Publications by authors named "Cihat Sen"

31 Publications

Maternal and perinatal outcomes in high vs low risk-pregnancies affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) working group on COVID-19.

Authors:
Francesco D'Antonio Cihat Sen Daniele DI Mascio Alberto Galindo Cecilia Villalain Ignacio Herraiz Resul Arısoy Ali Ovayolu Hasan Eroğlu Manuel Guerra Canales Subhashini Ladella Liviu Cojocaru Ozhan Turan Sifa Turan Eran Hadar Noa A Brzezinski-Sinai Sarah Dollinger Ozlem Uyaniklar Sakine Rahimli Ocakouglu Zeliha Atak Tanja Premru-Srsen Lilijana Kornhauser-Cerar Mirjam Druškovič Liana Ples Reyhan Gündüz Elif Ağaçayak Javier Alfonso Schvartzman Mercedes Negri Malbran Marco Liberati Francesca Di Sebastiano Ludovica Oronzi Chiara Cerra Danilo Buca Angelo Cagnacci Arianna Ramone Fabio Barra Andrea Carosso Chiara Benedetto Stefano Cosma Axelle Pintiaux Caroline Daelemans Elena Costa Ayşegül Özel Murat Muhçu Jesús S Jimenez Lopez Clara Alvarado Anna Luengo Piqueras Dolores Esteban Oliva Giovanni Battista Luca Schera Nicola Volpe Tiziana Frusca Igor Samardjiski Slagjana Simeonova Irena Aleksioska Papestiev Javier Hojman Ilgin Turkcuoglu Antonella Cromi Antonio Simone Laganà Fabio Ghezzi Angelo Sirico Alessandra Familiari Giovanni Scambia Zulfiya Khodjaeva Gennady T Sukhikh Ksenia A Gorina Renato Augusto Moreira de Sa Mariana Vaz Otto Henrique May Feuerschuette Anna Nunzia Della Gatta Aly Youssef Gaetana Di Donna Alicia Martinez-Varea Gabriela Loscalzo José Morales Roselló Vedran Stefanovic Irmeli Nupponen Kaisa Nelskylä Rodrigo Ayala Rebeca Garrote Molpeceres Asunción Pino Vázquez Fabrizio Sandri Ilaria Cataneo Marinella Lenzi Esra Tustas Haberal Erasmo Huertas Amadeo Sanchez Pedro Arango Amanda Bermejo María Monica Gonzalez Alcantara Gökhan Göynümer Erhan Okuyan Ciuhodaru Madalina Ana Concheiro Guisan Alejandra Martínez Schulte Valentina Esposito Valentina De Robertis Snezana Zdjelar Milan Lackovic Sladjana Mihajlovic Nelly Jekova Gabriele Saccone Mehmet Musa Aslan Maria Carmela Di Dedda Maisuri Chalid Jose Enrique Moros Canache George Daskalakis Panos Antsaklis Enrique Criado Vega Elisa Cueto Chiara Taccaliti Alicia Yeliz Aykanat Şerife Özlem Genç Bernd Froessler Petya Angelova Radulova Danila Morano Beatrice Bianchi Maria Giulia Lombana Marino Gabriella Meccariello Bindu Rohatgi Antonio Schiattarella Maddalena Morlando Nicola Colacurci Andrea Villasco Nicoletta Biglia Ana Luiza Santos Marques Alessandra Gatti Daniela Luvero Roberto Angioli Alejandro Pittaro Albert Lila Blanka Zlatohlávková

Am J Obstet Gynecol MFM 2021 Feb 20:100329. Epub 2021 Feb 20.

Department of Obstetrics and Gynecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic.

Objectives: To evaluate maternal and perinatal outcomes in high compared to low-risk pregnancies complicated by SARS-COV-2 infection.

Methods: This was a multinational retrospective cohort study including women with laboratory-confirmed SARS-COV-2 from 76 centers from 25 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation, or death. Secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal (NND) and perinatal (PND) death, and admission to neonatal intensive care unit. All these outcomes were assessed in high-risk compared to low-risk pregnancies. Pregnancies were considered as high risk in case of either pre-existing chronic medical conditions pre-existing pregnancy or obstetric disorders occurring in pregnancy. Fisher-test and logistic regression analysis were used to analyze the data.

