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COVID 19 PANDEMİSİNDE YÜKSEK RİSKLİ GEBELİKLERİN BELİRLENMESİ VE YÖNETİMİ: ANTENATAL TAKİP PİRAMİDİNİ TERSİNE ÇEVİRME ZAMANI MI ?

Year 2020, Volume: 17 Issue: 2, 388 - 393, 25.06.2020
https://doi.org/10.38136/jgon.726726

Abstract

Dünya Sağlık Örgütü (DSÖ) Koronavirüs hastalığı 2019 (COVID-19) infeksiyonu doğrulanmış veya şüphelenilenler de dahil olmak üzere tüm gebelerin kaliteli antenatal takip, doğum, ve lohusa takibi ve ruhsal sağlık hizmeti alma hakkına sahip olduğunu yayınladı. COVID-19’ un Dünya Sağlık Örgütü tarafından 11 Mart 2020 de pandemi olduğu ilanı 24 saat boyunca ve tatil günlerinden bağımsız kesintisiz doğum hizmeti veren, anne ve bebeği olarak iki ayrı hastanın sorumluluğunu taşıyan yegane brans olan kadın doğumun iş yükünü ve sorumluluğunu daha da ağırlaştırmıştır. Acili en fazla olan uzmanlık alanı olması yanında hem doğum hem de düşük gibi üreme ile ilgili durumların ve komplikasyonların kadın doğum hekimi ile gebenin çok yakın temas halinde ve uzun süre birarada bulunarak yönetildiği bilinmektedir. Doğumların %50’ sinden fazlasının sezaryen ile gerçekleştirilmesi ve cerrahinin getirdiği ek riskler, ultrasonografinin gebe muayenesinin bir parçası olarak kol boyundan daha kısa mesafeden uygulanması, 15-45 yaş aralığındaki gebe populayonda semptomatik dişında asemptomatik ya da presemptomatik (COVID-19) seyrinin sıklığı ve bulaş riski göz önüne alındığında kadın doğum hekimi mesleğini yüksek riskle uygulamaktadır. Bu nedenle erken dönemde gebelerin risk değerlendirmelerinin rahim içi gebelik doğrulandıktan sonra ilk trimesterde anne öyküsü ve karakteristik özellikleri ve biyofizik ve biyokimyasal testlerle yapılarak düşük risk grubu gebelerde 12, 20,37.ve doğum gerçekleşmemiş ise 41. gebelik haftasında ek sorunlar olmadığı takdirde muayenelerin yapılması, riskli grupta ise 12-34. haftalarda değerlendirmenin uzmanlarca gerçekleştirilmesi pandeminin yayılma hızına yetişme sıkıntısı çekebilecek olan sağlık sisteminin yükü ile birlikte, maternal ve perinatal komplikasyonları azaltabilecektir. Özellikle doğum ve düşük gibi işlemlerin ve zorunlu cerrahinin ertelenmesi mümkün olamayacağından düşük risk grubunda antenatal muayene aralıklarının açılması gerekmektedir. Bu nedenle, “yüksek riskli gebelik” kavramını öne çıkaran bir algoritmanın uygulanmasını hedeflemekteyiz. Bir taraftan da girişim gerektiren acil ve öncelikli hastalarda cerrahi ve sonrasında takip, infeksiyon koruma tedbirlerinin en üst düzeyde sağlandığı bir ortamda yapılmalıdır. Bu yazıda, obstetrik girişimlerin gebe ve sağlık çalışanı için güvenliliğin sağlandığı şartlarda gerçekleştirilebilmesi ve hem anne ve hem de fetusun güvenliliğini sağlayacak ve kadın doğum/perinatoloji ekibinin maksimum seviyede korunabilmesi için uygulanmasında yararlı olabilecek gebelikte “Yüksek risk algoritmasına” ilişkin bilgilendirme ve yönetim sunulmaktadır

