solid and hypoechoic cystic areas may indicate PMD as well as a complete mole with co-twin. At this point a promising recently reported Doppler sign may be distinctive. Stained-glass appearance of various degrees of blood flow under low pulse repetition frequency setting may be suggestive of PMD. PMD with normal karyotype in a low risk patient may lead to pregnancy follow up after proper counselling about the risks; however, termination may be an option upon parental consent or in case of the exact opposite of the above mentioned conditions. [PP-025] A rare case of primary lymphedema in pregnancy with subacute venous thrombosis Catherine Rose De Guzman Dela Rosa Obstetrics & Gynecology Department, Delos Santos Medical Center INTRODUCTION Primary Lymphedema occurs in 1/6000 live births. This is secondary to lymphatic agenesis, hypoplasia, or obstruction. Pregnancy has a relative risk of 4.3 % for venous thromboembolism (VTE) and is characterized by increased thrombin-generating potential, decreased endogenous anticoagulant effects and impaired fibrinolysis. CASE PRESENTATION A 26 year old primigravid, a diagnosed case of primary lymphedema, presented with bilateral leg swelling on her 22 weeks AOG. AV Dupplex scan of the lower extremity showed subacute venous thrombosis. Antenatally, she was diagnosed with gestational diabetes mellitus (GDM) controlled by medical nutrition therapy. At 30 weeks AOG, she was admitted for IV tocolysis with magnesium sulfate. Anti-coagulation with heparin and unfractionated heparin was maintained until 37 weeks AOG. Antenatal corticosteroids were administered with weekly surveillance of Biophysical Profile, Non Stress Test (BPS w/ NST), and glucose monitoring. At 38 weeks AOG, patient delivered vaginally under epidural anesthesia. Unfractionated heparin was continued at postpartum. Contraceptive with Medroxy Progesterone Acetate IM was initiated at 6 weeks postpartum. CONCLUSION Rigorous antenatal and postnatal surveillance is key in the management of pregnancy complicated by primary lymphedema and venous thrombosis Keywords: primary lymphedema, subacute venous thrombosis [PP-026] Low Maternal Glucose Levels on 50 g Glucose Challenge Test Support Protective Effects for Neonatal Outcomes Hasan Onur Topçu, Can Tekin Iskender, Sevki Celen, Aslı Oskovi, Dilek Uygur, Salim Erkaya Zekai Tahir Burak Women Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey Objective: To assess the perinatal outcomes in pregnant women with maternal hypoglycemia following second trimester oral glucose challenge test (GCT). Study Design: This retrospective case control study consisted of 2091 pregnant women who had hypoglycemia (glucose levels less than 88 mg/dl 1 hour following 50 gr GCT) on second trimester pregnancy and control group consisted of 2091 pregnant women with a GCT result between 88 and 130 mg/dl. Perinatal and neonatal characteristics obtained from electronic medical records were compared between groups.

28 Results: The rates of pregnancy complications were similar in both groups, except for a lower incidence of polyhydramnios and higher rate of deliveries before the 34th week of gestation in patients with hypoglycemia (0.5 vs. 1.1%, p=0.016 vs 2.6 vs. 1.7%, p=0.033); respectively. Neonates born to mothers with hypoglycemia had significantly less birth trauma (0.3 vs. 0.9%, p=0.027) and neonatal hypoglycemia. When the data for male and female infants were analyzed separately, male infants had a 1.5-fold (95% CI: ) increased chance of being small for gestational age (SGA), while the risk for female infants did not increase (OR: 0.79, 95% CI: ). Conclusion: Low maternal plasma glucose level on the GCT is associated with favorable outcomes, such as decreased rates of birth trauma and neonatal hypoglycemia. In addition, male infants have a higher risk of being SGA than female infants when maternal GCT results were <88 mg/dl. Keywords: hypoglycemia, 50 g oral glucose challenge test, perinatal outcomes, low birth weight, gender Figure 1 Histograms of glucose challenge test results, neonatal birth weight and gestational age at delivery in patients with hypoglycemia on GCT and control group

29 Figure 2 Risk of macrosomia in male and female fetuses obtained for different oral glucose challange test thresholds Figure 3

30 Risk of small for gestational age in male and female fetuses obtained for different oral glucose challange test thresholds Figure 4 Table 1. Comparison of clinical characteristics and pregnancy outcome between groups.

31 Hypoglycemia on GCT (n = 2091) Control (n = 2091) p Age (years) 26.9 ± ± 5.6 <0.001 Pre pregnancy BMI 23.1 ± ± 3.7 <0.001 Parity >= (49.8 %) 1042 (49.8 %) 7 (0.3 %) 754 (36.1 %) 1298 (62.1 %) 39 (1.9 %) <0.001 <0.001 <0.001 GCT (mg/dl) 77.7 ± ± 9.2 <0.001 Systemic disease 109 (5.2 %) 138 (6.6 %) Cesarean delivery 846 (38.5 %) 946 (45.2 %) <0.001 Gestational age at delivery > 42 weeks < 37 weeks < 34 weeks 38.4 ± (0.5 %) 252 (12.1 %) 55 (2.6 %) 38.3 ± (0.6 %) 266 (12.7 %) 35 (1.7 %) PPROM 26 (1.2 %) 36 (1.7 %) Preeclampsia 91 (4.4 %) 111 (5.3 %) Polyhydramnios 10 (0.5 %) 24 (1.1 %) Cholestasis of pregnancy 12 (0.6 %) 7 (0.3 %) Placenta Previa 8 (0.4 %) 16 (0.8 %) Ablatio placenta 10 (0.5 %) 8 (0.4 %) Data expressed as number (%), mean ± SD. BMI: Body mass index, GCT: Glucose challenge test, PPROM: Preterm premature rupture of membranes. Table 2. Comparison of neonatal characteristics between groups. Hypoglycemia on GCT (n = 2091) Control (n = 2091) p Neonatal birthweight Male Percentile (male) Female Percentile (female) > 4500 gr > 4000 gr < 2500 gr < 1500 gr > 90th percentile < 10th percentile < 5th percentile < 3rd percentile 3218 ± ± ± ± (0.4 %) 86 (4.1 %) 153 (7.3 %) 12 (0.6 %) 146 (7.0 %) 187 (8.9 %) 90 (4.3 %) 57 (2.7 %) 3318 ± ± ± ± (0.5 %) 142 (6.8 %) 154 (7.4 %) 18 (0.9 %) 235 (11.2 %) 162 (7.7 %) 87 (4.2 %)87 (4.2 %) 54 (2.6 %) <0.001 < < < Neonatal length Male 50.0 ± ± ± ± 2.5 <

32 Female Birth trauma 7 (0.3 %) 18 (0.9 %) NICU admission 119 (5.7 %) 133 (6.4 %) *Neonatal hypoglycemia 32 (1.5 %) 52 (2.5 %) <0.001 Major fetal anomaly 24 (1.1 %) 14 (0.7 %) Stillbirth 10 (0.5 %) 13 (0.6 %) Perinatal mortality 21 (1.0 %) 28 (1.3 %) Data expressed as number (%), mean ± SD. GCT: Glucose challenge test, NICU: Neonatal intensive care unit, *: neonatal plasma glucose levels were measured if the infants were premature, small for gestational age, large for gestational age, or any medical condition that was indicated. Table 3. Multivariate logistic regression analyses for prediction of adverse perinatal outcome in patients with hypoglycemic GCT. Characteristics Unadjusted Odds ratio (95 % CI) p Adjusted Odds ratio (95 % CI) Adjusted for* p R square Delivery < 34 weeks 1.59 ( ) ( ) PolyhydramniosPolyhydramnios 0.41 ( ) ( ) 3, Preeclampsia 0.81 ( ) ( ) ICP 1.72 ( ) ( ) Placenta previa 0.41 ( ) ( ) 1, Neonatal Birth weight > 4000gr > 90th percentile < 10th percentile 0.59 ( ) 0.59 ( ) 1.17 ( ) <0.001 < ( ) 0.66 ( ) 1.06 ( ) 1-3,16, < Birth Trauma** 0.34 ( ) (0.13-2,3,16,

33 0.81) GCT: Glucose challenge test, CI: Confidence Interval, ICP: Intrahepatic cholestatis of pregnancy, NICU: Neonatal intensive care unit admission. * 1: Age, 2:Parity, 3: Body mass index, 4: Maternal systemic disease, 5: Preeclampsia, 6: Preterm premature rupture of membranes, 7: Polyhydramnios, 8: Oligohydramnios, 9: Placenta previa, 10: Abruptio placenta, 11: Intrahepatic cholestasis of pregnancy, 12: Neonatal birth weight < 10th percentile, 13: Stillbirth, 14: Fetal anomaly, 15: Cesarean delivery, 16: Fetal sex, 17: Length of gestation.** Excluding cesarean deliveries [PP-027] No gallbladder on fetal ultrasound: How to counsel patients? Doruk Cevdi Katlan 1, Bulut Varlı 1, Bahar Konuralp Atakul 1, Tuncay Yüce 1, Feride Söylemez 1, Acar Koç 1 ( 1 ) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Background Aim Fetal gallbladder is visible by ultrasonography starting from 14 weeks of pregnancy. Nonvisualization of it is rare and occurs in 0,1-0,15% of pregnancies. Almost all isolated ones result in a normal healthy child. In most cases, it will be imaged later in pregnancy or in the neonatal period. Rarely, agenesis of the gallbladder, a benign condition with an incidence of 1:6300, is confirmed postnatally. In some rare cases association with cystic fibrosis has been documented. Some authors suggest its association with biliary atresia which has been reported as 0,7 per live births. Biliary atresia (BA) has two types: the fetal-embryonic form (10-25%) characterized by early cholestasis and associated heterotaxy syndrome, and perinatal-acquired form characterized by late onset of jaundice and associated viral infections. According to recent data, coexistence of absent gallbladder and BA is most likely a chance occurrence. However, if the absent gallbladder is non-isolated (coexistent with cardiovascular, skeletal anomalies etc.), it is associated with an increased risk for fetal chromosomal abnormalities. Here, it is aimed to emphasise the importance of visualization of gallbladder on second trimester ultrasound scan and patient counselling in case it is non-visible. Case Reports Two women, a 36-year old gravida 2, para 1 and a 24-year old gravida 4 para 2, were counselled due to non-visualization of fetal gallbladder on their routine second trimester ultrasound scan, both at 22 weeks 5 days, as an isolated abnormality. Their prenatal screening tests assigned low risk for aneuploidy. Upon counselling, both declined invasive prenatal diagnostic procedures. They are awaiting the results of parental cystic fibrosis screening tests, fetal gallbladders still non-visible. Conclusion Non-visible fetal gallbladder is a diagnosis that must be confirmed by at least two ultrasound exams performed at an interval of 7-15 days. A thorough examination is mandatory in order to document any coexistent anomaly necessitating karyotype analysis. In isolated cases of absence, parental cystic fibrosis screening should be considered. Since, recent literature suggests coexistence of BA or aneuploidy in isolated cases is a chance association, the parents should be reassured that the outcome is likely to be good and no further testing is required.

34 [PP-028] Correlation of fetal thymus size with cord blood vitamin D Esra Bahar Gür, Mehmet Serkan Gur, Ozlem İnce, Esin Kasap, Mine Genc, Sümeyra Tatar, Sultan Bugday, Guluzar Arzu Turan, Serkan Guclu Sifa University Aim: The aim of the present study was to evaluate the association of intrauterine vitamin D deficiency (VDD) with thymus size in full term fetuses. Methods: In this prospective study we evaluated mid-pregnancy serum 25-hydroxyvitamin D3 (25(OH)D3) concentrations in 162 pregnant women. Fetal thymus size were measured by ultrasound in third trimester. Fetal 25(OH)D3 levels evaluated by umbilical cord blood sampling. Correlation of maternal and fetal vitamin D levels, factors effecting vitamin D levels, association between thymus size and both fetal and maternal vitamin D concentrations were investigated. Results: Serum 25(OH) D3 concentrations were within the normal range in 48 (29.8%) mothers and 10 (13.1%) newborns. Body mass index, duration of seaside holiday and the season were founded which effecting factor on maternal vitamin D level. A strong correlation was found between maternal mid-pregnancy and cord blood 25(OH)D3 concentration (r=0.8, p< 0.001). Fetal thymus perimeter was significantly correlated with the thymic-thoracic ratio (r= 0.4, p<0.01). A significant linear correlation was observed between both mid-pregnancy and umbilical cord 25(OH)D3 concentration and thymus perimeter length (r= 0.35, p=0.04 and r=0.4, p<0.01, respectively). Both maternal and fetal vitamin D concentration within the normal range was associated with increased thymic perimeter relative to fetuses with VDD (p=0.04, p=0.03). Conclusions: VDD at fetal period may be contributed fetal programming of immune system by affecting development of thymus. Keywords: pregnancy, vitamin d, vitamin d deficiency, fetal thymus size, ultrasound figure 1 Sonogram of the thymus at the level of the 3-vessel view within the fetal thorax. (a) Thymicthoracic ratio. Tymus diameter was measured as its greatest width perpendicular to a line connecting the spine and sternum. (b) Thymic perimeter. figure 2

35 Figure 2. Flow chart of the study design. Table 1. Mean (±SD) Age (years) 29.5±4.3 Mean gestational week ( maternal vitamin D sampling) 25±0.5 Mean gestational week (thymus measurement) 38.7±0.9 BMI 28.8±2.6 Mothers n=162 Fetuses n=76 Severe deficiency (<=10 ng/ml) (n,%) Mild deficiency (10-20 ng/ml) (n,%) Normal level (>=20 ng/ml) (n,%) 57, , , , , , 13.1 Average level± SD (ng/ml ) 15.06± ±4.8 General characteristics and vitamin D status of the mothers and fetuses in the study. SD: standard deviation. BMI: Body mass index. Table 2. Variables ba (SE) P-value

36 Season,490 <0.01 Annual income, Mothers dressing style -, IU/day Vitamin d use during gestation -, IU/day Vitamin d use during gestation, BMI -, State of employment, Skin color -, Seaside holiday duration, Sun exposure -, Multiple linear regression analysis of factors associated with maternal serum 25(OH)D3 concentrations. R2 = 0.27, b is regression coefficient. a All variables are adjusted for one another. BMI: Body mass index. Table 3. Severe deficiency, umbilical cord (<=10 ng/ml, n=40) Mild deficiency umbilical cord, (10-20 ng/ml, n=26) Normal level, umbilical cord (>=20 ng/ml, n=10) Times New Roman P 76.9b b 94a Severe deficiency, maternal serum (<=10 ng/ml, n=29) Mild deficiency maternal serum (10-20 ng/ml, n=26) Normal level, maternal serum (>=20 ng/ml, n= 19) Times New Roman P 78.3a b 92.9c The relationship thymus perimeter with 25(OH)D3 concentrations in both maternal serum at mid-pregnancy and umbilical cord serum at delivery. p<0.05 statistical significance. [PP-029] Fetal vitamin D eksikliği yenidoğanın geçici taşipnesi için bir risk faktörü müdür? Esra Bahar Gür 1, Esin Kasap 1, Mine Genc 1, Sümeyra Tatar 1, Sultan Buğday 1, Gülüzar Arzu Turan 1, Ayda Haksever 3, Çiğdem Takma 2, Serkan Güçlü 1 1 şifa üniversitesi kadın hast ve doğum kliniği 2 ege üniversitesi 3 şifa üniversitesi pediatri kliniği Amaç: Çalışmamızın amacı, term fetuslarda fetal vitamin D (VD) eksikliğinin yenidoğan geçici taşipnesi (YGT) için bir risk faktörü olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Bu çalışmada miadında ve sezaryen ile dünyaya gelmiş 76 sağlıklı ve 34 YGT izlenen yenidoğan ile bu bebeklerin anneleri değerlendirildi. Annelerden 25-hidroksivitamin D3 (25(OH)D3) düzeylerine bakılmak üzere kan alındı ve VD eksikliğine etki edebilecek faktörler, bir anket ile sorgulandı. Doğumda umblikal kord 25(OH)D3 düzeyi bakmak üzere kan alındı. 25(OH)D3 düzeyleri izotop dilusyon likid kromatografi-tandem kitle spektrometre (LC-MS/MS) ile ölçüldü.

