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Mustafa Çelik
Mustafa Çelik Liv Hospital Content Team
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BPD of Foetus: The Ultimate Guide
BPD of Foetus: The Ultimate Guide 4

Understanding fetal measurements during pregnancy is key. One important measurement is the biparietal diameter (BPD). It’s a big part of fetal ultrasound biometry.bpd of foetus

BPD shows the size of the fetal head between two bones. It helps doctors check how the baby is growing. They can see if the baby is developing as it should.

At Liv Hospital, we use the latest ultrasound tech. This helps us get accurate BPD measurements. Doctors can then make better choices for the baby’s growth.

Key Takeaways

  • BPD is a key measurement in fetal ultrasound biometry.
  • It shows the size of the fetal head between two bones.
  • BPD helps doctors check the baby’s age and weight.
  • It also helps spot any growth issues early.
  • Liv Hospital uses advanced ultrasound tech for precise BPD measurements.

Understanding Biparietal Diameter (BPD) in Fetal Development

BPD of Foetus: The Ultimate Guide
BPD of Foetus: The Ultimate Guide 5

The Biparietal Diameter, or BPD, is a key measurement in fetal ultrasound exams. It shows the distance between the two parietal bones of the fetal skull. This is measured in a specific way during an ultrasound scan.

Definition and Anatomical Significance

BPD is the greatest distance between the parietal eminences of the fetal skull. It’s important because it shows how the fetal head is growing. This growth reflects the overall development of the fetus.

The measurement of BPD is taken from the outer edge of the proximal parietal bone to the inner edge of the distal parietal bone. This method ensures accurate and reliable assessment of fetal growth.

Historical Development of BPD Measurement

The use of BPD in fetal biometry has a long history, starting with early obstetric ultrasound. It was one of the first measurements used to estimate gestational age. Over time, ultrasound technology has improved, making BPD measurements more accurate.

BPD has been a key tool in assessing fetal development. It helps healthcare providers monitor growth and detect any issues early.

Role in Fetal Growth Assessment

BPD is essential for assessing fetal growth and development. It’s used to estimate gestational age, mainly between 13 and 20 weeks. By tracking BPD, healthcare providers can:

  • Assess fetal growth patterns and detect any deviations from the norm.
  • Estimate gestational age and predict the due date.
  • Monitor fetal development and detect any growth restrictions or abnormalities.

Measuring BPD, along with other parameters like Head Circumference (HC), Abdominal Circumference (AC), and Femur Length (FL), gives a full picture of fetal growth and development.

How BPD of Foetus Is Measured During Ultrasound

BPD of Foetus: The Ultimate Guide
BPD of Foetus: The Ultimate Guide 6

Measuring the Biparietal Diameter (BPD) of a fetus is key in fetal ultrasound biometry. It helps check how the fetus is growing and developing during pregnancy.

Proper Ultrasound Technique for BPD Measurement

For accurate BPD measurement, sonographers use a specific technique. They place the ultrasound probe to get a clear image of the fetal head. The image must show the cavum septum pellucidum, thalami, and third ventricle.

The BPD is measured from the outer edge of the proximal parietal bone to the inner edge of the distal parietal bone.

Key steps in BPD measurement:

  • Identify the correct plane: The transthalamic plane is used for BPD measurement.
  • Adjust the probe: Ensure the fetal head is not tilted or rotated.
  • Take the measurement: Calipers are placed on the outer and inner edges of the parietal bones.

Optimal Fetal Head Position for Accurate Readings

The fetal head’s position is vital for accurate BPD measurement. The best position is when the head is not compressed or flexed. Optimal fetal head positioning ensures the measurement is taken correctly, reducing errors.

Technological Considerations in Modern Ultrasound Equipment

Modern ultrasound equipment has made BPD measurements more accurate. Technologies like harmonic imaging and speckle reduction improve image quality. Many machines also have automated tools to help reduce human error.

Technological Feature

Benefit in BPD Measurement

Harmonic Imaging

Improved image resolution

Speckle Reduction

Enhanced image clarity

Automated Measurement Tools

Reduced operator variability

By using the right technique, optimal fetal positioning, and advanced technology, healthcare providers can get precise BPD measurements. These measurements are vital for tracking fetal growth and spotting any issues early in pregnancy.