Results: 887 singleton pregnancies tested positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab were included in the study. The risk of composite adverse maternal outcome was higher in high compared to low risk-pregnancies with an OR of 1.52 (95% CU 1.03-2.24; p= 0.035). Likewise, women carrying a high risk-pregnancies were also at higher risk of hospital admission (OR: 1.48, 95% CI 1.07-2.04; p= 0.002), presence of severe respiratory symptoms (OR: 2.13, 95% CI .41-3.21; p= 0.001), admission to ICU (OR: 2.63, 95% CI 1.42-4.88) and invasive mechanical ventilation (OR: 2.65, 95% CI 1.19- 5.94; p= .002). When exploring perinatal outcomes, high-risk pregnancies were also at high risk of adverse perinatal outcome with an OR 0f 1.78 (95% CI .15-2.72; p= 0.009). However, such association was mainly due to the higher incidence of miscarriage in high risk compared to low risk pregnancies (5.3% vs 1.6%, p= 0.008), while there was no difference as regard as the other explored outcomes between the two study groups. At logistic regression analysis, maternal age (OR: 1.12, 95% CI 1.02-1.22, p= 0.023) and the presence of a high-risk pregnancies (OR: 4.21, 95% CI 3.90-5.11, p<0.001) were independently associated with adverse maternal outcome.

Conclusions: High-risk pregnancies complicated by SARS-COV-2 infection are at higher risk of adverse maternal outcome compared to low-risk gestations.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896113PMC
February 2021

Incidence of multiple births in relation to current regulations in Turkey regarding embryo transfer.

BMC Pregnancy Childbirth 2021 Feb 9;21(1):117. Epub 2021 Feb 9.

Istanbul Memorial Bahcelievler Hospital, Perinatal Medicine Center, 34180, Istanbul, Turkey.

Background: Before 2010, there were no regulations in Turkey regarding the number of embryos to be transferred in one cycle. In March 2010, regulations restricting this number were implemented by the Turkish Ministry of Health. These specify the transfer of a maximum of one embryo in the first and second cycles and a maximum of two embryos in subsequent cycles in women aged < 35, and a maximum of two embryos in women aged ≥35 in any one cycle. Our study evaluates the effect of these regulations.

Methods: This large retrospective single center study first evaluates the incidence of multiple pregnancies before and after the implementation of the 2010 regulations. Secondly, it compares the clinical outcomes of double blastocyst transfer (DBT) and single blastocyst transfer (SBT) performed in compliance with these regulations from 2014 onwards.

Results: After the introduction of the 2010 regulations, the multiple pregnancy rate decreased significantly from 37.9 to 15.7%. The singleton live birth rate increased significantly, whereas multıiple live birth rates significantly decreased (p = < 0.001). When the clinical outcomes of SBT and DBT performed in compliance with regulations from 2014 onwards were evaluated, in patients < 35 years, the multiple pregnancy rate decreased from 47.2% in the DBT group to 1.7% in the SBT group (p = < 0.001). In patients ≥35 years, in the DBT group, the twin birth rate was again high at 28.4%, whereas in the SBT group, it was only 1.8% (p = < 0.001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups.

Conclusion: Turkish regulations have led to an encouragement of double embryo transfer (DET) as a routine practice, with many patients understanding it as an absolute right to have two embryos transferred. The results of our study suggest that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of single embryo transfer except in exceptional cases and particularly in women under 35 years old.
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http://dx.doi.org/10.1186/s12884-021-03616-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874669PMC
February 2021

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

J Perinat Med 2020 Dec 2;49(1):111-115. Epub 2020 Dec 2.

Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain.

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http://dx.doi.org/10.1515/jpm-2020-0539DOI Listing
December 2020