37 Yenidoğanlar, doğumdan sonraki ilk 24 saat YGT bulguları açısından izlendi. Bulgular: Serum 25(OH) D3 düzeyleri, kontrol ve YGT grubunda sırasıyla annelerin 22 sinde (% 32.5) ve 4 ünde (% 11.7 ); fetusların 10 unda (%14.7) ve 2 sinde (%5.8) normal (>=20 ng/ml) düzeydeydi. Ortalama maternal 25(OH)D3 düzeyi kontrol grubunda15.06±6.9 ve YGT grubunda 11.6±5.4 (p=0.05) ve kord kanı 25(OH)D3 düzeyi kontrol grubunda 12.3±4.8 ve YGT grubunda 7.4±3.8 (p<0.01) olarak heasplandı. Maternal ve umblikal kord 25(OH)D3 düzeyleri arasında güçlü ve anlamlı bir korelasyon izlendi (r=0.8, p< 0.001). Vücut kitle indeksi (VKİ), deniz kıyısı tatil süresi ve mevsim maternal vitamin D düzeyi üzerinde etkili faktörler olarak bulundu. YGT gelişen yenidoğanların kord kanı 25(OH) D3 düzeyi, kontrol grubundan anlamlı olarak düşük izlendi. Sonuç: Ülkemizde fetal ve maternal VD eksikliği yaygın görülmektedir. Fetal VD eksikliği, YGT için bir risk faktörü olabilir. Anahtar Kelimeler: gebelik, Vitamin D eksikliği, yenidoğan geçici taşipnesi Şekil 1. Çalışmanın akış şeması. şekil2

38 Maternal serum ve umblikal kord 25(OH)D3 düzeyleri arasındaki ilişki (Pearson korelasyon katsayısı= 0.8, p<0.01) Tablo 1. Yaş (yıl) Ortalama (±SD) Doğumdaki gebelik haftası Ortalama (±SD) VKİ Ortalama (±SD) Şiddetli VD eksikliği (<=10 ng/ml) (n,%) Ilımlı VD eksikliği (10-20 ng/ml) (n,%) Normal düzey (>=20 ng/ml) (n,%) Ortalama 25(OH)D3 düzeyi ± SD (ng/ml ) Kontol grubu (n=76) YGT grubu (n=34) 29.5± ± ± ± ± ± Maternal serum Umblikal kord Maternal serum Umblikal kord 27, , , , , , , , , , , , ± ± ± ±3.8 p p P1< 0.01 P2<0.01 P1= 0.6 P2=0.05 P1= 0.04 P2<0.01 P1= 0.05 P2<0.01

39 Doğumda maternal ve umblikal kord VD (vitamin D) düzeyleri SD: standard deviasyon. VKİ: Vücut kitle indeksi.p1: gruplar arası maternal serum 25(OH)D3 düzeyleri arasındaki ilşiki; P2: gruplar arası umblikal kord 25(OH)D3 düzeyleri arasındaki ilşiki. [PP-030] Postpartum Dönemdeki Kadınların Sosyal Destek Düzeyleri ve Depresyon Belirtileri Arasındaki İlişkinin İncelenmesi Gümrah Duygu Atmaca 1, Gülgün Durat 1, Kevser Özdemir 2, Serhan Cevrioğlu 3 1 Sakarya Üniversitesi Sağlık Yüksekokulu, Akıl Sağlığı ve Psikiyatri Ana Bilim Dalı, Sakarya 2 Sakarya Üniversitesi Sağlık Yüksekokulu, Doğum ve Kadın Hastalıkları Hemşireliği Ana Bilim Dalı, Sakarya 3 Sakarya Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Sakarya Giriş: Gebelik ve doğum sonrası süreç, kadında fizyolojik, ruhsal ve sosyal değişimlerin yaşandığı, psikiyatrik hastalıklara, özellikle de postpartum depresyona yakalanma riskinin en yüksek olduğu dönemdir. Yapılan çalışmalarda doğum sonu dönemde görülen psikiyatrik bozuklukların nedenleri arasında sosyal destek yetersizliği, eşler arasında uyumsuzluk ve stresli yaşam şartları gösterilmektedir. Çalışmamız, postpartum dönemdeki kadınların ailelerinden algıladıkları sosyal destek ile depresyon düzeyleri arasındaki ilişkinin incelenmesi amacıyla yapılmıştır. Gereç-Yöntem: Çalışmanın örneklemini Sakarya Üniversitesi Eğitim Araştırma Hastanesi lohusa servislerinde yatan ve çalışmaya katılmayı kabul eden 108 kadın oluşturmuştur. Veriler; görüşme formu, Aileden Algılanan Sosyal Destek Ölçeği ve Beck Depresyon Envanteri kullanılarak toplanmış, yüzdelik, korelasyon, Mann Whitney-U, Kruskal Wallis testleri ile değerlendirilmiştir. Bulgular: Çalışmaya katılan kadınların yaş ortalaması 26.86±4.41, evlilik süresi ortalaması 5.06±4.11 dir. Katılımcıların %52.8 i şehirde yaşamaktadır. Çalışma grubunu oluşturanların %86.6 sı sosyal destek aldığını; bunların %52.8 i ebeveynlerinden, %38.9 u kardeşlerinden, %22.2 si eşlerinin anne babasından, %13.9 u eşlerinden destek aldıklarını belirtmişlerdir. Kadınlardan çalışan, şehirde yaşayan, ekonomik durumu iyi, çekirdek aile yapısına sahip, eğitim durumu lisans ve üzeri, sosyal destek aldığını belirten ve gebeliği planlı olanların, sosyal destek ölçeği puan ortalamaları istatistiksel olarak anlamlı bir şekilde daha yüksek bulunmuştur (p<0.05). Çalışan, şehirde oturan ve ekonomik durumu iyi olan kadınların Beck Depresyon Ölçeği puan ortalamaları ise düşük bulunmuştur (p<0.05). Aileden algıladıkları sosyal destek ölçek puan ortalaması 26.31±5.91, Beck Depresyon envanterinden aldıkları puan ortalaması 7.69±6.68 dir. Aileden algılanan sosyal desyek düzeyi ile depresyon arasında negatif yönde orta düzeyde ilişki bulunmaktadır (p<0.05). Sonuç ve Öneriler: Çalışmamızda aileden algılanan sosyal destek düzeyi arttıkça depresyon belirti düzeyinin azaldığı bulunmuştur. Anahtar Kelimeler: Depresyon, postpartum dönem, sosyal destek

40 [PP-031] Gebeliğin son üç ayında çalışmaya devam etmenin postpartum depresyona etkisi Esra Bahar Gür 1, Gülüzar Arzu Turan 1, Sultan Buğday 1, Esin Kasap 1, Esma Burçak Zengin 2, Sümeyra Tatar 1, İrem Hepyılmaz 1, Serkan Güçlü 1 1 şifa üniversitesi kadın hast ve doğum kliniği 2 şifa üniversitesi psikiyatri kliniği Amaç: Postpartum depresyon, anneyi, bebeği ve çevresini etkiyen önemli bir sağlık sorunudur. PPD üzerine etkili faktörler daha önceki çalışmalarda araştırılmıştır. Ancak gebeliğin üçüncü üç aylık bölümünde uzatılmış iş hayatının postpartum depresyon üzerine etkisini gösteren veri mevcut değildir. Çalışmamızın amacı, gebeliğin son üç ayında uzatılmış iş yaşantısının postpartum depresyon üzerine etkisini araştırmaktır. Yöntem-Gereçler: Kliniğimizde Ekim 2013-Ekim 2014 tarihleri arasında takip edilen çalışan gebeler, ana kaynağımızı oluşturdu. Çalışma süresinin postpartum depresyona etkisini daha net ortaya koyabilmek için, postpartum depresyon üzerine etki etmesi olası durumlara sahip gebeler çalışmadan çıkarıldı. Doğum gerçekleştikten sonra, doğum ve yenidoğan komplikasyonu yaşayan katılımcılar, ayrıca çalışma dışına alındı. Katılımcılar doğum sonrası 4. haftada telefon ile aranarak Edinburgh Postnatal Depresyon Ölçeği (EPDÖ) ile değerlendirildi. Postpartum depresyona etki eden faktörler regresyon analizi ile değerlendirildi. Çalışma süresi ile EPDÖ puanı arasındaki ilişkiyi değerlendirmek için Pearson Korelasyon analizi yapıldı. Bulgular: Katılımcıların %21.7 i ( n=48) 12 ve üzerinde puan alması nedeniyle postpartum depresyon olarak değerlendirildi. Sosyo-demografik veriler gruplara ayrılarak, her bir alt grup için PPD sıklığı araştırıldığında, eğitim düzeyi, yıllık gelir, sosyal çevre desteği ve gebelikteki çalışma süresi alt grupları arasında postpartum depresyon sıklığı anlamlı olarak farklı bulundu. EPDÖ puanı ile çalışılan hafta sayısı arasındaki ilişki araştırıldığında, iki değer arasında güçlü ve pozitif bir ilişki olduğu görüldü (Pearson korelasyon katsayısı (r)= 0.4, p= 0.03) Tartışma: Gebeliğin son üç aylık döneminde uzatılmış iş yaşamı postpartum depresyonu etkiyen bir faktör olabilir. Anahtar Kelimeler: Postpartum depresyon, etkileyen faktörler, çalışma süresi tablo 1 Karakteristik özellikler guruplar Kişi sayısı(%) n=221 postpartum depresyon (EPDÖ>=12) kişi sayısı (%) n=48 (%21.7) P değeri Yaş < (46.1) 14 (16.6) 0.09 >= (38) 25 (28) >=30 84 (38) 23 (17.4) Eğitim düzeyi <=8 yıl 89 (40.2) 25 (28) 0.04 >8 yıl 132 (59.8) 23 (17.4) Yıllık gelir <=10 000$ 98 (44.3) 27 (27.5) 0.03 Doğum şekli Evlilik tatmini >10 000$ 123 (55.7) 21 (17) Vaginal doğum 101(45.8) 25 (20.8) 0.4 C/S 120 (54.2) 23 (22.7) Tatmin edici 145 (65.6) 26 (17.9) 0.08

41 Orta düzeyde 57 (25.7) 16 (28) yetersiz 19 (8.5) 6 (31.5) Sosyal çevre desteği Yeterli destek Orta düzeyde (18.5) (19.4) yetersiz (30) Aktif emzirme evet (16.3) 0.7 hayır 37 7 (18.9) Gebelikteki çalışma süresi 32. haftaya kadar (15.4) < haftaya kadar (29.5) Sosyo-demografik özellikler ve postpartum depresyon sıklığı. P<0.05 değeri istatistiksel anlamlılık olarak kabul edildi. tablo 2 Regresyon katsayısı Standart hata OR değeri %95 güven aralığı P değeri Yaş Eğitim düzeyi Yıllık gelir Doğum şekli Evlilik tatmini Sosyal çevre desteği Aktif emzirme Çalışma süresi (hafta olarak) Postpartum depresyona etki eden faktörler. Çoklu regresyon analizi yapıldı. P<0.05 değeri istatistiksel anlamlılık olarak kabul edildi. tablo3 Pearson korelasyon katsayısı p değeri Çalışma süresi / EPDÖ (hafta olarak) r= Çalışma süresi ile EPDÖ arasındaki ilişki. Pearson korelasyon analizi yapıldı.

42 [PP-032] Plasenta Akreata Nedeniyle Gelişen Geç Postpartum Kanama Tedavisinde Acar Usulü Kompresyon Sütürü ile Başarılı Tedavi; Olgu Sunumu Fedi Ercan 1, Fatma Kılıç 1, Berkan Sayal 1, Damlanur Üstün 2, Ali Acar 1 1 Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Konya 2 Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Ana Bilim Dalı, Konya GİRİŞ Plasenta yapışma anomalileri, plasentanın uterin duvar içine doğru anormal şekilde invaze olmasıdır.bu anomaliler plasenta akreata, inkreata ve perkreata olmak üzere 3 grupta incelenir.bu durum ciddi komplikasyonlara neden olabilir. Burada plasenta akreata nedeniyle postpartum 17.günde başlayan ciddi postpartum kanamanın(pk) tedavisinde kullanılan yeni sütür tekniği(acar usulü kompresyon sütürü) ile tedavi edilen olgu sunulmuştur. OLGU Hasta 17 gün önce dış merkezde vajinal doğum yapmış ve postpartum 17.günde gelişen abondan vajinal kanama nedeniyle merkezimize refere edilmiştir.muayenesinde serviks 2cm kadar açık olarak gözlenmiş ve kavite içerisine girilerek palpe edildiğinde korpus ön duvarda yaklaşık olarak 3x4cm boyutlarında uterusa dens olarak yapışmış doku palpe edilmiştir.başvuru esnasında masif vajinal kanaması olan ve vital bulguları stabil olmayan (tansiyon arteriyel 80/50 mmhg, radial nabız 118 atım/dakika ritmik-filiform, hemoglobin 6,4gr/dl)hastanın β-hcg ölçümü negatifti.ultrasonografik değerlendirmede intrauterin yaklaşık 42x45 mm boyutlarında düzensiz kontürlü,dopplerde vaskülarizasyon gösteren heterojen yumuşak doku kitlesi görülmüştür(resim 1).Hastaya acil laparotomi kararı alınarak histerotomi yapılmış ve uterus dens şekilde yapışmış yaklaşık 1 kotiledon büyüklüğündeki doku çıkarılmıştır(resim 2).Çıkarılan plasental yataktan gözlenen ciddi kanama Acar Usulü Kompresyon Sütürü konularak kontrol edilmiştir(resim 3). Ameliyat esnasında 2 ünite taze tam kan verilen hasta postop 3.günde taburcu edildi. TARTIŞMA PK gelişmekte olan ve gelişmiş ülkelerde maternal morbidite ve mortalitenin en önemli sebeplerinden biridir.plasenta yapışma anomalileri PK nedenleri arasında artık çok daha sık bir nedendir.geçirilmiş sezaryen doğum ve plasenta previa en başta gelen risk faktörleridir.tedavide kompresyon sütürleri son yıllarda popülarite kazanmıştır.bu vakada kullanılan teknik 2014 yılında Acar ve arkadaşları tarafından tarif edilen ve literatüre giren ''Acar Usulü Kompresyon Sütürü'' olup en yeni konservatif cerrahi seçeneklerden biridir. Anahtar Kelimeler: Postpartum Kanama, Plasenta İnvazyon Anomalisi, Uterin Kompresyon Sütürü

43 Resim 1 Plasenta Akreata Alanının Transvajinal Ultrasonografi Görüntüsü Resim 2 Çıkarılan plasenta dokusu. Maternal yüzden görünümü (A) ve nekroze alanlar da içeren diğer yüz (B). Resim 3