References

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  • 10. Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M,et al. Active monitoring of persons exposed to patients with confirmed COVID-19 — United States, January–February 2020. MMWR Morb Mortal Wkly Rep. 2020 doi : 10.15585/mmwr. mm6909e1external icon
  • 11. Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020 Mar 4 [Epub ahead of print].
  • 12. Wang W, Xu Y, Ruqin G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020 doi:10.1001/jama.2020.3786.
  • 13. Lauer SA, Grantz KH,B i Q et al.The incubation period of Coronavirus Disease 2019(COVID-19) From publicly reported confirmed cases: Estimation and Application. Ann Intern Med 2020 doi: 10.7326/M20-0504.
  • 14. Liu Y, Yan LM, Wan L et al. Viral dynamics in mild and severe cases of CVOID-19. Lancet Infect Dis doi.org/10.1016/S1473-3099(20)30232-2
  • 15. Wolfel R, Corman V, Guggemos W et al: Virological assessment of hospitalized cases of coronavirus disease 2019. doi: 10.1101/2020.03.05.20030502.
  • 16. Yu P, Zhu J, Zhang Z, Han Y. A familial cluster of infection associated with the 2019 novel coronavirus indicating possible person-to-person transmission during the incubation period. J Infect 2020 doi: 10.1093/jiaa077
  • 17. Huang R, Xia J, Chen Y, Shan C, Wu C. A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China. Lancet Infect Dis 2020 doi: 10.1016/ S1473-3099(20)30147-X
  • 18. Pan X, Chen D, Xia Y et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis 2020 doi : 10.1016/ S1473-3099(20)30114-6
  • 19. Tong Z-D, Tang A, Li K-F, Li P, Wang H-L, Yi J-P, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis. 2020 doi:10.3201/eid2605. 200198
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  • 21. Kimball A, Hatfield KM, Arons M, James A, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR, 3 April 2020, 69(13);377–81.
  • 22. Center for Disease Control and Prevention Website. Coronavirus (COVID-19). Available at: https://www.cdc. gov/ coronavirus/2019-nCoV/index.html. [Accessed: March 28, 2020]
  • 23. Wu ve McGoogan Guan WJ, Ni ZY, Hu Yet al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med.; 2020 28. doi: 10.1056/NEJMoa2002032.
  • 24. Lauer SA, Grantz KH, Bi Q et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med.  2020 Mar 10;M20-0504. doi: 10.7326/M20-0504. Online ahead of print
  • 25. Dashraathn P, Jing Lin Jeslyn W et al. Coronavirus Disease 2019(COVID-19) Pandemic and Pregnancy. Am J Obstet Gynecol 2020 Mar 23;S0002-9378(20)30343-4. doi: 10.1016 /j.ajog. 2020.03.021.Online ahead of print.
  • 26. Sutton D, Fuchs K, D’Alton M, Goffman D: Universal Screening for SARS-CoV-2 in Women Admitted for Delivery (letter) NEJM 2020 Apr 13; NEJMc2009316. doi: 10.1056/ NEJMc2009316. Online ahead of print
  • 27. Yu N, Li W, Kang Q et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020 Mar 24; doi: 10.1016/S1473-3099(20)30176-6
  • 28. Yang H,Wang C,Poon LC. Novel corona virus infection and pregnancy. Ultrasound Obstet Gynecol 2020; 55: 435–37
  • 29. Chen H, Guo J, Wang C et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395: 809–15