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Authors:
Daniele Di Mascio Cihat Sen Gabriele Saccone Alberto Galindo Amos Grünebaum Jun Yoshimatsu Milan Stanojevic Asım Kurjak Frank Chervenak María José Rodríguez Suárez Zita Maria Gambacorti-Passerini María de Los Angeles Anaya Baz Esther Vanessa Aguilar Galán Yolanda Cuñarro López Juan Antonio De León Luis Ignacio Cueto Hernández Ignacio Herraiz Cecilia Villalain Roberta Venturella Giuseppe Rizzo Ilenia Mappa Giovanni Gerosolima Lars Hellmeyer Josefine Königbauer Giada Ameli Tiziana Frusca Nicola Volpe Giovanni Battista Luca Schera Stefania Fieni Eutalia Esposito Giuliana Simonazzi Gaetana Di Donna Aly Youssef Anna Nunzia Della Gatta Mariano Catello Di Donna Vito Chiantera Natalina Buono Giulio Sozzi Pantaleo Greco Danila Morano Beatrice Bianchi Maria Giulia Lombana Marino Federica Laraud Arianna Ramone Angelo Cagnacci Fabio Barra Claudio Gustavino Simone Ferrero Fabio Ghezzi Antonella Cromi Antonio Simone Laganà Valentina Laurita Longo Francesca Stollagli Angelo Sirico Antonio Lanzone Lorenza Driul Fabiana Cecchini D Serena Xodo Brian Rodriguez Felipe Mercado-Olivares Deena Elkafrawi Giovanni Sisti Rosanna Esposito Antonio Coviello Marco Cerbone Maddalena Morlando Antonio Schiattarella Nicola Colacurci Pasquale De Franciscis Ilaria Cataneo Marinella Lenzi Fabrizio Sandri Riccardo Buscemi Giorgia Gattei Francesca Della Sala Eleonora Valori Maria Cristina Rovellotti Elisa Done Gilles Faron Leonardo Gucciardo Valentina Esposito Flaminia Vena Antonella Giancotti Roberto Brunelli Ludovico Muzii Luigi Nappi Felice Sorrentino Lorenzo Vasciaveo Marco Liberati Danilo Buca Martina Leombroni Francesca Di Sebastiano Luciano Di Tizio Diego Gazzolo Massimo Franchi Quintino Cesare Ianniciello Simone Garzon Giuliano Petriglia Leonardo Borrello Albaro Josè Nieto-Calvache Juan Manuel Burgos-Luna Caroline Kadji Andrew Carlin Elisa Bevilacqua Marina Moucho Pedro Viana Pinto Rita Figueiredo José Morales Roselló Gabriela Loscalzo Alicia Martinez-Varea Vincente Diago Jesús S Jimenez Lopez Alicia Yeliz Aykanat Stefano Cosma Andrea Carosso Chiara Benedetto Amanda Bermejo Otto Henrique May Feuerschuette Ozlem Uyaniklar Sakine Rahimli Ocakouglu Zeliha Atak Reyhan Gündüz Esra Tustas Haberal Bernd Froessler Anupam Parange Peter Palm Igor Samardjiski Chiara Taccaliti Erhan Okuyan George Daskalakis Renato Augusto Moreira de Sa Alejandro Pittaro Maria Luisa Gonzalez-Duran Ana Concheiro Guisan Şerife Özlem Genç Blanka Zlatohlávková Anna Luengo Piqueras Dolores Esteban Oliva Aylin Pelin Cil Olus Api Panos Antsaklis Liana Ples Ioannis Kyvernitakis Holger Maul Marcel Malan Albert Lila Roberta Granese Alfredo Ercoli Giuseppe Zoccali Andrea Villasco Nicoletta Biglia Ciuhodaru Madalina Elena Costa Caroline Daelemans Axelle Pintiaux Elisa Cueto Eran Hadar Sarah Dollinger Noa A Brzezinski Sinai Erasmo Huertas Pedro Arango Amadeo Sanchez Javier Alfonso Schvartzman Liviu Cojocaru Sifa Turan Ozhan Turan Maria Carmela Di Dedda Rebeca Garrote Molpeceres Snezana Zdjelar Tanja Premru-Srsen Lilijana Kornhauser Cerar Mirjam Druškovič Valentina De Robertis Vedran Stefanovic Irmeli Nupponen Kaisa Nelskylä Zulfiya Khodjaeva Ksenia A Gorina Gennady T Sukhikh Giuseppe Maria Maruotti Silvia Visentin Erich Cosmi Jacopo Ferrari Alessandra Gatti Daniela Luvero Roberto Angioli Ludovica Puri Marco Palumbo Giusella D'Urso Francesco Colaleo Agnese Maria Chiara Rapisarda Ilma Floriana Carbone Antonio Mollo Giovanni Nazzaro Mariavittoria Locci Maurizio Guida Attilio Di Spiezio Sardo Pierluigi Benedetti Panici Vincenzo Berghella Maria Elena Flacco Lamberto Manzoli Giuseppe Bifulco Giovanni Scambia Fulvio Zullo Francesco D'Antonio

J Perinat Med 2020 11;48(9):950-958

Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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http://dx.doi.org/10.1515/jpm-2020-0355DOI Listing
November 2020

Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine.

J Perinat Med 2020 Nov;48(9):867-873

Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia.

The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.
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http://dx.doi.org/10.1515/jpm-2020-0329DOI Listing
November 2020

Clinical management of coronavirus disease 2019 (COVID-19) in pregnancy: recommendations of WAPM-World Association of Perinatal Medicine.

J Perinat Med 2020 Nov;48(9):857-866

Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.

These guidelines follow the mission of the World Association of Perinatal Medicine, which brings together groups and individuals throughout the world with the goal of improving outcomes of maternal, fetal and neonatal (perinatal) patients. Guidelines for auditing, evaluation, and clinical care in perinatal medicine enable physicians diagnose, treat and follow-up of COVID-19-exposed pregnant women. These guidelines are based on quality evidence in the peer review literature as well as the experience of perinatal expert throughout the world. Physicians are advised to apply these guidelines to the local realities which they face. We plan to update these guidelines as new evidence become available.
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http://dx.doi.org/10.1515/jpm-2020-0265DOI Listing
November 2020

Ductus venosus-systemic shunt. Report of six cases and systematic review of the literature.