44 Kanayan plasenta ayrılma sahasına Acar Usulü Kompresyon Sütürü atılırken [PP-033] Uterin Atonide Fundal Serozal Plasental Alan Sütürasyonu; 5 vakanın analizi Ali Acar, Osman Balcı, Fedi Ercan, Cemre Alan, Berkan Sayal, Fatma Kılıç Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Konya Amaç: Plasentası fundusta yerleşik olan ve uterin atoni(ua) nedeniyle postpartum kanama gelişen hastalarda yeni bir konservatif cerrahi metod olan fundal plasenta serozal alan sütürasyonunun etkinliğinin değerlendirilmesidir. Yöntem-Gereçler: Çalışmada Ocak 2013-Mayıs 2014 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde postpartum kanama tanısı alan ve plasentası fundusa yerleşmiş fundal plasental serozal alan sütürasyonu uygulanan beş vaka incelenmiştir. Sütür materyali olarak 80 mm 1/2 yuvarlak iğneli 1 numara poliglaktin 910 sütür materyali kullanılmış ve şekil 1'de gösterilen şekilde uygulanmıştır. Bulgular: Postpartum kanama nedeni UA olan beş olgudan dördü sezaryen biri vajinal doğum yapmış hastalardı. Hastaların yaş ortalaması 27.8±2.3(20-31) idi. Üç hasta(%60) primigravida, iki hasta(%40) multigravida idi(tablo 1). Ortalama gravida 2.4(1-5), ortalama parite 1.8(1-4) idi. Hastaların ortalama gebelik haftaları 37.5±2.0(34-39) idi. Hastaların tamamında plasenta fundus yerleşimli iken ayrıca iki hastada plasenta akreata mevcuttu(%40). Sütür uygulanan beş hastada da kanama kontrolü sağlandı(%100). Vaka başına uygulanan ortalama sütür sayısı 2.0±1.0(1-3) idi. Ameliyatlara ait ortalama kan kaybı 1700±300cc( cc) ve hastalara uygulanan transfüzyon 2-4 ünite arasında idi. Ortalama ameliyat süresi 55±10 dakika(40-70) idi. Postoperatif dönemde hastaların hiçbirinde komplikasyon izlenmedi. Hastalar ortalama 3.5±1,5(2-5) günde taburcu edildiler. Sonuçlar:Anne ölümlerinin çoğu 1.ya da 2.basamak sağlık kuruluşlarında veya transport sırasında olmaktadır. Üçüncü basamak sağlık kuruluşlarına (donanımlı tıp fakülteleri ve eğitim hastaneleri)transport yapılırken geçen zaman hayati önem taşır. Tarif edilmeye çalışılan yöntem birinci ve ikinci basamak sağlık kuruluşlarında uygulanabilir, etkili, kolay, hızlı ve ciddi bir komplikasyon ile karşılaşma olasılığı olmayan ideale yakın bir yöntemdir. Anahtar Kelimeler: Postpartum Kanama, Kompresyon Sütürü, Uterin Atoni

45 Şekil 1 Sütürün şematik olarak geçtiği noktaların gösterimi Tablo 1 Sezaryan 4 hasta (%80) Vajinal Doğum 1 hasta(%20) Ortalama yaş 27.8±2.3 (20-31) Ortalama gravite 2.4 (1-5) Ortalama parite 1.8 (1-4) Primipar gebe 3 hasta (%60) Multipar gebe 2 hasta (%40) Ortalama hastanede kalış süresi 3.5 ± 1,5 (3-6)

46 Ortalama transfüzyon sayısı Ortalama operasyon süresi 2-4 Ünite 45±10 dakika Ortalama sütür sayısı/vaka 2.0±1.0 (1-3) Ortalama kan kaybı 1700±300 cc Çalışma grubunun genel özellikleri ve çalışma sonuçları [PP-034] Case report: Dandy Walker Syndrom prenatal diangnosis with Ultrasound Aida Aida Kumnova, Bleta Bleta Domi, Qamil Qamil Hamza, Butrint Butrint Kusari, Ilir Ilir Kadiri Regional Hospital Gjakova /Kosova. Department of perinatalogy. Summary The Dandy-Walker complex is a rare congenital intracranial malformation that comprises a spectrum of abnormalities of the posterior fossa which are classified as (a) Dandy-Walker malformation (cystic dilatation of the 4th ventricle, complete or partial agenesis of the cerebellar vermis and an enlarged posterior fossa) Findings: A 28 year old primigravida come in the routin ultrasound of the perinatal at 20 week of gestation.ultrasonography revealed a single live intra-uterine gestation with biparietal diameter and foetal femur length corresponding to 22 weeks of gestation. The foetal posterior fossa was of normal size but with a large anechoic lesion which was communicating with the 4thventricle. There was a suggestion of hypoplasia of the cerebellar vermis (Fig.1) but no evidence of hydrocephalus. The mesurments of the fetus was normale the FW 270 gr, umbilcal cord with one vein and one artery,cerebellum was18mm but cysterna magna was large 10mm.In Ultrasound scan it was not possible to see the vermis. It was diagnosed Dandy Wlakersyndrome and the patents did not want to do the prenatal diagnosis with amniocentesis. The abortion was induced with cytotec tablets 200 mcg every 3 hours and after 36 hours she aborted the fetus 280 grams with no facial malformations only in each leg was 4 fingers and in each hend was 6 fingers. Keywords: Dandy walker syndrome, ultrasound [PP-035] Gestasyonel diabetes mellitus tanısı alan gebelerde oksidatif stres markerları, serbest radikaller ve lipit profilinin maternal serum ve kord kanı düzeyleri Fatma Beyhekim 1, Aybike Pekin 2, Tolgay Tuyan Ilhan 2, Fikret Akyürek 3, Setenay Arzu Yılmaz 2, Özlem Seçilmiş Kerimoğlu 2, Abdullah Sivrikaya 3, Çetin Çelik 2, Ali Ünlü 3 1 Doktor Süreyya Adanalı Göksun Devlet Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Kahramanmaraş 2 Selçuk Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Konya 3 Selçuk Üniversitesi Tıp Fakültesi, Biyokimya Ana Bilim Dalı, Konya Amaç: Çalışmamızda gestasyonel diabetes mellitus (GDM) tanısı konulan gebelerde ve normal glukoz yükleme testi sonuçlarına sahip olan kontrol grubu gebelerde maternal ve fetal kan lipid profili ve oksidatif stres düzeylerinin değerlendirilmesi amaçlanmıştır. Gereç-Yöntem: Çalışmaya gestasyonel diabetes mellitus tanısı alan 65 gebe ve 65 kontrol grubu olmak üzere toplam 130 tekil gebeliğe sahip hasta dahil edilmiştir. Doğumda alınan maternal serum ve kord kanında LDL (düşük yoğunluklu lipoprotein), okside LDL, TOS (toplam oksidan seviye), TAS (toplam antioksidan seviye), Lp(a) (lipoprotein (a)), total kolesterol, trigliserid, HDL (yüksek yoğunluklu lipoprotein) düzeyleri değerlendirilmiştir. Bulgular: Maternal kanda bakılan TAS, Lp(a), okside LDL, HDL, LDL, total kolesterol, düzeylerinde GDM ve kontrol grubu arasında anlamlı bir farklılık saptanmamıştır. Ortalama trigliserid ve TOS

47 düzeyleri ise GDM grubunda daha yüksek olarak ölçülmüştür (p<0,05). GDM li gebeler diyet ile regüle edilen ve insülin kullanan gebeler olarak alt gruplarda değerlendirildiğinde Lp(a) ve LDL değerleri kan glukoz seviyesi diyet ile regüle olan grupta yüksek olarak ölçülmüştür (p<0,05). Kord kanı incelendiğinde ise okside LDL değeri GDM grubunda yüksek idi (p<0,05). Yine diyet ile regüle GDM olan gebelerin kord kanında okside LDL düzeyleri insülin kullanan gebelerden daha yüksek olarak ölçülmüştür (p<0,05). Sonuç: Maternal oksidatif stres belirteçlerinin (TOS ve Lp(a)) özellikle, kan glukoz düzeyi diyet ile regüle edilen GDM grubunda daha yüksek olduğu, yine gestasyonel diyabetik gebelerde kan lipid profilinde düzensizlik (yüksek trigliserid ve LDL düzeyleri) olduğu görülmüştür. Aynı zamanda diyet ile regüle GDM lu gebelerin bebeklerinde doğumda okside LDL düzeyleri daha yüksektir. Anahtar Kelimeler: Gestasyonel diabates mellitus, okside LDL, toplam antioksidan seviye, lipoprotein(a) [PP-036] Delivery in a Woman With Corrected Tetralogy of Fallot and Pulmonary Hypertension Ayşe Altındiş Bal 1, Ebru Yüce 1, Esra Aktepe Keskin 1, İnci Aslı Atar 2, Zehra Candan İltemir Duvan 1 1 Department of Obstetrics and Gynecology, Turgut Özal University Hospital, Ankara, TÜRKİYE 2 Department of Cardiology, Turgut Özal University Hospital, Ankara, TÜRKİYE One of the most important cause of morbidity and mortality in pregnancies is cardiac diseases. The number of pregnant women with congenital heart defect has increased because of early diagnosis and treatment of many congenital heart defects. Tetralogy of fallot is the most common form of cyanotic congenital heart disease after 1 year of age. Although pregnancy in patients with corrected tetralogy of fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications. Pulmonary arterial hypertension is one of the maternal cardiovascular complications, which is rare in corrected tetralogy of fallot. We describe the case of a 27-year-old woman with tetralogy of fallot, with a history of 2 previous cardiac operations, who underwent a caesarean section on 36th week pregnancy because of developing pulmonary arterial hypertension. Keywords: Tetralogy of Fallot, Pregnancy, Delivery, Pulmonary Hypertension [PP-037] Ultrasound diagnostic criteria of morbidly adherent placenta (MAP) Cringu Antoniu Ionescu 1, Liana Ples 2, Mihai Banacu 1, Irina Pacu 1 1 UMF Carol Davila Department Obstetrics Gynecology Clinical Emergency Hospital Sf Pantelimon Bucharest 2 Department Obstetrics Gynecology Bucur Maternity Clinical Emergency Hospital Sf Ioan Objectives Postpartum hemorrhage represent an important cause of maternal mortality.there are three forms of morbidly adherent placenta (MAP) placenta accreta, increta and percreta. Increasing incidence of cesarean section (CS) in the last ten years correlates with the incresed incidence of MAP. The pathologic adherent placenta occurs in 9,3% of women with placenta previa, the risk being 24% in those with a previous CS and 67% in those with three CS. Methods Using 2D gray and color doppler ultrasonography we investigated the presence of: 1. thinning or interruption of the hyperechoic interface between uterine serosa and blader wall termed the - bladder line-2. loss ef the echolucent area between the uterus and blader wall, 3. irregular retroplacental sonolucent areas, 4. presence of turbulent placental lacunae with high velocity flow. Using 3D power Doppler we can map the vascularization of the intraplacental and serosa-blader interface and we can investigate: 1. hypervascularity of the uterine-serosa wall interface 2.intraplacental hypervascularity 3. tourtuous vascularity with chaotic branching. We found that MAP patients have two out of five or more signs were detected. The most effective ultrasound criteria for detection of MAP were abnormal clear space and uterine serosa-blader wall

48 interface hypervascularity.using 3D power Doppler the numerous coherent vessels visualized in the placenta was best single criterion for diagnosis. Conclusion The rewieved ultrasound criteria may be useful for the prenatal diagnosis of MAP and 3D power Doppler can help to differentiate between placenta accreta and percreta. Key words:morbidly adherent placenta, 3D power Doppler,ultrasonography Keywords: ultrasonography, 3D power Doppler, Morbidly adherent placenta [PP-038] Terme Ulaşmış Tanatoforik Displazi; Olgu Sunumu Fedi Ercan, Ali Acar, Hande Kaçar, Berkan Sayal Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Konya GİRİŞ İskelet displazileri kalıtsal bağdoku hastalıkları içindeki oldukça heterojen bir grubu oluşturur. Bunlar arasında Fibroblast Büyüme Faktörü Reseptörü-3 (FGFR-3) geni mutasyonu sonucu meydana gelen displaziler akondroplazi, hipokondroplazi ve tanatoforik displazi(td)dir. TD, FGFR-3 geni mutasyonu sonucu oluşan en sık letal iskelet displazisidir, sıklığı 'de 3-6 kadardır. Ultrasonografi prenatal tanı sağlıyor olsa bile, TD fetusların in utero olarak diğer iskelet osteokondrodisplazilerinden ayırımı net olamamaktadır. Burada terme ulaşmış TD olgusu sunulmaktadır. OLGU SUNUMU Yirmiüç yaşında sağlıklı bir erkek çocuğu olan hasta SAT'a göre 36 hafta 4 günlük gebe iken başvurdu. Haftasına göre femur uzunluğu (FL) <2,3 persentil, humerus uzunluğu (HL) <5,0 persentil olarak tespit edildi (Şekil 1 ve 2). Polihidroamnios mevcuttu(şekil 3). Fetal yüzde frontal çıkıklık, burun kökü basıklığı ve mikrognati vardı(şekil 4). Kısa kostalar nedeniyle gelişen dar toraks mevcuttu(şekil 5). Femur boyu(fl)/abdomen çevresi(ac) oranı 0,15 idi (hipoplastik toraks). 37.gebelik haftasında uterin kontraksiyonların başlaması ve hiperekstansiyonda başa sahip makat geliş nedeniyle sezaryen yapılan hasta 2000gr, 5.dakika APGAR skoru 4, kız bebek doğurdu(şekil 6 ve 7). Solunum sıkıntısı nedeniyle entübe edidi, yenidoğan yoğunbakım ünitesine alındı ve postpartum 3. günde ex olan infantın moleküler genetik analizi TD tipi olarak netleşmiştir. TARTIŞMA TD dışındaki FGFR-3 ilişkili diğer iskelet displazileri akondroplazi ve hipokondroplazidir. Prenatal ultrasonografi TD den süphelenmek için ipuçları sağlar. Ancak bu bulgular tek başına, moleküler analiz olmadan kesin tanı için yeterli değildir. TD süphesi oluştuğunda intrauterin olarak tanıyı kesinleştiremek için standart sitogenetik analizin bir parçası olarak FGBR-3 gen lokusundaki TD spesifik mutasyonun tespit edilmesi ve hastayı bu bilgi projeksiyonunda prognoz ile ilgili aydınlatmak gerekir. Anahtar Kelimeler: Tanatoforik Displazi, İskelet Displazisi, Fibroblast Büyüme Faktörü Reseptörü- 3

49 Resim 1 Kısa femur (< 2,3 persentil) Resim 2

50 Kısa humerus (< 5,0 persentil) Resim 3

51 Polihidroamnios (Tek cepta >100 mm amniotik mayi) Resim 4 Fetal baş 2 boyutlu ultrasonografi ile sagittal planda görüntülenmiş ve belirgin frontal çıkıklık ile burun kökü basıklığı ile birlikte mikrognati izlenmekte (A), 3 boyutlu ultrasonografi ile aynı bulgular görülmekte(b). Resim 5

52 Belirgin hipoplastik toraks görüntüsü Resim 6 Çökmüş burun köprüsü ile belirgin frontal çıkıklık ve kısa yukarı dönmüş burun ucu Resim 7

53 Brakidaktili ve tipik 3 başlı mızrak el (A), mikromeli (B) ve çan şekilli göğüs kafesine (C) neden olan ağır kostal gelişim bozukluğu [PP-039] Effect of pre-intervention complete blood count testing and use of concomitant progesterone on pregnancy prolongation in cervical cerclage patients. Doruk Cevdi Katlan 1, Bahar Konuralp Atakul 1, Tuncay Yüce 1, Dilek Acar Yüksel 1, Acar Koç 1, Feride Söylemez 1 ( 1 ) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Aim Cervical cerclage placement for prevention of prematurity is based on either emergent (physical examination-indicated, E-C) or non-emergent (history-indicated or ultrasound-indicated, NE-C) indications. But beforehand, the patient must be evaluated for possible contraindications, including but not limited to uterine activity or overt chorioamnionitis, especially on the emergent setting. Although not diagnostic, leucocytosis in a pregnant patient (>15,0x109/L) may be indicative of an underlying infection, possibly chorioamnionitis. Maternal anemia (Hb <10,0 g/dl) is also related to poor pregnancy outcome. The aim of this study is to evaluate the effect of maternal leucocytosis and anemia and the concomitant use of progesterone, another well-documented intervention, on pregnancy prolongation in cerclage patients.