BPD Measurements Across Different Gestational Ages

BPD measurements are key in tracking fetal growth at various stages of pregnancy. They help us see if the fetus is growing well.

Expected BPD Values from First to Third Trimester

BPD measurements start early in pregnancy. They range from 2-3 mm at 6 weeks to 80-90 mm by 32 weeks. These numbers are vital for checking if the fetus is growing right.

In the first trimester, BPD helps guess the gestational age. As pregnancy moves into the second and third trimesters, these measurements are key for tracking growth and development.

BPD Growth Patterns and Velocity

BPD doesn’t grow at the same rate throughout pregnancy. It grows faster in the second trimester and slows down in the third. Knowing this helps spot any growth issues.

BPD growth speed is a sign of fetal health. Any abnormal growth might mean growth restriction or other problems.

BPD HC AC FL Normal Range in 32 Weeks

At 32 weeks, we measure BPD, HC, AC, and FL. For BPD, the normal range is 79-89 mm. HC, AC, and FL also have their normal ranges at this time.

At 32 weeks, a normal BPD is about 84 mm. HC is around 301 mm, AC is about 274 mm, and FL is roughly 62 mm. These numbers are important for checking fetal growth and development.

Knowing these measurements helps us give better prenatal care. By tracking these biometric parameters, we can spot and manage issues early. This ensures the best outcomes for both mom and baby.

BPD HC AC FL Chart Week by Week Analysis

A week-by-week look at BPD, HC, AC, and FL charts shows how a fetus grows. These measurements are key as pregnancy goes on. They help doctors spot any problems early.

First Trimester Measurements (Weeks 11-13)

In the first trimester, BPD, HC, AC, and FL measurements start to give us important info. They help date the pregnancy and spot any early growth issues.

Second Trimester Progression (Weeks 14-27)

In the second trimester, the fetus grows faster. BPD, HC, AC, and FL measurements are more important for checking growth. Regular ultrasounds during this time track the fetus’s growth.

Third Trimester Development (Weeks 28-40)

In the third trimester, BPD, HC, AC, and FL measurements are key for checking growth and planning for birth. Any big changes in growth might mean there’s a problem.

Understanding Growth Percentiles Throughout Pregnancy

Growth percentiles compare fetal measurements to a standard. Knowing these percentiles helps spot fetuses at risk for growth issues or being too big.

Gestational Age (Weeks)

BPD (mm)

HC (mm)

AC (mm)

FL (mm)

12

20-24

70-80

60-70

8-10

20

45-50

160-180

140-160

30-35

32

75-85

280-310

260-290

55-65

Relationship Between BPD and Other Biometric Parameters

It’s important to know how Biparietal Diameter (BPD) relates to other biometric parameters. BPD is a key measurement in fetal biometry. It helps evaluate fetal growth and development.

BPD and Head Circumference (HC) Correlation

BPD and Head Circumference (HC) are closely linked in fetal biometry. HC is calculated from BPD and Occipitofrontal Diameter (OFD). A strong link exists between BPD and HC, showing the growth of the fetal head.

Monitoring both helps assess fetal head growth. It also helps detect any abnormalities.

Comparing BPD with Abdominal Circumference (AC)

BPD measures the fetal head’s diameter, while Abdominal Circumference (AC) measures the abdomen’s circumference. AC is key for assessing fetal growth, including weight and detecting growth issues. Comparing BPD and AC shows how the fetal head and body grow proportionally.

BPD and Femur Length (FL) Relationships

Femur Length (FL) measures the fetal femur’s length. The relationship between BPD and FL is vital for assessing fetal growth and proportion. Both are important for estimating gestational age and fetal weight.

Understanding OFD (Occipitofrontal Diameter) in Relation to BPD

Occipitofrontal Diameter (OFD) measures from the external occipital protuberance to the forehead. OFD, with BPD, helps calculate Head Circumference (HC). The BPD to OFD ratio gives insights into the fetal head’s shape. This is important for assessing fetal development and spotting anomalies.

By studying the connections between BPD and other parameters like HC, AC, FL, and OFD, healthcare providers get a full picture of fetal development. This approach improves the accuracy of fetal assessments. It supports better prenatal care.

The Significance of BPD in Anatomy Scans

The anatomy scan is a key moment in pregnancy. It measures BPD, which is vital for checking the fetus’s health. This scan happens between 18 and 22 weeks of pregnancy. It’s a detailed ultrasound that looks at the fetus’s anatomy and growth.