J Matern Fetal Neonatal Med 2020 Mar 28;33(6):1015-1023. Epub 2019 Jan 28.

Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology, Division of Perinatology, Istanbul University, Istanbul, Turkey.

To evaluate the ultrasonographic features and pregnancy outcomes in women with ductus venosus-systemic shunt and systematic review of the literature. A computerized search was conducted to identify cases of ductus venosus-systemic shunt between September 2016 and January 2018. Six patients were identified. Antenatal records and neonatal outcomes are presented. A systematic Embase, SCOPUS, and Medline search of published literature from 1991 to 2018 was performed using the terms "ductus venosus," "agenesis," "absence," "absent," "missing," "aberrant," and "variant." Additional structural anomaly such as esophageal atresia with tracheoesophageal fistula was observed in one case. In other case, termination of pregnancy was performed due to Down syndrome. Other two of the six fetuses were monochorionic multiple pregnancies. In our review of the literature, additional anomalies were observed in 9 (42%) of the 21 cases. Our observation suggests that ductus venosus-systemic shunt can be associated with Down syndrome. Detailed examination should be performed to rule out additional abnormalities. Prognosis is good if the pathology is isolated.
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http://dx.doi.org/10.1080/14767058.2019.1569611DOI Listing
March 2020

Are complicated monochorionic twins more susceptible to indomethacin-induced fetal ductal constriction? Two cases of laser surgery for Twin-Twin Transfusion syndrome.

Turk J Obstet Gynecol 2018 Sep 3;15(3):200-203. Epub 2018 Sep 3.

İstanbul University Cerrahpaşa Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatal Medicine, İstanbul, Turkey.

Indomethacin is a commonly used medication against preterm delivery. Several reports of fetal ductal constriction have been described after indomethacin use in the literature; however, there are no previously documented reports describing an association between Twin-Twin Transfusion syndrome and a constrictor effect of indomethacin on the ductus arteriosus. Two patients were referred to our department for Twin-Twin Transfusion syndrome and each underwent placental laser surgery. Constriction of the ductus arteriosus occurred as early as 20 and 24 weeks' gestation following maternal use of indomethacin after laser surgery. Spontaneous amelioration was observed after discontinuation of the drug. The constrictor effect of indomethacin on the ductus arteriosus can be observed even after a single dose and as early as 20 weeks of gestation in complicated monochorionic twin pregnancies. We emphasize meticulous use of indomethacin in complicated monochorionic twin pregnancies because the constrictive effect seems to be independent of gestational age.
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http://dx.doi.org/10.4274/tjod.78095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127469PMC
September 2018

Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa.

J Perinat Med 2018 Dec;47(1):16-21

Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.

Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.
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http://dx.doi.org/10.1515/jpm-2018-0066DOI Listing
December 2018

Preterm labor and preterm birth.

Authors:
Cihat Sen

J Perinat Med 2017 Nov;45(8):911-913

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http://dx.doi.org/10.1515/jpm-2017-0298DOI Listing
November 2017

Fetal magnetic resonance imaging and ultrasound.

J Perinat Med 2016 Jul;44(5):533-42

Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.
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http://dx.doi.org/10.1515/jpm-2015-0226DOI Listing
July 2016

Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach.

J Perinat Med 2016 Mar;44(2):131-7

Mid trimester fetal anatomy scan is a fundamental part of routine antenatal care. Some U/S soft markers or controversial U/S signs are seen during the scan and create some confusion regarding their relation to fetal chromosomal abnormalities. Example of these signs: echogenic focus in the heart, echogenic bowel, renal pyelectasis, ventriculomegaly, polydactely, club foot, choroid plexus cyst, single umbilical artery. We are presenting an evidence based approach from the literature for management of these controversial U/S signs.
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http://dx.doi.org/10.1515/jpm-2015-0223DOI Listing
March 2016

Ultrasound in Africa: what can really be done?

J Perinat Med 2016 Mar;44(2):119-23

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important technology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa. It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.
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http://dx.doi.org/10.1515/jpm-2015-0224DOI Listing
March 2016

3D/4D sonography - any safety problem.