54 Methods Data of the patients who underwent McDonald cerclage procedure at Ankara University Department of Obstetrics and Gynaecology, between August 2007 and January 2015 were retrospectively gathered and analysed. Results Among 121 patients included in the analysis, complete blood count tests were obtainable for 115. Patients were grouped according to indication (E-C, n=33 or NE-C, n=82), fetal number (singleton, n=99 or multifetal, n=16) and possible combinations of these. When leucocytosis was present, prolongation of pregnancy was significantly lower for both the E-C and NE-C groups. This effect was much more prominent for singleton pregnancies especially for the E-C group. Among all groups, maternal anemia, revealed significant negative difference for the singletons. Concomitant maternal use of progesterone created no significant difference in all the possible combinations of groups of 121 patients. Conclusions Prolongation of pregnancy may not even be desirable with regard to the infective aetiology of preterm birth. Laboratory evaluation by a simple complete blood count may be helpful to clinical diagnosis of chorioamnionitis and maternal anemia predicting poor prognosis of pregnancy, although not diagnostic for cervical insufficiency. As our data suggests, this condition is especially valid for the literature recommended indications of cerclage; singleton and emergent ones. Adjunctive progesterone therapy used with cerclage showed no benefit, again consistent with the current knowledge. [PP-040] Posterior reversible encephalopathy syndrome: a case study Cihan İnan, Füsun G Varol, Selen G Erzincan, Cenk N Sayın Trakya University, Obstetrics and Gynecology, Perinatology Section "Posterior reversible encephalopathy syndrome" (PRES) is a condition that occurs due to several aetiologic causes resulting in vasogenic oedeme in the brain with the disruption of cerebral autoregulation. The diagnosis of PRES is made with clinic and neuro-radiologic imaging techniques. PRES most commonly covers the posterior cerebral regions. It might present particularly in pregnant women as a complication of pre-eclampsia and eclampsia, and it is very important to diagnose PRES in an accurate and rapid manner. This case study focuses on the case of a pregnant patient, who was diagnosed with PRES after her neuro-radiologic examination that was performed due to recurrent generalized tonic-clonic seizures and who was preterm and had intrauterine growth retardation. Keywords: PRES, Pre-eclampsia

55 Figure 1. Cranial MR images on the 1 day after C-section 1a. 1b Hyper-intense areas in T2AS-FLAIR in temporal-occipital-parietal lobes 1c 1d Hyperintense areas in subcortical-weighted T2AS-FLAIR in cortico-subcortical regions in frontal and occipital lobes Figure 2. Cranial MR image before the C-section

56 2a. Hyper-intense areas in T2 and FLAIR sequences in cerebellar region 2b. 2c. Hyperintense areas in T2 and FLAIR sequences in both occipital and parietal areas [PP-041] Prenatal Diagnosis of Fetal Abnormalities Aytekin Aydın, Mustafa Öztürk Etimesgut Military Hospital Obstetrics and Gynecology Objective: The purposes of this study were to describe the most frequent fetal abnomalities in our socio-economic conditions and to estimate the frequency of the most common fetal abnormalities in patients from the Etimesgut Military Hospital Ankara Materyal-Metod: Fetal abnomalities findings were retrospectively reviewed from 2012 to 2013 in 425 pregnant women. Ultrasound screening had performed at weeks in all pregnant women. Results: Fetal abnormalities were observed in 22 (0.5%) of the remaining 425 cases. The first and second trimester ultrasonograpy scan detected acrania (2 cases), facial clefts, omphalocele with megacystis, single artey and vein complications, cerebellar or vermian hypoplasia, high nuchal translucency (>=3mm 3 cases), lateral ventricular enlargement (>=11mm 3 cases), fetal renal pyelectesis (>=10mm 3 cases), posterior ürethral valve, talipes deformity (2 cases) and diaphragmatic hernia. The mean maternal age was 28 years old, and mean gestational age was 18 weeks. Conclusion: We have reported our prevalence of anomalies as 5 per 1000 births, similar to recent studies.

57 Keywords: Prenatal diagnosis, fetal abnormalities, city hospital [PP-042] A Trisomy 21 Case With Signs of Non-Immune Fetal Hydrops in 13 Gestational Week Mustafa Öztürk, Aytekin Aydın Etimesgut Military Hospital Obstetrics and Gynecology Objective: To present a case of non-immune hidrops fetalis due to trisomy 21 in 13. gestational week. Case: A 42 year old, gravida 3 para 2, woman was offered early first trimester CVS due to the findings of advanced age pregnancy, increased nuchal translucency thickness (NT= 6),absent nazal bone, hyperecojen bowel, generalize hydrops. Indrect coombs, biochemical and immunological infection markers were all reported as negative. A pregnancy termination was performed majorly due to a report of trisomy 21 on the analysis of the fetal karyotype, after obtaining an appropriate genetic counseling of the family. Fetus was macroscopically hydropic. Conclusion: Chromosomal abnormalities, Cardiovascular diseases and congenital infections can make generalized edema of the soft tissues with non immun hydrops fetalis. When non-immune fetal hydrops was detected in the first trimester, abnormalities of fetal karyotype should be evaluated at first. Keywords: Trisomy 21, non-immune fetal hydrops Figure

58 [PP-043] Kaybolan İkiz (Vanishing twin) Aytekin Aydın, Mustafa Öztürk Etimesgut Asker Hastanesi Kadın Doğum Servisi Amaç: Birinci trimesterde ikiz gebeliğin yaklaşık % 20 oranında kaybolan ikiz nedeniyle tekil gebeliğe dönebileceğini vurgulamak istedik. Giriş ve Yöntem: Birinci trimesterdeki ikiz gebelik oranı, doğumdaki ikiz doğum oranından daha fazladır. Fetüslerin ilk trimesterdeki sonografik incelemelerinde, ikiz gebeliklerin % oranında ikizlerden birinin ikinci trimesterden önce kaybedildiği, spontan redüksiyona uğradığı veya kaybolduğu bildirilmiştir (vanishing twin). Bazı olgularda gebelik tamamen abortus ile sonuçlanır. Ancak çoğu zaman bir fetüs kaybedilir. Olgumuzda birinci trimesterin sonuna doğru kaybolan ikiz vanishing twin fetüsün durumunu inceledik. Bulgular: Gebe 32 yaşında, G2 P1 dir. Ailede ikiz öyküsü ve önceki gebelikte anomali bulunmamaktadır. Gebenin sonografik incelemesinde, 8 haftalık CRL.1: 11,5 mm ve CRL.2: 10,8 mm ölçülerinde her ikisinde de kardiyak aktivite bulunan ikiz canlı fetüsler izlendi. Gebeye ikiz gebelik konusunda bilgiler verildi, 3 hafta sonra kontrole çağrıldı. Ancak gebe yaklaşık 4 hafta sonra geldiğinde 1. Fetüsün 12 haftalık ve canlı olduğu görülürken, 2. Fetüsün büyümesinin durduğu CRL.10 mm, de 8 haftada kaldığını ve kardiyak aktivitesinin olmadığı görüldü(resim 1). Gebeye bebeğinin birinin öldüğü ve diğerinin canlı olduğu ve konun önemi anlatıldı. Gebe 3 hafta sonra kontrole çağrıldı. 15. Haftada 2. Fetüsün yapısının kaybolması ve kesesinin küçülmesi nedeniyle 2. Fetüsün spontan redüksiyona uğradığı görülerek kaybolan ikiz = vanishing twin kabul edildi. Bir sonraki kontrolünde 19 haftalık gebe olan hastanın kontrolünde fetüsün 19 haftayla uyumlu olduğu görüldü. Sonuç: Çoğul gebelikte birinci ve ikinci trimesterde yapılan sonografik incelemelerin spontan fetal redüksiyonun belirlenmesinde önemli bir yer tuttuğu görülmektedir. Bu nedenle gebelerin düzenli rutin antenatal kontrolleri yaptırması gerekliliği unutulmamalı ve bu konuda gebeler eğitilmelidir. Anahtar Kelimeler: Kaybolan ikiz, Antenatal takip Resim

59 [PP-045] Trisomy 13 ultrasound findings associated with trisomy 18 Uğur Keskin 1, Fahri Burçin Fıratlıgil 1, Mustafa Ulubay 1, Ulaş Fidan 1, Mehmet Ferdi Kıncı 1, Deniz Torun 2, Kazım Emre Karaşahin 1 1 Obstetrics and Gynecology Department, Gulhane Military Medical Academy, Etlik, Ankara, Turkey 2 Department of Genetics, Gulhane Military Medical Academy, Etlik, Ankara, Turkey Objectives: The aim of this case report is to describe unlikely ultrasound findings of Edwards syndrome (trisomy 18). Patient and Methods: A 39-year-old patient with a history of gravida 3 and para 2 applied to our clinic for a routine control examination, first trimester screening at her 13th week of pregnancy. In the patient s anamnesis and antenatal care, no family history of aneuploidy was observed. In obstetric ultrasound findings, the fetus had holoprosencephaly, omphalocele and atrioventricular septal defect generally associated with Patau syndrome (trisomy 13). Therefore, the patient had been referred to a genetic counselor with the pre-diagnosis of Patau syndrome. Chorionic villus sampling (CVS) was offered for prenatal diagnosis. Results: After genetic analysis, CVS material was reported as Edwards syndrome, it was noncorrelated with our ultrasonographic findings. The pregnancy was terminated Conclusions: Patau syndrome as well as Edwards syndrome are characterized by a few of various malformations in the fetus that can be diagnosed by ultrasound. But that characterized ultrasound findings not only are used for definitive diagnosis but also be supported by genetic analysis. Keywords: trisomy 13, trisomy 18, omphalocele [PP-046] Preeclampsia risk evaluation according to clinical features and thrombophilic polymorphisms in a group of Romanian patients Georgiana Nemeti 1, Iulian Goidescu 1, Madalina Valeanu 3, Lucia Maria Procopciuc 2, Florin Stamatian 1, Gabriela Caracostea 1 1 Department of Obstetrics and Gynecology I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 2 Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj- Napoca 3 Department of Medical Informatics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania Objective: To establish the extent of the involvement of clinical risk profile features and thrombophilic polymorphisms in the stratification of risk for preeclampsia in a group of Romanian pregnant women. Method: 100 patients with hypertensive disorders of pregnacy were enrolled in the case group and 111 normotensive patients in the control group. Clinical profile features: maternal age, parity, gestational age, pregestational body mass index (BMI), smoking habit and contraceptive use. The thrombophilic genetic profile: factor V Leiden, 20210G-A prothrombin gene mutation, 677C-T and 1298A-C metylenetetrahydropholate reductase (MTHFR) gene mutations, was performed for both cases and controls. Results: In the case group we had 35 patients with pregnancy induced hypertension, 45 mild preeclampsias and 20 cases of severe disease. We confirmed the association between severe disease, nulliparity and obesity. Fetal haemodynamic adaptation was recorded in severe preeclampsia cases as increased resistivity on the umbilical artery, brain sparing and ductus venous reverse flow. Moreover, pregnancies with severe preeclampsia had a poor fetal outcome with low birthweight for the gestational age, Apgar score <7 at 5 minutes. Factor V Leiden & A1298C MTHFR mutations associated an increased risk of hypertensive disorders of pregnancy. Factor V Leiden & C677T MTHFR polymorphisms had an increased risk of severe preeclampsia. Conclusion: In the present study nulliparity and increased pregestational BMI are the clinical fetures shown to influence the risk of severe preeclampsia, correlating with a poor maternal-fetal outcome. Factor V Leiden and C677T MTHFR polymorphisms are associated with the risk of severe outcome preeclampsia.

60 Keywords: preeclampsia, thrombophilia, polymorphisms, risk profile [PP-047] Induction of labor with dinoprostone vaginal insert; is it safe and effective in term pregnancy with premature rupture of membranes? Ilke Topdağı Aydın, Halenur Bozdağ, Egemen Aydın, Kadir Güzin, Necdet Süer, Fulya Gökdağlı Medeniyet University Göztepe Training and Research Hospital Background/Aims: Controlled-release dinoproston vaginal insert is a locally applicated prostaglandin E2 formulation which is generally indicated in cervical ripening and induction of labor especialy in term pregnancies with unfavorable cervix. Although it was not recommended in patients with premature rupture of membranes in the past, it has been shown in a number of studies that it can safely be used in patients with premature rupture of membranes as well. Our aim in this study is to compare the efficacy and safety of controlled-release dinoprostone vaginal insert in patients with intact membranes and premature rupture of membranes (PROM). Methods: Eighty-six term pregnant patients with singleton pregnancy, with no prior uterine scar, vertex presentation, bishop score of 6 or more, were included in the study. Patients were divided into two groups as PROM patients (n:27) and patients with intact membranes (n:59). Results: There was significant diffence in cervical ripening time which was achieved at approximately 4 hours in the PROM group and 6 hours in the intact membrane group. There was no significant difference in terms of vaginal delivery ratio, Apgar scores and fetal gas parameters between the two groups. Conclusion: These data overall suggest that controlled-release dinoprostone insert use is effective and safe in patients with PROM just like in patients with intact membranes. Keywords: cervical ripening, induction of labor, dinoproston, premature rupture of membranes The evaluation of type of delivery PROM group (n:27) Intact membranes (n:59) vaginal birth 22(81,5%) 40(67,8%) cesarean delivery 5(18,5%) 19(32,2%) There was no siginificant difference in type of delivery between the two groups (p=0,189) The evaluation of neonatal outcomes PROM n(%) Intact membranes n(%) p 1.minute apgar score<7 1(3,7%) 8(13,7%) 0,262 5.minute apgar score<7 0(0%) 2(3,4%) 1,000 umbilical artery ph<7,2 2(7,4%) 5(8,4%) 1,000 neonatal intensive care unit administration 0(0%) 4(6,7%) 0,304 operative vaginal delivery (vacuum extraction) 1(3,7%) 0(0%) 1,000 There was no significant difference in neonatal outcomes between the two groups