What to Expect During the Anatomy Scan

During the anatomy scan, parents-to-be see a detailed look at their baby. The sonographer checks the fetus’s anatomy, including the brain and heart. They also measure BPD to see how the baby is growing.

The BPD measurement is important. It shows how the baby’s head is developing. This helps find any problems early.

How BPD Contributes to Overall Fetal Assessment

BPD is a key part of the anatomy scan. It measures the distance between the fetal skull’s bones. This gives insights into the baby’s growth and any possible issues.

BPD is combined with other measurements like head circumference and abdominal circumference. This gives a full picture of the baby’s development. It helps doctors spot any growth problems or other issues that need attention.

Timing of BPD Measurement in Routine Prenatal Care

BPD is usually checked during the anatomy scan in the second trimester. But, it might be done at other times too. The exact timing depends on the patient’s needs and risk factors.

In regular prenatal care, BPD is key for tracking the baby’s growth. By watching BPD changes, doctors can spot problems early. This helps them plan the best care for the baby.

Interpreting BPD Measurements: Normal vs. Abnormal Findings

Understanding Biparietal Diameter (BPD) measurements is key to checking on fetal growth. It helps us spot any growth problems early. We use BPD to see how a fetus is growing and if it’s growing right.

Understanding BPD Percentiles

BPD measurements are compared to growth charts to find out where the fetus stands. A fetus at the 50th percentile is right on track for its age. But, if it’s below the 10th or above the 90th percentile, it might have growth issues. Knowing these percentiles helps us watch over fetuses at risk.

Signs of Fetal Growth Restriction

Fetal growth restriction (FGR) happens when a fetus doesn’t grow as it should. Abnormal BPD measurements can signal FGR, along with other signs like smaller Head Circumference (HC) or Abdominal Circumference (AC). These signs help us spot and manage any problems early.

Indications of Macrosomia or Accelerated Growth

But, if a BPD measurement is way above average, it might mean the fetus is growing too fast. Macrosomia, or being too big, can make delivery risky. We look at BPD and other signs to figure out the fetus’s weight and plan for any challenges.

When BPD Measurements Suggest Microcephaly or Hydrocephaly

Abnormal BPD measurements can also hint at certain birth defects. Microcephaly, or a very small head, and hydrocephaly, or fluid buildup in the brain, are two conditions we might see. We use BPD with other ultrasound findings to diagnose these and talk to parents about what it means.

By carefully looking at BPD measurements and other signs, we get a full picture of fetal development. This lets us catch any problems early and give the best care to mom and baby.

Clinical Applications of BPD in Fetal Biometry

Biparietal Diameter (BPD) is key in fetal biometry for prenatal care. It’s used to check on fetal growth and spot issues early.

Estimating Gestational Age Using BPD

BPD helps estimate when a baby is due. In the second trimester, it’s very useful. Knowing the exact due date is important for planning care and delivery timing.

We combine BPD with other measurements for better due date guesses. This is helpful when the exact conception date is not known.

Predicting Fetal Weight with BPD and Other Parameters

BPD is used with other measurements like Head Circumference (HC), Abdominal Circumference (AC), and Femur Length (FL) to guess fetal weight. This is key for spotting growth problems and planning care.

Parameter

Role in Fetal Weight Estimation

BPD

Provides information on fetal head size

HC

Assesses the circumference of the fetal head

AC

Measures fetal abdominal size, indicative of fetal weight

FL

Evaluates the length of the fetal femur, contributing to overall fetal weight estimation

Role in Diagnosing Growth Abnormalities

BPD is vital for spotting growth issues in fetuses. By comparing BPD to expected values, doctors can find growth problems. Early detection leads to better care and outcomes.

BPD in High-Risk Pregnancy Monitoring

In high-risk pregnancies, BPD is used often to watch fetal growth. Regular ultrasounds help catch problems early. This lets doctors take the right steps to manage the pregnancy.

We stress the role of BPD in managing high-risk pregnancies. It helps ensure the best results for both mom and baby.

Conclusion: The Enduring Importance of BPD in Prenatal Care

We’ve looked into how Biparietal Diameter (BPD) is key in fetal ultrasound biometry. It helps check how a fetus is growing and developing. BPD is a vital part of prenatal care, giving insights into fetal growth all through pregnancy.