  • 30. Schwartz DA, Graham AL: Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020, 12, 194; doi:10.3390/ v12020194
  • 31. Ng, W.F.; Wong, S.F.; Lam, A.; Mak, Y.F.; Yao, H.; Lee, K.C.; Chow, K.M.; Yu, W.C.; Ho, L.C. The placentas of patients with severe acute respiratory syndrome: A pathophysiological evaluation. Pathology 2006, 38, 210–218
  • 32. Zhao J et al: Antibody responses to SARS-CoV-2 in patients of novel corona virus disease 2019 J Infect Dis 2020 Mar 28; ciaa344. doi: 10.1093/cid/ciaa344. Online ahead of print
  • 33. Yapar Eyi EG, Mollamahmutoglu L: An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med 2019 Oct 1:1-11. doi: 10.1080/ 14767058.2019.1670806. [Epub ahead of print]
  • 34. Ministry of Health Report. 1929. Memorandum on antenatal clinics: their conduct and scope. His Majesty’s Stationery Office, 1930. London.
  • 35. Nicolaides KH. 2011. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 31(1): 7–15.
  • 36. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn 2011; 31(1): 90–102.
  • 37. Akolekar R, Bower S, Flack N, Bilardo CM, Nicolaides KH. 2011a. Prediction of miscarriage and stillbirth at 11–13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 31(1): 38–45.
  • 38. van Ravenswaaij R, Tesselaar-van der Goot M, de Wolf S, van Leeuwen- Spruijt M, Visser GHA, Schielen PCJI. 2011. First-trimester serum PAPP-A and fβ-hCG concentrations and other maternal characteristics to establish logistic regression-based predictive rules for adverse pregnancy outcome. Prenat Diagn 2011; 31(1): 50–57.
  • 39. Beta J, Akolekar R, Ventura W, Syngelaki A, Nicolaides KH. 2011. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental perfusion and function at 11–13 weeks. Prenat Diagn 2011; 31(1): 75–83.
  • 40. Greco E, Lange A, Ushakov F, Rodriguez Calvo J, Nicolaides KH. 2011. Prediction of spontaneous preterm delivery from endocervical length at 11 to 13 weeks. Prenat Diagn 2011; 31(1): 84–89.
  • 41. Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016 ; 19;353:i1753
  • 42. Akolekar R, Syngelaki A, Sarquis R, Zvanca M, Nicolaides KH. 2011b. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31(1): 66–74.
  • 43. Karagiannis G, Akolekar R, Sarquis R, Wright D, Nicolaides KH. 2011. Prediction of small for gestation neonates from biophysical and biochemical markers at 11–13 weeks. Fetal Diagn Ther. 2011;29(2):148-54.
  • 44. Waugh N, Scotland G, McNamee P, et al. Screening for type 2 diabetes: literature review and economic modelling. Health Technol Assess 2007; 11(1–125).
  • 45. The HAPO Study Cooperative Research Group*Hyperglycemia and Adverse Pregnancy Outcome: N Engl J Med 2008; 358:1991-2002
  • 46. Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenat Diagn 2011 ;31(2):135-141.
  • 47. Plasencia W, Garcia R, Pereira S, Akolekar R, Nicolaides KH. 2011. Criteria for screening and diagnosis of gestational diabetes mellitus in the first- trimester of pregnancy. Fetal Diagn Ther. 2011;30(2):108-15.
  • 48. Poon LCY , Karagiannis G, Stratieva V , Syngelaki A, Nicolaides KH. 2011. First-trimester prediction of macrosomia.. Fetal Diagn Ther. 2011;29(2):139-147.
Year 2020, Volume: 17 Issue: 2, 388 - 393, 25.06.2020
https://doi.org/10.38136/jgon.726726