61 [PP-048] Fetal magnetic resonance imaging measurements of midbrain and hindbrain in agenesis of corpus callosum cases Tülay Öztürk 1, Semir Köse 2, Handan Güleryüz 1, Sabahattin Altunyurt 2 1 Dokuz Eylül University Medical Faculty Radiodiagnostic Department Pediatric Radiology Division İzmir Türkiye 2 Dokuz Eylül University Medical Faculty Obstetrics and Gynecology Department Perinatology Division İzmir Türkiye Summary: MB and HB malformations are commonly associated with cerebral anomalies and found in patients with intellectual disabilities. There is an increasing interest on the associated MB and HB anomalies in ACC cases to predict the prognosis and provide proper counselling. By establishing methodologies and nomograms, previous studies are paved the way for a more standardized assessment of these parameters. Objectives: To measure six parameters; 2 midbrain (tectal length, anteroposterior midbrain diameter), 2 hindbrain (anteroposterior pons diameter, pontine flexure) and 2 vermian (anteroposterior vermian diameter, superoinferior vermian diameter), in prenatally diagnosed agenesis of corpus callosum cases by fetal MRI according to newly introduced methodologies and nomograms. Method: Fetal MRI archive of 30 ACC cases retrospectively evaluated and true midsagittal sections used to assess the MB and HB parameters. The targeted measurements could be fulfilled in 22 of cases. T2 weighted single-shot fast spin echo (HASTE) sequences acquired with 1.5 Tesla Gyroscan NT Achieva software version (Philips Healthcare, Netherlands) were used for fetal MRI evaluations. Findings: Less than 5 percentile values for tectal length (TL), anteroposterior MB diameter (APMD), anteroposterior pons diameter (APPD), superoinferior vermis diameter (SIVD) and anteroposterior vermis diameter (APVD) were found in 10/22(45%), 5/22(23%), 6/22(27%) and 5/22(23%) of cases, respectively. In qualitative evaluation of pontine shape, 4/22 cases showed absent pontine flexure. Conclusions: Pontine maldevelopment seems to be associated with some ACC cases. Before counselling the family, MB and HB assessment should be incorporated into routine evaluation of such cases. Keywords: agenesis of corpus callosum, midbrain, pons, fetal MRI [PP-049] Prenatal diagnosis of meconium peritonitis secondary to ileum volvulus perforation: a case report Başak Kaya, Deniz Kanber Acar, Ali Ekiz, Salim Sezer, Gökhan Yıldırım, Halil Aslan Kanuni Sultan Süleyman Education and Research Hospital, Department of Perinatology, İstanbul, Türkiye Objective: Meconium peritonitis is defined as a sterile chemical peritonitis, that is induced by intrauterine bowel perforation. We aimed to present a case of meconium peritonitis and discuss the correlation of prenatal ultrasonographic findings and postnatal outcome. Method: Prenatal diagnosis of meconium peritonitis secondary to ileum volvulus perforation was discussed. Findings: A 24 year-old woman, gravida 4, para 1, was referred to our hospital at 35 weeks of gestation on suspicion of fetal intestinal abnormality. Ultrasound examination showed polyhydramnios, dilated bowel loops (maximum transverse diameter was 42mm), loculated fluid between liver serosa and anterior abdominal wall and diffuse intraabdominal calcifications. The preliminary diagnosis considered were volvulus and meconium peritonitis. Cesarean section was performed due to nonreassuring fetal heart rate and a 2730 gram female infant was delivered with apgar scores of 5 and 7 at 1 and 5 minutes. Laparotomy was performed following delivery at 2 hours of life. Intraoperative observation revealed ileal perforation due to volvulus. Ileal resection and ileostomy were performed. The diagnosis of meconium peritonitis due to ileum volvulus perforation was confirmed. Conclusion: Recent studies demonstrated that prenatal ultrasonographic findings of meconium peritonitis may anticipate the postnatal outcome and the need for postnatal surgery. Persistent

62 ascites, pseudocyst or dilated bowel loop are defined as the positive findings in prediction of the need for postnatal surgery with the highest sensitivity and a negative predictive value. In the presence of these findings the diagnosis of meconium peritonitis should be considered and delivery should be planned in a tertiary center. Keywords: meconium peritonitis, volvulus fetal ascites fetal bowel dilatation

63 [PP-050] Surgical treatment of uterine atony; asessment of final year obstetrics and gynecology residents with a questionnaire Baris Kaya 1, Burcin Karamustafaoglu Balci 2, Korkut Daglar 3, Mesut Polat 4, Abdullah Tuten 5, Onur Guralp 6 1 Near East University Faculty of Medicine, Department of Obstetrics and Gynecology 2 Medeniyet University, Goztepe Research and Training Hospital, Department of Obstetrics and Gynecology 3 Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey 4 Zeynep Kamil Education and Training Hospital, Istanbul, Turkey 5 Istanbul University, Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology, 6 Bozova State Hospital, Sanliurfa Introduction Postpartum hemorrhage is the number one cause of maternal mortality in developing countries and is the cause of 25 percent of maternal deaths worldwide. This study was designed to assess the attitudes of last-year residents towards surgical treatment of uterine atony. We aimed to find out which procedures they assisted and/or performed, how many times and to figure out their selfconception about the ability to perform the procedures by him/herself. Material and Methods This cross-sectional, descriptive-analytic study was conducted in Turkey. The target population was senior residents in obstetrics and gynecology. A self-administered questionnaire was used for data collection. Results A total of 162 persons filled the questionnaire. The majority of respondents were female (59.26%) % of the participants were working in training hospitals, whereas the rest (20.99 %) in

64 university clinics % of the responders never experienced postpartum atony resistant to medical treatment, whereas % experienced it more than ten times. Intrauterine balloon insertion from the vaginal route is the first choice of senior residents for the treatment of uterine atony resistant to medical treatment after vaginal birth. Unfortunately 22.22% of them never assisted to the insertion of intrauterine balloon, 66.05% never performed it by himself/herself and 12.35% think that he/she is not able to use it if needed. Conclusion An important percent of of OB&GYN senior residents did not see or perform keystone surgical procedures of the treatment of postpartum atony. More care should be taken about the education of the management of postpartum atony. Keywords: postpartum atony, senior residents, questionnaire, intrauterine balloon [PP-051] Gebelerin İlk Trimesterde NRS 2002 ile nutrisyonel durumunu değerlendirlmesi Nilüfer Akgün, Ebru Yüce, Müberra Namlıkalem, Ayşe Altındiş Bal, Zehra Candan İltemir Duvan Turgut Özal Üniversitesi Tıp Fakültesi,Kadın Hastalıkları Ana bilim Dalı, Ankara Nutrisyon Risk Taramasi-2002 (NRS-2002) ESPEN önerisi doğrultusunda hastaların beslenme durumunu değerlendirmek için kullanılmaktadır. Amaç: Bu çalışmanın amacı bir üniversite hastanesine başvuran gebelerin NRS-2002 skorlama sistemine göre beslenme durumunun değerlendirilmesidir. Yöntem: Turgut Özal Üniversitesi polikinliğine başvuran ilk trimester gebeliği bulunan hastalar beslenme durumu malnutrisyon riski açısından NRS 2002 skorlama sistemi ile değerlendirildi. Çalışma prospektif olarak yapıldı. Hastaların yaş, gravida, parite, boy, BKİ, gebelik başlangıç kilosu, gebelik haftasına göre vücut ağırlığı kayıt edildi. NRS 2002 skorlama sistemine göre nutrisyon değerlendirmesi yapıldı. NRS skoru >=3 olan hastalar malnutrisyon riski altında kabul edildi. Bulgular: Çalışmaya 112 hasta alındı. Yaş ortalaması 28,2±5,1 yıl, gravida 2,0±1,3, parite 0,8± 1,0, abort 0,3±0,6, gebelik haftası 9,8±2,2, boy 162,6±5,2, gebelik başlangıç kilosu 64,8±11,4 (min 46, max112), gebelik kilosu 64,5±10,8 ( min 49,max112), kilo kaybı 1,2±2,1( en fazla 7 kilo alınmış, en fazla 13 kilo verilmiş) BKİ 24.5±4,2 (min 16, max 41,7) idi. Gebelerin %20,5 inin vücut ağırlığı hiç değişmemiş, %42,8 olgu ilk trimesterde ağırlık artışı olup, %36.6 olgunun ise ilk trimesterde kilo kaybı olduğu saptandı. NRS skoru %61,6 gebede sıfır, %16,1 olguda bir puan, %15,2 olguda iki puan %7,1 olguda ise 3 puan olarak hesaplandı. Olguların BKİ ile kilo değişimi arasında anlamlı farklılık saptanmadı (p=0.471). Sonuç: Çalışmada ilk trimesterde gebelerin %7,1 inin malnutrisyon açısından riskli grupta olduğu saptandı. Gebelikte bulantı, kusma, iştah değişikliklerinin gebeliğe bağlı normal durumlar olarak kabul edilmesi nutrisyonel durumu ileri derecede bozuk olan gebelerin tanımlanma ve tedavi edilmesinde ileri derecede bir sorun oluşturmaktadır. Gebelikte malnutrisyon unutulmamalı nutrisyonel değerlendirme göz ardı edilmemelidir. Anahtar Kelimeler: Gebelik, NRS-2002, nutrisyonel değerlendirme [PP-053] Modifiye Shirodkar Serklaj Olgularının Retrosepktif Analizi Ayça Nazlı Bulut, Mehmet Serdar Kutuk, Mehmet Dolanbay, Gunel Eliyeva, Mahmut Tuncay Ozgun, Mustafa Basbug Erciyes Üniversitesi Kadın Hastalıkları ve Doğum Giriş: Bu çalışmanın amacı Modifiye Shirodkar Servikal Serklaj uygulamasının gebelik sonuçları üzerindeki etkisini incelemektir. Materyal-Metod: Erciyes Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum kliniğinde Ocak 2012-Şubat 2015 tarihleri arasında Modifiye Shirodkar servikal serklaj uygulanan hastalar retrospektif olarak tarandı. Sonuç: Çalışmaya toplamda 78 hasta dahil edildi. Hastaların ortalama yaşı 30.4±4.5 yıl ve BMI 27.4±4.2 kg/m2 idi. En sık endikasyon önceki preterm doğum + önceki ikinci trimester kayıpları (48/78, %61.5) olup, hastaların 14 ünde (%17.9) servikal dilatasyon, 10 unda (%12.8) uterin

65 anomali, 6 sında (%7.7) USG de kısa serviks izlenmesi nedeniyle serklaj uygulandı. 39 hastanın önceki gebeliklerinde ikinci trimester kaybı öyküsü olup, ortalama kayıp sayısı 2.25±1.79 (1-9 aralığında) idi. TVUSG ile hastaların ortalama servikal uzunlukları 22.2±10.1 mm olup, 38 hastada funneling vardı (%48.7). Çalışmaya dahil edilen hastalarda, serklaj işlemi ortalama 16+5±3+0 ıncı ( aralığında) gestasyonel haftada yapıldı. İşlem esnasında hiçbir hastada erken membran rüptürü (EMR), koryoamnioit, servikal laserasyon, ya da mesane yaralanması gibi bir komplikasyon gelişmedi. 42 hastaya (%53.8) tokolitik tedavi verildi ve ortalama hastanede yatış süresi 2.85 gün idi. 9 hastanın gebeliği halen devam etmekte olup ortalama gebelik haftası 31+1 dir. 55 (%70.5) hastada canlı doğum elde edildi. Çalışmaya dahil edilen ve gebeliği sonlanan tüm hastalarda ortalama doğum haftası 30+0 idi. Sonuç: Modifiye shirodkar serklaj operasyonu, mesane hasarı, kanama ve yara iyileşmesi açısından risk içermemektedir. Bu nedenle özellikle kısa serviksli olgularda serklaj operasyonunun etkinliğini artırmak için kullanılabilir. Anahtar Kelimeler: serklaj, shirodkar, erken doğum [PP-055] The effect of low molecular weight heparin or oral folic acid on pregnancy outcomes in patients with recurrent pregnancy loss and MTHFR mutations Mahmut Tuncay Ozgun 1, Mehmet Serdar Kutuk 1, Hatice Durmus 1, Semih Uludag 1, Mehmet Dolanbay 1, Tolga Atakul 2 1 Erciyes University, School of Medicine, Departments of Obstetrics and Gynecology 2 Karabuk University, of Medicine, Departments of Obstetrics and Gynecology Objectives: The purpose of the study was to evaluate the effect of low molecular weight heparin (LMWH) or oral folic acid treatment on pregnancy outcomes in patients with recurrent pregnancy loss and MTHFR mutations. Materials-Methods: The study included 89 pregnant patients with two or more previously pregnancy loss and MTHFR C667T and A1298C mutations. Before pregnancy the patients were evaluated due to recurrent pregnancy loss. The patients were grouped into two as LMWH group, starting the LMWH treatment within the first 7 weeks of pregnancy, and the folic acid group, only folic acid were supplemented. Obstetric outcomes were followed. Results: In the LMWH group, 49 women, and 40 pregnant women in the folic acid group were included. First trimester abortion rate was similar in two grups (LMWH group n= 10 (20.4%) folic acid group n= 9 (22.5%). (p = 1.00). Live birth rate was similar in both groups (79.6% vs 77.5%) (p = 1.00). In both groups during pregnancy, there was no significant difference in the incidence of preeclampsia, IUGR, postpartum DVT and postpartum hemorrhage. Conclusions: In the treatment of patients having recurrent pregnancy loss with MTHFR mutations, the choice of treatment should be oral folic acid instead of LMWH due to ease of use and lower cost. Keywords: LMWH, MTFR, pregnancy loss, folic acid [PP-056] Monokoryonik monoamniotik ikiz gebelik ve ikiz eşinde kloaka anomalisi olgu sunumu Burcin Karamustafaoglu Balci 1, Ibrahim Halil Kalelioğlu 2, Recep Has 2 1 Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum ABD 2 İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Kadın Hastalıkları ve Doğum ABD Giriş Monozigotik ikizlerde konjenital anomali oranı artmıştır. Kliniğimizde takip edilen kloaka anomalisi olan bir monokoryonik monoamniotik (MK-MA) ikiz gebelik olgusunu sunmaktayız. Vaka Sunumu 27 yaşındaki hasta 12+3 haftalık gebe iken çoğul gebelik endikasyonu ile başvurdu gebelik haftasında 2. düzey ultrasonografi yapıldı; MK-MA ikiz gebelik saptandı, fetusların birinde megasistis görüldü ve infravezikal obstrüksiyon düşünüldü, her iki fetusun da kız olduğu saptandı.