J Perinat Med 2016 Mar;44(2):125-9

Gray-scale image data are processed in 3D ultrasound by repeated scans of multiple planes within a few seconds to achieve one surface rendering image and three perpendicular plane images. The 4D image is achieved by repeating 3D images in short intervals, i.e. 3D and 4D ultrasound are based on simple B-mode images. During 3D/4D acquisition, a fetus in utero is exposed by ultrasound beam for only a few seconds, and it is as short as real-time B-mode scanning. Therefore, simple 3D imaging is as safe as a simple B-mode scan. The 4D ultrasound is also as safe as a simple B-mode scan, but the ultrasound exposure should be shorter than 30 min. The thermal index (TI) and mechanical index (MI) should both be lower than 1.0, and the ultrasound study is regulated by the Doppler ultrasound if it is combined with simple 3D or 4D ultrasound. Recently, some articles have reported the functional changes of animal fetal brain neuronal cells and liver cell apoptosis with Doppler ultrasound. We discuss cell apoptosis by ultrasound in this report. Diagnostic ultrasound safety is achieved by controlling the output pulse and continuous ultrasound waves using thermal and mechanical indices, which should be <1.0 in abdominal and transvaginal scan, pulsed Doppler, as well as 3D and 4D ultrasound. The lowest spatial peak temporal average (SPTA) intensity of the ultrasound to suppress cultured cell growth is 240 mW/cm2, below which no ultrasound effect has been reported. An ultrasound user must be trained to recognize the ultrasound bioeffects; thermal and mechanical indices, and how to reduce these when they are higher than 1.0 on the monitor display; and guide the proper use of the ultrasound under the ALARA principle, because the user is responsible for ensuring ultrasound safety.
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http://dx.doi.org/10.1515/jpm-2015-0225DOI Listing
March 2016

Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM).

J Perinat Med 2016 Oct;44(7):737-743

Fetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.
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http://dx.doi.org/10.1515/jpm-2015-0132DOI Listing
October 2016

Serial ultrasonographic examination of the fetal thymus in the prediction of early neonatal sepsis in preterm premature rupture of membranes.

Gynecol Obstet Invest 2014 9;78(3):201-7. Epub 2014 Sep 9.

Maternal and Fetal Medicine, Obstetrics and Gynecology, Yuzuncu Yuzyil University, Van, Turkey.

Background/aims: To evaluate the diagnostic accuracy of fetal thymus transverse diameter (FTTD) in predicting fetal infection in preterm premature rupture of membranes (PPROM) and compare its accuracy with cord blood tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).

Methods: Forty consecutive pregnancies complicated with PPROM between 26(1/7) and 36(6/7) gestational weeks were evaluated prospectively. Serial fetal ultrasonography follow-ups with 3-day intervals were performed beginning on the admission day. The FTTD was recorded on every ultrasonographic examination. Cord blood TNF-α and IL-6 values were measured after delivery.

Results: FTTD was decreased below 5% according to nomograms compared to the initial measurement in 45% of all PPROM cases. Decreased FTTD had a sensitivity of 100%, specificity of 73%, positive predictive value of 55%, and negative predictive value of 100% in predicting early neonatal sepsis. Cord blood TNF-α had a sensitivity of 80% and specificity of 90%, whereas IL-6 had a sensitivity of 90% and specificity of 63.3% in predicting early neonatal sepsis.

Conclusions: Assessment of the decrease in FTTD by serial ultrasonographic examinations is a promising 'prenatal' method for the early detection of early neonatal sepsis.
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http://dx.doi.org/10.1159/000364871DOI Listing
June 2015

Relationship between first trimester visualization of the intracranial translucency and spina bifida.

Arch Gynecol Obstet 2015 Mar 19;291(3):513-8. Epub 2014 Aug 19.

Obstetrics and Gynecology Department, Maternal Fetal Medicine Unit, Cerrahpaşa School of Medicine, Istanbul Universitesi, Istanbul, Turkey,

Purpose: To establish a reference range for the intracranial translucency (IT).

Methods: In this prospective study, we examined 596 singleton fetuses at 11-14 weeks of gestation using transabdominal ultrasonography. The distribution curves of the anterior-posterior diameter of the IT were established according to the gestational weeks, and the percentiles for 11-14 weeks of gestation were calculated. Regression analysis was performed to estimate the relationship between the anterior-posterior diameter of the IT and other fetal biometric parameters.

Results: The mean anterior-posterior diameter of the IT was 1.8 ± 0.4 mm. From 11 to 14 weeks of gestation, the IT diameter increased linearly with advancing gestation. The linear regression equation for the IT × crown-rump length (CRL) was IT = CRL × 0.0184 + 0.575 (R = 0.385, p < 0.001). The linear regression equation for the IT × biparietal diameter (BPD) was IT = BPD × 0.0532 + 0.632 (R = 0.346, p < 0.001). The linear regression equation for IT × gestational age (days) (GA) was ICT = GA × 0.024 - 0.339 (R = 0.25, p < 0.001). The linear regression analysis revealed significant correlations of the IT with CRL, BPD, and GA.