Getting BPD right during ultrasounds is very important. It helps guess the baby’s age, weight, and if there are any growth issues. BPD works with other measurements like Head Circumference, Abdominal Circumference, and Femur Length. Together, they give a full view of the fetus’s size and health.

Knowing what BPD ultrasound means is critical for doctors to make good choices in prenatal care. BPD’s ongoing role in today’s obstetrics shows its value in checking on a fetus’s health.

Looking ahead, BPD will keep being a key part in tracking fetal growth. This ensures the best results for pregnancies.

FAQ

What does BPD mean in fetal ultrasound biometry?

BPD stands for Biparietal Diameter. It measures the distance between the two sides of the fetal skull. This helps doctors check how the fetus is growing and estimate when it will be born.

How is BPD measured during an ultrasound?

To measure BPD, doctors use ultrasound. They place calipers on the outer and inner edges of the fetal skull. This is done in a view of the fetal head.

What is the normal range for BPD, HC, AC, and FL at 32 weeks of gestation?

At 32 weeks, the normal ranges are: BPD is 75-85 mm, HC is 280-310 mm, AC is 260-300 mm, and FL is 55-65 mm. These can vary slightly based on the reference chart used.

How does BPD relate to other fetal biometry parameters like HC, AC, and FL?

BPD is linked to other measurements like HC, AC, and FL. Together, they give a full picture of how the fetus is growing and developing.

What does it mean if BPD measurements are outside the normal range?

If BPD measurements are not normal, it could mean the fetus is not growing right. This could be due to growth restriction, being too big, or other issues like microcephaly or hydrocephaly. More tests are needed.

How is BPD used in estimating fetal weight and gestational age?

BPD is used with other measurements to guess the fetal weight and when it will be born. This is important for tracking the fetus’s growth and planning prenatal care.

What is the significance of BPD during anatomy scans?

During anatomy scans, BPD is checked to see how the fetal head is developing. It helps estimate the gestational age and gives a full view of the fetus’s anatomy and growth.

Can BPD measurements predict possible complications in pregnancy?

Yes, abnormal BPD measurements can suggest possible complications. This could be growth restriction or structural issues. Early detection allows for timely action and monitoring.

How often is BPD measured during pregnancy?

BPD is usually measured during the anatomy scan (around 18-22 weeks). It might be checked again in later ultrasounds, mainly in high-risk pregnancies or when tracking fetal growth.

What is the role of BPD in high-risk pregnancy monitoring?

In high-risk pregnancies, BPD helps closely watch the fetus’s growth. It helps detect issues early and guides management to ensure the best outcomes.


References

National Center for Biotechnology Information. Evidence-Based Medical Guidance. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409806/