66 17. gebelik haftasında amniosentez yapıldı gebelik haftasında tekrarlanan 2. düzey ultrasonografide anomali saptanmış olan fetusun bir böbreğinde obstrüksiyona sekonder kistik displazi ve karşı böbrekte ekojenite artışı ile beraber şüpheli displastik böbrek izlendi. Diğer fetusta anomali saptanmadı gebelik haftasında fetal kromozom analizinin sonucunun normal olduğu öğrenildi, sağ ve sol böbrekte subkortikal kistler izlendi, kolon ansı dilate idi, kloaka anomalisi olabileceği düşünüldü gebelik haftasında anomalisi olan fetusun anal sfinkteri görülemedi, her iki böbrek displastik, barsaklar dilate idi. 34. gebelik haftasında hasta fetal distres endikasyonu ile operasyon salonuna alındı. İki kız bebek doğurtuldu. Prenatal anomali tanısı olan fetusun postnatal üriner sistem ultrasonografisinde her iki böbrek atrofik izlendi (sağ 16 mm, sol 25 mm). Sol böbrekte birkaç adet en büyüğü 7*9 mm olmak üzere anekoik kistler izlendi. Hasta Çocuk Cerrahisi ve Çocuk Sağlığı ve Hastalıkları ekipleri tarafından tedavi edilmektedir. Sonuç Monozigotik ikizler artmış konjenital anomali ihtimaline sahiptir ve ikinci düzey ultrasonografik inceleme ve fetal ekokardiyografi gerektirirler. Kloaka anomalisi prenatal tanısı önemli olan bir patolojidir. Orta hatta kistik kitle görüldüğünde, bu kistin mesane olduğu kanıtlanırsa rektuma da bakarak mekonyum varlığı incelenmelidir. Bu tür vakalarda rektumda mekonyum yokluğu kloaka anomalisi tanısı koydurmaktadır. Anahtar Kelimeler: monokoryonik monoamniotik ikiz gebelik, kloaka anomalisi, fetal anomali [PP-057] Isolated fetal ascites: A case report Deniz Karçaaltıncaba, Murat Aykut Özek, Fırat Büyüktaşkın Gazi University, Department of Perinatology A 29-year-old woman was referred to our perinatology unit at 31 weeks of gestation with new onset fetal hydrops. On the sonogram, we observed isolated fetal ascites. The patient s blood type is A Rh ( ), antibody screening test was negative. She was tested negative for Parvovirus B19 and VDRL test. MCA Doppler PSV was between 1,3-1,5 MoM. Cordocentesis was performed to exclude the possible diagnosis of severe anemia. Complete blood count revealed mild fetal anemia. Then intrauterine transfusion was performed with the aim to relieve ascites. Karyotype analysis was reported to be normal. MRI scan revealed isolated fetal ascites (Figures 1 and 2). At 34 weeks of gestation, 150cc of the fetal intraabdominal fluid was punctured, and weekly aspirations were performed twice thereafter. Laboratory results of the fluid was compatible with chylous ascites. At 38 weeks of gestation elective cesarean delivery was performed and 4090gr male neonate was born with an APGAR score of 5/8 and was transferred to neonatal intensive care unit. 500cc of ascites was drained with paracentesis. Intravenous somatostatin analogue treatment was started after confirmation of chylous ascites. The last abdominal sonography was reported to be normal and he was sent home with subcutaneos injections of somatostatin analogue. Isolated fetal ascites is an infrequent condition. It s prevelance has not been established exactly yet. Most of the isolated fetal ascites cases have shown to be associated with congenital lymphatic abnormalities leading to chylous ascites. Biopsy of the small intestine is recommended for definitive diagnosis during postnatal period. Keywords: Fetal ascites, fetal paracentesis, lymphangiectasis

67 Figure 1 MRI image of the fetus displaying fetal ascites on sagittal view Figure 2 MRI image of the fetus displaying fetal ascites on transverve view.

68 [PP-058] Achondrogenesis Type 1b (Parenti Fraccaro): A Case Report Murat Aykut Özek, Yaman Değirmenci, Merih Bayram Gazi University, Department of Perinatology A 21 year-old primigravid woman was referred to our clinic at 21 weeks of gestation with the diagnosis of micromelia. The patient and her husband were not consanguineous, there was no teratogen exposure during pregnancy. Prenatal screening tests were in normal range. On fetal sonogram we detected thoracic hypoplasia, tetramicromelia (Figures 1&2) and hypomineralizition at calvarium. The patient was counselled about lethality of the condition and the family opted for termination of pregnancy. After termination of pregnancy, it was observed that the female fetus had short extremities, a small thorax, a bigger head ratio to thorax and micrognathia (Figure 3). Radiologic examination of the fetus confirmed hypomineralizition of the cranium (Figure 4) and micromelia. Achondrogenesis totally occurs approximately in 1/ births. The main cause is the mutation in the gene which is responsible for collagen type II structure. Type 1 is inherited in an autosomal recessive mode, but type 2 is mostly caused by de novo autosomal dominant mutations of the gene coding collagen structure (COL2A1). The genetic cause of achondrogenesis type 1a is TRIP11 gene mutation. The cause of type 1b achondrogenesis is the recessive mutation of gene DTDST and it is the most severe type. The diagnosis of achondrogenesis can be made as early as 13 to 14th weeks of gestation by detecting short femur length. The major finding is mostly micromelia. In our case, hypomineralization was prominent at calvarium, indicating type 1 achondrogenesis. There is no antenatal treatment for achondrogenesis and this disorder is always lethal. Keywords: Achondrogenesis, antenatal diagnosis Figure 1 Severe micromelia on sonogram

69 Figure 2 Thoracic hypoplasia, transverse view Figure 3

70 The fetus had short extremities, a small thorax, a bigger head ratio to thorax and micrognatia Figure 4

71 Fetogram. Hypomineralization of cranium and micromelia can be seen. [PP-059] Fetal akinesia deformation sequence: A case with early diagnosis Murat Aykut Özek, Deniz Karçaaltıncaba Gazi University, Department of Perinatology A 39-year-old woman (G5P3) was referred because of increased nuchal translucency (NT: 4,3 mm). Her first and third pregnancies were terminated because of arthrogryposis and hydrops fetalis; at gestational ages of 20 and 16, respectively. But, in neither of the cases, they gave consent to necropsy or genetic testing. She had also two healthy children with ages 9 and 3. The patient and her husband were consanguineous (2nd degree). Ultrasound examination at 11th week revealed increased nuchal translucency (NT: 4,2 mm) and no fetal movements were observed. Chorion villus sampling was performed and karyotype analysis was normal. On the ultrasound examination at 13th week; the fetus had cystic hygroma at the nuchal region, diffuse subcutaneous edema, micromelia and ankyloses affecting upper and lower extremities and bilateral clubfeet (Figures 1-4). The family was counselled about high lethality of the condition and they opted for termination of pregnancy (Figures 5&6). Fetal akinesia deformation sequence (FADS) is consisted of heterogenous group of conditions characterized with diffuse arthrogryposis. It s incidence is estimated to be 1/15,000. Ultrasonographic findings include absence of fetal motions, limb contractures, micrognathia, thoracic hypoplasia, increased nuchal translucency, cystic hygroma and hydrops fetalis. Because FADS is mainly inherited in an autosomal recessive mode, it has a recurrence risk of 25 % and the condition is lethal in most of the cases. Early diagnosis of fetal akinesia as 12 weeks of gestation is possible. Genetic mutations associated with the condition have been reported and analysis of those could help counseling and management. Keywords: Fetal akinesia deformation sequence, early diagnosis

72 Figure 1 Cystic hygroma Figure 2

73 Short femur Figure 3

74 Short humerus Figure 4

75 Limb contractures (upper and lower extremities) Figure 5 Fetus after termination. Limb contractures and tetramicromelia can be seen. Figure 6

76 Fetogram displaying short lims and contractures [PP-060] Spontaneous Ovarian Hyperstimulation Syndrome Complicating Natural Conception Murat Aykut Özek, Gizem Işık, Merih Bayram Gazi University, Department of Perinatology A 23 year-old primiparous woman admitted at 5 weeks of gestation. She had no symptoms regarding OHSS and the ultrasound scan revealed viable intrauterine pregnancy and normal appearing ovaries. At 11 weeks of gestation she attented with complaints of abdominal pain and distention. On sonography intrauterine pregnancy of 11 weeks of gestation and bilaterally enlarged ovaries 164 x88mm(right ovary), 105x105mm (left ovary) with multiple cysts were seen. Mild ascites was seen (Figure-1). Hemoglobine value was 15,7g/dl, hemotocrite was % 44,7, albumin level was 2,5 gr/dl and liver enzymes were increased (AST: 63u/l, ALT:96u/l). Thyroid function tests were normal. Abdominal circumference of the patient was 90cm. Management including close monitoring of vital signs, daily laboratory tests, intravenous hydration, thromboembolic prophylaxis with low molecular weight heparin and albumine replacement were initiated. At 12 weeks 1 day of gestation, abdominal ultrasound was performed, ovarian sizes were decreased bilaterally (right ovary: 119x116mm, left ovary: 83x84mm) and volume of ascites was relatively reduced (Figure 2). Laboratory results came up with the results of hemoglobine 10,4 g/dl, hemotocrite %32, AST: 27u/l, ALT: 52u/l, albumin level was 3,7 gr/dl. The abdominal circumference was also reduced (79 cm). OHSS only rarely occurs spontaneously. It has been associated with hypotyroidism, polycystic ovary syndrome, gonadotropin-producing adenoma, multiple pregnancy and Down syndrome. There are also cases which were reported to be idiopathic. Although spontaneous OHSS is rare; its diagnosis and treatment is important because it has high morbidity in its severe forms. Keywords: Ovarian Hyperstimulation Syndrome, Spontaneous

77 Figure 1 Initial abdominal sonographic findings of OHHS: A. Mild ascites and viable intrauterine pregnancy B. Right ovary C. Left ovary Figure 2 At 12 weeks 1 day of gestation sonographic findings: A. Volume of ascites is relatively reduced B. Right ovary C. Left ovary [PP-061] Giant cystic hygroma: Report of two cases Murat Aykut Özek, Tuncay Nas Gazi University, Department of Perinatology Our first case was a 26 year-old primigravid woman. She was referred with the diagnosis of cystic hygroma. At first trimester screening, NT was 1,3 mm. During the fetal anatomical screening, cystic hygroma at the posterior of the neck was detected (55x50 mm). Amniocentesis and fetal echocardiography were normal. No signs of hydrops developed, the dimensions of the mass were 80x70 mm at the last sonogram (Figure1). At 39 weeks of gestation, elective cesarean delivery was performed and male fetus weighing 2840 gr was delivered. After completion of postnatal first month, intralesional bleomycine therapy was performed. Our second case was a 34 year-old primigravid woman. At first trimester, NT was 1,6 mm. During the fetal anatomical screening, cystic hygroma located at the right anterolateral region of the neck was detected (35x25 mm). Amniocentesis and fetal echocardiography were normal. No signs of hydrops or polyhydramniosis developed. The dimensions of the mass were 110x95 mm at the last sonogram (Figure 2). At 34 weeks of gestation, the patient presented with preterm labor. Cesarean delivery was performed

78 and male fetus weighing 2440 gr was delivered. Intralesional bleomycine injection was performed and the newborn is being followed in the neonatal intensive care unit. Cystic hygroma is a congenital malformation of the lymphatic system. They are associated with chromosomal abnormalities and major structural anomalies. Their birth prevalence is approximately 1 in Complete excision of the mass is the treatment of choice but intralesional sclerosing agents is being used with success also. Keywords: Cystic hygroma, intralesional therapy Figure 1 Cystic hygroma at the posterior neck region, first case Figure 2

79 Cystic hygroma during the last sonogram of the second case [PP-062] A sudden onset late hemorrhagic complication of HELLP syndrome Ömer Demirtaş, Ömer Tolga Güler, Özer Öztekin, Serkan Karayiğit, Ibrahim Veysel Fenkci Pamukkale üniversitesi tıp fakültesi kadın hastalıkları ve doğum anabilim dalı Summary: HELLP syndrome is a life-threatening condition that should be managed delicately in order to minimize maternal morbidity. Objectives: To present a late hemorrhagic complication of HELLP syndrome in a patient after caesarean section. Methods: Patient file along with laboratory and clinical findings were analyzed. Findings: An 18 years old woman was referred to our centre at 30 weeks of pregnancy with severe preeclampsia-hellp. She also had signs of cerebral dysfunction. An emergent C-section was performed after stabilization of the patient. There was no abnormal coagulation status during surgery and the bleeding control was achieved. The first post-operative 24 hours of the patient was uneventful and the total peritoneal drainage was below 100 cc. However, a sudden increase in drainage (400 ml/hour) was observed at the 26st hour along with anuria. A second laparotomy was performed but no active bleeding vessel was observed. On the other hand, oozing type of bleeding was observed from peritoneal surfaces. Abdominal washing was performed and support of fresh frozen plasma was initiated. Postoperative follow showed no active drainage and the patient eventually discharged after 10 days later. Conclusions: Late complications of HELLP syndrome are not uncommon. Disseminating intravascular coagulation may result in serious suddenhemorrhagic complications even after 24 hours from termination of the pregnancy. Keywords: HELLP, postpartum complication, thrombocytopenia

80 [PP-063] The association of impaired gestational glucose tolerance with maternal and fetal outcomes Esin Kasap 1, Mine Genc 1, Arzu Turan 1, Fatma Eskicioglu 2, Ali Saklamaz 3, Nur Sahin 1, Serkan Guclu 1 1 Department of Obstetrics and Gynecology, Sifa University School of Medicine, İzmir, Turkey. 2 Department of Obstetrics and Gynecology,Merkez Efendi State Hospital,Manisa,Turkey 3 Department of Endocrinology, Sifa University School of Medicine, İzmir, Turkey Aim: The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes. Methods: A total of 200 pregnant women were included in this cross-sectional study. A 50 g oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 g of oral glucose in those with an abnormal 1-hour test result. Obstetric and perinatal outcomes were recorded. Results: No significant difference was observed in BMI, parity and age. While FBG did not differ significantly between IGT and GDM groups, subjects in GDM group had significantly higher 1, 2 and 3-hour blood glucose levels in 50 g GCT and OGTT tests.the following were not significantly different between groups.preterm labour (PL); pregnancy induced hypertension (PIH),preeclampsia,polyhydramnios,macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups as suggested by the absence of significant differences in the proportion of newborns with hyperbilirubinemia, hypoglycemia, or RDS. Conclusion(s): In conclusion, our results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.well-designed, larger prospective studies involving borderline GDM patients are warranted to further clarify this association. Keywords: Gestational diabetes, Impaired Glucose Tolerance, pregnancy Table 1. Comparative descriptive statistics in IGT and GDM groups Variables IGT (n=21) GDM (n=28) p-value BMI ± ± Fasting blood glucose (mg/dl) ± ± Age(years) ± ± Gr. Glucose Ghallenge Test ± ± * OGTT 1.HOUR ± ± * OGTT 2.HOUR ± ± * OGTT 3.HOUR ± ± * Neonatal birth weight (kg) ± ± * Parity IGT (%) GDM (%) p-value 1 8 (38.1) 5 (17.9) (42.9) 13 (46.4) (14.3) 7 (25.0) (4.8) 3 (10.7) 0.379