Conclusion: The IT increases linearly with increasing CRL, BPD, gestational age in weeks, and gestational age in days.
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http://dx.doi.org/10.1007/s00404-014-3410-6DOI Listing
March 2015

Controversial clinical practices for patients with preeclampsia or HELLP syndrome: a survey.

J Perinat Med 2015 Jan;43(1):61-6

Background: Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices.

Materials And Methods: An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009-2012) and HELLP syndrome (2005-2012). Online surveys were sent to all authors using the email addresses found in their publications.

Results: Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques.

Conclusions: A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.
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http://dx.doi.org/10.1515/jpm-2014-0109DOI Listing
January 2015

Correlation between First and Second Trimester Uterine Artery Doppler Velocimetry and Placental Bed Histopathology.

Int Sch Res Notices 2014 13;2014:890534. Epub 2014 Jul 13.

Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, 34098 Istanbul, Turkey.

Aim. To evaluate the relationship between uterine artery Doppler indices and placental bed histopathology independent of clinical outcome. Materials and Methods. Uterine artery measurements were performed to 510 pregnant women who had come for routine antenatal care in 11-14th and 20-24th weeks. Placental bed biopsies from 141 cases were taken during cesarean section. Physiological changes and abnormal placental histology findings were investigated and compared with Doppler findings. Results. 116 biopsies were accepted as adequate biopsy and included in the study. Physiological changes were seen in 100 biopsies. Statistically significant higher PI and RI values in second trimester and higher notch rate in both trimesters were detected in the abnormal placental histology group (P < 0,001). Conclusion. Strong relationship between uterine artery Doppler indices and preeclampsia or intrauterine growth retardation has been shown in previous studies. In our study, we concluded that there is significant relationship between Doppler findings and placental bed histopathology independent of clinical course.
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http://dx.doi.org/10.1155/2014/890534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897222PMC
July 2016

Diagnosis of congenital cytomegalovirus antigenemia by immunohistochemical detection of immediate early antigen.

Fetal Pediatr Pathol 2014 Feb 18;33(1):64-70. Epub 2013 Nov 18.

Zekai Tahir Burak Women Health Care, Education and Research Hospital, Perinatology, Ankara, Turkey.

Cytomegalovirus (CMV) can be a cause of fetal morbidity and mortality among approximately 1% of pregnancies. With an aim to detect CMV antigenemia among 51 pregnant women with/without clinically diagnosed abnormalities and intrauterine growth retardation (IUGR) maternal and fetal samples either prenatal (n:22) or postpartum (n:29) were obtained between 17-42 weeks of gestation to analyze anti-CMV IgG, IgM antibodies and cytoplasmic or nuclear CMV antigens. Cytoplasmic and nuclear CMV antigenemia was detected among 19.6% and 11.8% of maternal samples. These values were 29.4% and 17.6% for fetal samples. Among both maternal and fetal samples, there was a 100% correlation when IgG and IgM were negative. The correlation for IgG and IgM positivity was not present among maternal samples since cytoplasmic (37.5%) and nuclear (25%) antigens could not be demonstrated in spite of immunity. Cytoplasmic and nuclear CMV antigens were detected within fetal samples from subjects presenting maternal immunoglobulin positivity, clinical abnormality and clinically normal findings (50, 32, 16.7% and 50, 16, 5.6%) respectively. In conclusion, immunocytochemical detection of CMV antigenemia improves CMV infection diagnosis which may be associated with clinical abnormalities/IUGR.
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http://dx.doi.org/10.3109/15513815.2013.856500DOI Listing
February 2014

Choice of glucocorticoid in HELLP syndrome - dexamethasone versus betamethasone: revisiting the dilemma.

J Matern Fetal Neonatal Med 2012 Dec 24;25(12):2597-600. Epub 2012 Aug 24.

Obstetrics & Gynecology Department, ACIBADEM Kayseri Hospital, Kayseri, Turkey.

Objective: Maternal corticosteroid administration has been reported to improve the blood pressure, urine output, laboratory values of liver enzymes and platelets in HELLP syndrome. In this controversial subject, recently, Cochrane Database had updated its systematic review and in the subgroup analysis they indicated that dexamethasone was superior to betamethasone for the improvement of platelet counts and liver enzymes. However, there are several issues which need to be clarified about the subgroup analysis and the consequent conclusion.

Methods: Systematic review and re-analysis of the indicated studies.