Abstract

References

  • 1. Smith DL, Battle KE, Hay SI, Barker CM, Scott TW, McKenzie FE (2012) Ross, Macdonald, and a Theory for the Dynamics and Control of Mosquito-Transmitted Pathogens. PLoS Pathog 8(4): e1002588
  • 2. Read JM et al: Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic prediction MedRxiv-doi: https://doi.org/10.1101/2020.01.23.20018549. Jan. 23, 2020.
  • 3. Early Transmissibility Assessment of a Novel Coronavirus in Wuhan, China - Maimuna Majumder and Kenneth D. Mandl, Harvard University - Computational Health Informatics Program - Posted: 24 Jan 2020 Last revised: 27 Jan 2020
  • 4. Report 3: Transmissibility of 2019-nCoV - 25 January 2020 - Imperial College London
  • 5. World Health Organization.Report of the WHO-China Joint Mission on Coronavirus Disease 2019(COVID-19) 16-24 February 2020 [Internet]. Geneva: World Health Organization; 2020 Available from: https://www.who.int/docs/default- source/ coronaviruse/who-china-joint-mission-on-covid-19-final- report.pdf
  • 6. Chan J, Yuan S, Kok K et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020 doi: 10.1016/S0140- 6736(20)30154-9
  • 7. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; doi:10.1056/NEJMoa2001316.
  • 8. Liu J, Liao X, Qian S et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis 2020 doi.org/10.3201 /eid2606. 200239
  • 9. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
  • 10. Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M,et al. Active monitoring of persons exposed to patients with confirmed COVID-19 — United States, January–February 2020. MMWR Morb Mortal Wkly Rep. 2020 doi : 10.15585/mmwr. mm6909e1external icon
  • 11. Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020 Mar 4 [Epub ahead of print].
  • 12. Wang W, Xu Y, Ruqin G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020 doi:10.1001/jama.2020.3786.
  • 13. Lauer SA, Grantz KH,B i Q et al.The incubation period of Coronavirus Disease 2019(COVID-19) From publicly reported confirmed cases: Estimation and Application. Ann Intern Med 2020 doi: 10.7326/M20-0504.
  • 14. Liu Y, Yan LM, Wan L et al. Viral dynamics in mild and severe cases of CVOID-19. Lancet Infect Dis doi.org/10.1016/S1473-3099(20)30232-2
  • 15. Wolfel R, Corman V, Guggemos W et al: Virological assessment of hospitalized cases of coronavirus disease 2019. doi: 10.1101/2020.03.05.20030502.
  • 16. Yu P, Zhu J, Zhang Z, Han Y. A familial cluster of infection associated with the 2019 novel coronavirus indicating possible person-to-person transmission during the incubation period. J Infect 2020 doi: 10.1093/jiaa077
  • 17. Huang R, Xia J, Chen Y, Shan C, Wu C. A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China. Lancet Infect Dis 2020 doi: 10.1016/ S1473-3099(20)30147-X
  • 18. Pan X, Chen D, Xia Y et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis 2020 doi : 10.1016/ S1473-3099(20)30114-6
  • 19. Tong Z-D, Tang A, Li K-F, Li P, Wang H-L, Yi J-P, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis. 2020 doi:10.3201/eid2605. 200198
  • 20. Wei WE, Li Z, Chiew CJ, Yong SE, et al. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR, 1 April 2020/69.
  • 21. Kimball A, Hatfield KM, Arons M, James A, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR, 3 April 2020, 69(13);377–81.
  • 22. Center for Disease Control and Prevention Website. Coronavirus (COVID-19). Available at: https://www.cdc. gov/ coronavirus/2019-nCoV/index.html. [Accessed: March 28, 2020]
  • 23. Wu ve McGoogan Guan WJ, Ni ZY, Hu Yet al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med.; 2020 28. doi: 10.1056/NEJMoa2002032.
  • 24. Lauer SA, Grantz KH, Bi Q et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med.  2020 Mar 10;M20-0504. doi: 10.7326/M20-0504. Online ahead of print
  • 25. Dashraathn P, Jing Lin Jeslyn W et al. Coronavirus Disease 2019(COVID-19) Pandemic and Pregnancy. Am J Obstet Gynecol 2020 Mar 23;S0002-9378(20)30343-4. doi: 10.1016 /j.ajog. 2020.03.021.Online ahead of print.
  • 26. Sutton D, Fuchs K, D’Alton M, Goffman D: Universal Screening for SARS-CoV-2 in Women Admitted for Delivery (letter) NEJM 2020 Apr 13; NEJMc2009316. doi: 10.1056/ NEJMc2009316. Online ahead of print
