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Mustafa Çelik
Mustafa Çelik Liv Hospital Content Team
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EFW Meaning: The Ultimate Pregnancy Guide
EFW Meaning: The Ultimate Pregnancy Guide 4

Understanding Estimated Fetal Weight (EFW) is key for parents-to-be and doctors. It shows how a baby is growing and might be born. This is important throughout pregnancy.This is the ultimate guide to the EFW meaning in pregnancy. Learn what Estimated Fetal Weight is and why it’s a critical ultrasound metric.

At Liv Hospital, we use ultrasound to find the baby’s weight. We look at the head, belly, and leg. This helps us see if the baby is growing right and make the best care plans.

Watching the baby’s growth helps doctors find problems early. This means they can help the baby and mom sooner. It makes the pregnancy better.

Key Takeaways

  • Estimated Fetal Weight (EFW) is a key part of prenatal care.
  • EFW is found by measuring the baby’s head, belly, and leg on ultrasound.
  • Checking EFW helps find growth issues and guides doctors’ decisions.
  • EFW is vital for healthy pregnancies and good birth outcomes.
  • Accurate ultrasound biometry is used to find EFW.

EFW Meaning: Definition and Significance in Prenatal Care

EFW Meaning: The Ultimate Pregnancy Guide
EFW Meaning: The Ultimate Pregnancy Guide 5

EFW is key in obstetrics, giving insights into fetal growth and health. It helps estimate the fetus’s weight during pregnancy, mainly through ultrasound.

The Fundamental Concept of Estimated Fetal Weight

EFW is figured out by measuring things like head size, belly size, and leg length. These help doctors guess the baby’s weight and check if it’s growing right.

Why EFW Measurements Matter for Maternal and Fetal Health

EFW measurements are vital for spotting issues like slow growth or too big babies. They help doctors plan the best care and delivery, keeping mom and baby safe.

Knowing about EFW is important for parents-to-be. It shows how the baby is doing and growing. It helps us understand the ultrasound report better.

The Evolution of Fetal Weight Estimation

EFW Meaning: The Ultimate Pregnancy Guide
EFW Meaning: The Ultimate Pregnancy Guide 6

Fetal weight estimation has a long history of growth. It has seen many improvements in technology and methods. This journey shows our commitment to better prenatal care.

Historical Development of Measurement Techniques

Early methods for guessing fetal weight were simple but not very accurate. Clinical palpation and symphysis-fundal height measurements were some of the first. But, they had big problems, like not working well for overweight moms or twins.

Modern Ultrasound Technology in Fetal Assessment

The arrival of ultrasound technology changed how we guess fetal weight. Today’s ultrasound machines can measure important parts of the baby, like the head and belly. The Hadlock formula uses these numbers to guess the baby’s weight.

A leading expert said, “Ultrasound has made guessing fetal weight much better. It helps with better care and decisions before the baby is born.”

“Ultrasound in obstetrics has changed the game. It lets doctors check how the baby is growing and spot problems early.”

Accuracy Improvements Over Time

Fetal weight guesses have gotten much better over time. Better ultrasound tech and new formulas like Hadlock have helped a lot. Now, guessing fetal weight is key in prenatal care. It helps doctors keep an eye on the baby’s growth and find any problems.

The growth of fetal weight estimation shows our ongoing effort to improve prenatal care. As tech keeps getting better, we’ll see even more improvements in this important part of obstetric care.

Essential Biometric Measurements for Calculating EFW

Healthcare providers use key biometric parameters to estimate fetal weight (EFW). These measurements are vital for checking fetal growth and ensuring accurate EFW estimates.

Head Measurements: Circumference (HC) and Biparietal Diameter (BPD)

Head circumference (HC) and biparietal diameter (BPD) are important for understanding fetal head development. HC is the widest part of the head, and BPD is the distance between the two parietal bones. These help monitor growth and spot any issues.