Results: In the subgroup analysis two studies were included, which had used non-parametric methods for statistical analysis and yielded insignificant p-values that showed indifference between betamethasone and dexamethasone. However, the Cochrane meta-analysis had used parametric methods in contradistinction to the included studies and indicated significant difference between two steroids. Accordingly, results and conclusions of the Cochrane meta-analysis in this subgroup analysis cannot be justified with the indicated two studies.

Conclusion: Here we can only urge further studies to provide frank evidence about the comparison of dexamethasone and betamethasone in HELLP syndrome. Until shown to be true, we doubt the credibility of the subgroup analysis results of the Cochrane review and the application of these subgroup results into clinical practice.
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http://dx.doi.org/10.3109/14767058.2012.712571DOI Listing
December 2012

Bladder exstrophy.

Fetal Pediatr Pathol 2012 Aug 20;31(4):225-9. Epub 2012 Mar 20.

Istanbul University, Cerrahpasa School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Istanbul, Turkey.

Bladder exstrophy is a very rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed externally. The differential diagnosis includes omphalocele, gastroschisis, and cloacal exstrophy. Ultrasound and Doppler examinations are the main diagnostic tools. Although mortality is low, termination of pregnancy should be discussed due to serious morbidities.
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http://dx.doi.org/10.3109/15513815.2011.650286DOI Listing
August 2012

Multiple fetal anomalies in association with topiramate and oxcarbezepine treatment.

Fetal Pediatr Pathol 2012 Jun 13;31(3):154-8. Epub 2012 Mar 13.

Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

We present a case of a woman who used topiramate (100 mg) and oxcarbazepine (300 mg) continuously during pregnancy. Multiple fetal anomalies including limp defects of the lower extremities, pericardiac fluid collection, cardiomegaly, cleft lip and palate, absent right kidney, and dysplastic left kidney were found by ultrasonography. Labor was induced and anomalies were confirmed by autopsy. The malformation rate after exposure to oxcarbazepine in utero as a monotherapy was calculated to be 2.4%, which is compatible with the malformation rate seen in the general population. Topiramate is teratogenic in mice, rats, and rabbits, but there are very few reports about its teratogenicity in humans.
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http://dx.doi.org/10.3109/15513815.2012.659378DOI Listing
June 2012

Craniorachischisis with a variant of pentalogy of Cantrell, with lung extrophy.

Fetal Pediatr Pathol 2011 3;30(6):431-6. Epub 2011 Aug 3.

Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

A case of cranioraschischisis including incomplete pentalogy of Cantrell (PC) is described. The female fetus had a large omphalocele with evisceration of the heart, left lung, liver, stomach, and intestines accompanying anencephaly, cervical, thoracal lumbar, spina bifida. The fetus had ectopia cordis and diaphragmatic agenesia with an intact sternum. We present a case of a neonate with the stigmata for PC with the exception of a sternal defect. A literature review is also included. Sonographers should check for ventral and dorsal anomalies with PC because they may occur simultaneously.
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http://dx.doi.org/10.3109/15513815.2011.587500DOI Listing
March 2012

Late pregnancy associated plasma protein A levels decrease in preterm labor.

J Matern Fetal Neonatal Med 2011 Jul 11;24(7):923-7. Epub 2011 May 11.

Department of Obstetrics and Gynecology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The purpose of the present study is to evaluate late, 'at admission', Pregnancy-associated plasma protein-A (PAPP-A) levels as a predictor of preterm birth in women with complaints of preterm labor or preterm painful contractions.

Methods: Prospective cohort study of singleton gestations, 23-37 weeks, and symptoms of preterm labor. Primary end point was delivery < 37 weeks. Predictive PAPP-A values were calculated both for preterm delivery and threatened preterm delivery on receiver operator curve.

Results: In all, 41 women (38.3%) delivered before 37 weeks (Group 1); 32 women (30.7%) had symptoms of preterm labor but did not deliver preterm (Group 2); 31 women (29.7%) delivered term (Group 3, control). Mean PAPP-A levels in preterm-labor and its matched control were 33.4 ± 19.9 and 52.5 ± 25.4 mIU/ml, respectively, and difference was statistically significant (p = 0.003). Mean PAPP-A level in threatened preterm labor group was 47.6 ± 25.3 mIU/ml and difference was significant compared to preterm-labor, but not significant compared to control group (p = 0.028 and p = 0.74, respectively).

Conclusion: Late PAPP-A levels decreased in preterm labor, levels < 29.8 mIU/ml was associated with increased risk for preterm birth, supporting active management whereas cutoff value of 33.6 mIU/ml is useful for discrimination of preterm birth from threatened preterm birth reaching to term.
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http://dx.doi.org/10.3109/14767058.2010.531320DOI Listing
July 2011

Ethical dimensions of periviability.

J Perinat Med 2010 11 31;38(6):579-83. Epub 2010 Aug 31.