  • 27. Yu N, Li W, Kang Q et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020 Mar 24; doi: 10.1016/S1473-3099(20)30176-6
  • 28. Yang H,Wang C,Poon LC. Novel corona virus infection and pregnancy. Ultrasound Obstet Gynecol 2020; 55: 435–37
  • 29. Chen H, Guo J, Wang C et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395: 809–15
  • 30. Schwartz DA, Graham AL: Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020, 12, 194; doi:10.3390/ v12020194
  • 31. Ng, W.F.; Wong, S.F.; Lam, A.; Mak, Y.F.; Yao, H.; Lee, K.C.; Chow, K.M.; Yu, W.C.; Ho, L.C. The placentas of patients with severe acute respiratory syndrome: A pathophysiological evaluation. Pathology 2006, 38, 210–218
  • 32. Zhao J et al: Antibody responses to SARS-CoV-2 in patients of novel corona virus disease 2019 J Infect Dis 2020 Mar 28; ciaa344. doi: 10.1093/cid/ciaa344. Online ahead of print
  • 33. Yapar Eyi EG, Mollamahmutoglu L: An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med 2019 Oct 1:1-11. doi: 10.1080/ 14767058.2019.1670806. [Epub ahead of print]
  • 34. Ministry of Health Report. 1929. Memorandum on antenatal clinics: their conduct and scope. His Majesty’s Stationery Office, 1930. London.
  • 35. Nicolaides KH. 2011. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 31(1): 7–15.
  • 36. Syngelaki A, Chelemen T, Dagklis T, Allan L, Nicolaides KH. Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn 2011; 31(1): 90–102.
  • 37. Akolekar R, Bower S, Flack N, Bilardo CM, Nicolaides KH. 2011a. Prediction of miscarriage and stillbirth at 11–13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 31(1): 38–45.
  • 38. van Ravenswaaij R, Tesselaar-van der Goot M, de Wolf S, van Leeuwen- Spruijt M, Visser GHA, Schielen PCJI. 2011. First-trimester serum PAPP-A and fβ-hCG concentrations and other maternal characteristics to establish logistic regression-based predictive rules for adverse pregnancy outcome. Prenat Diagn 2011; 31(1): 50–57.
  • 39. Beta J, Akolekar R, Ventura W, Syngelaki A, Nicolaides KH. 2011. Prediction of spontaneous preterm delivery from maternal factors, obstetric history and placental perfusion and function at 11–13 weeks. Prenat Diagn 2011; 31(1): 75–83.
  • 40. Greco E, Lange A, Ushakov F, Rodriguez Calvo J, Nicolaides KH. 2011. Prediction of spontaneous preterm delivery from endocervical length at 11 to 13 weeks. Prenat Diagn 2011; 31(1): 84–89.
  • 41. Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016 ; 19;353:i1753
  • 42. Akolekar R, Syngelaki A, Sarquis R, Zvanca M, Nicolaides KH. 2011b. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31(1): 66–74.
  • 43. Karagiannis G, Akolekar R, Sarquis R, Wright D, Nicolaides KH. 2011. Prediction of small for gestation neonates from biophysical and biochemical markers at 11–13 weeks. Fetal Diagn Ther. 2011;29(2):148-54.
  • 44. Waugh N, Scotland G, McNamee P, et al. Screening for type 2 diabetes: literature review and economic modelling. Health Technol Assess 2007; 11(1–125).
  • 45. The HAPO Study Cooperative Research Group*Hyperglycemia and Adverse Pregnancy Outcome: N Engl J Med 2008; 358:1991-2002
  • 46. Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenat Diagn 2011 ;31(2):135-141.
  • 47. Plasencia W, Garcia R, Pereira S, Akolekar R, Nicolaides KH. 2011. Criteria for screening and diagnosis of gestational diabetes mellitus in the first- trimester of pregnancy. Fetal Diagn Ther. 2011;30(2):108-15.
  • 48. Poon LCY , Karagiannis G, Stratieva V , Syngelaki A, Nicolaides KH. 2011. First-trimester prediction of macrosomia.. Fetal Diagn Ther. 2011;29(2):139-147.
There are 48 citations in total.

Details

Primary Language Turkish
Subjects Obstetrics and Gynaecology
Journal Section Review
Authors

Elif Gül Yapar Eyi 0000-0001-7541-9197

Özlem Moraloğlu Tekin 0000-0001-8167-3837

Publication Date June 25, 2020
Submission Date April 25, 2020
Acceptance Date April 28, 2020
Published in Issue Year 2020 Volume: 17 Issue: 2

Cite

Vancouver Yapar Eyi EG, Moraloğlu Tekin Ö. COVID 19 PANDEMİSİNDE YÜKSEK RİSKLİ GEBELİKLERİN BELİRLENMESİ VE YÖNETİMİ: ANTENATAL TAKİP PİRAMİDİNİ TERSİNE ÇEVİRME ZAMANI MI ?. JGON. 2020;17(2):388-93.