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Öğe Does pregnancy interval after laparoscopic sleeve gastrectomy affect maternal and perinatal outcomes?(Taylor & Francis Ltd, 2019) Başbuğ, Alper; Kaya, Aşkı Ellibeş; Doğan, Sami; Pehlivan, Mevlüt; Göynümer, GökhanBackground: Obesity is a global health epidemic and is associated with many maternal and neonatal complications. Laparoscopic sleeve gastrectomy (LSG) is among the surgical treatments for obesity. The appropriate timing of pregnancy following LSG remains controversial and few studies have evaluated this public health issue. Objective: To evaluate the effect of pregnancy timing after LSG on maternal and perinatal outcomes. Study design: We performed a retrospective observational study of 23 pregnant women who underwent LSG at a tertiary hospital in Turkey. Women who became pregnant within 18 months of undergoing LSG were included in the early pregnancy after LSG group, and those who became pregnant after 18 months were included the late pregnancy after LSG group. Maternal and perinatal outcomes were evaluated, including gestational diabetes mellitus (GDM), pregnancy-associated hypertensive disorders, preterm birth, mode of delivery, small and large for gestational age births (small for gestational age (SGA), large for gestational age (LGA)), birth injury, and congenital malformations. Results: Body mass index (BMI) at conception was higher in the early pregnancy after LSG group than in the late pregnancy after LSG group (30.48 versus 27.25, respectively; p = .03). Pregnancy interval after LSG did not impact maternal-fetal complications or mode of delivery. After a 75 g oral glucose tolerance test (OGTT) for GDM, 75% (n = 6) of the early pregnancy group presented with early dumping syndrome, compared to only 13.3% (n = 2) of the late pregnancy after LSG group (p = .009). Conclusions: LSG may reduce obesity-related gestational complications, such as GDM and LGA. The interval between LSG and conception did not impact maternal or neonatal outcomes. Screening for GDM can result in dumping syndrome in pregnancies after LSG.Öğe Fetal Cardiac Anomalies(Springer India, 2018) Balcı, Burçin Karamustafaoğlu; Göynümer, Gökhan; Denktaş, Gurur Biliciler; Babaoğlu, Kadir; Lewis, Michael; Uzun, OrhanThis review is intended to give a practical guide to ultrasound recognition of the commonly observed fetal cardiac abnormalities and their key features on standard imaging planes during antenatal anomaly screening examinations. All information provided here, on the diagnosis and management of fetal cardiac anomalies, is based on the personal experiences of the authors and their expert reviews of the selected previously published studies.Öğe Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium(Springer Heidelberg, 2018) Balcı, Burçin Karamustafaoğlu; Göynümer, GökhanThe presence of echogenic amniotic fluid at term gestation on sonography is uncommon. The aim of our study was to investigate the incidence of echogenic amniotic fluid at term pregnancy, and to determine how often echogenic amniotic fluid was associated with meconium. All singleton pregnant women at term who were admitted to our labor unit and who delivered within 24 h of the ultrasound scan were included in the study. For each woman, gestational age, maternal age, gravidity, parity, the character of the amniotic fluid on ultrasound at admission (clear or echogenic), birth weight, and the character of the amniotic fluid on artificial or spontaneous rupture of membranes or on cesarean section (clear/with vernix/meconium-stained) were recorded. When amniotic fluid was assessed on ultrasound, among 278 patients, 9 (3.2%) patients' amniotic fluid was echogenic. When the amniotic fluid was assessed at delivery, the rates of meconium-stained amniotic fluid in women with and without echogenic amniotic fluid were 44.44% (4/9) and 9.3% (25/269), respectively; the difference was statistically significant (p = 0.035). We found a sensitivity and specificity of 13.79 and 97.99%, and a positive and negative predictive value of 44.44 and 90.7%, respectively, for echogenic amniotic fluid seen on ultrasound in identifying meconium-stained amniotic fluid. The incidence of echogenic amniotic fluid at term gestation was found as 3.2 and 44.4% of cases of echogenic amniotic fluid was associated with meconium.