Abdominal Circumference (AC) and Its Significance

Abdominal circumference (AC) is a key measurement for EFW. It shows the size of the fetal abdomen and is a good sign of growth. AC is also important for checking fetal nutrition and development.

Femur Length (FL) and Other Long Bone Measurements

Femur length (FL) measures the fetal femur’s length. It’s used with other long bone measurements to check skeletal development. These measurements help in estimating EFW and spotting growth issues.

By combining HC, BPD, AC, and FL, healthcare providers get a full picture of fetal development. Accurate measurements are key for reliable EFW calculations. This is important for monitoring fetal health and guiding prenatal care.

  • Key Biometric Measurements:Head Circumference (HC)
  • Biparietal Diameter (BPD)
  • Abdominal Circumference (AC)
  • Femur Length (FL)

The Hadlock Formula in EFW Calculation

In prenatal ultrasound, the Hadlock formula is a top choice for estimating fetal weight. It’s known for its accuracy and reliability.

Mathematical Principles Behind the Hadlock Method

The Hadlock formula combines fetal measurements like head circumference, abdominal circumference, and femur length. It uses a special math to link these to birth weight. This method is good because it can handle different growth rates.

When and Why the Hadlock Formula Is Used

Healthcare professionals often use the Hadlock formula because it’s accurate. It’s best in the third trimester for tracking growth and planning for birth. It’s a key tool for checking on the baby’s health.

Comparing Hadlock to Other Calculation Methods

There are many ways to estimate fetal weight, like the Shepard and Campbell formulas. But, research shows the Hadlock formula is usually more precise. Here’s a comparison of these methods.

EFW Method

Biometric Parameters Used

Accuracy

Hadlock

HC, AC, FL

High

Shepard

BPD, AC

Moderate

Campbell

AC

Moderate

Knowing the good and bad of each method helps doctors make better choices for prenatal care.

Interpreting Standard Deviation (SD) in EFW Results

Understanding Standard Deviation (SD) in Estimated Fetal Weight (EFW) results is key. SD values show how much a fetus’s weight differs from the average for its age. This helps us see if the fetus is growing as expected.

What SD Values Reveal About Fetal Development

SD values tell us about the range of fetal weights. A fetus with an EFW close to the mean is usually considered to have a normal weight. We use SD to check if a fetus is growing as it should or if there are concerns.

Normal vs. Concerning SD Ranges

EFW SD values usually fall between -2 and +2 SD. Values outside this range might mean the fetus is too small or too big. For example, an EFW below -2 SD could mean the fetus is not growing enough, while an EFW above +2 SD might mean it’s too big.

How SD Changes Throughout Pregnancy

SD values can change over time due to many factors. These include the mother’s health and how the fetus is developing. As pregnancy goes on, what’s considered normal can change. We keep an eye on these changes to make sure the fetus is growing well.

Gestational Age

Normal SD Range

20-24 weeks

-1 to +1 SD

24-28 weeks

-1.5 to +1.5 SD

28-32 weeks

-2 to +2 SD

By understanding and interpreting SD in EFW results, healthcare providers can make better decisions about prenatal care and any needed interventions.

Reading Your Ultrasound Report: What EFW in Sonography Means

Understanding your ultrasound report can be tough, mainly when it comes to EFW in sonography. Your doctor has probably explained the basics. But, diving into the details can feel overwhelming. We want to help you by explaining the important parts of EFW.

Decoding Common Terminology and Notations

Ultrasound reports use a lot of medical terms that might be hard to understand. You might see Hadlock formula and standard deviation. The Hadlock formula helps guess your baby’s weight. Standard deviation shows how your baby’s size compares to the average. Knowing these terms can make your report easier to understand.

Understanding Percentiles and Growth Charts

Percentiles are key in your ultrasound report. They show how your baby’s size compares to others at the same age. For example, being in the 50th percentile means your baby is average size. Being in the 90th percentile means they are larger than average. Growth charts track these measurements over time, showing how your baby is growing.