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Özgül Kafadar Obstetrics and Gynecology Prof. MD. Mehmet Sinan Beksaç Liv Hospital Ankara Prof. MD. Mehmet Sinan Beksaç Obstetrics and Gynecology Prof. MD. Türkan Gülpınar Liv Hospital Ankara Prof. MD. Türkan Gülpınar Obstetrics and Gynecology Prof. MD. İbrahim Alanbay Liv Hospital Ankara Prof. MD. İbrahim Alanbay Obstetrics and Gynecology Assoc. Prof. MD. Ali Ovayolu Liv Hospital Gaziantep Assoc. Prof. MD. Ali Ovayolu Obstetrics and Gynecology Op. MD. Eda Deniz Atkın Liv Hospital Gaziantep Op. MD. Eda Deniz Atkın Obstetrics and Gynecology Op. MD. Hatice Şahin Bıkmaz Liv Hospital Gaziantep Op. MD. Hatice Şahin Bıkmaz Obstetrics and Gynecology Op. MD. Merve Evrensel Liv Hospital Gaziantep Op. MD. Merve Evrensel Obstetrics and Gynecology Spec. MD. Ayça Bozoklar Nuh Liv Hospital Gaziantep Spec. MD. Ayça Bozoklar Nuh Obstetrics and Gynecology MD. Gamze Keleş Liv Hospital Samsun MD. Gamze Keleş Obstetrics and Gynecology Op. MD. Hilal Mürüvvet Bulut Aydemir Liv Hospital Samsun Op. MD. Hilal Mürüvvet Bulut Aydemir Obstetrics and Gynecology Op. MD. Sami Şahin Liv Hospital Samsun Op. MD. Sami Şahin Obstetrics and Gynecology Op. MD. Seher Sarı Kayalarlı Liv Hospital Samsun Op. MD. Seher Sarı Kayalarlı Obstetrics and Gynecology MD. KAMRAN NAĞIYEV Liv Bona Dea Hospital Bakü MD. KAMRAN NAĞIYEV Obstetrics and Gynecology Spec. MD.  AYNURE HEMIDOVA Liv Bona Dea Hospital Bakü Spec. MD. AYNURE HEMIDOVA Obstetrics and Gynecology Spec. MD. RAMİN QELENDEROV Liv Bona Dea Hospital Bakü Spec. MD. RAMİN QELENDEROV Obstetrics and Gynecology Spec. MD. İRANE QORÇİYEVA Liv Bona Dea Hospital Bakü Spec. MD. İRANE QORÇİYEVA Obstetrics and Gynecology Op. MD. Merve Akın Op. MD. Merve Akın Obstetrics and Gynecology Op. MD. Selda Atar Akal Op. MD. Selda Atar Akal Obstetrics and Gynecology Op. MD. Faik Tamer Sözen Liv Hospital Ulus + Liv Hospital Vadistanbul Op. MD. Faik Tamer Sözen Obstetrics and Gynecology Asst. Prof. MD. Yusuf Başkıran Liv Hospital Bahçeşehir + Liv Hospital Topkapı Asst. Prof. MD. Yusuf Başkıran Obstetrics and Gynecology
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Assoc. Prof. MD. Miraç Özalp Obstetrics and Gynecology

Assoc. Prof. MD. Miraç Özalp

Liv Hospital Ulus
Op. MD. Faik Tamer Sözen Obstetrics and Gynecology

Op. MD. Faik Tamer Sözen

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Op. MD. Seyfettin Özvural

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Prof. MD.  Mustafa Alper Karalök Obstetrics and Gynecology

Prof. MD. Mustafa Alper Karalök

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Prof. MD. Ayhan Sucak Obstetrics and Gynecology

Prof. MD. Ayhan Sucak

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Op. MD. Altuğ Semiz Obstetrics and Gynecology

Op. MD. Altuğ Semiz

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Op. MD. Asena Ayar Madenli Obstetrics and Gynecology

Op. MD. Asena Ayar Madenli

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Op. MD. Burak Hazine Obstetrics and Gynecology

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Op. MD. Gamze Baykan Özgüç Obstetrics and Gynecology

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Op. MD. Nesime Damla İplik Obstetrics and Gynecology

Op. MD. Nesime Damla İplik

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Op. MD. Ulviye Hanlı Obstetrics and Gynecology

Op. MD. Ulviye Hanlı

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Prof. MD. Mehmet Serdar Kütük Obstetrics and Gynecology

Prof. MD. Mehmet Serdar Kütük

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Assoc. Prof. MD. Mine Dağgez Gynecological Oncology

Assoc. Prof. MD. Mine Dağgez

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Asst. Prof. MD. Bülent Tekin Obstetrics and Gynecology

Asst. Prof. MD. Bülent Tekin

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Obstetrics and Gynecology

Asst. Prof. MD. Kübra Irmak

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Asst. Prof. MD. Yusuf Başkıran Obstetrics and Gynecology

Asst. Prof. MD. Yusuf Başkıran

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Liv Hospital Topkapı
Op. MD. Alp Koray Kinter Gynecological Oncology

Op. MD. Alp Koray Kinter

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Op. MD. Ayşe Bilgen Obstetrics and Gynecology

Op. MD. Ayşe Bilgen

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Op. MD. Betül Averbek Obstetrics and Gynecology

Op. MD. Betül Averbek

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Op. MD. Billur Küpelioglu Obstetrics and Gynecology

Op. MD. Billur Küpelioglu

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Op. MD. Cansu Kaya Obstetrics and Gynecology

Op. MD. Cansu Kaya

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Op. MD. Deniz Sarıkaya Kalkan Obstetrics and Gynecology

Op. MD. Deniz Sarıkaya Kalkan

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Op. MD. Selda Akal Obstetrics and Gynecology

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Spec. MD. Refaettin Şahin Perinatology