81 * p<0.05 was accepted for statistical significance.ogtt, oral glucose tolerance test;gdm, gestational diabetes mellitus;igt, impaired fasting glucose tolerance Table 2. Comparative categorical data in IGT and GDM groups Variables IGT GDM p-values Yes (%)No (%) Yes (%)No (%) Polyhydramnios 3 (14.3) 18 (85.7) 9 (32.1) 19 (67.9) Delivery before 37 weeks 0 (0) 21 (100) 3 (10.7) 25 (89.3) Vaginal birth 12 (57.1) 9 (42.9) 6 (21.4) 22 (78.6) * Cesarean delivery 9 (42.9) 12 (57.1) 22 (78.6) 6 (21.4) * Macrosomia 3 (14.3) 18 (85.7) 9 (32.1) 19 (67.9) Pre-eclampsia 3 (14.3) 18 (85.7) 4 (14.3) 24 (85.7) PIH 0 (0) 21 (100) 3 (10.7) 25 (89.3) Neonatal hyperbilirubinemia 4 (19.0) 17 (81.0) 7 (25.0) 21 (75.0) Neonatal hypoglycemia 0 (0) 21 (100) 4 (14.3) 24 (85.7) RDS 3 (14.3) 18 (85.7) 6 (21.4) 22 (78.6) * p<0.05 was accepted for statistical significance.; RDS: Respiratory Distress Syndrome; PIH: Pregnancy Induced Hypertension; GDM, gestational diabetes mellitus;igt, impaired fasting glucose tolerance [PP-064] Prenatal dönemde tanısı konulan Trizomi 18 ve Klinefelter Sendromunun birlikte olduğu çift anöploidi (48, XXY, +18) olgusu Sebahat Atar Gürel 1, Betül Yorgunlar 1, Esra Tuğ 2 1 İstanbul Medipol Üniversitesi, Tıp Fakültesi, Kadın Hastalıkları ve Doğum AD, Perinatoloji BD, İstanbul 2 Gazi Üniversitesi Tıp Fakültesi Tıbbi Genetik AD, Ankara Amaç: Çift anöploidi aynı kişide birden fazla sayıda farklı kromozomda anöploidinin bulunmasıdır. Trizomi 18 ve Klinefelter Sendromunun birlikte olduğu çift anöploidi (48, XXY, +18) olguları oldukça nadir olup burada kliniğimizde 17+5 gebelik haftasında tanısı konulan 48, XXY, +18 çift anöploidi olgusu sunularak literatür eşliğinde tartışılmıştır. Olgu: 41 yaşındaki olgunun ilk gebeliği olup ikili testinde trizomi 13/18 riskinin yüksek (risk:1/6) gelmesi nedeniyle 17+5 gebelik haftasında başvurdu. Gebeye amniyosentezden hemen önce yapılan genetik sonogramda fetal gelişim 16+2 hf ile uyumlu olup hipoplazik burun kemiği, inlet tipi VSD ile ductus venosusda diyastol sonu ters akım ile karakterize patolojik akım saptanıldı. Amniyosentez sonrası fetal karyotip Trizomi 18 ve Klinefelter Sendrom çift anöploidi (48, XXY, +18) geldi. Ailenin isteği ile gebelik dış merkezde sonlandırıldı. Sonuç: Bilgimiz dahilinde, kendi olgumuz ile birlikte prenatal dönemde tanı konulan toplam beş 48, XXY, +18 çift anöploidi olgusu bildirilmiş olup bunlardan sadece ikisinin tanısı previabl dönemde yapılmıştır. Previabl dönemde tanı konulan iki olguda da ultrason ile saptanılan bulgular çift anöploidi bulunmasına rağmen kolayca saptanılabilecek, ciddi anomaliler olmayıp kromozom anomalilerinin prenatal tanısında tarama testi ile genetik sonogramın önemini göstermektedir. Anahtar kelimeler: Çift anöploidi, trizomi 18, Klinefelter Sendromu, prenatal tanı, ultrasonografi Anahtar Kelimeler: ultrasonografi, prenatal tanı, trizomi 18, Klinefelter Sendromu, çift anöploidi

82 [PP-065] A case with tetra-amelia syndrome Gülenay Gencosmanoğlu Türkmen, Yüksel Oğuz, Mehmet Aytaç Yüksel, Enes Bil, Mehmet Seçkin Özışık, Eyüp Sabri Şeyhanlı şanlıurfa obstetrics and gynecology hospital Aim: to report a fetus with tetra-amelia syndrome A 26 years old Syrian woman who had a history of four times abortion at 20 weeks was referred our clinic for further investigation. On the routine antenatal ultrasound examination bilateral fetal extremities were not detected. BPD was measured as compatible with 16 weeks. In the sacral region a protrusion that was thought to be a tail was seen. Additionally a median cleft limb and palate, low located ears were detected. Iliac bones were not seen on the examination. Initially amniocentesis for chromosome analysis was offered to the patient; but not accepted by the family. Termination was done by oral and vaginal misoprostol.. After termination the observed findings at fetus were compatiple with ultrasound findings. Keywords: Tetra-amelia syndrome, anomaly screening

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86 [PP-066] On the track of gestational sac: An unusually located ectopic Pregnancy Doruk Cevdi Katlan 1, Bulut Varlı 1, Betül Yakıştıran 1, Tuncay Yüce 1, Salih Taşkın 1, Esra Çetinkaya 1, Fulya Dökmeci 1 ( 1 ) Ankara University School of Medicine Department of Obstetrics and Gynecology, Ankara, Turkey Background Aim Ectopic pregnancy, still a leading cause of morbidity and mortality despite the technological improvement in medicine, is mostly found to be localized in the fallopian tubes. However, there are rarely some that are implanted within the uterus but outside the endometrial cavity. The rarest of all, representing less than 1%, is the intramural ectopic pregnancy (IEP). It may be a dangerous criminal and sometimes a killer, suspicion being the mainstay of early diagnosis. Recent advances in sono-technology also help its detection before the occurrence of life-threatening complications and its treatment with less invasive procedures thus, improving the patients future fertility. Here, we aim to emphasise, even in the setting of a normally elevating β-hcg level, the inability to visualise intrauterine normally located gestational sac in the presence of alerting risk factors may end up with a surprising diagnosis. Case Report 26 year-old women with history of a healthy in vitro fertilization (IVF) twin delivery via caesarean section and a laparoscopic left salpingectomy due to a tubal ectopic pregnancy was admitted to our clinic with consecutive β-hcg levels of 800, 1841 and 3020 IU/L every other day. Ultrasound exam at first sight demonstrated no evidence of intrauterine pregnancy but careful work up revealed a 8,6 mm gestational sac with a CRL: 2,5 mm heart-beating embryo implanted to left superoposterior intramural-subserosal portion of the uterus. The sac was observed to be independent from endometrial lining covering uterine left cornu and in close vicinity to abdominal viscera and great vessels rendering a percutaneous local intervention risky. The patient was

87 informed about all the possible conservative and surgical treatment options. Upon her request, intramuscular methotrexate 80 mg was injected. At the fourth day of injection, her β-hcg level rised to 5226 IU/L with 10 mm sac and a still heart-beating embryo. Although stable hemodynamically, she did not want to comply with the follow up and requested laparotomic surgery at the fifth day. Intraoperatively, about-to-rupture ectopic sac was located in close proximity to left uterine cornu just adjacent to previous salpinjectomy stump, interpreted as cornual ectopic pregnancy. Wedge resection was performed and her postoperative follow up was uneventful. Conclusion The exact aetiology and pathogenesis of IEPs are unclear. One theory proposes invasion of myometrium through microscopic tracts caused by uterine trauma from surgical instrumentation or following IVF transfers. Therefore, when there is a suspicion of a pregnancy of unknown location, a careful patient history and a thorough ultrasonographic evaluation is mandatory. However, although it is possible to diagnose an IEP with ultrasound, it may be difficult to distinguish it from a cornual pregnancy. [PP-067] The first trimester ultrasonographic diagnosis of the mesomelic dysplasia in a previously affected family Uğur Keskin 1, Fahri Burçin Fıratlıgil 1, Mustafa Ulubay 1, Ulaş Fidan 1, Mehmet Ferdi Kıncı 1, Ali Ergün 2, Müfit Cemal Yenen 1 1 Obstetrics and Gynecology Department, Gulhane Military Medical Academy, Etlik, Ankara, Turkey 2 Obstetrics and Gynecology Department, Liv Hospital, Çankaya, Ankara, Turkey Objectives: The aim of this case report is to describe the sonographic findings of the upper limb mesomelia in the patient with previously affected pregnancy. Patient and Methods: A 34-year-old patient with a history of gravida 3, para 2 applied to our clinic for a routine control examination, at her 12th week of pregnancy. In the patient s anamnesis and antenatal care, a history of previous mesomelic term delivery and one with 27th gestastional week termination with anencephaly was observed. In obstetric ultrasound findings of the fetus; no visceral abnormalities was seen. The fetal biometric measurements were generally associated with 12th gestastional week. The humeral (6.5 mm) length was in 44.6th centile whereas the radial and ulnar lengths were under the 5th centile. Therefore, the patient had been referred to a genetic and orthopedic counselor with the diagnosis of upper limb mesomelia for information in detail. Results: After multidisciplinary information, the family decided to continuation of pregnancy. Conclusions: The mesomelic dysplasias are heterogeneous diseases characterized by irrational shortness of the radioulnar and/or tibiofibular segments of the distal limbs. The family should be evaluated by multidisciplinary approach and then the family should be informed in detail. It should be also explained to the family that even if the fetus having mesomelia is born, he can expose to several orthopedic surgical examination after newborn period, and it can be possible not to get the level for pursuing normal daily life even with the physical treatment procedures. Keywords: mesomelia, intermarriage, 5th centile [PP-068] Aberrant right subclavian artery (ARSA) in unselected population at second trimester ultrasound scan Selen Gürsoy Erzincan 1, Burcin Karamustafaoglu Balcı 1, Cengiz Tokgöz 3, Ibrahim Halil Kalelioglu 1 1 Selen Gursoy Erzincan, Istanbul University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Division, Istanbul, Turkey Istanbul, Turkey 2 Cengiz Tokgöz, Bilge Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey

88 Objectives: The aim of this study was to assess the incidence of aberrant right subclavian artery (ARSA) among unselected population. Methods: Presence or absence of ARSA was assessed in a population of 1913 second-trimester fetuses of unselected pregnant women. We searched for the ARSA on the three vessel trachea view using color Doppler. The patients with ARSA were offered invasive test for karyotype analysis and fluorescence in situ hybridization (FISH) for 22q11.2 microdeletion. For the patients do not accept invasive test prenatally, the karyotype was considered normal if the newborn appeared clinically normal. Results: Among 1913 patients, an ARSA was found in 20 fetuses, who were all chromosomally normal. So, the incidence of ARSA was 1.04% in this current study. There was only 1 patient with trisomy 21, who did not have ARSA. Multiple other markers of trisomy 21 was seen on this fetus; intracardiac echogenic focus, tetralogy of Fallot (TOF) and pyelectasis. Among 20 cases of ARSA, 12 were isolated and 8 were associated with other markers. Other markers were intracardiac echogenic focus (n=3), choroid plexus cyst (1), prefrontal edema (n=1), hydrocephaly (n=1), TOF (n=2). One of the cases of TOF was also associated with persistent left superior vena cava, hydrocephalus, rhombencephalosynapsis and unilateral renal agenesis. The patient opted to terminate the pregnancy. Conclusion: In our study, all fetuses with ARSA were chromosomally normal. Isolated ARSA is not a sufficient indication for karyotype analysis. Keywords: Aberrant right subclavian artery, trisomy 21, prenatal diagnosis Table 1. Demographic data of 20 patients with ARSA. patie nt no matern al age(ye ars) gestational age at diagnosis(w eeks) other cardiac anomal ies additional markers prior screen ing test NIP T invasi ve test ICEF ICEF ICEF negati ve negati ve positiv e negati ve choroid plexus cyst negati ve - norm al negati ve negati ve negati ve negati ve negati ve low risk negati - -

89 prefrontal edema TOF TOF, PLSV C rhombencephalosynapsis,hydrocep haly,unilateral renal agenesis ve negati ve positiv e negati ve negati ve negati ve negati ve negati ve negati ve negati ve ICEF: intracardiac echogenic focus. TOF: Tetralogy of Fallot. PLSVC: persistent left superior vena cava. NIPT: Non-Invasive Prenatal Testing [PP-069] Adverse perinatal outcomes of adolescent pregnancies in one center Istanbul, Turkey - norm al norm al Ali Ekiz 1, Elif Ciler Eren 2, Sezcan Mumusoglu 3, Dogukan Yildirim 1, Burchan Aydiner 1, Melih Bestel 1, Burak Ozkose 1, Hasan Cemal Ark 1 1 Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey. 2 Medipol Hospital 3 Istanbul Zeynep Kamil Maternity and Children Training and Research Hospital Purpose The objective of this study was to evaluate fetal and perinatal outcomes of pregnancies of adolescents and compare them with adult pregnancies. Material and Method This retrospective case-control study was carried out at Bakirkoy Maternity and Children's Diseases Education and Research Hospital in Istanbul, Turkey pregnancies who delivered between enrolled the study, 998 were adolescent pregnancies (Table 1) and 1493 were adults as controls. Results The mean age of the adolescent group was 17,10 and in the control group the mean age was found to be 26,73. Intermarriage, vaginal delivery, preterm rupture of membranes, preterm birth and preeclampsia were significantly higher in adolescent pregnancies than the control group. Gestational diabetes was more common with increasing age. There was no statistically meaningful difference between the groups in terms of intrauterine growth restriction(iugr), low birth weight, anemia, 5 minute APGAR score and intrauterine fetal demise (Table 2). Conclusion

90 Young maternal age is a risk factor for preterm birth, preterm rupture of membranes and preeclampsia. According to this study adolescent pregnancies are more risky and more likely to have adverse fetal outcomes. Keywords: Adverse Perinatal Outcomes, Adolescent Pregnancies Table 1 Age Number Of Patients % TOTAL Distribution of pregnancies according to the age Table 2 Obstetric Complications And Neonatal Results <= 18 age (adolescent) age (control) p value PPROM 54 (5,41 %) 35 (2,34 %) <0.001 Preterm Delivery(<37 w) 95 (9,51 %) 75 (5,02 %) <0.001 Preeclampsia 47 (4,70 %) 44 (2,94 %) <0.05 HELLP 1 (0,10 %) 3 (0,20 %) NS IUGR 39 (3,90 %) 52 (3,48 %) NS Intrauterine Demise 8 (0,80 %) 23 (1,54 %) NS Gestational Diabetes (GDM) 9 (0,90 %) 68 (4,55 %) <0.001 Placental Disorders 10 (1,00 %) 9 (0,60 %) NS 5th min APGAR <7 18 (1,80 %) 17 (1,13 %) NS Small for Gestational Age (<2500gr) 135(13,52 %) 160(10,71 %) NS Obstetric Complications And Neonatal Results [PP-070] Kell Alloimmunizasyonundan Etkilenmiş Gebeliğin Yönetimi; Olgu Sunumu Ali Ekiz 1, Deniz Kanber Açar 1, Halil Aslan 1, Ahmet Gül 2, Melih Bestel 1, Gökhan Yıldırım 1 1 Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi 2 İstanbul Prenatal Fetus ve Yeni doğanın Hemolitik Hastalığı (FYHH), fetusun veya yeni doğanın eritrositlerinin maternal antikorlar aracılığı ile yıkılmasından kaynaklanır. En sık neden Rh (D) alloimmunizasyonudur. En sık görülen minör kan grubu antikorları Kell` e karşı oluşmaktadır ve insidansı % arasındadır. 32 yaşında Gravida 5 Parite 4 yaşayan çocuk sayısı 1 olan hastanın ikinci ve üçüncü gebeliklerinde

91 tanı konamayan hidrops fetalis nedeniyle yeni doğan döneminde kayıp hikayesi mevcut. Hasta dördüncü gebeliğinde kliniğimize ilk defa 29. Gebelik haftasında hidrops fetalis bulguları ile başvurdu. Yapılan eritrosit minör grup değerlendirmesinde anne Kell negatif, baba ve ilk çocuğunun ise Kell pozitif olduğu tespit edildi. Ağır hidrops fetalis bulguları ile gelen hastanın orta serebral arter doppler bulguları fetal anemi ile uyumlu saptanmış ve intrauterin transfüzyon yapıldı. Ancak posttransfüzyonel fetüs intrauterin ex olarak saptandı. Hastanın beşinci gebeliğinde 6. Gebelik haftasından itibaren kliniğimizin takibine alındı. Rutin antenatal takibe ek olarak hastamıza 18. Gebelik haftasından başlayarak orta serebral arter doppleri ile fetal anemi değerlendirmesi yapıldı. 31. Gebelik haftasında yapılan değerlendirmede; fetal biyometrik ölçümler 30 hafta 1 gün ile uyumlu tahmini fetal kilo 1606 gr (50. persantil), MCA dopplerinde PSV (peak sistolik velosite) 75 cm/sn, 1.5 MoM üzerinde saptandı. Hasta iki kez intrauterin transfüzyon (Şekil 1) sonrasında gebeliğinin 34. Haftasında sezaryen ile 2740 gr, 50 cm boyunda, baş çevresi 34 cm olan kız bebek doğum yaptı. Bu sürede hiperbiluribinemi nedeniyle aralıklı fototerapi tedavisi aldı. Postpartum 8. Günde Hb 8.2 gr/dl ve Hct % 25.5 ile taburcu edildi. Yeni doğana hiç transfüzyon ihtiyacı olmadı. Anahtar Kelimeler: Fetus ve Yeni doğanın Hemolitik Hastalığı, Kell Alloimmunizasyonu, İntrauterin transfüzyon Şekil 1 İntrauterin transfüzyon umblikal kord plasenta insersiyon bölgesinden yapıldı