Öğe The levonorgestrel-releasing intrauterine system is associated with a reduction in dysmenorrhoea and dyspareunia, a decrease in CA 125 levels, and an increase in quality of life in women with suspected endometriosis(Wiley, 2018) Yücel, Neşe; Başkent, Erdem; Balcı, Burçin Karamustafaoğlu; Göynümer, GökhanBackground and aimsThe aim of this study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUS) in the symptomatic relief of pain in women with endometriosis and additionally, to assess the changes in women's life quality and serum cancer antigen (CA) 125 levels. Materials and methodsAll women who had an LNG-IUS inserted for the treatment of dysmenorrhea, chronic pelvic pain or both for more than six months over a two-year period were included in the study. Each woman was asked to complete questionnaires of the Short Form-36 and visual analogue scales (VAS) in the first visit and the third, sixth, ninth and twelfth months after the LNG-IUS insertion. CA 125 levels were measured at each visit. ResultsForty-five women were included in the study. At the end of 12months, mean dysmenorrhoea VAS score decreased from 6.13 to 2.88, mean dsyspareunia VAS score from 6.04 to 2.61 and CA 125 level from 50.67 to 22.45. Endometriomas reduced in size in six women (mean size decreased from 31 to 20mm) and disappeared in three. ConclusionsSeveral favourable outcomes were found following LNG-IUS insertion: (i) dyspareunia and dysmenorrhoea were clearly reduced; (ii) the size of endometriomas were decreased; (iii) CA 125 levels significantly decreased; (iv) a few women experienced the typical systemic adverse effects of progestogens; however, LNG-IUS-related adverse events were generally tolerable and the discontinuation rate was as low as 6.66% (3/45).Öğe Şiddetli Preeklampsiye Eşlik Eden HELLP Sendromu Olgularında Maternal ve Perinatal Sonuçların Değerlendirilmesi(2019) Günay, Taner; Turgut, Abdulkadir; Yardımcı, Oğuz Devrim; Bor, Ergül Demirçivi; Göynümer, GökhanAmaç: HELLP (hemoliz, yükselmiş karaciğer enzimleri, düşük trombosit sayısı) sendromunun eşlik ettiği şiddetli preeklamsi olguları ile HELLP sendromu olmayan şiddetli preeklampsi olgularında maternal ve perinatal sonuçların değerlendirilmesidir. Gereç ve Yöntem: Hastanemizde 2015 Ocak ile 2018 Temmuz arasında tanı almış ve doğum yapmış şiddetli preeklampsili gebeler retrospektif olarak değerlendirildi. Hastalar HELLP sendromu parametrelerine göre HELLP sendromu bulunan (Grup 1) ve bulunmayan (Grup 2) olarak iki gruba ayrıldı. İki grup preterm doğum, IUGR, dekolman plasenta, fetal ölüm gibi perinatal komplikasyonlar, bazı maternal morbidite ve mortalite nedenleri ve hematolojik ve biyokimyasal parametreler açısından değerlendirildi. Bulgular: 2015 Ocak ile 2018 Temmuz arasında hastanemizde 8730 doğum gerçekleşti ve 154 (%1.7) gebeye şiddetli preeklampsi (Grup 1), 38 (%0.4) gebe ise şiddetli preeklampsi+HELLP (Grup 2) sendromu tanısı aldı. Grup 1’de intrauterin gelişme geriliği 22 (%14.2), dekolman plasenta 8 (%5.2), preterm doğum %32.4 oranında görülürken, Grup 2’de bu oranlar sırasıyla 7 (%18.4), 3 (%7.8) ve % 26.3 olarak bulundu ve gruplar arasında anlamlı fark bulunmadı. Fetal ölüm oranları (%1.2’ye %5.2) ve sezaryen doğum oranları (%77.2’ye %86.8) açısından da gruplar açısından anlamlı fark bulunmadı ancak oranlar Grup 2’de daha yüksekti. Akut böbrek yetmezliği, dissemine intravasküler koagülasyon, yoğun bakım ihtiyacı ile kan ve kan ürünü transfüzyonu ihtiyacı da Grup 2’de daha yüksekti ve istatistiksel anlamlı fark tespit edildi. Sonuç: Şiddetli preeklampsi ve özellikle şiddetli preeklampsiye eşlik eden HELLP sendromu varlığı perinatal komplikasyonların yanında ciddi maternal morbidite ve mortalite artışı ile birliktelik göstermekte olup mümkün olan en kısa zamanda gebeliğin sonlandırılması ve uygun destek tedavisinin verilmesi gerekmektedir.