Spec. MD. Refaettin Şahin

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Assoc. Prof. MD. Nihal Çallıoğlu Perinatology

Assoc. Prof. MD. Nihal Çallıoğlu

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Assoc. Prof. MD. Semra Yüksel Obstetrics and Gynecology

Assoc. Prof. MD. Semra Yüksel

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Asst. Prof. MD. Serhat Şen Obstetrics and Gynecology

Asst. Prof. MD. Serhat Şen

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Op. MD. Elif Uysal Obstetrics and Gynecology

Op. MD. Elif Uysal

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Op. MD. Haldun Celal Özben Obstetrics and Gynecology

Op. MD. Haldun Celal Özben

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Op. MD. Meltem Özben Obstetrics and Gynecology

Op. MD. Meltem Özben

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Prof. MD. İsmet Alkış Obstetrics and Gynecology

Prof. MD. İsmet Alkış

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Assoc. Prof. MD.  Ümit Yasemin Sert Dinç Obstetrics and Gynecology

Assoc. Prof. MD. Ümit Yasemin Sert Dinç

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Assoc. Prof. MD. Aytac Jafarzade Obstetrics and Gynecology

Assoc. Prof. MD. Aytac Jafarzade

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Assoc. Prof. MD. Nazlı Topfedaisi Obstetrics and Gynecology

Assoc. Prof. MD. Nazlı Topfedaisi

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Assoc. Prof. MD. Nazlı Topfedaisi Özkan Gynecological Oncology

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Op. MD. Gökhan Kılıç Obstetrics and Gynecology

Op. MD. Gökhan Kılıç

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Op. MD. Zeynep Ataman Yıldırım Obstetrics and Gynecology

Op. MD. Zeynep Ataman Yıldırım

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Op. MD. Çetin Arık Obstetrics and Gynecology

Op. MD. Çetin Arık

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Op. MD. Özge Şehirli Obstetrics and Gynecology

Op. MD. Özge Şehirli

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Op. MD. Özgül Kafadar Obstetrics and Gynecology

Op. MD. Özgül Kafadar

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Prof. MD. Mehmet Sinan Beksaç Obstetrics and Gynecology

Prof. MD. Mehmet Sinan Beksaç

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Prof. MD. Türkan Gülpınar Obstetrics and Gynecology

Prof. MD. Türkan Gülpınar

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Prof. MD. İbrahim Alanbay Obstetrics and Gynecology

Prof. MD. İbrahim Alanbay

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Assoc. Prof. MD. Ali Ovayolu Obstetrics and Gynecology

Assoc. Prof. MD. Ali Ovayolu

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Op. MD. Eda Deniz Atkın Obstetrics and Gynecology

Op. MD. Eda Deniz Atkın

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Op. MD. Hatice Şahin Bıkmaz Obstetrics and Gynecology

Op. MD. Hatice Şahin Bıkmaz

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Op. MD. Merve Evrensel Obstetrics and Gynecology

Op. MD. Merve Evrensel

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Spec. MD. Ayça Bozoklar Nuh Obstetrics and Gynecology

Spec. MD. Ayça Bozoklar Nuh

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MD. Gamze Keleş Obstetrics and Gynecology

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Op. MD. Hilal Mürüvvet Bulut Aydemir Obstetrics and Gynecology

Op. MD. Hilal Mürüvvet Bulut Aydemir

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Op. MD. Sami Şahin Obstetrics and Gynecology

Op. MD. Sami Şahin

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Op. MD. Seher Sarı Kayalarlı Obstetrics and Gynecology

Op. MD. Seher Sarı Kayalarlı

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MD. KAMRAN NAĞIYEV Obstetrics and Gynecology

MD. KAMRAN NAĞIYEV

Liv Bona Dea Hospital Bakü
Spec. MD.  AYNURE HEMIDOVA Obstetrics and Gynecology

Spec. MD. AYNURE HEMIDOVA

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Spec. MD. RAMİN QELENDEROV Obstetrics and Gynecology

Spec. MD. RAMİN QELENDEROV

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Spec. MD. İRANE QORÇİYEVA Obstetrics and Gynecology

Spec. MD. İRANE QORÇİYEVA

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Op. MD. Merve Akın Obstetrics and Gynecology

Op. MD. Merve Akın

Op. MD. Selda Atar Akal Obstetrics and Gynecology

Op. MD. Selda Atar Akal

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