Questions to Ask Your Healthcare Provider About EFW Results

When you look at your ultrasound report, you might have questions. Ask your healthcare provider about what your baby’s EFW means, how it compares to past ultrasounds, and what might affect the measurement’s accuracy. Knowing this can make you feel more connected to your baby’s growth.

By understanding your ultrasound report and what it says about EFW in sonography, you can talk better with your healthcare provider. This can make you feel more informed about your pregnancy.

Normal EFW Ranges and Growth Patterns by Trimester

Knowing the normal Estimated Fetal Weight (EFW) ranges is key to tracking fetal growth during pregnancy. As we move through the trimesters, EFW becomes a key sign of fetal health.

First Trimester Baseline Measurements

In the first trimester, we set the baseline measurements. The EFW is usually measured by ultrasound, like Crown-Rump Length (CRL). At this early stage, the EFW range is quite narrow, showing the fetus’s early growth.

Second Trimester Growth Acceleration

The second trimester is when fetal growth really speeds up. The EFW range gets wider as the fetus grows fast. It’s very important to watch EFW during this time to catch any growth issues or problems. We use several measurements, like Head Circumference (HC), Abdominal Circumference (AC), and Femur Length (FL), to get an accurate fetal weight.

Third Trimester Development Patterns

In the third trimester, fetal growth keeps going fast, and EFW is a key sign of health. The EFW range is wider at this stage, showing the different ways fetuses can grow. It’s very important to keep an eye on EFW to spot any unusual changes, which could mean a problem.

Here’s a table showing the normal EFW ranges for each trimester:

Trimester

Normal EFW Range (grams)

Key Growth Indicators

First

0-100

CRL, Basic Biometric Parameters

Second

100-900

HC, AC, FL

Third

900-4000+

Continued growth, preparation for birth

By knowing these EFW ranges and growth patterns, doctors can better check on fetal development. This helps them make the best decisions for managing the pregnancy.

Identifying Abnormal Growth Through EFW Measurements

EFW measurements are key for spotting abnormal fetal growth. This can affect both mom and baby. It’s important to catch it early.

Abnormal growth shows up in different ways. This includes IUGR and macrosomia. Keeping an eye on EFW is vital for spotting and handling these issues.

Intrauterine Growth Restriction (IUGR): Causes and Detection

IUGR happens when a fetus doesn’t grow right inside the womb. It can be due to placental insufficiency, health issues in the mom, or genetics. EFW checks help find it early.

Macrosomia: Risk Factors and Management

Macrosomia means a baby is way bigger than usual. It’s linked to gestational diabetes and being overweight. EFW is key for managing it and planning for birth.

Growth Discordance in Multiple Pregnancies

In cases of twins or more, one baby might grow differently. EFW is essential for watching and managing this. It helps ensure the best for all babies.

Clinical Decision-Making Based on EFW Results

EFW results are key in making decisions about when and how to deliver a baby. They help doctors check how the baby is growing and spot any problems early.

Timing and Method of Delivery Considerations

The size of the baby, as shown by EFW, decides if a vaginal delivery is possible or if a cesarean is needed. A very big or small baby might need a different delivery plan. Doctors talk to patients about their options based on these factors.

Additional Testing Triggered by EFW Concerns

If the EFW shows the baby is growing abnormally, more tests might be needed. This could include more ultrasounds, non-stress tests, or biophysical profiles. These tests help doctors keep a close eye on the baby’s health.

Management Strategies for Growth Abnormalities

When EFW shows the baby is growing too fast or too slow, special plans are made. This might mean changing the pregnancy plan, like when to deliver or how often to check in.

EFW Percentile

Interpretation

Clinical Action

Below 10th percentile

Potential IUGR

Increased monitoring, possible early delivery

Between 10th-90th percentile

Normal growth

Continue routine prenatal care

Above 90th percentile

Potential macrosomia

Discuss delivery options, consider cesarean section

Understanding EFW results helps doctors make better decisions for the health of both mom and baby.