Department of Obstetrics and Gynecology, Weill Cornell Medical Center, New York, NY 10021, USA.

The birth of neonates at the limits of viability, or periviability, poses numerous challenges to health care providers and to systems of care, and the care of these pregnancies and neonates is fraught with ethical controversies. This statement summarizes the ethical principles involved in the care of periviable pregnancies and neonates, and provides expert clinical opinion about the numerous challenges posed by this problem around the world. Topics addressed include a summary of the published experience, an ethical framework, translating neonatal outcome data to the obstetric arena, management as a trial of intervention, referral to tertiary centers, neonatal resuscitation, cesarean delivery for fetal indication, and limits on life-sustaining neonatal treatment.
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http://dx.doi.org/10.1515/jpm.2010.098DOI Listing
November 2010

Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles.

J Perinat Med 2010 11 13;38(6):597-600. Epub 2010 Aug 13.

Perinatology Division of Obstetrics and Gynecology Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Aim: to compare short- and long-term complications of amniocentesis performed with 20G, 21G, and 22G needles.

Methods: this observational study included 793 pregnant women who underwent amniocentesis in the Perinatology Department of Cerrahpasa Medical Faculty, Istanbul University, Turkey. The patients were divided into three groups according to the needle size used for the procedure: 20G (Group 1), 21G (Group 2), and 22G (Group 3). The incidences of early and late complications were compared among groups.

Results: fetal loss rates did not differ among groups (Group 1=1.57%, Group 2=1.47%, Group 3=1.61%). Rates of vaginal bleeding (1.57%, 1.10%, and 0.81%, respectively), bloody amniotic fluid (2.32%, 6.23%, and 2.67%, respectively) and amniotic fluid leakage (1.57%, 1.10%, and 1.61%, respectively) were also similar among the three groups.

Conclusion: short- and long-term complications did not differ among amniocenteses performed with 20G, 21G, and 22G needles.
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http://dx.doi.org/10.1515/jpm.2010.105DOI Listing
November 2010

Antenatal diagnosis and prognosis of conjoined twins--a case report.

J Perinat Med 2003 ;31(5):427-30

University of Istanbul, Cerrahpasa Medical School, Department of Perinatology, Obstetric and Gynecology, Istanbul, Turkey.

In this report, two conjoined twin cases that were diagnosed at the 19th and 25th week of gestational age are reported. In the first case the pregnancy was terminated because of the very poor prognosis. In the second case the decision was made to continue the pregnancy after counseling explaining the possibility of a separation procedure with good prognosis being carried out after birth. The babies were delivered at 38 weeks of gestation and the separation procedure was carried out at ten months of age without any complications. In selected cases, there is no need to abort, because of the possibility of a separation procedure after birth with good prognosis. Color Doppler ultrasound examination in an early stage of pregnancy in cases of conjoined twin can make it possible to decide which cases are candidates for a separation procedure after birth.
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http://dx.doi.org/10.1515/JPM.2003.066DOI Listing
March 2004

Antalya consensus on perinatal care: the report of the 2nd World Congress of Perinatal Medicine for Developing Countries, 1-5 October 2002, Antalya, Turkey.

J Perinat Med 2003 ;31(5):361-72

Department of Perinatology, Obstetrics and Gynecology, Cerrahpaşa Medical School, Istanbul.

The goal of antenatal care is to help the mother to maintain her well-being and achieve a healthy outcome for herself and her infant. Education about pregnancy, child-bearing and childrearing is an important part of antenatal care. Because of the perception that pregnancy is a physiologic event, even today lots of women do not seek medical care until a problem occurs during their pregnancy. There are still unacceptable differences in the extent of perinatal problems in developed and developing countries. Over the last century almost all countries have accepted antenatal care principles. However, insufficiency of resources and a lack of women's compliance have proved to be obstacles in developing countries and have compelled the application of various standard programs. Unfortunately, these programs are not sufficiently effective in preventing and treating maternal mortality. A safe pregnancy and delivery is a human right. Maternal mortality and morbidity should not be ranked with other diseases, because child bearing is not a disease. For this reason a global ethical consideration imposes an obligation upon society to avoid these almost totally preventable deaths. Ensuring access to family planning is an important way of decreasing maternal death. Maternal morbidity and mortality as well as perinatal mortality can be reduced through the synergistic effect of combined interventions, without first attaining high levels of economic development. These interventions include: education for all, universal childbirth, access to family planning services, attendance at birth by professional health workers, access to good quality care in case of complications, and policies that raise women's social and economic status and increase their access to property and the labor force.
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http://dx.doi.org/10.1515/JPM.2003.055DOI Listing
March 2004