92 [PP-071] Lateral Cervical Mass: Prenatally detected Lymphangioma and postnatal management: a case report Selen Gürsoy Erzincan 1, Cihan Inan 1, N. Cenk Sayın 1, Mustafa Inan 2, Füsun G. Varol 1 1 Trakya University Faculty of Medicine, Department of Obstetrics & Gynecology, Division of Perinatology, Edirne, Turkey 2 Trakya University, Faculty of Medicine, Department of Pediatric Surgery, Edirne, Turkey Introduction: Lymphangiomas are commonly located in the soft tissue at the posterior neck region. We present the prenatal sonographic findings and postnatal outcome of a fetus with a huge lateral cervical lymphangioma. Case: A 21-year-old patient, gravida 1,para 0, was referred to our antenatal clinic at 28 weeks of gestation. Prenatal ultrasound and magnetic resonance imaging revealed a 83x62x74 mm cystic, septated, multilocular mass in the left lateral cervical region. On second level ultrasound no additional abnormality was detected except the edematous face of the fetus. The patient did not accept karyotype analysis. Although the mass increased in size (to 121x68x101 mm), no remarkable change was observed in the shape and texture of the mass. Cardiac failure, polyhydramnios or hydrops were not developed in the antenatal period. A male baby weighing 3715 gr was delivered by cesarean section with classical incision at 39 weeks of gestation, but EXIT procedure did not needed. Chromosomal analysis revealed normal karyotype and the newborn was operated by pediatric surgeons because of respiratory difficulty and feeding problems on the X0rd day. He is alive and gocondition in the 2nd month of life. Discussion: Multidisciplinary team approach is necessary for dealing with giant neck masses. Delivery of the fetus should be planned in a center capable of both managing potential immediate breathing and feeding problems. Keywords: lymphangioma, pregnancy, prenatal diagnosis

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96 [PP-072] Neurodevelopmental outcomes of premature infants Curteanu Ala, Pinzari Ludmila, Jitarciuc Ala, Caraus Tatiana Mother and Child Institute, Chisinau, Republic of Moldova The study s objective was to assess neurodevelopment in premature infants. Methods. The case notes of 155 babies with 6 follow-ups done, the last done at 2 years corrected age (c.a.), were analyzed. Children were divided into two groups: I children with birth weight (BW) less then 1500g and II - 27 children with BW more than 1500g. We used the Bayley Scales of Infant Development III to evaluate neurodevelopment. Findings. Severity of neurodevelopmental impairment at 2 years c.a. was more advanced in children from group I due to a more complicated evolution of neonatal period because of infectious complications, respiratory (respiratory distress syndrome) and cerebral (intraventricular hemorrhage (IVH), p<0,05, periventricular leukomalacia (PVL), p<0,05 and seizures, p <0,05) complications associated with prematurity. Evolution of the neurodevelopmental diagnoses at 2 years showed 71 (66,36%) children from group I and 17 (73.91%) children from group II were diagnosed as healthy. Severe neurological disorders prevailed also in the group I of children in

97 13,08% (14) cases being represented in 9,35% of cerebral palsy, hydrocephaly / ventriculomegaly and microcephaly both per 1,87% of cases. Conclusions. Neurodevelopment outcomes in children with BW less than 1500g was more compromised compared to children with a bigger weight due to extreme prematurity cases, prematurity severe complications, which led to the development of more frequent CP, posthemorrhagic hydrocephalus and microcephaly. Keywords: Neurodevelopment, premature baby, cerebral palsy [PP-073] Electronic register for monitoring congenital malformations and hereditary diseases in Moldova Curteanu Ala, Caraus Tatiana Mother and Child Institute, Chisinau, Republic of Moldova In Moldova about 700 children with various forms of congenital malformations (CM) and hereditary diseases (HD) are born annually. Monitoring is one of preventive measures aimed to reduce CM. The objective of this study was to determine prevalence, structure and risk factors for CM and HD recorded in the Electronic Register for monitoring CM in the country in Methods. The object of the study were children (live and dead) and fetuses with isolated or multiple CM reported by maternity wards. Thus, 721 cases of CM and HD were registered, of which cases were suspected at ultrasound examination, 28 cases - after interruption of pregnancy at 28 weeks of gestation and 693 cases were detected during postnatal period during physical examination, instrumental examinations, screening, surgical interventions in children or pathological examination of deceased children at 1 year of life. Findings. The prevalence of CM was 16 per 1000 births. Congenital malformations structure included: cardiac defects (21,1%), malformations of musculoskeletal (17,2%), urogenital and reproductive (14,3%) and gastrointestinal systems (13,3%). The major risk factors include: maternal age greater than 35 years, Gagauz and Ukrainian ethnicity. Conclusion. The unique Electronic Register on CM monitoring allows increasing the complexity of CM collection, as well to analyzing all cases of CM registered by different parameters such as: age, ethnicity, maternal occupation, harmful habits, etc. Keywords: Congenital malformation, Electronic Register, monitoring [PP-074] Dandy walker syndrome prenatal diagnosis with ultrasound Ilir Kadiri, Bleta Domi, Butrint Kusari, Qamil Hamza, Aida Kumnova Regional Hospital Gjakova /Kosova. Department of perinatalogy. The Dandy-Walker complex is a rare congenital intracranial malformation that comprises a spectrum of abnormalities of the posterior fossa which are classified as (a) Dandy-Walker malformation (cystic dilatation of the 4th ventricle, complete or partial agenesis of the cerebellar vermis and an enlarged posterior fossa) Findings: A 28 year old primi gravida come in the routine ultrasound of the perinatal at 20 week of gestation. Ultrasonography revealed a single live intra-uterine gestation with biparietal diameter and fetal Femur length corresponding to 22 weeks of gestation. The fetal posterior fossa was of normal size but with a large anechoic lesion which was communicating with the 4thventricle. There was a suggestion of hypoplasia of the cerebellar vermis (Fig.1) but no evidence of hydrocephalus. The measurements of the fetus was normal the FW 270 gr, umbilical cord with one vein and one artery,cerebellum was18mm but cysterna magna was large 10mm.In Ultrasound scan it was not possible to see the vermis. It was diagnosed Dandy Walker Syndrome and the patents did not want to do the prenatal diagnosis with amniocentesis. The abortion was induced with cytotec tablets 200 mcg every 3 hours and after 36 hours she

98 aborted the fetus 280 grams with no facial malformations only in each leg was 4 fingers and in each hand was 6 fingers. Keywords: Dandy walker syndrome, ultrasound 2D Dandy Walker Syndrome This figure is for 2 D Dandy Walker Syndrome 4D Dandy Walker

99 in this figure is presented the 4 D Dandy Walker Syndrome Baby Dandy Walker This figure presents the Dandy Walker Baby after abortion. [PP-075] Preeklampsili Gebeler ile Normal Gebelerde Ortalama Trombosit Hacmi Değerinin (MPV) Karşılaştırılması Zehra Yılmaz, Elif Yılmaz, Duygu Doğdu, Ismail Burak Gültekin, Osman Fadıl Kara, Tuncay Küçüközkan Dr.Sami Ulus Kadın Doğum,Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi,Ankara,Türkiye Giriş Preeklampsi hem maternal hem de fetal morbidite ve mortalitenin en önemli nedenlerinden bir

100 tanesidir. Preeklampsi patogenezinde en sık maternal spiral arterlerin yetersiz invazyonu suçlanmakla birlikte, trombosit fonksiyonlarındaki değişikliklerin de preeklampsiye neden olabileceğini gösteren çalışmalar mevcuttur. MPV (Ortama Trombosit Hacmi ) platelet aktivasyonu ve fonksiyonunu gösteren bir belirteçtir aynı zamanda inflamatuar belirteçi olarak da kullanılmaktadır. Biz bu çalışmamızda preeklampsi ve normal gebelerdeki MPV değerini karşılaştırmayı amaçladık. Yöntem Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları E.A.H. Yüksek Riskli Gebelik servisine Ocak 2013-Ocak 2015 tarihleri arasında preeklampsi tanısı ile yatırılan hastaların bilgileri tarandı. Hastaların yaşı, gestasyonel yaşı, idrardaki protein miktarı, kan sayımı parametreleri kaydedildi. Kontrol grubu olarak aynı dönemde polikliniğimize rutin kontrole gelen gebe hastalar seçildi. Preeklampsi hastaları ile kontrol; aynı zamanda hafif preeklampsi ile şiddetli preeklampsi grubundaki hastaların MPV değerleri karşılaştırıldı. Bulgular Toplam 94 preeklampsi 91 kontrol olmak üzere 185 hasta çalışmaya dahil edildi. Kontrol grubunda ortalama yaş 27,17±6,26; preeklampsi grubunda ortalama yaş 27,90±6,71 idi (p=0,44). Preeklampsi grubunda ortalama gestasyonel hafta 34,62±3,55; kontrol grubunda 35,26±3,33 idi (p=0,21). Preeklampsi grubunda ortalama MPV değeri 9,76±1,09; kontrol grubunda 9,46 ± 1,14 idi her iki grupta istatistiksel olarak anlamlı fark yoktu (p=0,074).toplam 63 hasta hafif, 32 hasta şiddetli preeklampsi olarak değerlendirildi. Her iki grupta da MPV değerleri arasında fark saptanmadı. (9,66±1,12, 9,85±1,035,p=0,44,sırasıyla) Sonuç MPV değerinin bazı sistemik hastalıklarda prognostik faktör olarak kullanılabileceği ile ilgili çalışmalar mevcuttur. Literatürde MPV değeri ile preeklampsi şiddeti arasında sınırlı sayıda çalışma mevcut olup, sonuçlar çelişkilidir. Biz bu çalışmamızda MPV değeri ile preeklampsi ve preeklampsi şiddeti arasında fark saptamadık. Anahtar Kelimeler: Preeklampsi, Gebelik, MPV [PP-077] Single Dose Antenatal Corticosteroid Application for Women at Risk of Preterm Labor Mehmet Sinan Beksaç 1, Taner Kasapoğlu 2, Ayşe Korkmaz 3, Ergun Karaağaoğlu 4 1 Department of Obstetrics and Gynecology, Perinatology Unit, School of Medicine, Hacettepe University, Ankara, TURKEY 2 Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, TURKEY; Department of Epidemiology, Institute of Health Sciences, Hacettepe University, Ankara, TURKEY 3 Department of Pediatrics, Neonatology Unit, School of Medicine, Hacettepe University, Ankara, TURKEY 4 Department of Biostatistics, School of Medicine, Hacettepe University, Ankara, TURKEY This study population consisted of 1252 preterm birth cases inbetween January2006- December2008 at the Ob/Gyn Department of Hacettepe University, Turkey. This retrospective cohort study is consisted of 547 preterm neonates delivered inbetween 24-34thgestational weeks. Average gestational week was 30,5±3,1. Study group (n:291) is consisted of the neonates of the pregnancies treated with a single course of steroid treatment defined as the use of 12mg doses of betamethasone twice, with births occurring between 24hours and 7days after the first dose. Viceversa, control group (n:202) consisted of neonates who had no antenatal corticosteroids. Patients with fetal abnormalities or medically terminated for another reasons weren t included. Patients were divided into three groups; 24th-28 thweeks(group1), 28th-32ndweeks(Group2), 32nd-34thweeks(Group3). In 24th-34thgestational weeks singleton pregnancies, pneumonia and sepsis frequency was higher in the study group (10,8%vs25,7% respectively) according to the control(3,6%vs14,5%)(p=0,033;p=0,030). In Group2, IVH and sepsis frequency was higher in study group(14,4%vs32,6%) according to the control(3,2%vs16,1%)(p=0,020;p=0,017). In Group3, sepsis frequency was higher in study group(10,2%) according to the control(6,6%). No overall decrease was seen in the incidence of RDS, conversely an increase in the incidence of RDS

101 was obviously noted in the study group(p=0,021,or:1.672, 95%[CI] ). Multivariate logistic regression analysis showed no statistical difference regarding the associated factors with the incidence of RDS. As a conclusion, the current regimen of antenatal corticosteroids utilized in singleton pregnancies does not reduce the overall incidence of RDS. Large population based and well-designed prospective cohort studies are needed to reveal the exact effects of antenatal corticosteroid administration on perinatal mobidity and mortality. Keywords: antenatal corticosteroid, preterm labor, respiratory distress syndrome, neonatal morbidity [PP-078] Maternal and fetal outcome of renal diseases Nergis Kender 1, Anil Erturk 1, Sinan Beksac 2 1 Hacettepe University, Department of Gynecology and Obstetrics 2 Hacettepe University, Department of Gynecology and Obstetrics, Division of Perinatology Renal diseases are associated with both increased risk for adverse maternal outcomes, including gestational hypertension, preeclampsia, eclampsia, and death, and also adverse fetal outcomes, including preterm birth, intrauterine growth restriction, small for gestational age, and still birth. To reveal the different effects of groups of renal diseases on pregnancy, 44 pregnancies with renal diseases were evaluated at Hacettepe University Perinatology Clinic between January 2001 and March These pregnancies were divided into three groups, renal cystic diseases, primary glomerulonephritis and secondary glomerulonephritis due to systemic diseases. Infants birth weight, gestation age, 24-hour urine protein excretion just before delivery were detected significantly different among these groups. It was determined that 21 of these 44 pregnancies were complicated with comorbidities such as preeclampsia, hypertension, HELLP syndrome. Patients with renal disease should be monitored jointly by a nephrologist and by an obstetrician. Delivery should be planned before and ideally actualized at a tertiary referral center. Keywords: renal disases, pregnancy, glomerulonephritis, proteinuria

102 Characteristics among three groups of renal diseases [PP-079] Perinatal Outcomes of Papillary Thyroid Cancer During Pregnancy Fatih Aktoz, Mert Turgal, Emine Aydın, Mehmet Sinan Beksaç Hacettepe University, School of Medicine, Departmant of Obstetrics and Gynecology, Ankara, Turkey. Summary Thyroid cancer is the most common endocrine malignancy and it s seen more often in women than men. Togetherness of pregnancy and thyroid cancer is not frequent but 10% of thyroid cancers of reproductive people are seen during pregnancy. No matter it has an effect on pregnancy or not, a cancer during pregnancy is a major stress for a woman. Therefore it is a powerful reason to research about it. However two individuals, mother and the fetus, are vulnerable. Because of this reason, there are limited data on this subject. One of them is a large retrospective study on 595 pregnancy associated thyroid cancer and there is no difference between pregnant and nonpregnant thyroid cancer in outcome, survival or morbidity. In the light of these informations, we want to evaluate our cases. Methods A retrospective evaluation was conducted Hacettepe University, Faculty of Medicine, Division of Maternal Fetal Medicine, Ankara, Turkey. Patient s surgical history, gestational history(gestational age, gravidity and parity), pregnancy outcomes(birth weight, sex), and pathological findings of baby and patient were recorded. Conclusion Overall, our case series has shown that there is no clear difference in perinatal outcomes of papillary thyroid cancer patients pregnancies and it s compatible with literature. Keywords: Thyroid cancer, papillary, pregnancy