Factors That Influence EFW Accuracy

It’s key for healthcare providers to know what affects EFW accuracy. The accuracy of Estimated Fetal Weight can change based on several things. We’ll look at these in this section.

Maternal Characteristics

Maternal characteristics are important for EFW accuracy. Things like maternal BMI, amniotic fluid amount, and placental position can influence ultrasound results. For example, a higher maternal BMI might make it harder to get clear ultrasound images, which could affect EFW accuracy.

Fetal Factors

Fetal factors also play a big role in EFW accuracy. The fetal position during the ultrasound, fetal activity levels, and gestational age can all affect measurements. For instance, an active fetus or one in a hard-to-reach position might lead to different EFW estimates.

Technical Considerations

Technical aspects, like the quality of the ultrasound equipment and the experience of the sonographer, are also key. Better ultrasound tech and skilled sonographers can make EFW measurements more reliable.

Knowing these factors helps healthcare providers understand EFW results better. This way, they can make better choices for prenatal care.

Conclusion: The Critical Role of EFW in Modern Obstetric Care

Estimated Fetal Weight (EFW) is key in modern obstetric care. It helps track fetal growth and guides doctors’ decisions. Knowing the efw meaning in pregnancy is important for both moms-to-be and their healthcare team. It helps spot any growth problems early on.

EFW is important because it can spot issues like too small or too big babies. This lets doctors act fast to help the baby grow well. It also helps decide when and how to deliver the baby.

As we keep improving in obstetric care, EFW’s role stays vital. It’s not just about measuring the baby’s size. It affects the quality of care for pregnant women. By focusing on EFW, we can watch pregnancies closely and solve problems quickly. This leads to better health for both mom and baby.

FAQ

What does EFW mean in pregnancy?

EFW stands for Estimated Fetal Weight. It’s a key measure to check on the baby’s growth during pregnancy. Doctors use ultrasound to get these measurements.

How is EFW calculated?

To find EFW, doctors look at the baby’s size in different ways. They measure the head, belly, and leg length. Then, they use a formula like the Hadlock formula to guess the baby’s weight.

What is the significance of EFW in prenatal care?

EFW is very important in prenatal care. It helps doctors keep an eye on the baby’s growth. They can spot any problems early and plan the best time for delivery.

What is the Hadlock formula used for?

The Hadlock formula is a common way to estimate EFW. It uses the measurements from the ultrasound to give a close guess of the baby’s weight.

How do I interpret my EFW results?

To understand your EFW results, look at the growth charts in your ultrasound report. Your doctor can explain what the numbers mean and answer any questions you have.

What is considered a normal EFW range?

A normal EFW range changes as the pregnancy goes on. Generally, a baby’s weight between the 10th and 90th percentile is seen as growing well.

What does it mean if my EFW is outside the normal range?

If your EFW is not in the normal range, it might mean the baby is growing too slow or too fast. Your doctor will talk about what this means and what to do next.

How accurate is EFW measurement?

EFW measurements are usually pretty accurate. But, they can be affected by things like the mom’s health and how the ultrasound is done. So, they’re not always 100% right.

What factors can affect EFW accuracy?

Several things can make EFW measurements less accurate. These include the mom’s weight, how much amniotic fluid there is, and the baby’s position. The quality of the ultrasound equipment and the skill of the sonographer also play a part.

What is SD EFW, and how is it used?

SD EFW stands for the standard deviation of the estimated fetal weight. It helps doctors understand if the baby’s weight is normal or not. A normal SD range means the baby is growing well, but a concerning range might mean there’s a problem.

How does EFW influence clinical decision-making?

EFW results can help doctors decide when and how to deliver the baby. If the EFW shows a problem, doctors might suggest more tests or special care to help the baby grow and be healthy.


References

World Health Organization. Evidence-Based Medical Guidance. Retrieved from https://www.who.int/publications/i/item/9789241549322

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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

Op. MD. Selda Akal

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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

Assoc. Prof. MD. Nazlı Topfedaisi Özkan

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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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